“Florida is not a physician-friendly state to practice medicine because of the high cost of medical liability insurance and excessive lawsuits,....the FMA PAC supports Rick Scott for Governor because he shares our goal of increasing access to quality health care for all of Florida’s citizens. Rick Scott is not afraid of taking on personal injury lawyers and shaking up the status quo in order to get things done for the people of Florida.”
President of the FMA PAC, Dr. Madelyn Butler
I tried to understand Rick Scott's healthcare plan and ideas, which convinced the Florida Medical Association Political Action Committee to endorse him as Gubernatorial Candidate.
First, I searched on his web site and found the following:
* On Abortion: "I believe that abortion is wrong and Roe versus Wade should be overturned."
o What shall I tell a woman who is pregnant but unmarried, unemployed, on food stamps and lives with friends or relatives?
o Teenagers who were raped or married women who were sexually attacked by their husbands?
o Should government tell women and doctors what to do and how to lives their lives?
* On Health Care:
o "As a businessman, I know I am held accountable for results, and I held the people in my company accountable for results, too. Delivering quality care at a lower cost to patients was a top priority when I ran Columbia/HCA, and when I started Solantic urgent care facilities here in Florida....In the 1990’s, we were able to transform the hospital industry and prove that free market health care can deliver high quality care at a lower cost to patients."
+ That’s it? We just have to emulate the Columbia/HCA model and open a couple of Solantic Urgent Care centers and we solve all healthcare problems? Guess, I can shred all my healthcare economics test books and magazines, join Rick Scott's model and everything will be just fine. How naive or stupid can anyone be to believe that? Obviously, the FMA PAC does!
o "Rick believes that our health care system should focus on choice, competition, accountability and personal responsibility."
+ So I will have the choice of choosing between an unaffordable health insurance policy or none?
+ Accountability and personal responsibility only applies to the consumers of healthcare but not Rick Scott who just made " some mistakes in his life."
o "Most recently, Rick led the fight to defeat President Obama’s government-run public option. As the founder of Conservatives for Patients’ Rights (CPR), an advocacy group dedicated to the free market principles of choice, competition, accountability and personal responsibility in health care, he was instrumental in defeating the public option plan that would have led to socialized medicine."
+ Fear mongering and painting the government as the boogeyman trying to enslave citizens is a silly and dangerous tactic which just reveals that Rick Scott and friends have no other arguments to offer to resolve the critical problem facing us today and in the near future: how to provide affordable healthcare for an aging population suffering from chronic diseases that consume already 75% of all health care spending.
* On healthcare management experience:
o " I’ve made mistakes in my life...I learned very hard lessons from what happened and those lessons have helped me become a better businessman and leader."
+ That’s it! Mistakes imply taking personal responsibility and not blaming others (i.e. Columbia/HCA) for it. These are the lessons he brings to the table and those character traits make him the knight in shining armor for the FMA PAC?
So what can I say about the FMA PAC decision to endorse Rick Scott? A sad day for Florida's doctors. A sad day for medicine.
Yours
Bernd
Tuesday, October 12, 2010
Monday, October 11, 2010
Strange Bedfellows: The FMA and Rick Scott
According to a posting on the Florida Medical Association PAC web site ( see attached) the FMA PAC is endorsing endorsing Rick Scott's candidacy as Governor for our State of Florida!!???
Even though I already lowered my expectation regarding FMA's actions and politics I am still surprised that the leadership of such an organization is willing to sacrifice its principles on the altar of political correctness. Sadly, ideology trumped rational thought and consideration. Its hard to believe that the FMA political leadership has omitted considering the following facts in their deliberation process. These facts are available for anyone to read on multiple web sites and were summarized by the Miami Herald in an article published on June 11th, 2010 http://www.miamiherald.com/2010/06/11/v-print/1674327/was-candidate-involved-in-us-healthcare.html, entitled "Was candidate Rick Scott involved in US Healthcare Scam."
In the article the author states that:
"Scott started what was first Columbia in the spring of 1987, purchasing two El Paso, Texas, hospitals. He quickly grew the company by purchasing more hospitals. A hospital network created efficiencies. Efficiencies created profits.
In 1994, Scott's Columbia purchased Tennessee-headquartered HCA and its 100 hospitals, and merged the companies. When Scott resigned as CEO in 1997, Columbia/HCA had grown to more than 340 hospitals, 135 surgery centers and 550 home health locations in 37 states and two foreign countries, Scott's campaign says. The company employed more than 285,000 people.
Now about Scott's departure in 1997. That year, federal agents went public with an investigation into the company, first seizing records from four El Paso-area hospitals and then expanding across the country. In time it became apparent that the investigation focused on whether Columbia/HCA bilked Medicare and Medicaid.
Scott resigned as CEO in July 1997, less than four months after the inquiry became public and before the depth of the investigation became clear. Company executives said that had Scott remained CEO, the entire chain could have been in jeopardy.
At issue, Scott says, is that he wanted to fight the federal government's accusations. The corporate board of the publicly traded company wanted to settle. And settle Columbia/HCA did.
In December 2000, the U.S. Justice Department announced what it called the largest government fraud settlement in U.S. history when Columbia/HCA agreed to pay $840 million in criminal fines and civil damages and penalties.
Among the revelations from the 2000 settlement, all of which apply to the time Scott was CEO:
• Columbia billed Medicare, Medicaid and other federal programs for tests that were not necessary or ordered by physicians.
• The company attached false diagnosis codes to patient records to increase reimbursement to the hospitals.
• The company illegally claimed nonreimbursable marketing and advertising costs as community education.
• Columbia billed the government for home health care visits for patients who did not qualify to receive them.
The government settled a second series of claims with Columbia/HCA in 2002 for an additional $881 million. The total fine: $1.7 billion."
Furthermore the article continues:
"As part of the 2000 settlement, Columbia/HCA agreed to plead guilty to at least 14 corporate felonies. A corporate felony comes with financial penalties but not jail time, since a corporation can't be sent to prison. Among the 14 felonies, Columbia/HCA pleaded guilty to three counts of conspiracy to defraud the United States.
Also, four Florida-based Columbia/HCA executives were indicted. Two were convicted of defrauding Medicare in 1999 and were sentenced to prison, only to have those convictions overturned on appeal. A third executive was acquitted. A jury failed to reach a verdict on the fourth.
Was Scott close to going to prison for his part in the case? It appears not at all.
The former CEO was never indicted and was never questioned in the case, he says. He may have been a target of the investigation -- an ABC News report from 1997 says he was -- but that never translated into charges."
Let's boil this down.
Was Scott running Columbia/HCA when it found itself at the center of a massive federal investigation? Yes.
Did the company pay a record $1.7 billion in government penalties and fines? Yes.
And as we checked in this item, did his former company commit fraud? Yes, it pleaded guilty to fraud charges as part of a settlement.
The million-dollar question is: How much of the blame ultimately falls on Scott? That's an answer we can't provide.
Scott was in charge, so he bears some responsibility and has said so. But there has yet to come to light any detail of how much he knew, and when he knew it. Though that won't keep us from looking.
What did Rick Scott had to say about all that? Either he pleaded the Fifth Amendment, or claims that he did not know what was going on in his own company. I ask myself just one question: How on earth can anyone entrust the keys to the Governors' office to Rick Scott?
Maybe we should admire the Chutzpah (audacity) of Rick Scott and those who endorse his candidacy?
Maybe its time that in light of these facts doctors should reconsider their support for the FMA's endorsement because this time their leadership went too far.
Yours
Bernd
Attachment: FMA PAC web site http://www.fmaonline.org/Layout_1Column.aspx?pageid=2580
FMA PAC – General Election Endorsements
Statewide Races
Governor – Rick Scott
Attorney General – Pam Bondi
Chief Financial Officer - Jeff Atwater
Commissioner of Agriculture - Adam Putnam
Even though I already lowered my expectation regarding FMA's actions and politics I am still surprised that the leadership of such an organization is willing to sacrifice its principles on the altar of political correctness. Sadly, ideology trumped rational thought and consideration. Its hard to believe that the FMA political leadership has omitted considering the following facts in their deliberation process. These facts are available for anyone to read on multiple web sites and were summarized by the Miami Herald in an article published on June 11th, 2010 http://www.miamiherald.com/2010/06/11/v-print/1674327/was-candidate-involved-in-us-healthcare.html, entitled "Was candidate Rick Scott involved in US Healthcare Scam."
In the article the author states that:
"Scott started what was first Columbia in the spring of 1987, purchasing two El Paso, Texas, hospitals. He quickly grew the company by purchasing more hospitals. A hospital network created efficiencies. Efficiencies created profits.
In 1994, Scott's Columbia purchased Tennessee-headquartered HCA and its 100 hospitals, and merged the companies. When Scott resigned as CEO in 1997, Columbia/HCA had grown to more than 340 hospitals, 135 surgery centers and 550 home health locations in 37 states and two foreign countries, Scott's campaign says. The company employed more than 285,000 people.
Now about Scott's departure in 1997. That year, federal agents went public with an investigation into the company, first seizing records from four El Paso-area hospitals and then expanding across the country. In time it became apparent that the investigation focused on whether Columbia/HCA bilked Medicare and Medicaid.
Scott resigned as CEO in July 1997, less than four months after the inquiry became public and before the depth of the investigation became clear. Company executives said that had Scott remained CEO, the entire chain could have been in jeopardy.
At issue, Scott says, is that he wanted to fight the federal government's accusations. The corporate board of the publicly traded company wanted to settle. And settle Columbia/HCA did.
In December 2000, the U.S. Justice Department announced what it called the largest government fraud settlement in U.S. history when Columbia/HCA agreed to pay $840 million in criminal fines and civil damages and penalties.
Among the revelations from the 2000 settlement, all of which apply to the time Scott was CEO:
• Columbia billed Medicare, Medicaid and other federal programs for tests that were not necessary or ordered by physicians.
• The company attached false diagnosis codes to patient records to increase reimbursement to the hospitals.
• The company illegally claimed nonreimbursable marketing and advertising costs as community education.
• Columbia billed the government for home health care visits for patients who did not qualify to receive them.
The government settled a second series of claims with Columbia/HCA in 2002 for an additional $881 million. The total fine: $1.7 billion."
Furthermore the article continues:
"As part of the 2000 settlement, Columbia/HCA agreed to plead guilty to at least 14 corporate felonies. A corporate felony comes with financial penalties but not jail time, since a corporation can't be sent to prison. Among the 14 felonies, Columbia/HCA pleaded guilty to three counts of conspiracy to defraud the United States.
Also, four Florida-based Columbia/HCA executives were indicted. Two were convicted of defrauding Medicare in 1999 and were sentenced to prison, only to have those convictions overturned on appeal. A third executive was acquitted. A jury failed to reach a verdict on the fourth.
Was Scott close to going to prison for his part in the case? It appears not at all.
The former CEO was never indicted and was never questioned in the case, he says. He may have been a target of the investigation -- an ABC News report from 1997 says he was -- but that never translated into charges."
Let's boil this down.
Was Scott running Columbia/HCA when it found itself at the center of a massive federal investigation? Yes.
Did the company pay a record $1.7 billion in government penalties and fines? Yes.
And as we checked in this item, did his former company commit fraud? Yes, it pleaded guilty to fraud charges as part of a settlement.
The million-dollar question is: How much of the blame ultimately falls on Scott? That's an answer we can't provide.
Scott was in charge, so he bears some responsibility and has said so. But there has yet to come to light any detail of how much he knew, and when he knew it. Though that won't keep us from looking.
What did Rick Scott had to say about all that? Either he pleaded the Fifth Amendment, or claims that he did not know what was going on in his own company. I ask myself just one question: How on earth can anyone entrust the keys to the Governors' office to Rick Scott?
Maybe we should admire the Chutzpah (audacity) of Rick Scott and those who endorse his candidacy?
Maybe its time that in light of these facts doctors should reconsider their support for the FMA's endorsement because this time their leadership went too far.
Yours
Bernd
Attachment: FMA PAC web site http://www.fmaonline.org/Layout_1Column.aspx?pageid=2580
FMA PAC – General Election Endorsements
Statewide Races
Governor – Rick Scott
Attorney General – Pam Bondi
Chief Financial Officer - Jeff Atwater
Commissioner of Agriculture - Adam Putnam
Sunday, October 3, 2010
Prescription Drug Prices
In todays Miami Herald State Representative Juan C. Zapata calls for a mandated use of generic drugs for Medicaid and other state-funded programs http://www.miamiherald.com/2010/10/03/1854185/mandate-use-of-generic-drugs-for.html . He is correct saying that the use of generic drugs will slow down the predicted explosive growth of Medicaid expenditures but the mandated use of generic drugs addresses only ONE aspect of the problem.According to a New York Times article , Drug Makers Accused of Ignoring Price Law,” http://www.nytimes.com/2010/10/03/us/03drug.html , drug manufacturers consistently defy complying with a federal law that requires them to provide the government with pricing data needed to calculate discounts on medications prescribed for Medicaid recipients. More than three-fourths of drug manufacturers did not fully comply with the law requiring them to provide price data. They are supposed to file monthly and quarterly reports on what wholesalers paid them for drugs eventually sold to retail pharmacies. Without price data, the federal government cannot compute rebates, and states may be unable to collect them. As a condition of having their drugs covered by Medicaid, pharmaceutical companies must agree to provide discounts in the form of rebates. Drug companies pay the rebates to state Medicaid programs. The federal government and the states share the cost of Medicaid — roughly $400 billion in the last year — and share the savings that result from the rebates. Under the health care law, the minimum rebate on brand-name drugs dispensed to Medicaid recipients was increased to 23.1 percent of the average manufacturer price, from 15.1 percent. The minimum rebate on generic drugs was increased to 13 percent, from 11 percent. The Congressional Budget Office estimates that the changes could save the federal government more than $35 billion over 10 years. Major drug companies are already reporting adverse effects on their revenues. However, drug companies stand to gain many customers with the scheduled Medicaid expansion in 2014. What can be done to address this problem? Under federal law, the government can impose penalties of $10,000 a day on a drug manufacturer that fails to provide the information “on a timely basis. According to the Inspector General at the Department of Health and Human Services the federal government has had this authority since 1990 but has not used it! Why not? We must control and limit the rising healthcare costs and drug manufactures must understand that they can be either be part of the problem, or part of the solution. We also should lift the limitation on prescription drug re-importation and stop the unscrupulous use of antipsychotic drugs, which generate over $14 billion in revenue for drug manufacturers. Otherwise, we have no choice but to resort to rationing of healthcare services and prescription drugs.
Yours
Bernd
Yours
Bernd
Thursday, September 30, 2010
Medicare Fraud
So, it finally happened! Jay Weaver, the Miami Herald journalist who uncovered many Medicare fraud issues in South Florida, wrote another excellent article reporting that CMS is now being forced to revamp its payment policy. In his latest article http://www.miamiherald.com/2010/09/30/v-print/1849528/medicares-new-order-first-weigh.html he emphasizes that:
"An anti-fraud provision, tucked into the Small Business Lending Act that became law Monday, would force Medicare to end its 45-year-old policy of paying claims quickly without verifying them. The Centers for Medicare and Medicaid Services, which pays out $500 billion yearly for elderly and disabled Americans, would have to adopt new billing software with ``predictive modeling'' by next year. Such analytical technology enables the credit card industry to detect questionable bills for, say, a flat-screen TV purchased outside a cardholder's immediate area so that companies can notify the customer and stop payment if fraud is a factor.The cost of rolling out the new billing technology would reach an estimated $930 million over the next decade but it may reduce or prevent paying one of every $7 to fraudulent claimants.
Furthermore, the new Affordable Care Act includes tougher penalties for offenders, expanded administrative powers for Medicare and $350 million to combat healthcare corruption over the next decade."
Sen. George LeMieux, R-Florida, who sponsored the anti-fraud bill, said he has been frustrated watching Medicare continue to pay billions to dubious healthcare providers for unnecessary or bogus services. But Senator LeMieux supports the Republican Party platform to repeal the same Affordable Care Act which funds such anti-fraud activities! Does he really believe that the voters are that stupid, or short-term memory challenged, to forget his election antics?
Its time that politicians start collaborating and cooperating to solve the real problems we are facing and to focus on stopping the Medicare fraud gravy train.
But maybe I am too naive to believe that politicians are capable to act and behave rationally.
Yours
Bernd
"An anti-fraud provision, tucked into the Small Business Lending Act that became law Monday, would force Medicare to end its 45-year-old policy of paying claims quickly without verifying them. The Centers for Medicare and Medicaid Services, which pays out $500 billion yearly for elderly and disabled Americans, would have to adopt new billing software with ``predictive modeling'' by next year. Such analytical technology enables the credit card industry to detect questionable bills for, say, a flat-screen TV purchased outside a cardholder's immediate area so that companies can notify the customer and stop payment if fraud is a factor.The cost of rolling out the new billing technology would reach an estimated $930 million over the next decade but it may reduce or prevent paying one of every $7 to fraudulent claimants.
Furthermore, the new Affordable Care Act includes tougher penalties for offenders, expanded administrative powers for Medicare and $350 million to combat healthcare corruption over the next decade."
Sen. George LeMieux, R-Florida, who sponsored the anti-fraud bill, said he has been frustrated watching Medicare continue to pay billions to dubious healthcare providers for unnecessary or bogus services. But Senator LeMieux supports the Republican Party platform to repeal the same Affordable Care Act which funds such anti-fraud activities! Does he really believe that the voters are that stupid, or short-term memory challenged, to forget his election antics?
Its time that politicians start collaborating and cooperating to solve the real problems we are facing and to focus on stopping the Medicare fraud gravy train.
But maybe I am too naive to believe that politicians are capable to act and behave rationally.
Yours
Bernd
Wednesday, September 22, 2010
Healthcare Reform
Several very important component of the federal healthcare reform package are going to go into effect tomorrow.
Therefore, we should review the facts (and not fiction) regarding those components which will protect our patients (i.e. our families) from insurance companies. I hope that physicians will finally embrace these reforms, too. There should be no reason to reject them!
I also recommend reading today's Miami Herald editorial supporting healthcare reform. I agree with the authors conclusion:
"But tweaking the law and trying to get rid of it altogether, as a lawsuit filed by Florida's attorney general and others aims to do, are two different things. The law is an investment in the health and future of the American people. It can be improved, but it should become a permanent feature of American society."
Read more: http://www.miamiherald.com/2010/09/22/v-print/1836040/healthcare-reform-should-be-here.html#ixzz10Jt5GrD4
Yours
Bernd
* Preventive services:
o Based on the theory that inexpensive preventive measures can reduce expensive hospital visits later, the reform act requires insurers to pay all costs for many immunization vaccines and screenings for colorectal cancer (for those over 50), depression, high blood pressure (for diabetics) and autism (for children 18 months to 24 months.)
o Also covered at 100 percent are mammograms for women over 40 and smoking cessation programs. For a full list of preventive services covered go to www.healthcare.gov/law/
* Adult children:
o All new private insurance that offers dependent coverage must allow parents to cover their children until age 26. They can live elsewhere and still be covered, and they must be charged at the policy's prevailing child rates.I
o If adult children can get insurance through their own jobs, they can't switch to their parents' existing job-based coverage if it's grandfathered. But if they don't have work coverage, they can move to parents' plans, even if the employers are planning to continue using their current plans.
* Right to appeal:
o Consumers covered under new, non-grandfathered insurance plans will have a right to appeal to an external party if, for example, their insurer denies coverage of treatments recommended by their doctors.
o Consumers will first have to file an internal appeal with the insurers. If not satisfied, they then can appeal to an impartial reviewer. Details of who will handle reviews and what regulations will apply are being worked out.
* No exclusions for children:
o In the past, insurers can -- and regularly did -- deny children with pre-existing conditions. As of Sept. 23, Thursday, they will be required to accept all kids, regardless of health status.
o This provision has led to spirited debate. Insurers' fear is that parents would wait until their kids got sick to buy coverage. `
o Insurers depend on providing coverage for a broad pool of people -- with the healthy majority paying premiums that fund the sick minority. Their fear with reform is that if only sick people sign up, insurers will lose huge amounts of money or need to raise premiums to horrendously high rates. Starting in 2014, that fear vanishes, because virtually everyone will be required then to have insurance.
o Health and Human Services recently responded to the insurers' fears about kid coverage, allowing insurers in the individual market to have an open enrollment period of, say, one month a year in which families could sign up children under 19 with pre-existing conditions. That means families will be encouraged to enroll healthy kids because they won't be able to automatically sign them up when they get sick.
* Lifetime caps removed:
o Many policies have limitations of $1 million, $2 million or even more. Most people never even have to think about them. But for those with severe chronic illness, their removal could mean a lot, possibly even preventing bankruptcy.
* High risk pools:
o For the truly desperate, the new high-risk pools can be a lifesaver -- but not a cheap one. They're intended for uninsured patients who have pre-existing conditions and can't get coverage elsewhere. They will serve as a bridge until 2014, when there are new government-regulated insurance exchanges accepting virtually everyone who can't get coverage elsewhere.
o Florida has had a high-risk pool for years, but because of the expense, it has been closed to new patients since 1991 and has only 250 members left.
o The Legislature opted not to re-open it in response to the reform act, meaning that the state's residents can sign up for a federally sponsored pool, known as the Pre-Existing Condition Insurance Plan.
o Under the plan, Florida residents will pay monthly rates ranging from $363 for those up to 34 and as much as $773 for those 55 and older, according to healthcare.gov . That's with a $2,500 deductible and maximum out-of-pocket of $5,950 a year. Those payments cover only part of their insurance costs. The feds have allocated $351 million to Florida to pick up the rest of the expenses till 2014. Critics fear that's not enough.
o The program is only for those who are legally in the United States, have been uninsured for at least six months and have been denied coverage because of a pre-existing condition. Applications are available at healthcare.gov or by calling (866) 717-5826.
* Limiting insurers' profits:
o Starting Jan. 1, insurers of large groups will be required to spend 85 percent of premiums on healthcare. For insurers of small groups and individual policies, it's 80 percent. In 2012, if insurers fail to meet these requirements, they must offer rebates to customers.
o Should money spent on converting to electronic records be counted as a medical expense or an administrative one? What about monitoring infectious disease rates in hospitals or money spent managing chronic conditions?
o The National Association of Insurance Commissioners has been working on draft guidelines. The U.S. Department of Health and Human Services says it has not yet received them.
* Other changes:
* About one million seniors have already received $250 rebate checks because of high prescription drug costs that were not covered by Medicare Part D.
* About 70 South Florida organizations -- including the Miami-Dade and Broward school systems -- will get funds to help pay for healthcare for retirees aged 55 to 64 who are not eligible for Medicare.
* Starting this year, businesses with no more than 25 workers with average annual wages under $50,000 can get tax credits of up to 35 percent of the costs of premiums.
For further information, healthcare.gov is the government site for the reform act. The Kaiser Family Foundation (kff.org), the Commonwealth Fund (commonwealthfund.org ) and Families USA (familiesusa.org) are three Washington nonprofits that provide details and analysis of the reform act.
Therefore, we should review the facts (and not fiction) regarding those components which will protect our patients (i.e. our families) from insurance companies. I hope that physicians will finally embrace these reforms, too. There should be no reason to reject them!
I also recommend reading today's Miami Herald editorial supporting healthcare reform. I agree with the authors conclusion:
"But tweaking the law and trying to get rid of it altogether, as a lawsuit filed by Florida's attorney general and others aims to do, are two different things. The law is an investment in the health and future of the American people. It can be improved, but it should become a permanent feature of American society."
Read more: http://www.miamiherald.com/2010/09/22/v-print/1836040/healthcare-reform-should-be-here.html#ixzz10Jt5GrD4
Yours
Bernd
* Preventive services:
o Based on the theory that inexpensive preventive measures can reduce expensive hospital visits later, the reform act requires insurers to pay all costs for many immunization vaccines and screenings for colorectal cancer (for those over 50), depression, high blood pressure (for diabetics) and autism (for children 18 months to 24 months.)
o Also covered at 100 percent are mammograms for women over 40 and smoking cessation programs. For a full list of preventive services covered go to www.healthcare.gov/law/
* Adult children:
o All new private insurance that offers dependent coverage must allow parents to cover their children until age 26. They can live elsewhere and still be covered, and they must be charged at the policy's prevailing child rates.I
o If adult children can get insurance through their own jobs, they can't switch to their parents' existing job-based coverage if it's grandfathered. But if they don't have work coverage, they can move to parents' plans, even if the employers are planning to continue using their current plans.
* Right to appeal:
o Consumers covered under new, non-grandfathered insurance plans will have a right to appeal to an external party if, for example, their insurer denies coverage of treatments recommended by their doctors.
o Consumers will first have to file an internal appeal with the insurers. If not satisfied, they then can appeal to an impartial reviewer. Details of who will handle reviews and what regulations will apply are being worked out.
* No exclusions for children:
o In the past, insurers can -- and regularly did -- deny children with pre-existing conditions. As of Sept. 23, Thursday, they will be required to accept all kids, regardless of health status.
o This provision has led to spirited debate. Insurers' fear is that parents would wait until their kids got sick to buy coverage. `
o Insurers depend on providing coverage for a broad pool of people -- with the healthy majority paying premiums that fund the sick minority. Their fear with reform is that if only sick people sign up, insurers will lose huge amounts of money or need to raise premiums to horrendously high rates. Starting in 2014, that fear vanishes, because virtually everyone will be required then to have insurance.
o Health and Human Services recently responded to the insurers' fears about kid coverage, allowing insurers in the individual market to have an open enrollment period of, say, one month a year in which families could sign up children under 19 with pre-existing conditions. That means families will be encouraged to enroll healthy kids because they won't be able to automatically sign them up when they get sick.
* Lifetime caps removed:
o Many policies have limitations of $1 million, $2 million or even more. Most people never even have to think about them. But for those with severe chronic illness, their removal could mean a lot, possibly even preventing bankruptcy.
* High risk pools:
o For the truly desperate, the new high-risk pools can be a lifesaver -- but not a cheap one. They're intended for uninsured patients who have pre-existing conditions and can't get coverage elsewhere. They will serve as a bridge until 2014, when there are new government-regulated insurance exchanges accepting virtually everyone who can't get coverage elsewhere.
o Florida has had a high-risk pool for years, but because of the expense, it has been closed to new patients since 1991 and has only 250 members left.
o The Legislature opted not to re-open it in response to the reform act, meaning that the state's residents can sign up for a federally sponsored pool, known as the Pre-Existing Condition Insurance Plan.
o Under the plan, Florida residents will pay monthly rates ranging from $363 for those up to 34 and as much as $773 for those 55 and older, according to healthcare.gov . That's with a $2,500 deductible and maximum out-of-pocket of $5,950 a year. Those payments cover only part of their insurance costs. The feds have allocated $351 million to Florida to pick up the rest of the expenses till 2014. Critics fear that's not enough.
o The program is only for those who are legally in the United States, have been uninsured for at least six months and have been denied coverage because of a pre-existing condition. Applications are available at healthcare.gov or by calling (866) 717-5826.
* Limiting insurers' profits:
o Starting Jan. 1, insurers of large groups will be required to spend 85 percent of premiums on healthcare. For insurers of small groups and individual policies, it's 80 percent. In 2012, if insurers fail to meet these requirements, they must offer rebates to customers.
o Should money spent on converting to electronic records be counted as a medical expense or an administrative one? What about monitoring infectious disease rates in hospitals or money spent managing chronic conditions?
o The National Association of Insurance Commissioners has been working on draft guidelines. The U.S. Department of Health and Human Services says it has not yet received them.
* Other changes:
* About one million seniors have already received $250 rebate checks because of high prescription drug costs that were not covered by Medicare Part D.
* About 70 South Florida organizations -- including the Miami-Dade and Broward school systems -- will get funds to help pay for healthcare for retirees aged 55 to 64 who are not eligible for Medicare.
* Starting this year, businesses with no more than 25 workers with average annual wages under $50,000 can get tax credits of up to 35 percent of the costs of premiums.
For further information, healthcare.gov is the government site for the reform act. The Kaiser Family Foundation (kff.org), the Commonwealth Fund (commonwealthfund.org ) and Families USA (familiesusa.org) are three Washington nonprofits that provide details and analysis of the reform act.
Monday, September 6, 2010
Shifting Healthcare Costs
According to a recent editorial published in the New York Times (Shifting the Health Cost Burden, September, 2nd, 2010) "the latest annual survey of employer health benefits contains good news for the employers but bad news for their workers."
What are the good news? The average total premium for employer-sponsored health insurance (typically paid partly by employers and partly by their workers) rose only a modest 3 percent this year for family plans, reaching $13,770 in 2010.
What are the bad news? The employee share of their premium soared by 14% reaching almost $4,000, while the amount employers contributed did not increase.
Whats are the results?
* Employers shifted virtually all of the increased premium costs to their employees , who were in a weak position to resist in an economy where there were few other jobs to jump to.
* Since 2005, while wages have increased just 18 percent, workers’ contributions to premiums have jumped 47 percent, almost twice as fast as the rise in the policy’s overall cost.
* Meanwhile insurances are getting stingier and less comprehensive.
* Workers face higher deductibles, forcing them to pay a larger share of their overall medical bills. The Kaiser survey found a significant increase in the number of employees who had a deductible of at least $1,000, to 27 percent this year, from 22 percent in 2009. Almost half of workers who are covered by a small employer with fewer than 200 workers have an annual deductible of that amount.
* Increasing out-of-pocket expenses will almost certainly reduce the number of medical office visits, will force staff to collect deductibles at the point-of-care, or bill the patients and write off the increasing amount of unpaid bills. This will further decrease the margins in family medicine offices and force doctors to see more patients for less money!
What can we do? Facing very tight profit margins doctors must improve the efficiency of their offices, teach their staff to work as teams and advertise their medical services to those seeking cheaper medical services.
Instead of working harder we must work smarter. Yelling and screaming will not help us to move forward. We must learn to run our offices as small businesses and adapt quickly to the rapidly changing market place.
Yours
Bernd
What are the good news? The average total premium for employer-sponsored health insurance (typically paid partly by employers and partly by their workers) rose only a modest 3 percent this year for family plans, reaching $13,770 in 2010.
What are the bad news? The employee share of their premium soared by 14% reaching almost $4,000, while the amount employers contributed did not increase.
Whats are the results?
* Employers shifted virtually all of the increased premium costs to their employees , who were in a weak position to resist in an economy where there were few other jobs to jump to.
* Since 2005, while wages have increased just 18 percent, workers’ contributions to premiums have jumped 47 percent, almost twice as fast as the rise in the policy’s overall cost.
* Meanwhile insurances are getting stingier and less comprehensive.
* Workers face higher deductibles, forcing them to pay a larger share of their overall medical bills. The Kaiser survey found a significant increase in the number of employees who had a deductible of at least $1,000, to 27 percent this year, from 22 percent in 2009. Almost half of workers who are covered by a small employer with fewer than 200 workers have an annual deductible of that amount.
* Increasing out-of-pocket expenses will almost certainly reduce the number of medical office visits, will force staff to collect deductibles at the point-of-care, or bill the patients and write off the increasing amount of unpaid bills. This will further decrease the margins in family medicine offices and force doctors to see more patients for less money!
What can we do? Facing very tight profit margins doctors must improve the efficiency of their offices, teach their staff to work as teams and advertise their medical services to those seeking cheaper medical services.
Instead of working harder we must work smarter. Yelling and screaming will not help us to move forward. We must learn to run our offices as small businesses and adapt quickly to the rapidly changing market place.
Yours
Bernd
Sunday, August 22, 2010
FMA Off Base Fighting Reform
The recently published OpEd succinctly characterizes the Florida Medical Association's policy vis-a-vis healthcare reform.
The authors concluded that
"The FMA's challenge to the AMA was the old guard denouncing the new. But the new way is what mainstream patients, doctors and the people who pay the bills for care desperately need. It is coming, and the FMA should get on board or out of the way."
In a NEJM (N Engl J Med 2009;360: 2495-2497) article Fisher et al clearly defines the positions we as physicians can take.
“ In the face of this uncertainty, physicians have a choice: to wait and see what happens or to lead the change our country needs. We'd prefer the latter....Physicians can become our most credible and effective leaders of progress toward a new world of coordinated, sensible, outcome-oriented care in which they and their communities will be far better off. Defending the status quo is a bankrupt plan, and physicians have an opportunity to help us all see beyond it."
I wholeheartedly agree with this conclusion.
Yours
Bernd
Guest column: Florida Medical Association is off base fighting reform
Source URL: http://jacksonville.com/opinion/letters-readers/2010-08-19/story/guest-column-florida-medical-association-base-fighting
At an Orlando meeting last week, Florida Medical Association members fumed that their parent, the American Medical Association, isn't adequately representing Florida's private practice doctors.
After talk of secession, they settled for writing a stern letter urging the AMA to straighten up.
The FMA dustup began with a resolution written by Douglas Stevens, a Fort Myers cosmetic surgeon - you can't make this stuff up - complaining that the AMA's support for recent reforms was "a severe intrusion in the patient-physician relationship and allows government control over essentially all aspects of medical care."
He wrote that it will "relegate physicians to the role of government employees ... and essentially end the profession of medicine as we know it."
A St. Petersburg neurological surgeon, David McKalip, added that without AMA support, reform would have died.
Well, no. Stevens might have had two reform provisions in mind.
One uses subsidies to encourage doctors to obtain electronic health record technologies, so patient information can be easily exchanged and unnecessary or redundant services can be reduced.
Some data would be submitted to a federal repository, so doctors can better understand how effectively they practice compared to their peers and how to improve if needed.
Of course, physicians opposed to these rules could opt to avoid patients whose care is paid for with public dollars. But we think most doctors will welcome the opportunity to modernize their care.
The second bone of contention was a well-intentioned but flawed 1997 Medicare formula, the Sustainable Growth Rate, which tied physician payments to the growth of the U.S. economy. If Medicare physician spending exceeded the target in one year, then payment the following year would be reduced.
But every year, Congress has delayed the payment reductions. Now, in 2010, the accumulated cuts would be 21.2 percent.
Congress is reluctant to spend the additional $200 billion to forgive the cuts. American specialists, who make triple the salaries of their primary care colleagues, are bound to see smaller Medicare checks.
In the past, we've had many differences with the AMA, which was often more focused on physicians and their economic prosperity than on patients and theirs, especially as health insurance costs relentlessly grew four times faster than the economy.
Through a specialist-dominated reimbursement advisory committee, the AMA urged Congress to pay specialists more at the expense of primary care physicians. So it is not far-fetched to lay much of the current health care cost crisis at the AMA's feet.
But recently, the AMA became more progressive. It mounted a three-year campaign for universal coverage. It supported government's efforts to reward the meaningful use of modern computerized tools and the best medical science in clinical practice.
They are incredibly important to us, but over the last half century, American physicians have been handsomely, even often excessively, rewarded.
But now, the system that has been hugely wasteful must find ways to reduce costs while improving quality, and make sure that care is accessible to everyone. These imperatives are emerging just as data and information tools are becoming more available. Health care will become more like a market than before.
Medical practice is changing profoundly, mostly for the better. Doctors will still be highly valued, but many may earn less.
The FMA's challenge to the AMA was the old guard denouncing the new. But the new way is what mainstream patients, doctors and the people who pay the bills for care desperately need.
It is coming, and the FMA should get on board or out of the way.
Brian Klepper of Atlantic Beach and David Kibbe, a physician from Chapel Hill, N.C., write on health care policy, market dynamics and technology.
The authors concluded that
"The FMA's challenge to the AMA was the old guard denouncing the new. But the new way is what mainstream patients, doctors and the people who pay the bills for care desperately need. It is coming, and the FMA should get on board or out of the way."
In a NEJM (N Engl J Med 2009;360: 2495-2497) article Fisher et al clearly defines the positions we as physicians can take.
“ In the face of this uncertainty, physicians have a choice: to wait and see what happens or to lead the change our country needs. We'd prefer the latter....Physicians can become our most credible and effective leaders of progress toward a new world of coordinated, sensible, outcome-oriented care in which they and their communities will be far better off. Defending the status quo is a bankrupt plan, and physicians have an opportunity to help us all see beyond it."
I wholeheartedly agree with this conclusion.
Yours
Bernd
Guest column: Florida Medical Association is off base fighting reform
Source URL: http://jacksonville.com/opinion/letters-readers/2010-08-19/story/guest-column-florida-medical-association-base-fighting
At an Orlando meeting last week, Florida Medical Association members fumed that their parent, the American Medical Association, isn't adequately representing Florida's private practice doctors.
After talk of secession, they settled for writing a stern letter urging the AMA to straighten up.
The FMA dustup began with a resolution written by Douglas Stevens, a Fort Myers cosmetic surgeon - you can't make this stuff up - complaining that the AMA's support for recent reforms was "a severe intrusion in the patient-physician relationship and allows government control over essentially all aspects of medical care."
He wrote that it will "relegate physicians to the role of government employees ... and essentially end the profession of medicine as we know it."
A St. Petersburg neurological surgeon, David McKalip, added that without AMA support, reform would have died.
Well, no. Stevens might have had two reform provisions in mind.
One uses subsidies to encourage doctors to obtain electronic health record technologies, so patient information can be easily exchanged and unnecessary or redundant services can be reduced.
Some data would be submitted to a federal repository, so doctors can better understand how effectively they practice compared to their peers and how to improve if needed.
Of course, physicians opposed to these rules could opt to avoid patients whose care is paid for with public dollars. But we think most doctors will welcome the opportunity to modernize their care.
The second bone of contention was a well-intentioned but flawed 1997 Medicare formula, the Sustainable Growth Rate, which tied physician payments to the growth of the U.S. economy. If Medicare physician spending exceeded the target in one year, then payment the following year would be reduced.
But every year, Congress has delayed the payment reductions. Now, in 2010, the accumulated cuts would be 21.2 percent.
Congress is reluctant to spend the additional $200 billion to forgive the cuts. American specialists, who make triple the salaries of their primary care colleagues, are bound to see smaller Medicare checks.
In the past, we've had many differences with the AMA, which was often more focused on physicians and their economic prosperity than on patients and theirs, especially as health insurance costs relentlessly grew four times faster than the economy.
Through a specialist-dominated reimbursement advisory committee, the AMA urged Congress to pay specialists more at the expense of primary care physicians. So it is not far-fetched to lay much of the current health care cost crisis at the AMA's feet.
But recently, the AMA became more progressive. It mounted a three-year campaign for universal coverage. It supported government's efforts to reward the meaningful use of modern computerized tools and the best medical science in clinical practice.
They are incredibly important to us, but over the last half century, American physicians have been handsomely, even often excessively, rewarded.
But now, the system that has been hugely wasteful must find ways to reduce costs while improving quality, and make sure that care is accessible to everyone. These imperatives are emerging just as data and information tools are becoming more available. Health care will become more like a market than before.
Medical practice is changing profoundly, mostly for the better. Doctors will still be highly valued, but many may earn less.
The FMA's challenge to the AMA was the old guard denouncing the new. But the new way is what mainstream patients, doctors and the people who pay the bills for care desperately need.
It is coming, and the FMA should get on board or out of the way.
Brian Klepper of Atlantic Beach and David Kibbe, a physician from Chapel Hill, N.C., write on health care policy, market dynamics and technology.
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