Savings iffy in health care reform, panelists agree
By Janet Hefler
Published: August 27, 2009
Panelists at a forum on health care Tuesday night agreed that Islanders could expect better quality health care at a state-of-the-art new hospital. But how to lower the cost of that care here, or nationally, remains a complicated and politically difficult a work in progress.
Dr. Pieter Pil, left, head of the medical staff at the Martha's Vineyard Hospital; Lynn Nicholas, chief of the Massachusetts Hospital Association; and Dr. Peter Slavin, president of Massachusetts General Hospital discussed health care Tuesday in Edgartown.About 100 people attended the program held in the Old Whaling Church in Edgartown, sponsored by The Martha's Vineyard Times and the Martha's Vineyard Preservation Trust.
The panelists included Dr. Pieter Pil, chief of the Martha's Vineyard Hospital medical staff, Dr. Peter Slavin, president of Massachusetts General Hospital, and Lynn Nicholas, president and CEO of the Massachusetts Hospital Association.
Times editor Doug Cabral moderated the discussion. In his introductory remarks, Dr. Slavin said that MGH and Martha's Vineyard Hospital (MVH) have had a positive and strong relationship for many years, even prior to the affiliation. MVH's recent affiliation with the Partners multi-hospital group has made a good situation even better, he said, most significantly in the areas of administration and medical records.
MVH physicians will use the MGH electronic medical record system, which Dr. Slavin said would provide significant advancement in the quality and safety of medical care on the Island.
The affiliation with MGH also will allow the Island's hospital to expand physicians' roles and their continuing education through tele-medicine, Dr. Slavin said. For example, a physician at MGH could help an Island physician evaluate the victim of a stroke on Martha's Vineyard through video conferencing.
Reporting that the new hospital construction is on budget and on schedule, Dr. Pil thanked the Island community for contributing to the capital campaign. In addition to the new hospital's state of the art features, such as 25 private patient rooms, Dr. Pil said he considers information technology one of the most important assets.
In addition to tele-communication for physicians, Dr. Pil said an online "patient gateway" will allow patients to check lab reports, communicate with their doctors, and receive information updates, even make appointments.
Ms. Nicholas, who visits hospitals all over the state, said that the Island's new hospital, to open in January, would be an absolute up-to-date facility.
In the meantime, she said, "This hospital is incredibly fiscally strong." The hospital's operating margins and net revenue are a tribute to the philanthropy of the community and its partnership with a major healthcare system such as Partners, she added.
Mr. Cabral also asked the panelists to comment on the role of the media in the complex national healthcare discussion now taking place.
Dr. Slavin said that the media's attempt to present both sides of an issue sometimes lends an undeserved validity to demagoguery from politicians in Washington. He was especially critical of recent attacks on President Obama's health care reforms for their end-of-life counseling provisions.
Dr. Slavin said the press should have pointed out the charges by some politicians that there would be "death panels" - a phrase used by former Alaska governor and Republican vice-presidential candidate Sarah Palin - strong-arming people to end their lives rather than seek medical care was simply demagoguery. He said it deserved to be dismissed by the media, rather than elevated to status as merely a view that competes with the explanations of the critics.
Expanding on that topic later, Ms. Nicholas said the end-of-life counseling controversy resulted in its removal from the health care reforms proposals.
"It is an abomination that has fallen off the plate," she said. Patients involved in their own end-of-life health care choices save about $20,000 in costs, Ms. Nicholas pointed out.
"The greatest expenditure in Medicare is what we do at the end of life," she said.
Ms. Nicholas said her pet peeve with the media is that reporters like "sound bites" and tend to highlight the most controversial, negative comments in an interview, when they may represent only a small part of the whole issue.
Dr. Pil said he has noticed that reports by the U.S. news media have painted a negative and erroneous picture of health care systems in other countries, Britain, for example, while touting the American health care system, which costs three to four times as much, as the best in the world. "We have our shortcomings," Dr. Pil said.
Mr. Cabral asked the panelists if they agreed that while all of them know how to deliver high-quality health care, they don't know how to cut costs.
Dr. Slavin offered cost saving suggestions, including simplifying the administrative side of medicine, coordinating care more efficiently, using cutting-edge, costly technology more prudently, and addressing payment reform.
Although there has been a lot of criticism of the public payer option that is in some of the proposed federal legislation, Dr. Slavin said private insurers add a layer of expense to the health care system. Medicare provides care at a lower cost than private insurers. Incentives to lower costs are lacking in the current procedure-based health care system. Paying for outcomes rather than procedures, would offer an incentive for care that might save money.
Ms. Nicholas said that insurance companies have become a costly "middle man" in the U.S., while other industrialized nations offer good care for everyone. Benefit design, a sort of a la carte approach to insurance benefit packages, would also increase costs.
Health care experts recommend program models that do away with fee for service medicine, Ms. Nicholas said. Currently, all costs such as procedures, tests, physician's visits, and all other medical costs are paid for separately.
Medicare is experimenting with a global payment system, which allocates a total amount of money for treatment up front. For example, Ms. Nicholas explained, a bulk sum for a hip replacement would go toward pre-operative care and post-operative care, as well as physical therapy, in addition to the surgery.
Under another model called a "capitation system," Ms. Nicholas said an insurance company would set aside a capped amount of money for each insured person. Similar to managed care programs, patients would see their primary care physicians first and then be referred to specialists as needed. Patients who do not require the use of all their benefit funds allocation would subsidize those who require more.
Dr. Slavin said that although the Medicare demonstration budget showed the global payment system would have a significant effect, he said he could not be sure the American public is ready to give up the freedom to go to the physicians and hospitals of their choice.
At Mr. Cabral's invitation, several members of the audience asked questions and made comments on healthcare issues, including superintendent of schools James Weiss.
Mr. Weiss serves on the board of the Cape Cod Municipal Health Group (CCMHG), a municipal joint healthcare purchase group through which employees and many school teachers in all six Island towns and some of the Island's regional agencies are insured.
Given the increasing rise in health insurance costs in his budget over the past three years and upcoming contract negotiations with five unions, Mr. Weiss asked the panel whether the system could be simplified so that a consumer could play a role in making decisions that would lower health insurance costs.
Dr. Pil suggested that higher deductible plans might help decrease costs. A person who has a $10 co-pay might be more apt to go to the emergency room for treatment of something minor, he said.
Dr. Slavin disagreed. Since Americans already spend more out of pocket, and most of that money is tied up in treatment for chronic diseases, such as diabetes, he said deductible plans are "double jeopardy" for low-income patients.
Complimenting the audience's thoughtful and informed questions, Ms. Nicholas suggested that Mr. Weiss take the lead in discussions with CCMHG members about retooling healthcare benefits design, perhaps through a cooperative that could rethink the way healthcare is delivered on the Island.
