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.
Tuesday, December 10, 2013
CMS AND ONC ACT TO SLOW DOWN THE HEALTH TRAIN EXPRESS
Numerous mandates for the Affordable Care Act have been delayed due to what seems to be a systemic overload of HHS and other regulatory agencies that go beyond the Affordable Care Act.
1. Individual Mandate
2. Last date of enrollment on Healthcare.gov pushed back to December 23rd for a January 1 2014 enrollment. (Is this another pipe dream? 7 days from enrollment to eligibility with authentication of finances?..Another example of fantasy planning by Obama and his administration..
These delays are only the tip of an iceberg upon which the Titanic Obamacare ship founders.
Early on in 2010 shortly after the Affordable Care Act became law, the DOJ warned about employer sponsored health plans. Rather than the Health Benefit Exchange impacting on only five percent of the population, the actual numbers willl be much greater perhaps as great as 80% excluding public programs.
Saturday, December 7, 2013
The Cream rises to the Top
Like my readers we are all struck by the quantity and quality of well written articles that could fill an entire edition of a daily newspaper such as the WSJ, the LA Times, or the Washington Post to just name a few of the dying breed of print publications, slowly being replaced by a digitized news world.
One of my favorite sources is always KevinMD. His blog now is mostly filled by other bloggers. This may not be a bad thing, since his blog is so well known. If your article is selected by KevinMD it has a very good chance of being read by other aggregators as well. Kevin was an early and successful example of someone who recognized the sea-change in medical communications. One of his recent articles by Neil Baum MD
Doctors: 10 lessons from the humble bumblebee
Accountable Care Organizations
I may have missed something, but my view was that the organization(s) would be amongst hospitals and their provider group(s) including IPAs. The prevailing concern was who would lead the effort, providers or hospitals ?
Well, fool me as the insurance companies and/or payers do an end run to possibly score the touchdown and perhaps even the after point.
Originally CMS promoted the idea of accountable care organizationr which would interface with CMS and private insurers would do the same. It remains to be seen if any of these designs will work to reduce cost, or just reduce care, increase frustration and bureaucracy for the delivery of health care.
During the past several weeks a number of insurance companies (Blue Shield is among the group) have announced formation of ACOs and are "inviting" their physicians and hospitals to join with their ACO to improve quality of care and reduced costs
No where in PPACA does it state that insurers cannot initiate or direct and ACO. It squarely places the insurer in control of the ACO, who can mandate standards of care. Was this an intent by omission in the 1300 pages of PPACA?
I would like to think so, however reading PPACA which covers a great deal of minutiae in health reform it is difficult to believe so.
Each day I receive at least ten emails inviting me to a meeting or webinar...usually in the D.C. area. Not many are held in mid country or on the west coast. National Consultant Organizations and Insurance Industry players charge hefty conference fees and someone is making a fair profit on these meetings. Even the relatively low cost of presenting webinars yield a tidy sum for an archived copy of the meeting on the internet.
ACO's will surely contribute to the increase in health costs to offset whatever ACOs were predicted to save. True governmental efficiency !
Thursday, December 5, 2013
5 Doctors You Should Be Following on Twitter
on TwitterRead , and Health Train Express @glevin1 or @digitalhealthspace
The article describes five pioneers in blogging and online information.
OK Google Voice : "What is Lupus?"
OK Google publish this blog !
Obamacare and Reimbursement Rates to Providers
"Covered California™ today announced 13 diverse health insurance plans that will offer in 2014, affordable, quality health care coverage to millions of Californians. The plans reflect a mix of large non- profit and commercial plan leaders, along with well-known Medi-Cal and regional plans.
The rates submitted to Covered California for the 2014 individual market ranged from two percent above to 29 percent below the 2013 average premium for small employer plans in California’s most populous regions. This is impressive since the 2014 products include doctor visits, prescriptions, hospital stays and more essential benefits; protecting consumers from the "gimmicks and gotchas" of many insurance policies. “This is a home run for consumers in every region of California,” said Peter V. Lee, Executive Director of Covered California. “Our active negotiating will not only benefit potential enrollees to Covered California, but will benefit all Californians by making health care affordable.” (No doubt that some of the rhetoric is self-serving for Covered California.)
Once plan rates are approved by state regulators, Covered California looks forward to signing final contracts and beginning the work of enrolling millions of Californians in the following health plans:
• Alameda Alliance for Health
• Anthem Blue Cross of California
• Blue Shield of California
• Chinese Community Health Plan
• Contra Costa Health Services
• Health Net
• Kaiser Permanente
• L.A. Care Health Plan
• Molina Healthcare
• Sharp Health Plan
• Valley Health Plan
• Ventura County Health Care Plan
• Western Health Advantage
"Covered California plans include the largest current health insurers in the individual market, as well as new entrants, regional plans and local Medi-Cal plans that want to be part of making history," Lee said. On average, there will be five plans from which to choose. Even in rural areas where choice has been historically sparse, there will be two or three health plans. Throughout the state consumers will have a choice of Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) and Exclusive Provider Organizations (EPOs). To get prices at such competitive points, winning health plans built their bids around the expectation of high enrollment, not high profit. Plans reduced profit margins down to two and three percent; embraced Affordable Care Act programs such as Accountable Care Organizations and Patient-Centered Medical Homes, that seek to improve care while lowering costs; found common ground with doctors, medical groups and hospitals on lower reimbursement rates to make care affordable.
(Note that many items such as Accountable Care Organizations, and Patient-Centered Medical Homes are still in development, untested, and not yet operational. which all sounds like a replay of the failed rollout of Healthcare.gov. )
Virtually every health plan designed a custom network for Covered California. Negotiations included a detailed review of each plan’s rates, their mix of hospitals, physicians and other providers, and their contingency plans for expanding networks in the event more consumers sign up than expected. The current list of insurers is for individual policies only.
Covered California will announce its options for small businesses to buy health insurance in June. Providers who will be approved for Covered California will be required to agree to new contracts and new reimbursement rates. The real final participants will be told when the signed contracts are ratified. Until then, all predictions are just that. I have heard from sources that the rates, even for conventional coverage under Covered California will be unique and include a sizable decrease to providers. No mention has been made about Medi-caid rates increasing....and frequently that is not known until the first payments are received by providers."
On the provider side....looking in on Covered California and whether to participate, most providers remain very cautious, and some have a wait and see attitude delaying a decision for at least one year. In the current environment of lean reimbursements, and profit margins, there are few providers willing to risk their 'livlihoods' and solvency on unproven programs, rift with political promises and goals.
Previous experience with government programs have created a lack of faith and/or trust in government programs with private insurers only slightly behind.
Few providers can expand their patient base without increasing overhead or numbers of providers. Most providers are already near capacity to see patients, and will not feel the need to see this new group of patients.
The exact method of reimbursement, if it changes from fee for service to another model is unknown, and mechanisms are still not yet in place for that to occur, either.
Iin summary it seems foolish for any segment of health to promise success when each has it's own issues and challenges that are intertwined while heading to an 'unknown destination'.
Wednesday, December 4, 2013
Does Obama really want the Affordable Care Act to Suceed?
Ultimately the impending confusion and chaos will make the public demand universal payer or some type of total governmental health system. The current system is unsustainable regardless, and the ACA is no better. In terms of the initial success or failure of Healthcare.gov the ultimate result will be who has an insurance card on January 1, 2014. Obama and his administration's announcements how successful the HBX now is, and how many people have enrolled, there remains a large gap between enrolling on an unproven and a demonstrated unproven IT system.
Tuesday, December 3, 2013
Covered California
1. Although I had successfully registered a user name and password on my next attempt the website refused to accept my userid/password. The password retriever did not recognize the user name.
2. The chat online function does not work.
3. Wait times are very long, and at times the link time-outs
Most people do not have the time to sit all day to access a web site that is critical in their life.
I made an appointment to see a 'certified insurance agent'. and/or Enrollment Counselors
There are many' private insurance agents, and also several non profit enrollment counselors in my area.
The choices appear to be highly prejudicial against 'white Americans' with many Hispanic, Native American, and African American organizations dominating the selections. Some choices were in the Federally Qualified Community Health Centers.
President Obama's efforts minimize the role and availability of already existing agents to enroll patients in all health plans. His emphasis has been on producing jobs for unemployed by training inexperienced 'non-profit beneficiaries' in the process.
My observations are that although the Affordable Care Act is designed for poorer Americans there are also many middle class Americans (white, yellow, and black) that would benefit from enrollment help.
There is a wide divergence of opinion on how much improvement has taken place in the past month regarding the national HealthCare.gov website. Democrats appear to be in denial clinging to 'wait and see'. Even when confronted about the failings of the system they are unable to address answers to specific issues. Republicans have become more critical,and outright hostile, frustrated by the lack of Democratic response to criticism, even when based on fact and evidence.
The states who have formed their own HBX in lieu of the national HBX appear to be better off...however, early numbers are deceiving and subject to variance. Early numbers of enrollees may not reflect how successful the Affordable Care Act will be. These numbers will depend upon the numbers who actually pay the premiums. The majority of users have been enrolled in the expanded Medi-caid program, and that is another disaster waiting to happen.
Obamacare does not and will not forge a uniform health system in the United States. Rather it will create several different tiers with a large percentage falling into lesser quality programs, less hospital and provider access. It will serve to stress further the already dysfunctional overburdened medicaid programs.
Monday, December 2, 2013
THE FUTURE OF MEDICINE
Sunday, December 1, 2013
A Doctor's Perspective of Obamacare
Wednesday, November 27, 2013
ObamaCare--The End of Affordable Care
Monday, November 18, 2013
What They Said Before the Train Wreck: The Top 10 Worst Quotes Pushing ObamaCare
A train looking for a track. MRC A Media Reality Check.
If we truly want health reform, we need to rethink the process.
I did not have my computer this past weekend, however I reverted to an older edition of my ‘software’….#2 yellow pencil and a yellow legal pad.
Thoughts flashed through my cranial space.
“ObamaCare”………..whose care is it, anyway? Obama is not delivering the care, so why should his name be on it.? The plan was orchestrated by Ezekiel Emanuel, a well known authority and academic expert on health policy matters. also elder sibling of Rahm Emanuel, known for his family traits of high achievers, and lack of humility or ability to be diplomatic. Rahm and Zeke used to go at it, something like this,
Emanuel and his brother Rahm frequently argue about healthcare policy. Emanuel mimics his brother's end of the conversation: "You want to change the whole healthcare system, and I can’t even get SCHIP [State Children’s Health Insurance Program] passed with dedicated funding? What kind of idiot are you?"[8]
Dr Emanuel spent thousands of hours and several years developing the plan. He was head of the NIH at one time as well. He was pretty high up in medical organizations and must be an expert on health care, yes? NO ? He has an outstanding bibliography having written papers on euthanasia, rationing, death panels, end of life and other optimistic and positive views on life.
I don’t believe he has seen a patient in many years, nor ever operated a medical practice business. The law rightly should be named after the author, let’s call it “Ezekiel Care”, or “Emanuel Care”. That sounds holy and authoritative. After all the law is over 1200 pages long, only slightly shorter than my bible at 1400 pages.
Obamacare is written much like the bible….a multitude of The Secretary of HHS shall………it does sound a bit biblical, indeed. Many ‘thou shalt’s under penalty of ……. Obamacare reads a bit like hail and brimstone. And it will truly end with an apocalypse. I am still figuring out who the 7 horsemen will be in this apocalypse.
However, as usual I digress…
Health Reform is too important to be in the political arena, nor reformed by the ingrained establishments of Congress, the Department of Health and Human Services (HHS) or the Center for Medicare Services (CMS).
Americans are now highly suspicious about both parties and see much self interest in Congress, progress bogged down by process and parliamentary. There is little if any creative thought going on in those mighty buildings.
In order for Americans to have faith and trust in a health system, the system cannot be devised or run by those in Washington, D.C. Perhaps even a referendum must be organized to win approval of a totally new organization.
Health is a ‘like no other’ service. It involves life or death matters (not only) with almost a religious sense of ethics, priorities and privacy matters.
Reform must be proposed by neutral agnostic non political principals. Who will be these leaders? That in itself will determine the ultimate outcome, success or failure of what is proposed. It will take Jeffersonian creativity to accomplishment and a strong believer in the Constitution. It has a great deal to do with freedom and individual rights.
All of our leaders and Supreme Court Justices are sworn to uphold the U.S. Constitution, however often fail to deliver on their oaths.
The task is awesome to develop a consensus among patients, providers, insurers, hospitals and regulators.
Empty Mandates are worthless, the proposal must have genuine timely deliverables to succeed. It should not be a ‘ Ponzi scheme’ dependent upon the early success of capitalization to work.
We need to begin again….Repeal Obama Care.