Horizon, Host: Ted Simons

May 27, 2009


Host: Ted Simons

Healthcare Reform

  |   Video
  • The president and CEO of Scottsdale Healthcare talks about health care reform and Health for Life.
Guests:
  • Tom Sadvary - President and C.E.O., Scottsdale Healthcare


View Transcript
Ted Simons:
President Barack Obama wants to reform our nation's healthcare system to make healthcare more affordable and make sure everyone is insured. Next week those issues will be addressed at a forum sponsored by the Arizona hospital and healthcare association. Here to tell us more, Tom Sadvary, president and C.E.O. of Scottsdale healthcare, thanks for joining us on Horizon.

Tom Sadvary:
Thanks, Ted. Happy to be here.

Ted Simons:
Healthcare must be reformed. Does everyone agree on that?

Tom Sadvary:
I think there's general consensus, Ted, that healthcare does need reform but there's obviously varied opinions as to how it happens. Healthcare reform discussions actually started many years ago as far back as Harry Truman's presidency. And I think the fact is that there's a lot of good things going on in healthcare right now, relative to excellent care givers, improvements in technology, quality of care is improving, life expectancy is improving, but there are obviously some major issues. Primarily in the area of costs that keep going up, the fact that there's over 40 million people in the country that have no health insurance, and the fact that there's some outcomes that are not what they should be in this system.

Ted Simons:
So how do you ensure quality in a reformed system? Another way of putting this is how do you make sure you do no harm?

Tom Sadvary:
Well, the first thing to do is to make sure that we have a great educational system, because it ultimately ends up as being one patient at a time. So whether it's a nurse, a phlebotomist, physician, or any other care giver we have to make sure we're training the best people in the best way. Secondly I think we have to hold all the care givers accountable for results, and to try to get towards evidence based practice as much as possible, realizing that it's difficult to do a one size fits all when you're caring for patients. And lastly I think we have to be transparent. I think every care giver needs to be very transparent to the individual patient and to show the results and to get the consumer involved in his or her own healthcare as well.

Ted Simons:
You mention training people in the best way possible. Is that happening now?

Tom Sadvary:
I think for the most part yes. I'm very proud of the medical schools, the nursing programs that we have both in Arizona as well as nationwide. The issue is that there are not enough of them. And the bottleneck, for example, in the state of Arizona where we have about 1500 men and women who have taken the prerequisites for nursing school is in the number of faculty. And the hospitals have worked in a collaborative manner with the community colleges as well as state universities but funding is an issue, so we need to understand that this is all about talent and quality of care is based on what's happening at the bedside with individual poem.

Ted Simons:
You also mentioned increasingly uninsured folks out there, how big of a problem is that?

Tom Sadvary:
It's a huge problem, Ted, there's over a million people in this state that are uninsured and over 40 million in the country. And that's a problem because it often denies access to healthcare services for these people or they often wait until they're so sick that they need an emergency department and that's not good for anybody at that point, if they are not taking care of themselves and not seeing the doctor when they need to.

Ted Simons:
Your other concern that you mentioned was rising healthcare costs. Again, how big of a problem is that, and in this economy especially, talk about that particular dynamic.

Tom Sadvary:
Sure. Well, the issue of the economy has hit all of us in many ways and with patients having to pay more money out of pocket because of high deductibles or co-payments; it often provides a barrier to access for care. So, for example, when the economy was going well and a patient has to pay several hundred dollars or a thousand dollars out of pocket for a healthcare service, that was not a big of a deal as much as it is now, and people are worried about every penny, and we understand that some patients are delaying elective care, but some patients are delaying the care they really need.

Ted Simons:
All that put together, does reform need to be radical? Does it need to be quick? How's the best way to reform?

Tom Sadvary:
Well, that's actually the $64,000 question, because I've heard that the incremental way of reforming healthcare is what was tried in the past and did not work. So it seems to me that the Obama administration and Congress is looking more at a big bang theory of healthcare reform and frankly I think the healthcare systems and with the forum that we're sponsoring next week with the American hospital association, sets out a platform of five reform initiatives that I think if implemented will really help and we call it not necessarily transforming care but or not reforming care but transforming the healthcare delivery system we provide throughout the country.

Ted Simons:
We have the website information for more information on the forum next week, which should be very informative. I want to get back to the first do no harm business. It seems as if radical change is needed, a lot of the players are on board, how do you make sure what comes out the reform is better? Is an improvement?

Tom Sadvary:
That's an excellent question, and I think part of it is for whatever reform system happens, to continue to focus on the individual patient as well as systems of care to give the care givers the best workplace for them to do their work. And I think part of the reform, Ted, has to be in making sure that individual patients understand the need for -- to take care of themselves and to have some incentives for wellness and to make sure that our primary care givers primarily our family doctors are first of all sufficient supply and making sure that there's a direct connection between those physicians and the individual patient. We also have to make sure that we are all transparent in terms of what we do on a quality basis and that we work together. We often see how doctors and hospitals compete. We talked about the medical arms race, but we believe there are also ways we can collaborate on safety initiatives and quality initiatives so that we can learn together and produce a better outcome for all of our patients.

Ted Simons:
It's interesting you bring that up because some folks see that competition as one of the reasons why America develops so many promising drugs and promising treatments and the more collaboration you get, the less invention you get. Is that a viable argument do you think?

Tom Sadvary:
I don't think so. I think collaboration is generally very, very good between hospitals, between research entities and it's interesting because innovation is so critical and it really starts at the bench research and translating that into clinical research as well, and I think frankly if you look at the results of what has happened in terms of patient outcomes, just look at cancer, for example, many forms of cancer that 10 or 15 years ago were fatal 80% of the time, now can be cured 80 to 100% of the time if they're treated in the right way.

Ted Simons:
All right. Very good. Thank you so much for joining us, again that forum will be Monday and again we had the website up there so folks who want more information on that are encouraged to look it up themselves.

Tom Sadvary:
Great, thank you very much.

Ted Simons:
Thank you.

Tom Sadvary:
Ok.

Legislative Update

  |   Video
  • Arizona Capitol Times reporter Jim Small has the latest legislative news from the state capitol.
Guests:
  • Jim Small - Arizona Capitol Times


View Transcript
Ted Simons:
Good evening and welcome to Horizon. I'm Ted Simons. This week lawmakers have been working in special session, calmed by the governor, to expand Arizona's corporate income tax credit program to help disabled and foster kids attend private schools. Joining me to talk about that and other legislative news is Arizona Capitol Time's reporter Jim Small. Jim, good to have you here, thanks for joining us.

Jim Small:
Thanks for having me, Ted.

Ted Simons:
House and senate decides this is ok legislation, correct?

Jim Small:
Yeah. They approved the bills today. The house passed their bill then the senate had an identical bill so they just voted on the house measure, passed along party lines, this is a debate we've had at the capitol for several years now surrounding the issues of voucher programs and tax credits and things like that. And you know, it got a little emotional at times and a little heated certainly back and forth, but ultimately this is something that passed and it's something that will be signed by the governor.

Ted Simons:
Let's talk again now exactly what this legislation does.

Jim Small:
Yeah, what it does is currently in law there's an existing tax credit program where individuals and corporations can give money to what are called student tuition organizations, and these are groups of basically funneling contributions, using them to create scholarships for private schools. This kind of expands that program and creates more or less a parallel program that is identified strictly for children who are in foster care and for disabled students who aren't having their needs met in public school. The purpose of this is to replace a voucher program where the state actually paid the private school tuitions for these students that was implemented two years ago in March, the state supreme court struck it down as unconstitutional and violated part of the state institution so this is the workaround to it. The tax credit mechanism upheld years ago.

Ted Simons:
Critics, Democrats are saying the state still is essentially paying for these folks by way of tax credits.

Jim Small:
Yeah, and they can say that, but the fact is the supreme court has said that this is legal to do because technically it's not state revenue, because it never goes from the taxpayer into the state treasury. It goes from the taxpayer to another organization to the students and so in one respect it's an issue of semantics, but, you know, that's what it is.

Ted Simons:
This was put on the fast track because they wanted to make sure this money was in the hands of these parents and kids in time for school?

Jim Small:
Yeah, that's the idea. It's not going to go into effect until 90 days after the special session ends, which was today. And so what that means is, you know, you're looking in late August at this point, so if they'd done it in the regular session we don't know when that's going to end. We're hoping near the end of June, but that puts you at the end of September, school's already started. These kids are kids that are currently in this program that are already going to private schools where, you know, their parents want them to go, would have to enroll in public school and wouldn't be able to go to the private schools.

Ted Simons:
You mentioned it got emotional down there. Sounds like things got a little testy at times. What's going on? Who was saying what and who was getting upset?

Jim Small:
Well, you know, this is a program that is certainly not liked by Democrats. And there was a lot of talk about how this was taking money, on the small group of children who are disabled while at the same time republicans are putting out budget proposals that are cutting -- making deep cuts into social services and healthcare services for disabled people. And then, you know, conversely you had republicans making the argument that look, these are kids, how can you not help these kids that need this help, you know, how can you vote no, against a program like this, where, you know, these parents have said we want to do this for our kids and the state has the ability to do it.

Ted Simons:
When Democrats would say this is now taking more money out of the general fund at a time when, you know, it needs all the money it can get, how do Republicans respond?

Jim Small:
The response is that these tax credits are capped at or the scholarships excuse me, to the students, are capped at 90% of what would be paid for that student to go to a public school. So, you know, they look at it and say look, if it's only 90% of the money they're going to get if they go to public school, this is actually a savings for the state and even though the money's not going into the general fund it's less to spend on education.

Ted Simons:
Governor likely to sign this?

Jim Small:
Yeah this deal was negotiated between leaders in the house, senate, and governor's office, so I have several expectation she'll sign it.

Ted Simons:
Democrats, correct, they're going to have a budget proposal relatively soon?

Jim Small:
Tomorrow morning actually 10:00 they're having a press conference, a joint budget proposal from the house and senate Democrats. They released the house Democrats released about a month ago, month and a half ago, and senate Democrats released a list of options prior to that as well and this is kind of the first time they're both going to be on the same page and the Democrat leaders said last week that they feel that they're going to be able to with this package that they will have more support for this package than republicans do for theirs.

Ted Simons:
Will they have enough support from a republican or two, or will they have enough with this package to be power brokers in any way, shape, or form down there?

Jim Small:
I doubt that right now. You know, we're still giving it another two or three weeks, it's no major progress has been made on the republican leadership side, you may start to see some republicans venturing into the territory of the Democrats for this, but I think right now it's really just a way for them to put something out and say look, we're doing what we're supposed to be doing. We have our own plan, here's why we think its better.

Ted Simons:
Before we let you go, I know you wrote about independent campaign committees out of the republican leadership. What is happening here?

Jim Small:
House speaker Kirk Adams and senate president Bob Burns have created their own kind of caucus campaign committees that they want to use to help expand the reach of republican legislators and get more elected. It's a bit of an odd move, independent of the state republican party, doesn't really have ties to them. Generally the state republican party will spend money supporting candidates in legislative races. It's an interesting issue, some people, critics are saying well, it's a way to try to divert money around the republican party because there's a lot of political strife, you know, within the republican party regarding the chairman and, you know some establishment people who aren't really happy with him, you know, but we talk to Randy, chairman of the republican party last week, and he said he's been aware of this and supports it and the idea is for these committees to work kind of cooperates with the republican party.

Ted Simons:
Have these kinds of committees worked elsewhere in the country? Is this something new for Arizona?

Jim Small:
It's not super new for Arizona, I mean, this was around 20 years ago, but campaign finance laws have been changed significantly since then and really kind of decrease's effectiveness of these kinds of committees. Other states have similar things and, you know, by all accounts they certainly work well and, you know, people who have been around Arizona politics for a long time will know that Burton Barre ran this kind of committee for the house republicans and wielded power with it.

Ted Simons:
But clean elections and matching funds put a new wrinkle, correct.

Jim Small:
Yes, and not only that, campaign contribution limits where every person can only give a certain at of money aggregate for the entire years, like $5,800 a think for a year. State republican and democratic parties can raise money ad infinitum, as much as they want, someone could write a $600,000 check and it doesn't affect those limits.

Ted Simons:
Jim thanks for joining us. Appreciate it.

Jim Small:
Thank you.

Residential Utility Consumer Office (RUCO)

  |   Video
  • When utilities ask the Arizona Corporation Commission for permission to raise rates, RUCO goes to work to protect the interests of residential electric, natural gas, telephone and water utility ratepayers. Learn more about this state agency and what it does to protect Arizona citizens from excessive utility costs.
Guests:
  • Jodi Jerich - Director, RUCO (Residential Utility Consumer Office)


View Transcript
Ted Simons:
Most of us don't have a close when it comes to the company that provides our electricity or water. And if you're stuck with a utility, you're also stuck with their rates, but as David Majure reports one state agency is looking out for you when utilities try charge you more.

David Majure:
The cost of water keeps rising for Paradise valley resident Janice Stony. In recent years she's watched the water company try to raise rates on more than one occasion.

Janice Stony:
We certainly have, and they're coming more frequently these days.

David Majure:
Now she's fighting another attempt.

Janice Stony:
The initial rate increase request was 39%.

David Majure:
Like all consumers, Janice wants to pay a fair price for her water, and she's pleased to know that the residential utility consumer office or RUCO is watching her back.

Dan Pozefsky:
Our purpose is to represent the ratepayers, in doing that our purpose is not necessarily to get the cheapest rate, although we obviously are looking towards getting a reasonable rate.

David Majure:
State regulated utilities including water, natural gas, and electric companies can't automatically raise their rates. They need approval from the Arizona corporation commission.

Dan Pozefsky:
They seek to increase their rates usually because of infrastructure costs or other type costs that have gone up.

David Majure:
First the utility must file an application for a rate increase, then they have to justify it.

Commission Member 1:
Good afternoon, everyone. Welcome back to the commission.

David Majure:
That takes place in hearings before one of the commission's administrative law judges.

Dan Pozefsky:
The process similar to the way it is in a court proceeding.

Commission Member 2:
There are a variety of reasons why the document should be excluded.

David Majure:
The utility presents its testimony and other documents as do interveners in the case.

Dan Pozefsky:
Good afternoon, Your Honor, Dan Pozefsky on behalf of RUCO.

David Majure:
RUCO is usually one of them.

Kris Mayes:
You need a diversity of opinions here at the commission. You need multiple organizations arguing cases in front of the commission, and if you don't have that, then I think you have, you know, you have a much less balanced system, RUCO balances the equation for consumers.

David Majure:
RUCO was established by statute in 1983 at a time when that balance may have tipped toward utilities.

Kris Mayes:
Yeah, in fact, there was a period in I believe the 1970s and 1980s where there was a view that the commission wasn't doing enough for consumers and so that's when the legislature created RUCO. It was back in the period when large expenditures were being made by utilities, the nuclear plant was very controversial, and I believe it was then that the idea for RUCO really got started.

Commission Member 1:
Does that answer the concerns for all the parties?

David Majure:
After hearing all the evidence, the judge makes a recommendation to the corporation commission which ultimately sets the utility's rates.

Kris Mayes:
This is the open meeting of the Arizona corporation commission.

David Majure:
At an open meeting, commissioners consider the judge's recommendation as well as input from parties such as RUCO.

Kris Mayes:
I value it hugely.

David Majure:
Chairman Kris Mayes says RUCO has a tremendous impact on cases heard by the commission.

Kris Mayes:
All of the recent A.P.S. rate cases, the recent gold canyon sewer case, in which RUCO came in and said you know what? This rate increase request is way too high. They were right. I agreed with them. And we ultimately passed amendments that lowered that rate increase.

Dan Pozefsky:
We've had a number of cases where I think we've been very effective and persuasive in getting the commission to see things our way. Ultimately they resulted in really millions and millions of dollars over the years since I've been here and I have seen it, millions of dollars that have gone to the benefits of ratepayers.

David Majure:
Ratepayers like Janice, who's hoping her water rates remain reasonable.

Janice Stony:
Hopefully in the end with all of that input in the process, why sanity will prevail.

Ted Simons:
Joining me now is Jodi Jerich, director of RUCO, the residential utility consumer office. Thanks for joining us on Horizon.

Jodi Jerich:
Thank you, thank you for having me.

Ted Simons:
As far as taking cases, when does RUCO intervene and how is that determined?

Jodi Jerich:
Well, Arizona law tasks RUCO with representing Arizona families and individuals before the corporation commission when regulated utilities go before that body, asking to increase rates that are paid by the customers. And the corporation commission has a very full plate in all the dockets that they have to consider and RUCO does not have the means available to intervene in every case. So what we do is we intervene in the very large rate cases and those cases where a utility is asking for either a very large amount of increase or is asking for a change in public policy that would be a new issue to be considered by the commission.

Ted Simons:
So when the utility asks for a relatively large increase and says here's why xyz, and you look at that and say that's large enough for us to take a look at ourselves.

Jodi Jerich:
That's right. RUCO has a staff of financial analysts and we go and audit the books of these utilities and look to see if their numbers are jiving with what is -- with what is reasonable and what the consumer needs to ensure reliable and safe drinking water, reliable electricity and natural gas and telecommunications services.

Ted Simons:
How long would a typical case last that you get involved in?

Jodi Jerich:
You know, it depends on the complexity of the case, but generally about 12 to 18 months.

Ted Simons:
Ok. When you have I don't know if this works, correct me if I'm wrong, but you have different ratepayers on the same case looking for different reactions, different results. First of all, does that happen and if it does, how do you handle it?

Jodi Jerich:
You are absolutely right. You have different people and different interested parties intervening in cases, you have a utility, you have commission staff that participate and you might have interest represented by -- that represent businesses or industrial users and then you'll have RUCO who represents individuals and Arizona families and each one has competing interests and we present our best arguments before the corporation commission and the commission decides which way to vote.

Ted Simons:
Interesting. Now, do you take complaints directly from consumers?

Jodi Jerich:
No. The commission has a very able bodied staff of consumer services department and so when people have complaints about their service, of -- they go directly to the corporation commission to file those complaints.

Ted Simons:
Ok and you kind of take it over from there.

Jodi Jerich:
We are involved primarily in rate cases and in formal dockets, not individual complaints.

Ted Simons:
How is RUCO funded?

Jodi Jerich:
We are, well, first off we have an annual budgets of a little over a million dollars and reared fund's from assessments on large utilities.

Ted Simons:
All right. And as far as -- again, correct me if I'm wrong, but aren't most of these types of agencies associated with attorney general offices and those sorts of things, and this is not necessarily the case in Arizona.

Jodi Jerich:
That is correct. In 1983 the legislature created the Arizona residential utility consumer office, and it is an office that is run by a director and that director is appointed by the governor and serves in her cabinet and is subject to senate confirmation. In other states it is very common to have a people's advocate that is an arm of the attorney general's office that will argue before their public utilities commission, and we argue before the constitutionally created corporation commission.

Ted Simons:
Ok. Last question here, everyone's looking at renewables as the future here. How does RUCO -- talk to us about that. Because the financing of renewables is such a major aspect.

Jodi Jerich:
You know, I believe that public officials and public opinion have clearly signaled that they want Arizona to be in the vanguard for renewable energy development and renewable energy generation, and RUCO fully supports the development of renewable energies to have clean green energy home grown in Arizona. But I say that with the caveat that RUCO wants every dollar that is spent for renewable energies to be used to its maximum effect, get the best bang for the buck from the money that ratepayers pay toward renewables.

Ted Simons:
It's going to be an interesting dynamic, isn't it?

Jodi Jerich:
Yes, it is.

Ted Simons:
Thanks for joining us, we appreciate it.

Jodi Jerich:
Thank you for having me.

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