Market Medicine NOT ObamaCare

No Need For ObamaCare If Providers Are Liberated

By CHARLES J. WILLEY
Posted 06/13/2012

We continue to read with dismay about the adverse effects of ObamaCare ... the crafty way it was passed, the 2,700-page bill no one read, the "Cornhusker Kickback" and other secret deals, the hidden regulation and costs. Now our fears about the bill are reality.

The Department of Health and Human Services has generated thousands of more pages of regulation. Even the government admits ObamaCare will cost at least twice its estimates and will increase health care costs by $2,000 annually per family. Many will not keep their current insurance and doctors.

Practicing doctors, who know best how to care for patients most cost effectively, are still today left out of the health care debate . .. a small voice among powerful lobbyists, politicians and regulators. Doctors are particularly skeptical about ObamaCare: 90% say premiums will go up; 70% say it will drive the best and brightest out of the profession; 65% say quality of care for their patients will decline. I am one of those doctors who fears for my patients' future care.

Real health care reform is possible and necessary. But it won't come from government regulation dictating methods of practice and health insurance purchase requirements. Over-reaching regulation depersonalizes patients and dissociates them from its demoralized doctors, favors hospitals that can manipulate the system, guarantees profit for giant insurance companies without regard to health outcome, and disenfranchises patients from authority over, and responsibility for, their own health and its costs.

Real health care reform comes from eliminating the misguided rules and incentives created by government and other interlopers into the patient-doctor covenant.

The high cost and limited access in our current system is caused by government. Here are a few examples:

Medicare currently pays hospitals two to four times more than a nonhospital vendor for the exact same stress test or MRI.

Government bans physician-owned specialty hospitals, such as orthopedic surgery centers, forever relegating joint replacement to be performed in the same high-cost operating suites as those used for cases involving puss, risking devastating prosthesis infection.

Doctors and nurses spend more time on regulatory paperwork than patient care. There is no patient-centered rationale for this regulation. In fact, these policies deny choices, diminish care, and increase costs.

The effect on my profession has been catastrophic. Doctors now need to function like lawyers if they care for Medicare patients, complying with thousands of regulations that no one understands, under threat of criminal penalties.

Many run for cover to hospital employment, whose expertise has sadly evolved to managing regulation to advantage every next government incentive. The results: soaring costs while individualized patient care suffers.

Real health care reform should encourage practice models (and their coordinated financing plans) that combine clinical and economic responsibility with our long-term patient relationship. We know this practice model works.

For 30 years, I've led physician groups who care for populations of seniors — with higher than average illness burden — at much lower than average total cost of care, with better outcomes.

I presently care for a regular Medicare population with quality rankings above 90% on six of seven measures. For an 11% higher illness burden, my total cost of care is 72% lower than average (CMS Quality and Resource Use Report, March 2, 2012).

I also provide superior care for 1,000 Medicare Advantage members, whose illness burden, quality and satisfaction scores are even higher, under a richer benefit plan than Medicare, at a cost of care which is 50% less than average.

If all Medicare beneficiaries were cared for under this model, Medicare could be administered for $290 billion annually instead of its current $580 billion, saving $2.9 trillion in 10 years, without any cuts, serving healthier, happier seniors.

Our practice model lowers cost by achieving lasting population health that finances a rich benefit plan so patients can afford recommended care, resulting in high patient satisfaction. We intervene early and often, minimizing the misery and costs of catastrophic illness.

We transfer a manageable portion of the risk for cost-of-care to the patients in the form of copayments, creating a meaningful short-term economic incentive to be healthy and respect their fiduciary duty to the health risk transfer pool.

We schedule fewer patients for longer well-placed visits, treat more patient situations ourselves, and work closely to lead specialists and hospitals to high quality, efficient care of patients. We use information technology to anticipate population care needs, rather than waiting for patients to become sick, avoiding the 'systems failure' of an emergency room visit.

We aggressively promote wellness through leadership and coaching, even paying YMCA membership fees helping seniors exercise and socialize. Many other medical groups use this model with similar quality, access, and low cost.

We don't need to reduce quality and access to care or create a massive government-mandated system to improve our health care. These do not benefit patient care, access, or cost. Medical groups know that we just need an environment that is free of ObamaCare and liberated from the pre-ObamaCare regulations that exist only to protect well-entrenched fiefdoms currently controlling health care.

Historically, we know that free markets provide free societies with competitive pricing, improved access for all, and greater innovation. They can do the same for health care. Restoring free markets with the advantages of information technology can redefine the existing strained patient-doctor covenant for the best result: high quality, low cost, long-term health for all.

The new scrutiny of the patient (the customer) armed with the bright light of information technology will greatly diminish the need for government regulation. We must liberate health care providers to innovate, compete and be rewarded not only on quality care for patients, but also on their performance and costs in achieving long-term population health.

Doing so will improve long-term citizen health and access to care, and reverse rising health care costs. The solution hides in strategically reducing government's role in health care.

This modest model solution already exists; it just needs room to breathe.

• Willey, an internist, is the founding CEO of several medical groups and a Medicare Advantage health plan, currently practicing with six physicians and five nurse practitioners as Innovare Health Advocates in St. Louis.