Health Care

Floor Speech

BREAK IN TRANSCRIPT

Mr. BLUMENTHAL. Mr. President, I want to thank my colleague, Chris Murphy. Senator Murphy has been a long-time champion on this issue. My colleagues may wonder why two Senators from Connecticut, both of our Senators, are here on the floor and part of this working group seeking to lead on this critically important issue of health care delivery.

The answer is we come from a State where it is working. We have seen the future in Connecticut's health care delivery system. It is still a work in progress, a lot of work still to be done, but Connecticut hospitals and providers and insurers and patients know it has to be our future, that cutting cost is essential to preserving and enhancing quality. Let me emphasize how important that basic principle is, because a lot of our colleagues believe there is a choice here between cutting costs and quality, that quality cannot be enhanced if we cut costs.

In fact, the opposite is true. Cutting the cost of health care is key to enhancing and improving quality. It is the way we will reduce premature discharges from hospitals, that we will diminish the number of discharges from hospitals without proper rehabilitation plans, and cut the number of hospital-acquired infections. It is not only possible to do but it is essential. It is a way we avoid the false choice--and it is a false choice--between preserving Medicare on the one hand and avoiding increasing copays, decreasing benefits, or increasing taxes, as my colleague from Connecticut has said.

I reject every one of those options as necessary to preserving Medicare. Increasing copays, decreasing benefits, or increasing taxes is not the way. In fact, increasing efficiencies and avoiding unnecessary wasteful and indeed harmful costs are necessary to preserve Medicare.

My mother taught me a number of things. She said, No. 1, if you don't have something nice to say about someone, don't say anything. So I am not here to say not-so-nice things about the folks who say we ought to cut Medicare benefits. But I would oppose those kinds of cuts as unnecessary and harmful.

She also said an ounce of prevention is worth a pound of cure. In fact, that basic truth is what will help save our health care system. Prevention of costs, prevention of illness, prevention of obesity and smoking, and other kinds of diseases and conditions that lead to increased health care costs are essential to this effort.

My mother said also listen to your younger brother. My brother, Dr. David Blumenthal, has been a pioneer and an expert in this area. As much as it pains me to acknowledge that my younger brother knows a lot more about this subject than I do, in fact, he has been able to enlighten me and many of our colleagues here on this point. I mention him and the others who are experts and pioneers in this effort. He is one of many who have advised and provided that kind of enlightenment.

Because there is no more kind of guesswork as to whether advances can be made in this area by cutting costs and raising quality. It has been documented. There are projections. It can be costed out. It can be scored, in my view. It can be the basis for action by my colleagues here in seeking to cut costs that are skyrocketing out of control.

I have seen these reforms at work throughout the State of Connecticut. This issue is of national importance, but it hits hospitals and providers in every one of our States. I have seen it and listened to folks who work at places such as St. Vincent's and Bridgeport Hospital, in Bridgeport; St. Mary's Hospital in Waterbury; Yale-New Haven and Greenwich Hospital, Middlesex Hospital. All around the State of Connecticut, I have seen the checklists at work, the protocols for hand washing, the increased attention to quality care that has helped reduce costs. They have helped improve patient care while reducing cost. They reject this false choice between quality and cost cutting. Both are possible. Both are essential.

We hear so much rhetoric about the Affordable Care Act in Washington. But in Connecticut, we see tangible examples of how it is working and making a difference. The implementation of the Affordable Care Act is a historic opportunity for continuing this work and expanding it nationwide. We need to continue our dedication to health care reform.

My colleagues and I have come to the floor today to call for smart reform that helps patients and avoids harm to them, and does not discourage providers from being a part of a Federal health care program. In fact, we need to identify areas of reforms within the health care system that we can address that will strengthen health care in this country and address the serious concerns about the skyrocketing costs of health care.

We have seen a slowdown in the growth of national health care expenditures over the past year. But slow growth certainly does not mean a decrease in overall expenditures. Smart policy decisions require that we address the ongoing problem of health care spending in this country, and turn a corner for the good by reducing the current costs.

I am concerned that there are shortsighted strategies, such as taking money from the Prevention and Public Health Care Fund established under the ACA, which has been a tactic unfortunately used by both parties in financing programs. That tactic will undermine our long-term efforts at reducing health care spending. The Prevention and Public Health Fund is used in Connecticut for programs such as mental health services and substance abuse prevention, as well as public health research and surveillance.

These measures will ultimately result in lower health care spending through prevention and preventive health care. But we need to stay committed and stay the course. What we need to do now is to continue to work toward developing a sustainable health care system, through structural reforms such as the accountable care organizations, health maintenance organizations, patient-centered medical homes that have provided advances in this area, and have created provider organizations that lead to greater provider acceptance of responsibility for health care outcomes in their patients.

Measuring the success of those organizations requires taking a closer look at whether the savings and outcome improvements actually materialize. We have to be hard-headed and clear-eyed about whether they are working. The metrics must be applied. We need to measure success. Measurements are possible; as I said at the outset, no longer a matter of guesswork. There are scientific-based measurements.

The success of these organizations will have more to do with how they are run than with how they are structured. As sophisticated as many of our health systems are, the development of process goals has only recently become a consideration. The Association of American Medical Colleges recommends, for example, the use of surgery checklists through their best practices program.

Peer-reviewed studies have shown that the use of comprehensive checklists is associated with reductions in complications and mortality during surgery. But they are most successful when health care organizations subscribe to a culture of safety. That culture of safety and prevention is essential.

Some hospitals in Connecticut have been rewarded through the Medicare Program for their commitment to improving quality through the use of process measures: Bridgeport Hospital, St. Mary's Hospital in Waterbury, Middlesex Hospital have all seen increases in reimbursement rates through the Value Based Purchasing Program.

Again, the Federal Government can provide incentives and encourage and support this effort. Manchester Memorial Hospital, Hartford Hospital, and Rockville General Hospital all have avoided Medicare penalties by lowering their readmission rates. While payment differences for these programs represent a small portion of the overall Medicare payment, hospitals should continue to be rewarded for addressing these issues.

I want to conclude by drawing attention to some of the innovative work being done in my State of Connecticut around delivery reform and data collection. I have mentioned the importance of measurements and metrics. Much of the work is supported by grants that were made available through the Affordable Care Act. But it has been the State itself that has decided how exactly to use these funds. While Connecticut has established a working group around innovative reforms which continues to work on specific proposals and recommendations for reforming the health care system, one of the areas of focus has been to ensure integrated clinical data exchange between health care providers.

Connecticut has invested in interoperable health information technology systems and developing an all payers claims data base to create comparable, transparent information that can be better used to understand utilization patterns and enhance care access.

One of the most basic aspects of reforming any system should be a clear understanding of where the biggest problems lie, and yet we still lack the data necessary in many systems to truly understand where the unnecessary spending is taking place. It is like a diagnosis of any kind of medical condition. Facts are essential. Data is key, and I believe an investment in information technology and data collection activities will help inform payers and consumers about where our health care dollars are being spent, where they are being spent most effectively, and where we can reduce spending that will ultimately enhance health care outcomes.

Connecticut is taking a considered and insightful approach to obtaining and utilizing data while considering the needs of consumers and looking toward developing stronger programs for telemedicine and provider coordination. Technology is advancing. Data collection can help implement technology where it does the most good.

We need tangible goals for long-term reform, and that is part of the work that we have described and we are undertaking as part of our task force.

I know my colleagues this evening all agree with me that we need to continue this work and take advantage of advancing technology, the metrics that are now being sampled, of good practices, leadership of providers, the medical community, and good ideas wherever they are and whoever is willing to offer them.

I wish to thank my colleagues for joining in this effort, and I look forward to returning on this subject.

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