A Call To Doctors From Medicare/Medicaid Chief: Advocate For The Poor
|By Audrey Dutton, The Idaho Statesman, Boise|
Berwick was in
Q: Physicians have talked about prohibitively low
A: I think checking back on the economics and the ethics is really important to do. For physicians, I know they're struggling now. [But] I think physicians need to speak up for the poor. In the end, the whole idea behind
Q: The 2010 health care reform law -- the Affordable Care Act -- would add tens of thousands of Idahoans to
A: There's a little bit of a phasing issue here. When we come to 2014, when the Affordable Care Act takes full effect, the
If the partnering that
Q: You're saying we should take the long view, that it's more expensive in the long run to cut
A: That's true in the economics of the community, the economics of the state, the global economics -- someone will pay [for treating the ill]. For the individual doctor struggling to have her practice or his practice survive, I understand a very low rate of pay makes it hard tomorrow, not next year. ... But at some point the country has to touch the moral question, which is: Are we committed to care for the poor?...
The way out of this box is ... what we call the triple aim: better care, better health and lower cost through improvement of care. This is particularly true of the
A smart state would be focusing on the needs of these dual eligibles and making sure they're in integrated, coordinated care that really meets their needs. That way they stay out of the hospital, they function at a higher level, their costs go down.
Q: There is some concern in the
A: If you envision the health care system we all want and need that is both better for our health and our care and lower cost ... you need strong primary care. That primary care could be a physician group practice affiliated with a hospital, or it could be a free-standing group.
This whole idea of a country that is shifting its attention from the hospital as the core of the system to the primary care setting, medical home -- your own physician, your own nurse -- that's a very important idea. So the health of the physician practice does count. And there is concern that ... we may end up in a system that's still too hospital-centric.
I think smart hospitals and hospital systems aren't going to go that way. They're going to move their thinking into being a much more ... integrated system, that they really value what the doctors and primary care systems are doing.
Q: What other ways are there to reduce costs?
A: The forms of waste right now are many.
One is overtreatment. We now know, scientifically, there's lots of things that happen to people that don't help them at all. You get an antibiotic but you have a viral cold? That's not helping you. Antibiotics don't kill viruses. When you get a test that you don't need, [that] you could have waited and you would have gotten well without the test?
The second is coordination failures. If you have a chronic illness today, your care is very likely to be fragmented. You go to one doctor, and they don't know what the other doctor did. Or you're in the hospital, you go home and nobody tells your primary care doctor what happened. Nobody comes to your home to help you set up the equipment or to take your meds. That costs tons of money because you get complications, and [you] go back into the hospital.
Another would be complications in care -- safety problems like infections in hospitals or post-operative complications. These complications, which are often very avoidable, when they happen they raise costs.
Q: Does the Affordable Care Act really help with that?
A: Value-based purchasing is the theme.
The same thing happens with doctors in a couple of years. It's called the value modifier. It adds a factor to physician payment related to the quality of the care and the metrics that are being used.
On the coordination side, there you have a bunch of new initiatives in payment, like accountable care organizations, bundled payment, medical homes.
These are all new ways to pay so the doctors in hospitals get rewarded [for good, coordinated] care.
Q: As lawmakers weigh budget priorities, wanting to save money but also wanting people to be healthy, what arguments should they consider?
A: They should consider drawing on the federal contribution to better care for the
(c)2012 The Idaho Statesman (Boise, Idaho)
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