Cornerstones of effective health care reform

By Dr. Mark J. Tyler

We are at our best when we, as a nation, work for the common well being of everyone. We are at such a point now with reference to reforming our health care.

I believe everyone understands that changes have to be explored, debated and implemented. I do not believe that our health care is inadequate or bad. It is the delivery of that care that is far from perfect. I would offer points of view that may or may not be included in the final product from Congress.

The Patient Centered Medical Home should be one of the cornerstones of reform. This includes family physicians, pediatricians, internists and health care extenders. We are educators at our core. However, we have a generation plus who access the medical system episodically and repeatedly with no education forthcoming. This costs each of us when it happens.

The one-on-one relationship established over years serves and enriches both physician and patient. Trust is established that transcends illness and wellness. The better your doctor/provider knows you and your family, the easier it is to recognize and care for your needs.

You, as a consumer, are educated on what constitutes appropriate self care versus the need to be concerned and/or the need to be seen. The medical home can manage 90 plus percent of the health care issues that arise in the primary care setting. It is the most cost-effective way of health care delivery. The population is healthier, better informed, requires fewer office visits and probably minimizes medications.

Reform related to the compensation of our providers should also be addressed and corrected. We cannot continue to reward providers based on quantity, but must reward based on quality parameters. This revision, I believe, was still in the House version and thank yous go to Representatives. Dave Loebsack and Bruce Braley for their tireless input and work on this issue.

Iowa's providers continually rank in the top five states in the quality of medicine practiced by measurable benchmarks. However, we continue to be one of the lowest states, if not the lowest, with reference to Medicare reimbursement. This is not a sustainable model for the providers of Iowa with our high percentage of the population over 65. It is also reflected in the rates of our private insurance companies because they base their reimbursements to the physicians on a multiplier of the Medicare rates.

Tort reform must also be addressed and modified. Medical providers and hospitals practice in one of the most controlled environments as pertains to guidelines, rules, regulations and reimbursement. I cannot apologize for medical errors. They do occur and it is a devastating occurrence not only for the person involved but for the provider as well. Compensation should be immediate and appropriate. Hopefully, this would allow some predictability to our insurance carriers and possibly to the premiums paid by the provider. Defensive medicine is practiced every day and it only adds to the cost of your insurance premiums, deductibles, co-pays and out-of-pocket expenses.

Numerous tests and imaging studies are ordered on the minuscule chance that something may have been missed. This misuse of resources costs all of us and it should be changed.

Why must we rush to institute changes when the consequences and the costs involved are not fully exposed, debated and understood? Reform is needed, but as it stands now, it appears to be more autocratic than democratic.

The American people deserve better. We can demand for once to put the people of the United States first. Eliminate the deals, bribes and petty self interests and allow reform that is meaningful, sustainable and affordable.

Dr. Mark J. Tyler is medical director for the Cedar Rapids Physician Hospital Organization.