Surgery News - August 2007 - (Page 3)

AUGUST 2007 • SURGERY NEWS NEWS Different Countries Face Similar Health Care Issues BY ERIK GOLDMAN Else vier Global Medical Ne ws WA S H I N G T O N — The globalization of health care is creating challenges for health care systems worldwide. Though the systems themselves may be very different in terms of financing and administration, the problems they must address—aging populations, increasing chronic disease, shrinking budgets, extreme mobility of both patients and health care professionals—are very similar. Health care analysts, administrators, and providers compared notes on these challenges at the fourth annual World Health Care Congress, sponsored by the Wall Street Journal and CNBC. “Despite the fact that health care may be organized and financed very differently in different countries, and there may be cultural differences, there are a lot of common themes, and shared objectives for high-performing health care systems, innovation, and sustainability,” said Robin Osborn, director of the International Program in Health Policy and Practice at the Commonwealth Fund. Simon Stevens, who served as a health care advisor in U.K. Prime Minister Tony Blair’s cabinet, said the United States is not alone in confronting a major health care crisis. Single-payer na- tional health systems of the sort around employer-funded health found in the United Kingdom care are not uniquely American. Corporations in many Euroand all over Europe make the dynamics a bit different, but they pean countries are footing the certainly do not avert the crises. bill for significant chunks of “Despite differences in financ- health care spending. “In the ing mechanisms, the challenges U.K., 52% of spending is private are similar across all industrial- sector spending, despite the fact ized nations. Tobacco, bad diet, that the delivery systems are govlack of exercise are driving the ernment funded,” he explained. Across the globe, health care is conditions that result in the greatest consumption of health increasingly a transnational encare resources, and tensions are deavor, with immigration, reloerupting across [health care] sys- cation, medical travel, and multitems due to changes in financing. AGING POPULATIONS ARE THE The U.S. is not the only country debating these isJUGGERNAUTS STRAINING sues. The challenges are the HEALTH CARE SYSTEMS IN same regardless of how you choose to finance the health NEARLY ALL INDUSTRIALIZED care,” said Mr. Stevens, now COUNTRIES. the CEO of UnitedHealth Group’s Ovations, a health plan for individuals over age 50. national business blurring Aging populations are the jug- borders. The establishment of gernauts straining health care the European Economic Comsystems in nearly all industrial- munity, the paragon of economized countries. Over the next 30 ic boundary breaking, has creatyears, the dependency ratio, an ed an interesting health care expression of the number of el- quandary, said Mr. Stevens. “In the earlier days of the [Euderly nonworking dependents versus younger working people, ropean Union], many had hopes “will grow rapidly in the U.S., that the confederation would lead Western Europe, Japan, and Chi- to harmonization of health care na. And this will radically change benefits. Not so. Per capita spendhow health care is financed,” Mr. ing on health care in Eastern and Western Europe is fourfold difStevens said. He added that while Ameri- ferent. Western Europe spends can corporate leaders have been way more. It is implausible to screaming the loudest, the issues have a set of uniform benefits that are acceptable in Germany but unaffordable in Slovakia.” Migration also has an impact. More people are living outside their countries of origin, and this makes for some peculiar health care dilemmas. Mr. Stevens noted that in many parts of the world, national borders are blurred. “In California, for example, we know there are 8 million Hispanics living in border counties. Many have dependents across the border in Mexico. How do we handle that? Can we mandate that dependents of U.S. employees only be treated in clinics in Mexico?” At the other end of the socioeconomic spectrum, thousands of retired U.S. citizens living in Mexico, Costa Rica, Panama, and other Central American countries are eligible for Medicare, but unable to get coverage for medical services or drugs they obtain where they live. “Does this mean these people must fly back to the U.S. every time they need medical care?” Physicians, nurses, and other medical personnel also have become highly mobile, often moving far from their countries of origin to countries of perceived opportunity. As just one example, Mr. Stevens said there are more Filipino nurses, born and trained in the Philippines, working in the United States than there are in the Philippines. In the European Union, there are significant migratory flows of health care professionals from east to west. This can result in shortages of qualified professionals in many countries, hindering the growth and development of their medical systems. Ironically, it is the influx of international patients seeking lower-cost health care that will be an important driver for the development of hospitals and the retaining of health professionals in nations such as Thailand, India, Hungary, and many Latin American countries. Health plan administrators are struggling to figure out ways to do business without borders. The challenges are daunting, said UnitedHealth Group’s Ori Karev. Speaking specifically of coverage for Americans obtaining care outside the United States, he noted, “There are a lot of complicated issues involved in this: transportation issues, authorization issues, tax issues in terms of the ways in which the IRS will treat medical travel expenses.” As countries such as India, Thailand, China, Brazil, and others become more affluent, their health care spending will increase, as will the number of risksharing plans. UnitedHealth Group is already a major health insurance player in India, with an employer-funded plan now covering 300,000 members via a large provider network. ■ CMS Projects 9.9% Cut in Medicare Payments for 2008 B Y M A RY E L L E N S C H N E I D E R Else vier Global Medical Ne ws a nearly 10% Medicare payments in if ConPhysicians will facereverse2008 thecut in gress does not act to it in next few months. Officials at the Centers for Medicare and Medicaid Services published a proposed rule outlining the projected 9.9% payment cut and other policy changes under the Medicare Physician Fee Schedule in the July 12 Federal Register; the agency will accept comments until Aug. 31. The final fee schedule rule will be published later this year. A 9.9% cut would have devastating consequences for physicians and patients alike but is unlikely to be carried out, physicians said in interviews. Instead, Congress is likely to provide a 1- or 2-year temporary reprieve as it has done for the past 5 years. By law, CMS officials must adjust physician payments according to the sustainable growth rate (SGR) formula, which calculates physician payments based in part on the gross domestic product. The major medical specialty societies have been lobbying for years to change the formula, which they say does not account for their rising practice costs. The projected cuts would also threaten to derail the voluntary CMS’ Physician Quality Reporting Initiative (PQRI) that began July 1, said Dr. Richard Hellman, president of the American Association of Clinical Endocrinologists. The PQRI program gives physicians a chance to earn up to a 1.5% bonus payment on all of their allowed Medicare charges if they report on certain quality indicators. CMS officials have touted the program as the first step in aligning payments with quality. But a significant payment cut could hamper those efforts, Dr. Hellman said, noting that physicians are unlikely to put the effort into a time-consuming, resource-intensive program where they can earn a 1.5% bonus when facing a 9.9% payment cut at the same time. The proposed rule also addresses the continuance of PQRI in 2008, and outlines new quality measures for next year. CMS officials are also considering the feasibility of accepting clinical data from electronic health records. The agency will weigh whether to accept data on a limited number of ambulatory care PQRI measures for which data may also be submitted under the current Doctors Office Quality Information Technology Project (DOQ-IT). In 2008, submission through an electronic health record would be an al- ternative to the current claims-based reporting of data. The proposed rule also outlines ways the agency would like to test the use of clinical data registries to report PQRI data. The testing, which would begin 2008, would evaluate methods for physicians to report data to clinical data registries and the registries to submit the data on the physician’s behalf to CMS. For example, the Society of Thoracic Surgeons has a national database registry that collects quality data on cardiac surgeries, including two PQRI quality measures. However, under the current setup for 2007 and 2008, physicians must report these measures separately to CMS through the claimsbased reporting process. CMS officials are proposing to fund the bonus payments for the 2008 PQRI program by using $1.35 billion provided by Congress as part of the Physician Assistance and Quality Initiative Fund. In the proposed rule, CMS said the bonus payments were likely to be about 1.5% of allowed Medicare charges, not to exceed 2%. That decision was criticized by the American Medical Association and other medical and surgical specialty societies, including the American College of Surgeons (ACS), which said the $1.35 billion should be used to reduce the projected 2008 physician pay cut. CMS estimates the $1.35 billion would reduce the projected cut by about 2%. “While we certainly support the concept of quality measurement, it makes no sense to try and ‘incentivize

Table of Contents Feed for the Digital Edition of Surgery News - August 2007

Contents Drug Developments News From the College Thoracic Surgery Head & Neck Surgery

Surgery News - August 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.