Last week, the votes were finally counted and the Senate healthcare reform bill received the majority of votes—albeit all Democratic votes—and passed 60-39. But with the start of reconciliation between the House and Senate bills slated a few weeks away, what direction is the bill headed for now?
President Obama's spokesperson, Robert Gibbs, stayed optimistic about the final bill's future: "People will have access to affordable insurance. People with insurance won't be discriminated against because of a pre-existing condition. We'll take some tough steps to ensure that insurance companies aren't using the money that's gotten from your premiums to pad their profits, but instead to provide much-needed medical care. I think the American people are on the verge of a very big win in healthcare reform in the—early in the next year," he said on NBC's Meet the Press yesterday.
"I think the president would tell you that what he sees in each of these bills is, in many cases, virtually identical: The major parts of healthcare reform that the president sought to have enacted as a candidate are now very close to happening, and he thinks the commonalty between the two proposals overlaps quite a bit," Gibbs said.
Rep. James Clyburn (D-SC), the House Majority Whip, said on CBS' Face the Nation that the reform process does not present unsurmountable problems. "I believe that both the House and Senate bills make tremendous contributions toward bending the cost curve. I think they do a great deal to bring more people into the system," he said.
But he noted that while "the Senate has done a very good bill, I think that the House has done a very good bill as well." But even without a public option, he said the bill will move forward: "Why do we want a public option? We want a public option to do basically three things: create more choice for insurers; create more competition for insurance companies; and to contain costs," he said.
On the other side of the aisle, the opinions are far less rosy. Senate Minority Leader Mitch McConnell (R-KY), on ABC's This Week, said there are "deep differences among many Democrats, and that the bill is a colossal failure."
Former House Majority Leader Newt Gingrich noted on "Meet the Press" that "when you start writing 2,000-page bills, you guarantee that no elected official knows what's in the legislation—it is a fundamentally flawed way of running this country—it's flawed in both parties."
Chronic wound care is among the procedures patients are not putting off amid the economic recession—and hospitals that partner with wound healing centers are reaping the benefits.
"I've definitely seen changes in the payer mix, but the volume is steady," says Renee Skinner, program director at 6-hospital system UNC Healthcare's Wound Healing Center. "When you have this type of issue, people will cut back on the things that are basic healthcare, but when they have an open wound that's painful, that's infective, they can't ignore that. You can see the impact in the individual patients' lives [due to layoffs], but the medical need doesn't change with the economic climate of a nation."
Wound healing centers tend to be revenue-drivers for hospitals because of both high demand and high-reimbursement rates. Diabetic, bariatric, and geriatric patients are most at risk for developing chronic wounds and, because of the aging boomer population and climbing diabetes and obesity rates, the number of wound care patients is expected to increase.
"UNC understood that wound care is a specialty and unfortunately in our culture there's a tremendous need, especially with the rise of diabetics in the nation," Skinner says of the Chapel Hill, NC system. "With a wound center, you can delve deep at UNC because we're close to the vascular center. You can't just treat the wound, you have to figure out why you have the wound… and they have access right here in the clinic to be able to treat the whole patient."
Hospitals with wound healing centers are often financially profitable because Medicare has a high-reimbursement rate for wound procedures and hyperbaric medicine, says Bob Bauman, MBA, chief development office at National Healing Corporation, a wound management company based out of Boca Raton, FL. The Medicare reimbursement rate is important to wound healing centers because a large percent of patients are under the plan, including 62% of patients treated by National Healing Corporation.
"In the last four-to-six years, CMS has had a steady reimbursement increase on those procedures, not only for the hospital, but the physicians who perform those procedures," he says. "The reason why Medicare has continued to increase it is because the cost of care is so effective."
Another benefit for a hospital to partner with a wound healing center is its popularity among referring physicians. "A wound care patient takes a lot of time—what we can offer is to focus on the specific care of the patient's wound," says Skinner. "It's very expensive to staff and keep up with the latest wound care products and plan of care, so for a general practice, it is not effective for them to try and manage this part of the patient's care."
Partnering with a wound healing center also gives hospitals the chance to one-up the competition. "It gives the hospital an opportunity to gain market share in a specific location, if they're the only hospital that provides that service line," Bauman says. And, unlike standalone wound healing centers, patients at a hospital-owned center can seamlessly be referred to other physicians in the organization.
Because having a wound healing center can be a strong market differentiator, many organizations have little need to launch any marketing efforts.
"We don't do a lot in terms of marketing direct to the consumer," says Terri Harris, director of the Wound Healing and Hyperbaric Oxygen Center at Chandler (AZ) Regional Medical Center. "It's expensive to put ads in the newspaper or TV and radio commercials, and we have to get authorization from insurance companies. I find it's better to do the education to the physician at his or her office and then they're able to refer the patient in."
Health reform brought us a bunch of new words and phrases to learn and use. But in case you missed some of them, here's a quick pastiche of some of the most interesting.
1. BoTax. Senate Majority Leader Harry Reid's health reform package included a proposal that would impose a 5% tax on all cosmetic surgery, raising about $5 billion between now and 2020 to help pay for health reform. But the idea was quickly thrown out.
Not only did plastic surgeons vehemently object, but the tax was seen as discriminatory toward women, some of whom argue that as they age, they need a bit of work done to maintain their appearance in a competitive workplace. They saw such a tax as sexist, because in men, an older appearance is seen as dignified, but in women not so much. The current discussion has shifted toward what might be called a "Brown Tax," a similar fee on those who use tanning salons.
2. Core or Process Measures versus Outcome Measures. Core measures are increasingly used as surrogates to rate quality of care during the process of providing that care. Health plans and government payers use these measurements to reward providers for completing steps in the road to improve quality.
For example, there is evidence that giving certain drugs to patients admitted to the hospital with symptoms of heart disease is associated with quicker recoveries and lower death rates.
Outcome measures, however, are a much more direct way of evaluating quality, such as counting the number of patients who fell, developed a hospital-acquired infection or wound, or died during or shortly after a particular surgical procedure.
3. Electronic Medical Records (EMR) versus Electronic Health Records (EHR). These acronyms were around before 2009, but more Americans are now aware of the technology. EMR and EHR are sometimes used interchangeably, but they are not the same thing, although further refinements of their definitions are ongoing. EMR is the electronic replacement of a paper chart and the record of a patient's history and care generated by one particular provider. An EHR, meanwhile, is a complete, long-term computerized electronic record of a patient's care culled from any and all provider settings.
The EHR connects multiple providers, such as hospitals and clinicians, laboratories, and prescription and/or pharmacy histories, test results, and care notes collected by any provider throughout time for one particular patient.
4. Engage With Grace. If asked where they wish to die, in a hospital with tubes and strangers, or at home with family and friends, most Americans would say they want to die at home.
The health reform debate this past year frequently drew attention to the fact that an enormous amount of the nation's healthcare dollars are spent during the last two years of life, when interventions will merely prolong life by a few weeks or months.
All too often at the end of life, doctors push family members to keep patients in the hospital to manage the death process. One such incident prompted a California family to launch Engage With Grace, an effort to provoke a national familial discussion about how people want to end their lives. It sounds morbid, but all too often patients affected by terminal illness have not sufficiently explained their wishes to their loved ones.
5. Garlic Milkshake. Rep. John Boehner doesn't think a government run health plan is a suitable solution for the uninsured and said in the fall that he doesn't think the American people like it either. "I'm still trying to find the first American to talk to who is in favor of the public option," the Ohio Republican said in September. "This is about as unpopular as a garlic milkshake."
Obviously, Boehner didn't understand the political chutzpah of Gilroy, the California town south of San Francisco that claims to be the garlic capital of the country, and where garlic milkshakes, or at least garlic ice cream, are considered a must-have delicacy.
Deeply offended, Rep. Mike Honda, a San Jose Democrat whose district includes Gilroy, promptly delivered Boehner a basket of Gilroy garlic to Boehner's office. He stopped short of trying to send him an actual milkshake or ice-cream, perhaps fearing it would sour or melt along the way.
Honda included a limerick, which his staff presumably wrote: "Two things make for a strong healthy heart.
Gilroy garlic, for one, a good start.
Public option? Also high in the American eye.
65 percent ne'er want it to part."
6. Guaranteed Issue. Increasingly popular provisions in health reform bills would prohibit health plans from rejecting an applicant based on pre-existing conditions or health risk. The bill approved by both houses of Congress would prevent carriers from setting premiums based on health status.
7. HAIs or Hospital Acquired Infections. Increasingly dreaded by care providers, hospital acquired infections, such as methicillin-resistant staphylococcus aureus or Clostridium difficile, kill 98,000 hospitalized patients. Efforts are underway to use creative efforts, such as hospital observers like secret shoppers, to make sure providers wash their hands whenever they're supposed to and that other universal precautions are taken.
There's more at stake for providers, as Medicare no longer pays for care required because of a HAI, leaving hospitals to absorb the cost of care on their own.
8. Medicare Buy-In.Now, apparently out the window, this health reform proposal would have allowed people between the ages of 55 and 64 to pay premiums in exchange for early eligibility in the Medicare program. Its fading chances are blamed on the fact that it is seen as too expensive, both for government and the would-be enrollee.
9. Nosocomial versus iatrogenic.These labels are frequently used interchangeably, but they too have a subtle difference. Nosocomial incidents originate in a hospital and are usually associated with infections when it's unclear how the incident occurred.
Iatrogenic incidents are the direct result of unintentional actions by a physician or surgeon, such as a sponge left in a surgical cavity or an infection carried by a doctor or nurse who touched two patients without washing.
10. VBP or Value-Based-Purchasing. VBP is a movement by employers and purchasers to get more for their money in improved results. One way to think of VBP is that it might eliminate coverage for procedures for which there is little evidence of efficacy.
According to the Agency for Healthcare Research and Quality, VBP is "any purchasing practices aimed at improving the value of healthcare services, where value is a function of both quality and cost. It can be helpful to think about value as the result of quality divided by cost."
Six years after Congress added a prescription drug benefit to Medicare, Democrats in the House and Senate are poised to make a change that would get rid of a gap that forces millions of elderly patients with especially high expenses for medicine to pay for much of it on their own, the Washington Post reports. The closing of the unusual gap in Medicare drug coverage would "forever end this indefensible injustice for American's seniors," Senate Majority Leader Harry M. Reid (D-NV) said in announcing that the Senate would join the House in supporting the change.
States that have already broadly expanded healthcare coverage are pushing back against the Senate overhaul bill, arguing that it unfairly penalizes them in favor of states that have done little or nothing to extend benefits to the uninsured, the New York Times reports. The bill passed by the Senate would move toward universal health insurance coverage in large part by expanding Medicaid, a program whose costs have traditionally been shared by the states and the federal government. The states that oppose the bill say they cannot afford to essentially subsidize other states' expansion of healthcare.
House and Senate negotiators will meet in January to mesh their health bills after the Senate voted 60-39 Christmas Eve for a bill that aims to deliver on a Democratic goal of extending insurance coverage to nearly every American. Abortion policy, taxes, and a proposed government-run health-insurance plan are at the core of the coming struggle, the Wall Street Journal reports. But just about everyone in the health industry have provisions they want to keep, change, or scrap, the Journal reports.
Major health insurers, which decided to support key aspects of President Barack Obama's healthcare overhaul, are now picking through the Senate's version of the legislation and finding cause for concern, the Wall Street Journal reports. Big insurers are still hoping to influence some language in the legislation before Congress sends it to the president, but the initiative is poised to change their industry more than any other sector of the U.S. healthcare system, the Journal reports.
Businesses are set to push for modifications to the Senate-approved health bill, while urging lawmakers to steer clear of the version passed by the House, the Wall Street Journal reports. The Senate bill has drawn tentative support from some large corporations and industry groups, despite containing a range of provisions that they hope to change. But businesses of all sizes oppose the House bill, which contains more-stringent requirements on employers to offer health coverage to employees.
In 1994, healthcare spending in Dallas and Sacramento was about the same. Since then, Dallas has become one of the highest-spending cities in the country. In Sacramento, medical inflation has cooled down, and the city now spends well below the national average. Healthcare workers in Sacramento say they bent the cost curve through integration. They cut duplication and waste by bringing doctors, hospitals, nurses, and other caregivers together so patient care could be coordinated, the Dallas Morning News reports.
Jason Boyd has been appointed interim chief executive of the Metro Nashville Hospital Authority. Boyd will assume the role on Feb. 1. Current CEO Dr. Reginald Coopwood recently told the authority's board that he plans to accept the chief executive post at Regional Medical Center in Memphis.
