Americans may be eating Thanksgiving leftovers before politicians finish picking bones with each other over health care reform.

"There’s still a long ways to go if they’re going to pass bills," Olympic Medical Center CEO Eric Lewis told hospital commissioners at their meeting Wednesday, Aug. 19.

He predicted three to four months of debating and dealing before any legislation reaches President Barack Obama’s desk.

Lewis said he was one of 10 hospital administrators and 10 public health officials who met with U.S. Rep. Norm Dicks, D-Belfair, on his mid-month visit to the North Olympic Peninsula.

OMC’s priority preferences for reform that Lewis outlined to Dicks include:

_ Geographic variation

_ Ability to form Accountable Care Organizations

_ Cost controls.

Geographic variation

This is the wide inconsistency in payments Medicare makes to doctors and hospitals in different areas of the United States.

All were "locked in" years ago, Lewis said, with much more money given to populous states such as New York, Florida, California and Texas.

Clallam County’s reimbursements from the federal health insurance program for elders are among the nation’s lowest 5 percent, he said.

Doctors in highly paid states are encouraged to perform more tests, order more hospital admissions and prescribe more expensive treatments, Lewis said, that don’t necessarily heal patients better or faster.

"It often doesn’t lead to better outcomes," he said.

"It’s a big problem for Washington state and Clallam County in particular."

Lewis said Dicks is insisting that the government conduct a two-year study of Medicare reimbursements, with billions of dollars added in 2112 and 2113 to poorly paid areas and big reductions in 2114 and 2115 for highly reimbursed regions.

The actual changes would be recommended by a panel similar to the Base Realignment and Closure Commission that determines the fate of military installations.

The president, Lewis said, could approve or reject the recommendations, but only all of them at once.

Accountable Care Organizations

These are federally funded pilot programs in primary care that would be judged on patients’ outcomes.

The Senate’s version of health care reform would allow hospitals to form ACOs; the House of Representatives’ legislation would exclude hospitals.

Cost controls

In negotiations over health care reform with the Obama administration, the hospital industry has promised to reduce the payments hospitals accept by $155 billion over the next 10 years.

For OMC, Lewis said, that would mean a potentially catastrophic loss of $24 million.

Current proposals also call for Medicare to eliminate payments for in-home visits from organizations like OMC’s Olympic Home Health.

Jim Casey is the editor of the Sequim Gazette.