ttached a stinging editorial published in yesterday's Miami Herald and my response in the form of a letter to the editor.
Yours
Bernd
The Miami Herald
Posted on Fri, Dec. 03, 2010
Tallahassee's pill mills
Lawmakers don't usually side with pill traffickers. But that's what the Florida Legislature unwittingly did during its brief, vengeance-fueled special session last month.
In the lust to override lame-duck Gov. Charlie Crist's vetoes on a handful of bills, the overwhelmingly Republican Legislature passed a law that requires legislative approval for any new government rules that cost more than $1 million over five years.
The law was touted as a measure to help stop the government from imposing excessive restrictions on business. All well and good. But it turns out the measure had a nasty side effect: It also halted the imposition of new regulations on the state's pill mills, which help feed an illegal pill pipeline.
How embarrassing. And predictable.
Lawmakers ignored warnings
Pill mills cause real suffering for addicts and their families, but lawmakers were more interested in the politics of punishing Gov. Crist for leaving the Republican Party than they were on studying what's good for the state and its residents. They ignored warning bells and rushed to pass a new law without understanding its implications.
Two years ago, lawmakers vowed to get serious about regulating pill mills -- after a Miami Herald series of articles spotlighted South Florida as the pill-mill capital of the United States. Doctors at these pain clinics, many in Broward County, served dual roles as pain and addiction specialists. The black market for painkillers in Florida flourished, spawning an epidemic of overdose deaths in Kentucky, Ohio, West Virginia, Tennessee and other states.
The new regulations, which were set to kick in Nov. 28, would have helped to curb some aspects of the abuse, specifying basic standards for pain clinics and surprise inspections each year, among other provisions.
Victims of the pain pill business counted the legislation a victory. And then lawmakers got the bright idea to override Gov. Crist's veto of the rule-making bill.
In his veto, Gov. Crist warned that nearly every rule would have to wait for the Legislature's approval under the new law, a mind-boggling thought given the number of rules that government can propagate. As of right now, there are roughly 600 proposed rules that have yet to take effect. No one knows how many of them now will require final legislative approval.
One, for sure: pill mill regulation.
Little opposition
There were a few voices of dissent amid the cry to override Gov. Crist's veto. Sen. Mike Fasano, R-New Port Richey, voted against the rule-making bill, saying it needed more study. Mr. Fasano was also the sponsor of the pill mill legislation.
Re-imposing the regulations may be delayed until the 2011 legislative session in the spring. The state Board of Medicine will discuss the regulations at its December meeting in Orlando.
For now, until lawmakers fix this unintended consequence of their own haste, the pill pushers win.
© 2010 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com
Read more: http://www.miamiherald.com/2010/12/03/v-print/1954918/tallahassees-pill-mills.html#ixzz176r4uQ3s
An editorial in today's Miami Herald entitled “Tallahassee's pill mills” correctly points out how the Republican dominated legislature voted to delay the implementation of tough new pain clinic regulations. Subsequently, the unscrupulous clinic operators and drug dealers in white coats, wrongly called “doctors,” can continue to churn out prescriptions for powerful painkiller. The legislators seem to be more concerned with ideological correctness and purity than the somber facts detailed in a recent report from the Florida Department of Law Enforcement released June 30th 2010 indicating that an average of seven Floridians per day die from prescription drug overdose! It appears that our legislators seem to live in another universe than most of us have to live in. In their world reality has to be adapted to fit political theory. In their world government regulation can only do harm and never do good. In their world pain clinics are successful businesses contributing to the overall economy and more regulations will drive them away from our state. They seem to forget that the regulations were carefully crafted by Democrats and Republicans to PROTECT our citizens from those unscrupulous businesses, which contribute to the DEATH of seven Floridians a day!! Now, the proposed rules must be submitted to the Legislature by Feb. 4 to qualify for consideration. Those that don't make it would have to wait until the 2012 legislative session. I am not only outraged by this political checkmate but also deeply concerned about its adverse impact on public health. This issue is too important to allow politicians to gamble away the lives of Florida’s citizen. We need to return to pragmatism and sound reasoning to address and resolve the problem of prescription drug abuse in Florida. Ideological grandstanding will only worsen the situation. We do not have much time left and the clock is ticking.
Bernd Wollschlaeger,MD,FAAFP,FASAM
Board certified Family Physicians & Addiction Specialist
16899 NE 15th Avenue, North Miami Beach,FL 33162 Phone: (305) 940-8717
E-mail: info@miamihealth.com
Member of the Prescription Drug Monitoring Implementation and Oversight Task Force
Saturday, December 04, 2010
Sunday, November 28, 2010
Health Policy Update
Attached a link http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=32 to a very interesting article about the provisions offered in the Affordable Care Act for early retiree healthinsurance benefits.
Its important that we educate ourselves about the many benefits the Patient Protection and Affordable Care Act can offer to so many Americans and to be able to respond intelligently to stereotypical accusation and falsifications of this important legislation.
THE FACTS (AND NOT FICTION) :
The number of employers offering health insurance coverage to early retirees---former employees older than 55 but not yet eligible for Medicare--has dropped sharply over the past two decades. Employers who have maintained that coverage have increased the share of premiums and other costs paid by enrollees. To help keep this type of coverage in place, the Affordable Care Act established a temporary program under which the federal government will reimburse retiree health plans for high-cost medical claims. This Early Retiree Reinsurance Program will pay 80 percent of each claim that exceeds $15,000, up to $90,000.
The program began in June 2010 and is slated to operate until the end of 2013. It is intended to slow the decline in employer health coverage for retirees and to help tide people over until 2014, when other provisions of the law go into effect. At that point, it will theoretically be easier for early retirees to obtain coverage through new state health insurance exchanges, often with the aid of subsidies. However, it isn't clear whether the $5 billion allotted for the program will cover the anticipated costs between now and 2014.
Among large employers (those with 200 or more workers) who provided health coverage in 2010, only 28 percent offered benefits to newly retired workers, down from 46 percent in 1991. State and local governments and employers with union workers were the most likely to offer retiree coverage. Only 3 percent of small employers (3-199 workers) offered retiree coverage this year . Some retirees are in the same plans as active workers, while others are in plans covering retirees only. In 2007, the most recent year for which numbers are available, an estimated 6.5 million people ages 55-64 had early retiree coverage, on their own or as dependents.
The Affordable Care Act requires the secretary of Health and Human Services (HHS) to establish a temporary reinsurance program. HHS issued implementing regulations on May 5, 2010, and the program took effect on June 1. It will continue through 2013, unless funds are exhausted sooner. Any group health plan that covers early retirees and is sponsored by an employer or union is eligible to participate. This includes private employers and state and local governments, but not federal civil and military retiree plans. Plan sponsors must file an application for each year and meet two key requirements:
1) The plan must have programs or procedures with the potential to generate cost savings for enrollees with chronic and high-cost conditions.
2) Sponsors also must use all reinsurance payments they receive to reduce the total cost of the plan or the costs paid by retirees. To receive the reinsurance payment from the government, the employer or plan sponsor must provide documentation that all the amounts included in its claim were actually paid out. This requirement raises at least two problems.
First, an employer plan commonly deducts the amount for which a participant is responsible--such as the deductible, coinsurance, or copayments--before making payment to a doctor, hospital, or other provider.
Second, there are still some health plans that pay providers on a so-called "capitated" basis, which means that the provider receives a fixed payment at a regular interval to provide all covered care for an enrollee, rather than being paid to provide care service by service. Other plans employ physicians or other professionals on a salaried basis. These plans may not always be able to calculate amounts spent for any particular patient
The Affordable Care Act appropriates $5 billion to cover claims and administrative costs for the reinsurance program through 2013. If at any time HHS anticipates that the funds are likely to be exhausted, it may stop accepting new applications from plan sponsors. To help HHS project future draws on the funds, each application is required to include a two-year projection of expected reimbursement amounts.
As of late October, HHS reported that nearly 3,600 employer plans had been accepted into the reinsurance program. These include more than half of the Fortune 500 companies, all major unions, and government entities in every state.
Some employers may not be certain that they will have enrollees with large enough claims to make applying worthwhile. The Employee Benefit Research Institute (EBRI) has estimated that 13 percent of early retirees or dependents incur claims of $15,000 or more during a year. However, this small share of enrollees accounts for 61 percent of all costs. EBRI calculates that subsidies from the reinsurance program would cover about one-fourth of total costs for an average employer's retiree plan.
However, some plans may have healthier populations or less-generous benefits, meaning that fewer enrollees would meet the $15,000 threshold. And in plans with fewer participants, claims experience is likely to fluctuate considerably from year to year. The rules appear to allow a plan sponsor to apply for the program after it has incurred the costs for which it will be seeking reimbursement. Although the estimated cost of applying is not high--about $2,000 per plan per year--some employers may be waiting to see if their potential subsidy is large enough to be worth the trouble.
Earlier this year, both EBRI and the Congressional Budget Office (CBO) projected that the $5 billion appropriation for the program would be exhausted before the program expires at the end of 2013. EBRI concluded that funds would be used up in 2011, while CBO expected them to last through part of 2012. However, EBRI assumes that all employers providing early retiree coverage will participate, and CBO's projection is likely similar. If employer participation remains low, the funds might stretch further. If the Affordable Care Act works as intended, people who retire in 2014 or later will have access to affordable and often subsidized coverage through state health insurance exchanges. This means that they may have less of a need to rely on coverage through their former employers. As a result, employer-provided retiree coverage is expected to continue to decline, and will no doubt play a steadily smaller role in the coverage of future retirees
Yours
Bernd
Its important that we educate ourselves about the many benefits the Patient Protection and Affordable Care Act can offer to so many Americans and to be able to respond intelligently to stereotypical accusation and falsifications of this important legislation.
THE FACTS (AND NOT FICTION) :
The number of employers offering health insurance coverage to early retirees---former employees older than 55 but not yet eligible for Medicare--has dropped sharply over the past two decades. Employers who have maintained that coverage have increased the share of premiums and other costs paid by enrollees. To help keep this type of coverage in place, the Affordable Care Act established a temporary program under which the federal government will reimburse retiree health plans for high-cost medical claims. This Early Retiree Reinsurance Program will pay 80 percent of each claim that exceeds $15,000, up to $90,000.
The program began in June 2010 and is slated to operate until the end of 2013. It is intended to slow the decline in employer health coverage for retirees and to help tide people over until 2014, when other provisions of the law go into effect. At that point, it will theoretically be easier for early retirees to obtain coverage through new state health insurance exchanges, often with the aid of subsidies. However, it isn't clear whether the $5 billion allotted for the program will cover the anticipated costs between now and 2014.
Among large employers (those with 200 or more workers) who provided health coverage in 2010, only 28 percent offered benefits to newly retired workers, down from 46 percent in 1991. State and local governments and employers with union workers were the most likely to offer retiree coverage. Only 3 percent of small employers (3-199 workers) offered retiree coverage this year . Some retirees are in the same plans as active workers, while others are in plans covering retirees only. In 2007, the most recent year for which numbers are available, an estimated 6.5 million people ages 55-64 had early retiree coverage, on their own or as dependents.
The Affordable Care Act requires the secretary of Health and Human Services (HHS) to establish a temporary reinsurance program. HHS issued implementing regulations on May 5, 2010, and the program took effect on June 1. It will continue through 2013, unless funds are exhausted sooner. Any group health plan that covers early retirees and is sponsored by an employer or union is eligible to participate. This includes private employers and state and local governments, but not federal civil and military retiree plans. Plan sponsors must file an application for each year and meet two key requirements:
1) The plan must have programs or procedures with the potential to generate cost savings for enrollees with chronic and high-cost conditions.
2) Sponsors also must use all reinsurance payments they receive to reduce the total cost of the plan or the costs paid by retirees. To receive the reinsurance payment from the government, the employer or plan sponsor must provide documentation that all the amounts included in its claim were actually paid out. This requirement raises at least two problems.
First, an employer plan commonly deducts the amount for which a participant is responsible--such as the deductible, coinsurance, or copayments--before making payment to a doctor, hospital, or other provider.
Second, there are still some health plans that pay providers on a so-called "capitated" basis, which means that the provider receives a fixed payment at a regular interval to provide all covered care for an enrollee, rather than being paid to provide care service by service. Other plans employ physicians or other professionals on a salaried basis. These plans may not always be able to calculate amounts spent for any particular patient
The Affordable Care Act appropriates $5 billion to cover claims and administrative costs for the reinsurance program through 2013. If at any time HHS anticipates that the funds are likely to be exhausted, it may stop accepting new applications from plan sponsors. To help HHS project future draws on the funds, each application is required to include a two-year projection of expected reimbursement amounts.
As of late October, HHS reported that nearly 3,600 employer plans had been accepted into the reinsurance program. These include more than half of the Fortune 500 companies, all major unions, and government entities in every state.
Some employers may not be certain that they will have enrollees with large enough claims to make applying worthwhile. The Employee Benefit Research Institute (EBRI) has estimated that 13 percent of early retirees or dependents incur claims of $15,000 or more during a year. However, this small share of enrollees accounts for 61 percent of all costs. EBRI calculates that subsidies from the reinsurance program would cover about one-fourth of total costs for an average employer's retiree plan.
However, some plans may have healthier populations or less-generous benefits, meaning that fewer enrollees would meet the $15,000 threshold. And in plans with fewer participants, claims experience is likely to fluctuate considerably from year to year. The rules appear to allow a plan sponsor to apply for the program after it has incurred the costs for which it will be seeking reimbursement. Although the estimated cost of applying is not high--about $2,000 per plan per year--some employers may be waiting to see if their potential subsidy is large enough to be worth the trouble.
Earlier this year, both EBRI and the Congressional Budget Office (CBO) projected that the $5 billion appropriation for the program would be exhausted before the program expires at the end of 2013. EBRI concluded that funds would be used up in 2011, while CBO expected them to last through part of 2012. However, EBRI assumes that all employers providing early retiree coverage will participate, and CBO's projection is likely similar. If employer participation remains low, the funds might stretch further. If the Affordable Care Act works as intended, people who retire in 2014 or later will have access to affordable and often subsidized coverage through state health insurance exchanges. This means that they may have less of a need to rely on coverage through their former employers. As a result, employer-provided retiree coverage is expected to continue to decline, and will no doubt play a steadily smaller role in the coverage of future retirees
Yours
Bernd
Saturday, November 27, 2010
Siberia in Florida: GOP Senator Gets the Cold Shoulder
It used to be you'd have to start every debate thinking: compromise. Now, the only constraint is their good judgment.''
Former Rep. Tom Feeney, R-Orlando, who Speaker of the Florida House from 2000 to 200.
Today’s Miami Herald article “Veteran senator won’t toe the line,” http://www.miamiherald.com/2010/11/25/1943608_p2/veteran-senator-wont-toe-the-line.html clearly points out the power shift in Tallahassee. The new GOP leadership is flexing its ideological muscles. No one will be allowed to think or act independently. Its the party line or political exile. Senator Fasano, a strong supporter of Governor’s Christ Senate campaign, had to endure the punishment straying from the ideological talking points. Fasano took to the Senate floor during last week's half-day special session and railed against a GOP blueprint for fixing Medicaid. The symbolic ``memorial'' resolution informs Congress that Florida plans to steer its Medicaid patients into managed care networks, an idea that has gained popularity in the state House. ``This is more than intent. We are setting policy today by doing this,'' scolded Fasano, a 16-year legislative veteran. ``This should have gone through committees. If you think you got a few phone calls last year, put people in an HMO and the phones will be ringing off the hook.''
But Fasano's protests were quickly drowned out by a GOP stampede in favor of the bill. In the new Senate, where newcomers value business and economic development over Fasano's populist consumerism, he has morphed from conservative stalwart to moderate maverick.
Lets not forget that Senator Fasano was also the sponsor of the pain clinic legislation that cracked down on facilities freely dispensing medications that are being used by drug abusers who were doctor-shopping. Fasano also was critical of the Legislature for passing the new rule-making bill, arguing it needed more study. As a result the state Department of Health now must determine whether the new rules exceed the threshold and require a legislative sign-off -- if they have a $1 million adverse impact over five years on economic growth, competitiveness, employment, investment, job creation or regulatory costs. For now, the upshot is that the rules are stalled. What will happen in the meantime? "What's going to happen is nothing," said Sen. Mike Fasano, R-New Port Richey. "And seven more people will die each and every day until the Legislature ratifies these rules that are being approved by the Board of Medicine and the Department of Health."
I wish we would have more outspoken politicians in Florida like Senator Fasano who think and act according to their conscience and not according to party discipline.
History provides a treasure trove of failed attempts to scuttle dissent and to impose rigorous party discipline. I hope that Floridian’s learn soon to regret their electoral choices. Otherwise we will be in big trouble.
Yours truly,
Bernd
Former Rep. Tom Feeney, R-Orlando, who Speaker of the Florida House from 2000 to 200.
Today’s Miami Herald article “Veteran senator won’t toe the line,” http://www.miamiherald.com/2010/11/25/1943608_p2/veteran-senator-wont-toe-the-line.html clearly points out the power shift in Tallahassee. The new GOP leadership is flexing its ideological muscles. No one will be allowed to think or act independently. Its the party line or political exile. Senator Fasano, a strong supporter of Governor’s Christ Senate campaign, had to endure the punishment straying from the ideological talking points. Fasano took to the Senate floor during last week's half-day special session and railed against a GOP blueprint for fixing Medicaid. The symbolic ``memorial'' resolution informs Congress that Florida plans to steer its Medicaid patients into managed care networks, an idea that has gained popularity in the state House. ``This is more than intent. We are setting policy today by doing this,'' scolded Fasano, a 16-year legislative veteran. ``This should have gone through committees. If you think you got a few phone calls last year, put people in an HMO and the phones will be ringing off the hook.''
But Fasano's protests were quickly drowned out by a GOP stampede in favor of the bill. In the new Senate, where newcomers value business and economic development over Fasano's populist consumerism, he has morphed from conservative stalwart to moderate maverick.
Lets not forget that Senator Fasano was also the sponsor of the pain clinic legislation that cracked down on facilities freely dispensing medications that are being used by drug abusers who were doctor-shopping. Fasano also was critical of the Legislature for passing the new rule-making bill, arguing it needed more study. As a result the state Department of Health now must determine whether the new rules exceed the threshold and require a legislative sign-off -- if they have a $1 million adverse impact over five years on economic growth, competitiveness, employment, investment, job creation or regulatory costs. For now, the upshot is that the rules are stalled. What will happen in the meantime? "What's going to happen is nothing," said Sen. Mike Fasano, R-New Port Richey. "And seven more people will die each and every day until the Legislature ratifies these rules that are being approved by the Board of Medicine and the Department of Health."
I wish we would have more outspoken politicians in Florida like Senator Fasano who think and act according to their conscience and not according to party discipline.
History provides a treasure trove of failed attempts to scuttle dissent and to impose rigorous party discipline. I hope that Floridian’s learn soon to regret their electoral choices. Otherwise we will be in big trouble.
Yours truly,
Bernd
Thursday, November 25, 2010
Money and Organized Medicine
Attached an article from the Sun Sentinel highlighting a sad chapter of organized medicine's attempts and efforts to buy political influence and cloud.
Alan Mendelson was once THE political power broker acting on behalf of the Florida Medical Association. Every ranking FMA official did not dare to miss joining one of the many political fundraiser which took place in Alan's house or office. I also participated in those events and have to ask myself why I did not see the writing on the wall! During Eleanor Sobel's Florida Senate campaign Alan Mendelsohn, then treasurer of the Florida Medical Association’s political action committee, aggressively raised money on her behalf and hailed her Aug. 26 victory in the Democratic primary as the FMA flexing its might.
We all were "encouraged" by our own county medical association and the FMA to donate at least $500 to People for a Better Florida Fund Inc. and many of us did so.
Eleanor Sobel's victory was considered a watershed moment demonstrating that Florida's doctors could buy influence in Tallahassee like so many other interest groups already did at that time and still do. When the whole house of cards collapsed everybody quickly pointed their fingers at Alan Mendelson. But did anything change ever since? We still believe that money can buy influence. Elected FMA officials still repeat the article of faith that " only money talks in Tallahassee."
Shouldn't we all take a step back from the political abyss and reconsider? Doesn't Alan Mendelson's behavior clearly demonstrate that money itself can corrode and corrupt anyone? Aren't we all susceptible to hybris? Shouldn't we reestablish core values of integrity, accountability and compassion instead? I hope that the leadership within organized medicine is listening because Alan's case is just the tip of the iceberg and the iceberg is entering hot water.
Happy Thanksgiving
Yours
Bernd
Broward power broker Mendelsohn set to plead guilty in federal case
32-count indictment included accusations of using fraudulent fundraising for his own gain
November 23, 2010|By Jon Burstein, Sun Sentinel
Broward political fundraiser and power broker Alan Mendelsohn is set to cut a plea deal in what federal authorities have described as a fraudulent political fundraising and lobbying scheme that he used to line his own pockets.
Mendelsohn, a Hollywood eye doctor whose influence opened doors at the state Capitol, is scheduled to go before U.S. District Judge William Zloch on Dec. 8 for a plea hearing, according to court papers filed Tuesday.
He is ready to plead guilty to a single conspiracy charge, which can carry no more than five years in prison, said Alvin Entin, one of Mendelsohn's attorneys.
We've reserved a plea date, and we're looking forward to resolving the matter satisfactorily for both sides," Entin said.
Mendelsohn, a member of Gov. Charlie Crist's 2006 gubernatorial transition team, built the Florida Medical Association into a political force as the chief fundraiser of its political action committee. He also helped pioneer the use in Florida of political organizations known as 527s, which are allowed to raise unlimited amounts of money to make statements about candidates and issues.
Federal prosecutors leveled a 32-count indictment against Mendelsohn in September 2009, accusing him of skimming more than $350,000 from the political action committees under his control. The money came from contributors who believed he was using the funds to advance their causes in Tallahassee.
Mendelsohn used some of that money to pay his mistress, buy her a house and a car and pay for his children's schooling, according to court documents.
Five criminal tax charges were tacked on Mendelsohn's corruption indictment in June.
In Mendelsohn's plea deal, the single conspiracy charge will be related to both the tax and political fundraising charges, Entin said. Court documents show that the judge will ask for "a full confession" at the hearing.
Mendelsohn, 52, first began lobbying lawmakers in 1999 on issues related to ophthalmologists, but within a few years, he was being hired to use his political muscle to help such entities as pari-mutuels and credit counseling companies.
In 2008, Mendelsohn demonstrated his might in Broward County by aggressively raising money for Eleanor Sobel in her winning bid in the Democratic primary for a state Senate seat. The Florida Medical Association's PAC and doctors largely funded a political organization that spent more than $600,000 in advertisements boosting Sobel and attacking her opponents
E-mails made public in a defamation lawsuit filed by one of Sobel's opponents portray Mendelsohn as a no-holds-barred fighter. Mendelsohn raised $51,000 for Sobel in a single day, according to the e-mails.
After Sobel's win, he wrote in an e-mail that he believed politicians would start coming to the Florida Medical Association and asking, "What can I start to do now to help you guys?"
He came on federal authorities' radar after he allegedly boasted he could use his influence and bribes to halt investigations into Mutual Benefits, a defunct investment company. Prosecutors say the Fort Lauderdale-based Mutual Benefits defrauded 30,000 investors worldwide of $837 million before the U.S. Securities and Exchange Commission shut it down in 2004.
Mendelsohn's claims helped set in motion a corruption investigation by the U.S. Department of Justice's Public Integrity Section. Mendelsohn is the only who has been arrested in it.
In Mendelsohn's indictment, though, federal authorities alleged that between 2003 and 2006, he funneled $87,000 to an unidentified then-public official.
Jon Burstein can be reached at jburstein@SunSentinel.com or 954-356-4491.
Alan Mendelson was once THE political power broker acting on behalf of the Florida Medical Association. Every ranking FMA official did not dare to miss joining one of the many political fundraiser which took place in Alan's house or office. I also participated in those events and have to ask myself why I did not see the writing on the wall! During Eleanor Sobel's Florida Senate campaign Alan Mendelsohn, then treasurer of the Florida Medical Association’s political action committee, aggressively raised money on her behalf and hailed her Aug. 26 victory in the Democratic primary as the FMA flexing its might.
We all were "encouraged" by our own county medical association and the FMA to donate at least $500 to People for a Better Florida Fund Inc. and many of us did so.
Eleanor Sobel's victory was considered a watershed moment demonstrating that Florida's doctors could buy influence in Tallahassee like so many other interest groups already did at that time and still do. When the whole house of cards collapsed everybody quickly pointed their fingers at Alan Mendelson. But did anything change ever since? We still believe that money can buy influence. Elected FMA officials still repeat the article of faith that " only money talks in Tallahassee."
Shouldn't we all take a step back from the political abyss and reconsider? Doesn't Alan Mendelson's behavior clearly demonstrate that money itself can corrode and corrupt anyone? Aren't we all susceptible to hybris? Shouldn't we reestablish core values of integrity, accountability and compassion instead? I hope that the leadership within organized medicine is listening because Alan's case is just the tip of the iceberg and the iceberg is entering hot water.
Happy Thanksgiving
Yours
Bernd
Broward power broker Mendelsohn set to plead guilty in federal case
32-count indictment included accusations of using fraudulent fundraising for his own gain
November 23, 2010|By Jon Burstein, Sun Sentinel
Broward political fundraiser and power broker Alan Mendelsohn is set to cut a plea deal in what federal authorities have described as a fraudulent political fundraising and lobbying scheme that he used to line his own pockets.
Mendelsohn, a Hollywood eye doctor whose influence opened doors at the state Capitol, is scheduled to go before U.S. District Judge William Zloch on Dec. 8 for a plea hearing, according to court papers filed Tuesday.
He is ready to plead guilty to a single conspiracy charge, which can carry no more than five years in prison, said Alvin Entin, one of Mendelsohn's attorneys.
We've reserved a plea date, and we're looking forward to resolving the matter satisfactorily for both sides," Entin said.
Mendelsohn, a member of Gov. Charlie Crist's 2006 gubernatorial transition team, built the Florida Medical Association into a political force as the chief fundraiser of its political action committee. He also helped pioneer the use in Florida of political organizations known as 527s, which are allowed to raise unlimited amounts of money to make statements about candidates and issues.
Federal prosecutors leveled a 32-count indictment against Mendelsohn in September 2009, accusing him of skimming more than $350,000 from the political action committees under his control. The money came from contributors who believed he was using the funds to advance their causes in Tallahassee.
Mendelsohn used some of that money to pay his mistress, buy her a house and a car and pay for his children's schooling, according to court documents.
Five criminal tax charges were tacked on Mendelsohn's corruption indictment in June.
In Mendelsohn's plea deal, the single conspiracy charge will be related to both the tax and political fundraising charges, Entin said. Court documents show that the judge will ask for "a full confession" at the hearing.
Mendelsohn, 52, first began lobbying lawmakers in 1999 on issues related to ophthalmologists, but within a few years, he was being hired to use his political muscle to help such entities as pari-mutuels and credit counseling companies.
In 2008, Mendelsohn demonstrated his might in Broward County by aggressively raising money for Eleanor Sobel in her winning bid in the Democratic primary for a state Senate seat. The Florida Medical Association's PAC and doctors largely funded a political organization that spent more than $600,000 in advertisements boosting Sobel and attacking her opponents
E-mails made public in a defamation lawsuit filed by one of Sobel's opponents portray Mendelsohn as a no-holds-barred fighter. Mendelsohn raised $51,000 for Sobel in a single day, according to the e-mails.
After Sobel's win, he wrote in an e-mail that he believed politicians would start coming to the Florida Medical Association and asking, "What can I start to do now to help you guys?"
He came on federal authorities' radar after he allegedly boasted he could use his influence and bribes to halt investigations into Mutual Benefits, a defunct investment company. Prosecutors say the Fort Lauderdale-based Mutual Benefits defrauded 30,000 investors worldwide of $837 million before the U.S. Securities and Exchange Commission shut it down in 2004.
Mendelsohn's claims helped set in motion a corruption investigation by the U.S. Department of Justice's Public Integrity Section. Mendelsohn is the only who has been arrested in it.
In Mendelsohn's indictment, though, federal authorities alleged that between 2003 and 2006, he funneled $87,000 to an unidentified then-public official.
Jon Burstein can be reached at jburstein@SunSentinel.com or 954-356-4491.
Monday, November 22, 2010
The ACO Conundrum
In a recent New York Times article,” Consumer Risk Feared as Health Law Spurs Merger” http://www.nytimes.com/2010/11/21/health/policy/21health.html?_r=1&pagewanted=print the author points out that consumer advocates fear that the health care law could worsen some of the very problems it was meant to solve — by reducing competition, driving up costs and creating incentives for doctors and hospitals to stint on care, in order to retain their cost-saving bonuses. Regulatory agencies face a delicate task: balancing the potential benefits of clinical cooperation with the need to enforce fraud, abuse and antitrust laws. Congress’s purpose was to foster cooperation in a health care system that is notoriously fragmented. The hope was that the new law would push doctors, hospitals and other health care providers to come together and jointly take responsibility for the cost and quality of care of patients, especially Medicare beneficiaries.
“ ..eight months into the new law there is a growing frenzy of mergers involving hospitals, clinics and doctor groups eager to share costs and savings, and cash in on the incentives. They, in turn, have deployed a small army of lawyers and lobbyists trying to persuade the Obama administration to relax or waive a body of older laws intended to thwart health care monopolies, and to protect against shoddy care and fraudulent billing of patients or Medicare. “
Furthermore, newly formed Accountable Care Organization (ACOs) could be tempted to hold down costs, and maximize profits, by cherry-picking healthier patients and denying care when it’s needed. Under the law, Medicare can penalize organizations that avoid high-risk, high-cost patients but enforcement mechanism are not sufficient to monitor those violations.
In addition Elizabeth B. Gilbertson, chief strategist of a union health plan for hotel and restaurant employees, also worries that the consolidation of health care providers could lead to higher prices.
“In some markets,” Ms. Gilbertson said, “the dominant hospital is like the sun at the center of the solar system. It owns physician groups, surgery centers, labs and pharmacies. Accountable care organizations bring more planets into the system and strengthen the bonds between them, making the whole entity more powerful, with a commensurate ability to raise prices.”
In conclusion Dr. Donald M. Berwick, the administrator of the Centers for Medicare and Medicaid Services, hails the benefits of “integrated care.” But, Dr. Berwick said, “we need to assure both patients and society at large that destructive, exploitative and costly forms of collusion and monopolistic behaviors do not emerge and thrive, disguised as cooperation.”
As physicians we should take the initiative and form collaborative practice organizations and work together to form ACOs that truly serve the public health and not only serve to line the deep pockets of entrenched interests.
The opportunity to act is now!
Bernd
“ ..eight months into the new law there is a growing frenzy of mergers involving hospitals, clinics and doctor groups eager to share costs and savings, and cash in on the incentives. They, in turn, have deployed a small army of lawyers and lobbyists trying to persuade the Obama administration to relax or waive a body of older laws intended to thwart health care monopolies, and to protect against shoddy care and fraudulent billing of patients or Medicare. “
Furthermore, newly formed Accountable Care Organization (ACOs) could be tempted to hold down costs, and maximize profits, by cherry-picking healthier patients and denying care when it’s needed. Under the law, Medicare can penalize organizations that avoid high-risk, high-cost patients but enforcement mechanism are not sufficient to monitor those violations.
In addition Elizabeth B. Gilbertson, chief strategist of a union health plan for hotel and restaurant employees, also worries that the consolidation of health care providers could lead to higher prices.
“In some markets,” Ms. Gilbertson said, “the dominant hospital is like the sun at the center of the solar system. It owns physician groups, surgery centers, labs and pharmacies. Accountable care organizations bring more planets into the system and strengthen the bonds between them, making the whole entity more powerful, with a commensurate ability to raise prices.”
In conclusion Dr. Donald M. Berwick, the administrator of the Centers for Medicare and Medicaid Services, hails the benefits of “integrated care.” But, Dr. Berwick said, “we need to assure both patients and society at large that destructive, exploitative and costly forms of collusion and monopolistic behaviors do not emerge and thrive, disguised as cooperation.”
As physicians we should take the initiative and form collaborative practice organizations and work together to form ACOs that truly serve the public health and not only serve to line the deep pockets of entrenched interests.
The opportunity to act is now!
Bernd
Saturday, November 20, 2010
Florida Legislature Delays Crackdown on Pain Clinics
In today’s Sun Sentinel front page article entitled “Crackdown on pain clinic stalls again” http://articles.sun-sentinel.com/2010-11-19/health/fl-hk-pain-clinic-rules-delayed-20101119_1_millions-of-narcotic-pills-pain-clinic-pills-for-drug-dealers Bob LaMendola reports how the Republican dominated legislature voted to delay the implementation of tough new pain clinic regulations. Subsequently, the unscrupulous clinic operators and drug dealers in white coats, wrongly called “doctors,” can continue to churn out prescriptions for powerful painkiller. As a result an average of seven Floridians per day will die from prescription drug overdose. The legislators seem to be more concerned with ideological correctness and purity than the somber facts detailed in a recent report from the Florida Department of Law Enforcement released June 30th 2010 http://www.fdle.state.fl.us/Content/News/June-2010/2009-Report-by-Florida-Medical-Examiners-Commissio.aspx:
• Prescription drug deaths monitored by the state Medical Examiner's Office continued to climb to 2,488 last year. That's an average of seven deaths per day.
• Oxycodone was the cause of 1,185 state deaths in 2009, a 26 percent increase from the year before and a whopping 249 percent increase from 2005.
• Deaths caused by some illegal drugs declined. Heroin deaths decreased by 20 percent to 111. And cocaine deaths decreased by 18.4 percent to 529.Law enforcement officials have attributed the opposing trends to the fact that prescription drugs are much easier and cheaper to obtain than illegal drugs.
• Prescription drugs account for 79 percent of all drug occurrences in this report when Ethyl Alcohol is excluded. Oxycodone occurrences increased by 23.8 percent in 2009 and deaths caused by Oxycodone also rose by 25.9 percent when compared to the previous year.
So what happened? According to the article the Legislature on Tuesday had taken action to override Gov. Charlie Crist's veto of HB 1565 that was passed during the 2010 legislative session. The bill, which now becomes law, says that proposed rules having significant financial impact – more than $1 million over five years – on small businesses such as pain clinics could not take effect until legislators ratified the rules. Because the pain clinic rules were not in effect on Tuesday, state officials said they cannot be enforced. One of the law's sponsors, Rep.Matt Gaetz, R-Fort Walton Beach, said he was not thinking about pill mills. The law aims to scrutinize rules that drive up regulatory costs and stop businesses from coming to Florida. As for the impact on pill mill rules, Gaetz said: "The benefits of the rulemaking bill outweighs some of the modest inconveniences." It appears to me that Mr. Gaetz lives in another universe than most of us have to live in. In his world reality has to be adapted to fit his political theory. In his world government regulation can only do harm and never do good. In his world pain clinics are successful businesses contributing to the overall economy and more regulations will drive them away from our state. He seems to forget that the regulations were carefully crafted by Democrats and Republicans to PROTECT our citizens from those unscrupulous businesses, which contribute to the DEATH of seven Floridians a day!! Now the proposed rules must be submitted to the Legislature by Feb. 4 to qualify for consideration. Those that don't make it would have to wait until the 2012 legislative session. I am not only outraged by this political checkmate but also deeply concerned about its adverse impact on public health. This issue is too important to allow politicians to gamble away the lives of Florida’s citizen. We need to return to pragmatism and sound reasoning to address and resolve the problem of prescription drug abuse in Florida. Ideological grandstanding will only worsen the situation. We do not have much time left and the clock is ticking.
Bernd Wollschlaeger,MD,FAAFP,FASAM
Board certified Family Physicians & Addiction Specialist
Member of the Prescription Drug Monitoring Implementation and Oversight Task Force
• Prescription drug deaths monitored by the state Medical Examiner's Office continued to climb to 2,488 last year. That's an average of seven deaths per day.
• Oxycodone was the cause of 1,185 state deaths in 2009, a 26 percent increase from the year before and a whopping 249 percent increase from 2005.
• Deaths caused by some illegal drugs declined. Heroin deaths decreased by 20 percent to 111. And cocaine deaths decreased by 18.4 percent to 529.Law enforcement officials have attributed the opposing trends to the fact that prescription drugs are much easier and cheaper to obtain than illegal drugs.
• Prescription drugs account for 79 percent of all drug occurrences in this report when Ethyl Alcohol is excluded. Oxycodone occurrences increased by 23.8 percent in 2009 and deaths caused by Oxycodone also rose by 25.9 percent when compared to the previous year.
So what happened? According to the article the Legislature on Tuesday had taken action to override Gov. Charlie Crist's veto of HB 1565 that was passed during the 2010 legislative session. The bill, which now becomes law, says that proposed rules having significant financial impact – more than $1 million over five years – on small businesses such as pain clinics could not take effect until legislators ratified the rules. Because the pain clinic rules were not in effect on Tuesday, state officials said they cannot be enforced. One of the law's sponsors, Rep.Matt Gaetz, R-Fort Walton Beach, said he was not thinking about pill mills. The law aims to scrutinize rules that drive up regulatory costs and stop businesses from coming to Florida. As for the impact on pill mill rules, Gaetz said: "The benefits of the rulemaking bill outweighs some of the modest inconveniences." It appears to me that Mr. Gaetz lives in another universe than most of us have to live in. In his world reality has to be adapted to fit his political theory. In his world government regulation can only do harm and never do good. In his world pain clinics are successful businesses contributing to the overall economy and more regulations will drive them away from our state. He seems to forget that the regulations were carefully crafted by Democrats and Republicans to PROTECT our citizens from those unscrupulous businesses, which contribute to the DEATH of seven Floridians a day!! Now the proposed rules must be submitted to the Legislature by Feb. 4 to qualify for consideration. Those that don't make it would have to wait until the 2012 legislative session. I am not only outraged by this political checkmate but also deeply concerned about its adverse impact on public health. This issue is too important to allow politicians to gamble away the lives of Florida’s citizen. We need to return to pragmatism and sound reasoning to address and resolve the problem of prescription drug abuse in Florida. Ideological grandstanding will only worsen the situation. We do not have much time left and the clock is ticking.
Bernd Wollschlaeger,MD,FAAFP,FASAM
Board certified Family Physicians & Addiction Specialist
Member of the Prescription Drug Monitoring Implementation and Oversight Task Force
Tuesday, November 16, 2010
Defensive Medicine
The Malpractice Myth: Republicans and Doctors offer no solutions
By Bernd Wollschlaeger,MD,FAAFP,FASAM
In a recent American Medical News article, “GOP state gains expected to have broad impact on physicians,” November 15, 2010, the author points out that the substantial GOP electoral gains could affect physicians and the health system. Medical liability reform legislation probably will receive a boost from the GOP victories, said Mark A. Peterson, a professor of public policy and political science at the University of California Los Angeles. For example, Alabama Gov.-elect Robert Bentley, MD, and Florida Gov.-elect Rick Scott -- founder of urgent-care chain Solantic -- campaigned on expanding tort reform for physicians and other health professionals. Both were endorsed by their respective state medical associations. "A central feature of Republican health care policy ... has been the notion that a major driver of costs has been malpractice" lawsuits, Peterson said. Subsequently, physicians are loudly repeating the myth that defensive medicine increases healthcare costs by up to 30% and that malpractice reform will stop and even reverse the cost increase. Rep. Tom Price (R-GA), a physician, said recently on the House Republican website America Speaking Out that “ any credible attempt to rein in the cost of health care must include a plan to address the whole issue of the practice of defensive medicine. It is estimated to cost an astounding $650 billion each year. That’s 26% of all money spent on health care. Defensive medicine does not raise the quality of care, only the cost.”
There is only one big problem: the political pundits within organized medicine are unable to provide any evidence to support their argument!
In a series of articles published in the September 2010 issue of Health Affairs the authors reached the following conclusions:
* Defensive medicine includes tests and procedures ordered by physicians principally to reduce perceived threats of medical malpractice liability. The practice is commonly assumed to increase health care costs. The results of studies of the costs of defensive medicine have been inconsistent. We found that estimated savings resulting from a 10 percent decline in medical malpractice premiums would be less than 1 percent of total medical care costs in every specialty. These savings are lower than most previous estimates, and they suggest that the presumed impact of tort reform on health care costs may be overstated.
* Physicians contend that the threat of malpractice lawsuits forces them to practice defensive medicine, which in turn raises the cost of health care. This argument underlies efforts to change malpractice laws through legislative tort reform. We evaluated physicians’ perceptions about malpractice claims in states where more objective indicators of malpractice risk, such as malpractice premiums, varied considerably. We found high levels of malpractice concern among both generalists and specialists in states where objective measures of malpractice risk were low. We also found relatively modest differences in physicians’ concerns across states with and without common tort reforms. These results suggest that many policies aimed at controlling malpractice costs may have a limited effect on physicians’ malpractice concerns.
* Concerns about reducing the rate of growth of health expenditures have reignited interest in medical liability reforms and their potential to save money by reducing the practice of defensive medicine. It is not easy to estimate the costs of the medical liability system, however. This article identifies the various components of liability system costs, generates national estimates for each component, and discusses the level of evidence available to support the estimates. Overall annual medical liability system costs, including defensive medicine, are estimated to be $55.6 billion in 2008 dollars, or 2.4 percent of total health care spending.
Notwithstanding all of the above quoted FACTS politicians and their physicians allies still place their bets on malpractice reform.
But we all could start reforming the system TODAY if we would firmly commit ourselves to practice DEFENSIBLE MEDICINE instead. What does that mean?
1. Following expert guidelines and recommendations in managing and treating patients.
2. Implementing patient safety measures to reduce deadly medical errors killing more than 100,000 Americans every year.
3. Collaborating medical care in teams comprised of ALL health care professionals including physicians, physician assistants and ARNPs.
4. Moving from physician centered to patient centered medicine
5. Integrating health information technology into our offices and learn to share medical information.
Even Tom Price (R-GA) admits that we need to “ adopt a set of best-practice guidelines for treatment – agreed to by physicians, not bureaucrats – to provide an affirmative legal defense.”
What are we waiting for? Lets start practicing defensible medicine today.
Yours truly,
Bernd
By Bernd Wollschlaeger,MD,FAAFP,FASAM
In a recent American Medical News article, “GOP state gains expected to have broad impact on physicians,” November 15, 2010, the author points out that the substantial GOP electoral gains could affect physicians and the health system. Medical liability reform legislation probably will receive a boost from the GOP victories, said Mark A. Peterson, a professor of public policy and political science at the University of California Los Angeles. For example, Alabama Gov.-elect Robert Bentley, MD, and Florida Gov.-elect Rick Scott -- founder of urgent-care chain Solantic -- campaigned on expanding tort reform for physicians and other health professionals. Both were endorsed by their respective state medical associations. "A central feature of Republican health care policy ... has been the notion that a major driver of costs has been malpractice" lawsuits, Peterson said. Subsequently, physicians are loudly repeating the myth that defensive medicine increases healthcare costs by up to 30% and that malpractice reform will stop and even reverse the cost increase. Rep. Tom Price (R-GA), a physician, said recently on the House Republican website America Speaking Out that “ any credible attempt to rein in the cost of health care must include a plan to address the whole issue of the practice of defensive medicine. It is estimated to cost an astounding $650 billion each year. That’s 26% of all money spent on health care. Defensive medicine does not raise the quality of care, only the cost.”
There is only one big problem: the political pundits within organized medicine are unable to provide any evidence to support their argument!
In a series of articles published in the September 2010 issue of Health Affairs the authors reached the following conclusions:
* Defensive medicine includes tests and procedures ordered by physicians principally to reduce perceived threats of medical malpractice liability. The practice is commonly assumed to increase health care costs. The results of studies of the costs of defensive medicine have been inconsistent. We found that estimated savings resulting from a 10 percent decline in medical malpractice premiums would be less than 1 percent of total medical care costs in every specialty. These savings are lower than most previous estimates, and they suggest that the presumed impact of tort reform on health care costs may be overstated.
* Physicians contend that the threat of malpractice lawsuits forces them to practice defensive medicine, which in turn raises the cost of health care. This argument underlies efforts to change malpractice laws through legislative tort reform. We evaluated physicians’ perceptions about malpractice claims in states where more objective indicators of malpractice risk, such as malpractice premiums, varied considerably. We found high levels of malpractice concern among both generalists and specialists in states where objective measures of malpractice risk were low. We also found relatively modest differences in physicians’ concerns across states with and without common tort reforms. These results suggest that many policies aimed at controlling malpractice costs may have a limited effect on physicians’ malpractice concerns.
* Concerns about reducing the rate of growth of health expenditures have reignited interest in medical liability reforms and their potential to save money by reducing the practice of defensive medicine. It is not easy to estimate the costs of the medical liability system, however. This article identifies the various components of liability system costs, generates national estimates for each component, and discusses the level of evidence available to support the estimates. Overall annual medical liability system costs, including defensive medicine, are estimated to be $55.6 billion in 2008 dollars, or 2.4 percent of total health care spending.
Notwithstanding all of the above quoted FACTS politicians and their physicians allies still place their bets on malpractice reform.
But we all could start reforming the system TODAY if we would firmly commit ourselves to practice DEFENSIBLE MEDICINE instead. What does that mean?
1. Following expert guidelines and recommendations in managing and treating patients.
2. Implementing patient safety measures to reduce deadly medical errors killing more than 100,000 Americans every year.
3. Collaborating medical care in teams comprised of ALL health care professionals including physicians, physician assistants and ARNPs.
4. Moving from physician centered to patient centered medicine
5. Integrating health information technology into our offices and learn to share medical information.
Even Tom Price (R-GA) admits that we need to “ adopt a set of best-practice guidelines for treatment – agreed to by physicians, not bureaucrats – to provide an affirmative legal defense.”
What are we waiting for? Lets start practicing defensible medicine today.
Yours truly,
Bernd
Wednesday, November 10, 2010
Physicians Role in ACOs
"A crucial question is who will control these ACOs. We can envision two possible futures: one of physician-controlled ACOs, with physicians affiliating and contracting with hospitals, controlling the flow of funds through the marketplace; and one of hospital-controlled ACOs that will employ physicians. Whoever controls the ACOs will capture the largest share of any savings."
Attached you find a link http://healthpolicyandreform.nejm.org/?p=13020&query=TOC to an important article "Physicians versus Hospitals as Leaders of Accountable Care Organizations" which was just published today on the NEJM website. I urge you to read the article and want to point out several important messages:
* The next few years will be a period of what economists call “creative destruction”: our fragmented, fee-for-service health care delivery system will be transformed into a higher-quality, higher-productivity system with strong incentives for efficient, coordinated care. Consequently, the actions of physicians and hospitals during this period will determine the structure of the delivery system for many years. The implications will be profound for hospitals’ dominant role in the health care system and for physicians’ income, autonomy, and work environments.
* The Affordable Care Act (ACA) aims to improve the quality of care and reduce costs. Doing so will require focused efforts to improve care for the 10% of patients who account for 64% of all U.S. health care costs.2 Much of this cost derives from high rates of unnecessary hospitalizations and potentially avoidable complications,3 and these, in turn, are partially driven by fee-for-service incentives that fail to adequately reward coordinated care that effectively prevents illness. The ACA includes numerous provisions designed to catalyze transformation of the delivery system, moving it away from fee for service and toward coordinated care.
* Incentives for the development of the information systems and infrastructure are necessary for better and more efficient management of chronic conditions.
* Achievement of this level of care coordination will require the development of larger integrated delivery organizations — preferably, accountable care organizations (ACOs) that incorporate primary care practices structured as patient-centered medical homes and that can support new investments in information systems and care teams and can maintain service hours resembling those of retailers. A move toward ACOs will mean major changes in the structure of physicians’ practices, since even physician-group–based ACOs may include one or more hospitals, though they may instead contract with hospitals for specific services chosen on the basis of their relative value.
* A crucial question is who will control these ACOs. We can envision two possible futures: one of physician-controlled ACOs, with physicians affiliating and contracting with hospitals, controlling the flow of funds through the marketplace; and one of hospital-controlled ACOs that will employ physicians. Whoever controls the ACOs will capture the largest share of any savings.
* For physicians to control ACOs, they would have to overcome several hurdles. The first is collaboration: ACOs will require clinical, administrative, and fiscal cooperation, and physicians have seldom demonstrated the ability to effectively organize themselves into groups, agree on clinical guidelines, and devise ways to equitably distribute money.
* If hospitals are to control ACOs, they, too, will need to overcome barriers. First, they will need to trade near-term revenue for long-term savings. Hospitals are typically at the center of current health care markets, and by focusing on procedures and severely ill patients, most have been fairly profitable. Building an ACO will require hospitals to shift to a more outpatient-focused, coordinated care model and forgo some profits from procedures and admissions.
* Holding off on creating ACOs is likely to be a bad long-term strategy for physicians.
* Therefore, the actor who moves first effectively is likely to assume the momentum and dominate the local market. A wait-and-see approach could succeed if the first mover executes poorly, failing to coordinate care and manage risk. But rather than controlling destiny, cautious actors will be hanging their fate on the mistakes of others.
Yours
Bernd
Attached you find a link http://healthpolicyandreform.nejm.org/?p=13020&query=TOC to an important article "Physicians versus Hospitals as Leaders of Accountable Care Organizations" which was just published today on the NEJM website. I urge you to read the article and want to point out several important messages:
* The next few years will be a period of what economists call “creative destruction”: our fragmented, fee-for-service health care delivery system will be transformed into a higher-quality, higher-productivity system with strong incentives for efficient, coordinated care. Consequently, the actions of physicians and hospitals during this period will determine the structure of the delivery system for many years. The implications will be profound for hospitals’ dominant role in the health care system and for physicians’ income, autonomy, and work environments.
* The Affordable Care Act (ACA) aims to improve the quality of care and reduce costs. Doing so will require focused efforts to improve care for the 10% of patients who account for 64% of all U.S. health care costs.2 Much of this cost derives from high rates of unnecessary hospitalizations and potentially avoidable complications,3 and these, in turn, are partially driven by fee-for-service incentives that fail to adequately reward coordinated care that effectively prevents illness. The ACA includes numerous provisions designed to catalyze transformation of the delivery system, moving it away from fee for service and toward coordinated care.
* Incentives for the development of the information systems and infrastructure are necessary for better and more efficient management of chronic conditions.
* Achievement of this level of care coordination will require the development of larger integrated delivery organizations — preferably, accountable care organizations (ACOs) that incorporate primary care practices structured as patient-centered medical homes and that can support new investments in information systems and care teams and can maintain service hours resembling those of retailers. A move toward ACOs will mean major changes in the structure of physicians’ practices, since even physician-group–based ACOs may include one or more hospitals, though they may instead contract with hospitals for specific services chosen on the basis of their relative value.
* A crucial question is who will control these ACOs. We can envision two possible futures: one of physician-controlled ACOs, with physicians affiliating and contracting with hospitals, controlling the flow of funds through the marketplace; and one of hospital-controlled ACOs that will employ physicians. Whoever controls the ACOs will capture the largest share of any savings.
* For physicians to control ACOs, they would have to overcome several hurdles. The first is collaboration: ACOs will require clinical, administrative, and fiscal cooperation, and physicians have seldom demonstrated the ability to effectively organize themselves into groups, agree on clinical guidelines, and devise ways to equitably distribute money.
* If hospitals are to control ACOs, they, too, will need to overcome barriers. First, they will need to trade near-term revenue for long-term savings. Hospitals are typically at the center of current health care markets, and by focusing on procedures and severely ill patients, most have been fairly profitable. Building an ACO will require hospitals to shift to a more outpatient-focused, coordinated care model and forgo some profits from procedures and admissions.
* Holding off on creating ACOs is likely to be a bad long-term strategy for physicians.
* Therefore, the actor who moves first effectively is likely to assume the momentum and dominate the local market. A wait-and-see approach could succeed if the first mover executes poorly, failing to coordinate care and manage risk. But rather than controlling destiny, cautious actors will be hanging their fate on the mistakes of others.
Yours
Bernd
Tuesday, November 09, 2010
How Medicare Killed the Family Doctor
Attached a link http://online.wsj.com/article/SB10001424052748704353504575596140752021042.html?mod=googlenews_wsj to an article published in the November 8th issues of the Wall Street Journal entitled " How Medicare Killed the Family Doctor."
The author correctly states that “The primary-care doctor has become a piece-rate worker focused on the volume of patients seen every day. As Medicare and insurers focused on trimming the costs of the most common procedures, the income and job satisfaction of primary-care doctors eroded.”
Furthermore, he points out that a possible solution includes “ making primary-care physicians the captains of the ship. They must have the time and financial resources necessary to take care of their patients, tailoring care to patients' specific conditions and needs. And they need the data to track their patients' results, so they can guide patient progress. They will then be able to slow (and sometimes reverse) their patients' illnesses, keeping them out of hospital emergency rooms and specialists' offices. The end result: reduced costs and improved quality of care.”
But it is of interest to note that he discards “new health-care service models, such as the concierge practice and the Patient-Centered Medical Home, [that] drew doctors away from the standard service models that most patients rely on for coverage.”
He obviously misunderstands the PCMH which essentially will empower the primary care physician.
What do you think?
Yours
Bernd
The author correctly states that “The primary-care doctor has become a piece-rate worker focused on the volume of patients seen every day. As Medicare and insurers focused on trimming the costs of the most common procedures, the income and job satisfaction of primary-care doctors eroded.”
Furthermore, he points out that a possible solution includes “ making primary-care physicians the captains of the ship. They must have the time and financial resources necessary to take care of their patients, tailoring care to patients' specific conditions and needs. And they need the data to track their patients' results, so they can guide patient progress. They will then be able to slow (and sometimes reverse) their patients' illnesses, keeping them out of hospital emergency rooms and specialists' offices. The end result: reduced costs and improved quality of care.”
But it is of interest to note that he discards “new health-care service models, such as the concierge practice and the Patient-Centered Medical Home, [that] drew doctors away from the standard service models that most patients rely on for coverage.”
He obviously misunderstands the PCMH which essentially will empower the primary care physician.
What do you think?
Yours
Bernd
Fewer Practices are Doctor-Owned
Attached a link http://online.wsj.com/article/SB10001424052748703856504575600412716683130.html?KEYWORDS=doctor#printMode to an article published in the November 8th issues of the Wall Street Journal entitled " Fewer Practices are Doctor-Owned."
The authors summarized the trend that the share of responding practices that were hospital-owned last year hit 55%, up from 50% in 2008 and around 30% five years earlier.
"The traditional model of doctors hanging up their own shingles is fading fast, as more go to work directly for hospitals that are building themselves into consolidated health-care providers." No knew revelation that "the trend is tied to the needs of both doctors and hospitals, as well as to emerging changes in how insurers and government programs pay for care. Many doctors have become frustrated with the duties involved in practice ownership, including wrangling with insurers, dunning patients for their out-of-pocket fees and acquiring new technology. Some young physicians are choosing to avoid such issues altogether and seeking the sometimes more regular hours of salaried positions."
What I consider as problematic that doctors are surrendering the autonomy to hospitals which are seeking to position themselves for new methods of payment, including an emerging model known as accountable-care organizations. These entities are supposed to save money and improve quality by better integrating patient care, with the health-care provider sharing in the financial benefits of new efficiencies BUT the consolidation wave is raising red flags among some regulators, researchers and health insurers, who warn that bigger health systems can use their leverage to push for higher rates. So what can doctors do? We need to learn the business of medicine and form collaborative primary care practices, or merge our practices to gain market share and leverage.
Surrendering our practices is not a solution. Salaried physicians can get fired too but their former practices remain in the hand of hospitals.
Yours
Bernd
The authors summarized the trend that the share of responding practices that were hospital-owned last year hit 55%, up from 50% in 2008 and around 30% five years earlier.
"The traditional model of doctors hanging up their own shingles is fading fast, as more go to work directly for hospitals that are building themselves into consolidated health-care providers." No knew revelation that "the trend is tied to the needs of both doctors and hospitals, as well as to emerging changes in how insurers and government programs pay for care. Many doctors have become frustrated with the duties involved in practice ownership, including wrangling with insurers, dunning patients for their out-of-pocket fees and acquiring new technology. Some young physicians are choosing to avoid such issues altogether and seeking the sometimes more regular hours of salaried positions."
What I consider as problematic that doctors are surrendering the autonomy to hospitals which are seeking to position themselves for new methods of payment, including an emerging model known as accountable-care organizations. These entities are supposed to save money and improve quality by better integrating patient care, with the health-care provider sharing in the financial benefits of new efficiencies BUT the consolidation wave is raising red flags among some regulators, researchers and health insurers, who warn that bigger health systems can use their leverage to push for higher rates. So what can doctors do? We need to learn the business of medicine and form collaborative primary care practices, or merge our practices to gain market share and leverage.
Surrendering our practices is not a solution. Salaried physicians can get fired too but their former practices remain in the hand of hospitals.
Yours
Bernd
Monday, November 08, 2010
Protect Medicare
Republicans are still gloating over their election victory but even they cannot escape reality. They successfully mislead seniors that Obama will take away their Medicare benefits and promised to maintain, even expand, the current Medicare system. Now John Boehner announced that he would push " to repeal $550 billion worth of Medicare cuts BUT omits to explain how he would pay for such a repeal.
But instead of solutions this position creates more problems!!!
Politifact.com http://politifact.com/truth-o-meter/statements/2010/sep/20/60-plus-association/medicare-cuts-health-care-law-will-hurt-seniors-sa/ has pointed out the truth to counter the misleading "Medicare cuts" propaganda and summarized the FACTS as follows:
" Medicare, a government-run health insurance program, provides health care coverage for the vast majority of Americans over age 65. It accounts for about 12 percent of the federal budget. It's important to note that the law does not take $500 billion out of the current Medicare budget. Rather, the bill attempts to slow the program's future growth, curtailing just over $500 billion in future spending over the next 10 years. Medicare spending will still increase -- the nonpartisan Congressional Budget Office projects Medicare spending will reach $929 billion in 2020, up from $499 billion in actual spending in 2009....
Some of the savings are for relatively minor programs, such as $36 billion for increases in premiums for higher-income beneficiaries and $12 billion for administrative changes. The law directs a new national board to identify $15.5 billion in savings, but the board -- the Independent Payment Advisory Board -- is prohibited from proposing anything that would ration care or reduce or modify benefits. More significantly, there's also $136 billion in projected savings that would come from changes to the Medicare Advantage program. About 25 percent of Medicare beneficiaries are enrolled in a Medicare Advantage plan....
The Medicare Advantage program was intended to bring more efficiency from the private sector to the Medicare program, but it hasn't worked as planned. A June 2009 analysis from the Medicare Payment Advisory Commission said that the Advantage programs costs taxpayers on average of 14 percent more than the traditional Medicare plan. President Barack Obama has said repeatedly that the Medicare Advantage plan wastes public money that could be put to better use.
The health care law that President Obama signed in March phases out extra payments for Medicare Advantage programs over the next three to six years to bring their costs in line with traditional Medicare and institutes other rules for the program.....
Finally, there's $220 billion in Medicare savings achieved by reducing annual increases in payments health care providers would otherwise receive from Medicare. The reductions are part of programs intended to improve care and make it more efficient, such as reducing payments for preventable hospital re-admissions. These adjustments are aimed at hospitals, skilled nursing facilities, and home health agencies.
The Office of the Actuary for Medicare and Medicaid Services questioned in an April 2010 report whether these levels of savings are realistic, saying that some health care providers would become unprofitable if payments were reduced. The actuary's report suggests that Congress will intervene to change the payment formula to avoid health care providers dropping out of Medicare.....
The $500 billion aren't actual cuts but reductions to future spending for a program that will still grow significantly in the next 10 years .... the reductions are ways to make Medicare more efficient [including] benefits to seniors, such as improved prescription drug coverage. "
Sometimes FACTS trump FICTION!!! Still we have yet to find a solution on how to protect the Medicare program and most stake holders are avoiding to contribute their share to avoid the inevitable financial meltdown. Unfortunately, they a re busy to get ready for the 2012 campaign. What can you do? Speak up. Collaborate to offer workable solutions. Stop ideologues from dominating the agenda. Too much is at stake and we should not stay silent!
Yours
Bernd
But instead of solutions this position creates more problems!!!
Politifact.com http://politifact.com/truth-o-meter/statements/2010/sep/20/60-plus-association/medicare-cuts-health-care-law-will-hurt-seniors-sa/ has pointed out the truth to counter the misleading "Medicare cuts" propaganda and summarized the FACTS as follows:
" Medicare, a government-run health insurance program, provides health care coverage for the vast majority of Americans over age 65. It accounts for about 12 percent of the federal budget. It's important to note that the law does not take $500 billion out of the current Medicare budget. Rather, the bill attempts to slow the program's future growth, curtailing just over $500 billion in future spending over the next 10 years. Medicare spending will still increase -- the nonpartisan Congressional Budget Office projects Medicare spending will reach $929 billion in 2020, up from $499 billion in actual spending in 2009....
Some of the savings are for relatively minor programs, such as $36 billion for increases in premiums for higher-income beneficiaries and $12 billion for administrative changes. The law directs a new national board to identify $15.5 billion in savings, but the board -- the Independent Payment Advisory Board -- is prohibited from proposing anything that would ration care or reduce or modify benefits. More significantly, there's also $136 billion in projected savings that would come from changes to the Medicare Advantage program. About 25 percent of Medicare beneficiaries are enrolled in a Medicare Advantage plan....
The Medicare Advantage program was intended to bring more efficiency from the private sector to the Medicare program, but it hasn't worked as planned. A June 2009 analysis from the Medicare Payment Advisory Commission said that the Advantage programs costs taxpayers on average of 14 percent more than the traditional Medicare plan. President Barack Obama has said repeatedly that the Medicare Advantage plan wastes public money that could be put to better use.
The health care law that President Obama signed in March phases out extra payments for Medicare Advantage programs over the next three to six years to bring their costs in line with traditional Medicare and institutes other rules for the program.....
Finally, there's $220 billion in Medicare savings achieved by reducing annual increases in payments health care providers would otherwise receive from Medicare. The reductions are part of programs intended to improve care and make it more efficient, such as reducing payments for preventable hospital re-admissions. These adjustments are aimed at hospitals, skilled nursing facilities, and home health agencies.
The Office of the Actuary for Medicare and Medicaid Services questioned in an April 2010 report whether these levels of savings are realistic, saying that some health care providers would become unprofitable if payments were reduced. The actuary's report suggests that Congress will intervene to change the payment formula to avoid health care providers dropping out of Medicare.....
The $500 billion aren't actual cuts but reductions to future spending for a program that will still grow significantly in the next 10 years .... the reductions are ways to make Medicare more efficient [including] benefits to seniors, such as improved prescription drug coverage. "
Sometimes FACTS trump FICTION!!! Still we have yet to find a solution on how to protect the Medicare program and most stake holders are avoiding to contribute their share to avoid the inevitable financial meltdown. Unfortunately, they a re busy to get ready for the 2012 campaign. What can you do? Speak up. Collaborate to offer workable solutions. Stop ideologues from dominating the agenda. Too much is at stake and we should not stay silent!
Yours
Bernd
Saturday, October 30, 2010
Rick Scott and The Department Of Health
Attached a troubling article published in the Naplesnews.com and subsequently in today's New York Times reporting a health-care fraud complaint against Solantic, a chain of walk-in centers co-founded by gubernatorial candidate Rick Scott in 2001.Solantic currently operates about 30 walk-in centers, mostly around Jacksonville and Orlando. The state Agency for Health Care Administration (AHCA) sent the complaint to the state health department Aug. 13, a week after receiving it. Various media outlets reported earlier that it was referred to federal officials. The complaint contains allegations raising standard of care issues that fall under the jurisdiction of the Department of Health. With respect to the Solantic complaint, AHCA decided not to conduct a probe because the allegations focus on possible fraud with Medicare and not with state-run Medicaid. As a result, AHCA officials forwarded the complaint to federal Medicare authorities on the same day they sent it to the state health department. The complaint alleges a number of potential wrongdoings at Solantic, including overbilling of Medicaid, Medicare, private insurance and TriCare, which is the government health plan for veterans. It says insurers were charged physician rates when patients were treated by nurse practitioners, that unnecessary tests were ordered and billed, and that outdated screenings were performed. Another allegation is that unnecessary prescriptions were written so patients purchased medications from internal pharmacies.
This raises several problematic issues:
1. If an investigation was opened and continues beyond Tuesday’s election with the potential that Scott is elected governor, any investigation could make for a conflict for the health department’s secretary, who is appointed by the governor.
2. Rick Scott already said that he wouldn’t get involved except for making the appointment of the head of the health department.
Maybe we should remember that if it looks like a duck, walks like a duck and quakes like a duck then its probably not a giraffe.
Yours
Bernd
Naples Daily News - Printer-friendly story
Rick Scott would pick agency head, but vows to stay clear of any state Solantic probe
The state Department of Health won't say what it has done with complaint against Scott's company
By LIZ FREEMAN
Thursday, October 28, 2010
NAPLES — The state Department of Health won’t discuss its handling of a health-care fraud complaint against Solantic, a chain of walk-in centers co-founded by gubernatorial candidate Rick Scott in 2001.
Solantic currently operates about 30 walk-in centers, mostly around Jacksonville and Orlando.
“We can’t acknowledge or deny the existence of a complaint,” said Eulinda Smith, a state health department spokeswoman.
However, a letter obtained by the Daily News under Florida’s public records law shows the state Agency for Health Care Administration (AHCA) sent the complaint to the state health department Aug. 13, a week after receiving it. Various media outlets reported earlier that it was referred to federal officials.
“The complaint contains allegations raising standard of care issues that more appropriately fall under the jurisdiction of the Department of Health,” Jerome Worley, chief of investigations for the Office of Inspector General with AHCA, wrote in a letter to the state Department of Health. “Please handle the complaint as you deem appropriate.”
The complaint was sent to AHCA anonymously but said the allegations were provided by Dr. Randy Prokes, a former medical director of a Solantic center in Jacksonville. The one-page form lists 10 allegations of wrongdoing and there are 26 pages of abbreviated notes about questionable practices at clinics with names of former or current Solantic employees as potential sources for investigators.
If an investigation was opened and continues beyond Tuesday’s election with the potential that Scott is elected governor, any investigation could make for a conflict for the health department’s secretary, who is appointed by the governor.
When asked while campaigning Thursday how he would handle that situation, Scott said he wouldn’t get involved except for making the appointment of the head of the health department.
“I’d recuse myself from any involvement,” he said. “I’m going to appoint the head of the position, but I’m not going to be involved in any decisions.”
Sent to the health department in mid-August, the complaint against Solantic Urgent Care of Jacksonville may have been dismissed as not part of the department’s purview, or officials may have found the allegations insufficient or unfounded. It is also possible an investigation was opened and continues.
Like many government agencies with investigative authority, the health department won’t confirm if it has the complaint in question.
The complaint caused a frenzy in mid-August when it became public after AHCA decided not to investigate and released it to the media. Scott detoured from campaigning in South Florida and held a press conference in Tallahassee. He told reporters his GOP opponent in the primary, Attorney General Bill McCollum, was using allegations received in an e-mail from Prokes for “Chicago-style smear politics.”
Solantic’s chief executive officer, Karen Bowling, likewise denied the allegations at the time and said Prokes was fired in 2009 for writing a prescription for a pain-killer outside the clinic.
Prokes, who couldn’t be reached for comment, stated in his e-mail to the Attorney General’s Office that he was fired after raising his concerns about wrongful practices at the clinics.
Allegations of potential fraud at Solantic brought back to the campaign forefront Scott’s past as chief executive officer of the former Columbia/HCA, which paid a record $1.7 billion in the late 1990s to settle Medicare fraud fines. Scott denied knowledge of the fraud and was never charged.
With respect to the Solantic complaint, AHCA decided not to conduct a probe because the allegations focus on possible fraud with Medicare and not with state-run Medicaid. As a result, AHCA officials forwarded the complaint to federal Medicare authorities on the same day they sent it to the state health department.
Similar to state investigative agencies, the Office of the Inspector General with the U.S. Health and Human Services “can neither confirm nor deny the receipt of a complaint,” according to Donald White, spokesman for that federal agency.
The state health department has jurisdiction over possible standard of care infractions by physicians and other state-licensed medical professionals; AHCA licenses medical facilities and investigates potential regulatory violations.
The complaint alleges a number of potential wrongdoings at Solantic, including overbilling of Medicaid, Medicare, private insurance and TriCare, which is the government health plan for veterans. It says insurers were charged physician rates when patients were treated by nurse practitioners, that unnecessary tests were ordered and billed, and that outdated screenings were performed. Another allegation is that unnecessary prescriptions were written so patients purchased medications from internal pharmacies.
Another claim is that a physician’s medical license was misused by Solantic to apply for a clinic license without the physician’s knowledge.
Both in August and recently, Scott campaign officials have said the allegations are old, were trumped up by the McCollum campaign before the primary and that Solantic aggressively responded to the claims.
“The guy (Prokes) was not even in the position to allege what he alleged,” said Brian Burgess, a Scott spokesman. “My understanding from the Solantic attorney, they would be told if there is even something going on.”
Responding to a recent follow-up inquiry by the Daily News to AHCA about why the agency declined to investigate, spokeswoman Tiffany Vause said Solantic clinics hadn’t filed any claims with the traditional Medicaid program but claims were filed with a few Medicaid managed care plans under state contract.
“The agency’s Bureau of Medicaid Program Integrity referred the complaint to these health plans for review,” she said in an e-mail.
In response to the allegation that Solantic used a physician’s license at another clinic site without the doctor’s knowledge, Vause said state law doesn’t allow the agency to sanction a clinic for such activity.
However, medical facilities can be cited during inspections for a variety of deficiencies with state regulations.
Three inspections at Solantic clinics in Orlando, Apopka and Lake Mary show they were flagged because the medical directors had failed to do periodic reviews of billing claims to make sure no fraudulent or unlawful claims were filed. One of the inspections was in late 2007 and two others were in April and August of this year.
AHCA spokeswoman Shelisha Durden said a clinic doesn’t pass an inspection until there are assurances that the billing review is in place and being done.
“The issue is whether the clinic had a process in place where the medical director conducted systematic reviews of the clinic’s bills, and also whether the director conducted these reviews,” she said.
* * * * *
This raises several problematic issues:
1. If an investigation was opened and continues beyond Tuesday’s election with the potential that Scott is elected governor, any investigation could make for a conflict for the health department’s secretary, who is appointed by the governor.
2. Rick Scott already said that he wouldn’t get involved except for making the appointment of the head of the health department.
Maybe we should remember that if it looks like a duck, walks like a duck and quakes like a duck then its probably not a giraffe.
Yours
Bernd
Naples Daily News - Printer-friendly story
Rick Scott would pick agency head, but vows to stay clear of any state Solantic probe
The state Department of Health won't say what it has done with complaint against Scott's company
By LIZ FREEMAN
Thursday, October 28, 2010
NAPLES — The state Department of Health won’t discuss its handling of a health-care fraud complaint against Solantic, a chain of walk-in centers co-founded by gubernatorial candidate Rick Scott in 2001.
Solantic currently operates about 30 walk-in centers, mostly around Jacksonville and Orlando.
“We can’t acknowledge or deny the existence of a complaint,” said Eulinda Smith, a state health department spokeswoman.
However, a letter obtained by the Daily News under Florida’s public records law shows the state Agency for Health Care Administration (AHCA) sent the complaint to the state health department Aug. 13, a week after receiving it. Various media outlets reported earlier that it was referred to federal officials.
“The complaint contains allegations raising standard of care issues that more appropriately fall under the jurisdiction of the Department of Health,” Jerome Worley, chief of investigations for the Office of Inspector General with AHCA, wrote in a letter to the state Department of Health. “Please handle the complaint as you deem appropriate.”
The complaint was sent to AHCA anonymously but said the allegations were provided by Dr. Randy Prokes, a former medical director of a Solantic center in Jacksonville. The one-page form lists 10 allegations of wrongdoing and there are 26 pages of abbreviated notes about questionable practices at clinics with names of former or current Solantic employees as potential sources for investigators.
If an investigation was opened and continues beyond Tuesday’s election with the potential that Scott is elected governor, any investigation could make for a conflict for the health department’s secretary, who is appointed by the governor.
When asked while campaigning Thursday how he would handle that situation, Scott said he wouldn’t get involved except for making the appointment of the head of the health department.
“I’d recuse myself from any involvement,” he said. “I’m going to appoint the head of the position, but I’m not going to be involved in any decisions.”
Sent to the health department in mid-August, the complaint against Solantic Urgent Care of Jacksonville may have been dismissed as not part of the department’s purview, or officials may have found the allegations insufficient or unfounded. It is also possible an investigation was opened and continues.
Like many government agencies with investigative authority, the health department won’t confirm if it has the complaint in question.
The complaint caused a frenzy in mid-August when it became public after AHCA decided not to investigate and released it to the media. Scott detoured from campaigning in South Florida and held a press conference in Tallahassee. He told reporters his GOP opponent in the primary, Attorney General Bill McCollum, was using allegations received in an e-mail from Prokes for “Chicago-style smear politics.”
Solantic’s chief executive officer, Karen Bowling, likewise denied the allegations at the time and said Prokes was fired in 2009 for writing a prescription for a pain-killer outside the clinic.
Prokes, who couldn’t be reached for comment, stated in his e-mail to the Attorney General’s Office that he was fired after raising his concerns about wrongful practices at the clinics.
Allegations of potential fraud at Solantic brought back to the campaign forefront Scott’s past as chief executive officer of the former Columbia/HCA, which paid a record $1.7 billion in the late 1990s to settle Medicare fraud fines. Scott denied knowledge of the fraud and was never charged.
With respect to the Solantic complaint, AHCA decided not to conduct a probe because the allegations focus on possible fraud with Medicare and not with state-run Medicaid. As a result, AHCA officials forwarded the complaint to federal Medicare authorities on the same day they sent it to the state health department.
Similar to state investigative agencies, the Office of the Inspector General with the U.S. Health and Human Services “can neither confirm nor deny the receipt of a complaint,” according to Donald White, spokesman for that federal agency.
The state health department has jurisdiction over possible standard of care infractions by physicians and other state-licensed medical professionals; AHCA licenses medical facilities and investigates potential regulatory violations.
The complaint alleges a number of potential wrongdoings at Solantic, including overbilling of Medicaid, Medicare, private insurance and TriCare, which is the government health plan for veterans. It says insurers were charged physician rates when patients were treated by nurse practitioners, that unnecessary tests were ordered and billed, and that outdated screenings were performed. Another allegation is that unnecessary prescriptions were written so patients purchased medications from internal pharmacies.
Another claim is that a physician’s medical license was misused by Solantic to apply for a clinic license without the physician’s knowledge.
Both in August and recently, Scott campaign officials have said the allegations are old, were trumped up by the McCollum campaign before the primary and that Solantic aggressively responded to the claims.
“The guy (Prokes) was not even in the position to allege what he alleged,” said Brian Burgess, a Scott spokesman. “My understanding from the Solantic attorney, they would be told if there is even something going on.”
Responding to a recent follow-up inquiry by the Daily News to AHCA about why the agency declined to investigate, spokeswoman Tiffany Vause said Solantic clinics hadn’t filed any claims with the traditional Medicaid program but claims were filed with a few Medicaid managed care plans under state contract.
“The agency’s Bureau of Medicaid Program Integrity referred the complaint to these health plans for review,” she said in an e-mail.
In response to the allegation that Solantic used a physician’s license at another clinic site without the doctor’s knowledge, Vause said state law doesn’t allow the agency to sanction a clinic for such activity.
However, medical facilities can be cited during inspections for a variety of deficiencies with state regulations.
Three inspections at Solantic clinics in Orlando, Apopka and Lake Mary show they were flagged because the medical directors had failed to do periodic reviews of billing claims to make sure no fraudulent or unlawful claims were filed. One of the inspections was in late 2007 and two others were in April and August of this year.
AHCA spokeswoman Shelisha Durden said a clinic doesn’t pass an inspection until there are assurances that the billing review is in place and being done.
“The issue is whether the clinic had a process in place where the medical director conducted systematic reviews of the clinic’s bills, and also whether the director conducted these reviews,” she said.
* * * * *
Sunday, October 24, 2010
Medicaid Reform: Different approaches but one correct answer
In the current edition of the South Florida Business Journal (October 22-28th,2010) the two gubernatorial candidates, Alex Sink (D) and Rick Scott(R)), answered questions related to the business climate in Florida.
One of them pertained to the future of Medicaid:
SFBJ: Would you make any changes to Florida’s Medicaid system, in areas such as provider funding, eligibility or the continuation of the Medicaid reform pilot program?
Sink: I will form a task force of all Medicaid system stakeholders to develop solutions for reducing this program’s burden on the state budget, and explore ways to address rising costs without jeopardizing the quality of care. Medicaid reforms are needed, as the program consumes about a fourth of the state’s budget; however, policymakers should ensure that changes actually work before imposing them upon the entire state.
SFBJ: Would you make any changes to Florida’s Medicaid system, in areas such as provider funding, eligibility or the continuation of the Medicaid reform pilot program?
Scott: I will seek a Medicaid waiver in order to allow Florida to create a voucher program in which Medicaid recipients would be able to shop for insurance on the private market. If we were not able get that waiver, I would seek to expand the Medicaid reform pilot program.
Comment: Medicaid reform pilot programs are solely intended to reduce the rapidly increasing Medicaid cost in Florida ($17.9 billion for the 2.6 million recipients - one out of every seven residents - and an 11 percent rise from the previous year) . But whats the reality? Doctors are complaining and refuse to participate because of low payments. Patients complain about delayed and limited services. Who does not complain? HMO's because they get the state contracts to care for Medicaid patients.
Vouchers: The argument sounds compelling. You provide Medicaid patients with a voucher and they can choose their own insurance and providers. The only problem: there are hardly any choices! Doctors drop out of Medicaid due to low payments and the insurance policy options are limited and contracts littered with exclusion criteria and limitations.
So if doctors are wary about Medicaid reform pilot programs why does organized medicine ENDORSES Rick Scott? Shouldn't we endorse the candidate who wants to ensure that changes actually work BEFORE imposing them upon the entire state? Please explain.
Bernd
One of them pertained to the future of Medicaid:
SFBJ: Would you make any changes to Florida’s Medicaid system, in areas such as provider funding, eligibility or the continuation of the Medicaid reform pilot program?
Sink: I will form a task force of all Medicaid system stakeholders to develop solutions for reducing this program’s burden on the state budget, and explore ways to address rising costs without jeopardizing the quality of care. Medicaid reforms are needed, as the program consumes about a fourth of the state’s budget; however, policymakers should ensure that changes actually work before imposing them upon the entire state.
SFBJ: Would you make any changes to Florida’s Medicaid system, in areas such as provider funding, eligibility or the continuation of the Medicaid reform pilot program?
Scott: I will seek a Medicaid waiver in order to allow Florida to create a voucher program in which Medicaid recipients would be able to shop for insurance on the private market. If we were not able get that waiver, I would seek to expand the Medicaid reform pilot program.
Comment: Medicaid reform pilot programs are solely intended to reduce the rapidly increasing Medicaid cost in Florida ($17.9 billion for the 2.6 million recipients - one out of every seven residents - and an 11 percent rise from the previous year) . But whats the reality? Doctors are complaining and refuse to participate because of low payments. Patients complain about delayed and limited services. Who does not complain? HMO's because they get the state contracts to care for Medicaid patients.
Vouchers: The argument sounds compelling. You provide Medicaid patients with a voucher and they can choose their own insurance and providers. The only problem: there are hardly any choices! Doctors drop out of Medicaid due to low payments and the insurance policy options are limited and contracts littered with exclusion criteria and limitations.
So if doctors are wary about Medicaid reform pilot programs why does organized medicine ENDORSES Rick Scott? Shouldn't we endorse the candidate who wants to ensure that changes actually work BEFORE imposing them upon the entire state? Please explain.
Bernd
Saturday, October 23, 2010
Malpractice Reform; A Fresh Start
Attached an interesting article published in the New York Times on October 20th, 2010.
In this article Peter Orszag, the former director of the White House Office of Management and Budget, emphasizes that Congress (Democrats AND Republicans alike) " missed an important opportunity to shield from malpractice liability any doctors who followed evidence based guidelines in treating their patients." He argues that malpractice reform, i.e.liability insurance reform, could encourage doctors to adopt new evidence more quickly.
He continues stating that instead of imposing caps on liability a far better strategy would be to provide safe harbor for doctors who follow evidence based guidelines. In such circumstances ANYONE who could demonstrate that he/she has followed the recommended course for treating a specific illness or condition could NOT be held liable! To successfully transform our broken malpractice system he suggests taking the following steps:
1. Organizations like the American Medical Association and the Institute of Medicine could also be called upon to issue the needed evidence-based standards for malpractice immunity.
2. Approach to reform will require larger investments in research into what works and what doesn’t. Fortunately, both the health care reform act and the 2009 economic stimulus act provided additional financing for such comparative effectiveness medical research, and the health care act provides for a Patient-Centered Outcomes Research Institute to coordinate the work.
3. Develop and fund information technology solutions that quickly suggest best-practice methods of treatment.
4. Align financial incentives for delivering higher-quality care and and to shift Medicare’s payments toward “fee for quality” rather than “fee for service.”
In my opinion we should discuss these ideas, ask for federal funding to start pilot projects and to actively support any such initiatives.
Unfortunately, organized medicine is focusing on liability caps as the ONLY solution for malpractice reform ignoring and discarding ANY other approaches to address and resolve this important issue. At this point in time progressive physicians and other healthcare professionals should form partnerships and alliance to counter this dogmatic position. Healthcare professionals should consider seeking representation in partnership with ALL participants in the healthcare delivery process including PAs,ARNPs,Nurses and hospital administrators and to engage in strategic planning sessions to develop rational responses to increasing complex problems.
This requires new leadership with the ability to listen, to tolerate other opinions and to seek a compromise based on the most common denominator.
Discussing malpractice reform also requires the inclusion of legal professionals and to engage the trial bar in the deliberations.
We must move from confrontation to collaboration and to stop dividing the world into "friends" and "enemies" of medicine.
Maybe just a dream but the opportunity to change is still present.
Yours
Bernd
October 20, 2010
Malpractice Methodology
By PETER ORSZAG
The health care legislation that Congress enacted earlier this year, contrary to much of today’s overheated rhetoric, does many things right. But it does almost nothing to reform medical malpractice laws. Lawmakers missed an important opportunity to shield from malpractice liability any doctors who followed evidence-based guidelines in treating their patients.
As President Obama noted in his speech to the American Medical Association in June 2009, too many doctors order unnecessary tests and treatments only because they believe it will protect them from a lawsuit. Instead, he said, “We need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine and encourage broader use of evidence-based guidelines.”
Why does this matter? Right now, health care is more evidence-free than you might think. And even where evidence-based clinical guidelines exist, research suggests that doctors follow them only about half of the time. One estimate suggests that it takes 17 years on average to incorporate new research findings into widespread practice. As a result, any clinical guidelines that exist often have limited impact.
How might we encourage doctors to adopt new evidence more quickly? Malpractice reform could help — possibly a lot.
The academic literature tends to play down the role of medical liability laws in driving up health care costs. Doctors themselves, however, almost universally state that malpractice statutes lead to extraneous testing and treatment.
It is also conceivable that because such laws usually focus on “customary practice” — that is, a doctor who has treated a patient the way most other doctors in the area would is considered safe from accusations of malpractice — they create a strong contagion effect among doctors. The laws, no matter how weak or stringent, may therefore explain why doctors in some parts of the country generally adopt much more intensive approaches than those in other areas do.
The traditional way to reform medical malpractice law has been to impose caps on liability — for example, by limiting punitive damages to something like $500,000. A far better strategy would be to provide safe harbor for doctors who follow evidence-based guidelines. Anyone who could demonstrate that he has followed the recommended course for treating a specific illness or condition could not be held liable.
The health care reform act that Congress passed earlier this year included a modest set of state pilot projects, including one in Oregon that is intended to experiment with this approach. But these pilots are small; the project in Oregon, for example, has only $300,000 in financing.
What’s needed is a much more aggressive national effort to protect doctors who follow evidence-based guidelines. That’s the only way that malpractice reform could broadly promote the adoption of best practices.
Congress has taken a step in this direction before. As Prof. James Blumstein of Vanderbilt University Law School has pointed out, a little-known provision in the Social Security Act amendments of 1972 provides immunity from malpractice liability to doctors who treat patients in conformity with the standards set forth by so-called quality improvement organizations — nonprofits under contract with Medicare that work to improve care. The provision remains in force, though those organizations have yet to set such standards.
Organizations like the American Medical Association and the Institute of Medicine could also be called upon to issue the needed evidence-based standards for malpractice immunity. But no matter which body is put in charge of certification, this approach to reform will require larger investments in research into what works and what doesn’t. Fortunately, both the health care reform act and the 2009 economic stimulus act provided additional financing for such comparative effectiveness medical research, and the health care act provides for a Patient-Centered Outcomes Research Institute to coordinate the work. It’s a good start.
Better technology would help, too. Your doctor’s computer should be able to not only pull up your health records (after you have approved such access) but also quickly suggest best-practice methods of treatment. The doctor should then be able to click through to read the supporting research. Subsidies in the stimulus act help doctors pay for this kind of technology.
A final step toward improving standard medical practice will be to better align financial incentives for delivering higher-quality care. Hospitals now lose Medicare dollars, for example, if they succeed in reducing readmissions. Medical professionals should be given incentives for better care rather than more care.
The health care reform act already includes measures that enable policymakers to shift Medicare’s payments toward “fee for quality” rather than “fee for service.” My next column will discuss these measures, which get far less credit than they should, in more detail.
Opponents of the act are generally off base in criticizing investments in improved care. In complaining about the missed opportunity to reform medical malpractice laws to promote evidence-based medical practice, on the other hand, the critics are entirely on target.
Peter Orszag, the director of the White House Office of Management and Budget from 2009 to 2010 and a distinguished visiting fellow at the Council on Foreign Relations, is a contributing columnist for The Times.
In this article Peter Orszag, the former director of the White House Office of Management and Budget, emphasizes that Congress (Democrats AND Republicans alike) " missed an important opportunity to shield from malpractice liability any doctors who followed evidence based guidelines in treating their patients." He argues that malpractice reform, i.e.liability insurance reform, could encourage doctors to adopt new evidence more quickly.
He continues stating that instead of imposing caps on liability a far better strategy would be to provide safe harbor for doctors who follow evidence based guidelines. In such circumstances ANYONE who could demonstrate that he/she has followed the recommended course for treating a specific illness or condition could NOT be held liable! To successfully transform our broken malpractice system he suggests taking the following steps:
1. Organizations like the American Medical Association and the Institute of Medicine could also be called upon to issue the needed evidence-based standards for malpractice immunity.
2. Approach to reform will require larger investments in research into what works and what doesn’t. Fortunately, both the health care reform act and the 2009 economic stimulus act provided additional financing for such comparative effectiveness medical research, and the health care act provides for a Patient-Centered Outcomes Research Institute to coordinate the work.
3. Develop and fund information technology solutions that quickly suggest best-practice methods of treatment.
4. Align financial incentives for delivering higher-quality care and and to shift Medicare’s payments toward “fee for quality” rather than “fee for service.”
In my opinion we should discuss these ideas, ask for federal funding to start pilot projects and to actively support any such initiatives.
Unfortunately, organized medicine is focusing on liability caps as the ONLY solution for malpractice reform ignoring and discarding ANY other approaches to address and resolve this important issue. At this point in time progressive physicians and other healthcare professionals should form partnerships and alliance to counter this dogmatic position. Healthcare professionals should consider seeking representation in partnership with ALL participants in the healthcare delivery process including PAs,ARNPs,Nurses and hospital administrators and to engage in strategic planning sessions to develop rational responses to increasing complex problems.
This requires new leadership with the ability to listen, to tolerate other opinions and to seek a compromise based on the most common denominator.
Discussing malpractice reform also requires the inclusion of legal professionals and to engage the trial bar in the deliberations.
We must move from confrontation to collaboration and to stop dividing the world into "friends" and "enemies" of medicine.
Maybe just a dream but the opportunity to change is still present.
Yours
Bernd
October 20, 2010
Malpractice Methodology
By PETER ORSZAG
The health care legislation that Congress enacted earlier this year, contrary to much of today’s overheated rhetoric, does many things right. But it does almost nothing to reform medical malpractice laws. Lawmakers missed an important opportunity to shield from malpractice liability any doctors who followed evidence-based guidelines in treating their patients.
As President Obama noted in his speech to the American Medical Association in June 2009, too many doctors order unnecessary tests and treatments only because they believe it will protect them from a lawsuit. Instead, he said, “We need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine and encourage broader use of evidence-based guidelines.”
Why does this matter? Right now, health care is more evidence-free than you might think. And even where evidence-based clinical guidelines exist, research suggests that doctors follow them only about half of the time. One estimate suggests that it takes 17 years on average to incorporate new research findings into widespread practice. As a result, any clinical guidelines that exist often have limited impact.
How might we encourage doctors to adopt new evidence more quickly? Malpractice reform could help — possibly a lot.
The academic literature tends to play down the role of medical liability laws in driving up health care costs. Doctors themselves, however, almost universally state that malpractice statutes lead to extraneous testing and treatment.
It is also conceivable that because such laws usually focus on “customary practice” — that is, a doctor who has treated a patient the way most other doctors in the area would is considered safe from accusations of malpractice — they create a strong contagion effect among doctors. The laws, no matter how weak or stringent, may therefore explain why doctors in some parts of the country generally adopt much more intensive approaches than those in other areas do.
The traditional way to reform medical malpractice law has been to impose caps on liability — for example, by limiting punitive damages to something like $500,000. A far better strategy would be to provide safe harbor for doctors who follow evidence-based guidelines. Anyone who could demonstrate that he has followed the recommended course for treating a specific illness or condition could not be held liable.
The health care reform act that Congress passed earlier this year included a modest set of state pilot projects, including one in Oregon that is intended to experiment with this approach. But these pilots are small; the project in Oregon, for example, has only $300,000 in financing.
What’s needed is a much more aggressive national effort to protect doctors who follow evidence-based guidelines. That’s the only way that malpractice reform could broadly promote the adoption of best practices.
Congress has taken a step in this direction before. As Prof. James Blumstein of Vanderbilt University Law School has pointed out, a little-known provision in the Social Security Act amendments of 1972 provides immunity from malpractice liability to doctors who treat patients in conformity with the standards set forth by so-called quality improvement organizations — nonprofits under contract with Medicare that work to improve care. The provision remains in force, though those organizations have yet to set such standards.
Organizations like the American Medical Association and the Institute of Medicine could also be called upon to issue the needed evidence-based standards for malpractice immunity. But no matter which body is put in charge of certification, this approach to reform will require larger investments in research into what works and what doesn’t. Fortunately, both the health care reform act and the 2009 economic stimulus act provided additional financing for such comparative effectiveness medical research, and the health care act provides for a Patient-Centered Outcomes Research Institute to coordinate the work. It’s a good start.
Better technology would help, too. Your doctor’s computer should be able to not only pull up your health records (after you have approved such access) but also quickly suggest best-practice methods of treatment. The doctor should then be able to click through to read the supporting research. Subsidies in the stimulus act help doctors pay for this kind of technology.
A final step toward improving standard medical practice will be to better align financial incentives for delivering higher-quality care. Hospitals now lose Medicare dollars, for example, if they succeed in reducing readmissions. Medical professionals should be given incentives for better care rather than more care.
The health care reform act already includes measures that enable policymakers to shift Medicare’s payments toward “fee for quality” rather than “fee for service.” My next column will discuss these measures, which get far less credit than they should, in more detail.
Opponents of the act are generally off base in criticizing investments in improved care. In complaining about the missed opportunity to reform medical malpractice laws to promote evidence-based medical practice, on the other hand, the critics are entirely on target.
Peter Orszag, the director of the White House Office of Management and Budget from 2009 to 2010 and a distinguished visiting fellow at the Council on Foreign Relations, is a contributing columnist for The Times.
Tuesday, October 12, 2010
Keep it Simple and Stupid: Rick Scott's Healthcare Plan and the FMA
“Florida is not a physician-friendly state to practice medicine because of the high cost of medical liability insurance and excessive lawsuits,....the FMA PAC supports Rick Scott for Governor because he shares our goal of increasing access to quality health care for all of Florida’s citizens. Rick Scott is not afraid of taking on personal injury lawyers and shaking up the status quo in order to get things done for the people of Florida.”
President of the FMA PAC, Dr. Madelyn Butler
I tried to understand Rick Scott's healthcare plan and ideas, which convinced the Florida Medical Association Political Action Committee to endorse him as Gubernatorial Candidate.
First, I searched on his web site and found the following:
* On Abortion: "I believe that abortion is wrong and Roe versus Wade should be overturned."
o What shall I tell a woman who is pregnant but unmarried, unemployed, on food stamps and lives with friends or relatives?
o Teenagers who were raped or married women who were sexually attacked by their husbands?
o Should government tell women and doctors what to do and how to lives their lives?
* On Health Care:
o "As a businessman, I know I am held accountable for results, and I held the people in my company accountable for results, too. Delivering quality care at a lower cost to patients was a top priority when I ran Columbia/HCA, and when I started Solantic urgent care facilities here in Florida....In the 1990’s, we were able to transform the hospital industry and prove that free market health care can deliver high quality care at a lower cost to patients."
+ That’s it? We just have to emulate the Columbia/HCA model and open a couple of Solantic Urgent Care centers and we solve all healthcare problems? Guess, I can shred all my healthcare economics test books and magazines, join Rick Scott's model and everything will be just fine. How naive or stupid can anyone be to believe that? Obviously, the FMA PAC does!
o "Rick believes that our health care system should focus on choice, competition, accountability and personal responsibility."
+ So I will have the choice of choosing between an unaffordable health insurance policy or none?
+ Accountability and personal responsibility only applies to the consumers of healthcare but not Rick Scott who just made " some mistakes in his life."
o "Most recently, Rick led the fight to defeat President Obama’s government-run public option. As the founder of Conservatives for Patients’ Rights (CPR), an advocacy group dedicated to the free market principles of choice, competition, accountability and personal responsibility in health care, he was instrumental in defeating the public option plan that would have led to socialized medicine."
+ Fear mongering and painting the government as the boogeyman trying to enslave citizens is a silly and dangerous tactic which just reveals that Rick Scott and friends have no other arguments to offer to resolve the critical problem facing us today and in the near future: how to provide affordable healthcare for an aging population suffering from chronic diseases that consume already 75% of all health care spending.
* On healthcare management experience:
o " I’ve made mistakes in my life...I learned very hard lessons from what happened and those lessons have helped me become a better businessman and leader."
+ That’s it! Mistakes imply taking personal responsibility and not blaming others (i.e. Columbia/HCA) for it. These are the lessons he brings to the table and those character traits make him the knight in shining armor for the FMA PAC?
So what can I say about the FMA PAC decision to endorse Rick Scott? A sad day for Florida's doctors. A sad day for medicine.
Yours
Bernd
President of the FMA PAC, Dr. Madelyn Butler
I tried to understand Rick Scott's healthcare plan and ideas, which convinced the Florida Medical Association Political Action Committee to endorse him as Gubernatorial Candidate.
First, I searched on his web site and found the following:
* On Abortion: "I believe that abortion is wrong and Roe versus Wade should be overturned."
o What shall I tell a woman who is pregnant but unmarried, unemployed, on food stamps and lives with friends or relatives?
o Teenagers who were raped or married women who were sexually attacked by their husbands?
o Should government tell women and doctors what to do and how to lives their lives?
* On Health Care:
o "As a businessman, I know I am held accountable for results, and I held the people in my company accountable for results, too. Delivering quality care at a lower cost to patients was a top priority when I ran Columbia/HCA, and when I started Solantic urgent care facilities here in Florida....In the 1990’s, we were able to transform the hospital industry and prove that free market health care can deliver high quality care at a lower cost to patients."
+ That’s it? We just have to emulate the Columbia/HCA model and open a couple of Solantic Urgent Care centers and we solve all healthcare problems? Guess, I can shred all my healthcare economics test books and magazines, join Rick Scott's model and everything will be just fine. How naive or stupid can anyone be to believe that? Obviously, the FMA PAC does!
o "Rick believes that our health care system should focus on choice, competition, accountability and personal responsibility."
+ So I will have the choice of choosing between an unaffordable health insurance policy or none?
+ Accountability and personal responsibility only applies to the consumers of healthcare but not Rick Scott who just made " some mistakes in his life."
o "Most recently, Rick led the fight to defeat President Obama’s government-run public option. As the founder of Conservatives for Patients’ Rights (CPR), an advocacy group dedicated to the free market principles of choice, competition, accountability and personal responsibility in health care, he was instrumental in defeating the public option plan that would have led to socialized medicine."
+ Fear mongering and painting the government as the boogeyman trying to enslave citizens is a silly and dangerous tactic which just reveals that Rick Scott and friends have no other arguments to offer to resolve the critical problem facing us today and in the near future: how to provide affordable healthcare for an aging population suffering from chronic diseases that consume already 75% of all health care spending.
* On healthcare management experience:
o " I’ve made mistakes in my life...I learned very hard lessons from what happened and those lessons have helped me become a better businessman and leader."
+ That’s it! Mistakes imply taking personal responsibility and not blaming others (i.e. Columbia/HCA) for it. These are the lessons he brings to the table and those character traits make him the knight in shining armor for the FMA PAC?
So what can I say about the FMA PAC decision to endorse Rick Scott? A sad day for Florida's doctors. A sad day for medicine.
Yours
Bernd
Monday, October 11, 2010
Strange Bedfellows: The FMA and Rick Scott
According to a posting on the Florida Medical Association PAC web site ( see attached) the FMA PAC is endorsing endorsing Rick Scott's candidacy as Governor for our State of Florida!!???
Even though I already lowered my expectation regarding FMA's actions and politics I am still surprised that the leadership of such an organization is willing to sacrifice its principles on the altar of political correctness. Sadly, ideology trumped rational thought and consideration. Its hard to believe that the FMA political leadership has omitted considering the following facts in their deliberation process. These facts are available for anyone to read on multiple web sites and were summarized by the Miami Herald in an article published on June 11th, 2010 http://www.miamiherald.com/2010/06/11/v-print/1674327/was-candidate-involved-in-us-healthcare.html, entitled "Was candidate Rick Scott Involved in US Healthcare Scam."
In the article the author states that:
"Scott started what was first Columbia in the spring of 1987, purchasing two El Paso, Texas, hospitals. He quickly grew the company by purchasing more hospitals. A hospital network created efficiencies. Efficiencies created profits.
In 1994, Scott's Columbia purchased Tennessee-headquartered HCA and its 100 hospitals, and merged the companies. When Scott resigned as CEO in 1997, Columbia/HCA had grown to more than 340 hospitals, 135 surgery centers and 550 home health locations in 37 states and two foreign countries, Scott's campaign says. The company employed more than 285,000 people.
Now about Scott's departure in 1997. That year, federal agents went public with an investigation into the company, first seizing records from four El Paso-area hospitals and then expanding across the country. In time it became apparent that the investigation focused on whether Columbia/HCA bilked Medicare and Medicaid.
Scott resigned as CEO in July 1997, less than four months after the inquiry became public and before the depth of the investigation became clear. Company executives said that had Scott remained CEO, the entire chain could have been in jeopardy.
At issue, Scott says, is that he wanted to fight the federal government's accusations. The corporate board of the publicly traded company wanted to settle. And settle Columbia/HCA did.
In December 2000, the U.S. Justice Department announced what it called the largest government fraud settlement in U.S. history when Columbia/HCA agreed to pay $840 million in criminal fines and civil damages and penalties.
Among the revelations from the 2000 settlement, all of which apply to the time Scott was CEO:
• Columbia billed Medicare, Medicaid and other federal programs for tests that were not necessary or ordered by physicians.
• The company attached false diagnosis codes to patient records to increase reimbursement to the hospitals.
• The company illegally claimed nonreimbursable marketing and advertising costs as community education.
• Columbia billed the government for home health care visits for patients who did not qualify to receive them.
The government settled a second series of claims with Columbia/HCA in 2002 for an additional $881 million. The total fine: $1.7 billion."
Furthermore the article continues:
"As part of the 2000 settlement, Columbia/HCA agreed to plead guilty to at least 14 corporate felonies. A corporate felony comes with financial penalties but not jail time, since a corporation can't be sent to prison. Among the 14 felonies, Columbia/HCA pleaded guilty to three counts of conspiracy to defraud the United States.
Also, four Florida-based Columbia/HCA executives were indicted. Two were convicted of defrauding Medicare in 1999 and were sentenced to prison, only to have those convictions overturned on appeal. A third executive was acquitted. A jury failed to reach a verdict on the fourth.
Was Scott close to going to prison for his part in the case? It appears not at all.
The former CEO was never indicted and was never questioned in the case, he says. He may have been a target of the investigation -- an ABC News report from 1997 says he was -- but that never translated into charges."
Let's boil this down.
Was Scott running Columbia/HCA when it found itself at the center of a massive federal investigation? Yes.
Did the company pay a record $1.7 billion in government penalties and fines? Yes.
And as we checked in this item, did his former company commit fraud? Yes, it pleaded guilty to fraud charges as part of a settlement.
The million-dollar question is: How much of the blame ultimately falls on Scott? That's an answer we can't provide.
Scott was in charge, so he bears some responsibility and has said so. But there has yet to come to light any detail of how much he knew, and when he knew it. Though that won't keep us from looking.
What did Rick Scott had to say about all that? Either he pleaded the Fifth Amendment, or claims that he did not know what was going on in his own company. I ask myself just one question: How on earth can anyone entrust the keys to the Governors' office to Rick Scott?
Maybe we should admire the Chutzpah (audacity) of Rick Scott and those who endorse his candidacy?
Maybe its time that in light of these facts doctors should reconsider their support for the FMA's endorsement because this time their leadership went too far.
Yours
Bernd
Attachment: FMA PAC web site http://www.fmaonline.org/Layout_1Column.aspx?pageid=2580
FMA PAC – General Election Endorsements
Statewide Races
Governor – Rick Scott
Attorney General – Pam Bondi
Chief Financial Officer - Jeff Atwater
Commissioner of Agriculture - Adam Putnam
Even though I already lowered my expectation regarding FMA's actions and politics I am still surprised that the leadership of such an organization is willing to sacrifice its principles on the altar of political correctness. Sadly, ideology trumped rational thought and consideration. Its hard to believe that the FMA political leadership has omitted considering the following facts in their deliberation process. These facts are available for anyone to read on multiple web sites and were summarized by the Miami Herald in an article published on June 11th, 2010 http://www.miamiherald.com/2010/06/11/v-print/1674327/was-candidate-involved-in-us-healthcare.html, entitled "Was candidate Rick Scott Involved in US Healthcare Scam."
In the article the author states that:
"Scott started what was first Columbia in the spring of 1987, purchasing two El Paso, Texas, hospitals. He quickly grew the company by purchasing more hospitals. A hospital network created efficiencies. Efficiencies created profits.
In 1994, Scott's Columbia purchased Tennessee-headquartered HCA and its 100 hospitals, and merged the companies. When Scott resigned as CEO in 1997, Columbia/HCA had grown to more than 340 hospitals, 135 surgery centers and 550 home health locations in 37 states and two foreign countries, Scott's campaign says. The company employed more than 285,000 people.
Now about Scott's departure in 1997. That year, federal agents went public with an investigation into the company, first seizing records from four El Paso-area hospitals and then expanding across the country. In time it became apparent that the investigation focused on whether Columbia/HCA bilked Medicare and Medicaid.
Scott resigned as CEO in July 1997, less than four months after the inquiry became public and before the depth of the investigation became clear. Company executives said that had Scott remained CEO, the entire chain could have been in jeopardy.
At issue, Scott says, is that he wanted to fight the federal government's accusations. The corporate board of the publicly traded company wanted to settle. And settle Columbia/HCA did.
In December 2000, the U.S. Justice Department announced what it called the largest government fraud settlement in U.S. history when Columbia/HCA agreed to pay $840 million in criminal fines and civil damages and penalties.
Among the revelations from the 2000 settlement, all of which apply to the time Scott was CEO:
• Columbia billed Medicare, Medicaid and other federal programs for tests that were not necessary or ordered by physicians.
• The company attached false diagnosis codes to patient records to increase reimbursement to the hospitals.
• The company illegally claimed nonreimbursable marketing and advertising costs as community education.
• Columbia billed the government for home health care visits for patients who did not qualify to receive them.
The government settled a second series of claims with Columbia/HCA in 2002 for an additional $881 million. The total fine: $1.7 billion."
Furthermore the article continues:
"As part of the 2000 settlement, Columbia/HCA agreed to plead guilty to at least 14 corporate felonies. A corporate felony comes with financial penalties but not jail time, since a corporation can't be sent to prison. Among the 14 felonies, Columbia/HCA pleaded guilty to three counts of conspiracy to defraud the United States.
Also, four Florida-based Columbia/HCA executives were indicted. Two were convicted of defrauding Medicare in 1999 and were sentenced to prison, only to have those convictions overturned on appeal. A third executive was acquitted. A jury failed to reach a verdict on the fourth.
Was Scott close to going to prison for his part in the case? It appears not at all.
The former CEO was never indicted and was never questioned in the case, he says. He may have been a target of the investigation -- an ABC News report from 1997 says he was -- but that never translated into charges."
Let's boil this down.
Was Scott running Columbia/HCA when it found itself at the center of a massive federal investigation? Yes.
Did the company pay a record $1.7 billion in government penalties and fines? Yes.
And as we checked in this item, did his former company commit fraud? Yes, it pleaded guilty to fraud charges as part of a settlement.
The million-dollar question is: How much of the blame ultimately falls on Scott? That's an answer we can't provide.
Scott was in charge, so he bears some responsibility and has said so. But there has yet to come to light any detail of how much he knew, and when he knew it. Though that won't keep us from looking.
What did Rick Scott had to say about all that? Either he pleaded the Fifth Amendment, or claims that he did not know what was going on in his own company. I ask myself just one question: How on earth can anyone entrust the keys to the Governors' office to Rick Scott?
Maybe we should admire the Chutzpah (audacity) of Rick Scott and those who endorse his candidacy?
Maybe its time that in light of these facts doctors should reconsider their support for the FMA's endorsement because this time their leadership went too far.
Yours
Bernd
Attachment: FMA PAC web site http://www.fmaonline.org/Layout_1Column.aspx?pageid=2580
FMA PAC – General Election Endorsements
Statewide Races
Governor – Rick Scott
Attorney General – Pam Bondi
Chief Financial Officer - Jeff Atwater
Commissioner of Agriculture - Adam Putnam
Sunday, October 03, 2010
Prescription Drug Prices
In todays Miami Herald State Representative Juan C. Zapata calls for a mandated use of generic drugs for Medicaid and other state-funded programs http://www.miamiherald.com/2010/10/03/1854185/mandate-use-of-generic-drugs-for.html . He is correct saying that the use of generic drugs will slow down the predicted explosive growth of Medicaid expenditures but the mandated use of generic drugs addresses only ONE aspect of the problem. According to a New York Times article , Drug Makers Accused of Ignoring Price Law,” http://www.nytimes.com/2010/10/03/us/03drug.html , drug manufacturers consistently defy complying with a federal law that requires them to provide the government with pricing data needed to calculate discounts on medications prescribed for Medicaid recipients. More than three-fourths of drug manufacturers did not fully comply with the law requiring them to provide price data. They are supposed to file monthly and quarterly reports on what wholesalers paid them for drugs eventually sold to retail pharmacies. Without price data, the federal government cannot compute rebates, and states may be unable to collect them. As a condition of having their drugs covered by Medicaid, pharmaceutical companies must agree to provide discounts in the form of rebates. Drug companies pay the rebates to state Medicaid programs. The federal government and the states share the cost of Medicaid — roughly $400 billion in the last year — and share the savings that result from the rebates. Under the health care law, the minimum rebate on brand-name drugs dispensed to Medicaid recipients was increased to 23.1 percent of the average manufacturer price, from 15.1 percent. The minimum rebate on generic drugs was increased to 13 percent, from 11 percent. The Congressional Budget Office estimates that the changes could save the federal government more than $35 billion over 10 years. Major drug companies are already reporting adverse effects on their revenues. However, drug companies stand to gain many customers with the scheduled Medicaid expansion in 2014. What can be done to address this problem? Under federal law, the government can impose penalties of $10,000 a day on a drug manufacturer that fails to provide the information “on a timely basis. According to the Inspector General at the Department of Health and Human Services the federal government has had this authority since 1990 but has not used it! Why not? We must control and limit the rising healthcare costs and drug manufactures must understand that they can be either be part of the problem, or part of the solution. We also should lift the limitation on prescription drug re-importation and stop the unscrupulous use of antipsychotic drugs, which generate over $14 billion in revenue for drug manufacturers. Otherwise, we have no choice but to resort to rationing of healthcare services and prescription drugs.
Yours
Bernd
Yours
Bernd
Thursday, September 30, 2010
Medicare Fraud
So, it finally happened! Jay Weaver, the Miami Herald journalist who uncovered many Medicare fraud issues in South Florida, wrote another excellent article reporting that CMS is now being forced to revamp its payment policy. In his latest article http://www.miamiherald.com/2010/09/30/v-print/1849528/medicares-new-order-first-weigh.html he emphasizes that:
"An anti-fraud provision, tucked into the Small Business Lending Act that became law Monday, would force Medicare to end its 45-year-old policy of paying claims quickly without verifying them. The Centers for Medicare and Medicaid Services, which pays out $500 billion yearly for elderly and disabled Americans, would have to adopt new billing software with ``predictive modeling'' by next year. Such analytical technology enables the credit card industry to detect questionable bills for, say, a flat-screen TV purchased outside a cardholder's immediate area so that companies can notify the customer and stop payment if fraud is a factor.The cost of rolling out the new billing technology would reach an estimated $930 million over the next decade but it may reduce or prevent paying one of every $7 to fraudulent claimants.
Furthermore, the new Affordable Care Act includes tougher penalties for offenders, expanded administrative powers for Medicare and $350 million to combat healthcare corruption over the next decade."
Sen. George LeMieux, R-Florida, who sponsored the anti-fraud bill, said he has been frustrated watching Medicare continue to pay billions to dubious healthcare providers for unnecessary or bogus services. But Senator LeMieux supports the Republican Party platform to repeal the same Affordable Care Act which funds such anti-fraud activities! Does he really believe that the voters are that stupid, or short-term memory challenged, to forget his election antics?
Its time that politicians start collaborating and cooperating to solve the real problems we are facing and to focus on stopping the Medicare fraud gravy train.
But maybe I am too naive to believe that politicians are capable to act and behave rationally.
Yours
Bernd
"An anti-fraud provision, tucked into the Small Business Lending Act that became law Monday, would force Medicare to end its 45-year-old policy of paying claims quickly without verifying them. The Centers for Medicare and Medicaid Services, which pays out $500 billion yearly for elderly and disabled Americans, would have to adopt new billing software with ``predictive modeling'' by next year. Such analytical technology enables the credit card industry to detect questionable bills for, say, a flat-screen TV purchased outside a cardholder's immediate area so that companies can notify the customer and stop payment if fraud is a factor.The cost of rolling out the new billing technology would reach an estimated $930 million over the next decade but it may reduce or prevent paying one of every $7 to fraudulent claimants.
Furthermore, the new Affordable Care Act includes tougher penalties for offenders, expanded administrative powers for Medicare and $350 million to combat healthcare corruption over the next decade."
Sen. George LeMieux, R-Florida, who sponsored the anti-fraud bill, said he has been frustrated watching Medicare continue to pay billions to dubious healthcare providers for unnecessary or bogus services. But Senator LeMieux supports the Republican Party platform to repeal the same Affordable Care Act which funds such anti-fraud activities! Does he really believe that the voters are that stupid, or short-term memory challenged, to forget his election antics?
Its time that politicians start collaborating and cooperating to solve the real problems we are facing and to focus on stopping the Medicare fraud gravy train.
But maybe I am too naive to believe that politicians are capable to act and behave rationally.
Yours
Bernd
Wednesday, September 22, 2010
Healthcare Reform
Several very important component of the federal healthcare reform package are going to go into effect tomorrow.
Therefore, we should review the facts (and not fiction) regarding those components which will protect our patients (i.e. our families) from insurance companies. I hope that physicians will finally embrace these reforms, too. There should be no reason to reject them!
I also recommend reading today's Miami Herald editorial supporting healthcare reform. I agree with the authors conclusion:
"But tweaking the law and trying to get rid of it altogether, as a lawsuit filed by Florida's attorney general and others aims to do, are two different things. The law is an investment in the health and future of the American people. It can be improved, but it should become a permanent feature of American society."
Read more: http://www.miamiherald.com/2010/09/22/v-print/1836040/healthcare-reform-should-be-here.html#ixzz10Jt5GrD4
Yours
Bernd
* Preventive services:
o Based on the theory that inexpensive preventive measures can reduce expensive hospital visits later, the reform act requires insurers to pay all costs for many immunization vaccines and screenings for colorectal cancer (for those over 50), depression, high blood pressure (for diabetics) and autism (for children 18 months to 24 months.)
o Also covered at 100 percent are mammograms for women over 40 and smoking cessation programs. For a full list of preventive services covered go to www.healthcare.gov/law/
* Adult children:
o All new private insurance that offers dependent coverage must allow parents to cover their children until age 26. They can live elsewhere and still be covered, and they must be charged at the policy's prevailing child rates.I
o If adult children can get insurance through their own jobs, they can't switch to their parents' existing job-based coverage if it's grandfathered. But if they don't have work coverage, they can move to parents' plans, even if the employers are planning to continue using their current plans.
* Right to appeal:
o Consumers covered under new, non-grandfathered insurance plans will have a right to appeal to an external party if, for example, their insurer denies coverage of treatments recommended by their doctors.
o Consumers will first have to file an internal appeal with the insurers. If not satisfied, they then can appeal to an impartial reviewer. Details of who will handle reviews and what regulations will apply are being worked out.
* No exclusions for children:
o In the past, insurers can -- and regularly did -- deny children with pre-existing conditions. As of Sept. 23, Thursday, they will be required to accept all kids, regardless of health status.
o This provision has led to spirited debate. Insurers' fear is that parents would wait until their kids got sick to buy coverage. `
o Insurers depend on providing coverage for a broad pool of people -- with the healthy majority paying premiums that fund the sick minority. Their fear with reform is that if only sick people sign up, insurers will lose huge amounts of money or need to raise premiums to horrendously high rates. Starting in 2014, that fear vanishes, because virtually everyone will be required then to have insurance.
o Health and Human Services recently responded to the insurers' fears about kid coverage, allowing insurers in the individual market to have an open enrollment period of, say, one month a year in which families could sign up children under 19 with pre-existing conditions. That means families will be encouraged to enroll healthy kids because they won't be able to automatically sign them up when they get sick.
* Lifetime caps removed:
o Many policies have limitations of $1 million, $2 million or even more. Most people never even have to think about them. But for those with severe chronic illness, their removal could mean a lot, possibly even preventing bankruptcy.
* High risk pools:
o For the truly desperate, the new high-risk pools can be a lifesaver -- but not a cheap one. They're intended for uninsured patients who have pre-existing conditions and can't get coverage elsewhere. They will serve as a bridge until 2014, when there are new government-regulated insurance exchanges accepting virtually everyone who can't get coverage elsewhere.
o Florida has had a high-risk pool for years, but because of the expense, it has been closed to new patients since 1991 and has only 250 members left.
o The Legislature opted not to re-open it in response to the reform act, meaning that the state's residents can sign up for a federally sponsored pool, known as the Pre-Existing Condition Insurance Plan.
o Under the plan, Florida residents will pay monthly rates ranging from $363 for those up to 34 and as much as $773 for those 55 and older, according to healthcare.gov . That's with a $2,500 deductible and maximum out-of-pocket of $5,950 a year. Those payments cover only part of their insurance costs. The feds have allocated $351 million to Florida to pick up the rest of the expenses till 2014. Critics fear that's not enough.
o The program is only for those who are legally in the United States, have been uninsured for at least six months and have been denied coverage because of a pre-existing condition. Applications are available at healthcare.gov or by calling (866) 717-5826.
* Limiting insurers' profits:
o Starting Jan. 1, insurers of large groups will be required to spend 85 percent of premiums on healthcare. For insurers of small groups and individual policies, it's 80 percent. In 2012, if insurers fail to meet these requirements, they must offer rebates to customers.
o Should money spent on converting to electronic records be counted as a medical expense or an administrative one? What about monitoring infectious disease rates in hospitals or money spent managing chronic conditions?
o The National Association of Insurance Commissioners has been working on draft guidelines. The U.S. Department of Health and Human Services says it has not yet received them.
* Other changes:
* About one million seniors have already received $250 rebate checks because of high prescription drug costs that were not covered by Medicare Part D.
* About 70 South Florida organizations -- including the Miami-Dade and Broward school systems -- will get funds to help pay for healthcare for retirees aged 55 to 64 who are not eligible for Medicare.
* Starting this year, businesses with no more than 25 workers with average annual wages under $50,000 can get tax credits of up to 35 percent of the costs of premiums.
For further information, healthcare.gov is the government site for the reform act. The Kaiser Family Foundation (kff.org), the Commonwealth Fund (commonwealthfund.org ) and Families USA (familiesusa.org) are three Washington nonprofits that provide details and analysis of the reform act.
Therefore, we should review the facts (and not fiction) regarding those components which will protect our patients (i.e. our families) from insurance companies. I hope that physicians will finally embrace these reforms, too. There should be no reason to reject them!
I also recommend reading today's Miami Herald editorial supporting healthcare reform. I agree with the authors conclusion:
"But tweaking the law and trying to get rid of it altogether, as a lawsuit filed by Florida's attorney general and others aims to do, are two different things. The law is an investment in the health and future of the American people. It can be improved, but it should become a permanent feature of American society."
Read more: http://www.miamiherald.com/2010/09/22/v-print/1836040/healthcare-reform-should-be-here.html#ixzz10Jt5GrD4
Yours
Bernd
* Preventive services:
o Based on the theory that inexpensive preventive measures can reduce expensive hospital visits later, the reform act requires insurers to pay all costs for many immunization vaccines and screenings for colorectal cancer (for those over 50), depression, high blood pressure (for diabetics) and autism (for children 18 months to 24 months.)
o Also covered at 100 percent are mammograms for women over 40 and smoking cessation programs. For a full list of preventive services covered go to www.healthcare.gov/law/
* Adult children:
o All new private insurance that offers dependent coverage must allow parents to cover their children until age 26. They can live elsewhere and still be covered, and they must be charged at the policy's prevailing child rates.I
o If adult children can get insurance through their own jobs, they can't switch to their parents' existing job-based coverage if it's grandfathered. But if they don't have work coverage, they can move to parents' plans, even if the employers are planning to continue using their current plans.
* Right to appeal:
o Consumers covered under new, non-grandfathered insurance plans will have a right to appeal to an external party if, for example, their insurer denies coverage of treatments recommended by their doctors.
o Consumers will first have to file an internal appeal with the insurers. If not satisfied, they then can appeal to an impartial reviewer. Details of who will handle reviews and what regulations will apply are being worked out.
* No exclusions for children:
o In the past, insurers can -- and regularly did -- deny children with pre-existing conditions. As of Sept. 23, Thursday, they will be required to accept all kids, regardless of health status.
o This provision has led to spirited debate. Insurers' fear is that parents would wait until their kids got sick to buy coverage. `
o Insurers depend on providing coverage for a broad pool of people -- with the healthy majority paying premiums that fund the sick minority. Their fear with reform is that if only sick people sign up, insurers will lose huge amounts of money or need to raise premiums to horrendously high rates. Starting in 2014, that fear vanishes, because virtually everyone will be required then to have insurance.
o Health and Human Services recently responded to the insurers' fears about kid coverage, allowing insurers in the individual market to have an open enrollment period of, say, one month a year in which families could sign up children under 19 with pre-existing conditions. That means families will be encouraged to enroll healthy kids because they won't be able to automatically sign them up when they get sick.
* Lifetime caps removed:
o Many policies have limitations of $1 million, $2 million or even more. Most people never even have to think about them. But for those with severe chronic illness, their removal could mean a lot, possibly even preventing bankruptcy.
* High risk pools:
o For the truly desperate, the new high-risk pools can be a lifesaver -- but not a cheap one. They're intended for uninsured patients who have pre-existing conditions and can't get coverage elsewhere. They will serve as a bridge until 2014, when there are new government-regulated insurance exchanges accepting virtually everyone who can't get coverage elsewhere.
o Florida has had a high-risk pool for years, but because of the expense, it has been closed to new patients since 1991 and has only 250 members left.
o The Legislature opted not to re-open it in response to the reform act, meaning that the state's residents can sign up for a federally sponsored pool, known as the Pre-Existing Condition Insurance Plan.
o Under the plan, Florida residents will pay monthly rates ranging from $363 for those up to 34 and as much as $773 for those 55 and older, according to healthcare.gov . That's with a $2,500 deductible and maximum out-of-pocket of $5,950 a year. Those payments cover only part of their insurance costs. The feds have allocated $351 million to Florida to pick up the rest of the expenses till 2014. Critics fear that's not enough.
o The program is only for those who are legally in the United States, have been uninsured for at least six months and have been denied coverage because of a pre-existing condition. Applications are available at healthcare.gov or by calling (866) 717-5826.
* Limiting insurers' profits:
o Starting Jan. 1, insurers of large groups will be required to spend 85 percent of premiums on healthcare. For insurers of small groups and individual policies, it's 80 percent. In 2012, if insurers fail to meet these requirements, they must offer rebates to customers.
o Should money spent on converting to electronic records be counted as a medical expense or an administrative one? What about monitoring infectious disease rates in hospitals or money spent managing chronic conditions?
o The National Association of Insurance Commissioners has been working on draft guidelines. The U.S. Department of Health and Human Services says it has not yet received them.
* Other changes:
* About one million seniors have already received $250 rebate checks because of high prescription drug costs that were not covered by Medicare Part D.
* About 70 South Florida organizations -- including the Miami-Dade and Broward school systems -- will get funds to help pay for healthcare for retirees aged 55 to 64 who are not eligible for Medicare.
* Starting this year, businesses with no more than 25 workers with average annual wages under $50,000 can get tax credits of up to 35 percent of the costs of premiums.
For further information, healthcare.gov is the government site for the reform act. The Kaiser Family Foundation (kff.org), the Commonwealth Fund (commonwealthfund.org ) and Families USA (familiesusa.org) are three Washington nonprofits that provide details and analysis of the reform act.
Monday, September 06, 2010
Shifting Healthcare Costs
According to a recent editorial published in the New York Times (Shifting the Health Cost Burden, September, 2nd, 2010) "the latest annual survey of employer health benefits contains good news for the employers but bad news for their workers."
What are the good news? The average total premium for employer-sponsored health insurance (typically paid partly by employers and partly by their workers) rose only a modest 3 percent this year for family plans, reaching $13,770 in 2010.
What are the bad news? The employee share of their premium soared by 14% reaching almost $4,000, while the amount employers contributed did not increase.
Whats are the results?
* Employers shifted virtually all of the increased premium costs to their employees , who were in a weak position to resist in an economy where there were few other jobs to jump to.
* Since 2005, while wages have increased just 18 percent, workers’ contributions to premiums have jumped 47 percent, almost twice as fast as the rise in the policy’s overall cost.
* Meanwhile insurances are getting stingier and less comprehensive.
* Workers face higher deductibles, forcing them to pay a larger share of their overall medical bills. The Kaiser survey found a significant increase in the number of employees who had a deductible of at least $1,000, to 27 percent this year, from 22 percent in 2009. Almost half of workers who are covered by a small employer with fewer than 200 workers have an annual deductible of that amount.
* Increasing out-of-pocket expenses will almost certainly reduce the number of medical office visits, will force staff to collect deductibles at the point-of-care, or bill the patients and write off the increasing amount of unpaid bills. This will further decrease the margins in family medicine offices and force doctors to see more patients for less money!
What can we do? Facing very tight profit margins doctors must improve the efficiency of their offices, teach their staff to work as teams and advertise their medical services to those seeking cheaper medical services.
Instead of working harder we must work smarter. Yelling and screaming will not help us to move forward. We must learn to run our offices as small businesses and adapt quickly to the rapidly changing market place.
Yours
Bernd
What are the good news? The average total premium for employer-sponsored health insurance (typically paid partly by employers and partly by their workers) rose only a modest 3 percent this year for family plans, reaching $13,770 in 2010.
What are the bad news? The employee share of their premium soared by 14% reaching almost $4,000, while the amount employers contributed did not increase.
Whats are the results?
* Employers shifted virtually all of the increased premium costs to their employees , who were in a weak position to resist in an economy where there were few other jobs to jump to.
* Since 2005, while wages have increased just 18 percent, workers’ contributions to premiums have jumped 47 percent, almost twice as fast as the rise in the policy’s overall cost.
* Meanwhile insurances are getting stingier and less comprehensive.
* Workers face higher deductibles, forcing them to pay a larger share of their overall medical bills. The Kaiser survey found a significant increase in the number of employees who had a deductible of at least $1,000, to 27 percent this year, from 22 percent in 2009. Almost half of workers who are covered by a small employer with fewer than 200 workers have an annual deductible of that amount.
* Increasing out-of-pocket expenses will almost certainly reduce the number of medical office visits, will force staff to collect deductibles at the point-of-care, or bill the patients and write off the increasing amount of unpaid bills. This will further decrease the margins in family medicine offices and force doctors to see more patients for less money!
What can we do? Facing very tight profit margins doctors must improve the efficiency of their offices, teach their staff to work as teams and advertise their medical services to those seeking cheaper medical services.
Instead of working harder we must work smarter. Yelling and screaming will not help us to move forward. We must learn to run our offices as small businesses and adapt quickly to the rapidly changing market place.
Yours
Bernd
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