Understanding Health Care Reform: Bridging the Gap Between Myth and Reality, 1st Edition (Hardback) book cover

Understanding Health Care Reform

Bridging the Gap Between Myth and Reality, 1st Edition

By Arthur M. Feldman, MD, PhD

Productivity Press

222 pages

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pub: 2011-12-14
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Description

After nearly a year of debate, in March 2010, Congress passed and the president signed the Patient Protection and Affordable Care Act to reform the U.S. health care system. The most significant social legislation since the civil rights legislation and the creation of Medicare and Medicaid, the bill’s passage has been met with great controversy. Political pundits, politicians, health care economists, and policy analysts have filled the airwaves and the lay press with their opinions, but little has been heard from those who have the most invested in health care delivery reform—patients and their doctors.

Understanding Health Care Reform: Bridging the Gap Between Myth and Reality provides readers with the information to make informed decisions and to help counter the bias of political pundits and the influence of the for-profit health care industry. The author introduces readers to a group of dedicated doctors, administrators, and patients whose experiences illustrate the strengths and weaknesses of the health care reform legislation. He also shares his own experiences as both a physician and a patient. The book puts the health care reform legislation in perspective by exploring ten critical areas:

  • The private insurance industry
  • Medicare and Medicaid
  • The elimination of waste caused by overutilization, high administrative fees, and fraud
  • Disease prevention and wellness programs
  • Care for the underserved—the health care "safety net"
  • Quality of care
  • The impending workforce shortage
  • Comparative-effectiveness research to compare treatments
  • Changes in the way medicine is practiced
  • Tort reform

Describing the reform act as the foundation and framing of a house, it outlines what doctors, patients, and families must focus on as states, the federal government, and the courts craft this legislation over time. The author cuts through the political rhetoric to address the core question: how do we preserve our ability to provide the best possible care for patients and fulfill our societal mission of providing care for our citizens independent of their financial means? Focusing on strengths and weaknesses, rather than what is right or wrong, he encourages readers to think creatively about their role in establishing a better system of health care in America.

Table of Contents

Introduction

Reforming the Private Insurance Industry

The Private Insurance Industry in the United States

Reforming the Private Insurance Industry

Flaws in the Patient Protection and Affordable Care Act

Strengthening the Health Care Reform Legislation

Notes

How Will Health Care Reform Affect the Medicare and Medicaid Populations?

About Medicare

How Does the Health Care Reform Legislation Change Medicare and Medicaid?

The Independence at Home Program

Medical Homes

Accountable Care Organizations

The Extension Program Hub

Community Health Centers

Lowering Medicare and Medicaid Costs

State Governments and Medicaid-Medicare Reform

Lowering Health Care Costs through Health Care Reform

Notes

Can We Lower Health Care Costs by Eliminating Waste?

Medical Waste and Economic Waste

Cost-Benefit Analysis

Controlling Medical and Economic Waste

Medical Spending in the Last Days of Life

The Patient Protection and Affordable Care Act and Waste

Placing the Burden of Cost Control on the Patient

Placing the Responsibility for Decreasing Waste on Hospitals

Unintended Consequences of Attempts to Eliminate Waste

Developing a Rational and National Strategy to Reduce Waste

Notes

The Role of Disease Prevention in Health Care Reform

Prevention and Wellness Programs in the Patient Protection and Affordable Care Act

Section 2705 of the Patient Protection and Affordable Care Act—Legislating Wellness!

The U.S. Preventive Services Task Force: Another Potential Flaw in the Patient Protection and Affordable Care Act

Prevention Doesn’t Lower Health Care Costs—It Might Actually Increase Them!

Addressing the Epidemic of Obesity—And Health Care Reform

Individuals Must Often Support the Costs of Prevention

Steps to Ensure Prevention and Wellness

Notes

How Will Health Care Reform Affect the Medically Underserved and the Safety Net Hospitals That Care for Them?

The Health Care Safety Net

The History of Safety Net Hospitals

Disproportionate-Share Hospital Payments

Safety Net Hospitals Falter When DSH Funds Are Redirected to Pay for Health Insurance

The Patient Protection and Affordable Care Act Threatens the Country’s Safety Net

Pay-for-Performance Can Also Threaten Safety Net Hospitals

The Health Care Exchange

Will the Exchanges Work?

Some States Are Ahead of the Curve—Others Behind It

Health Care Reform in Massachusetts: A Template for Health Care Exchanges?

How Can the Patient Protection and Affordable Care Act Be Modified to Protect the Safety Net?

Notes

How Can We Improve the Quality of Care in the United States?

The Cost-Quality Conundrum

The Dartmouth Atlas and Health Care Reform

Measuring Quality of Care

Measuring Quality of Care: The Health Care Reform Legislation

Pay-for-Performance

The Electronic Health Record

Value-Based Purchasing

Substantive Steps Taken by the Patient Protection and Affordable Care Act

What Additional Steps Should Congress Take to Ensure Quality of Care?

Notes

Will There Be Enough Doctors to Care for 35 Million New Patients?

How Does the Patient Protection and Affordable Care Act Address the Workforce Crisis?

The 1997 Balanced Budget Act and the Health Care Workforce Crisis

The Changing Demographics of the Physician Workforce

The Workforce Crisis Is Not in Primary Care Alone

Lessons from Massachusetts

How Have We Approached the Need to Increase the Number of Practicing Physicians in the United States?

Danger around the Corner

What Should We Do to Increase the Size of the Health Care Workforce?

Notes

Can Research Guide Us to Improved Care at Lower Costs?

Why Comparative-Effectiveness Research Has Become a Lightning Rod in the Health Care Debates

The Patient Protection and Affordable Care Act and Comparative-Effectiveness Research

The Potential Value of Comparative-Effectiveness Research

Can Comparative-Effectiveness Research Lower Costs?

Limitations of Comparative-Effectiveness Studies

Using Comparative-Effectiveness Research

Notes

How Will Health Care Reform Change the Way We Practice Medicine?

Physician Compensation

The Sustainable Growth Rate

How Did the Patient Protection and Affordable Care Act Change the Way Doctors Are Paid?

Pay-for-Performance

Payment Bundling

Global Payment

Electronic Health Records

Multispecialty Group Practices

The Independent Payment Advisory Board

How Can the Patient Protection and Affordable Care Act Be Improved?

Notes

Will We Ever See Tort Reform in the United States?

The Current Tort System

Malpractice Caps

The Patient Protection and Affordable Care Act Failed to Address Tort Reform

Medical Malpractice—A Silent Disease

Employment Law and the Health Professions

It Is Not Too Late—Novel Strategies for Reforming Our Tort System

Notes

Conclusion

Surviving Health Care Reform

Notes

Index

About the Author

Arthur M. Feldman, MD, PhD, is the Executive Dean at the Temple University School of Medicine.

Subject Categories

BISAC Subject Codes/Headings:
BUS041000
BUSINESS & ECONOMICS / Management
BUS070080
BUSINESS & ECONOMICS / Industries / Service Industries
MED002000
MEDICAL / Administration