Category: Defending PPACA

Want to know the future of Obamacare? Take a look at Fort Dodge, Iowa.

 

In Fort Dodge, this is changing. UnityPoint Health (which was, until this week, named Iowa Health System) is one of the 32 Pioneer Accountable Care Organizations that volunteered to have part of their Medicare payments tethered to a set of quality metrics.

While UnityPoint has hospitals across the state, it decided to focus its ACO effort on a relatively small segment of its population to limit the health system’s exposure to the possibility of losing money on the endeavor.

“If we completely missed the mark, we knew it wouldn’t be disastrous from a financial standpoint,” UnityPoint President Bill Leaver said. “We knew it wouldn’t be overwhelming, but a good size to start with.”

The Pioneer ACOs launched Jan. 1, 2012, and for the first year, the program only required them to report quality metrics. Their payments would not yet depend on how well they met 33 measures.

The most difficult part of preparing to move to a system that pays for value rather than volume in Fort Dodge was asking doctors to rethink how they do their jobs. They would be encouraged to delegate relatively routine care, for example, to other advanced practitioners, while focusing their own work on care management.

“That is harder work than we thought,” Leaver said. “For physicians, they run the office and they’re the captain of the ship. Instead of seeing a strep patient now, you might have other people working for you that you’re going to deploy.”

Overall, Leaver describes his experience with the ACO Pioneer program as “generally positive.” What he likes most about the program is that, when the hospital gets a lump sum for each patient, it has more control over treatment. The health system can prescribe treatments that Medicare would not traditionally reimburse.

Want to know the future of Obamacare? Take a look at Fort Dodge, Iowa.

Partisanship guides American attitudes on health-care reform – DC Breaking Local News Weather Sports FOX 5 WTTG

Partisanship guides American attitudes on health-care reform 

Predictably, individual views on the law’s effects — for good or ill — also fell along party lines. Twenty-two percent of Democrats say the ACA has had an overall positive effect on their lives, compared to only 4 percent of Republicans. Similarly, 42 percent of Republicans deem the overall effect as negative, compared with 9 percent of Democrats.

“Republicans are much more likely to see negative effects of the ACA, including some effects (increased taxes or a decline in quality of care) which are almost certainly not linked to the Affordable Care Act,” Taylor said. “Democrats tend to see positive effects that [also] may be real or imagined.”

Although the poll numbers appear mixed, Ron Pollack, executive director of Families USA in Washington, D.C., believes that public attitudes will lean more toward the positive as 2014 approaches and more of the law’s key elements are enacted.

Health care for all: Expanding Medicaid would save lives, suffering and money – Pittsburgh Post-Gazette – Printer friendly

Health care for all: Expanding Medicaid would save lives, suffering and money – Pittsburgh Post-Gazette – Printer friendly

My Piece on Medicaid expansion from the P-G:

Health care for all: Expanding Medicaid would save lives, suffering and money

One of the most common questions I get asked about the new health care law concerns how expanding health insurance coverage to millions of low-income families through Medicaid will affect those who already have insurance. “What will all of those new people with access to health care do to the rest of us? Will it make it harder to get access to our doctors? Will they clog up our emergency rooms and hospitals?”
As someone whose profession takes a strong position in favor of universal access to health care, I have a hard time saying anything but, “What a great problem to have!” It turns out to not even be a problem.
Massachusetts did this many years ago, as we are being frequently reminded, and the results are in. Use of emergency rooms is down, waiting times to see a primary care doctor are essentially unchanged and there has been a vast expansion in the use of preventive services: mammograms, colon cancer screens and prenatal care, for instance. Doctors and the people of Massachusetts overwhelmingly favor continuation of their program, and they are now proceeding to the really hard part: getting costs under control. Stay tuned!
An even more interesting experiment is being conducted in Oregon via an unhappy accident. Due to a shortage of funds, Medicaid eligibility was determined by lottery, creating a natural experiment of haves and have-nots. In the first year, those who were enrolled were 70 percent more likely to have a usual source of care, were 55 percent more likely to see the same doctor over time, received 30 percent more hospital care and received 35 percent more outpatient care, and much more.
Every doctor you know can tell you stories about how the lack of access to health insurance and health care has injured a patient’s health, life, limbs, finances or all of the above. I’ve had patients who work full time in jobs that fall far short of the American dream. They get by, but they can’t afford health insurance.
There’s the cabbie who recognizes his diabetes and determines to work harder and longer so he can buy insurance before he is stricken with the label even worse than diabetes: preexisting condition! He doesn’t make it and ends up in the ICU with diabetic ketoacidosis.
There’s the construction worker who has a controllable seizure disorder that goes uncontrolled. He ends up in the ICU multiple times.
There’s the woman who stays home to care for her dying mother and loses her insurance along with her job. When she finally gets to a doctor for herself, her cancer is far advanced.
So, for me and my profession, the most expansion for the most people is a best-case scenario. But others see expanding health insurance only through a short-term budgetary lens and consider covering nearly everyone a worst case.
For one thing, this view ignores the incredible deal states get when they accept Medicaid expansion. According to the Kaiser Foundation, by 2019 Pennsylvania would add about 482,000 new enrollees; another 282,000 who are eligible but don’t know it would come into the program. That’s more than three-quarters of a million people with access to care.
Critics point to the potential cost to the state of more than a billion dollars over six years. That’s a lot of money, but the federal government would pay more than $17 billion — over 94 percent of the cost. Furthermore, the additional billion would be only 1.4 percent more than Pennsylvania’s currently scheduled spending over that period. Even in a best-case scenario, with insurance for an additional 1.1 million Pennsylvanians, this figure would rise to only 2.7 percent.
One can choose to focus on the costs to the state and federal governments, but we spend many of those dollars already on the wrong end of the care continuum. Our governments already pay for patients who cannot pay for themselves, largely by cutting big checks to hospitals.
You can take care of a lot of diabetic cabbies for a lot of years for the cost of a stay in the ICU. Just because the costs don’t show up as a line item in a government budget — it could be labeled “Exorbitant Amounts of Money for Preventable Complications and Deaths” — doesn’t mean we don’t pay them.
A frequent talking point against expanding access to health care, “You can always go to an emergency room,” is actually dead on. Literally.
The law requires emergency rooms to treat and stabilize patients even if they have no means to pay. But no emergency room does cancer screening. Or prenatal care. No emergency room manages diabetes. Or congestive heart failure. As a result, many people don’t seek treatment until they are nearly dead.
Patients forgoing care or medicines because they can’t afford them simply shifts the costs from keeping people healthy to our extremely expensive system of “rescue care.” And remember, Massachusetts’ early experience and Oregon’s current experiment are showing the benefits to the entire system of getting people taken care of before they need an ER or ICU.
Not long ago, expanding access to health care was a nonpartisan goal. As recently as 2007, a bipartisan group of U.S. senators, including Republicans Jim DeMint and Trent Lott, wrote a letter to then-President George W. Bush pointing out that our health care system was in urgent need of repair. “Further delay is unacceptable as costs continue to skyrocket, our population ages and chronic illness increases. In addition, our businesses are at a severe disadvantage when their competitors in the global market get health care for ‘free.’ “
Their No. 1 priority? “Ensure that all Americans would have affordable, quality, private health coverage, while protecting current government programs. We believe the health care system cannot be fixed without providing solutions for everyone. Otherwise, the costs of those without insurance will continue to be shifted to those who do have coverage.”
Medicaid expansion, as well of the rest of the new health care law, represents our best effort so far in reaching these once-bipartisan goals. Pennsylvanians deserve an expansion of health insurance and health care, a healthier state, a healthier workforce and to continue the journey toward my profession’s goal: excellent, affordable health care for all.
Christopher M. Hughes practices intensive care and hospice medicine in Pittsburgh and is the Pennsylvania director of Doctors for America (www.drsfor america.org).

First Published October 4, 2012 12:00 am

Let health reform do its job

Let health reform do its job

A patient loses his insurance and it puts his life at risk. Everyday stuff in America.

Health insurance is essential for living well with chronic disease, and the loss of access to care is a major cause of preventable illness and death, but it is also ultimately much more costly to society than long-term continuous primary care. As a doctor, I know how to help people. I can’t do it when I don’t see them because they cannot afford to come in. We need to shift our care to the doctor’s office and away from the expensive emergency room.

The Affordable Care Act is in the process of correcting that fatal flaw in our health care system. With the benefits for seniors including making medications more affordable and shoring up Medicare, Medicaid expansion, health insurance exchanges (that would help people like Mr. Smith), subsidies to purchase insurance and spreading of risk across large populations to make possible the ending of exclusion for pre-existing conditions, the coverage gap for patients such as mine should ultimately be a thing of the past.

Most medical organizations are supporting the ACA. Most primary physicians favor it as at least a major step toward access to health care. Those who oppose it and work to create barriers to implement it have yet to offer a reasonable alternative that would help patients such as Mr. Smith. If they have one, it is time to tell the American people what they have in mind, and if not, they should step aside and let reform do what it was designed to do.

 From Doctors for America member Ian Gilson.

The Republican ticket’s big Medicare myth

The Republican ticket’s big Medicare myth

Obama’s Medicare reform plan isn’t that hard to find. It’s largely in Title III of The Patient Protection and Affordable Care Act. The basic strategy has three components: First, figure out what “quality” in health care is. Second, figure out how to pay for quality rather than paying for volume. Third, make it easier for Medicare to quickly update itself to reflect both advances in knowledge about what quality is and how to pay for it.

And so, in Title III, you’ll find dozens of different efforts to achieve these goals. The most famous of them is Section 3403, which establishes the Independent Payment Advisory Board (IPAB). But there’s also Section 3021, which creates the Center for Medicare and Medicaid Innovation, and Section 3025, which cuts hospital reimbursements if too many of their patients are readmitted, and Section 3001, which establishes value-based purchasing for hospital services, and Section 3015, which collects data on quality, and Section 3502, which advances the medical home model.

Some of the efforts are outside Title III. The Patient-Centered Outcomes Research Institute is actually in Title VI of the law. And then there are the subsequent reforms the administration has proposed to save more money. Those can be found on pages 33-37 of the president’s 2013 budget proposal. They include expanding IPAB’s mandate such that it can change Medicare’s benefit package and setting a growth cap on Medicare of GDP+0.5 percentage points — which is, by the way, the same growth cap that Rep. Paul Ryan imposes in the latest iteration of his budget.

Incivility Is a Partner in Health Care Reform Indicates Benepath CEO | Jul 23, 2012

Incivility Is a Partner in Health Care Reform Indicates Benepath CEO | Jul 23, 2012

There is another glitch looming large in the health care system. It is called incivility. “Incivility is the latest, but not the newest, issue to come to the fore in the health care system,” Clelland Green, RHU, CEO, and president of Benepath, Pennsylvania, indicated. “It is not new, but it does seem to be getting worse over time. Medical health professionals hand it out and conversely, put up with it, so it’s a two-way street with a dead end if this keeps escalating.”

Most know incivility to be intimidating, rude, disruptive or unwanted behavior aimed at someone else. It is typically an offensive, hostile or intimidating action that charges the environment in a highly negative manner. It has always been around, but seems to be getting worse. Victims of the potshots taken at them suffer real and distressing symptoms that may include humiliation, stress, depression, anger and an inability to sleep. “Call it what you want, incivility, relational aggression, lateral violence, or call a spade a spade and say that incivility is really bullying, by a slightly nicer name, but not by much,” Green added.

Bullies exist in every walk of life and for those who have the misfortune to run across them, they find themselves on the receiving end of abnormally aggressive actions and behavior that allows the individual to get control and power over others. Bullying exits in the workplace, in groups and in individual interactions. In a medical setting, it may be one nurse bullying another, management bullying a nurse, a nurse bullying a patient and vice versa, and the list goes on.

 The hard, cold fact of incivility is that it shreds workplace morale and interferes with patient safety. This type of behavior in a medical setting is far more widespread than we may imagine. The end result of working in this kind of hostile atmosphere is lower productivity, less inclination to take the initiative and fear, anger and stress and an increase in medical malpractice.

The statistics that show that bullying in workplaces across the nation is highly prevalent, with roughly 37 percent affected by it, at least 12 percent who have seen it transpire, 45 percent whose health has been impacted by bullying and a disturbing number of 40 percent who are subjected to it, but do not report it. “As it relates to the medical health profession,” said Green, “the bottom line is civility must be present for there to be professionalism. It is just that simple. Patients do not go to hospital to be subjected to this kind of behavior or attitude. Medical professionals need to get a grip.”

The Conservative Misinformation Campaign About Obamacare Has Worked Really, Really Well | Mother Jones

The Conservative Misinformation Campaign About Obamacare Has Worked Really, Really Well | Mother Jones

Andrew Sprung draws my attention to a Kaiser quiz about Obamacare from a few months ago, and you’ll be unsurprised to learn that most Americans don’t know much about it. I put the responses into graphical form, and what’s most interesting, I think, is to look at the right side of the chart: the questions that were most frequently gotten wrong.

All of them are tied together by a single thread: they’ve been the main targets of the conservative misinformation campaign against the Affordable Care Act. The tea party folks have never spent much time talking about low-income subsidies or tax credits or Medicaid expansion or pre-existing conditions. And guess what? Most people know how the law works in those areas.1

But conservatives do spend a lot of time rabble-rousing about death panels and illegal immigrants and Medicare cuts. And they also spend a lot of time bewailing the “government takeover” of healthcare, which includes things like the public option (“a new government run insurance plan”) and a supposed mandate that small businesses will all be required to offer health insurance for their employees. Sure enough, those are the areas where misunderstanding is highest.

That’s why I disagree with Andrew that misinformation about small businesses amounts to a “foot fault” by current standards of public discourse. In a way, he’s right, of course: it’s not a major flash point and it hasn’t gotten a lot of news coverage. But there’s a reason it’s the single most misunderstood issue. The Rush/Fox/Drudge axis has been screaming about the government takeover of healthcare for three years now, and it’s sunk in. Most people believe it. That’s why, faced with a question most of them really have no idea about, their immediate reaction is to believe that, in fact, government is once again planting its jackboot directly on the necks of America’s small businesses. It’s a small issue, but it’s also a bellwether that the broader conservative misinformation campaign has burrowed very deeply into the American psyche.

AlterNet: 10 Reasons Most People Like Obamacare Once They Know What’s Really In It

AlterNet: 10 Reasons Most People Like Obamacare Once They Know What’s Really In It

There are two Affordable Care Acts. There’s the legislation passed by Congress in 2009, and then there’s the mythical Affordable Care Act – the perfidious “government takeover” decried and demagogued by so many conservatives (and quite a few liberals). The former is quite popular, the latter gets decidedly mixed reviews.

Don’t take my word for it. A recent poll by the Kaiser Family Foundation found Americans split down the middle, with 41 percent approving of the law, and 40 percent saying they didn’t like it (PDF). But then Kaiser asked about 12 specific provisions in the legislation, and found that, on average, 63 percent of respondents approved of the nuts and bolts of Obamacare. Of the 12 measures they tested, only one – the controversial mandate to carry health insurance or pay a penalty – received the approval of less than half of Americans (35 percent).

Or consider this divide: while only 12 percent of Republicans had a positive view of the law overall, 47 percent, on average, viewed its specifics favorably.

Follow the link to read the ten reasons…

Ezra Klein: No, ‘Obamacare’ isn’t ‘the largest tax increase in the history of the world’ (in one chart)

No, ‘Obamacare’ isn’t ‘the largest tax increase in the history of the world’ (in one chart)

Since the Supreme Court decision, Republicans have been calling the Affordable Care Act “the largest tax increase in the history of the world.” Politifact rates this false. Kevin Drum’s got a table of the 15 significant tax increases since 1950, and the Affordable Care Act, which amounts to a tax increase of 0.49 percent of GDP, comes in 10th. Austin Frakt took Drum’s table and made a chart:

So no, the Affordable Care Act isn’t the “biggest tax hike in history.” It’s not even the biggest tax hike in the past 60 years. Or 50 years. Or 30 years. Or 20 years.