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Health Care Reform

Jan 17, 2012|

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 -- thought -- a year just a little over since the Health Care Reform. Bill passed -- and you know we have been hearing quite as much in the news this is many other things domestically and overseas and I'm going on worldwide. Everything from disasters too high. Well just a lot of disasters so we're going to focus a little bit on the state close 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 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 and what we offer the community. Excellent excellency 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 you know 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 Health Care 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 for those. Additional millions of people. The good news is that those people who now. Wait for disasters to strike. Have the potential. Of 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. Seeing the doctor in the office. And of course -- it's -- surgery or something like got hospital -- are under 10500. Times the cost of seeing the doctor in the opposite. -- good friend of mine who I'm broke his leg last year did not have insurance and now he's. Facing down a 30000 dollar -- Yeah and that's good 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 -- some of -- is a little bit experimental to see if it's if these plans work. And and hopefully can be implemented by the time we get this influx of thirty million people and other health system. 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. Handle the ever increasing costs that. They named it sometimes people make here. Is something called patient centered medical home and it is one of the potentials. Four. Again improving their. Eric 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 -- -- do a little bit reading up preparing for this interview and it seemed to me that the medical home system Larry 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. -- -- -- to its two major component. The patient centered medical file 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 I'd basically to have this. But very relationship driven. With that personal physician surrounded didn't. And helped out by -- primary care team of nurses and medical assistance -- All these other individuals -- help but also in the second part of that is. That they care that's provided is done in he. System. Of technological. Support because. There's down sides of the old you know and -- and a country family doctor can is that there's this need. For that person to understand. What's happening to their patients. In all the different elements of of the health care system because within Kaiser Permanente we have 28 different. Specialty department right there is this the range of technologies. Potential surgeries. There's so. 5000. Push corruption medicine to her mailbox and their 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 got three primary care doctor even knows about what's happening -- -- patients and that really does require. Technologies. Around. Electronic medical records system. And right. Which is something Kaiser Permanente is known for. Yeah I sure really was the in the northwest was the one at the vanguard we ended up having. All of our primary care doctors using electronic medical record in 1995. And all the specialists were on board by 1990. Seven so we really have. But in Denver what we're the end of one of the innovators in this area. -- now more and more even another health systems -- turned to see you know the computers -- actually in the and the camera names yeah. Another hospital that my wife and I go to can't we just this seems like they just start to put that in it and it's reaching out now the point where. Then again and in the mid with freeze is we just had a baby so we've been dealing with the middle graduation thank you and I you know I think that that is do you dealing with the midwives is a pre the correct me if I'm wrong but I think I think it's a pretty indicative -- this 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 with would doctor proper against. And so the hospital we were going to turns out that they had midwives that were associated with the hospital so there 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 our our baby was -- we needed a C section so we have all of these facilities of the hospital right across the street. And those are that's -- that's an integrated. A great example -- an integrated. System of care and they paid attention to. To your individual needs. But also he had also backup. And science and technology there when necessary so again it's that it's a great example of what we need to proceed and I am you know within Kaiser Permanente we have. I nurse midwives attending bursts in our hospital in our. 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 of surgical intervention. So it's a model you end up -- getting the best of both worlds -- you get that personal care that your physician. And physicians' assistants and nurse practitioners that no you and know your situation. In an ongoing fashion -- and yet also have to back up over Foster. -- and the value of things like that electronic medical records system is that no matter of where you are your health information. This is salable so if you ended up into -- into. You're visiting family in Salem resident physicians there could if you're seen -- Kaiser Permanente physician. They be able to pull up that information. And actually see all the elements of your medical care. It's everyone's literally on the same page everybody on the same page. Fantastic if you're just joining us you're listening to match your 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 -- -- -- he's a primary care physician at the Kaiser Permanente. And were kind of talking about the Laver and being world of health care. What's going on where we're 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 there's actually -- 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 dished out of that. Thirty million people -- gonna get cut fraiche. Probably have to send fifteen million will move into Medicaid. Now people who are you north Salem when they hear this they equate because. At least in the past. The state has had to paid somewhere between. Thirty to 40% of the 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 blob so all the details around with that coverage looks like. Lot of things still need to be worked out -- My understanding is that it's somewhere around anybody whose income is ever below 133%. Of federal poverty level. Which for. I ham radio. 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 that the question is where's the money gonna come to. Pay fraud that -- and one of the things that's happening is Medicare. Actually the reimbursement. To pass health plans that. Our Medicare Advantage programs. Actually decrease and that's actually something that -- permanent he is is looking at our reimbursement for 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 a lot of. Purchasers are gonna be paying. Health plan. More if they are high quality he programs and high quality is 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. -- how well then they do sure phase Medicare does surveys ask. Whether or not they're able to people were able to take care and 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 to -- Kaiser Permanente were. What we know we're gonna do very well on that. Because. Of the systems that we have in place and and we are at high quality provider in. I region at this point. So McKenna opening this up and it just kind of 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 last week every awarded 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 if you win you'll get additional reimbursement and were actually very excited about that right. Right now there's a lot of controversy may go -- -- the major controversies about this healthcare 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. The idea. Of being able to eliminate. The preexisting condition part. Is that you essentially had everybody covered so mean that people fit healthy 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 to care. Cost will be a -- unaffordable. And so now most people in the insurance. And policy area look that looked at it can it be able to get rid. Of the pre existing condition. Limitations. You need to have everybody involved corrected -- it just would become the again if you only buy insurance. When you you know for that thing except for the six months out of the twenty years that you needed to. What you'd have to pay me it is the equivalent of twenty years' worth of insurance growth -- health care wouldn't be you know 500 dollars a month could be. -- thousand dollars and I'm right I'm obviously exaggeration. But unfortunately. The cost of medicine. And technology is so high we really do need to spread it out over every want to. The other part of this the individual mandate component. Is that. Hospitals the 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 -- -- -- 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 -- 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 turn out right and those costing -- 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 yeah essentially to have. -- universal coverage. Most people. Again in the policy areas viewed 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 of the you -- is educated do it to the actual situation you take the politics out of it. It all the you know it makes a lot of sense an American unit in my own politics but just. It a lot of fiscal logical sense -- 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 -- that's that just makes sense. That that's what's that 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 to 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 used. Let's shift gears a little bit and you guys have a had Kaiser Permanente. You have new hospital aegis our building and there in the middle of building on Middlesbrough 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 over the last 130 years. It will care for you'll be a community hospital it will provide. Services to -- -- west side to obviously for a -- membership but. You know it's they'll be a community hospital people you know in ambulances -- for the closest facility that's where the ambulances will take people. And little what is the difference -- community hospital and and I guess I'm not commuting costs. I'm sorry I should have explained that there community hospital does routine inpatient care in a way that next level. It would be. I. High end specialty hospital where. You had very very complex technologies like open heart surgeries. -- work as an example is our -- sunny side medical center where we do. Are open heart surgery you we've we do all of our complex nurse surgical cases. -- Chinese side it's it's where. And another example of playing and wait tertiary center would be. Hospital that had -- neonatal 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 their with a burst. Yes I that would be taken care of in a community hospital. But if your wife had gone too premature labor let's say two months early -- you wouldn't move ten to one of feast. Regional centers where. That we're in neonatal intensive care was available so to immediately care freer your infant after. He or she was born Chelsea to -- means double -- I would do surgeries there will have. People Netscape who were. -- it come in because of pneumonia -- fully -- emergency room. We'll deal with. It comment that doesn't need Ted go into the trauma centers. I think we'll have all four special to -- Services urology. And again no B July and then orthopedics those type of of medical offices associated. With that centro also. So again we're very excited about it it's. It is so ahead of schedule and under budget. Teddy rose and some that say be sure even even saying that. Peace our hospital. Is. I think there's were starting with about a 150 bed. It's been over 300 million dollar and that's. And while -- -- -- while since this -- it's insane -- I can. Three or million dollars that's good a lot of running out of money lot of money well we are we're coming up on -- -- 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 do to give back to our community. -- we all are non profit. Organization so we are committed to. Provide benefit to our community. In I believe in. 2000. And we gave back a 190 million dollars. And my. That's that that's a little more in the third of hospital yeah. And the the. But we're also good. Two and a half billion dollar a year enterprise in the north west nationally were eight. 42 billion dollar a year enterprise. And nationally we invested back to billion dollars wow so this 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 -- -- population where the reimbursement from the state doesn't. You know maybe covers half of of these costs. But other. Places that we have been involved with participating. In -- -- food bank wasn't over 300000 dollar grant to help build. West facilities in Beaverton. We helped to be -- clinics and Multnomah County. Get up and running on that as I described before -- 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 those are examples of how we 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 the health of 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. Has been really really fascinating doctor thank you so much for taking the time today. Chairman 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 and Mack keep up on what's going on with us the mad mad world of health care how great all right well that'll do it for this addition to -- scope and Entercom communications. Public affairs program I've been your host Ted Douglas. If you have a 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 please put -- to scope in the subject line so it doesn't get snagged by my spam filter hoarding go directly to the station's website click on the community Lincoln to make your information there. Also be like here this program again you can visit our podcast page and mattress go PDX 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 -- trying get this information out to as many people as possible. Thank you again doctor thank you lost so much for listening.