With Cook County struggling to consolidate healthcare services, the state is on the verge of voting to shutter inpatient care at Oak Forest Hospital, a move some critics say will devastate patients and the community. A county proposal to convert the hospital into a large outpatient center will be considered Monday by the Illinois Health Facilities and Services Review Board, which is expected to support the plan. The move to end inpatient care was one of the more controversial proposals in the county's sweeping new strategy, unveiled in June, to address longstanding inefficiencies and improve preventive care in the Cook County Health & Hospitals System. Unions, however, objected because of expected job losses. In a report released this month, the Illinois Department of Public Health appeared to be siding with critics of the plan, warning that discontinuing inpatient care would hurt patients and burden other hospitals in the south suburbs.
A panel of the Health IT Policy Committee is exploring gaps in the infrastructure of health information exchange, solutions for which will be critical to some of the proposed objectives for stage 2 of meaningful use, such as incorporating lab results in structured data. The meaningful use work group wants to be sure that technologies, policies and standards will be in place in 2013 to support exchange goals. The use of the Direct Project for "push" exchanges, for example, is expected to grow rapidly among providers so they can share lab results and clinical summaries, said Farzad Mostashari, deputy national coordinator for policy and programs at the Office of the National Coordinator for Health IT. A few provider organizations have begun to use Direct, a form of secure email whose protocols have recently become operational, to enable simple exchanges between providers and between providers and labs. "What is encouraging is the near weekly addition of organizations and vendors who plan on embedding those simple protocols within their product," he said at a meeting of the meaningful use work group.
Researchers at the University of California, San Francisco, have been at the forefront of an emerging medical field that seeks to identify and help treat problems caused by stress. Now, these scientists hope to market their findings to physicians in the form of a test that can act as a personal report card on patients' health. "The science is there, and the time is right to bring it to the public," said Elizabeth Blackburn, one of the UCSF researchers who co-founded the business, Telome Health Inc. "We see a big market opportunity for this." Telome Health, which has 10 employees, is launching its website today to mark a more public phase of its business, following a flurry of studies in recent years that piggybacked on research by Blackburn and two of her colleagues, Jue Lin and Elissa Epel. Still, it might not be easy to persuade doctors and the public that they should pay about $200 to have their DNA examined as part of a regular check-up.
In a town where power is often measured in dollars controlled, Donald Berwick, MD, should be a rock star. CMS has a budget larger than the defense department and with the implementation of the Affordable Care Act, Berwick as the CMS administrator (at least for now) could influence healthcare policy for years to come. So why is his nomination being stonewalled?
The simple reason is probably because he will have money and power. But it is more complicated than that. Here is the lowdown on arguments swirling the beltway as to whether Berwick should stay or go.
It's politics. Tom Scully probably put it best. The former CMS director and Berwick supporter is widely quoted as saying, “You could nominate Gandhi to be head of CMS and that would controversial right now." Congressional Republicans were still licking their wounds from passage of the ACA when the White House nominated Berwick in April 2010. The GOP pounced and promised to make Berwick a poster child for everything wrong with the reform effort.
Congressional Democrats, worried that their ACA support would be an election issue, did not push for confirmation hearings. It looked like the nomination was dead until the Obama administration installed Berwick as a recess appointment.
This month 42 Republican senators signed a letter to Pres. Obama telling him that they will not support Berwick. That leaves 58 senators who may support the acting CMS chief, but rules require 60 votes for confirmation.
Why he should stay: CMS has had five administrators since 2000 and only two, Scully and Mark McClellan, were confirmed by the Senate. CMS is the agency Congress loves to hate. It has a lot of power, affects the lives of more than 100 million Americans and is a key player in the implementation of ACA. Opposition to Berwick looks like an effort to reignite the reform debate.
Why he should go: The White House waited for more than a month after passage of healthcare reform to nominate Berwick and then they tucked him away from the press and Congress. Instead of being proactive, the Obama administration has allowed Berwick opponents to set the tone and tenor of the argument. It makes you wonder if they really want the guy.
Berwick Said What?
Throughout his lengthy career Berwick has made a lot of comments and some of them are coming back to haunt him. According to his critics, Berwick is a radical proponent of healthcare rationing, so-called “death panels” and the British system of healthcare.
Why he should stay: Healthcare is too important to allow the level of discourse to fall so low.
Why he should go: In the era of the 24-hour news cycle, Berwick makes great theater. The soundbite rules so his speeches and writings are mined for controversy. Yes, the statements are often used out of context but as long as Berwick remains the nominee it will be hard for the healthcare reform debate to move beyond emotion-laden words like “rationing” and “death panels.”
Berwick's Qualifications
Don Berwick is a Harvard-educated pediatrician who has spent much of his career as a policy analyst. HealthLeaders Media wrote about him last year: "Berwick's record as a healthcare shepherd is unassailable. Through the Institute for Healthcare Improvement he founded, Berwick and his team cleverly hooked into the healthcare industry's untapped desire to improve with catchy, actionable programs like the 100,000 Lives Campaign. His critics worry that at CMS, what Berwick envisions would be less like feel-good voluntary programs and more toward British-style universal care of which he has spoken fondly."
Why he should stay: His specialty is examining how a healthcare system can improve patient care while holding down costs. That is exactly what everyone says should happen.
Why he should go: One ongoing criticism of Berwick is that he lacks experience in management and with health plans.
Major Players Endorse Berwick
The White House has released a seven-page, single-spaced document that lists more than 200 organizations that support Berwick’s nomination. Here are some of the ones that really matter: AARP, AMA, AHA, AHIP, Medical Group Management Association and the American Public Health Association. When was the last time they all agreed on anything?
Why he should stay: It looks like Berwick can get everyone to the table and that is vitally important as ACA moves to implementation.
Why he should go: No downside here.
Why it may not matter: Berwick can stay right where he is until the end of 2011. By then he will have filled his management positions with people who pretty much think like him. Marilyn Tavenner, who is now second in charge at CMS, would probably become the acting director. Also, the Obama administration has tucked the Office of Consumer Information and Insurance Oversight into a safe place within the mammoth CMS. It is a preemptive move to counter legislative efforts to defund the office, which is charged with developing healthcare reform rules and regs. Steve Larsen, the widely respected and consumer-friendly former Maryland insurance commissioner, heads that office and has already issued a first round of rules.
Why it does matter: His supporters consider Berwick a visionary and an innovator in terms of patient-centered quality healthcare. As the head of CMS he will have the final say over what pilot projects are funded through the new Center for Medicare and Medicaid Innovation. That is important because much of the heavy lifting in terms of policy development will be formed around the successful pilots.
Berwick's chances for confirmation depend more on politics than anything else.
With the baby boomer generation aging, the healthcare industry is bracing for a massive increase in elder care and some hospitals are preparing for that influx with emergency departments designed for seniors.
In Michigan, eight hospitals owned by Trinity Health System now have senior emergency departments. The first opened last summer and seven others rapidly followed.
"We opened the first senior emergency department in July 2010 and by January had them in eight hospitals," said Michele Szczypka, regional chief marketing officer for the St. Joseph Mercy network of hospitals. "And we've had a great response from patients and caregivers and have seen a 10.2% increase in the number of senior patients we serve since they've opened."
The departments are equipped with safety rails that help seniors get around and reduce the risk of falls. The beds have mattresses with pressure-reducing foam to make them more comfortable and large-print signage and over-sized clocks make it easier for seniors with vision problems. Seniors entering the regular emergency departments are given the option of being treated in the senior EDs.
Szczypka said nurses and doctors who staff the departments have all been trained in geriatric care and routinely screen patients for cognitive problems. "We had one patient who was repeatedly coming to our ER to be treated for complications from diabetes," said Szczypka. "And in our senior ED, we discovered it was matter of the patient not properly treating their diabetes. So the departments look for underlying conditions rather than just treat the problem."
The senior EDs range in size from 6 to 12 beds and are now a part of St. Joseph Mercy Ann Arbor, St. Joseph Mercy Brighton, St. Joseph Mercy Oakland, St. Joseph Mercy Port Huron, St. Joseph Mercy Saline, St. Joseph Mercy Livonia, Chelsea Community Hospital, and St. Joseph Mercy Livingston.
Szczypka said the hospital group developed a comprehensive marketing campaign to publicize its senior emergency departments. It has three radio commercials ranging from 15 to 60-second spots and three TV commercials that feature patient testimonials and an overview presented by an emergency department physician. It's also using print advertisements, social media, and billboards to get the message out.
"We used local advertising as each emergency department opened and launched the regional campaign in January," said Sczcypka.
St. Joseph got the idea from Holy Cross Hospital in Silver Springs, MD, which opened its senior ED in 2008. That hospital is also owned by Trinity Health System, which plans to expand the concept to 10 more hospitals in several state by 2013 and has two openings slated for Iowa this year. In addition to delivering enhanced treatment for seniors, the departments are expected to drive patient volume at the hospitals they serve.
"When you talk about marketing hospitals, there's a saying that kind of everybody knows, which is, 'The emergency room is your hospital's front door,'" said Bill Thomas, MD, a geriatric physician who helped developed the first senior ED at Holy Cross Hospital.
Hospitals in other states, including New Jersey, Texas and Kansas, are also testing the concept.
At Bronx-Lebanon, a hospital that exists only by the grace and taxed fortunes of the people of New York State, the CEO was paid $4.8 million in 2007 and $3.6 million in 2008, records show. At NewYork-Presbyterian, a hospital system that receives nearly half a billion dollars annually in public money, the CEO was paid $9.8 million in 2007 and $2.8 million in 2008. In an urgent search to cut the state's healthcare costs and lift revenue, a task force came up with a plan to increase the cost of a hospital stay by $5 and to limit housekeeping services for the disabled in their homes. One area of plump costs, however, remained undisturbed: executive suites where salaries and compensation run into the millions of dollars, even at the most financially struggling hospitals. A proposal to allow public financing for only the first $1 million in wages for an executive died before it even reached the task force.