Original links are included though some may have expired.

In This Issue:

1.) Alternative Justice for Injured Patients Proposed in Washington State
2.) Improving Quality and Lowering Costs
3.) Health Care That's Part of Your Daily Life
4.) The Barbershop Initiative

1.) Alternative Justice for Injured Patients Proposed in Washington State

Facing the prospect of two competing ballot initiatives on malpractice reform (one proposed by doctors and another by lawyers) in November, key legislators in Washington state are developing an initiative of their own. Their plan would give patients injured by malpractice access to quicker and less expensive justice, while helping to prevent injuries in the future. At the core of this initiative is an arbitration system, which is similar to the PPI proposal for health courts.

Authored by Rep. Patricia Lantz (D), and supported by House and Senate leadership, the initiative, called "Plan B," would encourage injured patients to use the arbitration system by reducing the length of time and inconvenience associated with a typical trial. It would appeal to doctors and hospitals whose maximum liability would be $1 million. It would also curb frivolous actions by requiring the losing party to pay the fees of the arbitrator. The arbitrator would issue a written ruling that could potentially be used as a guidepost for other arbitrators dealing with similar cases.

The initiative also includes patient safety measures to prevent injuries. It requires hospitals and other medical facilities to report patient injuries to the public health department. The reports would not be hampered by the medical staff's fear of being sued because they would not identify the doctors and patients involved. Instead, the department of health would analyze the circumstances and patterns of injuries over time in order to make sure the medical facility was taking corrective measures. It would also make public reports about patient injuries on a regional basis.

Washington's situation is similar to the one Florida faced in the 2004 election, when ballot initiatives from both doctors and lawyers were passed. The result is only a pause in the battle. Legislators in Washington state are boldly trying to resolve the conflict by aiming at what patients really need: swift and fair compensation for injuries when they occur and prevention of injuries in the future.

Meanwhile, the debate in Washington, D.C., over malpractice reform continues to force Americans into a false choice between giving up access to justice and access to less costly health care. Republicans have been pushing for a $250,000 cap on non-economic damages to lower the cost of malpractice insurance and thus the cost of health care. Democrats have opposed caps because they would make it harder for lawyers to take cases on a contingency basis where the patients pay only if the lawyer wins the case.

Health courts are better than arbitrary caps that would limit patients' access to justice. As a recent editorial in the Investor's Business Daily which endorsed PPI's proposal for health courts put it: "After all, not every plaintiffs attorney is a predator. Some want the truly harmed to be properly compensated and honestly feel that capping damages will in some cases prevent that."

Health courts would provide fair compensation to injured patients while also giving doctors clear legal signals to help them prevent injuries. That's the best way to reduce the costs of malpractice. It's time for a debate that gives patients what they deserve: access to justice and access to affordable health care.

For more information:

"Democrats Weigh in on Medical Malpractice,"
By Angela Galloway, Seattle Post-Intelligencer, March 15, 2005:
http://seattlepi.nwsource.com/local/
216042_medmal15.html

"Democrats offer solution to dueling malpractice initiatives,"
Washington House Democrats, March 14, 2005:
http://www.sdc.wa.gov/
Releases/Brown/2005/medmal.htm

"Health Courts: Fair and Reliable Justice for Injured Patients,"
By Nancy Udell and David B. Kendall,
Progressive Policy Institute, February 17, 2005:
http://www.ppionline.org/ppi_ci.cfm?knlgAreaID=111
&subsecid=138&contentid=253178

2.) Improving Quality and Lowering Costs

The fault lines in the emerging debate about rising health care costs go roughly like this: conservatives believe that individuals should be accountable for health care costs, while many liberals still look to the government as the only source of cost control. But both approaches ignore the fact that under any system, it's the doctors and hospitals that have the greatest impact on health care cost because they make the key decisions about how many resources should be used. A third way approach to cost restraint enables doctors and hospitals to be accountable for costs and quality.

That's the general approach suggested by Karen Davis, president of Commonwealth Fund. Her top 10 list for controlling health care costs includes: reduce hospitalization of patients with high-cost conditions; reduce overuse of medical procedures; and stop paying for medical errors. Interestingly, she has formerly urged government price controls as the solution to runaway medical inflation.

Her ideas mirror the cost control strategy of many large employers. A program called Bridges to Excellence is rapidly becoming a model for reform. According to an Associated Press story, the program pays "doctors extra money for meeting certain standards for care they provide for chronic illnesses. Doctors receive incentives ranging from $50 to $160 per patient annually." For making an investment in better care for patients with diabetes, participating companies see a net savings of about $175 per patient per month "through reduced hospital visits, less unnecessary testing, and other factors."

Making the health care system more accountable for its results is a well-established practice. As reported in the Hartford Courant, a survey of large employers by benefits-consulting firm Watson Wyatt Worldwide and the National Business Group on Health shows significant change: "About 95 percent of the firms surveyed are now using disease management programs -- closely tracking workers' illnesses and care -- up from 57 percent in 2003. Employers have also embraced behavior change programs, encouraging workers to undergo basic health screening, and outlining actions they can take to correct problems with weight, blood pressure, and other issues. The number of employers with such programs nearly doubled last year, to 68 percent. About a third of the employers are focusing on obesity reduction among workers, up from 14 percent in 2003."

It's time to expand such efforts beyond large employers. One way is through regional purchasing coalitions that can sponsor efforts to increase accountability for costs and quality across health care plans of varying size. In the Seattle area, King County Executive Ron Sims has created the Puget Sound Health Partnership which includes employers of all sizes, health plans, and the state's lead health care agency. It is similar to purchasing coalitions in California, Minnesota, and Florida.

Sims makes the challenge clear: "No one purchaser, plan, or health care professional group by itself is capable of creating the change necessary to decrease waste, improve the quality of care, and decrease the cost trends in the Puget Sound region. We must harness the collective strength and intelligence of our region to meet this challenge."

For more information:

"Taking a Walk on the Supply Side: 10 Steps to Control Health Care Costs,"
By Karen Davis, Commonwealth Fund, March 2005:
http://www.cmwf.org/aboutus/
aboutus_show.htm?doc_id=264016

"Pay-For-Performance Doctor Plan a Model,"
By Lisa Cornwell, AP/Yahoo, March 30, 2005:
http://story.news.yahoo.com/news?tmpl=story
&u=/ap/20050331/ap_on_he_me/doctor_quality

Bridges to Excellence:
http://www.bridgestoexcellence.com

"Companies Watching Out For Workers' Health,"
By Adam Geller, AP/Hartford Courant, March 18, 2005:
http://www.courant.com/business/
hc-healthcosts0318.artmar18,0,3586316.story

King County Health Advisory Task Force:
http://www.metrokc.gov/exec/hatf/

3.) Health Care That's Part of Your Daily Life

Too often, health care feels like something that's done to you, not with you. That's the impression you get in hospitals where sophisticated technology, and professionals with finely honed skills, dominate the scene. As patients, we're grateful for the technical prowess behind health care, but getting sick or hurt is disruptive enough without health care itself adding to the disruption.

Here's a simple way that hospitals can make health care less disruptive: Give patients and their families access to the Internet. The Internet is not only a vital part of most Americans daily lives, it is also a key source for health information. And since many of us are at the hospital when we face the most health care questions, it would be an invaluable resource.

Hospitals in Virginia, Indiana, Pennsylvania, and South Carolina have converted the TV's in patient rooms into interactive systems, according to the Washington Business Journal. Hospitals in Florida with a similar system report that patients can use it to "check e-mail ... surf the Internet ... as well as watch educational videos about various medical issues and procedures they may want to learn about." The system can also be used to page various departments within the hospital regarding non-medical issues, such as room accommodations and food, according to the Florida Times-Union.

Other hospitals have given patients with their own laptops access to the Internet through Wi-Fi networks and high-speed Ethernet connections in the patients' room just as many hotels offer.

Internet access may seem like a small thing, but it's emblematic of how health care should work. Health care and all of its wondrous systems need to fit into the patient's life, not the other way around. Imagine if the health care system itself was online like banking, retail, and media. Then health care would truly be part of our daily lives in the Information Age.

For more information:

"GetWell Network To Study In-Room Web Service,"
By Tania Anderson, Washington Business Journal, March 29, 2005:
http://washington.bizjournals.com/washington/
stories/2005/03/28/focus1.html

"Hospital Patients Surf Internet, Watch Movies, Sports,"
By Cherie Black, Florida Times-Union, January 21, 2005:
http://www.jacksonville.com/tu-online/stories/
012105/met_17746489.shtml

"Hot-Spots Come To The Hospital Room,"
By Marianne Kolbasuk McGee, InformationWeek, June 14, 2004:
http://www.informationweek.com/
showArticle.jhtml?articleID=21700415

"Whose Health is It Anyway?"
By S. Robert Levine, MD, Blueprint, (Spring 2000): http://www.ndol.org/ndol_ci.cfm?contentid=1011
&kaid=111&subid=138

4.) The Barbershop Initiative

For many of us, information about health care comes into our daily lives through someone other than a doctor. We may seek the advice of a friend because he or she has had similar problems. Or we may turn to someone in our community whom we trust, like our barber or beautician.

That's the premise behind the Barbershop Initiative, according to The Washington Post. A small non-profit group, Prostate Net, has signed up 800 barbers nationwide to provide their customers with first-hand information about prostrate cancer, which kills black men more than twice as often as white men.

The health care discussions barbers have with their customers are not limited to prostrate cancer. Joe Harrington, a prevention leader at Chicago's Rush University Medical Center explains: "This opens the door to talking about all-around preventive health care. We talk about what factors you can change. You can't change your race or your age, but you can change your lifestyle. Once we get people to a doctor, then they can also get screened for high cholesterol, blood pressure, diabetes."

Participating barbers receive educational briefings at 57 medical centers throughout the country and brochures from the National Cancer Institute. The program has received funding from MGM Studios as part of last year's release of the movie "Barbershop 2."

Beauticians are also a trusted source of information who can serve as a link to good health and health care as reported in Blueprint magazine. Such community connections are vital to bringing abstract public health goals home to every person. They should be a key part of all public health initiatives.

For more information:

"Cancer Effort Enlists Barbers,"
By Kari Lydersen, The Washington Post, March 28, 2005:
http://www.washingtonpost.com/
ac2/wp-dyn/A5416-2005Mar27

Prostrate Net:
www.prostate-online.org

"What Works: Outreach in Chattanooga,"
By Judy Packer-Tursman, Blueprint, (Spring 2000):
http://www.ndol.org/ndol_ci.cfm?contentid=1065
&kaid=111&subid=138

Newsletter compiled and written by David B. Kendall, PPI's senior fellow for health policy.