Enrollees at Health Exchanges Face Struggle to Prove Coverage
FORT WORTH — Paul D. Donahue and his wife, Angela, are among more than a million Americans who have signed up for health coverage through the federal insurance exchange. Mr. Donahue has a card in his wallet from his insurer to prove it. But when he tried to use it to get a flu shot and fill prescriptions this week, local pharmacies could not confirm his coverage, so he left without his medications.
Similar problems are occurring daily in doctors’ offices and drugstores around the country as consumers try to use insurance coverage that took effect on Jan. 1 under the Affordable Care Act.
In addition to the difficulties many face in proving they have coverage, patients are also having a hard time figuring out whether particular doctors are affiliated with their health insurance plan. Doctors themselves often do not know if they are in the network of providers for plans sold on the exchange.
A Busy Doctor’s Right Hand, Ever Ready to Type
Amid the controlled chaos that defines an average afternoon in an urban emergency department, Dr. Marian Bednar, an emergency room physician in Dallas, entered the exam room of an older woman who had fallen while walking her dog. Like any doctor, she asked questions, conducted an exam and gave a diagnosis — in this case, a fractured hand — while also doing something many physicians in today’s computerized world are no longer free to do: She gave the patient her full attention.
Standing a few feet away, tapping quickly and quietly at a laptop computer cradled in the crook of her left arm, was Amanda Nieto, 27, Dr. Bednar’s scribe and constant shadow. While Ms. Nieto updated the patient’s electronic chart, Dr. Bednar spoke to the woman, losing eye contact only to focus on the injured hand.
“With a scribe, I can think medically instead of clerically,” said Dr. Bednar, 40, who works at Texas Health Presbyterian Hospital Dallas.
Without much fanfare or planning, scribes have entered the scene in hundreds of clinics and emergency rooms. Physicians who use them say they feel liberated from the constant note-taking that modern electronic health records systems demand. Indeed, many of those doctors say that scribes have helped restore joy in the practice of medicine, which has been transformed — for good and for bad — by digital record-keeping.
“Having the scribe has been life-changing,” said Dr. Jennifer Sewing, a family medicine practitioner in St. Louis, who used to spend late nights at her computer finishing electronic patient charts. Now, she can relax with her family or go to bed instead.
Dr. Michael Murphy, the chief executive of ScribeAmerica, a company based in Aventura, Fla., that supplies scribes to hospitals and medical practices, estimates that there are nearly 10,000 scribes working in hospitals and medical practices around the country, with demand rising quickly. At his company alone, the number of scribes deployed to clinics and emergency departments has risen to 3,500 from 1,000 in the past three years. Many of them are people like Ms. Nieto, who works for PhysAssist, a company based in Fort Worth. Training typically takes between 15 and 21 days, and is done by the companies themselves. She plans to enter a master’s program to become a physician assistant.
I wonder how much the scribes described in the article above contribute to the still rising cost of medical care?
-SPC
Report Finds More Flaws in Digitizing Patient Files
Although the federal government is spending more than $22 billion to encourage hospitals and doctors to adopt electronic health records, it has failed to put safeguards in place to prevent the technology from being used for inflating costs and overbilling, according to a new report by a federal oversight agency.
The report, released on Wednesday by the Office of the Inspector General for the Health and Human Services Department, is the second in two months to warn about flaws in the oversight of the ambitious federal program aimed at converting patient records from paper to electronic. It comes as the Obama administration continues to face broad criticism over the troubled rollout of its health care law — especially the HealthCare.gov site.
Despite spending “considerable resources to promote widespread adoption of E.H.R.’s,” or electronic health records, the government has “directed less attention to addressing potential fraud and abuse,” according to the report.Medicare has not changed the way it tries to detect fraud and has provided its contractors “with limited guidance,” the report said.
The report was especially critical of the lack of guidelines around the widely used copy-and-paste function, also known as cloning, available in many of the largest electronic health record systems. The technique, which allows information to be quickly copied from one document to another, can reduce the time a doctor spends inputting patient data. But it can also be used to indicate more extensive — and expensive — patient exams or treatment than actually occurred. The result, some critics say, is that hospitals and doctors are overcharging Medicare for the care they are providing. While the report did not estimate the amount of fraud that may be occurring, earlier government estimates have said it could run in the hundreds of millions of dollars. Although the amount is a fraction of the trillions of dollars spent annually on health care, the lack of safeguards at a time when the new technology is becoming pervasive could allow the fraud to balloon.
Alexander's MaineCare expansion report has first public airing
A consultant’s study warns that expansion of Medicaid will bring Maine a significant economic burden, but critics dispute the numbers.
Maine should not expand its Medicaid program because it would add 124,000 recipients and increase its costs by $807 million over 10 years, says a consultant’s report released Friday by the LePage administration.
This report highlights the fact that Maine’s General Fund is on track to be consumed by the MaineCare program,” said Gary Alexander of the Alexander Group. “Expanding eligibility for MaineCare to the able-bodied residents of working age will place at risk existing commitments Maine has to their traditional Medicaid recipients: those who are disabled and those who are elderly.”
Alexander indicated that there are opportunities to improve the program if the federal government gives the state more flexibility.
The former Pennsylvania welfare director, whose reforms in that state have been assailed by a Democratic program auditor, presented the first installment of his $925,000, taxpayer-funded study of Maine’s public assistance program Friday at the headquarters of the Department of Health and Human Services.
The administration received the report nearly four weeks ago but refused to release it until Friday, despite requests under the Freedom of Access Act from media outlets including the Portland Press Herald. Administration officials conceded that the report is a public document but said it is complex and Gov. Paul LePage wanted time to digest it before its release.
Attorney General Janet Mills, a Democrat, urged the administration this week to release the report or risk a court ruling that it was violating the law. LePage said Mills could “sue me” if she wanted the documents released.
The report is one of three that Alexander was scheduled to submit to the state last month under the terms of his contract. It’s not known whether he has delivered the others – an analysis of Maine’s welfare programs and an overhaul plan for Medicaid.
DHHS Commissioner Mary Mayhew ended Friday’s news conference before reporters could ask about the other reports. The Press Herald made a formal request to the DHHS on Thursday for any other reports submitted by Alexander, but the department has not said whether it has them
Attorney General Janet Mills, a Democrat, urged the administration this week to release the report or risk a court ruling that it was violating the law. LePage said Mills could “sue me” if she wanted the documents released.
The report is one of three that Alexander was scheduled to submit to the state last month under the terms of his contract. It’s not known whether he has delivered the others – an analysis of Maine’s welfare programs and an overhaul plan for Medicaid.
DHHS Commissioner Mary Mayhew ended Friday’s news conference before reporters could ask about the other reports. The Press Herald made a formal request to the DHHS on Thursday for any other reports submitted by Alexander, but the department has not said whether it has them
Our View: Taxpayer money wasted on biased MaineCare study
The report may help Gov. LePage’s campaign, but it offers nothing to the state’s working poor.
Gov. LePage spent nearly $1 million of taxpayer money hiring a consultant to tell him what he wanted to hear about Medicaid expansion. On Friday, it was clear that the governor got what we paid for.
Gary Alexander, a well-traveled opponent of anti-poverty programs, delivered the first $100,000 installment of his study of Maine’s social service system. Alexander asserted that Maine could not afford to extend Medicaid coverage to up to 70,000 near-poor Maine residents who earn as much as $15,856 for an individual or $32,499 for a family of four, because it would cost more to accept federal funds to cover these people than it would to leave them without insurance. How he reached that conclusion is unclear, but it is at odds with independent studies by the nonpartisan Kaiser Family Foundation and the state’s Office of Fiscal and Program Review, which predicted that expanding Medicaid would be a net plus for the state budget.
But for the governor, this has never been an issue about dollars and cents, and the Alexander study delivers more fuel for his emotional, fact-free attacks on the recipients of state services.
In one telling page of his presentation, Alexander compares the number of “employed Mainers” to each MaineCare enrollee under the current scenario and if the state expanded its program. The consultant claimed that currently, each MaineCare enrollee is supported by 1.8 employed Mainers, and if MaineCare were expanded, the number would be 1.3.
The problem with this analysis is that plenty of MaineCare enrollees already are working Mainers, and most of the people who would gain coverage under the expansion are other people with jobs. Unless he has a trust fund, an adult with more than $15,000 a year income works, and he is not likely to have the kind of job that offers insurance. Gov. LePage can sneer about “able-bodied” people who “don’t work,” as he did last year in Falmouth, but Medicaid expansion is a program that would help hardworking Mainers who are on the brink of poverty.
The Alexander report doesn’t offer any ideas about how to help those people other than by denying them federally funded health insurance. The report does provide the governor with a political cudgel he can use in the upcoming gubernatorial race, blaming struggling working families for the state’s poor economy, avoiding taking any responsibility for his policies.
Alexander delivered what he was hired for, but it’s too bad that the governor didn’t spend the money looking for ways to really help people access health care instead of using it to help himself try to get re-elected.
Well paid in Maine: 20 top-paying jobs in the state
Maine |
Sunday, January 12, 2014
Money isn't everything. But if it were, you'd want to be a doctor.
Surgeons and physicians hold the highest-paying jobs in 11 of Maine's 16 counties, according to the Maine Department of Labor.
In four other counties, it pays to be a chief executive — $66 an hour or better, to be exact.
In Franklin County, pharmacists are on top.
Data collected by the state in 2013 show regional differences in wages and top-paying jobs around Maine — some even with projected openings around the corner.
Should any new year's resolution involve a career change or new path, the figures can be informative, with one career-counseling caveat: Make sure you'd want to do the job first.
"Life is way too short to be doing work we don't like," said Mary LaFontaine, manager of the Lewiston CareerCenter. "All the money in the world doesn't buy happiness, right?"
All 10 of the top 10 highest-paying jobs in Maine, and 14 of the top 20, are in the medical field, rounded out by sales engineers, architectural and natural sciences managers, physicists, judges and chief executives, a category that includes hospital heads.
With an average annual wage of $241,400, anesthesiologists have the highest-paying positions in the state, $6,000 ahead of surgeons and physicians and 14 times more than the lowest-paying job here, locker-room attendant.
Maine should learn from Dirigo Health’s high-priced lessons
Posted Jan. 12, 2014, at 3:04 p.m.
After 10 years of paying for the Dirigo Health program, the Maine taxpayer is finally off the hook. As of Dec. 31, the Dirigo tax on health insurance has been repealed.
Yes, indeed, some taxes do get repealed but, in the case of Dirigo, not until we had spent hundreds of millions of taxpayer dollars for a ideologically inspired program that accomplished few of its goals.
Dirigo was the signature program of the Baldacci administration. It was implemented with great fanfare, and the Maine press was on board. The Portland Press Herald called it “a bold plan.” The Bangor Daily News did, too. In fact, it seemed as though every Maine journalist, columnist, newscaster, prognosticator and pundit referred to Dirigo as “bold!” We rarely heard it described, however, as smart, responsible or “well thought out.”
Even the word “plan” could be considered inaccurate. There was no real cost-benefit analysis, no previous program to use as a template, just a risky and wildly optimistic leap into uncharted health care territory. Dirigo was an experiment that morphed and changed with each legislative session. Even Gov. John Baldacci has said, “We looked at it as a laboratory.” As did chief Dirigo architect Trish Reilly in her Dec. 27 1,400-word BDN OpEd that reviewed Dirigo’s “accomplishments.”
And every year, wholesale changes were made to this experiment in a futile attempt to correct the disappointing results. Grand promises were made to bring unwitting Republican legislators onboard so that the enabling law could be called “bipartisan.” And an expensive public relations campaign kept the public believing that Dirigo could work.
We were told that Dirigo would insure 130,000 uninsured Mainers in five years and 57,000 in the first year alone. We were told that the more people that were enrolled in the program, the more savings we would see in health care costs and health insurance premiums. Dirigo was also going to “provide competition” with its subsidized DirigoChoice insurance. Finally, Dirigo was supposed to “stabilize” the insurance market and health insurance premiums.
But that was not the reality. DirigoChoice never insured more than 15,000 people at any one time. There were no real “savings to the system” even though Dirigo claimed there were and charged insurance companies that amount. There was no competition given to the Maine insurance markets because the provider for DirigoChoice insurance was also the monopoly carrier in Maine — Anthem. And the market was never stabilized, and premiums continued to soar.
As these disappointing results from the program continued to roll in, the accommodating press reported little of Dirigo’s bad news and instead told the Maine people that we only needed to give Dirigo more time and more money to bring about success.
Meanwhile, the funding streams — and several were tried — could not keep up with the expenditures, and enrollment in DirigoChoice soon had to be capped.
The first Dirigo tax was the Savings Offset Program, which calculated Dirigo’s “savings to the health care system” through a complex formula and then taxed the health insurance carriers that amount.
Then there was the beer, wine and soda tax passed by the Democrats on a party-line vote and subsequently repealed by a people’s veto the following year.
Finally, on another party-line vote, they passed a straight tax on health insurance claims — but there was never enough money or “savings” to grow the program, and Dirigo continued on its downward trajectory.
Ultimately, the program lasted almost 10 years. There were some good benefits to those who were enrolled in DirigoChoice and to those who received subsidies, but few real long-term goals were accomplished. Dirigo did, however, provide us with some hard lessons:
— Subsidizing a comprehensive insurance product with taxpayer dollars through a government middleman is profoundly expensive.
Advocating for a Single Payer System
Passionate students spread their message to their peers
By Anna Zelivianskaia
Chicago Medicine, January 2014
Chicago Medicine, January 2014
Imagine these all-too-likely scenarios: Lisa Palmson recently lost her mother to breast cancer. Due to her family history, the physician recommends tamoxifen as a chemoprevention therapy. However, Lisa is unable to afford the co-pay. Paul Johnson has felt a burning sensation around his stomach for several weeks and it has recently gotten worse. Visits to his primary care physician are mostly covered by his insurance but his PCP refers him to a gastroenterologist whose services are not covered until Paul reaches a large annual insurance deductible. As a result, Paul cannot afford a visit. A year later he is diagnosed with gastric carcinoma due to Helicobacter pylori infection, a preventable cancer when caught early.
These types of scenarios happen every day in physician offices in America. Our health care system allows for high numbers of uninsured and underinsured, which prevents us from achieving the degree of care we are capable of. Medical decisions are no longer between the patient and doctor. Instead, every therapy and test must be approved by insurance companies, which operate with the goal of making a profit. Fortunately, many passionate medical students in Chicago are stepping up to advocate for changes.
Driven by the desire to improve patient care, medical students are educating other students and the public about the merits of a publicly funded, privately delivered, single-payer health care system. Scott Goldberg, an MS2 at the University of Chicago, has advocated for a single-payer system for several years and is now training other students to do so. He has set up workshops on how to write a political op-ed, trained students in community organizing, and even began educating undergraduates on the merits of a single payer. “For me,” he says, “it just made complete sense. Why can’t the richest country in the history of the world provide equitable, comprehensive insurance to all of its citizens? Until we eliminate private health insurance companies, we will never be able to fully achieve the ideal doctor-patient relationship in the American health care system.”
Similarly, Margaret Russell, an MS2 at Northwestern University, educates students on how our health care system works as well as teaches them the skills to change it. She recently presented an informational session on the federal bill for a single-payer system, H.R. 676. For Margaret, the fight is close to home: “I have seen firsthand how our fragmented and unjust insurance system stands in the way of patients receiving adequate care when they need it. … It is morally and ethically wrong for a patient’s insurance status to dictate the quality of their care.”
Helpful article to get into attention to detail on healthcare reforms. Nice one.
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