A handful of local providers gave Congresswoman Jaime Herrera Beutler their thoughts on the rising costs of health care, Medicare and health care incentives during a roundtable discussion Monday afternoon.
Herrera Beutler held the hourlong, invite-only listening session at PeaceHealth Southwest Medical Center. The discussion included PeaceHealth Southwest President Joe Kortum; Dr. Bob Djergaian, physician director for rehabilitation services; Dr. Brad Jensen, laboratory medical director; Dr. William McBride, a pulmonary and critical care provider for Southwest Medical Group; and Dr. Robin Virgin, a primary care provider for Southwest Medical Group.
The congresswoman invited the physicians to offer ideas for changes that could be made at the federal level.
“Making sure providers can continue to provide quality health care is important to me,” Herrera Beutler said.
Looming cuts to Medicare reimbursement rates are concerning for physicians, Djergaian said. Current rates don’t cover costs. Reducing rates by another 25 to 30 percent would make it even harder to provide care for Medicare patients, he said.
Herrera Beutler agreed and said the federal government shouldn’t reduce rates when current rates don’t cover costs. Reducing reimbursement rates is not a way to solve the problem with Medicare funding, she said.
“I would support a fix,” she said. “What I’d really like to see is a long-term fix.”
When reimbursement rates don’t cover the cost of providing the care, hospitals have to make up the difference elsewhere, Kortum said.
For example, PeaceHealth Southwest will bill about $1.3 billion for services this year. The medical center will only collect about $650 million. As a result, the medical center has to “jack up” its charges to make up the difference, Kortum said.
“Unfortunately, the population that can pay us isn’t keeping up with the population that can’t,” he said.
Part of the problem, Djergaian said, is there’s not enough focus on prevention.
“The system now rewards people for episodes of illness,” he said.
One reason why there isn’t more emphasis on preventive care, Virgin said, is because health insurance companies don’t look at the lifespan of a person’s health. Insurers only expect to cover patients until they change jobs (and insurers) or become unemployed and lose coverage, she said.
For that reason, insurers focus on cost savings in the present, rather than the long-term savings of healthier people, she said.
“They just get them through and save the most money they can until they’re on someone else’s payroll,” Virgin said.
In addition, physicians don’t have incentives to encourage prevention, Kortum said.
In Britain, for example, each physician has a certain number of patients assigned to them. Physicians receive incentives if a percentage of patients quit smoking or reduce their body mass index, Kortum said. Those incentives don’t exist here, he said.
The congresswoman said everyone needs to have “skin in the game” when it comes to health care decisions and costs. Making changes to the system will require thinking outside of the box, she said.
Kortum said he thinks the U.S. health care system needs fundamental changes.
The U.S. spends twice as much as other industrialized countries on health care costs but ranks 37th in outcomes, Kortum said. This country has the best doctors, the best medical schools and the best technology, yet results are lagging.
“To me, that cries out that our system is a mess,” he said.