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CMS nominee an advocate for change in health payment and innovation

BY DSN STAFF

WASHINGTON —If approved by the U.S. Senate, President Barack Obama’s choice to head the Centers for Medicare and Medicaid Services could have a profound, and ultimately positive, impact on the way retail pharmacy is practiced in this country.

In mid-April, the White House announced its nomination of Donald Berwick as the next administrator of CMS. A highly regarded pediatrician, educator and health-reform advocate affiliated with the Harvard School of Public Health and the Department of Medicine at Boston’s Children’s Hospital, Berwick will bring a deep commitment to overhauling the healthcare system to his confirmation hearings in the U.S. Senate.

Although perhaps little known to community pharmacy, Berwick is known as a high-profile advocate for innovation, transparency and health information technology—and for broadening health coverage to the uninsured. Thus, his efforts to overhaul the health payment model, encourage preventive health and build a more integrated decision-making platform among all health providers could elevate the future role of pharmacists.

As co-founder, president and CEO of the Institute for Healthcare Improvement, Berwick has emerged as a vocal champion of a more rational, cost-effective and outcomes-oriented healthcare system. Among the goals the IHI pursues: shedding light on health providers and hospitals to give patients and health plan payers more informed choices about their care and overhauling the way Medicare pays doctors, hospitals and other healthcare providers to reduce the old fee-for-service model in favor of an evidence-based, outcomes-oriented health system.

That puts Berwick in sync with many of the goals advanced by the White House in its ultimately successful battle to overhaul large parts of the U.S. healthcare system—including its bid for information sharing about health providers and a different method for paying doctors and health centers.

Berwick described himself as “flattered and humbled that President Obama…has nominated me to become the next administrator of…CMS. I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America’s healthcare system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

With little concrete information to show Berwick’s specific convictions regarding the proper role of community pharmacy in a reformed healthcare system, pharmacy officials reacted hopefully, if cautiously, to the nomination. Said NACDS president and CEO Steve Anderson, “The National Association of Chain Drug Stores looks forward to working with [Berwick].… Particularly as much of the focus on healthcare reform now will shift to the executive branch, the Centers for Medicare and Medicaid Services will play a major role in issues that affect peoples’ lives and the ability of healthcare providers to improve public health,” Anderson added. “On key pharmacy issues that have been rightfully included in healthcare reform, NACDS is eager to engage in this process.”

Another NACDS official pointed out that “although [Berwick’s] focus has always been primarily on hospitals, health systems and physicians in improving quality and outcomes, this does not mean that pharmacy can’t have an important role to play as well. Our industry’s vision is right in line with Berwick’s.”

Also weighing in was Tom Menighan, CEO of the American Pharmacists Association. “With the new healthcare-reform law, we still have lots of work ahead of us in the regulatory process to assure that our patients get the full benefit of pharmacist services, and we look forward to working with Dr. Berwick upon his confirmation,” he said.

In an interview last November with Kaiser Health News, Berwick passionately argued for breaking down the decision-making silos that still compartmentalize patient care and prevent a coordinated approach to successful treatment outcomes. “We have fragmented payment systems and fragmented institutional boundaries,” he told KHN. “The enemy is fragmentation. Until we fix structures and finance, it is going to be very hard to make fast progress.”

Berwick also articulated a strong need for greater transparency in how patient care is developed and delivered in order to share best practices and boost the health system’s overall performance.

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Retail clinics: Improved care at a lower cost

BY Michael Johnsen

WHAT IT MEANS AND WHY IT’S IMPORTANT Retail clinics. Save. Money. Without regard to who’s footing the bill exactly — healthcare payer or Jane Patient — retail clinics not only represent a significant cost savings across the board, but by siphoning nonemergency-yet-still-urgent cases out of the emergency rooms and doctors’ offices, retail clinics also can contribute to improved care across the healthcare continuum.

(THE NEWS: Study: Retail clinics save nonemergency patients money. For the full story, click here)

All told there were 119.2 million total ER visits in 2006, up 8.2% as compared with 2004, according to ACEP. Extrapolate that figure with WellPoint’s finding that 19.4% of those visits may be for nonemergencies across the entire nation, and the fuzzy math equates to an approximate 23.1 million non-emergency patients presenting across some 3,833 ERs. For whoever is paying for the cost of care, that’s an expenditure totaling $10.2 billion if every case were to present at an ER; as compared to $1.2 billion if every case were to present at a retail clinic. That’s the cost savings piece.

But cost savings aren’t the only benefit retail clinics afford the overall healthcare system —  there’s a general improvement in care. According to the American College of Emergency Physicians, average waiting times for patients triaged with non-emergency ailments at emergency departments range between one and two hours, but only when the ER isn’t crowded. That’s like saying that bee stings don’t hurt, you know, except when they do.

Let’s face it, in a nation of 309 million and counting, there are simply not enough points of care, be it for an emergency or nonemergency situation. Taking nonemergency visits out of emergency rooms would likely improve the efficiency of care for more critical patients, as well as the experience of care for noncritical patients. That’s the improved care piece.

Improved care at a lower cost, that’s what retail clinics bring to the table.

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Tide brings Loads of Hope to Dollar General

BY Allison Cerra

NASHVILLE Tide brought its mobile laundromat to a local Dollar General to benefit victims of the recent floods.

Tide’s Loads of Hope program visited a Nashville Dollar General May 12 to provide customers in the area with clean laundry. One truck and a fleet of vans house more than 32 energy-efficient washers and dryers that are capable of cleaning over 300 loads of laundry every day. Tide washs, dries and folds the clothes for these families for free.

The Loads of Hope program also benefited victims of Hurricanes Katrina and Ike, in addition to other natural disasters.

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