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Skriven 2006-08-22 23:31:16 av Whitehouse Press (1:3634/12.0)
Ärende: Press Release (0608221) for Tue, 2006 Aug 22
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Press Gaggle by Dana Perino and Health and Human Services Secretary Leavitt
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For Immediate Release
Office of the Press Secretary
August 22, 2006

Press Gaggle by Dana Perino and Health and Human Services Secretary Leavitt
Aboard Air Force One
En route Minneapolis, Minnesota



1:59 P.M. EDT

MS. PERINO: Good afternoon. We are on our way to Minnesota. I have a couple
of scheduling matters and an update for next week's week-ahead, and then
because we're going to be doing -- the President is going to be doing a
panel on health care, (inaudible), my special guest is Secretary Leavitt,
who is going to give you a bit of a rundown of what the President will be
talking about, the executive order he's going to be signing and answer a
few questions on that. And then I'll take the rest of your questions
afterward.

Just to go over the schedule quickly. The President had his regular
briefings this morning. He also had a meeting with his Homeland Security
Council, the topic was pandemic flu, an update on pandemic flu. As I said,
we're on our way to Minnesota for this panel on health transparency. And he
will attend the Bachmann for Congress and Minnesota Republican Party
reception. We arrive back tonight at 9:40 p.m.

One foreign leader call to mention. The President called President Karzai
of Afghanistan this morning. The call lasted about 10 minutes; it was
initiated by the President. He called President Karzai to congratulate him
on Afghanistan's Independence Day. They discussed security, education and
regional cooperation.

An update to next week's schedule, for your planning purposes. Obviously,
next week the nation will mark the anniversary of Hurricane Katrina. On
Monday, August 28th, the President will visit Gulfport and Biloxi,
Mississippi. He will remain overnight in New Orleans. On Tuesday, August
29th, the President will have events in New Orleans, and then remain
overnight in Crawford.

On Wednesday, August 30th, the President will have events in Little Rock,
Arkansas, and Nashville, Tennessee, and remain overnight in Salt Lake City,
Utah. On Thursday, August 31st, the President will have events in Salt Lake
City, and then he'll remain overnight in Camp David for the weekend. I
don't know if he's coming back Sunday or Monday -- I believe Sunday. We'll
get that for you later.

Let me turn it over to Secretary Leavitt to give you a little bit about
today, and then I'll take the rest of your questions.

SECRETARY LEAVITT: The subject of the executive order is health care. Let
me just put this in a short context. A lot of anxiety about health care. If
you're a consumer, you're feeling your paycheck erode because of health
care costs. If you're an employer, you're feeling your competitiveness
slip. We're paying about twice about as much as a country for health care
than our economic competitors. If you're a hospital or a doctor, you're
feeling the worry of how the system is going to work in the future. There
are a lot of issues related to how physicians are reimbursed by health
plans and Medicare.

Virtually everyone calls for a transformation of the system, a big change.
The question is, change to what, transformation to what. In some respects,
today is a big step toward answering that question. It's a significant step
toward an interoperable system of value-based competition. I want to repeat
that, because it's an important phrase, a system of -- an interoperable
system of value-based competition.

Let me break that down. By interoperable, most of you will be familiar with
the fact that many of the systems we depend on are interoperable. If you
pick up a telephone, cell phone, and you call someone who bought their cell
phone and their cell minutes from another carrier, it still works, because
the systems are interoperable. If you have an ATM or a credit card, you can
use it anywhere in the world and it works, because it's interoperable.
Everybody competes but uses the same system, basically, to transact their
affairs.

Health care isn't like that. Roughly 85 percent of all health care records
are still paper. So a part of what we'll be talking about today is the
interoperability of systems that manage health records.

The second phrase, value-based. Value is made up of two components. The
first is quality, and the other is price. The reality is, very few people
have a clue what their health treatments cost. And even fewer understand
the quality that they're receiving as it relates to other alternatives. The
consequence of that is that you have a system where, essentially, there are
no limits, and no one has an idea of what it's costing.

So value -- part of the executive order today will be dealing with
developing standards of quality so that consumers will have a better idea
of the quality of the care they're receiving. Part of it will deal with
price, being able to organize the health care system in a way that people
can have episodes of care, but they can compare one provider to another.

And then, of course, competition. We know as a matter of fact that if
people have information about what they're purchasing, that the quality
goes up and the price goes down. So an interoperable system of value-based
competition.

Now the -- if you're a consumer, what this means is that at some point in
the future, you'll get more information about not just the cost, but also
the quality. Over time, most insurance plans now are beginning to reward
those who are cost conscious, and in some ways, penalize those who are not.
They will have information about whether or not various doctors or various
hospitals provide high quality or low quality. If you're a doctor or a
hospital, it means that you will have information about the quality of the
care you're providing to your patients.

In the last two months, I visited 27 cities where there are quality
initiatives. Almost all of them were instigated by physicians looking for
ways to know whether the care they're providing is as high a quality as the
rest of the market. If you are an employer, it means that in the future you
will be able to inspire your employees to be more cost conscious by
rewarding those who choose high quality, low cost care.

Now, back to the executive order. Health care is a challenge to change.
It's a big system. It's almost 16 percent of the gross domestic product,
and it's made up of literally thousands of different providers. So changing
a system like that is difficult.

Some people argue that political will does not exist to change health care.
I would suggest that the problem may be different than that. It may be that
there's too much political will, and every time a proposal comes up,
everybody unholsters their political will and (inaudible) at each other,
and it creates a standoff that's existed for the last many years, and it
will likely exist in the future.

So this executive order is about changing the system by using the
purchasing power of the federal government to begin to shape the market in
conjunction with other payers.

Let me be more specific. The federal government pays for as much as 40
percent of all health care in America, when you combine Medicare, Medicaid,
Department of Defense, Veterans Administration, and the Office of Personnel
Management, which pays for the employees. If federal purchasing began to
make certain requirements of those from whom we purchase, in conjunction
with unions, large employers and states, it would begin to make a clear
signal to the market as to how it will be shaped in the future.

The executive order puts the federal government -- will change the federal
government's procurement habits in four very significant ways when it comes
to health care. The first is that standard health information technology
will be made a very high priority in our procurement. In other words, if
people in the future who sell to the federal government or are providers to
the federal government desire to do business with us electronically,
they'll have to use a set of standards that will be adopted uniformly
across the industry.

The second point is that value needs to be defined in order to provide this
quality price-value competition. So we'll be adopting a series of standards
for health quality that have been developed by the medical industry.

The third is price. It will be a condition of doing business with the
federal government if you're a health plan to make available information
regarding your claims. It also indicates that the federal government will
make available its Medicare claims information. Now, that's significant
because it means that efforts to aggregate claims information into the
episodes of care that can be compared, and quality that then can be
compared will now be actuarially sound.

Many people have tried to do this, many organizations, but they have lacked
one critical piece, and it's the information from the federal government.
We're changing that. We're going to begin to be an active partner in those
efforts.

And lastly, incentives. We will, as a result of this executive order, all
of the agencies of the federal government that procure health care will
begin to develop incentives that will provide that reward -- let me restate
that, that will reward consumers and providers who provide -- who have high
quality and low costs.

Now, as I indicated, this is a very important step toward an interoperable
system of value-based competition. Many of the things I've talked about are
happening in small measure today. It will continue to grow over the course
of the next several years, but there's a clear move, and we believe by the
end of the year, we will have not just the federal government, but a very
high number of this country's largest employers who will be adopting a
similar set of practices. We're approaching the larger unions in the
country, as well as the states to do the same thing. And so if 55 percent
or 60 percent of the health care purchasers in the country, or at least the
(inaudible), are adopting the same practices, it will clearly begin to
reshape the market. So that's the reason the executive order is of such
significance.

Minnesota has a -- one of six pilot sites where they are experimenting with
ways of defining quality and comparing it to price to compare value. And,
consequently, we chose to go there.

Q -- rewarding health providers (inaudible). Do these stand to confirm or
discriminate against providers dealing with a sicker population, or people
who (inaudible)?

SECRETARY LEAVITT: That's a very good question. The science of measuring
quality is still in its pioneering phase. One of the problems that will
need to be refined is being able to weigh those that have more serious
conditions from those who do not. Learning to categorize not just the
treatments, but the type of patients they are treating is a significant
part of what we're learning.

We currently have -- there are collaborative groups in, I would say, more
than two dozen cities that have been formed by doctors, hospitals,
insurance companies and employers to try to learn how to do this. We are
forming a network of both collaborative organizations and beginning to
harmonize their efforts so that we can learn how to deal with problems like
the one that you raise. That's one of the reasons that the measurement of
quality will start off in a quite basic way.

I'll give you an example. One of the quality measures is diabetes -- has to
do with diabetes. The measure is, have you checked the hemoglobin A1C on a
diabetic every quarter? We know that those who do have a check every
quarter have fewer complications, and ultimately their cost is less. So one
of the basic measures of quality is to determine whether or not a physician
or a practice has followed that. Another measure, if you were doing hip
operations, for example, would be how many re-admissions did you have
because of complications? So you can see in the future if I need a hip
operation.

Today if I wanted to pick a physician, I would get a list of physicians and
hospitals from my insurance company that they would pay for, but I'd know
nothing about it. In the future, a patient will be able to say, here are
the doctors in my area that my insurer will pay for; here's how many hip
operations they did, and here's the quality of them, based against a
standard; and here's how much they cost, based on the kind of patient I
will be; and, also, how satisfied were the patients. But you can see that
not only gives the patient more information, but it also begins to give the
physician a better sense of the quality that they're providing.

We've done this in nursing homes, and it works. Instantly, when this is
measured and people begin to -- and it's transparent -- the nursing homes,
the hospitals and the doctors begin to work hard to get better, make
certain that they're among the highest quality.

Q I can see why patients would want to maximize their quality when choosing
a doctor. What incentives do they have to choose one that's also
cost-effective, given that their health care premiums or contributions are
usually fixed?

SECRETARY LEAVITT: That's a very good point. But the reality is, where we
are today, it's almost impolite to ask about quality, and nobody has a
reason to care about the cost, because they just give their insurance card.
Over the course of time, we will see -- because of the high costs of health
care, we'll see more employers' health plans rewarding those who choose
high quality and low cost. For example, they may say, we're prepared to pay
100 percent of a high quality, low cost provider. But if you choose a
provider that is low quality and high priced, then we're not prepared to
pay 100 percent. You may have to pay part of that yourself.

So it begins to give people a sense of value and a reason to care. And we
know from previous experience that if people have that information, they
begin to make better choices.

Q How do you create a system that quickly, get it up and running for that
kind of data on quality and cost? I mean, how long of a project is this
going to be?

SECRETARY LEAVITT: Well, this is an insightful question, and one that I
want to be clear about. Some of this is happening today. But in order to
collect quality data, the first step is to define what it is you're
measuring; the second is to decide how you're going to measure it; and the
third is how do you collect the data.

Because 85 percent of the medical records are paper, quality measurement in
most places today is a nurse who comes in on a Saturday, has a two-foot
stack of health records, has to go through and find out if the patient's
hemoglobin A1C was checked last quarter, and then they have to bundle that
up and send it somewhere. That's why electronic medical records are so
important, because we have to define an electronic standard that will then
allow that information to be gathered automatically and continually
updated.

So the four major components are health IT, measuring value, being able to
aggregate cost in a way that can be compared, and then providing the
incentive. That is an interoperable system of value-based care. It will --
as we plan this out, see, this isn't the kind of thing you'll just flip a
switch and it will work. It will happen in phases and it will develop over
time. But I feel confident three years from now we'll look back and see
substantially more consumer information available for decision-making and
for doctors to improve their care.

Q What kind of feedback are you getting from professional groups, like the
AMA? Are they on board, or do they have reservations?

SECRETARY LEAVITT: I think it's safe to say that virtually everyone wants
this to happen, but for different reasons and for different concerns.
Employers have their hair on fire right now with concern. Their costs are
going up so fast they're beginning to lose their economic competitiveness.
They're seeing the wages that they pay their workers eroded.

I was just reading about my home state. I was governor of Utah for a time,
and I noted that the legislature gave teachers the biggest salary increase
in decades. But their paycheck -- the paycheck of the average teacher, or
many teachers, went down because of the health care cost. And that's
happening to industries --

(DROP IN FEED)

-- SECRETARY LEAVITT: -- that employers want this to happen real fast, and
if it's imperfect, it's okay with them. Health care -- doctors and
hospitals -- they want it to happen, but they want to make sure it's done
perfectly (inaudible) tension between them as to how quickly this can
happen. That's a healthy tension. It will keep us motivated to move
forward, but it will (inaudible) us to be cautious to assure that we've
done this well.

Q Thank you.

SECRETARY LEAVITT: Thank you.

MS. PERINO: Okay, special guest, Mike Leavitt. So do you have other
questions?

Q Any reaction on Iran? They say they are willing to start negotiations
tomorrow, and that --

MS. PERINO: Well, as you know, the Security Council deadline was August
31st. I'm not going to parse the Iranian government document today here on
the airplane. That is a job best left to the diplomats, the P-5 plus one,
led by the United States and President Bush, for them to review it. I
understand that the United States government has received a copy of it. We
are aware of the rhetoric that's been coming out of the regime about a
nuclear program, and the President made very clear to everyone yesterday in
his press conference that he thinks that that would be a mistake, and
dangerous for the region and the whole world.

So let's let the diplomats take a look at this response before we parse it
out too much here.

Q Has the President actually seen a copy? Has he read any of it yet?

MS. PERINO: I don't believe so, no, because it came out as we were on our
way here. I don't believe he's seen it yet.

Q The United Kingdom announced today that they're going to reduce their
troop levels by mid next year in Iraq. Any response to that?

MS. PERINO: I think the report that I saw -- I think it's the article
you're referring to -- was an unnamed source who said that troops could be
reduced. And so I think that we'll wait for official word from the U.K.
before having any further discussions. The issue about conditions on the
ground and making troop decisions about -- based on conditions on the
ground stands, and you heard the President talk about that yesterday.

Q But he hasn't spoken to Blair about this issue?

MS. PERINO: Not that I'm aware of. And, again, I point you back to the
unnamed source that said it could happen, not that it would.

Q Why a George Allen fundraiser tomorrow? Is the President concerned about
his statement the other day about the Webb staffer?

MS. PERINO: I was asked earlier if the President had qualms about
attending, and the answer is, no. Senator Allen apologized and I think it's
in everyone's best interest in this day of (inaudible) politics when
everyone is trying to improve the tone and discourse to accept apologizes
when they're offered. So the fundraiser will happen tomorrow evening, and
Senator Allen will be there, as well.

Okay, thank you.

END 2:24 P.M. EDT

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