Guest writer: Put patient care first

JAMES W. FASULES SPECIAL TO THE DEMOCRAT-GAZETT

In health care reform

LITTLE ROCK — According to the Kaiser Family Foundation, the cost of health care grows 2.5 percentage points more each year than the country’s Gross Domestic Product. Health care now accounts for 16 percent of the GDP.

Needless to say, look in any newspaper on any given day and you’ll find at least one story about health care. It’s a topic on everyone’s mind, and not surprisingly, it’s a topic that weighs heavily on the minds of health care providers.

Our current health care system is rapidly reaching a point where the quality of care is in jeopardy. Our current system supports uncoordinated and inconsistent care where huge differences in the amount of care don’t translate into differences in outcomes-a misaligned incentive to offer more care, not higher quality care.

Currently, access to quality care for minorities is a major deficiency, with African Americans and Hispanics tending to receive lower quality of care across a broad range of diseases. In the current system, physicians across the country continue to struggle with ever higher medical malpractice premiums while the Medicare fee schedule that sets physician payments fails to keep up with inflation. This means that physicians are paid less and less each year for providing the same care, potentially creating an even worse access problem.

Nationally, cardiac disease accounts for 43 percent of Medicare expenses. In Arkansas, our rate of deaths caused by heart disease and stroke is among the highest in the U.S. This high mortality rate is undoubtedly influenced by the rate of state residents who smoke: almost onequarter in 2006. In addition, a whopping 64 percent of adult residents are overweight or obese, not exactly helpful when it comes to managing heart disease.

Although personal responsibility definitely plays a role in these figures, our current health system doesn’t do much to help. Meanwhile, the rising cost of providing care is outstripping society’s ability to pay. Combine all these factors with 47 million uninsured Americans and the looming cost to Medicare as Baby Boomers retire, and you have a system primed for needed reform. (In Arkansas, 18 percent of state residents from 2005-06 were uninsured. That’s more than ahalf-million residents.)

To address the need for quality-based health system reform, the American College of Cardiology, or ACC, has launched a campaign called Quality First with thegoal of transforming health care from the inside out. The college firmly believes, as do I, that health care providers should be the key players in driving reform to assure that any new system is based on patient-centered care.

In recent meetings with congressional leaders in Washington, D.C., I discussed key principles that should be part of any reform effort. Universal access to basic care and some sort of public/private financing system to help stabilize the everincreasing costs of health care are givens. Payment reform also is necessary. The federal government and insurers need to devise better ways of compensating physicians for providing quality care.The current reimbursement method and its focus on process just aren’t working.

Reforms need to be driven by a focus on quality and outcomes. The ACC is already leading the way in this area. Not only does the college boast the largest national cardiovascular data registry, it also is a leader in the development ofclinical guidelines and appropriateness criteria to guide cardiovascular professionals and patients in their treatment decisions.

In addition, the ACC continues to build on these efforts and is working with payers, Congress and other physician organizations on pilot programs, legislation, stronger quality measures and expedited guidelines. By providing continually improving, high-quality cardiovascular care, we can maximize the value of federal dollars spent on Medicare and improve the health of Arkansans and all Americans.

The ACC’s efforts at improving patient care can be viewed as a model for reform. To work, the entire health care community, especially patients, must play a critical role in shaping the future system to ensure that any new system is grounded in care and not solely on costs.

If we aren’t involved now, reform will happen “to” us rather than “with” us. The problems we are experiencing today with the health care system will only grow steadily worse. Congress needs to focus on this issue now-and get it right. We must help, for the future viability of our own health care is at stake.

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James W. Fasules, M.D., a Little Rock cardiologist, serves on the board of trustees of the American College of Cardiology and is a past governor of the ACC’s Arkansas chapter.

Editorial, Pages 23 on 06/07/2008

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