Quality should incentivize healthcare reform

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CHICAGO—Cardiovascular healthcare professionals—who have helped achieve a 25 percent reduction in cardiovascular mortality in the past 10 years—are critical as leaders in the drive for healthcare quality excellence, according to Mark B. McClellan, MD, PhD, who delivered the 39th annual Louis F. Bishop Lecture at the American College of Cardiology (ACC) Scientific Sessions on Monday.

These achievements in mortality reduction have been accomplished through the diligent efforts of cardiovascular professionals developing novel educational efforts, new treatments, and employing cutting-edge diagnostic technologies in the battle against heart disease, he said.

McClellan, former commissioner of the FDA, former administrator of the Centers for Medicare and Medicaid Service (CMS) and currently director of the Engelberg Center for Healthcare Reform, asserted that quality had to come first in healthcare reform.

While at the FDA and CMS, McClellan developed and implemented major reforms in health policy, including the Medicare prescription drug benefit, the FDA’s Critical Path Initiative, and public-private initiatives to develop better information on the quality and cost of care.

Although medicine has seen an enormous number of clinical breakthroughs over the past quarter century, McClellan noted that a concern among the public is that the high cost of access to these new treatments may put them beyond the reach of the majority of patients.

“The public reaction to all this advancement is not optimism; it is concern, anxiety, and even anger,” he said. “Even if these better treatments keep coming along, they won’t be able to benefit because they won’t be able to afford it.”

The healthcare problem, McClellan noted, is getting tougher, not easier.

Healthcare policy reforms posed by U.S. presidential candidates from the Republican and Democratic parties offer some incremental steps in the right direction, he noted. However, the reality of healthcare policy is that there is no new money that will be available to be put into the healthcare system.

The U.S. is currently on the cusp (if not already in) a recession, the true costs of the Iraq and Afghanistan wars are beginning to be realized (which are significantly higher than forecast), and tax cuts enacted by the current administration will not expire until 2010. Combined, these factors curtail the amount of new funding that can be directed toward healthcare, McClellan observed.

In combination with this bleak outlook, physicians who implement quality care principles in their practice—which lead to healthier patients—are actually penalized for doing so.

“Many of you have focused on prevention, on better coordination of care, on keeping patients out of the hospital,” he said. “And what happens when you do that? Under the Medicare current payment system and virtually every major private insurance plan in this country, you lose money. They get the savings and you can’t make the investments in your practice to redesign it to deliver care more effectively.”

McClellan, along with the ACC and several other physician professional societies, advocate healthcare reform that rewards clinicians for delivering quality care. That is, an overhaul of the fee-for-service based payment structure that rewards healthcare professionals for providing preventative measures, using evidence-based care, and achieving efficiencies of service.

“The fundamentals are good for healthcare reform to move toward patient-centered care and a focus on value,” he said. “This is especially true if physicians can help hasten these efforts toward making payment systems what we really want—better quality, better prevention of complications, higher value services, and more cost-effectiveness and lower overall costs.”