De­ci­sive lead­er­ship is what’s miss­ing from health­care realm

Modern Healthcare - - FRONT PAGE - DAVID BURDA Ed­i­tor

Health pol­icy in this coun­try lacks di­rec­tion be­cause of a short­age of de­ci­sive lead­er­ship in both the public and pri­vate health­care sec­tors. The past few weeks have wit­nessed an un­prece­dented amount of waf­fling on im­por­tant health­care top­ics that only feeds the be­lief that if you just shout loud enough, the ob­ject of your ire will back off their po­si­tion rather than stand firm. The fact that this is an elec­tion year only makes things worse.

The lat­est waf­fle was the decision last week by HHS to post­pone the sched­uled Oct. 13, 2013 com­pli­ance date for the in­dus­try to switch to the ICD-10 sys­tem of di­ag­no­sis and pro­ce­dure codes. Never mind that the rest of the in­dus­tri­al­ized world has been us­ing ICD-10 for two decades and that U.S. providers have known about the switch for years, or­ga­nized medicine didn’t like it and that was that. Too costly, too bur­den­some, too complicated, too fast were among the rea­sons cited for push­ing ICD-10 com­pli­ance fur­ther into the fu­ture. HHS caved un­der the pres­sure, which surely will reap­pear with added vigor when the next com­pli­ance dead­line comes up.

While HHS was fold­ing, so too was the leg­isla­tive branch of the fed­eral gov­ern­ment on find­ing a per­ma­nent re­place­ment for the prob­lem­atic Medi­care sus­tain­able growth-rate for­mula for pay­ing doc­tors. Un­der the for­mula, physi­cians would have been sub­ject to a 27.4% re­duc­tion in their Medi­care pay­ment rates on March 1. But rather than deal­ing with the prob­lem, law­mak­ers again post­poned a decision by ex­tend­ing the SGR through the end of the year with the pay cut now sched­uled to take ef­fect on Jan. 1, 2013. We’ve lost track of the num­ber of times Congress passed the buck on this one. But you can be sure that come De­cem­ber, we’ll be writ­ing the same story but only plug­ging in dif­fer­ent dates.

Back to the ex­ec­u­tive branch. In Jan­uary, HHS re­leased a final rule im­ple­ment­ing a pro­vi­sion of the Pa­tient Pro­tec­tion and Af­ford­able Care Act that re­quires in­sur­ers to pro­vide cov­er­age for pre­ven­tive-care ser­vices to en­rollees with no co-pay­ment or de­ductible. The rule re­quired all em­ploy­ers to pro­vide that cov­er­age through their car­ri­ers to their em­ploy­ees, in­clud­ing cov­er­age for con­tra­cep­tives. The rule gave an ex­tra year to re­li­gious em­ploy­ers, in­clud­ing Ro­man Catholic hos­pi­tals, to com­ply with the rule if their re­li­gious doc­trines op­posed the use of con­tra­cep­tives. The back­lash from Catholic bish­ops, con­ser­va­tive groups and many Re­pub­li­can mem­bers of Congress was vo­cal and im­me­di­ate. Twenty-one days af­ter the final rule was un­veiled, Pres­i­dent Barack Obama backed off, an­nounc­ing that faith-based em­ploy­ers would not be re­quired to pay for con­tra­cep­tive cov­er­age as part of the ben­e­fits pack­age of­fered to their em­ploy­ees. In­stead, the em­ploy­ers’ car­ri­ers would be re­quired to of­fer that cov­er­age free of charge to any em­ployee who wanted it.

Mak­ing Obama’s re­ver­sal on birth con­trol seem lead-footed was a pri­vate-sec­tor turn­about from the Su­san G. Komen for the Cure or­ga­ni­za­tion. On Jan. 31, the As­so­ci­ated Press broke the news that the na­tion’s lead­ing breast can­cer or­ga­ni­za­tion de­cided to stop giv­ing money to Planned Par­ent­hood, the na­tion’s largest provider of abor­tion ser­vices, for breast­cancer screen­ing and re­lated ser­vices. The back­lash again was im­me­di­ate and vo­cal, this time from many women’s groups, lib­eral or­ga­ni­za­tions and Demo­cratic mem­bers of Congress. Three days later, Komen reversed it­self and said it would con­tinue to pro­vide grants to Planned Par­ent­hood.

We sup­port ef­fec­tive tech­nol­ogy, fair pay­ment for ser­vices, eq­ui­table ben­e­fits pack­ages and preven­tion and well­ness. We also sup­port the nec­es­sary lead­er­ship to see that these goals be­come a re­al­ity. We need lead­ers in health­care who have the courage of their con­vic­tions and who will see their ideas through to a suc­cess­ful con­clu­sion no mat­ter what the po­lit­i­cal or public re­la­tions cost.

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