Some promise but no cost solutions

By Tim Charles

Like every president since Teddy Roosevelt, President Barack Obama has set his sights on accessible, affordable and effective health care for all. Elements of the federal health care reform legislation passed into law suggest a promising turn in a right direction.

Those include removing immediately pre-existing limitations for children under age 19 and for all by 2014, adopting uniform standards/rules for electronic exchange of health information for health plans, emphasizing the medical home and chronic disease prevention and management models.

However, I am compelled to assess the consequences of this legislation both as a provider and as an employer of 2,700 individuals.

Within hours after the legislation passed, I attended a sobering assessment by Dr. John Kitzhaber, one of the pioneers of state-initiated health care reform. He asserted this legislation provides little reform. Rather, it simply buttresses a broken financial system for a few more years at a staggering cost, with a flawed methodology that doesn't address the drivers of the unrelenting escalation of health care costs. I share his concern.

As a provider in Iowa, I was disappointed the geographic disparity in Medicare reimbursement for services was not eliminated, as a significant assumption in paying for this reform rests in steady reductions in provider reimbursements (Iowa ranks among the lowest in the nation). For years, this has resulted in cost shifting to the privately insured.

As costs continue to rise, it is expected Medicaid's covered population will expand by about 50 percent. This may address the access issue, but it ignores the fact that Medicaid simply doesn't cover the cost of care. This presents a challenge for Iowa to recruit and retain top-quality physicians.

The migration to Medicaid coupled with Medicare reimbursement reductions, and the probable exit of some employers from offering insurance, rather opting to accept penalties, simply will place a greater burden on those paying premiums. Premiums likely will continue to rise.

So what do we do?

Cedar Rapids is a unique community that has cultivated an extraordinary medical delivery system. We have sown the seeds of a model approach to creating homegrown reform. Our commitment to nationally ranked quality, innovation and collaboration among physicians and hospitals offers a secure foundation.

Competition has worked to elevate services, technology and facilities that are uncommon for a community of this size. Dr. Donald Berwick's recognition of this uniqueness through the Institute for Healthcare Improvement is the penultimate verification. His and the institute's “triple aim” of meeting patient expectations, reducing the cost of care and improving the health of the population we serve remains our beacon. But, he also cautioned that we “might lose our way.”

Despite these concerns, I feel optimistic about our future if the following occurs:

l A health policy and planning forum immediately begins to define the architecture of the health delivery system desired by the large and small employers alike, recognizing that the health care delivery system of our community has been built with their sustained investment. Customers' direct involvement in shaping our system is value-added and imperative.

l This forum must address and reach consensus on a communitywide approach to recruitment and retention of high-caliber practitioners.

l Development of regional, collaborative relationships that leverage an estimated $100 million investment over the next 10 years for health information technology, eliminating fragmentation of data and duplication of tests, improving emergency care and fostering personal health management.

While we continue to increase our understanding of the recently enacted legislation, we must act locally to make certain we have the very best, most capable advocates in Des Moines and Washington to ensure the needs of Cedar Rapids are well served.

Tim Charles is CEO/president of Mercy Medical Center in Cedar Rapids. Comments: TCharles@mercycare.org