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Health Facts

Vermont Takes the Lead in Genuine, Effective Medical System Reform

An unlikely experiment is underway in one of the few American states where conservatives were unable to convince majorities of the populace to view government leadership as the Devil’s preferred path to socialism, if not Stalinism. Vermont, a bastion of good sense in this benighted era of irrationality, is one of, if not the, best of the states. The newly-elected governor, Peter Shumlin, wants to overhaul the state’s medical system. His plan for doing so is nothing less than the boogeyman to the Tea Party types, namely, single payer. Watch out for death panels! The governor’s goal is nothing less than a public option for the entire state. Best of all, there is no role in single payer as the governor sees it for the rapacious insurance companies. Michael Moore must be besides himself with joy.
Of course, a waiver from the federal government to implement a single payer plan will be required. The new governor believes that “the waiver is the easy part. The hard part is designing a single payer health care system that works and that delivers quality health care, gets insurers off our providers’ backs and has a reimbursement system that makes sense.” He adds, I believe if we design that system, we can sell it.”
The new governor sees the shift to single payer as an economic necessity as well as a move that will boost quality of life. A plot line showing a steep upward trajectory of rising costs convinced him that a single payer plan is essential. He has stated that such a big step is needed for the well-being of government itself, as well as companies and the citizens of Vermont.
The governor argues that costs will increase a billion dollars in the next year in Vermont. The average family will pay $7,000 more. This is on top of $32,000 paid now. This hurts the state economy and increases property taxes.
The governor campaigned on single payer, so the ambitious redesign plan comes as no surprise to voters. Key features include:
* Health benefits managed directly through citizens, not employers.
* Reimbursement related to outcomes, not pay for treatment/fee for service.
* Reliance placed on upgraded standards of uniform medical records and payments.
* Plans for implementing a single payer system and other options are shaped by the state legislature. The head of this study, a Harvard Economics Professor, made his own position clear in a New York Times interview: “You can have universal coverage and good quality health care while still managing to control costs. But you have to have a single-payer system to do it.” (See Anne Underwood, “Health Care Abroad,” The Business of Health Care, NY Times, November 3, 2009.)
In Vermont, unlike my own hapless state of Florida, Democrats control the executive and legislative branches. This makes prospects for a single payer system more likely than in most other states, if not any other state.
My chief wellness adviser in Vermont, Dr. Judd Allen, reported this week that the governor’s election and the drive to adopt a single payer health system in Vermont, “is perhaps one of the few bright spots in the election results. I worked very hard in Shumlin’s campaign and we only won by a few thousand votes. It is a big deal. I’ve written our governor-elect about helping with the transition.”
If the governor puts Dr. Allen on the case, look for Vermont to become a national model for the future of American medical system reform.
Be well and look on the bright side, even if you don’t have the good fortune to live in Vermont.…

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Department Of Health

Health Care Reform is a Joke, and Here’s Why

I can’t remember the last time something was such a huge story – and at the same time such a non-story. There are a couple of great reasons you can simply ignore all of the hoopla around the health care debate – unless you are a CEO wielding a lot of financial power, or similarly positioned.
First of all, this pie isn’t done yet. After all the good stuff is gutted from the Senate version of the bill (so we can get 60 votes to close debate) the party is still only starting. Next up – the House and Senate versions go to committee for reconciliation. The two versions which are now very different, have to be combined into one for the President to sign. There are going to be a lot of changes. Then, the revised bill has to be voted on again. Then the President signs it and we have a law. So, what will the final law look like? Who knows, but one thing is for sure, it won’t be written to help you or me, for the following reason….
The fix is in. By this I don’t necessarily mean that the content of the final bill is decided – no, it is actually a lot more depressing than that. The fix is in because our congress is bought and paid for. It takes millions of dollars to get elected to congress. Most politicians get their campaign funds, either directly or indirectly, from large corporations.
This makes them wary of doing anything that will upset said corporations, regardless of how it affects the country or their constituents. You may thing I am cynical, but it only takes a little number crunching to see what is really going on inside the beltway. Nate Silver, over at recently published a very interesting table charting which way congress members would vote on health care, bounced off of campaign contributions from the health insurance industry.
Huge surprise! Those members that get the most money from health insurance companies are more likely to scuttle reform. There could not be a clearer demonstration of the way our government actually works.
Something will most likely be passed, either in December 2009, or early 2010 – but it won’t really be written by congressional committees – no, it will be written by health insurance company lobbyists. So, what can you do about this? Not a lot. You can write and call your congressman and Senator. But they know where their bread is buttered.
My own guess is that nothing substantial will happen until about one third of everybody’s income is taken up by health care costs. The pain has to be truly unbearable to get most Americans up off of their cans to do something. And what we will do is to throw the bums out. Then, and only then will it be fixed. Of course unless there is a huge reform of campaign financing the same thing will simply happen again, with some other issue.
In the meantime rest assured that while you are wondering how the heck you are going to make an 800.00 per month premium payment, your congressman and Senator and their families are getting the best health care on the planet – paid for by you. All of the executives at the health insurance companies and their loved ones have nothing to worry about. After all, you are paying their premiums as well, in addition to huge bloated compensation packages.
So just sit back and watch the show if you like. There is nothing you or I can do about it anyway. Just remember that a show is all it is, put on for your benefit. They don’t really have to do anything to help us, or fix the problem – they simply need to make it look like they are.…

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Nutrition

Hospital Leadership, Strategy, And Culture In The Age of Health Care Reform

With just eleven months to go before the Value-Based Purchasing component of the Affordable Care Act is scheduled to go into effect, it is an auspicious time to consider how health care providers, and hospitals specifically, plan to successfully navigate the adaptive change to come. The delivery of health care is unique, complex, and currently fragmented. Over the past thirty years, no other industry has experienced such a massive infusion of technological advances while at the same time functioning within a culture that has slowly and methodically evolved over the past century. The evolutionary pace of health care culture is about to be shocked into a mandated reality. One that will inevitably require health care leadership to adopt a new, innovative perspective into the delivery of their services in order to meet the emerging requirements.
First, a bit on the details of the coming changes. The concept of Value-Based Purchasing is that the buyers of health care services (i.e. Medicare, Medicaid, and inevitably following the government’s lead, private insurers) hold the providers of health care services accountable for both cost and quality of care. While this may sound practical, pragmatic, and sensible, it effectively shifts the entire reimbursement landscape from diagnosis/procedure driven compensation to one that includes quality measures in five key areas of patient care. To support and drive this unprecedented change, the Department of Health and Human Services (HHS), is also incentivizing the voluntary formation of Accountable Care Organizations to reward providers that, through coordination, collaboration, and communication, cost-effectively deliver optimum patient outcomes throughout the continuum of the health care delivery system.
The proposed reimbursement system would hold providers accountable for both cost and quality of care from three days prior to hospital admittance to ninety days post hospital discharge. To get an idea of the complexity of variables, in terms of patient handoffs to the next responsible party in the continuum of care, I process mapped a patient entering a hospital for a surgical procedure. It is not atypical for a patient to be tested, diagnosed, nursed, supported, and cared for by as many as thirty individual, functional units both within and outside of the hospital. Units that function and communicate both internally and externally with teams of professionals focused on optimizing care. With each handoff and with each individual in each team or unit, variables of care and communication are introduced to the system.
Historically, quality systems from other industries (i.e. Six Sigma, Total Quality Management) have focused on wringing out the potential for variability within their value creation process. The fewer variables that can affect consistency, the greater the quality of outcomes. While this approach has proven effective in manufacturing industries, health care presents a collection of challenges that go well beyond such controlled environments. Health care also introduces the single most unpredictable variable of them all; each individual patient.
Another critical factor that cannot be ignored is the highly charged emotional landscape in which health care is delivered. The implications of failure go well beyond missing a quarterly sales quota or a monthly shipping target, and clinicians carry this heavy, emotional burden of responsibility with them, day-in and day-out. Add to this the chronic nursing shortage (which has been exacerbated by layoffs during the recession), the anxiety that comes with the ambiguity of unprecedented change, the layering of one new technology over another (which creates more information and the need for more monitoring), and an industry culture that has deep roots in a bygone era and the challenge before us comes into greater focus.
Which brings us to the question; what approach should leadership adopt in order to successfully migrate the delivery system through the inflection point where quality of care and cost containment intersect? How will this collection of independent contractors and institutions coordinate care and meet the new quality metrics proposed by HHS? The fact of the matter is, health care is the most human of our national industries and reforming it to meet the shifting demographic needs and economic constraints of our society may prompt leadership to revisit how they choose to engage and integrate the human element within the system.
In contemplating this approach, a canvasing of the peer-reviewed research into both quality of care and cost containment issues points to a possible solution; the cultivation of emotional intelligence in health care workers. After reviewing more than three dozen published studies, all of which confirmed the positive impact cultivating emotional intelligence has in clinical settings, I believe contemplating this approach warrants further exploration.
Emotional intelligence is a skill as much as an attribute. It is comprised by a set of competencies in Self-Awareness, Self Management, Social Awareness, and Relationship Management, all leading to Self Mastery. Fortunately, these are skills that can be developed and enhanced over the course of one’s …

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Healthy Nutrition

Mental Healthcare Reform – Present Successes and Future Challenges

As healthcare reform is becoming a reality, there is much to celebrate within the mental health community. This includes passage of a healthcare reform package that includes parity for mental health and addiction services, expansion of Medicaid to 133% of Federal Poverty Level, inclusion of behavioral health organizations and individuals with mental illnesses in the new Medicaid medical home state option, and authorization and increased funding for grants co-locating mental health treatment and primary care. These and a host of other provisions expand the opportunities for individuals with mental illnesses and addictions to obtain and maintain insurance coverage and access needed services.
But this is not the end of the mental healthcare battle. Simply put, mental health advocates must be ready to play in a new game, in a world where increasing numbers of individuals – by virtue of Medicaid expansion, the emerging Health Insurance Exchanges, and parity regulations – will have access to behavioral health services. We expect to see an additional 15 million individuals – an increase of 43% – eligible for Medicaid alone, with more than 30 million individuals overall who will, in the not too distant future, have insurance coverage.
But this is far more than a matter of numbers – it’s about working smarter. Advocates of mental healthcare anticipate that healthcare reform-driven service delivery redesign and payment reform will unfold at a rapid pace. In order to bend the cost curve, payment reform and service delivery redesign will change how health, mental health, and substance use services are integrated, funded, and managed. Providers must learn to practice healthcare the way healthcare will be done.
As mental healthcare providers and advocates, we must become savvy about positioning ourselves to take advantage of new markets and new opportunities to help control the design and delivery of healthcare services. We must begin to build relationships within and across the entire healthcare sector. As we revisit the concept of “managing care” for individuals and whole populations, we have to be certain that our focus on person-centered, recovery-focused treatment and services is not subsumed by the drive to “bend the curve” in healthcare costs. We must be able to demonstrate our value not only to our customers, but also as key players in these new healthcare consortia.
We must become accountable for efficient and effective services that show results across all health domains. We believe fee-for-service reimbursement will slowly become a thing of the past. So, too, will be the ability to claim that caseloads are full with no-show rates of 50% and more. We risk being left on the sidelines if we don’t move with deliberate speed to ensure continuity and timely access to care; comply with third-party payer requirements; coordinate care with a full range of health providers; and if necessary take on payers that refuse to honor the spirit and letter of the parity regulations.
We must become increasingly customer-focused, from the way we greet individuals who come through our door to the way we market our services. We should expect that with more money available in healthcare – particularly for mental health and addiction treatment – that new and well capitalized players will find behavioral health, traditionally a financially unattractive healthcare sector, far more appealing.
People will be insured and will have an increasing range of options available to them. What differentiates our mental healthcare services? Why should an individual choose to receive treatment and support from us? Are we offering services that will help them meet a full range of healthcare needs? Are our services culturally appropriate for the communities we serve? Can we help them understand and make appropriate use of their insurance coverage? We must retool our organizations with the knowledge that all individuals will now become true “consumers” of healthcare services.
At the same time, we must also be aware that our work is far from over at the state and federal level. Forty eight of 50 states are experiencing severe budget shortfalls. The threat is very real and the mental healthcare advocates are fighting hard to hold on to current funding as legislatures see an opportunity to continue to withdraw needed funds. This is surely a bad idea – even the most generous healthcare benefits will likely not cover the full range of wraparound supports that people with mental illnesses and addictions need to fully recover.
Eleanor Roosevelt once said, “It takes as much energy to wish as it does to plan.” All of our planning, advocacy, and leadership to date have borne fruit, but we must not be content to wish it all works out well. We must fight for our future – and the future of the individuals we are privileged to serve – by acting as key players in the brave new world of healthcare.…

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Healthier

Health Care Reform – How Are You Affected? – Part 3

If you are an employer with fewer than 50 full time and “full time equivalent” (FTE) employees, you will enjoy the luxury of being exempted from the most onerous provisions discussed in the previous article. If you offer health insurance coverage to your employees you will still have a few issues affecting your health plan.
Effective for tax year 2013, an additional Medicare Part A tax of 0.9% will be assessed on incomes above $200,000 for individuals or $250,000 for joint filers. This works out to a 62% increase over the current Medicare tax rate of 1.45%. Another tax of 3.8% will be assessed against unearned income for “high income” taxpayers.
Other taxes will go into effect on or before January 1, 2014, that relate to HSA account distributions. The so-called Cadillac tax on rich health plans will begin then as well, but perhaps one of the most notable tax increases actually began March 23, of this year. All tanning bed operators began paying an additional 10% tax surcharge for customer rental of tanning beds.
If you offer group health insurance, your plan will have to eliminate lifetime caps on Essential Health Benefits (EHBs). As was discussed previously, EHBs will be further defined by Health and Human Services. It is believed EHBs will include certain wellness, outpatient and hospitalization benefits. That is, all health insurance plans must offer these benefits and can not place caps on how much can be paid out under the plan. A few of the EHBs may be required to be offered exclusive of a plan deductible, such as routine physical exams.
The most important issue for small groups is the 35% tax credit that is available for tax year 2010. This credit is available through tax year 2013 if the employer contributes at least 50% of the total premium cost. The debate continues at present if the 50% contribution rate must apply to dependents’ premiums as well. The larger the business becomes, the smaller the credit becomes. Consultation with a knowledgeable tax professional is recommended.
The credit will stop after 2013. At that time a two-year tax credit will then be available if the small group plan is purchased through the government health insurance exchange.
Children of employees are eligible as dependents until age 26, regardless of marital or student status.
By January 1, 2010,annual caps on EHBs must be eliminated. Too, the small business will not be able to extend a waiting period for enrolling new employees beyond 90 days. Texas state law already requires no more than a 3-month wait.
Pre-existing health conditions must be fully covered by January 1, 2014 for adults. The mandate for children under 19 years must be in effect by September 23, 2010. Insurance companies are challenging the child provision however saying, the time frame is too soon for the mandate to be implemented.
As you shop for better deals for small group insurance or even individual insurance, HCR is supposed to open the door to expanded competition. You will be able to continue to shop for insurance as you have in the past, but you may also go direct with insurance carriers, or look at Consumer Owned and Oriented Plans (CO OPs), or even through a state run health insurance Exchange.
The exchanges, in conjunction with purchasing from carriers directly through third parties, will most likely be the same insurance carriers, similar plans and comparable premiums. Although, the Exchanges will require insurance companies to offer plan designs that satisfy unresolved minimum benefit levels. Only the CO OPs may be able to offer a little diversity in plan design, and because they are supposed to be owned by the individual group employers, the idea is that premiums will generally remain stable.
HCR will provide initial seed money to start up the CO OPs and Exchanges, but no one knows yet any details on how these programs must be structured. Some important questions remain to be answered.
-Can CO OPs cross state lines?
-Can CO OPs include different industry types?
-Who actually will run the program?
-Will multiple plan options be available to different employers’ unique needs?
Individuals will also be able to shop through the Exchanges, but will not be allowed the opportunity to enroll in CO OPs unless 1-person groups are allowed to participate. Eventually, the small group market and individual market probably will merge into just an individual market.
A lot more of the “fun” begins for small groups and individuals January 2014. As mentioned earlier, the Medicare tax begins. Also on that date, individuals must enroll in a health insurance plan that is equal to or better than EHBs or pay a penalty. The penalty is $95 or 1% of household income in 2014; $325 or 2% in 2015; or $695 or 2.5% in 2016 …

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Health Tips

Health Care Reform and Biotech

One of the most affected industries regarding the new health care reform is with biotechnology. One of the many provisions in the new health care reform bill is to reduce the prices of the medical prescriptions charged to Medicare and Medicaid. This will hurt the biotechnology industry because the research for new medication is very expensive and tedious work.
The size of the impact to the biotech industry is beginning to be realized and the health insurance providers are starting to resort to eliminating new medication, in favor of the more traditional medications of years ago. Since it takes time for the pharmaceutical companies to exhaust their patents on new health care medication, the health insurance industry is turning away sooner than what was originally expected.
This will translate into less medical prescriptions for the medical healthcare provider and the individual to choose. Many of the medical health care prescription medications we have on the market today are slowly disappearing as the pharmaceutical demand for them are dwindling by the millions.
The losses to the biotech industry is becoming evident and many of the staff are deciding how much longer they will continue with the companies. The provisions, suppliers, health insurance industry, and supporters are no longer able to offer high finances to continue the funding of current projects.
What will this mean for you and your family members? This will mean the health insurance industry will have more control over what you are able to purchase unless you have the monetary means to pay for a given medical prescription out of pocket. It always comes down to what is affordable and what is not affordable.
Many individuals who suffer with orphan diseases will find they will no longer have access to the medication they so desperately need. The funds are drying up because of the new health care reform bill and the prescription medication for the orphan diseases will dry up. This is because as funding dwindles, the money that remains will be focused on the more popular diseases.
This will sadly leave many individuals with a government-run health insurance policy without the necessary health care they require. How will a medical health care physician have the ability to identify and help a patient with an orphan disease when there is no prescription medication to keep it maintained?
This will leave millions of individuals to be forced to take care of themselves the best they are able and pray for better days in the future yet to develop. How sad for the families with children who need health care treatment. Where will they go? Whom will they turn to?…