The Senate Finance Committee hears testimony and is expected to examine in the coming months possible solutions to the problems posed by chronic disease care, which accounts for 93 percent of all Medicare spending.
Even by Washingtonian political standards, testimony for a Senate Finance panel hearing on addressing the crushing cost of chronic disease care opened on a dramatic note this week.
Tuesday morning's first witness knows the costs associated with chronic disease all too well. Stephanie Dempsey, an American Heart Association volunteer who lives in Georgia, has suffered with heart disease since she was 21, the 44-year-old told the senators.
Over the next several months, the committee is expected to examine several possible solutions to the problems posed by chronic disease care, which accounts for 93 percent of all Medicare spending, according to the panel's chairman, Ron Wyden (D-OR). Among the proposals the committee will be assessing is the Better Care, Lower Cost Act, which Wyden and three other lawmakers introduced in January.
"My heart disease is hereditary and has impacted all of the women in my family. My only sister died at the age of 28 from heart disease. My mother, who is 69, underwent quadruple bypass surgery at the age of 48, and my maternal grandmother died at the age of 72 from coronary artery disease."
As Dempsey read nearly verbatim from her prepared statement, there were several emotionally charged pauses as she described the impact her multiple chronic conditions had on her family.
"As you might imagine, my medical expenses are significant and are becoming more significant by the day. We fell behind on our mortgage and were forced to sell our home… As it became more difficult for me to manage my illnesses, the growing burdens became overwhelming for my husband, and after 21 years of marriage, he decided to walk away."
After Dempsey concluded her testimony, Wyden proclaimed that Congress is determined to ease her burden. "You asked that you not be forgotten, and you have here both Democrats and Republicans who want to make sure that doesn't happen."
Rare spirit of bipartisanship
Although a couple of senators on both sides of the aisle could not resist the temptation to alternately praise or poke holes in the politically polarizing federal Patient Protection and Affordable Care Act, all of the lawmakers present sought to set a bipartisan tone.
"Here's my bottom line: the way healthcare is delivered in America has to change," Wyden said in remarks that opened Tuesday's hearing. "This is not something that is going to be solved overnight. This committee hearing marks the beginning of a bipartisan effort."
Sen. Orrin Hatch (R-UT), the finance panel's ranking Republican member, said taking action to manage chronic illness more effectively and efficiently is "one area where both parties can make progress."
The Utah lawmaker said the country could not afford to ignore the daunting financial challenges that chronic disease pose to every American. "Healthcare costs place enormous strain on the federal budget," Hatch said, noting total healthcare spending in 2012 has been pegged at about $2.8 trillion or 17.2 percent of the US economy's gross domestic product.
David Rehm, president and CEO of Massachusetts-based hospice and primary care services provider HopeHealth, says common ground can only take the political leaders so far.
"All of the players recognize there is a problem, and it's focused around this population of patients," says Rehm. "They all share the same focus and the same goals. But the problem comes when you have to decide what you're going to do."
Coordination of care key
Nearly all of the witnesses and senators who spoke at Tuesday's hearing said improving coordination of care is the top priority to improve treatment of chronic disease and cut costs.
Wyden asked Dempsey and another witness, Mary Lehmann, who is serving as caregiver for her elderly husband as his Alzheimer's disease advances steadily, whether it would help them to have one "go-to person to coordinate the array of services."
"It would be life-changing. If I had that one person who was the go-to person," Dempsey said, "it would be invaluable… It would not only be life-changing, it would also be life-giving," Lehmann said of the possibility of having a care coordinator to help manage the treatment of her husband.
"Most of my time is spent feeling overwhelmed," she told Wyden.
William Bornstein MD, chief quality and medical officer at Atlanta-based Emory Healthcare, said boosting coordination of care for chronic disease patients is a Herculean test for healthcare and political leaders.
"The challenge is, how do we make sure all the care is coordinated to make sure we have a patient-centered approach," he said of chronic disease patients, noting that many have a dozen specialists that they see annually.
Sen. Johnny Isakson, (R- GA) asked Bornstein about Emory nurses who serve as care coordinators. The senator noted that Emory has taken on the cost of the nurse coordinators because they add tremendous value. "It costs more to do less and less to do more," Isakson said.
Bornstein said having care coordinators "embedded" at hospitals and other points of care is only part of the solution to the country's chronic illness problem.
"We need someone who is captaining the ship," he said, "but we also need all of the specialists to think about coordination of care."
When Bornstein treats people with diabetes, he said specialists working with his patients should be planning around the effects of multiple medications. "How often does that happen? In my experience, almost never," he said.
Rehm said coordination of care for chronic disease patients "is a challenge in a number of ways," adding that the necessity to take action is pressing.
Wyden said he and his colleagues on the Senate Finance panel are determined to make progress. "In the months ahead, this committee can find bipartisan solutions to meet the challenges and strengthen the American healthcare system, and I'm committed to working with the senators to address it."
Christopher Cheney is the CMO editor at HealthLeaders.