JULY 23, 2009 ISSUE
Where You Live Matters in Healthcare
Primary Care Saves Lives and Money
Apples don’t necessarily match apples when it comes to providing healthcare in medical centers across the United States. The quality and cost of the care provided varies greatly. Although the High Country’s nonprofit Appalachian Regional Healthcare System (ARHS) reports some strains because of the depressed economy and cost of indigent care, the healthcare picture here is much brighter than is being reported elsewhere.
Complicating comparisons of healthcare is that we don’t have a system in America, Salk Institute President William Brody told the National Press Club in Washington last year. “What we have is a patchwork quilt of different responses to different health problems. And as the years have gone by, that quilt has frayed.” Parts of the quilt in the High Country appear to be holding-up better than other areas of the country according to a conversation with officials of ARHS.
Even though the cost of providing ‘Charity Care’ to High Country residents rose as much as 73 percent between 2007 and 2008 and the number of elective procedures is down, ARHS continues to expand, adding needed clinics and undertaking an all encompassing information technology initiative.
“This is an IT project that mirrors President Obama’s wishes to be a part of healthcare reform across the whole country,” said Alice Salthouse, director of community outreach for ARHS. “We are ahead of the curve in this area and in the long-run; the IT project will save resources and enhance patient safety. This means all disciplines across our healthcare system are part of the ever-changing technology and process upgrades. ARHS has an ultimate goal of a complete electronic medical record system within four years.”
In June 2004, Watauga Medical Center and Charles A. Cannon, Jr. Memorial Hospital joined to form ARHS. The new relationship apparently increased efficiencies, cost savings and the ability to take the region’s healthcare to new levels of care that would not have been possible for either hospital to achieve on its own. ARHS welcomed Blowing Rock Hospital in June 2007, adding long-term care options for the community’s aging population.
“We are rated in the top two percent of national patient satisfaction scores,” said Gillian Baker, vice president of marketing and business development for ARHS. “We attribute our continued success to having local people making our decisions and contributing to our foundation. We feel that we are unique in the state, we are small and everyone takes pride in their work and our hospital consolidation allows us to operate more efficiently on economies of scale.”
Good news indeed for locals when compared to President Brody’s admonition that, “Consistency is sadly lacking in American healthcare. Every year thousands of wealthy patients travel from all corners of the globe to get access to American treatments for heart disease, cancer, neurological diseases, joint failures and so forth. Yet here is a dirty little secret: While the best of U.S. healthcare may be the world's finest, on average, American healthcare as a system performs poorly. A RAND survey of 30 common medical conditions in a dozen American communities found that patients get appropriate treatment only about 55 percent of the time.”
Maybe the best evidence available to use in comparing apple-to-apple care in the U.S. is the average cost per Medicare enrollee. Some areas of the country spend almost twice the average cost of other areas per enrollee according to the U.S. Department of Health and Human Services. For instance, in McAllen, Texas, Medicare spends $15,000 per enrollee—three thousand dollars more than the average person earns—and double the amount of the Mayo clinic region of Rochester, Minn. Numbers for the Medicare cost per enrollee in the High Country are not available.
“Most Americans would be delighted to have the quality of care found in places like Rochester, Minn.; Seattle, Wash. or Durham, North Carolina—all of which have world-class hospitals and costs that fall below the national average,” Peter Orszag, the President’s budget director, has stated. “If we brought the cost curve in the expensive places down to their level, Medicare’s problems—indeed, almost all the federal government’s budget problems for the next fifty years—would be solved. The difficulty is how to go about it.”
Perhaps Orszag should add ARHS to the above list. On July 9, High Country Press featured Boone’s Community Care Clinic, a volunteer healthcare provider organization that treats people without insurance or the financial means to see a doctor and is presently booked up two months in advance. ARHS, through its Appalachian Healthcare Project (AHP), underwrites the costs incurred for tests, services and drugs when treating patients referred to it from the volunteer clinic.
It’s common knowledge that citizens without insurance or the needed funds to see primary care providers overwhelm emergency rooms across the country, waiting until a chronic condition exacerbates.
“Imagine this scenario,” Baker said. “A person without insurance or the money to see a primary care provider develops a cough. They don’t take care of it and end up in the emergency room with pneumonia and may have a several day stay in the hospital. This is the most expensive way to provide healthcare. If the person had the wherewithal to see a primary care giver to treat the cough in the first place, those costs could have been avoided.”
Controlling chronic diseases like high blood pressure—which left untreated, can lead to stroke, heart attack or kidney failure—and consequently avoiding their catastrophic results is paramount to holding down medical expenses, locally and nationally. “Recognizing the local need to provide a continuum of care for those with chronic conditions but no financial means, we founded AHP in 2001, a collaborative program between area providers, the hospitals and pharmacies,” Baker said. “AHP is a shared effort of the medical community to provide healthcare services to low income, uninsured residents in Watauga and Avery counties. Physicians write of the care, the hospital writes of the services and the program has a pharmacy component that charges the patients a five-dollar co-payment.”
The project coordinates healthcare for patients by assigning a primary care provider, managing referrals to specialists, arranging diagnostic evaluations and interventional procedures and obtaining medications for patients. The program is available to people making 200 percent of the Federal poverty level. AHP presently serves 296 people.
The old adage that when the student is ready the teacher will come seems to apply to the cost conundrum of healthcare in America. And the most pressing question may be; DC, are you ready? Other healthcare provider success stories and models for controlling cost while providing quality care exist in pockets across the country according to a story in The New Yorker. Examples include: the Mayo Clinic, which is one of America’s highest-quality, lowest-cost healthcare systems; the Geisinger Health System in Danville, Penn.; the Marshfield Clinic in Marshfield, Wis.; Intermountain Healthcare in Salt Lake City, Utah; and Kaiser Permanente in Northern California. All are nonprofit institutions. And all have produced enviably higher quality and lower costs than the average American town enjoys.
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