Sunday Morning Brunch Topic, Is PPACA’s Demise Pending?

 

Another Elephant in The Room……summer edition.

President Obama’s dream team’s health reform law may becoming unhinged as more people read the law (thank you, Nancy Pelosi) If you have a week of spare time, you can read it also.

It shouldn’t take a panel of experts, such as healthcare executives, supreme court justices or ordinary citizens to read a document that encompasses their health and lives.

Written in verse similar to a ‘bible’ it states  multiple times that “the Secretary of Health and Human Services shall………”

 

GOP presidential candidate Mitt Romney, running mate Paul Ryan, and other Republicans are stressing $716 billion in cuts to Medicare that are part of President Obama's health care plan.

The $716 billion in cuts are aimed not at Medicare recipients, but at health care providers, such as hospitals and medical device makers; they also target what the administration calls waste and inefficiency in Medicare. 

Meanwhile, speaking in Florida -- where the Medicare issue is particularly resonant -- Ryan told a group of senior citizens that Obama's plan "raids $716 billion from the Medicare program to pay for the Obama care program."

Ryan said the cuts are hurting nursing homes and Medicare Advantage insurance plans, and that "Medicare should not be used as a piggy bank for Obama care."

Ryan’ plan includes a voucher system for private care, the details of which were not explained, although it has been claimed it would increase the cost of care by $6400/Medicare recipient.

Obama’s plan calls for reducing payments to nursing homes and providers amount to $ 716 billion over ten years.  Obama claims that Romney’s plan would shorten the life of Medicare by ten years and end Medicare as we know it, because of the voucher system Romney and Ryan propose.

While there is some substance to these arguments and which deserve an open, transparent and public debate, it skirts the real issues of why Obamacare is poorly constructed.

The public debate has been superficial and couched not only in political terms, but fundamental issues of the form of government our Republic proposes to represent.

 

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No Hospital Left Behind !

 

Is health care going to follow along the failed path of Education in the United States?

More than 2,000 hospitals — including some nationally recognized ones — will be penalized by the government starting in October because many of their patients are readmitted soon after discharge, new records show.

Together, these hospitals will forfeit about $280 million in Medicare funds over the next year as the government begins a wide-ranging push to start paying health care providers based on the quality of care they provide. One proposed measure is the rate of readmission.

With nearly one in five Medicare patients returning to the hospital within a month of discharge, the government considers readmissions a prime symptom of an overly expensive and uncoordinated health system.

Nearly 2 million Medicare beneficiaries are readmitted within 30 days of release each year, costing Medicare $17.5 billion in additional hospital bills. The national average readmission rate has remained steady at slightly above 19 percent for several years, even as many hospitals have worked harder to lower theirs.

These results reported by The Happy Hospitalist who also blogs and specializes in 'in patient hospital medicine".The report is in Kaiser Health News.

The penalties, authorized by the 2010 health care law, are part of a multipronged effort by Medicare to use its financial muscle to force improvements in hospital quality. In a few months, hospitals also will be penalized or rewarded based on how well they adhere to basic standards of care and how patients rated their experiences. Overall, Medicare has decided to penalize around two-thirds of the hospitals whose readmission rates it evaluated, the records show.

Kaiser Health News analysis of the records shows.  Hospitals that treat the most low-income patients will be hit particularly hard.

A total of 278 hospitals nationally will lose the maximum amount allowed under the health care law: 1 percent of their base Medicare reimbursements. Several of those are top-ranked institutions, including Hackensack University Medical Center in New Jersey, North Shore University Hospital in Manhasset, N.Y. and Beth Israel Deaconess Medical Center in Boston, a teaching hospital of Harvard Medical School

Most of these teaching hospitals treat  r uninsured patients on Medi-caid programs or other public safety net systems. Outpatient services are often very restricted, or unfunded. The patients have an increased rate of chronic illness which are more advanced in the first place since these patients do not get admitted until their disease is well advanced. Their care must be maximized prior to discharge, since their support  system is fragile or even not existent. This requires longer hospital stays, (which offsets the reduced re- admission rate)

"A lot of places have put in a lot of work and not seen improvement," said Dr. Kenneth Sands, senior vice president for quality at Beth Israel. "It is not completely understood what goes into an institution having a high readmission rate and what goes into improving" it.

Sands noted that Beth Israel, like several other hospitals with high readmission rates, also has unusually low mortality rates for its patients, which he says may reflect that the hospital does a good job at swiftly getting ailing patients back and preventing deaths.

Data for readmission rates are available in PDF or CSV files.

Atul Grover, chief public policy officer for the Association of American Medical Colleges, called Medicare’s new penalties "a total disregard for underserved patients and the hospitals that care for them." Blair Childs, an executive at the Premier healthcare alliance of hospitals, said: "It’s really ironic that you penalize the hospitals that need the funds to manage a particularly difficult population."

Does this sound familiar....??

Perhaps a wiser more prudent decision would be to implement this as a pilot program with regional distribution accordingly.

 

 

 

 

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A Critical Need. The System needs CPR

 

The passage of the Patient’s Protection and Affordable Act may be a mandate with an empty  promise.  Although it sets forth a detailed plan to build a new health insurance system, it does not address many issues in an orderly fashion. 

In fact the majority of physicians recognize and espouse the observation that the law will make the system worse.  It has been designed for political expediency to deliver visible benefits to expand access to healthcare, remove pre-existing barrier to coverage, and other highly visible benefits that are front-end loaded which will drive up costs, not decrease them.

One system cannot solve the multitude of challenges which are quite diverse between communities such as New York, Chicago, Los Angeles, rural cities such as Indio, California, Desert Hot Springs, California, Atlanta, Georgia or Oglethorpe GA.

A study that is often quoted is the “Dartmouth Study” of utilization and costs of a community such as McAllen Texas and  Portland Maine or Madison, WI or Mason City Iowa.  Statistics do not lie, but can be very deceiving when comparing such radically different demographics and diverse cultures.

Our community in the Inland Empire region of Southern California  combines a multi-cultural population, a high rate of unemployment (one of the highest in the  nation) and uninsured or medi-caid eligibles.  Riverside County and San Bernadino Counties are large, as large as some of the smallest states in the east. The western portions of both counties are metropolitan and the eastern portions rural, much like many states such as Maryland, New York and Georgia. This is not a unique problem in most states.             .

 

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Health Train at the Olympics 2012

 

Most of us have been watching the Olympics from London. It’s amazing  how records keep being broken.  Is it about more information about physiology, nutrition, and hopefully not  ‘doping’.  The medal winners seem to be getting younger and younger. ..why is that ?

As you may  be sitting on your couch or favorite chair some of you my increase your heart rate by that bag of popcorn, chips, cookies and milk, or that fast food brought home on the way from home.

Since studies have shown that 55% of us hold a smartphone in one hand while surfing the TV channels you want to look at all the new health mobile apps for exercise, and monitoring the state of your health and wellness.

Health Care IT: 2012 Olympics Shines Spotlight on Mobile Health and Fitness Apps

By Brian T. Horowitz on 2012-08-02

The Olympics are truly a great motivational event for young and older adults. Physical fitness is encouraged as a social event.

We hope your days are full of feel good summer fun! Those Olympians sure know how to play hard, so as the Olympic Games race full speed ahead, let's capture some of the athletes' positive energy and be inspired to live healthier today. Luckily, over 13,000 compassionate Medical Experts on HealthTap are always there to help you with your health questions, so ask away, and you'll learn ways you can feel better one day at a time. Wishing you all the best for a healthy week!

Here is a great place to begin your quest for “Olympic Gold”’.

Here's what's happening on HealthTap:

YOUR HEALTHSCORE:

 

WELLNESS SERIES- Let’s Get Grilling !

How do you Match Up  for the Gold ? Your Olympic athlete body match

Imagine the rush of an Olympic sprint, high dive, or pole vault: now that's easier than ever with the BBC's "Your Olympic athlete body match" app. Find out if you are built like a Chinese gymnast, an American swimmer, or a Ukrainian lifter. Dream big and be inspired!

Find a Social Media Companion for Wellness

 

Technorati Tags: #hcsm,#health,#wellness,#social,#olympics,#london,#mhealth,#mapp

 

 

Health Train Express is Social Media, is Your Blog?

 

I spoke to soon. Health Train Express will be around for a long time.

The responses to my announcement surprised me. I had many more readers than I had realized.  I guess analytics don’t always work, or I used the wrong ones.

After the announcement I quickly realized that blogs will never be dead. They amount to the  21st century ‘Journal’ for daily thoughts (used to be called a diary).  Perhaps I should rename it  e-Diary

While I enjoy using Google Plus, Twiiter, Facebook, to gesticulate, propose, analyze or ridicule.

Health Train will remain an important piece in my social media project.

I admit it, I failed I could not give up my platform.  There are  too many issues to  write about and a blog is the best for me. 

Physicians must not allow their patient to remain passive and just accept what Government decides to offer them in health. 

Physicians empower your patients. Patients empower your physicians.

What changed my attitude?   Of course, it is Regina Holladay

          

Here is a larger version of The Walking Gallery…deserves a better view.

 

There you have it.  Regina Holladay has been at this for several year . All of the stories are a visual treat and a testimony to patients.  Regina expresses her pain and frustration let hospital systems while her husband suffered with cancer.  Something we all know about and share our concerns with her.  Thank you Regina Holladay

WILL YOU TAKE THE RED PILL, OR THE BLUE PILL ?

MedStarter is an outgrowth of a social network innovation, KickStarter. Kickstarter is another social media approach to funding startups that require small amounts of capital as an investment through donations for worthwhile ideas.

 

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End of An Era

 

As I have read somewhere, ‘Nothing lasts forever’.

And so too are the lights going off here at Health Train Express.

It has been an eight year run with close to 1000 posts.

This will be the last Health Train Express blogpost.  A big thank you to ‘Blogger’ as well, now owned by Google.

In keeping with the trend Digital Health Space will assume the role of The Health Train Express

Health Care is undergoing some radical and important changes, and deservedly so in the 21st Century,  Now that we have survived Y2K (I think that is a pretty safe bet) I have evaluated the blog and what is happening in social media as well.

During the past six months our analytics reveal that my opinions and comments receive a much more global audience using social media, and further analysis also revealed that Google Plus will become my exclusive platform for the forseeable future. Of course nothing on the internet can be set in stone. Social media in medicine and health care has become well established. While Twitter and Facebook offer platforms, the unity of Google, Google Docs, Gmail, YouTube, Google Plus and Video Conferencing will allow me to video broadcast and interview important social media personalities using an integrated platform.

See you on the ‘other side’.

Gary Levin MD

This will allow the use of a central publishing source and eliminate much repetitive work.

Look for my comments, opinions, and diatribes on Google Plus at  +Digital Health Space.  Better yet put +Digital Health Space in one of your favorite circles.

 

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The Costly Consequence of Health Care Reform

 

The Costly Consequences of Health Care Reform (Courtesy of the Budget Committee)

Paul Ryan, Chairman, Committee on the Budget, U.S. House of Representatives

 

Let’s carry that a little bit more, forward, “If you earned a medical degree, or PhD, thank the government.  I remember borrowing and working my way through college and medical school.  The government did not give me loans, the banks did and the government ‘backed them’ since students did not have income or usual credit standing.  For a man who went to Harvard, Obama does not seem to understand very much. Who paid for his education?  Did he make it on his own, does he thank the government for what he has….the best insurance in the nation, a 747 to fly on, limousines, secret service, free room and board.  Barry, give us a break ! You are a liar and a hypocrite.  I don’t expect you to tell us that you lie, liars never do and liars never even know they lie !

Posted April 8, 2010

“I can make a firm pledge.  Under my plan, no family making less than $250,000 a year will see any form of tax increase.  Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes,”
President Obama, September 12, 2008

Beginning January 1, 2013, Obama Care imposes a 3.8% Medicare tax on unearned income of “high-income” taxpayers which could apply to proceeds from the sale of single family homes, townhouses, co-ops, condominiums, and even rental income, depending on your individual circumstances and any capital gains tax exclusions. Importantly, the “high income” thresholds are not indexed for inflation so will reach increasing numbers of middle-class taxpayers over time.

In February 2010, 5.02 million homes were sold, according to the National Association of Realtors (NAR). On any given day, the sale of a house, townhome, condominium, co-op, or income from a rental property could slam middle-income families with a new tax they can’t afford.

The new Obama Care tax is the first time the government will apply a 3.8 percent tax on unearned income. This new tax on home sales and unearned income and other Medicare taxes raise taxes more than $210 billion to pay for Obama Care.

The Costly Consequences of Health Care Reform (A legislative Review)

The issues are bi-partisan, Responsibility lies both at the feet of Republicans and Democrats.  Neither side can plead innocence.

 

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