Announcement from Larry Thompson, Director of the Whatcom Alliance for Health Care Access

A momentous accomplishment for our community that will go a log way to assist in our work to build a safe, efficient and effective Accountable Care Organization for Whatcom County.

"I am pleased to announce that the Center for Medicare Services (CMS) has recommended the Whatcom Alliance for Health Care Access (WAHA) for award of funds under the Care Transitions program (Project Impact). There are conditions on this award which have not yet been shared with us. We are scheduled to review these conditions by phone with CMS on January 17.

This is a multi-year award which carries with it up to $5.7 million to reimburse us for the cost of assisting patients to make safe transitions between care settings.

As you can appreciate, this is one key piece of several funding awards we must secure to fully implement the vision called for in our Phase I ACO work. On the other hand, the scale of the award relative to the current WAHA budget will present us all with stewardship and management challenges.

I would like to take this opportunity to thank our many community partners in this venture without whom this effort is merely a shell. As well, please join me in thanking our staff, especially Elya Moore, whose hard work and inspiration led to this success.

Larry Thompson"

3 Principles that can bring us together for meaningful healthcare reform

The usual discussion about health care reform often resembles a food fight in middle school. Insults pass for argument, and facts get ignored or selectively presented only when they bolster one's opinion. What would it look like if we talked about what we all truly care about. Could we have a different discussion?

When I have discussed this issue with others in my community, there are 3 important principles that seem to ring true with most of us.

First, we need to invest  in "us" and the future we want to build. If we envision America as a successful land of opportunity, it means that we need a healthy workforce, able to compete and healthy students able to learn new skills. Our investment now in an equitable system that allows that to happen is simply a requirement needed to  make it so! This future will not happen by accident, and our failure to act now will doom our next generation to a future much different than we would like for them.

Secondly, we must end waste! It makes no sense to spend money on treatments that do not heal, or on complicated paper work that drives up costs. Fraud must be eliminated. Research on how to improve care must be supported, and the public should see the benefits!

Finally,  we need to end cost shifting, and share the burden fairly. Medical pricing today makes no sense. The cash paying person is charged the most. Hospitals overcharge for some things to pay for what is not covered. Some people get a tax break on insurance and some do not. A healthy society needs every one to be covered, and the cost must be affordable for all, or our society will remain broken and care will remain out of reach for many.

Dr. Donald Berwick Resigns as Head of CMS

Donald Berwick, MD, a tireless advocate for patient safety in health care, has decided to resign his post as administrator of the Centers for Medicare and Medicaid Services (CMS), effective December 2. I am very sorry to see him go.

Dr. Berwick will have served only 17 months in the post. President Obama nominated Dr. Berwick, who was head of the Institute for Healthcare Improvement, for the CMS post in April 2010, a move that was hailed by diverse groups such as the American College of Physicians, the American Academy of Family Physicians, AARP, Walmart, and Consumers Union. Inspite ofthis broad based support, President Obama found that GOP opponents were blocking his Senate confirmation, as part of their all out strategy to stop health care reform. This caused the president to install Dr. Berwick as CMS administrator through a "pocket" appointment while the Senate was in recess, a special appointment that is set to expire by law at the end of 2011. Dr. Berwick was renominated in January 2011, but he still faced implacable opposition from Senate Republicans. His resignation, therefore, comes as no surprise.

According to news reports,  Dr. Berwick told the staff of the Department of Health and Human Services in an email, that he had "bittersweet emotions", and that although their work was challenging and incomplete, that "we are now well on our way to achieving a whole new level of security and quality for healthcare in America."

Amen. I hope so. Thank you, Dr. Berwick, for your leadership.

The Dawn of a New Day - 5 BIG wins in the Health Care reform Act

1. Health insurance companies will not be able to discriminate against you because you have a pre-existing condition.

The problem has been that millions of adults and children have been denied insurance specifically because they have a medical condition. The Kaiser Family Foundation says that 21 percent of people who apply for health insurance on their own get turned down, or charged a higher price or offered a plan that does not cover their pre-existing condition. This will stop!

2. Young adults will be able to keep their parents' insurance until age 26.

The health care reform legislation requires insurance companies to allow dependent children to stay on their parents' insurance policies until age 26. The children can't have jobs that offer insurance, and they must be claimed as dependents on their parents' taxes.

Currently dependents get booted off Mom and Dad's health insurance much earlier than this, depending on the state they live in, sometimes as early as age 19. This will stop!

3. You will be eligible for a subsidy to buy insurance if you make less than $88,000 per year for a family of four.

Starting in 2014, the health care reform bill provides subsidies for people who don't get insurance from their employers and therefore have to buy it on their own. The amount of the subsidy will computed based on your income, whether you're single or have a family, your age, and where you live. For example:

• A 40-year old making $30,000 a year in a medium-cost area of the country will get an $850 subsidy toward buying a policy, which should cost about $3,500, according to a Kaiser Family Foundation subsidy calculator.

• A 40-year-old in the same city who has a family of four and is making $60,000 will get a $4,220 subsidy toward a policy that costs $9,435.

You can estimate your own subsidy by using this Kaiser subsidy calculator.

4. If your employer does not offer insurance, that might change!

Starting in 2014, if your company employs more than 50 people, it will be required to offer you a health plan that covers at least 60 percent of your overall health costs, or the company will be fined $750 per year per full-time worker. That fine could increase to $2,000 if the reconciliation act passes.

5. Health care reform has major benefits for senior citizens!

The AARP reports that health care legislation does important things for seniors:

• It gives people on Medicare new access to free preventive services such as screenings for cancer and diabetes.
  
• It will decrease and then, by 2020 it will close the "doughnut hole," Part-D drug payment gap where Medicare stops paying once a senior has spent more than $2,830 on prescription drugs and resumes when the individual's out-of-pocket spending has reached about $4,550.
• Spending for Medicare beneficiaries is budgeted to increase 2 percent each year.

"We have met the enemy, and he is us!", Pogo

The US House and the Senate have both passed health care reform bills, and it is now up to the Conference Committee to craft a compromise bill that must then be passed by each legislative body. If a bill is ultimately signed into law by President Obama, we are likely to hear years of arguments as to whether or not this bill is a good or bad thing for our nation.

What likely will not be debated, however, is our corrupt and sclerotic political system that has produced these bills. Instead of honest debate, and collaboration about how to solve a problem, we have been treated to our representatives cynically selling their votes for this bill in order to to "buy votes back home" from local voters who continue to fall for this kind of nonsense. Want examples? Here are just a few:

Senator Ben Nelson, D-Neb., has insisted that the federal government promise to pick up the full cost of Medicaid expansion in his state, costing about $100 million over 10 years, paid for by the residents of other states. In addition, he insisted that a private, physician-owned hospital being built in Bellevue, Neb., be able to get referrals from doctors who own it, which according to new regulations will be illegal throughout the rest of the country.

Senator Christoper Dodd, D-Conn., procured $100 million dollars for construction of a hospital at a public university in his state.

Senator Patrick Leahy, D-Vt., negotiated $600 million in additional Medicaid benefits for his state over 10 years. Massachusetts is getting $500 million in Medicaid help for similar reasons, all paid for by those of us in other states.

Senator Mary Landrieu, D-La., extracted an extra $300 million in special funds for a new "Louisiana Purchase."

Senator Joe Lieberman, I-Conn.,along with most Republicans, has just taken the insurance money and tried to stop everything those lobbyists do not want.

Longshoremen union supporters of Democrats were exempted from most of a new tax on high-value health insurance plans, as were electrical linemen, police officers, firefighters, emergency first responders and workers in construction, mining, forestry, fishing and certain agriculture jobs.

As citizens can vote these people out of office any time we want, and yet we do not. We can insist on ethical behavior, but we do not. Yes, these bills are a complicated mess in many ways, although probably the best that we can do for now.

The problem is us. When we continue to re-elect corrupt, cynical politicians, who buy our votes with our own money, we get exactly what we deserve. So far, they have not been able to underestimate us.

Two News Stories that Help to Make It Clear Why We Need Comprehensive Health Care Reform

Big insurers spend much less on medical care than previously reported

Dow Jones Newswire reports that a US Senate Commerce Committee investigation found that the six largest US health insurers spent less on medical care than what industry officials estimated. Of the total amount received in premiums by the companies in the individual insurance market, 74 cents of every dollar were spent on medical care, according to a review of publicly available of data on industry earnings. Meanwhile, America's Health Insurance Plans estimated that the industry spent an average of 87 cents of every premium dollar on medical care. Click Here for Complete Story

HMOs planning large 2010 premium increases despite strong 3Q earnings.

Forbes Magazine notes that although "most of the major managed-care companies" have announced strong 3Q results, the message "during this earnings season is that HMOs are focused on rebuilding margins, even if it makes insurance even less affordable." Goldman Sachs analyst Matthew Borsch "calls it 'the highest pricing trend in years.' The premium increases he's seeing are in the neighborhood of 13 to 15 percent for next year." Analysts say HMOs are concentrating on making up for operating profit margins, which "reached zero last year for the industry as whole." Moreover, the companies not only want recompense for the "higher costs" they incurred this year from COBRA, they must "cover rising ordinary medical costs that show no signs of slowing down." Barclays analyst Joshua Raskin predicts overall health spending in 2010 will "climb 9 percent."

Click here for the complete story

What doctors think about health care reform

What do doctors think about proposed health care reform? The voices of physicians in the current debate have been almost exclusively from national physicians’ groups and societies, and little has been known about "the doctor in the trenches" and how they view things. A recent study the The New England Journal of Medicine sheds new light on this issue.

Turns out that a majority of physicians (62.9%) support reform that includes both a public and private plan options. 27.3% support reform offering only private options.

Read the entire article here

How American Health Care Killed My Father

That is the provocative title of an article by David Goldhill in the September, 2009 issue of The Atlantic monthly magazine. After the needless death of his father, Goldhill began a personal exploration of the health-care industry. He found that for years it has delivered poor service and irregular quality with an astonishingly high cost. It is a system, he argues, that is not worth preserving in anything like its current form, and he believes that the timid health-care reform now being contemplated will not fix it. His insights as a non-health care professional business executive, who looks at things from a business point of view, are profound, and I encourage everyone to read the article. You understanding of the compelling need for change will be enhanced.

So, if change is needed, what is the experts prescription for change, in a nutshell? In a September 6, 2009 article from the The Brookings Institution a group of 10 health care policy experts detail a set of concrete, feasible steps to revamp the system to control cost and improve saftey and quality. The plan, “Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth,” focuses on reducing the growth of health care spending, while also improving quality.

Their strategy consists of four interrelated pillars:

• First, we all need better information and tools to be more effective in getting the right care.
• Second, payments to health care providers should reward improvement in quality and reductions in cost growth, while emphasizing disease prevention and coordination of care.
• Third, health insurance markets must be reformed and government subsidies restructured to create competition and improve incentives around value improvement rather than risk selection. This will require all to be covered in some way.
  
• Fourth, people need support for improving their health and lowering overall health care costs, including incentives for achieving measurable health goals.

The report is well worth a read, in order to understand each of the pillars. Only by being informed on the issues so we know what is really being suggested can we cut through the claims of those trying to derail needed change. You can get a copy of this report by clicking on this text.

PolitiFact.com is A Place to Find out the Truth!

www.PolitiFact.com is a project of the St. Petersburg Times, the same newspaper that won the Pulitzer Prize for outstanding coverage of the 2008 presidential election.

This web site is the place for you to check the truth about claims made in the US health care debate. Reporters and editors from the Times fact-check statements by members of Congress, the White House, lobbyists and interest groups and then rate them on the "Truth-O-Meter". Amazing! Someone in the press doing actual journalism. The ratings range from "Pants on Fire" (recent winner Sarah Palin) all the way to "True". Check out these recent "Pants on Fire" rulings and enjoy yourself.

Report from a Town Hall Meeting, Mt. Vernon, Washington

The news had been full of reports of angry crowds with rude and obnoxious behavior, harassing members of Congress who were attempting to discuss health care reform with constituents, so it was with a little trepidation that I set out for the 2nd of 3 meetings hosted by Congressman Rick Larsen for Washington's 2nd Congressional District. Could the normally respectful and open minded people I live and work with behave this way? Turns out, I need not have worried!

So many people came to the meeting that the large auditorium was completely filled, and a crowd of thousands spilled over into the outside lawn. Speakers were set up so that all could hear, and Larsen made a point of coming out on to the lawn area to take questions. Congressman Larsen treated everyone with patience and respect. Oh, to be sure, there were some who seemed bent on stoking ill will, such as the guy who had a picture of the President defaced to look like Hitler. These folks were far outnumbered by those who came to listen and have true dialog, and when the Congressman singled out the picture of President Obama as Hitler, to say it was not reflective of true and honest criticism and debate, there was a loud and prolonged applause from 90% of those in attendance. To those who complained that the house bill was rushed through by people who did not understand it, he made it clear that he had read the entire bill, and had a copy with him to refer to if there were specific questions. And the questions did come!

One of the most interesting things I learned at this meeting is how confused and misinformed some worried people are about the truth contained in the recent bill passed by the House of Representatives. For example, one woman thought that payment for care would be limited to $5,000. The Congressman explained that no, this figure was a cap on expenses for her to be responsible for, and not a limit on benefits. Another thought that illegal aliens would be covered, and was told that they are explicitly not covered by this bill. There were many other examples.

Larsen made it clear that he is not approaching reform as an ideolog, but rather, he wants to accomplish practical change by keeping the following principles in mind:

• Ban discrimination for pre-existing conditions, age and gender;
• Don't try to fix what isn't broken. If people have insurance and doctors they like, they should be able to keep them;
• Eliminate fraud, waste and abuse in government health programs;
• Invest in prevention and pay for quality of care, not quantity of tests;
• And get reform that works for Washington State.

He particularly took pains to explain that Washington state currently is penalized for providing higher-quality, lower-cost care by Medicare because reimbursement rates are so low that many local doctors do not accept Medicare patients. Under the original health care reform bill introduced in the House, this problem was not fixed, and was expanded, so that the same unfair, wasteful reimbursement policies would have been expanded from Medicare to the public insurance option. As he said, "What good is an insurance card if you can't find a doctor who will treat you?" That was his reason for opposing the "public plan" option as presented. To improve this situation, Larsen has worked with colleagues from Washington and other states with the same problem to secure an agreement with House leadership to agree to reform Medicare payments, reward high-quality, cost-efficient care and remedy geographic disparities that hurt access to care for local patients.

All in all, I was very impressed. Congressman Larsen should be commended for working hard on our behalf, with clear principles of reform. He is obviously very knowledgeable and energized about this issue. Residents of our area should be commended for their attention and respectfulness of the town hall process. I was glad that I went.

One disappointment I do have is with our local newspaper, The Bellingham Herald. I could not find a report of our local meeting, but there were 2 articles with old news about how meetings are being disrupted. What a missed opportunity by our media to set the record straight!

Mayo Clinic Principles of Health Care reform

I had an interesting experience this week when my friend, retired pathologist Dr. Bob Gibb, asked me to sit in with him on a group telephone call among alumni physicians trained at the Mayo Clinic. It seems that Mayo has decided to try and play a "convener role" in our national discussion of health policy, and this phone conference was part of an effort to spread their message and get the word out about what they believe is central to true health care reform. They have also developed a web site for the Mayo Health Policy Center.

On the call I learned that Mayo has 4 cornerstone principles that they believe must be included for meanigful reform:

• Creating Value - do we actually improve health in a measurable way?
• Coordinated Care - Mayo is an example of working together and not in silos
  
• Payment Reform - provide incentives to coordinate care, improve outcomes and enhance patient decision making
• Health Insurance for All- essential in order to share risk, and improve the health of entire populations.

Although they have nailed 4 needed elements, I would add two more principles that I believe are also essential for us here in the United States:

• Choice - people want a choice of doctors, plans and hospitals when possible
  
• Access -the Massachusetts experience makes it clear that "insurance for all" is a hollow accomplishment without enough primary care doctors to provide access to care!

During the call, there was a discussion of the thought behind the Mayo cornerstones which noted that they support the personal medical home as a way of achieving the principles, they do not believe that simply expanding Medicare is rational, since it does not address value, coordination and payment reform, and they do support some pilot projects to sort out the various ideas of how to manage the needed change.

Steven Pearlstein noted in a recent Washington Post article, "If we really want to fix America's overpriced and under-performing health-care system, what really matters is changing the ways doctors practice medicine, individually and collectively. Everything else -- mandate or no mandate, the tax treatment of health benefits, whether there's a "public plan" to compete against private health insurers -- is just tinkering at the margin." I could not agree more. In order to get there, however, we will need to pay physicians differently to coordinate care, and measure results. For this reason, payment reform is the most critical first step. Indeed, the results we are seeing today are just what our payment system is designed to produce! The American College of Physicians (ACP) 2006 report actually predicts the imminent collapse of primary care in the United States, due to the inadequate and dysfunctional payment policies of the government and other third party payers.

We have an historic opportunity to change course. Thanks to the Mayo Clinic for weighing in!

PM Bellingham Discussion on KGMI

I had a very stimulating conversation about health care and our need for reform on the PM Bellingham radio program, hosted on KGMI radio by Jacqueline Cartier and Ken Mann. They asked great questions, and gave refreshing insight from a younger person's perspective

PM Bellingham Radio Program Link Click Here