A Look Down the Road at Medicare Cuts

Moody’s Investor’s Report:

Doctor, your credit score will suffer. You will freeze plans for investing in capital assets, personnel, EMRs, and new equipment leases.

There will be multiple and extended domino effects triggered by health insurance reform. I do not believe anyone should call the APPA health care reform.  It is clearly not so.

Medicare pays more than $300 billion to providers annually, covering the care of more than 40 million Americans. About 70% of corporate health providers rely on Medicare and Medicaid for more than one-third of their revenue.

Certain industries stand to face the sharpest cuts in government money, Moody’s says, namely home health, as well as oxygen and durable equipment companies. Hospice care, nursing homes and specialty hospitals are also expected to lose millions off what they receive now. Moody’s says we can expect consolidation in health industries, as providers acquire different health-care entities to diversify.

The entities less likely to face severe trims: inpatient hospitals, contrary to what hospital associations and most CEO’s complain about. Moody’s buttresses their point with a list of for-profit hospital entities that have been assigned stable outlooks. The report doesn’t measure what these cuts might mean for already struggling nonprofits.

• What and Who They Won't Cut wrote:  commentary from the WSJ article.

Due to massive inflows of corporate cash into the offices of our Congress People the Following Hundreds of Billions of Dollars of Competition Killing Direct and Indirect Government Subsidies will Never Be Cut or Taken Away from the Insurance Companies….

1) Medicare Part D subsidies for insurance and drug companies.
2) Medicare Advantage subsidies for insurance companies.
3) A Federal ban on Medicare Insurance Bidding on a drug formulary through competitive bidding.
4) A federal exemption for private health insurance companies from antitrust regulations allowing them to collude against patients, doctors and hospitals.
5) A ban on Federal grants to develop a single EMR and billing system for physicians, hospitals and therapists which would reveal clinical, preventative and surgical outcomes. Outcome revelations would crush the health insurance companies, and allow for free-market competition among doctors and hospitals based on quality and efficiency.
6) Continued protection of private health insurance companies from medical malpractice lawsuits via federal ERISA laws.
7) Continued reckless and negligent medical rationing by private health insurance companies via their non-physician employees.
8) A continued government ban on collective bargaining by physicians.
9) An inability of Medicare to enlarge its limited risk pool beyond that of the most expensive oldest, sickest and most physically disabled citizens of our nation thereby insuring the bankruptcy of our most effective and least rationed health insurance product for the elderly.
10) A continued allowance of 1.25 million personal bankruptcies due to a medical illness.
11) Continued real change in malpractice reform. Real malpractice reform would allow internists and family practitioners to fulfill their role as primary care physicians efficiently and productively, tackling dynamic illnesses without prematurely referring their sicker patients to expensive specialists without medical benefit.

So what, in typical corrupt government fashion, the higher powers of our bribed public officials have declared war on oxygen vendors, super specialty hospitals, home health, durable wheelchair and bed equipment companies, those who comfort the dying in hospice care, and those who care for the senile and feeble in nursing homes. Moody’s says we can expect consolidation in health industries this is to be expected…bigger insurance companies protected from collusion/anti trust laws, and ever shrinking quality of care due to health care rationing by insurance companies for bondholder and shareholder and executive benefits.

Shame

del.icio.us Tags: corruption,appa,medicare,credit ratings

Statistics From United Nations International Health Organization

 

It seems there is a serious discrepancy being bandied about by our health reformers.  In this report from the U.N.I.H.O. their proclamations about quality and availability of health care in the United State do not match these statistics

A recent “Investor’s Business Daily” article provided very interesting
statistics from a survey by the United Nations International Health
Organization.

Percentage of men and women who survived a cancer five years after diagnosis:
U.S. 65%
England 46%
Canada 42%

Percentage of patients diagnosed with diabetes who received treatment within six months:
U.S. 93%
England 15%
Canada 43%

Percentage of seniors needing hip replacement who received it within six months:
U.S. 90%
England 15%
Canada 43%

Percentage referred to a medical specialist who see one within one month:
U.S. 77%
England 40%
Canada 43%

Number of MRI scanners (a prime diagnostic tool) per million people:
U.S. 71
England 14
Canada 18

Percentage of seniors (65+), with low income, who say they are in “excellent health”:
U.S. 12%
England 2%
Canada 6%

I don’t know about you, but I don’t want “Universal Healthcare” comparable
to England or Canada .

for more information

Some criticism may be valid as to the origins of these figures. (see commentary)

Health Reform for Idiots, or Chicken Soup for Health Reform

I found a very nice simple animated explanation which distilled 1200 pages of the Health Reform Act.

A terrific little animated video created by the Kaiser Family Foundation surfaced today, explaining in layman's language what's in store for us with the recently passed Health Reform Law.

Narrated by the wonderful Cokie Roberts, this video attempts to simplify the vastly complex law, with the emphasis on those portions of the bill that impact us as regular folks and as healthcare providers.

del.icio.us Tags: health train express,cokie roberts,health reform,kaiser family foundation

What does the Border have to do with Accountability?

 

as Posted on The Health Care Blog

Does This ACO Thing Really Mean We Need to be ‘Accountable’?

By VINCE KURATIS

Last month The American College of Physicians (ACP) released a well-reasoned and thorough position paper, The Patient-Centered Medical Home Neighbor: The Interface of the Patient-Centered Medical Home with Specialty/Subspecialty Practices.

As I’ve written before, the Big Idea behind ACOs (Accountable Care Organizations) is the notion of accountability, not the specifics of organizational structure.

The purpose of the ACP position paper is to address the gaps that exist in care coordination when a physician refers a patient to a specialist. The obvious and logical answer proposed is to develop “Care Coordination Agreements” between primary care physicians and referring specialists, and the position paper takes 35 pages to explain why and how.

A simplified way of thinking about Care Coordination Agreements is that they recognize that coordination of care is a team sport, that specialists are part of the team, and that this paper proposes rules of the game about how primary care physicians and specialists should play together on behalf of their common patients.

However, there’s a great big CAVEAT buried in the position paper.  I don’t doubt the earnestness of the authors, but I do take this caveat as a Freudian slip recognition that not all specialists will be eager to play on the team and to play by the rules:

At this time, implementation of the above principles within care coordination agreements represents an aspiration goal…

The care coordination agreements should be viewed solely as a means of specifying a set of expected working procedures agreed upon by the collaborating practices toward the goals of improved communication and care coordination — they are not legally enforceable agreements between the practices. [emphasis of “solely” is in the original document, not added]

Translation:

Don’t expect to hold us accountable….and don’t expect to be able to sue us if we don’t get it right

del.icio.us Tags: Kuratis,ACO,Patient centered,Medical home,accountable care organization,american college of physicians

Virtual Immigration Fence Failure – A Lesson for Medicine?  from Medical Innovation Blog

Richard Reece, M.D.

As Americans, we believe “virtual surveillance” techniques, drones over Pakistan, orbiting spy satellites, cameras on street corners and in stores, telemonitoring of patients with chronic disease with implanted sensors, e-ordering systems to control utilization of high tech medical technologies, virtual integration of doctors and hospitals to reduce care fragmentation – will make us more secure and healthier.
This may be, but we need to understand better what’s taking place on both sides of the technology fence.
The Techno sphere Versus Boots on the Ground
Technologies, no matter how sophisticated, can never replace boots on the ground, humans on the frontlines, police on the streets, or the human needs of populations you are trying to deflect, defeat, control, or serve.
The Virtual Arizona Fence
The “virtual failure” of the “virtual fence” on the Arizona border is the latest example of surveillance technology limits. This “invisible” fence, consisting of strategically and periodically placed high tech radar towers equipped with state-of-the-art monitoring gadgets has failed to stem the tide of immigration. Where there’s a will, there’s a way around the fence.
After 4 years of effort, construction of 50 miles of fence over the 2000 mile Mexico-US border, and a $1 billion contract with Boeing, the Obama administration is abandoning the fence.
High winds, tumbling tumbleweeds, weak cameras, slow software, blurry images that confuse cars with humans, and determined immigrants in search of a better life have combined to circumvent the fence.
In the words of a New York Times editorial,
“The ‘virtual fence’ was a misbegotten idea from the start, based on the faulty premise that controlling immigration is as simple as closing the border — and that closing the border is a simple matter of more sensors, more fencing and more boots on the ground. So long as there is a demand for cheap labor, a hunger for better jobs here, and almost no legal way to get in, people will keep finding ways around any fence, virtual or not.”

The Lesson
For information technology enthusiasts and for those who monitor patient health behaviors through web-based “consumer empowerment” techniques or “physician improvement” technologies, there is a lesson to be learned here.
You cannot control human behaviors at the level of patient-doctor interactions no matter how “sophisticated” your data mining or monitoring efforts. And you cannot do it without more “boots on the ground,” more physicians in the clinical trenches to critically appraise human needs, to prevent “immigration” towards bad health and high cost hospitalizations.  (underline mine) High tech fences will not keep immigrants out of the human garden. And you cannot weed the garden using high tech information sensors.

Posted by Richard L. Reece, MD at 12:24 PM

Future of Health Reform

 

Today on CSPAN the Robert Wood Johnson Foundation presented a summation of the current environment in congress and future possible modifications to the health reform law.

Dean Rosen, former assistant to Bill Frist, MD, the former speaker of the house, Norman Ornstein, resident scholar at the American Enterprise Institute, and  Ed Howard, from the Alliance for Health Reform each give their expertise on current events.

VIDEO PROGRAM  CSPAN

KevinMD hosts Health Train Express

 

Just a pat on my back (spraining my shoulder) and a thanks to KevinMD for hosting Health Train tomorrow—Friday.

Politicians know S %@*t about Health Care

 

A good friend and colleague sent me a link to a video.  I advise you that there is a lot of foul language in it.  I thought it was outrageously funny and exactly on point.  When I thought hard about it I thought, What the f#%!k .  If Obama doesn’t understand it or get it by now he never will). 

Thanks again to Xtranormal,  the do it yourself  internet Pixar of the  21st Century.

 

The White House Oval Office

 

One of our problems as physicians is that we rarely say no, or go to h#@l!  We are always so reasonable and accommodating, while we slowly are boiled.  So I don’t believe I need to be polite, or politically correct or even have good manners.  I and most of my colleagues have been wrung out and demeaned beyond belief. 

You will all think I have lost it, and I am ready to hear that as well. But the AMA and the rest of it have not done any better kissing a@s,

and pouring $$’s  into the cesspool we call congress.

del.icio.us Tags: obama,congress,profanity

Cleaning up The Health Train Express

 

In an effort to speed up loading the landing page of my blog I have deleted many links, ads, and unnecessary ‘noise’.  Hopefully this will speed up your access, reduce internet traffic between sites.  This is my effort to make the internet more green.  For the time being I have left the blog links alone.

I will be playing with the overall design in the coming week. Anyone who has a strong feeling or opinion can leave a comment.

 

GML

Video Game and Butchers, What do they Have in common?

 

The '” boys “  over at  The Healing Blade  and  Nerdcore Learning bring new multimedia strategy to the healing arts.

Turn on your wide screen HDTV and get your controllers ready!

 

Those  long hours in the video game room may be paying dividends in learning as well as improving surgical skills.

The Butcher does not have to code, the surgeon does, butcher does not need malpractice coverage, no CME, not on call, does not need hospital privileges.   If you like to cut, be a butcher.

Health Train caught in an Earthquake???

 

 

Hospital Seismic Safety Report  February 2010

 

We all know about the seismic risks to buildings in California, including health care facilities.  The California Healthline recently  reported the summary information available as of November 6, 2010.

Unfortunately, although mandates for seismic retrofit was established many years ago, the vast majority of hospitals have not been officially evaluated for potential collapse in a major seismic event.

California does not require hospitals to determine their collapse risks, but facilities can do so voluntarily. Hospitals also do not need to determine collapse risks for each of their individual facilities, making it difficult for some hospitals to determine which building to retrofit first.

Efforts To Assess Risk

In 2002, California compiled a list of 1,100 hospitals that could pose a risk of collapse during an earthquake. Of those, the state conducted complex evaluations of 370 hospital buildings and determined that 280 facilities had low enough collapse risks to qualify for the 2030 seismic safety deadline.

State authorities now are focusing on about 700 hospital buildings that were placed in the highest-risk category.

Of those, the state has determined collapse risks for only 90 facilities. Fourteen of those 90 facilities have been assigned collapse risks of between 10% and 32%, far higher than the 1.2% collapse risk that officials deemed reasonably safe.

 A map showing the location of hospitals with buildings that have a 10 to 32 percent chance of collapsing in an earthquake. Click on this link to see more information about the 14 buildings located at these hospitals.

What's left are about 700 hospital buildings in the highest-risk category that still face deadlines to make changes. Officials only know the collapse risk for about 90 of those buildings, which range from .75 to 32 percent.

del.icio.us Tags: earthquake,hospital safety,seismic standards

Medicine from 40,000 feet

 

Way back in the mid 20th century when I graduated from George Washington University with an M.D. degree I imagined that I had “arrived”.  I remember my classmates selecting different specialties and eventually going off to clinical training. I could not imagine doing anything other than clinical work, and perhaps dabbling in some clinical research.  Some of my friends were studying ‘epidemiology’ and a new field ‘public health’.  At that time, it mostly  was dedicated to ‘epidemics’, vaccinations, preventive medicine, and things that to me did not really involved patient care.

Turn the page, 50 or 60 years. This specialty has morphed into having an MPH (Masters in Public Health), and perhaps an MBA in health administration..  Previously these professionals had little to do with your clinical practice on a daily basis.  Now these people are the groundbreakers, movers and shakers throughout the medical world in which we all practice.

My school is now known as “ George Washington University School of Medicine and Health Sciences. The previous formal division of Medical Clinical pursuits from allied health and health business has become blurred at the educational level.  This blurring of distinction has also occurred in the clinical world with PAs. NPs, Advanced Degree nursing specialties and the like.

As a delayed and recent student of this field , and as a result of my blogging research I see that the topography has changed drastically.  Previously treated with disdain, MPHs, and MBAs, and MHAs increasingly have invaded our insular clinical world.  Many health reformers and policy makers delved deep into the social psychology of medical practice, medical group organization, quality measures, and even reimbursements.  All of this has evolved into an environment of MPHs having a huge influence on governmental policy makers.   Many MPHs have evolved into a new specialty of Political Influence.  Many practice medicine, not by treating patients or treating diseases, but by spreadsheets, algorithms, and formulating treating diseases from 40,000 feet….far removed from the implications of their edicts.

The flack is coming from we clinicians on the ground.

Gee, I wish I had gotten that MPH.

del.icio.us Tags: MPH,MBA,NP,advanced degree RNs,MD,health sciences,public health,epidiemiology

Disruptive Luddites

 

For Ophthalmology Times:

The past year has seen a rapid acceleration and implementation of electronic medical records in medical practices. While some ophthalmologists long ago installed EMR it was for the reason of establishing a reliable medical record, and also to improve the efficiency of their practices, improve reimbursement and eliminate paper. Most ophthalmologists lagged in EMR usage due to lack of affordable solutions and the fear of disruptive technology.

During the second and rapid phase of adoption of new technology we have gone beyond 'early adopters', and the remainder of ophthalmology is adopting for political/financial incentives or social influence. Social influence plays a large role in the selection process of the EMR. Ophthalmologists and many physicians rely upon social medical peers for their demonstrations and testimonials regarding EMRs.

Like it or not in the next two years most of us will have adopted EMR and HIE (health information exchange), and not for just financial reasons. Instead of investing in that 4^th generation OCT, or Wave front analyzer you will opt to buy an EMR, for which you will be at least partially reimbursed. (and most likely more than a charge for an OCT or Wave front calculation. The smart money will go toward EMRs. In most specialties the reimbursements are being bundled, and the ROI or recapture of investment will be much less than the incentive for purchasing an EMR.

We will increasingly see that referral sources require electronic communication with specialists, and will expect consultation reports to be sent electronically, via the health information network(s). This will take some time to establish, but it is inevitable.

Like my analogy on the Health Train Express....move over or get run over! It is a bit like the negative effect of not adopting a disruptive technology. By not adopting a growing technology you will be at a disadvantage in the market place, which will more than disrupt your practice than if you had adopted EMR.

John Hamlaka MD, who is the CIO at Harvard makes the following observations.

“The ONC is concerned about the success of meaningful use Stage 1, “and if it turns out much of America can’t achieve meaningful use Stage 1, then more rigorous criteria are not a good idea,” he said. The ONC is expected to further refine the requirements and do a second-quarter 2011 checkpoint to see how it’s going.
Stage 1 programs start in January, attestation will begin in April, and the first incentive dollars will be awarded in May, Halamka said. “The implication for many of us is that you better make sure you have the capacity to do all these quality measures January through March, 2011.

“In some ways, quality measures as they exist are process measures,” said John D. Halamka, MD, during his closing keynote HIMSS Virtual Conference presentation.

Stage 2 will see the introduction of outcomes orientation, and Stage 3 will move to outcome measures, which measure the wellness of a patient instead of how many tests were ordered for a given patient, said Halamka, an emergency room physician and CIO of Beth Israel Deaconess Medical Center and Harvard Medical School, chair of the U.S. Healthcare IT Standards Panel (HITSP) and co-chair of the

When Do We Get to The Next Stop?

 

Did I miss my station? 

I’ve been riding the Health Train Express for several years. I seem to have missed many stops and find myself at the end of the road. Somewhere in between I have vague recollection of stops along the way,  SGR, HMO, PPO, IPA, PQRI, ARHQ, CMS, HITECH, PACA,NHIN, HIE. EMR, RHIO,HHS.

What does it all mean?

Jane M. Orient, M.D., is an On Air contributor speaking on Healthcare Reform. Dr. Orient has appeared on NBC, MSNBC, ABC and many major broadcast venues throughout the US, as well and her Op-eds have been printed in hundreds of local and international newspapers, magazines and followed on major blogs. She has been in solo practice of general internal medicine since 1981 and is a clinical lecturer in medicine at the University of Arizona College of Medicine. She received her undergraduate degrees in chemistry and mathematics from the University of Arizona, and her M.D. from Columbia University College of Physicians and Surgeons. She is the author of Sapira’s Art and Science of Bedside Diagnosis; the fourth edition has just been published by Lippincott, Williams & Wilkins. She also authored YOUR Doctor Is Not In: Healthy Skepticism about National Health Care, published by Crown. She is the executive director of the Association of American Physicians and Surgeons, a voice for patients’ and physicians’ independence since 1943. Complete curriculum vitae posted at www.drjaneorient.com. Additional information on health-related issues: www.aapsonline.org and www.takebackmedicine.com

Congress handed the Congressional Budget Office (CBO) some assumptions, the computers came up with the mix of adjustments needed to give a magic number under $1 trillion in 10 years, and the “Affordable Care Act” (ACA

Numbers are thrown about—but where’s a spreadsheet of the money flows? The President couldn’t exercise a line-item veto even if he had one because there aren’t any line items. For example, how can you budget for each of the new bureaucracies if you don’t even know exactly how many there are (159—more or less)? And are they counted in the $1 trillion cost?

This article by Dr Orient succinctly elaborates the incompetence of the ACA (Affordable Care Act) as she writes in The Health Care Blog.  It seems to have been written by a legal intern skilled at legalese without thought about a strategy for implementation. Each section is written with the assumption and without regard for the effects of a prior change in the health care system.

Her summation is chilling, and should be read by every American and our congressional representatives,  who should have read the bill before voting it’s approval.

PACA needs to be repealed and/or amended drastically. Let’s not give up and roll over.  Change is what he wanted, and change is what we will give  Obama.

del.icio.us Tags: affordable care,repeal,obama,Jane Orient MD,health train express,the health care blog,congress