Hot Off the Press: Kitzhaber Recognized; More Calls for Payment Reform Nationally and in WA state; Scamming Seniors and Costs of Medical Arms Race

Kitzhaber Named Most Influential Physician Executive by Modern Health Care for malpractice reform 

                                 Modern Health Care By Andis Robeznieks

Posted: April 20, 2013 – 12:01 am ET

As governor of Oregon, not only has Dr. John Kitzhaber brought Democrats and Republicans together to reform his state’s Medicaid program, he brought physicians and lawyers together to advance tort reform. 

Kitzhaber’s leadership in getting bipartisan passage of legislation dealing with volatile subjects helped put him on top of the roster of 43 men and seven women who were selected by Modern Healthcare and Modern Physician readers and editors as the nation’s 50 Most Influential Physician Executives in Healthcare. …

Kitzhaber provides an excellent example of how this is done. Earlier this month, it was announced that 22 companies had been approved to offer health and dental insurance to Oregon’s uninsured under the state’s health insurance exchange, which Kitzhaber says is moving ahead “on time and on budget.” But the splashier headlines were made last month, when the governor signed legislation creating a disclose-and-offer process that offers an alternative to contentious and lengthy litigation after a patient has been harmed.

The measure was approved by a 26-3 vote in the state Senate and a 55-1 vote by the state House of Representatives. Kitzhaber, a Democrat got the ball rolling when he presented what he called “the Holy Grail in medical politics,” a letter endorsing the bill approved by both the president of the Oregon Medical Association and the Oregon Trial Lawyers Association.

“That was big,” he says. “Traditionally, this has been a war of sound bites.”

For the full list of executives, click here.  http://www.modernhealthcare.com/gallery/20130420/PHOTO/420009999/PH

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The New Drumbeat:  We Must Change How We Pay for Health Care

We have written before on the many new calls to change how we pay for health care, from changing how physicians are paid, to purchasing value with flat fee for certain procedures, such as Boeing’s contract with the Cleveland Clinic.  A new coalition from Families USA to Pacific  Business Group on Health recommends spending and payment reform.

http://nchc.org/sites/default/files/Partnership%20for%20Sustainable%20Health%20Care.pdf

And just last week, we have a new report on the same issue from the Bi-Partisan Policy Center out of DC.

http://bipartisanpolicy.org/news/press-releases/2013/04/bipartisan-policy-center-proposes-new-modernized-integrated-medicare-sys

April Seattle CityClub Forum: Consolidating Care: Health Care Reform and the Medical Marketplace.  

                                     Interesting Subplot–Are hospitals dinosaurs?

The two key issues became changing a hospital-based model of care and how we pay physicians and hospitals—i.e., the need to change from a fee for service model to a quality and value model.  Pat Briggs, CEO, NW Physician Network, an independent physician owned risk based health system in Pierce County, now in South King County, said NPN  is in several shared savings programs with Franciscan Health System, CMS and the Polyclinic in King County.  The struggle is how to make costs transparent.

The Polyclinic, a multi-specialty physician clinic in Seattle, Lloyd David, CEO said, they are also developing some shared savings model with Premera Blue Cross.

Robert O’Brien, EVP, Group Health, noted the lack of transparency in hospital billing and facilities fees add to huge cost shifts to consumers in the new world of high deductibles.  There is no focus on the total cost of care and the number of procedures done.  The system is now moving toward paying for value and outcomes vs. unit costs of care.  He also indicated that there is too much capacity in the system.

Sarah Patterson, EVP and COO, Virginia Mason Medical Center pointed out the system perverse incentives. The payment system rewards procedures, but the new payment systems are moving toward keeping people healthy and at home.  Payers and employers need to work with the hospitals and physicians to examine re-imbursement models.

Rod Hochman. President and CEO, Providence Health and Services, pointed out that Seattle ranks 50th in the number of hospital beds per capita.  To see how Washington State compares to other states, see this Kaiser Family Foundation chart:  http://www.statehealthfacts.org/comparemaptable.jsp?ind=384&cat=8

Washington has 1.7 beds per capita while our close neighbor, Montana has 3.7 beds per capita.

Are contemporary hospitals dinosaurs?   Lloyd indicated that hospitals are increasing challenged today because they are a cost target.  They represent over 30% of all health care costs. http://facts.kff.org/chart.aspx?ch=857

The big problem all agreed was lack of transparency of cost, a fragmented system, and paying for units of care vs. paying for value and outcomes.

They all agreed that health care will look very different in the next four years.

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Seniors Target of Insurance Scams

This just in from Kaiser Health News and NPR.  This is a real heads up for insurance commissioners across the country.  Because it will not just be Medicare now.  The lack of information on the new ACA plans and the Navigators to help people sign up for new plans is going to be a nightmare of regulation and consumer protection.

http://www.kaiserhealthnews.org/Stories/2013/April/22/insurance-scams.aspx

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Costs of a Medical Arms Race

We are still working on our Technology Part II research.  Medical devices and technology are one of the leading cost drivers. Here’s one example: http://www.washingtonpost.com/national/health-science/two-dc-hospitals-vie-to-establish-costly-cancer-treatment-option/2013/04/07/d6270c0a-97d4-11e2-97cd-3d8c1afe4f0f_story.html

Kathleen O’Connor, April 22, 2013

About Kathleen

Kathleen O’Connor: 30+ year health care consumer advocate, non-profit executive and author. For more information about Kathleen, please see "About" on the main content bar above.
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