1st Edition

Understanding Health Care Reform Bridging the Gap Between Myth and Reality

By Arthur M. Feldman, MD, PhD Copyright 2012
    222 Pages
    by Productivity Press

    After nearly a year of debate, in March 2010, Congress passed and the president signed the Patient Protection and Affordable Care Act to reform the U.S. health care system. The most significant social legislation since the civil rights legislation and the creation of Medicare and Medicaid, the bill’s passage has been met with great controversy. Political pundits, politicians, health care economists, and policy analysts have filled the airwaves and the lay press with their opinions, but little has been heard from those who have the most invested in health care delivery reform—patients and their doctors.

    Understanding Health Care Reform: Bridging the Gap Between Myth and Reality provides readers with the information to make informed decisions and to help counter the bias of political pundits and the influence of the for-profit health care industry. The author introduces readers to a group of dedicated doctors, administrators, and patients whose experiences illustrate the strengths and weaknesses of the health care reform legislation. He also shares his own experiences as both a physician and a patient. The book puts the health care reform legislation in perspective by exploring ten critical areas:

    • The private insurance industry
    • Medicare and Medicaid
    • The elimination of waste caused by overutilization, high administrative fees, and fraud
    • Disease prevention and wellness programs
    • Care for the underserved—the health care "safety net"
    • Quality of care
    • The impending workforce shortage
    • Comparative-effectiveness research to compare treatments
    • Changes in the way medicine is practiced
    • Tort reform

    Describing the reform act as the foundation and framing of a house, it outlines what doctors, patients, and families must focus on as states, the federal government, and the courts craft this legislation over time. The author cuts through the political rhetoric to address the core question: how do we preserve our ability to provide the best possible care for patients and fulfill our societal mission of providing care for our citizens independent of their financial means? Focusing on strengths and weaknesses, rather than what is right or wrong, he encourages readers to think creatively about their role in establishing a better system of health care in America.

    Introduction

    Reforming the Private Insurance Industry
    The Private Insurance Industry in the United States
    Reforming the Private Insurance Industry
    Flaws in the Patient Protection and Affordable Care Act
    Strengthening the Health Care Reform Legislation
    Notes

    How Will Health Care Reform Affect the Medicare and Medicaid Populations?
    About Medicare
    How Does the Health Care Reform Legislation Change Medicare and Medicaid?
    The Independence at Home Program
    Medical Homes
    Accountable Care Organizations
    The Extension Program Hub
    Community Health Centers
    Lowering Medicare and Medicaid Costs
    State Governments and Medicaid-Medicare Reform
    Lowering Health Care Costs through Health Care Reform

    Notes

    Can We Lower Health Care Costs by Eliminating Waste?
    Medical Waste and Economic Waste
    Cost-Benefit Analysis
    Controlling Medical and Economic Waste
    Medical Spending in the Last Days of Life
    The Patient Protection and Affordable Care Act and Waste
    Placing the Burden of Cost Control on the Patient
    Placing the Responsibility for Decreasing Waste on Hospitals
    Unintended Consequences of Attempts to Eliminate Waste
    Developing a Rational and National Strategy to Reduce Waste

    Notes

    The Role of Disease Prevention in Health Care Reform
    Prevention and Wellness Programs in the Patient Protection and Affordable Care Act
    Section 2705 of the Patient Protection and Affordable Care Act—Legislating Wellness!
    The U.S. Preventive Services Task Force: Another Potential Flaw in the Patient Protection and Affordable Care Act
    Prevention Doesn’t Lower Health Care Costs—It Might Actually Increase Them!
    Addressing the Epidemic of Obesity—And Health Care Reform
    Individuals Must Often Support the Costs of Prevention

    Steps to Ensure Prevention and Wellness
    Notes

    How Will Health Care Reform Affect the Medically Underserved and the Safety Net Hospitals That Care for Them?
    The Health Care Safety Net
    The History of Safety Net Hospitals
    Disproportionate-Share Hospital Payments
    Safety Net Hospitals Falter When DSH Funds Are Redirected to Pay for Health Insurance
    The Patient Protection and Affordable Care Act Threatens the Country’s Safety Net
    Pay-for-Performance Can Also Threaten Safety Net Hospitals

    The Health Care Exchange
    Will the Exchanges Work?
    Some States Are Ahead of the Curve—Others Behind It
    Health Care Reform in Massachusetts: A Template for Health Care Exchanges?
    How Can the Patient Protection and Affordable Care Act Be Modified to Protect the Safety Net?
    Notes

    How Can We Improve the Quality of Care in the United States?
    The Cost-Quality Conundrum
    The Dartmouth Atlas and Health Care Reform
    Measuring Quality of Care
    Measuring Quality of Care: The Health Care Reform Legislation
    Pay-for-Performance
    The Electronic Health Record
    Value-Based Purchasing
    Substantive Steps Taken by the Patient Protection and Affordable Care Act
    What Additional Steps Should Congress Take to Ensure Quality of Care?
    Notes

    Will There Be Enough Doctors to Care for 35 Million New Patients?
    How Does the Patient Protection and Affordable Care Act Address the Workforce Crisis?
    The 1997 Balanced Budget Act and the Health Care Workforce Crisis
    The Changing Demographics of the Physician Workforce
    The Workforce Crisis Is Not in Primary Care Alone
    Lessons from Massachusetts
    How Have We Approached the Need to Increase the Number of Practicing Physicians in the United States?
    Danger around the Corner
    What Should We Do to Increase the Size of the Health Care Workforce?
    Notes

    Can Research Guide Us to Improved Care at Lower Costs?
    Why Comparative-Effectiveness Research Has Become a Lightning Rod in the Health Care Debates
    The Patient Protection and Affordable Care Act and Comparative-Effectiveness Research
    The Potential Value of Comparative-Effectiveness Research
    Can Comparative-Effectiveness Research Lower Costs?
    Limitations of Comparative-Effectiveness Studies
    Using Comparative-Effectiveness Research
    Notes

    How Will Health Care Reform Change the Way We Practice Medicine?
    Physician Compensation
    The Sustainable Growth Rate
    How Did the Patient Protection and Affordable Care Act Change the Way Doctors Are Paid?
    Pay-for-Performance
    Payment Bundling
    Global Payment
    Electronic Health Records
    Multispecialty Group Practices
    The Independent Payment Advisory Board

    How Can the Patient Protection and Affordable Care Act Be Improved?
    Notes

    Will We Ever See Tort Reform in the United States?
    The Current Tort System
    Malpractice Caps
    The Patient Protection and Affordable Care Act Failed to Address Tort Reform
    Medical Malpractice—A Silent Disease
    Employment Law and the Health Professions
    It Is Not Too Late—Novel Strategies for Reforming Our Tort System
    Notes

    Conclusion
    Surviving Health Care Reform
    Notes

    Index

    Biography

    Arthur M. Feldman, MD, PhD, is the Executive Dean at the Temple University School of Medicine.