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Department: Editorial

Does Health Reform Mean We Should Be Prepared for Name Calling?
Last month I interviewed Kathleen Sebelius, secretary of Health and Human Services (HHS), about the Affordable Care Act. The session, streamed live on the White House Web site, focused on the health insurance Patient Bill of Rights, which outlines the new rights and benefits in the health reform legislation.

Physician, Pharmacist Collaboration Cuts Costs
Pharmacists cannot prescribe and physicians cannot dispense, but there are overlaps in training and scope of practice between the two. As provisions in the Patient Protection and Affordable Care Act of 2010 are implemented, it will be increasingly important for all members of a health care team to bring their unique skills to support each patient’s ability to manage his or her health conditions.

Can Health Reform Reduce Medical Errors?
The statistics are well known to most physicians and pharmacists: preventable medical errors kill and seriously injure hundreds of thousands of Americans every year. If the federal Centers for Disease Control and Prevention included preventable medical errors as a disease-specific category, it would be the sixth leading cause of death in the United States.

Love It or Hate It, Health Reform Is Now Law
Virtually all Americans will be affected in some way with the enactment of the Patient Protection and Affordable Care Act, which President Obama signed into law in March. Love it or hate it, it’s the law, and coming regulations will give us a better sense of how the legislation will affect all of us in the coming years.

Are Health Plan Ratings Unfair to Physicians?
A number of physicians are unhappy about health plan efforts to rate physicians so they can place them in tiers according to how well they deliver care to plan members. The problem is that health plans rate physicians according to algorithms they apply to claims data. Then, plans place those physicians who have the best quality and cost scores in the upper tiers. Those physicians who have lower scores are placed in lower tiers. Plans then publish lists of these doctors and some are steering patients to higher-scoring physicians. For physicians, a particularly onerous aspect of this system involves the plans’ use of proprietary software to rate physicians. Since the data are unavailable to physicians, physician associations in Connecticut, Washington State, New York, and elsewhere have complained that the process is unfair.

Is a Seismic Shift Coming in Health Reform?
A shift may be occurring as politicians and health policy experts consider
moving away from a single-payer system similar to those in the United Kingdom, Canada, and France to a universal coverage system such as in the Netherlands and Switzerland. A universal coverage system in the United States would include government subsidies and consumer-driven features that allow patients and private insurers to pay for care at hospitals and from physicians. Democratic and Republican politicians, including some of the candidates for president, believe a single-payer system is unpopular. It is often labeled as socialized medicine. But these same politicians recognize that most Americans want universal coverage.

What Do Doctors Want From Health Reform?
Doctors’ attitudes toward health reform will help to make or break any reform proposal. Seeking to define trends among physicians, Sermo.com, a company in Cambridge, Mass., has established a Web site under a contract with the American Medical Association. Wall Street firms seeking health care trend data pay for part of the cost. Only licensed physicians can visit the site and post comments, and Sermo encourages them to join in the discussion forums. Reading the responses to a variety of posts, it’s possible to get an idea about what physicians are thinking. In general, the physicians who write for and post comments on the site distrust large integrated systems that reduce them to protocol-following functionaries. They also question the value of retail clinics and disease management systems in which they do not participate directly. It should come as no surprise that physicians remain wary and even hostile toward managed care, regarding its managers as intrusive, ill-informed, and obsessed with cost, not quality. They also seem to think that information technology is overrated.

Treatment of Chronic Illness Offers Lessons
Health care experts are seeking ways to improve the care of patients with chronic illness, such as arthritis, cardiovascular disease, cancer, and diabetes. Chronic illnesses are among the most prevalent, costly, and preventable of all health problems. The federal Centers for Disease Control and Prevention says chronic illnesses account for 70% of all deaths in the United States and more than 75% of the nation’s medical care costs.
What health care experts are learning about treating patients with chronic illness is somewhat heartening. For example, having patients participate in regular physical activity is associated with needing fewer medications and having fewer hospitalizations and physician visits, the CDC says.

Federal P4P Results Raise Questions
When evaluating pay for performance (P4P) programs, it’s important to consider the source. It’s not unusual for proponents of P4P to promote these programs by saying they produce remarkable results. Opponents of P4P, meanwhile, readily point out the flaws.

Last month, the federal Centers for Medicare & Medicaid Services (CMS) reported that its demonstration project involving P4P for 10 large physician groups was a success. And, by many measures, this statement is true. But, only two of the 10 groups received any financial performance incentive. All participating physician groups improved the clinical management of diabetes patients in the first year of the three-year Medicare Physician Group Practice Demonstration, CMS said.

Is There a Viable Alternative to Fee for Service?
Health policy experts, academics, and many physicians themselves believe fee for service payment is a leading cause of rising costs, inconsistent quality, duplicative service, lack of care coordination, and fraud.

Medicare and other patients bounce among doctors, most of whom are unaffiliated with one another and as a result, few patients have a single doctor central to the care they receive, says Peter Bach, MD, a physician at Memorial Sloan-Kettering who recently served as senior advisor to the federal Centers for Medicare & Medicaid Services (CMS). The problem is fee for service payment, Bach added. In fact, fee for service offers an incentive to physicians to provide more services and more expensive services, he said in a recent article in The Wall Street Journal.