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

5 Major Health Care Reform Changes Coming In 2013

 

Health care reform in the coming year will go on a kind of shakedown cruise to test the seaworthiness of America's evolving health care system as it becomes more cost-conscious and quality-focused under the Affordable Care Act.

In 2012, the health insurance law, also known as Obamacare, linked Medicare payments to the quality rather than quantity of care, started penalizing health insurers that charge too much in administrative fees and executive bonuses, and began rewarding good doctors who save Medicare money.

Medicaid pay raise for family doctors

Effective: Jan. 1, 2013

Currently, primary care doctors typically receive less for treating low-income Americans on Medicaid than for treating seniors covered by Medicare, even though both are federal-state programs.

But, beginning in January, state Medicaid programs will be required to pay at or above the Medicare rates, with the additional money coming solely from the federal government.

Dr. Jeff Cain, president of the American Academy of Family Physicians, says the continued emphasis on primary and preventive care is essential to effective reform.

"It's not a news flash that healthy people are cheaper to take care of than people who have diseases," he says. "One way we know we can cut costs and still maintain good quality is to have better primary care."

 

The timing of this pay raise is no accident, says Dr. Ron Greeno, public policy committee chair for the Society of Hospital Medicine.

"One thing the Affordable Care Act did was provide coverage for about 32 million patients that weren't covered before, and about half of those are eligible for Medicaid," he says. "They're trying to find primary care physicians who are willing to take more Medicaid patients."

In fact, without this and other health care reforms designed to strengthen primary care, America could face a shortage of 21,000 primary care physicians by 2015.

The average family doctor sees eight patients a week on either a discounted or free basis," which includes Medicaid patients, says Cain. "It's important that family doctors be able to have a financially viable practice and remain independent."

Health reform analysts will be cautiously analyzing the effect of each phase in.

LiveJournal Tags: health reform law,medicaid,primary care physicians

The Miracle of Finding a Physician

 

If you think finding a physician who ‘takes’ your insurance plan, think again !

 

 

infographic courtesy of Medical Billing Star

 

Doctors in Critical Condition !

Hate spending time in the waiting room of your physician’s office ? In a few years time you should count yourself to be lucky if you get to meet a physician at all! A recent study by the, The Physicians Foundation brings home an uncomfortable truth. That physicians are overworked underpaid, and, most are planning to leave the profession all together.

The Ailing Healthcare Industry…

Healthcare experts’ critic the latest reforms in the healthcare field and predict that there would be fewer physicians, in the years to come.

Though there may not be a mass, dramatic and headline grabbing exodus, if the current trend persists there could be 44,250 doctors lost in the next 4 years.

This coupled with 32 million newly insured Americans, can lead to longer waits to meet the doctor. And, less or no, patient engagement.

Has the Healthcare Industry Become too Expensive and Complicated?

Escalating costs of healthcare and mind bending regulations have made doctors, ailing patients desperately looking for a cure.

In a survey by Shana felt and colleagues of the Mayo clinic, a shocking 46% of doctors suffered from signs of a burnout.

We’ve Become Data Entry Clerks !

Money is hard to come by. But that is not the only reason physicians are contemplating early retirement. Family practitioner Mark Laza, in a recent summit, said that he’d cut 15% of his patient load.

He’d stopped seeing patients with low paying plans. But one major complaint he had was that doctors had become data entry clerks. The number of hours lost due to data entry made it harder to practice medicine, he complained.

It is a Crisis and not a Passing Phase…

This is a crisis that demands collective attention and action. It is a bitter truth but a truth nevertheless, that caring for patients isn’t the only priority of the doctor. To help a sick industry recover, it is essential that every physician maps out a game-plan.

It could be the tried and tested outsourcing solution or revamping compensation formulas. To hire part time staff to handle data entry tasks or working with a billing company. Whatever needs to be done needs to be done now ! To help physicians tide over challenges and emerging fiscally fit !

Tags: Doctors Become Data Entry Clerks Doctors in Critical Condition

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W H Y ? A New Public Health Issue?

 

Sandy Hook Elementary School                 Columbine High School

WHY ?

A new and dangerous public health threat has emerged in North America. As yet it is not known how the disease spreads. Outbreaks have been rare, but in the more recent two decades it has taken close to 100 lives in the U.S alone.

It kills swiftly but is not uniformly fatal. It leaves a trail of heartbreak and never ending questions? Those not killed by it's outbreak ask could we have been immunized against it? How can we find a cure or a treatment ?

What are we writing about here? Mass murders in schools, and public places.

Among the questions asked are;

Can it be predicted and/or prevented?

Why has it become more prevalent?

What are the risk factors?

Is there something wrong with our mental health systems?

Prediction of these events has been a total failure. Forensic psychologists and psychiatrists have elaborated on several personality traits in persons who commit these crimes. They caution however that these traits do not necessarily point to violent behavior.

There may be an explanation (or several) for it's increase in prevalence.

Questions 2 and 4 may be related.

 

The development of effective anti-psychotic and other psychotropic drugs to control unacceptable behavior, psychosis, anxiety and depression initiated a paradigm shift in the treatment of mental illness. Prior to 1980 severely and chronically emotionally disturbed people were admitted to either short term or long term psychiatric institutions. Most hospitals had a mental health ward that was secure and locked down. Some were smaller private residential facilities, but the vast majority were large state and/or federally administered facilities.

The institutions were expensive to maintain, and in the new era of 'effective' drugs to control aberrant behavior, it was deemed possible to treat more emotionally disturbed people as outpatients once their acute symptoms were controlled. The number of patients needing to be admitted both for short term or long term hospitalization decreased dramatically and gradually most of these in patient facilities closed or were downsized significantly. The ability to admit patients became more difficult.

The stigma of mental illness remains high. People are fearful of what they do not understand. While it is now better understood what causes emotional aberrations, (a chemical imbalance of the brain), only now has neuroscience been able to study the metabolic activity of the brain using metabolic scans coupled with MRI imaging.

Early studies reveal portions of the brain that 'light up” in emotional and/or physical activity. Studies are in the early phases of identifying behavior with localized activity. As research progresses it is hoped that more specific illnesses will be identified by brain scans.

Will this evolve into predictability of violence or other maladaptation's to human behavior? Will it become a routine screening test for some personality types? Perhaps the hope may be we can screen for these serious and fatal diseases much like we do now for cystic fibrosis, Tay-Sachs disease, trisomy 21 and other what we know now to be genetically identifiable at early stages.

We must be hopeful.

This particular Sunday most people are thinking, wondering why, also praying for the survivors and the tragic outcome for families, friends and our community.

More>>>>>>

GML

LiveJournal Tags: mental,murder,school,mental health,newtown,sandy hook

Doctor’s 2.0 in Paris !

 

Doctors 2.0 & You : Funding e-Patient Travel Scholarships.

The organizers of my favorite conference, Doctors 2.0 and You, are looking for people who could help fund the participation of e-patients in the next event this June. Please help if you can! We need a lot of e-patient participants in these events! (e- stands for empowered, engaged, and enabled)

We’re crowdfunding the participation (and travels) of e-Patients to our International Doctors 2.0 & You Conference in Paris this coming summer! This coming summer, we’re expecting patients, doctors, and innovators from over 40 countries and all walks of healthcare to attend..

 

         

 

Register here

 

             Doctor’s 2.0 Blog

 

Technorati Tags: doctor2.0,paris,e-patients,crowdfunding

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