With no end in sight for the controversy over health care reform, Macomb County health care providers are engaging with each other in an effort to educate citizens on what reform truly means for them.
"There is so much controversy going on now with this act and the repealing that's trying to be attempted and elements of it trying to be picked apart ... it's going to be very interesting to really understand and predict what's going to happen in 2014 when all of this comes about," said Henry Ford Hospital CEO Barbara Rossmann.
Rossmann helped break down the 1,000-page health care reform act for various Macomb County business leaders and health care providers who gathered Wednesday at Baker College for the seminar.
"Whether we agree with the contents of the bill and how it's being orchestrated or not, the intention is the right one," Rossmann said. "It's moving us toward continuity of care managed through primary care physicians."
Primary Care vs. Specialists
Reform will encourage would-be patients to contact their primary care physician first before seeking out a specialist.
Rossmann said a large part of increased health care costs is due to patients turning to specialists for care rather than allowing their primary care physician to coordinate their care.
"The specialists look at what they know," Rossmann said. "They can fix it and they take care of that (but) they don't look at you as a whole person. That's what a primary care physician does."
By allowing a primary care physician to coordinate and correct a patient's care, Rossmann said costs will decrease and the patient's overall health will be better monitored.
"As individuals we have a relationship with a primary care physician and we are accountable, in essence, to take accountability for our own health care and we work with our primary care physician to stay healthy," she said.
By the same token that Rossmann advocates primary care, she also supports the reduction of emergency room use.
How Does Less ER Use Benefit Hospitals and Patients?
Rossmann cites the "old world," or past practice in which hospital emergency rooms profited by volume rather than value of care provided, to emphasize the advantage of reform.
"Hospitals competed to bring patients in," she said. "The sickest thing we ever did was fight for ER volume. We advertise, 'Please come to our ER. We have 20-minute wait times.'"
But in doing so, ERs began servicing all medical needs, not just emergency cases. Patients opted for the ER when an urgent care facility or trip to the family doctor would have sufficed, and while the ER will address a patient's symptoms, information about the treatment does not always make it back to the primary care physician. This creates a disconnect in care.
However, as reform moves forward, Rossmann said health care costs will shift backward to charge for value rather than volume. Reform will also include:
- Bundled payment
- Focus on reducing hospital readmissions
- Transparency in cost and quality
- Evidence-based care
What's Easy vs. What's Right
With the implementation of the Patient Protection and Accountable Care Act of 2010, more commonly known as Obamacare, Rossmann said the issue for health care providers, insurance companies and employers will become a question of what is "the right thing to do."
The PPACA provides such benefits as coverage of adult children up to age 26 and prohibiting insurance companies from denying coverage based on pre-existing conditions; however, it also forces businesses to provide some form of coverage.
The latter requirement has many employers weighing the cost of paying the penalty for not following the law as opposed to providing such coverage, Rossmann said.
"We have a choice," Rossmann said. "We can either do the right thing for the right reasons or we can find something else to do. Health care right now is not for the weak of mind."
For Macomb County residents, Rossmann said the most important thing is to continually ask questions about the health care they receive, with the goal being to become as educated as possible about ways to maintain wellness.
The Effect of Health Care Reform for 300 Million Americans
For 150 million currently insured:
- Little change for large employer-based group plans
- More choice and subsidies for small business and individuals
- Protections on out-of-pocket expenses, lifetime caps (2010)
- Protections against denials or disenrollment for health reasons (2011)
- Estimated $1,000 per year relief from uncompensated care subsidy
For 45 million uninsured:
- 15 million will be added to Medicaid in 2014 (Eligible for families of four living on an annual income of $27,000. The cap is currently at $11,000 for a family of four.)
- 15 million will be able to buy insurance with subsidies
- Health insurance exchange (2011)
- High risk pool
- Adult children to age 26 stay on parent's plan (2010)
- 15 million remain unprotected, due to immigrant status or personal preference
For 45 million enrolled in Medicare
- No reduction in basic benefits
- Advantage plans for 12 million people, which includes a reduction in "extra" benefits
- Coverage of the gap in drug benefits ($252 rebate in 2010)
- New coverage for annual check-up and wellness benefits (2010)
For 65 million enrolled in Medicaid
- More primary care access (payments increased to Medicare payment level)
- Better access to hospital care, due to influx of federal funding