The Moral Healthcare Blog

Hospitals wounded by politics – Opinion – The Times-Tribune

Scranton’s three hospitals are among more than one-third of hospitals statewide that lost money in 2013. More than half of the state’s hospitals had profit margins lower than 4 percent for the year, the threshold for sustainability according to the Pennsylvania Health Care Cost Containment Council.

It’s a trend that likely will continue statewide through 2014 and beyond unless the Corbett administration abandons its politically inspired resistance to the Affordable Care Act’s expansion of Medicaid.

The losses have multiple causes, but one key driver is the rising cost of uncompensated care — treatment for patients who have no private or public insurance and cannot pay.

According to the council, known as PHC4, Pennsylvania hospitals provided more than $1 billion in uncompensated care in 2013, a 5 percent increase over 2012.

Gov. Tom Corbett foolishly has rejected a portion of the federal health care law which, in other states that have accepted it, has begun to diminish levels of uncompensated care and provide hospitals with much-needed revenue.

Under the ACA, the federal government pays 100 percent of the cost of Medicaid expansion to cover uninsured low-income workers in the first two years and covers 90 percent of the cost thereafter.

It’s an extraordinary deal for states. In Pennsylvania, it would have pumped about $17 billion into the health care economy through 2019, including about a $1.6 billion direct reduction in the amount of uncompensated care. That reduction likely would be higher because many people now receiving treatment at hospitals would have insurance enabling them to see other providers first.

Hospitals wounded by politics – Opinion – The Times-Tribune

Medicine’s Top Earners Are Not the M.D.s – NYTimes.com

THOUGH the recent release of Medicare’s physician payments cast a spotlight on the millions of dollars paid to some specialists, there is a startling secret behind America’s health care hierarchy: Physicians, the most highly trained members in the industry’s work force, are on average right in the middle of the compensation pack.
That is because the biggest bucks are currently earned not through the delivery of care, but from overseeing the business of medicine.
The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries, according to an analysis performed for The New York Times by Compdata Surveys: $584,000 on average for an insurance chief executive officer, $386,000 for a hospital C.E.O. and $237,000 for a hospital administrator, compared with $306,000 for a surgeon and $185,000 for a general doctor.

And those numbers almost certainly understate the payment gap, since top executives frequently earn the bulk of their income in nonsalary compensation. In a deal that is not unusual in the industry, Mark T. Bertolini, the chief executive of Aetna, earned a salary of about $977,000 in 2012 but a total compensation package of over $36 million, the bulk of it from stocks vested and options he exercised that year. Likewise, Ronald J. Del Mauro, a former president of Barnabas Health, a midsize health system in New Jersey, earned a salary of just $28,000 in 2012, the year he retired, but total compensation of $21.7 million.
The proliferation of high earners in the medical business and administration ranks adds to the United States’ $2.7 trillion health care bill and stands in stark contrast with other developed countries, where top-ranked hospitals have only skeleton administrative staffs and where health care workers are generally paid less. And many experts say it’s bad value for health care dollars.

Medicine’s Top Earners Are Not the M.D.s – NYTimes.com

Paper: Gov. Tom Corbett health plan would need 700 workers

HARRISBURG (AP) — Gov. Tom Corbett’s Healthy PA, an alternative to expanding Medicaid, will require the state to hire more than 700 new employees, a newspaper reported Monday.

The figure was far higher than most states have experienced and came as a surprise to some experts in public policy, The Philadelphia Inquirer said.

Most of the new hires would be caseworkers in offices scattered around the state, said Bev Mackereth, Corbett’s public welfare secretary. She said that under Pennsylvania’s system, the caseworkers do more than in some other states, including evaluating those who sign up for potential eligibility for other benefits as well.

She said in an interview Monday that Pennsylvania also trails some other states in automation, which adds to the cost.

“We’re getting there, and we’re not where other states are,” she said. “Some states have everything automated — it’s very easy for them to do.”

The newspaper said the state has estimated about 605,000 people would be newly eligible under Healthy PA. The first-year cost of the 700-plus new hires will be just over $30 million, much of it subsidized by the federal government.

Mackereth said the additional personnel costs would be more than covered by the estimated Healthy PA savings of $125 million.

The Department of Public Welfare estimates it would require even more new workers — about 1,200 of them — to expand Medicaid under the President Barack Obama’s landmark health care law.

Corbett, a Republican seeking a second term this year, is waiting to hear back from federal regulators about Healthy PA. It would use Medicaid expansion money to provide private insurance coverage for the same group of people. Those private insurers would be able to operate without some of Medicaid’s coverage rules.

Paper: Gov. Tom Corbett health plan would need 700 workers

Geisinger Health Plan enrolls more than 20,000 through Obamacare – themorningcall.com

Geisinger Health Plan, a health insurance company serving Lehigh, Northampton and 39 other Pennsylvania counties, added more than 20,000 members during the first open-enrollment period under the federal Affordable Care Act, the company announced Monday.

"We are extremely happy with the number of individuals who selected Geisinger Health Plan for their health insurance coverage," says David Brady, vice president of health care reform and commercial business development. "We felt it was important to offer individuals who were shopping on the marketplace a choice of coverage options that focused on quality and customer service. Based on our results, Pennsylvanians agreed."

Geisinger Health Plan offered 26 plans on the federal marketplace and GeisingerMarketplace.com, its private site, the company said in a statement.

Geisinger Health Plan enrolls more than 20,000 through Obamacare – themorningcall.com

Cost of Treatment May Influence Doctors – NYTimes.com

Saying they can no longer ignore the rising prices of health care, some of the most influential medical groups in the nation are recommending that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care.

The shift, little noticed outside the medical establishment but already controversial inside it, suggests that doctors are starting to redefine their roles, from being concerned exclusively about individual patients to exerting influence on how health care dollars are spent.

“We understand that we doctors should be and are stewards of the larger society as well as of the patient in our examination room,” said Dr. Lowell E. Schnipper, the chairman of a task force on value in cancer care at the American Society of Clinical Oncology.

Cost of Treatment May Influence Doctors – NYTimes.com

AMA, 51 Other Medical Organizations, oppose Gun Violence, Duh.

Letter from AMA and 51 other Medical Organizations. PDF here.

January 8, 2013

The President

The White House

1600 Pennsylvania Avenue

Washington, DC 20500

Dear Mr. President:

The undersigned medical organizations, together representing the vast majority of practicing physicians and medical students in the United States, share the nation’s grief and sadness over the recent tragic school shootings in Connecticut. As physicians, we see first-hand the devastating consequences of gun violence to victims and their families.

We offer our experience and expertise in finding workable, common sense solutions to reduce the epidemic of gun violence—indeed the overall culture of violence—in America. We also urge the nation to strengthen its commitment and resources to comprehensive access to mental health services, including screening, prevention, and treatment.

The investigation into the Connecticut shootings is still continuing, and the issues surrounding such violence are often complex and can vary significantly from case to case. Strategies for preventing gun-related tragedies must also be complex and carefully considered. The relatively easy access to the increased firepower of assault weapons, semi-automatic firearms, high-capacity magazines, and high-velocity ammunition heightens the risk of multiple gunshot wounds and severe penetrating trauma, resulting in more critical injuries and deaths. Even for those who manage to survive gun violence involving these weapons, the severity and lasting impact of their wounds, disabilities and

treatment leads to devastating consequences for families affected and society, and contributes to high medical costs for treatment and recovery. Renewing and strengthening the assault weapons ban, including banning high-capacity magazines, would be a step in the right direction.

Many of the deaths and injuries resulting from firearms are preventable. More resources are needed for safety education programs that promote more responsible use and storage of firearms. Physicians need to be able to have frank discussions with their patients and parents of patients about firearm safety issues and risks to help them safeguard their families from accidents. While the overwhelming majority of patients with mental illness are not violent, physicians and other health professionals must be trained to respond to those who have a mental illness that might make them more prone to commit violence.

Funding needs to be available for increased research on violence prevention in general, and on the epidemiology of gun-related injuries and deaths in particular, as well as to implement available evidence-based interventions. Of equal importance is providing sufficient access to mental health services. While we strongly supported the passage of the Mental Health Parity Act of 2008, unfortunately, the promise of better access to psychiatric treatment will not be a reality absent requisite federal and state funding. This effort should be combined with an education campaign that reduces the stigma of seeking mental health services.

Newtown, Connecticut has now been added to the sad litany of recent mass shootings, including Columbine, Virginia Tech, Fort Hood, Arizona, and Aurora. As we come together as a nation to mourn the most recent victims of senseless gun violence, we must make a real and lasting commitment to work together on meaningful solutions to prevent future tragedies. We stand ready to work with Congress and the Administration to make progress in protecting our communities, especially our children, from this epidemic of violence.

Sincerely,

American Medical Association

American Academy of Child and Adolescent Psychiatry

American Academy of Family Physicians

American Academy of Pain Medicine

American Academy of Pediatrics

American Academy of Urgent Care Medicine

American College of Emergency Physicians

American College of Mohs Surgery

American College of Occupational and Environmental Medicine

American College of Osteopathic Internists

American College of Phlebology

American College of Physicians

American College of Preventive Medicine

American College of Radiology

American College of Surgeons

American Congress of Obstetricians and Gynecologists

American Geriatrics Society

American Osteopathic Association

American Psychiatric Association

American Society for Clinical Pathology

American Society of Plastic Surgeons

Association of American Medical Colleges

College of American Pathologists

North American Spine Society

Renal Physicians Association

Society of Critical Care Medicine

The Society of Thoracic Surgeons

California Medical Association

Colorado Medical Society

Connecticut State Medical Society

Medical Society of Delaware

Medical Society of the District of Columbia

Illinois State Medical Society

Maine Medical Association

MedChi, The Maryland State Medical Society

Massachusetts Medical Society

Michigan State Medical Society

Minnesota Medical Association

Nebraska Medical Association

Nevada State Medical Association

Medical Society of New Jersey

New Mexico Medical Society

Oklahoma State Medical Association

Oregon Medical Association

Rhode Island Medical Society

South Dakota State Medical Association

Tennessee Medical Association

Texas Medical Association

Vermont Medical Society

Medical Society of Virginia

Washington State Medical Association

Wisconsin Medical Society

Even Critics of Safety Net Increasingly Depend on It – NYTimes.com

It speaks for itself…

LINDSTROM, Minn. — Ki Gulbranson owns a logo apparel shop, deals in jewelry on the side and referees youth soccer games. He makes about $39,000 a year and wants you to know that he does not need any help from the federal government.

He says that too many Americans lean on taxpayers rather than living within their means. He supports politicians who promise to cut government spending. In 2010, he printed T-shirts for the Tea Party campaign of a neighbor, Chip Cravaack, who ousted this region’s long-serving Democratic congressman.

Yet this year, as in each of the past three years, Mr. Gulbranson, 57, is counting on a payment of several thousand dollars from the federal government, a subsidy for working families called the earned-income tax credit. He has signed up his three school-age children to eat free breakfast and lunch at federal expense. And Medicare paid for his mother, 88, to have hip surgery twice.

Even Critics of Safety Net Increasingly Depend on It – NYTimes.com

Rand Paul Blocks Surgeon General Nominee For Saying Gun Violence Is A Public Health Threat | ThinkProgress

Rand Paul, of course, has no concept of a physician’s duty to help safeguard the health of actual people, both on an individual and population (public health) basis.

“As a physician, I am deeply concerned that he has advocated that
doctors use their position of trust to ask patients, including minors,
details about gun ownership in the home… Dr. Murthy has disqualified
himself from being Surgeon General because of his intent to use that
position to launch an attack on Americans’ right to own a firearm under
the guise of a public health and safety campaign.”

But Paul is actually out of step with most physicians. The idea that
gun violence is a danger to public health is utterly uncontroversial
among doctors’ groups, academic institutions that focus on public health, and children’s safety advocates.
Although Paul criticizes Murthy’s position that physicians and
pediatricians should ask patients about the presence of guns in their
households, the American Medical Association (AMA) adopted a resolution in 2011
officially opposing any law that bars doctors from having open
conversations about gun safety and the risks of having firearms in a
household with their patients.

In fact, just yesterday, the American Academy of Pediatrics (AAP)
issued new guidelines recommending that households with children who are
diagnosed with depression should remove guns and ammunition from their homes entirely.

Fear Mongering With Medicare – NYTimes.com

The Obama administration’s proposed cuts to Medicare Advantage plans — the private insurance plans that cover almost 30 percent of all Medicare beneficiaries — are fair and reasonable. As it happens, they are also mandated by law. Yet Republicans, sensing a campaign issue, are telling older and disabled Americans that the administration is “raiding Medicare Advantage to pay for Obamacare.” The health insurance industry, for its part, is warning that enrollees will suffer higher premiums, lower benefits and fewer choices among doctors if the cuts go into force.

Some of this could in fact happen, although the industry has cried wolf before and continues to thrive. But the key point is this: Over the past decade, enrollees in Medicare Advantage have received lots of extra benefits, thanks to unjustified federal subsidies to the insurance companies. Now they will have to do with somewhat less, unless the insurers are willing to absorb the cuts while maintaining benefits. Enrollment in these private plans, offered by companies like UnitedHealth and Humana, has more than doubled since 2006, in part because of lower premiums and extra benefits, like gym memberships, that are not included in traditional fee-for-service Medicare.

Fear Mongering With Medicare – NYTimes.com

Cabbies Hail For Health Insurance | NBC 10 Philadelphia

Getting health insurance in spite of Gov. Corbett!

About 80 percent of the nearly 5,000 taxi drivers in the city did not have insurance prior to the Affordable Care Act going into effect, said Ronald Blount, president of the Unified Taxi Workers Alliance of Pennsylvania.

"They were pretty much on their own," he said. "If a driver was hit by a drunk driver, the taxi auto insurance doesn’t cover the driver.”

"They’d be stuck with big medical bills,” added Blount, who said many drivers are plagued by “silent killers” like diabetes, high blood pressure and high cholesterol since many eat while on the go and are sitting for most of the day.

In an effort to enroll as many cabbies as possible, the TWA teamed up with two nonprofits focused on health care, Healthy Philadelphia and Get Covered America, to hold regular enrollment and information sessions.

Cabbies Hail For Health Insurance | NBC 10 Philadelphia