Health reform raises more questions than answers — what should you do?
While the details of health care reform were uncertain at press time, one point is clear: Change will be coming to outpatient surgery regardless, and providers need to be prepared.
One red flag raised by sources interviewed by Same-Day Surgery is that a health care system might emerge that is more focused on cost savings than patient safety.
"If you want to provide safe care and you're hoping to reduce costs, that's one thing; but if you want to reduce costs to provide safe care, that's another," says F. Dean Griffen, MD, FACS, attending surgeon at Louisiana State University Health Sciences Center (LSUHSC) in Shreveport, and CHRISTUS Schumpert Highland, and director of surgical stimulation, director of undergraduate surgical education, and professor of clinical surgery at LSUHSC. Griffen serves in leadership positions for the American College of Surgeons and is a former member of that organization's Health Policy Steering Committee.
Payers often don't consider the upfront costs, Griffen says. For example, an antibiotic impregnated venous catheter costs more than one that is nonimpregnated; however, administrators might not see the value of buying a more expensive item, he says.
"The savings is after the fact, because you have fewer infections, fewer prolonged hospitalizations, and better outcomes because you spent more up front," Griffen says. "If the new health care system designs itself around cost instead of safe care, they might miss a chance to spend money up front to save money later."
Also consider the example of surgeons who have experience with a particular type of device and who have better outcomes because of their experience with that device, even if it is more expensive, Griffen says. "If, on the other hand, some bean counter says only use this particular device because they have special deal contracted with a particular company that makes it cheaper, the persons with less experience with that device are compelled to use it and may have worse outcomes until they get used to it," he says.
Consider these other potential impacts:
The financial hit could be significant.
Ambulatory surgery centers already are taking a tremendous financial hit in the Medicare arena, says Bobby Hillert, executive director of the Texas Ambulatory Surgery Center Society in Austin. "So, any bill that uses the Medicare reimbursement model as a vision for health delivery would certainly have a negative impact on ASCs," he says. "If a health care overhaul law includes a public health insurance option with rates similar to Medicare that will put a very tight squeeze on the industry's finances."
On the positive side, millions more potential patients could gain health coverage under proposals to expand Medicaid and provide subsidies to purchase health coverage, according to a study by the Robert Wood Johnson Foundation and Kaiser Commission on Medicaid and the Uninsured.1 The groups also released studies estimating how many uninsured parents, childless adults, and children would be covered under these and other scenarios being considered as part of health care reform. (Editor's note: To access these studies, go to www.rwjf.org. Select "Health Reform." Under "latest reports from RWJF, select "How will the Uninsured Be Affected by Health Reform?")
• Providers might be less likely to invest in technology.
Providers will be paid a flat rate for a procedure regardless of the cost of the equipment, sources point out.
"If there is advanced technology that would do same thing as something else in less time, albeit not better, they would stick with the old equipment," Griffen says. And that's not all, he says. There will be less of a stimulus for manufacturers to develop new technology, he says.
• Managers' paperwork burden might increase.
The government's "Cash for Clunkers" program was an indication of a backlog in terms of the government's ability to complete deals, Griffen says. "Consider all the time it takes to fill out forms, and even then, the government can't act on it as rapidly as they send it in," he says.
Health care providers already carry a significant cost for paperwork, Griffen says. "It's largely designed for safer care; but on the other hand, when it becomes burdensome, and reimbursement doesn't allow one to show overhead cost, and it gets higher than your income, you're in trouble," he says.
• ASCs could get lumped in with attack on physician ownership.
At press time, a health care reform bill included language that would ban physician self-referral to hospitals in which they have an ownership interest, with limited exceptions for existing facilities that meet strict investment and disclosure rules. Could this focus on physician ownership affect physician-owned surgery centers? Absolutely, say sources interviewed by SDS, including Craig Jeffries, Esq., public policy consultant for the Association of periOperative Registered Nurses (AORN).
"I will tell you: Absolutely whatever is happening with physician ownership applies to surgery centers," Jeffries says. From "a political perspective, as long as Pete Stark [D-CA] is in Congress, sure, they're going to be lumped together."
The attack on physician-owned facilities is interesting, particularly in light of a recent report from Consumer Reports that show physician-owned hospitals ranking as the No. 1 hospital in 19 states, he says. Such reports seem to have little impact, sources say. "It's a continuing threat for physicians who have ownership in an ASC," Jeffries says. All physicians, regardless of what segment of the industry they might own, should be concerned by any attack on physician ownership, Hillert says. "Attacks on one segment of the health care industry can lead to attacks on other physician-owned segments of health care," he adds.
What you should do now
Regardless of the status of health care reform bills, there are steps that outpatient surgery managers can take to guide future policy, sources say.
One is to promote your program in the community through health fairs, speakers, and open houses, sources say. Another step is to build relationships with policy-makers. Work through your associations and your local representatives, Griffen says. "Those types of interventions are deemed to be your access to the system," he says.
If you've never been to a town hall meeting or visited the office of your representative or senator, start there, Jeffries advises. Introduce yourself to the staff, and invite the Congressional representative to your facility and/or to a meeting of the local chapter of your industry association, he says.
Build a personal relationship with your member of Congress and his or her health aides, Hillert says. "A lot of people are intimidated by the idea of building that relationship, but it's often as easy as picking up the phone," he says.
When Congressional representatives were on a recent break, Hillert and members of his association took advantage of that time to speak with their Congressional representatives and their aides. They told them how many surgery centers are in the state, how many people they employ, how much those centers pay in taxes, and what the projected economic impact is for 2009.
Their big message? "Despite the variety, these ASCs all have one thing in common: an intense emphasis on safety and quality," Hillert says.
Reference
- Dubay L, Cook A. How Will the Uninsured Be Affected by Health Reform? Princeton, NJ: Robert Wood Johnson Foundation; August 2009.
College of Surgeons takes issue with Obama Some "uninformed" statements from President Obama "deeply disturbed" the American College of Surgeons, which responded with an Aug. 12 press release defending the high-quality care provided by surgeons. "We want to set the record straight," the college said. Here is an excerpt of its response:1 Three weeks ago, the President suggested that a surgeon's decision to remove a child's tonsils is based on the desire to make a lot of money. That remark was ill-informed and dangerous, and we were dismayed by this characterization of the work surgeons do. Surgeons make decisions about recommending operations based on what's right for the patient. We assume that the President made these mistakes unintentionally, but we would urge him to have his facts correct before making another inflammatory and incorrect statement about surgeons and surgical care. Reference
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Infectious disease groups back HAI reporting bill Staffing requirement viewed favorably Five organizations representing the nation's experts in infectious diseases medicine, infection prevention in health care settings, and public health and disease prevention announced their support for a provision requiring national reporting of health care-acquired infection (HAI) rates, which, at press time, was contained within the health care reform bill introduced by leaders of the U.S. House of Representatives. The Association for Professionals in Infection Control and Epidemiology (APIC), the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the Council of State and Territorial Epidemiologists (CSTE) and the Trust for America's Health (TFAH) sent a joint letter to members of Congress regarding HR 3200, the America's Affordable Health Choices Act. The bill would require hospitals and ambulatory surgical centers to report HAI data through an existing national reporting network managed by the Centers for Disease Control and Prevention as a condition of participation in Medicare and Medicaid. "Overall, this is a win for patients," says APIC 2009 president Christine J. Nutty, RN, MSN, CIC. "Public reporting of HAIs may drive further improvement in health care processes which will reduce infections, save lives, and preserve health care dollars. We are pleased that the House bill would also address the need for highly trained staff to effectively implement the system." HAIs claim 99,000 lives annually and incur more than $20 billion in excess health care costs. The groups agreed that the public reporting provision found in HR 3200 is superior to approaches that have been put forth in other legislation. HR 3200 would establish a single national standard for HAI reporting, and it would ensure that public health scientists at CDC determine which infections are reported and how. By mandating reporting via CDC's National Healthcare Safety Network, the bill will build on existing mechanisms and create a robust system to monitor, study, and ultimately prevent HAIs. |
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