[Congressional Record Volume 153, Number 85 (Wednesday, May 23, 2007)]
[Senate]
[Pages S6495-S6497]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. WHITEHOUSE. Mr. President, on Tuesday, I came to the Senate floor 
to present ideas on health care reform, particularly on the problem of 
fixing the internal operations of our broken health care system so that 
it runs better, at less cost, and with improved care.
  I suggested that three fundamental things are wrong with our health 
care

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system: One, it doesn't adequately provide quality care or invest in 
prevention; two, the system doesn't have adequate information 
technology infrastructure; and, three, the way we pay for health care 
sends perverse price signals that misdirect market forces.
  I am here today to speak about quality reform, about those areas in 
our health care system where improving the quality of care will lower 
the cost--let me repeat that--where improving the quality of care will 
lower the cost.
  There is a lot at stake, in money and in lives. Up to 100,000 
Americans die every year as a result of unnecessary and avoidable 
medical errors. By some measures these outcomes are even getting worse. 
A 2003 article published in the New England Journal of Medicine 
revealed that the rate of hospital-acquired infections has actually 
increased over 36 percent since 1999. This increase has occurred even 
though we have shortened the average length of stay in a hospital and 
decreased the number of inpatient surgeries. In other words, infection 
rates rose that much even though the opportunities for exposure 
decreased.
  Pennsylvania has recently chronicled hospital-acquired infection data 
for its 168 general acute care hospitals. The numbers are staggering: 
19,154 patients acquired an infection while in the hospital in 2005, 
resulting in average commercial insurance payments of $45,601 higher 
than for patients who did not contract infections. That is big money 
that could be saved.
  Remember the example I gave on Tuesday from Michigan's intensive care 
unit reform. In a 15-month span between March 2004 and June 2005, the 
project saved 1,578 lives. It saved 81,020 days patients would 
otherwise have spent in the hospital, at great expense; and it saved 
over $165 million just in a 15-month period.
  However, it is not easy to pursue these quality reform initiatives. 
Funding is scarce, collaboration is required in an environment where 
people are pretty mad at each other, and the economics are perilous. 
When doctors and hospitals go to the trouble to figure out quality 
reform and implement it and pay for it, the effect on them is lowered 
revenues. Investing time and effort and capital in projects that reduce 
your revenues is not a great business model, but that is our health 
care system.
  Thankfully, efforts to pursue quality reform--in all these indicated 
States and locations on the chart--are flickering to life around the 
country, in local initiatives such as the Puget Sound Health Alliance 
in Washington, the Utah Health Information Network, the Indianapolis 
Network for Patient Care, and our own Rhode Island Quality Institute. 
These groups have gathered health care industry players together to 
seek the holy grail of improved care at lower cost.
  The fact that this is happening is itself a small miracle. The health 
care system is acrid with soured, angry relationships. When I was 
attorney general of Rhode Island, negotiations took place between one 
of our major hospital chains and our major health insurer in my office. 
It was not because I was a great mediator or that there was a role for 
the attorney general in this, it was simply because they were so angry 
with each other that I needed to calm things down and keep them in the 
room so the negotiations could proceed. For a bunch of reasons, through 
our Government policy to shortchange providers, through the perverse 
reward structure of our health care system, and our HMO experiment, we 
have encouraged combat among hospitals, doctors, and insurers, each 
trying to push their costs onto somebody else rather than working 
together for the common good.
  So these local health care quality initiatives from this toxic 
climate are as marvelous as that spontaneous Christmas truce in World 
War I, when the soldiers began singing Silent Night across the barbed-
wire wasteland, as they came out from the cold, muddy trenches to share 
cigarettes and schnapps with the enemy, men they had just been mustard-
gassing and machine-gunning.
  Let me tell you about the Rhode Island Quality Institute. By the time 
I became attorney general, I was already deep into health care, having 
served as insurance regulator, hospital trust administrator, fraud 
prosecutor, and health care reformer. I had seen firsthand the anger 
and the vitriol in the system. I had been successful in reforming the 
workers' compensation system and was optimistic about what sensible 
reforms could do to repair a broken administrative system. I saw common 
ground on how quality could lower cost. In 2001, I began to pull 
doctors, nurses, insurers, regulators, pharmacists, academics, and 
hospital administrators together. Over many months, we developed a 
concept of a statewide collaboration that would focus on producing 
significant, measurable improvements in health care quality, safety, 
and value in Rhode Island. The Rhode Island Quality Institute was born.
  Since then we have made significant progress in e-prescribing, 
electronic health records, ICU infection rates, and health information 
interoperability. This happened because the Quality Institute is a 
place where health care leaders can work through health care problems, 
despite economic signals that punish them for doing the right thing.
  For example, in Rhode Island, our hospitals are pursuing a quality 
improvement project in every intensive care unit in the State, modeled 
on the Michigan program. The Rhode Island ICU program had a significant 
hurdle to overcome, however. The cost was expected to be $400,000 per 
year to be borne by the hospitals. The savings, estimated to be $8 
million per year, went to the payers. For its $400,000 invested, a 
hospital actually stood to lose money from shorter intensive care unit 
stays and fewer procedures.
  For hospitals, truly pushing that quality envelope and striving for 
zero tolerance in infections in errors was economically self-abusive 
behavior. It took the Christmas truce relationships developed within 
the Rhode Island Quality Institute to overcome that obstacle.
  Now similar things are happening all over the country, in little 
flickering beginnings of reform. The easiest and best way to promote 
quality reform that lowers cost is to feed, with Federal grants, a 
little kindling into these flickering flames; to tend them gently with 
Federal encouragement and support, to network them together to share 
energy and information and ideas, to have Federal officials clear away 
regulatory obstacles to their initiatives, and to report on the best 
and brightest ideas and successes that emerge--in a nutshell, to create 
a MacArthur genius grant program to encourage these efforts and to 
clear the way for them through the bureaucracy.
  My legislation proposes a Federal grants program to do just that. A 
little money will go a long way. The CVS/Caremark charitable trust just 
guaranteed the Rhode Island Quality Institute $500,000 per year for the 
next 5 years, a great expression of business support and confidence, 
and it has made a world of difference. Compare that half-million-dollar 
yearly investment to the savings from the Keystone project in Michigan 
over a little more than a year, 15 months--$165 million. What if every 
Quality Institute-type organization got a half million dollars? There 
are somewhere in the neighborhood of 50 such organizations around the 
country now. The total savings they can generate could be hundreds of 
millions, billions of dollars perhaps, based on a yearly investment of 
perhaps $25 million.
  Don't forget, it is not just money. The Keystone project saved over 
1,500 lives. Quality reform is already on the march in local 
communities. To make a significant difference, we need do no more on 
the Federal level than support these initiatives, encourage new ones, 
transmit best practices and ideas, and, when necessary, secure waivers 
for them to help realize the promise of quality reform in both lives 
saved and dollars saved.
  I will close today by noting that if we can do three things 
together--quality reform, health IT investments, and reimbursement 
alignment--they will reinforce each other and compound the beneficial 
effects. Remember, health care is a dynamic system and cannot just be 
told what to do. We have to identify the problems, find their causes, 
and repair them. That is not a partisan or even a political effort; it 
is a repair job, and it has no more a Democratic or a Republican nature 
to it than an engine tune-up or a plumbing repair. We should work 
together on

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this issue to get it right. Hundreds of billions of dollars are at 
stake, and terrible consequences await American families and businesses 
as health care costs mount if we fail in our duty. While we still have 
the time before the economic, fiscal, and health consequences become 
too urgent for deliberate action, let us not fail in our duty. Let us 
grasp the controls of change.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Washington is 
recognized.

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