The Affordable Healthcare Act is Bad for Surgeons

Transcription

1 University of Colorado Department of Surgery The Affordable Healthcare Act is Bad for Surgeons Jessica A. Yu, R3 February 14, 2011

2 The Problem The Devil is in the Details

3 The Paradox Poor Value for the Money ~$8,000 per person/annually 17.6 % of GDP 50 million adults (17%) still uninsured

4 The Paradox Poor Value for the Money From RWJF, Center on Social Disparities in Health. Britt, J Am Coll Surg 2011;212:141-9.

5 Patient Protection and Affordable Care Act Four Main Components Improve access to primary care Better regulate the insurance industry Increase value (value = quality/cost) Sounds good, if we knew how to measure it Align provider incentives For which our track record is poor??

6 Healthcare Reform Surgeon Priorities The Patient Improve access and reduce disparities Improve quality Improve patient safety Workforce issues Tort reform ACCESS SAFETY QUALITY Britt LD, J Am Coll Surg 2011;212:141-9.

7 Patient Protection and Affordable Care Act Bad For Surgeons Spending less while doing more = less resources per patient Thus putting each of our priorities at risk ACCESS SAFETY QUALITY

8 Patient Protection and Affordable Care Act Bad For Surgeons Improve access and reduce disparities Limited funds Rationing care Quality improvement and Patient Safety Limited funds Innovation takes a hit while we fully fund reporting and quality initiatives that have historically small effect on outcomes Workforce issues Decreased compensation, erosion of autonomy and work ethic, no funding for resident positions

9 PPACA is Bad for Surgeons Rationing Care Bundled payments for procedures not a new concept Limited funds rationing of care provided to higher-risk patients Eventually need risk-adjusted models to evaluate quality, value, and compensation for all procedures Who will generate these risk-adjusted models? How will they be validated?

10 PPACA is Bad for Surgeons Rationing Care In the absence of tort reform, re-emphasizing clinical acumen means little Proceduralits receive bundled payments but consultants are paid by number of patient visits. In the absence of aligned provider incentives, bundled payments are just another excuse to disagree

11 PPACA is Bad for Surgeons QI - Putting the Cart Before the Horse Mandates the Physician Quality Reporting Initiative (PQRI) - incentives for reporting and penalties for not reporting Simultaneously authorizing $1.1 billion for Patient- Centered Outcomes Research Institute (PCORI) that determines the reporting measures Danger of being rated based on measures that will eventually have little impact on patient outcomes

12 PPACA is Bad for Surgeons QI - Putting the Cart Before the Horse Surgical Care Improvement Project Aim to reduce preventable surgical mortality and morbidity by 25% by 2010 Compliance Outcomes 15 of 16 correlations were nonsignificant Ingraham JM, J Am Coll Surg 2010;210:

13 PPACA is Bad for Surgeons Workforce Issues Lower preventive mortality associated with presence of a PCP Primary Care Resident Expansion program 5yr initiative Trauma centers has lowered mortality rates by 30% Surgeons are essential for the management of successful trauma centers No increased funding for surgery residency positions Loan repayment incentives limited for general surgeons though training is at least two years longer Sheldon GF, J Am Coll Surg 2010;210:

14 PPACA is Bad for Surgeons The View From 10,000 feet Medicine has become the art of managing extreme complexity and a test of whether such complexity can, in fact be humanly mastered.

15 We haven t agreed on how to define or measure value We haven t agreed on who will define value measures physicians, insurance co, independent researchers We haven t agreed on how we will monitor our progress We haven t agreed on how gains in value will be appropriately risk-adjusted and compensated

16 PPACA is Bad for Surgeons Summary Limited funds Rationing care Limited funds Innovation takes a hit. While we fund initiatives that minimally effect patient outcomes yet can negatively impact patient confidence Workforce shortage, compensation, and tort reform have not been adequately addressed

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