Posted: January 4, 2010

By Michael Schwartz
michael.schwartz@insidebiz.com
 
Well aware of the melees that have broken out at recent gatherings focused on health care reform, moderator Cathy Lewis praised the crowd at last week’s Cox Business Executive Discussion Series, “Health Care Reform from a Business Perspective,” for allowing the constructive panel session to get at the issues at hand.
 
“We made it through without uttering the words ‘death panel’ and without law enforcement being involved – well done,” said Lewis, executive editor at WHRO, to the crowd of about 200.
 
The event on Sept. 22 at The Founders Inn in Virginia Beach perhaps went off without a hitch because time is money in the business world and as the six-member panel made clear, the debate over health care reform deals with a financial predicament the business community cannot likely afford to deal with much longer.
 
Panelist Barbara Wallace, president and CEO of the Virginia Business Coalition on Health, made that point with a simple figure – 15 percent. That is the percent increase in annual health care costs that many of VBCH’s employer members are experiencing each year.
“We do see that change is absolutely needed,” Wallace said.
 
Business owner and panelist Jon Wheeler concurred. Nearly 10 percent of the total budget of his real estate company, Wheeler Interests in Virginia Beach, goes toward health care.
 
That’s more than he pays for rent for his office. “It’s getting unbearable,” he said.
 
Sixty-five percent of the people Newport News-based Patient Advocate Foundation tried to help last year were facing medical debt that was leading them to bankruptcy, said panelist Nancy Davenport-Ennis. She is founder and CEO of the foundation, which focuses on patients, and also the National Patient Advocate Foundation, which focuses on policy. Of that 65 percent, 93 percent had health insurance, evidence that the system isn’t working.
 
So how best to solve the problem and end the debate with tangible and effective results? Panel members said it starts with getting everyone involved in the discussion and the process, especially the business community.
 
U.S. employers purchase 54 percent of health care nationwide, Wallace said.
 
“Employers need to take a seat at the table,” she said.
 
The discussion also should include health insurance providers, represented on the panel by John DeGruttola, senior vice president, sales and marketing, at Optima Health.
 
“We have to get all stakeholders motivated,” DeGruttola said.
 
The debate over reform needs to get back to its roots, DeGruttola said, the idea of universal coverage.
 
“Some want to make it an evolution; some a revolution,” he said. “Everybody has to be in the pool. I hate to use the word mandated.”
 
Dr. Keith Newby Sr., president of Cardiology & Arrythmia Consultants Inc. in Norfolk, said he’s not a big fan of a single payer system, in this case having the federal government as payer. As he has seen in other government-run programs, “there’s certain bureaucratic red tape that may make delivery of care difficult.”
 
But Newby is not opposed to a federal mandate.
 
“Car insurance is mandated,” he said. “They found a way to make that work.”
 
Newby also brought up a topic that was repeated throughout the panel discussion, the need for reform to the legal system and the practice of defensive medicine. Because of the fear of lawsuits, many doctors practice “CYA,” Newby said. In other words, they practice a style of medicine that won’t get them sued in what he said is a “sue-happy society.”
 
Dr. James Dudley, a doctor of emergency medicine at Riverside Tappahannock Hospital and chairman of the board of Riverside Medical Group, gave an example of someone coming in to an emergency room thinking he needs an X-ray. The doctor doesn’t see the need, yet the patient demands it. Needless procedures that doctors perform in fear of legal backlash drive up costs.
 
“We balance customer service against the urge to provide evidence-based medicine,” Dudley said.
 
An audience member brought up the idea of creating a “no-fault” pool or fund of money that would cover costs related to malpractice issues rather than having these issues battled out in court, which wastes taxpayer dollars and drives up malpractice premiums. Davenport-Ennis said discussions are taking place about such a fund.
 
The panel discussed the idea of wellness and preventive health care, particularly dealing with the biggest cost-drivers in America – obesity-related conditions.
As a cardiologist, Newby sees firsthand much self-inflicted poor health. “I’m a firm believer that patients need to have a stake in their own health care,” he said.
Healthy people, Newby said, “are paying the price for being healthy,” as premiums are driven up across the board by a system dealing with an increasingly unhealthy nation.
 
“The healthy should have lower premiums,” he said.
 
Wheeler’s company is trying to combat that issue head on. Wheeler Interests has been recognized nationally for its initiatives to get and keep employees healthy in an attempt to control health care costs.
 
Wheeler said that early on in his company’s existence, about half his staff smoked.
 
Things have since changed. Now when he interviews potential employees, he asks up front if they smoke. Even if the smoking candidate is qualified for the job, Wheeler says, “When you stop smoking, please come back.”
 
“Smokers aren’t a protected class in Virginia,” he said.
 
Wheeler’s system includes a 2,800-square-foot gym on site, healthful lunches brought in for employees and a stretching class around noon. He is instituting a 30-minute workout with professional trainers before his employees set off for home every day.
 
Dudley argued that health literacy needs to be one of the foundations that any new system is built on. A health-literate population would allow prevention to begin long before an adult is at a job interview.
 
“How much easier would [Wheeler’s] efforts be if effective health literacy efforts started in pre-K,” Dudley said.
 
In that vein, Davenport-Ennis talked about the need to move what she calls the wholesome food trail into all socioeconomic segments of the population.
A workforce shortage must be addressed in the health care debate, particularly a shortage of primary care physicians, who are outnumbered by doctors seeking more lucrative specialty practices.
 
“Twenty-five percent of the doctors in this country are foreign nationals,” Dudley said. “And we’re all old.”
 
Only 6,000 of the total 26,000 medical school graduates in the U.S. last year went into primary care, Wallace said. Primary care physicians are overworked and earn less than other doctors.
 
“They don’t go into primary care because they can’t afford to,” Dudley said.
 
Other issues mentioned included the need to eliminate insurance company practices of annual and lifetime caps on medical spending for individuals and
clauses regarding pre-existing conditions.
 
While he knew some in the crowd might want his head for saying so, Newby said he wonders why hospitals are tax-exempt. Perhaps nonprofit hospitals operating with huge surpluses should pay taxes, he said.
 
An audience member questioned whether politicians are capable of coming up with a plan that will work and suggested maybe the nation would be better off creating a panel or board of experts from within the industry, like those on the panel, to craft a plan.
 
Davenport-Ennis said she believes Congress has worked deliberately to include all stakeholders in the plans that have been introduced thus far.
 
But Newby said he believes when it comes down to it, most politicians are too scared to go out on that limb, for fear of not being re-elected.
“I don’t know who that board should be comprised of,” Newby said. “I just know it shouldn’t be lawmakers.”