Obviously being drafted, but there is info in here that is very valuale
All new things involve tradeoffs. The key is to determine the benefits versuse the costs - and if those benefits can be obtained more effectively in another way.
Another question: Should we start hiring professionals trained in what counts or keep hiring politicians?
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No matter how poorly designed ObamaCare is, there MUST be an immediate replacement plan that is workable, which includes the Good/Keep items, listed below.
The plan appears to be a throwing together of lots of good ideas but with poor implementation and poor efficiencies (but "hoped for" great savings that appear to have no sound reality-based foundation).
It would appear, to me, that we would consider it a base requirement the equivalent of providing for those who are unable to provide for themselves to have preventive health care for every US Citizen.
Key questions: Is the benefit worth the cost? [The costs include more than direct costs: job loss, economy loss, etc., must be added in.]
Is there another, better way to accomplish thiis?
Absolute requirement: We assure adequate care to all stakeholders. [Just as with all of our "minimum" safety nets.]
BOTTOMLINE
Bottom-bottomline:
It is a matter of good management or bad management principles being coordinated with the good ideas in ObamaCare - and reducing the bad effects: Increased taxes, job loss, goverment complications, disincentives.
We need an informed new President to synthesize all of this - and to repeal the original mess.
For every 1000 men with good ideas, give me on who can implement them [effectively].
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Cover more people = higher total costs (duh!) [Not bad in itself, if benefit is greater, but not deniable either.]
Estimated cost has doubled, per the Congressional Budget Office (CBO). Article.
Nothing is for free. Believing otherwise is pure fantasy. Everything has trade-offs and consequences. There is no magic fairy.
Job loss: Additional costs for employers will reduce the number of employees, economics 101. (notice how romneycare put all the responsibility on the person [he vetoed employer fees] for using the healthcare, if they could afford it.)
Higher costs drive more jobs overseas, as the alternative will now be cheaper.
Higher taxes (hidden in the bill) will have a downward effect on the economy, always. Economics 101
Additional regulations lead to regulatory headaches and costs to adhere to. Duh!
Decouples the principles of paying for one's own use of a service and puts the costs on others. Of course, we need to have a means of avoiding bankruptcy or too significant of a loss for those people having assets.
Good/keep, but also could build into simultaneous replacement designed better:
Coverage for those with pre-existing conditions
Ban on insurance companies rescinging coverage for people who become seriously ill
Competitive free market competition
Preventive health care benefit - but how to implement...
The government does not run things well. Privatize wherever possible.
Disincentive for future doctor supply, drives up costs and wait times (or rationing necessary)
It is oppressive and excessive - Need Address specific "no-no's" in another way
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GOOD AND NECESSARY ITEMS
1.The ACA bans insurance companies from rescinding coverage from individuals who become seriously ill
while enrolled in a health policy
2. Ability to get coverage with pre-existing conditions.
3. Competitive free market competition
4. Preventive health care benefit - but how to implement...
ATTEMPT AT PREVENTIVE CARE
Of course, preventive care is identified as a critical item, which, I think, anyone would support.
And now the quetion is: How do we get people to use preventive care?
EVALUATION OF MANAGEMENT PRINCIPLES
The difference that determines how good this bill is (as it does, of course, have good ideas in it) lies in the question of whether it is using good management or bad management principles coordinated with the good ideas.
For every 1000 men with good ideas, give me on who can implement them [effectively]
TAXES ARE INCREASED
Nothing is free.
Total new tax revenue from the Act will amount to $409.2 billion over the next 10 years.
$78 billion will be realized before the end of fiscal 2014.
Summary of revenue sources:
Broaden Medicare tax base for high-income taxpayers: $210 billion
Annual fee on health insurance providers: $60 billion
40% excise tax on health coverage in excess of $10,200/$27,500: $32 billion
Impose annual fee on manufacturers and importers of branded drugs: $27 billion
Impose 2.3% excise tax on manufacturers and importers of
certain medical devices: $20 billion
Require information reporting on payments to corporations: $17 billion
Raise 7.5% Adjusted Gross Income floor on medical expenses
deduction to 10%: $15 billion
Limit contributions to flexible spending arrangements in
cafeteria plans to $2,500: $13 billion
All other revenue sources: $15 billion
WHAT IS COVERED
What is covered will be determined (mandated) by the government, which will then be, as one article puts it, acting in the new position in the administration: God.
TAKE $500 BILLION FROM MEDICARE; HOW GET PAID FOR IN THE FUTURE THEN?
Medicare Advantage touted by Sebelius
Feb 2, 2012: Health and Human Services Secretary Kathleen Sebelius touted Medicare Advantage as being “stronger than ever,”
But Kathryn Nix, a policy analyst in the Center for Health Policy Studies at The Heritage Foundation, told CNSNews.com that Medicare Advantage has a record of success dating back well before Obama’s health-care plan and that Obamacare will actually damage the plan.
“Extensive research has shown that Medicare Advantage was achieving higher quality than fee-for-service well before passage and enactment of the Affordable Care Act,” Nix said. “Instead of protecting the successful program, the health law makes harmful cuts to Medicare Advantage plans.”
Nix said that according to Centers for Medicare and Medicaid Services, an estimated $145 billion will be cut from Medicare Advantage over the first decade of Obamacare alone. [That would NOT be good, as it is one of the few effective programs to reduce costs of care!]
“The effect will be higher premiums or fewer benefits for Advantage enrollees, forcing seniors back into the flawed traditional Medicare program,” Nix said.
Created in 2003
Medicare Advantage program was created in 2003 through the Medicare Modernization Act.
The law gives seniors and other recipients the choice of using Medicare-approved private health care plans as an alternative to Medicare fee-for-service plans. Nix said in the report that in 2010, close to 25 percent of the Medicare population was enrolled in Medicare Advantage.
WAIVERS
Massive number of exceptions and exemptions - a mess!
On January 26, 2011, HHS said it had to date granted a total of 733 waivers for 2011, covering 2.1 million people, or about 1% of the privately insured population.
IS THE GOVERNMENT CAPABLE OF MANAGING EFFECTIVELY AND DECIDING EFFECTIVELY?
One oxymoron is efficient government or government management. It is not capable. Why? Because the incentives and the expertise are not there.
COSTS
Healthcare “reform programs” that are similar to those promoted by ObamaCare do not save the government money or reduce healthcare costs, according to a new report by the Congressional Budget Office (CBO).
CBO: "Putting the federal budget on a sustainable path would almost certainly require a significant reduction in the growth of federal health spending relative to current law (including this year’s health legislation)."
After the bill was signed, AT&T, Caterpillar, Verizon, and John Deere issued financial reports showing large current charges against earnings, up to US$1 billion in the case of AT&T, attributing the additional expenses to tax changes in the new health care law.
As of the bill's passage into law, the Congressional Budget Office (CBO) estimated the legislation would reduce the deficit by $143 billion over the first decade, but half of that was due to expected premiums for the C.L.A.S.S. Act, which has since been abandoned
However, CBO was required to exclude from its initial estimates the effects of likely "doc fix" legislation that would increase Medicare payments by more than $200 billion from 2010 to 2019.
Fails to use ways of reducing costs, such as high deductibles, a tradeoff of
COST REDUCTION
Increasing meaningful healthcare competition.
Reforming liability insurance tort, using expert medical courts
Greater management techniques:
System as to when and how to use Physicians assistants
Technological analysis systems and remote (where possible) consultations
(This is where Romney's approach and use of business type specialists would make a huge difference!
This is part of the historic great effect of the era of "true management of government".)
THE INDIVIDUAL MANDATE OR COST-SHARING?
Even analysts who usually favor markets over regulation — like economist Gary Becker, legal scholar Richard Posner, Ron Bailey of Reason magazine, and Robert Moffit of the Heritage Foundation — have voiced support for the individual mandate. (See Individual Mandate and RomneyCare Great Conservative Accomplishment.)
Is Free Riding Really the Problem?
Supporters of the individual mandate rely heavily on the problem of uncompensated care. People who lack health insurance nevertheless receive health care in this country, because hospitals and health care providers are unable or unwilling to turn them away. When recipients don't pay for their care, the rest of us end up footing the bill one way or another. Individual-mandate advocates contend, plausibly enough, that we should make the free riders pay for themselves. [!!!!!!].
So how much uncompensated care is received by the uninsured? The same study puts the number at about $35 billion a year in 2001, or only 2.8 percent of total health care expenditures for that year. In other words, even if the individual mandate works exactly as planned, it will affect at best a mere 3 percent of health care expenditures. ($35 billion a year is about 1//2 of the additional taxes on those above $250,000 of income from dropping the Bush tax cuts.)
EMPLOYERS ARE RESPONSIBLE FOR HEALTH INSURANCE (?)
Firms employing 50 or more people but not offering health insurance will also pay a shared responsibility requirement if the government has had to subsidize an employee's health care. See ObamaCare Employer Mandate .
This is an item that Romney didn't want to see in the Massachusetts Health Care Law. He vetoed it but it was overriden by the 85% Democratic legislature.
This is a key item that has a very large effect on jobs and the economy (even on driving jobs overseas), while the individual required cost-sharing in lieu of free riding does not.
PRE-EXISTING CONDITION INSURANCE EXISTS IN ALL STATES
PPA : Guaranteed issue and partial community rating will require insurers to offer the same premium to all applicants of the same age and geographical location without regard to most pre-existing conditions (excluding tobacco use).[This would, since nothing is free, increase the premiums for all other people. This is the same as a tax which would be used to cover the extra cost of the pre-existing condition.
Medical costs for enrollees in the health-care law’s high-risk insurance pools are expected to more than double initial predictions, the Obama administration said Thursday in a report on the new program.
The health-care law set aside $5 billion for a Pre-Existing Condition Insurance Plan, meant to provide health insurance to those who had been declined coverage by private carriers. Since its launch last summer, nearly 50,000 Americans have enrolled in the program.
The PCIP program will phase out in 2014, when insurers will be required to accept all applicants regardless of their health-care status.
Those who have enrolled in the program are projected to have significantly higher medical costs than the government initially expected. Each participant is expected to average $28,994 in medical costs in 2012, according to the report, more than double what government-contracted actuaries predicted in November 2010. Then, the analysts expected that the program would cost $13,026 per enrollee.
UNFAIR SHARING OF COSTS
If people incure more costs and we are to have a personal responsibility society, we need to avoid the "equalizing" everything for everybody. (Amusingly, in the movie Mao's Last Dancer, they insist on equalizing everybody and evilizing those who are more well-off and insisting on conformity for all.)
If someone has a pre-existing condition, they would be responsible for more costs, though a limit might have to be done, so that others will end up paying for their benefits to some extent.
Making the costs equal by gender, when woman incur and have been charged higher costs than men, is an "equalizing" that doesn't reflect reality. Of course, we want to idealistically see everything as equal and benefit all, but it is unfair to take from others when it is not necessary.
REQUIRE INSURERS TO SPEND CERTAIN PERCENT ON ELIGIBLE EXPENSES
Insurers must spend a certain percent of premium dollars on eligible expenses, subject to various waivers and exemptions; if an insurer fails to meet this requirement, there is no penalty, but a rebate must be issued to the policy holder. [This is government dictating the internal operations of a private enterprise.]
Co-payments, co-insurance, and deductibles are to be eliminated for select health care insurance benefits considered to be part of an "essential benefits package" for Level A or Level B preventive care.
It would be beter if the government allowed competition in open competitive markets to determine rates.
Requiring the copayments etc. above is an imposition on free choice, but it might be reasonably required for the public good. However, that determination needs to be made in expert consultation and using fact-based reasoning!
REPLACEMENT PLAN
Repealing the plan and then replacing it over time might be a very poor strategey.
Instead, we need to preserve what is good and vital by doing a simultaneous repeal-and-replace legislation.
This would involve combining several House bills (tort reform, pre-existing conditions, children's coverage, insurance across state lines, various pooling options, etc.)
It is advisable not to leave the elements in there that are the "intrusive, Big Government, jobs-killing core of that law" Yes, it indisputably has an effect on jobs!!!! See ObamaCare Job Losses
TERMINALLY ILL
If you are terminally ill under ObamaCare, you and your family will be "encouraged" or even mandated by the government to put you in hospice so you can die there, without further treatment.
Federal Coordinating Council for Comparative Research (FCCCR)
which was given the task of defining at what point people will be denied medical procedures treatment, determined that when people are medically diagnosed as "terminal," it will no longer be cost-effective for Medicare and/or Obamacare to pay for treatment.
Obama believes that "government can… be an honest broker in assessing and evaluating treatment options."
[Give choice, but pay out of assets if there are any.]
PHYSICIANS SUPPLY
Obamacare is projected to insure 34 million more Americans by 2019. But by 2015, the nation will face a physician shortage of 63,000 doctors across all specialties, up from 39,600 before the law passed. The last thing the U.S. health care system needs is “reform” that encourages a reduction in its work force.
The disincentives for people to go into or stay in the physician "workforce" must be solved - as a key objective - as it is one of the problems that dog all key universal care countries.
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Only for those wanting to go into alot of detail:
PHYSICIANS
(To be narrowed down, excellent info, though)
Most U.S. physicians believe health reform will increase access to government insurance programs but not reduce costs. Long term impacts on the system include fewer uninsured, increased ER wait times, and a change in incentives to providers.
- Most are pessimistic about the future of medicine as a result of health reform and think would-be physicians will consider other options.
- Most physicians indicated an increased demand for physician services by newly insured consumers and the exit of physicians to administrative roles in health plans, hospitals, and other settings are likely as a result of health reform. Expanded scope of practice to mid-level service providers could reduce the quality of care provided to primary care patients.
- Physicians believe evidence-based medicine improves quality of care but achieving physician adherence difficult.
- Most physicians believe payment reforms (e.g., bundled payments, performance-based incentives) will reduce their incomes and increase their administrative costs for needed infrastructure and quality measurement.
- Most physicians support tort reform: opinions about two major options vary little (separate medical court system with binding arbitration and a victims' fund vs. caps on pain and suffering for non-economic damages).
- Many physicians consider a practice in a large integrated health system or concierge medicine practice a viable alternative to private practice.
- Overall, physicians are split as to whether health reform is a good start or a step in the wrong direction. More than half hope to retire before they have to change the way they practice today.
- Provisions of the Affordable Care Act of 2010 (ACA) that change the face of medicine, such as implementing comparative effectiveness research, are considered by practitioners to pose considerable implementation challenges.
Implications
- Physicians are not inclined to support changes in the health system that threaten their clinical autonomy and income potential, so policy-makers and industry leaders should consider addressing these issues directly.
- Physicians recognize that private practice is decreasingly a career choice/option for most due to increased administrative complexity and regulatory compliance. Therefore, they are likely to affiliate with a “trusted partner” that provides income security, administrative support, and clinical autonomy within reason.
- Physicians recognize the value of health information technology (HIT) in managing patient care but fear loss of autonomy and increased costs. Therefore, indirect costs for not implementing HIT in work flow should be a major emphasis of discussion/support as “meaningful use” is addressed.
- Increased demand for primary care, exit of physicians to administrative roles, and reduced quality of care from mid-level practitioners may compound physician workforce shortages.
- Evidence-based medicine is intellectually accepted as the “gold standard” by most physicians, but a concern to physicians if applied incorrectly. Policy-makers should consider a “tools, not rules” approach as evidence is applied to physicians’ credentialing, performance reviews, and public reporting of outcomes and safety.
Causes of costs
9 out of 10 physicians believe that consumers’ unhealthy lifestyles and defensive medicine have influenced overall health care costs
Significantly hospital costs are key driver of overall health care system costs,
- About half of all physicians agreed fraud in the system and overutilization of surgery have a lot or some influence on health care costs.
- Felt overutilization of surgery is a key driver of health care costs.
- Government regulation is a key driver of health care costs.
- Payment incentives that reward volume instead of performance contribute to high costs of health care.
- New technologies and equipment as well as prescription drugs are other key cost drivers,
8 out of 10 physicians believe that increased Medicaid and Medicare managed care programs and increased "wait times" are likely changes as a result of the health reform bill
- Anticipate increased government managed care programs for Medicare and Medicaid (85%) and increased “wait times” for primary care appointments due to lack of providers will be the most likely changes as a result of the ACA.
- Least likely outcomes due to health insurance reforms include reduced administrative paperwork required by insurance plans (23%) and reduced health insurance costs for consumers (27%).
- Two thirds of physicians (65%) believe decreased quality of care due to increased mid-level service providers to manage access is very or somewhat likely.
- One third of all physicians believe enhanced solvency of the Medicare program is very or somewhat likely.
- Few believe reduced administrative paperwork will be likely
Nearly three quarters of physicians believe there is a high likelihood ERs could be overwhelmed if PCP visit slots are full due to changes in the health care reform law (PCP = personal care physician)
Longer ER "wait times" are also a likely consequence of the health reform bill
- Half of respondents believe there will be decreased access to health care due to hospital closures resulting from health reform.
- 4 out of 10 physicians (41%) feel less efficient patient care delivery due to computerized medical record/documentation requirements is very or somewhat likely. ?????
- Only 33% of physicians feel health reform is likely to eliminate disparities in health care.
- Even fewer (27%) feel health reform is likely to reduce costs of health care by increasing efficiency of doctors and hospitals.
- Few believe implementing evidence-based medicine as a key determinant of appropriate care is likely,
- Significantly more physicians in practice for 31+ years (72%) believe it is likely incentives for doctors will change from volume to performance compared to physicians in practice for less than 31 years (55%, 48%, and 45%).
78% of physicians say they would be comfortable if the model for liability reform involved a separate medical court system with binding arbitration and victims’ fund caps for pain and suffering for non-economic damages
The best and brightest who might have considered medicine as a career will think otherwise as a result of health reform
The practice setting with the greatest financial success potential would be in an administrative role in a large health care delivery system; 64% believe a concierge medicine practice that does not take insurance would also be successful
9 out of 10 physicians fear the new payment systems mean receiving inadequate payments for new services or bundled payments and higher administrative costs to implement and comply with new payment systems
- Other key financial risks noted by physicians include being penalized for focusing efforts on aspects of quality which are not measured or rewarded, having insufficient capital to install new infrastructure or successfully manage financial risk and having payment based on problematic measures of quality or cost.
- Physicians indicate having performance standards set at unreasonably high levels is an important factor when considering whether to take on more financial risk.
- Fearful of having insufficient capital to install new infrastructure or successfully manage financial risk
- Non-surgical specialists are significantly more fearful of being penalized for having improved quality or reduced utilization prior to the establishment of baselines for rewards compared to PCPs.
- Surgical specialists are significantly more fearful of experiencing a reduction in revenues through fewer referrals or lower utilization of services
The transition toward evidence-based medicine as a national standard will improve the quality of care for patients
Comparative effectiveness research: achieving consensus among physicians will be a major challenge to implementation
- Gaining consensus among physicians will be a key challenge
- 7 out of 10 physicians believe that potential conflict between cost effectiveness and clinical effectiveness will also be one of the most difficult CER implementation factors.
- Ensuring methods of evaluating strength of evidence are objective is also an implementation factor that 55% of physicians feel will be difficult to implement;
- Physicians believe implementing CER will also be made difficult by conflict between cost effectiveness and clinical effectiveness
- Gaining consensus among physicians will be a key challenge
- 7 out of 10 physicians believe that potential conflict between cost effectiveness and clinical effectiveness will also be one of the most difficult CER implementation factors.
- Ensuring methods of evaluating strength of evidence are objective is also an implementation factor that 55% of physicians feel will be difficult to implement
accountable care ...
Most U.S. physicians believe health reform will increase access to government insurance programs but not reduce costs. Long term impacts on the system include fewer uninsured, increased ER wait times, and a change in incentives to providers.
- Most are pessimistic about the future of medicine as a result of health reform and think would-be physicians will consider other options.
- Most physicians, especially surgeons, think health reform will hurt their incomes.
- Most physicians indicated an increased demand for physician services by newly insured consumers and the exit of physicians to administrative roles in health plans, hospitals, and other settings are likely as a result of health reform. Expanded scope of practice to mid-level service providers could reduce the quality of care provided to primary care patients.
•Physicians believe evidence-based medicine improves quality of care but achieving physician adherence difficult.
Most physicians believe payment reforms (e.g., bundled payments, performance-based incentives) will reduce their incomes and increase their administrative costs for needed infrastructure and quality measurement.
•Most physicians support tort reform: opinions about two major options vary little (separate medical court system with binding arbitration and a victims' fund vs. caps on pain and suffering for non-economic damages).
•Many physicians consider a practice in a large integrated health system or concierge medicine practice a viable alternative to private practice.
•Overall, physicians are split as to whether health reform is a good start or a step in the wrong direction. More than half hope to retire before they have to change the way they practice today.
•Provisions of the Affordable Care Act of 2010 (ACA) that change the face of medicine, such as implementing comparative effectiveness research, are considered by practitioners to pose considerable implementation challenges.
Implications
•Physicians are not inclined to support changes in the health system that threaten their clinical autonomy and income potential, so policy-makers and industry leaders should consider addressing these issues directly.
•Physicians recognize that private practice is decreasingly a career choice/option for most due to increased administrative complexity and regulatory compliance. Therefore, they are likely to affiliate with a “trusted partner” that provides income security, administrative support, and clinical autonomy within reason.
•Physicians recognize the value of health information technology (HIT) in managing patient care but fear loss of autonomy and increased costs. Therefore, indirect costs for not implementing HIT in work flow should be a major emphasis of discussion/support as “meaningful use” is addressed.
•Increased demand for primary care, exit of physicians to administrative roles, and reduced quality of care from mid-level practitioners may compound physician workforce shortages.
•Evidence-based medicine is intellectually accepted as the “gold standard” by most physicians, but a concern to physicians if applied incorrectly. Policy-makers should consider a “tools, not rules” approach as evidence is applied to physicians’ credentialing, performance reviews, and public reporting of outcomes and safety.
9 out of 10 physicians believe that consumers’ unhealthy lifestyles and defensive medicine have influenced overall health care costs
Significantly more physicians in the northeast (97%) feel hospital costs are key driver of overall health care system costs, compared to those located in the midwest or west (85% and 81%, respectively). Physicians over 50 were also significantly more likely to agree with this compared to those 25-39 (94% vs. 80%).
•About half of all physicians agreed fraud in the system (56%) and overutilization of surgery (51%) have a lot or some influence on health care costs.
•Significantly fewer surgeons (37%) versus PCPs (62%) and non-surgical specialists (53%) felt overutilization of surgery is a key driver of health care costs.
•Significantly more surgeons versus non-surgical specialists (79% vs. 65%) felt that government regulation is a key driver of health care costs.
•2 out of 3 physicians feel payment incentives that reward volume instead of performance contribute to high costs of health care.
•New technologies and equipment as well as prescription drugs are other key cost drivers, according to nearly 9 out of 10 physicians.
8 out of 10 physicians believe that increased Medicaid and Medicare managed care programs and increased "wait times" are likely changes as a result of the health reform bill
Most physicians anticipate increased government managed care programs for Medicare and Medicaid (85%) and increased “wait times” for primary care appointments due to lack of providers (83%) will be the most likely changes as a result of the ACA.
•Around one quarter of physicians feel the least likely outcomes due to health insurance reforms include reduced administrative paperwork required by insurance plans (23%) and reduced health insurance costs for consumers (27%).
•Two thirds of physicians (65%) believe decreased quality of care due to increased mid-level service providers to manage access is very or somewhat likely; significantly more surgical specialists (76%) believe this to be a very or somewhat likely outcome compared to non-surgical specialists or PCPs.
•One third (33%) of all physicians believe enhanced solvency of the Medicare program is very or somewhat likely.
•Significantly less physicians in the south (12%) and midwest (13%) believe reduced administrative paperwork will be likely compared to physicians in the northeast (34%) and west (33%).
Nearly three quarters of physicians (73%) believe there is a high likelihood ERs could be overwhelmed if PCP visit slots are full due to changes in the health care reform law
Longer ER "wait times" are also a likely consequence of the health reform bill, as reported by nearly 7 of 10 physicians.
•Half of respondents believe there will be decreased access to health care due to hospital closures resulting from health reform. Significantly more surgical specialists believe this is very or somewhat likely compared to non-surgical specialists or PCPs.
•4 out of 10 physicians (41%) feel less efficient patient care delivery due to computerized medical record/documentation requirements is very or somewhat likely. ?????
•Only 33% of physicians feel health reform is likely to eliminate disparities in health care.
•Even fewer (27%) feel health reform is likely to reduce costs of health care by increasing efficiency of doctors and hospitals.
•Significantly fewer physicians aged 40-49 (44%) believe implementing evidence-based medicine as a key determinant of appropriate care is likely, compared to physicians younger than 40 (68%) and those aged 50-59 (66%) and 60+ (76%).
•Significantly more physicians in practice for 31+ years (72%) believe it is likely incentives for doctors will change from volume to performance compared to physicians in practice for less than 31 years (55%, 48%, and 45%).
78% of physicians say they would be comfortable if the model for liability reform involved a separate medical court system with binding arbitration and victims’ fund caps for pain and suffering for non-economic damages
the best and brightest who might have considered medicine as a career will think otherwise as a result of health reform
the practice setting with the greatest financial success potential would be in an administrative role in a large health care delivery system; 64% believe a concierge medicine practice that does not take insurance would also be successful
9 out of 10 physicians fear the new payment systems mean receiving inadequate payments for new services or bundled payments and higher administrative costs to implement and comply with new payment systems
•Other key financial risks noted by physicians include being penalized for focusing efforts on aspects of quality which are not measured or rewarded, having insufficient capital to install new infrastructure or successfully manage financial risk and having payment based on problematic measures of quality or cost.
•PCPs are more likely than non-surgical specialists to indicate having performance standards set at unreasonably high levels is an important factor when considering whether to take on more financial risk.
•Physicians in the south (87%) and west (90%) are significantly more fearful of having insufficient capital to install new infrastructure or successfully manage financial risk compared to physicians in the northeast (77%).
•Non-surgical specialists are significantly more fearful of being penalized for having improved quality or reduced utilization prior to the establishment of baselines for rewards compared to PCPs (84% vs. 73%).
•Surgical specialists are significantly more fearful of experiencing a reduction in revenues through fewer referrals or lower utilization of services compared to PCPs and non-surgical specialists (88% vs. 66% and 63%); physicians in the northeast (80%) and south (76%) are also more fearful of this compared to physicians in the midwest (61%).
the transition toward evidence-based medicine as a national standard will improve the quality of care for patients
Comparative effectiveness research: achieving consensus among physicians will be a major challenge to implementation
•Physicians aged 40-49 are significantly less likely to believe gaining consensus among physicians will be a key challenge, compared to all other physicians (58% vs. 74-77%).
•7 out of 10 physicians believe that potential conflict between cost effectiveness and clinical effectiveness will also be one of the most difficult CER implementation factors.
•Ensuring methods of evaluating strength of evidence are objective is also an implementation factor that 55% of physicians feel will be difficult to implement; physicians in practice for 11+ years are more likely to agree with this compared to those in practice for 10 years or less (61-65% vs. 42%).
Physicians believe implementing CER will also be made difficult by conflict between cost effectiveness and clinical effectiveness
gaining consensus among physicians will be a key challenge, compared to all other physicians (58% vs. 74-77%).
•7 out of 10 physicians believe that potential conflict between cost effectiveness and clinical effectiveness will also be one of the most difficult CER implementation factors.
•Ensuring methods of evaluating strength of evidence are objective is also an implementation factor that 55% of physicians feel will be difficult to implement; physicians in practice for 11+ years are more likely to agree with this compared to those in practice for 10 years or less (61-65% vs. 42%).
accountable care ...
Working copy :
