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Will Cuts in Healthcare Save the Federal Budget?

Tuesday, December 6th, 2011

Healthcare budget and policy experts are waiting for Washington to eventually face the difficult task of finding even more savings to cut the deficit.  They anticipate that health spending — which makes up more than 20 percent of the federal budget — will be targeted.  Some healthcare leaders are already planning to redirect a debate they’re expecting in 2013.  They hope to prevent spending from being shifted from one part of the system to another.  Jack Lewin, chief executive of the American College of Cardiology, said that proposals to address the basic causes of high healthcare costs have mostly been ignored in Washington.

“We talk about them all the time, but there’s nothing that we’re doing in any of these proposals to get that done,” Lewin said.  “What we would like to get on the table that’s not there is a paradigm shift in thinking about how you control costs.”  According to Thomas Scully, a former Medicare administrator under President George W. Bush and now a senior counsel at Alston & Bird, an Atlanta-based law firm, “There’s going to be a Round Two (of cuts), but after the election, because of the economic pressures exerted by the national debt.”

Proposals include reducing payments to providers; asking beneficiaries to pay more for coverage; and raising the Medicare eligibility age.  The healthcare interests that might take another hit in 2013 want to start planning now.  Several key healthcare leaders – the majority of whom have been through other cost-cutting campaigns — say efforts to reduce spending too often transfer costs from the federal budget and individuals, insurers, doctors and hospitals.

These worries have caused “people from dramatically different quarters to start thinking about what to do to get their hands around this” and redirect the conversation, said Karen Ignagni, president of America’s Health Insurance Plans.  “I’ve been talking to a range of stakeholders about how to work together…to urge policymakers to look at what’s already out there now and build on it.”

The Patient Protection and Affordable Care Act (ACA) is one element of this debate.  Administration officials and other supporters of the law say it will help drive down costs through initiatives designed to promote primary care, emphasize on preventive medicine, study treatments to evaluate their effectiveness and rate hospitals and other providers on quality.  Other healthcare authorities counter that the law will not strongly impact costs because its reforms are small and will mature incrementally.

Additionally, the law saves money by cutting Medicare payments to hospitals and other providers; it also places some unwelcome standards on health plans.  For example, insurers cannot reject people with pre-existing conditions, must justify rate increases of 10 percent or more, and send rebates to consumers if they don’t spend a minimum of 80 percent of premiums on healthcare.

Writing in the Washington Post, Drew Altman and Larry Levitt – both with the Kaiser Family Foundation — note that “Healthcare costs are driving people into poverty.  Indeed, if the burden of healthcare expenses were not taken into account, then 10 million fewer people would have been classified as poor.  One of the biggest jumps in poverty under the new method is among people with private health insurance.  We tend to think of such people, most of whom get coverage through their jobs, as being better equipped to handle the cost of getting sick.  But even those who are insured are increasingly vulnerable to high healthcare costs, in no small part because, as costs keep rising, employers have shifted more of the burden onto workers.  The share of employees with an insurance deductible of $1,000 or more for single coverage has tripled in the past five years.  The trend is especially strong among small businesses, where half of workers faced a deductible of at least $1,000 in 2011.  For those on the edge of poverty, a big medical bill could send you over it — even if you have insurance.  The effect of healthcare costs is particularly acute for the elderly, with the proportion of seniors living in poverty increasing from nine percent under the official census measure to 16 percent under the alternative measure.  An astounding 49 percent of seniors are living at or below twice the poverty level, a threshold at which people are still considered low-income (up from 35 percent under the official method).

“It’s up to us to get really serious with the agenda so that, when the time comes after the election, we are prepared to offer serious proposals that deal with costs and that do not impair the quality of care,” said Ron Pollack, executive director of the consumer group Families USA.

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Showdown As Opposing Medicare Ads Debut

Wednesday, November 30th, 2011

A coalition of advocacy groups such as the Americans United for Change, Service Employees International Union, American Federation of State, County, the Municipal Employees and Service Employees International Union and Moveon.org recently started running a series of ads telling lawmakers not to cut Medicare benefits.  In particular, the ads target Representative Denny Rehberg (R-MT), Senator Dean Heller (R-NV) and Senator Scott Brown (R-MA).

“If you vote to cut Medicare, Representative Rehberg, I will remember it every time I visit my doctor.  I’ll remember you cut Medicare and Medicaid every time I fill my prescription,” says an elderly woman narrator in one of the ads.  “I’ll remember you cut Medicare every time I fall or get hurt. I’ll remember you protected millionaires over protecting my health. My friends will remember it, too — all of them.  Call Senator Heller.  Tell him to protect Medicare and Medicaid.”

Brian Walsh, the National Republican Senatorial Committee communications director, made light of the Democratic message, arguing that the half-trillion dollars they shifted out of Medicare to pay for healthcare reform makes their argument hollow.  “The irony of this pathetic attack ad is that in each of these three races, it’s actually the Democrat candidates who are all firmly on record supporting the $500 billion in Medicare cuts that were included in their massive healthcare overhaul,” said Walsh.  “The big labor unions funding this ad know that, but yet they are doing everything they can to mislead voters in Montana, Nevada and Massachusetts.”

In the meantime, the United States Chamber of Commerce is running commercials attacking Senators Sherrod Brown (D-OH) and Jon Tester (D-MT).  Friends of the U.S. Chamber criticize Tester for supporting “government-run healthcare” and challenges Brown on energy taxes.  The business community has been under unprecedented threat,” Rob Engstrom, part of a two-man team running the chamber’s political operation, said.  The trade group plans to break its previous political spending record — $50 million — to try to elect a more business-friendly Congress.  The Montana ad reminds viewers about Tester’s votes for “government-run healthcare” then urges voters to “call Senator Tester and tell him to stop supporting big government and start fighting for Montana’s families.”

Americans United for Change explains why it is running ads about protecting Medicare and Medicaid.  “For decades, seniors have relied on Medicare being a guaranteed benefit and those less fortunate have depended on Medicaid to provide long-term care and coverage for children.  These programs need to be strengthened to ensure they remain available for future generations, which means not gutting and decimating benefits, leaving low-income children, seniors, and people with disabilities out in the cold.  The key to making Medicare sustainable is reining in costs, not dumping more expenses onto seniors.  We are working to set the right priorities for an economically secure future while continuing to protect healthcare coverage for those who can least afford it.”

Writing for the Huffington Post, Sam Stein describes the Democratic ads as “Not exactly the most visually stimulating videos, the ads warn lawmakers that they will pay a political price for cutting Medicare or Medicaid.  That may prove to be popular politics — certainly, polls show that voters want the two healthcare programs protected — but the notion that cuts won’t ultimately be pursued is highly unlikely.  Aides on the Hill from both political parties have long agreed that there is room to trim down Medicare’s provider-side components.  Reforms to Medicaid, whether in the form of decreased help to the states or something more structural, have also been discussed.”

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ER Visits on the Rise, Thanks to Quick Treatment

Monday, October 24th, 2011

Visits to hospital emergency rooms soared to an all-time high of 136 million in 2009, according to new estimates provided by the Centers for Disease Control and Prevention (CDC).  This represents an approximately 10 percent increase from the 2008 statistic of 123.8 million.  The CDC study is one of three examinations of ER use being released at the American College of Emergency Physicians meeting.  

According to the CDC, patients under the age of 15 accounted for 21 percent of ER visits in 2009; patients between 15 and 24 made up 15 percent; patients between 25 and 44 accounted for 28 percent; patients between 45 and 64, 21 percent; and patients 65 and older, 15 percent.  Breaking visits down by gender, the CDC noted that women visited the ER at a rate of 48 visits per 100, while men had a rate of 42.   

The expected sources of payments for ER visits were private insurance, 39 percent; Medicaid or State Children’s Health Insurance Program, 29 percent; Medicare, 17 percent; other and unknown, five percent each.  Nineteen percent of ER visitors reported that they had no insurance.  The most typical reasons for visiting the ER were stomach and abdominal pain, 9.6 million; fever, 7.4 million; chest pain, 7.2 million; cough, 4.7 million; headache, four million; and shortness of breath and back symptoms, 3.7 million each.  

Physicians attributed the sharp increase to both greater demand for services and improvements that allow ERs to treat patients faster.   “With the economy, people have lost their coverage and, given the fact the emergency department is the safety net, they come to us,” said Dr. Jay Kaplan, an emergency physician at Marin General Hospital who serves on the board of the emergency physicians’ organization.  The physicians contend that it is counterproductive to discourage patients from going to the ER to save money in healthcare costs because they say it doesn’t.  “We’re efficient.  We take care of acute patients and that’s what we do well,” said Dr. Paul Kivela, managing partner of Napa Valley Emergency Medical Group, and a board member of the American College of Emergency Physicians.  

According to Dr. Michael Gerardi, an ACEP board member, he and his colleagues want comprehensive medical liability reform that includes indemnification based on recognized guidelines, caps on non-economic damages and medical courts where providers are judged by medical peers.  “In America, we sue far too often for bad outcomes and not deviations from standard of care,” Gerardi said.  “The overall anxiety of patients and the lack of acceptance that bad outcomes happen are driving costs.”  Because ERs are safety-net providers, they have become increasingly overcrowded.  One factor is the passage in 1986 of the Emergency Medical Treatment and Labor Act, which requires hospitals to provide people with emergency services, despite their inability to pay.  

It has been estimated that 13.7 percent of all emergency room visits could be treated in retail medical clinics, which are typically based in pharmacies or grocery stores.  These facilities are equipped to treat a limited number of minor conditions, such as throat infections or urinary tract infections.  An additional 13.4 percent of emergency room visits could be handled by urgent-care clinics — an independent medical facility that can handle a broader scope of problems, such as minor fractures and more serious injuries.  Urgent-care clinics typically are open on evenings and weekends, fulfilling the need for patients with occurring before or after typical physician office hours.

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Apple’s Visionary Steve Jobs Dies at Age 56

Monday, October 10th, 2011

Apple’s iconic co-founder and CEO Steve Jobs, who altered the habits of millions by reinventing computing, music and mobile phones, has died at the age of 56.  With Jobs’ passing, Apple has lost a visionary leader who inspired personal computing and products such as the iPod, iPhone and iPad.  In the world of medicine, the iPad has made a significant impact. Chilmark Research estimates that 22% of United States doctors are using iPads as of the end of 2010. A survey by Aptilon indicates that 80% of the remainder plan to buy an iPad sometime in 2011.  These innovations made Jobs one of his generation’s most significant industry leaders.  His death, following a long fight with a rare form of pancreatic cancer and a liver transplant, set off an outpouring of tributes as world leaders, business rivals and customers mourned his early death and celebrated his historic achievements.

“The world has lost a visionary.  And there may be no greater tribute to Steve’s success than the fact that much of the world learned of his passing on a device he invented,” said President Barack Obama.  Even Bill Gates, his rival at Microsoft, joined in the laments.  “For those of us lucky enough to get to work with him, it’s been an insanely great honor,” Gates said.

With a passion for minimalist design and a genius for marketing, Jobs laid the groundwork for Apple to flourish after his death, according to analysts and investors.  A college drop-out, Jobs altered technology in the late 1970s, when the Apple II became the first personal computer to gain a wide following.  He repeated his early success in 1984 with the Macintosh, which built on the breakthrough technologies developed partially at Xerox Parc to create the personal computing experience.

“Steve’s brilliance, passion and energy were the source of countless innovations that enrich and improve all of our lives. The world is immeasurably better because of Steve,” Apple said.  “His greatest love was for his wife, Laurene, and his family.  Our hearts go out to them and to all who were touched by his extraordinary gifts.”

According to Apple co-founder Steve Wozniak, “We’ve lost something we won’t get back,” he said.  “The way I see it, though, the way people love products he put so much into creating means he brought a lot of life to the world.”  Wozniak said that Jobs told him around the time he left Apple in 1985 that he had a feeling he would not live beyond the age of 40.  Because of that, “a lot of his life was focused on trying to get things done quickly,” Wozniak said.  “I think what made Apple products special was very much one person, but he left a legacy,” he said.  Wozniak hopes the company can continue to succeed despite Jobs’ death.

Computerworld raises the question “Where will that excitement come from now?”  When Jobs stepped down as CEO in August, industry analysts said that Apple, with a team of talented, creative employees, will be able to continue his tradition for ingenuity, if not all of his passion, perfectionism and energy.  “Steve’s excitement for technology will still come from Apple and from the team that Jobs carefully built that worked with him to give us the iPhone and iPad and many other successful products,” said Carolina Milanesi, a Gartner analyst.

“Jobs didn’t just change mobile phones — he reinvented them,” said Ken Dulaney, an analyst at Gartner.  “That was typical Steve.”  In another example, the iPad took user-centric values inherent in the touch-screen iPhone and larger-screen laptops, and found a useful compromise — a classic expression of Jobs’ ability to combine technological concepts, art and ideas and deliver a product that was termed “magical,” according to analysts.  “Apple, under Jobs’ leadership, focused on the user experience first and the technology second,” said Jack Gold, an analyst at J. Gold Associates.  “This focus was groundbreaking in that most tech companies were just the opposite.  Apple pioneered hiring many usability specialists, human factor engineers and designers before it was fashionable to do so.  Jobs’ vision of technology was to make a smooth intersection into our lives and our work, and that was what put Apple ahead of the pack.  He redirected engineering from technical engineering to engineering for usability.”

One question that has industry analysts abuzz is whether Apple will be able to maintain its dominant position now that Jobs is gone. Jobs’ passing and the industry’s mixed response to the recent iPhone 4S model create challenges for Apple in coming quarters,” said Neil Mawston, an analyst with Strategy Analytics.  “Industry eyes will inevitably turn to the iPad 3 launch next year to see whether Apple can continue the company’s impressive legacy of innovation created by Steve Jobs,” he said.  In a sign of deepening competition, Amazon.com recently unveiled its Kindle Fire tablet at an affordable $199 that could pose a serious threat to the iPad.  “Apple is facing a competitive firestorm from not just one company but a coalition of rivals that are trying to beat it, including some of the largest consumer electronics companies on the planet,” said Ben Wood, head of research at British mobile consultancy CCS Insight.

Writing in the Washington Post, Melissa Bell believes that one of Jobs’ longest-standing legacy will be the recognition that his illness and death are bringing to pancreatic cancer.  According to Bell, “Steve Jobs knew the art of keeping your cards close to your chest.  Though  leaks did spring from the closely guarded Apple world, Jobs was a master at unveiling his secrets only when the time was right for him.  As with his business ventures, so it was with his cancer.  Jobs ‘kept his illness behind a firewall,’ the Associated Press reported.  Apple released no more of a statement than that they lost a ‘visionary and creative genius, and the world … lost an amazing human being.’  It was not known whether Jobs died from the rare form of pancreatic cancer that plagued him for seven years, or from complications from a liver transplant two years ago.  Despite the lack of details, Jobs’ role as the very public face of Apple put his illness on display along with his products.”

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Is Getting People on Medicaid Doing More Harm Than Good?

Tuesday, July 19th, 2011

To control soaring Medicaid costs,  several states have started the new fiscal year by cutting payments to doctors, hospitals and other healthcare providers that treat the poor.  Some experts say the cuts could add to a shortage of physicians and other providers participating in Medicaid.  “Further depressing payment rates can only worsen the situation,” said Sara Rosenbaum, chair of the health policy department at George Washington University.  She says some states cutting rates — South Carolina, for example — already have acute Medicaid physician shortages.

Insurers and employers believe that cutting the rates will prompt providers to raise their prices for patients who have private insurance.  “It’s always a concern that when providers get less from Medicaid, that they will shift the costs to private insurance so families and employers pay more,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans (AHIP), the healthcare industry’s lobbyist group.

States reducing Medicaid payments to physicians are Colorado, Nebraska, Oregon and South Dakota.  Arizona, which cut rates in April, will impose another cut in October.  States reducing payments to hospitals include Colorado, Connecticut, Florida, Nebraska, New Hampshire, North Carolina, Oregon, Pennsylvania, South Carolina, Texas, Virginia and Washington.  New York cut hospital payment rates in April.  In March, California okayed a 10 percent Medicaid cut to doctors and hospitals; those reductions are pending because of a lawsuit that has not yet been resolved.

The payment cuts, which require federal approval, are part of an effort by states to cut Medicaid costs, typically the largest- or second-largest expense after education.  A joint state-federal program, Medicaid serves more than 50 million low-income and disabled Americans.  Under the provisions of the Patient Protection and Affordable Care Act (ACA), more than 16 million more people will become eligible 2014, with the federal government picking up the majority of the cost.  To lure more physicians to accept Medicaid patients, the law raises rates for primary-care physicians in 2013 and 2014 to match those paid by Medicare.  On average, states currently pay Medicaid providers approximately 72 percent of what Medicare pays.

Federal-state Medicaid costs totaled $366 billion in fiscal 2009.  The federal stimulus package gave states $100 billion to help pay their share, but that funding ended June 30, and “states are struggling,” said Laura Tobler, a policy analyst at the National Conference of State Legislatures.  The ACA does not allow states to restrict eligibility for the program.

Because of cuts in reimbursement, the Government Accounting Office (GAO) has found that fewer physicians are accepting children on Medicaid as patients.  More than 75 percent of 932 doctors surveyed by the GAO reported difficulty when referring children with public insurance for specialty care, citing an overall shortage of specialists, and different waiting lists for children receiving Medicaid or Children’s Health Insurance Program (CHIP) benefits than children covered by private insurance.  In 2010, more than 40 million children in the country received healthcare through one of the two programs which cost $79 billion in federal and state funds.  Physicians serving rural areas are more likely to accept new patients with Medicaid and CHIP than doctors in urban areas.  Rural primary-care doctors reported greater difficulty referring their Medicaid and CHIP patients to specialists than urban physicians.

Writing in Forbes, Avik Roy says that “The real problem, however, is that many physicians don’t accept Medicaid patients, primarily because Medicaid underpays them for their time and costs.  The Health Tracking Study Physician Survey found that internists are 8.5 times as likely to reject all Medicaid patients versus those with private insurance.  The New England Journal of Medicine recently published a study showing that 66 percent of Medicaid children were denied an appointment with a specialist for an urgent medical condition — such as uncontrolled asthma or seizures — compared to only 11 percent for the privately insured.  What makes this even more appalling is that we’re spending billions of dollars to take millions of children away from high-quality private insurance, and shoving them in Medicaid instead.  As Peter Suderman notes, the Congressional Budget Office has estimated that of the children who have been added to Medicaid’s sibling, the State Children’s’ Health Insurance Program (CHIP), one-quarter to one-half were adequately covered by private insurance beforehand.”

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MedPAC Seeks Reimbursement Increase

Monday, May 16th, 2011

The Medicare Payment Advisory Committee (MedPAC) has proposed that Congress raise physician payment rates for both hospital inpatient and outpatient services by one percent next year.   The independent advisory agency has also asked Congress to require the Secretary of Health and Human Resources (HHS) to adjust future payment rates to recover all over-payments resulting from documentation and coding enhancements.  Office visits, surgical procedures and therapeutic services will be covered, according to MedPAC policy analyst Cristina Boccuti.  Boccuti emphasized the “mounting frustration” from patients and providers, thanks to temporary fixes and coming reductions to the sustainable growth rate payment formula.

“The Premier healthcare alliance commends the Medicare Payment Advisory Commission for its recommendation of a full market-basket update for inpatient and outpatient Medicare payments,” said Blair Childs, Premier senior vice president of Public Affairs, a performance improvement alliance of more than 2,400 U.S. hospitals and 72,000-plus other healthcare sites using the power of collaboration to lead the transformation to high quality, cost-effective care.   “Such a recommendation signals to Congress that flat reductions in payment, rather than savings generated from delivery system reform, are imprudent given the poor state of the national economy.  MedPAC estimates that Medicare reimbursements are nearly six percent below cost, and a full market basket update is a minimum step required to ensure the continued patient access to non-profit hospitals.  Congress should consider these realities as it finalizes the historic healthcare reform legislation.”

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New Study Ranks Healthiness in the Nation’s 3,016 Counties

Tuesday, April 19th, 2011

A study led by the Robert Wood Johnson Foundation has ranked the level of healthiness in the more than 3,000 counties that comprise the United States. Conducted with the assistance of the University of Wisconsin’s Population Health Institute, the study entitled “County Health Rankings: Mobilizing Action Toward Community Health,” provides a snapshot of where America’s healthiest people live.

“This is a complicated story about what makes a community healthy and another not so healthy,” said report author Pat Remington, the associate dean for public health at the University of Wisconsin.  For example, researchers point to cities reputed for their top-quality medical centers – most notably Baltimore and Philadelphia — that ranked close to the bottom in their respective states.  “Social, economic and health habits may be at play there,” said James Marks, senior vice president and director of the foundation’s health group.

The researchers examined federal and state health-related data on 3,016 counties, according to Remington.  The information was analyzed by researchers who had created similar reports for the state of Wisconsin over the past six years.  Remington said   his group wanted to “bring it down to the ground level” by learning where strengths and weaknesses lie within individual counties.

Each county is examined in two ways:  “Health Outcomes” and “Health Factors.”  “Health Outcomes” look at a county’s disease and death rates.  The “Health Factors” rating is more complicated and examines such factors as obesity rates, smoking and alcohol use.  Socio-economic factors, such as unemployment, income and safety, also are considered in addition to access to healthcare and the local environmental.  “The ‘Health Outcomes’ rank is about current healthiness factors.  The ‘Health Factors’ rank is about where they are going — predictors of health,” Marks said.

Some of the results are eye-opening. The healthiest of Illinois’s 102 counties is Kendall, which is located next to LaSalle County, which ranked 65th.  LaSalle County, whose smoking rate is twice the national average, is home to twice as many people who can be considered to be in fair to poor health.  The divide between suburban and rural also comes into play here.  Kendall County is close enough to Chicago be almost be considered part of the metropolitan area, while LaSalle County is rural and home to many farms.  According to Dr. Remington, “Affluent suburbs tend to have higher-paying jobs, often in the cities, whereas rural communities often are dealing with loss of business.”  Rural populations also are in decline as younger and healthier people move away from places like LaSalle County to the cities where employment opportunities are more varied.  To improve the health of its citizens, LaSalle County health department officials are giving nicotine patches to smokers and educating school officials about obesity and diabetes.

“It’s hard to lead a healthy life if you don’t live in a healthy community,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation.  “The County Health Rankings are an annual check-up for communities to know how healthy they are and where they can improve.  We hope that policymakers, businesses, educators, public health departments and community residents will use the Rankings to develop solutions to help people live healthier lives.”

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2012 Budget Has Funds to Reform Medical Liability Laws

Wednesday, March 2nd, 2011

In a move that builds on the healthcare reforms contained in the Patient Protection and Affordable Care Act – and one that will make physicians very happy — President Barack Obama’s fiscal 2012 budget includes $250 million in grants over the next three years to subsidize efforts to help the states overhaul their medical liability laws. If the budget passes, the grants will be administered by the Justice Department in consultation with the Department of Health and Human Services (HHS).  As much as $100 million will be disbursed in fiscal 2012, with $50 million in each of the succeeding three years.  According to the Justice Department’s budget outline, the grants will fuel reforms that “fairly compensate patients who are harmed by negligence, reduce providers’ insurance premiums, weed out frivolous lawsuits, improve the quality of healthcare, and reduce medical costs associated with defensive medicine.”  The grants build upon $25 million in grants HHS awarded last June through the Agency for HealthCare Research and Quality safety and medical liability demonstration projects by states and health systems.

“I think the president is very serious about following up on this,” HHS Secretary Kathleen Sebelius,  whose agency would advise the Justice Department on awarding the grants, told the Senate Finance Committee.  Specific reforms might exclude caps on jury awards that the American Medical Association and Republican lawmakers have wanted for years.  At the same time, they include measures unacceptable to trial lawyers, a group that contributes heavily to Democratic candidates.

Philip K. Howard, chairman of Common Good, described the budget item as “A very significant moment for controlling healthcare costs.” Based in New York, Common Good has taken the lead in supporting special courts in which judges with healthcare backgrounds would resolve medical liability cases.  “With this budget item, President Obama is moving beyond bipartisanship and, in effect, saying that the country can no longer afford the rising healthcare costs that defensive medicine unnecessarily fuels,” Howard said.  President Obama also called for tort reform legislation in his 2011 State of the Union address.

The cost of defensive medicine to American healthcare consumers is not easy to estimate. Conservative estimates place the cost at approximately $50 billion a year.  The Obama debt commission estimated that its recommendations could save government programs $17 billion through 2020, calling for an aggressive effort to rewrite malpractice laws.

Gibson Vance, president of the American Association for Justice, described the proposal as “bad policy and bad for patients.”  The president’s proposal also got a chilly reception from congressional Republicans, who contend that he has promised more on malpractice than he has been able to deliver.  Obama initially voiced an interest in the issue during the lengthy healthcare reform debate.  He has opposed another malpractice alternative: capping the amount a patient can receive in a medical liability case.  This alternative is favored by many physicians and Republicans, but opposed by the majority of Democrats.

“These grants will help states reform their laws to pursue innovative approaches that will improve the quality of healthcare, fairly compensate patients who are harmed by negligence, reduce medical costs and liability, and protect patient safety,” said Justice Department spokeswoman Tracy Schmaler.

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A CLASS Act

Tuesday, March 1st, 2011

The Obama administration is fending off critics of the CLASS Act, a voluntary insurance program created by the Patient Protection and Affordable Care Act designed to assist individuals who require long-term care and who want to remain in their communities. Health and Human Services Secretary Kathleen Sebelius is looking into revisions to assure that the program is financially self-sustaining.  The Community Living Assistance Services and Support Act (CLASS Act), which HHS will oversee, is envisioned as providing cash benefits to be used for non-medical expenses, such as paying for a home health aide or a family member to provide care, make modifications to the home and provide special transportation needs.

Opponents to the CLASS Act, such as the Heritage Foundation’s Brian Blase, argue that the program won’t support itself and could become a burden to taxpayers.  Blase says the program is “a Ponzi scheme that transfers money from current payees to current beneficiaries.”  Some Republicans are even calling for the law’s repeal.  Sebelius disagrees, noting that her department is looking at options to make certain that doesn’t happen.  She emphasized the importance of attracting healthy, less-costly people to the program to rein in costs and said that her department is “looking at options for indexing premiums so they would rise along with benefits.”  In addition, she wants to “close loopholes” that would let people drop out of the program and then return without paying a penalty.

According to Howard Gleckman, Senior Research Associate at the Urban Institute, “A key goal of national long-term care insurance is to reduce the role of Medicaid, which today pays for more than 40 percent of all personal care for seniors and others with disabilities. While Medicaid provides a critical safety net, it also often forces the disabled into the wrong care, in the wrong place, at the wrong time.  For instance, most benefits go only to those in nursing homes, even though they are often the last place people want to live.  And to qualify, people normally are allowed to keep only a few thousand dollars of financial assets and earn only a few hundred dollars a month.”

To the extent that national long-term care insurance can cut the number of people who go broke and turn to Medicaid for help, both states and the federal government will also be winners.  Fully a third of Medicaid’s budget, or more than $100 billion a year, is spent on long-term care.  The Congressional Budget Office estimates that Medicaid will absorb a stunning one-sixth of all federal tax revenues by 2050, and is putting financial pressure on states to pay nearly 50 percent of its costs.

So, how does Congress fix the CLASS Act?  First, CLASS needs to be an insurance-only program.  http://www.sacbee.com/2011/02/14/3401075/fix-the-class-act-dont-repeal.html Congress should make personal assistance benefits available to working people with disabilities – but through a separate program.  Second, employers should be encouraged to include this insurance in their employee benefit plans.  CLASS will succeed only with significant enrollment, so Congress should add incentives that will encourage employers to interest their employees in the program.  Finally, Congress should create an independent fund to accumulate and invest CLASS premiums.  This would end the budget gimmickry that troubles deficit hawks.  More important, it would assure participants that they are buying real insurance and not just exchanging their premium dollars for government IOUs.

“Someday, perhaps, the United States will make the choice that nearly every other major developed nation in the world has already made.  And that is to create a national, mandatory, long-term care insurance system funded by some mix of taxes and premiums.  Coverage could be provided by private insurers – just as the Medicare Part D drug benefit is today – or it could be run by the government,” according to Gleckman.  “Given our current anti-government, anti-tax climate, this won’t happen any time soon.  But that doesn’t mean our long-term care needs are going away.  It costs more than $200-a-day, on average, to stay in a nursing home.  Home health aides cost $20 per hour.  And after reaching age 65, more than two out of three of us will need some long-term care before we die.  We are woefully unprepared both as families and as a society for these needs, and the problem will only get worse as 77 million baby boomers age.  Medicaid is not the answer.  Neither is repealing CLASS.”

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Michael Lee Stallard and Jason Pankau on Happiness in the Workplace

Monday, January 31st, 2011

“The life you live trains you for the life you’re going to lead.”  This is the opinion of Michael Lee Stallard and Jason Pankau, partners in E Pluribus Partners, the world’s leading experts on how rational and emotional connections can boost productivity, innovation and organizational performance in the workplace.

In a recent interview for the Alter+Care Inspire Podcasts, Stallard and Pankau cited a Gallup Poll that ranked 132 countries in terms of happiness.  The United States ranked 12th, which was lower than the Scandinavian nations of Denmark and Finland and even Costa Rica.  According to Stallard and Pankau, “If you look at what’s happening, people are working longer and harder days.  We spend the bulk of our waking lives in certain kinds of relational environments – this has an enormous impact on our happiness and ability to connect with others.”

Using a number of systems, including humanist psychologist Abraham Maslow’s hierarchy of needs, Stallard and Pankau have created a list of six universal human needs that people want to experience in the workplace.  They include:

  • Respect – When we are with people who are condescending, patronizing, passive-aggressive or who look down on us in some relational way, there is a negative emotional impact.  No one can thrive in that kind of environment, because humans need a basic level of respect in the workplace.
  • Recognition – We rely on the interactions of people around us to recharge our internal batteries.  Authentic, positive affirmation – not false – is the most effective.  Otherwise, employees are drained of energy.
  • Sense of belonging – Everyone needs people who have our backs and who are trustworthy.  These people help us live up to the values that we aspire to, support us and are with us through the ups and downs of life.
  • Autonomy – This gives us the freedom and flexibility to do our work free of bureaucratic red tape and without the presence of over-controlling personalities.  Autonomy allows us to master our tasks and assists with personal growth.
  • A challenging environment – When people are over challenged, they are stressed; conversely, people are bored when they are not challenged.  When work provides the right degree of challenge, people are so immersed in the task at hand that time flies and it is energizing.
  • Need for meaning – People typically derive meaning from work that is consistent with a mission that is important to them.  Additionally, they find meaning in the relational connections they have in the workplace; this provides a connection with their personal life.

Leading hospitals across the country recognize the need to create connections between management, physicians, nurses, staff, patients and – importantly – their families, because it positively impacts the quality of care and medical outcomes.  A primary proponent of fostering connections in healthcare environments is Herb Pardes, M.D., a psychiatrist who is president and CEO of New York-Presbyterian Hospital and New York-Presbyterian Healthcare System.  Other hospitals that are proactively creating workplace connections are the Yale New Haven Health System and the Cleveland Clinic.  To sign up for Michael Lee Stallard’s and Jason Pankau’s newsletter and receive a free digital download of their book, click here.

To listen to Michael Lee Stallard’s and Jason Pankau’s full interview on happiness in the workplace, click here.

 
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