[President Barack Obama on the campaign trail, prior to becoming president. Copy right.]
The Mayo Clinic Health Policy Center announced after President Barack Obama's state of the union address this week that the center remains committed to national health reform that will lead to health insurance coverage for all Americans.
I asked on behalf of the Post-Bulletin newspaper in Rochester, Minnesota, which publishes Pulse on Health, what will happen if health reform fails. The Mayo Policy Center enlisted a response from "physician advocate" Dr. Doug Wood, who said costs will continue to rise, employers will be forced to ask workers to pay more and that will leave less money (in my interpretation of the center's words) in the pockets of consumers.
My editor and I conferred and decided to ask the center to expand a little bit on its comments. I will post my questions and the answers I received from the Policy Center and Mayo Clinic in Arizona, where a single satellite clinic run by Mayo has stopped accepting some types of Medicare for five physicians, meaning Medicare recipients must pay some costs out of pocket themselves.
Pulse on Health: What will happen if health reform fails? Please include Mayo Clinic-specific examples and examples for the nation's health system as a whole.
Mayo Clinic Health Policy Center (comments from Dr. Doug Wood "a physician advocate within the Health Policy Center":
"Health care costs are higher than they need to be and these costs have adverse effects on access to care, ability to buy and afford insurance, and on the budgets of families, companies, states and the federal government. Health care costs have been rising faster than wages for too long and have been rising faster than other parts of the economy. Yet, for all this spending, we have not measurably improved the quality of health care. Said another way, we are not getting value for the money we are spending on health care.
Health care reform means changing the delivery system to provide better health for individuals and communities, safer care and reducing the total cost of care over time. Health care reform also means changing the payment system to drive and reward the needed delivery system reform. If reform does not pass, the costs of care will continue to rise, more people will be unable to afford insurance. Their health will suffer as needed care will be delayed. When untreated conditions can no longer be put off without treatment, hospitalization or emergency care are used more often, and the cost problems are exacerbated. Employers will have to ask employees to cover more costs and there will be less money for other spending. People who depend on Medicare will see increases in the premiums they pay for Part B as well as higher costs for their co-pays and prescription drugs. People who depend on state programs will experience problems with access and find it harder to sustain their health. The traditional price control methods used by Medicare and Medicaid will further reduce payments to providers. In the current Medicare system, this means across the board cuts to physicians and hospitals, as well as cuts to home health providers. Unfortunately, this continues to reward those who simply produce more tests and procedures, not better value. As a result, there are likely to be more problems for providers in parts of the country that are already effective and efficient (high value providers). They will have more difficulty shifting costs to others; some will likely go out of business and more will limit access for Medicare and Medicaid patients. None of this will stem total US spending because the areas of the U.S. that currently practice high volume medicine will have the incentive to do more, not less. We cannot afford to continue the status quo."
Follow-up question from Pulse on Health:
Does this mean that, if health reform fails, Mayo Clinic will by necessity stop accepting new Medicare patients, or decrease its acceptance of Medicare?
Josh Derr, Health Policy Center Manager:
We don't know that yet in regards to Mayo. Given our sincere focus on what's best for patients, we'll do whatever we can to continue to provide high quality care to our nation's seniors. However, as a general trend in the health care system, access will become more of a problem which further emphasizes the need for reform."
Pulse on Health:
Would it be accurate to say that the results of the pilot project in Arizona could have implications for whether Mayo Clinic changes its Medicare participation, in the event health reform fails?
Derr:
Honestly, we don't know that yet. Sorry for the noncommittal answer, (but) the AZ pilot wasn't implemented with that in mind.
Pulse on Health: Why was the pilot implemented? (We are next referred to Mayo in Arizona for a response from someone more intimately involved in that situation).
Michael Yardley, chair of the Division of Public Affairs at Mayo Clinic in Scottsdale, Arizona:
"This very small pilot -- it affects only primary care office visits to the five Mayo family medicine physicians at the family medicine facility in Glendale, Ariz. -- was implemented in response to the significant financial pressure created by Medicare reimbursement specifically in our primary care practice in Arizona. In order to preserve access for both our non-Medicare patients and our Medicare patients who were willing to bear the costs of their primary care, we decided to move forward with this opt out pilot. It was really either this or close that practice."
Pulse on Health:
So if Congress does not enact health reform, would it be accurate to say that Mayo clinic would use the Glendale pilot project to help determine whether to take similar actions at other Mayo sites in Arizona and and elsewhere?
Yardley:
No. But it would be accurate to say that regardless of what Congress does, Mayo Clinic remains firmly committed to working toward patient-centered changes that provide quality, affordable health care for all Americans.
Pulse on Health:
Do you mean that, if Congress does not enact health reform, changes to Mayo's Medicare participation are not an option?
Yardley:
All it means is that we are not speculating on what may or may not happen in Congress and how that may or may not impact Mayo Clinic. As always, we will make decisions based on what is in the best interest of our patients.
Pulse on Health
By Jeff Hansel, member Association of Health Care Journalists
Health Reporter for the Post-Bulletin newspaper, 18 1st Ave. S.E. in Rochester, Minnesota 55904
Twitter Hansel's Pulse: @Jeff Hansel
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