President Obama wooed the American Medical Association with talk of curbing malpractice lawsuits and canceling a proposed 21% cut in Medicare payments as he ramped up a newly aggressive effort to line up industry support for an overhaul of the nation's health system. But he refused to endorse the group's top goal of caps on damage awards and steadfastly defended creation of a government-sponsored health insurance program, which many physicians oppose.
In an effort to ensure that any overhaul of the U.S. healthcare system does not undermine the Massachusetts health insurance law, state legislative leaders will announce a special Senate committee to monitor congressional action and suggest potential changes. Chairing the new committee will be Senator Richard Moore, a Democrat who also is one of several state lawmakers invited to the White House to discuss how the Massachusetts' experience can help national leaders as they craft their blueprint.
A key Senate committee wrestled with details of a health plan that would allow nonprofit cooperatives to compete with private insurers and would tax healthcare benefits for the first time. Top Senate Finance Committee aides are scrubbing financing options in a bid to find more than $1 trillion needed to pay for a 10-year plan, and have settled on many details of how to expand coverage to the uninsured.
Under one financing proposal, healthcare benefits worth more than $17,000 would be taxed as regular income, a cap that would be allowed to grow annually, said people familiar with committee discussions. A version of this plan was evaluated by the Congressional Budget Office last year and found to raise some $450 billion over 10 years.
President Barack Obama called the cost of healthcare a "ticking time-bomb" that threatens to slow the nation's path to prosperity, as he pushed a massive reform plan during an appearance before the American Medical Association. "We are spending over $2 trillion a year on healthcare—almost 50% more per person than the next most costly nation," he said during a nearly hour-long speech before the doctors' group. "For all this spending, more of our citizens are uninsured, the quality of our care is often lower and we aren't any healthier."
Former Sen. Tom Daschle says controlling the cost of malpractice insurance will have to be a part of the Obama administration's overhaul of the healthcare system. The onetime Democratic leader in the Senate said he believes "tort reform is going to be on the table," and that it's important that all "stakeholders" in the looming debate be given a chance to be heard, according to the Associated Press.
The union that represents nurses and other healthcare workers at Bayonne (NJ) Medical Center has reached a tentative agreement with the hospital administration. The pact maintains seniority rights and severance pay in case of layoffs for members and establishes a new three-year contract, the union said. The agreement follows two months of negotiations that turned increasingly bitter, culminating in a three-day lockout of the Health Professionals and Allied Employees union at the facility.
The Medical College of Georgia received permission from a national accreditation agency to move ahead with plans to open a campus in Athens. The campus is scheduled to open in August 2010, and college officials will begin accepting applications later this month, spokeswoman Toni Baker said. The Liaison Committee on Medical Education sent a letter saying planning is on track to admit 40 students to the Medical College of Georgia/University of Georgia Partnership Campus in Athens. The two colleges are working together to expand medical education programs.
As the president spoke at the annual conference of the American Medical Association in Chicago, it became clear that one of the major health plans on the table would cost at least $1 trillion over 10 years yet leave tens of millions of people uninsured. An analysis released by the nonpartisan Congressional Budget Office raised the hurdles for draft legislation as the office concluded that a plan by the Health, Education, Labor and Pensions Committee's Democratic leaders would reduce the number of uninsured only by a net 16 million people. Even if the bill became law, the budget office said, 36 million people would remain uninsured in 2017.
Facilities in the United States and the United Kingdom are using storytelling to enhance the information that comes out of the patient history taken by a care provider, which is often used to get a better sense of how to treat the patient. Storytelling also helps providers develop a relationship with the patient and form a better understanding of an individual case.
"In asking the questions, the practitioner starts bringing out the texture of the person’s life, and not just the data," says Andre Heuer, DMin, LICSW, a storyteller, psychotherapist, and educator in Minneapolis. "The details begin to fill in, so it becomes a broader picture with movement and what the patient feels about the situation along the way."
Continuing to ask questions throughout the patient’s diagnosis will help develop a more cohesive story, allowing any gaps to be filled in that might have been missed otherwise. This also helps reveal unknown causes of a patient’s condition or illness and can lead to quicker responses, says Heuer.
Anna Tee, patient stories coordinator at the 1,000 Lives Campaign in Wales, an initiative of the United Kingdom’s National Health Service (NHS), says there has been a shift in belief from "the doctor knows best" to a recognition that the patient’s perspective should be considered. This belief has helped develop storytelling as a technique for patient care.
"'Patient stories' is a term that describes a powerful tool that is extremely effective in gathering, listening to, and making changes based on the patient’s voice," says Tee. The process must allow for a patient or patient caregiver to present his or her experience with an illness or condition in his or her own words "to gain an understanding of what it is like as a patient."
Why does storytelling capture the mind?
A "story" and "storytelling" each have benefits when broken down, says Haven. The following are a few reasons stories are more effective than using plain data:
Human minds are hardwired to think in very specific story terms; we make sense out of experience through story
Human memory is strongly enhanced by story, and there is a greater likelihood that we will retain the information shared through a story than information presented through detail points, which are more likely to be altered or forgotten
Stories create empathy
Points to remember
Before a facility can jump into using storytelling, staff members should clearly understand why they are using the tactic. This understanding, as well as organization and planning, are key factors to the program’s success.
"The hospital should be aware that there is value in storytelling, that staff members with patient contact need to understand what storytelling means, and that storytelling should not interrupt the normal flow of the hospital and staff members’ schedules," says Kendall Haven, author and master storyteller at the International Storytelling Center in Jonesborough, TN, which promotes the power of storytelling to enrich life in the home, workplace, and community.
After an understanding is established within the facility, an ethically appropriate and effective process can then be put into place, says Tee.
"The process of taking stories is very different from how people are used to working," says Tee. "It is a process that is interested in uncovering the experience from the patient’s perspective, which will enrich and improve healthcare provision in the future."
How a staff member tells a story, receives a story, and recounts a story to another person must all be taken into account, as there is more than one way storytelling can be presented. "The model developed by the 1,000 Lives Campaign talks about four main uses of stories: to inspire, to educate, for learning, and for promoting a better public understanding and awareness via the media," says Tee. "Listening to patients helps [the NHS] to see so many things that may otherwise go unnoticed and helps us build a picture of what it is like to receive healthcare and how it can be improved."
Stories can be told by the patient, a relative of the patient, or even through digital media to preserve the story and share it with a larger audience.
A relative’s story is just as important as the patient’s interpretation of what happened. The relative’s story offers a different, but valuable, perspective that can further the development of the patient’s case.
The American Medical Association and America's Health Insurance Plans have already spoken out about portions of President Barack Obama's healthcare reform plan, and a third major stakeholder came forward to criticize a part of the plan today.
Though the eyes of healthcare were on the AMA as the president spoke to the group in hopes of winning its support for his healthcare reform package, the American Hospital Association made it clear that it will not support healthcare reform that would cut hospital payments.
AHA President and CEO Rich Umbdenstock said Monday that hospitals support "systemic reform that lowers costs and improves care for patients," but opposes "more than $220 billion" in hospital payment cuts.
"Hospitals are already facing as much as $41 billion in cuts due to the Medicare payment system changes recently proposed by the Administration," Umbdenstock said. "Additional cuts of this magnitude could severely jeopardize hospitals' ability to care for their patients and communities."
Umbdenstock said hospitals support healthcare coverage expansion to all Americans, but that must happen in concert with "adequate financing for hospitals that serve large numbers of poor and uninsured patients."
AHA opposes a proposal to cut the Medicare and Medicaid Disproportionate Share Hospital programs, which the organization said "overlooks the critical role these important programs play in supporting a broad range of services for uninsured children and adults as well as essential community services such as trauma and burn units, disaster readiness, neonatal care, and emergency psychiatric services."
Programs like DSH help hospitals mitigate Medicare and Medicaid underpayments. Even with the DSH payments, federal programs still pay hospitals more than $32 billion below the cost of caring for patients on average, said Umbdenstock.
AHA is lobbying Congress to not cut DSH programs before:
Healthcare coverage is expanded to all Americans
Medicare and Medicaid underpayments are addressed
Umbdenstock said the AHA remains committed to reducing health costs, but can't support a program that would hurt hospitals at the same time.
"Reform must improve care for patients without crippling hospitals' ability to care for patients and communities. We stand ready to help the Administration and the Congress make thoughtful reform a reality," Umbdenstock said.
