At the same time, the nation’s fastest-growing age group is over 65. Government projections hold that in 2050 there will be 90 million Americans 65 and older, and 19 million people over age 85. The American Geriatrics Society argues that, ideally, the United States should have one geriatrician for every 300 aging people. But with the looming shortage of geriatricians, the society projects that by 2030 there will be only one geriatrician for every 3,798 older adults.
A vast majority of Americans have no conception of what lies ahead and — without geriatricians available to provide their health care — how substantially their lives will be affected. I know. It means that soon we may all soon be in the land of the pink bibs.
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Tuesday, September 29, 2015
Monday, September 28, 2015
Necessary Medicare Fraud Alerts:
Medicare Fraud and Abuse perpetrators are inventive...to say the least. How much of it is intentional or pre-meditated.
http://www.beckershospitalreview.com/legal-regulatory-issues/physician-who-billed-medicare-for-24-hour-workdays-convicted-of-fraud.html
http://www.beckershospitalreview.com/legal-regulatory-issues/5-recent-stark-law-settlements-september23.html
http://www.beckershospitalreview.com/legal-regulatory-issues/government-claims-hospital-owner-charged-medicare-for-bmws.html
http://www.beckershospitalreview.com/legal-regulatory-issues/prime-healthcare-sues-california-attorney-general-over-failed-hospital-deal.html
http://www.beckershospitalreview.com/legal-regulatory-issues/adventist-health-to-pay-record-breaking-118-7m-to-settle-improper-physician-compensation-claims.html
http://www.beckershospitalreview.com/legal-regulatory-issues/florida-hospital-district-to-pay-69-5m-to-settle-stark-law-false-clams-act-allegations.html
http://www.beckershospitalreview.com/legal-regulatory-issues/vanguard-health-systems-to-pay-2-9m-to-resolve-false-claims-kickback-allegations.html
Regulators to Shut Down Health Republic Insurance of New York - WSJ
It all started with great expectations. Health Republic Insurance of New York the largest COOP and fastest growing USA insurance company (0 to 215K members in 18 months) with over 42% year over year growth. A health plan with the mission of providing high quality and affordable care .
The insurer lost about $52.7 million in the first six months of this year, on top of a $77.5 million loss in 2014, according to regulatory filings. The move to wind down its operations was made jointly by officials from the federal Centers for Medicare & Medicaid Services; New York’s state insurance exchange, known as New York State of Health; and the New York State Department of Financial Services.
Regulators to Shut Down Health Republic Insurance of New York - WSJ
The insurer lost about $52.7 million in the first six months of this year, on top of a $77.5 million loss in 2014, according to regulatory filings. The move to wind down its operations was made jointly by officials from the federal Centers for Medicare & Medicaid Services; New York’s state insurance exchange, known as New York State of Health; and the New York State Department of Financial Services.
In a statement, Health Republic said it was “deeply disappointed” by the outcome, and pointed to “challenges placed on us by the structure of the CO-OP program.”
Health Republic has about 215,000 members, with about half holding individual plans and half under small-business coverage, a spokesman for the insurer said.
The regulators said they chose to take action before the exchange’s November open enrollment period, when individuals can choose coverage with a new insurer. Health Republic policies will remain in effect amid “an orderly wind down” of the insurer’s operations, they said. In a statement, Kevin Counihan, the CMS official who oversees insurance marketplace operations, said the move came “because of the likelihood that Health Republic Insurance of New York would become financially insolvent.”
The shuttering of Health Republic, at least the fourth to falter among the ACA’s original 23 co-ops around the country, reflects the losses many insurers are seeing in their business related to the health law’s exchanges, which are particularly acute for small plans without deep pockets or diversified lines of business.
In Health Republic’s case, its premiums appeared not to be set high enough to cover members’ health expenses and its own costs, said Deep Banerjee, an analyst with Standard & Poor’s Ratings Services. “They are paying out in claims and expenses a lot more than they are getting in the door,” he said.
A Health Republic spokesman said the insurer didn’t receive the full rate increases it requested from state regulators for 2015, and “we didn’t feel as if we got rate adequacy” for this year’s plans.
The situation was complicated by programs created under the health law to ease risks for insurers that signed up a lot of sicker, more-costly enrollees. Under one of those programs, Health Republic had expected to break even, but instead it was assessed to pay around $80 million into the program’s pool, likely reflecting that it enrolled a relatively healthier clientele compared with competitors. Health Republic also expected to receive $147 million under another one of those programs, known as risk corridors, the insurer said. Because of a tweak to a federal spending bill, insurers may not get as much as they have projected, Mr. Banerjee said—an issue that could squeeze other companies.
The co-ops were set up as nonprofit insurance entities governed by their members, and analysts have said several of those that remain are in challenging financial straits. Health Republic’s membership is far larger than the next-biggest co-op, which had around 131,000 enrolled, according to Mr. Banerjee.
The Iowa insurance regulator said in January that it would shut down CoOportunity Health. At least two other co-ops, in Nevada and Louisiana, have said they won’t offer plans next year.
Regulators to Shut Down Health Republic Insurance of New York - WSJ
Dr Jay Lee Keynote at 2015 APAMSA Conference
Collaboration has become essential for progress and growth of health care. Silos are nothing new and it began with Abraham Flexner's report over 10 years ago. It is based upon scientific approach to medicine. Flexner's model was a sea-change in medicine creating a scientific methodology to diagnosis and treatment of patients based upon science, such as pathology, physiology, anatomy and other disciplines.
Dr. Jay Lee, President of the California Academy of Family Physicians, gives keynote at 2015 Asian Pacific American Medical Student Association…D. Jay Leno points out that we have outgrown Flexner's model. Medicine has grown vertically and horizontally.
Dr. Lee covers the span of four generations in health care changes. No longer do we need to demonstrate in front of the White House, we can make a presence on facebook twitter, google, and blogs.
The triple AIM has become a goal. Donald Berwick coined tthe term. Today's trainees are in a 'golden moment' of medicine. The Affordable Care Act jolted the system...not as an end point but like a lottery basket it has stirred the mix and created change and the ability and necessity of using the ACA as a catalyst.
Physicians must be at diverse industry events in HIT and technology otherwise innovators do not have the knowlege or guidance. Expositions such as those at SXSW and the CES afford this opportunity. Many current common place technical devices were previously shown at these forums and later adopted my medicine by a physician entrepeneur.
Physicians need to become process engineers rather than medical directors. Medical directors follow an established framework, engineers design a new system.
Innovation and technology are not just about shiny new things, but also "blowing up the system, and creating new ideas for the system, work flows, application of population management for individuals. We need to create a new system capable of managing many more patients to continue to provide personalized and patient centered care.. If we do not accomplish this end our healthcare will deteriorate into an even more impersonal encounter for ourselves and our patients.We need to change from a health system that innovates to a culture of innovators that deliver health care. Innovation is not going faster.....it is about changing direction.
Most of the content is attributable to Jay Lee, M.D. he is a family practitioner, President of the California Academy of Family Practice.
Dr. Jay Lee, President of the California Academy of Family Physicians, gives keynote at 2015 Asian Pacific American Medical Student Association…D. Jay Leno points out that we have outgrown Flexner's model. Medicine has grown vertically and horizontally.
Dr. Lee covers the span of four generations in health care changes. No longer do we need to demonstrate in front of the White House, we can make a presence on facebook twitter, google, and blogs.
The triple AIM has become a goal. Donald Berwick coined tthe term. Today's trainees are in a 'golden moment' of medicine. The Affordable Care Act jolted the system...not as an end point but like a lottery basket it has stirred the mix and created change and the ability and necessity of using the ACA as a catalyst.
Physicians must be at diverse industry events in HIT and technology otherwise innovators do not have the knowlege or guidance. Expositions such as those at SXSW and the CES afford this opportunity. Many current common place technical devices were previously shown at these forums and later adopted my medicine by a physician entrepeneur.
Physicians need to become process engineers rather than medical directors. Medical directors follow an established framework, engineers design a new system.
Innovation and technology are not just about shiny new things, but also "blowing up the system, and creating new ideas for the system, work flows, application of population management for individuals. We need to create a new system capable of managing many more patients to continue to provide personalized and patient centered care.. If we do not accomplish this end our healthcare will deteriorate into an even more impersonal encounter for ourselves and our patients.We need to change from a health system that innovates to a culture of innovators that deliver health care. Innovation is not going faster.....it is about changing direction.
Most of the content is attributable to Jay Lee, M.D. he is a family practitioner, President of the California Academy of Family Practice.
Sunday, September 27, 2015
An Aging Population, Without the Doctors to Match -
We are already at the beginning of a new crisis in American Health Care. For those entering their senior years, according to Dr. David Reuben, a leading geriatrician at the U.C.L.A. Medical Center, a true national crisis is brewing.
Our average population age has gradually drifted up, due to longer life spans, the elimination of death from infectious diseases and cause of death from life-long chronic illness
Many people age prematurely or develop premature neurologic disease from stroke, heredity and chronic disease. The affordable care act will broaden coverage and add previously uniinsured to the insurance roles. Most patient who are 65 or over and the disabled are covered by Medicare and/or Medicaid.
Venture capitalist and entrepeneurs are investing in long term homes for the aged. National franchises are appearing.
The missing link is the absence of geriatricians.
Currently there are fewer than 8,000 geriatricians in practice nationwide — and that number is shrinking. “We are an endangered species,” said Dr. Rosanne Leipzig, a geriatrician at Mt. Sinai Medical Center in New York.
An Aging Population, Without the Doctors to Match - The New York Times
Our average population age has gradually drifted up, due to longer life spans, the elimination of death from infectious diseases and cause of death from life-long chronic illness
Many people age prematurely or develop premature neurologic disease from stroke, heredity and chronic disease. The affordable care act will broaden coverage and add previously uniinsured to the insurance roles. Most patient who are 65 or over and the disabled are covered by Medicare and/or Medicaid.
Venture capitalist and entrepeneurs are investing in long term homes for the aged. National franchises are appearing.
The missing link is the absence of geriatricians.
Currently there are fewer than 8,000 geriatricians in practice nationwide — and that number is shrinking. “We are an endangered species,” said Dr. Rosanne Leipzig, a geriatrician at Mt. Sinai Medical Center in New York.
How will we solve this shortage ? .....to be continued
An Aging Population, Without the Doctors to Match - The New York Times
Friday, September 25, 2015
Thursday, September 24, 2015
Wednesday, September 23, 2015
Public Health Issues in Central Valley of California: Thousands not receiving State Aid for Water
Drought has 14 communities on the brink of waterlessness
Parkwood's last well dried up in July. County officials, after much hand-wringing, made a deal with the city of Madera for a temporary water supply, but the arrangement prohibited Parkwood's 3,000 residents from using so much as a drop of water on their trees, shrubs or lawns. The county had to find a permanent water fix.
Parkwood is one of 28 small California communities that have since January cycled onto and off of a list of "critical water systems" that state officials say could run dry within 60 days. Amid the drought that is scorching the state and particularly the Central Valley, the State Water Resources Control Board decided this year, for the first time ever, to track areas on the brink of waterlessness.
"It's a sign of how severe this drought is," said Bruce Burton, an assistant deputy director for the board.
Public Health Issues in Central Valley of California: Thousands not receiving State Aid for Water
MedicineBall is the new Moneyball | Jordan Shlain MD | LinkedIn
MedicineBall is the new Moneyball
Jordan Shain, M.D. published a futuristic vision for patient centered medicine. The bottom line is the patient becomes not only the recipient of health care but an active collaborator.
Vocal patient advocates insist on patient involvement in the review of complications. It is the current mantra and politically correct statements of the media, at social events, on social media and cocktail parties.
What do the rest of the patient and doctor community really think? That is an unknown. It leads to a conclusion that this course is all well and good.
Without careful analysis this is much like a non blinded study the results of which may be open to question.
Most providers have long been involved in peer review. It has been part and parcel of American Medicine for decades. It may not be a uniform standard practice. Peer review at an academic medical center is much different than that in a small hospital. Patient collaboration may be very important in that setting as part of a regional quality assurance organization. The devil may be in the details.
A poor outcome may result in a medico-legal event. The evidence produced may introduce a new feature in law suits. Malpractice incidents may rise or fall.
- 2,431 views
Surgical Complication Rates and the new data perspective
(slightly updated)
In an age where the importance of data, statistics and predictive modeling win big games for baseball teams and make fat money for high-frequency traders, we are at the dawn of a new age of transparency in healthcare It behooves every actor, in every sector, to use this new perspective to constructively illuminate best practices and design an infrastructure for true operational, clinical and logistic efficiencies at large scale and the local level - all in the spirit of getting the patient the best outcome.
Every modern industry uses 'big data' to understand the dynamics of their market landscape. This in turn, enables them to make decisions and develop strategies for gaining market share and building their brands. Fortress medicine has received a shot over the bow regarding the power of this new data perspective and needs to craft visionary, courageous yet mindful strategies that includes the bright light of outcomes into their private practices, clinics and large institutions. Propublica, in a seminal article, Making the Cut, shows us the power of transparency in complications rates during surgery. Doctors and their patients, since the dawn of medicine, have existed in a world without clarity around outcomes - there was not way to meaningfully collect it and analyze it. What Yelp has done for small business and Zagat has done for fine restaurants,CMS just did for the medical profession….and it just might be a needed dose of datacillin to start an honest conversation about what this all means.
Medicine has always grappled with complications, death and disability, in the private halls of hospitals. These are called “M & m” rounds – and they occur on a regular basis. The goal of these rounds is to dissect major mistakes (mortality – capital ‘M’) and minor ones too (morbidity, little ‘m’).
These meetings are among peers and colleages, in strict confidence, to share mistakes as a mechanism of improving. The Institute of Medicine in their acclaimed report, To Err is Human, highlights that many mistakes and death are human error. To be clear, they highlighted all forms of error; including nurses and pharmacists entering the wrong dose into the computers – not solely surgical complications. The point is that errors happen to frequently and people wind up dead or disabled as a result. #notgood
I have personally attended my own father leading an M & m rounds to discuss an accidentally cut bile duct in a routine laparoscopic gall bladder removal. He was bummed out but not ashamed; rather he wanted to share his experience regarding variant anatomies (and we are mostly all different) that can lead to peril if specific maneuvers and procedures are not artfully choreographed. Sadly for the patient, a bad outcome occurred, yet in the end, an entire surgical department learns from his 'mistake'. Morbidity and mortality rounds are meant to disseminate learning’s, better practices and to highlight error in a constructive, albeit humbling way.
What Making the Cut elucidates is a new world order in healthcare. Everyone on a surgical team is now part of the statistical modeling; for better or worse. Was the surgeon responsible, was it the nurse, the anesthesiologist, the post-surgical care, the patient, the follow up care coordination process – who is ultimately responsible for a bad outcome that is not clear-cut...and in many cases may never be clear.
Some bad outcomes and complications are just plain bad luck...and hopefully the data isn't conflating all complications with a specific 'culprit'. We need to look carefully at how the CMS dataset was analyzed. The last thing we need is a publication bias to morph into lore.
Transparency on a grand scale will create the space for everyone to start talking to each other; stitching together the balkanized fiefdoms of medicine into coherent units that all see and own the outcome of individual patients – together. We can no longer hide behind the opaque veil of complexity and complex systems when in fact, taking care of patients is not complex, nor complicated. Just look at the orthopedist from small town Alabama with the best outcomes. What's his special sauce? It appears that he took personal interest in follow up care. Is follow up the best medicine? Seems like it plays a significant role. After all, once a diagnosis has been made and treatment is commenced; the only way to know if a complication is imminent is to stay connected with your patient. If warning signs should arise, action should be taken. Simple as that; not complex. Sadly, medical codes (any payment) do not really exist for follow up care…..The Centers for Medicare & Medicaid Services has made two significant moves int he past year. One is to start paying for the management of poly-chronic (think the sickest of the sick) care coordination. Crazy that the government had to come up with that idea...the private sector is myopic when it comes to long term solutions in the context of quarterly earnings. Furthermore, on July 13th just released new guidelines that will basically create a warranty for surgical procedures; specifically hip and knee surgery. Furthermore, a critical element of payment will be complication rates. The new paradigm in payment: Your income will be dependent on your outcomes. Incomes = outcomes.
The crazy thing is that doctors, and I am one, have historically not participated in the data collection game. This was just a artifact of geeky computer science engineers building crappy code that doctors hated using (and still, mostly do). RAND 2013 report on the state of physicans summarized here
Data will give us a new perspective, a data perspective. This new illuminating presence is an opportunity that presents itself once in a generation. We can now see things in a new light.
This puts doctors into the precarious position of being in the “if you’re not at the table, you may be on the menu’ paradigm. Physician data is currently collected by EMR vendors, insurance companies, laboratory and radiology companies, pharmacies, revenue cycle management companies and a host of other third parties - but not the doctor....or if they do, it's the exception. I have a hard time believing that your friendly, local insurance company will happily supply doctors all they data they want. This data is expensive, comes at a premium and is viewed through the lens of marketshare; not necessarily patient care.
Doctors need step up and start collecting their own data. As of now, all data often pre-analyzed by statisticians with conclusions drawn. Physicians have been reluctant to play the data game for good reason; they have always been at an asymmetrical disadvantage when it comes to the computational power of large institutions and their ‘crunched’ data. The time is now for the physician community to wake up and realize that if we don’t collect own our own data, and publish it; they will – and they will likely do it for their advantage.
The Centers for Medicare & Medicaid Services data that powers the Propublica article is a blunt instrument; like the first scalpel design– not sharp, not precise, but effective in making it's point known. Many will argue that they see a ‘sicker population’; they their patients are ‘more complex’, and while this may be true, the data scalpels will become more sophisticated over time and physicians should be designing these tools with every major stakeholder for the sole purpose of getting the best outcomes. After all, patients want the best outcome and they are the whole point of medicine.
As the world of transparency descends on the fuzzy humanity of medicine, we all need to recognize that we are dealing with variable human anatomy, variable human physiology and human emotion. Data holds a key; a very important one, however it does not hold the key. Participatory humanism plus data does.
Jordan Shlain is a practicing primary care physician and the founder and Chairman of Healthloop; a physician empowered, patient-engagement follow-up solution.
MedicineBall is the new Moneyball | Jordan Shlain MD | LinkedIn
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