There could be no more fitting end to the healthcare year of 2007 than President Bush sitting down in his Crawford, TX, ranch on Dec. 29 essentially taping a bandage on some fundamental healthcare problems still facing us. It was typical of a year that started with the best intentions to make progress in healthcare, but like so many personal resolutions ended in a pathetic whimper.
So basically what we have are two extensions--the State Children's Health Insurance Program stays at covering six million kids, and the Medicare physician fee reduction schedule gets officially procrastinated until June. Why should we have expected anything different? It sets up 2008 to be another year of policy workarounds and empty dialogue without much accountability toward fixing a healthcare system that threatens our national prosperity.
The fight over SCHIP shows in flashing lights just how petty the politics became. Progress toward any meaningful reform will require a progression of political steps, the first of which, I assert, must at least be some consensus on how we as a nation want to provide adequate healthcare coverage to our children. Both sides continue to accuse the other of using children either for or against the expansion toward government-sponsored universal care.
"Ultimately, our nation's goal should be to move children who have no health insurance to private coverage," President Bush said in an October radio address. That private coverage depends on mom and/or dad having a job that offers health coverage, and being able to afford premiums that grew 6.1 percent last year and now average $12,000 a year for a family of four, according to the Kaiser Family Foundation. So our nation's goal is to essentially push children into a private insurance market that is more expensive and more difficult to obtain?
The repeal of the Medicare physician fee reduction schedule until June likewise is a way to put off the pain, hoping that the lump will just go away. By mid-2008, Congress will be in the full heat of a presidential election cycle, with neither party wanting to risk its candidate's appeal.
"Regardless of the outcome in November 2008, there's no doubt the U.S. health system will experience transformative changes and disruptive innovation in coming years," says Paul H. Keckley, Ph.D., executive director of the Washington, D.C-based Deloitte Center for Health Solutions. "But for the next 12 months, it's wait and see."
When faced with a problem that threatens the health and safety of patients, good hospitals work with a sense of urgency. In Washington, unfortunately, the new year of healthcare continues to be dominated by political pie fights--as in who can keep the bigger piece--rather than meaningful movement. We can hope that other pressures on the system from employers, consumers and even internal pressures from hospitals and physicians, will keep some momentum toward change going in 2008.
When administrators at Schneck Medical Center in Seymour, IN, decided to construct a state-of-the-art cancer treatment facility, ideas for the site's design came from those that would be using it most: patients. In fact, the medical center and the project's designers utilized both community and staff input when constructing the new Schneck Cancer Center that opened in fall 2007.
Prior to construction of the new Schneck Cancer Center, Schneck Medical had offered medical oncology services since the 1980s. A lack of radiation therapy, however, forced patients to travel several miles to nearby cities for treatment. Schneck Medical serves a five-county radius in southeastern Indiana.
"Cancer is very exhausting in its own self--and it's worse for my chemotherapy patients because they have a battle going on in their body. Then they were having to travel every day 30-45 minutes one way to get radiation therapy," says Sally Acton, director of cancer services at Schneck Medical. "It just broke my heart because I would see how tired and debilitated they were with their disease. It was just an awful burden, so that was really the reason I wanted to see it, because it is hard to watch patients have to do that."
Acton has been at Schneck Medical for 20 years, and she says in that time she has asked countless cancer patients what they liked about what the facility offered, and what they would like to see if a cancer center was ever constructed on site. She also distributed a survey among her patients asking what they specifically would like to see in a cancer center.
"The reason we even started talking about the cancer center was because a community survey showed they wanted more cancer services, they wanted to have radiation therapy here--so it's the community that really asked for it," Acton says. "They often asked, 'Why would I go anywhere else if you offered it here?' "
The building was designed by Indianapolis-based BSA LifeStructures, which Acton says was very good about listening and accommodating the needs of both Schneck Medical and its patients. Private rooms, ample space for patients' family members, and a "healing garden" are all portions of the design that were incorporated by BSA LifeStructures after receiving suggestions from Schneck and the community.
"They had a lot of influence; we always try to consider the community when designing facilities," said Doug Abrams, an architect and associate principal at BSA LifeStructures. "The goal, especially in a cancer center, is to provide a healing environment, to serve the community by providing a stress reducing environment. Patients have a lot of ideas, they've been through the care process, and they're good about sharing their experiences."
Acton says she took information she gathered from patients and the community, and attended every construction meeting to provide input. One of the aspects she nixed early on was private treatment bays for the patients.
"Our culture is not that way. Our culture is you talk to everybody, you know everybody, or you are related to everybody you are in the room with--it's like one big support group," Acton says. "My patients wanted a centralized television system, they wanted to be able to talk to each other, so we just changed the chemotherapy room completely."
Although patients wanted the best technology available, Acton says for the most part requests from the community were reasonable. She said there were many intangible aspects that were important to the patients, such as communication among all doctors.
"Every place that I went it seemed like the medical oncology and the radiation oncology were two separate bodies and they weren't really looking at the patient as a whole person, and that's a huge deal--the community wants that and they deserve that," Acton says.
Another aspect that derived from the community's input was a "healing garden" visible from inside the facility. The garden also features a concrete walkway that allows patients to take their IV poles for walks out into the area, and it also provides places for them to sit.
"The community just wanted a calm atmosphere, and it very much is," Acton says.
By providing the community with an opportunity to help with the design, the entire project benefited, Abrams says. "The benefits are giving the community a sense of ownership and involvement in the project--and it helps the hospital reach its goal of serving the community."
In addition to providing input on the site's design, the Seymour community raised $4 million for the center and the building that houses the center is named for Don and Dana Myers--the largest contributors. Furthering the community-based feel, the center also features a resource section that provides a computer designated for community members where they can access research on cancer support groups and other cancer-related services.
"It's really the community's cancer center," Acton says. "They feel a part of it--and that is very important, to have this community understand that this is for them."
With many primary care doctors booking appointments weeks in advance and wait times of several hours at emergency rooms, the demand for urgent care centers across the country is growing. Many insurers are helping drive the expansion by offering patients lower co-pays if they choose an urgent care center over an emergency room.
Clinics that overbook patients could experience improved service and increased efficiency, according to a study. Researchers at the University of Colorado at Boulder Leeds School of Business developed a computer simulation tool that helps doctors weigh the benefits of seeing more patients and making the best use of healthcare workers and time against potential costs such as increased patient waiting and staff overtime.
Christina M. Fitz-Patrick has been appointed president and CEO of Nazareth Hospital in Philadelphia. Nazareth, in is part of the Conshohocken, PA, Mercy Health System, which is its region's largest Catholic healthcare system.
Officials at the Seattle-based Children's Hospital and Regional Medical Center say the hospital is nearly out of room in its current buildings and, to accommodate growth expected in the next two decades, would need to more than double the number of beds and the size of buildings. Neighbors have panned the hospital's initial plan, which included buildings as high as 240 feet, and a subsequent proposal that cut the maximum height to 160 feet.