Obamacare911.com

 

Many of my readers know that I have been a proponent os significant health reform, however remain critical of PPACA as passed into law. It is misguided to call this law “OBAMACARE”.  President Obama did not draft the legislation, had little to do with it’s writing and formation,  but signed it into law.  We can safely assign it’s passage to the Democratic Party, for not one Republican voted to pass this law. Despite Republican suggestions their advice was ignored and rejected. The media has vastly distorted the law, and it’s effects to the American Public. Other than academic physicians and the ‘flip flop’ American Medical Association, very very few clinical physicians in practice support it, whether they are in group practice or small solo practices.

If  you are an idealist, there is much to  say that this is a moral law, and creates social justice. However social justice at the expense of a significant minority tramples upon the minority rights to freedom of choice.  Those who still oppose PPACA deserve and have a right to be heard with some measure of respect.  They all too well know the danger of this law and many of these people are the same ones who are not insured at present.

On Saturday, the Oregonian reported that Oregon residents who buy their own health insurance "face major cost changes."

"The coverage cost shake-up for those purchasing their own coverage is just one of many major changes to the health care landscape rolling out this year courtesy of the Affordable Care Act," the newspaper said.

One of the major reasons I oppose it are the fact that is not ‘affordable’ and not protective.  Almost nothing in the law prevents insurance companies from raising their premiums and their costs to fall under the rule of 15% profit or 85% of their premiums going toward patient care.   So add to the equation the significant cost of audits of all health insurers.  It is almost as daunting as auditing the Department of Defense, or the audits of the General Accounting office of the U.S. Government.

The issue of the IRS monitoring the mandate and imposing penalties is groundbreaking having the IRS intrude into other areas of life, not withstanding the cowardly act of SCOTUS saying that is a tax to avoid ruling on the issue of constitutionality.  It is a surprising fact that Congress and the American people did not revolt at this decision. Shame on Scotus !

Tonight I saw an add on television promoting a new book “Obamacare911.com” or The Survival Guide to Obamacare, a hidden minefield of disingenuous choices.

Health Train Express hopes to find a ‘side track’ as ObamaCare passes in the express lane.  I prefer a slow and deliberate “local’ stopping at all stations to take on passengers.

P.S.   This is one train I would rather miss.

Technorati Tags: health train,obamacare 911,local,express,scotus,obama,congress,ppaca,obamacare,republican,democrat,oregonian

Openness and Transparency

 

 

Openness and transparency are not limited to medical records within the confines of health care (regulated by HIPAA for privacy), but is also occurring rapidly in academia and the logistics of publication of peer reviewed journals.

At one time articles were not published until they were presented at medical meetings, and symposia. This has changed radically.

Our sister blog, Digital Health Space also attempts to guide readers to close the space between providers, scientists, and patients. This mission statement is in the header for each post.

If one searches the medical articles a decade or more ago, you would find many findings reported in “Transactions…..of the Academy of ………. These articles would sometime take months or even a year to become public knowledge.

The process sequestered many findings from other professionals and even the general public  It tended to magnify ‘the secret society of academia” and specialists.

Change has taken place, and is explained further on PMC (PubMed Central).

Policy and Submission Process

A a result of NIH's Public Access policy, the final, peer reviewed author manuscripts of journal articles that are supported by NIH funding must be deposited into PMC via the NIH Manuscript Submission System (NIHMSS), as soon as the articles have been accepted for publication.

Specifically, the final manuscript supplied to PMC is the version that the journal has accepted for publication, including any revisions that the author has made during the peer review process.

The published version of the article usually includes additional changes made by the journal's editorial staff after acceptance of the author's final manuscript. These edits may be limited to matters of style and format or they could include more substantive changes made with the concurrence of the author.

 

Display of the Citation in PMC

The citation for the manuscript version of an article in PMC includes a reference to the published article. In addition, if the article includes a digital object identifier (DOI) or is from a journal that participates in NCBI's Link Out service, then the reference to the published article also provides a direct link to the full text of the article at the journal site.

For those physicians and scientists as well as patients this is a direct shortcut to knowledge….Patients do have a caveat that some of these articles are difficult to understand.  However most articles  have a summary/comment at the end which very nicely summarizes the gobbledygook .

Similar policies are also in place for papers supported by funding from agencies in the UK, Europe, and Canada. These manuscripts may be deposited through the Europe PMC submission system or the PMC Canada submission system.

 

Technorati Tags: openness,transparency pubmed,nih,nlm,pmc submission,ncbi,linkout.author,manuscript,hipaa,privacy

Health Insurers Raise Some Rates by Double Digits

 

Health Train Express and the New York Times are reporting Health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers.

Particularly vulnerable to the high rates are small businesses and people who do not have employer-provided insurance and must buy it on their own.

In California, Aetna is proposing rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent for some of those policy holders, according to the insurers’ filings with the state for 2013. These rate requests are all the more striking after a 39 percent rise sought by Anthem Blue Cross in 2010 helped give impetus to the law, known as the Affordable Care Act, which was passed the same year and will not be fully in effect until 2014.

In other states, like Florida and Ohio, insurers have been able to raise rates by at least 20 percent for some policy holders. The rate increases can amount to several hundred dollars a month.

The proposed increases compare with about 4 percent for families with employer-based policies.

This fact emphasizes how poorly PPACA performs in regard to "AFFORDABILITY”, a key feature in it’s name. The new law allows insurance premiums to have a huge difference in premiums between group and individual policies.  Individuals are excluded from  “leveling the playing field” and are paying an extra-ordinary price for health insurance, as has always been the case.

The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability.

New York, for example, recently used its sweeping powers to hold rate increases for 2013 in the individual and small group markets to under 10 percent. California can review rate requests for technical errors but cannot deny rate increases.

The double-digit requests in some states are being made despite evidence that overall health care costs appear to have slowed in recent years, increasing in the single digits annually as many people put off treatment because of the weak economy.

The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability.

Currently the public and patients have little knowledge of this glaring fact, and how misleading PPACA is in it’s current state.

We can lay this fact on congress who failed to read and/or understand the PPACA they passed for political expediency and gain by Democrats. Not one Republican voted for this law, a sure indicator something serious was wrong that goes beyond the partisan excuse.

Brace yourselves, the worst is yet to come.

At the same time while the law increased eligibility, premium rates will cause many to be unable afford insurance, and the difference may very well negate any gains from PPACA.

Where were the auditors, and the CBO, or anyone for that matter on this glaring and sad fact !

Apologies Necessary

 

Mea Culpa !

 

We recently did some analytics for Health Train Express and our sister blog, Digital Health Space.  We notice a sharp uptick in the number of duplicate cross posts on twitter, facebook and Google plus.  Yecch !  I know how much I hate that, as I am sure you do.  So we are doing a serious revision of our IT structure.  The past year we have experienced a gradual and encouraging growth in our readership. While not as explosive as Google, our budget is a bit more Spartan.   The blogs are curated by Health Works Collective (thank you Joan Justice ) and Networked Blog. We are experimenting on Pinterest having heard that the demographics there are uniquely “Women” and we want to embrace that community. In fact I see that the majority of bloggers are ladies who love socializing. Women have always been more verbal than men as shown by the fact they excel in language skills at an early age of development.  I know that I cannot out-talk my better half….she will consistently wear me down and ‘win’ the argument.

So five me a week or so before you “unfriend” me, unfollow me, and report me to Google for ‘abuse’, spam, or for being a ‘troll"’. I promise to behave.

Technorati Tags: mea culpa,troll,spam,abuse,social media,twitter,facebook,pinterest,google =

Employment Incentives for Physicians

 

 

Physicians now share many of the ‘employment’ concerns as others. As more MDs become employees of health systems they forfeit their own self-initiative and freedom to change their personal course, hours, and ability to perform for their patient’s best interest without concern for their employer’s mindset.

It is often a difficult walk.

According to CEB’s Quarterly Global Labor Market research Most employees when surveyed about jobs are searching  for the top five things employees look for when seeking a new job are:

1. Stability
2. Compensation
3. Respect
4. Health Benefits
5. Work-Life Balance

 

In today’s rapidly changing and evolving health organizations, the lone wolves and/or even small groups are at the mercy of larger health systems, and insurers who look for wide coverage availability.  The larger organizations may actually not be more efficient or better but they offer stability just on the basis of inertia.

Compensation has consistently risen in group practices

Respect. The day of the exceptional solo physician and/or specialist who is sought out is gone.  In a former time, individual exceptionalism drove solo practice or small group practice.  Today where searching for a physician personal recommendations have diminished except in a group practice where the primary care doctors have a closed system of specialists they must refer to in their group.  The quality is totally dependent upon the standards set by the group practice. Most solo physicians were and are respected because of their individualism and insistence on the physician-patient relationship.  The relationship is derived by patient choice of physician in a free market (which is rapidly disappearing). Patients still recognize the benefit of seeing a physician who is a ‘free agent’ to make decisions to refer to the “best” regardless of insurance restrictions and distance.  This becomes critical when diseases are severe, and not common, necessitating a search for providers who have experience with a disease or particular procedure in greater numbers.

Health Benefits:  Even physicians are unable to access or choose affordable care. This applies to their staff as well as themselves personally.. The quicksand of health plan reorganization, and uncertainty of PPACA, and ACOs and rising premiums will not change with health reform.  Health care may be somewhat more accessible especially to the previously uninsurable, but it will not be less expensive, and the currently insured will be paying more, as well as higher taxes, a hidden insurance premium cost.

Work-Life Balance:  Perhaps this is the major factor driving Physicians to becoming employed.  The relief of ‘running a business’  removes much stress from financial and legal liability. Having an institution with administrators increases cost, however it should professionalize the ‘C’ Suites and yield better business.  In a smaller private practice backup is less assured, dependent upon loose organization and often enforced by a department or emergency room coverage agreements. Today with many MDs avoiding hospital privilege the available consultants has diminished. Group practices have a built in enforceable duty schedule, and it is doable. “When people talk about work life balance they’re not saying they don’t want to work as much,” he says, maybe by way of calming the nerves of exasperated employers. “They’re simply saying they want flexibility in the time that they do work. The word flexibility needs to be recognized as not about how much to work but when that work is getting done.”

Physicians have rarely been under-employed, however there are great disparities in specialties due to severe shortages in mental health, pediatrics, and certain niche specialties. Shortages are often addressed by using allied health providers, nurse practitioners, or physician assistants.

In the past most physicians desired were self-employed. The Bureau of Labor and Statistics reported that  in the past 24 months the balance has shifted. A number of jobs in professional and related occupations have relatively high (above 10 percent) incorporated self-employment rates. For instance, the rate was very high for dentists, architects, physicians, and lawyers.  A recent survey by the Medical Group Management Association shows a nearly 75 percent increase in the number of active doctors employed by hospitals since 2000, and recent hospital announcements suggest this trend is accelerating.

With the changing paradigm of health care, the Massachusetts Medical Society conducted an email survey to Massachusetts physicians in order to learn more about the current practice environment in Massachusetts as it relates to employed physicians or physicians considering moving to an employed position.  

The email survey was sent to physician members and non-members in October 2012. Of those who responded to the survey, 60% were employed, 38% were self employed and 2% were self employed but considering an employed position.

(to be continued)

Technorati Tags: physician,unemployment,employed physicians,medical group management association,hospital physician employment,self,physician empployed physicians

The Health Reform Law and What will Happen to It

 

Some  are jumping for joy and dancing in the halls thinking, “Well I am glad that is over with.” Obamacare is now the   law of the land.

Many in Congress abdicated their responsibility either  by not  reading the  PPACA bill before  voting, or misguided to vote for it by others.

The decision was purely  a partisan decision passed  only because Democrats controlled the congress in both the Senate and the House of Representatives.

The one pervading evil of democracy is the tyranny of the majority, or rather of that party, not always the majority, that succeeds, by force or fraud, in carrying elections.

—The History of Freedom in Antiquity, 1877

Close to 50% of the legislature were not enthusiastic about this law. The rights of the  minority were clearly ignored by the  majority, without any  consideration of the impact on the minority ^{1 .}

Click  on   the image

 

In  addition  to the  basic  civics lesson,  there are   many  specifics regarding PPACA, which remain troubling.

A Resistance Movement Rises Against ObamaCare

(Grace-Marie Turner)

“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:  (“The full extent of damage the [Patient Protection and Affordable Care Act] causes to small businesses, the nation’s economy, and the American health care system will only be revealed with time. The State of Louisiana has no interest in being a party to this failure,” he wrote.

 

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. (certainly  not an option where unemployment remains   high and shows little real evidence for improvement.

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.

Although churches themselves are exempt, the mandate applies to religiously affiliated hospitals, colleges, charities and social service agencies. Cardinal Timothy Dolan recently said the Catholic Church will “not obey” the Obama Administration’s HHS mandate, a policy he classified as “immoral.”

There are three major   constituencies opposed to implementation of Obamacare; Religious, Business, Governors and Congress

There is  much more to play out in the next 12   months.  The current plan is brittle, subject to much criticism and lack of faith in it’s ability to perform as mandated. “(end quote)

 

1. Tyranny of  the Majority (The phrase "tyranny of the majority" (or "tyranny of the masses"), used in discussing systems of democracy and majority rule, envisions a scenario in which decisions made by a majority place its interests so far above those of an individual or minority group as to constitute active oppression, comparable to that of tyrants and despots.)

 

Technorati Tags: obamacare,galen,majority rule,minority rights,ppaca,health reform,insurance mandates,tyranny

National Library of Medicine How to Analyze Your Internet Information Source

 

Health Train Express began publishing in 2004. The  internet and platforms have changed radically since then, and so too has healthcare. Not so silently EMR and EHR have been adopted by many physicians   in some form or other. Social media has exploded  in the last 24   months and is being used by early adopters in very creative ways, adhering at all times to  HIPAA regulations. While social media can be used for many   innovative and creative ways in healthcare, it cannot be used for direct patient care.

Telemedicine has arrived, and coincidentally the development of affordable web cameras, increased processing power in consumer electronics and more widespread affordable high speed broadband. Commercial consumer video conferencing platforms are sprouting. One innovative entrepreneur has even developed a multilevel marketing business model. The subscription service fee is $29.oo a month and that fee is waived if users bring in three additional recruits. There is the option to partner and develop a residual revenue stream. (not required). The service offers a 24 hour “hotline” and 800 board certified physicians to either deal with the questions via emai, telephone, or videoconference. If the online MD is unable to make a decision or it is recommended that a clinic visit is necessary the patient is referred to a local MD. Physicians may also join the network with the same residual income plan. It is HIPAA compliant and the infrastructure  is on MDlive.com. Webdocs Network however is a separate VAR (Value Added Retailer).

Today the information overload is considerable. Searches on Google will result in millions of ‘hits” much of   it  promoted, enhanced by search engine optimization to increase the chances of being listed on the first page of Google Search results.

HHS, CMS, hospitals and   providers alike have developed web presence directed at providers and patients as well.  Mayo  Clinic  has offered a ‘Residency in Social Media” This, originating from a high quality and credible  institution has bolstered and encouraged social  media applications for physicians stressing   HIPAA compliance

Users at any level of experience can benefit greatly from a National Library of Medicine video tutorial .

Medline (A service of the National Library of Medicine) also offers a series of Video Tutorials on many subjects

 

Technorati Tags: telemedicine,mayo clinic,video conferencing,telehealth,hipaa,national library of medicine,health information tutorial,mdlive,internet,information,webdocnetwork,hhs,cms,nlm,nih national library of mediciine helth train express,digital health space

What Happened to 2012 ?

 

It’s that time of the year between  Christmas and the  New Year to assess events of 2012, successes and   failures, and also to predict for 2013.

Which events rank highest  for you ?  Rank them in order,  high to low.

Health Reform

Health Related  Technology

Social  Media

Career  plans and changes

Political events

Economy

Health Train Express is  curating your well thought out answers and will publish results on  December 30, 2013.

Send your opinion   to  Facebook    Google +  Twitter/glevin1   or   email  digitalhheallthspace@gmail.com

 

Technorati Tags: 2012,2013,predictions,health reform,heallth information,social media

What Happened to 2012 ?

 

It’s that time of the year between  Christmas and the  New Year to assess events of 2012, successes and   failures, and also to predict for 2013.

Which events rank highest  for you ?  Rank them in order,  high to low.

Health Reform

Health Related  Technology

Social  Media

Career  plans and changes

Political events

Economy

Health Train Express is  curating your well thought out answers and will publish results on  December 30, 2013.

Send your opinion   to  Facebook    Google +  Twitter   or   email  digitalhheallthspace@gmail.com

 

Technorati Tags: 2012,2013,predictions,health reform,heallth information,social media

A Social Media Holiday !

 

Health Train Express will be silent until December 26th. For those who may be overwhelmed with this “fiscal cliff” take measure in this musical feast. Enjoy the time with family !

 

Technorati Tags: holiday,music,symphony,social music,rob michaels,#hcsm

Just a tiny Scratch….or is it?

 

 

Visit NBCNews.com for breaking news, world news, and news about the economy

It’s a crowded day in the emergency department . All the beds are full, the waiting room also a line  has formed at the registration desk. It’s also the flu season when high fevers, stomach aches and sore throats which are prevalent at certain times of the  year. Perhaps for every 1000 patients presenting with a triad of routine symptoms such as these only 1 may have a serious life threatening illness.

Mixed in with these routine sounding cases are trauma,overdoses, cardiac events, broken bones and other acute surgical illnesses.  Physicians balance their time efficiently assessing severity of illness, complexity of diagnosis and care with the need to go through possibly a hundred patients/shift. Insurance companies frown upon ED visits since they are expensive as compared to office visits.

So physicians tread a narrow line between being overly cautious and moving briskly with their patients.

The story above has set into motion a call for standards in the ED where events can overtake process.

This should be included in the ‘never events’ algorithm…..no one leaves the ED without their laboratory results in hand…in addition to their presumptive diagnosis, referred to doctor, and instructions with warnings to watch for.

 

Technorati Tags: trauma,sepsis,infectious disease,emergency dept.,sore throats,stomach aches

Health Care Apocalypse December 23, 2012

 

Whatever took place with healthreform the past two years will pale when compared to the next three years, when the plan unfolds.

Congress did  not (Democrats?) read the bill prior to passing it without regard to its content.  Yet the public did not hold congress accountable for it’s irresponsible passage of PPACA.  I am more flabbergasted than ever.  All the things I was taught in school, college, medical school are not there any more. Few really know or even respect our fundamental foundation for true freedom.

It is no wonder our youth are confused about what is right or wrong.   You can make up your own minds.  Those are my thoughts.

We don’t need a Mayan Apocalypse…..we have an American Apocalypse.

I am not certain if anything can be done to alleviate the financial pain and health system compromise at this point.  At some point the reservoir is empty. Our choice is simple but painful….stop spending now.  Our system needs to recover economically. Re-inventing health system paradigms will not work. It requires huge investment of sums we no longer have.  The billions of dollars HHS and congress have earmarked in incentives will in the long run yield only mountains of data, which may be inaccurate at the worst, misleading at the least, and ultimately wasted.

Technorati Tags: apocalypse,mayan apocalypse,healthreform,ppaca,health reform law

No Hospital Left Behind

 

Does that sound familiar ?  It should since we had a similar program for boosting educational accomplishments.  The outcome of that program still remains very much in  question. 

Portions of this report are from Kaiser Health News analysis of the records.

It's no longer enough for hospitals to just send a bill to Medicare and get paid.

The nation's biggest insurer is starting to dole out bonuses and penalties to nearly 3,000 hospitals as it ties almost $1 billion in payments to the quality of care provided to patients.

In what amounts to a nationwide competition, Medicare compared hospitals on how faithfully they followed basic standards of care and howpatients rated their experiences. Medicare disclosed on Thursday how individual hospitals will fare when the program, created by the federal health law, begins in January.

Suprisingly some of the biggest and most well known hospitals will be penalized based upon their quality of care measures. These measures range from patient surveys, the use of antibiotics prior to surgery, and hospital readmission rates.

In many parts of the country, the hospitals that did the best are not the ones with the most outsize reputations, but regional and community hospitals instead. New York-Presbyterian in Manhattan and Massachusetts General Hospital in Boston, both dominant hospitals in their cities, will have their payments reduced.

Other leading names in the hospital industry, including the Cleveland Clinic and Intermountain Medical Center in Utah, will receive bonuses, although not the largest in their regions.

The danger here of course is that the prospective patient will translate economic coercion with either excellence or deficiency of quality of care. This is a cost containment carrot/stick issues.

In all, Medicare is rewarding 1,557 hospitals with more money and reducing payments to 1,427 others, according to a Kaiser Health News analysis of the records. Most hospitals are seeing far smaller changes than Treasure Valley or Auburn. For many, the bonus or penalty is little more than a rounding error on their bottom lines. And while the current bonus/penalty is small, it is scheduled to increase significantly.

It's not clear that the new payment program will significantly improve hospitals. Some studies of similar incentive programs have found that the improvements ended up not being any better than those of hospitals that weren't prodded financially. Nonetheless, the program is here to stay and is going to expand over the next few years, putting more money into play and adding new quality measures, including patient death rates.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

 

LiveJournal Tags: Kaiser,Hospitals,costs,penalties,bonus,Medicare,Cleveland Clinic,Intermountain Medical Center Kaiser health news,Cedar Sinai,New York Presbyterian