Dec 11 2009 Obama Transition Committee Health Care Forum on Roosevelt Island
In December of 2008, a community forum on Roosevelt Island produced the following recommendations to the incoming Obama Administration
Health Care Community Discussion
Held December 29th, 2008
Good Shepherd Community Center
Roosevelt Island, NY
Moderator: Jack Resnick, MD
Independence at Home was the focus of the meeting I led on Roosevelt Island in New York City on
December 29th, which was attended by over 100 people. I am a board-certified internist and my practice is based on Roosevelt Island, a small community between Queens and Manhattan in the East River.
I treat about 30% percent of my patients through house calls. Many of my patients are elderly or severely disabled, and I have found that what keeps them the healthiest is comprehensive treatment in the home – not the hospital. Five of my patients discuss this in a film that can be accessed at
Hospitals present myriad problems – they put patients at great risk for infection; they are understaffed; and the caregivers are not familiar with their patients. Human error and negligence are commonplace. A stay in the hospital for the frail, sick and elderly frequently results in reversible disorientation, delirium and, then, irreversible dementia.
Caring for these patients in the home provides them with greater independence, more informed and careful treatment, and increased personal attention. They live longer, are healthier and happier. And it’s cheaper.
Good home health care keeps patients out of hospitals, thus reducing the cost of hospital stays and
treatment by 30-60%. Several studies (S Okie and RJ Master in the New England Journal of Medicine, and SD Yaggy in Geritatrics) have proved this point.
Hospitalization accounts for 60% of Medicare’s cost per patient, on average, with an even higher
percentage for most of the patients for whom at-home care would be ideal, such as the elderly or disabled.
Bringing care into the home decreases costs significantly, making our system more efficient and cost effective while providing higher quality care.
Among the causes of the bloated cost of hospital care are:
1. Costly errors and hospital-acquired infections.
2. Culture of using too many super-specialists, invasive procedures, and diagnostic tests. These
resources are often used reflexively because “they are there” and need to be supported financially.
3. Administrative supra structure. Medical centers have become enormous institutions supporting many functions far removed from patient care.
I propose two major changes in how the system functions that would sharply reduce costs, dramatically
improve quality and make patients healthier and happier.
1. Move much of health care out of institutions (hospitals and nursing homes) and into homes. This
requires
• well-trained, well-paid caregivers
• nursing and medical services in the home
• electronic medical records
• early attention to advanced care planning
• continuous exercise and physical therapy
• live audio/video internet connection
2. Create cadre of physicians-in-charge delivering health care at home. This requires MDs who:
• are available 24/7
• know each patient intimately
• have immediate access to electronic medical records
• share in the monetary savings their efforts produce
Below is a table I developed that summarizes the estimated savings from a home-based care method.
Summary – as a percentage of predicted expenditure
| Low estimate | Medium Estimate | High Estimate | |
|---|---|---|---|
| total hospital savings | 21% | 32% | 42% |
| Cost of implementation | 15% | 23% | 39% |
| Savings to medicare | 6% | 9% | 12% |
In revamping the health care system, we must not only change the financing – we must reform the care
itself.
Jack Resnick, M.D.