Debate surrounds practice of bypassing local hospitals to get patients to specialty centers August 14, 2008
Posted by Obi Jo in health insurance, health reform, patient care.Tags: health insurance, healthcare, Hospitals, medical care access, patient care, patients, Physicians
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Critics are skeptical? No need for skepticism if you are the one in the ambulance. No thanks, take me to the specialty center please. Isn’t there a famous line that goes something like a “mind is a terrible thing to waste”. That is especially true if it is your brain you are talking about. Much of the complaining comes from insurance companies who do not want to pay more (or pay at all really) than THEY feel is necessary for a patient’s care. In the end, the best for the patient’s health should be the only consideration. If your brain were on the line, what would you do? . . . jomaxx
from USA Today . . . Bypassing closer hospitals to rush people with blood clots or bleeding in their brains to specialty hospitals is an increasingly common way to deliver the most advanced care as soon as possible.” This “treatment model is similar to the one developed years ago to help save the lives of those severely injured in accidents or by violence by passing local hospitals to reach one of the 255 U.S. trauma centers.” There are, however, “some in the medical community are skeptical about emergency crews bypassing community hospitals in favor of farther-away stroke centers.” Critics argue that “many patients who don’t stand to benefit from cutting-edge, and often experimental, care at specialty centers could get quality care at smaller hospitals.” Currently, four states “certify hospitals as stroke centers, and 43 more states have at least some hospitals that are certified by health quality groups,” such as “stroke centers.”
Joint Commission says physician outbursts threaten patient safety August 14, 2008
Posted by Obi Jo in health reform.Tags: healthcare, Hospitals, Joint Commission, medical staffs, patients, physician behavior, Physicians
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Well, it should come as no surprise that physicians and surgeons “act out” on occasion. The fact is that most of the time, the acting out is in response to inept, poorly trained, overworked, understaffed and underpaid medical staff, some of whom are often rude and lazy. In most cases, physicians are responding based on their concern for their patients. There is also an element of overwork, needless oversight, excess paperwork etc., etc., which play a role.
To be sure, there are physicians and surgeons who are well known for their “behavior”. However, while this may be undesirable and in some cases unacceptable, it is also unacceptable to create a climate where emotion, anger, frustration and intolerance for incompetence are stifled due to a desire by many for “politically correct” behavior and speech. Giving this kind of “thought control” to hospitals, health plans and insurance companies is unacceptable.
Actions alone, not words or emotions, should be the only criteria for judging physicians and surgeons. As is pointed out, some of the “worst offenders” in the eyes of hospital administrators and nurses are among the biggest admitters. Did anyone stop to think why those doctors might be in that position? Could it be that patients and the community know that those physicians take care of business and do not tolerate inferior care being given to their patients? The Joint Commission has for a long time been an organization whose mission has wandered farther and farther from real issues of patient care and this is just one more example of that . . . jomaxx
from the Boston Globe . . . The Joint Commission (JC), the national group that accredits healthcare organizations, “is requiring all hospitals, nursing homes, and other healthcare facilities to adopt ‘zero-tolerance’ policies by Jan. 1, including codes of conduct, ways to encourage staff to report bad behavior, and a process for helping and, if necessary, disciplining offenders.” An increasing amount of “research suggest[s] that swearing, yelling, and throwing objects are not just rude and offensive to co-workers, but hurt patients by increasing the likelihood of medical errors.” Last month, the JC “issued a safety alert to hospitals…, saying outbursts threaten patient safety because they prevent caregivers from working as a team.” According to Peter Angood, M.D., chief patient safety officer for the JC, “most hospitals have tolerated healthcare road rage to the point where it has become an accepted part of the culture.” Moreover, some say “[t]hat can be particularly true…in high-stakes surgery, a field that can attract high-intensity physicians who are used to being in charge.”
link to this article @ http://www.boston.com/news/local/massachusetts/articles/2008/08/10/hospitals_try_to_calm_doctors_outbursts/
from American Medical News. . . But, other physicians argue that “disruptive behavior policies, which can cover everything from criminal assaults to condescension, are often too vague, and [can be] used against physicians who may step on toes when advocating for patients, or who own competing specialty hospitals and ambulatory surgical centers,” Meanwhile, “[s]ome worry that the commission’s actions could make it easier for hospitals to target outspoken medical staff members.”
link to this article @ http://www.ama-assn.org/amednews/2008/08/18/prl20818.htm
AMA signals support of “truly interoperable” electronic health records August 11, 2008
Posted by Obi Jo in E Health, EHR (electronic health records), health reform.Tags: E Health, EHR (electronic health records), EMR, health, health care reform, health reform
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Everyone wants electronic medical (health) records. However, paying for them and deciding which format to use are the two major unanswered questions. We have seen technology battles over the past 30 years, such as: phonograph records versus 8 track tapes, 8 track tape versus cassettes, cassettes versus CD’s, beta versus VHS, VHS versus DVD, and now DVD versus Blue Ray . . . get the point. Not to mention the computer battles (Windows, Apple and so forth). Physicians cannot afford to retool over and over unless there is going to be some mechanism to help underwrite those costs. Inevitably, a web based solution is likely to be the most economical, feasible. This would also have the added benefits of being able to be monitored and upgraded on a regular basis relative cheaply . . . jomaxx
Costs forcing many Americans to delay or decline medical care August 11, 2008
Posted by Obi Jo in Underinsurance, health insurance, health insurance access.Tags: health care reform, health insurance, health insurance access, health reform, patients, policy cancellation, pre existing conditions, Underinsurance, underinsured
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We are all familiar with the terms insured and uninsured. However, perhaps the fastest growing group in America might be termed the “underinsured”. A combination of factors are occurring to drive up costs significantly for even those who can afford and find coverage. Higher deductibles, higher co-pays, more policy limitations and exclusions are all combining to increase out of pocket costs dramatically. This fact, along with others, speaks volumes to the need for major health insurance reform. We need open access to health insurance with no pre-existing condition exclusions, a base of benefits mandated that cannot be altered to fit the return on investment calculations of chief financial officers at major health insurers, and a guarantee of coverage by outlawing cancellation of policies due to illness or injury . . . jomaxx
Americans want REAL HEALTH REFORM August 9, 2008
Posted by Obi Jo in E Health, health reform.Tags: E Health, health, health care reform, health insurance, health insurance access, health reform, Hospitals, patients, Physicians
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Well, any surprise here? Reading the reviews of the latest Harris Poll released by The Commonwealth Fund below it is clear that REAL HEALTH REFORM is on track and in tune with the American populace. Most Americans, including me are very frustrated with the current health care system. First, let’s fix the health insurance access mess. Posted in this blog is “the plan” that will take us a long way to where we want to go in that regard. Other issues noted in this poll can be summed up by the word communication or lack thereof. I have commented before about the fact that the health delivery players, especially doctors, hospitals and payers, are very far behind on the curve when it comes to e-health initiatives and implementation. The resistance to doctor / patient email, e prescriptions and other forms of electronic communication is appalling throughout the medical system. No question we need broad reform, but lets start with access and that means health insurance reform . . . jomaxx
Americans are deeply dissatisfied with their healthcare choices, and want the presidential candidates to put healthcare reform high on their campaign agenda according to a survey conducted by Harris Interactive, and released on Thursday by the Commonwealth Fund, a charitable group promoting healthcare reform.
Investigators polled 1,004 adults over the phone, and found that 82 % believe that the U.S. healthcare system is in need of a complete overhaul.
32% of respondents called for a completely rebuilt health system while 50% felt it required fundamental changes
81% percent of respondents who were insured all year and 89% who were uninsured at some point during the year, called for fundamental change, or complete rebuilding
The survey, “titled Public Views on U.S. Health Care System Organization: A Call for New Directions,” also found that 90 % want “the presidential candidates” to “propose reforms that would improve the quality of healthcare, ensure that all Americans have affordable care, and reduce the number of uninsured.” 80 % said they supported efforts to improve healthcare performance, access, quality, and cost. For example, one in three said their doctors ordered tests that had already been done, or recommended unnecessary treatment. In fact, the majority “of the people surveyed expressed frustration with the way their healthcare was managed,” with 47% saying that “their healthcare was poorly coordinated; this lack of coordination included not being informed about test results, and having to make several calls to get the results.” Many respondents also “felt that important medical information wasn’t shared between doctors and nurses, or communicated between their doctor and specialists.”
The survey also found that a “large majority of patients say they want doctors to move to an all-electronic format for medical records and prescriptions. In addition, almost “90%…said they want their doctors to be able to share information electronically. Furthermore, “71% said they want their doctors to be able to order prescriptions by way of computers.
Notably, 44% said that they would access their own medical records via the Internet if available, and 48% said they would book appointments and email their doctors, if possible. Only 8% and 18%, said they were able to do that now.
Commonwealth Fund president Karen Davis, commented, “It is clear that our healthcare system isn’t giving Americans the healthcare they need and deserve. … The disorganization and inefficiency are affecting Americans in their everyday lives, and it’s obvious that people are looking for reform.”
Public Views on U.S. Health System Organization: A Call for New Directions
On behalf of The Commonwealth Fund Commission on a High Performance Health System, Harris Interactive surveyed a random sample of 1,004 U.S. adults (age 18 and older) to determine their experiences and perspectives on the organization of the nation’s health care system and ways to improve patient care. Eight of 10 respondents agreed that the health system needs either fundamental change or complete rebuilding. Adults’ health care experiences underscore the need to organize care systems to ensure timely access, better coordination, and better flow of information among doctors and patients. There is also a need to simplify health insurance administration. There was broad agreement among survey respondents that wider use of health information systems and greater care coordination could improve patient care. The majority of adults say it is very important for the 2008 presidential candidates to seek reforms to address health care quality, access, and costs.
Citation
S. K. H. How, A. Shih, J. Lau, and C. Schoen, Public Views on U.S. Health System Organization: A Call for New Directions, The Commonwealth Fund, August 2008
Link to more info on this poll @ http://www.commonwealthfund.org/surveys/surveys_show.htm?doc_id=698589
Opposition to merger of Pennsylvania’s top health insurers August 8, 2008
Posted by Obi Jo in Insurance Profits, health insurance, health reform.Tags: affordable health insurance, health care reform, health insurance, health insurance access, health plan mergers, health plans, health reform, Insurance Profits, physician payments, Physicians
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AMA testifies to Senate Judiciary Committee: Opposes merger of Pennsylvania’s top health insurers
The continued merger of health insurers leads to ever larger private entities whose shear mass and volume of data make them essentially regional monopolies. The fact that they operate in a vacuum of REAL regulation regarding benefits, underwriting and pricing makes these mergers all the more worrisome. The AMA, and others, are right to oppose this and other mergers. Until meaningful health insurance reform can be achieved with real access for ALL these types of actions should be halted. Congress would do well to begin to heed the mood of the American populace regarding the health insurance reform issue. Legislators and health insurance executives who wish to retain a private health insurance sector would do well to read “the plan” and strongly consider adopting each of its points . . . jomaxx
In testimony to the U.S. Senate Judiciary Committee last week, the AMA stated its opposition to a proposed merger of Pennsylvania insurers Highmark and Independence Blue Cross (IBC) and warned that this kind of consolidation is a threat to health care delivery systems across the country.
“The proposed merger between Highmark and IBC highlights the alarming consolidation trend among health insurers,” AMA Board of Trustees chair Joseph Heyman, MD, said in regard to the AMA’s July 31 testimony. “The AMA has long cautioned that this trend is responsible for a growing insurance market imbalance where patients and physicians are left vulnerable to the demands of a few giant health insurers.” . . . link to the testimony given by the AMA @ http://www.ama-assn.org/ama/pub/category/18815.html
California lawmakers considering health insurance reform bill August 8, 2008
Posted by Obi Jo in health insurance, health insurance access.Tags: affordable health insurance, health care reform, health insurance, health insurance access, health insurance reform, health reform, insurance access, pre existing conditions, underinsured
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California Governor Arnold Schwarzenegger fighting to open up private health insurance without restriction
Governor Schwarzenegger keeps trying and we hope he “will be back” to finish the job. Insurance should be accessible and affordable. He is on the right track – no pre-existing conditions, a basic menu of guaranteed benefits, profit restrictions on health insurance (like a regulated public utility), inability to cancel coverage except for non-payment. Patients unable to afford coverage will be directed to government based services (i.e. Medicaid, or Medi-Cal in California, Medicare and the like). Only through initiatives of this type can the health insurance crisis be brought under control . . . jomaxx
UPI reported that the “state of California is nearing a compromise on legislation that would tighten controls on individual medical insurance policies.” The measure “aims to restrict profit on individual policies, mandate a minimum for benefits, and regulate insurance companies’ ability to cancel plans retroactively.” But, the “plan falls short of Gov. Arnold Schwarzenegger’s (R) original plan of providing insurance for five million uninsured Californians.” . . . see link to full UPI article @ http://www.upi.com/Business_News/2008/08/04/California_insurance_bill_nears_completion/UPI-65931217862591/
Sarah Rubenstein wrote that “[s]tates face a Catch 22 when it comes to health policies that people buy on their own.” If they “[r]equire plans to provide certain benefits or bar them from rejecting individuals for coverage,…the result will be that the insurance gets more expensive.” If, however, the states “[g]ive insurers lots of latitude about who and what to cover,” then “cheaper plans are available — but often not for the older and sicker patients who need coverage most.” . . . see link to full NYT Health Blog post @ http://blogs.wsj.com/health/2008/08/04/california-takes-another-crack-at-insurance-reform/
UPDATE: Comment on “The Plan”: Personal Responsibility August 7, 2008
Posted by Obi Jo in health insurance, health reform.Tags: employer mandate, health care reform, health insurance, health reform, mandated health coverage, minimum wage, patients, personal health mandates, personal health responsibility, small business
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Here is my continuing update detailing, in greater depth, various points of “The Plan” designed to address the reasoning behind these ideas and the objections some have voiced.
(1) All persons must have health insurance from the private sector or government sponsored plans.
Many have objected to this as a violation of personal choice and freedom. However, I would suggest that it is a dereliction of civic resonsibility (if such a thing still exists in America) to force others (fellow citizens, doctors, hospitals, insurers, government - i.e. taxpayers) to pick up the tab for you when you become very sick or injured (as you WILL at some point in this life). By mandating coverage with penalties, just as we do for auto insurance, we put personal responsibility back in the equation. It has been far too long since that was the case as the government in particular, along with big labor and big business to varying degrees, have sought to remove responsibility from the individual and to displace it to some other entity.
(2) Proof of insurance would be required to get any type of license, enroll in school, apply for job, yearly confirmation will be required, etc. just as with automobile insurance.
Like all mandates, those without teeth fail. Therefore, there needs to be a “stick” which can be applied in the course of daily life, as opposed to a medical emergency (when no person will be denied care). The suggestion here is that all persons would be effected by these type of requirements and therefore the need to make sure that they have health coverage would be a strong driver for compliance.
(3) Fine of $1,000 if presenting to Doctor, Hospital, etc., for service without insurance, and must pay all expenses for services.
This item is potentially more problematic, but only in the case of a TRUE emergency. It would also require the cooperation of health care workers, doctors, offices, hospitals, clinics, etc. to report offenders. This is not necessarily the ideal scenario, however, along with point number 2, it forms the basis of a credible strategy to ensure compliance with point number 1, which, after all, is the real goal.
(4) The truly financially disadvantaged should be folded into the current Medicaid system with revisions; in that they should pay needs based premiums. As such, Medicaid, Medicare, disability, workers compensation, Government employees, Veterans, Retirement and children’s programs would not be significantly changed.
Here we get to one of the major issues, coverage (and access) for those without means to acquire private coverage in the marketplace. There is much to debate about each of the programs mentioned here. Many things can and should be changed about how these programs work. However, if we try to fix ALL issues in the system at once, the most major items of reform will not occur. Therefore, we MUST focus on what is achievable and provides the most benefit within the framework of our currently established free market/government based system. Expansion of these current forms of tax payer subsidized coverage should continue for the near term. Over time, some of these programs can be merged, rearranged or even eliminated without affecting the base of coverage provided.
(5) All company-sponsored programs would be phased out over three years (better than a tax break).
This will strike some as a major politically incorrect proposal. However, if we are to restore personal responsibility back to the system we must do so by removing the need for businesses, which are clearly not in the health insurance business, from it. Business should not be in the health business, but in business. The morass created by having to have benefit coordinators (who spend most of their time on health insurance matters) instead of focused on traditional benefits (retirement, vacation, leave etc, etc.) is inefficient and costly. By eliminating the need for businesses to carry these costs, they will receive a markedly reduced overhead, which is even better than a tax break to expand their current coverage systems.
(6) Minimum wage increased by $2.00 per hour so low income workers would have no excuse to offer for not having coverage.
Again, there will be resistance in many quarters to this proposal. As we well know, the minimum wage is in the process of being increased as we speak ($6.55 effective July 24, 2008 and then again rising to $7.25 per hour effective July 24, 2009). However, a further increase as suggested beyond this is a better format than asking businesses of all sizes to carry the full load for providing health insurance, which should be a personal responsibility. For a full time worker, this $2 increase translates to more than $4,000 per hear ($2 x 2080 hours). That is more than sufficient for workers to purchase their own health care coverage within the context of the full plan as outlined here.
