Isle health industry seeks
more bang for the buck

As costs swiftly rise, experts estimate that
$560 billion per year is wasted nationwide

Workers are likely to bear more responsibility and costs for their health care in years ahead and payment systems for doctors and hospitals may be tailored to performance.

Those were among solutions to runaway health care costs and improved quality of care discussed at a recent "State of Our Health" forum and conference on "Health Care in Hawaii: The Price of Progress" sponsored by the state Department of Health.

America's health care costs, now $1.7 trillion, will double in less than 10 years at the present growth rate, national officials said, stressing the need to apply some brakes.

Gov. Linda Lingle was among those warning the health system can't be sustained without changes.

Hawaii is the fourth healthiest state in the nation, with the second lowest uninsured rate and the longest life expectancy, but "these blessings create challenges," she said in a keynote address.

The number of Hawaii's seniors is expected to increase 2 1/2 times faster than the national average in years ahead, she said, stressing the need for public-private collaborations to deal with long-term care and other health-related problems.

She said her administration will again propose a tax credit for long-term care purchasers in the next legislative session.

There is too much emphasis on government and not enough on personal responsibility for health, Lingle said, pointing out many people smoke or use drugs, drink alcohol, don't exercise or eat right and expect government to take care of their health problems.

She said it's critically important to change lifestyle behavior through public awareness, especially educating children, so the system can continue to provide health care to those who need it.

Devon Herrick of the National Center for Policy Analysis said health care costs have climbed to $1.7 trillion from $40 billion 40 years ago. And an estimated 30 percent of health care is unnecessary, wasting $560 billion, the health economist said.

Herrick said 85 percent of health costs are paid through health plans that insulate patients from costs. People would spend less if they could make choices between quality and price, which he does through a personal health savings account, he said.

Richard Sorian, National Committee for Quality Assurance executive, said, "we need to demand greater accountability from the whole health care system and stop using the silo approach. We need to demand value for the money we're spending."

Hundreds of thousands of people die every year because of preventable medical errors and hospital-based infections, he said.

Measuring the quality of care and performance by hospitals and doctors will lead to greater improvements, Sorian said, noting programs are starting to recognize doctors who deliver consistently high quality care. Those who treat diabetes are the first, he said.

"Quality improvement should be the central business strategy today," said Kenneth Kizer, National Quality Forum president and chief executive officer.

Driving costs are the growing population of seniors, increased technology, chronic care needs, rising liability costs and excessive demands, among other factors, said Kizer, a former Kuakini Medical Center emergency room physician.

Baby boomers, becoming "elder boomers," are more knowledgeable because of the Internet's thousands of health-related Web sites, he said. They want higher quality medical services and they have less tolerance for health care deficiencies, he said.

Kizer said "pay for performance" is coming to the medical profession, with details being worked out in pilot and demonstration projects.

Jeff Flick, regional administrator for the Centers for Medicare and Medicaid Services, San Francisco, said CMS is changing the way it's paying doctors and hospitals as part of an effort to modernize and improve care. Reimbursements, now based on volume, will shift to quality measures and performance, he said.

Dr. Patricia Blanchette, Hawaii Medical Association president-elect and chairwoman of the John A. Burns Medical School's Department of Geriatric Medicine, said doctors are concerned that the pay, which has "been so bad for so long," will shift to people "who manage to play the game better than the others ... You have to be sure what you're measuring," she said. "It seems we're rushing to measure treatment before we understand diagnoses."

Also, many patients don't follow health care instructions, doctors said.

Rick Jackson, chief operating officer for MDX Hawaii and president of Hawaii Association of Health Plans, said about one-third of prescriptions are taken as intended, one-third aren't followed correctly and the other third are never filled.

Dr. Gerald McKenna, a Kauai psychiatrist and past HMA president, said, "managed care was a disaster for doctors" and pay for performance "won't work if physicians will be dancing bears for oversight." The term implies that physicians aren't already performing, he said.

Hawaii remains
healthy, with lapses

Health care quality in Hawaii ranks at or above the national average in key areas and patient satisfaction is higher than the average, a national official says.

Richard Sorian, vice president for public policy, National Committee for Quality Assurance, said Hawaii is continuing to lead the nation with health care improvements.

He reported results of 2004 health care quality measurements in Hawaii at a leadership forum on "State of Our Health" recently at the Sheraton Waikiki Hotel.

He said Hawaii is a model for other states with improvements in blood pressure control, use of beta blocker drugs after heart attacks, behavioral health, diabetes and other areas measured for quality.

Hawaii is doing well in care for children, leading the national average in immunizations last year, Sorian noted.

In cancer screenings, however, Hawaii fell below the national average, which was also too low, for colorectal cancer, he said. "That is a target for interventions."

"On the whole, Hawaii is quite healthy," commented state Health Director Chiyome Fukino, "but we have vulnerable groups."

Those with high rates of diabetes and obesity, for example, become lost in statistical averages, she said, stressing the importance of paying attention to health disparities.