Vitals Spotlight - We Give the Doctor an Exam

Dr. Kimberly Krohn  is a family practitioner in Minot, ND.  Dr. Robert Thompson is an allergist & immunologist in Grand Forks, ND. Dr. Michael Booth is a thoracic surgeon in Bismarck, ND.

Dr. Krohn, Dr. Thompson and Dr. Booth are members in the North Dakota Medical Association and they have voiced their strong feelings on a public option and the disastorous effects it would have to medical care in rural North Dakota.

The NDMA put out the following statement:

Very few states have a higher combination of high quality and cost-effective medical care than North Dakota. Yet, while North Dakotans contribute equally to Medicare, they have some of the lowest Medicare reimbursement rates in the country simply because we are a rural state.

For example, an average office visit in a North Dakota clinic in 2010 will result in a much lower Medicare reimbursement ($47.84) than a physician treating a similar patient in San Francisco ($66) — 31 percent less. A Medicare payment for a mammogram screening in North Dakota will be reimbursed at $49.92, while that same screening in San Francisco is reimbursed at $73.82 — more than 32 percent less for North Dakota. These are just two examples of how federal “geographic adjusters” impact North Dakota.

North Dakota does not receive Medicare reimbursement that fully covers the costs involved with diagnosing and treating patients. In addition, if people currently insured by Blue Cross Blue Shield North Dakota shift to a public option at Medicare rates, our largest hospitals will experience a decrease in funding by millions of dollars that would not be offset by new payments for people previously uninsured.

Resources are needed from all our payor sources — both government and private insurers — to ensure that we in North Dakota can recruit and keep good doctors and nurses and make sure we have the medical technology, available facility space and support needed to provide safe and efficient care for patients. We need to ensure that good medical care is available when and where it’s needed, and ensure that patients can choose their physician and health plan.

A public option tied to Medicare reimbursement will only make an already unfair situation worse for North Dakota, and would dismantle some of our nation’s most successful but vulnerable delivery systems which have produced higher-value, more cost-effective care. The promise of universal coverage could be dashed by just such a reduction in access.

NDMA is also advocating for reforms that provide the greatest possible access to medical care for patients at an affordable cost and provide incentives for better “value” that can actually reduce costs. Some examples are to encourage better preventive care and keep patients with chronic diseases healthier and out of the hospital. Promoting higher quality and more cost-effective care will reduce health care costs, as will good wellness and prevention initiatives.

We need support to implement patient-centered medical homes to improve care coordination, including increased funding for primary care services that does not come at the expense of good access to specialty care. We need to expand our healthcare workforce, including more support for medical education and residency programs.

We need health insurance reforms that eliminate barriers to competition, eliminate exclusions for pre-existing conditions, and assist people who cannot afford private insurance to purchase coverage.

We need meaningful medical liability reform that reduces the waste of resources cause by the “defensive” practice of medicine.

Finally, and perhaps most importantly, we need each and every citizen of North Dakota to do what you can to live a healthy lifestyle. Let’s reduce tobacco use through cessation and prevention and encourage each other in ways that decrease the incidence of obesity through good diet and exercise choices.

The current debate offers a major opportunity for North Dakota to address the unfair reduction in health care resources by the federal government, and to embrace what is best for North Dakota patients.