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Get to Know the Players in Health-Care Reform

The legislation signed into law by the president on March 22 provides the guidelines for changes in the U.S. health-care system. However, his signature is only the first step. The heavy lifting will take many years as the details are interpreted and implemented. The goal of this column is to educate and engage you in helping at the administrative level. The decision-makers guiding the process will have a big influence on the final impact on our health-care system from EMS to long-term care.

Sending a Clear Message
In the first week after the bill was signed into law, the president nominated Don Berwick, MD, to serve as administrator of the Centers for Medicare and Medicaid Services (CMS). The CMS administrator will be a critical voice in how health-care reform is implemented, because changes will significantly add to the Medicaid rolls. As a federal safety net program, Medicaid previously covered only children and pregnant women, as well as the aged, blind and disabled. This legislation expands the eligibility to individuals and families meeting a threshold of 133% of the federal poverty level, as defined by the U.S. government.

Additionally, health-care reform will have a great influence on Medicare. Established in 1965 by the federal government, Medicare is already a massive insurance program covering citizens 65 years of age or older, younger persons with certain defined disabilities and individuals with end-stage renal disease. In the coming years, enrollment is estimated to increase due to an aging population, and the Medicare payment structure is expected to be modified in favor of primary care.

Berwick has an impressive resume, and his nomination sends a clear message about the focus on quality and efficiency. He’s president and chief executive officer of the Institute for Healthcare Improvement (IHI) and a professor at Harvard Medical School and the Harvard School of Public Health.

Six years ago, Berwick and I stood on the same stage in Orlando, Fla., to introduce the 100K Lives Campaign, an effort to save 100,000 lives by improving patient safety in hospitals across the U.S. At the end of the campaign, a total of 3,100 hospitals participated and reduced in-patient deaths by an estimated 122,000. This campaign had a far-reaching impact, signaling the start of a nationwide push to improve clinical quality and patient safety in our health-care system.

I have no doubt that Berwick will continue his work on improving access, cost and quality across our health-care system if he’s installed as administrator of CMS. He’s a world-class expert on health-care quality, safety and performance measurement. His presence in government can help transition health care in our nation to a better place for everyone.

Know the Decision-Makers
In the June column, we established an absence of meaningful information on EMS in health-care reform legislation. This absence demonstrates a lack of EMS expertise at the table, negatively affecting the ability of EMS to influence the implementation of health-care reform.

Hospitals, physicians, pharmaceutical companies, clinical technology companies, insurers and even labor unions have strong influence in the political process. But even these organizations know that the process isn’t entirely political and about money. Substance is equally as important. Everyone in government—whether at the national, state or local level—pays attention to an expert. So, it’s important to identify EMS leaders and make sure they have opportunities to speak with the decision-makers.

When I mention decision-makers, you may be thinking about the president or your senator. Although it would be excellent to be able to bend their ears, it’s more reasonable and equally as important to build local and regional collaborations and relationships. This means meeting top administrators at your local hospital—not just those administrators associated with the emergency departments.

Build relationships with your state’s medical society, seek out key medical academic leaders outside of emergency medicine, and make a point to connect with the tertiary care hospital even if it’s not in your immediate district. Ask to meet their grant writers, because these folks can be exceptionally helpful in getting you to the table and helping you to secure additional resources. The health planning council or equivalent organization in your state also has a great deal of influence. Finally, know your elected officials.

With the midterm election coming up, it’s important to educate incumbents as well as freshman legislators. Work continuously to educate the parade of officials who can have influence at the legislative or administrative level in health care. This isn’t a captive audience, and the field of EMS is constantly evolving with new concerns, issues and protocols. You must stay engaged in the conversation and make the connections to influence and educate during the health-care reform discussion and beyond. The decisions being made will influence you, your family, and—most importantly—the way you and your organization care for your patients. JEMS



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