Jackson Memorial Hospital in Crisis

Jackson Memorial Hospital, one of our finest teaching hospitals in the U.S., is stuck in a perpetual financial crisis caused, among other reason, by poor management. The proposed solutions do not follow surgical precision thinking but can only be compared with brute amputations threatening to destroy this great institution. The current management lacks strategic vision and obviously does not understand that the rapidly changing health care market demands flexibility and quick adaptation to evolving concepts of care delivery and reimbursement. This requires the development of team based care harvesting the creativity and experience of the highly skilled workforce. Therefore, it's counter-intuitive to reduce the number of experienced health care workers who are needed to develop and sustain new care delivery systems such as the Patient Centered Medical Home (PCMH). The Patient Centered Medical Home is a model of care where each patient has an ongoing relationship with a personal clinician who leads a team that, together, takes responsibility for patient care. The clinician-led care team is responsible for providing all the patient's health care needs and when needed, coordinating care across the health care system. The comprehensive care provided by the medical home leads to better health, longer lives, higher patient satisfaction and less expensive care. Other hospital systems in the U.S. are successfully pursuing such concepts and are being rewarded financially. For example, all 11 hospitals and six large community health centers of the New York City Health and Hospitals Corporation have received medical home designation for delivering accessible, comprehensive and family-centered primary care to New Yorkers that aims to reduce avoidable healthcare costs over time. The special designation was granted by the National Committee for Quality Assurance (NCQA) to 616 primary care physicians who collectively care for nearly 100 percent of HHC's primary care population of more than 477,000 adult and pediatric patients. All of the HHC facilities received "Level 3" designation, the highest ranking, which will qualify HHC for more than $15 million in Medicaid reimbursement rate increases every year. Jackson Memorial Hospital can lead the field in health care innovation and its not too late to implement changes. But we need a management team that can translate vision into reality. Yours Bernd

Supreme Court and Health Care

On Monday morning the Supreme Court will begin hearing arguments about whether the Individual Mandate is constitutional. On what case law the Supreme Court can base its decision? Lets look at the facts. In a recent New York Times article titled " At Heart of Health Law Clash, a 1942 Case of a Farmer’s Wheat" the author points out that a 1942 decision, Wickard v. Filburn, is the basis for the Supreme Court’s modern understanding of the scope of federal power. What was the core issue? The U.S. government had established limits on wheat production based on acreage owned by a farmer, in order to drive up wheat prices during the Great Depression, and one farmer, Roscoe Filburn, was growing more than the limits permitted. Filburn was ordered to destroy his crops and pay a fine, even though he was producing the excess wheat for his own use and had no intention of selling it. The Supreme Court interpreted the United States Constitution's Commerce Clause under Article 1 Section 8, which permits the United States Congress "To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes". The Court decided that Filburn's wheat growing activities reduced the amount of wheat he would buy for chicken feed on the open market, and because wheat was traded nationally, Filburn's production of more wheat than he was allotted was affecting interstate commerce. Thus, Filburn's production could be regulated by the federal government. The Supreme Court issued a decision which included the following statement: "The power to regulate interstate commerce includes the power to regulate the prices at which commodities in that commerce are dealt in and practices affecting such prices." ( P. 128) And this is the issue we are dealing with today! The Filburn decision illustrates just how much leeway the federal government has under the Constitution’s commerce clause to regulate the choices individuals make in matters affecting the national economy. If the government can make farmers choose between growing crops on their own land and paying a penalty, the administration’s lawyers have said, it can surely tell people that they must obtain health insurance or pay a penalty. Now, if the Supreme Court decides that the individual mandates violates the commerce clause then insurance companies will face a quandary: on the one hand they have to offer health insurance coverage to each and every applicant regardless of his/her health status, but on the other hand they cannot sell enough insurance policies to healthy individuals to cover for those expenses because the individual mandate was declared unconstitutional. The health care law will still be valid BUT the financing will be on shaky grounds. Therefore, insurance companies already began to develop alternatives which will include steep premium increases for individual policies! Economists believe that the mandate, as envisioned by the law, will make a significant difference in reform’s impact. Some suggest that removing the mandate from the law would diminish the number of newly insured by nearly two-thirds and raise premiums overall by 30 percent. The Rand Institute researchers predict that eliminating the mandate would have little effect on premiums for individuals. But they, too, believe that health insurance coverage would fall dramatically — from 27 million additional people insured to just 15 million. Those are just projections, but the experts note that one state has managed to impose insurance reforms without weakening its insurance market. It’s Massachusetts, which happens to be the one state that also imposed an individual mandate. More than 98 percent of the state’s residents now have insurance, by far the highest percentage in the country. Premiums in the non-group market have fallen by 50 percent, relative to national trends, while premiums in the group market aren’t rising any faster than they were before the reforms began. Lets hope for the best and I predict the Supreme Court will uphold the individual mandate. Yours Bernd

Medical Practice in Crisis

Attached a link to an article "Why America's Doctors Are Struggling to Make Ends Meet" highlighting the dire economic straits of a medical clinic in Denver Colorado which followed all the recommendations to improve its care: electronic health record implementation, medical home project participation, quality improvement initiatives and care coordination. Nevertheless, the practice struggles to stay financially viable! I have embraced all of the above principles, too, and invested money and time in improving my practice and just obtained PCMH recognition. When will insurance companies follow to support those of us who work hard to improve care and to reduce healthcare costs? Will the savings be pocketed by insurance companies, or be shared with us? I think that we deserve an answer! Yours Bernd