Q&A: Expert advice

Staff writer Tammie Smith conducted video interviews with six people involved with health care for their perspectives on health- care reform. Here are select portions of those interviews. You can view the videos on TimesDispatch.com, search: health care reform.

Dr. E. Claiborne Irby Jr. Spine surgeon, practicing 23 years West End Orthopedic Clinic

Q. How do you see health-care reform affecting your day-to-day practice? Do you think you have experienced any effects of health- care reform yet as people anticipate what is going to happen?

A. "My gut is whatever happens, there are going to be more regulations, and with that more hurdles between what the patient and the doctor, what we come up with as a treatment plan and then carrying out the treatment plan. That does a real disservice to the patient. The best person to make the decision on a patient's care is [the patient ] and their doctor. Anything that creates a wedge between them I think is divisive to the practice of medicine.

"Clearly we have all seen a concern for reimbursement. When we think about getting advanced technology for our group, we certainly take [health-care reform] into account now. We are fortunate in that we are a large enough group that we have been able to get electronic medical records and digital X-ray, so we have been able to forge ahead. But as far as future planning down the road, it's definitely affecting what we do. A lot of the stuff that we would like to carry out to better serve our patients and provide better care, we are sort of sitting on the sidelines to see what will happen with health care."

Charles Russo Executive director SecureHorizons by UnitedHealthcare, offering Medicare Advantage plans to seniors

Q. Should seniors be worried about changes to their Medicare benefits as a result of health-care reform?

A. "There are definitely aspects of health-care reform that are positive for seniors - coverage within the donut hole, preventive screenings, free wellness exams, cancer screenings. Those items are very, very positive effects of health-care reform. I think it's unclear as to the long-term effects. There could be financial as well as access issues that could come up, but I think it's too early in the game, after three or four months of the bill being passed, to make that decision."

Gail Johnson President and CEO, Rainbow Station Inc., a preschool and school-age recreation franchise that also offers backup child care for mildly sick children. Employs 225 people at corporate- owned facilities.

Q. How will health-care reform affect your business? Do you provide your employees with health insurance?

A. "Health-care reform is set up so that if you reach the marker of 50 employees, then you must play as if you were a larger business. In other words, the same rules apply to me and my organization that would apply to Altria or another major corporation. All of the penalties, all of the consequences of pay or play, apply to me because I have reached that 50-employee marker. It's quite impactful.

"I am thrilled to say that we are able to provide 75 percent of the employee coverage. We only provide employee coverage to be fair. If we would provide extra family coverage, and we have a lot of single, young women, it would not be fair. We have family coverage available. We only pay the amount we would pay for a single person.

"In the bill, in iterations that may be subject to change, I may be required to pay family coverage. That immediately is a burden on me and what the health insurance would cost."

Dr. George Maughan Family physician Richmond Family Practice Q. Health-care reform puts more emphasis on preventive care. How will family physicians and other primary-care providers accommodate an influx of new patients? Do you expect the pay to get better?

A. "There have been statistics that suggest patients who have a primary-care physician have 30 percent less costs and 19 percent less incidence of mortality. So as family physicians we are convinced that a relationship with a physician on a long-term basis is important in health care and indeed may contribute to the solution to some of the problems in health care. . . . We do need more primary-care physicians regardless of whatever else happens.

"I am concerned about physician salaries. . . . There are some physicians who probably can't work any harder or any longer hours. We will need to see more patients. The reimbursement per patient will probably decrease, although I have heard there may be some incentives for performance. In other words, suppose we can reduce the number of patients who smoke cigarettes and identify and control people's diabetes. There are certain measures to prove success."

Marilyn H. West CEO M.H. West & Co. planning and consulting

Q. What are some strategies for providers and businesses trying to understand what the legislation means for them?

A. All of it doesn't happen at one time. My advice to clients is not to act too quickly. A lot of the information that continues to come out there is still a lot of interpretation as to what it means, what it does not mean. Take a careful look and scan what is happening to your organization internally, and then to be able to take what you have and play that against what the health-care- reform requirements are once we figure out what everything really is going to mean.

"I think whether you agreed or disagreed with health-care reform, we needed something to help us get to another place. We have a law on the books now. We have to figure out a way to strategically respond to it. We have to look at the customers we serve. What are your current capabilities in providing services to them. A lot of the emphasis is on wellness, too, so there's a lot of education that needs to take place."

Doug Gray Executive director Virginia Association of Health Plans

Q. How much are health-insurance premiums going to go up for provisions such as allowing adult children to remain on a parent's plan until they turn 26 and not being able to exclude coverage of pre-existing conditions? How will health exchanges, some call them connectors, operate?

A. "If there is additional expense to adding 20- to 25-year- olds, that cost will be socialized by the group. That's an extra burden that people are planning to spend another 1 to 2 percent more on.

"The idea of a connector is that the government is going to decide what a basic health-care benefit is. That's a huge decision. It will be the same regulatory process where the important detail decisions will be made. There are lots of items not included in a basic health-care benefit today that people would like to have included. The downside of adding them is that the policy gets more expensive. Remember it gets more expensive for everyone, not just for the employers. . . . The government at the federal level has stepped completely into the shoes of the insurer in terms of having to balance what people can afford and what they would like included in the policy. That's going to be a big issue whenever they figure out what a basic health-care benefit is."

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Talk to us

As we continue to report on the impact of health-care reform, we would like to hear from readers. E-mail your questions or concerns about the legislation to TLsmith@timesdispatch.com.

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ILLUSTRATION: PHOTOS

MEMO: Special Pullout; HEALTH-CARE REFORM

Originally published by RICHMOND TIMES-DISPATCH.

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