While waiting in line for a cup of coffee at a Dunkin Donuts I glimpsed at the front-page of USA TODAY reading that for two consecutive years not a single airline passenger died in a U.S. carrier crash! No passengers died in accidents in 2007 and 2008, a period in which commercial airliners carried 1.5 billion passengers on scheduled airline flights, according to a USA TODAY analysis of federal and industry data. That’s indeed great news! So why is that happening? Because government requirements during the past two decades have made planes safer in violent impacts and fires, reducing the likelihood of deaths,technology improvements led to the development of more reliable aircraft and better training of airline personnel contributed to this impressive record too.
In contrast a recent OIG (Office of Inspector General of the US Department of Health) study http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf found that one in seven Medicare patients were harmed by the care they received in the hospital during a month studied by the agency. The study shows that hospital patients are harmed much more frequently than previously estimated and points to the need for mandatory validated public reporting of medical errors, according to Consumers Union, the nonprofit publisher of Consumer Reports. The OIG study was based on a physician review of the medical records of a nationally representative sample of 780 Medicare patients during October 2008. It found that 134,000 hospitalized Medicare patients experienced medical harm in that month. The OIG calculated that Medicare patients harmed during that month required an additional $324 million in hospital care. The study estimated the annual cost for these events in hospital care alone at $4.4 billion. According to the OIG, an estimated 15,000 Medicare patients experienced medical errors in the hospital that contributed to their deaths each month. That amounts to about 180,000 patients annually. 25 states and the District of Columbia collect data from hospitals on the incidence of certain medical errors. But only six states have disclosed hospital-specific medical error information to the public. Even worse, half of all states do not have any medical error reporting requirements in place. In most states, hospital-specific information is kept secret and hospitals can get away with under-reporting errors because there is no effort made to systematically validate the data that hospitals are required to report.
So whats the conclusion? Its safer to receive medical care while flying? Maybe. Or, should we apply the experience gained in the airline industry to the medical industry? Would we better off establishing the medical equivalent of the FAA (Federal Aviation Administration)? I believe we should?
Maybe now is the time to reevaluate our approach to medical error prevention and to reconsider our resistance to report medical errors from which we all could learn from. But maybe I just like flying too much.
Yours
Bernd
Airlines go two years with no fatalities
By Alan Levin, USA TODAY
For the first time since the dawn of the jet age, two consecutive years have passed without a single airline passenger death in a U.S. carrier crash.
No passengers died in accidents in 2007 and 2008, a period in which commercial airliners carried 1.5 billion passengers on scheduled airline flights, according to a USA TODAY analysis of federal and industry data.
One major accident occurred during that time, last month's crash of a Continental Airlines jet in Denver.
Going without a crash fatality for a full year has been rare. Only four years since 1958 have passed without a passenger fatality, the analysis found. That makes the two-year string even more impressive, aviation safety experts say.
"It's a new record," says Arnold Barnett, a Massachusetts Institute of Technology professor who has written extensively about airline fatality risks.
"While it doesn't mean risk is now non-existent," Barnett says, "it certainly means they have done a fantastic job at keeping all these threats at bay."
Barnett calculates that it's more likely for a young child to be elected president in his or her lifetime than to die on a single jet flight in the USA or in similar industrial nations in Europe, Canada or Japan.
"It's just more evidence of what has been the improving safety record that we've seen over the past several years," says Bill Voss, president of the Flight Safety Foundation, a non-profit group that promotes aviation safety around the world.
Overall risks of death on an airline flight have dropped dramatically.
Fatality risk fell to 68 per billion fliers this decade, less than half the risk in the 1990s, according to National Transportation Safety Board (NTSB) data. Since 2002, the risks of dying on a flight plunged to 19 per billion, an 86% drop from the 1990s.
The fiery Continental Airlines crash Dec. 20 in Denver shows it can still be hazardous to fly. The jet turned off a runway while attempting to take off, breaking apart and bursting into flames.
All 115 people aboard escaped as jet fuel burned through the right side of the jet. The crash injured 38 people, five seriously, the NTSB said.
The crash helps illustrate why death rates have fallen, Voss says.
Government requirements during the past two decades have made planes safer in violent impacts and fires, reducing the likelihood of deaths, he says.
Technology improvements, more reliable aircraft and better training also have helped reduce accidents, Voss says.
The lack of fatal crashes creates new challenges for federal regulators and the airline industry. Further safety improvements must come from studying the minor anomalies of everyday flight.
"What we're looking at now is the risks before they manifest themselves into accidents," says Basil Barimo, with the Air Transport Association.
Monday, January 24, 2011
Saturday, January 22, 2011
Pain Clinics: Board of Medicine Calls For Rules Implementation
There are (mixed) good news to report in the struggle to curb the explosive growth of pain clinics in Florida.
According to a SunSentinel article published today the Florida Board of Medicine on Friday unanimously passed pain-clinic rules that will impose an estimated $65 million in costs despite Gov. Rick Scott's edict to ban rule-making this year.
Board members asked their staff to send letters to both the Legislature and the governor's Office of Fiscal Accountability and Regulatory Reform, explaining the need for immediate implementation of these rules, given the significant threat to public health and safety that some "pill mills" have created in the state. The four rules adopted on Friday set out the requirements for standards of care, inspections,accreditation and training in pain-management practices.
Several members, who met by conference call, mentioned that they support Scott's call for a halt to rule-making to make sure that the process doesn't unduly impose a burden on small businesses and the public. In fact, the board voted unanimously to suspend rule-making other than the regulations on pain clinics. The Department of Health commissioned a study by the Center for Economic Forecasting and Analysis at Florida State University after the Legislature required them for all pending rules with at least a $200,000 impact on business. The Center churned out the study in just one month in order to leave time for the board to decide whether to submit the rules by the Feb. 4 deadline for consideration during this year's legislative session. I still do not understand why "pain clinics" count as legitimate business entities!!!
Unfortunately, neither the Senate nor the House leadership are willing to call for a special session to pass these rules, therefore causing further implementation delay.
How many Floridians have to die before legislators understand that this is a public health emergency requiring a drastic and quick response?
Declaring a public health emergency would also allow for the immediate implementation of the Prescription Drug Monitoring Program which is hold up by a bidder protest.
The time to act is now!!!
Yours
Bernd
South Florida Sun-Sentinel.com Med board to legislators: End delay on pill mill rules
Rules would cost pain clinics, patients $65 million a year
By Bob LaMendola, Sun Sentinel
January 21, 2011
Florida regulators trying to stop the illicit flow of narcotic pills from rogue pain clinics called Friday for the state Legislature to quickly approve stricter rules.
The Florida Board of Medicine was ready to adopt new pain clinic rules but then legislators passed a law in November saying no rules could take effect until approved by the state House and Senate. Legislative action is not expected on any rules until the annual session starts March 8.
Friday, the medical board sent the rules to lawmakers and urged fast action. One board member, Dr. Steven Rosenberg of West Palm Beach, suggested a special session as early as next week, when most legislators are in Tallahassee for meetings.
"It would only take them a few minutes," Rosenberg said. "We can't afford to wait until the regular session in March. That's [hundreds more] people who will die as a result of the pill mills."
Officials estimate that seven Floridians die every day from prescription drug overdoses, some of those due to pill mills – unscrupulous pain clinics concentrated in South Florida that peddle large quantities of painkillers to dealers and addicts.
Don't expect any action before March, legislative officials said.
"A special session? That's not going to happen," said David Bishop, a spokesman for Senate President Mike Haridopolos, R-Indialantic. Legislators need time to review the details, he said.
Katy Betta, a spokeswoman for House Speaker Dean Cannon, R-Winter Park, said the medical board spent more than a year writing the rules, so a legislative subcommittee would spend a few weeks reviewing them.
The rules would let the state inspect pain clinics and punish clinic doctors for violations. The doctors would have to examine every patient before writing a prescription, give drug tests to patients and cut off pain pills to patients who abuse them.
The rules face another potential roadblock from Gov. Rick Scott, who this month froze all proposed rules for a review by his advisers. But officials said they did not think he would hold them up.
Rosenberg and other supporters said they worry that some pain clinic owners and physicians who oppose aspects of the rules might lobby legislators to change the wording and send the rules back to square one.
As part of its action in November, the Legislature ordered state officials to estimate the cost of every new rule. A report for the medical board found that pain clinic rules would cost about $65 million in the first year and $61 million a year in the future. Each of the 923 pain clinics – a state-high 117 in Broward County, 113 in Palm Beach County, 49 in Orange County – would pay $69,000 a year.
About $60,000 of that would be charged to patients, who will have to pay $17 each for urine tests twice a year, the report said.
Paul Sloan, a Venice pain clinic owner who is president of Florida Society of Pain Management Providers, said the cost is a little higher than expected but worth it.
The Florida Academy of Pain Medicine favored the rules and the cost Friday, but said the strongest part of crack down – a statewide database of pain pill prescriptions so police and doctors can track pill abusers – also is stalled. The database was to start Dec. 1 but is held up by a bidder's protest.
Bob LaMendola can be reached at blamendola@SunSentinel.com or 954-356-4526.
Copyright © 2011, South Florida Sun-Sentinel
According to a SunSentinel article published today the Florida Board of Medicine on Friday unanimously passed pain-clinic rules that will impose an estimated $65 million in costs despite Gov. Rick Scott's edict to ban rule-making this year.
Board members asked their staff to send letters to both the Legislature and the governor's Office of Fiscal Accountability and Regulatory Reform, explaining the need for immediate implementation of these rules, given the significant threat to public health and safety that some "pill mills" have created in the state. The four rules adopted on Friday set out the requirements for standards of care, inspections,accreditation and training in pain-management practices.
Several members, who met by conference call, mentioned that they support Scott's call for a halt to rule-making to make sure that the process doesn't unduly impose a burden on small businesses and the public. In fact, the board voted unanimously to suspend rule-making other than the regulations on pain clinics. The Department of Health commissioned a study by the Center for Economic Forecasting and Analysis at Florida State University after the Legislature required them for all pending rules with at least a $200,000 impact on business. The Center churned out the study in just one month in order to leave time for the board to decide whether to submit the rules by the Feb. 4 deadline for consideration during this year's legislative session. I still do not understand why "pain clinics" count as legitimate business entities!!!
Unfortunately, neither the Senate nor the House leadership are willing to call for a special session to pass these rules, therefore causing further implementation delay.
How many Floridians have to die before legislators understand that this is a public health emergency requiring a drastic and quick response?
Declaring a public health emergency would also allow for the immediate implementation of the Prescription Drug Monitoring Program which is hold up by a bidder protest.
The time to act is now!!!
Yours
Bernd
South Florida Sun-Sentinel.com Med board to legislators: End delay on pill mill rules
Rules would cost pain clinics, patients $65 million a year
By Bob LaMendola, Sun Sentinel
January 21, 2011
Florida regulators trying to stop the illicit flow of narcotic pills from rogue pain clinics called Friday for the state Legislature to quickly approve stricter rules.
The Florida Board of Medicine was ready to adopt new pain clinic rules but then legislators passed a law in November saying no rules could take effect until approved by the state House and Senate. Legislative action is not expected on any rules until the annual session starts March 8.
Friday, the medical board sent the rules to lawmakers and urged fast action. One board member, Dr. Steven Rosenberg of West Palm Beach, suggested a special session as early as next week, when most legislators are in Tallahassee for meetings.
"It would only take them a few minutes," Rosenberg said. "We can't afford to wait until the regular session in March. That's [hundreds more] people who will die as a result of the pill mills."
Officials estimate that seven Floridians die every day from prescription drug overdoses, some of those due to pill mills – unscrupulous pain clinics concentrated in South Florida that peddle large quantities of painkillers to dealers and addicts.
Don't expect any action before March, legislative officials said.
"A special session? That's not going to happen," said David Bishop, a spokesman for Senate President Mike Haridopolos, R-Indialantic. Legislators need time to review the details, he said.
Katy Betta, a spokeswoman for House Speaker Dean Cannon, R-Winter Park, said the medical board spent more than a year writing the rules, so a legislative subcommittee would spend a few weeks reviewing them.
The rules would let the state inspect pain clinics and punish clinic doctors for violations. The doctors would have to examine every patient before writing a prescription, give drug tests to patients and cut off pain pills to patients who abuse them.
The rules face another potential roadblock from Gov. Rick Scott, who this month froze all proposed rules for a review by his advisers. But officials said they did not think he would hold them up.
Rosenberg and other supporters said they worry that some pain clinic owners and physicians who oppose aspects of the rules might lobby legislators to change the wording and send the rules back to square one.
As part of its action in November, the Legislature ordered state officials to estimate the cost of every new rule. A report for the medical board found that pain clinic rules would cost about $65 million in the first year and $61 million a year in the future. Each of the 923 pain clinics – a state-high 117 in Broward County, 113 in Palm Beach County, 49 in Orange County – would pay $69,000 a year.
About $60,000 of that would be charged to patients, who will have to pay $17 each for urine tests twice a year, the report said.
Paul Sloan, a Venice pain clinic owner who is president of Florida Society of Pain Management Providers, said the cost is a little higher than expected but worth it.
The Florida Academy of Pain Medicine favored the rules and the cost Friday, but said the strongest part of crack down – a statewide database of pain pill prescriptions so police and doctors can track pill abusers – also is stalled. The database was to start Dec. 1 but is held up by a bidder's protest.
Bob LaMendola can be reached at blamendola@SunSentinel.com or 954-356-4526.
Copyright © 2011, South Florida Sun-Sentinel
Friday, January 21, 2011
Patient Can Receive their lab results - But not in Florida!
Attached an article published in today's Miami Herald reporting that Quest Diagnostics, the nation's largest provider of lab services, is allowing patients to get test results sent to them directly but is NOT permitted doing so in Florida! Why? Florida state statute 483.181 requires that lab results "must be reported directly to the licensed practitioner or other authorized person who requested.'' An administrative code interpretation states: "No report . . . shall be sent to the patient concerned except with the written consent of the authorized person who requested the test.''
In my opinion this need to change! Medicine should be a collaborative effort between physicians and patients. Accountability and transparency should be the focus of our medical care. In my practice each and every patient has the right to receive his/her diagnostic test results within 48 hours via e-mail or mail with attached interpretation of the results. This excludes results that requires a one-on-one discussion (positive HIV, significant MMG and Biopsy results etc.) One way to circumvent this issue is the establishment of personal health records and patient portals. I transfer all of my Allscript Prescription data to the patients personal health record if so requested. Many do not know that this even exists.
Looking forward to your feedback.
yours
Bernd
The Miami Herald
Posted on Fri, Jan. 21, 2011
Get lab results quickly, but not here
BY JOHN DORSCHNER
jdorschner@MiamiHerald.com
With healthcare experts pushing for more patient involvement, Quest Diagnostics, the nation's largest provider of lab services, is allowing patients to get test results sent to them directly -- but not in Florida.
``Disclosure and transparency is here and now,'' said Jon Cohen, Quest's chief medical officer, at a recent University of Miami symposium.
Well, not exactly here. Florida is one of 13 states that forbids diagnostic companies from transmitting results directly to patients.
That makes no sense to Beth Wheeling, a retired South Miami psychologist and cancer patient. ``Why is there this infantilization of the patient? Why do they think we cannot handle this? I hope Florida grows up.''
The Florida Medical Association and the American Medical Association did not respond to requests for comment.
The Quest initiative ``is the beginning of a trend toward more knowledge for consumers,'' said Russell Robbins, a doctor and principal at Mercer, a national consulting firm.
He said it has previously been possible for patients using some smaller labs to go to the Web for results, but with this new program ``the information is getting back freely'' by automatically being sent to smart phones via a special app.
LabCorp, the other big national testing company, did not respond to four requests for comment.
The Quest program, called Gazelle, is presently set up only for smart phones and includes ways for people to access and keep track of their medical records. Patients who sign up for the service have to wait 48 hours after the doctors get the results, so the physician can first have a chance to talk to patients.
Quest research shows that 7 percent of negative test results never reach patients because of communications mix-ups, Cohen said. In another 14 or 15 percent of cases, tests are duplicated by other doctors because they don't have access to the original results. That can be remedied by a patient having test results on a phone and being able to forward them quickly to whomever he or she wants.
One exception for Gazelle: It will not be used to transmit seriously bad news, such as testing positive for cancer or the HIV virus. ``That's best told by a professional,'' Cohen said.
Quest surveys show that patients who see test results -- cholesterol and blood sugar levels -- are more likely to be motivated to take better care of themselves.
That makes sense to Bernd Wollschlaeger, a North Miami Beach family physician and former president of the Dade Medical Association. ``I don't see any downside'' to the Quest program.
``We should be establishing collaborative care'' in which doctor and patient work together.
However, state statute 483.181 requires that lab results ``must be reported directly to the licensed practitioner or other authorized person who requested.''
An administrative code interpretation states: ``No report . . . shall be sent to the patient concerned except with the written consent of the authorized person who requested the test.''
A Quest spokesman said the company has software that allows doctors to forward Quest results to patients, which Florida doctors could use if they want.
Robbins, the Mercer consultant, said it's important that patients get the information to go along with the tests -- for example, what a number for platelets really means. ``Hopefully these results will be in conjunction with discussions with doctors.''
Robbins said a blood test ``is really a snapshot of when the blood was drawn,'' and it's often important that a result be compared with other results, which ideally would be kept in an electronic personal health record.
Wheeling, the retired psychologist, said she would love to see faster reporting on all sorts of tests because of the anxiety in waiting for results. She recalled going to the hospital for a scan to see if cancer had returned. The test showed it had not, but it took her a week to learn that.
``I think somebody at the hospital looked at the scan and could have told me within minutes,'' Wheeling said. ``The wait is totally unacceptable.''
In my opinion this need to change! Medicine should be a collaborative effort between physicians and patients. Accountability and transparency should be the focus of our medical care. In my practice each and every patient has the right to receive his/her diagnostic test results within 48 hours via e-mail or mail with attached interpretation of the results. This excludes results that requires a one-on-one discussion (positive HIV, significant MMG and Biopsy results etc.) One way to circumvent this issue is the establishment of personal health records and patient portals. I transfer all of my Allscript Prescription data to the patients personal health record if so requested. Many do not know that this even exists.
Looking forward to your feedback.
yours
Bernd
The Miami Herald
Posted on Fri, Jan. 21, 2011
Get lab results quickly, but not here
BY JOHN DORSCHNER
jdorschner@MiamiHerald.com
With healthcare experts pushing for more patient involvement, Quest Diagnostics, the nation's largest provider of lab services, is allowing patients to get test results sent to them directly -- but not in Florida.
``Disclosure and transparency is here and now,'' said Jon Cohen, Quest's chief medical officer, at a recent University of Miami symposium.
Well, not exactly here. Florida is one of 13 states that forbids diagnostic companies from transmitting results directly to patients.
That makes no sense to Beth Wheeling, a retired South Miami psychologist and cancer patient. ``Why is there this infantilization of the patient? Why do they think we cannot handle this? I hope Florida grows up.''
The Florida Medical Association and the American Medical Association did not respond to requests for comment.
The Quest initiative ``is the beginning of a trend toward more knowledge for consumers,'' said Russell Robbins, a doctor and principal at Mercer, a national consulting firm.
He said it has previously been possible for patients using some smaller labs to go to the Web for results, but with this new program ``the information is getting back freely'' by automatically being sent to smart phones via a special app.
LabCorp, the other big national testing company, did not respond to four requests for comment.
The Quest program, called Gazelle, is presently set up only for smart phones and includes ways for people to access and keep track of their medical records. Patients who sign up for the service have to wait 48 hours after the doctors get the results, so the physician can first have a chance to talk to patients.
Quest research shows that 7 percent of negative test results never reach patients because of communications mix-ups, Cohen said. In another 14 or 15 percent of cases, tests are duplicated by other doctors because they don't have access to the original results. That can be remedied by a patient having test results on a phone and being able to forward them quickly to whomever he or she wants.
One exception for Gazelle: It will not be used to transmit seriously bad news, such as testing positive for cancer or the HIV virus. ``That's best told by a professional,'' Cohen said.
Quest surveys show that patients who see test results -- cholesterol and blood sugar levels -- are more likely to be motivated to take better care of themselves.
That makes sense to Bernd Wollschlaeger, a North Miami Beach family physician and former president of the Dade Medical Association. ``I don't see any downside'' to the Quest program.
``We should be establishing collaborative care'' in which doctor and patient work together.
However, state statute 483.181 requires that lab results ``must be reported directly to the licensed practitioner or other authorized person who requested.''
An administrative code interpretation states: ``No report . . . shall be sent to the patient concerned except with the written consent of the authorized person who requested the test.''
A Quest spokesman said the company has software that allows doctors to forward Quest results to patients, which Florida doctors could use if they want.
Robbins, the Mercer consultant, said it's important that patients get the information to go along with the tests -- for example, what a number for platelets really means. ``Hopefully these results will be in conjunction with discussions with doctors.''
Robbins said a blood test ``is really a snapshot of when the blood was drawn,'' and it's often important that a result be compared with other results, which ideally would be kept in an electronic personal health record.
Wheeling, the retired psychologist, said she would love to see faster reporting on all sorts of tests because of the anxiety in waiting for results. She recalled going to the hospital for a scan to see if cancer had returned. The test showed it had not, but it took her a week to learn that.
``I think somebody at the hospital looked at the scan and could have told me within minutes,'' Wheeling said. ``The wait is totally unacceptable.''
Health Care Cost Control
I highly recommend reading this article http://www.newyorker.com/online/blogs/newsdesk/2011/01/atul-gawande-super-utilizers.html describing a strategy called " health-care hot-spotting " to lower health care costs.
This requires dedicated family physicians collaborating in health care delivery teams utilizing medical information technology tools.
As physicians we should learn how to benefit from cost-control.
Looking forward to your feedback.
Yours
Bernd
ABSTRACT: MEDICAL REPORT about innovative approaches to reducing health-care costs. Writer tells about Jeffrey Brenner, a physician in Camden, New Jersey, who has used data mining and statistical analysis to map health-care use and expenses. His calculations revealed that just one per cent of the hundred thousand people who made use of Camden’s medical facilities accounted for thirty per cent of its costs. That’s only a thousand people—about half the size of a typical family physician’s panel of patients. In his experience the people with the highest medical costs—the people cycling in and out of the hospital—were usually the people receiving the worst care. If he could find the people whose use of medical care was highest, he figured, he could do something to help them. If he helped them, he would also be lowering their health-care costs. Describes his work with those high-use patients, which led to the creation of the Camden Coalition of Healthcare Providers. By late 2010, his team had provided care for more than three hundred people on his “super-utilizer” map. The Camden Coalition has been able to measure its long-term effect on its first thirty-six super-utilizers. They averaged sixty-two hospital and E.R. visits per month before joining the program and thirty-seven visits after—a forty-per-cent reduction. Their hospital bills averaged $1.2 million per month before and just over half a million after—a fifty-six-per-cent reduction. These results don’t take into account Brenner’s personnel costs, or the costs of the medications the patients are now taking as prescribed, or the fact that some of the patients might have improved on their own (or died, reducing their costs permanently). The net savings are undoubtedly lower, but they remain, almost certainly, revolutionary. Writer visits the offices of Verisk Health, a data-mining company, which supplies “medical intelligence” to organizations that pay for health benefits. Besides the usual statisticians and economists, Verisk recruited doctors to dive into the data. One of those doctors, Nathan Gunn, guides the writer though the way data mining can be used to identify the most frequent users of health-care facilities and reduce their costs. Writer also visits the Special Care Center, a clinic in Atlantic City, which houses an experimental approach to primary care. Tells about the Center’s leader, Rushika Fernandopulle, and the intensive outpatient care for complex high-needs patients that the Center provides. In addition to physicians and nurses, the Center employs eight full-time “health coaches,” who help patients manage their health. Fernandopulle carefully tracks the statistics of the Center’s twelve hundred patients. After twelve months in the program, he found, their emergency-room visits and hospital admissions were reduced by more than forty per cent. Surgical procedures were down by a quarter. The patients were also markedly healthier. Considers difficulties in implementing these and other innovative ideas on a larger scale, including possible opposition from insurance companies and the health-care lobby.
This requires dedicated family physicians collaborating in health care delivery teams utilizing medical information technology tools.
As physicians we should learn how to benefit from cost-control.
Looking forward to your feedback.
Yours
Bernd
ABSTRACT: MEDICAL REPORT about innovative approaches to reducing health-care costs. Writer tells about Jeffrey Brenner, a physician in Camden, New Jersey, who has used data mining and statistical analysis to map health-care use and expenses. His calculations revealed that just one per cent of the hundred thousand people who made use of Camden’s medical facilities accounted for thirty per cent of its costs. That’s only a thousand people—about half the size of a typical family physician’s panel of patients. In his experience the people with the highest medical costs—the people cycling in and out of the hospital—were usually the people receiving the worst care. If he could find the people whose use of medical care was highest, he figured, he could do something to help them. If he helped them, he would also be lowering their health-care costs. Describes his work with those high-use patients, which led to the creation of the Camden Coalition of Healthcare Providers. By late 2010, his team had provided care for more than three hundred people on his “super-utilizer” map. The Camden Coalition has been able to measure its long-term effect on its first thirty-six super-utilizers. They averaged sixty-two hospital and E.R. visits per month before joining the program and thirty-seven visits after—a forty-per-cent reduction. Their hospital bills averaged $1.2 million per month before and just over half a million after—a fifty-six-per-cent reduction. These results don’t take into account Brenner’s personnel costs, or the costs of the medications the patients are now taking as prescribed, or the fact that some of the patients might have improved on their own (or died, reducing their costs permanently). The net savings are undoubtedly lower, but they remain, almost certainly, revolutionary. Writer visits the offices of Verisk Health, a data-mining company, which supplies “medical intelligence” to organizations that pay for health benefits. Besides the usual statisticians and economists, Verisk recruited doctors to dive into the data. One of those doctors, Nathan Gunn, guides the writer though the way data mining can be used to identify the most frequent users of health-care facilities and reduce their costs. Writer also visits the Special Care Center, a clinic in Atlantic City, which houses an experimental approach to primary care. Tells about the Center’s leader, Rushika Fernandopulle, and the intensive outpatient care for complex high-needs patients that the Center provides. In addition to physicians and nurses, the Center employs eight full-time “health coaches,” who help patients manage their health. Fernandopulle carefully tracks the statistics of the Center’s twelve hundred patients. After twelve months in the program, he found, their emergency-room visits and hospital admissions were reduced by more than forty per cent. Surgical procedures were down by a quarter. The patients were also markedly healthier. Considers difficulties in implementing these and other innovative ideas on a larger scale, including possible opposition from insurance companies and the health-care lobby.
Saturday, January 15, 2011
Doctors and Guns
Attached a link http://www.nwfdailynews.com/news/-36599--.html to an article reporting that state Representative Jason Brodeur (R-Sanford) and State Senator Greg Evers (R-Baker) introduced a legislative proposal ( HB 155 http://richmedia.onset.freedom.com/nwfdn/leze4b-14gunbill.pdf) which would make it a felony for a physician or staff member to ask patients or family members of patients if they own guns or store guns at home. If found guilty, the medical provider could be fined up to $5 million or face up to five years in jail.
I hope that I do not go too far to call this measure INSANE and hope that we speak up strongly against it!!
When do our legislators stop stepping in between us and our patients? I wholeheartedly agree with Dr. Scott Needle from Naples who said “Pediatricians have a right and a responsibility to ask appropriate questions as to a child’s safety and well-being, even if these questions might be uncomfortable to the parents. Likewise, however, no parent can be legally compelled to answer such questions.”
Yours
Bernd
New measure would bar doctors from asking patients if they own guns:
TALLAHASSEE — Doctors and other medical providers in Florida would be barred from asking patients — or the parents of child patients — if they have guns in their home under a measure that promises a major showdown between powerful lobbying groups.
The National Rifle Association’s top Florida lobbyist and a Florida Medical Association member both say the issue is among the top priorities for the upcoming legislative session, with the groups holding diametrically opposed positions on what doctors and their patients and families should be allowed to discuss during a medical visit.
Sponsored by state Rep. Jason Brodeur, R-Sanford, the bill (HB 155) would make it a felony for a physician or staff member to ask patients or family members of patients if they own guns or store guns at home.
If found guilty, the medical provider could be fined up to $5 million or face up to five years in jail.
State Sen. Greg Evers, R-Baker, introduced an identical Senate version of the bill on Thursday.
Gun rights groups say the measure was prompted by complaints from gun owners following an incident last summer in which an Ocala-area physician told a couple to find a new pediatrician after they refused to answer questions about whether they had guns in their home and how they were stored.
Marion Hammer, executive director of United Sportsmen of Florida and a former national NRA president, said the gun rights groups have no opposition to a physician’s office handing out brochures on gun safety, but the direct questioning on whether there are guns in the home of a patient and how they store them goes too far.
“Simply, it’s none of their business,” Hammer said.
Critics of the measure say it inappropriately puts a wedge between doctors and their patients by restricting what can be discussed. They say questions regarding gun ownership and how weapons are secured within homes are much like a pediatrician asking the parents of a child if their electric outlets have protective covers, or whether their pool is fenced in.
“No other area of physician inquiry has been deemed off-limits by the Legislature,” said Naples pediatrician Scott Needle.
“Pediatricians have a right and a responsibility to ask appropriate questions as to a child’s safety and well-being, even if these questions might be uncomfortable to the parents. Likewise, however, no parent can be legally compelled to answer such questions.”
I hope that I do not go too far to call this measure INSANE and hope that we speak up strongly against it!!
When do our legislators stop stepping in between us and our patients? I wholeheartedly agree with Dr. Scott Needle from Naples who said “Pediatricians have a right and a responsibility to ask appropriate questions as to a child’s safety and well-being, even if these questions might be uncomfortable to the parents. Likewise, however, no parent can be legally compelled to answer such questions.”
Yours
Bernd
New measure would bar doctors from asking patients if they own guns:
TALLAHASSEE — Doctors and other medical providers in Florida would be barred from asking patients — or the parents of child patients — if they have guns in their home under a measure that promises a major showdown between powerful lobbying groups.
The National Rifle Association’s top Florida lobbyist and a Florida Medical Association member both say the issue is among the top priorities for the upcoming legislative session, with the groups holding diametrically opposed positions on what doctors and their patients and families should be allowed to discuss during a medical visit.
Sponsored by state Rep. Jason Brodeur, R-Sanford, the bill (HB 155) would make it a felony for a physician or staff member to ask patients or family members of patients if they own guns or store guns at home.
If found guilty, the medical provider could be fined up to $5 million or face up to five years in jail.
State Sen. Greg Evers, R-Baker, introduced an identical Senate version of the bill on Thursday.
Gun rights groups say the measure was prompted by complaints from gun owners following an incident last summer in which an Ocala-area physician told a couple to find a new pediatrician after they refused to answer questions about whether they had guns in their home and how they were stored.
Marion Hammer, executive director of United Sportsmen of Florida and a former national NRA president, said the gun rights groups have no opposition to a physician’s office handing out brochures on gun safety, but the direct questioning on whether there are guns in the home of a patient and how they store them goes too far.
“Simply, it’s none of their business,” Hammer said.
Critics of the measure say it inappropriately puts a wedge between doctors and their patients by restricting what can be discussed. They say questions regarding gun ownership and how weapons are secured within homes are much like a pediatrician asking the parents of a child if their electric outlets have protective covers, or whether their pool is fenced in.
“No other area of physician inquiry has been deemed off-limits by the Legislature,” said Naples pediatrician Scott Needle.
“Pediatricians have a right and a responsibility to ask appropriate questions as to a child’s safety and well-being, even if these questions might be uncomfortable to the parents. Likewise, however, no parent can be legally compelled to answer such questions.”
Saturday, January 08, 2011
Escalating Health Insurance Premiums
A recent AMA News article http://www.ama-assn.org/amednews/2010/12/20/gvbf1220.htm highlights the increase of employer based health insurance premiums even BEFORE the so called "ObamaCare" was enacted by Congress and signed into law. One of California's largest health insurers - Blue Shield - announced plans to hike its premiums by as much as 59%. The jacked up premium rates are set to take effect on March 1, pending review from state insurance regulators. The move impacts 193,000 individual Blue Shield policy holders. The company, a member of the Blue Cross Blue Shield Association with 3.3 million members, which announced the move late Thursday, stressed that its decision has "almost nothing to do with the federal health reform law" and that ultimately the law will help slow down health care costs. But responding to this most recent increase the company said, "our individual market medical costs are rising rapidly due to higher provider prices, increased utilization, and the fact that healthier people are dropping coverage during a bad economy," the company said.
These are FACTS but, unfortunately, many are using FICTION to twist the reality claiming that the new health care law triggers a premium increase even BEFORE most of its components will be in effect in 2014.
Yours
Bernd
Health premiums leap 41% from 2003
Between 2003 and 2009, employer-based premiums for family health insurance coverage rose an average 41%, according to a Commonwealth Fund report released Dec. 2. Delaware saw the lowest increase at 21%, and Louisiana experienced the highest jump at 59%.
Although health insurance is becoming increasingly unaffordable for families, the report concluded that provisions in the Patient Protection and Affordable Care Act could help reverse the unsustainable increases. If implemented properly, provisions of the health reform law -- including tax credits for small businesses, dependent coverage for young adults up to age 26 and elimination of co-payments for preventive care -- could ensure that patients continue to see their physicians, the study said.
These are FACTS but, unfortunately, many are using FICTION to twist the reality claiming that the new health care law triggers a premium increase even BEFORE most of its components will be in effect in 2014.
Yours
Bernd
Health premiums leap 41% from 2003
Between 2003 and 2009, employer-based premiums for family health insurance coverage rose an average 41%, according to a Commonwealth Fund report released Dec. 2. Delaware saw the lowest increase at 21%, and Louisiana experienced the highest jump at 59%.
Although health insurance is becoming increasingly unaffordable for families, the report concluded that provisions in the Patient Protection and Affordable Care Act could help reverse the unsustainable increases. If implemented properly, provisions of the health reform law -- including tax credits for small businesses, dependent coverage for young adults up to age 26 and elimination of co-payments for preventive care -- could ensure that patients continue to see their physicians, the study said.
AMA Leads The Efforts to align e-Prescribing and EHR Implementation
ttached a link http://www.ama-assn.org/amednews/2010/12/20/gvsa1220.htm to a very interesting article published in the recent AMA News edition entitled, "Revise unfair e-prescribing policy, doctors say."
The American Medical Association and more than 100 other state and specialty medical societies are urging the Dept. of Health and Human Services to revise a Medicare e-prescribing policy that slaps doctors with a financial penalty in 2012 if they don't meet specified e-prescribing criteria during the first six months of 2011.Physician practices need to meet certain e-prescribing criteria during at least 10 office visits between Jan. 1 and June 30, 2011, according to the final rule. Physicians who don't must pay the government a penalty equal to 1% of all of their Part B earnings in 2012.
AMA leaders believe the penalty is unjustified, and they want CMS to change it.
"The last-minute decision to require e-prescribing in 2011 will force physicians to spend additional financial and administrative resources to purchase e-prescribing software that most of them will end up discarding when they transition to a complete EHR system," said AMA Secretary Steven J. Stack, MD.
Compounding the issue further is that the law prohibits physicians from receiving incentives from both the Medicare e-prescribing and the meaningful use program for electronic medical records. The AMA and other physician organizations believe the new e-prescribing regulations are duplicative because the EMR incentive program already contains an e-prescribing component.
Consequently, many physicians who decided to forgo purchasing an e-prescribing tool in favor of an EMR system could be left trying to catch up to e-prescribing requirements in early 2011.
So what can be done?
1.Physicians want CMS to extend the reporting period so it includes the first 10 months of 2011.
2.Doctors want CMS to add more exception categories consistent with recommendations made when the proposed rule came out this summer. For example, physicians who attest to meaningful use in 2011 or 2012 should be exempt from penalties associated with the program.
I hope that these reasonable adjustments can be implemented to ease the EHR transformation.
Yours
Bernd
The American Medical Association and more than 100 other state and specialty medical societies are urging the Dept. of Health and Human Services to revise a Medicare e-prescribing policy that slaps doctors with a financial penalty in 2012 if they don't meet specified e-prescribing criteria during the first six months of 2011.Physician practices need to meet certain e-prescribing criteria during at least 10 office visits between Jan. 1 and June 30, 2011, according to the final rule. Physicians who don't must pay the government a penalty equal to 1% of all of their Part B earnings in 2012.
AMA leaders believe the penalty is unjustified, and they want CMS to change it.
"The last-minute decision to require e-prescribing in 2011 will force physicians to spend additional financial and administrative resources to purchase e-prescribing software that most of them will end up discarding when they transition to a complete EHR system," said AMA Secretary Steven J. Stack, MD.
Compounding the issue further is that the law prohibits physicians from receiving incentives from both the Medicare e-prescribing and the meaningful use program for electronic medical records. The AMA and other physician organizations believe the new e-prescribing regulations are duplicative because the EMR incentive program already contains an e-prescribing component.
Consequently, many physicians who decided to forgo purchasing an e-prescribing tool in favor of an EMR system could be left trying to catch up to e-prescribing requirements in early 2011.
So what can be done?
1.Physicians want CMS to extend the reporting period so it includes the first 10 months of 2011.
2.Doctors want CMS to add more exception categories consistent with recommendations made when the proposed rule came out this summer. For example, physicians who attest to meaningful use in 2011 or 2012 should be exempt from penalties associated with the program.
I hope that these reasonable adjustments can be implemented to ease the EHR transformation.
Yours
Bernd
Sunday, January 02, 2011
The End To Public Hospitals
Attached a link http://www.miamiherald.com/2010/12/30/v-fullstory/1994541/need-for-public-hospitals-to-be.html to an interesting article published in the Miami Herald reporting that the governor-elect's transition team has recommended creation of a panel to study whether government-owned hospitals -- Miami-Dade's Jackson Health System and Broward's two hospital districts among them -- are necessary. Rick Scott has promised to run the government like a business and government support for hospital does not fit into his ideological paradigm.
But, as the Sun Sentinel reports in an article today, " .. companies exist to make profits, while governments are charged with performing services for a wide variety of people, including the needy."
I guess Rick Scott is used to firing people and thinks that we can just "fire" 500,000 Uninsured in Miami-Dade County too. Meanwhile, the State of Florida has failed so far to deliver promised Medicaid reforms, and stands to lose $350 million in special funding from the federal government unless it can get an extension of a waiver! These funds, called the Lower Income Pool, are crucial to Jackson Memorial fiscal survival, which received $258 million from the pool last year. But Rick Scott wants to keep distance from the federal government and we can kiss this waiver good-by too. Furthermore, in his ideological world the Unemployed are also at fault for their own calamity and need to shape up or commit themselves to community services. But how can they afford healthcare if they have no access to public healthcare services, no job and no money to pay the escalating healthinsurance premiums? I see those patients every single day. Hard working, decent American citizens abandoned by their own government! Guess, Rick Scott also indulges in nostalgic reminiscence of the "good old times" before government helped to protect workers from exploitation by industrialists, abolished child labor and unions successfully struggled for fair wages.
We definitely should not let him to drag our State backwards. We must save Jackson Memorial hospital and preserve our already strained public health system.
Yours
Bernd
But, as the Sun Sentinel reports in an article today, " .. companies exist to make profits, while governments are charged with performing services for a wide variety of people, including the needy."
I guess Rick Scott is used to firing people and thinks that we can just "fire" 500,000 Uninsured in Miami-Dade County too. Meanwhile, the State of Florida has failed so far to deliver promised Medicaid reforms, and stands to lose $350 million in special funding from the federal government unless it can get an extension of a waiver! These funds, called the Lower Income Pool, are crucial to Jackson Memorial fiscal survival, which received $258 million from the pool last year. But Rick Scott wants to keep distance from the federal government and we can kiss this waiver good-by too. Furthermore, in his ideological world the Unemployed are also at fault for their own calamity and need to shape up or commit themselves to community services. But how can they afford healthcare if they have no access to public healthcare services, no job and no money to pay the escalating healthinsurance premiums? I see those patients every single day. Hard working, decent American citizens abandoned by their own government! Guess, Rick Scott also indulges in nostalgic reminiscence of the "good old times" before government helped to protect workers from exploitation by industrialists, abolished child labor and unions successfully struggled for fair wages.
We definitely should not let him to drag our State backwards. We must save Jackson Memorial hospital and preserve our already strained public health system.
Yours
Bernd
Tuesday, December 28, 2010
Pill Mills are Gearing up for Big Business
Thanks to the ideological rigidity of our legislature and almost monoptic "vision" of our Governor-Elect the Prescription Drug Monitoring Program is almost dead before even going online. The Office of Drug Control is being dissolved and all employees are gone by January 3rd!
In today's Miami Herald editorial the issues at hand are being pointed out as they are.
Dr. Viamonte Ross, one of the few agency heads asked to resign, has the final opportunity to declare a public health emergency thereby forcing the state to approve an existing PDMP vendor contract. Unfortuantely, the Attorney General (and the Board of Medicine) do not believe that the current status quo justifies such an emergency order. The rate of prescription drug overdose death increased to 7 Floridians a day. So whats the "magic" number 10,20, 100...?
I urge all of you to contact your legislator to support an immediate declaration of a public health emergency.
Yours
Bernd
The Miami Herald
Posted on Tue, Dec. 28, 2010
Pill mills still going strong
When it comes to the unsavory and downright illegal, South Florida owns the market in healthcare scams. Miami-Dade County is the nation's epicenter of Medicare fraud. Broward County is the state's biggest black market in prescription pain killers like oxycodone. By now, many of the pill mills should have been shut down. They're not.
Thanks to lax state oversight, walk-in pain clinics have flourished in Florida in the last three years. A 2009 Miami Herald series highlighted the proliferation of these pill mills. Broward clinics alone sell more oxycodone than is sold in several states. Anyone can get hundreds of pain pills from these clinics. The powerful narcotics are then resold on the street.
The growth of pain clinics, often run by discredited doctors, is causing an epidemic of prescription overdose deaths, says Florida drug czar Bruce Grant. The rate of deaths is about seven per day -- a shocking number that's preventable.
By now, these clinics were supposed to be regulated under tough new rules. Instead, most reforms are in limbo thanks to a contract dispute and a blunder by the Legislature during its November special session.
In 2009, the Legislature passed a bill to create a statewide database of all prescription narcotics sold by doctors and pharmacists to prevent patients from ``doctor shopping'' -- going to multiple clinics and doctors for pills to later resell. Tougher rules governing doctors working in pain clinics and who could own them are also in the new law.
The due date for the database was Dec. 1. The deadline came and went, however, because a company bidding on the project has legally challenged the contract award. Mr. Grant has asked Florida's surgeon general, Dr. Ana M. Viamonte Ros, to approve the contract on an emergency basis to protect public health.
Dr. Viamonte Ros is one of the few agency heads told to resign by Gov.-elect Rick Scott. But she is on the job till Jan. 3. Given those seven daily drug overdoses, Dr. Viamonte Ros should set the database in motion.
The other big glitch in moving forward with the regulations happened because of GOP lawmakers' zeal to override outgoing Gov. Charlie Crist's vetoes. They revived an anti-regulation bill requiring any new rules that may cost businesses or the government more than $200,000 a year to be subjected to legislative review before implementation.
This has stalled many pill-mill regulations, which now must await lawmakers' scrutiny in 2011. In vetoing the bill in its first incarnation, Gov. Crist wisely warned that the law would have required almost every new rule -- which can number in the hundreds in one year alone -- to await mandated review before being applied. What a nightmare.
Despite the setbacks, the state health department commendably has enforced a few rules. In November, state officials began inspecting pain clinics for the first time. So far, 17 clinics have been shut down.
That's a start, but as of November, there were 142 registered clinics in Broward and 94 in Miami-Dade. So much more could be happening right now to prevent more unnecessary deaths.
© 2010 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com
In today's Miami Herald editorial the issues at hand are being pointed out as they are.
Dr. Viamonte Ross, one of the few agency heads asked to resign, has the final opportunity to declare a public health emergency thereby forcing the state to approve an existing PDMP vendor contract. Unfortuantely, the Attorney General (and the Board of Medicine) do not believe that the current status quo justifies such an emergency order. The rate of prescription drug overdose death increased to 7 Floridians a day. So whats the "magic" number 10,20, 100...?
I urge all of you to contact your legislator to support an immediate declaration of a public health emergency.
Yours
Bernd
The Miami Herald
Posted on Tue, Dec. 28, 2010
Pill mills still going strong
When it comes to the unsavory and downright illegal, South Florida owns the market in healthcare scams. Miami-Dade County is the nation's epicenter of Medicare fraud. Broward County is the state's biggest black market in prescription pain killers like oxycodone. By now, many of the pill mills should have been shut down. They're not.
Thanks to lax state oversight, walk-in pain clinics have flourished in Florida in the last three years. A 2009 Miami Herald series highlighted the proliferation of these pill mills. Broward clinics alone sell more oxycodone than is sold in several states. Anyone can get hundreds of pain pills from these clinics. The powerful narcotics are then resold on the street.
The growth of pain clinics, often run by discredited doctors, is causing an epidemic of prescription overdose deaths, says Florida drug czar Bruce Grant. The rate of deaths is about seven per day -- a shocking number that's preventable.
By now, these clinics were supposed to be regulated under tough new rules. Instead, most reforms are in limbo thanks to a contract dispute and a blunder by the Legislature during its November special session.
In 2009, the Legislature passed a bill to create a statewide database of all prescription narcotics sold by doctors and pharmacists to prevent patients from ``doctor shopping'' -- going to multiple clinics and doctors for pills to later resell. Tougher rules governing doctors working in pain clinics and who could own them are also in the new law.
The due date for the database was Dec. 1. The deadline came and went, however, because a company bidding on the project has legally challenged the contract award. Mr. Grant has asked Florida's surgeon general, Dr. Ana M. Viamonte Ros, to approve the contract on an emergency basis to protect public health.
Dr. Viamonte Ros is one of the few agency heads told to resign by Gov.-elect Rick Scott. But she is on the job till Jan. 3. Given those seven daily drug overdoses, Dr. Viamonte Ros should set the database in motion.
The other big glitch in moving forward with the regulations happened because of GOP lawmakers' zeal to override outgoing Gov. Charlie Crist's vetoes. They revived an anti-regulation bill requiring any new rules that may cost businesses or the government more than $200,000 a year to be subjected to legislative review before implementation.
This has stalled many pill-mill regulations, which now must await lawmakers' scrutiny in 2011. In vetoing the bill in its first incarnation, Gov. Crist wisely warned that the law would have required almost every new rule -- which can number in the hundreds in one year alone -- to await mandated review before being applied. What a nightmare.
Despite the setbacks, the state health department commendably has enforced a few rules. In November, state officials began inspecting pain clinics for the first time. So far, 17 clinics have been shut down.
That's a start, but as of November, there were 142 registered clinics in Broward and 94 in Miami-Dade. So much more could be happening right now to prevent more unnecessary deaths.
© 2010 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com
Monday, December 27, 2010
No Money For Florida
Recommend reading an interesting article entitled “ Medicaid Bonuses to Reward States for Insuring More Children,” http://www.nytimes.com/2010/12/27/health/policy/27medicaid.html?partner=rss&emc=rss reporting that the Obama administration plans to announce Monday that it will make $206 million in bonus Medicaid payments to 15 states — with more than a fourth of the total going to Alabama — for signing up children who are eligible for public health insurance but had previously failed to enroll.
This program was created to address the following issues:
* To enroll an estimated 4.7 million children who would be eligible for subsidized coverage if their families could be found and alerted. Two of every three uninsured children are thought to meet the income criteria for government insurance programs.
* The stubbornness of the problem is one reason the government expects millions of people to remain uninsured even after 2014, when the new health care law requires most Americans to have coverage and vastly expands government programs to make it affordable.
Alabama will receive a $55 million bonus, more than twice as much as any other state, for having 133,000 more children on its Medicaid rolls than projected by a formulated base line. The 15 states that will receive bonuses reported a total of 874,347 children above the baseline, which factors in population growth and, to some degree, demand driven by the economy.
Alabama, for example, has adopted “express lane eligibility” so that Medicaid application processors can use income findings from other safety net programs to validate eligibility.
Because of the formula’s requirements, none of the money will go to California, Texas or Florida, which account for nearly 40 percent of all uninsured children. States like Florida make enrollment cumbersome and devote minimal resources to marketing. Many of my patients have never heard about the program and I try assisting them to navigate poorly designed web sites and to complete forms they do not understand (neither do I.)
Shouldn't it be the goal of our new governor-elect to increase the enrollment for children qualifying for this program? Unfortunately, those children may have to wait for a long time because ideological purity comes first!
Who will pay the price? All of us, because those children will grow into sick adults requiring more expensive care to “correct” mistakes that could have been prevented in childhood.
This program was created to address the following issues:
* To enroll an estimated 4.7 million children who would be eligible for subsidized coverage if their families could be found and alerted. Two of every three uninsured children are thought to meet the income criteria for government insurance programs.
* The stubbornness of the problem is one reason the government expects millions of people to remain uninsured even after 2014, when the new health care law requires most Americans to have coverage and vastly expands government programs to make it affordable.
Alabama will receive a $55 million bonus, more than twice as much as any other state, for having 133,000 more children on its Medicaid rolls than projected by a formulated base line. The 15 states that will receive bonuses reported a total of 874,347 children above the baseline, which factors in population growth and, to some degree, demand driven by the economy.
Alabama, for example, has adopted “express lane eligibility” so that Medicaid application processors can use income findings from other safety net programs to validate eligibility.
Because of the formula’s requirements, none of the money will go to California, Texas or Florida, which account for nearly 40 percent of all uninsured children. States like Florida make enrollment cumbersome and devote minimal resources to marketing. Many of my patients have never heard about the program and I try assisting them to navigate poorly designed web sites and to complete forms they do not understand (neither do I.)
Shouldn't it be the goal of our new governor-elect to increase the enrollment for children qualifying for this program? Unfortunately, those children may have to wait for a long time because ideological purity comes first!
Who will pay the price? All of us, because those children will grow into sick adults requiring more expensive care to “correct” mistakes that could have been prevented in childhood.
Rick Scott and The Department Of Health: The Saga Begins
Finally, the planned program of Governor-elect Rick Scott is taking shape. Among the items that will affect doctors the most is the proposal calling for merging the Department of Health and the Agency for Health Care Administration. It would close the tuberculosis hospital at Lantana, privatize the state's mental hospitals, include the possible sale of Jackson Memorial Hospital in Miami and ....?!
Rick Scott seems to operate (again) in a vacuum, surrounded by advisors, not understanding the ramifications of his decisions.
The Florida Department of Health was created in 1889 one year after a devastating yellow fever outbreak killed over 400 citizens in Jacksonville and about 40 percent of the population fled the city due to a yellow fever epidemic which sickened a third of those who stayed. Similar epidemics of cholera and yellow fever struck the state almost annually, one of which almost wiped out the population of St. Joseph in 1841. In most cases, limited medical care was available for the sick and weaker people died, but not before infecting many others. Many survivors were carriers, continuing to pass the diseases to others as a result of poor sanitary practices. As a result control of infectious diseases was the major reason for establishment of public health services and remains a major focus today with new infectious diseases emerging as a the results of global climate change. In addition, substance abuse, including the devastating impact or prescription narcotic abuse and diversion, challenges the public health system killing seven (7) Floridians every day!! During the 1996 legislative session, the beleaguered Florida Department of Health and Rehabilitative Services was reconstructed as two entities: the Department of Health and the Florida Department of Children and Families to respond to the unique needs of its respective constituencies. Currently the Florida Department of Health operates County Health Departments in all 67 of the State's Counties. The agency employs more than 17,000 persons. It has championed immunization campaigns, tobacco control, and statewide preparedness response efforts. The Department of Health is a cabinet level agency of the state government, headed by the State Surgeon General who reports directly to the Governor.
I agree with Tim Stapelton, Florida Medical Association Senior Vice-President, that " ..this is a public safety concern and the governor must have a medical doctor advising him of these issues rather than another governor bureaucrat."
I also agree with Mr. Stapelton that its very questionable merging the department that REGULATES DOCTORS with the agencies that REGULATE HOSPITALS. This almost enshrines a conflict within the walls of one mega-agency. What kind of efficiencies does the governor-elect expect? On what expertise and experience is he basing his decision? Is he aware that his decision will undermine our already fledgling public health system?
Now is the time to raise our voices of concern and to let the (almost) one-party legislature know that absolute rule must be challenged.
Yours
Bernd
Rick Scott seems to operate (again) in a vacuum, surrounded by advisors, not understanding the ramifications of his decisions.
The Florida Department of Health was created in 1889 one year after a devastating yellow fever outbreak killed over 400 citizens in Jacksonville and about 40 percent of the population fled the city due to a yellow fever epidemic which sickened a third of those who stayed. Similar epidemics of cholera and yellow fever struck the state almost annually, one of which almost wiped out the population of St. Joseph in 1841. In most cases, limited medical care was available for the sick and weaker people died, but not before infecting many others. Many survivors were carriers, continuing to pass the diseases to others as a result of poor sanitary practices. As a result control of infectious diseases was the major reason for establishment of public health services and remains a major focus today with new infectious diseases emerging as a the results of global climate change. In addition, substance abuse, including the devastating impact or prescription narcotic abuse and diversion, challenges the public health system killing seven (7) Floridians every day!! During the 1996 legislative session, the beleaguered Florida Department of Health and Rehabilitative Services was reconstructed as two entities: the Department of Health and the Florida Department of Children and Families to respond to the unique needs of its respective constituencies. Currently the Florida Department of Health operates County Health Departments in all 67 of the State's Counties. The agency employs more than 17,000 persons. It has championed immunization campaigns, tobacco control, and statewide preparedness response efforts. The Department of Health is a cabinet level agency of the state government, headed by the State Surgeon General who reports directly to the Governor.
I agree with Tim Stapelton, Florida Medical Association Senior Vice-President, that " ..this is a public safety concern and the governor must have a medical doctor advising him of these issues rather than another governor bureaucrat."
I also agree with Mr. Stapelton that its very questionable merging the department that REGULATES DOCTORS with the agencies that REGULATE HOSPITALS. This almost enshrines a conflict within the walls of one mega-agency. What kind of efficiencies does the governor-elect expect? On what expertise and experience is he basing his decision? Is he aware that his decision will undermine our already fledgling public health system?
Now is the time to raise our voices of concern and to let the (almost) one-party legislature know that absolute rule must be challenged.
Yours
Bernd
Sunday, December 26, 2010
End-of-Life Care and Medicare
The New York Times reported today http://www.nytimes.com/2010/12/26/us/politics/26death.html?_r=2&hp that as of January 1st 2011 under a new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.
This is indeed good news for all family physicians because finally they can paid for a service we all are supposed to offer anyway.
I wonder how soon we can receive more detailed information about the new billing codes and reimbursement.
Bernd
This is indeed good news for all family physicians because finally they can paid for a service we all are supposed to offer anyway.
I wonder how soon we can receive more detailed information about the new billing codes and reimbursement.
Bernd
Wednesday, December 22, 2010
Closing the Office of Drug Control is Bad For Business
Governor-Elect Rick Scott notified all four full-time employees working in the governor's Office of Drug Control that their services will no longer be needed after he takes office next month. The office will be dissolved and all its duties turned over to the departments of Health and Law Enforcement.
Rick Scott has pledged to cut waste in state government and the annual budget of about $551,300 for funding the operations of the Office of Drug Control is considered "waste" that needs to be eliminated too.
But lets analyze and examine the facts:
* The Office of Drug Control was created by then Governor Jeb Bush in 1999 and is authorized by state statutes.
* The Office collaborates with other agencies on the implementation of a three-pronged approach of Prevention, Treatment and Law Enforcement to eliminate the devastation of substance abuse rampant in Florida's diverse communities.
* The Office issued a series of excellent reports http://www.flgov.com/drugcontrol/odc_statsreports.php documenting the increasing problem of drug abuse in Florida.
* The Office was instrumental in getting legislation passed that is intended to help curb prescription drug abuse — one bill targeting pain management clinics, which are often disguises for "pill mills," and another that establishes a prescription drug monitoring program.
* The Office championed the creation of a Prescription Drug Monitoring Program, which almost reached the point of going on-line.
* Prohibited by law to use state funds to pay for the PDMP Director Bruce Grant and his superb staff successfully obtained the necessary funding through federal grants and other sources
The current political leadership in Tallahassee seems to be under the impression that we DO NOT have a significant drug problem in Florida.
Governor Scott's spokesman Brian Burgess was quoted in an article that "I don't think we're going to have cocaine bales stacking up on the docks of Miami if we close this office."
Obviously, he did not bother to check the facts:
· Years of lax state laws and a plethora of pain clinics have made Florida a destination for prescription drug traffickers, drug peddling doctors and abusers.
· The DEA, using its most recent data, says that 49 out of 50 of the top oxycodone prescribers are located in Florida.
· The number of deaths caused by at least one prescription drug increased more than 100 percent from 2003 to 2009.
· Mark Fontaine, executive director of the Florida Alcohol and Drug Abuse Association, said a recent study showed that substance abuse has a $43 billion negative impact on the state economy due to loss of job productivity, and costs associated with hospital and emergency room visits and incarceration. Fontaine said about 65 percent of Florida inmates have substance abuse problems.
· A 2009 Florida Department of Law Enforcement study concluded seven people in Florida die every day- ALMOST 2500 FLORIDIANS A YEAR - due to prescription drug abuse.
YES, WE DO HAVE A DRUG PROBLEM IN FLORIDA AND YES IT HAS REACHED EPIDEMIC PROPORTIONS WITH ADVERSE SOCIAL AND ECONOMIC RAMIFICATIONS.
Is cutting $500,000 of "wasteful" spending is worth more than all of the above listed adverse impacts of substance abuse and diversion?
Isn't it penny wise and pond foolish to close the Office of Drug Control? Shouldn't such decisions be based on recommendation made as the result of a careful review process involving experts?
SAVING $500,000 IS A BAD BUSINESS DECISION!
I am certain that closing the Office of Drug Control will have a significant adverse impact on our efforts to combat and control substance abuse and diversion forcing the allocation of much higher funding of law enforcement to deal with the consequences of a failed policy.
GOVERNOR-ELECT RICK SCOTT PLEASE RECONSIDER THIS DECISION!
THE ELIMINATION OF THE OFFICE OF DRUG CONTROL IS BAD FOR BUSINESS AND BAD FOR OUR GREAT STATE OF FLORIDA.
Bernd Wollschlaeger,MD,FAAFP,FASAM
Family Physician& Addiction Specialist
Rick Scott has pledged to cut waste in state government and the annual budget of about $551,300 for funding the operations of the Office of Drug Control is considered "waste" that needs to be eliminated too.
But lets analyze and examine the facts:
* The Office of Drug Control was created by then Governor Jeb Bush in 1999 and is authorized by state statutes.
* The Office collaborates with other agencies on the implementation of a three-pronged approach of Prevention, Treatment and Law Enforcement to eliminate the devastation of substance abuse rampant in Florida's diverse communities.
* The Office issued a series of excellent reports http://www.flgov.com/drugcontrol/odc_statsreports.php documenting the increasing problem of drug abuse in Florida.
* The Office was instrumental in getting legislation passed that is intended to help curb prescription drug abuse — one bill targeting pain management clinics, which are often disguises for "pill mills," and another that establishes a prescription drug monitoring program.
* The Office championed the creation of a Prescription Drug Monitoring Program, which almost reached the point of going on-line.
* Prohibited by law to use state funds to pay for the PDMP Director Bruce Grant and his superb staff successfully obtained the necessary funding through federal grants and other sources
The current political leadership in Tallahassee seems to be under the impression that we DO NOT have a significant drug problem in Florida.
Governor Scott's spokesman Brian Burgess was quoted in an article that "I don't think we're going to have cocaine bales stacking up on the docks of Miami if we close this office."
Obviously, he did not bother to check the facts:
· Years of lax state laws and a plethora of pain clinics have made Florida a destination for prescription drug traffickers, drug peddling doctors and abusers.
· The DEA, using its most recent data, says that 49 out of 50 of the top oxycodone prescribers are located in Florida.
· The number of deaths caused by at least one prescription drug increased more than 100 percent from 2003 to 2009.
· Mark Fontaine, executive director of the Florida Alcohol and Drug Abuse Association, said a recent study showed that substance abuse has a $43 billion negative impact on the state economy due to loss of job productivity, and costs associated with hospital and emergency room visits and incarceration. Fontaine said about 65 percent of Florida inmates have substance abuse problems.
· A 2009 Florida Department of Law Enforcement study concluded seven people in Florida die every day- ALMOST 2500 FLORIDIANS A YEAR - due to prescription drug abuse.
YES, WE DO HAVE A DRUG PROBLEM IN FLORIDA AND YES IT HAS REACHED EPIDEMIC PROPORTIONS WITH ADVERSE SOCIAL AND ECONOMIC RAMIFICATIONS.
Is cutting $500,000 of "wasteful" spending is worth more than all of the above listed adverse impacts of substance abuse and diversion?
Isn't it penny wise and pond foolish to close the Office of Drug Control? Shouldn't such decisions be based on recommendation made as the result of a careful review process involving experts?
SAVING $500,000 IS A BAD BUSINESS DECISION!
I am certain that closing the Office of Drug Control will have a significant adverse impact on our efforts to combat and control substance abuse and diversion forcing the allocation of much higher funding of law enforcement to deal with the consequences of a failed policy.
GOVERNOR-ELECT RICK SCOTT PLEASE RECONSIDER THIS DECISION!
THE ELIMINATION OF THE OFFICE OF DRUG CONTROL IS BAD FOR BUSINESS AND BAD FOR OUR GREAT STATE OF FLORIDA.
Bernd Wollschlaeger,MD,FAAFP,FASAM
Family Physician& Addiction Specialist
Sunday, December 19, 2010
Medicaid Cuts
Pollice Verso: How State Legislators try to revive an ancient custom
A recent article in Wall Street Journal, Health Studies Cited for Transplant Cuts Put Under the Knife, http://online.wsj.com/article/SB10001424052748703395204576024213729831704.html, highlights the looming issue of cost control.
Faced with skyrocketing healthcare costs, states will be forced to make tough decision on care allocation and coverage.
Arizona already has taken drastic steps to drop Medicaid coverage for some organ transplants as the state tries to plug a $1 billion gap in its health-care budget for next year. The state agency that recommended that Arizona stop paying for transplants of lungs and, for certain patients, hearts and livers, has defended the move by citing studies and figures that it says demonstrate the ineffectiveness of the procedures. But the state agency has gone a step further by selecting studies that proves the point that certain transplants are ineffective. To make its case for cuts, the Arizona agency cited several sets of numbers. In dropping coverage of liver transplants for patients with hepatitis C, the state said liver recipients suffer recurrence of the disease at a rate of 100%. And the state argued that candidates for lung transplants would live just as long with other medical care, citing data from university studies. Several transplant experts, however, point to flaws in the data and the way the state's Medicaid agency, called the Health Care Cost Containment System, has used the figures. Arizona "used data that were outdated or data that made no sense, or they misinterpreted or misrepresented what experts said," says Michael Abecassis, director of Northwestern University's comprehensive transplant center and president of the surgeons group. For lungs, a crux of the state's position was a 1995 study of 49 patients at the University of Washington, 25 of whom received transplants; the rest were waiting at the time of the study. The study concluded that transplant recipients would live half a year longer than those who didn't get a new lung, but the difference wasn't statistically significant—in part because the sample size was so small. Also, researchers didn't wait to track patients' survival, instead extrapolating long-term mortality rates from deaths and sickness in the short run.
So, what’s the solution? States should not be permitted to arbitrarily decide what services can be covered under the states Medicaid program. Instead, they should follow evidence-based data and, most importantly, comparative effectiveness research data.
Otherwise, we will revert to the Pollice verso (thumbs turned) used in ancient Rome by the crowd to indicate if the defeated gladiator should be condemned to death. Soon we do not need gladiators to revive this custom. We just need legislators who will decide the fate of condemned Medicaid recipients.
Yours
Bernd
A recent article in Wall Street Journal, Health Studies Cited for Transplant Cuts Put Under the Knife, http://online.wsj.com/article/SB10001424052748703395204576024213729831704.html, highlights the looming issue of cost control.
Faced with skyrocketing healthcare costs, states will be forced to make tough decision on care allocation and coverage.
Arizona already has taken drastic steps to drop Medicaid coverage for some organ transplants as the state tries to plug a $1 billion gap in its health-care budget for next year. The state agency that recommended that Arizona stop paying for transplants of lungs and, for certain patients, hearts and livers, has defended the move by citing studies and figures that it says demonstrate the ineffectiveness of the procedures. But the state agency has gone a step further by selecting studies that proves the point that certain transplants are ineffective. To make its case for cuts, the Arizona agency cited several sets of numbers. In dropping coverage of liver transplants for patients with hepatitis C, the state said liver recipients suffer recurrence of the disease at a rate of 100%. And the state argued that candidates for lung transplants would live just as long with other medical care, citing data from university studies. Several transplant experts, however, point to flaws in the data and the way the state's Medicaid agency, called the Health Care Cost Containment System, has used the figures. Arizona "used data that were outdated or data that made no sense, or they misinterpreted or misrepresented what experts said," says Michael Abecassis, director of Northwestern University's comprehensive transplant center and president of the surgeons group. For lungs, a crux of the state's position was a 1995 study of 49 patients at the University of Washington, 25 of whom received transplants; the rest were waiting at the time of the study. The study concluded that transplant recipients would live half a year longer than those who didn't get a new lung, but the difference wasn't statistically significant—in part because the sample size was so small. Also, researchers didn't wait to track patients' survival, instead extrapolating long-term mortality rates from deaths and sickness in the short run.
So, what’s the solution? States should not be permitted to arbitrarily decide what services can be covered under the states Medicaid program. Instead, they should follow evidence-based data and, most importantly, comparative effectiveness research data.
Otherwise, we will revert to the Pollice verso (thumbs turned) used in ancient Rome by the crowd to indicate if the defeated gladiator should be condemned to death. Soon we do not need gladiators to revive this custom. We just need legislators who will decide the fate of condemned Medicaid recipients.
Yours
Bernd
Saturday, December 18, 2010
Healthcare Facts
An article (Read more: http://www.miamiherald.com/2010/12/17/v-print/1977925/politifactcoms-lie-of-year-government.html#ixzz18WWAFJAz ) published in today's edition of the Miami Herald entitled, PolitiFact Lie of the Year: 'Government takeover of health care', summarizes the falsehoods attributed to the overhaul of America's health insurance system.
PolitiFact editors and reporters have chosen ``government takeover of health care'' as the 2010 Lie of the Year. Uttered by dozens of politicians and leaders within organized medicine, it played an important role in shaping public opinion about the health care plan and was a significant factor in the Democrats' shellacking in the November elections. The Patient Protection and Affordable Care Act, also falsely called "Obama Care", was passed by Congress, and relies largely on the free market:
* Employers will continue to provide health insurance to the majority of Americans through private insurance companies
* Contrary to the claim, more people will get private health coverage. The law sets up ``exchanges'' where private insurers will compete to provide coverage to people who don't have it.
* The government will not seize control of hospitals or nationalize doctors.
* The law does not include the public option, a government-run insurance plan that would have competed with private insurers.
* The law gives tax credits to people who have difficulty affording insurance, so they can buy their coverage from private providers on the exchange. But here too, the approach relies on a free market with regulations, not socialized medicine.
PolitiFact reporters have studied the 906-page bill and interviewed independent health care experts. They concluded it is inaccurate to call the plan a government takeover because it relies largely on the existing system of health coverage provided by employers. It's true that the law does significantly increase government regulation of health insurers. But it is, at its heart, a system that relies on private companies and the free market.
I encourage you to respond accurately to your patient questions regarding this law and impact on their lives and our profession.
Lets remember that facts should rise above cheap talking points and ideological gibberish.
Yours
Bernd
PolitiFact editors and reporters have chosen ``government takeover of health care'' as the 2010 Lie of the Year. Uttered by dozens of politicians and leaders within organized medicine, it played an important role in shaping public opinion about the health care plan and was a significant factor in the Democrats' shellacking in the November elections. The Patient Protection and Affordable Care Act, also falsely called "Obama Care", was passed by Congress, and relies largely on the free market:
* Employers will continue to provide health insurance to the majority of Americans through private insurance companies
* Contrary to the claim, more people will get private health coverage. The law sets up ``exchanges'' where private insurers will compete to provide coverage to people who don't have it.
* The government will not seize control of hospitals or nationalize doctors.
* The law does not include the public option, a government-run insurance plan that would have competed with private insurers.
* The law gives tax credits to people who have difficulty affording insurance, so they can buy their coverage from private providers on the exchange. But here too, the approach relies on a free market with regulations, not socialized medicine.
PolitiFact reporters have studied the 906-page bill and interviewed independent health care experts. They concluded it is inaccurate to call the plan a government takeover because it relies largely on the existing system of health coverage provided by employers. It's true that the law does significantly increase government regulation of health insurers. But it is, at its heart, a system that relies on private companies and the free market.
I encourage you to respond accurately to your patient questions regarding this law and impact on their lives and our profession.
Lets remember that facts should rise above cheap talking points and ideological gibberish.
Yours
Bernd
Saturday, December 11, 2010
AMA Efforts Pay Off
Attached you find a recent AMA press release highlighting the important accomplishment of our AMA and other physician groups including the American Academy of Family Physicians to STOP the looming 25% Medicare cut for ONE year . This will protect many physicians practices from financial distress and will maintain and preserve access of seniors to physicians and other healthcare professionals. Now is the time to rally behind our AMA and to join this great organization to continue working on a long-term solution of the flawed physician reimbursement formula.
Yours
Bernd
AMA Outreach Recruiter
AMA: Congress Passes One-Year Delay Of Medicare Physician Cut
Bill Now Moves to President for Signature
For immediate release:
Dec. 9, 2010
Statement attributable to:
Cecil B. Wilson, MD
President, American Medical Association
“The AMA welcomes bipartisan House passage of legislation to stop the Medicare physician payment cut for one year. Stopping the steep 25 percent Medicare cut for one year was vital to preserve seniors’ access to physician care in 2011. Many physicians made clear that this year’s roller coaster ride, caused by five delays of this year’s cut, forced them to make difficult practice changes like limiting the number of Medicare patients they could treat.
“The AMA will be working closely with congressional leadership in the new year to develop a long-term solution to this perennial Medicare problem for seniors and their physicians. This one-year delay comes right as the oldest baby boomers reach age 65, adding urgency to the need for a long-term solution before this demographic tsunami swamps the Medicare program.
“Now that the legislation has passed both the U.S. Senate and House, the bill moves to the President to be signed into law. The AMA thanks bipartisan leaders in both the Senate and House and President Obama for their leadership on this issue to preserve seniors’ health care. The joint efforts of AARP, the military community, AMA and other physician groups helped make this one year delay a reality for patients and their physicians.”
###
Media contact:
Katherine Hatwell
American Medical Association
(202) 789-7419
katherine.hatwell@ama-assn.org
Brenda Craine
Director, AMA Media Relations
(202) 789-7447
brenda.craine@ama-assn.org
Follow AMA on Twitter and Facebook.
Yours
Bernd
AMA Outreach Recruiter
AMA: Congress Passes One-Year Delay Of Medicare Physician Cut
Bill Now Moves to President for Signature
For immediate release:
Dec. 9, 2010
Statement attributable to:
Cecil B. Wilson, MD
President, American Medical Association
“The AMA welcomes bipartisan House passage of legislation to stop the Medicare physician payment cut for one year. Stopping the steep 25 percent Medicare cut for one year was vital to preserve seniors’ access to physician care in 2011. Many physicians made clear that this year’s roller coaster ride, caused by five delays of this year’s cut, forced them to make difficult practice changes like limiting the number of Medicare patients they could treat.
“The AMA will be working closely with congressional leadership in the new year to develop a long-term solution to this perennial Medicare problem for seniors and their physicians. This one-year delay comes right as the oldest baby boomers reach age 65, adding urgency to the need for a long-term solution before this demographic tsunami swamps the Medicare program.
“Now that the legislation has passed both the U.S. Senate and House, the bill moves to the President to be signed into law. The AMA thanks bipartisan leaders in both the Senate and House and President Obama for their leadership on this issue to preserve seniors’ health care. The joint efforts of AARP, the military community, AMA and other physician groups helped make this one year delay a reality for patients and their physicians.”
###
Media contact:
Katherine Hatwell
American Medical Association
(202) 789-7419
katherine.hatwell@ama-assn.org
Brenda Craine
Director, AMA Media Relations
(202) 789-7447
brenda.craine@ama-assn.org
Follow AMA on Twitter and Facebook.
Wednesday, December 08, 2010
Florida Legislators and Pain Clinics
osted on Wed, Dec. 08, 2010; Miami Herald
State lawmakers must not give `pill mills' a pass
The Dec. 3 editorial, Tallahassee's pill mills, correctly points out how the Republican-dominated state Legislature voted to delay the implementation of tough new pain-clinic regulations.
Consequently, unscrupulous clinic operators and drug dealers in white coats, wrongly called ``doctors,'' can continue to churn out prescriptions for powerful painkillers.
Legislators seem more concerned with ideological correctness and purity than the sobering facts detailed in a report released in June by the Florida Department of Law Enforcement. It indicated that an average of seven Floridians a day die from prescription-drug overdose.
Our lawmakers seem to live in another universe than most of us. 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.
Legislators forget that the regulations were carefully crafted by Democrats and Republicans to protect Floridians from these unscrupulous businesses.
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 outraged by this political checkmate and concerned about its adverse impact on public health. This issue is too important to allow politicians to gamble away the lives of Florida residents. We need to return to pragmatism and sound reasoning to address and resolve the problem of prescription-drug abuse in the state. Ideological grandstanding will only worsen the situation. We do not have much time left -- and the clock is ticking.
Bernd Wollschlaeger,MD
North Miami Beach
http://www.miamiherald.com
Read more: http://www.miamiherald.com/2010/12/08/v-print/1963311/state-lawmakers-must-not-give.html#ixzz17a0ATueT
State lawmakers must not give `pill mills' a pass
The Dec. 3 editorial, Tallahassee's pill mills, correctly points out how the Republican-dominated state Legislature voted to delay the implementation of tough new pain-clinic regulations.
Consequently, unscrupulous clinic operators and drug dealers in white coats, wrongly called ``doctors,'' can continue to churn out prescriptions for powerful painkillers.
Legislators seem more concerned with ideological correctness and purity than the sobering facts detailed in a report released in June by the Florida Department of Law Enforcement. It indicated that an average of seven Floridians a day die from prescription-drug overdose.
Our lawmakers seem to live in another universe than most of us. 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.
Legislators forget that the regulations were carefully crafted by Democrats and Republicans to protect Floridians from these unscrupulous businesses.
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 outraged by this political checkmate and concerned about its adverse impact on public health. This issue is too important to allow politicians to gamble away the lives of Florida residents. We need to return to pragmatism and sound reasoning to address and resolve the problem of prescription-drug abuse in the state. Ideological grandstanding will only worsen the situation. We do not have much time left -- and the clock is ticking.
Bernd Wollschlaeger,MD
North Miami Beach
http://www.miamiherald.com
Read more: http://www.miamiherald.com/2010/12/08/v-print/1963311/state-lawmakers-must-not-give.html#ixzz17a0ATueT
Saturday, December 04, 2010
Pain Clinic Regulations Stalled
Attached some troubling updates regarding the pain clinic regulation issues:
1. A letter to the editor published in the Sun-Sentinel http://articles.sun-sentinel.com/2010-12-03/news/fl-pain-clinics-letter-1203-20101203_1_pain-clinics-prescriptions-for-powerful-painkillers-prescription-drug
2. Article about persistent over dose deaths in Florida http://www.sun-sentinel.com/health/os-deaths-florida-report-20101202,0,1564941.story
3. Medical Board Yanks License of Pediatrician http://www.sun-sentinel.com/health/fl-doctor-discipline-20101203,0,5563711.story
* Several troubling statements taken from the article:
* "On a related matter, a medical board panel decided not to take emergency action to initiate a strict set of pain clinic rules that have been delayed by legislative action. Legislators last month passed a law saying rules with substantial impact on small business cannot take effect until lawmakers give approval. The medical board could have declared the pill mill problem to be an emergency and put the rules into effect, but the panel found no grounds to do so."
* What other grounds do we need to declare an emergency??
Yours
Bernd
1. A letter to the editor published in the Sun-Sentinel http://articles.sun-sentinel.com/2010-12-03/news/fl-pain-clinics-letter-1203-20101203_1_pain-clinics-prescriptions-for-powerful-painkillers-prescription-drug
2. Article about persistent over dose deaths in Florida http://www.sun-sentinel.com/health/os-deaths-florida-report-20101202,0,1564941.story
3. Medical Board Yanks License of Pediatrician http://www.sun-sentinel.com/health/fl-doctor-discipline-20101203,0,5563711.story
* Several troubling statements taken from the article:
* "On a related matter, a medical board panel decided not to take emergency action to initiate a strict set of pain clinic rules that have been delayed by legislative action. Legislators last month passed a law saying rules with substantial impact on small business cannot take effect until lawmakers give approval. The medical board could have declared the pill mill problem to be an emergency and put the rules into effect, but the panel found no grounds to do so."
* What other grounds do we need to declare an emergency??
Yours
Bernd
Tallahassee's Pill Mills
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
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
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
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