I attended a Jesuit high school. There were two rules drilled into the students – never communicate in first person and never divulge too much of oneself for fear of losing objectivity. The notion of a blog is a 180 degree turnabout; but, it is imperative when addressing healthcare reform.
Healthcare as an industry affects each of us personally – at its crux is quality of life and the value of death.
President Obama turned on the switch for a great revolution in America with a reform agenda and stimulus proposal. Healthcare made the short list of immediate change. The President and Secreatary of Health initiated a dialogue, crafted volumonous proposals, and opened the floor for consensus. The objective of this effort was to create change and an outcome different than other presidents for the last century.
Franklin Roosevelt developed a government safety net of benefits – unique and essential for the time. His successor, Harry Truman, attempted healthcare reform and it was pushed back faster than the League of Nations proposal.
Richard Nixon endorsed change based on his relationship with Kaiser Permanente and belief that HMO was the reform prescription; it was found to be a placebo. Bill Clinton put his top person on the task, Hillary Rodham Clinton. She was forced to retrench and recreate herself early in the first term.
Today, it is President Obama. Sitting in an Sg2 conference a few years ago, the speaker said we were coming upon a perfect storm – the confluence of payers, providers, employers, and consumers, all agreeing reform was necessary and have a stake in its success. The economic recession in 2008 was merely the bam to get it moving. So, following months and months of messaging, positioning, and stage-setting, the debate is about to occur. Cable pundits believe reform legislation must occur before Senastor Ted Kennedy succumbs to disease. Morbid – or lauding for a career spent debating and searching for universal healthcare, there is a timetable and expectation for change.
Funding, option versus resolution, standards or dictums – the essence of the decision is the impact on people’s lives once legislation and expecations are created. Within the last twelve months my family’s life has been turned upside down as we navigated the healthcare industry.
A year ago my mother initially had a chest cold and within five days was in a cardiac care unit. Two days later the cardiologist told us that she would not survive stent placement or open heart. A week later after multisystem failure she was wheeled out of the hospital with two stents inserted and a physical and emotional state that would never be the same. During the last year her physical health has improved. A minor touch of the skin results in bleeding. Energy levels are still weak. Fear of another heart attack is ever present. After a life of bearing children, a car accident, broken neck, and the maladies of life – including the loss of a husband thirty years earlier from a surgical error, the heart attack was symbolic of mortality.
We learned to look for seasoned nurses on the floor. The family created a schedule to insure she was never left alone more than a half hour for fear someone would forget an oxygen treatment, not use paper tape, or get her sheets changed. Laptop was required for looking up phrases, terms, and diagnostic tests. The cell phone rule was never followed – it was a communication hub between the hospital and family and friends.
The physicians were instruments; for lack of a conductor we stepped in.
This year my mother looked at a bag of perscriptions from an array of specialists that were designed to keep her alive. Medicare Part B was available yet the doughnut – the time between reaching benefit coverage and deductible, was approximately five months. She began shopping pharmacies and superstores. One day she sat back and asked, “What happened? I can’t afford to take all of this and live.”
Last week, a friend from college called. Her mother had experienced prolonged chest pain. A heart patient residing full time in the Netherlands and on holiday in Indianapolis, the family was unsure what to do – a foreign nation, vacation insurance, no Medicare card (or even citizenship), and English was a second language. She agreed to go to the cardiac specialty hospital emergency department and a cardiologist who treated other members of the family met her there. Within six hours the decision was made to do immediate bypass surgery. By 11:00 pm, a holiday visiting her daughter and family was now focused on survival after multiple bypasses, diagnoses of another heart attack a day earlier, and a long recovery time. Hotels and scenic drives were shifted to a modern, state-of-the-art specialty hospital in Central Indiana.
The most interesting aspect of this itinerary was the patient’s husband and Indianapolis family reaction. When I walked in my friend’s father couldn’t believe how wonderful everyone was, the speed and action of the physicians and staff, or that they were a facility whose appearance was akin to a modern airport filled with care and compassion. If we were creating a marketing campaign it couldn’t have been worded any better.
These events taught me so much. I was never happy with my mother’s care. There was no integrated delivery system with primary care physician as her medical home leader working in concert with an array of specialists. What we had was a disjointed system, disillusioned medical staff, compliancy, and most of all an utter lack of patient-centric care. Her disease was treated as an inpatient and the system of care following discharge was present in text but not reality.
Universal coverage nearly killed my friend’s mom. Access was stymied by the need to meet standard protocols for care. Access is not rationed; it is a business. Caregivers provide care yet striving for the newest technology and latest techniques is just not there.
These two mothers experiencing heart disease fashioned bookends to a year including:
- American Medical Association support of the medical home model.
- Implementation of medical home models and telemedicine products nationwide.
- Support for information technology investment through ARRA legislation.
- Estimated investment for Obama Administration reform from $1 trillion to $1.5 trillion over a ten year period.
- Declining fortunes for Medicare Advantage holders.
- Realization that convenience care clinics were serving a healthcare option for low income and Hispanic patients versus the camp physicals and ear infections of suburban patients.
- Focus by the President on securing funds for reform from hospital payments and disproportionate share payments.
- Federal support for electronic medical record adoption. Implementation is beginning to look like the original rail system in the nation – tracks were of various sizes and shapes until a federal standard was implemented.
- World-wide recession impacting health system investment portfolios and ultimately creating the lowest margins in decades.
- Realization that the healthcare industry was not recession-proof after all.
Over the next several weeks and months legislators will be positioning in an effort to be reelected concurrent with creating generation-changing legislation. Physician organizations have already developed their sound bites (on NBC, reporting of the President’s reception at the AMA meeting included a statement by the physician-correspondent that she was not a member of the AMA and that the group often leaned to the right). Pharmaceutical companies are responding the revised physician marketing guidelines by creating B2B units to develop relationships with key clients.
Amid debate, positioning, communications, emails, CNN specials will be someone’s mother or father waiting in a surgical suite for their surgeon to perform life or death procedures. A father holding his child while an MRI suite is readied. A significant other driving to an outpatient center for care and worried — benefits are gone with her job. There is potential to care for these individuals at a cost of $500,000 on top of OMB’s trillion dollar anticipated expense.
The potential for these patients and their families to be at the center of the dialogue may not be a great wager.
Let’s hope my bad streak continues.
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