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Slide 2 Where Healthcare Is, Where Its Going, and How You Can Prepare for the Future Ashok Daftary, MD Slide 3 Slide 4 Healthcare Is Changing - What Will Happen Next? The future ain't what it used to be. Yogi Berra Slide 5 Not Every Current Issue Is New The biggest problem directly facing this group today is to see that the cost of producing professional service is kept within the ability of the average citizen to pay. Harry Harwick, Business Manager, Mayo Clinic 1st Annual Conference of Clinic Managers Madison, Wisconsin November 1, 1926 Slide 6 Satisfied with your physician? Slide 7 Is It? Quality? OR? Quantity? Slide 8 Slide 9 How did we get there? Theodore Roosevelt (1901-1909): A nation could not be strong with poor and sick citizens 1918: The American Association of Labor Legislation: Proposed sickness and burial benefits. Supported by the American Medical Association opposed by commercial insurers and the American Federation of labor The Great Depression: Franklin Roosevelt: Impolitic to include it in the Social Security Legislation Slide 10 How did we get there? World War II: Wage Price Controls: Health benefits in lieu of wages. Employers selected insurance and received a tax benefit. Unions realized it was a card in negotiations. Result wages have stagnated as health benefits explode. John Kennedy: Revived the movement Lyndon Johnson: Conceived with Wilbur Mills Hospital Insurance (Part A), Physician Insurance (Part B). Mills added Medicaid (insurance for the impoverished). AMA (Usual, Customary and Reasonable) Slide 11 How did we get there? Ronald Reagan: Medicare Catastrophic Coverage Act:(1988) Would have provided long term care coverage. Wealthy seniors opposed premiums politically unpopular George Bush: Medicare Modernization Act (Part D). Political theater. Suppression of Report of Medicare Auditor. Giveaway to Big Pharma. No importation or price controls Barack Obama: (Patient Protection and Affordable Care Act) Insurance subsidies, expansion of Medicaid. Accountable Care Organizations other fiscal controls. Will impact Medicare. Slide 12 Americans are fat and sick? Slide 13 Slide 14 America wins Europe catching up women head the pack Slide 15 Quality Slide 16 US Health System Ranks Last Among Eleven Countries on Measures of Access, Equity, Quality, Efficiency, and Healthy Lives June 2014 Slide 17 Slide 18 Slide 19 Costs Slide 20 Slide 21 Slide 22 Slide 23 Slide 24 Estimate $1 trillion. Slide 25 Outpatient Care The Big Driver Increased Utilization, Paying for quantity rather than quality, patients blind to quality and cost Slide 26 Slide 27 Slide 28 Slide 29 A lot of people think this is a free market for these drugs and therefore there is an internal regulation but it isnt. What you have is the only person who is holding the cards is the drug companies. Those words come from Ayelew Tefferi, the Mayo Clinic hematologist who gave me an interview filled with enough fear and loathing for Hunter S. Thompson. Tefferi just published an editorial in the Mayo Clinic Proceedings that is a stinging rebuke to the U.S. system of drug pricing and what he says is the greed of pharmaceutical companies. Cancer drug prices, the paper notes, have increased by an average of $8,500 a year for the past fifteen years. Even when drug companies give medicines away for free to the poor, he says, he sees his patients being harmed. We will clean you up of your savings and then we will give it to you free! he scoffs. Imagine you are working so hard and saving all this money with the intent to give it to the drug companies after you get old and you get cancer. That is not fair. Slide 30 Slide 31 The mergers cost money, they do not produce a product they sell one. The price of the product goes up, choices become fewer, patients fleeced MDs squeezed. Slide 32 Healthcare Is and Will Continue to Be a Significant Portion of Federal Spending ObamaCare will lead to a considerable increase in federal healthcare spending Slide 33 Federal Health Expenditures Are Continuing to Increase -- Maybe Slide 34 Practice Costs and Inflation Are Increasing More than Medicare Payment Physicians will drop Medicare Slide 35 Staff Costs and General Operational Costs Are Increasing Slide 36 Contractual Adjustments Are Increasing Slide 37 The Gray Tsunami Slide 38 Slide 39 Slide 40 Slide 41 Slide 42 Slide 43 Slide 44 Meet Mr. Middle America Slide 45 Let us meet the poster boy of the generation Video Click to Play Slide 46 Slide 47 Getting Old Erectile Dysfunction ICD 607.84 Slide 48 Click to Play Slide 49 Slide 50 Slide 51 Slide 52 Slide 53 We Aint Got A Barrel of Money Slide 54 Federal Government Becomes The Major Purchaser of Healthcare Slide 55 You are being sold Slide 56 Personal Physicians are Dinosaurs Slide 57 The study, published Monday in the journal Health Affairs, was based on an analysis of 2.1 million hospital claims from workers of self-insured employers between 2001 and 2007. The analysis by Stanford University researchers found prices were most likely to increase when hospitals bought physician practices, as opposed to hospitals forming looser contractual relationships with physicians. Slide 58 General Advice and Caution Your options to select physicians and health systems may be compromised by your insurance choices. Shop carefully you cannot debit your dollars to the Bank of Eternity Do not trust an insurance salesmans word of mouth they frequently speak with forked tongues. Ask for a copy of his /her license and the actual provider panel/drug formulary for the year you seek insurance. Forget the free breakfast and lunch bad for your health Slide 59 General Advice and Caution You will be lucky to have a personal physician There are few who see patients in the office, hospital and nursing home Check the qualifications of the choice of primary care physician Are they qualified for your needs, are they Board Certified and enrolled in a Maintenance of Certification Program American Board of Family Medicine American Board of Internal Medicine (most medical subspecialists included) American Board of Internal Medicine Slide 60 General Advice and Caution If you are unfortunate enough to be hospitalized, Have several or friends that you authorize to talk with the physicians Check whether you are admitted as an in patient or out patient Have one individual as the primary contact source. Slide 61 General Advice and Caution Check all your medical bills If incorrect protest them early Slide 62 over64.com Email:share.for.seniors@gmail.com