As Congress prepares to release legislation aimed at reforming the nation’s health care system, IHA has identified several key principles that Congress should consider while working on this legislation.

These Health Care Reform Principles can be summarized in the following points and provide the hospital perspective on what should be done concerning health care reform.

Coverage For All

Iowa is a well-insured state, but there are still nearly 300,000 Iowans who do not have health insurance.  People with insurance have a medical “home” and receive regular health care, but people who are uninsured tend to delay care, leading to more serious and expensive health care problems.

Nationwide, the epidemic of uninsured citizens (more than 50 million) has put an enormous strain on the health care system as a whole and hospitals are left with immense levels of charity care (health care that is provided to individuals without insurance).

Though Iowa hospitals are committed to providing high-quality health care to patients regardless of their ability to pay, charity care levels place an extraordinary financial strain on hospitals and raise costs for private-pay (insured) individuals.

IHA supports legislation that seeks to reduce the number of uninsured citizens in Iowa and across the U.S.  There are many methods for doing so, but as it stands now, this topic is shaping up to be the most contentious issue of the health care debate.  IHA will have further comment on this issue as details of various proposals become clearer and actual legislation begins making its way through Congress.

Focus on Wellness

Today’s health care system has a tendency to provide more “care” than “health.”  Preventing illness and disease and consistently addressing chronic condition keeps people out of the hospital, saves lives and lowers costs.

IHA supports methods that incent patients to remain healthy and health care providers to place a higher focus on preventive medicine and work toward treating illnesses before they occur or become serious through wellness and healthy lifestyle training.  IHA recognizes the importance of wellness as it relates to improving health, reducing health care costs and overall system utilization over time.

Highest Quality Care

Iowa is already a national leader in health care quality, but we can do even better by supporting evidence-based models of care and creating a payment system that rewards efficient medical practices, including wellness, prevention and telemedicine.  The Iowa Healthcare Collaborative is a critical partner for improving quality of care in Iowa.

As part of health care reform, Congress has proposed a “value-based purchasing” payment system that would exist within the Medicare program.  This new system would begin to reward value (low cost/high quality) care and would stop rewarding volume-based care (more patients treated equals more Medicare reimbursement).  The system would require hospitals to report quality measures to the government and, in turn, hospitals would receive payments based on those measures.  Higher quality would equal higher payments.

IHA supports such a concept in theory, but is hesitant to fully support the current proposal because of its “budget-neutral” (no new money) approach.  Essentially, the government is proposing cuts to overall hospital Medicare payments by 5 percent and then, based on the quality reporting, allowing the hospital to recoup the 5 percent by meeting cost and quality standards.

IHA maintains that because Iowa hospitals already receive some of the lowest Medicare reimbursements in the country (the Medicare program pays only a fraction of the actual cost of health care that results in hundreds of millions in underpayments statewide) this payment method would not be financially suitable for hospitals.  In addition, the proposal does not contain any incentives for delivering care efficiently, a key priority of IHA.

Make Care Efficient and Affordable

Greater efficiencies reduce costs.  For consumers, this means physicians and hospitals providing health care pricing and quality information that drives informed health care choices based on value.  Waste and inefficiency create drag on Iowa’s health care system.

Hospitals and physicians work hard to adopt efficient methods like LEAN manufacturing or Institute for Healthcare Improvement.  Overall technology and appropriate payment for care are the ultimate keys to creating a health care system that is efficient and affordable.

IHA supports efforts aimed at providing incentives for improved efficiency.  Studies show that once maximum efficiency is reached, reductions in overall cost and delivery system waste will soon follow.

Invest in the Best Information Technology Possible

The American Recovery and Reinvestment Act (stimulus bill) invested nearly $20 billion in incentive payments for health care providers to begin adopting electronic medical records.  IHA supports this effort and agrees that health information technology (IT) is essential to providing quality care.  Medical records that are standardized and portable will bring about greater efficiency, reduce errors and lower cost.  Most importantly, electronic records will help coordinate each patient’s care between each health care provider.  IHA supports steps aimed at incenting providers to adopt these technologies and will continue to work with hospitals to assist in the implementation of these new technologies.

Are there other approaches and ideas that IHA should consider of that are not outlined?  Please explain by leaving a comment on this post.

IHA looks forward to receiving your questions, concerns and alternatives on these and other issues.

For an even more in depth look at IHA positions on the above issues, view the IHA’s Federal Position papers available for download on our website.