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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Washington Highlights

Senate Finance Committee Holds Hearing on Chronic Illness

July 18, 2014—The Senate Finance Committee July 15 held a hearing entitled, “Chronic Illness: Addressing Patients’ Unmet Needs,” focused on exploring the many challenges facing patients with chronic illness and health care provider approaches to better health delivery and improved care coordination.

Finance Committee Chair Ron Wyden (D-Ore.) opened by emphasizing the importance of the hearing and describing chronic illness as “the biggest challenge ahead for Medicare and the future of America’s health care system.”

Chairman Wyden cautioned the committee that the need to improve chronic disease management is important for all Americans and not just Medicare beneficiaries, saying, “It’s not just seniors who are affected by chronic disease. Half of all American adults have at least one chronic condition. These diseases account for 70 percent of deaths, limit the activities of tens of millions more Americans, and cost the economy billions each year.”

Ranking Member Orrin Hatch (R-Utah) agreed with the chairman on the need to address chronic disease saying, “This is one area that – if we choose to work together — I believe the committee can find real, bipartisan solutions that not only improve care coordination and lower overall health care costs, but also give complex patients better tools to more effectively navigate the health care system.”

Sen. Hatch then suggested the increase in Medicare beneficiaries opting for Medicare Advantage may be driven by traditional fee-for-service Medicare’s inability to properly manage chronic disease saying, “The successful Medicare Advantage program does give patients the option to receive benefits from private plans that are incentivized to manage care across all settings. However, traditional Medicare fails to meaningfully encourage providers to engage in labor - intensive and time consuming patient care coordination.”

Testifying before the committee, William A. Bornstein, M.D., Ph.D., Chief Medical Officer and Chief Quality Officer at Emory Healthcare, explained his experiences caring for chronic care patients, stating, “I know firsthand the challenges faced by our patients with multiple chronic medical conditions…Many of these patients see multiple specialists — they may be seeing me for diabetes care, a cardiologist for care of the coronary artery disease, a nephrologist for care of the kidney disease, etc. Everything each of us does affects the whole patient. Many problems, like elevated blood pressure and elevated cholesterol overlap each of our specialties. The challenge is in how we make sure all the care is coordinated.”

Dr. Bornstein also described how Emory Healthcare is working to better coordinate care delivery across their entire health system and the importance of the Emory Patient-Centered Primary Care Clinic which “aims to improve the overall health care experience by creating a new care model emphasizing personalized, evidence-based medicine and greater coordination of care.”

Responding to comments that Congress should address how health care is delivered and paid for, Dr. Bornstein said, ”We are using the expertise we have developed in building the Emory Patient-Centered Primary Care Clinic to help the practices in our network become equally effective medical homes. However, again in a fee-for-service payment model, the extra costs entailed in care coordination are not reimbursed nor are there offsets for the reductions in revenue that occur (which become savings to the payers). In the fee-for-service payment system, these efforts are not reimbursed and the reduction in face-to-face patient time would result in adverse financial consequences...We need payment structures that facilitate and reward these activities, rather than those that reward doing more to patients (tests, procedures, etc.) independent of outcome.”

Contact:

Len Marquez
Director, Government Relations
Telephone: 202-862-6281
Email: lmarquez@aamc.org

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For More Information

Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org