HCCD Report Kansas 66083

December 31, 2008

To: Tom Daschle, Secretary-designate of HHS

From: Dr. Jean-Pierre, Ph D.

Reference: Healthcare Discussion Report

Introduction:

The arranged meeting scheduled for Saturday, December 27, 2008 about 3:00 p.m. was cancelled due to a predicted storm. This led me to be creative by visiting people in their place of employment or gathering. Moderated two discussion groups with positive outcomes. It should be noted these meetings were not previously scheduled. Used the provided template to guide and facilitate the discussion. First met with 4 professionals from the Fire Department and our discussion lasted 50 minutes. The second meeting was held a day after with a Christian group composed of 9 people but only 8 people fully participated to the discussion that lasted 1 hour and 12 minutes. In these two occasions no picture was taken or discussion recorded. All 12 participants were informed of the protocol set for this type of discussion, but only one in each group read the protocol for others. At the onset I highlighted the importance of the healthcare discussion and the need for inputs from common people and those who have deeper knowledge of the issues confronted in the healthcare systems. All 12 participants were eager to get going, however, they settled to provide a feedback from the selected questions.

Discussion:

Using open-ended questions, I introduced the following topics for discussion:

What do you perceive is the biggest problem in the healthcare system?

a)      Cost of health insurance

b)      Cost of health care services

c)      Quality of healthcare

All twelve participants agreed that premiums were too high and necessitate reduction. These two groups expanded on these three areas, however, professionals with a collective understanding on healthcare issues offered clarity and meaningful reasoning in probing for solutions. The healthcare rising cost was broken into four categories. First, citizens to bear part of the blame in the rising of the healthcare cost. Secondly, the pharmaceutical industry and the lobbyists, and thirdly, the insurance industries, and fourthly, increased litigations due to malpractice lawsuits. Due to time constraint the two groups gave limited answers to the many questions that should have been debated. The inactive participant though present took no part to the discussion.

Citizen contribution to the healthcare crisis:

More often citizens abuse the healthcare system by seeking emergency care when generally speaking many of them never really needed emergency interventions. Some for lack of means of transportation to local clinics would call for emergency services and taken by ambulances to emergency care. This misuse of services compounds the cost of healthcare. Due to legal implication many of such services cannot be denied. Four people out of 8 participants in the second group recognized citizen abuse of the healthcare system. However, others from the same subgroup felt all means should be available when a need for healthcare attention is present. They also felt that healthcare cost should not be an issue for everyone. When I asked how to correct abuses to lower the healthcare cost? The overwhelming majority suggested “Mass Education on Healthcare Costs and Services” that is needed. Under this caption variant responses were given in the delivery of the healthcare education to the masses.

A question was asked by one of the participants, how many choices should be made in answering to these questions? The general consensus was as many as possible. The opinion was divided on how to address the healthcare problems. From the tally, 3 participants preferred community meetings; six participants preferred traditional town hall meetings; seven participants leaned toward the use of surveys to expand the reach of those who could not otherwise attend a public meeting; the 12 participants all agreed for the white House leadership on the issue and 4 supported the hearings on C-SPAN. All twelve participants agreed on (a) and (b), but on quality of healthcare or (C) only 7 participants marked the box. Five participants felt it was difficult to find an affordable health insurance without employer’s sponsored plan. Eight participants felt there was a generalized lack of emphasis on healthcare prevention.

The pharmaceutical industry and the lobbyists:

The two groups cited for more regulations of the drug companies and more regulatory policies aimed at restricting drug companies for commercially advertising pharmaceutical drugs on Television and more regulatory enforcing a prohibition on pharmaceutical lobbyists in influencing healthcare costs.

The insurance industries:

Professionals expressed serious concerns due to lack of standardize care to prevent redundant work or duplication of procedures. Some examples cited by professionals in the field such as “Intravenous lines (IV),” established in the field, end up getting removed and restarted once patients were admitted in the Emergency Room (ER). This action caused patients to be billed twice for the same procedures. The same was true for patients requiring endotreacheal tube (E-T) in the field to establish patent airways, before or immediately after a chest-radiology (X-Ray) is completed in the ER, the E-T gets removed and reinserted with the hospital E-T. For every charge on the patient, there is a double charge for procedures and equipment used. The same is true for field data communicated to ER nurses; these data get ignored or overlooked. Instead of using these data as baselines, the ER forcibly gathers new data to establish the new baselines to protect themselves against any malpractice lawsuit. Consequently patients get also billed twice for the same procedures. This amplifies lack of good communication and trust between two different ancillaries resulting in the doubling of the cost of care and the time spent in protecting hospitals against any potential lawsuit. Much of the healthcare time is spent in protecting institutions instead of attending to the needs of patients.

If a healthcare provider spends most his or her time caring for the sick, he or she would likely miss to cover the necessary steps that prevent a lawsuit, which in turn inflate revenues. In the presence of high cost of care most insurance companies tend to double the premiums or deny paying for services performed. The same insurance services do not mind a redundant work that increases the cost. Much of that according to professionals is based on fear of the unknown that produces high cost. In order to maintain healthcare premiums patients are required to pay high deductible before insurance covers the cost. Consequently most people who cannot afford the premium refuse to seek medical attention. As a result, many people stay home when they actually need medical attention. Insurance companies never looked to the cost generated by redundant work that increases the cost. They let hospitals to deal with this problem with lawmakers. Lack of adequate healthcare oversight squarely put pressure on the insurers to accept the terms set by the hospitals, insurance companies, lawmakers, and drug companies.

Increased litigations due to malpractice lawsuits:

Some unnecessary procedures are imposed in the healthcare delivery system to prevent litigations and financial losses in the event of any lawsuit. Duplication and redundant work result from an effort to try to prevent lawsuits. According to professionals, lawyers fuel the cost of care by introducing unnecessary steps in the delivery of the healthcare services. These unnecessary steps add no benefits in the patient care. To the contrary they are overriding the cost of care while squarely blaming the healthcare delivery system. These costs of care are passed on to the patients and billed to the insurance companies. Consequently the insurance companies take the option to pay or deny paying the cost of care. As the medical cost rises so does the premiums.

The two groups believed that lowering the cost of healthcare would not endanger the quality of healthcare. They both agreed that streamlining healthcare systems should prevent redundant work and over billing. Both groups also believed by improving the delivery systems, healthcare providers would compete for clients on quality of healthcare services instead on the cost of care. Standardization of care would improve the delivery of services and meet clients’ satisfaction and undercut lawsuits. There was a general consensus that providing quality care would not undermine or limit good wages. Professionals added, if only if, all healthcare principles were properly applied then wages would go up instead of down. When asked how? The consensus was that hospitals would compete for good healthcare providers. Such competition would enhance quality and promote good wages.

Moderator’s Opinion:

This is an interesting topic that necessitates further studies using “Mixed Methods Research” involving an exploratory study (qualitative method) and a confirmatory study (quantitative method). Data obtain from such a study will highlight the course of action to take to improve healthcare delivery systems and maximize appropriate strategies that could be used to enhance the healthcare delivery system and streamline the cost to meet targeted goals. At the same time such an analysis will offer a clear understanding of the healthcare issues using quantifiable data without bias. Because of the urgency of the situation to probe the healthcare situation, this could not be done at this time. However, Survey methods will research a large segment of the population while town meetings could highlight major healthcare issues and increase an awareness of the large segment of the population. This may force people to think through how to best contribute to an affordable healthcare system in the country.

Conclusion:

The twelve participants thought this was an overwhelming task trying to resolve the healthcare mess. Out of 12 participants, 11 felt the discussion should have been broken in parts to look into different scenarios that stimulate the cost of care before dealing with the total overhaul of this sector. They expressed they would be willing to take part to such discussion if the subject matter was broken down into parts. Some offered the use of incremental steps before revising the entire healthcare system. Six participants never thought they would ever be asked to debate on healthcare issues.

In summation, I believe we barely touched the subject. However, these two groups also believed in drastic measures to overturn crisis imposed by this sector on the economy. To avoid further economic pressures all 12 participants agreed that these were extremes economic times that require extreme measures to resolve healthcare issues before they bring down the entire economic sector. Other important questions were not explored due to the limited time. Every participant was thanked for willing to share ideas without personal commitment to participate in group discussion. All 12 participants were asked to be informed by surfing on the web to look for potential solution to this crisis.

Moderator’s Report: December 2008

Dr. Jean-Pierre, Ph D.