Panelists at an MGMA Conference forum on health reform came to quick consensus on two key points. First, without reform, the health care system would be caught in an unsustainable spiral of increasing costs and decreasing quality. Second, the reform legislation recently passed in Congress falls far short of the mark in addressing either issue.

"The list of unintended consequences is long," noted Michael McCallister, president and CEO of insurer Humana Inc., during the Oct. 25 discussion. He and other panelists underscored the point, noting that expanding Medicaid eligibility may indeed broaden the pool of the insured. At the same time, Medicaid payments usually do not cover costs, thus shifting the burden increasingly onto private health plans. McCallister added that smaller health insurance plans will likely lack the resources to expand and upgrade their information systems to meet what could be a deluge of new enrollees as the insurance mandate kicks in.

James Rohack, M.D., immediate past president of the American Medical Association, said that unless Congress addresses the flaws in the current Medicare payment calculation formula for physicians, reform is meaningless. Under the current arrangement, physicians periodically face drastic reimbursement cuts under Medicare, when temporary formula freezes expire. Rohack also said the legislation ignored the fact that major expenses derive from relatively small groups of the population. The disproportionate cost of futile, end-of-life treatment could be sidestepped by engaging patients in discussion about advance directives while they are healthy, he contended.

Panelists suggested a bright future for software vendors of disease management programs. Increasingly, they concurred, employers will demand that their insured workers with chronic illnesses enroll in such programs to help mitigate cost. Another big push for I.T.-enabled workflows will come from the need for increased productivity on the part of providers. "It is up to us to figure out how to innovate," said Rohack. Otherwise a glut of new patients could overwhelm practices once mandates for insurance coverage begin.

The annual MGMA conference is taking place this week in New Orleans.

--Gary Baldwin


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