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Health Care Reform

Mar 27, 2011|

A discussion with Dr. Tom Syltebo, from Kaiser Permanente, about the state of health care reform and some explanation of what to expect in the coming years.

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Automatically Generated Transcript (may not be 100% accurate)

You're listening to -- go through a series of interviews with people of interest in northwest Oregon and southwest Washington I'm your host ten Douglas now it's been a thought -- a year just a little over since the Health Care Reform. Bill passed and you know we haven't been hearing quite as much in the news this -- many other things domestically and overseas have been going on worldwide. Everything from disasters too high. Well just a lot of disasters so we going to focus a little bit on the state -- health care right now what's going on what's coming up. What sort of new innovations are out there and to speak about just that very thing. I have with me today doctor Thomas -- though -- primary care physician for Kaiser Permanente how are you sir I'm very good thank you. Excellent well it's a kick things off regular -- little bit of background on yourself and what you do for Kaiser Permanente. Well I am actually retired from clinical practice and I am now working in the quality department. And going out and talking to our group customers about Kaiser Permanente and what we offered a community. Excellent excellent too your perfect person for me to be talking to him so let's talk a little bit about Health Care Reform it's been a little while since has been at the forefront of the news this kind of always been their people debating back and forth but I think if we if we take it off the table for too long people -- gonna forget it's even going on and -- gonna come up. In 2014 a lot of these major provisions are gonna kick -- -- me a lot more people come into the health system and how we gonna take care of them. -- that's a great challenge is going to be taking care in an organized way of an additional thirty million people. Right now there's the assumption of about 45 million people living in the United States who don't have health insurance. The healthcare reform process. Adds. Somewhere between thirty and 32 million and you can just imagine what to worries are around okay how do we eat. Handled that cost -- nose. Additional millions of people. The good news is bad that those people who now all. Wait for disasters to strike. Have the potential. I'm getting a regular medical care. Prevention and early detection. And management of chronic diseases before that the disaster strikes. And hopefully -- are not getting the most expensive care. Right we're talking about the young people who don't have insurance maybe our self employed or work for companies doesn't provide insurance for them. They wait until you know they feel a lump or something terrible happens and then all of a sudden they've got to. Get insurance and now they've got a pre existing condition and the prices through the roof. That's all or they simply can't get to medical coverage. Oftentimes because of cost issues so what happens is people glued to the emergency room. After again after the disastrous as struck where costs are ten times that it seemed a doctor in the office. And I of course -- it's a surgery or something like that hospital stays -- 110500. Times the cost of -- a doctor in the office. Grab good friend of mine who I've broke his leg last year did not have insurance and now he's. Facing down a 30000 dollar -- Yeah and that's. -- the bad news of our health system. And bright. So there are things that did organizations like Kaiser Permanente are putting into place to help we'll display and I guess is some of -- is a little bit experimental to see if it's if these plans work. And then hopefully can be implemented by the time we get this influx of thirty million people under Nelson's. But the hope is that by getting people linked in two primary care practices. And making those primary care practices. More to people ball. We will be able to. Provide more care to patients with better outcomes. And be able to. And goal the ever increasing costs with the name that sometimes people make here. Is something called patient centered medical home and it is one of the potentials. Four. Again improving their. Care experience for an individual. For improving quality and safety and if not reducing costs somehow. Decreasing. What we've been seeing is this inflation. In health care that much greater than what we see in the rest of society. And correct me if I'm rob as do a little bit reading up preparing for this interview and it seemed to me that the medical home system there is it's. It's it's almost like taking a step backwards into kind of more of your a country doctor model where it's it's a much more personal relationship with your your regular physician. Yet they -- to its two major component. The patient centered medical home menu you identified. Probably the most important part and that's the connection. Of the individual. Two in primary care physician or nurse practitioners and physician assistant. Can fill that role also sure but basically to have this. But very relationship driven. -- sad personal physician surrounded didn't. And helped out by net primary care team of nurses and medical assistance at all these other individuals our help but. Also did the second part of that is. That they care that's provided is done in. System. Of technological. Support because. There's a downside to the old you know and a hat and a country family doctor can is that there's the need. For that person to understand. What's happening to their patients. In all the different elements of of that health care system because it's within Kaiser Permanente we have 28 different. Specialty department right there is this the range of technologies. Potential surgeries. There's. 5000. Description medicines that are available and there needs to be coordination. A scare when the person is and up and the emergence or more in the hospital so that more on the patients. Interest are taking Kara. But also -- three primary care doctor even knows about what's happening with their patience and that really does require. Technologies. Around. Electronic medical records systems. And right. Which is something Kaiser Permanente is known for. Yeah pressure really was the in the northwest was the one of the vanguard -- we ended up having. All of our primary care doctors using electronic medical record in 1995. And all the special swarm gored by 1997. So we really have -- Denver -- -- one of the innovators in this area. -- now more and more even another health system jeers turned to see you know the computers actually in the and the camera names yeah. Another hospital that my wife and I go to -- we just this seems like it just start to put that in it and it's reaching out now the point where. There again and in the mid with freeze is we just had a baby so we've been dealing with the middle congratulations thank you. And I you know I think that that is do you dealing with the midwives is a pre be correct me if I'm wrong but I think I think it's a pretty indicative -- -- -- example. But what we're talking about here here this is a case of my my wife wanted to go with midwives rather isn't going with it was a good doctor proper against. And so the hospital we were going to turns out that they had midwives that were associated with the hospital so they're actually right across the street frank so we got to go to the midwives all that stuff. And they turned out that we you know are Barbie -- breach we needed a C section so we have all of these facilities of the hospital run across the street. And those -- that's the that's been integrated. A great example of an integrated. System of care and they paid attention to your individual needs. But also he had also backup. And science in the technology there when necessary so again it's that it's a great example of what we need to proceed. You know within Kaiser Permanente we have nurse midwives attending bursts in our hospital and are. Birthing center at such and people have those those options and of course there's an obstetrician. Available 24 hours a day if in fact -- emergency occurs where there's the need for. Some type -- surgical intervention. So it's a model you end up kind of getting the best of both worlds EU get that personal care that your physician. And physicians' assistants and nurse practitioners that no you and know your situation now in an ongoing fashion brand and yet also have to back -- -- -- -- and the value of things like that electronic medical records system is that no matter where you are your health information. Is available so if you ended up into their into. You were visiting. Family in Salem resident physicians there could fehr assumed I had Kaiser Permanente physician -- be able to pull up bad information. And actually see all the elements of your medical care. So everyone's literally on the same page everybody on the same page. Fantastic if you're just joining us you're listening to -- scope a series of interviews with people of interest to northwest organist southwest Washington I'm your host Ted Douglas. Today I'm talking to a doctor Tom -- though he's a primary care physician at the Kaiser Permanente. And we're kind of talking about the Laver nineteen world of health care what's going on. Where were Hadden and when you can do and what what the -- systems are due to kind of prepare. For the influx of over thirty million people coming in 2014. As part of health care reform now let's also talk a little bit about Medicaid and how that's gonna be affected by this Health Care Reform. Well they didn't actually -- it let's talk both about there's two different things that there's Medicaid and Medicare. Contestant and both of them are significantly influence stress -- The task federal government -- healthcare reform will pay a working war. And moved them into Medicaid so we'll see. It may -- -- and in dished out of that thirty million people are gonna get cut fraiche. Probably half of them fifteen million will move into Medicaid. Now. People who are -- north Salem when they hear this but they quake because at least in the past. The state has had to pay somewhere between. Thirty to 40% of the costs for Medicaid coverage for this expansion. That as part of healthcare reform. That is going to be covered. At least initially a 100% by the federal government -- so all the details around with that coverage looks like. Lot of things still need to be worked out but my understanding is that it's somewhere. -- around anybody whose income is at or below 133%. -- Federal poverty level which for. I am Leo. Four moves it up to about 30000 dollars a year. Anybody at or below that we'll have coverage through Medicaid. Tennessee now what happens with you know the question is where's the money gonna come to. Pay for all that and -- and one of the things that's happening is Medicare. Actually the reimbursements. To health plans that. Our Medicare Advantage program. Actually decrease and that's actually something that cash Permanente is is looking at our reimbursement from Medicare patients. Decrease. Interest infineon and actually in many ways a very radical change that's going to be happening. Is that health plans will be able to earn back. Some of that money that is being taken away and for the first time that of these I know left purchasers are gonna be paying. Health plan. More if they are high quality he programs and high quality it's gonna be based on you know. Home you know percentage of people who are getting hammered women are getting mammograms and and diabetics getting the appropriate I checks and blood checked some things like that. I'm how well then they do surveys Medicare disservice to ask. Whether or not they were able to people were able to take care in a timely way so all of these -- again both clinical quality issues in patient experience. Will be looked dead and high quality plants will actually come out with additional reimbursement Japan -- in Kaiser Permanente where. -- we know we're gonna do very well on that. Because. The systems that we have in place and and we are at high quality provider in the I region at this point. So -- opening this up -- to -- about the free market system it's condemned. Require everyone to come up a little bit. Well we think that money reimbursement. Is a major motivates. You know it's just seems. In our system that seems to make a difference so. Again in the past we every ward had just calling him whether or not that's the right care of the wrong care. We -- we. We've paid for that equally and now we're moving to an environment where if you provide the best care. And right care you'll win you'll get additional reimbursement and we're actually very excited about that right. Right now there's a lot of controversy may go to -- the major controversies about this Health Care Reform bill. Is the individual mandate part of of the reform. That people by 2014. Have to get health insurance or they face a fine now the fine as I understand it is not. Super enforceable so it's more a little bit of a slap on the wrist is like 6700 bucks a year if you don't get the insurance and then you can still get the insurance. Even if he do you have that catastrophe or if you were you find yourself sick you -- your insurance right then. Without you know running into. All the stipulations and and limitations of pre existing conditions and that's of that mandate is is very much a part of this reform but with this country's a lot of people fighting that part of it what happens if that goes away. It's probably the biggest challenge. That this the whole insurance system basis because. -- the idea. Of being able to eliminate. This pre existing condition part is that you essentially kept everybody covered so mean that people fit healthy people. Our. I mean help paying for when these. Oftentimes unpredictable disasters occur. If one is able. To essentially not pay when you're not having problems and then to jumpin. When you do need care. And cost will be a pop unaffordable. And so now most people in the insurance. And policy area look -- that looked at it can it be able to get rid. The pre existing condition. Limitations. You need to have everybody involved correct -- it just would become the again if you only buy insurance. When new. Uniform that says ask for the six months out of the twenty years that you needed to. What you'd have to pay me is the equivalent of twenty years' worth of insurance -- you know health care wouldn't be you know 500 dollars a month could be. 5000 dollars a -- right I'm obviously exaggerate sure so that unfortunately. The cost of medicine. And technology is so high we really do need to. Spread it out or hurt everyone the other part of this the individual mandate component. Is that. Hospital's. Emergency rooms don't have the option of being able to say no. Right person who shows up without insurance. Right I hope so and so did taxpayers have -- for. Or or an act against that -- to people who would do go to the hospital. It's the people who bodies right people buying insurance or will they assumption is somewhere between ten to 20%. Insurance premiums. Paid for people who do not have. Adequate coverage. Because again you can't get blood from coming -- right and those -- need to be paid so it's that it's a real challenge in our country where. We're a country based on you know people having individual freedom. And yet for us to be able to provide care yeah essentially to have it. Because universal coverage. Most people. Again in the policy area views that individual mandate is critical. Yeah I'll let you know way is so much this gets tied to politics and I think that. If some but the you get is educated -- it to the actual situation music to politics out of it. -- all the you know it makes a lot of sense an American Indian and in my own politics but just. It a lot of fiscal logical sense it it did make sense to me you leave spread the money rather be pays a little bit. For a long time. So it's not as noticeable. And then everyone's covered and they -- that's that just makes sense. That's that's what's been what you just articulated this what's behind. That idea around individual mandate that. Right and it may -- makes sense for me you know we have every once required if you drive a car you have to have insurance and it's the same sort of thing all right before I had too far down this. If you think of political -- Let's shift gears a little bit and you guys have a had Kaiser Permanente. You have new hospital -- are building in the in the middle of building on the liberal to me about that. Well we're obviously very excited about it it's. First new hospital being built in the Portland metro area. I think or the last 25 or thirty years. And it will hold care for you'll be a community hospital it will provide. Services to smooth the west side to obviously for a west -- membership but you know it's they'll be a community hospital people you know in. Ambulances -- for the closest facility that's where ambulances will take people. And little what is the difference GA community hospital and and I hasn't gone community hospital for. I -- I'm sorry I should explain that there community hospital does routine inpatient care in a way that next level. It would be. I and specialty hospital where. You had very very complex technologies like open heart -- used to work as an example is our pitchers on the side medical center where we do. Are open heart surgery we've. We do all of far complex nurse surgical cases. That's funny side it's it's where the and another example of play and wait tertiary center would be. A hospital that had been neonatal intensive care where you get high risk group obstetrics you'd you know you with your recently you and your wife's experience with their with a burst. Yes I that would be taking care of in a community hospital bed. If your wife had gone into premature labor let's say two months early -- you would have to move ten to one of the east regional centers where. That word neonatal intensive care was available so to immediately care freer your infant after. He or she was born -- said to -- means that will -- I would do surgeries there will have. People Netscape who are. In it come in because of pneumonia will have a fully staffed emergency room. We'll deal with. It comment that doesn't need -- go into the trauma centers I think we'll have all of our special T. Services urology. And again no will be July and then orthopedics those type -- Medical offices associated. Would that central -- And so again we're very excited about it it's. It is so ahead of schedule and under budget. They were -- things to say be sure even even saying that peace. Our hospital. Is. I think there were starting with about a 150 -- It's been over 300 million dollar in -- And while I do back while since this is it's insane act. I can. Three or million dollars that's good a lot of -- automatic lot of money well we -- we're coming up on the end of our time here but being a public affairs show I didn't wanna give a moment to talk a little bit about. Kaiser Permanente and what they -- to give back to our community. -- We all are non profit. Organization so we are committed to crack provide benefit to our community. In I believe in. 2000. And we gave back under nineteen million dollars. And I'm not. That's that that's a little more in the third of hospital yeah. And the the. But we're also heard. Two and a half billion dollar a year enterprise in the north west nationally word eight. 42 billion dollar a year enterprise. And nationally we invested back to billion dollars wow so the so on the types of things that we go on and support. Probably our major. Effort into actually providing what we think the highest care to. Populations like authenticate population where the a reimbursement from the state doesn't. And maybe covers half of of these costs but other. Places that we have been involved with. Participating. In body -- food bank with over 300000 dollar grant to help build west facilities in Beaverton. We helped to be -- clinics and Multnomah County can get up and running on that as I described before of essential electronic medical record. And we gave both two dollars and time. Of our our staff to go out now -- these people so -- examples of how we can I give back to our community it's it's part of our mission. Our mission is to preside. High quality affordable health care and to improve help. Our communities. That's fantastic I've been talking to you doctor Tom sold to vote. Primary care physician at Kaiser Permanente and if you're just joining us I encourage you to go to our website and give that information in just a moment then and then listen back to this might help you understand a little bit about what's going on with Health Care Reform. -- didn't really really fascinating doctor thank you so much for taking the time today. Thank you very much and that I would love to have you back in a few months and mobile kind of check in with each other every now and then in Mack keep up on what's going on with us the mad mad world of health care how great all right -- that'll do it for this addition to -- -- and Entercom communications. Public affairs program I've been your host Ted Douglas. If given nonprofit or public affairs organization they would like to let others know about please email me at microscope @entercom.com. And there comes starts of the need. And police put the microscope in the subject line so it doesn't it snagged by my spam filter or Ringo directly to the station's website click on the community -- into -- -- information there. All cities like here this program again you can visit our podcast page and mattress -- X dot com we'll find -- and the last couple months for the episodes. And please feel free to share this on your FaceBook you MySpace here. Blog or Twitter or what have you was trying get this information out to as many people as possible. Thank you again doctor thank you lost so much for listening.