Tuesday
Feb032009
The High Cost of Doing Nothing
Tuesday, February 3, 2009 at 6:58PM
Coffee Brown, MD, University of New Mexico, for Talk Radio News Service
For each increase of one percent in the unemployment rate, the number of medically uninsured goes up by approximately 1 million, according to Professor Jeanne Lambrew, Deputy Director of the new White House Office of Health Care Reform. Unemployment and medical debt in turn, increases foreclosures, she stated while addressing the National Health Policy Conference in Washington D.C., speaking at the National Health Policy Conference.
The coming spike in the uninsured will trigger a provision in the recovery act to subsidize 65 percent of cobra payments. When workers lose their jobs, they usually lose their insurance as well. By law, they can continue their former plan for six months by paying the entire premium plus two percent. This is about 80 percent of typical unemployment benefits, rendering it unaffordable for most. It may be wise to offer medicare as a less expensive, longer-lasting alternative, Lambrew said.
She also expressed concern over medical error rates that are higher in America than in peer nations. Health reform is needed to address these problems and the healthcare workforce shortage as well. This in turn will create lasting jobs, and cash flow within communities, she concluded.
Robert Berensen said that there is no longer any significant debate about the need for healthcare reform, now it’s about the form of the healthcare delivery system itself. The effort to reform the system has been gridlocked for 30 years, he said.
Paul Wallace, M.D., spoke for Kaiser Permanente and Glenn Steele, M.D., spoke for the Geisinger Health System. They described private sector innovations aimed at increasing efficiency, such as varying pay structures to improve healthcare benchmarks. The most important of these was getting caregivers to adopt electronic records. This measure speeds flow, reduces redundancy and reduces errors by making sure that the patient’s history is up-to-date at each visit, even when they cannot see their usual provider.
Both physicians emphasized the importance of a patient “care home”, a clinic and staff who know the patient well. This practice, the modern equivalent of the family doctor, is increasingly common as states experiment with ways to reduce costs and increase patient satisfaction. Results reported at several recent conferences have been very positive.
Sen. Max Baucus, D-Mont., at the National Health Policy Conference, said there are several good reasons for healthcare reform right now.
First, he said, the cost of doing nothing has become greater than the cost of doing something. Prices were rising faster than inflation even before the crash, he said. By 2014, half of U.S. households will be spending 45 percent of their total incomes on health insurance premiums.
Second, the current system is failing. Costs are higher and quality markers are lower than for other industrialized nations. Medical errors are killing tens of thousands of us a year, largely due to poor Health IT systems, which are now a major item in the recovery package.
Third, there is an unprecedented degree of bipartisan and even industry support.
Baucus concluded with the statement that the first priority has to be changes that create economic stimulus, and the second needs to be speed, while the momentum is favorable. The problem, he said, is that we also have an economic crisis, two wars, and an oil-dependence crisis competing for the attention of congress and the president.
For each increase of one percent in the unemployment rate, the number of medically uninsured goes up by approximately 1 million, according to Professor Jeanne Lambrew, Deputy Director of the new White House Office of Health Care Reform. Unemployment and medical debt in turn, increases foreclosures, she stated while addressing the National Health Policy Conference in Washington D.C., speaking at the National Health Policy Conference.
The coming spike in the uninsured will trigger a provision in the recovery act to subsidize 65 percent of cobra payments. When workers lose their jobs, they usually lose their insurance as well. By law, they can continue their former plan for six months by paying the entire premium plus two percent. This is about 80 percent of typical unemployment benefits, rendering it unaffordable for most. It may be wise to offer medicare as a less expensive, longer-lasting alternative, Lambrew said.
She also expressed concern over medical error rates that are higher in America than in peer nations. Health reform is needed to address these problems and the healthcare workforce shortage as well. This in turn will create lasting jobs, and cash flow within communities, she concluded.
Robert Berensen said that there is no longer any significant debate about the need for healthcare reform, now it’s about the form of the healthcare delivery system itself. The effort to reform the system has been gridlocked for 30 years, he said.
Paul Wallace, M.D., spoke for Kaiser Permanente and Glenn Steele, M.D., spoke for the Geisinger Health System. They described private sector innovations aimed at increasing efficiency, such as varying pay structures to improve healthcare benchmarks. The most important of these was getting caregivers to adopt electronic records. This measure speeds flow, reduces redundancy and reduces errors by making sure that the patient’s history is up-to-date at each visit, even when they cannot see their usual provider.
Both physicians emphasized the importance of a patient “care home”, a clinic and staff who know the patient well. This practice, the modern equivalent of the family doctor, is increasingly common as states experiment with ways to reduce costs and increase patient satisfaction. Results reported at several recent conferences have been very positive.
Sen. Max Baucus, D-Mont., at the National Health Policy Conference, said there are several good reasons for healthcare reform right now.
First, he said, the cost of doing nothing has become greater than the cost of doing something. Prices were rising faster than inflation even before the crash, he said. By 2014, half of U.S. households will be spending 45 percent of their total incomes on health insurance premiums.
Second, the current system is failing. Costs are higher and quality markers are lower than for other industrialized nations. Medical errors are killing tens of thousands of us a year, largely due to poor Health IT systems, which are now a major item in the recovery package.
Third, there is an unprecedented degree of bipartisan and even industry support.
Baucus concluded with the statement that the first priority has to be changes that create economic stimulus, and the second needs to be speed, while the momentum is favorable. The problem, he said, is that we also have an economic crisis, two wars, and an oil-dependence crisis competing for the attention of congress and the president.
Low-hanging fruit.
Coffee Brown, University of New Mexico, Talk Radio News
The Alliance for Health Reform presented findings of recent pilot studies showing that major improvements in healthcare are possible now, even in advance of new technologies and structures.
Ed Howard, Alliance for Health Reform, said that less than two percent of hospitals have “fully integrated” Health Information Technology (HIT). Even as hospitals invest in hardware, software, and training, the systems won’t work unless everyone uses them, he said. Where HIT is used effectively, he finished, quality and cost control are measurably improved. In other words, HIT does deliver better, faster, less expensive care.
But only when its use is coordinated among providers (often called “Care Teams”), according to Carolyn M. Clancy, MD, Director of the Agency for Healthcare Research and Quality (AHRQ). When the Electronic Medical Record (EMR) merely recreates the chart as an electronic document, “it can actually allow us to make the same mistakes faster.”
She cited the Provnost Study showing that when computers helped to coordinate care among all of the caregivers, using checklists, prompts, and feedback, infected lines in the ICU were reduced nearly to zero.
Jon Rasmussen, Pharm. D., Chief of Clinical Pharmacy Cardiovascular Services, and Susan Kuca, RN, Cardiac Care Coordinator, described Kaiser Permanente’s intricately coordinated care. They said the program had reduced the risk of subsequent fatal heart attack by 88 percent if begun immediately after hospitalization, and by 73 percent even if started much later, such as when a patient with existing heart disease came into the system from elsewhere.
Greg Halvorson, Chairman and CEO of Kaiser Permanente Health Plan, said we are the only industrialized country without universal health care. He said healthcare can and should be both better and more affordable. Halvorson described a RAND study covering 5 million patients over 2 years that found 25 percent of care was wrong or harmful, implying that U.S. savings in healthcare from efficiency alone could be one-half to one trillion dollars.
Diabetics account for 30 percent of Medicaid dollars, yet their carewas rated as “right only eight percent of the time.”
Big deductibles had the opposite of their intended effect by causing beneficiaries to delay care too long, he said.
In the case of chronic care, one percent of patients use 35 percent ofthe dollars, and ten percent use 80 percent of total dollars. “Chronic
care is a team sport,” Halvorson said.
The consensus of the panel was that, even without a single new treatment or device, coordination of ongoing care could save billions
or trillions of dollars, while improving outcomes.