Prevention Matters

Politico reported yesterday that former Columbia/Hospital Corporation of America CEO Richard Scott is leading a conservative group to block healthcare reform. The group, called Conservatives for Patients Rights, is launching a multimillion-dollar campaign in opposition to government-run coverage, and that Scott himself is putting $5 million into the effort.

Over at Health Beat, Maggie Mahar gives us more details about Scott's past contributions to the health care system:

"Internal hospital records would later show that hospital executives were paid enormous bonuses, not for reducing infections or lowering mortality rates, but for meeting financial targets such as 'growth in admissions and surgery cases.' In 1995 one-fourth of Columbia’s administrators won bonuses equaling 80 percent of their salaries—or more. When bonuses become that large, some critics charge, they no longer function simply as incentives. They invite fraud. Scott also did his best to avoid needy patients, questioning whether hospitals should throw their doors open to one and all.

"...In July of 1997, the FBI swooped down on HCA hospitals in five states. Within weeks, three executives were indicted on charges of Medicare fraud, and the board had ousted Scott. The investigation revealed that the hospital chain had been bilking Medicare while simultaneously handing over kickbacks and perks to physicians who steered patients to its hospitals. One can only wonder how many of those patients really needed to be hospitalized—and how many were harmed.

"The company did not fight the charges. In 2000, HCA (which by then had expunged “Columbia” from its name) pleaded guilty to no fewer than 14 felonies. Over the next two years, it would pay a total of $1.7 billion in criminal and civil fines."

The Philadelphia Inquirer quotes Sen. Max Baucus, chairman of the Senate Finance Committee and one of the most influential voices in Washington on health care, as promising to introduce comprehensive health-care legislation in June, "certainly before the chamber's August recess."

"He said that he planned to introduce a bipartisan bill with Sen. Charles E. Grassley (R., Iowa) that would adopt a mix of public and private solutions and that he hoped 70 senators would approve it."

Rep. Henry Waxman (D-CA) and Representative Todd Platts (R-PA) this week will introduce the “Family Smoking Prevention and Tobacco Control Act.” This bipartisan legislation would give the Food and Drug Administration authority to regulate tobacco products and to provide ongoing oversight to protect the public’s health.

"Tobacco is the deadliest product on the market today, killing almost 400,000 Americans every yearm," said Corinne G. Husten, MD, MPH, interim president of Partnership for Prevention. "Yet, it is one of the least regulated consumer products. It is long past time for tobacco products to be regulated to save more lives and protect the public’s health."

One significant provision in the bill would require makers of tobacco products that are marketed as safer than other tobacco products to demonstrate their claims. Millions of Americans were convinced to switch to low-tar cigarettes believing they reduced their risk of lung cancer. Many years later, low-tar cigarettes were found to be just as harmful as full-tar. Many deaths could have been prevented if this information had been known and people were encouraged to quit smoking instead.

"Partnership calls on the full House, which overwhelmingly approved a similar bill last July, to quickly pass this legislation," Husten said. "The sooner this legislation becomes law, the sooner we can save more lives and reduce health care costs."

Appearing on ABC’s “This Week” with George Stephanopoulos, Office of Management and Budget Director Peter Orszag said President Obama is willing to consider the idea of a health-care board or commission that would de-politicize the process by taking some power from Congress. Orszag also said the president is so determined to get health-care reform passed this year that he would propose another revenue source if Congress blocked some of the ideas in his current plan.

Kansas Gov. Kathleen Sebelius has put all speculation to rest and agreed to be President Obama's nominee as Secretary of Health and Human Services. The deal was announced in the Sunday news outlets, and the formal announcement will be made Monday afternoon, prior to this week's White House summit on helath reform

Sebelius has received a lot of ink about her efforts as state insurance commissioner to hold down premium rates, and for her cost-containment efforts as governor. But she also launched the HealthyKansas initiative in November 2004 to promote prevention and wellness. The initiative is a comprehensive effort to control health care costs, improve the quality health care and raise awareness of the dangers of obesity in children and adults.

Encouraging use of medical services – and discouraging use of services without evidence of effectiveness – will be critical to improving the performance of our health system and to controlling healthcare costs. A New York Times editorial rightly gives Medicare credit for proposing not to cover virtual colonoscopies since they are believed to be less effective at discovering small polyps than standard optical colonoscopies.

The quasi-governmental U.S. Preventive Services Task Force and Task Force on Community Preventive Services – the groups charged with evaluating the effectiveness of clinical and community-based preventive services – have been leaders in the movement toward evidence-based medicine. They have carefully identified those preventive services that are proven to be effective. Where there is evidence that preventive services are ineffective, or where there is simply insufficient evidence to even render a judgment, the task forces say so.

Decision-makers across the health system should follow the lead of the Medicare program and provide coverage of proven services while discouraging use of services of uncertain benefit. This is an important first step in moving toward a health system that provides high quality and ensures that our health dollars are spent wisely.