J. James Rohack, MD, FACC President, AMA Director, Scott

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J. James Rohack, MD, FACCPresident,
AMADirector, Scott White Center for Healthcare
PolicyProfessor of Medicine and Humanities,
TAMHSC

• Information Only
• ACC Board of Governors
• September 13, 2009
• Heart House

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AMA Priorities for Health System Reform-Update
from Dr. James Rohack

• Expand coverage and choice
• Public sector reforms
• Improve quality and patient safety
• Reduce costs
• Enhance prevention and wellness
• Payment and delivery system reforms
• J. James Rohack, MD, FACC, FACP
• President, American Medical Association
• Director, Scott White Center for Healthcare
  Policy
• Professor of Medicine and Humanities, TAMHSC

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Expand Coverage and Choice

• Provide subsidies to low-income (e.g., tax
  credits) to help purchase health insurance
• Enable individuals to purchase insurance through
  FEHBP or other options
• Make regressive tax policies more progressive
• Support direct subsidies for high-risk patients
  (e.g., risk pools, reinsurance)
• Require a greater level of individual
  responsibility
• Implement health insurance market reforms
• Continue to oppose single-payer plans

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Public Sector Reforms

• Enroll SCHIP eligible children and expand
  eligibility to higher percentages of FPL
• Eliminate existing Medicaid categorical
  requirements and establish uniform eligibility
  for all below 100 of FPL
• Replace Medicare SGR with alternative update
  methodology
• Eliminate subsidies for Medicare Advantage
• Allow use of public sector contributions to
  support existing private coverage
• Improve physician payment levels

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The Medicare DilemmaPractice Costs vs. Medicare
Payment Updates
Practice Costs
Medicare Cuts
Physician cost data is from the MEI, a
conservative measure of practice cost growth
maintained by CMS. Medicare cuts are from the
2008 Medicare Trustees report, with adjustments
to reflect Sec. 131 of P.L. 110-275. Prepared by
American Medical Association, Division of
Economic and Health Policy Research, August 2008.
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Improve Quality and Patient Safety

• Develop quality measures and appropriateness
  standards
• Develop evidence-based performance measures that
  enable continual QI and are the basis for
  rewarding high quality, cost-effective, safe care
• Support practice-based solutions (e.g., HIT,
  decision support, continual performance
  monitoring) that enable incorporating measurement
  into practice to support QI
• Evaluate and improve PQRI
• Facilitate physician involvement with patient
  safety organizations

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Reduce Costs

• Reduce the burden of preventable disease and
  better manage chronic disease
• Support comparative effectiveness research
• Address variation in the utilization of health
  care services, particularly at the state/regional
  level
• Make health care delivery more efficient
• Reduce non-clinical costs that do not contribute
  value to patient care

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Enhance Prevention and Wellness

• Support integrated approach to encourage the
  adoption of healthy lifestyles for physicians and
  their patients
• Urge the inclusion of wide range of
  evidence-based preventive services in insurance
  plans
• Support adequate federal funding for biomedical
  research, including prevention
• Encourage CBO to score the long- and short-term
  budget deficit reductions and costs associated
  with prevention
• Eliminate racial, ethnic and gender disparities
  through infrastructure and programmatic change

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Payment and Delivery System Reforms

• Develop physician-relevant HIT systems (e.g.,
  interoperability) and provide incentives to build
  the infrastructure
• Develop value-based payment methodologies (e.g.,
  patient-centered medical home, management of
  chronic disease)
• Pursue antitrust relief, fair physician
  contracting, and greater transparency
• Enact alternative medical liability reforms

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Four Ways to Reduce Costs

• Administrative simplification, standardization,
  and transparency to support effective markets
• Aligning quality and efficiency incentives so
  physicians, hospitals, and other health care
  providers work together towards the same high
  standards
• Coordinated care, using evidence-based best
  practices to reduce hospitalization and manage
  chronic disease, and implementing proven clinical
  prevention strategies
• Reducing costs through improved care delivery
  models, health information technology, workforce
  deployment and development, and regulatory
  reforms

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AMA Prescription for Healthcare Reform

• Affordable Coverage for All
• Prevention and Personal responsibility
• Quality Improvement
• Reducing Costs
• Delivery Reform
• Fiscal Responsibility and Sustainability

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2009 ACC Legislative Conference

• We in America do not have government by the
  majority. We have government by the majority who
  participate.
• Thomas Jefferson3rd president of US (1743 -
  1826)