Via E-Mail to [email protected]

Total Page:16

File Type:pdf, Size:1020Kb

Via E-Mail to Comments@Vermontact128study.Com Via e-mail to [email protected] February 3, 2011 William Hsiao, Ph.D. 124 Mt. Auburn Street, Suite 410 South Cambridge, MA 02138 Dear Dr. Hsiao: On behalf of Fletcher Allen Health Care, Vermont’s academic medical center, I would like to thank you and your team for the efforts you put into developing the draft Act 128 report issued on January 19. Despite the limitations placed on that work that you have described – a small budget and short timeframe – the draft report reflects a great deal of research, analysis and thoughtfulness. We also appreciate the many meetings you and your team hosted for so many stakeholders, including Fletcher Allen’s clinical and administrative leaders. We were pleased to see that many of the concepts that are common to the three major designs included in the report are ones that have been under discussion, or have been implemented in some form in Vermont, in the past several years. We at Fletcher Allen have been fully supportive of those reforms, and have already incorporated many of them into our operations and organizational culture. Those include: An integrated care system that includes ten primary care practices, a large multi- specialty physician practice (the University of Vermont Medical Group, physicians jointly employed by Fletcher Allen and the UVM College of Medicine), and a full spectrum of inpatient and outpatient care services. As recognized on pages 49 – 50 of the report, Fletcher Allen’s hospital service area is among the highest-performing in the three-state region discussed in the Tri- State Report commissioned by the Department of Banking, Insurance, Securities and Health Care Administration in 2010, including having the lowest per- member per-month costs; the lowest rates of Emergency Department visits, potentially-avoidable ED visits, and hospitalizations for ambulatory-sensitive conditions; and among the lowest hospital re-admission rates. A commitment to primary care and the primary care workforce. Unlike some academic medical centers, Fletcher Allen recognizes the importance of a strong primary care presence in the communities we serve, and along with the UVM College of Medicine – our partner in the academic medical center – we continue Fletcher Allen Health Care – 111 Colchester Avenue – Burlington, VT 05401 Dr. William Hsiao February 3, 2011 Page 2 to invest resources into educating and training primary care providers as well as promoting primary care through the expansion of the Blueprint for Health’s patient-centered medical home model (discussed in more detail below). An electronic health record capable of capturing and using information on a real-time basis not only for claims processing, but for quality improvement and operational efficiency purposes. Over the past several years, Fletcher Allen has invested over $70 million (capital and operating expenses) in implementing a system-wide EHR known as PRISM (Patient Record and Information System Management). As of December 2010, PRISM is now live in our inpatient setting and all of our outpatient offices and clinics. It is also available to referring providers who are not part of Fletcher Allen, but whose patients we care for. Fletcher Allen is now among the top 3 – 4% of health care institutions in the U.S. that have a fully-integrated EHR system. Fletcher Allen was the second pilot site for the state’s Blueprint for Health, which is focused on transforming both the delivery of care and how care is reimbursed. We are expanding our Blueprint activities from the original pilot site (the Aesculapius Health Center, Vermont’s largest primary care practice) to our other nine primary care practices, and are also working with several community-based primary care practices as well as the Community Health Center of Burlington to assist them in implementing the patient-centered medical home model. This includes developing Community Health Teams for over 30 primary care practices and over 100,000 patients. We are also working with the Department of Vermont Health Access to expand our Blueprint pilot to include specialty care, targeting patients with chronic heart disease as a first step. We are actively exploring the potential for creating or participating in an Accountable Care Organization (ACO) or Healthcare Innovation Zone (HIZ), an ACO-like designation authorized under the Patient Protection and Affordable Care Act (ACA) that emphasizes not only changes in care delivery and payment, but achieving those goals in the context of academic medicine and the education of new health care professionals. (In fact, we are eagerly awaiting the release of ACO regulations being prepared by the federal Centers for Medicare and Medicaid Services.) We have also been active participants in the Payment Reform Advisory Group formed in late 2010 to advise the new Director of Payment Reform for Vermont in his development of a strategic plan for payment reform in Vermont. Our physician-hospital organization, Vermont Managed Care, has 15 years of experience in accepting capitated risk for defined populations of patients, and of managing their care cost-effectively. VMC contracts for and manages care for 2 Dr. William Hsiao February 3, 2011 Page 3 over 40,000 covered lives across six counties in northern and central Vermont, with a care network that includes ten hospitals and over 3,000 providers. Our James M. Jeffords Institute for Quality and Operational Effectiveness has fifteen years of experience in clinical process redesign and implementation. The Institute is focused on ensuring that Fletcher Allen meets its strategic goals in the area of quality, patient safety and operational efficiency. Its care management philosophy, developed in 1995, echoes the “six aims” adopted several years later by the Institute of Medicine: “Fletcher Allen Health Care is committed to continuously improving the quality of care provided to our patients. It is our fundamental belief that high quality care is cost-effective care. The care management process will result in standardization of patient care that is patient-focused, evidence based, built on consensus and data-driven, results in improved outcomes, safe, efficient in resource consumption, and economically viable.” The Institute’s functions and resources include measurement (providing expert analysis of data to support clinical research, clinical and operational process improvement and ongoing monitoring of performance indicators), patient safety (focusing on proactive risk reduction and promotion of patient safety initiatives), and quality consultation (providing expertise in project management and all relevant analytic and process improvement techniques are available to serve the needs of the organization). Having said that, we did identify a number of concerns and questions arising from the draft report, which we have addressed in detail in the enclosed comments. Some of our overarching concerns include: The need for state-based reform efforts to align with the ACA, whose implementation is already well underway. Our concern about the reliance on national data to understand Vermont’s health care system and to model the impact of any changes to it. There are many areas in which Vermont’s health care system is structured differently or operates differently than elsewhere, and we believe there is real danger in assuming that national statistics – particularly those around potential cost savings – can simply be scaled to Vermont. While the options would move many Vermonters into a single-payer plan for the benefit package chosen, there would still be many other payers that providers would be dealing with. Fletcher Allen alone, for example, currently processes claims for about 1,150 unique insurers, many (if not most) of whom would not be affected by the “single channel” being proposed in the options. This materially impacts the savings assumptions in the report. 3 Dr. William Hsiao February 3, 2011 Page 4 While the report at one point recognizes the fragility of Vermont’s hospital system (acknowledging that “[a]ny measurable reduction [in the] total amount paid to Vermont hospitals could jeopardize the survival of Vermont hospitals”), we do not believe that this concern is adequately addressed. For example, Fletcher Allen is the only hospital in Vermont with a credit rating, and that rating is already at the low end of the industry norm. Any deterioration in our finances will threaten our ability to maintain our current services while transitioning to a new care delivery system. Thank you for the opportunity to submit these comments. We look forward to your consideration of these comments, and to the final version of the report. Sincerely, Melinda L. Estes, M.D. President and Chief Executive Officer Enc. 4 Fletcher Allen comments on Hsiao Report February 3, 2011 We have divided up our comments into several categories, as well as offering some general comments at the beginning (including comments that did not fit well into the categories we used). General Comments One of the most important principles for Fletcher Allen is that any state-based reform effort must align with the Patient Protection and Affordable Care Act (ACA), whose implementation is already underway. We recognize that Option 3, in particular, seeks to do that, and would hope that any legislation that is introduced will do the same. The report does not discuss the impact of anticipated cuts to Medicare and Disproportionate Share Hospital (DSH) payments that will occur over the next several years under the ACA. It is not clear whether these were considered in each design model and their savings assumptions. As importantly, the final report should also address the impact of the Governor’s proposed changes in state health care spending as announced in his budget address on January 25, especially in the context of the need for a strong health care infrastructure to deliver the care contemplated in all of the options. Those include an increase in provider taxes on hospitals and moving the Catamount Health program out of the private insurance market and into Medicaid, thereby reducing payments to providers from roughly 110% of costs to much-lower Medicaid levels.
Recommended publications
  • The Hippocratic Dilemmas Guanxi and Professional Work in Hospital Care in China
    China Perspectives 2016/4 | 2016 The Health System and Access to Healthcare in China The Hippocratic Dilemmas Guanxi and Professional Work in Hospital Care in China Longwen Fu and Cheris Shun-Ching Chan Electronic version URL: http://journals.openedition.org/chinaperspectives/7091 ISSN: 1996-4617 Publisher Centre d'étude français sur la Chine contemporaine Printed version Date of publication: 1 December 2016 Number of pages: 19-27 ISSN: 2070-3449 Electronic reference Longwen Fu and Cheris Shun-Ching Chan, « The Hippocratic Dilemmas », China Perspectives [Online], 2016/4 | 2016, Online since 01 December 2017, connection on 28 October 2019. URL : http:// journals.openedition.org/chinaperspectives/7091 © All rights reserved Special feature China perspectives The Hippocratic Dilemmas Guanxi and Professional Work in Hospital Care in China LONGWEN FU AND CHERIS SHUN-CHING CHAN ABSTRACT: Patients mobilising guanxi (interpersonal relations) to gain access to hospital care is prevalent in post-Mao China. Yet few studies have centred on how medical professionals deal with guanxi patients. Based on ethnographic research and applying an analytical frame of Chi - nese guanxi developed by Fei Xiaotong (1992 [1948]) and Cheris Shun-ching Chan (2009), this article examines the dilemmas that Chinese phy - sicians face in weighing professional standards versus guanxi . We divide the patients into three general categories: patients without any guanxi , patients with weak to moderate ties with physicians, and patients with strong ties with physicians. We find that physicians face few di - lemmas when they interact with patients without guanxi . They largely adhere to their professional code of practice and generally display do - minance over the patients.
    [Show full text]
  • View Latest Version Here. the Challenge Of
    This transcript was exported on Jul 02, 2020 - view latest version here. Steven Goldstein: Good morning, good afternoon, good evening, wherever you are. My name is Steven Goldstein and I'm the director of the Taiwan Workshop at the Fairbank Center at Harvard University. And I'm very pleased today to moderate a round table on the COVID-19 virus and the experience in Taiwan. Let me just start off with a few thoughts. Taiwan appears to be the land of miracles. In the 1970s, when I was a grad... well, I was more than a graduate student, the Taiwan miracle was the economic transformation that took place in Taiwan, after the establishment of rule on the Island. In the two thousands, or in the turn of the 20th century, the Taiwan miracle was a political miracle. It was the democratization of an authoritarian regime. Steven Goldstein: And now people are talking of a third miracle Taiwan's response to the COVID-19 virus. You see the more I read about it, the more I see terms like gold standard being used to characterize the Taiwan experience. Miracle's not a good word, because every one of those miracles, including the miracle today has been the result of political leadership and societal participation. They're the result of policies led by political leaders with the participation and cooperation of the people. This was unquestionably the case in the first two miracles. And today it's becoming increasingly clear that the same holds for the present miracle. Political leadership, societal effort, combined with technological capabilities, social policies, government institutions have all played central roles in Taiwan's response.
    [Show full text]
  • Dr. William Hsiao
    Distinguished Achievement Citation William Hsiao Class of 1959 With this presentation of Ohio Wesleyan’s Distinguished Achievement Citation, the Ohio Wesleyan University Alumni Association Board of Directors is honored and privileged to recognize William Hsiao and his career as a public administrator, humanitarian, and professor. He is considered one of the world's foremost experts on health care economics and financing. His advice to leaders of state and government both here and abroad has changed the lives of millions of people across the world. A native of Beijing, Dr. Hsiao graduated from OWU in 1959 with a degree in Physics and Math. Following graduation, he worked as an actuary for the Connecticut General Life Insurance Company. In 1968, Dr. Hsiao became Deputy Chief Actuary for the Social Security Administration where he led two blue-ribbon panels regarding the actuarial viability of the Social Security System. He left government service in 1971 and entered the graduate program at Harvard University where he obtained a Master of Public Administration, Master of Arts, and Ph.D. in Economics in 1982. During his studies, he served as a consultant to the U.S. House and Senate on Social Security. Dr. Hsiao was appointed to the faculty of the Harvard School of Public Health as an Assistant Professor in 1979 and became a full professor in 1986. He currently serves as the K.T. Li Professor of Economics at the Harvard School of Public Health. Dr. Hsiao regularly advises U.S. government agencies, foreign governments, and non-governmental organizations such as the World Bank, UNICEF, and the World Health Organization.
    [Show full text]
  • Gabriel M. Leung and John Bacon Shone
    (GLWHGE\ *DEULHO0/HXQJ DQG -RKQ%DFRQ6KRQH A Project of the Medical and Health Research Network The University of Hong Kong Hong Kong University Press The University of Hong Kong Pokfulam Road Hong Kong www.hkupress.org © 2006 Hong Kong University Press ISBN 978-962-209-804-6 (Hardback) ISBN 978-988-8139-55-2 (Paperback) All rights reserved. No portion of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage or retrieval system, without prior permission in writing from the publisher. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library. 10 9 8 7 6 5 4 Printed and bound by CTPS Digiprints Ltd. in Hong Kong, China Contents Foreword ix Preface xi List of Contributors xv PART I Forces of Change 1 Part I Commentary History, Ethics and Forces of Change 3 John Bacon-Shone and Gabriel M. Leung 1. A Historical Review: The Colonial Legacy 17 Derek Gould 2. Philosophy, Ethics and Societal Values in Health System Reform 27 Marc Roberts 3. Confucian Care-Based Philosophical Foundation of Health Care 41 Julia Tao 4. Implications of the Demographic Transition 61 Paul Yip, Joseph Lee and C.K. Law 5. Changing Patient Expectations 81 Iris Chan and Mary Ann Benitez 6. Comparative Health System Models in East Asia 95 Ruiping Fan and Ian Holliday vi Contents 7. The Role of Public Health in Social Justice: The Next Steps in 109 Hong Kong Anthony Hedley PART II The Organisation and 135 Management of Health Care Parts II & III Commentary Organisational, Management and Quality of Care Issues 137 Gabriel M.
    [Show full text]
  • APBC 2013 Final Program
    Conference Program Image by Magnus Larsson under Creative Commons APBC 2013 | 1 Contents Welcome ....................................................................... 2 APBC 2013 Organization ............................................... 3 General Information ...................................................... 5 Keynote Speakers ..........................................................12 Conference Schedule .................................................. 14 Posters Index ................................................................. 21 Sponsors ........................................................................ 26 Notes ............................................................................. 28 2 | APBC 2013 APBC 2013 | 3 Welcome APBC 2013 Organization Dear APBC 2013 attendee, Conference Chair • Steven Jones, BC Genome Sciences Centre, Canada On behalf of the APBC 2013 organizing committee, it is a pleasure to welcome you in Vancouver, British Columbia. This is the 11th Asia-Pacific Bioinformatics Conference, and the first to extend to the Pacific coast of North America. Program Chair • S. Cenk Sahinalp, Simon Fraser University, Canada This year we will have 40 papers presented in APBC selected out of more than 100 submissions. We will also feature 3 distinguished plenary speakers Local Organizing Committee who will each provide salient insights into the application of next-generation • Inanc Birol, University of British Columbia, Canada DNA sequencing. Additionally, an industry panel on application of bioinformatics
    [Show full text]
  • Challenges for the Health Systems of China and India
    June 2008 O Volume 2 O Issue 3 PARDEE RAND GRADUATE SCHOOL Policy Insight Caring for a Third of the World’s Population Challenges for the Health Systems of China and India hina and India together have more than 2 ularly in improving birth outcomes and preventing Cbillion residents, accounting for nearly 40 communicable diseases. percent of the total world population. Over Overall, people in China live longer, healthier the past 50 years, both of these countries have made lives than people in India. The difference between substantial gains in health, including increases in women is larger than that for men, resulting in life expectancy, reductions in infant mortality, and part from the 10-fold greater maternal death rate Sai Ma, Ph.D. PRGS Alumna the eradication of several diseases. Yet China and for Indian compared with Chinese women.1 Assistant Scientist, Johns Hopkins University India still lag behind many countries on key mea- Significant differences exist in causes of death sures of health, and the health gains achieved have as well. In China, noncommunicable diseases, been uneven across subpopulations. particularly chronic obstructive pulmonary dis- Comparing the health systems in China and ease and cancer, account for 77 percent of all India illuminates the health challenges common to deaths. In India, however, more than 40 percent both nations as well as those that are distinct to of all deaths are due to communicable diseases— each of them. Such a comparison is also timely, as including HIV/AIDS, diarrhoeal diseases, respira- health care reform is high on the political agenda tory infections, and perinatal conditions (Liu, Rao, Neeraj Sood, Ph.D.
    [Show full text]
  • Act 128 Health System Reform Design
    Act 128 Health System Reform Design Achieving Affordable Universal Health Care in Vermont Submitted by WILLIAM C. HSIAO, PhD, FSA K.T. Li Professor of Economics Harvard University STEVEN KAPPEL, MPA Principal Policy Integrity, LLC JONATHAN GRUBER, PhD Professor of Economics Massachusetts Institute of Technology And a team of health policy analysts February 17, 2011 ACKNOWLEDGEMENTS We would like to thank the more than 100 individuals who met or talked with us over the course of this study, sharing their views, ideas and insights on health reform in Vermont. Without their contributions, our work would not have been possible. _________ We would also like to thank the numerous Vermonters and Vermont organizations who provided thoughtful comments and insight during the public comment period. Their efforts helped make this report better, clearer and hopefully more useful to the State of Vermont. The comments pointed out some gaps, lack of clarity and inadequate analysis in our draft report. We are deeply grateful for these comments and have revised our draft report to improve the completeness and clarity of our analysis. The comments painted a clear picture of the diversity of views, of experiences with the health care system, of the deep feelings and beliefs about what a health care system should be, and the desire to do better for Vermonters. The comments also showed a sense of trepidation at the prospect of major systemic change, despite a general agreement over the unacceptability of the status quo. Health care touches us all, in personal, professional and economic ways. Major change brings uncertainties. We strongly believe, however, that Vermont can achieve its goals and set a model for the nation for an equitable, affordable, high-performing health system.
    [Show full text]
  • Global Hospital Management Survey – China
    Global Hospital Management Survey – China Management in Healthcare Report CONTENTS Contents .......................................................................................... 1 Executive Summary ......................................................................... 2 GHMS - China .................................................................................. 3 Public Hospital Reform in China ........................................................................... 3 Project Background............................................................................................... 5 Project Methodology ............................................................................................ 6 Pilot Study ....................................................................................... 8 Hospital Selection ................................................................................................. 8 Interview Selection ............................................................................................... 9 Summary Results ........................................................................... 10 Overall Hospital Management Score .................................................................. 10 International Comparisons ................................................................................. 11 Factors for Variation ........................................................................................... 13 Hospital Management in China .....................................................
    [Show full text]
  • Universal Health Coverage: the Case of China William Hsiao, Mingqiang Li and Shufang Zhang
    Working Paper 2014-15 Universal Health Coverage The Case of China William Hsiao, Mingqiang Li and Shufang Zhang prepared for the UNRISD project on Towards Universal Social Security in Emerging Economies: Process, Institutions and Actors November 2014 UNRISD Working Papers are posted online to stimulate discussion and critical comment. The United Nations Research Institute for Social Development (UNRISD) is an autonomous research institute within the UN system that undertakes multidisciplinary research and policy analysis on the social dimensions of contemporary development issues. Through our work we aim to ensure that social equity, inclusion and justice are central to development thinking, policy and practice. UNRISD, Palais des Nations 1211 Geneva 10, Switzerland Tel: +41 (0)22 9173020 Fax: +41 (0)22 9170650 [email protected] www.unrisd.org Copyright © United Nations Research Institute for Social Development This is not a formal UNRISD publication. The responsibility for opinions expressed in signed studies rests solely with their author(s), and availability on the UNRISD Web site (www.unrisd.org) does not constitute an endorsement by UNRISD of the opinions expressed in them. No publication or distribution of these papers is permitted without the prior authorization of the author(s), except for personal use. Contents Acronyms ......................................................................................................................... ii Summary .........................................................................................................................
    [Show full text]
  • An Informal Conversation with Professor William Hsiao | Globalhealt
    An Economist’s Perspective on the U.S. Health Care System: An Inform... http://globalhealth.harvard.edu/news/economist’s-perspective-us-health-c... GOING GLOBAL PREPARING LEADERS WORLDWIDE WORK LATEST ACTIVITIES ABOUT HGHI Home » Latest Activities Informal Conversations with ... An Economist’s Perspective on the U.S. Health The HGHI Informal Conversation Series offers Care System: An Informal Conversation with faculty and students the opportunity to engage in dialogue on cutting-edge cross-disciplinary Professor William Hsiao issues, exploring new ideas, challenges, and opportunities that impact global health. Below Does Lipitor — $6 per dose in is the schedule of speakers for Fall 2013. New Zealand — really need to All series conversations take place from cost $124 in the U.S.?[1] Why 12-1:30 PM at the Harvard Global Health are Americans charged up to Institute, 104 Mt. Auburn Street, 3rd floor, five times more than patients in Cambridge, Massachusetts other countries for a Wednesday, October 30, colonoscopy or hip 2013 replacement? Why do just 40 Ahmed Ragab, PhD, MD, percent of American medical graduates choose to practice primary care Richard T. Watson when the ratio is 60 percent in Europe? Can ethics balance profit to Assistant Professor of shape an American health care system that is equitable, affordable, and Science and Religion, effective? Harvard Divinity School. Professor Ragab will be discussing the role of religion and culture in global health. These were just some of the provocative questions that Professor William Hsiao invited students, faculty, and staff to explore on November 21, Thursday, November 21, 2013, as part of the Harvard Global Health Institute (HGHI) "Informal 2013 Conversations," a series of roundtable luncheons that invites dialogue on William Hsiao, PhD, K.
    [Show full text]
  • A Unique Health Care System for Vermont
    The Vermont Option: Achieving Affordable Universal Health Care Submitted by WILLIAM C. HSIAO, PhD, FSA K.T. Li Professor of Economics Harvard University STEVEN KAPPEL, MPA Principal Policy Integrity, LLC JONATHAN GRUBER, PhD Professor of Economics Massachusetts Institute of Technology and a team of health policy analysts June 21, 2010 TABLE OF CONTENTS Introduction ................................................................................................................................................... 2 Bidder Qualifications .................................................................................................................................... 3 I. Background .......................................................................................................................................... .. 4 I.1 Financing .......................................................................................................................................... 5 I.2 Payment ........................................................................................................................................... .. 8 I.3 Organization .................................................................................................................................... .. 9 I.4 Regulation ....................................................................................................................................... 1 0 II. Goals and Strategies ............................................................................................................................
    [Show full text]
  • Privatization and Its Discontents — the Evolving Chinese Health Care System David Blumenthal, M.D., M.P.P., and William Hsiao, Ph.D
    The new england journal of medicine health policy reports Privatization and Its Discontents — The Evolving Chinese Health Care System David Blumenthal, M.D., M.P.P., and William Hsiao, Ph.D. For the first-time visitor, China is breathtaking — er makes its domestic affairs — and particularly, its a land of extraordinary vitality, unimaginable size, internal political stability — potentially important and outlandish contrasts. Its cities hum with en- for people around the globe. In that context, one of ergy, purpose, and impenetrable traffic jams chok- the most fascinating and important aspects of Chi- ing inadequate roadways. It is home to one quar- na’s recent history has been the evolution of its ter of the world’s population, and more and more health care system. As its economy boomed, in part of its 1.3 billion people have flocked into megalopo- by emulating Western economic methods, its health lises (such as Shanghai, with more than 16 million care system nearly imploded, partly because China people, and Beijing, with more than 13 million) that adopted (wittingly or not) the strategies of some dwarf anything in the Western world. And while U.S. proponents of radical health care privatization. those cities sprout soaring, glass-shelled skyscrap- Ironically, the citizens of the United States, a bastion ers and business centers that make even London of capitalism, now enjoy far more protection against and Paris look modest, much of the rural popula- the cost of illness than the citizens of China, a nom- tion, which numbers 900 million, lives in poverty inally socialist nation. As a result, China faces huge and desperation that are reminiscent of the world’s health care problems that make those of the United most forgotten regions.
    [Show full text]