According to a report late last year from the National Committee for Quality Assurance, the quality of health care improved in 2007 for millions of Americans, but "significant variations in performance continue to leave many people receiving substandard care."

While the report did not cover Amador County specifically, it does note that health care varies widely in rural areas.

So how is Amador County doing?

Local nurses report the major problem here is the lack of enough general practitioners, termed internalists. "We are under-served and under-funded," said registered nurse Susan Wahlstrom. "People have to travel too far to a clinic for a physician. A big issue is that insurance companies like Blue Shield and CalPers don't include us in their service area."

Local RN Lynette Monroe agreed. "We need more internists, but because we have an elderly population, and Medicare and Medi-Cal limit the fees they cover, many doctors won't come here, especially with the astronomical cost of malpractice insurance, sometimes as high as $150,000."

However, Judy Boetzer, public relations specialist for Sutter Amador Hospital, highlighted the recent arrival of two physicians, pediatrician Amy Appleton and family practice physician Catherine Leja, who will be working out of the Plymouth family practice office. Sutter Amador also has family practice offices in Jackson and Pioneer.

Keeping score

About hospital care, Boetzer said Sutter Amador is "doing better than most," pointing to the data that comes from patients who are mailed surveys after they have been discharged. "We (and Sutter Health as a whole) voluntarily choose to publicly report these scores," she said.

And, in fact, www.hospitalcompare.hhs.gov shows Sutter Amador's ratings in various areas/services compare favorably with a large HMO like Kaiser Permanente, for example. Both Sutter Amador and Mark Twain St. Joseph's Hospital in San Andreas show higher scores of patient satisfaction than Kaiser. On how well doctors and nurses communicate with their patients about medication and ongoing treatment, the two smaller hospitals earned 72 percent approval ratings, compared with Kaiser's 61 percent.

Regarding information given for recovery at home, Sutter Amador scored higher than either, 82 percent satisfaction compared to Kaiser's 75 percent. All three hospitals evidently need to work on explaining medication to patients before giving it, since only 50 percent of patients who took the survey expressed satisfaction. In overall satisfaction, nearly 70 percent of Sutter Amador patients gave the hospital a rating of nine or 10 on a scale of 10. Only half of Kaiser patients did so.

Insurance shortcomings

According to the NCQA report, while quality improved for most people in private health insurance plans nationwide, there was little improvement in the care delivered to those enrolled in Medicare and Medicaid, the nation's two largest public health care programs.

"Eliminating variations in the delivery of evidence-based care across the health care system could save up to 88,000 lives each year," the report concludes. According to Boetzer, there is no difference in the care given to Sutter Amador patients with differing insurance providers.

Medicare and Medi-Cal do not earn high marks in the NCQA report, which shows improvements on only 44 of 54 measures of health care quality. One area of notable improvement was the rate at which Medicare beneficiaries were kept on life-saving beta-blocker drugs six months after suffering a heart attack; another was delivery of childhood immunizations.

One unsettling trend found in the report is the overuse of antibiotics for adults with acute viral bronchitis. In 2005, NCQA began measuring the overuse of these drugs in adults and children. In that first year, nearly two thirds of adults with acute viral bronchitis were prescribed an antibiotic, despite the fact that such drugs have no effect on that condition. In 2007, that rate rose to 75 percent. "Such inappropriate care wastes vital health care resources and contributes to the rise of drug-resistant bacteria, threatening the health of patients and communities," the report states. Interestingly, health plans and physicians appear to be doing a better job with children; inappropriate use of antibiotics in that age group was between 15 and 25 percent.

Reforming health care

NCQA urges policy makers to include three important elements in any health reform bill: 1. Require routine quality measurement and reporting by all health plans and providers; 2. Establish benchmarks for improvement in each region of the country to reduce variations in care quality; and 3. Enact reforms that tie payment to the quality of care delivered by plans and providers.

Sutter Amador CEO Anne Platt recently shared some of her personal views on reform with the Ledger Dispatch.

"The topic of health care reform is so broad that I would need much longer to formulate a thorough response," she said. "I believe that our health care system needs to assure access, quality and affordability for our citizens. I believe that no person should be denied necessary health care services because of their inability to pay. I also believe that access to care is a shared responsibility of our community, including all health care organizations, providers, government agencies, community groups and the private insurance market. I also think patients need to take more responsibility for management of their care by receiving education about their chronic conditions and being compliant with their care plans. I think that payment mechanisms should include incentives to improve quality and that all providers should have similar incentives to promote more collaboration and partnership in the provision of care."

There is a growing body of professionals who differ radically from the status quo. For example, when the Ledger Dispatch asked Gloria St. John, MA, MBA, Sutter Creek homeopathic practitioner and author of "From Doctor to Healer: The Transformative Journey," she was quick to discuss personal responsibility.

"What could improve health care? The most important shift that would improve health status would be for every individual to take responsibility for his/her own health and well-being - from the youngest child to elders," she said. "This shift would be in direct contrast to the current trend toward medicalizing the entire life cycle from pre-conception to death. Under this plan, health care would become a daily task of disease prevention, commitment to proactive healthy behaviors and, when needed, self care, using natural therapies, without the side effects of drugs.

"Individuals would be central in meeting their own health needs," she continued. "They would then use the medical care system of professionals, tests and institutions as consultants to their own self-designed program. This approach would result in a much more engaged and healthy population - preserved from the ill effects of the thoughtless use of household and environmental toxins, emotionally balanced through physical, mental, and spiritual practices, and enjoying enhanced health through good diet, herbs, homeopathy, Chinese medicine and naturopathic therapies."

The State of Health Care Quality 2008 is available on NCQA's Web site, http://www.ncqa.org/sohc. Information about St. John's book can be found at www.goldhillshomeopathy.com.