Thursday, June 28, 2012

A Great Decision for Our Country…. Our Work Continues!


Today, the Supreme Court announced its decision that the Patient Protection and Affordable Care Act is indeed constitutional. This was a great decision for our country. Our health care system is not meeting the needs of the American people, it is too costly, and it is placing unacceptable burdens on our industries, especially on small businesses, where most of our jobs are created. The Affordable Care Act sets in motion many necessary changes to get us to better health, better care, and lower cost.

We of the GBMC HealthCare system have been worried that the law would be found unconstitutional but we were committed to moving forward with the transition of our system to a "fee for health" model no matter what the justices decided. Now, we will have no excuse! It’s now clearly on us. We must stay in action.

We have a great hospital, a great hospice, great doctors, and great nurses. We have great clinicians of all sorts and a wonderful leadership team and fantastic support staff. Everyone is working very, very hard. We have come a long way and the metrics support this. But we have a long way to go to get to perfection for every patient, every time. We have a long way to go to create the system of care that is integrated and that anticipates what the patient will need before she needs it.

But we are well on our way. At our hospital, errors and near misses are now much more likely to be reported and our “time to action” in using what we learn from errors to redesign the system is shorter. Our people are now much more likely to understand the causes of patient harm, that people make mistakes and that we must design systems to mitigate the effect of human error.

In the hospital, we have appropriately moved to electronic ordering and record-keeping to make information necessary for the care of a patient more visible and reliably available. We have embedded many evidence-based order sets in the computer system to help assure that patients get the right care.

We are measurably cleaner and measurably better at communicating with our patients. We have created a better organizational model for empowering our physician leaders. It is very hard to create the necessary workable structure to get private-practicing physicians to believe that they have a voice and that it is heard. I think we are closer now to that reality.

We have been known at GBMC as being a great surgical hospital. We have recruited a number of surgeons from other hospitals who have begun working at GBMC to fill gaps and to restore our surgical case volume. When the evidence is that a patient needs surgery, we want it done in our hospital.

We have created the Greater Baltimore Health Alliance and have welcomed nearly 20 privately practicing primary care providers to go with our nearly 80 employed primary care providers to serve as the fulcrum of integration. They are nearly all now using the same electronic outpatient record and that information is available to clinicians throughout our system. In a few weeks, we will begin implementing our electronic medical record in specialists’ offices and connecting our record to those specialists who already have their own computerized record. We are looking forward to GBHA being accepted as an accountable care organization in the very near future. We will have our first GBHA Board meeting and our first Specialty Advisory Board meeting by the end of the month and we hope to have some exciting news to report around July 10th!

Our GBMA primary care offices have extended their appointment hours and the GBMA leaders are working on an after-hours plan the will reduce the need for the use of non-integrated urgent care centers. Our Hunt Valley office has achieved level 3 patient-centered medical home status and by the end of the year, the rest of the offices will have achieved the same distinction. We have implemented our patient portal, myGBMC, so that the patient can get access to his or her records and help coordinate his or her own care. On August 1, we will launch our new Geckle Diabetes Center. Building on our diabetes educational center, we will now have a team that oversees diabetes care throughout our system and that will be actively working to continually improve diabetes outcomes and avoid hospitalizations.

We have recreated our employee health insurance plan to attract our people to stay within our system for their care. This new plan will give us the opportunity to generate better health and care for our own workforce and their dependents.

These are certainly exciting times. They are times of change for the better. Our community needs us to do this. Future generations are desperate for us to be successful. We must keep moving towards our vision. 

34 comments:

  1. Well stated. Seeing as you might have a better vantage point than most, do you see any negative impact from this act on already insured people?

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    1. I think that the biggest risk on already insured people is that we don't continue what the law starts. If we don't get our costs under control, almost no employer or no individual will be able to afford care. Even without the law, many small business owners are considering eliminating health insurance for their employees or only paying a fixed portion of the premium.

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  2. Can you explain the opposition's perspective on the new legislation? If it is such a positive thing, why are those against it, SO against it?

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    1. I think most people who are against it are afraid that the law will not deliver better health, and better care and that costs will go up. But I don't think they even know what is in the law. They think that the law is about a "government takeover" of healthcare. Actually, the law incentivizes private providers of care to change the way they do business and provides incentives to reduce Medicare costs.

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  3. I have spoken to many Health Care Professionals, They are not as excited as you.
    I feel Goverment is involved enough in my life, and not always in a "GOOD" way.
    I beleive the middle man will be squeezed again!

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    1. It is hard to imagine a system that would be fair and would work where the government wasn't involved at all. This bill doesn't get the government more involved in care. It does mandate that everyone have insurance but it sets up new ways to get insurance in the private market. It also creates new ways to lower the cost of Medicare. Do you believe we should get rid of Medicare? That is a government program. Before Medicare, many elderly people in American could not afford care.

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  4. I think this is a great step for America. Everyone deserves to have healthcare in a country as big as ours.

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    1. I agree. Many if not most Europeans have looked up to America for decades. But my European friends can't believe that not all citizens have health insurance in America.

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  5. These are very exciting times to be in health care. GBMC, through your leadership, is leading the way. Congratulations.

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    1. Thanks but the congratulations go to everyone in our family that is working towards measurably better health with better care and lower cost.

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  6. I am thrilled with the Supreme Court's decision and this is indeed a great day for America!! I look forward to the day when health care is a right for everyone and not just a privilege for the lucky few.

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  7. It seems that no supporter of this 2000 plus page bill which was passed without being read in the first place can ever answer my question of why union workers and the Congress don't have to abide by this law. This is nothing short of discrimination in my opinion. If this is so great, how come doctors are saying on television that they are going to leave the field? I'm so afraid that hospitals (I pray that I'm wrong but maybe even GBMC) will have to layoff more people or even worse be out of business within the next decade because of this disaster. I believe in reform but not this way and I don't want to be told that I'm a heartless individual for being against this. Get coverage for people that need it but don't screw everyone elses up. The analogy is when there's a leaky faucet, you don't burn down the whole house. I as an American will always call this sham ObamaCare and it's meant to be a derogatory slight. It can't be forgotten that most of the Congresspeople who voted for this were shown the door during the 2010 midterm election. The end result will be people including me punishing Obama for this deed at the ballot box in November.

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    1. Thanks for your comments. I know that many physicians are not in favor of this law. But I know many who are. As I said, i think that many people are afraid that the changes in the law won't improve the overall system. I believe that they will.

      The issue of GBMC and layoffs is a good one to discuss. Businesses can no longer afford to pay the large annual increases in healthcare premiums for their employees in our present system. Because of this, the money that we (GBMC)are paid for care is remaining the same, as our costs go up. This is the reason for people losing their jobs, not reform. The cost of health insurance in our country is a major impediment to job growth.

      What are the specific parts of the law that you don't want? What is it about the law that is "screwing people"? Help me understand.

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    2. I want the Congress and all the labor unions to abide by this. If we the people have to take this mandate then the waivers that were granted to some people need to be rescinded. Also, the IRS having access to my medical information gives me more incentive to NOT go to the doctors. I'll just take my chances taking vitamins everyday. Patient privacy is obviously gone now as HIPPA has officially been thrown in the trashcan. Also the concept of doctors having to get approval from the government to perform procedures on a patient is an absolute screw job to the American people. People are also screwed near the end of their life with this bill as healthcare rationing also known as death panels takes place. Controversial recess appointee to Medicare CMS Donald Berwick was even quoted as saying "The decision is not whether we will ration care. The decision will be whether we ration care with our eyes open." It's no wonder he was shown the door in 2011.

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  8. I could not agree more anonymous. How can doctor Chessare with a straight face claim that the government is not involved when the court declared the penalty a tax instead? Who handles taxes doctor Chessare? The IRS. I know people that have been audited. Do any of you want the IRS having access to your health care choices? The poster is right, if this healthcare is so great than why are there exemptions to special interests? Lastly, what this proves is that our elected leaders can pass bills that do not tax us as citizens, yet the supreme court can re-writed the legislation. If the passers of obamacare had stated that there would be taxation, it would never have passed.

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    1. Thanks, anonymous. I didn't say that the government wasn't involved. I said that the new law doesn't get the government more involved in providing care. This law makes it easier for an individual to afford health insurance. It prohibits insurance companies from denying insurance because the individual is already sick, and it allows for young adults to stay on their parents insurance until 26. It creates incentives to drive waste out of Medicare.

      What is it that you don't want in the law?

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  9. just the way this bill was passed and forced down our necks,should,make you worried!! the federal govt seems to believe their better at judging whats best for the masses.. DR. chessare you come from the only state which had already inacted simular policy, yet i havent read,from you,any positive comparisons. are there any? YES our system is busted.. but minor tweeks would fix it.... not turing it over to theives, cheats,and special interest.. i dont for a second believe the federal govt has our best interest at heart. this law will be reversed. for those that love socialized medicine or think its a wonderful thing? then move to europe. and why is it they've exempted themselves and the unions from the new law?? I smell a rat....

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    1. Great question about Massahusetts. I was very proud of Governor Romney for introducing health reform legislation in Massachusetts. Today, Massachusetts is the only state in the union where over 90% of citizens have health insurance. In Maryland we are at about 80% now. In Texas, for example, 26% of citizens have no insurance. Most of the uninsured are working Americans. When they get sick and need care in our present system, many file for bankruptcy. Governor Romney fixed that in Massachusetts. He created a market for competition among health insurers, called "The Connector" where small business owners or individuals could buy insurance for their employees and he created incentives for them to do this

      In Massachusetts (which has always had very expensive care) they also realized that just getting insurance for the uninsured was only part one of reform. They also had to change the incentives to lower the cost. The private sector (Blue Cross and other health insurers)and the new Governor are now leading the charge on this part 2 of reform.

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  11. I would like to know Dr. Chessare's political affiliation. How are we going to pay for this Tax nightmare? This was forced down the throats of Americans and we will not stand for this! The election in November will be one of the most important days in the history of our great country. God Bless America!!

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    1. Thanks, anonymous. I am a registered as an independent voter. I believe that the affordable care act is the beginning of the work that will reduce waste in our health care system and reduce overall health care spending. I believe that it is the beginning of the work that will save Medicare. I am not sure what you are referring to by a "tax" nightmare. If you mean that the law requires all to have health insurance, I am for that. The net will be healthcare savings for our country and a chance to save Medicare coverage that so many elderly people depend on.

      I too believe that election day is very important for our country.

      What are your ideas to make our health care system financially sustainable?

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  12. Any time the government passes a law that applies to everyone but themselves you have to question its benefit. How about the leaders and representatives for the people of this country be required to actually start living the way we do....by the laws that they set up. Or how about if the solutions to the problems they create come out of their pockets which are much fuller than most of ours. Each seat in the government needs to be replaced with a common US citizen. I am afraid for the future of this country.

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    1. Thanks, Anonymous. What do you mean when you say that the "government passes a law that applies to everyone but themselves?"

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  13. It is unfortunate that our positions and ideas are judged by political affiliations instead of on the merit of the idea itself. Many opponents and proponents to this healthcare bill seem not to know what is in it, which is unfortunate

    The law has good parts and bad parts to it. It compels individuals to purchase insurance from private companies, but some people prefer the Public Option while others wish nothing would happen. The insurance exchanges are good in theory, but if there are only limited companies of health insurances within the exchange, it is very easy to set up oligopoly market forces. All of these are challenging issues to address, but the cost of doing nothing is worse. People die because of no health insurance. Companies falter because they cannot pay increasingly expensive premiums. Our society is sick, and maybe this ACA bill can help us transition to basic health coverage for all, focusing on disease prevention, and give some semblance of market transparency. My personal feeling is that Health Care has such information assymetry that it is impossible to truly set up a market competition for insurance.

    In any case, we need to focus on what is right for all citizens of the US. Do we cherish the thought that all individuals are created, or do we want a society where all individuals are segregated by income?(Jim Crow for poor, "segregated but equal"). Do we care if our nation's health and well being dependent upon the graces of billionaire charity (donations to Hospital, JHH as prime example), or do we care of public institutions that if managed fairly, may create public health wealth?

    ACA is certainly a horrible piece of legislation, but perhaps it can be refined. If this insurance exchange becomes too "oligopolistic", perhaps a public insurance program for basic health coverage can be considered (Like Canada)

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    1. I agree with everything you say accept that I don't think the ACA is horrible. It is way too complicated but it got that way because the writers were trying to make as many people happy as they could.

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  14. canada and most of europe are socialized medicine. and for the common cold and other minor complications the socialized method works but,when it comes to major illness transplants and the like? the socialized method has failed the masses everytime!!!!!! why do the citizens of those countries flock to the united states for major services? if they can afford it. its because in their own countries they've been placed on a waiting list of years or they've been rejected treatment because of age or lifestyle.... thank god for the ballot box!!!!! i wonder how the folks that like this form of medicine will feel when their told you cant have kemo but here's a 2x2 and tape.... and heres a real scare. how will we feel when we realize our wonderful healthcare system and its people have morphed into the attitudes and work ethic of our own evs dept because it the eyes of this writer thats what you get when you allow govt and unions to make choices for us.. FUNNY HOW THEY EXEMPT THEMSELVES AND THE MONEY LAUNDERING UNION... I THINK I WILL FOLLOW THE LEAD OF SAID UNIONS THIS NOV AND AND VOTE. AND VOTE OFTEN.....

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    1. What do you mean by "socialized medicine?" In Germany, which spends only 60% of what we do the system is almost totally private. Their outcomes are as good or better than ours and their citizens are much happier than ours with their system.

      The Affordable Care Act does not have the government getting more involved in the provision of care. It incentivizes the private system to care for our citizens. It also creates incentives to improve Medicare. Do you want to see the end of Medicare? Medicare is run by the government and they spend less than 10% on administration. No private insurer gets close to that by the way. They are all much higher.

      You should read T.R. Reid's book The Healing of America. Yes, we all need to vote, but please get the facts. You have not taken the time to educate yourself about the health systems of the world.

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  15. Dr Chessare - So what that the Supreme Court found this constitutional? Flag burning is constitutional, but it's not right and it does nothing. Our nation is bankrupt because of the terrible misuses of funds and excessive taxation. How are we suppose to pay for this boondoggle? Millions are without jobs. Obama was suppose to get us out of this mess. He hasn't. And now we're suppose to give him four more years?! I think not. I have to believe there's just not that many stupid people in this country. Our only hope is to have a Republican Senate, Republican House and a Republican President.

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  16. Since there will be "penalties" (taxes) imposed on non-participating individuals.....what kind of penalties can we expect insurance companies to pay for their lack of cost control and mismanagement? And most of all the DRUG COMPANIES ie: GlaxoSmithKline for falsly promoting medications and taking huge profits at OUR COSTS! They need some "mandates" next!

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  17. Thank you Dr.for your time on this matter.I wish everyone would read THE HEALING OF AMERICA....as you have suggested....then we can really discuss health care. So many people just don't know what they are talking about.We all have to be educated in this matter.Maybe GBMC could buy in quantity...this book and we could get it less expensively for all employees.....there are other ones also. .....maybe we could be the hospital with the most knowledgeable employees in the U.S.....about health care delivery and health care costs. I have been an RN for 48 yrs.(20 at this institution) and I am sad that hardly anyone understands the situation.

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  18. well anonymous i doubt you could read the 2000 plus pages and make heads or tales of it.. every day some new fact comes out about this plan, which is now law.... WE HAVE TO VOTE FOR IT BEFORE SO WE CAN FIND OUT WHAT'S IN IT... What a joke.. the normal law abiding citizens have one more chance to get rid of this trash legeslation and thats in november!!! insurance rates have already gone up 6 percent this year alone and their headed up even more.. you clam most of us have no idea what we're talking about? so by you being a nurse for 48 years makes what? the end all on the matter?? many of us dont trust govt to do any good. many doctors refuse to take medicade and medicare because the reimbursment is not sufficient and, i dont blame them.. do you actually believe this law will be any different?? and since books are being suggested? how about if you anonymous pick up any book by mark levine in fact i suggest you listen on am680 here in baltimore week nights at 7-9pm maybe you could also benifit from learning.. health care is not a right!!!! the nanny state is not the way out

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  19. As Ronald Reagan stated, "As government expands, liberty contracts." The ACA is a supreme example of the wrong direction that our country has taken. When the government takes over 1/7th of the GDP, this cannot be a good thing. If it were such a good thing for 'all' Americans, then why has Congress exempted themselves from this provision and granted many wavers to unions? The ACA contains at least 20 new and higher taxes for the American people. Here are just a few that will have an enormous impact:

    The Device Manufacturing Tax:
    This 2.3 percent tax on medical device makers will raise the price of every pacemaker, prosthetic limb, stent, and operating table. This will undoubtedly raise the operating costs of the hospital. Think as to whom these costs will be passed on to, and how will this tax effect some of the small businesses that make these devices?

    Raise "Haircut" for Medical Itemized Deduction from 7.5% to 10% of AGI($15.2 bil/Jan 2013):
    Currently, those facing high medical expenses are allowed a deduction for medical expenses to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI). The new provision imposes a threshold of 10 percent of AGI; it is waived for 65+ taxpayers in 2013-2016 only.

    The Flexible Spending Account Cap:
    The 24 million Americans who have Flexible Spending Accounts will face a new federally imposed $2,500 annual cap. These pre-tax accounts, which currently have no federal limit, are used to purchase everything from contact lenses to children’s braces. With the cost of braces being as high as $7,200, this tax provision will play an unwelcome role in everyday kitchen-table health care decisions.

    The Tax on Investment Income:
    Under current law, the capital gains tax rate for all Americans rises from 15 to 20 percent in 2013, while the top dividend rate rises from 15 to 39.6 percent. The new ObamaCare surtax takes the top capital gains rate to 23.8 percent and top dividend rate to 43.4 percent. The tax will take a minimum of $123 billion out of taxpayer pockets over the next ten years.

    The Medicare Payroll Tax increase:
    This tax soaks employers to the tune of $86 billion over the next ten years.

    Employer Mandate Tax:
    If an employer does not offer health coverage, and at least one employee qualifies for a health tax credit, the employer must pay an additional non-deductible tax of $2000 for all full-time employees. This provision applies to all employers with 50 or more employees. If any employee actually receives coverage through the exchange, the penalty on the employer for that employee rises to $3000. If the employer requires a waiting period to enroll in coverage of 30-60 days, there is a $400 tax per employee ($600 if the period is 60 days or longer).

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  20. Excise Tax on Comprehensive Health Insurance Plans($32 bil/Jan 2018):
    Starting in 2018, new 40 percent excise tax on “Cadillac” health insurance plans ($10,200 single/$27,500 family). For early retirees and high-risk professions exists a higher threshold ($11,500 single/$29,450 family). CPI +1 percentage point indexed.

    Medicine Cabinet Tax($5 bil/Jan 2011):
    Americans no longer able to use health savings account (HSA), flexible spending account (FSA), or health reimbursement (HRA) pre-tax dollars to purchase non-prescription, over-the-counter medicines (except insulin)

    Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D($4.5 bil/Jan 2013)

    Blue Cross/Blue Shield Tax Hike($0.4 bil/Jan 2010:
    The special tax deduction in current law for Blue Cross/Blue Shield companies would only be allowed if 85 percent or more of premium revenues are spent on clinical services

    Excise Tax on Charitable Hospitals(Min$/immediate):
    $50,000 per hospital if they fail to meet new "community health assessment needs," "financial assistance," and "billing and collection" rules set by HHS

    Tax on Innovator Drug Companies($22.2 bil/Jan 2010):
    $2.3 billion annual tax on the industry imposed relative to share of sales made that year.

    Tax on Health Insurers($60.1 bil/Jan 2014):
    Annual tax on the industry imposed relative to health insurance premiums collected that year. The stipulation phases in gradually until 2018, and is fully-imposed on firms with $50 million in profits.

    $500,000 Annual Executive Compensation Limit for Health Insurance Executives($0.6 bil/Jan 2013)

    Employer Reporting of Insurance on W-2(Min$/Jan 2011): Preamble to taxing health benefits on individual tax returns.

    Corporate 1099-MISC Information Reporting($17.1 bil/Jan 2012): Requires businesses to send 1099-MISC information tax forms to corporations (currently limited to individuals), a huge compliance burden for small employers

    “Black liquor” tax hike(Tax hike of $23.6 billion). This is a tax increase on a type of bio-fuel.

    Codification of the “economic substance doctrine”(Tax hike of $4.5 billion). This provision allows the IRS to disallow completely-legal tax deductions and other legal tax-minimizing plans just because the IRS deems that the action lacks “substance” and is merely intended to reduce taxes owed.

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  21. Naming a few examples of the government mismanaging our funds- Social Security: The fund that helps finance benefits for 44 million senior citizens and survivors of deceased workers will be exhausted by 2035.

    Social Security’s disability program, which helps support 11 million Americans, will run through its trust fund in 2016.

    Medicare fraud is costing taxpayers $60 billion annually.

    Have you been to a DMV lately? And now you are going to trust the government with your healthcare?

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