Category Archives: Politics

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.

Michigan’s Medicare Fraud Problem Caused By Lax Home Care Regulation

Michigan Lags Behind Other States In Home Care Regulation

Home Care services will play a key role in the ever-changing healthcare system.  With an avalanche of Baby Boomers nearing retirement age, the healthcare system is desperate for services that provide quality care cost efficiently while keeping patients from making costly emergency room visits.

Baby Boomers are also demanding more innovation and service improvements in healthcare just as they have of every other service they have consumed. Skilled Home Care, Hospice and Telemedicine have proliferated as a result.  So much so that lawmakers and policy wonks in Washington are expecting a dramatic increase in Home Care utilization over the next decade.

So what’s holding the rapidly growing home care industry back? Fraud.  New companies have sprung forth to meet demand with many founders having little to no experience in healthcare service delivery. Without the proper expertise to compete by providing quality service, owners turn to fraudulent schemes to make ends meet.

As a deterrent to fraudulent behavior the FBI has made a public spectacle of Medicare fraud busts.  The FBI press releases have had their intended effect but they have also had the unintended consequence of deterring patients form using the service.  That combined with the reluctance of doctors to refer to potentially fraudulent providers has slowed the development of this much needed service.

Falling Short

Most states have faced the fraud problem head-on by requiring companies to apply for a state license in addition to the federal Medicare license.  The extra requirements have served as their own deterrent to Medicare fraud.

Still there are four states in the union that don’t require any additional licensing to operate a home care company.  Michigan, Ohio, Iowa and Massachusetts all refrain from further regulating the home care industry. To their credit Ohio and Massachusetts require additional licensing for the professionals that work in the industry.  However Michigan Home Care Companies remain the least regulated and companies in the state remain a major target of the FBI’s Medicare fraud task force.

A Hot-Bed Of Activity

mcquade
Barbara MCquade, US District Attorney, Eastern District

Since 2013 the FBI’s Medicare Fraud Task force has indicted more than 70 Michigan healthcare professionals for medical fraud worth over $410 million. Even the FBI has noticed that southeast Michigan has become a hot bed for fraud activity.

“For whatever reason I think Southeast Michigan has become an opportune area to operate in,” said F.B.I. Special Agent in Charge Andy Arena. “That’s what this task force is trying to show. That this is not the place to be. Get out.”

The Reasons Fraud Runs Rampant In Michigan

Owners Lack Health Care Service Experience

The increase in fraud could have something to do how easily an entrepreneur can open a home care agency in Michigan. Even with little to no knowledge of the healthcare system.  Potential owners can also obtain a license to operate a home care at a relatively small cost. Normally expensive costs like labor can be purchased cheaply through contractual agreements with payment deferred until after the operator receives the license.

This year the federal agency overseeing Medicare and Medicaid reimbursement (CMS) finally issued a moratorium on new home care licenses. However the move comes after many fraudulent companies are already in operation in Michigan.

Infrequent Inspections

Another factor contributing to fraud is the infrequency of home care regulation provided in the current system.  Federal Medicare regulations require that licensed home care agencies be inspected

Photo Courtesy www.FreeDigital Photos.net David Castillo Dominici
Photo Courtesy www.FreeDigital Photos.net David Castillo Dominici

every two years. The Centers for Medicare and Medicaid Services (CMS) depend on third-party regulators to facilitate the survey process. Organizations like the Community Health Accreditation Partner (also known as CHAP) and the Joint Commission provide professionals to conducting inspections.  Although all inspectors receive training a shortage of inspectors often puts the process behind schedule.

The gap between inspections (known in the industry as surveys) opens a window of non-compliance with agencies able to ignore regulations without fear of inspection.  During this time agencies often go without key staff like Qualified Administrators, Clinical Directors, Medical Directors and key office staff to cut overhead cost and squeeze more profit out of the bottom line.  This practice adversely effects care and lowers the inter-agency accountability.  Without key healthcare professionals taking an active part in the company, owners often cut corners and open the door for fraud.

Not A Small Problem

The fraud problem isn’t limited to small companies or start-up companies.  Large companies with years of experience have also fallen into fraudulent habits either through malicious intent or negligent.

More regulation, especially in Michigan can help stem the tide of fraudulent behavior. Additional state licensing, requiring licensed administrators and an increase in inspection frequency can help fix a horribly flawed system.  For now consumers should make themselves aware of the warning signs of Medicare fraud as well as asking their lawmakers to increase home care regulations.

The cost efficiency of home care service can go along way to saving the healthcare system.  Until fraud is rooted out however the American taxpayers will have to foot the bill for billions of dollars in increased healthcare cost.

Presidential Candidates Should Look Beyond Obama Care Repeal

Like it or hate it, the Affordable Care Act (aka Obama Care) was the most significant legislation to be passed into law since the Patriot Act.  The sweeping reform of the healthcare system had the country in an uproar after along passing along party lines in a democrat controlled congress.  Now the uproar has been reduced to a murmur as more and more American’s seek to get coverage from the insurance marketplace.

That is of course unless you listen to the Republican Candidates who vow to “repeal and replace” a law that is set cost the federal government $2.76 Trillion over 20 years including over $270 billion in administrative costs.  

The GOP prefers an open market that will allow competition to lower cost for consumers and increase accessibility for consumers.

But the changes in how consumers buy insurance is nothing compared to the changes in the healthcare system at large since the ACA’s passage. The insurance reimbursement to Hospital systems and the physicians has changed drastically.  Quality Care Thresholds have also changed making reimbursement based on outcomes and not volume of patients treated.  Mountains of policy and regulations changes have occurred as a result.

It is the mountain of new rules that makes the notion of totally repealing Obama Care a false premise. It can only be tweaked but never rolled back completely.

This may be disconcerting for the one issue voters out their who hope a vote for a Tea Party Candidate can get them the type of healthcare reform they prefer.

So if the law can’t be repealed, how can we effect change?

The Affordable Care Act is so complex federal agencies are still working on the regulations that will enforce the spirit of the law.  Decisions on how healthcare organizations are funded, the availability of expensive treatments and quality of care indicators are all being discussed as you read this post.

The ACA gives government agencies more power over our healthcare decision then any other point in our American history. Now is the time for consumers to stay vigilant and voice concerns over the new policies and program being put into place.

The 2016 Presidential Candidates need to back away from sound bites full of empty rhetoric and educate the voters on how they can effect change moving forward. Adhering strictly to the talking points won’t accomplish this.

If the Republican field is truly serious about protecting the healthcare consumer from government overreach they should appoint a healthcare advisor to each of their campaigns to take a hard look the new regulations are having on real people. Otherwise any talk about improving the healthcare system is a waste of our time.

Obama Care Battle Continues After Federal Ruling

Just when you thought all the fuss about Obama Care was over.  Wednesday’s ruling  by Federal Court Judge Rosemary Collyer put the Obama Care fight back on the table and thrusting it into the political spotlight after years of battle.

At the core of the judges decision is funding for the monstrous trillion-dollar healthcare program which was allocated by executive order instead of the regular appropriations process.

“The House of Representatives as an institution would suffer a concrete, particularized injury if the Executive were able to draw funds from the Treasury without a valid appropriation,” Judge Collyer said in her 43-page decision.

Because congress was passed over in the appropriations they did not have the opportunity to excercise their constitutional duties.  Now according to the Judge they can sue for the right to fund (or defund) the program, a lawsuit that will likely land Obama Care on the steps of the supreme court once again.

“The president’s unilateral change to Obamacare was unprecedented and outside the powers granted to his office under our Constitution,” Mr. Boehner said in a statement after the ruling. “I am grateful to the court for ruling that this historic overreach can be challenged by the coequal branch of government with the sole power to create or change the law.”

What does the Republican lawsuit mean for consumers.  Not much considering Republicans are not likely to strip millions of American’s of health coverage during an elections cycle.  However if congressional republicans are success in the suit against the executive branch you may see some changes to the health insurance market place.

If you are hoping that the Collyer’s decision will be the beginning of the end of Obama Care keep hoping.  Reams of paper have already been used to write the regulations guiding the implementation of the wide-reaching health care law.  Consumers may see some tweaks but don’t expect the program to completely roll back.  But don’t expect that to stop the candidates from talking about it as Obama Care will become a hot campaign issue once again thanks to the ruling.

Listen to the Fischer Report during Conversations In Care on Wednesday’s at 8 pm.