Just as the primary race for the White House kicked off, Modern Healthcare, Modern Physician's sister publication, published my views on the subject of healthcare reform in a commentary. In the article, I speculated on the possible directions we might take—if the winner of the presidential election decided to pursue a comprehensive overhaul of healthcare.
Fast forward to March 2010. As I listened to remarks by President Obama on the historic passage of reform legislation, it seemed appropriate to reflect on how far we have come and how much further we have to go.
The new reform law is a critical first step toward that transformation. In my 2008 commentary, I pointed to the need to provide coverage and a “medical home” to each individual. Under the new law, 32 million Americans will be able to obtain insurance coverage and access the high-quality healthcare they deserve. The act also creates a program to establish and fund community health teams to provide medical homes and coordinated care for individuals with chronic conditions.
The need to implement better care models is a critical component of ongoing reform. In addition to providing insurance, it is essential that we better integrate the delivery of care by physicians, hospitals and other providers, and revamp our current payment system, which often encourages unnecessary care.
Included in the new reform law is a proposal offered by the Association of American Medical Colleges that could accomplish these goals. The establishment of “healthcare innovations zones,” or HIZ, is one of the programs that could be used to pilot new payment and delivery strategies under the Center for Medicare and Medicaid Innovation to be established by HHS Secretary Kathleen Sebelius within the next year.
The HIZ proposal, originally introduced as legislation by Rep. Allyson Schwartz (D-Pa.), would create an alliance of academic medical centers, local hospitals, physicians, insurers and other partners that could design and test new, more patient-centered models of care. These models would promote quality and “bend the curve” on costs. Academic medical centers are uniquely positioned to be vital partners in these zones. Home to highly trained physicians and scientists with the best facilities, these institutions can integrate health services, collect data on clinical outcomes and redesign educational programs to prepare doctors for a 21st century healthcare system. As part of HIZ, the nation's academic medical centers can lead the way in the next steps we must take to achieve true reform: aligning fundamental changes to the delivery system with changes in financing.
While the new healthcare reform law offers many opportunities for meaningful change, it will also present many challenges that we must address as we continue the “work in progress” of healthcare reform.
Now more than ever, the nation must expand the physician workforce to accommodate millions of newly covered Americans and a rapidly growing Medicare population. Our U.S. medical schools are already doing their part by increasing enrollment. Congress must join in this effort by lifting the caps on Medicare-supported residency positions so that future physicians can finish their training.
It is also imperative that we repeal the deeply flawed physician payment formula and replace it with a new system that will guarantee Medicare patients the stability and access to the care they deserve. The recent freeze on cuts to Medicare physician payments, while welcome, is only a temporary solution to a long-standing problem.
To build on healthcare reforms and continue their efforts to redesign patient care, U.S. hospitals must remain fiscally viable. The cuts to Medicare and Medicaid disproportionate-share hospital payments included in the new law will significantly reduce funding for these institutions. These reductions must be carefully monitored to make certain they do not undermine the nation's safety net before we know the outcome of coverage expansion.
We must also be equally vigilant of the new Independent Payment Advisory Board and ensure that any proposals it develops to slow the growth of Medicare spending do not produce unintended, damaging consequences, such as jeopardizing patient access to the unique healthcare services provided by teaching hospitals and the clinical providers of the nation's medical schools.
The journey we have been on for the past year has been a long and arduous one for our nation. The debate often deteriorated into a bitter blame game over whether the market or the government was better equipped to fix healthcare. The rancorous discussions of last summer's town hall meetings grew into angry Capitol Hill protests and culminated in frightening threats against members of Congress.
This was not America at its best. Despite these moments, we have produced a landmark reform law, the first step toward truly transforming healthcare in our country. Now, as the late Sen. Ted Kennedy said in 2008, “the work begins anew.”
Darrell Kirch, M.D.
President and CEOAssociation of American Medical CollegesWashington