Regarding “Ryan: Plan is bipartisan
," Medicare was enacted 47 years ago to provide a medical safety net for those who were lucky enough to live longer than average. It has become a welfare program, even for the rich, and even for today's young seniors who will live, on average, another 10-12 years after eligibility. Medicare beneficiaries currently pay a rather small portion of their expenses, which has fueled overutilization. Medicare has been paying providers fees for their services without holding them accountable for quality and the health of the patient. Finally, when all of the baby boomers become eligible, the pyramid scheme of taxing younger workers for Medicare is going to bust.
Most reasonable people agree that Obamacare does little to fundamentally reform the system, instead relying on new taxes and penalties, price controls and rationing. Regardless of the outcome of the presidential election, I believe the Rivlin-Ryan-Wyden plan offers a bipartisan approach to real and lasting reform. Many people worry whether the premium support payments will keep up with current medical inflation. Isn't that the point? More competition among insurers and providers, lower utilization, more patient choice, healthier patients—isn't that the best hope we have for bending the cost curve?
President and CEO
Fremont (Neb.) Area Medical Center
Regarding “Ryan: Plan is bipartisan
," I support the Romney/Ryan plan. Obama and his re-election team have been deceiving with regard to Medicare/Medicaid and what ACA really means for American healthcare consumers as well as providers.
The bottom line is that the U.S. spends nearly 18% of its gross domestic product on healthcare, whereas other developed countries spend 9% to 11%. More importantly, Americans have healthcare that is inferior to those countries that spend less. More money is not more value. I believe that Obama views ACA and its inherent changes to Medicare and Medicaid as an interim step to a true government-run, national healthcare system.
Taking fraud out of the system (Obama's solution to the $750 billion) is not going to get the job done. That has been the party line for years and it has yet to be managed. I believe that the private sector, if given the opportunity, can manage the healthcare more efficiently and we will have a system that provides more value to American healthcare consumers.
Dr. Donald Saelinger
Hawaii Pacific Health
Regarding “Mixed results seen on Blues medical-home project
," I applaud the patient-centered medical home work reported by Andis Robeznieks and Dr. Sam Romeo's staunch support in his letter
for involving patients as integral partners in their care. Strengthening healthcare in the U.S. requires significant change in primary-care practices and payment strategies. A patient-centered medical home provides an effective means of contributing to this change. Also, the PCMH goals of improving outcomes while reducing cost dictate that patients be active, engaged participants in their care, thereby becoming agents for that change.
Primary-care practices pursuing PCMH status face considerable changes in the way they work, including approaches used to track preventive care and treatment, along with those designed to monitor test and laboratory results. Successful practices implement care-management strategies and partnerships with community agencies. They integrate specialists and acute-care institutions using clearly defined communication channels (often electronic in nature).
In addition to capital expenditures for information system installation or upgrades, PCMH practices tend to hire additional full-time equivalents to meet the increased work effort. Payers must recognize this additional work and expense through increased per-member-per-month payments and monetary incentives for quality achievements. As both Robeznieks and Romeo noted, payers may realize expense savings. Lower expenses result from a reduction in inpatient admissions and a decrease in emergency department visits.
Finally, PCMH patients must assume an active role in their care. PCMH standards support actualization of patient involvement through patient education, patient self-management strategies and increased access to providers (open, after-hours and electronic access).
Working together, physicians, payers and patients can improve healthcare in the U.S.
Senior consulting manager
Chadds Ford, Pa.
I have been an avid reader and follower of Modern Healthcare for the past 31 years that I have been involved in healthcare as either a CEO or consultant. On occasions, I have questioned the sources used for the information that is printed. The most recent was drawn to my attention in your Sept. 3 publication. Regarding “Expertise on call
,” you listed your assumption of the top emergency department contractors by size. I question the accuracy of your information as Emergency Staffing Solutions should have been on that list. Emergency Staffing Solutions has in excess of 60 contracts in 14 states, with 25 being strictly emergency department management. Emergency Staffing Solutions of Dallas is a nationally established firm that has been providing emergency department management services since 2001.
Executive vice president
Emergency Staffing Solutions
Editor's Note: The ranking in question is based on voluntary submissions to Modern Healthcare's 2012 Outsourcing Survey.