Technology Brings the Human Touch Through VoIP

VoIP. It sounds like a special effect from a Saturday morning cartoon, doesn't it? Like many funny sounding words in common usage, it is actually an acronym. It stands for Voice Over Internet Protocol. If you've ever seen an advertisement for Vonage, Skype or numerous other services, that is what they are: voice transmission over the Internet rather than through regular phone lines.

The reason I bring this up is because of a recent article in The Charlotte Business Journal in North Carolina. It seems that VoIP is being leveraged to help bring a human face back to an arena infamous for phone queues and voicemail boxes. Carolinas HealthCare System and Nortel Networks Corp. have come together and deployed a virtual contact center staffed by roughly 1,000 agents trained in health care. The system is reported to direct over 640,000 calls each month.

“We pride ourselves on delivering personalized patient care second to none,” says Daniel Wiens, senior vice president of the Carolinas Physicians Network. “We believe the tone is set with the patient’s very first call, and in a medical situation, people will always be more comfortable dealing with a person. That’s why reaching a person right up front, rather than a recorded message, is so very important.”

As someone who uses VoIP extensively in my work, and also someone who shares the modern American impatience with automated phone menus, this sounds like a good way to make the current tech work for the health care system.

The initial program covers no less than six hospitals and sixty-six doctor's offices as well as numerous other health care providers in the area. I think they are off to a good start!

SOURCE: "Carolinas HealthCare adds VoIP service to respond to patients’ calls" 08/27/08
photo courtesy of trekkyandy, used under its Creative Commons license

VA Brings Health Care To Rural Vets

Access. It can make all the difference in the world. The best health care means nothing if you cannot get to it. With that in mind, the Veterans Administration is rolling out a program aimed at vets who live in rural areas -- areas often out of easy reach of health care professionals and hospitals.

In early 2009, a group of mobile health clinics will come online servicing twenty-four counties in six states. The four RV style vehicles will bring health care and mental health care to vets who find distance an obstacle in procuring treatment.

Via Market Watch:

"VA is committed to providing primary care and mental health care for veterans in rural areas," said Secretary of Veterans Affairs Dr. James B. Peake. "Health care should be based upon the needs of patients, not their ability to travel to a clinic or medical center."

The program, entitled Rural Mobile Health Care Clinics, is in its early stages. Vehicles are still being acquired and outfitted with an eye towards a 2009 launch date for the program. Deployment of the mobile clinics will be based on a variety of factors including need for access, community collaboration, and the degree to which the units will expand the variety of services available.

SOURCE: "VA Mobile Health Care Clinics Reach Rural Veterans" 08/27/08
photo courtesy of Matt McGee, used under its Creative Commons license

Billions in Medical Costs Saved by Tobacco

I smoke. I wish I did not. I've been trying to quit for almost two decades now with pathetic results. I know it is important to my health and increasingly to my wallet as well. Unfortunately, I must admit my addiction. What is really boggling to the mind is a recent study by researchers at the University of California that shows an unexpected way that smoking effects us all financially: health care costs. Now I know everyone is aware that health cost are higher for smokers, but this report brings a whole new perspective to things.

California's state Tobacco Control Program has saved $86 billion dollars (in 2004 dollars, FYI) in individual health care costs during its first 15 years in place.

Via Science Daily:

During the same period, the state spent only a total of $1.8 billion on the program, a 50-to-1 return on investment, according to study findings. The study is the first that has been able to quantifiably connect tobacco control to healthcare savings, say its authors.

The savings come from the 3.6 billion packs of cigarettes that were not smoked as a result of these programs between the beginning of the Tobacco Control Program and the end of the study in '04. While great for health care consumers, I am sure the tobacco industry is not happy. Those lost sales account for $9.2 billion dollars in sales.

Now those of you familiar with George C. Halvorson's position on chronic conditions are aware that he considers them to be a lion's share of overall health care expenditures. Numerous studies indicate that lung cancer and heart disease -- both of which are inextricably linked to smoking -- are very high on the list of those chronic conditions. With that info in hand, these findings are hardly surprising, but it is the fact that this study presents the first verifiable link between attempts at tobacco control/regulation and health care savings that is a landmark.

Go on over and give the original article a read. There is a lot of documentation and a very nice run down on how they collected and analyzed their data.

SOURCE: "California Tobacco Control Program Saved Billions In Medical Costs" 08/26/08
photo courtesy of Saudi, used under its Creative Commons license

Uninsured Health Care Spending: $30 Billion Out of Pocket

There is a new report from researchers at George Mason University in Fairfax, VA, and the Urban Institute think tank in Washington, D.C. The findings are disturbing. Discussions about health care costs are generally an unsettling course of conversation these days. The dollar signs seem to keep mounting up.

Jane Zhang of The Wall Street Journal reports:

Americans who lack health insurance will spend about $30 billion out of pocket on medical care this year, but others -- mainly the government -- will end up covering another $56 billion in costs, according to a new study.

A grand total of $86 billion? That is quite a pretty penny. The health care equation is most certainly one that tends to produce and incredible amount of dollar signs. Let's take a look at a bit more detail:

The new study estimates the government pays 75%, or $42.9 billion, of the amount uninsured patients can't pay -- through Medicaid, the federal-state health-insurance for the poor and Medicare, the federal program for the elderly and disabled, as well as state and local taxes.

So if the government is paying, that means the money is ultimately coming out of the pockets of the taxpayers. State and local taxes are just the beginning. The other programs listed above all derive their revenue from the tax base as well.

There are a huge variety of factors that play into the final cost of any health care procedure, payment rates tend to fluctuate according to the method by which they are negotiated. The complexity of the issue is succinctly set forth later in Ms. Zhang's article:

Complicating the measure: Some doctors and hospitals donate time and forgo profit to cover poor people, and in some cases private donations cover the costs. Just how much money doctors and hospitals lose in caring for the uninsured is difficult to pin down, partly because group plans often negotiate lower payment rates than other consumers are billed. For this study, Mr. Hadley of George Mason University defined uncompensated care as the difference between how much the uninsured paid and what the providers would have received had those patients been privately insured.

So the net end result, according to the study, is that the majority of the monies used to defray the health care costs of the uninsured end up showing vastly more of an impact on our taxes than on the insurance premiums of those with private policies.

It is predicted that this report in conjunction with the two being released by the Census Bureau today will re-energize the debate about health care reform and health care costs. The Census Bureau reports will focus on income, poverty and the uninsured, and are sure to bring more attention to the issues covered here.

SOURCE: "Uninsured to Spend $30 Billion, Study Says" 08/25/08
photo courtesy of Saad.Akhtar, used under its Creative Commons license

Gov. Gregoire Begins Testing Consumer Managed Health Records

Washington Governor Chris Gregoire and the Legislature of his state are known proponents of using electronic health records as a means of increasing accuracy of treatment and reducing the administrative costs associated with health care. Now it seems that they are experimenting with an approach that could prove very useful in this regard.

Via MarketWatch:

Starting in early 2009, more than 18,000 Washingtonians in three different communities will have the opportunity to organize and manage access to their own health information under separate health record bank pilot project grants from the Washington State Health Care Authority (HCA).

In an age of social networking and user generated content, this looks like a logical way to proceed. The so-called Health Record Banks will greatly expand access to personal health data, which is now, almost universally, scattered across multiple platforms and locations depending on what providers the patient in question uses. Centralizing the data and increasing access is a sound plan, one which the state of Washington seems to making strides in.

The Health Care Authority will be closely monitoring the usage and benefits of the health record bank pilots. Using this new technology, patients will have the ability to view and share a copy of their health information - without having to recreate the records from mounds of information, prescriptions and medical information.

The $1.7 million dollar effort include the Spokane-based Inland Northwest Health Services, Cashmere-based Community Choice Healthcare Network, and Bellingham-based St. Joseph Hospital Foundation and The Critical Junctures Institute. It is an approach that will be watched carefully to see if a system involving direct consumer management of health data is a viable option.

Work on the record banks is supposed to begin immediately, with the system going live in early 2009.

SOURCE: "Three Pilot Projects to Receive Grants from the Washington State Health Care Authority Totaling $1.7 Million to Test Consumer Managed Health Record Banks" 08/20/08
photo courtesy of Gov. Chris Gregoire's Media Center

Be Bold!

As expected, I am not the only one to immediately jump on the figures presented in the most recent Commonwealth Fund Report. (See yesterday's post.) Chellie Pingree, Democratic nominee for the U.S. House of Representatives for Maine's 1st District and former Maine State Senate Majority Leader, has written a piece that not only looks at the figures, but puts them into a local context for her state. She also provides a call to action to politicians to be bold in their decisions when legislating on health care issues.

Chellie Pingree on The Huffington Post:

Access to quality, affordable health care is particularly important here in Maine, where many of us own small businesses or are self-employed. Many Maine families have put together a way to make a decent living (and often it includes more than one job) -- until it comes time to figure out how to pay for health care.

When I was in the Maine Senate and proposed Maine RX -- a plan to lower prescription drug costs by forcing the pharmaceutical companies to negotiate -- I was told by many people that it was too big an idea, and we couldn't overcome opposition from the drug companies. Those corporations certainly put up a good fight -- all the way to the US Supreme Court -- but in the end we prevailed.

The lesson is that, as elected officials, we shouldn't be afraid of a bold idea. More often than not, the public will already be there while the politicians lag behind. This new survey from the Commonwealth Fund provides the hard numbers to back that up: almost everyone believes we need to fundamentally overhaul or rebuild the system.

It is my belief that no matter what side of the political aisle you are on, the exhortation to be bold is one worth listening to. The health care system of the United States is obviously broken. This is not only common wisdom but extensively documented by a variety of sources. Universal coverage is something I would term a fundamental rebuild. Do you agree?

We need health care reform now. It is a mission critical issue for American citizens. George C. Halvorson said it very well, “It’s definitely time to bite the bullet on universal coverage. The ethnic, racial, and economic disparities in care that exist now ought to push us all into creating universal coverage at the fastest possible speed -- and the new opportunity to link universal coverage to real health care reform using electronic data about actual care delivery ought to give us a sense that the time to act is now.”

Your health is your greatest asset. Isn't it time to treat it as such?

SOURCE: "Healthcare System Overhaul -- 82% of Us Want It" 08/20/08
photo courtesy of jepoirrier, used under its Creative Commons license

72 Million Find Health Care Bills a Burden

Bloomberg has an interesting article up by Aliza Marcus in which they take a look at the impact that health care costs are having on the average American. By now, everyone is familiar with the fact that 47 million people in the US have no coverage. What you may not be aware of is that for a grand total of 72 million people, the cost of health care is a major issue.

Documentation of the 34% rise in cost over the past two years via Bloomberg:

An estimated 72 million adults under age 65 have difficulty paying their medical bills or are paying off debt from health-care expenses, based on the survey, taken last year and released today by the Commonwealth Fund, a health-policy center in New York. Sixty-one percent of those struggling said they had health insurance.

As someone who has been paying off medical bills from a bout with kidney stones since 2004, I can relate. When viewed from inside the queue, the costs are monolithic, especially on a writer's pay. For the average Joe, it can often become a choice between health care or a roof over your head. Not a pleasant decision to make.

Based on the newer survey, 28 million Americans used all their savings on medical expenses, 21 million built up substantial credit-card debt and 21 million couldn't pay for basics such as food, heat or rent.

"Working people are struggling to pay their bills and accruing medical debt,'' said Sara Collins, the fund's assistant vice president, in a statement.

I used to have savings. Really, I did. Thankfully, I have not hit the point where it becomes a choice between the bill and groceries, although there have been months where it went unpaid in order to ensure that I could put food on the table. It gives me an unfortunate inside view of the situation.

Having coverage does little if the bills are unpayable. This is why cost-reducing measures like the enforcement of industry wide standards and practices and implementation of electronic medical records are so important.

SOURCE: "Medical Bills Burden 72 Million Working-Age Adults in U.S. " 08/20/08
photo courtesy of Ashley Pollack, used under its Creative Commons license

California Court Rules Care Cannot Be Withheld From Gays

Health care access is a constant issue in modern America. The poor of our country have so little of it due to finances. Many rural residents don't have it simply because there are no health professionals nearby. Then there is an aspect of access I don't believe I have touched upon until now: access for gays.

That sort of discrimination, rooted in this case in religious beliefs of the practitioners, was determined illegal yesterday.

Via The Associated Press:

California's highest court on Monday barred doctors from invoking their religious beliefs as a reason to deny treatment to gays and lesbians, ruling that state law prohibiting sexual orientation discrimination extends to the medical profession.

Justice Joyce Kennard wrote that two Christian fertility doctors who refused to artificially inseminate a lesbian have neither a free speech right nor a religious exemption from the state's law, which "imposes on business establishments certain antidiscrimination obligations."

There are more than enough hurdles to be leaped over when navigating the American health care system as it currently stands. Adding discrimination to that array is something that the California court and I agree on. It should not be done. Since the business of health care is huge, as evinced by statistics shared in prior posts here and numerous reports elsewhere, it should be held to the same antidiscrimination practices as other businesses that cater to the general public.
It also seems that I am not alone in thinking that this is a decision that could well have far reaching implications on the national level as well:

Jennifer Pizer, [Guadalupe] Benitez's [the plaintiff's] attorney, said that the ruling was "a victory for public health" and that she expected it to have nationwide influence.

"It was clear and emphatic that discrimination has no place in doctors' offices," Pizer said.

The ruling was unanimous and a succinct 18 pages, a contrast to the state Supreme Court's 4-3 schism in May legalizing marriage between same-sex couples.

It is good to see that while the debates rage on about other issues impacting the gay community, the line has been drawn on the fundamental right to health care. Despite, as one might imagine, a wide variety of groups supporting the Christian doctors, an even wider array of groups stepped up to the plate in favor of an end to these practices.

While The American Civil Rights Union, The Islamic Medical Association of North America, the Christian Medical & Dental Associations and a variety of anti-abortion groups fought against it support from across the spectrum was forthcoming from an even wider array of groups.

The California Medical Association reversed its early support of the Christian doctors after receiving a barrage of criticism from gay rights activists, joining health care provider Kaiser Foundation Health Plan to oppose the Christian doctors.

The American Civil Liberties Union, California Attorney General Jerry Brown, the National Health Law Program and the Gay and Lesbian Medical Association filed papers backing Benitez.

All in all, it was a good day in court, one which takes us a small step closer to universal health care, and access thereof.

SOURCE: "Calif top court: Docs can't withhold care to gays" 08/18/08
photo courtesy of Made Underground, used under its Creative Commons license

Cost of Care: The Long Term

Medicine costs. Hospital equipment costs. Staffing for health care providers costs. Emergency services cost. To make matters worse, these costs are consistently rising, and not slowly.

This is one of the pillars of the health care crisis facing our nation, the cost of care. It is frequently noted in headlines and blog posts, often focusing on a patient who either in unable to pay for needed care or in studies that project its steady and unrelenting increase in the future.

One aspect of the cost issue that is not as often touched upon is how these cost factors will impact late life long-term care. Prudential Financial's newly issued "2008 Long-Term Care Cost of Care" research report aims a microscope at these issues and provides some useful and startling tools as well.

Via Market Watch:

Prudential's Cost of Care study sheds light on the State-specific average costs associated with nursing homes, assisted living facilities, and home health care services. The study results show the average assisted living costs and average nursing home costs in Alaska as the most expensive in the country at $82,956 per year and $183,595 per year respectively. Detroit ranked the highest for home health care hourly rate at $38.

The fact is, without proper planning, the annual cost of long-term care can quickly deplete even a sizable nest egg. "While no one wants to think about 'that time' when they may need care in an assisted living facility, a nursing home, or at home care, it's essential that consumers consider the costs now and implement a financial plan to help ensure they receive the quality of care they desire," added [Andy] Mako [Senior Vice President, Long-Term Care Insurance, Prudential].

I'm glad I don't live in Alaska. I doubt I'll come close to a six-figure income in my own lifetime, let alone be able to pay that in my retirement. As with most health care oriented figures, these are sobering to consider. Of course, Prudential does lend a hand with coming to grips with the problem in an informed fashion. They have a new cost of care mapping tool online which allows those interested to drill down and get state by state cost info, in some cases involving larger urban areas. It even gives city by city data.

Check it out. The numbers will probably startle you.

SOURCE: "Prudential Study Sheds Light on the Increasing Costs of Long-Term Care- Interactive web-based tool allows consumers to view city and state specific cost data" 08/18/08
photo courtesy of EggyBird, used under its Creative Commons license

Electronic Medical Records: An Open Source Option

Electronic medical records are commonly acknowledged as something that can slice a huge percentage of current health care costs right off the top. The big issue is getting them deployed and implemented. For many smaller practices, and some larger ones as well, the price of getting an EMR system set up and all of the current records entered into it is prohibitive.

Of course, this is the 21st Century and creative options abound. What would happen if we subtracted the cost of the EMR software itself from the equation? After all, look at how many people use Google's Gmail for the small price of having advertisements displayed in the margins. What is something similar could be done with an EMR application?

Dana Blankenhorn over at ZDNet Health Care answers that question as he reviews a new approach to electronic record keeping:

It’s called Practice Fusion, and if you can tolerate some ads on your screen you can use it as a software service free of charge.

Chris Anderson of Wired calls this the "Google Model" having coined the term "Freeconomics" to describe the result.

As always, security is an issue, but this looks like a model that might have legs. If proven secure and successful, this could end up being a quantum leap for adoption of EMR systems. I am curious to see reports on the security of the software as that will certainly be a major factor in how viable it proves to be. In the meantime, I am stunned that I have not seen anyone take this approach before.

In an age increasingly defined by open source, it is a logical stance.

SOURCE: "Psst. Want a free Electronic Medical Records system?" 07/31/08
photo courtesy of magerleagues, used under its Creative Commons license

A Great Experiment

Everybody wants it. Better health care results for less financial outlay, that is. It's so high on most people's lists that it pulls even in their estimation with the Holy Grail of health care: universal care.

This is why an examination of a demo project being run by the Centers for Medicare and Medicaid Services is well in order. While the results so far are neither large in scale nor conclusive, they do show a consistent trend in the desired direction. The approach is a logical one. They are trying to re-leverage the system of incentives used in health care.

The current incentive system is, as stated by George C. Halvorson, "perverse." This project is testing out a different approach, one in which incentives are are earned by hitting a series of quality benchmarks. There are ten group practices involved in the program.

Vi Anna Wilde Matthews of The Wall Street Journal's Health Blog:

The groups scored nearly perfectly on quality measures for diabetes, heart failure and coronary artery disease, with half achieving the targets for all 27 bogeys, and all of the groups meeting at least 25. But only four achieved the CMS efficiency targets and won the extra payments tied to saving the government money and achieving quality standards. See more details by clicking here.

The savings were measured in a typically convoluted way-– the doctor groups got the bonus if the growth of the demonstration participants’ Medicare costs was at least 2% slower than the growth for other beneficiaries in their geographic areas.

John Pilotte, the CMS project director for the pilot, told the Health Blog he felt the savings results were still “very positive,” and better than the first year, when just two groups achieved the goal. Still, he added, “it sort of underscores the challenges and the difficulties in managing care for the Medicare population.”

Nothing is perfect and all things take practice. With the program still in its early phases but already showing measurable improvement, I would say this is one worth watching.

SOURCE: "In Experiment, Doctors Save Medicare Money While Improving Care" 08/15/08
photo courtesy of takomabibelot, used under its Creative Commons license

Texas As An Example?

When ranking states, Texas is next to last in children's access to health care, yet U.S. Sen. John Cornyn (R-Texas) presents it as a shining example for the rest of the nation.

Here's a clipping from the Commonwealth Fund report (emphasis mine):

[...] the 13 states at the bottom quartile of the overall performance ranking—Illinois, New Mexico, New Jersey, Alaska, Oregon, Arkansas, Nevada, Texas, Arizona, Louisiana, Mississippi, Florida, and Oklahoma—lag well behind their peers on multiple indicators across dimensions[...]

Now for a bit of perspective on his health care stance: Cornyn voted against SCHIP, which now covers about half a million Texas children. He also opposed the reinstatement of adequate Medicare reimbursements to providers. Cornyn initially opposed reinstating adequate Medicare reimbursements to doctors, causing the Texas Medical Association to rescind their endorsement of him during a recent re-election bid.

Now according to The Houston Chronicle he has been speaking out about Texas as a shining example. Here's a quote form the Chronicle story:

"So, you have to understand what I mean when I say I want to make Washington, D.C., and the rest of our country more like Texas (because), frankly, we know the policies that actually work." [-U.S. Sen. John Cornyn]

As the debate continues and we see more instances like this, it would behoove us all to beware of political spin from either side and focus on the facts. The Commonwealth Fund has been doing a magnificent job of providing hard data at a time when it is so desperately needed. Thanks, guys!

SOURCE: "Out of touch Senator's depiction of Texas' health care system as a national role model departs from reality" 08/14/08
SOURCE: "U.S. Variations in Child Health System Performance: A State Scorecard" 05/25/08
photo courtesy of little black spot on the sun today, used under its Creative Commons license

Deval Patrick: Massachusetts Health Care Law Signed

A few days ago, Massachusetts Governor Deval Patrick signed into law one of the nation's strictest limits on gifts given to medical professionals by drug salespeople. Applauded by some and excoriated by others, the law attempts to curtail the influence of marketing in health care.

Hitting another health care issue near and dear to our hearts here at Health Care Reform Now!, it also supplies $25 million to promote the transition to electronic medical records. Other sections of the law give regulators the power to hold hearings over rises in health insurance premiums and also require the state university to increase the size of its classes in order to produce more primary care doctors.

Despite having more doctors per capita than anywhere else in the country, Massachusetts is still facing a shortage -- one predicted to worsen as more people gain insurance and enter the health care equation. This is a critical aspect of the big picture since primary care doctors are the ones who make the initial care decisions.

Still, with all the variety of measures embraced, the one which is causing the most stir is the limit on corporate gift giving. The pharmaceutical industry's trade group Pharma has stated that lawmakers could regret their efforts, citing the fact that it would create a chilling effect on researchers if their research grants were posted on a public listing of industry gifts.

Via Scott Allen at The Boston Globe:

[Sen. Mark] Montigny [New Bedford Democrat] had hoped that, after failing twice, he might succeed in banning gift-giving between salespeople and healthcare professionals altogether. However, representatives of the drug and medical device industry successfully argued that the measure went too far, potentially banning money paid to doctors and hospitals to conduct medical research. Though the Senate passed the full ban, the House backed only restrictions.

Still, the limits in the law put Massachusetts at the forefront of states in cracking down on the use of financial incentives to persuade doctors to prescribe particular drugs or medical devices. In addition to banning some gifts and requiring disclosure of others, it calls for the state to develop a code of conduct for industry representatives that includes a $5,000 fine for each violation.

The great experiment of Massachusetts continues!

SOURCE: "Leaders nip, tuck healthcare policy - Limits enacted on drug firm gifts" 08/11/08
photo courtesy of limako used under its Creative Commons license

What's Wrong With US Health Care: Jane's Story

Karen Hover is a doctor in Maine. As such, she is in a prime position to note the shortfalls, mistakes, and outright failures of the American health care system. On Monday, she wrote a guest OpEd column for The Bangor Daily News in which she puts a face on these wide and dangerous gaps in the way we take care of our sick.

In it, she relays the story of "Jane" (not her real name), an administrative assistant who suffered an accident that broke both her elbows after falling off a roof. As you might imagine, the splints used to immobilize the fractures stretched from fingers to armpits. She rapidly discovered that the splints kept her from being able to do, well, anything.

"I couldn’t scratch my nose, or feed myself, or get a glass of water, or pull my pants down." She needed around the clock care. Jane called her insurance company, which told her that her plan included 100 days of skilled care.

Arrangements were made to go to a rehabilitation facility on Friday, which was good because Jane’s friend had to go back to work. When Jane arrived, around noon, administrators told her that the insurance company had denied her claim and that she could not be admitted because she had no need for skilled medical care. After a couple of hours on the telephone, no one had a better idea, so she was sent back to the emergency room. By this time, she needed to go to the toilet, but staff refused to take her because of fear of liability. Her ex-husband helped her.

Can you imagine? Not the runaround -- that is something we have all come to expect (at least those of us who have had to deal with the health care system directly) -- but the treatment. Imagine yourself with both arms in splints, bladder bursting, lots of people around whose job is to help you, and yet no one does. This points up an aspect of the current system I do not often get to touch upon: the fact that often there seems to be no attempt made to help a patient preserve basic dignity.

The emergency room was packed. She was seen by a doctor who asked her if she had cash to pay for a hospital room. He talked to her about going to a local shelter. Jane was hungry, dirty and in pain. "I just need someone to take care of me," she said. A stranger who had been following the story brought Jane supper at 10 p.m. and fed it to her. She was admitted at midnight.

Jane's adventures are far from over though. It took another eight days of refusing her claim before the insurance agency came around and had her transferred to a rehab facility. Sounds like things should have been fine from there on out, doesn't it? Unfortunately not.

She was sent to the same facility that had treated her so badly before and spent three weeks there, enjoying inappropriate food, an accidental injury, an often unclean toilet, miscommunications between staff and her orthopedist, and a banging door that prevented sleep. The splints were removed. Jane went home with a new case of athlete’s foot. She learned to use her arms again and is now back at work. She feels her family and friends were very supportive.

No, this is not a scene from Stephen King's The Kingdom. It is yet another homegrown horror story cultivated right here in the United States. This is why we need to keep health care at the forefront of the Presidential debate, to stop this from happening.

For Jane's sake.

SOURCE: "Karen Hover: How our health care system failed Jane" 08/11/08
photo courtesy of hypertypos, used under its Creative Commons license

Democrats: Health Care For All!

This weekend, the Democrats managed to reach consensus on a platform that "commits the party to guaranteed health care for all." Sen. Obama still adheres to his standing position about not mandating coverage, but finding ways to make it more accessible.

While Sen. Obama still declines to adopt a mandate as part of his strategy, the fact that this plank in the platform has been finalized brings the Democratic Party's overall stance closer to the the approach favored by Sen. Clinton.

Now that the Dems have settled on their stance, I'm sure this will be heating up on the campaign trail. Sen. McCain will now have definite targets for debate, and with the recent scandal over John Edwards' affair keeping his wife Elizabeth out of the ring, the Republicans must be heaving a sigh of relief.

Advisers in both the Clinton and Obama camps seem happy, and activists within the party are mollified enough to have dropped their tougher stance demanding a single payer system.

SOURCE: "Democrats adopt goal of health care guarantee" 08/09/08
photo courtesy of Steve Rhodes, used under its Creative Commons license

This Just In: The Percentages! (Again)

Wow! Here we go with another report. Two of them, even! The mountain of evidence that our health care system is fractured, costly, error prone, and generally not functioning just grew a bit higher. More reports have come to light this week. First, the survey entitled "Public Views on U.S. Health Care System Organization: A Call for New Directions," which questioned 1,004 adults about their views of and experience with the American health care system.

Once again, we find that the issues are so obvious you can almost predict what will be said.

• 9 out of 10 want Presidential reforms to improve the quality of health care, ensure that all Americans have affordable care, and reduce the number of uninsured.
• 8 out of 10 support efforts to improve health care performance, access, quality and cost.
• 1 out of 3 said their doctors performed unnecessary procedures or ordered duplicate tests.
• 47 percent said their health care was poorly coordinated.
• 9 out of 10 consider it important that they have one place or one doctor responsible for their primary care and coordination of all their care.
• 9 out of 10 wanted easier access to their medical records.
• Nearly 3 out of 4 (73%) had trouble getting access to health care providers outside the hours of 9am-5pm, M-F without going to an emergency room.
• 26% of adults with health insurance had trouble getting same or next day appointments with providers when ill.
  
• 39% of adults with health insurance had trouble reaching their provider on the phone when needed.

All in all, 82% of Americans believe that the health care system is broken and in need complete restructuring and/or change on a fundamental level. Hopefully this will make an impact during the run for the White House. The vast majority of Americans want Health Care Reform Now!.

Back To The Mall: Urgent Care Clinics

One of the big trends we keep returning to is the retail health clinic. Located in malls or "big box" stores, they combine low cost, excellent access, and short wait times. These clinics are not what I am going to examine today. Instead I'd like to share an article about urgent care clinics.

What's the difference? Laura Landro of The Wall Street Journal defines it:

[...] urgent-care centers aren't to be confused with the new crop of retail health clinics popping up in drugstores, which are run by nurse practitioners who prescribe medicine for minor illnesses and provide vaccinations. Urgent-care-center physicians and other medical staffers can put casts on broken bones, sew up lacerations, provide intravenous fluids for dehydrated patients, and deploy advanced life-support equipment for both adults and children. They often have equipment not available in physicians' offices, such as X-rays.

So basically, this is a concept that could well step in and take a lot of pressure off of emergency rooms if it becomes widespread enough.

These facilities aim to fill the gap between the growing shortage of primary-care doctors and a shrinking number of already-crowded hospital emergency departments, with no appointment necessary and extended evening and weekend hours. Urgent-care clinics are staffed by physicians, offer wait times as little as a few minutes and charge $60 to $200 depending on the procedure -- a fraction of the typical $1,000-plus emergency department visit. Some offer discounts and payment plans for the uninsured; for those with coverage, co-payments vary by insurance plan but may be less than half the amount of an ER visit, which can range from $50 to $200.

The last time I went to the emergency room it cost me five thousand dollars, and all I got was a nine hour wait, some painkillers after hour four, and the useful information that "they're kidney stones and you'll just have to wait it out." This sort of personal experience, one which is incredibly common in modern America, predisposes one to look kindly on this newer breed of medical care.

Of course there are also issues and drawbacks, as there are with everything. The lack of standards or a system of accreditation are cause for concern amongst many. In an effort to address this and preclude formal regulation, the Urgent Care Association of America has struck an agreement with the Joint Commission (the non-profit responsible for accrediting hospitals and health-care organizations) to take over accreditation and publish national quality standards by 2010.

Lee Resnick, President of the Urgent Care Association and Director of University Hospitals Urgent Care, says urgent care clinics diagnose serious health issues like cancer for patients who come in for something that seems more trivial. Simple symptoms may bring in patients who the doctors recognize as having heart attacks or strokes. The short wait time allows these illnesses to be revealed in time to get patients into an ambulance and on their way to an ER, where admissions can be fast-tracked due to the initial diagnosis.

Go check out Ms. Landro's article. It has a whole lot more analysis.

SOURCE: "Options Expand For Avoiding Crowded ERs" 08/06/08
photo courtesy of Charlie Bosmore, used under its Creative Commons license

Dateline Illinois: New Bipartisan Legislation

Senator Dick Durbin has allied himself with a variety of business and labor groups to co-author legislation to provide more affordable health care options for small businesses.

Via All American Patriots:

The bi-partisan legislation was introduced in partnership with Senators Olympia Snowe (R-Maine), Blanche Lincoln (D-Ark.) and Norm Coleman (R-Minn.). Nationwide, there are 47.1 million employees in 5.8 million small businesses and 14.1 million self-employed individuals.

The Small Business Health Options Program (SHOP) addresses the number one problem for many small businesses and the self-employed -- the high cost of providing health care for their employees -- by:

* Allowing small businesses to band together and spread the risk over a large number of participants in order to obtain lower premiums.
* Providing tax credits for small business owners to offset contributions to employee premiums.
* Banning health status rating in order to protect businesses from large rate increases simply because one employee gets sick.

Developed to help combat annual premium jumps that usually rank in the double digits, this bill is receiving praise from a number of concerned parties. From Charles McMillan, the President-Elect of the National Association of Realtors to Todd Stottlemyer, President and CEO of the NFIB, supporters are sanguine about the effects this will have for both independent contractors and employees of small businesses. The extreme nature of this burden is illustrated by McMillan's comment that for the average realtor, "the total cost of health insurance can rival or even exceed their monthly mortgage."

As an independent contractor myself, I understand the fears and the costs involved. I am consistently grateful for the fact that I have health insurance, which I only have because of my lovely wife's health care plan from her job. Even insured I often become the statistic as I put off health care that is not urgent due to the rising costs.

I can assure you that this is one piece of legislation I will be keeping a careful eye on.

SOURCE: "Senator Durbin Introduces Bipartisan Legislation to Provide Affordable Health Insurance Plan for Small Businesses" 08/05/08
photo courtesy of Larsz, used under its Creative Commons license

Fed Up Consumers Vote With Their Actions

High costs. Long lines. Horror stories about quality issues and errors in care. These are the things that come most easily to mind for the average American when the topic of health care comes up.

The last time I had to wait in the emergency room, I was there for 9 hours before I even got any pain killers. Since I was there due to an attack of kidney stones you may imagine how displeased I was. For those lucky enough not to have had experience with these vicious little mineral deposits, they are painful enough to leave you doubled over in agony unable to function. One friend of mine who has both given birth to twins and had kidney stones tells me the stones were more painful. Based on my experience, I can believe it.

The bill was extraordinary and even with insurance I am still paying it off four years later.

This makes it hardly surprising that two topics I have written about here on the Health Care Reform Now! blog are rearing their heads again as many Americans embrace them attempting to avoiding our own system's well documented pitfalls. I speak of medical tourism and the growing number of retail health clinics opening up in big box stores like Walgreens and Wal-Mart across the country.

Via Linda Johnson at SFGate:

The number of people heading abroad for "medical tourism" could jump tenfold in the next decade, to nearly 16 million Americans a year seeking cheaper knee and hip replacements, nose jobs, prostate and shoulder surgery, and even heart bypasses, according to a forecast by health care consultants at the Deloitte Center for Health Solutions.

Meanwhile, the number of retail clinics operating in pharmacies, big-box and discount stores and supermarkets has jumped from about 200 in 2006 to nearly 1,000 last month, according to a second report from the Deloitte center.

[...] The two reports show potential big savings for U.S. consumers - and probably their health insurers - would come at the cost of American hospitals and doctors losing billions of dollars a year in revenue.

"Significant numbers of people are willing to vote with their feet to try something different, whether it's retail clinics or medical tourism," said Paul Keckley, the center's executive director. "U.S. providers are having to pay attention."

Ms. Johnson focused her article more on the medical tourism aspects, examining the benefits, drawbacks, and some very interesting arrangements made with American hospitals for pre- and post-procedure care. Even so, she does cover the rise of medical clinics like the one in my local Walgreeens that are rapidly assuming an important place in the health care landscape.

SOURCE: "Americans look abroad to save on health care - Medical tourism could jump tenfold in next decade" 08/03/08
photo courtesy of eowin, used under its Creative Commons license

Write a Prescription For A Platform

Once again we return to the political side of health care, a side that will be instrumental in shaping its future one way or the other. Right now there is news of interest from the Democratic Party. They have come together to hammer out the details of the official party platform on health care.

Mark Silva at The Chicago Tribune's political blog, The Swamp, brings us the current incarnation of the wording:

The committee charged with crafting a platform for the Democrats agreed today in Cleveland to call health care "a shared responsibility between employers, workers, insurers, providers and government. All Americans should have coverage they can afford."

He also details a low-key tug of war between Obama's people and the Clinton camp concerning the proposed wording, with the Clinton side pulling for stronger language supporting shared responsibility among other things.

The wording agreed upon today is merely a draft, pending approval Saturday when it is presented to the full platform committee in Pittsburgh, PA. The final proposal will be presented to the Democratic convention on August 25 in Denver, CO. I wonder how many permutations it will go through?

SOURCE: "Health care: Democrats start writing Rx: Fulfilling the promise of 'universal health care,' that's the question." 08/03/08
photo courtesy of macwagen, used under its Creative Commons license

The Swiss Approach

One of the things George C. Halvorson stresses in Health Care Reform Now! is that we should look at the systems in place around the world that provide universal care. Not with the idea of adopting a foreign system outright, but rather in order to see what elements we might be able to adopt in order to create a truly American system responsive to our particular needs as a nation. That element of his approach came to mind for me early this morning while listening to NPR with my wife this morning over coffee.

This morning, they aired a program which delved into the way the Swiss system works, and it seems to me that there are a lot of things to consider in their way of administering health care.

Via NPR:

At first glance, Switzerland's health care system looks like it could be the perfect political compromise for the United States.

As Republicans would prefer, individuals — not employers or the government — choose from a broad array of health plans, sold by private insurance companies.

And as Democrats urge, everyone in Switzerland has health coverage (it's required by law), with the government providing generous subsidies for those who couldn't otherwise afford it.

NPR goes beyond that first glance and delves into the system in detail. One of their findings is important but hardly shocking: rising costs are a major issue. While Switzerland's 7.5 million people are very happy with the system as it stands they are not immune to the rising costs that are such an important issue during our own health care debate.

There are many things about their system that are appealing, and the public satisfaction level is unparalleled in the United States. One of the ways in which the Swiss operate (pardon the pun) is that insurers are not permitted to make a profit on basic health plans.

Where Swiss health insurers can and do make profits, however, is on supplemental coverage. This is for things like dentistry, alternative medicine (which is popular in Switzerland), and semiprivate or private hospital rooms. For 30 francs per month, Cecile and her husband have a supplementary policy that covers, "for example, all kinds of prevention, not-on-the-list medication, help at home, glasses, transport, alternative medicine. That's a good one," she says.

Jue Rovner's article for NPR is well worth the read. She speaks with a family that has lived both here in the US and in Switerland and are able to make direct comparisons between the two systems. One thing I found really interesting was the difference in mindset she reveals between the way the Swiss and Americans view the idea of social safety nets such as universal care. Cecile Crettol-Rappaz, one of the women interviewed, states it pretty succinctly:

"You are so used to having this individualistic way of thinking, and that's why you don't have these social [safety] nets. You still have this pioneer mentality where everyone has to take care of themselves."

All in all this is great source material for the debate. I wonder how much attention it will get over the next four months or so.

SOURCE: "In Switzerland, A Health Care Model For America?" 07/31/08
photo courtesy of Fr Antunes, used under its Creative Commons license