Rhetoric and reality in the economic stimulus package: The AMA's approach to health system reform.
As physicians, it is important that we make decisions based on evidence and fact. Unfortunately, that became a challenge recently as conflicting information swirled in regard to the important health information technology (HIT) and comparative effectiveness research provisions included in the recent economic stimulus bill. To help AMA members make sense of these provisions, here are some facts to consider.
Experts from the most respected medical institutions in the country have all urged accelerating the adoption of HIT to facilitate quality improvement and, over time, lower costs. For years, the AMA and other physician groups have urged policymakers to help fund physician HIT acquisition costs.
The economic stimulus package provides approximately $19 billion in Medicare and Medicaid incentives over five years to assist physicians in purchasing HIT systems. This is the first substantial federal funding provided to help physicians implement HIT systems-systems that will generate benefits across the health care spectrum. While the bill does include Medicare payment reductions (starting at 1 percent) for physicians who do not implement HIT systems, these do not take effect until 2015 and there are exceptions for significant hardship cases.
Throughout the legislative process, the AMA has urged flexibility in implementing these provisions given the uncertainties surrounding this issue. Also, we have made it clear that these incentives are doomed if Congress fails to address the long-term viability of the Medicare physician payment system (including replacing the sustainable growth rate formula). The final HIT provisions are not exactly what we would have drafted, but they do represent real progress and a major improvement upon the status quo.
Suggestions that a Department of Health and Human Services Office of Health Information Technology (which currently exists and was established by former President George W. Bush) "will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective" are unfounded. There is no such authority in the legislation.
Another provision that has been widely attacked is the increase in government support for comparative effectiveness research (CER) and the coordination of this research through a new advisory council of federal agency representatives.
The AMA and many other health groups have endorsed the concept of research to provide physicians with information on the comparative effectiveness of different medical treatment options. Physicians and their patients both can benefit from research that demonstrates whether a particular treatment option results in better outcomes.
The AMA has stressed that research findings should be driven by clinical evidence and not be used solely to identify and promote the cheapest treatment option. The AMA has also successfully advocated that entities conducting this research not make coverage and payment decisions.
The CER Advisory Council has been erroneously compared to the Federal Health Board envisioned by former Sen. Tom Daschle. The two bodies have little in common, however. The CER Advisory Council would be responsible for setting research priorities and avoiding duplication across various government agencies. It has no authority to restrict payments or make coverage decisions, or establish national practice guidelines, and it does not grant Medicare officials new authority to impose a cost-effectiveness standard. The health care provisions contained in the recent economic stimulus bill, however, mark just the first step of a longer journey toward health system reform.
The AMA is fully engaged in this debate and shares the concerns of individual physicians regarding some of the ideas being floated.
We oppose a single-payer system and other proposals that move our health care system in the wrong direction. Likewise, we must remain vigilant that the positive health care provisions in the stimulus package or subsequent legislative proposals are not twisted or corrupted toward an end that compromises physician practice and patient care. Standing pat, however, is not an option. The current state of our health care system is not sustainable. Over the years, our AMA House of Delegates has adopted sensible policies that outlined reasonable reforms that will benefit all stakeholders. We are using these reform objectives to guide us in the current debate. They include:
* Expanding affordable health insurance coverage for all;
* Reducing costs and increasing value in health care services;
* Eliminating excessive administrative burdens;
* Increasing investments in wellness and prevention services;
* Empowering physicians to improve quality through evidence-based medicine;
* Reforming government insurance programs by providing adequate physician payments to assure timely access for patients;
* Implementing essential payment and delivery reforms to optimize health care expenditures, including medical liability and antitrust reforms.
The pressure for health system reform is not just coming from President Obama or the Democrats in Congress. Many Republicans in Congress and every major stakeholder group-patients, businesses, physicians, health provider organizations and insurers-are all calling for a transformation of our health care system. To succeed, reforms must be adopted as part of a comprehensive strategy that balances issues of coverage, access, quality and cost.
The political and legislative process presents real challenges. Fierce partisanship impedes constructive dialogue and has triggered decisions to short-circuit the deliberative process. Frequently, final legislative language is available too late to allow for thoughtful review and consultation before committee or floor action. Legislative language is also subject to interpretations and can be as indecipherable as an insurance contract. Congress needs to apply the same level of transparency to its work that it is calling for in the health sector.
The AMA's commitment to you is to serve as the strongest possible advocate for meaningful health system reforms that will empower physicians to help patients lead healthy and productive lives. Our success depends on your support and engagement.
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www.ama-assn.org/go/grassroots.
Finally, please continue to provide us with your feedback and input on how we can do a better job of serving the physicians of America.
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