In This Issue
We have an new LinkedIn site under the name Hawai'i Pacific Chapter of ACHE. Please join us as we expand our social media outreach program to our members. The purpose of the LinkedIn site is to create of forum in which to reach out and connect with other members for purposes of advancement, to get subject matter expertise to help tackle your health care challenges, and to share events happening within our region.|
Coral Andrews, FACHE
Jen Chahanovich, FACHE
CHAIR, Guam Local Program Council
Lance Segawa, FACHE
Bobbie Ornellas, FACHE
Joanne Reid, FACHE
Steve Robertson, FACHE
IMMEDIATE PAST PRESIDENT
Stan Berry, FACHE
HFMA Hawaii Chapter 2012 Annual Conference “Believe to Achieve”
By LTC Tanya A. Peacock, FACHE
The Hawaii chapter of the Healthcare Financial Management Association held their annual conference in Honolulu, HI. Titled “Believe to Achieve,” this conference focused on current issues in healthcare financing from a local perspective. ACHE participants received CEUs for attendance. The purpose of this article is to summarize the first two General Sessions of the conference to share healthcare knowledge with the Hawaii-Pacific Chapter of ACHE.
Frances Miller, JD, led the first General Session with her presentation on “Value for Money: Cost containment in an uncertain era.” She began her presentation with a discussion about reform and the current state of healthcare spending in the United States. The statistics regarding healthcare continue to be astounding. The United States is ranked #37 by the World Health organization. Eighteen percent of the population is uninsured, and the U.S. spent almost 18% of GDP on healthcare. (Defense spending is approximately 2%). Physician fees, scans and imaging, drug prices and hospital charges far exceed those of Canada and Europe. She postulates that healthcare prices are high in the United States due to the cost of drugs and devices, administrative overhead, the malpractice system, tighter regulations and technology.
Professor Miller tackled the subject of healthcare spending from the perspective of comparative effectiveness, personalized medicine, end of life care, and payment reforms. She suggests that these areas may be possibilities for cost containment.
Comparative effectiveness research examines the effectiveness of competing interventions. The Institute of Medicine estimates that sound scientific studies only support less than ½ of current treatment. Professor Miller cited the Dartmouth Atlas of Healthcare as a resource to analyze variations in treatment. The Dartmouth Atlas project has documented variations in the distribution of medical resources for over 20 years using Medicare data and can be found at http://www.dartmouthatlas.org/ Although the Patient Care Act specifically prohibits Medicare from making coverage decisions based solely on comparative effectiveness research, by emphasizing patient centered medicine and by using effectiveness data it is possible to provide better care at reduced costs. She cited Susan Dentzer’s article “Comparative Effectiveness: Coherent Health Care At Last?” in Health Affairs as an excellent overview of the topic http://content.healthaffairs.org/content/29/10/1756.full
A second possible area for cost containment is personalized medicine. She highlighted that most prescription drugs are effective in only about 60% of patients. She cited a variety of treatments that are specific to an individual. For example, pharmacogenetics, (the way genes cause different drug responses) and Genetic testing (https://www.23andme.com/?gclid=CO2Z5cjq0K8CFQ2FhwodAxwiFw).
Another potential area for cost containment is end of life care. One–third of the Medicare budget is dedicated to end of life care. Although the average person would prefer to spend as much time in a home-like setting with pain control, over 55% of Medicare patients died in a hospital. Educating patients about advanced directives, medically futile treatment, and even palliative sedation is imperative. Although a controversial topic, she addressed patient assisted suicide as well. To date, Oregon, Washington, Montana, and Georgia have patient-assisted suicide laws. Opponents have argued that by legalizing patient assisted suicide, deaths will increase. Interestingly, only 1/5 of 1% of deaths in Oregon over the last 15 years was a result of Patient Assisted Suicide.
Her final topic was payment reform. She cited numerous resources. The first was Pay for performance (P4P). Of particular interest was the data compiled by the Leapfrog group. The Leapfrog group focuses on reducing preventable medical mistakes, encourages transparency and rewards hospitals for quality, safety and affordability. Patient safety ratings for hospitals may be found at http://www.leapfroggroup.org/ Additional P4P resources can be found on the AHRQ website. Other reforms include Accountable care organizations, Global budgeting, and the Independent Payment Advisory Board http://www.cbpp.org/cms/index.cfm?fa=view&id=3702. She concluded in an upbeat manner with a quote from Alexis de Tocqueville about American progress “In the United States, things move from the impossible to the inevitable, never stopping at the probable.”
The second General session “Best practices in Adapting to local regulations, market and trends: A Panel Discussion” consisted of the following local leaders in healthcare: Dr. Ginny Pressler from Hawaii Pacific Health; Coral Andrews, Hawaii Connect Coordinator; Dr. Thomas Tsang, Governor’s Health transformation office; and Hilton Raethel, Hawaii Medical Service Association (Blue Cross Blue Shield of Hawaii).
The patient population of Hawaii is unique. Hawaii has an overall healthier population, lower rate of uninsured, and lower premium costs than the mainland states and attributes these figures to the Hawaii Prepaid Health Care Act. Hawaii also does not have a provider tax, however patients in acute facilities await placement in lower levels of care.
The most interesting initiative discussed by the panel members involved Hawaii State Act 205, otherwise known as the Hawaii Health Insurance Exchange Act. As part of the Federal Patient Protection and Affordable Care Act, the state of Hawaii will establish a health insurance exchange to connect buyers and sellers of health and dental insurance. It will also facilitate the sale of federally-qualified plans. The intent is to design a customer relationship management web-portal. Consumers would input personal information and then they will be provided with a menu of available health plans. To determine eligibility for health coverage, consumers would be required to meet certain criteria. For example, a consumer would consent to a criminal background check and an income, assets, and assessment verification by the IRS. The state received a federal grant in order to implement the exchange by 1 January 2014. More information can be found at http://www.hawaiihealthconnector.com/
In summary, I found this conference to be extremely informative. Because I recently arrived from the mainland, I found this conference especially helpful in highlighting healthcare issues that are specific to Hawaii. I was also pleased to note that the lunch presentation was given by LTC Dwight Kellicut, MD, a vascular surgeon from Tripler Army Medical Center, who provided an excellent overview of Army medicine from a historical perspective and sent a positive message about his two deployments to Iraq.
|7 June Advancement Seminar
11 July ACHE Breakfast and HAH meeting