COMMENTARY: Mr. President, Medicare IS NOT Medicaid ! March 30, 2009
Posted by Obi Jo in health reform.Tags: CMS, Congress, health care reform, health insurance, health insurance reform, health plans, health reform, Insurance, Medicaid, Medicare, Medicare payroll tax, Medicare premiums, payroll taxes, President, President of the United States, taxes, underinsured, uninsured, welfare
3 comments
This past week has seen a great deal of exposure for President Obama in the media – press conferences, internet “community” meetings as well as numerous newsworthy emanations from the White House and Administration. This site has become somewhat frustrated in the continued phraseology of the President and others in the Administration and in Washington DC. This relates to the continued discussion of “entitlements” with respect to health care and the growth of Medicare and Medicaid, as if they were one and the same.
Let us please set the record straight for all to understand.
Medicare DOES NOT EQUAL Medicaid
First some facts about Medicare:
(1) It is an INSURANCE PROGRAM supported by payroll taxes and subscriber premiums.
(2) Workers pay a percentage of income as withholding on their income to the Medicare Fund (it should be sequetered but is in the general fund, more about this later).
(3) Beneficiaries, PAY a monthly premium for medical services, as well as drug benefits. They also may pay for hospital coverage if they have not worked for at least 40 quarters (10 years) during which they made tax contributions to the fund.
So those who are eligible for and participate in Medicare are NOT receiving an “entitlement” but health insurance. They have paid Medicare taxes and pay Medicare insurance premiums. This is not welfare or health care “given” by the largess of the politicos in DC.
Now some facts about Medicaid:
(1) Medicaid is funded by State sources drawn from state budgets via state income taxes, property taxes or other fees. These funds come usually out of the general fund.
(2) State funds are matched by the Federal government, through CMS, with funds from the federal general fund, which is drawn from federal income taxes primarily.
(3) Those eligible for Medicaid usually meet some combination of lack of income or limited assets. It is therefore in fact, a form of health care “welfare”.
So, those on Medicaid are mostly those who have not contributed greatly to the system via taxes or who have such limited income or assets as to be without the ability to obtain health insurance in the private market. Indeed, many Medicare beneficiares suffer the indignity of having to “desitute” themselves in order to get Medicaid nursing home benefits etc. (more on that issue for another time).
There is no shame in being on Medicaid. But it is NOT the same as being on Medicare. One is a form of welfare, the other a tax and premium supported insurance.
Indeed, esentailly all Medicare beneficiaries, are in fact contributors to the tax basis which supports Medicaid through both state and federal taxes.
Mr. President, please read this and get these facts straight. If the Medicare fund has a shortfall, first repay what is owed to it from the siphoning of monies into the general fund, second raise tax rates if needed and thirdly raise premiums. All of these options are unpopular but real alternatives. As for Medicaid, you can only raise the income tax rates and states do the same – certainly not popular and there is not enough wealth at the “top” to rake in without tax increases all the way to bottom tier (more on general tax reform and its impact on health care options later).
In the end, MEDICARE IS NOT MEDICAID ! . . . jomaxx and obi jo
REFERENCES AND LINKS:
http://questions.medicare.gov/cgi-bin/medicare.cfg/php/enduser/std_adp.php?p_faqid=2100
http://www.cms.hhs.gov/MedicaidGenInfo/
http://www.aarp.org/health/insurance/articles/2000medicare_rates.html
Real Health Reform begins here ! March 19, 2009
Posted by Obi Jo in health insurance reform.Tags: CMS, Congress, dependent health coverage, health, health care reform, health insurance, health insurance access, health Insurance exclusions, health insurance reform, health plans, health reform, healthcare, Hospitals, Insurance, insurance access, insurance benefits, Insurance Profits, medical care access, patient care, patients, personal health responsibility, Physicians, pre existing conditions, President of the United States, underinsured, uninsured
2 comments
Thanks Medscape for recognizing that Real Health Reform has a REAL solution (see article below by Nancy Terry) that can be implemented NOW without excessive expenditure, major governmental interference and with a modicum of expense. All other proposals, including those being offered by the President and his administration are long term, expensive, overly bureaucratic and fraught with legitimate concerns over rationing, interference in medical research and the doctor/patient relationship. To better understand the rationale for “the plan” we have proposed link to “the plan” and the sub-heading of “details on the plan” . . . obi jo
“Healthcare reform cannot wait, it must not wait, and it will not wait another year.” With those words, President Barack Obama, in his first address to a joint session of Congress, rallied Congress and the American people to tackle the “crushing cost of healthcare.” Yet, it remains to be seen whether the President’s reform efforts will target one of the most wasteful sectors of healthcare — the health insurance industry.
Recent postings on Medscape’s Physician Connect (MPC), an all-physician discussion board, deride the excesses of health insurance companies and exhort the need to restructure, if not eliminate, the for-profit health insurance industry.
“Commercial, for-profit health insurance is one of the greatest Ponzi schemes ever foisted on the public,” says a family medicine physician. “The executives are the ones that benefit to the detriment of everyone else. How else does the president of one of the largest insurance companies get to be a billionaire? By being at the top of the pyramid of companies’ and individuals’ premium payments.”
“The single most important factor in the atrociously high cost of healthcare in the United States is the rapacious, money-hungry insurance companies and their fat cat CEOs,” comments an MPC contributor.
“The damage that the insurance companies do is not limited to the salaries of the CEOs,” says another contributor. “They waste the time and resources of healthcare workers, institutions, and patients. They are clearly a negative, wasteful element in healthcare today that needs to be heavily regulated, changed, or eliminated.”
Physicians point to a number of supposedly routine practices of the health insurance companies that cry out for oversight. One MPC participant remarks that health insurance companies increase their premiums even as they decrease coverage. Another discussant notes that insurers typically burden physicians and patients with filing requirements as part of a strategy to delay or deny legitimate claims. According to one contributor, some companies frequently change their coding schemas to avoid paying legitimate claims. “The insurance companies make billions of dollars in profit each year,” says one MPC commentator, “and they do it by limiting care, denying claims, limiting contracts, and limiting reimbursements.”
The practice of systematically denying legitimate reimbursement claims by insurance companies has been the focus of an ongoing investigation by New York Attorney General Andrew Cuomo. In January 2009, Cuomo reached an agreement with UnitedHealth Group, Inc. that the insurer would shut down its controversial Ingenix database and pay $50 million to fund a nonprofit, independent database for the purpose of establishing fair compensation rates. The Ingenix database, which was owned by UnitedHealth, served all the major insurers and, according to The Wall Street Journal, skewed downward the “usual and customary” rates of out-of-network insurance reimbursements through “faulty data collection, poor pooling procedures, and lack of audits, thus forcing customers to pay more out of their own pockets for healthcare.” In February, WellPoint, Inc., the nation’s largest health insurer, agreed to Cuomo’s request to pay $10 million to help fund the new database. WellPoint is the sixth insurance company to make such an agreement with Cuomo’s office. As quoted by New York Daily News, Cuomo commented on the insurers’ use of the Ingenix database, saying, “This is as egregious a situation as I’ve seen, of a virtual monopoly.”
Is health insurance a scam? The 100 MPC postings in response to that question are unanimous in their assertion that the health insurance industry needs reform. Yet, MPC contributors are divided as to the extent and nature of that reform.
“The health insurance system is so profoundly flawed,” says one MPC contributor, “that the only solution is a nonprofit, single-payer healthcare system.” Other MPC contributors contend that a single-payer system would harbor its own set of problems. Comments a psychiatrist, “I would rather have evil insurance companies than absolute power concentrated in a single agency. If you have a complaint about an insurance company, you can complain to the regulators and drop the insurance. If you have a complaint about the government, you are screwed.”
Advocates of a single-payer system singled out Physicians for a National Health Program as a resource outlining the salient features of a single-payer system. Similarly, several advocates for reorganization of the for-profit insurance system directed readers to Real Health Reform, which proposes, among other healthcare reforms, the restructuring of private health insurance into a regulated utility.
Other contributors less concerned about the overall structure of the industry advocate that health insurance coverage should more closely resemble other types of insurance. “When we protect our house and car, the purpose has traditionally been to provide a safety net if the unforeseen happens to us,” points out an endocrinologist. “Health insurance is not that way. We have come to expect medical insurance to subsidize ordinary expenses, like our prescriptions and our office visits and any number of interventions that are not in themselves financially devastating, the way an auto collision or a home fire would be.” A family medicine physician comments, “Health insurance needs to be made into real insurance that only covers catastrophic events. Then it will be cheaper for everyone.”
Evident throughout the postings is a sense of frustration. One participant comments, “The people are not happy with health insurance, the physicians and allied personnel are not happy with health insurance. What is the government waiting for?”
Some MPC contributors refuse to take a wait-and-see attitude. They advocate that physicians who are disgruntled with the health insurance industry should effectively boycott health insurance.
“We need to immediately stop taking all third-party payments,” says an MPC contributor.
“Bill patients at the time of service,” advises another contributor. “Provide them with the invoice and tell them the truth, the larger truth — that you, the doctor, are not in the business of bandying about with insurance clerks and petty tyrants whose motivation is nothing but to frustrate payment and cost you valuable time and energy, which is duly relegated to patient care.”
“Stop making contracts with HMOs, hospitals, and health insurance,” recommends a neurologist. “Return to cash payment. When other doctors see it works for them the way it has for many, guess what? The yoyos who keep your insurance clerk and billing staff on hold for 2 hours asking for notes and records will be collecting pink slips.”
But the question remains: will the President’s health reform initiative take on the health insurance industry? MPC contributors hope the answer to that question is yes. “Our healthcare system is broken largely due to the insurance companies,” comments an MPC contributor. A urologist agrees, “Only through insurance reform can we begin the process of real healthcare reform.”
EMR from Wal-Mart & Sam’s Club March 13, 2009
Posted by Obi Jo in E Health, EHR (electronic health records), health reform.Tags: health reform, EMR, health, health care reform, Physicians, healthcare, E Health, patients, personal health responsibility, patient care, PHR, medical records, outcomes, medical care, Wal-Mart, Dell Computers, eClinicalWorks, Avalere Health
add a comment
Well, here is the market at its best. Computer makers, software developers and mass retailers aligning to service an industry that they have each been only peripherally involved in. If successful it could mark a new model for initiation, implementation and integration of e-health and HIT (health information technology) solutions and advances into medical practice. This site welcomes the likes of Dell, Wal-Mart and eClinicalWorks to this collaborative effort. Time will tell if it will be successful, but this site is hopeful. American ingenuity is still the best and by linking areas of expertise, we can solve the HIT problem in ways that the government cannot foresee or ever develop . . . obi jo
Wal-Mart to offer lower-priced electronic medical records system.
Wal-Mart Stores Inc. is planning to sell computer systems for keeping electronic medical records to small doctor groups who have shied away from the programs because of their high cost. Along with”computer maker Dell Inc. and closely held software maker eClinicalWorks, Wal-Mart will offer a lower-priced medical records system, plus installation and maintenance, through its Sam’s Club membership warehouses. Physicians would direct their follow-up questions about the system to Sam’s Club, which would then be routed to the appropriate person at Dell or eClinicalWorks. The system will be made available at the clubs in the spring for $25,000 for the first installed system, and $10,000 for each additional system, plus $4,000 to $5,000 a year in maintenance costs. Currently, fewer than 20% of US physicians use electronic medical records, and many complain about the upfront costs for small practices, but, Wal-Mart believes it could shave somewhere between 30 to 50% off the cost, currently estimated at $124,000 for a single doctor to upgrade to electronic health records over 5 years. Instead, the cost would be closer to $44,000, the maximum in incentive payments available to single-practice physicians, using Wal-Mart’s system.
READ: Sam’s Club to Provide Digital Medical Tools @ http://online.wsj.com/article/SB123681683265602347.html
READ: Wal-Mart to enter medical records digitization market @ http://www.google.com/hostednews/afp/article/ALeqM5ivLQYwX-Ho5c8TAteuu0Q4ZcA7KQ
READ: Behind Wal-Mart’s E-Health Records Plans @ http://www.informationweek.com/blog/main/archives/2009/03/behind_walmarts.html
INFO LINK @ http://instoresnow.walmart.com/Wellness-Center.aspx
INFO LINK @ http://www.avalerehealth.net/
INFO LINK @ http://www.eclinicalworks.com/
INFO LINK @ http://www.dell.com/content/topics/reftopic.aspx/bsd/odg/13263_search_generic_hsb?c=us&cs=&l=en&s=gen&ST=dell&dgc=ST&cid=16010&lid=380485
Medicare “logic” sadly lacking March 13, 2009
Posted by Obi Jo in Medicare.Tags: CMS, end stage renal disease, ESRD, health care reform, health Insurance exclusions, health insurance reform, insurance denials, kidney failure, Medicare, NIDDK, NIH, outcomes, patient care, patients, renal disease, transplants
2 comments
This site has raised concerns over coverage limitations and rationing in health care before, especially in light of ongoing debates in Washington DC. The article below points to the totally illogical practice of Medicare, which covers end stage renal disease and transplantation, whereby life saving immunosuppressive drugs are only covered for three years post transplant – the assumption being that these patients now “no longer” have renal failure. Only government bureaucrats could be so lame and insensitive in their interpretation of coverage decisions. Oh, we know, Medicare can’t pay for everything, that is a fact, but to allow patients the “gift of life” via a transplant, then three years later pull the rug out due to the “rules of the program” is beyond cruel and unjust. We need officials who will deal with health realities more honestly. If Medicare no longer wishes to have end stage renal disease carved out as an exception which allows those under 65 to qualify for Medicare, then change that rule on the front end, not on the back end, and deal with the political heat, or get out of the kitchen . . . jomaxx
Margaret Oliver, a 47-year-old hairdresser in Venice, Calif., received a lifesaving kidney transplant in 2002. The government covered the costs under a special Medicare program for the hundreds of thousands of Americans with kidney failure who need either dialysis or a transplant. Three years later, Medicare stopped paying for the expensive immunosuppressive drugs that Ms. Oliver needed to minimize the risk that her body would reject the organ. Because her kidney was functioning successfully at that point, she was no longer considered to be suffering from end-stage disease and so no longer qualified for the special coverage
Read more @ http://www.nytimes.com/2009/03/13/health/13kidney.html?_r=1
http://www2.niddk.nih.gov/
http://www.kidney.org/
Incentives needed to move EMR implentation forward March 10, 2009
Posted by Obi Jo in E Health.Tags: health reform, EMR, physician payments, health care reform, Congress, President, E Health, health information technology, patients, physician behavior, patient care, physician education, PHR, outcomes
add a comment
One thing learned early in the career of every medical innovator is that if your new idea requires major ergonomic or situational changes in the delivery system to work, its adoption will be slow, piece-meal and likely insufficient to make a significant difference in the system. As this article points out, this is not a technology problem but a system innovation problem. There needs to be not only incentives, but real support and some degree of uniform software applications so that interoperability is maximized. It has been our observation that by and large, the government does a poor job at this type of thing. Time will tell, but Federal dollars would be best spent supporting the initiative without becoming the defacto supplier of EMR solutions themselves. The marketplace has a wide array of sophisticated choices available, we just need the correct market incentives to get this going . . . jomaxx©
Small physicians’ practices may have difficulty implementing EHRs, experts say.
In its economic recovery package, the Obama administration plans to spend $19 billion to accelerate the use of computerized medical records in doctors’ offices. And, according to some medical experts, “electronic patient records, when used wisely, can help curb costs and improve care. But, 3/4 ths of the nation’s doctors practice in small offices such an investment…looks like a cost for which they are not reimbursed. Obama’s legislation would provide incentive payments of more than $40,000 spread over a few years for a physician who buys and uses electronic health records (EHRs). These payments, however, would only go towards the ‘meaningful use’ of digital records, and the government has not yet defined that term precisely. The legislation also calls for creation of ‘regional health IT extension centers, which some experts say may serve as a crucial bridge to success by helping physicians in small offices adopt and use electronic records. . .
It is scarcely surprising, then, that only about 17 percent of the nation’s physicians are using computerized patient records, according to a government-sponsored survey published last year in The New England Journal of Medicine. So the legislation states that physicians will be paid only for the “meaningful use” of digital records. The government has not yet defined that term precisely. While the long-term goal is better health for patients, that can take years to measure. Consequently, many health experts predict that the meaningful use will be a requirement to collect and report measurements that can be closely correlated with improved health. Examples would be data for blood glucose, cholesterol and blood pressure levels for diabetes patients . . . . . read article @ http://www.nytimes.com/2009/03/01/business/01unbox.html?_r=1&ref=health
Medicare decision demonstrates the true future of rationing March 7, 2009
Posted by Obi Jo in health insurance, health reform, patient care.Tags: cancer, CMS, colon cancer, diagnosis, health, health Insurance exclusions, health insurance reform, health rationing, health reform, healthcare, Medicaid, medical care access, Medicare, outcomes, patient care, patients, Physicians, prevention, rationing, screening
2 comments
Does anyone really doubt that the government will use rationing to control medical “costs”. Here is a timely example just within the last two weeks of CMS (Centers for Medicare and Medicaid Services) denying a modern, alternative procedure for the detection of colon cancer. Death due to colon cancer, a leading cause of cancer death, can be prevented with early detection. Virtual coloscopy offers patients and doctors and option to traditional edoscopic methods which for various reasons may be less desireable for individual patients. Additionally, it is well known that traditional endoscopic colonocopy has a fairly high failure rate at detecting lesions in the right or ascending colon and cecum, due to difficulty in visulization at this level. Why is CMS against an alternative? Certainly the adminitrative team at CMS along with its advisory panel can all afford an option like this. However, they are willing to deny Medicare beneficiaries this option since it “might not apply as the study group mean age was 58 years”. You mean the older you get the more you like have a snake like tube many feet in length inserted into your rectum, under sedation? Hardly. This is about choice. Giveing Medicare beneficiaries and their doctors THE CHOICE. There is no argument that traditonal colonoscopy has advantages (such as direct visualization and the ability to take a biopsy), but there are advantages to virtual colonoscopy as well. One has to wonder if CMS read the government’s own web site (see below from the NIH- National Institutes of Health). Finally, CBS News (see link below) reported that many states fail in their efforts to screen for colon cancer due to insurance variations in coverage. They can now add CMS to that list. Is it hard to imagine that President Obama’s Compartive Effectiveness “Politburo” will not do the same and likely more: limit choice, ration care and remove options and choice from American’s and their physicians . . . jomaxx
Medicare tentatively decides not to pay for virtual colonoscopies
Medicare has tentatively decided not to pay for virtual colonoscopies, dealing a setback to a technique that some medical experts recommend as a more tolerable alternative to conventional colonoscopy in screening for colon cancer. In an online statement, CMS said that there was insufficient evidence to conclude that virtual colonoscopy [also known as CT colonography] improves outcomes in Medicare beneficiaries. In its analysis, Medicare said many studies supporting virtual colonoscopy were done in people with a mean age around 58, so results might not fully apply to Medicare’s older population.
Read more @ Medicare Blow to Virtual Colonoscopies @ http://www.nytimes.com/2009/02/13/health/policy/13colon.html?scp=1&sq=%2b%22cancer+screening%22&st=nyt
Virtual Colonoscopy
Virtual colonoscopy is a procedure used to look for signs of pre-cancerous growths, called polyps; cancer; and other diseases of the large intestine. Images of the large intestine are taken using computerized tomography (CT) or, less often, magnetic resonance imaging (MRI). A computer puts the images together to create an animated, three-dimensional view of the inside of the large intestine.
How is virtual colonoscopy different from conventional colonoscopy?
The main difference between virtual and conventional colonoscopy is how the doctor sees inside the colon. Conventional colonoscopy uses a long, lighted, flexible tube called a colonoscope to view the inside of the colon, whereas virtual colonoscopy uses CT or MRI.
What are the advantages of virtual colonoscopy?
Virtual colonoscopy does not require the insertion of a colonoscope into the entire length of the colon. Instead, a thin tube is inserted through the anus and into the rectum to expand the large intestine with air.
No sedation is needed. A patient can return to usual activities or go home after the procedure without the aid of another person.
Virtual colonoscopy provides clearer, more detailed images than a conventional x ray using a barium enema—sometimes called a lower GI series.
Virtual colonoscopy takes less time than either conventional colonoscopy or a lower GI series.
Virtual colonoscopy can see inside a colon that is narrowed due to inflammation or the presence of an abnormal growth.
Read more @ http://digestive.niddk.nih.gov/ddiseases/pubs/virtualcolonoscopy/#advantages
Colon Cancer State Rankings Colorectal cancer is the second leading cause of cancer deaths for men and women in this country, killing nearly 50,000 people annually. But when detected early, it can be successfully treated the vast majority of the time. The results of the 2009 Colorectal Cancer Screening Legislation Report Card were recently released. CBS News medical correspondent Dr. Jon LaPook reports that for the first time since it was first issued six years ago, the report shows that more states have received an A than a failing grade for their colon cancer screening laws. Twenty-one states, plus D.C., got an A, and 19 have gotten an F . . . Read more @ http://www.cbsnews.com/stories/2009/03/05/eveningnews/main4847055.shtml
SPECIAL COMMENTARY: And these folks are going to fix health care, etc., etc. ??? Hardly … March 6, 2009
Posted by Obi Jo in health reform.Tags: capitalism, Congress, Constition of the United States, deficits, economics, economy, Federal Reserve, free market, health, health care reform, health reform, House of Representatives, inflation, Lobbyists, President, President of the United States, Senate, Supreme Court, taxes
add a comment
It has become increasingly clear that efforts toward real health reform are going to be used as a ruse for many other far reaching changes in the basic tenants underlying the American experiment . . . including our Constitution, notions of individual liberties, rights and responsibilities and our market based, capitalist economic system. Clearly health reform does not require these things. Unfortunately, in this hour, we cannot separate health reform from political reform, therefore we will find it necessary, from time to time to comment on these broader issues that will in the end effect health care either directly or indirectly . . . obi jo and jomaxx
The 545 People Responsible For All Of U.S. Woes
Original editorial by Charley Reese first published by the Orlando Sentinel Star newspaper in the early 1980’s
Update and Revision by jomaxx and obi jo
Politicians are the only people in the world who create problems and then campaign against them.
Have you ever wondered why, if both the Democrats and the Republicans are against deficits, we have deficits?
Have you ever wondered why, if all the politicians are against inflation and high taxes, we have inflation and high taxes?
We don’t propose a federal budget. The president does.
We don’t have the Constitutional authority to vote on appropriations. The House of Representatives does.
We don’t write the tax code. Congress does.
We don’t set fiscal policy. Congress does.
We don’t control monetary policy. The Federal Reserve Bank does.
100 senators, 435 congressmen, 1 president and 9 Supreme Court justices – 545 human beings out of 300+ million – are directly, legally, morally and individually responsible for the domestic problems that plague this country.
Members of the Federal Reserve Board were excluced because that problem was created by the Congress. In 1913, Congress delegated its Constitutional duty to provide a sound currency to a federally chartered but private central bank.
All the special interests and lobbyists are also excluded for a sound reason. They have no legal authority. They have no ability to coerce a senator, a congressman or a president to do one cotton-picking thing. If they offer a politician $1 million dollars in cash. The politician has the power to accept or reject it. No matter what the lobbyist promises, it is the legislators responsibility to determine how he votes.
A CONFIDENCE CONSPIRACY
Don’t you see how the con game is played on the people by the politicians? Those 545 human beings spend much of their energy convincing you that what they did is not their fault. They cooperate in this common con regardless of party.
What separates a politician from a normal human being is an excessive amount of gall. No normal human being would have the gall of our current Congress persons who blame the previous President for THEIR failures. Who blame the current President for THEIR problems. And those who now, after decrying the deficits of the past 8 years, are prepared to triple down on the debt. And for what purpose? We can only surmise . . . but it does not look good for the nation of dreams built by our Founding Father’s genius, courage and tenacity.
The President can only propose a budget. He cannot force the Congress to accept it.
The Constitution, which is the supreme law of the land, gives sole responsibility to the House of Representatives for originating appropriations and taxes.
Ms. Pelosi is the speaker of the House. She is the leader of the majority party. She and fellow Democrats, can approve any budget they want. If the president vetoes it, they can pass it over his veto.
REPLACE SCOUNDRELS
It seems inconceivable that a nation of 300+ million cannot replace 545 people who stand convicted — by present and past facts – of incompetence and irresponsibility.
Can you think of a single domestic problem, from an unfair tax code to defense overruns, that is not traceable directly to those 545 people.
When you fully grasp the plain truth that 545 people exercise the power of the federal government, then it must follow that what exists is what they want to exist.
If the tax code is unfair, it’s because they want it unfair.
If the budget is in the red, it’s because they want it in the red.
If we have wars in Iraq and Afghanistan (as well as troops still in Korea, Germany and many other locations), it’s because they want them.
There are no insoluble government problems.
Do not let these 545 people shift the blame to bureaucrats, whom they hire and whose jobs they can abolish; to lobbyists, whose gifts and advice they can reject; to regulators, to whom they give the power to regulate and from whom they can take it.
Above all, do not let them con you into the belief that there exist disembodied mystical forces like “the economy,” “inflation” or “politics” that prevent them from doing what they take an oath to do.
Those 545 people and they alone are responsible. They and they alone have the power.
They and they alone should be held accountable by the people who are their bosses – provided we the people have the gumption to manage our own employees.
Pay for Performance (P4P) moves forward under CMS March 4, 2009
Posted by Obi Jo in health reform.Tags: health reform, physician payments, health care reform, Congress, physician behavior, CMS, outcomes, government, comparative effectiveness, health policy
add a comment
As the government begins to work on its “Comparative Effectiveness” plans for health care reform it is good to keep in mind some of the key elements noted in the summary listed below. First, who will determine what is “effective” health care? Second, while we may all feel we know what safety, efficiency, timeliness and patient centered may mean (if in fact any good definitions really exist) what or earth is “equity” in terms of evaluating health delivery by physicians. All of these items speak to the concept of some Sovietization of health policy with health commissars reporting to the newly appointed Health Czar (perhaps that title is not an accident) and the comparative effectiveness committees making sure that “re-education” is accomplished so that physicians can continue to be licensed. Far fetched? Overly dramatic you say. Don’t bet on it if these health care reformers get their way . . . obi jo
CMS hard at work on “reform”
Both the federal government and private payors are committed to moving from a payment system based on volume of services to one based on quality of services and efficiencies enacted (such as elimination of duplicative tests). Quality is determined by scores obtained on specific quality performance measures, such as those included in the recent CMS Physician Quality Reporting Initiative (PQRI). To date, the Medicare program has linked quality to payment through “pay for reporting;” nursing homes, home health agencies, health plans, dialysis facilities and hospitals all have current payment tied to the provision of reports on identified quality measures.
The PQRI is simply the physician version of this same general approach: physicians who voluntarily report on three or more applicable measures are eligible to receive a 2 percent bonus. The only way in which this program differs from those of the other providers is that it is still voluntary, at least for now.
However, Congress has taken a number of steps to ratchet up pressure in this area. In the Medicare Improvements for Patients and Physicians Act (MIPPA), passed in July 2008, Congress required the Centers for Medicare & Medicaid Services (CMS) to submit a detailed plan by May of 2010 for physician value based purchasing (PVBP). A similar plan was required of CMS by Congress for hospitals in early 2008. Recently, Senator Charles Grassley (RIA), ranking member of the powerful
Senate Finance Committee that has jurisdiction over Medicare, has been circulating a bill designed to enact key provisions of that hospital plan. It is anticipated that Congress will follow suit once CMS delivers the required physician plan in 2010.
What is value based purchasing?
Simply put, value based purchasing is the institution of payment for performance, in contrast to the pay for reporting efforts noted above. According to a CMS Issues Paper released to the public in late November 2008, value based purchasing “….aligns payment more directly to the quality and efficiency of care provided by rewarding providers for their measured performance across the dimensions of quality.” The dimensions of quality to which the paper refers are the six goals of the healthcare system identified by the Institute of Medicine (IOM) in its 2001 report, Crossing the Quality Chasm: safety, effectiveness, efficiency, timeliness, patient-centeredness and equity.
While CMS has launched a number of demonstration projects and other initiatives that are pertinent to physician value based purchasing, it has not yet synthesized the information gathered from these multiple efforts into a coherent whole, nor has it yet moved forward with the plan for hospital value based purchasing. To prepare the plan required by Congress, CMS held a public “Listening Session” on December 9 to pose numerous questions to physician organizations and to obtain their feedback.
Four CMS subgroups – Measures, Incentive Structure, Data Strategy and Infrastructure, and Public Reporting – have been formed to work on the plan. These workgroups are still in their early phases; the listening session focused on the progress of each group and the many questions that must be answered prior to preparation of the report.
Health Reform will require patients & doctors input but . . . March 4, 2009
Posted by Obi Jo in health reform.Tags: affordable health insurance, comparative effectiveness, health insurance, health insurance reform, health reform, outcomes, patients, personal health responsibility, physician behavior, Physicians
2 comments
A timely article that raises excellent questions, but comes to some faulty conclusions. First, the costs comparisons between US health care and Europe are bogus. Since most European countries have two tier systems with 80% or so of the population using the regulated, state controlled health service and the remainder opting for private coverage, private doctors and hospitals. The state systems impose strict controls on drugs, devices, access to those as well as age limitations on certain services etc. (such as transplants and the like). The US system is based on physicians being advocates for their INDIVIDUAL patients, not for some “group”. When you are sick or in need of surgery you certainly want someone focused on what is best for YOU, not the so called “system”. Additionally, using items like the number of uninsured, life expectancy and neonatal death rates is very misleading. The insurance problem can be addressed in large measure with changes that this site has outlined and which could be implemented by the President tomorrow (or could have been by any of the last several Presidents, both Democrat and Republican). Both life expectancy and neonatal death rates are highly effected by behavior. Teenage pregnancy, smoking, alcohol and drug abuse all contribute in a country of this size (over 300 million) in large measure to our poorer “statistical” standing in these areas. When you add in the major health problems presented to our emergency rooms by the estimated 12 million illegal aliens living in the United States (not undocumented immigrants as one NYT reporter euphemistically referred to them), you begin to understand that statistics are in the eye of the beholder. The basis of comparative studies is by definition group modeling and not tailoring therapy or treatment to an individual. These “deciders” in the government will surely be medical doctors and the like, who are far, far removed from caring for INDIVIDUAL patients. Are reforms necessary . . . yes. However, many of the reforms needed are common sense, low cost items that can be implemented without the need to create an ever greater government bureaucracy . . . jomaxx
Tara Parker-Pope writes in the Sciences Times section, that “much of the focus” of the nation’s healthcare reform “is on the role the government and insurance companies will play in a revamped health system,” while “little attention has been paid to the role that patients and their doctors have played in shaping the way medical care is delivered.” But, Parker-Pope contends that “for any reform to work, patients will have to change their behavior” by accepting that the “best” care “doesn’t always mean the newest drug or the latest treatment.” The Obama administration’s “economic stimulus plan includes $1.1 billion for studies that will ask basic questions about the comparative effectiveness of expensive procedures versus less expensive ones,” and some experts argue that making this information accessible to the public “would be important for healthcare reform to succeed.” But, Parker-Pope notes that “even when such comparisons are available,” physicians and patients “tend to ignore it.” She states that “the looming question is whether patients are ready to embrace the realities of reform.”
Read @ A Hurdle for Health Reform:Patients and Their Doctors – http://www.nytimes.com/2009/03/03/health/03well.html?_r=3&ref=health
