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The Politics of Health Care
Topic: The Politics of Health Care (Read 217910 times)
Squeezing savings out of dying
Reply #1400 on:
February 12, 2015, 10:32:49 AM »
There will be a crush of middle players finding ways to ring money out of this. Will this save us money? Short answer: no. While I am not totally against this as IMHO there is some reasonable aspects to this, I won't like how it will be "sold" to the public. It will be sold as "all in the interests of patient care". The real driver is costs.
****IMPROVING PATIENT CARE
Engaging Public Health in End-of-Life Issues: It Is Time to Step Up to the Plate
Jaya K. Rao, MD, MHS, Deputy Editor
The Doctor: For Life and at the End of Life
Ann Intern Med. 2015;162(3):230-231. doi:10.7326/M14-2479
This article was published online first at
on 9 December 2014.
In September 2014, the Institute of Medicine (IOM) released its fifth full report on end-of-life issues, “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life” (1). Acknowledging the substantial progress made since its first report on these issues was published in 1997 (2), this report identifies recommendations within 5 domains. It is particularly encouraging to see the following recommendation for public education and engagement in the report: “Civic leaders, public health and other governmental agencies ... should engage their constituents and provide fact based information about care of people with advanced serious illness to encourage advance care planning and informed choice based on the needs and values of individuals.” Because I was one of the first authors to articulate a role for public health with respect to end-of-life issues (3) while I was working at the Centers for Disease Control and Prevention (CDC), it is noteworthy that this is the first IOM report to explicitly mention that public health has a role in this arena. By describing the work on end-of-life issues done by the public health community during the past decade, I hope that policymakers, members of the IOM Committee, and health professionals can use and build on these efforts.
Although end-of-life issues have long been considered a societal problem that needs to be improved, the field of public health has only begun to embrace end-of-life as a health concern. Because public health's primary focus is to prevent illness and premature death due to chronic disease and other health threats, public health professionals' reluctance to acknowledge death or its circumstances may be understandable. However—whether we wish to admit it or not—prevention has its limits, and everyone will die eventually. Some public health professionals may also believe that end-of-life issues are a health system problem rather than a priority to be addressed through population health efforts. Public health priorities tend to have at least one of the following characteristics: a large population burden, a major effect in terms of health and other consequences, and the potential for prevention.
In 2002, a literature review that I coauthored (3) clearly showed that end-of-life issues met the criteria of a public health priority. This review was designed as a primer to document the relevance and importance of these issues to the public health community. Given that public health is a key partner of the health care system for many health issues, we proposed that public health could disseminate culturally appropriate materials about advance care planning to the public, thus reaching persons before they were faced with making end-of-life decisions. In addition, we made a case for considering advance care planning as a critical part of chronic disease management programs.
Working closely with the CDC, chronic disease partners in state health departments identified priority end-of-life actions for public health (4). More than 200 public health stakeholders were engaged in this effort and made 103 recommendations for end-of-life activities across a range of topics (for example, public education, professional education, and research and evaluation). Of note, 3 of the 5 initial priorities identified as public health end-of-life actions are consistent with the spirit of the IOM's recommendation to educate and engage the public: to educate the public about hospice and palliative care and the importance of having an advance directive or health care proxy and to collect, analyze, and share data about the end of life through state surveys.
One of these actions has resulted in the development of online information on advance care planning for the public and public health and aging services professionals. For example, the CDC's Healthy Aging Web site (
) presents materials for the public on advance care planning, including links to decision aids, state-specific advance directive forms, legal guides, and other end-of-life resources (such as hospice and palliative care organizations and information for caregivers). An online modular training course on advance care planning also was developed for public health and aging services professionals. Since then, more than 1000 health professionals have completed the course (Anderson L. Personal communication.), which is available for free and offers continuing education credits (
In addition to providing educational materials to the public, the 2014 IOM report suggests that government agencies undertake and share behavioral research aimed at assessing public perceptions and actions with respect to end-of-life care. Although national polls in the United States have provided periodic insights into public perspectives on end-of-life issues, ongoing population-based national surveys currently do not include questions about the end of life (5). Recently, end-of-life surveillance items were administered to a nationally representative sample of U.S. consumers to assess factors associated with completion of advance directives. This survey found that 26.3% of respondents had an advance directive and nearly 70.0% had concerns about end-of-life care, such as the costs of care, the pain that they might have, or their comfort and dignity during this period (6). Black or Hispanic persons or those who lack the knowledge to have concerns about the end of life were less likely to have advance directives; these groups may represent potential targets for intervention.
Although a PubMed search for “public health” and “end of life” still yields few articles addressing a population approach to end-of-life issues (most of which are presented here), the broader public health community has recently begun to acknowledge this issue. Several states (5, 7) and communities included palliative care questions as state-added items to the Behavioral Risk Factor Surveillance System. Other authors have declared end of life as a public health crisis (
and the dying as a vulnerable population that should be a concern of public health (9). More recently, the American Public Health Association adopted a policy statement in 2013 on the role of public health in addressing unmet needs in serious illness and at the end of life (10). Such steps represent incremental progress.
In making its recommendations, the IOM appropriately considered the end of life as an issue that requires the involvement of sectors beyond the health care system. Hopefully, public health will heed the IOM's call for action and continue to build on the recommendations of the IOM and key public health stakeholders with respect to end-of-life issues. And, when the IOM writes its next end-of-life report, perhaps public health can influence the next set of recommendations.
Re: The Politics of Health Care
Reply #1401 on:
February 14, 2015, 11:58:58 PM »
I really don't want to be a government employee but this is where it is going. I no of no significant scientific evidence that sex is a decent form or aerobic exercise unless one is being whipped while running on a treadmill. This is just patently ridiculous:
*****British Doctors Told to Prescribe Sex as Exercise
by A.B. Sanderson13 Feb 201586
Medical experts have recommended that exercise is something which GPs should be prescribing more often, describing it as “a wonder drug” which is important in the prevention of many common diseases.
The report from the Academy of Medical Royal Colleges says that physical activity plays a significant role in the management of long term conditions but its impact is so positive that it needs to take a greater role in the daily routine of children and adults, the Daily Mail reports.
There is, it says, a direct correlation between the increasingly sedentary lifestyle and conditions such as diabetes and obesity.
And worryingly, over 40 per cent of adults do not reach the minimum recommended level of 30 minutes of moderately intense exercise five times per week.
Regular exercise can prevent dementia, type 2 diabetes, some cancers, depression, heart disease and other common serious conditions – reducing the risk of each by at least 30% – better than many drugs.
But rather than simply telling doctors to send their patients down the gym or pounding the streets in lycra, the authors suggest there are a huge number of ways to raise the heart rate which fit into a person’s schedule.
The report says that fun activities are more likely to be sustained, suggesting many activities can be promoted including dog walking, dancing and even having sex. ‘Basing activities in communities leads to sustained acceptance’ it says, although the report offers no comment on whether this applies to the latter activity.
And it is not just the health of patients which will improve with more adults taking part in community dance classes or training for charity events: The costs of physical inactivity to the UK, the NHS and other public bodies are estimated to be in excess of £15bn.
There are also other costs which are less simple to quantify, including the effects of bad health on families and communities. Lack of physical activity is, is says, acknowledged as one of the top four factors responsible for premature deaths and long term diseases.
Chairman of the Academy of Medical Royal Colleges Professor Dame Sue Bailey sailed:
“This is about people and their doctors believing that the small effort involved is worth it because they are worth it.
“There really is a miracle cure staring us in the face, one which too many patients and doctors have quite simply forgotten about.
“This is about people and their doctors believing that the small effort involved is worth it because they are worth it. This needs to work across the life-course, from children to the very elderly.”
But the advice was not welcomed everywhere, with Joyce Robins of Patient Concern saying, “It’s none of GPs’ business to be talking about patients’ sex lives. I would take amiss at that and I’m sure many others would too.
“This is particularly true as nowadays most patients don’t even know their family doctor.”*****
How to answer this?
Reply #1402 on:
March 02, 2015, 01:20:43 PM »
Re: The Politics of Health Care
Reply #1403 on:
March 06, 2015, 07:07:40 PM »
The speaker I heard today could answer this. The numbers and stats above are probably all distortions. The Affordable Health Care Act has done little if anything to reduce costs. The administrative costs could be as high as 30%. The only ones who did well are the same ones who havce done well in the rest of the economy - big companies who have the resources to squeeze out all competition and soak the system. Without the input of tax dollars to supplement these companies they would go out of business. We are supplementing them with tax money.
I ask everyone who reads this board:
How much less are you paying for your insurance and is your plan better than last year or the year before that?
I know the answer.
The speaker I heard advocates for single payer. He made a strong case and almost has me convinced he may be right.
If I can find the website he recommended I'll post but I lost the site when I left a piece of paper somewhere while answering a page.
Based on what his presentation concluded based on a lot of statistics and sources the Newsweek piece is exactly what one would expect from a veiled Democrat outlet - pure propaganda.
Re: The Politics of Health Care
Reply #1404 on:
March 08, 2015, 09:47:41 AM »
This is one article from the organization the speaker (I noted in the previous post) was promoting. I am not a member and would not.
A rather socialistic group. Yet they are right about pointing out the large layer of administrative costs.
He thinks the AHA is going to fail in a few years. One could argue it is designed to fail in the march to single payer. I don't know.
King v Burwell: an interesting argument
Reply #1405 on:
March 09, 2015, 09:29:02 AM »
WASHINGTON — In 2012, the Supreme Court declared that Congress had put “a gun to the head” of states by pressuring them to expand Medicaid, and it said that such “economic dragooning” of the states violated federalism principles embedded in the Constitution.
Now, in a separate case, comments by several justices indicate that they could uphold a pillar of the Affordable Care Act — insurance subsidies for millions of lower-income people — by invoking those same principles.
In 2012, the court said it would be unconstitutional for Congress to cut off all Medicaid payments to states that refused to expand eligibility, and this ruling instantly transformed the expansion of Medicaid into a state option.
That precedent echoed through oral arguments last week before the court; justices again expressed respect for federalism and state sovereignty.
Under the health care law, Congress gave states a choice: They could establish and operate their own competitive insurance marketplaces, or they could rely on one established by the federal government. It was, several justices said, inconceivable that Congress would then punish states that used the federal exchange by denying insurance subsidies to their residents.
Justice Anthony M. Kennedy suggested that such a choice could coerce states in a potentially unconstitutional way. Under the theory favored by critics of the health care law, Justice Kennedy said last week, “the states are being told either create your own exchange, or we’ll send your insurance market into a death spiral,” and “the cost of insurance will be sky high.”
Mark H. Gallant, a health lawyer at Cozen O’Connor in Philadelphia, said: “Justice Kennedy’s take on this case was a brilliant touch. He used the plaintiffs’ own argument against them to suggest that it would be unconstitutionally coercive if Congress made the subsidies depend on a state’s decision to establish an exchange.”
Plaintiffs in the case, King v. Burwell, say the Affordable Care Act authorizes subsidies only in states that created their own insurance exchanges.
Justice Antonin Scalia said it was “gobbledygook” for the Obama administration to suggest that an exchange set up by the federal government “qualifies as an exchange established by the state.” When the language of the law is clear and unambiguous, he said, the court cannot twist the words to avoid “untoward consequences.”
And Justice Samuel A. Alito Jr. said the court could delay the impact of its ruling if the consequences were as disruptive as the administration said.
But the Obama administration argues that the subsidies are available in all states, including more than 30 that refused to establish exchanges and rely on the federal marketplace. Without the subsidies, it says, many people would be unable to afford insurance, and healthier consumers would go without coverage, leaving insurers with a sicker, more expensive pool of customers.
The Affordable Care Act has begun reducing the number of uninsured in two main ways: by expanding Medicaid and by providing tax credits to subsidize private insurance purchased through the public exchanges. The court, which focused on Medicaid three years ago, is now examining the subsidies.
Continue reading the main story Continue reading the main story
Continue reading the main story
Justice Sonia Sotomayor told the plaintiffs’ lawyer, Michael A. Carvin, that if the court accepted his argument, it would be “intruding on the federal-state relationship, because then the states are going to be coerced into establishing their own exchanges.”
And Justice Elena Kagan said Congress had not warned states of the consequences if they chose to use the federal exchange. In interpreting statutes, Justice Kagan said, the court presumes that “Congress does not mean to impose heavy burdens and draconian choices on states unless it says so awfully clearly.”
For decades, more conservative justices have emphasized respect for state sovereignty. The court often uses “basic principles of federalism embodied in the Constitution to resolve ambiguity in a federal statute,” Chief Justice John G. Roberts Jr. said in his opinion for the court in an unrelated case nine months ago.
The oral arguments also showed how the court, in the digital age, could be influenced by a flood of research, analysis and commentary from bloggers, scholars and advocates forecasting dire consequences if insurance subsidies end. More than 20 legal briefs have conveyed those concerns to the court, citing studies by groups like the Commonwealth Fund, the Urban Institute, the Kaiser Family Foundation, the RAND Corporation and Families USA.
“In the last six weeks,” said Abbe R. Gluck, a law professor at Yale, “people finally woke up and became aware of the drastic real-world consequences.”
A typical study, from the Urban Institute, based on a computer model of the health care system, was titled: “Implications of a Supreme Court Finding for the Plaintiff in King v. Burwell: 8.2 Million More Uninsured and 35 Percent Higher Premiums.”
When ruling on appeals, judges typically make decisions by closely reading the law and applying it to the facts of a case, as revealed in a trial court. But in the subsidies case, supporters of the health care law found a way to bring their predictions to the Supreme Court justices’ attention.
The government argued that Congress could not have imposed such drastic consequences on states without discussing the impact and without giving clear, explicit notice to the states.
“If that was really the plan, then the consequence for the states would be in neon lights in this statute,” said Solicitor General Donald B. Verrilli Jr.
Justice Kennedy has long been a protector of the states. They need clear notice of the conditions attached to federal funds so they can “guard against excessive federal intrusion into state affairs and be vigilant in policing the boundaries of federal power,” he wrote in 1999.
The Affordable Care Act expanded federal power, but preserved a large role for states.
Mr. Carvin, the plaintiffs’ lawyer, said the law had offered an irresistible incentive — “billions of free federal dollars” in subsidies — as an inducement for states to set up exchanges.
“That’s hardly invading state sovereignty,” Mr. Carvin said.
WSJ: Future Obamacare costs keep falling
Reply #1406 on:
March 09, 2015, 02:25:10 PM »
What say we?
Future Obamacare Costs Keep Falling
By Nick Timiraos and Stephanie Armour
Floridians sign up for the Affordable Care Act in February. The nonpartisan Congressional Budget Office projects the law will cost the government 11% less than their forecast six weeks ago.
Nearly five years after President Barack Obama signed the Affordable Care Act into law, federal budget scorekeepers have sharply revised down the projected costs of the signature bill.
In the latest projection, published by the nonpartisan Congressional Budget Office on Monday, the major provisions of the law will cost the government 11% less than they forecast six weeks ago, or $142 billion over the coming decade.
Overall, the health-care law will now cost 29% less for the 2015-19 period than was first forecast by the CBO when the law was signed in March 2010. Back then, the CBO and the congressional Joint Committee on Taxation estimated that for the last five years of their 10-year projection, Obamacare would cost $710 billion. Now, they expect it will cost $506 billion for the same period.
In 2019, for example, the agencies project Obamacare will cost $116 billion, which is down 33% from the initial forecast for the same year made in 2010.
Monday’s report illustrates two dynamics at play. First, health-care costs are rising more slowly than previous forecasts assumed. And slightly fewer people than anticipated are signing up for health insurance through federal exchanges.
The CBO estimates the government will spend 20% less on subsidies provided to individuals who purchase health insurance through the federal health exchange, or around $209 billion in lower-than-projected costs over the coming 10 years.
The government won’t see all of that savings, however, because the CBO also estimates that the government will collect less money from taxes on certain high-premium insurance plans. The latest forecast now projects taxes on those so-called “Cadillac” plans will bring in 41% less money, or $62 billion in reduced revenues. The CBO forecast shows that in 2022, the tax will bring 71% less than projected in 2012.
The decrease in government spending on the health-exchange subsidies is linked in part to projections of slower growth in health care spending. The growth in private health insurance spending per enrollee over the 2006-2013 period averaged 1.8% per year, compared with an average rate of 5% per year during the 1998-2005 period, according to the report.
In the past, the CBO had assumed that the recent slowdown in health-care inflation was temporary and would quickly reverse. The latest projections assume that health-care inflation will rise more modestly.
The slower growth in health care spending is attributed in part to the slow economic recovery and more insurance cost-sharing requirements like deductibles, which have prompted consumers to rein in their own spending on medical care. Medicare spending growth has also slowed.
The CBO report also decreased its estimate of the number of people who will be without health insurance to around 25 million, from its prior forecast of 27 million.
The report also reflects lower-than-expected enrollment in federal and state exchanges set up under the Affordable Care Act. The Obama administration said about 11.4 million people signed up for private insurance through the health law’s exchanges so far this year.
The CBO earlier estimated that 13 million people would enroll in private health plans in 2015 but has since lowered that projection.
Last Edit: March 09, 2015, 03:35:36 PM by Crafty_Dog
Re: The Politics of Health Care
Reply #1407 on:
March 11, 2015, 10:25:27 PM »
The Ugly Civil War in American Medicine
By Kurt Eichenwald 3/10/15 at 12:04 PM
A group of doctors is charging that the American Board of Internal Medicine has forced them to do meaningless work to fatten the board’s bloated coffers. Blend Images/Alamy
Are physicians in the United States getting dumber? That is what one of the most powerful medical boards is suggesting, according to its critics. And, depending on the answer, tens of millions of dollars funneled annually to this non-profit organization are at stake.
The provocative question is a rhetorical weapon in bizarre war, one that could transform medicine for years. On one side is the American Board of Internal Medicine (ABIM), which certifies that doctors have met nationally recognized standards, and has been advocating for more testing of physicians. On the other side are tens of thousands of internists, cardiologists, anesthesiologists and the like who say the ABIM has forced them to do busywork that serves no purpose other than to fatten the board’s bloated coffers.
“We don’t want to do meaningless work and we don’t want to pay fees that are unreasonable and we don’t want to line the pockets of administrators,’’ says Dr. Paul Teirstein, a nationally-prominent physician who is chief of cardiology at Scripps Clinic and who is now leading the doctor revolt.
Try Newsweek for only $1.25 per week
The physicians lining up with Teirstein are not a bunch of stumblebums afraid of a few tests. They include some of this nation’s best-known medical practitioners and academicians, from institutions like the Mayo Clinic, Harvard Medical School, Columbia Medical School and other powerhouses in the field.
This spat is hardly academic, though. Some doctors are leaving medicine because they believe the ABIM is abusing its monopoly for money, forcing physicians to unnecessarily sacrifice time with their patients and time for their personal lives.
A little history: For decades, doctors took one exam, usually just after finishing training, to prove they had absorbed enough medical knowledge to treat patients. Internists—best known as primary care physicians—would take one test while those who chose subspecialties of internal medicine—cardiovascular disease, critical care, infectious disease, rheumatology—sat for additional exams. Doctors maintained their certification status by participating in programs known as “continuing medical education,” which, when done right, keep physicians up on developments in their field.
The value to a doctor of being certified can scarcely be overstated. Many organizations will not hire uncertified doctors. And, without that stamp of approval, even doctors who open their own practices rarely receive permission from hospital boards to treat their patients in hospitals. It was a sensible way to make sure doctors stayed on top of their game and weed out incompetent clinicians.
Someone, of course, had to pay for the testing and continuing education, and it was usually the doctors. So physicians shelled out money to the ABIM to take the tests, and then ponied up more cash to attend conferences and other programs for continuing medical education. Few objected—it was worth the money to keep up the profession’s standards.
But then ABIM decided that rather than just having doctors take one certification test, maybe they should take two. Or three. Or more. Under this new rule adopted in the early 1990s, internists and subspecialists recertify every 10 years with new tests. In other words, a doctor certified at the age of 30 could look forward to taking an ABIM exam at least three more times before retirement. This was not cheap—doctors spend thousands of dollars not only for the tests, but for review sessions, for time away from their practices. And with each new test, the ABIM made more money.
Physicians sheepishly went along with the process, assuming their good old pal the ABIM was working hard to make sure medical practitioners were fully qualified.
Then, something strange happened, doctors say. The tests started including questions about medical problems that had nothing to do with how doctors did their jobs. For example, anesthesiologists who worked exclusively with adults were required to answer questions about pediatric anesthesiology. To the layman, those might not sound like a big difference, but it completely ignores how medicine is practiced. For the anesthesiologist, for example, the measurements, methods and almost every other element of putting a child to sleep for surgery is completely different than for an adult (what is the perfect measurement for an adult in a particular scenario could kill the child). And these aren’t calculations that are pulled off a chart; they involve very technical analysis that adult anesthesiologists don’t even know how to do, because they never use them. So the doctors have to spend hours reviewing issues they hadn’t seen since medical school to learn how to do something they have never—and will never—do. Then there are the internists, who are forced to learn details of a subspecialty that they would never use because, in the real world, the first thing they would do is call a subspecialist colleague for a consult—so again, the doctors have to spend time re-learning information that has nothing to do with the actual practice of medicine.
Videos and study sessions sold to help doctors prepare for re-certification exams often featured instructors saying physicians would never see a particular condition or use a certain diagnostic technique, but they needed to review it because it would be on the test. “Exam questions often are not relevant to physicians’ practice,” Teirstein says. “The questions are often out-dated. Most of the studying is done to learn the best answer for the test, which is very often not the current best practice.”
The result? According to the ABIM’S figures, the percentage of doctors passing the recertification test started dropping steadily. In 2010, some 88 percent of internists taking the maintenance of certification exams passed; by 2014, that had fallen to 80 percent. Hematologists dropped from 91% to 82%. Interventional cardiologists went from 94% to 88%. Kidney specialists, 95% to 84%. Lung experts, 90% to 79%.
Wow. Was it Obamacare? Ebola? A sign of the end times? What was turning so many American doctors so stupid all of sudden? Not to worry, the ABIM declares—the board could help doctors keep their certification. All they had to do was pay to take the tests again. Making doctors appear ignorant became big business, worth millions of dollars, and the ABIM went from being a genial organization celebrated by the medical profession to something more akin to a protection racket.
The ABIM disputes that characterization. Lorie B. Slass, a spokesperson for the ABIM, says “there have been and always will be” fluctuations in test results, since different groups of doctors are taking the exam each year. But in each of the categories cited above, there are no statistically significant fluctuations—the passing rate keeps going down. So the point remains: Either doctors are getting dumber each year, or the test that helps determine who gets to practice medicine has less and less to do with the actual practice of medicine.
Slass says the suggestion that the ABIM is “purposefully failing candidates on their exams to generate more revenue is flat-out wrong.” Maybe so, but according to the Form 990s filed with the Internal Revenue Service, in 2001—just as the earliest round of new-test standard was kicking in, the ABIM brought in $16 million in revenue. Its total compensation for all of its top officers and directors was $1.3 million. The highest paid officer received about $230,000 a year. Two others made about $200,000, and the starting salary below that was less than $150,000. Printing was its largest contractor expense. That was followed by legal fees of $106,000.
Twelve years later? ABIM is showering cash on its top executives—including some officers earning more than $400,000 a year. In the tax period ending June 2013—the latest data available—ABIM brought in $55 million in revenue. Its highest paid officer made more than $800,000 a year from ABIM and related ventures. The total pay for ABIM’s top officers quadrupled. Its largest contractor expense went to the same law firm it was using a decade earlier, but the amounts charged were 20 times more.
And there is another organization called the ABIM Foundation that does...well, it’s not quite clear what it does. Its website reads like a lot of mumbo-jumbo. The Foundation conducts surveys on how “organizational leaders have advanced professionalism among practicing physicians.” And it is very proud of its “Choosing Wisely” program, an initiative “to help providers and patients engage in conversations to reduce overuse of tests and procedures,” with pamphlets, videos and other means.
Doesn’t sound like much, until you crack open the 990s. This organization is loaded. In the tax year ended 2013, it brought in $20 million—not from contributions, not from selling a product, not for providing a service. No, the foundation earned $20 million on the $74 million in assets it holds.
The foundation racked up $5.2 million in expenses, which—other than $245,000 it gave to the ABIM—was divided into two categories: compensation and “other.” Who is getting all this compensation? The very same people who are top earners at the ABIM. Deep in the filings, it says the foundation spends $1.9 million in “program and project expenses,” with no explanation what the programs and projects are.
There are some expenditures, though, that are easy to understand: The foundation spends $153,439 a year on at least one condominium. And it picks up the tab so the spouse of the top-officer can fly along on business trips for free.
The ABIM is not what it was. Its original mission was to make sure doctors provide patients with the best care. When condominiums and lavish salaries and free trips and making money off of physicians failing tests became a priority, the evidence suggests the organization lost its way.
But that may not matter soon. In January 2014, when the ABIM issued a series of new requirements for maintaining certification—that would have generated all new fees—Teirstein and his colleagues declared “enough.” They recently formed a new recertification organization called the “National Board of Physicians and Surgeons.” It will only consider doctors for recertification who have passed the initial certification exam that has been required for decades. Doctors must also log a set number of hours with programs that qualify under guidelines as continuing medical education. The group’s fees are much, much lower than those charged by the ABIM. And its board and management—all top names in medicine—work for free.
This new board is not just about breaking the ABIM monopoly, Teirstein says, but is also part of an effort to put the right people in charge of the profession’s future. Medicine has been “controlled by individuals who are not involved with the day to day care of patients,” he says. “It is time for practicing physicians to take back the leadership.”
Forbes praises Obamacare
Reply #1408 on:
April 06, 2015, 06:00:43 PM »
Re: Forbes praises Obamacare
Reply #1409 on:
April 07, 2015, 10:32:30 AM »
Quote from: Crafty_Dog on April 06, 2015, 06:00:43 PM
Lol. Not exactly Forbes the conservative, but a writer found a sentence regarding jobs in the health sector that didn't mention the anti-job effect of two dozen tax increases within Obamacare, the loss of full time jobs elsewhere, the shift from full time to part time work, the stampede of working age adults leaving the work force, the permanent loss of trillions of dollars of GDP or the epidemic of people going on food stamps and permanent disability. The article admits the oddity of finding a sentence in a report like not also pointing out the economic damages of Obamacare and other Obama policies.
84% of Obamacare enrollees are on government subsidy. We already had free healthcare for the poor. Obamacare is a welfare dependency program for people who were once self sufficient and middle class. As Elizabeth Warren would say, good for them. (Really it isn't.) Shifting of resources was bound to occur in a trillion dollar program but no jobs and no wealth is created by robbing Peter to pay Paul.
From the article: The health care industry added 22,000 jobs last month, which was about on par with February totals for health services jobs, according to the jobs report issued Friday by the U.S. Department of Labor’s Bureau of Labor Statistics.
That statistic counts part time workers at minimum wage with no benefits on an equal footing with doctors leaving their practices. Some economic measure!
This was in Forbes too: Worst recovery since WWII. " ...total of about 10 million missing jobs."
The unemployment rate today is 9.8%
calculated at the workforce participation rate we had when Barack Obama was first inaugurated. The median wage is up by zero and income inequality is widening. The growth rate for all of last year was a miserable 2.2% and Q1 2015 was even worse. You have to be a blindfolded liberal or First Trust economist to see any of this as positive economic news for Main Street America.
TX panel votes to limit telemedicine
Reply #1410 on:
April 11, 2015, 11:48:01 AM »
It all depends on who is doing the talking
Reply #1411 on:
April 14, 2015, 08:18:22 PM »
The million dollar question:
"But Mr. Chicotel of the California advocacy group said the Kaiser example pointed to a broader tension within the quickly changing health care world: At what point does a desire to keep costs low trump concerns for quality?"
As Nursing Homes Chase Lucrative Patients, Quality of Care Is Said to Lag
****The New York TimesThe New York Times
The New York Times
By KATIE THOMAS8 hrs ago
A USS Arizona survivor salutes the remembrance wall of the USS Arizona during a memorial service for the 73rd anniversary of the attack on the US naval base at Pearl harbor, on December 7, 2014, in Pearl Harbor, Hawaii
Dr. Lois Johnson-Hamerman, a retired neonatologist, entered a Philadelphia nursing facility for short-term rehabilitation of an injured foot. She later required hospitalization for an infected bedsore. © Jessica Kourkounis for The New York Times Dr. Lois Johnson-Hamerman, a retired neonatologist, entered a Philadelphia nursing facility for short-term rehabilitation of an injured foot. She later required hospitalization for an infected bedsore.
Promises of “decadent” hot baths on demand, putting greens and gurgling waterfalls to calm the mind: These luxurious touches rarely conjure images of a stay in a nursing home.
But in a cutthroat race for Medicare dollars, nursing homes are turning to amenities like those to lure patients who are leaving a hospital and need short-term rehabilitation after an injury or illness, rather than long-term care at the end of life.
Even as nursing homes are busily investing in luxury living quarters, however, the quality of care is strikingly uneven. And it is clear that many of the homes are not up to the challenge of providing the intensive medical care that rehabilitation requires. Many are often short on nurses and aides and do not have doctors on staff.
A report released in 2014 by the Department of Health and Human Services’ Office of the Inspector General found that 22 percent of Medicare patients who stayed in a nursing facility for 35 days or less experienced harm as a result of their medical care. An additional 11 percent suffered temporary injury. The report estimated that Medicare spent $2.8 billion on hospital treatment in 2011 because of harm experienced in nursing facilities.
“These nursing homes were not built for this purpose,” said Dr. Arif Nazir, an associate professor of clinical medicine at Indiana University who studies geriatrics. He said many patients leave hospitals with acute medical needs, before infections have been fully treated, or as they adjust to new medications.
“These patients are leaving the hospital half-cooked, and believe me, the latter part of the cooking is the hardest part,” he said.
Competition for these patients has become intense because Medicare, the health insurance program for older adults, pays 84 percent more for short-term patients than nursing homes typically get from Medicaid, the health insurance program for the poor, for long-term residents.
At the same time, hospitals are trying to cut costs by pushing some patients out early — like those who have had hip replacement or heart surgery, for example. Not quite ready to go home, they need continuing care somewhere. And for older adults, Medicare usually pays the bill.
The combination of factors has created a bull market in the once-struggling industry as investors clamor to snatch up homes with the most potential to bring in short-term patients. Sale prices of nursing homes averaged $76,500 per bed last year — the second consecutive year of record-breaking prices, according to Irving Levin Associates, which analyzes the senior housing market.
So lucrative are Medicare payments that some homes have decided not to take lower-paying Medicaid patients at all.
The shifting landscape, some say, marginalizes poor long-term residents with extensive medical needs. “This focus on Medicare, Medicare, Medicare has pushed out people in the custodial care world,” said Anthony Chicotel, a staff lawyer at California Advocates for Nursing Home Reform, who says he fields calls at least once a week from residents who are being evicted because their Medicare coverage, which lasts 100 days, is expiring and the residents will transition to lower-paying Medicaid insurance. “They’re being pushed out, and they don’t have anywhere to go, really, that can take care of them.”
Representatives of nursing homes acknowledge that the challenges are substantial, but they are optimistic about the progress they are making.
“It’s uneven, but I think, that said, we’re trending in the right direction,” said Dr. David Gifford, the senior vice president of quality and regulatory affairs at the American Health Care Association, an industry trade group. “I think you’re seeing a much greater linking of quality, and an emphasis on it,” he added.
Dr. Gifford and others say they are paying close attention to quality — not only because it is the right thing to do, but because hospitals and large health systems are beginning to demand it. Under the new health care law, hospitals may be penalized if too many of their patients are readmitted within a certain time.
“Hospitals are starting to get really worried, and when hospitals are worried, skilled nursing facilities are worried, because they are their sources of patients,” said David Grabowski, a professor of health care policy at the Harvard Medical School.
Promises of Care
Dr. Lois Johnson-Hamerman, a retired neonatologist, said she thought she had done her homework when she checked into the Watermark at Logan Square, a nursing facility in Philadelphia.
The home had a reputation for quality and got high marks from the federal government. Until a recent revision, its website promised “top-notch health care” with amenities including a staff willing to administer a “decadent hot bath” at any hour of the day.
But just one month after arriving at Watermark for short-term rehabilitation of an injured foot in 2012, Dr. Johnson-Hamerman ended up in the emergency room with a severe bedsore that had become dangerously infected. Far from the service she said she had been promised, she said the workers never gave her a full bath or shower, were slow to respond to her requests to have her diaper changed and did not turn her every few hours, a crucial step in preventing bedsores.
She said she left the facility only after friends, including doctors and nurses, became so horrified by her care that they insisted that she be taken to a hospital.
Geriatric researchers call this disconnect the “chandelier effect.” Attractive lobbies and enticing amenities do not always mean that a home provides good medical care.
In reality, said Dr. Steven Handler, a geriatrician and assistant professor at the University of Pittsburgh School of Medicine, many nursing homes are struggling to provide consistent, quality care despite genuine efforts. “The nursing homes are kind of stuck in an older model that is based on a very small operating margin, low-staffing model and low physician presence,” he said.
Dr. Johnson-Hamerman, who is 87, is suing Watermark over what she describes as negligent care.
“At least I’m still here,” she said recently at her home. “But where would I be if I didn’t have the friends and resources to do something about it?”
C. Jill Hofer, a spokeswoman for Watermark, said that the home was committed to providing quality care and that it denied the allegations in the lawsuit.
Bull Market for Short-Term Homes
The nursing home industry has long argued that it relies on higher Medicare payments to offset the rates it receives from Medicaid, which usually pays for the care of long-term residents.
And indeed, even though facilities earned a 2 percent overall profit in 2013, they lost about 2 percent on non-Medicare patients, according to the Medicare Payment Advisory Commission, or Medpac, an agency of Congress.
But in recent years, that focus on Medicare patients has intensified as many long-term residents have moved to assisted-living facilities and hospitals have sought to discharge patients earlier. On a typical day in 2000, about 9 percent of residents in an average nursing home were covered by Medicare, according to federal data. By 2014, that had risen to 15 percent.
Some companies are now eliminating Medicaid payments entirely by building homes solely for the more lucrative short-term patients.
Santé Partners, a developer in Arizona, recently opened four nursing homes that do not accept any long-term residents. A fifth is set to break ground this summer.
The buildings resemble hotels, with high-quality restaurants and private rooms that have kitchenettes. Developers say their singular focus allows them to provide better care.
“I think pretty much every company now is going in this direction,” said C. Mark Hansen, the president and chief executive of Santé Partners.
Some for-profit chains have aggressively increased their numbers of Medicare patients. In California, the share of Medicare patients at several large chains has far outpaced the state average, according to an analysis of state nursing home data by The New York Times.
On a typical day in 2012, about 11 percent of beds in California nursing homes were occupied by Medicare patients, The Times’s analysis showed.
But at HCR ManorCare, one of the nation’s largest chains, 32 percent were Medicare patients at its California nursing homes. At the Ensign Group, a large chain based in California, Medicare covered 20 percent of patients on a typical day in 2012.
HCR ManorCare said that it had invested in treating patients with complex medical needs and that that helped explain why its percentage of Medicare patients was higher than the state average. A spokeswoman for Ensign declined to comment.
Ensign is one of several chains that has recently paid federal fines to settle charges that they exaggerated the therapy needs of patients to increase Medicare payments. The company paid $48 million in 2013 to settle such claims. In October, a large Canadian company, Extendicare Health Services, paid $38 million in a similar case.
Even homes with a history of poor care are marketing their high-end amenities. The Medford Multicare Center for Living on Long Island recently opened a wing intended for short-term care known as “The Lux at Medford.” Guests have access to a putting green, a model apartment and a parked PT Cruiser to teach them how to resume their day-to-day activities.
The New York State attorney general sued the facility last year over issues of quality, and seven employees were indicted on a range of charges related to the death of Aurelia Rios, a patient in the facility’s ventilator unit. Federal officials recently placed the home on a watch list of the nation’s poorest-performing facilities.
Jason Newman, a spokesman for the home, says the owners of Medford dispute the charges. “The owners of this facility care very, very much about this place,” he said.
Claims of Lapses, and Death
Deaths attributed to lapses in care are not uncommon. In 2010, Mary Dwyer checked into Harborview Healthcare Center in Jersey City to recuperate after dislocating her shoulder in a fall.
Ms. Dwyer, who was 87, planned to return home, but her condition deteriorated rapidly because of what her family described as negligent care. Staff members were so overworked that Ms. Dwyer was not fed properly and not repositioned frequently in her bed, according to a lawsuit the family later filed in New Jersey state court alleging negligence and wrongful death.
In a month, Ms. Dwyer lost 20 pounds and developed a bedsore so severe that it exposed her bone.
She was treated at a hospital for her injury, and she died about a month later. Last year, a jury awarded her family more than $13 million.
The amount has since been reduced to $4.75 million and the case is being appealed by the nursing home. A spokeswoman for Harborview said the company denied the charges and maintained an outstanding record for quality.
“Nobody really took responsibility,” Ms. Dwyer’s daughter, Henrietta Dwyer, said recently. “It seemed nobody was accountable for anything.”
Industry specialists say that competition is so intense that eventually quality will prevail, as hospitals and insurers, who cover some Medicare patients, will balk at sending patients to homes that perform poorly.
Siblings Georgette Dwyer, left, Henrietta Dwyer and James Dwyer. Within a month of checking into a nursing home after dislocating her shoulder, their mother lost 20 pounds and developed a severe bedsore. She died a month later. © Bryan Anselm for The New York Times Siblings Georgette Dwyer, left, Henrietta Dwyer and James Dwyer. Within a month of checking into a nursing home after dislocating her shoulder, their mother lost 20 pounds and developed a severe bedsore…
Hospitals now pay penalties if too many patients are readmitted.
And under new payment models, health systems are beginning to coordinate the care of patients even after they leave the hospital. They are rewarded for keeping costs low, but they also must prove that certain quality goals are met.
The Medford Multicare Center for Living on Long Island has a wing for short-term care known as “The Lux at Medford.” It includes a parked car so residents can practice getting in and out. © Kirsten Luce for The New York Times The Medford Multicare Center for Living on Long Island has a wing for short-term care known as “The Lux at Medford.” It includes a parked car so residents can practice getting in and out.
“It’s happening at a head-spinning rate,” said Dr. Nazir of Indiana University. “It has been a very positive thing.”
Dr. Gifford of the industry trade group said his group’s members had reduced re-hospitalization rates by 14 percent. And the group has supported other measures to improve quality, he said, including one passed by Congress last year that will withhold a percentage of Medicare payments from facilities, who can then earn back some of the money if they meet certain standards.
Mr. Hansen, the chief executive of Santé Partners, said his facilities did not bring in high profits because the company invests heavily in quality. That investment pays off, he said, because he can demonstrate that his facilities provide good care at a lower cost than, say, a hospital.
“It’s bringing down the total cost of the health care spend,” Mr. Hansen said.
Still, some insurers and hospitals continue to send patients to homes with poor records.
Kaiser Permanente, which combines a nonprofit insurance plan with its own hospitals and clinics, sends patients to a network of outside nursing homes in Maryland and Virginia that the organization says meet its “high standards of care.” However, of the 12 so-called core nursing homes in Kaiser’s network, four held a one-star rating for their health inspection. One was ranked five stars, the highest score.
After The New York Times contacted Kaiser, a spokesman said it would end its association with one of the poorly rated homes, Commonwealth Health & Rehab Center in Fairfax, Va.
The spokesman said that the company sends Kaiser doctors and staff members to the facilities to treat its patients, and that most of them are placed in homes with the higher ratings. He said Kaiser was working with the low-rated homes to improve their conditions.
“The care and safety of our members and patients are our top priorities,” said the spokesman, Marc Brown.
But Mr. Chicotel of the California advocacy group said the Kaiser example pointed to a broader tension within the quickly changing health care world: At what point does a desire to keep costs low trump concerns for quality?
“I think a lot of the time when it comes to managed care, it’s a race to the
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