Pa. health care cost council takes political hit

The Pennsylvania Health Care Cost Containment Council - nationally known for reporting on the quality and cost of medical care across the state - is now itself in critical condition.

Despite wide support from business and labor unions, nearly all of the council's 43 staff members have been terminated due to a political tussle between Gov. Rendell and Senate Republicans over two unrelated disputes - giving uninsured Pennsylvanians access to affordable coverage and subsidies of part of doctors medical malpractice insurance.

At the last minute, language to extend the malpractice subsidy was inserted into the Senate bill reauthorizing the council, known as PHC4.

But the governor has said he would not extend that subsidy, called the MCARE abatement, until the Legislature passes a bill that provides affordable insurance to more of the state's 800,000 uninsured adults.

"What happened here is that the Senate added language to the bill reauthorizing the council that they knew that the governor could not and would not support," said Chuck Ardo, Rendell's spokesman. "The governor would be more than willing to sign a clean bill if one were to reach his desk."

That might not happen. The standoff continued yesterday when the Senate passed a bill including both a reauthorization of PHC4 and an extension of the MCARE abatement through 2009.

"At this point, our position is that both programs have proven to be valuable and both should be extended, and we are optimistic that House leaders will allow for a vote," said Erik Arneson, a spokesman for Senate Majority Leader Dominic Pileggi (R., Delaware County).

Arneson noted that in 2003, a similar issue arose and PHC4 was not reauthorized until July 17. At the time, however, no one was laid off and the agency stayed open as Rendell and legislators negotiated a deal.

"This is an unnecessary stunt by the governor and a very unfortunate one," Arneson said.

Rendell administration officials countered that in 2003, the General Assembly and governor worked through the summer on a budget. This year, legislative leaders have stated that they plan to go into recess until mid-September.

"We will be here if they want to come back and pass a clean bill," said Donna Cooper, Rendell's policy director.

Yesterday, only a skeleton crew of five staffers remained at PHC4 to protect more than two decades of sensitive health records on patients stored in the agency's computers. The agency, which has a $5 million budget, was formed in 1986.

It was unclear if this contretemps marked the agency's death knell or just another round of brinkmanship between the governor and the Senate.

Still, news of the imminent demise of an agency whose work has been copied and built on by many other states and national agencies rippled through the small community of health-care-quality experts.

"They have done some of the most creative work in the country in using hospital administrative to report on quality and safety," said Anne Elixhauser, senior research scientist at the agency for Health Care Research and Quality, the lead federal agency on medical quality. "To see this organization go down like that is mind boggling."

In 1992, the council issued a report on heart-bypass surgery that showed how well patients fared by hospital. Four years later, it issued a first-of-its-kind report on heart attacks, and a decade after that, made Pennsylvania the first state to report on infections patients contracted under hospitals care.

The effort to report on so-called hospital acquired infections led to a lawsuit, from the Hospital and HealthSystems Association of Pennsylvania, asserting that the agency's data collection was flawed. The suit was rejected.

Even so, the hospital group yesterday said it supports the reauthorization of PHC4 with some changes.

"We are trying to make sure that the reporting is aligned with other reporting requirements for instance on the federal level," said Melissa Speck, senior director of regulatory advocacy for the association.

Others counter that Pennsylvania would be ceding its leadership position in health-care data as other states and the federal government are looking to extend its work.

"It would be very hard to contend that Pennsylvania is still a leader in public accountability for quality and value in health care without the council," said David B. Nash, chairman of the department of health policy at Jefferson Medical College and chair of the agency's advisory board.

Carolyn Clancy, director of the Agency for Healthcare Research and Quality, said:

"PHC4 has been ahead of the curve in understanding how to use data generated by health care to help policy makers learn where they can get the most bang for the buck and where to target their efforts to improve quality and safety."