Miscellaneous Info., Statistics, Etc. - Food for Thought - a Pawn

Hi everyone -

Well another day, more policy reading. I tackled Max Baucus's Call to Action that he wrote back in November 2008. I'm going to talk a little about it today here - but I'm going to reserve my kudos for now. After reading some news posts today - I believe his health care proposal to the President is different from the Call to Action he wrote last year. So, I actually want to read the new plan before committing to it.

He did have some interesting statistics:

46 Million UnInsured Americans - 15% of Population
25 Million UnderInsured Americans
158 Million Americans are Covered by Employer-Offered Plans
U.S. spends 16% of GNP on Health Care - Over Twice as Much Averaged as Any Other
Industrialized Nation
U.S. is 19th in World in Unneccesary Deaths
U.S. is 29th out 37 Nations in Infant Mortality
Adults get Recommended Care only 55% of Time
Children get Reccommended Care only 47% of Time
People get Preventative Care only 41% of Time


At first look, I was pretty impressed. It's obvious he's coming at it from a Finance perspective.
The Call to Action had a lot of the same stuff in it that the House Bill 3200 has in it.

Here are just a few of the similar points:

You can Keep your Doctor if you Like Him/Her
No Pre-Existing Conditions Allowed
Electronic Records Integration
Preventative Services for Free
Subsidies to Individuals and Small Businesses who Need Assistance with Premiums
Expansion of the Medicaid Program and Indian Health Plan
No Waiting Period for Disabled or other Legal Immigrants (children and pregnant women)
Reform for Medicare/Medicaid to Control Fraud and Abuse and Quality vs Quantity HealthCare
Heath Care Exchange with a Public Plan

So a lot of similarities - but:

I did find a few interesting additions - although maybe they are in the House Bill as well - I haven't gotten all the way through the 1000+ pages yet. It's a bit boring after awhile and I needed a distraction.

I can entertain some other talking points.

He has proposed an early buy-in for Medicare for people between 55 and 65. This could work two fold. It could help those people in this age range that don't have affordable options to health care. Plus, it would also help the Medicare fund as these people would be paying premiums. Something to think about.

Plus, his plan also concentrated a great deal on expanding the community health programs. He thinks it would be cheaper to transfer some of the care of the elderly back into the community - ie) funded community medical centers, medical homes, home health programs, etc... as opposed to institutionalizing everyone in nursing facilities. He feels most people would prefer to stay in their homes - and he feels we need to train more health care professionals to care for these people - to give some relief to their families.

And he concentrates a great deal on quality care vs quantity of care. He calls for malpractice reform to get doctor's away from defensive doctoring.

Interesting, while reading his proposal, I found myself a pawn in someone's program - unknowingly so. It seems that some governmental agencies - I believe The Joint Commission and Medicare, in particular - has been experimenting with quality health care measures. It appears that that they have been creating what I'll call, well what they call core measures - which basically are best clinical practices for certain diseases. For example, making sure heart attack patients have aspirin given on arrival to the ER, making sure pneumonia patients have antibiotics started on them within 4 hours of arrival to the ER, making sure patients with CHF have certain tests and medications depending on the outcome of those tests, etc.... Well this is all great stuff - finally someone is making sure we're treating patients according to best clinical practices - practices that have produced better patient outcomes and decreased morbidity. Well that's all fine and dandy- wonderful for patients and the world in general. The only thing I was dumbfounded by was the comment in Baucus's proposal that said Medicare was actually paying hospitals for this. Well no wonder all our yearly bonuses are based on the adherence to these "core measures". Again, it's all good news - it's in the patients' best interest - but I wish at some point, the hospital that I worked for had some transparency on this issue.

So how would you feel if you found out that your yearly bonuses were based on the hospital's reimbursement by the insurance company???? instead of just the mere fact that the facility was on the cutting-edge of health care in best clinical practice???

I guess at first take, I felt a little betrayed for not being told - but in the end, if it's better for the patient, then it's better for us all. And if the new guidelines for payment are going to be based on quality outcomes, it's an interesting concept - and why not be one of the first systems that are using it.

Anyway - more later. Let me know what you'd like to hear about next?

Goodnight.