HHS Secretary Calls for Paradigm Shift, Urges Use of Medical Homes

(Source: AAFP News Now from 5/15/2009)

Health and Human Services (HHS) Secretary Kathleen Sebelius urged Congress to enact a healthcare reform plan that provides a medical home for every American while shifting the nation's treatment paradigm from a sickness-based to a wellness-based system.

"It is clear that the current situation is unaffordable, unsustainable and unacceptable," said Ms. Sebelius during testimony before the House Ways and Means Committee on May 6. "The cost of healthcare is crushing businesses and families," she said, adding that U.S. industries are becoming less competitive than their global counterparts because they are struggling with the high cost of healthcare.

Ms. Sebelius pointed out that nearly 50 million Americans lack health insurance, and many end up coming into the emergency room with serious conditions as a result. Consequently, they "wind up with the least effective, most expensive care because they did not get preventive care," said Ms. Sebelius.

"They do not have a healthcare home, and all of us pay for that," she added.

Ms. Sebelius told the committee that the United States needs to get a handle on healthcare costs by "shifting the system toward prevention and wellness, while making sure all Americans have a health home."

According to Ms. Sebelius, the workforce pipeline for primary care providers is very thin. "I want to make sure, as we shift this system to a wellness system, that we have the providers who are capable of making that shift," she noted, calling for changing payment incentives to "more appropriately reward primary care without disadvantaging specialty care."

"If we begin to have payments based on outcomes, if we recognize that dollars spent on wellness pay huge dividends to lower healthcare costs on the other end, then I think we can have a system where more people will choose general practice, primary care and family practice as opposed to (sub)specialty care as a way they can be successful," she said.

Rep. Kevin Brady, R-Texas, addressed physician payment issues during the hearing, saying, "It is truly a mess the way we reimburse physicians under Medicare." It drives good physicians out of the system and away from elderly patients who most need those physicians, Mr. Brady added.

"It is embarrassing to have (physicians) come up here every year to beg for a 1 or 1.5 percent increase," particularly when the costs of treating patients and doing business far exceed that amount, said Mr. Brady. He called for a sustainable fix for Medicare's sustainable growth rate (SGR) formula.

Physicians are facing a 21 percent cut in the Medicare payment rate under the SGR on Friday, Jan. 1, 2010, unless Congress acts. Ms. Sebelius said the "21 percent cut that is looming right over the horizon is totally unacceptable."

"Nothing could be more disruptive to the healthcare system that underpins moving forward on health reform than losing providers," she said. "The administration and I look forward to working with Congress to address not only the current crisis that is right around the corner, but a long-term sustainable (solution) to make sure seniors and our most disabled populations who rely on Medicare services can keep the doctor they want and need and keep the health services that are so vital.