Legislature(2011 - 2012)CAPITOL 106
03/01/2012 03:00 PM House HEALTH & SOCIAL SERVICES
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| Presentation: Alaska State Hospital and Nursing Home Association | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 1, 2012
3:05 p.m.
MEMBERS PRESENT
Representative Wes Keller, Chair
Representative Alan Dick, Vice Chair
Representative Bob Herron
Representative Paul Seaton
Representative Beth Kerttula
Representative Bob Miller
Representative Charisse Millett
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
PRESENTATION: ALASKA STATE HOSPITAL AND NURSING HOME ASSOCIATION
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
MIKE POWERS
Fairbanks Memorial Hospital
Fairbanks, Alaska
POSITION STATEMENT: Testified and answered questions during a
PowerPoint presentation titled "Overview of Alaska's Hospitals
and Nursing Homes."
RICK DAVIS, CEO
Central Peninsula Hospital
Soldotna, Alaska
POSITION STATEMENT: Testified and answered questions during a
PowerPoint presentation titled "Overview of Alaska's Hospitals
and Nursing Homes."
ROBERT LETSON, CEO
South Peninsula Hospital
Homer, Alaska
POSITION STATEMENT: Testified and answered questions during a
PowerPoint presentation titled "Overview of Alaska's Hospitals
and Nursing Homes."
LIZ WOODYARD, CEO
Petersburg Medical Center
Petersburg, Alaska
POSITION STATEMENT: Testified and answered questions during a
PowerPoint presentation titled "Overview of Alaska's Hospitals
and Nursing Homes."
MILLIE DUNCAN, Administrator
Wildflower Court
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions during a
PowerPoint presentation titled "Overview of Alaska's Hospitals
and Nursing Homes."
KAREN PERDUE, President/CEO
Alaska State Hospital & Nursing Home Association (ASHNHA)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the overview of
Alaska's Hospitals and Nursing Homes.
ACTION NARRATIVE
3:05:19 PM
CHAIR WES KELLER called the House Health and Social Services
Standing Committee meeting to order at 3:05 p.m.
Representatives Keller, Miller, Seaton, and Dick were present at
the call to order. Representatives Millett, Herron, and
Kerttula arrived as the meeting was in progress.
^Presentation: Alaska State Hospital and Nursing Home
Association
Presentation: Alaska State Hospital and Nursing Home Association
3:06:52 PM
CHAIR KELLER announced that the only order of business would be
a presentation by the Alaska State Hospital and Nursing Home
Association (ASHNHA).
3:06:58 PM
MIKE POWERS, Fairbanks Memorial Hospital, established that
hospitals and nursing homes were economic anchors for a
community, as they were a recession proof industry. He directed
attention to the Silver Tsunami, the population over 65 years of
age, and noted that this group will increase 127 percent by
2034. He affirmed that hospitals were also education partners,
and he reported that an earlier 17 percent vacancy rate for
nurses had almost been filled by the University of Alaska
nursing program. In Fairbanks, more than 1000 students had an
educational experience through the Area Health Education
Centers. He confirmed that major life passages occurred between
the walls of the hospital. He directed attention to slide 1,
"Alaska is Beyond Rural when compared to other States," and
observed that Alaska was very unique, as it was still a frontier
state.
3:10:56 PM
MR. POWERS indicated slide 2, "78% of Health Facilities in
Alaska have Special Federal Designation," and pointed out that
almost 80 percent of the health care facilities in Alaska had a
federal designation, which allowed flexibility in reimbursement
and regulation relative to the uniqueness of the critical access
hospitals in rural areas.
3:11:21 PM
MR. POWERS moved on to slide 3, "Health Care is a Major Employer
in Alaska," and reported that almost 1 out of every 10 jobs in
Alaska was health care related, with a payroll of $1.5 billion.
3:11:34 PM
MR. POWERS supplied slide 4, "Half of all Health Care Employment
is in Hospitals & Nursing Homes," and stated that hospitals,
nursing homes, and physician clinics accounted for 80 percent of
health care jobs.
3:11:50 PM
MR. POWERS moved on to slide 5, "Health Care Employment is
throughout the State," noting that health care employment
followed the population patterns of the state. He shared slide
6, "Health Facilities are Impacted by Higher Costs," pointing to
the cost of living index and various costs within the major
cities of Alaska.
3:12:43 PM
MR. POWERS stated that, compared to other states, the cost of
living in Alaska was about 30 percent higher and the hospital
costs were about 38 percent higher, slide 7, "Alaska Costs
Compared to Comparison States."
MR. POWERS, showing the pictures on slide 8, "Cost Drivers
Impacting the Cost of Care in Alaska," stated that the cost
drivers for health care tended to be recruiting, retaining, and
training the work force.
MR. POWERS pointing to slide 9, "Alaska Pays More for Health
Care Practitioners than 8 Comparison States," shared that the
high hourly annual salary in Alaska allowed many people to stay
in their community to work in health care.
3:13:25 PM
MR. POWERS directing attention to slide 10, "The Silver
Tsunami," stated that the increase of Alaska seniors was "a
freight train headed our way and we need to address...." He
declared hospitals and long term care to be an important part of
the solution.
3:13:56 PM
MR. POWERS confirmed that more than 36 percent of the
transportation for trauma care was in excess of 60 miles, slide
11, "Patients Must Travel to Receive Care."
3:14:25 PM
MR. POWERS, slide 12, "Hospitals Must Serve All Who Need Care,"
reported that uncompensated care in Alaska, $178 million in
2009, was a driver of costs.
CHAIR KELLER asked for an explanation to the difference between
lost revenue and uncompensated care.
MR. POWERS said that he would look into the answer.
3:15:11 PM
MR. POWERS declared that Alaska communities were defined by the
rural health care facilities, the sole community providers,
whose service included normal birth deliveries, psychoses,
alcohol abuse, and pneumonia, slide 14, "Who Do We Serve." He
described the unique relationship between the native and
military health care communities in Fairbanks.
3:16:18 PM
MR. POWERS indicated slide 15, "Economic Impact," and detailed
that Fairbanks Memorial Hospital had 1350 employees, spent $107
million for salaries and benefits, and had gross revenues of
$360 million. He shared that sufficient capital was an on-going
issue, and explained the upcoming 10 year campaign of fund
raising.
MR. POWERS, slide 16, described the key "Challenges" at
Fairbanks Memorial Hospital which included adolescent behavioral
health services and the contracts with Boys and Girls homes,
community behavioral health centers, and counseling centers. He
cited community ownership, physician recruitment, and the focus
on nursing programs as "Sources of Pride."
3:18:14 PM
MR. POWERS offered slide 17, "Going Forward," and said that
physician integration with the Tanana Valley clinic was an
opportunity to co-ordinate care and keep expenses down.
3:18:52 PM
RICK DAVIS, CEO, Central Peninsula Hospital, directed attention
to slide 18, "Central Peninsula Hospital," and summarized that
Central Peninsula was a 49 bed acute care hospital, with 8
outpatient clinics, and a 60 bed long term care facility. He
noted that there were 720 employees, with 25 MDs. He moved on
to slide 19, "Who Do We Serve," and listed the primary service
area to be the 37,000 residents from Cooper Landing to Nikiski
to Kenai to Clam Gulch. He listed the secondary service area of
50,000 residents to include Seward, Homer, and the entire Kenai
Peninsula. He reported that the hospital was owned by the Kenai
Peninsula Borough and managed through a lease operating
agreement.
3:20:31 PM
MR. DAVIS stated that Central Peninsula Hospital was community
owned, with 25 staff and 25 independent physicians, and a strong
ownership culture, slide 20, "Sources of Pride/Special
Challenges." He pointed to competing entities attempting to
take over the profitable services as the biggest challenge to
the hospital.
3:21:29 PM
MR. DAVIS directed attention to slide 21, "Going Forward," and
discussed each of the following: preparation for the federal
health care reform, hardwiring the quality and patient
satisfaction process, implementing the Electronic Health
records, and exploring contracting possibilities beyond the
hospital services.
3:22:41 PM
MR. DAVIS addressed slide 23, "Two Specific Categories of Value
Based Purchasing," and detailed that quality of care and patient
satisfaction would determine the reimbursement from Medicaid and
Medicare. He explained that this was designed to shift hospital
care delivery from a quantity base to a quality service base.
He stated that there were 17 process-of-care measures for
quality service included in the five core measure categories.
3:24:55 PM
MR. DAVIS detailed slides 24 and 25, "Core Measures," listing
the five core measures: heart failure, heart attack, pneumonia,
health care associated infections, and surgical care
improvement. He clarified that these core measures would
account for 70 percent of the hospital's value based purchasing
payment. He shared that the remaining 30 percent would be based
on eight patient satisfaction measures. He stated that 1
percent of the Medicare payment would be based on compliance
with these two measures. He reported that these measures were
evidence based, best demonstrated practices which had been
proven to lower infections and hospital medication errors, while
increasing quality outcomes.
3:26:51 PM
MR. DAVIS pointed to the graph on slide 27, "Central Peninsula
Hospital Perfect Care Scores," depicting the quarterly hospital
scores for patient care. He stated that the goal for the
hospital had been for a 95 percent rating, which had been
consistently maintained for the past three years.
MR. DAVIS listed the eight measures for patient satisfaction on
slide 28, "Patient Experience," and stated that this information
was available on-line. Referring to slide 29, "Strategies to
Improve the Patient Experience," he affirmed that the hospital
administration reviewed every patient satisfaction survey, with
follow up phone calls to address any patient concerns. He
shared that hourly nursing rounds had been implemented, and that
the management team also made rounds.
3:28:37 PM
MR. DAVIS moved on to slide 30, "Percentage of Patients Rating
the Hospital 9 or 10," a bar graph comparing Central Peninsula
Hospital with the U.S. and Alaska averages.
3:29:10 PM
MR. DAVIS furnished slide 31, "Awards and Recognition," calling
it the "bragging awards and recognitions slide." He confirmed
that Central Peninsula Hospital had been named a top hospital in
core measure compliance in the State of Alaska in 2011. He
opined that the Patient Protection and Affordable Care Act was
refocusing delivery systems toward good quality service.
3:30:27 PM
ROBERT LETSON, CEO, South Peninsula Hospital, confirmed that he
had been in hospital administration for 35 years, with the last
4 years as the CEO at South Peninsula Hospital. He directed
attention to slide 32, "South Peninsula Hospital Homer, Alaska,"
summarizing that the hospital had 22 acute beds and 28 long-term
beds, was a non-profit owned by the Kenai Peninsula Borough, and
had 285 employees with an annual payroll of $16.5 million. He
shared that there were 22 active physicians working in the two
family practice clinics, the two surgery clinics, and the
orthopedic clinic. He reported that there were an average of 10
patients daily in the acute care, 26 patients daily in the long-
term care, and more than 29,000 outpatients annually. Moving on
to slide 33, "Who Do We Serve," he explained that the service
for 12,700 residents covered an area of 8317 square miles. He
noted that it was 75 miles to the next closest hospital. He
relayed that the senior population was growing at a rate of 25
percent, faster than the state and national average. He
detailed the payer mix to be 33 percent from Medicare, 32
percent by commercial insurance, 24 percent from Medicaid, and
11 percent from either charity or self pay.
3:33:47 PM
MR. LETSON stated that South Peninsula Hospital was the largest
employer on the southern peninsula and its economic multiplier
translated to a $96 million impact in the local community, slide
34, "Economic Impact." He reported on a recent Alaska State
Hospital and Nursing Home Association (ASHNA) community benefit
study which found that Alaska hospitals supplied $151 million in
community benefits. He stated that, in 2011, the cost of
charity care at the hospital had been $789,000.
3:35:26 PM
MR. LETSON introduced slide 35, "Special Challenges," listing
recruitment and staffing for pharmacists, nurses, physical
therapists, lab technicians, psychiatrists, and family practice
physicians as ongoing major hurdles. He stated that a
psychiatric residency program would be a boon, as psychiatric
issues were 15 percent of the emergency room visits. He stated
that the mandatory requirement for electronic health records was
burdensome for small hospitals. He pointed to the stress placed
on the long term care facility by an aging population with
multiple complex diagnoses. He discussed the challenge of
rising energy costs, and reported that a change to natural gas
power would save $300,000 annually for South Peninsula Hospital.
He shared that inconsistent patient volume in small hospitals
resulted in a drop in revenue, while costs remained fixed. He
called attention to the community support for the hospital as a
major source of pride.
3:39:00 PM
MR. LETSON reviewed slide 36, "Going Forward," stating "change
is the new norm" due to health care reform. He emphasized that
this was the only way that hospitals would survive in the new
climate of "more service for less reimbursement." He pointed
out that reimbursement would now be based on quality measures,
and not just on a provided service and that it was essential for
alignment between physicians and providers. He projected that
there would be an increase in outpatient clinics and a decrease
for in-patient services, observing that the growing number of
seniors could alter that trend.
3:40:07 PM
MR. LETSON offered slides 37 and 38, "Critical Access Hospital-
CAH," and disclosed that there were 1300 critical access
hospitals in the U.S. Noting that CAHs were designated in 1997,
he listed the requirements, which included location in a rural
area, more than 35 miles from another hospital; and, 25 or fewer
beds, with an average length of stay of less than 96 hours. It
must also have 24 hour emergency service, participate in a rural
health network, and establish credentialing and quality
assurance agreements with a larger hospital. He confirmed that
CAHs were paid 101 percent of reasonable costs, instead of the
usual prospective payment system which reimbursed by diagnosis.
He reported that most CAHs had a low operating margin, usually
2-3 percent, although in Alaska this could be 5 percent.
3:42:15 PM
MR. LETSON shared that, in 2011, South Peninsula Hospital was
recognized as one of the "Top 100 Critical Access Hospitals"
nationwide by the National Rural Health Care Association. He
declared the CAH to be an economic engine in small communities,
as they offered a broad scope of health care to many citizens.
He opined that any reduction for reimbursement to CAHs could be
disastrous for the local economy and rural health care.
3:44:22 PM
LIZ WOODYARD, CEO, Petersburg Medical Center, explained that
Petersburg Medical Center was not similar to other CAHs, slide
40, "Petersburg Medical Center," as there were many areas of
challenge. She explained that the hospital was non-profit, and
although it was owned by the city, it did not receive any
financial support from the city. She stated that 70 percent of
the operating budget was for labor, and that recruitment of
physicians was a challenge. She noted that there were 4
physicians, as it was necessary for cycled time, and 95
employees. She reported that the acute daily care patient
average was less than 1, but the long-term care daily patient
average was 13. She explained that the swing care daily average
for those patients who were not long term care, but not quite
ready to go home, was 3 patients.
3:48:32 PM
MS. WOODYARD, discussing slide 41, "Who Do We Serve," reported
that although the population of the Petersburg region was 3000,
there had been an 8 percent population decline in the region
since 2000, with a corresponding 27 percent decline in school
enrollment. She stated that there were not as many young
families staying in Petersburg. She declared that commercial
fishing was the biggest industry. She noted that the medical
center had 12 acute care and 15 long term care beds. She stated
that long term care financially supported the other hospital
services.
3:49:41 PM
MS. WOODYARD described the services offered by the medical
center to include physical therapy, wound care, home health in
the community, and chemotherapy, slide 42, "Petersburg Medical
Center." She explained the difficulty of not offering services
in ICU, OB deliveries, and anesthesia, declaring that this lack
of service affected whether young families moved to Petersburg.
She noted that a lack of patients in OB, OR, and ICU did not
allow nurses to gain the necessary competencies.
3:53:44 PM
MS. WOODYARD declared that although Petersburg was a wonderful
community, the financial stability of the hospital was in
jeopardy, slide 43, "Special Challenges." She announced the
financial loss to be $800,000 in the last year. She shared that
there was a reserve of $3.7 million, but that financials needed
to turn around. She noted that the key was for an increase of
patients. She declared the need for a new roof on the long term
care facility, as it was more than 50 years old, leaked, and
could not be patched. She stated that the architectural design
would cost $70,000. She confirmed another challenge to be for
replacement of broken equipment, as shipping and installation
schedules could often delay these projects. She emphasized that
all the employees were proud to be working at the hospital.
3:56:06 PM
MILLIE DUNCAN, Administrator, Wildflower Court, directed
attention to slide 44, "Wildflower Court," stating that the
nursing home was a non-profit organization, was not connected to
Bartlett Hospital, and had opened in 1977. Moving on to slide
45, "Who Do We Serve," she reported that, as this was one of
only two assisted living programs in Juneau, there was a younger
population at Wildflower Court, and more physically capable than
the state and national averages.
3:57:56 PM
MS. DUNCAN addressing slide 46, "Who Do We Serve," shared that
66 percent of admissions were for rehabilitation services and
wound care, with 55 percent of the residents being discharged to
home care after 2 months at Wildflower Court. Referring to
slide 47, "Economic Impact," she reported that Wildflower Court
employed 105 staff with a payroll, including benefits, of $6.7
million. She stated that $172,000 was paid for professional
contract services, and that $1 million was spent locally for
supplies and equipment. She declared that Wildflower Court had
57 beds and could provide services for an average of 100
individuals each year.
3:59:05 PM
MS. DUNCAN summarized slide 48, "Special Challenges," declaring
that the complexity of the residents' conditions and diagnosis
was increasing, and pointing to the growing number of residents
with mental health diagnosis, including dementia, schizophrenia,
and depression. She established that the majority of staff at
Wildflower Court were certified nursing assistants, with only 13
weeks of training for dealing with these complex medical and
mental health issues. She affirmed the necessity for providing
a quality of life for a relatively young population, sharing
that "trying to do bingo or big band sing along for activities
just doesn't cut it for our population."
4:01:52 PM
MS. DUNCAN proudly stated that Wildflower Court had, for two
years, received the Bronze Quality Award by the American Health
Care Association, and was nationally ranked in the top 10
percent for staff, resident, and family satisfaction. She
mentioned that the program had twice received the Mountain-
Pacific Quality award and also participated in a program, "The
Eden Alternative," which developed a community, rather than an
institution, within a nursing home, slide 49, "Sources of
Pride." She observed that the ultimate, long term goals were to
receive the Malcolm Baldridge Quality Award, the Well Workplace
Award, and the Employer of Choice Award, as shown on slide 50,
"Going Forward." She stated that the journey was important to
both the staff and the residents of Wildlife Court.
4:03:26 PM
MS. DUNCAN shared a definition for nursing homes:
The nursing homes of the past may once have been a
retirement home for the unhealthy but today they have
evolved into highly skilled medical centers serving a
very different population with complicated medical
issues needing treatment for longer periods than what
is practical in a hospital.
MS. DUNCAN, directing attention to slide 52, "Nursing Homes:
Confronting Today's Challenges," stated that, as one in seven
residents of nursing homes is under 65, an increase of 22
percent in the last eight years, the psychological and social
needs were a greater challenge than the physical needs. She
stated that half of the residents had dementia, Alzheimer's, or
a related disorder, while one third had behavior disorders. She
shared that research studies showed that nursing homes provided
better care for individuals with pneumonia or infections, and
that nursing home residents, when admitted to acute care
hospitals, often returned to the nursing home "more functionally
and cognitively impaired."
CHAIR KELLER asked the panel to state the most immediate needs.
4:07:09 PM
MR. POWERS, in response, stated that typically health care was
thought of in terms of cost, quality and access. He directed
attention toward two small, specific programs, perioperative
nursing and psychiatric residency. Explaining that the
perioperative nursing program was an effort to train the next
generation of nurses in Operating Room (OR) procedures, he
declared a need for an additional $85,000 in funding. He
pointed out that the hospital industry had already supplied
$375,000 toward the program. He explained that the three
Anchorage medical centers had set up the program for the "best
and the brightest from the facilities to come in, train, go back
to the communities, and train for an additional 27 weeks." He
cited that the University of Alaska nursing program was "a great
process, but now what happens is, within the hospital, these
specialty areas ... need special training." He declared "the
WWAMI [Washington, Wyoming, Alaska, Montana, and Idaho Area
Health Education Center] program had been a wonderful workforce
engine" as residents were returning to their communities, but
that psychiatry was needed for many vulnerable patients. He
declared that this request for $75,000 would allow residency
sites, through the WWAMI program, to be established throughout
Alaska.
4:10:07 PM
MS. DUNCAN agreed with the need for the psychiatric program,
explaining that it was essential, though often difficult, for
Wildflower Court to receive psychiatric consultation for
direction to best serve its residents.
4:11:09 PM
REPRESENTATIVE DICK observed that this need for psychiatric help
was a statewide issue, probably necessitating more than one
travelling psychiatrist.
4:12:48 PM
MR. LETSON observed that his family doctors and emergency room
staff had reported that 20 percent of their patients had
psychiatric issues in addition to their other illnesses. He
declared that many doctors remained where they had performed
their medical residency. He suggested that tele-medicine might
also provide solutions for remote areas.
4:13:`57 PM
MR. POWERS agreed with Representative Dick that this was
critical for all the hospitals, especially for the long term
care facilities. He agreed that a psychiatric residency was a
good idea, explaining that Bartlett Memorial Hospital, in
Juneau, had hired psychiatrists and then contracted their
services with outpatient agencies. He pointed out that the
hospital could offer a better benefit package than a smaller
agency, with a more flexible schedule.
4:15:55 PM
REPRESENTATIVE MILLER asked what was driving this cost explosion
in every aspect of health care over the last 30 years. He
declared that this cost increase was much greater than the rate
of inflation. He asked what could be done to control this.
4:17:13 PM
MR. POWERS replied that labor and capital depreciation were the
most expensive issues. He stated that an alignment of
physicians and hospitals would bring a co-ordination of care,
and efficiencies for recruitment and retention. This would have
a significant impact on costs, and would "help bend that
exorbitant cost curve." He declared that the embracement of
technology would lower costs, but that some older staff members
were threatened by the new technology.
4:19:22 PM
MR. LETSON stated that the salaries and benefits were 60 percent
of the costs at South Peninsula Hospital. He declared that the
medical home concept, when a family doctor was the gatekeeper to
procedures and had incentive to keep the patient well, was
necessary to get control of the costs. He stated, "Health care
is insatiable. There's all kinds of health care needs, and
unless someone's trying to keep people well, it will never slow
down enough...." He reported that conditions such as obesity
and diabetes were getting worse, and, instead of just treating
the episode, incentives were needed to stay healthy.
4:22:04 PM
KAREN PERDUE, President/CEO, Alaska State Hospital & Nursing
Home Association (ASHNHA), in response to Chair Keller, said
that ASHNA represented all the hospitals and nursing homes in
Alaska, except two in Barrow.
4:22:22 PM
REPRESENTATIVE DICK asked if the proposed Indian Health Service
(IHS) facility would affect Central Peninsula Hospital.
4:22:39 PM
MR. DAVIS, in response, said that he had heard the facility
would not be available for non-beneficiary participants. He
agreed to keep the committee apprised of any future
developments.
4:23:19 PM
CHAIR KELLER expressed concern with the short term costs for the
perioperative nurses program. He declared a need for more
competition.
4:24:58 PM
MR. LETSON emphasized the importance for the Certificate of Need
program. He explained that hospitals did not function under an
economic model of "more competition is better." He gave an
example of a competing specialty center, pointing out that only
a few departments created revenue for a hospital. "If someone
cherry picks those services away from the hospital, the
hospital's left with the charity care, bad debt, and they lose
the paying services, and they either lose their hospital or it
becomes a band-aid station or the taxes go up for the citizens."
He stressed the importance for Certificate of Need, as
duplication of the most profitable services could destroy a
local health care system. He opined that smaller hospitals in
Alaska would be destroyed without the Certificate of Need.
4:27:18 PM
REPRESENTATIVE SEATON, reflecting on the long term solution for
preventive medicine, referred to House Concurrent Resolution
(HCR) 5, which passed unanimously during 2011. He relayed that
the resolution calls on the State of Alaska to embark on a
prevention of disease model for health care. He shared that the
resolution also provides awareness for the benefits of Vitamin
D. He directed attention to the Fraser Health [British
Columbia] health care residential provider program, which had
adopted a protocol of 20,000 IU of Vitamin D each week. He
noted that the goal of this protocol was to reduce the number of
fractures by 10 - 25 percent, pointing out that the prevention
of one fracture would pay the annual cost for the entire Vitamin
D program. He asked if the nursing homes and hospitals were
aware of HCR 5 and the Vitamin D studies. He listed some of the
attributes cited for Vitamin D, which included a 30 percent
decrease for Type 2 diabetes, and significant improvement for
seasonal affective disorder. He offered an example of a
required regimen of 10,000 IU of Vitamin D for the 10 days prior
to elective orthopedic surgery, which resulted in a 50 percent
reduction in infection.
4:31:55 PM
MS. DUNCAN reported that, although the Wildflower Court
dietician, medical director, and staff were in agreement to the
benefits of Vitamin D use, and a regimen had been started for
all the residents, she could not substantiate any results. She
opined that a reduction in the need for psychoactive drugs was
attributable, in part, to Vitamin D. She offered her belief
that most of the patient falls were a result of poor judgment,
caused when residents leaned too far.
4:34:04 PM
CHAIR KELLER asked for a prediction to the determination by the
U.S. Supreme Court for the Patient Protection and Affordable
Care Act.
4:34:44 PM
MR. POWERS, in response, predicted that, except for the
individual mandate, the act would pass.
MR. LETSON emphasized that health care was not sustainable as it
is, so a course of action will need to be taken. He declared
that the challenge was ahead of us, regardless of the Supreme
Court decision.
4:35:39 PM
MR. DAVIS offered his belief that the incentives driving the
Patient Protection and Affordable Care Act were the same as
those issues just discussed. He opined that the quality
initiatives in the act would "provide better outcomes for
everyone." He shared that the concepts might need adjustment,
but that it was necessary to clinically integrate the physician
and the hospital. He referenced an earlier presentation he had
attended by Commissioner Streur (Department of Health and Social
Services) and Commissioner Hultberg (Department of
Administration) which compared the significant difference in
charges by physicians in Alaska to those by physicians in the
State of Washington. He declared a need for motivation toward
change, and he expressed his agreement that the act would pass.
4:37:29 PM
REPRESENTATIVE SEATON, returning to discussion of HCR 5, stated
that the main purpose of the resolution was to move toward a
prevention model for health care. He directed attention to
national studies for the use of check lists in hospitals, which
resulted in a dramatic lowering of infections. He asked if the
hospitals and nursing homes in Alaska used check lists for
procedures.
4:38:15 PM
MR. LETSON, in response, said that hospitals used check lists,
with many surgeries scheduling a time out prior to the procedure
in order to double check. He shared that evidence based
medicine had check lists for complex procedures. He allowed
that although this standard was not yet complete, it was more
prevalent for complex procedures.
4:39:10 PM
REPRESENTATIVE SEATON referenced a study which determined that
infection rates were lower when check lists were used during
catheter procedures. He expressed a desire for the full
integration of check lists and other preventive methods.
4:40:31 PM
CHAIR KELLER, offering a final thought on the upcoming [health
care] crisis, referred to an ISER [Institute of Social and
Economic Research] study which compared the spending [for health
care] to the cumulative wages for all Alaskans, and stated "I
know I don't spend half my income on health care, and I do spend
some, so the point that hit home with me because of that
comparison is that the difference, all that money that is being
spent, is evident throughout our society, construction, spin off
jobs, whatever..." He declared that the U.S. Supreme Court
decision did not matter, as there was a greater crisis,
especially for those with the least ability to pay.
4:42:06 PM
MR. POWERS paraphrased comments by Commissioner Hultberg
(Department of Administration) during an earlier presentation:
don't tell me about all these jobs you're creating, I
consider that an opportunity cost. What about
everything else we've gotta do. We're putting this
money into health care and we could be doing something
else.
MR. POWERS offered his belief that this was "an excellent
philosophic suggestion." He questioned the point of balance for
health care spending in Alaska and keeping services in the
state, noting that Commissioner Hultberg had responded to "keep
the dialogue going." He expressed his gratitude for the
opportunity to present with the committee, and in reference to
the current health care spending, he declared "we know this is
unsustainable."
4:43:32 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:43 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| PP_House_2-24-12 Final ASHNA.pptx |
HHSS 3/1/2012 3:00:00 PM |