tag:blogger.com,1999:blog-68718115796515634342024-02-19T06:42:35.903-08:00Health Reform WatchA Weblog of the Health Law & Policy Program of Seton Hall University School of LawUnknownnoreply@blogger.comBlogger72125tag:blogger.com,1999:blog-6871811579651563434.post-84724716842513547772009-07-30T10:26:00.000-07:002009-07-30T10:26:32.269-07:00Turning Up the Heat on Fraud and Abuse–Part of the Solution to Health Reform?<a href="http://www.healthreformwatch.com/2009/07/29/turning-up-the-heat-on-fraud-and-abuse-part-of-the-solution-to-health-reform/">Turning Up the Heat on Fraud and Abuse–Part of the Solution to Health Reform?</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-53308925565122130342009-07-21T16:49:00.000-07:002009-07-21T16:49:16.012-07:00Do You Want Rats in YOUR Baby’s Crib? The RNC Poses Some Questions<a href="http://www.healthreformwatch.com/2009/07/20/do-you-want-rats-in-your-babys-crib-the-rnc-poses-some-questions/">Do You Want Rats in YOUR Baby’s Crib? The RNC Poses Some Questions</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-56268652760669577782009-06-08T14:43:00.001-07:002009-06-08T14:43:51.765-07:00Making the Case for the Public Plan, Part I: The Difficulty of Private Health Insurance RegulationAs health reform <a href="http://www.nytimes.com/2009/06/07/magazine/07congress-t.html">moves to the top </a>of the Congressional agenda, we will be hearing a lot about a possible "<a href="http://www.concurringopinions.com/archives/2009/05/an-antitrust-angle-on-the-public-plan.html">public option</a>" in the plan. Earlier this Spring I began thinking about whether a public option was absolutely necessary to a successful reform. I started out hoping that it wasn't, because Republican leaders despise it, and Democrats have sometimes let the "<a href="http://www.princeton.edu/~starr/20starr.html">perfect be the enemy of the good</a>" in health reform. But I'm now convinced that a public option is necessary, and I hope to spend a few posts explaining why.<br /><br /><span class="fullpost"><br /><br />To begin with, we should get clear on exactly what insurers do. I have tried to summarize it in a one page chart, which appears <a href="http://law.shu.edu/publications/FacultyPublications/presentation/pasquale/pasquale_classifying_insurer_activities2.pdf">here</a>. The right column focuses on the purely positive role of insurers--how they add value to the health care system. With massive amounts of data at their disposal, they can identify best and worst providers, good and bad treatments, and even spot dangerous side effects in drugs and devices. They can invest in new technology to better process claims. To the extent that they retain long-term relationships with customers, they have an incentive to reduce costs by keeping those patients healthy. <br /><br />But the structure of the US health insurance market makes it difficult for most private insurers to respond to such incentives. About 21% of insurance policyholders <a href="http://wsomfaculty.case.edu/rebitzer/Employer-Based%20Insurance%20Markets%20and%20Investments%20in%20Health_02.pdf">cancel their plans </a>in any given year, meaning that the average customer's commitment to a plan lasts for about three years. That's just not enough time for an insurer to gain much investing in the health of its members.* There are many more profitable strategies--which lead me to the left side of the column, bad insurer practices.<br /><br />Health care costs are highly concentrated among a small portion of the population. As <a href="http://www.ahrq.gov/research/ria19/expendria.htm">AHRQ notes</a>, "Half of the population spends little or nothing on health care, while 5 percent of the population spends almost half of the total amount." (The famed 80/20 rule also applies in health care expenditures.) This creates almost irresistible pressures for private insurers to "risk select;" i.e., to <a href="http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1167043">avoid covering those who need care most</a>. While "pre-existing conditions" exclusions and <a href="http://www.latimes.com/features/health/medicine/la-ed-health5-2009jun05,0,81780.story">recissions</a> are most common in the individual insurance market, they and other tactics can undermine the idea of risk-pooling at the core of any feasible insurance scheme. Given that many private insurers began thriving by cherry picking (and lemon dropping) the healthiest (and sickest) customers, they have long resisted regulation of risk selection.<br /><br />But now, as the chances for reform increase, leading private insurers are beginning to <a href="http://www.pnhp.org/blog/2008/11/20/ahip-bcbsa-support-guaranteed-issue-and-individual-mandate/">soften their approach</a> in order to argue that a public plan is not necessary. They are promising to accept "guaranteed issue" coverage, "with no pre-existing condition exclusions." They have even promoted plans for "risk adjustment," which "spreads costs for the highest-risk individuals." Would regulation like that preclude the need for a public option? <br /><br />I don't think so, because there are so many other ways for insurance companies to drive away the sickest customers. As noted in the <a href="http://law.shu.edu/publications/FacultyPublications/presentation/pasquale/pasquale_classifying_insurer_activities2.pdf">chart</a>, subtler selection can include refusal to respond to needs of high cost patients in order to drive them away, and attracting a disproportionate share of low‐risk individuals. For example, a plan might decide to increase coverage of gyms and cosmetic procedures (to attract fit customers) and devise complex forms to be filled out monthly in order for a patient to get oxygen or insulin (to repel customers with congestive heart failure or diabetes). These are not merely hypothetical concerns. The Netherlands is often held up as a model for US reform because of recent moves there to make their traditionally solidaristic system more market-oriented. But risk selection <a href="http://content.healthaffairs.org/cgi/content/full/27/3/771">threatens to unravel </a>the Dutch "middle ground:"<br /><br /><blockquote>[After the Dutch moved in a more American direction, insurers] have more tools for managing care, which can also be used to select risks. . . . Insurers have more room to define the precise entitlements of their insured groups, which can be used to select favorable risks. Third, insurers are allowed to sell mandatory health insurance together with any other type of non–life insurance (such as supplementary health insurance, sick leave insurance, and car insurance), which prior to 2006 was not allowed. </blockquote><br /><br /><blockquote>In particular, supplementary health insurance can be an effective tool for risk selection, because insurers are allowed to reject applicants based on their health status. Fourth, insurers are free to give premium rebates to groups for the mandatory basic insurance, which prior to 2006 was not allowed. A group can have any risk composition, and the "organizer" of the group can selectively enroll preferred members only. Although the rebate for the basic insurance is at most 10 percent, insurers can give these groups any rebate on supplementary health insurance or other insurance products. . . . Given the increasing incentives and expanding tools for risk selection, further improvements of the risk-equalization method are necessary to prevent insurers from engaging in risk selection, which occurs, for example, in Switzerland.</blockquote><br /><br />US insurers are sure to import methods like that, and to continue along current lines of risk selection. As health policy expert <a href="http://finance.senate.gov/healthsummit2008/Statements/Karen%20Pollitz%20Testimony.pdf">Karen Pollitz</a> has noted, all of the following tactics can be used to risk select: <br /><br />--“Street” underwriting<br />--Selective marketing (including in competing markets)<br />--Renewal rating<br />--Closed blocks<br />--Benefit designs<br />--Payment practices<br />--Provider network design<br /><br />Congress or HHS or state insurance commissioners <span style="font-style:italic;">could</span> try to outlaw or restrict risk selection practices one by one. But as Pollitz has noted, as of 1997, the "US Department of Labor had resources to review each employer-sponsored group health plan under its jurisdiction once every 300 years." The Bush years probably did not significantly address that shortage. Moreover, "state insurance department staff levels declined 11% in 2007 while premium volume increased 12%." The personnel simply aren't there, and when they are, they are as likely as not to be outgunned by private sector attorneys, lobbyists, and experts-for-hire. The right way to discipline private insurers is to have competition from a public option--not to allow them to continue a risk-selection race-to-the-bottom by deflecting regulation. <br /><br />I have taught health care regulation at both Seton Hall and Yale Law Schools, and my students have always been dismayed by the cat-and-mouse games that regulators and insurers play to control (and evade control of) risk selection. I have very little faith that DOL, HHS, or their state equivalents (who are also often tasked with regulating life and auto insurance and banks) can really make private insurers accountable, no matter how ingeniously the insurance exchanges are designed. <br /><br />So that's a case for the public plan largely based on the problems with private insurance regulation. For a positive case, which I'll develop in my next post, I'll focus on the middle column of the chart--<a href="http://law.shu.edu/publications/FacultyPublications/presentation/pasquale/pasquale_classifying_insurer_activities2.pdf">eternally contested insurer actions</a> designed to ration access to providers.<br /><br />*For recognition of this problem in the context of bariatric surgery, and a creative plan for solving it, see Ronen Avraham and K.A.D. Camara, <em>The Tragedy of the Human Commons</em>, 29 <span style="font-style:italic;">Cardozo Law Review</span> 479 ("<a href="http://www.slate.com/id/2219033/">bariatric surgery</a> is just one example of insurers' failure to cover prospectively efficient treatments. A similar confluence of insureds switching insurers frequently, high transaction costs of individualized contracts, and medical-industry lobbying explain insurers' failure to cover other prospectively efficient treatments."). <br /><br />X-Posted: <a href="http://www.concurringopinions.com/?author=14">Concurring Opinions</a>. <br /></span>Frank Pasqualehttp://www.blogger.com/profile/06781189394947342774noreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-57161223686116199932009-05-13T13:41:00.000-07:002009-05-13T14:02:08.786-07:00Greaney on the Public PlanIs genuine health reform possible? Several recent developments are promising. President Obama's big Congressional majorities (plus the <a href="http://www.businessweek.com/ap/financialnews/D9844TH01.htm" target="_blank">Specter defection)</a> are reminiscent of the Johnson-era milieu that led to Medicare and Medicaid. Key interest groups are less "<a href="http://www.nytimes.com/2009/05/11/opinion/11krugman.html?_r=1&pagewanted=print">Harry and Louise</a>" and more "try to appease." Most importantly, the failures of managed care, consumer-directed health care, and other artifacts of the "ownership society" are now self-evident. As unemployment rises, lack of insurance spikes, <a href="http://uc.princeton.edu/main/index.php/component/content/article/4301">compounding the misery</a> of many of those unlucky enough to get thrown out of work.<br /><br />What could derail real health reform? Most likely, fake health care reform, particularly the kind that assumes there is something near a "<a href="http://bostonreview.net/BR34.3/baker.php">free market</a>" in operation now. As health care antitrust scholar Thomas Greaney <a href="http://www.stltoday.com/stltoday/news/stories.nsf/editorialcommentary/story/0A0D849E52BCD7D4862575B3007EECDF?OpenDocument">argued yesterday</a>, markets for health care are often very concentrated or riddled with barriers to entry: <br /><br /><blockquote>The unfortunate fact is that a majority of the country is served by a few dominant insurers. (In 16 states, one insurer accounts for more than 50 percent of private enrollment; in 36 states, three insurers have more than 65 percent of enrollment). Likewise, because of lax antitrust enforcement, most markets are characterized by dominant hospital systems and little competition among high-end physician specialists.</blockquote><br /><br /><blockquote>In these circumstances, which economists call 'bilateral monopoly," the players often reach an accommodation in which they share the monopoly profits rather than compete vigorously. A prime example is the <a href="http://www.healthbeatblog.com/2009/02/partners-in-power.html">experience in Massachusetts</a>, where Blue Cross/Blue Shield, the dominant insurer, reached an understanding with the dominant hospital system, Partners Healthcare, that entrenched higher prices for health insurance and hospital care.</blockquote><br /><br />Some might hold out hope that the Obama administration's <a href="http://www.nytimes.com/2009/05/12/business/economy/12antitrust.html">new emphasis</a> on antitrust enforcement might solve that problem, but I would not hold my breath. After losing <a href="http://content.healthaffairs.org/cgi/content/full/22/6/101">seven hospital merger cases </a>in a row, the government is not exactly in a position to go storming into health care markets to demand competition. Only <a href="http://baselinescenario.com/2009/05/03/zephyr-teachout/">new antitrust laws </a>are likely to accomplish much in that direction, and even if they were by some miracle adopted this year, I can't imagine them having much effect within any reasonable time frame.<br /><a name='more'></a><br />Rather than hoping for a magical market to provide care for all, it's time to realize that only a <a href="http://www.sharedprosperity.org/bp180.html">guaranteed public option</a> can optimally balance access, cost-control, and the type of value-based purchasing that leads to quality improvement. The public option now discussed by the Obama Administration and the Senate Finance Committee won't displace private insurance for the already insured. In fact, as Greaney notes, it may well help some private insurers by providing "a benchmark to hold up against private plans' quality and cost performance." The public option will almost certainly be one of many choices for health insurance consumers, expanding choice rather than constricting it.<br /><br />By providing transparent accounts of coverage decisions, the public plan may well spearhead the types of comparative effectiveness analysis and evidence-based medicine that all health scholars agree need to be at the heart of rational health policy. As Diane Archer <a href="http://energycommerce.house.gov/Press_111/20090402/testimony_archer.pdf">compellingly testified</a>, "disclosure of insurer medical and cost data would drive accountability from the private insurers and promote better behavior." In a sector as permeated by government subsidies and regulations as health care, a public plan option offers some hope that the demand side in health care can gain some bargaining power relative to the supply side.<br /><br />[X-Posted at <a href="http://www.concurringopinions.com/archives/2009/05/an-antitrust-angle-on-the-public-plan.html">Concurring Opinions</a>.]Frank Pasqualehttp://www.blogger.com/profile/06781189394947342774noreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-51144376429546242142009-03-06T10:29:00.001-08:002009-03-06T10:38:07.754-08:00The Life Cycle of Objectionable Drug Marketing Practices<em>[This is a guest post by </em><a href="http://www2.law.smu.edu/faculty/Cortez"><em>Nathan Cortez</em></a><em>, assistant professor of law at the Dedman School of Law at Southern Methodist University. Cortez has published in the peer-reviewed</em> Food and Drug Law Journal <em>and </em><a href="http://nathan.cortez.googlepages.com/"><em>teaches international health, pharmaceutical and administrative law</em></a><em>. I've learned a lot from his work, and I'm happy he's agreed to let me post this here.]</em><br /><br /><br />By Nathan Cortez<br /><br />The pharmaceutical industry spends some serious coin on sales and marketing—anywhere between <a href="http://medicine.plosjournals.org/archive/1549-1676/5/1/pdf/10.1371_journal.pmed.0050001-S.pdf">$30 billion and $57 billion</a> per year. And this money funds much more than the ubiquitous ad campaigns to which we’ve grown accustomed (sing along if you know the “<a href="http://www.youtube.com/watch?v=vne7ZqfPaD4">Viva Viagra</a>” jingle). Over the years, sales and marketing departments have conjured up increasingly creative marketing practices of questionable legality. For example, drug companies have funded “research” and “educational” grants of questionable validity, sponsored continuing medical education (CME), paid ghost writers to generate favorable journal articles, provided free gifts, meals, and entertainment to prescribers, paid prescribers as speakers, consultants, or preceptors, and even hired <a href="http://www.nytimes.com/2005/11/28/business/28cheer.html">former college cheerleaders</a> to gain access to prescribers. Most of these practices have been condemned, and many have been prosecuted, resulting in billions in settlements for federal and state governments. The pharmaceutical industry can’t even <a href="http://www.usdoj.gov/opa/pr/2001/October/513civ.htm">give away free drugs</a> without being punished.<br /><br />Last Monday, the <em>New York Times</em> highlighted yet another objectionable drug marketing practice: <a href="http://www.nytimes.com/2009/03/03/business/03medschool.html">targeting medical schools</a>. As the article explains, drug companies have long had ties to medical schools and their students by funding endowed chairs, faculty prizes, research grants, capital improvements, and even volunteering employees to teach classes. Students get showered with enough free pizza and trinkets to think that they might already have prescribing privileges. More recently, the Times reports that the faculty at Harvard Medical School has come under fire for its ties to drug companies that hire faculty as speakers, consultants, or even board members. More than 200 Harvard Med students have objected, leading the school to convene a 19-member panel to reevaluate the school’s conflict-of-interest policies (meanwhile, the <a href="http://www.startribune.com/business/40682112.html?page=1&c=y">University of Minnesota Medical School is loosening them</a>).<br /><br />In the “Life Cycle of Objectionable Drug Marketing Practices,” we’re currently at the “media coverage and public outrage” phase. Gradually, most of the practices listed in the initial paragraph have either disappeared or have lost their allure. Media coverage and public outrage is quickly followed by government outrage (<a href="http://www.nytimes.com/2009/03/04/business/04pfizer.html?em">possibly even Congressional hearings</a>) and promises of self-regulation by the drug companies to preempt more stringent regulation. Self-regulatory efforts like the <a href="http://www.phrma.org/files/PhRMA%20Marketing%20Code%202008.pdf">PhRMA Code</a> and the <a href="http://www.ama-assn.org/ama/pub/education-careers/continuing-medical-education/cme-credit-offerings/ama-cme-courses/ethical-guidelines-gifts-physicians-industry.shtml">AMA Ethical Guidelines</a> provide some bright-line standards for complying with ridiculously broad laws like the federal anti-kickback statute and its complicated <a href="http://oig.hhs.gov/fraud/safeharborregulations_archive.asp">safe harbors</a>. If companies still don’t get the hint, the government simply tells drug companies <a href="http://www.oig.hhs.gov/fraud/docs/complianceguidance/draftcpgpharm09272002.pdf">what not to do</a>.<br /><br />And if none of these events ends the Life Cycle of the Objectionable Drug Marketing Practice, litigation usually does. Pretty much every major pharmaceutical company has settled a <a href="http://www.oig.hhs.gov/fraud/cia/cia_list.asp">Corporate Integrity Agreement</a> with the government for violating federal drug marketing laws—the latest being a <a href="http://www.usdoj.gov/civil/ocl/cases/Cases/Eli_Lilly/index.htm">staggering $1.4 billion settlement</a> paid by Eli Lilly to settle claims that it illegally marketed its anti-psychotic drug Zyprexa. By settling, companies thus avoid the “death penalty”—being excluded from Medicare and Medicaid.<br /><br />Although the drug companies never die, the practices usually do, precipitated by an avalanche of government investigations, whistleblower suits, shareholder suits, and even marginally-related product liability suits. Federal and state lawmakers also pile on. In the last few years, nine states have enacted (and dozens have considered) <a href="http://www.ncsl.org/programs/health/rxads.htm">pharmaceutical marketing laws</a>, requiring disclosures of marketing payments made by drug companies to potential prescribers, in addition to caps on payments, disclosure of sales representative activities, and other prohibitions. Indeed, the Senate Finance Committee is currently considering a <a href="http://thomas.loc.gov/cgi-bin/query/z?c111:S.301:">federal bill</a> that would explicity preempt state laws.<br /><br />Thus, the Objectionable Drug Marketing Practice dies a violent death. It can rest in peace, but the sales and marketing departments can’t. Because they have to find new ways to drive market share.Frank Pasqualehttp://www.blogger.com/profile/06781189394947342774noreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-27715030850394062042009-02-15T22:05:00.000-08:002009-02-15T22:09:15.398-08:00We Have Moved to a New Website, Please Visit Us ThereWe Have Moved to a New Website, Please Visit Us <a href="http://www.healthreformwatch.com/">There </a><br />at<br /><br /><a href="http://www.healthreformwatch.com/"><span style="font-size:180%;">www.HEALTH REFORM WATCH.COM</span></a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-26401956320144037342009-02-11T11:33:00.000-08:002009-02-11T20:02:37.142-08:00New Candidates to Head HHS Emerge, Suspense Mounts<span style="font-family:arial;">Two additional candidates have emerged as possible nominees to be secretary of health and human services, <a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/02/10/AR2009021003600.html">reports</a> <span style="FONT-STYLE: italic">The Washington Post</span>. According to Democratic sources in and around the White House, those candidates are Lloyd Dean and Jack Lew.<br /><br /></span><span style="font-family:arial;">Dean is chief executive of San Francisco-based </span><span style="font-family:arial;"><a href="http://www.chwhealth.org/index.htm">Catholic Healthcare West</a></span><span style="font-family:arial;"> and was recently named one of the top 25 minority health care executives by <a href="http://www.modernhealthcare.com/">Modern Healthcare Magazine</a>. Lew was involved in health care reform during the Clinton Administration and worked in the White House <a href="http://www.whitehouse.gov/omb/">Office of Management and Budget</a>, according to <span style="FONT-STYLE: italic">The Post</span>. One small snag, reports <span style="FONT-STYLE: italic">The Post</span>, is that Lew was recently confirmed as deputy secretary of state.<br /><br /></span><span style="font-family:arial;">Yesterday we reported that <a href="http://www.healthreformwatch.com/2009/02/10/sebelius-podesta-on-obamas-short-list-to-replace-daschle/">Kansas Governor Kathleen Sebelius was at the top of Obama's list</a> to replace former Senator Tom Daschle as the nominee for U.S. Secretary of Health & Human Services. Sebelius removed herself from consideration for a cabinet position last December, citing the need to reform Kansas' budget. However, <span style="FONT-STYLE: italic">The Wall Street Journal </span><a href="http://online.wsj.com/article/SB123422196804465411.html">reports</a> that Gov. Sebelius told Ron Pollack, president of <a href="http://www.familiesusa.org/">Families USA</a>, that she would accept the nomination for secretary of health and human services. </span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-24752299985346765682009-02-10T08:02:00.000-08:002009-02-10T10:11:43.177-08:00Sebelius, Podesta on Obama's Short List to Replace Daschle<span style="font-family:arial;">We are pleased to announce that we have moved to a new website, <a href="http://www.healthreformwatch.com/">HealthReformWatch.com</a>. The article below, and a host of other new links and resources, may be found there and <a href="http://www.healthreformwatch.com/2009/02/10/sebelius-podesta-on-obamas-short-list-to-replace-daschle/">here</a>.<br /><br />A top official in the Obama administration says that Kansas Governor Kathleen Sebelius is at the top of the list to replace former Senator Tom Daschle as President Obama’s nominee for Secretary of Health & Human Services, <a href="http://www.kansascity.com/444/story/1023954.html">according</a> </span><span style="font-family:arial;">to the <em>AP/Kansas City Star</em>. This comes after <a href="http://www.healthreformwatch.com/2009/02/03/healthtaxes/">Daschle withdrew his nomination</a> </span><span style="font-family:arial;">last week, leaving many wondering about the future of U.S. health care reform.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">Sebelius has been praised by advocacy groups for the “watchdog role” that she played for eight years as insurance commissioner before she became governor. The Kansas Governor was an early supporter of Obama’s campaign for the presidency. After Obama won the election in November, she was in consideration for several cabinet posts. In early December though, she announced that she had removed herself from consideration for a Washington job, citing Kansas' budget problems that needed her attention.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">Also on Obama’s short list is former White House chief of staff under President Clinton, John Podesta, and Tennessee Governor Phil Bredeson. Some advocacy groups are reportedly lining up to oppose the nomination of the Democratic governor from Tennessee. Bredeson remains under consideration but was not as likely as Sebelius to make the final cut, the senior official said.</span><br /><br /><span style="font-family:arial;">As governor, Bredesen reduced the state's Medicaid beneficiaries by 170,000 adults in 2005 as a result of budget constraints, and reduced benefits for thousands more TennCare beneficiaries, <a href="http://www.statesman.com/news/content/shared-gen/ap/US_Presidential_Cabinet/HHS_Bredesen.html">according</a> to the <em>AP/Austin American-Statesman</em>. <span style="font-family:arial;">In 1980, Bredesen founded a health maintenance organization called HealthAmerica Corp., which became the country's second-largest HMO before he sold it in 1986 for about $400 million.</span><br /></span><br /><span style="font-family:arial;">Critics of Bredesen, who say he has administered the largest public health insurance cuts in U.S. history, say that the cuts illustrate why he is "the wrong person to lead an effort to expand health insurance coverage."</span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:Arial;">Others argue that Bredesen had to make difficult decisions that ultimately led to the preservation of Tennessee's struggling health care system, thereby averting disaster. </span><br /><span style="font-family:Arial;"></span><br /><span style="font-family:arial;"></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-77840586783369135342009-02-07T14:07:00.000-08:002009-02-07T14:16:50.559-08:00LoJacking Grandma and "Reality Mining," or "Daddy, What was Anonymity?"We have moved to another website, <a href="http://www.healthreformwatch.com/">HealthReformWatch.com</a> and you may find this post <a href="http://www.healthreformwatch.com/2009/02/07/lojacking-grandma-and-reality-mining-or-daddy-what-was-anonymity/">here</a>.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-41099714362265825612009-02-05T10:33:00.000-08:002009-02-05T10:46:26.745-08:00In the Wake of Daschle's Withdrawal, Obama Signs Bill to Expand SCHIP Coverage<span style="font-family:arial;">President Obama signed the bill extending health coverage to millions of low-income children yesterday after it the House gave final approval, </span><a href="http://www.nytimes.com/2009/02/05/us/politics/05health.html?_r=1"><span style="font-family:arial;">according</span></a><span style="font-family:arial;"> to <em>The New York Times</em>. Many see this as a signal of the president’s clear intention to guarantee coverage for all Americans.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">Since August 2007, the House has voted at least seven times for legislation to expand the popular </span><a title="More articles about the State Children's Health Insurance Program (S-CHIP)." href="http://www.cms.hhs.gov/home/schip.asp"><span style="font-family:arial;">State Children’s Health Insurance Program</span></a><span style="font-family:arial;">. In a recent blog we explained how </span><a href="http://healthreformwatch.blogspot.com/2009/01/bill-before-congress-would-extend.html"><span style="font-family:arial;">Former-president George W. Bush twice vetoed similar legislation</span></a><span style="font-family:arial;">. Bush adamantly opposed the legislation on the ground that it would lead to “government-run health care for every American,” reports <em>The Times</em>.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">Rep. Henry A. Waxman, a California Democrat said that the bill was “a down payment” and “an essential start” to the ultimate goal of health reform. Speaker Nancy Pelosi proclaimed the passage and signing of the bill as the result of the last fall’s historic presidential election, stating:</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;"><blockquote><span style="font-family:arial;">“This is the beginning of the change that the American people voted for in the last election, and that we will achieve with President Barack Obama.”</span> </blockquote></span><br /><span style="font-family:arial;">One of the major features of the bill is that it allows states to cover certain legal immigrants, who are currently barred from <a href="http://www.cms.hhs.gov/home/medicaid.asp">Medicaid</a> and the State Children’s Health Insurance Program for five years after they enter the United States.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">According to <em>The Times</em>:</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;"><blockquote><span style="font-family:arial;">“The bill requires states to verify that people covered by the children’s health program are United States citizens or legal residents. But states are given a new option. Instead of requiring people to produce documents showing citizenship, states can try to verify eligibility by matching a person’s name and </span><span style="font-family:arial;">Social Security</span><span style="font-family:arial;"> number against federal records.”</span> </blockquote></span><br /><span style="font-family:arial;">In addition to allowing states to extend coverage to legal immigrants without requiring five years of residence, the bill also requires states to provide dental care and equal coverage of mental and physicial illnesses – or “mental health parity" – under the children’s health program.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">Expansion of the State Children’s Health Insurance Program comes as <a href="http://healthreformwatch.blogspot.com/2009/02/health-taxes.html">Tom Daschle’s withdrawal from nomination for Secretary of Health & Human Services</a> has many worried that the "overhaul" of the U.S. health care system could be seriously delayed, </span><a href="http://www.medicalnewstoday.com/articles/137947.php"><span style="font-family:arial;">according</span></a><span style="font-family:arial;"> to Medical News Today.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;"><blockquote><span style="font-family:arial;">"Obama is unlikely to find someone with both the health policy experience and congressional connections of Daschle,"</span><br /></blockquote></span><br /><a href="http://corporate.cq.com/wmspage.cfm?parm1=12"><span style="font-family:arial;">reports</span></a><span style="font-family:arial;"> CQ Today.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-15311221572134736652009-02-03T11:08:00.000-08:002009-02-10T08:45:46.996-08:00Health & Taxes<span style="font-family:arial;">Only a few short months ago, Barack Obama was elected President of the United States of America. Supporters rejoiced, “Yes we did!” Shortly after that historic event, then President-elect Obama announced his nomination of former senator Tom Daschle to be his secretary of health and human services. Advocates of universal health care reform were ecstatic. </span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">With the release of <em><a href="http://books.google.com/books?id=b4ZOip6AqK8C&printsec=frontcover&dq=critical+daschle&ei=VpeISZibB4mENtT5pKoF">Critical: What We Can Do About the Health-Care Crisis</a></em> and his nomination for U.S. Secretary of Health and Human Services, it seemed that Tom Daschle was the solution to all of our nation's health care woes: a fragmented and inefficient patchwork of public and private payors, rising costs, too many government ties to the private sector, and a lack of uniformity on the proper spelling of “health care."</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">Yet it appears that <em>that</em> dream is over: Daschle announced today that he is </span><a href="http://www.cnn.com/2009/POLITICS/02/03/daschle/index.html"><span style="font-family:arial;">withdrawing his nomination</span></a><span style="font-family:arial;"> for Secretary of Health and Human Services. CNN.com </span><a href="http://www.cnn.com/2009/POLITICS/02/03/daschle/index.html"><span style="font-family:arial;">reports</span></a><span style="font-family:arial;"> that, in announcing his withdrawal, Daschle said:</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;"><blockquote><span style="font-family:arial;">“[I]f 30 years of exposure to the challenges inherent in our system has taught me anything, it has taught me that this work will require a leader who can operate with the full faith of Congress and the American people, and without distraction."</span></blockquote></span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">The president said Tuesday he accepts Daschle's decision "with sadness and regret," </span><a href="http://www.cnn.com/2009/POLITICS/02/03/daschle/index.html"><span style="font-family:arial;">according</span></a><span style="font-family:arial;"> to CNN.com.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">Daschle’s withdrawal comes just hours after a <em>New York Times</em> </span><a href="http://www.nytimes.com/2009/02/03/opinion/03tue1.html"><span style="font-family:arial;">editorial</span></a><span style="font-family:arial;"> was published calling for him to step down. Citing Daschle’s “failure to pay substantial taxes that were owed and his sizable income from health-related companies while he worked in the private sector, “ <em>The</em> <em>Times</em> stated its belief that: </span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;"><blockquote><span style="font-family:arial;">“Mr. Daschle ought to step aside and let the president choose a less-blemished successor.”</span></blockquote></span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;"><em>The Times</em> furthered its demand, stating:</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;"><blockquote><span style="font-family:arial;">“Mr. Daschle’s financial ties to major players in the health care industry may prove to be even more troublesome as health reform efforts proceed. Like many former power players in Washington, Mr. Daschle cashed in on his political savvy and influence to earn $5 million in recent years, including more than $2 million from Alston & Bird, a law and lobbying firm; more than $2 million from the private equity firm, InterMedia Advisors, which provided the car and driver; and hundreds of thousands of dollars for speeches to interest groups, including those representing health insurance plans, medical equipment distributors and pharmacy boards.”</span></blockquote></span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">and</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;"><blockquote><span style="font-family:arial;">“Although Mr. Daschle was not a registered lobbyist, he offered policy advice to the UnitedHealth Group, a huge insurance conglomerate. He was also a trustee of the Mayo Clinic in Minnesota, on whose behalf he voiced opposition to a federal loan for a freight rail line near the clinic’s headquarters in Rochester, Minn.”</span></blockquote></span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">White House press secretary Robert Gibbs said on Tuesday that while the president is disappointed at Daschle's withdrawal, the issue of health reform is “bigger than any one person.” Gibbs stated that the Obama administration has set the bar for ethics “higher than any administration in the history of the United States.”</span><br /><br /><span style="font-family:arial;">News of Daschle's withdrawal is sure to bring criticism to President Obama for his cabinet choices, especially in light of the recent controversy surrounding Timothy Geithner's failure to pay taxes.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-68319779678107824172009-02-02T13:44:00.000-08:002009-02-02T14:05:31.876-08:00HHS OIG Report Finds Part D Private Insurers Overcharged for Billions, Lack of CMS Oversight<span style="font-family:arial;">According to a recent report by the <a href="http://www.oig.hhs.gov/">Department of Health & Human Services, Office of Inspector General</a>, private insurance companies that operate plans under the Medicare prescription drug benefit have overcharged Medicare beneficiaries and the program by several billion dollars since the program began in 2006.</span><span style="font-family:arial;"><br /><br />According to the report, 80% of health insurers that operate plans under the Medicare prescription drug benefit overcharged the program by about $4.4 billion in 2006 alone. </span><span style="font-family:arial;">In addition, The McClatchy/Raleigh <span style="font-style: italic;">News & Observer</span> <a href="http://www.newsobserver.com/politics/story/1389623.html">reports</a> that the <a href="http://www.cms.hhs.gov/">Centers for Medicare & Medicaid Services</a> (CMS) remains unaware of the total impact of the practice because of its failure to perform required audits.<br /><br /></span><span style="font-family:arial;">The prescription drug benefit was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). Under the MMA, CMS contracts with private insurance companies to provide drug coverage to Medicare beneficiaries. Each insurer offers a bid, which represents the company's estimate of the average monthly revenue it would need to provide the basic prescription drug benefit to each beneficiary.</span><span style="font-family:arial;"><br /><br />CMS is required to complete financial audits of at least a third of all the insurance companies that offer the prescription drug benefit to determine how they set their prices. For 2006, CMS was required to perform 165 audits. However, according to the report, the Inspector General found that, as of April, CMS had begun only seven, or 4 percent.</span><span style="font-family:arial;"><br /><br />According to the report, there are 158 other audits from 2006 remaining to be done and audits for 2007 and 2008 waiting in the wings. It is estimated that problems found in the first year of the program aren't likely to be fixed before 2010.<br /><br /></span><span style="font-family:arial;">In response to the Inspector General's findings, the <span style="font-style: italic;">News & Observer</span> reports that Sen. Claire McCaskill, a Missouri Democrat, said:<br /><br /></span><span style="font-family:arial;"><blockquote>"It shows a mind-set that could care less about wasting taxpayer money, that has no problem with padding profits of drug companies with hard-earned taxpayer dollars."</blockquote><br /><br /></span><span style="font-family:arial;">The Inspector General's report comes as Congressional Democrats last week introduced <a href="http://healthreformwatch.blogspot.com/2009/01/new-bill-to-create-prescription-drug.html">a bill that would allow Original Medicare to establish one or more plans to compete with private Medicare drug plans</a>.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-22520210391719770972009-01-29T20:39:00.000-08:002009-02-15T22:03:51.452-08:00Health Care, "Common Sense" and a Global Health Blogging Experiment<span style="font-family:arial;">We have moved to another website, please find the post "Health Care, "Common Sense" and a Global Health Blogging Experiment" <a href="http://www.healthreformwatch.com/2009/01/29/health-care-common-sense-and-a-global-health-blogging-experiment/">here</a>.<br /><br />Today,<a href="http://www.healthreformwatch.com/2009/01/29/health-care-common-sense-and-a-global-health-blogging-experiment/"> </a><a href="http://www.healthreformwatch.com/2009/01/29/health-care-common-sense-and-a-global-health-blogging-experiment/">Health Reform Watch</a> is participating in a “<a href="http://globalhealthreport.blogspot.com/2009/01/proposed-global-health-blogging.html">Global Health Blogging experiment</a>” coordinated by <a href="http://homepage.mac.com/cgnewyork/cgormanhealth2/christine.html">Christine Gorman</a> of <a href="http://globalhealthreport.blogspot.com/">Global Health Report</a>. Health Bloggers from around the world will all be converging to discuss a topic: for today, “prevention v. treatment,” and, to some extent—the underlying realities in which this experiment in synchronized dissemination is being conducted as they relate to global health concerns. I thought I’d take a look at the “to some extent.”</span><br /><br /><span style="font-family:arial;">Ms. Gorman proposed this idea as a means of assembling something of a critical mass to explore issues regarding “Global Health” and as a means of gauging the mass of that mass. In addition to organizing the assemblage, Ms. Gorman also asked some <a href="http://globalhealthreport.blogspot.com/2009/01/community-organizing-meets-global.html">prescient questions</a> about the nature of the medium and the endeavor itself. It is here that I will focus.</span><br /><br /><span style="font-family:arial;">She asks,</span><br /><br /><span style="font-family:arial;"></span><blockquote><span style="font-family:arial;">Is a social network around global health news starting to emerge organically on the web? What can we do to nurture it? Do economic realities dictate that this will have to be a volunteer led endeavor, at least for a while?</span></blockquote><br /><span style="font-family:arial;"></span><blockquote><span style="font-family:arial;">Or, another way of putting that last question: Is news about global health subject to the same market failures that afflict products for global health (e.g. free-market forces alone will not lead to new tuberculosis medications and other drugs that affect mostly the poorest people in the world)?</span><br /></blockquote><br /><span style="font-family:arial;">These are good questions. And as I think about the economic forces and the affect of such upon the dissemination of information, I find myself thinking that even with the emergence of a somewhat new journalistic paradigm—the blog— the dissemination of information is still largely governed by the older rule: zero sum. And this goes for time and money—as well as focus. </span><br /><br /><span style="font-family:arial;">In many ways the blog is merely the modern progeny of its paper ancestor—the pamphlet, a time honored medium purveyed by amateur and psuedo-professional journalists and would be statesmen with some design on shaping policy and the contours of their fellow citizens’ minds. But it is perhaps important to remember that <a href="http://en.wikipedia.org/wiki/Thomas_Paine">Thomas Paine’s</a> revolutionary <a href="http://commons.wikimedia.org/wiki/File:Commonsense.jpg%20picture"><span style="font-style: italic;">Common Sense</span></a>, perhaps the most famous and influential American pamphlet of all time, was sold for a price—and it sold very well (it should be noted though that Paine donated his royalties to George Washington’s Continental Army <a href="http://books.google.com/books?id=gSb4xNZQ-4QC&pg=PA90&lpg=PA90&dq=cover+price++%22common+sense%22+thomas+paine&source=web&ots=DN5aQlX4Fh&sig=4J1l-nI7BgvkIKbY-AcBoUC6CFs&hl=en&sa=X&oi=book_result&resnum=9&ct=result">for the procurement of mittens</a>). It did not hurt sales that the first printing appeared at a time when King George had just denounced the Colonies to Parliament. <span style="font-style: italic;">Common Sense</span> was of the moment; "Global Health" is not.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">Media has always been largely about timing. Certainly one of the reasons why Thomas Paine’s tract became so very popular is because it fomented revolution—at a time when revolution was in the air. </span><br /><br /><span style="font-family:arial;">To the extent that the U.S. is to play a role, the timing for global health concerns doesn’t seem to be particularly auspicious.</span><br /><br /><span style="font-family:arial;">In this country, at present, domestic health care reform is “in the air.” And as this country struggles to take hold of the many pronged beast which health reform and universal coverage is—one might imagine that the attention of many—who might otherwise be drawn to the deplorable conditions in health care experienced elsewhere, may, understandably, find themselves drawn to issues closer to home. </span><br /><br /><span style="font-family:arial;">There are times, due to circumstances, in which one’s labor is multiplied by the <span style="font-style: italic;">zeitgeist</span>. As it pertains to U.S. health care, this is one of those times. But the <span style="font-style: italic;">zeitgeist</span> is also capable of division: simply put, in 1776 if Thomas Paine had written instead about the plight of the French, the Continental Army would have had cold hands. </span><br /><br /><span style="font-family:arial;">I have no doubt that in this age of international commerce and intercontinental flight, no one is more than a few hours away from <a href="http://law.shu.edu/journals/lawreview/symposium/oct08/index.htm">the onset of widespread disease</a>—and I am well familiar with John Donne’s imperative; I know that <a href="http://healthreformwatch.blogspot.com/2009/01/ringing-in-new-year-in-health-care-for.html">the bell doth toll for me</a>. But I also know that this country has functioned for years without a comprehensive health care system—and that now seems to be the time to remedy that.</span><br /><br /><span style="font-family:arial;">As such, one might imagine that members of the field, living in the U.S., who may have written and focused on both domestic and international health care in the past, may well find reason to devote their attention more fully to matters domestic at this internally critical time. I would suggest that as America seeks to resolve its own health care issues, this may be a determinate factor for the attention (or lack thereof) to global health issues. Zero sum.</span><br /><br /><span style="font-family:arial;">But all is not lost. After American Independence, Paine got around to helping the French. In 1791 Thomas Paine wrote the very popular <a href="http://en.wikipedia.org/wiki/Thomas_Paine"><span style="font-style: italic;">Rights of Man</span></a> which defended the French Revolution against Edmund Burke’s attack in Reflections on the Revolution in France (1790). In 1792, despite not speaking French, Paine was elected to the French National Convention.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-84993689305333780162009-01-28T11:05:00.000-08:002009-01-28T11:27:16.970-08:00New Bill to Create Prescription Drug Benefit Through Original Medicare Comes As CMS Expansion of Off-Label Drugs for Cancer Treatment Draws Criticism<span style="font-family:arial;">Yesterday, Congressional Democrats introduced legislation (<a href="http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.684:">HR 684</a>, <a href="http://thomas.loc.gov/cgi-bin/query/z?c111:s.330:">S 330</a>) that would allow Original Medicare to establish one or more plans to compete with private plans under the Part D prescription drug benefit, according to <a href="http://corporate.cq.com/wmspage.cfm?parm1=95"><span style="font-style: italic;">CQ HealthBeat</span></a>. The legislation would also require the Secretary of Health and Human Services to negotiate directly with pharmaceutical companies for the prices of medications under Part D.</span><span style="font-family:arial;"><br /><br />Additionally, it would strengthen the ability of Medicare beneficiaries to appeal denials of coverage for medically necessary medications under all Medicare Part D plans. </span><span style="font-family:arial;"><br /><br />The bill was sponsored by Senate Majority Whip Richard Durbin (D-Ill.) and Reps. Marion Berry (D-Ark.) and Jan Schakowsky (D-Ill.). According to Berry, the plans established by Medicare would have the ability to obtain discounts on medications that private plans could not match.<br /><br />Rep. Schakowsky claimed:</span><br /><br /><span style="font-family:arial;"><blockquote>"Under our bill, seniors and people with disabilities would finally be able to select a Medicare-operated drug plan that provides a guaranteed benefit without having to worry that their premiums will drastically increase or their access to needed drugs will drastically decrease each year."<span style="font-family:arial;"></span></blockquote><br /><br /><a href="http://www.phrma.org/">Pharmaceutical Research and Manufacturers of America</a> Senior Vice President Ken Johnson said that the group had begun to review the legislation and pledged to work with sponsors to help Medicare beneficiaries obtain medically necessary medications. Johnson added that:<br /><br /><br /><span style="font-family:arial;"><blockquote>"It's important to note, however, that the competitive market approach of the Medicare drug benefit is working well for patients and taxpayers."<span style="font-family:arial;"></span></blockquote><br /><br />Supporters of the bill disagree with this statement, including <a href="http://www.medicarerights.org/">Medicare Rights Center</a>, which has long advocated for the addition of a drug coverage option to Original Medicare. The organization claims, in its report <a href="http://www.medicarerights.org/pdf/The_Best_Medicine.pdf"><span style="font-style: italic;">The Best Medicine,</span></a> that private prescription drug plans create higher costs, gaps in coverage, instability, and the danger of consumer confusion and marketing fraud.</span><span style="font-family:arial;"><br /><br />Rep. Berry added that:</span><br /><br /><span style="font-family:arial;"><blockquote>"If this works as we think it will, most of the private plans would drop out [of the Medicare prescription drug benefit]."</blockquote></span><span style="font-family:arial;"><br /><br />This comes as a <a href="http://www.cms.hhs.gov/">Centers for Medicare and Medicaid</a> ruling last fall allowing the coverage of drugs for off-label uses to treat cancer patients has begun to draw controversy. <span style="font-style: italic;">The New York Times</span> <a href="http://www.nytimes.com/2009/01/27/health/27cancer.html?_r=1">reports</a> that the new ruling changed the authority of drug compendiums. </span><span style="font-family:arial;"><br /><br />Previously, Medicare representatives were supposed to consult compendiums and use their own discretion to interpret recommendations in determining coverage. Under the new ruling, the decision now is based only on the compendiums, "even when there is little clinical evidence behind a particular recommendation," according to <span style="font-style: italic;">The Times</span>.</span><span style="font-family:arial;"><br /><br />The problem with the new ruling, says <span style="font-style: italic;">The Times</span>, is that there are possible conflicts of interest because "some of these new compendiums have close financial ties to the drug industry." Additionally, <span style="font-style: italic;">The Times</span> reports that "it is hard to predict how much" Medicare spending on cancer drugs could increase as a result of the new rules because Medicare officials canceled a cost analysis of the changes.<br /><br />It added:<br /></span><br /><span style="font-family:arial;"><blockquote>"[The changes] seem almost certain to raise the federal drug bill," which could make it "more difficult for the new administration to rein in spending on unproven medical treatments." </blockquote></span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-35768246620973553062009-01-26T18:20:00.000-08:002009-01-26T18:35:25.956-08:00CMS Ruling May Pose Serious Problems for New York Seniors<span style="font-family:arial;">Federal law protects married couples from having to choose between divorcing and becoming impoverished when one spouse needs expensive nursing home care. For 20 years, this law allowed the healthier spouse to retain income and assets while the sicker spouse is covered by <a href="http://www.cms.hhs.gov/home/medicaid.asp">Medicaid</a>. </span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">In <a href="http://www.state.ny.us/">New York State</a>, the same benefit has been extended to people with illnesses like Alzheimer's disease or cancer who receive care at home, which is both less expensive and less disruptive to relationships. </span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">That benefit may no longer be available to the spouses of those patients receiving care at home, <a href="http://www.nytimes.com/2009/01/24/nyregion/24spouse.html?_r=1&em)">according to</a> <em>The New York Times</em>. Last fall, the <a href="http://www.cms.hhs.gov/">Centers for Medicare and Medicaid Services</a> sent a letter to New York health officials outlining a legal ruling declaring that couples in which both partners live at home are not entitled to the same protection as those couples where one spouse is in a nursing home.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">According to the article, </span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;"><blockquote><span style="font-family:arial;">"The change was originally supposed to go into effect in December, but the Paterson administration and the New York Congressional delegation have won a delay until March 1, and are hoping that President Obama will reverse the Bush administration’s ruling."</span></blockquote></span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">Federal Medicaid officials say that:</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;"><blockquote><span style="font-family:arial;">"[W]hen Congress gave the states the option to extend the so-called spousal impoverishment protections to home health care, it intended to protect only the neediest people, and that New York State is protecting people with too much retirement income."</span></blockquote></span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">So far, the ruling has been subject to several vocal opponents, including Senator Charles E. Schumer, a New York Democrat, who said:</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;"><blockquote><span style="font-family:arial;">“[The New York] policy makes imminent sense to ensure that seniors and the spouses who care for them do not fall in to poverty." </span></blockquote></span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">and </span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;"><blockquote><span style="font-family:arial;">"The Bush administration is trying to pull the rug out from under thousands of seniors in New York who depend on this critical program year in and year out just to survive.”</span></blockquote></span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">The state Health Department estimates that 3,000 couples will be affected by this change, while advocates for the elderly say the number is closer to 4,000. </span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">Several thousand couples may be faced with a difficult choice this March. If the federal protection ceases to apply to those patients who receive care at home, the inevitable choice for many couples will be to forego keeping their current home care with a Medicaid "spend-down" for the long-term care option protected by federal law. </span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">Clearly, the shift of 4,000 patients to long-term care would increase overall cost; a burden that would have to be shouldered by the Medicaid program. Moreover, it raises concerns about the quality of care those patients going from home-based care to long-term care will receive.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-38898370177813138262009-01-25T18:11:00.000-08:002009-01-25T18:13:08.674-08:00Prolegomena to Prononymity: What's the Worst that Can Happen?America <a href="http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1238358">needs electronic medical records</a> (EMR). There are plenty of reasons why we are so far behind other nations in consolidating medical data: lack of strong central leadership on the issue, unwarranted faith in markets to produce solutions, and overwhelmed medical professionals who have little if any slack time to put a new system into place. Even as President Obama pushes for investment in EMR, <a href="http://www.nytimes.com/2009/01/18/us/politics/18health.html?_r=1&scp=1&sq=push%20to%20link%20medical%20data&st=cse">privacy concerns</a> are also slowing down progress: <br /><br /><blockquote>Lawmakers, caught in a crossfire of lobbying by the health care industry and consumer groups, have been unable to agree on privacy safeguards that would allow patients to control the use of their medical records. . . . The data in medical records has great potential commercial value. Several companies, for example, buy and sell huge amounts of data on the prescribing habits of doctors, and the information has proved invaluable to pharmaceutical sales representatives.</blockquote><br /><br /><blockquote>“Health I.T. without privacy is an excellent way for companies to establish a gold mine of information that can be used to increase profits, promote expensive drugs, cherry-pick patients who are cheaper to insure and market directly to consumers,” said Dr. Deborah C. Peel, coordinator of the Coalition for Patient Privacy, which includes the American Civil Liberties Union among its members.</blockquote><br /><br />Health IT turns out to be one many areas where a drive for prononymity--that is, the de-anonymizing of records of on- and off-line life--is running up against a wall of wary citizens and consumers. In the health field, I think that resistance is only going to end if we have a robust "backstop" of health care in place so that citizens don't have to worry about losing all coverage if a digital dossier presents them as a bad risk. (Medicaid as presently constituted <a href="http://www.nytimes.com/2009/01/22/us/22medicaid.html?ref=your-money">does not count</a>.) Far from overwhelming the health care system with pent-up demand, universal health coverage may be a prerequisite for generating support for the type of EMR that will provide us all with far better care.<br /><br />A trend to prononymity in general should be matched with greater commitment to assuring that it won't result in particularly harsh results. For example, people should not be denied a job for being<a href="http://lawprofessors.typepad.com/laborprof_blog/2009/01/political-hirin.html"> identifiable as a Democrat</a> in a blog post, whatever Monica Goodling thinks. Nor should doctor's notes about a patient's dark thoughts come back to haunt the patient when she or he applies for medical insurance. And if they do, there should be a genuine insurer of last resort available--not the patchwork of Medicaid and charity care that presently leave so many uninsured people <a href="http://www.newyorker.com/reporting/2009/01/26/090126fa_fact_gawande">falling through the cracks</a>. <br /><br />That's one reason why I advocate the development of a Fair Reputation Reporting Act, which would allow individuals to know the documentary basis of certain key adverse decisions. I summarize the proposal <a href="http://www.law.uchicago.edu/events/index.html?Event=447">here</a>: <br /><br /><blockquote>Reputation regulation has become essential because traditional restrictions on data flows inadequately constrain decisionmakers and important intermediaries (including search engines and bulletin boards). . . . Persistent and searchable databases now feed unprecedented amounts of poorly vetted information into vital decisions about employment, credit, and insurance. Rumors about a person's sexual orientation (or experiences), health status, incompetence, or nastiness can percolate in blogs and message boards.</blockquote><br /><br /><blockquote>Even if the First Amendment and anonymity protect the authors of such rumors, affected individuals deserve to know whether certain important decisionmakers rely on them. In limited cases, the intermediary source of the information should also provide the target of a derogatory posting with the opportunity to annotate it. A Fair Reputation Reporting Act would empower individuals to know the basis of adverse employment, credit, and insurance decisions—and to go to their source (and the source of their salience) to demand some relief from digital scarlet letters.</blockquote><br /><br />In summary, privacy concerns are only likely to die down if individuals know either 1) that the consequences of a privacy breach are not likely to be severe or 2) that they can find out instances of the improper use of data. In the health care context in the US, neither qualifier holds: the individual insurance market <a href="http://www.scribd.com/doc/11256238/HarpersMagazine2009020082380">routinely denies</a> care to individuals on the basis of pre-existing conditions, and individuals have little sense of exactly how such determinations are made. Prononymity needs to work both ways: if our health conditions are to be the subject of increasing availability, so too must the decision-making processes that could use that data to our detriment become more transparent. <br /><br />PS: Market mavens may promote a "Google Health Search" as the optimal solution here. If this 800 pound gorilla can get all the publishers in line to settle their copyright claims, perhaps it has some chance at bringing the medical industry to heel; however, the political power of doctors and insurers dwarfs that of publishers. The concentration of that much data in one company should also provoke some worries.Frank Pasqualehttp://www.blogger.com/profile/06781189394947342774noreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-35802769085981441612009-01-23T19:51:00.000-08:002009-01-23T20:07:33.707-08:00Bill Would Require Transparency of Physician Relationships with Pharma, Medical Device Companies<span style="font-family:arial;">Yesterday Sens. Chuck Grassley (R-Iowa) and Herb Kohl (D-Wis.) announced a bill (S 301) that would require pharmaceutical and medical device companies to publicly disclose any gifts and payments to physicians valued at $100 or more per calendar year, according to </span><a href="http://corporate.cq.com/wmspage.cfm?parm1=95"><em><span style="font-family:arial;">CQ Healthbeat</span></em></a><span style="font-family:arial;">.<br /><br />The bill introduced yesterday requires companies to report such gifts and payments to the </span><a href="http://www.hhs.gov/"><span style="font-family:arial;">U.S. Department of Health & Human Services</span></a><span style="font-family:arial;"> once per year. Similar legislation introduced last year would have required quarterly disclosure of gifts or payments over $25 per year.<br /><br />Additionally, if passed, the legislation would pre-empt state laws that require disclosure of gifts and payments to physicians.<br /><br />So far, the bill has gathered support from various sectors. Proponents of the bill argue that it will allow patients to “fully trust the relationship they have with their doctor.”<br /><br />Representatives of the pharmaceutical and medical device industry have expressed support for a “uniform national standard . . . [as opposed to] a patchwork approach by all 50 states.”<br /><br />It seems that the only group unlikely to support the proposed legislation is physicians. However, the bill allows for physicians to contest the reports made by pharmaceutical and medical device companies, which would be reviewed by Health & Human Services.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-7737947368552286602009-01-23T00:40:00.000-08:002009-01-23T01:13:58.900-08:00More Prescriptions Go Unfilled, is Uncle Sam “Penny Wise?”<meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CMichael%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="PlaceName"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="PlaceType"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="country-region"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id="ieooui"></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:Wingdings; panose-1:5 0 0 0 0 0 0 0 0 0; mso-font-charset:2; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:0 268435456 0 0 -2147483648 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} a:link, span.MsoHyperlink {color:blue; text-decoration:underline; text-underline:single;} a:visited, span.MsoHyperlinkFollowed {color:purple; text-decoration:underline; text-underline:single;} p {mso-margin-top-alt:auto; margin-right:0in; mso-margin-bottom-alt:auto; margin-left:0in; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:1882551735; mso-list-template-ids:1967788912;} @list l0:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in; mso-ansi-font-size:10.0pt; font-family:Symbol;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--><o:p></o:p><span style="font-family:arial;">The New York Times <a href="http://www.nytimes.com/2009/01/23/health/23drug.html?_r=1">reports</a> that “One in seven Americans under age 65 went without prescribed medicines in 2007” and that “that figure is up substantially since 2003, when one in 10 people under 65 went without a prescription drug because they couldn’t afford it, according to the Center for Studying Health System Change in Washington, D.C.”
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<br />The Times also reported that Laurie E. Felland, a senior health researcher at the center and lead author of the study, noted that because these numbers are from 2007, they may well be higher now due to the <a href="http://healthreformwatch.blogspot.com/2009/01/normal-0-false-false-false.html">recession</a>.
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<br />“The people who were least able to afford medicine were often those who needed it most, Ms. Felland said: uninsured, working-age adults suffering from at least one chronic medical condition. Almost two-thirds of them in the survey said they had gone without filling a prescription.”
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<br />The affect among those with chronic conditions is particularly disturbing in light of the data on the relative expense of treating chronic conditions, and the additional expense that neglect in treatment can cause. The Department of Health and Human Services (HHS) has reported that
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<br /><span style="font-weight: bold;"><a href="http://www.ahrq.gov/research/ria19/expendria.htm#MostExpensive"></a></span></span><span style="font-family:arial;"><span style="font-weight: bold;"><a href="http://www.ahrq.gov/research/ria19/expendria.htm#MostExpensive"></a></span></span><blockquote><span style="font-family:arial;"><span style="font-weight: bold;"><a href="http://www.ahrq.gov/research/ria19/expendria.htm#MostExpensive">Chronic Conditions Contribute to Higher Health Care Costs</a>
<br /></span>
<br />Twenty-five percent of the U.S. community population were reported to have one or more of five major chronic conditions: ·
<br /></span><ul><li><span style="font-family:arial;">Mood disorders </span></li><li><span style="font-family:arial;">Diabetes </span></li><li><span style="font-family:arial;">Heart disease </span></li><li><span style="font-family:arial;">Asthma </span></li><li><span style="font-family:arial;">Hypertension </span></li></ul><span style="font-family:arial;">
<br />Spending to treat these five conditions alone amounted to $62.3 billion in 1996. Moreover, people with chronic conditions tend to have other conditions and illnesses. <span style="font-weight: bold;">
<br />
<br />When the other illnesses are added in, total expenses for people with these five major chronic conditions rise to $270 billion, or 49 percent of total health care costs</span>, according to 1996 MEPS data. On an individual level, treatment for the average patient with asthma was $663 per year in 1996, but when the full cost of care for asthma and other coexistent illnesses is taken into account, the average cost was $2,779.
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<br />Expenses for people with one chronic condition were twice as great as for those without any chronic conditions. Spending for those with five or more chronic conditions was about 14 times greater than spending for those without any chronic conditions. Persons with five or more conditions also have high hospital expenditures. In New York State during 2002, of the 1.3 million different persons admitted to the hospital, the 27 percent with five or more chronic conditions accounted for 47 percent of all inpatient costs. (emphasis added, footnotes omitted).</span><span style="font-family:arial;">
<br /></span></blockquote><span style="font-family:arial;">
<br />Perhaps as we consider the large number of persons with chronic conditions who are not taking prescribed medications, we should also consider <a href="http://healthreformwatch.blogspot.com/search?q=medicaid+california">a recent five-year retrospective study </a>of almost 5 million California residents which found that “People who have spotty Medicaid coverage are more than three times likelier than those who maintain continuous coverage to be hospitalized for an illness that could have been managed outside the hospital with doctors’ visits and medication.”
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<br />Hospitalization is expensive.
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<br />Also, as we noted in a recent post, <a href="http://www.kff.org/medicare/medicare082108nr.cfm">the Kaiser Foundation has shown</a> that many seniors , who account for a great deal of the health expense in this country (but are not included in the </span><span style="font-family:arial;">the Center for Studying Health System Change report)</span><span style="font-family:arial;">, also cease or diminish the use of their medications as a result of “<a href="http://healthreformwatch.blogspot.com/2009/01/donut-holes-how-much-is-that.html">the donut hole</a>” in Medicare prescription drug coverage—a gap in coverage which leaves many seniors “on their own” for payments of thousands of dollars per year.
<br /></span><p><a href="http://healthreformwatch.blogspot.com/2009/01/donut-holes-how-much-is-that.html"></a></p> Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-6871811579651563434.post-56240694353972611652009-01-21T20:41:00.000-08:002009-01-21T21:01:22.098-08:00Health Care Jobs Up, & Expected to Stay That Way<meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CMichael%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="City"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id="ieooui"></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p face="arial" class="MsoNormal"></p><span style="font-family: arial;">The sickness of one is the work of the other. <span style="font-style: italic;">The Wall Street Journal</span> <a href="http://online.wsj.com/article/BT-CO-20090120-716545.html">reports</a> that “Health care saw a net gain of 419,000 jobs in 2008 and its growth outlook continues to be strong through 2016, according to the Bureau of Labor Statistics.”
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<br />According to <span style="font-style: italic;">WSJ</span>, Dennis Damp, “the Pittsburgh, Pa.-based author of ‘Healthcare Job Explosion’ and editor of Healthcarejobs.org, a free recruiting Web site,” said that “about half of the BLS' 30 fastest-growing occupations through 2016 are health-related.”
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<br />An examination of the latest BLS <a href="http://www.bls.gov/news.release/pdf/empsit.pdf">report</a> (p. 25) shows that employment numbers were up in every category of health care jobs tracked. <span style="font-style: italic;">WSJ</span> reports that “among specific occupations, the number of registered nurses grew the most, adding 168,000 jobs through November as hospitals and agencies tried to address a nationwide nursing shortage.”
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<br /><span style="font-style: italic;">The Journal</span> also reports that “The number of home care aides grew by 64,000 in 2008, the BLS said. Office and administrative support workers such as medical-records clerks accounted for 14% of the overall increase in health-care jobs year over year.” That 14% increase would be equivalent to approximately 59,000 jobs.
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<br />John Challenger, chief executive of outplacement consulting firm Challenger, Gray & Christmas in Chicago is reported by <span style="font-style: italic;">WSJ</span> to have said that in health care, "Long-term forces are outweighing the short-term recessionary forces." Mr. Challenger cited “the aging of the baby boomers, rapid product development in biotechnology and increased momentum for comprehensive national health-care reform” as being “likely to drive job growth this year.”
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<br />Mr. Challenger also noted that "There's strong demand for <a href="http://healthreformwatch.blogspot.com/2008/12/model-wanted.html">geriatricians</a>, physical therapists and nurses of all kinds….noting support work is hot as well, especially as the incoming Obama administration takes up health reform. 'A commitment to a new kind of more universal health-care system is going to create a new structure and consequently new jobs."</span>
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<br /> <span style="font-family: arial;">Read the full WSJ article <a href="http://online.wsj.com/article/BT-CO-20090120-716545.html">here</a>. </span><p class="MsoNormal"><span style="" lang="EN"><span style="font-family:arial;"></span><o:p></o:p></span></p> Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-6871811579651563434.post-16115776791930917522009-01-21T00:15:00.000-08:002009-01-21T00:59:47.741-08:00Health Care and Productivity, a National Cost<span style="font-family: arial;">Having just returned from my family physician (who stayed open past hours to see me), perhaps you will forgive me if, not feeling well myself, I dwell for a moment upon the cost of illness and inefficiency. Not as a matter of out of pocket cost, <span style="font-style: italic;">per se</span>, but as a matter of <a href="http://healthreformwatch.blogspot.com/2009/01/ringing-in-new-year-in-health-care-for.html">macroeconomic cost</a>—a roughshod (I am sick) calculus based upon diminished productivity and national opportunity cost: simply put, if I am busy being sick, I may well have to forego the productivity of work—or I may perform that work at a lesser level ( I suppose this post will tell).<br /><br /></span><span style="font-family: arial;">In addition, if my family physician and his staff of two are grudgingly forced to devote numerous hours to a maddening array of paperwork and phone calls (“it gets worse every year”) in an attempt to navigate the various streams of insurance authorizations and payments (“some of it seems designed solely to frustrate and slow or prevent payment”) —he will not be seeing patients. Tomorrow, he will not be seeing patients; he will be trying to catch up on paperwork—as will his staff.<br /><br /></span><span style="font-family: arial;">Perhaps then, when we consider that Health Care costs amount to <a href="http://www.washingtonpost.com/wp-dyn/content/article/2006/01/09/AR2006010901932.html">16% of the GDP</a>, we might also consider that this number does not take into account the <a href="http://www.joem.org/pt/re/joem/abstract.00043764-199911000-00005.htm;jsessionid=J2jBDLr6kvMYySyHGrRS3cSRfyPytL0SSyv2hvlyYxM7NDhvp2xw%2197158217%21181195629%218091%21-1">difficult to guage loss </a>of national <a href="http://cat.inist.fr/?aModele=afficheN&cpsidt=16785591">productivity</a>. And although the sickness of one can be the work of another, the exchange does not seem to be an even one as it relates to national production: the doctor functioning, in a sense, as a support and enabler to the productivity of others. Having said that, if that doctor is unavailable (through lack of insurance or remoteness) to remedy the ills of the now unproductive (or the less productive) the nation suffers for it. If the doctor is needlessly enmeshed in tasks, inefficient and ancillary to patient treatment, the nation suffers for it.<br /> </span><br /><span style="font-family: arial;">One of the first national health lessons this country received came on the heels of World War I. </span><br /><span style="font-family: arial;"></span><blockquote><span style="font-family: arial;"><a href="http://www.unm.edu/%7Elkravitz/Article%20folder/history.html">With the United States' entry into the battle</a>, hundreds of thousands of military personnel were drafted and trained for combat. After the war was fought and won, statistics were released from the draft with disturbing data regarding fitness levels. It was found that one out of every three drafted individuals was unfit for combat and many of those drafted were highly unfit prior to military training. Government legislation was passed that ordered the improvement of physical education programs within the public schools. </span></blockquote><br /><span style="font-family: arial;"></span><blockquote><span style="font-family: arial;"><a href="http://www.bordeninstitute.army.mil/published_volumes/mpmvol1/pm1ch7.pdf">During</a> the period from September 1917 through November 1918, records show that 2,801,635 men were inducted into the Army. Out of the approximately 10,000,000 registered men, roughly 2,510,000 were examined by local draft boards. During the first 4 months of mobilization, roughly one in three men were rejected on physical grounds, but the rejection rate dropped to one in four during the following 8 months. (p. 149)<br /></span></blockquote><br /><span style="font-family: arial;">Having put forth the effort to remedy such, we were better physically prepared when it came time to fight World War II. We will be fortunate if some cataclysmic event does not lead us now to some statistical reckoning of our “unfit” and “extremely unfit” as regards our national productivity.<br /><br /></span><span style="font-family: arial;">I do not point this out as a means of suggesting that we need to actively prepare ourselves for some form of larger global military conflict. But perhaps in some ways the “event” has already occurred, and only the reckoning remains. In his<a href="http://news.aol.com/main/inauguration/article/text-of-obama-inaugural-address/312186"> inaugural address</a> President Barack Obama entreated us: </span><br /><span style="font-family: arial;"></span><blockquote><span style="font-family: arial;">"Let it be told to the future world ... that in the depth of winter, when nothing but hope and virtue could survive...that the city and the country, alarmed at one common danger, came forth to meet (it)."</span></blockquote><br /><br /><span style="font-family: arial;"></span><blockquote><span style="font-family: arial;">America, in the face of our common dangers, in this winter of our hardship, let us remember these timeless words. With hope and virtue, let us brave once more the icy currents, and endure what storms may come. Let it be said by our children's children that when we were tested we refused to let this journey end, that we did not turn back nor did we falter; and with eyes fixed on the horizon and God's grace upon us, we carried forth that great gift of freedom and delivered it safely to future generations.</span><br /></blockquote><br /><span style="font-family: arial;">He’s right. We must "come forth to meet it." We cannot turn back and we cannot falter as we struggle to deliver this hard won gift of freedom to future generations. And it would be best if as we brave these icy currents in this winter of our hardship-- we were not sick. And if we were sick, that we all had doctors. And if we all had doctors, that they were not too busy filling out paperwork designed to frustrate them. As we learned through World War I, as a nation, we simply cannot afford to squander our physical and intellectual capital.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-76323525864034179772009-01-18T23:30:00.000-08:002009-01-19T00:50:19.830-08:00Dr. David Brailer and Electronic Medical Records: Perhaps the Chairman Doth Protest Too Much<meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CMichael%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="PlaceName"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="PlaceType"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id="ieooui"></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:Wingdings; panose-1:5 0 0 0 0 0 0 0 0 0; mso-font-charset:2; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:0 268435456 0 0 -2147483648 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} p {mso-margin-top-alt:auto; margin-right:0in; mso-margin-bottom-alt:auto; margin-left:0in; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:846481975; mso-list-template-ids:-1214630064;} @list l0:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in; mso-ansi-font-size:10.0pt; font-family:Symbol;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--><span style="font-family: arial;">Dr. David J. Brailer, appointed by President Bush in 2004 as the first National Coordinator for Health Information Technology, has written an article for <a style="font-style: italic;" href="http://healthaffairs.org/blog/2009/01/14/complete-the-work-on-health-information-technology/">Health Affairs</a> worth reading. Dr. Brailer notes that President-elect Obama “has pledged $50 billion to bring health information tools into widespread use (which is $49,950,000 more than President Bush gave me to spend).” (Note: as the present budget for the office of National Coordinator is a little more than $66 million, I believe Dr. Brailer meant to say that the budget during his tenure was roughly $50 million, which would make Obama’s $50 billion $49,950,000,<span style="font-weight: bold;">000</span> more. Apparently, I’m not the only one <a href="http://healthreformwatch.blogspot.com/2009/01/b-here-b-there-how-much-is-that.html">confused by billions</a>).
<br />
<br />Having said that, Dr. Brailer has some suggestions worth noting, not the least of which is that ensuring structural compatibility and integration of data systems are paramount necessities which will require more than just “hiring the geek squad.” He states
<br />
<br /><blockquote>Setting up an electronic health record is a complex task, requiring data integration, clinical algorithms and complex software customization. Likewise, helping physicians and other health care workers learn to work with electronic tools is more than point-and-click training. Electronic health records change the very nature of health care work – clinical decision-making, communications, documentation and learning. Our national transition to digital medicine requires a large supply of specialists – upwards of 50,000 people, including physicians, nurses and pharmacists – who understand both clinical medicine and information technology. It takes years to train these people, and they are already in short supply, so now is the time to start.
<br /></blockquote>
<br />I have no contention with the assertion that “setting up an electronic health record is a complex task,” and surely, at the end of a $50 billion investment no one wants to look up to see a Med e-record Tower of Babel. But Dr. Brailer’s assertion that “helping physicians and other health care workers learn to work with electronic tools is more than point-and-click training” is somewhat at odds with recent <a href="http://www.nytimes.com/2008/12/27/business/27record.html?_r=2">articles in <span style="font-style: italic;">The</span> <span style="font-style: italic;">NY Times</span></a>, one of which shows <a href="http://www.nytimes.com/imagepages/2008/12/26/business/20081227_RECORDS_GRAPHIC.html">what an electronic medical record looks like</a> and explains how pertinent and potentially life saving information “is just a few clicks away.”
<br />
<br />Dr. Brailer also states that we need to address what he characterizes as
<br />
<br /><blockquote>the growing chasm between the physicians and hospitals that have electronic records and those that do not. Most large and urban hospitals as well as larger physician practices are far along in using electronic health records. Rural hospitals, nursing homes and small physician practices lag far behind. They face many barriers, but foremost among them is the lack of capital to purchase and implement information tools. </blockquote>
<br />
<br />Dr. Brailer states that “Sales pipelines and hospital and physician budgets show that electronic health record purchases have slowed, indicating that the market wave has gone as far as it can. Now is the time for government incentives to help along those who do not have these systems.”
<br />
<br />But Brailer wants to incentivize the “use” of electronic medical records much in the way that Congress has done so regarding “electronic prescribing.” He states: “Medicare pays physicians a 2% bonus for using eprescribing on appropriate patients starting in 2009, and this incentive converts to a 3% penalty for those who do not eprescribe in 2013.”
<br />
<br />Of course, Brailer is right to make the distinction between "purchase" and "use." No one wants to subsidize a high tech, dust gathering coat rack. He makes the point that “We should not incent physicians and hospitals simply to purchase electronic records. We get no benefit when a physician or hospital buys an electronic record. What we should do is reward the use of these tools as part of a patient’s care.”
<br />
<br />What he fails to address, however, in this incremental ROI “pay for use” approach is what he characterizes as the “foremost barrier” to those “Rural hospitals, nursing homes and small physician practices” on the other side of e-med record chasm: initial capital outlay.
<br />
<br />Considering<a href="http://healthreformwatch.blogspot.com/2008/12/hospitals-face-losses-some-close.html"> the financial difficulties of many hospitals—and the chilled credit markets</a>— it is somewhat difficult to envision how the gradual return on investment through “pay for use” will offer great affect for those medical service providers who, at present, have a “lack of capital to purchase and implement information tools.” It is not, however, hard to envision how such a continuous “pay for use” incentive would benefit those larger providers who have already implemented electronic medical record systems.
<br />
<br />Additional payments each time they used what they have already invested in would, no doubt, provide an additional dividend which these typically larger providers would greatly appreciate. It is not at all clear, however, that such a program, requiring significant investments of capital—which may well not be available at this time—will lessen the “chasm” by any great measure.
<br />
<br /><span style="font-style: italic;">The New York Times</span> has <a href="http://www.nytimes.com/2008/12/27/business/27record.html?_r=1">reported</a> that
<br /></span><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} a:link, span.MsoHyperlink {color:blue; text-decoration:underline; text-underline:single;} a:visited, span.MsoHyperlinkFollowed {color:purple; text-decoration:underline; text-underline:single;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]-->
<br /><blockquote><span style="font-family: arial;">For most doctors, who work in small practices, an investment in electronic health records looks simply like a cost for which they will not be reimbursed. That is why policy experts say any government financial incentives to use electronic records — matching grants or other subsidies — should be focused on practices with 10 or fewer doctors, which still account for three-fourths of all doctors in this country. Only about 17 percent of the nation’s physicians are using computerized patient records, according to a government-sponsored survey published in The</span> New England Journal Of Medicine.</blockquote><span style="font-family: arial;">The Times also reports that those who are presently using electronic medical records tend to be part of larger health care organizations.</span>
<br />
<br /><span style="font-family: arial;">No longer the </span><span style="font-family: arial;">National Coordinator for Health Information Technology</span><span style="font-family: arial;">, Dr. Brailer is now the Chairman of <a href="http://www.healthevolutionpartners.com/index.htm">Health Evolution Partners</a>; it is a health care <a href="http://www.healthevolutionpartners.com/focus.html">investment fund</a>:
<br />
<br />“Health Evolution Partners invests in the world’s leading health care companies. We seek out companies that are driving critical shifts in how health care is financed, organized and delivered.”
<br />
<br /><a href="http://www.healthevolutionpartners.com/about.html">….We use these assets to help our portfolio companies:</a>
<br /></span><ul><li><span style="font-family: arial;">Build strategies with unusually high potential </span></li><li><span style="font-family: arial;">Navigate and mitigate business, policy and regulatory risks </span></li><li><span style="font-family: arial;">Develop and shape the market for their products and services </span></li><li><span style="font-family: arial;">Enhance the growth and returns for their shareholders</span></li></ul><p class="MsoNormal"><span style="font-family: Arial;"></span></p><span style="font-family: arial;"></span><p style="margin-left: 0.5in; text-indent: -0.25in;"></p> Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-46087870094720986672009-01-17T00:45:00.000-08:002009-01-17T01:25:48.040-08:00A “B” Here, a “B” There… How Much is That?<span style="font-family:arial;">“House Democrats Announce $825B Economic Stimulus Package With $157B for Health Care”</span><br /><br /><span style="font-family:arial;">That is the title of a well written and informative article from <a href="http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=56503">Kaiser</a> (1/16). The title is, for the most part, self explanatory— and the funding breakdown, especially as it regards health care, is explained well enough within the article itself—at least for today. It is a two year $825 billion "stimulus package."</span><br /><br /><span style="font-family:arial;">The breakdown alone could be the subject of at least ten posts, and will ultimately amount to what I’m sure will be countless discussions and debates in the months to come. As well it should. For the moment, however, it may be sufficient to merely read the article. And maybe attempt some perspective.</span><br /><br /><span style="font-family:arial;">I hate to admit this, but I really don't know how much a billion is. I can grasp millions (I can just multiply the value of my house—though the multiplier has grown considerably over the last few years) but billions escape me (considering TARP, that last phrase may be more apt than I am comfortable with). But…</span><br /><br /><span style="font-family:arial;">A billion is a thousand million. It is written 1,000,000,000.<br /><br />I do not find that particularly helpful, but it’s a start.</span><br /><br /><span style="font-family:arial;">Years ago, the United States produced $1000 bills; Grover Cleveland graces the front of them and there are said to be a number of them still in <a href="http://www.thesilvercurrencyexchange.com/Currency/1000-dollar-US-bill-front.jpg">existence</a>. It is also <a href="http://www.youtube.com/watch?v=um0guhNGPPM">said</a> that if you tightly stacked 1 billion dollars in clean crisp thousand dollar bills and piled them—they would rise 63 miles into the air. If you did the same for $825 billion the stack would rise 51,975 miles into the air. Commercial jets generally fly at around 7.7 miles in the air. The circumference of the earth at the equator is roughly 24,901 miles—that’s twice around and then some. And remember, these are <span style="font-style: italic;">thousand dollar bills</span>.</span><br /><br /><span style="font-family:arial;">It is estimated that to count from one to a billion would take you <a href="http://mathforum.org/%7Esanders/geometry/GP10BillionEtc.html">95 years</a>. To count to 825 billion would take you at least 78,375 years. It will not take us nearly as long to spend it.</span><br /><br /><span style="font-family:arial;">And by the way, 825 billion is just 175 billion short of a trillion. A trillion is a thousand billion, or a million million, and is written 1,000,000,000,000. </span><br /><br /><span style="font-family:arial;">And yes, I find this even less helpful. But my guess is, before the two years are up, we'll have to figure out what "a trillion" is as well.<br /></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-44378586315295487182009-01-15T09:43:00.000-08:002009-01-15T10:16:53.305-08:00Is the Medicare Advantage Program Really Advantageous?<span style="font-family:arial;"><span style="font-style: italic;">CQ Politics</span> <a href="http://www.cqpolitics.com/wmspage.cfm?docid=news-000003007221">reports</a> that President-elect <a href="http://change.gov/">Obama</a> is committed to the elimination of Medicare Advantage plans. Obama told ABC's "This Week" that Medicare Advantage plans are an example of cost-cutting government initiatives that do not work. </span><br /><span style="font-family:arial;"><br />This is especially interesting in light of the <a href="http://www.cms.hhs.gov/">Centers for Medicare and Medicaid Services</a> ordering <a href="http://www.wellpoint.com/">WellPoint</a> to temporarily suspend enrollment and marketing efforts for its Medicare plans on Monday. <span style="font-style: italic;">The Los Angeles Times</span> <a href="http://www.latimes.com/news/local/valley/la-fi-wellpoint13-2009jan13,0,7448212.story">reports</a> that the sanctions followed a "sharp" increase in complaints. Reportedly, some customers of WellPoint were unable to receive their prescription drugs while others were o</span><span style="font-family:arial;">vercharged because of computer mistakes. </span><br /><span style="font-family:arial;"><br />Along with President-elect Obama, Senate Majority Leader Harry Reid (Nev.) has signaled his intent to "scale back" the Medicare Advantage Program, according to <a href="http://thehill.com/leading-the-news/obama-reid-take-dead--aim-at-medicare-hmos-2009-01-14.html%29"><span style="font-style: italic;">The Hill</span></a>. Medicare Advantage plans offer health insurance to more than 10 million of the 45 million Medicare benficiaries. However, the Medicare Payment Advisory Committee <a href="http://www.medpac.gov/">reports</a> that Medicare Advantage plans cost the government 13% more per beneficiary on average than Original Medicare in 2008. </span><br /><span style="font-family:arial;"><br />Democrats say that $15 billion of the annual $94 billion in subsidies granted to Medicare Advantage plans are the result of "overpayments."</span><br /><span style="font-family:arial;"><br />Surely, any attempt to eliminate Medicare Advantage plans from the Medicare program will be met with fierce opposition from private insurance companies. In response to the threat of elimination, <a href="http://www.ahip.org/">America's Health Insurance Companies</a> said that the so-called "overpayments" are used to help purchase prescription drug coverage, vision care, and chiropractic services for which Original Medicare does not pay. </span><br /><span style="font-family:arial;"><br />There may be some merit to this argument as Original Medicare is lacking in many crucial coverage areas, including dental services which left untreated can be fatal. Thus, it is quite possible that the elimination of Medicare Advantage plans could result in many seniors facing</span><br /><br /><span style="font-family:arial;"><blockquote>reduced benefits, limited health care choices and higher out-of-pocket costs,</blockquote> </span><span style="font-family:arial;"><br />according to America's Health Insurance Companies.</span>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-6871811579651563434.post-25758574096927250452009-01-14T21:32:00.000-08:002009-01-14T22:18:19.671-08:00Surgical Checklist Said to Save Lives & Money<meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CMichael%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="State"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="City"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="country-region"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id="ieooui"></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal"></p><span style="font-family: arial;">The use of a basic <a href="http://content.nejm.org/cgi/data/NEJMsa0810119/DC1/1">checklist</a> was shown to be associated with a substantial decrease in surgical deaths and complications. In what the <a href="http://apnews.myway.com/article/20090114/D95N6TNG1.html">A.P</a>. referred to as a “a large international study of how to avoid blatant operating room mistakes,” researchers found a 47 per cent decrease in death and a more than one third decrease in complications—from 11% to 7%-- concomitant with the use of a 19 point checklist designed by the World Health Organization.
<br />
<br /><span style="font-style: italic;">A.P</span> reports that regarding the <a href="http://content.nejm.org/cgi/content/full/NEJMsa0810119v1/T1">elements on the list</a> (many of which concern matters such as verifying the patient’s identification, marking the area to be incised with a magic marker, discussing patient allergies and surgical team member responsibilities, and accounting for all needles, sponges and instruments after the surgery) </span><span style="font-family: arial;"> <blockquote>U.S. hospitals have been required since 2004 to take some of these precautions. But the 19-item checklist used in the study was far more detailed than what is required or what many institutions do.
<br />
<br />The researchers estimated that implementing the longer checklist in all U.S. operating rooms would save at least $15 billion a year. </blockquote>
<br />The study, which was conducted in both “wealthy” and “poor” nations in eight city hospitals across the world (including Seattle, Washington), was published in the <a href="http://content.nejm.org/cgi/content/full/NEJMsa0810119">New England Journal of Medicine</a>; its results were said to have “startled the researchers.”</span><p class="MsoNormal"></p> Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6871811579651563434.post-63813712382057527112009-01-13T15:22:00.000-08:002009-01-14T09:52:37.057-08:00Bill Before Congress Would Extend Health Insurance to Children of Legal Immigrants Sooner<span style="font-family:arial;"><em>The New York Times</em> </span><a href="http://www.nytimes.com/2009/01/13/us/13health.html"><span style="font-family:arial;">reports</span></a><span style="font-family:arial;"> that Congress will likely pass a bill to provide health insurance to millions of low-income children. Similar legislation was twice vetoed by President Bush in 2007.<br /></span><br /><span style="font-family:arial;">Under the proposed legislation, states would have the option to restore health insurance benefits to legal immigrants under 21 as well as pregnant women. Currently, legal immigrants are barred from </span><a href="http://www.cms.hhs.gov/home/medicaid.asp"><span style="font-family:arial;">Medicaid</span></a><span style="font-family:arial;"> and the </span><a href="http://www.cms.hhs.gov/home/schip.asp"><span style="font-family:arial;">State <span style="color:#800080;">Children's </span>Health Insurance Program </span></a><span style="font-family:arial;">for the first five years after they enter the United States.<br /><br /></span><span style="font-family:arial;"></span><span style="font-family:arial;">It is estimated that 400,000 to 600,000 immigrant children are affected by the restriction currently in place. <em>The Times</em> notes that:</span><br /><span style="font-family:arial;"></span><br /><br /><span style="font-family:arial;"><blockquote><span style="font-family:arial;">Among children, legal immigrants are less likely to<br />receive immunizations and routine dental care.</span></blockquote></span><br /><span style="font-family:arial;">and</span><br /><br /><span style="font-family:arial;"><blockquote><span style="font-family:arial;">[A]mong women, legal immigrants are less likely to receive<br />prenatal care.</span></blockquote></span><br /><span style="font-family:arial;">Opponents of the bill argue that the original purpose of program—to serve the children of the working poor—has not been fulfilled, raising concerns about extending it to legal immigrants and others groups not originally contemplated.<br /></span><br /><span style="font-family:arial;">Others argue that the expected costs of the bill would be too great. The program currently covers about 6.6 million children and costs the federal government $5 billion a year. <em>The Times</em> estimates that the passage of the bill could double the annual expense of the program. The expanded program proposed by the new bill would be financed by tobacco taxes.<br /></span><br /><span style="font-family:arial;">President-elect </span><a href="http://change.gov/"><span style="font-family:arial;">Obama</span></a><span style="font-family:arial;"> has already expressed his support for allowing states to offer health insurance to legal immigrant children before the five-year waiting period is met.<br /></span><br /><span style="font-family:arial;">Generally, the bill is garnering significant support from various sectors. Many people feel that all children should have health insurance. There is great support for this proposition as well. By extending health insurance to more children including legal immigrants, not only will children in need of care be provided for, but by providing greater access to preventive care, states will reduce overall health care costs .</span>Unknownnoreply@blogger.com0