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Panel Detail:

Tuesday, April 24, 2007
9:25 AM - 10:40 AM

Your Health Care: Getting Through the Maze

Moderator:

Richard Merkin, CEO and Founder, Heritage Provider Network; FasterCures Board Member

Marc Hoffing explains that his organization determines high-risk patients and assigns case managers to them and their families.

Glenn Melnick, a professor at the University of Southern California, noted that in the past year, the nation has seen a 9 percent increase in premiums. Standard health insurance is based on the idea of fee-for-service reimbursement, which means it rewards physicians who perform more tests, prescribe more treatments. In fact, he asserted, many practices are revenue-motivated, and this is a factor in the rise in health-care costs. For example, hospital committees may insist on keeping patients in ICUs -- patients who have no hope for recovery. Such decisions can cost up to $5 million or $6 million per case.

"Lowering costs and improving quality of care may be a nationwide solution" to the problem from the economic perspective, said Melnick.

Marc Hoffing with Desert Medical Group and Oasis IPA explained that organization has come up with various ways to reduce health-care costs. One way is determining high-risk patients and assigning so-called case managers to them and their families. "We have built a system to respond to patients' needs," he said.

"In health care geography is destiny," added Hoffing. For instance, California patients usually spend only a few days in ICUs, while those in Florida may spend several weeks, even for similar conditions. An average hospital stay bill charges may run up to $10,000 or $11,000 per day. One way to reduce these expenses, he explained, is to perform necessary procedures when a patient is admitted to the hospital or, if admitted on Friday, to provide necessary care over the weekend.

Gordon Yenokida with Regal Medical Group agreed that there is a problem with fee-for-service principle. "When doctors are compensated based on the number of the procedures, and not their necessity," he said, "there takes place an over-utilization." Physicians need to start asking themselves if the tests they order are truly necessary.

Robert O'Keefe with Coastal Communities Physician Network provided information on the various programs his organization has implemented. For example, the program Choices helps develop reasonable expectations for patients and their families, including end-of-life options. He agreed that weekend procedures may be beneficial for hospitals. In fact, he stated, "28 percent of health-care costs can be saved by performing procedures on the weekends." O'Keefe also suggested that more can be done in outpatient settings and that hospitals could be used only as ICUs. All participants agreed that health-care system has to consider a variety of issues. As Merkin noted, health care "has to be integrated and led by physicians who can lead and can maintain their organizations with fiscal integrity." Switching from a fee-for-service reimbursement principle, they said, would help change the health-care system and provide higher quality of services and lowered costs.

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