At the same time, the nation’s fastest-growing age group is over 65. Government projections hold that in 2050 there will be 90 million Americans 65 and older, and 19 million people over age 85. The American Geriatrics Society argues that, ideally, the United States should have one geriatrician for every 300 aging people. But with the looming shortage of geriatricians, the society projects that by 2030 there will be only one geriatrician for every 3,798 older adults.
A vast majority of Americans have no conception of what lies ahead and — without geriatricians available to provide their health care — how substantially their lives will be affected. I know. It means that soon we may all soon be in the land of the pink bibs.
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, September 29, 2015
Monday, September 28, 2015
Necessary Medicare Fraud Alerts:
Medicare Fraud and Abuse perpetrators are inventive...to say the least. How much of it is intentional or pre-meditated.
http://www.beckershospitalreview.com/legal-regulatory-issues/physician-who-billed-medicare-for-24-hour-workdays-convicted-of-fraud.html
http://www.beckershospitalreview.com/legal-regulatory-issues/5-recent-stark-law-settlements-september23.html
http://www.beckershospitalreview.com/legal-regulatory-issues/government-claims-hospital-owner-charged-medicare-for-bmws.html
http://www.beckershospitalreview.com/legal-regulatory-issues/prime-healthcare-sues-california-attorney-general-over-failed-hospital-deal.html
http://www.beckershospitalreview.com/legal-regulatory-issues/adventist-health-to-pay-record-breaking-118-7m-to-settle-improper-physician-compensation-claims.html
http://www.beckershospitalreview.com/legal-regulatory-issues/florida-hospital-district-to-pay-69-5m-to-settle-stark-law-false-clams-act-allegations.html
http://www.beckershospitalreview.com/legal-regulatory-issues/vanguard-health-systems-to-pay-2-9m-to-resolve-false-claims-kickback-allegations.html
Regulators to Shut Down Health Republic Insurance of New York - WSJ
It all started with great expectations. Health Republic Insurance of New York the largest COOP and fastest growing USA insurance company (0 to 215K members in 18 months) with over 42% year over year growth. A health plan with the mission of providing high quality and affordable care .
The insurer lost about $52.7 million in the first six months of this year, on top of a $77.5 million loss in 2014, according to regulatory filings. The move to wind down its operations was made jointly by officials from the federal Centers for Medicare & Medicaid Services; New York’s state insurance exchange, known as New York State of Health; and the New York State Department of Financial Services.
Regulators to Shut Down Health Republic Insurance of New York - WSJ
The insurer lost about $52.7 million in the first six months of this year, on top of a $77.5 million loss in 2014, according to regulatory filings. The move to wind down its operations was made jointly by officials from the federal Centers for Medicare & Medicaid Services; New York’s state insurance exchange, known as New York State of Health; and the New York State Department of Financial Services.
In a statement, Health Republic said it was “deeply disappointed” by the outcome, and pointed to “challenges placed on us by the structure of the CO-OP program.”
Health Republic has about 215,000 members, with about half holding individual plans and half under small-business coverage, a spokesman for the insurer said.
The regulators said they chose to take action before the exchange’s November open enrollment period, when individuals can choose coverage with a new insurer. Health Republic policies will remain in effect amid “an orderly wind down” of the insurer’s operations, they said. In a statement, Kevin Counihan, the CMS official who oversees insurance marketplace operations, said the move came “because of the likelihood that Health Republic Insurance of New York would become financially insolvent.”
The shuttering of Health Republic, at least the fourth to falter among the ACA’s original 23 co-ops around the country, reflects the losses many insurers are seeing in their business related to the health law’s exchanges, which are particularly acute for small plans without deep pockets or diversified lines of business.
In Health Republic’s case, its premiums appeared not to be set high enough to cover members’ health expenses and its own costs, said Deep Banerjee, an analyst with Standard & Poor’s Ratings Services. “They are paying out in claims and expenses a lot more than they are getting in the door,” he said.
A Health Republic spokesman said the insurer didn’t receive the full rate increases it requested from state regulators for 2015, and “we didn’t feel as if we got rate adequacy” for this year’s plans.
The situation was complicated by programs created under the health law to ease risks for insurers that signed up a lot of sicker, more-costly enrollees. Under one of those programs, Health Republic had expected to break even, but instead it was assessed to pay around $80 million into the program’s pool, likely reflecting that it enrolled a relatively healthier clientele compared with competitors. Health Republic also expected to receive $147 million under another one of those programs, known as risk corridors, the insurer said. Because of a tweak to a federal spending bill, insurers may not get as much as they have projected, Mr. Banerjee said—an issue that could squeeze other companies.
The co-ops were set up as nonprofit insurance entities governed by their members, and analysts have said several of those that remain are in challenging financial straits. Health Republic’s membership is far larger than the next-biggest co-op, which had around 131,000 enrolled, according to Mr. Banerjee.
The Iowa insurance regulator said in January that it would shut down CoOportunity Health. At least two other co-ops, in Nevada and Louisiana, have said they won’t offer plans next year.
Regulators to Shut Down Health Republic Insurance of New York - WSJ
Dr Jay Lee Keynote at 2015 APAMSA Conference
Collaboration has become essential for progress and growth of health care. Silos are nothing new and it began with Abraham Flexner's report over 10 years ago. It is based upon scientific approach to medicine. Flexner's model was a sea-change in medicine creating a scientific methodology to diagnosis and treatment of patients based upon science, such as pathology, physiology, anatomy and other disciplines.
Dr. Jay Lee, President of the California Academy of Family Physicians, gives keynote at 2015 Asian Pacific American Medical Student Association…D. Jay Leno points out that we have outgrown Flexner's model. Medicine has grown vertically and horizontally.
Dr. Lee covers the span of four generations in health care changes. No longer do we need to demonstrate in front of the White House, we can make a presence on facebook twitter, google, and blogs.
The triple AIM has become a goal. Donald Berwick coined tthe term. Today's trainees are in a 'golden moment' of medicine. The Affordable Care Act jolted the system...not as an end point but like a lottery basket it has stirred the mix and created change and the ability and necessity of using the ACA as a catalyst.
Physicians must be at diverse industry events in HIT and technology otherwise innovators do not have the knowlege or guidance. Expositions such as those at SXSW and the CES afford this opportunity. Many current common place technical devices were previously shown at these forums and later adopted my medicine by a physician entrepeneur.
Physicians need to become process engineers rather than medical directors. Medical directors follow an established framework, engineers design a new system.
Innovation and technology are not just about shiny new things, but also "blowing up the system, and creating new ideas for the system, work flows, application of population management for individuals. We need to create a new system capable of managing many more patients to continue to provide personalized and patient centered care.. If we do not accomplish this end our healthcare will deteriorate into an even more impersonal encounter for ourselves and our patients.We need to change from a health system that innovates to a culture of innovators that deliver health care. Innovation is not going faster.....it is about changing direction.
Most of the content is attributable to Jay Lee, M.D. he is a family practitioner, President of the California Academy of Family Practice.
Dr. Jay Lee, President of the California Academy of Family Physicians, gives keynote at 2015 Asian Pacific American Medical Student Association…D. Jay Leno points out that we have outgrown Flexner's model. Medicine has grown vertically and horizontally.
Dr. Lee covers the span of four generations in health care changes. No longer do we need to demonstrate in front of the White House, we can make a presence on facebook twitter, google, and blogs.
The triple AIM has become a goal. Donald Berwick coined tthe term. Today's trainees are in a 'golden moment' of medicine. The Affordable Care Act jolted the system...not as an end point but like a lottery basket it has stirred the mix and created change and the ability and necessity of using the ACA as a catalyst.
Physicians must be at diverse industry events in HIT and technology otherwise innovators do not have the knowlege or guidance. Expositions such as those at SXSW and the CES afford this opportunity. Many current common place technical devices were previously shown at these forums and later adopted my medicine by a physician entrepeneur.
Physicians need to become process engineers rather than medical directors. Medical directors follow an established framework, engineers design a new system.
Innovation and technology are not just about shiny new things, but also "blowing up the system, and creating new ideas for the system, work flows, application of population management for individuals. We need to create a new system capable of managing many more patients to continue to provide personalized and patient centered care.. If we do not accomplish this end our healthcare will deteriorate into an even more impersonal encounter for ourselves and our patients.We need to change from a health system that innovates to a culture of innovators that deliver health care. Innovation is not going faster.....it is about changing direction.
Most of the content is attributable to Jay Lee, M.D. he is a family practitioner, President of the California Academy of Family Practice.
Sunday, September 27, 2015
An Aging Population, Without the Doctors to Match -
We are already at the beginning of a new crisis in American Health Care. For those entering their senior years, according to Dr. David Reuben, a leading geriatrician at the U.C.L.A. Medical Center, a true national crisis is brewing.
Our average population age has gradually drifted up, due to longer life spans, the elimination of death from infectious diseases and cause of death from life-long chronic illness
Many people age prematurely or develop premature neurologic disease from stroke, heredity and chronic disease. The affordable care act will broaden coverage and add previously uniinsured to the insurance roles. Most patient who are 65 or over and the disabled are covered by Medicare and/or Medicaid.
Venture capitalist and entrepeneurs are investing in long term homes for the aged. National franchises are appearing.
The missing link is the absence of geriatricians.
Currently there are fewer than 8,000 geriatricians in practice nationwide — and that number is shrinking. “We are an endangered species,” said Dr. Rosanne Leipzig, a geriatrician at Mt. Sinai Medical Center in New York.
An Aging Population, Without the Doctors to Match - The New York Times
Our average population age has gradually drifted up, due to longer life spans, the elimination of death from infectious diseases and cause of death from life-long chronic illness
Many people age prematurely or develop premature neurologic disease from stroke, heredity and chronic disease. The affordable care act will broaden coverage and add previously uniinsured to the insurance roles. Most patient who are 65 or over and the disabled are covered by Medicare and/or Medicaid.
Venture capitalist and entrepeneurs are investing in long term homes for the aged. National franchises are appearing.
The missing link is the absence of geriatricians.
How will we solve this shortage ? .....to be continued
An Aging Population, Without the Doctors to Match - The New York Times
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