HCAO News

Hospitalized but 'under observation'? Seniors, beware

Elderly.jpeg

By Mark Miller
CHICAGO Thu Jan 23, 2014

(Reuters) - A growing number of seniors who think they've been hospitalized are finding that they really weren't.

The problem isn't memory loss, confusion or dementia. Instead, seniors on Medicare who did in fact spend multiple nights in the hospital are learning later on that they weren't formally admitted. Instead, they had "observation status" - a Medicare classification that can cost seniors thousands of extra dollars if they need post-hospital nursing care.

Medicare covers the first 100 days of care in skilled nursing facilities, but only for patients who were first formally admitted to a hospital for three consecutive days.

But federal data shows that the number of Medicare patients classified as under observation has jumped sharply in recent years, to 1.4 million in 2011 from 920,000 in 2006. And the trend isn't limited to patients who spend short periods of time in the hospital: The number of observation stays lasting more than 48 hours stood at 112,000 in 2011, compared with just 27,600 in 2006.

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Weaponized Profits: The US Health Care System

by Donna Smith  published Sunday, Sept. 22, 2013 on Common Dreams

Weaponized profits.jpg

Many people who advocate for an improved and expanded Medicare for all for life health system in the US tend to vilify the for-profit, private insurance industry and big Pharma but ignore the atrocities committed by almost every other segment of the system. If we are to fix what ails the US health care system, we will have to get a whole lot more honest about all of the factions that lift profit-making above all else when engaging in the delivery of health care services.

And no matter what Congress does or does not do with the Affordable Care Act/Obamacare, until those of us being most grossly effected by our dysfunctional, profit-first health care system get honest about all the players and their roles in that dysfunction, we will continue to tinker around the edges and watch the numbers of health care dead and broke climb ever higher.

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Letter to Representative Walden

Frank Erickson, MD 

Frank Erickson, MD 

by Frank Erickson, MD
Published in the East Oregonian, Aug. 24-35

Rep. Walden:

On Medicare's 48th anniversary, I would again urge you to reconsider your stand on health care and support H.R. 676, the Expanded and Improved Medicare for All Act in order to achieve universal coverage, cost savings and minimize the profit motive from being used in health care decisions.  The recently published Friedman report shows how full access to care via improved Medicare for all would save over $14 Billion in 2014 alone:

Quoting from a PNHP.org email today (8/21/13):
"Professor Gerald Friedman released his new fiscal study, “Funding H.R. 676:  The Expanded and Improved Medicare for All Act – How we can afford a national single-payer health plan in 2014,” at a well-attended congressional staff briefing on Capitol Hill on July 31. The briefing was hosted by PNHP and Public Citizen. The study shows that a single-payer system would cover everyone, is economically feasible, and would save billions annually."

Counter to your recent Medford experience cited in your newsletter, many of the docs in the Pendleton IPA can recall how private insurers have postponed with-held payments on thin excuses, cost small offices perpetual extra administrative efforts due to claims and permission shenanigans which have repeatedly delayed and prevented appropriate care; many of us would not be sorry to see private insurers replaced by a universal single payer system that works.  We are not so interested as you seem to be in protecting the existing insurers due to their past history of abuse of both patients and docs in the name of profit.  PPACA simply perpetuates and increases utilization of third party insurers in the non-system we currently call health care in America.  We want the everybody in, nobody out insurance provided by H.R. 676.  Save lives, save money, stop medical bankruptcies.  Support H.R. 676.

Frank Erickson, M.D. Is a Radiologist from Pendleton, Oregon who toured with the Mad As Hell Doctors in 2011 through eastern Oregon. He has served as a Radiation Safety Officer in the Navy and practiced as a Board Certified Diagnostic Radiologist since 1986. His interests are focussed on maximizing health care outcomes for his patients who he now sees as all of us through his participation in PNHP and Health Care for All Oregon.

Medicare Birthday Party, PDX

The Larger Stakes in the Fight over Medicare

By Peter Shapiro

Forty-eight years ago this month, Lyndon Johnson overcame years of resistance by the medical establishment and signed Medicare into law. It’s as close as this country has ever come to establishing the kind of universal, publicly funded, “single payer” health care system that prevails in most other industrialized countries.  Coming at a time when half the nation’s seniors lived in poverty, its passage quickly demonstrated that it was possible for the federal government to provide health coverage for the   costliest section of the population to insure, at a fraction of the administrative cost required by private industry.

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Medicare ‘cost-savings’ rules pushing costs onto patients

A sick system

By Robert Kuttner for The Boston Globe/Opinion
July 18, 2013

THE COST OF Medicare, the top driver of runaway entitlement outlays, seems to be stabilizing at last. For the past three years, Medicare inflation has moderated to an annual average of 3.9 percent. But if you look more deeply, a lot of these supposed savings are actually a shift in costs to patients. As Congress and the administration devise new ways to restrain Medicare, this disguised form of rationing is likely to worsen.

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Medicare fraud outrunning enforcement efforts

Official: agency failed to investigate 1,200 complaints due to staff shortages, and more cuts coming
By Fred Schulte
July 1, 2013 The Center for Public Integrity

Citing massive budget and staff cuts, federal officials are set to scale back or drop a host of investigations into Medicare and Medicaid fraud and abuse — even though cracking down on government waste and cutting health care costs have been top priorities for the Obama administration.

The Department of Health and Human Services Office of Inspector General is set to lose a total of 400 staffers that are deployed nationwide as a primary defense against health care fraud and abuse. Though agency officials have yet to decide which investigations will be shelved as staff dwindles, the existing staff is already stretched so thin that the agency has failed to act on 1,200 complaints over the past year alleging wrongdoing — and expects that number to rise. The OIG began shedding staff at the beginning of the year.

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30 Million To Remain Uninsured Under Obamacare: New State-By-State Estimates At Health Affairs Blog

Published in Medical News Today, June 7, 2013

Harvard and CUNY researchers say 4.9 million Texans and 3.7 million Californians will still be uninsured in 2016

A study released recently on the Health Affairs blog finds that between 29.8 million and 31.0 million people will remain uninsured after the implementation of the Affordable Care Act in 2016 and breaks down those figures by state.

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Instead Of Being More Efficient, Private Insurers' Medicare Advantage Plans Have Cost Medicare Almost $300 Billion More Over The Life Of The Program

http://www.medicalnewstoday.com/releases/260424.php

Medical News Today, May 14, 2013

A study published online finds that the private insurance companies that participate in Medicare under the Medicare Advantage program and its predecessors have cost the publicly funded program for the elderly and disabled an extra $282.6 billion since 1985, most of it over the past eight years. In 2012 alone, private insurers were overpaid $34.1 billion.

That's wasted money that should have been spent on improving patient care, shoring up Medicare's trust fund or reducing the federal deficit, the researchers say.

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The privatization of Medicare by Advantage plans

by Paco Maribona, HCAO-Lincoln City
 
Insurers, lobbyists, and many in Congress successfully lobbied against the minor cuts to the Medicare Advantage plans which were supposed to take effect starting 2014, under ACA, the Affordable Care Act (aka Obamacare). Instead of cutting their generous subsidies (often around $800-$1200/person/month) by only 2.2% , they'll be getting a 3.3% raise. 
 
Medicare Advantage plans, including HMOs, PPOs, and other versions, are steps towards the privatization of Medicare. While some of these programs, like Kaiser, can coexist with the traditional Medicare Part A and B and Supplement plans, they are heavily subsidized by Medicare. Right now about 24% of plans are so called Advantage plans (Advantage Insurers). Which if they grow too much, could ultimately kill traditional single payer Medicare.

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