Friday, March 12, 2010

Professionals serving health industry sound off on health care reform

Business First of Louisville - on Friday, March 12, 2010

The debate about health care reform has been raging throughout the country. Opinions run the gamut. So is the case with Business First’s 2010 Partners in Health Care.

As part of the research process in developing content for this year’s Partners in Health Care publication, which is included with this issue, Business First surveyed the 2010 Partners and asked them what they would like to see changed about the health care system in the United States.

Business First’s 173 Partners in Health Care are the business brains behind the local health care economy.

They range from hospital system administrators to researchers/entrepreneurs to architects to attorneys to construction managers.

Their opinions on this issue are as varied as their talents, responsibilities and experiences.

Here is a selection of their comments. Some have been edited for space considerations.


“Reduce the role of the insurance companies as they do not add any value or save any lives. Federally enact tort reform. Reward wellness and chronic illness management. Increase research funding.”

— Robert Barbier, CFO and senior vice president, University of Louisville Hospital

Improve access to preventative and primary care. Focus on an interdisciplinary team approach to include physicians, nurse practitioners and clinicians, therapists, pharmacists and others.

There should be provisions for care outside of the traditional “health care” settings in less costly environments, such as the home, schools, community clinics and other community-based settings.

Tort reform is needed to reduce the fear of litigation.Incentives of the providers should be aligned to force collaboration among clinicians, hospitals and payers.

— Joanne Berryman, senior vice president, Jewish Hospital & St. Mary’s HealthCare; dean, College of Health and Natural Science, Spalding University

There should be improved access to care and funding to support it, as well as greater accountability for physicians, hospitals and health providers for improved clinical outcomes.

Insurance reform would allow greater portability, coverage and payment for services rendered.

— Martin J. “Marty” Bonick, president and CEO, Jewish Hospital Medical Campus; vice president, Jewish Hospital & St. Mary’s HealthCare Inc.

“Do not tie (health care insurance) to an employer-based system. This creates problems with gaps in coverage and portability. Reduce the complexity and unnecessary claims management systems currently in place that add cost with little value.”

— Howard F. Bracco, president and CEO, Seven Counties Services Inc.

Pre-existing conditions should be eliminated as a criteria for being accepted or rejected from insurance coverage. Small businesses should be allowed to organize as an association to purchase health insurance and should not be denied that right by insurance companies.

There should be national malpractice reform “that will limit punitive damages to reduce costs and enable states to recruit physicians on an equal footing.”

People should be able to continue on their insurance plans if they move to another state, and insurance companies should be able to compete across state lines.

“There should be a national funding system that incentivizes states to develop health care systems for children and adults that have long-term mental illness resulting from developmental disabilities or brain injury.”

— Timothy F. Brady, president and CEO, Our Lady of Peace

“Add the uninsured to the Medicare and Medicaid system, which appears to work reasonably well. Fund these so that they are solvent, and increase the efforts to attack waste and fraud.

— Dr. E. Britt Brockman, physician and managing partner, John-Kenyon American Eye Institute

“I believe that it is unfair to ask hard-working productive businesses and employees to pay for people who do not work to have themselves insured.”

— John Carroll, president and CEO, Creative Strategies Inc.

“Eliminate the fee-for-service payment system and implement a system more closely tied to an outcome and/or the health status of the individual.”

— Mark B. Carter, managing partner, Dean Dorton Ford PSC

Do not alter the current system, “but rather add hospitals and clinics for the uninsured. The VA hospital system would be a good model for the concept. The VA system works for our veterans and should work for the uninsured.”

— Michael L. Clark, director of design, H&H Design-Build

“We need to move toward a more preventive rather than reactive health care model. By aligning incentives toward wellness, acuity levels, as well as the associated costs, could be reduced.”

— Joseph DeVenuto, system vice president, information services and chief information officer, Norton Healthcare Inc.

“Our health care system is so convoluted, with many of the wrong incentives driving how we as patients are treated. There is no question that we need health care reform. The most important first step is to make sure that everyone gets covered, as our current system distorts how we cover or pay for the treatment of uninsured people.

“Those of us with insurance pay for those who do not have it, either through higher taxes or higher insurance premiums today. If everyone was covered, a lot of this subsidizing of the system, this cost sharing, would go away, making our costs and payments more transparent. … Standardizing care based on best practices, evidence based medicine, would be another significant improvement.”

— George Emont, managing partner, Triathlon Medical Ventures, Kentucky Seed Capital Fund

“We need to get everyone equally involved, with appropriate incentives, to control health care costs — hospitals/health care providers, physicians, managed care companies, pharmaceutical companies, suppliers and others. This needs to be a coordinated effort.”

Michael Gough, senior vice president and CFO, Norton Healthcare Inc.

“Tort reform is desperately needed. Much of the testing provided in our industry is unnecessary. However, providers perform these tests in the event they are sued for medical malpractice.”

— Dennis Johnson, administrator, Baptist Hospital Northeast

“Tort reform is the first and best thing we can do to dramatically reduce the quantity and scale of medical lawsuits. This would truly lower costs by lowering malpractice insurance premiums.

“Second, restrictions on insurance competition across state lines need to be eliminated to open up competition by all insurance companies in all states. Let the free market bring down insurance costs through competition.

“Provide tax credits for those who want health insurance but truly cannot afford it.

— Mark D. Ketterer, senior project executive, Messer Construction Co.

Payment incentives between all payers and providers should be aligned. “Accountable Care Organizations show some promise in this regard. We must move quickly to advance the several case studies and move toward normalizing these concepts across the country.”

— Thomas D. Kmetz, president of Kosair Children’s Hospital and Pediatric Services

“It’s no secret that we spend more per capita on health care than any other industrialized nation and don’t necessarily get better results. We need to focus our dollars and efforts on things that work. We have a very fragmented delivery system that rewards doing more rather than doing what’s right.

“We should be looking at opportunities to better integrate health care providers across the continuum of care so that we don’t duplicate services. Also, we need to make certain that the services we do provide are provided in the most cost-effective setting.”

— Steve MacLauchlan, president, Norton Audubon Hospital

“Our current health care system is, for the insured population, a creation of unconscious demand. Many insured Americans believe a trip to the physician’s office costs $10. While we get explanation of benefits forms telling what our insurance paid, what many of us pay for a trip to the doctor is $10.

“The fundamental problem with the medical benefit system — and why the debate is so difficult — is that Americans don’t know what health care really costs.

“High-deductible plans offer a great start to demand management. But in general, insured Americans don’t know what their health care costs. Providers, insurance companies, even the government aren’t to blame for this crisis.

“The fix is not easy or cheap, but step one is to make all Americans aware of what a visit to a physician, or a hospital, or an urgent care center really costs.”

— Clifford Maesaka, president and CEO, Delta Dental of Kentucky

There should be increased support for the training and education of the next generation of physicians and other providers, and, in turn, there should be better access to health care services.

— Ken Marshall, chief operating officer, senior vice president, University of Louisville Hospital

“I would change the government payment structure. I believe that if all people in the United States were covered, some risk would be defused, as the good risk reduces the exposure of the bad risk.

“Right now all the bad risk goes to the feds, and the good risk lies with the insurance companies. They should be required to take the bad with the good and spread the premiums through larger and more diverse risk pools.”

— Cristine M. Miller, partner, Mountjoy Chilton Medley LLP

“Our ‘safety net’ systems do not provide adequate health care security for underserved populations. This is particularly true in less affluent states like Kentucky. I hope that the current health care reform discussions will help address these issues.”

— Dr. Donald M. Miller, director, James Graham Brown Cancer Center; associate vice president for health affairs, University of Louisville School of Medicine

Emphasize prevention and look to other countries such as Switzerland and states such as North Carolina and Maine as examples of what might work best nationwide

— Michael Muldoon, executive director, Health Enterprises Network

“I would like to see a system that mandates personal responsibility. Perhaps make it more like auto insurance, where everyone personally buys a policy from a carrier — not through employers.

“Credits could be offered for low earners, etc., but insurance companies would be forced to compete on cost and results, which would be pushed back through the entire system.”

— Kent Oyler, CEO, OPM Services Inc.

“Adequate reimbursement continues to be one of health care’s biggest challenges. Medicare and Medicaid hospital payments fail to keep up with the cost of care.

“Additionally, hospitals have seen a significant rise in the number of indigent and uninsured patients, causing margins to be squeezed even tighter.

“Despite rising costs and governmental payments that do not cover the cost of care, Kentucky hospitals continue to provide the safety net for the uninsured and low income population.”

— Michael T. Rust, president, Kentucky Hospital Association

“Tort reform is needed. Those who are injured do deserve a fair measure of compensation – amounts based on facts and not emotion.

“A Congressional Budget Office report issued in October 2009 determined that reforming the medical malpractice insurance system could save $54 billion over the next decade by placing caps on non-economic and punitive damages and shortening the statute of limitations for filing lawsuits.

“Liability costs, including insurance premiums and settlements, currently make up 2 percent, or $35 billion, of health care providers’ annual spending.”

— Tommy J. Smith, president and CEO, Baptist Healthcare System Inc.

Private insurers should receive incentives to provide low-cost policies to cover the uninsured. There should be tort reform.

Cut taxes on small businesses and their owners to stimulate job growth. Allow insurance companies to compete nationally to foster increased competition.

Minimize government involvement as much as possible in health care (and everywhere else).

— Ty Wilburn, chairman and CEO, Merit Health Systems

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