#62: Pod Save Health Care: The Curbsiders Foray into health policy

October 15, 2017 | By Matthew Watto, MD

Remedy your ignorance as we review some basics of health care policy with Dr. Fatima Syed, Chair of the Council of Residents and Fellows for the American College of Physicians. Dr. Syed is early career physician whose work is already affecting health policy at a national level. You can do it too and we’ll teach you where to start along with defining basic, but poorly understood concepts like The Affordable Care Act, universal health care, single payer health care, MACRA, MIPS, and how “quality” is really measured. Don’t miss this part one in our health care policy for beginners series.

Full show notes available at http://thecurbsiders.com/podcast

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Policy Pearls:
Dr. Syed recommends looking for a professional organization in your specialty, that aligns with your values. Then, get involved! Don’t just read articles and opinions that agree with your views/beliefs. Learn your opposition’s point-of-view. Below is a brief and slightly more in-depth summary of what we discussed on air.

Universal health care refers to all citizens having access to quality health care. Single payer is one potential way to achieve universal care where a single entity would provide health care for everyone e.g. Bernie Sanders’ “Medicare for all”.

The Affordable Care Act (ACA aka ObamaCare) was passed in 2010 as a step towards providing universal health care in the US. It established an individual mandate requiring most US citizens to have health care. Those without coverage pay a tax penalty of the greater of $695 per year up to a maximum of three times that amount ($2,085) per family or 2.5% of household income. State-based exchanges were created to help individuals purchase insurance coverage in an online marketplace with hopes of promoting competition. Individuals/families with income between 133-400% of the federal poverty level are eligible for premium/cost-sharing credits.

The ACA’s insurance reform allows for rate variation based only on age, premium rating area (e.g. high cost areas like NYC can charge higher rates), family composition, and tobacco use. It allows students to remain on parent’s health insurance until age 26. Insurers can no longer deny coverage based on preexisting conditions. The ACA abolished limits on annual and lifetime coverage to prevent families from going bankrupt paying for expensive medical bills.

Health care quality in the US ranks poorly among developed nations. Quality measures can be objective (e.g. life expectancy), or subjective (e.g. patient surveys). Dr. Brigham pointed out that it may be unfair to compare the US to countries with nationalized health care because uninsured patients in the US might negatively affect our perceived quality, life expectancy, etc. The US ranked last in the 2017 Commonwealth Fund Health Care survey despite ranking highest in health care spending.  

MACRA, the Medicare Access and CHIP Reauthorization Act, is legislation passed in 2015 that replaced the previous Medicare reimbursement schedule with a new pay-for-performance program focused on quality, value, and accountability. This legislation combines previous quality, value and incentive programs into a single Merit-based Incentive Payment System (MIPS).  MIPS replaces the old fee-for-service payment model used by Medicare where physician pay was based on the quantity, but not quality of medical care. MIPS is designed to shift focus to the quality of care provided and de-incentivize unnecessary diagnostic testing and treatment. Why should you care? Physicians will be penalized if they do not meet quality standards. They must bill and code to a level that reflects each patient’s complexity and the level of care provided, or suffer financial losses.  

Health care changes occur gradually. The current ideas for nationalized health care have been entertained since Teddy Roosevelt!

Goal: Listeners will learn the basics of the affordable care act, payment reform, quality measures, and how to become an advocate for themselves and their patients.

Learning objectives:
After listening to this episode listeners will…

1. Define the Affordable Care Act
2. Differentiate between universal health care and single payer health care
3. Explain the basic concept of MACRA and MIPS and how it affects physicians
4. Recall the different ways that quality can be measured

Disclosures: Dr. Syed reports no relevant financial disclosures

Time Stamps
00:00 Intro
03:20 Getting to know our guest
07:23 How to get involved in a professional organization
09:37 Resources to learn health policy
14:06 The Affordable Care Act and ObamaCare
17:56 What is MACRA, MIPS and how do they affect physicians?
23:09 Nationalized health care in the US versus other countries
25:33 Universal and “single payer” health care defined
27:00 How is quality health care defined? Why is the US rated so poorly?
32:53 Recap and summary of what we’ve learned
34:09 Dr. Syed’s take home points
35:36 Outro

Links from the show:

1. Invisible Man (book) by Ralph Ellison
2. Invisible Man (book) by H.G. Wells
3. Ghost Dad (film) w/Bill Cosby
4. Health Affairs Journal for Health Policy http://www.healthaffairs.org
5. Kaiser Family Foundation https://www.kff.org
6. Bob Doherty on Twitter @bobdohertyacp
7. Andy Slavitt on Twitter @aslavitt
8. How Single-Payer Health Care Could Trip Up Democrats It’s their version of “repeal and replace.” But converting to “Medicare for all” requires complicated choices. By MARGOT SANGER-KATZ (NY Times Sept 11, 2017)
9. Fresh Air (podcast) – How Health Care Became Big Business with Elisabeth Rosenthal
10. Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care. CommonWealthFund.org
11. Summary of the Affordable Care Act Fact Sheet from KFF.org
12. Helpful articles on MACRA (legislation) and MIPS (payment program enacted by MACRA) https://khn.org/news/faq-medicare-lays-out-plans-for-changing-doctors-pay/ or https://www.practicefusion.com/blog/what-is-macra-and-mips/