With less than two weeks to strike a deal or face a default on the nation’s $14 trillion debt, Congressional leaders are scrambling to piece together a package of program cuts and revenue options can be accepted by Senate Democrats, the White House and conservative House Republicans.

This week the so-called “Gang of Six” released a new proposal that is gaining traction.  Members include Senators Saxby Chambliss (R-GA), Tom Coburn (R-OK), Kent Conrad (D-ND), Mike Crapo (R-ID), Dick Durbin (D-IL) and Mark Warner (D-VA).

Their plan to seeks to reduce national deficit by nearly $4 trillion over 10 years and proposes billions in cuts from Medicare and Medicaid.  A few of members of the Gang of Six have yet to formally sign off on the framework but President Obama, after reviewing the proposal, added his support saying that proposal is on the right track concerning this issue.

The proposal seeks a two-part process with $500 billion in initial cuts followed by a process for congressional committees to pass a larger deficit reduction measure within 6 months.  Committees would be responsible for finding additional discretionary cuts and $800 – $900 billion in entitlement savings, as well as $1.1 trillion in new revenues.

The plan is unlikely to emerge in the short-term discussion of how to address the debt ceiling by August 2, though it could set up a series of short-term extensions giving Congress time to work on a larger measure.

The proposal comes on the heels of a party-line vote in the House this week on the bill referred to as the “cut, cap, and balance” legislation.  The 234-190 vote was backed by the freshmen “tea-party” caucus, even though it’s been widely reported that the legislation is dead on arrival in the Senate and faces a White House veto.

IHA has issued a series of Action Alerts urging Congress to protect hospital payments under Medicare and Medicaid as negotiations continue:

Prospective Payment System Hospitals – Take Action Here
Critical Access Hospitals – Take Action Here
Rural Prospective Payment or “Tweener” Hospitals – Take Action Here

President Obama, in response to the House Republican budget plan, released his administration’s proposal that seeks to reduce the deficit by $4 trillion over the next decade.

Though the proposal is merely a framework, early analysis shows that of the $4 trillion in sought reductions, at least one quarter of the savings the president is requesting comes from reductions in government health care spending, in particular the Medicare and Medicaid programs.  These programs have come to the forefront of discussions when dealing with the national debt, which is currently more than $14 trillion.

The president’s plan seeks to achieve Medicare and Medicaid savings of $480 billion by 2023 and an additional $1 trillion over the following decade (2023-2033).

The plan would:

• Strengthen the power of the controversial Independent Payment Advisory Board
• Reform the Medicaid program’s Federal-State Partnership
• Make changes to Medicare’s prescription drug program
• Reduce costs by improving patient safety
• Reduce abuse in the Medicare and Medicaid programs

The White House has released more detail here.

The proposal comes in response to the House Republican proposal that would make more fundamental changes to the Medicare program — while the president’s proposal aims to make changes to the program as it exists today.  House Budget Committee Chair Paul Ryan (R-WI) stands by his committee’s proposal and came out yesterday critical of the Obama plan.

On the Ryan plan, the president said, “I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry with a shrinking benefit to pay for rising costs.”

It is unclear at this time which, if any, of the presidents’ or the House Republican proposal will gain enough traction to move forward, but even on first look of the side-by-side comparision of the proposals one can easily see stark differences that will add to the overall difficulty of compromise on these tough issues.

IHA will continue to evaluate the proposals and monitor their progress.

It’s official: Health care reform guru Donald Berwick has been formally announced by President Obama as his nominee to head the Centers for Medicare & Medicaid Services (CMS).  The first sentence of the president’s two-sentence statement about Berwick succinctly addresses why he was chosen: “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost.” 

Bringing real value to government-supported health care will be Dr. Berwick’s foremost challenge.  And with health care reform set to trim billions of dollars from the Medicare program while adding millions of new enrollees to Medicaid, it is a formidable challenge, indeed. 

But Dr. Berwick has two things going for him.  First, he knows what he is talking about.  His work and leadership at the Institute for Healthcare Improvement (IHI), which he cofounded nearly 20 years ago, has led to changes in the way hospitals provide health care that have saved lives, lowered costs and improved quality.  IHI’s current initiative, it’s “Improvement Map,” is perhaps its most ambitious.  

The Improvement Map is an interactive, Web-based tool designed to bring together the best knowledge available on key process improvements that lead to exceptional patient care. It offers clear guidance through the often confusing health care landscape, helping hospitals set change agendas, establish priorities, organize work and optimize resources.  The Improvement Map is also a testament to IHI’s dedication to shared learning, which it established from its beginning through collaboratives, learning networks and mentor hospitals (among these are Mercy Medical Center and St. Luke’s Hospital in Cedar Rapids, University of Iowa Hospitals and Clinics in Iowa City and Buena Vista Regional Medical Center in Storm Lake). 

But leaders succeed only when they energize followers, and that is Dr. Berwick’s other strength.  Throughout the medical world, Dr. Berwick is highly respected not only for his ideas but for his ability to bring key players to the table and keep them there.  Time and again, Dr. Berwick has been described as “a visionary.”  Hospital leaders in Iowa continue to be pleased about his nomination: 

“I was very excited to hear of the nomination of Dr. Don Berwick as the administrator for CMS,” said Jim FitzPatrick, CEO at Mercy Medical Center-North Iowa in Mason City.  “Dr. Berwick has spent his career on a quest for improving quality in the nation’s health care system.  His passion for improving processes for our patients and keeping focus on the ‘big dot’ issues to eliminate defects in care makes him the perfect leader for CMS. 

“Dr. Berwick’s appointment to CMS would be very positive for the health care industry,” said Eric Lothe, administrator at Iowa Lutheran Hospital in Des Moines.  “He has a long history of setting transformational goals for health care quality and then achieving great results.  Dr. Berwick would continue the focused work of IHI to help physicians and hospitals improve quality, reduce errors and eliminate adverse events.” 

The real question is, can Dr. Berwick’s ability to unite diverse interests come through in a U.S. Senate that remains bitterly divided over health care reform?  Can he show that not only can Medicare and Medicaid lead the way in improving care, but they can do it at less cost?  And can he hold his ground should talk of “rationing” and perhaps even “death panels” rear its ugly head? 

Answers should come fairly quickly, as Dr. Berwick’s first stop will be in front of the Senate Finance Committee and its ranking Republican, Iowa’s own Chuck Grassley.

The 2008 presidential campaign introduced mainstream America to the power of social media and online communication in a way it had never experienced before.  People organized events, made donations and contacted supporters like they have always done, but the amplification for their messages that social technology provided enabled them to reach more people more quickly.  As people began realizing how impactful this technology could be when used in the right way, more organizations and political groups began integrating it into their communications strategies.

Social media penetrates politics and the public

This leads us to today, when individuals, groups and companies are using freely available technology to engage loyal supporters and introduce their messages to people who may never have heard them before.  Aside from consumers and private-sector organizations, these users also include members of local, state and federal government.

What was once often only discussed behind closed doors or in whispers between party members is now made available to consume in the public forum.  This new age of transparency and interaction allows people to make opinions and thoughts known before they have the chance to pass through political filters or press secretaries.

Be ready for real-time feedback and responses

A recent example includes several messages sourced from Senator Chuck Grassley (R-IA) illustrating his frustration with President Obama, who was making a stop in Europe last week.  There is nothing new about Senators and politicians having disagreements with the president, but the channel through which Grassley’s views were presented and the public availability of said comments would have been unheard of just a few years earlier.

Grassley posted several messages on his Twitter account, a microblogging social network where users can exchange short messages with friends, addressing his concerns with the president:

“Pres Obama you got nerve while u sightseeing in Paris to tell us ‘time to deliver’ on health care.  We still on skedul/even workinWKEND.”

“Pres Obama while u sightseeing in Paris u said ‘time to delivr on healthcare’ When you are a ‘hammer’ u think evrything is NAIL I’m no NAIL.”

These messages from Senator Grassley were seen by at least 11,000 people who follow the senator’s messages (tweets) directly, while hundreds and perhaps thousands more read them as the media caught wind of the story.  There is nothing inherently wrong with what Grassley posted (and they are still available to see at http://twitter.com/chuckgrassley), but the message and the lesson are that we need to be aware of the tools that surround us and know how best to use them.

People are out there talking; are you ready to listen?

Conversations are taking place all over the world about the topics, issues and concerns of everyone, just as they always have.  The new problem is understanding how those messages can spread and what role we play in addressing or interacting with them.

IHA has taken a strong stance in the realm of social media – this interactive, participatory two-way type of dialogue – by establishing our own grounds online and staking claim to the issues most important to Iowa’s community hospitals.  As the voice of hospitals and health care in Iowa, it is IHA’s responsibility to be represented wherever discussions are happening, be it on Capitol Hill or Facebook.

Apart from the IHA Web site, the blog acts as IHA’s authoritative clearinghouse for contact via social media with the public and beyond.  All of our interactive actions direct back to this home base in an effort to clarify IHA’s mission, vision and values.

As IHA continues along this path into the future of communication and dialogue, it will adapt to change, but the core existence and purpose will remain:  supporting the missions of Iowa’s hospitals.

Looking to learn more about how IHA is engaging individuals and influencers by using these social technologies? Keep reading our blog and see the about page for more details.

What questions do you have? How are you using these techologies to impact your goals?

During his weekly address to the nation on Saturday, President Obama announced that he will seek more than $300 billion in additional cuts from Medicare and Medicaid payments to help finance health care reform.

Two-thirds of the new proposed spending cuts come from hospital payments.  The President proposed $106 billion in ‘savings’ by cutting the Medicare and Medicaid DSH programs by 75 percent.  In addition, the President proposed $110 billion in ‘savings’ by reducing inflationary updates with an annual ‘productivity adjustment,’ the greatest impact on hospitals.

These ‘savings’ are in addition to the President’s FY2010 budget proposal to cut Medicare and Medicaid spending by $309 billion. They are also in addition to the $38 billion in previously announced reform-related cuts, and $41 billion in cuts in the proposed FY 2010 inpatient PPS rule.

IHA will be analyzing the proposal’s specifics and determining as best possible the Iowa impact. IHA will also be coordinating our messages and advocacy strategy with AHA.  Please stay tuned for next action steps on this important issue.