Lawmakers, physician groups vow to fight for physician payment reform

The healthcare reform law falls far short of reforming a healthcare payment system that is bankrupting the nation, but progress remains possible, lawmakers and physicians agreed Tuesday at a panel on payment reform.

Sen. Tom Coburn (R-Okla.) launched the discussion, hosted by The Hill and sponsored by the American College of Cardiology, by acknowledging "we have designed exactly the tragedy that we have" — namely, a payment system, largely driven by Medicare, that pays for quantity rather than quality of care. That argument was repeated throughout the healthcare reform debate, but Coburn, a family physician, advocated for specific steps: 

• encourage physicians to spend more time with their patients by changing billing codes to consider time, skills sets and outcomes;
• create pilot programs in federal health programs that reward physicians who order fewer tests without decreasing the quality of care they provide; and 
• address the issue of medical liability.

Rep. Brian Baird (D-Wash.), a clinical psychologist, repeated his call for ending Medicare and Medicaid. His alternative would cover everyone by replacing the unwieldy array of federal and state health insurance programs with a needs-based voucher system.

Baird held out on supporting the healthcare reform law until the last minute because it fails to overhaul the existing programs. But he defended several provisions of the new law, particularly comparative effectiveness research he said is vital to rewarding quality care and keeping costs under control.

"Sadly," he said, "it is easy to sometimes demagogue that and say, 'Well, somebody wants to tell your doctor what they can do for you.' Well, if the doctor isn't doing what is right for you, maybe somebody ought to tell them that."

Both lawmakers agreed the only way to control costs is to give healthcare consumers incentives to choose the care that meets their needs.

"We will never control the cost of healthcare," Coburn said, "until we have a reconnection of the discriminating consumer."

Physician leaders vowed to work together to press for changes to the delivery system.

John Tooker, associate executive vice president of the American College of Physicians, said it was important going forward to make it clear that the debate "isn't about getting more money for doctors, this is really about improving the way healthcare is delivered to patients."

"The leadership of the major organizations in organized medicine will be necessary to make this happen," Tooker said. "Ultimately, though, I think (changes to delivery reform) will require building a coalition that will include other key stakeholders ... including consumers, employers, insurers."

The physicians added that political leaders also had a responsibility to leave rhetoric aside and work together to change the system.

Ralph Brindis, president of the American College of Cardiology (ACC), pointed out, for example, that Coburn and Medicare administrator Donald Berwick seem to have similar views on paying for quality, but Berwick has been vilified by Republicans as a proponent of rationing.

"A lot of people see the problems similarly and have opportunities where they could work better together to solve them as opposed to worry about who's getting all the credit," Brindis said. "We can all get the credit together."

Jack Lewin, chief executive officer of the ACC, said flatly that health reform "ain't going to get repealed." But physicians, the media and lawmakers need to work together to change the way care is paid for and delivered.

"Our fear," Lewin said, "is that we have more gridlock and that would be very unfortunate."