Health Reform in Eyes of MGMA President

Prelude: Members of MGMA help manage more than 300,000 physicians. That’s why the words of their president are worth reading and heeding.

By Matthew Vuletich, MGMA senior writer/editor

Proclaiming himself "fired up and ready to go," MGMA President and CEO William F. Jessee, MD, FACMPE, urged MGMA members to rise to the challenges facing the U.S. healthcare system in their own practices.

"We can and we must find a better way" to deliver healthcare, he said in his keynote address at the MGMA 2009 Annual Conference in Denver.
Jessee said the U.S. healthcare system is:

• Fragmented

• Costly

• Inequitable

• "Spotty" when it comes to quality

• "Perverse" when it comes to physician pay incentives

He outlined what needs to occur to transform the system from the 37th ranked system in the world to one of the best.

Fragmentation

The United States has more than 1,000 insurance companies and more than 100,000 benefit combinations. "We shuttle patients from one office to another, but their medical information often isn't shuttled with them," he said. "Hospitals don't communicate with one another, nor with the physicians who refer patients to them."

Costliness

Healthcare costs increase every year, often several times faster than the inflation rate. Americans spend $7,600 per capita on medical care.

Inequity

Access to and the quality of care varies by the color of patients' skin, whether they live in urban, suburban or rural areas, and what kind of insurance they have – provided they have any at all, Jesse noted.

Spotty quality

"Many of our physicians and hospitals are among the finest in the world. People come from thousands of miles away to be cared for at world-famous institutions such as Virginia Mason, Mayo, Cleveland, Dartmouth Hitchcock, Scott and White, Joslin, M.D. Anderson, and many others," Jessee said. "But we also provide some of our citizens with care that falls far below a reasonable standard – and all too often, we actually do harm to those who most need our help."

Perverse incentives

"Hospitals and physicians are paid more for patients who develop complications than those who don't," he noted. "Physicians who succeed in keeping patients with diabetes or congestive heart failure well and out of the hospital are punished with lower incomes than those who are less successful."

Expanding coverage

Despite the proliferation and severity of challenges, Jessee described himself as more optimistic about the possibility of fixing the system than he has been for a decade. Although much of the rhetoric in Washington, D.C., about how to cover uninsured Americans is "designed solely to frighten people and obscure the real issues," he said, it is encouraging that some that some "civil" dialogue about how to truly expand coverage is occurring at all.

People who are satisfied with their current coverage should be able to keep it, Jessee said. He decried as immoral some of insurance companies' most egregious practices, such as denying coverage for pre-existing conditions and making "windfall profits from an essential commodity."


Changing what we pay for

"True healthcare reform requires payment reform," Jessee insisted. The system needs to move from a volume-based system to one that rewards physicians for keeping patients healthy and preventing hospital readmissions.
We also need to tackle administrative costs by standardizing benefits and payment processes across insurers, eliminating duplicative efforts and making better use of information management technologies, Jessee said.

Safety

Jessee challenged members to "create a culture within [their own] organizations in which safe patient care is not just assumed but actively cherished. It's up to the leaders of our healthcare organizations – both clinicians and administrators – to take the lead in creating a culture that values safe, high-quality care – above all else."

However, employers, insurance companies and public payers must financially reward Medical group practices for improved safety and quality while providing disincentives for substandard care.

Patients

Americans can't sit on the side of the debate, though, just waiting for the benefits of reform.

"We are the world's most obese nation," Jessee pointed out. "More than 60 percent of our population is overweight." Combine that with the large number of young people who smoke, alcohol abuse, illicit drug use, reckless sexual behavior and violence, and it's clear that everyone will have a hand in changing our system. "It’s a challenge to educators, to families and to individuals. Reforming the healthcare payment system so that it encourages healthy behaviors – and creates financial disincentives for unhealthy behaviors – is a key part of healthcare reform and a key step towards restoring personal responsibility for health."

Despite the number and level of the challenges, Jessee insisted that "working together, we can meet the challenge, and we can create a healthier and more prosperous nation," Jessee said. "Let's do it together."

Conclusion

It is nice to meet a man who remains an optimist, especially after he has just recited reasons to be a pessimist.

I have never agreed with the liberal think tank WHO’s 37th U.S. ranking, nor do I think the U.S. health care system is tanking. But I must say a little more communication, would surely help ease current fragmentation. I'm skeptical government can make care cost less. Historically, federal largess and nobless has never made costs regress. Still, government might help legislate equity and more coverage. These have been goals of progressives since antiquity at which no one takes umbrage.

As for perverse incentives and changing for what we pay. Those are very slippery things to measure and to weigh. Improving quality and safety are system issues that require plugging holes in tough cultural tissues. The last and hardest thing to do is changing patient behaviors. That’s beyond most doctors' reach since patients are their own saviors.

Dr. Richard Reece is author, blogger, speaker, and innovation and reform commentator. Dr. Reece’s latest book, Obama, Doctors, and Health Reform (IUniverse.com) is available at amazon.com, barnesandnoble.com, and booksamillion.com for $31.95 (hardcover), $21.95 (softcover), and $6.95 (electronic). For information on speaking fees and arrangements, call 860-395-1501.