Christine Craig is WakeMed’s director of government affairs.

Are you interested in what the federal Wake County delegation has to say about health care reform? Stay informed by checking their web sites.

“This is the best chance we have to reduce sky-rocketing health care cost for North Carolina families.”  Congressman Bob Etheridge

“Health insurance reform is essential to ensuring coverage and controlling health care costs, now and in the future.” Congressman Brad Miller

“We must pass health care reform that invests in our nation’s future by providing families with high-quality care, giving businesses access to affordable plans for their employees, and reining in government spending.” Congressman David Price

“Currently, health care expenditures account for 16% of our nation’s GDP.  This is unsustainable, and one goal of reforming health care must be to enact sound policies that drive health care costs down so that all Americans can access quality and affordable health care.” Senator Richard Burr

“Here is why we need reform: ten years ago, North Carolinians paid $6,000 in annual family premiums. Today they pay $12,000. By 2016, it is projected that families will pay $24,000. North Carolina’s families deserve better than this.” Senator Kay Hagan

Yesterday was a historic day for health care as the House voted to pass the health care reform bill that was approved by the Senate in December. We would like to acknowledge and commend the leadership of North Carolina’s congressional representatives, particularly Brad Miller, David Price and Bob Etheridge, for voting in support of this historic legislation.  We have worked closely with our representatives and their staffs from the beginning of the health care reform conversation up to the final vote yesterday. We are grateful that our delegation made every effort to understand how this legislation will affect our state’s hospitals and patients.

This legislation is a historic step that will ensure the majority of Americans have health insurance. When fully implemented, 95 percent of American citizens will be covered.

But this legislation is not perfect, and there are still challenges ahead. We wish that significant cost control measures such as medical liability reform had been included in the bill. And, the Congressional Budget Office estimates that there will be 23 million people living in America, many of whom are not U.S. citizens, who will remain uninsured.  These people will still need health care services, making programs like Disproportionate Share very important for hospitals like WakeMed that care for a majority of the uninsured in their communities (disproportionate share is a federal program that provides slightly higher reimbursement rates for hospitals that care for the largest percentage of uninsured patients.  We have blogged on the importance of preserving this program in the past.) We recognize that all health care providers will face challenges in implementing these new changes – like a shift in the payment system that focuses on volumes to one that focuses on quality outcomes.

WakeMed is ready to embrace these challenges, and we applaud Congress for taking such major steps to reform America’s very complex health system.

Representative Brad Miller

Congressman Brad Miller has been a great friend of WakeMed’s since his days in the North Carolina General Assembly in the 1990’s, and has since been elected to the U.S. House of Representatives. He’s on his way back up to Washington this week, and was able to stop by WakeMed on Monday to take a tour of WakeMed’s new Children’s Hospital and discuss several health care reform issues.

Changes must be made to the current health care system, as I’ve said time and again, but the changes must protect – and improve – WakeMed’s ability as a safety net hospital to provide care to our community regardless of their ability to pay.

Currently, Medicaid payments to hospitals and providers fall short in covering the costs of services delivered.  Expanding Medicaid to more individuals, as both the Senate and House bills propose, will exacerbate the already difficult financial situation faced by many hospitals.

Congressman Miller agreed that the proposed health care reform legislation will be an opportunity to start anew, and that a focus on improving cost efficiency is vital. Spending money efficiently and effectively is important because here at WakeMed, we’re already operating on a pretty tight margin. Last year, WakeMed provided more than $135,000,000 in uncompensated care, which accounted for 16.5% of our total operating expenses. Uncompensated care is defined as the total cost of treating charity care patients, bad debt costs and unreimbursed costs of treating Medicare and Medicaid patients. Medicare and Medicaid programs reimburse providers at less than the full cost of providing care.

The Congressman was also interested in finding cost savings in the system. He was supportive of WakeMed’s desire to study cost effective alternatives to the current emergency department triage process – which is complicated by the federal law known as EMTALA.

It was reassuring to hear Congressman Miller’s strong support of the health care reform bills, particularly his support of the issues that are pertinent to our organization – such as the funding for trauma centers that Christine Craig discussed in a previous post, and funding for programs on childhood diseases like asthma and diabetes.

Just after our conversation, State Government Radio caught up with Congressman Miller for an interview. “Health care premiums have doubled in the last 10 years, and we can’t do that again. Something’s gotta give,” he said.

My hope – and our work –is that our nation will take meaningful steps to assure that everyone in need has true and timely access to care. Likewise, we need to reduce the cost of healthcare and – importantly – make significant advances in the quality and safety of care across the nation. On our watch as healthcare providers, we all have an obligation to be engaged in the discussion and to provide meaningful input. And while it is unlikely that everyone will agree on all the key or even minor points, in America it is important that everyone always has a right to contribute to the final policy outcome. In the care of health care, the decisions made will impact not only everyone here today, but also generations to come. Health care reform is serious stuff and deserves our full and focused attention.

Their visit coincided with a report from the Congressional Budget Office indicating that malpractice reform could have saved about $11 billion in health care costs this year. We need to create limits for medical malpractice lawsuits, while still ensuring that patients are appropriately compensated for avoidable mistakes. I think it’s important to include medical malpractice reform as part of the health care package for one primary reason – it will reduce health care costs.  As Congress works to solve the health care issues facing our country, it shouldn’t overlook such a significant opportunity to reduce costs and improve health care.

To provide you with additional insight and information, I asked Dr. Ravish Sachar, a cardiologist with Wake Heart & Vascular Associates to write about his trip to Washington and his views on tort reform.

Tort Reform from a Physician Perspective
Ravish Sachar, MD
Wake Heart & Vascular Associates

Cost and access are critical issues that need to be addressed in health care reform, but to date everything except malpractice reform (which has major impact on both) seems to be on the table. This is why I recently accompanied a group of physicians from the Triangle area to Washington DC to meet with legislators to present our case for medical malpractice reform (Dr. Subhash Gumber, Dr. Prashant Patel, Dr. Joel Schneider, Dr. Matthew Hook, Dr. Benjamin Atkeson, Dr. Lakshman Rao, Dr. Brent Elmers, and Dr. Ritu Saluja). Our group met with staff and Congressional members in the offices of Senator Hagan and Representatives Schuler, Price, Miller, Etheridge and McIntyre.

The issue is this: one of the first lectures most physicians hear when starting their training is on how to avoid lawsuits.  This sets the tone for the way we practice medicine in this country – defensively.  The implications of defensive medicine are costly. It increases the price of our health care exponentially. For example, several studies have shown that approximately 90% of all physicians report ordering tests for defensive reasons, and between 18 to 26 percent of all imaging tests ordered by physicians are done so in an effort to avoid potential litigation.  These unnecessary tests clog our health care system, increase risks and cost for patients, and impede access as a whole. But the implications of medical malpractice go far beyond the costs of unnecessary tests and procedures. It also impacts where and how physicians choose to practice, thus, creating healthcare access issues.

We thank our legislators for listening to us and hope that the information we conveyed will be taken into account as they work toward a final health reform bill.  Real changes in the tort system could equal real savings that would go a long way in covering the large uninsured population.

Physiciansfortortreform.org has more information on the subject and, if you are a physician and agree that malpractice reform should be part of the overall healthcare reform, please show your support by signing the petition.

Over the weekend, Senator Max Baucus circulated a draft of the long-awaited plan from the Senate Finance Committee. While the Committee’s proposal omits a public insurance option, it expands Medicaid coverage to millions of Americans who are currently ineligible an proposes insurance options offered by non-profit co-operatives. Many people are expecting to hear significant detail from President Obama, including whether or not he will support legislation that doesn’t include a public option, when he addresses a joint session of Congress tomorrow evening.

With the House of Representatives tentatively scheduled to recess for the year at the end of October, the time table leaves me to wonder what legislation will land on the President’s desk to be signed. As I’ve said many times before, our current health care system is in bad need of repair, and it starts with health insurance coverage for all.  There is no shortage of common-sense reforms that everyone agrees can significantly improve patient care and reduce health care expenses. Here’s hoping that President Obama and our Congressional leadership can find a way to build bipartisan support for those measures that we know will have an immediate, positive impact on patient care and our nation’s bottom line.