Friday, July 31, 2015

Couples Compete for the Morning Workout - WSJ

A predawn swim; the weekend handoff; children are ‘firehouse ready’


"Staking out prime time for exercise is the land-grab of modern day parents. Once children come along, working out often seems more like a luxury than a basic need. Compared with a night out for cocktails, a request for an hour of PILATES would seem like something no one would want to deny a spouse. But that isn’t always the case."

After she had her second child, Michelle Jacobs was desperate to get fit. The 43-year-old baby gear retail executive joined a gym and went every morning at 5:30 a.m.—a big improvement over Jillian Michaelsexercise DVDs in the living room. All was great, until her husband caught the workout bug.

Initially he was content with one SoulCycle class on Tuesday mornings. But then he wanted Thursdays.

Staking out prime time for exercise is the land-grab of modern day parents. Once children come along, working out often seems more like a luxury than a basic need. Compared with a night out for cocktails, a request for an hour of Pilates would seem like something no one would want to deny a spouse. But that isn’t always the case.

Couples squeeze in athletic windows at odd hours, sometimes in the dark of night, to avoid disrupting quality family time. Some spouses push for priority, but promise the workout means a smile and a day of devoted caretaking in return.

With two children to prep for school, and both Ms. Jacobs and her husband commuting from the suburbs into New York City for work, there wasn’t time for both to claim the mornings. Evenings were their only chance to be with the children. Now Ms. Jacobs spins, lifts weights or runs every other morning, plus Sunday, when she tag teams with her husband, tossing the car keys to him as they pass on the front walk.

Eric Roza, 47, a vice president at Oracle Corp.and self-declared fitness nut in Boulder, Colo., admits that tension around workout turf “has been bubbling up.” He does CrossFit weekdays at 5:30 a.m., returning to help get four children through the morning scramble at 6:50 a.m., which means his wife Melissa can never go to a 6:30 a.m. strength class she loves. Until recently, he never considered whether this was fair. “I’ve always had this presumption that my workout comes first. I’m like, ‘Come on, Honey, it’s my self-medication. It’s my therapy,’” he says.

Her less obsessive approach compounded the problem. Her job managing the CrossFit gym the pair own is more flexible, so his work schedule dominated. She was always too busy to exercise midday.

After some “tough conversations”, Mr. Roza says he is prepared to make changes. “I realize now I can’t just keep my head in the sand,” he says.

Who gets priority, and how time is apportioned, can reveal deeper relationship dynamics, therapists say. One partner demanding his or her workout matters more “can be heard by the other as, ‘I’m just a little more important than you are in this partnership,’” says Washington, D.C. psychotherapist Karen Osterle. She adds that gender roles can play a part in the power struggle. “The negotiation is becoming more complex as more women become the chief breadwinners,” says Ms. Osterle.

Swiss trainlike schedules help. “I tell couples to sit down on Sunday night with a glass of wine or cup of tea and the calendar,” says Samantha Ettus,a Los Angeles-based life coach and author of a book on efficient living. “Exercise has to go on the to-do list just like business meetings.”
A rigid routine has allowed Martina Jones and her husband Chris to keep competing, even as parents—she does marathons, biathlons and triathlons, and he is an open-water swimmer. The San Francisco couple both have demanding product management jobs, so “making it explicit is the only way to make it work,” says Ms Jones.

The new emphasis on prevention and wellness is emphasized by the Affordable Care Act. There are also managed care and Medicare Advantage plans that offer complementary memberships in sports clubs. "Silver Sneakers' is one of those programs offered here in California by 'SCAN'. Seniors do not have the same time constraints of parenthood or work.

It is a challenge for millenials and Gen-X adults. Studies have shown the benefits of aerobic exercise, and walking for those with diabetes, hypertension, elevated body-mass index. It has been shown to delay or reverse osteoporosis, reduce the liklihood of colon and breast cancer.

Joanna Strober, who runs a Palo Alto, Calif., weight-loss startup and her entrepreneur husband race for the same treadmill. If he beats her downstairs, she doesn’t get to exercise that day. “I do not complain, but, yes, I’m mad.” A second treadmill wouldn’t work. “We wouldn’t agree on the TV show,” she says.

Couples Compete for the Morning Workout - WSJ

Wednesday, July 29, 2015

JAMA Network | JAMA | Hospital Characteristics Associated With Penalties in the Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program

Hospital Characteristics Associated With Penalties in the Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program

Another paradoxical result becomes apparent impeaching the meaning of statistics in health care. Like the Propublica report on Surgeon grading, the findings of the HAC   Hospital Readmissons Programs reveal that 'better hospitals' (according to JCAH metrics) sometimes perform more poorly than under-rated hospitals. It points out that re-admission rates may be a meaningless benchmark to rate  hospitals. It may only serve to reduce Medicare reimbursements just for it's only purpose.

Main Outcomes and Measures  Hospital characteristics associated with penalization.
Results  Of the 3284 hospitals participating in the HAC program, 721 (22.0%) were penalized. Hospitals were more likely to be penalized if they were accredited by the Joint Commission (24.0% accredited, 14.4% not accredited; odds ratio [OR], 1.33; 95% CI, 1.04-1.70); they were major teaching hospitals (42.3%; OR, 1.58; 95% CI, 1.09-2.29) or very major teaching hospitals (62.2%; OR, 2.61; 95% CI, 1.55-4.39; vs nonteaching hospitals, 17.0%); they cared for more complex patient populations based on case mix index (quartile 4 vs quartile 1: 32.8% vs 12.1%; OR, 1.98; 95% CI, 1.44-2.71); or they were safety-net hospitals vs non–safety-net hospitals (28.3% vs 19.9%; OR, 1.36; 95% CI, 1.11-1.68).  Hospitals with the highest quality score of 8 were penalized significantly more frequently than hospitals with the lowest quality score of 0 (67.3% [37/55] vs 12.6% [53/422]; P < .001 for trend).

Conclusions and Relevance  Among hospitals participating in the HAC Reduction Program, hospitals that were penalized more frequently had more quality accreditations, offered advanced services, were major teaching institutions, and had better performance on other process and outcome measures. These paradoxical findings suggest that the approach for assessing hospital penalties in the HAC Reduction Program merits reconsideration to ensure it is achieving the intended goals.

Policy makers must reassess these programs and remove them if they do not stand the test of time.  Reductions of medicare reimbursement may penalize the wrong hospitals.

JAMA Network | JAMA | Hospital Characteristics Associated With Penalties in the Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program

More on the Propublica Study of Surgeon Complications

Numerous organizations are focused on reducing complications, reducing hospital admissions, and looking for a means to determine if certain surgeons or hospitals are 'outliers' in terms of complications.

Most of these studies are intended to decrease costs as a result hopefully of this analysis. Even well designed studies such as Propublica's are fraught with incorrect assumptions. Statistics should only be taken at face value and individual case studies are imperative.  Many cases require a deep dyve to extract information that will improve safety and  diminish complications.

Some controversy and a deeper look into the Propublica Study reveal mitigating information about less than optimal statistics for some surgeons.

photo by Shutterstock

When a bad surgeon is the one you want: ProPublica introduces a paradox

As posted to  KevinMD by  | PHYSICIAN  

Case #1

Morbidity Hunter’s real name is Harjinder Singh. He migrated from Punjab and works in a safety net hospital in North Philadelphia. Singh wanted to work in Beverley Hills, but to convert his J1-visa to a green card, he had to work in an area of need. Once he started working, he liked his job. His daughters liked their school, and his wife liked the house they bought. Singh doesn’t have shiny teeth. He hasn’t appeared on TV, although his daughters tease that he can play Sonny from Exotic Marigold Hotel.
Singh’s colleagues named him Morbidity Hunter because he operates regardless of how sick his patients are. He never says no. Nearly all his patients are obese and diabetic. The school of public health sends students to shadow him to learn about polypharmacy. The hospital went on a spree of hiring hospitalists when Singh started.
His patients, straddling the Federal Poverty Limit, don’t rate him on Yelp. His patients don’t use Yelp. Even if they were informed consumers they would have to choose Singh, because there are very few orthopedic surgeons who are willing to operate on them in that zip code. His patients haven’t heard of Cherry Picker. They don’t ski, ballroom dance or run half marathons.
Singh, too, is good at his craft. Technically excellent, to be precise. You wouldn’t know that from looking at the rates of readmission, infection, and deep vein thrombosis in his patients. But the staff in the operating room know that, as do his colleagues, whom he has often helped out in tough operations. Even Cherry admires him.
Singh is not in for the money. He doesn’t make as much money as Cherry, but makes enough. He doesn’t operate for glory. He operates for professional pride — an ethereal concept that eludes some health economists.
It’s hard to zap the morale of this sturdy lad from the Punjab. But the data transparency movement achieved that. He always knew that operating on the sickest, poorest and most disenfranchised section of society was not going to be lucrative. But he never knew he was going to be made the captain of their ship — he was happy to captain the placement of their total hip — but what happened before or after they entered the operating room was not his fault, he felt.
People began to call Singh an incompetent surgeon. He objected, but he could not understand the logic behind the numbers which were incriminating him. His complication rates were the highest in Philadelphia. Numbers don’t lie, supposedly. This was too much for him to bear. He didn’t mind losing the pitiful bonuses that CMS was withholding from him, but the reason broke his heart: his poor quality.
Singh was puzzled by people who claimed to lose sleep over the poor. The chasm between their sentimentality and actions baffled him. Punjab began to make more sense than Philadelphia. But then Cherry invited Singh to join his practice in New York. Cherry promised Singh that he could operate on technically challenging patients. Grudgingly, Singh accepted the offer, which made his wife very excited about shopping for Indian food in Queens. She insisted, though, that Singh had to see a dentist first.
Homo sapiens have always sought redemption. Today it is through data. Numbers have replaced Yahweh and Indra. But, just like the old gods were, numbers can be moody, arbitrary and, occasionally, downright unfair. Numbers are a human construct, after all.
Case #2

Cherry Picker lives in the Upper East Side of New York. His patients give him great reviews on Yelp. His patients read every comment on Yelp before making any decision. Cherry Picker has a beautiful family. When he smiles, light refracts from his shiny teeth.
Cherry regularly appears on TV. He writes for the sleek, metrosexual publication, FHM. Cherry specializes in knee injuries in weekend warriors. His patients often call him from the ski slopes in Colorado, Whistler ,and Zermatt. Cherry is good at his craft. But his patients are even better at their craft — post-operative recovery. Cherry doesn’t actively seek such patients. His patients are selected for him by his zip code, reputation, long waiting list and Yelp.
Simpson’s paradox — where the conclusions are actually, and precisely, the opposite of what is inferred from the data. That is, for example, when a study shows the superiority of an inferior treatment, and vice versa. he data release by ProPublica is a reservoir of Simpson’s paradox. This means when the data says “bad surgeon,” the surgeon might, in fact be a Top Gun — a technically-gifted, Morbidity Hunter — the last hope of the poor and sick.

Aren’t you intrigued and perturbed by this paradox? This means that data may not be just telling half-truths, but flat out lying.

The truth is if you have a great outcome,  you think your surgeon is the best.  If it is less than optimal there is a wide range of reactions. Some surgeons have great bedside manners...sometimes they get away with 'murder' or complications. Some surgeons have no bedside manners. These surgeons may leave patients in doubt, especially if their outcome is less than optimal.

PPACA (OBAMACARE) The Good, the Bad and the Ugly

When the PPACA was passed by the U.S. Congress (heavily Democratic) it was largely an uninown law.  Several years later we know much more about it. As one reads the actual law the print becomes smaller and smaller as you develop nausea,  headache, and confusion.

Statistics out this month reveal how many more millions of people are now insured. That is the 'GOOD"

Analysis reveal the higher  deductibles, and co-pays are the "BAD".

Lack of accessiblity, the limited number of providers accepting PPACA policies, and a 'poverty algorithm defeat some from obtaining health insurance and the involvement of the Internal Revenue Service  are the "UGLY"

Ain't The Way To Die |

Published on Jul 28, 2015
"Just gonna stand there and watch me burn, end of life and all my wishes go unheard." Visit for more on how to start this conversation.

Lyrics and more here:

Based on the Eminem & Rihanna song, "Love The Way You Lie."

Lyrics by ZDoggMD (Dr. Zubin Damania) and Dr. Harry Duh.

Audio engineering, mixing, production, and chorus vocals by Devin Moore.

Thanks to Success 3.0 Summit for supporting this production and to:

Wake Up The Movie:
Storyworks Production Company
Director, Michael Shaun Conaway
Producer, Alex Melnyk
Editor, Sean Horvath
Colorist, Mark Anton Read

Special thanks to the residents and staff of the University of Nevada School of Medicine.

Please share widely...and thank you Dr ZdoggMD

Tuesday, July 28, 2015

What are the best three life hacks?

 by:  Dan HollidayRecruiter, Traveler, Runner, CrossFitter, Philosopher & Lover of History; 

You may be wondering what does the title have to do with Health Train Express ?

We are all on the train of life, and it is an express.  While I came up with this title almost ten years ago, it has served well all these years, providing a transportation through HMOs, Managed care, Health Reform, HIT,  the Affordable Care Act and so on and on.

Not so much "life-hacks" but things that have made me successful(ish):
  • Exercise really is the solution to so many of life's issues (moods, health, etc.).  It's not just hype.  My entire life has been changed in monumental ways because of exercise.  If you're not getting enough exercise (or unless you are one of the rare like 1% of people who genuinely can be healthy without it) then you are suffering in some way.  It doesn't have to be CrossFit or running marathons, but you should be exercising.
  • Make a list of your priorities (including people).  Update it as necessary, but refer to it frequently.  It will help you make decisions on what is important in life.  It's cold.  It's calculating.  But so are you, we all are; we all have priorities (and we hate to admit that we rank people and things, but you do, we all do -- I'm just honest about it and write it down; if you're in my life, you're on the list).  The difference between those who cannot prioritize and those that do is about two heartbeats in making decisions that most people agonize over.
  • It's better to do things than to have things.  I'm not rich, but I can do one or the other.  I can afford nice things. I could have all sorts of great shit that people would look at and desire.  I can travel and do things and have great experiences with my husband.  But I can't do both.  Doing things together builds your relationships; having things seems to distract away from what's important.
Okay, and one more:
  • If you have plans, have re-evaluation periods and benchmarks.  It's hard.  It ain't fun.  But if you don't have goals and dates that those goals need to meet, then you are unlikely to succeed in a lot of things you try to do.  Your goals should be flexible (mine change all the time), but the ones I have, have evaluation periods that I look back and think, "Why am I doing this?"  If I'm not on track to meet the goals, if I feel like I'm missing the mark (or that it's no longer worth it), I evaluate and change course.
Let's watch Dustin Garis' TEDxRenfrewColllingwood take on this:

Do you want to grow your material wealth ? or:

"Grow  your wealth of Life Profit"

So  you ask, What does this have to do with Health Care? Nothing, and everything. It should however place a proper priority on life on the Health Train Express.

In 50 years none of this will be relevant.  (I hope much sooner)

Obamacare rates to rise 4% in California for 2016 - LA Times

Peter V. Lee is the executive director of Covered California. James C. Robinson is a professor of health economics at UC Berkeley.

California's Obamacare exchange negotiated a 4% average rate increase for the second year in a row, defying dire predictions about health insurance sticker shock across the country.
The modest price increases for 2016 may be welcome news for many of the 1.3 million Californians who buy individual policies through the state marketplace, known as Covered California.
California's rates are a key barometer of how the Affordable Care Act is working nationwide, and the results indicate that industry giants Anthem and Kaiser Permanente are eager to compete for customers in the nation's biggest Obamacare market.
Leading up to Monday's announcement there had been a steady drumbeat of news about major insurers outside California seeking hefty rate hikes of 20% to 40% for Obamacare open
enrollment this fall.
Overall, 44% of Covered California customers said they found it difficult to pay their monthly premiums now, according to a recent survey. And some people have indicated that they feel shortchanged in terms of the doctors they can see and the service they get from their health insurer or the exchange when problems arise.
Free market forces can be a powerful tool to contain health costs. But for that tool to work, consumers need the support of an active purchaser that can go toe-to-toe with the insurers. Other states and the federal exchange would be wise to look at what's working in California.

Monday, July 27, 2015

Shopping for a Doctor Who 'Fits' - The New York Times

All newly minted physicians go through a learning curve. They have learned all the ABCs of medical science, and then some.

Life experience comes to us through dribs and drabs if we are fortunate, or it may hit us in the face all at once.

At times physicians must 'unlearn' best practices, ethics, and other ethereal values or face consequences.

At times bad manners, or poor judgment rather than a medical error results in a medico-legal situation. And there are many attorneys willing to help there, on either side.

Shopping for a Doctor Who 'Fits' - The New York Times

Second opinions are a normal part of my line of work. I specialize in rare diseases affecting the bone marrow, and feel privileged both to practice at a hospital where I can focus on these esoteric illnesses, and to be considered competent enough at what I do that people seek my input on their diagnoses and therapies. At the same time, I never discourage my own patients from seeking the opinions of others, as their conditions are unusual and serious, and frequently deserve advice from more than one doctor. It’s what I would ask for if one of my own family members became sick.

But that wasn’t exactly why this woman was seeing me. She had arranged this appointment because she didn’t like her other doctor, and wanted to see if she liked me better.
These kinds of clinic visits have also become a normal part of my practice.
Decades ago, when physicians worked within a much more paternalistic system, such “doctor shopping” would have been considered inappropriate. Your doctor’s medical opinions were considered authoritative, incontrovertible and often final. Patients who challenged them were labeled “difficult,” and worried about developing a reputation that would influence their care, both with their own doctor and with others – as in the 1996 “Seinfeld” episode called “The Package,” in which Elaine is blackballed from being seen in medical offices and tries to steal her own medical records to erase her “difficult patient” status.
In recent years, patients have become more empowered to demand both good care, and a good attitude. Given some of the stories I have heard, I can’t say that I blame them.
One patient recounted how, when she mentioned to her primary oncologist that she wanted to seek my opinion, he told her to take her medical records with her because if she did see me, he would refuse to ever treat her again.
Another patient called me from his hospital room to give an account of his recent interaction with a doctor who recommended a course of chemotherapy for his refractory cancer.
“When I asked some questions about it, she basically told me it was her way or the highway. This is a big decision,” he told me. “I don’t want to go into it lightly.”
I reaffirmed that he, and not the other doctor, was in control of his destiny and treatment options, and reviewed the possibilities with him so that he could make a decision. I then called that doctor to relay his choice, which happened to be what she recommended – but on his terms, where he was included in the process.
Other times the interactions aren’t quite as dramatic, but represent more of a dissonance of personalities. Patients feel their doctors may be overly confident, or not confident enough; excessively nurturing, or too aloof. Alternatively, they simply may not “click.”
It cuts both ways. Doctors may not like some of their patients.
Years ago, I was asked to care for a prisoner who had just been diagnosed with lung cancer. When I entered his hospital room, he was lying in bed in his prison jump suit, his leg handcuffed to the bed’s footboard, as two guards stood by his side. As I explained his diagnosis and treatment to him, he stared at me, unblinking, with hate in his eyes. Every hair on my body prickled until I left his room. A guard who followed me into the hallway told me why my patient was in jail: He had killed his wife using a hammer.
I did not like that patient. But I put my emotion aside and cared for him, without judgment and to the best of my abilities, because it was both my job, and my duty.
I worry that we are increasingly losing sight of why our patients are seeing us. It is not because they want to, but because they are sick – they are hurting, not us. In their moments of need, we should disregard any feelings of indignation if our patients seek the opinion of another, or our disappointment that they don’t immediately accept our advice. We should support them as they make decisions about their own health – even if those decisions don’t include us.
As I walked into the exam room to meet my new consult, I put on a warm, welcoming smile. I didn’t want her to feel the least bit uncomfortable about the reason for her visit. Because this was about her medical care, and not about anyone’s pride.
Dr. Mikkael Sekeres is director of the leukemia program at theCleveland Clinic.

Does Health Care need "The Donald" ?

The shock wave of Donald Trump is passing over the political landscape. The "Donald" has no patience for political correctness. He trucks no incompetence, and does not bear fools easily. Plainly he is in your face and does not accept standard answers for  problems we have all witnessed for what seems time immemorial.

I like him, his approach, and disbelieving attitude. First of all  he is a great actor, who won't allow himself to be upstaged.  If he goes down it will be with a flurry of the "Donald's" hair. All those who label him as a  fool or a 'jackass' are missing the point, and the more they label him, the more support he receives from potential voters, Republicans or Democrats.

All you politicos, Get it straight. The public is fed up with the usual committee decisions, passing of laws that are not enforced, the border, immigration, educational incompetence, a failed economic plan, and the unearned 'tenure' of our elected representatives, and congressmen and senators who don't read or understand the bills they sign. That would fail you in elementary school. So why do we allow or condone this in our representatives?

Trump approaches issues like his flagship trade mark, the tsunami-like hair style...he leads with it, it washes over you and then  sucks you down and back.

Trumps says what we all have thought or felt, but would not say out loud. We are all too afraid to do that. We might lose friends, jobs, money, family or some other valued asset in our lives.

Frankly "Scarlett, I don't give a damn !" Donald Trump
would say.

The same can be said about health care and  health reform.

Such as it is we have had a constant flow of "experts" managing our health system.. It's a bit like the ship of fools, who are appointed because of their expertise on health.  Once in command they realize how they are outgunned by bureaucrats, and politicians who are experts in deception, half-truths, believers in algorithms and who knows what else.

For Example

The Players at HHS and CMS

Which leads most of us to ponder about our gut feelings regarding the Affordable Care Act, Accountable Care Organizations, Meaningful Use, and Value Based Reimbursements.

So,  who will be the "Donald" for Health Care?  Applicants apply here.

Saturday, July 25, 2015

Hospital waiting times 'likely to get worse', health board chief says - BBC News

So. you think it's bad here in the United States.......Wait, because it will become worse as hospitals become insolvent and close, and the ACA and medi-caid force hospitals to run in the red. Our health system is on very thin ice. Who will bail you out when you cannot get into a hospital ?

Hospital waiting times 'likely to get worse', health board chief says - BBC News

Coming to America ?

BBC News NI revealed on Wednesday that the number of patients waiting for appointments at Musgrave Park Hospital in Belfast had risen by 75%.
Some patients have had to wait up to 74 weeks to see a specialist.
Valerie Watts apologised to patients who have waited an "inordinate amount of time" for surgery.
"It is both regrettable and it was also disturbing for me to hear about those [waiting times]," she said.
"I am not proud to hear some of these stories, as CEO presiding over the Health and Social Care Board, to hear about these waiting times."


But she told BBC Radio Ulster's Stephen Nolan Show that waiting times were likely to get worse "because of the budget".
"We must understand that we have a finite budget within which we are working with this year," she said.

Musgrave Park Hospital's waiting list rises by 75%

Back surgery patients have been worst affected and can expect to wait 18 months for an appointment, according to internal documents leaked to the BBC.
They also show waiting times for knee and hip appointments are over one year.
A 43-year-old man who needs back surgery said he fears he will not be able to walk by the time he is treated.

'Breached targets'

George Anderson, a father of two from County Antrim, said he could not believe what he was hearing when he was told he would have to wait 67 weeks - almost 17 months - for an appointment.
"I don't think by then I will be able to walk. I am trying to do a day's work, trying to make a living, pay a mortgage, look after my kids and family and in 67 weeks I don't think I will be capable of doing all of that," Mr Anderson said.
"My biggest fear is that in 67 weeks I won't be able to pay my mortgage."

George Anderson speaking to the BBC's Marie-Louise Connolly
George Anderson told the BBC's Marie-Louise Connolly that he fears he may not be able to walk by the time he is treated for back problems

Musgrave Park Hospital in south Belfast is Northern Ireland's regional centre for orthopaedics.
The documents leaked to the BBC had been shared between management and consultants.
They show there is a 74-week (18 month) waiting list to see a back surgery consultant.
For knee appointments, the wait is 59 weeks, while hip patients have to wait 56 weeks.
The documents also show that up to this month, there had been 11,846 breaches of the 18-week waiting list target for a specialist appointment.


A majority of these breaches involve patients with back problems.
The BBC understands that the Belfast Health Trust is currently trying to recruit back specialists and this is part of the problem.
The 75% overall rise in the number of patients on waiting lists includes both inpatient and outpatient appointments.
In March 2013, a total of 19,644 people were waiting for inpatient and outpatient appointments at Musgrave, but by March this year, the figure had risen to 34,358 patients.


Within the Belfast Trust, waiting lists for ophthalmology (eyes), neurology, gastroenterology, and ear, nose and throat (ENT) appointments have also grown considerably.

Belfast Health Trust waiting lists

Ophthalmology - 9 047
Gastroenterology - 4,595
Neurology - 4,556
ENT - 4,050

Health Policy Legislative Update - 7/25/2015

The Federal Register lists some very important votes which are pending this week regarding repeal, and/ or amendments tothe Affordable Care Act.

Health Policy Legislative Update - 7/25/2015

Health Policy Legislative Update - 7/25/2015

Marilyn Singleton, MD, JD summarizes recent healthcare-related legislative activity on Capitol Hill.

Senator Mike Lee Takes Bold Step to Repeal ObamaCare

The Washington Post and Freedom Works are reporting on Senator Lee's plan to force the Senate to take a substantive vote on repealing ObamaCare. If successful, only 51 votes would be needed to proceed on the repeal amendment instead of 60. Lee's effort ties into the highway funding bill and votes are likely to be taken in a Sunday, July 26th session of the Senate. Freedom Works is urging Americans to ask their Senators to support this plan to repeal ObamaCare.

Bills that Assume the ACA is Here to Stay.

Expansion HSAs under the Affordable Care Act

On July 9, 2015, H.R. 3006, the Helping Save Americans’ Health Care Choices Act was introduced by Rep. John Fleming (R-LA) and referred to the House Ways and Means Committee. The bill would allow the treatment of a high deductible health plan as a qualified health plan under PPACA.

The bill would amend the Affordable Care Act to repeal:
  • the 20% penalty for distributions from a health savings account (HSA) or an Archer medical savings account (Archer MSA) not used for qualified medical expenses,
  • the prohibition on distributions from an HSA for over-the-counter drugs, and
  • the limitation on health flexible spending arrangements under cafeteria plans.
The bill would amend the Internal Revenue Code to allow:
  • a retirement savings tax credit for contributions to an HSA;
  • payment of premiums for high deductible health plans from an HSA;
  • a tax deduction for medical expenses incurred prior to the establishment of an HSA;
  • an increase of the HSA maximum allowable contribution amount to match the limit on deductible and out-of-pocket expenses under an HSA;
  • an exclusion from gross income of employer-provided coverage for qualified long-term care services that is provided through a flexible spending or similar arrangement;
  • eligibility for veterans with a service-connected disability, participants in Tricare, and certain Medicare beneficiaries for participation in an HSA;
  • both spouses to make catch-up contributions to the same HSA account; and
  • a tax deduction for amounts paid by patients to their primary physician in advance for the right to receive medical services on an as-needed basis.
Full text:

Attack on ACA Provisions that Could Ration Care

On July 8, 2015, S. 1718, the Four Rationers Repeal Act of 2015 was introduced by Sen. Pat Roberts (R-KS) and referred to the Senate Finance Committee. The bill would repeal:
  • the ACA’s Independent Payment Advisory Board;
  • the ACA provisions establishing the Center for Medicare and Medicaid Innovation.
  • the provisions with regard to preventive health services that prohibit cost sharing requirements for evidence-based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force.
  • The ACA requirements that: (1) the Director of the Agency for Healthcare Research and Quality convene an independent Preventive Services Task Force, and (2) the Director of the Centers for Disease Control and Prevention (CDC) convene an independent Community Preventive Services Task Force. Restores provisions of law amended by such provisions.
The bill would prohibit the Secretary of Health and Human Services (HHS) from using data obtained from comparative effectiveness research to deny or delay coverage of an item or service under a federal health care program. It also requires the Secretary to ensure that comparative effectiveness research conducted or supported by the federal government accounts for factors contributing to differences in the treatment response and preferences of patients, including patient-reported outcomes, genomics and personalized medicine, the unique needs of health disparity populations, and indirect patient benefits.

Full text:

Changes to Medicare

Expanding Government Control Over Medicare Program

On July 14, 2015, H.R. 3061, the Medicare Prescription Drug Price Negotiation Act of 2015 was introduced by Rep. Peter Welch (D-VT) and referred to the House Energy and Ways and Means Committees. The bill would require the Secretary of Health and Human Services (HHS) to negotiate with pharmaceutical manufacturers the prices that may be charged to Medicare part D prescription drug plan (PDP) sponsors and Medicare Advantage (MA) organizations for covered part D drugs for part D eligible individuals who are enrolled under a PDP or under an MA-Prescription Drug (MA-PD) plan.

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Medicare Advantage Changes

On June 17, 2015, H.R. 2570, the Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act of 2015 which was introduced by Rep. Diane Black (R-TN) passed the House. The bill combines some issues addressed piecemeal in earlier bills. First, the bill revises criteria for qualifying as a meaningful user of electronic health records (meaningful EHR user). For any payment year after 2015 any patient encounter of an eligible professional occurring at an eligible ambulatory surgical center shall not be treated as one in determining whether an eligible professional qualifies as a meaningful EHR user.

The bill also requires the Department of Health and Human Services (HHS) to establish a three-year demonstration program to test the use of value-based insurance design methodologies under the eligible Medicare Advantage (MA) plans offered by MA organizations under part C (Medicare+Choice Program). “Value-based insurance design methodology” is one for identifying specific prescription medications, and clinical services payable under Medicare, for which copayments, coinsurance, or both would improve the management of specific chronic clinical conditions because of the high value and effectiveness of such medications and services for such specific chronic clinical conditions, as approved by HHS. Hopefully, this will not be a stepping stone to rationing.

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Expansion of Medicare Telehealth Services

On July 7, 2015, H.R. 2948, the Telehealth Parity Act of 2015 was introduced by Rep. Mike Thompson (D-CA) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would expand Medicare coverage of telehealth services. The bill would expand the term “originating site” to include federally qualified health centers and any rural health clinic where the patient is located. The bill authorizes as additional telehealth providers certified diabetes educator or licensed respiratory therapist, audiologist, occupational therapist, physical therapist, or speech language pathologist.

The bill requires the Comptroller General (GAO) to study the effectiveness of remote patient monitoring on decreasing hospital readmissions for specified chronic conditions, and the savings to the Medicare program associated with use of such monitoring.

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On July 15, 2015, H.R. 3081, the TELEmedicine for MEDicare Act of 2015 or the TELE–MED Act of 2015 was introduced by Rep. Devin Nunes (R-CA) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would permit certain Medicare providers licensed in a state to provide telemedicine services to Medicare beneficiaries in a different state. Any disciplinary actions would be under the jurisdiction of the health provider’s licensing state.

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On July 15, 2015, the identical bill in the Senate was introduced by Sen. Mazie Hirano (D-HI) with bipartisan support and referred to the Senate Finance Committee.

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Women’s Health

Bill to End All Restrictions on Abortion Coverage

On July 8, 2015, H.R. 2972, the Equal Access to Abortion Coverage in Health Insurance (EACH Woman) Act of 2015 was introduced by Rep. Barbara Lee (D-CA) and 25 co-sponsors and referred to the House Energy and Commerce and Oversight and Government Reform Committees. The bill would overturn the 1976 congressional ban on providing federal funds for abortions. Specifically, the bill would require the federal government to: (1) ensure coverage for abortion care in public health insurance programs including Medicaid, Medicare, and the Children’s Health Insurance Program;

(2) in its role as an employer or health plan sponsor, ensure coverage for abortion care for participants and beneficiaries; and (3) in its role as a provider of health services, ensure abortion care is made available to individuals who are eligible to receive services in its own facilities or in facilities with which it contracts to provide medical care.

The bill would also prohibit any federal or state restrictions on private insurance coverage of abortion care.

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Over-the-Counter Contraceptives

On May 21, 2015, S. 1438, the Allowing Greater Access to Safe and Effective Contraception Act was introduced by Sen. Kelly Ayotte (R-NH) and Sen. Cory Gardner (R-CO) and referred to the Senate Finance Committee. The bill would require priority review by the FDA of applications for contraceptive drugs intended for routine use and the drug is intended for those 18 years and older. This would pave the way for over-the-counter hormonal contraceptives.

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Is this a Joke?

On July 20, 2015, H.R. 3117, the Fund Essential Menstruation Products Act of 2015 or the FEM Products Act of 2015 was introduced by Rep. Grace Meng (D-NY) and referred to the House Ways and Means Committee. The bill would provide for reimbursement from health flexible spending arrangements for feminine hygiene products, such as tampons, pads, liners, cups, sponges, douches, wipes, sprays, and similar products used by women with respect to menstruation or other genital-tract secretions.

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Bill to Improve Surveillance and Education About Overdoses

Fortunately, the bill does not take the “punish the doctor” approach.

On June 23, 2015, S. 1654, the Overdose Prevention Act was introduced by Sen. Jack Reed (D-RI) and referred to the Senate Health, Education, Labor, and Pensions Committee. The preamble to the bill notes that nearly 44,000 people in the United States died from a drug overdose in 2013. More than 80 percent of those deaths were due to unintentional drug overdoses, and many could have been prevented. Opioid medications such as oxycodone and hydrocodone were involved in nearly 46 percent of all unintentional drug poisoning deaths in 2013.

Accordingly, this bill would require the Substance Abuse and Mental Health Services Administration (SAMHSA) to enter into cooperative agreements to reduce deaths from drug overdoses by: (1) purchasing and distributing naloxone (a medication that rapidly reverses overdose from heroin or other drugs with effects similar to opium) or a similar drug; and (2) educating or training the public, first responders, or health professionals on drug overdose prevention or response. The Centers for Disease Control and Prevention must improve drug overdose surveillance by entering into cooperative agreements to: (1) provide training to improve identification of drug overdose as the cause of death, and (2) establish a national program for reporting drug overdoses. The National Institute on Drug Abuse (NIDA) must prioritize, conduct, and support research on circumstances that contribute to drug overdose, drugs associated with fatal overdose, and overdose prevention methods. NIDA must support research on drug overdose treatments that can be administered by lay persons or first responders.

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