Last week a delegation of nearly 100 Leadership Health Care members visited Washington, D.C., to meet with policymakers about all things health care. The two hottest topics were, of course, accountable care organizations and health care IT, according to LHC Director Judith Byrd. But the various speakers and panelists touched on an array of issues around implementing the health care reform legislation how it will shape the nation's health care delivery system.

One of the most valuable aspects of the trip was the fact that, because the same group of people attended every session together, the conversation among them was able to build throughout the two-day trip, said Michele Peden of Iasis Healthcare. 

"It continued the conversation and led to deeper learning," she said.

Jim Lackey, who serves as the liasion between the boards of LHC and the Nashville Health Care Council, said it's enlightening to see the "inner workings" of Washington and how difficult it is to get thigns done.

"They are all good people who are really trying," Lackey said of the Tennessee delegation, which met with LHC members as part of the trip. He added: "You also realize that although Nashville thinks it runs the business of healthcare, the folks on the hill have a ton of control."

The healthcare compact bill came out of a House Health subcommittee.

Rep. Mark White explains:

“It will allow us to draw all the money the federal government will give us anyway Just draw it down in a big grant, a big block And then we figure it’s right around twenty-two billion dollars we would just take that money and design our own health care program.”

The idea is similar to one coming out of Washington to save trillions of dollars. In a budget proposal put forward by Republicans Tuesday, block grants are used to cut costs and give states more autonomy in running their Medicaid programs.

As for the state legislation, Tennessee Democrats oppose the health care compact, calling it an attack on President Obama’s health care reform. The bill now goes to the House Health Committee.

One year ago today, Joe Biden said a bad word into a hot mic, and the President signed health-care reform bill into law. The Tennessean hits you with a pro, a con and another pro in celebration.

This time, they are pushing legislation to create an interstate compact to supplant Medicaid, Medicare and all other federal health care programs. Under this bill, states in the compact would run the programs as they see fit with their shares of federal money — $16 billion in Tennessee’s case. “Other states are joining us in this effort,” said Senate Judiciary Committee chair Mae Beavers, R-Mt. Juliet, the bill’s sponsor. “An interstate health care compact is a powerful vehicle for states to confront the federal health care law.” Beavers said her bill “essentially provides a permanent waiver for each member state to create whatever health care regulations the legislature deems best for the citizens of that state.” She envisions “a secure funding stream and maximum flexibility for state legislators” that “will create the conditions for multiple solutions to emerge to the health care crisis.”

State Senate Speaker Ron Ramsey says different states need different approaches to health insurance. He says Tennessee has much more in common with neighbors like North Carolina and Virginia than with states like California . “And it’s not a one-size-fits-all, all across the nation. I think if you have these compacts of like-minded, like-interest states, it would be a much better program than having a one-size-fits-all pushed down from the federal government.”

“While previous studies have demonstrated a reduction in readmissions based on the capacity of hospitals and clinics to provide supplemental discharge counseling, this study demonstrates that the same effect can be achieved through efficiently scaled and delivered telephonic interventions,” said James E. Pope, M.D., Chief Science Officer, Healthways. “These findings clearly indicate that timely discharge follow-up by telephone to supplement standard care is effective at reducing near-term hospital readmissions, thus providing a means of reducing costs for health plans and their members.”

While AMSG trades at a discounted valuation and is favorably leveraged to a recovery in health care service volumes, DB continues to believe the fundamental outlook in the ASC space remains challenging due to excess capacity and weak pricing power.

So Cooper sits while federal police powers gather. Cooper sits while the freedom to buy or not to buy is threatened. Cooper sits while a $1 trillion unfunded mandate from ObamaCare comes closer day by day. State Sen. Mae Beavers, R-Mt. Juliet, plans to reintroduce the Tennessee Health Freedom Act when the Legislature reconvenes, but, because of separation of powers, Cooper likely cannot be forced to join other state attorneys general in their challenge of ObamaCare. And that exposes a curious quandary for Tennessee. Cooper is accountable to no one. Tennessee's attorney general is appointed by the state Supreme Court, a court dominated by Democrats because of the General Assembly being controlled by Democrats for a century or so and Democratic Gov. Phil Bredesen's appointment of four of the five justices. Cooper's eight-year term doesn't expire until 2014 and voters have no recourse to remove him. The people of Tennessee made clear their minds in November when they gave Republicans commanding control of state government. Gov.-elect Bill Haslam and Lt. Gov. Ron Ramsey support legal challenges of ObamaCare. The state Senate and the new House will surely resist ObamaCare's unbridled exercise of police powers. Cooper should fight for Tennesseans. Or resign.

The Community Health offers are the clearest indication yet that the federal health overhaul law is accelerating a wave of consolidation within the hospital industry. That wave started before President Barack Obama signed the sweeping legislation in March, but it is kicking into high gear as hospitals try to prepare for sweeping changes in the way they coordinate treatments for patients and work with doctors. The law aims to redesign the medical system so that hospitals and other health-care providers are paid for providing coordinated care to patients instead of for every test and operation they perform. Because of this, hospitals say, it makes sense to buy up other hospital groups and doctors' practices to make it easier to provide an umbrella care organization. Hospitals are also trying to buffer the hit they expect from the law's steep government payment cuts and from the coming threat of a more consolidated health-insurance industry. Being bigger will give them more power to negotiate the prices insurers pay them.