I hope you're right, and I hope I run a practice that gives me as much optimism as yours.
I hope so too. I just read this Philadelphia Inquire article over dinner. Catch the proposal regarding dental hygienists. I hope the PA Dental Society hops on this immediately to determine the implications.
Rendell: 47 ideas to cut health costs
His sweeping proposal covers insurance, hospital mistakes, nutrition and smoking. And it won't hurt the budget, aides said. Reaction was subdued. By Amy Worden and Josh Goldstein Inquirer Staff Writers
HARRISBURG - In a proposal that could have profound effects on the multibillion-dollar health-care industry and touch virtually every Pennsylvanian, Gov. Rendell announced yesterday that he wanted to drive down the spiraling costs of care while improving its quality and expanding access for all. Designed as the centerpiece of Rendell's second term, the plan is aimed at covering the state's 767,000 uninsured residents. But more broadly, he said, it targets the increasing amount of "unnecessary and avoidable" health-care costs, which topped $7.6 billion last year, and the troubling rise in chronic disease rates. "We cannot allow this situation to go on any longer," Rendell said at a Capitol news conference. "It's the right plan at the right time." The core proposal would provide affordable health insurance to all adults, with payments based on income. Rendell said he wanted the legislature to approve it by June 30 and for it to take effect next January. Among the first quality and cost areas that Rendell said he wanted to address is hospital-acquired infections, which increase death rates, extend hospital stays, and cost the state $1 billion a year.
Rendell's 47 initiatives follow plans being implemented in Massachusetts, Maine and Vermont, and most recently advanced by Gov. Arnold Schwarzenegger in California, but it goes well beyond universal insurance.
The initiatives also include child-nutrition programs and a statewide smoking ban. Cost estimates for Rendell's "Prescription for Pennsylvania" will be kept under wraps until he announces his budget Feb. 6. But state officials said employer and worker contributions, federal grants, and increased tobacco taxes would primarily cover any new costs, leaving a minimal budgetary impact. Many of the initiatives would require legislative approval. Most legislative leaders, who learned the details yesterday, said they welcomed the new ideas, but some voiced concerned about the costs. "The fact that the governor left gaping holes in how to pay for this is a glaring omission and makes it very difficult to comment," said Eric Arneson, spokesman for Senate Majority Leader Dominic F. Pileggi (R., Chester).
No bills have been drafted, and Senate and House leaders said they would not move any legislation until they held hearings. While early reaction from representatives of hospitals, doctors and insurers was muted, the plan is likely to run into hurdles as Rendell pushes the legislation and regulations to implement it. The group representing most of the major hospitals in the state said it welcomed the opportunity for discussion about health-care reform, but reserved comment until officials see the state budget proposal and specific legislation. "We want to provide greater access and coverage for people in a way that does not harm providers," said Roger Baumgarten, spokesman for the Hospital and Health System Association of Pennsylvania. Mark A. Piasio, president of the Pennsylvania Medical Society, said the plan's goals were "laudable."
"It is consistent with our mission," said Piasio, an orthopedic surgeon from Clearfield County. "We can't do it - it's got to come from governor, and there is nothing that is ill-advised or bad policy." Joseph A. Frick, president and chief executive officer of Independence Blue Cross, called the proposal "a template for change" that meshes with the company's mission to improve access to quality, affordable health care.
Under "Cover All Pennsylvanians," lower-income adults would pay as little as $10 a month for coverage including presciption drugs. Higher-income workers would pay up to $280 per person, the estimated monthly price for a state-subsidized policy.
Rendell's plan would also create restrictions to discourage businesses from dropping benefits. The state would fund the insurance program through a new tax on smokeless tobacco and cigars, an increase in the cigarette tax, a 3 percent assessment on businesses that do not offer health-care benefits to workers, and federal matching funds. Parents would be able to provide coverage for dependent children up to age 30, and the state's four-year colleges and universities would have to ensure that full-time students were insured or had access to a health clinic. Michael Campbell, executive director of the Pennsylvania Health Law Project, said his nonprofit groups got a dozen or more calls a month from people who could not afford health insurance.
"The governor's plan, if enacted the way it was described,... would probably give health insurance to all of them," he said. "Only a handful of states have taken this on, this would put us in the top tier." The proposal also includes a series of quality and safety initiatives to tackle hospital-acquired infections and other often preventable medical errors. Rendell estimates they could save billions of dollars and reduce the human toll from preventable complications.
Rendell's plan would strengthen the power of the state Insurance Department. Insurers would be barred from using factors other than age, location, and size of the family to set rates for small-business group plans. In addition, rate increases would face greater scrutiny. Health insurers would have to offer rebates to groups if spending on health care fell below 75 percent of the premiums collected from that group.
New regulations would require hospitals to provide a primary-care alternative for people who go to the emergency room with problems that don't need urgent care. Rendell said he hoped to use his regulatory powers and the state's clout as a major purchaser of health care to promote safer care. In the future, the state intends to stop paying hospitals for treatment stemming from medical errors or preventable complications. "We will not pay for misadventures," said Rosemarie Greco, director of the governor's office for health-care reform. Eventually, hospitals would be required to track infections with electronic monitoring systems to prevent underreporting the problem. Finally, a system of regional boards would be created to oversee spending projects at hospitals to ensure that expansions or major equipment purchases were necessary.
The plan would increase access to care by lifting state regulations on some providers, such as nurse practitioners and dental hygienists - who are now forbidden to perform certain procedures. For example, dental hygienists are trained to fill cavities, but regulations prevent them from doing so.
Insurers would be required to pay appropriately for care provided at primary-care clinics by nurse practitioners, who are registered nurses and hold master's degrees in nursing. The state would also create incentives for providers to offer evening and weekend hours to increase access to care.
First Reactions To Rendell's Plan
"The proposal, as described in the press documents, leaves much to the imagination in terms of the details of how the commonwealth will implement each aspect of the reform proposal. We look forward to seeing how this unfolds." - Ralph W. Muller, chief executive officer, Pennsylvania Health System
"The overall proposal itself gives me a better sense that I am going to get some kind of care." - Carl A. Grant, 56, Germantown resident
with a low-wage job
"Obviously the numbers have to work in terms of the cost, but it looks pretty exciting from our perspective." - John Dodds, director
of the Philadelphia Unemployment Project
"The changes proposed will not only help expand care to underserved communities in the region and throughout the state, but also ensures people get good care." - Susan E. Sherman, a nurse and president of the Independence Foundation
"Gov. Rendell has expanded the role of nurse practitioners as a vehicle to achieve access to affordable quality care for more people."
- Nancy L. Rothman, director of community-based practice for Temple University's department of nursing
"While these states - Massachusetts, Maine, Vermont and now Pennsylvania and California - are leading the way, I don't think this country can achieve universal coverage through state initiatives on their own. There must be federal support." - Jennifer Tolbert, principle policy analyst, Kaiser Family Foundation in Washington
"There will need to be a lot of work to flesh out the method by which payments are reduced or revised or modified based on how hospitals perform - P.J. Brennan, chief medical officer, University of Pennsylvania Health System
