ama rohack sections special groups hsr 6-13-2009

8/14/2019 AMA Rohack Sections Special Groups HSR 6-13-2009

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AMA Health System Reform 2009

J. James Rohack, MDPresident-Elect, American Medical Association

Director, Scott & White Center

for Healthcare Policy

Professor of Medicine and Humanities, TAMHSC

AMA Sections/Special Groups

Chicago, IL

June 13, 2009


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Is it time

for health system reform? Does the current system work?

The private sector wants changes

The White House and Congresswant reform in 2009

How will new reforms alter the

medical practice environment? The stakes clearly are high


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AMA Priorities for

Health System Reform

Expand coverage and choice

Public sector reforms

Improve quality and patient safety Reduce costs

Enhance prevention and wellness

Payment and delivery system reforms


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Expand Coverage and Choice

Provide subsidies to low-income (e.g., tax

credits) to help purchase health insurance

Enable individuals to purchase insurance

through FEHBP or other options

Make regressive tax policies more progressive

Support direct subsidies for high-risk patients

(e.g., risk pools, reinsurance)

Require a greater level of individual

responsibility Implement health insurance market reforms

Continue to oppose single-payer plans


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Public Sector Reforms

Enroll SCHIP eligible children and expand

eligibility to higher percentages of FPL Eliminate existing Medicaid categorical

requirements and establish uniform eligibilityfor all below 100% of FPL

Replace Medicare SGR with alternative updatemethodology

Eliminate subsidies for Medicare Advantage

Allow use of public sector contributions tosupport existing private coverage

Improve physician payment levels


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The Medicare Dilemma:The Medicare Dilemma:Practice Costs vs. Medicare Payment UpdatesPractice Costs vs. Medicare Payment Updates

Physician cost data is from the MEI, a conservative measure of practice cost growth maintained by CMS. Medicare cuts are from the

2008 Medicare Trustees report, with adjustments to reflect Sec. 131 of P.L. 110-275. Prepared by American Medical Association,

Division of Economic and Health Policy Research, August 2008.

-50%

-40%

-30%

-20%

-10%

0%

10%

20%

30%

40%

50%

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Practice Costs

Medicare Cuts


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Improve Quality and Patient Safety Develop quality measures and appropriateness

standards

Develop evidence-based performancemeasures that enable continual QI and are thebasis for rewarding high quality, cost-effective,safe care

Support practice-based solutions (e.g., HIT,decision support, continual performancemonitoring) that enable incorporatingmeasurement into practice to support QI

Evaluate and improve PQRI

Facilitate physician involvement with patientsafety organizations


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Reduce Costs

Reduce the burden of preventable disease and

better manage chronic disease

Support comparative effectiveness research

Address variation in the utilization of health

care services, particularly at the state/regionallevel

Make health care delivery more efficient

Reduce non-clinical costs that do not contributevalue to patient care


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Enhance Prevention and Wellness Support integrated approach to encourage the

adoption of healthy lifestyles for physicians and

their patients Urge the inclusion of wide range of evidence-

based preventive services in insurance plans

Support adequate federal funding forbiomedical research, including prevention

Encourage CBO to score the long- and short-term budget deficit reductions and costs

associated with prevention Eliminate racial, ethnic and gender disparitiesthrough infrastructure and programmaticchange


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Payment and Delivery System Reforms

Develop physician-relevant HIT systems(e.g., interoperability) and provideincentives to build the infrastructure

Develop value-based payment

methodologies (e.g., patient-centeredmedical home, management of chronicdisease)

Pursue antitrust relief, fair physiciancontracting, and greater transparency

Enact alternative medical liability reforms


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Bending the Spending Curve

The AMA was a participant at the White

House on May 11, 2009 in an historic

meeting of the private and public sector to

achieve a vision of affordable healthinsurance coverage for all Americans

preserving choice of the patient of their

physician


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Four Ways to Reduce Costs

Administrative simplification, standardization, andtransparency to support effective markets

Aligning quality and efficiency incentives so physicians,hospitals, and other health care providers work togethertowards the same high standards

Coordinated care, using evidence-based best practicesto reduce hospitalization and manage chronic disease,and implementing proven clinical prevention strategies

Reducing costs through improved care delivery models,

health information technology, workforce deploymentand development, and regulatory reforms


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Follow up Letter June 1, 2009

Improve Care Transitions to Avoid HospitalReadmissions

Create Best Practices to Reduce UnnecessaryUtilization

Low Back Pain PCI for chronic stable angina

Induction of Labor/Caesarean sections

Sinusitis prescriptions and radiograph

Diagnostic imaging: CTA for PTE; MRI of knee,shoulder; CT/MRI of head; Stress Echo; SPECT MPI

Medication Reconciliation


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AMA Fully Engaged

Keys Points I have learned:

Together, we are stronger

Divided into our specialty tribes, we willlose


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ama rohack sections special groups hsr 6-13-2009

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