Let's throw a pair of numbers out there: 26% and 3%. Those are the percentages for emergency department (ED) diversion rates Providence St. Joseph Medical Center, Burbank, CA, saw prior to and after targeting the topic for improvement with Six Sigma.
Since introducing Six Sigma in its Southern California medical centers, Providence California has seen across the board improvements in clinical outcomes, care, customer relations, and finance.
The ED became the organization's first target for improvement. Three areas were highlighted: ambulance diversion rates, number of patients who left without seeing a physician, and overall length of stay in the department.
"The spark was started at the system level," says Arnold R. Schaffer, vice president and chief executive with Providence California, part of Providence Health & Services.
Like all organizations, Schaffer says, Providence was searching for ways to strive towards excellence in quality. It began a process of exposing senior and upper management to different models for process improvement in other industries.
"We realized it's really improbable to take someone else's model and [implement] it in your organization," says Schaffer. "You've got to find your own way. We in California immediately went a different route."
This meant the first step to implementing Six Sigma was bringing in fresh eyes—the system brought in a high-level Six Sigma Black Belt and taught the person about healthcare rather than teaching a healthcare expert about Six Sigma.
"Then we made a major commitment—we knew this wasn't flavor of the month," says Schaffer. "We funded it aggressively. It sometimes appeared we overfunded it."
But, Schaffer noted, push doesn't work well in management—the trick is to get management buy-in so pull happens instead.
"After about 18 or 24 months, as [Six Sigma] built up slowly, the results were so impressive that the organization started to pull," says Schaffer.
Allocating resources
The organization is up to 10 full-time black belts, 32 change facilitators, one master black belt, and two master change facilitators.
"We use them between five hospitals and all of our support services," says Schaffer. "Rather than strictly embedding them in single hospitals—which we had also done for a while—allocation of resources and priority of setting is done on a regional setting."
Despite these impressive numbers, there is still room for expansion—and Schaffer is all for it.
"The return on investment is so great that I'm happy to get more," says Schaffer. "It's not one of those things to keep resources down. Try to get your organization to pull more resources. The more they pull the more you get."
So—how big was that return on investment? How about $11 million in savings?
And it's not just about the money, says Schaffer.
"Take out the salaries of those people involved and you have a tremendous financial pickup. A lot of the work that they do though we don't measure in financial terms," says Schaffer. "There are all sorts of things you could put money to, but it gets too squishy. All numbers that come out for our Lean Six Sigma program are validated by our CFOs, and CFOs are not squishy."
Immediate results
Providence operates an independent blood center, with several bloodmobiles on the road.
"We increased our availability, not just volumes of blood, because we had people backed up wanting to donate, but prior to Lean Six Sigma we were only able to capture 30 units a day per vehicle," says Schaffer. After Six Sigma? That number jumped to 75 units a day per vehicle.
Successes occurred inside the walls as well.
"The one that really touches me the most directly, that we're the most thrilled about—we have a hospital in Burbank whose ED was overwhelmed at all times," says Schaffer.
The ED had a diversion rate between 25% and 30%. It was this facility that saw its diversion rate drop down to 3%.
"It was a total redesign, but not physical," says Schaffer.
EDs have a lot of similarities across the country—it has been said that EDs are 80% the same regardless of facility. ("That 20% is a big difference," notes Schaffer.) Most ED staff "grew up" in another ED. They've worked in the same environment most of their lives. This means you've got to use a zero-base process redesign.
"The black belts help the team to do this," says Schaffer. "They see no boundaries."
Those new eyes mean it's possible to entirely change a department, while retaining the same walls, layout, staff, and equipment.
Other improvements:
The percentage of patients who left the ED without seeing a physician dropped from 8% to 3%
Patient satisfaction skyrocketed—prior to Six Sigma in the ED, patient satisfaction hovered at 67%, and jumped to 97% afterward
Positive responses to wait times climbed from 44% to 85%
A virtual nurse named "Elizabeth" is helping nurses and patients during the discharge process.
Elizabeth is a computer-animated character created from combining the facial expressions and gestures of doctors and nurses that Timothy Bickmore, a computer scientist at Northeastern University in Boston, MA, taped. With the help of an animator, Bickmore was able to create all the animation segments the nurse delivers, which will also be Elizabeth's responsibility.
Elizabeth tries to help patients understand discharge information. According to the Centers for Disease Control and Prevention latest statistics, 40 million patients are discharged from hospitals every year without fully understanding the follow-up care needed to prevent readmission. Other national studies show that 20% of patients are readmitted to the hospital 30 days after discharge, with a third of those readmissions preventable.
With Bickmore's system, when a patient is ready for discharge, a touch-screen computer can be wheeled to the bedside. All the patient's discharge information is pre-programmed, so Elizabeth can directly help the patient answer any questions or concerns they might have.
Elizabeth can discuss the 1,500 most commonly prescribed medications and she also quizzes patients to make sure they understand the information given to them. If the patient happens to get a question wrong, and Elizabeth is unable to answer the question, the nurse receives an alert.
Using Elizabeth is not intended to be a replacement for the nursing staff, but to offer a helping hand to staff members and their patients. The use of virtual nurse also intends to provide patients with a comprehensive informational review upon discharge. As the average discharge conversation between a nurse and a patient is eight minutes, the new system will allow patients to take their time and better comprehend the information presented to them.
Still in the clinical trials of the system, Bickmore eventually plans to develop an application where patients can talk to the virtual nurse while in the comfort of their own home.
Sentara Williamsburg (VA) Regional Medical Center (SWRMC) marked five years without a case of ventilator-associated pneumonia (VAP) in February 2009 and is hoping to report six years in February 2010.
This milestone, which at one time many facilities believed to be unattainable, has been achieved through members of the care team adhering to protocols, understanding the importance of their jobs, and evaluating the need for placing patients on a ventilator in the first place.
"We focus heavily on device utilization, because if you don't put a patient on a vent, [he or she] can't get ventilator-associated pneumonia," Kathy McCoy, ¬RN-BC, BSN, CCRN, ICU manager and director of patient care services at SWRMC, said in a presentation at the IHI's 21st National Forum on Quality Improvement in December 2009. "The less days you have them on a vent, the less their chances are of developing ventilator-associated pneumonia."
When patients arrive, staff members evaluate whether they need to be ¬intubated, or whether there is a bridge, such as BiPAP, that can be done instead, said McCoy.
SWRMC is a 145-bed nonprofit hospital (part of the larger Sentara system) with a 16-bed ICU. The ICU's average daily census is seven patients, and on average there are two or three new patients per week on a ventilator, who spend an average of 2.3 days using it. ICU patients at SWRMC cost an average of $6,000 less than patients at comparable facilities, and its rate of zero VAPs has allowed the facility to reside in the top 10% of all facilities in the United States, with respect to VAP rates.
So how has SWRMC managed to banish VAP, the second most common hospital-acquired infection (HAI) in hospitals and the most common HAI in ICUs? Although many factors are involved, the simplest way to describe the achievement is the hospital's increased focus on reducing length of stay in addition to decreasing ventilator days. Because so few patients are placed on ventilators at SWRMC, even one case of VAP will cause the facility's VAP rate to skyrocket. Additionally, SWRMC's ICU has the luxury of utilizing its own dedicated intensivist to manage patients.
Practices changed to prevent VAP
In 2003, members of the ICU staff created an ICU partnership council. It was made up of a nurse, respiratory therapist, physician, nutritionist, and pharmacist. They focused first on caring for the ventilated patient.
To start, the council implemented the IHI's ventilator bundle, which includes the following actions:
Elevation of the head of the bed
Daily "sedation vacation" and assessment of readiness to extubate
Peptic ulcer disease prophylaxis
Deep venous thrombosis prophylaxis
To adhere to this bundle, the council developed policies and procedures, said McCoy. First, the team worked on a ventilator order sheet. The order sheet contained the criteria that needed to be implemented for patients on a ventilator, most of which are listed in the IHI bundle. Next, the team developed a procedure for sedation vacation, defining what tasks should be done during a vacation and what taking one means for a patient, and an intensive insulin protocol. Last, staff members focused largely on oral care procedures.
"We really had no guidelines on what oral care meant," said McCoy. "We used to do oral care whenever the staff felt like the patient needed oral care." Staff members were also using saline down the endotracheal tube, she said. The staff changed its policy so that saline was used only rarely and put an oral care procedure in place to define what was expected of staff members.
To ensure compliance with the VAP bundle, a member of the quality improvement staff audits ICU staff members' practices. Staff members are held accountable if they are aware of their responsibilities but fail to perform them, said McCoy. Charge nurses in the ICU participate in peer coaching with other nurses on the unit to help them improve compliance. McCoy also posts the compliance rates with the bundle indicators so that staff members have an idea of how they are performing.
Additionally, the ICU implemented daily interdisciplinary patient rounds. When they first began, the rounds consisted of a nurse and respiratory therapist. Now, the three- to five-minute rounds consist of those staff members plus a physician, a nutritionist, a pharmacist, a case manager, infection control specialists, and a palliative care nurse.
"This is probably one of the best things that our team agreed to try," said McCoy. "It took showing the staff what interdisciplinary rounds could do for the patient—that [the rounds were] truly helping the patient get well, rather than just busywork for them."
While it might not qualify yet as a warm embrace, safety and facilities professionals in hospitals in 2009 at least shook hands with Twitter and found new ways to get their messages across using the social media site.
For those of you unfamiliar with Twitter, at its core is the ability for users to post short, 140-character updates—known as "tweets"—about what they're doing. You can keep track of other's tweets you're interested in (i.e., people you're "following") and also see who's reading your tweets (i.e., "followers"). You need to be registered with Twitter to follow someone's tweets.
Disaster management seems to be a natural extension of Twitter for hospital safety officers and emergency management coordinators. Here are two examples of many seen over the past year:
After the mass shootings at Ford Hood, TX, on November 5, Scott & White Hospital in Temple, TX, revved up its existing Twitter presence with useful updates (the hospital received 10 shooting victims). Among the information tweeted: the operating status of the hospital's ER and wait times for volunteers to give blood.
Sts. Mary & Elizabeth Hospital in Louisville, KY, experienced terrible flooding in August, and the facility used Twitter to keep the public and employees up-to-date on evacuated patients and building conditions.
Tweeting has not been lost on The Joint Commission. In its August 2009 Environment of Care News, the accreditor noted that an emergency management standard requires hospitals to prepare for emergency communications with staff members, external authorities, patients, families, media, vendors, and other healthcare facilities. Social media sites are a good strategy for emergency communication, the commission said. Other hospitals use Twitter to promote safety initiatives to their staff members and the public.
The communications department at SSM Health Care in St. Louis created an animated safety champion named Super Carol, who appears in employee-focused print and online media, offering information on hot-button issues, such as handwashing protocols, patient lifting, and needlestick prevention. SSM uses its Twitter account in part to update people about the latest adventures of Super Carol.
"Safety can be numbing to people because we preach it all the time," said Lorraine Kee, SSM's corporate Web manager. "I like [Super Carol] because it pushes it out in a newer, fresher way."
Safety officers can also find tweets from others to be helpful on the job. Earlier in December, U.S. Secretary of Labor Hilda Solis tweeted about her agency's updated regulatory agenda, which included information about an airborne transmissible disease standard, which is posed to become a big issue for safety officers.
Hundreds of women in Cabarrus County, NC, are proudly touting pink pins in support of breast health, and their numbers are rising every day. Carolinas Medical Center-NorthEast gives the pins to women who have received a mammogram—a demographic that has increased since the 457-bed hospital launched an awareness campaign last year. The effort won the organization a platinum award in the women's health service line category at the 2009 HealthLeaders Media Marketing Awards.
CMC-NorthEast launched the campaign after a survey found that just 36% of women in the county had a mammogram. Marketers wanted to educate the community about mammogram effectiveness and clear up common misconceptions. The campaign included print, direct mail, outdoor, and online elements.
"The photos used in this campaign were diverse, younger looking women," CMC-NorthEast wrote in its entry form for the awards. "We wanted to relay the message that breast cancer is not reserved for the older population. Images of mothers with their children were used to convey that a woman's health not only affects her life, but the lives of her children and other family members as well."
The campaign also alerted potential patients of the hospital's extended mammography hours, which make it more convenient for busy women to get screened. Campaign copy was printed in English and in Spanish to reach a wide audience.
"The imagery was upbeat and positive," one judge wrote. "Copy really drove the campaign and offered the information needed to meet the objectives. Imagery and copy in Spanish worked well with the original campaign information (muy bien) without resorting to stereotypical visual support. The stats are woven in to the copy naturally."
The ads resonated with locals, too. The number of screening mammograms in Cabarrus County increased to 27.7% in 2008 and to 42% in 2009. From April 2007 to April 2008, CMC-NorthEast increased screenings by more than 800 mammograms.
It's the end of December and you know what that means: One million editors are busy putting together slideshows of recently-dead celebrities, the 12 best YouTube videos of dogs howling "I love you," and montages of the Miracle on the Hudson. Two mornings ago, while getting ready for work, I actually stopped what I was doing to watch a segment on the "stupidest criminals of 2009." And I'm not ashamed to admit I enjoyed it.
1. Hospitals will look for new ways to use new media and social media, including Twitter. That's right: I predicted that Twitter would be hot in 2009. What do you think? Should I quit my day job, buy some head scarves and a crystal ball, and take my act on the road?
It seems so obvious in hindsight, but I also added a caveat that I think hospital and health system marketers came to understand in 2009, after the novelty of blogging 140-characters at a time wore off: Social media marketing might be all the rage in 2009, I wrote, but it doesn't mean guaranteed success or a positive return on investment. You still need a strategy to communicate the right message and reach the right customers.
I almost wore out my keyboard writing about and participating in social media in 2009. I don't expect that will change in 2010, but I am curious to see if Twitter will go the way of Friendster and MySpace or if it will take off like Facebook and YouTube. Even more suspenseful: Will I re-read this column a year from now and scoff at the fact that I thought Facebook and YouTube would have staying power?
2. Healthcare will look to other industries for innovative ideas. I'd make this prediction again this year, in part because recycling is good for the planet and in part because I think the healthcare industry hasn't quite gotten there, yet. Don't get me wrong, we had a few other issues on our minds (and wallets) in 2009. But I have faith this trend might still catch on. A common theme in this year's HealthLeaders Media Hospital of the Future Now event was the lessons that healthcare leaders can learn from outside industries. A discussion panel on patient experience, for example, included Gar Crispell, general manager for the American Girl Doll retailer, who talked about going beyond good customer service to create memorable experiences for customers. The opportunities are there. It's just a question of whether leaders will have the bandwidth to pursue them in 2010.
3. Internal communications will remain hot as hospitals look to stay upbeat in a downturn. I'm not sure how well I did with this one—I think some hospitals and health systems did a better job than others of allaying employees' fears about layoffs and other economic worries. As usual, it came down to leadership and communication style. You either had leaders who were candid in their communications or you had ones that clammed up. Not much the marketing department could do with the latter.
On the other hand, I think that in 2009 we had a collective "a-ha moment" as we came to understand that employee satisfaction is one of the biggest influencers on patient satisfaction. The math is simple: Happy employees equal happy patients and families, creating increased word of mouth, a stronger brand, and a better bottom line. And as the importance of the patient experience continues to grow in 2010, I think healthcare organizations will catch up with me on this prediction, too.
One more prediction for you: Unless my crystal ball is cracked, next week's column will take a look at the year ahead and the healthcare marketing trends that will emerge in 2010.
An added bonus: It's also a popular time of year for "top 10" stories. One of my top picks? 10 Weird Healthcare Stories of 2009 by HealthLeaders Media editor John Commins.
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It's been just 60 days since two small hospitals in rural Kansas teamed up to host a successful celebrity basketball game, which raised $40,000 for women's cancer prevention.
But the event was more than just a sold-out game.
The event itself became a vehicle to educate and energize health awareness in an area troubled by the economic recession and poor access to care.
Because of the game, and the money raised, five small towns (total population 2,500) will have mobile digital mammography, in a Winnebago, starting in February. Women will have access to colonoscopies through a program provided by Pratt Regional Medical Center, which is 90 miles away.
So, in the spirit of the end of the year and the holidays, I asked the CEO of one of the hospitals, Benjamin Anderson of 24-bed Ashland Health Center, to dissect why the event worked so well so other rural health officials might try a similar event.
But first let's explain what happened. The idea to put on a celebrity game sprung from the imagination of Joe LaBelle, a 21-year-old dishwasher in the Ashland hospital kitchen, Anderson says.
Through fate, LaBelle happened to share a car ride with Anderson. LaBelle had been attending services for his grandmother, who had just died of breast cancer that was caught too late. And he was fresh with regret, and "what ifs" what if a mammogram had caught his grandmother's lump in time.
Anderson says women delay mammography in their rural areas. "Women are driving an hour to get a mammogram, and many drive 2.5 hours to Wichita for a digital mammogram," he says. Another impediment is the cost, $100 to $150 for a mammogram, plus loss of a day's pay to make the drive, plus costs of gasoline.
"The expense can amount to several hundred dollars. So often, women just don't get them," Anderson explains.
Members of the community started to join in the discussions, which noted that women's health is critically important to the health of entire families.
"Women make up 80% of the healthcare decisions for their families, but when they're managing health not just for themselves, but often both sets of parents and grandparents, mom tends to neglect her own," Anderson says. "So when mom comes down with stage 4 breast cancer, everyone else's health is affected too."
"When we educate and empower women to take responsibility for themselves, they bring along everyone else," Anderson says. "They even persuade men to undergo prostate exams."
Residents in the area formed a group called the WEPAC Alliance (named after the five towns in the area: Wilmore, Englewood, Protection, Ashland, and Coldwater) and just about everyone played an important role.
LaBelle suggested that the region's health providers, Ashland Health Center and 14-bed Comanche County Hospital in nearby Coldwater, team up to think about a basketball event.
Soon, celebrity players, including Jackie Stiles, the all-time leading scorer in NCAA women's basketball who grew up in a nearby small town, agreed to participate. So did star players from college teams in Kansas, Missouri, Nebraska, and Iowa. Fox Television kicked in, and advertisers paid for travel. About 138 sponsor names are listed on the Web site. There were about $30,000 in-kind contributions for uniforms, game basketballs, and many other material or advertising donations, and $40,000 in cash. A Jumbotron was brought in so people who couldn't buy tickets could watch the game in the Ashland High School football field. The Kansas State and University of Kansas cheerleaders volunteered too.
Writing about the event in Sports Illustrated Nov. 2, columnist Joe Posnanski described the tremendous spirit as like that depicted in the movie It's A Wonderful Life.
One amazing lesson, Anderson says, was the discovery that five communities that might compete and fight—especially because of the economic downturn that has taken so many businesses and jobs and sometimes pitted communities against each other—"dropped their walls, locked arms, and found a way to work together."
Tickets were sold for $30 and the 1,000 seats in the Ashland gymnasium were sold out in just a few hours, Anderson says.
Next year, he adds, the coordinating committee will market more aggressively outside their communities to sell more tickets and bring in more resources. And there will be an effort to televise the game nationally, perhaps to sell more tickets to people from out of town who come to watch.
"We had people coming from North Dakota; Austin, TX; Springfield, MO; Colorado; and Kansas City," Anderson says.
And of course one of the best outcomes from the entire experience is a new appreciation among women in these communities of the importance of prevention screening.
What lessons learned would he like to share with other hospital officials who might like to duplicate the effort? One of the most important, he says, is something administrators like him should understand: "The best ideas don't come from administration. They come from people like a dishwasher in our kitchen, Joe LaBelle."
This time of year, journalists, writers, and editors try their hands at playing Nostradamus.
We think back on the current year, and predict what the next year will bring. Usually we offer these predictions at the start of the year and never look back at them. But this year I decided to look back to see how right—and how wrong—I was about 2009.
The year 2009 brought great hope—and fear. A new president and Congress looked to make changes to healthcare. This talk was celebrated by some in healthcare, while others—namely health insurers—were concerned about how these changes would affect them.
So, let's look back at 2009 and see how I did:
Healthcare reforms: Think incremental
On this one, I was correct in one aspect. I predicted health reform would be slow, but I also suggested that any health reform would not be meaningful." That's hard to gauge. As part of that prediction, I also suggested that states would not wait for the feds and would implement their own reforms. That has not been the case as states have stood pat while waiting for reform to make its way through Washington.
More children will get insurance in 2009
This one was a home run. I predicted that Congress would renew the State Children's Health Insurance Program (SCHIP) within President Barack Obama's first 100 days and lower income thresholds that would allow states to provide coverage to more children. Obama signed a new law that expanded SCHIP by roughly $35 billion over five years in February after a partisan vote on Capitol Hill.
I was right, but you didn't need to a crystal ball for this one—or my third prediction.
Medicare Advantage fight begins
Anyone who followed the 2008 presidential campaign should have seen this coming. Then-candidate Obama made it clear he did not like Medicare Advantage, saw it as a Republican giveaway to private insurance companies, and bristled at Medicare Advantage services costing the federal government 14% more than traditional Medicare.
Within three months of the new president taking office, the Obama administration implemented more regulations for health insurers that offer Medicare Advantage and the Centers for Medicare and Medicaid Services lowered Medicare Advantage reimbursements to health insurers.
Cutting Medicare Advantage payments are also seen as a way to help fund health reform and a source to help balance the federal budget.
In response, some insurers have dropped out of the Medicare Advantage program and more could follow with the payment cuts being eyed in health reform.
What will be interesting is to see if there is any political backlash from seniors when the impact of lost Medicare Advantage programs is felt in 2010.
More employers will turn to CDHPs
The percentage of employers with consumer-driven health plans did not spike as much as I expected in 2009, but the growth of CDHPs has been gradual since they became an option in the early-2000s. America's Health Insurance Plans said CDHPs increased by 2.5 million members between 2008 and 2009, but CDHPs are still not anywhere near as popular as PPOs and HMOs.
However, these plans are affecting other types of benefit design—both negatively and positively. First, on the negative side CDHPs have inspired employers to create high-deductible plans, which in many ways are just a means to pass health costs onto the consumer. What's often lacking in those plans is the education component. On the plus side, forward-thinking employers and health plans are learning from consumer plans and spreading that education to other plans. So, some insurers are now offering the same healthcare educational opportunities to members regardless of their benefit design.
Whether CDHPs gain a greater share of the market will depend on what happens in Washington (CDHPs are seen as a Republican solution), as well as whether insurers and employers can actually reduce health costs by empowering—and properly educating—the healthcare consumer.
Questions about DM
Disease management advocates were happy to see 2009 after a difficult year in which CMS ended the DM-inspired Medicare Health Support demonstration project because of disappointing results, and experts questioned whether DM actually reduced costs and improved outcomes.
DM saw its rocky stretches this year too, including LifeMasters Supported SelfCare Inc. filing for bankruptcy in September.
I predicted that 2009 would be a year in which the health industry continued to question DM and it was up to DM to release objective reports about which offerings work best for particular disease states. If DM didn't start this process, I predicted that 2009 could mark the beginning of the end of DM.
The industry studies are still lacking, but employers are also still investing in DM—and the industry is making strides in moving from the old nurse call-center-based model to one that incorporates technology, self-management, member empowerment, and face-to-face interaction when needed.
Chronic care is going to become even more important as more baby boomers move into retirement age. There is a place for DM to flourish in the next 20 years—and those who innovate are the ones who will survive.
There's my look back on 2009, which was an eventful year for healthcare at the national level. I expect the states to get active again in reforms in 2010 and look for ways to bridge gaps left from federal health reform legislation.
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Skilled nursing facilities (SNF) have been waiting for a new advanced beneficiary notice (ABN) for years and their wait may finally be over. During the December SNF Open Door Forum, the Centers for Medicare & Medicaid Services (CMS) announced that providers should expect to see the new SNF ABN (form CMS-10055) early next year.
"The new form is currently undergoing the agency's internal approval process and should be ready to implement by the end of January," said Charlayne Vann, healthcare policy consultant at CMS.
When items or services are not expected to be covered by Medicare, SNFs must issue a beneficiary notification to the resident prior to providing the services. This notification informs the resident of his or her financial responsibility for the service. If a beneficiary notice is not issued, issued outside the time period, or is issued improperly, the SNF may be responsible to cover the cost of the service.
Unfortunately, the current beneficiary notification process can be confusing because of the multiple forms SNFs have to choose from. For example, when Part A services are ending but the resident will remain in the SNF for custodial care or therapy, SNFs can issue the SNF ABN or one of five SNF denial letters. Once use of the new SNF ABN becomes mandatory, there will no longer be the option to use the denial letters, thus simplifying the beneficiary notification process.
"We will have a transition period from the old form to the new and expect to implement mandatory use of the new form by March 2010," Vann said.
Once the new SNF ABN is approved, it will be posted on the beneficiary notices initiative page on the CMS Web site at www.cms.hhs.gov/BNI/.
Florida Attorney General Bill McCollum says his office will conduct a legal review of the healthcare bills in Congress to determine the constitutionality of the individual mandate that makes health insurance a requirement.
McCollum, a former Congressman who is also a Republican candidate for governor in 2010, says he has asked attorneys general in other states to join his review, and he suggested that a court battle would be waged if the reforms as they are now written become law.
"The healthcare legislation moving through Congress is troubling for several reasons including its big government approach, its tremendous cost to taxpayers, and ultimately its mandates on Floridians," McCollum said. "Most concerning is the individual mandate that a person must pay a fine or tax if he or she does not obtain federally required health care insurance."
"I have grave concerns about the constitutionality of this mandate. Such a 'living tax' is worrisome because it would be levied on a person who does nothing, a person who simply wishes not to be forced to buy health insurance coverage," McCollum said. "The mandate is especially troubling to Floridians who are guaranteed through the Florida Constitution to have 'the right to be let alone and free from governmental intrusion into [their] private life.'"
McCollum says his legal review will focus on the possible violations of the Commerce Clause and Taxing Power in the U.S. Constitution.
McCollum already is among at least 10 of 19 Republican attorneys general who are evaluating the constitutionality of the Senate bill provision that provides 100% federal Medicaid funding for Nebraska, without similar funding going to states like Florida. The funding windfall was demanded by Sen. Ben Nelson, D-NE, to win his support for the Senate bill.
Democrats dismissed McCollum's review as political theater. "McCollum's argument is not just silly, it's insulting to the people of Florida given his record of trying to dismantle Social Security and Medicare every chance he could get," said Eric Jotkoff, Florida Democratic Party spokesman. "Under McCollum's flawed logic, Americans are "forced" to have Social Security and Medicare taxes deducted from their paychecks. Is McCollum declaring Social Security and Medicare 'unconstitutional?' Is that why he devoted so much of his Congressional career to undercutting them?"
At a media availability Tuesday, McCollum rejected those suggestions.
"I'm not opposed to healthcare reform as such though I'm not happy with this particular bill, and I want to be constructive about it," he said. "On the other hand if they want to pass a bill that contains flawed provisions that impose this type of individual mandate, I think there has to be a serious look as to whether the states join together to protect our citizens and challenge the constitutionality of such a provision."
McCollum also dismissed suggestions that his review was a campaign publicity stunt designed to show his opposition to a bill that the GOP primary voter base loathes.
"You can look at this any way you want to," he said. "I'm looking at this as the attorney general of the state of Florida. I would be doing this whether I were running for governor or not," he said.
