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  • Physicians are Not Medicine’s Top Earners October 24, 2014
    Physicians are the most highly trained members of the medical industry’s force, yet have median compensation.  The largest salaries go to the Medicrats who oversee the business of medicine. Insurance CEOs average $584,000 compared to surgeons ($306,000) or a general …
  • Health Benefits of Honey October 22, 2014
    Honey has been used as a natural sweetener long before sugar. Bees collect pollen from  plant to plant, which is passed along from bee to bee until it eventually is deposited into the honeycomb. They beat their wings to evaporate …
  • Rotten Food and the VA Hospital October 20, 2014
    by G. Keith Smith, MD Imagine for a moment that you own and operate a restaurant knowing that if you provide spoiled food and rotten service, you will subsequently make more money.  You openly employ strong-arm and intimidation tactics to …
  • Hospitals want patients to pay in advance October 17, 2014
    Hospitals are asking for payments from patients before they leave the facility so they don’t end up with unpaid bills. Knowing the costs before the procedure is important because insurance deductibles are increasing and so are procedure costs. Obamacare policies …
  • State Highlights: Mass. First To Require Health Care Price Tags; Health Disparities In Wis. October 15, 2014
    A selection of health policy stories from Massachusetts, Wisconsin, Illinois, Connecticut, California, Texas, South Dakota and Pennsylvania. WBUR: Massachusetts Becomes First State To Require Price Tags For Health Care Massachusetts has launched a new era of shopping. It began last …
  • Physicians Remove Government from Medical Equation October 13, 2014
    by Gerard Gianoli, MD Doctors in Nevada and across the country are protesting against the government’s intrusion into health care, but we aren’t voicing our concerns using bullhorns and pickets. Instead, many of the state’s 5,400 physicians are protesting silently …
  • Revolutionary Idea Could Change Medicine October 10, 2014
    For those of us who get woozy when having blood drawn for routine testing, a simple pin prick may be the blood test of the future. Elizabeth Holmes, the CEO and founder of Theranos, says that her company can run …
  • Why Accountable Care Organizations Are Failing October 8, 2014
    by Richard Amerling, MD Accountable Care Organizations (ACOs), a key piece of the Affordable Care Act (“ObamaCare”) “reform” plan, are failing because they must fail. ACOs are based on faulty assumptions, poor economics, and junk science. They would not exist …
  • Common Sense Travel Restrictions to Stop Ebola: Dr. Jane Orient October 7, 2014
    Dr. Orient appears on Cavuto – October 6, 2014
  • What Employers Can Do To Reduce The Cost Of Obamacare October 6, 2014
    The Obamacare mandate will be enforced on large employers in 2015 and small employers in 2016. Large companies who self-insure can have a plan that does not cover hospitalization, mental health care, or emergency room visits.  Small companies have to …
  • Ralph Weber Talks About Fixed Pricing – Video October 3, 2014
    You can ask the price of a procedure at a hospital, but may ask several different people before finally getting an answer. Listing set prices for procedures has lead to medical tourism. People will travel to get the price they …
  • Here’s The Thing #5 Fixed Pricing HD October 3, 2014
  • Economists Say Third-Party Payment Key to Increases in Medical Cost October 1, 2014
    The rapid increase in medical costs starting in the 1970s is commonly ascribed be market imperfections. However, federal and state governments have long suppressed the functioning of the market system in the medical industry, write Maureen Buff and Timothy Terrell, …
  • Health Insurance Exchanges Waste Taxpayer Money September 29, 2014
    Obamacare may surpass Cash for Clunkers to become the prime example of federal taxpayer resource mismanagement. For every dollar in premiums for exchange coverage, taxpayers paid 94 cents in subsidies to either enroll people or encourage them to do so. …
  • Mesothelioma: An avoidable cancer? September 26, 2014
    by Sue Redmond Did you know? Mesothelioma is an aggressive cancer that attacks the lining of the body cavity called the mesothelium (80% of which occur within the lining of the lungs). The only known cause to mesothelioma is exposure …
  • Government Healthcare is Breech of Contract September 24, 2014
    by G. Keith Smith, MD One of the smartest people I have ever met is a property and contracts lawyer, someone from whom I have gleaned countless and valuable insights over the years.  He has advised me, among other things, …
  • Dr. Alieta Eck Campaign Update September 24, 2014
    Dr. Eck http://EckForCongress.com speaks to colleagues at AAPS 71st annual meeting on September 5, 2014.
  • Is There A Provider In The House? September 22, 2014
    by Marilyn Singleton, MD, JD Physicians have a proud heritage. We can boast Dr. Benjamin Rush, a founding father, signer of the Declaration of Independence, Surgeon General of the Continental Army, and opponent of slavery. And Dr. James Derham, born …
  • From EBM to Guidelines September 20, 2014
    Richard Amerling, MD presents at the 71st Annual Meeting of the Association of American Physicians and Surgeons, September 5, 2014.
  • Flaw In Federal Software Lets Employers Offer Plans Without Hospital Benefits September 19, 2014
    A flaw in the federal calculator for certifying that insurance meets the health law’s toughest standard is leading dozens of large employers to offer plans that lack basic benefits such as hospitalization coverage, according to brokers and consultants. The calculator …

Physicians are Not Medicine’s Top Earners

doctorgroupPhysicians are the most highly trained members of the medical industry’s force, yet have median compensation.  The largest salaries go to the Medicrats who oversee the business of medicine. Insurance CEOs average $584,000 compared to surgeons ($306,000) or a general doctor ($185,000). The bulk of nonsalary compensation for administrators is from stocks and options. It is incredible that insurance executives are paid so much more than highly trained surgeons. Barnabas Health lists more than 20 vice presidents who earn over $350,000 per year. Hospitals claim that the large pay is necessary to attract those who have the expertise needed. Administrative costs are 20 to 30% of the U.S. health care bill, far higher than any other country. American insurers spent more than twice as much as any other country on administrative costs.

Doctors are growing very frustrated with all the business people interfering with the practice of medicine and are burdened by the excessive administrative costs, which are affecting the cost for medical care. Doctors are pushing back against the system: This past spring, doctors in northern Wisconsin created an ad in their local medical journal demanding widespread reforms to lower prices. This movement was started when a surgeon, Dr. Hans Rechsteiner, discovered that an appendectomy ($1700) patient was billed over $12,000. Physicians have a stressful job that they find fulfilling and want to do well for their patients – without the financial burden and regulatory headaches.

http://www.nytimes.com/2014/05/18/sunday-review/doctors-salaries-are-not-the-big-cost.html

Rosenthal, Elisabeth. “Medicine’s Top Earners Are Not the M.D.s.” Sunday Review. The New York Times, 17 May 2014. Web. 23 Oct 2014.

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Posted in Business and Medicine Tagged , , , , , , , |

Health Benefits of Honey

Honey has been used as a natural sweetener long before sugar. Bees collect pollen from  beecombplant to plant, which is passed along from bee to bee until it eventually is deposited into the honeycomb. They beat their wings to evaporate the water as it solidifies into honey. Honey can be stored indefinitely if not exposed to air or water.  There are 300 kinds of honey in America.

Honey Makes Excellent Cough Medicine – It relieves irritation in the mouth and throat providing a protective coating. Honey works as well as some over the counter cough medicines, soothing cough and other sleeping difficulties.

Honey Can Treat Wounds – Honey has antibacterial, antifungal, and antioxidant features for treating wounds. Manuka honey made from flowers of the Manuka bush has been found to destroy more than 250 strains of bacteria including MRSA, MSSA, and VRE. Manuka has extra antimicrobial qualities not found in any other honey. Honey releases hydrogen peroxide through an enzymatic process. Any type of unprocessed honey helps wounds and ulcers heal when applied topically.

Honey Improves Your Scalp – Honey diluted with warm water improves scalp conditions that cause dandruff and itching.

Honey Boosts Your Energy – If you want a quick energy boost, a spoonful of honey will work.  There are also energy bars made with honey.

sb10067340d-001Honey Reduces Allergy Symptoms – Locally produced honey contains local pollen spores. By taking a teaspoon of locally made honey each day, you can build up your immunity to the allergens.

 

Honey attracts and retains moisture, making it a great addition to personal care products.

  • Honey Hair Conditioner: Mix 1/2 cup honey with 1/4 cup olive oil. Let sit on hair for 30 minutes. Then shampoo as normal and rinse.
  • Honey Body Lotion: Mix 5 tablespoons honey, 2 tablespoons rose oil, 2 cups almond oil. Apply to dry skin.
  • Honey Almond Scrub: Mix 3 teaspoons honey, 1 teaspoon olive oil, 6.5 tablespoons crushed almonds. Rub the scrub on your face gently and rinse with warm water. Honey also fights acne if used as a face wash.

 

Not all honey is the same.  Some have 100 times more potent antibacterial activity thanhoneyJars others. More than 75% of honey in American supermarkets is so processed that it has no medicinal value, nearly void of pollen. Most of this “fake” honey is made in China. Farmers markets, co-ops, and natural stores have full, proper amount of pollen. Be sure the honey you choose is raw, unfiltered, and from a trusted source.

Honey is high in fructose, nearly 53%. Eating raw honey in moderation provides many health benefits as listed above.

http://articles.mercola.com/sites/articles/archive/2014/10/20/health-benefits-honey.aspx

Mercola MD, Joseph. “5 Things You Didn’t Know About Honey.” Health. Mercola.com, 20 Oct 2014. Web. 21 Oct 2014.

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Posted in Health (taking care of yourself) Tagged , , , , , , , |

Rotten Food and the VA Hospital

by G. Keith Smith, MD

Imagine for a moment that you own and operate a restaurant knowing that if you provide foodservicespoiled food and rotten service, you will subsequently make more money.  You openly employ strong-arm and intimidation tactics to keep any conscientious employees from revealing what is really going on in the kitchen.  Sound like a restaurant people would want to frequent?

This is the VA hospital system.  High mortality rates, patient neglect, extreme waiting lines, intimidation of wannabe whistleblowers, you have it all.  And a 17 billion dollar bonus from Washington for providing this fine service.  One of the three senators to vote against rewarding this incompetence and malevolence was Oklahoma’s own Dr. Tom Coburn, soon retiring to his plough.

Awarding more loot to the VA after the revelation of the most recent and deadly fiascos in their hospital system should come as no surprise, though, as any government program that fails only does so because not enough money was allocated in the first place, right?  Coburn, cited a 60% budget increase at the VA in the last few years to argue against the idea that a lack of loot was the trouble.  He basically said the congress was about to give the alcoholic VA another drink.  Not exactly what they need.

What they need is to not exist at all.  Any one who claims to be a fan of single payer health care or government-provided health care should tour or possibly receive their “healthcare” at a VA hospital.  Nothing could open such an individual’s mind to market alternatives any faster.  Compassion and competence doesn’t typically come from the untouchable folks who are paid the same whether they do or don’t provide compassion and competence.  If you think I am kidding, notice carefully the number of times you will see the difficulty firing someone at the VA is referenced when you read about pending reforms.

The free market destroys businesses and institutions providing the type of “care” rendered at the VA, a concept the Austrian economists refer to as “creative destruction.”  This powerful cleansing mechanism of the market allows for a better allocation of resources to those businesses or institutions that provide the products and services that people actually want.  No such mechanism exists in governmental programs.  The opposite incentive exists, rather, to generate sufficient complaints and misery, a strategy which guarantees even more taxpayer money.  Unfortunately with the disaster of the VA’s version of Obamacare, we have seen this demonstrated once again.

http://surgerycenterofoklahoma.tumblr.com/post/94001599222/poisonous-restaurants-and-the-va-hospitals

Smith MD, G. Keith. “Poisonous Restaurants and the VA Hospitals.” Blog, Aug 2014. Web. 19 Oct 2014.

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Posted in Health Care News Tagged , , , , , , , |

Hospitals want patients to pay in advance

hospital-art-toyHospitals are asking for payments from patients before they leave the facility so they don’t end up with unpaid bills. Knowing the costs before the procedure is important because insurance deductibles are increasing and so are procedure costs. Obamacare policies on the exchanges are raising premiums even quicker. If a patient cannot afford their hospital bill, payment plans and loans are available. They have the option of waiting for their insurance to process their claim. Northwestern Memorial Hospital in Chicago has a financial counseling program, and is planning to expand it to all departments in the next few years. The average deductible for an employer plan is up almost 50% from five years ago, with the most common being $5000. Receiving payments in advance improves hospitals’ profit. Uncompensated care makes up 6% of hospital expenses.

http://money.cnn.com/2014/09/29/news/economy/hospitals-deductibles-payments-patients/index.html

Luhby, Tami. “Hospitals ask patients to pay upfront.” Economy. CNN Money, 29 Sept 2014. Web. 16 Oct 2014.

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Posted in Hospital Bills Tagged , , , , , , , |

State Highlights: Mass. First To Require Health Care Price Tags; Health Disparities In Wis.

A selection of health policy stories from Massachusetts, Wisconsin, Illinois, Connecticut, California, Texas, South Dakota and Pennsylvania.

WBUR: Massachusetts Becomes First State To Require Price Tags For Health Careromneycare
Massachusetts has launched a new era of shopping. It began last week. Did you notice? Right this minute, if you have private health insurance, you can go to your health insurer’s website and find the price of everything from an office visit to an MRI to a Cesarean Section. For the first time, health care prices are public. … Then two years ago Massachusetts passed a law that pushed health insurers and hospitals to start making this once vigorously guarded information more public. Now as of October 1st, Massachusetts is the first state to require that insurers offer real time prices (Bebinger, 10/8).

Milwaukee Journal Sentinel: Wisconsin’s High Health Care Rank Hides Unequal Minority Care
Wisconsin remains one of the top states in the country for the quality of its health care system and its access to health care. But the state’s strong overall performance masks a long-standing flaw: African-Americans and Latinos are much less likely to receive the same quality of care or have the same access as whites. The disparities can be seen in the annual State Snapshots compiled by the federal Agency for Healthcare Research and Quality. The report is based on more than 100 measures of quality and access to care (Boulton, 10/7).

Modern Healthcare: Illinois Tackling Medicaid With Aggressive ACO Model
The development of Medicare and private accountable care organizations has led many states to adopt similar approaches to managing care and costs for their Medicaid populations. In Illinois, provider groups are starting one of the most aggressive state-sponsored projects in which they will eventually bear all financial risk (Herman, 10/7).

CT Mirror: Children’s Mental Health Changes Aimed At Addressing ER Crisis
Gov. Dannel P. Malloy is expected to announce a plan Wednesday to expand the services available for children and teens with significant mental health needs, a response to concerns about the growing number of young people going to — and often stuck in — emergency rooms in psychiatric crisis. The plan includes making more crisis stabilization and respite beds available for young people with mental health needs, additional funding to encourage providers to open more psychiatric residential treatment beds, and funds for additional therapeutic support for children with acute needs who live at home or in congregate care (Levin Becker, 10/7).

Los Angeles Times: Supreme Court Is Asked Again To Block Texas Law On Abortion Clinics
Because of the law, critics say more than 900,000 Texas women of reproductive age now live more than 150 miles from a licensed abortion facility. The impact is most severe among low-income women who find it hardest to travel, they said. … More than 20 years ago, the Supreme Court said states may regulate abortion to protect the health of women, but they may not put an “undue burden” on those who seek to end an early pregnancy. Justices have not yet defined what amounts to an “undue burden” on these women (Savage, 10/7).

The Associated Press: Clinic Stops Abortions After Confusion Over Ruling
The only remaining abortion clinic in Texas west of San Antonio has halted abortions following days of confusion over the interpretation of a federal court ruling, an official with the clinic said Tuesday. Gloria Martinez, administrative nurse at Hilltop Women’s Reproductive Center, said her center thought it was exempted from a rule that requires clinics to upgrade to surgical centers. State officials “called us Friday, saying that we could open, so we opened Saturday. Then they called us Saturday, around 3 in the afternoon, telling us we needed to close immediately,” Martinez said. The ruling last week by the 5th U.S. Circuit Court of Appeals allowed Texas to enforce tough restrictions that effectively close all but seven abortion facilities in the state. The ruling provided exemptions for a clinic in El Paso (Llorca, 10/7).

The Associated Press: South Dakota Measure On Doctor Choice Stirs Debate
South Dakota patients could have more choice of doctors within their health insurance networks if voters approve a ballot measure that is drawing strong opposition from the health insurance industry. The proposal on the ballot, Initiated Measure 17, seems simple enough: doctors who agree to the conditions set forth by insurers, including payments for services provided to patients, could join the insurer’s preferred providers list. Preferred providers, also known as in-network doctors, usually charge less for services than those outside the network (Cano, 10/7).

Stateline: Medicaid ADHD Treatment Under Scrutiny
Attention Deficit Hyperactivity Disorder, or ADHD, affects one in every seven school-aged children in the U.S., and between 2003 and 2011 the number of children diagnosed with the condition rose by more than 40 percent. Doctors have considerable leeway in deciding the best course of treatment for a child with the condition, no matter who is paying the bill. But children covered by Medicaid, the joint federal-state health care program for the poor, are at least 50 percent more likely to be diagnosed with the disorder. Georgia alone spends $28 million to $33 million annually on these treatments out of $2.5 billion Medicaid budget, according to the Barton Child Law and Policy Center here at Emory University. That is partly because of the toll poverty takes on kids and a lack of resources in poorer schools (Vestal, 10/8).

Sacramento Bee: Steinberg To Launch Mental Health Foundation
Outgoing [California] Senate leader Darrell Steinberg said Tuesday that after he leaves the Legislature at the end of next month he will form a foundation to work on mental-health policy issues, an area that has long been a priority for the Sacramento Democrat (Rosenhall, 10/7).

Pittsburgh Post-Gazette: Pennsylvania Regulators: Highmark Medicare Plan Violates Consent Decree
The state and UPMC say one of Highmark’s brand new Medicare Advantage products runs afoul of the recent consent decree signed by the two health giants, and both are contemplating legal action in order to have the plan nixed by state courts. The plan in question is a narrow-network “Community Blue” plan, with monthly premiums starting at $0. UPMC’s hospitals are not part of the plan’s doctor network, nor are Excela Health in Westmoreland County, Butler Health System or Washington Health System (Toland, 10/6).

San Jose Mercury News/Monterey Herald: Seaside VA Clinic Forced To Cut Back On Mental Health Services
On the campus of CSU Monterey Bay, the Department of Veterans Affairs clinic at 3401 Engineer Lane sees about 2,800 veterans a year for mental health issues, including post-traumatic stress disorder. But following the departure of two psychiatrists in July, the clinic will now require many mental health patients to use videoconferencing with out-of-county doctors and will no longer allow walk-ins, unless it is an emergency. VA spokesman Michael Hill-Jackson said it is seeking to replace the psychiatrists, who made up half the staff (Molnar, 10/7).

California Healthline: New Leaders In Legislature Plan To Include Health Care Issues On Agenda
Assembly member Toni Atkins (D-San Diego) assumed the Assembly Speaker role in May, and Sen. Kevin de León (D-Los Angeles) is expected to be named Senate pro Tem later this month. The two legislators covered a range of issues at yesterday’s Public Policy Institute of California event, moderated by PPIC president and CEO Mark Baldassare. Health care topics included Medi-Cal provider reimbursement rates and extending health care coverage to the undocumented population (Gorn, 10/7).

Boston Globe: Gubernatorial Rivals Spar Over Child Agency, Health Care
Democrat Martha Coakley and Republican Charlie Baker were more combative in their second debate, quarreling pointedly Tuesday night over the state’s troubled child protection system and spiraling health care costs (Levenson, 10/8).

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from major news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

khn_logo_lightKaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

http://www.kaiserhealthnews.org/Daily-Reports/2014/October/08/state-roundup.aspx

“State Highlights: Mass. First To Require Health Care Price Tags; Health Disparities In Wis.” Daily Reports. Kaiser Health News, 8 Oct 2014. Web. 14 Oct 2014.

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Posted in Health Care News Tagged , , , , , , |

Physicians Remove Government from Medical Equation

by Gerard Gianoli, MD

Doctors in Nevada and across the country are protesting against the government’s Image courtesy of [dream designs] FreeDigitalPhotos.net2intrusion into health care, but we aren’t voicing our concerns using bullhorns and pickets. Instead, many of the state’s 5,400 physicians are protesting silently through their practice decisions.

Having graduated from medical school 28 years ago, I have witnessed firsthand the transformation of our country’s health care system. Then, medical practice focused more on the deeply personal decisions made between doctor and patient. Today, however, bureaucrats are inserting themselves ever deeper into every aspect of health care.

Physicians across the country are responding to this evolution — and most recently the Affordable Care Act — by shielding their practices from government interference. Chief among them: Opting out of Medicare and Medicaid, transitioning to practices that don’t accept insurance, and starting “concierge” practices that charge annual fees.

All of these options ultimately serve the same purpose: They free physicians to spend more time with patients.

Consider the number of doctors opting out of or otherwise avoiding Medicare and Medicaid. In 2014, one in four physicians either refuse or are limiting the number of Medicare patients they see, according to a new study conducted by the Physicians Foundation. In recent years, a similar number of physicians simply stopped accepting Medicaid altogether. This is because of many factors, including unpredictable reimbursement rates and burdensome regulations, and more.

These ailments have become so acute that thousands of other physicians are dropping out of these government-run health care programs altogether. According to the Centers for Medicare and Medicaid Services, nearly 10,000 physicians opted out of Medicare in 2012 — a 160 percent increase from 2009. At a time when 11,000 baby boomers are turning 65 every day, this population segment can ill afford a shortage of physicians. Yet that is exactly what government intrusion into health care is causing.

Physicians are instead embracing practice models that limit government interference. This meddling can come either directly through government-paid health care — e.g., Medicare and Medicaid — or indirectly through regulations applied to private insurance policies — e.g., the Affordable Care Act.

For evidence, witness the emergence of “concierge” medicine and third-party-free practices. The first charges patients periodic membership fees; the second refuses insurance coverage altogether, thus dodging the government regulations that come with it.

The Physicians Foundation study found that fully 20 percent of physicians either practice or are planning to practice some form of concierge or third-party-free medicine. This number has doubled in only two years. No wonder: By eliminating the cumbersome insurance billing process, doctors can save an average of 40 percent in overhead expenses, leading to lower fees.

More importantly, doctors can spend more time helping patients, rather than fighting with insurers and bureaucrats on the phone.

Doctors are reacting to government intrusion into health care in other ways, too. Over the last decade, there has been a dramatic migration of physicians away from small private practices toward employed positions at larger hospital-owned medical networks.

As recently as 2008, fully 62 percent of physicians described themselves as independent practice owners. Today, that number has dwindled to just 38 percent. During that same period, the number of hospital-employed physicians surged, from 38 percent in 2008 to 53 percent in 2014.

This is a troubling trend. Hospital employment inserts yet another wedge between doctors and patients. On top of Washington’s regulatory burdens, hospitals make still greater paperwork and compliance demands. Physicians are thus dealing with multiple and compounding intrusions into the doctor-patient relationship — yet they have to accept it. Thanks to the Affordable Care Act and other bureaucratic attacks, they can’t financially survive as private practitioners.

Through all of this, doctors’ primary concern is our patients’ well-being. Yet Washington’s ever-increasing meddling limits our ability to help them. Until politicians and bureaucrats stop encroaching on the waiting room, the treatment room, and everything and everyone in between, more doctors will seek to help their patients by avoiding the government.

Gerard J. Gianoli, M.D., is a neuro-otologist who practices in Covington, La.

http://www.reviewjournal.com/opinion/doctors-subtract-government-medical-equation

Gianoli MD, Gerard J. “Doctors subtract government from medical equation.” Opinion. The Las Vegas Review-Journal, 3 Oct 2014. Web. 12 Oct 2014.

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Posted in Free market medicine Tagged , , , , , , |

Revolutionary Idea Could Change Medicine

blood-testFor those of us who get woozy when having blood drawn for routine testing, a simple pin prick may be the blood test of the future. Elizabeth Holmes, the CEO and founder of Theranos, says that her company can run hundreds of tests on a drop of blood more quickly than vials and at less cost. She developed this company because traditional blood testing is difficult, expensive, and prone to error (not to mention a cause of anxiety to some). The company’s methods are protected by dozens of patents. Their new blood tests are done at your nearest Walgreens and can have results in four hours, saving the time and money of an office visit. One drop of blood can be used for dozens of tests, rather than having separate blood drawn for each test. Theranos lists their prices online and are quite affordable. Each test is 50% of Medicare/Medicaid reimbursements. Patients also have access to their own results, so they can change their diet and lifestyle accordingly.

http://finance.yahoo.com/news/womans-revolutionary-idea-made-her-143400959.html

Loria, Kevin. “This Woman’s Revolutionary Idea Made Her A Billionaire — And Could Change Medicine.” Yahoo Finance. Yahoo, 4 Oct 2014. Web. 9 Oct 2014.

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Posted in Health Care Innovation Tagged , , , , , , , |

Why Accountable Care Organizations Are Failing

by Richard Amerling, MD

acoAccountable Care Organizations (ACOs), a key piece of the Affordable Care Act (“ObamaCare”) “reform” plan, are failing because they must fail. ACOs are based on faulty assumptions, poor economics, and junk science. They would not exist in a truly free market, and are best viewed as a product of government central planners and crony capitalism.

I first characterized ACOs about a year ago as little more than HMOs with lipstick in response to a report on the poor performance of the 32 pioneer ACOs. Now comes news that three more of the original groups will jump ship, leaving only 19 of the original 32 still on board. A nearly 50 percent attrition rate should be seen as a death knell for the concept, as these were likely the best of the best, and the inducements most generous. Reasonable people would head back to the drawing board. But we are dealing with government bureaucrats, health policy wonks, and administrators. They will damn the torpedoes and push on at flank speed.

What is wrong with the ACO model? Pretty much everything. The idea that an organization with control over health care dollars will be able to improve actual hard outcomes (as opposed to secondary endpoint numbers) is a collective fantasy. Keeping patients healthy and out of hospitals is already the goal of all physicians I know. The only problems we encounter in collaborating are those imposed by federal regulations (HIPAA). The real problem is that outpatient primary care physicians are not paid enough to devote adequate time to patients with complex problems. The ACO does not solve this problem. Rather, it creates financial disincentives to hospitalize patients or to refer for advanced care (similar to HMOs). This will lead to poor outcomes for the sickest patients, and ultimately, higher costs.

Money saved by rationing care (or by improving care; let’s be optimists), will be consumed largely by the considerable administrative infrastructure required of the ACO. This includes hiring even more administrators to track outcomes and costs, installing and maintaining expense electronic health record systems, and training of staff. EHRs have many problems, do not improve productivity, and impinge on the patient-physician relationship, impairing quality of care.

“Quality” benchmarks are numerical targets for blood pressure, blood sugar, cholesterol, etc., determined by various guideline panels, most of which are dominated by industry-supported physicians. This will lead to inappropriate over-treatment in many individuals, with greater expense and worse outcomes over time. For example, aggressive targeting of low blood sugar has been shown to cause weight gain and higher mortality in patients with type 2 diabetes. It’s not a coincidence that Big Pharma heavily supported ObamaCare.

ACOs are based on the assumption that fee-for-service medical practice is responsible for the high cost of medical care. This is demonstrably false. Direct third party payment, spearheaded by Medicare, is the culprit.

And of course, when Uncle Sam is your partner, there is always risk that rules and payment will be changed, sometimes arbitrarily and without warning. As reported in Modern Healthcare, “as ACOs grow more efficient and Medicare adjusts savings targets accordingly, it may also grow increasingly difficult for ACOs everywhere to earn savings.” Furthermore, “Medicare’s ACO programs so far have produced inconsistent results, some of which policy experts and ACO executives have blamed on how Medicare calculates how much ACOs potentially saved the program. Last week, the CMS announced that the initiatives saved Medicare $817 million through 2013. Dozens of participants shared $445 million of that amount, but three-quarters of ACOs saw nothing after failing to do sufficiently well against the financial benchmarks” [emphasis mine]. So, only a handful saw any real profit, and you can be sure Medicare will alter their formula to not allow whatever they consider to be excessive profit.

It is clear that for ACOs to be profitable, they will need to engage in the old HMO practice of cherry-picking healthy patients. Last week I saw a 65-year-old woman with kidney disease on top of severe lung, liver and heart disease. It took more than an hour just to sort through her records and medications. ACOs will go out of their way to avoid recruiting patients such as this. The only hope for such patients is within the traditional fee-for-service system.

Our hope is that this system is allowed to survive.


Richard Amerling, MD is an Associate Professor of Clinical Medicine and a renowned academic nephrologist at the Beth Israel Medical Center in New York City. Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981. He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania. He has written and lectured extensively on health care issues and is President of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians’ Declaration of Independence and is a seasoned speaker and on-air contributor.

http://www.aapsonline.org/index.php/site/article/why_accountable_care_organizations_are_failing/

Amerling MD, Richard. “Why Accountable Care Organizations Are Failing.” What’s New. Association of American Physicians and Surgeons, 6 Oct 2014. Web. 7 Oct 2014.

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Posted in Health Care Reform Tagged , , , , , , , |

Common Sense Travel Restrictions to Stop Ebola: Dr. Jane Orient

Dr. Orient appears on Cavuto – October 6, 2014

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Posted in Medibid Television, Tax Increases

What Employers Can Do To Reduce The Cost Of Obamacare

StressedAccountantThe Obamacare mandate will be enforced on large employers in 2015 and small employers in 2016. Large companies who self-insure can have a plan that does not cover hospitalization, mental health care, or emergency room visits.  Small companies have to cover all these things.  Here are some strategies that employers are using:

Stay Small. – An employer with less than 49 employees is exempt from the mandate. However, if someone owns three separate businesses, the IRS will treat them as one business, not three. This discourages new business development. Also, two 15-hour a week employees will be counted as one full time equivalent.

Use Part-Time Labor. – Part time jobs are multiplying while full time jobs are holding steady. Making sure employees stay under 30 hours will require tight time scheduling.

Use Non-Employee Labor. – Independent contractors are not employees. Even if theysitting-at-desk work at the employer’s workplace, contractors are not counted as employees if they do not have regular hours. The temp business is booming in anticipation of the mandate.

Charge Employees the Maximum Allowable Premium. – A health plan is called “affordable” if the premium does not exceed 9.5% of an employee’s wages. Under Obamacare, the employer doesn’t have to cover dependents. The employee’s contribution will be made with after-tax dollars, whereas the employer’s share will be paid with before-tax dollars. After an employer has offered insurance, the employee and his family are not able to get a subsidy in the insurance exchange. What is in the best interest of the employer is harmful to the employee.

Offer a Minimum Essential Coverage (MEC) Plan. – As long as an employer offers insurance with minimum essential coverage, they can escape the fine. Ralph Weber of MediBid says that this can be a skimpy plan which includes doctor visits and drugs, but not inpatient surgery or ER visits.

Offer a MEC Plan with an Opportunity to Upgrade to Obamacare Compatible Insurance. – Employers can offer an upgrade to a plan that meets “affordability” and “minimum actuarial value” test. If the employee turns down the offer, the employer is no longer at risk for the $3000 fine.

obamacare calculatorTake Advantage of Imperfections in the Minimum Value Calculator. – Benefits for self-insured companies can differ from benefits in a standard plan, but the employer has to cover at least 60% of expected costs in a standard plan. Hospitalization, mental health care, imaging, ER visits, and specialist services do not have to be included to meet the government’s test.

Pay the Fine. – Employers can drop coverage and pay a fine of $2000 per employee. This is a high price, but less than the cost of insurance. With this option, the employees can apply for subsidized insurance in the exchange.  This is a win-win choice – the employer saves money and the employee gets a subsidy worth much more.

http://www.forbes.com/sites/johngoodman/2014/09/16/what-can-employers-do-to-reduce-the-cost-of-obamacare-2/

Goodman, John C. “What Can Employers Do To Reduce The Cost Of Obamacare?” Healthcare, Fiscal, and Tax. Forbes, 16 Sep 2014. Web. 5 Oct 2014.

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