System Overhaul
Dr. Meltzer is encouraged by Obama’s plan to create an independent, government-funded board charged with scientifically comparing the effectiveness of pharmaceutical drugs, medical devices, and procedures, and presenting the results to the medical community. He foresees hospitalists gaining opportunities to participate in clinical research as well as enroll patients in clinical trials.
“Over the long run, we’ll probably end up with therapies that will be better for patients and will control costs,” Dr. Meltzer says. “We spend a lot of money on things that don’t work or don’t work very well.”
In the short term, hospitalists should be on the lookout for:
- Grants and other assistance to implement health information technology systems, such as electronic medical records.
- Financial incentives aimed at improving the coordination and quality of care, including the use of drugs, medical devices, and procedures deemed by independent researchers to be the most effective.
- Requirements to collect data on measures of healthcare costs and quality for public reporting purposes and penalties, if the numbers dip below acceptable levels.
- In the long term, hospitals and hospitalists should see:
- Rising revenues as more patients are insured by private insurers, a new national health plan, and government programs, which Obama intends to expand.
- Increased workloads as patients turn to hospitals for care they can’t get at overwhelmed primary-care doctors’ offices.
- More hospitalists entering the field, as general and internal medicine becomes more lucrative and Obama backs efforts to offer medical school graduates incentives to go into general medicine.
- Changes in reimbursements as the nation’s healthcare system begins to adopt best practice, medical home, and bundling models.
Calling a comparative-effectiveness board “absolutely essential,” the Common-wealth Fund’s Davis says the U.S. has fallen far behind other countries in reviewing and rating therapies. Part of the reason is a fear that comparative effectiveness would stymie innovation and prevent doctors and patients from pursuing their choice of treatments, Dr. Meltzer says.
Opponents point to the book “Critical: What We Can Do About the Healthcare Crisis,” which Daschle and Lambrew co-wrote last year. In the book, Daschle advocates creating a federal health board outside the influence of Congress that would decide which procedures and therapies should be covered under public and private insurance plans. Obama has yet to support such a concept.
“There is that danger, but we live in an even more dangerous health system now,” says Dr. Meltzer, who predicts comparative-effectiveness legislation will advance this year. “I will be shocked and profoundly disappointed if we don’t see the legislation.”
Dr. Meltzer and other experts are less certain as to when Obama will move on other parts of his proposal, although Feder believes the president will try to create a national health-plan option and establish a national health insurance exchange, a kind of one-stop shop offering consumers health plans that would meet a minimum level of benefits, sometime in the next four years.
The national health-plan benefits could be similar to what federal employees receive, namely guaranteed health coverage and long-term care benefits, a wide variety of health plans to choose from, and insurability for pre-existing conditions. Private insurers would have to sell policies to everyone, regardless of pre-existing health conditions, and consumers who are unable to afford the premiums would be eligible for tax credits. The president’s plan stops short of requiring all Americans to have health insurance.
