Aging And Your Family: Finding The Systems that Work

Introduction:   As we gather with family and friends on this celebration of our national independence, let’s think on independence and quality of life as we or our family members age.

Despite harping about the flaws of our health care system I have seen a system work. After my father’s death I became my mother’s caregiver.   I was confident I could manage her care. I had worked in and wrote about health care for nearly 30 years.  I started my health care career in aging and long-term care.  I had been a Medicare HMO marketing director.  I knew it all.  I thought.   Here’s what happened to my family until we found a system that worked:

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A New Direction for O’ConnorReport: ACA “Watch Dog” and new Showcases of Success

The Supreme Court’s decision validates the core of the Affordable Care Act.  Still much more remains to assure safety, quality and value (bang for the buck). To date, I have focused on the systems’ ills. What we heard loud and clear when we at CodeBlueNow! asked  people about the system was: “Show us what It Will Look Like.” 

As we create a new more user friendly, engaging and robust website, I want to do two things:  1) be a watchdog on the system and 2) be a ‘scout’ that showcases the good and the possible.  My concerns and interests are:

  • Mergers and consolidations among insurers, hospital systems and ‘multi-vendors’
  • Increase in for-profit providers especially in home health care, senior residences and hospice
  • Meaningful patient surveys
  • Real Community engagement models for quality and needs assessments
  • Successful replicable models of care, quality measures
  • Accountability at all levels—cost, quality, safety and community engagement

Ezekiel Emanuel, one of the ACA’s architects, voices similar concerns about consolidations and anti-trust in Reinventing American Health Care. 

The Supreme Court decision is a major victory, but there are more than a few big battles/issues ahead.  As a friend said about the system after reading my book:  “Too many cooks in the kitchen.”  So we must remain alert.

That said, there are more and more bright lights as we will see next:

Coming next—a look at a long-term care system that actually worked for my mother and me. Plus some models of hope for frail elders as 10,000 baby boomers a day turn 65 into a system that is not prepared for them……..Yet. Continue reading

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Insurers Consolidate and Merge and A Quick History of Health Care Reform: The Good, the Bad and the Ugly

No matter what the Supreme Court Decides

Much remains to be done.  Insurance is regulated at the state level.  Even if subsidies are approved, more fights remain ahead.  http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.html

Insurance company consolidation:

“Merger activity is heating up now because the insurers have become tremendously cash-rich,” says Fuller, who studied the balance sheets of several companies this week. “While hospital revenue is improving somewhat,” he says, “the balance of power when negotiating with the merged companies will definitely be in favor of the insurers,” Fuller predicts.  317643/MegaMergers-Among-Health-Insurers-Bode-Ill-for-Hospitals

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A short selection from  “A Quick History of Health Care Reform,”  in The Buck Still Stops Nowhere (order now!)   Or, support this independent voice and donate today!  We give you news and tools you won’t find elsewhere! 

A Quick History

Benjamin Franklin starts insurance for fire protection. Insurance
not considered commerce and therefore not subject to federal
regulation
• 1752—Benjamin Franklin founds insurance
industry with Philadelphia Contributionship of
Houses from Loss by Fire.

• 1869—in Paul v. Virginia Supreme Court decides “issuing a policy of insurance is not a transaction of commerce.” States have responsibility for taxation and regulation of insurance.

• 1929—1932—Committee on the Costs of
Medical Care formed. A private national
commission created by AMA to examine
ways to control health care costs and prevent
bankruptcies for American families. Failed.

• 1942—1950’s—Wage-price freeze. War Labor
Board rules wage price controls do not apply
to fringe benefits, such as health care. National
Labor Relations Board rules that employee
benefit plans are subject to collective bargaining.
Health care benefits allowed as compensation
during WWII wage /price freeze. Beginning of
health care as a form of employee compensation.
FDR administration.

• 1944—Supreme Court in U.S. v. South-Eastern Underwriters Association decision declares insurance is commerce and therefore subject to federal regulation and oversight.

• 1945—Congress enacts McCarran-Ferguson

Act and gave states continuing authority to
regulate and tax insurance and declared that
state regulation was in best interest of consumer.
Insurance exempt from federal anti-trust laws.
This act over turned the 1944 Supreme Court
Southeastern Underwriters decision that made
insurance regulation subject to federal regulation.

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Non Profit Hospital Profits Double–But There are Tools You Can Use

Non-Profit Hospital ‘profits’ have doubled in the last decade. Don’t give up hope!  There are tools we can use.

1) Non-profit hospitals must report executive compensation to the IRS on Form 990 Schedule J.  Washington state reports their compensation annually. This is public record.  Information can be found for hospitals in other states. See WA State’s report here:  http://www.doh.wa.gov/DataandStatisticalReports/HealthcareinWashington/HospitalandPatientData/HospitalFinancialData/HospitalEmployeeCompensation/2014HospitalEmployeeCompensationReports

2) The Affordable Care Act requires hospitals to conduct community needs assessments and promote their financial assistance policies.  If they do not comply they face penalties of $50,000. That can be $50,000 per hospital in a larger hospital system. http://healthaffairs.org/blog/2015/01/23/additional-requirements-for-charitable-hospitals-final-rules-on-community-health-needs-assessments-and-financial-assistance/

Hospital boards of trustees are responsible to see their institution complies. This is what non-profit hospitals are required to do to remain tax exempt: http://healthaffairs.org/blog/2015/06/17/health-affairs-web-first-us-nonprofit-hospital-tax-exemption-almost-doubles-between-2002-and-2011/

3) The Washington Health Alliance in Washington state produced a series of reports on costs, quality and community check-ups.  www.wahealthalliance.org  Much of their information is public record as well. Public record information, however, is just not easy to find.

Keep reading!

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Did You Know? New Series on Long-term Care. PART I: Medicare Can’t Negotiate Drug Prices—VA and Medicaid Can

The Presidential election season is once again upon us.  The Affordable Care Act deals with some Medicare issues, but some key ones are not addressed. Pharmaceutical costs and long-term care are two of them.  Here is a question you can ask!

Why can’t Medicare negotiate rates with pharmaceutical companies, but Medicaid and the VA can?

A Story: Congressman Billy Tauzin led the Medicare Part D legislation that added prescription drug benefits to Medicare.  Medicare Part D, however, prohibits Medicare from direct rate negotiations with pharmaceutical companies.  It leaves rate negotiation to individual Medicare supplemental insurance policies with less negotiating power and leverage because of their smaller size.

Medicare Part D legislation passed in 2003 and became effective in 2006.  In 2005 Billy Tauzin was named CEO of PhRMA (Pharmaceutical Research and Manufacturers of America) the professional and  lobbying organization for the pharmaceutical industry.  Tauzin led PhRMA from 2005-2010.  www.phrma.org

As candidates hit the campaign trail ask them why Medicare can’t negotiate   rates, but Medicaid and the VA can?

We need to hold elected officials accountable to our needs, not those of deep pocket donors–be they PAC, corporations or employees of corporations who can make large contributions.

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I could use your help! I can’t do all this alone.   I want to start a Kickstarter (crowdfunding) campaign to raise funds to make my website more user friendly, accessible and robust for both my blog, my book and people’s stories. To kick off  a campaign, I need a mock/proto type of the website, a brief video explaining what I intend to do with the website, blog and book.  I have video producer/filmer and the website developer lined up and they can start in July.  If I have funding.  I seek modest support of  $3,000–$4,000 from now through July.  

The campaign will be to create an interactive robust, user friendly website that can post individual stories, new articles, updates and reports and have video capability for people to tell their stories.  It will also highlight and promote elements of the book so it is not something static stuck on a shelf as the winds of health care shift.

Please Donate Today:   I need your support to give you information and tools you can use and won’t find easily elsewhere.   

My heartfelt thanks for your constant encouragement and support.  There is still much to do no matter what the Supreme Court decides this June.

Kathleen

 Story Background Information and Sources: 

http://kff.org/medicare/video/the-story-of-medicare-a-timeline/

http://blog.cahealthadvocates.org/2014/05/why-cant-medicare-negotiate-lower-drug-prices-for-part-d/

http://sunlightfoundation.com/blog/2010/02/12/the-legacy-of-billy-tauzin-the-white-house-phrma-deal/ Continue reading

Posted in business, consumer protection, Health Care Reform, medical bankruptcy, Medicare, patients' voice, policy and politics, technology and pharmaceutical costs | Tagged , , , , , , , , , , , , , | Leave a comment

What Hospital Executive Earn 2014: Linking Compensation, Quality and Accountability

1. Hospital Executive Compensation

The Washington State Department of Health’s annual hospital executive compensation report is being released in May and June as data are assembled.  Executive compensation includes:

  • base compensation
  • bonus and incentive compensation
  • other reportable compensation
  • retirement and deferred compensation
  •  non-taxable benefits

Washington State is the only state that requires such public reporting.   

The state’s information is from the IRS Form 990 Schedule J.  All non-profit hospitals must use the 990 Schedule J in their annual tax filing. This information is public record. Therefore, you can find information about hospitals in your state. 

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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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