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<< Previous   of   Next >>   ADVERTISEMENT   CONTACT THE HERALD Melanie Munk, Features Editor munk@heraldnet.com   Published: Sunday, August 24, 2008 Everett Clinic methods saving on Medicare spending By Linda Bryant Smith Herald Columnist Medicare is a "fiscal train wreck" in the words of Secretary of the Treasury Henry Paulson, who has repeatedly warned the fund will be bankrupt by 2019 unless drastic changes in this system occur. Meanwhile, the real victims of that pending train wreck, folks depending on Medicare, have difficulty finding a medical clinic or physician accepting new Medicare patients. Why? Medicare payments don't begin to cover the true cost of services. Most large medical clinics in Snohomish County that still accept Medicare patients lose millions of dollars each year. That's why we should all care about the findings of a national demonstration project involving 10 medical clinics across the country that shows the Everett Clinic improved the quality of care for older patients and at the same time managed to save Medicare and patients nearly $1.6 million in one year. The project will continue two more years. One of the largest chunks of Medicare spending is the cost of care for chronic conditions such as diabetes and heart disease. This study project tracked success in working with patients who have these conditions. At the Everett Clinic they speak of their work in this effort as "high tech and high touch," said Dr. James Lee who heads the clinic's participation in the national study. The clinic's new electronic records system with computers in each exam room "glues" all of a patient's records together, he said. These records include reports from all the medical professionals they see in the course of treatment. For example, a patient with diabetes might be seeing a urologist, an internist, a foot specialist, a nutritionist and an ophthalmologist. When the patient comes into the clinic, all this data is in a single computer file that's easily accessed and becomes part of the planning between doctor and patient. Records of medications the patient takes and the results of blood tests or other procedures are there as well. The end result is that the blood-sugar control rate among Everett Clinic patients with diabetes is at 88 percent compared with the national average of 76 percent. "By keeping sugar in control and avoiding complications such as blindness and foot ulcers, we are making sure our seniors with diabetes live a better life," Lee said. Not every clinic or every physician has this sophisticated electronics record system. It costs a bundle and Medicare doesn't help with the tab. So what can you do if you have diabetes, whether you're on Medicare now or will be in a few years? Follow the clinic's model. Keep your own records and make them accurate. Have a list of every medication you take and reports of any visits you've made to other medical specialists with you when you see your family physician. Have regular eye and foot exams. Make sure your blood sugar levels are checked on a regular basis along with your cholesterol. Work with your doctor to manage your disease. Be pro-active, and that includes doing your part with diet and exercise. So what else, has Dr. Lee learned as the study moves forward? Coordinating care for any illness or injury is critical, especially when it involves a hospital stay, he said. "Do all your doctors have all of the information? When you leave the hospital are all your doctors and your family on track with what comes next?" The clinic took an extra step here, by adding a "hospital coach." Ivy Fung, a registered nurse and longtime clinic employee, visits patients in the hospital before they're discharged and helps them plan for what they'll need at home as well as scheduling the next appointment with their physician. "When a patient is going through complicated treatments it's easy to feel lost," Lee said. Fung's hospital visit allows her to troubleshoot what the issues are at home, what the patient needs and to ensure the family is on board. She can determine if the patient needs visits by a home health nurse. All the info she gathers goes back into that electronic health record, that "glue" that ensures a patient doesn't get lost in the system. And while the study project has been successful in developing health care models that can be used across the country, the Everett Clinic still experienced a $7.6 million loss caring for Medicare patients last year, Lee said. We have 47 million Americans who have no medical insurance and millions of older Americans engaged in a health care program that is in serious financial peril. Just before gallivanting off for a five-week paid vacation at the end of July, Congress passed Medicare legislation that staved off a 10.6 percent cut in reimbursement to physicians. That really didn't solve the problem; it just gave Congress an 18-month breather before the next mandated Medicare cuts. In the end, we'll all probably have to pay more, either in taxes or Part B premiums or both. But the president we elect in November better come ready to change the system and Congress has to stop babbling and start producing effective legislation. If one medical clinic in one community could provide better care for its older patients and reduce overall costs to Medicare at the same time, that model of care should most certainly be considered in a new, improved version of Medicare or a national health care plan. If there's going to be a train wreck because the feds can't get this done, I have some suggestions about who should be on the train. Linda Bryant Smith writes about growing older, surviving and finding a little gold in the golden years.You can reach her at ljbryantsmith@yahoo.com.

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