March 06, 2014
As policymakers look for ways to address Medicare’s financial challenges and make the program more cost-efficient, it’s inevitable that the discussion will turn at some point to end-of-life care. And it’s easy to understand why.
As you break down Medicare spending, it becomes clear that a disproportionate amount of resources are devoted to providing care to beneficiaries in their final year of life. The Centers for Medicare and Medicaid Services (CMS) has estimated that 25 percent of Medicare expenditures are spent on services for the five percent of beneficiaries who die each year.
But, as Premier Healthcare Alliance president and CEO Susan DeVore wrote in a thoughtful essay in the Wall Street Journal, the key to effectively addressing this issue is not to look at end-of-life care as a cost challenge. Rather, the focus must be on empowering patients and their families to fully understand their healthcare options. “If this is done well, the rest will follow,” she wrote.
In her WSJ piece, Ms. DeVore, a Healthcare Leadership Council member, addresses the variation in end-of-life care among hospitals, pointing out that some terminally ill patients were spending their final days in intensive care settings even though there were no medical solutions that could improve their health outcomes. Better, she wrote, that patients and families have the information and the conversations with caregivers to make educated choices about whether a patient’s final days should be spent in a hospital or at home.
I recommend that individuals, particularly those who are in caregiving roles, read Ms. DeVore’s essay. As she put it so well, “This topic (of end-of-life care) shouldn’t center on cost. It’s about dignity, compassion, comfort and making the most out of the last days of a terminal patient’s life.”
February 19, 2014
In a town that thrives on disagreement, there is a stunning degree of unanimity around the idea that the Center for Medicare and Medicaid Services (CMS) is moving in the wrong direction with its proposed regulations that would bring about sweeping changes to the Medicare Part D prescription drug program.
Over 230 organizations – representing patients, seniors, multiple healthcare sectors, employers and Americans with disabilities — have signed a letter that was delivered to CMS, urging the agency to withdraw the proposed rules. The letter states that the regulations “will severely impede beneficiaries’ access to affordable health plans and medications and threaten “to disrupt the positive effect the (Part D) program is having on beneficiaries’ health and the Medicare program as a whole.”
In thinking about these proposed rules, the first question that comes to mind is……why? The Medicare Part D program, as it stands, is an irrefutable success story. It has the approval of 90 percent of seniors. Average monthly premiums have remained at steady, affordable levels. And the cost to taxpayers over the past decade has been more than 40 percent below original Congressional Budget Office projections.
So why attempt to “fix” what isn’t at all broken?
These rules aren’t a case of tinkering at the margins of the Part D program. We’re talking about fundamental changes in how the system operates. The rules would place new restrictions on the Part D plan options available to seniors. There would be changes in the range of medications that could be available in certain pharmaceutical classes. And Congress’s clear intent that pharmaceutical pricing be determined by private sector negotiations – with the federal government keeping hands off – would be blatantly disregarded. Part D’s success in delivering affordability and healthcare quality would be placed at risk.
This is not to say that CMS, healthcare sectors and patients shouldn’t work together to continually improve the Medicare prescription drug program, but any changes should build upon the fundamental principles of consumer choice and competition that have made the program successful and improved the health and well-being of millions of beneficiaries. These proposed regulations don’t meet that criteria and, in fact, would undermine those core strengths.
January 31, 2014
Last year, the book “Best Care Anywhere: Why VA Health Care Would Work Better for Everyone” entered its third printing. The book tells of a Veterans Administration healthcare system that, according to the author, is far superior to the private sector in both quality care delivery and cost containment. The message delivered in this book, in fact, became something of a core liberal talking point during health reform debates – that the wonders of single-payer, government-run healthcare can be seen on full display at the VA.
This week, CNN is painting a different picture of the VA system, reporting that at least 19 veterans have died as a result of delays in receiving routine diagnostic exams such as colonoscopies and endoscopies. This follows an earlier CNN report that as many as 7,000 veterans in just two states alone – South Carolina and Georgia — are on a backlog list to receive these fundamental diagnostic screenings.
And, as the cable network points out, not a single person has been dismissed or demoted as a result of this substandard care, and the VA is consistently ignoring congressional committee requests for explanations and accountability. One has to agree with Rep. John Barrow (D-GA) who said, “We have a duty to make sure the veterans who serve get the best health care possible. And it is very obvious that, for too long and for too many folks, that hasn’t happened.”
This is not to say that the VA doesn’t carry out some aspects of healthcare very well. The institution has, for example, been among the early adopters in demonstrating the effective use and value of electronic medical records.
But in terms of the argument that all of American healthcare should emulate this type of bureaucratically-run system, it’s been made clear this week that several thousand service men and women have reason to disagree with that thesis. For too many who have dedicated their lives to serving their country, the concept of getting the right care at the right time isn’t happening. That’s simply unacceptable.
January 07, 2014
Let’s give credit to “Meet the Press” for choosing to address healthcare in its January 5 installment by turning to actual health industry leaders instead of the usual Washington, D.C. talking heads.
Cleveland Clinic CEO Toby Cosgrove and Mayo Clinic CEO John Noseworthy, both physicians as well as hospital executives, joined host David Gregory to discuss the implementation of the Affordable Care Act and, just as importantly, other healthcare issues that deserve more attention than they generally receive in the media.
Both Dr. Cosgrove and Dr. Noseworthy, for example, emphasized the importance of improving a Medicare program that is headed toward insolvency, saying that this a key to addressing healthcare costs. To quote Dr. Noseworthy, “The long-term sustainability of Medicare is something no one has taken on yet. The nation has to have the courage to step up to the looming insolvency of Medicare.”
And Dr. Cosgrove also emphasized the critical role of wellness and disease prevention in achieving health system sustainability. Mentioning the cost ramifications of the growing obesity epidemic in the United States, he said, “We need to have incentives for individuals to take care of themselves, and that’s not a big enough part of the new law as it should be.”
Dr. Noseworthy and Dr. Cosgrove are both members of the Healthcare Leadership Council.
You can see the video of their Meet the Press appearance here. Articles about their comments can be found here and here.
December 22, 2013
Posting a summary of the remarks offered by one of its recent featured speakers, the secretary-treasurer of the National Union of Healthcare Workers, the National Press Club headlined its synopsis with “Union Official Debunks Workplace Wellness Programs.”
The problem with that headline is simply, well, he really didn’t.
John Borsos’s Press Club remarks could be boiled down to these points:
• There is no evidence workplace wellness programs improve health or save money.
• Wellness incentives are unfair to those who don’t choose to try to achieve them.
• Wellness programs are an invasion of personal privacy.
• What America really needs is a single-payer healthcare system.
What America actually needs is a discussion about wellness and disease prevention that relies more on facts than hyperbole. Employers throughout the country have, in fact, developed firm evidence that wellness initiatives are bringing greater health to employees and reducing healthcare costs. You can find specific metrics on many of these successes in a compendium we have published, The Future Is Here.
On the topic of how to make wellness programs work in the workplace setting, I urge you to read the post by Colin Watts of Weight Watchers below. He offers an insightful discussion on the relative efficacy of carrots versus sticks in these programs.
And, as to privacy, as Kaiser Permanente, CVS Caremark and others have pointed out ad nauseum, wellness profiles of employees are collected and viewed in the aggregate. Individual privacy is constantly respected and protected.
The fact is, we are facing a significant, disturbing escalation in chronic illnesses like diabetes, heart disease and pulmonary illness that will affect both the health and finances of the U.S. population, not to mention the sustainability of our healthcare system. We need bold action to address this growing problem, and that action cannot exclude the eight or more hours each day that millions of Americans spend at their workplace.