Jackson Memorial Hospital in Crisis

Jackson Memorial Hospital, one of our finest teaching hospitals in the U.S., is stuck in a perpetual financial crisis caused, among other reason, by poor management. The proposed solutions do not follow surgical precision thinking but can only be compared with brute amputations threatening to destroy this great institution. The current management lacks strategic vision and obviously does not understand that the rapidly changing health care market demands flexibility and quick adaptation to evolving concepts of care delivery and reimbursement. This requires the development of team based care harvesting the creativity and experience of the highly skilled workforce. Therefore, it's counter-intuitive to reduce the number of experienced health care workers who are needed to develop and sustain new care delivery systems such as the Patient Centered Medical Home (PCMH). The Patient Centered Medical Home is a model of care where each patient has an ongoing relationship with a personal clinician who leads a team that, together, takes responsibility for patient care. The clinician-led care team is responsible for providing all the patient's health care needs and when needed, coordinating care across the health care system. The comprehensive care provided by the medical home leads to better health, longer lives, higher patient satisfaction and less expensive care. Other hospital systems in the U.S. are successfully pursuing such concepts and are being rewarded financially. For example, all 11 hospitals and six large community health centers of the New York City Health and Hospitals Corporation have received medical home designation for delivering accessible, comprehensive and family-centered primary care to New Yorkers that aims to reduce avoidable healthcare costs over time. The special designation was granted by the National Committee for Quality Assurance (NCQA) to 616 primary care physicians who collectively care for nearly 100 percent of HHC's primary care population of more than 477,000 adult and pediatric patients. All of the HHC facilities received "Level 3" designation, the highest ranking, which will qualify HHC for more than $15 million in Medicaid reimbursement rate increases every year. Jackson Memorial Hospital can lead the field in health care innovation and its not too late to implement changes. But we need a management team that can translate vision into reality. Yours Bernd

Supreme Court and Health Care

On Monday morning the Supreme Court will begin hearing arguments about whether the Individual Mandate is constitutional. On what case law the Supreme Court can base its decision? Lets look at the facts. In a recent New York Times article titled " At Heart of Health Law Clash, a 1942 Case of a Farmer’s Wheat" the author points out that a 1942 decision, Wickard v. Filburn, is the basis for the Supreme Court’s modern understanding of the scope of federal power. What was the core issue? The U.S. government had established limits on wheat production based on acreage owned by a farmer, in order to drive up wheat prices during the Great Depression, and one farmer, Roscoe Filburn, was growing more than the limits permitted. Filburn was ordered to destroy his crops and pay a fine, even though he was producing the excess wheat for his own use and had no intention of selling it. The Supreme Court interpreted the United States Constitution's Commerce Clause under Article 1 Section 8, which permits the United States Congress "To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes". The Court decided that Filburn's wheat growing activities reduced the amount of wheat he would buy for chicken feed on the open market, and because wheat was traded nationally, Filburn's production of more wheat than he was allotted was affecting interstate commerce. Thus, Filburn's production could be regulated by the federal government. The Supreme Court issued a decision which included the following statement: "The power to regulate interstate commerce includes the power to regulate the prices at which commodities in that commerce are dealt in and practices affecting such prices." ( P. 128) And this is the issue we are dealing with today! The Filburn decision illustrates just how much leeway the federal government has under the Constitution’s commerce clause to regulate the choices individuals make in matters affecting the national economy. If the government can make farmers choose between growing crops on their own land and paying a penalty, the administration’s lawyers have said, it can surely tell people that they must obtain health insurance or pay a penalty. Now, if the Supreme Court decides that the individual mandates violates the commerce clause then insurance companies will face a quandary: on the one hand they have to offer health insurance coverage to each and every applicant regardless of his/her health status, but on the other hand they cannot sell enough insurance policies to healthy individuals to cover for those expenses because the individual mandate was declared unconstitutional. The health care law will still be valid BUT the financing will be on shaky grounds. Therefore, insurance companies already began to develop alternatives which will include steep premium increases for individual policies! Economists believe that the mandate, as envisioned by the law, will make a significant difference in reform’s impact. Some suggest that removing the mandate from the law would diminish the number of newly insured by nearly two-thirds and raise premiums overall by 30 percent. The Rand Institute researchers predict that eliminating the mandate would have little effect on premiums for individuals. But they, too, believe that health insurance coverage would fall dramatically — from 27 million additional people insured to just 15 million. Those are just projections, but the experts note that one state has managed to impose insurance reforms without weakening its insurance market. It’s Massachusetts, which happens to be the one state that also imposed an individual mandate. More than 98 percent of the state’s residents now have insurance, by far the highest percentage in the country. Premiums in the non-group market have fallen by 50 percent, relative to national trends, while premiums in the group market aren’t rising any faster than they were before the reforms began. Lets hope for the best and I predict the Supreme Court will uphold the individual mandate. Yours Bernd

Medical Practice in Crisis

Attached a link to an article "Why America's Doctors Are Struggling to Make Ends Meet" highlighting the dire economic straits of a medical clinic in Denver Colorado which followed all the recommendations to improve its care: electronic health record implementation, medical home project participation, quality improvement initiatives and care coordination. Nevertheless, the practice struggles to stay financially viable! I have embraced all of the above principles, too, and invested money and time in improving my practice and just obtained PCMH recognition. When will insurance companies follow to support those of us who work hard to improve care and to reduce healthcare costs? Will the savings be pocketed by insurance companies, or be shared with us? I think that we deserve an answer! Yours Bernd

Overseas Patients

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

Deep Cuts for Mental Health and Substance Abuse Treatment Programs

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

Immaculate Conception

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

United Healthcare and Payment reform

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

The Business of Medicine

Attached a link http://www.miamiherald.com/2012/01/22/2601913_p3/hospitals-hiring-doctors-to-get.html to an interesting article written by John Dorschner titled "Hospitals hiring doctors to get ready for reform" highlighting the growing trend of hospitals purchasing physicians practices. Its of interest to note that executives at Baptist and Holy Cross say " the physicians’ practices on their own do not break even after being purchased, but ancillary income from such measures as diagnostic tests boost the bottom line." But more diagnostic tests and procedures also means more health care expenditures! At Jackson Health System, Miami-Dade’s public hospitals, the unaudited financial statements for fiscal 2011 show that the doctors’ practices lost $4.4 million! One employed physician argues that he likes this arrangement because he doesn’t have to spend time dealing with all the business aspects of a private practice. But understanding the business of medicine is exactly what we need to prevail in the rapidly changing health care environment. We cannot pretend that we can practice medicine in splendid isolation and to leave the "dirty" business to others. That's a prescription for certain marginalization and disempowerment. We must acquire knowledge and skills to master the business of medicine in order to practice medicine more efficiently. What do you think? Yours Bernd

Why We Need The Individual Mandate

Attached a link http://www.rwjf.org/files/research/20120112qs70onepager.pdf to an interesting study by the Urban Institute of the Robert Wood Johnson Foundation titled "Eliminating the Individual Mandate: Effects on Premiums, Coverage, and Uncompensated Care," analyzing the different scenarios resulting from the elimination of the individual mandate. Under the Patient Protection and Affordable Care Act (ACA) passed by Congress, most Americans will be required to be covered by health insurance or pay a penalty—the so-called individual mandate. The legality of this feature is being debated in the courts. These Urban Institute authors estimate the effects of the ACA and the individual mandate, as well as various levels of exchange participation, using a model that simulates decisions of individuals and businesses in response to policy changes. Exchange enrollment is viewed as necessary to reduce adverse selection, or the likelihood of only the sickest choosing to be insured. The researchers found that without the individual mandate: Between 40 and 42 million would remain uninsured as opposed to 26 million with the mandate; Private coverage would fall 11 million, covering 4 million fewer people than it would have without reform; Uncompensated care spending would be much higher due to the increased number of uninsured; Individual premiums in the health benefit exchanges would increase by 10 percent in a scenario assuming high exchange participation and by 25 percent with a low participation scenario. Removing the mandate from the ACA while expanding Medicaid eligibility would decrease the number of people with private coverage by 3.6 million. Uncompensated care would increase by $20 billion. I strongly recommend reading this study which provides clear and convincing arguments in favor of the individual mandate. Yours Bernd

Health Insurance

Attached a link http://meps.ahrq.gov/mepsweb/data_files/publications/st354/stat354.pdf to a very interesting federal study titled "The Concentration and Persistence in the Level of Health Expenditures over Time: Estimates for the U.S. Population, 2008-2009" published by the Center for Financing, Access, and Cost Trends of the Agency for Healthcare Research and Quality. Using information from the Household Component of the Medical Expenditure Panel Survey (MEPS-HC) for 2008 and 2009, this report provides detailed estimates of the persistence in the level of health care expenditures over time. Studies that examine the persistence of high levels of expenditures over time are essential to help discern the factors most likely to drive health care spending and the characteristics of the individuals who incur them. According to the study in 2008, 1 percent of the population accounted for 20.2 percent of total health care expenditures, and in 2009, the top 1 percent accounted for 21.8 percent of the total expenditures with an annual mean expenditure of $90,061. The lower 50 percent of the population ranked by their expenditures accounted for only 3.1 percent and 2.9 percent of the total for 2008 and 2009 respectively. Of those individuals ranked at the top 1 percent of the health care expenditure distribution in 2008, 20 percent maintained this ranking with respect to their 2009 health care expenditures In both 2008 and 2009, the top 5 percent of the population accounted for nearly 50 percent of health care expenditures. Individuals who were between the ages of 45 and 64 and the elderly (65 and older) were disproportionately represented among the population that remained in the top decile of spenders for both 2008 and 2009. While the elderly represented 13.2 percent of the overall population, they represented 42.9 percent of those individuals who remained in the top decile of spenders. Focusing on the under age 65 population, health insurance coverage status also distinguished individuals who remained in the top decile of spenders from their counterparts in the lower half of the distribution. Individuals who were uninsured for all of calendar year 2009 were disproportionately represented among the population that remained in the lower half of the distribution based on health care spending. While 15.5 percent of the overall population under age 65 was uninsured for all of 2009, the full-year uninsured comprised 25.9 percent of all individuals remaining in the bottom half of spenders (figure 6). Alternatively, only 3.6 percent of those under age 65 who remained in the top decile of spenders were uninsured. What can we learn from the data and how should the data influence public policy? We are spending a disproportionally high percentage of precious healthcare dollars on a very small percentage of sick people.Most of them suffer from preventable chronic diseases which we still cannot manage properly within our existing healthcare system. The overwhelming majority of those "high" spenders were insured and there annual mean expenditure of $90,061 are not covered by the healthcare premiums they pay. The overwhelming majority of healthy "low" spender are uninsured and therefore do not contribute with their health insurance premium payment to cover for their eventuality of their own care needs. Taking all of these facts into consideration we should support an individual mandate that requires health insurance coverage for each and every American to spread the insurance risk. Spreading the risk assures that as the number of people in a given group gets larger, a company or governmental agency can more easily spread the risk (that would be the risk of a payout) among the pool of participants. They can therefore better estimate the average cost (or payout) per person in the event that one or even several of the group are victims of a catastrophic event. In the absence of such a mandate insurance companies can simply not afford to continue paying 50% of health care expenditures on 5% of the population!!! Alternative proposals to create high-risk pools are doomed to fail because the risk to cover "sick" participants is so high that it results in unaffordable health insurance premiums by private insurance companies. If those companies choose to opt out of providing insurances for such a high-risk pool then the government remains the insurer of the last resort, i.e the tax payer. Yours Bernd

US Healthcare Costs

According to the latest edition of "Health at a Glance" http://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2011_health_glance-2011-en published by the Organization for Economic Co-operation and Development (OECD) The United States stands out as performing very well in the area of cancer care, achieving higher rates of screening and survival from different types of cancer than most other developed countries. The United States does not do well in preventing costly hospital admissions for chronic conditions, such as asthma or chronic obstructive pulmonary disease, which should normally be managed through proper primary care. Avoidable hospital admissions for asthma complications and chronic obstructive pulmonary disease (COPD) are much greater in the United States than the OECD average. For asthma admissions, the rate in the United States was 121 per 100 000 adults in 2009, more than two times greater than the OECD average of 52. For COPD, hospital admission in the United States was 230 per 100 000 adults, compared with an OECD average of 198. Regarding healthcare expenditures the United States spent 17.4% of GDP on health in 2009, much more than the OECD average of 9.6%. Spending per person is two-and-a-half times higher than the OECD average. Following the United States were the Netherlands, France and Germany, which allocated respectively 12.0%, 11.8% and 11.6% of their GDP to health. Is US health spending higher due to higher prices or higher service provision? (or both?) Facts: 1) US prices for a set of hospital services is over 60% higher than the average of 12 OECD countries, 2) US prices for certain procedures (including appendectomy,coronary angioplasty, coronary artery bypass graft, hip & knee replacement) are much higher than in other OECD countries, 3) Almost DOUBLE the spending on Insurance administration expressed in terms of purchasing power parity. Its also of interest to note that in most countries, health spending is largely financed out of taxes or social security contributions, with private insurance or ‘out-of-pocket’ payments playing a significant but secondary role. This is not the case in the United States which, together with Mexico and Chile, is the only OECD country where the government plays the smallest role in financing health spending. The public share of health expenditure in the United States was 47.7% in 2009, much lower than the OECD average of 71.7%. However, the level of health spending in the United States is so high that public (i.e. government) spending on health per capita is greater than in all other OECD countries, except Norway and the Netherlands. For this amount of public expenditure in the United States, government provided in 2009 insurance coverage only for the elderly and disabled people (through Medicare) and some of the poor (through Medicaid and the State Children’s Health Insurance Program, SCHIP), whereas in most other OECD countries this was enough for government to provide universal health insurance. Public spending on health in the United States has been growing more rapidly than private spending since 1990, largely due to expansions in coverage. Private insurance accounted for 33% of total health spending in the United States in 2009, by far the largest share among OECD countries. Beside the United States, Canada and France are the only two other OECD countries where private insurance represents more than 10% of total health spending. Conclusions: we are spending more for healthcare per person than in any other country in the world utilizing an inefficient private insurance model. But also public (i.e. government) spending on health per capita is greater than in all other OECD countries but fails to provide universal coverage. We must achieve a broad based consensus on how to efficiently allocate our healthcare resource to achieve high quality healthcare for all Americans. Tinkering on the edge will not provide us with a meaningful and sustainable solution. If we do not engage in such a dialogue now we will face rationing and further economic slowdown. Yours Bernd

Medical Errors Awaiting Prevention

Attached a link http://www.nytimes.com/2012/01/06/health/study-of-medicare-patients-finds-most-hospital-errors-unreported.html to an interesting article titled "Report Finds Most Errors at Hospitals Go Unreported" pointing out that according to recent federal study hospital employees recognize and report only one out of seven errors, accidents and other events that harm Medicare patients while they are hospitalized. According to the study, from Daniel R. Levinson, inspector general of the Department of Health and Human Services, some of the most serious problems, including some that caused patients to die, were not reported.The inspector general estimated that more than 130,000 Medicare beneficiaries experienced one or more adverse events in hospitals in a single month. Many hospital administrators acknowledged that their employees were underreporting injuries and infections that occurred in the hospital, he said. More often, Mr. Levinson said, the problem is that hospital employees do not recognize “what constitutes patient harm” or do not realize that particular events harmed patients and should be reported. In some cases, he said, employees assumed someone else would report the episode, or they thought it was so common that it did not need to be reported, or “suspected that the events were isolated incidents unlikely to recur.”The inspector general found that “hospitals made few changes to policies or practices” after employees reported harm to patients. In many cases, hospital executives told federal investigators that the events did not reveal any “systemic quality problems.”Organizations that inspect and accredit hospitals generally “do not scrutinize” how hospitals keep track of medical errors and other adverse events, the study said. The federal investigators did an in-depth review of 293 cases in which patients had been harmed. Forty of those cases were reported to hospital managers, and 28 were investigated by the hospitals, but only five led to changes in policies or practices, the study said. What are possible solutions? 1) Train staff to report medical errors and to automatically flag those patients within an electronic health record for IMMEDIATE quality assurance review 2) Utilize software which automatically triggers alerts for diagnoses and conditions including medication errors, severe bedsores, infections that patients acquire in hospitals, delirium resulting from overuse of painkillers and excessive bleeding linked to improper use of blood thinners. 3) Deploy medical error prevention teams within hospitals to educate staff and to assist in the implementation of lessons learned from a root-cause analysis into the clinical practice. I am confident that we can achieve our goals to reduce medical errors and to save lives. Yours Bernd

Medicaid Pilot Program in Florida

Letter to the Editor published in Miami Herald, December 23rd, 2011 Patients protected The Dec. 16 article State can expand Medicaid pilot program incorrectly stated that the federal government approved the expansion of the Medicaid pilot project. Actually, the extension of the five-county Medicaid pilot project was approved until 2014, but with significant improvements to the program. They include the denial of the medical-loss-ratio waiver requiring the participating private health plans to spend 85 percent of the funds on patient care and the denial of capping benefit levels for Medicaid beneficiaries, which prevents the termination of Medicaid services because recipients have already met their maximum. These requirements will protect patients from arbitrary insurance denials and will force private health insurance plans to manage the taxpayers’ dollars more efficiently and responsibly. We should continue to oppose any expansion of the pilot project unless the state of Florida can provide solid data that it improves access and enhances the quality of healthcare for all Medicaid enrollees. Bernd Wollschlaeger, MD,

ER, Dental Care and Medicaid

I recommend reading an article published in today's Sun Sentinel titled "More patients turning to ERs for dental care" summarizing the findings of a study by the Florida Oral Health Coalition which found that more than 115,000 people went to the hospital last year for dental care that could have been prevented or done at a much lower cost in a dentist's office. That's up 9 percent since 2008. More than 15,500 of them were children. ERs charged $88 million for that dental care last year — $30 million to Florida's state-federal Medicaid program , the study found. Hospitals not reimbursed for the care likely pass on the cost to other patients through higher charges. The reliance on ERs for tooth care was even heavier in South Florida, with the number of ER visits up 32 percent in Broward County since 2008. To tackle the problem, the group suggests expanding services that can be offered by dental hygienists, raising Medicaid payments to attract more dentists, having Medicaid cover adult dental care, and expanding county health department dental clinics. But the recommendations would require more tax money at a time when state officials are trying to shrink the Medicaid budget.

Florida Medicaid Pilot

On Thursday the federal officials agreed to extend Florida's five-county Medicaid managed-care experiment to 2014 but required the state to make significant improvements to the program. They include the denial of the medical-loss-ratio waiver requiring the participating private health plans to spend 85 percent of funds on patient care and the denial to cap benefit levels for Medicaid beneficiaries preventing the termination of Medicaid services because recipients had already met their $500,000 maximum for the year. These requirements will protect patients from arbitrary insurance service denials and will force private health insurance plans to manage taxpayers dollars efficiently and responsibly. Meanwhile, we should continue to oppose any expansion of the pilot project UNLESS the State of Florida can provide solid and indisputable data that the pilot project improves access and enhances the quality of care for all  Medicaid enrollees. So far I have not found any evidence to substantiate Governor Scott's claim that "we've seen higher quality in administration of care, produced cost savings and consumers in the pilot have found improved access for Medicaid recipients." Looking forward to your feedback. Yours Bernd For more information see: http://htpolitics.com/2011/12/15/feds-make-key-decisions-on-medicaid-and-health-insurance-for-floridians http://blogs.orlandosentinel.com/news_politics/2011/12/what-is-changing-in-florida-medicaid-maybe.html

The Sick Business of Medicine

Attached a link http://www.miamiherald.com/2011/11/12/2499995/finances-strain-the-marriage-between.html to an interesting article by John Dorschner published in the Miami Herald titled "Finances strain the marriage between Jackson and the University of Miami" which details the increasingly strained relationship between Jackson Memorial Hospital and the University of Miami. At the center of the dispute are insured patients seeking medical care at Jackson Memorial hospital. UM critics claim that UM physician direct these patients to the UM hospital across the street, and that Jackson Memorial hospital is left with treating the uninsured patients. Miami-Dade taxpayers pay Jackson Memorial $330 million a year to treat uninsured people who seek treatment in the county-owned Jackson system. As part of the system that has evolved over the years, Jackson also pays UM when its doctors treat the uninsured at Jackson. UM critics also claim that once an uninsured patient gets insurance UM doctors are shifting their care to the UM hospital, which then receives the Medicare reimbursement money. UM calls that patient choice. Jackson counters that its paying patients shouldn’t be siphoned off to UM facilities. What troubles me is that patients are being considered as milkable cash cows and once they are loosing their production value they are being pushed back into Jackson Memorial Hospital. Its a sick system which encourages overutilization of medical services and drives up healthcare costs even further. Yours Bernd

Health Care Cost Control

"Unfortunately, few people really understand how much we spend on health care,how much we need to spend to provide quality care, and the difference between the two." The New York Times published three articles by Ezekiel Jonathan Emanuel,MD PhD focusing on how to control the escalating health care costs in the United States. I highly recommend reading the articles published so far and have attached the links to each article below. The following bullet points represent an excerpt of the arguments made in his articles: How much do we spent on health care in the United States? In 2010, the United States spent $2.6 trillion on health care, over $8,000 per American.The United States spends on health care alone what the 65 million people of France spend on everything: education, defense, the environment, scientific research, vacations, food, housing, cars, clothes and health care. In other words, our health care spending is the fifth largest economy in the world. For more than 30 years, health care costs have been growing 2 percent faster than the overall economy. That means every year we spend ever more on health care and therefore have to spend less on other things — or borrow money to pay for the extra health care. If we continue at this rate of growth, health care will be roughly one-third of the entire economy by 2035 — one of every three dollars will go to health care — and nearly half by 2080. This level of spending on health care is high, but is it worth it? Does it make us healthier? The United States spends around 20-30 percent more per person than the next highest-spending countries, Switzerland and Norway BUT the United States is not getting 20 or 30 percent better health care or results than other countries! As a country we are actually doing worse than a number of countries, like France and Germany, that spend considerably less! How do we spent our health care dollars and how can we start saving? In health care, you have to be talking about tens of billions of dollars before you are talking about real money. A useful threshold for savings is 1 percent of costs, which comes to $26 billion a year. Anything less is simply not meaningful. Cutting health insurance companies profits? Last year, health insurance companies did rack up big profits, but it turns out that the combined profits of the country’s five largest for-profit health insurance companies — United, WellPoint, Aetna, Humana and Cigna — were $11.7 billion, only 0.5 percent of total health care spending. Even confiscating every penny of those profits would add up to less than half of the cost-saving threshold. Cutting drug companies profits? Between 2004 and 2009, generic drug use rose from 57 to nearly 75 percent of all prescriptions. Paradoxically, over those same years, the total amount Americans spent on drugs actually increased by 31 percent — the same rate as overall health care expenditures. Even the best estimates suggest that savings from expanding generics’ use even further are, according to the Department of Health and Human Services, “likely to be small relative to total spending on drugs.” Pharmaceutical costs account for roughly 10 percent of total health care spending, some $260 billion in 2010. Importing brand name drugs from abroad would cut about 2 percent from that — $5 billion per year. Another cost control disappointment. Malpractice reform is the solution? In 2009, the Congressional Budget Office did a comprehensive assessment of the potential cost savings from medical malpractice reforms. Its conclusions: A package that included a $250,000 cap on noneconomic damages, a $500,000 cap on punitive damages and a one-year statute of limitations for claims by adults would save about $11 billion a year — 40 percent from reduced malpractice premiums and the rest in the form of fewer defensive procedures like M.R.I.’s. Frankly, $11 billion is not insignificant BUT at less than half the $26 billion threshold, malpractice reform is certainly not a cost savings magic bullet either. Restrict health care spending on exorbitantly expensive patients? An unpublished analysis of nearly 20 million commercially insured patients(provided to the author of the article) showed that there were only 255 patients who consumed over $1 million in 2010. Together they spent 0.5 percent of all costs — a very large number for so few patients, but just half the 1 percent threshold for cost-saving that matters. And not all of those costs could be saved. Are administrative services one of the biggest money wasters in our health care system? Administration accounts for roughly 14 percent of what the United States spends on health care, or about $360 billion per year. About half of all administrative costs — $163 billion in 2009 — are borne by Medicare, Medicaid and insurance companies. The other half pays for the legions employed by doctors and hospitals to fill out billing forms, keep records, apply for credentials and perform the myriad other administrative functions associated with health care. The range of expert opinions on how much of this could be saved goes as high as $180 billion, or half of current expenditures. But a more conservative and reasonable estimate comes from David Cutler, an economist at Harvard, who calculates that for the whole system — for insurers as well as doctors and hospitals — electronic billing and credentialing could save $32 billion a year. And United Health comes to a similar estimate, with 20 percent of savings going to the government, 50 percent to physicians and hospitals and 30 percent to insurers. For health care cuts to matter, they have to be above 1 percent of total costs, or $26 billion a year, and this conservative estimate certainly meets that threshold!!! How do we get to these savings? First, electronic health records would eliminate the need to fill out the same forms over and over. An electronic credentialing system shared by all hospitals, insurance companies, Medicare, Medicaid, state licensing boards and other government agencies, like the Drug Enforcement Administration, could reduce much of the paperwork doctors are responsible for that patients never see. Requiring all parties to use electronic health records and an online system for physician credentialing would reduce frustration and save billions. But the real savings is in billing. There are at least six steps in the process: 1) determining a patient’s eligibility for services; 2) obtaining prior authorization for specialist visits, tests and treatments; 3) submitting claims by doctors and hospitals to insurers; 4) verifying whether a claim was received and where in the process it is; 5) adjudicating denials of claims; and 6) receiving payment. Substantial costs arise from the fact that doctors, hospitals and other care providers must bill multiple insurance companies. Instead of having a unified electronic billing system in which a patient could simply swipe an A.T.M.-like card for automatic verification of eligibility, claims processing and payment, we have a complicated system with lots of expensive manual data entry that produces costly mistakes. The Affordable Care Act requires the Department of Health and Human Services to develop operating standards for electronic eligibility determination and payment — steps one and six — in the next few years, but we need to go further. We need the standard operating rules to encompass authorizing tests and treatments, submitting claims, verifying where in the process a claim is and the real-time adjudication of denials. And we must accelerate the process, covering all steps by 2015. Finally, the government needs to require that all parties — doctors, hospitals, insurers, government agencies — use the electronic systems. This platform of electronic eligibility, claims and payment would — in addition to saving billions of dollars in paperwork — facilitate anti-fraud measures like those used by credit card companies. It would ease the administrative burden on doctors, letting them do the work that really matters — treating patients. Finally, it could improve care through built-in guidelines; if a doctor tried to schedule a stent implantation for a patient with stable heart disease, the system could tell him to try medication first; if he tried to order an M.R.I for a patient with normal back pain, it could tell him to prescribe physical therapy first. We have to realize that there are no " magic bullets" to solve our health care cost crisis.Any solutions offered so far to provide universal health care coverage will fail UNLESS they are being combined with meaningful and sustained cost control measures. This requires a total reform of our reimbursement system transforming it from a quantity to a quality focused service industry utilizing state-of-the-art information technology tools. Unless we are not willing to change, we are going to be forced to further ration medical services. What do we prefer? Yours Bernd Links: Spending More Doesn’t Make Us Healthier, http://opinionator.blogs.nytimes.com/2011/10/27/spending-more-doesnt-make-us-healthier/ Less Than $26 Billion? Don’t Bother., http://opinionator.blogs.nytimes.com/2011/11/03/less-than-26-billion-dont-bother/ Billions Wasted on Billing, http://opinionator.blogs.nytimes.com/2011/11/12/billions-wasted-on-billing/#more-112339

Personhood Amendment

On November 8th Mississippi voters will be asked to decide on a proposed amendment to the state constitution, which would define as a person “every human being from the moment of fertilization, cloning, or the functional equivalent thereof.” For most voters it sounds like a good idea and it will most probably pass. Therefore, several other states, including Florida http://personhoodfl.com/, are preparing similar constitutional amendments. Florida Senate Majority Leader and former US Senate Candidate Mike Haridopolos recently signed the FL Personhood Amendment!! The ambiguous language in the Florida and Mississippi 'personhood' amendment are intentionally not being represented properly by the proponents of this ballot initiative. A recent New York Times article http://www.nytimes.com/2011/10/31/opinion/mississippis-ambiguous-personhood-amendment.html correctly points out the following problems: "First, what does “fertilization” mean? As embryologists recognize, fertilization is a process, a continuum, rather than a fixed point. The term “fertilization” — which is sometimes considered synonymous with “conception” — could mean at least four different things: penetration of the egg by a sperm, assembly of the new embryonic genome, successful activation of that genome, and implantation of the embryo in the uterus. The first occurs immediately; the last occurs approximately two weeks after insemination (or, in the case of embryos created through in vitro fertilization that do not get implanted, never). Thus, on some reasonable readings of the amendment, certain forms of birth control, stem cell derivation and the destruction of embryos created through in vitro fertilization would seem impermissible, while on other equally reasonable readings they are not." Following the "logic" of the "personhood" advocates doctors can be charged with manslaughter or even murder by prescribing morning after pills, because it can irritate the lining of the uterus (endometrium) so as to inhibit implantation of a fertilized egg, i.e. "killing a person." A doctor could also be criminally charged by inserting an IUD because it adversely affects a new embryo as it enters the uterus, thus preventing it from implanting in the uterine lining . Again, according to the "personhood" advocates this constitutes the "killing of a person." Even though, abortions are still being protected by federal law women may still face criminal charges according to state law. Other unintended consequences include the question if the treatment of an ectopic or a molar pregnancy requires first a court order to overrule a "personhood" amendment in the respective state constitution. Needless to mention that any delay of these time-sensitive treatment decisions may harm the mother and even jeopardize the life and well-being of a women. I urge all of you to speak up against any such ballot initiatives, to protect the physician-patient relationship and to guard against further state intrusion into our lives. Yours Bernd

Drug Treatment Instead Of Prison

Attached a link http://www.sun-sentinel.com/news/opinion/editorials/fl-prison-bill-editorial-dl-20111030,0,3676874.story to an interesting editorial published in today's Sun Sentinel titled " State prisons need drug treatment alternative." The Sun Sentinel Editorial Board supports legislation — CS/HB 177 and SB 448 — which intends to establish a re-entry program for nonviolent offenders that offers intensive substance abuse treatment, adult education courses and vocational training as alternatives to long prison sentences. The idea is to reduce recidivism, which is essential if state officials want to get a handle on the costs of incarceration. The bills are sponsored by State Sen. Ellyn Bogdanoff, R-Fort Lauderdale, and State Rep. Ari Porth, D-Coral Springs. The two lawmakers are trying to pass needed, positive legislation to help the state of Florida reduce the costs of operating its prisons. In my opinion we should support this legislation and begin lobbying members of the Florida House and Senate. E-mail, twitter, mail or call your representative because " Unlike prison privatization and the more controversial ideas to cut state prison costs, the re-entry program is a simple solution that promises both savings and a much-needed reduction in the state's ongoing recidivism problem." Yours Bernd

Substance Abuse Counseling and Preventive Health Care

Attached a link http://www.ama-assn.org/amednews/2011/10/17/bica1017.htm to an interesting article titled "Counseling on alcohol helps patients and is billable" published in AMA News and posted on October 17th, 2011. Several highlights:

* Since early 2011, many commercially insured patients have been able to receive alcohol counseling paid at 100% with no co-pay or deductible, and the same is expected to be true for Medicare beneficiaries as of Jan. 1, 2012.
* Just asking about alcohol abuse will not necessarily lead to reimbursable payment, but treating those who screen positive most probably will. In addition to the usual fee-for-service, other incentives on the table should further make dealing with the issue more financially feasible for practices and make it more likely that patients will enter treatment.
* Tracking the percentage of adolescents and adults with new episodes of alcohol or other drug dependence who initiate treatment is on the list of eligible professional measure specifications from the Centers for Medicare & Medicaid Services.
* Information should be noted in the patient's chart, along with the time spent on this task. Counseling sessions longer than 15 minutes are billable, but shorter ones are not.
* On July 19, CMS issued a proposed decision memo stating that, as of Jan. 1, 2012, Medicare will cover annual alcohol misuse screening. (A final decision has not yet been made.) Under the proposal, Medicare would pay for four brief, face-to-face behavioral counseling interventions a year. The American Medical Association and other medical societies support his move.
* In addition, alcohol misuse screening and counseling is on the list of preventive services that non-grandfathered health plans must cover at 100% with no deductible or co-pay, according to the Patient Protection and Affordable Care Act. Grandfathered health insurance plans are those that have not changed since the health system reform law was enacted. Non-grandfathered ones are new policies issued after Sept. 23, 2010, and must cover a recommended list of preventive services with no cost-sharing with patients.
* When billing private insurers, the CPT codes are 99408 for an intervention lasting 15 to 30 minutes. An intervention longer than 30 minutes should be coded 99409. H0049 is the code for alcohol and drug screening of Medicaid beneficiaries. H0050 can be used for every 15 minutes of intervention. The services can be provided by a nurse practitioner or physician assistant as well as a physician.

Yours
Bernd

Drug Testing Halted

Attached a link http://www.miamiherald.com/2011/10/24/2470519/florida-welfare-drug-testing-halted.html to another article titled "Florida's welfare drug testing halted by federal judge" reporting that A federal judge in Orlando on Monday temporarily blocked Florida’s controversial law requiring welfare applicants be drug tested in order to receive benefits. Judge Mary Scriven issued a temporary injunction against the state, writing in a 37-page order that the law could violate the Constitution’s Fourth Amendment ban on illegal search and seizure.Gov. Rick Scott, who signed the measure into law on May 31, touted it as a way to ensure taxpayer money isn’t “wasted” on those who use drugs. “Hopefully more people will focus on not using illegal drugs,” he said then.
But, in her order, Scriven issued a scathing assessment of the state’s argument in favor of the drug tests, saying the state failed to prove “special needs” as to why it should conduct such searches without probable cause or reasonable suspicion, as the law requires. “If invoking an interest in preventing public funds from potentially being used to fund drug use were the only requirement to establish a special need,” Scriven wrote, “the state could impose drug testing as an eligibility requirement for every beneficiary of every government program. Such blanket intrusions cannot be countenanced under the Fourth Amendment.”
Fortunately, our legal system still provides protection against the growing government intrusion in our lives spearheaded by a conservative majority in our legislature. We need to continue to push back the growing number of bills threatening not only the practice of medicine but also the freedoms each and every citizen is entitled to.
Yours
Bernd

Florida Prescription Drug Monitoring Program

Attached a link http://www.usatoday.com/news/nation/story/2011-10-13/pill-mill-drug-trafficking/50896242/1?loc=interstitialskip to an interesting article in USA Today titled "States target prescriptions by 'pill mills'" highlighting the Florida painmill problem, the actions taken to combat this issue which include the Prescription Drug Monitoring Program ( PDMP) . We should be ware that the death rate from oxycodone in Florida increased 265% from 2003 to 2009, the CDC found. By 2009, the number of deaths involving prescription drugs was four times the deaths involving street drugs, the CDC said in a July report. Hopefully, the number will decrease but this requires our active participation and support INCLUDING our use of the just recently launched PDMP, or E-FORCSE.
I am using this program now for the last week and am pleased to report that it truly works! For example, I have implemented a protocol which requires that the prescription record of each and every patient who receives a controlled substances has to be crosschecked with the medication listed on E-FORCSE.
I have already discovered that several of my patients did not inform me that they visit different physicians to receive controlled substances. One patient who is currently being treated with Suboxone received prescriptions for a total of 360 Hydrocodone pills from another MD "specializing" in pain management. I called her and she was very surprised to find out that I knew what she was prescribed. She tried to convince me that she only fills these scripts for "psychological reasons" but is not taking but hoarding them at home. I asked her to come to my office for a follow-up visit including drug testing but she never showed up. I suspect that she may sell, or share this medications with others.
I urge you to obtain your username and password and to incorporate this valuable tool into your practice.
Yours
Bernd

The number of Uninsured continue to soar!

Attached you find a link http://www.miamiherald.com/2011/09/30/2432980/uninsured-situation-worsens-in.html to an excellent article article by John Dorschner published in today's Miami Herald titled " More in S.Florida going uninsured" focusing on the soaring numbers of uninsured even in middle-class suburbs." The facts are indeed stunning and sobering:

"The data shows that almost a third — 31.2 percent — of adults aged 18 to 64 in the Kendall area, a middle-class suburb, were uninsured in 2010, up from 19.6 percent in 2008.
Those grim numbers reflect South Florida’s recent economic struggles that have driven up unemployment and forced many small employers to drop insurance coverage, said Steven Ullmann, a health policy expert at the University of Miami. The figures are part of a larger trend of growing numbers of uninsured and shrinking alternatives for the poor throughout Miami-Dade and Broward counties."

"The Kendall uninsured numbers — 50 percent higher than national figure for the same 18-to-64 age group — are “a reflection of everything the economy has been through,” Ullmann said. “It’s becoming an issue nationwide, but it’s reflected even more so in our local economy.”

"The Census data, released last month, shows 31.8 percent of Miami-Dade’s residents of all ages were uninsured in 2010. In Broward, it was 24 percent. In Monroe County, 32 percent — compared with a national average of 16.3 percent."

"A stunning 57 percent of Hialeah residents in that age group were uninsured in 2010, up from 53 percent in 2008.
In the City of Miami, 50.4 percent of 18-to-64-year-olds were uninsured, compared to 45.8 percent in 2008. In Deerfield Beach, 48.5 percent were uninsured, compared to 33.6 percent in 2008. In Miami Gardens, it was 39.9 percent, compared to 35.2 percent in 2008, while Miami Beach registered very little change, with 35 percent, compared to 35.8 percent in 2008. Weston continues to be the place in South Florida with the lowest rate of uninsured residents in the 18-to-64 age group, with 17.9 percent, compared to 13.8 percent in 2008."

The poor are also getting squeezed, says Ullmann. Many of them can qualify for Medicaid, the state-federal program for the poor, but Ullmann notes that as the state’s budget shrinks, legislators have been trying to reduce the program by lowering payments and forcing patients into health maintenance organizations."

Unfortunately, these numbers are not going to change and may even worsen. Many of those who are lucky enough to find a job are NOT offered health insurance because health insurance premiums for employer-provided health insurance jumped 8-9 percent in 2011, passing $15000 for family coverage!
As a result more people seek health care in emergency rooms driving up the costs even further, because those with insurance are paying the share for those who don't, or cannot, pay. Meanwhile, politicians are still engaged in trench warfare to fight off "Obamacare."
We must face reality and find solutions to this problem. One of them would be a countywide effort to create a network of primary care clinics offering a Patient-Centered Medical Home (PCMH) coordinating medical care. Such a network could be financed by grants and federal subsidies. The costs of such care would be substantially lower compared to the emergency room services provided. For example, one of my asthma patients has utilized the emergency room 2-4 times per month for treatment and medication refills. He is now enrolled in a chronic disease management program and has used the ER only once in two years.
I hope that common sense will prevail. Otherwise, we are going to face a very bleak future.
Yours
Bernd

The Legality of Online Health Care Discounts

Attached you find a link http://www.baltimoresun.com/health/fl-hk-groupon-medical-20110925,0,6420216.story to an interesting article titled "Are Groupon discounts for medical treatments illegal?" highlighting an important issue: Those big discounts on health care treatments offered on websites like Groupon may be illegal, medical law experts say. Not for the patients but for the medical professionals giving them.
"The law is very strict. This seems like a problem," said Michael Segal, a South Florida health-care lawyer. "I would urge [practitioners] to be very careful. You don't want to find out there's a concern after you have done it."
A number of national and local medical associations, including the Palm Beach County Medical Society last month, have warned members because the issue is still in doubt. Florida regulators said they have not discussed it. Medicare has taken no position. Nor has the American Medical Association or other medical trade groups.

Yours
Bernd

Hospital Performance

Attached a link http://www.nytimes.com/2011/09/15/us/hospital-performance-improved-report-finds.html to an interesting article titled "Report Finds Improved Performance by Hospitals," reporting that in the latest advance for health care accountability, the country’s leading hospital accreditation board, the Joint Commission, released a list http://www.jointcommission.org/assets/1/18/Top_Performers_2010_list_9_13_11.pdf on Tuesday of 405 medical centers that have been the most diligent in following protocols to treat conditions like heart attack and pneumonia. Almost without exception, most highly regarded hospitals in the United States, from Johns Hopkins in Baltimore to the Mayo Clinic in Rochester, Minn., did not make the list!

"With evidence-based ratings gaining prevalence, and a strengthening link between quality and payment, the Joint Commission report raised questions about how consumers should best use the data newly available to them. Increasingly, one component of that inquiry may be whether hospital reputations are deserved or mythologized."

"As an example, none of the 17 medical centers listed by U.S. News & World Report on its “Best Hospitals Honor Roll” this year are on the Joint Commission’s list of 405 hospitals that received at least a 95 percent composite score for compliance with treatment standards. About one-third of a hospital’s score in the U.S. News methodology is based on its reputation as gauged by a survey of physicians...the Joint Commission list of top performers included a disproportionate share of small and rural hospitals, as well as 20 Veterans Affairs medical centers. About 14 percent of roughly 3,000 eligible hospitals made the cut."

"As it is, both private and government health insurers are beginning to tie hospital reimbursements to quality measures like infection rates and readmissions. Next year, compliance with procedural standards will become even more consequential, as the Joint Commission plans to withhold accreditation from any hospital that posts a composite score below 85 percent."

This report serves as a reminder that payers will use this data to strengthen the link between quality and payment.
Therefore, physicians should consider adjusting their treatment protocols and quality measurements accordingly.

Yours

Bernd

Wollschlaeger et al vs. Farmer et al

Court Grants Preliminary Injunction Against Physician Gag Law

Since Taking Effect, Unconstitutional Gag Law Had Chilled Speech by Florida Doctors

The Florida chapters of three national medical organizations, along with six physicians, applauded the decision of a federal district judge today to immediately block enforcement of the new state law that bars healthcare professionals from asking patients if they own guns and have them stored properly. These questions are a key element in the practice of preventive medicine.

The groups, along with individual doctors, had asked Judge Marcia Cooke of the U.S. District Court for the Southern District, Miami Division to issue a preliminary injunction because the new law has already curtailed the First Amendment rights of physicians across the state to speak with their patients about gun safety. A preliminary injunction is an order that prevents a party from pursuing a particular course of conduct until a case has been decided. To grant a preliminary injunction, the court must find that plaintiffs have a substantial likelihood of success on the merits of the case.

Lisa A. Cosgrove, M.D., FAAP, President of the Florida Chapter of the American Academy of Pediatrics (Florida Pediatric Society) said: “Pediatricians simply want to do what they do best: protect children. We hope that now we will be able to get back to working with parents to maintain their guns, pools and poisons to keep kids safe."

Dennis Mayeaux, MD, Chair, Board of Directors, Florida Academy of Family Physicians said: “The impact of this law has already caused serious rifts in physician-patient relationships. Casual conversations with patients often bring other medical issues to light, and erosion of these opportunities also erodes the quality of care. The preliminary injunction will now allow us to talk to our patients again about firearm safety.”

Stuart Himmelstein, M.D., American College of Physicians Governor for Florida, stated: "Reversing this law is essential in order to preserve the sanctity of the doctor -patient relationship by keeping the government out of the exam room. The preliminary injunction will preserve free speech between both doctors and patients as protected by the Constitution and which is necessary to obtain the highest of quality care that every citizen deserves."

Physicians and other healthcare professionals routinely provide their patients with information about a variety of health risks in the home and broader environment. Such preventive counseling has become a cornerstone in the practice of medicine and is recommended by numerous professional medical societies. In the course of practicing preventive medicine, healthcare professionals routinely ask and counsel patients about firearm safety.

The state chapters of the American Academy of Pediatrics, American Academy of Family Physicians, and American College of Physicians collectively represent more than 11,000 healthcare professionals in Florida. On June 24, 2011, these organizations, along with six individual physicians, filed papers asking the court to enjoin the law because it substantially curtailed their First Amendment rights to exchange information with patients about gun safety.

The lawsuit challenging the Physician Gag law was originally filed on June 6, 2011, shortly after Governor Scott signed it into law. Prior to filing suit, the physician groups urged the Governor to veto the legislation since it infringes the First Amendment rights of healthcare professionals throughout Florida.

The organizations and individual physicians in the lawsuit are represented by Ropes & Gray (lead counsel), Astigarraga Davis (local counsel), and lawyers from the Brady Center to Prevent Gun Violence’s Legal Action Project.


####

PDMP goes online!

Attached a link http://www.miamiherald.com/2011/09/01/2385732/fla-prescription-data-base-goes.html to an article from today's Miami Herald titled " Fla. prescription database goes into operation" highlighting the fact that as of September 1st Florida's prescription drug tracking system finally was up and running. That means that dispensers and pharmacies must upload their prescription data for Schedule II to IV to the database. Rebecca Poston, the system's program director in the Department of Health said that "Everything is working wonderful, I have not heard of any glitches related to the dispensers registering or uploading information in the system."
The Department of Health will not begin registering doctors and pharmacists until Oct 1, nor will they be able to get information out of the database until Oct. 17. In my opinion the registration and training process should start now and be phased in either by region, or other criteria to be determined by the Department to allow for a smooth transition and to motivate doctors to use the system. Its not too late to do that but leaving it until October 1st is cutting it too short.
Yours
Bernd

United Health On The Move

Attached a link http://online.wsj.com/article/SB10001424053111903895904576542553422509280.html to an article titled" UnitedHealth Buys California Group of 2,300 Doctors" reporting that United Healthcare will acquire the management arm of Monarch HealthCare, an Irvine, Calif., association that includes approximately 2,300 physicians in a range of specialties. This will establish United's Optum health-services unit as a formidable presence in California. Optum had previously taken over the management arms of two smaller southern California groups, AppleCare Medical Group and Memorial HealthCare Independent Practice Association.This serves as an example of how lines are blurring between insurance companies and health-care providers.
What can we do? Consider forming cohesive primary care and/or multi-specialty associations, utilizing EHR technology and based on the Patient-Centered-Medical-Home Model to compete in the rapidly changing healthcare marketplace.
We cannot ignore the writing on the wall. Change is inevitable!
Yours
Bernd

Pill Mills Under Pressure

Attached a link http://www.nytimes.com/2011/09/01/us/01drugs.html to today's New York Times front page article titled "Florida Shutting ‘Pill Mill’ Clinics."
The article highlights the accomplishments made despite the initial resistance by the current administration in Tallahassee.:

As of July, Florida doctors are barred, with a few exceptions, from dispensing narcotics and addictive medicines in their offices or clinics. As a result, doctors’ purchases of Oxycodone, which reached 32.2 million doses in the first six months of 2010, fell by 97 percent in the same period this year.
One indication that law enforcement officials are choking the supply of prescription drugs sold illegally in Florida is that the price of Oxycodone on the streets here has nearly doubled from last year, to $15 per pill from $8.
On Commercial Boulevard, a major street in Broward County, the number of pain clinics has fallen in the past year from 29 to one.
The fallout from the tougher laws may include an increase in pharmacy robberies, a problem that has been worse in Florida than any other state since 2007 (there were 65 armed robberies of pharmacies here last year).

As of today any health care practitioner who has dispensed a Schedule II-IV controlled substance, as defined in section 893.03, F.S. (i.e., OxyContin®, Percocet®, Vicodin®, Klonopin®, Xanax®, and Valium®), is required to report dispensing information to the Prescription Drug Monitoring Program’s database within seven (7) days after dispensing, in accordance with section 893.055, F.S. This includes pharmacies licensed under chapter 465, F.S., and dispensing health care practitioners licensed under chapter 458, 459, 461, 462, or 466, F.S
Now we must push to start educate physicians on how to use the PDMP and to encourage accessing the database to identify "doctors shoppers."
I am optimistic that we can achieve our goals.
Yours
Bernd

Drug Testing for Welfare Recipients

Attached some food for thought regarding the mandatory drug testing for welfare recipients:

When Florida Gov. Rick Scott (R) signed the law requiring welfare recipients to pass annual drug tests to collect benefits, he justified the likely unconstitutional law by saying it would save the state money by keeping drug users from using public money to subsidize their drug habits. Drug use, Scott claimed, was higher among welfare recipients than among the rest of the population.According to preliminary results from the state’s first round of testing, however, has seemingly proven both of those claims false. Only 2 percent of welfare recipients failed drug tests, meaning the state must reimburse the cost of the $30 drug tests to the 96 percent of recipients who passed drug tests (two percent did not take the tests). After reimbursements, the state’s savings will be almost negligible, the Tampa Tribune reports:
Cost of the tests averages about $30. Assuming that 1,000 to 1,500 applicants take the test every month, the state will owe about $28,800-$43,200 monthly in reimbursements to those who test drug-free.
That compares with roughly $32,200-$48,200 the state may save on one month’s worth of rejected applicants.
Net savings to the state: $3,400 to $5,000 annually on one month’s worth of rejected applicants. Over 12 months, the money saved on all rejected applicants would add up to $40,800 to $60,000 for a program that state analysts have predicted will cost $178 million this fiscal year.
This should serve as an example that our government in Florida seems to base its decisions on ideological assumption instead on rational thought and consideration.
Yours

Bernd


Bernd Wollschlaeger,MD,FAAFP,FASAM
16899 NE 15th Avenue
North Miami Beach,FL 33162
Phone: (305) 940-8717
Fax: (305) 940-8871
Web Site: www.miamihealth.com
Blog: http://floridadocs.blogspot.com
Twitter: http://www.twitter.com/dadedoc

Primary Care Defunded

Attached you find a link to an article by John Dorschner titled "Clinics for poor threatened by cuts" http://www.miamiherald.com/2011/08/17/2366741/south-florida-clinics-threatened.html pointing out that " federal support of clinics [ community health centers] took a big hit in the recent deficit reduction deal in Washington and may be taking an even bigger one when Congress starts a new round of budget-cutting in the near future. At the same time, some free clinics in South Florida that also help the poor — often with little or no government support — are running out of funds and are in danger of closing."
Dorschner further reports that the creators of the federal healthcare reform act considered primary care such an important way to cut costs that the act authorized $11 billion to bolster care at “federally qualified health centers,” which include nine clinics with more than 30 locations in Miami-Dade and Broward. Congress authorized $1 billion for new federally qualified facilities or expansions of existing ones this year. But the $1 billion allocation was slashed to about $90 million for new facilities during the recent budget cuts. Only 67 of 2000 applications for new federally qualified centers were funded. More cuts may be coming as a new congressional deficit reduction committee gets under way.
In my opinion cutting primary care services is a penny-wise and pound-foolish decision . Now, those uninsured will be left with no other choice but to use the emergency rooms of local hospitals for their care resulting in far higher costs, poor care coordination and no continuity of care.
How can we talk sense to politicians who seem to ignore those facts? Are they really so detached from reality, or is is just about scoring points for their re-election campaigns? We must speak up and defend the rights of those who now do not have anyone left to speak up for them. Both parties in congress are at fault and our president doesn't dare to rock the boat. Enough is enough!!

Health Insurance Policy

Attached a link to an interesting article http://online.wsj.com/article/SB10001424053111904253204576512494056148396.html published in today's WSJ reporting that as part of the health-care overhaul law federal regulators are expected to unveil on Wednesday the proposed health insurance policy summary form of health insurance policies , that will lay out the details of each policy, from deductibles to how much it might cost to have a baby. The requirement is supposed to take effect next March. Currently, states mandate certain disclosures from health insurers, but they vary by state. The information often comes as part of a document known as the certificate of coverage or evidence of coverage, which can run to dozens of densely written pages and is often supplied ONLY AFTER a consumer has signed up for a policy. Employers offering coverage typically provide materials to their workers, but these also don't follow any common national format.
The proposed new summary is expected to closely follow a draft version from a committee convened by the National Association of Insurance Commissioners, people with knowledge of the matter said. Health and Human Services is expected to finalize the form after a public comment period. Insurers said they were concerned about the potential cost and administrative burden of the new requirement, particularly if they have to create different iterations of the form for every possible plan design a consumer could explore and for every single employer.
Of course they are concerned because for the first time the policies will be readable, comparable and can form the basis of rational decision making in a complex market place. Who does understand his/her current health care policy? I don't !! I still struggle to understand how much my insurance will cover for a colonoscopy and how much I have to budget for this procedure. If we want a free market place then we should allow for measures that create accountability and transparency. Currently, insurance companies will make every effort to maintain the status quo, which disenfranchises the consumer. We should support these new federal regulation and to express our opinions during the public comment period. Let's not miss this opportunity.
Yours
Bernd

The Blues Treatment For Mental Health Providers

Attached a very troublesome article I just received today reporting that on July 27, 2011 Blue Cross Blue Shield of Florida began notifying ALL of their mental health providers (licensed social workers, licensed mental health counselors, psychologists, and psychiatrists) that effective November 30th, 2011 they would be terminated, without cause.
They were also notified that that if providers would like to join the new company they are partnering with, New Directions, so that they can provide services to their patrons, they would need to complete a new contract (sent under separate cover) within 15 days and agree to significant cuts (35-55%) in reimbursement rates, as well as other disturbing clauses such as only being able to refer to in-network providers, etc.
Since BCBS is considered to be one of the largest providers of insurance for mental/behavioral health in Florida, this termination could potentially place hundreds/thousands of providers in a position of being underemployed and/or unemployed, and worse, leave thousands of patients without coverage or access to mental health/psychological treatment.


CNN producer note
iReport -
On July 27, 2011 Blue Cross Blue Shield of Florida began notifying ALL of
their mental health providers (licensed social workers, licensed mental
health counselors, psychologists, and psychiatrists) that effective Nov 30,
2011 they would be terminated, without cause. That is, they will no longer
be providers for BCBS-FL. In this notice, current providers were also
instructed to notify BCBS subscribers/patients of this coming termination
directly and on behalf of BCBS-FL.

BCBS-FL also indicated that if providers would like to join the new company
they are partnering with, New Directions, so that they can provide services
to their patrons, they would need to complete a new contract (sent under
separate cover) within 15 days and agree to significant cuts (35-55%) in
reimbursement rates, as well as other disturbing clauses such as only being
able to refer to in-network providers, etc.

Interestingly, New Directions appears to be a subsidiary of BCBS-FL. So, as
if it isn't horrible enough that ALL of the mental/behavioral health
providers have been "fired" at the same time and patients will likely find
themselves with poor quality care or no care at all, it appears that they
(the same company-BCBS-FL) fired its contractors and then offered them the
oportunity to reapply for rehire within the same week, but only if they
agree to sign a new contract, with entirely different terms.

This action (termination of providers only in one area) also seems to be a
possible violation of the Federal Mental Health Parity Law which protects
against the discrimination of mental health services. It does not appear
that any of the other healthcare providers or "medical" providers had their
contracts terminated.

Since BCBS is considered to be one of the largest providers of insurance for
mental/behavioral health in Florida, this termination could potentially
place hundreds/thousands of providers in a position of being underemployed
and/or unemployed, and worse, leave thousands of patients without coverage
or access to mental health/psychological treatment.

The ripple effect of these actions by BCBS-FL could be deadly to the people,
communities, and businesses throughout FL. leaving many unable to make a
reasonable living and thousands (including Seniors with BCBS as a secondary
policy) unable to access and/or pay for mental health treatment and
psychological services.

--
Bernd Wollschlaeger,MD,FAAFP,FASAM
16899 NE 15th Avenue
North Miami Beach,FL 33162
Phone: (305) 940-8717
Fax: (305) 402-2989
Web Site: www.miamihealth.com
Blog: http://floridadocs.blogspot.com
Twitter: @dadedoc

Florida Turns Down Federal Money

Attached a link to a recent article published in the NYT http://www.nytimes.com/2011/08/01/us/01florida.html pointing out that despite having the country’s fourth-highest unemployment rate, its second-highest rate of people without insurance and a $3.7 billion budget gap this year, the Florida has turned away scores of millions of dollars in grants made available under the Affordable Care Act. And it is not pursuing grants worth many millions more.
Although Florida is the fourth most populous state, it ranks 12th in the amount of money received from health care act grants, according to the government’s grant-tracking Web site. The law has directed $46.4 million to the state out of $1.98 billion awarded nationally. Much of the money has gone directly to local governments, community groups and medical providers. The Florida government even went so far to deny funding for community health centers! Three of four grants to expand community health clinics in Florida went to medical centers that are beyond the reach of the governor and the Legislature. The fourth was to the Osceola County Health Department, which under Florida law is effectively a unit of state government. The Legislature used its power to not authorize a grant won by the county to expand two health centers and build a third.
This represents not only irresponsible ideology driven behavior but it also threatens the fragile health of our communities.
Its time to raise our voices and to act as responsible citizens of our great state of Florida.
Yours

Bernd

Iraqi Healthcare

According to data analyzed by various think tanks the United States of America, i.e. taxpayers like you and me, spent (or wasted) almost ONE TRILLION DOLLAR in Iraq!! Among the many "gifts" we provided was our financial and logistical support for an Iraqi constitution.
It's of interest to note that Article 31 of the Iraqi Constitution, drafted by the U.S. administration in 2005 and ratified by the Iraqi people, includes state-guaranteed (single payer) healthcare for life for every Iraqi citizen!! Article 31 reads: "First: Every citizen has the right to health care. The State shall maintain public health and provide the means of prevention and treatment by building different types of hospitals and health institutions. Second: Individuals and entities have the right to build hospitals, clinics,or private health care centers under the supervision of the State, and this shall be regulated by law."
There are other health care guarantees, including special provisions for children, the elderly, and the handicapped elsewhere in the 43-page document.
So let me make it clear: Our taxpayer money was used to draft a constitution which contains state-guaranteed healthcare for life for every citizens BUT the same rights are being denied for the very same U.S. citizen who paid for this constitution??!!
Naturally, all of our legislators enjoy guaranteed state-funded healthcare, state-guaranteed pensions, state guaranteed salaries etc. BUT the same legislators want us to believe that all state-funded activities are evil and must be cut or eliminated! Naturally, excluding those benefits they enjoy!!
Churchill once said that " The inherent virtue of socialism is the equal sharing of misery." Maybe this is now a virtue of our democracy and our legislators want us to share the misery and allocate the benefits of freedom to those they choose.
Its up to us to let them do that.
Yours
Bernd

Child Abuse Prevention in Florida

The Miami Herald reports in today's edition  http://www.miamiherald.com/2011/07/20/2323475/florida-spurns-50-million-for.html that Florida lawmakers have rejected more than $50 million in federal child abuse prevention money because its is being offered through the Affordable Health Care Act which lawmakers oppose for  "philosophical", i.e. ideological,  reasons. The money would have paid, among other things, for a visiting nurse program run by Healthy Families Florida, one of the most successful child-abuse prevention efforts in the nation. And because the federal Race to the Top educational-reform effort is tied to the child-abuse prevention program that Healthy Families administers, the state may also lose a four-year block grant worth an additional $100 million in federal dollars!!
Its of interest to follow the "reasoning" of a key lawmaker, State Senator Joe Negron, opposed to Healthy Families Florida. State Sen. Joe Negron, who chairs his chamber’s Health and Human Services Appropriations Subcommittee, said he long has been philosophically opposed to Healthy Families, which he views as an intrusion into the private lives of parents.“I believe in providing basic information to parents at hospitals and medical settings,” said Negron, a Palm City Republican. “I am not persuaded that it is a good idea to show up at a family’s home year after year giving advice and guidance. I do not think that is a core, essential function of government.”
According to his "logic" its OK for government to censure  doctors free speech and to figure out by themselves, and under the threat of punishment,  what  basic information to parents at hospitals and medical settings is relevant to prevent child abuse.
Its also of interest to note that nobody wants to take responsibility for the rejection of federal funds.
On Wednesday, leaders of the state House and Senate and the governor’s office all insisted they had nothing to do with rejecting the money.“The grant was included in [the state Department of Health’s] legislative budget request, but beyond that, the executive branch never advocated for it and a budget amendment was not submitted,” said Katherine Betta, spokeswoman for Republican House Speaker Dean Cannon of Winter Park. Brian Burgess, a spokesman for Gov. Rick Scott, said Scott did ask for the money. Burgess produced a budget request that has the proposal. “If there is to be finger-pointing,” he said, “it should be directed elsewhere.”
In contrast to previous posturing the Governor and Republican lawmakers seem to be odds at whom to blame (or to cheer) for rejecting the grant money.
Meanwhile, more children will suffer and some may even loose their lives.
As physicians we are obligated to speak up!!

Yours
Bernd

United Health Care Profits Rose 13%

Today's New York Times article entitled " Profit Up 13%, United Health Raises Outlook" http://www.nytimes.com/2011/07/20/business/unitedhealth-groups-2nd-quarter-profit-jumps-13-percent.html reports that The United Health Group one of the nation’s largest health insurers, reported its second-quarter results on Tuesday, and the good news for the industry appeared likely to continue. UnitedHealth announced a double-digit increase in profits and raised its estimates for 2011 earnings. Its net income rose 13 percent, to $1.27 billion, or $1.16 a share, compared with $1.12 billion, or 99 cents a share, one year ago. And revenue increased 8 percent, to $25.23 billion. UnitedHealth was the first of the big insurers to report this quarter, and once again, the high profits appear to be partly the result of more budget-consciousness by their customers, even as the insurers ask for higher premiums. As they have for many months now, Americans seem to be putting off or forgoing medical care because of the weak economy and the increasing amount they are required to pay in medical bills as their deductibles and co-payments climb. In late spring, many health insurers said it was too soon to tell whether utilization would eventually rebound to the same levels as before the downturn. They argued that they could not count on the demand for medical care staying at relatively low levels.So the company continued to benefit from consumers making fewer doctor visits as they try to save money in the tough economy.
Following the logic of a free market economy, they should lower their premiums to entice consumers to "buy" healthcare services. But these rules DO NOT apply to the so-called "healthcare market" which is controlled by a few monopolies, in which only one seller faces many buyers who have no choice but to buy the product regardless of price.
Unfortunately, these monopolies also are acting as monopsonies, in which only one buyer faces many sellers. In this cases providers of health care services (doctors, hospitals etc) have no choice but to sell their services to a large insurance company because its buying power dwarfs the remaining market.
Ironically, the Patient Protection and Affordable Care Act will inadvertently exacerbate this situation because for-profit insurance companies play an essential role in the provision of services.
Who will suffer? The consumer who is forced to buy these expensive insurance products and the doctors whose negotiating power has been curtailed by regulations.
In this context a single-payer system, or a model based on not-for-profit insurance companies (i.e. Germany), may serve as a solution.
Unfortunately, we are doomed because we swallowed the "free market" ideology bait with hook, line and sinker and in the end have no choice but to stick with the worst solution anyone can offer.

Yours

Bernd

Graduate Medical Education

Federal Budget Cuts Threaten Graduate Medical Education:

In their efforts to reduce the federal deficit the partisan negotiators seem to agree on one issue only: drastic cuts of the Medicare subsidy for postgraduate medical education and funding reduction for advanced equipment that teaching hospital require to train young doctors.

The recommendations made by the National Commission on Fiscal Responsibility and Reform, currently under consideration, would cut about $5.8 billion in graduate medical education funding from the nation’s teaching hospitals. This represents a 53% cut compared to the current $10.9 billion in payments!! The Simpson Bowles Commission, which advised President Obama on debt and deficit reduction called in December 2010 for reducing “excess” payments to hospitals for medical education. The commission said the payments could be brought in line with the costs of medical education by limiting the direct subsidy to 120 % of the national average salary paid to residents. A second, indirect subsidy, which pays for intensive services and advanced equipment should also be reduced.

The proposed draconian cuts will jeopardize the sorely needed expansion of graduate medical education in the U.S . and exacerbate the looming physicians shortage. Who will care for the baby boomers seeking medical services? Who will provide primary care physicians once millions of Americans gain access to healthcare coverage in 2014?

The proposed measures are based on penny wise and pound foolish approaches to cover our federal deficit and ignore the long-term investments needed to protect our crumbling healthcare service infrastructure in the U.S. The suggestions were developed by politicians with a limited political life cycle instead by healthcare planners who are being tasked to develop policy and not politics.

I suggest to review thoughtful proposals such as the Nineteenth Report by the Council on Graduate Medical Education (COGME) entitled “ Enhancing Flexibility in Graduate Medical Education” http://www.hrsa.gov/advisorycommittees/bhpradvisory/cogme/Reports/nineteenthrpt.pdf before throwing out the baby with the bath water.

The future of our healthcare is at stake and politicians must step aside to let experts take charge.

Yours

Bernd

When Ideology Trumps Compassion

When Ideology Trumps Common Sense and Compassion:

In the past week, Florida lawmakers turned down a $2.1 million federal grant that would pave the way for the state to receive $35 million in federal funding that would move elderly and disabled patients from nursing homes to their own homes during the next five years. With the help of this federal funding elderly people could be moved out of nursing homes to independent-living facilities or to support care at home with their families resulting in less money to be spend on nursing-home care. Republican legislators defended their refusal of the latest federal grant, known as the Money Follows the Person funding. "Not only would accepting the Money Follows the Person grant go against our policy of implementing federal health-care reform, but it would be redundant to the multiple efforts that Florida has already made to improve the delivery of long-term care," said Rep. Denise Grimsley, R-Sebring, chairwoman of the state's House Appropriations Committee.
Grimsley said the federal grant came with "significantly higher administrative costs that have been unnecessary" because Florida already has been successful at moving people from nursing homes. Nan Rich, Leader of the Senate Democratic Caucus, disagrees. In a letter to the editor published in todays Miami Herald http://www.miamiherald.com/2011/07/02/2295756/rejecting-funds-to-help-elderly.html she argues that “ the funding would have garnered Florida $35,7 million in federal funds over the next five years.” She is correct stating that “ Florida's share of the federal funds will go to another state whose leaders aren't willing to shortchange their elderly and disabled for the sake of ideology.” The remainder of her letter speaks for itself and is worthwhile reading in its entirety:
“It just doesn’t make any sense for Florida to refuse the “Money Follows the Person” funds. The grant covered 100 percent of the staffing and administrative costs. The federal Medicaid match for this program would have increased from about 56 percent to almost 78 percent for the first year, and we would have been under no obligation to continue the program after that. Even if we did, however, we’d still save money by moving more eligible people out of nursing homes. Our state’s seniors, disabled people and taxpayers deserve better than the short-sighted political posturing that we saw last week.”
Is there any hope that rational thought will prevail in Tallahassee?
Yours
Bernd

Drug Testing for Welfare Recipients

Drug Test Law May Face Costly Legal Challenges:

Attached a link http://www.orlandosentinel.com/health/os-drug-tests-welfare-20110630,0,5410762.story to an article published in today's Orlando Sentinel pointing out that a new state law requiring welfare applicants to be drug-tested goes into effect today.

The law stipulates that parents with minor children who request temporary cash assistance must undergo a drug test. The average benefit check per family is $240 a month with a lifetime limit of 48 months.

About 4,000 Floridians each month may be affected by the new law. The 93,000 state residents already receiving such benefits would not be affected unless they reapply. In addition all parents who test positive for drugs — including legal drugs not prescribed for the parent — will be reported automatically to the state's abuse hotline. Applicants will have to pay for the drug tests themselves, though those who test negative will be reimbursed in the first benefit check they receive. Those who test positive also would have the chance to get a second, more-sophisticated screening — at their own expense of up to $100 — and have an official medical review of the testing (MRO) . It is still unclear whether those expenses would be reimbursed if the applicant is ultimately cleared. The law may violate the constitutional standard requiring that the government must have reason to believe an individual is using drugs before demanding a test. Michigan, the only other state to pass a similar law, had it struck down in court. Therefore, it most probably will face a costly legal challenge on taxpayers expense!! Furthermore, by implementing this policy the state government should have provided drug treatment options for those welfare recipients with children who test positive for drugs. The new law falls shot of this option, too.

In my opinion this new law is a bad idea which will face a long and costly court battle and will further divert scarce state resources from more important issues such as drug use prevention and treatment programs.

Happy 4th of July,


Yours

Bernd