Health reform is all about having more hospital beds and more doctors. That’s the message that a general audience might take from the media’s coverage of the AMA’s report card on public hospitals.
Why is there such a large gap between what the public hears about health reform and the discussions occurring in heath policy circles?
The latest issue of the Asia Pacific Journal of Health Management, for example, includes articles about the need to do things differently, and calling for “disruptive innovation” rather than business as usual.
The journal’s editorial notes: “While the focus remains on hospital acute care, the importance of the primary healthcare sector is diminished and we need to return to a vision that is focussed on what is required to deliver effective patient journeys, the promotion of self-managed care, equitable access to services for all and, improved population health for communities.”
If we want to foster more innovation in health care, perhaps we should be looking towards the US, suggests Croakey’s Washington correspondent, Dr Lesley Russell.
Lesley Russell writes:
This week the Center for Medicare and Medicaid Services within the US Department of Health and Human Services officially established the Center for Medicare and Medicaid Innovation, which is intended to study ways of delivering care and paying providers that can save money for the Medicare and Medicaid programs.
The centre, a key health care reform initiative, will consult widely with health care stakeholders including hospitals, doctors, consumers, payers, employers, states and federal agencies to create partnerships and also receive feedback on its operations.
Physician Richard Gilfillan is the acting director of the new centre. “The center will identify and test care models that provide beneficiaries with a seamless care experience, better health and lower costs,” he said in a news release. “By working together with innovative and committed providers, we can create a system that works better for everyone. We want to identify, validate and scale models that have been effective in achieving better outcomes and improving quality of care, but may be relatively unknown.”
Dr Gilfillan comes with excellent qualifications for the job, but a pedigree that would have some Australian health bureaucrats looking askance. From 2005 to 2009, he was president and CEO of Geisinger Health Plan and executive vice president of insurance operations for Geisinger Health System, a large integrated health system with 750 physicians, three hospitals, and 12,000 employees. There, he helped design a bundled payment, episode-of-care reimbursement system (known as ProvenCare) for acute surgical and medical care that rewards providers for providing high quality outcomes.
The new centre has already announced several programs to improve primary care in the US. The agency has named eight states to participate in a demonstration project that will evaluate the effectiveness of doctors and other healthcare professionals working in a more integrated way and receiving coordinated payment from Medicare, Medicaid and private health plans. It will include about 1,200 ‘medical homes’ (these are like GP SuperClinics) that treat up to 1 million Medicare beneficiaries.
The new Medicaid Health Home State Plan option will allow Medicaid enrollees with at least two chronic conditions to designate a provider as a ‘health home’ (the term used in medical for a medical home) to coordinate treatments. States that implement this option will receive more federal support to promote these ‘health homes’ in their Medicaid programs.
In addition, the agency announced the Federally Qualified Health Center Advanced Primary Care Practice Demonstration to evaluate doctors and other health professionals working in teams to treat low-income patients at community health centers. The demonstration will be conducted in up to 500 federally qualified health centers and provide care for up to 195,000 people.
The Center for Innovation is not just about fostering a culture of innovation in health care and improving health outcomes. It also has an important role to play in helping to hold costs down and keeping the health care system sustainable.
This role was reinforced last week in the proposal from the co-chairs of the President’s National Commission on Fiscal Responsibility and Reform, which recognised that these new ways to pay for health care services will produce real savings – something that opponents of health care reforms consistently deny. This approach is obviously in conflict with that of conservatives who want to repeal the Affordable Care Act.
• Dr Lesley Russell is a Senior Fellow at the Center for American Progress in Washington DC. She is a Research Associate at both the Menzies Centre for Health Policy and the US Studies Centre at the University of Sydney.
Dr Pesce spoke at length at the media conference yesterday about hospital alternatives and non-traditional hospital services such as hospital in the home.
At the moment we are in election mode in Victoria, and both parties have promised much needed additional beds. AMA Victoria statements have emphasised that these additional beds should provide the room for innovation and reform.
Our main election statement says, in part:
“We need a plan not only to increase hospital capacity in line with growing population, but to look towards innovation and bold ideas in the health system….
… the long term vision for Victoria’s health care should not just be more of the same.”
There are a number of examples of what we’d like to see in Victoria at http://www.amavic.com.au/stateelection2010.
[Dr Harry Hemley is President, AMA Victoria]
It’s not a really good idea to listen to the richest union in the country with their continual whining about more stuff.
It is always about more money for them.
Government and the public need to realise that the AMA are not the only voice that speak for doctors. There are numerous organisations that represent doctors, but the AMA does represent the richest and best connected doctors politically. When I hear their public statements I take them in context, but I wonder how many others do? They only represent certain doctors, and mostly not those who work in primary health care and preventative health. Bed spaces, public and private, are money making opportunities for doctors. One has to be able to pay for the kids private school fees! Having said all that, there is a shortage of beds in the public health system a result of 30 years of rationalisation, reorganisation, delineation of hospital roles, the shortage of nurses, especially skilled and experienced nurses, and it is useful to have the big booming voice of the AMA reminding government of the shortage and the social and health impacts of that shortage of beds. And at the same time we need to move ahead with the development of primary health care and preventative health strategies and the government is doing that with the establishment this week under legislation of the National Preventative Health Agency. There is great hope for this Agency, particularly in rural and remote areas.
>> Bed spaces, public and private, are money making opportunities for doctors. One has to be able to pay for the kids private school fees!
You are incorrect.
Doctors in *public* hospitals are paid the same salary regardless of how many patients they see or operations they do. Specialist surgeons are paid the same salary as specialist endocrinologists.
Doctors working *privately* earn money in relation to how much they can bill the patient/medicare. Surgeons can thus earn much more than physicians who don’t do procedures, which attract much higher fees and medicare rebates than a consultation. There is thus a financial incentive for doctors working privately to see as many patients as possible and bill them for procedures rather than a consultation. The ethical issues behind this are clear.
Of course, many doctors work in both systems, but the fact remains that public hospital specialists don’t earn anything extra if they put more beds in (besides any required overtime to see those patients).