MDs seek MBAs as health care gets more complex
Nervous dental patients who make their first visit to Dr. Sree Koka may feel calmer because they have watched his video on YouTube. It answers many of their questions: Is the doctor male or female? Does he speak English? Is he nice?
In the video, Koka introduces himself, cracks a few jokes, and suggests what patients should think about for their first appointment. He created the spot while attending MIT’s Executive MBA Program where he learned the benefits of focusing on personal relationships, not just technical expertise.
“I’ve come to realize that unless that relationship is good,” said Koka, chairman of dental specialties at the Mayo Clinic, “almost nothing I do technically is going to work well. It’s not just about the teeth but everything the teeth represent: patients’ quality of life, social esteem, self-confidence, pain, comfort, and their smile.”
Koka is one of a surprising number of senior-level health care professionals seeking an executive master’s of business administration from MIT’s Sloan School of Management in part because of the federal Affordable Care Act, also known as Obamacare, and other changes in the health marketplace. For the first time, health care has more students in MIT’s executive MBA program than any other industry, accounting for about 1 in 5 members of the class of 2014.
Medicare ‘cost-savings’ rules pushing costs onto patients
by Robert Kuttner - Boston GlobeTHE COST OF Medicare, the top driver of runaway entitlement outlays, seems to be stabilizing at last. For the past three years, Medicare inflation has moderated to an annual average of 3.9 percent. But if you look more deeply, a lot of these supposed savings are actually a shift in costs to patients. As Congress and the administration devise new ways to restrain Medicare, this disguised form of rationing is likely to worsen.
I had a vivid glimpse of this trend in my own family this past winter. In late February, my mother, age 99, had a bad fall. She was taken by ambulance to the closest hospital, Mass. General. Miraculously, she broke no bones, but her face was so badly swollen and bruised that she was unrecognizable and in severe pain.
My mother ended up staying four days. A couple of days in, we got an unpleasant financial surprise. Even though she was placed in the MGH’s maxillofacial inpatient unit, where she got excellent care, my mother was classified as being there “for observation” — meaning that she was considered an outpatient for billing purposes.
This meant that the bill — over $20,000 — was coded under the Medicare outpatient category (Part B) with a 20 percent patient co-pay. Being classed as an outpatient also disqualified my mother from any Medicare benefits in a rehab facility or skilled nursing home after she was discharged.
How could a 99-year-old badly injured woman on an inpatient unit be an “outpatient?” And why would Mass. General, one of our most distinguished community resources, do such a thing?
http://www.bostonglobe.com/opinion/2013/07/18/medicare-disguised-form-rationing/W6sF7dkTW08oGOlSekzlFI/story.html?s_campaign=email_BG_TodaysHeadline
House GOP has no alternative to health care law
WASHINGTON — Three years after campaigning on a vow to ‘‘repeal and replace’’ President Obama’s health care law, House Republicans have yet to advance an alternative for the system they have voted more than three dozen times to abolish in whole or in part.
Officially, the effort is ‘‘in progress’’ — and has been since Jan. 19, 2011, according to GOP.gov, a leadership-run website.
But internal divisions, disagreement about political tactics, and Obama’s 2012 reelection add up to uncertainty on whether Republicans will vote on a plan of their own before the 2014 elections, or if not by then, perhaps before the president leaves office, more than six years after the original promise.
Sixteen months before those elections, some Republicans cite no need to offer an alternative. ‘‘I don’t think it’s a matter of what we put on the floor right now,’’ said Representative Greg Walden of Oregon, who heads the party’s campaign committee. He added that what is important is ‘‘trying to delay Obamacare.’’
Michigan congressman Fred Upton, who leads a committee with jurisdiction on health care, said, ‘‘If we are successful in ultimately repealing this legislation, then yes, we will have a replacement bill ready to come back with.’’
In an interview on CBS’s “Face the Nation’’ on Sunday, House Speaker John Boehner said Congress ‘‘ought to be judged on how many laws we repeal,’’ not by how many new laws it creates.
The Ohio Republican was responding to a general question about how little Congress is doing these days. He says the United States has ‘‘more laws than the administration could ever enforce.’’
Boehner said that view may be unpopular but he and his allies in Congress are fighting for what they believe in. ‘‘Sometimes the American people don’t like this mess,’’ he said.
Officially, the effort is ‘‘in progress’’ — and has been since Jan. 19, 2011, according to GOP.gov, a leadership-run website.
But internal divisions, disagreement about political tactics, and Obama’s 2012 reelection add up to uncertainty on whether Republicans will vote on a plan of their own before the 2014 elections, or if not by then, perhaps before the president leaves office, more than six years after the original promise.
Sixteen months before those elections, some Republicans cite no need to offer an alternative. ‘‘I don’t think it’s a matter of what we put on the floor right now,’’ said Representative Greg Walden of Oregon, who heads the party’s campaign committee. He added that what is important is ‘‘trying to delay Obamacare.’’
Michigan congressman Fred Upton, who leads a committee with jurisdiction on health care, said, ‘‘If we are successful in ultimately repealing this legislation, then yes, we will have a replacement bill ready to come back with.’’
In an interview on CBS’s “Face the Nation’’ on Sunday, House Speaker John Boehner said Congress ‘‘ought to be judged on how many laws we repeal,’’ not by how many new laws it creates.
The Ohio Republican was responding to a general question about how little Congress is doing these days. He says the United States has ‘‘more laws than the administration could ever enforce.’’
Boehner said that view may be unpopular but he and his allies in Congress are fighting for what they believe in. ‘‘Sometimes the American people don’t like this mess,’’ he said.
N.H. Republicans blocking Medicaid expansion
WASHINGTON — With partisan bickering, delays, and confusion on the rise nationally over the impending launch of President Obama’s health care law, tens of thousands of low-income people in New Hampshire are watching the calendar, caught up in their own anxious uncertainty.
Republicans in the Legislature have blocked the state from participating in a federally funded expansion of the Medicaid program, meaning that up to 58,000 Granite State residents are in line to be denied coverage.
But the decision may not be final. The state has established a commission to report back with nonbinding recommendations in October, giving advocates slim hopes of a turnaround and leaving potential beneficiaries in a state of limbo. Meanwhile, the clock is ticking towards a Jan. 1 deadline for the legal mandate that individuals obtain insurance.
This is the sort of bureaucratic bind and confusion that is spurring predictions of turbulence surrounding Obamacare’s liftoff, and generating anger among representatives of the poor in New Hampshire who say Republicans are seeking to sabotage the national health care law.
“Once again, they’re playing a political game in saying no to all aspects of Obamacare, no matter how common sense and right for us as a state and as a nation,’’ said Kary Jencks of the New Hampshire Citizens Alliance, a social justice advocacy group. “The folks who end up paying a price are the hard-working middle- and low-income people.’’
http://www.bostonglobe.com/news/politics/2013/07/20/new-hampshire-residents-left-limbo-legislature-blocks-medicaid-expansion/SShvWrRhkCeFu4KNkStOFM/story.html?s_campaign=email_BG_TodaysHeadline
Updated: 12:18 AM
The deaths prompted a public outcry, followed by a class-action suit in 1989 that resulted in a court-approved agreement on parameters for state care of adults with mental illness.
A report released last week makes clear the state is slipping in its efforts to meet these standards. People with severe mental illness are supposed to get help accessing community services within seven days of making a request. Instead, they're waiting an average of two months, with some waiting nearly a year.
Republicans in the Legislature have blocked the state from participating in a federally funded expansion of the Medicaid program, meaning that up to 58,000 Granite State residents are in line to be denied coverage.
But the decision may not be final. The state has established a commission to report back with nonbinding recommendations in October, giving advocates slim hopes of a turnaround and leaving potential beneficiaries in a state of limbo. Meanwhile, the clock is ticking towards a Jan. 1 deadline for the legal mandate that individuals obtain insurance.
This is the sort of bureaucratic bind and confusion that is spurring predictions of turbulence surrounding Obamacare’s liftoff, and generating anger among representatives of the poor in New Hampshire who say Republicans are seeking to sabotage the national health care law.
“Once again, they’re playing a political game in saying no to all aspects of Obamacare, no matter how common sense and right for us as a state and as a nation,’’ said Kary Jencks of the New Hampshire Citizens Alliance, a social justice advocacy group. “The folks who end up paying a price are the hard-working middle- and low-income people.’’
http://www.bostonglobe.com/news/politics/2013/07/20/new-hampshire-residents-left-limbo-legislature-blocks-medicaid-expansion/SShvWrRhkCeFu4KNkStOFM/story.html?s_campaign=email_BG_TodaysHeadline
Legacy on Line in Fierce Drive on Health Law
By MICHAEL D. SHEAR
WASHINGTON — When Denis R. McDonough, the White House chief of staff, first saw the document in a meeting in the Roosevelt Room, he immediately dispatched his aides to the West Wing basement to get copies for all of President Obama’s top advisers.
Royal blue and emblazoned with the White House seal, the “Official Affordable Care Act Enrollment Countdown” is a paper calendar that keeps track of the time before uninsured Americans can begin signing up for coverage under the president’s signature health care law.
On Tuesday, the top page said simply: “70 Days Left.”
The message is clear. Few things are more important to the White House this year than a successful health care rollout on Oct. 1, when millions of uninsured Americans will be required to obtain private health coverage in government-run marketplaces. Getting it right — or wrong — will help determine Mr. Obama’s place in history.
Enter the Obamacare Team, some two dozen political operators and data-crunching technocrats charged with carrying out the biggest health care overhaul since Medicare in the 1960s — but with more pitfalls. Their job is to sell the law to large numbers of Americans who remain divided about its value and wary of its impact. Republicans have seized on one Democratic description of the health care law as a “train wreck,” particularly after the administration announced a politically damaging one-year delay in a key provision of the law.
Working out of war rooms in the West Wing basement, the Eisenhower Executive Office Building and the Department of Health and Human Services, the team is first trying to find in the next year 2.7 million uninsured people between 18 and 35, most of whom are healthy. Just as Mr. Obama’s electoral success hinged on the turnout machine he created in Chicago, the fate of the health care law rests on whether his administration can turn out and enroll the uninsured.
“The key for us is to take this out of the abstract and make it very, very, very real,” one of the leaders of the effort, David Simas, told a dozen White House aides during a strategy session in the West Wing last week.
At Too Many Hospitals, a Revolving Door
By JUDITH GRAHAM
Jessie Gruman can’t remember the number of times she’s been hospitalized for cancer. The list of the conditions she’s had over almost 40 years is daunting: from Hodgkin’s lymphoma to cancers of the cervix and lung.
But Ms. Gruman, 59, can’t forget her experience three years ago, when it was time to leave the hospital after having her stomach removed, a consequence of gastric cancer.
Ms. Gruman was alone; her husband was on his way to this hospital but hadn’t yet arrived. This is all she remembers a nurse saying before she was shown the door.
Here is a prescription for pain medication. Don’t drive if you take it. Call your surgeon if you have a temperature or are worried about anything. Go see your doctor in two weeks. Do you want a flu shot? I can give you one before you leave. If you need a wheel chair to take you to the door, I’ll call for one. If not, you can go home. Take care of yourself. You are going to do great!
What wasn’t communicated to Ms. Gruman: Here’s a number to call if you have any questions. Here’s the medical expert who’s in charge of your follow-up care and how to reach him or her. Here’s the plan for your care over the next month, and here’s the plan for the next six months.
Or this: You’re going to experience a lot of challenges when you get home. Here are the three or four concerns that should be your priorities. Here’s what your caregiver needs to know to help you most effectively. Here are resources in the community that might be of assistance.
Or this: You’re going to experience a lot of challenges when you get home. Here are the three or four concerns that should be your priorities. Here’s what your caregiver needs to know to help you most effectively. Here are resources in the community that might be of assistance.
Given the inadequacies in care for discharged patients — a well-documented and common problem — is it any wonder that so many bounce back to hospitals after they’re sent home?
How Much Could Medicare for All Save You?
By Rich Smith
The Motley Fool, July 21, 2013
The Motley Fool, July 21, 2013
The government put a key piece of Obamacare back on the shelf last week, when it announced that companies employing more than 50 workers will have an extra year to begin offering health insurance without facing fines.
Whether you consider this good news or bad news probably depends on whether you were a fan or a foe of the Affordable Care Act in the first place.
But could it be that the ACA isn't really needed at all? Could an alternative idea -- "Medicare for all" -- actually do a better job of controlling medical costs, and making health care affordable for Americans?
But could it be that the ACA isn't really needed at all? Could an alternative idea -- "Medicare for all" -- actually do a better job of controlling medical costs, and making health care affordable for Americans?
Obamacare -- but cheaper
A new survey released by the number-crunching technocrats at NerdWallet last month clearly illustrates how extending Medicare coverage to all Americans might cut costs for everyone. According to NerdWallet, Medicare generally pays out no more than $0.27 for every dollar that hospitals bill it for medical services -- a savings of 73%. Put another way, an uninsured patient receiving the same care as is provided to a patient covered by Medicare can expect to pay nearly four times as much.
Some lose hours, get no insurance under health law
To avoid paying for coverage, employers push workers just below the 'full-time' threshold.
By SANDHYA SOMASHEKHAR The Washington Post
WASHINGTON – For Kevin Pace, the president's health care law could have meant better health insurance. Instead, it produced a pay cut.
Like many of his colleagues, the adjunct music professor at Northern Virginia Community College had a hefty course load, despite his official status as a part-time employee. But his employer, the state, slashed his hours this spring to avoid a Jan. 1 requirement that all full-time workers be offered health insurance. The law defines "full time" as 30 hours a week or more.
"We work so hard for so little pay," Pace said. "You would think they would want to make an investment in society, pay the teachers back and give us health care."
Earlier this month, the Obama administration delayed the employer insurance requirement until January 2015. But the state of Virginia, like some other employers around the country that capped part-timers' hours in anticipation of the initial deadline, has no plans to abandon its new 29-hour-a-week limit.
The impact on Pace and thousands of other workers in Virginia is an unintended consequence of the health law, which, as the most sweeping social program in decades, is beginning to reshape aspects of American life.
First lady asks for Latinos' help on health care
In her remarks, Mrs. Obama tied the push to get the uninsured to sign up for health care to her campaign against childhood obesity.
The Associated Press
NEW ORLEANS — Michelle Obama urged Latino activists on Tuesday to help sign people up for her husband's health care overhaul, especially the millions of younger, healthier people the system will need to offset the cost of caring for older, sicker consumers.
Our View: State must fulfill pledge to help mentally ill
Posted:TodayUpdated: 12:18 AM
A recent report makes clear Maine is slipping in efforts to comply with a court-ordered plan.
Some 25 years ago, a rash of patient deaths at the Augusta Mental Health Institute was attributed to overcrowding, a shortage of community-based treatment options and a deteriorating facility.The deaths prompted a public outcry, followed by a class-action suit in 1989 that resulted in a court-approved agreement on parameters for state care of adults with mental illness.
A report released last week makes clear the state is slipping in its efforts to meet these standards. People with severe mental illness are supposed to get help accessing community services within seven days of making a request. Instead, they're waiting an average of two months, with some waiting nearly a year.
Healthcare overhaul leads hospitals to focus on patient satisfaction
Under healthcare overhaul, federal payments to hospitals are tied to patient satisfaction. Customer service efforts are underway.
By Anna Gorman
5:45 PM PDT, July 20, 2013
SAN FRANCISCO — For years, the check-in process in the urgent care center of this city's large, downtown hospital was reminiscent of a visit to the DMV. The ailing and sick walked in, pulled a number, took a seat and waited to be called. Many grew impatient and exasperated.
Now, patients at San Francisco General Hospital are greeted by a smiling face and a helping hand to guide them along the path to getting care. It's one of a series of customer-friendly touches being added at the 156-year-old institution by a newly named “chief patient experience officer.”
“Saying ‘number 32' versus ‘Mr. Jones' is dramatically different,” said Baljeet Sangha, who holds the new position. “We have to remind ourselves these are people.”
Under the national healthcare overhaul, patient experiences matter. Federal payments are being tied to surveys that gauge patient attitudes about such things as a hospital's noise and cleanliness, communication and pain management.
If patients are happy, hospitals get more money. If they aren't, hospitals get less. That's prodding hospital executives to make changes to improve the patient experience. Televisions are being upgraded, cafeteria fare improved and patient call signals answered more promptly, officials say.
“The goal is not to turn hospitals into hotels,” said Patrick Conway, chief medical officer for the federal Centers for Medicare & Medicaid Services, “but to ensure that every patient and family has the best possible experience when they are hospitalized.”
Positive patient experiences can affect medical outcomes and a hospital's bottom line, Conway said. If nurses clearly communicate discharge instructions, for example, patients better understand what they need to do to stay healthy and avoid costly readmissions.
Competition is partly responsible for the transformation. People have access to hospital patient satisfaction and quality scores, empowering them to make informed choices about where to seek care. Public hospitals, particularly, risk losing large numbers of newly insured patients.
Now, patients at San Francisco General Hospital are greeted by a smiling face and a helping hand to guide them along the path to getting care. It's one of a series of customer-friendly touches being added at the 156-year-old institution by a newly named “chief patient experience officer.”
“Saying ‘number 32' versus ‘Mr. Jones' is dramatically different,” said Baljeet Sangha, who holds the new position. “We have to remind ourselves these are people.”
Under the national healthcare overhaul, patient experiences matter. Federal payments are being tied to surveys that gauge patient attitudes about such things as a hospital's noise and cleanliness, communication and pain management.
If patients are happy, hospitals get more money. If they aren't, hospitals get less. That's prodding hospital executives to make changes to improve the patient experience. Televisions are being upgraded, cafeteria fare improved and patient call signals answered more promptly, officials say.
“The goal is not to turn hospitals into hotels,” said Patrick Conway, chief medical officer for the federal Centers for Medicare & Medicaid Services, “but to ensure that every patient and family has the best possible experience when they are hospitalized.”
Positive patient experiences can affect medical outcomes and a hospital's bottom line, Conway said. If nurses clearly communicate discharge instructions, for example, patients better understand what they need to do to stay healthy and avoid costly readmissions.
Competition is partly responsible for the transformation. People have access to hospital patient satisfaction and quality scores, empowering them to make informed choices about where to seek care. Public hospitals, particularly, risk losing large numbers of newly insured patients.
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