Hospitalists on Healthcare: 'Politicians Can't Fix This'

Marcia Frellick

May 05, 2017

LAS VEGAS — As the US House of Representatives passed the American Health Care Act (AHCA) on Thursday, speakers here at the Society of Hospital Medicine 2017 Annual Meeting were weighing in on what's next.

"This bill will not become law," said Ron Greeno, MD, president and chair of public policy for the society and senior adviser for medical affairs at TeamHealth in North Hollywood, California.

"A bill may become law, but it will not be this one," he told Medscape Medical News.

The bill to repeal and replace the Affordable Care Act narrowly passed the House, as expected, on a mostly party-line vote of 217 to 213, but it is unclear what will happen in the Senate.

Still, any version of this bill will not stop the momentum of the change from fee for service to paying for value, Dr Greeno explained.

 
MACRA will have a greater impact on all US providers than any piece of legislation in our lifetime.
 

The strongest signal of that has been the bipartisan passage — with a vote of 92 to 8 — of the Medicare Access and CHIP Reauthorization Act (MACRA).

"Both parties understand that if we don't move away from rewards for production, we're going to continue to produce at a level that bankrupts the Medicare trust fund," he said.

"MACRA will have a greater impact on all US providers than any piece of legislation in our lifetime," he predicted.

As legislators debate which changes will give Americans affordable access to quality care, the bottom line in healthcare, according to Dr Greeno, is that "politicians can't fix this."

They can decide who pays more or less and who receives what services, but "that won't save us," he warned. "The only thing that can save our healthcare system is if we lower the cost of care. Only we can do that," with higher-value care without poorer outcomes.

 
I'm a longtime Republican, I'm a Republican lobbyist, so what you're hearing from me is stark reality. This bill is going nowhere.
 

The AHCA bill, in its current form, won't become law, said Jennifer Bell, cofounder of Chamberhill Strategies in Washington, DC, and lobbyist on the Hill for the Society of Hospital Medicine.

"I'm a longtime Republican, I'm a Republican lobbyist, so what you're hearing from me is stark reality," she said. "This bill is going nowhere. Republican Senate leader Mitch McConnell has already said he will not bring this bill to a vote."

Her personal affiliation does not affect her lobbying for the society, she emphasized, which is nonpartisan.

Hospitalists are very concerned about the aspects of the bill that will likely reduce insurance coverage, particularly the ban on further Medicaid expansion, because fewer patients will seek the care they need, Bell told Medscape Medical News.

"The American Health Care Act is about repealing Medicaid expansion more than anything else," she pointed out. But the bill goes beyond expansion to promote Medicaid reform, and many senators are not convinced this is the time to do that, she added.

Far more children are covered by Medicaid than by the Children's Health Insurance Program (CHIP), "so changes at the state level to Medicaid are quite serious," she explained.

According to current trends, Medicaid needs are growing so much that by early in the next decade, as much will be spent on Medicaid as on Medicare, Dr Greeno reported.

 
Both parties understand that if we don't move away from rewards for production, we're going to continue to produce at a level that bankrupts the Medicare trust fund.
 

"If we get to the point where we run out of money, think of how many people will not be covered. It will be calamitous," he said.

Positive system change could come from the example set by California, the first state to enroll all Medicaid recipients in a managed care plan that puts providers at risk and rewards them for lowering costs, he explained.

"Why don't they just put every Medicare patient on Medicare Advantage?" Dr Greeno asked. "The ones in it like it. Quite frankly, it's a political issue. The Republicans like Medicare Advantage and the Democrats don't."

Dr Greeno has disclosed no relevant financial relationships. Ms Bell is a lobbyist but has no other financial relationships.

Society of Hospital Medicine (HM) 2017 Annual Meeting. Presented May 4, 2017.

Follow Medscape Internal Medicine on Twitter @MedscapeIM and Marcia Frellick @mfrellick

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