Healthcare Reform And Teaching Hospitals
adonis123 - 04-21-10 00:36

Leaders at the nation's medical schools and teaching hospitals are hailing the new health care reform laws, but say big changes to the health care system itself—and not just insurance—are still needed.

The AAMC and academic medicine leaders reiterated their support for the legislation in a March 16 meeting with President Obama, in which AAMC President and CEO Darrell G. Kirch, M.D., called insurance expansion a "moral imperative."

"We have taken the first step toward truly transforming health care in this country," Kirch said in a statement following the signing. "The nation's medical schools and teaching hospitals now stand ready to work with the administration and Congress to advance significant changes to our health care delivery system."

The law, signed March 23, will cover 32 million Americans, 16 million of them through Medicaid.

"There are millions more with coverage, and that's a terrific thing," said Elliot J. Sussman, M.D., M.B.A., president and chief executive officer of Lehigh Valley Hospital and Health Network in Pennsylvania. "This resonates very powerfully with everyone in academic medicine, from students and faculty to nurses and technicians, and everyone else who helps provide the safety net for our country."

The expanded coverage will cost $938 billion, but changes are projected by the nonpartisan Congressional Budget Office to reduce the federal budget deficit by $138 billion over 10 years. In addition to increased coverage, hospital leaders lauded improvements to the Medicare Part D prescription drug plan, increased payments for primary care services, and a ban on physician-owned hospitals, which often focus on lucrative or low-risk patients.

Some economists have said, however, that the bill does not go far enough in its efforts to drive down costs and revamp a delivery system widely believed to be dysfunctional.

Many in academic medicine point out that the legislation does not adequately address the nation's physician workforce shortage, which will grow as newly insured patients enter the system.

The legislation will redistribute a certain portion of unused, Medicare supported graduate medical education slots—preliminary estimates put the number at 600-700—to health professions shortage areas and regions with low resident-physician-to-population ratios. This represents a fraction of the 15,000 new slots requested by the academic medicine community and other groups.

"The doubling of the population over age 65 means it will be difficult to meet care needs, and more people coming onto Medicaid rolls and insurance exchanges will exacerbate that," said AAMC Chief Advocacy Officer Atul Grover, M.D., Ph.D. "We currently train about 25,000 doctors a year, and will need another 5,000 or so per year if we are going to meet the needs of the next decade."

The legislation also reduces Medicare and Medicaid disproportionate share hospital (DSH) payments by $36.2 billion. Hospital leaders said the DSH payments, which go to hospitals with high uninsured and Medicaid patient populations, should not be ratcheted down until there is a clearer picture of how Medicaid patients will affect bottom lines. The cuts will begin in fiscal 2014.

An overhaul of Medicare's sustainable growth rate formula for calculating physician payments remains elusive. Physicians have long sought changes to the formula, which calls for a 21 percent payment cut that must be averted each year by a special act of Congress. Several other measures will directly affect hospital operations. Beginning in fiscal 2013, hospitals will receive Medicare cuts if they do not meet specific benchmarks on hospital readmissions. The U.S. Department of Health and Human Services will begin calculating and reporting readmission rates using the so-called "all cause" method—a move proponents say is the simplest way to track a complex issue. However, some hospital leaders say this is not the best approach because it counts all readmissions, regardless of reason or context, that occur within 30 days of discharge.

"Many hospitals are treating at-risk populations, including the disabled or the psychotic," said Steven H. Lipstein, M.H.A., president and CEO of BJC HealthCare in St. Louis. "Resources for treating these patients outside the hospital do not exist. So caring for them inside the hospital becomes the only option."

Hospitals and faculty group practices will have an opportunity to try out new models of care and reimbursement. The reform laws establish the Center for Medicare and Medicaid Innovation (CMI) within the federal Centers for Medicare and Medicaid Services (CMS) to test payment and delivery models that improve quality and slow cost growth. Among these are pilots for the medical home, which centralizes care around a primary physician and compensates that physician accordingly, and the AAMC's proposal for Healthcare Innovation Zones, a designated geographic region containing an academic medical center and other entities that would test new models of delivery within a defined population. The law authorizes $10 billion for CMI activities.

Starting in 2015, the new Independent Payment Advisory Board (IPAB) will submit proposals to Congress designed to rein in Medicare spending. Under the legislation, Congress must implement IPAB recommendations or find another way to achieve equivalent savings. Hospitals are excluded from any IPAB proposals through 2019.

"We don't yet know what the composition of the board will be, or whether they will take into account the special care that teaching hospitals provide," Lipstein said.

The board, which will not replace the Medicare Payment Advisory Commission, is predicted to save $15.5 billion in its first 10 years.

In the coming months, CMS will begin to literally put the reform laws into practice with a series of proposed regulations. Each proposal will include a public comment period.

"We will need to work hard and work collaboratively with the federal and state governments to come up with new systems of care," Sussman said.

U can also access the above info thro' the link :
http://www.aamc.org/newsroom/reporter/april10/healthcare.htm

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