Five years will come and go

November 9, 2009

The has been a great deal of debate over the level of government intervention in health care as a result of reform legislation.

Here is but one small example of what is contained in the recently passed House bill, HR 3962 you can decide for yourself:

“(C) USE OF COPAYMENTS- In establishing cost-sharing levels for basic, enhanced, and premium plans under this subsection, the Secretary shall, to the maximum extent possible, use only copayments and not coinsurance.”

Those of us who design and manage health plans have known for years that the move to copayments was a mistake because it is far more difficult to keep up with inflation and to maintain a target level of cost sharing. Prescription drug plans have even moved from copays to coinsurance.

However, when it comes to managing costs for ALL plan participants, including the majority in a plan with little or no expenses in a year, it appears the politicians are smarter than employee benefit professionals.

Keep in mind that while employer plan designs are grandfathered for five years under HR 3962, after that all bets are off. That’s a long time for Congress to act to “improve” the benefits.

Perhaps it is really time to retire.

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Posted by rdquinn

A deal is a deal

November 9, 2009

A deal is a deal or is it? Here is a summary of the deal made by the Obama administration for hospitals to help save $155 billion for health care reform. What do you think are the chances that anyone will have any idea of these savings or more important, how does this kind of deal help the average American covered by private health benefits? The answer to the last part is simply ( unless you believe hosptals can give up this revenue with no consequences) the private sector will pick up the slack.

And I have another question, if the insurance company premiums are the cause of our woes as many would have us believe, how is it that hospitals are not critized for over charging based on this deal?

The leading hospital groups – the American Hospital Association, the Federation of American Hospitals, and the Catholic Health Association – agreed to accept $155 billion less in Medicare reimbursements over 10 years. In exchange, Sen. Max Baucus (D) of Montana, the Finance Committee chair, agreed to exempt hospitals from the cost-cutting regime under a proposed new Medicare Commission for its first few years of operation. That deal was not clear until the committee released legislative language on its bill. The Congressional Budget Office, for example, was not aware that hospitals were exempt from cuts when it estimated the bill’s impact on the federal deficit.

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The full text

November 9, 2009

If you are interested here is where you can find the full text of health care reform legislation.

http://thomas.loc.gov/

Blogsurfer.us

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Posted by rdquinn

Just a thought on jobs

November 8, 2009

I am reading the Sunday New York Times editorial about unemployment and the call for more federal intervention to create jobs.

With the passage of the next stage toward health care reform the federal government is doing it’s part to create a massive bureaucracy and the jobs that go with it.

What about the private sector? Many of the people and organizations who decry government intervention in anything seem to have no trouble cutting jobs when the next quarterly earnings report is in jeopardy of dropping a penny or two.

It is almost as if some corporations are using the economy as an excuse to clean house or cut costs simply for a better short term objective. Listen to me, a conservative at heart criticizing capitalists.

While manufacturing jobs of necessity are in direct proportion to production, many jobs lost do not have such a direct relationship. It is these jobs that corporations can favorably impact. Sure times are tough, but any reasonable person and certainly any sophisticated investor knows that things will improve even if it takes two or three years, or more to the point eight to twelve quarters. A sound, well managed company is not going away simply because of a downturn.

As unemployment rises and stagnates at high levels more and more government action will result with the accompanying increasing debt eventually leading to higher taxes……

So, corporations of America wouldn’t it be better to maintain control, retain your good talent and be better postioned for the recovery by avoiding layoffs even if you have to explain to a bunch of analysts what you are doing and why and that earnings will suffer a bit for a few quarters?

As many observers have noted, favorable earnings reports have been driven by cost cutting, not revenue growth. We all know it’s a big game, what we seem to forget is that it is people (people with long memories) who are the pawns in this game.

In today’s corporate jargon you hear terms like “employee engagement,” “employee alignment,” and the old standby being “on board.” Guess what captains of industry, your corporate communications can’t turn BS into fertilizer. And, take note HR departments as you warmly embrace and believe your own PR about human capital, this is partly your fault and you should be fighting for your workforce not enabling the CFO, and you should be doing it because it is in the long term best interest of your organization.

Just as with health care, you can’t have it all without paying the price, pay now or pay later. Maintain control or gripe about government intervention and taxes (which if I recall accounting 101 also impact net earnings).

Perhaps it can be said much simpler, do the right thing.

Blogsurfer.us

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Posted by rdquinn

Some real causes of health care costs

November 8, 2009

Our members of Congress are fond out touting health cost savings. Of course we know that what we are getting in health care reform has no resemblance to a strategy to control costs.

Here is info that explains some of the root causes.

http://money.cnn.com/2009/11/03/news/economy/healthcare_hidden_hazards_costs/

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Posted by rdquinn

The state of health care reform…just for fun.

November 7, 2009
Let me get this straight…….

1.     we’re going to pass a health care plan
2.     written by a committee whose head says he doesn’t understand it,
3.     passed by a Congress that hasn’t read it but exempts themselves from it,
4.     signed by a president that also hasn’t read it, and who smokes,
5.     with funding administered by a treasury chief who didn’t  pay his taxes,
6.     overseen by a surgeon general who is obese, and
7.     financed by a country that’s nearly broke.

What possibly could go wrong?

 

health cartoon.jpeg

Can't take credit for this one, but you get the idea

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Posted by rdquinn

AARP and AMA represent little

November 7, 2009

The House of Representatives health care reform legislation gained some momentum yesterday when AARP, which represents 40 million seniors, and the American Medical Association each endorsed the measure.

This should tell you something about how effective the legislation will be in managing costs.

Both organizations have more clout among politicians than they have any actual representation of the constituents they claim to represent. The AARP sells stuff, publishes a magazine and sends people cards when they turn 55 or is it 50 now.

The AARP no more represents the senior citizens of the US than the AMA represents the majority of physicians in America. The AARP wants the donut hole for Part D of Medicare closed never mind the cost and the AMA wants no reduction in physician fees under Medicare never mind the cost.

These self serving, irresponsible positions only make the cost of “reform” that much more difficult to deal with for all Americans. One can only speculate how reforming health care became the vehicle for expanding an entitlement that was opposed by Democrats when enacted by the Bush administration. Oh right, seniors vote. Despite the fact that those most in need are young families especially lower income families, we continue to use valuable national resources disproportionally for seniors, oh right, they vote.

Despite the fact Medicare is in big time fiscal trouble with the insertion of text into two thousand pages of new legislation we make the problem worse.

Oh right …………

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Governments own job stimulus

November 7, 2009

I didn’t do the research on this so I can’t attest to it being 100% accurate. However, I do recognize these various agencies and Programs from reviewing the legislation. A collegue sent this to me.

To all those folks who welcome government intervention in just about anything. Here you go, bureauocracy in action. Have your checkbook handy for the next fifty years.

Something for everyone and then some.

In case you’re looking for the jobs of the future, here is a list of 111 new programs, agencies, boards, panels, groups, etc. in the House national health care plan:

Retiree Reserve Trust Fund (Section 111(d), p. 61)
Grant program for wellness programs to small employers (Section 112, p. 62)
Grant program for State health access programs (Section 114, p. 72)
Program of administrative simplification (Section 115, p. 76)
Health Benefits Advisory Committee (Section 223, p. 111)
Health Choices Administration (Section 241, p. 131)
Qualified Health Benefits Plan Ombudsman (Section 244, p. 138)
Health Insurance Exchange (Section 201, p. 155)
Program for technical assistance to employees of small businesses buying Exchange coverage (Section 305(h), p. 191)
Mechanism for insurance risk pooling to be established by Health Choices Commissioner (Section 306(b), p. 194)
Health Insurance Exchange Trust Fund (Section 307, p. 195)
State-based Health Insurance Exchanges (Section 308, p. 197)
Grant program for health insurance cooperatives (Section 310, p. 206)
“Public Health Insurance Option” (Section 321, p. 211)
Ombudsman for “Public Health Insurance Option” (Section 321(d), p. 213)
Account for receipts and disbursements for “Public Health Insurance Option” (Section 322(b), p. 215)
Telehealth Advisory Committee (Section 1191 (b), p. 589)
Demonstration program providing reimbursement for “culturally and linguistically appropriate services” (Section 1222, p. 617)
Demonstration program for shared decision making using patient decision aids (Section 1236, p. 648)
Accountable Care Organization pilot program under Medicare (Section 1301, p. 653)
Independent patient-centered medical home pilot program under Medicare (Section 1302, p. 672)
Community-based medical home pilot program under Medicare (Section 1302(d), p. 681)
Independence at home demonstration program (Section 1312, p. 718)
Center for Comparative Effectiveness Research (Section 1401(a), p. 734)
Comparative Effectiveness Research Commission (Section 1401(a), p. 738)
Patient ombudsman for comparative effectiveness research (Section 1401(a), p. 753)
Quality assurance and performance improvement program for skilled nursing facilities (Section 1412(b)(1), p. 784)
Quality assurance and performance improvement program for nursing facilities (Section 1412 (b)(2), p. 786)
Special focus facility program for skilled nursing facilities (Section 1413(a)(3), p. 796)
Special focus facility program for nursing facilities (Section 1413(b)(3), p. 804)
National independent monitor pilot program for skilled nursing facilities and nursing facilities (Section 1422, p. 859)
Demonstration program for approved teaching health centers with respect to Medicare GME (Section 1502(d), p. 933)
Pilot program to develop anti-fraud compliance systems for Medicare providers (Section 1635, p. 978)
Special Inspector General for the Health Insurance Exchange (Section 1647, p. 1000)
Medical home pilot program under Medicaid (Section 1722, p. 1058)
Accountable Care Organization pilot program under Medicaid (Section 1730A, p. 1073)
Nursing facility supplemental payment program (Section 1745, p. 1106)
Demonstration program for Medicaid coverage to stabilize emergency medical conditions in institutions for mental diseases (Section 1787, p. 1149)
Comparative Effectiveness Research Trust Fund (Section 1802, p. 1162)
“Identifiable office or program” within CMS to “provide for improved coordination between Medicare and Medicaid in the case of dual eligibles” (Section 1905, p. 1191)
Center for Medicare and Medicaid Innovation (Section 1907, p. 1198)
Public Health Investment Fund (Section 2002, p. 1214)
Scholarships for service in health professional needs areas (Section 2211, p. 1224)
Program for training medical residents in community-based settings (Section 2214, p. 1236)
Grant program for training in dentistry programs (Section 2215, p. 1240)
Public Health Workforce Corps (Section 2231, p. 1253)
Public health workforce scholarship program (Section 2231, p. 1254)
Public health workforce loan forgiveness program (Section 2231, p. 1258)
Grant program for innovations in interdisciplinary care (Section 2252, p. 1272)
Advisory Committee on Health Workforce Evaluation and Assessment (Section 2261, p. 1275)
Prevention and Wellness Trust (Section 2301, p. 1286)
Clinical Prevention Stakeholders Board (Section 2301, p. 1295)
Community Prevention Stakeholders Board (Section 2301, p. 1301)
Grant program for community prevention and wellness research (Section 2301, p. 1305)
Grant program for research and demonstration projects related to wellness incentives (Section 2301, p. 1305)
Grant program for community prevention and wellness services (Section 2301, p. 1308)
Grant program for public health infrastructure (Section 2301, p. 1313)
Center for Quality Improvement (Section 2401, p. 1322)
Assistant Secretary for Health Information (Section 2402, p. 1330)
Grant program to support the operation of school-based health clinics (Section 2511, p. 1352)
Grant program for nurse-managed health centers (Section 2512, p. 1361)
Grants for labor-management programs for nursing training (Section 2521, p. 1372)
Grant program for interdisciplinary mental and behavioral health training (Section 2522, p. 1382)
“No Child Left Unimmunized Against Influenza” demonstration grant program (Section 2524, p. 1391)
Healthy Teen Initiative grant program regarding teen pregnancy (Section 2526, p. 1398)
Grant program for interdisciplinary training, education, and services for individuals with autism (Section 2527(a), p. 1402)
University centers for excellence in developmental disabilities education (Section 2527(b), p. 1410)
Grant program to implement medication therapy management services (Section 2528, p. 1412)
Grant program to promote positive health behaviors in underserved communities (Section 2530, p. 1422)
Grant program for State alternative medical liability laws (Section 2531, p. 1431)
Grant program to develop infant mortality programs (Section 2532, p. 1433)
Grant program to prepare secondary school students for careers in health professions (Section 2533, p. 1437)
Grant program for community-based collaborative care (Section 2534, p. 1440)
Grant program for community-based overweight and obesity prevention (Section 2535, p. 1457)
Grant program for reducing the student-to-school nurse ratio in primary and secondary schools (Section 2536, p. 1462)
Demonstration project of grants to medical-legal partnerships (Section 2537, p. 1464)
Center for Emergency Care under the Assistant Secretary for Preparedness and Response (Section 2552, p. 1478)
Council for Emergency Care (Section 2552, p 1479)
Grant program to support demonstration programs that design and implement regionalized emergency care systems (Section 2553, p. 1480)
Grant program to assist veterans who wish to become emergency medical technicians upon discharge (Section 2554, p. 1487)
Interagency Pain Research Coordinating Committee (Section 2562, p. 1494)
National Medical Device Registry (Section 2571, p. 1501)
CLASS Independence Fund (Section 2581, p. 1597)
CLASS Independence Fund Board of Trustees (Section 2581, p. 1598)
CLASS Independence Advisory Council (Section 2581, p. 1602)
Health and Human Services Coordinating Committee on Women’s Health (Section 2588, p. 1610)
National Women’s Health Information Center (Section 2588, p. 1611)
Centers for Disease Control Office of Women’s Health (Section 2588, p. 1614)
Agency for Healthcare Research and Quality Office of Women’s Health and Gender-Based Research (Section 2588, p. 1617)
Health Resources and Services Administration Office of Women’s Health (Section 2588, p. 1618)
Food and Drug Administration Office of Women’s Health (Section 2588, p. 1621)
Personal Care Attendant Workforce Advisory Panel (Section 2589(a)(2), p. 1624)
Grant program for national health workforce online training (Section 2591, p. 1629)
Grant program to disseminate best practices on implementing health workforce investment programs (Section 2591, p. 1632)
Demonstration program for chronic shortages of health professionals (Section 3101, p. 1717)
Demonstration program for substance abuse counselor educational curricula (Section 3101, p. 1719)
Program of Indian community education on mental illness (Section 3101, p. 1722)
Intergovernmental Task Force on Indian environmental and nuclear hazards (Section 3101, p. 1754)
Office of Indian Men’s Health (Section 3101, p. 1765)
Indian Health facilities appropriation advisory board (Section 3101, p. 1774)
Indian Health facilities needs assessment workgroup (Section 3101, p. 1775)
Indian Health Service tribal facilities joint venture demonstration projects (Section 3101, p. 1809)
Urban youth treatment center demonstration project (Section 3101, p. 1873)
Grants to Urban Indian Organizations for diabetes prevention (Section 3101, p. 1874)
Grants to Urban Indian Organizations for health IT adoption (Section 3101, p. 1877)
Mental health technician training program (Section 3101, p. 1898)
Indian youth telemental health demonstration project (Section 3101, p. 1909)
Program for treatment of child sexual abuse victims and perpetrators (Section 3101, p. 1925)
Program for treatment of domestic violence and sexual abuse (Section 3101, p. 1927)
Native American Health and Wellness Foundation (Section 3103, p. 1966)
Committee for the Establishment of the Native American Health and Wellness Foundation (Section 3103, p. 1968)

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Posted by rdquinn

Major concerns-largely ignored

November 6, 2009

Employers have major concerns about the current versions of health care reform, not small among them the fact that there is way too little emphasis on actually controlling costs beyond shifting costs to the public sector.

With unemployment at 10.2 percent is this the best time to be talking about additional costs for employers?

Here is a link to a letter sent to the House of Representatives by the American Benefits Council, an organization of medium and large employers.

http://www.americanbenefitscouncil.org/documents/hcr_council-house-letter110509.pdf

Blogsurfer.us

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Posted by rdquinn

Please don’t read this if you are driving

November 6, 2009

On my way to a meeting the other day I overshot my turnpike exit by 150 miles. I was distracted, pure and simple. Frankly, I don’t recall if the distraction was a phone call, reading the paper, sending an e-mail or checking the market futures index on my iPhone. Or, it could have been shaving, Twittering, putting on makeup (an illustrative comment only) or petting the dog on my lap.

But does it matter, what’s a little distraction? Now if you drive in New York state you better beware, that state has a law against texting, you can’t read, type or send a text message…OMG it says nothing about sending a e-mail, quite a different matter as those who pay their monthly texting charge know.

So, now in NY you can’t talk or send a text message on a cell phone while driving. No doubt this will be the most ignored law in the world, unfortunately.

I really think they need to go after those makeup artists and shavers. I have to go; need to put this laptop down before I get to the toll booth.

Happy motoring!

 

blogsurfer.us

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Posted by rdquinn

Unhealthy America

November 5, 2009

If you want to read a most convoluted view of health care in America take a look at “Unhealthy America” in the November 5th New York Times. The writer provides a litany of statistics about the low ranking of US health care compared to the rest of the world and then concludes that it is the lack of universal coverage causing those statistics even noting that Americans 65 and older have a longer life expectancy than the rest of the world because of Medicare.

He concludes that leaving a hospital as soon as possible is bad and even calls negative the many hernia surgeries done on an outpatient basis. Needless to say he takes the usual shot at insurance companies for denying care (an insurance plan may deny payment for a service, buy they never deny care – I know we can’t afford to pay ourselves, well sometimes that’s true, but isn’t that the point it’s the cost of care stupid!).

I have managed health benefits covering 40,000 lives for over 45 years and never once did I get a complaint about a person being arbitrarily kicked out if the hospital or being denied payment for care When denial did occur there were clear medical reasons for such action and confirmed by independent medical experts (and often the treating doctor as well who told a different story to the patient because it was less aggravation).

The views expressed in this editorial serve to enforce the myth we can have it all and we can afford to have a government program just write a check for any claim presented, hey just like Medicare. How’s that working out?

No doubt some people without any health insurance coverage receive less than optimum care and do not have access to the very best (to be determined) providers but even if that were true for every uninsured person who needed medical care (many do not) it would not support the statistics presented.

What this article does is condem the medical community for providing lousy health care and if that’s true there is nothing in pending legislation that changes any of that. In addition, the same providers render care to Medicare patients and to the 70 million Americans with self-insured employer coverage and to everyone else as well.

Perhaps we should accept the fact that a physician’s integrity, skill and credibility is based solely on the payment he or she receives.

One can only wonder what point of view can conclude that a government run health care system will automatically correct every flaw in health care delivery. I have it, we are going to import a new cadre of doctors from Canada, Germany, Ireland and even Slovania.

http://www.nytimes.com/2009/11/05/opinion/05kristof.html?_r=1

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Posted by rdquinn

The Republican Health Reform Plan

November 5, 2009

I hear Republicans have a plan to reform health care. Before I spend too much time reading what they have, let me summarize the plan and save us all some time.

A little right, a little wrong, too little, too late, irrelevant, FAGETABOUTIT!

Where have they been with constructive ideas for the last nine months? You can’t solve the problem with wishful thinking any more than you can with government control over every tongue depressor sold. Yeah, fifty states regulating insurance companies is absurd, malpractice awards are outrageous in some cases, but fixing that won’t get people covered or manage costs in the long run any more than getting everyone covered can be called health care reform.

As I said FAGETABOUTIT

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Posted by rdquinn

House legislation limits ability to change retiree benefits

November 5, 2009

 

The House health care reform bill includes a provision that limits an employer’s ability to reduce retiree health benefits. The legislation says that employers cannot lower the benefits or raise premiums.  However, it also says that as long as any reduction is not substantial it is okay.  So, what does substantial mean?  There is some general discussion but clearly, if this provision remains it will require substantial regulatory clarification.  A substantial decrease in benefits is one that is greater than a 5% reduction in actuarial value.  Likewise, premiums in terms of dollars and percentage of premium cannot be raised by more than 5%; interestingly any Cap on employer costs in effect at the time of retirement can be honored.

 

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Posted by rdquinn

AT&T get it right

November 5, 2009

You know that little guy who asks “can you hear me now?” The one with a crowd following him around. I could sure use him now. Just to let you know that AT&T 3g network sucks on Maui, HI.

My Blackberry works fine, my wife’s phone works fine and for good reason, they are both on the Verizon network. Even my Kindle works and who knows what network that is on. But my iPhone doesn’t work fine at all unless you like watching that little thingy go round and round and never send or receive anything or you are obsessed with the word “searching” because you will see a lot of that, but you won’t see any bars and instead of 3G you will see E. I suspect that doesn’t stand for exceptional perhaps egads you’re where? At the moment I see the famous “no service”.

I’m posting this via my iPhone. The last time I did that from here it took an hour for an upload that should take 30 seconds. So while I am sending it on November 3rd if you don’t see it until Thanksgiving you know why.

Shame on you AT&T or whoever you really are, this is the 21st century, get it right everywhere.

Blogsurfer.us

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Wanna buy a turnpike?

November 4, 2009

Well, the doughboy Republican won in NJ over the multi-millionaire Democrat. Is this REAL change?

I am waiting for my real estate taxes to drop, my income tax rate to drop and the state’s fiscal problems resolved without taking away all the neat stuff previous governors have given us.

Anyone want to buy a turnpike?

Politicians are the only people on earth who can achieve (?) totally opposing goals simultaneously.

The last time a NJ governor delivered on tax relief she did it in part by raiding a fund for the future cost of retiree medical benefits promised to state workers. How did that work out? Today the liability for that (growing) obligation is over $50 billion. While many NJ citizens have no health insurance and most are paying through the nose for health insurance premiums, state workers have the Cadillac of Cadillac health plans at little or no cost to them. Change that Mr Christie, and good luck.

We are all surfs only we don’t know it. On the other hand those of us who vote allow this to happen so we deserve what we get. I voted for Christie only because I wanted the other change agent in Washington to get a message and because does it really matter?

Right after voting I got on a plane to Maui where I sit as I write this. I figured that while I wait for my taxes to go down a surer bet was to spend what I accumulated from 48 years of working.

Mahala

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