The Senate Health, Education, Labor and Pensions (HELP) Committee on Thursday held a hearing titled “Delivery Reform: The Roles of Primary and Specialty Care in Innovative New Delivery Models.” Along with the Finance Committee, HELP has held multiple hearings on related topics and is moving toward crafting comprehensive health reform legislation.
The following summary of the hearing was provided to ASA by Health Policy Source:
Senator Sherrod Brown (D-OH), who chaired the hearing, noted that the current U.S. healthcare system has been faulted for lacking coordination of care and cost-effectiveness. While concepts like the patient-centered medical home have been suggested, Brown noted that there are design and implementation challenges, and that some have questioned whether the model will increase spending in some cases, as well as whether a primary care physician is the best provider for all patients. For example, he said, women often consider their ob/gyn to be their primary doctor.
Witnesses offered a number of recommendations. Ken Thorpe, a professor of health policy at Emory University, said prevention and care coordination must be built into fee-for-service Medicare to drive change throughout the healthcare system. Thorpe said there is good data on how to do care coordination well from integrated systems such as Intermountain Healthcare and Geisinger. But he said the critical issue is how to transform care at predominantly small physician practices. To fill the gap, he said, the U.S. should fund community health teams. The concept has worked at the state level, Thorpe said, and would generate savings while improving outcomes if implemented nationally.
Dr. Steven Schlossberg, a urologist who testified on behalf of the Alliance of Specialty Medicine, urged the Committee to test the medical home model before using it widely. Schlossberg said he’s concerned that medical homes would exclude specialists, who he said are better at diagnosing and managing some chronic or complex conditions. He said reform should not limit access to medical specialists and also called for reform of the Medicare Sustainable Growth Rate formula, which he said is flawed and distorts commercial reimbursement rates.
Dr. Michael Nachomovitz, an executive with University Hospitals in Cleveland, Ohio, said physicians need simpler safe harbor rules protecting them from fraud and abuse allegations in order to encourage models like accountable care organizations (ACOs). Nachomovitz also said medical students are avoiding primary care because of malpractice costs, poor reimbursement and the high cost of a medical education. Dr. Michael Cooper, a professor at University of Pennsylvania, focused on the role of training in addressing the current physician shortage, which he said will complicate implementation of health reform. Although physicians are increasingly using physician assistants and nurse practitioners to reduce their workload, Cooper said Congress needs to lift caps on graduate medical education within Medicare to allow more residency slots. In general, Cooper said, Congress should resist building a new delivery system but enable innovative approaches to develop.
Finally, Dr. Marsha Raulerson, a pediatrician from rural Alabama, said doctors like her routinely coordinate care with schools and medical specialists and counsel parents without being reimbursed for it. Raulerson said her practice was losing money, forcing her to lay off an office assistant and take a pay cut herself before she was able to qualify as a rural health clinic in July 2007. Raulerson said 70% of patients in her practice are covered by Medicaid and another 5% by SCHIP. Those who get insurance frequently are on and off Medicaid, she said, while others outgrow SCHIP at age 19 and can’t afford coverage through their jobs.View an archived webcast of the hearing here