Just how healthy is the healthcare marketplace? If you ask the insurance companies, business couldn’t be brisker, even if it involves fraudulent activity cloaked within the invisibility of the homeless. Just ask the CEO of a Los Angeles County hospital.
FBI agents arrested Rudra Sabaratnam, 64, the owner and top executive of a hospital, and Estill Mitts, 64, the operator of a homeless “assessment center” in the city’s Skid Row area. They enticed homeless people with the promise of payments to act as hospital patients, an indictment alleges. The homeless people are said to have received medical treatment, and the government was billed for the services. The unnecessary hospital treatments were then billed to Medicare and Medi-Cal in a scheme that began in August 2004 and lasted until about October 2007, the indictment states.
It’s a familiar refrain, and one Minnesota senator is making it this time; that is, the call for certain reform of the Medicare payment reimbursement system. In an op-ed, the Democratic senator pushes quality over quantity as the sole parameter for the assignment of Medicare dollars. Although the concept is familiar, Sen. Amy Klobuchar argues, the aggressive adoption of quality claims reporting will result in streamlined payments for “standards of care” which can be applied equally in disparate care settings.
Making Medicare a purchaser of quality, rather than just an indiscriminant government guarantor of entitled healthcare to certain patient populations is a step in that direction, according to Klobuchar. The problem is — this is known already. The initial fixes must reach beyond establishing vague quality parameters to stimulate change among those on the frontlines of healthcare quality — the physicians. Adoption by this critical segment of healthcare delivery in this country will be hard to achieve without discrete, concrete goals. Unfortunately, for the providers on the front lines of healthcare (primary care), getting paid is the immediate quality concern. | LINK
Sen. Edward Kennedy added even more drama to the bill that aims to cut Medicare reimbursements to physicians.
Casting his vote so that the bill blocking those pending cuts passed the Senate proved to be, at the very least, a symbolic victory….that is, until it gets to George W Bush’s desk where he has promised to veto it. Now, even if the President proceeds with a promised veto, the Democrats can claim they saved the day for 44 million seniors on Medicare and fault Republicans for not being sufficiently interested in the health care needs of elderly Americans.
That may suit the party’s purpose in the upcoming election, but the reality is far more complicated. Kennedy’s vote doesn’t automatically fix the troubled government healthcare guarantor; it merely opens a window into what may be just around the corner if universal healthcare financed completely by the government becomes reality: Congress becomes the arbiter of those health care budgets, every special interest group – including doctors – will press for higher payments, without fail. And experience tells us, Congress won’t have the courage to resist. Chaos? You bet. | LINK
What’s this? One state’s legislature passes an affordable health insurance bill, but Democratic lawmakers deride it?
The plan, discussed in the middle of the night after a rancorous marathon session, would give people options on what kinds of services to get coverage for - from preventive care to office visits to emergency care.
It would also aim to create a public-private corporation that House Republicans said would help create a marketplace for health-care services and insurance — a feature that is the main difference from a plan put forth by Gov. Charlie Crist and approved by the state Senate on Wednesday.
The House staff estimated it would take $1 million to run the corporation. Crist’s analysts said it could cost up to $8 million, while the governor’s plan wouldn’t cost anything.
It’s not enough of a peoples’ plan in the eyes of the Florida Democrats — while the state’s Republicans try to create the perfect blend of market-driven, government sponsored healthcare choice. | LINK
Minnesota health plans spent more on medical and administrative costs than they received in premiums in 2007, meaning premiums may rise faster in the future.
But wait, a spate of good news here: prescription drug prices remained flat. And in a year in which revenue from the generation of novel agents appears bleak (not to mention the call for greater transparency in pharma trials), this is really not surprising. Perhaps it’s welcome. | LINK
UPDATE/RELATED: The state’s legislature will decide whether to expand its Medicaid program to include additional poor, a conflict of interest of sorts (Minnesota’s Republican governor instituted a task force to answer this question — which resulted in the request for over a quarter of a billion dollars in healthcare funding, directly opposing his massive line-item veto to balance the $1B budget deficit). | LINK
A healthy kidney removed while the diseased one remains. Retained surgical instruments in the abdomen following surgery. An incorrect limb amputated. Darn right, these errors are preventable. And according to a recent study among Medicare patients, from 2004 to 2006, they cost the nation’s largest haealthcare insurer almost $9B. Some may think this is old news, but the sad fact is that to err is human, to prevent the medical sort is truly divine. | LINK
It’s nothing short of a miracle. The Bush administration has announced the immediate need for universal, complete government backed and sponsored healthcare coverage. Starting today, any patient can go anywhere for his or her healthcare and the government will pick up the tab. They can be seen for anything without regard to cost. Sky’s the limit. Big Pharma, all major managed care organizations, device companies, and yes — even CMS — are all on board with this sudden change in healthcare policy. It appears as though the Democratic candidates for president, Hillary Clinton and Barack Obama, are a little perplexed over this breaking news — as they now have no compelling healthcare platform to differentiate themselves from what the current president is proposing.
What’s making headlines in the healthcare blogosphere this weekend? Funny you should ask. A study highlights the mortality risk of using old stored blood for transfusions in cardiac surgery patients.
In response to the growing concern, some hospitals have modified their procedures for cardiac surgery — one of the largest consumers of donor blood — to minimize the need for transfusions.
New practices include increased use of blood scavenging during surgery, sending patients home with a lower-than-normal percentage of red cells in their blood, new drugs to prevent intra- and post-operative bleeding and, perhaps most important, reducing anemia before surgery.
Another study may help men decide between three different treatments for prostate cancer.
An interesting analysis awaits the reader comparing Republicans’ and Democrats’ worldviews on how improving the delivery of healthcare would be implemented in the next presidential administration.
A local engineers union is protesting St. Louis Park (MN)-based multispecialty clinic Park Nicollet’s decision to jettison at least two Medicare Advantage plans. Representatives of Local 49 of the International Union of Operating Engineers are upset that the clinic plans to utilize other health plans in its coverage umbrella. One of the plans in question, Humana Gold Choice, is all the union offers its retirees — many of whom are currently involved in costly, chronic treatments.
Minnesota’s AG supports the union, which blames Park Nicollet of leaving its healthcare beneficiaries without adequate coverage and little time to ponder alternative choices. Park Nicollet reps cite the plans’ aggressive desire for profit over sound coverage and practice efficiency, something they say does not jibe with the clinic’s non-profit mission.
Union leaders point the finger at the healthcare organization. The clinic, in turn, blasts the private fee-for-service insurance industry and its practices. As is becoming increasingly the norm in the Medicare managed care sphere, the beneficiary is the one who suffers in cases like this. | LINK
Last week, the House passed HR 1424, a bill meant to provide parity between mental and physical illness and the healthcare services rendered for their diagnoses. The major provisos included within the legislation mainly prohibit health plans from either requiring larger copays to initiate coverage or setting reimbursement caps on those services. However, the bill would not affect employers who offer plans to fifty or fewer employees. The Bush admin opposes each measure. | LINK
Healthcare payer Humana tries to do its part in trying to cut its payments to Medicare — via incentivization.
Humana last month launched a program, called “Healthy Returns,” that provides its Medicare plan beneficiaries with gift cards to Macy’s, CVS, Lowe’s and Borders as an incentive to adopt healthier lifestyles, Florida Health News reports. The program involves three pilot projects. Under the first program, beneficiaries who enrolled in coverage this year can earn a $15 gift card if they complete a health risk assessment. The assessment will determine whether beneficiaries should exercise more, change their diets or take other steps to reduce the risk of developing health problems. To date, 35,000 beneficiaries nationwide have earned the reward. The two other projects include a more extensive preventive care program and a disease management program for diabetics. Those programs offer gift cards valued up to $125.
You go under the knife to get your appendix removed because of a sudden rupture; this certainly constitutes a medical emergency. However, you almost die from this usually routine surgery after a blood typing snafu results in a graft-vs.-host reaction that lands you in the ICU. You recover, but not until after your flirtation with death.
Then you receive the bill from the hospital in the mail. The hospital is charging you for the ICU stay in addition to the emergency appendectomy. Unfortunately, these incidents are not uncommon, and only ten states have agreements among acute hospitals which will waive fees generated via preventable hospital errors.
It just goes to show you how steep a price some for-profit healthcare organizations pay for caring more about the bottom line than their consumers-patients:
Health Net Inc. said on Wednesday it would lower its previously announced quarterly profit after a California arbitrator ordered the insurer to pay $9.4 million for canceling a cancer patient’s coverage.
The company said it would lower net income for the fourth quarter to $116.9 million, or $1.04 per share, from its previously reported net income of $123.4 million, or $1.10 per share.
The for-profit payer is an example for other plans and organizations which sacrifice quality for a payment system based upon trying to retain the biggest risk pool possible. | LINK
It’s a familiar refrain, and one Minnesota senator is making it this time; that is, the call for certain reform of the Medicare payment reimbursement system. In an op-ed, the Democratic senator pushes quality over quantity as the sole parameter for the assignment of Medicare dollars. Although the concept is familiar, Sen. Amy Klobuchar argues, the aggressive adoption of quality claims reporting will result in streamlined payments for “standards of care” which can be applied equally in disparate care settings.
