Chief state health official addresses island medical board
New Block Island Health Services Executive Director Barbara Baldwin introduced Dr. Michael Fine, director of the Rhode Island Department of Health, at the BIHS meeting Wednesday, February 6. About 20 residents, including Town Council members, attended the meeting.
Fine addressed the difficulties medical providers confront in the face of a byzantine insurance system, and offered ideas to address the situation.
Fine, who has held his post since July 2011, spoke of the importance of BIHS to the local community, and to the state and country as well, since it serves as a model.
“We are an unusual country: We have health care, but no health care system. We need to organize services better. What you do here is so incredibly important. You’ve figured out how to provide services to all,” Fine said, decrying the high cost of health care in the country.
He noted the difficulty of running a primary care practice, with “its multiple payers, growing multiple demands and changeable medical environment.” He added that these pressures put a “huge strain and drain on primary care providers.”
Fine explained that fewer young doctors were going into primary care; rather most went into internal medicine and pediatrics and “headed for specialties.”
Board secretary Kay Lewis explained: “We are very challenged here. We have 1,000 year-round residents. We are running a primary care practice and emergency care in summers [for an expanded population].”
Fine added, “And you don’t have a pharmacy or a hospital.” Lewis said that the island had the support of a fine local rescue squad and of Life Star.
Lewis said patient fees were unable to cover expenses at the island’s Medical Center, and that the board must “struggle each year to close the gap.” She asked Fine if he saw anything on the horizon that might help the local facility.
Fine said the way the health care system currently worked, with the multiple insurers competing, resulted in a huge burden for medical practices: “For everyone who walks through the door, you have to find a different way to do the billing.”
Primary Care Trust
Fine has advocated that the state move toward a primary care trust, a system set up to take the place of ordinary insurance and organized to provide funding for general practitioners. Trusts promote the development of primary care practices that offer state residents inclusive “community-based, multi-disciplinary primary care practices.”
In a question and answer session, Fine said that eventually many hospitals — many of which were already losing revenue — would close as a result of “medical evolution, which is the outcome of improvements in health care, preventive care and in medical technology.”
He said if there were three or more health centers within a population center, “you reduce the necessity of going to emergency rooms.” He added the idea was to “pull funding for primary care out of insurances and into a trust.”
Asked about Accountable Care Organizations, Fine said, “ACOs would be collaborative; they would take the bulk of the money to be spent on each person and would contract with home health providers, with specialists and with primary health organizations.”
In effect, the move was toward public support for medical care, just as municipalities support schools, police and fire departments. “It’s not to argue that private practice in medicine shouldn’t continue; most of us think it should.”
He stressed, however, that he hadn’t gone to medical school “to create bills for insurance companies, but to take care of people.”
Nancy Greenaway, former BIHS director, said, “Thank you for appreciating the value of the medical center. It was intended to serve people of all means and all ages. We worked with the state, and yours is the first voice acknowledging this work.” Fine returned thanks to Greenaway for her efforts.
Speaking of Rhode Island’s Health Department, Fine said it had been very successful in immunizing against sexually transmitted diseases, influenza and childhood diseases. He pointed out that Rhode Island is the only state that purchases all its vaccines and distributes them to practitioners. As a result, he said, “We have the best immunization rate in the country!”
Electronic medical records
Following Fine, former interim director Peter Baute made a presentation on the center’s move toward electronic medical record keeping (EMR). At this point, two members of the board, Sue Hagedorn and Bob Fallon joined the meeting through speaker phone hook-ups.
“The old system is not efficient,” Baute said, crediting the Medical Center staff with doing the preliminary developmental work on EMR. He gave the examples of relevant patient information being immediately available to health care providers, including medical histories, medical allergies, vital signs, lab test results, etc.
“Better organization leads to better medical care,” Baute added. He also said that adopting such a system was mandatory to meet eligibility criteria for the Medicare incentive program.
“If we had achieved ‘meaningful use’ in 2012, we would have received $44,000,” Baute said. “Now, if we achieve it by December 31, 2013, we’ll receive $39,000. The longer we wait, the less we’ll be eligible for.”
“Meaningful use,” as defined by the federal government, is a “set of standards that governs the use of electronic health records and allows eligible providers to earn incentive payments by meeting specific criteria.”
In addition to eligibility for Medicare incentives, achieving meaningful use for the local center would assure grants of $3,000 from the Rhode Island Quality Institute, $2,000 from Blue Cross and $1,500 from United Health Care.
Baute said if the center didn’t meet criteria for meaningful use in establishing EMR, it would be subject to penalties from Medicare and Blue Cross in the form of lower reimbursements.
Federal guidelines establish that eligibility is predicated only on physicians achieving meaningful use, a policy that precludes nurse practitioners from doing so. Reached after the meeting, Baldwin said she found the national policy troubling, as it seemed to place limitations on services nurse practitioners could provide. Baldwin planned to look further into the issue.
After investigating several software options, Baute said he and the staff were inclined to go with Amazing Charts, which would require a one-time fee of $2,000 for licensing, a $1,900 annual fee for support and maintenance, $49 for KidsNet, an immunization interface, and several other nominal interface costs.
When Baute described how patient records would be transferred to an electronic system, he generated a lively response from audience members. He suggested that the staff might ask members of the board with medical backgrounds to assist in making the transfers.
Audience member Gerry Comeau said that as much as she respected board members she didn’t want her medical files to be seen by them. Others in the audience clearly agreed. Board member Shannon Morgan suggested patients could be notified and their wishes determined beforehand. After considerable back and forth, the discussion ended with general agreement that they might have to look for other solutions to the problem.
Baute asked the board for its approval in making the selection of the software program. After much discussion the board voted to make a final decision at its next meeting.
Because Second Warden Ken Lacoste, the town-appointed member of the medical board, had to recuse himself, only five board members were present to vote on a management agreement reached by the town and BIHS. Without a quorum, that decision was also tabled for the next meeting.
The next board meeting is scheduled for February 25.