A new, hopeful way to look at health care
 |
|
||||||||||
The most remarkable thing about the meeting was not the participants but what was said - and not said. What political Washington considers the most important health-care issues - the patients' bill of rights, Medicare drug benefits - went unmentioned. Instead, the visitors listened and learned from the team of briefers about error rates in dispensing pharmaceuticals and the number of infections contracted in hospitals.
The host of the gathering - and the man as passionate about health-care reform as anyone at the table - was Treasury Secretary Paul O'Neill, who in his earlier life as the CEO of Pittsburgh-based Alcoa had been instrumental in forming the Pittsburgh Regional Healthcare Initiative, a cutting-edge consortium of providers, consumers, insurers and employers, whose goal is to demonstrate that sense can be made of the hodge-podge that is the American health-care system.
Ever since he came to Washington, O'Neill has been telling the president, his Cabinet colleagues and lawmakers of both parties that they need to see what is happening in health care in southwestern Pennsylvania.
The consortium was formed three years ago, with O'Neill and Karen Wolk Feinstein, president of the Jewish Healthcare Foundation, as its heads. It now includes 32 hospitals, four major insurers, more than 30 business executives, the Pennsylvania attorney general and hundreds of physicians. Its work is supported by the Centers for Disease Control and a $1 million grant from the Robert Wood Johnson Foundation.
While most of its projects are incomplete, O'Neill told the visitors that enough has been learned to convince him that "with the money we are spending in this country, we have the resources to provide top-quality medical care for every American."
That can happen, the conferees were told, only if the health-care system is turned on its head - not by changing its financing, as the Clinton administration proposed - but by focusing all its parts "on the patient at the point of care."
That sounds like a cliché, but it is not. As the head of nursing at one of the participating hospitals said, "Nurses now serve the hospital, not their patients," distracted by other duties from being the front-line caregivers.
Another example: Medical records now are kept in the offices of doctors and hospitals, often unavailable to others. The consortium is working with electronics firms to develop a "smart card" with an individual's entire medical history and background on it, including not only allergies but whether she uses a seat belt and has a smoke alarm. Each person would decide for herself what information to share, but an attending physician could be alerted not to order tests already performed elsewhere and not to give a drug that wars with one already being taken.
The effort to improve quality and reduce costs involves collecting and sharing data on medical outcomes. Initially reluctant, the participating, highly competitive doctors and hospitals agreed to report to each other the outcomes of their hip and knee replacements and their cardiac surgeries. Come to find out, one out of six heart patients has to be readmitted, half of them within a week of being discharged. Now the physicians are trying to identify, as a group, which patients should be hospitalized longer to avoid the trauma and expense of the return hospitalization.
Similar quality and cost controls are being applied to eliminate errors and delays in dispensing drugs and avoiding the all-too-prevalent hospital infections.
Frist and Kennedy left Pittsburgh talking about federal legislation that would create a center in Thompson's department for "quality improvement and patient safety," expand the database needed to identify and eliminate frequent medical errors, and provide legal protection for people in the health-care system who voluntarily disclose where the problems are.
It's a different and hopeful way of thinking about one of the major challenges this nation faces.