Prejudice in the Hospital

An interesting Perspective...Reverse discrimination.

How do doctors deal with discrimination?

Minority Nurse

Kimani Paul-Emile wrote,   :Patients’ Racial Preferencesand the Medical Culture  of Accommodation"  in the UCLA Law Review

The Beginning

The aftermath

Racial prejudice travels in both  directions.

What your Doctors are now facing MIPS: The New Meaningful Use -

In April 2015, due to overwhelming bipartisan support, President Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) into law, effectively changing the playing eld. The legislation repeals Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula and replaces it with a new Quality Payment Program (QPP).

The proposed QPP consists of two tracks in a bid to reduce quality reporting burdens; Advanced Alternative Payment Models (APMs), and Merit-based Incentive Payment System (MIPS). In this white paper we will take a closer look at MIPS, covering areas of interest such as:

• What is MIPS?
• Penalties & Incentives
• Impact of MIPS
• Ways to Prepare

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MIPS: The New Meaningful Use - White Papers - EHRIntelligence

Trump, GOP In Congress Could Use ‘Must-Pass’ Bills To Bring Health Changes | Kaiser Health News

Throughout the campaign, President-Elect Donald Trump’s entire health message consisted of promising to repeal the Affordable Care Act.

That remains difficult with Democrats still commanding enough power in the Senate to block the 60 votes needed for a full repeal. Republicans could use fast-track budget authority to make some major changes to the law, although that could take some time. In the short term, however, Trump could use executive power to make some major changes on his own.

Beyond the health law, Trump also could push for some Republican perennials, such as giving states block grants to handle Medicaid, allowing insurers to sell across state lines and establishing a federal high-risk insurance pool for people who are ill and unable to get private insurance.

But those options, too, would likely meet Democratic resistance, and it’s unclear where health will land on what could be a jam-packed White House agenda.

Given their druthers, Trump and congressional Republicans would push to end the individual and employer mandates, eliminate ACA insurance reforms such as minimum essential benefit packages, pare back and restructure the premium subsidies, and junk the CMS Innovation Center and the Medicare Independent Payment Advisory Board, said Douglas Holtz-Eakin, an adviser to Sen. John McCain's 2008 presidential campaign and former director of the Congressional Budget Office.

Experts say those measures would largely unravel the ACA system and could lead to millions of people losing coverage.

It's not clear whether or how a Trump administration would provide subsidies to help people buy or keep coverage. The House Republican leaders' plan proposed refundable tax credits for individuals without access to employer-based or public coverage. But the Trump campaign's seven-point healthcare proposal and the GOP health policy agenda don't mention any subsidy mechanism. Another issue is that if they moved to repeal the ACA and its hundreds of billions in revenue, Republicans would have no way to fund subsidies for the uninsured, noted John Goodman, a veteran Republican health policy expert.

Trump, GOP In Congress Could Use ‘Must-Pass’ Bills To Bring Health Changes | Kaiser Health News

Trump upset will force healthcare leaders to rethink the future - Modern Healthcare Modern Healthcare business news, research, data and events

Republican Donald Trump's shocking victory Tuesday will force a major shift in the healthcare industry's thinking about its future. Combined with the GOP's retention of control of the Senate and the House, a Trump presidency enables conservatives to repeal or roll back the Affordable Care Act and implement at least some of the proposals outlined in the GOP party platform and the recent House Republican leadership white paper on healthcare. 

Addressing supporters just before 3 a.m. ET, Trump struck a conciliatory tone and did not specifically mention the ACA. “It is time for us to come together as one united people,” he said. “It's time.”

But the assumption of Republican control over both the White House and Congress most likely means an end to the expansion of Medicaid to the 19 states that have not yet implemented it, and puts the expansion in the other 31 states in serious jeopardy. 

Still there are divisions even among conservatives over issues such as Medicare restructuring and how to help Americans afford health insurance. And Senate Democrats almost certainly would try to use their filibuster power to block major ACA changes.

After being behind in the polls for the entire general election campaign, Trump shocked political analysts. Democrat Hillary Clinton reportedly called Trump to concede the race. 

Healthcare leaders were not prepared or eager for the healthcare changes a Trump victory would bring about. Modern Healthcare's second-quarter CEO Power Panel, a survey of 86 healthcare CEOs, found that the chief executives overwhelmingly backed the Affordable Care Act and supported its goal of pushing providers away from fee-for-service medicine and toward delivering value-based care.

The overwhelming message from the survey was that the next president and Congress should stay the course set by President Barack Obama and the ACA. “I think the Affordable Care Act needs to stay, and we need to keep improving it,” said Dr. Gary Kaplan, CEO of the not-for-profit Virginia Mason Health System in Seattle. “I think that we can put together great minds and make some further improvements and hopefully take it out of being a pol




Trump upset will force healthcare leaders to rethink the future - Modern Healthcare Modern Healthcare business news, research, data and events

20 Questions for President Trump | Public Health Post

The last six and a half years have been uncharted territory in our nation’s century-long 

debate over health reform. For the first time the fight was about how to implement an attempt at near-universal coverage 

rather over what this plan should look like and what could win enough support in Congress. The Affordable 

Care Act (ACA) has survived major political, legislative, and legal tests, including dozens of 

repeal votes, two Supreme Court decisions, the 2012 

presidential election, and state-level resistance.

I was outside the Supreme Court on June 25, 2015 when the King v. Burwell decision was released. I was there the moment activists switched their signs from saying “Don’t you dare take my care” to “The ACA is here to stay.” I wrote that we could finally say with some certainty that they were right, the law is here to stay. They were wrong. I was wrong.

Donald Trump’s victory throws the future of health reform into complete chaos. He will take office in January 2017 with Republican majorities in the House and Senate. President Trump, Speaker Ryan, and Senate Majority Leader McConnell have all made repeated promises to get rid of Obamacare. They will face enormous pressure to follow through with their threats of repeal. Approximately 21 million people are projected to lose insurance if they follow through with their initial proposals.

The first step to figuring out where to go from here is understanding what decisions are on the horizon. Here are my first 20 questions about health reform under the Trump administration , in no particular order:

1. Will Republicans follow through with repealing the ACA? It is one thing to make threats when there is no chance they will come to pass. Where will health reform fit in the constellation of issues Donald Trump promised to focus on such as immigration and the economy?

2. If they decide to move forward with repeal in the first year—as I fully expect them to do—what will this look like? The details matter greatly. Will this be a mostly symbolic gesture to appease the conservative base without upsetting interest groups and taking away people’s insurance, or will this be a more comprehensive overhaul of the ACA?

3. Will legislation to repeal the ACA include specifics about what to replace it with or will these be two separate conversations?  The history of health reform clearly shows that it is very hard to gain consensus on the details even if there is agreement on the broad goals. It will be much harder to pass repeal legislation if Republicans have to agree on what comes next.

4. I expect they will target the individual mandate. What will they do to combat the likely adverse selection problems that will lead to weakened risk pools and increased premiums increases?

5. Will they try to keep popular parts of the law such as allowing children to stay on their parents’ plans until age 26 or banning insurance companies from excluding people because of pre-existing conditions?

6. Will Republicans re-claim ownership of policy ideas they supported before they became part of Obamacare, such as using tax-credits to subsidize the purchase of private insurance through state-based health insurance exchanges?

7. Would they repeal the ACA’s coverage expansions across the board or use a federalism approach similar to the ACA which gives states flexibility to opt-in to keeping things like the Medicaid expansion and insurance exchanges?

8. What does a repeal timeline look like? How long will insurance companies, states, and consumers have to adapt before the coverage expansions are phased out?

9. What effect will all this uncertainty have on the current enrollment period for the exchanges?

10. What will state leaders do? In particular, what will leaders do in the states that have expanded Medicaid but voted for Trump, including Arizona, Michigan, and Pennsylvania? Will they fight to keep the federal money coming into their state or will they support ending the expansion?

11. Will we finally see a voter feedback effect in which the 20 million people who stand to lose insurance mobilize and fight against the ACA’s repeal? We have not seen this in Kentucky where Governor Bevin has undone the state’s exchange and is trying to remove or scale back the state’s Medicaid expansion.

12. What happens to all the current and future negotiations over Medicaid 1115 waivers? Will the Trump administration halt conversations? Will they be more permissive and allow things like work requirements which the Obama administration has rejected?

13. Will any state try a 1332 waiver? If so, how will the Trump administration respond?

14. Assuming block grants are part of the ACA replacement plan, what does this actually look like? What will this mean for states and beneficiaries?

15. This a crucial stage in the dramatic movement away from fee for service to alternative payment models. Will the Trump administration continue in this direction or shift course entirely?

16. What is the future of Accountable Care Organizations?

17. What happens when the Children’s Health Insurance Program (CHIP) expires on September 1, 2017? Will the bipartisan coalition that has supported CHIP further erode? Check out these articles in NEJM and Health Affairs that Jon Oberlander and I wrote about CHIP politics as it stood earlier this year.

18. Will Donald Trump follow through with his early campaign promises to allow Medicare to negotiate pharmaceutical prices?

19. Will public health emerge as a health reform issue that can transcend the partisan divide? In other words, will leaders be able to move beyond the fights over insurance coverage to focus on non-partisan population health issues such as maternal and infant mortality?

20. What does the future look like for federal funding for research on health services, medical care, and social sciences through AHRQ, NIH, and NSF?

20 Questions for President Trump | Public Health Post

FDA launches app contest for opioid overdoses | Articles | HIPAA

An “unprecedented opioid epidemic” has prompted health leaders to launch a first-of-its-kind public outreach that could save lives.

The U.S. Food and Drug Administration has launched the 2016 Naloxone App Competition. The goal? To give opioid users a way to get access to naloxone via their phone.

This week, the FDA released details of the contest. ABCNews.com was among the numerous news outlets that teased the challenge:

The FDA, along with the National Institute on Drug Abuse (NIDA) and the Substance Abuseand Mental Health Services Administration (SAMHSA) announced the 2016 Naloxone App Competition on Monday to bring together computer programmers, public health researchers and other experts to help combat the opioid crisis. The goal is to create an easy-to-use app that will identify the closest provider of naloxone, whether it's a hospital, clinic or police station.

FDA launches app contest for opioid overdoses | Articles | HIPAA

Trump Can Kill Obamacare With Or Without Help From Congress -

T.G.I.O.  (Thank God it's Over)

President-elect Donald Trump has promised over and over in recent months that he will repeal and replace the Affordable Care Act, also called Obamacare, when he reaches the White House.

"Obamacare is a disaster. You know it. We all know it," Trump said at a debate last month. "We have to repeal it and replace it with something absolutely much less expensive."

Now that Trump will move into the Oval Office in January, the question is whether he'll be able to completely repeal the six-year-old law that has had an impact on every aspect of the U.S. health care system.

"It's a challenge for a Trump presidency," says Jack Hoadley, a research professor at Georgetown University's Health Policy Institute. "To get a true repeal and replace through, he needs 60 votes in the Senate." That's the minimum number of votes needed to overcome a filibuster in the Senate.

"Repeal of the law is absolutely going to come up, and the only potential defense against that would be a Democratic filibuster — if Republicans even allow a filibuster," says Austin Frakt, a health economist who runs the blog The Incidental Economist.

But even if Trump can't repeal the Affordable Care Act in its entirety, there's a lot he can do through rule-making and smaller legislative changes to weaken the law and mold it more to his liking.

Trump upset will force healthcare leaders to rethink the future

Modern Healthcare - Nov. 9, 2016
Republican Donald Trump's shocking victory Tuesday will force a major shift in the healthcare industry's thinking about its future. Combined with the GOP's retention of control of the Senate and the House, a Trump presidency enables conservatives to repeal or roll back the Affordable Care Act and implement at least some of the proposals outlined in the GOP party platform and the recent House Republican leadership white paper on healthcare. 

Trump Can Kill Obamacare With Or Without Help From Congress
Capital Public Radio - Nov. 9, 2016
President-elect Donald Trump has promised over and over in recent months that he will repeal and replace the Affordable Care Act, also called Obamacare, when he reaches the White House. Now that Trump will move into the Oval Office in January, the question is whether he'll be able to completely repeal the six-year-old law that has had an impact on every aspect of the U.S. health care system.


Trump Can Kill Obamacare With Or Without Help From Congress - capradio.org