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Hospital Performance Improved But Are Measurements Accurate? September 17, 2011

Posted by jomaxx in : health care news, health care reform, health reform, Hospitals, medicine, patient care, Physicians, Public Health , add a comment

Is performance or reputation more important?

Does reputation equate to performance?

Are the data being measured of real patient care value?

A new report released by the Joint Commission on Accreditation of Hospitals (JCAH) suggests that on a variety of fronts hospitals are doing a better job of patient care. They looked specifically at five areas of care: heart attack, heart failure, pneumonia, surgical, children’s asthma.  The report shows that in terms of several quality measures, such as administering antibiotics in a timely manner to surgical or ICU patient, giving aspirin to heart attack patients on admission to the ER and the like, overall hospitals have improved in last couple of years.

The new report identifies 405 hospitals out of over 3,000 (14%) accredited by the JCAH.   Those selected had to achieve a compliance score of at least 95% in one or more of the five key areas monitored during this review.  Some hospitals achieved these scores in only one category, others in two, three or more.  The complete list has been published.

Of note is the finding that none of the 17 medical centers listed by U.S. News & World Report on its “Best Hospitals Honor Roll” this year are on the Joint Commission’s list of 405 hospitals that received at least a 95% composite score for compliance with treatment standards. About one-third of a hospital’s score in the U.S. News methodology is also based on its reputation as gauged by a survey of physicians.

The findings bring into question how deserving these institutions are of their reputations.  Still other measures of quality are out there including Medicare’s Hospital Compare site which lists among other things, mortality and morbidity rates for hospitals based on Medicare data.

It should also be noted that many hospitals that did not make this list still scored very highly and only missed the list by a few percentage points.  In fact it could well be that the difference in some cases was not performance at all, but simply lack of detailed documentation, which is really all JCAH and Medicare can go by in their respective data compilations.

The entire “science” of medical comparative outcomes is still really in it’s infancy, with many confounding factors needing to be considered and analyzed to achieve a true picture of outcomes and valid comparisons between facilities and treatments.  Still, it is clear that with increasing data collection, better analytical evaluation can be undertaken and a more informed patient and provider population will result.

Report Finds Improved Performance by Hospitals – http://is.gd/STHqr4

2010 Top Performers on Key Quality Measures – http://is.gd/YK09jV

Hospital Compare – http://is.gd/QfMaQ9

Family Doctors Sue CMS, RUC Over Alleged Price Fixing August 16, 2011

Posted by jomaxx in : Devices, health care news, health care reform, Medicare, Physicians, politics, Public Health , add a comment

A 74-page law suit, filed this week in U.S. District Court in Maryland by six Georgia physicians, claims that the RUC (Relative Value Scale Update Committee) violates the Federal Advisory Committee Act’s requirements for representation, transparency, and methodological rigor.  These plaintiffs claim, the RUC has systematically overvalued many specialty procedures while undervaluing primary care. They contend that the existing payment structure that RUC has dominated is a huge driver of healthcare costs.  They argue that the health care system as a result has too many specialists doing too many unnecessary procedures and the price that we pay doctors has been fixed by this secret little committee of the AMA, which they feel is illegal.  They also note that CMS (Centers for Medicare & Medicaid Services) has accepted more than 90% of recommendations made by the RUC.  They further contend, that this fact and the resulting higher income for specialists has discouraged medical students from primary care and exacerbated the nation’s shortage of generalist physicians.

The current chair of the RUC, Barbara Levy, MD, acknowledged the lawsuit in an official statement but did not refer to any specific allegations. Instead, she focused on the fact that the RUC is an independent panel of physicians from all medical specialties, including primary care, who make recommendations to CMS as all citizens have a right to do. These volunteers provide physicians’ voice and expertise to Medicare decision-makers through their recommendations. Of course, in reality, there is really no other highly organized entity that functions in the manner of the RUC. The plaintiffs say they have tried to go through the traditional process of petitioning the AAFP  (American Academy of Family Physicians) and the AMA (American Medical Association).   They say that their complaints were ignored by the AMA, and the AAFP who sits on the RUC committee.  The fact that the AAFP and other specialty groups sit on the committee makes using professional societies as advocates for change essentially impossible.

Another overlooked fact is that this group also passes judgement on new medical technologies and the payments that should accompany them.  In lieu of CMS’s almost universal acceptance of RUC recommendations, this makes innovators of medical technology a prisoner to the RUC process,  which includes obtaining a CPT code which is necessary for payment by any insurer including Medicare and Medicaid.  Failure to obtain such a code, even if the new device or product is FDA approved, is essentially a death sentence from a market perspective for any new innovation as there will be essentially no revenue available to support its use.

While this system ostensibly protects the public to a degree, that is a false assumption.  It falls to the FDA (Food and Drug Administration) to determine the safety and efficacy of drugs and devices. Certainly, there have been complaints about the performance of that duty by FDA. However, in no way is the RUC or AMA tasked with these duties.  Nevertheless, they can act as a de facto regulator by failing to ‘recommend’ to CMS that a code be established for payment.  Additionally, in line with the lawsuit allegations, even when the RUC and CPT committees do recommend a code for payment, they then recommend a rate of payment, thus setting a value on those services.

This is part and parcel of the contention by the plaintiffs in the lawsuit, that the RUC artificially undervalues certain procedural or office codes to the benefit of some and detriment of others. To be sure, valuing medical services is difficult under the system that currently exists.   That said, it would appear that transparency and accountability are lacking in that the RUC, as an ‘arms length’ entity is not directly contracted to CMS, yet CMS, despite this, seems to use the RUC as their ‘rating agency’ when it comes to new procedures, codes and the values placed on those codes. Therefore, despite any formal relationship, the working relationship would appear to suggest that it is in fact contractual at least in the operational sense.

It will be very interesting to see  how the courts rule in this case, since depending on the ruling, we could have a continuation of the status quo, or open up an entire process to review, revision and potentially replacement . . . obi jo

Primary Care Physicians File Lawsuit to Bring More Transparency to RUC Process – Physicians Allege That Relationship Between CMS, RUC is Illegal – http://is.gd/eGdrW8

A Legal Challenge to CMS’ Reliance on the RUC – http://is.gd/XFFsWV

Doctors Sue HHS, CMS Over ‘Secretive’ Payment Committee – http://is.gd/OWDGob

AAFP Calls for RUC Reforms, but Won’t Back Suit – http://is.gd/zCptzV

RBRVS: Resource-Based Relative Value Scale – http://is.gd/O9IF8I

RUC Members 2011 – http://is.gd/WNeRK0

AMA/Specialty Society RVS Update Committee – http://is.gd/VOGnbR


Federal Budget 101 July 21, 2011

Posted by jomaxx in : health care reform, health reform, Insurance, politics, Public Health , add a comment

This is a reprint of a letter to the editor published in The Advocate in Baton Rouge, Louisiana, regarding the budget dilemma. How is this related to real health reform . . . the answer is obvious, we lack the funds to achieve any grandiose federal program . . . and lack the will, so it seems, to address health reform in the proper manner which is dealing with consumers and insurers directly . . . obi jo

Federal Budget 101 (by David Thomas)

The U.S. Congress sets a federal budget every year in the trillions of dollars. Few people know how much money that is so we created a breakdown of federal spending in simple terms. Let’s put the 2011 federal budget into perspective:

U.S. income: $2,170,000,000,000
Federal budget: $3,820,000,000,000
New debt: $ 1,650,000,000,000
National debt: $14,271,000,000,000
Recent budget cut: $ 38,500,000,000 (about 1 percent of the budget)

It helps to think about these numbers in terms that we can relate to. Let’s remove eight zeros from these numbers and pretend this is the household budget for the fictitious Jones family.

Total annual income for the Jones family: $21,700
Amount of money the Jones family spent: $38,200
Amount of new debt added to the credit card: $16,500
Outstanding balance on the credit card: $142,710
Amount cut from the budget: $385

So in effect last month Congress, or in this example the Jones family, sat down at the kitchen table and agreed to cut $385 from its annual budget. What family would cut $385 of spending in order to solve $16,500 in deficit spending?

It is a start, although hardly a solution.

Now after years of this, the Jones family has $142,710 of debt on its credit card (which is the equivalent of the national debt).

You would think the Jones family would recognize and address this situation, but it does not. Neither does Congress.

The root of the debt problem is that the voters typically do not send people to Congress to save money. They are sent there to bring home the bacon to their own home state.

To effect budget change, we need to change the job description and give Congress new marching orders.

It is awfully hard (but not impossible) to reverse course and tell the government to stop borrowing money from our children and spending it now.

In effect, what we have is a reverse mortgage on the country. The problem is that the voters have become addicted to the money. Moreover, the American voters are still in the denial stage, and do not want to face the possibility of going into rehab.

Chief Executive Officer
Equitas Capital Advisors LLC

David S. Thomas, Jr., CIMA®
Senior Investment Management Consultant
Chief Executive Officer
Equitas Capital Advisors, LLC
365 Canal Street, Suite 3050
New Orleans, LA 70130

Share this with others if  you feel it makes the situation we face more understandable.  I think for many it would . . . obi jo

Civil Rights Issues? Age Discrimination? Worries About Proposed Kidney Transplant Rules March 15, 2011

Posted by Obi Jo in : health care news, health care reform, Medicare, medicine, patient care, Public Health , add a comment

Proposed Change in Rules for Kidney Transplants Raises Concern – Proposal would use age as criteria to select kidney recipients

New Kidney Transplant Rules Start of Rationing? – More than 80% of people awaiting organs need a kidney

News regarding  proposed changes in the formula by which kidneys are allocated for transplant has caused a stir in the medical community. The United Network for Organ Sharing (UNOS) has proposed changing rules for allocation of kidneys, the most sought after organs for transplantation. Under the new concept, consideration would be given to the age and health of the individual, favoring younger patients over older patients.  The idea is to maximize the life of the organ donated, at least in theory. 1, 2, 3

If adopted, this plan would radically change the current protocol from one that gives priority to patients who have been on the waiting list longest. The current rules have been essentially unchanged for over 25 years. These new rules would match recipients and organs as noted based on age and health to try to maximize the number of years provided by each kidney – the most sought-after organ for transplants.4

The chairman of the committee charged with reviewing donation protocols defends the concept by arguing that UNOS is trying to get the most out of a scarce resource.  They point out that there are many more patients waiting for kidneys than donors annually. United Network for Organ Sharing (UNOS), is a private nonprofit group.  They are contracted by the federal government to coordinate organ allocation.  As such, they are the recipients of taxpayer monies from the federal government. 4, 5

UNOS on it’s website defines it’s goal, mission and procedures as follows: UNOS uses an online database system (UNet) that collects, stores, analyzes and publishes all data that pertains to the patient waiting list, organ matching, and transplants. The system was launched in October of 1999.  It contains data regarding every organ donation and transplant event occurring in the United States since 1986. UNet is described by UNOS as a fail-safe, 24/7, secure Internet-based transplant information database. UNet enables the organ transplant institutions to: register patients for transplants, match donated organs to waiting patients, and manage the time-sensitive, life-critical data of all patients, before and after their transplants. 5

The proposed change, the first major overhaul of the system in a quarter century, is an ethical minefield and is sure to raise serious moral questions.  A number of transplant surgeons, bioethicists and patient advocates are welcoming the change. Many agree that age should be a factor in determining allocation of organs. However, others worry that this is a slippery slope of moral rationalization raising all of the gravest concerns about medical rationing.  Some have raised concerns that the changes might alter the pool of available organs by changing the pattern of people making living donations. Some also complain that the new system would unfairly penalize middle-aged and elderly patients at a time when the overall population is getting older.

Also, using criteria such as age, especially for an agency funded with federal tax dollars, implicates civil rights issues, specifically age discrimination.  Additionally, others query that if age is to be considered, why not perceived societal worth?  Are not many awaiting transplant more accomplished citizens than others? Should that factor be considered as well as age?  For example, should an otherwise healthy 50 or 60 year old, who might be business leader, physician, judge, attorney or other community leader be passed over in favor of a 25 year old who might be illiterate, on welfare and have a criminal history? Using age as a criterion will more than likely bring issues of comparative worth into the discussion.  These issues, as is obvious, are fraught with complexity, moral ambiguity and ethical concerns. 4, 5, 6, 7

The Office of Civil Rights (OCR) enforces the Age Discrimination Act of 1975 (Age Act), which prohibits discrimination on the basis of age in programs and activities receiving Federal financial assistance from HHS.  Under the Age Act, recipients may not exclude, deny, or limit services to, or otherwise discriminate against, persons on the basis of age. The Age Act does not cover employment discrimination that is enforced by the EEOC. The Age Act also does not apply to certain age distinctions in Federal, State, or local statutes or ordinances.  In addition, a recipient may take an action that is otherwise prohibited if the action reasonably takes into account age as a factor that is necessary to the normal operation or achievement of a statutory objective of a program. OCR ensures that people have equal access to and an opportunity to receive services from all HHS funded programs and services. Persons who believe they (or someone else) have been discriminated against — because of race, color, national origin, age, or disability — in health care or human services may file a complaint with OCR.5, 6, 7

One must worry that the very real accomplishments of UNOS could be overshadowed and endangered by embarking on this ethically tenuous new course.  Clearly, a federally funded (tax payer funded) private entity must carefully evaluate civil rights concerns when making alterations in its allocation scheme.  Otherwise, many of the issues already discussed above will come to the fore.  It would also seem that the United States Justice Department as well as the Civil Rights Division should review a change of this magnitude.  We would assume HHS and CMS would as well since all end stage renal patients are on Medicare, regardless of age and Medicare covers all transplants. 5, 6, 7

1. Young Patients Waiting for Kidneys May Get Priority

2. Under kidney transplant proposal, younger patients would get the best organs

3. Kidney transplant proposal would give an edge to younger patients

4. Waiting for a transplant

5. United Network for Organ Sharing (UNOS)

6. Medicare Coverage of Kidney Dialysis and Kidney Transplant Services

7. Discrimination on the Basis of Age

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American Surgeons Consider Suicide More Than We Realize January 22, 2011

Posted by jomaxx in : health care news, health reform, medicine, Mental Health, Physicians, Public Health , add a comment

Suicidal Ideation Of Concern Among American Surgeons *

Rate 1.5 to 3 times higher than in general public

A recent study has indicated reasons for concern about the rate of suicidal thought among practicing surgeons in the United States.1 Suicide is a higher cause of mortality for physicians in general compared with other professions as well as the general public.  It would appear that a combination of general work related stress, job burnout, depression and pressures brought about by medical or surgical errors takes it toll.  The constant threat of litigation over imagined or real malpractice seems to be a major issue, particularly among surgeons for whom the risk of such actions is the greatest.  It also appears that surgeons are less likely to seek professional help for their depression than the general public and that the rate of suicidal thought is significantly higher among surgeons than the general public. 1, 3, 4, 5

One in 16 surgeons reported suicidal ideation in the preceding year according to data reported in the Archives of Surgery.  The study was based on a questionnaire sent to members of the American College of Surgeons.  Nearly 8,000 surgeons responded. Among surgeons 45 and older, the rate was 1.5 to 3 times higher than the general US population.  Persons who are highly educated, employed and married have lower rates of suicidal thoughts.  This makes these findings more startling as surgeons in the study were mostly married (88%), clearly highly educated, and essentially fully employed.   Also of interest was the finding that suicidal thoughts were higher in surgeons in the 45-54 age group than in younger individuals, the exact reverse of the usual findings in the general population where 45-54 year olds have lower rates of suicidal ideation than  younger persons. Historically, the suicide risk rate among physicians has been reported as higher in female physicians, but the results of this study found no differences between the sexes in the risk of suicidal thought. Depression has long been associated with suicidal thoughts and actions.  However, burn out has only recently begun to be recognized as a major factor leading to depression, suicidal thought and action.  Previous studies in medical students had demonstrated the impact of burnout as well. 1, 2

It is of concern that highly trained physicians and surgeons would not seek mental health services to deal with burnout, depression and suicidal thought. The most common reason given for this is that there appears to be great concern about licensing and loss of one’s professional career.  Licensing boards are generally focused on physician impairment as opposed to physician illness and treatment, so that the fact of a diagnosis of depression would generally not be sufficient to warrant any action in most cases, especially if treatment is ongoing.  Still, many physicians, surgeons in particular, have great distrust of medical licensing boards as well as other professional monitoring organizations. This may well stem from the very nature of surgical training, practice and art, where a surgeon is solely responsible for his/her actions in the operative theater, as well as the outcome,

be it positive or negative. 1, 3, 4, 5

Health reform actions at the federal and state level will no doubt only add to the burden as more and more persons are brought into the mainstream of the medical care system.  Additionally, the rapidly expanding ranks of the elderly, due to the aging of the baby boomers is having an impact on the numbers of patients needing treatment and surgical interventions. All of this is occurring amidst an environment where medical school enrollments and residency training slots have not expanded rapidly enough to keep pace with demand.  Of particular concern is the effect of burnout in pushing experienced surgeons 50 and over into early retirement or reduced workload situations.  Another factor in play is the hostile reimbursement environment that forces physicians to deal with a plethora of varying rules across a spectrum of thousands of health insurance plans.  This is in addition to the intense pressures on payment implemented at the federal level though Medicare and at the state level though Medicaid.

All in all, a very worrisome picture is painted by this study.  We can only hope that bringing this data to light will encourage surgeons who may be facing some of these issues to seek help just as any patient would – and as they would advise their own patients to do.  We need all the experienced physicians and surgeons we can get, and we need them to be healthy in body and mind . . . obi jo and jomaxx

* Suicidal Ideation Raises Concern Among American Surgeons

1. Special Report, Suicidal Ideation Among American Surgeons (Arch Surg 2011;146(1):54-62)

2. Burnout and Suicidal Ideation among U.S. Medical Students

3. Study: Errors lead surgeons to contemplate suicide

4. Surgeons and suicide: a study in burnout

5. Depression, Burnout Make Surgeons Mull Suicide

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Health Insurers Charged with Increasing Anti-Competitive Behavior November 25, 2010

Posted by Obi Jo in : health care news, health care reform, health insurance, health insurance reform, Hospitals, Insurance, patient care, Physicians, politics, Public Health, Tax Policy , add a comment

Justice Department Sues Blue Cross of Michigan

Recently, a case involving Blue Cross Blue Shield of Michigan (BCBSM) has received attention in the press (USA Today, Detroit Free Press, Kaiser Health News).  The case involves alleged attempts by Blue Cross of Michigan to inhibit competition in the health insurance marketplace.  Specifically, the case in question focuses on TheraMatrix, a physical therapy provider.  They apparently were able to carve out coverage contracts with major employers such as automakers for physical therapy services.  That brought about a host of reactions from BCBSM and local hospitals aligned with Michigan’s dominant health insurance carrier. 1,2,3,4,5,6

This case highlights among other issues, most favored nation (MFN) status in contracts offered by BCBSM to potential participating hospitals.  These types of clauses in health insurance contracts are under attack in general, and specifically in this case, are the subject of a legal action brought by the United States Justice Department as well as the State of Michigan against BCBSM. 6,7

Additionally, it has been reported that insurers nationally have been hoarding huge reserves of cash, far in excess of actuarially required amounts to meet future demands.  The reasons for this are not clear, but one can of course speculate that this excess cash is being invested to increase profits for health insurers. 8

It has been argued that one of the best ways to deal with health insurers in the private market is to view them in the same light as a utility.  That would allow them to be regulated not just in terms of their solvency and adequacy of reserves, but also in terms of their rate structure in relation to those issues and their overall profitability.  It is clear that regulated utilities still make money, earn profits and yield returns for their investors.  The same would be true of regulated health insurers. 9

Elsewhere in the nation, Blue Cross Blue Shield of Louisiana (BCBSLA), that states largest insurer, and East Jefferson General Hospital (EJGH) in the New Orleans market have been engaged in a war of words following failed negotiations over a new contract.  BCBSLA argues that EJGH wanted higher payments for services than other local hospitals.  EJGH argues that BCBSLA is building excess reserves while cutting services and raising premiums.  The two sides ended their contract last month leaving many locals without access to one of the areas major hospitals. 10,11,12

The issues raised by the recent news regarding anti-competitive behavior, excess cash and profits, along with continuing rate increases all point to a market which has run amuck.  Free markets are generally best, however, when vital services are at stake, necessary regulation must be implemented.  The fact that in many states, one or two major health insurers hold sway over the majority of the market raises classic anti-trust questions. 13,14

Currently, the health reform bill fashioned by Congress that was passed along partisan lines last December, does not resolve these issues.  In fact, in many ways, in complicates them.  Still the bill fails to address issues of rate structure, premium increases, profitability, and anti-trust issues, which are of major concern when discussing health insurance reform.

Removal of anti-trust exemptions, along with the ability of health insurers to sell across state lines would be major steps toward improving access to affordable private coverage.  However, this can only come to pass if there is proper exercise of regulatory control over health insurance rates as outlined above.  Only these reforms will secure both the private health insurance market and the needed changes the citizenry deserves. 15

  1. Did Blues bully cost-saving firm in Michigan?
  2. Case against Blue Cross shows difficulty of cutting health costs
  3. BCBS Of Michigan Alleged To Have Crushed Pilot Physical Therapy Program It Saw As Competition
  4. TheraMatrix
  5. Blue Cross Blue Shield of Michigan
  6. Feds accuse Mich. Blue Cross of anti-competitive contracts
  7. UNITED STATES OF AMERICA and the STATE OF MICHIGAN, Plaintiffs, v. BLUE CROSS BLUE SHIELD OF MICHIGAN, a Michigan nonprofit healthcare corporation, Defendant (Case 2:10-cv-14155-DPH -MKM Document 1 Filed 10/18/10)
  8. Consumer group: Insurers kept surplus while hiking premiums
  9. Details on “the plan”
  10. East Jefferson General Hospital seeks arbiter in dispute with insurer
  11. East Jefferson General Hospital
  12. Blue Cross Blue Shield of Louisiana
  13. Healthcare Sector Comes Under Increased Government Antitrust Scrutiny
  14. Are Insurance Companies Still Exempt From Antitrust Laws?
  15. Health Insurers Charged with Increasing Anti-Competitive Behavior

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Practicing Physicians Advisory Council Discontinued in Health Reform Bill November 22, 2010

Posted by Obi Jo in : health care news, health care reform, health reform, Medicare, medicine, Physicians, Public Health, Tax Policy , add a comment

Affordable Care Act Cuts Out Physician Input – Secretary of HHS Given Full Discretion over Fees and Reimbursement

It would appear, that the more we learn about the new health reform bill, the more we have to be concerned about.  In a brief sentence, deep within the bill, we are informed that Section 1868(q) of the Social Security Act (42 U.S.C. 1395ee(A) is repealed. 1

Well, now just who would know what that is all about?  It seems that Congress at one time, felt it important that a panel of PRACTICING physicians, who actually live and work under the payment rules of Medicare, should get together quarterly, to discuss with HHS and CMS issues related to billing, coding and reimbursement. The common sense behind this makes one wonder how Congress ever came up with this in the first place.

When one goes to the CMS site to review this topic, one finds this text:

‘In accordance with H.R. 3950, section 3134(b)(2) of the Patient Protection and Affordable Care Act, repeals section 1860(a) of the Social Security Act (42 U.S.C. 1395ee(a)), which provided for the establishment of the Practicing Physicians Advisory Council (PPAC), and specified the PPAC’s composition and meeting schedule. The date of enactment of this provision is March 23, 2010. Therefore, the PPAC is being discontinued and the June meeting will not be held.’ 2,3

In other words, those who wrote the health bill (now who was that?) determined that it was in the best interests of health care to eliminate any face-to-face discussion between physicians and bureaucrats at CMS. No doubt, since the health bill now gives all discretion to the Secretary of HHS in regard to determining fee related matters; it was best to remove any pesky interference.  Heaven forbid we should actually have input from doctors working in the real world, under these regulations and payment policies give any feedback.

It is exactly this kind of broad latitude given to the Secretary of HHS, in the absence of any modifying input from those actually providing care and services that has prompted concern, indeed fear, from many.  With physician shortages likely to become exacerbated by any expansion of access, the elimination of practicing physician input would seem to be unwise at best, and at worst, a designed move to eliminate objection to the likely severe cost cutting that the Secretary of HHS is going to undertake.  It has also prompted negative commentary in the media. 4,5

We can only hope that his provision will be removed and the input from practicing physicians will again be sought after and respected . . . obi jo and jomaxx

1. H.R.3590Patient Protection and Affordable Care Act

2. Practicing Physicians Advisory Council


4. Practicing doctors are losing a voice

5. Affordable Care Act Cuts Out Physician Input

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Adult Vaccinations: Neglected Preventative Medicine September 29, 2010

Posted by Obi Jo in : health care news, health care reform, health insurance reform, health reform, Medicare, medicine, Pharmaceuticals, Physicians, Public Health, women , add a comment

The CDC believes that far too few adults are maintaining vaccinations or getting vaccinated at all. C.D.C. recommends that ALL people 19 and older receive immunizations against as many as 14 infectious diseases, while remembering that not all adults require every vaccine. Most of the time, adults rarely think about getting shots unless they are injured or plan travel to an undeveloped country.

For example, this year alone, over 11,000 cases of whooping cough (pertussis) have been reported nationwide. Infections are near record levels in California and 9 infants have died. No doubt some of these young children had not received all of their vaccinations.  Still, it is firmly believed that some of those deaths could have been prevented if more adults had also been immunized.

CDC studies currently show that only 7% of Americans over age 60 have received the herpes zoster vaccine to prevent shingles.  Shingles is a painful nerve infection which can become a chronic pain issue and cause debilitation. The widely publicized vaccine against the two types of human papilloma virus that cause 70% of all cervical cancers has to date only been received by an estimated 11% of young women.

More concerning is data from a study by the National Foundation for Infectious Diseases conducted in 2007 which showed that 40% responded that if they had been vaccinated as a child they no longer needed any other vaccinations.  Even worse is that some 18% said that vaccines were not necessary for adults at all.

One aspect of the new health care law should be of some help in removing barriers that may be keeping adults away from vaccinations.  The new health plan mandates that group and individual health plans along with Medicare provide preventive health services, including immunizations recommended by the C.D.C., at no charge. For insured persons, that will mean no co-payments, co-insurance or deductibles. However, that is not the entire story. If your insurance is through a group or individual health plan, your plan must be new, or have been substantively changed, in order for the new requirements to apply. Also, some of the CDC recommendations, those which are most recent, will not be covered initially.

From the standpoint of disease prevention, vaccines are cheap.  One trip to the emergency room due to a significant case of the flu or pneumonia can generate bills totally in the thousands of dollars. Flu shots are almost always to be found for about $20 and for many individuals, are often found at no charge.  Pneumonia vaccines cost around $70 to $80 versus potentially much more if you get pneumonia.

Many local pharmacies, including most of the large chain pharmacies offer vaccinations.  Some even have so-called “retail clinics” and administer a wide range of vaccines.  The most well known include CVS MinuteClinics and Walgreens Take Care Clinics. A wide range of vaccines can be obtained at these pharmacies.  Prices vary but some examples include: hepatitis A ($110-$120) and B ($100-$110), meningitis ($140-$150), pneumonia ($70-$80) and DPT (diphtheria, pertussis and tetanus ($80-$90). There are literally thousands of pharmacies nationwide offering these services, with many open daily.  Usually appointments are not necessary nor are prescriptions.  Some larger chains even offer travel vaccines with specified lists for defined areas of travel. In all states, pharmacists are licensed to give flu shots after taking some basic courses.  Many states allow pharmacists to administer a full range of vaccines as well.

This raises the question, why can’t I get these shots from my doctor? In many cases you can, but increasingly, the cost of vaccines are not covered for physicians at a rate commensurate with what they must pay.  Also, administration costs are barely if at all covered by many insurers.  Recently, flu shots were available at the local family doctor here, but were not “advertised” and given only if established patients asked.  This was actually done as a courtesy. So it would appear that vaccines have made the jump to the public health arena completely.  This is good news overall, as the broader the range of persons vaccinated against communicable disease, the better for all, regardless of age. This is especially true in an age where inter-continental and international travel occur thousands of times daily . . . jomaxx and obi jo

Cost and Lack of Awareness Hamper Adult Vaccination Efforts – http://www.nytimes.com/2010/09/25/health/25patient.html?_r=1&emc=tnt&tntemail0=y

Saving Lives:Integrating Vaccines for Adults into Routine Care – http://www.nfid.org/pdf/publications/adultimmcta.pdf

Grantee Immunization Websites – http://www.cdc.gov/vaccines/spec-grps/prog-mgrs/grantee-imz-websites.htm

Vaccinations for Adults:You’re NEVER too old to get immunized! – http://www.immunize.org/catg.d/p4030.pdf

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Small Business Health Insurance Tax Credit Goes Into Effect September 27, 2010

Posted by Obi Jo in : health care news, health care reform, health insurance reform, health reform, Insurance, politics, Public Health, Tax Policy , add a comment

One aspect of the new health care bill being implemented is the small business health insurance tax credit.  It is estimated that the value of these credits will reach some $40 billion over the next 10 years. Those tax credits of course are being offset by large tax increases in other areas, including taxes on businesses and individuals.  This year, the tax credit extends to companies with fewer than 25 full-time workers and average wages of less than $50,000 a year. To qualify, employers must pay at least 50% of their employees’ health care premiums. Small businesses with 10 full-time employees or fewer earning an average of $25,000 or less are eligible for the largest credit, 35% of their health insurance premium costs. Companies with larger numbers of employees earning more receive smaller credits on a sliding scale. Analysis shows that up to 16.6 million workers are in firms that would be eligible for the tax credit in 2010 to 2013.

The tax credit only applies to “employees” and excludes owners and their families of small businesses. This would seem to be a somewhat punitive measure which punishes small firms, sole proprietors, LLC and S corps.  For some reason, Congress and the President felt that these entities did not qualify for a health insurance credit even though increasingly, many couples run their businesses as a LLCs with only one or two partners. This would appear to be a flaw in the application of this “benefit”.

Nevertheless, this may be some good news to some small employers over the short-term, although it is clear that premium increases will continue over the next several years, which will make the future end of these credits very painful and problematic for those businesses who fail to plan for that day of reckoning . . . obi jo

Lightening the Health Care Load for Small Businesses – http://www.nytimes.com/2010/09/18/health/18patient.html?_r=1&emc=tnt&tntemail0=y

Realizing Health Reform’s Potential: Small Businesses and the Affordable Care Act of 2010 – http://www.commonwealthfund.org/Content/Publications/Issue-Briefs/2010/Sep/Small-Businesses.aspx

Small Business Health Care Tax Credit Worksheet – http://www.irs.gov/pub/irs-utl/3_simple_steps.pdf

Fact Sheet: Small Business Health Care Tax Credit – http://www.whitehouse.gov/the-press-office/fact-sheet-small-business-health-care-tax-credit

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Full Impact of Taxes in Health Reform Bill Now Coming to Surface September 14, 2010

Posted by Obi Jo in : health care news, health care reform, health insurance, health insurance reform, health reform, politics, Public Health, Tax Policy , add a comment

Back in March, House Speaker Nancy Pelosi (D-California), when speaking about what was in the then pending ObamaCare plan said, “Congress has to pass the bill so you can find out what’s in it, away from the fog of controversy.” We see.  Vote now, read later.  Then much later begin to understand the mess that these inside the beltway power addicts have created.

Well folks, your friendly Congress persons did just that.  They (almost exclusively Democrats) passed the bill.  Since that time all Americans have been finding out just what is in it. And in short they do not like it and are liking even less these Democratic politicians (or any career politician of any party) that foisted this 2,400 page monstrosity upon the citizenry.

Now, we find a little noticed revenue provision, one of about 15 in the bill, which was essentially “overlooked” (guess that was too much for these pols to read) places enormous bureaucratic tax reporting burdens on all businesses.  At present a large number of Democrats are j0ining with Republicans in calling for repeal of this onerous tax provision in the new health care law.

The theory was that in order to improve compliance with tax laws, businesses would be required to file a 1099 tax form identifying anyone to whom they pay $600 or more for goods or merchandise in a year. Businesses will also have to send copies of the form to their vendors, suppliers and contractors.    Under the law, businesses will be required to report purchases of items like office equipment, food and bottled water, gasoline, lumber and plumbing supplies if payments to any vendor in the course of a year total at least $600. They will, in many cases, also have to report payments for things like travel and telephone and Internet service.  The annual reports must include the vendor’s address and taxpayer identification number.  In other words, if you buy more than $600 a year in gas from the corner station, you have file a 1099 for your payments to them and report it to the IRS.  Does anyone have time for this nonsense?

Understandably, businesses are denouncing the requirement.  Even the national taxpayer advocate at the Internal Revenue Service, Nina E. Olson, said the reporting burden might “turn out to be disproportionate as compared with any resulting improvement in tax compliance.”

Republicans want a full repeal. In a recent speech, the House Republican leader, Representative John A. Boehner of Ohio, said the “1099 mandate” showed how the health care law could “wreak havoc on employers and entrepreneurs.” Republicans also see this as just one example of  the intrusive role the I.R.S. will play in enforcing the health care law, including its requirement for most Americans to carry insurance.

In the end, we can see that tax policy and tax reform are linked to health reform (as is immigration reform as we have posted on previously).  In the end, we have believed that all Congress accomplished was to set up a system of reduced benefits for Medicare and increased fees and taxes to find a way to subsidize health insurance for the variously estimated 30 or so million without coverage, many of whom choose to be without coverage.  We are no fans of the health insurance industry, but saddling American citizens and businesses with onerous taxes and reporting requirements is not the way to go . . . obi jo and jomaxx

Many Push for Repeal of Tax Provision in Health Law – http://www.nytimes.com/2010/09/12/health/policy/12health.html?_r=1&emc=tnt&tntemail0=y

Movement to Repeal ObamaCare Tax Requirement Gains Momentum – http://www.thenewamerican.com/index.php/usnews/health-care/4584-movement-to-repeal-obamacare-tax-requirement-gains-momentum

Democrats join GOP in bid to repeal payment reports – http://www.newsobserver.com/2010/09/12/676676/democrats-join-gop-in-bid-to-repeal.html

Health care reform bill summary: powerful tax bombs, delayed fuses – http://www.csmonitor.com/Business/Tax-VOX/2010/0323/Health-care-reform-bill-summary-powerful-tax-bombs-delayed-fuses

Josten: Repeal the 1099 Reporting Mandate – http://www.rollcall.com/news/49737-1.html

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