Stanley Feld M.D.,FACP,MACE
Modernizing the Medicaid Benefit and Protecting Medicare Beneficiary Choice
The health security for low‐income families and American seniors is threatened by the outdated formulas and exploding costs of Medicaid and Medicare. These vital programs require significant reforms to better balance value for those beneficiaries in greatest need and protection for U.S. taxpayers. The Patients’ Choice Act would make important improvements to both programs without limiting eligibility or benefits by:
• Integrating low‐income families with dependent children into higher‐quality private plans through direct assistance
What is the definition of higher-quality private plans? Who is going to judge quality? How is government going to fund these “higher quality private plans?”
• Removing the stigma of Medicaid and providing access to the same coverage options available to all Americans
How will this be accomplished when Medicaid reimburses so poorly. There is a shortage of Medicaid physicians already. These physicians must do a volume business (Medicaid Mills) to make ends meet. These volume practices (Medicaid Mills) are being investigated for fraud.
• Realigning responsibility between federal and state governments in order to better coordinate benefits by requiring the Medicare program to assume Medicaid responsibility of premiums, cost‐sharing, and deductibles for low‐income seniors
The above is just words. It almost sounds as if the federal and state government are going to be responsible for increased funding for private enterprise.
• Rebalancing long‐term care services to ensure choice between institutionalized and home‐based care
• Empowering Medicare beneficiaries with more choices and more power by reforming Medicare Advantage
Medicare Advantage is recognized as an insurance product designed to rid the government of the Medicare entitlement . The government under the Republican administration paid an extra $3,000.00 per person to outsource the responsibility for Medicaid from the state to the healthcare insurance industry. The cost is unsustainable. Excess profits flow to the healthcare insurance industry.
• Allowing for the creation of Medicare Accountable Care Organizations that would improve payment to
physicians, hospitals, pharmacists, and nurses for demonstrable improvements in quality and patient satisfaction while reducing costs
This is a “pay for performance a system” that ultimately cannot work because of intrinsic defects in the pay for performance concept. Quality medical care has not been defined appropriately. Is it defined as medical outcomes, financial outcomes, number of test performed or disease discovery?
• Requiring wealthy Medicare beneficiaries to contribute a little more for their care under Medicare Part D
Medicare Part D is a poorly constructed in the present form. It is written to the advantage of the healthcare insurance industry, the pharmacies and the pharmachuetical companies. It is not a patient centric plan.
Ensuring Compensation for Injured Patients
Our current legal system does a poor job at compensating patients for medical mistakes in a fair and efficient manner. Instead of nurturing an environment where medical professionals can openly learn from their mistakes, our legal system often forces doctors and patients into contentious courtroom disputes. The Patients’ Choice Act would reform this broken system that helps drive health care costs out of control by:
• Encouraging states to adopt a number of legal alternatives entirely run by the state that would include the establishment of expert medical panels to resolve disputes, creation of health courts, or a combination of both
This is logical. How are they going to encourage states to adopt legal alternatives when the law makers are lawyers? When there aren’t specific legislative action points nothing gets done.
Establishing Transparency in Health Care Price and Quality
For a vibrant health care market to function properly, patients must know what services cost and who provides the best service. Uniform and reliable measures of reporting quality and price information should be designed by the stakeholders in health care rather than the heavy‐hand of government. The Patients’ Choice Act would bring this much needed transparency into the health care market by:
• Creating a Healthcare Services Commission that relies on a public/private partnership to enhance the quality, appropriateness and effectiveness of health care services through the publication and enforcement of quality and price information
• Empowering the private sector – rather than Washington bureaucrats – to set standards on price and quality with the input from all major stakeholders in health care, as well as the general public
• Ensuring that measures of effectiveness keep pace with innovation
This is the most logical proposal in the plan. It also contains specific action points. However it keeps the power in the healthcare insurance industry’s hands. It should put the power in the consumers’ hands. If the private sector (healthcare insurance industry) does not cooperate, it should be restricted from selling insurance by the state board of insurers.
There is the entire proposal. There is nothing new and no outline of action to accomplish any part of the proposal.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
I would like to Thanks for the informative post. I really appreciate it. The health security for low‐income families and American seniors are threatened by the outdated formulas and exploding costs of Medicaid and Medicare. These vital programs require significant reforms to better balance value for those beneficiaries in greatest need and protection for U.S. taxpayers.
The above is just words. It almost sounds as if the federal and state government is going to be responsible for increased funding for private enterprise.
This is logical. How are they going to encourage states to adopt legal alternatives when the law makers are lawyers? When there aren’t specific legislative action points nothing gets done.
Chiropractic EMR
Posted by: Chiropractic EMR | January 06, 2011 at 02:28 AM
Where is CBO’s calculation for Fraud?
Healthcare Fraud- SEC Fraud - Bankruptcy Fraud and Financial Fraud – a trail that just ended in December 2008 where Leo Wise, not at ethics CBO stated?
'Ladies and gentlemen, this is a case of staggering fraud,' Leo Wise said. 'It is one of the largest frauds the FBI has ever investigated.
RICK SCOTT - Chairman of Conservatives for Patients' Rights
July 26, 1997, Los Angeles Times article:
A controversial deal maker whose hard-nosed business tactics have reshaped the medical industry resigned Friday as scandal engulfed the vast hospital empire he had assembled over the last decade.
Richard Scott -- sometimes called "the Bill Gates of health care" – was chairman of Columbia/HCA Healthcare Corp. –
Columbia/HCA was a partnership of financier Richard Rainwater of Ft. Worth and lawyer Richard Scott. Scott was recently terminated by Darla Moore, the wife of Richard Rainwater amid a massive federal investigation into the Medicare billing, physician recruiting and home-care practices of the nation's largest for-profit health care company.
Columbia was the nation's largest provider of healthcare services, with facilities in 36 states, England, Switzerland and Spain. Columbia's networks include 342 hospitals, 148 surgery centers, more than 570 home health locations, and a nationwide pharmacy benefit management; A Pharmacy Benefit Manager (PBM) is a third party administrator of prescription drug programs.
Medicare Part D? Is this government subsidized program profitable for your company- whatever the name is today- 2009?
2009-The Wall Street Journal reported that Richard Scott, "the former chief executive of HCA Inc," had formed the non-profit organization Conservatives for Patients' Rights as part of a "lobbying campaign to derail or modify" President Obama's health care proposals, but failed to note that Scott’s departure from HCA in 1997 amid a federal investigation into the company's Medicare billing, physician recruiting, and home-care practices.
While Senator Frist was the majority leader in Congress this is what was settled on the massive fraud- at his family’s empire:
2003- WWW.USDOJ.GOV
HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company)
LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED
Healthcare Fraud-SEC Fraud-Bankruptcy Fraud-Financial Fraud-----Some of the LARGEST FRAUD CASES in our country all stem from the Balanced Budget Act of 1997.
On Sept 8, 1998 Standard and Poors downgraded the bonds of Charter/HCA to negative bases on poor earnings.
Rainwater also owned a large stake in Magellan Health Care which controls Charter Medical.
Magellan, run by Darla Moore, is the largest network of psychiatric hospitals in the country. They are becoming more and more involved in obtaining government money for services formerly not covered as health care, according to Fortune Magazine.
Columbia/HCA Healthcare Corp. - the nation's largest for-profit health care company decided to sell its home health-care business
Home health - was struggling under the Balanced Budget Act of 1997- about 1,400 agencies closed nationwide in 1998.
On July 29, 1999 Medshares filed the largest corporate bankruptcy filed in the state of Tennessee.
The court utilized the DIP Finance tool. Darla Moore, the wife of Richard Rainwater and according to Fortune Magazine, was the creator of DIP Finance while at Chase Bank in late 80’s.
At Medshares, consolidation is key to its strategy of being one of the survivors of the home health shakeout. Its management company, TBN of Tennessee Inc., swallowed up the home health units of Columbia/ HCA Healthcare Corp. and Integrated Health Services in late 1998 and early 1999, only to file for bankruptcy protection for Medshares and Soleus Healthcare Services, formerly IHS Home Care, a few months later.
2002 FBI raids National Century Financial Enterprises
“This case is one of the largest corporate fraud investigations involving a privately held company headquartered in small town America,” said Assistant Director Kenneth W. Kaiser of the FBI Criminal Investigative Division.
'Ladies and gentlemen, this is a case of staggering fraud,' Leo Wise said. 'It is one of the largest frauds the FBI has ever investigated.
All of Columbia Homecare Group units were at National Century Financial Enterprises.
ONE month before GW Bush left office- All other execs at National Century Financial Enterprises were found guilty and convicted.
December 2008 - the largest fraud case FBI has ever investigated-ONE ACQUITTAL-
Posted by: sasha2008 | June 23, 2009 at 08:00 AM