Since health care reform was reintroduced in Congress, the topic has spurred stakeholders to blame each other. SCRN talked to the chief medical officer of Wellpoint, one of the nation’s largest insurance providers, with more than 34 million members in its affiliated plans. Sam Nussbaum, Executive Vice President and Chief Medical Officer for WellPoint says the debate has gotten off track and that “the real issue in health care reform is where we’re spending 87 cents on the dollar and that is the delivery of services by doctors, hospitals, the drugs that we take and that’s where we need to make health care higher quality and more affordable.”Nussbaum says that doctors need to be asked some tough questions about the medical choices they make,”Ask them, why do they do CT scans, why if someone has a mild head injury do they get an MRI inthe emergency room? Why are diagnostic tests done, maybe half of Americans have had CT scans exposing them to certain radiation. I think there are some concerns.”
Nussbaum says doctors want to use the best tools and technology for their patients, and that some of these measure are defensive medicine.
Nussbaum says, “Some of it is that we have built a payment system that rewards the units of care, how much we do, not the quality of the patient care that results from the medical services. And it’s doctors and it’s hospitals, we all have a role to play.”
Wellpoint released a statement saying for meaningful health care reform to occur, the debate should not “villainize” any one player, because it is the responsibility of everyone in the industry to develop a higher-performing, lower cost health care system that is accessible to all Americans. Then the company went on to list the quote “key drivers” in rising cost to be, frankly, every other stakeholder.
The list Wellpoint gives:
-Physicians who provide too many services, at least 30% of which do not improve health
-Pharmaceutical companies who challenge generic medications that perform equally well at a fraction of the price
-Health plans that don’t provide clear information on the quality and cost of physicians and hospitals
-Medicare and Medicaid programs that lack the political will to adopt the best approaches to improving quality while lowering costs
-Federal, state and local governments that have failed to address costly new public health epidemics such as childhood obesity and diabetes.
The national and state medical associations, of course, take issue with that assessment. American Medical Association board member and chair-elect, Ardis Hoven, M.D., says the important thing is providing the best value to her patients.
“Give me the information, give me the tools. Let me and my patient figure out what is best for them and if we stick to that, we’ll provide the care that we need to be providing.”