To Our Members
May 2008
CT Center for Patient Safety goes to Washington DC
Submitted by Carrie Simon, Chair Germ Warfare Committee
On April 16th, Jean Rexford and I attended a Congressional Hearing titled,” Healthcare-Associated Infections: A Preventable Epidemic.” This hearing examined the problem of healthcare-associated infections and whether the Department of Health and Human Services is showing adequate leadership to combat this public health threat.
The witnesses who testified were: Don Wright, Principal Deputy Assistant Secretary for Health; Cynthia Bascetta, Director for Health Care Issues, GAO; Dr. Peter Pronovost, Medical Director, Center for Innovation in Quality Patient Care, Johns Hopkins University Medical School; John Labriola, Senior V.P. and Hospital Director, William Beaumont Hospital- Royal Oak; Leah Binder, CEO, The Leapfrog Group; Edward Lawton, MRSA survivor; and Betsy McCaughey, Founder and Chairman ,The Committee to Reduce Infection Deaths.
All the witnesses and every Committee member on both sides of the aisle were in agreement that HAIs are a problem, and something needs to be done. Cynthia Bascetta discussed a GAO report that just came out which strongly recommends that the “Secretary of Health and Human Services identify priorities among the recommended practices in the CDC’s guidelines and determine how to promote implementation.” She said “they also need to establish greater consistency and compatibility of the data collected on HAIs to increase information available, including reliable national estimates of the major types of HAIs”. Other highlights of the hearing included Dr. Provonost, who discussed the problem of funding for delivery of healthcare services. “For every dollar the Federal Government spends on traditional biomedical research, it spends a penny on research to ensure patients actually receive the interventions identified through biomedical research. Given this imbalance, it is understandable the US has some of the best basic and clinical science research, yet the worst patient health outcomes in the industrialized world”. Betsy McCaughey made a powerful argument as well. She stated the size of the HAI problem is much greater than the CDC’s official estimate of 1.7 million per year. In addition the cost of the problem for every 2 million hospital infections is about $30.5 billion dollars in treatment alone. McCaughey stated that what is needed to prevent these infections is cleaning and screening.
Probably the most surprising testimony came from Committee member Dan Burton of Indiana. Representative Burton related a personal story of his acquiring a hospital infection after shoulder surgery. He said that his physician told him that nothing was wrong with him, even though he was not feeling well. The physician said he could go for an MRI of his shoulder, “but it would be a waste of a thousand dollars.” Fortunately, Dan Burton did not listen to his doctor, had the MRI, discovered the infection, and was quickly put on IV antibiotics. But what if he had listened, and not insisted on the MRI? Just as we know that prevention is important, so too is the medical professional’s awareness of the signs and symptoms of HAIs, so that patients can get treatment expeditiously. I am grateful to our Executive Director, Jean Rexford and Lisa McGiffert from the Stop Hospital Infections Campaign of Consumers Union, for inviting me to attend this informative hearing.
April 21 informational hearing in the Public Health Committee on conflicts of interest created by the pharmaceutical industry.
Finally a hearing! Our efforts to create transparency and accountability have been stonewalled. We have a long way to go but clearly this hearing is a first step. Marcia Hams from Community Catalyst in Boston brought the consumer perspective to the committee. A few of her points are highlighted here but her entire presentation can be found on our web site.
Since 2000, promotional spending by the pharmaceutical companies has skyrocketed from $12,000,000 to almost $20,000,000. This averages out to an increase of over 9% each year.
The industry spent $8.2 billion in 2006 on drug marketing to doctors. That averages out to $10,000 per doctor. There are over 100,000 sales reps - one for every eight doctors.
Over $5.1 billion was spent in marketing to consumers during that same year. The advertising focuses on new, expensive treatment as well as ads promoting drugs for new “diseases.” The 50 most heavily marketed drugs accounted for 50% of increased sales.
Marketing is 30% of the cost of drugs and half that
is spent on research and development.
What would patient centered care look like? Here are some ways to look at reforming the system:
Cost containment is not a useful framework. We are spending more and not getting better outcomes. Discussion should be “Are we getting our money’s worth?”
Some top drivers of costs:
- Purchasing not coordinated
- Investment is in high tech – once purchased and owned by a facility, it will be used – test needed or not
- Investment in specialty care
- Higher and higher administrative costs
- Doctors paid by procedure and not by prevention
More care is not necessarily better care:
- Supply in healthcare is not the solution
- In general, many doctors, many tests no rhyme or reason
- Pay for performance should be pay for improvement
Change the way we pay for medical errors/reward hospitals that do the right thing and not pay for the wrong thing
Regulation in healthcare is needed. Supply works differently. If there are new hospital beds, they will get filled. If there are a lot of surgeons, there will be a lot of surgery
Increased insurance regulation:
Improving care coordination:
- Electronic records
- Medical team
- Case management
- Patient education
- Integration of financial streams
Administrative efficiency:
- Standardization of health insurance
- Decrease in the numbers and the kinds of policies and their variables
- Coordination of purchasing
Primary care incentive: We have enough doctors, just not enough primary care doctors.
Review of medical technology:
- Why and when it is being used, incentives not to use unless appropriate
- Is it adding value?
Prescriptions:
- Review direct to consumer marketing
- Conflicts of interest – doctors and drug companies – banning gifts.
What are your ideas? We know what does not work What do you think should be included in reform?
CT’s Medical Examining Board Loses More Ground
Public Citizen reports that the bottom 10 states, those with the lowest serious disciplinary action rates for 2005-2007, were, starting with the lowest: South Carolina (1.18 actions per 1,000 physicians); Minnesota (1.24); Mississippi (1.46); Wisconsin (1.63); South Dakota (1.95); Nevada (2.19); Connecticut (2.21); Washington (2.24); Maryland (2.26); and New Jersey(2.32). The Medical Examining Board meets the third Tuesday of each month at 1:30 at the CT Department of Public Health.
The Public may attend
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