Attached an excellent and very interesting article written by John Dorschner highlighting the proliferation of Urgent Care centers within the Baptist Health system in South Florida.
The proponents of urgent care centers emphasize the improved access and reduced costs of care versus ER care.
One UM Family Medicine faculty teacher is being quoted too:
``The residents now going out on their own -- two or three are going to work for urgent care companies and five or so are going to larger, already established practices,'' Roberts said. ``That's just the way things are.''
I beg to differ and passionately disagree with the opinions stated.
Why? Because Urgent Care may be " cheaper" compared to emergency room visits BUT it does contribute to the fragmentation of care, the absence of care coordination and will further reduce urgently needed cash flow in primary care clinics.
Unfortunately, insurance companies seem to like the concept too. Therefore, urgent care and walk-in clinics are popping up all over Miami even in my neighborhood.
Do they provide better care ? Absolutely not!! For care coordination and continuity of care they "refer" the tough cases to family doctors because they Urgent care docs want to deliver quick fixes and have no time for history taking gibberish.
I am afraid that in search for the easy and quick buck family medicine residents will prefer those urgent care clinics.
So what can we do? Join the urgent care bandwagon? No!! We must focus on the development of collaborate practice models, develop medical homes and contract with employer groups demonstrating better and more cost-effective care.
Otherwise, we will contribute to the steady increase in healthcare costs and the fragmentation of healthcare deliver.
That's NOT just the way things are!
Looking forward to your comments.
Yours
Bernd
Posted on Fri, Jul. 02, 2010
Baptist Health makes urgent care push
BY JOHN DORSCHNER
jdorschner@MiamiHerald.com
With primary care increasingly hard to access, Baptist Health South Florida keeps expanding its urgent care centers in Miami-Dade and Broward -- and offending the chief executive of the huge Memorial Healthcare System in the process.
Urgent care -- providing faster, simpler treatment than hospital emergency rooms -- has proven to be a successful model for the prosperous Baptist system, even while smaller urgent care shops in South Florida have slid into bankruptcy.
``They're doing very well,'' said Patricia Rosello, chief executive of Baptist Out-Patient Services.
Indeed they are. Baptist Out-Patient, which includes diagnostic and imaging services, earned $52.3 million on $142.7 million in patient revenue in fiscal 2009, according to audited statements. That's a 36 percent rate of return -- and 40 percent of the $131.3 million in net income earned by the entire system, which has five hospitals.
Baptist is not alone in seeing a huge need for primary care. Many chain pharmacies stores in South Florida -- including Walgreens and CVS -- now have walk-in clinics, usually staffed by nurse practitioners who can dispense simple prescriptions for such things as antibiotics.
Aventura Medical Center, an HCA facility, is taking a slightly different tack, opening a primary care clinic in Miami Lakes operated by physicians it employs. It keeps regular doctor's hours -- daytime, Monday through Friday.
The hospital is looking cautiously at widening the service. ``We will expand geographically only as it makes strategic sense and will continue to build physician practices in communities where there is a need for primary care,'' said Aventura spokeswoman Robyn Kane.
LONGER HOURS
Baptist Medical Plazas offer broader services and longer hours -- generally 11 a.m. to 11 p.m. daily, with board-certified physicians always on duty, generally with X-rays and other tests available because the centers include outpatient diagnostic and imaging services.
Baptist now has 13 centers, with more on the way. It entered Broward last year, in Coral Springs. Its latest, opened in May, is in Davie, at Griffin Road and University Drive -- an area dominated by Memorial, the prosperous government healthcare system that dominates South Broward.
Memorial has focused on its hospitals, having only one urgent care center, in Pembroke Pines. Still, Memorial Chief Executive Frank Sacco was not happy to see Baptist's advertising in Davie: ``You'll find compassionate Baptist Health doctors and nurses. . . Broward, it's time to get treated better!''
Sacco sent a letter last month to Memorial staff: ``Such statements are offensive to thousands of dedicated and accomplished healthcare professionals. . . . It disappoints me to see Baptist Health South Florida disparage all of us.''
Baptist's Rosello says no attack was intended against Memorial.
The centers have been using the same line in their Miami-Dade advertising for the past three years: ``It's time to get treated better.''
Baptist surveys show that 90 percent of its urgent care patients walk out the door within two hours of entering, Rosello said. That's much better than lengthy waits that occur in most emergency rooms.
``We started the centers to decompress the emergency room,'' Rosello said. Baptist Hospital's, in particular, was often crammed with patients waiting for treatment. ``But then it became its own business,'' he said.
One reason: Most insurers discovered that pushing people toward urgent care is cheaper than ER visits. Baptist's own health plan for employees, for example, requires a $50 co-pay for urgent care versus $100 for an ER visit.
In the fall, another Baptist center will open in western Broward, at Dykes Road and Pines Boulevard, Rosello said. Next year, a Brickell facility is expected to open near the intersection of U.S. 1 and the Rickenbacker Causeway. Another six may open in the next three years, Rosello said.
TOUGH MARKET
Baptist's pineapple logo has become a recognizable symbol, even in Broward, where many South Dade residents moved after Hurricane Andrew in 1992. But many lesser-known centers have struggled in the market.
ER Urgent Care Centers had three facilities in South Florida. In 2004, when a reporter visited one of them, in Hallandale Beach, there were no patients. ``Our biggest problem is getting the public educated,'' said an executive of the firm. It filed for bankruptcy in 2008.
In Broward, Alan Roberts, a physician, operated three Sunshine Medical Centers, including one in downtown Fort Lauderdale, but ended up selling them to Concentra, a Dallas-based nationwide system that has the financial heft to market to patients and get good deals from insurers.
Another chain, Jacksonville-based Solantic, has 30 locations in the state, including four in Broward.
Roberts, who now teaches part time in the University of Miami family medicine program, said urgent care is only going to get bigger, because low reimbursement rates aren't enough for primary care doctors to open solo practices.
``The residents now going out on their own -- two or three are going to work for urgent care companies and five or so are going to larger, already established practices,'' Roberts said. ``That's just the way things are.''
© 2010 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com
Read more: http://www.miamiherald.com/2010/07/02/v-print/1711396/baptist-makes-urgent-care-push.html#ixzz0sZzFUpSe
Showing posts with label Health Policy. Show all posts
Showing posts with label Health Policy. Show all posts
Friday, July 02, 2010
Monday, August 24, 2009
Universal Health Insurance
Attached you find a summary of a bill (HR676)which so far has not been discussed during the current healthcare refom debate.It should be at least considered as an option and not discarded just because its politically difficult to promote.
Bernd Wollschlaeger,MD
H.R. 676, “The United States National Health Care Act,”
Or “Expanded & Improved Medicare For All”
Introduced by Rep. John Conyers, Jr.
Brief Summary of Legislation
The United States National Health Care Act (USNHC) establishes a unique American universal health insurance program with single payer financing. The bill would create a publicly financed, privately delivered health care system that improves and expands the already existing Medicare program to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans will have access, guaranteed by law, to the highest quality and most cost effective health care services regardless of their employment, income or health care status. In short, health care becomes a human right. With 47 million uninsured Americans, and another 50 million who are underinsured, the time has come to change our inefficient and costly fragmented non-system of health care.
Who is Eligible
Every person living or visiting in the United States and the U.S. Territories would receive a United States National Health Insurance Card and ID number once they enroll at the appropriate location. Social Security numbers may not be used when assigning ID cards.
Health Care Services Covered
This program will cover all medically necessary services, including primary care, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, hearing services, long term care, palliative care, podiatric care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices. There no co-pays or deductibles under this act.
Conversion To A Non-Profit Health Care System
Doctors, hospitals, and clinics will continue to operate as privately entities. However, they will be unable to issue stock. Private health insurers shall be prohibited under this act from selling coverage that duplicates the benefits of the USNHC program. Exceptions to this rule include coverage for cosmetic surgery, and other medically unnecessary treatments. Those workers who are displaced as the result of the transition to a non-profit health care system will be the first to be hired and retrained under this act. Furthermore, workers would receive their same salary for up to two years, and would then be eligible for unemployment benefits. The conversion to a not-for- profit health care system will take place as soon as possible, but not to exceed a 15 year period, through the sale of U.S. treasury bonds.
Cost Containment Provisions/ Reimbursement
The USNHC program will negotiate reimbursement rates annually with physicians, allow for global budgets (monthly lump sums for operating expenses) for hospitals, and negotiate prices for prescription drugs, medical supplies and equipment. A “Medicare For All Trust Fund” will be established to ensure a dedicated stream of funding. An annual Congressional appropriation is also authorized to ensure optimal levels of funding for the program, in particular, to ensure the requisite number of physicians and nurses need in the health care delivery system.
H.R. 676 Would Reduce Overall Health Care Costs
Families Will Pay Less
Currently, the average family of four covered under an employee health plan spends a total of $4,225 on health care annually – $2,713 on premiums and another $1,522 on medical services, drugs and supplies (Employer Health Benefits 2006 Annual Survey, Kaiser Family Foundation and Health Research and Educational Trust; U.S. Department of Labor, Bureau of Labor Statistics, Consumer Expenditure Survey.) This figure does not include the additional 1.45% Medicare payroll tax levied on employees. A study by Dean Baker of the Center for Economic Research and Policy concluded that under H.R. 676, a family of four making the median family income of $56,200 per year would pay about $2,700 for all health care costs.
Business Will Pay Less
In 2006, health insurers charged employers an average of $11,500 for a health plan for a family of four. On average, the employer paid 74% of this premium, or $8,510 per year. This figure does not include the additional 1.45% payroll tax levied on employers for Medicare. Under H.R. 676, employers would pay a 4.75% payroll tax for all health care costs. For an employee making the median family income of $56,200 per year, the employer would pay about $2,700.
The Nation Will Pay About the Same, While Covering All Americans
Savings from reduced administration, bulk purchasing, and coordination among providers will allow coverage for all Americans while reducing health care inflation in the long term. Annual savings from enacting H.R. 676 are estimated at $387 billion (Baker).
Proposed Funding For USNHC Program
· Maintain current federal and state funding for existing health care programs
· Establish employer/employee payroll tax of 4.75% (includes present 1.45% Medicare tax)
· Establish a 5% health tax on the top 5% of income earners, 10% tax on top 1% of wage earners
· ¼ of 1% stock transaction tax
· Close corporate tax loopholes
· Repeal the Bush tax cuts for the highest income earners
Bernd Wollschlaeger,MD
H.R. 676, “The United States National Health Care Act,”
Or “Expanded & Improved Medicare For All”
Introduced by Rep. John Conyers, Jr.
Brief Summary of Legislation
The United States National Health Care Act (USNHC) establishes a unique American universal health insurance program with single payer financing. The bill would create a publicly financed, privately delivered health care system that improves and expands the already existing Medicare program to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans will have access, guaranteed by law, to the highest quality and most cost effective health care services regardless of their employment, income or health care status. In short, health care becomes a human right. With 47 million uninsured Americans, and another 50 million who are underinsured, the time has come to change our inefficient and costly fragmented non-system of health care.
Who is Eligible
Every person living or visiting in the United States and the U.S. Territories would receive a United States National Health Insurance Card and ID number once they enroll at the appropriate location. Social Security numbers may not be used when assigning ID cards.
Health Care Services Covered
This program will cover all medically necessary services, including primary care, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, hearing services, long term care, palliative care, podiatric care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices. There no co-pays or deductibles under this act.
Conversion To A Non-Profit Health Care System
Doctors, hospitals, and clinics will continue to operate as privately entities. However, they will be unable to issue stock. Private health insurers shall be prohibited under this act from selling coverage that duplicates the benefits of the USNHC program. Exceptions to this rule include coverage for cosmetic surgery, and other medically unnecessary treatments. Those workers who are displaced as the result of the transition to a non-profit health care system will be the first to be hired and retrained under this act. Furthermore, workers would receive their same salary for up to two years, and would then be eligible for unemployment benefits. The conversion to a not-for- profit health care system will take place as soon as possible, but not to exceed a 15 year period, through the sale of U.S. treasury bonds.
Cost Containment Provisions/ Reimbursement
The USNHC program will negotiate reimbursement rates annually with physicians, allow for global budgets (monthly lump sums for operating expenses) for hospitals, and negotiate prices for prescription drugs, medical supplies and equipment. A “Medicare For All Trust Fund” will be established to ensure a dedicated stream of funding. An annual Congressional appropriation is also authorized to ensure optimal levels of funding for the program, in particular, to ensure the requisite number of physicians and nurses need in the health care delivery system.
H.R. 676 Would Reduce Overall Health Care Costs
Families Will Pay Less
Currently, the average family of four covered under an employee health plan spends a total of $4,225 on health care annually – $2,713 on premiums and another $1,522 on medical services, drugs and supplies (Employer Health Benefits 2006 Annual Survey, Kaiser Family Foundation and Health Research and Educational Trust; U.S. Department of Labor, Bureau of Labor Statistics, Consumer Expenditure Survey.) This figure does not include the additional 1.45% Medicare payroll tax levied on employees. A study by Dean Baker of the Center for Economic Research and Policy concluded that under H.R. 676, a family of four making the median family income of $56,200 per year would pay about $2,700 for all health care costs.
Business Will Pay Less
In 2006, health insurers charged employers an average of $11,500 for a health plan for a family of four. On average, the employer paid 74% of this premium, or $8,510 per year. This figure does not include the additional 1.45% payroll tax levied on employers for Medicare. Under H.R. 676, employers would pay a 4.75% payroll tax for all health care costs. For an employee making the median family income of $56,200 per year, the employer would pay about $2,700.
The Nation Will Pay About the Same, While Covering All Americans
Savings from reduced administration, bulk purchasing, and coordination among providers will allow coverage for all Americans while reducing health care inflation in the long term. Annual savings from enacting H.R. 676 are estimated at $387 billion (Baker).
Proposed Funding For USNHC Program
· Maintain current federal and state funding for existing health care programs
· Establish employer/employee payroll tax of 4.75% (includes present 1.45% Medicare tax)
· Establish a 5% health tax on the top 5% of income earners, 10% tax on top 1% of wage earners
· ¼ of 1% stock transaction tax
· Close corporate tax loopholes
· Repeal the Bush tax cuts for the highest income earners
Friday, July 24, 2009
AMA Supports Reform
Kudos to Dr.Cecil Wilson, President Elect of the AMA, whose letter to the editor was published in todays Miami Herald.
He should be applauded for standing up for what we know is right: comprehensive healthcare reform benefiting all Americans.
Thank you Dr. Wilson for your commitment to our profession and the public health.
Bernd Wollschlaeger,MD,FAAFP,FASAM
AMA Member & Outreach Recruiter
============================================================================
AMA to Miami Herald: AMA Supports Reform
July 23, 2009 (published)
Miami Herald
Letter to the Editor
Floridians without health-insurance coverage are in dire straits (Report: 3,560 Floridians will lose health insurance every week, July 16). For their sake, we must achieve meaningful healthcare reform that provides all Americans with access to affordable, high-quality coverage.
The American Medical Association is committed to health reform this year that covers the uninsured, improves quality and ensures patients get the best value from healthcare spending. Important progress has been made with the House and Senate vigorously working on legislation. The AMA will stay actively engaged to make certain health reform that will improve the health of America's patients is accomplished.
The uninsured crisis playing out in Florida is one that can be seen all across America.
We must seize the opportunity this year to pass comprehensive health reform.
Cecil B. Wilson, MD
President-elect, American Medical Association
He should be applauded for standing up for what we know is right: comprehensive healthcare reform benefiting all Americans.
Thank you Dr. Wilson for your commitment to our profession and the public health.
Bernd Wollschlaeger,MD,FAAFP,FASAM
AMA Member & Outreach Recruiter
============================================================================
AMA to Miami Herald: AMA Supports Reform
July 23, 2009 (published)
Miami Herald
Letter to the Editor
Floridians without health-insurance coverage are in dire straits (Report: 3,560 Floridians will lose health insurance every week, July 16). For their sake, we must achieve meaningful healthcare reform that provides all Americans with access to affordable, high-quality coverage.
The American Medical Association is committed to health reform this year that covers the uninsured, improves quality and ensures patients get the best value from healthcare spending. Important progress has been made with the House and Senate vigorously working on legislation. The AMA will stay actively engaged to make certain health reform that will improve the health of America's patients is accomplished.
The uninsured crisis playing out in Florida is one that can be seen all across America.
We must seize the opportunity this year to pass comprehensive health reform.
Cecil B. Wilson, MD
President-elect, American Medical Association
Monday, June 29, 2009
Medicare Fraud Continues!
Crackdown on Medicare fraud
On several occasions I reported on this blog http://floridadocs.blogspot.com/ about the audacious and callous Medicare fraud and abuse activity here in South Florida. During my tenure as DCMA President I met twice with representatives and senior executives of First Coast Service Options (FCSO) , the regional Medicare administrator, to discuss and understand why on one hand doctors in South Florida are being nickeled and dimed for legitimate services rendered but on the other hand billions of dollars are being paid out for obvious fraudulent claims. The most egregious example is the ongoing payment for HIV infusion “treatments” which, according to the court testimony of a leading HIV treatment expert, are obsolete, replaced for years by more effective oral antiretroviral drugs and not being utilized in clinical practice anymore. In most cases unscrupulous clinic owners, aided and abetted by medical doctors, set up such HIV Infusion clinics, recruited Medicare recipients suffering from HIV/AIDS and billed Medicare for services never rendered, In a series of award winning articles published in the Miami Herald Jay Weaver pointed out the continuous payment for those “services “ despite assurance made by First Coast Service Options that the payment were ceased. In a meeting with FCSO I personally received assurances that “ no such checks are being issued anymore.” Obviously, thats not the truth. I a recent article published on Saturday, June 27th 2009 http://www.miamiherald.com/news/front-page/v-print/story/1116390.html Experts estimate Medicare loses at least $60 billion to fraud every year, with Miami-Dade County at the center of the national crisis. I a recent crackdown agents broke up a Miami-based ring that allegedly schemed to defraud Medicare of $100 million by filing false claims for obsolete HIV therapy across five states. Two of the eight suspects have fled to Cuba.The organization, which was paid $30 million by the federal health insurance program, exported a fraudulent local business enterprise to Georgia, Louisiana, North Carolina and South Carolina by using empty storefronts and post office boxes, authorities said. What is being done to stop the bleeding of precious Medicare dollars? Well, I personally have written letters to the editors of local newspapers pointing out the obvious mismanagement of funds by FCSO. I have written to each and every member of the congressional delegation from Florida and only ONE responded advising me to contact the Officer of Inspector General to file a complaint! Thats it! Meanwhile, Medicare still considers such treatment "reasonable and necessary" and continues to pay hundreds of millions of dollars for fraudulent claims every year. FCSO refuses to consider the one and ONLY option: stop payment of ALL HIV infusion therapy claims in Florida/South Florida. The response: We can't because patients who actually need the treatment would be denied services -- a policy no-no at Medicare. But experts have testified that no one needs this treatments anymore!! If any patient would require such treatment it would be an exception and Medicare could consider payment on a case by case basis! Lets be clear: Medicare officials know the claims are fraudulent. Medicare says it has adopted technology to block false claims for HIV infusion treatment, yet the government program still misses hundreds of millions of dollars annually. To add insult to injury on September 12th, 2008 the Centers for Medicare & Medicaid Services (CMS) announced that First Coast Service Options, Inc. (FCSO) has been awarded a contract of up to five years for the combined administration of Part A and Part B Medicare claims payment in Florida, Puerto Rico, and U.S. Virgin Islands. This represents not only a contract renewal but EXPANSION! In a press release CMS emphasized that “ with this award, CMS continues its progress in reengineering the way in which the government contracts for claims administration for the largest part of the Medicare program. CMS is seeking the best value, from a cost and technical perspective for this critical function.” The “best value” they probably get from FCSO is the waste of Medicare dollars! But they do not stop here! FCSO will be financially awarded too! In the same press release CMS officials emphasized that “ the contract for FCSO includes a base period and four one-year options and will provide FCSO with an opportunity to earn award fees based on its ability to meet or exceed the performance requirements set by CMS.” So they can earn extra dollars on the fraudulent claims amount?
So what can be done:
1)Call, e-mail or write your representative and/or Senator to hold FCSO responsible for every dollar wasted.
2)Petition the Office of Inspector General of the US Department of Health & Human Services at HHSTips@oig.hhs.gov to investigate FCSO business activities.
3)Force FCSO to repay each and every dollar of fraudulent claims paid and hold company executives legally accountable for their actions (or inactions)
In times of financial crisis we all have to act in a cautious manner exercising our duties , obligations and responsibilities as citizens. The blatant abuse of the Medicare system has to stop!
Yours
Bernd
On several occasions I reported on this blog http://floridadocs.blogspot.com/ about the audacious and callous Medicare fraud and abuse activity here in South Florida. During my tenure as DCMA President I met twice with representatives and senior executives of First Coast Service Options (FCSO) , the regional Medicare administrator, to discuss and understand why on one hand doctors in South Florida are being nickeled and dimed for legitimate services rendered but on the other hand billions of dollars are being paid out for obvious fraudulent claims. The most egregious example is the ongoing payment for HIV infusion “treatments” which, according to the court testimony of a leading HIV treatment expert, are obsolete, replaced for years by more effective oral antiretroviral drugs and not being utilized in clinical practice anymore. In most cases unscrupulous clinic owners, aided and abetted by medical doctors, set up such HIV Infusion clinics, recruited Medicare recipients suffering from HIV/AIDS and billed Medicare for services never rendered, In a series of award winning articles published in the Miami Herald Jay Weaver pointed out the continuous payment for those “services “ despite assurance made by First Coast Service Options that the payment were ceased. In a meeting with FCSO I personally received assurances that “ no such checks are being issued anymore.” Obviously, thats not the truth. I a recent article published on Saturday, June 27th 2009 http://www.miamiherald.com/news/front-page/v-print/story/1116390.html Experts estimate Medicare loses at least $60 billion to fraud every year, with Miami-Dade County at the center of the national crisis. I a recent crackdown agents broke up a Miami-based ring that allegedly schemed to defraud Medicare of $100 million by filing false claims for obsolete HIV therapy across five states. Two of the eight suspects have fled to Cuba.The organization, which was paid $30 million by the federal health insurance program, exported a fraudulent local business enterprise to Georgia, Louisiana, North Carolina and South Carolina by using empty storefronts and post office boxes, authorities said. What is being done to stop the bleeding of precious Medicare dollars? Well, I personally have written letters to the editors of local newspapers pointing out the obvious mismanagement of funds by FCSO. I have written to each and every member of the congressional delegation from Florida and only ONE responded advising me to contact the Officer of Inspector General to file a complaint! Thats it! Meanwhile, Medicare still considers such treatment "reasonable and necessary" and continues to pay hundreds of millions of dollars for fraudulent claims every year. FCSO refuses to consider the one and ONLY option: stop payment of ALL HIV infusion therapy claims in Florida/South Florida. The response: We can't because patients who actually need the treatment would be denied services -- a policy no-no at Medicare. But experts have testified that no one needs this treatments anymore!! If any patient would require such treatment it would be an exception and Medicare could consider payment on a case by case basis! Lets be clear: Medicare officials know the claims are fraudulent. Medicare says it has adopted technology to block false claims for HIV infusion treatment, yet the government program still misses hundreds of millions of dollars annually. To add insult to injury on September 12th, 2008 the Centers for Medicare & Medicaid Services (CMS) announced that First Coast Service Options, Inc. (FCSO) has been awarded a contract of up to five years for the combined administration of Part A and Part B Medicare claims payment in Florida, Puerto Rico, and U.S. Virgin Islands. This represents not only a contract renewal but EXPANSION! In a press release CMS emphasized that “ with this award, CMS continues its progress in reengineering the way in which the government contracts for claims administration for the largest part of the Medicare program. CMS is seeking the best value, from a cost and technical perspective for this critical function.” The “best value” they probably get from FCSO is the waste of Medicare dollars! But they do not stop here! FCSO will be financially awarded too! In the same press release CMS officials emphasized that “ the contract for FCSO includes a base period and four one-year options and will provide FCSO with an opportunity to earn award fees based on its ability to meet or exceed the performance requirements set by CMS.” So they can earn extra dollars on the fraudulent claims amount?
So what can be done:
1)Call, e-mail or write your representative and/or Senator to hold FCSO responsible for every dollar wasted.
2)Petition the Office of Inspector General of the US Department of Health & Human Services at HHSTips@oig.hhs.gov to investigate FCSO business activities.
3)Force FCSO to repay each and every dollar of fraudulent claims paid and hold company executives legally accountable for their actions (or inactions)
In times of financial crisis we all have to act in a cautious manner exercising our duties , obligations and responsibilities as citizens. The blatant abuse of the Medicare system has to stop!
Yours
Bernd
Friday, May 08, 2009
Prescription Drug Legislation Faces Opposition
Attached an article from the Palm Beach Post regarding the prescription drug legislation. I hope that our organization speaks up in FAVOR of the legislation and AGAINST the request to torpedo this bill.
This legislation is the first step towards curbing the narcotic abuse.
The argument that " the sensitive personal and medical information contained in such a database would be susceptible to cyber terrorists and criminals who would use information against the citizens of Florida," is ludicrous!
Does that mean we will also stop using ATMs and Internet banking because our data could be misused by cyber terrorists or criminals?
When do politicians learn that fear-based politics is leading us nowhere?
We need to save lives and stop those drug-dealers in a white coat who claim to be doctors! They are not! They are drug dealers and they know it!
Please visit South Florida to understand the enormity of the problems. The number of pain clinics skyrocketed almost 100 % since last year! The nations TOP 30 narcotic drug prescriber's practice in Dade and Broward county! Hard to believe but its true. Doctors can be drug dealers, too!!
Yours
Bernd
============================================================================
Drug database access worries some in Florida House
By MICHAEL C. BENDER
Palm Beach Post Capital Bureau
Thursday, May 07, 2009
TALLAHASSEE — Thirteen state House Republicans sent a letter to Gov. Charlie Crist on Thursday, asking him to veto a bill one of their fellow GOP leaders sponsored.
Ten of the 13 lawmakers voted against the bill to create a prescription drug database in Florida. Three of the Republicans - Adam Hasner of Boca Raton, Anitere Flores of Miami and Dean Cannon of Winter Park - did not vote on the original bill.
The bill, sponsored by House budget co-chairman Marcelo Llorente, R-Miami, is aimed at curbing drug abuse. It was approved unanimously in the Senate and on a 113-10 vote in the House.
But a similar database was recently hacked in Virginia, according to TheWashington Post. House Republicans cited that story in their letter to Crist.
"This request is based on a well founded fear that the sensitive personal and medical information contained in such a database would be susceptible to cyber terrorists and criminals who would use information against the citizens of Florida," according to the letter.
Crist's press office did not comment.
Llorente said the bill (SB 462) creates a task force that will "ensure the protection of personal information."
"The tragic deaths of almost 10 Floridians a day must stop," Llorente said. "I urge the governor to sign this bill expeditiously in an effort to end the practice of doctor shopping."
In addition to Hasner, other local Republican lawmakers signing the letter were Reps. Ellyn Bogdanoff of Fort Lauderdale and Carl Domino of Jupiter.
This legislation is the first step towards curbing the narcotic abuse.
The argument that " the sensitive personal and medical information contained in such a database would be susceptible to cyber terrorists and criminals who would use information against the citizens of Florida," is ludicrous!
Does that mean we will also stop using ATMs and Internet banking because our data could be misused by cyber terrorists or criminals?
When do politicians learn that fear-based politics is leading us nowhere?
We need to save lives and stop those drug-dealers in a white coat who claim to be doctors! They are not! They are drug dealers and they know it!
Please visit South Florida to understand the enormity of the problems. The number of pain clinics skyrocketed almost 100 % since last year! The nations TOP 30 narcotic drug prescriber's practice in Dade and Broward county! Hard to believe but its true. Doctors can be drug dealers, too!!
Yours
Bernd
============================================================================
Drug database access worries some in Florida House
By MICHAEL C. BENDER
Palm Beach Post Capital Bureau
Thursday, May 07, 2009
TALLAHASSEE — Thirteen state House Republicans sent a letter to Gov. Charlie Crist on Thursday, asking him to veto a bill one of their fellow GOP leaders sponsored.
Ten of the 13 lawmakers voted against the bill to create a prescription drug database in Florida. Three of the Republicans - Adam Hasner of Boca Raton, Anitere Flores of Miami and Dean Cannon of Winter Park - did not vote on the original bill.
The bill, sponsored by House budget co-chairman Marcelo Llorente, R-Miami, is aimed at curbing drug abuse. It was approved unanimously in the Senate and on a 113-10 vote in the House.
But a similar database was recently hacked in Virginia, according to TheWashington Post. House Republicans cited that story in their letter to Crist.
"This request is based on a well founded fear that the sensitive personal and medical information contained in such a database would be susceptible to cyber terrorists and criminals who would use information against the citizens of Florida," according to the letter.
Crist's press office did not comment.
Llorente said the bill (SB 462) creates a task force that will "ensure the protection of personal information."
"The tragic deaths of almost 10 Floridians a day must stop," Llorente said. "I urge the governor to sign this bill expeditiously in an effort to end the practice of doctor shopping."
In addition to Hasner, other local Republican lawmakers signing the letter were Reps. Ellyn Bogdanoff of Fort Lauderdale and Carl Domino of Jupiter.
Tuesday, April 14, 2009
Drug Dealers in a White Coat
Miami Herald, Letter To The Editor
Posted on Mon, Apr. 13, 2009
Public health should be legislative priority
Re the April 8 editorial Belatedly, Florida takes on prescription-drug dealers: The unprecedented concentration of ''pain clinics'' in our community contributes to out-of-control opioid abuse, narcotic-drug dealing and endangers public health. It requires the concerted efforts of law enforcement, political leadership and the medical community to root out this problem. Several steps can be taken right now:
• Impose a moratorium on dispensing narcotics in physician's offices unless the prescribing physician is board certified in anesthesiology and pain medicine and operates within a licensed and certified facility to be approved by a designated agency.
• Make mandatory monthly inspections of all pain clinics in South Florida. Skilled inspectors can be trained to randomly audit charts and on-site pharmacies and monitor patient flow.
• Conduct criminal background checks of all operators and their financial backers, which will be reviewed and updated quarterly.
• Implement a prescription-drug monitoring system to identify drug-seekers and doctor-shoppers.
• Require the Board of Medicine to suspend the license of any physician who violates the standards of care as it pertains to inappropriate prescription of narcotics.
Let's act together to rid our community of these narco-cowboys. Let's protect our families, friends and patients from such predators. We can't be afraid to call them by their name: drug dealers in white coats.
BERND WOLLSCHLAEGER, MD, president, Dade County Medical Association, North Miami Beach
Posted on Mon, Apr. 13, 2009
Public health should be legislative priority
Re the April 8 editorial Belatedly, Florida takes on prescription-drug dealers: The unprecedented concentration of ''pain clinics'' in our community contributes to out-of-control opioid abuse, narcotic-drug dealing and endangers public health. It requires the concerted efforts of law enforcement, political leadership and the medical community to root out this problem. Several steps can be taken right now:
• Impose a moratorium on dispensing narcotics in physician's offices unless the prescribing physician is board certified in anesthesiology and pain medicine and operates within a licensed and certified facility to be approved by a designated agency.
• Make mandatory monthly inspections of all pain clinics in South Florida. Skilled inspectors can be trained to randomly audit charts and on-site pharmacies and monitor patient flow.
• Conduct criminal background checks of all operators and their financial backers, which will be reviewed and updated quarterly.
• Implement a prescription-drug monitoring system to identify drug-seekers and doctor-shoppers.
• Require the Board of Medicine to suspend the license of any physician who violates the standards of care as it pertains to inappropriate prescription of narcotics.
Let's act together to rid our community of these narco-cowboys. Let's protect our families, friends and patients from such predators. We can't be afraid to call them by their name: drug dealers in white coats.
BERND WOLLSCHLAEGER, MD, president, Dade County Medical Association, North Miami Beach
Saturday, April 04, 2009
Every American is entitled to affordable healthcare!
Saturday, April 4, 2009
Letter To The Editor
“Every American is entitled to affordable healthcare!”
The Miami Herald Editorial Board is correct: every American should have access to affordable healthcare delivered by a physician of their choice. But expanding coverage only increases the volume of healthcare services and costs! This shortsighted focus misses the bigger picture.
We have to realign our payment system and reward quality and not the quantity of medical services rendered. The current reimbursement system is centered on a volume-based model and must shift towards a value-based system instead. We have to rebuild our primary care system and reward family physicians who spent valuable time with patients teaching healthy lifestyle and nutrition to prevent the incidence of chronic diseases. We should motivate and reward physicians to integrate their practices within collaborative practice models or groups. Utilizing shared Electronic Health Records based on Web 2.0 technologies physicians can communicate easily and securely. Such systems can measure and compare their performance, create a framework for quality and not quantity based reimbursement. Furthermore, physicians will learn to work within a team of medical professionals to optimize the treatment outcome for their patients.
As a result of the above outlined steps we can finally provide a Patient Centered Medical Home with a high degree of personalized care coordination, access beyond the acute care episode, and identification of key medical and community resources to meet the patients’ needs.
We as physicians have the choice to proactively change the delivery of healthcare today! We have the tools available to make this happen. Lets not miss this opportunity!
Bernd Wollschlaeger,MD,FAAFP,FASAM - President, Dade County Medical Association
16899 NE 15th Avenue, North Miami Beach, FL 33162
Phone: (305) 940-8717
E-mail: info@miamihealth.com
=======================================================================================
MIAMI HERALD
Posted on Fri, Apr. 03, 2009
Health insurance out of balance
Among the many issues on America's healthcare-reform agenda, one deserving a high priority should be to level the playing field for people looking to buy health insurance. As it now stands, insurers have most of the advantages. Example: rejecting potential customers because of ''preexisting conditions.'' Congress and President Barack Obama should put a stop to this practice. Meanwhile, Florida Insurance Commissioner Kevin McCarty should ask the Legislature for reforms.
Patients blacklisted
In a Page One story last Sunday, Miami Herald reporter John Dorschner described how some insurers use secretive underwriting guidelines to blacklist people with certain ailments or who take certain drugs. For example, one insurer's guideline recommends rejecting people who have diabetes, multiple sclerosis, schizophrenia, Parkinson's Disease, Hepatitis C or AIDS/HIV. Other guidelines suggest automatic denial of people who take the anti-clotting drug Plavix or Seroquel, of those who use prescribed anti-psychotic medications, and anyone who uses certain medications for sleep apnea.
Insurers should not be expected to automatically enroll anyone who applies for a policy. They must be able to determine the amount of risk they are taking on in order to price policies appropriately and to earn a profit. Insurers also need to be able to protect themselves from people who lie about ailments in order to get coverage. At the same time, though, honest consumers should get a fair shake, which means not having to demonstrate a level of pristine health that virtually no one can attain. Without the right rules in place, insurers would cover only healthy people and have no risk at all.
Insurers say that their underwriting rules are based on standards set by the industry and by the state and federal governments. This is where change should begin. President Obama has said he wants to make insurance much more affordable and that having nearly 50 million Americans without health coverage is unacceptable. He stops short, however, of embracing universal healthcare.
A bit of progress
In December, some of the country's top insurers said they were willing to stop using preexisting conditions as a basis for pricing policies in return for laws requiring universal coverage. This, at least, is a start. Universal healthcare may, or may not, be the best solution, but it is clear that too many Americans have been squeezed out of the insurance market -- and that must change.
Commissioner McCarty can get the ball rolling by asking the Legislature to adopt underwriting guidelines that protect consumers. Congress should help President Obama make health insurance available to every American.
Letter To The Editor
“Every American is entitled to affordable healthcare!”
The Miami Herald Editorial Board is correct: every American should have access to affordable healthcare delivered by a physician of their choice. But expanding coverage only increases the volume of healthcare services and costs! This shortsighted focus misses the bigger picture.
We have to realign our payment system and reward quality and not the quantity of medical services rendered. The current reimbursement system is centered on a volume-based model and must shift towards a value-based system instead. We have to rebuild our primary care system and reward family physicians who spent valuable time with patients teaching healthy lifestyle and nutrition to prevent the incidence of chronic diseases. We should motivate and reward physicians to integrate their practices within collaborative practice models or groups. Utilizing shared Electronic Health Records based on Web 2.0 technologies physicians can communicate easily and securely. Such systems can measure and compare their performance, create a framework for quality and not quantity based reimbursement. Furthermore, physicians will learn to work within a team of medical professionals to optimize the treatment outcome for their patients.
As a result of the above outlined steps we can finally provide a Patient Centered Medical Home with a high degree of personalized care coordination, access beyond the acute care episode, and identification of key medical and community resources to meet the patients’ needs.
We as physicians have the choice to proactively change the delivery of healthcare today! We have the tools available to make this happen. Lets not miss this opportunity!
Bernd Wollschlaeger,MD,FAAFP,FASAM - President, Dade County Medical Association
16899 NE 15th Avenue, North Miami Beach, FL 33162
Phone: (305) 940-8717
E-mail: info@miamihealth.com
=======================================================================================
MIAMI HERALD
Posted on Fri, Apr. 03, 2009
Health insurance out of balance
Among the many issues on America's healthcare-reform agenda, one deserving a high priority should be to level the playing field for people looking to buy health insurance. As it now stands, insurers have most of the advantages. Example: rejecting potential customers because of ''preexisting conditions.'' Congress and President Barack Obama should put a stop to this practice. Meanwhile, Florida Insurance Commissioner Kevin McCarty should ask the Legislature for reforms.
Patients blacklisted
In a Page One story last Sunday, Miami Herald reporter John Dorschner described how some insurers use secretive underwriting guidelines to blacklist people with certain ailments or who take certain drugs. For example, one insurer's guideline recommends rejecting people who have diabetes, multiple sclerosis, schizophrenia, Parkinson's Disease, Hepatitis C or AIDS/HIV. Other guidelines suggest automatic denial of people who take the anti-clotting drug Plavix or Seroquel, of those who use prescribed anti-psychotic medications, and anyone who uses certain medications for sleep apnea.
Insurers should not be expected to automatically enroll anyone who applies for a policy. They must be able to determine the amount of risk they are taking on in order to price policies appropriately and to earn a profit. Insurers also need to be able to protect themselves from people who lie about ailments in order to get coverage. At the same time, though, honest consumers should get a fair shake, which means not having to demonstrate a level of pristine health that virtually no one can attain. Without the right rules in place, insurers would cover only healthy people and have no risk at all.
Insurers say that their underwriting rules are based on standards set by the industry and by the state and federal governments. This is where change should begin. President Obama has said he wants to make insurance much more affordable and that having nearly 50 million Americans without health coverage is unacceptable. He stops short, however, of embracing universal healthcare.
A bit of progress
In December, some of the country's top insurers said they were willing to stop using preexisting conditions as a basis for pricing policies in return for laws requiring universal coverage. This, at least, is a start. Universal healthcare may, or may not, be the best solution, but it is clear that too many Americans have been squeezed out of the insurance market -- and that must change.
Commissioner McCarty can get the ball rolling by asking the Legislature to adopt underwriting guidelines that protect consumers. Congress should help President Obama make health insurance available to every American.
Thursday, March 19, 2009
South Florida Doctor Cares For The Uninsured
Attached some bad and good news regarding the situation of the Uninsured in Florida.
Whats the BAD news?
The Miami Herald today reported that according to recent Census Bureau report more than five million Floridians were uninsured for at least a month during 2007 and 2008.
That works out to 38.1 percent of residents under 65. Almost four out of five of those were uninsured for six months or more, the report said.
Those figures reveal that Florida is slightly worse than the national average of 33.1 percent uninsured at some point during 2007 and 2008.
Other information from the study about Florida:
• More than four out of five uninsured Floridians, or 80.8 percent, were in working families.''
• More than three-fifths, or 60.7 percent, were individuals or families with incomes below twice the poverty line -- $42,400 of annual income for a family of four.''
Hispanics and African Americans were much more likely to be uninsured than non-Hispanic whites: 54.4 percent of Hispanics, 42.5 percent of African Americans, compared to 30.2 percent of non-Hispanic whites.
The study was based on the most recent Census Bureau reports and the Agency for Health Care Research and Quality.
Whats the GOOD news?
Some doctors are doing something about it and one of them, a South Miami radiologist, was featured in the Miami Herald.
Congratulation Dr. Kallos and we should honor her as an outstanding doctor and humanist.
============================================================================
Posted on Thu, Mar. 19, 2009
South Florida doctors offer options for uninsured
BY JOHN DORSCHNER
With the number of uninsured rising daily, a prominent South Miami radiologist is offering free mammogram screenings for women who have lost their jobs and health insurance.
''In the spirit of Barack Obama, we need to volunteer to help our country,'' said Nilza Kallos, who operates the Breast Health Center and Diagnostic Ultrasound.
She challenged other physicians to make similar offers. ''This could be like an invitation to other doctors to step up,'' she said.
``I've heard surgeons say they don't have enough work. Well, how about helping those who need help?''
Kallos' offer comes as many financially pressed patients are curtailing care because they can't afford it. Some are insured and can't even afford the co-payments. Few doctors in South Florida are matching Kallos' free offer, but many in Broward and Miami-Dade are offering discounts to those who need them.
''The situation has reached the crisis stage,'' says Bernd Wollschlaeger, a North Miami Beach physician and president of the Dade County Medical Association.
``I think we need to do something.''
He says he and others are lowering their prices for their uninsured patients or giving them other help if they can't afford to pay. ''If you donate some of your time, it comes back to help you,'' because patients will remember helpful doctors when the economy improves.
Tony Prieto, president of the Broward County Medical Association, said in a statement: ``Patients need to understand that doctors have bills to pay, staff salaries, and office expenses, but we are compassionate, reasonable people who want to help our patients.
``Patients who have lost their insurance should know that most doctors are willing to work with their patients, set up payment plans and give cash discounts so that the patients can still have access to care.''
Those doctors include Barbara Martin, a Tamarac internist. ''In my office we are not charging for any visits to patients who are in bad situations,'' Martin wrote in an e-mail. ``Also we are trying to get them medications that they can afford at Wal-Mart, and samples at the office.''
''I would be happy to offer services discounted to anyone who has lost a job,'' wrote Richard Rubenstein, a Tamarac dermatologist, in an e-mail.
Some doctors note they have always offered help to the uninsured.
Alan Routman, a Fort Lauderdale orthopedic surgeon, said: ``I've been giving patients without insurance 30 percent discounts for cash or credit-card payments forever.''
The burden of more people seeking cheaper healthcare often falls on publicly-funded health centers, who take all patients regardless of whether they have insurance. Jennifer Capezzuti, a primary care doctor at Broward Health, notes that she has been spending ``excessive amounts of time evaluating patient's prescriptions and switching to generic alternatives.''
At the Breast Center in South Miami, Kallos has long been known as a doctor who reached out to help the community.
In 2008, she was honored as a ''Woman of Vision'' by the American Committee for the Weizmann Institute of Science.
''The worst thing,'' Kallos said, 'is when I hear a woman say, `Oh, I lost my job and my insurance. I'll skip my mammogram this year.' Well, this could cost her a life,'' if a cancer went untreated for a year.
Kallos said she might have to spread out the appointments over time if she is inundated by request for free services.
''If it's a regular mammogram, it can wait a little bit. But if she says she has a lump, we'll do that right away,'' she said.
Edited and Published by
Berdn Wollschlaeger,MD,FAAFP,FASAM
President,Dade County Medical Association
Whats the BAD news?
The Miami Herald today reported that according to recent Census Bureau report more than five million Floridians were uninsured for at least a month during 2007 and 2008.
That works out to 38.1 percent of residents under 65. Almost four out of five of those were uninsured for six months or more, the report said.
Those figures reveal that Florida is slightly worse than the national average of 33.1 percent uninsured at some point during 2007 and 2008.
Other information from the study about Florida:
• More than four out of five uninsured Floridians, or 80.8 percent, were in working families.''
• More than three-fifths, or 60.7 percent, were individuals or families with incomes below twice the poverty line -- $42,400 of annual income for a family of four.''
Hispanics and African Americans were much more likely to be uninsured than non-Hispanic whites: 54.4 percent of Hispanics, 42.5 percent of African Americans, compared to 30.2 percent of non-Hispanic whites.
The study was based on the most recent Census Bureau reports and the Agency for Health Care Research and Quality.
Whats the GOOD news?
Some doctors are doing something about it and one of them, a South Miami radiologist, was featured in the Miami Herald.
Congratulation Dr. Kallos and we should honor her as an outstanding doctor and humanist.
============================================================================
Posted on Thu, Mar. 19, 2009
South Florida doctors offer options for uninsured
BY JOHN DORSCHNER
With the number of uninsured rising daily, a prominent South Miami radiologist is offering free mammogram screenings for women who have lost their jobs and health insurance.
''In the spirit of Barack Obama, we need to volunteer to help our country,'' said Nilza Kallos, who operates the Breast Health Center and Diagnostic Ultrasound.
She challenged other physicians to make similar offers. ''This could be like an invitation to other doctors to step up,'' she said.
``I've heard surgeons say they don't have enough work. Well, how about helping those who need help?''
Kallos' offer comes as many financially pressed patients are curtailing care because they can't afford it. Some are insured and can't even afford the co-payments. Few doctors in South Florida are matching Kallos' free offer, but many in Broward and Miami-Dade are offering discounts to those who need them.
''The situation has reached the crisis stage,'' says Bernd Wollschlaeger, a North Miami Beach physician and president of the Dade County Medical Association.
``I think we need to do something.''
He says he and others are lowering their prices for their uninsured patients or giving them other help if they can't afford to pay. ''If you donate some of your time, it comes back to help you,'' because patients will remember helpful doctors when the economy improves.
Tony Prieto, president of the Broward County Medical Association, said in a statement: ``Patients need to understand that doctors have bills to pay, staff salaries, and office expenses, but we are compassionate, reasonable people who want to help our patients.
``Patients who have lost their insurance should know that most doctors are willing to work with their patients, set up payment plans and give cash discounts so that the patients can still have access to care.''
Those doctors include Barbara Martin, a Tamarac internist. ''In my office we are not charging for any visits to patients who are in bad situations,'' Martin wrote in an e-mail. ``Also we are trying to get them medications that they can afford at Wal-Mart, and samples at the office.''
''I would be happy to offer services discounted to anyone who has lost a job,'' wrote Richard Rubenstein, a Tamarac dermatologist, in an e-mail.
Some doctors note they have always offered help to the uninsured.
Alan Routman, a Fort Lauderdale orthopedic surgeon, said: ``I've been giving patients without insurance 30 percent discounts for cash or credit-card payments forever.''
The burden of more people seeking cheaper healthcare often falls on publicly-funded health centers, who take all patients regardless of whether they have insurance. Jennifer Capezzuti, a primary care doctor at Broward Health, notes that she has been spending ``excessive amounts of time evaluating patient's prescriptions and switching to generic alternatives.''
At the Breast Center in South Miami, Kallos has long been known as a doctor who reached out to help the community.
In 2008, she was honored as a ''Woman of Vision'' by the American Committee for the Weizmann Institute of Science.
''The worst thing,'' Kallos said, 'is when I hear a woman say, `Oh, I lost my job and my insurance. I'll skip my mammogram this year.' Well, this could cost her a life,'' if a cancer went untreated for a year.
Kallos said she might have to spread out the appointments over time if she is inundated by request for free services.
''If it's a regular mammogram, it can wait a little bit. But if she says she has a lump, we'll do that right away,'' she said.
Edited and Published by
Berdn Wollschlaeger,MD,FAAFP,FASAM
President,Dade County Medical Association
Sunday, March 15, 2009
Home Health Care Fraud
Miami - Dade county tops the list again.
Investigators of the Government Accountability Office (GAO) cited that:
> Unusually large share of diabetic patients receiving home healthcare in the county -- 50 percent. That's nearly triple the
average rate in all other major metro areas nationwide.
> The number of Medicare-licensed home healthcare agencies reached 8,463 in 2006 -- up from 6,553 in 2002. More than
half of that increase occurred in two states, Florida and Texas.
> In 2006 Medicare spent about $13 billion for homebound patients nationwide receiving skilled nursing, aide and other visits
-- up about 44 percent from expenses in 2002. Yet over that five-year period, the number of home healthcare patients
using Medicare home services grew by 17 percent.
> In Miami-Dade in 2007, home healthcare agencies received more than $550 million from Medicare for treating patients.
That was four times greater than all Medicare payments for similar services billed in Chicago, Dallas, Houston and Atlanta,
even though there are more people over age 65 in each of those metro areas, the report says.
What are the factors contributing to the problem?
> Unscrupulous business people who can open a home-health company without any background screening or proper vetting
procedure.
> Unethical doctors who expect and receive CASH payment in brown bags (yes, its true) for each patient referral, even though
home health care is not indicated.
> Medicare outsourced home health administration to private contractors who are not being watched or being held
accountable for their services.
SOLUTIONS:
> Stop private contracting process(Moratorium)
> Freeze licensure of all home health companies in Dade County and review their business practices. Unfortunately, South
Florida politicians do not have the guts (or cannot afford being cut-off from a guaranteed money flow) to stand up to that
Home Health lobby.
> Revoke the license of each and every doctor who accepts kickbacks.
Radical solutions? Yes they are! But something has to be done to stop the bleeding!
PS: Please send all hate mail and threats to the State Attorneys office.
Posted on Fri, Mar. 13, 2009
Study blasts rampant healthcare fraud, especially in Miami-Dade
BY JAY WEAVER
A U.S. government watchdog agency has singled out Miami-Dade County for acute fraud in the $13 billion home healthcare industry, in a newly released report that spotlights runaway costs due to suspicious Medicare billing.
The Government Accountability Office cited the unusually large share of diabetic patients receiving home healthcare in the county -- 50 percent. That's nearly triple the average rate in all other major metro areas nationwide.
GAO investigators blamed Medicare for poor oversight of home healthcare agencies, citing hundreds of millions of dollars in ''improper payments'' for fraudulent claims in Miami, Houston, Los Angeles and other metropolitan areas.
The findings of the report, which analyzed 2002-2006 Medicare billings, angered the ranking Republican member of the Senate Finance Committee. U.S. Sen. Charles E. Grassley, R-Iowa, warned top officials of the nation's health insurance program for the elderly that they must confront fraud as part of President Barack Obama's goal to reform Medicare.
''I regret to say that it seems to me that [Medicare] is out of touch with the home health benefit and has yet to recognize the vulnerabilities inherent in the system,'' Grassley wrote Medicare's acting administrator.
``In order to bring much needed integrity into this program, [Medicare] needs to stop dropping the ball.''
Several of the troubling findings in the GAO report -- including questionable Medicare billing by Miami-Dade home healthcare agencies for services either not necessary or not provided -- were disclosed in The Miami Herald last November. The story showed that the problem has continued beyond the five years covered in the GAO report, with billings reaching $16.5 billion last year.
Medicare officials said they have taken steps to stop fraud -- including suspending more than $100 million in annual payments to 13 home healthcare agencies in Miami-Dade last fall. They're suspected of overbilling for nurses treating homebound diabetic patients who don't need help injecting their insulin.
Medicare is also conducting audits of claims and payments to determine whether services were actually prescribed by doctors and provided by agencies.
BACKGROUND CHECKS
But Medicare said it isn't screening home healthcare applicants for criminal backgrounds, as recommended by the watchdog agency.
The GAO report found that in 2006 Medicare spent about $13 billion for homebound patients nationwide receiving skilled nursing, aide and other visits -- up about 44 percent from expenses in 2002. Yet over that five-year period, the number of home healthcare patients using Medicare home services grew by 17 percent.
Overall, home healthcare spending was highest in California, Florida, Louisiana, Nevada, Oklahoma, Texas and Utah.
Another startling statistic: the number of Medicare-licensed home healthcare agencies reached 8,463 in 2006 -- up from 6,553 in 2002. More than half of that increase occurred in two states, Florida and Texas.
'UPCODING' RAMPANT
GAO investigators said that as those numbers have soared, so have fraudulent and abusive billing practices. Among them: ``upcoding -- overstating the severity of a beneficiary's condition.''
That practice is rampant in Miami-Dade, where home healthcare agencies are suspected of paying kickbacks to homebound patients diagnosed with diabetes who don't need nurses to inject their insulin twice daily.
The GAO report noted that in Miami-Dade in 2007, home healthcare agencies received more than $550 million from Medicare for treating patients. That was four times greater than all Medicare payments for similar services billed in Chicago, Dallas, Houston and Atlanta, even though there are more people over age 65 in each of those metro areas, the report says.
Investigators of the Government Accountability Office (GAO) cited that:
> Unusually large share of diabetic patients receiving home healthcare in the county -- 50 percent. That's nearly triple the
average rate in all other major metro areas nationwide.
> The number of Medicare-licensed home healthcare agencies reached 8,463 in 2006 -- up from 6,553 in 2002. More than
half of that increase occurred in two states, Florida and Texas.
> In 2006 Medicare spent about $13 billion for homebound patients nationwide receiving skilled nursing, aide and other visits
-- up about 44 percent from expenses in 2002. Yet over that five-year period, the number of home healthcare patients
using Medicare home services grew by 17 percent.
> In Miami-Dade in 2007, home healthcare agencies received more than $550 million from Medicare for treating patients.
That was four times greater than all Medicare payments for similar services billed in Chicago, Dallas, Houston and Atlanta,
even though there are more people over age 65 in each of those metro areas, the report says.
What are the factors contributing to the problem?
> Unscrupulous business people who can open a home-health company without any background screening or proper vetting
procedure.
> Unethical doctors who expect and receive CASH payment in brown bags (yes, its true) for each patient referral, even though
home health care is not indicated.
> Medicare outsourced home health administration to private contractors who are not being watched or being held
accountable for their services.
SOLUTIONS:
> Stop private contracting process(Moratorium)
> Freeze licensure of all home health companies in Dade County and review their business practices. Unfortunately, South
Florida politicians do not have the guts (or cannot afford being cut-off from a guaranteed money flow) to stand up to that
Home Health lobby.
> Revoke the license of each and every doctor who accepts kickbacks.
Radical solutions? Yes they are! But something has to be done to stop the bleeding!
PS: Please send all hate mail and threats to the State Attorneys office.
Posted on Fri, Mar. 13, 2009
Study blasts rampant healthcare fraud, especially in Miami-Dade
BY JAY WEAVER
A U.S. government watchdog agency has singled out Miami-Dade County for acute fraud in the $13 billion home healthcare industry, in a newly released report that spotlights runaway costs due to suspicious Medicare billing.
The Government Accountability Office cited the unusually large share of diabetic patients receiving home healthcare in the county -- 50 percent. That's nearly triple the average rate in all other major metro areas nationwide.
GAO investigators blamed Medicare for poor oversight of home healthcare agencies, citing hundreds of millions of dollars in ''improper payments'' for fraudulent claims in Miami, Houston, Los Angeles and other metropolitan areas.
The findings of the report, which analyzed 2002-2006 Medicare billings, angered the ranking Republican member of the Senate Finance Committee. U.S. Sen. Charles E. Grassley, R-Iowa, warned top officials of the nation's health insurance program for the elderly that they must confront fraud as part of President Barack Obama's goal to reform Medicare.
''I regret to say that it seems to me that [Medicare] is out of touch with the home health benefit and has yet to recognize the vulnerabilities inherent in the system,'' Grassley wrote Medicare's acting administrator.
``In order to bring much needed integrity into this program, [Medicare] needs to stop dropping the ball.''
Several of the troubling findings in the GAO report -- including questionable Medicare billing by Miami-Dade home healthcare agencies for services either not necessary or not provided -- were disclosed in The Miami Herald last November. The story showed that the problem has continued beyond the five years covered in the GAO report, with billings reaching $16.5 billion last year.
Medicare officials said they have taken steps to stop fraud -- including suspending more than $100 million in annual payments to 13 home healthcare agencies in Miami-Dade last fall. They're suspected of overbilling for nurses treating homebound diabetic patients who don't need help injecting their insulin.
Medicare is also conducting audits of claims and payments to determine whether services were actually prescribed by doctors and provided by agencies.
BACKGROUND CHECKS
But Medicare said it isn't screening home healthcare applicants for criminal backgrounds, as recommended by the watchdog agency.
The GAO report found that in 2006 Medicare spent about $13 billion for homebound patients nationwide receiving skilled nursing, aide and other visits -- up about 44 percent from expenses in 2002. Yet over that five-year period, the number of home healthcare patients using Medicare home services grew by 17 percent.
Overall, home healthcare spending was highest in California, Florida, Louisiana, Nevada, Oklahoma, Texas and Utah.
Another startling statistic: the number of Medicare-licensed home healthcare agencies reached 8,463 in 2006 -- up from 6,553 in 2002. More than half of that increase occurred in two states, Florida and Texas.
'UPCODING' RAMPANT
GAO investigators said that as those numbers have soared, so have fraudulent and abusive billing practices. Among them: ``upcoding -- overstating the severity of a beneficiary's condition.''
That practice is rampant in Miami-Dade, where home healthcare agencies are suspected of paying kickbacks to homebound patients diagnosed with diabetes who don't need nurses to inject their insulin twice daily.
The GAO report noted that in Miami-Dade in 2007, home healthcare agencies received more than $550 million from Medicare for treating patients. That was four times greater than all Medicare payments for similar services billed in Chicago, Dallas, Houston and Atlanta, even though there are more people over age 65 in each of those metro areas, the report says.
Saturday, March 14, 2009
Primary Care in Crisis
Dear Friends and Colleagues:
Attached a great article from todays Miami Herald focusing on efforts to boost primary care funding.
I wholeheartedly support such efforts but am concerned to direct the funding for community health center only!
Lets not forget that the overwhelming majority of primary care visits are being rendered in private doctors offices!
In order to adapt to the rapidly changing healthcare market place those offices need the following:
* Logistical support to form collaborative practice networks to leverage their purchasing power, reduce administrative overhead, optimize practice management, access to skilled and trained human resources etc.
* Educate physicians and staff on how to integrate their practices into the medical home delivery system
* Optimize practice workflow to reduce patient error, increase quality and ascertain outcome
* Install and implement state-of-the art medical information technology tools
* Continuous assistance and support in the transformation process
This requires financial incentives, loans and grants and the active participation of specialty societies and other physician groups.
We must double our efforts to increase the workforce of primary care physicians. The clock is ticking.
Bernd
Posted on Sat, Mar. 14, 2009
Study: Florida would save money by boosting primary care
BY JOHN DORSCHNER
Legislators are expected to receive next week a research paper that concludes the state could save $700 million a year in healthcare costs by making sure Floridians had a place to go for primary care.
More basic screenings and preventive care would keep many people out of expensive trips to the emergency room, wrote four researchers from The George Washington University. At present, 3.8 million Floridians don't have insurance, the study reports, and eight million ``lack access to a regular source of primary healthcare.''
The report comes at a time when the Obama administration is pouring $10 million into Florida's community health centers as part of the stimulus package, and more money may be on the way.
The Florida Association of Community Health Centers plans to use the George Washington University study to make a case that the Legislature should double funding for public clinics next year -- from $15.3 million to $31 million. The group also favors a $1 per pack increase in cigarette taxes.
''We're not asking for a lot,'' said Andrew Behrman, president of the association. ``And it could do a lot to help Florida.''
Both Democratic and Republican policymakers say more emphasis on primary care is the best way to reduce overall healthcare costs, but finding the dollars to finance it has been a challenge.
Behrman's group advocates getting the $31 million from the billion-dollar Lower Income Pool, made up of federal and local tax dollars intended for institutions that do the most for the poor and uninsured, such as the large public hospitals.
Anthony Carvalho, president of the Safety Net Hospital Alliance of Florida, which includes the Broward and Miami-Dade public hospitals, said, ''We think primary care initiatives are good,'' but he wasn't certain whether LIP is the best way to fund.
At present an LIP council, led by large public hospitals, recommends to the Legislature how the pool money should be spent. The Safety Net group, whose members form the bulk of the council, favors its retention. The Health Centers group supports a bill to abolish the council.
Meanwhile, money is rolling in from Washington. The Broward Community and Family Health Centers in Hollywood is getting $1.3 million in stimulus money to expand operations.
Community Health of South Florida (was just informed by a federal agency that it could receive $995,000 to help its seven clinics assist the poor and uninsured.
CHI Chief Executive Brodes Hartley said the group's clinics treated 58,000 patients in 2007, 65,000 in 2008 and are expecting increased growth this year. Hartley said he hopes to use the new funds to hire another obstetrician-gynecologist to deliver babies in South Dade and for other matters.
Attached a great article from todays Miami Herald focusing on efforts to boost primary care funding.
I wholeheartedly support such efforts but am concerned to direct the funding for community health center only!
Lets not forget that the overwhelming majority of primary care visits are being rendered in private doctors offices!
In order to adapt to the rapidly changing healthcare market place those offices need the following:
* Logistical support to form collaborative practice networks to leverage their purchasing power, reduce administrative overhead, optimize practice management, access to skilled and trained human resources etc.
* Educate physicians and staff on how to integrate their practices into the medical home delivery system
* Optimize practice workflow to reduce patient error, increase quality and ascertain outcome
* Install and implement state-of-the art medical information technology tools
* Continuous assistance and support in the transformation process
This requires financial incentives, loans and grants and the active participation of specialty societies and other physician groups.
We must double our efforts to increase the workforce of primary care physicians. The clock is ticking.
Bernd
Posted on Sat, Mar. 14, 2009
Study: Florida would save money by boosting primary care
BY JOHN DORSCHNER
Legislators are expected to receive next week a research paper that concludes the state could save $700 million a year in healthcare costs by making sure Floridians had a place to go for primary care.
More basic screenings and preventive care would keep many people out of expensive trips to the emergency room, wrote four researchers from The George Washington University. At present, 3.8 million Floridians don't have insurance, the study reports, and eight million ``lack access to a regular source of primary healthcare.''
The report comes at a time when the Obama administration is pouring $10 million into Florida's community health centers as part of the stimulus package, and more money may be on the way.
The Florida Association of Community Health Centers plans to use the George Washington University study to make a case that the Legislature should double funding for public clinics next year -- from $15.3 million to $31 million. The group also favors a $1 per pack increase in cigarette taxes.
''We're not asking for a lot,'' said Andrew Behrman, president of the association. ``And it could do a lot to help Florida.''
Both Democratic and Republican policymakers say more emphasis on primary care is the best way to reduce overall healthcare costs, but finding the dollars to finance it has been a challenge.
Behrman's group advocates getting the $31 million from the billion-dollar Lower Income Pool, made up of federal and local tax dollars intended for institutions that do the most for the poor and uninsured, such as the large public hospitals.
Anthony Carvalho, president of the Safety Net Hospital Alliance of Florida, which includes the Broward and Miami-Dade public hospitals, said, ''We think primary care initiatives are good,'' but he wasn't certain whether LIP is the best way to fund.
At present an LIP council, led by large public hospitals, recommends to the Legislature how the pool money should be spent. The Safety Net group, whose members form the bulk of the council, favors its retention. The Health Centers group supports a bill to abolish the council.
Meanwhile, money is rolling in from Washington. The Broward Community and Family Health Centers in Hollywood is getting $1.3 million in stimulus money to expand operations.
Community Health of South Florida (was just informed by a federal agency that it could receive $995,000 to help its seven clinics assist the poor and uninsured.
CHI Chief Executive Brodes Hartley said the group's clinics treated 58,000 patients in 2007, 65,000 in 2008 and are expecting increased growth this year. Hartley said he hopes to use the new funds to hire another obstetrician-gynecologist to deliver babies in South Dade and for other matters.
Thursday, March 12, 2009
Pain Clinics
Wednesday, February 11, 2009
MESSAGE FROM YOUR PRESIDENT:
Painless Choices: Cocaine Cowboys Version 2.0
“Cocaine Cowboys” is a 2006 documentary film, which chronicles the development of the illegal drug trade in Miami during the 1970s and 1980s with interviews of both law enforcement and organized crime leaders. The film reveals that much of the economic growth, which took place in Miami during this time period, was a benefit of the drug trade. As members of the drug trade made immense amounts of money, this money flowed in large amounts into legitimate businesses. As a result, drug money indirectly financed the construction of many of the modern high-rise buildings in southern Florida. Later, when law enforcement pressure drove many major players out of the picture, many high-end stores and businesses closed because of plummeting sales.
But drug dealers and their cronies do have learned their lessons and refined their approach. Their basic premise: why going underground if one can deal narcotics legally. What ingredients do you need? A medical office, a doctor’s license,a DEA number, on-site drug dispensing and plenty of advertisement space. All of the above results in a booming cash business in our midst, attracting clients from as far away as Alabama, Kentucky and Georgia. One street newspaper features a “Health & Wellness” section brimming with almost fifty (50) pain clinic ads strategically following the “adult business” section.
In those ads “renowned” pain “doctors” want you to “ get back the life you once knew”, to help you to “ break free from pain” and suggest that “in all this madness good doctors matter.” Naturally, most of those clinics are happy to provide you with any narcotics of your choice if you provide the “proof” to be in pain. An MRI indicating an abnormality suffices to qualify you as a legitimate pain patients. From then on one can receive a variety of narcotics of choice from their menu, dispensed on-site, and with an almost guaranteed refill option, otherwise their business model would suffer. In many cases these unscrupulous modern narco cowboys make millions of dollars a year in CASH!
I have had the “pleasure” encountering several of those “colleagues” who in many cases have no formal training in pain medicine, are semi-retired, had licensure problems, and appear to be board certified in predatory medicine.
The unprecedented concentration of those “pain clinics” in midst our community contributes to out-of-control opioid abuse, narcotic drug dealing and endangers the public health. In my opinion, several of those pain clinics are financed and operated by criminal gangs and the proceeds of their activities are being invested in local businesses, including real estate.It requires the concerted efforts of law-enforcement, political leadership and the medical community to root out his problem. Several steps can be taken right now:
1) Impose a moratorium of dispensing narcotics in physician’s offices, unless the prescribing physician is board-certified in anesthesiology and pain medicine and operates within a licensed and certified facility to be approved by a designated agency. This will immediately reduce the phenomenon of “ pill shoppers” who are pretending to suffer from pain, receive narcotics in numerous pain clinics and then sell those for a huge profit on the street.
2) Mandatory monthly inspection of all pain clinics in South Florida. Skilled inspectors can be trained to randomly audit charts, on-site pharmacies and monitor the patient flow at so-called pain clinics.
3) Criminal background checks of all operators and their financial backers to be reviewed and updated on a quarterly basis.
4) Implementation of a prescription drug monitoring system as a tool to identify drug-seekers and doctor-shoppers.
5) Requiring the Board of Medicine to suspend the license of any physician who violates the standards of care as it pertains to inappropriate prescription of narcotics.
I want to emphasize that the above proposed sanction DO NOT APPLY to most physicians in private practice who in almost all cases legitimately prescribe narcotics for pain. The “physicians” in questions in those pain clinics prescribe hundreds of powerful narcotics at a time to anyone pretending to be in pain! Their “standard of practice” does NOT equate our high standards of care. Les act together to rid our community from these narco cowboys. Lets protect our families, friends and patients from those predators.
Don’t be afraid to call them by their name: drug dealers in a white coat.
MESSAGE FROM YOUR PRESIDENT:
Painless Choices: Cocaine Cowboys Version 2.0
“Cocaine Cowboys” is a 2006 documentary film, which chronicles the development of the illegal drug trade in Miami during the 1970s and 1980s with interviews of both law enforcement and organized crime leaders. The film reveals that much of the economic growth, which took place in Miami during this time period, was a benefit of the drug trade. As members of the drug trade made immense amounts of money, this money flowed in large amounts into legitimate businesses. As a result, drug money indirectly financed the construction of many of the modern high-rise buildings in southern Florida. Later, when law enforcement pressure drove many major players out of the picture, many high-end stores and businesses closed because of plummeting sales.
But drug dealers and their cronies do have learned their lessons and refined their approach. Their basic premise: why going underground if one can deal narcotics legally. What ingredients do you need? A medical office, a doctor’s license,a DEA number, on-site drug dispensing and plenty of advertisement space. All of the above results in a booming cash business in our midst, attracting clients from as far away as Alabama, Kentucky and Georgia. One street newspaper features a “Health & Wellness” section brimming with almost fifty (50) pain clinic ads strategically following the “adult business” section.
In those ads “renowned” pain “doctors” want you to “ get back the life you once knew”, to help you to “ break free from pain” and suggest that “in all this madness good doctors matter.” Naturally, most of those clinics are happy to provide you with any narcotics of your choice if you provide the “proof” to be in pain. An MRI indicating an abnormality suffices to qualify you as a legitimate pain patients. From then on one can receive a variety of narcotics of choice from their menu, dispensed on-site, and with an almost guaranteed refill option, otherwise their business model would suffer. In many cases these unscrupulous modern narco cowboys make millions of dollars a year in CASH!
I have had the “pleasure” encountering several of those “colleagues” who in many cases have no formal training in pain medicine, are semi-retired, had licensure problems, and appear to be board certified in predatory medicine.
The unprecedented concentration of those “pain clinics” in midst our community contributes to out-of-control opioid abuse, narcotic drug dealing and endangers the public health. In my opinion, several of those pain clinics are financed and operated by criminal gangs and the proceeds of their activities are being invested in local businesses, including real estate.It requires the concerted efforts of law-enforcement, political leadership and the medical community to root out his problem. Several steps can be taken right now:
1) Impose a moratorium of dispensing narcotics in physician’s offices, unless the prescribing physician is board-certified in anesthesiology and pain medicine and operates within a licensed and certified facility to be approved by a designated agency. This will immediately reduce the phenomenon of “ pill shoppers” who are pretending to suffer from pain, receive narcotics in numerous pain clinics and then sell those for a huge profit on the street.
2) Mandatory monthly inspection of all pain clinics in South Florida. Skilled inspectors can be trained to randomly audit charts, on-site pharmacies and monitor the patient flow at so-called pain clinics.
3) Criminal background checks of all operators and their financial backers to be reviewed and updated on a quarterly basis.
4) Implementation of a prescription drug monitoring system as a tool to identify drug-seekers and doctor-shoppers.
5) Requiring the Board of Medicine to suspend the license of any physician who violates the standards of care as it pertains to inappropriate prescription of narcotics.
I want to emphasize that the above proposed sanction DO NOT APPLY to most physicians in private practice who in almost all cases legitimately prescribe narcotics for pain. The “physicians” in questions in those pain clinics prescribe hundreds of powerful narcotics at a time to anyone pretending to be in pain! Their “standard of practice” does NOT equate our high standards of care. Les act together to rid our community from these narco cowboys. Lets protect our families, friends and patients from those predators.
Don’t be afraid to call them by their name: drug dealers in a white coat.
Health Care On Life Support
Wednesday, March 11, 2009
MESSAGE FROM YOUR PRESIDENT:
Health Care on Life Support: Challenges and Opportunities
By now, most of you have heard that every business in America is buckling under the increasing costs of healthcare expenses. Year after year, health care costs grow faster than the rest of the economy, straining families, businesses, and government budgets. The Center for Medicare and Medicaid Services reported this week that total health care spending rose 6.1 percent in 2007; slightly less than the growth of 6.7 percent in 2006. Even so, it continued to expand faster than the overall economy, which is contracting., reaching a total of $ 2.2 Trillion in 2007, or 16.2 percent of the gross domestic product (GDP). Americans will spend $2.4 trillion on health care in 2008, which is equal to $7,900 a person! Despite the record spending there are 46 million Americans (and growing) without health insurance. No industrialized nation in the world comes even close to the percentage of GDP America spends on healthcare. There is strong evidence that much of this spending does not contribute to better health. Americans spend twice as much per person as the average among other industrialized countries, and yet our life expectancy and infant mortality rates are below average. At least one-third of medical procedures have questionable benefits, according to the Rand Corporation. Based on a study of regional variation, Dartmouth researchers concluded that Medicare spending could be reduced by 29 percent without reducing effective care or affecting health outcomes. The finding suggests that the entire American health care system spends roughly $700 billion a year that does not improve health outcomes. On top of it, in Dade county alone billions of precious health care dollars disappear every year and wind up in the pockets of crooks and criminals. Many businesses also face unique challenges. They lack the negotiating clout needed to obtain favorable rates from insurance companies, and their inability to spread risk across a large group of employees means that the health problems of a single employee can drive premiums up to unaffordable levels. Without economies of scale, small businesses also face larger administrative costs for each worker covered. Small business owners and their employees account for an estimated 27 million of the 47 million Americans without health insurance. Some employers are dropping health insurance, while employment is growing more quickly in industries that are less likely to cover their workers. As a result, fewer and fewer Americans receive health coverage from work. The percentage of Americans covered by employers dropped from 62 percent in 2003 to 59 percent in 2008, the equivalent of 8 million people losing coverage. And for tens of millions of Americans ineligible for Medicare, Medicaid, or another public program, no viable alternative exists to employer-sponsored insurance. There are several issues that need to be fixed to address the health care cost explosion :
1) We must transform health care from a fragmented system into a coordinated and integrated delivery system utilizing information technology, thereby enabling healthcare professionals to measure cost, quality and outcome at the point-of-care.
2) Fundamental payment reforms that encourages doctors and hospitals to improve management of chronic diseases and adopt proven treatments. We have to shift from a volume-based to a value-based reimbursement system. This will reward doctors to spend time with their patients and to focus on the core value of patient care. Otherwise, we will use an entire generation of urgently needed primary care physicians.
3) Promote the application of business management principles in medical offices to help doctors to work smarter and NOT harder.
4) Emphasize the use of generic drugs that can provide equally or even more effective treatment at lower cost. Retail spending on prescription drugs rose only 4.9 percent in 2007, versus 8.6 percent growth in 2006, which is due to the increased use of generic drugs.
5) Stop the preferred funding for Medicare Advantage Plans leading to higher reimbursement and higher costs (115 percent of fee-for-service traditional Medicare). The only beneficiaries are commercial insurance companies which rake in higher profits per member and drain public coffers.
These are just a few ideas that should be assessed and evaluated. As doctors we should take a proactive position and start reshaping our practices. Many of us are stuck in the daily routine and are afraid to change. Organized medicine can and will play a greater role to leverage the risk and assist the individual doctors along the process of change. If we do not adjust to the changing market now, others will enforce painful solutions. Let’s be proactive and not reactive!
MESSAGE FROM YOUR PRESIDENT:
Health Care on Life Support: Challenges and Opportunities
By now, most of you have heard that every business in America is buckling under the increasing costs of healthcare expenses. Year after year, health care costs grow faster than the rest of the economy, straining families, businesses, and government budgets. The Center for Medicare and Medicaid Services reported this week that total health care spending rose 6.1 percent in 2007; slightly less than the growth of 6.7 percent in 2006. Even so, it continued to expand faster than the overall economy, which is contracting., reaching a total of $ 2.2 Trillion in 2007, or 16.2 percent of the gross domestic product (GDP). Americans will spend $2.4 trillion on health care in 2008, which is equal to $7,900 a person! Despite the record spending there are 46 million Americans (and growing) without health insurance. No industrialized nation in the world comes even close to the percentage of GDP America spends on healthcare. There is strong evidence that much of this spending does not contribute to better health. Americans spend twice as much per person as the average among other industrialized countries, and yet our life expectancy and infant mortality rates are below average. At least one-third of medical procedures have questionable benefits, according to the Rand Corporation. Based on a study of regional variation, Dartmouth researchers concluded that Medicare spending could be reduced by 29 percent without reducing effective care or affecting health outcomes. The finding suggests that the entire American health care system spends roughly $700 billion a year that does not improve health outcomes. On top of it, in Dade county alone billions of precious health care dollars disappear every year and wind up in the pockets of crooks and criminals. Many businesses also face unique challenges. They lack the negotiating clout needed to obtain favorable rates from insurance companies, and their inability to spread risk across a large group of employees means that the health problems of a single employee can drive premiums up to unaffordable levels. Without economies of scale, small businesses also face larger administrative costs for each worker covered. Small business owners and their employees account for an estimated 27 million of the 47 million Americans without health insurance. Some employers are dropping health insurance, while employment is growing more quickly in industries that are less likely to cover their workers. As a result, fewer and fewer Americans receive health coverage from work. The percentage of Americans covered by employers dropped from 62 percent in 2003 to 59 percent in 2008, the equivalent of 8 million people losing coverage. And for tens of millions of Americans ineligible for Medicare, Medicaid, or another public program, no viable alternative exists to employer-sponsored insurance. There are several issues that need to be fixed to address the health care cost explosion :
1) We must transform health care from a fragmented system into a coordinated and integrated delivery system utilizing information technology, thereby enabling healthcare professionals to measure cost, quality and outcome at the point-of-care.
2) Fundamental payment reforms that encourages doctors and hospitals to improve management of chronic diseases and adopt proven treatments. We have to shift from a volume-based to a value-based reimbursement system. This will reward doctors to spend time with their patients and to focus on the core value of patient care. Otherwise, we will use an entire generation of urgently needed primary care physicians.
3) Promote the application of business management principles in medical offices to help doctors to work smarter and NOT harder.
4) Emphasize the use of generic drugs that can provide equally or even more effective treatment at lower cost. Retail spending on prescription drugs rose only 4.9 percent in 2007, versus 8.6 percent growth in 2006, which is due to the increased use of generic drugs.
5) Stop the preferred funding for Medicare Advantage Plans leading to higher reimbursement and higher costs (115 percent of fee-for-service traditional Medicare). The only beneficiaries are commercial insurance companies which rake in higher profits per member and drain public coffers.
These are just a few ideas that should be assessed and evaluated. As doctors we should take a proactive position and start reshaping our practices. Many of us are stuck in the daily routine and are afraid to change. Organized medicine can and will play a greater role to leverage the risk and assist the individual doctors along the process of change. If we do not adjust to the changing market now, others will enforce painful solutions. Let’s be proactive and not reactive!
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