Thinking about Evidence-Based Medicine and Professional Liability (Plus Project Hope, Military Healthcare, and More…) I spoke this month with healthcare economist Gail Wilensky, the former Administrator of HCFA (1990-92), now known as the Centers for Medicare & Medicaid Services (CMS). Dr. Wilensky also served as chair of the Medicare Payment Advisory Commission (Med-PAC) from 1997-2001, and she previously chaired one of Med-PAC’s predecessor commissions, the Physician Payment Review Commission. Given Dr. Wilensky’s credentials and background, it’s not surprising that she believes changing physician incentives to be key to healthcare reform. But she doesn’t view physician incentives as simply a function of reimbursement. In addition, she points to the critical need for comparative effectiveness (a concept repeatedly cited in this column over the last few months) as a tool to reforming our system of professional liability. As she points out, “We can’t reasonably expect physicians and hospitals to practice in a more conservative manner without exposing themselves to increased liability, unless we provide Elizabeth Carder-Thompson (ECT): Let’s start with health reform; this has been an interesting month, to say the least. Is health reform dead forever? Is reform even salvageable at this point? Gail Wilensky (GW): I think that the large scale, trillion dollar-plus version of healthcare reform probably is dead at this stage. Whether a smaller reform package will be attempted is less clear. Even that won’t be easy to do. There is some discussion of using the reconciliation process to piece out various parts of healthcare reform. I will be surprised if it happens. And if it does happen, I think it’s a big mistake for Democrats, in part because there is already a lot of concern about Washington being “business as usual” and up to its old tricks. Reconthem with liability protection. And the best way to provide that protection is to use evidenced-based strategies.” It’s a logical view, but not one articulated very often or very loudly. For many concerned about health reform generally, the last few winter months have been depressing ones, marked by name-calling and stalemate, and seemingly exacerbated by the blizzard conditions plaguing Washington, DC. For her part, Gail Wilensky professes to having given up on the prospect of a big bang of healthcare reform, and she looks instead to incremental steps. Time will tell. Dr. Wilensky currently serves as a senior fellow at Project HOPE, an international health foundation, and she also reflects below on Project HOPE’s role in Haitian relief efforts generally. Finally, her career has included a number of posts examining military healthcare, such as serving on the Board of Regents of the Uniformed Services University of the Health Sciences (USUHS), serving as president of the Defense Health Board, a Federal advisory to the Secretary of Defense, and as co-chair of the Department of Defense Task Force on the Future of Military Health Care, in addition to being part of the President’s Commission on Care for America’s Returning Wounded Warriors (The Shalala Commission). She provides below her views on vulnerabilities in our system confronting our returning soldiers. ElizabEth CardEr-thompson President, FY2010 ECarder@ReedSmith.com ciliation would be regarded as a way of circumventing the regular legislative process, and therefore play into the angst and anger out in the population. I’d be very surprised if reconciliation were to happen, but I think it’s being explored. ECT: You don’t think that right now there is any common ground for Republicans and Democrats? GW: It’s hard to know. There is a lot of ill will right now. Many Republicans have felt that they weren’t part of the process because they didn’t need to be a part of the process – the Democrats didn’t need their votes. That was probably felt and believed by both sides. It is hard to change those dynamics. It’s a little early to say it is not possible to craft legislation that would pick up one or two Republi- cans in the Senate. Although I think it’s unlikely, the question is: would whatever that is included be of interest to the House which has been more partisan and further to the left than the Senate all along? ECT: And if health reform ultimately fails, what consequences will the American people suffer? GW: There are short run and intermediate run problems. We have had and will continue to have approximately 15% of the population without coverage. That’s a problem for the people that are uncovered, and also a problem for the communities where they live. We need to figure out a way to get coverage to all (Continued on page 25) healthlawyers.org 1 previous page next page