CHEROKEE COUNTY REPUBLICAN WOMEN’S DINNER

NATIONAL HEALTHCARE REFORM

David CookExecutive Director

Medical Association of Georgia

April 22, 2009

MEDICAL ASSOCIATION OF GEORGIA

• Professional society for Georgia’s medical doctors.

• 6,600 physician members of all specialties in all regions of the state.

The National Landscape

New Administration and

Congressional Leaders Aligned

The Framework

• Expanded Government Health Plans (Medicare –Medicaid - SCHIP).

• Government Competition With the Private Sector

• Expanded Government Role in Making Health Care Decisions

Expanded Government Health Plans

• SCHIP: Expand eligibility to children with family income of 400%FPL [$85,000]. Also expands coverage for adults. HR 1

• Medicare: Medicare for all? Allow person age 55 or older to buy into Medicare. Baucus • Medicaid: $87 Billion stimulus funds to maintain eligibility in tough budget year. HR 1 Floor i.e. Coverage for everyone at 100% FPL Baucus/Kennedy

Direct Government Competition With Private Sector?

• Individual Mandate? Employer Mandate?

• Massachusetts Model?

• Federal Employees Health Benefit Plan?

• Critical Mass.

HealthCare Decisions

“The federal government is in the position to develop national quality standards that everyone would follow.” Tom Daschle

HealthCare Decisions

• Federal Coordinating Council for Comparative Effectiveness Research [HR 1- Stimulus]

• 15 members appointed by President, all government employees to assess comparative effectiveness and appropriateness of health care treatments.

• National Institute for Health and Clinical Excellence [NICE]

COMPARATIVE EFFECTIVENESS

“Scarcity of data on comparative effectiveness means that decisions about what treatments to use often depend on anecdotal evidence, conjecture and the experience and judgment of individual physicians.” CBO

COMPARATIVE EFFECTIVENESS

“Without hard evidence, however, decisions about what treatment to recommend often depends on the individual experience and judgment of physicians.” CBO

COMPARATIVE EFFECTIVENESS

“The analysis may focus only on the relative medical benefits and risks of each option, or it may also weigh both the costs and benefits of those options.” CBO

QALY

• Quality Adjusted Life Year: The metric used to determine how much value exists in improving health or avoiding various side effects.

• Measured in cost per QALY gained.

Health Information Technology

• $19 Billion in Stimulus Plan as incentives to adopt EHR.

• Continued funding in Budget resolution.

• Obama Campaign: Savings from implementing HIT will fund large part of health care reform. (?)

HIT- Privacy

• Concern about Privacy often barrier to enactment of HIT Legislation.

• Trust & Candor critical to the Physician –Patient Relationship

• Health Insurance Portability & Accountability Act (1996)

• Stimulus Plan Expands Privacy Protections:– Applies HIPAA to business associates and covered entities.– Requires notification to patients of privacy breach– Prohibits sale of patient information without patient consent.– Prohibits private vendors from paying to obtain patient information for marketing purposes.

Privacy Challenges

• Continue to Strengthen HIPAA–Health Information Exchanges–Marketing–Deidentification of Data

• Protect Privacy when PHI Leaves the Health Care System

–Consent too easy to obtain?–Limit Data recipients?

The Funding

• Stimulus Plan

• Budget Resolution–$634 Billion “down payment” on health care reform. (10 years).

–Tax increases for those making more than $250,000 ($318 billion) Mortgage Interest Deductions and charitable contributions.

–“Additional funding will be needed” Budget Narrative

• Appropriations Bills

THANK YOU