Meet the Press with Mayo Clinic and Cleveland Clinic

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

Dr. John Noseworthy, President and CEO at Mayo Clinic, appeared on Meet the Press with David Gregory alongside with Dr. Toby Cosgrove, CEO of Cleveland Clinic, this past Sunday to discuss the impact of the Affordable Care Act and the future of health care in America.

issues covered by Dr. Noseworthy included:

1. The need to modernize the health care delivery system to drive quality at lower cost.
2. Dealing with the sustainability of Medicare in the long term.
3. Using available technology such as telemedicine to improve patient care and deliver knowledge.
4. Funding research through the National Institutes of Health.

Dr. Noseworthy emphasized the Mayo Clinic has remained outside the political arena. 

Mayo Clinic and Cleveland Clinic represent the best of IDNs (Integrated Delivery Systems). Most healthcare in the U.S. is delivered by much smaller organizations. MC and CC easily are converted to a formal Accountable Care Organization and are being promoted as ideal models for quality of care, and reduced costs.  Not all organizations have these  full potentials.  The expense and investment for smaller institutions may not have a return on investment nor demonstrate cost savings.

ACO Expectations may be Unrealistic

According to a survery of  115 Hospital C-Level executives reveal that about 18% are participating in accountable care organization activities.  This figure is increased from 5% % in 2012.   Half of respondents expect to be in an ACO by the end of 2014.

Whether that lofty figure can be reached remains to be seen. Provider alliance Premier Inc. conducted the new survey in August but only recently released results. The spring 2012 survey found that nearly 52 percent of respondents expected to be in the ACO arena by the end of 2013. Now, Premier estimates only 23.5 percent will reach that goal.

A further analysis of hosptial size revealed: 

Non-rural hospitals are most likely to participate in an ACO, followed by hospitals in integrated delivery systems; and rural hospitals are least likely to participate, followed by standalone facilities.

Large hospitals are moving more quickly toward ACOs than smaller ones, although the majority of surveyed hospitals are making infrastructure investments to manage population health.

This may be effected by the availability of capital resources which are often lacking in smaller institutions, and a much smaller group of medical providers and/or a lack of specialty access.

These investments include lifestyle and wellness coaching by more than 70 percent of respondents, telemedicine by almost half of rural facilities compared with one-third of non-rural hospitals, and patient-centered medical homes, which are popular for all types.

The efforts include a wide variety of investments to increase utiilization of the ACO as a public health resource. 

* The investments include lifestyle and wellness coaching by more than 70 percent of respondents, telemedicine by almost half of rural facilities compared with one-third of non-rural hospitals, and patient-centered medical homes, which are popular for all types.

* Fifty-one percent of responding hospitals are partnering with large local employers to improve care.

* Large numbers of respondents are gearing up for analytics to support population health. More than 72 percent are integrating claims and clinical data, half are using predictive analytics to forecast needs and 46 percent are using a data warehouse to reduce information silos.

* More than 40 percent are partnering with insurers, particularly for upside-only shared savings programs.

The programs require strategic rethinking of hospital scope of care.  The effort will require integration of previously unlinked services in preventive medicine, and health, wellness and nutrition.

The full report from Premiere Inc can be found here.

Signing up for the Affordable Care Act

Step one:

Access your Health Benefit Echange on the Web.  Register, if you want to (or can) Write down your user ID and password.   It may not matter since your user id and password may not be saved in the system.  Rather than using  your SS number or case number they want  you to make up a user id and/or password you will likely forget.

Expect to receive  a message the site is down, we want to help you try again later. blah, blah, blah.
Once you are able to access the site the page loads will be irregular, very slow  to load and may disconnect.   Your best time to reach a site is between mindinte and 5  AM,  however  you also may receive "the site is down for maintenance'... try during our regular business hours.

When you resort to calling.  Set your telephone auto dialer and begin calling at five minutes before the exchanges open.  I receive a message that my wait time would be 5 minutes....I waited 45 minutes.  This was after ten attempts during regular business hours. If  you do not call before ten minutes after the phones are on....forget it.


Step two:

Once I accessed a human being, things went very well. The agent was more than helpful and spent 30 minutes going over enrollment.  In fact because my first attempt went so badly even with help I had to re-enroll in a different insurance company.  Some of the least expensive plansl have very limited provider and hospital access.

Because I am a retired MD I know many of the physicians that were listed as providers. The providers were often foreign medical graduates, spoke multiple languages, such as Vietnamese, Tagalag, Hindi, and Spanish. The FMGs were multicultural.    Also most of the providers in Covered California were predominantly former Med-Cal providers and familiar with Medicaid patients and reimbursement.

The printed subsidies were complicated and many times the subsidy rates made no sense for some policies. The best approach is to wait an receive your invoice, then call if you have a question.  Be certain it is correct because once you pay your premium you are locked in for one year, except for life-changing events such as additon to famly, loss of employment and/or changes in income. The next entrollment period is October 2014.

My advice is to not rush. Delaying enrollment will only mean your activation date is delayed a month. Spend a lot of time going over all your options for your income level. Search from   high to low premiums to assess the differences,  which can be subtle with deductibles, co pays for drugs and providers. Some have high co pays for medications. Plan on spending several hours to study it and assess your needs.  The web site is very good for comparing   how much  medical care you use annually, and the number of prescription drugs you use.

Now that my wife is enrolled I am relieved....15 years with her being uninsurable, with a very high copayment for her disability Medi-caid coverage was terrible, and inhumane.

Regardless of the Affordable Care Act. having an insurance cared will NOT cure our problems. The ACA does not address accessibilty, uniformity of coverage, or qualty of care.  Most of the law addresses insurance companies, and does nothing to relieve providers from a terrible and overriding responsibility for their patients with little help or cooperation from the bureaucrats.

Media reports indicate there will be a serious and committed effort to make major amendment, additions to, or repeal the Act.  Most responsible leaders who are not political idealogues are in favor of this course.

Ideologues and Unrealistic Expectations

Comments from Gary Levin MD are underlined and italicized:

Today I am amazed at an enthusiastic article about the Affordable Care Act by Eugene Robinson from Tallahassee.com.

His unbridled enthusiasm in the face of many difficulties that have nothing to do with health care exemplifies those who designed this law and passed it without reading it.

Here are some of his unsubtantiated claims and perhaps 'wishful thinking'

Eugene Robinson:  Washington Post

"Now that the fight over Obamacare is history, perhaps everyone can finally focus on making the program work the way it was designed. Or, preferably, better.

The fight is history, you realize. Done. Finito. Yesterday’s news.

Any existential threat to the Affordable Care Act ended with the popping of champagne corks as the new year arrived. That was when an estimated 6 million uninsured Americans received coverage through expanded Medicaid eligibility or the federal and state health insurance exchanges. Obamacare is now a fait accompli; nobody is going to take this coverage away."

1. The fight is not history, we are barely through round one and all the points go to the opponents of the ACA.

2. Six million Americans have not received coverage from the ACA. Registering is only the first step. It took me over ten hours of fumbling on the web site, and on hold via telephone. How many will be able to pay premiums by deadlines, or negotiate the difficult process of acquiring a provider. 

"There may be more huffing, puffing and symbolic attempts at repeal by Republicans in Congress. There may be continued resistance and sabotage by Republican governors and GOP-controlled state legislatures. But the whole context has changed."

The upside of the ACA is that all previously uninsurable patients now are enrolled no matter what pre-existing condition they have A+++++.

Can the ACA be improved?  Most definitely. The argument should not be Republican against Democrat.  Political party does not immunize one against illness.

I wholly agree with Mr. Robinson's analysis regarding the eventual goal of a uniform health system.  To call it universal care is a misnomer.

"The real problem with the ACA, and let’s be honest, is that it doesn’t go far enough. The decision to work within the existing framework of private, for-profit insurance companies meant building a tremendously complicated new system that still doesn’t quite get the job done: Even if all the states were fully participating, only about 30 million of the 48 million uninsured would be covered.

Yes Obamacare does not go far enough, however that is not the principle flaw. There is no one principle flaw, if there are any that is the poor analysis  and proposed implementation of a major expenditure that will effect most businesses,  all patients, and our national budget, and come up short.  If we are intent, committed and dedicated to these goals then let's get it right (or mostly right the first time)

Obamacare does establish the principle that health care is a right, not a privilege — and that this is true not just for children, the elderly and the poor but for all Americans.

Throughout the nation’s history, it has taken long, hard work to win universal recognition of what we consider our basic rights

This is a political and philosophical statement, not about health care. We need to keep these issues separate.  I agree with him about the tenet that all people should have health care financing.

Our first step should be to put on hold further mandates while the act is re-evaluated. Repeal is not an option, however amendment is a reality and not an 'existential' argument.

Mr Robinson's  article is not objective, nor unbiased. He totally neglects the weaknesses of the law which will require amendments.  Placing the issue in terms of a 'battle' between political parties does disservice to dedicated professionals who have  been in the system,  and who were neglected during the planning process.

To ignored the flaws would be a fatal mistake, health care costs will soar and there will still be large gaps in the insured population

Contact Eugene Robinson ateugenerobinson@washpost.com.

Contact Gary Levin MD at gmlevinmd@digitalhealthspace.com

Survey on the Affordable Care Act

Following the botched rollout of the affordable care act, people are dazed (perhaps a better term would be "shock and awed' by the limp and incompetent rush to open the exchange on time rather than do  it right the first time.  Having to do it  over must have cost big time !

The good news for those of us who see the ACA as a mis-step toward uniform health care (note I did not call it Universal Health Care.   An inadequate and poorly constructed Universal Payer Plan is not necessarily uniform.

The very public event has opened the door for much discussion and now the time is ripe for changing the plan to something much better, less expensive and equitable, not designed to redistribute wealth. That is not what health care is about.  Obama's plan is deceitful in most ways..  The only redistribution of wealth would be to insurers, big  pharma, and the U.S. government at taxpayer expense.

Freedom Works has just released a survey that you should look at and participate.  This is your chance to participate with new ideas.

Freedom Works is an organization now intent upon  health reform and maintaining the underlying freedoms we as all Americans cherish.

How will Freedom Works support our goals for health reform? Freedom Works not only is interested in health care, it also  works across a wide variety of niches with a consistent underlying standard based on our most fundamental beliefs of freedom and constitutional law.

An email arrived in my inbox from Freedom Works that i would share with all my readers, providers, patients, employees of our health system and leaders in Congress.

This is your chance to weigh in on improving the Accountable Care Act.  Take the Survey constructed by Freedom Works.

Looking Back at 2013

This report is somewhat late due to last minute projects at the end of 2013 and the confusion about the individual mandate, the botched launching of health benefit exchanges and some other unexpected tasks

We reviewed the 'best"  Health Train Express posts of 2013 as measured by the number of comments and our analytics.

IRS VIOLATES HIPAA FACES LAWSUIT BY A "J Holiday Message for Health and Wellness WHY AREN'T DOCTORS INVOLVED IN HEALT Does Obama really want the Affordable Care Act Covered California What They Said Before the Train Wreck: The To Sebelius will be a no-show at Obamacare hearing The Beginning or The End to the Affordable Care Act There were many more 'favorites".  The highest number of page views was in the category of the Affordable Care Act. This was to be expected, given the high ranking of the ACA for search engines. Visit the sites on Health Train Express for many more interesting topics. Health Train Express has archived our posts dating back to 2005.  The focus of posts has changed over the  years, and reveals the dynamism of health care and reform.

Happy New Year .... NOT for Health Reform

Should we be content that we made it through 2013, it seems we always do, no matter what happpens.  Now is the time to become accountable and assertive to determine our future health care.

Many aspects come together to produce 'the perfect storm'.  This storm is not necessarily a destructive one. It has set off an early warning signal for our country that we must be cautious of how we reform our health system.

Nevertheless our health system is in shambles, further delays in revising it, or continuing on with the ACA will lead to a train wreck.

Obamacare is focused on health insurance, with caveats, rewards, and penalties.. Neither patients or providers were the center of the reform.  The  item that did serve patients was solving the pre-existing conditions as a reason  for denying coverage,and eliminating the cap on coverage.

Health Reform will not take place in isolation or in one swoop,  and despite the ACA we will not yet have a functioning plan, nor will we if we continue with the present legislation.

Health Train Express receives a daily stream of analysis and recommendations for future modification to our system.  Neither hype, grandiosity, political motives nor slick marketing by 'celebrities' is going to 'fix' our system.

The good news is that we do have the finest scientific and technical resources already at our beck and call. All of this is available, it's a question of distribution, and we can compare it to supply line  management. We do not need a "Manhattan Project" to invent a new technology.  We already possess it. Perhaps this is an oversimplification, however many have compared our system to other industries, such as the airline business, the banking business and shipping businesses. No one model correctly addresses health financing.

There are aspects, accessibility, funding, prevention, and correcting the huge cost disparites and how to correct the burden for deficits & reimbursements.

Although  the ACA passed in 2010, we are more than three years down the road,  and most of the ACA has not occurred.  Further delays will occur now due to the inability to implement the first stages and mandates.  What has happened is the insurance companies have been sent into disarray, and have been asked already to double back.

The extent of increases in implementation cost will accelerate further and even cancel whatever cost reductions are predicted by the ACA.   Some studies have already demonstrated this fact.

Fortunately, the disagreements and controversy have focused attention on our health system for many who have been  passive and willing to accept the system for what it is. Each  year we witness a steady increase in premiums, increasing deductibles, increasing co-payments and decreasing reimbursements. We have mistakenly used tax law to minimize or maximize gains from insurance coverage with MSPs, HSAs, and now face a myriad of new, unproven schemes such as Accountable Care Organizations (ACO) predicted to decrease cost and improve quality.

It is a highly complex equation, involving some market economics, and a system of reimbursement that defies logic.  For some time the financing has been approached as a point of service transaction(POS) with creative financing such as capitation, some tax credits, and deductions. A portion of the state's public social service system is deemed 'free care' although it is not.

There are many 'misnomers' , such as 'usual and customary charges', pre-paid rates, adjustments, and cash deductions, Insurance companies have based their rates and policies upon algorithms and actuarial analysis, and a 'fudge factor' for unpredictability.

Many have sad, health care is a right, based upon aspects of the constitution in regard to the pursuit of happiness and freedom.  Although the word health does not appear in the  constitution, health can be construed to be a part of pursuing........life and happiness.

Others state that health care is not a right and not everyone should have health coverage, with a bit of 'they don't deserve it.  Neither truly can be legitimized by such a callous attitude.

What we need is a steady hand on the system that will deal equitably and with imperturbability the illnesses of human life and the equal ability to cope with it.

Freedom Works is an organization now intent upon  health reform and maintaining the underlying freedoms we as all Americans cherish.

How will Freedom Works support our goals for health reform? Freedom Works not only is interested in health care, it also  works across a wide variety of niches with a consistent underlying standard based on our most fundamental beliefs of freedom and constitutional law.

An email arrived in my inbox from Freedom Works that i would share with all my readers, providers, patients, employees of our health system and leaders in Congress.

This is your chance to weigh in on improving the Accountable Care Act.  Take the Survey constructed by Freedom Works.