“The health care bill was primarily about insurance reform and coverage, not health care delivery reform.” This statement was made by Jamie Orlikoff, of Orlikoff and Associates, a consulting firm that specializes in healthcare issues. He addressed a gathering of community leaders in Rapid City, South Dakota, in December.
Regardless of what the Supreme Court or Congress may do to the current health care law, we can expect to see many changes in how health care will be delivered. Many things happening within Medicare and apart from the health care bill have bipartisan support and agreement, which aren’t getting a lot of press coverage.
One big area of agreement is that, in the future, medical providers will be penalized for actions they are rewarded for now. Orlikoff noted the current health care system rewards the wrong areas. The current volume-based system that pays providers more for doing more doesn’t make sense.
He gave several examples where hospitals can actually profit from poor treatment, such as food poisoning, staph infections, or readmissions. As callous as it may seem, in each of these cases a patient needs more medical attention, which means there is a monetary bonus. “We must move away from fee for service,” Orlikoff insisted.
In the future, health care providers will be punished monetarily for such events. Instead of receiving reimbursement for each service, the hospital will receive one fixed “bundled payment” for a procedure that will include all pre-op and post-op services. Hospitals won’t be reimbursed by Medicare for readmissions at all, and actually will be penalized if their readmissions exceed a certain percentage. The intention is to give hospitals the incentive to “get it right” the first time.
One downside I see to this is in cases where a readmission is unavoidable. Hospitals will have incentive to cut corners, as they won’t be receiving reimbursement.
Orlikoff said that “It’s the patient’s fault” will no longer be an accepted excuse. “Much of what goes on in health care is blamed on the patient, yet 50% of prescriptions are not filled because the patient doesn’t understand why the medication is necessary and 48% of patients could not tell you what their diagnosis was 15 seconds after leaving the physician’s office.”
He concluded the new reimbursement methods will require health care professionals to find new ways of delivering information and following up.
Another area of agreement concerns transparency in cost and quality. Orlikoff emphasized how difficult it is to determine the cost of a procedure. “How much will this cost?” “I don’t know, but you will know at the end of the operation.” He added the same is true in trying to find out the quality of care or success of a procedure.
Health care providers’ cost and quality information will soon be released to everyone. It will list the average mortality rates and costs for procedures for hospitals. Starting in 2012, the Department of Health and Human Services will track and release hospitals’ harm rates, and hospitals in the bottom 25% will be penalized. In 2015 this tracking will be expanded to physicians, who will receive bonuses for high quality care and be penalized for low quality care.
There is also broad agreement to move toward evidence based care, meaning if there is no scientific evidence a medication or procedure works, Medicare will not pay. Orlikoff asserted, “Fifty percent of what we do in health care is not based on science.”
Clearly, the health care reform bill didn’t address all of the concerns over health care reform. Whether the law is amended, repealed, or kept intact, the debate over health care is only beginning.
