Obama to governors: Opt out of health law if you can do better


By Julie Rovner, NPR News
This story comes from our partner NPR‘s Shots blog.

President Obama is moving to quell a rebellion among the ranks of the nation’s governors, who want more of a say in how billions of dollars in shared health care dollars are spent.

At a working session Sunday, several governors called for turning the joint federal-state Medicaid program into a system of “block grants,” where they would be able take federal dollars and spend them as they see fit.

That’s something long pushed by Republicans, and long opposed by Democrats.

Instead, however, at the governor’s annual visit to the White House Monday, President Obama offered a much smaller concession to health spending flexibility: Endorsement of a bipartisan proposal to allow states to opt out of most of last year’s health law’s requirements sooner than was originally envisioned when the law was passed.

“Beginning in 2017, if you can come up with a better system for your state to provide coverage of the same quality and affordability as the Affordable Care Act, you can take that route instead,” Obama told the governors.

And Obama said he supported moving that date up to 2014, as proposed by Sens. Ron Wyden, D-Ore., and Scott Brown, R-Mass., to “give [governors] flexibility more quickly, while still guaranteeing the American people reform.”

A lot of people have called this the “calling their bluff” proposal. And Sen. Wyden, who’s been shopping the bill around to both Democratic and Republican governors, doesn’t completely disagree.

“You’ve got a lot of states where Republican governors, Republican legislatures, are clearly going to have their ideas about health reform,” Wyden said in an interview. “As long as they meet the coverage requirements in the bill, they can do it. And progressive folks are gonna try the same kinds of approaches.”

In fact, noted Wyden, Vermont Gov. Peter Shumlin is pushing for the idea of having a“single payer” system rather than requiring everyone to have private health insurance.

Republicans governors, however, aren’t yet embracing Wyden’s proposal, or President Obama’s promise of more flexibility in health care spending.

“He says very nice things and he says them very nicely,” said Gov. Chris Christie, R-N.J. “But in the end I have a job to do, and what I’d like is to have the flexibility to exercise the authority that the people of New Jersey gave me in November of 2009.”

Meanwhile, Kansas Republican Gov. Sam Brownback, echoing the concerns of many governors, says what he really wants isn’t more flexibility when it comes to the health care law, but for Medicaid.

“Medicaid is creating a huge hole in my budget and we had to take money from all other places in state government to fill the Medicaid hole,” Brownback said.

On Tuesday several governors will testify before the House Energy and Commerce Committee on the impact of the new health law on Medicaid and state budgets. It’s a hearing that’s expected pour more fuel on the fire of the ongoing health wars.

Text of the President’s remarks on healthcare reform

Which brings me to the final topic that’s going to help determine our ability to win the future, and that’s getting control of our health care costs.  Now, I am aware that I have not convinced everybody here to be a member of the Affordable Care Act fan club.  But surely we can agree that for decades, our governments, our families, our businesses watched as health costs ate up more and more of their bottom line.  There’s no disputing that.  That didn’t just happen last year.  It didn’t just happen two years ago.  It’s been going on for years now.

We also know that the biggest driver of the federal debt is Medicare costs.  Nothing else comes close.  We could implement every cut that the House of Representatives right now has proposed and it would not make a dent in our long-term budget, wouldn’t make a dent in our long-term deficits — because of healthcare costs.  We know it’s one of the biggest strains in your state budgets — Medicaid.

And for years, politicians of both parties promised one thing:  real reform.  Everybody talked about it.  Well, we’ve decided to finally do something about it — to create a structure that would preserve our system of private health insurance; would protect our consumers from the worst abuses of insurance companies; would create competition and lower costs by putting in place new exchanges, run by the states, where Americans could pool together to increase their purchasing power and select from various plans to choose what’s best for them — the same way that members of Congress do, the same way that those who are lucky enough to work for big employers do.

And the fact is, that the Affordable Care Act has done more to rein in rising costs, make sure everyone can buy insurance, and attack the federal deficit than we’ve seen in years.  And that’s not just my opinion; that’s the opinion of the Congressional Budget Office — nonpartisan — the same one that puts out numbers that when it’s handy to go after me, people trot out and say, boy, these are — look at these numbers.  So they’re saying we’re saving a trillion bucks because of this act on our health care costs.  Otherwise, we’d be a trillion dollars more in the red.  That’s something that we should build on, not break down.

Now, that doesn’t mean that the job of health care reform is complete.  We still have to implement the law, and we have to implement it in a smart and non-bureaucratic way.  I know that many of you have asked for flexibility for your states under this law.  In fact, I agree with Mitt Romney, who recently said he’s proud of what he accomplished on health care in Massachusetts and supports giving states the power to determine their own health care solutions.  He’s right.  Alabama is not going to have exactly the same needs as Massachusetts or California or North Dakota.  We believe in that flexibility.

So right now, under the law, under the Affordable Care Act,
Massachusetts and Utah already operate exchanges of their own that are very different — operate them in their own way.  And we made sure that the law allowed that.  The same applies for other requests, like choosing benefit rules that meet the needs of your citizens, or allowing for consumer-driven plans and health savings accounts.

And this recognition that states need flexibility to tailor their approach to their unique needs is why part of the law says that, beginning in 2017, if you can come up with a better system for your state to provide coverage of the same quality and affordability as the Affordable Care Act, you can take that route instead.  That portion of the law has not been remarked on much.  It says by 2017, if you have a better way of doing it, help yourself, go ahead, take that route.

Now, some folks have said, well, that’s not soon enough.  So a few weeks ago, Oregon Senator Ron Wyden, a Democrat, and Massachusetts Senator Scott Brown, a Republican, and Louisiana Senator Mary Landrieu, they proposed legislation that would accelerate that provision.  So it would allow states to apply for such a waiver by 2014 instead of 2017.

I think that’s a reasonable proposal.  I support it.  It will give you flexibility more quickly, while still guaranteeing the American people reform.  If your state can create a plan that covers as many people as affordably and comprehensively as the Affordable Care Act does — without increasing the deficit  — you can implement that plan.  And we’ll work with you to do it.  I’ve said before, I don’t believe that any single party has a monopoly on good ideas.  And I will go to bat for whatever works, no matter who or where it comes from.

I also share your concern about Medicaid costs.  I know this has been a topic of significant conversation over the last couple of days.  We know that over half of all Medicaid costs come from just 5 percent of enrollees, many of whom are what’s called dual eligibles — seniors in Medicare as well as in Medicaid.  The Affordable Care Act helps address this by changing the incentives for providers so that they start adopting best practices that will work to reduce cost while improving quality.

But we understand the pressure you’re under.  We understand that we’ve got to do more.  So today — and I mentioned this to Christine last night — I’m asking you to name a bipartisan group of governors to work with Secretary Sebelius on ways to lower costs and improve the quality of care for these Americans.  And if you can come up with more ways to reduce Medicaid costs while still providing quality care to those who need it I will support those proposals as well.

So here’s the bottom line.  Once fully implemented, I’m convinced the Affordable Care Act will do what it was designed it to do — cut costs, cover everybody, end the worst abuses in the insurance industry, and bring down our long-term deficits.  I am not open to re-fighting the battles of the last two years, or undoing the progress that we’ve made.  But I am willing to work with anyone — anybody in this room, Democrat or Republican, governors or member of Congress — to make this law even better; to make care even better; to make it more affordable and fix what needs fixing.

You see, part of the genius of our Founders was the establishment of a federal system in which each of our states serves as a laboratory for our democracy.  Through this process, some of the best state ideas became some of America’s best ideas.  So whether it’s through Race to the Top, or improving the Affordable Care Act, or reforming the way that we approach social programs by ensuring that spending is tied to success, our approach has been to give you the flexibility that you need to find your own innovative ways forward.  In fact, this week I’m issuing a Presidential Memorandum that instructs all government agencies to follow this flexible approach wherever the law allows.

But even as we preserve the freedom and diversity that is at the heart of federalism, let’s remember that we are one nation.  We are one people.  Our economy is national.  Our fates are intertwined.  Today, we’re not competing with each other; we’re competing with other countries that are hungry to win new jobs, hungry to win new industries.

I’m confident we will win this competition as long as we’re fighting it together.  And I know that, whatever our differences, you share that goal.  So you’ve got a partner in the White House to make this happen.  And I hope that this becomes the start of a productive and serious conversation going forward — one that I want to start by answering some of your questions.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Map of Detroit by race and ethnicity

Higher death rates persist among poor Black Americans


By Carl Sherman, Contributing Writer

Health Behavior News Service

Map of Detroit by race and ethnicity

In 2000, a black, working-aged resident of a poor neighborhood significantly was more likely to die than a white American — a situation that essentially remained unchanged from 20 years earlier, according to a study in the April issue of the American Journal of Public Health.

“The public health profession has been committed to reducing, if not eliminating, racial disparities in health and according to these measures, the glass of progress is at best half full,” said Arline Geronimus, ScD, lead study author.

The failure to reduce the toll of chronic illness is of particular concern, said Geronimus, a professor of health behavior and health education at the University of Michigan.

Map by Bill Rankin: Radical Cartography

The researchers analyzed death-certificate data for three predominantly black, poor, urban neighborhoods, two comparable rural communities and a poor white urban, rural community.

Yearly death rates for black men and women ages 16 to 65 in these communities were higher than for whites nationwide — nearly three times higher, for example, for a resident of eastside Detroit.

A 16-year-old male in Detroit, Chicago’s South Side or Harlem had a 50 percent to 62 percent chance of surviving to age 65, compared with 80 percent for a typical white male the same age, the researchers found.

White working-aged residents of poor urban communities and residents of poor rural areas also died sooner than most Americans, although the difference was not as marked.

Death rates in groups studied had declined from 1990 to 2000, but this latest finding essentially meant a return to higher 1980 levels.

While reasons for persistent disparities in mortality remain unclear, the analysis suggested that illnesses like cancer, diabetes and heart disease are a main factor. “We haven’t adequately addressed prevention and management of chronic disease” in these communities, Geronimus said.

The largest improvement in mortality from 1990 to 2000 was among urban black males and largely reflected fewer homicides. Gains for black women were small and their cancer rates actually increased, Geronimus said.

Brian Smedley, Ph.D., vice president and director of the Health Policy Institute at the Joint Center for Political and Economic Studies in Washington, said that these findings spotlight the importance of community factors. “If you live in a high-poverty area, your risk of early death rises substantially,” he said. “In many cases your ZIP code is more important than your genetic code.”

While most health promotion efforts focus on individual behavior, “this research expands our lens,” Smedley said. Beyond the direct impact of factors like pollution and violence, local variations in accessibility of fresh foods, recreational facilities and medical care “often shape what individuals do.”

Geronimus said a vital need is research that disentangles links between race, poverty and mortality, but in the meantime, “we should target urban high-poverty areas for better diagnosis and management of chronic disease to prevent excess deaths.”

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

Screen shot 2011-02-23 at 10.42.27 PM

Many Americans incorrectly believe health law has been repealed


By Jordan Rau
KHN Staff Writer

Feb 24, 2011

A poll released Thursday found extensive public confusion about the health care law, with 22 percent of Americans incorrectly believing it has been repealed and another 26 percent unsure or unwilling to say.

The results come after the Republican-controlled House of Representatives voted to repeal the law last month, and two federal judges ruled the law was unconstitutional.

After extensive media coverage of these events, only 52 percent of Americans accurately said the health care law, which passed last year, remained intact, according to the poll from the Kaiser Family Foundation.  (KHN is a program of the foundation.)

The poll found that unfavorable views of the law among the elderly have risen to 59 percent, up from 40 percent in December. Republican opposition has grown over recent months, to 84 percent, while 66 percent of Democrats remain supportive and independents are divided. Republicans are more passionate in their opposition than Democrats are enthusiastic about the law.

There remains no consensus about whether to keep, expand, replace or repeal the law. Forty-eight percent are opposed to the law, while 43 percent favor it. Sixty-one percent of those polled oppose Congress cutting off funding of the law in order to block it, as many Republican lawmakers are considering.

A majority of the public has not tired of the debate, but there is much more interest in Congress focusing on the economy, jobs and the budget deficit than on the law. Still, 19 percent of voters want to repeal the law and replace it with a Republican alternative, and 20 percent want to get rid of it.

Several of the individual provisions of the law, including subsidies to help the poor buy insurance and  eventual elimination of the Medicare “doughnut hole” where seniors don’t have coverage for prescription drugs, remain popular with the majority of the public, regardless of their party affiliation. Sixty-seven percent of Americans want to repeal the requirement that everyone hold insurance.

Nearly one in three Republicans thought the law had been repealed. One in four independents and one in eight Democrats thought the same. People with higher incomes as well as those with college degrees were more likely to have an accurate view of the status of the law.

Though the House has voted for repeal, getting rid of the law still requires the approval of the Democrat-controlled Senate and President Barack Obama – something that is unimaginable to political observers.

The public had a better understanding of the status of implementation of the law, with 62 percent saying that some but not all of its provisions had been put into place. Only a minority believe the law has affected them, with 14 percent saying they have benefited and 17 percent saying they had experienced a negative impact.

The public isn’t particularly optimistic about the law’s eventual impact: a minority believe the law will make things better for the country, middle class Americans, the elderly, Medicare, the economy or their own family.

The foundation conducted the survey of 1,202 adults between Feb. 8 and Feb. 13. The margin of error was +/- 3 percentage points.

Contact: jrau@kff.org

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Swedish Logo Large

Eight new physicians join Swedish Neuroscience Institute


Dr. Lam

Dr. Arthur Lam will join the Swedish Neuroscience Institute and Physician Anesthesia Services as medical director of neuroanesthesia and neurocritical care, and medical director of the Spencer Vascular Laboratory.

Dr. Repovic

Dr. Pavle Repovic specializes in autoimmune disorders, multiple sclerosis, limb numbness, neuroimmunology, immunology and double vision. Dr. Repovic is a certified diplomat of the American Board of Psychiatry and Neurology.

Dr. Lee Liou, a specialist in General Neurology and neuromuscular disease, joins the Swedish Neuroscience Institute as an outpatient clinician and hospitalist.

Dr. Simon

Dr. Ednea Simon joins the Epilepsy and Pediatric Neurology team at the Swedish Neuroscience Institute. Dr. Simon is a member of the American Epilepsy Society, the Child Neurology Society and the American Academy of Neurology.

Dr. Lina Fine specializes in sleep medicine and neuropsychiatry. She has conducted extensive research on insomnia, neuropharmacology and neurochemistry. Dr. Fine is certified by the American Board of Psychiatry and Neurology.

Dr. Young

Dr. Ronald Young joins Gamma Knife Radiosurgery Program at the Swedish Neuroscience Institute. Previously, he was the director of the Gamma Knife Center at Northwest Hospital for 17 years, served as head of neurosurgery at the University of California Irvine and was a professor at the University of California Los Angeles. He also has expertise in Deep Brain Stimulation.

Dr. Douglas Backhouse oversees the Center for Hearing and Skull Base Surgery, a practice to help those living with hearing loss, deafness, ear disease and skull based tumors. Dr. Backhouse’s particular interests include cochlear and auditory brainstem implants, middle ear implants, facial nerve disorders, otosclerosis, chronic otitis media, acoustic neuromas, inherited ear malformations, neurofibromatosis type-2, and hereditary and childhood hearing loss.

Dr. Malik

Dr. Amer Malik, who specializes in ischemic and hemorrhagic stroke care, joins the Swedish Neuroscience Institute Stroke Program.

He is also a member of several professional societies including the Society of Vascular and Interventional Neurology, the American Heart Association / American Stroke Association, and the American Academy of Neurology.


GOP budget cuts seek to throttle health reform law


By Julie Rovner, NPR News

This story comes from KaiserHealthNews partner NPR‘s Shots blog.

Did House Republicans keep their promise to defund the health care overhaul as part of their bill to cut more than $60 billion from the federal budget for the rest of the fiscal year?

You betcha. They’ve come up with more than half a dozen ways to throttle spending on overhaul, in fact.

Most of the attention went to the amendment to the spending bill offered by Rep. Denny Rehberg (R-MT). Rehberg, who chairs the spending subcommittee that oversees the Department of Health and Human Services, offered language to the bill that would bar the use of funds to pay the salaries of any HHS “employee, officer, contractor, or grantee” to implement the health law. It passed on a 239-187 vote, almost exclusively along party lines.

But just in case that doesn’t work, House Republicans passed several other amendments as well.

Rep. Rehberg

Now you may be thinking, well, this particular bill isn’t going anywhere, since the Senate has already said it won’t vote for cuts as deep as the House is demanding, and President Obama has already threatened a veto of the measure, even before the language was added to try to block his signature domestic policy achievement.

But it’s worth a look at some of these other GOP health amendments, not only to get a peek at the party’s strategy going forward for the rest of the year, but to get an idea where Republicans think the health measure’s soft spots are that could win over some wavering Democrats.

As it turned out, there weren’t many waverers in the House. None of the amendments got more than eight Democratic votes (and even the overall bill got three Democratic ‘ayes.’).

But Republicans seemed to zero on in what they — and many opinion polls — perceive as the least popular aspects of the measure.

For example, by a vote of 246-182, the House adopted an amendment by Rep. JoAnn Emerson (R-MO) that would bar the IRS from implementing or enforcing the portion of the law that requires nearly every American to have health insurance starting in the year 2014. That was the high water mark for Democratic support, at eight.

The House also adopted an amendment, 241-185, by Rep. Tom Price (R-GA) that would block funding for rules that require insurers to spend a minimum percentage of their premium revenues on medical care. The so-called “medical loss ratio” rules are in effect as of this year.

Two other Republicans sought to make it more difficult for the federal government to build the infrastructure the law needs to expand insurance coverage starting in 2014.

By a vote of 241-184 members adopted an amendment offered by Rep. Cory Gardner (R-CO) to bar funding for creation of state health insurance exchanges, while they voted 239-183 for an amendment offered by Health Subcommittee Chairman Joe Pitts (R-PA) to block funding of rules defining “essential benefits” all health plans must include.

At least a couple of amendments, however, didn’t make the cut. Because the measure under consideration last week was technically a spending bill, it was subject to strict rules that prohibit changing legislative language.

When Rep. Rosa DeLauro (D-CT) challenged one amendment offered by Rep. Steve King (R-IA) for violating that rule against legislating on a spending bill, however, Rep. Anthony Weiner (D-NY) mockingly jumped to King’s defense.

“The point of order suggests the gentleman is legislating on an appropriation bill. I have watched those guys. They are incapable,” Weiner said. “Almost metaphysically impossible for the gentleman to be legislating. He doesn’t know how. How could we possibly have legislating in this bill?”

Rep. Rob Bishop (R-UT), who was acting as speaker at the time, dryly responded, “The chair is prepared to rule and has been entertained.” Bishop then ruled that the amendment was in fact legislating and was out of order.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

An umbrella sheltering medicines - credit Microsoft

View: Congress must provide states more Medicaid flexibility


By Congresswoman Cathy McMorris Rodgers and Jason Mercier

When President Obama signed the unpopular Patient Protection and Affordable Care Act last year, he made many promises, including that the law would increase health-care access and lower costs. As states begin the process of devising their annual budgets, it’s more clear than ever that those promises aren’t being kept — especially in our home state of Washington.

Rep. McMorris Rodgers

State officials last year debated opting-out of the federal Medicaid program so they could preserve flexibility in providing health-care services to needy families. Currently, Washington faces a projected $5 billion state budget shortfall. The alternative to opting out of Medicaid is the potential elimination of all state-only health-care programs such as the Basic Health Plan, prescription-drug coverage and the Disability Lifeline program.

The new federal health-care law imposes a Medicaid Maintenance of Eligibility restriction on the states that prohibits local elected officials from making reductions. This restriction, combined with looming state budget deficits, means legislators and governors are faced with the painful decision of funding state-only health-care programs or providing matching funds for federal Medicaid dollars — they can’t do both.

Already health officials in Nevada and Wyoming have drafted white papers discussing the possibility of opting out of Medicaid to preserve more budget flexibility. Similar conversations are occurring across the country in blue states like Washington and red states like Texas. This problem transcends which party controls a state’s budget and demands bipartisan congressional support for Medicaid reform.

Though a state actually opting out of Medicaid remains unlikely, the fact that it is openly being discussed signifies the need for states to have more flexibility in the Medicaid program. Otherwise state health-care spending will be limited to administering the federal Medicaid program at the expense of state-directed priorities.

Jason Mercier

While the new Republican majority in the U.S. House will not provide states another federal bailout, it can work with the Senate to reform the Medicaid program to provide states the discretion to make local health-care decisions. We are working on a proposal to do just this.

Unless states are provided more flexibility over Medicaid spending they will be forced to either opt out of the program or eliminate state-only health-care priorities. A better strategy would be for Congress to transform the current categorically restricted Medicaid program, which is dictated by D.C. priorities, into an indexed block-grant program that would allow each state to design a comprehensive state-based health-care system that meets the unique needs and priorities of its citizens while protecting the most vulnerable.

Many states are already asking the federal government for this type of Medicaid flexibility, including legislators here in Washington. Last month, state Sens. Linda Evans Parlette, Joe Zarelli, Randi Becker and Minority Leader Mike Hewitt introduced Senate Bill 5596 to require the Department of Social and Health Services to request an indexed Medicaid block-grant waiver to “allow the state to operate as a laboratory of innovation for bending the cost curve, preserving the safety net, and improving the management of care for low-income populations.”

To help determine what indexed growth factor should be used for a Medicaid block-grant program, governors and state Medicaid directors across the country should work with Congress to design a fiscal growth factor that would meet state needs. This type of reform would also help Congress with its deficit-reduction efforts since Medicaid costs would be more predictable.

Congress should reform Medicaid to avoid radical disruptions to state health-care networks. Failure to do so will result in states merely becoming passive administrators of the federal Medicaid program while state-only health-care programs are eliminated to balance budgets.

Reforming Medicaid into an indexed block grant that provides state spending flexibility will instead facilitate 50 laboratories of democracy working to identify innovative health-care reforms to provide a meaningful safety net for the most vulnerable in our society.

The article first appeared as an op-ed in The Seattle Times.

Rep. Cathy McMorris Rodgers, left, represents Washington’s 5th Congressional District and serves as vice chair of the House Republican Conference. Jason Mercier is director of the Center for Government Reform at the Washington Policy Center based in Seattle.

Hospital Hallway

Health reform law targets hospital readmissions


By Michelle Andrews

“Welcome back” are two words you’d really rather not hear at a hospital, especially if you’ve just been discharged. Yet one in five Medicare patients found themselves back in the hospital within 30 days of leaving it in 2003 and 2004, according to a recent study in the New England Journal of Medicine.

Even more troubling is the possibility that three-quarters of those readmissions might have been prevented, as estimated in a 2007 report by the Medicare Payment Advisory Commission (MedPAC), an independent agency that advises Congress.

What gives? All too often, experts, say, the problems that send patients back to the hospital might have been avoided if there had been a better handoff from the hospital to the people responsible for the next phase in a patient’s recovery, whether it’s the patient himself and his family, a home health agency, a nursing home or a hospice.

“We don’t do a good job of coordinating care,” says Patricia Rutherford, vice president at the Institute for Healthcare Improvement, which is directing a multi-state initiative to reduce rehospitalizations.

Hospital readmissions aren’t only bad for patients’ health, they’re expensive.

Discharged patients may be confused about their new medication regimen, for example, or they may not understand diet restrictions. Maybe they don’t have transportation to a follow-up appointment; worse, they may not have an appointment scheduled at all.

In fact, the New England Journal of Medicine study found that half of patients who were readmitted within 30 days hadn’t visited a doctor since their discharge. “For very sick patients being discharged by hospitals, we think that’s way too late,” says Rutherford.

More From This Series: Insuring Your Health

Hospital readmissions aren’t only bad for patients’ health, they’re expensive. MedPAC estimated that in 2005 readmissions cost the Medicare program $15 billion, $12 billion of which could have been avoided.

The health-care overhaul takes aim at the problem by penalizing hospitals with higher-than-expected readmission rates for Medicare patients who had been treated for heart failure, heart attack or pneumonia.

Those hospitals could see their Medicare payments reduced by up to 1 percent beginning in October 2012, 2 percent the following year and 3 percent the next. The law expands in later years the list of conditions that can result in penalties.

The Department of Health and Human Services allows consumers to make side-by-side comparisons of hospitals’ readmission rates for heart failure, heart attack and pneumonia at hospitalcompare.hhs.gov.

“There’s a very strong case to be made that if you want to change something as important as readmission, you’ve got to look at every lever you’ve got,” says Stephen Jencks, a physician and lead author of the NEJM study. “Payment is a very important one, but by no means the only one.”

A growing number of hospitals and health systems are already working on the readmissions problem with support from nonprofit groups and foundations.

Piedmont Hospital in Atlanta is one. A few years ago, it began participating in Project Boost, a discharge-transition program developed by the Society of Hospital Medicine.

Through Boost, Piedmont proactively targets patients who are at high-risk of readmission. Staff members use a checklist to ensure that potential logistical and psychosocial problems are addressed before the patient leaves the hospital. Another priority: scheduling patients before discharge for their first follow-up visit to the doctor.

Patients also receive a form to take home that explains in simple terms why they were in the hospital; what they need to do to continue their recovery, including medications, diet restrictions and warning signs of trouble; and whom to call if they experience problems. Within three days of discharge, a nurse calls to check on them.

“It’s more work, it takes more time and there’s more confusion” until the new processes are in place, says Matthew Schreiber, chief medical officer for the 480-bed hospital.

But the effort has paid off. Thirty-day readmission rates for patients under age 70 have declined from 13 percent to just under 4 percent since the program began; rates for those 70 and older have dropped from 16 percent to 11 percent.

A Project Boost phone call may have helped Bill Cox avoid a hospital readmission. Among many medical problems, the 58-year-old recently had femoral bypass surgery at Piedmont to reroute blood from the large artery in his leg to avoid a blockage there.

After Cox returned home, a nurse practitioner from the hospital called to check on how he was doing. One of the questions she asked his wife, Rhonda, was whether he had had a blood test to see if his dose of Coumadin, a blood thinner, was the correct one. Coumadin can cause fatal bleeding, and patients who are on it must have their blood tested regularly.

He hadn’t done so, so the nurse practitioner asked the local home health agency helping the couple to arrange for the test.

As it turned out, the dose needed adjustment. “His blood was too thin,” says Rhonda Cox. “It was just like water.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Globe floating in air

Does Gates funding taint media’s global health coverage? — Seattle Times asks


In a front page article, Seattle Times reporters Sandi Doughton and Kristi Heim ask whether the more than $50 million the Bill & Melinda Gates Foundation has given to the media and media programs could be biasing the media’s coverage of global health and foreign policy.

They write:

The foundation’s grants to media organizations such as ABC and The Guardian, one of Britain’s leading newspapers, raise obvious conflict-of-interest questions: How can reporting be unbiased when a major player holds the purse strings?

But direct funding of media organizations is only one way the world’s most powerful foundation influences what the public reads, hears and watches.

To garner attention for the issues it cares about, the foundation has invested millions in training programs for journalists. It funds research on the most effective ways to craft media messages. Gates-backed think tanks turn out media fact sheets and newspaper opinion pieces. Magazines and scientific journals get Gates money to publish research and articles. Experts coached in Gates-funded programs write columns that appear in media outlets from The New York Times to The Huffington Post, while digital portals blur the line between journalism and spin.

Some journalists fear the Gates funding is undermining their independent coverage of controversies covering global health and foreign aids policy:

Marc Cooper, assistant professor at the University of Southern California’s Annenberg School for Communication & Journalism, “finds it ‘laughable’ when media claim Gates money doesn’t influence their coverage, ” say Doughton and Heim. “Every grant comes with at least one string attached, he said: the hope that the grant will be renewed. Recipients can be reluctant to bite the hand that feeds them.”

Tom Paulson, author of KPLU’s global health blog Humanosphere, has written extensively on the media’s peculiar relationship with the Gates Foundation.

These kind of arrangements confuse or disturb some people and I’ve given the media folks at the Gates Foundation a bit of grief over the past few months about the nature of some of these partnerships. This might seem kind of odd, I know, since I work for NPR, which also has been funded by the world’s largest philanthropy to report on global health and development issues — and which is what I do (even though I get no Gates money)

Despite my criticisms and tendency to poke fun at the stories about Bill and Melinda done by these media partners that appear a bit keister-kissing, I think overall this is a good thing. I just believe these arrangements need more scrutiny and, frankly, the media does a poor job of scrutinizing itself.

To learn more:

  • Go to Tom Paulson’s Humanosphere blog where you can find a number of posts on the topics, including a Q&A with Kate James, head of communications at the Gates Foundation.

Seattle Times calls for marijuana legalization


Image: Oren neu dag / Creative Commons License

In its Sunday editorial, The Seattle Times calls for the Washington state Legislature to legalize marijuana.

The paper’s editorial board writes:

“Marijuana should be legalized, regulated and taxed. The push to repeal federal prohibition should come from the states, and it should begin with the state of Washington.”

In the editorial, the paper endorses state House Bill 1550, which would legalize marijuana and sell it through the state liquor stores to customers over 21 who consume it in private.

Prohibition has not worked, the paper argues, and the costs of enforcement its is too dear, including:

  • The expense of enforcing current laws.
  • The stigmatization of people arrested and convicted for possession.
  • The undermining of civil liberties during investigations by such measures as wiretapping and home searches.
  • The promotion of criminal activities–including gang activities–by forcing the distribution and sale underground.
  • The loss of estimated $300 million in potential revenue that taxes on the legal sale of marijuana could bring in.

“Some drugs have such horrible effects on the human body that the costs of prohibition may be worth it. Not marijuana. This state’s experience with medical marijuana and Seattle’s tolerance policy suggest that with cannabis, legalization will work — and surprisingly well.”

To learn more:


A guide to GOP proposals to slash family planning


By Aimee Miles

Controversy over the GOP’s reproductive health agenda is mounting as House members consider a budget plan that slashes funds for family planning clinics and eliminates federal support for Planned Parenthood, a major provider of reproductive health care in the U.S.

Republican leaders say that desperate times call for painful cuts in federal spending—and abortion providers are a prime target.

Rep. Mike Pence

Rep. Pence

“Nobody is saying that Planned Parenthood cannot continue to be the largest abortion provider in America, but why do millions of pro-life taxpayers have to pay for it?” Rep. Mike Pence, R-Ind., one of the leaders of the effort to strip such funding from the bill, said in a floor speech Thursday.

Rep. Lee

Planned Parenthood has launched a fierce public relations campaign against the measure, backed by progressive Democrats who have vowed to fight the GOP.

“It’s just amazing that the Republican leadership is anti-choice and on the other hand, anti-family planning,” Rep. Barbara Lee, D-Calif., said at a press conference on Tuesday. She added, “This is a war on women.”

What Is Title X?

Title X (ten) of the Public Service Act is a federal grant program signed into law by President Richard Nixon in 1970. According to the Guttmacher Institute, a New York-based reproductive health research center, the law had broad bipartisan support and was the result of increasing concerns that low-income women were not able to get access to family planning services and had higher rates of unwanted pregnancies than more affluent women.

Title X grants, which are administered through state health departments or regional agencies, support family planning programs in 4,500 clinics serving 5 million individuals across the country.

The funds, which totaled $317 million last year, are used to provide a range of reproductive health and family planning services primarily to low-income individuals.

The program is run by the Department of Health and Human Services and provides funding for contraceptive counseling and supplies, STD testing, breast and cervical cancer screenings, vasectomies, hypertension and blood pressure measurement, prenatal care and sex education.

While Title X is the only federal program dedicated exclusively to reproductive health care, it isn’t the only source of public funding for family planning services, or even the largest.

About 12 percent of the $1.85 billion in public funds spent on family planning services in 2006 came from Title X, according to Guttmacher. The biggest chunk of funds—71 percent—came from Medicaid, a joint federal-state health program for low-income individuals and families. The remainder was funded through various federal block grants and state appropriations.

What Are Republicans Proposing?

Several measures offered by Republicans are part of a House budget bill.

The House is expected to vote today on a measure that would eliminate all Title X funding as part of a massive bill that would set budget levels for the remainder of the fiscal year, which ends Sept. 30.

That “continuing resolution,” H.R. 1, seeks to trim billions of dollars from discretionary funding in the federal budget. Once the House has passed a bill, it will go to the Senate for consideration.

A spending bill must be enacted by March 4, when the current temporary funding ends.

The House Friday approved an amendment offered by Pence to the spending bill that cuts all forms of federal funding for Planned Parenthood, which operates a network of more than 800 family planning clinics nationwide. Planned Parenthood receives roughly $360 million in federal assistance annually through Medicaid, Maternal and Child Health block grants and other sources.

The GOP’s plans to cut Title X and to defund Planned Parenthood are at odds with President Barack Obama’s priorities—the president requested $372 million for family planning in his FY 2012 budget.

Does This Affect Abortion Coverage?

Current law prohibits health care providers from using federal money to finance abortions. But the law doesn’t bar Title X grantees from using other funds to cover abortion-related care, so long as they keep those funds segregated from federal grant money.

Before introducing his amendment to the spending bill, Pence had also introduced H.R. 217, known as the “Title X Abortion Provider Prohibition Act,” which would prevent health centers that offer abortion services from receiving future Title X family planning grants (exceptions would be made in cases of rape, incest or a threat to the mother’s health).

The bill has been effectively tabled pending the vote on the overall spending continuous resolution, which, if enacted, would eliminate the need for H.R. 217.

Several other bills dealing with abortion funding have also been introduced.

What Do Family Planning Supporters Say Is At Stake?

Reproductive health advocates such as Families USA, Planned Parenthood and NARAL Pro-Choice America argue that eliminating or restricting access to Title X money would cut off vital financial support for health centers that are providing care at steeply discounted rates for low-income patients.

According to Adam Sonfield, a senior public policy associate at the Guttmacher Institute, Title X money gives clinics the flexibility to invest in things like outreach and infrastructure—something Medicaid payments don’t account for. The institute also estimates that the contraceptive services offered at Title X centers prevent 973,000 unintended pregnancies each year.

Planned Parenthood says six in 10 family planning centers in the U.S. receive Title X funds, which account for 24 percent of their revenues. Planned Parenthood is the largest single recipient of Title X money, securing about a quarter of the total allocated to health centers each year.

According to Karen Rowley, who oversees several Planned Parenthood-affiliated health centers in California’s Fresno area, clinics are already turning away patients because of the overwhelming demand for services. Losing all federal funding would further exacerbate the problem.

“Many of our patients would go without medical care, not only reproductive healthcare but for primary care needs,” Rowley said.

The national organization has painted a picture that is even more dire—63 percent of its health centers would be at risk for shutting down altogether if H.R. 1 passes, the group says.

What Do Critics Say About Cutting Planned Parenthood’s Federal Funds?

The Heritage Foundation, a conservative think tank based in D.C., presents a different view.

Chuck Donovan, a senior research fellow at the foundation, says Planned Parenthood has significant income beyond federal funding, citing a 2010 GAO report indicating the organization’s income was $388 million between 2002 and 2007. “They can afford to join in the belt-tightening that is happening all across the country,” he said.

As for the other health centers that would be affected by Title X cuts, Donovan said that supporting family planning through tax rebates or vouchers, rather than a categorical funding program with an established mandate, would be a better option.

“Our preference is to fund health care through things that give individuals choice,” he said.

Pence has acknowledged that health centers use Title X money to perform valuable services that he supports, but he contends that the funds are also being used to support abortions indirectly by covering operating costs and other related expenses for Planned Parenthood and other abortion providers.

“Eliminating Title X funding has never been my goal,” he said on the floor Thursday. “My focus has and will remain on denying taxpayer dollars to Planned Parenthood or any organization that provides or promotes abortion as a means of birth control.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Arizona State flag

Feds help states seeking to cut Medicaid rolls


By Marilyn Werber Serafini
KHN Staff Writer

By telling Arizona Tuesday it can effectively end Medicaid coverage of a quarter million people, the Obama administration has pointed out a potential escape hatch for other financially strapped states seeking to cut people from the program.

It’s just not clear how big the hatch is.

Arizona Gov. Jan Brewer had asked for a waiver from a requirement in the new health care law that states maintain current eligibility levels for Medicaid between now and 2014, when a huge expansion of the program begins.

But Health and Human Services Secretary Kathleen Sebelius told Brewer that she didn’t need Washington’s permission to cut the state’s Medicaid rolls.

Gov. Brewer

Years ago, Arizona voluntarily expanded its program to include many childless adults not normally covered by Medicaid, the federal-state health care program that covers 48 million poor, disabled and elderly people nationwide.

Federal authority for that expires Sept. 30, after which the state can revamp its program, according to Sebelius.

“States can allow their waivers to expire,” said Mary Kahn, a spokeswoman at the federal Centers for Medicare and Medicaid Services.

Waivers are time limited, she said, and states have “no obligation to renew them. Once they expire, the Affordable Care Act is pretty clear that they can trim their Medicaid rolls for two populations – nondisabled and non-pregnant adults.”

Matt Salo, executive director of the National Association of Medicaid Directors, says that the Obama administration is “walking that fine line of trying to be helpful [to states] but trying not to undermine health reform.”

Local Opinion: In an op-ed article in Wednesday’s Seattle Times, Congresswoman Cathy McMorris Rodgers (photo) and co-author Jason Mercier make the case that Congress must provide states more flexibility to implement programs that best serve their own citizens.

How many states might be able to scale back programs – and when – isn’t immediately clear. Nor is it clear how many Medicaid enrollees might be at risk.

The Centers for Medicare and Medicaid Services website provides an incomplete picture, but it appears that many of the states that received permission to expand their programs beyond federal minimum requirements haven’t added nearly as many extra people as Arizona has — leaving fewer that could be cut.

Governors have been demanding relief in the face of recession-driven budget problems and the scheduled end of federal stimulus aid that helped them fund Medicaid ends in June. But advocates for the poor warn that people will suffer.

Edwin Park

“These are very low income people,” says Edwin Park of the liberal Center on Budget and Policy Priorities.

According to Ron Pollack, executive director of the consumer group FamiliesUSA, most states haven’t expanded their programs so much that there are many people they can cut now. Only three states provide Medicaid coverage for adults who don’t have children and earn more than 133 percent of the federal poverty level, he says.

He cites 10 states and the District of Columbia that provide coverage for parents at that income level: Connecticut, Illinois, Louisiana, Massachusetts, Minnesota, New Jersey, New York, Rhode Island, Vermont and Wisconsin.

Park says Arizona is unusual in that its entire Medicaid program is run under a waiver from HHS. Other states, however, have waivers for such things as expanding coverage to childless adults, creating managed care programs or extending family planning services to enrollees.

Michigan Plan First! was designed to serve about 200,000 women by providing family planning services to women from the age of 19 through 44 with incomes at or below 185 percent of the federal poverty level, which would be about $20,035. The women must not otherwise qualify for Medicaid or have other insurance coverage.

Julie Appleby, Chris Weaver, Lexie Verdon and Aimee Miles contributed to this article.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.



Two new primary care physicians join The Polyclinic First Hill


The Polyclinic First Hill has added two new primary care physicians to its staff: Dr. Linda Pourmassina, MD, an internal medicine physician, and Dr. Robert Goode, MD, a family medicine physician.


Dr. Goode will provide primary care to adults.  He has a special interest in adult chronic disease management, preventive care, GLBT (gay, lesbian, bisexual, transgender) health care, depression and anxiety.  He may be contacted at (206) 860-4562.

Dr. Pourmassina

Dr. Goode most recently worked in the Swedish Medical Center Executive Health Department serving as co-medical director, providing a comprehensive health assessment, diagnostic evaluation, and personalized life-treatment plan for patients.

Dr. Pourmassina, MD most recently was with Virginia Mason’s Federal Way Clinic. While her practice covers all aspects of internal medicine, Dr. Pourmassina says she is especially interested in preventive care.

Dr. Pourmassina also writes a medical blog called “Pulsus” which can be found at www.pulsus.wordpress.com.

To contact:

  • Dr. Pourmassina also may be reached at (206) 860-4572.
  • Dr. Goode may be contacted at (206) 860-4562.

Experts seek to simplify medication labels that often confuse patients


By Michelle Andrews

“Take two tablets by mouth twice daily.” This printed instruction, common on prescription pill bottles, might seem straightforward. Yet in a study, nearly half of patients misunderstood what it or other common label instructions meant.

Click to see Annals study

Now the non-profit organization that sets quality and safety standards for drugs approved by the Food and Drug Administration is aiming to simplify, clarify and standardize the labels that are affixed to those drugs.

The U.S. Pharmacopeia proposal, developed in conjunction with a group of independent experts, was released early this year for public comment. If adopted by state pharmacy boards nationwide, its developers hope it will help remove one of the many barriers that discourage people from taking their prescription drugs.

Medication compliance, or “adherence,” as it’s called, is a big problem. Despite the fact that 87 percent of people in a recent survey said they thought prescription medicines were important to their health, only about half of those surveyed take their drugs as directed. People skip doses, take the wrong number of pills, and take pills at the wrong time of day, among many other problems. Poor adherence results in up to $290 billion annually in medical expenses each year, according to NEHI, a health research organization.

In general, people are more compliant with drugs for acute conditions such as a bladder infection than for chronic problems like diabetes. But both are problematic, and the reasons people offer for not taking their drugs are as varied as the drugs they’re not taking.

In that patient survey, 59 percent said they stopped taking their medication because they were feeling better and didn’t think it was necessary to continue, while 25 percent said they stopped because they weren’t feeling any better. Thirty-seven percent were worried about side effects, while 24 percent said their drugs were too expensive.

Click to read more about the survey.

With such varied reasons for noncompliance, experts agree that solutions must be varied, too. “There is no silver bullet,” says Bob Nease, chief scientist at Express Scripts, a large pharmacy benefit manager for employers and insurers.

Simple forgetfulness may be the culprit in many cases of nonadherence, especially when a drug doesn’t actually make people feel any different. Drugs to treat high cholesterol or high blood pressure fall into this category. Many researchers and others involved in medication adherence issues are excited about the potential of technology to both educate patients and provide a “tickler” system to remind them to take their drugs.

Researchers at the Center for Connected Health in Boston, for example, found that sending daily text messages to patients with a type of eczema increased drug adherence, as did wireless pill bottle “GlowCaps” that light up and beep when high blood pressure patients miss a dose.

The center, a division of Partners HealthCare, works to identify ways that technology can help change patient behavior and improve health outcomes. With medication adherence, “What we’ve found is that the power of simple reminders is enormous,” says the center’s director, Dr. Joseph Kvedar.


Even the unlikeliest people need an assist now and then. Kvedar uses a GlowCap to remind him to take his cholesterol lowering drug every night.

At 9 p.m., the pill cap lights up to remind him it’s time to take his pill. If he’s not near his pill bottle, a small plug-in unit in his kitchen that looks like a nightlight glows at the same time to remind him. When he takes his dose, the cap relays the information wirelessly to the company network. But if he still hasn’t taken his pill after an hour has passed, the cap emits a ring tone. If he fails again to take a dose after another hour, the system calls him on his cell phone to remind him.

Kvedar says he would have expected his adherence would be 100 percent, but “I’ve discovered with the GlowCap that I would have forgotten some nights.”

There are many lower tech ways to improve adherence, say experts. Communication is key. If doctors and pharmacists make a point of explaining possible side effects and the importance of completing a course of treatment, for example, a patient may be less likely to discontinue taking a drug if he experiences a side effect.

More From This Series: Insuring Your Health

As for costs, reducing or eliminating copayments for drugs increases patients’ adherence, says Dr. Niteesh Choudhry, an assistant professor of medicine at Harvard Medical School who has conducted research on the subject. Increasingly, companies are picking up the tab for medications to treat their employees’ chronic conditions, with the expectation that doing so means they’ll save money down the road through lower medical costs.

While no single strategy or technology will get everyone to take their medicine as directed, experts agree that clear instructions on the pill bottle are a basic requirement if that’s to happen. Many of the USP recommendations seem commonsensical: place patient information and instructions at the top of the label in bigger type than the doctor or pharmacy name or information on refills and expiration; use everyday words like high blood pressure instead of hypertension; keep auxiliary information, such as warnings, simple and straightforward.

And to avoid confusion over things such as dosages and when to take the medication, the recommendations say, keep those instructions separate and simple, using numbers instead of words when appropriate. With those guidelines in mind, perhaps fewer people would be confused by the instruction that started this column. The new and improved pill bottle would read, “Take 2 tablets by mouth in the morning and 2 tablets by mouth in the evening.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Group Health Logo

How Seattle’s Group Health holds costs down


By Bara Vaida

One of the lesser-known parts of the new health law is a provision that provides federal loans to help fund health cooperatives. Advocates say these Consumer Operated and Oriented Plans, or co-ops, essentially insurers run by their members, encourage competition especially in the individual and small business health insurance markets. This month, HHS will begin considering rules for the co-ops.

Currently there are very few co-ops in the U.S., but one that is considered a model of success is Group Health – a 64-year-old Seattle based nonprofit health system that provides insurance to more than 600,000 people. It employs doctors, nurses and other providers, owns clinics and also partners with hospitals to provide inpatient care. In 2009, Consumers Reports ranked Group Health as the nation’s top health maintenance organization in terms of consumer satisfaction.

Scott Armstrong, the CEO of Group Health, sat down with KHN’s Bara Vaida, just prior to the House of Representatives’ vote to repeal the health law. Here are edited excerpts from the interview:

Q. Insurance rates, broadly, keep going up, and your rates have gone up too — in 2009, up about 13 percent. Are they going to go up this year?

A. They will go up. Of course, our premium rate increases are entirely a function of our medical expense trends and so to the degree that we are successful at organizing care delivery so that those medical expense trends are lower, our premium rates will be lower. … Our expectation is that we’ll keep our rate increases in the single digits.

Q. What has been the biggest thing that you’ve been able to change to keep costs from rising so quickly?

A. The change in our primary care practice, often referred to as a medical home, is a great example. We have changed the schedule patterns for our primary care providers basically giving them much more time with every patient. We’ve changed how our nurses and pharmacists work collaboratively with our primary care doctors to manage the care for a panel of patients.

We are reaching out to patients who are overdue for visits, scheduling time for e-mail and phone visits and overall being a much more assertive coordinator of our patients’ care. The results have been amazing, … showing that investing in primary care in an integrated system like this will drive — by almost 20-percent — emergency room visits down, will drive hospital utilization down by more than 10 percent.

Q. There’s been a lot of talk about accountable care organizations and whether that might be one of the solutions.

A. Well the hardest part about these accountable care organizations is that there are very few organizations today that actually have an ability to know what is happening for a population of patients as they get care through the system. The accountable care organizations have to create a specialty practice where specialists are willing to sit down and engage patients in shared clinical decision making and [for example] ask a patient who’s a good prospect for a total knee replacement whether they really understand the implications, the risks and other issues associated with a knee replacement versus other alternative approaches to getting their knee problem taken care of.

Today, those surgeons are motivated to do surgery. They don’t really have time to engage the patient in consideration of these choices. If an accountable care organization creates a structure where those doctors do have the time and it makes sense for them to lower their surgery rates but to improve the health of the population that they’re caring for, then accountable care organizations will be doing good work.

Q. Is that the way it works with Group Health with specialists?

A. We have about a dozen specialty procedures where we are making the time to, through the use of DVDs and through interviews with our providers, involve our patient in an objective evaluation of two, three, four different alternative therapies or approaches to dealing with their issue whether it’s hysterectomies, knee replacements other joint replacements.

In some of these high-volume procedures, we’re seeing a 10-to-12-percent drop in the procedure rate itself. We’re finding that patients are thrilled to be involved and to know really what the implications of these choices are. We’re finding that the providers are very gratified by the fact that they are able to engage in this dialogue with their patients.

Q. There’s also been talk of ACOs driving hospital consolidation and insurance companies have been worried that hospitals will sort of gang together and charge more to insurers.

A. The cost of hospital care is a fairly large part of the overall cost of care for our patients but it is just one relatively small slice in the overall care experience for the patients….

Far more relevant than whether hospitals, to use your term, are ganging together and raising their rates inappropriately is the degree to which our patients are in those hospital beds inappropriately. We know that even within our own system there’s fairly wide variation in days from one hospital to the other.

The Medicare population has a readmission rate that’s over 20 percent. If you think about that, when one in five patients being readmitted to the hospital for the same diagnosis within 30 days of being discharged is symptomatic of a system that’s not really working very well as a system.

Our thinking was that well let’s cut that in half. We have — through just changing certain basic practices, making sure that patients were discharged with a visit to their primary care doctor within two weeks, making sure every patient discharged understands their medications and gets a phone call from the nurse that saw them in the hospital within two days.

These simple kinds of changes have reduced our readmission rate at Group Health to somewhere in the mid-teens to low-teens. This will, for our system alone, annually save more than $50 million.

Q. I want to just wrap this up and talk about Washington. How do [Republican attempts to repeal the federal health law] affect your business?

A. It has no bearing at all. We are as focused as ever on the kind of changes that we’ve been talking about to the care delivery system, …regardless of what the federal law is.

I would be disappointed, I mean deeply disappointed, if the law was repealed because there are features of it that do help advance and accelerate this kind of change but it won’t change the priorities that we set and the way that we spend our time.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.