Senate Majority Leader Harry Reid (D-NV) has announced the release of the Patient Protection and Affordable Care Act, the Senate’s health care reform bill.  The bill contains combined provisions from the Health, Education, Labor and Pension and Finance committee bills and has been scored by the Congressional Budget Office (CBO).

The CBO report says the bill will expand health insurance coverage to 94 percent of the population and will cost under $1 trillion and reduce the federal deficit by $127 billion over the next 10 years.

The 2,000 page bill includes major changes to the health care system including, health insurance industry reforms, prevention and wellness Initiatives, workforce initiatives and health care transparency proposals.

The bill also includes a government-sponsored public health insurance option.  The Senate bill, however, is vastly different from the House’s public option proposal as the Senate proposes to allow states to opt-out of offering the public plan if the state’s legislature and governor so choose.

For hospitals and doctors, payment rates would be individually negotiated with the Department of Health and Human Services.

Another key provision for hospitals is moving Medicare away from paying for volume but rather paying for value.  IHA has advocates for efficiency measures to be included in Medicare value-based purchasing program, and the Senate bill includes the IHA-supported measures that would also help to reduce geographic variations in Medicare spending by increasing payments for hospitals that provide high-quality care at a low cost and provide incentives for lower performing hospitals to become more efficient.

Overall IHA maintains concerns about the coverage levels and would like to see coverage expanded to at least 96 percent of the population at a minimum that more closely aligns with provisions contained in the House bill.

The Senate is poised to take action on the bill yet this week, and could have a final bill passed shortly after the Thanksgiving recess.

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Throughout the lengthy health care reform debate in Washington, D.C. the battle over regional variations in health care continues.  At issue is an IHA-supported provision in the House bill (H.R. 3962) that directs the Institute of Medicine (IOM) to conduct a study on variations in Medicare spending across the U.S. and reward more providers that use resources more efficiently and incent low-performers to become more efficient.

Providers (especially large academic medical centers) in high-cost areas are opposed to this provision, explaining that because they treat sicker and poorer patients and provide medical education as teaching institutions, their costs are inevitably going to be higher than non-teaching hospitals in non-urban areas.

However, a recent Health Affairs study showed that there is no correlation among patient characteristics including race, socioeconomic status or severity of illness that contribute to such huge regional disparities.  The study concluded that, in fact, the opposite is true.

The study showed that hospitals considered to be more efficient (low-cost, high-quality) providers like the University of California-San Francisco (UCSF), Cleveland Clinic and University of Chicago Medical Center are actually treating more black and low-income patients than the less efficient medical centers like New York University Medical Center (NYU) in Manhattan and Cedars-Sinai in Los Angeles.  The study noted that only 4 percent of NYU’s patients and 9 percent of Cedars-Sinai’s patients are African American, compared to 69 percent for the University of Chicago and 28 percent for the Cleveland Clinic.

Removing race from the equation and focusing solely on poverty yields similar results.  The study found “there is no relationship between the number of days patients spend in the hospital and the proportion of patients who are poor” as shown in the chart below.

So what causes these huge regional variations in health care?  The study indicates that the length of time patients with similar characteristics and ailments spend in the hospital could be oen major driver of increased cost.  Looking at two similar academic medical centers, the study concluded that, “In Philadelphia, Hahnemann University Hospital used about 40 percent more days for treating blacks than the University of Pennsylvania. (Patients at Penn still spend more days in the hospitals than comparable patients at more efficient medical centers such as the University of Chicago, UCSF, or the Cleveland Clinic.)”

These findings certainly counter the providers that continue to rely on their patient mix and demographics to support their inefficiencies and overutilization.  The report also highlights a recent study published in the New England Journal of Medicine that also found that poverty and race had virtually no impact on increases in utilization or cost.

Hospitals in Iowa provide some of the highest quality of care in the nation at some of the lowest costs.  However, Medicare reimburses Iowa hospitals at a much lower rate than other less efficient hospitals that simply cannot continue to justify their waste.

Rewarding efficiency based on true value (high quality, low cost) should remain a top-priority during the remaining debate on health care reform, and once and for all put an end to overpaying for waste and inefficiency in health care, but rather put the resources to a better use and reward those providers that have the best outcomes at the lowest cost.

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William Galbraith
Physician
Mercy Medical Center-Cedar Rapids

William B. Galbraith, M.D., personifies the truest definition of a “Hospital Hero.”  For years, he has reached out to those in need.  His selfless commitment to his practice and the community is remarkable and genuine, a reflection of his true character.

His professional knowledge, skill and expertise as a medical practitioner are impeccable. Dr. Galbraith directed the University of Iowa Medical Outpatient Clinic for four years and practiced internal medicine for more than 30 years in Cedar Rapids. He was a consultant internist before subspecialty internal medicine became the rule. He was president of the Linn County Medical Society, the medical staff of Mercy Medical Center and a Director/Emeritus Director of the American Board of Internal Medicine. His efforts established the Crawford Diabetes Education Center at Mercy in 1986 and he served on its board.  Upon retirement from private practice, he returned to the university as a Professor of Clinical Internal Medicine before retiring again in 1998.

But Dr. Galbraith truly shines in his tireless advocacy for those with the most urgent need for health care: the working poor.  His leadership helped establish the Community Health Free Clinic in 2001. Funded entirely through charitable donations, this clinic has become a major medical facility in its own right, tending to the medical needs of the uninsured and under-served of east-central Iowa.

But the clinic would not be where it is today without Dr. Galbraith’s perseverance. Thanks to his acumen in organizing, fund-raising and problem-solving, the Community Health Free Clinic is still able to charge no fees for its services.

Clinic co-founder Darlene Schmidt characterizes Dr. Galbraith as a “one of a kind” gentleman, consensus builder, visionary, listener and patient advocate.  Colleagues praise him as a healer and mentor whose moral and ethical standards are above reproach.

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Featuring hospital and health care headlines from the media and Web from November 6-November 13.

Support ’em with makeovers
Jane Klingson, a volunteer cosmetologist at the Trinity Regional Medical Center Cancer Center, sees her work with the Look Good … Feel Better program as more than a chance to make a difference.  It’s helping cancer survivors or women fighting cancer get back what they might have lost to the disease.  November 9, Fort Dodge Messenger)

Iowa State engineers develop 3-D software to give a view inside the body
James Oliver picked up an Xbox game controller, looked up to a video screen and used the device’s buttons and joystick to fly through a patient’s chest cavity for an up-close look at the bottom of the heart.  And there was a sight doctors had never seen before: an accurate, 3-D view inside a patient’s body accessible with a personal computer.  (November 11, Genetic Engineering & Biotechnology News)

Unity receives grant money to help flood victims
Help is available for Muscatine County residents still feeling overwhelmed by the 2008 flood or other natural disasters.  Unity Healthcare New Horizons recently received a $19,360 grant to help prevent substance abuse in connection with natural disasters and to treat flood survivors who are struggling with substance abuse or other issues. (November 7, Muscatine Journal)

Local medical team returns from Kenya
Michele Burnes, a physician’s assistant at the Urbana Family Medical Clinic and at Virginia Gay Hospital, and Sharon Dieter, a nurse at Virginia Gay Hospital, recently returned from Kenya, where they were part of an eastern Iowa team working at a medical clinic founded by Spanda, Inc., a non-profit organization founded by Cedar Rapids optometrist DeAnn Fitzgerald.  (November 11, Cedar Valley Daily Times) 

McDonald house, Miller provide needed support
Brenda Miller’s job goes beyond fund-raising and administrative work. As executive director for the Ronald McDonald House, she often lends an ear to family members who need to talk or celebrate a milestone in their child’s life. She also works with a 26-member board of directors and manages a staff of four people.  (November 11, Des Moines Register) 

Construction begins on new VA Clinic
It’s official – and being Veterans Day, the time and place were only fitting. On behalf of the U.S. Dept. of Veterans Affairs, members of the VA Central Iowa Health Care System formally announced the future opening of its third Community Based Outpatient Clinic Wednesday at the former Econo Foods building in Marshalltown.  (November 12, Marshalltown Times Republican)

State workers debate merits of givebacks
Unions in Iowa so rarely give up the hard-fought provisions locked into their contracts that some state employees are warning fellow workers not to do it now – even if it means 479 of them will be laid off.  (November 12, Des Moines Register) 

U.S.  Headlines

Making health care better
The crisis behind the health care debate is about one thing above all: the scattershot nature of American medicine. The fee-for-service payment system – combined with our own instincts as patients – encourages ever more testing and treatments. We’re not sure which ones make a difference, but we keep on getting them, and costs keep rising. Could the evidence-based medicine practiced at Intermountain Healthcare could be the cure for American health care?  (November 8, New York Times Magazine)

An interview with Dr. Donald Berwick
Dr. Berwick about the dynamics of the health overhaul debate. He says that most of the focus has been on cutting costs and finding the money to cover the uninsured. But often lost in the legislative tussling is a third, just as important goal: Improving the quality of care.  (November 12, Kaiser Health News) 

U.S. health care sector is a fairly green giant
According to the first estimate of the sector’s carbon footprint, the healthcare industry emits less than its share of the gases that promote global warming, compared to its size in the economy. Hospitals, nursing homes, drug companies and the rest of the sector contributed 8 percent of U.S. emissions. Hospitals are the biggest offenders, a finding that may motivate more of them to audit their energy usage and plant rooftop gardens – as one big Chicago hospital has done.  (November 11, Associated Press) 

Doctors embrace social networking
Doctors around South Florida and the rest of the country are using the social networking tools to bring patients’ families and the general public into operating rooms, sometimes sharing step-by-step medical procedures. They favor the real-time updates and videos as a way to reduce the fear factor of surgeries and educate people about the realities of certain procedures, especially new ones.  (November 11, Miami Herald)

The medical industry grumbles, but it stands to gain
The business world found plenty to complain about as it assessed the House bill that would make sweeping changes in the healthcare system and extend insurance coverage to millions more Americans. Insurers do not like the provision to create a new government-run insurance program. Drug makers oppose billions of dollars in rebates they would have to give to the government over 10 years. Medical devices are not happy about the proposed 2.5 percent tax on their products.  (November 8, New York Times) 

Current ‘death panel’ uproar echoes decades-old controversy
It was early summer. A senior federal health official wrote a memo suggesting that living wills – documents that can convey patients’ wishes about when to end life support – could help curb health-care costs. The memo leaked to the media. By August, a New York Times’ column said the official ‘likes euthanasia.’ Sound like this year’s angry August? Well, this story unfolded in 1977.  (November 10, Kaiser Health News) 

Dutch view of choice in U.S. care: it’s limited
The health system in the United States may be twice as expensive as those in Europe, and the population may be less healthy, but at least Americans have access to many more choices of doctors and insurers. Right?  No, says Ab Klink, the Dutch health minister.  (November 9, New York Times)

 

Iowa Headlines

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Genesis Health System, the Genesis Health Services Foundation, Clinton VNA Foundation and the Scott County Public Health Department are coordinating an ambitious plan to vaccinate as many as 8,000 children in the region against seasonal influenza. 

Through the generous support of business partners, area professional sports teams, charity groups and individuals, nearly $210,000 has been raised to pay for the vaccine for Flu-Free Quad Cities. 

This is the third year for the rapidly expanding program. Last year, more than 3,000 school children in Davenport, Clinton, Moline and East Moline took advantage of free flu protection. 

The program will be expanded to as many children as possible in 79 schools this fall.  The vaccinations will again be provided free to children who voluntarily participate in Flu-Free Quad Cities.  Parents need only to return a consent form.

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