[Congressional Record Volume 154, Number 20 (Thursday, February 7, 2008)]
[Senate]
[Pages S759-S760]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   WIRED FOR HEALTH CARE QUALITY ACT

  Mr. WHITEHOUSE. Mr. President, today I rise to speak for a few 
moments about health care and to recognize the extraordinary work four 
Members of this body have done to promote an integrated, interoperable 
health information technology infrastructure in this country. Senators 
Kennedy and Enzi on the HELP Committee, Senator Hillary Clinton, and 
Senator Hatch, along with their talented staffs, have balanced a 
tremendous number of interests to put forward a very promising first 
step in our long journey toward reforming our ailing health care 
system. I commend their tremendous effort in drafting the Wired Act. I 
look forward to working to see strong health information technology 
legislation passed in the Senate, in the House, and signed into law by 
the President.
  Adoption of health information technology is a vital part of saving 
lives and lowering costs in our health care system. The RAND 
Corporation estimates, in its most conservative estimation, that a 
national, interoperable HIT system could save $81 billion per year. As 
Senators Kennedy, Enzi, Clinton, and Hatch are so aware, America's 
health care information infrastructure is decades behind where it 
should be. We are losing billions and billions of dollars--I sound like 
Carl Sagan: billions and billions of stars--billions and billions of 
dollars to waste, inefficiency, and poor quality care as a result of 
that failure. Ultimately, and most tragically, lives are lost to 
preventable medical errors because health care providers do not have 
adequate decision support for their determinations on medical 
treatment, medication, and so forth.
  I am an enthusiastic supporter of health IT as one mechanism of 
fixing our broken health care system. In fact, one of the first bills I 
introduced as a Senator was the National Health Information Technology 
and Privacy Advancement Act, in which I proposed a national not-for-
profit entity with Presidential appointment subject to advice and 
consent of the Senate, possessing rulemaking power to set national 
standards under the Administrative Procedures Act, and with the ability 
to set licensing and access fees to raise capital for necessary 
investments outside the Federal budget process.
  I still believe that is the best and most effective kind of 
authority. I also recognize there are many good ideas out there. But 
time is short. We cannot snap our fingers and be an IT-enabled health 
care environment. Development, testing, buildout, and adoption will all 
take time. We do not have much time. A tsunami of health care costs is 
sweeping down on us, inevitably, as baby boomers age and costs 
increase.
  The Comptroller General of the United States has warned us of what he 
called ``unprecedented stormy seas ahead that threaten to swamp the 
ship of state.'' He testified that ``we've never seen anything like 
what we're headed into''--never in our history. Our present Federal 
health care liability, if nothing changes, is $34 trillion. That is a 
``34'' with 12 zeros behind it. It comprises the bulk of the $53 
trillion in Federal liabilities we are presently obliged to pay in 
coming years. Now--now--is the time to get started in humane ways to 
avert this fiscal crisis. Health IT is a baseline platform necessary to 
even try to respond humanely to the looming crisis.

  Unfortunately, in moving toward our ultimate objective, we must 
realize that health IT adoption alone will not stop the tidal wave of 
health care costs. As I think we all know, our health care system is 
broken in more ways than one. Look at the signs of its failure.
  The number of uninsured Americans is climbing and will soon hit 50 
million. Despite the best doctors, the best nurses, the best equipment 
and procedures, and the best medical education in the world, as many as 
100,000 Americans are killed every year by unnecessary and avoidable 
medical errors. Life expectancy, obesity rates, and infant mortality 
rates are a cause for national embarrassment compared to other 
industrialized nations. The annual cost of the system exceeds $2 
trillion, and is expected soon to double.
  We spend more of our country's GDP on health care than any other 
industrialized country: 16 percent--double the average of the European 
Union. More American families are bankrupted by health care costs than 
any other cause. There is more health care than steel in Ford cars. 
There is more health care than coffee beans in Starbucks coffee.
  Hospitals are broke. Doctors are furious. Paperwork is choking the 
system. This system is crying out for reform.
  I believe that comprehensive restructuring of our health care system 
must rapidly address three critical issues. As I have already said, the 
first is the development of a national, interoperable, secure health 
information technology infrastructure. But there are two other equally 
important issues: One, the American health care system must invest 
properly in quality and prevention, promising areas where better care 
actually lowers cost; and, two, the way we pay for all this, the way we 
pay for health care, sends perverse price signals that drive market 
behavior away from the public interest, that drive behavior away from 
what we want.
  So these are the three critical issues at the core of the health care 
crisis in this country--inadequate health information technology, 
inadequate attention to quality and prevention, and a perverse price 
signal system.
  Let us look first at how improved quality of care can lower cost. 
That intersection of where improved quality of care and lower cost 
intersect should be our national holy grail in health care. The 
Keystone Project in Michigan shows how effective this can be. It went 
into a significant number of Michigan ICUs--not all of them but a 
significant number--to improve quality and reduce, for instance, line 
infections and respiratory complications. Between March 2004 and June 
2005, the project saved 1,578 lives--in just that year and 2 months. It 
saved 81,000-plus patient days that otherwise would have been spent in 
the hospital, saving over $156 million. It is a win-win.
  The Rhode Island Quality Institute in my State took this model 
statewide, with every hospital participating, and we are already seeing 
the number of hospital-acquired infections declining, and the costs 
declining as well. The same principles can be applied to prevention, as 
well as to quality improvement.
  Local efforts around the country, such as the Rhode Island Quality 
Institute, Washington State's Puget Sound Health Care Alliance, and 
Utah's Health Information Network, are leading the way. We need, as a 
nation, to get behind these State and local efforts. As many Members of 
the Chamber know, any good business needs to do research and 
development and these local efforts are the R&D on which we can base 
reform of our broken health care system.
  All across America, in local communities, where people know and trust 
each other, the reforms of our system are being dreamed, negotiated, 
tested, and implemented. We need to nourish this effort, and I thank my 
15 bipartisan cosponsors for supporting a small grant program I 
proposed to do just that.

[[Page S760]]

  Now, consider why this quality reform is not happening spontaneously 
all over the country if those big savings are there waiting to be 
tapped. Think of Michigan: In 15 months, in one State, with not even 
all of the intensive care units participating, $156 million was saved. 
A report out of Pennsylvania showed they spent over $2 billion a year 
on hospital-acquired infections.
  Why is quality reform not happening everywhere? Well, primarily 
because the economics of health care punish you if you try. For 
example, a group of hospitals in Utah began following guidelines of the 
American Thoracic Society for treating community-acquired pneumonia. 
Significant complications fell from 15.3 percent to 11.6 percent. 
Inpatient mortality--a nice way of saying fewer people died--fell from 
7.2 percent to 5.3 percent, and the resulting cost savings exceeded 
$500,000 per year.
  Sounds like another success story. But the net operating income of 
the facilities participating dropped by over $200,000 a year because 
the treatment that resulted in the healthier patients was reimbursed at 
$12,000 per case less.
  In Rhode Island, we saw the same thing. When we started the ICU 
reform, I talked to the Hospital Association of Rhode Island, and they 
estimated a $400,000 cost per intensive care unit, but as much as $8 
million in savings--a 20-to-1 payback. I said: Why not go for this? 
They said: You don't understand. All the savings go to the insurers. 
For us, this is $400,000 cash out of our pockets, and potentially $8 
million out of our top line in revenues.
  Name a business that will sensibly invest $400,000 out of its cash to 
lose $8 million in revenues. With reimbursement incentives like those, 
it is no wonder reform is such an uphill struggle.

  We are at such a primitive stage in developing cost-saving, quality 
measures, and the economics work against us, so we have to tackle this 
now. An idea that will get us started: In my Improved Medical Incentive 
Act, I propose that State medical societies and specialty groups be 
allowed to present ``best practices'' to their local State health 
departments. If they do, and a Health Department determines this is a 
best practice that will save money and save lives, then two 
consequences follow. CMS would be obliged to create a pricing 
differential favoring those best practices, and private insurers would 
be forbidden to deny claims for services consistent with the approved 
best practices. If people want to object, fine. Go to the hearing. 
Let's do this in a regular fashion.
  The determination of what gets paid for in our health care system 
right now is made in back rooms of the claims denial operations of 
insurance companies in scattered fashion, largely without oversight or 
review and laboring under heavy conflict of interest. If we move that 
determination toward proper formal hearings, we can expand statewide 
best practices in a way that the economics will support.
  Our health care problem is serious, it is vast, and it is looming. 
Health care IT is a crucial instrument in the health care reform 
toolbox, but it is not an end in itself. To fully realize its benefits, 
it must be coupled with a focus on quality improvement and a 
realignment of payment incentives. These three elements must move 
forward together.
  Let me emphasize in conclusion as energetically as I can: The time is 
now. Time is wasting now. The need is urgent. It may not feel like it, 
but solving this problem with system reforms such as this will take 
several years. If we don't start now, when the fiscal tsunami hits, we 
will be left with only fiscal solutions to the problem. It is immediate 
ones but unpleasant ones, including massive tax hikes or massive 
benefit cuts. If we are standing here, and if I am standing here 5 or 
10 years from now having that tragic choice in front of me, well, shame 
on us if in our folly, in our improvidence, we were too intellectually 
lazy and too bereft of basic foresight to have taken the steps now that 
could have averted that sickening choice.
  As my colleagues know, we are seeing the beginnings of this debate 
now. The Bush administration has squandered its opportunity for 
meaningful health information technology reform, has squandered its 
opportunity for meaningful quality reform, and has squandered its 
opportunity for meaningful reimbursement design reform. Now, in the 
2009 budget the President presented, he is proposing deep cuts in 
Medicare. We have to get ahead of this problem. This is a wake-up call. 
The time is now.
  I look forward to working with my colleagues on both sides of the 
aisle to get this important work done.
  Mr. President, I yield the floor, and I suggest the absence of a 
quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. FEINGOLD. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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