December Postings 12/6/2008

Good Morning to all:

Am back at work following the healthcare scene in DC and interviewing for placement on a congressional staff. Once I make a final selection, I will fill you all in on this process. It is not for the timid or shy. Also, you must be of sound wind and limb to undertake this journal because walking the halls of congress is not kind on one's feet...... This picture was taken by Kathryn Higgins (M. Stanley). To get this money shot, you must be standing in Virginia at the Iwo Jima Memorial. Thanks KHigs!

Also, I would like to alert the community to a crisis in our ability to support the future physicians and scientists. The Kentucky Science Fair provides $$$ to support fairs all over the state to showcase our high schoolers. The Wall Street Debacle has depleted their funds and has placed our ability to support the fair this year at risk. More than 55% of the winners of these fairs go on to attend colleges and universities across the commonwealth. If you have any dollars to spare please get in touch with me or the science teachers at your local highschool. We can link you with the KSF and their fund manager. All the dollars go to support the fair - prizes for the kids and travel to the international science and engineering fair. I have been president of the DuPont Manual Science Fair Board and the group of parents who work on this board are dedicated to science education for all of our children. Please, please, we need your support to bridge this year while we work on longer term solutions.

And now, back to our blog...........

Today's topic: Informing yourself for the change to come

The ideas concerning reform are swirling thick and fast like snowflakes in a blizzard. There are a few new websites that I would like to call your attention to:

1. http://www.kff.org/uninsured

This one is hosted by the Kaiser Foundation and provides a guide to their view on addressing the healthcare problems of the uninsured and others.

2. See the NY Times Opt Ed, Dec 4th by Jonathan Gruber, MIT professor on jobs in healthcare.

3. See NY Times story, Dec 5th on Tom Daschle and his planned Health Care Community Discussions. Mr. Daschle will be nominated to head-up HHS sometime next week. Sen. Ken Salazar is working with him to set-up these discussions across the US over the next two weeks. Go to Change.gov to get your comments in the mix. I have already. Perhaps they will organize one of these sessions close enough so that folks from L'ville can attend.

Later this week I am attending a conference on Medicare/Medicaid Demonstration projects. These types of projects are the sites where healthcare models are tested with support from the government agencies that oversee these organizations (i.e. Centers for Medicare/Medicaid Services).

Health care reform gets serious....

Health Care Reform is Starting to get serious. There is bipartisan talk going around town and appearing on websites near you.

One paper that I would like to call your attention to one that was published Nov 12, 2008 by chairman of the Senate Finance, committee Max Baucus (D-MT). I would encourage all of you to go to http://www.finance.senate.gov/ and obtain a copy of the 98 page report. There are four detailed chapters which I will not go over here.

A second paper that I would like to call your attention to is http://www.healthpolicycenter.org/. This is an 11 page analysis of the Obama plan. In our next posting, I will attempt to compare and contrast these plans for the folks back home.

'Til next time.

Mardi Gras on the Potomac Part 1

This morning I went for a stroll around the neighborhood. I saw this neon sign on an artist's studio... The weather was rather warm and spring-like. More like February in New Orleans than DC in November. I saw a Dogwood tree bloom. ??Thanks global warming.....

Since today is Saturday, I will keep this short.

If you get a chance to visit (not during the upcoming inauguration but sometime after things calm down), take in the new Congressional Visitors Center. It officially opens December 2nd but they are giving group tours and gathering Tourist feedback.

Our group of fellows (44 in all) experienced:

1. An IMAX size movie that rapidly moves through the approximately 300 years of U.S. legislative history. Good, not so good, and really bad legislation are touched upon in a way that would be informative to those of us who are casually familiar with history.

2. A guided tour where are participants were given a personal PA system. This allowed the group to hear all the guides commentary - no matter where you were standing. This is a definite plus. It was funny initially when one member of our tour got the feed from a different guide and did not hear some of the jokes we were laughing about. That was fixed pretty easily. Total time for the tour 25 minutes.

3. The opportunity to view the entrance to both Speaker Pelosi's and Senate Minority Leader Mitch McConnell's space. You can give the salute that you think is appropriate.

4. Henry Clay's statue in the rotunda (this blog is, afterall for Kentuckians!).

Visiting the Congressional Visitors Center is definitely a festive thing to do while visiting the nation's capital. Just be sure to take a comfortable pair of shoes and you will have a good time. The facilities (bathrooms, snacks) are a definite plus.


'Til Next Time

Health Care Reform - Hope Floats

On this Veteran's Day, I wanted to take a moment lay out some of the ideas that are floating around for healthcare reform. Delivering care to the men and women returning from Iraq and Afghanistan present a challenge to facilities across the country. We thank them for their sacrifice. My youngest brother was in Desert Storm, so.......I know.

Here are rumors that I've heard, in no particular order:


1. Alter the Federal / State Medicaid match so that the state contribution is reduced. This would give the states money for other things - like increasing health care for a broader group of people. (Quick fix)



2. Expand the size, scope, and number of Community Health Centers (Family Health Centers). This would have the same impact as #1 but would give a longer lasting fix to healthcare access issues. How this expansion will occur is still under develpoment. (Longer term fix)



I am working with a team of health care congressional fellows and think that you all probably have other - even better ideas for this legislation. Now is the time to get your ideas out there!



Short of printing more money, what else can we do to increase access, improve quality, and improve affordabilty? This blog has the capability for you to post your ideas. The only rule is that we must be civil - no bad language, no slander. Just good constructive ideas.



Come on. Let those ideas flow!

'Til next time.

Teamwork in the capital

Every morning when I walk to training sessions, I cross 16th street NW. This is the view I get straight into the White House (center of the image). I don't know if you can see it but it really inspires me......

For those of you who are too young to know the history of healthcare and education politics / legislation in the U.S., there are two names you should know:

Edward Kennedy (D - Mass, well known)

Orrin Hatch (R - Utah, not so well known but equally as powerful)

Practically all the bills that fund the 'safety net' are co-sponsored by these two incredible men. Examples include the Community Health Centers (...i.e. Portland and Park DuValle); the Children's Health Insurance Program (sCHIP), Medicare and Medicaid related stuff.

They do not always disagree about the pathway but they do agree with the fundamental premise that Americans need care during times of illness.

As we all know, it is the staff that work with these well known Senators who do the heavy lifting of getting a bill through the Senate.

It was my great good fortune yesterday to sit down for 2 hours with two dynamic legislative staffers from each office. These individuals could not be more different in externally if one had designed them to be that way. As the conversation progressed, it was clear that red or blue, each was committed to working through the divide to get U.S. citizens what we need.

I am currently interviewing with senate offices and good people like these two for a final placement. After Dec 6th, I will work with some member of the Senate healthcare team to write legislation. Yes ladies and gentlemen, I will probably get the opportunity to draft legislation for consideration by the Senate.

I will, of course, have that draft reviewed by others but this is the genius of our political system. We are the only governing form in the world where the legislators write the bills. Everywhere else - UK, France, Germany - the bills are written by the leader and the legislators fight over it.

When President Obama gives his vision for healthcare reform, it is the Senate and the House that will shape it into legislation. The President suggests, the Legislators shape it in a form that reflects the will of the electorate.

I was in awe of the knowledge and commitment of the Hatch staffer and the Kennedy staffer to this bipartisan process.

Bottomline: Don't believe everything you read in the papers. Teamwork is alive and well in the nation's capital.

'Til next time.

Greetings from the District of Chaos

28 October 2008

I am writing this blog for my friends and neighbors in Louisville who also have an interest in healthcare. As you all know, I am spending the next year learning about the congress and (hopefully) getting to know how our tax dollars flow into healthcare.

I will try to focus on the business at hand and stay away from personal issues, trials and tribulations. However, I do want you all to know that I miss your smiling faces.

Today there are two newsworthy items that each of you should know about:

1. Mental Health Parity: The Bailout bill was good for something.

2. Building a Medical Home: Surveying the floor plans



Item 1: Mental Health Parity

Did you know that embedded within the 700 billion Wall Street bailout was a little something - HR6331 Medicare Improvements for Patients and Providers Act of 2008?

The House vote was 483-41 (Yarmuth yes!); the Senate 70 - 26 (don't know how our guys did).

This provides improved payment for psychiatrists and other Part B mental health service providers such as psychologists and social workers.

Specifics: For the rest of 2008 and for 2009, the bill provides a temporary 5% increase in payment for psychotherapy services provided in an inpatient, outpatient, office, partial hospital, or residential care setting provided that the services are 'insight oriented, behavior modifying...supportive... or interactive psychotherapy.'

There are other provisions beginning in 2010 such a reduction in the 50% copay by 5% per year through 2013. In 2014, the copay for MH will be 20%, i.e. the same as other Part B services.

Let's get busy!

Info Source:
Pamela Greenberg Association for Behavioral Health and Wellness
Nicholas Meyers, American Psychiatric Association
Ralph Ibson, Mental Health America

Item 2: Building the Medical Home: Surveying the floor plan

This was a 90 minute briefing by the National Health Policy Forum. Participants:
Don Klitgaard MD (Myrtue Medical Center, Harlan Iowa)
Don Liss MD (Regional Medical Director Aetna, Philadelphia, PA)
Paul Kaye MD (Hudson River Healthcare Community Health Center, Peeksill NY)
Kim B Davis-Allen (Alabama Medicaid)

There were many, many interesting points made in this session. I would encourage anyone who is interested in this issue to google the speakers and obtain their powerpoint slides.

Here is a summary of their major points:
1. D. Liss gave a realistic assessment of the problems associated with paying for all of this.
2. Medical education (i.e. physician training programs) are missing from the conversation. This does not bode well for training future primary care physicians.
3. Kim Allen showed how well a Medical Home could work for a state-wide system. Apparently 21% of all persons in alabama are on Medicaid.

4. The Non-medicaid, non-medicare population is completely absent from this discussion.

I had two questions for the panel:
Q How do the facilities obtain and maintain the information technology required for a Level 1 medical home?
The response was basically, we grew big enough to have the financial resources required. This was not helpful for small and medium size practices.

Q How does the growing presence of retail clinics influence the implementation of a Medical Home?
One panelist said that the presence of $4 'scripts have increased patient acceptance of generic medications. Most have no idea.

I hope to hear from all who read this. What would you like to know? How can I improve the format of this blog. We are one week away from the election. Since I am an absentee voter, I will keep my comments to myself and pray that whoever gets into the White House will keep healthcare at the top of their agenda.