United States Sen. Sheldon Whitehouse, D-R.I., last week urged his colleagues during a speech on the Senate floor to act quickly to implement healthcare IT legislation, calling for more federal support of healthcare IT adoption, coupled with quality measure improvements and supportive reimbursement policies.
Whitehouse, in an interview with Health Imaging News, said that a significant healthcare cost problem exists with only two general ways of coping with it—either raise taxes or cut healthcare benefits to the population.
“We could wait until the wolf is really at the door and then take fiscal measures to protect the healthcare program’s financial health like raise taxes or cut healthcare benefits, which are unfortunate choices,” Whitehouse said. “But they are the choices that could be implemented rapidly if we don’t act responsibly now with a combination of a proper health IT platform, a real emphasis on the area of healthcare where quality improvement lowers cost and a realignment of our reimbursement system to create proper incentives and transform the system in a way that will save vast sums of money all the while providing better and safer care.”
When asked by Health Imaging News how payment incentives should be realigned to move health reform forward, Whitehouse said that the system was so broken that it was not easy to cite one specific reform that could solve the problem.
“With health IT, for instance, the risk-reward loop has been broken so that providers, who are expected to take on most of the investment risk in building a health IT infrastructure, find that very little of the reward of that investment comes back to them,” he said. “Most of it goes to the payors – the insurance companies, the government and other people – so people are behaving economically sensibly when they participate in a healthcare system that has been noted to have the worst IT infrastructure of any American industry, with the exception of the mining industry.”
Another part of the payment incentive equation, Whitehouse said, is that insurance companies do not expect to keep customers for very long, specifically not past the age of 65, when people become eligible for Medicare. “So they have very little incentive to invest in prevention strategies that will protect their customer’s health over the long haul because it is a money loser for them to invest their money now in preventing a disease that either some other insurance company or Uncle Sam will have to pay for,” Whitehouse said.
President George W. Bush’s recently released 2009 budget proposed unprecedented reductions in Medicare spending for non-physician providers, as well as shrinking payments for physician services in the fee-for-service program. If the proposed cuts are approved, Whitehouse said the group most at risk will be physicians and their patients.
“We have already seen doctors begin to flee the Medicare system as reimbursement levels are not enough to keep practices afloat, and there will come a point when that trickle of doctors becomes a flood,” Whitehouse said. “That is the risk.”
The senator said he has faced this battle before in Rhode Island for workers’ compensation reform. In that situation, he said, the insurance companies and actuaries that were hired to quantify the reform informed officials that if reimbursements to doctors providing worker's compensation were cut by 15 percent, the savings would be exponential.
“We knew that it did not seem right and instead established a workers' compensation medical advisory board to try to bring care within protocols set by the specialty groups themselves to control costs,” he said. “Since then, the rate of growth for workers’ compensation costs has been less than the rate of general medicine.”
“Regarding Medicare reimbursement, people will either dodge around it by disaggregating their billing or they will leave the system,” he said. “When you have a broken system, just putting less money into it is not the answer. Fixing the system so that is works properly for the money that is put into it, I think, is a better answer.”
Whitehouse added that since the healthcare system is more complex than workers’ compensation, it is going to take more effort to move forward with health reforms. “It is going to take more time for the system reforms to be agreed on, be installed,