Address of Tommy G. Thompson
Secretary of Health and Human Services
to the Health Forum Leadership Summit
sponsored by the American Hospital Association
and the International Hospital Federation

Thank you, Dick (Dick Davidson, President of AHA), for that kind introduction. And it's great to see you again. I would like to thank you and Dr. Yeoh (Dr. E.K. Yeoh, President of the International Hospital Federation, and Secretary of Health, Welfare, and Food in Hong Kong) for inviting me to address you. I would also like to thank Dennis Barry and David Bernd for their service, and Mayor Brown and Humphrey Taylor for their comments.

I'm pleased to join the Americans in the audience in welcoming foreign health and hospital officials to the United States. I appreciate you making the trip, and I know we have much to learn from many of you. And I hope you will pardon me while I tell my fellow Americans how proud I am of the role America's hospitals play in providing high-quality research and in preventing, treating, and curing disease. Thank you all for your service.

As great as our health care system is, my friends, you know and I know that it can be even better. We have a vision for health care that builds on our strength: competition in a free economy. In our vision, physicians can focus on the quality of their care, not the quantity of their paperwork. In our vision, state governments can have more flexibility under Medicaid to deliver care in efficient ways and to offer benefits to those in need.

You chose to work in health care because you want to keep people healthy. I became Secretary of Health and Human Services to make sure government makes your job easier, not harder.

Over the past two years, through waivers and state plan amendments, we have already expanded access to health coverage for more than 2.2 million people, and expanded the range of benefits offered to 6.7 million other Americans. We have also proposed tax-based supports to help low-income Americans purchase health insurance.

We know that the more information and choices people have, the healthier they are. This afternoon, I want to talk about how we are working to give people more and better information and more choices so they can preserve and improve their health. And I am going to ask for your help.

Thanks to your hard work, the treatment Americans get in hospitals has grown dramatically better. Unfortunately, the way we treat our bodies day to day is getting worse.

I think you are familiar with the scope of the problem:

• 125 million American suffer from one or more chronic illnesses.
• 64% of adults are overweight or obese.
• obesity is the fastest growing cause of disease and death.
• At least 16 million Americans have Type 2 diabetes. That's almost one out of every 20 people. At least 16 million more have pre-diabetes.
• Obesity aggravates hypertension, which contributes to the number one cause of death in this country: heart disease. In 2002, heart disease had a negative economic impact of $214 billion - including $115 billion in direct medical costs.

My goal as Secretary is to do everything I can to ensure that Americans are strong, healthy, and independent. So I spread the word about prevention every chance I get. I also started the Steps to a Healthier-US initiative to engage others in spreading the word. We encourage people to eat better, to exercise, to stop smoking, and to avoid risky behaviors.

Let's face it: some of us are restrained eaters, and some of us aren't. And given the abundance of foods-including fast foods-from which we choose every day, everyone who's not a restrained eater is eating too much. And people who want to eat better need accurate information about their food choices.

Last month, we gave consumers better information by requiring food manufacturers to list trans fat on food labels.

Earlier this week I convened a summit of obesity experts. One of the scientists at the summit pointed out that many Americans have a hard time making sense of food labels and using them to develop a healthy diet. I have directed the FDA health claims task force to make recommendations on making food labels easier to understand so Americans can eat better and live better.

Last month I spoke to the food industry in Chicago, and I found it very receptive to my message. I have met with fast food companies, and many of them are taking encouraging steps. Some examples are:

• Kraft Foods recently announced it is eliminating all marketing in schools. It is also going to make its product line healthier.
• Recently, I met with the CEO of Coca-Cola. I am pleased to tell you that Coke is
• Adding healthier beverages to its product line.
• Moving away from exclusive pouring contracts with big dollar advance payments.
• And putting nutritional information on vending machines in schools.
• Unilever is eliminating trans fatty acids from its margarine.
• Dole Food Company is bringing health messages of fruits and vegetables to its consumers. Yesterday, they ran a full-page ad in numerous national newspapers.
• And, just this week, I met with Pepsi.
• Pepsi's "better for you" and "good for you" products account for 43% of its sales.
• In addition, they are producing their Frito Lay salty snack foods with no hydrogenated oils, which of course are trans fats.
• Kraft, Coke, Unilever, Dole, and Pepsi are all good examples of companies taking Steps to a HealthierUS. And I encourage other companies to follow suit.

I'd like to enlist all of you as well. First, get good health information to your employees and their families. Encourage them to eat right and exercise, and make it convenient for them to make it a habit. Ask them to choose their food carefully. Encourage them to reduce their consumption of cholesterol, saturated fat, and trans fat. And don't smoke.

As hospitals, you give health information and advice to countless people every day. So after you give the prevention message to your employees, enlist them in encouraging your patients as well.

We also want to make health care more affordable, and one way to do that is regulatory reform. One of my first acts in January 2001 was give my Advisory Committee on Regulatory Reform the mission of finding ways to make it easier for hospitals and other providers to provide health care while still maintaining high standards. The Committee sent me its final report a few months ago, and we have already fully implemented 35 recommendations and partially implemented another 35. And we are working on even more.

We've streamlined paperwork requirements in the Minimum Data Set form for nurses and other clinical staff who care for Medicare beneficiaries in nursing homes. And, we've cut in half the time needed to complete the Medicare Assessment Form.

We received your comments on EMTALA-over 600 of them. We are finalizing the new EMTALA regulation. It's just common sense in every emergency room that doctors should be saving lives, not filling out paperwork. I know many of you are very excited about this pending change, and I can tell you it will be worth the wait. These are just a few examples of our work to make regulations more sensible.

We haven't left this report on the shelf. We are implementing its recommendations to relieve the burdens on your industry without sacrificing the quality of care you provide.

We also want you to be fairly paid for the great work you do. As you know, we just announced that in October we will increase Medicare inpatient payment rates by 3.4 percent. This is the full market basket increase, for only the second time since 1983.

You deserve it. After all, you deliver great care, and more people need to know how great it is. And we're helping there, too. I want to thank the AHA for working with HHS to develop our hospital quality initiative-the voluntary reporting initiative. I also want to thank those of you who have agreed to participate. Together, we will give consumers convenient and objective measures they can use when choosing a hospital. With the same data, we will help hospitals identify where you can improve to compete for more patients.

Of course, a great way to improve quality is by preventing errors. The Institute of Medicine estimates that 45,000 to 98,000 Americans die each year because of medical errors. Even more Americans are disabled and need care to address health problems caused by medical errors.

By adding the cost of disability, lost income, lost productivity at home, and the costs of additional care needed because of medical errors, the Institute estimates that these preventable medical errors cost between $17 and $29 billion a year.

Our Agency for Healthcare Research and Quality has developed a special set of patient safety indicators that can help hospitals reduce medical errors for all of your patients. Obviously, no one wants to think about occasions like this, but of course we have to confront them in order to prevent them. I think I speak for everyone here when I say, We are confronting medical errors, and we are determined to prevent them.

We also want to encourage doctors, hospitals, and other experts to speak frankly and work together to improve quality, without increasing your exposure to frivolous lawsuits. That's why the President and I have strongly supported Patient Safety Organization legislation for a year and a half.

I congratulate the Senate HELP committee for a approving a very strong bill 20-0 last week. This bill would help doctors and hospitals to improve quality.

But doctors and hospitals are not the only ones who can help prevent errors. Patients can play a role, too, by asking good questions, and staying informed about their health and their treatments. And I'm pleased to announce this afternoon that we are showing them how to do that.

As you know, when doctors ask patients what medications they're taking, and what dosage, both the doctor and the patient get frustrated when the patient can't remember. And when a patient leaves a medical appointment confused or mistaken about what to do next, that confusion can lead to errors.

In order to reduce the risks that patients may face in the course of receiving health care services, I am proud to present the 5 Steps to Safer Health Care information campaign.

We developed it in partnership with the AHA and the American Medical Association, and I want to thank both of them for their cooperation.

This poster will help. Imagine you are a patient in a waiting room and you see this.

1. Ask questions if you have doubts or concerns.
2. Keep and bring a list of all the medicines you take.
3. Get the results of any test or procedure.
4. Talk to your doctor about which hospital is best for your health needs.
5. Make sure you understand what will happen if you need surgery.

The posters and fact sheets should help patients avoid errors related to prescription medicines, laboratory tests and procedures, and surgery. I want to encourage every doctor and every hospital to make this information available to patients. The simplest thing to do is just hang this poster in waiting rooms. It will remind patients to collect their thoughts and plan the questions they need to ask the doctor or the nurse. And everyone involved in health care will be armed with better, more accurate information.

Our quality initiative, our patient safety indicators, our patient safety organizations, our 5 Steps campaign will all help prevent medical errors. When errors do happen, we can agree that patients should be compensated fairly.

But if you could find a goal in the current medical liability system in most states, that goal would obviously not be either the prevention of errors or fair compensation for injury. As a result, average jury awards have doubled from $475,000 in 1996 to $1 million in 2000. And medical liability premiums have skyrocketed.

This is a national problem that requires a national solution.

Under our proposal, injured patients would collect full actual, out-of-pocket damages--not unlimited non-economic damages.

We would enact key procedural reforms:

• elimination of joint and several liability
• uniform statute of limitations
• collateral source rule reform
• and reasonable limits and court approval of attorney contingency fees.

I'm pleased that the Senate debated our reform, and I'm disappointed that allies of the trial lawyers filibustered the bill. I hope the Senate will reconsider. Trial lawyers should not be driving good doctors out of medicine.

I want to thank your industry for the way you handled the April 14th deadline for the HIPAA privacy rule. You told me you had concerns, I told you we would respond, and we did. You had the same concerns we had: protecting the privacy of patients without interfering with prompt delivery of care. We took your concerns to heart, and the rule is better because of our dialogue. We were able to improve the way regulations balance these goals, and we couldn't have done it without your excellent input.

I also want to thank you for the work many of you have already done to prepare for the October 16 deadline for filing electronic claims. Many of you are already able to submit compliant claims, and many others are nearly there.

But we all know there is much work to be done. The testing numbers are lower than we would like. We've been doing extensive outreach to help you catch up. CMS.gov has reams of useful information. We've also issued an advisory to help you if you're not there yet. The best way to make sure you get paid on time is to work with your health plans-including Medicare, vendors, and clearinghouses-and test, test, test.

I appreciate the amount of work involved, and I want to assure you that your cooperation will make our health care system more efficient and more effective.

But I want to tell that our goal is not to punish hospitals who are working hard toward compliance. If you are making a good faith effort, we are not going to punish you for missing the deadline.

We must also improve the systems in which our hard-working, dedicated health care professionals provide care and services. To do so, we should focus on increasing the use of informatics and other tools; enhancing communication between frontline caregivers and all members of the health care team; and using evidence-based interventions in medical care and health promotion.

At HHS, we have already taken a number of key steps. Let me tell you about a few of them:

• The FDA has proposed a new rule for bar coding medications. This will improve patient safety by allowing information systems to reduce preventable medication.
• We're making a common medical language available to all members of the health care community-free of charge. We have signed a licensing agreement with the College of American Pathologists to allow free use of its standardized medical vocabulary system, SNOMED.
• I am pleased to announce that this week the Institute of Medicine provided HHS with recommendations on the design of a standardized model of an electronic health record. In cooperation with the Veterans Administration, we have asked the HL7 standards development organization to evaluate this model.
• With a new investment of $50 million (in FY04), our Agency for Healthcare Research and Quality will work with the Indian Health Service and other agencies to demonstrate how more robust information technology systems can improve care for some of our most vulnerable Americans, urban or rural. We will also call on the strength of the free market through partnerships with providers, purchasers, and IT vendors.

So far I have talked about how we can improve the care we give routinely. But we must also be prepared for crisis. Our hospital system, with the help of our great scientists at CDC, handled the SARS outbreak extremely well, and I thank you. One of the things we learned from the SARS affair was the importance of hospitals and your personnel being prepared for outbreaks.

I want to make it clear that the risk of an intentional outbreak of smallpox has not changed. That's why it is time for hospitals to encourage your employees to get vaccinated for smallpox. Data from the US military experience in implementing this vaccination program show that there have been few bad reactions. In fact, most adverse effects occurred at rates well below historical rates. The data suggest that vaccination programs can be implemented with fewer serious adverse effects than we had thought.

We heard you when you asked to be exempted from liability for smallpox vaccinations, and we heard you when you asked for a compensation fund. We got $42 million this year for smallpox compensation. We have $515 million to improve hospitals' and emergency department's capacity to respond to bioterror and similar attacks, and we've asked Congress for $518 for next year. In addition to $940 million to improve State and local bioterrorism preparedness, Congress also provided a supplemental appropriation in April of $100 million to help States with any added costs associated with meeting their smallpox vaccination objectives.

Our responsibility to keep Americans strong, healthy, and independent is an awesome one. But our responsibility does not stop at the water's edge. You've heard of "dollar diplomacy?" Well I practice doctor diplomacy.

I went to Africa and saw the damage wrought by AIDS with my own eyes. The sorrow and the horror defy description - and, it sometimes seems, the powers of science. I knew we had to do more to fight AIDS.

I went to Afghanistan last year and was horrified by the medical treatment, particularly for pregnant women. I knew a little American help would go a long way.

And I'm happy to report that we are doing our part. You all know about the President's commitment to spend $15 billion to fight AIDS in Africa and the Caribbean. No American administration has ever invested more to combat this deadly disease.

One of the ways we are helping is by supporting the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria. I am chairman of this partnership, and I know how effective it is and will be in stopping the spread of AIDS.

Another way we are fighting AIDS is through twinning. By connecting hospitals in developed countries with those in developing countries, twinning provides better training and development of health care services.

All the medicine in the world -generic or not, re-imported or made locally - won't stem the sweeping tide of misery and suffering of AIDS unless doctors have the knowledge and skills that they need.

Twinning will increase the effectiveness of the resources of the Global Fund, messages such as the Ugandan ABC HIV prevention method, and the discoveries and innovations of our top scientists. We will restore hope where there is no hope and bring life to places in the shadow of death.

We believe that life and liberty are the fundamental birthright, not just of Americans, but of all mankind. Our sense of duty to our fellow man demands that we help others along the road to this same end.

We have already built a women's and children's health clinic in Kabul. And we're working to improve health care in Iraq as well.

Improving people's health, and in fact enlisting people in improving their own health and their families' health, is one of the greatest projects we can undertake. And the more choices and information we give people, the healthier they will be.

Thank you, all of you, wherever you work, for helping to improve the quality of health and the quality of life around the world.

Last Revised: August 5, 2003

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