Saturday
The benefits of preventive care
Larry Shriver is still attached to his feet - both of them. Shriver, a longtime diabetic, gets a lot of mileage out of that joke, but he also uses it to illustrate how important it is for him to manage his diabetes.The chronic disease reduces circulation and, without proper care, can lead to foot or leg amputations. Since joining a diabetes care management program at Billings Clinic 18 months ago, Shriver, 68, has managed to keep his feet - and the rest of his body - pretty healthy.
The Billings man's good health has probably saved the federal government some money, and it could end up shaping the future of health care in the United States. Billings Clinic is among 10 medical centers across the country participating in a three-year federal challenge to lower their costs to Medicare by focusing on preventive care for diabetes, heart failure and coronary artery disease.
The study, called a demonstration project, aims to determine whether increased spending on preventive measures such as chronic disease management can reduce future health care costs for amputations or other hospitalizations.
The government earlier this month released results for the first year of the project, during which prevention efforts across all 10 study sites saved Medicare $21 million, said Dr. Douglas Carr, medical director for Billings Clinic.And all of the sites sufficiently improved their performance on at least seven of 10 quality measures. Billings Clinic met eight of the 10 quality benchmarks.Two of the sites - Marshfield Clinic in Marshfield, Wis., and the University of Michigan Faculty Group Practice in Ann Arbor - performed well enough and eked out enough savings to earn bonus checks from Medicare.
Billings Clinic didn't cut enough costs to get a bonus - Carr said the hospital achieved some savings but declined to say how much - but administrators have no regrets about participating in the study, which has entered its third year."It has been the impetus for us to do some great things," Carr said. "We have kept people out of the hospital."Under the current Medicare system, the government pays providers on a fee-for-service basis, meaning they receive a flat rate for each service they provide, regardless of whether it is necessary.
The government "will pay hospitals more to churn Medicare patients than to do the right thing the first time," Carr said.But health care costs are skyrocketing, and some fear that Medicare and Medicaid will go bankrupt if changes aren't made.That's where the demonstration project comes in. It could persuade the government to place more emphasis on the quality of care and less on the quantity.
"We really are hopeful we can influence Medicare policy," Carr said.Billings Clinic and the nine other participating medical centers are trying to improve quality - and lower costs - by preventing unnecessary hospital admissions. Billings Clinic spent about $4 million to implement a series of measures meant to keep people out of the hospital, including a team approach to diabetes care and a remote monitoring system for people with heart failure.The Tel-Assurance program for heart failure patients became operational during the second year of the federal demonstration project, so the government hasn't evaluated it yet.
But Carr said it has already cut hospitalizations by almost 60 percent for a savings of about $2.2 million.Allen Martin credits the Tel-Assurance program with knocking him off the nation's heart transplant list.Martin's heart failure was so serious last year that he flew to Denver more than once expecting to receive a transplant.He didn't get one because problems were identified with the potential donor hearts, and eventually doctors decided he didn't need a transplant.
"They took me off the active transplant list and put me on the inactive one," Martin said. "I think a lot has to do with my medications and those people watching over me."Every morning, Martin uses his telephone to transmit his weight and other health information to nurses at Billings Clinic. If anything looks unusual, a nurse calls Martin and helps him adjust his medication or make an appointment to see his physician.
Martin said the constant monitoring has improved his health - he has not been hospitalized since he signed up for Tel-Assurance in January 2005 - and his state of mind.At 59, Martin is too young for Medicare, so the government isn't tracking his health as part of the demonstration project.But Billings Clinic didn't limit its prevention efforts to Medicare beneficiaries, and it won't end the measures when the study concludes
.Carr said the medical center agreed to participate in the study because it was the right thing to do - even if it meant losing money - and ending the preventive measures wouldn't be the right thing to do. Source
The Billings man's good health has probably saved the federal government some money, and it could end up shaping the future of health care in the United States. Billings Clinic is among 10 medical centers across the country participating in a three-year federal challenge to lower their costs to Medicare by focusing on preventive care for diabetes, heart failure and coronary artery disease.
The study, called a demonstration project, aims to determine whether increased spending on preventive measures such as chronic disease management can reduce future health care costs for amputations or other hospitalizations.
The government earlier this month released results for the first year of the project, during which prevention efforts across all 10 study sites saved Medicare $21 million, said Dr. Douglas Carr, medical director for Billings Clinic.And all of the sites sufficiently improved their performance on at least seven of 10 quality measures. Billings Clinic met eight of the 10 quality benchmarks.Two of the sites - Marshfield Clinic in Marshfield, Wis., and the University of Michigan Faculty Group Practice in Ann Arbor - performed well enough and eked out enough savings to earn bonus checks from Medicare.
Billings Clinic didn't cut enough costs to get a bonus - Carr said the hospital achieved some savings but declined to say how much - but administrators have no regrets about participating in the study, which has entered its third year."It has been the impetus for us to do some great things," Carr said. "We have kept people out of the hospital."Under the current Medicare system, the government pays providers on a fee-for-service basis, meaning they receive a flat rate for each service they provide, regardless of whether it is necessary.
The government "will pay hospitals more to churn Medicare patients than to do the right thing the first time," Carr said.But health care costs are skyrocketing, and some fear that Medicare and Medicaid will go bankrupt if changes aren't made.That's where the demonstration project comes in. It could persuade the government to place more emphasis on the quality of care and less on the quantity.
"We really are hopeful we can influence Medicare policy," Carr said.Billings Clinic and the nine other participating medical centers are trying to improve quality - and lower costs - by preventing unnecessary hospital admissions. Billings Clinic spent about $4 million to implement a series of measures meant to keep people out of the hospital, including a team approach to diabetes care and a remote monitoring system for people with heart failure.The Tel-Assurance program for heart failure patients became operational during the second year of the federal demonstration project, so the government hasn't evaluated it yet.
But Carr said it has already cut hospitalizations by almost 60 percent for a savings of about $2.2 million.Allen Martin credits the Tel-Assurance program with knocking him off the nation's heart transplant list.Martin's heart failure was so serious last year that he flew to Denver more than once expecting to receive a transplant.He didn't get one because problems were identified with the potential donor hearts, and eventually doctors decided he didn't need a transplant.
"They took me off the active transplant list and put me on the inactive one," Martin said. "I think a lot has to do with my medications and those people watching over me."Every morning, Martin uses his telephone to transmit his weight and other health information to nurses at Billings Clinic. If anything looks unusual, a nurse calls Martin and helps him adjust his medication or make an appointment to see his physician.
Martin said the constant monitoring has improved his health - he has not been hospitalized since he signed up for Tel-Assurance in January 2005 - and his state of mind.At 59, Martin is too young for Medicare, so the government isn't tracking his health as part of the demonstration project.But Billings Clinic didn't limit its prevention efforts to Medicare beneficiaries, and it won't end the measures when the study concludes
.Carr said the medical center agreed to participate in the study because it was the right thing to do - even if it meant losing money - and ending the preventive measures wouldn't be the right thing to do. Source
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