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Medicine: Healthcare System

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Price Competition for Medical Care

December 9, 2012
inDisinformation and the healthcare system, Healthcare Insurance Industry, Innovations in Healthcare, Medicine: Healthcare System, Stakeholder Mistrust
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Stanley Feld
M.D.,FACP,MACE

Thank goodness many physicians are starting to recognize the problems of abuse
and waste in government run healthcare programs.  The run up in cost is secondary to the
healthcare insurance industry taking 40% of the healthcare dollars off the top
as patient care dollars and the hospital systems over inflating the costs to
patients because of inflated operating expenses and administrative salaries.

Physicians realize that an efficient free market system will reduce the
cost of care. Physicians are tired for being blamed for the entire healthcare
systems problems. They do not deny being part of the problem.

Many physicians have decided to move forward and develop consumer driven
free market systems of care. 

One example is Nextera Health in Longmont Colorado. I have discussed this
previously.

Nextera Healthcare
is a new model for delivering primary care at an affordable price. It follows
many of the principles embodied in my ideal medical savings account
model.  Nextera delivers compassionate care at an affordable cost and
encourages patients to be responsible for their health.

Nextera
Healthcare services all of a families needs at an affordable monthly cost. It is
combined with a high deductible healthcare insurance plan to cover costly
illness.  

The
reason I am so high on Nextera Healthcare is that it closely fits a model of
healthcare delivery that will work to decrease the cost of medical care. It
will increase the quality of medical care and permit primary care to be a
viable specialty. 

Nextera Healthcare has the potential to permit the patient
to be responsible for managing their health and their healthcare dollars.

Nextera
Healthcare has the potential to reduce healthcare cost to individuals, employer
sponsored self insured plans, associations and even government funded
healthcare plans while permitting consumers to make their own healthcare
decisions.

Surgeons are developing their own innovative systems.  In free standing surgery centers they are
developing surgical procedures that cost at least 70% less than Medicare is
paying hospitals for the same procedure.   

 Dr. Keith Smith, co-founder and managing
partner of the Surgery Center of Oklahoma, took
an initiative that would only be considered radical in the health care
industry.

Dr. Smith posted a
list of prices online for 112 common surgical
procedures. Dr. Smith ,an anesthesiologists, became disillusioned about how
patients were treated and charged at St. Anthony Hospital in Oklahoma City.  

Dr. Smith’s goal
was to create a for-profit facility that could deliver first-rate care at a
fraction of what traditional hospitals charge. The goal was to eliminate the
hospital and healthcare insurance industry as the middlemen while decreasing
the cost of surgical care without decreasing the quality of care.

He wanted to create a system in which consumers and their employers
could receive surgical value at an affordable price. In the existing healthcare
system patients have no incentive to look for dollar value.

A healthcare system in which consumers buy goods or services from a
physician, surgeon or hospital systems all being paid for by the healthcare
insurance industry or government does not constituent incentive for consumers
to seek value and quality.

The lack of patient responsibility and value hunting is one of the major
causes of exploding U.S. heath care costs.

Physician owned transparent Surgery Centers are becoming increasingly
common as Americans look for alternatives to the traditional health care market
which is unaffordable and out of reach.

Consumer-driven models are appearing as fewer people have healthcare
coverage from their employers and are on their own

The unintended consequences of Obamacare are creating more uninsured not
less. The Medicaid insurance coverage that Obamacare is offering is
unappealing.

Patients may have no choice but to look outside the traditional health
care industry in the face of higher costs and reduced access to doctors and
hospitals. It is only going to get worse as we get deeper into Obamacare.

The Oklahoma Surgery
Center demonstrates that it’s possible to offer high quality care at low
prices. Surgeons can do twice as many surgeries in an outpatient surgery center
than they can in a traditional hospital surgical suite.

Most industries
try to improve efficiency. However, simple efficiencies have not occurred in
most traditional hospitals. Surgeons spend half their time waiting for the
patients to come to the operating room or for the availability of operating
rooms and equipment.

The Surgery
centers have solved these efficiency problems. They can service surgeons’ needs
at less than half the cost without the wasted time.

A key reason is
there are not multiple administrators creating multiple regulations and
collecting multiple $500,000 to $3 million dollar a year salaries. Surgical
centers have one head nurse responsible for everything and zero administrators.

The cost of a “complex
bilateral sinus procedure” at the Surgery Center was an all-inclusive $5,885.
The traditional hospital bill totaled $33,505 without the surgeon’s and
anesthesiologist’s bill included.

It was discovered
at the time of the nasal surgery that the hospital charged $360 for a
dexamethasone injection. A dexamethasone injection cost the hospital $.75.

 A fentanyl shot which is a pain-killer cost the
hospital system $1.50 but the bill to the insurance company was $630.00 dollars.
Everyone has heard of the $45.00 hospital aspirin   

A traditional
hospital discounted non-inclusive bill to the healthcare insurance industry for
a carpel-tunnel release would be $7,452. The fee for the procedure pre-op is
not be available. The same procedure done for the all-inclusive transparent
cost at the Surgery Center was $2,775.

More tragic was
that the patient would have had to pay $5,299 out-of-pocket  to cover her deductible and co-pay for the
hospital bill before she even received the bills for physicians’ services. 

Below are some
examples of the differences in costs for procedures.

 
Transparency-Matters-larger jpg
A list of the surgical fee for the Oklahoma Surgery Center is on its web
site. http://www.surgerycenterok.com/pricing.php

How do hospital systems get away with this?

The more the hospital bills the more the insurance company puts in reserve.
The reserves are in the medical costs column and include the non-discounted
costs. The result is greater profit for the insurance company.

President Obama does not want physicians to be innovative in this way.
He wants physicians to be dependent employees of hospital systems. His goal is
to control physicians and dictate their medical care.

President Obama has provided some non-transparent favors to hospital systems
that are forcing physicians to be employed by hospitals. 

"A new provision buried in Obamacare effectively prohibits doctors from starting their
own hospitals or expanding the hospitals they already own, which has been
widely interpreted as a give-away to the American Hospital Association."

Hospital systems claim they must charge more to cover their overhead and
bureaucratic inefficiencies. So fix your system. Surgery centers have.

Dr. Smith says: "Everyone can
see what the prices are at the Surgery Center, and that affordable health care
is possible. So the jig is up.”

Dr. Smith believes that despite the obstacles being put in the way by
Obamacare, market-driven facilities like his will thrive and proliferate as
consumers catch on to costly collusion between big government and big health
care.

I totally agree. As Obamacare’s unintended consequences proliferate
consumers and captured physicians (hospital employed) will pay more attention
to physician innovation. The jig for big government and big healthcare will
certainly be up.

 The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Bad Ideas Made Worse By Unintended Consequences

December 5, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System
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Stanley Feld M.D., FACP,MACE

I love when someone has great innovative ideas that have a chance to be
effective. I dislike ideas that anyone using common sense can see it is going
to fail.

President Obama is trying to set up health insurance exchanges in all 50
states.

Common sense tells us the exchanges will not work. They are counter to
stakeholders’ vested interests. They are trying to force stakeholders into
doing something they do not want to do. Health insurance exchanges will be
unmanageable. The costs will be uncontrollable. They will lead to waste and
fraud and abuse.

Government’s role should be to level the playing field for all
stakeholders and then get out of the way.

America’s healthcare system needs innovations that inspire the
healthcare industry to be competitive and efficient.

What are the specific problems with health insurance exchanges?

Health insurance exchanges were supposed to be operational by October
2013.  Only preliminary rules have been
published to date.

The states are not anxious to be subject to federal controls that
challenges state rights and drives states deeper into debt.

The federal government is requiring full transparency from the states
while it is conducting all of the setup work in secret.

Federal officials have disclosed little about their plans to the states
or the press. They have been vague about the financing for the health insurance
exchanges.

The Obama administration has stated that if states decline to
participate in health insurances exchanges by December 15, 2012
(postposed from August 15 to November 15 and now December 15) the federal government
will form its own exchanges for those states.

President Obama sold Obamacare to congress and the American people on
the basis that it was going to save $115 billion dollars in healthcare spending
in ten years. This number was calculated by the CBO on the basis of data
provided by the Obama administration.

The most recent CBO estimate using recent data is that healthcare
spending will increase by $2.5 trillion dollars over the next ten years.

Obamacare does not permit federally operated exchanges to provide
subsidies to enrollees that the enrollees would be eligible for in state
operated exchanges.

This provision was included in the law to encourage the states’ creation
of exchanges. States would then receive additional money from the federal
government.

The administration did not anticipate so many states would refuse to
participate.

Sarah Kliff wrote for the Washington
Post: wrote that there are many other problems
facing the health insurance exchanges.

“After people become aware of benefits, the health exchange faces its
biggest challenge: Figuring out who is eligible for what. In many states those
who earn less than 133 percent of the Federal Poverty Line are eligible for
Medicaid — except if the state has already extended benefits to an even higher
level, as 35 states have for children.”

“There may be different family members eligible for different programs,”
says Sam Gibbs, vice president of sales at eHealthInsurance. “There needs to be
a technology system that can support that activity, and look at multiple
programs for multiple people.”

A state can’t figure out how much an individual earns on its own. For
that, it needs to ping a federal data hub that does not yet exist.

The problems with President
Obama’s health insurance exchanges are worse. The exchange subsidies will vary
by income and family size. A federal agency does not exist that can tell a
family’s current income. It takes the IRS at least a year and a quarter to
determine last year’s income.

Family income can vary
substantially from year to year. 
Families have to pay healthcare insurance premiums based on what they
earned over a year ago. The breadwinners might be unemployed and required to
pay an unaffordable premium.

The federal government does
not seem to have developed its plans for a federally run health insurance
exchange. It looks as if the federal government’s plan was to stick the costs
and administration on to the states even though it promised to pay for the fist
two years.

Its goal was to force
states to do what the federal government wants them to do. Running a health
insurance exchange will be at great cost to the states and state budget
deficits.

The health insurance
exchange development is a mess. The real threat lies in its execution and
implementation.

It will be surprising if
they are operational by January 2014. The cost overruns will be astronomical.
They are already substantial. The unintended consequence will escalate.

In order to pay for the
exchanges President Obama’s administration just announced a 3.5% tax on every
premium sold by a healthcare insurance company. The result will make insurance
less affordable.

The original announcement
was revised. The 3.5% premium tax would only apply in states that did not have
state health insurance exchanges.

 The announcement sounds like a little power
play by the Obama administration.

The healthcare insurance
companies will simply pass the tax on to consumers with increased premiums.

The increase will have no
effect on the profitability of the healthcare insurance industry.

The government should enforce
the new Medical Loss ratio of 80/20. Eighty percent  of healthcare premiums should go to direct
patient care.

The government should not
permit help desk expenses and physician network development expenses to be
charged to direct medical care.

The government should
change the accounting rules. The formula for counting unpaid liabilities as
direct medical care expenses is outrageous. Much of these reserves are medical
reimbursement are the remains of discount fees have been  paid to providers already for direct patient
care.    

There are many other
categories of expenses that should not be included in the 80% of direct medical
care.

The federal government
needs the healthcare industry to adjudicate claims and perform all of the
administrative services for all the government funded healthcare services.
Government accounting for its own overhead does not include the fees charged by
the healthcare insurance industry to provide these services.

There is so much the public
does not know about how Medicare and Medicaid money is spent. If the government
were transparent it would let the people know what the defects are and then
force government to fix them.

Apparently President Obama
prefers to go deeper in debt.

All the stakeholders are
villains and take advantage of the healthcare system. The healthcare insurance
industry is the worst villain. Health insurance exchanges will not cure this.

They will make it worse. 

 

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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States Decline to Set Up Exchanges for Insurance

December 2, 2012
inMedicine: Healthcare System
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 Stanley Feld M.D.,FACP,MACE

President Obama has an interesting
way of negotiating. Rather than trying to  compromise and meeting some of the needs of the
opposition, he always plays a game of chicken at the last minute.

Most of his supposed
innovations have failed because of this.

He has backed off many of
his proposed innovations either because of resistance by opponents or because the
innovation was impractical.

The CLASS ACT (Community Living Assistance Services and Supports) was abandoned
by the administration because once it became apparent that providing long-term
care would be impractical, unaffordable and impossible to execute.

The same realization is
emerging for the formation of the health insurance exchanges (HIX). Health
insurance exchanges were supposed to be operational in every state on January
1, 2014.

The traditional media continues
to play right into President Obama’s hands. It makes a battle between the good
guys and the bad guys out of every issue  rather than presenting the facts about the
issues.

President Obama and his team
are always the good guys. All of the critical issues for success or failure of
the health insurance exchanges have been left out of the public debate.

President Obama’s idealistic
hope was that all the states would make their commitment to set up the
exchanges. Many states have refused to set up the health exchanges. President
Obama increased state subsidies for the exchanges without congressional
approval to encourage states to join.

By August 2012 only 13
states agreed to set up their own state health insurance exchanges. As of the
end of November 2012 only 17 states agreed to set up their own healthcare
insurance exchanges.

The revised deadline of
November 15, 2012 for signing up has been extended to December 15, 2012.

States wanting to pursue a
"partnership exchange", a hybrid exchange to decrease costs to the
states by increasing Federal Funding still have until Feb. 15, 2013 to submit a
declaration letter and blueprint for its exchange. 

Federal officials have
stated if states do not set up the exchanges the federal government will.

“The exchanges — online markets where
consumers can shop for private insurance subsidized by the federal government —
are a centerpiece of President
Obama’shealth care law.”

HHS was supposed to certify HIX blueprints for all 50 states by Jan. 1,
2013.  The states are supposed to be ready for open enrollment by Oct. 1,
2013 and operational on Jan. 1, 2014.  

As of November 19, 2012, seventeen states, NY, MA, RI, NH, DC, KY, DE, W
VA, MS. NM, CO, CA. OR, NV, MN, WA, and HI have declared their intention to establish
a State-based Exchange (SBE).

Federal regulations have not been released. I will bet some of above
states will drop out when they will be able to calculate their costs.

The nineteen states that have definitely declined to participate in the
health insurance exchanges at this point are TX, OK, KS, NB, ME, VT, SD, ND, AK
WY, MT, VA, GA, AL, MO, SC, OH, IN, WI.

Most of these states realize the financial burden, administrative
burden, and challenge to states rights Obamacare’s health Insurance exchanges
will place on their states as they try desperately to balance their own
budgets.

An additional five states, AR, NC, Il, MN, and ME are pursuing an ill
defined  partnership plan offered by the
Obama administration to set up a health insurance exchange.

Nine states are undecided but leading toward rejection.

A total of 28 states are leaning towaed total rejection of the health
insurance exchange concept and 22 states are interested.

I am not a Rick Perry fan but sometimes he says some smart things.

"Neither
a 'state' exchange nor the expansion of Medicaid under the Orwellian-named
P.P.A.C.A. would result in better 'patient protection' or in more 'affordable
care,'" Texas Gov. Rick Perry said in July in a letter to
Health and Human Services Secretary Kathleen Sebelius. "What they would do
is make Texas a mere appendage of the federal government when it comes to
health care."

The administration has published preliminary regulations. Even though
the exchanges are supposed to be state run, the federal government is going to
dictate the rules. The loss of state rule is making many state governors
nervous.

 Gov. John R. Kasich of
Ohio, a Republican, said Friday that his state “will not run an Obamacare
health exchange, but will instead leave that to the federal government to do.”

“Based on the
information we have,” Mr. Kasich said, “states do not have any flexibility to
build and manage exchanges in ways that respond to unique needs of their
citizens.”

Gov. Scott Walker of Wisconsin said, “under
the law, Wisconsin taxpayers will not have meaningful control over the health
care policies and services sold to Wisconsin residents.”

Gov. Nathan Deal of Georgia, a Republican said, “his state would not establish an exchange. He expressed
concern about what he described as “the one-size-fits-all approach and high
federal burden imposed on states.”

It will be interesting to
see how President Obama is going to get around this problem. Especially when
the last CBO estimate of the cost of Obamacare will be $2.5 trillion dollars
over the next ten years rather than decreasing the cost of healthcare by $115
billion dollars over the next 10 as originally estimated.

This problem represents
just a fraction of the problems health insurance exchanges are facing.

I will cover some of the
other problems in my next blog. Stay tuned.

 The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Where I Am Coming From

November 26, 2012
inMedicine: Healthcare System
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Stanley

Feld M.D.,FACP,MACE

I realize that many people
read my blog by just glancing at it. It is difficult for a casual reader to
grasp my hypothesis.

The devil is always in the
details. The details expose defects and unintended consequences.

Yogi Berra once said, "You've got to be very careful if you don't know where you are going because you might not get there."

Many readers believe I am
very critical of President Obama’s plan to reform the healthcare system. This impression
is correct.

To my chagrin many of my
non-physician friends, who are President Obama lovers, hold it against me.

The basic goals of President
Obama’s healthcare reform plan are correct.

In my view his philosophy and
methods are wrong. I have pointed out the faults with his philosophy and
methods and why they cannot work.

President Obama wants
universal access to healthcare that is affordable and is delivered using best medical
practices.

I have the same goals.  

I have outlined a consumer
driven healthcare system which emphasizes freedom of choice, individual independence
and personal responsibility.

President Obama is imposing a
government driven healthcare system emphasizing a lack of freedom of choice,
mandates, penalties, dependence and entitlements.

I appreciate that President
Obama can only visualize accomplishing his goals by government decree,
regulations and enforcement.

I believe Americans are smart,
want freedom of choice, personal dignity and can assume responsibility for
their choices.

I believe government control
will result in increased waste, inefficiency and corruption at the expense of
effective medical care for consumers.

President Obama thinks government
control is the only way to control costs. I believe the more government control
is imposed on consumers the greater the costs.  

President Obama wants bureaucrats
to make medical decisions for consumers and physicians. If physicians do not
cooperated he is willing to substitute “healthcare providers” for physicians.

President Obama does not
respect consumers’ ability to make the right choices.

I believe in consumers’
intelligence. The government’s responsibility is to provide tools for consumers
to make intelligent choices.

It is difficult to find an
effectively functioning, centrally controlled healthcare system. The statistics
are questionable. I recently   described
the Canadian healthcare system.  

Consumers and physicians can get
used to centrally controlled healthcare systems. They learn to tolerate it.
However, these healthcare systems are not as affordable as many contend. 

Innovation and vibrancy comes
from a healthcare system in which the major stakeholders have the incentives to
be innovative.

Obamacare has caused
secondary stakeholders (healthcare insurance industry, hospitals and hospital
administrators, drug companies, medical device companies and information
technology companies) to position themselves to take advantage of the centrally
controlled healthcare system.

Obamacare is not aligning all
the stakeholders’ incentives. It is further misaligning incentives. Obamacare
will cause a rapid demise of the healthcare system. 

A more centralized government
controlled healthcare system will result in greater dysfunction of the
healthcare system, increasing cost and less effective medical care for the
majority of consumers.

If America evolves to a
single party payer healthcare system, which I believe is President Obama’s goal,
the achievement of his goals for affordable care for all using best practices
will become more elusive.

On May 11, 2006 I published my first blog. This was
pre President Obama. President Obama wasn’t the first president who has
contributed to the dysfunction and ultimate demise of the healthcare system.

I thought it would be fun to see “What I Was About” on
May 11, 2006. 

 

"Repairing The Healthcare System.

Stanley Feld M.D.,FACP,MACE

Preamble

This blog is
about Stanley Feld M.D., FACP, MACE’s studied view for repairing the health
care system.

There is been
much written daily about the defects in the health care system. All
stakeholders are to blame for the severe distortion in today’s healthcare
system including consumers (patients).

Unfortunately,
few healthcare policy wonks have asked practicing physicians what they think
the healthcare systems’ problem are. Neither has anyone asked the practicing
physician what an acceptable solutions would be.

Persons not
affected by the distortions and dysfunction in the health care system pay
little attention to the broken system. Fortunately 80% of the population are
not sick. They are not in need of an effective and functional healthcare system.

People not immediately affected by any system
do not pay attention to the defects in those systems.

However,
the healthcare system is vital to every citizen both in the short term or long
term.

Our broken
health care system cannot be ignored any longer. Our personal health and the
health of our citizens is the most precious asset we have as individuals, and
vital to the country’s success and well being in the future.

In my view, we
are going through a process similar to the slow boiling of a frog. We are
noticing the rise in temperature little by little, but are too lethargic to
take action and jump out of the pot. The effort is much too difficult.

However, we
must take action now!!  Soon, we will all
be cooked.

What
is the solution to America’s dysfunctional healthcare system?

Americans live
in a free consumer driven economic environment for most goods and services.

The only way
to get us out of this increasing hot water is for consumers to understand the
structural defects in the broken healthcare system. Then they must act.

Someone must
outline an effective and easy plan of action that aligns all the stakeholders
incentives.

In reality,
all of the stakeholders are to blame for the distortions in the system. The
stakeholders need to be answerable to consumers. Consumer (patients) can exert
power only after understanding the structural defects in the healthcare system.

The goal of
this blog is to explain reasons for these defects, as well as the potential
solutions. In my view the solutions I will propose will ultimately fix the
system.

Presently most
of the stakeholders’ incentives are misaligned. The proposed solutions are
aimed at aligning all the stakeholders’ incentives. All previous solutions have
served to misalign incentives even further resulting in our present
dysfunctional system.

The previous
governmental adjustments have resulted in a system that is much too expensive,
has much too much waste, is inefficient, and almost unworkable.

The result is
that all of the stakeholders are very stressed and unhappy.

Over the next
weeks or months, I will outline the problems in the healthcare system and the
solutions to creating a functional healthcare system."

I said the above in May 2006.I am continuing to
point out the increasing problems as well as my solutions. The key to the
solution is a healthcare system in which  consumers’ drive the healthcare system and
have responsibility for their health and healthcare dollars.

As the incidence of obesity continues to
increase and as the baby boomers continue to retire, a system must be developed
to create independence and responsibility and not entitlement and irresponsibility. 

  The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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What Is The Insurance Value Of Medicare?

November 19, 2012
inHealthcare Insurance Industry, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests
• Leave a comment

Stanley Feld M.D.,FACP,MACE

 

Healthcare insurance is
great if you do not need it.

The wonderful thing
about Medicare is private insurance is not available to seniors.  

Healthcare insurance companies
are not interested in covering consumers with health risks or preexisting
illnesses.

In fact private
individual healthcare insurance policies are not available to an unemployed 55
year old person with mild obesity and hypertension.

If you are employed and
over 65 years old with mild obesity and hypertension the healthcare insurance
industry is required to insure you under your employer healthcare plan.

The employed person
receives healthcare coverage with pre-tax dollars.

 A person who might be
eligible to purchase individual healthcare insurance must pay with after-tax
dollars.

This is unfair but
easily corrected.

The pre-tax/post tax
issue could be solved if the state insurance boards required the healthcare
insurance companies, wanting to sell private insurance in that state, cover
everyone applying for insurance. The insurance company should be required to
set the premiums based on community rating.

Everyone should pay
premiums with pre-tax dollars.

Medicare, through
government inefficiency, has become very expensive. If it were efficient
insurance it would be less expensive to both consumers and the government.

Most working people have
no idea of Medicare’s cost to them during their working years.

Medicare’s yearly tax
withholding is 1.45% of salary. A worker earning
$100,000 a year pays $1450 yearly to the Medicare Trust Fund. In 40 years that
person would pay $58,000 into the Trust Fund.

When they became eligible
for;

 Medicare Part B the yearly premium in 2012 was
means tested.

 

If your yearly income in 2010 was

You pay (in 2012)

File individual tax return

File joint tax return

$85,000
or less

$170,000
or less

$99.90

above
$85,000 up to $107,000

above
$170,000 up to $214,000

$139.90

above
$107,000 up to $160,000

above
$214,000 up to $320,000

$199.80

above
$160,000 up to $214,000

above
$320,000 up to $428,000

$259.70

 

 

 

In
2013 the Medicare Part B premiums are going to increase.

 

 

 

 

 

 

 

 

 

 

 

 

 
   

 

 

 

 

 

If your yearly income in 2011 was

You pay (in 2013)

File individual tax return

File joint tax return

$85,000
or less

$170,000
or less

$104.90

above
$85,000 up to $107,000

above
$170,000 up to $214,000

$146.90

above
$107,000 up to $160,000

above
$214,000 up to $320,000

$209.80

above
$160,000 up to $214,000

above
$320,000 up to $428,000

$272.70

above
$214,000

above
$428,000

$335.70

 

Income is defined as
income from all sources such as capital gains, interest, pension annuities,
social security and all earned income.

Further premium increases have been announced for 2014 but
have not been published.

Medicare premiums are
taken out of each Social Security check.

The Medicare Part B
insurance has deductible and co-pay rules. Medicare Part B deductibles apply
for each hospital stay, ER visits and physician office visits.

For each benefit period
you pay:

  • A total of $1,156 for each hospital admission of
    1-60 days.
  • $289 per day for days 61-90 of a hospital stay.
  • $578 per day for days 91-150 of a hospital stay
    (Lifetime Reserve Days).
  • All costs for each day beyond 150 days.
  •  

Skilled Nursing Facility
Coinsurance

  • $144.50 per day for days 21 through 100 each
    benefit period. Days 1-20 are free.
  •  

Part B: (covers Medicare eligible physician services, outpatient
hospital services, certain home health services, durable medical equipment)

  • $140.00 per year. (Note: You pay 20% of the
    Medicare-approved amount for services after you meet the $140.00 deductible.)

 

The deductible for the
first $140 dollars worth of services plus 20% of any physicians and hospital
bill can add up as one gets older. It becomes unaffordable for many seniors.

 

Medicare Part B’s deductibles
and copays’ costs makes Medicare gap coverage   essential.

Premiums For Medicare Part
F   

Policy Summary

Monthly Premium:
$84 – $302  depending on age and benefits

Estimated Annual
Cost: $6,050.00

Benefits

  • Basic Benefits Medigap
    Basic Benefits definition[?] – Opens in a
    new window
  • Skilled Nursing Facilities Skilled
    Nursing Facility definition[?] – Opens in a
    new window
  • Part A Deductible Part
    A (Hospital Insurance) definition[?] – Opens
    in a new window
  • Part B Deductible Part
    B (Medical Insurance) definition[?] – Opens
    in a new window
  • Part B Excess Charges (100%)
  • Foreign Travel Emergency
  • Preventive Services

 Medicare
Part D is the drug benefit plan. Medicare Part D helps reduce the cost of
medications.

Medicare
Part D is also means tested. There are multiple plans to pick. Some include
complete payment for brand named drugs and some cover the donut. The price can
range from $40 to $120 per month per senior depending on the coverage a senior
picks. The additional means tested fees are below.

The
brand named drugs are expensive. Most drug chains have followed Wal-Mart’s lead
and charge $4.00 for generic drugs. This forces seniors to purchase generic
drugs

Medicare
Part D is expensive and unfair for seniors needing brand named drugs.

The Means Testing Formula For Medicare
Part D 2012

 If your yearly income in 2010 was

You pay

File individual tax return

File joint tax return

$85,000
or less

$170,000
or less

Your
plan premium

above
$85,000 up to $107,000

above
$170,000 up to $214,000

$11.60
+ your plan premium

above
$107,000 up to $160,000

above
$214,000 up to $320,000

$29.90
+ your plan premium

above
$160,000 up to $214,000

above
$320,000 up to $428,000

$48.10+
your plan premium

above
$214,000

above
$428,000

$66.40
+ your plan premium

 http://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

 Medigap
fees and Medicare Part D fees are paid with post tax dollars.

These
costs are in addition to seniors having contributed $58,000 to the Medicare
Trust Fund during their working years.

“The reason we have
health insurance at all is not that health care is expensive, but rather that
there is great uncertainty about who will need very expensive and potentially
lifesaving care and when they will need it. Medicare should give beneficiaries
not just access to medical care, but also protection from the risk of
catastrophic spending.” 

Medicare
coverage is not cheap. President Obama’s Obamacare is going to make it more
expensive with less access to care.

 Why
is Medicare Part B,F,D  so expensive when
the average person on Medicare spends only $6,600 dollar per year?

This
is the major question. The government should focus on the answer. It should not
be spending time and money on a system that is punitive to patients and
physicians and has little chance of being successful.

The
money creating the Medicare deficit is going somewhere. Where?

The cost to Medicare beneficiaries is high.
The protection against economic ruin is limited. The basic benefit lacks a cap
on out-of-pocket spending, so beneficiaries are exposed to the risk of
open-ended cost sharing that can generate substantial financial strain (or
deplete assets for surviving spouses).1 

Moreover,
the odds of facing a catastrophic expense mount over time. Almost 50% of
beneficiaries are hospitalized at least once over a 4-year period.2 

If
we are going protect our seniors from financial strain or ruin Medicare must
reassess it premises and reduce its administrative waste. It must be completely
transparent. If the government did it correctly it would provide an affordable
healthcare insurance plan for seniors.

“Everyone knows the dice is loaded.”
Leonard Cohen.

  

http://youtu.be/GUfS8LyeUyM

 

At
the moment seniors do not have another choice. It is the only game in town.

 The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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  • Julie Anderson • November 20, 2012

    Healthcare policies must even beneficial to the seniors but they shows the less interest and they concentrate on the other categories.\They show the less interest because these are already with the problem and with them we will have no benefit!!!
    Medicare

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It Is Time To Re-examine Our Premises

November 14, 2012
inConsumer Driven Health Care, Medicine: Healthcare System
• Leave a comment

Stanley Feld M.D.,FACP,MACE

About once a week I have an in-depth conversation with my
son Brad. In my view his perception of the world is more accurate than most. In
his younger days I did most of the teaching and he did most of the listening.

Today, I do most of the listening and he does most of the
teaching. This morning he said something profound. We were talking about large
corporations business models. He said most corporations do not know what
business they are in.

He is right. As technologies change business model must
change. If the business model does not change the corporation cannot survive.

The healthcare industry and the medical care industry
(physicians and hospital systems) must re-examine their premises and change
their business model.

President Obama is trying to change the business model
with Obamacare. In reality he is not changing the old business model at all. He
is expanding the old business model that has failed.

He is also making the business model more complicated. He
is building an elaborate and expensive structure whose goal is to decrease
costs. It will cause the system to fail faster.

Obamacare is adding a more punitive and restrictive
element to healthcare delivery rather that a more innovative and rewarding
element to both the patients and physicians.

It is not designed to promote health; it is designed to
cut costs by limiting access to care, rationing care and decreasing freedom of
choice.

Obamacare pays lip service to preventive care. Preventive
care will be largely ineffective because of the reimbursement metrics and lack
of incentives provided to consumers. 
Consumers must be incentive driven.

There are many examples of long time successful
corporations that could not change their business model fast enough. These
companies were muscle bound either because of a lack of vision, a lack of
leadership, multiple committee meetings and too much decentralization of an
ever-expanding bureaucracy.

Eastman Kodak is a perfect example. It was the premier film,
film processing and photography paper manufacturer in the world.

 Kodak did not
recognize that it was  in the imaging
business. The technology of digital photography put Kodak out of business
because Kodak could not change its business model fast enough.

Royal Typewriter Company viewed itself as a typewriter
manufacturer. As soon as IBM developed the innovative Selectric typewriter
Royal should have figured it out.

Royal should have developed a faster and more innovative
typewriter. Royal also should have jumped on the development of a typewriter
that would store the typed data.  Instead
it was more of the same old.

It did not take long for consumers to drive the
typewriter companies out of business.  Word
processing on computers made typing documents  easier and more useful.

The railroad business did not have the vision to understand
it was in the transportation business. Airplanes, eighteen-wheelers and
Greyhound buses almost drove the railroads out of business. Railroads did not realize
that consumers wanted a better product. A product that is faster and cheaper.

Railroads have only partially recovered.  

Consumers drive innovation. If a new great product is
introduced to consumers, the new product can take off at the expense of the
legacy product.

Just think about ITunes and the music industry, the
IPHONE and the legacy landline telephone industry and the IPAD and the desktop
computer industry.

Amazon has dis-intermediated the Book Publishing industry
with its Kindle and wireless downloading of books.

The opportunity in healthcare is similar. However
Obamacare is driving the country in the opposite direction away from a consumer
driven industry into a government controlled, bureaucratically dictated
decision making industry.

The business model
of 2020 should look like this.

Slide14
Instead it is going to look like the slide below under Obamacare. The
healthcare industry is going to collapse under its own structure.

 
Slide11

The
effective future business model will put consumers in charge of their
healthcare dollars and provide consumers with financial incentives to stay
healthy.

It
will decrease the healthcare industry’s control of the healthcare system.
Consumers will have control of their own first dollar coverage.

Consumers
will drive the healthcare system to produce the best medical product. They will
seek high quality care at the lowest price.

Physicians
and hospital systems will want to produce the best product at the lowest prices
so they can attract patients.

Only
a consumer driven healthcare system will drive the technologies of efficiency
into the healthcare system.

Remember,
without patients or physicians there would not be a healthcare system.

My
2020 business model of the future can be studied in detail on the following
links.

  The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Eyes Wide Shut

November 11, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System, Physician's Problems
• Leave a comment

Stanley Feld M.D.,FACP,MACE

 

I cannot believe the results
of the Presidential election.

All of President Obama’s
policies have failed so far. All have served to inhibit economic growth or make
it worse.

Yet the majority of
Americans voted for President Obama. Why could this occur when many of the
structural ideas and ideals representative of the United States are being dismantled?

This is a great county.
Americans accept the winner and move on.  They continue to speak to their neighbors who
had the other guy’s sign in their front yard.

On the other hand it amazes
me to see that the electorate ignores the real issues and votes for the  personality. Marshall McLuhan was correct. The media is the message. Why the media
is ignoring the facts is beyond me.   

It is disappointing because
Americans are also ignoring the obvious coming unintended consequences that are
going to be the result of their voting decision.

The devil is always in the
details. I have presented my views of how the medical care system is going to
be destroyed by Obamacare. It is only a matter of time.

The healthcare system is
becoming too expensive, unsustainable, impersonal, rationed. The result will be
a denial of access to medical care for many Americans. 

Obamacare’s effect will become
the opposite of what President Obama intended and  promised.

I have also stated that his
strategies for change have been misguided.  

President Obama’s advisors
are all ivory tower professors and bureaucrats. They have no understanding of
what is happening in the street at the interface between patients and
physicians.

Ideologically they want to
make medical care better for all. President Obama does not understand the
pressures and the reality of the real practice interactions between physicians
and patients or physicians and their communities.

President Obama believes
that healthcare should be an entitlement and not an individual responsibility. Healthcare
entitlements will never solve America’s problems with obesity and chronic
diseases.

In the process of making
healthcare an entitlement, President Obama is devaluing the skills of those
practicing medicine.

Many physicians have quit
practice because of adverse conditions. The result will be a decreasing
physician workforce in an increasing covered population. This is not a good equation.

Most physicians do not
accept Medicaid and many have stopped accepting Medicare.

This will shift the burden of
higher cost of medical care to seniors and poor people.  

Bob
Doherty is Senior Vice President of Governmental Affairs and Public Policy,
American College of Physicians. His blog at The ACP Advocate Blog is reprinted below.
It deserves a wide audience.

Bob
Doherty has dealt with the socioeconomic concerns of Internists and Internal
Medicine Sub Specialists for at least 30 years both at the American Society for
Internal Medicine and later after ASIM merged with American College of
Physicians.

Bob
Doherty wrote this article discussing the effects of Obamacare on the practicing
physician. He presents practicing physicians’ complaints about  Obamacare.

This
article should be read carefully. President Obama should pay attention to
physicians’ complaints.

 “The
micro level of health reform cannot be ignored”

by BOB DOHERTY on November 5th,
2012in POLICY

 

Much of what passes for debate on
health care during this election year is focused on the macro side, on big
issues like how do we cover the uninsured or restructure Medicare and Medicaid
financing.  But for all of the talk about vouchers and block grants and
insurance mandates, the candidates are missing the micro issues that really
matter most to doctors and their patients, which is how health care policy
directly affects the quality of the patient-physician encounter.

Talk to physicians around the
country, as I regularly do, and these are some of the issues that have them
most concerned:

1. Will anyone do
anything about the oppressive burden of paperwork and red tape?
2. Will the candidates’ “macro” proposals for reforming healthcare and
entitlements result in more or less paperwork and red tape?
3. I already don’t have enough time to spend with patients but now I am
expected to counsel them on preventive care, lifestyle choices, and the
effectiveness of different treatments?   How is this possible?
4. Electronic health records, great concept, but they don’t really streamline
the process as advertised, if anything, they just make things more difficult,
and besides, they still don’t communicate with other systems.
5. Everyone wants to measure me, but the measures don’t agree with other, they
measure the wrong things and they are difficult to report on.   And
who is measuring the value and effectiveness of the measures themselves?
6. Okay, I am supposed to practice cost conscious care, but who is going to
stop a lawyer from suing me if I don’t give a patient the test they asked for?
7. Why is my cognitive care paid so little while procedures and drugs are paid
exorbitant rates?
8. Payers and government keep imposing more penalties, for not e-prescribing,
for not converting to ICD-10, for not meaningfully using my electronic health
record, for not complying with their pay for performance schemes.  By the
time they get done fining me for noncompliance, I will have had to shut my
office. Then who will take care of my patients?
9. And who has the time to keep track of all of these mandates, incentives,
rules, and penalties?  I would have to hire a full-time person keep on top
of everything. Who is going to pay for that?
10. So I am supposed to transform my practice?  Well, we all want to do
our part, but who is going to pay for that?  Besides, my patients seem to
think my practice is just fine as it is

Now, I don’t really expect Obama
and Romney to come out with plans to address these micro health policies. 
But it is reasonable to hold their macro proposals to a standard of whether
they will make all of these aggravations and intrusions better or worse. 
And at some point, policymakers–no matter their political leanings and plans to
reform healthcare at the macro level, need to pay attention to what is
happening at the micro patient-doctor encounter level.  After all, the
boldest of big ideas won’t make healthcare better if it makes it harder for
physicians to give their patients the care they need.

Physician advocacy
organizations also need to pay attention to the micro issues.  ACP prides
itself on taking on the big issues like controlling health care costs and allocating health care resources rationally.  
But the College puts at least as much effort into the micro issues, from objecting to the latest EHR mandates to offering alternatives to ICD 10 coding to advocating for higher payments.

The goal must be to fashion
public policies that improve care at the macro level — universal access to
coverage, spending health care dollars more wisely, and improving healthcare
delivery systems — while also removing barriers at the micro level that intrude
on the patient-doctor relationship.  Both are equally important.

Bob Doherty is Senior Vice President of Governmental Affairs and
Public Policy, American College of Physicians and blogs at The ACP Advocate Blog.”

 

Bob
Doherty has been an advocate of Obamacare in the past. He has highlighted the
idealist principles of Obamacare. I am happy that he is starting to realize the
unintended consequences that will occur as a result of  Obamacare.

Healthcare
is only one area of life that President Obama is affecting adversely. I believe
the majority of the population will start realizing soon that re-electing
President Obama was a mistake.

Hopefully
it does not become an irreversible disaster.

  The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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It Is All About Trust

November 4, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley
Feld M.D.,FACP,MACE

I
voted for President Obama in 2008 because he promised us hope and change. I
knew little of his past or present ideology. He was an attractive candidate and
promised hope.  The New York Times never
went into depth about his past, past interests or past performances.

Americans
trusted him and voted for him. He looked like and acted like the candidate of
hope. I trusted him to lead America on the right path.

President
Obama has done so many things wrong in the last 4 years that it is amazing to
me that anyone trusts him today.

Yet
he even said in one of his stump speeches “you
know me and you know you can trust me.”

Immediately
after his inauguration America was confronted with an $800 billion dollar
stimulus package that promised to produce millions of shovel ready jobs. 

There
weren’t many shovel ready jobs. He baled out some companies and not others. All
the bale outs were at taxpayer expense.

This
stimulus package provided lots of money to increase the size of government. In
fact, President Obama used a sizable about of this money to build a government
bureaucracy for a healthcare bill that was yet to be written.

A
few things developed that made me suspicious of President Obama’s ideology.  President Obama is dedicated to big
government and big spending even though it is inefficient and not directed
toward its original goal.

I
have not been a fan of John Maynard Keynes since I read Fredrick Hayek ‘s “Road to
Serfdom.” 

FDR
did not spend his way out of the depression. World War II got us out of the
depression.

Keynesian
economic has not worked. President Obama was clearly putting us on a “Road to
Serfdom” with his out of control spending and increased national debt by over
$4 trillion dollars.

President
Obama has made many annoying moves in the last four years to fake out the
American public.

Common
denominators have been a lack of transparency, a disregard for the legislative
branch of government and an overuse of executive orders.

Recent
lack of transparency is illustrated by Fast and Furious and the tragic Benghazi
tragedy.

The
mainstream media’s coverage has been disgraceful.  http://query.nytimes.com/search/sitesearch/#/Bengasi%2C+Libya+consulate/

Other
annoying actions have been the transfer of power from the congress to the
executive branch and the intimidation of the Supreme Court.

It
seems that he either ignores the constitution or gets around its meaning in
some way. The notion that the constitution is an antiquated document is
offensive and appalling.

The
media as been manipulated by the way events and facts are presented.  November 2nd unemployment results are an
outstanding example.

Americans
have been conditioned over the years to get their news from sound bites and not
detailed facts. Whichever sound bite is present the most times becomes the
fact.

The
economy is not doing well. It is growing at a very slow pace. Job growth is
slow. The presentation of the monthly data is confusing.

The November 2 unemployment
headline was; “Latest Jobs Report Shows Persistent Economic
Growth.”

 The first sentence was there were 171,000 new
jobs in October. The economy needs 500,000 new jobs per month for a normal recovery.

Consumers
still cannot get jobs, credit or loans from banks.

The
last sentence in the press release stated that unemployment rate rose from 7.8%
to 7.9%. No one remembers the last sentence

Since
the media is the message and 171,000 new jobs sounds like a big number that is
better than expected. It gives the illusion that the economy is improving on
President Obama’s watch.

Americans are not
stupid. The New York Times is trying much too hard to get President Obama re-elected.

President
Obama has generated mistrust by Americans for the promises he made about Medicare
and Obamacare. The amount of money spent, so far, by the President Obama on
Obamacare is not available to the public.

The
analysis of the increase in middle class taxes already in place as a result of
Obamacare are not discussed by the main stream media nor by President Obama.  

There
are 10 hidden taxes on citizens making less than $250,000 a year i.e. the
Medicare payroll tax. This tax is going up from 2.9 percent to 3.8 percent. There is an additional 3.8
percent Medicare tax added to investment income. Together, this will cost
taxpayers $318 billion from 2013 to 2022. These taxes were not obvious to the
great majority.

The
impact of future Obamacare taxes on the middle class is going to be
overwhelming. The new taxes were written into Obamacare but not presented to
the public. This serves to increase the mistrust for President Obama and his
promise for transparency.

The
one thing I learned from Hayek is that you cannot manipulate the economy by
edict or force without limiting freedom. In a “free” society “ the unintended
consequences and costs are certain to get out of control.

Costs
can be controlled in a level playing field competitive free market. The
consumer driven market is non-existent. Consumers must start to understand
their power in society.

Government
should make rules that level the paying field for all and then get out of the
way. No spinning the facts and no non-transparent activities. No favoritism to
lobbyists, associations or unions.

Rules
should be made for the benefit of the people in a competitive environment.

Medicare
premiums and deductible expenses for senior will raise not decrease as promised
by President Obama. Out of pocket expenses will rise.

Seniors’ standard Medicare
Part B monthly premiums will jump from $99.90 to $128.20 at the low end of the
means testing while their Part B deductibles will rise from $140 to $180. Seniors’ Medicare hospital deductible on admission will
increase from $1,156 to $1,336, while their daily hospital
coinsurance will climb from $289 to $334 in out of pocket expenses.

I
have pointed out that Obama care’s main feature, ACO’s, will be impossible to
execute and will subsequently fail. This will lead to greater distortions of
the healthcare system.

The
result will be a decrease in choice, a decrease in the freedom to choose your
physicians or recommended care, a decrease in access to care and rationing of
care once the government has total control.

This
does not included increases in costs to seniors and the middle class that has
been scheduled by Obamacare.   

All
the stakeholders have taken advantage of the healthcare system in its present
form. The stakeholders are the healthcare insurance industry, the hospital
systems, the government, the patients and the physicians.

The
healthcare system needs a new business model in order to survive. President
Obama’s business model is not the one. The public does not trust it.

The
actions of the stakeholders are natural as these stakeholders try to survive.

 It is government’s job to make the rules so
these dysfunctional survival methods cannot flourish.  

President
Obama cannot be an effective leader in the future. The public does not trust
him any more.

  The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Big Data Is A Major Problem For The Healthcare System.

October 31, 2012
inChronic Disese Management, Consumer Driven Health Care, Information Technology in Healthcare, Medicine: Healthcare System
• Leave a comment

Stanley Feld M.D.,FACP,MACE

President
Obama is blinded by his ideology. His healthcare policy goal is to eventually
have a single party payer system. Medical care will be commoditized with
treatment decisions made by the central government.

It
is a charade that his health insurance exchanges will lead to affordable
private insurance. It is misguided to believe that a non-elected central
committee (IPAB) will be tolerated to make treatment decisions for the
population.

The
larger pretense is that President Obama is building an inexpensive bureaucracy.
Last week he again stated that government overhead for Medicare and Medicaid is
very low. He again declared that the overhead expense is only 2½ percent.

It
cost two and one half percent for the central government to outsource administrative
services to the healthcare insurance industry. The healthcare insurance
industry, in turn, charges the government 18-40% to administer the programs.

Everyone
knows most everything government run is inefficient. President Obama is
enlarging the scope of government in all areas at a time when government is too
large and inefficient. The government’s income is $1 trillion dollars less than
its expenses per year since he has been President.

President
Obama thinks if he spends enough money he will spend his way out off the jam.

President
Obama believes one way to become more efficient is to gather more data. He can
then figure out which hospital systems and physicians are inefficient and
penalize them.

This
philosophy has two potential pitfalls. If the data is faulty the conclusions
are wrong. The second pitfall is that penalties do not encourage cooperation
and meaningful improvements. 

“Decision-making in
healthcare can be painfully slow, as any physician will tell you. Hospital systems and
physicians are being spurred on in part because healthcare is beginning to deal
with a shift in reimbursement toward one that rewards quality and disincentives
inefficiency and waste.

One problem is that quality is not clearly
defined and is sometime false. The government must reexamine its premises.

Most hospitals and health systems have lots of
data that might improve outcomes and cut waste.

The
problem is getting that data, which is often unstructured, into a format that
allows clinicians to make decisions faster and in a more coordinated fashion.

All
of the innovation is happening without input from physicians. It is being done
to decrease the cost of the hospitals. One thought would be to get rid of a few
excess salaried, $750,000 a year hospital administrators and $2,000,0000 plus
healthcare insurance company administrators which would go a long way to reduce
the cost of healthcare coverage.

Instead
the government is looking to penalize physicians. Physicians are the providers
that deliver medical care.

There
is software being developed that deals with real time processing of clinical
data. The software can communicate those data to networked physicians instantly
and help physicians deliver more timely care.

Many
hospital systems are trying to install these real time systems. Unfortunately,
many hospital administrators do not understand its power as a teaching tool to
increase the efficiency and effectiveness of medical care.

 The hospital systems’ only interest is in the
financial result and the question of whether the huge investment is worth the
capital expenditure.

Some
physician group practices, independent of hospital systems, are incorporating
these software systems into their electronic medical records. These groups recognize the potential
importance of having instantaneous predictive data.

Most
physicians do not have an EMR and only 7% of physicians have a fully
functioning EMR.

In
the monograph from “Pathways to Data Analytics” two things were very apparent. It
looks like the healthcare insurance industry controls the committee and its
plans is to continue to control the healthcare dollars and hope to control the
healthcare data.

Increasingly, a
data-driven approach to healthcare is necessary.

The complexity of clinical care requires it, says Glenn Crotty
Jr., MD, FACP, executive vice president and chief operating officer at CaMC.

 “We’re moving from an
individual practitioner cottage industry to a team-based process now . . .. [Medical
care] is beyond the capacity of any one individual to be expert enough to do
that. So we have to do it in a team.”

A team requires information. The changing dynamics of healthcare
spending and reimbursements also require data to navigate.

“Our analytics are not just for finance, which traditionally is
what hospitals invested in,” says St. Luke’s Chief Quality Officer Donna Sabol
, MSN, RN. “When you look at how [hospital] payment is changing [to] a value-based
equation, you have to have good analytics for finance and for quality.”

Absent from the report is the patient and his/her responsibility
to the therapeutic unit. Until some policy maker understands the role of
patients to the therapeutic unit they will get nowhere in improving the
healthcare system.

A glaring example is the money spent by hospital systems to
improve the discharge process to avoid re-hospitalization within the 30 days
post discharge.

Obamacare has instituted the rule November1,2012 that if a
patient is re-hospitalized within 30 days of the initial hospitalization the
hospital system will not get paid.

I can think of 5 ways hospital systems can get around this rule
without suffering the penalty. 

None-the-less the hospital systems are buying software to study
and automate the process to avoid re-hospitalization using its clinical data in
real time.

 The Seton Hospital System in Austin Texas
might have figured it partially out.

It started what it calls an extensivist
program. It is acting as an extension of its physicians care to help avoid re-hospitalization
and use the best data it can collect.

Its is helping clinicians identify patients who
would benefit most from extra attention following discharge. The program
started with congestive heart failure patient


"A
lot of it is about enabling decision-making," Ryan Leslie says

"It's taking the whole universe of
information we have and cutting out what's extraneous and giving clinicians the
information they need to make decisions."

Ryan Leslie is vice
president of analytics and health economics at Seton Healthcare system.  He is taking
unstructured clinical information and connecting that with billing or
administrative information and social demographic information.

He says,  "you start connecting all those things
together and you get a more complete picture of the patient as a person, rather
than as a recipient of a bill," he says. "That's been the exciting
thing recently. You realize that a patients' success or failure may not have to
do with the care plan details or the clinical attributes of the patient as much
as the social attributes."

Physicians
outside the hospital work with a team of social workers, nurses, and others to
visit patient homes and figure out what's keeping a patient from effectively
following treatment protocols that will likely keep them out of the hospital.

The software
helps determine, based on a host of combined data, which patients are most
likely to be re-hospitalized within 30 days. Targeting the patients is like
looking into a crystal ball. The hospital system cannot afford to service all
the patients with congestive heart failure. The program is in its early stages.
If successful the plan is to expand it to diabetes and other chronic diseases.

This will
happen well beyond November 2012 and January 1,2014. This hospital system
finally realized that it can and must be an extension of its physicians’ care
and not a competitor for patient care.

Missing is the
patients responsibility and incentive in not being readmitted to the hospital.
This can only be accomplished when consumers not only have a desire to be
healthy they have a financial interest to stay healthy.

This can be
accomplished in a consumer driven healthcare system where the patients are responsible
for their health and own their healthcare dollars. The easiest way to get there
is using my ideal medical savings accounts.

 The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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