Overseas Patients

Attached a link New push to bring overseas patients to South Florida to an interesting article reporting that Broward and Palm Beach counties are becoming more common destinations for seriously ill patients from overseas who need sophisticated treatment that is unavailable or very expensive in their homelands. Its ironic that according to Deloitte consulting services, in 2010 875,000 Americans traveling outside U.S. borders to receive health care: dental work, elective hip replacements, even bypass surgery. Why? Because the astronomic costs and often substandard quality of health care services in the U.S. force many middle-class workers to seek medical care abroad. Such care is being rendered by board certified medical doctors at Joint Commission International certified health care facilities. Lured by more affordable medical care and modern facilities, places like Malaysia, India and Turkey, have also become hot-spots for patients seeking procedures abroad, according to experts.Medscape News web site has forecast medical tourism in Asia could generate $4.4billion by 2012.According to the Korea Health Industry Development Institute, the number of tourists coming to South Korea ballooned last year to nearly 82,000, generating about $700million in revenues. By next year, Singapore aims to treat a million foreign patients a year, generating about $3billion for the economy, the Singapore Straits Times has reported; while neighbouring Malaysia, attracted nearly 400,000 medical tourists last year, and aims to increase that number to 1.9million by 2020. The Philippines also sees itself as a cut-price destination, and is projecting the number of medical tourists to hit one million by 2015, generating at least $1billion in revenue. Why should U.S. citizens be forced to travel abroad!! They deserve affordable and excellent care right here at home, too!! I guess we have to continue dreaming and save money for our next flight!

Deep Cuts for Mental Health and Substance Abuse Treatment Programs

Attached a link State Senate proposes $87 million cut in mental health, substance-abuse programs to an article titled " State Senate proposes $87 million cut in mental health, substance-abuse programs" reporting that a Florida Senate proposal would make deep cuts in funding for adult mental health and substance-abuse programs, and entirely eliminate support for some of them.The proposal would slash overall state spending on adult mental health and substance-abuse treatment by about 40 percent, or $87 million.The cuts would include eliminating state support for some programs — including, potentially, the Miami Behavioral Health Center and the Northside Mental Health Center in Tampa. Sen. Joe Negron, the Stuart Republican in charge of the Senate’s healthcare budget, stated that “When it comes to funding, an 85-year-old woman in a nursing home matters more to me than a 45-year-old guy with a substance-abuse problem,” he said. “It’s all about priorities.” Unfortunately, his statement reveals that most politicians have yet to understand that mental health and substance abuse treatment represents cost-effective care! The benefits of treatment far outweigh the costs. Even beyond the enormous physical and psychological costs, treatment can save money by diminishing the huge financial consequences imposed on employers and taxpayers. Comparing the direct cost of treatment to monetary benefits to society determined that on average, costs were $1,583 compared to a benefit of $11,487 (a benefit-cost ratio of 7:1)! In comparing cost offsets in Washington State of people in treatment to non-treated, the authors noted lower medical costs ($311/month); lower state hospital expenses ($48/month); lower community psychiatric hospital costs ($16/month); reduced likelihood of arrest by 16%; and reduced likelihood of felony convictions by 34%! It is a penny wise and pound foolish approach to CUT finding for mental health and substance abuse treatment because in the long run we as tax payers have to pay the higher price for short term political decisions. For more information see Cost Offset Substance Abuse. I urge you to e-mail, call or write Senator Negron! Yours Bernd

Immaculate Conception

The uproar about birth control coverage by insurance companies not only points out the friction between freedom to choose birth control and religious liberties but also the fallacy of our employer-based healthcare system. Yes, I defend religious freedom but I question the authority of religious institutions to impose their morality on others. I understand that bishops and priest do not have to worry about the impact of contraception on their families but I do. Maybe I should not speak up because I am a Jew but I vigorously defend the right of catholic women (and men) to choose the most suitable form of birth control. According to a study by the Guttmacher Institute three quarter of sexually active women of modest means, ages 18-34, said that they could NOT afford a baby BUT thirty percent had put off a gynecological or family planning visit to save money. For those still using an oral contraceptive, one quarter skipped their daily pill to safe money. The cost of birth control is one reason why poor women are more than three times as likely to have unintended pregnancies. We all pay for this failed approach to family planning! Every dollar the U.S. government spends on family planning reduces Medicaid expenditures by $3.74!! If each employer (such as the catholic church and other affiliated institutions, can reserve the right to raise "moral objections" to almost each and every aspect of a broad-based healthcare coverage then we are in real trouble! Whats next? Infertility treatment, already covered only by a quarter of health insurance companies, may be next. Whats about erectile dysfunction treatment for seniors? Treatment for gender identity problems in teenagers? Maybe some orthodox Islamic or Jewish employers will not pay for treatment in clinics that do not provide sex-segregated waiting rooms, or only male gynecologists. Maybe some employers object to gay doctors on moral grounds? In these times of a religiously and ideologically based culture war anything is possible! When will it stop? Well, there is one solution! A single-payer system funded by the tax payer in which each recipient receives a benefit card to CHOOSE healthcare coverage from any doctor, clinic, hospital, emergency room of their choice! Wow, free choice! What an outrageous thought! I hope that more will speak up against the Ayatollization of our society. Yes, I am for religious freedom but priest, rabbis and imans should confine their morality to their respective church, temple or mosque and leave it up to us to make moral choices! Yours Bernd

United Healthcare and Payment reform

Attached a link http://online.wsj.com/article/SB10001424052970203315804577211660010608608.html to an interesting article published in the Wall Street Journal titled " New Way to Pay Doctors: UnitedHealth, Nation's Largest Insurer, Is Latest to Announce Fee Overhaul." According to the article " Under the new plan the carrier is rolling out, part of medical providers' compensation could be tied to goals such as avoiding hospital readmissions and ensuring patients get recommended screenings. UnitedHealth has been trying such efforts on a more limited scale, but now the company says it plans to roll out new contracts nationwide that could include financial rewards for care the company considers high-quality and efficient, and in some cases potentially withhold expected increases if certain standards aren't met." Under an aggressive projection, costs could amount to as much as $3.27 per member a month by 2015, with savings as high as $7.80, the documents said. Using a less-aggressive scenario, the company said, the costs could amount to 46 cents, and the savings to $1.35, per member a month. Much of the cost under both projections wouldn't be locked in, since it would be tied to bonuses that providers would get only if they hit certain goals; indeed, those payments may be calculated as a share of the overall savings achieved. According to the released information pieces of the new payments may be in lieu of increases to traditional fees. Driving the payment reform is the growing realization that the current health-care payment system, with its fees for each service, is flawed. The current system entices quantity but no quality and a value-based reimbursement system would stire healthcare towards prevention, quality and outcome oriented care. Donald Berwick, former administrator of the Centers for Medicare and Medicaid Services, said the initiative "looks promising," but it would be important for the incentives to be strongly enough tied to quality and patient-satisfaction measures, in addition to efficiency goals, to "ensure there's no skimping" on care. In a description of some of its pilot programs, the carrier mentioned potential bonuses of $1 to $3 per member a month for primary-care physicians. For a different provider setup, called accountable care organizations, the document said the bonuses could amount to $1 to $5 per member a month. Accountable care organizations can be built around hospitals or doctor groups, and they generally involve a provider taking overall responsibility for a group of patients. UnitedHealth also said it could offer "clinical integration" fees for providers that make changes aimed at better tracking patients' conditions and coordinating their care. This would include the model known as "patient-centered medical homes," which are typically set up by primary-care doctors, but the fees could also be available to other providers making similar efforts. In my opinion physicians can and should play a proactive role in the payment reform initiative. We have to reorganize our practices , implement efficiency measurements and form groups organized along the Patient-Centered Medical Home concept. We cannot expect that insurance companies will provide us with the panacea for our economic woes. Now is the time to act! Yours Bernd