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U.S. Senator Bob Corker of Tennessee visited the Vanderbilt Children’s Hospital to hold a Health Care Rountable. (L to R): Dr. Martin Sandler, Vanderbilt University Chancellor Nick Zeppos and Senator Bob Corker.

Bob Corker, Tennessee’s freshman U.S. senator, knows something about the issues of the healthcare system and insurance coverage from his experiences as a businessman, mayor of Chattanooga and commissioner of finance and administration for Tennessee. But he wants to know more.

Corker has joined senate colleagues in authoring the “Every American Insured Health Act,” a bill to provide access to private, portable and affordable healthcare to every family in America.

To learn more from healthcare providers who are wrestling with how to provide care for 800,000 Tennesseans who lack adequate health insurance coverage, Corker has scheduled a series of 10 roundtable discussions with healthcare leaders across the state.

The first of these healthcare roundtables, held at the Monroe Carell Jr. Children’s Hospital at Vanderbilt at the end of May, brought together industry leaders from Middle Tennessee to share their thoughts on why change is needed.

Among those attending the roundtable from Vanderbilt were Chancellor Nicholas Zeppos; William Stead, MD, associate vice chancellor for health affairs; Colleen Conway-Welch, PhD, dean of the School of Nursing; Martin Sandler, MD, associate vice chancellor for hospital affairs; Jim Jirjis, MD, medical director of internal medicine; Mark Frisse, MD, director of regional informatics programs; and Kevin Churchwell, MD, CEO of Vanderbilt Children’s Hospital.

Others participating in this first roundtable were: Nancy Anness, vice president of advocacy, access, and community clinics, for Saint Thomas Health System; Reginald Coopwood, MD, CEO of Nashville Metro General Hospital; Wayne Riley, MD, president and CEO of Meharry Medical College; Tom Herron, CEO of Centennial Medical Center; and TennCare director Darin Gordon.

After welcoming remarks by Churchwell, Zeppos outlined some of the significant challenges healthcare providers are facing in today’s climate. Zeppos said this year VUMC is facing $86 million in uncompensated care … a number expected to jump to $97 million in 2009.

Corker expects the U.S. Senate to center its healthcare focus on the problem of the uninsured starting in the next session, which opens in January after the presidential election.

When Corker first ran for the Senate in 1994, he understood that people were resistant to government involvement in healthcare, but he said he is now convinced the current feeling is tremendously different and that people are looking to the government for help in making the system work.

Corker reiterated his conviction that there is a moral responsibility to deal with this major economic issue to ensure that “our healthcare system stays the best in the world.”

The two issues facing legislators, Corker outlined, are financing and the tremendous increase in healthcare costs, which he said includes a high percentage of wasteful spending.

Meharry’s Riley pointed out there is not a healthcare “system” in this country, rather a mass of “sectors” with unique viewpoints.

Corker said there must be a technology to enable groups to talk to each other. “It’s hard for me to believe we haven’t made this happen,” Corker said, about communication between the different “silos” that store healthcare information.

Vanderbilt’s Frisse reported such communication is possible even if it isn’t widespread. He pointed to a successful collaboration in a government-funded health information exchange that makes clinical information accumulated on one million patients of the major healthcare providers in Memphis available, with the patients’ consent, to emergency rooms and other providers on a secure basis in the citywide system.

Corker expressed confidence that the financing issue could be solved in the Senate, but he insisted the system couldn’t be designed from the top down and wouldn’t be effective and functional without involving providers in its design.

“There ought to be some model that the private sector can help us define,” Corker said.

Vanderbilt’s Conway-Welch said the current reimbursement system represents volume, not necessarily value. She advocated adding more responsibility to the duties of well-trained nurse practitioners as a way to spread resources more effectively. Conway-Welch noted the challenge is that “there are not the right providers in the right place for the right type of care.”

Riley felt that pay-for-service plans could do more harm than good. “Let’s face it,” he said, “the moose on the table is the government in healthcare and the idea of identifying pay-for-service without clear standards of care.”

Vanderbilt’s Jirjis said the absence of standards and incentives hinders reimbursement and makes insurers reluctant to cover care that is not consistently valued.

“We find ourselves in disagreement over the target,” TennCare’s Gordon added, “and end up paying for piecework. We don’t have an infrastructure to handle the load or a system to identify quality so there is an incentive to dis-enroll ‘bad patients’ whose chronic illnesses stress the available resources.”

Vanderbilt’s Stead agreed, and said there must be negotiation to “do less or receive less,” and that there must be a change to require players to interact with each other.

As the roundtable drew to a close with a brief discussion on whether healthcare is a right or a privilege, Corker said he had found this first roundtable to be “sobering,” but he remains convinced that the right model can be conceived and implemented to improve one of the country’s most pressing problems.



July 2008

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