jessica flory rachel ruggeri. background information 46m in the us are uninsured (15.3% of the...

Jessica FloryRachel Ruggeri

Background Information46M in the US are uninsured (15.3% of the

population)

25M are underinsured

Adults receive recommended care 55% of the time

Children receive recommended care 47% of the time

Current Health Care SystemPrivate Health Insurance

Employer-sponsored Insurance: 59.3%Individual Health Insurance: 9%

Public Health InsuranceMedicareMedicaid

Government run programs cover ~27.8%By 2031 predicted Medicare enrollment:

77 mil

Current Health Care SystemOther Public Systems

Veterans AdministrationState Children’s Health Insurance

Program (SCHIP) TRICAREFederal Employee Health Benefits Plan

(FEHBP)

Current Health Care SystemHMO

In networkPPO

In and out of networkDeductiblesCo-paymentsMonthly premiums

Discussion:What are the flaws in our current system?

The National Debthttp://www.brillig.com/debt_clock/

http://www.brillig.com/debt_clock/faq.html

Health Care Expenses

•1/3 of spending does NOT improve American’s health outcomes

•Overhead and administrative costs

Health Care Expenses

•2017: Health care expenditure expected to be 4.3 trillion

Quality of US Health CareUS ranks last of 19

industrialized countries in unnecessary deaths due to medical errors

US ranks 29th of 37 for infant mortality

Necessary care not received in:Diabetes patients 55% of

the timeBreast cancer patients

25% of the timeChildren 47% of the time

Health Care Expenditure• Comparative Costs:

• MRI cost in Japan = $100 MRI cost in US = $1200

• Administrative cost in Switzerland = 5.5% total HC cost•Administrative cost in US = 22% total private HC cost

Health Care Premiums

Costs of care for the uninsured borne by those with insurance

Providers charge higher prices to those with private coverage to make up for costs lost in providing uncompensated care

This leads to increased premiums

President ObamaGoal of Health Care Reform:

“Affordable and high quality universal coverage through a mix of private and expanded public insurance”

http://www.youtube.com/watch?v=0VV7BcDT2ug

Obama-Biden PlanImprove efficiency and lower costs by:

1. Adopting state of the art technology systems

2. Ensure that patients receive/providers deliver the best possible care

Ex. prevention and chronic disease mgmt.

3. Reform market structure to increase competition

Obama-Biden PlanEnsure new and affordable health

insurance options by:

1.Guarantee eligibility for health care plans• Children required to have health

insurance• Employers required to offer health

insurance

Obama-Biden Plan2. Create a National Health Insurance

Exchange (NHIE) to help individuals and businesses purchase private health insurance

• Comprehensive benefits similar FEHBP

• Essential services including mental health, maternity, and preventative care

Obama-Biden Plan3. Provide new tax credits to families and

small businesses who cannot afford health insurance

For small businesses up to 50% of premiums paid will be a refundable tax credit

4. Require all large employers to contribute toward health coverage for employees or toward the cost of the public plan

5. Require health care coverage for all children• Young people up to age 25 will continue to

have coverage under their parent’s plan

Obama-Biden Plan6. Expand eligibility for Medicaid and SCHIP7. Allow flexibility for state health reform

plans Minimum standards of the national plan

must be met

8. Changes to private insurance Prohibit insurers from denying coverage

based on pre-existing conditions Disclose the percentage of amount of

premiums going to patient care vs. administrative costs

DiscussionWhat do you think?

APTA Letter to Obama"APTA believes strongly that its vision

of the delivery of physical therapist services is well aligned with the path for health care reform your have outlined throughout your campaign. This vision seeks to break through the antiquated delivery models of the past in an effort to improve access, enhance quality, and reduce overall health care costs."

APTA Letter to ObamaAPTA's vision for improved access and cost reduction:

1. "physical therapist services will be provided only by licensed PTs and by PTAs under the direction and supervision of physical therapists“

2. "consumers will be able to visit a physical therapists directly, without the need for a physician referral, for prevention, wellness, and the management of functional limitations, impairments, chronic conditions, and disabilities"

APTA Letter to Obama3. "physical therapists will be

practitioners of choice in patients'/clients' health networks and will hold all privileges of autonomous physical therapy practice“

4. "a qualified physical therapist workforce will be supported by federal investment to ensure quality, reduce costs, and, most important, ensure access"

APTA Letter to Max BaucusChairman, Senate Committee on

FinanceSenator of Montana

"APTA applauds your Call to Action: Health Reform 2009 and stands ready to assist you and your Senate colleagues pass meaningful policies to reform our health care system."

Increase Access to Affordable Coverage

“patient protection language … to ensure non-discrimination of providers and access to qualified providers”

“elimination of the two-year wait period for Medicare eligibility”

Increase Access to Affordable Coverage cont.

"elimination of unnecessary barriers to access health care providers … physicians are required to certify the plan of care for physical therapy services under Medicare even as 45 states have eliminated the physician referral requirement … adds cost without any significant evidence of quality or patient safety"

Increase Access to Affordable Coverage cont.

"improved funding for Indian Health Services … physical therapists have a 23% vacancy rate in the IHS … loan repayment programs, scholarships, and innovative programs to recruit physical therapists“

"enhanced coverage of and a focus on prevention, wellness, and chronic care management … enhancement of rehabilitation services is a necessary focus in any reform initiatives"

Discussion:Your thoughts

Improve Value by Reforming Health Care Delivery

"significant improvements in payments to primary care providers as a foundation to a more efficient and effective health care delivery system … it is also counterproductive and inconsistent with the goal of this call to action to improve the payment system to reward primary care at the cost of other providers, whether they are physician specialties or non-physicians that serve the continuum of care delivery with high quality, cost-effective interventions"

Improve Value by Reforming Health Care Delivery cont.

"reform of payment methodology for providers that bill the fee schedule … APTA strongly supports repeal of the sustainable growth rate and replacement of this flawed formula with a more accurate index of medical inflation … APTA has concerns with present alternatives to the SGR that only complicate the problem by dividing the formula into separate categories"


"reform of therapy service payment policies … patients under Medicare are subject to an arbitrary cap on their services regardless of their diagnosis or the physical therapist's clinical decision making …APTA believes that an alternative payment methodology should be based on … the patient assessment that leads to a severity-intensity model that holds the profession accountable for this assessment"


"continued expansion and transition from pay for reporting to pay for performance … tie payment to the individual's national provider identification (NPI) number“

"reforming the clinical training programs for health care providers … critical funding is needed to provide sustainable infrastructure for non-physician providers, such as physical therapists"


"incentives for the wide-adoption of health information technology … improve efficiencies, enhance quality, and reduce long-term costs … APTA has developed an electronic health record and national outcomes database that will only facilitate effective policies for therapy services in the future"


"investment in comparative effectiveness research … physical therapy utilized in collaboration with pharmaceuticals, pre and post surgeries, and with medical devices could also provide efficiencies that would reform our current delivery model"

Finance a More Efficient Health Care System

"increased efforts to curb fraud, abuse and waste in the health care system … eliminate referral for profit situations in health care … this creates perverse incentives for increased utilization, limited patient choice, and inefficiencies to the delivery of health care services … APTA calls for the elimination of physical therapy as an "in-office ancillary services exception" … to reduce this incentive"

Finance a More Efficient Health Care System cont.

"enhanced transparency in pricing, incentives, and quality will only assist consumers make informed decisions about their health care … patient accessibility to provider registries and outcome databases would be essential to achieving this objective"

Finance a More Efficient Health Care System cont.

"passage of meaningful professional liability reform … high malpractice rates and a culture that promote inefficiencies and utilization concerns … APTA supports the passage of professional liability reform to transform this culture and reduce costs to the delivery system"

References:1. APTA Health Care Reform Resource Center;

http://www.apta.org/AM/Template.cfm?Section=Home&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=55505

1. Baucus Plan: A Call to Action: Health Care Reform in 20092. APTA Letter to Sen. Baucus3. Obama Campaign Health Care Plan4. APTA Letter to Obama

2. Kaiser Family Foundation; www.health08.org3. Centers for Medicare & Medicaid; www.cms.hhs.gov4. Wikipedia, Health Care in the United States;

http://en.wikipedia.org/wiki/Health_care_in_the_United_States5. The Real Truth, America’s Healthcare Crisis: Is There a Solution?;

http://www.realtruth.org/articles/090203-005-health.html6. U.S. National Debt Clock; http://www.brillig.com/debt_clock/7. U.S. National Debt Clock FAQ;

http://www.brillig.com/debt_clock/faq.html8. YouTube; http://www.youtube.com/watch?v=0VV7BcDT2ug

jessica flory rachel ruggeri. background information 46m in the us are uninsured (15.3% of the...

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