09/18/09 — State of the Community forum

View Archive

State of the Community forum

By Phyllis Moore
Published in News on September 18, 2009 1:46 PM

Health care reform took center stage Thursday during a community forum at Wayne Memorial Hospital, sponsored by the Wayne County Chamber of Commerce.

The "State of the Community Health Care" featured a five-member panel discussing local and national health care efforts. Partici-pating were Lanier Cansler, N.C. Secretary of Health and Human Services; Barbara Morales-Burke, vice president of health policy for Blue Cross Blue Shield North Carolina; Bill Paugh, president and CEO of Wayne Memorial; Dr. Jim Stack-house, treasurer of the American College of Physi-cians; and Dr. David Tayloe, president of the American Academy of Pediatrics.

The two-hour session centered primarily around health care options and insurance.

"We're in very interesting times, and this topic of health care is very important to me," said Cansler, particularly in light of the current economic climate.

"When we're in a bad budget situation and budget cuts are necessary, obviously health care has to take part of that burden. We're in an economic downturn, so more people are seeking services through Medicaid. Because of the budget issue the state's facing, we're looking to trim $1.7 billion."

Juxtaposed with those cuts is the fact that there are an estimated 10,000 more people in the Medicaid program than had been projected, he added.

"We have got to find ways to do things smarter and to leverage assets that we have," he said.

Other concerns include H1N, which, while perhaps milder than formerly thought, still spreads rapidly and impacts the younger population, and mental health, Cansler said.

"We're trying to figure out what to do with mental health but not in coordination with the public health," he said. "How do we continue to try to make progress in mental health? How do we leverage our other assets to be able to access that?"

One way he suggested would be to address duplication of efforts. He referenced a case of a person who had 362 CT scans in two years, simply by going from one emergency department to another without a consistent tracking record that could have prevented the abuse of tests.

"We're expecting close to a quarter billion dollars in the next year to help with health care across the state," Cansler said.

He also suggested the need to develop "a strong standard of care between the psychiatrist and the local provider."

Citing Cherry Hospital as an example, he said patients typically are hospitalized for less than seven days, stabilized, then released back into the community. Unfortun-ately, if contact with a local provider is lacking, especially if the patient is from another area, a breakdown in the system often results.

"When there's a long wait when they go back to their community and don't stay on that medication, there's a problem," he said.

That is not to say anything needs to change at Cherry, Cansler said, especially for patients requiring more care.

"They're going to need to focus on long-term, so we take care of those that can be stabilized and taken care of locally," he said. "It costs less to take care of them in the local community than in the long-term."

Tayloe, founder of Goldsboro Pediatrics, said there's definitely need for health care reform, particularly in regard to children.

"Insurance should have child-specific benefits -- affordable premiums and cost care, medical homes for all, appropriate payment," he said. "AAP supports health care reform."

The national academy urges health care access for all children, Tayloe said, recommending providing full benefits for all children.

Like the mental health scenario of patients seeking medical attention from an array of sources without a way to cross-reference care, Tayloe said the "continuous loop" is what bothers him most and what needs to be addressed.

"A good longitudinal record needs to happen," he said.

While the health care system is complex, Ms. Morales-Burke maintained that "fixing our system is a must."

"We want to see a good bill passed this year, but we want it to be built on the system that we have -- consider the costs, the benefits, the trade-offs and see what the impact is," she said.

"We really do agree, I think, in large measure with hospitals and others that it's critical to reduce the number of uninsured in our state, to increase access for people who do not have access."

Paugh agreed, pointing out that the hospital's charity care is expected to increase 20 percent this year and bad debts by 15 percent.

"The largest increase for our costs for fiscal year ending Sept. 30 will be in the charity care and bad debt," he said. "We feel the effects of the economy."

Stackhouse said there are several paradoxes in the current medical arena, particularly with fewer graduates from medical school opting to become primary care physicians -- about 280-300, less than 2 percent, of medical students each year expressing an interest in primary care.

And yet primary care physicians are still a popular choice for most patients -- caring for patients with epidemic or chronic problems, coordinating the journey through the health care system and arranging appropriate consultations.

As for HR3200, the 1,034-page House bill on health care reform, Stackhouse said a lot of issues line up with policies already in place by the American College of Physicians and American Academy of Pediatrics.

Both he and Tayloe recommended a Web site that provides unbiased information on the topic -- Kaiser Family Foundation, kff.org.