Monday, April 6, 2009

With opening day almost behind us, now comes the hard part

Last night was opening night for the 2009 Major League Baseball season, although I haven't ever quite accepted the idea of baseball opening with a night game. So let's call today opening day.

Opening day is a time, of course, when every baseball fan is brimming with optimism about their team's prospects, even the stalwart fans of the Pirates, Royals and Nationals, when all logic should tell otherwise.

The same might be said of health care reform. President Obama and other advocates of health reform have done what they can to lay the groundwork for success. But the time for optimism is over. Now comes the hard part of finding a winning strategy to prevail over the long haul.

By the dog days of summer (August congressional recess), health care reformers will have a pretty good idea if they are close to bringing home the title of health care reform or are falling out of contention. By fall, they likely will know if it is really going to happen, or whether they'll be left crying "wait until next year" as Cubs fans have been doing for over 100 years (which is about how long the U.S. has been trying, and failing, to enact health care reform).

Let's look at where things stand today. Obama can point to some successes: reauthorization of SCHIP and the health care "down payments" in the stimulus bill. The pending House and Senate budget resolutions give a green light to the President's health care reform agenda, but with the big catch that it will all need to be paid for with savings, budget cuts, or revenue (tax) increases.

For physicians, the biggest challenge going forward may be whether the profession will embrace the need for comprehensive reform of the health care delivery system, including physician payments, or fight to keep a status quo that is failing so many patients and physicians.

The budget resolution approved by the House of Representatives does something very clever to force the issue among doctors. It basically would forgive the hundreds of billions of dollars in accumulated federal debt associated with the annual Medicare payment cuts associated with the Sustainable Growth Rate (SGR) formula, without requiring that this cost be offset by budget or pay cuts or revenue increases somewhere else. Wiping out this accumulated cost would allow Congress to enact a long-term solution to the SGR.

But for physicians to get the SGR money, they will have to be on board with reforms, according to the budget resolution, to create "incentives to encourage efficiency and higher quality care in a way that supports financial sustainability, improve payment accuracy to encourage efficient use of resource and ensure that primary care receives appropriate compensation, improve coordination of care, or hold providers accountable for their utilization patterns and quality of care."

The Senate budget resolution, although it talks about the need to make Medicare improvements to support training of more primary care physicians, doesn't provide access to the funds needed to get rid of the SGR and make other payment reforms, including reforms to support primary care, without making cuts somewhere else. The House and Senate will need to resolve these and other differences, and a final vote on a joint budget resolution is expected when Congress returns from its spring recess. ACP is strongly supporting the House language, because it creates a roadmap for eliminating the SGR cuts and reforming payments to ensure appropriate payment for primary care, to improve care coordination, and make health care more effective and efficient.

My sense, though, is that much of the medical profession isn't quite prepared yet to embrace the "quo" of supporting reforms to improve payment for primary care and holding physicians accountable in exchange for the "quid" of getting the SGR money.

And since physician payment and health care delivery reforms are considered to be essential ingredients of comprehensive health care reform, how physicians respond to this challenge will have a lot to do with whether President Obama and other health care reformers will be able to celebrate a historic October victory, or whether they will once again be disappointed, as so many baseball fans also will be.

Today's question: Do you think physicians are ready to support payment reforms to ensure better payment for primary care , improve efficiency and quality, and improve accountability - in exchange for getting rid of the Medicare SGR pay cuts?

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