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MCOMBER: Obviously we’re concerned about the healthcare reform. There are a lot of unknowns. We’ve been participating on the state side with the Medicaid reform, and we’re waiting to see where that’s going to go.
One of the things that concerns us is that they say physicians are going to be responsible for outcomes. We’re on board with that as long as some of the savings that are supposedly going to happen from these efforts will come back to the physicians, at least in part, because the reality is—and particularly in the Medicaid side of things—physicians’ reimbursement rates are very low.
We support the medical home concept and some of the other things that are happening. As to the medical home, it all depends on how you implement it, because if you don’t implement medical home correctly, you could actually increase cost. If medical home becomes a gatekeeper in that patients have to go to a family practitioner or somebody else to get to a specialist, you’re going to increase costs.
The appropriate way to look at medical homes is to say, “How can our primary care practitioners treat and manage diseases effectively? How can they help patients manage them?”
We absolutely believe the rates and the growth in healthcare are not sustainable. Physicians should lead where we go with care. They’re the ones who are actually treating patients; they’re the providers and they need to be out in front of reform.
One of the things that we’re looking at is the different specialties and their best practices. We don’t call them best practices—we would say practice protocols. Some specialties have a lot of different protocols that they can follow and some don’t, so that’s something that all of our specialties need to step up to and work on.
Along with that, we have to have tort reform. If we’re following best practices, if we’re doing certain protocols, then we ought to have a certain level of protection. The number one thing that physicians are sued for in Utah is failure to diagnose. Well, if that’s the case, you’re going to do more tests. So tort reform needs to be included in healthcare reform.
And patients need to have incentives for their piece of healthcare—healthy living. One of the biggest problems we have in Utah and across the country is obesity, and much of that is caused by choices. Not all of it. But patients need to step up to also decrease cost.
HASBROUCK: I’ve been impressed with the physician community over the last several years; in Utah they really are stepping up to want to engage in change.
The shorthand that we’re using is changing payment to pay for value rather than volume. And in order to demonstrate value, that requires good information. So a piece of that is investing in equipment and processes that produce the information, liked electronic health records. Part of our business with HealthInsight is to work with the federal government in promoting meaningful use of computerized medical records. We’ve actually exceeded our goal in terms of recruitment of primary care in the state.
In some states, docs have been resistant, and the progress towards meaningful use hasn’t happened. So I see that as a positive sign for our community.
The Health Information Exchange is important in terms of decreasing duplication and error and improving quality. That information exchange is a cross-entity exercise that the medical community has embraced and supported. Some of those investment dollars are from the federal government and will be going away. If we don’t change the payment systems, those investments will collapse—if you’re just being paid for volume, you can’t sustain those systems in your practices.
So the time is right for a shift from volume to value in terms of payment. And what the steps are to get there, you know, the devil is in the details, as Dean said. But I support Michelle’s view that physicians are invested and engaged in doing this. They’re members of this community. They want to be a part of adding value to the community.
CARBONE: I had a private practice called The Eye Doctor, a provider of services for a quarter century. But I saw there was something that wasn’t getting addressed, so I closed my practice and started a nonprofit that will give Medicaid patients and basically the uninsured, underserved, vision care.
You said that the physicians need to step up, but I think most physicians don’t because they feel they’re being regularly told what to do. And so there’s an issue there that needs to be addressed.
In the past seven years there has been an increase of 70 percent in usage. And fewer and fewer medical students are enrolling. So what’s going to happen with that? That’s going to be a huge problem if usage is going up and there are less providers.