Five Questions With: Edward Quinlan

After weeks of fiery rhetoric and rowdy town hall meetings, the partisan divide over health care reform is as clear as ever, and public anxieties have undoubtedly grown.
But the reform effort is far from dead; in fact, with President Obama’s address to Congress and the release of the Senate Finance Committee’s long-awaited take on the issue, it appears to be kicking into high gear.
Edward J. Quinlan, president of the Hospital Association of Rhode Island, answered questions about local hospitals’ perspective on reform and how the plan unveiled by Senate Finance Chairman Max Baucus, D-Mont., fits with their priorities.

PBN: The American Hospital Association has been a very active participant in health care reform discussions. How much have HARI and its members done directly?
QUINLAN: Our participation has been extremely active since the debate began. We’ve worked very closely with the American Hospital Association, but also with our congressional delegation, with Sens. Reed and Whitehouse, as members of the HELP Committee, which produced its own bill several months ago.
We’ve had active and continuing discussions with Senate and House members, and five hospital CEOs and I were actually in Washington [on Sept. 15] on a Medicare payment issue, and we had the opportunity to discuss health care reform with Reps. Kennedy as well as Sens. Reed and Whitehouse.

PBN: What are your members’ top priorities in health care reform?
QUINLAN: Obviously any major overhaul of health care is going to have a profound impact on those who provide care. … We’ve worked closely with the American Hospital Association and helped produce a compromise with the White House and the Senate Finance Committee in May that recognized that any decrease in payments to hospitals would need to be offset by a commitment to design health reform that will reduce the uninsured. Sen. Baucus’ bill would appear to meet the framework of that agreement, recognizing that much work remains to be done. [The bill] … will now be reviewed by the full Finance Committee, and this now moves into a stage that combines policy and politics. Amendments to Senator Baucus’ package are likely, and everyone should watch this process very closely.

PBN: How does the hospitals’ compromise with the President and the Finance Committee work, and how would the insurance reforms being discussed affect you?
QUINLAN: The agreement would reduce payments to hospitals in Rhode Island by over $500 million in the next 10 years. We are hoping that those reductions in payments will be offset by an increase in the insured. This is obviously a very, very bold endeavor, and it requires a great deal of specificity [in any law passed] going forward. There would be triggers – as the uninsured rate decreases, payments would be adjusted accordingly … the figure being used now is [to reduce the rate] to about 5 percent. …
Any ability to lower the uninsured rate, which in our state now exceeds 11 percent – doubling in the last six years – is going to lower uncompensated care, which now exceeds $100 million a year. It would provide coverage and insurance to new populations, improve their health status, and give them the ability to seek appropriate care at the appropriate time and in the appropriate place, and it would reduce the burden on hospitals to meet the needs of all people who need care.
On the insurance market reforms being considered, it’s important to note that there are variations state by state. For example, Blue Cross & Blue Shield of Rhode Island does not bar coverage based on pre-existing conditions. … On a national level, there are elements that would bring long-overdue reforms that are consumer-friendly, well documented and much needed.

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PBN: The President and others have talked about paying for this expansion of coverage, to a great extent, by increasing efficiency in the delivery system and reducing fraud and waste. Do you think that’s realistic, and how might it affect hospitals? And how does the Medicare payment system play into the discussion?
QUINLAN: Improved efficiency and reducing waste is often used as a cost-cutting assumption, often referenced, more difficult to quantify. However, if there was the ability to seriously address two issues: administrative simplification and medical liability and tort reform, those would be two ways to significantly reduce costs in the system, and both are addressed in Sen. Baucus’ legislation. … We have also begun discussions in our state with the commercial insurers about administrative simplification, and we continue to pursue legislation in Rhode Island regarding medical liability and tort reform. …
Medicare reimbursement is based on the DRG [diagnosis-related groups] system, under which you are paid based on the diagnosis code, of which there are now over 700. Individual states have different Medicare rates. A concern we continue to have is that hospitals in our state are paid at 90 percent of their cost; the national average is 95 percent; we are ranked 32nd in the country. … A concern we had relative to the public option was that Medicare rates would be used; Sen. Baucus’ bill does not contain a public option, and it does not appear to be under serious consideration, though it is in the Senate HELP bill and in the House bills.

PBN: This August was intense, with the town hall meetings and all the drama on TV. Did you see a lot of reform-related anxiety and confusion among your patients, and what have hospitals done to educate patients?
QUINLAN: I’m not sure the month of August – the town hall meetings and the media coverage – really enlightened the debate. It made, at times, for great theater, but the nation should really begin to pay attention to the policy details that emerge in the coming weeks. This is now where the serious work will begin. It is our hope now that with better public understanding and knowledge, there will be more discussion of what is in these bills, as opposed to what is not in them. … We are likely looking at change, not reform.

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