Volume 17, No. 2, Spring 2009
What the government giveth, the government also may taketh away. That was the theme that emerged during the most recent meeting of the Advisory Board of To Your Good Health, A Health Care Newsletter, at Cape Cod Community College.
Advisory Board member Gary Sheehan, President/CEO of Cape Medical Supply, was an invited attendee at the March 17 Northeast White House Regional Forum on Health Reform at the University of Vermont.
“It was an interesting forum and an interesting debate and it demonstrated in one room just how thorny the issue is,” he reported.
“But,” he continued, “one of my biggest concerns relative to the reform train that’s moving along involved the President’s recent budget that projected $37 billion in cuts for home health care services over the next 10 years even though these services provide what is effectively the lowest cost form of care.”
“That’s surprising, because part of the reform package is actually increasing funds in the social areas of health like community centers and behavioral health services,” said Dr. Herbert Mathewson, Medical Director of the VNA of Cape Cod, which would be directly affected. “So with one hand they are handing money over and on the other hand they are taking it away.”
Denise Dever, president of HomeInstead, which specializes in non-medical home care, noted that the threatened cuts could only make a bad situation worse. “We’re a growing industry, but we’re there for a reason. We’re keeping seniors in home longer but [even now] many are dying with no medical people with them,” she said.
Hospice also faces “a restructuring of Medicare payments,” according to David Rehm, President/CEO of Hospice & Palliative Care of Cape Cod, who pointed out that hospice programs were targeted for the largest cuts of any category of health care providers.
The warning of these potential cuts was contained in a little-noted report by a little-known outfit called MedPAC, the Medicare Payment Advisory Commission, an independent Congressional agency created to advise Congress twice a year on issues affecting the Medicare program.
Dr. Mathewson pointed out that the MedPAC study showed that ‘for-profit” Hospice programs were the largest cause of unanticipated growth in costs to Medicare and the report urged the government to focus on this area. [He noted that VNA of Cape Cod, an affiliate of Cape Cod Healthcare, also provides a non-profit Hospice service.]
A national computer grid for transferring medical records seems like a no-brainer in terms of increasing efficiency and minimizing the potential for errors. But it can be a financial time bomb, board members agreed.
“It is possible, considering the dollars we’re talking about, to make an enormous mistake that can have years of ramifications,” said Van Northcross, regional marketing director for Cape Cod Healthcare. “We’re on the verge of making a very major IT investment. We’re going to change our entire operating platform and it’s critical that we come up with an operating system that’s compatible, not only with the healthcare providers here on the Cape and Southeast Massachusetts, but nationally and even internationally. It’s a scary time because we’re all under a deadline to get it done. Yet there’s a lack at the national level of guidance and every one of us is vulnerable to that kind of costly and even fatal mistake.”
“We’re all struggling with the same issue,” said Steve Abbott, retired President/CEO of Cape Cod Healthcare. “Why does it have to be such a ‘cottage’ decision, an individual challenge of 5,000 hospitals? Where’s the research, where’s the organization?”
Mr. Rehm agreed , “We need a national standard for medical information,” but he did recommend a solution, simply expanding the current system utilized by the Veterans Administration. “It’s absolutely the best and it’s just sitting there and working every day.”
Barbara Murphy, Chair of Health Sciences and Coordinator of Nursing at Cape Cod Community College, noted one hidden cost the IT explosion. The college will have to add relevant courses and faculty to its curriculum “even as we’re already facing a teaching shortage for our nursing school.”
Carole Stasiowski, director of communications for the Rehabilitation Hospital of the Cape and Islands, added another potential unintended consequence.
“If the stimulus money trickles down the way it’s supposed to, there will be a big investment in healthcare IT. And there is a lot of good potential there,” she said, “However, operating these systems requires high skill levels and the cost of implementing the systems and getting people trained, plus rising salaries from the competition to hire these folks creates its own cost spiral. Yet, at the same time there remains the need to hire primary care physicians, therapists, nurses and others who are in demand. We just hope there’s money in the package for these sorts of things.”
The Board agreed that the economy factors into the overall picture of healthcare reform. As Mr. Abbott summed up, “I’ve been listening to the rhetoric and trying to figure out what’s on President Obama’s mind and basically his message is an economic one; that the healthcare system is such a cost burden to American businesses that it is rendering them unable to compete. Which then raises the question, what are we going to do about that? Are we going to reduce prices as I hear they’re going to do with home care, or are we going to get serious about restructuring?”
And he warned of “all those special interests and well-funded lobbies already organizing to kill” any meaningful reform.
Which prompted Andy Young, a former trustee of Cape Cod Hospital, to speak for the consumer who wonders, “With the vast panoply of lobbyists up and down the line, who represents me? I work, but I would like some assurance that I have insurance in the future and I’m not sure I do. And whom do I consult? There is pressure on businesses to supply insurance, but the very small businesses that we have on the Cape with a small employee base simply cannot afford it.”