HIPAA, Privacy, No Guaranties,

 

HIPAA, the Health Information, Privacy and Accountability Act, passed in  1996        (several hundred or more pages) was passed to insure the security of your medical data by hospitals, providers, employees and all those who come in contact with your confidential medical records. The Law also has several other provisions, unrelated to privacy and confidentiality.

Old obsolete, but effective way….shred or burn.

Modern Technology has eliminated the paper shredder, and now there are new electronic barriers and locks on data access.

Today criminals (or the government) can access your data from anywhere without breaking into your office or filing cabinets.

 

U.S. Terrorism Agency to Tap a Vast Database of Citizens

Now through a series of unrelated incidents the tide has swept in and  a new and possibly dangerous potential for a ‘seizure’ of your private information without warrants, or judicial approval.

(Wall Street Journal)

Top U.S. intelligence officials gathered in the White House Situation Room in March to debate a controversial proposal. Counterterrorism officials wanted to create a government dragnet, sweeping up millions of records about U.S. citizens—even people suspected of no crime.

Not everyone was on board. "This is a sea change in the way that the government interacts with the general public," Mary Ellen Callahan, chief privacy officer of the Department of Homeland Security, argued in the meeting, according to people familiar with the discussions.

A week later, the attorney general signed the changes into effect.

The Wall Street Journal has reconstructed the clash over the counterterrorism program within the administration of President Barack Obama. The debate was a confrontation between some who viewed it as a matter of efficiency—how long to keep data, for instance, or where it should be stored—and others who saw it as granting authority for unprecedented  government surveillance of U.S. citizens.

The rules now allow the little-known National Counterterrorism Center to examine the government files of U.S. citizens for possible criminal behavior, even if there is no reason to suspect them. That is a departure from past practice, which barred the agency from storing information about ordinary Americans unless a person was a terror suspect or related to an investigation.

Technorati Tags: terror,privacy,counterterrorism,barak obama,wall street journal,homeland security,cybersecurity,hipaa,database

Is Resistance Futile ?

A Resistance Movement Rises Against ObamaCare

Considerable opposition forces are becoming allies in order to stop Obamacare (Accountable Care Act)

Grace-Marie Turner

This article appears in the December 24, 2012 issue of Forbes.

ObamaCare may be the law, but a major resistance movement has already sprouted across the U.S. Though approval of the unpopular law stood at only 38% on Nov. 6, the elections were not a referendum on ObamaCare mainly because Governor Romney was unable to prosecute the case against its most despised provisions – the individual mandate, employer mandate and state-run health exchanges – since all were in the law he signed in Massachusetts.

 

With the election over and no chance President Obama will sign legislation repealing the law, implementation is proceeding. But the ObamaCare Resistance Movement has begun. Some examples:

 

Congress: “ObamaCare has to go,” wrote House Speaker John Boehner. He said, “There are essentially three major routes to repeal of the president’s law: the courts, the presidential election process and the congressional oversight process. With two of those three routes having come up short, the third and final one becomes more important than ever.” He pledged “vigorous oversight” and said House committees are already conducting investigations of possible improper spending.

 

Governors: The health law relies on states to expand insurance coverage through Medicaid and to set up bureaucracies, called exchanges, through which new health insurance subsidies will be distributed. Governor Bobby Jindal wrote a letter to the Department of Health & Human Services explaining why Louisiana will not be creating a state ObamaCare exchange:

Religious leaders: The Obama Administration’s decision to force employers to provide access to contraception, abortion-inducing drugs and sterilization at no cost to their employees has prompted 40 lawsuits by Catholic dioceses and other organizations claiming it violates their First Amendment protection of religious liberty.

At least 21 states have said they definitely or probably will not set up state exchanges, with Ohio, Wisconsin, Maine, Nebraska, South Carolina, Georgia and Indiana most recently joining the opposition.

Businesses: Companies with more than 50 employees are searching for ways to avoid the penalties for not complying with the law’s employer mandate. They must either provide government-approved health insurance or pay a fine of $2,000 for each full-time worker. But companies can escape the fines if they make the painful decision to cut workers to part-time – defined in the law as less than 30 hours a week.

 

Denny’s franchise owner John Metz of Florida said he would “love to cover all employees” with health insurance, “but to pay $5,000 per employee would cost us $175,000 per restaurant, and unfortunately, most of our restaurants don’t make $175,000 a year. I can’t afford it.”

 

Religious leaders: The Obama Administration’s decision to force employers to provide access to contraception, abortion-inducing drugs and sterilization at no cost to their employees has prompted 40 lawsuits by Catholic dioceses and other organizations claiming it violates their First Amendment protection of religious liberty.  In highly unusual statement Cardinal Timothy Dolan recently said the Catholic Church will “not obey” the Obama Administration’s HHS mandate, a policy he classified as “immoral.”

Citizens: The individual mandate will take effect in 2014, and the CBO expects at least 6 million people to pay the initial $95 fine rather than purchase expensive, government-prescribed health insurance.

 

And the number surely will rise as the ObamaCare Resistance Movement grows.

Read online at Forbes

 

Dangerous Assumptions Part II

Dangerous Assumptions..........Part II

Things are about to get worse....much worse.

HHS released some further details about the rollout of the Accountable Care Act. No doubt this is why Congress denied reading the bill...as per Nancy Pelosi.

It is apparent that congress did not want this legislation to be successful. They passed it with total disregard for how it would be implemented or the secondary consequences therof. They essentially wanted to take credit for passing the bill and letting it's outcome fall where it may.

Fact ! Just how disjointed the medicare planning process is,

Medicare SGR payment cut looms as January 1 deadline approaches

Congress has three weeks left to stop the 26.5 percent Medicare sustainable growth rate (SGR) physician payment cuts (to take effect on January 1, 2013) before they adjourn for the holidays. The California Medical association (CMA) urges physicians to keep the pressure on Congress to stop these cuts.

Comprehensive reform of the Medicare physician payment system is long overdue. Working together, CMA, American Medical Association, national specialty societies and state medical associations are currently developing an alternative Medicare payment system that will stabilize the Medicare program and promote high quality, high value care. Physicians are leading the way. But first, Congress must act responsibly and stop the scheduled Medicare SGR payment cut of 26.5 percent. Such cuts seriously threaten the viability of California physician practices and your ability to care for patients.

This has only been going on the past fifteen years or more. Congress keeps kicking the can down the road. They even failed to address this key point in the accountable care act, when pointed out by physician groups.

Fact !

Failure to launch ! ACA is barely out of the gate and funds are being diverted. (nice planning)

In recent days, Senate and House Republicans have floated a proposal to take the $10-30 billion earmarked under the Affordable Care Act (ACA) to provide much needed Medicaid payment increases for primary care physicians and to use that money instead to help avoid the fiscal cliff or fund the SGR. CMA strongly opposes such a move.

Fact ! Medicaid can not afford to have 3 million more eligibles

California’s Medi-Cal rates are already nearly the lowest in the nation. Currently, three quarters of the physicians in California cannot afford to participate in the program and 50 percent of Medi-Cal patients can't find a doctor. The gaping hole in the safety net will be further exacerbated as there will be 3 million uninsured who will be newly eligible for Medi-Cal in 2014 under the ACA.

Fact ! More regulations and reporting are descending on the healthcare community.

Medicare FFS Physician Feedback Program/Value-Based Payment Modifier details the overall mechanism for measuring and regulating quality of care.

The Value-based Payment Modifiers will depend upon a new and untested ICD 10 code with highly detailed specifics to link to CPT billing codes. The chances for errors and denied reimbursement are magnified exponentially.
The overall regulations include:
Section 3007 of the Affordable Care Act mandated that, by 2015, CMS begin applying a value modifier under the Medicare Physician Fee Schedule (MPFS).  Both cost and quality data are to be included in calculating payments for physicians.

• Physicians in groups of 100 or more eligible professionals who submit claims to Medicare under a single tax identification number will be subject to the value modifier in 2015, based on their performance in calendar year 2013.
• All physicians who participate in Fee-For-Service Medicare will be impacted by CMS’s emphasis on reporting quality data through PQRS and by 2017 will be affected by the value modifier.

Report Templates and Methodologies Disseminated in 2010, and plans for 2013-2017

The enactment of the Accountable Care Act and participation in Medi-caid requires that all physicians must re-enroll in 2013. (over 750,000 applications).

Fact ! Expect the Unexpected:

New insurance fee in health overhaul law likely to hit consumers

Published December 10, 2012

Associated Press

Your medical plan is facing an unexpected expense, so you probably are, too. It's a new, $63-per-head fee to cushion the cost of covering people with pre-existing conditions under President Obama's health care overhaul. 

The charge, buried in a recent regulation, works out to tens of millions of dollars for the largest companies, employers say. Most of that is likely to be passed on to workers. 

Employee benefits lawyer Chantel Sheaks calls it a "sleeper issue" with significant financial consequences, particularly for large employers. 

"Especially at a time when we are facing economic uncertainty, (companies will) be hit with a multi-million dollar assessment without getting anything back for it," said Sheaks, a principal at Buck Consultants, a Xerox subsidiary. 

Based on figures provided in the regulation, employer and individual health plans covering an estimated 190 million Americans could owe the per-person fee. 

The Obama administration says it is a temporary assessment levied for three years starting in 2014, designed to raise $25 billion. It starts at $63 and then declines. 

Most of the money will go into a fund administered by the Health and Human Services Department. It will be used to cushion health insurance companies from the initial hard-to-predict costs of covering uninsured people with medical problems. Under the law, insurers will be forbidden from turning away the sick as of Jan. 1, 2014. 

The program "is intended to help millions of Americans purchase affordable health insurance, reduce unreimbursed usage of hospital and other medical facilities by the uninsured and thereby lower medical expenses and premiums for all," the Obama administration says in the regulation. An accompanying media fact sheet issued Nov. 30 referred to "contributions" without detailing the total cost and scope of the program. 

Of the total pot, $5 billion will go directly to the U.S. Treasury, apparently to offset the cost of shoring up employer-sponsored coverage for early retirees. 

The $25 billion fee is part of a bigger package of taxes and fees to finance Obama's expansion of coverage to the uninsured. It all comes to about $700 billion over 10 years, and includes higher Medicare taxes effective this Jan. 1 on individuals making more than $200,000 per year or couples making more than $250,000. People above those threshold amounts also face an additional 3.8 percent tax on their investment income. 

But the insurance fee had been overlooked as employers focused on other costs in the law, including fines for medium and large firms that don't provide coverage. 

"This kind of came out of the blue and was a surprisingly large amount," said Gretchen Young, senior vice president for health policy at the ERISA Industry Committee, a group that represents large employers on benefits issues. 

Word started getting out in the spring, said Young, but hard cost estimates surfaced only recently with the new regulation. It set the per capita rate at $5.25 per month, which works out to $63 a year. 

America's Health Insurance Plans, the major industry trade group for health insurers, says the fund is an important program that will help stabilize the market and mitigate cost increases for consumers as the changes in Obama's law take effect. 

But employers already offering coverage to their workers don't see why they have to pony up for the stabilization fund, which mainly helps the individual insurance market. The redistribution puts the biggest companies on the hook for tens of millions of dollars. 

"It just adds on to everything else that is expected to increase health care costs," said economist Paul Fronstin of the nonprofit Employee Benefit Research Institute. 

The fee will be assessed on all "major medical" insurance plans, including those provided by employers and those purchased individually by consumers. Large employers will owe the fee directly. That's because major companies usually pay upfront for most of the health care costs of their employees. It may not be apparent to workers, but the insurance company they deal with is basically an agent administering the plan for their employer. 

The fee will total $12 billion in 2014, $8 billion in 2015 and $5 billion in 2016. That means the per-head assessment would be smaller each year, around $40 in 2015 instead of $63. 

It will phase out completely in 2017 -- unless Congress, with lawmakers searching everywhere for revenue to reduce federal deficits -- decides to extend it.

Read more: http://www.foxnews.com/politics/2012/12/10/new-insurance-fee-in-health-overhaul-law-likely-to-hit-consumers/#ixzz2EigSIleO

Health Reform and Tax Implications

 

The Patient Protection and Affordability Care Act (Obamacare) will neither improve affordability, nor protect patients.  Much like Franz Kafka’s Catch 22, the name itself is an oxymoron, designed to mislead the public.  Wise physicians, hospitals and others are analyzing the law which was passed two years ago.  It has taken that long to analyze the bill which Nancy Pelosi so accurately described as, “We won’t know what’s in it until it passes.” 

My political message here is, “Why do the citizens of her district keep electing her?”  The politics of the situation obviously is that someone is funding her campaigns and many Senators and Congressmen “owe her” for deeds she accomplished for their interests in other areas of legislation. (that is the way it works, like it or not. It is what it is).

In addition to the Internal Revenue Service policing what businesses are doing about providing health insurance to employees, there are several other negative impacts upon the taxpayer wallet.

Attribution:  USAA Insurance remarks on Health Reform

Tax Tips:

Health Care Reform: What Will It Mean for You in 2013?

---

Many Americans could face higher tax bills Jan. 1, 2013, as a result of four health care-reform law changes.

Here's a look at what's about to hit — unless Congress otherwise acts — and how you may be able to minimize the impact to you.

"This is a good time to give your health planning a checkup."

What's Coming Jan. 1

1. Limit on flexible spending account (FSA) contributions. Today, employers set their own caps on how much employees can contribute to these plans that let them use pretax money to pay for health care expenses. For 2013, the government will enforce a $2,500 limit per employee.

2. A new Medicare surtax on investment income. Until now, Medicare taxes have only applied to earned income. For 2013, taxpayers filing individually with wages and self-employment income above $200,000 ($250,000 for married couples filing jointly) will pay a 3.8% surtax on the lower of:

• Their net investment income — which includes interest, dividends, capital gains and other amounts.
• The amount of their modified adjusted gross income that is greater than $200,000 ($250,000 for married couples filing jointly).

3. An additional Medicare tax on wages and self-employment income for some. The existing Medicare payroll tax of 2.9% (of which 1.45% is paid by a taxpayer through payroll deductions) will be increased by 0.9% on wages or self-employment income that exceeds $200,000 for single and qualifying head of household and widow(er) filers ($250,000 for married couples filing jointly).

4. Higher hurdle for deducting medical expenses. Currently, out-of-pocket medical costs only are deductible to the extent they exceed 7.5% of your adjusted gross income. For 2013, that hurdle will rise to 10%. But if you're 65 or older, that threshold remains frozen at 7.5% through 2016.

What You Can Do Now

"Between new taxes and the ongoing rise in medical costs, this is a good time to give your health planning a checkup. Here is some preventive medicine of a financial kind you may consider:

• If you have scheduled medical procedures, don't skip them. It may pay to get them over with — and paid for — in 2012 if you can, before the higher threshold for deducting medical expenses hits in 2013.
• Continue to contribute to your employee-offered FSA. While FSAs face a maximum $2,500 per employee for 2013, they're still a valuable and tax-advantaged way to manage health costs. If you haven't missed next year's enrollment period, sign up for an FSA to divert money from your salary into this account that you can tap for qualified health-care expenses. Plan carefully, though, because under the current rules you'll forfeit any unused money left in the account at the end of the plan year.
• If you're eligible, contribute to a health savings account (HSA). Available to people with high-deductible health insurance plans, they can be purchased on your own or sometimes through an employer. HSAs give you a tax deduction for contributions and tax-free treatment of qualified withdrawals for health-related expenses. For 2012, annual contributions to HSAs generally are limited to $3,100 for an individual and $6,250 for families. (Individuals age 55 or older can contribute an extra $1,000 a year.) In 2013, the contribution limits increase to $3,250 for an individual and $6,450 for families.
• If you'll be hit by the new 3.8% surtax on investment income, consider making some portfolio moves in 2012. For example, if you're thinking of selling an investment with a $40,000 capital gain that would be subject to the tax, you could save tax dollars by selling or rebalancing this year rather than next. This also may be a good time to consider allocating more of your fixed income investments to tax-exempt bonds or tax-exempt bond funds and taking full advantage of pretax contributions to employer retirement plans.
• Plan for health expenses through every stage of your life. If you're age 45 or older, that means considering obtaining long-term care insurance — and realizing that coverage gets more expensive the longer you wait. As you explore your options, find out if your employer offers a plan, or learn what long-term care solutions are available to you. 
• Manage your Medicare benefits wisely. If you're approaching Medicare eligibility at age 65 or are already enrolled, learn how you can protect yourself against gaps in Medicare coverage.

What's on the Horizon: Health Reform's 2014 Provisions

• Insurance will be universally available. Health insurers won't be allowed to turn down applicants because of their medical history.
• Medicaid eligibility expands. Medicaid is a health insurance program for low-income Americans that's funded by the federal and state governments and administered by the states. In 2014, eligibility will expand to include Americans younger than 65 with income less than 133% of the federal poverty level. Today, eligibility varies by state and the age of the beneficiary. In most states, a parent is only covered if their income is less than 50% of the poverty level, according to the Kaiser Commission on Medicaid and the Uninsured. (For a family of four, the federal poverty level currently is around $23,000 in most states.)
• Federal help with premiums. If your household income for the taxable year is between 100% and 400% of the federal poverty level and you are not eligible for or offered other acceptable coverage, you may be eligible for health insurance premium tax credits that will reduce your out-of-pocket costs.
• Insurance becomes mandatory. If you can afford it but don't buy it, you'll generally be subject to a penalty that's being phased in over three years, starting in 2014 at a maximum of $285 per family or 1% of taxable income, whichever is greater. By 2016, the Congressional Budget Office projects the maximum family penalty will be between $12,000 and $12,500.
• New price rules. Health insurers won't be able to charge a higher premium because of an unfavorable medical history or a lower one if you're especially healthy. Rates will only vary with age, geographic location, family size, participation in a health promotion program and tobacco use.
• Insurance shopping centers. To promote availability and competition, each state will offer an online shopping exchange where consumers can shop for standardized health plans.
• A change for business owners. Employers of 50 or more full-time employees who don't offer health insurance coverage risk paying an annual penalty tax of $2,000 per full-time employee, excluding the first 30 employees. This penalty is triggered if just one employee is eligible for federal premium subsidies.

Things have gotten crazy ever since the Supreme Court upheld the healthcare reform law (PPACA).  There’s 13,000 pages of regulations and the IRS, Health and Human Services, and many other agencies haven’t even gotten started yet.  There are nearly 200 agencies and various government entities involved in the law. “It’s a delegation of extensive authority, from Congress to the Department of Health and Human Services and a lot of boards, commissions and bureaus throughout the bureaucracy,” said Matt Spalding of the Heritage Foundation. “We counted about 180 or so.”

What You May Have Missed

While there are many new health reform provisions that have yet to hit, many Americans are still trying to catch up with what's already changed. Here are the parts of the Affordable Care Act that already have been implemented:

• Closing Medicare's coverage gap. Out-of-pocket expenses are dropping for those with Part D prescription drug coverage. For now, if you reach the gap in Medicare coverage (sometimes called the "doughnut hole"), you'll get a 50% discount on covered brand-name drugs and a 14% discount on generic drugs. These savings are scheduled to grow over the coming years until the gap is completely eliminated in 2020.
• Small-business tax credit. This credit is valued at up to 35% (up to 25% for qualified nonprofits) of the amount qualified small employers pay for their workers' health insurance.
• A break for early retirees covered by employer plans. Employer health plans may be eligible for reimbursement for some of the cost of providing coverage to retirees age 55 who have not yet reached 65, if they meet certain requirements. Employers have to pass the savings along to those retirees through lower premiums, deductibles or co-payments.
• A first step to help people with pre-existing conditions. Insurance pools have been created to give access to affordable coverage. HealthCare.gov provides a simple tool to help you explore your options.
• Money burned by tanning. A 10% tax is charged for indoor tanning that isn't performed by a licensed medical professional.
• No more lifetime limits. Insurers may no longer impose lifetime dollar caps on most insurance benefits. In addition, some annual dollar limits also are being phased out.
• New restriction on canceling coverage. If your employer makes an honest mistake on your insurance application, insurance companies can no longer retroactively cancel your coverage. Insurers who want to try to rescind coverage must provide 30 days' notice to give you time to appeal the decision.
• Extended coverage for adult children. Young adults can stay on their parents' health plans until their 26th birthday — with their parents' permission. There's no additional cost beyond the normal family premium. It's a different story if you're covered by TRICARE, where you'll pay as much as $200 a month to keep an adult child between ages 21 and 26 on your policy.
• Guaranteed coverage for children. New health plans and work-based plans can't deny coverage to children younger than 19 with pre-existing conditions.
• Preventive-care changes for new private plans. Many newer plans must cover preventive care without deductibles or co-payments.
• Medicare preventive-care changes. Medicare beneficiaries no longer are charged co-payments or deductibles for many preventive services.
• A new restriction on HSAs and FSAs. Tax-free withdrawals to buy over-the-counter medicine are no longer allowed.
• A stiffer penalty for nonqualified withdrawals from HSAs. The penalty tax for nonqualified withdrawals doubles to 20%.
• Medicare Advantage plans face financial squeeze. The government's reimbursements to Medicare Advantage plans face budget cuts over the next several years. In response, these plans may be forced to raise premiums or reduce benefits, or both.

Find more ways to get prepared for 2013.

What to Ask

If you have questions about how these changes could affect your bottom line, speak with a USAA financial advisor or your tax specialist. Here are some questions to ask:

• Does my health insurance policy qualify me to contribute to a health savings account?
• Aside from helping mitigate the Medicare investment surtax, would including tax-exempt municipal bonds or tax-exempt bond funds in my portfolio provide other benefits?
• Is there an advantage to buying long-term care insurance compared to paying those costs out of pocket?
• Children can stay on their parents' health insurance policies until age 26, but are there advantages to buying them a separate policy instead?

You can find more information at the official federal site for the Affordable Care Act, HealthCare.gov.

Healthcare Reform Magazine published an article, on July 1, 2012:

Don’t Get Left Behind: What PPACA’s Survival Means Going Forward

It clearly exposes how satisfied the health insurance and intermediary organization are with PPACA.  Their bottom line is,

Move On and Comply with Healthcare Reform

Our supposed allies have abandoned the fight since their profits will be untouched or even increased.

The Tidal Wave of Bureaucracy continues.

Comments here: or at twitter/@glevin1  or email to:  gmlevinmd@gmail.com and read more here and, is it the Law of the Land ?

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McAllen Texas

 

Dangerous Assumptions in Health Reform

Attribution to :  DMCB, a brainy and literature-based resource by Jaan Sidorov

Is it time to review some of the basic tenents upon which the Accountable Care Act was passed?

Remember the Atul Gawande and McAllen Texas fracas? That New Yorker article captured the national spotlight and put a harsh glare on areas of the United States that had unexplained high rates of health care utilization. Dr. Gawande blamed the local culture of fee-for-service private practice, while the Disease Management Care Blog wondered if it was a statistical fluke and/or the burdens of a chronically ill population.

The article by Atul Gwande was published in the New Yorker Magazine and criticized by DMCB, other highly visible publications, duplicated, quoted, tweeted and distributed widely. The analytic gurus and health officials were suspicious that this analysis was flawed. Statistics can be mis-applied at times to prove anything you want, or innocently yield false results. In this case the goal of finding disparities in health costs was solely based upon Medicare's needs, and misinterpreted by all because it was restricted to billings to Medicare. Private insurer's and cash payments were left out of the data analyzed for the study.

McAllen Texas and Healthcare Utilization: A Function of Statistical Variation, Not Poor Policy

Not mentioned is that both communities are heavily influenced by demographics (high cohort of Latinos).

Some of the Affordable Care Act was based on this flawed study.

“It took a second look when that hapless locale was seized upon by Peter Orszag of the Office of Management and Budget (OMB), Consumer Reports and some notable blogs as the symbol for all that ails American healthcare. Commentators are accusing the ‘McAllens of this country’ of consciously and unconsciously economically ripping off the system with precious little quality to show for it.

Yet, the dubious DMCB (Disease Management Care Blog) and also Health Train Express at that time remained unexcited about Dr. Gawande’s faux discovery and disappointed that others haven’t considered the most likely cause of McAllen’s outlier status. Is there something really special about McAllen or is something else going on?

It took a while, but the Disease Management Care Blog finally caught up with this follow-up study on the contrast in health care costs between the Texas towns of McAllen and El Paso. “

It is the nature of our minds to believe there must be something “causing” outliers. In other words, there must be something about McAllen that attracted all those coins, right? The DMCB, in reading Dr. Gawande’s article, thinks that may be true in Miami (which is number 1 in the U.S), but it doesn’t think that's the case for McAllen as described in the New Yorker magazine article. The gumshoe M.D. reporting clearly shows the McAllen providers are mystified by their status. It’s not as though they planned to take advantage of the system. In fact, they didn’t. That’s because it’s all random.

This is important because most healthcare providers involved in quality improvement learned long ago that ‘identifying’ and then ‘managing’ outliers with targeted interventions is a poor way to promote overall system improvement. Outliers naturally regress to the mean over time and they're not the problem anyway. Rather, the trick is to reduce overall variation around the mean (reducing the standard deviation) and to move all providers toward a better average level of behavior. That’s a lot of complicated work that, frankly, isn’t as enthralling to editors or the readers of The New Yorker. It's too much work.

DMCB summarized,

“While popular media can be forgiven for using simplistic descriptions of extreme outlier anedotes to pander to a political agenda, the DMCB isn’t too sure about Dr. Gawande. However, the DMCB is most frightened by potential reaction of the OMB. Short of complete central planning for the entire health care system, random distributions of performance, expense, quality, claims, satisfaction and countless other measures around a mean will be unavoidable. Of all persons, Dr. Orszag should understand that outliers are an ironic certainty, not evidence of malfeasance. Most are anomalies, not proof of anything. They are, in short, interesting, but not lessons and certainly not the stuff of policy making. “

 

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Why Obama Care Is Still No Sure Thing

 

Part I

The majority of state governors are Republicans, and they have the power to disarm the health-care law.

by  James Capretta and Yuval Levin  from the Wall Street Journal

“Champions of Obama Care want Americans to believe that the president's re-election ended the battle over the law. It did no such thing. The Patient Protection and Affordable Care Act won't be fully repealed while Barack Obama is in office, but the administration is heavily dependent on the states for its implementation.

Republicans will hold 30 governorships starting in January, and at last week's meeting of the Republican Governors Association they made it clear that they remain highly critical of the health law.

States still have two key choices to make that together will put them in the driver's seat: whether to create state health-insurance exchanges, and whether to expand Medicaid. They should say "no" to both.

At its core, Obama Care is a massive entitlement expansion. Between vastly increased Medicaid eligibility and new premium subsidies, it is expected to bring 30 million more people onto the federal government's entitlement rolls. The law anticipates that the states will take on the burden of implementing the expansions, but states can opt out of both.

Running the exchanges would be an administrative nightmare for states.

The exchanges would create unsustainable pressures on each state's insurance market, treating similarly situated people differently by providing far greater subsidies for those in the exchanges than those in employer plans—yielding perverse incentives that distort consumer and employer decisions and increase costs.”

There is no denying that federal regulations always mandate ‘workarounds’ to overcome perverse incentives and penalties imposed by new regulations.  Obama care will be one of the worst.”

 

REASONS-TO-OPPOSE-EXCHANGES

This white paper from the “Citizen’s Council for Health Freedom”, details the flawed Health Insurance Benefit Exchange.

““President Obama won re-election and Democrats maintained control of the Senate this month, but the states hold the future of Obama Care in their hands. Knowing the harm the law would do to their citizens, to the economy and to American health care, governors should refuse to become its enablers.”

Mr. Capretta is a fellow at the Ethics and Public Policy Center and a visiting fellow at the American Enterprise Institute. Mr. Levin is a fellow at the EPPC and editor of National Affairs.

Part II to follow…………………….

 

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mHealth Summit at the Gaylord Convention Center

 

December 3-5th, Starting today .  #mhs12

The largest event of its kind, the 4th annual mHealth Summit brings together leaders in government, the private sector, industry, academia, providers and not-for-profit organizations from across the mHealth ecosystem to advance collaboration in the use of wireless technology to improve health outcomes in the United States and abroad. mHealthSummit.  This year (2012) the focus is on mobile health apps. As expected and predicted mobile health and apss have been and will be a developers heaven.

If you are like me you can enjoy regular updates by subscribing.  This year’s summit is being held in Washington D.C. at the Gaylord Convention Center.

Today, Monday 12/03/2012 

On the tweet #mhs12 table of contents: (a sampling of today’s morning tweets)

http://www.complete-digital.com/

http://www.techurself.com/

http://www.disruptivewomen.net/

http://techchange.org/

http://chilmarkresearch.com/

http://startuphealth.tumblr.com/post/36758636894/24-hot-mhealth-companies-featured-at-the-startup-health

 

In addition to the StarUp Health Mobile Health Pavilion, StartUp Health’s CEO Steven Krein will moderate a dynamic roundtable featuring a diverse group of the country’s leading thought leaders in mHealth innovation. The panel will be interactive and be taking questions from the audience.

 

 

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It’s The Law of The Land, or is It?

 

For those who state “PACA is the law of the land, so get on with it”; they are sadly mistaken. While our goal is and should be a system that is universal, accessible and affordable to all...PPACA is on a course to certain death as the cancer of bureaucracy overwhelms our ability to pay for it, as will also gridlock our current system. We as physicians and healthcare providers simply can not nor should not sit by idly to let this poorly devised system be set in stone. (author: gml)

The battle begins:

Stuart Taylor, Jr. is an author, journalist and nonresident fellow at the Brookings Institution, and this work is attributed to him.

Analysis: Health Exchanges And The Litigation Landscape

The pending challenges to the law, and related regulations, range from the Goldwater Institute's claim that it gives the Independent Payment Advisory Board unconstitutionally broad powers over Medicare services and payments, to the more than 35 lawsuits by religious employers attacking a Department of Health and Human Services rule that requires them to provide their employees with insurance that covers women's contraceptives without a copayment.

The broadest and potentially most damaging of the legal challenges turns on whether Congress intended that tax credits and subsidies to help consumers buy health insurance be available only through state-created exchanges. Many states are signaling that they may not create their own exchanges, leaving the federal government to do so, as the law requires.

If subsidies and tax credits aren't available in states with federally run exchanges, conservative legal scholars say, then two other lynchpins of the law would also be undermined: the requirements that employers of a certain size offer insurance and that most individuals buy insurance.

Confident of their case, some health law opponents, including Jonathan Adler of Case Western Reserve Law School, Michael Cannon of the libertarian Cato Institute andNational Affairs editor Yuval Levin, are urging Republican-led governments to refuse to set up the online insurance purchasing exchanges, which would, as the argument goes, make their residents ineligible for the tax credits and subsidies. They say that this step also would gut the so-called employer mandate, which the law says will take effect in states where residents are eligible for such assistance.

The mandate requires employers with more than 50 full-time workers to offer health insurance policies for employees and their families that include a minimum set of benefits, or pay a tax of $2,000 per employee for failing to do so. The tax wouldn't apply to the first 30 workers.

Health law critics theorize that by refusing to set up exchanges, states could also carve a hole in the provision that requires individuals to either obtain insurance or pay a tax as a consequence of choosing not to, which the Supreme Court upheld in June. And if states could disable both the employer mandate and part of the individual mandate, they could wreak havoc with the law's overall operation.

Confident of their case, some health law opponents, including Jonathan Adler of Case Western Reserve Law School, Michael Cannon of the libertarian Cato Institute andNational Affairs editor Yuval Levin, are urging Republican-led governments to refuse to set up the online insurance purchasing exchanges, which would, as the argument goes, make their residents ineligible for the tax credits and subsidies. They say that this step also would gut the so-called employer mandate, which the law says will take effect in states where residents are eligible for such assistance.

The mandate requires employers with more than 50 full-time workers to offer health insurance policies for employees and their families that include a minimum set of benefits, or pay a tax of $2,000 per employee for failing to do so. The tax wouldn't apply to the first 30 workers.

Health law critics theorize that by refusing to set up exchanges, states could also carve a hole in the provision that requires individuals to either obtain insurance or pay a tax as a consequence of choosing not to, which the Supreme Court upheld in June. And if states could disable both the employer mandate and part of the individual mandate, they could wreak havoc with the law's overall operation.

Last year, the Internal Revenue Service issued an interpretive rule saying that federal exchanges also would have the power to distribute the tax credits and subsidies.

But Oklahoma Attorney General E. Scott Pruitt, a Republican whose state has refused to set up an insurance exchange, has urged a federal district court to invalidate the IRS rule and thereby nullify the employer mandate in Oklahoma.

With only 17 states having so far committed to creating their own health insurance exchanges -- in part because of concern that the administration has not provided clear guidance on how they should work -- more lawsuits could be on the way, brought by states, employers or both.

These arguments are detailed in a paper to be published in Health Matrix by Adler and Cannon. There are, of course, also forceful counterarguments.

All original KHN material – articles, graphics and videos – can be used for free, if you credit us and link to us. Learn more

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Sun Tzu and the Art of EHR Adoption

Sun Tzu and the Art of EHR Adoption

TEDMED Greatest Health Challenges

 

Social media for medicine is having a far greater effect than even many pundits predicted.

If you have an idea, post it to your network, and I find using all of them exponentially increases your influence…right or wrong. That requires credibility and reliable sources of information as well as a thick skin. I find there are always smarter (than I am) readers out there willing and able to challenge you. It also requires the proper attribution for the original source. I like to put it in quotes, and then I add my humble by proceeding it with [authors comments].  So far, no letters from attorneys and no inquiries from the Department of Homeland Security.

TEDMED is now producing Google Hangouts every Thursday morning at 11:00 AM on the Greatest Health Challenges.

Thus far there have been two events which I have embedded here:

The Role of The Patient

The Care Giver Crisis

As these proceed I hope to include these in my blog on Thursday.

You will find these videos on the YouTube Channel for Catherine Andrews When you subscribe to her channel, you will receive an email to remind you of each broadcast.

 

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Year End Special Edition about Sources for Health Information for Social Media

BLACK FRIDAY and Health Care

 

What we need is a Health Care Black Friday !  Yes, fellow Friday shoppers here are the stats derived from a ‘big blue’ (IBM) for you Gen Xers) data dive. Why is IBM  watching mobile?

• Online sales are up 20 percent for this same time period over Black Friday 2011.
• The number of consumers using a mobile device to visit a retailer’s site is at 28 percent, up from 18.1 percent in 2011.
• The number of consumers using their mobile device to make a purchase is 14.3 percent, up from 10.3 percent in 2011.
• Shoppers using the iPad led to more retail purchases more often per visit than other mobile devices, with conversion rates reaching 4.2 percent, higher than all other mobile devices.
• Shoppers referred from social networks like Facebook and Twitter generated 0.18 percent of all online sales on Black Friday.

So, you might be wondering how IBM gets all this i

In fact the internet humming (or is it buzz?) on Thursday, soon after that turkey/ham/prime rib) begins .

All Things Digital reported statistics from yesterday.

Last year, it was Cyber Monday — this year, it’s turned out to be Mobile Thursday. What’s next? Social Network Saturday? Self-Driving Car Sunday? (We still have Black Friday, by the way, which is today.)

And, indeed, the Mobile Thursday phrase got some big laps around the track, with numerous online shopping surveys — coming out faster than you can buy that new tablet — using it in their flash reports yesterday and today.

This year’s anecdotal meme: Apple iPads go well with pumpkin pie.

Black Friday is “SOCIAL” as evidenced by the following video.

The poignant focus of All Things Digital’s article,

“If you think about consumers, and you think about the amount of technology that they have at their hands, to reach out to read reviews and talk to friends and families, they’re incredibly empowered. There’s not one purchase decision that they make that is not impacted by some element of social networks. What does that do to the companies that have to deal with that by offering the best products and services, and you see companies are struggling to do that: To make the right offer at the right time with the right price. When they do it well, we all talk about how it went well; and when they do it badly, we talk about how annoying it was.” Is it this way with Health Care (YET) ?

Has this phenomenon spread to Health Care?

I would like to see IBM use their analytics on health consumer habits.

Here might be some of the things patients might search for after dinner.

1.  Bloated feeling in abdomen

2..Nausea when thinking about breakfast the next AM

3..Severe headache after drinking wine with dinner

4..Somnolence after dinner

5  Stimulants after dinner

6. Channel line-up for Football

7. Channel line-up for sports reporting

8. Google maps for directions to home

9. Google maps for directions to Best Buy, Target, Wal-Mart, Sears or nearest mall.

Sirius most frequent question, “Where are the best deals today?”

So Black Friday and Health care have much in common.  They are both social.

I have an idea for the next “Developers Challenge”

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