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 !
HEALTH TRAIN EXPRESS Mission: To promulgate health education across the internet: Follow or subscribe to Health Train Express as well as Digital Health Space for all the updates for health policy, reform, public health issues. Health Train Express is published several times a week.Subscribe and receive an email alert each time it is published. Health Train Express has been published since 2006.
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 !
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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.
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.
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.
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.
If you think finding a physician who ‘takes’ your insurance plan, think again !
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.
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.
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.
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.
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 !
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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
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..
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.
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.
The Patient Protection and Affordability Care Act (Obamacare) will neither improve affordability, nor protect patients. Much like Franz Kafka’s Catch 22, the name itself is an oxymoron, designed to mislead the public. Wise physicians, hospitals and others are analyzing the law which was passed two years ago. It has taken that long to analyze the bill which Nancy Pelosi so accurately described as, “We won’t know what’s in it until it passes.”
My political message here is, “Why do the citizens of her district keep electing her?” The politics of the situation obviously is that someone is funding her campaigns and many Senators and Congressmen “owe her” for deeds she accomplished for their interests in other areas of legislation. (that is the way it works, like it or not. It is what it is).
In addition to the Internal Revenue Service policing what businesses are doing about providing health insurance to employees, there are several other negative impacts upon the taxpayer wallet.
Attribution: USAA Insurance remarks on Health Reform
Tax Tips:
Health Care Reform: What Will It Mean for You in 2013?
Many Americans could face higher tax bills Jan. 1, 2013, as a result of four health care-reform law changes.
Here's a look at what's about to hit — unless Congress otherwise acts — and how you may be able to minimize the impact to you.
"This is a good time to give your health planning a checkup."
1. Limit on flexible spending account (FSA) contributions. Today, employers set their own caps on how much employees can contribute to these plans that let them use pretax money to pay for health care expenses. For 2013, the government will enforce a $2,500 limit per employee.
2. A new Medicare surtax on investment income. Until now, Medicare taxes have only applied to earned income. For 2013, taxpayers filing individually with wages and self-employment income above $200,000 ($250,000 for married couples filing jointly) will pay a 3.8% surtax on the lower of:
3. An additional Medicare tax on wages and self-employment income for some. The existing Medicare payroll tax of 2.9% (of which 1.45% is paid by a taxpayer through payroll deductions) will be increased by 0.9% on wages or self-employment income that exceeds $200,000 for single and qualifying head of household and widow(er) filers ($250,000 for married couples filing jointly).
4. Higher hurdle for deducting medical expenses. Currently, out-of-pocket medical costs only are deductible to the extent they exceed 7.5% of your adjusted gross income. For 2013, that hurdle will rise to 10%. But if you're 65 or older, that threshold remains frozen at 7.5% through 2016.
"Between new taxes and the ongoing rise in medical costs, this is a good time to give your health planning a checkup. Here is some preventive medicine of a financial kind you may consider:
Things have gotten crazy ever since the Supreme Court upheld the healthcare reform law (PPACA). There’s 13,000 pages of regulations and the IRS, Health and Human Services, and many other agencies haven’t even gotten started yet. There are nearly 200 agencies and various government entities involved in the law. “It’s a delegation of extensive authority, from Congress to the Department of Health and Human Services and a lot of boards, commissions and bureaus throughout the bureaucracy,” said Matt Spalding of the Heritage Foundation. “We counted about 180 or so.”
While there are many new health reform provisions that have yet to hit, many Americans are still trying to catch up with what's already changed. Here are the parts of the Affordable Care Act that already have been implemented:
If you have questions about how these changes could affect your bottom line, speak with a USAA financial advisor or your tax specialist. Here are some questions to ask:
You can find more information at the official federal site for the Affordable Care Act, HealthCare.gov.
Healthcare Reform Magazine published an article, on July 1, 2012:
It clearly exposes how satisfied the health insurance and intermediary organization are with PPACA. Their bottom line is,
Our supposed allies have abandoned the fight since their profits will be untouched or even increased.
The Tidal Wave of Bureaucracy continues.
Comments here: or at twitter/@glevin1 or email to: gmlevinmd@gmail.com and read more here and, is it the Law of the Land ?
Dangerous Assumptions in Health Reform
Attribution to : DMCB, a brainy and literature-based resource by Jaan Sidorov
Is it time to review some of the basic tenents upon which the Accountable Care Act was passed?
Remember the Atul Gawande and McAllen Texas fracas? That New Yorker article captured the national spotlight and put a harsh glare on areas of the United States that had unexplained high rates of health care utilization. Dr. Gawande blamed the local culture of fee-for-service private practice, while the Disease Management Care Blog wondered if it was a statistical fluke and/or the burdens of a chronically ill population.
The article by Atul Gwande was published in the New Yorker Magazine and criticized by DMCB, other highly visible publications, duplicated, quoted, tweeted and distributed widely. The analytic gurus and health officials were suspicious that this analysis was flawed. Statistics can be mis-applied at times to prove anything you want, or innocently yield false results. In this case the goal of finding disparities in health costs was solely based upon Medicare's needs, and misinterpreted by all because it was restricted to billings to Medicare. Private insurer's and cash payments were left out of the data analyzed for the study.
Not mentioned is that both communities are heavily influenced by demographics (high cohort of Latinos).
Some of the Affordable Care Act was based on this flawed study.
“It took a second look when that hapless locale was seized upon by Peter Orszag of the Office of Management and Budget (OMB), Consumer Reports and some notable blogs as the symbol for all that ails American healthcare. Commentators are accusing the ‘McAllens of this country’ of consciously and unconsciously economically ripping off the system with precious little quality to show for it.
Yet, the dubious DMCB (Disease Management Care Blog) and also Health Train Express at that time remained unexcited about Dr. Gawande’s faux discovery and disappointed that others haven’t considered the most likely cause of McAllen’s outlier status. Is there something really special about McAllen or is something else going on?
It took a while, but the Disease Management Care Blog finally caught up with this follow-up study on the contrast in health care costs between the Texas towns of McAllen and El Paso. “
It is the nature of our minds to believe there must be something “causing” outliers. In other words, there must be something about McAllen that attracted all those coins, right? The DMCB, in reading Dr. Gawande’s article, thinks that may be true in Miami (which is number 1 in the U.S), but it doesn’t think that's the case for McAllen as described in the New Yorker magazine article. The gumshoe M.D. reporting clearly shows the McAllen providers are mystified by their status. It’s not as though they planned to take advantage of the system. In fact, they didn’t. That’s because it’s all random.
This is important because most healthcare providers involved in quality improvement learned long ago that ‘identifying’ and then ‘managing’ outliers with targeted interventions is a poor way to promote overall system improvement. Outliers naturally regress to the mean over time and they're not the problem anyway. Rather, the trick is to reduce overall variation around the mean (reducing the standard deviation) and to move all providers toward a better average level of behavior. That’s a lot of complicated work that, frankly, isn’t as enthralling to editors or the readers of The New Yorker. It's too much work.
DMCB summarized,
“While popular media can be forgiven for using simplistic descriptions of extreme outlier anedotes to pander to a political agenda, the DMCB isn’t too sure about Dr. Gawande. However, the DMCB is most frightened by potential reaction of the OMB. Short of complete central planning for the entire health care system, random distributions of performance, expense, quality, claims, satisfaction and countless other measures around a mean will be unavoidable. Of all persons, Dr. Orszag should understand that outliers are an ironic certainty, not evidence of malfeasance. Most are anomalies, not proof of anything. They are, in short, interesting, but not lessons and certainly not the stuff of policy making. “
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