Health Care in the Future

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Gloom, Doom and the Baby Boom
Health Care in the Future
Raymond J. Gibbons, MD Mayo Clinic
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Disclosure Statement

Raymond J. Gibbons, MD
Research grants(significant) Radiant Medical
KAI Pharmaceuticals TargeGen TherOx King
Pharmaceuticals
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Disclosure Statement

Raymond J. Gibbons, MD
Consultant(modest) Hawaii Biotech Cardiovascula
r Clinical Studies(WOMEN Study) Consumers
Union TIMI 37A
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• Health care crisis
• Attention on imaging
• Quality
• Efficiency

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• Health care crisis
• Attention on imaging
• Quality
• Efficiency

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Health Care Costs15-Year Cumulative Inflation
1991 100
Sources AMA, Kaiser Family Foundation
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Less Reimbursement forMedicare/Medicaid Services
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Demographics and Cardiology
P(i,t) P(i-l, t-l) D(i,t) I(i,t) E(i,t)
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Population Over 65

Year
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U.S. Federal SpendingActual 2005
Congressional Budget Office
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Workers per Medicare Retiree
Health Care Financing Administration
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Health Care Spending
Public
Annual growth ()
GDP
Private
Congressional Budget Office
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Medicare and Medicaid
Actual
Projection
Total federal revenue
GDP()
Congressional Budget Office
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Medicare
The degree of uncertainty about whether future
sources will be adequate to meet our current
statutory obligations to the coming generation of
retirees is daunting.
Alan Greenspan Chairman, Federal Reserve
Bank January 25, 2004
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Medicare
The longer we wait, the more severe, the more
draconian, the more difficult the adjustment is
going to be I think the right time to start is
about 10 years ago.
Ben Bernanke Chairman, Federal Reserve
Bank January 18, 2007
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2007 Annual Report
Medicare Trustees

• The Hospital Insurance Trust Fund could be
  brought into balance with
• An immediate 122 increase in payroll tax
  (1.45?3.22)
• An immediate 51 reduction in spending
• Some combination of the two

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Need for Change in Health Care

• Little public discussion elephantin the
  corner
• Required changes will increase
• Long overdue
• Further delay
• ? Number of uninsured
• ? Racial/ethnic disparities
• Wage stagnation
• ? Commitment to education
• Threat to the country

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InertiaStatus quo Short-term effects
Necessity oflong-term change
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• Health care crisis
• Attention on imaging
• Quality
• Efficiency

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Blue Cross to require pre-approval for
scans MRI, other imaging costs up 20 in
year Boston Globe September 6, 2005
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Medicare Cardiac Procedures
Rate/1,000

Circ 113 374, 2006
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Less reimbursement forMedicare services
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Deficit Reduction Act of 2005

• Good news Elimination of 4.4 decrease in MD
  payment
• Bad news Reduction in payments for imaging
  78465 decreased by 75

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SCHIP/Medicare
House Version

• Good news Eliminates 9.9 decrease in 2008 and
  5 decrease in 2009
• Bad news In 2010, SGR replaced with new system
  with 6 separate targets imaging growth
  limited to GDP
• Unknown comparative effectiveness

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Imaging Stress Testing - Medicare
Ratio of rates of imaging stress testing to the
U.S. average by hospital referral region (1996)
Wennberg et al The Dartmouth Atlas of
Cardiovascular Health Care, 1999
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