Health and Human Services nominee Kathleen Sebelius amended three years' worth of tax returns to correct errors, paying back taxes and interest totaling just under $8,000. She is the fifth nominee to run into tax problems, though Senate Finance Committee Chairman Max Baucus said in a statement that the errors were "minor [and] unintentional" and expressed strong support for her confirmation.
The first of two hearings began on the confirmation of Gov. Kathleen Sebelius to become the Obama administration's secretary of health and human services. The Democratic governor of Kansas faced a largely friendly audience from the Senate Health, Education, Labor and Pensions Committee. Sebelius appears before the Finance Committee on April 2. A date for full confirmation by the Senate, if her name is moved out of committee, remains uncertain.
Efforts to overhaul the healthcare system have moved ahead rapidly, with the insurance industry making several major concessions and the chairmen of five Congressional committees reaching a consensus on the main ingredients of legislation. The chairmen agree that everyone must carry insurance and that employers should be required to help pay for it. They also agree that the government should offer a public health insurance plan as an alternative to private insurance. But members of Congress are just now turning to the most explosive issues, which could delay or derail the process.
Just when single-payer advocates thought the individual mandate idea was nearing its demise, Washington lawmakers placed defibrillation pads on the patient and shocked it back to life.
As the major cog of the Massachusetts healthcare reform effort, the individual mandate requires residents to purchase health insurance. The result has been miniscule uninsured numbers in the Bay State, but healthcare costs continue to spiral. I'm surprised that the individual mandate is now being considered a healthcare reform option. It's not that I don't like the concept—it's that only seven months ago the idea seemed dead.
Now, the individual mandate idea is back—and the single-payer option is the idea on the outs. As part of its healthcare reform plan, America's Health Insurance Plans included the individual mandate as well as agreeing to accept all members and not charging sicker individuals more for their coverage.
The biggest boost to the individual mandate since the Clinton campaign came Friday when the Health Reform Dialogue included the concept in its report as a path to healthcare reform. The group, comprised of 18 organizations, including AARP, AHIP, the American College of Physicians, American Hospital Association, American Medical Association, American Nurses Association, Blue Cross and Blue Shield Association, Business Roundtable, and the U.S. Chamber of Commerce, could not find consensus on the most difficult healthcare issues, but it agreed on a two-pronged approach: Build on employer-sponsored insurance and expand public safety-net programs for low-income people and families.
The groups suggest three areas in which to focus: increasing coverage and access, strengthening wellness and prevention, and ensuring quality and value.
The first of these three is the easiest because it requires money and expanding/creating programs to cover most or all of the 46 million uninsured Americans. Expanding coverage is costly, but it's easier than controlling costs and improving quality—Massachusetts leaders have learned.
Strengthening wellness and prevention, and ensuring quality and value are where reform will face its hardest obstacles.
It's not easy to get people to take better care of themselves—just ask a health coach. The Centers for Disease Control and Prevention estimates that eliminating three risk factors—poor diet, inactivity, and tobacco use—would prevent 80% of heart disease and stroke, 80% of Type 2 diabetes, and 40% of cancer. I wrote an article for the September 2008 HealthLeaders magazine that was part of a package of stories called the 10 Events that Could Change Healthcare. My contribution was "What if People Actually Start Taking Care of Themselves?"
I spoke to David B. Nash, MD, MBA, one of the leaders in population health, who is chair of the department of health policy at Jefferson Medical College of Thomas Jefferson University in Philadelphia. He said only 3% of the American population follow four basic wellness goals: Don't smoke, stay close to their ideal body weight, exercise three times a week for at least 20 minutes, and eat fruits and vegetables regularly.
If that percentage increased to a mere 9% of the population, he suggested, hospital admissions would plummet for bronchitis and upper respiratory problems, heart attacks and strokes, and diabetes.
Getting Americans to follow through on better health is not easy. If they won't take better care of themselves for loved ones, you can't expect the argument that their health affects the U.S. economy will work.
And then we come to the issue of cost and quality. Controlling costs will require changing the way we pay for care. Rather than pay strictly for services, the feds will need to develop a way to pay for care coordination and raise compensation levels for primary care, while creating incentives for physicians to accept sicker patients. That's not easy. Changing payment should improve quality, but we also need to test what works and improve cost and quality transparency, so individuals can visit physicians who are providing the best services.
True healthcare reform is going to take a long time, and I still don't expect a major bill will get through Congress this year. One only needs to look at the Health Reform Dialogue. The coalition of groups couldn't come to a consensus on the issues of the employer's role in healthcare reform or whether to create a public insurance option to compete with private insurers, and it lost two unions from its coalition, the American Federation of State, County and Municipal Employees and the Service Employees, because they couldn't support the final report.
Most agree that healthcare reform is needed, but what primary care doctors think is required is not the same as specialists, health insurers, employers, Democratic lawmakers, Republication lawmakers, or hospitals.
Though some have bashed the Health Reform Dialogue for its report, and I admit I was hoping for greater consensus, this is a nice first step in what will be a lengthy healthcare reform debate.
The industry should realize that any reform package that comes from Washington will have something for everyone, but no one will love it. In other words, prepare for disappointment.
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The Collaborative Communications Summit is scheduled for June 16-17, 2009, in Fort Lauderdale. The summit is designed to help top-level executives, legislators, physicians, regulators and technologists handle health information technology change, policy development, and changing business models, according to the organization's Web site.
For some patients considering medical travel, the headaches surrounding the trip may outweigh the benefits:
What part of the world should I travel to?
Is the region safe?
Where will I stay before and after the procedure?
What if something goes wrong?
At least one company, Medtral New Zealand, tries to allay these fears by helping consumers through every step in the process. Prospective patients are assigned a personal "International Patient Coordinator" who helps organize travel, treatment, and care— including help obtaining a medical visa, consultations, accommodations, and arrangements for aftercare in the country.
"We believe that because of the alignment, both medically and culturally, with the U.S. that this is something that will appeal to Americans who are seeking high quality elective surgery that is at a price they can afford," says Edward Watson, MD, Medtral New Zealand's executive chairman and director.
Watson estimates New Zealand treats 500-600 patients from abroad annually, but it could grow well into the thousands if Medtral does its job.
"For patients who are looking for lower-cost, high quality procedures, this would fit them because what we say is that the quality will be as good if not better than the quality in the United States, for a price which is about 15%-20% of the cost in the U.S.," Watson says.
To get the word out, Watson says Medtral will increasingly use its previous customers to serve as spokespeople to talk to other Americans who are considering medical travel to New Zealand. Medtral also provides virtual tours of hospitals and boasts surgeons who are willing to communicate directly with prospective patients about what they can expect.
Medtral is also working with U.S. insurers to get patients from abroad.
"We're in discussion with health insurers around the country about them offering an option of medical travel for their existing clients, as well as offering a lower premium product to attract new customers and obviously who do not currently have health insurance," Watson says.
Medtral's hands-on approach to helping consumers with medical travel begins with an extensive screening process. Medtral representatives ask potential medical travelers detailed questions, examine their diagnostic tests, and generally make sure they need an operation. The litigious nature of the United States leads to doctors practicing defensive medicine, and in turn adds to the significant costs of healthcare, Watson says.
"We are flabbergasted in certain areas, of how many patients there are that have been offered surgery in the U.S. and our surgeons in New Zealand say frankly, 'they don't need an operation,'" he says.
Watson says the New Zealand medical travel industry currently focuses primarily on cardiac and orthopedic procedures, but New Zealand is researching which services would prove most lucrative, including live donor renal transplantation.
"The reason being the variance between the cost in the U.S. for live donor renal transplantation and what we can do it for in New Zealand is so huge, that there must be a market even if that market is small," Watson says. "With 76,000 Americans on the waiting list for renal transplantation, there is obviously a sizable need there as well."
All of the hospitals Medtral uses are accredited by Quality Health New Zealand, which uses quality standards based on those used in Australia and Canada. QHNZ itself is accredited by the worldwide umbrella organization, the International Society for Quality in Healthcare. ISQua is the same organization responsible for accrediting the Joint Commission International.
Watson credits JCI for its marketing efforts, because that is what many Americans looking for medical travel options base their opinions on. But when Americans choose hospitals simply because of JCI, they are basically ignoring all other members of ISQua, Watson says.
"They all have the same standards, so why not choose an ISQua member accreditation body instead of choosing just JCI?" he asks.
He notes, however, that accreditation should be only part of what potential medical travel patients consider when choosing a provider. Patients need to think about how the provider fits with their cultural, as well as medical, needs, and if the provider has processes in place if something goes wrong. Safety aspects both inside and out of the hospital should be considered as well, he says.
"The important thing for the consumer is quality, there are no two-ways about it," Watson says. "You want it to be like it is back home, but hopefully less expensive. And I think those things, more than the accreditation of the hospitals, are probably more important to get across to the consumers."
Watson is confident that with effective marketing, medical travel to New Zealand could become a booming business—especially if U.S. companies that pay for their employees' health plans realize the savings they could achieve.
After going through the current economic crisis, these U.S. companies will be wary and looking for more ways to reduce expenditures—one of the biggest being healthcare, Watson says. By offering a package to New Zealand that covers travel, the procedure, and recovery time at a significant savings, Watson says it will be hard for companies to turn it down.
"Once America has got over the shock of what they are going through and innovation starts to come to the fore again, we believe that innovative companies will see this as a viable option," Watson says.
Ben Cole is an associate online editor with HealthLeaders Media. He can be reached at bcole@healthleadersmedia.com.Note: You can sign up to receiveHealthLeaders Media Global, a free weekly e-newsletter that provides strategic information on the business of healthcare management from around the globe.