Thursday, July 23, 2009


Last evening I watched the whitehouse news conference, during which President Obama outlined his 'vision" for healthcare in America.  Unfortunately his speech had little specifics other than how wonderful life would be with his reform measures.

As in most political campaigns the message was what would happen if we did not adopt these changes. Surely the sky would fall. It sounds a bit like "Chicken Little".

The message from Congress is becoming quite clear. SLOW DOWN!

Providers, both in small practices and in large integrated health care organizations, such as the Mayo Clinic have exposed some basic flaws in reform measures being considered in Congress.

This from the WSJ Health Blog:

Mayo Clinic CEO: Medicare Payment Model Is a ‘Catastrophe’

Mayo Clinic, along with 18 other health care organizations around the country, sent an open letter to Congress on July 22.

Posted by Jacob Goldstein

Health ReformDenis Cortese, the doc who runs the Mayo Clinic, swung by the Health Blog’s office today to talk health reform. His bottom line, which he’s been repeating in public in the past few days: The big health-care bill unveiled last week in the House of Representatives misses a key opportunity to change the way Medicare pays for health care.

What’s more, Cortese argued, adding a new public plan that covers more people and pays for care the same way as Medicare won’t work, because the rapid rise in health costs will …continue. “A Medicare model is a catastrophe,” he said.

The basic argument Cortese and the Mayo Health Policy Center have been making for a while now is a variation on a familiar theme: Doctors and hospitals should be paid on the based value they provide rather than simply paid a fee for every procedure they do. Those who have better outcomes with less risk and fewer costs to the system should be rewarded.

Yes, it’s tough to value care for some conditions, but there are others where there are solid, risk-adjusted measures to evaluate patient outcomes. And Medicare could go a long way by starting with a few common conditions, such as diabetes and heart disease, Cortese said.

“Why don’t we give instructions to the Health and Human Services Secretary to start value-based purchasing right now in Medicare?” he said.

The message is clear: We must fix medicare first.  Any reform is doomed to fail based upon the flaws in medicare payment methodology.  Who  regulates medicare?  Congress supposedly does with advice from a number of groups, some  physician groups and many others such as AHRQ.   If medicare is any indication of how well Congress makes decisions. ?????

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