Improving healthcare in Iowa

With the changing landscape of healthcare in Iowa and across the country, Joe LeValley, of the Mercy Health Network, said reforms will change the system for the better.

LeValley spoke to about 30 people Tuesday night at Webster City Middle School. He began by looking at the idea that the United States has the best healthcare system in the world. He said the nation’s health system has made progress over the years. He cited an American Heart Association study published this year which showed an across the board decrease deaths from diseases including congestive heart failure and stroke from 1994 to 2004.

However, LeValley said the current healthcare system is not sustainable. The U.S. has much higher spending on healthcare as a percent of its gross domestic product than other nations. Healthcare costs for people over age 60 increases in all of those countries, but rockets up past $40,000 on average in the U.S. compared to about $10,000 in the United Kingdom, according to a 2009 Carnegie Mellon University study.

LeValley also presented data which shows that hospital price growth continues downward, that physicians are paid less than 10 years ago. What has then happened then, according to LeValley is that more doctors have been involved with each individual patient’s care. According to The New York Times, in 2009, 77 doctors were billed for a single medicare patient on average in the last six months of a patients life. He said the current healthcare system is set up to encourage that.

“All they’re doing in New York City is responding to the system that they’ve been given to work in,” LeValley said.

As another example, he said Mercy Health Network rolled out a program 12 years ago to better care for patients with congestive heart failure. LeValley said patients with congestive heart failure are often in and out of the hospital to treat the disease.

In the program, the network used nurse case managers and daily phone calls to record patient’s vital signs at a low cost which reduced the readmission of those patients by 85 percent.

However, LeValley said their reward was millions of dollars lost due to fewer hospital admissions.

“The system is set up to discourage hospitals from doing the right thing,” LeValley said. “This isn’t sustainable in that form.”

To change the model, LeValley introduced the concept of shared savings which attributes people to a certain health system.

Using Mercy Hospital in Des Moines as an example, 62,000 people were determined to mainly use the hospital and their network and the network is responsible for their costs.

Under shared savings, each dollar those people use on healthcare, whether with the network or outside of it, is tallied up. If they spend less money than they did last year, Mercy gets to keep half of the savings.

“That’s real incentive to keep those 62,000 people as healthy as possible,” LeValley said. “Suddenly, those people, every test or procedure the doctor orders in effect reduces their bonus check at the end of the year. Every dollar they save by keeping a person healthy, they get a better bonus check at the end of the year.”

Right now, the program is voluntary and the Mercy Health Network is participating in it. Citing the New York Times article again, he said areas like that have less incentive to take part in shared savings. However, LeValley said he hopes it will become the standard over time.

To participate in shared savings, LeValley said Mercy was required to form an Accountable Care Organization, ACO, a separate entity to manage the improvement of care and the acceptance of those bonuses. Aside from shifting the incentive of how to provide healthcare, LeValley said the Mercy ACO also manages data between care providers to avoid duplication of services and prevent medical errors. The Mercy ACO includes 58 participating organizations and over 1,000 providers.

“Local community doctors and hospitals are going to be more important than ever in the future,” LeValley said.