[BUMPED 09.16.09 10 AM — Originally posted: 09.11.08 5:22 PM]
▲ We’re underway — the Chairman is quoting John Donne — “No man is an island. . . .” — We must connect these lonely, desolate “islands” of our US Health Care Delivery, into one cohesive nation. . . .
▲ Sen. Baucus contrasts primary care, from primary care providers v. tertiary care (in the ER, for example) statistics — US v. Australia — and how much less, per person, Australia spends on health-care
▲ Sen. Grassley now explaining the fragmented, siloed system — with lack of accountability, and lack of affordability. . . . the way we pay for health care drives many of these problems.
▲ Mark Miller, of the Medicare Payment Advisory Commission — is proposing “bundled” payments for hospitalizations — rather than paying for each test, service or visit by a doctor. . . .
▲ Dr. Glenn Steele of Geisinger Health System points out that his hospital is able to recieve higher rembursement for making mistakes, than it receives when the hospital “gets it right” the first time. He explained that if a patient gets an infection, after any-given routine surgery — the hospital receives extended payments to treat the infection inside the hospital, thus generating more revenue than if the patient had gone home — and stayed healthy — two or three days after surgery. This must end.
▲ Eric G. Campbell, of Harvad, notes the ubiquitous inter-relations between industry and treating or prescribing physicians, and explains how it often leads to undesired results: doctors receiving gifts from drug companies are more likely to give their patients the companies’ drugs, than those who do not accept such gifts. He next outlines industry-supported research (without full and frank disclosure of remuneration): that has led to concerns that the research is biased in favor of industry-positions. . . .
▲ Dr. Berensen, of the Urban Institute, suggests that “medical home” concepts may not always solve the ills we perceive from over-treatment, and inappropriate use. Moreover, incentives must be created to encourage physicians, other professionals and institutional providers to become part of accountable care organizations, and then incentives must be created for those organizations to improve value for purchasers.
As a prime example, whether or not the kinds of organizations I have described develop broadly throughout the country, delivery system reform of any kind will not succeed if hospitals continue to be rewarded for increasing the volume of inpatient admissions and penalized for working with physicians and other clinicians to avoid hospitalization for large numbers of patients with so-called “ambulatory care-sensitive conditions.”
If these patients receive appropriate ambulatory care, many would not need to be hospitalized, but currently hospitals have no financial interest in joining collaborative efforts to develop the needed alternative delivery approaches. . . .
[Other duties call — I’ll be offline for a few hours.]
This next Senate hearing — in the series of three, immediately before election day 2008 — will be held on September 16 –- Delivery system reform –- creating a patient-centered model of care, understanding the importance of primary care and developing new approaches to shore up its role in the health system. This is the one to which Big Pharma ought listen most-intently.
The fianl hearing in the series will be held on September 23 –- Insurance market reform -– exploring ways to improve access to coverage through pooling arrangements, or through the creation of a health insurance exchange or “connector” -– connecting individuals, small businesses and those eligible for premium subsidies to available health insurance plans.
The Full Witness Line-up — for the first Senate hearing:
[LIVE REALMEDIA VIDEO LINK, here, on Hearing-day morning.]
UNITED STATES SENATE
COMMITTEE HEARING NOTICE
The Case for Delivery System Reform“
September 16, 2008, at 10:00 a.m.,
in 215 Dirksen Senate Office Building
Senator Max Baucus, MT
Senator Charles Grassley, IA
[Click on each name, above, and below,for full-text, easy-view versions of the statements, on Hearing day.]
Mark E. Miller, Ph.D., Executive Director, Medicare Payment Advisory Commission, Washington, DC
Glenn Steele Jr., M.D., Ph.D., President and Chief Executive Officer, Geisinger Health System, Danville, PA
Robert Berenson, M.D., Senior Fellow, Urban Institute, Washington, DC
Eric G. Campbell, Ph.D., Associate Professor, Harvard University School of Medicine, Boston, MA
Max Baucus (D, MT),
United States Senator,
and Chairman, Senate
Committee on Finance
Charles S. Grassley (R, IA)
United States Senator
and Ranking Member,
Committee on Finance
We’ll have LIVE video, and when the below-light is “ON” — live-blogging as welll — so do join us!