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A Glimpse Into The Present

A Glimpse Into The Present. Arie Friedman, M.D. Physicians Council for Responsible Reform.

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A Glimpse Into The Present

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  1. A Glimpse Into The Present Arie Friedman, M.D. Physicians Council for Responsible Reform

  2. “Unless we put medical freedom into the constitution the time will come when medicine will organize into an undercover dictatorship and force people who wish doctors and treatment of their own choice to submit to only what the dictating outfit offers.” Benjamin Rush

  3. Patient Protection and Affordable Care Act of 2010 Health Care and Education Reconciliation Act of 2010

  4. Regulatory Process

  5. Centers for Medicare and Medicaid Services • Directly manages Medicare • Partners with states in managing Medicaid • Writes the guidelines for all medical billing • Controls much of medical education • Will innovate new delivery systems • Will innovate new payment systems • Will innovate new guidelines and protocols • Will incentivize providers to provide quality care

  6. Donald Berwick, M.D.

  7. Cynics beware, I am a romantic about the [UKs] National Health Service; I love it. All I need to do to rediscover the romance is to look at health care in my own country. Berwick DM, 2008

  8. “We believe, and refuse to be dissuaded, that the National Health Service, with its moral intent, commitment to equity, and store of knowledge, has the inherent capability to become the greatest healthcare system of any nation.” Berwick DM, 2006

  9. “As Americans, we know dependence on market forces for constructive change is playing with fire.” Berwick DM, 2006

  10. “Young doctors and nurses should emerge from training understanding the values of standardization and the risks of too great an emphasis on individual autonomy.” Berwick DM, 2005

  11. “An immense resource for progress in improving the NHS—the key resource, in my view—has been the consistent focus of government, emanating from the Prime Minister personally, on raising the bar for NHS performance.” Berwick DM, 2004

  12. “The modernization process sought to establish accountabilities, structures, resources, and schedules in the NHS that no one at all is in a position to establish in the pluralistic, chaotic, leaderless US healthcare system.” Berwick DM, 2004

  13. “The UK can decide, as an entire nation, to improve its cancer care outcomes... Indeed, the recent NHS Plan proposes exactly those improvements and backs up the strategy with specific plans, accountable management structures, and major infusions of money.” Berwick DM, 2000

  14. UK Cancer Outcomes • Breast Cancer – 88% worse than U.S. • Prostate Cancer - 604% • Worse in literally every other major form of cancer

  15. People are policy

  16. What are we talking about? • Guidelines • Incentive payments • Penalties in ratings and payments • Outcomes payments • Hospital ratings combined with bundling • State mandates for medicaid • Etc, etc, etc...

  17. Privacy

  18. SEC. 4302. UNDERSTANDING HEALTH DISPARITIES: DATA COLLECTION AND ANALYSIS.

  19. Data Collection • Begins within 2 years • All federally funded or supported: • Health care, public health program, activity or survey • Includes Dept. of Labor and Census surveys • Measures sex, primary language, disability status • Includes anything else deemed apropriate by the Secretary of HHS

  20. ...sufficient data to generate statistically reliable estimates by racial, ethnic, sex, primary language, and disability status subgroups for applicants, recipients or participants using, if needed, statistical oversamples of these subpopulations • ...any other demographic data as deemed appropriate by the Secretary regarding health disparities.

  21. Sources of Data • Reported by applicant, recipient, or participant • Reported by parents of above • Health care providers • How many have disability compliant equpment • How many employees have been trained in “disability awareness”, etc. • Will include at a minimum info on race, ethnicity, sex, primary language, and disability status

  22. Who gets it? • Office of Minority Health • National Center on Minority Health and Health Disparities • Agency for Healthcare Research and Quality • Centers for Disease Control and Prevention • Centers for Medicare and Medicaid Services • Indian Health Service and associated studies • Office of Rural Health • Anyone else the Secretary of HHS wants

  23. ‘‘(2) REPORTING OF DATA.—The Secretary shall report data and analyses described in (a) and (b) through— ‘‘(A) public postings on the Internet websites of the Department of Health and Human Services; and ‘‘(B) any other reporting or dissemination mechanisms determined appropriate by the Secretary.

  24. ‘‘(3) AVAILABILITY OF DATA.—The Secretary may make data described in (a) and (b) available for additional research, analyses, and dissemination to other Federal agencies, non-governmental entities, and the public,

  25. SEC. 4203. REMOVING BARRIERS AND IMPROVING ACCESS TO WELLNESS FOR INDIVIDUALS WITH DISABILITIES.

  26. SEC. 5306. MENTAL AND BEHAVIORAL HEALTH EDUCATIONAND TRAINING GRANTS. • B.A.s, M.A.s, Ph.D.s, in social work • Develop social work teaching faculty • Higher learning degrees in all aspects of behavioral health • Preservice or in-service training of paraprofessional child/adolescent professionals

  27. Eligibility • (1) participation in the institutions’ programs of individuals and groups from different racial, ethnic, cultural, geographic, religious, linguistic, andclass backgrounds, and different genders and sexual orientations • (2) knowledge and understanding of the concerns of the individuals and groups described in subsection (a) • (3) any internship or other field placement program assisted under the grant will prioritize cultural and linguistic competency • (4) the institution will provide to the Secretarysuch data, assurances, and information as the Secretary may require • INSTITUTIONAL REQUIREMENT.—For grants authorized under subsection (a)(1), at least 4 of the grant recipients shall be historically black colleges or universitiesor other minority-serving institutions.

  28. “And finally, don't complain—I have visited settings in Rwanda, Mozambique, Peru, and Palestine where every person I met had 100 times more reasons to complain than I do. And none did. Complaint is waste.” Berwick DM, 2004

  29. Controversy is only dreaded by the advocates of error. Benjamin Rush

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