State requiring facilities to participate in system or pay to opt out

Jerry Mitchell
jmitchell@clarionledger.com

Mississippi has begun sending out notices for the nation’s first “pay or play” trauma care system.

Starting Sept. 1, hospitals in must agree to be part of the state’s trauma care system or opt out by paying up to $1.492 million - the estimate it would cost a hospital for that trauma care. The statewide system officially begins Jan. 1.

“I’m proud of our state for stepping up to the front,” said State Health Officer Dr. Ed Thompson. “People are going to be alive five years from now that wouldn’t be if we hadn’t passed this thing.”

Until this change, Mississippi’s voluntary trauma system had been in danger. In 2002, 23 Level III or higher hospitals participated in the system. Now 12 participate.

Thompson said the result is huge holes in the trauma care system for Mississippians who live in east central Mississippi and have no Level III or higher hospital. The same is true, he said, for those living in southwest Mississippi.

The first hour of trauma care is called the “golden hour” and is critical, he said. “If you get patients to the right level of trauma care within that first hour, you have a much better chance of saving their lives and preserving their functions.”

Thompson anticipates more Mississippi hospitals coming back into the system, but he wouldn’t speculate on which ones they might be.

One Jackson hospital that hasn’t taken part in the past is now considering joining the trauma system.

“We haven’t come to a conclusion yet,” said Paul Arrington, vice president of St. Dominic Hospital. “We want to figure out what’s best.”

Two out-of-state hospitals expected to take part in Mississippi’s trauma system are the Med of Memphis and the University of South Alabama Medical Center in Mobile.

Depending on how many hospitals participate, the trauma fund could receive as much as $20 million annually from the hospitals that opt out. A combination of fees collected from driver’s license renewals, traffic fines, car tag collections, gun permit renewals, inspection stickers, boat registration renewals, motorcycle and ATV fees are expected to generate another $14 million annually toward trauma care. Those funds would then be used to compensate participating hospitals for treating uninsured trauma patients.

Connie Potter, executive director for the National Foundation for Trauma Care, called Mississippi’s new system “a fairly innovative solution” that’s easily the most ambitious among state plans.

Arizona is supposed to take in $20 million for trauma care through casino gaming. Tennessee is dedicating two cents of its cigarette tax to trauma care.

Nationwide, the foundation is pushing for $100 million in legislation before Congress to help cover the costs of uncompensated trauma care, Potter said. “There are too many people who are uninsured, too many people not covered by Medicaid.”

The challenge for Mississippi will be “attracting and retaining trauma specialists,” she said. “There is a dwindling supply of physicians.”

Then-Gov. Kirk Fordice signed the Mississippi Trauma Care Act in 1998, not long after suffering a near-fatal car wreck.

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www.aatn.us

Part of the approach the AATN uses to bring focus to health care providers is the fact that the Physicians, Nurses and equipment in the U.S. are the best and have no equal anywhere in the world.

However, when you have a system that still operates as it has since the 19th century, you already have a large hurdle facing the provider and more so the person seeking treatment.

Below is an article from Journal of the American Medical Association.

Dated July 21st, 2008

“At the heart of the challenge (health care reform) is transforming a 19th-century craft-oriented delivery system to provide 21st-century biomedical science and technology. Most physicians still practice alone, in partnerships, or in small groups. Small practices generally have less capacity to implement electronic medical records, less frequently use teams to care for patients with chronic illness, and are less able to provide statistically reliable and valid data on quality and efficiency measures. A more solid foundation of physician organizations is needed to avoid having the system crumble under the increased weight of greater demand for care and technological advances.”

www.aatn.us

Florida Gov. Charlie Crist (R) has signed a bill allowing uninsured Floridians to purchase affordable health insurance plans largely free of expensive, superfluous mandated health insurance coverages.

Experts are lauding the new legislation, the Cover Florida Health Access Act, as a positive step toward affordable health insurance and a model program for other states.

Mandates Cause Uninsurance

Every state has laws requiring certain procedures and illnesses be covered by every insurance policy sold within its borders. Florida currently has the 13th most among the states, with 48 coverage mandates, including hair prosthesis, orthotics, and second surgical opinion. It also has one of the highest uninsured rates (21 percent, or roughly 3.8 million people) in the country–a fact experts say is no coincidence.

“Government regulation drives up the cost of health insurance and is a significant factor in denying health insurance to the working poor,” said Michael Tanner, a senior fellow at the Cato Institute. “If government were to mandate that the only car anyone could own was a Lexus, it wouldn’t be long before the poor lacked transportation. Sometimes people have to drive a Kia. Kudos to the Florida legislature for belatedly recognizing an economic fact of life.”

“This important step forward by Florida reflects what many [people] nationwide know all too well: Consumers can’t afford the ‘benefits’ lawmakers force on them,” said Joel White, a senior fellow at the Galen Institute. “In many cases the good intentions of lawmakers to ‘protect’ consumers by mandating benefits they cannot afford or do not want has ‘protected’ them into the ranks of the uninsured.

“The U.S. Congress should take heed of Florida’s action and pass legislation that expands consumer choices,” White added.

‘Giant Step Forward’

Cover Florida, signed by Crist in early June, will allow individuals who qualify to purchase “bare bones” insurance policies that cover only the treatments consumers want to pay for instead of all the treatments and procedures Tallahassee has declared mandatory in the past. It is expected to save eligible Floridians hundreds of dollars in premiums while reducing the number of uninsured in the state.

“Florida’s new insurance law is a giant step forward toward affordable health insurance that should serve as a model for other states,” said Stephen J. Entin, president of the Institute for Research on the Economics of Taxation.

Entin explained, “It will allow consumers who have been without insurance for at least six months to buy policies that meet their personal requirements, free of expensive mandates formerly required by the legislature at the behest of special interests.”

Florida Health Insurance Consumers in Driver’s Seat

“Other states should follow Florida’s lead and allow insurers to sell innovative policies consumers actually want,” said Devon Herrick, a senior fellow at the National Center for Policy Analysis.

Cover Florida “puts the consumer in the driver’s seat, instead of the providers,” said Entin. “The resulting competition for the consumer’s dollar will make insurance attractive to many who must now go without.”

Jeff Emanuel (emanuel@heartland.org) is research fellow for health care policy at The Heartland Institute and managing editor of Health Care News.

By: Heartland.org - Mon, 07/28/2008 - 01:52

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MASSACHUSETTS’S UNIVERSAL health care law turned one in April. To survive, its guardians have had to make many changes, each of which has increased current and future government spending, increased the government’s role in regulating the healthcare market, decreased individual responsibility to purchase insurance, and made certain that the plan will fall far short of achieving universal coverage.

The promise of the law was simple and seductive: Require people to purchase health insurance, make the insurance affordable, or at least tax-deductible, and then fine those who don’t comply. Subsidies could come from the current money devoted to the Uncompensated Care Pool and the federal taxpayers. Universal coverage, then, would be achieved with little new spending.

Numerous problems existed with this plan, but the fairy tale quality appealed to politicians and the national media, so it passed to much fanfare.

Interestingly, the Commonwealth Health Insurance Connector Authority, the bureaucrats in charge of implementing the plan, decided that the universal individual mandate does not apply to everyone, but rather only those who can afford the premiums. Therefore, nearly one in five of the currently uninsured will be exempt from the law.

The Connector Board also bowed to pressure and reduced the monthly premiums on the subsidized-but-not-entirely-free healthcare plans. This will increase the program’s costs by $13 million.

Even at these reduced rates, the plans will still not be attractive to many. People earning between 151 percent and 300 percent of the federal poverty limit — $25,000 to $110,000 for families and $15,316 to $50,000 for individuals — are expected to pay up to 9.6 percent of their income on insurance premiums, or pay fines. (This 9.6 percent is before any co pays and cost sharing.) Meanwhile, taxpayers are still subsidizing them by as much as 94 percent of total costs.

The structure is a gourmet recipe for runaway spending. With this level of premium, those who don’t value insurance enough to make financial sacrifice to purchase it will neglect to do so. The fine — set at $216 — will be more attractive than the premium. Politicians will be under strong pressure to not enforce the mandate once the fines increase to meaningful levels. Indeed, they have already shown their willingness to back away from it for the 20 percent of people, and have set up a waiver process to exempt others on a case-by-case basis.

At the same time, the massive premium subsidy will make these plans extremely attractive to individuals who expect to use large quantities of healthcare. The population paying the premiums will be older and sicker than the general population. Spending will explode. It will come from somewhere, most likely the taxpayer.

Early data already provide evidence of this dynamic. As of April 1, 62,979 individuals had signed up for Commonwealth Care, the subsidized plans. Of these, 52,500 were enrolled in the totally free option. Give something for nothing, and people sign up. The plans in which people have to pay are a different story. Sign-ups have been slow, and the people who have enrolled are older and sicker than those signing up for the free plan.

The average age of a person in the free plan is 36, while the average age in the paid plans is 47. Of the free plans, there have been 214 specialty referrals per 1,000 enrollees. Of the paid plans, there have been 416 specialty referrals per 1,000 enrollees.

The system is set up to tax the young and healthy — who typically have both less income and less wealth — to subsidize those who are older and less healthy. One goal, according to the organization Health Care For All, is “to create a statewide credible risk pool, so healthy people ‘prepay’ toward their medical care.”

The problem with this is that the young and healthy, who are already prepaying for Medicare out of every paycheck, may object to this new form of taxation. According to the state’s own data, it’s not the young and healthy who use the Uncompensated Care Pool or who abuse emergency rooms, so the real point is the prepay or taxation and subsidization of a so-called risk pool.

So one year in, we have a plan that, even if no more concessions to liberal advocates are made, falls 20 percent short of its stated goal. Its costs have already increased by at least $13 million and are on track to skyrocket by some multiple of this once the doctors’ bills start coming in. Happy Birthday.

Sally C. Pipes is president and CEO of the Pacific Research Institute.

You want to know the scary part?  Compared to a year ago, new and start up businesses fell to less than half of the preceding year. Why?  New business owner, small and medium cannot afford the “New form of taxation without representation” Universal Healthcare is a economy killer and killer to your loved ones, because they have to wait one hundred thousand times longer to be seen, diagnosed and treated.

Take the example of a woman living in the UK whom waited over 6 months to find out why she was having excruciating and frequent headaches. In the U.S. as we are now, a simple scan would have revealed the treatable tumor growing in her head.  But alas, her family was lamenting her long wait when they laid her to rest because she could not make the appointment, which was  the day after her funeral.

Don’t believe half the things the news media says in regards to the U.S. Health care system being broken.  Its not, by the way compared to Canada, UK and Massachusetts, its by far better and you can bet your family on it.

Universal Health Care: Case closed

Belief in economic and scientific progress is deeply engrained in the American way of life. As residents of a “can do” nation, Americans expect that our children will be better off than their parents, and that scientific breakthroughs will eventually conquer disease. Evidence that health care in this country is slipping backward is, therefore, deeply troubling.

Despite the best efforts of millions of talented and dedicated health care professionals, The Commonwealth Fund’s latest Commission on a High Performance Health System National Scorecard on U.S. Health System Performance demonstrates that, in fact, we are losing ground. The first Scorecard was published in 2006. The new Scorecard, published this month, finds disturbing evidence that the health system is on the wrong track. In nearly every category measured, the health system performs worse than two years ago—scoring just 65 out of 100 across 37 indicators, where 100 represents not what is ideal but what has actually been achieved in some places for some groups of people.

The Scorecard takes a broad look at how well the U.S. health care system is doing, where improvements are needed, and what examples of good care exist that could serve as models for the rest of the country. It looks at specific issues: Do people have access to the health care they need? Are they getting the highest-quality care, and are we spending money and using health care resources efficiently?

One of the primary reasons for the system’s poor performance is worsening access to care. In 2007, more than 75 million adults—42 percent of all adults ages 19 to 64—were either uninsured or underinsured during the year, up from 35 percent in 2003. This means that millions of Americans are unable to get the care they need.

The Scorecard also found evidence that the billions spent on U.S. health care—far more than any other industrialized country—are often squandered on administrative costs, inefficient systems, wasteful care, or treatment of preventable conditions.

The U.S. also failed to keep up with advances in health outcomes, falling from 15th to 19th among industrialized nations in terms of the number of premature deaths that could potentially have been prevented by timely access to care.

The good news? There have been some gains in the quality of care. Performance on a key measure of patient safety—hospital standardized mortality ratios, which were targeted in the Institute for Healthcare Improvement’s “100,000 Lives campaign”—improved significantly, by 19 percent from 2000–2002 to 2004–2006. Moreover, hospitals are increasingly meeting evidence-based treatment guidelines, for which data are collected and reported on a Medicare Web site. Rates of control of two common chronic conditions, diabetes and high blood pressure, also have improved significantly. These measures are publicly reported by health plans, and physician groups are increasingly rewarded for improving treatment of these conditions. So improvement is possible, but it takes leadership, concerted action, and monitoring of progress.

If the U.S. health system achieved benchmark levels of performance, there would be real benefits in terms of health, patient experiences, and savings. For example:

• Thirty-seven million more adults would have an accessible primary care provider, and 70 million more adults would receive all recommended preventive care.
• 100,000 fewer people would die from causes that could have been prevented by good care.
• The Medicare program could potentially save at least $12 billion a year by reducing readmissions or reducing hospitalizations for preventable conditions.
• If we could lower the administrative costs of health insurances to the level found in Germany, which like the U.S. has a blended public–private health system, we could save $51 billion a year. Reaching levels achieved in the best performing countries would save an estimated $102 billion per year.

These and other findings make a compelling case for change in the way U.S. health care is financed, organized, and delivered. A new Presidential administration in 2009 will provide a historic opportunity to change direction. A comprehensive strategy that simultaneously aims to ensure health insurance for all, improve quality, and achieve greater efficiency is needed to close gaps in performance. The goal should be a 2010 National Scorecard that lives up to the best of what is possible with American ingenuity and the considerable resources invested in our health sector.

As always, I’m interested in your feedback. Please take advantage of our commenting feature by clicking on the “Post a Comment” button. Select comments will be published on this page.

Source: The Commonwealth Fund July 2008

Prepared for the Commonwealth Fund Commission on a High Performance Health System, the National Scorecard on U.S. Health System Performance, 2008, updates the 2006 Scorecard, the first comprehensive means of measuring and monitoring health care outcomes, quality, access, efficiency, and equity in the United States. The 2008 Scorecard, which presents trends for each dimension of health system performance and for individual indicators, confirms that the U.S. health system continues to fall far short of what is attainable, especially given the resources invested. Across 37 core indicators of performance, the U.S. achieves an overall score of 65 out of a possible 100 when comparing national averages with U.S. and international performance benchmarks. Overall, performance did not improve from 2006 to 2008. Access to health care significantly declined, while health system efficiency remained low. Quality metrics that have been the focus of national campaigns or public reporting efforts did show gains.

Executive Summary

Every family wants the best care for an ill or injured family member. Most are grateful for the care and attention received. Yet, evidence in the National Scorecard on U.S. Health System Performance, 2008, shows that care typically falls far short of what is achievable. Quality of care is highly variable, and opportunities are routinely missed to prevent disease, disability, hospitalization, and mortality. Across 37 indicators of performance, the U.S. achieves an overall score of 65 out of a possible 100 when comparing national averages with benchmarks of best performance achieved internationally and within the United States.

Even more troubling, the U.S. health system is on the wrong track. Overall, performance has not improved since the first National Scorecard was issued in 2006. Of greatest concern, access to health care has significantly declined. As of 2007, more than 75 million adults—42 percent of all adults ages 19 to 64—were either uninsured during the year or underinsured, up from 35 percent in 2003. At the same time, the U.S. failed to keep pace with gains in health outcomes achieved by the leading countries. The U.S. now ranks last out of 19 countries on a measure of mortality amenable to medical care, falling from 15th as other countries raised the bar on performance. Up to 101,000 fewer people would die prematurely if the U.S. could achieve leading, benchmark country rates.

The exception to this overall trend occurred for quality metrics that have been the focus of national campaigns or public reporting. For example, a key patient safety measure—hospital standardized mortality ratios (HSMRs)—improved by 19 percent from 2000–2002 to 2004–2006. This sustained improvement followed widespread availability of risk-adjusted measures coupled with several high-profile local and national programs to improve hospital safety and reduce mortality. Hospitals are showing measurable improvement on basic treatment guidelines for which data are collected and reported nationally on federal Web sites. Rates of control of two common chronic conditions, diabetes and high blood pressure, have also improved significantly. These measures are publicly reported by health plans, and physician groups are increasingly rewarded for results in improving treatment of these conditions.

The U.S. spends twice per capita what other major industrialized countries spend on health care, and costs continue to rise faster than income. We are headed toward $1 of every $5 of national income going toward health care. We should expect a better return on this investment.

Performance on measures of health system efficiency remains especially low, with the U.S. scoring 53 out of 100 on measures gauging inappropriate, wasteful, or fragmented care; avoidable hospitalizations; variation in quality and costs; administrative costs; and use of information technology. Lowering insurance administrative costs alone could save up to $100 billion a year at the lowest country rates.

National leadership is urgently needed to yield greater value for the resources devoted to health care.

The National Scorecard

The National Scorecard includes 37 indicators in five dimensions of health system performance: healthy lives, quality, access, efficiency, and equity. U.S. average performance is compared with benchmarks drawn from the top 10 percent of U.S. states, regions, health plans, hospitals, or other providers or top-performing countries, with a maximum possible score of 100. If average U.S. performance came close to the top rates achieved at home or internationally, then average scores would approach 100.

In 2008, the U.S. as a whole scored only 65, compared with a score of 67 in 2006—well below the achievable benchmarks. Average scores on each of the five dimensions ranged from a low of 53 for efficiency to 72 for healthy lives.

On those indicators for which trend data exist, performance compared with benchmarks more often worsened than improved, primarily because of declines in national rates between the 2006 and 2008 Scorecards. Overall, national scores declined for 41 percent of indicators, while one-third (35%) improved, and the rest exhibited no change (or were not updated). Exhibit 2 lists indicators and summarizes scores and benchmark rates.

As observed in the first Scorecard, the bottom group of hospitals, health plans, or geographic regions is often well behind even average rates, with as much as a fivefold spread between top and bottom rates. On key indicators, a 50 percent improvement or more would be required to achieve benchmark levels.

Scorecard Highlights and Key Findings

The U.S. continues to perform far below what is achievable, with wide gaps between average and benchmark performance across dimensions. Despite some encouraging pockets of improvement, the country as a whole has failed to keep pace with levels of performance attained by leading nations, delivery systems, states, and regions. Following are major highlights from the Scorecard by performance dimension:

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