Tuesday, July 31, 2012

Health Care Reform Articles-August 1, 2012

Medical Debt Collector to Settle Suit for $2.5 Million

Accretive Health, one of the nation’s largest collectors of medical debt, has agreed to pay $2.5 million to the Minnesota state attorney general’s office to settle accusations that it violated a federal law requiring hospitals to provide emergency care, even if patients cannot afford to pay.
The company has not admitted wrongdoing.
As part of Monday’s settlement, Accretive Health is also barred from contracting with hospitals within the state for at least two years, effectively ending its business at three Minnesota hospitals. For four years after that, the company will have to obtain permission from the attorney general before resuming business in the state.
In April, Lori Swanson, the Minnesota attorney general, disclosed hundreds of Accretive’s internal documents that outlined aggressive collection tactics, including embedding debt collectors in emergency rooms and pressuring patients to pay before receiving treatment.
Carol Wall, a 53-year-old Minnesota resident, said “a woman with a computer cart” told her she owed $300 as she was “vaginally hemorrhaging large amounts of blood” at an Accretive-affiliated emergency room in January, according to court records.
Another patient, Terry Mackel, 50, said he was asked to pay $363.55 at another Accretive-affiliated emergency room in Minnesota as he waited “alone, groggy and hooked up to an IV” waiting to see an emergency room doctor, according to court documents. Fearing that it was the only way to see a doctor, both patients paid.

More Treatment, More Mistakes

DOCTORS make mistakes. They may be mistakes of technique, judgment, ignorance or even, sometimes, recklessness. Regardless of the cause, each time a mistake happens, a patient may suffer. We fail to uphold our profession’s basic oath: “First, do no harm.”
According to a 1999 report by the Institute of Medicine, as many as 98,000 Americans were dying every year because of medical mistakes. Today, exact figures are hard to come by because states don’t abide by the same reporting guidelines, and few cases gain as much attention as that of Rory Staunton, the 12-year-old boy whodied of septic shock this spring after being sent home from a New York hospital. But a reasonable estimate is that medical mistakes now kill around 200,000 Americans every year. That would make them one of the leading causes of death in the United States. Why have these mistakes been so hard to prevent?
Here’s one theory. It is a given that American doctors perform a staggering number of tests and procedures, far more than in other industrialized nations, and far more than we used to. Since 1996, the percentage of doctor visits leading to at least five drugs’ being prescribed has nearly tripled, and the number of M.R.I. scans quadrupled.

In a twist, Romney lauds Israeli health care system

Health Care Reform Articles-JULY 31, 2012

Look Who’s Praising Socialized Medicine

MItt Romney’s inability to stay on script is really getting surreal. Today he lavished praise on the Israeli health care system, which has indeed done a fine job of controlling costs while maintaining high quality. But as everyone who knows anything about it quickly pointed out, the secret of Israel’s success is … intense government involvement. It’s a single-payer system; but unlike Medicare, it also sets a budget per capita (adjusted for health status), so that the nonprofit plans are in effect forced to set priorities for treatment and also negotiate hard over provider payments; think of it as price controls plus death panels.

Romney praises health care in Israel, where ‘strong government influence’ has driven down costs

By Sarah Kliff , Updated: 

Republican presidential candidate Mitt Romney had some very kind things to say about the Israeli health care system at a fundraiser there Monday. He praised Israel for spending just 8 percent of its GDP on health care and still remaining a “pretty healthy nation:”
 When our health care costs are completely out of control. Do you realize what health care spending is as a percentage of the GDP in Israel? 8 percent. You spend 8 percent of GDP on health care. And you’re a pretty healthy nation. We spend 18 percent of our GDP on health care. 10 percentage points more. That gap, that 10 percent cost, let me compare that with the size of our military. Our military budget is 4 percent. Our gap with Israel is 10 points of GDP. We have to find ways, not just to provide health care to more people, but to find ways to finally manage our health care costs.

Bill aims to curb health spending in Massachusetts

Allowable increases would be tied to growth of economy

By Liz Kowalczyk

  JULY 31, 2012
Legislative leaders announced a compromise Monday to tame soaring health care costs, setting the stage for Massachusetts to become the first state to ­establish a target limiting how much providers and insurers spend on medical care.
The plan — expected to be voted on by the House and Senate on Tuesday, the final scheduled day for passing legislation — would allow health spending to grow no faster than the state economy overall through 2017. For the five years after that, spending would slow further, to half a percentage point below the growth of the state’s economy, although leaders would have the power under certain circumstances to soften that target.

Penobscot Community Health Care joins effort to improve health of Medicare patients

Posted July 30, 2012, at 5:43 p.m.
BREWER, Maine — Penobscot Community Health Care is the latest Maine health organization to join a national effort that rewards doctors for keeping their patients healthy and happy.
PCHC announced Monday that it will join Eastern Maine Healthcare Systems’ “accountable care organization,” a group of providers tasked with better coordinating treatment for seniors covered by Medicare and saving taxpayer money.
Under the model, formalized under the federal health reform law, doctors and hospitals that show they have improved Medicare patients’ health and satisfaction get a cut of any savings in the form of bonus payments. Providers that don’t make the grade either forgo the extra money or pay a penalty.
“You don’t get any financial gain in an ACO unless the most important thing happens, which is you have to demonstrate that your patients are getting healthier and that there’s a very high level of satisfaction by your patients,” said Kenneth Schmidt, president and CEO of PCHC.
The new approach is designed to upend the existing system that pays health care providers based on the number of patients they see and the amount of services and procedures they order. The hope is that doctors, nurses and other providers will work together to keep better tabs on patients’ health.

Americans generally favor Medicaid expansion, but less so at home

Posted July 31, 2012, at 8:52 a.m.

Americans are broadly supportive of the health care law’s expansion of Medicaid to cover millions of uninsured people, according to a new poll. But they are less enthusiastic about expanding it in their own states after they realize state taxpayers will pick up some of the cost.
Last month the U.S. Supreme Court upheld most of the Affordable Care Act, but allowed states to opt out of the law’s plan to enlarge Medicaid, the state-federal health program for the poor. The law directed states to cover those earning up to 133 percent of the federal poverty level, or about $14,800 for individuals and $25,400 for a family of three, far above the levels currently covered by Medicaid in most states. Officials in several Republican states, including Florida, Louisiana and Texas, have said they don’t want to participate.

Saturday, July 28, 2012

Health Care Reform Articles-JULY 30, 2012

Medicare’s Birthday: Open Letter to the President and Leadership from Health Professionals, Lawyers and Advocates for Medicare for All

This Open Letter was published to honor Medicare’s 47th birthday. It comes on the heels of the Supreme Court upholding the Affordable Care Act and increasing threats to Medicaid and Medicare. The letter argues for the expansion of Medicare to all people in the United States and sees Medicare as the solution, not the problem.
Open Letter to the President and Leadership from Health Professionals, Lawyers and Advocates for Medicare for All
July 30, 2012
Dear Mr. President, Secretary Sebelius, Majority Leaders Reid and Cantor, Speaker Boehner and Minority Leaders McConnell and Pelosi,

Drug firm to pay Maine $1.4M for overcharging MaineCare

Posted July 27, 2012, at 2:35 p.m.
AUGUSTA, Maine — Maine will receive $1.4 million as part of a national settlement with a drug wholesaler accused of inflating prices for prescription medications and overcharging state Medicaid programs.
Maine Attorney General William Schneider on Friday announced Maine’s share of the $151 million settlement reached with McKesson Corporation, one of the country’s largest drug wholesalers. The settlement is with Maine and 28 other states.
“The state paid artificially high prices due to the manipulation of the drug reimbursement system by this corporation,” Schneider said in a press release. “Through this settlement, MaineCare will receive restitution for those excessive payments.”

Doctor Shortage Likely to Worsen With Health Law

RIVERSIDE, Calif. — In the Inland Empire, an economically depressed region in Southern California, President Obama’s health care law is expected to extend insurance coverage to more than 300,000 people by 2014. But coverage will not necessarily translate into care: Local health experts doubt there will be enough doctors to meet the area’s needs. There are not enough now.
Other places around the country, including the Mississippi Delta, Detroit and suburban Phoenix, face similar problems. The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.
Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans. It typically takes a decade to train a doctor.
“We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists,” said Dr. G. Richard Olds, the dean of the new medical school at the University of California, Riverside, founded in part to address the region’s doctor shortage. “We’ll have a 5,000-physician shortage in 10 years, no matter what anybody does.”

Medicaid After the Supreme Court Decision

Last week there were two disturbing reports about Medicaid, a program of health insurance for the poor that is mostly managed by the states and jointly paid for by the federal and state governments. The Congressional Budget Office predicted that states with a large number of poor people would not expand their Medicaid programs as required by the health care reform law now that the Supreme Court had made expansion optional. And a Harvard study unrelated to the court decision made it clear that a failure to expand Medicaid would likely doom thousands of low-income people to death or poor health.
Revising earlier estimates to take account of the decision, the budget office said that making expanded assistance optional could leave three million more people uninsured in 2022, saving the federal government $84 billion through 2022 because it would not have to subsidize their coverage.
The analysts made no effort to predict which states would or would not expand Medicaid. Instead, they looked at various factors that might influence the states’ decisions and predicted that some would not respond to even the extremely generous matching money that the reform law provided.

New Mass. law allows drug coupons for prescription drugs

If Obama loses the election, here’s why

By Drew Westen,

With 100 days left in the presidential campaign, perhaps the two most vexing questions in American politics are: How could President Obama possibly lose? And, how could he possibly win?
Americans are scared, angry and struggling. They used to talk about job satisfaction; now they talk about just holding on to their jobs. No incumbent since FDR has ever won reelection with unemployment numbers remotely resembling today’s. What voters feel about their lives and dreams in the months leading up to an election tends to stick to the president when they enter the voting booth. And right now what’s sticking to Obama isn’t good.
But it sure helps to face a candidate as uncomfortable in his own skin, as likely to say by accident what he really means and as wrong for the times as Mitt Romney. In an era when even conservatives are populists, enraged about the favors granted the rich and well-connected, Romney is running as a CEO who thinks his taxes are too high. Voters just aren’t warming up to a guy who enjoys firing people and attempts to woo the people of Michigan by referring to his wife’s “couple of Cadillacs.” If Obama offers what well-paid elites call a “jobless recovery,” Romney offers the only thing worse: a promise to restore the policies that led to the joblessness that made a recovery necessary.
So, beyond the anemic economy, why do the latest polls show the former Massachusetts governor in a dead heat with the president? Because Obama’s administration made three crucial errors that enabled the Republican obstructionism that has tied his hands for the past two years, with GOP leaders shooting down any idea — even if it’s one of their own — that might have helped the president strengthen the economy. And those mistakes have made possible what was unimaginable in January 2009: that a private-equity baron lacking a sense of noblesse oblige, and preaching the gospel of deregulation and lower taxes for the rich, might actually win the presidency four years after those policies led to the collapse of the U.S. economy.

Worries grow as healthcare firms send jobs overseas

Some healthcare companies are starting to shift clinical services and decision-making on medical care overseas, primarily to India and the Philippines.

By Don Lee, Los Angeles Times
5:00 AM PDT, July 25, 2012,0,4219801,print.story

New health-care incentives create happier Maine patients

Posted July 29, 2012, at 6:46 a.m.
To save money, doctors and insurance companies across the nation are dramatically changing the way they do business.
As a result, tens of thousands of Maine patients — Medicare, Medicaid and privately insured — are beginning to see a change in their relationship with their providers.
At the heart of it: Health care groups are putting greater emphasis on preventive medicine and paying more attention to patient safety and satisfaction. And the healthier and happier those doctors keep their patients, the greater their financial reward.
“We’re trying (to be) more proactive instead of reactive, health-focused rather than rescue-focused,” said Dr. Ned Claxton, medical director of Central Maine Healthcare‘s new accountable care organization and president of the medical staff.
Doctors currently earn money by the patient and the service provided. A 15-minute office visit, for example, nets doctors a certain amount. The more patients a doctor sees, the more money the doctor gets, regardless of whether those patients get healthier or sicker, are happy or unhappy with their care.
Health care reform’s Affordable Care Act requires Medicare this year to establish a shared-savings program with doctors to improve care and cut costs. Because healthy patients cost insurance less than sick ones, and preventive care costs less than crisis or chronic care, the idea was to give doctors an incentive to keep patients healthy by giving those doctors a piece of the savings.

Insurance Companies Gaming the System – Don’t Be Fooled

Has your insurance company called you recently to ask you to sign up for a wellness or disease management program?  Has that same company told you it’s a free service to policyholders and promised you that they do not share the information with the departments and people who administer your benefits and claims?  You – like me and millions of other Americans – are being scammed. 
Follow the money, my friends, and do not believe for one minute that the same company that would deny medications, health treatments and care to you would suddenly have your best interests at heart.  It’s the money.  It’s always been the money.
As soon as the Patient Protection and Affordable Care Act (PPACA) was passed, we were all told that finally the insurance companies would have to spend more of the premium dollars they collect on actual healthcare.  Look it up here for the nitty-gritty.
In short, The Kaiser Family Foundation writes, “The provision requires most insurance companies that cover individuals and small businesses to spend at least 80% of their premium dollars on health care (i.e. medical claims) and quality improvement, leaving no more than 20% for administration, marketing, and profit. Large group plans must spend at least 85 percent of premium dollars on health care. Insurers failing to meet these standards will have to pay rebates to consumers beginning later this year.”

OPINION: the cost of care for Colorado's victims [2]

One of the reasons Americans seem so willing to tolerate the fact that 50 million of us are uninsured and almost 30 million more of us are underinsured is that most of us who have coverage assume we are OK. That nothing truly catastrophic will happen to us, and that, even if it did, our insurance policies will pay our bills and keep us whole.
Who would think that a decision to go see a movie on a Friday night could change our lives—and the lives of our families—forever? That we or a loved one, even with what we believed was decent coverage, might become a victim of violence that could leave us not only disabled for life but also potentially bankrupt and homeless?
That random act of violence in Aurora, Colorado  earlier this month could have happened anywhere in America, of course—or in any other country, for that matter—but among the world’s developed nations, we live in the only one where the families of some of the injured would have to face begging for money to pay the doctors and hospitals and keep the sheriff and his foreclosure papers at bay.  Talk about American exceptionalism. This is one area where, sadly, we truly are unique.

The Entitled Generation

IF you were born before 1946 or after 1964, you are free to go. Kindly close the door on your way out. I need a private moment with my fellow baby boomers.
So. I imagine you’re all feeling a little unappreciated these days. We seem to have entered one of our periodic seasons of boomer-bashing. In rapid Op-Ed succession, we children of the postwar demographic bulge have been blamed for turning religion into an indulgent free-for-all, for giving elites a bad name and for making greed respectable, or at least acceptable. That’s just this month, and just on this page. And it’s not only conservatives beating us with the Woodstock whip. Kurt Andersen, a confessed liberal and one of our more prolific cultural omnivores, started the latest thumping July 4 with an argument that amoral self-gratification is just the flip side of social liberation: “Thanks to the ’60s, we are all shamelessly selfish.”
The notion that our generation has been spoiled rotten is not a terribly new thought. A dozen years ago Paul Begala (of Bill Clinton and CNN fame) published in Esquire the classic of boomer-loathing, “The Worst Generation.” “The Baby Boomers are the most self-centered, self-seeking, self-interested, self-absorbed, self-indulgent, self-aggrandizing generation in American history,” he declared. It’s a sturdy genre. Perhaps while Googling yourself you have come across the blog Boomer Deathwatch (“Because one day, they’ll all be dead”), a checklist of famous boomers who hit their actuarial sell-by dates. Even Barack Obama, who styles himself post-boomer though he was born in 1961, complained in “The Audacity of Hope” that today’s hyperpolarized political discourse began with the “psychodrama of the baby boom generation.”

Republicans vs. Women

Even with a persistent gender gap in a presidential election year, House Republicans have not given up on their campaign to narrow access to birth control, abortion care and lifesaving cancer screenings. Far from it.
A new Republican spending proposal revives some of the more extreme attacks on women’s health and freedom that were blocked by the Senate earlier in this Congress. The resurrection is part of an alarming national crusade that goes beyond abortion rights and strikes broadly at women’s health in general.
These setbacks are recycled from the Congressional trash bin in the fiscal 2013 spending bill for federal health, labor and education programs approved by a House appropriations subcommittee on July 18 over loud objections from Democratic members to these and other provisions.
The measure would bar Planned Parenthood’s network of clinics, which serve millions of women across the country, from receiving any federal money unless the health group agreed to no longer offer abortion services for which it uses no federal dollars — a patently unconstitutional provision. It would also eliminate financing for Title X, the effective federal family-planning program for low-income women that provides birth control, breast and cervical cancer screenings, and testing for sexually-transmitted diseases. Without this program, some women would die, and unintended pregnancies would rise, resulting in some 400,000 more abortions a year and increases in Medicaid-related costs, according to the Guttmacher Institute, a leading authority on reproductive health.

Health insurance mandate faces huge resistance in Oklahoma

By Published: July 29

OKLAHOMA CITY — The Supreme Court may have declared that the government can order Americans to get health insurance, but that doesn’t mean they’re going to sign up.
Nowhere is that more evident than Oklahoma, a conservative state with an independent streak and a disdain for the strong arm of government. The state cannot even get residents to comply with car insurance laws; roughly a quarter of the drivers here lack it, one of the highest rates in the country.
When it comes to health insurance, the effort to sign people up isn’t likely to get much help from the state. Antipathy toward President Obama’s signature health-care overhaul runs so deep that when the federal government awarded Oklahoma a large grant to plan for the new law, the governor turned away the money — all $54 million of it.
The idea that the federal government will persuade reluctant people here to get insurance elicited head-shaking chuckles at Cattlemen’s Steakhouse, an iconic old restaurant in the Stockyards City neighborhood, which is lined with street banners reading “Where the Wild West still lives.”
“That kind of frontier mentality maintains in Oklahoma, and it’s not a bad thing. It’s a good thing,” said Mark Cunningham, 64, an Army veteran having breakfast with a couple of friends in a dimly lighted booth recently. Considering the car insurance statistic, he said, “I suspect they’re going to run into the same kind of trouble on health insurance.”
Although Obama’s health-care overhaul cleared a major hurdle last month when it was upheld by the Supreme Court, the government continues to face challenges as it implements the largest social program in decades. Among the biggest is the resistance, both personal and political, that officials face as they try to achieve the law’s most ambitious goal — ­extending health coverage to 30 million uninsured Americans.
That includes people who will become newly eligible for Medicaid coverage and others who can buy insurance through new state exchanges. Beginning in 2014, most Americans will be required to get health coverage or face a fine come tax time. But it will not be a simple task to get so many people to purchase coverage, and the Congressional Budget Office estimates that, for a variety of reasons, fewer than half of the 30 million will actually gain coverage in that first year.

Presbyterians, TIAA-CREF hear call to divest from private health insurance firms

By Katie Robbins
Healthcare not Wealthcare, July 27, 2012
In the midst of a fierce debate on the national level around the Supreme Court’s decision to uphold the Affordable Care Act, the Divestment Campaign for Health Care made its official debut. Its stated mission: “to expose how the health insurance industry puts the need for profit above the needs of patients and to escalate public support for total removal of the private health insurance companies from our nation’s health care.”
Leading advocacy organizations dedicated to single-payer health care are committed to pursuing a divestment campaign from private health insurance companies in order to transform the treatment of health care as a commodity into a basic human right for all people in the U.S.
“We are responsible for our investments, and particularly as health care workers and patients, we see the immorality of the private health insurance companies as they deny payment for care in order to create huge profits for shareholders," says Dr. Rob Stone of Bloomington, Ind., a leader in the effort. "Those who stand for a just and equitable health care system must recognize the corrupting force of the private health insurance industry on our political process that costs tens of thousands of lives every year in addition to being a huge financial drain.”