Local lawmakers, medical professionals push for reform

Health care reform is a necessity and not just a political football, Central Virginia medical professionals and members of Congress said last week.

That reform’s profile can be shaped, at least a little, by people in the 5th and 6th congressional districts during August when Reps. Tom Perriello and Bob Goodlatte will be taking the temperature of their constituents on what the reform should look like.

“This is about more conversation with the American people,” Perriello, D-5th District, said Friday, adding that he hasn’t taken a position on the bill “because it isn’t done yet.”

Neither the full House of Representatives nor the U.S. Senate will vote on health care before September, when they return from Congress’ August recess.

One topic they’ll be discussing is who should pay for treatment — the government, insurance companies or a new kind of cost-sharing plan.

The real payments for medical care for everyone — including the elderly and the uninsured who visit ERs — have been shifting by default onto employer-based private insurance in a system that can’t survive unless it’s reformed, officials of Centra Health System said.

“They’re absolutely right,” said Goodlatte, R-6th District, who also agreed that some of the reform bills in Congress are unfair to hospitals such as Centra that already are cutting costs.

“I’ve heard the same thing at other hospitals around my district,” Goodlatte said.

“There’s no reward for providing better medical care. That has got to change in any bill that Congress considers,” Goodlatte said.

On-screen debate in July has focused mostly on whether health reform should have a public insurance plan that’s open to everyone.

Insurers, hospitals and conservative members of Congress — including some Democrats known as Blue Dogs — have been leery of a wide-open public insurance plan that also would set payments at the Medicare level.

Behind the scenes, conversations in Congress have focused on deeper reform issues such as ways to get uninsured people into health plans they can afford to pay for, Goodlatte and Perriello said.

Sen. Mark Warner, D-Va., in a letter signed by 12 fellow senators, said cost-cutting efficiencies are “a critical step to curb health care spending,” and urged Senate leaders to forge a bill that models health care on hospitals that have been efficient.

Five different committees in Congress are working on health-care legislation. One bill has emerged in the Senate, two have been OK’d in the House and a third was on the verge of approval in a House committee Friday after some of the fiscally conservative Blue Dogs agreed on terms.

Goodlatte said none of the Democrat-backed plans was fiscally adequate and all of them moved toward “the slippery slope of government takeover of medical care.”

Republicans were getting ready to propose a plan Friday that Goodlatte said would level the tax playing field and provide incentives to make insurance coverage more widely available.

A key element of the Republican plan, he said, was an “association health plan” that would let groups of small employers join larger pools with up to 200 small businesses buying insurance coverage for employees.

Liability reform would be part of the Republican plan, he said, and it would seek to end defensive practice of medicine, in which unnecessary tests are done as a defense against potential lawsuits. Democratic versions of reform pay little attention to malpractice insurance problems.

Insurance also should be portable, he said, allowing people with coverage in one job to take it to another workplace.

Centra Health officials who talked about the reform issue last week focused on the plans’ early concept to cut $155 billion in Medicare and Medicaid payments over the next decade, as offered by the American Hospital Association in early July.

Those plans would cut each hospital by the same amount, roughly 2 percent, for every Medicare case it handles, said George Dawson, president of Centra Health.

Centra’s reimbursement from Medicare already is low at $6,399 per patient, Dawson said, and a better system of reform would reward Centra for the efficiencies it has developed in electronic medical records and reduced operating costs.

Noting that the average cost of a Medicare case in Dallas is $10,103, Dawson said the proposed system wouldn’t encourage less-efficient hospitals to improve.

Dr. Chal Nunn, Centra’s chief medical officer, said, “So they’re going to cut Dallas 2 percent and cut us 2 percent equally. It doesn’t make any sense. Our value here is so great that we should be rewarded for that, so we are incentivized to do that.”

Dawson called the proposal “shaving the price off the top of piecework,” because Medicare pays hospitals on a per-case basis, and the system encourages them to simply take in more cases to generate income.

A better system, he said, would reward a medical system that encourages preventive care and leads people to maintain better health instead of depending on emergency rooms in crisis situations.