Hoping to "provoke some discussion" among various interests, the Medical Group Management Association is calling for a radical overhaul of the private-sector healthcare payment system in the United States to remove variability and the billions of dollars of waste it causes.
"We're hoping that this is sort of a lightning rod for some public debate," says William Jessee, M.D., CEO of the 19,000-member MGMA, based in Englewood, Colo. Jessee unveiled the MGMA manifesto at the annual meeting of the organization last month in Philadelphia.
Initial reactions from others suggest there will be no shortage of debate on the proposal, though there is some room for finding common ground.
The MGMA endorsed the concept of a "simplified payment system" by calling for the standardization of payer contracts, clinical guidelines, physician credentialing, drug formularies and other sources of administrative redundancy while maintaining the current multiple-payer framework of the U.S. healthcare system.
"We do not believe that the current financing and payment system can long be sustained. Similarly, we do not believe that a government-run, single-payer national health system is a viable solution to this problem," the MGMA board of directors says in a statement.
"We welcome comments on and criticism of this concept, and hope that it can contribute to the rapid identification of solutions to this immense problem," the board says.
Comments already are pouring in.
Former National Institutes of Health and American Red Cross chief Bernadine Healy, M.D., who delivered a keynote address at the MGMA meeting, acknowledges the MGMA change list is a tall order but says, "If there is an easy solution to healthcare in this country, we would have figured it out by now."
The MGMA is sending letters to state medical societies soliciting comments from members and is considering holding a national symposium sometime next year, a spokesperson says.
"The problem we face is that no two payers work the same way," Jessee says. "This is sucking up a huge amount of our nation's healthcare system and it's not benefiting anyone."
"Why should clinical guidelines depend on who the insurance plan is?" Jessee asks. He makes a similar inquiry about drug formularies but acknowledges pharmaceutical companies likely will fight any effort to standardize drug lists.
Samuel Nussbaum, M.D., CMO of Indianapolis-based Anthem, which owns Blue Cross and Blue Shield plans in nine states, contends that payers already defer to the judgment of medical professionals in adopting clinical protocols, disease management programs and formularies.
"These are all consensus standards that take the best clinical knowledge," Nussbaum says of clinical guidelines.
Jessee also derides the practice of multiple fee schedules, saying that only healthcare and the airline industry have so many prices for the same service--and airlines set their own fares, while healthcare providers have little say in what they will be paid. He calls the MGMA proposal for a single fee schedule "perhaps the biggest lightning rod we've tossed out so far."
Susan Pisano, spokesperson for the American Association of Health Plans, says a single price list goes against the nature of consumerism. "We live in a country where the public is interested in choice," Pisano says.
However, Pisano notes that there is room for accord on many of the issues, including physician credentialing. The MGMA agrees on this point.
"Credentialing is probably the prototype," says Jessee.
The Council of Affordable Quality Healthcare, a coalition of managed care companies and industry groups, is rolling out a one-stop credentialing program state by state.
Jessee also calls the recent decision by the National Library of Medicine to license the Snomed CT standardized set of clinical terminologies for free nationwide usage a "step in the right direction."
Warren White, administrator of the multispecialty Southwestern Medical Clinic in Berrien Springs, Mich., is philosophical.
"We have to start someplace," he says. "The way we facilitate change is to get people thinking about what needs to be done."
Nussbaum agrees that the opening of dialogue is a positive step. "These are journeys. We all want to get there," he says. "What's clear is that America needs a viable solution to rising healthcare costs."
In other news from the MGMA conference, the organization announced plans to create the Group Practice Research Network.
Under a 20-month, $300,000 contract from the Agency for Healthcare Research and Quality, the MGMA will work with the University of Minnesota and Georgetown University to collect, analyze and disseminate information from about 1,000 medical groups.
The first order of business is to merge MGMA files with those of the AMA, hospital purchasing cooperative VHA and private data vendors to create a definitive list of group practices in the United States.