GOP DOCTORS' CAUCUS

Rep. Murphy

Washington, Feb 24 -

February 24, 2010

The Honorable Paul Ryan
113 Longworth HOB
Washington, DC 20515

Dear Mr. Ryan,

Americans want quality reforms that will improve the delivery of healthcare at a lower cost. True healthcare reform legislation would eliminate the $800 billion to $1 trillion of waste in the $2.5 trillion healthcare system. Unfortunately, the President’s newest proposal will make healthcare more expensive and use more taxpayer dollars to finance a broken system.

Combating waste and fraud is crucial to reducing costs, but we’re ignoring why the system is so costly. Ninety-five percent of Medicare spending is for chronic diseases like hypertension, heart disease, and diabetes. Much of that spending is for tests, procedures, and hospitalization. This fee-for-medical service model has been in place with little or no modification since Medicare and Medicaid were established in the 1960s. In the meantime, approaches to disease management have advanced considerably.

A February 2008 report by the New England Healthcare Institute found that in a $2.5 trillion healthcare system — 75% of which is spent on chronic disease — $800 billion is spent on treatments and procedures that are not the most effective or efficient.[1] Other studies have repeatedly found that healthcare dollars are better spent on treating diseases with evidence-based standards and protocols that manage and integrate care rather than pay for piecework performance, tests, exams, and procedures.

Congress would do well to focus on fixing the system rather than raising taxes to pay for the old system. It is far more medically and cost-effective to use a disease management approach to chronic illness where staff actively ensures patients adhere to prescribed treatments between the doctor and patient, and actively integrate care across medical disciplines.

 
Reported Benefits From Chronic Disease Management By Insurers and Providers
• UPMC in Pittsburgh reduced hospitalization rates for diabetic seniors by 75%.
• Washington Hospital in Washington, PA cut admission rates by 50% for heart disease patients.
• Gateway Health Plan in Southwestern Pennsylvania reduced asthma-related hospitalizations by 28% for Medicaid beneficiaries.

Here are specific ideas that will improve the quality of care and reduce healthcare costs:

1. Fix Federally-Funded Care First. Create a quality reform commission, comprised of doctors, hospital administrators, and other experts in healthcare to update Medicaid and Medicare. The commission will identify and fix inefficiencies in Medicare and Medicaid — allowing more money to be dedicated to improved care, not simply payment for services rendered. Initially, the commission will focus on establishing disease management standards for the top chronic diseases such as heart disease, cancer, stroke, chronic obstructive pulmonary disease and diabetes. If Medicare paid for some level of chronic disease management, the program would ultimately save money from avoidable hospitalizations and complications.

2. Promote Evidence-Based Medicine. Establish Standards of Clinical Excellence developed by clinicians, university researchers and healthcare providers for doctors to reference in determining optimal delivery of care for patients. The wide variability nationwide in treatments and medication use is often below clinical efficacy. This accounts for more than $600 billion in waste. Standards of Clinical Excellence would be updated regularly and be part of what doctors can easily access in “intelligent” electronic medical records and could be applied as models of care, but doctors would have the authority to tailor the treatment to the unique needs of the patients. These standards should not be based on government panels of non-medical comparative effectiveness research. Rather, they should utilize the clinical standards and protocols established by the American Academy of Pediatrics, American College of Surgeons, etc.

3. Quality Transparency. Require transparency for identifiable problems such as hospital-acquired infections — a $50 billion a year cost to our healthcare system. And reward hospitals with good records. When a patient enters a hospital, he or she should be assured that their condition will be treated. No one enters a hospital to become sicker. Nearly 100,000 out of the two million people who acquire an infection at a hospital will die . That’s more than the deaths caused by AIDS, breast cancer, or auto accidents. For example, H.R. 3104, the Healthy Hospitals Act would require hospitals and ambulatory surgical centers to report data on infections patients have acquired during their stay using the National Health Safety Network at the Centers for Disease Control. This information would be posted online for the public to review, compare, and ultimately bring the market to bear on reducing HAI and its associated costs. The mean total hospital charge for patients with a hospital-acquired infection was $191,872, while the average cost for those patients without such infections was $35,168. The handful of states that currently publish this information demonstrate considerable improvement in lives and dollars saved. There are also other areas where we should push for transparency that improves quality and drives down costs.

4. Better Primary Care Access. 56 million Americans lack sufficient access to primary care because there is a physician shortage in their neighborhood. Regular primary care is associated with better care, disease prevention, and cost savings. A June 2009 Government Accountability Office report found that doctors and nurses choose not to volunteer their time at federally-funded community health centers (CHC) because medical liability insurance often costs between tens of thousands and $100,000 a year. We can ensure that many of these uninsured and underinsured people see a doctor by covering CHC volunteer physicians under the Federal Torts Claim Act – and for a mere $1.5 million a year. Oddly enough, physicians who volunteer at a free clinic are covered by the FTCA. H.R. 1745, the Family Health Care Accessibility Act would give FTCA protection to CHC volunteer doctors. This legislation will save Medicaid from having to pay costly hospitalizations that result from a lack of primary care. From July 2007 to June 2008, Floridians received $41.15 million worth of services from the 9,278 health professionals who volunteered through this program.

Real healthcare reform means innovation in medicine, preventive care, collaborative care, and disease management programs. Real insurance reform gives people the choice to purchase insurance across state lines, the choice to pool together and purchase insurance in groups, and adopt standards that make insurance personal, permanent, and portable. Instead, the President wants to tax medical devices, pharmaceuticals, and insurance policies. This will accomplish the opposite of the reform effort’s purported goal to lower healthcare costs.

Instead of making medical care more expensive through higher taxes and more bureaucracy, Congress must implement changes to care delivery that reward wellness, not just treatments, and reestablish the doctor-patient relationship as the center of improved healthcare. It is my hope that Congress can still enact a product that will include real reforms making quality healthcare affordable for all.

The fundamental difference in the plan put forth by the Democrats and the President versus true healthcare reform is that their plan will increase costs by a trillion dollars. Our plan can yield several hundred billions in healthcare savings a year.

Sincerely,

Tim Murphy
Member of Congress

Cc:       Minority Leader John Boehner
The Honorable Eric Cantor
The Honorable Dave Camp
The Honorable Joe Barton
The Honorable John Kline