by Scott McIntyre on Thursday, March 11, 2010
Leave a CommentTodd Linden, CEO at Grinnell Regional Medical Center, did a nice job this week on his blog talking about “health care” versus “sick care”:
The health care system in this country has really been more of a “sick care” system. Too much emphasis has been on mending bodies after health has left them. We have shielded folks from the true cost of health care through the proliferation and misuse of health insurance. The personal responsibility for maintaining optimal health has not been incented in the system. Although a growing number of Americans are health conscious, it is hard to deny the obvious epidemic of poor health.
The “sick care” issue is at the foundation of health care reform. It is one of the reasons health care and health insurance costs have risen. We live in a very healthy society and most of us take it for granted, even though it was only 70 or 80 years ago that thousands of Americans were killed by accidents and diseases that scarcely exist today. Advances in medicine, safety and nutrition keep people out of the hospital. And when they go to the hospital, advances in treatment – like minimally invasive surgery – mean procedures are safer, recovery is faster and the likelihood of complications is greatly reduced.
Our good health also comes with our good insurance coverage. Since World War II, we have been a well-covered society. On the up side, this has given broad access to the health care system and increased both the quantity and quality of life. On the down side, as Todd notes, it has shielded health care users from the real cost of care and incented providers to offer more but not always better care.
People don’t like going to the hospital and today they almost never have to. But when they do go unexpectedly, it can be quite serious and very expensive. For those with insurance, there is little incentive to prevent these occasions – the relatively low out-of-pocket cost and the fact that even very sick people are healed is what most of us see and remember. For those without insurance, the result is often even more serious illness as they delay treatment.
Certainly, we need to make sure as many people as possible are insured. But how our society “uses” health care must also change and hospitals are helping make that happen with a focus on prevention and wellness. This has been going at Grinnell Regional Medical Center in many ways and for several years, as Todd mentions. In fact, every Iowa hospital provides services and programs that support prevention and advance wellness. But hospitals are doing more than putting out the water and waiting for the horses to come around. They are actively working to change our health care culture, to change our society’s mindset and put a focus on wellness.
But cultural shifts don’t happen overnight. It will take all of us, as health care consumers and providers, to create a true “health care” system.
by Dan Royer on Wednesday, March 3, 2010
President Barack Obama held a press conference Wednesday outlining his plans on health care reform that has stalled in Congress. As was predicted, the president asked Congress to schedule a final “up-or-down” vote on health care reform legislation and took it a step further by adding his endorsement of using the budget reconciliation process to finish the process.
“I believe the United States Congress owes the American people a final vote on health care reform,” Obama said. He continued by mentioning a myriad of other bills that were passed with a simple majority rather than the currently required “super-majority” of 60 votes needed in the Senate to pass legislation.
The Democrats held onto a 60 vote majority until the election of Republican Scott Brown in Massachusetts.
Republican lawmakers insist that using the reconciliation procedure would cause outrage in the public and further the intense partisan gridlock facing the Congress. Regardless, Obama requested that Congress take action in the next few weeks. The president also highlighted the Republican ideas that he has agreed to include in his proposal and again told Republicans that starting over is not an option.
IHA will continue to monitor the process along with the new budget numbers and coverage estimates that result from the president’s new proposal.
by Scott McIntyre on Thursday, February 25, 2010
Click on this photo to see it and other images from Legislative Day.
IHA hosted another very successful Legislative Day yesterday in Des Moines, with more than 600 hospital advocates filling the Polk County Convention Complex and then streaming to the Capitol to meet with legislators.
The group heard an outstanding speaker, Iowa State University Political Science Professor Steffen Schmidt, known as “Dr. Politics,” who reminded advocates that they should not let cynicism about the political process ruin their morally powerful effort to improve the state and national health care system.
IHA President and CEO Kirk Norris captured the spirit of “e pluribus unum” – from many, one – in his message of strength through unity.
And as he briefed advocates on the issues of the day, IHA Senior Vice President Greg Boattenhamer showed how Iowa hospitals have stepped up to the plate to help the state overcome its budget difficulties through a provider assessment plan that would pump $65 million into Medicaid.
Legislative Day is hugely important for Iowa hospitals as it connects advocates one-to-one with their legislators and reminds legislators of the broad-based support Iowa hospitals have in their communities and throughout the state.
By participating in Legislative Day, these advocates tell the “hospital story,” inform their legislators and show them that hospitals deserve the same support at the Statehouse as they receive in their communities.
by Scott McIntyre on Monday, February 22, 2010
The editorial page of the Boston Globe provides a brief item on the importance of evidence-based medicine with regard to reducing costs and improving health care. The editorial points to two examples: A 2007 study that showed that drugs work just as well as stents in treating chest pain and a 2002 study that showed generic drugs work just as well as name brands.
The central point of the editorial is that neither of these cost-saving approaches has been as widely adopted as one might expect. Why? Because the insurance companies – both public and private – have provided few, if any, incentives to adopt them.
This is yet another illustration of how health care spending is being driven by something other than value. Instead, it is driven by a system that rewards quantity – a physician who does more testing and procedures will be paid, even if those tests were not the best or possibly even unnecessary.
The Globe emphasizes evidence-based best practices and notes that “Medicare should have the authority to weigh both comparative effectiveness and cost in steering doctors to the best practices.” In other words, Effectiveness + Cost = Value.
In Iowa, we are fortunate to have a health care system that, particularly in the community hospital setting, is dominated by a culture of patient-centered primary care. This means care tends to be provided in a coordinated fashion with the primary care physician at its foundation. Patient-centered primary care works when best practices are emphasized. And when that happens, real value in health care is the result.
This is why Medicare would save billions of dollars every year if it demanded, as the Globe editorial suggests, the same value from others that Iowa already provides.
by Scott McIntyre on Tuesday, February 16, 2010
Iowa’s already-struggling mental health care system has taken another hit , as Ellsworth Municipal Hospital (EMH) in Iowa Falls announced that, within the next two months, it would be closing its inpatient behavioral health service and its chemical dependency program.
This was not an easy decision for EMH leaders to make. Only a handful of mental health programs like these exist in Iowa and the services at EMH are heavily used by patients from all over the state. In fact, only 15 percent of the hospital’s inpatient behavioral health patients come from Hardin County. This is no surprise; after all, 83 of Iowa’s 99 counties are considered mental health professional shortage areas. With only about seven practicing psychiatrists for every 100,000 residents, Iowa ranks 47th in the nation for access to mental health care.
In Iowa Falls, EMH has done all it could to keep its inpatient program functioning. The hospital streamlined the program, reduced staff and discontinued its transportation program. But because of lagging reimbursement, particularly from Medicare and Medicaid, the program has been a drain on overall hospital finances. This is a problem for all Iowa hospitals offering behavioral health services, but the impact is much greater for small facilities like EMH, which do not have the patient volume to make up for the losses. This is why only a handful of these small hospitals offer any kind of behavioral health program (inpatient or outpatient).
The good news for people in and around centrally located Hardin County is that inpatient behavioral health services in Des Moines and Waterloo are relatively close by. For much of the rest of Iowa, particularly in the western half of the state, the distances are much greater.
What needs to be done? IHA is advocating for programs that would attract more psychiatrists to the state, such as student loan repayment programs. Expanding telemedicine services through high-speed Internet would allow more patients to utilitize online counseling rather than having to travel to urban areas where behavioral health programs and practitioners are concentrated. IHA has been steadfast in pushing to keep the state’s mental health institutes in Cherokee, Clarinda, Independence and Mount Pleasant open – Iowa needs more access to mental health services, not less.
IHA also continuously advocates for increasing Medicare and Medicaid payments to hospitals and doctors. Hospitals lose millions of dollars each year because these programs do not cover the full cost of care.
