The Buck Still Stops Nowhere–Why I Had To Write It–Excepts from the Introduction

The Buck Still Stops Nowhere: third edition


I am stunningly lucky to be alive. I suffered a stroke in January 2014 but my type of stroke has an 80 to 90 percent recovery rate.  I was on the floor of my home for two days before friends could reach the manager to have her check on me because I was not answering my phone or e-mails. The manager called 911.  The EMT team rushed me to Harborview, a regional medical center.  I was yellow, black and blue over my entire body.  I was barely breathing.  My left side was immobile. Neither the medics nor the ER physicians expected me to live.

I had incredible care from excellent health care professionals. I had robust health insurance through Medicare. I have strong and close networks of friends and colleagues who shouldered me through.  And, I know the health care system.  Even with all these gifts I still faced problems. Too many are not blessed with such gifts for support, which is why I am updating my earlier book—being a patient brought a greater personal immediacy and a deeper understanding of our system’s significant flaws.  I have support, coverage, friends, colleagues and knowledge.  Too many don’t.  Which is why I write….

….I had to make decisions and was faced with forms and bills I still do not understand…. Because I was so near death I was taken to a hospital that was not a contract hospital with my supplemental insurance. I signed the form that said I ‘knew’ this was a ‘non-contract’ hospital for stroke care. I feared for months about the bill that I knew would surely come for non-contract services. Luckily, it never came.  This is now a year later.

I was labeled as anxious because I wanted to understand and know my medications. There were so many white pills. How do I know I have the right pill? How do I know if the dose is correct? I thought I was simply fact checking.

Medicare covered not only my hospital care but my rehabilitation care.  Those without rehabilitation care can face devastating personal and financial blows….

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Selected Sample from The Buck Still Stops Nowhere–Long Term Care

The following is an excerpt from The Buck Still Stops Nowhere: 

Long Term Care and Nursing Homes

The stealth danger in the health care system is assisted living and long-term nursing home care. Assisted living, home health and nursing home costs and staffing are grenades waiting to explode. Salaries for nursing home workers are not on par with workers in other sectors of the economy. Indeed, workers in the pet care industry often receive more pay than personal care workers in senior care facilities or in home health care.

Work in assisted living, adult family homes and skilled nursing facilities is hard work, involving lifting, bathing, feeding and caring for fragile and vulnerable people. People in these settings not only need health care services, they also need extensive social support services such as transportation and social engagement services to keep them mentally and physically engaged rather than sitting and staring at TVs. Continue reading

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European companies financing American health mergers? Under the Radar??

Professional contract physician groups are growing, profitable and attracting foreign investors.   A short article was sent to me from Oregon about one such group. The last few paragraphs peaked my interest. “Sound” refers to Sound Physicians. Italics are mine:

“In the past year, Sound has been swept up in the merger and acquisition trend in health care.

In July, Fresenius Medical Care, which is based in Germany, invested $600 million in Sound, according to Reuters news service, and became its majority owner.”

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Patient Safety Series; Tax Dollars for Health Care; Medicaid and Long-term Care

My book is at the printer and should be ready by the end of the month–topics include among other things an historical chart of health care reform “efforts” and the cost containment backfires of approaches and counter approaches.  The book is short and to the point.  You can still donate and receive a signed copy.

Patient Safety

One of the publications I trust is the non-profit group Propublica.   They have started a series on patient safety that promises to be well worth reading:

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Charitable Assests from Non-profit conversions; Medical Errors Understated? and interesting facts on doctors and patients

There were major virulent battles over conversion of non-profit insurers to for-profit.

An emerging issue is the purchase/merger of non-profit hospitals by private, for-profit hospitals.  According to the January 19, 2015 Industry Insights from the Cain Brothers, this consolidation has attracted the attention of the Federal Trade Commission and the Department of Justice.  State Attorney Generals are now becoming the “….new gatekeepers of health system mergers. Many states have statutes in place that require the state attorney to review change of control transactions involving nonprofit health  care systems, often with higher standards for taxable conversions.”

Given the amount of money that was transferred back to the states from insurance conversion, this is an issue that merits attention.

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Hospital Community Health Needs Assessment Fines and IRS Status; What One Hospital Did; and Hospital Quality Surveys

The final rules were issued in December  2014 for hospital Community Health Needs Assessments (CHANs)as part of the Affordable Care Act. Failure to meet these criteria can lead to both a $50,000 fine and possible loss of the hospital’s 501©(3) non-profit status. These rules impact 80% of all US hospitals as well as the 23% that are government hospitals.  These provisions apply to all facilities a hospital operates.

Three key provisions include:

  • Community Health Needs Assessments at least every three years and an annual implementation strategy; (the industry’s word for this is population health)

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More Washington Hospitals Near the Bottom for Quality– Which Now Gives Communities Leverage for Safe, Affordable Quality Care

More Washington State hospitals are fined this year than last for quality care. This is precisely why we need to make patient safety and quality our highest priority!  And why communities must be involved. Who was fined?

See the Washington Health Alliance Report:

And the story by the Puget Sound Business Journal on their blog:

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The Buck STILL Stops Nowhere–order now–Here’s Why; Coming Next–Big Changes for Hospitals

The Buck Still Stops Nowhere

If you ever wondered why you must read the new The Buck Still Stops Nowhere, just read the stories below.  Open the link and scroll down to related stories on pre-existing conditions and other attempts to get around some key provisions of  the Patient Protection and Affordable Care Act.–6NoZHCzujP6D9qsDlZOJa8RdD18CrtZ9LMH_g7LytmmgEqR4jjuMYmPGPk5F8hADGCy07xzOpayijfG-Xd9tHjO7r_g&_hsmi=15800345

Donate and Order Now: The Buck Still Stops Nowhere:  the Primer–A no nonsense clear-English brief description about the financial incentives that drive the health care system and what is behind the jargon and rhetoric.  Coming February/early March.

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It’s Been A Year: I’m Back; Excerpt: Creed and Greed–The Buck Stops Nowhere; medical bills and housing foreclosures equal population of Texas and Florida

It’s been one year since my stroke (Jan. 19, 2014). I am back with new insights and a re-doubled commitment to consumer advocacy.  I am working on the 3rd Edition of The Buck Stops Nowhere.  Here is an excerpt from the 2nd Edition published in 2003. 

An excerpt, 2nd edition (2003)–Chapter 3:  Creed, Greed and Compensation:

When greed holds hands with ideology, it is easy for those who do not have an extreme ideological point of view to get lost or shut down in the dialog…It is almost impossible, even for thoughtful people, to make independent decisions given the barrage of ideological positions about an issue that touches each of us and our families every day. We have no baseline of what the issues are, and therefore, we trust no one.

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