I Survived: You and Your Family Can Too

Dear Readers,

You have not heard from me since January because I had a major stroke.  It was most probably January 19th, but I was found and taken by ambulance to Harborview Medical Center on January 21st. I was in assisted living from February 11 to March 2nd when I returned home, with care.  It is a miracle I am alive. By all rights I should be dead.  But I’m not.

Ironically I was working on all the pieces I should have had in place before the stroke. I now have them in place.  You should have them as well if you live alone or have family and friends who do.

I am just flat out miraculously lucky. I have friends who worried when I had not called back or returned e-mails for a day or so—“that’s not like Kathleen.”  A friend called a friend who called the manager of the complex where I live.  The manager found me and I gather I was every shade of purple, green and blue that can be imagined.  I was lying on the floor and luckily still, but barely, breathing.  By all rights I should be dead. By all rights I should not be able to write this at all.

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And now a little more about the full story: Why Are Hospitals Really Changing Billing Status?? and Keep Your Eye on Maryland

A story ran Thursday night (1/9/14) about the new billing code at American hospitals, called “observation care.”  I hope you can open this without the accompanying commercial ad.  Basically, the story is about the problem of the new billing code for seniors in hospitals–called observation care.  If a patient is in observation care, their subsequent care in a rehab facility is not covered because rehab care requires ‘in patient’ hospital care according to existing Medicare rules and regulations.

What is missing from this story, told only by hospital association executives and a patient is why hospitals started this new billing practice.

Last year, for the first time, hospitals were fined by Medicare if there were too many re-admissions of patients who had recently had surgery.  By changing the coding to “observation,” patients are not technically re-admitted to in-patient care, and therefore,  the hospitals are not subject to fines by Medicare.

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Report on Catholic Hospital Mergers

Here are excerpts from www.MergerWatch.org on Catholic Hospital mergers that we reported on earlier this week.  The report seems to be framed as an issue of women’s health, but it is a broader issue that also affects end of life care.   Very interesting information also on charity care by hospital type.

http://www.bizjournals.com/seattle/blog/health-care-inc/2013/12/new-report-says-catholic-hospitals.html?ana=e_ptl_hc

My best wishes to you and your families during this Holiday Season.

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Major Report This Week on Catholic Hospital System Mergers and Impact on Reproductive Health and End of Life Care; Health Care Costs and Children’s Poverty and A Promising Program

First, my best wishes to you all for a lovely holiday season with family and friends. Thank you for your patience with me these past several months as a major writing project has kept me from the midst of the fray.

This week, however, MergerWatch, an organization out of New York will be releasing a report on the impact of the Catholic health system mergers with non-catholic institutions and the implications of that expansion on reproductive and end of life care.  For information on MergerWatch, see their website:  http://www.mergerwatch.org/

Here is the article about their upcoming report.

http://www.modernhealthcare.com/article/20131214/MAGAZINE/312149950?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMWGFWdndGRWxYOU9qTENvK25lK0g4UUxyMmxlMDVxbHc9PQ==

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Shrinking Health Care Networks on Exchanges, Expensive out of Network Costs, Local Hospitals Not Passing Quality Standards, Problems with Post Hospital Costs for Medicare, and more

While everyone is focusing on whether or not Healthcare.gov is going to work,  there are other significant issues about access that must be addressed.   A critical issues is who is in the networks offered in the insurance exchange products.

http://www.washingtonpost.com/national/health-science/insurers-restricting-choice-of-doctors-and-hospitals-to-keep-costs-down/2013/11/20/98c84e20-4bb4-11e3-ac54-aa84301ced81_story.html

What is at issue in these network restrictions is cost–and consumers could unknowingly be getting the short end of the stick.  As reported in The Seattle Times: 

“Premera, for example, limits annual out-of-pocket costs for in-network care at $6,350. But out-of-pocket expenses for care outside the network are “unlimited.”  (emphasis mine).

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Health care costs slowing, Failing to repeal it, GOP takes new aim at ACA, Medicaid expansion–just write off almost the entire south, while Congress has its own personal exchange

My apologizes for being remiss in sending regular stories and updates.  I have been working on a major writing contract with a series of tight deadlines this month and next.  These recent stories caught my attention, and they should yours.

Washington State ACA enrollment update:  As of November 78,000 people have enrolled through the state exchange and another 55,000 have completed applications.

Health Care Costs are Slowing.  Could provisions of the ACA already have a positive impact on health care costs?  See chart and story.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/11/20/this-chart-is-amazing-news-for-our-health-cost-problem/?wprss=rss_business&clsrd&wpisrc=nl_wonk

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We Must Find a Better Way

Please read the important article below about pricing of pharmaceutical products.  The issue, however,  is not just pharmaceutical products.  We ran a story in this blog in April about the high costs of some other therapies and how venture capital firms were building the treatments, as well as setting the prices for their products and services. It is not just cancer facilities, such as the Proton Cancer treatment facilities and medical devices we reported on (Health Care Technologies, Part I. Go to search on this site and ask for Proton Cancer therapy or Health Care Technology, Part I).  It is the high costs of pharmaceutical products as well.

This article in The Seattle Times is an excellent example of how pharmaceutical companies are setting their prices and what those families who have rare disorders face financially for potentially life-saving drugs. While this article focuses on pharmaceutical companies, they are not the only group that does this.

http://apps.seattletimes.com/reports/pharma-windfall/2013/nov/9/mining-rare-diseases/

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Transparency vs. Accountability: Washington State $3.4 Million Grant to Study Price Transparency

Washington State was just awarded a $3.4 million grant to fund a public/private partnership to examine health care price transparency.

http://www.bizjournals.com/seattle/blog/health-care-inc/2013/10/washington-wins-34-million-to.html

Specifically, the Washington State Office of Financial Management, the Health Care Authority, and the Office of the Insurance Commissioner are working with the Puget Sound Health Alliance (Alliance) to develop a statewide data center. The project will begin in October 2013 and end in September 2015.

The state will use the federal funds to establish a voluntary or mandatory reporting for all public and private purchasers by building upon claims data information already submitted to the Alliance.  The grant will also be used to create an inventory of medical cost data sources in the state; improve IT infrastructure; establish protocols on data access; and develop strategies to disseminate information to consumers.

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Drug Costs, Fast Tracking and Dangers of Some Biologics; Getting Caught in Medical Debt; Continuing Looks Into and Questions about Hospital CEO Salaries; Bree Collaborative Seeks Public Comment on Bundled Payments for Hips and Knees; How the ACA Impacts Employers, and Finally a Survey That Let’s You Object, Abstain and Comment! And Happy Birthday, Dick Spady, 90 YO 10/15!

While health care costs have been slowing, drugs are becoming increasingly expensive. This article raises troubling questions about how we set our pharmaceutical and medical device costs. Even agencies that are supposed to police medicines and devices let the manufacturers set the price.

http://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-simple-breath.html?nl=todaysheadlines&emc=edit_th_20131013

I am including this article on fast-tracking drugs.   This abstract deals with the new move to fast track ‘biosimilars.’   I did an earlier article on some of the problems with fast-tracking other medications.  Clinical trials are relatively short; most of the people in the trials are healthy; most trials include only 1,000′s of people. When the approved drugs go to market, they are used by hundreds of thousands people, many of whom will have other health issues—which has led many health insurers to not use new medications until they have been on the market for five years.

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On The Eve of the ACA Enrollment: There Are Issues Other than Enrollment

Now here is a terrific idea thanks to ConsumerReports!  Demand warranties of medical devices, such as knees and hips,  just as we do for dishwashers, refrigerators and cars. Isn’t something in our bodies, or robots doing things to our bodies, every bit as important as warranting a refrigerator? You can buy a new refrigerator; it is not as easy if faulty hips need replacement or shredded metal in your body.   This would be an excellent idea to hold the FDA more accountable!

http://www.consumerreports.org/cro/news/2013/09/replacement-hip-and-knees-need-a-lemon-law/index.htm

An intriguing idea for hospitals with uninsured patients who are in and out of hospital ERs:  http://www.healthleadersmedia.com/content/HEP-296819/Can-Hospitals-Pay-Patients-Health-Insurance-Premiums

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