Physicians speak out on healthcare

A first hand account of the meeting at Rutland Regional Medical Ceneter

by Dan McCauliffe, MD

RUTLAND – Approximately 40 physicians and some dentists met with local state representatives to voice their concerns over Vermont’s health care reform efforts. The meeting was held at the Rutland Regional Medical Center on Jan 16th. Mike Fisher (chairman of the House Committee on Health Care) and Claire Ayer (chairwoman of the Senate Health and Welfare Committee) were also in attendance.

Physicians and dentists spent two hours voicing concerns about the upcoming Green Mountain Care (GMC) single-payer healthcare system. Although the need for reform was strongly acknowledged, the lack of details of what GMC will be, and the concerns mentioned below, help explain why no provider openly endorsed the GMC plan.

The strong need to contain healthcare costs was addressed. Dr. Susan Blish and other physicians voiced concerns that if patients gain easier access to health care services, but don’t share more responsibility for both healthy living and cost-containment, then how can we expect to keep costs under control. Dr Mel Boynton endorsed consumer-driven health care as a means to better engage patients in controlling health care costs and several physicians voiced that health savings accounts (HSAs) were a good vehicle for patient involvement in cost control.

Drs. Siva, Radamacher, Pisanelli and others mentioned the need for tort-reform, so that physicians see less need to order extra, unnecessary tests to help prevent malpractice suits. This would help cut down on health care costs. Dr. Susan Blish mentioned the high cost of futile end-of-life care, that should also be addressed to lower the cost of health care.

I mentioned that GMC is likely to proceed with global budgets as a cost-control mechanism. This payment scheme will force lower payments upon hospitals and health care providers. This will lead to prolonged waiting periods to access care, and the rationing of services, as is the case in countries that use global health care budgets. This will be exacerbated with universal access, if patients don’t share more responsibility in controlling health care costs, and significant medical malpractice reform measures are not implemented.

Dr. Phil Lapp, Dr. Dan Foley and others stated that GMC’s plan to pay physicians based on performance would be very problematic, as physicians will be held accountable for patients who are high risk and more likely to have a bad outcome, or patients who don’t take their medications, follow the doctor’s orders, and live risky and otherwise unhealthy lifestyles. (As an aside, a CBO report released days after the meeting indicates that these measures have largely failed in pilot studies.)

Sustainability of the system was a major concern voiced by many in attendance. Dr. Chris Higgins mentioned other state-run health care programs that have failed, such as Maine’s Dirigo plan, and has concerns that GMC may fail but on a much larger scale.

There are many uncertainties and Dr. Dan Foley mentioned that there should be an “off ramp” mechanism to pull the plug on GMC, and have a backup plan if things don’t turn out as hoped for. Without a backup plan it was feared that GMC could potentially cause prolonged and perhaps irreparable harm to Vermont’s health care system and economy.

Physicians and dentists alike shared concerns of the difficulty we have been having recruiting physicians and dentist to our state, and how GMC may exacerbate this problem. Several doctor’s mentioned that if their services are not valued as highly as they are in other states, there be will an exodus of physicians from Vermont.

It was suggested that state legislators from other regions of the state have similar meetings with providers. It was also mentioned that the GMC Board might consider going around the state to the various hospitals and listening to providers. I would add that they should also consider similar meetings around the state to meet with business men and women, and the general public to hear additional concerns. Such meetings might help them better shape the GMC system, and avoid potential pitfalls and unintended consequences so that whatever system they devise, has the best chance of being financially sustainable, while preserving a quality healthcare system for the benefit of all Vermonters.