Comments to 10/11/21 Healthy CA Commission Provider Payments meeting:
This seems to have been primarily about institutional funding structures. The individual/small group community ensconced practices need to be considered. And in this, fee-for-service is an appropriate reimbursement structure that minimizes onerous admin requirements.
Above and beyond the present state of affairs, there is the looming disaster of further administrative burden/diversion of resources and distraction from good clinical practice by the unproven concept of supposed performance-based compensation structures. Not only is this reimbursement approach unproven it is logically and demonstratively discriminatory.
The reality is that the insurance corporations and government administrators are now in charge and, in general, have no clue about the delivery of clinical services. What they know is outcomes and value-based number crunching. And what they know is wrong. Such approaches make logical and administrative sense but not only make no clinical sense-- they are destructive clinically and socio-economically.
Please don’t be confused by/support the decade old Insurance propaganda presented today that wants to conflate global budgeting and performance based reimbursement. They are incompatible and promote disparities.
According to the March 13, 2018 article in JAMA ( Rita Rubin MA) --"The problem, health policy researchers say, is that evidence about how best to evaluate health care quality is lacking and currently used measures fail to account for differences in patients’ socioeconomic and health status that could skew quality scores in favor of practices that care for higher-income, better-educated, and less-complex patients. …
… J. Michael McWilliams, MD, PhD, a general internist and professor of health care policy at Harvard Medical School… (in his) recent study in Annals of Internal Medicine, McWilliams and his coauthors found that the … Physician Value-Based Payment Modifier Program had no effect on the quality or efficiency of care provided and likely exacerbated health care disparities by disproportionately penalizing practices that care for lower-income or sicker patients.” (emphasis mine)
We are “still in a pretty crappy state” with healthcare costs because insurance corps and Big Pharm are still running the show. Single Payer puts the People in as the Director of the show.
Remembering that this Commission is about Unified Financing—not multiple “All Payer” financing--- Global budget are an appropriate approach to hospitals and large institutions. But--Hospitals should not “MAKE MONEY.” Hospitals and the healthcare system should make people healthy and be supported by the entire community. “If you don’t use it you can keep it” incentivizes restricting services.
Re: Price driven increase in Healthcare costs-- Insurance corporations and Pharm are incentivized to drive prices upward… There is little downward price competition between the corporations or the drug companies. For insurance--the higher the cost of healthcare the more their percentage of costs return to them. For pharm the more they can charge the more they profit.
Physician Group consolidation is being driven by the need to represent/protect themselves from power of insurance corporations and hospitals.
Hospital consolidation is both similarly driven and a driver of the admin heavy managed care health funding system.
No, Senator Pan, Public Health is not unified financing-- As Behavioral Health Director for Family Services San Francisco I had anywhere from 5- 10 primary funding streams I had to coordinate each year… Including Insurance, Medi’s, County funding, county and state grants, foundation funding…etc…. And re: the school nurses—See Dr Marya’s neoliberal comment
