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Showing posts with label consumer protections. Show all posts
Showing posts with label consumer protections. Show all posts

Sunday, August 6, 2017

Trump Report Card-Cabinet Actions Midway Through First Year

Trump Report Card-Midpoint Year 1


Donald Trump has been POTUS for half of his first year and this article reviews what his cabinet has accomplished and the direct impacts on you. President Trump’s opinions and omissions do create harmful consequences as this report card illustrates.

What’s at Stake
Cabinet Member
Perspectives
Analysis
Your Health
The Secretary of Health and Human Services controls the following agencies: Centers for Medicare and Medicaid, Food and Drug Administration, administers the Affordable Care Act, and grants more money for medical research than any other agency in the world.
Tom Price, Republican from Georgia, He is an orthopedic surgeon, and represents one of the healthcare sectors with expensive medical devices and lucrative profit margins for health systems. Resentful of the 3% medical device tax his industry pays to fund the Affordable Care Act for low-income Americans.
Wants to get rid of Obama Care and replace it with another insurance based payment system. Questions the value of the Centers for Medicare and Medicaid innovation through Demonstration Projects. He wants to reduce the footprint of government policymaking in healthcare. Though he wants consumers to shoulder more responsibility for their health care, he questions the value of performance assessment as a component of government funding and oversight by government agencies. CMS’s Accountable Care Organization program has been successful and 31% of 2015 participants received bonuses. There are 400 healthcare systems participating in this program.
Would he impinge on medical research by eliminating stem cell research as his predecessor George Bush did?
🔻Price has used HHS money to discredit the Affordable Care Act. It is unclear what will be done to support the open enrollment period which starts in 2 months. 🔻Trump may try to strangle the act by refusing to pay the financial subsidies to insurers who participate in the exchanges, thus causing them to drop out. This ploy would produce a result sought by many Republicans-to kill the ACA. Millions could still end up without healthcare and no public option. 🔻Other death knells may include cutting some of the funding provisions for the act, such as the 3% medical device tax. 🔻The agency may also stop enforcing proof of medical insurance requirements with the IRS, thus gutting revenue from fines for companies and individuals who do not comply.[1] 🔻The proposed federal budget seeks a 20% cut for Health and Human Services, which will hurt medical research and is yet to be approved, but is next on the docket.  🔻
And finally, another legislative rollback-loosening the requirement that religious organizations offer birth control under their medical insurance.[2]
Your Air and Water
The Environmental Protection Agency sets standards for air & water quality, extracts fines from offenders, and litigates as required for compliance with federal and state laws.
Scott Pruitt, Republican, former Attorney General and former senator from Oklahoma, Secretary of Environmental Protection Agency
The EPA was created by the Nixon Administration and is responsible for improvements in air and water quality throughout the nation. Pruitt wants to gut the Clean Water and Clean Air Acts signed by the Obama Administration. Has pledged to dismantle the EPA and is in the back pocket of the oil and gas industry. He has been vociferous in his lawsuits against government regulations. Doesn’t think global warming is an issue. Wants to get out of the Paris Climate Change Accords, which were signed by 95 countries.

🔻U.S. dropped out of the Paris Accords, a nonbinding commitment to cut greenhouse gases, the greatest contributor to global warming and the melting of the polar ice caps. Obama Administration Clean Air Act forces power plants, especially coal powered ones, to reduce particulate emissions. The act established standards for emissions but allows flexibility for states to administer. 🔻The Trump administration has provided a 90-day stay on implementation of the Clean Air mandate. Tough luck for the asthmatics. The OMB’s budget will detail financial impacts of this act and Department of Interior revenues.[3] 🔻The Keystone Pipeline is back to transport earth scorching arboreal forest decimating Canadian tar sand oil to the U.S. for exportation. 🔻Congress also approved exportation of U.S. oil reserves because we are producing more than we need, whereas in normal market economics, production would decline when there is a market surplus. This is a subsidy for the oil industry.
Your Children’s Education Department of Education sets national standards for education (No Left Behind and Common Core), provides funding, and enforcement of standards
Betsy DeVos, former chairwoman of the Michigan Republican Party, is from the Amway family of billionaires and has never attended a public school, nor have her children. She attended Calvin College, a private liberal arts college.   She is the sister of infamous military defense contractor, Eric Prince, founder of private mercenary group, Blackwater.

Wants to deconstruct the agency and give more responsibilities to states, counties, and individual districts to set curriculum. She is a huge supporter of charter schools, which are funded with public funds but operate like private schools. She advocates a school voucher system where the government would essentially provide support for private schools. In Michigan, 80% of the schools are run by private companies. She is does not believe in recognizing homosexuality.
🔻Budget includes a 13% reduction in education funding.[4] 🔻This includes reducing college loans for low-income students under federal loan programs. 🔻Other actions include reducing Title IX enforcement of sanctions for campus sexual assaults. 🔻Relaxing federal standards to comply with Every Student Succeeds Act, for which 12 states have already submitted plans.[5]
🔺Surprisingly she appeared to waffle on the lavatory restriction for transgender folks, crossing AG Sessions.
She still needs to learn to spell.

Your Money
The Department of the Treasury, oversees revenue collection through the IRS, and sets standards for currency and financial management for the nation
Steve Mnunchin, former Goldman Saks executive and Hollywood film financier, is a Wall Street banker insider, who graduated from Yale.
Wants to loosen the Dodd-Frank  reserve standards for banks, created to prevent another financial meltdown due to hedge funders and bad bank decisions. The landmark Dodd-Frank Act, stewarded by Senator Elisabeth Warren,  created liquidity standards for banks to prevent the financial collapse of the nation and the world. If the U.S. government hadn’t bailed out AIG Insurance, General Motors, Fannie Mae, Freddie Mac, and a host of banks the depression would have been much more severe. (ProPublica.org, 2016)
Trump and Mnunchin cannot agree on the budget. 🔻He has identified methods to ease banking regulations without Congressional approval, including bank solvency stress tests, passed after the 2007 banking collapse.🔻 And most grievously, reducing the power of the Consumer Financial Protection Bureau, which has been successful in reducing predatory behavior by lenders.[6] Funding for this agency is not subject to Congressional approval-Trump wants to change this. CFPB has created lending standards for banks to verify income before providing mortgages. Enforcment-27 million Americans have received settlements from banks because of its actions.[7]
Your Liberty
The Attorney General of the United States, oversees the administration of federal laws, court system, and the enforcement of anti-trust and civil rights laws.

Jeff Sessions, Attorney General, is a former Republican Senator from Alabama, and former Attorney General of Alabama. He was rejected by the Reagan Administration for a federal judicial appointment because of racist views.
Has a reputation of being anti-immigrant, anti-Muslim, and anti-gay (LBGTQ). One of the most conservative members of Congress often at odds with his own party. Is a supporter of the stop and frisk ethos.  Widely considered to have racist views.
Sessions has been neutered by Trump and the investigation into the Russian election coupe. 🔻The ill-conceived Muslim travel ban is subject to lawsuits. 🔻He has instigated the war on drugs, wants to remove judicial discretionary sentencing, and imprison more people. Think Opioid abusers in jail not in treatment.🔻 Also revived a federal law allowing government to seize property for those suspected of crimes.🔻 He dumped the National Committee for Forensic Science, which aims to improve crime solving techniques and accuracy.[8]
Your National Parks
The Secretary of the Interior oversees the vaunted National Parks system, national forests, and all public lands, including the Bureau of Indian Affairs.
Ryan Zinke is a Republican freshman senator from Whitefish, Montana who is a former navy SEAL commander.
One of his most alarming views is he considers climate change to be unsettled. We don’t know anything about his governance perspectives. He has friends in the coal and fossil fuel industries, which is why the freshman senator with no regulatory experience was made a cabinet member. Montana has many tribal lands, including the Flathead Indian Reservation, near Whitefish.
🔻Reduced the fees coal companies pay to strip coal from our federal lands.[9]🔻Overturned Obama Administration ruling which stopped coal companies from mining on federal lands.[10] Coal is no longer an economical source of power, especially if the gov. makes them pay fair market rate for leases. Coal is one of the greatest contributors to particulates in air pollution. Much of the coal being gouged out of the earth now goes to China, the largest polluter in the world. 🔻Next up-looking to limit the rules which restrict the greenhouse methane gas production from oil and gas sites on federal lands. In other words, it is back to raping and pillaging public lands as usual.
Your World
The Secretary of State is 4th in line to the presidency and is chief negotiator of foreign policy on behalf of the nation, also responsible for coordination and security of diplomatic posts.
Rex Tillerson, former chief executive of Exxon, has lucrative financial interests in countries which are considered enemies, including Russia.
Tillerson has a fifteen-year relationship with Putin, czar of Russia and advocates loosening of economic sanctions. Unlike other Trump nominees, he favors climate change action, including the carbon cap taxes on emissions. He also favors supporting the 2015 Paris Accords for Climate Change Action. He probably would favor the Keystone Pipeline completion.
The far-flung oil and gas interests of Exon and his personal wealth may be impacted by actions of the federal government. With the Mueller subpoenas, no one is safe from the Russian scandal. It appears Trump does not listen to the Secretary of State, preferring to decide foreign policy with those whom were not subject to Congressional approval, the informal Whitehouse advisers and of course, his children. Tillerson is a micromanager focusing on reorganizing the State Department.
Transportation
The Secretary of Transportation
oversees highway safety and road construction projects.
Elaine Chao is the former head of the Department of Labor and married to Senate Majority leader, Mitch McConnell. In other words, the ultimate insider.
One of Trump’s centerpiece platforms is the rebuilding of America, so Chao will be responsible for contract letting, management, and other infrastructure requirements.
Chao has not accomplished anything of note because the federal budget is not yet approved nor is an infrastructure bill. She is waiting in the wings.
Keeping the Lights On
The Secretary of Energy has oversight of the nation’s nuclear arsenal, also sets policy on utilization of resources to develop and maintain the nation’s energy grid.
Rick Perry, is the former Texas Governor, failed presidential candidate, and middling Dancing with the Stars Contestant. Of note, he was once a Democrat.
The only qualification Mr. Perry has for energy expertise, is his support of wind power in his home state. He has no scientific background and has suggested the Department of Energy could be eliminated.
Perry is on the National Security Committee but he does not appear to have done anything to enhance our security. He did slam the Paris Accords. Important to note, two nuclear power projects were shut down in July in South Carolina because they were not financially viable given other less costly energy alternatives. A list of other nuclear power projects which have been cancelled is included in the footnotes. [11] [12] [13]

Progress
Women’s March✅ Science March✅ Defeating the repeal of the Affordable Care Act✅ It is heartening to see the massive efforts of citizens who are thwarting the Trump Administration regularly.  Hopefully this article will provide some ideas on other policy issues which require attention and action.  Trump has proven himself to be the nightmare we all feared, a global disrupter who does more harm than good. A thriving democracy is an essential component of liberty and I am heartened by the participation of millennials in many of the efforts to resist the Trump Administration’s selfish initiatives. For more information on efforts to curb disastrous environmental policies, read  Geoff Dembicki's, "Are We Screwed-How A New Generation Is Fighting To Survive Climate Change," Bloomsbury Press.  And this is the healthpolicymaven signing off and encouraging you to share this article with all who value their democracy.

Roberta Winter is a freelance journalist who publishes under the trademark healthpolicymaven, which has been in continuous use since 2007. She is a public policy and healthcare book reviewer for the New York Journal of Books, a technical writer, and author. Her consumer guidebook to the U.S. healthcare system was published by Rowman & Littlefield in 2013. https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972




Tuesday, May 20, 2014

State Laws Which Inform the Consumer of Health Care Prices and Quality



Does Your State Help or Hinder Your Access to Quality Health Care?
This article reviews state health care laws impacting clinical care and resourcing in light of the Accountable Care Act and the needs for primary health care. The recent articles in the academic Health Affairs Journal and by the nonprofit advocacy group, The Commonwealth Fund, address the issue of market competition in health care delivery and the impact on services as well as the potential for anti-trust issues. Anti-trust occurs when a single health care entity or a consortium of providers exerts enough control of the market in a given geographic region, to dictate prices, and to be able to perform in an atmosphere where the consumers have fewer choices. In other words, to charge more without offering an improvement in service. Now, with that in mind, some of the state laws that throw a monkey wrench into this idea of a competitive marketplace for health care are; certificate of need requirements, any-willing-provider regulations, and scope of practice limitations. One example of a legislative limitation on the regulation of health care services, as reported in the state-wide surveys in Unraveling U.S. Health Care-A Personal Guide[1], several states outlaw the practice of naturopathy, which limits the number of clinicians for primary health care. There are also administrative limitations which states use to restrict access for clinical training, such as limiting the funding to university programs for nurse practitioners, thereby restricting the number of clinicians available in the health care system. From an economic standpoint this keeps the compensation high for the practitioners, but results in a dearth of clinicians in an area of great societal need.
As Martin Gaynor points out in Health Affairs’ May 2, 2014 publication, Competition Policy, and Markets: Navigating the Enforcement and Policy Maze, health care delivery, inclusive of insurance and health care services is governed by many different and oft times conflicting entities, from federal to state and local governments.[2] This mishmash of regulation does not result in more effective or less expensive health care.
The Patient Protection and Affordable Care Act created the Accountable Care Act mandates for health care organizations, which pays for clinical performance for treatment of targeted diseases. Now that the ACA has been implemented by many health care systems, financial rewards have been paid, and two years of data is available, there has been sufficient time for states to evaluate and modify their health care sector regulations.  One of the consequences of the ACA has been the merger of many hospitals, which has reduced competition and services in some areas. In Washington State, as I have previously written, Providence Health Care acquired Swedish Hospital Group and Peace Health controls many of the markets in smaller cities throughout the state. Though consolidation may benefit these health care behemoths, it does not necessarily improve or reduce the cost of health care for the consumer.
In order to have an effective market place, one must have a willing buyer and a willing seller, in pure economic terms. Health care, because it is so heavily regulated is not a typical consumer good, however, because most of the health care systems in the United States are not government owned, we do essentially have a privatized system of health care delivery, albeit one which is heavily subsidized by government payments.
These states have enacted price transparency laws for health care providers to bolster their consumer marketplace in light of the Accountable Care Act provisions: Arizona, Arkansas, California, Colorado, Delaware, Florida, Illinois, Indiana, Kentucky, Maine, Massachusetts, Minnesota, Missouri, Nevada, New Hampshire, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Texas, Utah, Virginia, Vermont, Washington, and Wisconsin.
Though price transparency is one of the key aspects of an effective consumer market place from which to buy goods and services, it is not optimal unless you also have the quality of the services also disclosed. Medicare has tracked health care outcomes for years and there is information available by procedure for price and quality on its web site. In January 2014, I presented a consumer tutorial on this tool in my Phinney Community Center presentation. It was obvious from that presentation, that consumers still find the availability of health care quality information difficult to understand and access. If we are going to persist in offering a private sector market place for the purchase of health services, we must demand that price and quality information be available. Clinical outcomes, such as hospital readmission rates, infections, and surgical errors, are examples of health care quality measures. Though aggregated information is available on this data, few states have taken the time to match patient outcomes with pricing. As detailed in chapter seven, Patient Safety-Who Reports Medical Errors, in my 2013 book, Unraveling U.S. Health Care-A Personal Guide[3], Minnesota has a state web site that allows anyone to view each hospital’s medical errors in the state.
As revealed in the National Conference of State Legislatures’ April 2014  article, Transparency and Disclosure of Health Costs and Provider Payments: State Actions, Minnesota is also the state which has created a commission to link health care quality and pricing information in a consumer friendly model, to enhance the effectiveness of its health care market place.[4] This level of transparency is the gold standard and is something consumer driven health care advocates should demand.
Nevada also has an interesting law which mandates health care providers must charge everyone the same price for the same service, in other words they can’t charge higher prices to the uninsured or for those on different health plans. This too, is an interesting approach to a market place correction, because if all prices for the services are set and transparent, then the health care providers must compete on quality, which is really, the most important aspect of health care.  It will be interesting to see how this plays out in Nevada.
And of course, Maryland has had a mandate for level pricing for hospital services on the books for thirty years, and it has been effective in keeping health care costs down, as reported in my December 2013 article on hospital price transparency.
Stay tuned for more information on initiatives to improve consumer information on health care quality and price thus enabling individuals to make informed health care decisions. And this is the healthpolicymaven signing off, encouraging you to share this article with anyone who may benefit.


[1] http://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972
[2] http://content.healthaffairs.org/content/early/2014/05/13/hlthaff.2013.0810
[3] http://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972
[4] http://www.ncsl.org/research/health/transparency-and-disclosure-health-costs.aspx#Legislation

Friday, September 13, 2013

Ten Things You May Not Know About The Accountable Care Act



Ten Things Health Care Consumers May Not Know About the Accountable Care Act

The Accountable Care Act is perhaps the most meaningful of the 2010 health care reform mandates and a number of health care organizations have completed their first year in the program. This article highlights some of the consumer protection and cost cutting mandates and reveals the impetus for each element.
1-Application of evidence-based medical care, as a means to evaluate and pay for health services  
One of the results of the fifty-state, private payer national health care panorama is there are a lot of differences in patient care patterns, with some doctors ignoring the evidence based recommendations of national organizations, which result in disparate clinical outcomes. This means significant variances in patient deaths, re-admission rates for hospitalizations following treatment, and medical complications. An example of this phenomenon is in cardiac care, which has expanded the application of the very expensive cardiac pacemaker devices from the initial 1984 list of fifty-six diagnosis to the 2008 guidelines now at eighty- eight.[1] The problem with this robust expansion is scope-creep because only 5% of these recommendations are backed by the findings of “gold standard” randomized double-blind studies, which control for bias and are subject to rigorous scientific controls. To put it bluntly, many patients have received pacemakers for which the clinical research shows were not justified.
Cardiac device manufacturers like St. Jude Medical and Medtronic earn a tidy sum, roughly $7,500 for each pacemaker device, regardless of what the hospital receives in compensation and Medicare pays for most of these devices.[2] The medical device companies have earned between 48% and 20% net profits for years, meanwhile many hospitals  serving Medicare and Medicaid patients are starved for cash, as the current Medicare reimbursement model rewards the device makers and the cardiac specialist more than the hospital or the primary care doctor.
 The creation of the Patient Centered Outcomes Research Institute is an attempt to have an independent third party entity audit and recommend treatment practices based on scientific studies, especially for government funded health care programs. Many health care companies are outraged about this new agency oversight, but it is directly due to the opportunistic behavior of medical suppliers, specialists, and some hospitals at the expense of the health care system.
2-Creation of the Medical Home Criteria due to the over emphasis on specialty care while ignoring primary care
Facts of life in American health care include a plethora of specialists swarming over a patient in an acute care setting, but no one coordinating patient health over the care continuum. Medical schools produce more specialists than primary care providers now and the specialists earn a lot more money, which means political power in hospitals, medical associations, and in the beltway. By way of comparison, the mean income of cardiologists in 1987 was $271,555 versus less than $100,000 for primary care doctors, including family practitioners and pediatricians. Medicare is primarily to blame for this discrepancy as its reimbursement for clinical care has favored procedures and not time spent with patients. Ergo the doctor who spends the most time with the patient and may be the better practitioner will make less money.
3- Improved integration of patient care by observing key diagnosis and patient outcomes and paying people more for improved clinical performance
The Accountable Care Act links reimbursement payments from Medicare and Medicaid to clinical outcomes, in an attempt by the government to provide better stewardship of what we are getting for our health care investment. Specific conditions that the Accountable Care Act Shared Savings Program includes are: Chronic obstructive pulmonary disease (adult asthma), high blood pressure, heart failure, stroke, and diabetes. The ACO mandates attempt to assess clinical performance through a risk standardized assessment of chronic medical conditions, by reviewing hospital data, with the goal being the reduction in hospital admissions. In order to be eligible for the enhanced savings program the Centers for Medicare and Medicaid require hospitals which participate to report on the following metrics: patient caregiver experience, care coordination and patient safety, preventive health, and patient management for the at-risk population.
4-Accountable Care Act creates bundled payments for renal or kidney dialysis which is a cost containment measurement for this $78,000 per patient per year treatment, which is almost entirely paid for by Medicare.  
5-The Sunshine Act mandates disclosure of financial payments from medical device manufacturers and the pharmaceutical industry to health care providers.
The Sunshine Act, which is part of the Accountable Care Act mandates disclosure of financial payments from medical device manufactures (aka cardiac devices and orthopedic joints) and from the pharmaceutical industry to health care providers, including doctors and hospitals.[3] The highly profitable medical device industry has a practice of offering on-site bonuses for using their lucrative devices, which are now being prescribed for treatments which are not in compliance with evidence based treatment protocols.  So to assist the consumer, the government is attempting, through this mandate to shine a bit of light on conflicts of interest for treatment practices, so that you can make an informed decision on your procedure and where you have it done.
6-CMS, the government agency overseeing Medicare and Medicaid has established national performance metrics for key medical conditions which impact 80% of the national population. These benchmarks will establish a performance and reporting standard for all organizations, regardless of whether they choose to participate in the ACO Shared Savings Program. This new level of transparency will increase patient safety as better information becomes available to health care consumers.
7-ACO attempts to improve care for diabetes and heart disease patients
 By requiring 100% compliance with the six measures of clinical care, in order to achieve the increase in reimbursement under the Accountable Care Shared Savings Program, CMS hopes to stem the tide of these costly medical conditions. The measures of clinical care include; health status, health promotion and education, caregiver to patient communication, timely care, patient safety, and care coordination. This level of scrutiny is based on the drastic increase in disease prevalence and the need for the country to create a national intervention.
8-Establishment of the Independent Payment Advisory Board to reign-in health care overcharging
The Accountable Care Act has created the Independent Payment Advisory Board, which has broad authority to review and make recommendations for payment changes for health care services under Medicare. This is actually an aspect of the law that has great potential for cost containment authority, if congress will not capitulate to the powerful medical industrial lobby by refusing to deploy recommended changes. For example, why should cardiac device manufacturers continue to receive such exorbitant reimbursements at the expense of primary care services, so a realignment of payment could occur there. The point of the IPAB is to slow the growth of Medicare, which is presently escalating in an unsustainable fashion and everyone in Congress is in agreement on this factoid.
9-Savings Generated from the Accountable Care Act Will Shore-up the Medicare Trust Fund
The focus of the ACO mandates is to deliver better clinical outcomes and to reduce the long term trajectory of Medicare costs. Since Medicare is funded by payroll taxes and general funds, it is of concern to us all.
10-Accountable Care Act Increases Funding for More Fraud Auditors
Medicare fraud has been a problem since inception, because of entrepreneurial health care suppliers, clinicians, and hospitals. FYI the current Governor of Florida was at the helm of HMA, a large hospital chain when it was convicted of fraudulent Medicare billing, and he was asked to step down.[4] The Office of the Inspector General has found that for every dollar invested in fraud detection seventeen are recovered, yet a budget request for this in 2005, was denied by Congress(medical industrial lobbyists at work again).[5]
So the next time you are forced to listen to the grousing about the health care reforms and Obama care, just remember there are many consumer protection elements  which have the potential to transform the health care paradigm in this country and that is precisely what we need.
Feel free to share this article, written by Roberta E. Winter, MHA, MPA, and the author of Unraveling U.S. Health Care-A Personal Guide. http://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972






[1] Knocking on Heaven’s Door, Katy Butler, Scribner, a division of Simon & Schuster, 2013, chapter 12, p. 177, 2008 American College of Cardiology, Heart Rhythm Society, and the American Heart Association update for treatment guidelines.
[2] Knocking on Heaven’s Door, Katy Butler, Scribner, a division of Simon & Schuster, 2013, chapter 4, p. 64
[5] It’s Enough To Make You Sick-The Failure of American Health Care and a Prescription for the Cure,  Jeffrey Lobosky, MD, Rowman & Littlefield, 2012, chapter 13, page 208