Taxpayers subsidizing 76% of premium under health care law Associated Press

Healthcare.gov  If you missed signing up, here are some other alternatives

People who signed up for coverage under President Obama's health care law are paying about $80 a month in premiums on average, the administration reported Wednesday.


The new numbers from the Health and Human Services Department cover only the 36 states where the federal government took the lead in setting up new insurance markets, accounting for about 5.4 million of the 8 million people who signed up nationally.

Among the major findings:

-- Taxpayers are subsidizing 76 percent of the average monthly premium in the 36 federally administered markets.

-- The average premium is $346 a month, but the typical enrollee pays just $82. Tax credits averaging $264 a month cover the difference. The government pays the subsidy directly to insurers.

-- After tax credits, Mississippians paid the least for coverage - averaging just $23 a month on average premiums of $438. Among people in the 36 states, New Jersey residents paid the most - an average of $148 on premiums averaging $465 a month.

-- For this year, the average consumer could pick from five insurance companies and 47 different plans, although choice was more limited in a small number of states. From a range of platinum, gold, silver and bronze plans, most people picked silver.

-- There was a link between greater competition and lower premiums. For each additional insurer in a local market, premiums for the benchmark silver plan declined by 4 percent.

-- Premiums varied widely between states, ranging from an average of $536 in Wyoming to $243 in Utah.

Federal officials say they don't yet have complete data on the 14 states running their own markets.

Processed red meat harmful to heart

Processed red meat harmful to heart

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• Jun 16, 2014
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In general, red meat is not considered as healthy. A Swedish study, which was published in "Circulation", now indicates an increased risk of heart failure and related deaths when processed red meat is consumed.

Researchers from the Karolinska Institutet in Stockholm studied eating habits in a cohort of 37,035 men (aged between 45 and 79 years) over the course of twelve years. The study differentiated between consuming unprocessed and processed red meat. The latter included cold cuts, sausage, pies and black pudding.

During the course of the study, 2,891 men were diagnosed with heart failure and 266 died from it. The risk of heart failure was 28 per cent higher for men who ate the most processed red meat (more than 75 grams per day) compared to men who ate the least (less than 25 grams per day). People who ate the most processed meat also had double the risk of death from heart failure than people with the least consumption.

For each 50 gram increase per day, the risk of heart failure increased by eight per cent and that of death from heart failure by 38 per cent. In contrast, eating unprocessed red meat had no effect on the risk.

"To reduce your risk of heart failure and other cardiovascular diseases we suggest avoiding processed red meat in your diet, and limiting the amount of unprocessed red meat to one to two servings per week or less", said study author Joanna Kaluza from the University of Warsaw. It was assumed that the results would be similar for women.

Google Glass and Health Care

If you are a practicing physician, it woul be hard to miss all the changes due to EHR adoption, and Health Information Exchanges.

The HIT space is also being invaded by other applications and consumer hardware/software platforms easily adapted to medical practice.  Some innovator surgeons and medical physicians also have taken available platforms and adapting them to patient care.  HIPAA has prepared the innovators for security and privacy of patient medical information.

Google has many apps that can be used in a medical environment.

Google glass has been used by  some surgeons to teach and/or get consultations in real time.

Google Glass has been of interest to the healthcare industry for a while, and while performing surgery with Glass is nothing new, complying with HIPAA standards while doing it is.

We go into this in more detail at:  Digital Health Space.

Physicians Have Abdicated Power

Background:

During the last two decades physicians have abdicated their role to CMS and payers fo policing each other. Resident physicians are closely supervised and gradually given more responsibility for decision making as they proceed from PGY 1-PGY4.  As a chief resident they are responsible for much of the activity of junior residents. Surgical and/or medical residents in certain specialties have their proposed surgical cases reviewed by either a chief resident, or director of the training program prior to scheduling.

During the first year of practice or if the MD change hospitals medical staff regulatons require providers to have a  proctor during a certain number of cases to insure proper judgment and  competence.

Following this period they are allowed to operate alone.  Further proctoring is usually not necessary unless there is a complication or a death. Usually this takes place in a departmental meeting for review. This often serves as a learning experience and is not a punitive affair. If the difficulties persist the physician will be required to obtain further training or more supervision until he demonstrates competence.  The entire process is physician led. It is private and confidential and not discoverable by non-physicians.

During the last two decades physicians have been lax in many regards, and have not required chart reviews prior to surgery nor review of treatment protocols unless there is an untoward event resulting in a morbidity or mortality and after the fact.

Current:

The review and authorization procedure now is conducted by insurers for prior authorization by a non-physician or a medical director for a payer.  This occurs away from the clinical setting when the physician submits the case  history, and proposed procedure.  The intensity of the review by CMS and payers is usually determined by the level of cost and number of procedures that are done.  The ultimate goal is not patient safety, nor quality of care. It is to reduce cost.  Their benchmark for what is reviewed is a simple algorithm.   #of cases X cost/case = total cost. Cases that are done in high volume, or high expense will require prior authorization. Such cases or diagnostics include Cataract removal, Hysterectomy, Spine surgery, Interventional cardiology. Many of these are surgical or advanced medical interventions. Many of the reviews are for expensive imaging, such as MRI or CT imaging.

There has been a gradual erosion of self determination and  pre-surgical review by physicians and surgeons, allowing CMS and payers to intrude into physician-patient relationshiphs.

Future:

Physicians will reclaim the role of ascertaining quality control and prevention of abuse and fraud by peer-review of  expensive and high volume procedures prior to procedures, both diagnostic and Invasive.  It will be required that all pre-surgical cases be reviewed by another member of the department prior to scheduling (except for emergent or urgent need.) The insurance company should not have any role in  prior authorization.  That will be the purview of medical staff, much like PQRI was performed in the late 1980s for cataract removal.  

This system will allow peer and case review for the medical staff and immediate feedback for non-compliant providers.

The insurance system will be simplified.   Delays and/or denials could be eliminated for review, authorization and payments.  Administrative expense could be reduced. This will require some additonal time and effort by physicians.  That is the price for professional freedoms.  Freedom takes effort to maintain.

Is this an idealized vision for the future, or will it come to pass?  Only you and I can decide.

The time has come to draw a red line in the sands of health care.

The 3 I s

The Three “I’s” of the Affordable Care Act

The triple ‘AIM’ is a term often quoted by health policy pundits.

CALIFORNIA’S MEDICAID CONUNDRUM

While California’s Medicaid enrollment exceeded projections by 1.4 million, many of those new enrollees had already been eligible for the program. The federal government provides states a 100% Medicaid match through 2016, but that’s only for those individuals newly eligible under the 2010 health-care law; if individuals who had already been eligible for but not enrolled in Medicaid come out of the woodwork, states will pay a portion of those costs. In 2012, the Department of Health and Human Services estimated that states would pay an average of 43% of those enrollees’ Medicaid costs in this fiscal year.

Some states opted to expand Medicaid under the health-care law, raising costs and budgetary pressures at a time of volatile tax revenue. In some cases, the result has been cognitive dissonance. California Gov. Jerry Brown was quoted in Thursday’s Journal saying: “We can’t spend at the peak of the revenue cycle--we need to save that money, as much of it as we can.” But two days earlier, Mr. Brown had expressed pride in the “huge social commitment” that health-care expansion represented in his state--even as it caused a billion-dollar overspend.

Ultimately, states that expand Medicaid could face pressure to cut other important services, whether health-related or in areas such as corrections or education. Recent trends have moved toward reductions because when an irresistible force such as a shrinking tax base meets an immovable object--the rising costs from expanding Medicaid--something has to give.

SOURCE: Wall Street Journal

The three Is of the Affordable Care Act,  Inadequate  Ill-conceived,   and incompetent

Physicians have Abdicated Power

Background:

During the last two decades physicians have abdicated their role to CMS and payers fo policing each other. Resident physicians are closely supervised and gradually given more responsibility for decision making as they proceed from PGY 1-PGY4.  As a chief resident they are responsible for much of the activity of junior residents. Surgical and/or medical residents in certain specialties have their proposed surgical cases reviewed by either a chief resident, or director of the training program prior to scheduling.

During the first year of practice or if the MD change hospitals medical staff regulatons require providers to have a  proctor during a certain number of cases to insure proper judgment and  competence.

Following this period they are allowed to operate alone.  Further proctoring is usually not necessary unless there is a complication or a death. Usually this takes place in a departmental meeting for review. This often serves as a learning experience and is not a punitive affair. If the difficulties persist the physician will be required to obtain further training or more supervision until he demonstrates competence.  The entire process is physician led. It is private and confidential and not discoverable by non-physicians.

During the last two decades physicians have been lax in many regards, and have not required chart reviews prior to surgery nor review of treatment protocols unless there is an untoward event resulting in a morbidity or mortality and after the fact.

Current:

The review and authorization procedure now is conducted by insurers for prior authorization by a non-physician or a medical director for a payer.  This occurs away from the clinical setting when the physician submits the case  history, and proposed procedure.  The intensity of the review by CMS and payers is usually determined by the level of cost and number of procedures that are done.  The ultimate goal is not patient safety, nor quality of care. It is to reduce cost.  Their benchmark for what is reviewed is a simple algorithm.   #of cases X cost/case = total cost. Cases that are done in high volume, or high expense will require prior authorization. Such cases or diagnostics include Cataract removal, Hysterectomy, Spine surgery, Interventional cardiology. Many of these are surgical or advanced medical interventions. Many of the reviews are for expensive imaging, such as MRI or CT imaging.

There has been a gradual erosion of self determination and  pre-surgical review by physicians and surgeons, allowing CMS and payers to intrude into physician-patient relationshiphs.

Future:

Physicians will reclaim the role of ascertaining quality control and prevention of abuse and fraud by peer-review of  expensive and high volume procedures prior to procedures, both diagnostic and Invasive.  It will be required that all pre-surgical cases be reviewed by another member of the department prior to scheduling (except for emergent or urgent need.) The insurance company should not have any role in  prior authorization.  That will be the purview of medical staff, much like PQRI was performed in the late 1980s for cataract removal.  

This system will allow peer and case review for the medical staff and immediate feedback for non-compliant providers.

The insurance system will be simplified.   Delays and/or denials could be eliminated for review, authorization and payments.  Administrative expense could be reduced. This will require some additonal time and effort by physicians.  That is the price for professional freedoms.  Freedom takes effort to maintain.

Is this an idealized vision for the future, or will it come to pass?  Only you and I can decide.

The time has come to draw a red line in the sands of health care.

Big Data, Friend or Foe ?

No Child Left Behind

Recently I heard an NPR report on the increasing displeasure about The “No Child Left Behind”, a Department of Education program initiated during the Bush administration.  It’s stated goal was to improve the performance of children in school.  Teachers were to be held accountable for their student’s performance as measured by the ‘Star Test’.  Many teachers became disillusioned wiith teaching using this metric as a measure of their competence. Many suffered “burn out’ and left the profession.  The mantra “teaching to the test’ became a war cry for the movement.  Charter schools popped up throughout the nation as a safety valve for the embattled eudcational system to remove teachers from the bureaucracy which now became more important than understanding the subject matter. Teachers were to improve test scores to a benchmark to demonstrate success in revised curricula.  Data about improvement in the weak portions of the school system became paramount, rather than keynoting the best parts of the American School System.

Big Data, Friend or Foe ?

Does this sound similar to our current health care conundrum? HHS, another federal bureaucracy, and many state health departments are intent on the same measurements collecting ‘big data’ from elaborate  HIT structure incentivized with federal tax dollars.  The similarity is frightening as the powers that be are more interested in figures than real patient care.  Bureaucrats are not seeking improved health care, just the measure of how much  can be saved with shorter stays in hospital. In order to accomodate these mandates, massive consolidation is taking place in health organizations.