Health care professionals air concerns to Michaud

Posted Aug. 28, 2009, at 7:20 p.m.

BANGOR, Maine — Dozens of invited health care professionals and administrators took part in a three-hour forum on Friday hosted by U.S. Rep. Mike Michaud and aimed at collecting testimony about national health reform legislation taking shape in Washington.

In his opening remarks at Eastern Maine Community College, Michaud stressed that he will not decide how to vote on the House bill until it is in its final form. The encyclopedic bill with its many amendments is in the process of being completed for formal debate and voting when Congress reconvenes Sept. 15.

Michaud is one of a group of fiscally conservative Blue Dog Democrats in Washington who have slowed passage of the legislation. He said Friday that it would be “unconscionable” to rush through the process of drafting comprehensive health care reform and stressed that he has spent the August recess seeking comment on the complex issue from health care providers, consumers and other constituents in Maine.

Comments at Friday’s forum ranged from specific concerns about physician payment formulas and proposed Medicare cuts to a spirited assertion that the proposed reform doesn’t do enough to improve the nation’s convoluted health care system.

“This is not health care reform; this is health care coverage reform,” protested Dr. Julie Balaban, speaking for the Maine Psychiatric Association. “The system needs to be stripped down completely. We need to start all over and make it as simple as possible.”

Balaban said Congress has drafted the reform legislation without meaningful input from doctors and other front-line clinicians, guided instead by pressure from lobbyists for the health insurance and pharmaceutical industries and other groups.

For example, she said, most doctors find a measure in the legislation that would ban the use of federal funds for abortions “medically and ethically unjustifiable.” A focus on implementing electronic patient records in all practices ignores the reality that the technology remains fragmented and inefficient, she said, tying up clinician time better spent caring for patients.

And while imposing strict regulatory standards on the health insurance industry — a strong component of the evolving legislation in both the House and Senate — would help, she said, ensuring compliance would create “another layer of bureaucracy” in Washington rather than materially improve the quality of health care.

Several speakers supported paying primary care physicians more to provide counseling, education and support to their patients. The current reimbursement formulas used by the federal government and private insurance companies reward doctors for procedures, tests and treatments but pay them inadequately for the preventive care that would reduce the need for such services, they said.

Medicare reductions proposed in the House legislation could have unintended consequences, said Nadine Grosso of the Maine Health Care Association, which represents nursing homes in Maine. Grosso said many nursing homes rely on short-stay Medicare patients, admitted for physical, speech or occupational therapy, to offset the low Medicaid reimbursements they receive for their long-term residents. If Medicare gets cut, she said, nursing homes could find themselves forced to lay off staff, cut services or even close their doors.

Lisa Harvey-McPherson, vice president for continuum of care at Eastern Maine Healthcare Systems in Brewer, said a public option linked to Medicare reimbursement rates would undercut hospitals’ revenue streams by driving down competitive hospital rates paid by private insurers.

“If we solve the problem of the uninsured based on Medicare rates, we will undermine our entire health care system,” she said.

A number of speakers raised the issue of end-of-life care. Rejecting the specter of “death panels” recently invoked by some conservative groups, Kandyce Powell of the Maine Hospice Council said planning for appropriate care at the end of life empowers patients and their families and saves money in the health care system. Doctors and other providers should be paid for the time they devote to discussing the issue with patients, she said, along with other kinds of counseling that promote healing and healthful lifestyles.

Michaud took comments and asked questions of speakers from 9:30 a.m. until 12:30 p.m. After the meeting, he said he was concerned about the impact of the proposed Medicare cuts and impressed with the number of people who weighed in on the issue of end-of-life care.

Responding to recent criticism that he and other members of Maine’s congressional delegation have not made themselves available to constituents during the August recess, Michaud countered that in addition to hosting Friday’s invitational forum, he has held two phone-in forums on the health care debate and toured two health care facilities in the sprawling 2nd District.

“I cover four-fifths of the state,” he said. “I can’t be everywhere, but I’ve been very accessible over this August break.”

On Tuesday, Michaud will host an invitational meeting in Fairfield for consumers and consumer groups before returning to Washington on Sept. 7.

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