Health Care Reform Explained Your Questions Answered By: Susan Jaffe | Source: AARP Bulletin Today | April 1, 2010 * 

 WHERE WE STAND From AARP CEO A. Barry Rand: “We are thankful for the leadership, courage and hard work Members of Congress and the President demonstrated in ensuring they followed through on their commitment to older Americans.” Read more WANT TO TAKE ACTION? HealthActionNow.org Join the movement! SEE ALSO • Get the Facts on Health Reform BREAKING NEWS • Follow us on Twitter • Fan us on Facebook Need help understanding the new health care reforms? You’re not alone. The legislation is more than 2,000 pages—longer than Tolstoy’s epic novel War and Peace—and it’s crammed with new benefits, rules, penalties and projects, spread out over years. To help you find out just what it all means to you, AARP will be answering your questions about health care reform online. E-mail your questions to HCRquestions@aarp.org.

Then check back here for the answers and information you need to know. Q. I’m over 50 and have been turned away by health insurers who either won’t sell me coverage or charge so much I can’t afford to buy it, all because of my health problems. How long do I have to wait before I can get covered? A. If you have preexisting medical conditions and have been unable to get health insurance for at least six months, you should be eligible to buy coverage through a temporary federally funded program called a “high-risk pool.”

 Under the new law, this option—expected to be available by July—will cover about 2 million men and women in your situation. Older members cannot be charged more than four times what younger members pay for this coverage, and out-of-pocket expenses are limited to $5,950 for an individual or $11,900 for a family this year. This isn’t a new idea: Many states already offer high-risk pools for their residents, but some are closed to new enrollees because of high costs.

That will change and every state will be participating, thanks to an influx of $5 billion in federal aid. How much premiums will cost to join the high-risk pool, in which hospitals and doctors will participate, and exactly what will be covered are among the key details yet to be worked out. So it’s no surprise that at this point, there isn’t a telephone number the public can call for more information. This program ends in 2014, when insurance companies will be required to sell policies to anyone, regardless of their preexisting medical conditions. Q. I’m having trouble now finding a primary care doctor. Will it be harder for me to get one when millions more people get health insurance because of this new law? A.

While 32 million people will eventually be added to the rolls of the insured, that won’t happen overnight or in one fell swoop. It will take time, and about half will be insured through state health insurance exchanges, which won’t open until 2014. But you are right—it can be hard to find a primary care doctor who will accept a new patient, especially as the nation’s population grows older and demand increases. During the health reform debate, Republican critics such as Florida Sen. George LeMieux warned that a physician shortage could undermine the entire reform effort: “It’s not health care reform if the doctor is not in,” he said. The new law addresses the shortage of primary care doctors in three basic ways.

• First, primary care doctors who treat Medicare patients will receive an extra 10 percent bonus from 2011 to 2016, and earn another small bonus if they file health care quality reports with Medicare. In addition, the law adjusts Medicare payments to reflect the variations in medical costs by geographical area, which the American Medical Association says will benefit doctors in 42 states.

The measure also raises payments for family physicians who treat patients in Medicaid, the government’s health care program for low-income people. And it reduces paperwork for doctors who treat Medicare and Medicaid patients—another sweetener to entice physicians into the programs. • The second way the law tackles the shortage is by providing incentives for doctors to go into the primary care field.

For example, it expands loan forgiveness programs to defray the cost of medical school and provides money for primary care training programs at teaching hospitals. It also provides grants to medical schools to recruit and train students who will practice medicine in rural communities.

There are similar incentives for training nurses and other medical providers, which should help ease the demand for primary care doctors. • Finally, the law encourages changes in how patients are treated by creating “accountable care organizations”—physician and other medical groups—which will be paid according to how well the patient fares, rather than the number of services provided, explained Jean Silver-Isenstadt, M.D., executive director of the National Physicians Alliance. “This means that issues that can be handled over the phone, will be, and patients won’t be required to come in for an office visit just to ensure the physician gets paid,” she said.

“This will free up valuable time for doctors to see more patients.” No one knows for sure whether bonuses and other changes will build up the supply of primary care doctors fast enough to keep pace with demand. Susan Jaffe has written about health care reform for Health Affairs and covered aging issues for the Cleveland Plain Dealer.

Recently the US Chamber of Commerce was on the hill speaking to Congress about the health care system and the impact it has on small businesses.  The Chamber called for measured a approach to health care reform.  Click on the link for more details about what happened.

uschambermagazine.com/content/090608w

Article from the NYTimes.com
By SHERYL GAY STOLBERG
 

WASHINGTON — After months of insisting he would leave the details to Congress,
President Obama has concluded that he must exert greater control over the health
care debate and is preparing an intense push for legislation that will include
speeches, town-hall-style meetings and much deeper engagement with lawmakers,
senior White House officials say.
 

Mindful of the failures of former President Bill Clinton, whose intricate
proposal for universal care collapsed on Capitol Hill 15 years ago, Mr. Obama
until now had charted a different course, setting forth broad principles and
concentrating on bringing disparate factions — doctors, insurers, hospitals,
pharmaceutical companies, labor unions — to the negotiating table.
But Mr. Obama has grown concerned that he is losing the debate over certain
policy prescriptions he favors, like a government-run insurance plan to compete
with the private sector, said one Democrat familiar with his thinking. With
Congress beginning a burst of work on the measure, top advisers say, the
president is determined to make certain the final bill bears his stamp.
“Ultimately, as happened with the recovery act, it will become President Obama’s
plan,” the White House budget director, Peter R. Orszag, said in an interview.
“I think you will see that evolution occurring over the next few weeks. We will
be weighing in more definitively, and you will see him out there.”
On Saturday, while Mr. Obama was traveling in Europe, he used his weekly radio
and Internet address to make the case that “the status quo is broken” and to set
forth his ambitious goals.
 

Broadly speaking, he wants to extend coverage to the 45 million uninsured while
lowering costs, improving quality and preserving consumer choice. His budget
includes what he called a “historic down payment” of $634 billion over 10 years,
accomplished mostly by slowing Medicare growth and limiting tax breaks for those
with high incomes.
 

“We must attack the root causes of skyrocketing health costs,” Mr. Obama said,
pointing to the Mayo Clinic in Minnesota and other institutions as among those
that offer high-quality care at low cost. “We should learn from their successes
and promote the best practices, not the most expensive ones. That’s how we’ll
achieve reform that fixes what doesn’t work and builds on what does.”
The radio address was the start of a public relations campaign coinciding with a
50-state grass-roots effort that Organizing for America, the president’s
political group, began Saturday to promote a health care overhaul. His hope is
to provide what his chief of staff, Rahm Emanuel, called “air cover” for
lawmakers to adopt his priorities. It is a gamble by the White House that Mr.
Obama can translate his approval ratings into legislative action.
“Obviously,” Mr. Emanuel said, “the president’s adoption of something makes it
easier to vote for, because he’s — let’s be honest — popular, and the public
trusts him.”
 

But as Mr. Obama wades into the details of the legislative debate — a process
that began last week when he released a letter staking out certain specific
policy positions for the first time — he will face increasingly difficult
choices and risks.

Aides say he will not dictate the fine print. “It was never his intent to come
to Congress with stone tablets,“ said his senior adviser, David Axelrod. But he
will increasingly make his preferences known.

If he embraces a tax on employee benefits, an idea he attacked when he was
running for president, he may infuriate labor and the middle class. If he
insists on a big-government plan in the image of Medicare, he could lose any
hope of Republican support and ignite an insurance industry backlash. If he does
not come up with credible ways to pay for his plan, which by some estimates
could cost more than $1 trillion over 10 years, moderate Democrats could balk.
Many Republicans are already angry over the emphasis Mr. Obama placed on the
public plan in last week’s letter. Senator Mitch McConnell, the Republican
leader, said Friday that “the key to a bipartisan bill is not to have a
government plan in the bill.”

Mr. Obama is well aware of these risks, advisers say. “This is what he is now
very focused on,“ Mr. Orszag said. “What are the key things that are
nonnegotiable? He is asking those sorts of questions: What are the drop-dead
things that we need to have in order to have some hope of addressing long-term
cost growth?”

Senator Charles E. Grassley of Iowa, the senior Republican on the Finance
Committee, recalled how Mr. Obama made a personal pledge of bipartisanship when
he and Senator Max Baucus of Montana, the committee’s Democratic chairman,
joined the president for a private lunch at the White House last month.
“I said, ‘Yeah, it’s a problem,’ ” Mr. Grassley said of the public plan, “and he
said something along the lines of, ‘If I get 85 percent of what I want with a
bipartisan vote, or 100 percent with 51 votes, all Democrat, I’d rather have it
be bipartisan.’ ”

On Friday, Mr. Grassley said he viewed the letter as “a political document, not
a policy document,” intended to shore up Democratic support while letting Mr.
Obama remain flexible.

Senator Ron Wyden, an Oregon Democrat who is a longtime proponent of revamping
health care, said Mr. Obama seemed to be wrestling with how far he could push
Congress.

“The president is very much aware that to bring about enduring change — health
care reform that lasts, gets implemented, wins the support of the American
people and does not get repealed in a couple of years — you need bipartisan
support,” said Mr. Wyden, who was among two dozen Senate Democrats who met with
Mr. Obama about health care last week. “So he’s grappling with, how do you do
that?”

Mr. Obama began taking steps to make his case early in his administration. He
convened a “fiscal summit” where health care was a major topic, followed by a
“health summit.” Not long ago, he invited industry leaders to the White House,
where they pledged to cut $2 trillion in health care costs over the next decade.
But he has been restrained in his dealings with Congress.
He has, however, shown himself willing to exercise his presidential muscle when
he thinks it is necessary. In April, Senator Kent Conrad of North Dakota, the
Budget Committee chairman, balked at the idea of having the Senate consider
health legislation under the fast-track process known as reconciliation, which
could avoid a Republican filibuster. At a private meeting, Mr. Obama pressed him
on it.

“ ‘I want to keep it on the table as an option,’ ” Mr. Conrad recalled the
president saying. Not long after that, Mr. Emanuel, the White House chief of
staff, visited Mr. Conrad on Capitol Hill. Mr. Conrad was not convinced, but
decided not to stand in the way. “The Budget Committee chairman does not top the
president of the United States,” he said.

Going forward, Mr. Emanuel said, lawmakers could expect “quiet one-on-one
discussions” with the president.

But Republicans like Mr. Grassley say that after promising to leave the
legislative process to Congress, Mr. Obama must be cautious about his words, and
about the appearance of meddling.

“He’s doing good by staying out of it as much as he is,” Mr. Grassley said.
“He’d better use kid gloves at the start.”

The Wall Street Journal
Editorial Submission
Submitted by:  Matthew Radin, Conflict Management Attorney and Mediator 
Liberty Group/ Healthtors Association
www.healthtors.com

 Electronic Medical Records

Streamlining Healthcare Processes without Streamlining Claim, Legal and Conflict Resolution Processes Will Increase Medical Malpractice Claims, Increase Costs and Drive More Physicians Out of the Practice of Medicine 

A November 2008 report from The Physicians’ Foundation says that nearly half the nation’s practicing primary care physicians—more than 150,000—will stop practicing or reduce the number of patients seen. The reasons for dissatisfaction among primary care physicians, once referred to as general practice or family doctors, include “increased time dealing with nonclinical paperwork, difficulty receiving reimbursement and burdensome government regulations.”

Doctors are leaving their practices often because of overwhelming and ever-increasing malpractice costs and ever-decreasing reimbursements.  The premiums malpractice insurers charge physicians keep increasing to keep pace with the enormous awards lawyers often seek, through settlement or a jury trial. At the same time, doctors are paid less for services because of reimbursement reductions. 

This Physicians’ Foundation report was written before the President announced his goal to digitize medical record systems in both the hospital and physician’s office.  If implementations of these systems do not address the needs of physicians, the flight of physicians from the practice of medicine can be expected to increase even further. 

Physicians need an advocate to represent their interests in these discussions.  Physicians need solutions to their primary business problem; i.e., shrinking profits.  They need solutions that will increase reimbursements and decrease costs.  With respect to Electronic Medical Records (EMRs), they need solutions that will enable the physician to pay for the EMR and use the EMR in a way that enhances physician profitability. 

Dr. Sam Bierstock, Founder of Champions in Healthcare, has been educating me about the handful of major vendors of Hospital EMR Systems and the hundreds of vendors of Physician EMR Systems … most of which do not communicate with each other. While the Hospital EMR systems are helping the hospital to enhance profitability, little is being done to help the physician.  I have interviewed several physicians who report that the incidence of medical errors in physicians offices are increasing with EMR implementations, because the EMR systems are time consuming and cumbersome to use in comparison to their paper-based counterparts.  In most cases, physicians are straddling two systems, one paper and one electronic … which, in reality is NO system at all.  Without a single comprehensive EMR and document management solution, these systems can be expected to increase, not decrease, administrative costs and malpractice risk.

Change is tough.  Let’s assume that these risks will diminish over time as the EMR systems improve and as younger, computer-savvy physicians figure out how to make them work for their offices.  We still must deal with the problem of keeping physicians in the practice of medicine over the next ten years. 

The “Four Cornerstones of Value-Driven Health Care" outlined by the United States Department of Health and Human Services (HHS)  are:

1. Support health information technology
2. Provide quality information
3. Provide pricing information
4. Promote quality and efficiency of care

In order to keep physicians in the practice of medicine, HHS should also support a companion proposed “Four Cornerstones of Value-Driven Healthcare Conflict Management.”  These proposed “Four Cornerstones” are: 

1. Support health care conflict management information technology
2. Provide quality information about health care related conflicts and the cost of medical malpractice insurance and claims 
3. Provide financial information and metrics to drive early, cost-effective resolution of claims and potential claims and reduce unnecessary litigation expense 
4. Promote quality and efficiency of claims, legal and conflict management services to reduce the overall cost of medical malpractice insurance and health insurance and reward the lawyers and mediators who help healthcare providers to achieve these goals.    

What is the alternative to a companion “Four Cornerstones of Value-Driven Healthcare Conflict Management?”  A medical malpractice litigation system that holds physicians accountable for failing to meet the appropriate “standard of care” while encouraging them to use EMRs that have “NO standards.” 

For EMR systems to work as envisioned by President Obama, we are going to need data standards and process standards that tie into the clinical standards, healthcare administration, banking and reimbursement standards, data privacy standards (e.g. HIPAA) and the standards that must be evolved for resolving healthcare related disputes.  Without such standards, every baby delivery represents the potential for a  multi-million dollar jury verdict that further plunges our healthcare system into financial ruin.  And, EMRs will only make these cases easier for a plaintiff’s attorney to prove medical malpractice (i.e., the failure to meet the appropriate “standard of care”) unless they are fully integrated with a paper-based document management and conflict management system.    

We have become all too familiar with the concepts of Managed Health Care and Health Management Organizations (HMO’s).  When are we going to have Managed Legal Care and Lawyer Management Organizations (LMO’s)?  The time has come! 

We need to avoid the jury system wherever it makes sense to do.  This can be accomplished by streamlining claim and legal processes in a way that promotes resolution through Alternative Dispute Resolution (especially Arbitration preceded by Mediation), reduces the cost of conflict resolution and promotes relationships between the patient and  provider and among the various providers involved in the patient’s care. 

Doctors and patients who are concerned about the quality of health care and minimizing medical errors and the exorbitant costs associated with medical errors (especially the cost of medical malpractice insurance and the cost of practicing defensive medicine) should be looking for insurance programs that streamline health care and claim/ legal processes in a way that enhances quality and reduces the cost of resolving conflict.    

Typically, medical malpractice defense lawyers get paid by the hour, without consideration of the quality of the result achieved.  Therefore, the lawyer who achieves an early, cost-effective resolution of a dispute loses tens of thousands of dollars that can be generated through a long and costly discovery, pre-trial and trial process.  Just like physicians, lawyers need a financial model that rewards them for achieving excellent results with a focus on quality, efficiency and client satisfaction. 

As an attorney, myself, I call on health care professionals to "Wake Up" and start taking control over their destinies, beginning with a critical examination of their planned EMR implementation and a dialogue focused on creating solutions that promote: 1.  better management of patient expectations;  2.  better communication with patients and providers (including hospitals, nursing homes, physicians and allied health providers such as nurses); 3. early identification and correction of medical errors;  4. early identification and resolution of medical malpractice claims; and 5. medical malpractice insurance programs that provide financial incentives for good EMR-focused risk reduction programs.    

We have the technology to do wonderful things in healthcare and reform the healthcare system entirely through exciting and innovative technology. We also have the technology to do wonderful things in insurance and legal care and reform the process of healthcare conflict management through exciting and innovative technology.  Without careful coordination of these technologies and practical standards that enable these technologies to share data and DOCUMENTS,  the costs of EMR systems will far outweigh their benefits. 

Matthew Radin,  Conflict Management Attorney and Mediator

The Wall Street Journal
Submitted by:
Samuel R. Bierstock, MD, BSEE
Founder & President, Champions in Healthcare, LLC www.championsinhealthcare.com
Former Chief Medical Officer, IBM Inc./ Healthlink, Inc.

 Electronic Medical Records A Great Idea That May Well Do Away With the Doctors Who Use Them

The President has announced his goal to digitalize our nation’s medical record system. If achieved, this wonderful and lofty notion would certainly reduce medical errors, increase the quality of care delivered, bring consistency of care to our citizens, reduce costs associated with delivering health care, and quite possibly drive the physicians who are supposed to use them out of business.

The buzzards are already beginning to circle.

Physicians and nurses are the most pressured of all professionals, with expectations of their performance and its unimaginable responsibilities beyond the comprehension of people who have never made life and death decisions hundreds of times a day. With every decision and action comes the risk of being held liable and losing both their profession and their assets. The very mechanics of using electronic medical records in their current state of development has complicated the lives of many clinicians who use them and have been slow in being adopted for that reason. With luck, that will change.

What few people realize is that using a computer to document every decision, every action, and the assessment of every piece of information that streams to clinicians in real time represents a major change in the way clinicians have to think and work, and an audit trail that has begun the salivation process of every malpractice attorney who has finally realized what is about to be imposed on the medical profession. An electronic medical record system can track how long a doctor looked at a document, if he or she scrolled down to read the entire thing, how long it took a doctor or nurse to respond to an alert or notification of an abnormal result, how long it took for them to answer their email, and the accuracy of their every assessment, thought and action. It can track whether their decisions and actions meet the most recent guidelines or research results in a world where thousands and thousands of new papers and research are published every week.

This may sound wonderful for those receiving care, but how many people reading this article would want to use such a system in their work knowing that their every thought and action could be audited and evaluated by others who make their living suing you for everything you own?

The President’s plan calls for rewarding physicians who purchase and install electronic medical record systems through a series of financial incentives over a period of years.

Mr. President – thanks for the thought and the money, but if you really want to see this work – call off the dogs before the kennel doors open.

Instead of pouring still more money into yet another system in an effort to eliminate its problems, get to the heart of the matter. Reduce liability premiums for physicians and hospitals that install and use electronic medical records. Protect physicians who will have their every move, thought and action auditable at the most granular level. (Personally, I might like to know that I can finish dinner or brush my teeth before responding to a real time alert that someone’s blood sugar was a little high without someone suing me because I took too long to act.) Establish standards of expectation for clinicians who will be working in a world of real time data that is delivered to them as quickly as it is generated. Place limits on what audited user-activity information can be deposed in malpractice litigation, while still providing the opportunity for those who have been victims of genuine malpractice to seek justifiable compensation. There is a middle road wherein standards and expectations of how to practice in a whole new world of real time data can be established and it must be addressed in order to allow those who use electronic medical systems to do their jobs without apprehension and fear.

We have the technology to do wonderful things in healthcare and reform the system entirely through exciting and innovative technology. Most doctors recognize the wonderful benefits that an electronic medical system can bring to the quality of care they deliver, and want to use them. But what we also need is for our physicians and nurses to be able to use these tools without fear of the foxes lurking around the henhouse looking for the tiniest of opportunities to attack. Otherwise what we will end up with is a very expensive and technologically advanced universal electronic medical record system with no doctors who want to use it, and a lot of very rich lawyers.

Sam Bierstock, MD