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U.S. Department of Health and Human Services | ||||
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| REMARKS BY: | TOMMY G. THOMPSON, SECRETARY OF HEALTH AND HUMAN SERVICES |
| PLACE: | The American Medical Society, Chicago, Illnois |
| DATE: | July 18 2002 |
Thanks also to Dr. Ed Hill and to you, Dr. Mike Maves … and although he isn't here, I so appreciate the work of my good friend Dr. Tim Flaherty of my great home state of Wisconsin.
It's such a pleasure to be with all of you. You are the men and women who truly are setting the course for American medicine. The specialties you represent range the spectrum of medical practice. The expertise, the dedication and the compassion you and your colleagues provide to the American people make our health care system the best in the world.
And as someone who just had his knee scoped, I'm especially appreciative of the orthopedic surgeons and anesthesiologists in the audience.
I'm walking just fine … and am even planning for my first post-surgery softball game. I'm personally a beneficiary of the extraordinary quality of care that physicians, nurses and health care professionals of all kinds offer in our country.
My friends, we're living in the most amazing era of medicine in human history. In the last century, life expectancy for women in the United States doubled. We're now performing prenatal surgery on unborn children. We're producing cardio-therapies that are sustaining and improving life for the elderly.
The list of near-miraculous treatments and drugs … so many of which we've come to take for granted … is longer than I could reasonably list.
Yet, as we all know too well, all is not well with American medicine. In point of fact, we are dealing with a system of health care delivery that is, at its root, dysfunctional. The problem is neither with caregivers nor with the quality of care itself. To the contrary, as I've just said, America has the finest health care professionals and the finest caliber of medical treatment of any nation … at any time … in history.
The problem - the crisis - is the means by which care is delivered or paid for. The system by which care is delivered has simply not matured at the same pace as the technologies and treatments now available.
I've traveled all over the country. I've met with caregivers at major hospitals and at clinics on Indian reservations. I've seen rural health care in Alaska and urban health care in our largest cities. I've spoken with America's leading medical researchers … and with men and women in communities of all sizes and in every area of specialization who work to provide health and healing to America's families.
I've traveled to Spain and Germany … I've been to Canada. I've discussed health care with some of the leading policymakers and caregivers in the world. And sadly, I have to report that in Western society broadly, the various systems of care are eroding with ever- greater rapidity.
I've come to one central conclusion: The way we provide care is in jeopardy of collapse. It is clouded by regulatory burdens that are confusing, duplicative and extremely time-consuming. Physicians and nurses almost have to obtain advanced degrees in business administration, accounting and jurisprudence just to run their offices from day to day.
Patients have to fill out endless forms … get transferred from place to place … worry about what insurance will pay for what treatment and at what cost.
I would submit that such an environment is not what any of you envisioned as your worked your way through medical school. You saw yourselves caring for people in pain … bringing healing to broken and ailing bodies … offering calm and comfort to wounded spirits.
Instead, you are forced to jump through hoop after hoop of paperwork, rules, legal consultations, insurance forms and so on.
Let me tell you something up-front: I know that one of those hoops involves Medicare payments. And I also know that you're concerned with the payment reimbursement schedule. So am I. Although Congress makes the decision on the amount, I'm certainly working to remedy the problem.
And I can't believe Congress will leave this year without dealing with the payment issue. I'm monitoring this situation very closely … CMS Administrator Tom Scully, who many of you know, is keeping a close eye on what's happening on this issue on Capital Hill.
Please know we want to work with you on this matter. We don't an adversarial position to develop. So let's keep the lines of communication open. We'll find a solution together. And this is another reason we have to move forward in modernizing and strengthening Medicare.
My friends, we have to fundamentally change the current health care delivery system in our country. The myriad rules, regulations and restrictions that make obtaining good health care difficult, if not impossible, have to be reviewed carefully and, when necessary, jettisoned like useless ballast.
I'm committed to preserving the best of America's medical system - the research and development that produces the drugs and treatments and procedures that are promoting longer, better lives for so many people.
Rather, I'm thinking of renewal, transformation and essential change in the delivery of care. In the next year, you will see from my Department bold new ideas and initiatives to fundamentally change and improve our health care system.
One of the things I'm planning to do is call a national conference at Jackson Hole, Wyoming. I'm going to invite leaders from medicine, law, policymaking and economics to talk together, gain insight and address the full range of issues that have to be dealt with before true reform can begin.
I'm looking forward to inviting some of you in this room to the conference. And whether you're able to attend or not, I hope every one of you will give me your counsel and input as we begin to move forward.
We're already taking some significant steps. We've launched a 27-member commission - my Advisory Committee on Regulatory Reform, headed by Dr. Doug Wood of the Mayo Clinic - whose job is to develop a plan for comprehensive regulatory reform.
When we flood doctors and hospitals with excessive paperwork, patients suffer the consequences. The commission is especially focused on CMS and the FDA, which have the heaviest regulatory burdens.
This panel, which has already held hearings all over the country, is helping us restore common sense to the regulatory process.
I should note that we've put in place the first-ever federal privacy standards to protect patients' medical records and other health information. These standards provide patients with access to their medical records and more control over how their personal health information is used and disclosed.
At the same time, they allow you and your colleagues to have access to the information you need to treat your patients with the knowledge and thoroughness they deserve.
We're also looking at rules affecting Medicare and Medicaid … and we have acted on the Emergency Medical Treatment and Labor Act, commonly called EMTALA, or the Anti-Dumping Law.
Our proposed rules would require that hospital-affiliated facilities without emergency capabilities must now have a protocol in place for ensuring that patients in need of emergency facilities get it without delay from facilities that are appropriately equipped and staffed to provide emergency care.
This means that patients will get the emergency care they need. It's a major step forward, and potentially thousands of lives could be saved once it's implemented.
Last month we launched a new effort to streamline Medicare's paperwork requirements for home health nurses and therapists so they can focus more on providing quality care for their patients.
Traditionally, home health agencies have assessed patients 10 separate times during the course of treatment. The proposed changes would eliminate two out of the ten assessments and reduce the number of questions in the remaining eight assessments.
We estimate that this will save nearly $56 million annually and free-up more than 2.6 hours of time for those involved in the assessments.
This action stems directly from the recommendations of the Advisory Council. And there's a lot more to come.
We've changed the rule on third-party payer filings, so that now the forms can be submitted every 60 days instead of every 30.
We're pushing ahead with our comprehensive effort to modernize and improve Medicare. We're working to extend quality, affordable care to the nearly 40 million Americans who still lack health insurance.
The FDA is looking at using the new PDUFA bill to speed-up drug approval and is improving its standards for risk-assessment. And we've launched the most significant and far-reaching preventive health campaign ever.
But there's another area of reform that must - I repeat, must - be among the highest priorities we can develop: malpractice reform.
America is experiencing a medical malpractice insurance coverage crisis that is increasing the cost of health care, decreasing access to doctors and hospitals for many patients and lowering the overall quality of care provided to patients.
As you know better than anyone, medical malpractice premiums have skyrocketed in recent years. The major cause of increased premiums is the growing size of malpractice judgments and the costs of litigation. The average jury award has tripled since 1994 to a whopping $3.5 million. In 2001, insurers paid $1.40 in claims for every dollar in premiums.
Ironically, studies indicate that as little as 25 percent of professional liability insurance premiums are returned to those who have been injured by medical error. And, on average, patients have to wait almost five years before receiving any compensation.
And this year, eight states reported premium increases of over 30 percent in 2002. Since premiums account for one percent of health care costs and up to a quarter of physician incomes, this is a self-evident problem. For example, St. Paul Insurance, which covered at least 25% of the market in 12 states, is no longer writing malpractice insurance. And only one insurance carrier remains in West Virginia.
As doctors find themselves without malpractice coverage, they are moving their practices or closing them altogether. For example, most OB/GYNs in Las Vegas are refusing to take on new patients. This means that pregnant women cannot get the essential, lifesaving prenatal care they need.
Las Vegas' only trauma center closed its emergency department because physicians were unable to obtain liability insurance for emergency care. And Mississippi doctors have moved to Louisiana because malpractice insurance is unavailable in Mississippi.
This disruption of access to care is unacceptable. It's got to stop, and changes to the system that will make it stop must, and will, be made.
Fear of liability results in the practice of defensive medicine, which further increases health care costs perhaps by as much as $50 billion per year. Seventy-five percent of physicians admit that fear of litigation led them to order more tests and refer more patients to specialists than they otherwise would.
Fear of liability also prevents providers from performing quality self-evaluations and improvements. The high costs of insurance are causing providers to defer purchases of new medical equipment and the hiring of needed staff. And, of course, this results in reduced access to care for many patients in many cities.
Because federal government health programs cover approximately 50 percent of Americans, rising malpractice costs as a part of healthcare expenses is a matter of great federal interest.
The direct cost to the federal government of increasing malpractice costs is $6 billion per year, which includes. The 1,000 percent - that's 1,000 percent - increase in liability costs for nursing homes since 1990 is financed largely through Medicaid and Medicare.
So, we're developing a comprehensive medical malpractice reform proposal that will serve two goals: First, to enhance health care quality by encouraging early recognition of medical errors and targeting prompt compensation to those who have been truly injured by medical errors … and second, to reduce excessive non-economic damages awards unconnected to remedying real errors.
This approach will reduce health care costs and enhance health care access. The Administration plans to unveil this reform proposal in the near future. As leaders of America's medical specialty societies, you know how vitally important these issues are. You know we can't simply dawdle through another round of studies, reports and brow-furrowing conferences.
So, since we're in Chicago, it's only fitting that I close with a statement by Illinois' greatest son, Abraham Lincoln, who knew something about taking decisive action.
"Give me six hours to chop down a tree," said Mr. Lincoln, "and I will spend the first four sharpening the axe."
We've spent years sharpening our axes. Now it's time to begin chopping … to begin the transformation of our health care delivery system. With your help, we can and will do it, and I look forward to your counsel and support as we undertake this bold and very necessary initiative.
Thank you again, and I'll be glad to answer some questions.