J. James Rohack, MD, FACCPresident, AMA

Director, Scott & White Center for Healthcare Policy

Professor of Medicine and Humanities, TAMHSC

Information OnlyACC Board of Governors

September 13, 2009

Heart House

AMA Priorities for Health System Reform-Update from Dr. James Rohack

• Expand coverage and choice• Public sector reforms• Improve quality and patient safety• Reduce costs• Enhance prevention and wellness• Payment and delivery system reforms

J. James Rohack, MD, FACC, FACPPresident, American Medical AssociationDirector, Scott & White Center for Healthcare PolicyProfessor of Medicine and Humanities, TAMHSC

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

Public Sector Reforms• Enroll SCHIP eligible children and expand

eligibility to higher percentages of FPL• Eliminate existing Medicaid categorical

requirements and establish uniform eligibility for all below 100% of FPL

• Replace Medicare SGR with alternative update methodology

• Eliminate subsidies for Medicare Advantage• Allow use of public sector contributions to

support existing private coverage• Improve physician payment levels

The Medicare Dilemma:Practice 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

Improve Quality and Patient Safety• Develop quality measures and appropriateness

standards• Develop evidence-based performance measures

that enable continual QI and are the basis for rewarding high quality, cost-effective, safe care

• Support practice-based solutions (e.g., HIT, decision support, continual performance monitoring) that enable incorporating measurement into practice to support QI

• Evaluate and improve PQRI• Facilitate physician involvement with patient

safety organizations

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/regional level

• Make health care delivery more efficient• Reduce non-clinical costs that do not

contribute value to patient care

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 for biomedical 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 disparities through infrastructure and programmatic change

Payment and Delivery System Reforms• Develop physician-relevant HIT systems

(e.g., interoperability) and provide incentives to build the infrastructure

• Develop value-based payment methodologies (e.g., patient-centered medical home, management of chronic disease)

• Pursue antitrust relief, fair physician contracting, and greater transparency

• Enact alternative medical liability reforms

Four Ways to Reduce Costs• Administrative simplification, standardization, and

transparency to support effective markets• Aligning quality and efficiency incentives so physicians,

hospitals, and other health care providers work together towards the same high standards

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

• Reducing costs through improved care delivery models, health information technology, workforce deployment and development, and regulatory reforms

AMA Prescription for Healthcare Reform

• Affordable Coverage for All

• Prevention and Personal responsibility

• Quality Improvement

• Reducing Costs

• Delivery Reform

• Fiscal Responsibility and Sustainability

2009 ACC Legislative Conference

• We in America do not have government by the majority. We have government by the majority who participate.

– Thomas Jefferson3rd president of US (1743 - 1826)