1. February 24, 2011

2. National and State deficits. Health care expenditures continually increasing; while outcomes are declining. Consuming more and more of the GDP. Outcome: Unsustainable health care program. Sources: House Energy and Commerce Com.; Kaiser Family Foundation

3. The Outstanding Public Debt as of 2 Feb. 2011 is: $14,115,416,540,382 Estimated population of the United States is 309,659,662; so each citizen's share of this debt is $45,539. The National Debt has continued to increase an average of…. $4.17 billion per day since September 28, 2007!

4. China = $896B (20.6%); down from $940B (27%) since July 09. Japan = $877B (20.2%); up from $721B (20.5%) since July 09. U.K. = $511B (11.8%); up from $97B (2.7%) since July 09. Total securities (debt) = $4.3T

5. We wont get where we need to be by trying harder the old way. If you want new results, you need a new system. (Einsteins definition of insanity – Doing the same thing over and over again and expecting different results) CMS (Berwicks) three goals; 1) better care, 2) better population health, and 3) reduction of per capita health care costs. Emphasis will be on chronic disease prevention. Healthcare IT News, Oct 2010

6. Of the total Medicare dollars spent on health care, 30% of Medicare dollars is spent on last year of beneficiaries life. As part of the HCR laws, the projected number of eligible citizens to receive health care benefits is 32 million. Its projected that half of this group will come via the Medicaid program. Impact to clinics and/or physicians? Impact on hospitals, nursing homes, H/H & Hospices?

7. In Miami, FL, (South)…. The last six months of your life you will: see mostly specialists – 46 times; spend more than 6 days in ICU and have a 27% chance of dying in a hospital ICU. In Portland, OR, (PNW)… youll go to the doctor 18 times, half of those visits w your primary care doctor; one day in the ICU and have a 13% chance of dying in the ICU. (Higher odds of dying at home with Hospice support). USA Today

8. Sources: Health at a Glance 2009: OECD Indicators 7,290 4,417

9. Sources: National Health Expenditure Projections 2008-2019

10. Sources: Health at a Glance 2009: OECD Indicators $5,790 138% Premium inc. 42% Wage and Benefits Increase 31% Overall Inflation

11. SAN FRANCISCO – Six Fortune 500 companies and Massachusetts have launched Catalyst for Payment Reform, a non-profit organization focused on helping large employers use their leverage to accelerate healthcare payment reforms. CPR's executive director will be Suzanne Delbanco, PhD, the founder and former CEO of The Leapfrog Group, an organization that seeks to leverage the group purchasing power of employers to influence healthcare safety, quality and consumer value. She brings a track record of working with large healthcare purchasers to create change in the healthcare marketplace. The group consists of the Boeing Company, Delta Air Lines, Equity Healthcare, GE, the Group Insurance Commission of the Commonwealth of Massachusetts, the Intel Corporation and Wal-Mart Stores. Each has agreed to advocate for healthcare payment approaches that reduce costs and waste while spurring higher quality and to work to put such payments in place with the health insurance plans with which they contract. Healthcare Finance News, Oct. 21, 2010 Massachusetts, Fortune 500 companies create organization to push payment reform October 21, 2010 | Chris Anderson, Contributing Editor

12. State of Washingtons budget shortfall for the present biennium is $500M (2009-2011) and a $4.6B shortfall for 2011-13 biennium. Additional budget cuts will be needed – much of the budget is protected (60%) and cannot be cut. TSMH cut in M/A Reimbursement ~$250K in 2011. Additional cuts?? Washington State Hospital Association

14. Sources: Frontline - WBGH Educational Foundation

15. NationMaster.com/Health Statistics>Obesity; Kaiser Family Foundation, 2008

16. Sources: House Energy and Commerce Com.; Kaiser Family Foundation 41 nations have greater life expectancy than USA. Two decades ago USA was 11 th 42 nd

18. HCR is most significant expansion of Federal benefits since Medicare & Medicaid in 1965. Increasing health care costs/variations and increasing cost per capita. Troubled economy and increasing national (and state) debt exacerbates a fragmented system that continues to consume a greater % of the GDP (and state budgets).

19. More cuts coming from the State. Employers are looking for new methods or means to curb rising health care costs and premiums. Money spent vs outcomes (cost = value); Assumption: a lot of waste in the system. Doubtful that HCR will be repealed. The present course is not sustainable!!

20. Focus on reducing costs, waste and improving quality (value/outcomes). Increased emphasis on evidence-based outcomes or protocols. Focus on outpatient quality and reporting (hospitals, clinics and physicians). Insurance programs that will have a greater focus on prevention – keeping patients out of the hospitals and E/Ds.

21. Demand for Primary care and diagnostic services will grow. (Shortages of physicians will be exacerbated). Local health departments along with Home Health/Hospice and other non-based hospital service lines will become more utilized. Continued shift of physicians to employed models.

22. Accountable care organizations (ACOs): a method for integrating local physicians with other members of the health care system and rewarding them for controlling costs and improving quality, which ultimately will have the potential to drive payment reform (down) in the public and private health care sectors. Uncertainty: The alignment of primary care physicians with specialists, hospitals, health plans and other industry stakeholders could prove challenging. Sources: Deloitte & Co.

23. Ultimate goal: ACO – Integrated system that receives reimbursement for reducing costs and meeting quality improvement markers. Sources: House Energy and Commerce Com.; Kaiser Family Foundation

24. Payment mechanism will shift from volume to value (or quality). Some large health systems will get into the insurance business. (super regional systems) Increase consolidation w/in the industry (more mergers, affiliations, etc.) of hospitals, systems, physicians & clinics. Community based focus of delivery models on how to handle chronic diseases and/or illnesses.