Independent Physicians Network 9/25/12

Galen Institute
Galen InstituteGalen Institute
A not-for-profit
 health and tax policy
research organization
                         What’s coming and
                         what it means for
                         medical practice

                         Grace-Marie Turner
                         September 25, 2012
                         Independent Physicians Network
   /GalenInstitute
   www.galen.org
www.galen.org
Source: Ari Melber,‖POLL: Half of Americans Don’t Know How Court Ruled on Healthcare,‖ The Nation, July 4, 2012,
http://www.thenation.com/blog/168720/poll-half-americans-dont-know-how-court-ruled-healthcare#.
Americans’ views
                        after Supreme Court decision
• Americans say the health law will make things
  worse rather than better for taxpayers, businesses,
  doctors, and those who currently have health
  insurance.
• Health care will be an extremely or very important
  issue for 82% of Americans in deciding their vote
  for the president in November.
• Opposition to the law is higher now than before the
  Supreme Court decision.
Sources: ―Americans: Healthcare Law Helps Some, Hurts Others ,‖ Gallup, July 16, 2012, http://www.gallup.com/poll/155726/Americans-Healthcare-Law-
Helps-Hurts-Others.aspx. The New York Times/CBS News Poll, July 11-16, 2012, http://s3.documentcloud.org/documents/402362/jul12a-ocr.pdf. ―Kaiser
Health Tracking Poll,‖ The Kaiser Family Foundation, July 2012, http://www.kff.org/kaiserpolls/upload/8339-C.pdf
Source: Kaiser Family Foundation, July 2012.
Americans agreed on goals for health reform…

       • The U.S. needs health reform to:
                – make coverage more affordable
                – assure quality, and
                – expand access to insurance
       • Most people rate their own coverage as
         good or excellent
       • They want stability. Change is for others.


www.galen.org
Independent Physicians Network 9/25/12
Independent Physicians Network 9/25/12
Taxes and spending in ObamaCare




Source: Avik Roy, ―Fact-Checking the Obama Campaign's Defense of its $716 Billion Cut to Medicare,‖ Forbes: The Apothecary, August 16, 2012,
http://www.forbes.com/sites/aroy/2012/08/16/fact-checking-the-obama-campaigns-defense-of-its-716-billion-cut-to-medicare/.
Two issues:
Taxes. Trust.
ObamaCare’s New Taxes




Source: Philip Dittmer and William McBride, ―Obamacare's New Taxes, And How You May Be Affected,‖ Tax Foundation, July 5, 2012,
http://taxfoundation.org/blog/obamacares-new-taxes-and-how-you-may-be-affected.
More ObamaCare Taxes




Source: Philip Dittmer and William McBride, ―Obamacare's New Taxes, And How You May Be Affected,‖ Tax Foundation, July 5, 2012,
http://taxfoundation.org/blog/obamacares-new-taxes-and-how-you-may-be-affected.
Obamacare's 7 Tax Hikes On
                      Under $250,000-A-Year Earners




Source: Ebeling, Ashlea, Forbes Staff - "Obamacare's 7 Tax Hikes On Under $250,000-A-Year Earners,‖
http://www.atr.org/important-numbers-obama-a7130.
The law fails to meet goals
  • Health costs and health spending increase
  • One-third of businesses may drop insurance
  • Young people worried about high cost of policies
  • Doctors concerned about Medicaid expansion
    and fraying the safety net
  • Seniors worried about rationing of care and
    finding a doctor who takes Medicare
  • 30 million will remain uninsured -- CBO
www.galen.org
Some realities




www.galen.org
Independent Physicians Network 9/25/12
Independent Physicians Network 9/25/12
Independent Physicians Network 9/25/12
Source: Frank Hill, ―The High Cost Impact of More Regulation and Admin/Executive Staff on Health Care Inflation,‖ Telemachus, July 22, 2012,
http://www.telemachusleaps.com/2012/07/the-high-cost-impact-of-more-regulation.html.
The AMA and practicing physicians

      • The SGR Medicare payment fix was its
        key bargaining chip
      • The chance for a permanent fix is missed;
        the president got the AMA endorsement
        for an empty promise
      • Budget concerns in the Congress mean
        short-term fixes are likely to continue


www.galen.org
The Doctors Co. Survey:
– 60% say increased patient volume will
  hurt the level of care they can provide

– 43% said they are thinking about
  retiring in the next five years

– Nine out of ten said they would
  discourage friends and family members
  from pursuing a career in medicine



  http://www.thedoctors.com/TDC/PressRoom/PressContent/CON_ID_004671
Physician concerns

      • Questions about Accountable Care
        Organizations
      • Authority of HHS Secretary to set new
        rules for quality of care
      • Regulatory requirements impacting private
        medical practices
      • More burdensome record-keeping


www.galen.org
Specific changes to watch

     • IPAB — the Independent Payment Advisory
       Board
     • Patient-Centered Outcomes Research
       Institute and comparative effectiveness
       ―guidelines‖
     • Physician Quality Reporting Initiative
     • Value-based Payment Modifier

www.galen.org
CRS previews impact of health law on physicians
      PPACA has the potential to change fundamental aspects of how
      physicians organize, practice, and deliver care in the future.

      • Some of these provisions create new structures and entities, like the
        CMS Center for Medicare and Medicaid Innovation and the
        Patient-Centered Outcomes Research Institute

      • Others seek to develop alternatives to traditional fee-for-service
        payment, such as the National Pilot Program on Payment Bundling, the
        shared savings program (including the accountable care organization,
        or ACO, model), or the value-based payment modifier under the
        physician fee schedule

      In the long run, these provisions combined have the potential to be the most
      substantial of the PPACA and the Reconciliation Act modifications affecting
      physicians and related providers.


Patricia A. Davis, Jim Hahn, Paulette C. Morgan, Julie Stone, and Sibyl Tilson, ―Medicare Provisions in the Patient Protection and Affordable Care Act,
(PPACA): Summary and Timeline,‖ November 3, 2010, http://www.politico.com/static/PPM191_timeline.html.
Health care in 2012
   • Legislation
     Depends upon the outcome of the election
   • Regulation
     13,000+ pages so far
   • Legal
     Many other court challenges continue
   • Political
     The voters will ultimately decide on Nov. 6


www.galen.org
Americans agreed on goals for health reform…

       • The U.S. needs health reform to:
                – make coverage more affordable
                – assure quality, and
                – expand access to insurance
       • Most people rate their own coverage as
         good or excellent
       • They want stability. Change is for others.


www.galen.org
Independent Physicians Network 9/25/12
Even Europeans going the other way

                    • Consumerism
                    • Value of private enterprise
                      and competition
                    • Doctor-patient relationship
                    • Decentralized
                      decision-making




www.galen.org
A market-based solution
“Defined contributions” for health coverage
  A system that puts doctors and patients in charge of
  medical decisions

Restructuring financing for a 21st century health
sector
• Medicare
• Medicaid
• Private Insurance
Common themes

Focus on:
• Personal responsibility by recipients
• Better coordination of care
• Incentives for patient participation
• Doctors, not bureaucrats, decide
• Greater focus on patients
Why ObamaCare Is Wrong for America
          How does the health care law
          drive up costs?

          Is your doctor really in charge of
          your health care decisions?

          Are your Constitutional rights
          threatened?



          Discover the law’s impact on
          your life in a new book from
          four nationally recognized
          health policy experts

          Published by Broadside Books,
          an imprint of HarperCollins          www.WrongForAmericaBook.com


www.galen.org
Grace-Marie Turner
   A not-for-profit
 health and tax policy
research organization
                         Galen Institute
                         703-299-8900
                         gracemarie@galen.org




                         Subscribe to our free email alerts at
   /GalenInstitute
   www.galen.org         www.galen.org/subscribe
1 de 32

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Independent Physicians Network 9/25/12

  • 1. A not-for-profit health and tax policy research organization What’s coming and what it means for medical practice Grace-Marie Turner September 25, 2012 Independent Physicians Network /GalenInstitute www.galen.org
  • 3. Source: Ari Melber,‖POLL: Half of Americans Don’t Know How Court Ruled on Healthcare,‖ The Nation, July 4, 2012, http://www.thenation.com/blog/168720/poll-half-americans-dont-know-how-court-ruled-healthcare#.
  • 4. Americans’ views after Supreme Court decision • Americans say the health law will make things worse rather than better for taxpayers, businesses, doctors, and those who currently have health insurance. • Health care will be an extremely or very important issue for 82% of Americans in deciding their vote for the president in November. • Opposition to the law is higher now than before the Supreme Court decision. Sources: ―Americans: Healthcare Law Helps Some, Hurts Others ,‖ Gallup, July 16, 2012, http://www.gallup.com/poll/155726/Americans-Healthcare-Law- Helps-Hurts-Others.aspx. The New York Times/CBS News Poll, July 11-16, 2012, http://s3.documentcloud.org/documents/402362/jul12a-ocr.pdf. ―Kaiser Health Tracking Poll,‖ The Kaiser Family Foundation, July 2012, http://www.kff.org/kaiserpolls/upload/8339-C.pdf
  • 5. Source: Kaiser Family Foundation, July 2012.
  • 6. Americans agreed on goals for health reform… • The U.S. needs health reform to: – make coverage more affordable – assure quality, and – expand access to insurance • Most people rate their own coverage as good or excellent • They want stability. Change is for others. www.galen.org
  • 9. Taxes and spending in ObamaCare Source: Avik Roy, ―Fact-Checking the Obama Campaign's Defense of its $716 Billion Cut to Medicare,‖ Forbes: The Apothecary, August 16, 2012, http://www.forbes.com/sites/aroy/2012/08/16/fact-checking-the-obama-campaigns-defense-of-its-716-billion-cut-to-medicare/.
  • 11. ObamaCare’s New Taxes Source: Philip Dittmer and William McBride, ―Obamacare's New Taxes, And How You May Be Affected,‖ Tax Foundation, July 5, 2012, http://taxfoundation.org/blog/obamacares-new-taxes-and-how-you-may-be-affected.
  • 12. More ObamaCare Taxes Source: Philip Dittmer and William McBride, ―Obamacare's New Taxes, And How You May Be Affected,‖ Tax Foundation, July 5, 2012, http://taxfoundation.org/blog/obamacares-new-taxes-and-how-you-may-be-affected.
  • 13. Obamacare's 7 Tax Hikes On Under $250,000-A-Year Earners Source: Ebeling, Ashlea, Forbes Staff - "Obamacare's 7 Tax Hikes On Under $250,000-A-Year Earners,‖ http://www.atr.org/important-numbers-obama-a7130.
  • 14. The law fails to meet goals • Health costs and health spending increase • One-third of businesses may drop insurance • Young people worried about high cost of policies • Doctors concerned about Medicaid expansion and fraying the safety net • Seniors worried about rationing of care and finding a doctor who takes Medicare • 30 million will remain uninsured -- CBO www.galen.org
  • 19. Source: Frank Hill, ―The High Cost Impact of More Regulation and Admin/Executive Staff on Health Care Inflation,‖ Telemachus, July 22, 2012, http://www.telemachusleaps.com/2012/07/the-high-cost-impact-of-more-regulation.html.
  • 20. The AMA and practicing physicians • The SGR Medicare payment fix was its key bargaining chip • The chance for a permanent fix is missed; the president got the AMA endorsement for an empty promise • Budget concerns in the Congress mean short-term fixes are likely to continue www.galen.org
  • 21. The Doctors Co. Survey: – 60% say increased patient volume will hurt the level of care they can provide – 43% said they are thinking about retiring in the next five years – Nine out of ten said they would discourage friends and family members from pursuing a career in medicine http://www.thedoctors.com/TDC/PressRoom/PressContent/CON_ID_004671
  • 22. Physician concerns • Questions about Accountable Care Organizations • Authority of HHS Secretary to set new rules for quality of care • Regulatory requirements impacting private medical practices • More burdensome record-keeping www.galen.org
  • 23. Specific changes to watch • IPAB — the Independent Payment Advisory Board • Patient-Centered Outcomes Research Institute and comparative effectiveness ―guidelines‖ • Physician Quality Reporting Initiative • Value-based Payment Modifier www.galen.org
  • 24. CRS previews impact of health law on physicians PPACA has the potential to change fundamental aspects of how physicians organize, practice, and deliver care in the future. • Some of these provisions create new structures and entities, like the CMS Center for Medicare and Medicaid Innovation and the Patient-Centered Outcomes Research Institute • Others seek to develop alternatives to traditional fee-for-service payment, such as the National Pilot Program on Payment Bundling, the shared savings program (including the accountable care organization, or ACO, model), or the value-based payment modifier under the physician fee schedule In the long run, these provisions combined have the potential to be the most substantial of the PPACA and the Reconciliation Act modifications affecting physicians and related providers. Patricia A. Davis, Jim Hahn, Paulette C. Morgan, Julie Stone, and Sibyl Tilson, ―Medicare Provisions in the Patient Protection and Affordable Care Act, (PPACA): Summary and Timeline,‖ November 3, 2010, http://www.politico.com/static/PPM191_timeline.html.
  • 25. Health care in 2012 • Legislation Depends upon the outcome of the election • Regulation 13,000+ pages so far • Legal Many other court challenges continue • Political The voters will ultimately decide on Nov. 6 www.galen.org
  • 26. Americans agreed on goals for health reform… • The U.S. needs health reform to: – make coverage more affordable – assure quality, and – expand access to insurance • Most people rate their own coverage as good or excellent • They want stability. Change is for others. www.galen.org
  • 28. Even Europeans going the other way • Consumerism • Value of private enterprise and competition • Doctor-patient relationship • Decentralized decision-making www.galen.org
  • 29. A market-based solution “Defined contributions” for health coverage A system that puts doctors and patients in charge of medical decisions Restructuring financing for a 21st century health sector • Medicare • Medicaid • Private Insurance
  • 30. Common themes Focus on: • Personal responsibility by recipients • Better coordination of care • Incentives for patient participation • Doctors, not bureaucrats, decide • Greater focus on patients
  • 31. Why ObamaCare Is Wrong for America How does the health care law drive up costs? Is your doctor really in charge of your health care decisions? Are your Constitutional rights threatened? Discover the law’s impact on your life in a new book from four nationally recognized health policy experts Published by Broadside Books, an imprint of HarperCollins www.WrongForAmericaBook.com www.galen.org
  • 32. Grace-Marie Turner A not-for-profit health and tax policy research organization Galen Institute 703-299-8900 gracemarie@galen.org Subscribe to our free email alerts at /GalenInstitute www.galen.org www.galen.org/subscribe