Date: 2009-03-23
Speaker: TIM MURPHY (republican)
Chamber: H
State: Pennsylvania

I thank the gentleman from Georgia. not only for your leadership in health care but for your time here. You know. we have many times discussed the issues involved in health care. and although I hear many people talk about the issue of accessible and affordable quality health care. very often the solution offered in this body by government is more government. and that is health care is expensive. so lets have someone pay for itthe government. Along those lines. Medicare and Medicaid oftentimes list it as. because so much is spent thereand I think Medicaid is $350 billion a year there. Between Medicare. Medicaid and the VA. almost half of the Federal mandatory budget is spent. The question is: Are they effective? Are they efficient? Does it have qualitybasedhealth care? I want to bring up just a couple issues here and emphasize the importance of that doctorpatient relationship. I am a psychologist. For many years. I have worked for hospitals in the Pittsburgh region in the pediatric. maternity and general medicine settings. but I have always had a strong relationship in working with a wide range of physicians and with other health care specialists. recognizing it is a team and in letting the team do their work that you really end up with some significant savings in quality of care. Let me talk about a couple of ways that that does occur. A recent report sent out by the New England Health Care Institute noted that the U.S. really spends more on health care than any other nation on Earth. and many times people talk about the negatives of our health care system in terms of higher rates. for example. of infant mortality. but there are concerns about how that data is reached. I will not go into that now. What I do want to point out. however. is that out of this $2.3 trillion health care system. which is very expensive and gets in the way of a lot of families affording health care. one of the deep concerns. perhaps. is that 30 to 40 percent of those health care dollars are wasted. $600 billion to $700 billion is what is listed in this report. Let me name a couple of things that go into this. If we let the doctorpatient relationship take supremacy over this and let physicians make decisions for what patients need. there are some changes we might see. First of all. unexplained variations in the intensity of medical and surgical procedures. including but not limited to endoflife care. the overuse of coronary artery bypass surgery and the overuse of percutaneous coronary procedures has the potential of avoidable costs of $600 billion. The misuse of drugs. overprescribing and underprescribing: some $52 billion. The overuse of nonurgent Emergency Department care: the savings could be $21 billion. The overuse of generic antihypertensive*: a potential savings of $3 billion. The list goes on. Now the question is: Why would these conditions exist? Well. actually. government. itself. stands in the way in many cases. and sometimes. well. it is the way health insurance is set up. but if the issue were instead that physicians could be the ones who are moving forward in this. I believe a lot of savings could take place. I believe what we should be doing as a legislative body is finding ways to break down those barriers and really helping to improve. One of the points to be made by a number of the doctors here on the floor tonight is about having more physicians involved. Lets take one of those aspects. Having a health care home is important. and one of the health care homes for people in some areas has to do with having a community health center. Now. community health centers provide great quality of care with a wide range of medical services. as my colleagues note. Yet there is a shortage of physicians. in part. because it is not the best paying position in the world. but many physicians want to help. The strange thing about this is that. in a wide range of health care areas. if you work at a community health center. your medical malpractice insurance is paid. If you volunteer. you are on your own. and so these clinics say. We cannot possibly afford that. There are different kinds of malpractice insurance that is not important to get into at this point. We have tried a number of times to allow it so physicians could actually volunteerso psychologists could volunteer. so dentists. podiatrists. social workers. and nurse practitionersbut no. the government says. We cannot let you do that. There are also areas. too. that come up here in terms of how we could let disease management work. Here is one of the strangest things that happens with Medicaid: You know. one group that has a great deal of problems is that of people with severe diabetes. The severe diabetics. if they have problems with the circulation in their feet. for example. the real tragedy might be that they might have their feet amputated. but isnt it strange that Medicare and Medicaid will not pay for that physician or that nurse to monitor the patients closelyto call them. to work with them. to do more than just give them a pamphlet. but to work closely with them to keep them out of the hospital. to make sure that they are getting their insulin. to make sure they are monitored for their weight. et cetera. but we will not pay for that? We will pay $50.000 for that tragic surgery that could have been avoided. but we will not pay money to help when they manage the care. Now I might say that there is a recent study that came out that. I believe. is. filled with methodological flaws. saying that disease management has some cuestionable applications. Unfortunately. they focused on those who oftentimes had the most severe illnesses. As I am sure many of the physicians. here tonight can attest. the real value is getting to that patient early or when the complications begin to show up rather than to wait until the end. I know. in my career as a psychologist. I had a patient who is now a deeply depressed. suicidal inpatient. When you could have been working with them years before. it makes a big difference in their outcomes. We have to make sure that the system that we allow here with health insurance and with physicians working with patients really allows for a great deal of predischarge planning. of working closely and individualizing that care and for making sure that it is there. Let me mention a couple of other things as we proceed forward. Recent legislation under the House set aside nearly $2 billion to help physician practices have health information technology. A good idea. The question is how it is done. If that health information technology is merely paying for keeping hospital records on a computer. that is not going to be enough because that is a passive system that only makes it a little easier to pull up records rather than having to wait for the records to arrive. What we need is a smart. interactive system that is pbrtable for the patient so that records follow the patient. not so that patients follow the records. We have to make sure it is private. that confidentiality is protected. and we have to make sure it is personal so that the relationship between doctor and patient is what is paramount here. That physician and information they dre obtaining and what they are writing whenever they have a diagnosis is a smart record that also helps provide information to that doctor about best practices. about feedback. about prescriptions. and even about the feedback of whether or not that patient got that prescription and if he is following through. It is all of those things. In todays world. because there is a shortage * of physicians and because insurance - with Medicare. Medicaid or private insurance oftentimes does not pay for having the physician actually work to follow up with the patient. then that health IT is just one. big. expensive thing on the desk of the physician. and it is not really providing the care they need. Let me mention one other thing here. and that has to do with point of care lab tests. The system we have designed is one whereand because some physicians have been found when they own the labsthe concern was were they overprescribing lab tests. I would love to hear some input from my physician colleagues on that. too. So what did they say? They said. Lets not allow physicians to do this at all. where sometimes the most valuable thing is if the physician says. I need an xray. I need a lab test. I need this information right away. Instead. they have to send that patient out to a lab or send the information out. It could be a couple of weeks before they would get it back. The best way to improve patient compliance is quicker information. Even to allow. for example. pharmacies and drug stores to provide some of this lab information would be more valuable. All this feeds into the system * that part of the way to save the $600 billion or $700 billion worth of loss in the health care system is to put the tools in the hands of those who provide the health care. Make sure there are enough physicians. Make sure they have the tools they need so that as they diagnose. as they prescribe. as they work with other colleagues in the health care field that that information is shared in an effective way that is personal. that is private. that is portable. and actually that is permanent. too. These are not records that are lost as a person moves on to another health care plan or whatever they do in life. Part of what we are doing here as the GOP Doctors Caucus is operating on the idea that we are all gathered together here to really work on making sure that we are developing patientcentered. patientdriven health care reforms based on quality. access. affordability. portability. and choice. Over the coming months. you will hear from us continually speak about this because we believe we have a health care system that can be based upon those. that can save massive amounts of money and that can save hundreds of thousands of lives. That needs to be our goal. not only to do no harm but to make sure we put health care back in