What are your priorities for health reform?

Physicians know that the health care system needs to change. Doctors for America wants to understand your priorities for health reform so we work to pass legislation that addresses those priorities.

Take this poll to let us know what your top priorities are in health reform. For each broad principle we have provided some background information and how each principle is being represented in the current health reform legislation.

Doctors who have spoken so far: 740

Investment in prevention and wellness efforts (Topic 1 of 10)


Background: Chronic diseases – such as heart disease, stroke, cancer, and diabetes – are the most prevalent and preventable of all health problems and also the most costly. Nearly half (45%) of Americans suffer from one or more chronic conditions. Chronic disease accounts for 70% of all deaths (more than 1.7 million people). An estimated 80% of heart disease, stroke, and type-2 diabetes, and 40% of cancers, could be prevented if Americans stopped smoking, adopted healthy diets, and became more physically active. Efforts to guard against and better manage illness are an effective tool to improve health and attempt to contain costs over the long term. A financial investment would be need to create a better infrastructure for prevention health services and the cost savings may only be realized over the long term. Current Health Reform Legislation:
  • Requires that all preventive services are provided with no co-payments for patients
  • Creates community-based programs to deliver prevention and wellness services
  • Expands funding for Community Health Centers
High Priority
Important, but not a priority
Not important to me
 
Comments or story:

Realign payment incentives to reward physicians and hospitals for
high quality and effective care and not just volume of services (Topic 2 of 10)


Background: Today's payment systems reward providers for delivering more care rather than better care. Under the current system, the more visits, tests, images and services providers deliver, the more they are paid — regardless of the quality or the health outcomes of the patient. The perverse incentives have driven medicine to a breaking point where many physicians can only spend a short time with a patient, just to keep their practices afloat. Additionally, much of the administrative, phone call/email follow-up, care coordination work done by physicians goes unreimbursed in the current payment system. In a fee-for-service payment system, as in the one used for Medicare, the more services you provide . . . the more you get paid. This does not incentivize innovative methods to care for patients.

 Current Health Reform Legislation:
  • Reforms the flawed physician payment mechanism in Medicare (sustainable growth rate or "SGR" formula)
  • Pilots for innovative concepts such as accountable care organizations, medical homes, and bundling of acute and post-acute provider payments.
  • Creates new payment incentives to decrease preventable hospital readmissions.
  • Creates new methods for administrative simplification.
High Priority
Important, but not a priority
Not important to me
 
Comments or story:

Guaranteed health insurance for all people -- regardless of their health (Topic 3 of 10)


Background: Covering all Americans would ensure that the insurance market functions effectively. Insurance works because policyholders pay into their plans when healthy, and have their medical bills paid when they are sick. Additionally, covering all Americans is essential to effective prevention and wellness efforts and managing chronic illnesses. Efforts to guard against and better manage illness are an important tool to improve health and contain costs but, without every American in the system, those efforts will fall short of their full potential. Lastly, the U.S. is the only developed country that does not guarantee health coverage for all its citizens, with 47 million uninsured in 2008 and another 25 million underinsured. Current Health Reform Legislation
  • Small businesses and qualified individuals can enter the health insurance exchange and choose from private and public health insurance options.
  • Individual Mandate with subsidies to help individuals, families buy health insurance in the exchange
  • Subsidies for small businesses to purchase health insurance
  • Prevents denial of coverage for pre-existing conditions
  • Minimum benefits package in the insurance exchange and public insurance
High Priority
Important, but not a priority
Not important to me
 
Comments or story:

Establish a public health insurance option – that is publically accountable and transparent
(Topic 4 of 10)


Background: The public insurance option can provide guaranteed access to health insurance, especially in poorly-covered areas. It would provide competition for private insurance companies which are currently functioning in highly concentrated markets with little competitive pressure. It would also help implement many of the reform provisions contained in the health reform bill. Opponents of a public option fear it will drive private insurers out of business. Proponents fear that without it, insurance companies will continue to drive up costs, decrease access, and sacrifice patient care in the interest of stockholders. Increasing the ability and options for all Americans to have health insurance will also help end the shifting of costs of care from the uninsured to the insured. Current Health Reform Legislation
  • A public health insurance option that would be one of many choices within the health insurance exchange
  • Includes subsidies for the middle class to purchase health insurance
  • Includes subsidies for small businesses to purchase health insurance for their employees
  • Would otherwise NOT be subsidized by taxpayer money – exists on a level playing field with private insurance
  • Would establish quality and cost benchmarks
High Priority
Important, but not a priority
Not important to me
 
Comments or story:

Malpractice reform (Topic 5 of 10)


Background: Careful reforms of medical malpractice laws can lower administrative costs and health spending throughout the system, while ensuring that injured patients are compensated fairly for their losses. Malpractice reform could address money and time spent on litigation as well as improve patient and provider satisfaction with the resolution of complaints or grievances. Current Health Reform Legislation:
  • Small steps towards malpractice reform have been taken in the currently introduced House bill but it has not been address in a comprehensive way.
  • It is still possible that malpractice reform options can be added in during the fall legislative session through the amendment process.
  • Other components of reform like health information technology and comparative effectiveness research should help to improve patient safety and protect doctors from malpractice suits
High Priority
Important, but not a priority
Not important to me
 
Comments or story:

Investment in the primary care workforce (Topic 6 of 10)


Background: Primary care is the keystone of a high-performing health care system. Increasing the supply and availability of primary care practitioners by improving the value placed on their work is a necessary step toward meaningful reform. Primary care has been shown to improve quality and restrain costs in the health care system. However, primary care is in crisis – few doctors are entering the field. One reason is that primary care physicians earn approximately 55% of the average earnings of all other non-primary care specialties. Current Health Reform Legislation
  • Enhances the primary care workforce
    • Increase payments to primary care providers under Medicare and Medicaid.
    • Provides loan forgiveness for primary care physicians who practice in underserved areas
  • Increases funding for the National Health Service Corp
High Priority
Important, but not a priority
Not important to me
 
Comments or story:

Replace the Sustainable Growth Rate (Topic 7 of 10)


Background: The sustainable growth rate was enacted by Congress to control growth in Medicare payments to physicians. When spending reaches a certain target amount, payments to physicians are reduced. Spending has grown every year beyond the SGR target but payment cuts to physicians have been prevented by annual short-term Congressional legislation to stop it. In the current SGR-based system, physician payments in 2010 would be reduced 20%. Current Health Reform Legislation
  • Reforms of the flawed physician payment mechanism in Medicare (sustainable growth rate or "SGR" formula)
  • Stops the expected 20% payment cut due next year
  • Wipes away the accumulated debt from the SGR
High Priority
Important, but not a priority
Not important to me
 
Comments or story:

Reward care coordination through pilot testing the medical home
and other care delivery models (Topic 8 of 10)


Background: The Patient Centered Medical Home (PCMH) is model of care that is designed to improve quality and achieve efficiencies by recognizing and supporting the value of care that is provided to patients by primary care physicians, working in practices that have the information systems needed to achieve the best outcomes. The model is based on a large and growing body of evidence that shows that care delivered by primary care physicians, supported with information systems and with the appropriate reimbursement incentives, can improve the quality and efficiency of care provided to patients, especially for patients with multiple chronic illnesses. CMS has begun several demonstration programs to test the medical home model in fee-for-service Medicare. Current Health Reform Legislation
  • Pilots for innovative concepts such as accountable care organizations, medical homes, and bundling of acute and post-acute provider payments.
  • Creates new payment incentives to decrease preventable hospital readmissions.
High Priority
Important, but not a priority
Not important to me
 
Comments or story:

Provide doctors with unbiased research on how different treatments compare (Topic 9 of 10)


Background: Comparative effectiveness research examines the relative merits of two active therapeutic approaches by direct comparison. Understanding the relative effectiveness of different treatments, procedures, and drugs allows for enhanced evidence-based clinical decision. Pharmaceutical and medical device industries do not typically conduct studies that compare two similar treatment modalities. Current Health Reform Legislation
  • Establishes a Center for Comparative Effectiveness Research within the Agency for Healthcare Research and Quality (AHRQ)
  • Establishes a public/private stakeholder commission known as the "Comparative Effectiveness Commission" to oversee the Center, determine national priorities for research, identify research methods and standards of evidence, support forums to increase stakeholder feedback, appoint advisory panels on specific national priorities, and make recommendations for the dissemination of findings.
High Priority
Important, but not a priority
Not important to me
 
Comments or story:

What other priorities would you like included in health reform legislation? (Topic 10 of 10)


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