Former Emporian Herb Kuhn, who is the No. 2 man at the Centers for Medicare and Medicaid Services, had a busy day Monday as he traveled through Kansas talking to people during Medicare open enrollment, which goes until Dec. 31.
Kuhn, who also serves as the acting director of the Center for Medicaid and State Operations, stopped in Emporia, where he lived from 1969 to 1981. Kuhn is the son of John and Carolyn Kuhn. He attended Lowther Middle School, Emporia High School and graduated from Emporia State University with a bachelor of science in accounting degree.
While in Emporia, Kuhn shared some information about Medicare and Medicaid.
“What we do really matters,” Kuhn said.
Billions for health
Kuhn said the Medicaid business is a large one. He said the proposed $15 billion auto loan guarantee package would only cover about a week’s worth of spending for Medicare and the $700 billion package would only cover Medicaid for a year and two weeks.
“We’re extraordinarily big in terms of the size of things we do,” Kuhn said.
Kuhn said that people in the public and in the health care profession are primarily asking two key questions: How to make health care affordable and how to improve the safety and quality of health care. As a result, the concept of value-based purchasing has been introduced in the Medicare system.
“That means a lot of different things to a lot of people,” Kuhn said. “If you look at our health care system we have right now, there is no real coordination and we don’t measure it very well.”
Avoiding mistakes
One of the things Medicare is doing involves avoiding the “never events,” Kuhn said. “Never” events include wrong-side surgery or wrong-patient surgery and certain infections that patients may develop.
“We started in October of this year where we pay differently if we know that there is good clinical evidence that something should never occur or if somebody came into the hospital and they wound up contracting something, we’re not going to pay more for that anymore.”
Kuhn said that approach got immediate attention and has yielded positive results.
“We have started to change things on the way not only hospitals are thinking and how they are engineering care and how they are collaborating their systems on how to improve reliability in care,” he said. “What we are really trying to do across the board is measure more on outcomes and try to drive better value in terms of the process.”
Still, it takes time to change something the size of Medicare, Kuhn said.
“It’s like trying to turn an aircraft around,” he said. “It takes awhile.”
Managing diseases
Medicare also is working with Medicare beneficiaries who have a lot of chronic health issues.
“Five percent of Medicare beneficiaries consume almost 50 percent of the resources,” Kuhn said. “These are people with multiple chronic conditions.”
To help alleviate this, Medicare is looking at better ways to manage diseases and establishing a medical home for patients.
“The idea there is (we’re) really trying to create a medical home within a physician’s office or a group of physicians for better managing the patient,” he said. “Not only take care of them but do more in terms of managing chronic conditions.”
Medicare also is moving toward more transparency, something that Newman Regional Health also is doing. This means putting information about hospitals, care facilities and other medical facilities out for the public to see.
“One thing we all know is people like to know what their neighbors think,” Kuhn said.
A new Web site will launch on Thursday through Medicare that will give each nursing home around the country that is contracted with Medicare a star rating system.
“We deal with 15,800 nursing homes in this country,” Kuhn said. “I think this will be empowering for consumers to make choices and I think it will improve the quality of care also.”
Issues for Emporia
Several issues face a community of Emporia’s size, Kuhn added. Medicare is trying to make sure it has stability in payment systems to provide strong infrastructure for communities regardless of size in terms of hospitals, nursing homes and other medical facilities.
“The other part is to make sure that those systems are robust enough so that it allows them to bring in the new technologies and new innovations and at least have access to them so that people in Emporia are treated no differently than those in large urban areas,” Kuhn said.
Kuhn added that people in a community Emporia’s size should not expect different treatment than a larger city.
“We’re trying to make sure that the information we put out for the health care providers or for the consumers is transparent for everybody and they can say that the care they get in Emporia is no different than the care they get in Kansas City or Chicago or anywhere else,” he said. “It should not differentiate between the two. People in small communities shouldn’t expect any less.”
There are 4,800 Medicare beneficiaries in the Lyon County area, Kuhn said. To help that population, Medicare is reaching out to caregivers. A newsletter was launched to address caregivers.
“What’s important for folks in a rural community like this is a lot of caregivers aren’t living at home with their parents,” said Peter Ashkenaz, spokesman for Kuhn’s office. “We put information out there that can help them.”
That information includes resources in towns and cities so caregivers who aren’t physically present can make informed choices.
Enrollment deadline
Kuhn also talked about open enrollment for Medicare programs. Open enrollment runs through Dec. 31. He said there are 48 prescription drug programs in Kansas. However, enrollees aren’t expected to choose from 48 programs. There are online tools and counselors who are there to assist consumers based on their needs. Choices are narrowed based on needs, medications and several other factors.
“We want them to go into 2009 feeling pretty satisfied and pretty secure knowing they are in good shape,” Kuhn said. “It costs us a lot less to keep people healthy than to treat them when they are sick.”
Kuhn said he does not know what he will be doing after Jan. 20. He is a political appointee and expects his job will change.
“I want to stay in the health care field,” he said. “I think I have some things to offer in that area. I really want to help continue this movement to greater transparency, a greater value to health care and how to improve the system. ...”