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After two days of hearings in front of different Senate committees, the nomination of Kansas Governor Kathleen Sebelius appears to have moved closer to confirmation by the full Senate.
Gov. Sebelius recently appeared before the Senate Health, Education, Labor and Pensions Committee, chaired by Sen. Ted Kennedy, followed by an appearance before the Senate Finance Committee, chaired by Sen. Baucus.
In both instances, Gov. Sebelius was accompanied and introduced by former Kansas Sen. Robert Dole. She also was introduced and supported by Sen. Pat Roberts, who is a member of both Senate committees. Both Sen. Roberts and Sen. Dole urged Gov. Sebelius to work in a bipartisan manner to achieve health care reform. Beyond the substance of what they said, the simple fact that both Sen. Roberts and Sen. Dole, whom are prominent Republicans and were there to back Gov. Sebelius, sent a strong message to Senators that she enjoys broad support.
Throughout the course of the two hearings, Gov. Sebelius demonstrated an excellent command of the role and function of the U.S. Department of Health and Human Services, as well as a thorough understanding of the health care issues facing policymakers in Washington. She was knowledgeable of the work that senators on the two committees had done on health issues in the past, and she praised several members of the two committees, including Sen. Roberts for that work.
Gov. Sebelius was clearly supportive of the health care reform blueprint that President Barack Obama has set forth, including the public plan option that has become one of the more controversial points of discussions. She stressed numerous times that reforming the health care system is tied to recovery from the current economic downturn and that "crushing" costs are a major problem. She pledged to aggressively pursue the "fraud and abuse" that many lawmakers seem to think is rampant in the Medicare program, while working to enroll all of those eligible for federal programs.
With regard to CMS specifically, the Governor said: "CMS can also promote quality and efficiency, enhancing value for beneficiaries and taxpayers and leading by example for health reform. It can use 21st-century information technology to ensure its payments are aligned with quality and are fair, yet not excessive. CMS can support disease management, 'medical homes,' and other approaches to improve care and potentially reduce costs for people with chronic conditions. In addition, by using its demonstration authority, CMS can identify the cutting-edge practices that lay the foundation for a high-performing health system. At the same time, it is imperative for CMS to focus on prevention and primary care, steering its resources toward wellness rather than sickness."
While there were several "unfriendly" questions from a few Republican senators throughout the hearing process, those questions essentially amounted to criticisms of the health reform blueprint contained in the Obama budget proposal.
All in all, the hearings have to be seen as a successful entrance into Washington politics by Gov. Sebelius. At the same time, final confirmation apparently will not take place as soon as some had hoped. Senate Finance Committee Chairman Max Baucus (D-MT) said Thursday afternoon that a stay had been put on the Sebelius confirmation, which had been expected to occur later in the day. The stay came about because Senate Republicans wanted more time to review the nomination. Baucus said that the vote would have to wait until after the regularly scheduled, two-week spring recess, which starts April 6. We'll keep you posted as this process moves forward.
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President Barack Obama's recent Health Reform Summit involved more than 100 participants representing health care, business, insurance and consumer interests. In the President's opening remarks, he emphasized the need for action now. "We cannot delay this discussion any longer," Obama said. "Health care reform is no longer just a moral imperative, it is a fiscal imperative. If we want to create jobs, rebuild our economy and get our federal budget under control, then we must address the crushing cost of health care this year." The President also signaled that he will be guided by pragmatism as much as ideology. "If there is a way of getting this done where we're driving down costs and people are getting health insurance at an affordable rate and have choice of doctor, have flexibility in terms of their plans, and we could do that entirely through the market, I'd be happy to do it that way," he said, referring to a plan that relies entirely on private-sector insurers. Alternatively, "If there was a way of doing it that involved more government regulation and involvement, I'm happy to do it that way as well," he added.
American Hospital Association President and CEO Rich Umbdenstock shared the hospital field's views on health care reform with summit attendees. Umbdenstock said hospitals believe that "reform has to be comprehensive and it has to be inclusive of all of the stakeholders," adding that reform must address the elements that comprise Health for Life: Better Health. Better Health Care, AHA's health reform framework. "First is coverage for all, and we're very pleased to hear the President's commitment to that. We believe you really can't solve the cost problem … until you start to get everyone into the system at the right time and in the right place," he said.
Was the President’s summit the beginning of the march toward achieving reform of this country's health care system? Or was it just another in a long line of false starts in this area? I suppose the odds weigh more in favor of the latter. Remember that most presidents since Harry S. Truman have proposed some type of major health reform, from Truman's call for national health insurance to Nixon's proposal for mandatory health insurance to Reagan's approval of the Medicare Catastrophic Coverage Act (which was later repealed) to Clinton's famous health reform proposals. As a country, we have a history of being uncomfortable with attempts at major overhaul of the health care system. Indeed, there has been much commentary about how the President's plan is too big, costs too much and that the Administration is trying to act on too many fronts.
On the other hand, there is something a little different about how this discussion is starting out. Unlike the Clinton plan of the 90s, there is more transparency and inclusiveness involving the development of President Obama's plan. Whereas, President Clinton created his plan behind closed doors and then announced it to the public, Obama kicked off his effort by inviting all the stakeholders to the White House to hear their thoughts on the best way to proceed. Despite lots of political wrangling, there also seems to be agreement that something needs to be done. In fact, both House and Senate committee chairs have vowed that they would get a health reform bill to the President by next fall. And while there are many who say the President should focus on the economy first and foremost, there are plenty who argue that fixing health care is an integral part of fixing the economy.
Whether or not you agree with the elements of his plan, President Obama deserves credit for the way he has started this debate. He invited both Republicans and Democrats to the summit. He has made it clear that good ideas will be welcomed, an attitude that will assist in creating some common ground.
But we should not be misled about the size of the political divide the President is trying to bridge. There are real differences about the role of the government on the one hand, and the role of private insurance companies on the other. Our job is to not to join in the political noise from the fringes, but to set aside politics and constructively engage in this important discussion about the future of our health care system. We'll be talking a lot more about the specifics of the President's health reform efforts in the weeks and months to come.
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The first adjournment of the 2009 Kansas Legislative Session occurred April 3 as legislators headed home for a short break. Several legislative issues were wrapped up prior to the legislators heading home, including the passage of the State fiscal year 2010 budget, a comprehensive energy policy, and an increase in the State minimum wage. While legislators are expected to return to Topeka for the commencement of the veto session on April 29, many people will be closely watching the new State revenue forecast that is expected to be released on April 17. Depending on the news, legislators may need to revisit many of the budget items that were agreed upon at the end of the regular legislative session.
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Recently, the Internal Revenue Service released a final report on its 2006 survey of not-for-profit hospitals. The report found that the nearly 500 hospitals surveyed dedicated an average 9 percent of total revenues to community benefit. The report cautioned that attempts to set a percentage threshold for determining compliance with community benefit "could have disproportionate impacts on hospitals, depending upon their size, where they are located, their community benefit mix, and other hospital and community demographics."
Despite the fact that the survey tool used to create this report was flawed, policymakers will continue to be interested in an increased level of community benefit reporting. Members of Congress continue to question the amount of charitable care provided by hospitals and have threatened to put in place a percentage of revenue standard that not-for-profit hospitals would have to meet. Further, our legislature's Senate Public Health Committee has held hearings on the topic of medical debt and its implications on health care policy.
I don't need to tell you that community benefit reporting is more than simply adding up the amount of charity care your hospital provides and printing it in a colorful brochure. It is far more than that – free and reduced community wellness programs, health education, screening, providing assistance to school health programs and much more are all equally important community benefit programs and are rooted in your mission to provide community benefits. It is the cornerstone of the mission of a community hospital.
Last year, the Kansas Hospital Association Board authorized staff to provide KHA members access to the Catholic Health Association/Voluntary Hospital Association Web-based community benefit portal – CBISA. CBISA is the standard the IRS used in designing their new Form 990 report. To date, we have 62 KHA member hospitals enrolled and participating in the CBISA program. While that is a significant number, we need more participants to be able to use the aggregate information in a meaningful way. In addition, we all know that increased community benefit reporting is on the horizon. This project is a good way to get in front of the curve, and best of all, the software is free.
Kansas hospitals are committed to reliable and accurate transparency so that the communities they serve have more information about them. An excellent way to help accomplish that goal is to make use of the CBISA tool that has been made available. KHA also will use aggregate data in a statewide report to demonstrate the role, value and benefit of community hospitals in Kansas. This report is a powerful tool for advocacy and public.
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Our next Trustee Webinar is scheduled from noon to 1 p.m. on April 22. This Webinar will review the steps necessary to create an effective physician recruiting plan and the various elements that need to be included. Kurt Mosley, vice president of business development for Merritt Hawkins & Associates, will be the presenter for this program.
The Trustee Webinar registration form with more information is available on the KHA Web site. In addition, you also can register online for the program. Questions can be directed to the KHA Education Department at (785) 233-7436.
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Sixty-three Kansas hospitals responded to a recent KHA Pulse (a poll about current issues) on the physician workforce. Reporting Critical Access Hospitals indicated that one out of every four physicians is employed, compared to less than one in seven physicians at reporting prospective payment system hospitals.
Overall, hospital participants reported 95 vacancies, 25 in CAHs. Two out of every three hospitals reported active recruitment in progress. At the time of the survey, these 63 hospitals were recruiting 156 physicians, 71 were in primary care. Another 194 physicians are expected to be needed in the next three to five years.
Without question, geographic location was the number one barrier to recruiting physicians. With the difficulties added by competition for a limited number of physicians willing to practice in rural areas of Kansas, came the issues of increased call/coverage requirements, financial expectations, aging facilities and expectations of a potential physician's spouse and family. Several indicated that current medical staff were not supportive or were not willing to begin recruitment in advance of future retirements.
Thirty percent of the participating hospitals used contracts with ER groups, these were equally split between those who used these contracts to augment coverage by community-based physicians and those who relied on contracts alone. The majority who relied on contracts alone were in larger rural or urban communities. The majority of the hospitals reported utilizing community-based physicians that were either employed by the hospital or in private practice.
Less than half (41 percent) of the reporting hospitals provided additional compensation for call coverage to primary care physicians. A majority of the 41 percent were CAHs. Very few respondents, less than 1 percent, reported additional pay for specialists. Combined with increasing difficulty in recruiting physicians, call coverage and compensation for this traditional responsibility is becoming a larger issue for hospitals in every part of the state and all sizes of facilities.
For the complete survey questions and results, go to the Pulse Poll results on the KHA Web site.
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Mark your calendars for this year's Critical Issues Summit for Hospital Boards, scheduled for Aug. 27 and 28 at the Marriott Hotel in Wichita. Our keynote speaker will be George H. Labovitz, PhD, the lead author of the best seller, The Power of Alignment: How Great Companies Stay Centered and Accomplish Extraordinary Things (John Wiley & Sons, Inc., May 1997). Dr. Labovitz will discuss how using distributive leadership will create an organization that is "customercentic." Registration materials for this program will be mailed in the next couple of weeks.
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The Kansas Health Policy Authority has created an executive- and board-driven dashboard based on 14 indicators selected from the following four workgroups.
- Access to Care:
- Persons with private health insurance
- Persons with government health insurance
- Medical professional to population ratio
- Quality and Efficiency:
- Asthma admissions for children
- Heart attack patients – aspirin administration within 24 hours of admit
- Admits for diabetes with complications for adults
- Affordability and Sustainability:
- Average employer contribution for individual and family health plans
- Average employee's share of premium for individual and family health plans
- Average costs of co-insurance
- Health and Wellness:
- Adult smoking rate
- Adolescent smoking rate
- Overweight/obesity rates in adults
- Overweight/obesity rates in adolescents
- Percent adolescents and adults who participate in recommended levels of physical activity
The dashboard may be viewed on KHPA's Web site. KHPA established a Data Consortium to ensure the effective collection, management, use and dissemination of health care data to improve decision-making in the design and financing of health care and public health and wellness policies.
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The Kansas Hospital Association's recent public opinion survey found the top concerns of Kansas residents are the increasing number of uninsured residents, state budget cuts for health care and the cost of health care services. The survey found that a majority of Kansans, 60 percent, have a personal relationship with someone who is uninsured or they themselves were uninsured. And nearly half, 48 percent, of those surveyed indicated that they were concerned about the possibility of losing their health care coverage in the near future.
Access to affordable, quality health care is a top priority to Kansas hospitals. And making sure we have a workforce to provide this care is essential and an issue of grave importance. Unfortunately, one in five Kansas residents surveyed, 19 percent, reported the shortage of health care professionals in the area where they live affected their ability to get health care.
In addition to the concerns of cost, coverage and access, Kansans overwhelmingly indicated support for a statewide smoking ban, with 75 percent of those surveyed saying they would support a statewide ban on cigarettes, and the same number supporting a tax increase of 75 cents per pack on cigarettes, if that money was used to fund public health care services. In the immediate future, a statewide smoking ban is a way in which we can bring down overall health costs, but it also creates a nonsmoking culture in our state, which has health benefits for all Kansans. The complete survey results can be found on the KHA Web site.
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Much has been made about whether this legislation is too much or too little; whether it represents an inappropriate role for the federal government; and how much impact it will have on our weakened economy.
Regardless of your political views regarding the stimulus package, it is a fact this legislation contains numerous provisions that send a positive message to the health care community. The act includes $87 billion in additional Medicaid funding for states; $24.7 billion to help workers maintain their health insurance under the Consolidated Omnibus Budget Reconciliation Act or COBRA; $1 billion for clinical preventive services and community-based prevention programs; $20 billion in Medicaid and Medicare funding to help providers adopt health information technology systems; and $10 billion in additional funding for the National Institutes of Health. A more detailed summary of these provisions can be found on the KHA Web site. For Kansas, this means an additional $450 million for its Medicaid programs over the next three years, with $111 million of those funds arriving over the next three or four months.
With all these elements to digest, it is unfortunate that much of the health care-related discussion has been about what is essentially a non-issue. There has been a lot of angst on talk radio, cable news and some editorial pages that the appropriation of funds for "comparative effectiveness research" means that the federal government is going to tell physicians how to practice medicine. Well, the government already pours millions of dollars every year into comparative effectiveness research through the National Institutes of Health and the Agency for Healthcare Research and Quality. And it is certainly no surprise to health care providers that we already have bureaucrats, both in and out of government, looking over the shoulders of those who deliver care. This phenomenon is part and parcel of managed care; and frankly, it is sometimes difficult to tell whether the government or a private health plan is the worst offender. Even Newt Gingrich's own Center for Health Transformation dismisses this argument, stating that "modernizing our health care system through information technology and robust, comparative research will push our health care system into the 21st century."
To be sure, the recently passed economic stimulus bill was an enormous piece of legislation that covered all sectors of the American economy. The old phrase "the devil is in the details" has never been truer. For those in Congress, there certainly were valid reasons to vote against the proposal. (Although you shouldn't be surprised to see some of those who voted against it taking credit for bringing funds to their states.) The central point now, however, is that the American Recovery and Reinvestment Act has become the law of the land. Instead of continuing the argument over the merits of the legislation, let's move on to the next phase of this project. All of our elected officials, on both the state and federal level, must put aside partisan politics and work together to make sure that the State of Kansas gets its fair share of funding from the stimulus package. The dollars that have been appropriated can go a long way to support the health care system in our state, but we must all be dedicated to getting them to the right place. We'll be working closely with federal and state officials to guarantee that happens.
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Few business organizations survive for 100 years. The Mayo Clinic has not only survived for more than a century, but it has continuously performed at a premier level. Leonard Berry and Kent Seltman's recently published book, Management Lessons from Mayo Clinic, describes in detail the management values, culture and policies that are the foundation of this enduring success. During the afternoon session of the Executive Leadership Forum, Kent Seltman will discus how Mayo's focus on its primary value – the needs of the patient come first – has created a "customer experience" that earns spontaneous and positive word-of-mouth from more than 90 percent of its patients.
Following Seltman's remarks, a panel of hospital executives will review the ideas presented in the book and discuss how these concepts can be applied to Kansas hospitals, large and small. Participants will be introduced to practices that produce stellar clinic results, organizational efficiency and interpersonal service. In addition, all participants will be given a copy of the book to take back and share with others at their hospital.
This year's Executive Leadership Forum will be May 7 in Junction City, and the Frank L. Gentry Golf Tournament will be May 8 in Milford. The brochure for this program is available online. Questions can be directed to the KHA Education Department at (785) 233-7436.
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If you haven't done so already, register for access to the member-only sections of the Kansas Hospital Association Web site. To register, go to www.kha-net.org and click on "Login" (located in the upper, left-hand side of the home page). Scroll down to "If you are a new user, click here to register." After you type in the requested information (you choose your own username and password), please allow one business day for KHA staff to verify your information. You will receive an e-mail from us when your username and password have been activated. If you forget your username and password, click on "Login" and scroll down to "Click here for a username and/or password reminder." Your username and/or password will then automatically be e-mailed to you.
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