Testimony
Craig A. Backs, MD
President, Illinois State Medical Society
Illinois Senate Health and Human Services Committee
Regarding: SB 2561, “Healthy Illinois Act”
February 15, 2006
Good morning. My name is Dr. Craig Backs. I am the president of the Illinois State Medical Society and I maintain an active internal medicine practice right here in Springfield. I appreciate this opportunity to testify today before your committee. On behalf of our 14,000 physician members statewide, ISMS stands in strong opposition to SB 2561.
Through our committees and policy making structures, ISMS has brought together multiple experts on health care delivery systems. Over the years, we have devoted considerable resources to identifying model principles for health system reform. I’d like to describe to you today how SB 2561 directly conflicts with many of those principles, and how this bill may actually do harm to patients.
The Healthy Illinois Act’s presumed goal of expanding access to affordable health care is a shared objective of our medical society. Unfortunately, SB 2561 would not meet this well- intended goal. Any attempt to widen health care access by increasing bureaucracy is unhealthy and is the wrong prescription for what ails Illinois.
In our state, a government run health system is hardly the model for reform we should pursue, based on a sampling of our current publicly-funded health programs. Medicaid payments are notoriously low, and it often takes a very long time to receive reimbursements after a physician submits his or her bill for payment under this program. Patients seeking care at publicly-funded facilities such as Stroger Hospital in Cook County experience long wait times for needed care. In spite of its importance to those it serves, most patients with a choice are not choosing Stroger. We need to look beyond governmentimposed solutions to solve the access-to-care problems facing the people of Illinois.
This bill would create a health care quality forum which at first blush sounds like a worthy endeavor. However, I would caution you, our lawmakers, that any move to legislate how a physician treats a patient will only further restrict access to care. Instead of relying on a physician’s special knowledge and expertise, this bill would have state employees regulate quality for all health care professionals in Illinois, without seeking physician input on setting these standards.
It’s also important to note there are a number of groups and government-supported entities already assessing the delivery of care and the development of quality measures – all with the direct and continuing input of physicians. On the national level, a host of organizations are developing quality measures for health care services.
I can speak personally about our state’s ongoing efforts to expand care, through my involvement as a member of the Adequate Health Care Task Force established by this General Assembly. Conceived via the Health Care Justice Act, this task force is conducting a serious and deliberate dialogue on how to best implement health system reform. In the coming months the task force will issue its proposals for reform, which will come after receiving input from an extensive and comprehensive range of
stakeholders.
This bill disrespects and duplicates this task force and other ongoing efforts. Private payers and other voluntary quality organizations are already performing these activities.
Furthermore, attempts to legislate best practices could prove dangerous for patients, as advancements in medicine change much faster than the law. Today’s “best practices” will be the “old way” of doing things by the time legislation is passed.
Even more outrageous, this bill would attempt to compensate physicians based on performance. I would suggest to the members of this committee that performance is subjective and, as much as we would like, we cannot always control medical outcomes or patient lifestyle choices. Paying physicians based on blunt and inappropriate performance measures would hurt, not help, quality.
One of the stated goals of this legislation is to promote the development of the health care workforce. In actuality, it would have the opposite effect. The “cost containment” section of SB 2561 would require every licensed physician to report to the Healthy Illinois Authority annually, listing the percentage increase in net revenue from the preceding year. What is the goal here? Physicians consider this aspect of the proposal as a direct attack on the practice of medicine.
This section is a strong disincentive for doctors to come to Illinois and to stay. In only the rarest of instances do physicians have the ability to set their own fees. Virtually every medical fee is dictated by outside interests, whether it be Medicare, Medicaid, participation in a managed care plan or most recently the new workers’ compensation fee schedule. Physicians often lack the ability or power to negotiate fees, so managed care contracts are often based on the Medicare payment rate. This rate is slated to be reduced by 26% in coming years if Congress does not intercede to restore funding. In sum, physicians’ rates are REDUCED every year. This reduction leads to fewer physicians. Fewer physicians means less access to medical care. Let’s not add to this growing access problem through bad legislation.
Finally, how can we expect each and every licensed physician in Illinois to meet the reporting criteria? Many, many physicians keep an active Illinois license, but no longer practice here. Some physicians work in an academic or research environment and do not provide regular patient care. Others are retired, but keep a license for volunteer purposes. This one-size-fits-all brand of regulation is ill-suited to physicians, and fails to recognize the diversity of our medical work force.
In its attempt to institute onerous best practice regulations, unfair price controls and increased taxes, this act will crease access to quality care. It will increase the cost of health care coverage for those currently insured. This bill fails to address in any reasonable manner the growing demand for health care or the need for patients to have more responsibility for their own heath care decisions, such as incentives for choosing a healthier lifestyles and refundable tax credits for purchasing insurance plans.
For the many reasons just cited, ISMS stands strongly opposed to this bill. Thank you for this opportunity to testify. I would be happy to answer any of your questions.
ISMS is a professional membership association representing over 14,000 physicians in all specialties statewide.