Pennsylvania’s Corrections Department is getting creative in the healthcare delivery to its aging prison population. With funding courtesy a grant from the National Institute of Nursing Research, the state will be bringing together the appropriate caregiving provider contingent to study the cheapest and most effective ways to deliver end of life (EOL) care. This pro-active move will likely be a point of reference as state budgets come under increasing pressure to provide this level of service to this patient population in the unique ”perfect storm” of declining state budgets devoted to healthcare delivery; exponential growth of geriatric populations/units in correctional facilities; and competition for federal healthcare dollars as the result of the Obama reform package (whenever that occurs).

The project will develop an intervention toolkit for use by staff at any prison in the country. [..] Prison workers, including health care professionals, chaplains, prison society volunteers and corrections officers, will provide information on current limitations, strengths, existing perceptions of end-of-life care among prison stakeholders and areas of care that bear improvement. Using the data collected, researchers will create a set of educational strategies for use by prison staff that they can tailor to fit individual prison’s needs.

The devotion of grant money to fund this type of research is appealing and compelling on many fronts — not the least of which is a shared national discourse which is sure to follow on such unique EOL care initiatives. | LINK

Barack Obama’s back is to the wall this week. There’s irony occurring on many fronts. For one, the state which has served as the beacon for his multitude of campaign promises on healthcare reform — Massachusetts — is the battleground for a struggling Democratic candidate all too willing to carry the late Senator Ted Kennedy’s reform mantle into the next decade in the face of fierce Republican opposition at the hands of an opportunist who just wants to nix any Democrat’s vote on reform on a national level.

Also, the nailbiter of a race for Kennedy’s senate seat is just the latest election contest to test Obama’s campaigning mettle. Up until now, he has not been particularly effective for either former NJ Senator-turned-Governor John Corzine (who lost his seat last year) or former VA Gov. Tim Kaine, who lost as well. Finally, this entire push and effort for Obama’s party to elect the Mass. Dem candidate is now widely seen as a referendum on the healthcare debate — as sentiment in which Massachusetts’ troubles with reform are driving a wave of conservative populist sentiment against Obama and his campaign for healthcare reform on a national level.

Democrats have major reason to be concerned. At risk is not only the entire meaning of the final vote on healthcare reform, but also the precedent this entire episode sets on 2010 as a predictor of Obama’s ability to lead the party out from under increasing Republican fervor for domestic policy alternatives on issues other than healthcare, not to mention a smoldering Afghanistan policy. | LINK

The state of Minnesota is doing a better job with preventing deaths in hospitals due to avoidable medical errors, but non-fatal events in other care environments persist.

In all, four people died as a result of “adverse events” at Minnesota hospitals in the 12 months ending October 2009, compared to 18 the year before. That was the fewest deaths since the state began reporting the statistics in 2005. This is also the first year that no hospital reported a fatal fall.

Good news overall in a state which prides itself in using tools designed to keep the lines of communication open in all care settings in which procedure driven interventions comprise the majority of reimbursed care. Of course, it always helps to know that this is an area ripe for reform within Medicare. | LINK

The run up to passage of the health reform bill has left a gaping hole for Obama to fill — that of CMS head. (Tom Daschle obviously didn’t work out.) The NYT has a concise wrap of the apparent indifference the White House has given to the issue of exactly who will be running Medicare, and it goes so far as suggesting that it is an issue that is secondary at the moment. Obama’s lack of attention in this area is yet another indictment, for some, of his lack of key leadership in spite of his commitment to health reform as his number one domestic policy point.

Given that whomever Obama appoints to the position passes Senate confirmation, the enormity of the task leading CMS will require talent health policy watchers have rarely seen in this position. Overseeing the development of multiple insurance exchanges along with the possible formation of payment advisory commissions, oversight bodies and demonstration projects in the midst of the most sweeping federal legislation in decades is not for the faint of heart. Can’t wait to see his appointee’s qualifications. | LINK

The Agency for Healthcare Research & Quality figures in the reform formula quite predominantly. The organization and its rankings are a proxy of sorts for the shifting of funds for acute hospital reimbursements under Medicare. A point of contention in the entire reform debate involved lowered rates of reimbursement for hospital services delivered by high-quality ranked acute care hospitals in favor of those whose overheads were higher, patient populations were greater, and needs were ripe with the potential for waste — namely urban, inner city acute facilities. Needless to say, the addition of debt incurred by so-called charity care and unreimbursable costs at the hands of Medicare beneficiaries were enough to tip the operating costs of some precariously perched hospitals sufficiently in the red to effect closure.

A by-product of reform in Washington intended to subvert this payment inequity among high quality (suburban, community, and semi-rural) and high waste (predominantly urban, inner city) hospitals under the new Medicare reform formula could be creating perverse incentives for hospitals in more favorable geographic locations to garner higher rates of reimbursements, simply because the patient populations served may not require as much cost to deliver that care. This would, in turn, affect hospitals which serve a more medically heterogeneous population and also happen to provide highly ranked quality care

Consequently, systems like Mayo expect to reap millions more under new Medicare reform rules, unlike hospitals of all sizes in major urban cores. | LINK

Healthcare spending in the United States rose just 4.4 percent in 2008. That’s the lowest rate on record, according to CMS. The recession was cited as the major factor; however, spending’s share of the GDP rose to 16.2 percent in last year. A big chunk of the spending comes from acute hospital healthcare delivery.

Of course, the decline in insurance as a mode of delivery was met by increases in outlays to Medicare (greater spending on care to the elderly and disabled) and Medicaid (shifts of government funds to cash-strapped states to finance their care initiatives). Many are correct in tempering enthusiasm for such belt-tightening as government spending with respect to healthcare expenditures rose last year.

If there were any reason Republicans wanted the reform bill’s negotiating and reconciliation sessions transparent, it certainly is that last one. | LINK

[The following editorial is crossposted at HealthcareWealthcare.com]

I’ve written much on my health policy blog … of the microscope under which the state of Massachusetts is operating its own brand of healthcare delivery in the wake of universal healthcare coverage. The ambitious undertaking by the state’s lawmakers to introduce the concept of universal coverage to its citizens over two years ago attempts to answer the question — can healthcare delivery costs be reined in while mandating care for everyone? The answer is, to the surprise of no one, a resounding “no”. As a matter of fact, the cost of covering an additional 430,000 people has thrown the state’s healthcare economy into a tailspin.

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The great state of Tennessee, where I’m originally from, gives us this latest nugget of news from the health reform front.

State Reps. Debra Maggart, R-Hendersonville, and Susan Lynn, R-Mt. Juliet, are asking the state’s attorney general to take legal action to stop the federal healthcare reform bill because it would expand Medicaid.

The two state Republicans sent a letter to Tennessee’s attorney general asking him to file suit against the federal government on the eve of the reform bill’s passage. Citing the familiar GOP refrain of state’s rights, they fear for the “sovereignty” of the state against the “unconstitutional” action of the federal government in expanding Medicaid as a result of reform. Is secession from the U.S. based upon health reform next? | LINK

Senate Republicans have taken a curious tone as the reform debate has plopped itself squarely onto the party’s lap. Taking the especially dubious mantle as a defender of Medicare, the GOP’s call to action could be interpreted, at best, as really looking out for the financial well being for the stability of a very broken system — one whose funds are on the brink of instability. At worst, the move is just another strategic ploy in poking holes into the Democrats’ overarching plans for publicly funded healthcare delivery.

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