OUTLINE OF HEALTH CARE PLANOUTLINE OF HEALTH CARE PLAN

RICHARD R. SCHNEIDER, MDRICHARD R. SCHNEIDER, MD

F.A.C.P., F.A.C.C.F.A.C.P., F.A.C.C.

Health Care PlanHealth Care Plan

  

Medical Provider Value Medical Provider Value ScoreScore

By Richard R. Schneider, MDBy Richard R. Schneider, MD

      Value = Value = Outcome score X severity of Outcome score X severity of

illness scoreillness score

    Average cost per patientAverage cost per patient

  

HEALTHCARE COSTSHEALTHCARE COSTS

1.1. $ 2.2 Trillion per year total $ 2.2 Trillion per year total

2.2. 300 million Americans equals > $7000 300 million Americans equals > $7000 per personper person

3.3. Recent estimate by Price Waterhouse Recent estimate by Price Waterhouse more than One Trillion Dollars wasted more than One Trillion Dollars wasted every yearevery year

4.4. 31% Overhead 31% Overhead

5.5. Massive over utilization of resourcesMassive over utilization of resources

What We Get for Our What We Get for Our MoneyMoney

54% correct diagnosis and treatment 54% correct diagnosis and treatment (Rand (Rand corporation, New England Journal of Medicine)corporation, New England Journal of Medicine)

Huge numbers of medical errorsHuge numbers of medical errors 47 million uninsured at any given time47 million uninsured at any given time 75 million uninsured during any given year75 million uninsured during any given year

Solving the ProblemSolving the Problem

Republicans want a “market based Republicans want a “market based solution”solution”

Democrats want Universal affordable Democrats want Universal affordable coveragecoverage

Everyone wants more for their moneyEveryone wants more for their money

Creating a “Medical Creating a “Medical Marketplace”Marketplace”

The market for medical care today simply does not exist. One must be The market for medical care today simply does not exist. One must be created.created.

Markets require knowing what you’re getting and how much it costs.Markets require knowing what you’re getting and how much it costs. To know what you’re getting: Must Measure severity of illness adjusted To know what you’re getting: Must Measure severity of illness adjusted

outcomes.outcomes. To know what your paying: Must measure resource expenditure to achieve To know what your paying: Must measure resource expenditure to achieve

those outcomes.those outcomes. Grade “A” providers: Excellent outcomes/low cost per patient.Grade “A” providers: Excellent outcomes/low cost per patient. Grade “B” providers: Good outcomes/average cost per patientGrade “B” providers: Good outcomes/average cost per patient Grade “C” providers: Poor outcomes/high cost per patientGrade “C” providers: Poor outcomes/high cost per patient Must maintain “fee for service” payment schedule for doctors. Pay “A” Must maintain “fee for service” payment schedule for doctors. Pay “A”

providers 10% higher reimbursements. Pay “C” providers 10% lower providers 10% higher reimbursements. Pay “C” providers 10% lower reimbursements.reimbursements.

““Report cards” must be made public so patients can chose the best doctors. Report cards” must be made public so patients can chose the best doctors. (Similar to recent recommendations by The Institute of Medicine.)(Similar to recent recommendations by The Institute of Medicine.)

Doctors must have easy and rapid appeals process to correct mistakes in Doctors must have easy and rapid appeals process to correct mistakes in their “report cards”their “report cards”

Accurate Quality Accurate Quality MeasurementMeasurement

Accurate outcome measures can be obtained by simply using the same Accurate outcome measures can be obtained by simply using the same statistical tools that have been used for decades to perform clinical trials statistical tools that have been used for decades to perform clinical trials of medications and procedures. These analytic techniques are scalable of medications and procedures. These analytic techniques are scalable to large numbers of physicians using powerful modern computer to large numbers of physicians using powerful modern computer technologies.technologies.

Only outcome measures are meaningful; “process” measures are Only outcome measures are meaningful; “process” measures are meaningless because they do not correlate with better patient outcomes.meaningless because they do not correlate with better patient outcomes.

Outcome measures are only scientifically and mathematically accurate if Outcome measures are only scientifically and mathematically accurate if they take into account initial severity of illness.they take into account initial severity of illness.

Quality and cost measurements must use uniform criteria and adequate Quality and cost measurements must use uniform criteria and adequate sample sizes and be performed by an unbiased organization. Hospitals sample sizes and be performed by an unbiased organization. Hospitals and insurance companies or HMO’s are and insurance companies or HMO’s are notnot unbiased. Only the Federal unbiased. Only the Federal Government can be trusted.Government can be trusted.

Physician Associations and Congress need to work together to devise Physician Associations and Congress need to work together to devise methodology and quality criteria.methodology and quality criteria.

Which is more important, to measure the performance statistics for Which is more important, to measure the performance statistics for thousands of professional athletes or hundreds of thousands of thousands of professional athletes or hundreds of thousands of professional physicians?professional physicians?

Medicare for AllMedicare for All

“ “We hold these truths to be self evident…the We hold these truths to be self evident…the right to life, …”right to life, …”

When these words were written doctors could do little to prolong life.When these words were written doctors could do little to prolong life. In the 21In the 21stst Century, if one doesn’t have access to healthcare, one Century, if one doesn’t have access to healthcare, one

doesn’t have the right to life.doesn’t have the right to life. Denying healthcare to anyone is simply Un-American. This is a self Denying healthcare to anyone is simply Un-American. This is a self

evident truth and is not debatable. Period.evident truth and is not debatable. Period. Recent opinion polls indicate a majority of the public and of Recent opinion polls indicate a majority of the public and of

physicians are in favor of more government involvement in physicians are in favor of more government involvement in healthcare.healthcare.

Universal CoverageUniversal Coverage Expand “fee for service” Medicare to cover all Expand “fee for service” Medicare to cover all

Americans.Americans. Medicare to measure severity of illness adjusted Medicare to measure severity of illness adjusted

outcomes and resource utilization for all outcomes and resource utilization for all providers.providers.

Resource utilization includes: cost of Resource utilization includes: cost of medications, testing costs, cost of medications, testing costs, cost of hospitalizations, surgeries and other procedures, hospitalizations, surgeries and other procedures, etc.etc.

Outcomes measurement includes severity of Outcomes measurement includes severity of illness adjusted mortality, morbidity, and illness adjusted mortality, morbidity, and measurements of clinical improvement.measurements of clinical improvement.

Benefits to Benefits to WhistleblowersWhistleblowers

Government will track quality of care for all doctorsGovernment will track quality of care for all doctors.. Whistleblowers will not be needed to report poor quality Whistleblowers will not be needed to report poor quality

care. Good doctors should not have to be courageous to care. Good doctors should not have to be courageous to protect their patients.protect their patients.

The excellent quality of care provided by many The excellent quality of care provided by many whistleblower physicians will be documented and whistleblower physicians will be documented and available to be used in their defense.available to be used in their defense.

High quality low cost doctors will generate more revenue High quality low cost doctors will generate more revenue for their practices or institutions and will therefore gain in for their practices or institutions and will therefore gain in power and influence over low quality high cost doctors.power and influence over low quality high cost doctors.

Economic SavingsEconomic Savings Reduce overhead from 31% to 16% saving > Reduce overhead from 31% to 16% saving >

$300 billion/ year.$300 billion/ year. Reduce resource utilization by 15% saving > Reduce resource utilization by 15% saving >

$300 billion/year.$300 billion/year. Massive reduction in episodes of malpractice Massive reduction in episodes of malpractice

with associated dramatic reduction in with associated dramatic reduction in malpractice premiums.malpractice premiums.

Redirect part of economic savings into Medicare Redirect part of economic savings into Medicare funding to pay for universal coverage and funding to pay for universal coverage and increased reimbursements for doctors.increased reimbursements for doctors.

Benefits for Doctors and Benefits for Doctors and HospitalsHospitals

All physician services are fee for service.All physician services are fee for service. 47 Million new “paying customers”. No need to provide 47 Million new “paying customers”. No need to provide

“free care”. No bad debt to write off.“free care”. No bad debt to write off. Patients free to chose any doctor including specialists Patients free to chose any doctor including specialists

without “gate keepers”.without “gate keepers”. Doctors will regain professional autonomy. The interests Doctors will regain professional autonomy. The interests

of doctors and patients will be realigned.of doctors and patients will be realigned. Treatments and tests not subject to excessive scrutiny Treatments and tests not subject to excessive scrutiny

and denials.and denials. Greater financial and job security for doctors in additionGreater financial and job security for doctors in addition

to higher incomes.to higher incomes.

Benefits to BusinessBenefits to Business

Decreased labor costs due to absence of Decreased labor costs due to absence of expenditures for health insurance.expenditures for health insurance.

Employment decisions will be based on ability to Employment decisions will be based on ability to do the job not on age or health status.do the job not on age or health status.

Healthier more mobile work force will improve Healthier more mobile work force will improve overall productivity.overall productivity.

Overall increase in profits.Overall increase in profits. Overall increase in economic prosperity will Overall increase in economic prosperity will

increase demand for all goods and services.increase demand for all goods and services.