211: Hotline to Care

211. That's the number Detroit residents who lack insurance will soon be able to call for health care assistance. Patricia Anstett, medical writer for the Detroit Free Press, reports the details:

The Safety Net Resource Center is to begin operations within the next few weeks, run by the Detroit Wayne County Health Authority and 25 community organizations.

Callers to United Way's 211 hotline will receive information on where to find free care, said Chris Allen, chief executive officer of the health authority. The authority, which helps coordinate information on uninsured and underinsured people in the area, is able to offer the additional help because federal and state funds have helped the agency's budget grow from $2 million several years ago to $8 million today, Allen said.

With the millions of uninsured in the U.S., it is surprising that this is the first time I have run across an initiative of this nature. One of the objectives is to connect patients with a "medical home," a place where their medical care needs are centralized. Allen is quoted as saying of medical homes, "It's where they belong, not in the emergency department."

The 90,000 uninsured of Detroit's east side are the initial primary target of the program.

SOURCE: "211 hotline to free care nears" 04/28/08
photo courtesy of tj_scenes, used according to its Creative Commons license

Rockefeller, Congress, and Healthcare: The Quote Heard 'Round The Net

One of the big topics in the blogosphere right now is the article by Manu Raju on The Hill that talks about Congressional Democrats crabwalking on the issue of health care reform:

Congressional Democrats are backing away from healthcare reform promises made by their two presidential candidates, saying that even if their party controls the White House and Congress, sweeping change will be difficult.

It is still seven months before Election Day, but already senior Democrats are maneuvering to lower public expectations on the key policy issue.

Considering the profile of the health care debate in the current election, this is news that, unsurprisingly, seems to be spreading like wildfire across the Internet. The most often quoted part is this statement:

"We all know there is not enough money to do all this stuff," said Sen. Jay Rockefeller (D-W.Va.), a Finance Committee member and an Obama supporter, referring to the presidential candidates' healthcare plans. “What they are doing is … laying out their ambitions."

Ezra Klein at The American Prospect has his doubts about the veracity of this report, and that quote is one of the reasons:

That scans oddly for two reasons. The first is money. Obama's aides say the plan would cost between $50 billion and $65 billion a year. Assume they're lowballing, and the real number is $80 billion. That's some cash, to be sure but it's not a level of outlay that tends to make Senators balk. We're spending far more on Iraq, on tax cuts, and a host of other projects. The money could probably be found fairly easily -- and it's certainly not hard for Senators to say it could be found fairly easily. So that looks strange.

When viewed in relation to other governmental expenditures it does seem like a comparatively small sum. Klein goes on to analyze the quote itself and the reporter who provides it:

The second oddity is "all this stuff." A health care bill contains a lot of stuff, to be sure, but it's generally referred to in the singular. It's a bill. It's big, and you can either do it or not do it. Moreover, the only proof we have that he was talking health care is that the reporter says so. It sounds to me like Rockefeller is saying something much broader and more mundane: That if you look at the domestic agendas of Clinton and Obama, there's not enough money nor political will to do all of it. You're not going to get health care and tax cuts and energy policy and housing reform and education and poverty and everything else you promised in the campaign. And even if you could muster the will, you can't find the funds. That leads to the question of priorities, but that's no surprise.

Jonathon Cohn of the New Republic's response is dismayed:

This is pretty discouraging stuff. Rockefeller is a longtime advocate for universal coverage; his moral commitment to the issue is not in question. And Baucus, whose comments were much less negative but still not enthusiastic, chairs the Finance Committee--through which any universal coverage bill must go.

Still, this isn't the last word on the subject. I just got off the phone with Andy Stern, president of the Service Employees International Union, who in recent years has done as much to promote the cause of universal coverage as any single person in politics. And he is not at all happy.

"I thought it was embarassing," Stern said. "I think it showed an incredible lack of appreciation for what most Americans are confronting every day in this health care system. ... What was said in this aritcle is not the kind of leadership that I think Americans are expecting after this election."

Whatever the context of the quotes was, it sure is generating a lot of discussion. I am sure that by the time this is posted there will be a vast array of opinions being voiced from blog pulpits and news outlets everywhere. Go check out these articles and render your own opinion. Our comments section welcomes you!

SOURCE: "Dems hedge on Health Care" 04/23/08
SOURCE: "Is Congress Backing Off health Care Reform?" 04/24/08
SOURCE: " Stern to Congress: Don't Chicken Out on Health Care." 04/24/08
photo courtesy of The Gold Guys /Lumax Art, used under its Creative Commons license

Medicaid Battle: Congress vs. The Veto

A battle over proposed cost saving measure proposed by the Bush administration is brewing in the U.S. House of Representatives. With a veto threat already on the table, things are looking interesting as another face-off between the two branches of government begins.

Jim Abrams gives us the scoop in his article for Time Magazine:

Passage of the legislation in a vote scheduled for later Wednesday would send it to the Senate Finance Committee, where Chairman Max Baucus, D-Mont., is reviewing options for suspending the regulations, his press officer said.

The governors of all 50 states, state Medicaid directors and others oppose the rules, Energy and Commerce Committee Chairman John Dingell, D-Mich., told the House. "They know the devastating effects these rules would have on local communities, upon hospitals, and upon vulnerable beneficiaries." Dingell's committee approved the bill earlier this month on a 46-0 vote. [Emphasis added. -GW]

So far during the current administration Congress has only been able to successfully override one veto from the President: a water projects bill last November. While this does not bode well for Congress in the coming conflict, this issue is far from dead in the water. Legislators, state governors, health care providers and more are coming together in favor of the moratorium because they fear the administrations plans will simply cost shift the burden to the poor and the state governments.

Once again, the Executive branch and Legislative branch of our government are locking horns, this time on one of the top issues of the current electoral season.

The White House, in a statement Tuesday warning of a veto threat, said the bill would "thwart these efforts of the federal government to regain fiscal accountability and integrity in Medicaid." Health and Human Services Secretary Mike Leavitt, in a letter to lawmakers, said it "puts billions of dollars of federal funds at risk, and may turn back progress that has already been made to stop abusive state practices."

But the proposed changes have met opposition from states, health care providers and advocates for poor who say they will shift costs from the federal government to the states and create new hardships for the needy. "Some of these regulations already have become effective and current state estimates of the impact could be as high as four times the administration's $13 billion estimate," National Governors Association chairman Tim Pawlenty, D-Minn., and other governors wrote lawmakers this month. Timely action to impose the one-year moratorium was "critical to avert significant disruptions in coverage for vulnerable populations," they wrote.

So it looks like the fiscal side of American health care rears its head once again. With 48 million people participating in Medicaid over 2007 the impact of this legislation will be felt far and wide. The Time article paints the cost of Medicaid programs at $352 billion, $200 of which was supplied by the federal government, an amount guaranteed to make the public sit up and take notice.

When was the last time you can recall the governors of all 50 states in the U.S. agreeing on something?

SOURCE: "House Challenging Medicaid Rules" 04/23/08
photo courtesy of euthman, used according to its Creative Commons license

Email and Your M.D.

Among American doctors, less than a third use email as a health care tool. Alicia Chang of the Associate Press takes a look at this strange deficiency:

"People are able to file their taxes online, buy and sell household goods, and manage their financial accounts," said Susannah Fox of the Pew Internet & American Life Project. "The health care industry seems to be lagging behind other industries."

Doctors have their reasons for not hitting the reply button more often. Some worry it will increase their workload, and most physicians don't get reimbursed for it by insurance companies. Others fear hackers could compromise patient privacy — even though doctors who do e-mail generally do it through password-protected Web sites.

Once again, we see an example of how embracing Internet technology, even in its most basic form, can improve the overall health care crisis our nation faces. The studies available state that not only is response time quicker from doctors who use email, but it also helps to reduce costly office visits and repeated phone calls.

For example, a 2007 University of Pittsburgh study published in the journal Pediatrics followed 121 families who e-mailed their doctors. Researchers found 40 percent of e-mails were sent after business hours and only about 6 percent were urgent. Doctors received on average about one e-mail a day and responded 57 percent faster than by telephone.

A separate study by health care giant Kaiser Permanente published in the American Journal of Managed Care last year found patients who used its secure Web system were 7 to 10 percent less likely to schedule an office visit. Patients also made 14 percent fewer phone calls than those who did not use the online services.

In Chang's article she adds a human face to the equation: Suzanne Kreuziger, R.N. Kreuziger works for a doctor who chooses not to utilize email. Kreuziger stresses the ability to have a documented virtual paper trail that she can go back to at any point as a key element of why email can be such an incredibly useful tool for both physicians and patients. Being able to simplify basic needs such as asking for prescription refills, setting appointments, and getting medical test results would be a boon to all involved.

She also points out that the complaint on the part of providers that time spent emailing is not billable seems to hold little water as phone calls are also not billable, and take a greater amount of time in most cases. Chang provides a wonderful look at this minor but important aspect of American health care.

It's not the first time the medical field has been slow to embrace technology. When the first telephones became widely available in the late 1800s, doctors were concerned about being swamped with calls.

Would YOU like to be able to communicate with your doctor via email? Share your thoughts.

SOURCE: "It's no LOL: Few US doctors answer e-mails from patients" 04/22/08
photo courtesy of Mzelle Biscotte, used according to its Creative Commons license

Veterans Vs. The VA: Health Care Showdown

Vietnam. Iraq. Afganistan. Names that evoke a variety of emotion laden memories, and stridently held opinions.

Neil MacFarquhar of The New York Times tells us how these memories and opinions have entered the courtroom in a federal case pitting the Office of Veterans Affairs (VA) against Veterans for Common Sense and Veterans United for Truth. The reason for this face off? You guessed it, health care issues:

"Our ultimate goal is guaranteed health care, timely health care, timely decisions on disability payments," Gordon P. Erspamer, the lead lawyer representing the two veterans groups, said in an interview.

"The system is choking on the claims; the delays are unconscionable," Mr. Erspamer said.

The trial, before Judge Samuel Conti, an Army veteran of World War II, does not seek monetary damages but asks the court to appoint a special master or otherwise intervene to make the department run more efficiently.

Claims for help from the department jumped 25 percent in recent years, hitting 838,000, Richard G. Lepley said in his opening statement for the government.

The defense said the jump was generated by a combination of veterans returning from Iraq and Afghanistan, where head injuries that can lead to stress problems are a signature issue, as well as an upswing of Vietnam veterans seeking help for medical conditions associated with aging. News coverage from the current wars has also led to new mental health problems among Vietnam veterans, said Kerri J. Childress, a spokeswoman for the veterans department in Palo Alto, Calif.

So the aging of the Baby Boomers is creating one wave of new patients as the survivors of Vietnam begin retiring while another wave of young and injured soldiers is returning home from the Iraq/Afganistan theater of operations. Meanwhile, the VA is stuck in the middle and drastically understaffed.

Kerri J. Childress, a spokeswoman for the veterans department in Palo Alto, California, quoted the number of suicides among veterans over the past year at 6,600. That's 20% of all suicides, or one in every five suicides occurring in the United States. Combine that with extended wait times for treatment caused by lack of personnel and it paints a grim picture indeed for our soldiers.

Some of the statements made at the trial paint a grim initial picture of the VA defense:

The number — 126 suicides a week, higher than the 120 published in previous studies — was in a December e-mail message from Dr. Ira Katz, the head of mental health services for Veterans Affairs, to Dr. Michael J. Kussman, the under secretary for the Veterans Health Administration in the department. Mr. Erspamer displayed the message in his opening argument.

The department has long been reluctant to release specific numbers regarding suicides or suicide attempts, lawyers for the veterans groups said. "We certainly think there was a cover-up in some sense," said Heather Moser, a lawyer for the plaintiffs.

A second department e-mail message from Dr. Katz shown at the trial starts with "Shh!" and refers to the 12,000 veterans per year who attempt suicide while under department treatment. "Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?" it asks.

This is one story that bears watching.

SOURCE: "In Federal Suit, 2 Views of Veterans’ Health Care" 04/22/08
photo courtesy of Jurek D., used according to its Creative Commons license

Sin Tax For Health

Many states have considered enacting additional taxes -- so-called "sin taxes"-- on tobacco products to help defray the skyrocketing cost of health care. The Kaiser Family Foundation has just released a report on this very subject that should prove of interest:

Several states have sought to increase their tobacco taxes to fund health care programs and address budget deficits, but efforts to increase tobacco taxes in some cases have prevented the passage of health care proposals, the New York Times reports.

According to the Tobacco Merchants Association, in 2008, 22 state legislatures have considered bills that would increase tobacco taxes. Last year, 11 states enacted such legislation, according to the National Conference of State Legislatures. R.J. Reynolds Tobacco estimates that state tobacco taxes raise $14.5 billion in revenue annually and that the federal tobacco tax raises $7.3 billion in revenue annually.

"For some states, tobacco taxes are seen as a kind of magic bullet that are really quite different from less popular kinds of taxes," Richard Cauchi, a health policy analyst from the National Conference of State Legislatures, said, adding, "Legislators are able to argue that it's a sin tax, and the voters seem more accepting if they know the funds are going to be earmarked for some kind of health initiative."

The report goes on to detail recent efforts along these lines that various states have put on the table. California, New York, South Carolina, and Massachusetts efforts are detailed on their site.

As always the arguments pro and con have a familiar ring to them:

• "It will help prevent underage smoking."
• "It is an unreliable source of revenue."
• "It is unfair to smokers"
• "It will generate the revenue we need."

It is no secret that the tobacco companies are against this, and they bring an amazing advertising budget with them when they engage the battle for public support. California Speaker Fabian Nunez has been quoted many times across the media as saying that "Big Tobacco" killed health care efforts in California. The question truly is whether this is a viable approach or not. Will diminishing sales in areas that do enact a tobacco tax provide enough revenue to make an impact on the health care system as it stands?

SOURCE: "Kaiser Daily Helath Policy Report" 04/21/08
photo courtesy of Porcelin Girl used according to its Creative Commons license

5th Annual World Health Care Congress

A stupendous array of health care expertise is gathered in Washington, D.C., supplemented by the health care policy advisors for U.S. Presidential candidates Sen. Barack Obama, Sen. Hillary Clinton and Sen. John McCain. It's the World Health Care Congress, and as you might expect, George C. Halvorson is there.

From the press release about this morning's panel:

-- Hear the Presidential candidates' platforms for health care reform

-- Compare proposals to address universal coverage and the fiscal
stability of Medicare

-- Reactor panelists provide an in-depth critique by evaluating the
economic and social impact of Democratic and Republican proposals

Panelists:
-- U.S. Rep. Jim Cooper (D-TN), Health Care Policy Advisor to Sen. Barack
Obama

-- Chris Jennings, Health Care Policy Advisor to Sen. Hillary Clinton,
former Senior Health Care Advisor to President Clinton.

-- Thomas Miller, resident fellow, American Enterprise Institute for
Public Policy Research, Health Care Policy Advisor to Sen. John McCain

-- George Shutlz, former U.S. Secretary of State, Labor and Treasury, co-
author "Putting Our House In Order: A Guide to Social Security and
Health Care Reform"

-- George Halvorson, Chairman and CEO, Kaiser Foundation Health Plans and
Hospitals

Health care reform, universal coverage, Medicare woes, and a solid analysis of the positions taken by our current crop of Presidential candidates should make for a fascinating (and hopefully productive) gathering.

The listing above covers on the first panel of the day for this event, in addition to those listed above there is an extensive roll call of movers and shakers in the Health Care scene in attendance who will be combining their expertise:

• Michael Leavitt, Secretary, U.S. Department of Health and Human Services
• James Hagedorn, CEO, Scotts Miracle-Gro Company
• Delos (Toby) Cosgrove, MD CEO, Cleveland Clinic
• Denis Cortese, CEO, Mayo Clinic
• Greg Tullman, CEO, Allscripts
• George Halvorson, Chairman and CEO, Kaiser Foundation Health Plans and Hospitals
• Mack Banner, CEO, Bumrungrad International (Thailand)
• Sam Nussbaum, Executive Vice President and Chief Medical Officer, Wellpoint
• Thomas Miller, health care policy advisor to Sen. John McCain
• Prof. Hans Rosling, MD, PhD Professor of International Health, Karolinska Institutet (Sweden)
• Michael Howe, CEO, MinuteClinic
• Paul Speranza, Chairman, U.S. Chamber of Commerce, Vice Chairman and General Counsel, Wegmans Food Markets
  

Best of all, in my opinion, is the fact that you can stream MP3 audio podcasts of the featured speakers here. Look for Mr. Halvorson's podcast, "Reforming the Delivery of Care to Impact 85% of Total Health Care Costs." It just went live!

Today, I would like to close with a quote about the event:

"This is the largest gathering of health care providers, thinkers and experts anywhere in this world."
—Lee Scott, President & CEO, Wal-Mart Stores, Inc.

Let us hope this massive array of talent and expertise can help us find our way down this complex and emotionally charged path to effective health care reform!

SOURCE: "5th Annual World Health Care Congress Kicks off April 21 With Obama, Clinton, McCain Health Care Policy Advisor Presidential Health Care Agenda Forum" 04/21/08
SOURCE: "5th Annual World Health Care Congress- Podcasts"
photo: Screencap of WHCC Website

Baby Boomers and the Shrinking Health Care Workforce

Medical News Today brings us more disquieting news about the state of health care as it relates to the wave of Baby Boomers soon to retire. According to a report from the Institute of Medicine, the health care industry is not only unprepared to meet the health needs of the coming onslaught of retirees, but is also lacking enough staff to provide proper care for them:

The Gerontological Society of America (GSA), the nation's largest organization devoted to aging research, fully supports the publication's call for a labor pool of adequate size and competency to care for a rapidly increasing over-65 population.

"This pivotal report lays out a much-needed strategy for developing a network of health professionals and frontline workers to avert a crisis in quality care for older persons," said GSA President Lisa Gwyther, MSW. "Complex chronic illness is an issue that we all will face with age. The current fragmented system of care desperately requires an increase in better-prepared personnel to sustain itself."

When you combine the number of Americans reaching retirement age in the next few years with the continually extending life expectancy, an uneasy picture emerges. To aggravate the situation, the number of geriatric specialists is shrinking.

Marie Bernard, MD, president of The Association for Gerontology in Higher Education (GSA's educational unit), said policymakers must act quickly to address these problems.

"To meet the needs of our aging parents and grandparents, we need to increase the number of geriatric health specialists - both to provide care for those older adults with the most complex issues and to train the rest of the workforce in the common medical problems of old age," Bernard said.

The elderly already are responsible for a disproportionate amount of health care resources, partly due to the prevalence of chronic conditions that require continual or serial treatments. With the number of people in that age bracket doubling in the next few years, this issue is, like so many that we write about here, critical.

SOURCE: "Looming Baby Boomer Health Care Crisis; GSA Bolsters Call For Stronger Workforce" 04/18/08
photo courtesy of mishajane used according to its Creative Commons license

Hammergrin on Health Care

While looking around the Internet, I ran across a great little essay on the 800-CEO-Read Blog penned by John Hammergrin of McKesson Corporation, a 175-year-old heath care company. Since he seems to be very much of a similar mind to George C. Halvorson, I thought that sharing parts of that blog might be well received. Here is a bit from the column in which he addresses the issue of our national health care crisis from the standpoint of business and the market:

In most industries, top performing businesses excel by being the low cost producer, putting out the best product, and meeting or beating customer expectations. The market works because consumers are able to choose the services that meet their needs best. In the health care industry, costs are distorted by government interference in the market and quality differences are disguised by a lack of consumer information and choice. Moreover, while we can argue that "customer" is another word for patient, would the customer in any other market make critical decisions without concern for cost or quality and put up with the inconveniences, inefficiencies and high error rates of health care?

The lack of available and consistent information is indeed a huge stumbling block, and one that I have written about here on several occasions. While the argument does seem lucid overall, I must point out that for many in this country medical care is a last resort, mostly due to these aforementioned costs. This means waiting until a trip to the emergency room in unavoidable, at which point cost comparisons and examination of the care quality of the provider are moot.

Chronic diseases account for most of our health care expenditures and require coordinated rather than episodic care. We need to incentivize and organize providers to manage long-term illnesses better. The fear of medical malpractice suits are driving up costs by encouraging unnecessary treatment. We need sensible reform to reduce the preponderance of defensive medicine. Quality of care and outcomes need to be the new measuring sticks by which we assess, select and pay providers for their health care services. We need greater transparency to give primary care physicians and health care consumers the ability to choose the best doctors, hospitals, insurance providers and technicians, while also creating industry-wide standards for the latest in best practice.

No matter which candidate prevails in November, the popular concerns we have about health care right now are going to evolve rapidly once the next administration begins. As a business leader, I support universal access through tax incentives and individual choice (not a de facto expansion of Medicare) because I believe that having everyone in the insurance pool is fundamental to reducing costs and creating a competitive insurance market. But as Governor Schwarzenegger learned when the California Senate Health Care Panel rejected a bill mandating health care for all state residents, sweeping reform is even more difficult when economic times are tough.

And that would seem to be a major concern as we watch the news become more pessimistic each day regarding the American economy. Even so, many other factors do play an important part that is not to be overshadowed by economic insecurity. Hammergrin sums up his position in this regard as follows:

We don't need to control the health care market through mandates and cost containment legislation, we need to unleash it by giving people the ability to make better informed choices. After all, health care is the one product all consumers need, guaranteed.

SOURCE: "An essay from John Hammergren on health care reform"04/14/08
photo courtesy of brykmantra, used according to its Creative Commons license

Women In Massachusetts: Left Behind?

The Boston Herald's Eva Wolchover brings to light and interesting angle on Massachusetts' attempts at universal health care, namely that it fails to provide affordable or adequate heath care for women. A Suffolk University report titled “Women and Health Care Reform in Massachusetts” by Professor Susan Sered is the source of the data:

“Women use the health care system far more than men do,” said Sered. “They use it on behalf of their families, their children, their elderly family members, etc. As we began to interview women we found that some of them couldn't use their insurance because they couldn't afford their co-pays.”

Women largely neglected by the reform bill, she said, include those in the moderate-income bracket; immigrant women, who if undocumented are left out all together; late-middle aged-women once covered under a spouse’s plan; and young adults.

Moderate-income women earn too much to qualify for Commonwealth Care but cannot afford private coverage, Sered said. Young women are lured by low premiums under the Young Adult Plan but are then strapped with vastly expensive co-pays and deductibleswhen the need for care does arise.

The article juxtaposes Sered's study results with a single woman's case. The single woman in question is one who does benefit from the system currently in place. While her story is compelling, it is the story of only one woman. While she is almost certainly not the only one of her gender benefiting from the Massachusetts approach, Sered's study does raise some disturbing questions about how many woman actually do.

Give it a look and tell us what you think.

SOURCE: "AWomen's Care Lags" 04/13/08
photo courtesy of The Alieness Gisella Giardino23, used according to its Creative Commons license

Elizabeth Edwards backs Clinton on Health Care

Martina Stewart, an Associate Producer at CNN, reports that Elizabeth Edwards has now publicly endorsed the health plan of presidential hopeful Sen. Hillary Clinton. Details appear in Stewart's article on CNN's Political Ticker:

Elizabeth Edwards, wife of former Democratic presidential hopeful John Edwards, is picking sides in the Democratic nomination race – at least with respect to health care. In an interview that aired Wednesday on ABC’s “Good Morning America,” she threw her support behind Sen. Hillary Clinton’s health care plan.

“In order to ensure that we have universal coverage, we need to say everybody has to join,” Edwards told ABC’s Robin Roberts. “So, for that reason, the mandates that Sen. Clinton is talking about, I think are going to be more successful in achieving the goal,” she added.

Both health care plans have the same goals, said Edwards, but “I just have more confidence in Sen. Clinton’s policies than Sen. Obama’s on this particular issue.”

This is not the first time that Edwards, a cancer survivor, has had good things to say about Clinton's approach to health care. Last September she even noted its similarities to the one her husband, John Edwards, espoused during his bid for the Democratic nomination. As noted on this blog, she has also been quite critical of Sen. John McCain's plan, stating that is gives too much leeway for insurance providers to deny coverage based on pre-existing conditions.

This public statement is one that will certainly have an impact on the battle between Clinton and Obama for the Democratic nomination. Even though neither John nor Elizabeth Edwards have made a formal endorsement of either candidate, endorsing Clinton's health care plan carries a lot of weight due to the high profile of the issue in the current race for the Oval Office.

SOURCE: "Elizabeth Edwards backs Clinton's health care plan over Obama's" 04/09/08
photo courtesy of John Edwards 2008, used according to its Creative Commons license

More Does Not Mean Better: Chronic Disease Care

The uneven distribution of health care costs is a vitally important aspect of the overall reform debate. Five chronic diseases account for 75% of our total national expenditures for health care across the board.

On Monday, the Dartmouth Atlas of Health Care put out a press release (via The Earth Times) about their newest study in which they focus on the part that Medicare plays in this aspect of the ongoing battle for health care reform. Evidently the amount paid by Medicare is highly variable, as is the treatment received:

"This report demonstrates the need to overhaul the ways we care for Americans with chronic illness," said Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation. "The extent of variation in Medicare spending, and the evidence that more care does not result in better outcomes, should lead us to ask if some chronically ill Americans are getting more care than they or their families actually want or need."

The first image that came into my mind while reading this was that of an auto mechanic advising a complete engine overhaul to treat a set of failing spark plugs. More is not always better.

The new edition of the Dartmouth Atlas of Health Care: Tracking the Care of Patients with Severe Chronic Illness shows that institutions that give better care can do it at a lower cost because they don't over-treat patients. However, the Atlas documents that Medicare and most other payers encourage the over-use of acute-care hospital services and the proliferation of medical specialists thanks to misplaced financial incentives, especially for treating chronically ill people.

This is a serious problem. Caring for people with chronic disease now accounts for more than 75 percent of all health-care spending. And over-use and overspending is not just a Medicare problem--the health-care system as a whole lacks efficient, effective ways of caring for people with severe chronic illnesses.

Misplaced financial incentives, indeed. As George C. Halvorson has pointed out in his book, Health Care Reform Now!, there are over 9,000 billing codes for medical procedures, yet not a single one exists for a cure. The Dartmouth report supports the assertion that it is not the only the cost of care but also the sheer number of procedures prescribed, some necessary and some not, that is at the core of this aspect of the problem.

The Dartmouth Atlas Project studied the records of millions of Medicare enrollees who died from 2001 to 2005 and had at least one of nine severe chronic illnesses. Using those records, researchers benchmarked care nationally to the care provided in the region where Mayo has its flagship clinics and is far and away the dominant health care provider. Total spending for the population in this study was $289 billion over the five years. If the spending per patient everywhere mirrored that in Mayo's home region of Rochester, Minn., Medicare could have saved $50.1 billion, or 17.3 percent of all spending on these patients alone. A benchmark to a higher cost but efficient region such as Sacramento, Calif., where labor costs are the 26th highest of the 306 regions, shows Medicare would still have saved $28.9 billion.

The study paints a picture of a system in disarray over the treatment of these illnesses. There are no good, clear guidelines for when to hospitalize these patients, admit them to intensive care, refer them to medical specialists or--for most conditions--when to order diagnostic or imaging tests..

The numbers are both enlightening and disturbing. The wide variances from provider to provider point to a lack of consensus on proper course of treatment for these ailments as well as the lack of systems thinking in the industry, e.g., lack of across the board standards and measurements of performance.

The links below will take you to the full press release as well as to the Dartmouth Atlas of Health Care site where you can purchase or download the full report itself.

SOURCE:"Press Release: Chronically Ill Patients Get More Care, Less Quality, Says Latest Dartmouth Atlas" 04/07/08
SOURCE:"The Dartmouth Atlas of Health Care"
photo courtesy of Mel B., used under this Creative Commons license

Health Care Meltdown: A Small Town Mirror of The National Woes

Blue Island, Illinois, is the home of St. Francis Hospital, which will be shutting its doors in about four months. Phil Kadner of The SouthTown Star examines the way that this small town hospital's plight mirrors the overall breakdown in health care across the United States:

Executives for its corporate parent, SSM Health Care, said the company couldn't even give the hospital away when it offered to assume its $40 million debt.

What happened?

What happened is a litany of woes all to familiar to those of us who write about health care issues. First amongst the issues is the constant refrain of financial strain. Cost of care once again rears its ugly head.

Medicaid reimbursements, which pay for medical care for the poor, haven't been increasedin Illinois in 15 years. At St. Francis, officials claim that means they get back about 11 cents for every $1 they spend.

Vince Pryor, the chief financial officer at Ingalls Memorial Hospital in Harvey, which likely is to get many of the patients that used to go to St. Francis, estimated his hospital gets about 18 cents back on the dollar from Medicaid.

But even at those meager reimbursement rates, the state has not sent Medicaid payments to hospitals since November.

He goes on to cite a variety of problems, boiling the abstract down to the concrete with St. Francis as the practical illustration. Reimbursement rates, astronomical and no standardized administrative fees, non standardized bookkeeping and accounting practices, and more.

400, 000 hospital visits per year will now be going to other emergency rooms in the area, a fact which illustrates the regional impact of this closure. Go take a look at the article. If we don't reform American health care it could presage things to come...

SOURCE:"Health care problem explodes right here" 04/01/08
photo courtesy of reivax, used under this Creative Commons license

New York State Funds Digital Health Care Resources

Annemarie Franczyk who writes for Business First of Buffalo brings us tidings from New York about new funding for HealthLink:

New York state is putting $5.3 million behind a local effort to create better electronic links among doctors and health-care organizations.

The Western New York Clinical Information Exchange, or WNYCIE, received the two-year round of funding from Albany to support expansion of HealtheLink, the computer-based information system that is connecting health-care providers.

Daniel Porreca, WNYCIE executive director, said the organization will use the grant in several areas: linking doctors and others with Medicaid patient records, creating public health surveillance and reporting mechanisms, and reporting outcomes data. WNYCIE applied for, but did not receive, funding for the purchase of electronic health records, but grants for such programs might be available in the future, Porreca said.

While this does not yet include electronic medical records, it is still a large step forward in the embrace of digital resources. This is the fifth round of funding for interoperable electronic systems geared towards streamlining care delivery.

As with EMRs, it should do quite a bit to weed out duplicate testing while improving coordination amongst care providers.

SOURCE: State funding improved health-care links" 04/01/08
photo courtesy of paraflyer, used under this Creative Commons license

Hard Questions for John McCain from Elizabeth Edwards

Being on opposite sides of the political divide, it is not surprising that presidential hopeful Sen. John McCain and the wife of former hopeful John Edwards disagree on a number of issues.

This has now been thrown into sharp relief by a recent guest posting by Elizabeth Edwards on the ThinkProgress website:

I freely admit that I am confused about the role of overnight funding in repurchase markets in the collapse of Bear Stearns. What I am not confused about is John McCain’s health care proposal. Apparently Douglas Holtz-Eakin, a senior policy advisor to McCain, thinks I do “not understand the comprehensive nature of the senator’s proposal.” The problem, Douglas, is that, despite fuzzy language and feel-good lines in the Senator’s proposal, I do understand exactly how devastating it will be to people who have the health conditions with which the Senator and I are confronted (melanoma for him, breast cancer for me) but do not have the financial resources we have. In very unconfusing language: they are left outside the clinic doors.

She then proceeds to ask a series of very pointed questions about the McCain plan from the perspective of a person with an existing condition. Emphasizing his reputation for being a "straight talker," she calls on him to provide straight to in response to her questions.

It is a sobering post. Especially when her lead in question is:

Under your plan, Senator McCain, would any health insurer be required to sell you or me (or those like us with pre-existing conditions) a health insurance policy?

She goes on to ask incisive questions about the market driven approach, pointing out that cheap insurance is often made available through efforts on the insurer's part to avoid treatment of high cost or chronic diseases such as her own cancer.

We will see what, if any, response is to be had from the McCain camp as time goes by.

SOURCE: "sponds: Why Are People Like Me Left Out Of Your Health Care Proposal, Sen. McCain?" 04/01/08
photo courtesy of Library of Congress via pingnews, used under this Creative Commons license

Clinton Campaign Behind on Staff Health Care Benefits

Today, we are going to take a look at an aspect of the ongoing debate about health care amongst the U.S. Presidential candidates that is, for a change, new.

Politico's Kenneth P. Vogel broke this news:

Among the debts reported this month by Hillary Rodham Clinton’s struggling presidential campaign, the $292,000 in unpaid health insurance premiums for her campaign staff stands out.

Since health care reform is a major plank in Senator Clinton's campaign, this news has great potential to damage her efforts and credibility on that front.

Clinton campaign spokesman Jay Carson assured Politico that there was no interruption in staff benefits as a result of this situation. He also stated that Aetna Healthcare and Blue Cross Blue Shield, the health care providers for campaign staff, had been paid in full this month.

“Sometimes invoices are not paid immediately because we need additional information for our records, or to verify expenses,” Carson said in a statement e-mailed to Politico. “Sometimes invoices arrive at the very end of the month at the cutoff of the reporting period, which means that we are required to report them as a debt on the current FEC report, even where they are paid in regular course during the next month.”

But the unpaid bills to Aetna were at least two months old, according to FEC filings.

They show the campaign ended last year owing Aetna more than $213,000 for “employee benefits.”

During the first two months of the year, the campaign did not pay down any of that debt. In fact, it accrued another $16,000 in unpaid bills last month, and it finished the month owing Aetna $229,000.

Just like any other business, the Clinton Campaign faces employee benefits as one of their most major expenditures. Also just like other businesses, it is not uncommon to carry an unpaid balance from month to month. Carson emphasized that the campaign follows normal business practices in dealing with their bills, which are paid "regularly."

By contrast, Senator McCain had no unpaid health provider bills as of the end of February, and Senator Obama had a balance of $908 owed to AIG American International Group for "insurance." The contrast is already being touted across media and internet sources.

In a race that involves the issue of universal health care as a fundamental component, this news has potential to upset the political apple cart in fairly short order.

SOURCE: "Clinton didn't pay health insurance bills" 03/31/08
photo courtesy of Center for American Progress Action Fund , used under this Creative Commons license

Budget Shortfalls Produce Health Care Cuts In Many States

Today, I would like to direct your attention to the Kaiser Network's Daily Health Policy Report of March 31, 2008. Their continuing roundups of pertinent health care news are always useful and informative.*

The reason I would like to focus on this particular new roundup is the overall topic: state level budget shortfalls endangering health care funding. The weakness of the current American economy combined with more than half of U.S. states facing shortfalls in their budgets the outcome for medically oriented spending seems bleak.

The budgetary gaps run the gamut, but generally all fall into the range of billions of dollars. On the lower end we have states like Florida whose shortfall is only about 43 billion, with California taking the lead with a deficit of $16 billion. No matter which side of the spectrum you look at the solution continues to be spending cuts. Medical care is often the first to feel the ax when budgets run low due to the perception of "immediate savings" and the skyrocketing escalation of costs.

California Gov. Arnold Schwarzenegger (R) has already proposed $650 million in cuts to Healthy Families (California's SCHIP program). Those cuts have the potential to affect as many as 7 million people amongst the seniors and disabled of the state's population.

Even in Florida, the ax bites deep as this incomplete list of cuts shows us:

The House proposal would eliminate hospice coverage for 8,000 terminally ill beneficiaries, coverage of hospitalization costs for 20,000 transplant recipients, and diagnosis and care for 2,300 children with cleft lips or cleft palates. The House measure also would eliminate coverage of dental and vision care, as well as hearing aids, for 146,000 seniors to save $32 million. In addition, the budget proposal would reduce funding for the Medically Needy program by $170 million.

A faltering economy and continually rising costs of care have created a climate where this type of news will probably be a daily occurrence. As a nation, we need to implement systems thinking, even out the distribution of health care costs, implement electronic medical records, and basically do whatever it takes to reform our health care "non-system."

*Disclosure: The Health Care Reform Now! Blog does have a relationship with Kaiser due to it being a companion blog to Kaiser CEO George C. Halvorson's latest book, Health Care Reform Now!.

EDIT 4/24/08: The Kaiser Daily Reports are a product (free service) of the Kaiser Family Foundation, which is actually not at associated with Kaiser Permanent, Kaiser Foundation Health Plan or Kaiser Foundation Hospitals. The disclosure above was purely my own error and I greatly appreciate Robin at the KFF setting me straight on the matter! For more info about the Kaiser Family Foundation follow this link.

SOURCE: "Coverage & Access | Cuts to Health Care, Other Programs by States Trying To Address Budget Shortfalls Might Disproportionately Hurt Low-Income Populations" 03/31/08
photo courtesy of Jeff Keen, used under this Creative Commons license