MMA Viewpoint
Cutting Costs Must Not Harm Patients
Last year, the Minnesota Legislature enacted legislation to reform health care in the state by changing the way it is paid for and delivered, expanding insurance coverage to those who don’t have it, and promoting public health initiatives aimed at reducing the incidence of costly, lifestyle-related illnesses. Now, the push for reform has moved to the national stage, as the Obama administration and Congress are promoting sweeping changes designed to make health care more efficient, effective, and available to all. Some of the reforms being proposed will be evolutionary and some revolutionary, but all of them will change how you and I practice.
Reforms such as requiring hospitals and clinics to move from paper-based to electronic medical record systems, medical homes, and rewarding quality are good ones. Not only will they save the system money, they’ll also lead to better care for our patients. These ideas are consistent with what the MMA has proposed over the years and the direction Minnesota is heading. However, other reforms focused solely on achieving short-term savings are concerning. For example, efforts to establish a so-called “public option” could be devastating for Minnesota if it results in the federal government offering an insurance option that is based on the payment structure Medicare uses. The cost-shifting caused by the underfunding of Medicare and Medicaid is one of the main culprits of rapidly rising health care costs. If a public option isn’t adequately funded, hospitals and clinics would be forced to cost-shift even more to private insurance causing health costs to rise even faster.
Of course, health care costs are a grave concern. But I am worried that reforms that focus only on cutting spending leave the patient as the odd man out. Not only that, I’m concerned that many of the approaches, policies, and programs that help patients most and save money in the long-run might be discounted by politicians because they will initially increase costs. Having practices operate as medical homes is one example of a reform strategy that requires an upfront investment in resources but will ultimately result in better care and lower costs for patients with chronic health issues. Moving toward electronic health record systems is another. And many public health initiatives require spending money to achieve savings in the future.
Patients are the ones who will experience the outcomes—good or bad—of any reform initiative. If reform results in decisions that are scripted by politicians and policymakers and not by physicians and patients working together, we may get a system that weakens rather than strengthens the physician-patient relationship. That is not what we need in health care. The success of a reform strategy such as the medical home requires that physicians be encouraged and have incentives to understand the needs of their patients in order to prevent health problems or detect them early when there’s the best potential for a good outcome.
Keeping patients as our central focus has been my aim during my tenure as chair of the board of the MMA for the last four years. I will continue to work toward that goal as a trustee and as a physician interested in the health care reform movement. I will not be silent about patients. They are the reason I became a physician and continue to practice medicine.