OUTLINE OF HEALTH CARE PLAN

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OUTLINE OF HEALTH CARE PLAN

• RICHARD R. SCHNEIDER, MD
• F.A.C.P., F.A.C.C.

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Health Care Plan

•  
• Medical Provider Value Score
• By Richard R. Schneider,
  MD
•  
•  Value Outcome score X severity of illness
  score
•   Average cost per patient
•  

3
HEALTHCARE COSTS

1. 2.2 Trillion per year total
2. 300 million Americans equals gt 7000 per person
3. Recent estimate by Price Waterhouse more than One
   Trillion Dollars wasted every year
4. 31 Overhead
5. Massive over utilization of resources

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What We Get for Our Money

• 54 correct diagnosis and treatment (Rand
  corporation, New England Journal of Medicine)
• Huge numbers of medical errors
• 47 million uninsured at any given time
• 75 million uninsured during any given year

5
Solving the Problem

• Republicans want a market based solution
• Democrats want Universal affordable coverage
• Everyone wants more for their money

6
Creating a Medical Marketplace

• The market for medical care today simply does not
  exist. One must be created.
• Markets require knowing what youre getting and
  how much it costs.
• To know what youre getting Must Measure
  severity of illness adjusted outcomes.
• To know what your paying Must measure resource
  expenditure to achieve those outcomes.
• Grade A providers Excellent outcomes/low cost
  per patient.
• Grade B providers Good outcomes/average cost
  per patient
• Grade C providers Poor outcomes/high cost per
  patient
• Must maintain fee for service payment schedule
  for doctors. Pay A providers 10 higher
  reimbursements. Pay C providers 10 lower
  reimbursements.
• Report cards must be made public so patients
  can chose the best doctors. (Similar to recent
  recommendations by The Institute of Medicine.)
• Doctors must have easy and rapid appeals process
  to correct mistakes in their report cards

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Accurate Quality Measurement

• Accurate outcome measures can be obtained by
  simply using the same statistical tools that have
  been used for decades to perform clinical trials
  of medications and procedures. These analytic
  techniques are scalable to large numbers of
  physicians using powerful modern computer
  technologies.
• Only outcome measures are meaningful process
  measures are meaningless because they do not
  correlate with better patient outcomes.
• Outcome measures are only scientifically and
  mathematically accurate if they take into
  account initial severity of illness.
• Quality and cost measurements must use uniform
  criteria and adequate sample sizes and be
  performed by an unbiased organization. Hospitals
  and insurance companies or HMOs are not
  unbiased. Only the Federal Government can be
  trusted.
• Physician Associations and Congress need to work
  together to devise methodology and quality
  criteria.
• Which is more important, to measure the
  performance statistics for thousands of
  professional athletes or hundreds of thousands of
  professional physicians?

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Medicare for All

• We hold these truths to be self evidentthe
  right to life,
• When these words were written doctors could do
  little to prolong life.
• In the 21st Century, if one doesnt have access
  to healthcare, one doesnt have the right to
  life.
• Denying healthcare to anyone is simply
  Un-American. This is a self evident truth and
  is not debatable. Period.
• Recent opinion polls indicate a majority of the
  public and of physicians are in favor of more
  government involvement in healthcare.

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Universal Coverage

• Expand fee for service Medicare to cover all
  Americans.
• Medicare to measure severity of illness adjusted
  outcomes and resource utilization for all
  providers.
• Resource utilization includes cost of
  medications, testing costs, cost of
  hospitalizations, surgeries and other procedures,
  etc.
• Outcomes measurement includes severity of illness
  adjusted mortality, morbidity, and measurements
  of clinical improvement.

10
Benefits to Whistleblowers

• Government will track quality of care for all
  doctors.
• Whistleblowers will not be needed to report poor
  quality care. Good doctors should not have to be
  courageous to protect their patients.
• The excellent quality of care provided by many
  whistleblower physicians will be documented and
  available to be used in their defense.
• High quality low cost doctors will generate more
  revenue for their practices or institutions and
  will therefore gain in power and influence over
  low quality high cost doctors.

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Economic Savings

• Reduce overhead from 31 to 16 saving gt 300
  billion/ year.
• Reduce resource utilization by 15 saving gt 300
  billion/year.
• Massive reduction in episodes of malpractice with
  associated dramatic reduction in malpractice
  premiums.
• Redirect part of economic savings into Medicare
  funding to pay for universal coverage and
  increased reimbursements for doctors.

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Benefits for Doctors and Hospitals

• All physician services are fee for service.
• 47 Million new paying customers. No need to
  provide free care. No bad debt to write off.
• Patients free to chose any doctor including
  specialists without gate keepers.
• Doctors will regain professional autonomy. The
  interests of doctors and patients will be
  realigned.
• Treatments and tests not subject to excessive
  scrutiny and denials.
• Greater financial and job security for doctors in
  addition to higher incomes.

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Benefits to Business

• Decreased labor costs due to absence of
  expenditures for health insurance.
• Employment decisions will be based on ability to
  do the job not on age or health status.
• Healthier more mobile work force will improve
  overall productivity.
• Overall increase in profits.
• Overall increase in economic prosperity will
  increase demand for all goods and services.