A hospital executive's perspective on reform

The health care reform proposals coming out of Washington are a mixed bag, says Bill Downey, executive vice president and chief operating officer of Riverside Health System, based in Newport News.

William B. DowneyParts of it he agrees with, such as pushing for electronic medical records to cut down on costly medical errors.

But he said the so-called "public option" — a government-run health insurance program that is the centerpiece of President Barack Obama's proposal — would hinder Americans' access to health care.

The increasing cost of health care is forcing fewer businesses to offer it to employees. A public option could cause more employers to drop coverage, Downey said, because they would know that their employees could be covered by the public option.

And it would likely reimburse on par with Medicare and Medicaid, leaving health systems coming up short. "We're already subsidizing Medicare and Medicaid patients," he said.

He added that the public option puts the nation on a path to the nationalized health care systems of Canada and Great Britain, where patients are on waiting lists to receive care. U.S. patients haven't had to deal with that, Downey said.

"I think that's an issue that really hasn't been talked about in the health care reform — the American public's response to how they would potentially deal with rationing," Downey said.

He supports malpractice reform, because malpractice insurance is driving up the cost of care, as well as integrating electronic medical records. Electronic records can cut down on errors, improve outcomes and save money.

Democratic Sen. Mark R. Warner proposed a bill that would address end-of-life care, one of the biggest expenses of Medicare. The bill includes educating physicians, patients and families about the end stages of disease.

For example, families should think about their loved ones' quality of life before putting them on a ventilator for months when it won't change the outcome of a terminal illness and is costly, he said.

The government could find some savings if it worked with private insurers to come up with a standard billing process. For example, insurance reimbursements are lower on the Peninsula than the Southside, he said.

And Medicare payments vary across the nation. It averages $16,000 per beneficiary in Miami and about $6,000 or $7,000 on the Peninsula. The system rewards parts of the country that don't necessarily have better quality, Downey said.

"I think there's a lot of things they can do before they go the public-option angle to get some efficiencies and cost savings," he said.

Medicare discrepancies
$16,000
Payments per beneficiary in Miami

$6,000-$7,000
Average payments per beneficiary on the Peninsula

Published: July 13, 2009



 

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