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Health Care Reform

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University of Texas Southwestern Medical Center Dallas, Texas ... Medical Malpractice. Rise in defensive medicine. Presently at the center of many access problems. ... – PowerPoint PPT presentation

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Title: Health Care Reform


1
  • Health Care Reform
  • Protecting the Patient-Physician Relationship
  • David E. Rogers, MD, MBA
  • Assistant Prof. Obstetrics and Gynecology
  • University of Texas Southwestern Medical Center
    Dallas, Texas

2
  • The Patient-Physician Relationship

Much more than what we see in television and
movies.
3
The Deterioration of the Patient-Physician
Relationship
  • Depersonalization of Practice
  • Managed Care and Physician Networks have led to
    physicians being bought and sold like
    commodities.
  • Loss of Autonomy and Administrative Hassles
  • Institutional and governmental oversight and
    regulation. Practice guidelines.
  • Medical Malpractice
  • Rise in defensive medicine. Presently at the
    center of many access problems.
  • Lower Reimbursement
  • Doctors have to be able to keep their doors open.
  • Information Technology Computers
  • Is it good or bad for patients?

4
Physician Problems with Healthcare Reform
  • The practice of medicine is enormously COMPLEX!
  • The unavoidable Paradox
  • COST QUALITY ACCESS
  • We can only control TWO at a time.

5
  • Texas Medical Association
  • 2008
  • Physician Survey Data

6
  • Being insured does not necessarily give access
    to care

Insurance ? Health Care
7
From 2008 TMA Physician Survey
8
From 2008 TMA Physician Survey
9
From 2008 TMA Physician Survey
10
  • Why dont physicians accept all payers?

11
From 2008 TMA Physician Survey
12
From 2008 TMA Physician Survey
13
From 2008 TMA Physician Survey
14
Physician Cost/Revenue Comparison
Sources MGMA Cost Survey (medians), Centers for
Medicare Medicaid Services , Medicaid Fee
Schedule
Note Cost and revenue are reported here per
Relative Value Unit a Medicare measure of the
units of service produced. One RVU is
approximately the value of the simplest office
visit for a new patient.
15
The Bottom Line with Medicare / Medicaid
  • RVUs are measures of services provided.
  • MGMA measured practice cost 58 / RVU.
  • Medicare pays 36 / RVU.
  • The 22 deficit represents a NEGATIVE 38
    OPERATING MARGIN for a practice if it were a
    totally government reimbursed practice!

16
Government or insurance programs might
not improve access to care if they
  • Increase the administrative cost for physicians
    and patients
  • Take too much of the physicians time and
    attention away from patient care
  • Pay less than it costs the physician to provide
    care
  • Increase demand for physician care more than they
    increase physician supply.
  • Increase payment problems, inadequacies and
    inefficiencies which will decrease physician
    supply or decrease the number of patients than
    can be treated by physicians.

17
Challenges for the Public and Government
  • Understand / Respect the enormous training and
    sacrifice it takes to become a physician.
  • Understand the enormous COMPLEXITY of medical
    care.
  • Understand the COST QUALITY ACCESS paradox.
  • Understand that medical decisions are best left
    in the hands of patients and their physicians.

18
Challenges for Physicians and other Providers
  • Continue to take care of our patients! JOB 1
  • Understand the COST QUALITY ACCESS paradox.
  • Be willing to participate in the solution making
    process.
  • Understand that when the dust settles on whatever
    type of health care reform we have…the
    Patient-Physician Relationship may be the only
    aspect of healthcare where we still have some
    influence.

19
UT Southwestern Medical Center
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