Archive for the ‘Medicare/Medicaid’ Category
Mass Shootings and a Mental-Health Disgrace
The federal bureaucracy is anti-patient, anti-family and anti-medical care. Reform is essential
VIDEO – PAUL RYAN – TRADE, RESULTS FROM THE WAR ON POVERTY, HEALTHCARE, ENTITLEMENTS, REFLECTIONS FROM THE 2012 ELECTION, DEFENSE BUDGETTuesday, July 7th, 2015
July 2, 2015
In the 1990s insurance companies developed managed-care plans that greatly increased their profits at the expense of the physician. With the Affordable Care Act, we are seeing new groups profiting from changes to the health-care system. Entrepreneurs and hospital executives are capitalizing on organizing physicians into groups called Accountable Care Organizations from which they will take a very substantial percentage of collected income. Now that physicians are being required to use electronic medical records, the companies that develop them are harvesting money from physicians’ practices and from hospitals.
The push to use electronic medical records has had more than financial costs. Although it is convenient to have patient records accessible on the Internet, the data processing involved has been extremely time consuming—a sentiment echoed by most of my colleagues. To save time, I was advised by a consultant to enter data into the electronic record during the office visit. When I tried this I found that typing in the data was disruptive to the patient visit. My eyes were focused on the keyboard and the lack of direct contact kept patients from opening up and discussing their medical and personal problems. I soon returned to my old method of dictating notes and pasting a print-out of the dictation into the electronic record.
Yet to avoid future financial penalties from Medicare, I must demonstrate “meaningful use” of the electronic record. This involves documenting that I covered a checklist of items during the office visit, so I spend 90 minutes each day entering mostly meaningless data. This is time better spent calling patients to answer questions or keeping updated with the medical literature.
If electronic records ever allow physicians to obtain data from previous laboratory and imaging testing, it will improve costs and patient care. So far, however, the data in electronic records—like paper charts—can’t be shared unless physicians work in the same health-care system.
My practice quickly adopted the new Medicare requirements for electronically prescribing medications. Yet patients often do not want their prescription sent electronically. They want a physical copy—either because they don’t trust the Internet or because they don’t need to fill the prescription immediately. If I don’t electronically prescribe for a certain number of Medicare patients, I am penalized with a decrease in reimbursement that can rise to a maximum of 5%. Patients should have a choice in how their prescriptions are delivered, and physicians shouldn’t be penalized for how the patients choose. (more…)
Republicans do have a replacement healthcare plan! Nancy
EXCERPT FROM THIS ARTICLE: The benefits of the digital revolution are large. But we’ll also have to deal with problems and unanticipated consequences, mostly related to privacy, the possibility of misuse, and the concern that patients might be overwhelmed with so much information. The government via the FDA will need to play a role to ameliorate all three of these potential issues. Regardless, digital medicine is coming over the next few years with the force of a hurricane whether we doctors—and we patients—are ready or not.
A sweeping transformation of medicine has begun that will rival in importance the introduction of anesthesia or the discovery of the germ basis of infectious disease. It will change how patients and physicians interact. It will change medical research and therapy. “Sick care”—the current model of waiting for you to get sick and then trying to alleviate symptoms and make you well—will become true “health care,” where prevention is the mantra and driving force. Welcome to the world of digital medicine.
First and foremost, the digitalization of medicine will personalize health care: Treatment will be tailored to each person as a unique individual suffering a unique illness according to his or her genetic makeup. Currently, therapy is based on population statistics. Patients are separated into groups defined in various ways but usually by similar symptoms or by the results of basic lab tests (like cholesterol levels). These groups are then treated with drugs that may help many people, but not all of them, and often only a fraction of them. By incorporating information from an individual’s DNA, the data made available through digitalization will enable clinicians to match individuals with treatments. Only patients who will benefit will get a particular drug.
This is huge. Giving drugs to patients who are not helped has been enormously expensive and often perverse. Particularly with anticancer drugs, it often condemns such patients to horrendous side effects for no benefit.
Second, digitalization will democratize medicine: You will own or control the data about your own medical condition, and you will be able to analyze it instantly by your connectivity to the Web. In many ways, the profession of medicine today is where Christianity was when the Gutenberg Bible put scriptures into the hands of the laity. But the profession is going to change, subtly and not so subtly shifting power away from the medical-industrial complex: doctors, health insurers, hospitals, medical labs and Big Pharma. (more…)
An Obamacare Report Card
The grades are bad so far—and likely to get worse
Christopher J. Conover
Perhaps the most unpleasant aspect of my otherwise quite enjoyable job as a college professor has been the requirement to assign grades to students. Given that we’re now about halfway through implementation of the Affordable Care Act—which even President Obama is happy to call “Obamacare”—it seems appropriate to assign midterm grades. These are not intended as a forecast of the final grade; moreover, implementation of Obamacare is the responsibility of many thousands of individuals, not just one. Nevertheless, as President Truman’s legendary Oval Office desk sign reminds us, “The buck stops here” when it comes to presidential leadership. So whether President Obama likes it or not, the public and historians are likely to base their assessment of his performance on how well his “signature piece of domestic legislation” is implemented.
First Grading Standard:
Promises vs. Performance
Both as a candidate and as president, Barack Obama has made at least 80 promises related to health care. For purposes of grading, I have focused on the 8 most consequential.
Promise #1: Universal Coverage. Candidate Obama promised on June 23, 2007: “I will sign a universal health care bill into law by the end of my first term as president that will cover every American.” The latest CBO projections last May show that as of the end of 2013, Obamacare will have reduced the number of nonelderly uninsured by less than 4 percent. This figure excludes 11 million unauthorized immigrants (51 percent of whom are uninsured). Even when Obamacare is fully implemented in 2017, it will cover only 92 percent of the nonelderly population who are not unauthorized immigrants (nearly everyone age 65 and above is already covered by Medicare), and 84.7 percent of that group already had coverage in March 2009, a full year before Obamacare was signed into law. Even if we concede that other countries relying on an individual mandate have failed to drive their uninsured rates below 1 percent (Switzerland) or 1.5 percent (Netherlands), Obamacare will close only 53 percent of the gap that existed when President Obama was sworn into office. Grade: F.
Promise #2: No New Taxes on the Middle Class. Candidate Obama promised on September 12, 2008: “I can make a firm pledge under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes.” Using official estimates from the Congressional Budget Office and the Joint Committee on Taxation, the House Ways and Means Committee projects that Obamacare will increase federal revenues by $1.058 trillion between 2013 and 2022. Only 30 percent of this total will be raised from taxes that exclusively target taxpayers earning over $200,000 (singles) or $250,000 (married). The remaining 70 percent will be borne by households at all other income levels. Tax Policy Center figures show that such households do not account for more than half of all federal taxes. So even if we generously assume such households will bear a similar share of the myriad levies to be imposed on health insurers, medical device manufacturers, and drug manufacturers—levies which will be passed onto consumers—that still leaves at least 35 percent to be borne by families at or below middle-class incomes.
And these figures do not include the hundreds of billions of dollars in new revenue that will have to be collected by states to pay for their share of Obamacare-induced growth in Medicaid. Nor do they include the impact of “taxation by regulation”—i.e., the tens of billions of dollars in higher premiums that young Americans are being forced to pay under Obamacare’s modified community rating rules in order to subsidize predominantly higher-income people who happen to be older. In short, President Obama’s promise at best was 65 percent true and more likely 50 percent or less true. Grade: F. (more…)