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Thursday, September 22, 2016

Anthem, Cigna Have Accused Each Other of Merger Breach - WSJ

The ink has barely made it to the paper, and Anthem and Cigna have gotten cold feet regarding their proposed merger.

The blowback from the public and the DOJ, FTC are working, even without a formal filing or restraining order. In order to save face....blame each other. It's a no lose situation for counsel for either company.  What the heck, those guys are on multi-mllion dollar retainers either way...A nice cash flow for the junior non  partner attorneys for the big law firms in the health and insurance niche.  They most likely reasoned it would cost more money to litigate than to simply carry on as they are now. (that is how obscene the amount of money is at stake and how much money these companies have under their mattresses. How long is the American public going to put up with these rules that bankers and insurance companies write for themselves ? Are we a ship of fools ? Yes


Sometimes it makes me wish I had gone to law school...no HMOs no ObamaCare, no EMRs Meaningful use, MACRA, MIPS, Accountable Care Organization, getting paid for volume, not outcomes....etc. Now that I am retired (I am young only 73 and my life expectancy is still pretty good according to the latest stats. I could retrain here at my local Western law school and make some really big bucks !

Doctors don't seem to have time anymore for Wednesday (or is it Thursday) afternoon golf..but since I am retired I do. Even though I don't play golf I am willing to give up my afternoon nap time to study for my new profession.











Anthem, Cigna Have Accused Each Other of Merger Breach - WSJ

The Top Gun of Health Train Express Blogs for 2016 (so far)

Our readership fluctuates quite a bit, averaging a paltry 200-300 users/day. Most of the readership is from the U.S. and the U.K.

This year we had several posts that went well above 1000 readers/day.  Like most internet publications readership depends heavily upon Google searchs.  Readership continues for days, weeks months and even years.  We network our contributions on facebook, twitter Newsana, Digg, Redditr and a list of email subscribers. We have an RSS  feed as well.




Top Gun Posts:






Mark Zuckerberg, Priscilla Chan unveil $3 billion effort to cure disease

Mark Zuckerberg and spouse have joined the list of other philanthropists such as William and Melinda Gates,  Paul Allen, Sean Parker, Mayor Michael Bloomberg, and the Koch brothers are donating billions of dollars to many scientific and health related research efforts.



Sean Parker, the cofounder of Napster, has committed $250 million to develop new cancer treatments. Former New York City Mayor Michael Bloomberg is leading a coalition of philanthropists putting up $100 million for a separate cancer initiative. And philanthropist and entrepreneur Paul Allen committed $100 million in March to an initiative that backs risky, cutting-edge science that more conventional funders might avoid.

Paul Allen created the Paul G. Allen Family Foundation  launched in 2010, funds scientists who take “out-of-the-box approaches at the very edges of knowledge,” as Allen put it. The program’s 2015 awards for Alzheimer’s research, for instance, largely passed over scientists who focus on the leading (and, so far, leading-to-nothing-useful-to-patients) hypothesis that the disease can be treated by eliminating amyloid plaques.
Billionaire businessmen Charles and David Koch have also given tens of millions to cancer research.
And Bill Gates funds public health projects around the world, including malaria and polio prevention efforts, through his charitable foundation.







Mark Zuckerberg, Priscilla Chan unveil $3 billion effort to cure disease

Wednesday, September 21, 2016

UnitedHealth survey: More shop around for healthcare, but insurance literacy falls short


While more American consumers are taking advantage of tech tools to comparison shop for healthcare, they still lack basic knowledge about health insurance and dread selecting a health benefits plan.

This one of the major failures of the American Health System.  Interestingly it is also a major failure in the American Tax System.  Two items so important to every citizen cause great angst and frustration for all.

A new survey from UnitedHealth details those and other findings, offering both positive signs for consumer engagement and areas that suggest health insurers have more work to do as they look to improve their members' experience.
Indeed, “this survey underscores why UnitedHealthcare is working to simplify the healthcare experience for people and help them take full advantage of their healthcare benefits,” Rebecca Madsen, UnitedHealthcare chief consumer officer, said in an announcement.
Here’s a look at some of the survey’s key findings:

Highlights:
  • Nearly a third of respondents have used the internet or mobile apps during the last year to compare the cost of medical services, which is more than double the rate in 2012. The uptick was most significant among young people.
  • Among all comparison shoppers, 81 percent described the process of using online or mobile resources as “very” or “somewhat” helpful.
  • Fifty-six percent of survey respondents who are employed full time said they would be interested in using a wearable fitness tracker as part of a workplace wellness program.
  • Thirty-seven percent of respondents said they were “very" or “somewhat" likely to use telemedicine to access healthcare services.

Lowlights:
  • Only 7 percent of respondents could successfully define all four basic health insurance concepts: plan premium, deductible, co-insurance and out-of-pocket maximum. Consumers had the most trouble defining co-insurance and out-of-pocket maximum.
  • Many survey respondents underestimated the actual cost of specific healthcare services. For a knee replacement procedure, for example, 63 percent estimated the cost to be lower than the national average of $35,000, and only 11 percent answered correctly.
  • The task of selecting a health plan is not one that consumers relish, as 25 percent would rather file their annual income taxes. And 28 percent said having to review their health benefits during open enrollment would be worse than the hassle of losing their mobile phone.

In addition, despite the increased uptake of tech tools by consumers, 78 percent of respondents preferred speaking with a customer service representative to resolve an issue or ask a question--the clear winner over email, online chat or mobile app. When customers do speak to a representative, 30 percent ranked the person’s knowledge as the most important factor of the experience.

The system must be deconstructed to one in which the number of choices is much less, more intuitive and less subject to making critical errors in selecting coverage.




Fierce HealthCare

Forbes column: CBO Blesses Violation of Separation of Powers - gmlevinmd@gmail.com - Gmail

Forbes column: CBO Blesses Violation of Separation of Powers - gmlevinmd@gmail.com - Gmail

'Micro-hospitals' offer alternative to urgent care model | FierceHealthcare



A revolution is taking place in the delivery of health care

Bedless hospitals. 

Consumers like the convenience and accessibility of urgent care clinics. But hospitals may have found another model that better meets the needs of patients: the “micro-hospital.”
While the state of Colorado prefers to call them "community hospitals," these licensed facilities offer emergency medical care, inpatient care, surgery, laboratory and radiology services, Michael Slubowski, president of CEO of SCL Health told Hospital & Health Networks. SCL, which is based in Denver, plans to open four locations in neighborhood settings with it's partner Emerus. The facilities are priced higher than urgent care centers, but less than a full-service hospital, and can treat a wider range of conditions because they have inpatient beds, he said. 

Most micro-hospitals operate 24 hours a day, seven days a week and usually have eight to 10 inpatient  beds for observation and short-stays, according to the Advisory Board. "No two micro-hospitals are exactly the same in their design or service mix, but one trend is becoming clear. Most health systems are using them as entry points into markets where demand would not be able to support a full-scale hospital," the Advisory Board noted in a recent report. 

"Micro-hospitals like this are more suited for large urban and suburban metro areas," he told the publication. "This model would probably be too large and complex for a rural market. It definitely is a trend, among many trends occurring in healthcare, to create more accessible, cost-effective access points and alternative delivery models." Driving this experiment is the desire to have highly efficient operations and specialized care giving. Industry is finding bigger is not always better and cost containment may more easily be achieved in smaller facilities.

Telehealth

FTC, DOJ back Teladoc in battle with the Texas Medical Board  
Teladoc is getting support from the Federal Trade Commission and the Department of Justice in its lengthy battle with the Texas Medical Board (TMB) over the latter’s face-to-face appointment requirement before a physician can prescribe medications via telemedicine.


Teladoc says that such a requirement limits and hinders use of telemedicine services within the state.
Last December, TMB was denied a motion to dismiss Teladoc’s 2011 antitrust lawsuit--the board then appealed that decision in January.
In an amici curiae brief, filed in the Fifth Circuit Court, the FTC and DOJ call that appeal an attempt to “evade the substance of federal antitrust law," and add that, basically, the court doesn't have jurisdiction over the appeal. 
The brief goes on to say that if the court does feel it has a right to jurisdiction over the appeal, "it should hold that the state action doctrine does not shield the TMB’s rules from federal antitrust scrutiny because the TMB did not carry its burden to show active supervision."
"There is no evidence that any disinterested state official reviewed the TMB rules at issue to determine whether they promote state regulatory policy rather than TMB doctors’ private interests in excluding telehealth--and its lower prices--from the Texas market," the brief says.
In conclusion, DOJ and FTC say that the appeal should be dismissed "for lack of appellate jurisdiction."
The FTC has shown support for telemedicine before, backing a telemedicine provisionpresented in March as part of legislation working its way through the Alaska Senate.

Remote televideo visits and screening

This ability will decrease non compliance for non ambulatory and/or non compliant patients. It provides a means of communication visually, with a nurse practitioner or medical assistant. Some insurance companies already reimburse for diabetic retinopathy screening at home for non compliant patients. The socioeconomic benefit has already been demonstrated. 1


'Micro-hospitals' offer alternative to urgent care model | FierceHealthcare


Monday, September 19, 2016

Help Preserve Our Privacy-Data Selling for Profit Epidemic |

It is your data, but are you sharing the profit ?


Each time I check my mail or bank statement I do not see any deposits coming from my health insurance company or hospital for the moneys they earned from selling my data, anonymized or not. This information is becoming more commonly known.


The larger question is it  still your data if your identifying information has been removed? Apparently so,  as this challenge has been rebuffed by powerful corporate interests. Profiteering from a sick or well person's data is now acceptable business practice.

This story is curated from an article by Barbara Duck in You Caring


The Story

I am an active consumer advocate and write about our data being sold frequently and we don't know to who, what kind of data they sell, and how it will impact us. We need a law to require all who sells data in the US to buy a license and disclose what they sell and to whom. Here's the reason why...(Think Anthem Breach)

This call was different as the caller proceeded to tell me that their records indicate that I am one who takes blood thinners.  They also had my name and address information which they disclosed at the beginning of the call.  So what's the problem here?

I don't take blood thinners, never been prescribed any and have not taken any in my life!  

Where did this information come from?  It was derived by the data sellers on the internet piecing together information they mine and some algorithm determined with making this match that "I take blood thinners"!  This is enough to make anyone mad as hell!  It made me mad as I used to be a data base person that did this kind of work too.  I have a pretty good idea on the data mechanics here.  

Now we hear that the hackers of Anthem came from China, do you want your records sold all over China and the US?  That's why they hacked to get data to sell, period.  Hackers can repackage our data, hide the original formats and bingo they have a money maker.  When this happens and being there's no licensing attached to identify origins, well companies will end up buying stolen data at some point, why we need licensing!!  Here's the rest of what happened to me..

Long and short of this, my data has been sold and I have been repackaged and who knows how many other places have this "flawed data" about me on file?  I'm not one who has ever taken blood thinners and I have no way to fix this.

I have no way to find who did this to get it corrected and remember this is all on my own dime and time too!  The data sellers don't care as flawed data gets the same price as good data, so I'm screwed and can't remove this and I don't know where and when it will appear again and I'm mad.  My hands are completely tied and I can't fix this.  This is why we need an index for this.

I have no way to find who did this to get it corrected and remember this is all on my own dime and time too!  The data sellers don't care as flawed data gets the same price as good data, so I'm screwed and can't remove this and I don't know where and when it will appear again and I'm mad.  My hands are completely tied and I can't fix this.  This is why we need an index for this.

Who in the hell are all these data sellers?  

Now when people do research about me to find what's on the web, I have no clue when this will pop up again and it will at some point, depends how many bought this information about me.  So I go apply for a loan as an example and guess what "I'm a person that takes blood thinners" shows up.  

With all the extensive data searching we do today, this person who could be the one approving the loan will see this!  What could be their next move?  Easy, look and purchase more data about me, like get an actuary report from another data seller that shows the risk of how long they think I will live!!  This happens folks and this an example with me here but it happens.  

So depending on what comes back if my risk of not living long enough has impact, well guess what, I get no loan.

More about other matters:

Here's some additional reference and information with more details about how this works against us with privacy and no transparency....

Did you know you are "secretly" scored? What is a score? Well think back to school if you will and remember how you were graded, and this is happening all the time today, but it's not a test you are taking to get scored, companies and buying and selling your data and you don't even know it. Worse yet, when there are errors, guess what, the score is wrong, but you have no way to even know you have a flawed score out there that people are using to make some kind of decision. 

Did you know that when you call most insurance call centers they are "scoring" your voice?When you hear "this call may be recorded..." what's really occurring is that millions of computer algorithms are listening to you and determining what your current state of mind is. You can read more here about how that occurs and the software used. 

Do you know that health insurers are buying your Visa and Master Card records? They sure are and those too are analyzed and used along with other data they may have on file about you. This is becoming more common practice all the time. They could be doing that, but they have a lot more than just clothes purchases and could be looking at anything including your grocery bill, and so on.  

Do you want your health insurer to know everything you buy and scrutinize it? You can read more here about how that works. 


There really are few ways to track your information once it  goes into a  server either cloud based or in your office. The cost of insuring your privacy is considerable and is another addition to health care costs.

The over-riding weakness of the system is that all of the data resides in one place (or more) It is not compartmentalized and a simple breach can result in massive data exposure.



Help Preserve Our Privacy-Data Selling for Profit Epidemic | Other - YouCaring

Saturday, September 17, 2016

This Homemade Mosquito Spray will Protect you from the Zika Virus —


Home made Mosquito Repellant


The Zika virus spreads via vector transmission. Individuals infected with Zika do not display signs and symptoms of infection. In some cases, the following signs and symptoms are reported:
  • general feeling of discomfort
  • rash and muscle pain
  • mild fever
  • red eyes
The incubation period, that which is the time from exposure to the manifestation of symptoms, is still unknown, but is likely to be a few days to a week.
The most adverse effect of the Zika virus is microcephaly, a condition characterized by fatal congenital condition that is common among infants. This happens when a pregnant woman is exposed to the Zika virus. There have been new cases of the virus from UK to Brazil, exposing many newborns to congenital anomalies.
Based on research conducted so far, the virus does not spread from person to person like, a cold, but through vector transmission- a mosquito biting an infected person and then on to another individual who then contracts the virus.
To date, there is no known vaccine to prevent or medication to treat the Zika virus infection. One effective measure of avoiding infection is by avoiding mosquito bites altogether in places where cases of Zika virus have been reported.

Homemade Essential Oil Mosquito Spray Repellent
Instead of applying harsh mosquito spray ion the skin, use a homemade essential oil spray to avoid mosquito bites altogether. Here are the ingredients to make an all-natural essential oil repellent:
What you need:
2 tsp lemongrass essential oil
2 tsp eucalyptus essential oil
2 tsp citronella essential oil
13 ounces witch hazel
How to make:
  1. Combine the ingredients and shake well.
  2. Pour the essential oil mixture into spray bottles
  3. This essential oil preparation can last for a month or two. Make sure to store the mixture in glass spray bottles.



This Homemade Mosquito Spray will Protect your from the Zika Virus 




Obamacare should have been named Emanuel Care




Ezekiel Emanuel's part in formulating the Affordable Care Act was overshadowed as it became known by President Obamas campaigning for it's passage. The bill was passed by the Republicans refusal to compromise on some important values to all Americans. The democrats won a political victory by expediency.  The clock was ticking and the moment was at hand.  Rather than passing an intelligent, logicall and well thought out law the ACA was passed with an end goal in mind, not the liklihood that it would work.

A major goal was to insure 40 million Amercans that were then uninsured.  The goal was not achieved, however missing it by tens of millions, leaving those still uninsured. Affordability is open to question.

I thought it would be a good time to republish my thoughts of November 2013,  

What They Said Before the Train Wreck: The Top 10 Worst Quotes Pushing ObamaCare


Patient-Centered Care? Not for This Patient |



Patient-Centered Care? Not for This Patient

And not for how many more?

Any situation such as the one described here sometimes defies any algorithm or ven diagram designed to assure continuity and totality of patient management.
The term seems to have evolved to assuage patient concerns that our health system is in run-away mode driven by self interest of providers, specialists, primary care physicians, insurance companies, pharma, and our government. Each has it's own self-interest.
Now in the era of 'big data' and analytics another powerful force is taking over. " the patient experience'.  Surveys present the opportunity to serve up how well providers, hospitals and insurers meet standards of compliance. In a world of check boxes rankings depend upon documented compliance with an arbitrary bar, and without looking deeper into the evaluation.
Given the task of measurement by managers the statistician becomes a 'king maker' with his numbers. At first glance knowing the numbers seems to be objective and factual. Most highly educated professionals know that statistics often lie, and are only probabilities. Statistics do not solve problems, they are merely one of the tools for managers, providers and others to support ideas and proposals for change-making.











Credits: Patient-Centered Care? Not for This Patient | Medpage Today
President Obama, in the Rose Garden, signed the so-called doc-fix bill, which permanently ended automatic Medicare payment cuts to doctors.


The 20 year war by physicians to rescind the SGR (sustained growth rate)  which had been designed to decrease the inflation of health cost has been placed. The result was a trade-off for MACRA and MIPS.

Administratively MACRA and MIPA are highly complex and require significant and expensive reorganization.  Will it save money? That is a good question. Has anyone seen a financial analysis of these requirements?

Friday, September 16, 2016

Agate Resources insiders made $34 million on sale of company that used public funds to provide health care to low-income Oregonians | Local | Eugene, Oregon

Is this a legal transaction ?

Is this an ethical transaction?

A small group of insiders in a private Eugene company that managed medical services for low-income Lane County residents made about $34 million when the company sold last year to a large out-of-state buyer, documents obtained by The Register-­Guard show.
For-profit Agate Resources owned and ran Trillium Community Health Plan, which oversees the Oregon Health Plan in Lane County, using federal and state government money to provide health care for about 94,000 low-income residents in Lane County and 2,000 in Douglas County.
The sale has been controversial because of concern that Agate held onto government Medicaid money to make itself attractive to a buyer, instead of spending more aggressively to provide doctors and medical services for Oregon Health Plan patients.
Early last year, 13,000 Lane County OHP patients did not have a primary care doctor. The problem wasn’t fully resolved until a year later.
Centene reported in its latest annual report that it bought Agate in September for $109 million. Agate shareholders divvied up that cash, according to the sale plan documents obtained by The Register-Guard.
Eleven Agate executives and directors became millionaires over night, the documents show. They include Chief Executive Officer Terry Coplin, who received the biggest single sale payout, of about $5.7 million, and Chief Financial Officer David Cole, who received about $4.2 million, the sale documents show.

Agate Resources insiders made $34 million on sale of company that used public funds to provide health care to low-income Oregonians | Local | Eugene, Oregon

Medicare's second-highest paid doc accepts three-year exclusion

One of the country’s highest paid physicians agreed to a three-year exclusion to settle claims that he billed Medicare for medically unnecessary cardiac procedures, according tothe Department of Justice.


Last year, the DOJ joined two whistleblower lawsuits against Asad Qamar, who owned the Institute of Cardiovascular Excellence in Ocala, Florida. The lawsuits alleged that he regularly billed for unnecessary procedures and violated the Anti-Kickback Statute by waiving Medicare copayments. Months later, the Centers for Medicare & Medicaid Services banned Qamar from the Medicare program, prompting support from a Super PAC of former patients who were “disgusted and distressed” by the government’s portrayal of Qamar.
In addition to a three-year exclusion from Medicare, Qamar will pay $2 million and forgo an additional $5.3 million in suspended claims.
One thing to remember is that these occurences are rare. The real question is how medicare waits so long to act on these suspicious billings. The claims should be suspended pending adequate analysis.  The system needs to be proactive to avoid fraud and theft from the public tillers.
Fraud such as this is inexcusable, and the alleged perpetrator should have his medical license suspended  pending further analysis.  With this volume of surgery  his records also should be thoroughly examined. No doubt he owned his own surgery center and had no peer review. Were the procedures even indicated ?
These issues brought forth by the DOJ on behalf of CMS are difficult to analyze at times. There were a number of providers in this group and it may be that all were included under his billing identifications. No other providers were named in the action.
Here is the doctors letter of response to his patients. Bottom line...pay a fine, make retitution and you are still in business...all about money for the feds....not a real moral or ethical issue for them. Was he guilty.  I present.... you decide.  

Patients are easily fooled, especially if complication rates are low. Examine the Facebook pages of grateful happy patients. PR and marketing can be clever camouflage for deception and fraud

WebMD reports multiple physicians in this group. Dr Qamar may have been the only interventional cardiologists receiving referrals from the other cardiologists. The devil is in the details. It is a standard practice for cardiologists, and other interventional providers who no longer operate to see and diagnose patients with serious cardiac problems and refer them to someone who performs PCCT. It is also a proven fact that 'high volume' surgeons have fewer complications... We do not know all of the details which become murky and obscured by what is published by others. Either that or the doctor is a sociopath. Case closed.

Digital Health Space neither agrees or disagrees with any stipulated legal settlement between Dr Assad Qamar with CMS and/or HHS.  This is only opinion..

Thursday, September 15, 2016

Dropout by Dartmouth Raises Questions on Health Law Cost-Savings Effort - The New York Times



 In its quest to remake the nation’s health care system, the Obama administration has urged doctors and hospitals to band together to improve care and cut costs, using a model devised by researchers atDartmouth College.
But Dartmouth itself, facing mounting financial losses in the federal program, has dropped out, raising questions about the future of the new entities known as accountable care organizations, created under the Affordable Care Act.
The entities are in the vanguard of efforts under the health law to moveMedicare away from a disjointed fee-for-service system to a new model that rewards doctors who collaborate and coordinate care.
Medicare now has more than 400 accountable care organizations, serving eight million of the 57 million Medicare beneficiaries. Obama administration officials say the new entities are saving money while improving care, but some independent experts have questioned those claims.
“There’s little in the way of analysis or data about how A.C.O.s did in 2015,” said Dr. Ashish K. Jha, a professor at the Harvard School of Public Health. “The results have not been a home run.”
In addition, he said, “there is little reason to think that A.C.O.s will bend the cost curve in a meaningful way” unless they bear more financial risk, sharing losses as well as savings with the government.
An evaluation for the federal government found that Dartmouth’s accountable care organization had reduced Medicare spending on hospital stays, medical procedures, imaging and tests. And it achieved goals for the quality of care. But it was still subject to financial penalties because it did not meet money-saving benchmarks set by federal officials.
“We were cutting costs and saving money and then paying a penalty on top of that,” said Dr. Robert A. Greene, an executive vice president of the Dartmouth-Hitchcock health system. “We would have loved to stay in the federal program, but it was just not sustainable.”
Dr. Elliott S. Fisher, the director of the Dartmouth Institute for Health Policy and Clinical Practice, said: “It’s hard to achieve savings if, like Dartmouth, you are a low-cost provider to begin with. I helped design the model of accountable care organizations. So it’s sad that we could not make it work here.”
The idea of accountable care organizations and the name are generally traced back to a paper in 2006 by Dr. Fisher and colleagues at Dartmouth and its medical school. Writing in the journal Health Affairs, they reported that Medicare beneficiaries received most of their care from doctors who were directly or indirectly affiliated with a local hospital.
Rather than trying to measure the performance of individual doctors, they said, Medicare should assess the hospital and the doctors together and hold them jointly accountable for the cost and quality of care provided to a defined group of Medicare patients.
In effect, this was an effort to overcome the fragmented nature of most American health care and to replicate some of the benefits of managed care while still allowing Medicare patients to visit any doctors they wanted.
The new entities, unlike health maintenance organizations, “can’t tell you which health care providers to see” and “can’t limit your Medicare benefits,” the Obama administration tells beneficiaries. But, it says, doctors and hospitals working together in an accountable care organization can share information, including test results and prescription drug data, so it is easier for them to coordinate care for patients.
This result is the outcome of muddled thinking. True cost savings and reductions in fees would not be known for some time.  They also exclude the organizational costs and information technology (software development) to administer the new organization.
Accountable care organizations are one of many demonstration projects being conducted by the Center for Medicare and Medicaid Innovation, an office created by the Affordable Care Act to test new ways of financing and delivering care. Under the law, the secretary of health and human services has sweeping power to expand such projects nationwide if she finds that they would reduce Medicare spending without harming the quality of care.
The center is testing new ways to pay for prescription drugs, medical devices, cancer care, hip replacement surgery and many other services.
The Congressional Budget Office predicts that the center’s activities will save $34 billion over the next 10 years, although it does not know which projects will save money.
Bottom line:
We want you to reorganize to save money, and we will penalize you if you don't or cannot.  (CMS Center for Innovation)






Dropout by Dartmouth Raises Questions on Health Law Cost-Savings Effort - The New York Times