Consumer Directed Healthcare

By BENJAMIN BREWER, M.D.

With gas prices hovering around $4 a gallon, my patients are cutting back on medical care.

A 59-year-old woman decided not to have a mammogram this year. At her age, she should be screened for colon cancer, too, but she is holding off until she becomes eligible for Medicare at 65.

Despite having some medical insurance as a self-employed cleaning woman, she is pinching pennies by scrimping on preventive care. If she develops cancer of the colon or breast she won’t have saved anything. This year she is taking her chances. 
 
Rising deductibles, stiff drug co-payments and increasing prices for just about everything are forcing some hard choices about health. Care that doesn’t strike patients as critical is getting delayed. As the economy squeezes my patients, they are showing up sicker.

A patient quit smoking so he could afford gas for the 40 mile commute to work in a packaging plant. He has been living paycheck to paycheck for years and his rent just went up. I was glad that something finally motivated him to stop smoking.

The bad news was that he came to the office with severe pneumonia two days after refusing to let an E.R. doctor admit him to the hospital. My patient was afraid of the expense and all the time he would go without pay from work.

To make matters worse, he didn’t fill the antibiotic prescription he was given either. The $50 co-payment was unaffordable, he said. This is a case when an insurer would have been better off picking up the antibiotic tab to avoid a larger expense. But there’s no easy way for a doctor to override a plan’s co-pay or to let an insurer know its rules are about to make something very expensive happen.

When the patient came to see me, his condition had deteriorated. I persuaded him to let me admit him to the local hospital. He was in such bad shape that he was soon transferred to the ICU of a large medical center. His care will end up costing tens of thousands of dollars.

It was no surprise to me to read recently that claims severity and costs for health insurers took an unexpected jump this year. Many patients are not able to bear even a moderate expense to save their insurance companies the cost of major claims.

A 53-year-old patient couldn’t avoid a trip to see me when his finger was fractured in a log splitter. After X-rays and having his fingertip sutured together, the man required several trips to the office for dressing changes and monitoring for infection.

He’s been unable to work as a laborer in the month since he got hurt. With no money coming in, he’s racked up $200 in office co-payments for visits that his insurance won’t be covering. We’re carrying his balance until he can get back to work.

He isn’t the only one in arrears. As a result of lean times, accounts receivable from uninsured patients in my practice is trending up. About 5% of our patients are uninsured.

Patients are still having babies at the same rate. But elective procedures, preventive exams and compliance with prescriptions are all down.

Some of my patients are taking themselves off medications. Just last week I encountered patients who stopped their cholesterol medication and urinary incontinence medications. I’m getting fewer refill requests for E.D. drugs, like Viagra, too.

I noticed an uptick in patients canceling appointments and just not showing up over the last few weeks. More people are asking for advice over the phone and trying to avoid an office visit.

Many of our patients travel 20 or 30 miles to see us, and I think gas prices are affecting no-show and cancellation rates, particularly with low income patients.

My total number of office visits is off 5% from last year. Another indication of the slowdown is that I’m getting my nursing home rounds done. I’m pretty well caught up on my daily deluge of paperwork, too. When things are busy, I almost never get those things accomplished.

It occurred to me in an idle moment that I would be a lot busier if the $600 government stimulus checks had been spent on a basket of basic primary care services. That would have paid for 130 million people to have had most of their health needs met for a year. Instead, folks around here seem to be spending more on $4 gas.

http://online.wsj.com/article/SB121675678304374527.html?mod=2_1566_topbox

Will Giving Doctors More Money to Coordinate Care Pay Off?

By JULIE APPLEBY
July 14, 2008

States, the federal government and private insurers are experimenting with an idea to cut costs and make patients happier: Paying primary-care doctors extra money to oversee and coordinate patients’ care.

The pay boost rewards doctors who reshape their practices to recreate an era when a trusted family physician helped patients through hospitalizations, coordinated specialist care and provided routine screenings. Such efforts may save money by reducing hospitalizations, ER visits and disease.

Dubbed “medical homes,” the concept is a modern twist on an idea first promoted in the 1960s. Under most pilot projects being tested, primary-care doctors who have established medical homes will receive additional fees ranging from just a few dollars a month per patient to more than $35,000 a year per doctor from states, Medicare or other insurers.

Medicare this year will choose eight states to test whether paying primary-care doctors more per month to treat patients with chronic illnesses in medical home settings results in better care and lower costs than traditional practices.

The concept aims to change rushed doctor’s appointments and fragmented specialist care by creating patient care “teams,” which could include nurse practitioners, nutritionists or other medical staff. Medical homes also offer longer office hours, electronic medical records and same-day appointments.

The idea is that patients would turn to a trusted adviser, either the doctor or another team member, for preventive and routine care and rely on that person to help coordinate needed screenings, specialist visits and other care, says Terry McGeeney, head of TransforMED, a subsidiary of the American Academy of Family Physicians that helps doctors create such practices.

While health maintenance organizations and managed care companies aimed for such coordination, many didn’t pay doctors adequately for it, instead rewarding them financially for restricting care, says McGeeney. Under medical homes, he says, doctors won’t prevent patients from seeing specialists or ordering tests.

It’s not clear how well such plans will work. North Carolina saved $231 million in 2002-03 by setting up medical homes in its Medicaid program.

Joseph Antos, an economist at the conservative American Enterprise Institute, says no one argues with the goal, but: “If all we’re doing is rearranging the deck chairs on the medical Titanic, and spending more money, that’s clearly not something we want to do.”

The idea appeals to doctors such as Joseph Mambu, who set up his Pennsylvania practice as a medical home. They recreate “the old-fashioned doctor who has the time to get to know you,” he says. “This is our last, best hope to save primary care.”

Copyright © 2008 ABC News Internet Ventures

Study leads to debates on mandates

By Kay Lazar
Globe Staff / July 8, 2008

A long-awaited report concludes that 12 cents of every $1 paid for health insurance in Massachusetts goes toward 26 state-mandated benefits, from maternity and mental healthcare to infertility and diabetes services.

Graphic Estimated spending on mandated benefits
Statewide, the price tag is $1.3 billion a year, says the report released yesterday by the Division of Health Care Finance and Policy. It was commissioned in 2006 as part of the state’s near-universal health insurance law.

Insurers and small business groups said the findings show that mandates are helping to drive up costs, making coverage unaffordable as many businesses and workers struggle. The business groups said the mandates translate to roughly $1,300 annually per employee in a family healthcare plan.

But some mandates are also required under federal law, the report said, meaning that employers would have to offer those benefits even if the state mandates were not in place. Excluding such benefits, the report concludes that the cost of the state’s mandates would be no higher than $687 million a year, or roughly 6 cents of every $1 paid for health insurance.

State lawmakers are now considering proposals that could require employers to add more benefits, including expanded mental healthcare coverage.

“It’s getting harder and harder for both employees and employers to pay healthcare costs,” said Dr. Marylou Buyse, president of the Massachusetts Association of Health Plans, which represents most of the state’s health insurers.

“We believe there should be a moratorium on all new mandates until healthcare costs rise at the same rate as general inflation,” she said. “Right now, healthcare costs are about two to three times the rate of inflation.”

The report’s authors reviewed health studies about the various mandates and estimated that most of them are cost-effective. But they suggested that regulators may consider removing some that are not considered the standard of care, such as bone marrow transplants for treatment of breast cancer. The report also noted that just five of the mandates - maternity, mental health, home health, preventive care for children, and infertility services - account for 80 percent of the total cost of the mandated benefits.

Advocates for universal health coverage said these conclusions show that regulators and lawmakers are not going to be able to wring significant cost savings from slashing existing benefits.

“Healthcare costs are going to require serious grappling of root causes of cost inflation, which are not these mandated benefits,” said Brian Rosman, research director at Health Care for All, a nonprofit that lobbies for affordable healthcare and pushed for the state’s 2006 landmark health insurance overhaul.

The law included a moratorium on adding mandated health benefits until the state published a report detailing the costs of existing mandates. The report released yesterday effectively lifts that moratorium.

The report did not calculate the cost of mandatory prescription drug coverage, which is being phased in this year.

Small business owners say that that mandate alone is likely to boost costs by another 3 to 4 percent.

“Legislators think companies are all big businesses who can afford to pay, and that’s not true,” said Bill Vernon, state director of the National Federation of Independent Business, which represents small business owners.

Vernon said small business owners are bearing the brunt of the state mandates because most larger companies are exempt from state insurance rules under federal law.

He said healthcare costs are typically the second- or third-largest employer expense and that mandates make it tough for small companies to tailor their coverage to the benefits that would most help their employees.

“Perhaps the employees want something else, like higher pay or more 401K contributions,” he said. “It’s the [lack of] flexibility that really irritates small business owners.”

By JIM ABRAMS 

WASHINGTON (AP) — The Bush administration said Monday it will delay paying doctors for treating Medicare patients in early July to give Congress more time to block a scheduled 10.6 percent fee cut.

The move by the Centers for Medicare and Medicaid Services doesn’t block the cut, scheduled to take place Tuesday. It’s up to Congress to decide that.

But to give Congress more time to act, the agency will instruct its contractors to delay the processing of any physician or non-physician Medicare claims for health care services given during the first 10 business days of July. Claims for services received on before June 30 will be processed as usual.

CMS will not be making any payments at the 10.6 percent reduced rate until July 15, at the earliest, agency spokesman Jeff Nelligan said. The delay in processing claims probably means that claims that would have been paid in mid-July will be delayed up to a week, the agency estimates.

Another option would have been to issue on-time payments at the lower rate and pay the rest later after Congress fixes the problem.

Congress, facing the prospect of millions of angry seniors at the polls in November, will be under tremendous pressure to act quickly when it returns to Washington the week of July 7 to prevent the cuts in payments for some 600,000 doctors who treat Medicare patients. The cuts were scheduled because of a formula that requires fee cuts when spending exceeds established goals.

But Senate Republicans and the White House are in a standoff with Democrats seeking to cut subsidies to insurance companies that provide Medicare coverage to “pay for” easing the payment cuts to doctors. There’s no guarantee the standoff will be broken soon.

Lawmakers on all sides promise that if the impasse goes on and doctors receive the lower payments, they’ll get repaid retroactively through automatically reprocessed claims. That’s more difficult than it sounds, given the millions of Medicare claims that have to be processed every day. A comparable situation that occurred in early 2006 took six months to fully fix.

HHS Secretary Mike Leavitt had promised Friday that his agency “will take all steps available to the department under the law to minimize the impact on providers and beneficiaries.” On Monday, the department used its administrative tools to delay implementing the scheduled 10.6 percent cuts.

Democrats on Capitol Hill say that the administration is following existing anti-fraud rules that require a two-week delay before most Medicare payments to doctors can be paid anyway. Republicans say the real issue is processing of claims, not the payment of them.

Almost every year, Congress finds a way to block the automatic Medicare cuts. But last week the Senate fell just one vote short of the 60 needed to proceed to legislation that would have stopped the cut.

In a particularly vitriolic exchange, Democrats and Republicans blamed each other for what Dr. Nancy H. Nielsen, president of the American Medical Association, said has put the country “at the brink of a Medicare meltdown.”

“Seniors need continued access to the doctors they trust. It’s urgent that Congress make that happen,” the AMA said in ads taken out in Capitol Hill newspapers read by members of Congress and their aides.

Doctors have complained for years that Medicare payments have failed to cover rising costs.

This year, majority Democrats homed in on cutting the Medicare Advantage program, which is an ideological issue for both parties. The Bush administration and Republicans like Medicare Advantage because it lets the elderly and disabled choose to get their health benefits through private insurers rather than through traditional Medicare. Democrats argued that government payments to the insurers are too generous.

The White House warned that President Bush would be urged to veto a bill that contained cuts to Medicare Advantage.

That didn’t stop the House last Tuesday from approving the legislation 355-59, well above the margin needed to override a veto. Every Democrat supported it, and Republicans, bucking their president, voted 129-59 for it.

Associated Press writers Kevin Freking and Andrew Taylor contributed to this report.

By CARLA K. JOHNSON, Associated Press Writer

CHICAGO - Some health insurance companies rate doctors on their performance. Now doctors are turning the tables.
The American Medical Association issued its first health insurance report card at the group’s annual meeting Monday. The primary focus is on how quickly and accurately doctors get paid.

“Physicians are spending 14 percent of their total revenue to simply obtain what they’ve earned,” said Dr. William Dolan, an AMA board member.

The report card is an effort to reduce the cost of claims processing to doctors and help them as they negotiate contracts with insurance companies, he said. The report card will help patients if it reduces wasteful administrative costs, Dolan added.

The report card compares Medicare and seven national commercial health insurers on the timeliness and accuracy of claims processing. It is based on a random sample drawn from 3 million claims.

There are no grades like A, B and C, and many of the technical measures may not mean much to most patients. But business leaders and health policy makers are interested in cutting an estimated annual $210 billion in wasted administrative claims processing costs, AMA leaders said.

Four years ago, Dr. Marcy Zwelling got so frustrated with the time and cost of making sure she was paid accurately by insurers that she stopped dealing with them. She now runs a so-called “boutique” practice. Most of her patients pay her an annual fee out of their own pockets.

“The best thing is, I get to be a doctor” instead of a claims processor, said Zwelling, of Los Alamitos, Calif. She says she doesn’t make any more money than she did when she accepted insurance, but she has more time with patients.

UnitedHealthcare had the lowest rate of contract compliance, according to the AMA report. About 62 percent of medical services billed were paid by UnitedHealthcare at the contracted rate, compared with 71 percent for Aetna and 98 percent for Medicare.

UnitedHealthcare spokesman Gregory Thompson said doctors and their billing services share responsibility for prompt payment. “Data show there is often a significant lag time between when services are provided and physician claims are submitted,” he said.

He said UnitedHealthcare has improved its electronic claims systems and noted the AMA gave the company higher ratings on other measures.

Medicare performed better than the private insurers in most areas, said Dr. Lawrence Casalino, a University of Chicago health economist and former physician. Commercial insurance plans compete by promising employers that they are tough on holding down the cost of claims, he said.

“There’s no question that administrative costs for doctors and the country would be a lot lower in a single-payer system,” Casalino said in an interview after the meeting. But a market-based system has advantages of competition, choice and innovation, he said. “Are the benefits enough to justify the cost?”

Peter Lee of the Pacific Business Group on Health welcomed the report card, but said he hoped the AMA would look at a broader range of areas that would be helpful to consumers.

“Increased payments to physicians means increased premiums and increased costs in a system that is spiraling out of control,” Lee said.

Susan Pisano, a spokeswoman for America’s Health Insurance Plans, said that for claims to be processed accurately and quickly it takes two parties: insurers and doctors.

She complained that while insurance companies that rate doctors generally share the information with doctors before they make it public, the AMA did not share its report with insurers before releasing it online Monday.

In other action Monday:

• The delegates voted to lobby for legislative changes that would allow pilot studies to find out if offering financial incentives would increase the number of organs available for transplant from deceased donors. According to the AMA resolution, pilot studies involving payment are barred under the National Organ Transplantation Act.

• Delegates took a step back from endorsing programs that use undercover patients to evaluate the performance of doctors and their staffs. The delegates sent the matter back to the AMA ethics council. Doctors were concerned that these sham patients, used by some hospitals and clinics to evaluate health care performance, take time away from real patients.

___

Report Card: http://www.ama-assn.org/go/cureforclaims

By RAHUL K. PARIKH, M.D.
Published: June 10, 2008

It wasn’t the boy I had a problem with. It was his mother.
 
We had met a few months earlier, when I gave her 14-year-old son a diagnosis of mild asthma. I didn’t mind her tough questions, but her tone of voice put me on edge. She seemed suspicious, almost angry. Still, in the end I decided she was just a smart, assertive parent, and I let it go.
 
This time, she was more confrontational. She complained she had been “forced” to bring in her son for a physical because his school needed a doctor’s clearance before he could play sports. What kind of racket did we doctors have with schools? Why did she have to bring in her son when she knew he was healthy? I was taking her money for doing this?

I bit my tongue and tried to tell her why I thought they belonged here. Yes, he was probably very healthy. But an annual checkup could help him learn to take charge of his own health as he grew up, and it would give me a chance to encourage healthy choices and to get a good sense his emotional health during these challenging years. Finally, I pointed out, he was due for a tetanus booster.

She was unimpressed. “I don’t believe in preventive care,” she said. “I’ll treat him for tetanus if he needs it.”

The rest of the visit went more smoothly, mainly because Mom left the room so I could examine her son. But before they left, she again accused me of taking her money, saying I hadn’t done anything different from their previous visits. Before I could reply, her son politely confirmed that this visit had been more comprehensive.

I have had my share of difficult patients and parents. But putting up with this lady had taken more time than it was worth, and it interfered with my taking care of her son. I wasn’t sure I wanted to do it again.

I considered my options. I could be stoic, do my job and keep the boy in my practice. I could call his mother and ask her to keep her opinions to herself so I could focus on her son, though my instincts told me that this wouldn’t stop her. Finally, I could decline to see her son, and therefore her, ever again. In other words, fire my patient.

The physician-patient compact basically states that a doctor will care for a patient in exchange for compensation and that the patient will heed the doctor’s advice. Patients who disagree with their physicians, or just dislike them, are free to go elsewhere.

By the same token, this mutual contract gives a doctor the right to dismiss a patient. The most obvious reasons are failing to pay or missing multiple appointments. Refusing to adhere to treatments can lead to dismissal. So can being abusive to the medical staff.

Of course, we need to exercise this option sensibly. Doctors cannot fire a patient in dire straits like severe pain, bleeding or a life-threatening situation. And of course, we cannot refuse to see patients because of their race, age, sexual orientation and so on.

But could I fire a patient because I didn’t like his mother? Colleagues who had studied the ethics and legal issues told me that the answer wasn’t clear-cut. Obviously, I couldn’t just abandon them. Yet like a lot of legal jargon, the word “abandonment” is open to interpretation. I decided it meant that as long as I wasn’t leaving anyone out to dry with a serious, immediate medical problem, that I gave a patient reasonable notice and provided options about where to continue getting care, I was within my rights.

I thought about our conversation on the tetanus booster, when the mother said she didn’t believe in preventive care. I’m a pediatrician — prevention is in my DNA. If I accepted her view, I’d be compromising my conscience and my professional ethics. I couldn’t do that.

I wrote a letter addressed to my patient’s mother and sent by certified mail. I kept it brief: “Sometimes, a patient or family and doctor aren’t compatible. … Therefore, I will be dismissing you from my practice.” I went on to advise them how they could get a new pediatrician and told them that until they found a new doctor, I would continue to care for her child’s mild asthma.

Two weeks later, I received notice that they had gotten it. The child had signed for it, which made me feel bad because I didn’t have anything against him. Checking his chart, I saw that his mother had chosen a new pediatrician, a colleague of mine. They hadn’t seen him yet.

I considered telling my colleague about my experience. Perhaps warning him so he could remember to take extra care would help get them off to a better start. On the other hand, perhaps I would unfairly bias him against this child and his mother.

I decided to keep quiet. After all, it could have just been me. 

Rahul K. Parikh is a physician in Walnut Creek, Calif. He writes about medicine for Salon.

Check other readers comments:  http://community.nytimes.com/article/comments/2008/06/10/health/views/10case.html

A story of battling cancer and battling hospital bills.

http://cosmos.bcst.yahoo.com/up/player/popup/?rn=3906861&cl=8111503&ch=4226723&src=news

WHERE CAN I GET THE BEST PRICES ON PRESCRIPTION DRUGS?

First of all, whether you are 25, 45 or over 65, prescription costs can be a bear. Some carriers won’t cover certain drugs, some drugs haven’t been in wide spread use long enough to be approved by various carriers, some are excluded due to sheer cost….. but there is help!

There are many avenues to saving money if you don’t have a health plan that covers your particular medication needs - or if you don’t have a plan at all.

First….. doctor’s samples. Almost every prescription that a doctor can write has been given to him in sample form, by pharmaceutical reps. If nothing else, a doctor should be able to give you a two week to two month supply of samples. Some doctors have kept patients going indefinitely on samples.

Second….. ask if the prescription comes in a generic form. It is surprising how many doctors just write out the prescription for the brand name, even when there is a generic.

Third….. if you take a medication that is in a breakable tablet form, ask your doctor to write it for double your usual strength with the instructions to break it in half. The price difference between 20 and 40mgs of a drug is often less than 20%. Sometimes, there is no difference.

Fourth….. shop around! Many of the stores have those wonderful $4 generics. For the most part, the least expensive retail store I have seen for brand name is Costco. Go to www.costco.com and check out any of your prescriptions - you may be surprised by some of those rates.

Fifth….. I have never heard a horror story about prescriptions filled in Mexico but, since those factories are simply independently contracted and Canada’s are owned and operated by many of the manufacturer’s themselves, I would tend to trust Canada more…

Sixth….. Canadian mail order. For some reason, some folks think this isn’t around anymore. The only ones complaining about Canadian mail order are all the “middle men” involved in the distribution of prescription drugs who won’t get their “cut” if you buy your prescription outside the US. By the time a medication leaves the factory and gets to your drug store, it goes through about six distribution points, each with their own fee tacked on. Try www.candrugstore.com. Once on this very easy-to-use website, use Promo Code 898 and your first order will get free shipping, even if you have ordered in the past. Or call 866-444-6376 to place your order - again, reference Promo Code 898. Note: they do not, never have and never will order from China due to quality control issues.

Also, the patent on brand name drugs is only good in the US. Many of the same companies who

manufacture prescription drugs in the US make them in Canada also -  in their own facilities and

in a generic form. This is true - and the cost, ordering through Canada, is anywhere from 35% to

75% less the cost of the brand name equivalent.

Seventh….. if you are low income or simply have some really costly meds, you can contact the manufacturer directly and ask if they participate in any prescription assistance programs. Many do and none advertise this. All it takes is for you and your doctor to fill out a form and send it in. Many drugs costing in the $75 to $300 range are dispensed at little or no charge by the manufacturers.

Bear in mind, too, that many brand name and some generics, are manufactured in China, regardless of where you are buying them. There have been some recalls of prescription drugs manufactured in China that contain heparin. The Internet is a valuable tool is keeping up with this type of information. 

The above tips are for everyone - not just the over-65, the unemployed, the disabled…. everyone.

Docmos is a company I have recently founded with several other people that tackles a fundamental problem in health care:  Providers do not compete on the value (i.e., quality over cost) they deliver to the end consumer.  This, of course, creates the situation where costs can spiral out of control.   

Our company has chosen to target the radiological services industry (which cost US health care more than $100 billion last year).  Rather than competing just on quality, through our company radiology facilities will be able to compete on cost in order to attract patients.  This is fundamental change and truly a step closer to an “open market.”   Please take a look at our website, www.docmos.com, to see value proposition.

Sincerely,

Herb Singh, MD, CEO

Docmos http://www.docmos.com/

The Internet search giant’s service, Google Health, at www.google.com/health, is the latest entrant in the growing field of companies offering personal health records on the Web. Their ranks range from longtime online health services like WebMD to the software powerhouse Microsoft to start-ups like Revolution Health.

The companies all hope to capitalize eventually on the trend of increasingly seeking health information online, and the potential of Internet tools to help consumers manage their own health care and medical spending.

Google enters the field of personal health records with a leading online brand, deep pockets and a wealth of technical skills. In a two-month trial this year, the Cleveland Clinic found that its patients were eager to use the Google health records.

The pilot project, limited to 1,600 patients, was quickly oversubscribed, said C. Martin Harris, the Cleveland Clinic’s chief information officer. Dr. Harris also said that when the clinic’s online health records, introduced in 2004, were linked to the Google record the clinic’s records were used more frequently by patients. “It positioned our personal health record more into an activity that they use every day,” Dr. Harris said.

The Google record, he said, allows the user to send personal information, at the individual’s discretion, into the clinic record or to pull information from the clinic records into the Google personal file.

The ability of patients to send information, in particular, can be helpful to clinic doctors, Dr. Harris said. For example, if a person sees specialists outside the clinic and receives a drug prescription from an outside doctor, it raises the risk of harmful drug interactions. “Until now, if a patient doesn’t remember to tell me,” he said, “I don’t know about drugs prescribed outside the Cleveland Clinic system.”

In the Cleveland trial, patients apparently did not shun the Google health records because of qualms that their personal health information might not be secure if held by a large technology company.

In Google Health, as in the pilot project, the company is not selling advertisements. And what information is shared with doctors, clinics or pharmacies is controlled by the individual, said Marissa Mayer, Google’s vice president of search products.

More than two dozen companies and institutions announced that they are partners with Google Health, including Walgreens, CVS, the American Heart Association, Quest Diagnostics, Beth Israel Deaconess Medical Center and the Cleveland Clinic. The partnerships are not exclusive arrangements.

Cleveland Clinic, for example, is also talking to Microsoft. “As these online services become available, we expect to connect to them all,” Dr. Harris said.

Google Health, Ms. Mayer said, represents a “large ongoing initiative” by the company, which she said she hoped would eventually include “thousands of partners and millions of users.”

Almost Four In 10 Report Serious Financial Burden Caused By Medical Bills; 7 Percent Say Someone In Their Household Got Married So They or Their Spouse Could Get Health Benefits

For further information contact:
Craig Palosky, (202) 347-5270, cpalosky@kff.org
Kate Schoen, (650) 854-9400, kschoen@kff.org

Menlo Park, CA – Health care costs rank among Americans’ top personal economic problems, and their struggles to deal with those costs have affected both their financial well-being and their family’s health care, a new Kaiser Family Foundation poll finds.

Conducted by the Foundation’s public opinion researchers, the April poll probes into the economic concerns facing Americans and the ways they have dealt with the cost of health care.

Across a series of economic concerns, health care costs rank near the top.  Nearly three in 10 Americans (28 percent) report that they or their families have had a serious problem paying for health care and health insurance as a result of recent changes in the economy, behind paying for gas (44 percent) and about tied with getting a good-paying job or raise in pay (29 percent).  Smaller shares report serious problems paying their rent or mortgage (19 percent), dealing with credit card or other personal debt (18 percent), paying for food (18 percent) or losing money in the stock market (16 percent).

Reports of families facing serious economic problems extend up into middle-income families, with almost three in 10 (28 percent) of those earning between $30,000 and $75,000, reporting a serious problem paying for health care or health insurance as a result of recent changes in the economy.

Health care costs are also having ripple effects on family budgets.  In a separate series of questions asking about the personal economic consequences of medical bills, nearly four in 10 (37 percent) report at least one of six financial troubles over the past five years as a result of medical bills: having difficulties paying other bills (20 percent); being contacted by a collections agency (20 percent); using up all or most of their savings (17 percent); being unable to pay for basic necessities such as food, heat or housing (12 percent); borrowing money (10 percent); or declaring bankruptcy (3 percent).

“Many people view health and the economy as separate issues, but the cost of health care is a significant pocketbook issue for many families and paying for health care has become a key dimension of the public’s economic concerns,” Kaiser President and CEO Drew E. Altman said.

The poll also finds that health benefits play a key role in people’s decisions to switch jobs or stay in their current job.  Nearly a quarter (23 percent) say that, within the past year, they or a member of their household have either taken a new job or stuck with their current job (instead of taking a new one) primarily because of better health benefits.

Perhaps surprisingly, health coverage is also a factor in some people’s decisions to get married.  Among all adults, 7 percent say that, in the past year, they or someone in their household decided to get married in order to have access to their spouse’s health care benefits, or so their spouse could have access to their benefits (see Data Note: Rush to the Altar?).

The high cost of health care also caused a significant number of Americans to delay or go without medical care.  When asked about the impact of costs on their families’ health care, more than four in 10 (42 percent) say that, within the past year, they or a family member living in their household have experienced at least one of five specific consequences due to cost: put off or postponed getting needed care (29 percent); skipped a recommended medical test or treatment (24 percent); not filled a prescription (23 percent); cut pills in half or skipped doses of medicine (19 percent); or had problems getting mental health care (8 percent).

People generally are more likely to report taking these actions now than in the past – for instance, 24 percent now report skipping a recommended medical test or treatment in the past year because of the cost, up from 17 percent in 2005.

Kaiser also released the results of its April Kaiser Health Tracking Poll: Election 2008, the seventh in a series tracking voters’ views about where health care fits as an issue in the 2008 presidential election, as well as their views on potential approaches to health reform.  The latest survey finds voters are most likely to name the economy as one of the two most important issues for the candidates to discuss, followed by Iraq and health care.  The three issues rank in the same order among Democrats, Republicans and independents.  Early polls in the series have also looked at the ways health care costs contribute to voters’ concern about the economy.

The polls were designed and analyzed by public opinion researchers at the Kaiser Family Foundation. A nationally representative random sample of 2,003 adults was interviewed by telephone between April 3 and 13, 2008.  The margin of sampling error for the survey is plus or minus 3 percentage points.  For results based on subgroups, the sampling error is higher.

We are engaged in a national debate about the directions of health care reform. Many experts agree that patient-centered care and health information technology (HIT) are critical elements of our future delivery system. The 2008 Information Therapy (Ix®) Conference at the Newseum will provide a fabulous venue for a national dialog on the intersection of patient-centered care (PCC) and health information technology (HIT). Opening in early 2008 just blocks down Pennsylvania Avenue from the US Capitol, the Newseum—an interactive museum of media in celebration of the first amendment—was designed to celebrate free access to information. On June 12-13, the 7th annual Ix Conference will challenge health care leaders to seize the opportunity for enhanced patient-centered care and delivery system redesign by integrating Ix into HIT.

For the agenda and more conference details, click HERE.

Our next President will undoubtedly have their hands full.  There are several issues already on the agenda and our next President will have to hit the ground running.  That being said…  What realistic changes can the American people hope to see from the next President elect with regards to the following topics?  What issue do you feel is the most important?   
  

National Security  

Health Care

War in Iraq

Tax issues

Federal Budget

Education

 By: Jack McHugh

What follows is my personal view only, and is very much a “minority position” in the free market movement community. This plan is not my idea. It was proposed by author Charles Murray in his 2006 book, “In Our Hands: A Plan to Replace the Welfare State” (AEI Press):

For countless excellent reasons free-market defenders will bitterly oppose socializing the health care delivery system, but perhaps they should not resist socializing the cost of health care. An analogy may be seen in this nation’s system of public education.

Starting around 150 years ago, this nation made a decision that we would not allow the ability of parents to pay to determine whether or not an individual acquires an education. I believe that today we are at a similar point with health care.

We made a tragic mistake in public education back then, which was to give the government control of the delivery system in addition to giving it control of the finances. Imagine how different things would have turned out had a decision been made at the start to implement a school voucher system — the government would pay to educate every child, but the education itself would be provided by a school of a parent’s choosing. Such a system could also make sense for health care, given several prerequisites and considerations.

If:

• The “Scope of Practice/Licensure Raj” were repealed.

• Negotiable waivers of liability were made enforceable.

• Decisions were forced early in life about extraordinary end of life procedures, by requiring individuals to begin paying for this option with (expensive) insurance riders.

• Every person age 21 and older bought health insurance, spreading the cost across the entire population (given the next two components this would be neither an unenforceable imposition nor an infringement of individual freedom).

Then health care costs could be reduced and spread widely enough to allow the following:

• The cost of a health care insurance policy with a $2,500 deductible would be just $4,000 or less, with universal community rating (everyone would pay $4,000, regardless of age or prior health condition).
• This is low enough that giving a universal insurance voucher to every adult for such a policy would cost no more (or even less) than the current health care system.
• This system would be compatible with tax-advantaged HSAs. If they chose, individuals could buy additional coverage beyond the basic policy provided by the voucher, for things like extraordinary end of life care, or lower deductibles. It’s likely that the rational choice would be to stick with the basic policy, and accumulate the savings in an HSA

***Jack McHugh is senior legislative analyst for the Mackinac Center for Public Policy, a research and educational institute headquartered in Midland, Mich.

With the future of U.S. healthcare on unsteady ground, both the insured and uninsured are looking for creative ways to lower their medical expenses. This list has ideas to help you hack frustrating insurance policies, stay healthy so that you can lessen the amount of times you visit the doctor each year, and even explore alternatives like free clinics and international medicine.

 http://www.rncentral.com/nursing-library/careplans/50-easy-tips-to-lower-healthcare-expenses

A new report looks at how nine private hospitals near King/Harbor Medical Center are functioning since that county-run facility closed last August.  Downey Regional Medical Center is on that list. Not long ago, KPCC’s (89.3) Patricia Nazario toured its emergency room.

Report Looks at Impact of King/Harbor Closure

http://www.scpr.org/news/stories/2008/03/21/08_chs_report_032108.html

For the past 15 or so years,  politicians have campaigned and debated about healthcare reform.  They talk of the 45+ million people in this country that do not have health insurance and that they have a plan to “fix” it so that everyone can have it.   The numbers sound astonishing until you realize that it represents approximately 15% of the total population. The good news is that 85% of the residents in this country do have health insurance coverage! 

My father worked for a small business that did not supply health insurance coverage while my mother stayed at home to raise seven children.  They purchased family plan coverage through Blue Cross Blue Shield without government assistance. We were all relatively healthy as children and, accept for the occasional broken bone or sprained ankle, did not frequent the hospital emergency room.   The population of the United States was much less back then but the percentage of uninsured people was probably much higher than today.  The lack of health insurance coverage was never a topic of political campaigns.

As to the 15% that are not covered, are they all minors or unemployed adults?   If some of them are working for companies that do not provide health insurance coverage, there are options that do not require government intervention-medical savings accounts, flexible spending accounts and high deductible health plans.  For many it comes down to a matter of priorities, LCD TV versus Plasma TV; fast food or home-cooked food.  If they took the savings and put it into one of these accounts they would be surprised at  how quickly it grows.

Our constitution grants all citizens certain inalienable rights, however, I do not recall health insurance being one of them!!

Big-box behemoth Wal-Mart has ventured into the healthcare realm, offering low-cost, walk-in clinics in more and more of its stores every day. Although Wal-Mart medicine may not sound like a great idea at first, these clinics can bring good changes to the health care industry, like insurance-free care, eased emergency rooms, and more widespread treatments. Of course, the plan is not without its drawbacks, creating a “Wal-Mart effect” on small practitioners, as well as a race to the bottom.

Here, we’ll take a good look at some of the implications you might not have thought about.

http://www.rncentral.com/nursing-library/careplans/20-surprising-ways-wal-mart-clinics-affect-us-healthcare

By Michael Coonan
100% Service Connected Disabled Veteran
Corpsman, 1st Platoon, Alpha Co, 1/9,  3rd Marine Division 1967/68

COMMON PROBLEMS EXPERIENCED BY VETERANS AT VA HEALTH CLINICS

The following is not an exhaustive list of problems with the VA health care system.  Other veterans could surely add their experiences to more accurately reflect the scope of the problems in the VA health care system.  The veteran receiving health care from the VA health care system does not have specific lists of “Patients Rights” relating access to care and a mechanism for enforcing these rights. 
 
1)  Access to specialty health care services beyond the VA’s primary physician is frequently delayed and/or denied.  VA administrators frequently stonewall the veteran as he/she requests answers regarding access to health care questions.  

2)  There are limited or no appeal rights when the veterans are denied treatment, or the treatment has lengthy delays before receipt.

3)  The VA’s Fees Basis system and the VA’s Clinical Manager system operate in the dark without any accountability to the veterans seeking health care.

4)  Veteran Administration health care administrators and Veteran Administration clinical managers rarely (if ever) respond to questions or issues raised by veterans seeking health care.

5)  The Veterans Administration health clinic’s P & T Committee is charged with making life and death treatment decisions about health care for veterans.  This committee is not held accountable for their actions.  This committee does not have minutes for these meetings, where vital decisions are made regarding access to treatment for veterans. 

6)  The Veterans Administration’s health care system is overly complicated and not well understood by veterans or the public.  Therefore, veterans, and those caring for them, do not know how to deal with the VA system as they struggle to get health care.

7)  The Veterans Administration’s “Patient Advocate” position is not able to function as an effective, independent, advocate for veterans, because the “Advocate” works directly under the authority of the VA’s health clinic/hospital administrator.  This organizational arrangement reduces the “Advocate” to functioning much like a “toothless eunuch” as they seek to advocate for Veterans.  The title “Patient Advocate” is a misnomer. 

A)  When the Veterans Administration’s Patient Advocate represents the rights of a veteran effectively, the advocate risks losing his or her job because the nature of advocacy is to “rock the boat”. 

B)  The VA administration “Patient Advocate” cannot make the problems they find with the VA health care system public.  This limits the “Advocate’s” usefulness in becoming a positive change agent to correct problems in the VA’s health care system.  Consequently, serious problems in the VA health system are buried in the bureaucracy, with no chance for public discussion and/or reform.  Because of the inertia of the current system, VA management and clinical staff who are incompetent, neglectful and indifferent to the plight of the Veterans are able to hide in plain sight in the self-protecting VA health care bureaucracy.  

A SUGGESTION FOR MAKING THE VA HEALTH SYSTEM ACCOUNTABLE
 
1)  With no additional cost in public funds, an independent Patient Advocate/Ombudsman function in each VA clinic and hospital shall be established. This Patient Advocate/Ombudsman will be responsible to independently investigate complaints from/on behalf of veterans.

2)  At no additional cost in public funds, an independent Planning and Advisory Council at each VA hospital/health clinic will be established.  This Planning and Advisory Council shall be composed of veterans who are receiving their health care at that hospital or clinic.  The Planning and Advisory Council members shall be elected by veterans who are receiving treatment at that hospital or clinic and shall not receive any compensation except travel expenses.

3)  The current in-house Veterans Administration “Patient Advocate” function will be terminated.  The money used for this function will be transferred to the US Department of Health and Human Services to pay for new Patient Advocate/Ombudsman position.  This Patient Advocate/Ombudsman will also staff the VA clinics or hospitals independent Planning and Advisory Council.

4)  The Planning and Advisory Council for each VA clinic and/or hospital will be responsible for hiring and supervising the Patient Advocate/Ombudsman.  The Patient Advocate/Ombudsman shall not have a conflict and they shall not be a Veteran, nor related to a Veteran, nor be an employee of the VA system, nor a relative of a person who works for the VA system.  The Patient Advocate/Ombudsman shall not be eligible for employment in the VA for one year from the time they terminate as the Patient Advocate/Ombudsman.  

5)  The Patient Advocate/ Ombudsman will be responsible for accepting and investigating all complaints from veterans, or persons representing a veteran, in regards to issues relating to health care at that VA clinic or hospital, including contracted services.

6)  With written permission from the Veteran or responsible party, the Patient Advocate/Ombudsman will have access to all records generated by the Veterans Administration, or contracted agencies, in their lawful investigation of a veteran’s complaint.

7)  Complaints will be resolved at the lowest level possible.  If the complaint is determined by the Patient Advocate/Ombudsman to have merit, this complaint (with permission of the veteran or responsible party), will be moved up to the chain of command.  If the complaint is not resolved within 30 days of receipt of the complaint, (with the veteran’s or responsible party’s permission), this complaint will be brought to the VA’s Hospital or Clinic Planning and Advisory Council.  The veteran’s identity will be protected while the complaint enters the public domain.

8)  The VA’s Hospital or Clinic Planning and Advisory Council will be responsible for reviewing the budget and policy matters for their respective hospital or clinic.  The Planning and Advisory Council will have access to all budgetary, demographic, policy and procedures manuals, as well as treatment data (not confidential medical records) generated by their respective VA Hospital or Clinic. 

9)  The VA’s Hospital or Clinic Planning and Advisory Council will be responsible for writing an annual plan which includes a summary of budgetary, demographic and treatment data that includes a description of any issue which relates to problems the veterans experience with access to treatment and quality of treatment.  Their plan will be updated quarterly, based upon findings from the Patient Advocate and from the findings of the Planning and Advisory Council’s committees.  There will be on unified internet web site that includes all of the plans, reports and other documents for all VA Planning and Advisory Councils in the US.  This web site will be open to the public.

10) The VA’s Hospital and Clinic Planning and Advisory Council is responsible for developing recommendations for resolving systemic problems by recommending to the VA Administration at all levels and the Congress, reforms that will streamline the administrative costs, identify cost cutting options, while improving the quality and access to health care for all Veterans.  The reports generated by the Planning and Advisory Council will be public records and available to the public via the internet.

11) The Veterans Administration will be proscribed from creating any rule or policy that infringes upon or impairs either the Patient Advocate/Ombudsman or the VA Hospital or Clinic Planning and Advisory Council from carrying out its mandated duties.

12) The procedures/rules for operation of the VA Patient Advocate/Ombudsman position and the VA’s Hospital Planning and Advisory Council shall be developed independently from the Veterans Administration.  The Veterans Administration function in this regard is merely to review and comment, only.   

13) The funds allocated for the VA’s “Patient Advocate function, will be transferred to the US Department of Health and Human Services.  These funds will then be distributed to each state’s Protection and Advocacy Office.  These funds will then be distributed to each VA’s Hospital Planning and Advisory Council.  This arrangement will assure that the Council and Patient Advocate/Ombudsman funding is secure.  The Protection and Advocacy will have not oversight responsibilities over the VA Patient Advocate/Ombudsman nor the VA Planning and Advisory Council.

Here are some interesting stats: of the so-called 47,000,000 uninsured in the US (and I truly believe that is a bit exaggerated, but we will use those figures), please understand that uninsured does not mean uninsurable. Also, let’s please assume that those figures relate to citizens and legal residents….  Here is what I have found over the last 16 years as a high risk and hard to place specialist:

- one third of the uninsured who call me - or who I call - tell me they think someone one should pay for it. Can they get it? YES. Can they qualify for it through decent health? YES. Can they afford it? YES. Do they believe they should pay for it? NO

- one-third have the erroneous belief that since they haven’t seen sick or needed it, insurance is a waste of money and they will get it “when they need it.” I ask them if they believe they can wait till they have a car accident to get auto insurance? They usually say “that’s not the same.” Yes, it IS the same. Insurance is about covering you for a risk that hasn’t happened, not one that already has. Otherwise, no one would ever buy homeowners insurance, car insurance, travel insurance, life insurance… it’s insurance

- one-third have truly fallen through the cracks. They tend to earn a low level of income and have many health issues and their employers do not provide group coverage. Or they earn a decent