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.
Sunday, March 15, 2009
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.
Friday, March 13, 2009
Walmart and EHR
Great idea? Successful EHR integration boils down to three components:
Installation-Implementation-Transformation
Most companies do a good job to install and implement a system but hardly provide any service on how to use an EHR to reduce costs, maximize outcome and improve quality. Basic question: how do they help me to transform my practice to achieve ROI (Return on Investment) and utilize the collected data to improve my financial performance.
Walmart may sell the product but what's happening afterwards if you need individualized support?
Bernd
March 11, 2009
Wal-Mart Plans to Market Digital Health Records System
By STEVE LOHR
Wal-Mart Stores is striding into the market for electronic health records, seeking to bring the technology into the mainstream for physicians in small offices, where most of America’s doctors practice medicine.
Wal-Mart’s move comes as the Obama administration is trying to jump-start the adoption of digital medical records with $19 billion of incentives in the economic stimulus package.
The company plans to team its Sam’s Club division with Dell for computers and eClinicalWorks, a fast-growing private company, for software. Wal-Mart says its package deal of hardware, software, installation, maintenance and training will make the technology more accessible and affordable, undercutting rival health information technology suppliers by as much as half.
“We’re a high-volume, low-cost company,” said Marcus Osborne, senior director for health care business development at Wal-Mart. “And I would argue that mentality is sorely lacking in the health care industry.”
The Sam’s Club offering, to be made available this spring, will be under $25,000 for the first physician in a practice, and about $10,000 for each additional doctor. After the installation and training, continuing annual costs for maintenance and support will be $4,000 to $6,500 a year, the company estimates.
Wal-Mart says it had explored the opportunity in health information technology long before the presidential election. About 200,000 health care providers, mostly doctors, are among Sam Club’s 47 million members. And the company’s research showed the technology was becoming less costly and interest was rising among small physician practices, according to Todd Matherly, vice president for health and wellness at Sam’s Club.
The financial incentives in the administration plan — more than $40,000 per physician over a few years, to install and use electronic health records — could accelerate adoption. When used properly, most health experts agree, digital records can curb costs and improve care.
But many, especially physicians in small offices, doubt the wisdom of switching to electronic health records, given their cost and complexity.
Only about 17 percent of the nation’s physicians are using computerized patient records, according to a government-sponsored survey published last year in The New England Journal of Medicine. The use of electronic health records is widespread in large physician groups, but three-fourths of the nation’s doctors work in small practices of 10 physicians or fewer.
Wal-Mart, however, has the potential to bring not only lower costs but also an efficient distribution channel to cater to small physician groups. Traditional health technology suppliers, experts say, have tended to shun the small physician offices because it has been costly to sell to them. Taken together, they make up a large market, but they are scattered.
“If Wal-Mart is successful, this could be a game-changer,” observed Dr. David J. Brailer, former national coordinator for health information technology in the Bush administration.
In the package, Dell is offering either a desktop or a tablet personal computer. Many physicians prefer tablet PCs because they more closely resemble their familiar paper notepads and make for easier communication with the patient, since the doctor is not behind a desktop screen.
EClinicalWorks, which is used by 25,000 physicians, mostly in small practices, will provide the electronic record and practice management software, for billing and patient registration, as a service over the Internet. This “software as a service” model can trim costs considerably and make technical support and maintenance less complicated, because less software resides on the personal computer in a doctor’s office.
Dell will be responsible for installation of the computers, while eClinicalWorks will handle software installation, training and maintenance. Wal-Mart is using its buying power for discounts on both the hardware and software.
Wal-Mart’s role, according to Mr. Osborne, is to put the bundle of technology into an affordable and accessible offering. “We’re the systems integrator, an aggregator,” he said.
The company’s test bed for the technology it will soon offer physicians has been its own health care clinics, staffed by third-party physicians and nurses. Started in September 2006, 30 such clinics are now in stores in eight states. The clinics use the technology Wal-Mart will offer to physicians.
“That’s where the learning came from, and they were the kernel of this idea,” Mr. Osborne said.
Installation-Implementation-Transformation
Most companies do a good job to install and implement a system but hardly provide any service on how to use an EHR to reduce costs, maximize outcome and improve quality. Basic question: how do they help me to transform my practice to achieve ROI (Return on Investment) and utilize the collected data to improve my financial performance.
Walmart may sell the product but what's happening afterwards if you need individualized support?
Bernd
March 11, 2009
Wal-Mart Plans to Market Digital Health Records System
By STEVE LOHR
Wal-Mart Stores is striding into the market for electronic health records, seeking to bring the technology into the mainstream for physicians in small offices, where most of America’s doctors practice medicine.
Wal-Mart’s move comes as the Obama administration is trying to jump-start the adoption of digital medical records with $19 billion of incentives in the economic stimulus package.
The company plans to team its Sam’s Club division with Dell for computers and eClinicalWorks, a fast-growing private company, for software. Wal-Mart says its package deal of hardware, software, installation, maintenance and training will make the technology more accessible and affordable, undercutting rival health information technology suppliers by as much as half.
“We’re a high-volume, low-cost company,” said Marcus Osborne, senior director for health care business development at Wal-Mart. “And I would argue that mentality is sorely lacking in the health care industry.”
The Sam’s Club offering, to be made available this spring, will be under $25,000 for the first physician in a practice, and about $10,000 for each additional doctor. After the installation and training, continuing annual costs for maintenance and support will be $4,000 to $6,500 a year, the company estimates.
Wal-Mart says it had explored the opportunity in health information technology long before the presidential election. About 200,000 health care providers, mostly doctors, are among Sam Club’s 47 million members. And the company’s research showed the technology was becoming less costly and interest was rising among small physician practices, according to Todd Matherly, vice president for health and wellness at Sam’s Club.
The financial incentives in the administration plan — more than $40,000 per physician over a few years, to install and use electronic health records — could accelerate adoption. When used properly, most health experts agree, digital records can curb costs and improve care.
But many, especially physicians in small offices, doubt the wisdom of switching to electronic health records, given their cost and complexity.
Only about 17 percent of the nation’s physicians are using computerized patient records, according to a government-sponsored survey published last year in The New England Journal of Medicine. The use of electronic health records is widespread in large physician groups, but three-fourths of the nation’s doctors work in small practices of 10 physicians or fewer.
Wal-Mart, however, has the potential to bring not only lower costs but also an efficient distribution channel to cater to small physician groups. Traditional health technology suppliers, experts say, have tended to shun the small physician offices because it has been costly to sell to them. Taken together, they make up a large market, but they are scattered.
“If Wal-Mart is successful, this could be a game-changer,” observed Dr. David J. Brailer, former national coordinator for health information technology in the Bush administration.
In the package, Dell is offering either a desktop or a tablet personal computer. Many physicians prefer tablet PCs because they more closely resemble their familiar paper notepads and make for easier communication with the patient, since the doctor is not behind a desktop screen.
EClinicalWorks, which is used by 25,000 physicians, mostly in small practices, will provide the electronic record and practice management software, for billing and patient registration, as a service over the Internet. This “software as a service” model can trim costs considerably and make technical support and maintenance less complicated, because less software resides on the personal computer in a doctor’s office.
Dell will be responsible for installation of the computers, while eClinicalWorks will handle software installation, training and maintenance. Wal-Mart is using its buying power for discounts on both the hardware and software.
Wal-Mart’s role, according to Mr. Osborne, is to put the bundle of technology into an affordable and accessible offering. “We’re the systems integrator, an aggregator,” he said.
The company’s test bed for the technology it will soon offer physicians has been its own health care clinics, staffed by third-party physicians and nurses. Started in September 2006, 30 such clinics are now in stores in eight states. The clinics use the technology Wal-Mart will offer to physicians.
“That’s where the learning came from, and they were the kernel of this idea,” Mr. Osborne said.
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!
EHR Implementation
Medical Information Technology
Your Monthly IT Guide since 1995!
EHR Or Not EHR: That’s Still A Question?
By Bernd Wollschlaeger,MD,FAAFP,FASAM
Many doctors are still debating passionately the merits of an Electronic Health Record (EHR). Some claim that the government has no right to mandate its use, others are suspicious that such systems provide government with the tool to peek into their practice and that “big brother” should stay out of their office.
The majority of doctors I have spoken with are mostly concerned about the costs of the switch from paper to electronic record system. With the average traditional EHR systems running about $50,000 per physician, not including monthly maintenance costs, many docs are hesitant to sign-off on such an expense, especially in those challenging economic times.
Furthermore, doctors have been fed horror stories of EHR implementation failures and the fact that thirty percent of medical practices that adopt a full-fledged EHR system deinstall it later!
It’s also of interest to consider the detrimental short term impact of the stimulus package upon adoption of Electronic Health Records systems. Some have attributed an almost Kafkaesque quality to stimulus package because it will probably serve as a speed bump to EHR adoption until the details of the act have been spelled out. Up until the passage of the stimulus package, adoption of EHR systems has been proceeding slowly but steadily. However, the vaguely defined promise of $17 billion in reimbursements for EHR if unknown criteria are met could result in gridlock among purchasers, i.e. doctors and hospitals, in the short term while they wait for finalization of the provisions of the stimulus package’s Health Information Technology for Economic and Clinical Health Act (HITECH Act). At this point I can state with a high likelihood of certainty that our government will NOT provide financial support to doctors to purchase hard- and software but will incentivize their use. In plain English: you will get paid MORE for demonstrating and proving the “meaningful” use of an EHR system in your practice. This undefined description will likely deter healthcare organizations from rushing to purchase an EHR system.
Another speed bump of the HITECH Act pertains to the reimbursement modality which would only be provided if a certified EHR was implemented. However, the certification standard is to be developed by an office (ONCHIT) that has not been staffed yet, with a coordinator that has not been named yet and by the Secretary of HHS, who has just been appointed.
So what do I advise you to do?
1) Start preparing your practice for the switch toward an EHR. That requires thorough workflow assessment and the careful parsing of essential information out of your existing paper record. This will achieve two goals: a) that your future EHR will model your current workflow, b) that you can transfer the extracted patient information quickly into your new EHR system.
2) Do NOT focus on the big number ($50,000/per physician). This number pertains to the OLD legacy system on which most current EHR software is based. These systems require costly installation, maintenance, updates and can not be adjusted to your practice. Focus instead on the new technologies. The Web 2.0, or second generation of web development and design, aims to facilitate communication, secure information sharing, interoperability and collaboration on the Internet. Web 2.0 websites allow users to do more than just retrieve information. They can build on the interactive facilities of “Web 1.0” to provide the Internet as computing platform, allowing users to run software-applications entirely through a browser. Users can own the data on a Web 2.0 site and exercise control over that data. These sites may have an architecture of participation that encourages users to add value to the application as they use it. This will dramatically cut costs to ~ $6000/year/physician.
3) The new Web 2.0 technologies offer interactive web-based software application with modular design components. For example, you can use an appointment scheduler, a patient registry and lab module to manage your information flow and allow patient to choose their doctors appointment whenever and whereever they want to do it. I am successfully applying such a module for > 2 years and my patients are loving it.
Jumping on the EHR bandwagon NOW gives you a competitive edge and allows use to benefit from the multitude of additional reimbursement opportunities including e-prescribing, quality of care reporting and chronic disease management.
Don’t way and be proactive. Change does not offer only financial opportunities but will provide greater job satisfaction.
We will help you along the way!
Disclosure: The author is a practicing family physician, addiction specialist and computer consultant. In addition, he is a founder and managing partner of a medical IT company.
Your Monthly IT Guide since 1995!
EHR Or Not EHR: That’s Still A Question?
By Bernd Wollschlaeger,MD,FAAFP,FASAM
Many doctors are still debating passionately the merits of an Electronic Health Record (EHR). Some claim that the government has no right to mandate its use, others are suspicious that such systems provide government with the tool to peek into their practice and that “big brother” should stay out of their office.
The majority of doctors I have spoken with are mostly concerned about the costs of the switch from paper to electronic record system. With the average traditional EHR systems running about $50,000 per physician, not including monthly maintenance costs, many docs are hesitant to sign-off on such an expense, especially in those challenging economic times.
Furthermore, doctors have been fed horror stories of EHR implementation failures and the fact that thirty percent of medical practices that adopt a full-fledged EHR system deinstall it later!
It’s also of interest to consider the detrimental short term impact of the stimulus package upon adoption of Electronic Health Records systems. Some have attributed an almost Kafkaesque quality to stimulus package because it will probably serve as a speed bump to EHR adoption until the details of the act have been spelled out. Up until the passage of the stimulus package, adoption of EHR systems has been proceeding slowly but steadily. However, the vaguely defined promise of $17 billion in reimbursements for EHR if unknown criteria are met could result in gridlock among purchasers, i.e. doctors and hospitals, in the short term while they wait for finalization of the provisions of the stimulus package’s Health Information Technology for Economic and Clinical Health Act (HITECH Act). At this point I can state with a high likelihood of certainty that our government will NOT provide financial support to doctors to purchase hard- and software but will incentivize their use. In plain English: you will get paid MORE for demonstrating and proving the “meaningful” use of an EHR system in your practice. This undefined description will likely deter healthcare organizations from rushing to purchase an EHR system.
Another speed bump of the HITECH Act pertains to the reimbursement modality which would only be provided if a certified EHR was implemented. However, the certification standard is to be developed by an office (ONCHIT) that has not been staffed yet, with a coordinator that has not been named yet and by the Secretary of HHS, who has just been appointed.
So what do I advise you to do?
1) Start preparing your practice for the switch toward an EHR. That requires thorough workflow assessment and the careful parsing of essential information out of your existing paper record. This will achieve two goals: a) that your future EHR will model your current workflow, b) that you can transfer the extracted patient information quickly into your new EHR system.
2) Do NOT focus on the big number ($50,000/per physician). This number pertains to the OLD legacy system on which most current EHR software is based. These systems require costly installation, maintenance, updates and can not be adjusted to your practice. Focus instead on the new technologies. The Web 2.0, or second generation of web development and design, aims to facilitate communication, secure information sharing, interoperability and collaboration on the Internet. Web 2.0 websites allow users to do more than just retrieve information. They can build on the interactive facilities of “Web 1.0” to provide the Internet as computing platform, allowing users to run software-applications entirely through a browser. Users can own the data on a Web 2.0 site and exercise control over that data. These sites may have an architecture of participation that encourages users to add value to the application as they use it. This will dramatically cut costs to ~ $6000/year/physician.
3) The new Web 2.0 technologies offer interactive web-based software application with modular design components. For example, you can use an appointment scheduler, a patient registry and lab module to manage your information flow and allow patient to choose their doctors appointment whenever and whereever they want to do it. I am successfully applying such a module for > 2 years and my patients are loving it.
Jumping on the EHR bandwagon NOW gives you a competitive edge and allows use to benefit from the multitude of additional reimbursement opportunities including e-prescribing, quality of care reporting and chronic disease management.
Don’t way and be proactive. Change does not offer only financial opportunities but will provide greater job satisfaction.
We will help you along the way!
Disclosure: The author is a practicing family physician, addiction specialist and computer consultant. In addition, he is a founder and managing partner of a medical IT company.
Monday, March 09, 2009
Health IT and Medical Economics
"It is very easy to scare people with lies. It is much, much harder to educate them with facts.
But effective persuasion does not depend entirely on facts. It also depends on credibility, honesty, simplicity, repetition, and organization. "
Attached two very interesting articles from "Health Affairs" dedicating an entire issue on Electronic Health Records http://content.healthaffairs.org/current.shtml
I highly recommend those articles to assist you in parsing out the myth and the facts.
Most industrialized nations USE EHRs but docs in the US still debating the issue based on perceived "facts" which resemble secular religious propositions that are not proved or demonstrated but considered to be self-evident.
Cooler heads must prevail. Rational thinking versus emotional knee-jerk-reflex reactions are required.
Its absolutely silly (and dangerous) to call those of us who support a coordinated health care delivery systems as "socialists" and "enemies" of the free-market system.
Any smart business man wants to control costs, ascertain quality and maximize outcome of the services rendered. Most docs don't seem to get this basic economic ABC and roll their eyes when I ask them about PL & cash flow& other financial performance statements.
We must adapt to a rapidly changing market place. If not we do not need a meteor impact to go extinct!
One great article is a must read:
* The Attack On Health IT And Comparative Effectiveness Research: A Warning For What Lies Ahead
* http://healthaffairs.org/blog/2009/03/04/the-attack-on-health-it-and-comparative-effectiveness-research-a-warning-for-what-lies-ahead
Attached the abstracts of some other articles in the same issue:
Health Information Technology: On The Fast Track At Last?
A MAJOR ANOMALY OF THE Information Age is that a huge sector of the U.S. economy has been so lacking—and for so long—in its use of information technology (IT). As dozens of major industries retooled themselves in the 1980s around new means of conveying, processing, and analyzing information, health care largely sat on the sidelines. We all suffered. How many deaths or injuries have occurred because clinicians lacked the right information about the right patient at the right time—when much or all of it could have been acted upon through the use of health IT?
Just why health care lagged so badly in adopting IT is a complex story, deeply interwoven with much of the sector’s lingering cottage-industry nature. More than half of doctors still practice in groups of four or fewer physicians; not surprisingly, a survey published in the New England Journal of Medicine (3 July 2008) suggests that only about one in eight physicians have even a basic electronic record system. Despite the substantial growth of e-prescribing, as Maria Friedman and colleagues note in this volume, the vast majority of doctors still write out their prescriptions by hand.
In the classic terms of a vicious cycle, the fact that health IT hasn’t been broadly adopted has almost certainly reinforced these cottage-industry tendencies—not to mention the many other failings of our health care enterprise. If you can’t or won’t share information across health care settings, the system inevitably remains much as the Institute of Medicine’s Crossing the Quality Chasm report summed up in 2001: insufficiently centered on patients, error-prone, needlessly inefficient, uncoordinated, and delivering vastly inadequate value for the dollars expended.
Now the overall health IT environment is changing, if not fast enough, as this issue of Health Affairs makes clear. One measure of progress is that plans are afoot in Washington to incorporate substantial health IT investments into an economic stimulus package, in hopes of boosting the economy while building the backbone of a twenty-first-century health care system. There’s already ample evidence that these technologies can and will be enablers of massive restructuring of health care delivery. In this issue’s Report from the Field, our journalism partnership with Kaiser Health News, Carleen Hawn reports on how a small but growing corps of clinicians are tapping into social-media tools such as Facebook to communicate with patients and reorganize their practices. And as Caroline Chen and colleagues record, when Kaiser Permanente introduced comprehensive electronic health records, complete with secure e-mail messaging between clinicians and patients, primary care office visits dropped by 25 percent. Can we seriously contemplate redressing the supposed primary care shortage by adding thousands more physicians before we get similar IT systems in place nationwide?
As the papers in this volume make clear, we shouldn’t embrace the likely benefits of health IT without ignoring the risks or the considerable implementation challenges ahead. Jos Aarts and Ross Koppel remind us that adoption of computerized physician order entry (CPOE) systems has been associated in some instances with unintended consequences—including, counterintuitively, more adverse drug events, not fewer. Deven McGraw and Linda Dimitropoulos and their colleagues argue that it will be critical to build public trust in health IT by addressing privacy concerns. That will be no small matter, since the combination of an unwieldy federal regulation and myriad contradictory state laws makes overall national policy on the privacy of health information a complete mess.
As of this writing, even assembling a health IT piece of a stimulus package is having its problems. Years of talk about standard-setting still hasn’t produced a sure-fire path to interoperability among competing proprietary health IT systems. If the goal is to share information broadly for the public’s benefit, why should taxpayers be asked to invest more in systems that won’t talk to each other? Talk about Bridges to Nowhere, IT-style! Surely a nation that once agreed on a common standard for the width of railroad tracks ought to be able to agree on interoperability of electronic health information. But we’re not there yet.
As momentum for health reform builds in Washington, addressing such concerns should be deemed every bit as important as broadening health insurance coverage or focusing on prevention. We thank the funders who made this well-timed thematic issue possible: the Markle Foundation, the California HealthCare Foundation, and the federal Agency for Healthcare Research and Quality.
Susan Dentzer, Editor-In-Chief
The Promises And Pitfalls Of Health Information Technology
Successful innovators leave no doubt that health information technology (IT) can have a dramatic impact on care, despite the challenges of implementation and adoption. The papers in the sections that follow describe efforts all along the continuum from large health care organizations to small independent physician practices.
Catherine Chen and colleagues document how adoption in Hawaii of Kaiser Permanente’s new comprehensive electronic health record (EHR) system—complete with secure e-mail messaging and "e-visits" between physicians and patients—has reduced enrollees’ old-fashioned office visits for primary care by more than 25 percent in four years. Next, Anna-Lisa Silvestre and colleagues report survey results describing how Kaiser’s patients value the convenience of online appointment scheduling, e-mail contact with their doctors, and instant access to lab test results. Stephen Parente and colleagues report on EHRs’ impact on patient safety and find some evidence of positive effects. Farzad Mostashari and associates then describe state-backed efforts to implement health IT among independent physician practices in Massachusetts and New York City.
Carleen Hawn’s Report from the Field on social media in health care focuses on how various organizations, physician practices, and patients are making growing use of these tools. Personal health records (PHRs)—either stand-alone or as patient-oriented complements to EHRs—have important potential in such areas as promoting better self-management for patients with chronic conditions. However, as James Kahn and colleagues report, PHRs are unlikely to fulfill their promise without improved health literacy and computer competency for many patients. Joy Grossman and colleagues describe how health insurers are developing and promoting PHRs but are also encountering lack of trust and privacy concerns among patients, providers, and payers.
Medicare’s apparently sure-fire strategy of promoting electronic prescribing with payment incentives has hit snags as well, Maria Friedman and colleagues report. A comparison by Jos Aarts and Ross Koppel of efforts under way in the United States and six other industrialized countries to implement computerized physician order entry (CPOE) systems shows advantages—even though adoption is slow, systems are often poorly integrated, they’re producing new and different types of errors, and users are frequently frustrated.
The Kaiser Permanente Electronic Health Record: Transforming And Streamlining Modalities Of Care
Catherine Chen, Terhilda Garrido, Don Chock, Grant Okawa and Louise Liang
Abstract
We examined the impact of implementing a comprehensive electronic health record (EHR) system on ambulatory care use in an integrated health care delivery system with more than 225,000 members. Between 2004 and 2007, the annual age/sex-adjusted total office visit rate decreased 26.2 percent, the adjusted primary care office visit rate decreased 25.3 percent, and the adjusted specialty care office visit rate decreased 21.5 percent. Scheduled telephone visits increased more than eightfold, and secure e-mail messaging, which began in late 2005, increased nearly sixfold by 2007. Introducing an EHR creates operational efficiencies by offering nontraditional, patient-centered ways of providing care.
Health Information Technology And Patient Safety: Evidence From Panel Data
Stephen T. Parente and Jeffrey S. McCullough
The potential of health information technology (IT) to transform health care delivery has spurred health IT adoption and will likely contribute to increased investments in coming years. Although an extensive literature shows the value of health IT at leading academic institutions, its broader value remains unknown. We sought to estimate IT’s effect on key patient safety measures in a national sample. Using four years of Medicare inpatient data, we found that electronic medical records have a small, positive effect on patient safety. Although these results are encouraging, we suggest that investment in health IT should be accompanied by investment in the evidence base needed to evaluate it.
But effective persuasion does not depend entirely on facts. It also depends on credibility, honesty, simplicity, repetition, and organization. "
Attached two very interesting articles from "Health Affairs" dedicating an entire issue on Electronic Health Records http://content.healthaffairs.org/current.shtml
I highly recommend those articles to assist you in parsing out the myth and the facts.
Most industrialized nations USE EHRs but docs in the US still debating the issue based on perceived "facts" which resemble secular religious propositions that are not proved or demonstrated but considered to be self-evident.
Cooler heads must prevail. Rational thinking versus emotional knee-jerk-reflex reactions are required.
Its absolutely silly (and dangerous) to call those of us who support a coordinated health care delivery systems as "socialists" and "enemies" of the free-market system.
Any smart business man wants to control costs, ascertain quality and maximize outcome of the services rendered. Most docs don't seem to get this basic economic ABC and roll their eyes when I ask them about PL & cash flow& other financial performance statements.
We must adapt to a rapidly changing market place. If not we do not need a meteor impact to go extinct!
One great article is a must read:
* The Attack On Health IT And Comparative Effectiveness Research: A Warning For What Lies Ahead
* http://healthaffairs.org/blog/2009/03/04/the-attack-on-health-it-and-comparative-effectiveness-research-a-warning-for-what-lies-ahead
Attached the abstracts of some other articles in the same issue:
Health Information Technology: On The Fast Track At Last?
A MAJOR ANOMALY OF THE Information Age is that a huge sector of the U.S. economy has been so lacking—and for so long—in its use of information technology (IT). As dozens of major industries retooled themselves in the 1980s around new means of conveying, processing, and analyzing information, health care largely sat on the sidelines. We all suffered. How many deaths or injuries have occurred because clinicians lacked the right information about the right patient at the right time—when much or all of it could have been acted upon through the use of health IT?
Just why health care lagged so badly in adopting IT is a complex story, deeply interwoven with much of the sector’s lingering cottage-industry nature. More than half of doctors still practice in groups of four or fewer physicians; not surprisingly, a survey published in the New England Journal of Medicine (3 July 2008) suggests that only about one in eight physicians have even a basic electronic record system. Despite the substantial growth of e-prescribing, as Maria Friedman and colleagues note in this volume, the vast majority of doctors still write out their prescriptions by hand.
In the classic terms of a vicious cycle, the fact that health IT hasn’t been broadly adopted has almost certainly reinforced these cottage-industry tendencies—not to mention the many other failings of our health care enterprise. If you can’t or won’t share information across health care settings, the system inevitably remains much as the Institute of Medicine’s Crossing the Quality Chasm report summed up in 2001: insufficiently centered on patients, error-prone, needlessly inefficient, uncoordinated, and delivering vastly inadequate value for the dollars expended.
Now the overall health IT environment is changing, if not fast enough, as this issue of Health Affairs makes clear. One measure of progress is that plans are afoot in Washington to incorporate substantial health IT investments into an economic stimulus package, in hopes of boosting the economy while building the backbone of a twenty-first-century health care system. There’s already ample evidence that these technologies can and will be enablers of massive restructuring of health care delivery. In this issue’s Report from the Field, our journalism partnership with Kaiser Health News, Carleen Hawn reports on how a small but growing corps of clinicians are tapping into social-media tools such as Facebook to communicate with patients and reorganize their practices. And as Caroline Chen and colleagues record, when Kaiser Permanente introduced comprehensive electronic health records, complete with secure e-mail messaging between clinicians and patients, primary care office visits dropped by 25 percent. Can we seriously contemplate redressing the supposed primary care shortage by adding thousands more physicians before we get similar IT systems in place nationwide?
As the papers in this volume make clear, we shouldn’t embrace the likely benefits of health IT without ignoring the risks or the considerable implementation challenges ahead. Jos Aarts and Ross Koppel remind us that adoption of computerized physician order entry (CPOE) systems has been associated in some instances with unintended consequences—including, counterintuitively, more adverse drug events, not fewer. Deven McGraw and Linda Dimitropoulos and their colleagues argue that it will be critical to build public trust in health IT by addressing privacy concerns. That will be no small matter, since the combination of an unwieldy federal regulation and myriad contradictory state laws makes overall national policy on the privacy of health information a complete mess.
As of this writing, even assembling a health IT piece of a stimulus package is having its problems. Years of talk about standard-setting still hasn’t produced a sure-fire path to interoperability among competing proprietary health IT systems. If the goal is to share information broadly for the public’s benefit, why should taxpayers be asked to invest more in systems that won’t talk to each other? Talk about Bridges to Nowhere, IT-style! Surely a nation that once agreed on a common standard for the width of railroad tracks ought to be able to agree on interoperability of electronic health information. But we’re not there yet.
As momentum for health reform builds in Washington, addressing such concerns should be deemed every bit as important as broadening health insurance coverage or focusing on prevention. We thank the funders who made this well-timed thematic issue possible: the Markle Foundation, the California HealthCare Foundation, and the federal Agency for Healthcare Research and Quality.
Susan Dentzer, Editor-In-Chief
The Promises And Pitfalls Of Health Information Technology
Successful innovators leave no doubt that health information technology (IT) can have a dramatic impact on care, despite the challenges of implementation and adoption. The papers in the sections that follow describe efforts all along the continuum from large health care organizations to small independent physician practices.
Catherine Chen and colleagues document how adoption in Hawaii of Kaiser Permanente’s new comprehensive electronic health record (EHR) system—complete with secure e-mail messaging and "e-visits" between physicians and patients—has reduced enrollees’ old-fashioned office visits for primary care by more than 25 percent in four years. Next, Anna-Lisa Silvestre and colleagues report survey results describing how Kaiser’s patients value the convenience of online appointment scheduling, e-mail contact with their doctors, and instant access to lab test results. Stephen Parente and colleagues report on EHRs’ impact on patient safety and find some evidence of positive effects. Farzad Mostashari and associates then describe state-backed efforts to implement health IT among independent physician practices in Massachusetts and New York City.
Carleen Hawn’s Report from the Field on social media in health care focuses on how various organizations, physician practices, and patients are making growing use of these tools. Personal health records (PHRs)—either stand-alone or as patient-oriented complements to EHRs—have important potential in such areas as promoting better self-management for patients with chronic conditions. However, as James Kahn and colleagues report, PHRs are unlikely to fulfill their promise without improved health literacy and computer competency for many patients. Joy Grossman and colleagues describe how health insurers are developing and promoting PHRs but are also encountering lack of trust and privacy concerns among patients, providers, and payers.
Medicare’s apparently sure-fire strategy of promoting electronic prescribing with payment incentives has hit snags as well, Maria Friedman and colleagues report. A comparison by Jos Aarts and Ross Koppel of efforts under way in the United States and six other industrialized countries to implement computerized physician order entry (CPOE) systems shows advantages—even though adoption is slow, systems are often poorly integrated, they’re producing new and different types of errors, and users are frequently frustrated.
The Kaiser Permanente Electronic Health Record: Transforming And Streamlining Modalities Of Care
Catherine Chen, Terhilda Garrido, Don Chock, Grant Okawa and Louise Liang
Abstract
We examined the impact of implementing a comprehensive electronic health record (EHR) system on ambulatory care use in an integrated health care delivery system with more than 225,000 members. Between 2004 and 2007, the annual age/sex-adjusted total office visit rate decreased 26.2 percent, the adjusted primary care office visit rate decreased 25.3 percent, and the adjusted specialty care office visit rate decreased 21.5 percent. Scheduled telephone visits increased more than eightfold, and secure e-mail messaging, which began in late 2005, increased nearly sixfold by 2007. Introducing an EHR creates operational efficiencies by offering nontraditional, patient-centered ways of providing care.
Health Information Technology And Patient Safety: Evidence From Panel Data
Stephen T. Parente and Jeffrey S. McCullough
The potential of health information technology (IT) to transform health care delivery has spurred health IT adoption and will likely contribute to increased investments in coming years. Although an extensive literature shows the value of health IT at leading academic institutions, its broader value remains unknown. We sought to estimate IT’s effect on key patient safety measures in a national sample. Using four years of Medicare inpatient data, we found that electronic medical records have a small, positive effect on patient safety. Although these results are encouraging, we suggest that investment in health IT should be accompanied by investment in the evidence base needed to evaluate it.
Tuesday, February 17, 2009
First Coast Service Option
Thursday, January 15, 2009
MESSAGE FROM YOUR PRESIDENT:
Medicare Reimbursement and First Coast Service Option
In my last column I provided you with my midterm assessment. I indicated that we initiated a dialogue with representatives of First Coast Service Options (FCSO), the regional Medicare administrator and have met twice with their Chief Medical Director and their Executive Committee. I also reported that we discussed on how to clarify the claims payment process and that we agreed to limit and reduce the onerous prepayment review requirements. Unfortunately, these discussions led nowhere and I now question the competence of and integrity of their entire operation.
Who is FCSO?
FCSO and its parent, Blue Cross and Blue Shield (BCBS) of Florida, have been involved in Medicare program administration since the inception of the Medicare program. FCSO incorporated as a wholly owned subsidiary of BCBSF in May 1998, licensed in Florida as a Third Party Administrator and began operations in January 1999. BCBS Medicare contracts were formally transferred to FCSO effective October 2003. FCSO is one of the largest CMS Medicare contractors processing $ 17 Billion in claims annually.
What is the problem?
FCSO claims that “ as one of Florida’s largest payers of health care benefits. We are committed to making the most of this unique opportunity.” Well, they do indeed!
According to a 2007 report of the Office of the Inspector General at the Department of Health and Human Services South Florida health care clinics submitted $2.2 Billion in claims for HIV drug-infusion claims in 2005 – 22 times more than the rest of the country combined!
The reports states that “ CMS has had limited success in controlling the aberrant billing practices of South Florida infusion therapy providers. CMS and its contractors have used multiple approaches, but none has proven effective over time. The most common tools include payment suspensions, revocations, and claims-processing edits. CMS has taken limited action to strengthen the enrollment process for new providers “
A series for recommendation were made and the report summarizes its findings as follows:
“CMS’s positive response to our recommendations, including its initiation of the new demonstration project, indicates that the agency is now moving toward strategies that should more effectively protect the integrity of Medicare payments in South Florida.”
How do they define success:
“Although billing increased from $1.5 to $3.3 Billion (CY 2004-2006) ,Medicare payments in Florida dropped from $1 Billion to $890 Million ... as a direct result of CMS' containment efforts.”
Hardly a success story to me! Recent CMS data suggest that the "successful" containment efforts succeeded to contain as much (or little) as before.
Guess what; the party continues and First Coast Service Options continues to pay!
How do I call it? Incompetence and negligence.
The Miami Herald published a superb article series exposing these fraudulent activities but FCSO is still in denial that this problem exists!
So, they nickle and dime good doctors and impose arbitrary 100% prepayment review requirements BUT allow crooks to sail a cruise ship sized fraud operation through their loopholes.
FCSO promised to cooperate with us to reduce this onerous financial burden, which jeopardizes the viability of medical practices and will eventually limit access for Medicare recipients.
Despite multiple e-mails and communications they still continue this tactics. I suspect that they create a smoke screen on our expense to impress regulators and to conceal their true deficiencies.
What can we do? Well, now is time to play hardball! We need to notify members of Congress and the Senate and demand an audit and review of all FCSO activities. I consider a congressional hearing as necessary to address the intolerable waste of billions of taxpayer’s money!
The waste of money and abuse of physicians has to stop! The system can work if administered by smart and responsible managers. I have lost all confidence that FCSO can fulfill its charge and mandate to administer the Medicare program in Florida. I know that I will be attacked. I am aware that they are stronger. I am just a simple family doctor but I am not afraid to state the obvious failures and mistakes.
Now, its time to act! Enough is enough!
MESSAGE FROM YOUR PRESIDENT:
Medicare Reimbursement and First Coast Service Option
In my last column I provided you with my midterm assessment. I indicated that we initiated a dialogue with representatives of First Coast Service Options (FCSO), the regional Medicare administrator and have met twice with their Chief Medical Director and their Executive Committee. I also reported that we discussed on how to clarify the claims payment process and that we agreed to limit and reduce the onerous prepayment review requirements. Unfortunately, these discussions led nowhere and I now question the competence of and integrity of their entire operation.
Who is FCSO?
FCSO and its parent, Blue Cross and Blue Shield (BCBS) of Florida, have been involved in Medicare program administration since the inception of the Medicare program. FCSO incorporated as a wholly owned subsidiary of BCBSF in May 1998, licensed in Florida as a Third Party Administrator and began operations in January 1999. BCBS Medicare contracts were formally transferred to FCSO effective October 2003. FCSO is one of the largest CMS Medicare contractors processing $ 17 Billion in claims annually.
What is the problem?
FCSO claims that “ as one of Florida’s largest payers of health care benefits. We are committed to making the most of this unique opportunity.” Well, they do indeed!
According to a 2007 report of the Office of the Inspector General at the Department of Health and Human Services South Florida health care clinics submitted $2.2 Billion in claims for HIV drug-infusion claims in 2005 – 22 times more than the rest of the country combined!
The reports states that “ CMS has had limited success in controlling the aberrant billing practices of South Florida infusion therapy providers. CMS and its contractors have used multiple approaches, but none has proven effective over time. The most common tools include payment suspensions, revocations, and claims-processing edits. CMS has taken limited action to strengthen the enrollment process for new providers “
A series for recommendation were made and the report summarizes its findings as follows:
“CMS’s positive response to our recommendations, including its initiation of the new demonstration project, indicates that the agency is now moving toward strategies that should more effectively protect the integrity of Medicare payments in South Florida.”
How do they define success:
“Although billing increased from $1.5 to $3.3 Billion (CY 2004-2006) ,Medicare payments in Florida dropped from $1 Billion to $890 Million ... as a direct result of CMS' containment efforts.”
Hardly a success story to me! Recent CMS data suggest that the "successful" containment efforts succeeded to contain as much (or little) as before.
Guess what; the party continues and First Coast Service Options continues to pay!
How do I call it? Incompetence and negligence.
The Miami Herald published a superb article series exposing these fraudulent activities but FCSO is still in denial that this problem exists!
So, they nickle and dime good doctors and impose arbitrary 100% prepayment review requirements BUT allow crooks to sail a cruise ship sized fraud operation through their loopholes.
FCSO promised to cooperate with us to reduce this onerous financial burden, which jeopardizes the viability of medical practices and will eventually limit access for Medicare recipients.
Despite multiple e-mails and communications they still continue this tactics. I suspect that they create a smoke screen on our expense to impress regulators and to conceal their true deficiencies.
What can we do? Well, now is time to play hardball! We need to notify members of Congress and the Senate and demand an audit and review of all FCSO activities. I consider a congressional hearing as necessary to address the intolerable waste of billions of taxpayer’s money!
The waste of money and abuse of physicians has to stop! The system can work if administered by smart and responsible managers. I have lost all confidence that FCSO can fulfill its charge and mandate to administer the Medicare program in Florida. I know that I will be attacked. I am aware that they are stronger. I am just a simple family doctor but I am not afraid to state the obvious failures and mistakes.
Now, its time to act! Enough is enough!
Cocaine Cowboys and 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.
Tuesday, January 27, 2009
Medicare and Government Contractors: Who Controls Them?
Thursday, January 15, 2009
MESSAGE FROM YOUR PRESIDENT:
Medicare Reimbursement and First Coast Service Option
In my last column I provided you with my midterm assessment. I indicated that we initiated a dialogue with representatives of First Coast Service Options (FCSO), the regional Medicare administrator and have met twice with their Chief Medical Director and their Executive Committee. I also reported that we discussed on how to clarify the claims payment process and that we agreed to limit and reduce the onerous prepayment review requirements. Unfortunately, these discussions led nowhere and I now question the competence of and integrity of their entire operation.
Who is FCSO?
FCSO and its parent, Blue Cross and Blue Shield (BCBS) of Florida, have been involved in Medicare program administration since the inception of the Medicare program. FCSO incorporated as a wholly owned subsidiary of BCBSF in May 1998, licensed in Florida as a Third Party Administrator and began operations in January 1999. BCBS Medicare contracts were formally transferred to FCSO effective October 2003. FCSO is one of the largest CMS Medicare contractors processing $ 17 Billion in claims annually.
What is the problem?
FCSO claims that “ as one of Florida’s largest payers of health care benefits. We are committed to making the most of this unique opportunity.” Well, they do indeed!
According to a 2007 report of the Office of the Inspector General at the Department of Health and Human Services South Florida health care clinics submitted $2.2 Billion in claims for HIV drug-infusion claims in 2005 – 22 times more than the rest of the country combined!
The reports states that “ CMS has had limited success in controlling the aberrant billing practices of South Florida infusion therapy providers. CMS and its contractors have used multiple approaches, but none has proven effective over time. The most common tools include payment suspensions, revocations, and claims-processing edits. CMS has taken limited action to strengthen the enrollment process for new providers “
A series for recommendation were made and the report summarizes its findings as follows:
“CMS’s positive response to our recommendations, including its initiation of the new demonstration project, indicates that the agency is now moving toward strategies that should more effectively protect the integrity of Medicare payments in South Florida.”
How do they define success:
“Although billing increased from $1.5 to $3.3 Billion (CY 2004-2006) ,Medicare payments in Florida dropped from $1 Billion to $890 Million ... as a direct result of CMS' containment efforts.”
Hardly a success story to me! Recent CMS data suggest that the "successful" containment efforts succeeded to contain as much (or little) as before.
Guess what; the party continues and First Coast Service Options continues to pay!
How do I call it? Incompetence and negligence.
The Miami Herald published a superb article series exposing these fraudulent activities but FCSO is still in denial that this problem exists!
So, they nickle and dime good doctors and impose arbitrary 100% prepayment review requirements BUT allow crooks to sail a cruise ship sized fraud operation through their loopholes.
FCSO promised to cooperate with us to reduce this onerous financial burden, which jeopardizes the viability of medical practices and will eventually limit access for Medicare recipients.
Despite multiple e-mails and communications they still continue this tactics. I suspect that they create a smoke screen on our expense to impress regulators and to conceal their true deficiencies.
What can we do? Well, now is time to play hardball! We need to notify members of Congress and the Senate and demand an audit and review of all FCSO activities. I consider a congressional hearing as necessary to address the intolerable waste of billions of taxpayer’s money!
The waste of money and abuse of physicians has to stop! The system can work if administered by smart and responsible managers. I have lost all confidence that FCSO can fulfill its charge and mandate to administer the Medicare program in Florida. I know that I will be attacked. I am aware that they are stronger. I am just a simple family doctor but I am not afraid to state the obvious failures and mistakes.
Now, its time to act! Enough is enough!
MESSAGE FROM YOUR PRESIDENT:
Medicare Reimbursement and First Coast Service Option
In my last column I provided you with my midterm assessment. I indicated that we initiated a dialogue with representatives of First Coast Service Options (FCSO), the regional Medicare administrator and have met twice with their Chief Medical Director and their Executive Committee. I also reported that we discussed on how to clarify the claims payment process and that we agreed to limit and reduce the onerous prepayment review requirements. Unfortunately, these discussions led nowhere and I now question the competence of and integrity of their entire operation.
Who is FCSO?
FCSO and its parent, Blue Cross and Blue Shield (BCBS) of Florida, have been involved in Medicare program administration since the inception of the Medicare program. FCSO incorporated as a wholly owned subsidiary of BCBSF in May 1998, licensed in Florida as a Third Party Administrator and began operations in January 1999. BCBS Medicare contracts were formally transferred to FCSO effective October 2003. FCSO is one of the largest CMS Medicare contractors processing $ 17 Billion in claims annually.
What is the problem?
FCSO claims that “ as one of Florida’s largest payers of health care benefits. We are committed to making the most of this unique opportunity.” Well, they do indeed!
According to a 2007 report of the Office of the Inspector General at the Department of Health and Human Services South Florida health care clinics submitted $2.2 Billion in claims for HIV drug-infusion claims in 2005 – 22 times more than the rest of the country combined!
The reports states that “ CMS has had limited success in controlling the aberrant billing practices of South Florida infusion therapy providers. CMS and its contractors have used multiple approaches, but none has proven effective over time. The most common tools include payment suspensions, revocations, and claims-processing edits. CMS has taken limited action to strengthen the enrollment process for new providers “
A series for recommendation were made and the report summarizes its findings as follows:
“CMS’s positive response to our recommendations, including its initiation of the new demonstration project, indicates that the agency is now moving toward strategies that should more effectively protect the integrity of Medicare payments in South Florida.”
How do they define success:
“Although billing increased from $1.5 to $3.3 Billion (CY 2004-2006) ,Medicare payments in Florida dropped from $1 Billion to $890 Million ... as a direct result of CMS' containment efforts.”
Hardly a success story to me! Recent CMS data suggest that the "successful" containment efforts succeeded to contain as much (or little) as before.
Guess what; the party continues and First Coast Service Options continues to pay!
How do I call it? Incompetence and negligence.
The Miami Herald published a superb article series exposing these fraudulent activities but FCSO is still in denial that this problem exists!
So, they nickle and dime good doctors and impose arbitrary 100% prepayment review requirements BUT allow crooks to sail a cruise ship sized fraud operation through their loopholes.
FCSO promised to cooperate with us to reduce this onerous financial burden, which jeopardizes the viability of medical practices and will eventually limit access for Medicare recipients.
Despite multiple e-mails and communications they still continue this tactics. I suspect that they create a smoke screen on our expense to impress regulators and to conceal their true deficiencies.
What can we do? Well, now is time to play hardball! We need to notify members of Congress and the Senate and demand an audit and review of all FCSO activities. I consider a congressional hearing as necessary to address the intolerable waste of billions of taxpayer’s money!
The waste of money and abuse of physicians has to stop! The system can work if administered by smart and responsible managers. I have lost all confidence that FCSO can fulfill its charge and mandate to administer the Medicare program in Florida. I know that I will be attacked. I am aware that they are stronger. I am just a simple family doctor but I am not afraid to state the obvious failures and mistakes.
Now, its time to act! Enough is enough!
Thursday, January 15, 2009
Medicare Fraud and Government Inaction
I just finished reading the complete 2007 report from the Office of Inspector General of the Department of Health and Human Services entitled ABERRANT BILLING IN SOUTH FLORIDA FOR BENEFICIARIES WITH HIV/AIDS.
The reports opens with the following finding:
" In the last half of 2006, three South Florida counties accounted for half the total amount, and 79 percent of the amount for drugs, billed nationally for Medicare beneficiaries with HIV/AIDS. Most of the charges originating in these counties were for nonoral drugs; drug claims represented just 16 percent of the submitted charges in other geographic areas. Aberrant claims patterns differentiated South Florida providers and beneficiaries from those in the rest of the country."
"CMS has had limited success in controlling the aberrant billing practices of South Florida infusion therapy providers. CMS and its contractors have used multiple approaches, but none has proven effective over time. The most common tools include payment suspensions, revocations, and claims-processing edits. CMS has taken limited action to strengthen the enrollment process for new providers. "
A series for recommendation are being made and the report summarizes its findings as follows:
"CMS’s positive response to our recommendations, including its initiation of the new demonstration project, indicates that the agency is now moving toward strategies that should more effectively protect the integrity of Medicare payments in South Florida."
How do they define "success":
"Although billing increased from $1.5 to $3.3 Billion (CY 2004-2006) ,Medicare payments in Florida dropped from $1 Billion to $890 Million ... as a direct result of CMS' containment efforts."
Hardly a success story to me! Recent CMS data suggest that the "successful" containment efforts succeeded to contain as much (or little) as before.
Guess what; the party continues and First Coast Service Options continues to pay!
So, they nickle and dime good doctors and impose arbitrary 100% prepayment review requirements BUT allow crooks to sail a cruiseship through their loopholes.
How do I call it? Incompetence, negligence and stupidity. Maybe even more?
Yes, we need more third party oversight of the largest CMS contractor, First Coast Service Options, operations. As a contractor they should be scrutinized by Congress. But maybe there is too much money involved and too many people may loose their job financed by taxpayers money.
Or maybe I am just paranoid and should let it go.I don't think so.
Bernd
The reports opens with the following finding:
" In the last half of 2006, three South Florida counties accounted for half the total amount, and 79 percent of the amount for drugs, billed nationally for Medicare beneficiaries with HIV/AIDS. Most of the charges originating in these counties were for nonoral drugs; drug claims represented just 16 percent of the submitted charges in other geographic areas. Aberrant claims patterns differentiated South Florida providers and beneficiaries from those in the rest of the country."
"CMS has had limited success in controlling the aberrant billing practices of South Florida infusion therapy providers. CMS and its contractors have used multiple approaches, but none has proven effective over time. The most common tools include payment suspensions, revocations, and claims-processing edits. CMS has taken limited action to strengthen the enrollment process for new providers. "
A series for recommendation are being made and the report summarizes its findings as follows:
"CMS’s positive response to our recommendations, including its initiation of the new demonstration project, indicates that the agency is now moving toward strategies that should more effectively protect the integrity of Medicare payments in South Florida."
How do they define "success":
"Although billing increased from $1.5 to $3.3 Billion (CY 2004-2006) ,Medicare payments in Florida dropped from $1 Billion to $890 Million ... as a direct result of CMS' containment efforts."
Hardly a success story to me! Recent CMS data suggest that the "successful" containment efforts succeeded to contain as much (or little) as before.
Guess what; the party continues and First Coast Service Options continues to pay!
So, they nickle and dime good doctors and impose arbitrary 100% prepayment review requirements BUT allow crooks to sail a cruiseship through their loopholes.
How do I call it? Incompetence, negligence and stupidity. Maybe even more?
Yes, we need more third party oversight of the largest CMS contractor, First Coast Service Options, operations. As a contractor they should be scrutinized by Congress. But maybe there is too much money involved and too many people may loose their job financed by taxpayers money.
Or maybe I am just paranoid and should let it go.I don't think so.
Bernd
Sunday, November 23, 2008
Medicare Home Health Services
Dear Friends and Colleagues:
Attached you find an article from todays Miami Herald reporting that Medicare will suspend millions of dollars in payments to dozens of additional home healthcare providers in Miami-Dade after a federal judge ruled it has the power to stop reimbursements to companies suspected of overcharging for diabetic and other services.
The callous abuse of the Medicare system, a vital lifeline of needed healthcare service for millions of senior patients, has reached new heights in South Florida. here are the facts for Dade county ALONE:
* Miami-Dade is home to 334 Medicare-certified home healthcare providers.
* All together, the top 10 home health providers were paid $139 million by Medicare in 2007.
* Medicare issued the suspensions after finding that it spends one of every 15 dollars on home healthcare nationwide in one county -- Miami-Dade.
* The agency's spending in Miami-Dade totals $1.3 billion out of a nationwide budget of $16.5 billion.
* Since 2001, Medicare's Miami-Dade payments for home healthcare has grown at a pace 13 times the national rate.
There are only two conclusions: either the demand for home health care service has increased by 13 x times the national rate OR (more likely) unscrupulous provides are defrauding the system.
As physicians we MUST work collaboratively with law enforcement and CMS to STOP this abbuse. Every dollar diverted for for fraud will further jeopardize our struggle for reimbursement of physicians services.
We should also NOT stop from reporting those physicians who receive hefty and lucrative referral fees from home health companies. Protecting those "colleagues" means acquiescing to fraud and abuse of the system.
Yours
Bernd
Posted on Sun, Nov. 23, 2008
Ruling halts Medicare payments to more Miami-Dade home healthcare providers
BY JAY WEAVER
Medicare will suspend millions of dollars in payments to dozens of additional home healthcare providers in Miami-Dade after a federal judge ruled it has the power to stop reimbursements to companies suspected of overcharging for diabetic and other services.
The government agency began the crackdown on the top 10 Miami-Dade home healthcare operators in October, citing potential fraud, but one of the providers sued in federal court claiming Medicare exceeded its authority.
This week, U.S. District Judge Paul Huck sided with Medicare, saying the taxpayer-funded program's suspension policy is ``reasonable and appropriate.''
His decision allows Medicare to continue halting payments to local companies suspected of submitting excessive claims for nurses treating homebound patients who either aren't diabetic or don't need help injecting insulin.
Miami-Dade is home to 334 Medicare-certified home healthcare providers. Many could be affected by the giant entitlement program's unprecedented suspensions.
''Because of the judge's decision, we will be able to expand our efforts to look at other home healthcare companies for payment suspensions and audits,'' Medicare spokesman Peter Ashkenaz said Friday. ``We just want to make sure the people getting home healthcare services are receiving them under the law.''
The judge's decision followed a Miami Herald story that detailed how the home healthcare company that sued Medicare over the suspension policy had billed the agency about $75,000 last year for a nurse to inject the insulin of a homebound diabetic patient.
But the patient, 92-year-old Maria C. Perez, who was living in a Westchester group home, told the Miami Herald that she has never been diabetic and didn't receive twice-a-day insulin injections from a visiting nurse in the latter half of 2007.
Her family doctor and medical records backed up her statement.
Home Care Services Provider, based in Kendall, said it did send a nurse twice daily to treat Perez for diabetes from June to November last year based on a prescribed referral by a Hialeah physician. It denied any wrongdoing.
MULLING AN APPEAL
As for the dispute over Medicare's suspension policy, the company's lawyer said it is considering an appeal of the judge's decision, filed Wednesday.
''We respectfully disagree with the court's ruling,'' attorney Anthony Vitale said in a statement. ``We believed then and we believe now that the Medicare payment suspension regulation is illegal.''
But that dispute with Medicare could be the least of Home Care Services Provider's problems.
The company's Miami-Dade owner, Maria Del Carmen Escarpio, 48, was charged in July with defrauding the Florida Medicaid program, which covers healthcare services for low-income people.
She's accused of using her Kendall home healthcare business to bill the state program $447,000 in wound care supplies and oxygen equipment that were never delivered to Medicaid patients in 2003-04. Moreover, the patients didn't have any wounds or need the oxygen, state authorities said.
''We're vigorously defending her in that case,'' said Escarpio's criminal attorney, Louis Martinez. ``It has nothing to do whatsoever with the current Medicare case [in federal court] nor does it have anything do with the suspension.''
In early October, Medicare suspended millions of dollars in payments to the top 10 home healthcare agencies in Miami-Dade County, citing a spike in questionable billing for diabetic and other services.
All together, the 10 providers were paid $139 million by Medicare in 2007.
The suspensions, which entail audits of claims and payments dating back to 2004, are in effect for at least six months.
FIRST TARGETS
Among the first targets: Home Care Services Provider, which received $12 million in Medicare payments last year.
About 72 percent of its income came from treating mostly homebound diabetic patients, records show.
Medicare issued the suspensions after finding that it spends one of every 15 dollars on home healthcare nationwide in one county -- Miami-Dade.
The agency's spending in Miami-Dade totals $1.3 billion. Its nationwide budget is $16.5 billion.
Since 2001, Medicare's Miami-Dade payments for home healthcare has grown at a pace 13 times the national rate.
What Medicare officials have found is that the massive health insurance program for the elderly and disabled is losing potentially hundreds of millions of dollars a year in Miami-Dade to fraud, abuse and waste in home healthcare.
The first round of Medicare suspensions in Miami-Dade were based on ''reliable information'' that home care claims submitted last year ''may have involved an overpayment, fraud or misrepresentation,'' according to an Oct. 3 Medicare letter sent to the targeted companies.
DIFFERENT SIGNATURES
The letter noted that certain physicians had told Medicare that their signatures didn't match those on prescribed patient care plans submitted to home care providers.
But one Miami-Dade operator, Patient Care, Inc., fired back a letter, saying it was ``being unfairly herded into the slaughterhouse as a result of its success and not a single shred of evidence.''
Attached you find an article from todays Miami Herald reporting that Medicare will suspend millions of dollars in payments to dozens of additional home healthcare providers in Miami-Dade after a federal judge ruled it has the power to stop reimbursements to companies suspected of overcharging for diabetic and other services.
The callous abuse of the Medicare system, a vital lifeline of needed healthcare service for millions of senior patients, has reached new heights in South Florida. here are the facts for Dade county ALONE:
* Miami-Dade is home to 334 Medicare-certified home healthcare providers.
* All together, the top 10 home health providers were paid $139 million by Medicare in 2007.
* Medicare issued the suspensions after finding that it spends one of every 15 dollars on home healthcare nationwide in one county -- Miami-Dade.
* The agency's spending in Miami-Dade totals $1.3 billion out of a nationwide budget of $16.5 billion.
* Since 2001, Medicare's Miami-Dade payments for home healthcare has grown at a pace 13 times the national rate.
There are only two conclusions: either the demand for home health care service has increased by 13 x times the national rate OR (more likely) unscrupulous provides are defrauding the system.
As physicians we MUST work collaboratively with law enforcement and CMS to STOP this abbuse. Every dollar diverted for for fraud will further jeopardize our struggle for reimbursement of physicians services.
We should also NOT stop from reporting those physicians who receive hefty and lucrative referral fees from home health companies. Protecting those "colleagues" means acquiescing to fraud and abuse of the system.
Yours
Bernd
Posted on Sun, Nov. 23, 2008
Ruling halts Medicare payments to more Miami-Dade home healthcare providers
BY JAY WEAVER
Medicare will suspend millions of dollars in payments to dozens of additional home healthcare providers in Miami-Dade after a federal judge ruled it has the power to stop reimbursements to companies suspected of overcharging for diabetic and other services.
The government agency began the crackdown on the top 10 Miami-Dade home healthcare operators in October, citing potential fraud, but one of the providers sued in federal court claiming Medicare exceeded its authority.
This week, U.S. District Judge Paul Huck sided with Medicare, saying the taxpayer-funded program's suspension policy is ``reasonable and appropriate.''
His decision allows Medicare to continue halting payments to local companies suspected of submitting excessive claims for nurses treating homebound patients who either aren't diabetic or don't need help injecting insulin.
Miami-Dade is home to 334 Medicare-certified home healthcare providers. Many could be affected by the giant entitlement program's unprecedented suspensions.
''Because of the judge's decision, we will be able to expand our efforts to look at other home healthcare companies for payment suspensions and audits,'' Medicare spokesman Peter Ashkenaz said Friday. ``We just want to make sure the people getting home healthcare services are receiving them under the law.''
The judge's decision followed a Miami Herald story that detailed how the home healthcare company that sued Medicare over the suspension policy had billed the agency about $75,000 last year for a nurse to inject the insulin of a homebound diabetic patient.
But the patient, 92-year-old Maria C. Perez, who was living in a Westchester group home, told the Miami Herald that she has never been diabetic and didn't receive twice-a-day insulin injections from a visiting nurse in the latter half of 2007.
Her family doctor and medical records backed up her statement.
Home Care Services Provider, based in Kendall, said it did send a nurse twice daily to treat Perez for diabetes from June to November last year based on a prescribed referral by a Hialeah physician. It denied any wrongdoing.
MULLING AN APPEAL
As for the dispute over Medicare's suspension policy, the company's lawyer said it is considering an appeal of the judge's decision, filed Wednesday.
''We respectfully disagree with the court's ruling,'' attorney Anthony Vitale said in a statement. ``We believed then and we believe now that the Medicare payment suspension regulation is illegal.''
But that dispute with Medicare could be the least of Home Care Services Provider's problems.
The company's Miami-Dade owner, Maria Del Carmen Escarpio, 48, was charged in July with defrauding the Florida Medicaid program, which covers healthcare services for low-income people.
She's accused of using her Kendall home healthcare business to bill the state program $447,000 in wound care supplies and oxygen equipment that were never delivered to Medicaid patients in 2003-04. Moreover, the patients didn't have any wounds or need the oxygen, state authorities said.
''We're vigorously defending her in that case,'' said Escarpio's criminal attorney, Louis Martinez. ``It has nothing to do whatsoever with the current Medicare case [in federal court] nor does it have anything do with the suspension.''
In early October, Medicare suspended millions of dollars in payments to the top 10 home healthcare agencies in Miami-Dade County, citing a spike in questionable billing for diabetic and other services.
All together, the 10 providers were paid $139 million by Medicare in 2007.
The suspensions, which entail audits of claims and payments dating back to 2004, are in effect for at least six months.
FIRST TARGETS
Among the first targets: Home Care Services Provider, which received $12 million in Medicare payments last year.
About 72 percent of its income came from treating mostly homebound diabetic patients, records show.
Medicare issued the suspensions after finding that it spends one of every 15 dollars on home healthcare nationwide in one county -- Miami-Dade.
The agency's spending in Miami-Dade totals $1.3 billion. Its nationwide budget is $16.5 billion.
Since 2001, Medicare's Miami-Dade payments for home healthcare has grown at a pace 13 times the national rate.
What Medicare officials have found is that the massive health insurance program for the elderly and disabled is losing potentially hundreds of millions of dollars a year in Miami-Dade to fraud, abuse and waste in home healthcare.
The first round of Medicare suspensions in Miami-Dade were based on ''reliable information'' that home care claims submitted last year ''may have involved an overpayment, fraud or misrepresentation,'' according to an Oct. 3 Medicare letter sent to the targeted companies.
DIFFERENT SIGNATURES
The letter noted that certain physicians had told Medicare that their signatures didn't match those on prescribed patient care plans submitted to home care providers.
But one Miami-Dade operator, Patient Care, Inc., fired back a letter, saying it was ``being unfairly herded into the slaughterhouse as a result of its success and not a single shred of evidence.''
Tuesday, November 18, 2008
Home Health Care Fraud
DADE COUNTY: THE HOME HEALTH CARE FRAUD CAPITOL OF THE NATION
The Miami Herald ran another excellent investigative report about the rampant fraud and abuse committed by Home Health Care Service agencies. http://www.miamiherald.com/living/health/v-fullstory/story/773538.html
Some facts.
• Medicare spends one of every 15 dollars on home healthcare nationwide in one county -- Miami-Dade. Medicare's total budget: $16.5 billion.
• Since 2001, Medicare's payments for home healthcare in Miami-Dade have grown by a whopping 1,750 percent -- to $1.3 billion -- while the pool of people over 65 diagnosed with diabetes grew by just 30 percent.
• Medicare was billed roughly $75,000 by a Home Health Care Service provider for twice-daily nursing visits to inject her with insulin to control diabetes during the latter half of 2007.
• According to federal records, Medicare paid one company about $12.6 million last year. A little more than 70 percent of its income was for treating homebound diabetic patients, records show.
What can we do:
1. Report any attempt by home health company representatives offering financial “incentives” for patient referrals.
2. Report any physicians that you know have accepted such arrangements
3. Carefully scrutinize orders to be signed by the physician for inconsistencies and blatantly false medical services allegedly ordered by you.
4. Periodically review “routine” home health service requests.
5. Deny services that include for example “ twice daily insulin injections administered by a nurse. Ask why the patient is unable to learn the self-administration of insulin injections.
6. Do not hesitate calling the local US attorneys office and/or your local medical society to report any suspicious activities.
Remember, that EVERY DOLLAR embezzled by this crooks is one dollar less paying for legitimate medical services rendered by had-working honest doctors!
Therefore, we need to be on alert pointing out fraud and abuse whenever it occurs in our community. No, we are not snitches but responsible members of our community who care for the viability of the Medicare program.
We need to work together on that and other issues. Together we are stronger. Together we can address this challenge.
The Miami Herald ran another excellent investigative report about the rampant fraud and abuse committed by Home Health Care Service agencies. http://www.miamiherald.com/living/health/v-fullstory/story/773538.html
Some facts.
• Medicare spends one of every 15 dollars on home healthcare nationwide in one county -- Miami-Dade. Medicare's total budget: $16.5 billion.
• Since 2001, Medicare's payments for home healthcare in Miami-Dade have grown by a whopping 1,750 percent -- to $1.3 billion -- while the pool of people over 65 diagnosed with diabetes grew by just 30 percent.
• Medicare was billed roughly $75,000 by a Home Health Care Service provider for twice-daily nursing visits to inject her with insulin to control diabetes during the latter half of 2007.
• According to federal records, Medicare paid one company about $12.6 million last year. A little more than 70 percent of its income was for treating homebound diabetic patients, records show.
What can we do:
1. Report any attempt by home health company representatives offering financial “incentives” for patient referrals.
2. Report any physicians that you know have accepted such arrangements
3. Carefully scrutinize orders to be signed by the physician for inconsistencies and blatantly false medical services allegedly ordered by you.
4. Periodically review “routine” home health service requests.
5. Deny services that include for example “ twice daily insulin injections administered by a nurse. Ask why the patient is unable to learn the self-administration of insulin injections.
6. Do not hesitate calling the local US attorneys office and/or your local medical society to report any suspicious activities.
Remember, that EVERY DOLLAR embezzled by this crooks is one dollar less paying for legitimate medical services rendered by had-working honest doctors!
Therefore, we need to be on alert pointing out fraud and abuse whenever it occurs in our community. No, we are not snitches but responsible members of our community who care for the viability of the Medicare program.
We need to work together on that and other issues. Together we are stronger. Together we can address this challenge.
Monday, November 17, 2008
Fight Medicare Fraud
WE HAVE TO FIGHT AGAINST MEDICARE FRAUD!
The Miami Herald reported again several troubling cases of Medicare fraud
The stories are very familiar:
• A family-run enterprise of medical equipment and billing companies submitted more than $17 million in false claims to Medicare, they admitted in court. Their haul: $5 million. The family's scheme was launched in 1999, when David and Laura Hernandez opened their first medical equipment company, said Assistant U.S. Attorney Ryan Stumphauzer.In a statement filed in court, the three admitted opening a string of equipment suppliers in Miami-Dade and starting a billing company to file false claims with Medicare. The billing company was owned by Laura Hernandez. David Hernandez, in the lead role, recruited four people to register as the official owners of four equipment-supply companies to conceal his participation in the scam, according to the court statement. Those ''nominee'' owners, members of another family, were charged in a separate Medicare fraud indictment. Husband and wife Jose Echevarria and Magaly Martinez, along with their son, Yuniel Echevarria, and his wife, Suyima Torres, pleaded guilty earlier this year. To fuel the racket, David Hernandez and his brother, Jose, paid kickbacks to patients for the use of their Medicare numbers. In turn, the brothers billed the federal insurance program for products, such as beds, catheters and pumps, that were never delivered to anyone. Proceeds of the fraud were deposited in the corporate bank accounts of the family's medical equipment companies. Hernandez also laundered some of the Medicare reimbursements through shell companies with ''medical-sounding'' names that were set up to cash checks at banks so his family could pocket the proceeds, according to the statement filed in court. Some of that taxpayer money enabled the Hernandezes to pay $331,000 to buy the Pembroke Pines home in 2002.
• A Miami doctor and nurse have been convicted of billing Medicare for millions of dollars in false claims for obsolete HIV therapy at a local clinic owned by three brothers who fled to Cuba to avoid prosecution. Dr. Ana Alvarez-Jacinto and Sandra Mateos, found guilty by a Miami federal jury Friday, played key roles in an $11 million scam involving HIV-positive patients who received kickbacks in exchange for letting the clinic use their Medicare numbers to bill the federal program. The two women who opened St. Jude Rehab Center as partners with Carlos, Jose and Luis Benitez -- fugitives charged in a separate indictment -- had already pleaded guilty to fraud this year. Mariela Rodriguez and Aisa Perera, who ran St. Jude from June to November 2003, collected $8 million from the false Medicare claims.
• A local physician convicted of Medicare fraud for his role in a massive HIV therapy racket run by three Miami-Dade brothers was sentenced to seven years in prison on Tuesday. Ronald Harris, 58, wrote prescriptions to bill Medicare for an obsolete treatment that was not provided to patients with the virus that causes AIDS, according to court records. The patients received cash kickbacks in exchange for letting the Miami physician bill the federal health insurance program with their Medicare numbers.In August, Harris pleaded guilty to a conspiracy charge as the medical director for Physicians Med-Care in Miami and Physicians Health Med-Care in Hallandale Beach. The two HIV clinics submitted $26.2 million in false claims to Medicare between 2002 and 2004.
Lets be reminded that EVERY DOLLAR embezzled by this crooks is one dollar less paying for legitimate medical services rendered by had-working honest doctors!
Therefore, we need to be on alert pointing out fraud and abuse whenever it occurs in our community. No, we are not snitches but responsible members of our community who care for the viability of the Medicare program.
We need to work together on that and other issues. Together we are stronger. Together we can address this challenge.
The Miami Herald reported again several troubling cases of Medicare fraud
The stories are very familiar:
• A family-run enterprise of medical equipment and billing companies submitted more than $17 million in false claims to Medicare, they admitted in court. Their haul: $5 million. The family's scheme was launched in 1999, when David and Laura Hernandez opened their first medical equipment company, said Assistant U.S. Attorney Ryan Stumphauzer.In a statement filed in court, the three admitted opening a string of equipment suppliers in Miami-Dade and starting a billing company to file false claims with Medicare. The billing company was owned by Laura Hernandez. David Hernandez, in the lead role, recruited four people to register as the official owners of four equipment-supply companies to conceal his participation in the scam, according to the court statement. Those ''nominee'' owners, members of another family, were charged in a separate Medicare fraud indictment. Husband and wife Jose Echevarria and Magaly Martinez, along with their son, Yuniel Echevarria, and his wife, Suyima Torres, pleaded guilty earlier this year. To fuel the racket, David Hernandez and his brother, Jose, paid kickbacks to patients for the use of their Medicare numbers. In turn, the brothers billed the federal insurance program for products, such as beds, catheters and pumps, that were never delivered to anyone. Proceeds of the fraud were deposited in the corporate bank accounts of the family's medical equipment companies. Hernandez also laundered some of the Medicare reimbursements through shell companies with ''medical-sounding'' names that were set up to cash checks at banks so his family could pocket the proceeds, according to the statement filed in court. Some of that taxpayer money enabled the Hernandezes to pay $331,000 to buy the Pembroke Pines home in 2002.
• A Miami doctor and nurse have been convicted of billing Medicare for millions of dollars in false claims for obsolete HIV therapy at a local clinic owned by three brothers who fled to Cuba to avoid prosecution. Dr. Ana Alvarez-Jacinto and Sandra Mateos, found guilty by a Miami federal jury Friday, played key roles in an $11 million scam involving HIV-positive patients who received kickbacks in exchange for letting the clinic use their Medicare numbers to bill the federal program. The two women who opened St. Jude Rehab Center as partners with Carlos, Jose and Luis Benitez -- fugitives charged in a separate indictment -- had already pleaded guilty to fraud this year. Mariela Rodriguez and Aisa Perera, who ran St. Jude from June to November 2003, collected $8 million from the false Medicare claims.
• A local physician convicted of Medicare fraud for his role in a massive HIV therapy racket run by three Miami-Dade brothers was sentenced to seven years in prison on Tuesday. Ronald Harris, 58, wrote prescriptions to bill Medicare for an obsolete treatment that was not provided to patients with the virus that causes AIDS, according to court records. The patients received cash kickbacks in exchange for letting the Miami physician bill the federal health insurance program with their Medicare numbers.In August, Harris pleaded guilty to a conspiracy charge as the medical director for Physicians Med-Care in Miami and Physicians Health Med-Care in Hallandale Beach. The two HIV clinics submitted $26.2 million in false claims to Medicare between 2002 and 2004.
Lets be reminded that EVERY DOLLAR embezzled by this crooks is one dollar less paying for legitimate medical services rendered by had-working honest doctors!
Therefore, we need to be on alert pointing out fraud and abuse whenever it occurs in our community. No, we are not snitches but responsible members of our community who care for the viability of the Medicare program.
We need to work together on that and other issues. Together we are stronger. Together we can address this challenge.
The Election Is Over. What Shall We Do Now?
MESSAGE FROM YOUR PRESIDENT:
The Election Is Over. What Shall We Do Now?
The two year long presidential election session is over. Before our President - Elect can get down to business the political pundits are already preparing for the 2012 presidential elections. Furthermore, those who are unhappy with the outcome of the election are vowing to “resist” any changes to be promised by the new administration. During the recent Interim Meeting of the American Medical Association in Orlando some attendees even went a step further. A current member of the United States House of Representatives called upon doctors to carry - hopefully in a figurative manner - a loaded shotgun to fight for their freedom. A former AMA President even dared to compare the status of doctors in the US to that of Jews in Nazi Germany!
This kind of hyperbolic rhetoric is not only unacceptable but also misses the mark!
I am confident that the majority of AMA delegates do not support these positions.
What we need are pragmatic solutions to the problems we are facing: stagnating reimbursement, increasing practice costs, third-party control of our practices and unnecessary regulatory burden.
This requires the ability to reach out to all parties involved in the healthcare delivery process, listen to arguments, tolerate other opinions and reach a compromise. Collaboration and not confrontation will help us to achieve our goals. As I said many times before: we need to sit at the table, otherwise we are going to be the menu item on the table.
Therefore, I will remain focused on assisting our members to continue practicing medicine. But I will also remind each of you that there is no way back to the “good old days of medicine.” The only constant in life is change! We have to adapt to the rapidly changing economic environment and find the best solutions that suit us.
Verbal radicalism and defiance will only lead us into a political dead end street.
Many of you are helping me to identify the problems and we try our best to resolve them. One of the issues pertains to the sluggish Medicare reimbursement for services rendered and the onerous prepayment chart review requirements.
Therefore, on 10/22/08 I traveled to Jacksonville and met with the CEO and President Mrs. Sandy Coston and the Vice Chairman Mr. Curtis Lord of FIRST COAST, the regional Medicare administrator. I also had the opportunity to meet and speak with all department heads including claims processing support, claims processing center, provider customers service, provider enrollment, program integrity and Medicare Education and Performance Solution. We discussed ONE single topic: how to improve the claims processing and reimbursement process. We agreed to ease the prepayment review process thereby reducing the chart review requirements. I will depend on your feedback to monitor the promised improvements. On the evening preceding my trip I received a call from a physician reporting that he has not received ANY Medicare reimbursement in the last 6 months and that ALL of his claims were rejected. I was able to resolve the problem within 24-hours and he will receive all payments due.
You need you to join our DCMA to support these and other projects, which help you to practice medicine and to provide quality care to your patients.
What are you waiting for? Join today!
Yours
Bernd Wollschlaeger,MD,FAAFP,FASAM
President, Dade County Medical Association
The Election Is Over. What Shall We Do Now?
The two year long presidential election session is over. Before our President - Elect can get down to business the political pundits are already preparing for the 2012 presidential elections. Furthermore, those who are unhappy with the outcome of the election are vowing to “resist” any changes to be promised by the new administration. During the recent Interim Meeting of the American Medical Association in Orlando some attendees even went a step further. A current member of the United States House of Representatives called upon doctors to carry - hopefully in a figurative manner - a loaded shotgun to fight for their freedom. A former AMA President even dared to compare the status of doctors in the US to that of Jews in Nazi Germany!
This kind of hyperbolic rhetoric is not only unacceptable but also misses the mark!
I am confident that the majority of AMA delegates do not support these positions.
What we need are pragmatic solutions to the problems we are facing: stagnating reimbursement, increasing practice costs, third-party control of our practices and unnecessary regulatory burden.
This requires the ability to reach out to all parties involved in the healthcare delivery process, listen to arguments, tolerate other opinions and reach a compromise. Collaboration and not confrontation will help us to achieve our goals. As I said many times before: we need to sit at the table, otherwise we are going to be the menu item on the table.
Therefore, I will remain focused on assisting our members to continue practicing medicine. But I will also remind each of you that there is no way back to the “good old days of medicine.” The only constant in life is change! We have to adapt to the rapidly changing economic environment and find the best solutions that suit us.
Verbal radicalism and defiance will only lead us into a political dead end street.
Many of you are helping me to identify the problems and we try our best to resolve them. One of the issues pertains to the sluggish Medicare reimbursement for services rendered and the onerous prepayment chart review requirements.
Therefore, on 10/22/08 I traveled to Jacksonville and met with the CEO and President Mrs. Sandy Coston and the Vice Chairman Mr. Curtis Lord of FIRST COAST, the regional Medicare administrator. I also had the opportunity to meet and speak with all department heads including claims processing support, claims processing center, provider customers service, provider enrollment, program integrity and Medicare Education and Performance Solution. We discussed ONE single topic: how to improve the claims processing and reimbursement process. We agreed to ease the prepayment review process thereby reducing the chart review requirements. I will depend on your feedback to monitor the promised improvements. On the evening preceding my trip I received a call from a physician reporting that he has not received ANY Medicare reimbursement in the last 6 months and that ALL of his claims were rejected. I was able to resolve the problem within 24-hours and he will receive all payments due.
You need you to join our DCMA to support these and other projects, which help you to practice medicine and to provide quality care to your patients.
What are you waiting for? Join today!
Yours
Bernd Wollschlaeger,MD,FAAFP,FASAM
President, Dade County Medical Association
Tuesday, November 04, 2008
Women and Health Insurance
A recent study revealed a scandalous phenomenon: that women pay more than do men of the same age for identical healthcare coverage provided by individual insurance policies! This "gender rating" is discriminatory and MUST stop! We have to regulate the insurance market to guarantee that all insurance companies follow the same rules. No, this is not socialism, but smart government policy to stop discrimination and to introduce fairness into the health insurance system.
Yours
Bernd
Posted on Mon, Nov. 03, 2008
Women pay more for insurance -- why?
It is an unpleasant fact that life sometimes can be an uneven experience, delivering different results for the same effort, or producing failure when success is warranted. In a well-organized society such as ours, insurance is designed to even out the rough spots somewhat by spreading risk broadly.
Which is why it should come as a surprise that women pay more than do men of the same age for identical healthcare coverage provided by individual-insurance policies. What is worse, men and women are finding it exceedingly expensive, if not impossible, to find coverage for some illnesses through the individual-insurance market.
Revealing study
This is something Congress should look into, not with a mind-set of heavy-handed mandates, mind you, but with the idea of listening to healthcare consumers and insurance companies and finding common ground for new approaches. A recent study by the National Women's Law Center shed some light on the matter. See the study at www.nwlc.org/; click on the report, Nowhere to Turn . . .
The study found that the individual-insurance market -- unlike group insurance purchased through an employer -- uses ''gender rating.'' This allows an insurer to charge women higher premiums than men for the same coverage. More and more people are discovering these discrepancies thanks to the failing U.S. economy, which has resulted in job losses for hundreds of thousands of Americans, who find themselves looking for new insurance coverage.
Some recently laid-off people who had full healthcare coverage in their previous jobs are finding that they can't get coverage at any price with individual insurers for some ailments because of ''preexisting conditions.'' Moreover, many women are finding that they are paying 30 percent more for insurance than men because of their gender. Insurers say their claim experiences show that women use healthcare services more and, therefore, are charged more. In other words, women are more likely to get checkups and visit the doctor more because, well . . . they just do.
Illogical comparison
Some insurers say this is similar to auto-insurance rates that are higher for men than women because men have more accidents and file more claims. The comparison seems logical but, in fact, it really is not. Women who proactively monitor their health may identify problems earlier, get treatment sooner and ultimately cost an insurer less. A man who crashes his car isn't involved in proactive, preventive behavior.
Society's long-term interest should be to promote more of the former behavior than the latter. This should be the goal of insurers, too. Finding a nexus between affordable healthcare and a financially viable insurance market won't be easy. Congress can get closer to a solution by hearing from, and listening to, all parties.
Yours
Bernd
Posted on Mon, Nov. 03, 2008
Women pay more for insurance -- why?
It is an unpleasant fact that life sometimes can be an uneven experience, delivering different results for the same effort, or producing failure when success is warranted. In a well-organized society such as ours, insurance is designed to even out the rough spots somewhat by spreading risk broadly.
Which is why it should come as a surprise that women pay more than do men of the same age for identical healthcare coverage provided by individual-insurance policies. What is worse, men and women are finding it exceedingly expensive, if not impossible, to find coverage for some illnesses through the individual-insurance market.
Revealing study
This is something Congress should look into, not with a mind-set of heavy-handed mandates, mind you, but with the idea of listening to healthcare consumers and insurance companies and finding common ground for new approaches. A recent study by the National Women's Law Center shed some light on the matter. See the study at www.nwlc.org/; click on the report, Nowhere to Turn . . .
The study found that the individual-insurance market -- unlike group insurance purchased through an employer -- uses ''gender rating.'' This allows an insurer to charge women higher premiums than men for the same coverage. More and more people are discovering these discrepancies thanks to the failing U.S. economy, which has resulted in job losses for hundreds of thousands of Americans, who find themselves looking for new insurance coverage.
Some recently laid-off people who had full healthcare coverage in their previous jobs are finding that they can't get coverage at any price with individual insurers for some ailments because of ''preexisting conditions.'' Moreover, many women are finding that they are paying 30 percent more for insurance than men because of their gender. Insurers say their claim experiences show that women use healthcare services more and, therefore, are charged more. In other words, women are more likely to get checkups and visit the doctor more because, well . . . they just do.
Illogical comparison
Some insurers say this is similar to auto-insurance rates that are higher for men than women because men have more accidents and file more claims. The comparison seems logical but, in fact, it really is not. Women who proactively monitor their health may identify problems earlier, get treatment sooner and ultimately cost an insurer less. A man who crashes his car isn't involved in proactive, preventive behavior.
Society's long-term interest should be to promote more of the former behavior than the latter. This should be the goal of insurers, too. Finding a nexus between affordable healthcare and a financially viable insurance market won't be easy. Congress can get closer to a solution by hearing from, and listening to, all parties.
Tuesday, October 07, 2008
Medicare Cuts Will Pay For Health Care Benefits
"John McCain would pay for his health plan with major reductions to Medicare and Medicaid, a top aide said, in a move that independent analysts estimate could result in cuts of $1.3 trillion over 10 years to the government programs."
Dear Friends and Colleagues:
Attached an interesting article from the Wall Street Journal reporting that Douglas Holtz-Eakin, Sen. McCain's senior policy adviser, indicated that McCain's proposed health care plan will be funded with savings from Medicare and Medicaid.
Independent analysts estimate that this could result in cuts of $1.3 trillion over 10 years to the government programs.
Mr. Holtz-Eakin said the Medicare and Medicaid changes would improve the programs and eliminate fraud, but he didn't detail where the cuts would come from. "It's about giving them the benefit package that has been promised to them by law at lower cost," he said.
Sen. McCain's plan to offer a new tax credit of $2,500 per person and $5,000 per family toward insurance premiums. This would allow people to buy health coverage on the open market, where they may have more choices and might look for a better bargain.In exchange, the government would begin taxing the value of health benefits people get through work. If an employer spends $10,000 to buy a worker health insurance, the worker would pay taxes on that money.
The nonpartisan Tax Policy Center, a Washington think tank, estimates that the McCain plan would cost the government $1.3 trillion over 10 years. The plan would allow as many as five million more people to have insurance, it estimates.
The Tax Policy Center estimates that Obama's plan would cost $1.6 trillion over 10 years and cover 34 million more people.
Comment:
Senator McCain seems to be ill advised to suggest MASSIVE Medicare cuts to finance his health care plan. In States like Florida, and especially South Florida, Medicare recipients will definitely not support any Medicare cuts and neither will doctors who already struggle with fair reimbursement issues.
I guess, that SGR refom will also fall by the wayside because there is no money to bail out doctors.
McCain's proposal is another speed bump on the road towards healthcare recovery.
Yours
Bernd
Shana Tova, Happy New Year and Chatima Tova
McCain Plans Federal Health Cuts
Medicare, Medicaid Spending Would Be Reduced to Offset Proposed Tax Credit
John McCain would pay for his health plan with major reductions to Medicare and Medicaid, a top aide said, in a move that independent analysts estimate could result in cuts of $1.3 trillion over 10 years to the government programs.
The Republican presidential nominee has said little about the proposed cuts, but they are needed to keep his health-care plan "budget neutral," as he has promised. The McCain campaign hasn't given a specific figure for the cuts, but didn't dispute the analysts' estimate.
In the months since Sen. McCain introduced his health plan, statements made by his campaign have implied that the new tax credits he is proposing to help Americans buy health insurance would be paid for with other tax increases.
But Douglas Holtz-Eakin, Sen. McCain's senior policy adviser, said Sunday that the campaign has always planned to fund the tax credits, in part, with savings from Medicare and Medicaid. Those government health-care programs serve seniors, poor families and the disabled. Medicare spending for the fiscal year ended Sept. 30 is estimated at $457.5 billion.
Mr. Holtz-Eakin said the Medicare and Medicaid changes would improve the programs and eliminate fraud, but he didn't detail where the cuts would come from. "It's about giving them the benefit package that has been promised to them by law at lower cost," he said.
Both Sen. McCain and his Democratic rival, Sen. Barack Obama, have recently sought to refocus on health care. The issue once ranked at the top of voters' domestic concerns, but has in recent months been eclipsed by energy and the economy.
Sen. McCain charges that the Obama plan, which would create a government-run marketplace in which people could buy coverage, would lead to government-run health care. Sen. Obama charges that Sen. McCain's plan would leave many people unable to get insurance.
Sen. Obama's campaign turned up the volume in a major push on health care over the weekend with two days of attacks from the stump, four new television advertisements, a series of health-care events across the country and fliers to voters' homes in swing states.
Sen. Obama is focused on Sen. McCain's plan to offer a new tax credit of $2,500 per person and $5,000 per family toward insurance premiums. This would allow people to buy health coverage on the open market, where they may have more choices and might look for a better bargain.
In exchange, the government would begin taxing the value of health benefits people get through work. If an employer spends $10,000 to buy a worker health insurance, the worker would pay taxes on that money.
"It's a shell game," Sen. Obama told an outdoor rally of 28,000 people Sunday in Asheville, N.C. "Sen. McCain gives you a tax credit with one hand -- but raises your taxes with the other."
Sen. McCain's plan actually would lower taxes for most people. But that means the plan wouldn't pay for itself, because it cuts certain taxes more than it raises others.
The federal government imposes two taxes on wages, generally: an income tax, which funds the government's general operations, and the payroll tax, paid for by employers and employees, which funds Social Security and Medicare. If Sen. McCain were to apply both of these to the value of health benefits, he could fully pay for his new tax credits. That is what aides have in the past suggested he would do.
In April, when Sen. McCain gave a major speech about his health plan, Mr. Holtz-Eakin, the senior policy adviser, said the tax provisions alone were budget neutral -- meaning that health benefits would have to be subject to both income and payroll taxes.
Campaign officials have regularly implied since then that the tax plan was a wash. In the vice-presidential debate last week, Alaska Gov. Sarah Palin described Sen. McCain's proposed tax credits and said: "That's budget neutral. That doesn't cost the government anything, as opposed to Barack Obama's plan to mandate health-care coverage and have this universal, government-run program."
Mr. Holtz-Eakin said the campaign never intended to apply the payroll tax to health benefits. That means that most people would see a net tax cut, contrary to Sen. Obama's assertions. Only those with very rich benefits packages are likely to see a net increase in taxes. But it also means that Sen. McCain must fill a huge budget hole -- which the campaign says will come from cuts to Medicare and Medicaid.
The nonpartisan Tax Policy Center, a Washington think tank, estimates that the McCain plan would cost the government $1.3 trillion over 10 years. The plan would allow as many as five million more people to have insurance, it estimates.
Mr. Holtz-Eakin said the plan is accurately described as budget neutral because it assumes enough savings in Medicare and Medicaid spending to make up the difference. He said the savings would come from eliminating Medicare fraud and by reforming payment policies to lower the overall cost of care. He said the new tax credits will help some low-income people avoid joining Medicaid. The campaign also proposes increasing Medicare premiums for wealthier seniors.
Sen. Obama also would rely on some Medicare savings to pay for his health-care plan, which would offer subsidies to help consumers pay for premiums. The Tax Policy Center estimates that his plan would cost $1.6 trillion over 10 years and cover 34 million more people.
Write to Laura Meckler at laura.meckler@wsj.com
Dear Friends and Colleagues:
Attached an interesting article from the Wall Street Journal reporting that Douglas Holtz-Eakin, Sen. McCain's senior policy adviser, indicated that McCain's proposed health care plan will be funded with savings from Medicare and Medicaid.
Independent analysts estimate that this could result in cuts of $1.3 trillion over 10 years to the government programs.
Mr. Holtz-Eakin said the Medicare and Medicaid changes would improve the programs and eliminate fraud, but he didn't detail where the cuts would come from. "It's about giving them the benefit package that has been promised to them by law at lower cost," he said.
Sen. McCain's plan to offer a new tax credit of $2,500 per person and $5,000 per family toward insurance premiums. This would allow people to buy health coverage on the open market, where they may have more choices and might look for a better bargain.In exchange, the government would begin taxing the value of health benefits people get through work. If an employer spends $10,000 to buy a worker health insurance, the worker would pay taxes on that money.
The nonpartisan Tax Policy Center, a Washington think tank, estimates that the McCain plan would cost the government $1.3 trillion over 10 years. The plan would allow as many as five million more people to have insurance, it estimates.
The Tax Policy Center estimates that Obama's plan would cost $1.6 trillion over 10 years and cover 34 million more people.
Comment:
Senator McCain seems to be ill advised to suggest MASSIVE Medicare cuts to finance his health care plan. In States like Florida, and especially South Florida, Medicare recipients will definitely not support any Medicare cuts and neither will doctors who already struggle with fair reimbursement issues.
I guess, that SGR refom will also fall by the wayside because there is no money to bail out doctors.
McCain's proposal is another speed bump on the road towards healthcare recovery.
Yours
Bernd
Shana Tova, Happy New Year and Chatima Tova
McCain Plans Federal Health Cuts
Medicare, Medicaid Spending Would Be Reduced to Offset Proposed Tax Credit
John McCain would pay for his health plan with major reductions to Medicare and Medicaid, a top aide said, in a move that independent analysts estimate could result in cuts of $1.3 trillion over 10 years to the government programs.
The Republican presidential nominee has said little about the proposed cuts, but they are needed to keep his health-care plan "budget neutral," as he has promised. The McCain campaign hasn't given a specific figure for the cuts, but didn't dispute the analysts' estimate.
In the months since Sen. McCain introduced his health plan, statements made by his campaign have implied that the new tax credits he is proposing to help Americans buy health insurance would be paid for with other tax increases.
But Douglas Holtz-Eakin, Sen. McCain's senior policy adviser, said Sunday that the campaign has always planned to fund the tax credits, in part, with savings from Medicare and Medicaid. Those government health-care programs serve seniors, poor families and the disabled. Medicare spending for the fiscal year ended Sept. 30 is estimated at $457.5 billion.
Mr. Holtz-Eakin said the Medicare and Medicaid changes would improve the programs and eliminate fraud, but he didn't detail where the cuts would come from. "It's about giving them the benefit package that has been promised to them by law at lower cost," he said.
Both Sen. McCain and his Democratic rival, Sen. Barack Obama, have recently sought to refocus on health care. The issue once ranked at the top of voters' domestic concerns, but has in recent months been eclipsed by energy and the economy.
Sen. McCain charges that the Obama plan, which would create a government-run marketplace in which people could buy coverage, would lead to government-run health care. Sen. Obama charges that Sen. McCain's plan would leave many people unable to get insurance.
Sen. Obama's campaign turned up the volume in a major push on health care over the weekend with two days of attacks from the stump, four new television advertisements, a series of health-care events across the country and fliers to voters' homes in swing states.
Sen. Obama is focused on Sen. McCain's plan to offer a new tax credit of $2,500 per person and $5,000 per family toward insurance premiums. This would allow people to buy health coverage on the open market, where they may have more choices and might look for a better bargain.
In exchange, the government would begin taxing the value of health benefits people get through work. If an employer spends $10,000 to buy a worker health insurance, the worker would pay taxes on that money.
"It's a shell game," Sen. Obama told an outdoor rally of 28,000 people Sunday in Asheville, N.C. "Sen. McCain gives you a tax credit with one hand -- but raises your taxes with the other."
Sen. McCain's plan actually would lower taxes for most people. But that means the plan wouldn't pay for itself, because it cuts certain taxes more than it raises others.
The federal government imposes two taxes on wages, generally: an income tax, which funds the government's general operations, and the payroll tax, paid for by employers and employees, which funds Social Security and Medicare. If Sen. McCain were to apply both of these to the value of health benefits, he could fully pay for his new tax credits. That is what aides have in the past suggested he would do.
In April, when Sen. McCain gave a major speech about his health plan, Mr. Holtz-Eakin, the senior policy adviser, said the tax provisions alone were budget neutral -- meaning that health benefits would have to be subject to both income and payroll taxes.
Campaign officials have regularly implied since then that the tax plan was a wash. In the vice-presidential debate last week, Alaska Gov. Sarah Palin described Sen. McCain's proposed tax credits and said: "That's budget neutral. That doesn't cost the government anything, as opposed to Barack Obama's plan to mandate health-care coverage and have this universal, government-run program."
Mr. Holtz-Eakin said the campaign never intended to apply the payroll tax to health benefits. That means that most people would see a net tax cut, contrary to Sen. Obama's assertions. Only those with very rich benefits packages are likely to see a net increase in taxes. But it also means that Sen. McCain must fill a huge budget hole -- which the campaign says will come from cuts to Medicare and Medicaid.
The nonpartisan Tax Policy Center, a Washington think tank, estimates that the McCain plan would cost the government $1.3 trillion over 10 years. The plan would allow as many as five million more people to have insurance, it estimates.
Mr. Holtz-Eakin said the plan is accurately described as budget neutral because it assumes enough savings in Medicare and Medicaid spending to make up the difference. He said the savings would come from eliminating Medicare fraud and by reforming payment policies to lower the overall cost of care. He said the new tax credits will help some low-income people avoid joining Medicaid. The campaign also proposes increasing Medicare premiums for wealthier seniors.
Sen. Obama also would rely on some Medicare savings to pay for his health-care plan, which would offer subsidies to help consumers pay for premiums. The Tax Policy Center estimates that his plan would cost $1.6 trillion over 10 years and cover 34 million more people.
Write to Laura Meckler at laura.meckler@wsj.com
Friday, August 08, 2008
FMA and EVP
Dear Friends and Colleagues:
First of all, I would like to thank all of you who supported my election as one of your AMA Delegate. I am grateful, honored and humbled to have gained your support and will work diligently with our delegation to represent your interests. Please feel free calling me 24/7 -Cell Phone: (305) 342-2522) - or contact me via e-mail at info@miamihealth.com to express your concerns and to voice your opinion. You elected me to represent you and I need to hear from you to fulfill my obligation and responsibilities.
I also want to take the opportunity to share some of my concerns regarding the selection of a new EVP for our FMA.
Some of you may recall my vocal opposition last year to the modus operandi on how our FMA leadership decided to part from our previous EVP, Sandra Mortham.
We were assured that the selection and appointment of Sandra's successor would follow an open and transparent process. Subsequently, the services of a consulting company (OPIS,LLC) were retained and we were left with the impression that an EVP search committee would interview potential candidates and that each applicant would undergo a vetting process to ascertain his/her qualifications. On Monday I received the President's Weekly Report which included the following announcement:
"Following the close of Annual Meeting, the FMA Board of Governors met. Among other business, we received the report of the EVP search committee as presented by FMA President Elect James Dolan. The Search committee recommended that the Board of Governors begin contract negotiations with Mr. Tim Stapleton for the EVP position. After a lengthy deliberation, the Board of Governors voted overwhelmingly to approve the recommendation of the search committee to appoint Mr. Timothy J. Stapleton as the new Executive Vice President of the Florida Medical Association."
I want to stress that I do not question Tim's qualification as our future EVP, admire and respect his professional qualifications, and like him personally. Nevertheless, I was troubled reading a letter written by the President and Principal of OPIS and directed to the FMA BOG raising a series of concerns regarding the EVP selection process. The letter is not marked confidential and circulated prior and during the FMA meeting among the delegates.
Let me share some of the issues mentioned in the letter with you, including marked quotes from the letter.
THE ISSUES:
OPIS was charged to perform a management audit for our organization and one of the questions OPIS was asked to address was:
How do we prevent a repetition of what has occurred twice before with EVPs?
"A previous board, faced with filling the EVP position as well as the potential of losing its lobbyist, elected to address both issues by promoting the lobbyist to the EVP position. As we now know, the decision proved to have disastrous consequences for the FMA. In response to that question, we recommended that the FMA engage a search firm. Our position has not changed."
"We advised the board to adopt what 99.9 % of all organizations, for-profit and non-profit, adopt – a single CEO reporting to the board. The board made a nearly unanimous decision to hire an EVP. It charged the search committee to develop a job description as well as an RFP to solicit proposals from search firms."
"The search committee has completed both elements of that charge. It is our understanding, that based on its review of the proposals, as well as an evaluation of the performance of the current staff, the committee is recommending offering Mr. Stapleton the position and to only use a search firm if an agreement acceptable to both parties cannot be reached."
"We strongly advise the FMA board to not follow this path."
Well, let me emphasize that our FMA has paid over $70,000 for these consultants and I would assume that their recommendations would be taken into serious consideration. So why did our FMA leadership decide to ignore their advice?
Lets continue reading the letter:
"We are not suggesting Mr. Stapleton is unqualified for the EVP position. We are stating that offering Mr. Stapleton the position without comparing his qualifications against those of other applicants is not in keeping with the board’s fiduciary responsibility. Moreover, it opens the organization to repeating the same error it made with the last EVP."
"If Mr. Stapleton is, indeed, the best candidate for the position, a proper search will confirm the wisdom of that choice. Moreover, proper vetting will assure the membership that the board has made a prudent decision. This process serves all. Neither Mr. Stapleton, nor the board, nor the membership will be served by a decision that has not been properly vetted."
"In summary, we strongly urge the board to stay the course it set at the last board meeting: engage the services of a search firm that will assist the board in vetting and selecting the best candidate for the position. We would also urge that, as a declared candidate for the position, Mr. Stapleton recuse himself from any board activity related to the search process. Neither he nor the organization will benefit from any perception that as a candidate he was afforded information that was not available to other candidates.
No process comes with a guarantee. We can state unequivocally that the process we have recommended is fraught with far less error than using a process that has not worked well for the FMA in the past."
"We are not saying that hiring Mr. Stapleton is a mistake. Rather we are saying that repeating the process used to hire the last EVP is a serious mistake. We realize the board faces a critical issue and stand ready to assist you in any way possible."
So, what can we do? I stressed last year that our FMA leadership should adhere to the following principles of organizational management::
* Accountability of its leadership
* Transparency of the decision making process
* System of checks and balances and reestablish democratic principles
Lets ask our leadership WHY they have chosen to ignore the advice of their high-paid consultants?
What vetting process did our new EVP undergo and how many applications of suitable candidates have they reviewed?
How many candidates have been interviewed? What are the facts supporting the recommendation of the FMA EVP search committee to select Tim Stapelton as our new EVP?
Should we expect answers to those questions? What is your opinion?
Yours
Bernd Wollschlaeger,MD
FMA Member
AMA Delegate
First of all, I would like to thank all of you who supported my election as one of your AMA Delegate. I am grateful, honored and humbled to have gained your support and will work diligently with our delegation to represent your interests. Please feel free calling me 24/7 -Cell Phone: (305) 342-2522) - or contact me via e-mail at info@miamihealth.com to express your concerns and to voice your opinion. You elected me to represent you and I need to hear from you to fulfill my obligation and responsibilities.
I also want to take the opportunity to share some of my concerns regarding the selection of a new EVP for our FMA.
Some of you may recall my vocal opposition last year to the modus operandi on how our FMA leadership decided to part from our previous EVP, Sandra Mortham.
We were assured that the selection and appointment of Sandra's successor would follow an open and transparent process. Subsequently, the services of a consulting company (OPIS,LLC) were retained and we were left with the impression that an EVP search committee would interview potential candidates and that each applicant would undergo a vetting process to ascertain his/her qualifications. On Monday I received the President's Weekly Report which included the following announcement:
"Following the close of Annual Meeting, the FMA Board of Governors met. Among other business, we received the report of the EVP search committee as presented by FMA President Elect James Dolan. The Search committee recommended that the Board of Governors begin contract negotiations with Mr. Tim Stapleton for the EVP position. After a lengthy deliberation, the Board of Governors voted overwhelmingly to approve the recommendation of the search committee to appoint Mr. Timothy J. Stapleton as the new Executive Vice President of the Florida Medical Association."
I want to stress that I do not question Tim's qualification as our future EVP, admire and respect his professional qualifications, and like him personally. Nevertheless, I was troubled reading a letter written by the President and Principal of OPIS and directed to the FMA BOG raising a series of concerns regarding the EVP selection process. The letter is not marked confidential and circulated prior and during the FMA meeting among the delegates.
Let me share some of the issues mentioned in the letter with you, including marked quotes from the letter.
THE ISSUES:
OPIS was charged to perform a management audit for our organization and one of the questions OPIS was asked to address was:
How do we prevent a repetition of what has occurred twice before with EVPs?
"A previous board, faced with filling the EVP position as well as the potential of losing its lobbyist, elected to address both issues by promoting the lobbyist to the EVP position. As we now know, the decision proved to have disastrous consequences for the FMA. In response to that question, we recommended that the FMA engage a search firm. Our position has not changed."
"We advised the board to adopt what 99.9 % of all organizations, for-profit and non-profit, adopt – a single CEO reporting to the board. The board made a nearly unanimous decision to hire an EVP. It charged the search committee to develop a job description as well as an RFP to solicit proposals from search firms."
"The search committee has completed both elements of that charge. It is our understanding, that based on its review of the proposals, as well as an evaluation of the performance of the current staff, the committee is recommending offering Mr. Stapleton the position and to only use a search firm if an agreement acceptable to both parties cannot be reached."
"We strongly advise the FMA board to not follow this path."
Well, let me emphasize that our FMA has paid over $70,000 for these consultants and I would assume that their recommendations would be taken into serious consideration. So why did our FMA leadership decide to ignore their advice?
Lets continue reading the letter:
"We are not suggesting Mr. Stapleton is unqualified for the EVP position. We are stating that offering Mr. Stapleton the position without comparing his qualifications against those of other applicants is not in keeping with the board’s fiduciary responsibility. Moreover, it opens the organization to repeating the same error it made with the last EVP."
"If Mr. Stapleton is, indeed, the best candidate for the position, a proper search will confirm the wisdom of that choice. Moreover, proper vetting will assure the membership that the board has made a prudent decision. This process serves all. Neither Mr. Stapleton, nor the board, nor the membership will be served by a decision that has not been properly vetted."
"In summary, we strongly urge the board to stay the course it set at the last board meeting: engage the services of a search firm that will assist the board in vetting and selecting the best candidate for the position. We would also urge that, as a declared candidate for the position, Mr. Stapleton recuse himself from any board activity related to the search process. Neither he nor the organization will benefit from any perception that as a candidate he was afforded information that was not available to other candidates.
No process comes with a guarantee. We can state unequivocally that the process we have recommended is fraught with far less error than using a process that has not worked well for the FMA in the past."
"We are not saying that hiring Mr. Stapleton is a mistake. Rather we are saying that repeating the process used to hire the last EVP is a serious mistake. We realize the board faces a critical issue and stand ready to assist you in any way possible."
So, what can we do? I stressed last year that our FMA leadership should adhere to the following principles of organizational management::
* Accountability of its leadership
* Transparency of the decision making process
* System of checks and balances and reestablish democratic principles
Lets ask our leadership WHY they have chosen to ignore the advice of their high-paid consultants?
What vetting process did our new EVP undergo and how many applications of suitable candidates have they reviewed?
How many candidates have been interviewed? What are the facts supporting the recommendation of the FMA EVP search committee to select Tim Stapelton as our new EVP?
Should we expect answers to those questions? What is your opinion?
Yours
Bernd Wollschlaeger,MD
FMA Member
AMA Delegate
Wednesday, July 09, 2008
Medicare Bill Passed The Senate
Wednesday, July 09, 2008
Dear Friends and Colleagues:
Good news! The U.S. Senate just passed HR 6331, the Medicare Improvement for Patients and Providers Act of 2008, by a veto-proof majority of 69-30. Both Florida Senators, Sen. Martinez and Sen. Nelson, voted in favor of the bill.
As you know, the legislation replaces the 10.6% payment cut that went into effect on July 1 with a 0.5% update extension through December 31, 2008. For calendar year 2009, the update will be 1.1%. Other important provisions such as extending the GPCI floor on physician work were also included.
This success is due to the relentless pressure grassroots campaign lead by our American Medical Association and many others, including our county medical society. Our letter to Mel Martinez may have contributed to his change of opinion too We have to continue putting pressure on politicians who seem to represent the insurance industry but not the interests of their constituents. Don't forget that politicians want to get reelected!
The bill must now be signed into law by President Bush, who has signaled on more than one occasion that he intends to veto it. However, given the fact that the payment cuts have already occurred and that the bill passed both chambers with the two-third majority needed to override a veto, there is some reason to question next steps by the White House.
Our campaign has to continue and we have to flood the White House with calls and letters.
Again, thank you for your effort and support.
Together we are stronger.
Yours
Bernd
Bernd Wollschlaeger,MD, FAAFP,FASAM
President, Dade County Medical Association
AMA Delegate
Dear Friends and Colleagues:
Good news! The U.S. Senate just passed HR 6331, the Medicare Improvement for Patients and Providers Act of 2008, by a veto-proof majority of 69-30. Both Florida Senators, Sen. Martinez and Sen. Nelson, voted in favor of the bill.
As you know, the legislation replaces the 10.6% payment cut that went into effect on July 1 with a 0.5% update extension through December 31, 2008. For calendar year 2009, the update will be 1.1%. Other important provisions such as extending the GPCI floor on physician work were also included.
This success is due to the relentless pressure grassroots campaign lead by our American Medical Association and many others, including our county medical society. Our letter to Mel Martinez may have contributed to his change of opinion too We have to continue putting pressure on politicians who seem to represent the insurance industry but not the interests of their constituents. Don't forget that politicians want to get reelected!
The bill must now be signed into law by President Bush, who has signaled on more than one occasion that he intends to veto it. However, given the fact that the payment cuts have already occurred and that the bill passed both chambers with the two-third majority needed to override a veto, there is some reason to question next steps by the White House.
Our campaign has to continue and we have to flood the White House with calls and letters.
Again, thank you for your effort and support.
Together we are stronger.
Yours
Bernd
Bernd Wollschlaeger,MD, FAAFP,FASAM
President, Dade County Medical Association
AMA Delegate
Friday, June 27, 2008
Medicare Cuts
Congress failed to stop the 10.6% Medicare cut.
Dear Friends and Colleagues:
Unfortunately, by a vote of 58 to 40 the Senate failed to follow the example of the House and adopt H.R. 6331 - the “Medicare Improvements to Patients and Providers Act”
60 votes were needed to pass the bill. In a procedural move, the Senate Majority Leader Harry Reid (D-NV) changed his vote to "No" so that he could call the bill up at a future date. Therefore the measure fell one vote short of being adopted.
Lobbyist and representatives of our American Medical Association worked VERY hard to fight the looming Medicare cuts, but our elected officials voted against our interests.
Our AMA issued the following press release:
“The physicians of America are outraged that a group of Republican senators followed the direction of the Bush Administration and voted to protect health insurance companies at the expense of America’s seniors, disabled and military families."
Comment:
U.S. Senator Mel Martinez voted AGAINST the bill, U.S. Senator Bill Nelson voted FOR the bill,.
“These senators leave for their 4th of July picnics knowing that the most vulnerable Americans are at risk because of the Senate's inability to act to stop drastic payment cuts for health care services that are needed by our Medicare and TRICARE patients
“The House voted to preserve access to care for Medicare patients in a bipartisan landslide vote to pass H.R. 6331 by an overwhelming margin of 355 to 59. The House made seniors, the disabled and military families a top priority. The AMA appreciates the courage of the 59 Senators, including nine Republicans, who voted to put patients ahead of partisan politics and vote for H.R. 6331.
“Today, thanks to some senators, we stand at the brink of a Medicare meltdown. On July 1 – just four days from now – the government will slash Medicare physician payments by 10.6 percent, forcing many physicians to make the difficult choice to limit the number of Medicare patients in their practices.
"The Senate must return from their recess and make seniors’ health care their top priority. For doctors, this is not a partisan issue - it's a patient access issue."
What can we do now?
* Call upon our Senators to return from their recess and make seniors’ health care their top priority. For doctors, this is not a partisan issue - it's a patient access issue.
* Call Senator Bill Nelson to congratulate him for his courageous support of this bill Phone# 202 224-5274 or 305 536-5999.
* Call Senator Mel Martinez and advise him that his position has been duly noted and that we will inform our patients accordingly Phone#202 224-3041 or 305 444-8332
* Limit non-urgent Medicare appointments until congress acts and reverses the cut and inform our patients why we are forced to take those steps.
* Hand out information to our patients asking them to call their representatives to protest the looming drastic Medicare cuts
* Join your county, state and national medical association to support our efforts protecting your interests.
NOW is the time to act as a group! Our patients access to health care services is at stake and we have to stop private insurance companies from pocketing Medicare dollars.
Yours
Bernd Wollschlaeger,MD,FAAFP,FASAM
President, Dade County Medical Association
Dear Friends and Colleagues:
Unfortunately, by a vote of 58 to 40 the Senate failed to follow the example of the House and adopt H.R. 6331 - the “Medicare Improvements to Patients and Providers Act”
60 votes were needed to pass the bill. In a procedural move, the Senate Majority Leader Harry Reid (D-NV) changed his vote to "No" so that he could call the bill up at a future date. Therefore the measure fell one vote short of being adopted.
Lobbyist and representatives of our American Medical Association worked VERY hard to fight the looming Medicare cuts, but our elected officials voted against our interests.
Our AMA issued the following press release:
“The physicians of America are outraged that a group of Republican senators followed the direction of the Bush Administration and voted to protect health insurance companies at the expense of America’s seniors, disabled and military families."
Comment:
U.S. Senator Mel Martinez voted AGAINST the bill, U.S. Senator Bill Nelson voted FOR the bill,.
“These senators leave for their 4th of July picnics knowing that the most vulnerable Americans are at risk because of the Senate's inability to act to stop drastic payment cuts for health care services that are needed by our Medicare and TRICARE patients
“The House voted to preserve access to care for Medicare patients in a bipartisan landslide vote to pass H.R. 6331 by an overwhelming margin of 355 to 59. The House made seniors, the disabled and military families a top priority. The AMA appreciates the courage of the 59 Senators, including nine Republicans, who voted to put patients ahead of partisan politics and vote for H.R. 6331.
“Today, thanks to some senators, we stand at the brink of a Medicare meltdown. On July 1 – just four days from now – the government will slash Medicare physician payments by 10.6 percent, forcing many physicians to make the difficult choice to limit the number of Medicare patients in their practices.
"The Senate must return from their recess and make seniors’ health care their top priority. For doctors, this is not a partisan issue - it's a patient access issue."
What can we do now?
* Call upon our Senators to return from their recess and make seniors’ health care their top priority. For doctors, this is not a partisan issue - it's a patient access issue.
* Call Senator Bill Nelson to congratulate him for his courageous support of this bill Phone# 202 224-5274 or 305 536-5999.
* Call Senator Mel Martinez and advise him that his position has been duly noted and that we will inform our patients accordingly Phone#202 224-3041 or 305 444-8332
* Limit non-urgent Medicare appointments until congress acts and reverses the cut and inform our patients why we are forced to take those steps.
* Hand out information to our patients asking them to call their representatives to protest the looming drastic Medicare cuts
* Join your county, state and national medical association to support our efforts protecting your interests.
NOW is the time to act as a group! Our patients access to health care services is at stake and we have to stop private insurance companies from pocketing Medicare dollars.
Yours
Bernd Wollschlaeger,MD,FAAFP,FASAM
President, Dade County Medical Association
Thursday, June 12, 2008
Medicare Cuts and The Senate Vote Today
Dear Friends and Colleagues:
Today, Senate Bill 3101 "The Medicare Improvements for Patients and Providers Act " sponsored by Senator Baucus failed to gather enough support in the Senate for a closure vote.
It includes provisions to address serious, long-standing Medicare problems faced by millions of seniors on fixed incomes struggling every day with rapidly rising Medicare, food, and gasoline costs.
CBO (Congressional Budget Office) estimates that S. 3101 with that proposed amendment would increase spending on physicians’ and other services by $19.8 billion over the 2008-2013 period and
$62.8 billion over the 2008-2018 period; those amounts would be offset by reductions in payments to other providers (primarily Medicare Advantage plans). Taken together, the bill would reduce direct spending by $5 million over both the 2008-2013 and 2008-2018 periods, CBO estimates. S. 3101, when amended, would avert a reduction to Medicare’s physician fee schedule planned for July 1, 2008, by freezing those fees at their current levels for the remainder of the year and increasing them by 1.1 percent in January 2009. Beyond 2009, fees would be held at their current-law levels, necessitating a 21 percent reduction in 2010. The bill would also extend many expiring provisions of Medicare, expand Medicare’s coverage of preventive services, and modify the rules governing eligibility for the Medicare Savings Program. New spending under the bill would be offset largely by reductions in payments to and enrollment in Medicare Advantage plans. The bill, with the amendment, would phase out double payments for indirect medical education made to plans and hospitals for Medicare Advantage enrollees. It also would require private fee-for-service plans to adopt networks, with some exceptions, leading to decreases in enrollment and reduced outlays.
Senators who opposed the Baucus bill argued that the improvements for poor seniors were fiscally irresponsible, yet supported increased payments to physicians.
Those opposing SB 3101 support a legislation offered by Sen. Charles Grassley (R-IA).
Sen. Charles Grassley (R-Iowa) on Wednesday introduced the Preserving Access to Medicare Act of 2008, legislation intended to postpone a scheduled 10.6 percent reduction to Medicare physician payments. Sen. Grassley said the cuts would likely affect seniors’ access to physicians. Under Grassley’s bill, a 0.5 percent physician update would be provided for the rest of 2008. That percentage would increase to 1.1 percent for 2009. To help pay for the plan, the bill would cut over the next five years roughly $12.5 billion from privately run Medicare Advantage plans.
The measure also offers incentive payments to healthcare professionals for using a qualified e-prescribing system. Rural home health agencies would see a five percent home health add-on payment for 2009, and starting Jan. 1, certain skilled nursing facilities would be included as originating sites for the telehealth services initiative.
Sen. Grassley said that unlike similar legislation introduced by Sen. Max Baucus (D-Mont.), his bill was far more likely to be signed into law because it “does not make large, unwarranted cuts to Medicare Advantage.”
The Baucus bill, the Patients and Providers Act of 2008 (S. 3101), would cut roughly $13 billion from the private Medicare Advantage plans.
Comment:
Personally, I favor the Baucus plan but I am mindful and realistic that it would have been vetoed by President Bush and in the absence of a veto-proof majority would have died anyway.
Nevertheless, its failure demonstrates who are our friends and foes in the Senate.
From Florida Senator Martinez voted AGAINST the Baucus bill and we should send him a letter reminding him that Florida's seniors are a strong voting block and will exercise their right to vote in 2010 when his term will expire.
Let's remind our Senators that their attitude and position regarding Medicare reimbursement for physicians will be monitored by us!!
Yours truly,
Bernd
President,DCMA
===============================================================================================================================================
Grouped By Vote PositionYEAs ---54
Akaka (D-HI)Baucus (D-MT)Bayh (D-IN)Biden (D-DE)Bingaman (D-NM)Boxer (D-CA)Brown (D-OH)Byrd (D-WV)Cantwell (D-WA)Cardin (D-MD)Carper (D-DE)Casey (D-PA)Coleman (R-MN)Collins (R-ME)Conrad (D-ND)Dodd (D-CT)Dole (R-NC)Dorgan (D-ND)Durbin (D-IL)Feingold (D-WI)Feinstein (D-CA)Harkin (D-IA)Johnson (D-SD)Kerry (D-MA)Klobuchar (D-MN)Kohl (D-WI)Lautenberg (D-NJ)Leahy (D-VT)Levin (D-MI)Lieberman (ID-CT)Lincoln (D-AR)McCaskill (D-MO)Menendez (D-NJ)Mikulski (D-MD)Murkowski (R-AK)Murray (D-WA)Nelson (D-FL)Nelson (D-NE)Pryor (D-AR)Reed (D-RI)Roberts (R-KS)Rockefeller (D-WV)Salazar (D-CO)Sanders (I-VT)Schumer (D-NY)Smith (R-OR)Snowe (R-ME)Specter (R-PA)Stabenow (D-MI)Stevens (R-AK)Tester (D-MT)Webb (D-VA)Whitehouse (D-RI)Wyden (D-OR)
NAYs ---39
Alexander (R-TN)Allard (R-CO)Barrasso (R-WY)Bennett (R-UT)Bond (R-MO)Brownback (R-KS)Bunning (R-KY)Burr (R-NC)Chambliss (R-GA)Coburn (R-OK)Cochran (R-MS)Corker (R-TN)Cornyn (R-TX)Craig (R-ID)Crapo (R-ID)DeMint (R-SC)Domenici (R-NM)Ensign (R-NV)Enzi (R-WY)Graham (R-SC)Grassley (R-IA)Gregg (R-NH)Hagel (R-NE)Hatch (R-UT)Hutchison (R-TX)Inhofe (R-OK)Isakson (R-GA)Kyl (R-AZ)Lugar (R-IN)Martinez (R-FL)McConnell (R-KY)Reid (D-NV)Sessions (R-AL)Shelby (R-AL)Thune (R-SD)Vitter (R-LA)Voinovich (R-OH)Warner (R-VA)Wicker (R-MS)
Not Voting - 7
Clinton (D-NY)Inouye (D-HI)Kennedy (D-MA)Landrieu (D-LA)McCain (R-AZ)Obama (D-IL)Sununu (R-NH)
Today, Senate Bill 3101 "The Medicare Improvements for Patients and Providers Act " sponsored by Senator Baucus failed to gather enough support in the Senate for a closure vote.
It includes provisions to address serious, long-standing Medicare problems faced by millions of seniors on fixed incomes struggling every day with rapidly rising Medicare, food, and gasoline costs.
CBO (Congressional Budget Office) estimates that S. 3101 with that proposed amendment would increase spending on physicians’ and other services by $19.8 billion over the 2008-2013 period and
$62.8 billion over the 2008-2018 period; those amounts would be offset by reductions in payments to other providers (primarily Medicare Advantage plans). Taken together, the bill would reduce direct spending by $5 million over both the 2008-2013 and 2008-2018 periods, CBO estimates. S. 3101, when amended, would avert a reduction to Medicare’s physician fee schedule planned for July 1, 2008, by freezing those fees at their current levels for the remainder of the year and increasing them by 1.1 percent in January 2009. Beyond 2009, fees would be held at their current-law levels, necessitating a 21 percent reduction in 2010. The bill would also extend many expiring provisions of Medicare, expand Medicare’s coverage of preventive services, and modify the rules governing eligibility for the Medicare Savings Program. New spending under the bill would be offset largely by reductions in payments to and enrollment in Medicare Advantage plans. The bill, with the amendment, would phase out double payments for indirect medical education made to plans and hospitals for Medicare Advantage enrollees. It also would require private fee-for-service plans to adopt networks, with some exceptions, leading to decreases in enrollment and reduced outlays.
Senators who opposed the Baucus bill argued that the improvements for poor seniors were fiscally irresponsible, yet supported increased payments to physicians.
Those opposing SB 3101 support a legislation offered by Sen. Charles Grassley (R-IA).
Sen. Charles Grassley (R-Iowa) on Wednesday introduced the Preserving Access to Medicare Act of 2008, legislation intended to postpone a scheduled 10.6 percent reduction to Medicare physician payments. Sen. Grassley said the cuts would likely affect seniors’ access to physicians. Under Grassley’s bill, a 0.5 percent physician update would be provided for the rest of 2008. That percentage would increase to 1.1 percent for 2009. To help pay for the plan, the bill would cut over the next five years roughly $12.5 billion from privately run Medicare Advantage plans.
The measure also offers incentive payments to healthcare professionals for using a qualified e-prescribing system. Rural home health agencies would see a five percent home health add-on payment for 2009, and starting Jan. 1, certain skilled nursing facilities would be included as originating sites for the telehealth services initiative.
Sen. Grassley said that unlike similar legislation introduced by Sen. Max Baucus (D-Mont.), his bill was far more likely to be signed into law because it “does not make large, unwarranted cuts to Medicare Advantage.”
The Baucus bill, the Patients and Providers Act of 2008 (S. 3101), would cut roughly $13 billion from the private Medicare Advantage plans.
Comment:
Personally, I favor the Baucus plan but I am mindful and realistic that it would have been vetoed by President Bush and in the absence of a veto-proof majority would have died anyway.
Nevertheless, its failure demonstrates who are our friends and foes in the Senate.
From Florida Senator Martinez voted AGAINST the Baucus bill and we should send him a letter reminding him that Florida's seniors are a strong voting block and will exercise their right to vote in 2010 when his term will expire.
Let's remind our Senators that their attitude and position regarding Medicare reimbursement for physicians will be monitored by us!!
Yours truly,
Bernd
President,DCMA
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Grouped By Vote PositionYEAs ---54
Akaka (D-HI)Baucus (D-MT)Bayh (D-IN)Biden (D-DE)Bingaman (D-NM)Boxer (D-CA)Brown (D-OH)Byrd (D-WV)Cantwell (D-WA)Cardin (D-MD)Carper (D-DE)Casey (D-PA)Coleman (R-MN)Collins (R-ME)Conrad (D-ND)Dodd (D-CT)Dole (R-NC)Dorgan (D-ND)Durbin (D-IL)Feingold (D-WI)Feinstein (D-CA)Harkin (D-IA)Johnson (D-SD)Kerry (D-MA)Klobuchar (D-MN)Kohl (D-WI)Lautenberg (D-NJ)Leahy (D-VT)Levin (D-MI)Lieberman (ID-CT)Lincoln (D-AR)McCaskill (D-MO)Menendez (D-NJ)Mikulski (D-MD)Murkowski (R-AK)Murray (D-WA)Nelson (D-FL)Nelson (D-NE)Pryor (D-AR)Reed (D-RI)Roberts (R-KS)Rockefeller (D-WV)Salazar (D-CO)Sanders (I-VT)Schumer (D-NY)Smith (R-OR)Snowe (R-ME)Specter (R-PA)Stabenow (D-MI)Stevens (R-AK)Tester (D-MT)Webb (D-VA)Whitehouse (D-RI)Wyden (D-OR)
NAYs ---39
Alexander (R-TN)Allard (R-CO)Barrasso (R-WY)Bennett (R-UT)Bond (R-MO)Brownback (R-KS)Bunning (R-KY)Burr (R-NC)Chambliss (R-GA)Coburn (R-OK)Cochran (R-MS)Corker (R-TN)Cornyn (R-TX)Craig (R-ID)Crapo (R-ID)DeMint (R-SC)Domenici (R-NM)Ensign (R-NV)Enzi (R-WY)Graham (R-SC)Grassley (R-IA)Gregg (R-NH)Hagel (R-NE)Hatch (R-UT)Hutchison (R-TX)Inhofe (R-OK)Isakson (R-GA)Kyl (R-AZ)Lugar (R-IN)Martinez (R-FL)McConnell (R-KY)Reid (D-NV)Sessions (R-AL)Shelby (R-AL)Thune (R-SD)Vitter (R-LA)Voinovich (R-OH)Warner (R-VA)Wicker (R-MS)
Not Voting - 7
Clinton (D-NY)Inouye (D-HI)Kennedy (D-MA)Landrieu (D-LA)McCain (R-AZ)Obama (D-IL)Sununu (R-NH)
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