Stanley Feld M.D., FACP, MACE Menu

Medicine: Healthcare System

Permalink:

ObamaCare Is Not A Cost Savings Act

March 28, 2012
inMedicine: Healthcare System, Patients Problems, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D., FACP,MACE

The evidence is mounting that President Obama’s healthcare reform act will not make healthcare more efficient or more affordable.

I have pointed out that Obamacare will create a healthcare system that will limit innovation, lead to healthcare rationing, and lower the quality of care.  All this is coming our way.

The theoretical cost savings proposed and confirmed by the CBO on data given to it by President Obama has not worked out as promised.

It couldn’t work out as I predicted with the creation of a massive bureaucracy and its generation of massive rules and regulations to enable the government to control the healthcare system.

I would have loved to see President Obama create a system of affordable healthcare that is accessible to everyone. President Obama’s did not. He has created a financial and healthcare delivery mess.

He has the wrong business model.

He was able to pass his healthcare reform act by faking out the congress and the CBO using unrealistic numbers about cost saving.

President Obama repeatedly claimed that the annual healthcare premium per family would decrease by $2,500 per year before the end of his first term. We are almost at the end of his first term and the average cost of a yearly premium has increased $2,200 according to a Kaiser Family Foundation report.

President Obama claims seniors enjoy their Medicare coverage. I believe it is great to provide guaranteed insurance for seniors despite pre-existing illness.

However, the costs of Medicare premiums and Medicare’s initial deductibles have increased since 2009 while the covered services have decreased.  

President Obama has also told seniors that their Medicare Part D benefits have improved under his watch. However, the cost of Part D, the deductibles and the costs of the different tier drugs have all increased.

“The CBO's initial estimate in March 2010 of ObamaCare's budget impact showed it saving money, reducing the federal deficit by $143 billion in the first 10 years. But that positive estimate was largely the product of gimmicks inserted into the bill by Democratic leaders to hide the law's true cost.”

Last month President Obama’s proposed fiscal 2013 budget included $111 billion in additional spending for the premium subsidies in the health law's insurance exchanges. Many states are refusing to sign up for health Insurance exchanges even though President Obama said he would pay 90% of the cost of these exchange in the first couple of years.

The states are broke and in the red. They have a constitutional obligation to have a balance budget.

The healthcare insurance exchanges are a President Obama ploy to get states to sell insurance to the uninsured increasing the state’s deficit. President Obama and congressional leaders said it would only affect one million Americans who would lose their employer-sponsored healthcare coverage.

This did not seem like an accurate number to me. The healthcare insurance premiums were $13,000 per family. If the employer did not provide healthcare coverage the penalty to an employer would be $2,000 per employee per year.  The numbers given to the CBO clearly was a misrepresentation.

According to the CBO, 154 million Americans are covered under employer-sponsored plans. The cost to taxpayers would be huge and further increase the deficit if 50% of those individuals lost their coverage and became eligible for the $10,000 per year subsidy.

A McKinsey & Co. study in June 2011 showed that 30%-50% of employers plan to stop offering health insurance to their employees once the health law is implemented in 2014.

Employers dropping employer sponsored healthcare coverage will expose their employees to large financial risk even with the proposed government subsidy.

Employers would be making most employees eligible for huge subsidies in the new health-care exchanges. The government paid subsidy would be up to $10,000 for a household income of $64,000 per year.

This was another trick play by President Obama to get everyone into a public option and government run socialized medicine.

 “In recent testimony before the Senate Appropriations Committee, Health and Human Services Secretary Kathleen Sebelius told me that America's health insurance system is in a "death spiral." She failed to acknowledge that implementation of ObamaCare will be the cause of that death spiral, and American taxpayers will be left to pick up the tab.”

We have also learned that President Obama gave 1400 corporations exemptions from Obamacare. These corporations provided “Minimed healthcare insurance” to their low wage earning employees. Minimed healthcare insurance provides little coverage to low wage earning employees. Hundreds of thousands of these people are essentially uninsured.

On the data given to the CBO, the premiums collected by the Community Living Assistance Services and Support Act (CLASS Act) were estimated to reduce the budget deficit by $70 billion dollars per year.

The new CLASS Act program is voluntary. Premiums are estimated to be $123 per month for workers who choose to participate. It covers home care for those who become disabled at any age, not just those over age 65.

This is a pretty low premium. It seemed too cheap to be true. Congress had to impose a secret tax on all taxpayers to cover the cost of CLASS.

 

“All taxpayers will all be taxed $150-$250 PER MONTH beginning in 2011 for the NEW Community Living Assistance Services and Support Act (CLASS Act) that was added to the Reconciliation Bill on Friday night, Mar 19, 2010, before Congress voted on Sunday, Mar. 21, 2010. It will help pay for long-term home-care for the elderly. Isn’t that nice?”

 

These are only a few examples of President Obama’s disinformation provided to the American taxpayer before and after his healthcare reform act was passed.

If the American taxpayer only listened and knew these facts and unintended consequences beforehand this bill would have never passed. If the Democrats in congress studied the bill beforehand they would have never passed it.

America had President Obama’s healthcare pulled over its eyes. This is the reason Vice President Biden said on an open mike, “This is a big f—–g deal”

  

 

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

Please have a friend subscribe

 

 

 

 

 

 

 

 

 

  • GED Online • March 29, 2012

    This is a very beautiful and interesting research
    The most educating one i have read today!
    GED Online

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

Medicare Coding Is Becoming More Complicated Under Obamacare

March 25, 2012
inMedicaid, Medicare, Medicine: Healthcare System, Physician's Problems
• Leave a comment

Stanley Feld M.D.,FACP,MACE

Physicians make coding errors. These errors result in decreased reimbursement.   The denied claims might not be noticed for months by the physicians’ office.

In a busy practice the details of all the changes in coding rules are sometimes impossible to understand.

An entire coding industry with coding professionals taking certification examinations has developed with a great increase in the cost to the healthcare system.  

President Obama’s healthcare reform act is trying to institute a completely new electronic claims system. It is called 5010. It will replace claims system 4010.

As far as I can tell the goal is to obtain more data on physicians’ practice patterns. The goal of the new system is to determine the “quality” of physicians care. If the quality is poor, reimbursement will be reduced. Claims will be denied. Its execution looks confusing and expensive.

5010 was suppose to be in place and required for all to use by January 1, 2012. Apparently, it was not fully installed or tested by enough healthcare organizations to be validated. The date of full implementation was moved to March 31, 2012. Last week full implementation was moved to June 30, 2012.

The other complicated “innovation” of Obamacare is ICD 10 coding system.  This new coding system replaces ICD-9. It has increased the number of codes from 18,000 to 68,000 for coding in-patient and out-patient care. Effective implementation of these codes will be very difficult.

The implementation of these two “innovations” will add billions of dollars to the cost of healthcare.

 It will increase physicians’ paperwork. It will result in more mistakes. It is questionable whether the new systems will increase the quality of care.

It is adding more complexity to an already dysfunctional system.

It is impossible for physicians to keep up with all the new regulations the Centers for Medicare and Medicaid Services is about to impose on them.

Most physicians do not have the time to study the new regulations and their implications. They hope their professional organizations will pick up the important ones and point out the problems in plain English.

Many times one regulation contradicts another regulation. The administrative service providers (healthcare insurance industry) for CMS interpret the regulations the way they want. There is often a lack of consistency from state to state.

The Texas Medical Association recently informed us of an error related to submission of measure No.235, Hypertension: Plan of Care for the 2012 Physician Quality Reporting System.

 The Texas Medical Association sent the following message to all Texas physicians. I challenge anyone to understand this message.

The Centers for Medicare & Medicaid Services (CMS) has identified an error related to the submission of measure No. 235, Hypertension: Plan of Care, for the 2012 Physician Quality Reporting System (PQRS). Hypertension: Plan of Care is a claims/registry measure with G-codes that are inactive due to an error. Consequently, Medicare carrier TrailBlazer has rejected or denied claims containing the G-codes associated with the measure.

The following is a note I received from a physician.

“I thought I went to medical school to learn how to take care of sick patients?”

“I did not go to medical school to deal with complicated and impossible rules and regulations daily. These regulations interfere with my ability to help sick patients”

Physicians are faced with these confusing rules daily. I do not believe that these rules promote quality care for patients. These rules serve to irritate physicians. The rule changes result in a non-user friendly Medicare system.  I predict it will ultimately result in non-cooperation by physicians.

The TMA goes on to tell us what CMS is going to do and what we can do to obtain reimbursement for treatment given using CMS’ rules.

 CMS will reactivate the codes G8675, G8676, G8677, G8678, G8679, G8680, and 4050F with its next update of the HCPCS code data in April 2012. For 2012 claims-based reporting, PQRS requires at least three measures be reported at a 50-percent reporting rate.

In the interim, if you had intended to report this measure via claims for the 2012 PQRS, consider doing the following:

  • Report additional measures to substitute for measure No. 235, Hypertension: Plan of Care.
  • Hypertension: Plan of Care is a per-visit measure, which requires reporting for 50 percent of eligible patient visits. Therefore, you could report the measure on more than 50 percent of eligible visits from April through December 2012 to increase the likelihood for successful reporting of the measure.

As an alternative to reporting PQRS quality measures via claims, physicians can report using a qualified registry (PDF). TMA endorses two such vendors. Or, practices can submit measures using a qualified electronic health record (PDF).

Published March 16, 2012

Is it any wonder the Medicare and Medicaid System have tremendous bureaucratic cost overruns?

There has to be a better way?

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

Please have a friend subscribe

 

  • Brandon • August 31, 2012

    Interesting… thank you for the blog. In regards to the medical coding, you said they added some 50,000 new codes. Was the purpose to dilute the system, or to just make sure there is a code for every imaginable situation? Is there like a database or something that you just search keywords and you find the correct code? I have to be honest, I find this fascinating, I had no idea this was how medical billing worked.. or didn’t work I should say.

  • does textyourexback work • October 3, 2013

    Do you mind if I quote a couple of your articles as long as I provide credit and sources back to your weblog? My website is in the exact same area of interest as yours and my visitors would definitely benefit from some of the information you provide here. Please let me know if this okay with you. Thanks!

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

The Relationship Between Type 2 Diabetes Mellitus And Statin Therapy

March 21, 2012
inChronic Disese Management, Consumer Driven Health Care, Medicine: Healthcare System
• Leave a comment

Stanley Feld M.D. FACP, MACE

Readers have continuously reminded me that consumers are not smart enough to purchase the right kind of healthcare.

"Hello Dr. Feld,

What is your solution for patients who simply aren’t educated enough to make these decisions on their own? In “Redefining Healthcare” Michael Porter advocates a role for insurers to help in this regard and I’m wondering what your thoughts are given that the fastest growing demographic in America is poor, uneducated, and potentially (as a result) unhealthy folks."

I refuse to believe that consumers are too stupid to be educated if properly motivated.

I welcome insurance companies trying to educate consumers but they are doing it for their benefit and not the patients’ benefit. The education offered is not an extension of the physician’s care and will therefore be ineffective.

I respect the intelligence of all consumers. They will want to become educated consumers as soon as there is a financial benefit.

Any educational system built will have no effect on about 10% of the population. These people will be a burden to society.

The government and the healthcare insurance companies had their day trying to fix the healthcare system.

It is now the consumers’ turn to use their consumer power to fix the healthcare system. Consumers are starting to realize they need to be responsible for their care. They are also realizing they must control their healthcare dollars.

In order to be a wise healthcare consumer, they must understand their chronic disease.

The recent FDA statement about statins causing Type 2 Diabetes has been confusing to patients. Statins can be expensive. Patients will not spend the money for the statin nor adhere to a treatment plan if they think they will be harmed by the medication.

An understanding of the pathophysiology of Type 2 Diabetes and hypercholesterolemia will make it clear that there is no relationship between statin therapy and its causing diabetes.

At least 20% of the population has genetic insulin resistance. There is a slight difference between ethnic groups with the incidence being 30% in Hispanics and Native Americans.

This genetic defect results in a rising insulin level as the patient becomes obese, older and/or stressed.

The increase in childhood obesity in genetic insulin resistance children is causing an increase in childhood Type 2 Diabetes.

The underlying genetic defect can express itself before the blood sugar rises out of the “normal range.”

Insulin Resistance Syndrome has had several names over the past 30 years. One name was the Deadly Quartet. The quartet consists of obesity, hypertension, hypercholesterolemia, and diabetes.

Insulin Resistance Syndrome’s new name is Metabolic Syndrome. Each disease can present independently at different times. Hypertension, hyperlipidemia and diabetes are usually precipitated by obesity, stress or steroid therapy.

If patients understood the pathophysiology of metabolic syndrome they would try hard to lose weight and adhere to medication prescribed.

Patients must be taught to become the professor of their disease.

It is insufficient to say “doc, my cholesterol is high, fix me”. The only people who can “fix” patients with chronic diseases are patients themselves.

What do we know about Type 2 Diabetes Mellitus and insulin resistance?

1. The incidence of Clinical Type 2 Diabetes Mellitus is high in patients who are obese.

2. Clinical Type 2 Diabetes (high blood sugar) can disappear with weight loss and exercise in early onset diabetes. These patients still have insulin resistance but the resistance is decreased and the blood sugars become normal.

3. Obesity must be decreased in order to eliminate overt diabetes. If not, the medical cost of treating diabetes and its complications will continue to rise.

4. High LDL cholesterol is a frequent complication of Type 2 Diabetes.

5. High LDL levels cause coronary artery plaques. The result can be myocardial infarction (heart attack).

6. Diabetes Mellitus is frequently first discovered at the time of a myocardial infarction (heart attack). Mildly elevated blood sugars could remain asymptomatic for an average 8 years and discovered after a complication of diabetes (heart attack) occurs.

7. Treating high LDL cholesterol with statins in Type 2 Diabetics decreases the incidence of myocardial infarction.

8. Statins decrease the production of LDL in the liver by inhibiting an enzyme that produces LDL.

9. High blood sugar and high insulin levels also decrease nitric oxide levels in the lining of blood vessels (endothelium). The result is a narrowing of the coronary arteries.

10. Statins stimulate an increased endothelial nitric oxide production. Statins dilate the coronary arteries.

11. The dilatation of the coronary arteries along with the decrease in LDL production decreases plaque formation and the risk of a myocardial infarction.

12. High insulin levels in early Metabolic Syndrome inhibits LDL receptors ability in the liver to attach to circulating LDL. This inability to attach to the liver cells decreases the liver’s ability to sense there is enough cholesterol in the blood stream. The liver then increases the production of LDL.

13. Statins inhibit the liver from producing more LDL. Lowering the LDL produced decreases LDL in the blood stream.

14. Logically, by lowering LDL cholesterol production with a statin the effect of insulin resistance to increase cholesterol production is neutralized. The use of statins in Insulin Resistance Syndrome does not cause diabetes.

15. Therefore data for the FDA’s black box warning is wrong.

Education is the key to chronic disease management.

Physicians must teach patients in terms they can understand. Education will only be effective if patients are motivated to learn.

Physicians must be motivated by consumers to teach. Consumers controlling their healthcare dollars could motivate physicians to teach them at their level. Physicians could use their own social networks to provide customized instruction.

Obesity is the core-precipitating problem in Metabolic Syndrome. My ideal Medical Saving Account with its financial incentive could help change the obesity problem in America.

The ideal MSA might even compel the experts to not throw misinformation around lightly and frighten the public.

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

Please send the blog to a friend

 

  • Pietr • March 23, 2012

    “Those who restrain desire do so because theirs is weak enough to be restrained.”
    ― William Blake
    >It is insufficient to say “doc, my cholesterol is high, fix me”. The only people who can “fix” patients with chronic diseases are patients themselves.
    Dr. Feld, this statement is a copout. You throw the responsibility back at the patient and your hands in the air. Since you recognize that obesity is an refractory to treatment, it is easier to blame the patient to sloth and gluttony and absolve yourself.
    The treatment of obesity was available 20 years ago with the combined agonists fenfluramine and phentermine. Unfortunately, these drugs were off patent and Dr. Weintraub and his colleagues didn’t see the danger. When the cardiac and pulmonary problems occurred, FEN/PHEN had no advocate and its promise disappeared.
    Treatments for OCD and addiction using dopamine and serotonin agonists/precursor have been described. The current protocol uses the immediate precursors levodopa and serotonin. Another duo taken together increases cerebral acetylcholine and crushes nicotine craving. Lecithin and pantothenate (vit B5) are dirt cheap and have absolutely no risk.
    These simple treatments do not make money for PHARMA, in fact they are a threat to its very existence. PHARMA would be foolish not to fight against their use. In my case, they destroyed my career, reputation and life.
    Tell your alcoholics, cocaine addicts and fatties that the system has failed them rather than blaming them.
    I hope you enjoy the Blake quotation.
    We seem to differ not only on the price of nude tennis balls (Spaldeens) in 1950 but also the solution for medical management. I hope we can converse civilly in the future for I respect the quality of your writing and the degree of intellect and trust in your motivations.
    Pietr Hitzig
    http://sites.google.com/site/pietrhitzig/

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

New Statin Therapy Warnings and Its Science

March 18, 2012
inConsumer Driven Health Care, Disinformation and the healthcare system, Information Technology in Healthcare, Medicine: Healthcare System
• Leave a comment

Stanley Feld M.D.,FACP,MACE

I have said repeatedly that patients have to become the Professors of Their Disease. A reader recently wrote, “ The average consumers are not smart enough to evaluat complicated clinical data.”

My answer is that it is the responsibility for their physicians to teach them how to evaluate the data used to decide on their cause of therapy.

Physicians’ goals are to their treat patients with the best possible evidence based medicine. It is the patient’s responsibility to understand the reasons for the treatment and be responsible for adhering to the treatment.

In my opinion, during the last decade, arriving at the best evidence based medical care has become very difficult. The design of clinical research studies has become sloppy. The statistical results of the studies have frequently been misrepresented. Statistical trends have been interpreted as being statistical truths.

However, once a statistical trend has been reported and accepted as evidence the non- statically significant data have resulted in producing defective healthcare policy and decreasing the quality of medical treatment.

One prime example has been my opinion of the effect of the Women’s Health Initiative on women’s health. Another is the conclusion of the FDA to put a black box treatment warning in the labeling of statins.

The conclusions drawn from the clinical data for the recent black box warning are wrong. The studies are wrong because the clinical studies were designed poorly or the conclusions were not statistically significant.

There are a few simple statistical rules that must be followed for a study to prove that the conclusions are correct and a medication has a certain statistically significant effect.

The p value must be less than .05, the confidence interval must not cross 1 and the hazard ratio must be 2 or greater. It must also be a well designed study to be able to show a valid effect.

  The women’s health initiative was poorly designed. In my opinion the study design alone disqualifies the study results. 

  1.  TNT (Treating to New Targets) trial,[4] 351 of 3798 patients randomized to 80 mg of atorvastatin and 308 of 3797 randomized to 10 mg developed new-onset type 2 diabetes mellitus (T2DM) (9.24% vs 8.11%, adjusted hazard ratio [HR]: 1.10, less than 2, 95% confidence interval [CI]: 0.94-1.29, crosses 1 P = .226). Not significant.
  2.  In the IDEAL (Incremental Decrease in End Points Through Aggressive Lipid Lowering) trial,[5] 239 of 3737 patients randomized to atorvastatin 80 mg/day and 208 of 3724 patients randomized to simvastatin 20 mg/day developed new-onset T2DM (6.40% vs 5.59%, adjusted HR: 1.19, 95% CI: 0.98-1.43, P = .072). Not Significant.
  3. Across the 3 trials, there was no difference in the major cardiovascular events, which were 11.3% in patients with and 10.8% in patients without new-onset T2DM (adjusted HR: 1.02, 95% CI: 0.77-1.35, P = .69) including the SPARCL trial were not significant.  
  4. In a meta-analysis of 13 clinical trials with 91,140 participants showed no significant difference. It is my opinion that meta-analysis is worthless because of variation in each study’s design.  

I understand that the first reaction of a reader would be that it is impossible for the average person to understand the significance of this science.

There is no reason this information could not be explained to people in various formats from very advanced to cartoon simple. The explanations could be available on an Internet social network 24/7 chosen by their physicians.

I believe patients could understand the information once they were motivated to be responsible for their medical care.

I am astonished that “experts” would propagate this disinformation on topics as important as the health and well being of the population.

Hopefully a consumer driven healthcare system would compel everyone to be more careful in examining data from clinical research studies. 

 

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

Please send the blog to a friend

 

 

  • warhammer tau • March 21, 2012

    Thanks for this post,Good to know that there are still interesting information which you can learn browsing the net and it really helps you a lot.

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

Let’s Talk About Statins

March 14, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System, Patients Problems
• Leave a comment

Stanley Feld M.D.,FACP,MACE

The New York Times did it again. Once again we are experiencing media hyperbole. The first sentence tells it all.

We’re overdosing on cholesterol-lowering statins, and the consequence could be a sharp increase in the incidence of Type 2 diabetes.

Bingo.  For years teaching physicians have worked hard trying to convince practicing physicians the virtues of statin therapy to lower the incidence of coronary artery disease by lowering LDL cholesterol (bad cholesterol).

Finally, it took hold. Practicing physicians tried for years to convince their patients to take statins to decrease the risk of heart attacks.

Over the years evidence mounted proving that normal total cholesterol value should be lower than 200 mgs% from a previous normal of 240 mg%.  The normal LDL cholesterol should be lowered to 100 mgs% from 150% mgs%.

This was not a pharmaceutical industry’s conspiracy. It was arrived at with actual statistically significant clinical data.

The New York Times goes on to say;

“This past week, the Food and Drug Administration raised questions about the side effects of these drugs and developed new labels for these medications that will now warn of the risk of diabetes and memory loss. The announcement said the risk was “small” and should not materially affect the use of these medications.”

As soon as the first sentence was read it immediately put the safety of statins in question. There was no discussion of the flawed data used to reach this conclusion.

I predict the warning that resulted from flawed data will result in the unwarranted  decrease in physicians prescribing statins and patients refusing to take statins.

“ The data are somewhat ambiguous for memory loss. But the magnitude of the problem for diabetes becomes much more apparent with careful examination of the data from large clinical trials.”

I believe the data is shabby for both increasing the incidence of diabetes and the decrease in cognitive function.

I also believe the scientists at the FDA also believe the data is shabby.

FDA’s statements include;

"1. However, because statins are so widely used, there is a heightened awareness by the public when we make any safety-related labeling changes to this class of drugs."

"These changes do not in any way alter the risk-benefit calculus for this class of drugs. We continue to believe that the benefits of statins far outweigh their risks, but we do want clinicians and patients to be aware of their side effects so that they can be used in the most safe and effective manner possible."

The media has emphasized the safety label change warning patients of the possibility of getting diabetes as a result of taking statins. The fact is there are so many flaws in the studies sited that initiated the label change that the changes are unwarranted.

The FDA goes on to state,

“ We are not recommending that patients be discontinued from their statin therapy based on a small increase in blood sugar levels.”

“Rather, elevations in blood sugar levels should be treated with dietary and lifestyle management and/or adjustment or initiation of antidiabetic therapies. We do not consider this a reason to not continue or not initiate statins, particularly in the diabetic population where patients are at increased risk for major adverse cardiovascular events and statin therapy has been shown to reduce that risk.”

This disclaimer had not been emphasized in the traditional media. The Women’s Health Initiative (WHI) another flawed study did not have one statistically significant leg to the study. Yet it’s handling in the traditional media changed the course of women’s health forever. Evidence from the WHI was used as study material. The statement below assumes the conclusion of harmful effects of statins is real.

“Despite the higher hazard ratios observed in the WHI study, we do not have strong evidence suggesting that there is a gender effect for the development of this adverse effect.”

The FDA looked at the effect of statins on neurocognitive function.

“We looked at those study results; there was no difference in neurocognitive functioning observed between patients exposed to statin therapy vs those unexposed, including in executive function (attention and speed) and memory, both immediate and delayed.”

There is no evidence here.

"There were trials conducted with statins to see if they could improve cognitive functioning in patients with mild to moderate Alzheimer disease. We reviewed the results of one such study, which showed neither evidence of benefit nor harm in cognitive functioning associated with statin therapy.”

My fear is the misleading warnings being publicized in the press will change the course of therapy for patients at risk for coronary artery disease.

The science used to arrive at these warnings is shabby. It is important to understand the defects in the evidence so that society does not do to statins what it did to hormone replacement therapy for women's health.

 

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

Please send the blog to a friend

 

 

Permalink:

Healthcare Insurance Industry’s’ New Business Model Is Wrong.

February 29, 2012
inConsumer Driven Health Care, Healthcare Insurance Industry, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D.,FACP,MACE

One percent of the people spend 25% of the healthcare dollars. Twenty percent of the people spend 80% of the healthcare dollars.

It would be important to know why this is true. Then figure out what could be done about it Stakeholders need to agree on a course of action.

It would be a good idea to understand what physicians think should be done. 

“One percent of patients account for more than 25 percent of health care spending among the privately insured, according to a new study. Their medical bills average nearly $100,000 a year for multiple hospital stays, doctors’ visits, trips to emergency rooms and prescription drugs.”

The 1% and the 20% are suffering from complications of a chronic disease.

The incidence of chronic diseases is on the rise in the United States. A major precipitating factor for this is obesity.

The incidence of Type 2 Diabetes Mellitus is increasing in both adults and young children, as the incidence of obesity is increasing.

The incidence of complications of Diabetes Mellitus will increase in the future. The result will be an increase in the cost of medical care.

President Obama’s healthcare reform act will expand healthcare coverage to 32 million uninsured in 2014. Obamacare is forcing the healthcare insurance industry to change its business model in order in order to remain profitable.

Premiums are out of the reach of most businesses and individuals. Premium increases are not an option.

High-risk individuals are denied healthcare insurance coverage. High-risk patients automatically get coverage in corporate healthcare plans. The healthcare insurance industry simply raises premiums on corporate groups in order to maintain its profits.

Something must be done to decrease the increase in chronic disease and its complications. 

The government cannot afford to insure its present patient obligations much less the 32 million uninsured.

“As the new federal health care law aims to expand care and control costs, the people in the medical 1 percent are getting more attention from the nation’s health insurers.”

Twenty percent of the population not 1% should be getting the attention of the healthcare insurance industry.

“Studies have already shown that Medicare spending is concentrated on a small group of individuals who are seriously ill.

An analysis by the IMS Institute for Healthcare Informatics, the research arm of IMS Health, a health information company in Danbury, Conn., provides a rare glimpse into the medical problems of people with private health insurance that are under 65.

About three-quarters of them suffer from at least one chronic condition that could spiral out of control without proper care.”

Most of these people were obese.

The healthcare insurance industry cannot avoid these patients after 2014.

“Insurance companies will be required to enroll millions of new customers without the ability to turn them away or charge them higher premiums if they are sick. They will prosper only if they are able to coordinate care and prevent patients from reaching that top 1 percent.”

The healthcare insurance industry realizes it must fundamentally change its business model.

The healthcare insurance industry has a problem developing a new business model that would work. The industry does not want to lose control over patients, their physicians and the monies paid into the healthcare system.

The healthcare industry does not have a clue about how to actually repair the healthcare system. It is focused on its own bottom line rather than looking at business models that will be beneficial to everyone and align all the stakeholders’ incentives.

The healthcare insurance industry is planning on instituting programs that will tinker with the edges. It will not fix the problems.

The new business models will increase the percentage of money the insurance industry receives for direct patient care maintaining a Medical-Loss ratio of 15%. There is no interest in providing patients with financial incentives and a choice.

The net result will be higher costs and system failure. The weird thing is most of the healthcare insurance industry executives know it.

“The reality is if we don’t figure out how to get to the patients, we’re not going to get where they need to be,” said Dr. Lonny Reisman, the chief medical officer for Aetna.

The reality is that the system must be consumer driven with consumers in charge of their healthcare and their healthcare dollars.

At the moment patients have no incentive to decrease the cost of care. Hundreds of patients have told me that they go to the doctor to fix their illness. Medicare or their insurance pays. The patients have no idea of the costs they incur nor do they care. They have no interest in controlling their disease.

My ideal medical saving accounts would give the patients incentive to learn about their disease. They would be interested in self-managing their disease with the physician and his medical care team being the coach.

“The next challenge, say insurers, is to figure out how best to work with a person’s doctor. Because many of these patients seem to be seeing many doctors and taking many medications, there may be no one who is accountable for the patients’ overall health.” 

Physicians have figured out what services get paid by the healthcare insurance industry. They do not get paid for educating patients about their disease.

The healthcare insurance industry and the government have developed a punitive bureaucracy.   

An attempt is being made to penalize or reward physicians for medical outcomes. Pay for Performance (P4P) is a punitive payment system. It will fail. 

Patients are responsible in large part for the onset of their medical problems and in controlling their medical outcomes. Physicians cannot be responsible for patients’ outcomes. It is the responsibility of the patient.

“Insurers are also still grappling with their understanding of human nature — why some people simply don’t take care of themselves or take their medicine or go to the doctor, even when it is clear that they should.”

Patient outcomes have nothing to do with human nature. It has everything to do with financial incentive and effective education.

Spokes 5 and 6 of my future state business model has everything to do with patients’ responsibility for caring for their disease and the physicians’ responsibility to the patients. It has nothing to do with physicians’ and patients’ responsibility to the healthcare insurance industry or government.

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

Please send the blog to a friend

 

  • online loans no credit check • October 10, 2013

    This is very interesting, You’re a very skilled blogger. I have joined your rss feed and look forward to seeking more of your fantastic post. Also, I have shared your web site in my social networks!

  • 鑽石能量水 • October 19, 2013

    Hurrah! After all I got a webpage from where I be able to really obtain helpful information concerning my study and knowledge.

  • •••
  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

Spokes 5 and 6- Future State Of Healthcare Business Model

February 26, 2012
inChronic Disese Management, Information Technology in Healthcare, Innovations in Healthcare, Medicine: Healthcare System
• Leave a comment

Stanley Feld M.D.,FACP,MACE

Spokes 5 and 6 of future state business model for the healthcare system’s survival must be understood as one unit.  Chronic Disease Management and Education As An Extension Of The Physicians Care are two simple concepts.

 

Slide22

 

Slide21

 

Patient education is a crucial element in the care of patients whether the disease is acute or chronic. Systems must be set up so that education is an extension of the physician’s care in order to be effective.

Education is less effective if it is not personalized and unrelated to the patient’s physician.

Both concepts have been devalued by President Obama’s healthcare reform plan. The chronic disease management concept has been devalued with the administration’s pilot studies showing that chronic disease management programs do not decrease the quality of care or cost of care.

The pilot studies were conducted by freestanding clinics. The education was not an extension of the patient’s physician care. Medical care is a personalized endeavor that requires a personal relationship between patients and physicians.

At its core the quality of medical care is enhanced by a strong physician patient relationship. This relationship is critical to a successful patient outcome and decreases in the cost of medical care.

An analogous educational event happened to me in my junior year in high school.

I was on the high school baseball team. Baseball practice started in February. It rained and snowed a lot in New York City in February. If it rained we would practice in the gym. We couldn’t have baseball practice outside one day.

On that day the gym was taken. The baseball team was sent to the study hall the last period of the day. My year before geometry teacher was in charge of that particular study hall.

I was an excellent high school student. I never missed a question on a geometry test.

I loved my geometry teacher. It was easy for me to understand everything she taught.  This was an example of a positive teacher student relationship.

I was taking trigonometry that spring term. The chairman of the math department was my teacher.

I had a poor relationship with that teacher. He was not enthusiastic about trigonometry.

He was detached from his students and their needs. He had no interest in relating to us.

I could not understand a thing he taught.  I figured I could tolerate him.  I thought I had to ability to learn the course directly from the textbook.

To my surprise I could not understand any of the concepts in trigonometry when I was studying at home. I was resigned to the fact that I was going to fail trigonometry.

My geometry teacher saw me in the study hall. She came up to me an asked me how I was doing. I told her I was going to fail trigonometry.

I could not stand Dr. B and I could not retain anything he taught. I also found it impossible to teach myself trigonometry from the text.

She asked me what period I had lunch and which period I had trigonometry. I had lunch the 5th period and trig the 6th period.

She said she taught trigonometry the 5th period and she could transfer me into her class and into 6th period lunch. She was also a student advisor.

Her words were as if a weight was lifted from my back. She said there was one problem. The departmental first quarter test in trigonometry was being given tomorrow. If you do not know anything you will fail. I said I understood.

After dinner I went into my room to study for the test. I started on page one of the text. Everything I read stuck. All of a sudden trigonometry was understandable and every trigonometry problem was easy to solve. All my anxiety about trigonometry melted away.

The next day I took the departmental test in my new 5th period trigonometry classroom. I got 100% on the trigonometry test. I received an A+ in trigonometry at the end of the semester and 100% on the New York Regent examination. I did not miss a trigonometry question the whole term.

This lesson stuck with me throughout my medical career. A positive physician patient relationship is just as powerful as the positive teacher student relationship. Both enable patients and students to reach their potential.

Obamacare is interfering and methodically destroying the ability to form a positive patient physician relationship.

The regulations are punitive. Patient care is becoming depersonalized and commoditized.

I predict Obamacare is going to make the medical outcomes worse and the cost of healthcare higher.

After 30 years of practicing Clinical Endocrinology I am convinced that the therapeutic effect of the patient physician relationship is a major factor contributing to the healing process.

Chronic disease management does not work unless the patient physician relationship is intact.

President Obama has proven this with his pilot studies in chronic disease management.

President Obama has not proven that chronic disease management as an extension of physicians care does not work.

Combined with a positive patient-physician relationship, chronic disease management with education as an extension of the physicians care can work.  Patients can be motivated to maintain control of their disease. Patients controlling their disease will decrease the complications, morbidity and mortality of the chronic disease.

The result will be a decrease in the cost of healthcare.

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

Please send the blog to a friend

 

 

 

 

 

 

 

 

 

 

 

 

 

  • Education Management Software • March 5, 2012

    Do yourself a favor and learn them while you’re young. They have a lot of practical applications, including remembering people’s names.

  • Practice Management Software • April 13, 2012

    A lot of what you say is absolutely correct. It’s no use longing for the better “old” days ’cause there was no such thing. It was precisely becuase there was a problem with healthcare, that Obamacare became a reality. Yes, the doctor-patient relationship is sacred, but at whose expense? If the patient has no respect for the associated costs, takes little, if any, responsibility for his/her healthcare, the burden falls elsewhere. Despite our increasing standards of living, healthcare cost increases has seen no abatement. I see Obamacare as an attempt to do something about this. We do not have unlimited resources, even though healthcare is a basic human right.

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

How Could A Social Networking Company Make Money In Healthcare?

February 22, 2012
inChronic Disese Management, Consumer Driven Health Care, Medicine: Healthcare System
• Leave a comment

Stanley Feld M.D.,FACP, MACE

My last blog about individual healthcare insurance policies generated a lot of comments from young people starting up a business and individuals operating their own business at home. I also received several from entrepreneurs looking to start a business.

One person wrote,

"Dear Dr. Feld

So we have now learned that high deductible plans are what people should be purchasing. We also learned that they should be self insuring for $10,000 which is the highest deductible insurance at the lowest price.

 Over $10,000 is where are at the greatest financial risk. True insurance should cover our greatest risk.

I would like to know where is the business opportunity is for an Internet company that runs social networks?

 

 

 Sincerely

Z"

I said the world belongs to young people 20-50 years old. They also understand the power and mechanics of social networking.

If there was a social network dedicated to describing the advantages and disadvantages of the healthcare insurance options available to the unemployed, self- employed and under insured there would be many members. If those members had the ability to have input it would grow even larger with appropriate marketing.

I have not figured out how social networking sites make money except through advertising. I imagine many companies would like to get the attention of these consumers who are seeking healthcare insurance advice.

It has been reported that people change their job up to 8 times during their career. More and more people are in start-up businesses and need healthcare insurance for their employees. Many people are becoming consultants and are self-employed. They all need healthcare insurance for their family.

President Obama’s answer to the problem is the government will provide the healthcare insurance for you. Healthcare insurance is a right as an American.

There are several problems with this statement. The government cannot afford to provide adequate healthcare insurance for the entire population.

Britain has proved it. They are reverting back to a pay for service system. The socialist democrats in Europe have proved that. Each country is going bankrupt.

The business opportunity would be to teach the people who are self-insured or uninsured about the rip off of the healthcare insurance industry and to teach them how to save money.

How many start up companies do you guess are uninsured or under insured or not insured for catastrophic illness because they cannot afford the healthcare insurance premiums?

The chances are many start up employees will not get sick. True healthcare insurance should be a hedge against catastrophic illness.

If someone gets sick in a company, the company could pay the employee for the amount he spent before they reached the full deduction.

The high deductible individual policy is not tax deductible. If it were made tax deductible by citizen demand to congress through social networking the voice of the individual could be heard. Congress might be forced to act.

Start up companies and other companies would save money. These companies would be placed on the same playing field as companies who pay for employee insurance with pre tax dollars. The social network could even form an association of self-employed companies and enjoy the tax benefits and purchasing power of large corporations.

This would represent a threat to the healthcare insurance industry. They would do everything to stop. So would the government.

If you do the math for the government, the government would be saving much more money than it would collecting taxes. 

An appropriate social network could stop the healthcare insurance industry's grotesque business model in its tracks.

It could save billions of dollars. It could create incentive for people to take better care of themselves. 

Many large and small companies are self-insured. The law lets these companies deduct their healthcare insurance with pre tax dollars. These companies could offer my ideal medical saving account with a $7,500 trust account. They could then reinsure employees for over $7,500 with a reinsurance company. 

Employees would obtain first dollar coverage after the deductible is reached.

In the worst case the company would save $6,000 per employee. In the best case it would save $13,000 per employee.

http://www.lijit.com/search?uri=http%3A%2F%2Fwww.lijit.com%2Fusers%2Fstanleyfeld&start_time=&p=g&blog_uri=http%3A%2F%2Fstanleyfeldmdmace.typepad.com%2F&blog_platform=&view_id=&link_id=7386&flavor=&q=ideal+medical+savings+accounts&x=0&y=0 

I suspect even the traditional insurance companies would provide the re-insurance.  These healthcare companies have already negotiated fees with physicians, hospitals and drug companies. 

If the healthcare insurance industry did not provide re-insurance its negotiated fees could be obtained easily.

A bank or a mutual fund could adjudicate the claims instantly.

The large corporations, who are self-insured, all have HR officers. The HR officers I have met either do not seem to have the bandwidth to investigate the possibility of the ideal medical saving account structure or they are trapped into outsourcing the details of the corporation’s self-insured healthcare plans to middlemen. I have a feeling the commitments of some with middlemen are long term.  

If all this could happen it would be an important first step in the development of social networking in healthcare and medical care.

Consumers need education for the care of their chronic disease such as diabetes, asthma, chronic lung disease, heart disease and chronic gastrointestinal diseases. Many of these diseases are a result of obesity.

If social networking could discourage the ever-increasing incidence of obesity, society would decrease healthcare costs dramatically. 

If patients learned how to manage their own disease the cost of medical care would decrease precipitously.  

Why?

Because 80% of the healthcare dollars spent on direct patient care are spent on the complications of chronic diseases that are not well managed by patients.

Many drug companies and medical device companies would advertise on these social networking sites.  

Consumers must drive the healthcare system in order for the healthcare system to be repaired. Not government or the healthcare insurance industry.

Consumers feel powerless at present. Empowering consumers through social networking will disrupt the entire healthcare systems supply chain for the better.

Consumers are up against a government that wants to tell them what they have to do. They are up against healthcare insurance companies that charge obscene premiums. They are up against hospitals, physicians and emergency rooms that have exorbitant charges.

Consumers are up against diseases such as obesity which precipitates many chronic diseases.

Consumers are frustrated and need leadership and guidance.

The phenomenal growth in social networking can give consumers the tool they need to control their health and drive the healthcare system.

Social networking is the only way to start a consumer driven healthcare movement. It has to happen before the medical care system is destroyed.

The young people expert (20-50 years old) in social networking have to become engaged. 

Those young people have to understand physician mentality and the importance of the patient physician relationship.

I will be happy to help in any way I can.

 

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

Please send the blog to a friend

 

 

 

 

 

 

 

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

I Left My Job: What Do I Do Now For Healthcare Insurance Coverage?

February 19, 2012
inHealthcare Insurance Industry, Medicine: Healthcare System, Patients Problems
• Leave a comment

Stanley Feld M.D.,FACP,MACE

“Dear Dr. Feld

My wife and I are 43 years old. We have a 7 year old daughter. All three of us are in excellent health. We have minimal medical bills and yearly checkups. 

I just left an executive position in a company that had excellent healthcare insurance.

 I am in the process of hunting for a new executive position. I am currently uninsured. I have the option to buy COBRA insurance for the next 18 months or until I get a job with good healthcare benefits.

The COBRA premium quoted to me to be $1600 per month or $19,200 per year. My former employer told me he was paying $15,000 for the same insurance.

I cannot afford $19,200 per year. Neither can I afford not to have healthcare insurance coverage for my family in case of catastrophic illness. I searched the Internet for the best option.

There were at least 97 healthcare insurance policies offered for individual coverage. After I got through understanding the fifth policy I was exhausted. None seemed to be a good deal.

I have been a reader of your blog and always say to myself thank God I do not have to deal with the dysfunction you describe. I could not believe I would be in this situation.

You seem to understand the problems in the healthcare system. What do I do next?

Thank you in advance for any help you can offer.

Sincerely

H”

I have received other letters of disbelief from young people. They did not appreciate how unfair, non transparent and truly dysfunctional the healthcare system was until they encountered the problems.

The future belongs to the 20 -50 year old age group not seniors. They are all consumers and potential patients. They are are going to need a viable healthcare system at some point in their life.

This age group must take an interest in developing an understanding of and take responsibility for getting involved in fixing the dysfunctional healthcare system now.

In general 20-50 year olds are not sick. Only 20% of the population is involved in dealing with the healthcare industry at one time.  Eighty percent of the population does not interact with the healthcare system. When they do they realize how dysfunctional it is.

100% of the consumers must demand, simultaneously, the healthcare system become transparent and equitable.

The structure of Present Obama’s healthcare reform plan has not yet delivered nor does it have a chance to deliver is promises. In fact, it has made the healthcare system more dysfunctional and unfair.   

Change in the system has to be consumer driven in order to force the government to reform the system so it is affordable and accessible to all. This means honestly eliminating waste at all levels.

President Obama’s waivers to favored groups and concession to vested interests political pressures will not improve the system.  

I totally understand that when dysfunction affects the other guy, young busy unaffected consumers have no interest in being involved in actively changing the system. However, they are going to be the other guy at some point.

In answer to the reader’s question “What do I do?”

He could sign up for COBRA. The COBRA system is a flawed system. It is a dishonest promise.  COBRA was accepted by congress and consumers without understanding its underlying consequences.  

“The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. “

Nothing in the Department of Labor’s document covers how the premiums are determined by the healthcare insurance industry.

A consumer electing to take COBRA is charged the calculated premium for an individual healthcare plan. The premium is very high.  

Actuarial calculation is designed to the benefit of the healthcare insurance industry. The calculation is not transparent. I suspect the government does not oversee the calculation.

COBRA is about the only option good for a 50 year old obese male with hypertension and hyperlipidemia who has a wife and a 7 year old child. He would be rejected for all private insurance plans.

The individual state’s “high risk pools’” premiums are even higher than COBRA’s premium. The high risk insurance coverage is less inclusive because it excludes any possible risk from underlying conditions.  

I felt compelled to help this reader.

He needed coverage in case of a catastrophic illness in his family until he obtained a new position. At his age and health history he should not have any trouble getting accepted for a high deductible policy.

I told him to check which insurance company his family’s physicians accept. It was UnitedHealth.

The 8th plan down the list of UnitedHealth options for high deductible was a $10,000 called Plan 100. The premium would be $318.82 a month. The deductible was $10,000. The plan provides full first dollar coverage after the $10,000 deductible is met up to 1 million dollars.

UnitedHealth Plan 100 underwritten by Golden Rule also had a $7,500 deductible for $417.

I thought this was the plan for this family. Their routine healthcare costs were less than $1000 year. The premium for the $7,500 deductible is $5004 per year. Total savings vs. COBRA is $19,200-$6004= $13,196.

If there was a catastrophic illness in his family and it cost more than $7,500 his total cost would be $7500 plus $5004 for his premium for a total cost of $12,504. He would still save $6,696 (19,200 for COBRA vs. $12,504= $6,696).

The big disadvantage is his premium costs are not tax deductible as it would be for an employer. At a 30% tax rate this consumer would have to earn $27,429 in order to pay $19,200. 

The adjudication of claims is simple. The physicians send the bill to UnitedHealth. UnitedHealth allows physicians their negotiated fee. The consumer is then sent an explanation of benefits for allowable fees.

Since the consumer has not reached the deductible, he is required to pay the physician’s allowable fee. This fee is credited toward his $7,500 deductible.

When the deductible is reached the full allowable amount for services is paid. This is the best deal under the present healthcare insurance options for this family of three.

He bought the high deductible Plus 100 insurance. He also complained about the confusing array of options and prices, the lack of transparency about these options, and difficulty in easily understanding the options.

He said he is a pretty smart fellow. He had difficulty in figuring out what to do and was ready to pay for COBRA coverage.

He asked, “How could people of average intelligence figure it out?

It would be easy if there were a questionnaire that would automatically determine consumers’ healthcare policy needs and direct them toward healthcare insurance policies that would fix their needs.

I told him the game is rigged. The insurance industry does not want you to figure out what policy is best for you. It wants you to buy the most expensive policy that might not address your needs.

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

Please send the blog to a friend

 

 

 

 

  • Jem • February 21, 2012

    It is consider a hard time to a people like us nowadays whereby our source of income is just a means of our jobs. Insurance is essential for our future assurance, but how to afford it if the private sector insurance premium is so huge, I think the government should step in, and to regulate the policy whereby beneficial to both insurer and the customers.

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.