Rendell scores some modest victories in expanded health care push


Gov. Ed Rendell could not persuade state lawmakers this year to embrace the cornerstone of his sweeping health care reform plan: expanding state-subsidized health coverage to roughly 800,000 uninsured adults.

But his administration won some smaller victories in its effort to lower the cost and improve the quality and availability of health care.

Certain health care professionals who aren’t doctors, such as nurse midwives and nurse practitioners, were granted broader authority to provide basic medical care. And hospitals and nursing homes face new requirements for reporting and reducing the number of infections contracted by patients under their care.

“We took tremendous steps for cost control of our health care delivery system,” Rendell said earlier this month.

The administration views non-doctor health professionals as a crucial link in the health care system because they provide preventive care at lower prices, filling a void left by a declining number of general-practice physicians in some parts of the state.

Pennsylvania’s laws previously prevented nurse practitioners _ registered nurses with advanced degrees and specialized training _ from performing the full range of health care duties for which they have been trained, such as ordering medical equipment and making referrals for certain medical therapies, said Morgan Plant, a lobbyist for the Pennsylvania Coalition of Nurse Practitioners.

“This makes it easier for consumers who are being routinely treated by nurse practitioners to be able to access physical therapy, respiratory therapy, dietary consultants,” Plant said.

The changes will also end Pennsylvania’s distinction as the only state barring nurse midwives from prescribing drugs. However, midwives will not be able to write prescriptions until state regulations are updated to conform with the new law.

The state Board of Medicine recently published a first draft of the regulations for public comment. Vivian Lowenstein, president of the Pennsylvania Association of Licensed Midwives, said she hopes they will become final within the next six months.

“It was a huge victory in terms of women’s access to health care,” Lowenstein said.

Other regulatory changes will need to address issues such as how many nurse practitioners a doctor may supervise at one time, Plant said.

Reducing hospital-acquired infections, which the administration says added nearly $3.5 billion to hospital charges last year, is another goal of Rendell’s plan.

Another new law requires hospitals, outpatient surgery centers and nursing homes to develop state-approved infection control systems and report all hospital-acquired infections to the U.S. Centers for Disease Control and Prevention. Facilities that reduce infections by 10 percent from the previous year will be rewarded with cash payments from the state starting in 2009.

The law also requires hospitals to begin implementing computerized infection monitoring systems next year. Those that cannot make the change without financial or technical assistance would be allowed to continue using their current systems.

Hospital officials had pushed for flexibility in implementing electronic monitoring. They had feared the law would be costly if the state had mandated the use of a single, statewide reporting system, said Melissa Speck of the Hospital and Healthsystem Association of Pennsylvania.

A 2006 hospital association survey found that about one-quarter of the state’s hospitals were using electronic systems to monitor infections.

Rendell’s Cover All Pennsylvanians insurance expansion plan foundered in the face of a lobbying blitz by business groups against a payroll tax he proposed on all but the smallest businesses that do not insure their employees. The governor had been counting on the payroll tax and a portion of state cigarette tax revenue to finance his $317 million plan.

Earlier this month, Rendell sought to make approval of the insurance expansion a condition for renewing a state subsidy that helps doctors pay for supplemental medical-malpractice insurance from a state-run fund known as MCare. He has proposed using part of a more than $400 million surplus in that fund for the insurance expansion in place of the payroll tax, and met opposition from Republicans in the House and Senate.

Rep. Todd Eachus, D-Luzerne, who has coordinated efforts to pass legislation in the House to carry out Rendell’s plan, said he is hopeful that a bipartisan group of House members can negotiate a compromise bill to send to the Senate after the Legislature returns to session next month.

But Stephen MacNett, chief counsel to the Senate GOP, said any insurance expansion will be a tough sell in the Republican-controlled Senate, no matter how it is funded.

“There is a recognition on the part of our members that this is going to be a hugely expensive new venture,” MacNett said. “What is certain is that very substantial taxes would be required no later than the end of the Rendell administration to be able to fund the program. It’s wrong as governmental policy to create massive new programs and leave decisions on how to fund them to another day.”

RoseMarie B. Greco, director of the Gov.’s Office of Health Care Reform, called the lack of action on insurance disappointing, but not surprising.

Even so, the progress that occurred on other issues was noteworthy, she said, considering that even some “internal skeptics” in the administration warned that the Legislature wasn’t likely to pass any health care legislation before its summer break. The bills regarding midwives and hospital infection control received final approval and were signed by Rendell in July.
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