Dear Friends and Colleagues:
Attached you find an article from todays Miami Herald reporting that Medicare will suspend millions of dollars in payments to dozens of additional home healthcare providers in Miami-Dade after a federal judge ruled it has the power to stop reimbursements to companies suspected of overcharging for diabetic and other services.
The callous abuse of the Medicare system, a vital lifeline of needed healthcare service for millions of senior patients, has reached new heights in South Florida. here are the facts for Dade county ALONE:
* Miami-Dade is home to 334 Medicare-certified home healthcare providers.
* All together, the top 10 home health providers were paid $139 million by Medicare in 2007.
* Medicare issued the suspensions after finding that it spends one of every 15 dollars on home healthcare nationwide in one county -- Miami-Dade.
* The agency's spending in Miami-Dade totals $1.3 billion out of a nationwide budget of $16.5 billion.
* Since 2001, Medicare's Miami-Dade payments for home healthcare has grown at a pace 13 times the national rate.
There are only two conclusions: either the demand for home health care service has increased by 13 x times the national rate OR (more likely) unscrupulous provides are defrauding the system.
As physicians we MUST work collaboratively with law enforcement and CMS to STOP this abbuse. Every dollar diverted for for fraud will further jeopardize our struggle for reimbursement of physicians services.
We should also NOT stop from reporting those physicians who receive hefty and lucrative referral fees from home health companies. Protecting those "colleagues" means acquiescing to fraud and abuse of the system.
Yours
Bernd
Posted on Sun, Nov. 23, 2008
Ruling halts Medicare payments to more Miami-Dade home healthcare providers
BY JAY WEAVER
Medicare will suspend millions of dollars in payments to dozens of additional home healthcare providers in Miami-Dade after a federal judge ruled it has the power to stop reimbursements to companies suspected of overcharging for diabetic and other services.
The government agency began the crackdown on the top 10 Miami-Dade home healthcare operators in October, citing potential fraud, but one of the providers sued in federal court claiming Medicare exceeded its authority.
This week, U.S. District Judge Paul Huck sided with Medicare, saying the taxpayer-funded program's suspension policy is ``reasonable and appropriate.''
His decision allows Medicare to continue halting payments to local companies suspected of submitting excessive claims for nurses treating homebound patients who either aren't diabetic or don't need help injecting insulin.
Miami-Dade is home to 334 Medicare-certified home healthcare providers. Many could be affected by the giant entitlement program's unprecedented suspensions.
''Because of the judge's decision, we will be able to expand our efforts to look at other home healthcare companies for payment suspensions and audits,'' Medicare spokesman Peter Ashkenaz said Friday. ``We just want to make sure the people getting home healthcare services are receiving them under the law.''
The judge's decision followed a Miami Herald story that detailed how the home healthcare company that sued Medicare over the suspension policy had billed the agency about $75,000 last year for a nurse to inject the insulin of a homebound diabetic patient.
But the patient, 92-year-old Maria C. Perez, who was living in a Westchester group home, told the Miami Herald that she has never been diabetic and didn't receive twice-a-day insulin injections from a visiting nurse in the latter half of 2007.
Her family doctor and medical records backed up her statement.
Home Care Services Provider, based in Kendall, said it did send a nurse twice daily to treat Perez for diabetes from June to November last year based on a prescribed referral by a Hialeah physician. It denied any wrongdoing.
MULLING AN APPEAL
As for the dispute over Medicare's suspension policy, the company's lawyer said it is considering an appeal of the judge's decision, filed Wednesday.
''We respectfully disagree with the court's ruling,'' attorney Anthony Vitale said in a statement. ``We believed then and we believe now that the Medicare payment suspension regulation is illegal.''
But that dispute with Medicare could be the least of Home Care Services Provider's problems.
The company's Miami-Dade owner, Maria Del Carmen Escarpio, 48, was charged in July with defrauding the Florida Medicaid program, which covers healthcare services for low-income people.
She's accused of using her Kendall home healthcare business to bill the state program $447,000 in wound care supplies and oxygen equipment that were never delivered to Medicaid patients in 2003-04. Moreover, the patients didn't have any wounds or need the oxygen, state authorities said.
''We're vigorously defending her in that case,'' said Escarpio's criminal attorney, Louis Martinez. ``It has nothing to do whatsoever with the current Medicare case [in federal court] nor does it have anything do with the suspension.''
In early October, Medicare suspended millions of dollars in payments to the top 10 home healthcare agencies in Miami-Dade County, citing a spike in questionable billing for diabetic and other services.
All together, the 10 providers were paid $139 million by Medicare in 2007.
The suspensions, which entail audits of claims and payments dating back to 2004, are in effect for at least six months.
FIRST TARGETS
Among the first targets: Home Care Services Provider, which received $12 million in Medicare payments last year.
About 72 percent of its income came from treating mostly homebound diabetic patients, records show.
Medicare issued the suspensions after finding that it spends one of every 15 dollars on home healthcare nationwide in one county -- Miami-Dade.
The agency's spending in Miami-Dade totals $1.3 billion. Its nationwide budget is $16.5 billion.
Since 2001, Medicare's Miami-Dade payments for home healthcare has grown at a pace 13 times the national rate.
What Medicare officials have found is that the massive health insurance program for the elderly and disabled is losing potentially hundreds of millions of dollars a year in Miami-Dade to fraud, abuse and waste in home healthcare.
The first round of Medicare suspensions in Miami-Dade were based on ''reliable information'' that home care claims submitted last year ''may have involved an overpayment, fraud or misrepresentation,'' according to an Oct. 3 Medicare letter sent to the targeted companies.
DIFFERENT SIGNATURES
The letter noted that certain physicians had told Medicare that their signatures didn't match those on prescribed patient care plans submitted to home care providers.
But one Miami-Dade operator, Patient Care, Inc., fired back a letter, saying it was ``being unfairly herded into the slaughterhouse as a result of its success and not a single shred of evidence.''
Sunday, November 23, 2008
Tuesday, November 18, 2008
Home Health Care Fraud
DADE COUNTY: THE HOME HEALTH CARE FRAUD CAPITOL OF THE NATION
The Miami Herald ran another excellent investigative report about the rampant fraud and abuse committed by Home Health Care Service agencies. http://www.miamiherald.com/living/health/v-fullstory/story/773538.html
Some facts.
• Medicare spends one of every 15 dollars on home healthcare nationwide in one county -- Miami-Dade. Medicare's total budget: $16.5 billion.
• Since 2001, Medicare's payments for home healthcare in Miami-Dade have grown by a whopping 1,750 percent -- to $1.3 billion -- while the pool of people over 65 diagnosed with diabetes grew by just 30 percent.
• Medicare was billed roughly $75,000 by a Home Health Care Service provider for twice-daily nursing visits to inject her with insulin to control diabetes during the latter half of 2007.
• According to federal records, Medicare paid one company about $12.6 million last year. A little more than 70 percent of its income was for treating homebound diabetic patients, records show.
What can we do:
1. Report any attempt by home health company representatives offering financial “incentives” for patient referrals.
2. Report any physicians that you know have accepted such arrangements
3. Carefully scrutinize orders to be signed by the physician for inconsistencies and blatantly false medical services allegedly ordered by you.
4. Periodically review “routine” home health service requests.
5. Deny services that include for example “ twice daily insulin injections administered by a nurse. Ask why the patient is unable to learn the self-administration of insulin injections.
6. Do not hesitate calling the local US attorneys office and/or your local medical society to report any suspicious activities.
Remember, that EVERY DOLLAR embezzled by this crooks is one dollar less paying for legitimate medical services rendered by had-working honest doctors!
Therefore, we need to be on alert pointing out fraud and abuse whenever it occurs in our community. No, we are not snitches but responsible members of our community who care for the viability of the Medicare program.
We need to work together on that and other issues. Together we are stronger. Together we can address this challenge.
The Miami Herald ran another excellent investigative report about the rampant fraud and abuse committed by Home Health Care Service agencies. http://www.miamiherald.com/living/health/v-fullstory/story/773538.html
Some facts.
• Medicare spends one of every 15 dollars on home healthcare nationwide in one county -- Miami-Dade. Medicare's total budget: $16.5 billion.
• Since 2001, Medicare's payments for home healthcare in Miami-Dade have grown by a whopping 1,750 percent -- to $1.3 billion -- while the pool of people over 65 diagnosed with diabetes grew by just 30 percent.
• Medicare was billed roughly $75,000 by a Home Health Care Service provider for twice-daily nursing visits to inject her with insulin to control diabetes during the latter half of 2007.
• According to federal records, Medicare paid one company about $12.6 million last year. A little more than 70 percent of its income was for treating homebound diabetic patients, records show.
What can we do:
1. Report any attempt by home health company representatives offering financial “incentives” for patient referrals.
2. Report any physicians that you know have accepted such arrangements
3. Carefully scrutinize orders to be signed by the physician for inconsistencies and blatantly false medical services allegedly ordered by you.
4. Periodically review “routine” home health service requests.
5. Deny services that include for example “ twice daily insulin injections administered by a nurse. Ask why the patient is unable to learn the self-administration of insulin injections.
6. Do not hesitate calling the local US attorneys office and/or your local medical society to report any suspicious activities.
Remember, that EVERY DOLLAR embezzled by this crooks is one dollar less paying for legitimate medical services rendered by had-working honest doctors!
Therefore, we need to be on alert pointing out fraud and abuse whenever it occurs in our community. No, we are not snitches but responsible members of our community who care for the viability of the Medicare program.
We need to work together on that and other issues. Together we are stronger. Together we can address this challenge.
Monday, November 17, 2008
Fight Medicare Fraud
WE HAVE TO FIGHT AGAINST MEDICARE FRAUD!
The Miami Herald reported again several troubling cases of Medicare fraud
The stories are very familiar:
• A family-run enterprise of medical equipment and billing companies submitted more than $17 million in false claims to Medicare, they admitted in court. Their haul: $5 million. The family's scheme was launched in 1999, when David and Laura Hernandez opened their first medical equipment company, said Assistant U.S. Attorney Ryan Stumphauzer.In a statement filed in court, the three admitted opening a string of equipment suppliers in Miami-Dade and starting a billing company to file false claims with Medicare. The billing company was owned by Laura Hernandez. David Hernandez, in the lead role, recruited four people to register as the official owners of four equipment-supply companies to conceal his participation in the scam, according to the court statement. Those ''nominee'' owners, members of another family, were charged in a separate Medicare fraud indictment. Husband and wife Jose Echevarria and Magaly Martinez, along with their son, Yuniel Echevarria, and his wife, Suyima Torres, pleaded guilty earlier this year. To fuel the racket, David Hernandez and his brother, Jose, paid kickbacks to patients for the use of their Medicare numbers. In turn, the brothers billed the federal insurance program for products, such as beds, catheters and pumps, that were never delivered to anyone. Proceeds of the fraud were deposited in the corporate bank accounts of the family's medical equipment companies. Hernandez also laundered some of the Medicare reimbursements through shell companies with ''medical-sounding'' names that were set up to cash checks at banks so his family could pocket the proceeds, according to the statement filed in court. Some of that taxpayer money enabled the Hernandezes to pay $331,000 to buy the Pembroke Pines home in 2002.
• A Miami doctor and nurse have been convicted of billing Medicare for millions of dollars in false claims for obsolete HIV therapy at a local clinic owned by three brothers who fled to Cuba to avoid prosecution. Dr. Ana Alvarez-Jacinto and Sandra Mateos, found guilty by a Miami federal jury Friday, played key roles in an $11 million scam involving HIV-positive patients who received kickbacks in exchange for letting the clinic use their Medicare numbers to bill the federal program. The two women who opened St. Jude Rehab Center as partners with Carlos, Jose and Luis Benitez -- fugitives charged in a separate indictment -- had already pleaded guilty to fraud this year. Mariela Rodriguez and Aisa Perera, who ran St. Jude from June to November 2003, collected $8 million from the false Medicare claims.
• A local physician convicted of Medicare fraud for his role in a massive HIV therapy racket run by three Miami-Dade brothers was sentenced to seven years in prison on Tuesday. Ronald Harris, 58, wrote prescriptions to bill Medicare for an obsolete treatment that was not provided to patients with the virus that causes AIDS, according to court records. The patients received cash kickbacks in exchange for letting the Miami physician bill the federal health insurance program with their Medicare numbers.In August, Harris pleaded guilty to a conspiracy charge as the medical director for Physicians Med-Care in Miami and Physicians Health Med-Care in Hallandale Beach. The two HIV clinics submitted $26.2 million in false claims to Medicare between 2002 and 2004.
Lets be reminded that EVERY DOLLAR embezzled by this crooks is one dollar less paying for legitimate medical services rendered by had-working honest doctors!
Therefore, we need to be on alert pointing out fraud and abuse whenever it occurs in our community. No, we are not snitches but responsible members of our community who care for the viability of the Medicare program.
We need to work together on that and other issues. Together we are stronger. Together we can address this challenge.
The Miami Herald reported again several troubling cases of Medicare fraud
The stories are very familiar:
• A family-run enterprise of medical equipment and billing companies submitted more than $17 million in false claims to Medicare, they admitted in court. Their haul: $5 million. The family's scheme was launched in 1999, when David and Laura Hernandez opened their first medical equipment company, said Assistant U.S. Attorney Ryan Stumphauzer.In a statement filed in court, the three admitted opening a string of equipment suppliers in Miami-Dade and starting a billing company to file false claims with Medicare. The billing company was owned by Laura Hernandez. David Hernandez, in the lead role, recruited four people to register as the official owners of four equipment-supply companies to conceal his participation in the scam, according to the court statement. Those ''nominee'' owners, members of another family, were charged in a separate Medicare fraud indictment. Husband and wife Jose Echevarria and Magaly Martinez, along with their son, Yuniel Echevarria, and his wife, Suyima Torres, pleaded guilty earlier this year. To fuel the racket, David Hernandez and his brother, Jose, paid kickbacks to patients for the use of their Medicare numbers. In turn, the brothers billed the federal insurance program for products, such as beds, catheters and pumps, that were never delivered to anyone. Proceeds of the fraud were deposited in the corporate bank accounts of the family's medical equipment companies. Hernandez also laundered some of the Medicare reimbursements through shell companies with ''medical-sounding'' names that were set up to cash checks at banks so his family could pocket the proceeds, according to the statement filed in court. Some of that taxpayer money enabled the Hernandezes to pay $331,000 to buy the Pembroke Pines home in 2002.
• A Miami doctor and nurse have been convicted of billing Medicare for millions of dollars in false claims for obsolete HIV therapy at a local clinic owned by three brothers who fled to Cuba to avoid prosecution. Dr. Ana Alvarez-Jacinto and Sandra Mateos, found guilty by a Miami federal jury Friday, played key roles in an $11 million scam involving HIV-positive patients who received kickbacks in exchange for letting the clinic use their Medicare numbers to bill the federal program. The two women who opened St. Jude Rehab Center as partners with Carlos, Jose and Luis Benitez -- fugitives charged in a separate indictment -- had already pleaded guilty to fraud this year. Mariela Rodriguez and Aisa Perera, who ran St. Jude from June to November 2003, collected $8 million from the false Medicare claims.
• A local physician convicted of Medicare fraud for his role in a massive HIV therapy racket run by three Miami-Dade brothers was sentenced to seven years in prison on Tuesday. Ronald Harris, 58, wrote prescriptions to bill Medicare for an obsolete treatment that was not provided to patients with the virus that causes AIDS, according to court records. The patients received cash kickbacks in exchange for letting the Miami physician bill the federal health insurance program with their Medicare numbers.In August, Harris pleaded guilty to a conspiracy charge as the medical director for Physicians Med-Care in Miami and Physicians Health Med-Care in Hallandale Beach. The two HIV clinics submitted $26.2 million in false claims to Medicare between 2002 and 2004.
Lets be reminded that EVERY DOLLAR embezzled by this crooks is one dollar less paying for legitimate medical services rendered by had-working honest doctors!
Therefore, we need to be on alert pointing out fraud and abuse whenever it occurs in our community. No, we are not snitches but responsible members of our community who care for the viability of the Medicare program.
We need to work together on that and other issues. Together we are stronger. Together we can address this challenge.
The Election Is Over. What Shall We Do Now?
MESSAGE FROM YOUR PRESIDENT:
The Election Is Over. What Shall We Do Now?
The two year long presidential election session is over. Before our President - Elect can get down to business the political pundits are already preparing for the 2012 presidential elections. Furthermore, those who are unhappy with the outcome of the election are vowing to “resist” any changes to be promised by the new administration. During the recent Interim Meeting of the American Medical Association in Orlando some attendees even went a step further. A current member of the United States House of Representatives called upon doctors to carry - hopefully in a figurative manner - a loaded shotgun to fight for their freedom. A former AMA President even dared to compare the status of doctors in the US to that of Jews in Nazi Germany!
This kind of hyperbolic rhetoric is not only unacceptable but also misses the mark!
I am confident that the majority of AMA delegates do not support these positions.
What we need are pragmatic solutions to the problems we are facing: stagnating reimbursement, increasing practice costs, third-party control of our practices and unnecessary regulatory burden.
This requires the ability to reach out to all parties involved in the healthcare delivery process, listen to arguments, tolerate other opinions and reach a compromise. Collaboration and not confrontation will help us to achieve our goals. As I said many times before: we need to sit at the table, otherwise we are going to be the menu item on the table.
Therefore, I will remain focused on assisting our members to continue practicing medicine. But I will also remind each of you that there is no way back to the “good old days of medicine.” The only constant in life is change! We have to adapt to the rapidly changing economic environment and find the best solutions that suit us.
Verbal radicalism and defiance will only lead us into a political dead end street.
Many of you are helping me to identify the problems and we try our best to resolve them. One of the issues pertains to the sluggish Medicare reimbursement for services rendered and the onerous prepayment chart review requirements.
Therefore, on 10/22/08 I traveled to Jacksonville and met with the CEO and President Mrs. Sandy Coston and the Vice Chairman Mr. Curtis Lord of FIRST COAST, the regional Medicare administrator. I also had the opportunity to meet and speak with all department heads including claims processing support, claims processing center, provider customers service, provider enrollment, program integrity and Medicare Education and Performance Solution. We discussed ONE single topic: how to improve the claims processing and reimbursement process. We agreed to ease the prepayment review process thereby reducing the chart review requirements. I will depend on your feedback to monitor the promised improvements. On the evening preceding my trip I received a call from a physician reporting that he has not received ANY Medicare reimbursement in the last 6 months and that ALL of his claims were rejected. I was able to resolve the problem within 24-hours and he will receive all payments due.
You need you to join our DCMA to support these and other projects, which help you to practice medicine and to provide quality care to your patients.
What are you waiting for? Join today!
Yours
Bernd Wollschlaeger,MD,FAAFP,FASAM
President, Dade County Medical Association
The Election Is Over. What Shall We Do Now?
The two year long presidential election session is over. Before our President - Elect can get down to business the political pundits are already preparing for the 2012 presidential elections. Furthermore, those who are unhappy with the outcome of the election are vowing to “resist” any changes to be promised by the new administration. During the recent Interim Meeting of the American Medical Association in Orlando some attendees even went a step further. A current member of the United States House of Representatives called upon doctors to carry - hopefully in a figurative manner - a loaded shotgun to fight for their freedom. A former AMA President even dared to compare the status of doctors in the US to that of Jews in Nazi Germany!
This kind of hyperbolic rhetoric is not only unacceptable but also misses the mark!
I am confident that the majority of AMA delegates do not support these positions.
What we need are pragmatic solutions to the problems we are facing: stagnating reimbursement, increasing practice costs, third-party control of our practices and unnecessary regulatory burden.
This requires the ability to reach out to all parties involved in the healthcare delivery process, listen to arguments, tolerate other opinions and reach a compromise. Collaboration and not confrontation will help us to achieve our goals. As I said many times before: we need to sit at the table, otherwise we are going to be the menu item on the table.
Therefore, I will remain focused on assisting our members to continue practicing medicine. But I will also remind each of you that there is no way back to the “good old days of medicine.” The only constant in life is change! We have to adapt to the rapidly changing economic environment and find the best solutions that suit us.
Verbal radicalism and defiance will only lead us into a political dead end street.
Many of you are helping me to identify the problems and we try our best to resolve them. One of the issues pertains to the sluggish Medicare reimbursement for services rendered and the onerous prepayment chart review requirements.
Therefore, on 10/22/08 I traveled to Jacksonville and met with the CEO and President Mrs. Sandy Coston and the Vice Chairman Mr. Curtis Lord of FIRST COAST, the regional Medicare administrator. I also had the opportunity to meet and speak with all department heads including claims processing support, claims processing center, provider customers service, provider enrollment, program integrity and Medicare Education and Performance Solution. We discussed ONE single topic: how to improve the claims processing and reimbursement process. We agreed to ease the prepayment review process thereby reducing the chart review requirements. I will depend on your feedback to monitor the promised improvements. On the evening preceding my trip I received a call from a physician reporting that he has not received ANY Medicare reimbursement in the last 6 months and that ALL of his claims were rejected. I was able to resolve the problem within 24-hours and he will receive all payments due.
You need you to join our DCMA to support these and other projects, which help you to practice medicine and to provide quality care to your patients.
What are you waiting for? Join today!
Yours
Bernd Wollschlaeger,MD,FAAFP,FASAM
President, Dade County Medical Association
Tuesday, November 04, 2008
Women and Health Insurance
A recent study revealed a scandalous phenomenon: that women pay more than do men of the same age for identical healthcare coverage provided by individual insurance policies! This "gender rating" is discriminatory and MUST stop! We have to regulate the insurance market to guarantee that all insurance companies follow the same rules. No, this is not socialism, but smart government policy to stop discrimination and to introduce fairness into the health insurance system.
Yours
Bernd
Posted on Mon, Nov. 03, 2008
Women pay more for insurance -- why?
It is an unpleasant fact that life sometimes can be an uneven experience, delivering different results for the same effort, or producing failure when success is warranted. In a well-organized society such as ours, insurance is designed to even out the rough spots somewhat by spreading risk broadly.
Which is why it should come as a surprise that women pay more than do men of the same age for identical healthcare coverage provided by individual-insurance policies. What is worse, men and women are finding it exceedingly expensive, if not impossible, to find coverage for some illnesses through the individual-insurance market.
Revealing study
This is something Congress should look into, not with a mind-set of heavy-handed mandates, mind you, but with the idea of listening to healthcare consumers and insurance companies and finding common ground for new approaches. A recent study by the National Women's Law Center shed some light on the matter. See the study at www.nwlc.org/; click on the report, Nowhere to Turn . . .
The study found that the individual-insurance market -- unlike group insurance purchased through an employer -- uses ''gender rating.'' This allows an insurer to charge women higher premiums than men for the same coverage. More and more people are discovering these discrepancies thanks to the failing U.S. economy, which has resulted in job losses for hundreds of thousands of Americans, who find themselves looking for new insurance coverage.
Some recently laid-off people who had full healthcare coverage in their previous jobs are finding that they can't get coverage at any price with individual insurers for some ailments because of ''preexisting conditions.'' Moreover, many women are finding that they are paying 30 percent more for insurance than men because of their gender. Insurers say their claim experiences show that women use healthcare services more and, therefore, are charged more. In other words, women are more likely to get checkups and visit the doctor more because, well . . . they just do.
Illogical comparison
Some insurers say this is similar to auto-insurance rates that are higher for men than women because men have more accidents and file more claims. The comparison seems logical but, in fact, it really is not. Women who proactively monitor their health may identify problems earlier, get treatment sooner and ultimately cost an insurer less. A man who crashes his car isn't involved in proactive, preventive behavior.
Society's long-term interest should be to promote more of the former behavior than the latter. This should be the goal of insurers, too. Finding a nexus between affordable healthcare and a financially viable insurance market won't be easy. Congress can get closer to a solution by hearing from, and listening to, all parties.
Yours
Bernd
Posted on Mon, Nov. 03, 2008
Women pay more for insurance -- why?
It is an unpleasant fact that life sometimes can be an uneven experience, delivering different results for the same effort, or producing failure when success is warranted. In a well-organized society such as ours, insurance is designed to even out the rough spots somewhat by spreading risk broadly.
Which is why it should come as a surprise that women pay more than do men of the same age for identical healthcare coverage provided by individual-insurance policies. What is worse, men and women are finding it exceedingly expensive, if not impossible, to find coverage for some illnesses through the individual-insurance market.
Revealing study
This is something Congress should look into, not with a mind-set of heavy-handed mandates, mind you, but with the idea of listening to healthcare consumers and insurance companies and finding common ground for new approaches. A recent study by the National Women's Law Center shed some light on the matter. See the study at www.nwlc.org/; click on the report, Nowhere to Turn . . .
The study found that the individual-insurance market -- unlike group insurance purchased through an employer -- uses ''gender rating.'' This allows an insurer to charge women higher premiums than men for the same coverage. More and more people are discovering these discrepancies thanks to the failing U.S. economy, which has resulted in job losses for hundreds of thousands of Americans, who find themselves looking for new insurance coverage.
Some recently laid-off people who had full healthcare coverage in their previous jobs are finding that they can't get coverage at any price with individual insurers for some ailments because of ''preexisting conditions.'' Moreover, many women are finding that they are paying 30 percent more for insurance than men because of their gender. Insurers say their claim experiences show that women use healthcare services more and, therefore, are charged more. In other words, women are more likely to get checkups and visit the doctor more because, well . . . they just do.
Illogical comparison
Some insurers say this is similar to auto-insurance rates that are higher for men than women because men have more accidents and file more claims. The comparison seems logical but, in fact, it really is not. Women who proactively monitor their health may identify problems earlier, get treatment sooner and ultimately cost an insurer less. A man who crashes his car isn't involved in proactive, preventive behavior.
Society's long-term interest should be to promote more of the former behavior than the latter. This should be the goal of insurers, too. Finding a nexus between affordable healthcare and a financially viable insurance market won't be easy. Congress can get closer to a solution by hearing from, and listening to, all parties.
Tuesday, October 07, 2008
Medicare Cuts Will Pay For Health Care Benefits
"John McCain would pay for his health plan with major reductions to Medicare and Medicaid, a top aide said, in a move that independent analysts estimate could result in cuts of $1.3 trillion over 10 years to the government programs."
Dear Friends and Colleagues:
Attached an interesting article from the Wall Street Journal reporting that Douglas Holtz-Eakin, Sen. McCain's senior policy adviser, indicated that McCain's proposed health care plan will be funded with savings from Medicare and Medicaid.
Independent analysts estimate that this could result in cuts of $1.3 trillion over 10 years to the government programs.
Mr. Holtz-Eakin said the Medicare and Medicaid changes would improve the programs and eliminate fraud, but he didn't detail where the cuts would come from. "It's about giving them the benefit package that has been promised to them by law at lower cost," he said.
Sen. McCain's plan to offer a new tax credit of $2,500 per person and $5,000 per family toward insurance premiums. This would allow people to buy health coverage on the open market, where they may have more choices and might look for a better bargain.In exchange, the government would begin taxing the value of health benefits people get through work. If an employer spends $10,000 to buy a worker health insurance, the worker would pay taxes on that money.
The nonpartisan Tax Policy Center, a Washington think tank, estimates that the McCain plan would cost the government $1.3 trillion over 10 years. The plan would allow as many as five million more people to have insurance, it estimates.
The Tax Policy Center estimates that Obama's plan would cost $1.6 trillion over 10 years and cover 34 million more people.
Comment:
Senator McCain seems to be ill advised to suggest MASSIVE Medicare cuts to finance his health care plan. In States like Florida, and especially South Florida, Medicare recipients will definitely not support any Medicare cuts and neither will doctors who already struggle with fair reimbursement issues.
I guess, that SGR refom will also fall by the wayside because there is no money to bail out doctors.
McCain's proposal is another speed bump on the road towards healthcare recovery.
Yours
Bernd
Shana Tova, Happy New Year and Chatima Tova
McCain Plans Federal Health Cuts
Medicare, Medicaid Spending Would Be Reduced to Offset Proposed Tax Credit
John McCain would pay for his health plan with major reductions to Medicare and Medicaid, a top aide said, in a move that independent analysts estimate could result in cuts of $1.3 trillion over 10 years to the government programs.
The Republican presidential nominee has said little about the proposed cuts, but they are needed to keep his health-care plan "budget neutral," as he has promised. The McCain campaign hasn't given a specific figure for the cuts, but didn't dispute the analysts' estimate.
In the months since Sen. McCain introduced his health plan, statements made by his campaign have implied that the new tax credits he is proposing to help Americans buy health insurance would be paid for with other tax increases.
But Douglas Holtz-Eakin, Sen. McCain's senior policy adviser, said Sunday that the campaign has always planned to fund the tax credits, in part, with savings from Medicare and Medicaid. Those government health-care programs serve seniors, poor families and the disabled. Medicare spending for the fiscal year ended Sept. 30 is estimated at $457.5 billion.
Mr. Holtz-Eakin said the Medicare and Medicaid changes would improve the programs and eliminate fraud, but he didn't detail where the cuts would come from. "It's about giving them the benefit package that has been promised to them by law at lower cost," he said.
Both Sen. McCain and his Democratic rival, Sen. Barack Obama, have recently sought to refocus on health care. The issue once ranked at the top of voters' domestic concerns, but has in recent months been eclipsed by energy and the economy.
Sen. McCain charges that the Obama plan, which would create a government-run marketplace in which people could buy coverage, would lead to government-run health care. Sen. Obama charges that Sen. McCain's plan would leave many people unable to get insurance.
Sen. Obama's campaign turned up the volume in a major push on health care over the weekend with two days of attacks from the stump, four new television advertisements, a series of health-care events across the country and fliers to voters' homes in swing states.
Sen. Obama is focused on Sen. McCain's plan to offer a new tax credit of $2,500 per person and $5,000 per family toward insurance premiums. This would allow people to buy health coverage on the open market, where they may have more choices and might look for a better bargain.
In exchange, the government would begin taxing the value of health benefits people get through work. If an employer spends $10,000 to buy a worker health insurance, the worker would pay taxes on that money.
"It's a shell game," Sen. Obama told an outdoor rally of 28,000 people Sunday in Asheville, N.C. "Sen. McCain gives you a tax credit with one hand -- but raises your taxes with the other."
Sen. McCain's plan actually would lower taxes for most people. But that means the plan wouldn't pay for itself, because it cuts certain taxes more than it raises others.
The federal government imposes two taxes on wages, generally: an income tax, which funds the government's general operations, and the payroll tax, paid for by employers and employees, which funds Social Security and Medicare. If Sen. McCain were to apply both of these to the value of health benefits, he could fully pay for his new tax credits. That is what aides have in the past suggested he would do.
In April, when Sen. McCain gave a major speech about his health plan, Mr. Holtz-Eakin, the senior policy adviser, said the tax provisions alone were budget neutral -- meaning that health benefits would have to be subject to both income and payroll taxes.
Campaign officials have regularly implied since then that the tax plan was a wash. In the vice-presidential debate last week, Alaska Gov. Sarah Palin described Sen. McCain's proposed tax credits and said: "That's budget neutral. That doesn't cost the government anything, as opposed to Barack Obama's plan to mandate health-care coverage and have this universal, government-run program."
Mr. Holtz-Eakin said the campaign never intended to apply the payroll tax to health benefits. That means that most people would see a net tax cut, contrary to Sen. Obama's assertions. Only those with very rich benefits packages are likely to see a net increase in taxes. But it also means that Sen. McCain must fill a huge budget hole -- which the campaign says will come from cuts to Medicare and Medicaid.
The nonpartisan Tax Policy Center, a Washington think tank, estimates that the McCain plan would cost the government $1.3 trillion over 10 years. The plan would allow as many as five million more people to have insurance, it estimates.
Mr. Holtz-Eakin said the plan is accurately described as budget neutral because it assumes enough savings in Medicare and Medicaid spending to make up the difference. He said the savings would come from eliminating Medicare fraud and by reforming payment policies to lower the overall cost of care. He said the new tax credits will help some low-income people avoid joining Medicaid. The campaign also proposes increasing Medicare premiums for wealthier seniors.
Sen. Obama also would rely on some Medicare savings to pay for his health-care plan, which would offer subsidies to help consumers pay for premiums. The Tax Policy Center estimates that his plan would cost $1.6 trillion over 10 years and cover 34 million more people.
Write to Laura Meckler at laura.meckler@wsj.com
Dear Friends and Colleagues:
Attached an interesting article from the Wall Street Journal reporting that Douglas Holtz-Eakin, Sen. McCain's senior policy adviser, indicated that McCain's proposed health care plan will be funded with savings from Medicare and Medicaid.
Independent analysts estimate that this could result in cuts of $1.3 trillion over 10 years to the government programs.
Mr. Holtz-Eakin said the Medicare and Medicaid changes would improve the programs and eliminate fraud, but he didn't detail where the cuts would come from. "It's about giving them the benefit package that has been promised to them by law at lower cost," he said.
Sen. McCain's plan to offer a new tax credit of $2,500 per person and $5,000 per family toward insurance premiums. This would allow people to buy health coverage on the open market, where they may have more choices and might look for a better bargain.In exchange, the government would begin taxing the value of health benefits people get through work. If an employer spends $10,000 to buy a worker health insurance, the worker would pay taxes on that money.
The nonpartisan Tax Policy Center, a Washington think tank, estimates that the McCain plan would cost the government $1.3 trillion over 10 years. The plan would allow as many as five million more people to have insurance, it estimates.
The Tax Policy Center estimates that Obama's plan would cost $1.6 trillion over 10 years and cover 34 million more people.
Comment:
Senator McCain seems to be ill advised to suggest MASSIVE Medicare cuts to finance his health care plan. In States like Florida, and especially South Florida, Medicare recipients will definitely not support any Medicare cuts and neither will doctors who already struggle with fair reimbursement issues.
I guess, that SGR refom will also fall by the wayside because there is no money to bail out doctors.
McCain's proposal is another speed bump on the road towards healthcare recovery.
Yours
Bernd
Shana Tova, Happy New Year and Chatima Tova
McCain Plans Federal Health Cuts
Medicare, Medicaid Spending Would Be Reduced to Offset Proposed Tax Credit
John McCain would pay for his health plan with major reductions to Medicare and Medicaid, a top aide said, in a move that independent analysts estimate could result in cuts of $1.3 trillion over 10 years to the government programs.
The Republican presidential nominee has said little about the proposed cuts, but they are needed to keep his health-care plan "budget neutral," as he has promised. The McCain campaign hasn't given a specific figure for the cuts, but didn't dispute the analysts' estimate.
In the months since Sen. McCain introduced his health plan, statements made by his campaign have implied that the new tax credits he is proposing to help Americans buy health insurance would be paid for with other tax increases.
But Douglas Holtz-Eakin, Sen. McCain's senior policy adviser, said Sunday that the campaign has always planned to fund the tax credits, in part, with savings from Medicare and Medicaid. Those government health-care programs serve seniors, poor families and the disabled. Medicare spending for the fiscal year ended Sept. 30 is estimated at $457.5 billion.
Mr. Holtz-Eakin said the Medicare and Medicaid changes would improve the programs and eliminate fraud, but he didn't detail where the cuts would come from. "It's about giving them the benefit package that has been promised to them by law at lower cost," he said.
Both Sen. McCain and his Democratic rival, Sen. Barack Obama, have recently sought to refocus on health care. The issue once ranked at the top of voters' domestic concerns, but has in recent months been eclipsed by energy and the economy.
Sen. McCain charges that the Obama plan, which would create a government-run marketplace in which people could buy coverage, would lead to government-run health care. Sen. Obama charges that Sen. McCain's plan would leave many people unable to get insurance.
Sen. Obama's campaign turned up the volume in a major push on health care over the weekend with two days of attacks from the stump, four new television advertisements, a series of health-care events across the country and fliers to voters' homes in swing states.
Sen. Obama is focused on Sen. McCain's plan to offer a new tax credit of $2,500 per person and $5,000 per family toward insurance premiums. This would allow people to buy health coverage on the open market, where they may have more choices and might look for a better bargain.
In exchange, the government would begin taxing the value of health benefits people get through work. If an employer spends $10,000 to buy a worker health insurance, the worker would pay taxes on that money.
"It's a shell game," Sen. Obama told an outdoor rally of 28,000 people Sunday in Asheville, N.C. "Sen. McCain gives you a tax credit with one hand -- but raises your taxes with the other."
Sen. McCain's plan actually would lower taxes for most people. But that means the plan wouldn't pay for itself, because it cuts certain taxes more than it raises others.
The federal government imposes two taxes on wages, generally: an income tax, which funds the government's general operations, and the payroll tax, paid for by employers and employees, which funds Social Security and Medicare. If Sen. McCain were to apply both of these to the value of health benefits, he could fully pay for his new tax credits. That is what aides have in the past suggested he would do.
In April, when Sen. McCain gave a major speech about his health plan, Mr. Holtz-Eakin, the senior policy adviser, said the tax provisions alone were budget neutral -- meaning that health benefits would have to be subject to both income and payroll taxes.
Campaign officials have regularly implied since then that the tax plan was a wash. In the vice-presidential debate last week, Alaska Gov. Sarah Palin described Sen. McCain's proposed tax credits and said: "That's budget neutral. That doesn't cost the government anything, as opposed to Barack Obama's plan to mandate health-care coverage and have this universal, government-run program."
Mr. Holtz-Eakin said the campaign never intended to apply the payroll tax to health benefits. That means that most people would see a net tax cut, contrary to Sen. Obama's assertions. Only those with very rich benefits packages are likely to see a net increase in taxes. But it also means that Sen. McCain must fill a huge budget hole -- which the campaign says will come from cuts to Medicare and Medicaid.
The nonpartisan Tax Policy Center, a Washington think tank, estimates that the McCain plan would cost the government $1.3 trillion over 10 years. The plan would allow as many as five million more people to have insurance, it estimates.
Mr. Holtz-Eakin said the plan is accurately described as budget neutral because it assumes enough savings in Medicare and Medicaid spending to make up the difference. He said the savings would come from eliminating Medicare fraud and by reforming payment policies to lower the overall cost of care. He said the new tax credits will help some low-income people avoid joining Medicaid. The campaign also proposes increasing Medicare premiums for wealthier seniors.
Sen. Obama also would rely on some Medicare savings to pay for his health-care plan, which would offer subsidies to help consumers pay for premiums. The Tax Policy Center estimates that his plan would cost $1.6 trillion over 10 years and cover 34 million more people.
Write to Laura Meckler at laura.meckler@wsj.com
Friday, August 08, 2008
FMA and EVP
Dear Friends and Colleagues:
First of all, I would like to thank all of you who supported my election as one of your AMA Delegate. I am grateful, honored and humbled to have gained your support and will work diligently with our delegation to represent your interests. Please feel free calling me 24/7 -Cell Phone: (305) 342-2522) - or contact me via e-mail at info@miamihealth.com to express your concerns and to voice your opinion. You elected me to represent you and I need to hear from you to fulfill my obligation and responsibilities.
I also want to take the opportunity to share some of my concerns regarding the selection of a new EVP for our FMA.
Some of you may recall my vocal opposition last year to the modus operandi on how our FMA leadership decided to part from our previous EVP, Sandra Mortham.
We were assured that the selection and appointment of Sandra's successor would follow an open and transparent process. Subsequently, the services of a consulting company (OPIS,LLC) were retained and we were left with the impression that an EVP search committee would interview potential candidates and that each applicant would undergo a vetting process to ascertain his/her qualifications. On Monday I received the President's Weekly Report which included the following announcement:
"Following the close of Annual Meeting, the FMA Board of Governors met. Among other business, we received the report of the EVP search committee as presented by FMA President Elect James Dolan. The Search committee recommended that the Board of Governors begin contract negotiations with Mr. Tim Stapleton for the EVP position. After a lengthy deliberation, the Board of Governors voted overwhelmingly to approve the recommendation of the search committee to appoint Mr. Timothy J. Stapleton as the new Executive Vice President of the Florida Medical Association."
I want to stress that I do not question Tim's qualification as our future EVP, admire and respect his professional qualifications, and like him personally. Nevertheless, I was troubled reading a letter written by the President and Principal of OPIS and directed to the FMA BOG raising a series of concerns regarding the EVP selection process. The letter is not marked confidential and circulated prior and during the FMA meeting among the delegates.
Let me share some of the issues mentioned in the letter with you, including marked quotes from the letter.
THE ISSUES:
OPIS was charged to perform a management audit for our organization and one of the questions OPIS was asked to address was:
How do we prevent a repetition of what has occurred twice before with EVPs?
"A previous board, faced with filling the EVP position as well as the potential of losing its lobbyist, elected to address both issues by promoting the lobbyist to the EVP position. As we now know, the decision proved to have disastrous consequences for the FMA. In response to that question, we recommended that the FMA engage a search firm. Our position has not changed."
"We advised the board to adopt what 99.9 % of all organizations, for-profit and non-profit, adopt – a single CEO reporting to the board. The board made a nearly unanimous decision to hire an EVP. It charged the search committee to develop a job description as well as an RFP to solicit proposals from search firms."
"The search committee has completed both elements of that charge. It is our understanding, that based on its review of the proposals, as well as an evaluation of the performance of the current staff, the committee is recommending offering Mr. Stapleton the position and to only use a search firm if an agreement acceptable to both parties cannot be reached."
"We strongly advise the FMA board to not follow this path."
Well, let me emphasize that our FMA has paid over $70,000 for these consultants and I would assume that their recommendations would be taken into serious consideration. So why did our FMA leadership decide to ignore their advice?
Lets continue reading the letter:
"We are not suggesting Mr. Stapleton is unqualified for the EVP position. We are stating that offering Mr. Stapleton the position without comparing his qualifications against those of other applicants is not in keeping with the board’s fiduciary responsibility. Moreover, it opens the organization to repeating the same error it made with the last EVP."
"If Mr. Stapleton is, indeed, the best candidate for the position, a proper search will confirm the wisdom of that choice. Moreover, proper vetting will assure the membership that the board has made a prudent decision. This process serves all. Neither Mr. Stapleton, nor the board, nor the membership will be served by a decision that has not been properly vetted."
"In summary, we strongly urge the board to stay the course it set at the last board meeting: engage the services of a search firm that will assist the board in vetting and selecting the best candidate for the position. We would also urge that, as a declared candidate for the position, Mr. Stapleton recuse himself from any board activity related to the search process. Neither he nor the organization will benefit from any perception that as a candidate he was afforded information that was not available to other candidates.
No process comes with a guarantee. We can state unequivocally that the process we have recommended is fraught with far less error than using a process that has not worked well for the FMA in the past."
"We are not saying that hiring Mr. Stapleton is a mistake. Rather we are saying that repeating the process used to hire the last EVP is a serious mistake. We realize the board faces a critical issue and stand ready to assist you in any way possible."
So, what can we do? I stressed last year that our FMA leadership should adhere to the following principles of organizational management::
* Accountability of its leadership
* Transparency of the decision making process
* System of checks and balances and reestablish democratic principles
Lets ask our leadership WHY they have chosen to ignore the advice of their high-paid consultants?
What vetting process did our new EVP undergo and how many applications of suitable candidates have they reviewed?
How many candidates have been interviewed? What are the facts supporting the recommendation of the FMA EVP search committee to select Tim Stapelton as our new EVP?
Should we expect answers to those questions? What is your opinion?
Yours
Bernd Wollschlaeger,MD
FMA Member
AMA Delegate
First of all, I would like to thank all of you who supported my election as one of your AMA Delegate. I am grateful, honored and humbled to have gained your support and will work diligently with our delegation to represent your interests. Please feel free calling me 24/7 -Cell Phone: (305) 342-2522) - or contact me via e-mail at info@miamihealth.com to express your concerns and to voice your opinion. You elected me to represent you and I need to hear from you to fulfill my obligation and responsibilities.
I also want to take the opportunity to share some of my concerns regarding the selection of a new EVP for our FMA.
Some of you may recall my vocal opposition last year to the modus operandi on how our FMA leadership decided to part from our previous EVP, Sandra Mortham.
We were assured that the selection and appointment of Sandra's successor would follow an open and transparent process. Subsequently, the services of a consulting company (OPIS,LLC) were retained and we were left with the impression that an EVP search committee would interview potential candidates and that each applicant would undergo a vetting process to ascertain his/her qualifications. On Monday I received the President's Weekly Report which included the following announcement:
"Following the close of Annual Meeting, the FMA Board of Governors met. Among other business, we received the report of the EVP search committee as presented by FMA President Elect James Dolan. The Search committee recommended that the Board of Governors begin contract negotiations with Mr. Tim Stapleton for the EVP position. After a lengthy deliberation, the Board of Governors voted overwhelmingly to approve the recommendation of the search committee to appoint Mr. Timothy J. Stapleton as the new Executive Vice President of the Florida Medical Association."
I want to stress that I do not question Tim's qualification as our future EVP, admire and respect his professional qualifications, and like him personally. Nevertheless, I was troubled reading a letter written by the President and Principal of OPIS and directed to the FMA BOG raising a series of concerns regarding the EVP selection process. The letter is not marked confidential and circulated prior and during the FMA meeting among the delegates.
Let me share some of the issues mentioned in the letter with you, including marked quotes from the letter.
THE ISSUES:
OPIS was charged to perform a management audit for our organization and one of the questions OPIS was asked to address was:
How do we prevent a repetition of what has occurred twice before with EVPs?
"A previous board, faced with filling the EVP position as well as the potential of losing its lobbyist, elected to address both issues by promoting the lobbyist to the EVP position. As we now know, the decision proved to have disastrous consequences for the FMA. In response to that question, we recommended that the FMA engage a search firm. Our position has not changed."
"We advised the board to adopt what 99.9 % of all organizations, for-profit and non-profit, adopt – a single CEO reporting to the board. The board made a nearly unanimous decision to hire an EVP. It charged the search committee to develop a job description as well as an RFP to solicit proposals from search firms."
"The search committee has completed both elements of that charge. It is our understanding, that based on its review of the proposals, as well as an evaluation of the performance of the current staff, the committee is recommending offering Mr. Stapleton the position and to only use a search firm if an agreement acceptable to both parties cannot be reached."
"We strongly advise the FMA board to not follow this path."
Well, let me emphasize that our FMA has paid over $70,000 for these consultants and I would assume that their recommendations would be taken into serious consideration. So why did our FMA leadership decide to ignore their advice?
Lets continue reading the letter:
"We are not suggesting Mr. Stapleton is unqualified for the EVP position. We are stating that offering Mr. Stapleton the position without comparing his qualifications against those of other applicants is not in keeping with the board’s fiduciary responsibility. Moreover, it opens the organization to repeating the same error it made with the last EVP."
"If Mr. Stapleton is, indeed, the best candidate for the position, a proper search will confirm the wisdom of that choice. Moreover, proper vetting will assure the membership that the board has made a prudent decision. This process serves all. Neither Mr. Stapleton, nor the board, nor the membership will be served by a decision that has not been properly vetted."
"In summary, we strongly urge the board to stay the course it set at the last board meeting: engage the services of a search firm that will assist the board in vetting and selecting the best candidate for the position. We would also urge that, as a declared candidate for the position, Mr. Stapleton recuse himself from any board activity related to the search process. Neither he nor the organization will benefit from any perception that as a candidate he was afforded information that was not available to other candidates.
No process comes with a guarantee. We can state unequivocally that the process we have recommended is fraught with far less error than using a process that has not worked well for the FMA in the past."
"We are not saying that hiring Mr. Stapleton is a mistake. Rather we are saying that repeating the process used to hire the last EVP is a serious mistake. We realize the board faces a critical issue and stand ready to assist you in any way possible."
So, what can we do? I stressed last year that our FMA leadership should adhere to the following principles of organizational management::
* Accountability of its leadership
* Transparency of the decision making process
* System of checks and balances and reestablish democratic principles
Lets ask our leadership WHY they have chosen to ignore the advice of their high-paid consultants?
What vetting process did our new EVP undergo and how many applications of suitable candidates have they reviewed?
How many candidates have been interviewed? What are the facts supporting the recommendation of the FMA EVP search committee to select Tim Stapelton as our new EVP?
Should we expect answers to those questions? What is your opinion?
Yours
Bernd Wollschlaeger,MD
FMA Member
AMA Delegate
Wednesday, July 09, 2008
Medicare Bill Passed The Senate
Wednesday, July 09, 2008
Dear Friends and Colleagues:
Good news! The U.S. Senate just passed HR 6331, the Medicare Improvement for Patients and Providers Act of 2008, by a veto-proof majority of 69-30. Both Florida Senators, Sen. Martinez and Sen. Nelson, voted in favor of the bill.
As you know, the legislation replaces the 10.6% payment cut that went into effect on July 1 with a 0.5% update extension through December 31, 2008. For calendar year 2009, the update will be 1.1%. Other important provisions such as extending the GPCI floor on physician work were also included.
This success is due to the relentless pressure grassroots campaign lead by our American Medical Association and many others, including our county medical society. Our letter to Mel Martinez may have contributed to his change of opinion too We have to continue putting pressure on politicians who seem to represent the insurance industry but not the interests of their constituents. Don't forget that politicians want to get reelected!
The bill must now be signed into law by President Bush, who has signaled on more than one occasion that he intends to veto it. However, given the fact that the payment cuts have already occurred and that the bill passed both chambers with the two-third majority needed to override a veto, there is some reason to question next steps by the White House.
Our campaign has to continue and we have to flood the White House with calls and letters.
Again, thank you for your effort and support.
Together we are stronger.
Yours
Bernd
Bernd Wollschlaeger,MD, FAAFP,FASAM
President, Dade County Medical Association
AMA Delegate
Dear Friends and Colleagues:
Good news! The U.S. Senate just passed HR 6331, the Medicare Improvement for Patients and Providers Act of 2008, by a veto-proof majority of 69-30. Both Florida Senators, Sen. Martinez and Sen. Nelson, voted in favor of the bill.
As you know, the legislation replaces the 10.6% payment cut that went into effect on July 1 with a 0.5% update extension through December 31, 2008. For calendar year 2009, the update will be 1.1%. Other important provisions such as extending the GPCI floor on physician work were also included.
This success is due to the relentless pressure grassroots campaign lead by our American Medical Association and many others, including our county medical society. Our letter to Mel Martinez may have contributed to his change of opinion too We have to continue putting pressure on politicians who seem to represent the insurance industry but not the interests of their constituents. Don't forget that politicians want to get reelected!
The bill must now be signed into law by President Bush, who has signaled on more than one occasion that he intends to veto it. However, given the fact that the payment cuts have already occurred and that the bill passed both chambers with the two-third majority needed to override a veto, there is some reason to question next steps by the White House.
Our campaign has to continue and we have to flood the White House with calls and letters.
Again, thank you for your effort and support.
Together we are stronger.
Yours
Bernd
Bernd Wollschlaeger,MD, FAAFP,FASAM
President, Dade County Medical Association
AMA Delegate
Friday, June 27, 2008
Medicare Cuts
Congress failed to stop the 10.6% Medicare cut.
Dear Friends and Colleagues:
Unfortunately, by a vote of 58 to 40 the Senate failed to follow the example of the House and adopt H.R. 6331 - the “Medicare Improvements to Patients and Providers Act”
60 votes were needed to pass the bill. In a procedural move, the Senate Majority Leader Harry Reid (D-NV) changed his vote to "No" so that he could call the bill up at a future date. Therefore the measure fell one vote short of being adopted.
Lobbyist and representatives of our American Medical Association worked VERY hard to fight the looming Medicare cuts, but our elected officials voted against our interests.
Our AMA issued the following press release:
“The physicians of America are outraged that a group of Republican senators followed the direction of the Bush Administration and voted to protect health insurance companies at the expense of America’s seniors, disabled and military families."
Comment:
U.S. Senator Mel Martinez voted AGAINST the bill, U.S. Senator Bill Nelson voted FOR the bill,.
“These senators leave for their 4th of July picnics knowing that the most vulnerable Americans are at risk because of the Senate's inability to act to stop drastic payment cuts for health care services that are needed by our Medicare and TRICARE patients
“The House voted to preserve access to care for Medicare patients in a bipartisan landslide vote to pass H.R. 6331 by an overwhelming margin of 355 to 59. The House made seniors, the disabled and military families a top priority. The AMA appreciates the courage of the 59 Senators, including nine Republicans, who voted to put patients ahead of partisan politics and vote for H.R. 6331.
“Today, thanks to some senators, we stand at the brink of a Medicare meltdown. On July 1 – just four days from now – the government will slash Medicare physician payments by 10.6 percent, forcing many physicians to make the difficult choice to limit the number of Medicare patients in their practices.
"The Senate must return from their recess and make seniors’ health care their top priority. For doctors, this is not a partisan issue - it's a patient access issue."
What can we do now?
* Call upon our Senators to return from their recess and make seniors’ health care their top priority. For doctors, this is not a partisan issue - it's a patient access issue.
* Call Senator Bill Nelson to congratulate him for his courageous support of this bill Phone# 202 224-5274 or 305 536-5999.
* Call Senator Mel Martinez and advise him that his position has been duly noted and that we will inform our patients accordingly Phone#202 224-3041 or 305 444-8332
* Limit non-urgent Medicare appointments until congress acts and reverses the cut and inform our patients why we are forced to take those steps.
* Hand out information to our patients asking them to call their representatives to protest the looming drastic Medicare cuts
* Join your county, state and national medical association to support our efforts protecting your interests.
NOW is the time to act as a group! Our patients access to health care services is at stake and we have to stop private insurance companies from pocketing Medicare dollars.
Yours
Bernd Wollschlaeger,MD,FAAFP,FASAM
President, Dade County Medical Association
Dear Friends and Colleagues:
Unfortunately, by a vote of 58 to 40 the Senate failed to follow the example of the House and adopt H.R. 6331 - the “Medicare Improvements to Patients and Providers Act”
60 votes were needed to pass the bill. In a procedural move, the Senate Majority Leader Harry Reid (D-NV) changed his vote to "No" so that he could call the bill up at a future date. Therefore the measure fell one vote short of being adopted.
Lobbyist and representatives of our American Medical Association worked VERY hard to fight the looming Medicare cuts, but our elected officials voted against our interests.
Our AMA issued the following press release:
“The physicians of America are outraged that a group of Republican senators followed the direction of the Bush Administration and voted to protect health insurance companies at the expense of America’s seniors, disabled and military families."
Comment:
U.S. Senator Mel Martinez voted AGAINST the bill, U.S. Senator Bill Nelson voted FOR the bill,.
“These senators leave for their 4th of July picnics knowing that the most vulnerable Americans are at risk because of the Senate's inability to act to stop drastic payment cuts for health care services that are needed by our Medicare and TRICARE patients
“The House voted to preserve access to care for Medicare patients in a bipartisan landslide vote to pass H.R. 6331 by an overwhelming margin of 355 to 59. The House made seniors, the disabled and military families a top priority. The AMA appreciates the courage of the 59 Senators, including nine Republicans, who voted to put patients ahead of partisan politics and vote for H.R. 6331.
“Today, thanks to some senators, we stand at the brink of a Medicare meltdown. On July 1 – just four days from now – the government will slash Medicare physician payments by 10.6 percent, forcing many physicians to make the difficult choice to limit the number of Medicare patients in their practices.
"The Senate must return from their recess and make seniors’ health care their top priority. For doctors, this is not a partisan issue - it's a patient access issue."
What can we do now?
* Call upon our Senators to return from their recess and make seniors’ health care their top priority. For doctors, this is not a partisan issue - it's a patient access issue.
* Call Senator Bill Nelson to congratulate him for his courageous support of this bill Phone# 202 224-5274 or 305 536-5999.
* Call Senator Mel Martinez and advise him that his position has been duly noted and that we will inform our patients accordingly Phone#202 224-3041 or 305 444-8332
* Limit non-urgent Medicare appointments until congress acts and reverses the cut and inform our patients why we are forced to take those steps.
* Hand out information to our patients asking them to call their representatives to protest the looming drastic Medicare cuts
* Join your county, state and national medical association to support our efforts protecting your interests.
NOW is the time to act as a group! Our patients access to health care services is at stake and we have to stop private insurance companies from pocketing Medicare dollars.
Yours
Bernd Wollschlaeger,MD,FAAFP,FASAM
President, Dade County Medical Association
Thursday, June 12, 2008
Medicare Cuts and The Senate Vote Today
Dear Friends and Colleagues:
Today, Senate Bill 3101 "The Medicare Improvements for Patients and Providers Act " sponsored by Senator Baucus failed to gather enough support in the Senate for a closure vote.
It includes provisions to address serious, long-standing Medicare problems faced by millions of seniors on fixed incomes struggling every day with rapidly rising Medicare, food, and gasoline costs.
CBO (Congressional Budget Office) estimates that S. 3101 with that proposed amendment would increase spending on physicians’ and other services by $19.8 billion over the 2008-2013 period and
$62.8 billion over the 2008-2018 period; those amounts would be offset by reductions in payments to other providers (primarily Medicare Advantage plans). Taken together, the bill would reduce direct spending by $5 million over both the 2008-2013 and 2008-2018 periods, CBO estimates. S. 3101, when amended, would avert a reduction to Medicare’s physician fee schedule planned for July 1, 2008, by freezing those fees at their current levels for the remainder of the year and increasing them by 1.1 percent in January 2009. Beyond 2009, fees would be held at their current-law levels, necessitating a 21 percent reduction in 2010. The bill would also extend many expiring provisions of Medicare, expand Medicare’s coverage of preventive services, and modify the rules governing eligibility for the Medicare Savings Program. New spending under the bill would be offset largely by reductions in payments to and enrollment in Medicare Advantage plans. The bill, with the amendment, would phase out double payments for indirect medical education made to plans and hospitals for Medicare Advantage enrollees. It also would require private fee-for-service plans to adopt networks, with some exceptions, leading to decreases in enrollment and reduced outlays.
Senators who opposed the Baucus bill argued that the improvements for poor seniors were fiscally irresponsible, yet supported increased payments to physicians.
Those opposing SB 3101 support a legislation offered by Sen. Charles Grassley (R-IA).
Sen. Charles Grassley (R-Iowa) on Wednesday introduced the Preserving Access to Medicare Act of 2008, legislation intended to postpone a scheduled 10.6 percent reduction to Medicare physician payments. Sen. Grassley said the cuts would likely affect seniors’ access to physicians. Under Grassley’s bill, a 0.5 percent physician update would be provided for the rest of 2008. That percentage would increase to 1.1 percent for 2009. To help pay for the plan, the bill would cut over the next five years roughly $12.5 billion from privately run Medicare Advantage plans.
The measure also offers incentive payments to healthcare professionals for using a qualified e-prescribing system. Rural home health agencies would see a five percent home health add-on payment for 2009, and starting Jan. 1, certain skilled nursing facilities would be included as originating sites for the telehealth services initiative.
Sen. Grassley said that unlike similar legislation introduced by Sen. Max Baucus (D-Mont.), his bill was far more likely to be signed into law because it “does not make large, unwarranted cuts to Medicare Advantage.”
The Baucus bill, the Patients and Providers Act of 2008 (S. 3101), would cut roughly $13 billion from the private Medicare Advantage plans.
Comment:
Personally, I favor the Baucus plan but I am mindful and realistic that it would have been vetoed by President Bush and in the absence of a veto-proof majority would have died anyway.
Nevertheless, its failure demonstrates who are our friends and foes in the Senate.
From Florida Senator Martinez voted AGAINST the Baucus bill and we should send him a letter reminding him that Florida's seniors are a strong voting block and will exercise their right to vote in 2010 when his term will expire.
Let's remind our Senators that their attitude and position regarding Medicare reimbursement for physicians will be monitored by us!!
Yours truly,
Bernd
President,DCMA
===============================================================================================================================================
Grouped By Vote PositionYEAs ---54
Akaka (D-HI)Baucus (D-MT)Bayh (D-IN)Biden (D-DE)Bingaman (D-NM)Boxer (D-CA)Brown (D-OH)Byrd (D-WV)Cantwell (D-WA)Cardin (D-MD)Carper (D-DE)Casey (D-PA)Coleman (R-MN)Collins (R-ME)Conrad (D-ND)Dodd (D-CT)Dole (R-NC)Dorgan (D-ND)Durbin (D-IL)Feingold (D-WI)Feinstein (D-CA)Harkin (D-IA)Johnson (D-SD)Kerry (D-MA)Klobuchar (D-MN)Kohl (D-WI)Lautenberg (D-NJ)Leahy (D-VT)Levin (D-MI)Lieberman (ID-CT)Lincoln (D-AR)McCaskill (D-MO)Menendez (D-NJ)Mikulski (D-MD)Murkowski (R-AK)Murray (D-WA)Nelson (D-FL)Nelson (D-NE)Pryor (D-AR)Reed (D-RI)Roberts (R-KS)Rockefeller (D-WV)Salazar (D-CO)Sanders (I-VT)Schumer (D-NY)Smith (R-OR)Snowe (R-ME)Specter (R-PA)Stabenow (D-MI)Stevens (R-AK)Tester (D-MT)Webb (D-VA)Whitehouse (D-RI)Wyden (D-OR)
NAYs ---39
Alexander (R-TN)Allard (R-CO)Barrasso (R-WY)Bennett (R-UT)Bond (R-MO)Brownback (R-KS)Bunning (R-KY)Burr (R-NC)Chambliss (R-GA)Coburn (R-OK)Cochran (R-MS)Corker (R-TN)Cornyn (R-TX)Craig (R-ID)Crapo (R-ID)DeMint (R-SC)Domenici (R-NM)Ensign (R-NV)Enzi (R-WY)Graham (R-SC)Grassley (R-IA)Gregg (R-NH)Hagel (R-NE)Hatch (R-UT)Hutchison (R-TX)Inhofe (R-OK)Isakson (R-GA)Kyl (R-AZ)Lugar (R-IN)Martinez (R-FL)McConnell (R-KY)Reid (D-NV)Sessions (R-AL)Shelby (R-AL)Thune (R-SD)Vitter (R-LA)Voinovich (R-OH)Warner (R-VA)Wicker (R-MS)
Not Voting - 7
Clinton (D-NY)Inouye (D-HI)Kennedy (D-MA)Landrieu (D-LA)McCain (R-AZ)Obama (D-IL)Sununu (R-NH)
Today, Senate Bill 3101 "The Medicare Improvements for Patients and Providers Act " sponsored by Senator Baucus failed to gather enough support in the Senate for a closure vote.
It includes provisions to address serious, long-standing Medicare problems faced by millions of seniors on fixed incomes struggling every day with rapidly rising Medicare, food, and gasoline costs.
CBO (Congressional Budget Office) estimates that S. 3101 with that proposed amendment would increase spending on physicians’ and other services by $19.8 billion over the 2008-2013 period and
$62.8 billion over the 2008-2018 period; those amounts would be offset by reductions in payments to other providers (primarily Medicare Advantage plans). Taken together, the bill would reduce direct spending by $5 million over both the 2008-2013 and 2008-2018 periods, CBO estimates. S. 3101, when amended, would avert a reduction to Medicare’s physician fee schedule planned for July 1, 2008, by freezing those fees at their current levels for the remainder of the year and increasing them by 1.1 percent in January 2009. Beyond 2009, fees would be held at their current-law levels, necessitating a 21 percent reduction in 2010. The bill would also extend many expiring provisions of Medicare, expand Medicare’s coverage of preventive services, and modify the rules governing eligibility for the Medicare Savings Program. New spending under the bill would be offset largely by reductions in payments to and enrollment in Medicare Advantage plans. The bill, with the amendment, would phase out double payments for indirect medical education made to plans and hospitals for Medicare Advantage enrollees. It also would require private fee-for-service plans to adopt networks, with some exceptions, leading to decreases in enrollment and reduced outlays.
Senators who opposed the Baucus bill argued that the improvements for poor seniors were fiscally irresponsible, yet supported increased payments to physicians.
Those opposing SB 3101 support a legislation offered by Sen. Charles Grassley (R-IA).
Sen. Charles Grassley (R-Iowa) on Wednesday introduced the Preserving Access to Medicare Act of 2008, legislation intended to postpone a scheduled 10.6 percent reduction to Medicare physician payments. Sen. Grassley said the cuts would likely affect seniors’ access to physicians. Under Grassley’s bill, a 0.5 percent physician update would be provided for the rest of 2008. That percentage would increase to 1.1 percent for 2009. To help pay for the plan, the bill would cut over the next five years roughly $12.5 billion from privately run Medicare Advantage plans.
The measure also offers incentive payments to healthcare professionals for using a qualified e-prescribing system. Rural home health agencies would see a five percent home health add-on payment for 2009, and starting Jan. 1, certain skilled nursing facilities would be included as originating sites for the telehealth services initiative.
Sen. Grassley said that unlike similar legislation introduced by Sen. Max Baucus (D-Mont.), his bill was far more likely to be signed into law because it “does not make large, unwarranted cuts to Medicare Advantage.”
The Baucus bill, the Patients and Providers Act of 2008 (S. 3101), would cut roughly $13 billion from the private Medicare Advantage plans.
Comment:
Personally, I favor the Baucus plan but I am mindful and realistic that it would have been vetoed by President Bush and in the absence of a veto-proof majority would have died anyway.
Nevertheless, its failure demonstrates who are our friends and foes in the Senate.
From Florida Senator Martinez voted AGAINST the Baucus bill and we should send him a letter reminding him that Florida's seniors are a strong voting block and will exercise their right to vote in 2010 when his term will expire.
Let's remind our Senators that their attitude and position regarding Medicare reimbursement for physicians will be monitored by us!!
Yours truly,
Bernd
President,DCMA
===============================================================================================================================================
Grouped By Vote PositionYEAs ---54
Akaka (D-HI)Baucus (D-MT)Bayh (D-IN)Biden (D-DE)Bingaman (D-NM)Boxer (D-CA)Brown (D-OH)Byrd (D-WV)Cantwell (D-WA)Cardin (D-MD)Carper (D-DE)Casey (D-PA)Coleman (R-MN)Collins (R-ME)Conrad (D-ND)Dodd (D-CT)Dole (R-NC)Dorgan (D-ND)Durbin (D-IL)Feingold (D-WI)Feinstein (D-CA)Harkin (D-IA)Johnson (D-SD)Kerry (D-MA)Klobuchar (D-MN)Kohl (D-WI)Lautenberg (D-NJ)Leahy (D-VT)Levin (D-MI)Lieberman (ID-CT)Lincoln (D-AR)McCaskill (D-MO)Menendez (D-NJ)Mikulski (D-MD)Murkowski (R-AK)Murray (D-WA)Nelson (D-FL)Nelson (D-NE)Pryor (D-AR)Reed (D-RI)Roberts (R-KS)Rockefeller (D-WV)Salazar (D-CO)Sanders (I-VT)Schumer (D-NY)Smith (R-OR)Snowe (R-ME)Specter (R-PA)Stabenow (D-MI)Stevens (R-AK)Tester (D-MT)Webb (D-VA)Whitehouse (D-RI)Wyden (D-OR)
NAYs ---39
Alexander (R-TN)Allard (R-CO)Barrasso (R-WY)Bennett (R-UT)Bond (R-MO)Brownback (R-KS)Bunning (R-KY)Burr (R-NC)Chambliss (R-GA)Coburn (R-OK)Cochran (R-MS)Corker (R-TN)Cornyn (R-TX)Craig (R-ID)Crapo (R-ID)DeMint (R-SC)Domenici (R-NM)Ensign (R-NV)Enzi (R-WY)Graham (R-SC)Grassley (R-IA)Gregg (R-NH)Hagel (R-NE)Hatch (R-UT)Hutchison (R-TX)Inhofe (R-OK)Isakson (R-GA)Kyl (R-AZ)Lugar (R-IN)Martinez (R-FL)McConnell (R-KY)Reid (D-NV)Sessions (R-AL)Shelby (R-AL)Thune (R-SD)Vitter (R-LA)Voinovich (R-OH)Warner (R-VA)Wicker (R-MS)
Not Voting - 7
Clinton (D-NY)Inouye (D-HI)Kennedy (D-MA)Landrieu (D-LA)McCain (R-AZ)Obama (D-IL)Sununu (R-NH)
Tuesday, April 22, 2008
Medicaid Reform
Dear Friends and Colleagues:
Attached two letters to the editor published in the Miami Herald. The first by our very own Dr. Arthur Palamara cautions against the expansion of the Medicaid reform program into Miami-Dade County.His letter from April 22nd is a response to the letter from Representative Galvano published on April 19th.
I congratulate Dr. Palamara to his pointed response. We have to be careful to let ideology trump reason. Based on the best evidence the current Medicaid pilot program in Broward county has not met the expectations, or (less euphemistically) has failed.
We should not jump on the Medicaid reform bandwagon but review the results of the current pilot.
Further reform implementation should be based on facts and not wishful thinking. We need to solve the problem of Medicaid financing and protect healthcare for those in need.Our voices need to be heard and I encourage you to particiapte in the political debate.
Yours
Bernd
Posted on Tue, Apr. 22, 2008
Flaws in Medicaid
Re state Rep. Bill Galvano's April 19 letter, Expand Medicaid reforms: His assumptions of improved care for Medicaid patients are unsubstantiated. If anything, the contrary is true. Medicaid has regressed from a coordinated system of services to one that is highly fragmented, erecting innumerable obstacles for patients and providers.
Transfering healthier patients into for-profit HMOs leaves sicker and more-debilitated patients in the public-supported Provider Service Networks (PSNs).
Escalating costs suggest that neither of the two Broward Hospital District's PSNs will participate within a year.
While Medicaid reform may look good on paper, Broward's experience suggests that it does not function as designed. The Florida inspector general and the regulatory Agency for Health Care Administration recommend that the program not be expanded until additional data are accrued.
While the Legislature's desire to curb expense is appropriate, its parsimony should not be borne on the backs of Florida's most vulnerable patients.
ARTHUR E. PALAMARA, M.D., Hollywood
Posted on Sat, Apr. 19, 2008
Expand Medicaid reforms
More than 400,000 residents of Miami-Dade County depend on Medicaid. They have limited resources; many of them have serious, chronic disease or disabilities. They have no other source of healthcare coverage. They need and deserve our help -- not just more money, but better care and better results.
It is time to expand Medicaid reform to Miami-Dade because reform offers a better way. The current Medicaid system is flawed. Although Medicaid seems to offer an extensive menu of services, access is uncertain, coordination is random and outcomes are unknown.
Medicaid reform puts patients first. In current reform areas, participants have more plan choices. When they select a plan, they are choosing a unique set of benefits. Reform plans are offering new services -- the first time Medicaid ever expanded services without additional funding. Preventive dental care for adults and over-the-counter drugs are two of the most popular add-ons.
In the second year of reform, four plans expanded the extras and four more added benefits. Reform plans also reduced patient cost-sharing. Reform offers incentives for healthy behaviors. The key to making Medicaid serve patients better is to make the patients themselves the bellwether of success.
To bring state spending back within bounds, Medicaid funding -- now 27 percent of Florida's budget -- must be reduced. We can cut eligibility, eliminate services or reduce prices. Medicaid reform offers a better way by providing incentives for innovations that deliver services more efficiently and effectively and the tools to manage Medicaid in a way that best serves both patients and taxpayers.
REP. BILL GALVANO, chair, state House Committee on Healthy Families, Bradenton
Attached two letters to the editor published in the Miami Herald. The first by our very own Dr. Arthur Palamara cautions against the expansion of the Medicaid reform program into Miami-Dade County.His letter from April 22nd is a response to the letter from Representative Galvano published on April 19th.
I congratulate Dr. Palamara to his pointed response. We have to be careful to let ideology trump reason. Based on the best evidence the current Medicaid pilot program in Broward county has not met the expectations, or (less euphemistically) has failed.
We should not jump on the Medicaid reform bandwagon but review the results of the current pilot.
Further reform implementation should be based on facts and not wishful thinking. We need to solve the problem of Medicaid financing and protect healthcare for those in need.Our voices need to be heard and I encourage you to particiapte in the political debate.
Yours
Bernd
Posted on Tue, Apr. 22, 2008
Flaws in Medicaid
Re state Rep. Bill Galvano's April 19 letter, Expand Medicaid reforms: His assumptions of improved care for Medicaid patients are unsubstantiated. If anything, the contrary is true. Medicaid has regressed from a coordinated system of services to one that is highly fragmented, erecting innumerable obstacles for patients and providers.
Transfering healthier patients into for-profit HMOs leaves sicker and more-debilitated patients in the public-supported Provider Service Networks (PSNs).
Escalating costs suggest that neither of the two Broward Hospital District's PSNs will participate within a year.
While Medicaid reform may look good on paper, Broward's experience suggests that it does not function as designed. The Florida inspector general and the regulatory Agency for Health Care Administration recommend that the program not be expanded until additional data are accrued.
While the Legislature's desire to curb expense is appropriate, its parsimony should not be borne on the backs of Florida's most vulnerable patients.
ARTHUR E. PALAMARA, M.D., Hollywood
Posted on Sat, Apr. 19, 2008
Expand Medicaid reforms
More than 400,000 residents of Miami-Dade County depend on Medicaid. They have limited resources; many of them have serious, chronic disease or disabilities. They have no other source of healthcare coverage. They need and deserve our help -- not just more money, but better care and better results.
It is time to expand Medicaid reform to Miami-Dade because reform offers a better way. The current Medicaid system is flawed. Although Medicaid seems to offer an extensive menu of services, access is uncertain, coordination is random and outcomes are unknown.
Medicaid reform puts patients first. In current reform areas, participants have more plan choices. When they select a plan, they are choosing a unique set of benefits. Reform plans are offering new services -- the first time Medicaid ever expanded services without additional funding. Preventive dental care for adults and over-the-counter drugs are two of the most popular add-ons.
In the second year of reform, four plans expanded the extras and four more added benefits. Reform plans also reduced patient cost-sharing. Reform offers incentives for healthy behaviors. The key to making Medicaid serve patients better is to make the patients themselves the bellwether of success.
To bring state spending back within bounds, Medicaid funding -- now 27 percent of Florida's budget -- must be reduced. We can cut eligibility, eliminate services or reduce prices. Medicaid reform offers a better way by providing incentives for innovations that deliver services more efficiently and effectively and the tools to manage Medicaid in a way that best serves both patients and taxpayers.
REP. BILL GALVANO, chair, state House Committee on Healthy Families, Bradenton
Wednesday, April 09, 2008
Mental Health Parity
Dear Friends and Colleagues:
Representative Ed Homan (R-Tampa) has been tirelessly working on a Mental Health Parity Bill.
Today, it passed with 18-Yeas and )-Nays the Healthcare Council.
House Bill 19 amends s. 627.6688, F.S., to add substance-related disorders to the mandated offering required
by that section. The bill repeals s. 627.669, F.S., which imposes a mandated offering for substance abuse
services. The bill further amends s. 627.6688, F.S., to specifically define those mental health conditions that
must be covered within the mandated offering, generally including all diagnostic categories of mental health
conditions listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders and as
listed in the mental and behavioral disorders section of the current International Classification of Diseases.
The bill deletes current law limiting mental health benefits by specific service areas, such as inpatient benefits,
and inserts a general statement that the mental health benefits may not be more restrictive than the treatment
limitations and cost-sharing requirements that are applicable to other diseases, illnesses, and medical
conditions.
The bill mandates that the parity requirements be separately applied to each benefit package offered by an
employer.
The bill would have an indeterminate negative fiscal impact on the State Employees’ Group Health Self-
Insurance Trust Fund.
The effective date of the bill is January 1, 2009.
For more detailed information please visit http://edhoman.com/public/parity.html
Bill Number: 0019
Bill Name: HB 19
Action: Favorable With Council Substitute
Committee: Healthcare Council
Location: Morris Hall (17 HOB)
Duration: 3.50
Date: 4/8/2008 8:30:00 AM
Sponsor: Homan (CO-SPONSORS) Anderson; Brandenburg; Brisé; ...
Subject: Coverage for Mental, Nervous, and Substance-relate...
Y Anderson Y Galvano Y Harrell Y Patronis Y Schwartz
Y Ausley Y Garcia, R. Y Hays Y Porth Y Skidmore
Y Bean Y Gibson, H. Y Hooper Y Roberson Y Zapata
Y Cusack Y Grimsley Y Hudson
Total Yeas: 18 Total Nays: 0 Total Missed: 0 Total Votes: 18
Please contact your legislator to thank them for their support and encourage them to move this bill forward for final passage.
Also contact Rep. Ed Homan to express your support for his efforts and contribute to his campaign.
Yours
Bernd
Representative Ed Homan (R-Tampa) has been tirelessly working on a Mental Health Parity Bill.
Today, it passed with 18-Yeas and )-Nays the Healthcare Council.
House Bill 19 amends s. 627.6688, F.S., to add substance-related disorders to the mandated offering required
by that section. The bill repeals s. 627.669, F.S., which imposes a mandated offering for substance abuse
services. The bill further amends s. 627.6688, F.S., to specifically define those mental health conditions that
must be covered within the mandated offering, generally including all diagnostic categories of mental health
conditions listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders and as
listed in the mental and behavioral disorders section of the current International Classification of Diseases.
The bill deletes current law limiting mental health benefits by specific service areas, such as inpatient benefits,
and inserts a general statement that the mental health benefits may not be more restrictive than the treatment
limitations and cost-sharing requirements that are applicable to other diseases, illnesses, and medical
conditions.
The bill mandates that the parity requirements be separately applied to each benefit package offered by an
employer.
The bill would have an indeterminate negative fiscal impact on the State Employees’ Group Health Self-
Insurance Trust Fund.
The effective date of the bill is January 1, 2009.
For more detailed information please visit http://edhoman.com/public/parity.html
Bill Number: 0019
Bill Name: HB 19
Action: Favorable With Council Substitute
Committee: Healthcare Council
Location: Morris Hall (17 HOB)
Duration: 3.50
Date: 4/8/2008 8:30:00 AM
Sponsor: Homan (CO-SPONSORS) Anderson; Brandenburg; Brisé; ...
Subject: Coverage for Mental, Nervous, and Substance-relate...
Y Anderson Y Galvano Y Harrell Y Patronis Y Schwartz
Y Ausley Y Garcia, R. Y Hays Y Porth Y Skidmore
Y Bean Y Gibson, H. Y Hooper Y Roberson Y Zapata
Y Cusack Y Grimsley Y Hudson
Total Yeas: 18 Total Nays: 0 Total Missed: 0 Total Votes: 18
Please contact your legislator to thank them for their support and encourage them to move this bill forward for final passage.
Also contact Rep. Ed Homan to express your support for his efforts and contribute to his campaign.
Yours
Bernd
Tuesday, April 08, 2008
OUR AMA IS THE VOICE FOR THE UNINSURED
Dear Friends and Colleagues:
Massive healthcare cuts on state level will further increase the number of Americans without health insurance. Now, the burden has fallen to cities and counties to tackle the growing problem that prevents millions of people from getting timely medical care.In Dade County almost 30% of all residents lack healthinsurance coverage. As a physician and citizen I will not remain silent! In my practice almost ALL of my patient have no health insurance and the number is growing every day. I am seeing more patients every day and many of my clients represent hardworking and lawabiding men and women. They desperately try to make a living amidst sharply increasing costs for food, mortgage, utilities and gas. They do not qualify for Medicaid but can't afford health insurance. They often ask me," Who speaks up for me?"
Now we can proudly answer that OUR AMA is stepping up to the challenge and has released a Health Insurance Reform proposal that can truly address the problem. As an AMA Delegate I have started to speak about the plan and just today spoke at a meeting of a local Democratic Party Club.
Most have never heard about the plan. The questions after the presentations reflect great interest and cautious support.
I encourage each of you to read about the proposal (http://www.ama-assn.org/ama/pub/category/17712.html) which hinges on three elements: 1) Tax credits instead of tax exclusion and subsidy for the high federal income tax brackets, 2) Individually Selected and Owned Health Insurance, 3) Development of New Health Insurance Markets.
Consumer choice is the cornerstone of the AMA's proposal to expand coverage. The AMA plan would limit the role of government to those who cannot afford any insurance, avoiding a one-size-fits-all approach.
The plan is not be perfect but can serve as a platform for discussion and can be amended or expanded.
I am developing a power point presentation about the proposal for the lay audience and am happy to share it with any of you.
As AMA members we should all engage in informing our patients, our families and legislators about this proposal.
Now is NOT the time to question if we have a problem with uninsured Americans but to focus on how to resolve the problem.
Our FMA should be an active partner in this campaign and not stand on the sidelines questioning the validity of the number of uninsured. Realism is the only -ism we should pursue. Our contribution to solve this problem will promote our public image!
I am carrying the message to community groups, the chambers of commerce and to anyone who wants to listen and debate the issue on a rational basis.
Now its your turn! Join us in this campaign!
Yours
Bernd
FOR MORE INFORMATION SEE:
* http://www.ama-assn.org/ama/pub/category/18351.html
* http://www.ama-assn.org/ama/pub/category/17712.html
* http://jama.ama-assn.org/cgi/content/full/291/18/2237
Massive healthcare cuts on state level will further increase the number of Americans without health insurance. Now, the burden has fallen to cities and counties to tackle the growing problem that prevents millions of people from getting timely medical care.In Dade County almost 30% of all residents lack healthinsurance coverage. As a physician and citizen I will not remain silent! In my practice almost ALL of my patient have no health insurance and the number is growing every day. I am seeing more patients every day and many of my clients represent hardworking and lawabiding men and women. They desperately try to make a living amidst sharply increasing costs for food, mortgage, utilities and gas. They do not qualify for Medicaid but can't afford health insurance. They often ask me," Who speaks up for me?"
Now we can proudly answer that OUR AMA is stepping up to the challenge and has released a Health Insurance Reform proposal that can truly address the problem. As an AMA Delegate I have started to speak about the plan and just today spoke at a meeting of a local Democratic Party Club.
Most have never heard about the plan. The questions after the presentations reflect great interest and cautious support.
I encourage each of you to read about the proposal (http://www.ama-assn.org/ama/pub/category/17712.html) which hinges on three elements: 1) Tax credits instead of tax exclusion and subsidy for the high federal income tax brackets, 2) Individually Selected and Owned Health Insurance, 3) Development of New Health Insurance Markets.
Consumer choice is the cornerstone of the AMA's proposal to expand coverage. The AMA plan would limit the role of government to those who cannot afford any insurance, avoiding a one-size-fits-all approach.
The plan is not be perfect but can serve as a platform for discussion and can be amended or expanded.
I am developing a power point presentation about the proposal for the lay audience and am happy to share it with any of you.
As AMA members we should all engage in informing our patients, our families and legislators about this proposal.
Now is NOT the time to question if we have a problem with uninsured Americans but to focus on how to resolve the problem.
Our FMA should be an active partner in this campaign and not stand on the sidelines questioning the validity of the number of uninsured. Realism is the only -ism we should pursue. Our contribution to solve this problem will promote our public image!
I am carrying the message to community groups, the chambers of commerce and to anyone who wants to listen and debate the issue on a rational basis.
Now its your turn! Join us in this campaign!
Yours
Bernd
FOR MORE INFORMATION SEE:
* http://www.ama-assn.org/ama/pub/category/18351.html
* http://www.ama-assn.org/ama/pub/category/17712.html
* http://jama.ama-assn.org/cgi/content/full/291/18/2237
Wednesday, April 02, 2008
Physicians Ranking
"The Patient Charter drafted by the Consumer-Purchaser Disclosure Project requires health insurers to be more transparent and balanced when providing information to patients. These crucial principles offer hope that patients will be able to trust the information to make informed health care choices. Safeguards must ensure that physician rating information does not result in reduced access to care or disrupt patients' longstanding relationships with their physicians.Efforts by health insurers to rate physicians must not be driven solely by costs and economics. The primary goal of these programs must be to promote quality care using meaningful measures. The AMA has long been involved in these efforts through the Physician Consortium for Performance Improvement and National Quality Forum."
Dear Friends and Colleagues;
Attached you find a recent press release from the AMA regarding the Consumer-Purchaser Disclosure Project.
In this press release the AMA supports the coalition's call for transparency and accurate reporting among health insurers
I applaud our AMA to take this proactive approach and to call for an opening of the insurance companies physician rating programs for careful evaluation to assess accuracy, integrity and fairness.
As physicians we need to collaborate on establishing an accurate and transparent quality measurement and reporting system that provide our patients with an objective yardstick to measure and rank their physicians performance.
Yours
Bernd
AMA Delegate
==============================================================================================================
For immediate release
April 1, 2008
Statement attributed to:
Nancy Nielsen, MD
AMA President elect
"The American Medical Association applauds efforts by the Consumer-Purchaser Disclosure Project to raise the bar on the reliability and validity of information that health insurers provide to patients.
"The Patient Charter drafted by the Consumer-Purchaser Disclosure Project requires health insurers to be more transparent and balanced when providing information to patients. These crucial principles offer hope that patients will be able to trust the information to make informed health care choices. Safeguards must ensure that physician rating information does not result in reduced access to care or disrupt patients' longstanding relationships with their physicians.
"Efforts by health insurers to rate physicians must not be driven solely by costs and economics. The primary goal of these programs must be to promote quality care using meaningful measures. The AMA has long been involved in these efforts through the Physician Consortium for Performance Improvement and National Quality Forum.
"Instead of tiered and narrow networks, the AMA believes that providing valid data to physicians and patients will better improve the quality and efficiency of care.
"The work of the Consumer-Purchaser Disclosure Project reinforces the need to protect access to care and the patient-physician relationship by requiring insurers to open their physician rating programs for careful evaluation to assess accuracy, integrity and fairness.
"Although additional work must be done to accurately and fairly evaluate the individual work of physicians, the AMA sees the Patient Charter as an important step in the right direction and we offer our assistance in ensuring its criteria are appropriate and measurable."
###
Dear Friends and Colleagues;
Attached you find a recent press release from the AMA regarding the Consumer-Purchaser Disclosure Project.
In this press release the AMA supports the coalition's call for transparency and accurate reporting among health insurers
I applaud our AMA to take this proactive approach and to call for an opening of the insurance companies physician rating programs for careful evaluation to assess accuracy, integrity and fairness.
As physicians we need to collaborate on establishing an accurate and transparent quality measurement and reporting system that provide our patients with an objective yardstick to measure and rank their physicians performance.
Yours
Bernd
AMA Delegate
==============================================================================================================
For immediate release
April 1, 2008
Statement attributed to:
Nancy Nielsen, MD
AMA President elect
"The American Medical Association applauds efforts by the Consumer-Purchaser Disclosure Project to raise the bar on the reliability and validity of information that health insurers provide to patients.
"The Patient Charter drafted by the Consumer-Purchaser Disclosure Project requires health insurers to be more transparent and balanced when providing information to patients. These crucial principles offer hope that patients will be able to trust the information to make informed health care choices. Safeguards must ensure that physician rating information does not result in reduced access to care or disrupt patients' longstanding relationships with their physicians.
"Efforts by health insurers to rate physicians must not be driven solely by costs and economics. The primary goal of these programs must be to promote quality care using meaningful measures. The AMA has long been involved in these efforts through the Physician Consortium for Performance Improvement and National Quality Forum.
"Instead of tiered and narrow networks, the AMA believes that providing valid data to physicians and patients will better improve the quality and efficiency of care.
"The work of the Consumer-Purchaser Disclosure Project reinforces the need to protect access to care and the patient-physician relationship by requiring insurers to open their physician rating programs for careful evaluation to assess accuracy, integrity and fairness.
"Although additional work must be done to accurately and fairly evaluate the individual work of physicians, the AMA sees the Patient Charter as an important step in the right direction and we offer our assistance in ensuring its criteria are appropriate and measurable."
###
Monday, March 24, 2008
Board of Medicine
"True, the Board should move with care and caution before taking away a doctor's primary means of support. However, the Board also must consider the risk to consumers, whose health and very existence could be at stake. If there is doubt, deference should be made to safeguarding the life and limb of patients......
.....The Board's mission is to protect consumers by licensing and regulating doctors and other healthcare providers. This means putting consumers first, not doctors.
Dear Friend and Colleagues:
Attached a Miami Herald editorial regarding a Miami doctor whose legal trouble received wide exposure in the local media.
I personally know the doctor and deeply regret his professional trouble and struggle. I am also a volunteer expert witness for the Florida Department of Health, have attended Board meetings and have no doubt that each and every Board member diligently considers the merits of each and every case that is being presented for review.
The Boards mission is to " protect health care consumers by licensing qualified health providers ..[and] .. establishing and enforcing health care standards.."
Doing so the Board often has to navigate the narrow course between Scylla (the physicians right to privacy and guarantee of due process ) and Charybdis ( the consumers protection).
In this process the Board is often accused to be either too hard or too soft on doctors. I can empathize with Board members who feel that that they are damned if they do, damned if they don't.
We need to support the efforts of the Board by being proactive in regulating OURSELVES and not to ignore or tolerate the wrongdoing of a FEW doctors. We should not shy away from either talking to those doctors or utilizing the established channels of notifying the Board of any behavior that violate the high health standards in our community.
I would prefer proactive self-regulation to legal actions imposed on our profession by third parties.
The choice is ours and the reported case in question could have been addressed and resolved before hitting the headlines of a local news paper.
Lets remember that each of us or our family members are healthcare consumers too and may have been or will be harmed by actions or inactions of a fellow doctor who does not abide to the same health care standards that we do. Would we keep our mouth shut? I don't think so. Therefore we should learn from this tragic case in question and draw our own conclusions on how to act in the future.
Yours
Bernd
Posted on Fri, Mar. 21, 2008
Troubled doctor puts patients at risk
It is hard to understand why Miami doctor Alex Zakharia, after facing a string of legal and professional setbacks, still has approval from the state of Florida to practice medicine. Dr. Zakharia, 70, has admitted to suffering memory problems and possible strokes. He has pleaded guilty to lying about his credentials as a heart surgeon and was suspended by a Miami hospital after several of his patients died.
Yet the state Board of Medicine says Dr. Zakharia's license is still good and lists his status as ''clear/active'' on its website.
Dr. Zakharia's travails have been chronicled in news stories for more than a year, and the Board is expected to issue a final order on his status next month. Still, the Board's handling of the case raises the question of whose interest takes precedence, a troubled doctor's or the well-being of unsuspecting healthcare consumers.
When asked about Dr. Zakharia's well-documented troubles, Department of Health spokeswoman Eulinda Jackson told Miami Herald reporter John Dorschner that the Board must follow due process. ''That's the way it works, and for good reason,'' she said.
True, the Board should move with care and caution before taking away a doctor's primary means of support. However, the Board also must consider the risk to consumers, whose health and very existence could be at stake. If there is doubt, deference should be made to safeguarding the life and limb of patients.
In this case, the Board had every reason to be aware of Zakharia's troubles, including his legal problems, and could have issued an emergency suspension. A nurse who worked with the doctor said she complained and sent copies of Miami Herald stories about the doctor's problem to the Board.
Regulating doctors
Florida voters wanted to make sure patients' rights are protected when they passed a constitutional amendment in 2004 that allows disclosure to patients about ''adverse medical events'' in hospitals. The amendment had been tied up in court since passage, but the Florida Supreme Court recently settled matters by affirming that patients have a right to know about mistakes made by doctors and hospitals.
The Board's mission is to protect consumers by licensing and regulating doctors and other healthcare providers. This means putting consumers first, not doctors.
.....The Board's mission is to protect consumers by licensing and regulating doctors and other healthcare providers. This means putting consumers first, not doctors.
Dear Friend and Colleagues:
Attached a Miami Herald editorial regarding a Miami doctor whose legal trouble received wide exposure in the local media.
I personally know the doctor and deeply regret his professional trouble and struggle. I am also a volunteer expert witness for the Florida Department of Health, have attended Board meetings and have no doubt that each and every Board member diligently considers the merits of each and every case that is being presented for review.
The Boards mission is to " protect health care consumers by licensing qualified health providers ..[and] .. establishing and enforcing health care standards.."
Doing so the Board often has to navigate the narrow course between Scylla (the physicians right to privacy and guarantee of due process ) and Charybdis ( the consumers protection).
In this process the Board is often accused to be either too hard or too soft on doctors. I can empathize with Board members who feel that that they are damned if they do, damned if they don't.
We need to support the efforts of the Board by being proactive in regulating OURSELVES and not to ignore or tolerate the wrongdoing of a FEW doctors. We should not shy away from either talking to those doctors or utilizing the established channels of notifying the Board of any behavior that violate the high health standards in our community.
I would prefer proactive self-regulation to legal actions imposed on our profession by third parties.
The choice is ours and the reported case in question could have been addressed and resolved before hitting the headlines of a local news paper.
Lets remember that each of us or our family members are healthcare consumers too and may have been or will be harmed by actions or inactions of a fellow doctor who does not abide to the same health care standards that we do. Would we keep our mouth shut? I don't think so. Therefore we should learn from this tragic case in question and draw our own conclusions on how to act in the future.
Yours
Bernd
Posted on Fri, Mar. 21, 2008
Troubled doctor puts patients at risk
It is hard to understand why Miami doctor Alex Zakharia, after facing a string of legal and professional setbacks, still has approval from the state of Florida to practice medicine. Dr. Zakharia, 70, has admitted to suffering memory problems and possible strokes. He has pleaded guilty to lying about his credentials as a heart surgeon and was suspended by a Miami hospital after several of his patients died.
Yet the state Board of Medicine says Dr. Zakharia's license is still good and lists his status as ''clear/active'' on its website.
Dr. Zakharia's travails have been chronicled in news stories for more than a year, and the Board is expected to issue a final order on his status next month. Still, the Board's handling of the case raises the question of whose interest takes precedence, a troubled doctor's or the well-being of unsuspecting healthcare consumers.
When asked about Dr. Zakharia's well-documented troubles, Department of Health spokeswoman Eulinda Jackson told Miami Herald reporter John Dorschner that the Board must follow due process. ''That's the way it works, and for good reason,'' she said.
True, the Board should move with care and caution before taking away a doctor's primary means of support. However, the Board also must consider the risk to consumers, whose health and very existence could be at stake. If there is doubt, deference should be made to safeguarding the life and limb of patients.
In this case, the Board had every reason to be aware of Zakharia's troubles, including his legal problems, and could have issued an emergency suspension. A nurse who worked with the doctor said she complained and sent copies of Miami Herald stories about the doctor's problem to the Board.
Regulating doctors
Florida voters wanted to make sure patients' rights are protected when they passed a constitutional amendment in 2004 that allows disclosure to patients about ''adverse medical events'' in hospitals. The amendment had been tied up in court since passage, but the Florida Supreme Court recently settled matters by affirming that patients have a right to know about mistakes made by doctors and hospitals.
The Board's mission is to protect consumers by licensing and regulating doctors and other healthcare providers. This means putting consumers first, not doctors.
Thursday, March 20, 2008
Florida Plans To Restrict Access For IMGs from Cuba
Dear Friends and Colleagues;
Again, Florida is leading the field in "innovative thinking" regarding International Medical Graduates (IMGs) .
This time a lawmaker introduced a bill that wouldn't allow Americans who get their medical degree in Cuba to practice medicine in Florida The bill is aimed at students who accept scholarships from the Cuban government to attend the Latin American School of Medical Sciences in Havana. About 150 American students are currently enrolled in the school and would be affected, according to information provided to the committee by the bill sponsor, Rep. Eddy Gonzalez, R-Hialeah.
Obviously, this bill is based purely on ideological grounds and should be rejected. What's next? Physicians who study abroad at "Muslim schools" or obtained a medical degree from those countries belonging to the "axis of evil."
I call upon the AAFP and AMA to oppose such an action.
Yours
Bernd
Chair, Florida Medical Association IMG Section & Past Chair of the AMA IMG Governing Council
Posted on Tue, Mar. 18, 2008
Bill would make Cuban medical degree worthless
ASSOCIATED PRESS
Americans who get their medical degree in Cuba wouldn't be allowed to practice medicine in Florida under a bill discussed by the House Health Quality Committee.
The panel didn't vote on the bill (HB 685) but could as early as next week.
The measure is aimed at students who accept scholarships from the Cuban government to attend the Latin American School of Medical Sciences in Havana. About 150 American students are currently enrolled in the school and would be affected, according to information provided to the committee by the bill sponsor, Rep. Eddy Gonzalez, R-Hialeah.
According to the information provided by Gonzalez, eight American students have graduated from the school and are currently practicing in the United States, but none are working in Florida. Since no graduates of the program have Florida medical licenses, the bill would only affect those graduates who try to become licensed here in the future.
The scholarship program, coordinated by an organization called the Interreligious Foundation for Community Organization, takes advantage of an exception in the U.S. embargo of Cuba for educational programs. The scholarships are open to Americans who go to Cuba for a 6-year medical school program and then agree to return to the United States to practice medicine in poor or underserved communities in the United States.
If the measure were to pass, Florida would be the first U.S. state to bar graduates of the program from practicing medicine here.
Again, Florida is leading the field in "innovative thinking" regarding International Medical Graduates (IMGs) .
This time a lawmaker introduced a bill that wouldn't allow Americans who get their medical degree in Cuba to practice medicine in Florida The bill is aimed at students who accept scholarships from the Cuban government to attend the Latin American School of Medical Sciences in Havana. About 150 American students are currently enrolled in the school and would be affected, according to information provided to the committee by the bill sponsor, Rep. Eddy Gonzalez, R-Hialeah.
Obviously, this bill is based purely on ideological grounds and should be rejected. What's next? Physicians who study abroad at "Muslim schools" or obtained a medical degree from those countries belonging to the "axis of evil."
I call upon the AAFP and AMA to oppose such an action.
Yours
Bernd
Chair, Florida Medical Association IMG Section & Past Chair of the AMA IMG Governing Council
Posted on Tue, Mar. 18, 2008
Bill would make Cuban medical degree worthless
ASSOCIATED PRESS
Americans who get their medical degree in Cuba wouldn't be allowed to practice medicine in Florida under a bill discussed by the House Health Quality Committee.
The panel didn't vote on the bill (HB 685) but could as early as next week.
The measure is aimed at students who accept scholarships from the Cuban government to attend the Latin American School of Medical Sciences in Havana. About 150 American students are currently enrolled in the school and would be affected, according to information provided to the committee by the bill sponsor, Rep. Eddy Gonzalez, R-Hialeah.
According to the information provided by Gonzalez, eight American students have graduated from the school and are currently practicing in the United States, but none are working in Florida. Since no graduates of the program have Florida medical licenses, the bill would only affect those graduates who try to become licensed here in the future.
The scholarship program, coordinated by an organization called the Interreligious Foundation for Community Organization, takes advantage of an exception in the U.S. embargo of Cuba for educational programs. The scholarships are open to Americans who go to Cuba for a 6-year medical school program and then agree to return to the United States to practice medicine in poor or underserved communities in the United States.
If the measure were to pass, Florida would be the first U.S. state to bar graduates of the program from practicing medicine here.
Medical Students Vote With Their Feet
"Although there are far fewer positions in dermatology (320 residencies in 2007) than in internal medicine (5,517) and family medicine (2,603), the field is attracting some of the best and brightest future doctors. Seniors accepted in 2007 as residents in dermatology and two other appearance-related fields — plastic surgery and otolaryngology (ear, nose and throat doctors, some of whom perform facial cosmetic surgery) — had the highest median medical-board scores and the highest percentage of members in the medical honor society among 18 specialties, the report said."
Dear Friends and Colleagues:
Attached an article from todays New York Times reporting about the preference of US medical students to seek out postgraduate training positions in lucrative specialties such as dermatology, ENT and plastic surgery.
I am not opposed to medical students choosing training positions in such specialties. What concerns me that the brightest minds seem to avoid primary care residency training positions which present complex challenges ( example: chronic disease management) that require input of the best and brightest in our profession.
Can we blame them to choose otherwise?According to the NEJM the prevalence of chronic conditions — most of which are handled in primary care settings — is increasing, as are requirements for their proper management. Not only has the number of primary care tasks grown exponentially, but physician performance is being measured and physicians are even being paid according to their ability to perform these tasks reliably and consistently. It has been estimated that it would take 10.6 hours per working day to deliver all recommended care for patients with chronic conditions, plus 7.4 hours per day to provide evidence-based preventive care, to an average panel of 2500 patients (the mean U.S. panel size is 2300)! A seemingly unsurmountable task that requires complex information management systems and the sophisticated staff to implement them. Such primary care experts should be reimbursement properly but they are not!
Our reimbursement system is tilted towards non-primary care specialties.Thirty minutes spent performing a diagnostic, surgical, or imaging procedure often pays three times as much as a 30-minute visit with a patient with diabetes, heart failure, headache, and depression. The median income of specialists in 2004 was almost twice that of primary care physicians, a gap that is widening. In 2004 all visits to primary care physicians (FP,IM, Peds) accounted for almost half of the overall total of 967.3 million office visits but only 30 percent of the $152 billion spent on office-based care. The remaining 70 percent was spent on specialty care. This misalignment of reimbursement causes a shortage in primary care physicians and subsequently creating a population of medically disenfranchised individuals who lack access to medical homes. Fair reimbursement is the first step towards stopping the bleeding of primary care health care services.
Bernd
PS: Happy Purim holiday.
==============================================================================================================
New York Times - March 19, 2008
The Price of Beauty
For Top Medical Students, an Attractive Field
By NATASHA SINGER
BOSTON — March Madness has a different meaning for Thomas Hocker and Meena Singh, a married couple in their final year at the Harvard Medical School, who are waiting to learn Thursday if they have been accepted into their residency programs of choice.
Already saddled with about $330,000 in education loans, they borrowed $20,000 more so they could fly around the country this winter for about two dozen residency interviews each. All told, each applied to 90 such training programs.
Ms. Singh, pregnant during interview season, gave birth to their second daughter in early January. Three days later, she flew to Miami for an interview.
The search has been difficult not because they are mediocre students; indeed, each has a brand-name education, academic honors and published research on disease. No, it has been hard because they aspire to be dermatologists.
As thousands of medical students await word this week on residency programs, two specialties concerned with physical appearance — dermatology and plastic surgery — are among the most competitive.
Only 61 percent of seniors at American medical schools whose first choice was dermatology received a residency in that field last year, compared with 98 percent for those whose first choice was internal medicine and 99 percent for those seeking family medicine, according to a report by the Association of American Medical Colleges and the National Resident Matching Program, which pairs candidates and programs. Although there are far fewer positions in dermatology (320 residencies in 2007) than in internal medicine (5,517) and family medicine (2,603), the field is attracting some of the best and brightest future doctors.
Seniors accepted in 2007 as residents in dermatology and two other appearance-related fields — plastic surgery and otolaryngology (ear, nose and throat doctors, some of whom perform facial cosmetic surgery) — had the highest median medical-board scores and the highest percentage of members in the medical honor society among 18 specialties, the report said.
The vogue for such specialties is part of a migration of a top tier of American medical students from branches of health care that manage major diseases toward specialties that improve the life of patients — and the lives of physicians, with better pay, more autonomy and more-controllable hours.
“It is an unfortunate circumstance that you can spend an hour with a patient treating them for diabetes and hypertension and make $100, or you can do Botox and make $2,000 in the same time,” said Dr. Eric C. Parlette, 35, a dermatologist in Chestnut Hill, Mass., who chose his field because he wanted to perform procedures, like skin-cancer surgery and cosmetic treatments, while keeping regular hours and earning a rewarding salary.
Medical school professors and administrators say such discrepancies are dissuading some top students at American medical schools from entering fields, like family medicine, that manage the most prevalent serious illnesses. They are being replaced in part by graduates of foreign medical schools, some of whom return to their home countries to practice.
“We have a shortage in America of primary-care or family-type doctors,” said Dr. Joel M. Felner, a cardiology professor who is the associate dean for clinical education at Emory University School of Medicine in Atlanta. Last year, the school enlarged its incoming class, hoping more students would specialize in the major diseases and preventative care, he said. “We do need dermatologists, but I am more worried about the really sick people and dermatologists aren’t taking care of them,” Dr. Felner said.
Until recently, saving skin did not have the cachet of saving lives. Doctors in other fields jokingly dismissed dermatology as a province of red-spot diseases that could not really be cured, but weren’t going to kill patients. Twenty-five years ago, the fiercest competition among medical students was for internal medicine and general surgery.
But dermatology’s status is rising, not just for the pay, hours and independence, but also because of the growing variety of treatments and devices in this fast-developing field that can help people in a looks-obsessed world. At a time of increased discussion of enhancing beauty, as well as narrowing standards for skin perfection, the public has a newfound esteem for doctors who treat appearance.
“People greatly value the skin because it is what is on the outside that is the face you present to the world,” Mr. Hocker said one evening last month after coming off a hospital shift in which he dealt with afflictions like heart failure and kidney failure. “Most dermatological diseases won’t kill you, but they can greatly affect your quality of life.”
Some dermatology professors said the growing allure of their field among medical students has raised the bar for applicants over the last decade. “Dermatology has always attracted bright students,” said Dr. Harley A. Haynes, a dermatology professor at the Harvard Medical School who has been mentoring medical students there since 1970. “But now we are getting more of the brightest and the best.”
Dr. Haynes likes to joke that even faculty members might not be accepted for a residency if they applied today.
A Psychological Lifeline
For an idea of the competition facing dermatology aspirants, consider the application numbers. Last fall, 383 people applied for 6 places — an average of about 64 applicants per spot — in Harvard’s dermatology program. By comparison, Harvard College received an average of 11 applications per offer of admission in the class of 2010.
Mr. Hocker and Ms. Singh were well prepared for the Darwinian process of landing a dermatology residency when they met as classmates at the Harvard Medical School in 2003. Mr. Hocker, 27, holds a graduate degree from Cambridge University and an undergraduate degree in chemistry from Yale, where he was a champion hurdler. Ms. Singh, 26, was in several honor societies as a biomedical engineering student at the University of Southern California.
During her senior year, she competed on an MTV reality show called “Sorority Life,” but was ejected midseason for being too studious.
“In one scene, you see her all happy getting the acceptance letter from Harvard and in the next scene, you see her crying up a storm because she has been de-pledged from the sorority,” Mr. Hocker recalled fondly.
Neither student had planned to become a skin specialist.
Growing up in Kansas City, Kan., Ms. Singh loved visiting the hospital with her mother, an internist with long relationships with a diverse group of patients. Ms. Singh said she initially planned to emulate her mother, a physician who focuses on treating major adult diseases.
A lecture on skin-pigment conditions like vitiligo changed her mind.
“Nobody can see if you have hypertension or asthma, but everybody knows if you have a pigmentary disorder and these changes are a lot more obvious and devastating to patients with skin of color,” Ms. Singh said. “Having something on your skin is not life or death for people, but it can be equally important for them emotionally as a life-threatening disease.”
Indeed, dermatology can be a psychological lifeline for people with severe skin problems. At pools or the beach, some people shun those with psoriasis who have scaly skin, fearing the condition is contagious, doctors said. People with deep acne scars say it affects their personal and professional lives.
Then there is the growing popularity among otherwise healthy people of tweaking one’s appearance with cosmetic treatments, from Botox injections to lip plumping and laser hair removal. Plastic surgeons, dermatologists and facial surgeons in the United States performed about 9.6 million such nonsurgical treatments in 2007, almost nine times the number a decade earlier, according to the American Society for Aesthetic Plastic Surgery.
‘Your Input Is Valued’
Mr. Hocker was finally sold on dermatology last year, while on a clinical rotation during which neurosurgeons called him and a dermatology resident to an intensive-care ward for a consultation. A patient, in a coma after surgery, was covered with mysterious red half-moon-shaped blisters. They could not determine the cause. Then Dr. Haynes of Harvard arrived.
“Dr. Haynes comes in and he is like a walking CAT scan, who eyeballs her from head to toe and has the diagnosis in 15 seconds,” Mr. Hocker said. The verdict: a rare blistering disorder caused by an allergy to an antibiotic.
Mr. Hocker said he liked the idea of drawing independent conclusions without tests or consultations with other doctors.
“The No. 1 thing that is going to save your life is the humdrum preventative stuff like blood pressure and cholesterol,” Mr. Hocker said. “But there is not a lot of respect for doctors who do that because anyone can get into it. But if you are an expert where no one else is, like the eye or the skin, your input is valued.”
Dermatology also attracts students like Mr. Hocker because of the potential for basic research on skin diseases that can lead to new treatments. Mr. Hocker said he plans to focus his career on researching the role of genetics in problems like skin cancer and abnormal scarring; he took a year off during medical school to conduct melanoma research.
While students like Mr. Hocker choose dermatology planning on research careers, others end up focusing on cosmetic treatments like skin tightening and resurfacing. Half of the dermatology residents graduating over the last five years from the program at the Boston Medical Center have chosen postgraduate fellowships that teach a combination of skin-cancer operations and cosmetic procedures, according to Dr. Barbara A. Gilchrest, the chairwoman of dermatology at Boston University School of Medicine.
Work Less, Earn More
Dermatologists say they enjoy the variety of a specialty that encompasses serious illnesses like skin cancer and psoriasis as well as conditions like uncombable hair syndrome.
But students interested in such work also often factor in personal benefits. Internists, for example, worked an average of 50 hours a week in 2006 while dermatologists worked about 40 hours, according to an annual survey by Medical Economics magazine. Dermatology also offers more independence from the bureaucracy of managed care, because patients pay up front for cosmetic procedures not covered by health insurance.
And while an internist earns an average of $191,525, a dermatologist earns an average of $390,274, according to an annual survey conducted by the Medical Group Management Association, whose membership includes more than 21,000 managers of medical practices. Dermatologists who specialize in cosmetic treatments or in skin-cancer operations can earn much more.
For thousands of medical students nationwide, especially those trying to enter the most competitive fields, this week — when residency acceptances are announced — has been fraught with tension. The National Resident Matching Program uses an algorithm to pair applicants with the one program they have ranked highest that also preferred them, a system that leaves some applicants disappointed.
Mr. Hocker and Ms. Singh face even longer odds because they entered the match process as a couple, seeking positions at the same program, or at least in the same region.
On Monday, when applicants learned whether they had been paired with a program at all, Mr. Hocker and Ms. Singh found out they will each obtain a residency. Thursday, they find out where.
“My friends going into general medicine and general surgery pretty much have an idea that they are going to be at their No. 1 or No. 2 school,” Ms. Singh said. “But we really could be anywhere in the country, together or not together.”
She added: “We would have a better chance of winning ‘American Idol.’ ”
Dear Friends and Colleagues:
Attached an article from todays New York Times reporting about the preference of US medical students to seek out postgraduate training positions in lucrative specialties such as dermatology, ENT and plastic surgery.
I am not opposed to medical students choosing training positions in such specialties. What concerns me that the brightest minds seem to avoid primary care residency training positions which present complex challenges ( example: chronic disease management) that require input of the best and brightest in our profession.
Can we blame them to choose otherwise?According to the NEJM the prevalence of chronic conditions — most of which are handled in primary care settings — is increasing, as are requirements for their proper management. Not only has the number of primary care tasks grown exponentially, but physician performance is being measured and physicians are even being paid according to their ability to perform these tasks reliably and consistently. It has been estimated that it would take 10.6 hours per working day to deliver all recommended care for patients with chronic conditions, plus 7.4 hours per day to provide evidence-based preventive care, to an average panel of 2500 patients (the mean U.S. panel size is 2300)! A seemingly unsurmountable task that requires complex information management systems and the sophisticated staff to implement them. Such primary care experts should be reimbursement properly but they are not!
Our reimbursement system is tilted towards non-primary care specialties.Thirty minutes spent performing a diagnostic, surgical, or imaging procedure often pays three times as much as a 30-minute visit with a patient with diabetes, heart failure, headache, and depression. The median income of specialists in 2004 was almost twice that of primary care physicians, a gap that is widening. In 2004 all visits to primary care physicians (FP,IM, Peds) accounted for almost half of the overall total of 967.3 million office visits but only 30 percent of the $152 billion spent on office-based care. The remaining 70 percent was spent on specialty care. This misalignment of reimbursement causes a shortage in primary care physicians and subsequently creating a population of medically disenfranchised individuals who lack access to medical homes. Fair reimbursement is the first step towards stopping the bleeding of primary care health care services.
Bernd
PS: Happy Purim holiday.
==============================================================================================================
New York Times - March 19, 2008
The Price of Beauty
For Top Medical Students, an Attractive Field
By NATASHA SINGER
BOSTON — March Madness has a different meaning for Thomas Hocker and Meena Singh, a married couple in their final year at the Harvard Medical School, who are waiting to learn Thursday if they have been accepted into their residency programs of choice.
Already saddled with about $330,000 in education loans, they borrowed $20,000 more so they could fly around the country this winter for about two dozen residency interviews each. All told, each applied to 90 such training programs.
Ms. Singh, pregnant during interview season, gave birth to their second daughter in early January. Three days later, she flew to Miami for an interview.
The search has been difficult not because they are mediocre students; indeed, each has a brand-name education, academic honors and published research on disease. No, it has been hard because they aspire to be dermatologists.
As thousands of medical students await word this week on residency programs, two specialties concerned with physical appearance — dermatology and plastic surgery — are among the most competitive.
Only 61 percent of seniors at American medical schools whose first choice was dermatology received a residency in that field last year, compared with 98 percent for those whose first choice was internal medicine and 99 percent for those seeking family medicine, according to a report by the Association of American Medical Colleges and the National Resident Matching Program, which pairs candidates and programs. Although there are far fewer positions in dermatology (320 residencies in 2007) than in internal medicine (5,517) and family medicine (2,603), the field is attracting some of the best and brightest future doctors.
Seniors accepted in 2007 as residents in dermatology and two other appearance-related fields — plastic surgery and otolaryngology (ear, nose and throat doctors, some of whom perform facial cosmetic surgery) — had the highest median medical-board scores and the highest percentage of members in the medical honor society among 18 specialties, the report said.
The vogue for such specialties is part of a migration of a top tier of American medical students from branches of health care that manage major diseases toward specialties that improve the life of patients — and the lives of physicians, with better pay, more autonomy and more-controllable hours.
“It is an unfortunate circumstance that you can spend an hour with a patient treating them for diabetes and hypertension and make $100, or you can do Botox and make $2,000 in the same time,” said Dr. Eric C. Parlette, 35, a dermatologist in Chestnut Hill, Mass., who chose his field because he wanted to perform procedures, like skin-cancer surgery and cosmetic treatments, while keeping regular hours and earning a rewarding salary.
Medical school professors and administrators say such discrepancies are dissuading some top students at American medical schools from entering fields, like family medicine, that manage the most prevalent serious illnesses. They are being replaced in part by graduates of foreign medical schools, some of whom return to their home countries to practice.
“We have a shortage in America of primary-care or family-type doctors,” said Dr. Joel M. Felner, a cardiology professor who is the associate dean for clinical education at Emory University School of Medicine in Atlanta. Last year, the school enlarged its incoming class, hoping more students would specialize in the major diseases and preventative care, he said. “We do need dermatologists, but I am more worried about the really sick people and dermatologists aren’t taking care of them,” Dr. Felner said.
Until recently, saving skin did not have the cachet of saving lives. Doctors in other fields jokingly dismissed dermatology as a province of red-spot diseases that could not really be cured, but weren’t going to kill patients. Twenty-five years ago, the fiercest competition among medical students was for internal medicine and general surgery.
But dermatology’s status is rising, not just for the pay, hours and independence, but also because of the growing variety of treatments and devices in this fast-developing field that can help people in a looks-obsessed world. At a time of increased discussion of enhancing beauty, as well as narrowing standards for skin perfection, the public has a newfound esteem for doctors who treat appearance.
“People greatly value the skin because it is what is on the outside that is the face you present to the world,” Mr. Hocker said one evening last month after coming off a hospital shift in which he dealt with afflictions like heart failure and kidney failure. “Most dermatological diseases won’t kill you, but they can greatly affect your quality of life.”
Some dermatology professors said the growing allure of their field among medical students has raised the bar for applicants over the last decade. “Dermatology has always attracted bright students,” said Dr. Harley A. Haynes, a dermatology professor at the Harvard Medical School who has been mentoring medical students there since 1970. “But now we are getting more of the brightest and the best.”
Dr. Haynes likes to joke that even faculty members might not be accepted for a residency if they applied today.
A Psychological Lifeline
For an idea of the competition facing dermatology aspirants, consider the application numbers. Last fall, 383 people applied for 6 places — an average of about 64 applicants per spot — in Harvard’s dermatology program. By comparison, Harvard College received an average of 11 applications per offer of admission in the class of 2010.
Mr. Hocker and Ms. Singh were well prepared for the Darwinian process of landing a dermatology residency when they met as classmates at the Harvard Medical School in 2003. Mr. Hocker, 27, holds a graduate degree from Cambridge University and an undergraduate degree in chemistry from Yale, where he was a champion hurdler. Ms. Singh, 26, was in several honor societies as a biomedical engineering student at the University of Southern California.
During her senior year, she competed on an MTV reality show called “Sorority Life,” but was ejected midseason for being too studious.
“In one scene, you see her all happy getting the acceptance letter from Harvard and in the next scene, you see her crying up a storm because she has been de-pledged from the sorority,” Mr. Hocker recalled fondly.
Neither student had planned to become a skin specialist.
Growing up in Kansas City, Kan., Ms. Singh loved visiting the hospital with her mother, an internist with long relationships with a diverse group of patients. Ms. Singh said she initially planned to emulate her mother, a physician who focuses on treating major adult diseases.
A lecture on skin-pigment conditions like vitiligo changed her mind.
“Nobody can see if you have hypertension or asthma, but everybody knows if you have a pigmentary disorder and these changes are a lot more obvious and devastating to patients with skin of color,” Ms. Singh said. “Having something on your skin is not life or death for people, but it can be equally important for them emotionally as a life-threatening disease.”
Indeed, dermatology can be a psychological lifeline for people with severe skin problems. At pools or the beach, some people shun those with psoriasis who have scaly skin, fearing the condition is contagious, doctors said. People with deep acne scars say it affects their personal and professional lives.
Then there is the growing popularity among otherwise healthy people of tweaking one’s appearance with cosmetic treatments, from Botox injections to lip plumping and laser hair removal. Plastic surgeons, dermatologists and facial surgeons in the United States performed about 9.6 million such nonsurgical treatments in 2007, almost nine times the number a decade earlier, according to the American Society for Aesthetic Plastic Surgery.
‘Your Input Is Valued’
Mr. Hocker was finally sold on dermatology last year, while on a clinical rotation during which neurosurgeons called him and a dermatology resident to an intensive-care ward for a consultation. A patient, in a coma after surgery, was covered with mysterious red half-moon-shaped blisters. They could not determine the cause. Then Dr. Haynes of Harvard arrived.
“Dr. Haynes comes in and he is like a walking CAT scan, who eyeballs her from head to toe and has the diagnosis in 15 seconds,” Mr. Hocker said. The verdict: a rare blistering disorder caused by an allergy to an antibiotic.
Mr. Hocker said he liked the idea of drawing independent conclusions without tests or consultations with other doctors.
“The No. 1 thing that is going to save your life is the humdrum preventative stuff like blood pressure and cholesterol,” Mr. Hocker said. “But there is not a lot of respect for doctors who do that because anyone can get into it. But if you are an expert where no one else is, like the eye or the skin, your input is valued.”
Dermatology also attracts students like Mr. Hocker because of the potential for basic research on skin diseases that can lead to new treatments. Mr. Hocker said he plans to focus his career on researching the role of genetics in problems like skin cancer and abnormal scarring; he took a year off during medical school to conduct melanoma research.
While students like Mr. Hocker choose dermatology planning on research careers, others end up focusing on cosmetic treatments like skin tightening and resurfacing. Half of the dermatology residents graduating over the last five years from the program at the Boston Medical Center have chosen postgraduate fellowships that teach a combination of skin-cancer operations and cosmetic procedures, according to Dr. Barbara A. Gilchrest, the chairwoman of dermatology at Boston University School of Medicine.
Work Less, Earn More
Dermatologists say they enjoy the variety of a specialty that encompasses serious illnesses like skin cancer and psoriasis as well as conditions like uncombable hair syndrome.
But students interested in such work also often factor in personal benefits. Internists, for example, worked an average of 50 hours a week in 2006 while dermatologists worked about 40 hours, according to an annual survey by Medical Economics magazine. Dermatology also offers more independence from the bureaucracy of managed care, because patients pay up front for cosmetic procedures not covered by health insurance.
And while an internist earns an average of $191,525, a dermatologist earns an average of $390,274, according to an annual survey conducted by the Medical Group Management Association, whose membership includes more than 21,000 managers of medical practices. Dermatologists who specialize in cosmetic treatments or in skin-cancer operations can earn much more.
For thousands of medical students nationwide, especially those trying to enter the most competitive fields, this week — when residency acceptances are announced — has been fraught with tension. The National Resident Matching Program uses an algorithm to pair applicants with the one program they have ranked highest that also preferred them, a system that leaves some applicants disappointed.
Mr. Hocker and Ms. Singh face even longer odds because they entered the match process as a couple, seeking positions at the same program, or at least in the same region.
On Monday, when applicants learned whether they had been paired with a program at all, Mr. Hocker and Ms. Singh found out they will each obtain a residency. Thursday, they find out where.
“My friends going into general medicine and general surgery pretty much have an idea that they are going to be at their No. 1 or No. 2 school,” Ms. Singh said. “But we really could be anywhere in the country, together or not together.”
She added: “We would have a better chance of winning ‘American Idol.’ ”
Friday, February 15, 2008
Health Care Reform: A Different Perspective
"Despite our crisis of escalating costs, dwindling insurance coverage, and deteriorating conditions of medical practice, true national health insurance that would not rely on private insurers remains at the fringes of the national debate. This reality reflects the immense power of the insurance and pharmaceutical industries, the political fragmentation and ambivalence of the medical profession, the intimidation of politicians, and the erroneous media images of dissatisfied patients in universal systems.Sometimes, we Americans do the right thing only after having exhausted all other alternatives. It remains to be seen how much exhaustion the health care system will suffer before we turn to national health insurance."
Dear Friends and Colleagues:
An article published in the February 7th issue of the New England Journal of Medicine http://content.nejm.org/cgi/content/full/358/6/549 , the author summarizes the problems associated with our health care system as follows:
The Problem:
"U.S. health care expenditures rose 6.7% in 2006, the government recently reported. According to the Centers for Medicare and Medicaid Services, total health care expenditures exceeded $2.1 trillion, or more than $7,000 for every American man, woman, and child.1 Medicare costs jumped a record 18.7%, driven by the new privatized drug benefit. Total health care spending, now amounting to 16% of the gross domestic product, is projected to reach 20% in just 7 years."
Common reasons attributed to the relentless medical inflation
* the aging population, the proliferation of new technologies,
* poor diet and lack of exercise,
* the tendency of supply (physicians, hospitals, tests, pharmaceuticals, medical devices, and novel treatments) to generate its own demand,
* excessive litigation and defensive medicine
* tax-favored insurance coverage.
The author offers a different opinion, or second opinion:
"The extreme failure of the United States to contain medical costs results primarily from our unique, pervasive commercialization. The dominance of for-profit insurance and pharmaceutical companies, a new wave of investor-owned specialty hospitals, and profit-maximizing behavior even by nonprofit players raise costs and distort resource allocation. Profits, billing, marketing, and the gratuitous costs of private bureaucracies siphon off $400 billion to $500 billion of the $2.1 trillion spent, but the more serious and less appreciated syndrome is the set of perverse incentives produced by commercial dominance of the system."
He asks the question why markets do not optimize efficiency and offer the following explanation:
"The private insurance system's main techniques for holding down costs are practicing risk selection, limiting the services covered, constraining payments to providers, and shifting costs to patients. But given the system's fragmentation and perverse incentives, much cost-effective care is squeezed out, resources are increasingly allocated in response to profit opportunities rather than medical need, many attainable efficiencies are not achieved, unnecessary medical care is provided for profit, administrative expenses are high, and enormous sums are squandered in efforts to game the system. The result is a blend of overtreatment and undertreatment — and escalating costs. Researchers calculate that between one fifth and one third of medical outlays do nothing to improve health."
Furthermore he claims that:
"Great health improvements can be achieved through basic public health measures and a population-based approach to wellness and medical care. But entrepreneurs do not prosper by providing these services, and those who need them most are the least likely to have insurance. Innumerable studies have shown that consistent application of standard protocols for conditions such as diabetes, asthma, and elevated cholesterol levels, use of clinically proven screenings such as annual mammograms, provision of childhood immunizations, and changes to diet and exercise can improve health and prevent larger outlays later on. Comprehensive, government-organized, universal health insurance systems are far better equipped to realize these efficiencies because everyone is covered and there are no incentives to pursue the most profitable treatments rather than those dictated by medical need. Although the populations of most countries that belong to the Organization for Economic Cooperation and Development are older than the U.S. population, these countries have been far more successful at containing costs without compromising care."
He points out several cost-containment tactics applied by insurance companies to maximize their profits:
" A popular strategy among cost-containment consultants relies on the psychology of income targeting. The idea is that physicians have a mental picture of expected earnings — an income target. If the insurance plan squeezes their income by reducing payments per visit, doctors compensate by increasing their caseload and spending less time with each patient.
This false economy is a telling example of the myopia of commercialized managed care. It may save the plan money in the short run, but as any practicing physician can testify, the strategy has multiple self-defeating effects. A doctor's most precious commodity is time — adequate time to review a chart, take a history, truly listen to a patient. You can't do all that in 10 minutes. Harried primary care doctors are more likely to miss cues, make mistakes, and — ironically enough — order more tests to compensate for lack of hands-on assessment. They are also more likely to make more referrals to specialists for procedures they could perform more cost-effectively themselves, given adequate time and compensation. And the gap between generalist and specialist pay is widening."
"A second cost-containment tactic is to hike deductibles and copayments, whose frank purpose is to dissuade people from going to the doctor. But sometimes seeing the doctor is medically indicated, and waiting until conditions are dire costs the system far more money than it saves. Moreover, at some point during each year, more than 80 million Americans go without coverage, which makes them even less likely to seek preventive care."
"..the system also has inflationary effects on hospitals' revenue-maximization strategies. Large hospitals, which still have substantial bargaining power with insurers, necessarily cross-subsidize services. The emergency department may lose money, but cardiology makes a bundle. So hospitals fiercely defend their profit centers, investing heavily in facilities for lucrative procedures that will attract physicians and patients. For the system as a whole, it would be far more cost-effective to shift resources from subspecialists to primary care. But in an uncoordinated, commercialized system, specialists might take their business elsewhere, so they have the leverage to maintain their incomes and privileges — and thereby distort cost-effective resource allocation."
He concludes the article calling for the creation of a universal system of comprehensive national health care because:
"A comprehensive national system is far better positioned to match resources with needs — and not through the so-called rationing of care. (It is the U.S. system that has the most de facto rationing — high rates of uninsurance, exclusions for preexisting conditions, excessive deductibles and copayments, and shorter hospital stays and physician visits.) A universal system suffers far less of the feast-or-famine misallocation of resources driven by profit maximization. It also saves huge sums that our system wastes on administration, billing, marketing, profit, executive compensation, and risk selection. When the British National Health Service faced a shortage of primary care doctors, it adjusted pay schedules and added incentives for high-quality care, and the shortage diminished. Our commercialized system seems incapable of producing that result.
Despite our crisis of escalating costs, dwindling insurance coverage, and deteriorating conditions of medical practice, true national health insurance that would not rely on private insurers remains at the fringes of the national debate. This reality reflects the immense power of the insurance and pharmaceutical industries, the political fragmentation and ambivalence of the medical profession, the intimidation of politicians, and the erroneous media images of dissatisfied patients in universal systems.
Sometimes, we Americans do the right thing only after having exhausted all other alternatives. It remains to be seen how much exhaustion the health care system will suffer before we turn to national health insurance."
Yours
Bernd Wollschlaeger,MD,FAAFP
Dear Friends and Colleagues:
An article published in the February 7th issue of the New England Journal of Medicine http://content.nejm.org/cgi/content/full/358/6/549 , the author summarizes the problems associated with our health care system as follows:
The Problem:
"U.S. health care expenditures rose 6.7% in 2006, the government recently reported. According to the Centers for Medicare and Medicaid Services, total health care expenditures exceeded $2.1 trillion, or more than $7,000 for every American man, woman, and child.1 Medicare costs jumped a record 18.7%, driven by the new privatized drug benefit. Total health care spending, now amounting to 16% of the gross domestic product, is projected to reach 20% in just 7 years."
Common reasons attributed to the relentless medical inflation
* the aging population, the proliferation of new technologies,
* poor diet and lack of exercise,
* the tendency of supply (physicians, hospitals, tests, pharmaceuticals, medical devices, and novel treatments) to generate its own demand,
* excessive litigation and defensive medicine
* tax-favored insurance coverage.
The author offers a different opinion, or second opinion:
"The extreme failure of the United States to contain medical costs results primarily from our unique, pervasive commercialization. The dominance of for-profit insurance and pharmaceutical companies, a new wave of investor-owned specialty hospitals, and profit-maximizing behavior even by nonprofit players raise costs and distort resource allocation. Profits, billing, marketing, and the gratuitous costs of private bureaucracies siphon off $400 billion to $500 billion of the $2.1 trillion spent, but the more serious and less appreciated syndrome is the set of perverse incentives produced by commercial dominance of the system."
He asks the question why markets do not optimize efficiency and offer the following explanation:
"The private insurance system's main techniques for holding down costs are practicing risk selection, limiting the services covered, constraining payments to providers, and shifting costs to patients. But given the system's fragmentation and perverse incentives, much cost-effective care is squeezed out, resources are increasingly allocated in response to profit opportunities rather than medical need, many attainable efficiencies are not achieved, unnecessary medical care is provided for profit, administrative expenses are high, and enormous sums are squandered in efforts to game the system. The result is a blend of overtreatment and undertreatment — and escalating costs. Researchers calculate that between one fifth and one third of medical outlays do nothing to improve health."
Furthermore he claims that:
"Great health improvements can be achieved through basic public health measures and a population-based approach to wellness and medical care. But entrepreneurs do not prosper by providing these services, and those who need them most are the least likely to have insurance. Innumerable studies have shown that consistent application of standard protocols for conditions such as diabetes, asthma, and elevated cholesterol levels, use of clinically proven screenings such as annual mammograms, provision of childhood immunizations, and changes to diet and exercise can improve health and prevent larger outlays later on. Comprehensive, government-organized, universal health insurance systems are far better equipped to realize these efficiencies because everyone is covered and there are no incentives to pursue the most profitable treatments rather than those dictated by medical need. Although the populations of most countries that belong to the Organization for Economic Cooperation and Development are older than the U.S. population, these countries have been far more successful at containing costs without compromising care."
He points out several cost-containment tactics applied by insurance companies to maximize their profits:
" A popular strategy among cost-containment consultants relies on the psychology of income targeting. The idea is that physicians have a mental picture of expected earnings — an income target. If the insurance plan squeezes their income by reducing payments per visit, doctors compensate by increasing their caseload and spending less time with each patient.
This false economy is a telling example of the myopia of commercialized managed care. It may save the plan money in the short run, but as any practicing physician can testify, the strategy has multiple self-defeating effects. A doctor's most precious commodity is time — adequate time to review a chart, take a history, truly listen to a patient. You can't do all that in 10 minutes. Harried primary care doctors are more likely to miss cues, make mistakes, and — ironically enough — order more tests to compensate for lack of hands-on assessment. They are also more likely to make more referrals to specialists for procedures they could perform more cost-effectively themselves, given adequate time and compensation. And the gap between generalist and specialist pay is widening."
"A second cost-containment tactic is to hike deductibles and copayments, whose frank purpose is to dissuade people from going to the doctor. But sometimes seeing the doctor is medically indicated, and waiting until conditions are dire costs the system far more money than it saves. Moreover, at some point during each year, more than 80 million Americans go without coverage, which makes them even less likely to seek preventive care."
"..the system also has inflationary effects on hospitals' revenue-maximization strategies. Large hospitals, which still have substantial bargaining power with insurers, necessarily cross-subsidize services. The emergency department may lose money, but cardiology makes a bundle. So hospitals fiercely defend their profit centers, investing heavily in facilities for lucrative procedures that will attract physicians and patients. For the system as a whole, it would be far more cost-effective to shift resources from subspecialists to primary care. But in an uncoordinated, commercialized system, specialists might take their business elsewhere, so they have the leverage to maintain their incomes and privileges — and thereby distort cost-effective resource allocation."
He concludes the article calling for the creation of a universal system of comprehensive national health care because:
"A comprehensive national system is far better positioned to match resources with needs — and not through the so-called rationing of care. (It is the U.S. system that has the most de facto rationing — high rates of uninsurance, exclusions for preexisting conditions, excessive deductibles and copayments, and shorter hospital stays and physician visits.) A universal system suffers far less of the feast-or-famine misallocation of resources driven by profit maximization. It also saves huge sums that our system wastes on administration, billing, marketing, profit, executive compensation, and risk selection. When the British National Health Service faced a shortage of primary care doctors, it adjusted pay schedules and added incentives for high-quality care, and the shortage diminished. Our commercialized system seems incapable of producing that result.
Despite our crisis of escalating costs, dwindling insurance coverage, and deteriorating conditions of medical practice, true national health insurance that would not rely on private insurers remains at the fringes of the national debate. This reality reflects the immense power of the insurance and pharmaceutical industries, the political fragmentation and ambivalence of the medical profession, the intimidation of politicians, and the erroneous media images of dissatisfied patients in universal systems.
Sometimes, we Americans do the right thing only after having exhausted all other alternatives. It remains to be seen how much exhaustion the health care system will suffer before we turn to national health insurance."
Yours
Bernd Wollschlaeger,MD,FAAFP
Wednesday, January 16, 2008
Response to Lombana Article
Attached an Op_ed I have submitted to the Miami Herald in response to the Lombana article.
Med-mal crisis: Working Towards A Solution
Doctors in South Florida faces the highest professional liability insurance premiums in the nation. With rapidly increasing premiums threatening the economic viability of many physicians and restricting access to needed medical care, organized medicine four years ago launched a campaign to preserve the practice of medicine in Florida. After a contentious and costly fight the Legislature responded by limiting the amounts malpractice victims can win in lawsuits – about $500,000 per doctor in most cases. Voters changed the state constitution to cap how much victim’s lawyers can get paid in contingency fees: 30 percent of the first $250,000 won (that's a maximum of $75,000) and 10 percent above that. Subsequently, the measures helped stabilize and even reduce the malpractice premiums paid in Florida. According to the state Office of Insurance Regulation Rates dropped 3 percent on average last year, but for may this is still a drop in the bucket.
Even though, the majority of medical liability claims are closed without payment to the plaintiff the physicians who win at trial still have large fees to pay for their defenses. Average defense costs were $93,559 per claim in cases where the defendant prevailed at trial. And in cases where the claim was dropped or dismissed, costs to defendants averaged $18,774.
In the daily medical practice the threat of a lawsuit hangs like a sword of Damocles over physician’s heads. This has unintended consequences including limited access to specialists in rural areas and medical residents’ growing concerns about liability issues may cause them to avoid choosing high-risk specialties or practicing in a crisis state. Forty-eight percent of students in their third or fourth year of medical school indicated the liability situation was a factor in their specialty choice, which will adversely impact the already shrinking physicians supply in a crisis state such as Florida.
According to a U.S. Department of Health and Human Services report medical liability adds billions to the cost of health care each year – which means higher health insurance premiums and higher medical costs for all Americans.
We need to find an alternative to the current litigation system, which is threatening health care quality for all Americans as well as raising the costs of health care for all Americans.
In the search for alternatives we must adapt new paradigms of thinking and abandon trench warfare in which doctors oppose lawyers and insurance companies.
Problem solving approaches requires cooperation instead of confrontation and should include the following:
1. The trial bar and organized medicine should jointly develop an alternative to the current litigation system that may include features of a no-fault approach and specialized medical courts.
2. Insurance companies must do a better job of rate setting during good markets in order to minimize steep rate hikes during bad ones. Most did the opposite during the 1990s. They underpriced policies and relied on investment gains to offset underwriting losses. Insurance regulators must be vigilant in monitoring the premiums charged policyholders. In monitoring companies' financial health, state officials should focus on underwriting profits and losses, independent of the company's investment income.
3. Insurance companies should change the way they rate individual policyholders, from a focus on specialty, risk, and location to a focus on actual claims history rewarding doctors with high skill levels of care.
4. Create a national reinsurance plan that includes all US companies that write malpractice insurance. The insurers would cede certain premiums to the plan, and, in return, the plan would assume responsibility for all claims over a set catastrophic amount. This would prevent excessive premium fluctuations.
These are just a few suggestions that may help to reform our flawed medical liability system.
Most importantly we must create a system that effectively and fairly compensates injured patients, deters poor quality medical care, and encourages the adherence to the highest standards of care for all Floridians.
The time is running out and we have to act NOW!
Bernd Wollschlaeger,MD,FAAFP
President-Elect, Dade County Medical Association
E-mail: info@miamihealth.com
=====================================================================================================================
Posted on Mon, Jan. 14, 2008
Future of med-mal caps in doubt
BY HECTOR LOMBANA
Five years ago, following a well-documented battle between insurance companies and patient rights groups,
Florida capped statutory damages on medical malpractice insurance awards. Recent news suggests that the future of these caps may be in jeopardy.
One Florida court ruled the caps unconstitutional; another court ruled them constitutional. The issue is expected to return to the spotlight as the cases are appealed to the state's Supreme Court.
Medical malpractice lawsuits are declining nationwide, even in states without caps, while in Florida insurers earn record profits. It appears the medical malpractice ''crisis,'' propagated by the insurance and healthcare industries' campaign of fear, may have been vastly overstated.
Medical liability claims filed against healthcare providers continue to fall nationwide because of more patient-safety programs created by hospitals, according to a recent study by AON Corp. in conjunction with the American Society for Healthcare Risk Management. The annual report concludes the frequency and severity of hospital claims are at new lows, resulting in a loss-cost trend that is the lowest in the study's eight-year history.
The authors of the report said that hospitals are creating patient-safety programs for emergency rooms and obstetric departments. They predict hospitals will spend less on liability judgments, and many will realize lower liability expenses in 2008.
The news that malpractice claims are diminishing nationwide is not a surprise to medical malpractice attorneys. Lawsuits involving mishandled deliveries have helped to force hospitals to focus more on fetal heart monitoring and high-risk deliveries, and improvements in the assessment of patient symptoms in emergency departments can also be traced to successful malpractice cases.
As lawyers have argued for years, the ''free market'' of meritorious litigation has forced healthcare providers to react. The reduction of claims means lives are being saved and disabilities prevented, which results in a significant positive impact for our society and economy.
Additionally, a report from the Florida Office of Insurance Regulation indicates the number of claims has declined, and the state's seven largest medical malpractice insurers (covering two-thirds of the entire market) had net income of $2.2 billion in 2006, compared to $700 million in 2005. All but one of these insurers noted a decline in the percentage of premiums allocated to claims and expenses.
The health of the market led seven new companies to enter the state's medical malpractice insurance marketplace in 2006, and the increased competition and profitability of all of the insurers yielded a 3 percent rate reduction for the average physician in the state. In addition, four of the seven largest insurers filed to lower their rates in 2007, but some did not change their rates despite paying less in claims.
While the medical and insurance industries along with their legions of ''Big Business'' lobbyists will claim that the numbers reflect positive results of the med-mal reforms in Florida and many other states, the attorneys who represent the victims of negligent medical care understand that they truly illustrate how the caps on damages have prevented attorneys from taking on many meritorious but difficult cases.
The role of medical malpractice attorneys is to help victims of medical negligence acquire justice and recover just compensation for their pain and suffering as well as economic loss. However, the current caps on damages in Florida make it impossible for qualified lawyers to take on some of the most meritorious and severe cases.
By their very nature, these cases require expensive investigations by experts in order to determine their validity, and lawyers will refuse to take them on if they believe that the injured individual will go through the hardships and emotional toll of a trial only to receive little or nothing in return.
The caps have effectively denied many injured patients their day in court, and that has fueled the increased profits that the medical malpractice insurance companies are now enjoying.
After nearly five years of caps in Florida, the hoax of a supposed med-mal crisis based on a campaign of fear that falsely attributed the rising costs of healthcare to lawsuits has been exposed and is now starting to unravel. The caps on damages have only proven that they are able to enrich the insurance companies to the detriment of the injured, and the future of these caps in Florida and other states now appears to be very much in question.
Hector Lombana is a partner with the Coral Gables-based law firm of Gamba & Lombana P.A., which focuses on medical malpractice, commercial law and litigation.
Med-mal crisis: Working Towards A Solution
Doctors in South Florida faces the highest professional liability insurance premiums in the nation. With rapidly increasing premiums threatening the economic viability of many physicians and restricting access to needed medical care, organized medicine four years ago launched a campaign to preserve the practice of medicine in Florida. After a contentious and costly fight the Legislature responded by limiting the amounts malpractice victims can win in lawsuits – about $500,000 per doctor in most cases. Voters changed the state constitution to cap how much victim’s lawyers can get paid in contingency fees: 30 percent of the first $250,000 won (that's a maximum of $75,000) and 10 percent above that. Subsequently, the measures helped stabilize and even reduce the malpractice premiums paid in Florida. According to the state Office of Insurance Regulation Rates dropped 3 percent on average last year, but for may this is still a drop in the bucket.
Even though, the majority of medical liability claims are closed without payment to the plaintiff the physicians who win at trial still have large fees to pay for their defenses. Average defense costs were $93,559 per claim in cases where the defendant prevailed at trial. And in cases where the claim was dropped or dismissed, costs to defendants averaged $18,774.
In the daily medical practice the threat of a lawsuit hangs like a sword of Damocles over physician’s heads. This has unintended consequences including limited access to specialists in rural areas and medical residents’ growing concerns about liability issues may cause them to avoid choosing high-risk specialties or practicing in a crisis state. Forty-eight percent of students in their third or fourth year of medical school indicated the liability situation was a factor in their specialty choice, which will adversely impact the already shrinking physicians supply in a crisis state such as Florida.
According to a U.S. Department of Health and Human Services report medical liability adds billions to the cost of health care each year – which means higher health insurance premiums and higher medical costs for all Americans.
We need to find an alternative to the current litigation system, which is threatening health care quality for all Americans as well as raising the costs of health care for all Americans.
In the search for alternatives we must adapt new paradigms of thinking and abandon trench warfare in which doctors oppose lawyers and insurance companies.
Problem solving approaches requires cooperation instead of confrontation and should include the following:
1. The trial bar and organized medicine should jointly develop an alternative to the current litigation system that may include features of a no-fault approach and specialized medical courts.
2. Insurance companies must do a better job of rate setting during good markets in order to minimize steep rate hikes during bad ones. Most did the opposite during the 1990s. They underpriced policies and relied on investment gains to offset underwriting losses. Insurance regulators must be vigilant in monitoring the premiums charged policyholders. In monitoring companies' financial health, state officials should focus on underwriting profits and losses, independent of the company's investment income.
3. Insurance companies should change the way they rate individual policyholders, from a focus on specialty, risk, and location to a focus on actual claims history rewarding doctors with high skill levels of care.
4. Create a national reinsurance plan that includes all US companies that write malpractice insurance. The insurers would cede certain premiums to the plan, and, in return, the plan would assume responsibility for all claims over a set catastrophic amount. This would prevent excessive premium fluctuations.
These are just a few suggestions that may help to reform our flawed medical liability system.
Most importantly we must create a system that effectively and fairly compensates injured patients, deters poor quality medical care, and encourages the adherence to the highest standards of care for all Floridians.
The time is running out and we have to act NOW!
Bernd Wollschlaeger,MD,FAAFP
President-Elect, Dade County Medical Association
E-mail: info@miamihealth.com
=====================================================================================================================
Posted on Mon, Jan. 14, 2008
Future of med-mal caps in doubt
BY HECTOR LOMBANA
Five years ago, following a well-documented battle between insurance companies and patient rights groups,
Florida capped statutory damages on medical malpractice insurance awards. Recent news suggests that the future of these caps may be in jeopardy.
One Florida court ruled the caps unconstitutional; another court ruled them constitutional. The issue is expected to return to the spotlight as the cases are appealed to the state's Supreme Court.
Medical malpractice lawsuits are declining nationwide, even in states without caps, while in Florida insurers earn record profits. It appears the medical malpractice ''crisis,'' propagated by the insurance and healthcare industries' campaign of fear, may have been vastly overstated.
Medical liability claims filed against healthcare providers continue to fall nationwide because of more patient-safety programs created by hospitals, according to a recent study by AON Corp. in conjunction with the American Society for Healthcare Risk Management. The annual report concludes the frequency and severity of hospital claims are at new lows, resulting in a loss-cost trend that is the lowest in the study's eight-year history.
The authors of the report said that hospitals are creating patient-safety programs for emergency rooms and obstetric departments. They predict hospitals will spend less on liability judgments, and many will realize lower liability expenses in 2008.
The news that malpractice claims are diminishing nationwide is not a surprise to medical malpractice attorneys. Lawsuits involving mishandled deliveries have helped to force hospitals to focus more on fetal heart monitoring and high-risk deliveries, and improvements in the assessment of patient symptoms in emergency departments can also be traced to successful malpractice cases.
As lawyers have argued for years, the ''free market'' of meritorious litigation has forced healthcare providers to react. The reduction of claims means lives are being saved and disabilities prevented, which results in a significant positive impact for our society and economy.
Additionally, a report from the Florida Office of Insurance Regulation indicates the number of claims has declined, and the state's seven largest medical malpractice insurers (covering two-thirds of the entire market) had net income of $2.2 billion in 2006, compared to $700 million in 2005. All but one of these insurers noted a decline in the percentage of premiums allocated to claims and expenses.
The health of the market led seven new companies to enter the state's medical malpractice insurance marketplace in 2006, and the increased competition and profitability of all of the insurers yielded a 3 percent rate reduction for the average physician in the state. In addition, four of the seven largest insurers filed to lower their rates in 2007, but some did not change their rates despite paying less in claims.
While the medical and insurance industries along with their legions of ''Big Business'' lobbyists will claim that the numbers reflect positive results of the med-mal reforms in Florida and many other states, the attorneys who represent the victims of negligent medical care understand that they truly illustrate how the caps on damages have prevented attorneys from taking on many meritorious but difficult cases.
The role of medical malpractice attorneys is to help victims of medical negligence acquire justice and recover just compensation for their pain and suffering as well as economic loss. However, the current caps on damages in Florida make it impossible for qualified lawyers to take on some of the most meritorious and severe cases.
By their very nature, these cases require expensive investigations by experts in order to determine their validity, and lawyers will refuse to take them on if they believe that the injured individual will go through the hardships and emotional toll of a trial only to receive little or nothing in return.
The caps have effectively denied many injured patients their day in court, and that has fueled the increased profits that the medical malpractice insurance companies are now enjoying.
After nearly five years of caps in Florida, the hoax of a supposed med-mal crisis based on a campaign of fear that falsely attributed the rising costs of healthcare to lawsuits has been exposed and is now starting to unravel. The caps on damages have only proven that they are able to enrich the insurance companies to the detriment of the injured, and the future of these caps in Florida and other states now appears to be very much in question.
Hector Lombana is a partner with the Coral Gables-based law firm of Gamba & Lombana P.A., which focuses on medical malpractice, commercial law and litigation.
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