09/06 - Remaking Louisiana Medicine

How has the devastaion of hurricanes effected Louisiana's Health Care System?

Concern about rising health care costs and the quality of care has put a spotlight on American medicine in recent years. The devastation wreaked by hurricanes Rita and Katrina on the medical infrastructure in south Louisiana has affected the care of over one million Louisianans, and disrupted the training of Louisiana's next cohort of doctors.

Panelists:

* Julie Cherry
* David W. Hood
* Representative Joe R. Salter
* Roxane Townsend, MD

Co-sponsors:

* Louisiana Health Care Review, Inc.


* Remaking American Medicine

Backgrounder

According to many observers, there is a quality of care crisis in American medicine. Despite the prevalence of advanced procedures and effective drugs, some believe the system is in chaos and in need of immediate attention. Compared to other industrialized countries, the US has high rates of medication error, inefficient coordination of care and high out-of-pocket costs.

Louisiana’s medical system suffers all of these ills and more. In their 2005 national health care ranking, the United Health Foundation placed the state 49th. That’s an improvement: for 13 out of the last 15 years, Louisiana has ranked 50th.

Diseases are not the only threat to America’s health. In 2000, an Institute of Medicine report estimated that between 48,000 and 98,000 people die each year from preventable medical errors. One million more are injured. Medical errors are the fourth leading cause of death in the U.S.

According to the Institute of Medicine, most medical errors are not attributable to individual negligence or misconduct.

Surgeon John Paige agrees. He teaches at the LSU Health Science School of Medicine in New Orleans. “The reason why these things happen is complexity. You put humans in the mix and humans are prone to error and you have to recognize that fact.”

He claims the key to reducing medical errors is to focus on improving the systems of delivering care. Paige says, “We have to admit the fact that we make mistakes. And a way to get around or preventing mistakes from happening is creating redundant systems that help kind of trap those mistakes before they lead down to a catastrophe.

The LSU Health Science Center School of Medicine is applying high-tech solutions to the problem of medical errors. Third year medical students make their life or death diagnoses in an advanced simulation lab run by Dr. Valeriy Kozmenko.

Med student Thomas Raggio can hone his skills on a talking, breathing patient-robot without endangering a human subject. Raggio says, “We’re simulating different life threatening scenarios that we would like to be seeing in a controlled environment, prior to seeing it in a real life situation. We’re getting all of our medical errors out of the way here on a dummy that we can’t do any real damage to.”

Dr. Paige says, “They’re allowed to make mistakes. In fact, you create situations where they’re more likely to make mistakes. But it’s a safe environment. If the patient dies, they can just reboot the machine and they can do it over again.”

The use of electronic medical records promises to mitigate some types of medical errors. Hand-held bedside computers are being used to eliminate reliance on handwriting for ordering medications and other treatment needs. Department of Veterans Affairs hospitals are using hand-held, wireless computers and bar-coding, which has cut overall hospital medication error rates by 70 percent.

As with medical errors, hospital-acquired infections claim tens of thousands of victims every year. Dr. Pete Lopez, with the LSU Health Science Center, is an expert in infection control.

“Because it is such a big problem,” he says, “any accredited hospital in this country actually has to show that it’s providing surveillance, prevention and control methods for hospital acquired infections. Data show that about 5 percent of all patients in hospitals will develop an infection.” According to Dr. Lopez, “If you really want to look at this concretely, we are actually talking about four and a half billion dollars a year in this country being paid for the management of hospital acquired infections.”

Few hospitals in Louisiana make infection data public, so the cost in lives and dollars locally is hard to determine.

The state ranks 33rd on per capita health care spending. But in Louisiana, health outcomes are not always directly related to the amount of money spent on health care.

“In Medicare, we spend the highest amount per recipient in the country and we have the lowest outcomes as Medicare measures quality outcome,” according to Dr. Fred Cerise, the head of the Louisiana Department of Health and Hospitals. “We pay for episodes of illness. We pay for visits but we don’t pay to manage the care of a population to get good outcomes to improve the health of the community. And I think that’s what I’m hearing from folks in term of the need to redesign the way we deliver care.”

Improving outcomes for chronic care patients – those with heart disease, cancer or diabetes, for example – would go a long way toward relieving financial stain Louisiana’s medical system. Nationally, chronic conditions consume 70 percent of all health care resources.

The three most common causes of death in Louisiana are chronic diseases. Heart disease is the leading killer, accounting for approximately 27% of the state’s deaths in 2001. Cancer is the second leading cause of Louisiana deaths, followed by Stroke.

Diabetes was associated with about 16 percent of all Louisiana hospital stays in 2001. Louisiana has the highest rate of death due to diabetes in the nation. Among Louisianians aged 65 or older, nearly 20 percent are diabetic.

The Leonard J. Chabert Medical Center in Houma has developed effective strategies for dealing with chronic diseases, including diabetes. In 2003, the National Association of Public Hospitals cited Chabert, which is part of the Louisiana Charity Hospital system, as “a model for all Disease Management efforts.”

A key component of any successful treatment program is the relationship established between patient and provider. Linda Sharpless runs a clinic with a mostly rural clientele in Tangipahoa Parish. If patients can relate to their doctor,” she says,”they will perform better. They will follow instructions better. If they feel the doctor has a real interest in whether they get better or not, the patient will perform better.”

Better communication between patient and provider and among medical professionals at the institutional level may hold the key to better, safer outcomes for Louisianians in need of health care.

Stay Healthy Louisiana launches staffed, toll-free health hotline

September 13, 2006, New Orleans, LA – The Stay Healthy Louisiana program has launched a new, staffed toll-free telephone hotline offering disaster readiness and hurricane recovery health tips, as well as general public health information. The number is 1-888-LA-INFO-4U, or 1-888-524-6364, and health specialists take calls between 8 a.m. and 6 p.m., Monday-Friday.

Operators will provide information in English and Spanish and will have contact information for other hotlines and other important health-related phone numbers. During non-business hours, callers will be able to retrieve recorded information on health issues.

Launched after Hurricanes Katrina and Rita, Stay Healthy Louisiana was designed to provide Louisiana residents with easy access to critical public health information following the crisis. Now, thanks to funding support from the Centers for Disease Control Foundation’s Emergency Preparedness and Response Fund, the Stay Healthy Louisiana campaign is moving forward with a focus on preparation for disasters and emergency situations.

In the coming months the Stay Healthy Louisiana campaign will expand its focus beyond emergency preparedness to other health issues, such as, disease prevention, mental health, fitness and nutrition and safe environmental conditions. The http://www.stayhealthyla.org Web site will become a centralized resource for public health information in Louisiana.

For more information on the Stay Healthy Louisiana campaign, contact Rob Anderson, Stay Healthy Louisiana Communications & Media Manager, at 504-301-9854 or .(JavaScript must be enabled to view this email address).

Information on the Stay Healthy Louisiana Partner agencies:

The mission of the Louisiana Department of Health and Hospitals (DHH) is to protect and promote health and to ensure access to medical, preventive, and rehabilitative services for all citizens of the State of Louisiana.

The goal of the Louisiana Public Health Institute (LPHI) is to promote and improve health and quality of life in Louisiana at the community, parish, and state level. We connect people, ideas, organizations, and resources to bring about positive change.

The CDC Foundation helps the Centers for Disease Control and Prevention do more, faster by forging effective partnerships between CDC and individuals, foundations and corporations to fight threats to health and safety.

Since 1997 the Louisiana Public Health Institute (LPHI), has worked to promote and improve the health and quality of life in Louisiana through public-private partnering at the community, parish and state level and provide information for decision making and policy development. Current activities employ a community-based systems approach to improving access to care, environmental tobacco policy change, health promotion and disease prevention, and enhancing the capacity of communities to address critical and chronic health issues. LPHI is a member of the National Network of Public Health Institutes and is the administrative home of their national office. For more information visit http://www.lphi.org

LPB is glad to offer you several avenues to assist you to find out more about issues regarding your health concerns and needs. We have Web resources that may be of help to you as you conduct your research. There is a list of consumer-oriented products and tools that you wish to review. All of these sites are user-friendly and all of the materials are easily downloadable.

* How do Health Care Systems Recover, and Even Improve, After a Catastrophe?
by Frederick Cerise, MD, Secretary, Louisiana Department of Health and Hospitals
* The November 1999 report of the Institute of Medicine (IOM), entitled To Err Is Human: Building A Safer Health System, focused a great deal of attention on the issue of medical errors and patient safety.
* The Report to the President on Medical Errors was issued in February 2000. For more information on medical errors, select http://www.ahrq.gov/qual/errorsix.htm.
* The final report of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry, released in 1998, identified medical errors as one of the four major challenges facing the Nation in improving health care quality.
* Reducing Errors in Health Care. Translating Research Into Practice, April 2000. AHRQ Publication No. 00-PO58. Agency for Healthcare Research and Quality, Rockville, MD.
* “Chronic Diseases: The Leading Causes of Death in Louisiana”
Date last reviewed: 11/14/2005
Content source: National Center for Chronic Disease Prevention and Health Promotion

For Consumers: Patients and Familes as Partners
Aimed at family members, this checklist provides suggestions on how consumers can determine if their physician or other healthcare provider embraces patient-and-family-centered care.
Developed by the Institute for Family-Centered Care
http://www.ramcampaign.org/pages/documents/PATIENTSANDFAMILIESASPARTNERS-forconsumers_000.doc

Top Ten Tips on Advisory Roles
Aimed at patients and family members, this list is meant to encourage consumers to actively participate in healthcare change.
Developed by the Institute for Family-Centered Care
http://www.ramcampaign.org/pages/documents/TOPTENADVISORYROLES_000.doc

Top Ten Tips to Ensure Quality Care
This list suggest how patients and family members can become partners in their own healthcare and help to ensure quality outcomes.
Developed by the Institute for Family-Centered Care
http://www.ramcampaign.org/pages/documents/TopTentoEnsureQualitycare_000.doc

Guide to Health Care Quality: How to Know It When You See It
The tips presented here are provided to help patients take on a more active role in making decisions about their own healthcare.
Developed by the Agency for Healthcare Research and Quality (AHRQ). http://www.ahrq.gov/consumer/guidetoq/guidetoq.pdf

A Guide for Patients and Families: Improving Health Care Quality
This guide presents information and lists resources to help patients and families receive better quality healthcare.
Developed through a cooperative effort by the agencies of the Department of Health and Human Services.
http://www.ahrq.gov/consumer/qntlite/qntlite.pdf

20 Tips to Help Prevent Medical Errors
A fact sheet that provides practical advice to help prevent medical errors in hospitals, clinics, doctors' offices, outpatient surgery centers, nursing homes, pharmacies, and the patient's own home. Developed by the Agency for Healthcare Research and Quality (AHRQ). http://www.ahrq.gov/consumer/20tips.htm

5 Steps to Safer Health Care
This fact sheet tells consumers what to do to obtain safer healthcare. Developed by the Department of Health and Human Services in partnership with the American Hospital Association and the American Medical Association. http://www.ahrq.gov/consumer/5steps.htm

Quick Checks for Quality
Handy checklists for choosing health plans, doctors, hospitals, long term care, and treatments. Developed by the Agency for Healthcare Research and Quality (AHRQ). http://www.ahrq.gov/consumer/quick.htm

Now You Have a Diagnosis: What's Next?
Guide to help those diagnosed with a serious illness or chronic condition find research and other information that can help make the best treatment decisions.
Developed by the Agency for Healthcare Research and Quality (AHRQ). http://www.ahrq.gov/path/beactive.htm

Remaking Missouri Medicine: Guide to Quality Health Care
Contains information, tips, and resources on topics including Being a Patient, Chronic Disease Management, Caring for Seniors, and Access for All.
Developed by KETC in St. Louis and Primaris, Missouri's Quality Improvement Organization, and its statewide coalition. http://www.ketc.org/productions/remakingmed/RMMBooklet.pdf

Eight "Quick Tips" for Consumers
Contains eight "quick tips" for consumers, addressing: medication management, how to talk to healthcare providers, patient safety in hospitals, resources for the underinsured, chronic disease management, and how patients should communicate with family members. Developed by WFYI in Indianapolis, working with Health Care Excel, the state's Quality Improvement Organization, and its statewide coalition.
http://www.ramcampaign.org/pages/RAM-PBS_Deliverable_WFYI-8_TIPS.htm

Viva la Vida! Controle Su Diabetes / Live Your Life! Control Your Diabetes
A bilingual patient education booklet designed to help Latino Medicare beneficiaries take charge of their diabetes care and live their lives to the fullest. Contains information for caregivers and family members. The booklet contains easy-to­follow instructions for disease management and is fully illustrated with easy-to-read graphics. Available in both Spanish and English. Developed by Lumetra, the Quality Improvement Organization for California.
http://www.lumetra.com/resource-center/index.aspx?id=538

Next Steps after Your Diagnosis: Finding Information and Support
Next Steps after Your Diagnosis offers general advice for people with almost any disease or condition. It also has tips to help patients learn more about a specific problem and how it can be treated. Available in both Spanish and English. Developed by the Agency for Healthcare Research and Quality (AHRQ). http://www.ahrq.gov/consumer/diaginfo.htm

Having Surgery? What You Need to Know
Questions to ask the doctor and surgeon to help patients and family members understand more about a planned surgical procedure. Developed by the Agency for Healthcare Research and Quality (AHRQ). http://www.ahrq.gov/consumer/surgery/surgery.htm

Brave New Home: Changing the Culture of Nursing Home Care
A consumer guide for viewers of a local PBS series on nursing home culture change. Provides discussion topics and resources to help viewers understand more about transformational change and to help them find skilled care for loved ones in nursing home settings. Developed by Qualis Health, the Quality Improvement Organization for Idaho and Washington. http://www.qualishealth.org/upload/BraveNewHomeGuide.pdf

Remaking American Medicine View more information and series air times on LPB: Press Release.

Remaking American Medicine
National Coalition Members

AARP: The American Association of Retired Persons (AARP) is a nonprofit, nonpartisan membership organization dedicated to making life better for people 50 and over. We provide information and resources; engage in legislative, regulatory and legal advocacy; assist members in serving their communities; and offer a wide range of unique benefits, special products, and services for our members.

Agency for Healthcare Research and Quality: The Agency for Healthcare Research and Quality's (AHRQ) mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. Information from AHRQ's research helps people make more informed decisions and improve the quality of health care services.

Read the latest news from AHRQ in the "What's New"

section of their Web site.

AcademyHealth: AcademyHealth is the professional home for health services researchers, policy analysts, and practitioners, and a leading, non-partisan resource for the best in health research and policy. AcademyHealth promotes interaction across the health research and policy arenas by bringing together a broad spectrum of players to share their perspectives, learn from each other, and strengthen their working relationships.


Alliance of Community Health Plans: ACHP helps its members lead their communities in providing affordable, high-quality care and coverage that offers outstanding value for the health care dollar and provides a platform to improve health care nationally. It's mission is to promote the highest standards of health care quality and health improvement through collaborative learning, innovation and advocacy.

American Academy of Orthopaedic Surgeons: The American Academy of Orthopaedic Surgeons (AAOS) provides education programs for orthopaedic surgeons, allied health professionals and the public. The Academy also serves as an advocate for improved patient care, medical liability reform, and increased Federal funding for musculoskeletal research. AAOS is the world's largest medical association of musculoskeletal specialists, serving approximately 28,000 members internationally.

American Academy of Pediatrics: The American Academy of Pediatrics (AAP) and its members dedicate their efforts and resources to the health, safety and well being of infants, children, adolescents and young adults. The AAP has approximately 60,000 members in the United States, Canada and Latin America. Members include pediatricians, pediatric medical sub-specialists and pediatric surgical specialist

American Association of Colleges of Nursing: The American Association of Colleges of Nursing (AACN) is the national voice for baccalaureate, master’s and doctoral degree nursing programs in the U.S. Representing more than 590 member institutions, AACN works to improve the quality of our nation’s health care by preparing a well-educated nursing workforce. The association works to establish quality standards for baccalaureate and graduate nursing programs, influence the nursing profession to improve health care, and promote public support for professional nursing education, research, and practice.

American Cancer Society: The American Cancer Society (ACS) is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and service.

American College of Physicians: The American College of Physicians (ACP) is the nation's largest medical specialty society. Its mission is to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine.

American College of Surgeons: The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients.

American Diabetes Association: The American Diabetes Association is the nation's leading nonprofit health organization providing diabetes research, information and advocacy. Founded in 1940, the American Diabetes Association conducts programs in all 50 states and the District of Columbia, reaching hundreds of communities. Find out what is happening in your area. The mission of the Association is to prevent and cure diabetes and to improve the lives of all people affected by diabetes.


American Health Quality Association: The American Health Quality Association (AHQA) is a charitable, educational, not-for-profit national membership association dedicated to health care quality through community-based, independent quality evaluation and improvement programs. AQHA represents Quality Improvement Organizations (QIOs) and professionals working to improve the quality of health care in communities across America.

American Health Quality Foundation: The American Health Quality Foundation (AHQF) is the non-profit, charitable, educational affiliate of The American Health Quality Association. The Foundation works on a portfolio of activities that support the present and future work of the Quality Improvement Organizations (QIOs) for Medicare beneficiaries and others. In addition, AHQF conducts research and educational activities in a number of areas, including health policy and health care quality improvement methods. A priority of the Foundation is to facilitate national level partnerships to facilitate meaningful health care quality improvement in local communities across the nation.

American Heart Association: The mission of the American Heart Association (AHA) is to reduce disability and death from cardiovascular diseases and stroke. The American Heart Association is vested in influencing and contributing to the quality of care and health outcomes that impact communities today and in the future. AHA is committed to advancing the prevention, diagnosis and treatment of cardiovascular patients, ultimately reducing disability and death from heart disease and stroke.

American Hospital Association: The mission of the American Hospital Association (AHA) is to advance the health of individuals and communities. AHA is the national organization that represents and serves all types of hospitals, health care networks, and their patients and communities. Founded in 1898, AHA provides education for health care leaders and is a source of information on health care issues and trends.

American Nurses Association: The ANA is the only full-service professional organization representing the nation's 2.9 million registered nurses through its 54 constituent member nurses associations. The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public. ** Visit the Connect with Others database to get information about state chapters of the American Nurses Association

American Organization of Nurse Executives (AONE): Founded in 1967, the American Organization of Nurse Executives (AONE), a subsidiary of the American Hospital Association, is a national organization of over 5,000 nurses who design, facilitate, and manage care. Its mission is to represent nurse leaders who improve healthcare. AONE members are leaders in collaboration and catalysts for innovation. AONE's vision is "Shaping the future of healthcare through innovative nursing leadership."

American Osteopathic Association: The goal of the American Osteopathic Association (AOA) is to organize the efforts of individual physicians and colleges to advance the osteopathic medical profession. The AOA's mission is to advance the philosophy and practice of osteopathic medicine by promoting excellence in education, research, and the delivery of quality, cost-effective health care within a distinct, unified profession.

Amgen Foundation:The Amgen Foundation seeks to advance science education; improve patient access to quality care; and strengthen the communities where Amgen staff members live and work. Since 1991, the Foundation has made $70 million in grants to local, regional and national nonprofit organizations that impact society in inspiring and innovative ways. It has also supported disaster relief efforts both domestically and internationally.

Association of American Medical Colleges: The Association of American Medical Colleges (AAMC) is a non-profit association founded in 1876 to work for reform in medical education. The AAMC has as its purpose the improvement of the nation's health through the advancement of medical schools and teaching hospitals.

Association for Community Affiliated Plans: The mission of the association is to improve the health of vulnerable populations through the support of Medicaid-focused community affiliated health plans committed to these populations and the providers who serve them.

Buyers Health Care Action Group: The Buyers Health Care Action Group (BHCAG) is a coalition of public and private employers working to recreate the health care system so consumers will get the care they need in the right place, at the right time and at the right price. They develop purchaser strategies and seek out consumer information tools that promote a safe, timely, efficient, effective, equitable and patient-centered health care system.

Center for Health Care Strategies, Inc.: The Center for Health Care Strategies (CHCS) was established in 1995 to improve the quality of health and health-related services for beneficiaries of our nation's health coverage safety net -- Medicaid and the State Children's Health Insurance Program. The core of CHCS' work is to identify and demonstrate best practices in Medicaid-managed care.

Centers for Disease Control and Prevention: The Centers for Disease Control and Prevention (CDC) is one of the 13 major operating components of the Department of Health and Human Services (HHS), the principal agency in the United States government for protecting the health and safety of all Americans. CDC has remained at the forefront of public health efforts to prevent and control infectious and chronic diseases, injuries, workplace hazards, disabilities, and environmental health threats. CDC applies research and findings to improve people’s daily lives and responds to health emergencies—something that distinguishes CDC from its peer agencies.

Centers for Medicare & Medicaid Services: The Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services, administers the Medicare program, and works in partnership with the States to administer Medicaid, the State Children's Health Insurance Program (SCHIP), and health insurance portability standards.

Grantmakers in Health: Grantmakers In Health (GIH) is a nonprofit, educational organization dedicated to helping foundations and corporate giving programs improve the nation's health. Its mission is to foster communication and collaboration among grantmakers and others, and to help strengthen the grantmaking community's knowledge, skills, and effectiveness.

HRET - American Hospital Association: The goal of the Health Research and Educational Trust (HRET) is to advance ideas and practices beneficial to health care practitioners, institutions, consumers and society at large. Its principal activities focus on identifying, exploring, demonstrating and evaluating key strategic health care issues affecting innovative health care delivery systems, educating the field about the implications of changing health policies and developing strategies for community health improvement.

Institute for Family-Centered Care: The Institute for Family-Centered Care is a non-profit organization that provides leadership to advance the understanding and practice of patient- and family-centered care. By promoting collaborative, empowering relationships between patients, families and health care providers, the Institute facilitates patient- and family-centered change in health care settings, serving individuals of all ages and their families.

Institute for Healthcare Improvement: The Institute for Healthcare Improvement (IHI) is a not-for-profit organization driving the improvement of health by advancing the quality and value of health care. Its mission is to improve the lives of patients, the health of communities, and the joy of the health care workforce. IHI's goals are for health care for all with no needless deaths, no needless pain or suffering, no helplessness in those served or serving, no unwanted waiting and no waste.

Institute for Safe Medication Practices: The Institute for Safe Medication Practices (ISMP) is a nonprofit organization recognized worldwide as the premier education resource for understanding and preventing medication errors. ISMP has nearly 30 years of experience in helping keep patients safe, and continues to lead efforts to improve the medication use process. ISMP also provides timely medication safety information to the healthcare community, policy makers, and the general public.

Joint Commission on Accreditation of Healthcare Organizations: The mission of the Joint Commission on Accreditation of Healthcare Organizations is to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations. The Joint Commission evaluates and accredits more than 15,000 health care organizations and programs in the United States.

Mid-America Coalition on Health Care : The Mid-America Coalition on Health Care (Coalition) is an employer-driven organization bringing together the region’s healthcare delivery stakeholders (physicians and medical societies, health plans, hospitals, unions, pharmaceutical companies, academic institutions and bi-state governmental units) to address the rising costs of health care and improve the health and wellness of employees and all residents of the Kansas City area.

National Alliance for Hispanic Health: The National Alliance for Hispanic Health is the nation's oldest and largest network of Hispanic health professionals. The nation's action forum for Hispanic health, Alliance members deliver caring services to over 14 million persons every year making a daily difference in the lives of Hispanic communities. For more information, visit the Alliance's web site: http://www.hispanichealth.org/ or call 1-866-SU-FAMILIA.

National Association of Children's Hospitals and Related Institutions: NACHRI is a not-for-profit organization of 181 children's hospitals, large pediatric units of medical centers and related health systems throughout North America. NACHRI promotes the health and well-being of all children and their families through support of children's hospitals and health systems. NACHRI works to ensure access to health care for all children and to ensure that children's hospitals' continue to provide services needed by children.

National Association for Home Care and Hospice: NAHC is the nation's largest trade association representing the interests and concerns of home care agencies, hospices, home care aide organizations, and medical equipment suppliers. Simply put, NAHC is the one organization dedicated to making home care and hospice providers lives easier.

National Association of Public Hospitals and Health Systems: The National Association of Public Hospitals and Health Systems represents over 100 hospitals and health systems that together comprise the essential infrastructure of many of America's largest metropolitan health systems. The association has made significant strides in educating decision makers about the unique needs of and challenges faced by member hospitals and the nation's most vulnerable populations.

National Business Coalition on Health: The National Business Coalition on Health provides expertise, resources, and a voice to its member coalitions across the country and represents each community coalition at the national level. As a "coalition of coalitions," the NBCH spreads the tenets and practical applications of Community Health Reform to areas where employers have yet to organize their purchasing power. For five years, NBCH has pursued national purchasing initiatives to offer turn-key health care products and services to community coalitions and their member employers. The NBCH is dedicated to making the coalition movement the vehicle for meaningful change in the health care system throughout the United States.

National Business Group on Health: The National Business Group on Health, is the only national non-profit organization exclusively devoted to representing the perspective of large employers and providing practical solutions to its members' most important health care problems. Business Group members are primarily Fortune 500 companies – including the nation's most innovative health care purchasers – who provide health coverage for more than 45million U.S. workers, retirees, and their families. The Business Group fosters the development of a quality health care delivery system and treatments based on scientific evidence of effectiveness.

National Coalition on Health Care: The National Coalition on Health Care is the nation’s largest and most broadly representative alliance working to improve America’s health care. The Coalition, which was founded in 1990 and is non-profit and rigorously non-partisan, is comprised of almost 100 organizations, employing or representing about 150 million Americans. Members are united in the belief that we need – and can achieve – better, more affordable health care for all Americans.

National Governors Association : The National Governors Association (NGA) is the collective voice of the nation's governors and one of Washington, D.C.'s, most respected public policy organizations. NGA provides governors and their senior staff members with services that range from representing states on Capitol Hill and before the Administration on key federal issues to developing policy reports on innovative state programs and hosting networking seminars for state government executive branch officials.

National Health Council : The National Health Council promotes the health of all people, and supports and advocates on behalf of the voluntary health movement. Since its founding in 1920, the National Health Council has established itself as a dynamic forum for policy development — the place where all segments of the health care community meet for reasoned discussion and persuasive advocacy. Today, the Council has grown to more than 115 member organizations representing many areas of health care.

National Hispanic Medical Association: The National Hispanic Medical Association (NHMA) is a non-profit association representing 36,000 licensed Hispanic physicians in the United States. The mission of the organization is to improve the health of Hispanics and other underserved populations.

National Initiative for Children's Healthcare Quality (NICHQ): NICHQ is an education and research organization dedicated solely to improving the quality of health care provided to children. Founded in 1999, NICHQ's mission is to eliminate the gap between what is and what can be in health care for all children. A national organization with its home office in Boston, NICHQ also has offices in Vermont and Washington State. Led by experienced children's health care professionals, NICHQ works to improve children's health care independently and by working in collaboration with others who share this goal.


National Medical Association: The National Medical Association (NMA) is the largest and oldest national organization representing African-American physicians and their patients in the United States. It is committed to improving the quality of health among minorities and disadvantaged people through its membership, professional development, community health education, advocacy, research and partnerships with federal and private agencies.

National Organization of Nurse Practitioner Faculties: The National Organization of Nurse Practitioner Faculties (NONPF) is the only organization specifically devoted to promoting quality nurse practitioner (NP) education at the national and international levels. Starting in 1974 as a small group of educators meeting to develop the first NP curriculum guidelines, NONPF has evolved as the leading organization for NP faculty sharing the commitment of excellence in NP educations. Today, the organization represents a global network of over 1350 educators.


National Partnership for Women & Families: The National Partnership for Women & Families is a nonprofit, nonpartisan organization that uses public education and advocacy to promote fairness in the workplace, access to quality health care, and policies that help women and men meet the dual responsibilities of work and family. Working with business, government, unions, nonprofit organizations, and the media, the National Partnership is a voice for fairness, a source for solutions, and a force for change. Visit NPWF's RAM Web page

National Quality Forum: The National Quality Forum (NQF) is a not-for-profit membership organization created in 1999 to develop and implement a national strategy for healthcare quality measurement and reporting. It does so chiefly by endorsing measures of healthcare performance that, by virtue of NQF's unique, transparent, and rigorous Consensus Development Process, have special legal standing as national voluntary consensus standards.

The Henry J. Kaiser Family Foundation: The Henry J. Kaiser Family Foundation is a non-profit, private operating foundation focusing on the major health care issues facing the nation. The Foundation is an independent voice and source of facts and analysis for policymakers, the media, the health care community, and the general public. KFF develops and runs its own research and communications programs, often in partnership with outside organizations. The Foundation is not associated with Kaiser Permanente or Kaiser Industries.


The Robert Wood Johnson Foundation: The Robert Wood Johnson Foundation® (RWJF), is the largest philanthropy devoted exclusively to health and health care in the United States. RWJF seeks to improve the health and health care of all Americans. RWJF prioritizes grants into four goal areas: to assure that all Americans have access to quality health care at reasonable cost; to improve the quality of care and support for people with chronic health conditions; to promote healthy communities and lifestyles and to reduce the personal, social and economic harm caused by substance abuse - tobacco, alcohol, and illicit drugs.

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Will proposed legislation help rein in costs or create arbitrary caps that hinder agencies in delivering services?

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