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He’s not the only provider with deep concerns about the U.S. health care system.
Dr. Jeff Thompson, CEO at Gundersen Lutheran, argues that health care providers must make changes to improve quality and cost efficiency — and that some are doing just that.
Mayo Clinic, the parent organization of Franciscan Skemp, is sponsoring a meeting today to discuss broad health-care proposals, including universal care, changes in the way the federal government reimburses institutions under Medicare, quality initiatives and cost efficiencies.
One of the issues it is pushing involves better coordination of care.
Gundersen Lutheran, Thompson said, has instituted a program of care coordinators, registered nurses who each coordinate the care of about 40 to 60 patients with serious chronic illnesses.
That coordination includes a regular program of calling patients and making sure they are there for appointments.
Eighty percent of the cost of health care involves 20 percent of the patients. People at the end of their lives and those with chronic illnesses make up the population for which most of the health care dollar is spent. So it makes sense to have the best possible coordination of their care — making sure all the doctors, nurses and other professionals are communicating.
While Thompson notes that the upper Midwest does the best job on quality and cost efficiency (a contention that is borne out by Mayo officials and also in national studies) that quality and efficiency does not seem to be rewarded when it comes time for the federal government to reimburse institutions under Medicare.
Other states — including states where the medical outcomes are worse than in the upper Midwest — get more money in Medicare reimbursement.
For Midwest institutions, Medicare does not cover the entire costs of care. Where do you suppose institutions make up the difference? Anyone with private pay or commercial insurance gets charged more to make up the difference.
That reimbursement pattern needs to change, but it’s a tough sell because no member of Congress is going to willingly support a bill that costs local health care institutions more money, regardless of fairness.
Meanwhile, big challenges are ahead, as the huge baby boom generation goes into retirement and begins to rack up big medical expenses under Medicare. Thompson said the costs of that over time could be in the $30 trillion to $60 trillion range. Keep in mind that the national debt, at record levels, is up around $9 trillion.
What do we need to do? Become even more efficient and make the federal government more fair in its reimbursement.
But there are individual responsibilities as well. Wisconsin residents, for instance, are more obese than the rest of the nation. They drink too much, smoke too much and exercise too little. All of that plays a role.
Political leaders take an overly narrow view of health care issues. Democrats tend to focus on access to insurance, while Republicans focus almost completely on cost.
But unless we get a handle on quality, cost efficiency, reimbursement fairness and lifestyle issues, we won’t solve the problem.
It’s complicated, but that’s real life.
