Molpus: Representatives of all these groups say they support reform, that is, making health care more affordable and accessible while improving quality and efficiency. But what has some worried is the cost cutting in current services that may be necessary to expand care to the uninsured. Hundreds of billions of dollars are to be squeezed out of Medicare and Medicaid, the government programs for seniors and the poor. Depending on how the final legislation is written, it could cause havoc with hospital budgets, according to Mike Anderson, interim chief medical officer for University Hospitals.
Mike Anderson: The devil's in the details of how we pay for that. If it comes on the backs of academic medical centers who are already straining in this economy to take care of patients then that's not the right way to do it. If you look at hospitals across this country, over 50 percent are losing money every month. If we put more financial strain on this hospitals we may see more of them closing which, of course, would be a terrible impact on care.
Molpus: Anderson and other guests on the sound of ideas suggested that reimbursements hospitals get from Medicare and Medicaid are too low now for them to break even. The C-E-O of the Cleveland Clinic, Toby Cosgrove, said 50 percent of its patients are covered by those two programs.
Toby Cosgrove: The average hospital across the country loses 6% on medicare patients and 14% on medicaid patients.
Molpus: Hospitals try to stay in the black by cost shifting, charging higher rates to patients with private insurance and some, like the Cleveland Clinic are organized in ways that also help them balance the books. For one, it is an integrated health care system meaning that the doctors and hospital are all part of one organization; they are on the same team but Cosgrove says reform...as currently defined by Congress...does little to make this model more the norm than the exception.
Toby Cosgrove: And that really has not been part of the legislation that's going forward. The only step in that direction is "bundled payments."
Molpus: Bundled payments means hospitals and providers would be given a flat fee for a knee replacement, for example.
Several guests said its still unclear whether reform will fundamentally change the way doctors are paid. Cosgrove and others talked about the need to pay for health outcomes, not treatments and procedures. Too often now, they said, the system rewards unnecessary testing and pays nothing for time doctors could spend helping their patients prevent disease through behavior changes. One caller to the show, joan, a physician from mayfield said she spent 17 years in internal medicine, focused on prevention and it worked....except that she went broke.
Joan: People got healthier. In my first year of practice we had bypass surgery at least one case a month; heart attack several a month; in my last four years of practice, two patients had heart attacks, both were still smokers. The problem is the healthier my patients became, the more my income dropped with a huge practice, going 60-70 hours a week I took home 36 thousand dollars and I realized I had to close.
Molpus: Based on what our guests said today health care reform would do a few things to change situations like that but they are buried deep in the text of the legislation. As Julie Rovner, a health care correspondent for NPR said, many in this debate hope that incentives governing how medicine is practiced will be a strong part of any final bill... even if it isn't now.