While the American Medical Association is throwing its support behind the House version of the health care reform bill, providers say there’s still a lot of work to be done.
The AMA says House Bill 3200 offers the best chance for administrative reform, while also maintaining the doctor-patient relationship.
“The bottom line, for doctors, is that we want to care for patients,” said James Rohack, president of the American Medical Association. “That patient-physician relationship, we want to make sure that it won’t be interfered with by government bureaucrats or insurance bureaucrats.”
The AMA says two problems led to spiraling health care costs: defensive medicine and the administrative burden placed on doctors by health insurance companies.
Defensive medicine, Rohack said, is when doctors order unnecessary tests to protect themselves from legal proceedings.
“As a general rule, doctors spend four years in medical school and three to seven years in additional training,” he said. “We know best how to care for patients. It can be frustrating sometimes to have that care placed in the hands of clerks who are trying to control costs by setting up unnecessary barriers to care.”
The AMA also hopes that the House bill will relieve the burden of too much paperwork that hinders doctors’ abilities to care for patients.
“In Colorado, 80 percent of practices are single practices, or just two to three doctors,” Rohack said. “And they spend an hour and a half every day on paperwork. Every insurance company has a different form, different ways to file claims. This bill will create one form — for everyone — for Medicare, Medicaid, insurance companies. It will greatly simplify the work.”
Another reason why the physicians’ group supports the bill is that it would require the Food and Drug Administration to compare the efficacies of drugs and devices.
“Right now, the FDA will tell you if a drug or device works and if it’s safe, but doctors don’t know which works best and in what circumstances,” Rohack said. “This will expand the FDA’s reach to include that information.”
The AMA also supports the insurance reform portion of the bill, which would expand options for 47 million people without insurance.
“It will prohibit insurance companies from excluding people because of pre-exiting conditions,” Rohack said. “Right now, if you have a heart condition, an insurance company can provide an exclusion and not cover that condition.”
John Suits, associate administrator for government affairs at Memorial Health System supports some provisions of the bill, but also has some reservations.
“We just want to provide quality care, and do it efficiently,” he said. “That’s where this bill really helps, removing some of the barriers to care placed by insurance companies.”
But, he said the final version will need to set realistic payment levels for health care providers.
“Right now, they haven’t set reimbursement rates, and if they are at the same levels as Medicare, then there’s a problem,” Suits said. “They also haven’t said anything about how they’re going to pay for it. The numbers have been left out of this bill.”
That is one reason health care providers are split on the bill, said Ira Gorman, a health administration professor at Regis University, who also is a member of the American Physical Therapy Association.
“There’s a concern that cost controls aren’t as delineated as they would like them to be,” he said. “We need to see cost measures on the reimbursement side, and that hasn’t been outlined or discussed.”
However, Gorman said he believes that hospitals and doctors have exaggerated claims about Medicare reimbursements being too low.
“They are still making money,” he said. “So in a reform bill, they might not make as much. Hospital association data since 2007 shows that profits are higher and that Medicare reimbursement doesn’t come in below costs — hospitals are just charging higher fees.”
Gorman also believes the bill will benefit businesses, giving them a larger, national risk pool to purchase insurance. And, he said, government coverage from Medicare use less money for administrative costs.
“Medicare only uses 3 percent of its money for administrative costs,” he said. “Compare that to traditional companies that spend up to 23 percent. There’s a large savings there.”
Suits said some health care discussions have centered on capping the money used for profit and administrative costs to 15 percent. That option has health insurance executives “nervous,” he said.
Most analysts believe reform will happen this year, but the legislation that passes will only include some of the provisions of 3200.
“The Senate has its chance, then they have to reach a compromise bill between the two,” Suits said. “I imagine what we see in the fall will only include a few provisions of 3200 — and lobbyists are going to be successful in changing the rest.”