Arkansas Leaders Assess Obama's, Others' Health Proposals on Arkansas Medical News Inc.

Arkansas Leaders Assess Obama's, Others' Health Proposals

By: BECKY GILLETTE

Reform Badly Needed, but Economy Could Cause Delays

The nation's current economic problems could delay the major healthcare reforms promised by President Barack Obama during his campaign. But some of the provisions are favored by Arkansas medical leaders who believe the reforms, if enacted, could result in better care delivered at a more economical cost.

There is no doubt that reform is needed, said Dennis Yelvington, MD, president, Arkansas Academy of Family Physicians.

"We have an upside down system in America right now," Yelvington said. "Specialists and subspecialists are providing more medical services than primary care physicians. That is more expensive than having care provided by family physicians. Studies show family physicians provide less expensive care that is just as good as a lot of specialty care."

One of the top Obama-Biden proposals is to invest $10 billion in a nationally standardized electronic health information technology system. The intent is to coordinate care and reduce medical errors.

"A lot of care is disjoined and copied in certain incidences," Yelvington said. "There can be unnecessary tests that have already been done. Communication between doctors might be good in one system. But when you get out of that system, there can be poor communication."

Family physicians are supportive of a concept backed by Obama-Biden called the "patient-centered medical home." Patients are cared for by a physician who leads a medical team that coordinates all aspects of patient care using appropriate technology.

"The patient-centered medical home with good communication allowed by the standardization of national health records is what family physicians are pushing for," Yelvington said. "There is an emphasis on prevention in primary care. The fact is we need better immunizations, and better care of chronic diseases. That is a big benefit of the medical home, caring for patients with diseases like diabetes and hypertension to provide early treatment or prevention to prevent expensive complications. Other countries emphasizing family medicine have had good results in improving health outcomes while minimizing costs."

Yelvington expects delay in the healthcare reforms because of the economy. The economy, not healthcare, is likely to be the number one issue in the next year. But he still expects progress on the medical home concept, at least getting started on it with pilot projects across the nation.

"Blue Cross and Blue Shield are looking at doing some of that with their covered lives," said Yelvington, who practices at the Stuttgart Medical Clinic. "A lot of other insurance companies and HMOs have been trying to do that, also."

The Obama-Biden plan also promised to tackle the problems with the increasingly large number of people in the U.S. without health insurance. There is also concern about people who are underinsured. Many people have health insurance with high deductibles. Insurance premiums, deductibles, and co-pays for doctor visits and prescriptions are all increasing, often resulting in failure to continue treatment for chronic conditions like hypertension or diabetes.

"Hospitals are also struggling with the number of uninsured," Yelvington said.

Paul Cunningham, senior vice president, Arkansas Hospital Association, said it is costly when people who don't have insurance put off healthcare until it becomes an emergency situation.

"The emergency room may be the only place people know to get care if they don't have a primary care physician," Cunningham said. "If you or your child gets sick, and you have nowhere else to get it, you are likely to go to the emergency room. This is why hospitals are safety net providers."

Hospitals are seeing more patients come in with no health plan or high deductible plans.

"What we are seeing in the past several months with the economy having its problems is that bad debts and charity care write offs are increasing for hospitals in Arkansas, as well as everywhere else," Cunningham said.

It is possible the new Congress will take up legislation early this year similar to the "Healthy Americans Act" introduced in the 2008 session by Sen. Ron Wyden. The plan called for guaranteeing private healthcare coverage for all Americans, providing incentives to focus wellness and disease management and establishing tough cost containment measures.

Recently, Sen. Max Baucus released a white paper on healthcare reform. His proposals would guarantee health insurance for all Americans by facilitating sales of private insurance, expanding Medicaid and Medicare and requiring most employers to provide health benefits.

"It covers numerous fronts," Cunningham said. "Certainly there are many things in there that will get a lot of debate in the coming months. It is too early to say what looks good and what doesn't…Some of those are pretty drastic."

One proposal would create a value-based purchasing system for hospitals that would be a "pay for performance program" where hospitals that meet certain quality standards would get higher Medicare payments. Hospitals that don't meet those standards would get less.

"Nationally hospitals expect some movement on a value-based purchasing system," he said. "This has been in discussion a couple of years."

In addition, Sen. Ted Kennedy and Rep. Pete Stark are expected to propose legislation for healthcare reforms of their own. Those proposals might be even more extreme.

The Arkansas Hospital Association and its counterparts across the country have been working closely with the American Hospital Association for development of a framework called "Health for Life" for what should be included in healthcare reform. Much of that involves getting people insured.

"I think everyone agrees there will be some kind of healthcare reform," Cunningham said. "Whether that happens in 2009 or 2010 remains to be seen. I think something is going to happen. We just don't know yet what shape it is going to take."