Health Care Reform

National Legislation Stalls, But PA Keeps Moving

Comprehensive national health care reform seemed around the corner until the U.S. Senate lost its filibuster-proof 60-vote Democratic supermajority a few weeks ago. The future of reform changed overnight.

Nevertheless, the underlying issues behind reform--expanded coverage for the uninsured, making coverage more affordable, insurance reform, and improving health care delivery--remain as important as ever to hospitals and patients. Hospitals across Pennsylvania continue to lead the way, making progress and advocating for improvements, even though the enactment of a comprehensive national plan now looks uncertain. Hospitals also must continue to advocate for important areas of reform in the absence of a comprehensive plan.

Health Information Technology

Health information technology, such as electronic health records, can change the way providers capture, access, and report clinical information. These new capabilities could support transformations in the way health care is delivered and financed. Pennsylvania hospitals carved out a leadership position in the adoption of health information technology several years ago. Hospitals have begun important initiatives to implement electronic health records, computerized physician order-entry, the review of test results, and e-prescribing.

Paying for Results

Instead of paying for separate, individual health care procedures by multiple providers, Medicare and other payors could "bundle" payments, encouraging providers to integrate their services and work together to provide care. In Pennsylvania, many hospitals are exploring the creation of new delivery models that integrate services across the continuum of care, especially for chronic illnesses. The hospital community continues to support a reform provision that would create voluntary hospital pilot programs to explore the use of bundled reimbursements.

Research on Comparative Effectiveness

Hospitals and physicians have embraced evidence-based medicine. The use of clinical standards--protocols that have been proven by research to work--is a familiar concept. In addition, a national center to study the relative effectiveness of medical treatments has been established.

Filling the Physician Pipeline

The U.S. is expected to face a shortage of more than 125,000 physicians by 2025. With physicians spending eight or more years in training, we must start educating more doctors now. The hospital community continues to urge Congress to create more Medicare-supported training positions for residents. Unused residency positions should be redistributed to hospitals that can fill these slots. New positions should be added to expand training in primary care and needed specialties.

Expanding Coverage Through Medicaid

The hospital community strongly advocates for the extension of the temporary increase in the Federal Medical Assistance Percentage (FMAP) included in the American Recovery and Reinvestment Act. The funds were intended to be used by states to cover the cost of the growing number of low-income residents applying for Medicaid, due in part to the prolonged economic recession. Pennsylvania should use its increased FMAP dollars accordingly. State government should continue to provide access to needed health care for Medicaid patients while maintaining eligibility, benefits, and hospital payments at current levels.

Expanding Coverage Through Insurance Reforms

Changes should be made to the health insurance marketplace to help more people get and keep commercial coverage. The hospital community continues to support these reforms:

• No one should be denied coverage, or have their coverage taken away, because of their health status or pre-existing health condition.
• Insurers should not be able to put caps on the amount of health care services beneficiaries need and use or the costs incurred.
• Insurers should not be able to impose excessive waiting periods before enrollees receive their health care benefits.
• Limits for "premium rating bands" should be established. Premium rating bands determine how much insurers can increase premiums for people who are in poor health and discount premiums for people who are in excellent health.
• Clinical trials are essential for advances in medicine. Insurers should not be allowed to cancel coverage for patients that participate in clinical trials. Insurers should also be required to cover the routine care costs associated with clinical trials.

Your Role in Health Care Reform

Health care reform is complex, controversial, and crucial to the long-term health of Pennsylvania, the nation, our economy. Americans have the finest health care in the world, yet too many people lack access to that care when they need it. Health care costs are rising faster than inflation, accounting for more of our gross domestic product, and making American companies less competitive in the global marketplace. As part of the hospital family, you are in a unique position to understand and communicate the issues behind health care reform and the important work your hospital is already doing to improve the situation. Subscribe now to this newsletter to stay updated--and join the conversation.