Clinton urges move away from fee-for-service payment mode

April 11, 2014
Area(s) of Interest: Licensing & Regulatory Issues Professional Development & Education 

Former Secretary of State Hillary Rodham Clinton today addressed 700 physicians, practice managers, medical students and others at the Western Health Care Leadership Academy in San Diego. Delivering the keynote address live via satellite, Secretary Clinton urged the California Medical Association to work with other like-minded organizations to help advance meaningful health care delivery and payment reform, instead of continuing to “rejigger” a broken system.


“At some point, we have to move away from fee for service payment for medical care,” said Secretary Clinton. “It is not serving physicians well, or any other health care providers, and I don’t believe it’s serving patients well.”



Secretary Clinton told attendees that she shares physicians’ frustration with Congress’s inability to make any progress on fixing the current broken payment system. She said she would like to see more systemic reform so that physicians are fully reimbursed for everything that goes into the care of patients. “It is deeply bothersome to me that it is still not accepted that a lot of what constitutes wellness—things that a physician can be promoting with his or her patients—should be reimbursed by Medicare,” Clinton said. “When a physician sits down with a patient and says ‘I’m going to give you a nutrition regimen. I’m going to have my nurse or my PA check in on you to make sure that you’re walking every day.’ These are all things that would keep that patient out of the operating room for a bypass or a stent or some other expensive intervention.”



“We’re never going to resolve the injustice, the unpredictability, the unfairness that unfortunately permeates the current system,” she said. “We need to move away from this very narrow approach to reimbursing physicians.”



“At some point, I hope we’re going to be able to take a look at the broad base of funding streams, both public and private, that go into funding health care–particularly physicians’ pay—and look more at who the patient is and what the doctor is providing that patient, instead of what the program is and how we can keep trying to put square pegs in a round hole.”



Secretary Clinton also held up California’s implementation of the Affordable Care Act as a model for the nation. “We’re going to be watching closely what happens in California. Seeing what works, and what doesn’t. States like California, intent on covering more citizens and fostering bold experimentation to improve outcomes and reduce costs, will not only lead the way, but help everyone else find the way.”



Secretary Clinton also urged all stakeholders to work together to keep pushing for improvements to the health care system. “The transparency called for under the Affordable Care act is going to reveal a lot of information. Some of it may be surprising. And some of it may even be quite troubling,” said Clinton. “But for the first time, we’re going to see information. And everyone will be able to look at the same information. We can then try and figure out ‘Is there a problem that needs to be fixed?’”



The data collected under the Affordable Care act will, according to Clinton, will allow us to ask questions that will give us much better insight into how we can move towards a more efficient, quality driven health care system.



“I think this is a great opportunity, if we do it with that kind of open attitude of ‘let’s learn what works, let’s make this better.’ Let’s hear from physicians and nurses and pharmacists, you name it. Everyone come to the table. What do you think needs to be changed?”



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