Medical Waste: 90 More Don'ts For Your Doctor
Doctors do stuff — tests, procedures, drug regimens and operations. It's what they're trained to do, what they're paid to do and often what they fear not doing.
So it's pretty significant that a broad array of medical specialty groups is issuing an expanding list of don'ts for physicians.
Don't induce labor or perform a cesarean section for a baby who's less than full-term unless there's a valid medical reason, say the American College of Obstetrics and Gynecology and the American Academy of Family Physicians. (It can increase the risk of learning disabilities and respiratory problems.)
Don't automatically do a CT scan on a child with a minor head injury, warns the American Academy of Pediatrics. (Currently half of all such children get them, when simple observation is just as good and spares radiation risk.)
Bitter Pill: Why Medical Bills Are Killing Us
Read more: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2LdaDmWzz
1. Routine Care, Unforgettable Bills
When Sean Recchi, a 42-year-old from Lancaster, Ohio, was told last March that he had non-Hodgkin’s lymphoma, his wife Stephanie knew she had to get him to MD Anderson Cancer Center in Houston. Stephanie’s father had been treated there 10 years earlier, and she and her family credited the doctors and nurses at MD Anderson with extending his life by at least eight years.
When Sean Recchi, a 42-year-old from Lancaster, Ohio, was told last March that he had non-Hodgkin’s lymphoma, his wife Stephanie knew she had to get him to MD Anderson Cancer Center in Houston. Stephanie’s father had been treated there 10 years earlier, and she and her family credited the doctors and nurses at MD Anderson with extending his life by at least eight years.
Because Stephanie and her husband had recently started their own small technology business, they were unable to buy comprehensive health insurance. For $469 a month, or about 20% of their income, they had been able to get only a policy that covered just $2,000 per day of any hospital costs. “We don’t take that kind of discount insurance,” said the woman at MD Anderson when Stephanie called to make an appointment for Sean.
Stephanie was then told by a billing clerk that the estimated cost of Sean’s visit — just to be examined for six days so a treatment plan could be devised — would be $48,900, due in advance. Stephanie got her mother to write her a check. “You do anything you can in a situation like that,” she says. The Recchis flew to Houston, leaving Stephanie’s mother to care for their two teenage children.
About a week later, Stephanie had to ask her mother for $35,000 more so Sean could begin the treatment the doctors had decided was urgent. His condition had worsened rapidly since he had arrived in Houston. He was “sweating and shaking with chills and pains,” Stephanie recalls. “He had a large mass in his chest that was … growing. He was panicked.”
Nonetheless, Sean was held for about 90 minutes in a reception area, she says, because the hospital could not confirm that the check had cleared. Sean was allowed to see the doctor only after he advanced MD Anderson $7,500 from his credit card. The hospital says there was nothing unusual about how Sean was kept waiting. According to MD Anderson communications manager Julie Penne, “Asking for advance payment for services is a common, if unfortunate, situation that confronts hospitals all over the United States.
http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/print/
Governors Fall Away in G.O.P. Opposition to More Medicaid
By ABBY GOODNOUGH and ROBERT PEAR
Under pressure from the health care industry and consumer advocates, seven Republican governors are cautiously moving to expand Medicaid, giving an unexpected boost to President Obama’s plan to insure some 30 million more Americans.
The Supreme Court ruled last year that expanding Medicaid to include many more low-income people was an option under the new federal health care law, not a requirement, tossing the decision to the states and touching off battles in many capitols.
The federal government will pay the entire cost of covering newly eligible beneficiaries from 2014 to 2016, and 90 percent or more later. But many Republican governors and lawmakers immediately questioned whether that commitment would last, and whether increased spending on Medicaid makes sense, given the size of the federal budgetdeficit. Some flatly declared they would not consider it.
In Florida, where Gov. Rick Scott reversed his position and on Wednesday announced his support for expanding Medicaid, proponents say that doing so will not only save lives, but also create jobs and stimulate the economy. Similar arguments have swayed the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who in recent months have announced their intention to expand Medicaid.
The shift has delighted supporters of the law.
“I think this means the dominoes are falling,” said Ronald F. Pollack, the executive director of Families USA, a consumer group. “The message is, ‘Even though I may not have supported and even strongly opposed the Affordable Care Act, it would be harmful to the citizens of my state if I didn’t opt into taking these very substantial federal dollars to help people who truly need it.’ ”
Nationwide, Medicaid covers 60 million people, most of them low-income or disabled. The Congressional Budget Office has estimated that 17 million more people could be enrolled if all states took the expansion option. So far, 22 states have said they will expand the program, 17 have opted against it, and 11 have not yet decided, according to Avalere Health, a consulting firm.
GOP governors make peace with Obamacare
By Dana Milbank,
“It is not a white flag of surrender,” Florida Gov. Rick Scott said.
This was technically true: Scott did not wave a banner of any color when he announced Wednesday that he wants Florida to expand Medicaid, a key piece of Obamacare.
But make no mistake: Scott, a tea party Republican and outspoken critic of the law, was laying down arms in defeat. The former hospital executive won his gubernatorial race in 2010 by campaigning against Obamacare, and as governor he fought the law in court. Even when the Supreme Court ruled against his position last year, he vowed defiance.
“We’re not going to implement Obamacare in Florida,” he said then. “We’re not going to expand Medicaid.”
The about-face by Scott, the seventh Republican governor to accept Obama’s expansion of government-funded health care for the poor, is a crucial validation of the president’s signature initiative. In his announcement, Scott made a moral case for the Medicaid expansion as compelling as the law’s proponents ever made.
“This country is the greatest in the world, and it’s the greatest largely because of how we value the weakest among us,” said Scott, in a blazer and open-collar oxford, said in his announcement. “It shouldn’t depend on your Zip code or your tax bracket. No mother or father should despair over whether they have access to high-quality health care for their sick child.” With federal funds covering the cost, “I cannot in good conscience deny Floridians that needed access to health care.”
Conscience is trumping politics elsewhere, too, even as the tea party maintains its grip on Republicans in Washington. Thirteen states, mostly in the South, have so far opted out of the Medicaid expansion, according to the Advisory Board Co. Twenty-three and the District have opted in, accepting federal funds (100 percent for three years and at least 90 percent after that) to extend Medicaid to those with incomes up to about $31,000 for a family of four. “States are deciding this deal is simply too good to pass up,” Health and Human Services Secretary Kathleen Sebelius told reporters Thursday.
LePage says mental health care best remedy for gun violence
But Maine's annual spending on mental health care has dropped by $27 million since 2008.
By Kelley Bouchard kbouchard@mainetoday.com
Staff Writer
Staff Writer
Gov. Paul LePage is pointing to his record on mental health care spending as he lobbies the Obama administration and Maine's congressional delegation to follow his lead rather than support increased gun control in response to the shootings in Newtown, Conn.
But the governor's record is mixed when it comes to supporting programs that serve people with mental and behavioral health problems, say advocates who monitor Maine's mental health care programs.
LePage released letters Wednesday that he sent to Vice President Joe Biden on Jan. 16 and to Maine's congressional delegation on Feb. 1, each saying that "the problem we face has little to do with firearm ownership and nearly everything to do with mental health issues."
LePage noted that he has increased funding for mental health services required under a consent decree by $2 million, and that he has increased funding for people with developmental disabilities by $6.7 million.
While mental illnesses differ from developmental disabilities, LePage wrote that he is "confident these initiatives will mean much more to the individuals receiving these services – and will provide more public safety – than simply enacting unnecessary gun laws."
LePage noted in an accompanying news release that Maine recently got a notable B grade from the National Alliance on Mental Illness and that the state increased its mental health budget 15 percent from 2009 to 2012.
http://www.pressherald.com/politics/lepage-says-health-care-best-rx-for-gun-violence_2013-02-22.html
Democrat proposes alternative to LePage liquor plan without hospital debt payoff
Posted Feb. 21, 2013, at 6:15 p.m.
AUGUSTA, Maine — The Democratic leader in the Maine Senate on Thursday put forth a liquor contract proposal of his own as a legislative committee prepares to take up a competing bill from Gov. Paul LePage to renegotiate the state’s wholesale liquor contract and use the proceeds to pay off a $484 million debt the state owes to hospitals.
Republicans immediately slammed the proposal from Sen. Seth Goodall, D-Richmond, and accused Democrats of stalling on the hospital debt repayment. A newly formed company that plans to bid on the state’s wholesale liquor contract also slammed the proposal.
Goodall’s legislation sets out an alternative for putting the state’s wholesale liquor business out to bid. The legislation, however, doesn’t attach the wholesale liquor contract to a plan for paying off the hospital debt.
“That discussion needs to be separate from making sure we have a process in place to make sure we get the best value for the state of Maine,” Goodall said, echoing comments earlier this month from Democratic leaders.
Goodall’s bill, LD 644, would require a company vying to operate the state’s wholesale liquor business to pay the state either $20 million or $200 million up front at the start of the 10-year contract. The legislation also would require a fixed annual payment from the company and a slice of annual profits based on the size of the initial payment.
In addition, Goodall’s bill would require that any company competing for the wholesale liquor contract pay a nonrefundable $25,000 application fee. And if the state can’t find a new wholesale liquor contractor in time for the current contract’s July 1, 2014, expiration, Goodall’s bill would allow the state to extend the current contract — held by Maine Beverage Co. — for another year in exchange for at least $34 million from the company.
Goodall said his plan would guarantee that a private sector company with adequate financial and operational wherewithal would end up with the contract.
“We need to make sure they have experience in the industry, that they have the knowledge, that they have the warehousing and delivery capacity,” he said. “This is a contract that’s worth hundreds of millions of dollars, and it requires significant service.”
Goodall said the LePage administration hasn’t laid out sufficient detail about its plans for bidding out the contract.
Central Maine Healthcare pulls bid to manage Brunswick hospital
Posted Feb. 21, 2013, at 7:51 p.m.
BRUNSWICK, Maine — Central Maine Healthcare in Lewiston announced Thursday that it has requested that the state suspend for one year the hospital’s bid to acquire Parkview Adventist Medical Center in Brunswick.
The Maine Department of Health and Human Services was reviewing a Certificate of Need application filed by CHMC and Parkview in August 2012 seeking approval for the merger.
But at a meeting in January, DHHS suggested that Central Maine Healthcare conduct a feasibility study “about the future of Parkview,” Chuck Gill, vice president for public affairs at CMHC, said Thursday.
“We looked at what they requested and realized it would take quite a bit of time to put the information together,” he said.
Gill said the department requested information “about the future of Parkview and what the organizations will be doing to make sure Parkview can thrive in the future.”
According to a release issued Thursday by CMHC and Parkview, “The leadership of both Central Maine Healthcare and Parkview remain upbeat about Parkview’s continued important role as a healthcare provider. Although this delay is unfortunate, Parkview still expects to become part of Central Maine Healthcare in the future. In the interim, Parkview will continue to serve the people of the mid-coast region with compassion and distinction.”
Parkview spokesperson Tory Ryden on Thursday referred calls to Gill.
After CMHC filed its Certificate of Need application, Mid Coast Hospital in Brunswick sought to block the plan and filed its own competing Certificate of Need application in an attempt to absorb all of Parkview’s operations and create a single hospital in Brunswick.
In October, hundreds of people attended a public hearing in Brunswick to weigh in on the proposal. Many that night spoke of loyalty to faith-based Parkview, while others argued that the midcoast region could not support two hospitals.
Maine wins $33 million to test health care innovations
Posted Feb. 21, 2013, at 4:48 p.m.
Maine will receive up to $33 million from the federal government over the next three and a half years to test a plan to improve residents’ health care while cutting costs.
Maine and five other states are the first recipients of more than $250 million in funding awards made under the federal Affordable Care Act, the U.S. Department of Health and Human Services announced Thursday. The money is designed to help states find new ways of paying for and delivering health care that could ultimately lower costs for Medicare, Medicaid and the Children’s Health Insurance Program while making those programs’ beneficiaries healthier.
HHS hopes to foster state-level innovations that could eventually stem the tide of rising costs in Medicaid, the state-federal health insurance program for the poor, and the Medicare program for the elderly and disabled. Maine’s Medicaid program, known as MaineCare, accounts for about a third of the total state budget. Like Medicaid programs in other states, it faces critical funding shortages.
In a conference call on Thursday with reporters, HHS Secretary Kathleen Sebelius acknowledged the burden of mounting health care costs on the economy, states, businesses and consumers.
“Too many Americans receive care that’s fragmented, unreliable and generates poor health outcomes,” she said. “The good news is that we have numerous examples from across the country of how improvements in care delivery can both lower costs and improve health.”
Maine’s plan is a broad effort that includes expanding the creation of “accountable care organizations,” or groups of health providers that are promised incentives for better coordinating each patient’s care while also trimming costs. The model, which ties payments to health care quality metrics, stresses patient safety, better management of chronic diseases, and preventive health services.
The accountable care organization model was formalized under President Barack Obama’s health reform law, upheld in late June by the U.S. Supreme Court. It’s being tested in regions across the country.
HHS was impressed with work done by Maine health providers in recent years to collaborate with other stakeholders to improve health care, and then broaden those efforts statewide, Richard Gilfillan, director of the Center for Medicare and Medicaid Innovation at HHS, said in the conference call.
“Many providers in Maine had come together with private entities and with payers and the state government and have been thinking about planning specific initiatives to address transforming care in their local communities,” he said.
Maine’s plan also calls for strengthening coordination among primary care providers and public health, behavioral health and long-term care organizations. The federal funding will allow the state to continue work to facilitate better partnerships between patients and their families and their primary care physicians.
The state additionally seeks to make better use of health data for more transparent and detailed reporting of health care costs and quality.
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