Declining reimbursements, increasing expenses and looming reform experiments forced physicians and hospitals to examine how to best work together and stay competitive. How do we bring all parties into the dialogue in order to determine the proper “alignment” and organization of any new health care delivery system?

 

The Medical Staff Advocacy Committee was created at the Broward County Medical Association to address that need and facilitate positive communication and dialogue between various parties.

As physician rights have eroded they have become alienated, disempowered and unengaged so we created the first Bill of Rights and Responsibilities model for physicians and medical staffs in the United States. These include:

 

The right to care for patients without compromise; The right to freely advocate for patient safety; The right to be compensated for providing care; The right to care for our own well being; These rights also imply core patient care responsibilities.

 

Adoption of these rights and responsibilities into hospital medical staff bylaws and discussions about healthcare reform will significantly improve the practice environment, quality and cost efficient care.

 

Our voice should address Florida Medicaid Reform, a demonstration looking to improve the value of the Medicaid delivery system operating under an 1115 Research and Demonstration Waiver by CMS. The program placing Medicaid patients into HMO’s and PSN’s in Florida expires in 2011.

 

After years there is no clear and convincing evidence that the experiment has produced cost savings or ensures access and quality care. There is growing evidence that there is decreased access, deficient provider networks, instability and inconsistency in the Medicaid plans available to patients.

 

The fundamental difficulty obtaining both specialty and primary care is that very few doctors are willing to participate in Medicaid HMOs or PSNs. This is due to Medicaid reimbursement rates too low to cover providers’ overhead, and bureaucratic barriers implemented to get paid. As a consequence, medical care access through the emergency rooms is on the rise.

 

The Georgetown Report raises the critical question: Do any potential savings represent efficiencies that plans are making, or simply reduced access or reimbursements to necessary care?

 

From my experience and observations regarding Medicaid Reform: there is decreased access to care, inaccurate information provided, higher costs, poorer care, fewer services, more forms, less satisfaction and no informed choice. As a physician I believe Medicaid Reform must be redirected.

 

Following public outcry and testimony by consumer protection groups CMS did not simply extend the waiver, but will process and modify the special terms and conditions of the demonstration to address concerns.

 

Budget sensitive Governor-elect’s “Health Care Transition Team” issued major recommendations including consolidation of the state’s health care agencies, repeal of the federal health care law, and the continued shifting of Medicaid patients to managed care.

 

Of particular interest are the sections about hospitals and the federal and state financial plan. It is well intended and written using terms such as LIP payments (Low income pool) and IGT (sophisticated intergovernmental transfers).

 

But sobering statistics are at play in light of our current economy. According to the Department of Children and Families, there are over 2 million calls a month from patients requesting Medicaid coverage and food stamps yet it can only handle 300,000.

 

So the new financial implications and inherited bureaucracy fail to safeguard and account for the availability of physicians, hospitals and state workers to facilitate reform.

 

Ironically the recommendations to repeal the Patient Protection and Affordability Act as unconstitutional is contradicted by taking away the rights of patients in Medicaid reform or using programs that failed to show any increased access or decreased costs.

 

Health experts say unless patients and physicians are happy with any new system, it is likely to fail. The solution is our voice and seat at the table when decisions are made. Information and communication are critical for physicians, hospitals and payers in order to align together.

 

So this is the time of opportunity to be engaged in dialogue and keep it simple. Do what we do best, which is to practice quality medicine and be an outspoken advocate for the well being of our patients and our own.