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Health Care in the Future

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... Report Slide 17 Slide 18 Slide 19 Slide 20 Medicare Cardiac Procedures Slide 22 Deficit Reduction Act of 2005 SCHIP/Medicare Slide 25 ... – PowerPoint PPT presentation

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Title: Health Care in the Future


1
Gloom, Doom and the Baby Boom
Health Care in the Future
Raymond J. Gibbons, MD Mayo Clinic
CP988919-1
2
Disclosure Statement

Raymond J. Gibbons, MD
Research grants(significant) Radiant Medical
KAI Pharmaceuticals TargeGen TherOx King
Pharmaceuticals
3
Disclosure Statement

Raymond J. Gibbons, MD
Consultant(modest) Hawaii Biotech Cardiovascula
r Clinical Studies(WOMEN Study) Consumers
Union TIMI 37A
4
  • Health care crisis
  • Attention on imaging
  • Quality
  • Efficiency

CP1279194-7
5
  • Health care crisis
  • Attention on imaging
  • Quality
  • Efficiency

CP1279194-8
6
Health Care Costs15-Year Cumulative Inflation
1991 100
Sources AMA, Kaiser Family Foundation
7
Less Reimbursement forMedicare/Medicaid Services
CP1246692-2
8
Demographics and Cardiology
P(i,t) P(i-l, t-l) D(i,t) I(i,t) E(i,t)
CP941130-20
9
Population Over 65

Year
CP941130-21
10
U.S. Federal SpendingActual 2005
Congressional Budget Office
CP1245974-1
11
Workers per Medicare Retiree
Health Care Financing Administration
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12
Health Care Spending
Public
Annual growth ()
GDP
Private
Congressional Budget Office
CP1279194-19
13
Medicare and Medicaid
Actual
Projection
Total federal revenue
GDP()
Congressional Budget Office
CP1283309-6
14
Medicare
The degree of uncertainty about whether future
sources will be adequate to meet our current
statutory obligations to the coming generation of
retirees is daunting.
Alan Greenspan Chairman, Federal Reserve
Bank January 25, 2004
CP1279194-3
15
Medicare
The longer we wait, the more severe, the more
draconian, the more difficult the adjustment is
going to be I think the right time to start is
about 10 years ago.
Ben Bernanke Chairman, Federal Reserve
Bank January 18, 2007
CP1279194-2
16
2007 Annual Report
Medicare Trustees
  • The Hospital Insurance Trust Fund could be
    brought into balance with
  • An immediate 122 increase in payroll tax
    (1.45?3.22)
  • An immediate 51 reduction in spending
  • Some combination of the two

CP1279194-4
17
Need for Change in Health Care
  • Little public discussion elephantin the
    corner
  • Required changes will increase
  • Long overdue
  • Further delay
  • ? Number of uninsured
  • ? Racial/ethnic disparities
  • Wage stagnation
  • ? Commitment to education
  • Threat to the country

CP1243922-1
18
InertiaStatus quo Short-term effects
Necessity oflong-term change
CP1243922-2
19
  • Health care crisis
  • Attention on imaging
  • Quality
  • Efficiency

CP1279194-9
20
Blue Cross to require pre-approval for
scans MRI, other imaging costs up 20 in
year Boston Globe September 6, 2005
21
Medicare Cardiac Procedures
Rate/1,000

Circ 113 374, 2006
CP1218939-2
22
Less reimbursement forMedicare services
CP1246692-3
23
Deficit Reduction Act of 2005
  • Good news Elimination of 4.4 decrease in MD
    payment
  • Bad news Reduction in payments for imaging
    78465 decreased by 75

CP1279194-1
24
SCHIP/Medicare
House Version
  • Good news Eliminates 9.9 decrease in 2008 and
    5 decrease in 2009
  • Bad news In 2010, SGR replaced with new system
    with 6 separate targets imaging growth
    limited to GDP
  • Unknown comparative effectiveness

CP1279194-5
25
Imaging Stress Testing - Medicare
Ratio of rates of imaging stress testing to the
U.S. average by hospital referral region (1996)
Wennberg et al The Dartmouth Atlas of
Cardiovascular Health Care, 1999
CP1279194-15
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