What Baucus got right ... and wrong

Senate Finance Committee chairman Max Baucus (D-Mont.) released his committee's health care reform proposal last week to much criticism from his own party. But "despite all the vitriolic complaints from the left -- Howard Dean is becoming living proof that health care reform should offer a universal entitlement to Valium -- Baucus has advanced the historic Democratic cause of providing health security to all Americans by demonstrating that it can be compatible with fiscal responsibility and long-term cost control."

So writes Ronald Brownstein in The Atlantic.

In a Sept. 16 analysis of the proposal, the Congressional Budget Office concluded that the bill would reduce the federal deficit by $49 billion over 10 years and would produce savings equal to .5 percent of GDP after two decades. The bill does not include a public plan but would result in 94 percent of nonelderly people receiving coverage by 2019, excluding illegal immigrants. Notably, it would also provide a 10-percent bonus for primary care physicians on select E&M services under the Medicare fee schedule for five years.

The Baucus bill accomplishes all this by "creating a revenue stream [including a 35-percent excise tax on high-end health plans] that rises as fast as health care costs, and reshaping the incentives in the medical system in ways that should help 'bend the curve' on those long-term cost increases. Without those two elements any coverage expansion will prove unaffordable, and thus unsustainable, over time," writes Brownstein.

The bill's strategies for reshaping incentives include:

• Comparing the amount all physicians spend on patients with similar conditions and cutting Medicare reimbursements by five percent for those who generate the highest costs.

• Linking hospital reimbursement to their performance on quality measures.

• Allowing groups of providers to share in any savings for more effectively managing patients' care under Medicare.

• Creating an Innovation Center within the Health and Human Services Department that would fund experiments in coordinated care and payment reform.

• Creating an independent Medicare Commission that would be required to offer proposals for cost-savings whenever Medicare spending rises too fast and whose proposals would be fast-tracked for consideration by Congress.

The AMA has voiced several concerns, including the bill's use of payment penalties for physician outliers and the bill's failure to permanently repeal the sustainable growth rate (SGR) formula that would subject physicians to Medicare payment cuts of 40 percent over the next several years.

The bill is currently being amended in committee. Once approved, it will have to be merged with the Senate HELP committee's bill before going to the Senate floor.

Posted at 10:51AM Sep 23, 2009 by Brandi White  |  Comments[0]

What's behind the success of the most efficient medical community in the nation?

The Dartmouth Atlas of Health Care recently identified Grand Junction, Colo., as one of the most efficient medical communities in the nation (see our previous post on this topic). Its average Medicare spending per capita was $5,900 in 2006, about 30 percent lower than the national average of $8,300, while its quality ratings were much higher. A new report sheds light on why this medical community has been so successful and cites factors such as a local health plan that shares valid, individualized performance data with physicians and provides financial incentives for achieving quality and efficiency targets; cooperation between primary care physicians and specialist physicians; effective charity care and hospice programs; a community-wide EHR system paid for by the local IPA and HMO; fewer hospital beds and employees than the national average; and more primary care physicians than the national average. The report concludes with this:

"Primary care is the core of any high performance health system. Throughout a patient’s life, primary care physicians in Grand Junction are involved in all levels of treatment. Continuity and collaboration between primary care physicians, specialists, and other members of care teams leads to higher-quality care, better outcomes, and lower costs. Most importantly, team-based care refocuses the delivery system on the patient, not on the provider. Nevertheless, Grand Junction’s leaders are concerned by the extreme shortage of new primary care physicians entering the workforce. Primary care plays a central role in every collaborative, high-quality, and efficient health system. Thus, we must support primary care expansion within reform legislation, not as an afterthought. Without increased support for primary care, the miracle of Grand Junction’s health system could prove to be but an inspirational memory."

Posted at 10:30AM Sep 03, 2009 by Brandi White  |  Comments[0]

Solving the cost conundrum: Lessons from Grand Junction

An article in the June 1st New Yorker by physician and medical journalist Atul Gawande, MD, should be required reading for physicians concerned about the economics of medical practice. And what family physician isn’t? “The Cost Conundrum” presents the results of an investigation that began with the Dartmouth Atlas and led Gawande to one of the highest-cost health care communities in the U.S. – McAllen, Texas – and to one of the lowest – Grand Junction, Colo. – in search of an explanation for the three-fold difference in Medicare spending between these two cities. In exploring several hypotheses, Gawande contrasts the medical cultures in these communities and arrives at a conclusion sure to make many a physician squirm: The source of the difference in health care spending is “overuse of medicine” by hospitals and physicians alike. “Physicians in places like McAllen behave differently from others. The $2.4-trillion question is why. Unless we figure it out, health reform will fail,” Gawande writes.

The article captured the interest of President Obama, who cited the article in a meeting with two dozen Democratic senators earlier this week and said in effect, "This is what we've got to fix," according to one senator quoted in the New York Times.

Gawande suggests that cities like McAllen would be better served by “accountable-care organizations” like Grand Junction’s, “in which doctors collaborate to increase prevention and the quality of care, while discouraging overtreatment, undertreatment, and sheer profiteering.”

Roger Shenkel, MD, a physician leader in Grand Junction, Colo., was a member of the FPM Board of Editors for more than 10 years. During this time he wrote or co-authored a number of articles that reveal some of the health care strategies and tactics that underlie his community’s success. Dr. Shenkel also introduced us to his Grand Junction colleague Phil Mohler, MD, who wrote or co-authored several FPM articles that share the same themes of cost-effectiveness, quality and collaboration between physicians, medical groups, administrators and payers. We think you’ll find the articles as timely and useful now as when we first published them:

• New Drugs: How to Decide Which Ones to Prescribe
• Improving Chronic Illness Care: Lessons Learned in a Private Practice
• 1-800-Chronic Disease Management
• Weighing the Risks and Benefits of Clinical Interventions
• What Every Physician Should Know About Generic Drugs
• Creating a Successful After-Hours Clinic
• Building Rapport With Consultants: A Matter of Economics
• IPA Formation in Rural America: Nothing Like the City Slickers Do
• Medicaid Miracle in Mesa County
• Rural Managed Care: A 20-Year Road to Success

Posted at 04:09PM Jun 12, 2009 by Leigh Ann Backer  |  Comments[0]

Health care isn't recession-proof, says survey

The troubled economy may be causing more patients to worry about health care costs and, in some cases, forgo needed care, according to the results of a recent AAFP survey of 505 family physicians.

Nearly 90 percent of the family physician respondents said more of their patients have expressed concerns recently about their ability to pay for their health care needs; 73 percent have seen an increase in uninsured patients in their practices; 58 percent have seen an increase in appointment cancellations; and 54 percent reported a drop in patient volume since January 2008.

Additionally, 73 percent of respondents said they have seen evidence of patients cutting prescription doses to save money, and 60 percent have seen more health problems caused by patients forgoing needed preventive care.

How are FPs responding? Two-thirds said they were taking steps such as discounting their fees, increasing charity care, providing free screenings and moving patients to generic prescriptions. Forty-four percent said they are having to cut, or consider cutting, services or staff.

Posted at 01:29PM May 19, 2009 by Brandi White  |  Comments[0]