Big questions, few answers at Corker healthcare roundtable

Senator on whirlwind tour of state that will discuss challenges, potential solutions for health sector

Email | Print By Walker Duncan

Sen. Corker

U.S. Senator Bob Corker met this morning with a variety of Nashville’s healthcare community leaders to hash out some of the issues they’d like to see addressed as healthcare reform looms in the seemingly near future.

Corker began the roundtable at Monroe Carrel Jr. Children's Hospital by touting legislative efforts to get at the issue of financing health coverage and making private health coverage affordable to all. Financing along with the rising cost of care are, as he sees it, two of the primary issues in healthcare reform – and, he thinks, issues that can be fixed in the very near future.

The panel – which included VU Chancellor Nick Zeppos, nursing school dean Colleen Conway-Welch, TennCare chief Darin Gordon, Metro General CEO Reginald Coopwood, representatives from both HCA and Saint Thomas Health Services – acknowledged that, yes, financing is a major issue, but then proceeded to pile on a half dozen more major issues of their own.

One of the topics that absorbed a fair amount of the conversation was the idea that the U.S. healthcare system is really less of a “system” per se than it is a collection of sectors whose natural and sometimes destructive competition creates problems.

Corker acknowledged the issue but warned that a top-down federal solution might be the wrong option as such national measures tend to be more blunt instruments. Instead, he called on the private sector – and specifically the panelists – to come up with a model of change that the government can work with.

The conversation then moved to the issue of pay for performance and the many-headed hydra that concept sprouts.

The fragmentation of the various healthcare sectors and the differing approaches of private payers has led to headaches for all as no clear universal metric for quality exists. Further, some of the panelists noted that possible government quality incentives could actually create a natural incentive to drop care for the chronically ill because such patients would be a drag on providers’ performance. Similarly, others noted that certain studies have shown that paying for performance can be detrimental to care for the indigent.

The meeting was not simply a list of problems as some cost-cutting ideas were floated. Conway-Welch, for instance, advocated the benefits of expanding the role of nurse practitioners in various areas of care.

But the most blatant proof that there are still issues running far deeper than financing, pay for performance or even sector fragmentation came with the last comment time allowed. Centennial Medical Center CEO Tom Herron said he would like to see the bigger debate include the question of whether healthcare is a privilege or a right.

Unfortunately, even that question is more complicated. If mandated coverage ever becomes the solution, you would have to add “patriotic duty” to that list of options.

Corker, steadfastly saying that fixing the financing side of the issue would be a step down the right path, concluded the meeting calling his first morning back from the Memorial Day holiday “most sobering.”

He will be very sober this week: This morning's gathering was the first of 10 such meetings he will hold across the state in the coming days.