Physicians can lead health care reform through payment and delivery system reforms

May 20, 2009

Physicians can and should play a leading role in achieving health care reform by working towards comprehensive reform of the way health care is paid for and delivered, helping achieve a guaranteed 1.5 percent annual savings in health care costs that would pay for covering all Americans, according to a New England Journal of Medicine Perspective piece published online today.

In "Achieving Reform—How Physicians Can Help," co-authors Elliott Fisher, M.D. M.P.H. professor at the Dartmouth Institute for Health Policy and Clinical Practice, Donald M. Berwick, M.D., M.P.P. president and CEO of the Institute for Healthcare Improvement, and Karen Davis, president of The Commonwealth Fund say that achieving savings that are sufficient to cover everyone is possible, and "need not impose a hardship on patients or providers."

Slowing the growth of health care costs by 1.5 percentage points annually would allow spending—including total provider income—to rise from $2.6 trillion in 2010 to $4.3 trillion in 2020, while saving the health care system $3.1 trillion of the estimated $40 trillion the U.S. is projected to spend in that 11-year period.

The authors say that to achieve real reform, voluntary efforts to achieve savings may not be enough, and legislation may be needed that will allow the federal government to reduce updates in Medicare fees if the 1.5 percent annual savings target is exceeded. Further, the savings should be linked both to health insurance coverage for all and comprehensive reform of the health care delivery and payment systems.

The authors cite reforms physicians could champion to eliminate waste and avoidable complications, such as integrated systems of care, innovative payment models including shared savings, bundled payments, or global fees for primary, acute, or comprehensive care, and performance measures that promote care coordination.

"U.S. physicians are leaders in providing excellent medical care, and can also be leaders in the effort to achieve a U.S. health system that is also excellent," said Commonwealth Fund President Karen Davis. "A high performing U.S. health system is what all physicians and patients need and deserve for the future health and economic security of our nation.

The authors conclude that "physicians can become our most credible and effective leaders of progress toward a new world of coordinated, sensible, outcome-oriented care in which they and their communities will be far better off. Defending the status quo is a bankrupt plan for the United States, and physicians have an opportunity to help us all see beyond it."

"This is a clarion call to U.S. to seize this once-in-a lifetime opportunity to achieve health care reform that deserves the name reform," said Dr. Elliott Fisher. "Physician leadership can be the key to ensuring success. Let's not miss this chance."

Source: Commonwealth Fund (news : web)

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Nan2
not rated yet May 27, 2009
On the clinical side physicians must play a role for the massive reform necessary in this nation. However, without reforms in the business of medicine those changes on the clinical level won't be adequate. Metering of care, modeling of care will not solve the problem.

Structural changes in insurance, pharmaceuticals, medical devices/supplies, etc. must also undergo massive reform or to state it more simply: Reform in business/investment/funding/R&D. Double digit inflation in these areas year over year for over 10 years have produced the lions share of increased costs in health care. Returning to a patient centric paradigm vs profit centric in mandatory in reforming the system. Business models of the last 20 years failed, private interests won out over public interest which is the root of failures.