All posts by Anthony Fischer

Tony is Associate Producer of the successful podcast Conversations In Care and Executive Producer of The Fischer Report. As an Elder Care Advocate with over 20 years experience on multiple levels of the healthcare continuum, Tony brings caregivers news and analysis of the latest healthcare news so they can prepare for changes in the healthcare system. That said he has been known to have an opinion on politics from time to time.

Iowa Poll Sets Stage For Marco Rubio Surge

On the eve of the first primary of the 2016 presidential election cycle, the Des Monies Register has released its most recent poll results.  The poll of likely caucus-goers holds some interesting revelations as to who could emerge with momentum after Monday’s vote.

The most interesting numbers have to do with Marco Rubio whose campaign has been hampered by a split in the mainstream republican vote among several candidates.

The poll shows that Marco Rubio is the second choice among mainstream republican voters with 21% saying they support the Florida Senator.  The leader among the mainstream is Donald Trump at 34%.

Thirty-eight percent of likely GOP caucus-goers identify themselves as primarily mainstream, rather than tea party or evangelical conservative, and Trump does better than any other candidate with 34 percent of their support. Rubio is next at 21 percent. Cruz gets only 10 percent of these voters. via De Moines Register

Interestingly Ted Cruz came in third among those who identified themselves as mainstream republicans at 10%.

Marco Rubio scored the second highest image rating in the poll at 70% just behind Dr. Ben Carson at 72%. That positive image has made Rubio the second choice among voters in nearly every category.

This sets the stage for Marco Rubio to have a surge in the Iowa caucus.  If support waivers for the other candidates Rubio will benefit.

A last-minute change of heart could happen. Rubio, Cruz and Carson are among the only candidates with a positive favorability rating. Further he is one of only a handful of candidates whose supporters are enthusiastic about him becoming the nominee. On the down side less than half of Rubio’s supporters

If Rubio could skim a point or two from the other candidates it could be enough to give him a strong second place finish in Iowa with serious momentum going into the New Hampshire primary next week.

A second place finish by Rubio would likely spell the end for a couple of campaigns who are depending on the same group of voters to give them an impressive finish on Monday. Added incentive for Rubio to finish strong as he could pick up support in the primaries ahead  from those candidates who drop out .

GOP Debate: Winners, Losers and What We Learned

It is starting to get hot on the Republican Primary campaign trail as the top tier of candidates solidify their support for the upcoming caucus in Iowa. In an effort to cull the herd of hopefuls, the Republican National committee has scheduled a gauntlet of debates that has become more about attrition than policy discussion.

What gave this debate a more interest than some of the others was its proximity to the Iowa Caucus on the campaign calendar. At least four or five of the candidates in this debate field probably won’t be on the debate stage next time around. So for some it was an audition for Vice President while others made a last attempt at shoring up support in hopes of a surprise showing in Iowa or New Hampshire.


The two front runners earned that title as they traded barbs and held off attacks by some of the other candidates. Pundits questioned whether Donald Trump would be able to stand up to the increased scrutiny that would come with fewer candidates on the main debate stage. The Donald answered the call with a solid response on the trade war with China while refusing to back down on his controversial stand against Muslims.

Mr. Trump might have had the line of the night when he asked if he was angry. Trump replied my saying that “I will wear the mantle of anger”, a line that will score big points with his base of support.

Senator Ted Cruz also had a big night. He successfully fended off questions about his birth status and recent stories about mishandled campaign filings. He also was successful in restating his position on National Defense and earned some cheers from the crowd when he talked about how he would have handled the recent capture of American Sailors.


Dr. Ben Carson had another lack luster GOP debate performance which was highlighted by his complaints that he wasn’t getting enough airtime. Carson failed to cover any new ground and stayed away from the serious policy debates about taxes and the trade deficit.

Jeb Bush was also largely ineffective using the same tired talking points that have him dropping in the polls. Bush keeps floating a message that is just not getting any traction leaving some to wonder why he is still in the race.

What We Learned

During and exchange Senator Ted Cruz suggested that Donald Trump might make a good Vice President on his ticket. Trump said that he would probably “go back to building buildings if this doesn’t work out.”

As far as potential Vice Presidents two candidate stood apart in tonight’s GOP debate. Carly Fiorina showed off the impressive debate and interview skills that could be an asset on the campaign trail. John Kasich solid answers on policy and strong track record as Ohio governor make him a strong VP choice.

Read Related Post: Fiorina Shines In Debate

GOP Debate: Carly Fiorina Shines Again

Carly Fiorina, Rick Santorum Shine in Undercard GOP Debate

In what could be their last chance on the GOP debate stage, Rick Santorum and Carly Fiorina had some memorable lines in the undercard debate for the Republicans.

One of the best lines came from Fiorina when she accused President Obama of having a “Bromance” with Russian President Vladamir Putin referring to the Obama administrations recent dealing with the quasi-dictator.

For his part, Santorum looked reinvigorated in front of friendly crowd.  He referred to South Carolina as his “home away from home” because he has two sons attending the Citadel Military College.  The comfort level showed as Santorum had his best debate effort to date.

In closing remarks Rick Santorum made the case that he was the only candidate in the field to have a winning track record against Hillary Clinton citing a senate debate in which a Bill he was arguing for passed.  Mike Huckabee pointed out that he also has experience battling the Clinton political machine during his time as Arkansas governor.

Although non of the candidates did anything to hurt themselves their performances are inconsequential at this point unless one of the “mainstage” debaters step on a land mine.  With the Iowa Caucuses just 18 days away, its hard to imagine any of the undercard candidates building enough support  to stay in the race.

The real value in this debate for Fiorina is to audition as a potential Vice Presidential Candidate.  Because the Republicans suffer from the false perception that they lack diversity in the party. Fiorina could be an attractive choice for Vice President.

Not only does Fiorina offer diversity to a potential presidential ticket, she has shown the ability to serve as an attack dog for the Republican nominee.   A strong women on the ticket could take the “war on women” attack off the table for the Democrats.

Expect the Republican field to become much more focused after the Iowa caucuses on February 1st and New Hampshire Primary on February 20th.  The candidates who have been running toward the back of the pack will be forced to drop out as fund raising becomes more difficult as Super Tuesday draws near.


Think Obamacare Doesn’t Affect You? Think Again

Even If You Don’t Get A Subsidy,  Obamacare Affects You

Open enrollment season is coming to an end. People all of the country are tucking away their insurance cards as dreams of government subsidies dance through their heads. And as the Obama administration touts the success of the program, many Americans who get more traditional coverage through their employer are turning an apathetic ear.

Those Americans who have insurance through an employer are under the impression the Affordable Care Act (also known as Obamacare) doesn’t affect them because they are not getting a subsidy. As a result they have tuned out the debate over health care coverage.

If you are one of those people that think that the Obamacare law doesn’t affect you, this post will give you a few reason to think again.

Stifling Patient Choice

Lost in all the noise about mandated health insurance coverage is the fact the Affordable Care Act completely changed the way Hospital systems and physicians are reimbursed.

At the Hospital level, the reimbursement system changed to a focus on individual outcomes rather than the number of patients and the time in which they are treated. Now insurances are looking for whether or not hospitals are evaluating patients for all possible health issues that could cause a readmission. That includes anticipating medical needs the patient might have after discharge form the hospital.

In general, if a patient is readmitted within 30 days the hospital system receives a penalty imposed on future reimbursement. The system includes the hospital and all of the doctors that work within it.

This change in focus has resulted in massive changes in healthcare systems. Because Hospitals are forced to anticipate future healthcare needs of patients, they have been expanding into other services like home care, hospice and even nursing homes.

By doing this hospitals hope to avoid readmission by controlling where patients are referred after discharge. This can stifle patient choice if patients lack knowledge about the services to which they are being referred.

Read Related Story: Hi-jacked Healthcare and How I Regained Control

Restricted Hospital Admissions

In order to be Re-admitted to the Hospital you have to be admitted in the first place. That is why now more than ever Hospitals are careful about who they actually admit to the hospital. Many people don’t know that when a patient goes to the emergency room they are not actually admitted to the Hospital. Emergency falls into a type of outpatient care where admission to the hospital is not necessary.

Because of the focus on outcomes, Hospitals are now increasingly careful which patients they actually admit for inpatient care. If there isn’t a clear positive outcome, hospitals may resist admitting a patient in order to avoid a re-admission later on.

The difference between admission and outpatient treatment is a key distinction for insurance companies. Some tests and treatments aren’t covered if given on an outpatient basis. Hospital admission is also trigger for insurance coverage of other services like Sub-Acute Rehab. If a visit to the ER turns into an overnight stay, don’t assume you have been admitted, ask the attending physician.

We Are All Stakeholders

Even if you don’t receive a direct subsidy for your healthcare coverage, Affordable Care Act regulations have most definitely effected your company’s health care insurance policies. Whether it be an increase in premium or change in enrollment procedures this law effects everyone.

It is silly to think that universal healthcare coverage will be repealed, no matter who wins the white house in 2016. That is why it is important to be aware of the changes in our healthcare system and they effect the average American. If the country is going to get universal healthcare coverage right, we need the input from every American.

Small Business Owners Prepare for Baby Boomer Effect

If you are a regular reader of The Fischer Report, you are well aware of the dramatic effect the Baby Boomer generation is having on the health care system. As Boomers who work in the health care industry retire, the workforce is struggling to keep up with the increasing demand those same Baby Boomers are putting on the system.

The same thing is happening to small business owners.  As owners reach retirement age they will find it increasingly difficult to sell their business because there is a smaller pool of buyers.  It is a problem illustrated in a recent survey by the University of UConn School of Business.

The survey studied the shrinking number of potential small business buyers compared to the number of retiring business owners. It showed a dramatic decrease in the potential buyers that could put the squeeze on Boomers who are trying to profit from a life’s work.

Looking ahead between 2015 and 2025, we estimate that over 19,000 business owners will want to retire, with fewer than 23,000 new owners to take their places. Put differently, the ratio of willing buyers to willing sellers will fall from 1.6 in recent years to 1.2 in the years to come.

The report goes on to illustrate the effects this could have on retiring Baby Boomer business owners that could put a serious damper on retirement plans.

This will likely have one of two effects: it will encourage the prospective sellers to work longer, or it will force those sellers to accept lower sale prices for their companies. At times, it will have both effects. Prospective sellers may work longer than they want hoping for a better price that never comes and ultimately sell at a discount anyway.

If you think this is a problem for Connecticut think again.  The report compared the Baby Boomer dilemma in the Nutmeg State to the nation and found the effect intensifies.

Nationally, we are on the verge of an even more pronounced change in the ratio of older business owners looking to sell vs. younger adults that might consider buying businesses. As shown in Exhibit 6, this ratio ranged from 1.34 to 2.05 from 1950 through 2000. This means that, in the second half of the 20th century, there were substantially more prospective “buyers” than “sellers.” It is a different story in the 21st century, as this ratio is projected to be just slightly over 1:1 from 2015 onward.

Yet another illustration of how the Baby Boomer generation will challenge our systems as our country prepares to help the largest generation enjoy their golden years.  We must innovate to meet demand and control cost.  Failing to do so could be a greater threat to our national success then any other influence.


Fixing Home Care: Low Wages for Home Health Aides a Complex Issue

Baby Boomers are retiring at a startling rates and their need for long-term care at home is causing the health care industry a host of problems.  The biggest of which is a shrinking workforce especially among home health aides.

The problem of finding people to work as home health aides involves a number of factors. These jobs are often low paying with some working for as low as $8.50 an hour without benefits.  It’s a shockingly low rate of pay considering the amount of responsibility a home health aide has. In fact most those who use long-term care services in their home depend on home health aides for everything from basic household chores to medically necessary treatment needed on a daily basis. In the case of the frail elderly the lack of care could have dire consequences.

Take for example an Elderly Lady in Ithaca, New York who according to the local newspaper had to go to the hospital because she lacked the home care support she needed.

An elderly, wheelchair-bound Tompkins County woman says she was left for almost two months without the home care aide she needs.

Lane Woods, 68, of Trumansburg says this isn’t the first time this has happened. A six-week stint without an aide when she lived in Niagara County ended with her being sent to the ICU due to the strains of caring for herself and maintaining her home without assistance.

The paper goes on to site several local officials who blame the shortage of home health aide workers for the limited access to home care services.

What is playing out in New York is happening all over the country as baby boomers and their children struggle to met the challenges left by increasing health care demands.  The elderly often depend on home health aides to provide care when family or friends are at work.  The shortage leaves many of the frail elderly to fend for themselves at home often with disastrous results.

Adding to the problem of low pay is the breakneck increase in demand for home based services.  According to a 2013 report by the U.S. Bureau of Labor Statistics, Personal Care Aides, Home Health Aides and Nursing Assistants are job categories projected to see an over 48% increase in job openings by 2022.  Those three segments combined, all of which are employed by the home care industry, will make up the nations second largest workforce with 4.8 million laborers by 2022.  Only the retail workforce is larger.

Government Still Part of the Problem

Now before you start beating the drum for government mandated pay increases you should consider that increasing the hourly rate is only part of the problem.  During 2015 various states around the country have begun mandating wage increases for home care workers.  A good first step but only half the problem.

In an effort to keep up with the increased cost of health care delivery, Medicare and Medicaid have been making deep cuts in reimbursement over the last five years. The most recent is scheduled to take place in 2016 and will slash $350 million from the Medicare budget.  The latest cost saving measure by the government adds to the $60 million in cuts that took effect just this year. Medicaid has seen similar cuts in recent years although those vary by state.

That leaves home care companies struggling to find away to deal with pay rate mandates while receiving less in reimbursement.

Lack of Coverage

Medicare only covers short-term home health care based on acute need often of only an hour or two a day for duration of 60 days.  But what happens to the frail elderly who need services for longer than Medicare based insurance coverage can provide. Those patients are often left without access to the care needed to help them age in pace at home. Rather the lack of care often ends like our lady from New York with a trip to the hospital and possibly a nursing home.

For patient to receive long-term home health care they often have to pay out-of-pocket or depend on local aging services agencies to provide subsidized care (often funded by Medicaid). But decreasing reimbursements and program cuts make access to care provided through these agencies difficult at best with most having to spend time on a waiting list before funding is available.

Fixing the Problem

Such a complex problem requires a dynamic solution.  Policymakers and health care industry leaders must come together and develop ways to provide access to quality care for those who need it most our frail elderly. Of course cost will be a factor which means compromises both government agencies and the health care industry will have to make sacrifices. The home health care industry will have to accept some additional regulations in order to combat fraud and waste and the government will have to increase its efficiency in processing and reimbursing claims.

The Fischer Report will not just present a problem without a solution. That is why we are starting a series of articles called Fixing Home Health Care where we will spotlight ways the public and private sectors are working together to solve the health care crisis for our seniors and forward new ideas that could help in the future. Hopefully it generates the discussion about how we can better care for our elderly.

Telemedicine Is The Latest Innovation Spurred By Baby Boomers

Necessity is the mother of invention they say.  But in the case of the Baby Boomer generations it is also the mother of innovation.  The nations largest generation is demanding more convince and efficiency from their health care providers and providers are responding with more creative use of technology.

The latest innovation is coming from the field of Telemedicine when patients and doctors are using technology to increase communication and avoid unnecessary cost.

Telemedicine is not a new concept.  The method of communicating a patients health status remotely through the telephone has been around for about a decade.  One of the earliest pioneers in telemedicine was Philips who developed the Lifeline system as an emergency alert system for the frail elderly.  Lifeline later developed automated medication reminder/dispensing systems as well as ways to communicate vitals remotely to a patients primary physicians office.

Now the game is changing again as home-based health care services like visiting physicians and home care companies are utilizing telemedicine to communicate more effectively with patients. A recent article in US News written Dr. Vik Bakhru, CEO of First Opinion a mobile health company in San Francisco, says his company is using both new and existing technology to improve communication with their patients.

The implications for telemedicine are far-reaching, and have the potential to completely transform the health care industry for the better. Take for instance those unnecessary doctor visits, which are easily the biggest contributor to the long waiting room times and short doctor/patient face time. Too often, these visits are simply to determine if an ailment actually needs the attention of a doctor.

When the answer is no, it is a completely wasted trip. But if a patient is simply wondering if a skin irritation is minor or symptomatic of a more serious condition, having the ability to text message a doctor or text a photo of the affected area to a physician to get an informed opinion on next steps could be a major time saver – not to mention that it gives the patient peace of mind, faster. By streamlining that first contact, the whole industry will begin to see positive effects as less time and money is wasted in the waiting room.

Dr. Bakhru goes on to say “What we need is a bridge between efficiency and efficacy, between cost-effectiveness and quality of care.”


The industry is in desperate need of cost saving measures as the number of retired American’s grows at a record pace.  Telemedicine could be the method that can finally cut some of the waste in the health care system without sacrificing quality.

The forward thinking folks at First Opinion aren’t the only medical professionals using technology to get better outcomes for patients.  Some home care companies are including emergency alert systems like Lifeline as part of their service to better respond to their patients needs.  Traditional doctors offices are also turning to things like web cams to check on patients at home.

For those family members who are trying to care for an elderly parent while holding down a full-time job, telemedicine can help keep them in connect with key members of the health care team.

Tell us your story, have you successfully used telemedicine technology as a caregiver.  We would love to hear from you.  Leave a comment below or send an email to

New Wage Laws Coming For Home Care Workers

The national fervor to increase the minimum wage is about to take over Private Duty home care.  A final rule issued by the US Department of Labor mandates that companies who provide a home care worker for “companionship and safety” are now required to pay at least minimum wage.  The rule further states that companies providing such care will also be mandated that home care worker be paid overtime when required.

The U.S. Department of Labor has taken a hands off approach when it comes to home care workers in the past.  But changes in the healthcare industry have caused them to change course according to a post on the Supreme Court of the United State Blog. 

The department reversed course on the issue after concluding that home care has changed markedly, with fewer elderly and disabled individuals going to nursing homes or other institutional providers, and opting instead to remain in their homes and get their assistance there.

It all started with Long Island Home Care v. Coke, a case heard eight years ago in front of the Supreme Court when a home care worker brought suit demanding to be paid minimum wage.  The worker lost the case based on the latest amendment to the Fair Labor Standards Act that said that”domestic workers” were not entitled to minimum wage.

Now thanks to the Department of Labors change of heart and a federal court ruling that upheld the wage increase, the supreme court will decide again whether Private Duty home care workers are subject to the same rights as the rest of the workforce.

The rule to increase wages was supposed to go into effect October 13th but will likely be delayed while the Supreme Court hears the case.

If the Supreme Court finds that Home Care workers are now subject to the Fait Labor Standards Act then home health aides may find themselves in line for more increases as the fight to increase the national minimum wages reaches its conclusion.

More and more consumers are choosing at home care options over institutional care settings.  With an entire industry shifting to home based services, it is time to give home care workers that same status as we give others in the workforce.  It is a necessary step to force improvement in an industry that is now responsible to caring for the most vulnerable of our countries citizens.

Home Health Care Agencies Must Innovate To Meet Demand

Home Health Care Report: Innovate Or Die

Home Health is considered by many analysts to be a major are of growth in healthcare in the coming years.  With the retiring Baby Boomer demanding more convenient, personalized and home based care options, Home Health Care is in an excellent position to capitalize on massive influx of new patients.

But with all the potential in the home care market there have been even more challenges.  Fraudulent activity and substandard care have caused consumer trust in home health care to erode.  In response to the fraud, regulatory agencies have added restrictions, cut reimbursement and doubled down on law enforcement.  The punitive nature of this enforcement has stifled innovation and caused home health agencies to be overly cautious with new service delivery models.

Home Health Companies are looking for the next great money making innovation. photo courtesy
Home Health Care companies are looking for the next great money making innovation. photo courtesy

The regulations surrounding insurance reform and the proliferation of Accountable Care Organizations have many independent small to medium-sized home care companies grasping at ways to grow census in a system becoming increasingly exclusive.  The companies who fail to innovate and develop multiple revenue streams have been forced to close their doors while other are working to develop new service delivery models to meet the rising demand for home care services.

Some of that demand can be found in specialized services focusing on diagnoses that cause the most hospital readmissions.  There is a push to reduce hospital readmissions under the new Accountable Care system that penalizes hospitals for return trips to the ER after a hospital stay. To accomplish this goal hospitals are partnering with Home Health Care companies to find new ways to treat patients who are at high risk for readmission.

These programs often include disease education, raising awareness of community resources and frequent visits from Home Care professionals to help with the transition.  What is more, these programs are often reimbursed outside of the traditional Medicare system Home Care companies have become comfortable with.

Home Health Care programs that prove the ability to reduce health care cost are often funded by third-party insurance “carve-outs” or grants which fund healthcare innovation.  Palliative Care, Care Transition and disease management programs are all examples of programs that are being funded by these sources.

The innovation game isn’t just for the large Home Care companies.  A small to medium sized company can jump in if they have a solid structure that favors permanent over contract employees. A company who works almost entirely with contractor may find it difficult to control cost and quality in a newly developed program that could sudden operational changes.  However companies who focus on permanent employees may find the cost of change easier to manage.

Home Care companies who are able to innovate in the new Accountable Care system would thrive in the years to come.  More innovation can only serve to improve the greatest healthcare system in the world.

Questions about this post?  Email

Google Alphabet Hopes To Spur Innovation With Investment

There Is More Technological Innovation Coming To Healthcare

Just as healthcare systems are fully implementing electronic medical records, even more technological innovation is coming to healthcare.  But instead of targeting providers these innovations will be available directly to consumers.

So who is driving the new innovation inspiration? Google of course.  For those who have tracked Google lately this is no surprise.  Google recently founded a holding company called Alphabet.  That company has declared war on Diabetes, naming the disease as an area of focus.

photo of a Google Contact Lense from July 2015
photo of a Google Contact Lense from July 2015

Don’t expect Alphabet, a spin off of Google X, to stop at Diabetes.  An investment bank Cowen and Company has tracked Google and thinks the tech giant could be on the verge of making major investments in new healthcare innovations.

A recent report by the investment bank says: “A closer look at Google’s vast health care efforts,” the report says, “reveals that the company is targeting very large markets with an expansive list of projects that with even minor success could justify the company’s recent investments.”

An article by Mark Bergen of re/, a tech blog focusing on dot coms, cites Google’s major investments in companies focused on telemedicine, dermatology and Diabetes.

With the new influx of money into healthcare research and development, Google hopes it can add a spark to the industries normally slow pace.  Picking up that pace would be advised as the healthcare industry prepares for the enormous and expensive challenge of caring for the retiring Baby Boomer generation.

Healthcare systems, who are already struggling with a shrinking workforce and lack of licensed professionals, are looking for any way to provide quality care at a lower cost.  Medicare and other third-party insurers would also welcome innovations that allow patients to receive lower cost care at home.

Read Related Post: Lawmakers Predict A Healthcare Revolution

They say necessity is the mother of invention. That cliché is more true today than it has ever been as the nation tries to avoid a potential healthcare crisis caused by a title wave of aging Baby Boomers.