Page 10 - Deleware Medical Journal - September/October 2019

PRESIDENT’S PAGE
Medicare rolls, the number of people without the ability to pay for Medicare supplements will only increase. Having true transparency in medical pricing
is necessary to protect this financially fragile population. This will allow smarter consumer decisions.
In August 2017, USA Today compared costs for hospital-based MRIs and freestanding MRIs by state. They found that the difference was in the thousands. Alaska was highest at $3,200 differential and Michigan was close behind at $2,500.
In late June, President Trump signed an executive order giving the Department of Health and Human Services 60 days to write the hospital requirements
on publishing “standard charge information.” Hopefully consumers
of health care and ERISA employers contracting for health insurance will be able to compare the cost of care in an independent physician’s office to the cost in a hospital-based practice. Then, the empowered consumer can choose the low-cost, high-quality provider.
It is interesting that the major lobbying groups for hospitals and insurers (American Hospital Association, Blue Cross Blue Shield Association, and America’s Health Insurance Plans)
are all against price transparency and educating consumers. They seem to agree that consumer ignorance is bliss for hospital systems and insurers.
Bundled payments to hospitals were held out as another way to increase efficiency and lower cost. For example: a hospital system will receive an annual lump sum to perform all of
the hip replacements on a specific population. This is a form of direct contracting. Typical payors would include national employers managing their employees’ health care and
state governments managing their employees. The patient is examined by a local physician. The local physician feels that the patient needs a hip replacement. The patient is transported to the institution contracted to do the hip replacement and costs are increased by travel expenses — hotels, airline tickets, and restaurants. Then the surgeon at the tertiary care facility examines the patient and states that they do not yet need a hip replacement and instead suggests three more steroid injections at three-month intervals.
A bundled payment option will
in effect cap the number of hip replacements in a year. The surgeon knows that the annual bundled payments will only cover a certain number of hip replacements. For the hospital system to maximize financial return on the contract, they have to ration care. By ordering the steroid injections, the surgeon is trying to postpone the patient’s surgery into the next year’s bundled payment.
The fight by the Centers for Medicare
and Medicaid Services (CMS) to get rid of fee for service and instead pay for value has been a failed experiment. This process drives up administrative costs and has never been shown
to decrease mortality. By forcing MACRA and MIPS on doctors, whole new industries have grown to assist in MIPS and MACRA data collection and the reporting of that data to CMS. In 2017, Modern Healthcare reported that CMS estimated the cost of MACRA compliance at $1.3 billion. Given
the impotence of electronic medical records and the tremendous cost charged by vendors for EMR upgrades, the CMS cost estimate is obviously low.
The high-quality, low-cost care
has always been in the hands of independent physicians. The high-quality, high-cost care is the bailiwick of the too-big-to-fail hospital systems that wield their clout over insurers, patients, and independent physicians.
Thank you for your continued support of the Medical Society of Delaware
as we work to support the needs of all Delaware physicians.
Andrew W. Dahlke, MD
President, Medical Society of Delaware
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Del Med J | September/October 2019 | Vol. 91 | No. 5