This post was authored by Douglas Weaver, MD, MACC, past president of the ACC.

This year has been a painful one for healthcare providers due to the continued atmosphere of uncertainty.  Many of us began this year working on initiatives that deal with some of the changes attendant with the Affordable Care Act – e.g. reduce unnecessary admissions and change them to observation status, decrease readmissions for patients with a recent MI or for heart failure, and putting together means to provide better continuity of care.  Before the election, it was impossible to fully engage given the polarizing rhetoric between parties.  At the present time our payment policies don’t reward either physicians or hospitals for reducing readmissions, and rather we take a hit.

However, even after the election, it still isn’t better. We are in an environment with continued partisan bickering about the legislation, lack of agreement on a common approach to sequestration, the tax cuts, unemployment benefit extension, reducing the deficit, how to pay for the SGR (and possibly with further Medicaid cuts, reduced NIH funding, loss of facility based E and M dollars, IME reductions).

After studying the issues and listening to the pundits, I have come to the following conclusions: first, our national debt is a major problem and one that needs to be fixed.  If you include the “promised entitlements” of Medicare and Social Security, it is close to 86 trillion dollars — and this number would require collecting 8 trillion dollars a year in taxes to just keep it from going higher. Congress can’t agree on ways to get a few hundred billion to balance the budget for the coming year. The total earnings of all of us filing tax returns is a little over 5 trillion dollars a year — and that is earnings not the taxes you and I currently pay.  Conclusion: we have to curb entitlements no matter what happens to taxes.

Second, people are spending less on healthcare. Visits are down, admissions are down—the cost curve has been bent already. If you count up the 50 million people in our country with no insurance, add 40 million who do, but who can’t pay their deductibles or co-pays, and the almost 55 million on Medicaid—this says that half the people in our country can’t afford our healthcare.  Conclusion: it is not about healthcare inflationary costs (these are now fixed), it is about the absolute cost.  Cost of healthcare in the U.S. is 1.5 to 2 times more expensive than elsewhere.  With peoples’ individual contributions increasing for care, they are voting with their feet and avoiding, when possible, doctor visits and procedures.

Lastly, there are some basic problems with the way we are approaching enacting “change.”  If all of our patients are going to pay more now for coverage and we are going to move to pay for quality, our patients should be getting something for this right up front—not years down the road.  Second, don’t harness the providers to the plain vanilla PQRS quality reporting measures and 18 month old administrative data to track performance. Instead, let specialty societies like the ACC, who can focus initiatives in areas where its members determine deserve improvement, and support these organizations to provide feedback and tools for improvement to their constituencies, instead of funding a larger, but less relevant reporting now done by the insurers.

We are adaptable—we can move more quickly and deliver more, but not at our own expense. We can however do so with a promised reduction in the overall cost of care and with equal or higher satisfaction from our patients.

< Back to Listings