Simplification is key aim of Clinton health plan


"The American health-care system is (like a) quartet that has added people to hold the chairs, to hand the violins in, and has required the musicians to stop at the third or fourth page" of "music to call somebody to make sure they can go to the next bar."

) -- Hillary Rodham Clinton

Hillary Rodham Clinton, meet Lee Emerson, of Saint Mary Hospital in Langhorne, Pa. She's one of the beleaguered health-care musicians you described last month in your speech to Congress.

"There's so much nonsense we have to deal with now," says Ms. Emerson, who supervises patient-care reviews.

"We have 42 different insurance contracts. Each one has its own requirements. Each one uses different criteria. If we could just standardize the forms, we could cut back tremendously."

In March, Ms. Emerson's hospital was cited by the federally funded Keystone Peer Review Organization Inc. for failing to include the word "the" in a hospital form.

"I had to write a corrective action plan . . . swear to them it wouldn't happen again," Ms. Emerson said.

John DiNardi 3d, executive director of the peer-review organization, which monitors treatment for Medicare patients, said he was required by law to send the letter.

"It's mandated by the government. Legally, we have to cite them. That's not really us," he said.

Bill and Hillary Clinton say they want to put an end to such hassles. America's health-care system is choking to death on fine print, they have said. Mountains of claims forms clog the system's arteries. Rules and regulations frustrate patients and physicians.

Now, the Clinton team proposes to change all that by cutting paper work and getting bureaucrats off the backs of doctors, nurses and other medical providers.

Largely overlooked in the health-reform debate is how President Clinton would simplify the $900 billion U.S. medical system.

Details in his draft plan show the Clinton team doesn't intend to stop at streamlining paper work. It wants to overhaul the entire medical system -- from how doctors deliver care to the way claims forms are filed.

Through its proposed National Quality Management Program, an elaborate plan to improve the quality of medical care, the administration wants to shift the focus of insurers away from looking over the shoulders of physicians during and after treatment.

Indeed, the plan even calls for eliminating the federally funded Peer Review Organizations such as Mr. DiNardi's. They were created in the mid-'80s to monitor the way doctors and hospitals treat Medicare patients. Often criticized for nitpicking and hassling doctors and hospitals, the PROs have a budget of nearly $500 million.

Instead of the review groups, the Clinton proposal envisions the creation of broad standards of care that would help guide health providers as they initiate treatment.

A 15-member advisory council under the National Health Board would be responsible for developing the standards used to measure care under the Clinton program. Data from consumer surveys, quality reports and studies of finances, plan enrollments and patient care would flow back and forth between the federal government, states, purchasing pools and health plans.

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