Our Visit with Congressman James E. Clyburn on HealthCare Reform

On Monday afternoon, I went to Columbia to meet with Congressman James Clyburn to obtain his counsel about health reform.  The meeting was held in his offices at 1225 Lady Street.  Ms. Barvetta Singletary, Deputy Chief of Staff and Policy Director, also attended the meeting from his staff.

Donna Isgett,  McLeod Vice President for Clinical and Operational Effectiveness, joined me for the meeting.  Donna updated the Congressman and his staff on the results of our work in a national quality project,  Quest.  This national project categorizes and compares patient outcomes in three areas:
     (1)  Evidence-Based Care,
     (2)  Cost of Care,
     (3)  Expected Mortality

In all three categories, the results for patient’s at McLeod is better than or equal to the top performance threshold.  There are 165 hospitals participating in the national quality project.  Donna explained how Physician-led teams use data and evidence-based care to find solutions for improving care for patients, achieving these results.

We also discussed a model examining some of the reform measures that are currently being discussed in Congress.  The model was prepared by Fulton Ervin and JoAnne Allen (see blog on 7/2 ).  Specifically, we shared how changes in ‘Disproportionate Share’ or the offering of a ‘Public Plan’ might negatively affect McLeod based on the planning model we are using.  We asked Congressman Clyburn and his staff for advice about the assumptions in our model.

Congressman James E. Clyburn

Congressman James E. Clyburn

Congressman Clyburn was thoughtful in his responses and willingness to discuss our assumptions for the model.  He gave us some additional insight into what to look for between now and October 15, the date the President has asked for a plan from Congress.  We also briefly discussed employer mandates and readmissions.  We thanked Congressman Clyburn for his time and the information he shared with us.  We offered to be available with additional information on these or other issues.

Additional Background on Readmissions
As mentioned above, one of the proposals being considered for hospitals with higher-than-expected readmission is a reduction in their Medicare payments for each Medicare discharge.  Performance would be evaluated based upon the 30-day readmission measures for heart attack, heart failure and pneumonia.  Hospitals with actual readmission rates higher than their Medicare-calculated expected readmission rate would see a reduction in payment by having their Medicare payments multiplied by an adjustment factor that is the greater of: (1) a hospital-specific readmission adjustment factor based on the number of readmissions to the hospital in excess of the expected readmission rate; or, (2) a reduction of .99 in 2011, .98 in 2012, .97 in 2013 and .95 in 2014 and beyond.

After the meeting, we reviewed our data, and on a preliminary basis, it looks better than the state or nation.  However, we understand the overall health of our patients, the distance some live from the hospital – - and we would be concerned about a provision which reduces payment for readmissions.  I plan to write the Congressman about the experience of our medical staff in working on readmissions.  In general, we would be concerned about reducing payments to hospitals or physicians due readmissions as there may be many reasons the patient needed readmission. 

If you would like to discuss this issue, please respond in the comment section below.  If you would like to write your representative to voice your thoughts or ideas, please the contact information below.

The Honorable James E. Clyburn
United States House of Representatives
Washington, D. C. 20515

The Honorable John M. Spratt, Jr.
United States House of Representatives
Washington, D. C.  20515

The Honorable Lindsey Graham
United States Senate
Washington, D. C.  20510

The Honorable Jim DeMint
United States Senate
Washington, D. C.  20510

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