Want Health Care Accountability? Here’s What is Possible.

Washington State does it again: 

First state to require hospitals to report executive salaries in June 2013. The blog I wrote about that is still read daily. The report is updated annually. Here is the first blog on that topic:  http://oconnorreport.com/2013/06/what-hospital-executives-earn/  There were follow up blogs on hospital salaries and accountability. More blogs to come as the data is updated.

Washington Health Alliance:  www.wahealthalliance.org created an ‘all-payer’ data base which means the public, providers and employers now have transparency and information about quality and affordable care in Washington State.  The bill creating this database had broad bi-partisan support and  support of  businesses, health-care providers and patient organizations.  Other reports include:  Disparities in Health; Choosing Wisely; Hospital Sticker Shock, Medical Group Survey Results, among others.  Contact the Alliance for greater detail on their new study.

Foundation for Health Care Quality (www.qualityhealth.org) built a culture of trust and began working collaboratively with physicians so they could improve their skills, reduce practice variations and develop accurate clinical information to improve quality and patient outcomes. Since 1988 they have expanded their programs from clinical to patient safety and now a Patient and Family Advisory Council.  See their website for the range of programs.

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American Health Policy, the Commercialization of Non-Profits and the Affordable Care Act

When Americans think of non-profit organizations we usually think of charitable organizations serving our communities, such as our non-profit hospitals.  An eye opening article by Dr. Daniel M. Fox, President Emeritus, The Milbank Memorial Fund, however, (http://www.milbank.org/), lays bare the perverse incentives and paradoxes that have actually increased the growth and commercialization of health care non-profits.  His premise is that US policies have resulted in both the expansion and the commercialization of health care non-profits.  His article also offers hope that the Affordable Care Act may actually constrain some of this commercialization and more truly serve communities, patients and families: 

POLICY COMMERCIALIZING NONPROFITS IN HEALTH: THE HISTORY OF A PARADOX FROM THE 19TH CENTURY TO THE ACA

Findings:  A paradox with deep historical roots persists as a result of consensus about its value for both population health and the revenue of individuals and organizations in the health care sector.  Participants in this consensus include leaders of governance who have disagreed about many other issues.  The paradox persists because of assumptions about the burden of disease and how to address it, as well as about the effects of biomedical science that is translated into professional education, practice, and the organization of services for the prevention, diagnosis, treatment and management of illness. “   (italics mine).

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Medicare and Insurance Profits: Not Again!

In the late 1980′s I was the marketing manager for a for-profit HMO that bilked seniors.  Once I learned that I left. But it took about a year.  That work, however, fueled me to be an ardent patient/consumer advocate.  Please read this blog this and share it.  

Medicare Advantage Plans became law the same year as the Medicare Pharmaceutical benefit in 2003.  Medicare is prohibited from negotiating rates with pharmaceutical companies.  The VA is not.  More on this later, but for now private Medicare Advantage programs and Medicare.  

THEN——”Cut off: HMOs trim elderly for profit” (July 30, 2000) The Seattle Times 

….“Medicare HMOs are the canary in the coal mine. As Medicare goes, so goes the nation. Because of its size and influence, whatever it does will be copied by the commercial plans that follow the path of least resistance.

“And, don’t listen to anyone who says, “who’s going to pay for it?” We are all paying for it now. Just ask any senior who has to change plans. Unless and until we say what we want – a system that supports the health and well-being of our seniors and the health and well-being of our communities and our nation, then we will remain stuck with a crippled system that is more concerned about cash than care.” ….   (Emphasis mine)

http://www.oconnorreport.com/old/pgs/hmo.html  From The Seattle Times

AND NOW—–”Former Rep. Allyson Schwartz’s new group, The Better Medicare Alliance, is not what it appears” (April 27, 2015)  Public Integrity

 ….“Insurers that participate in the Medicare Advantage program devote big chunks of their advertising and sales budgets to lure seniors away from the traditional Medicare program, which costs taxpayers less. For many seniors, the marketing is irresistible. Enrollment in Medicare Advantage plans jumped 10 percent between 2013 and 2014. Thirty percent of Medicare’s 54 million beneficiaries are now in a Medicare Advantage plan.

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Follow the Money! Two articles hot off the press from Modern Health Care

“Controversially, free-standing ERs in many states don’t have to accept Medicare and Medicaid. Their ability to cherry-pick patients would essentially divert older and lower-income patients toward traditional hospital ERs. Also, building a free-standing ER often doesn’t require a certificate of need. ”  (emphasis mine)

http://www.modernhealthcare.com/article/20150423/NEWS/150429947?utm_source=modernhealthcare&utm_medium=email&utm_content=20150423-NEWS-150429947&utm_campaign=financedaily

“In most states, stand-alone ERs that do not accept Medicare and Medicaid—insurance acceptance varies—do not need to comply with the federal Emergency Medical Treatment and Labor Act. This allows them to accept only patients with the means to pay. In addition, some states also allow stand-alone ERs to bypass the certificate-of-need process, an additional hurdle for traditional hospital operators looking to expand in the same area.”  (emphasis mine)

http://www.modernhealthcare.com/article/20131005/MAGAZINE/310059957

What You Can Do!!  Send this to your Senator, Congressman, Governor and state representatives.  And friends–until and unless we say NO, this is going to keep happening!!  I hope this comes through. These are the last articles for me to read for free in Modern Health before I have to pay $$$ to subscribe.  If you can’t open these articles let me know.  I can get copies. 

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O’ConnorReport featured in”Must Reads” on Linkedin; first books are printing–order now; finally–new Medicare ID coming

The O’ConnorReport  was featured in Linkedin’s Must Read list:  https://www.linkedin.com/pulse/more-good-news-health-care-kathleen-o-connor?trk=eml-b2_content_ecosystem_digest-network_publishes-249-null&midToken=AQG9xKY8gS1irQ&fromEmail=fromEmail&ut=11ICjH3uK7zCI1

The Buck Still Stops Nowhere is finished. The first books are being printed. All books are all print-on-demand until I have finalized contract arrangements with a book distributor and digital editions.  As I am fond of telling my friends:  “The easiest part of writing a book is writing the book.”  The book includes references and suggested readings—and a Quick History of Health Reform since 1869.  Yes.  1869. This is not a typo.

Order now and be the first to read what many in the industry don’t want you to read. 

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Some Good News on Health Care Horizon!

This agreement isn’t perfect but it’s a start:   http://www.nytimes.com/2015/04/16/opinion/keep-patients-healthy-and-doctors-sane.html emc=edit_th_20150416&nl=todaysheadlines&nlid=54404043

It matters because: 

Health Care is a foreign country– with incomprehensible language, rules, customs, bills and money: 

  • Medicare can’t negotiate drug prices but the VA can.
  • Health care services have not been rewarded for quality, safety and outcomes.
  • Insurance rules and rates vary state by state.
  • Rules and taxes differ between large and small employers.
  • Insurance is not considered commerce.
  • Competition actually increases health care costs.  
  • Both Republican and Democratic administrations caused cost increases.

And Much More—BUT..There are things you can do in your own community.

Read The Buck Still Stops Nowhere to find outIt’s a short, 100 page, hard hitting guide you can’t find anywhere else. We’re in the early publishing, print on demand stage to prepare for broader distribution. We have: 

  • ISBN and Library of Congress/copyright numbers.
  • References, readings and a quick reform history since 1869. 
  • Knowledgeable external reviewers.
  • All testimonials newly confirmed.

Price:  $12.95, (plus tax for Washington state orders).  All orders plus shipping and handling–$20. Books currently print on demand only.  Orders payable to:  Kathleen O’Connor LLC (registered in Washington State). Or order on line via PayPal.  Pre-book store orders autographed.  

  • Pre-bookstore copies available late April or very early May.
  • Copies available in some book stores May or June.
  • All pre-digital book costs (including book stores) include shipping and handling
  • Digital books available in late May or early June. 

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Uninsured Rate Drops–But HOT Issues Remain Ahead

The Gallup Poll reported today (4/13/15) that the number of uninsured dropped to its lowest point since 2008. Read the Gallup story here:  http://www.gallup.com/poll/182348/uninsured-rate-dips-first-quarter.aspx?utm_source=Well-Being&utm_medium=newsfeed&utm_campaign=tiles

This is wonderful news.  BUT.  The biggest fight looms ahead with the Cadillac Tax and potential fines of $2,000 per employee that large employers (100+) could face:  http://www.politico.com/story/2015/04/obamacare-health-care-cadillac-tax-116659.html

This is a very complicated issue that is filled with legalize about–numbers of hours worked—spousal coverage–job title–, etc.etc. etc.  I am not a legal expert on all the technicalities, but…

BRIEFLY: Large employers self-fund/insure their health care benefits. Therefore, they are not an insurance company. Consequently, they are not regulated like insurance companies nor are they subject to state insurance rules and taxes.  Insurance is regulated at the state level.  Consequently, large employers:

  • Do not pay an insurance company to insure their health benefits.
  • Invest instead what they would have paid in insurance premiums and then hire an insurance company or a third party administrator to manage the benefits.  
  • Are exempt from state premium taxes and state mandated benefits.
  • Don’t pay health insurance premium taxes to the state that small businesses and individuals must pay to their state.

This is going to be a  huge fight over benefits, regulations and taxes.  The summary below is about the most understandable I could find quickly:

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If You Wondered Why I titled the book: The Buck Still Stops Nowhere–Just read this

United’s CEO salary  and compensation speaks for itself. See below.

Pharmaceutical profits have gone from 18.6% in 1999 to over 44% now–this the most profitable industry in the country even over banking and financial interests.  This is why you should read my book!  If we don’t do something, money will keep going to special interest pockets like his!

United, by the way, just bought a pharmaceutical company:

“UnitedHealth’s announced acquisition of pharmacy benefit manager Catamaran Corp. for $12.8 billion on March 31 will make Minnetonka-based UnitedHealth the largest company in Minnesota — public or private.”

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“IT Depends”–Why America’s Health Care IS All Dollars and No Sense–And What YOU Can Do

The Buck Stops Nowhere--Front Cover

 Why America’s Health Care is All Dollars and No Sense and What You Can Do © (excerpt–page 5)

  “A Clear Concise Guide to America’s Health Care”

  • Health Care is foreign territory. Unlike foreign countries there is no embassy or safe haven.
  • What you pay depends on where you live, your insurance and where you work.
  • Insurance rules are different in each state.
  • Even federal programs like Medicare have different rates   and fees in each state including physician fees.
  • Medicare doesn’t cover what most people think it does.
  • Medicaid, which is a joint program between the federal government and the states, has different coverage, costs and fees in each state.
  •  There are no consistent or constant rules. Federal and state policies shift constantly.
  • Insurance rules in one state do not apply in another.
  • There is no common language much less an understandable one.
  • There are no consistent, predictable costs and no way for anyone to compare them.
  • No one is accountable.
  • Nothing is constant.
  • The only two words that apply to the health care system are:

 IT DEPENDS

********

Which is why you must read: The Buck Still Stops Nowhere–3rd Edition.

$20-$25 covers the book, postage, shipping and handling and an autograph.   Kindle/digital versions coming soon.  Contact me for group rates and shipping. Order by clicking on donate button or by contacting me directly.

We must act now to focus on accountability, quality, safety and value–or we can just keep letting special interests win.

Kathleen O’Connor April 6, 2015

 

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Selected testimonials–3rd Edition The Buck Still Stops Nowhere

The Buck Still Stops Nowhere:  Selected Testimonials Third Edition

Kathleen O’Connor’s updated The Buck Stops Nowhere is a great place for Americans to familiarize themselves with the major flaws in our health care system. And no one attacks this set of problems with more passion and integrity.

Edward Howard,  Executive Vice President, Alliance for Health Reform, Washington DC

Finally! A book that cuts through the complexity and gets to the heart of the matter—safety and quality for everyone.

RADM Herb M. Bridge, USNR (ret) United States Navy, Co-Chairman, Ben Bridge Jewelers

Kathleen O’Connor brings fresh insights to a topic long covered up by industry insiders. Health care reporting becomes clear and incisive in her hands. She speaks for the average person lost in the complications of health care policy, and she does so with clarity and courage.

James Vesely, Editorial Page Editor, The Seattle Times, retired

More testimonials in book. 

Some Key Points:  Learn More

  • Pharmaceutical profits 44% up from 18% in early 2000′s
  • Potential loss of  hospitals’ 501(c)(3) status and potential fines of $10,000
  • Insurance not considered commerce
  • Prices increased under both Johnson and Reagan; FDR and Nixon
  • Who is and who is not subject to Affordable Care Act

And what YOU CAN do!

Support a good cause–the public’s voice!   Order now!  100 pages. Paperback only.  Available April.  E-book in process.  Order with credit card via donation button on website.  Or order by e-mail.   $25.00 includes author signature, postage and handling (one book).  Includes a 5 and 1/2  page Quick History of Health Care Reform since 1869.  Group rates available. 

Updated/new website coming soon.

Copyright, Kathleen O’Connor (c). All rights reserved.  March 2015

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