Local Health Care Leaders Discuss Policy and Reform

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UW Health CEOsMADISON - The ongoing health care debate deals in numbers so large they are almost abstract. Tens of millions of uninsured U.S. citizens. A $900 billion outlay over the next decade. Deficit projections in the trillions.


At "National Health Care Reform: Acting Nationally, Impacting Locally," a forum involving six of Madison's most prominent players in local health care policy, UW Hospital and Clinics CEO Donna Katen-Bahensky used a much simpler figure - 147 - in responding to a question about the rapid increase of health care costs.


"Within our single billing office we have 147 billing contracts," she said, and with each contract separate processes and procedures, governing rules and forms to be filled out in triplicate and faxed to different offices. "One issue that is going to have to be dealt with is simplifying the administration. If we can bring down that cost we would bring down the cost of our health care."


Katen-Bahensky was joined for the forum, moderated by NBC-15 news anchor Sarah Carlson and offered as part of the University of Wisconsin's Forward Thinking series, by:

  • Jeff Grossman, MD, President and CEO, UW Medical Foundation
  • Jim Woodward, President and CEO, Meriter Hospital
  • Frank Byrne, MD, President, St. Mary's Hospital
  • Lon Sprecher, President and COO, Dean Health
  • Geoffrey Priest, CMO, Meriter Hospital

The wide-ranging discussion, which featured topics selected beforehand by panel members as well as questions submitted by members of a crowd that nearly filled the Wisconsin Union Theater, produced more consensus than contention.


Two unifying themes emerged: Everyone on the panel agreed all U.S. citizens deserve coverage, and no single panacea exists for the cost-cutting that needs to occur for reform to succeed.


"We need universal health care," Dr. Grossman said. "Everybody would agree there is a need for lifetime coverage without hitches - that it's portable, it goes with you wherever you go."


"Everyone needs a viable way into the health care system," added Dr. Byrne, "that isn't going to the emergency room at 11 at night."


But universal coverage will be untenable if the current system, ripe with avoidable costs as it is, is not modified.


"There is not one single reason why health care is so expensive," Woodward said. "There are a number of misaligned incentives that create additional costs. First and foremost, we have 45 million people uninsured. Cost is being borne by hospitals and emergency rooms when people get sick. The cost is being shifted to those folks who have some form of insurance."


One of those misaligned incentives is a system that rewards the volume of care more than the effectiveness of the approach. In many instances, physician reimbursement is predicated by the number of tests and procedures performed and has nothing to do with efficiently restoring a patient's health.


"Incentives are misaligned," Sprecher said. "Doctors get paid for how much they do, not how much they prevent. Nobody in Washington is really talking about that in any great depth."


The panelists pointed to the adoption of an accountable care model, with reimbursement tied to quality care, as a crucial element in the equation to balance the health care budget and reduce spending.


"The move toward an accountable system is the most exciting part of reform," Katen-Bahensky said. "To do that you have to have patients helping us make decisions. We have to listen to people who know their own needs."


Encouraging patients to adopt healthy lifestyles could have a dramatic impact, as well. The least expensive way to treat a chronic disease like diabetes, after all, is to prevent the disease from taking root.


"We're spending on the wrong end of chronic disease," Dr. Byrne said. "We're spending on patients after they get sick rather than preventing them from getting sick."


Employers and insurance companies can and do play a key role in prevention by providing wellness programs, like fitness and nutrition counseling or access to smoking-cessation programs.


"We're looking at what makes for a healthier work force," Sprecher said. "What can we do to lift all boats to make us a better employer? We all agreed it would be wellness. Will that give returns next year? No. But over the next eight to 10 years it will."


Katen-Bahensky agreed and used Unity, the insurance group aligned with UW Health, as an example. "The benefit of having a provider-owned HMO is we can work directly with the organization and say, 'Help us help you.' Wellness is a decade-long investment."


Even if all the pieces of reform fall into place, the panelists pointed to the alarming shortage of primary care physicians as a potential obstacle to successful reform. Primary care physicians are in many ways the faces of health care, because they see patients regularly and provide the early counsel so key to prevention. And there simply aren't enough of them to handle the swelling demand.


"The uninsured can get care at the hospital," Priest said. "What they can't get is primary care. To add 48 million people to the current primary care system will overtax it."


It's a difficult problem, to say the least. None of the six experts claimed to have an inarguable solution. But with the health of a nation in the balance, all insisted the status quo is inadequate and bold steps need to be taken.


"We have some moral decisions to make here," Dr. Grossman said. "Changing how we deliver care is extremely complicated. This is not a state problem. It's a national problem. From my perspective the biggest thing we need to do is get people insured. Once we do that, we will find a way to deal with the revenue and cost issues."

Date Published: 12/17/2009

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