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Thursday, October 2, 2014

Health Care Reform Articles - October 2, 2014

Single-payer health plan in Maine would benefit everyone

By William D. Clark, M.D.
Portland (Maine) Press Herald, Letters, Sept. 30, 2014
Steve Mistler’s Sept. 17 article “Number of Mainers without health insurance rose 9 percent in 2013″ notes Maine is one of two states with “a rise in the number of people without health insurance from 2012 to 2013.” Thus, Maine’s uninsured comprise “147,000, or 11.2 percent of the state’s population.”
Mistler reports tactical comments from gubernatorial candidates. No one mentions covering every Maine person with a fair and economical single-payer plan. Can Maine accomplish single-payer, and who would benefit?
  • People benefit. Everyone is covered from birth to death – period. No premiums, no searching for the “right” coverage. No bankruptcy when hit by a car or cancer. Health outcomes improve.
  • Employers benefit. They escape from the tension between insurer negotiations and worker benefits versus salaries, and create more Maine jobs.
  • Health care providers benefit. Physicians reclaim their mission of healing. Hospitals and all providers get simple billing, prompt payment and fewer “authorization” hassles. Dramatic discrepancies in physician salaries disappear, but all make a decent living.
  • Maine benefits. Maine creates a patient care-oriented system, and more clinicians choose primary care. No Medicaid hassles, and no “hidden tax” to cover the uninsured. First-year savings of $1 billion (as estimated by health care policy expert Dr. William Hsiao, who testified before the Legislature in 2010) bolsters Maine’s economy.
Maine could accomplish this. The Affordable Care Act allows states to insure their people if they provide coverage at least as comprehensive as ACA benefits, beginning in 2017. Everyone pays Maine a tax on income – when well, not when sick.
Decades of tweaking our profit-oriented system have failed, and our recent tweak drives people crazy and sends billions to insurance companies. They return useless paperwork while maximizing profits. Trying to reward competition excluded 147,000 Mainers and made the ACA prohibitively expensive and dauntingly complex.
Dr. William D. Clark resides in Woolwich.

Obamacare 2.0

by Senator Bernie Sanders

The Affordable Care Act has made modest improvements in American health care since it took effect. Twenty million Americans have gained insurance under the law, including young people who can stay on their parents’ policies and others who may no longer be denied insurance because of pre-existing conditions. The law also has expanded access to primary care to some 4 million more Americans through community health centers that also provide dental care, low-cost prescription drugs and mental health counseling.
But the United States remains, shamefully, the only major country on Earth that does not guarantee health care to all its people as a right. And because of the profiteering of the pharmaceutical industry and private insurance companies, the United States spends almost twice as much per capita on health care as any other nation, while our infant mortality and preventable deaths are higher than most other countries. If our goal is to provide high-quality health care for all Americans in a cost-effective way, we must move toward a single-payer system.
The health insurance lobby and other opponents of single-payer care make it sound scary. It’s not. In fact, a large, single-payer system already exists in the United States: It’s called Medicare. People enrolled in the system give it high marks. More importantly, it has succeeded in providing near-universal coverage to Americans over age 65.
I am very proud that my home state of Vermont is now moving forward on a plan to establish a single-payer health care system to provide coverage for every man, woman and child in our state. I believe we can be a model for the rest of the country. A single-payer system guaranteeing health care for all will not only be a source of great security to the American people; it will also be good for our economy. Entrepreneurs and small businesses will be free to develop their business plans without worrying about the cost and complexity of providing health care for themselves and their employees. Millions of Americans won’t have to stay in jobs they don’t like because their family needs health care.
The goal of real health-care reform must be high-quality, universal coverage in a cost-effective way—with an emphasis on disease prevention. We must ensure, to as great a degree as possible, that the money we put into health coverage goes to the delivery of health care, not to paper-pushing, astronomical profits and lining CEOs’ pockets.
Sen. Bernie Sanders, (Ind.-Vermont), is chair of the Primary Health and Aging Subcommittee of the Health, Education, Labor and Pensions Committee.



Obamacare’s Surprises

Most of the debate over the Affordable Care Act has focused on its coverage provisions: the health-care exchanges where Americans can shop for insurance, the controversial mandates for employers and individuals and the expansion of Medicaid in the states. But in a 900-plus-page landmark bill, there are bound to be a few surprises. Here are some of Obamacare’s hidden corners.
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Open payments
On Tuesday, Sept. 30, a trove of data on how much money doctors have received from drug and pharmaceutical manufacturers is set to be released to the public. The Open Payments database is the result of the ACA’s “Sunshine Act,” a transparency push born of concerns that physicians’ prescription and treatment choices could be influenced by their financial relationships.
The other Medicaid expansion
Before Obamacare, kids’ eligibility for public coverage depended as much on their age as their families’ income, with many states cutting them off Medicaid at age six. But unlike adult expansion, under the ACA, opening up Medicaid to low-income kids past age six was not optional. The law makes eligible all children between ages six and 18 who come from households that make up to 133 percent of the federal poverty level—currently $31,721 for a family of four. Of the 21 states that had to expand Medicaid for kids, 11 still don’t cover their parents at the same level. (The Supreme Court’s June 2012 ruling didn’t affect the children’s provision.)
Breastfeeding benefits
The health-care law generally require health plans to cover breastfeeding counseling and equipment—including breast pumps—for pregnant and nursing women. According to HHS, “Your plan may provide guidance on whether the covered pump is manual or electric, how long the coverage of a rented pump lasts, and when they’ll provide the pump (before or after you have the baby).” Larger businesses also have to give women pumping break time—and privacy.
Home visits to at-risk families of young children
The health law funded “Maternal, Infant, and Early Childhood Home Visiting”—a voluntary program for pregnant women and families of children up to age five. The program, which is state- or local-run and uses nurses and social workers, is for families at risk because the parents are themselves young (under 21), low-income, in at-risk communities or have a history of abuse or neglect.
Menu labeling
Menus in chain restaurants and some retail food shops will have to show the calorie count of their offerings, and more detailed nutritional information should be available for consumers who want it. There’s been a lot of industry haggling over the specifics of the FDA rules implementing the law, however, so the labeling requirements haven’t been finalized yet. A few states have their own menu label laws, and some chains have started posting the counts voluntarily.
Long-term care

The ACA didn’t fix one of the big unsolved problems in U.S. health care: how to finance long-term care for patients suffering from a disability or a chronic illness such as Alzheimer’s disease. A portion of the ACA (CLASS) that would have taken on a small piece of that challenge was scrapped because the numbers didn’t quite add up. But the ACA does contain several pilot programs aimed at finding ways to allow very frail and sick people to avoid nursing homes or institutions by having at-home care and social services. In addition, the health law will allow a group of hospices to test “concurrent care”—letting terminally ill people get hospice care without having to give up all their curative treatment at the same time, the usual condition for Medicare hospice.

5 Things We Learned From New Database Of Payments To Doctors

by Charles Ornstein

The federal government unveiled data Tuesday detailing 4.4 million payments made to doctors and teaching hospitals by pharmaceutical and medical device companies.
The launch of the so-called Open Payments website, mandated under a provision of the Affordable Care Act, was far from glitch-free: Some users encountered long delays and sometimes error messages trying to access its seven data tables. Also, the site didn't provide consumers with an easy-to-use look-up tool, a single place to search for a doctor's name and see all results across data files.
It will take a while to dig deeply into this new trove of data, which covers the period of August to December 2013 and includes general and research payments, as well as payments to companies' physician investors. All told, according to officials from the Centers for Medicare and Medicaid Services, companies spent a total of $3.5 billionduring that period on 546,000 individual physicians and almost 1,360 teaching hospitals.
So what's interesting at first glance? With the caveats we'll detail, here's a few nuggets:
1) As predicted, the data are messy and are difficult to analyze.
2) Even more data was redacted than the government had said there would be.
3) Companies spend a huge amount of money on royalty payments.
3) Companies spend a huge amount of money on royalty payments.
5) Doctors travel a lot, courtesy of drug and device companies.


Maine doctors received more than $4M from drug, device makers in 2013

Posted Oct. 01, 2014, at 5:45 a.m.
Maine doctors received more than $4 million from drug and medical device makers during the latter part of 2013, according to a new federal database that spotlights physicians’ ties with the health care industry.
The searchable database includes $3.5 billion worth of legal — but often controversial — payments to doctors and teaching hospitals by all pharmaceutical and medical device manufacturers in the country. The Open Payments program, created under the 2010 Affordable Care Act, lists compensation for consulting, travel, meals, promotional speaking and other gifts made from August to December 2013. Payments to doctors, dentists, podiatrists, optometrists and chiropractors must be disclosed.
The data includes payments to 560,000 physicians from across the nation. Experts warned the information is incomplete, covering just five months of last year and omitting many records.
The Maine records include $1,420,921 in general payments and $2,746,036 in payments specifically for research. All payments amounting to more than $10 must be reported, so the data included everything from lunches to major grants for clinical drug trials.
In publicly releasing the information on 4.4 million payments, the U.S. Centers for Medicare and Medicaid Services aims to discourage overly cozy relationships that could lead to flawed medicine. The agency also seeks to help patients learn if their doctors receive money from companies whose products they prescribe.
“CMS is committed to transparency, and this is an opportunity for the public to learn about the relationships among health care providers, and pharmaceutical and device companies,” CMS Administrator Marilyn Tavenner said in a news release.
Financial ties between doctors and the medical industry do not necessarily indicate wrongdoing. The payments can fund research that leads to the development of life-saving medications and technology. They are also common, with 94 percent of U.S. physicians reporting ties with the industry, according to a 2007 study in the New England Journal of Medicine.
More recent data show such payments falling steeply since the Sunshine Act provision of the health reform law, which that called for the data’s release, passed four years ago.

Doctors Find Barriers to Sharing Digital Medical Records



As a practicing ear, nose and throat specialist in Ahoskie, N.C., Dr. Raghuvir B. Gelot says that little has frustrated him more than the digital record system he installed a few years ago.
The problem: His system, made by one company, cannot share patient records with the local medical center, which uses a program made by another company.
The two companies are quick to deny responsibility, each blaming the other.
Regardless of who is at fault, doctors and hospital executives across the country say they are distressed that the expensive electronic health record systems they installed in the hopes of reducing costs and improving the coordination of patient care — a major goal of the Affordable Care Act — simply do not share information with competing systems.
The issue is especially critical now as many hospitals and doctors scramble to install the latest versions of their digital record systems to demonstrate to regulators starting Wednesday that they can share some patient data. Those who cannot will face reductions in Medicare reimbursements down the road.

What you should know about the new doctor payment data

Posted Oct. 01, 2014, at 8:46 a.m.
Planning to look up payments drug and medical device companies made to your doctor? Be aware of the information’s shortcomings first.
The data’s missing a lot of payments. It covers payments made over only for five months, from August to December 2013. If your doctor received compensation in say, February of last year, that won’t show up. The federal government says future data will be more complete, with information for all 12 months of this year expected next summer.
The federal Centers for Medicare and Medicaid Services also said that a third of the payment records companies submitted wouldn’t be released immediately, after concerns about the data’s integrity arose. In investigating one doctor’s complaint, CMS discovered many physicians were assigned erroneous identification numbers. The problems forced the agency to delay the database’s publication.
Some payments were intentionally excluded. Physicians, dentists, podiatrists, chiropractors and optometrists are covered. But drug and medical technology companies don’t have to report payments to other health professionals under the law, such as nurse practitioners.
Companies can also hold off on publicly releasing payments related to research for new products until after gaining FDA approval or four years after the payment was made, whichever comes first, according to a report by ProPublica.
A wide variety of compensation is included. The database includes everything from fees for speaking at events to research grants and entertainment and meals. As ProPublica pointed out, different types of payments indicate varying levels of involvement with a company.
The database has errors. This marks the first time CMS has released this data, so some problems are expected. Drug and medical device manufacturers may make mistakes in submitting the data, and the American Medical Association has said the 45-day window physicians were given to review and dispute payments before Tuesday’s release was insufficient and confusing. Of the nearly 550,000 physicians affected by mandate, only 26,000 were able to register to review their data and pursue corrections for any inaccuracies.
Other sources of information are available. Also check out ProPublica’s Dollars for Docs tool, which has tracked similar information since 2009.



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