by guest blogger, Christopher Dawes, CEO & President of Lucile Packard Children's HospitalLast week in Washington I had the honor of speaking to about 300 of America’s health care opinion leaders for The Atlantic magazine’s national forum. There were two panels, both of which focused on how providers, hospitals and patients will experience the implementation of the new health care laws.
These forums provided an important opportunity for me to:
- Express my personal support for and appreciation of the Obama administration and the House and Senate leadership for holding strong through a long process to success, from introduction of the bill to the signing ceremony. While the new law is imperfect, it includes many immediate and critical benefits for children, such as the bans on pre-existing conditions and annual and lifetime caps, the extension of dependent coverage through age 26, provisions to improve quality, and the first national Medicaid payment standard that should help to improve access.
- Explain that coverage does not equal access. Pediatrics and its subspecialties pay less than other specialties, and Medicaid reimbursement rates are much lower than Medicare. Together these add up to disincentives for young physicians to enter pediatrics. But even among practicing pediatricians, only 50 percent—according to the American Academy of Pediatrics—will see patients covered by Medicaid. The new laws intend to reverse this shortage by requiring that for two years Medicaid pay for evaluation and maintenance visits at Medicare rates. The laws also include a provision for a $30 million loan forgiveness program for physicians who choose to become pediatric subspecialists. Until these providers are trained and available appointments increased, children may still have to wait as long as six months to see a pediatric specialist.
- Disseminate knowledge about the difficulties of sustainability. As state budgets are shrinking at historic rates, children’s hospitals face significant cuts. This challenge will be exacerbated by the new law’s reduction of disproportionate share hospital (DSH) payments to those hospitals serving large populations of patients insured by Medicaid by a total of $14 billion through 2019. To this shrinking budget, the law adds a potential 16 million new Medicaid enrollees. Yet, many children’s hospitals already provided care to these patients when they were uninsured. Going forward, creating a sustainable model for universal health care will require deeper assessment of and adjustments to the new laws.
- Explore solutions that could resolve many of these challenges. These include bending the cost curve by supporting quality initiatives that work, such as the prevention of catheter-associated blood stream infections through a research collaborative created by NACHRI.
Like many people, our moderator, The Atlantic’s senior editor, Clive Crook, was genuinely shocked to learn that Medicaid varies so much from state to state and that patients cannot predict their eligibility status from one state to the next. In addition, as many providers in one state may accept Medicaid, there may be far fewer who do so in the next state, drastically reducing even an insured child’s access to needed care. Mr. Crook, like many of us, plans to follow these developments in the future.
The panel that I was on featured noted health care leaders, and health economists along with a fresh perspective from DeAnn Friedholm of the Consumer’s Union. Friedholm argued persuasively that the best part of the new law is its expansion of transparency to help patients and caregivers make vital decisions, a point of view we have long embraced throughout Lucile Packard Children’s Hospital.
At the end of the morning, Rep. Henry Waxman (D-CA), veteran of many past health care battles, spoke about his belief that health reform will need continuous tweaking in the coming years to fix the parts that need improvement and strengthen the parts that do the most good, provide the most savings and improve outcomes for the most patients. I was pleased and honored to hear Rep. Waxman echo my message of “coverage does not equal access” in his responses to questions. It is a terribly important message to convey.
The Atlantic magazine’s national health care forum raised my hopes that we may in fact be getting on the right track, at last, for the destination we all want: a health care system that works and provides the best outcomes for our patients. But there is still a long road ahead. Reform may be the law of the land now, but we must ensure this reform effort works to improve the health of every child.
Photograph courtsey of Sam Kittner.