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'Aiming Higher' with Mark McClellan

JULY 29, 2005 -- It was not your typical Mark B. McClellan speech. The CMS administrator has been described as the consummate staffer, a person with an unmatched ability to sweat all the small stuff needed to make something big happen but one who never makes himself the story and whose speechifying accordingly is more detail and less driving vision.

But in a speech Thursday to the National Press Club, McClellan not only ventured into the personal, but also struck a bipartisan theme that allowed him to simultaneously doff a cap to the Democratic founders of Medicare and Medicaid and quietly convey that Republicans could run them better, while criticizing the programs in their current state as bloated with inefficiency.

The occasion was the 40th anniversary of the two programs, and McClellan's theme was setting loftier goals. He credited President Lyndon Johnson with achieving his goal of ensuring the dignity of elderly Americans with the creation in 1965 of Medicare. "But at 40 years old, Medicare needs to aim higher than that," McClellan said. "We can keep the promise of dignity, but we aim higher in helping you get much better health," he said.

'Swollen Feet . . .'
In that vein, McClellan recalled his frustration practicing internal medicine before joining the federal government. "I can remember one patient, really nice guy, breathing heavily with swollen feet, who showed up on one of my emergency room shifts with complications from heart failure.

"We got him stabilized, gave him a few free samples of drugs, and I remember looking at him as we were about to send him on his way. I just knew he wasn't going to fill the prescriptions I gave him—and he didn't have drug coverage.

"And I wasn't sure it would matter even if he did—he told me that before he came in, he hadn't taken his medicines because he wasn't sure what they were for, and he had forgotten what he was supposed to do if he started to gain a little weight or notice a little swelling. And he had just eaten some really salty pizza and had a smoke.

"I looked at him . . . and thought to myself, this doesn't have to happen. If only someone could explain to him, in terms that work for him, why his diet and exercise . . . matter so much with heart failure. If only someone could help him understand why he needed to take each of his medicines, and the early signs of his heart getting worse and what to do if that happened.

". . . All of this might be prevented, and that kind of support would have been much cheaper. But I had a patient with a bleeding ulcer in the next room, and I had to go."

Aiming high not only consists of new drug and screening benefits but also giving patients "effective support so . . . they can take the necessary steps to maintain and improve their health" using those benefits, McClellan said. As a step in that direction, he announced a pilot program called "Medicare Health Support," which would prevent complications such as the ones that brought his heart failure patient to the ER.

The project aims to educate heart failure and diabetes patients about how they can practice better preventive care, issue reminders and make home visits to keep them on track, and more efficiently manage their care through electronic medical records. "It's important to note that heart failure and diabetes account for most Medicare costs," McClellan said.

. . . Bloated Medicare
With modern medicine, "Medicare and Medicaid can help provide better, more innovative care for less. We are failing to do this now. When 50 percent of our beneficiaries do not get recommended preventive care, and over 45 percent do not get proven effective care for their illnesses, we are spending much more than we should on preventable complications."

McClellan cited other statistics illustrating inefficiencies in Medicare. For example, he said program spending is at least 30 percent more than it needs to be because doctors practice medicine differently around the country. Other research says that more than 30 percent of seniors get prescriptions that make them sicker. "We simply can't keep doing this and have a Medicare program that is up to date and sustainable," he said.

McClellan also announced a program, the Surgical Care Improvement Project, that aims to reduce preventable surgical complications by 25 percent by 2010.

"Among the 42 million operations performed in the U.S. each year, up to 40 percent have complications after the operation," he said. "If we . . . eliminate just 1 percent of inefficient care in overall Medicare spending over the next five years, we can improve patient access by increasing payment rates to physicians by 1.5 percent each year instead of cutting the rates."

A Poke at the Press Corps
Under considerable pressure from the moderator, a more personal side of McClellan—or rather of his family—emerged in other ways at the National Press Club event.

After sidestepping a request to compare Presidents Bush and Bill Clinton as bosses (McClellan advised the latter on Medicare drug coverage), he was asked to explain how he deals with criticism of his brother, Scott, the White House press secretary, and his mother, Carol Keeton Strayhorn, a Republican politician trying to unseat current GOP Texas Gov. Rick Perry.

"They do a very good job of not taking this sort of thing very personally," he replied. Less so his six-year-old twin daughters, he said, relating an anecdote about them watching the White House press corp grill their uncle during a recent briefing. "One of them walked up to the television and punched one of those reporters," McClellan said.

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