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Health Care Reform

Apr 1, 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 as many other things domestically and overseas have been going on worldwide. Everything from disasters too -- Well just a lot of disasters so we're going to focus a little bit. On the state of health care right now what's going non 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 -- and though he primary care physician for Kaiser Permanente how are you sir I'm very good thank you excellent well let's say kick things off regular listeners a 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 -- 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 are gonna forget it's even going on and -- gonna come up. In 2014 a lot of these major provisions are gonna kicking and screaming a lot more people come into the health system and how we gonna take care of them. That's the 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 and I healthcare reform process. Adds. Somewhere between thirty and 32 million and you can just imagine what to worries are around okay how do we. Handled that costs for those. Additional millions of people. The good news is that those people who now. Wait for disasters to strike. And the potential. Of getting. A regular medical care prevention and early detection. And management of chronic diseases before is that 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 to pre existing condition and the prices through the roof. -- all or they simply can't get 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 -- assert ten times that -- to doctor in the office. And of course if it's and surgery or something like that hospital stays are under 10500. Times the cost of seeing the doctor in the opposite. -- 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. Then the bad news of our health system. Bright so there are things it 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 and a little -- And that the hope is that by getting people linked into 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 handle the ever increasing costs that 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 the 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 and -- kind of more of your country doctor model where it's it's a much more personal relationship with your your regular physician. -- good -- to its two major component. The patient centered medical home menu you identified. Probably the most important part and that's the connection. 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 crippling. With that personal physician surrounded didn't. And helped out -- -- primary care team of nurses and medical assistance at all these other individuals that'll help but. Also do the second part of that is. That they care that's provided is done in he. System. A technological support because. There a downside to the old -- and -- and a country family doctor can is that there's -- need. For that person to understand. What's happening to their patients. In all the different elements of of the health care system because it would -- community we have 28 different. Specialty department right there is this a range of technologies. Potential surgeries. There's. 5000. Push corruption medicines that are available and there needs to be coordination. Care when the person is and -- and the emergence or more in the hospital so that more on the patients. Interest start taking character but also that they primary care doctor even knows about what's happening with their patience and that really does require. Technologies. Around. Electronic medical records system. And right. Which is something Kaiser Permanente is known for. Yeah pressure really was the in the northwest was the one of the vanguard and we ended up having. All of our primary care doctors using electronic medical record in 1995. And all the special -- bored by 1997. So we really have. But again we're what we're the end of one of the innovators in this area. Yeah now more and more even another health system jeers turned to see you know the computers actually in the and -- camera names yeah. Another hospital that my wife and I go to -- we just this seems like they just start to put that and 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 -- pray we correct me if I'm wrong but I think I think it's a pretty indicative -- -- -- example. -- what we're talking about here here this is a case of my my wife wanted to go with midwives rather than going with with would doctor proper against. And so the hospital we were going do turns out that they had midwives that were associated with the hospital so there actually ran across the street frank so we got to go to the midwives all that stuff. And they turned out that we you know our Barbie -- breach we needed a C section so. We have all of these facilities of the hospital run across the street. And in those -- that's the that's been integrated. A great example of -- integrated. System of care and they paid attention to. 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. I 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 without model you end up kind of getting the best of both worlds he get that personal care that your physician. And physicians' assistants and nurse practitioners that no UN no your situation now in an ongoing fashion brand and yet also have the backup of a -- lost. -- 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 -- into. You're visiting family in Salem resident physicians there could -- -- Kaiser Permanente physicians. -- be able to pull up that 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 now we're kind of talking about the lab or nineteen world of health care what's going on where -- -- 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. But they didn't actually do it let's talk both about there's two different things that there's Medicaid and Medicare. Contestant and both of them are significantly influenced with this. The federal government would healthcare reform will take a work in the war. And moved them into Medicaid so we'll see. It may be -- and then dished out of that thirty million people we're gonna get tougher H. Probably half of them fifteen million will move into Medicaid. Now people who -- north Salem when they hear this. They quake because at least in the past. The state has had to -- somewhere between. Thirty to 40% of -- costs for Medicaid coverage. For this expansion. That as part of Health Care Reform. That is going to be covered. At least initially a 100% by the federal government -- so all the details around without coverage looks like. Lot of things still need to be worked out -- My understanding is that it's somewhere around anybody whose income is -- below under 33% of federal poverty level. Which for. I am Leo. Four moves it up to about 30000 dollars a year. Anybody at a below that we'll have coverage through Medicaid. Tennessee now what happens with you know that the question is where's the money gonna come get. Page crawl -- that he's been one of the things that's happening is Medicare. There actually there reimbursements. To health plans that. Our Medicare Advantage programs. Actually decrease and that's actually something that -- Permanente is is looking at our reimbursement for Medicare patients. Decreased. Interesting thing in 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 a -- I know loved. Purchasers are gonna be paying. Health plan. More if they are high quality he programs and -- quality is going to 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. How well there and they do sure phase Medicare disservice to ask. Whether or not they're able to people were able to take care in a timely way so all these again both clinical quality issues -- patient experience. Will be looked bad and. High quality plans will actually come out with additional reimbursement to Compaq which can Kaiser Permanente we're. -- we know we're gonna do very well on that. Because. The system that we have in place and and we are at high quality provider in the region at this point. So we can opening this up -- to cut 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 seemed. In our system that seems to make a difference so. Again in the past we every ward -- just calling him whether or not that's the right care of Iran 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 the right care you'll win you'll get additional reimbursement and her -- actually very excited about that right. Right now there's a lot of controversy may go on -- the major controversies about this Health Care Reform bill. Is the individual mandate part of that 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 you do you have that catastrophe or if you were you find yourself sick you can buy 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 it. The the idea. Of being able to eliminate. -- pre existing condition part is that you essentially kept everybody covered so mean that people can help keep people. Our. Pain help paying for when these. Oftentimes unpredictable disasters occur is if one is able. To essentially not pay when you're not having problems and then to jumpin. When you do need care. -- cost will be. Unaffordable. So now most people in the insurance. And policy area looked at it looked at it can it be able to get rid. The pre existing condition. Limitations. You need to have everybody involved correct and it just would become the again if you only buy insurance. When you 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. I thousand dollars a -- right I'm obviously exaggerate sure -- that unfortunately. The cost of medicine. And technology is so high that we really do need to. Spread it out all for everyone to 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 taxpayer -- -- painful. Or or that I -- that the of the 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%. Of insurance premiums. Paid for people who do not have. Adequate coverage. Because. Again you can't get blood from a cut right and those costs and to be paid so it's 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 -- essentially to have. -- universal coverage. Most people. Again in the policy area view that individual mandate is critical. Yeah I'll let you know -- is so much this gets tied to politics and I think that. If some but the -- is educated do it to the actual situation -- take the politics out of it. It all 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 that it did did make sense to me you leave spread the money router -- pays a little bit. For a long time. So it's not as noticeable. And then everyone's covered and they haven't that's that just makes sense. That that's what's been what you just articulated this what's behind. That idea around individual mandate. Right and it may make 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 the typical political views. Let's shift gears a little bit and you guys have -- had Kaiser Permanente. You have a new hospital aegis our building and -- in the middle of building on Middlesbrough to me about that. Well we're obviously very excited about it it's that. First new hospital being built in the Portland metro area. I think or the last 25 or thirty years. It will care for -- be a community hospital it will provide. Services to the west side to obviously far west side 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 -- Manhattan -- hasn't gone community hospital for. I'm sorry I should explain that better community hospital does routine inpatient care in ways that next level. It would be. -- high end specialty hospital where. Do you. Had very very complex technologies like open heart surgeries. Or as an example is our -- sunny side medical center where we do. Are open heart surgery we've. We do all of our complex nurse surgical cases. That's funny side it it's where the another example of playing and -- tertiary center would be. A hospital that had a near Natal intensive care where you get high risk group. Obstetrics and you'd you know you with your recently you and your wife's experience with -- with a burst yeah so I that would be taking care of in the community hospital. But if your wife had gone into premature labor let's say two months early call you would have to move ten to one of feast. Regional centers where. That weren't -- Natal intensive care was available so to immediately care for earlier you're infant after. He or she was born shell said to -- -- means that will -- doubled to surgeries there. Will have. People Netscape who are. In it. It come in because of pneumonia while fully staffed emergency room. We'll deal with. It -- that doesn't need to go into the trauma centers. I think we'll have all of our special -- Services urology. And again will be July and then orthopedics those type of of medical offices associated. Would that -- -- up. So again we're very excited about it it's it is so ahead of schedule and under budget. He risks and -- -- say be sure even even saying that. These -- hospital. It is. I think there were starting with about a 150 bed. It's been over 300 million dollar and -- And while -- do act while since this -- it's insane act. I can. Three -- million dollars that's good a lot of -- -- lot of money well we are we're coming up on the end of our time here but -- a public affairs show I -- wanna give a moment to talk a little bit about. Kaiser Permanente and what they do to give back to our community. -- we all are non profit. Organization so we are committed to cook -- provide benefit to our community. I 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 -- But we're also heard. Two and a half billion dollar a year enterprise in the north west nationally word neat. 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 -- actually providing what we think the highest care to populations like -- indicate population where. The -- reimbursement from the state doesn't. You know maybe covers half of -- cost. But other. Places that we have been involved with. Participating. In new York and food bank with over 300000 dollar grant to help build west facilities in Beaverton. We helped to be -- clinics in Multnomah County. 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 and help train these people so -- examples of how we give back to our community it's it's part of our mission. Our mission is to provide. High quality affordable health care and to improve the health. Our communities. That's fantastic I I've been talking to you doctor Tom -- to vote. Primary care physician at Kaiser Permanente and if you're just joining us I encourage you to go to our website I'll give that information and just a moment then and then listen back to this might help you understand little bit about what's going on with Health Care Reform. Has been really really fascinating doctor thank you so much for taking the time today. I'm very much and that I would love to have you back in a few months -- mobile kind of check in with each other every now and then in 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. If given nonprofit or public affairs organization they would like to let others know about please email me at microscope @entercom.com. And intercom starts of the need. And police put the microscope in the subject line so it doesn't get snagged by my spam filter or in go directly to the station's website click on the community -- into may -- information there. Also you'd like to hear this program again you can visit our podcast page and -- -- PDX dot com we'll find this 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 doctors think you lost so much for listening.