Sen. James Leddy, Co-chair; Rep. Janet Ancel; Rep. Steven Maier; Rep. Francis “Topper” McFaun; Walter Freed

MEMBERS ABSENT:

Rep. John Tracy, Co-chair; Sen. Ann Cummings; Sen. Jane Kitchel; Sen. Kevin Mullin; John Bloomer, Jr.

Also Present:

Legislative and Joint Fiscal staff, members of the Administration, the public and the press.

Meeting Recorded:

CD 2005 - 18, 19, 20, 21

1. Convene, Review and Approve 11/15/05 Meeting Minutes

Senator Leddy convened the meeting at 9:50 a.m. in Room 11 at the State House, Montpelier , Vermont . Senator Leddy asked for a motion to accept the 11/15/05 meeting minutes as presented. A motion was made and seconded. The motion passed unanimously on a voice vote.

2. Presentation on Health Care and Discussion —Chronic Care Issues in Vermont
Kenneth Thorpe, Ph.D., Consultant, Commission on Health Care Reform

Documents distributed:

• Presentation to the Vermont Commission on Health Care Reform, Presented by Dr. Kenneth E. Thorpe, Dec. 16, 2005

Kenneth Thorpe, Ph.D., Consultant to the Commission, gave a PowerPoint presentation on chronic care management. Key topics:

1. Challenges facing a “fast-track” implementation of the state’s chronic care initiative
   
2. How do other states / state Medicaid programs design disease management programs?
   
3. Lessons and implications for the Commission discussion

Issues:

• Case management for physicians—costs and compensation

• Technology issues including hardware—many small physician offices are still all paper; costs for small rural practices to get equipment and training

• Savings in moving to electronic billing

• Extended discussion of RFP process for disease management for Medicaid and State employees

• Using Chronic Care model for overall health care management

Comments: need to move to more direct discussions with those working on these issues, including Commissioner Jarris; Q: models re hospital care? A: Louisiana & Minneapolis.

3. Medical Event Reporting  
George E. Ritter Jr., MD, Senior Vice President and CMO, Safe Care Systems Group, APPTIS

Documents distributed:

• Safety Event Reporting, Presented by Dr. George E. Ritter, Jr., MD, Dec. 16,
  2005
• “The Long road to Patient Safety: A Status Report on Patient Safety Systems”
  (Journal of the American Medical Association). [hard copy only]

George E. Ritter Jr., MD, Senior Vice President and CMO, Safe Care Systems Group, APPTIS, gave a PowerPoint presentation on Safety Event Reporting and the Patient Safety Crisis.

Topics:

• Patient safety needs to be a top priority in healthcare
• Patient Safety & Quality Improvement Act of 2005
• JCAHO Accreditation Mandates
• Leapfrog and other employer and payer-driven initiatives
• State medical error reporting laws in 27 states
• Clinical care is a Chain of Processes
• Improving safety outcomes requires sound reasoning, effective practices, reliable systems; in a Learning organization
• Recommended solutions include using APPTIS safety reporting software
• Key elements of successful safety reporting systems

Other points:

“Heinrich Ratio”: for every serious accident, there are 28 or 29 less serious ones, and over 300 near misses;

Q: Hospitals’ fear of bad PR? A: can get good PR from publicizing safety reporting reform efforts;

Q: Recommendations for Vermont ? A: The national legislation is a good start;

Do legislation to set up patient safety event reporting within hospitals, with filtered data to a state report. Be careful about reporting to the doctor and nurse licensing authorities.

Q: Focus on leadership? A: Yes. Need to build a culture of safety; but not blame-free—this is a professional environment.

Q: Cost of his software? A: He will get information on that. Software is scalable, and cost depends on scale.

4. Update on Request for Proposal for Health Care Information Systems in Vermont

Catherine Benham, Staff Director to the Commission, reported on the RFP process. There is a finalist, who is having discussions with staff and others, re details of contract. Hans Kastensmith is the finalist.

Sen. Leddy praised Catherine Benham: “The work Catherine has been doing is outstanding. … I for one can’t say thank you enough.”

5. Future Meeting Planning  

In January, Dr. Thorpe will present information on various proposals. His contract is ending—Commission needs to discuss possible extensions. C. Benham recommends continuing to work with him. Sen. Leddy: Our intent is to work with Dr. Thorpe beyond January. His contract is currently with the Commission; may want to involve the other committees working on health care.

Tentative date for next Commission meeting: Thursday afternoon, January 12, 2006 .

The Commission could invite the other health care committees to attend.

Sen. Leddy reported on productive discussions recently with members of the Administration. Issues included chronic care—need to modify some approaches; how to engage and involve OVHA and Medicaid more. Sen. Leddy distributed copies of correspondence with the Administration.

Respectfully submitted,

/s/ Loring Starr, Legislative Council

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