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A Disaster, Not A Glitch

October 13, 2013
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests
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Stanley
Feld M.D.,FACP,MACE

 

There is an important
lesson in the recent Healthcare Insurance Exchange computer program “glitches”.

Once more the Obama
administration only presents a fragment of the truth. Unfortunately, the
traditional media accepts President Obama’s explanation and that is the news.

 

http://youtu.be/OCZLy_-IJ_s

The online
health insurance exchange program should be very easy to execute. All of the
major healthcare insurance companies have an online presence. People can go
online, put in simple demographics, and in a matter of seconds they can have at
least 100 healthcare insurance products to choose from. 

The Obama administration told the media that the software
developed for the web site, by CGI a Canadian company with offices in
Washington D.C., had an estimated cost of $93 million.

USAspending.gov said it cost the government $634 million dollars. The site calculated the cost from grants paid to CGI. This is seven times the
estimate published by the administration.

“Not only was the site still experiencing
substantial problems a week after launching, but the White House had reportedly
been aware for months that the HealthCare.gov website had flaws and might not be
ready to launch. Yet officials insisted on the Oct. 1 roll out anyway.”

The problems experienced by people trying to use the user
interface was something that was tested least or not done right — or both.'

– James
Turner, a member of the technical staff at software firm Beeonics, Inc.

The healthcare industry,
participating in the new exchange, complained “loudly” that the site had
experienced problems before the launch.  

Speaker of the
House John Boehner asked, "How can we tax people for not
buying a product from a website that doesn't work?"

The front end user experience is only a fraction
of the problem with the federal health insurance exchange site. A front end user’s
experience typically means there is something wrong with the basic construction
of the software.

The
monumental issue of the site involves interfacing seamlessly the multiple
government agencies (IRS, HSS, CMS, Welfare, Food Stamps and others) and
private insurers legacy’ computer networks. Each agency and organization has a
myriad of computer networks that must interface with the health insurance
exchange web site.

It is
reality easy to have a pretty front end interface with the user. If the
software program is poor the interface is a disaster.

These
computer networks must be integrated into what appears to be a fancy front end.
It looks as if this software is incapable of this very complex integration.

It is
one of the reasons that verifying patient for subsides has been dropped and the
government is going to take the patient’s word.

These
problems were published in blogs for months. The software  failed initial testing.

The
Obama administration did not delay the launch despite these warnings.

Now President Obama has
told us that this is a small “glitch.” He compare it a glitch Apple had with
its launch and it did not put them out of business.

"Take
away the volume and it works," President Barack Obama's chief technology
adviser, Todd Park, told
USA Today. 

Either
President Obama does not know what is going on or he is not telling the truth to
the American people.

The
administration has blamed the glitch on the high volume of people trying to
access the site. This is partially true.  

The prediction by experts is it will likely take
months to get it running properly. The rollout was disastrous.  There were 8.6 million unique visitors in the
first 3 days hoping to apply and enroll in a healthcare
insurance plan.  Instead they experienced
an online nightmare, with websites crashing, refusing to load, and failing to
offer comprehensive choices.

 The demographics of the 8.6 million are
unknown. They may all have been high risk uninsured people.

“The Daily Mail is reporting that
sources within HHS are saying only 51,000 people signed up for insurance via
the government run website Healthcare.gov in the first 12 days, 

Two HHS career civil servants told
the Daily Mail that only 6200 people signed up on the first day. “

White House and administration officials continue to insist they
have no idea how many people have signed up but will release the numbers
monthly after November 1.

Is the administration trying
to hide something?

“If the state-run
exchanges were to have a similar response rate for six months, the national
enrollment total would be approximately 2 million in six months."

That number is less than
29 per cent of the 7 million the Obama administration would need, according to
the nonpartisan Congressional Budget Office, in order to balance the new health
insurance system's books and keep it from financial collapse.”

The White
House’s published goal is to enroll at least 2.7 million young, healthy people
between the ages of 18 and 35 in 6 months.

The monthly
premiums of healthy, low risk people are needed to offset the cost
of health care for older, sicker Americans who will certainly try
enroll.

The CGI website states;

“Exchanges
must provide many different functions, the soundest approaches bring together
expertise and best practices in federal and state health programs, commercial
insurance, data exchange, portals, e-commerce over the cloud, and financial
management.”

“ CGI
brings all of this expertise to the table, along with direct experience in
developing sustainable HIX programs. We also have a dedicated group of subject
matter experts tracking best practices for state HIX and integrated
eligibility systems across the United States.”

CGI knows
what to say. It has not shown that they know what to do.

The Obama
administration may have wasted $634 million taxpayer dollars on software that
does not work.

This is
more than a glitch. This is a disaster.

Just wait
and see the prices for a Bronze level healthcare insurance plan once people can
negotiate the site.

No one is
going to be able to afford the insurance in the Affordable Care Act
(Obamacare).

Another
disaster will be coming your way complements of Obamacare.

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

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EMRs Real Politics.

April 28, 2013
inConsumer Driven Health Care, EMR, Medicine: Healthcare System, Summary Blogs
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Stanley Feld M.D.,FACP,MACE

 

Dr. Jerome Groopman and Dr.Pamela
Hartzmen uncovered the real politics of EMRs.  They are both on the staff of Beth
Israel Deaconess Medical Center in Boston and on the faculty of Harvard Medical
School.

 Dr. Groopman wrote a best seller “How
Doctors Think.”

In a Wall Street
Journal article they wrote,

 “The electronic medical record (EMR) is touted
as the key to containing costs, reducing errors, improving quality, and
simplifying administration: an “elegant exercise in wishful thinking

Dr. Groopman and Pamela Hartzman debunk the 2005 RAND study. The
RAND EMR study of 2005 led to President Obama’s belief that EMRs will save $81
billion dollars a year for the healthcare system.

Groopman and Hartzman show that there is little evidence to
support the president’s belief.

The RAND analysts claim that more than $350
billion would be saved on inpatient care and nearly $150 billion on outpatient
care over a 15-year period of time.

Unfortunately, data from three other studies, a cardiology
group, a Harvard group and Canadian group showed there is no savings difference
between paper records and electronic records.

Dr. Groopman claims the RAND study is self-serving to EMR software
companies that sponsored the study.

 

 Allscripts
Healthcare Solutions, the Cerner Corporation and Epic Systems of Verona, Wis. are the major EMR software companies.

 “In February 2009, after years of behind-the-scenes lobbying by
Allscripts and others, legislation to promote the use of electronic records was
signed into law as part of President Obama’s economic stimulus bill.

“But today, as doctors and hospitals struggle to make new records
systems work, the clear winners are big companies like Allscripts that lobbied
for that legislation and pushed aside smaller competitors.”

At Allscripts Healthcare
solutions, annual sales have more than doubled from $548 million in 2009 to an
estimated $1.44 billion last year.

At the Cerner Corporation of Kansas City, Mo., sales rose 60 percent during that
period.  

“Current and former industry executives say that
big digital records companies like Cerner, Allscripts and Epic Systems of
Verona, Wis., have reaped enormous rewards because of the legislation they
pushed for.”

Unfortunately, many of the
EMR systems bought by large hospital systems and physician practices are not
fully functional. They do not fit the administration’s criteria of meaningful-use
EMRs. These EMRs are requiring additional hospital systems and physicians;
practices outlays of cash to make them fully functional.

Panama
City-based Pain Clinic of Northwest FL filed a purported class action lawsuit
on Dec. 20, 2012 against Chicago-based Allscripts (NASDAQ: MDRX).

“The purported class action
lawsuit says that about 5,000 small group physicians were sold an EMR called
MyWay from 2009 until late last year, when the company stopped supporting the
product.”

“The company was also hit with
a federal shareholder class action securities fraud lawsuit in the Northern
Illinois District last year over allegations that it misled investors about the
performance of its EHR programs.”

 The MyWay EMR cost about $40,000
per physician. ThePain Clinic of Northwest Florida claims it was misled by
Allscripts Healthcare Solution.  The
Clinic stated that MyWay has “shortcoming
and inherent defects,”  

The
complaint says Allscripts was unable to obtain “meaningful use” bonus status
for MyWay because of the problems with the program. The lawsuit claims that

 “Allscripts has been unjustly enriched by
retaining the money paid by MyWay purchasers and users without delivering an
EHR software product that performs as it was intended to work,”

 These costs are always
passed on to the consumer. Drs. Groopman and Hartzman  go on to say,

“The
president and his health-care team have yet to address these difficult and
pressing issues.

 Our culture adores technology, so it is not
surprising that the electronic medical record has been touted as the first
important step in curing the ills of our health-care system.

But
this notion is an overly simplistic and unsubstantiated part of the solution.


It is important to note Drs. Groopman and Hartzman’s total
and refreshing frankness.

“We both voted
for President Obama, in part because of his pragmatic approach to problems,
belief in empirical data, and openness to changing his mind when those data
contradict his initial approach to a problem”.

“ We need the
president to apply scientific rigor to fix our
health-care system rather than rely on elegant exercises in wishful thinking.”

Please note that Drs. Groopman and Hartzman said it not
me.

In
a new study The RAND Corp has backed off on its 2005 study earlier this year
and withdrew its estimate of saving to the healthcare system of $81 billion
dollars annually.

In the
RAND Corp’s view, the disappointing performance of health IT to date can be
largely attributed to several factors:

 

  1.  “Sluggish
    adoption of health IT systems
  2.   Coupled
    with the choice of systems that are neither interoperable nor easy to use;
  3.   The
    failure of health care providers and institutions to reengineer care processes
    to reap the full benefits of health IT.
  4.  We
    believe that the original promise of health IT can be met if the systems are
    redesigned to address these flaws by creating more-standardized systems that
    are easier to use,
  5.  EMR are
    truly interoperable,
  6.  Afford patients more access to and control
    over their health data.
  7.  Providers must do their part by reengineering
    care processes to take full advantage of efficiencies offered by health IT, in
    the context of redesigned payment models that favor value over volume.”

 

It should not be a blame game.

General Electric sponsored this new RAND study.  It is important to note that GE is a major
Allscripts competitor.

There is true value in the EMRs to patient care. However the
focus of the marketing and development is on the wrong customer.

The RAND still does not get it. Perhaps
it does not want to get it.

EMRs should be for the benefit of physicians and their
patients. It must be at a price physicians can afford to pay. It should not be
for the benefit of the government, the healthcare insurance industry and
hospital systems.

It should be a tool to
continually educate physicians and patients. It should not be a tool used by
secondary stakeholders to penalize physicians and patients.

Patients and physicians control My Ideal Electronic Medical
Record. It should be seriously considered to achieve the maximum benefit of EMRs’
potential.

I believe it would be of value to interested readers to go
to this link.

 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=Idel+Electronic+Medical+Record+%28EMR%29&x=33&y=6.

 Those articles will
not only describe the problems with EMRs, problems which I have predicted and are
now recognized. These articles will also outline real  solutions to having universal adoption of
EMRs.

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

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Health Insurance Exchanges And The Federal Government

September 16, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
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 Stanley Feld M.D., FACP,
MACE

Health
Insurance Exchanges are supposed to be state-regulated
and standardized health care plans in the United
States, from which individuals may purchase health insurance
coverage eligible for federal subsidies.

All exchanges must be fully certified and
operational by January 1, 2014 under federal law.[1]

The health insurance
exchanges in all states are not going to be operational on time.

However, Americans of
all income brackets are experiencing the increases in 20 hidden taxes in
Obamacare right now. The increase in taxes is supposed to amount to $1.2
trillion dollars.

The health insurance
exchanges, are supposedly one of the centerpieces of President Obama’s health care law,

Their formation is failing
despite President Obama’s publicity.

If they are created President
Obama will have a clear path to the Democratic Party’s cherished Public Option.

This will be a giant
step to achieving a single party payer healthcare system.

Unfortunately, the
single party payer system will in turn fail because it will be unaffordable for
America.

Individual states and
the healthcare insurance industry will do everything they can to undermine the
success of health insurance exchanges.

Federal officials never
thought they would end up running the Health Insurance Exchanges. President
Obama’s plan was to dump this formidable and complex task on the states. Half
the states have refused to participate.

“Obama
administration officials are getting ready to set up and operate new health insurance markets
in about half the states, where local officials appear unwilling or unable to
do so.” 

“So far, Governors of 13 states with nearly
one-third of the United States population have sent letters to the Obama administration
saying they intend to set up exchanges. Complete applications are due on Nov.
16, 2013.”

In other words, 37 states have not signed up
yet. Once those 13 states that have signed up and start calculating their costs
for setting up and running the health insurance exchanges I suspect they will
also withdraw.

The Secretary of Health and
Human Services, Kathleen Sibelius’ plan was to complete the regulations for the
states to start the health insurance exchanges by January 1,2014. 

The Secretary of Health and
Human Service has emphasized that states must meet her standards of transparency
and accountability.

The federal government requires
state exchanges to develop budgets and project operating costs, revenues and
expenditures to the central government’s satisfaction.

States must explain how the
revenue will be generated and how the exchange will address any financial
deficits.

The federal government wants to
set up the rules and require the states to execute these rules at the states
expense. President Obama promised to “fund” the exchanges for the states for
two years. After that they are on their own.

The health exchange programs
will be delayed because the government pledged to set up the health exchanges
in the states that opted out of the program. It has not started to set up these
exchanges.

Creation
of Health Insurance Exchanges is a complex and expensive task. States are
required to operate under a balanced budget. States cannot balance their
budgets with health insurance exchanges unless they further increase taxes.

 “Federal and state officials and health policy experts expect that
the federal government will run the exchanges in about half of the 50 states.”

 My
guess is it will be closer to 35 states. Federal officials are preparing to do
the job. It will be poorly executed and difficult politically.

President Obama knows the
public fears a federal takeover of the healthcare system. He realizes the
public understands the health Insurance exchanges are one more step toward a
federal takeover of the healthcare system.

The Obama administration
does not want to encourage that fear by taking over the Health Insurance
Exchanges.

Neither does the Obama
administration want to alienate state officials whose help they need to execute
the federally run healthcare exchanges.

The federal government
does not have the manpower to run all these exchanges. It is outsourcing the
work to private contractors.

We have seen the
disastrous abuse to physicians by outsourcing fraud and abuse investigations to
private contractors.

“The Obama
administration has invited advertising agencies to devise an elaborate
“outreach and education campaign” to publicize the federal exchanges and their
potential benefits for consumers.”

The Federal officials
are hiring private contractors to provide “in-person assistance” to consumers
and to operate call centers.

President Obama’s
administration has attacked Mitt Romney and Bain Capital for outsourcing of
jobs.

President Obama is now outsourcing
these jobs to a foreign company, while America desperately needs jobs here.
This is duplicity to its highest degree.

He better keep it out of
the mainstream media or Mitt Romney out to get it in the mainstream media
somehow.

Federal officials
have turned to the American subsidiary of a Canadian company, the CGI Group, to
provide information technology services to the federal exchanges under a
contract that could be worth $93.7 million over five years.

Kathleen Sibelius has demanded total transparency
of state health insurance exchanges yet planning for the federal exchanges has been done
almost entirely behind closed doors.

“We have gotten
little bits of information here and there about how the federal exchange might
operate,” said Linda J. Sheppard, a senior official at the Kansas Insurance
Department.

“I was on a panel at
Rockhurst University here, and I was asked, ‘Where is the Web site for the
federal exchange?’ I chuckled. There really isn’t any federal exchange Web
site.”

In New Hampshire, Thomas
M. Harte, the president of Landmark Benefits, which arranges health insurance
for 300 employers of all sizes, said:

“Nobody has any idea
what the federal exchange will look like. There has not been much communication
between officials drafting plans for the federal exchange and the people who
will use it: consumers, employers, brokers and insurers.”

Administration officials
have not set forth a budget for the federal exchanges.

“They said they
intended to charge “user fees” to the participating health insurance plans.

It is unclear whether
the fees are subject to approval by Congress or whether insurers could pass the
costs on to consumers.”

The Federal Government
is not telling us what they are going to do. It is not following its call for transparent
regulations.

It is pretty clear to me
this will be one of many steps toward the destruction of the healthcare system.
The healthcare system will self implode. At that point everyone will be begging
the government to take over.

It will be impossible
for President Obama to take over a business the government cannot afford.

A key to Repairing the
Healthcare System is to decrease the outsourcing and bureaucratic complexity.

It is to let Americans
be independent, own their healthcare dollars and their health and not be
dependent on government complexity, inefficiency and rationing of care.

Entitlements do not save
money!

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

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Permalink:

Health Insurance Exchanges And The Federal Government

August 8, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D., FACP,MACE

Health Insurance Exchanges are supposed to be state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance eligible for federal subsidies.

 All exchanges must be fully certified and operational by January 1, 2014 under federal law.[1] 

It is not going to happen on time. However the 20 hidden taxes in Obamacare are happening right now.

The health insurance exchanges, are supposedly one of the centerpieces of President Obama’s health care law,

Their formation is failing.

President Obama will then have a clear path to a Public Option and a single party payer healthcare system.

Unfortunately, the single party payer system will fail because it will be unaffordable for Americans and the federal government.

The states and the healthcare insurance industry will do everything they can to undermine its success.

Federal officials never thought they would end up running the Health Insurance Exchanges. Their plan was to dump this formidable and complex task on the states. Half the states refused to participate.

“Obama administration officials are getting ready to set up and operate new health insurance markets in about half the states, where local officials appear unwilling or unable to do so.”

 “So far, Governors of 13 states with nearly one-third of the United States population have sent letters to the Obama administration saying they intend to set up exchanges. Complete applications are due on Nov. 16, 2013.”

Stated another way, 37 states have not signed up yet. Once those 13 states that have signed up calculate the cost to setting up and running the health insurance exchanges I suspect they will withdraw.

The Secretary of Health and Human Services, Kathleen Sibelius’,plan was to create regulations for the states to develop the health insurance exchanges by January 1,2014. She has emphasized that states must meet her standards of transparency and accountability.

The federal government requires state exchanges to develop budgets and project operating costs, revenues and expenditures.

 There are a great many regulations attached to qualify as a state exchange.

States must explain how the revenue will be generated and how the exchange will address any financial deficits.

 The federal government wants to set up the rules that require the states to execute these rules at the states expense after the federal government funds the exchange for two years.

The health exchange program will be delayed because the government pledged to set up the health exchanges in the states that opted out of the program.

Creation of Health Insurance Exchanges is a complex and expensive task. States have to operate under a balanced budget. States cannot afford this undertaking.

“Federal and state officials and health policy experts expect that the federal government will run the exchanges in about half of the 50 states.”

 

My guess is it will be closer to 35 states. Federal officials are preparing to do the job but it will be a difficult political task.

The public fears a federal takeover of the healthcare system. This takeover is one more step by the government to increase its control over the healthcare system.

The Obama administration does not want to encourge that fear with its takeover of Health Insurance Exchanges.

The Obama administration does not want to alienate state officials whose help they need in the execution of the federally run healthcare exchanges.

The federal government does not have the manpower to run all these exchanges. It is outsourcing the work to private contractors.

We have seen the disastrous abuse to physicians by outsourcing fraud and abuse investigations to private contractors.

“The Obama administration has invited advertising agencies to devise an elaborate “outreach and education campaign” to publicize the federal exchanges and their potential benefits for consumers.” 

The Federal officials are hiring private contractors to provide “in-person assistance” to consumers and to operate call centers.

President Obama’s administration has attacked Mitt Romney and Bain Capital for outsourcing of jobs.

President Obama is now outsourcing these jobs to a foreign company, while America desperately needs jobs here.

Federal officials have turned to the American subsidiary of a Canadian company, the CGI Group, to provide information technology services to the federal exchanges under a contract that could be worth $93.7 million over five years.

Kathleen Sibelius has demanded total transparency of state health insurance exchanges yet planning for the federal exchanges has been done almost entirely behind closed doors.

“We have gotten little bits of information here and there about how the federal exchange might operate,” said Linda J. Sheppard, a senior official at the Kansas Insurance Department.

“I was on a panel at Rockhurst University here, and I was asked, ‘Where is the Web site for the federal exchange?’ I chuckled. There really isn’t any federal exchange Web site.”

In New Hampshire, Thomas M. Harte, the president of Landmark Benefits, which arranges health insurance for 300 employers of all sizes, said:

“Nobody has any idea what the federal exchange will look like. There has not been much communication between officials drafting plans for the federal exchange and the people who will use it: consumers, employers, brokers and insurers.”

Administration officials have not set forth a budget for the federal exchanges.

“They said they intended to charge “user fees” to the participating health insurance plans.

It is unclear whether the fees are subject to approval by Congress or whether insurers could pass the costs on to consumers.”

I get it.

The Federal Government is not telling us what they are going to do because they probably want to follow its non-transparent regulations.

It is pretty clear this will be one of many steps toward the destruction of the healthcare system. The healthcare system will self implode. At that point everyone will be begging the government to take over.

It will be impossible for President Obama to take over a business system it cannot afford.

A key to Repairing the Healthcare System is to decrease the outsourcing and bureaucratic complexity.

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

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Permalink:

Easy Things to Do To Fix Medicare Part D

August 3, 2011
inHealthcare Insurance Industry, 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 

Twenty seven million individuals were enrolled in Medicare Part D as of December 2009. The government spent $51 billion to subsidize Medicare Part D in 2009. The $51 billion dollars spent is in addition to seniors’ premiums and co-pays. The government subsidy was $1,889 per individual subscriber. 

Who is making the money?

 “A provision in the Medicare Modernization Act (MMA), known as the "noninterference" provision, expressly prohibits the Medicare program (the government) from directly negotiating lower prescription drug prices with pharmaceutical manufacturers.”

 This was a gift to the healthcare insurance industry by the government as a result of intense lobbying efforts. 

Over 300 private plans (Medicare Plan D sponsors) enter into negotiations with pharmaceutical manufacturers separately to deliver Medicare Part D benefits.

Medicare Part D eligible seniors are forced to deal with an overwhelming number of private plans with varying formularies, premiums, deductibles, and co-pays in order to receive prescription drug coverage. The differences in prices are available but it is difficult to make comparisons.

The government negotiates directly with the pharmaceutical manufactures for the VA system. The VA system pays 42% less than Medicare plans for prescription drugs. The high volume contracts save money for the government and are lucrative to the pharmaceutical companies.

The various Medicare Part D plans cover about 85% of the most popular 200 drugs on average. The VA’s national formulary covers 59% of the most popular 200 drugs.

If Medicare Part D negotiated the same drug prices as the VA, the government would be able to decrease its subsidy $510 per beneficiary per year or a total of $14 billion per year (2009 prices).

Research by respected economist Dean Baker shows that the federal government and Medicare beneficiaries would save $600 billion between 2006 and 2013 if Medicare were allowed to directly offer a Part D benefit and to negotiate prices with pharmaceutical manufacturers. 7Such significant savings could be used to close Part D's donut hole and to lower cost-sharing for Medicare beneficiaries.

There are reasons for the twenty-six percent difference in formulary. Either the government-negotiated prices are too expensive and deemed marginally more effective than the drug ordered or the less expensive drug is determined to be just as effective. 

The judgment is made by the procurement system that negotiates price.

Is the cheaper drug as effective for a particular patient? This decision should be made by the patients’ physicians and patients and not by bureaucrats. It should be the patient’s choice to pay the difference. 

The procurement systems bureaucrats could be wrong.  

If the government negotiated for all the Medicare Part D participants the government’s purchasing power should be greater than the VA system. Its negotiated price would be better. The savings should reduce the government’s Medicare Part D subsidy significantly.

President Obama sort of understood this concept. He included the government’s right to negotiate drug prices in his Healthcare Reform Act. He subsequently removed the provision from his Healthcare Reform Act in exchange for the healthcare insurance industry’s and the pharmaceutical industry’s support of “Obamacare.” Seniors and the Medicare Part D program have lost.

It is obvious that there is much fraud, waste and abuse in Medicare Part D. February 2011; the Government Accounting Office published an example of CMS bureaucratic inefficiency and waste.

The Government Accounting Office (GAO) has designated Medicare as a high-risk program. The size, nature, and complexity of the Part D program make it particularly vulnerable risk to fraud, waste, and abuse. The GAO and the Inspector General of HHS requires all Part D sponsors (healthcare insurance industry) to have programs to safeguard Part D from fraud, waste, and abuse.

 CMS is responsible for managing and overseeing the Part D program. CMS regulations require Part D sponsors to have compliance plans that must include measures that detect, correct, and prevent fraud, waste, and abuse. 

 Congress asked the GAO to examine the extent of CMS's implementation of the oversight of Part D sponsors' (healthcare insurance industry) compliance programs to avoid fraud and abuse.

  CMS bureaucrats have written extensive documents containing many rules and regulations to combat waste, fraud and abuse.  CMS then outsources the Medicare Part D audit to Medicare Drug Integrity Contractors (MEDICs) to support its Medicare Part D audit efforts.

 The 2010 audit was supposed to be finalized in early 2011. It has not been completed as of July 30,2011.

CMS officials reported that they conducted only 33 audits out of 290 Medicare Part D sponsors (Healthcare insurance industry) in 2010.

“The 33 sponsors represented 11 percent of Part D sponsors, 56 percent of plans, and covered 62 percent of enrolled beneficiaries in 2010 according to agency officials. As of February 2011, CMS had not made all audit findings available but had taken formal enforcement actions against several sponsors resulting from the on-site audits according to agency officials.”

 “As of December 2010, officials reported that the agency had issued five marketing and enrollment sanctions and one contract termination action based, in part, on the results of these audit findings noting failure to comply with CMS compliance plan requirements.” 

 It is hard to imagine how many deficiencies exist among the other 257 Medicare Part D sponsors not yet audited. How long should these audits take? How severe will the penalties be? How can seniors know if their Part D plan is sound?

CMS has not been able to audit or enforce its own regulations that are suppose to protect seniors from fraud and abuse efficiently and effectively.

What can possibly go wrong with ‘Obamacare” with 256 new bureaucratic agencies and many thousands of new regulations?

The only healthcare system that could work is a consumer driven healthcare system with alignment of all the stakeholders’ interests.

Unfortunately, that is not going to happen anytime soon. Seniors are starting to take things into their own hands.

“After investigating several Canadian pharmacies, my wife and I paid $624.77 for a three-month supply of drugs at an online Vancouver registered pharmacy. These same drugs cost us $1,208.04 buying at Walgreen's, Target, and Kmart where we shopped for the lowest prices.”

"What's the catch? If Big Pharma had its way, customs and the FDA would be confiscating all imported drugs, crying that the government can't guarantee their safety."

"But that just isn't the case. Your pharmaceuticals come in the same sealed packages you get at your corner drugstore."
 

"Anyway, it would be politically incorrect to arrest grandma for trying to make ends meet. Some members of Congress even encourage the practice by listing Canadian pharmacies on their Web sites."

The Wal-Mart $10 prescription fee for generic drugs also works if your physician accepts generic substitution. 

A reader sent me a link to a website. http://babayoga.drugcutpillsrx.com/?camp=priagiji

 I reviewed the web site. It is based in San Francisco. The site offers large discounts on branded and generic medication. It is much less expensive than Medicare Part D. Senoirs could afford to buy the medication without using up credits toward the donut and use Medicare Part D only when needed.

It is going to take proactive approaches by seniors (consumer driven) to force the government to serve their vested interests and not the vested interests of the healthcare insurance industry and the pharmaceutical industry.

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

 

 

 

 

 

 

Permalink:

Is Barack Obama Any Different Than Other Politicians? Part 5

August 24, 2008
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests
• Leave a comment

 

Stanley Feld M.D.,FACP, MACE

From a distance everything Barack Obama says sounds great. The events of the last eight years have created cynicism and despair. We are a nation thirsty for hope to solve our many problems.

In healthcare the basic problem is not how we are going to pay for healthcare for all of our citizens but how to change the healthcare delivery system to create a healthier society and less chronic disease. Eighty percent of our healthcare dollars are spent on the treatment of chronic disease.

Barack Obama’s National Health Insurance Exchange does not address the basic problem in a meaningful way. It creates another bureaucracy that will drive competition out of the market place. It will result in socialized medicine with all of its bureaucratic and monetary problems.

 

“National Health Insurance Exchange:

The Obama plan will create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible.

I believe his National Health Insurance Exchange will drive the private insurance companies out of the healthcare insurance business. This might not be a half bad idea since the healthcare insurance industry controls healthcare cost and earns a grotesque amount of money. Also the government outsources and will continue to outsource its Medicare administrative services to the healthcare insurance industry at an equally large profit.

“ Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and have the same standards for quality and efficiency. The Exchange would evaluate plans and make the differences among the plans, including cost of services, public.”

The only option remaining would be the new public plan similar to Medicare Part C the coverage that Senator Kennedy has. In recent years Medicare Part B has experienced increasing deficits. The increasing deficits have resulted in increasing costs to seniors and decreasing healthcare benefits. Increasing costs and deficits are inevitable in a single party payer system if the basic problems in the healthcare system are not addressed.

I believe the goal of the Democratic Party is to convert our healthcare system to a system of universal care with a single party payer. Hillary Clinton tried it in 1993 and Barack Obama will try in 2009 if elected.

It has been said that democratic countries in the west with single party payers do just fine. Canada and England have healthcare systems with universal care with a single party payer. All one has to do is look online at newspapers in Canada (National Post) and London ( Evening Star) to see how well these systems are really doing for their citizen. The following articles appeared in the National Post in Canada

1. Millions of Canadians lack family doctor

MD uses lottery to cull patients Not first such case as lack of doctors causes huge caseloads. In the latest jarring illustration of the country’s doctor shortage, a family physician in Northern Ontario has used a lottery to determine which patients would be ejected from his overloaded practice.

 

2. Let private sector into health care: CMA president Day

“We must not deny any patient access to essential health care based on ability to pay; nor should we deny access based on a shortage of doctors, hospital beds or operating time.

“Competition, consumer choice and market principles barely exist in our health system. The CMA President is asking for the basic principles that stimulate organizations to work properly

“Let’s note that three of the main Olympic values — excellence, universality, sustainability — are similar to our values and aspirations for a truly great health system. “And, of course, an integral part of the Olympics is competition. Without competition we cannot expect improvement, let alone excellence. “I believe that if we are to preserve universal health care for the next generation, we need to embrace similar principles.”

He clearly pointed out the problems with the Canadian system.

“And he bemoaned the fact that more than one million Canadians were on waiting lists for health care and that five million people did not have access to a family doctor. Yet neither the governing Conservatives nor the Liberal opposition seemed to care, he charged.”

This is what I worry about with Barack Obama’s healthcare plan.

“Individually, most [politicians] have a deep understanding of the plight of our health-care system.”Collectively, especially at the federal level, they are reluctant — even afraid — of engaging in a meaningful public policy discussion on health.

Claude Castonguay, a former health minister in Quebec summarized the findings of a report he submitted to the provincial government. He said that public health care system, as it now stood, was not financially sustainable.

 

The following articles appeared in the London Evening Star

 

1. Doctors call for ‘rationing’ of NHS services

“Rationing of services in the NHS is a ‘fact of life’, doctors insisted. The British Medical Association said a postcode lottery operates nationwide with some treatments denied to patients simply because of where they live.

It called for a charter that would tell patients exactly what ‘core’ services they are entitled to receive in England.

But in order to make the NHS work successfully, the BMA says the day-to-day running of the service must be wrested from politicians.

James Johnson, chairman of the BMA’s council, said there had to be an end to the ‘constant political dabbling’ and ‘micro-management’. “

2. London’s healthcare is lagging

3. Third of broken hip victims have to wait two days for surgery

“Thousands of elderly people with broken bones caused by falls are being betrayed by a postcode lottery in NHS care. A report says around one in three broken hip victims had to wait more than 48 hours for surgery – a delay that could have put their lives in danger. “

Enough said about the glories of socialized medicine in Canada or England. Is this what the American people want? Some say most people are satisfied with the healthcare service they receive in Canada and England. Only 20% of the population is sick at any one time. Therefore (most) have no idea what is going on in the healthcare system. It is easy to say they are satisfied with the system when they are not sick.

Rather than our next President creating another ineffective bureaucracy and costly entitlement program all he would have to do is

  1. level the tax playing field for the self employed to be able buy insurance with pre tax dollars
  2. permit the purchase of insurance across state lines
  3. produce purchasing power and negotiating power for consumers with hospitals and physicians and insurance companies in a real price transparent environment
  4. impose community rating with universal coverage regardless of pre-existing illness

  5. provide ownership of the first $6000 to the consumer

I would bet consumers would use their healthcare dollar wisely.

Barack Obama’s National Health Insurance Exchange is a bad idea. It will not work if passed. The fact is the plan is not hopeful. It is the opposite of Barack Obama’s message of hope. A message America dearly needs.

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

Permalink:

Where would you rather be sick?

June 18, 2006
inEMR
• Leave a comment

Stanley Feld M.D.,FACP,MACE

A few days ago I wrote about USA Today article “Study: Canadians Healthier than Americans.” The take home message of the article was socialized medicine in Canada is better that the medical system in America. I pointed out that the article had many defects in study design. The data derived from the study was poor. The study did not prove anything. It did however simply add noise to the debate.

On June 15, 2006 the Wall Street Journal published and article “Where would you rather be sick?” This article was to be the answer to the Canadian study. The article pointed out some of the defects in the Canadian study. The article then went on to state the survival rates for treating illness is far superior in the U.S than in Canada. Therefore when one becomes ill it is much better to be ill in the US under our system of healthcare than it is to get ill in Canada under their system of healthcare.

For the students of my blog, the facts in the WSJ article have nothing to do with the defects in our system. These defects must be repaired. A system that has 45 million uninsured, restricts access to care, daily creates more and more economic strain on every stakeholder in the system, and has the key element of the system (patient care and the physician patient relationships) deteriorating has problems that have to be fixed immediately.

As stated previously, we, physicians, know how to fix things that are broken better than any country on the planet. The healthcare system must learn how maintain health before complications occur. Fixing the complication absorb 80% of the healthcare dollar. Our fixing the complication of disease is what is bankrupting the system. The system has not been set up to maintain health. It is trying slowly but we are not even close.

We can not get distracted by noise or “Fooled by Randomness” fooled by random data. We must state focused as we work our way to the solution. In order to do this we “the patients and potential patients” must think critically and dismiss the noise we are exposed to daily.

The Weekend

Cecelia and I came to Boulder, to celebrate our 43rd Wedding Anniversary and Father’s Day with my two boys, Brad and Daniel, their wives, Amy and Laura and our granddaughter Sabrina. It has been a fabulous weekend. Forty three years feels like yesterday and the ride gets better each year. We are tremendously proud of our kids and their families.

Cecelia rented a PT Cruiser convertible. We drove all around Boulder like two teenagers the entire weekend. Our kids were and are great to us. Thanks for the wonderful weekend!

Thanks Brad

I want to thank Brad to plugging my blog in Feld Thoughts. You can all help by sending the blog information to you email lists and asking everyone to subscribe. When I get into “what to we do to fix the system? ", I will need as many people from all walks of life as I can get to act to repair the healthcare system.

Thanks in advance for participating and helping !

Permalink:

I love it!!

June 7, 2006
inMedicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

I love it! These are the type of comments I wanted to stimulate. My comment is below the quoted article.

Stan

Think about this too.

Richard

Many “people” are stupid and this is why a system depending on them making the choice is unacceptable.

You need to note the most recent article on health care comparisons, published recently by Mike Stobbe of the Associated Press. The article follows.

Survey
Canadians report better health

by Mike Stobbe
Associated Press

Atlanta — You can add Canadians to the list of foreigners who are healthier than Americans.
Americans are 42 percent more likely than Canadians to have diabetes, 32 percent more likely to have high blood pressure, and 12 percent more likely to have arthritis, Harvard Medical School researchers found.

Comparing Conditions

Problem Americans Canadians
________________________________________
Diabetes 6.7% 4.7%
High blood pressure 18.3% 13.9%
Arthritis 17.9% 16.0%
Obesity 21.0% 15.0%
Sedentary lifestyle 13.5% 6.5%
Smoker 17.0% 19.0%

That is according to a phone survey in which American and Canadian adults were asked about their health. Less than a month ago, other researchers reported middle-aged, white Americans are much sicker than their British counterparts.
“We’re really falling behind other nations,” said Dr. Steffie Woolhandler, a co-author of the Canadian study.
Canada’s national health insurance program is at least part of the reason for the differences found in the study, Woolhandler said. Universal coverage makes it easier for more Canadians to get disease-preventing health services, she said.
James Smith, a Rand Corp. researcher who co-authored the American-English study, disagreed. His research found that England’s national health insurance program did not explain the difference in disease rates, because even Americans with insurance were in worse health.
Woolhandler said her findings were different in at least one important respect: In the Canadian study, insured Americans and Canadians had about the same rates of disease. The uninsured Americans made the overall U.S. figures worse, she said.
The study, released Tuesday, is being published in the American Journal of Public Health. It is based on a telephone survey of about 3,500 Canadians and 5,200 U.S. residents, all 18 or older, in 2002-2003.
The results are based on what those surveyed said about their health. The researchers in the American-English study surveyed participants and also examined people and conducted lab tests on them.

I just finished a book call Fooled by Randomness by Nassim Nicholas Talas

It is a book on how to judge stock trading statistics. The subtitle is “The Hidden Role of Chance in Life and in the Markets . Telephone surveys have a gigantic selection bias. The selection bias does not flatten out with large sampling. The conclusions if forceful enough or impact full enough become the eventually become the truth in decision making. However, the evidence in this article, in reality, is observational and not randomly controlled scientific evidence.

This data would be classified at Level 4 data. It suggests a difference in health but does not prove a thing. How many Hispanics and Blacks were in the American survey as opposed to the Canadian survey? Is the survey reproducible with the same number of participants, and a controlled mix of patients? These are just a couple of the many questions that must be answered.

People are not stupid when they have enough accurate information. The challenge to our healthcare system is to provide accurate and transparent information. The patient can then make a wise choice. We must work our way through all the noise presented daily.

People also become very smart when they have some skin in the game. My goal is to teach physicians and patients how to demand both so that the facilitator stakeholders feel they have to produce to satisfy the will of the major stakeholders, the patients and the physicians.

Stanley Feld M.D.,FACP,MACE

Permalink:

And you think we have problems ?

June 6, 2006
inMedicine: Healthcare System
• Leave a comment

Stanley Feld M.D. FACP, MACE

Canada has been very proud of its government directed single party payer Healthcare System. Everyone in Canada automatically has health care coverage. The system in Canada has been compared to the American Healthcare System. The impression through the media has been that Canada’s System is what an effective healthcare system should be However, last year, the Canadian Supreme Court ruled that people of Canada should be entitled to buy private health insurance. Prior to the Supreme Court decision, a choice of private insurance was forbidden.

The headline in The National Post of Canada on Saturday June 3, 2006 read,

“51% say private care OK”.

The Supreme Court decision has brought the argument about the purchase of private healthcare insurance into public debate. A percentage of the population has been dissatisfied with the Medicare system for a long time. However, no one talked about it. In theChaoulli decision, the Supreme Court declared Quebec’s ban on private health insurance is unconstitutional.

A survey of 3,000 Canadians brought out some incredible opposing opinions. Fifty-one per cent of respondents identify with the statement “If we are unhappy with the service we receive from Medicare, we should have the right to spend our
own money to buy health care outside the public Medicare system.”

49% believe that “when it comes to health care, everyone should be equal and no one should be allowed to spend their own money to get better services.”

An overwhelming majority of respondents believe the government should focus on making the public system better so no
one feels any need to pay for private health care. This is a clear indication that there are endogenous defects in the single party payer government directed healthcare system in Canada.

The identical sentiments are prevalent in England. The Hillary Clinton “Healthcare Reform initiative”
advocated a single party payer system similar to the Canadian system. The advantages of both the Canadian system and British system were widely quoted at that time.

Why is our system and their system creating such discomfort among patients and physicians? One is supposedly a private system (United States Healthcare System) and one is a government run system (Canada). The answer is obvious to me. Each of them limits access to care.

A system that is truly market driven, and lets the patients exercise control over their choice of care would be a system that would work. If the patients were responsible for their care and had control of their own healthcare dollars the defects in the system would be their responsibility.

The answer is found in examples in the retail arena. Wal-Mart and Target have done so well because they sell quality products at a transparently affordable price. If the quality decreases or the price is too high, people will switch to a different vendor. Why has Target done better in the clothing area than Wal-Mart? Target has better quality and style at about the same price! Target figured out how to get a competitive advantage. Wal-Mart is presently redoing the clothing section of its business to compete.

People are not stupid. They know when their freedom of choice and access is restricted. When freedom is restricted the people react; hopefully our politicians respond. If things get bad enough, people will elect different representatives.