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In a political environment that changes by the hour, David W. Parke II, MD, the Academy’s executive vice president/chief executive officer, and William L. Rich III, MD, the Academy’s medical director for Health Policy, discuss the guiding principles that shape the Academy’s role in the debate on health care reform.
Dr. Parke: Bill, as we continue to move through the health care reform debate, many ophthalmologists are feeling helpless and frustrated with the process. Since ophthalmologists represent only 3 percent of the physician population, they feel helpless that their voice isn’t being heard. And, as physicians, they are frustrated because the embedded language of the bills is not based on data and scientific evidence.
Yet as the nation and media engage in debate on whether health care reform is necessary or if the public option is a good decision, several of our physician experts have taught us that focusing on the details—minor modifications to legislation—gives us the potential to make a dramatic difference in how we practice medicine. It’s not the media-grabbing headlines but rather the finer points of the legislation where the Academy will have the greatest impact.
Dr. Rich: I couldn’t agree with you more, David. Any health care reform in this economic environment brings with it confusion, strong emotions and misinformation that muddies any informed debate. As physicians, we are analytical and thus frustrated by this public relations phase of legislation. Consequently, we need to stay focused on our goals and make sure that the principles of the Academy are reflected in the pending legislation.
Dr. Parke: What are the principles guiding the process?
Dr. Rich: One of the major issues of the debate is how we pay for 44 million uninsured when the country is having a difficult time financing health care through public and private insurance. In addressing this issue, our core principles lead our actions: We want to see a pluralistic system, not a single-payer system. We want to see prudent allocation of society’s resources but not at the expense of fair payments to physicians. And we want to emphasize patient access to physicians and specialists.
Through the guidance of the Academy’s board of trustees, we are able to articulate these principles to the policy makers. The Academy also serves on the 10-member advisory panel of the American Medical Association and the American College of Surgeons. Through this coalition, we are making the voice of ophthalmology heard.
Dr. Parke: Bill, what are the advances we have achieved so far with the health reform bills?
Dr. Rich: Using our core principles, we are advancing several components for bills on both the House and Senate side that protect patients and physicians. Here is a quick overview:
- Getting rid of the 21 percent fee cut in physician Medicare payments scheduled for Jan. 1, 2010, which is driven by the sustainable growth rate (SGR) formula.
- Eliminating the egregiously unfair SGR, which, if left in place, would result in 40 percent in payment cuts scheduled to impact physicians under the Medicare program.
- Recognizing the need to enhance payments to primary care physicians but not at the expense of specialty physicians.
- Derailing the creation of an independent decision-making body that would have set and implemented payment policies and rates.
- Making sure that if a proposed public health insurance option does pass, physicians are not mandated to participate in it. Diligence is vital here; an initial proposal required Medicare-participating physicians to also participate in the public health insurance option.
- Understanding that while new Medicare payment options are inevitable in this health care reform climate, we seek to require that any new reimbursement mechanisms are proven and valid. For example, the model of bundling all services in one payment for an episode of care should undergo rigorous scrutiny and research before being permanently implemented.
- Recognizing the importance of increasing the quality of care provided by physicians, but seeking better administration of quality metrics so physicians who want to participate can have a positive impact on patients without burdensome administrative problems.
Let me add that a significant victory for the Academy was an agreement in the House bill to drop ultrasound and other office testing from Medicare imaging payment cuts. The new utilization policy is now limited to major imaging devices such as MRI, CAT and PET.
Dr. Parke: I want to point out that because almost all practicing ophthalmologists belong to the Academy, we have a tremendous advantage in this reform process. While we face different issues across our subspecialties, for example retina vs. refractive, we are all ophthalmologists first, and we recognize the power that this unity gives us. We work closely with the subspecialty societies, and when Academy representatives go to Capitol Hill to advocate for our profession and patients, there is no question in the minds of the legislators that we truly represent the profession.
Bill, from a historical perspective, how does the current health care debate compare to the Medicare legislation of the 1960s?
Dr. Rich: I think this current reform effort will have a greater impact on physicians and patients. To put this in perspective, it took from 1933 to 1964 to move toward a model that covered populations at risk, in this case the elderly. Today, we have a much bigger economic challenge—covering the uninsured. This is more far-reaching than Medicare. The most important thing we are trying to do is fight for the future of our younger doctors. We know they were attracted to the profession because they love ophthalmology and the stimulation provided by medicine. We want to leave them an environment where they can provide services to an aging population without altering the nature of our profession.
It is important that we all must face the reality that some sort of substantive change in the basic economics of health care will be made. We must continue to pursue a reasonable approach to health care reform, or we will see cuts resembling the 21 percent go into effect.
The way to get heard in this debate is to return again and again to our core principles. While we are constantly looking after the financial interests of our members, we come to the table with the goal of increasing quality and access of care for our patients, rather than focusing exclusively on payment schedules.
It is important for our members to know that we have done our background work, advocated for patients and members, and yet we are still not sure what the final product will be. What I am sure of is that when the dust settles, no one will be 100 percent happy. But we are hoping that patients, ophthalmologists and society will be better off.
Dr. Parke: Indeed, we could assume a strident, take-no-prisoners approach to this debate, yet we would make little impact because we wouldn’t be representing the greater interests of our members and our patients. Our professional happiness and success will be determined in large measure by the focused efforts we are making on certain key issues. None of us can afford to sit on the sidelines.