Return Of National Health Reform?
This is an excellent synthesis about current Washington health care politics,from a 4/5/95 editorial in the Washington Post.
"How times and roles do change... The Republicans have promised to balance the budget. As the president kept pointing out and just about everyone agreed last year, there's no way to do that without imposing tight constraints on the giant health insurance programs, Medicare and Medicaid, that are now a sixth of all spending and the main budget engines. The health care problem and the budget problem are in a sense the same. Mr. Clinton's idea is that this year the Republicans should be the ones to take the heat for proposing a solution. As Mr. Dole put it, "The president wants to have it both ways and not do anything. He's out there bashing us. I think it's time for the president to become relevant in this process and join us.'"
"The Republicans deserve praise if in fact they move to curtail the cost of the health care programs. But deciding somehow to cap the cost and thereby reduce the deficit and keep the Medicare trust fund from running dry and all those other good things -- that's the relatively easy part. The hard part is then figuring out how to live within the caps without doing damage to the health care of the elderly or poor or merely shifting the cost of that care from the federal government to others -- the states, for example - who may be less capable of paying it."
"The two great problems of health care remain what they were a year ago. The health care system doesn't cover everyone and even so costs too much. At any given moment a seventh of the population is now without health insurance even as the system consumes $1 of every $7 Americans spend. Except as a forcing device, a cut in federal health care spending won't solve either of these problems. Rather, it could make care even costlier and less accessible to the elderly, disabled and poor."
"Congress shouldn't just cut and run. It and the president have to work through what they expect to happen next. If they want to cut the budget, as they should, they will also have to do what they failed to do last year and restructure the health care system. Right now the two sides are mostly exchanging taunts. They should begin exchanging practical ideas."
Map data obtained via internet connection from the Bureau of the Census, Statistical Abstract of the United States, 1994,for ordering info, please call 301-763-5299 or email firstname.lastname@example.org.
'95-97 Medicaid HMO Penetration
The shaded counties below are targeted by the State of Wisconsin to have 100% enrollment of the following Medicaid beneficiaries: AFDC, Healthy Start Children and Healthy Start Pregnant Women by September, 1996. The remaining counties are expected to have a Medicaid penetration of the eligible population from 0% (Door County) to 16.8% (Price County). The criteria used to make this prediction was a "gut feeling" of local area "readiness." Map idea from Tom Jones, Wisconsin Hospital Association.
Another Wisconsin Step Forward
Republican Senator Peggy Rosenzweig is introducing a health insurance reform bill for the small market (groups <100) - very similar to last session's Senate Bill 722 but with language that should avoid an abortion blockade. Short of individuals not being able to afford an insurance plan, this bill will address the major flaws in Wisconsin's health insurance market:
- limits on the preexisting condition limitation
- portability of policies, employer to employer
- guaranteed issue
- modified community rating
Milbank Selects Wisconsin Proposal
The Milbank Memorial Fund in New York City has accepted a proposal to work with the Wisconsin Network for Health Policy Network and the Cooperative. We proposed a partnership to further explore public policy issues related to defining and managing the potential conflicts between collaboration and competition.
As noted in last month's report, it is believed that the challenge with this issue may be related to deeply held but conflicting values - we seek unduplicated use of scarce resources and the "integrated", "seamless" delivery of health care but we also prize consumer choice, private enterprise and competitive markets. Depending upon which perspective one chooses, either a negative or positive spin can be put on many aspects of our coming new age in health care,for example, is it best seen as the formation of regional "integrated service networks" or as the development of monopolies and the sanctioning of monopolistic practices?
Work Force Planning - Accountability
The Primary Care Consortium of Wisconsin's proposal for a statewide work force plan has been linked with the results of an AHEC strategic planning retreat. Having also gained the support of the Rural Health Development Council, there is hope that the State Biennial Budget Bill will adopt the following idea:
The State of Wisconsin each biennium spends tens of millions of dollars of General Purpose Revenue dollars to train health care providers without the benefit of even a basic work force or education plan. The state continues to face major problems relative to the supply and distribution of primary care providers. Two basic sets of questions need to be thoroughly addressed: (1) how can educational institutions receiving State funds to train or educate primary care providers be more effective, and (2) what is the relationship between their programs and the need for primary care providers throughout the state?
It would greatly benefit the state if the University of Wisconsin, the Medical College of Wisconsin and Marquette University would work cooperatively with the Wisconsin Area Health Education Center System and the Consortium for Primary Care in Wisconsin to develop a statewide primary health care work force plan. The cooperative state-wide plan needs to be completed by July 1st, 1996.
In addition, the University of Wisconsin, Medical College of Wisconsin
and Marquette University each need to develop their own institutional plan
for those health care training or educational programs receiving state
Each institution's plan needs to: (a) address the following disciplines: dentistry, nursing, medicine, pharmacy, physical therapy and physician assistants,(b) address recommendations from the cooperative state-wide plan available by July 1st, 1996 and (c) be submitted to the Governor and the Legislature by September 1st, 1996 in time for public reaction before the Governor submits the administration's biennial budget bill.
The proposal includes specific issues that each institutional plan needs to address:
WI Wage Data Distorts Payments
You would not expect wages to vary significantly between neighboring
rural hospitals. But you can't compare apples and oranges. As part of a
joint venture by the Wisconsin Hospital Association and RWHC, it has become
clear that Medicare is doing just that,they are including the lower wages
related to non-Medicare skilled nursing facilities operated by rural hospitals
into those hospitals' Medicare average hourly wages.
This is a significant problem for two reasons:
- Under-Pays All Rural Wisconsin Hospitals
Combination facilities (rural hospital inpatient services and skilled nursing home care) are common in Wisconsin and Minnesota but rare elsewhere. Consequently the lower payments due to this data error disproportionately affect Wisconsin and Minnesota.
- Blocks Improvement Of Current Wage Index
There is almost universal agreement that the current system of throwing all rural hospitals into a statewide rural wage pool is artificial and a poor model of actual wage markets. However all models that might better reflect actual wage markets have been distorted and made politically less feasible due to data errors that are otherwise hidden in the existing statewide rural wage index.
WI Rural Isn't Just Rural Anymore
An excerpt from the Editorial in this month's Corporate Report Wisconsin by Pete Millard highlights the changing nature of rural Wisconsin and its inherent strength.
"Rural Wisconsin is no longer synonymous with 'farming.' The trend is that rural communities are becoming focused on manufacturing. Nationwide, there are just as many people employed in manufacturing in rural areas as in urban areas."
"I believe that, as the telecommunications revolution envelops more communities away from Southeast Wisconsin or the Capital City, more of the state's medium sized cities should tout their rural attributes."
"We are lucky in Wisconsin for two reasons: the state is predominately rural at heart (and rural economic development is trendy),and the rural areas in this state are well represented by colleges and universities - a winning combination."
RWHC Director To Be WHIMA President
Carla Gorski, Director of Health Information Services for the Cooperative has been elected to the post of President-Elect of her state professional association. The 1300 member Wisconsin Health Information Management Association has as its mission to promote the management of quality health care information. It places an emphasis on the balancing of patients' privacy rights with legitimate uses of data to improve quality outcomes. Since 1988, Carla has been part of the RWHC leadership team to enhance our role in this field of critical and growing importance.
Federal Rural Health Block Grant
Congressman Steve Gunderson's Office is working with others on draft legislation to develop a specific block grant for rural health, consolidating existing grants such as Outreach, State Offices of Rural Health, Telecommunication, Trauma Care, etc.. While some oppose any block grants, this approach would protect federal moneys previously allocated to rural health that are at significant risk of being lost through merger into larger, general purpose grants. In addition, their draft supports moving the Federal Office Of Rural Health Policy into the Office of the Assistant Secretary to give rural health needed visibility. (I suggested that, we go for the whole loaf, the Secretary's Office.)
Fed Policies For Rural Networking
This month, I was at an invitational meeting in Washington sponsored by the Robert Wood Johnson Foundation to identify priority issues for federal action re rural health networks. The four priority issues in rank order were:
A Virtual Hospital Next Door
For me, the highlight of the University of Wisconsin Medical School's Medical Education Day at the Promega Technology Center in Fitchburg was ironically a demonstration of the University of Iowa Medical School's Virtual Hospital.
If you didn't get a copy of Netscape for your computer as previously recommended, you surely now have a good reason to do so. The following information was downloaded from their site which you can reach at
"The Virtual Hospital (VH) is a continuously updated medical multimedia database stored on computers and accessed through high speed networks 24 hours a day. The VH will provide invaluable patient care support and distance learning to practicing physicians."
"The VH information may be used to answer patient care questions, thus putting the latest medical information at physicians' fingertips. This same information may be used for Continuing Medical Education (CME), delivering CME to physicians' offices and homes at a convenient time and location. The VH is built on pre-existing computer and communication standards and uses the World Wide Web (WWW) software technology to store, organize, and distribute our multimedia textbooks (MMTBs) contained within it. We define a MMTB to be a program that patterns its user interface after a printed textbook. Our MMTBs incorporate functions such as free text searching, the ability to play video and audio clips, and to display an unlimited number of high-resolution images."
Sample Services from the Virtual Hospital:
Information Primarily for Healthcare Providers:
Multimedia Textbooks (MMTB)
Multimedia Teaching Files(MMTF)
Patient Simulations/Virtual Patients
Clinical Practice Guidelines
The UIHC Formulary
The UIHC Clinical Lab Reference Manual
Grand Rounds, Lectures, and Conferences
Department of Surgery
UI College of Medicine Curriculum
History of Medicine
Other Internet Health Science Resources
UIHC Informm HIS Gateway
UI National Lab. of Rural Telemedicine
Health Care Provider Newletters
Continuing Medical Education Information
Information Primarily for Patients:
Patient Guide: Acute Low Back Problems
Iowa Health Book
UIHC Physicians Directory
How to get to the UIHC
Patient Representative Program
Poison Control Center
The UIHC Medical Museum
Helping Children Cope with the ICU
American Family Physician Handouts
Meeting With Governor Thompson
Each year, members of the Wisconsin Health and Education Facilities Authority meet with the Governor. He reiterated his support for the Authority and in response to a request, indicated support for WHEFA bonds being state tax exempt IF a budget neutral way to do so could be identified. The policy objective is to make WHEFA more accessible to providers currently using local municipal bond conduits for their state tax exemption not available through WHEFA. With tongue only half in cheek, he added it was a pleasure to meet with WHEFA as he spent most of his time these days discussing ten to twelve thousand dollars items people want back in the budget bill.
From The Insanity In Oklahoma...
Many of you may have read David Broder's syndicated item in the April 25th Wisconsin State Journal. For those who didn't, here are are a few of his key ideas:
"Because politics is, thank goodness, subordinate to many other aspects of American life, the forces that change our politics in fundamental ways usually arise from events in the outside world - not from Government... At this point, we can only speculate about what Oklahoma City and the spector of extremist domestic terrorism may do, but some reactions have surfaced strongly:
"Embrace Change, Cherish Values"
This quote, shared at the UW Medical Education Day in a presentation on the future of telecommunication, is from Mark Friesse, M.D. at Washington University, St. Louis. I can think of few better words to keep in mind.
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