Tag Archives: Families USA

Experts Call on Docs to Lead Cost Control

Doctors must play an integral role in reducing health care costs, health policy experts say. At the annual conference of consumer group Families USA, Dr. Atul Gawande and Dr. Ezekiel J. Emanuel said that doctors participating in reducing costs will have a greater affect than the health care law itself.

Dr. Atul Gawande / Frances Correa/ Elsevier Global Medical News

“Washington will not be able to save the costs. They’ll provide the framework, but in your communities, that’s where you’ll do it,” said Dr. Gawande, a health policy researcher and endocrine surgeon at Brigham and Women’s Hospital in Boston. Dr. Gawande said that the Affordable Care Act will provide the data for doctors to identify where to trim costs. Both Dr. Gawande and Dr. Emanuel said doctors can take a leading role in cost control by focusing on the sickest 5% of patients. According to a 2009 report from the Agency for Healthcare Research and Quality, the sickest 5% of patients account for 50% of national health care expenditures.

Dr. Gawande cited the work of Dr. Jeffrey Brenner. By analyzing medical billing data from practices in Camden, N.J., Dr. Brenner, a primary care physician, was able to map out the most impoverished areas with the highest health care costs. With a focused approach that included home visits and the help of social workers, Dr. Brenner decreased one patient’s inpatient hospital time from 7 months in one year to 3 weeks. While under his care, the patient lost 200 pounds, and quit smoking, drinking, and using cocaine. At the same time, the patient’s hospital costs decreased by 60%. Dr. Gawande wrote about Dr. Brenner’s strategy in a January 2011 article in the New Yorker.

Dr. Emanuel, a recognized expert on health and chair of the department of medical ethics and health policy at the University of Pennsylvania, Philadelphia, said rising health care costs threaten many aspects of American society, particularly education, workers’ wages, and the nation’s position in the world, as well as by putting an economic squeeze on middle class. Dr. Emanuel also served as special adviser for health policy to the director of the White House Office of Management and Budget from January 2009 to January 2011, where he helped craft the Affordable Care Act.

Dr. Ezekiel Emanuel / Frances Correa/Elsevier Global Medical News

“If you care about how our kids are going to educated in the future, you have to care about heath care costs,” Dr. Emanuel said, adding that increased health care costs directly affect tuition rates. For example, from 2001 to 2011, employer contributions to health insurance increased by 113%, according to the Kaiser Family Foundation. Meanwhile, tuition for public universities increased 72% over the past decade, according to the College Board. Dr. Emanuel projected that, as health care costs continue to rise, states will be forced to take the money from other programs, leaving education and health care at the greatest risk.

“We can reduce costs without sacrificing access … [doctors] have to be committed to doing that,” Dr. Emanuel said.

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Filed under Family Medicine, Health Policy, health reform, IMNG, Practice Trends, Primary care, Uncategorized

Groundhog Day for Health Reform

This morning I woke up and went to the same press briefing on health reform that I’ve gone to at least a half dozen times before in the last year. With almost the same cast of characters (sponsored by Families USA and a broad coalition) just begging for passage.  Which got me to feeling like I was living out the plot line of the 1993 Bill Murray movie Groundhog Day.

Photo by Alicia Ault

In that film, Murray’s character realizes that he’s living the same day over and over. At first, it’s very disturbing and causes a bit of an existential crisis for him. But soon he realizes that he can get away with just about anything, because everything will reset back to zero when he wakes up the next morning. So he behaves like a general scalliwag. Eventually, though, he tires of it (it’s more complicated, but you have to see the movie), and he starts using his power to affect the future for good, not evil. In the end, he is redeemed, winning the woman of his dreams.

This week — and for most of the last, say, 7 months or so — Democrats and Republicans in Congress have been acting a little bit as if their actions on health reform will have no long-term consequences — like the “Bad” Bill Murray character.

I’m just wondering if they’ll wake up some time — maybe later this week? — and realize that they could actually use their abilities to do something good.

— Alicia Ault (on Twitter @aliciaault)

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Filed under Health Policy, health reform, IMNG

Just Three Republicans?

From “Prospects For Bipartisan Health Reform,” a breakfast conference at Union Station in Washington, and the Senate Finance Committee mark-up of its health reform plan in the Hart Office Building:

Quick question: How many Republicans are likely to sign on to the health reform package now making its way through the Senate?  Apparently, only three, if you believe the prognostication offered by an august group of Washington insiders this morning: former Louisiana House Member Billy Tauzin (now CEO of the Pharmaceutical Research and Manufacturers of America); Ron Pollack, executive director of the advocacy group Families USA;  and John Rother, executive vice president for policy and strategy at AARP.

The Pontificating Panel/Photo by Alicia Ault

The Pontificating Panel/Photo by Alicia Ault

Former Senate majority leader Tom Daschle, whose Bipartisan Policy Center hosted the breakfast, was even less sanguine.  He said maybe two Republicans might cross their GOP leaders to back a reform package.

Mr. Daschle may be more in the know.  After all, as the Washington Post recently reported in a front page story, he occupies one of the most prominent seats at Tosca, Washington’s newest power lunch spot.

But it certainly doesn’t require a crystal ball or longtime inside-the-beltway chops to discern the lack of bipartisanship.

Just a few blocks away, the Senate Finance Committee had begun the second day of deliberations on its draft reform plan.   It was not pretty.  Republican amendments were being struck down with impunity by the Democratic majority;  Democrats’ amendments were largely adopted by the same majority.

Chairman Max Baucus (D-Mont.) struggled to rein in a near-mutiny incited by Sen. Jim Bunning (R-Ky.) over whether the committee was moving too fast.  (The same Jim Bunning who was caught napping during the first day of mark-up.) Sen. Olympia Snowe (R-Maine), the chairman’s lone Republican supporter after almost three months of negotiations, jumped ship and joined with Sen. Bunning in condemning what she called an illogical and improper rush.

Sen. Bunning’s attempt to delay a vote  was being echoed across the Hill. Or maybe his amendment — which would have required the legislation to be posted and a Congressional Budget Office score to be in hand before the committee voted — was an echo of what was happening elsewhere, as House and Senate Republicans vociferously pushed for passage of a bill that would require all legislation to be posted online or otherwise made public at least 72 hours before a floor vote.  See Minority Leader John Boehner’s release here and Sen. Lisa Murkowski’s YouTube video here.

Sen. Baucus tried to muzzle his Republican colleague several times, but committee member Orrin Hatch (R-Utah) interceded and Sen. Bunning got his say.  In the end, a Baucus-led amendment passed; it was a slight variation on the Bunning theme, requiring that the panel make its bill public 72 hours before it voted.

But it left a sour taste in Republicans’ mouths.

The sausage-making is getting bloodier.

How many Senate Republicans do you think will vote for the final health reform package? Take our poll.

— Alicia Ault (on Twitter @aliciaault)
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