Massive health care reform roundup; fitting current efforts into coalition report framework

As I recently summarized, the The National Coalition on Health Care agreed on the following five principles or goals for a reformed health care system:

Health Care Coverage for All

Cost Management

Improvement of Health Care Quality and Safety

Equitable Financing

Simplified Administration. . .

The Coalition was emphatic that reform must not be piecemeal. But comprehensive government-pushed reform may be unrealistic, perhaps undesirable. The fact is that there are exciting things going on now that are moving us incrementally and piecemeal toward these goals.

Read on for a few I have collected over the last month or so.

Contributing to cost management, coverage for all?

“Next to the Express Checkout, Express Medical Care” (By Michelle Andrews)

[C]linics, called MinuteClinics, are cropping up in Target and Cub Foods stores in the Minneapolis-St. Paul area. Now in 10 stores, the MinuteClinics aim to diagnose and treat about a dozen common ailments - like strep throat, sinus and ear infections and seasonal allergies - in about 15 minutes. They also provide vaccinations and offer screenings for cholesterol and blood pressure problems.

Because waiting times can stretch into hours at doctors’ offices, urgent-care clinics and emergency rooms, the clinics’ slogan, “You’re sick, we’re quick,” has a powerful appeal. . . .

The clinics are staffed by nurse practitioners, who typically have a four-year degree and a two-year master’s degree in nursing. All clinics have a doctor available by phone during business hours. . .

At MinuteClinic, the computer system flags patients who come back repeatedly with the same complaint, so they can be referred to a doctor . . . Read more

The Cincinnati Business Courier had this: “Hubert opts for wellness; Program worth cost, Harrison firm says” (by Andrea Tortora)

[F]or Harrison-based Hubert . . . the $10,000 it’s spending on health screenings, a walking program and personal coaches pays off in other ways.

Hubert’s move into wellness shows the variety of steps companies will take to try to reduce health care costs. And as insurers become more convinced that wellness works, they are creating health plans that make consumers more responsible for their health spending.

These two approaches go hand in hand. Simply shifting cost to employees with higher employee premium contributions, copayments, or higher deductible policies coupled with HSA’s has the possibility of creating a perverse incentive for people to ignore basic preventive health care. Yet it is important for them to be aware of the actual cost of health care so that they can make good decisions — and don’t overuse care. Hence the need for innovative policies to improve preventive care. . .

Hubert offered cholesterol, glucose and blood pressure screenings, and a health risk assessment to its 300 employees. Workers received a personalized report and recommendations. Hubert got a summary that it will use to plan programs for next year. . .

The Hubert 10,000 Step Challenge encourages employees to keep a log of their daily steps. Those who turn in the forms and meet their goals are eligible for prizes. Van Sant said 118 employees purchased $15 pedometers and often compare their daily stats. About 75 regularly turn in their logs. . . Read more

Simply controlling weight through diet and exercise, and screening and treating high cholesterol, high blood pressure, and diabetes can result in huge savings terms of the much higher medical costs that can be incurred in these conditions result in serious complications.

Improvement of Health Care Quality?

Aspen Publishers’ Spencer Benefits Reports: “Adults Received Only About Half Of Recommended Medical Care, With Potential Serious Outcomes,”

The article refers to a RAND study: “Profiling the Quality of Care in Communities: Results from the Community Quality Index Study,” [link to abstract only; full text available for fee] in the May/June 2004 issue of the journal Health Affairs.

The RAND quality indicators are available at “Quality of Care for General Medical Conditions: A Review of the Literature and Quality Indicators”

Boston.com reports: “A prescription for healthcare — Professor: Get industry to compete over quality instead of shifting costs” This is about Harvard professor Michael E. Porter’s “long essay in the June edition of Harvard Business Review, [in which] . . . Porter argues for redefining healthcare competition on the level of specific diseases and treatments, rather than on the level of health plans, networks, or hospital groups.”

Quality and cost?

Two articles on an issue whose time has come — doctors communicating with patients via e-mail.

What’s the issue, you may wonder? Duh - - it’s about money. Insurance companies don’t pay them to do this (perhaps also not to talk to patients on the phone?) It’s about time they did.

Boston.com: “The doctor will e-you now; Insurers to pay physicians to answer questions over Web”

seattlepi.com: “The doctor will e-mail you now; More and more go online to message patients, but there’s a downside” (by Julie Davidow)

Ever heard of a “hospitalist”?

Richmond Times-Dispatch: “Doctors utilizing new form of help; Use of ‘hospitalists’ to oversee a patient’s stay is on the rise in the area” (by Tammie Smith)

The hospitalist movement has taken off in the decade or so since Dr. Robert M. Wachter, a physician and professor of medicine at the University of California at San Francisco, first coined the term. Wachter, credited with starting the hospitalist movement, will be in Richmond tomorrow for a meeting on patient safety, which is expected to attract about 200 health-care professionals from around the state.

“If you are a patient in a hospital and have a whole bunch of things wrong with you, in the old days there was no one to be the ‘orchestra conductor’ to make sure the right things were done in the right sequence,” said Wachter, in a phone interview last week.

“Your regular doctor is so busy in the office all day long. You are being cared for by a rotating band of specialists,” he said.

Hospitalists bring continuity to inpatient medical care, writes Wachter in “Internal Bleeding,” a book about medical errors, which he co-authored with a colleague.

Simplified Administration?

Reuters (via Boston.com) reports: “US pushes digital medical records; Experts believe result would be fewer errors”

Medical records, a last bastion of paper and pen, may be dragged into the electronic age under a new strategy outlined by the US government yesterday.

Health and Human Services Secretary Tommy Thompson said he was starting by appointing a panel of executives to figure out how much it will cost to switch hospitals, pharmacies, and other bits and pieces of the healthcare system to computer-based technology. . .

Healthcare experts agree that going digital will reduce errors that kill up to 98,000 patients a year, will speed many aspects of healthcare, and reduce the paperwork burden.
Handheld computers are seen everywhere from the carrier who delivers packages to stock-checkers in stores, but doctors still scribble out prescriptions and notes in notoriously illegible script.. . .

As a first step, the Center for Medicare and Medicaid Services plans to introduce an Internet-based portal that Medicare beneficiaries can use to see their claims information. Medicare also will press for the use of electronic health records.

To encourage hospitals and clinics to go electronic, the government plans to look at incentives such as regional contracts, grants, and low-interest loans. . .

Last April President Bush said he wanted to ensure that most Americans have electronic health records within 10 years. He has proposed an additional $50 million in his 2005 budget to assist that effort. . .

The discussion has already spawned a small industry of companies that want to offer electronic record systems. . .

The American Medical Association, which represents about 300,000 doctors, welcomed yesterday’s news. Read more

From USA TODAY: “Health care’s paper trail is costly route” (by Julie Schmit)

Based on tech’s impact on other industries, . . . technology could cut health care costs by at least 25% and improve care. . .

It won’t be an easy fix, though. . . Health care is a huge, fragmented industry: 700,000 doctors; 5,700 hospitals. Each piece collects data its own way. Existing systems don’t talk to each other. More common standards are needed. Privacy has been a concern.

The biggest reason, though, is economic. Doctors and hospitals bear the cost of new hardware and software. Their productivity suffers when they change decades-old work processes. But those who pay for care, insurers and employers, get the first financial benefit because of increased efficiency and fewer costly errors.

For many doctors, “the economics don’t work.” . . . A]n internist in Rhode Island, uses computers to process office bills and appointments. He banks online. But [he] still uses paper medical charts for patients. Existing software is too hard to use, he says. Then there’s the cost — “$10,000, $20,000 or more per doctor,” he says. Sure, he’d eventually benefit. But the real financial gain would go to insurers, hospitals and others. “And they’re not paying anything for it.” . .

What a cheap, lame, lazy excuse.

I know how it is with lawyers. We can afford exciting new software, it increases productivity dramatically within a few months max, and we can pocket the savings or share them with clients. But we too often are late adopters because: “we’ve always done it this way;” and we make good money as it is, so the need to enhance productivity is not so obvious.

If doctors have fixed rates negotiated with insurers for procedures, why wouldn’t their overhead savings go 100% into their own pockets? If they end up more productive, they get a more relaxed pace or time for more patients, or both.

I’ve been told the problem is the immediate savings are not so clear. Doctors find it takes at least as long to enter information electronically as to hand scribble prescriptions and notes.

But there is a longer-term benefit to everyone, as with any computerized system — once the data has been entered, its accessibility and portability is dramatically improved. Doctors will benefit when they are able to access information virtually immediately, instead of paying for staff to retrieve paper files and then paging through those files looking for particulars.

Health and Human Services Secretary Tommy Thompson estimates the USA could save $140 billion a year using more tech.. . .

More important, tech could improve care. . . If doctors adopted computer systems that not only replaced paper records but also warned if a drug prescribed to a patient might interact badly with another they’re taking, 2.1 million fewer patients would suffer drug reactions. . .

Maimonides Medical Center . . . no longer uses paper patient charts, having undergone a $42 million tech update over seven years. Doctors and nurses put notes, test orders and prescriptions into PCs linked to databases. No X-rays are lost. Before, one in five were. . .

The article continues with more examples of how private enterprise is moving, independently of government, in this direction:

WellPoint (WLP), the nation’s No. 2 insurer, in January announced $40 million to help 19,000 doctors buy tech products.

Blue Cross Blue Shield of Massachusetts recently put up $50 million to fund a pilot project to electronically connect doctors, hospitals, insurers and patients in one community so records easily follow patients. The aim is to go statewide.

Bridges to Excellence, an employer coalition including General Electric and Ford Motor, formed last year. It’s paying eligible doctors $50 per year per patient to use tech to improve care.

The Leapfrog Group, founded in 2000, surveys hospitals on tech use. The idea: The tech savvy will be more efficient and offer better care, so should get more patients. Leapfrog’s coalition includes 150 employers, including General Motors, GE and Verizon, covering 35 million people. Read more

From the White House website: “Transforming Health Care: The President’s Health Information Technology Plan”

Here’s the remainder of the Bush healthcare agenda from the White House site

This agenda is sharply criticized here: Boston.com: “Bush’s health care scam” (by Robert Kuttner)

President Bush, speaking Tuesday at a Youngstown, Ohio, community health center, promised to help more uninsured Americans obtain affordable health care. But his key proposals are dubious health policy, waste taxpayer dollars, and are unlikely to increase coverage.

This author slams tax credits for purchase of health insurance, association health plans, and health savings accounts. He scores some good points, although some of us who are not strongly in the ABB (anybody but Bush) camp might miss these points due to being turned off by the harsh rhetoric (e.g., These proposals “deserve more attention because they epitomize Bush’s utterly cynical approach to governing,” [not because health care is an important issue]).

Towards health-care coverage for all?

Investors Business Daily had this very interesting story about private employers assisting the uninsured: “A Corporate Strategy For The Uninsured” (by Amy Reeves)

This year some of the country’s largest businesses are banding together to try to widen coverage for their workers, ex-workers and dependents. . .

Some 50 corporate heavyweights, including IBM, General Electric, McDonald’s, General Motors and Textron, have agreed to form a health-insurance buying pool for those who aren’t covered.

The pool targets part-time workers, ex-workers whose COBRA has run out, retirees under age 65, contract workers and younger folks who’ve outgrown their parents’ coverage. The group estimates 4 million people might qualify.

The idea emerged last year from the HR Policy Association, or HRPA, a group of about 200 top companies. . .

The group created a Health Care Policy Roundtable, which first met in November. The roundtable faced a task that had been tried before and hadn’t always worked. But . . . this time was different because high-level execs got involved. . .

The companies decided that by pulling together a huge untapped group of potential customers for the health insurers, they’d be able to bargain the rates down lower than what a lone buyer could get. They’d also be able to pool the risk so high-risk people could afford coverage.

But member firms want something in return from the insurers: transparency. They want information on the quality of specific hospitals and doctors so they know they’re getting the best deal. . . Read more