Does health plan need exam?

Lawmakers writing health care reform legislation in Washington should make a few trips to their local hospitals, Valley hospital executives say.

"(Lawmakers) need to talk to people in the field," said Michael O'Keefe, Evangelical Community Hospital's president and CEO, during a recent public forum. "Not administrators or lobbyists, but the doctors and physicians. They'd find better opportunities to review and get answers."

During recent interviews at Evangelical Community Hospital in Lewisburg and the Geisinger Health System in Danville, administrators agreed that action must be taken to ensure quality, cost-effective care and encourage a higher level of preventative assistance.

"We see a local level of individuals without health care," O'Keefe said, adding that employer-provided health care is vital.

"When an individual loses their job, they lose insurance, don't have coverage and wait too long for care," he said. "People without coverage don't get preventative care."

Patients need to focus on what they are doing to manage their own health, said Seth Frazier, vice president of Transformation at Geisinger Health System, and if they're doing that, insurance shouldn't be contingent on whether an individual has a pre-existing condition.

Individuals who have pre-existing conditions have real health care needs and must find a way to get the care they need and not go without. The problem is how to pay for it, he said.

"We all know for many, if you don't go to the doctor, you stop taking medication, don't get diagnostic tests and that will lead to health care costs spiraling far worse than if you managed the conditions as you moved forward," Frazier said. "We need a healthy respect for financing challenges to provide coverage, but do it in a way not to bankrupt the country, challenge employers with higher health care costs and provide the right level of reimbursement."

Balancing costs

Increasing costs, for patients and health care providers, are pushing the health care industry into critical condition, the administrators said.

"In my opinion, we need a vision, one common vision or goal everyone can rally around," O'Keefe said. "We need to control costs and expand coverage. This has become a reimbursement crisis -- people are afraid or fearful of payments, and that can cause as much angst as the illness."

The costs often pile up for patients who are diagnosed with chronic diseases, so O'Keefe and Dr. J. Lawrence Ginsburg, a practicing physician and vice president of medical affairs at Evangelical, suggest a base minimum, or a cap on costs.

"The real danger is the fact that the government decision is political," Ginsburg said, "not necessarily a scientific or medical decision."

Frazier said health care providers should be rewarded for quality. Incentives for coordinating care, as opposed to providing individual services, are also important, he said.

"Right now, the system is so driven around payment for individual services that care coordination is not financially rewarded and often systems are not in place to make sure it happens," he said.

He also said the Medicare trust fund is facing significant financial issues that must be addressed.

Frazier added that lawmakers also need to figure out a way to reimburse providers to continue quality care.

"Getting the right balance is challenging," he said.

Emphasis on local quality and care

Both hospitals have implemented programs to provide higher quality care.

Frazier said Geisinger's ProvenCare program -- a fixed-price program that standardizes care using the best available medicine -- has improved outcomes and reduced complications.

Personal Health Navigator -- a system of coordinated care for patients with complex conditions -- improves cost-effectiveness and leads to better outcomes.

There is a dramatic reduction in readmissions and primary admissions, Frazier said.

"What's exciting and drawn national attention is the fact we've shown and prompted these core thoughts about providing better patient care," he said. "It can, in fact, lead to better quality and a more cost-effective outcome but in a much more patient-oriented manner rather than administrative manner."

Evangelical Community Hospital has received Health Grades Awards, has an exceedingly low infection rate and works hard and successfully at safe and preventative care.

"If you're sick and need care, the care is here," said Ginsburg. "Everyone who walks through that door is on an equal playing field."

One program the officials pointed out was the hospital's Virtual Tumor Board, where all of a patient's physicians and family members can gather, look at medical records, test results and X-rays at one time.

"We continue to put emphasis on safety and quality. We standardize processes and procedures for best practices," O'Keefe said. "It's an exciting field. Miracles happen here -- newborns are born, people receive a new hip or knee and are able to walk again, people breathe again. Every day, it's rewarding."