EXPANDED AND IMPROVED MEDICARE FOR ALL KEEPS OUR FEDERAL PROGRAM MEDICARE STRONG!
I spoke yesterday about Maryland using private non-profits and quasi-governmental designation to usurp the right of citizens of Maryland to legislate-----to have a voice in public policy and to vote for a politician who will push that stance. Today I want to revisit Maryland and its ubiquitous COMMISSIONS. Commissions are just a nice way of saying----this body will take legislating away from City Hall or Maryland Assembly and allow a Governor or Mayoral appointee decide major policy. So, Governor O'Malley fill Maryland's commissions with people that are neo-liberal----working for corporate profit and that is the way policy goes. All Marylanders know the Public Service Commission always goes the way of the corporation with very small concessions for the public. The Gambling Commission already works to see that most profits made by gambling corporations stay with gambling corporations. AND SO ON.
Well, Maryland even has a Maryland Health Services Cost Review Commission/The Maryland Health Care Commission (MHCC.
People liking the idea of small government almost never mean dismantle all oversight and accountability to allow systemic fraud and corruption. Republican voters see that as less social services or programs and/or lower taxes. What neo-liberals and neo-cons have done is eliminate all public protections and the path to public justice for citizens when they are victims of fraud and corruption. This is what small government means to global corporate pols. You might think the description of Maryland's Health regulatory system below sounds like it is doing good things but I include an update from citizens of Maryland who do not get what these corporate pols pretend all Marylanders do receive in health care. Maryland used these commissions to receive an exemption from Medicare and Medicaid regulations basically ending Federal protections for seniors and the poor as these programs were treated just as private insurers. Remember, Medicare serves to keep health prices lower-----it is only massive health industry fraud and profiteering with no oversight of the Medicare program that has prices higher than need be. So, when Maryland received an exemption from Medicare it was allowed to create a tiered level of service and access according to income that kept seniors and the poor from receiving the benefits due. Needless to say these are often the sickest populations so you can see why health care costs were lower while hospitals became more profitable.
I always like to preface who those excluded were just so people having the attitude that the poor should be excluded see who these people are. Also, remember the goal for neo-liberals and neo-cons is an end to the US middle-class and a push towards all citizens being at or near poverty. These policies will effect most people.
Overview of Maryland Regulatory System for Hospital Oversight
In Maryland, hospitals are regulated by several agencies:
- The Maryland Health Care Commission (MHCC) administers the certificate of need (CON) program.
- The Office of Health Care Quality (OHCQ) in the Department of Health and Mental Hygiene (DHMH) oversees licensing requirements.
- The Health Services Cost Review Commission (HSCRC) regulates the rates hospitals can charge for care.
The MHCC Certificate of Need (CON) program is designed to make sure that new health care services and facilities are developed only as needed. This decision is made based on measures that have been developed with public input. For each proposal, the MHCC considers the following:
- Quality of care
- Geographic access to care
- Financial access to care
The CON program oversees the following health care providers:
- Acute-care general hospitals.
- Specified acute-care services including obstetrics, pediatrics, and acute psychiatry.
- Special hospitals (chronic, psychiatric, rehabilitation, and pediatric).
- A new health care facility is built, developed, or established.
- An existing or previously approved, but unbuilt, health care facility is moved to another site.
- The bed capacity of a health care facility is changed.
- The type or scope of any health care service is changed, if the health care service is offered by a health care facility.
- Capital expenditures are made by or on behalf of a health care facility.
Within the Department of Health and Mental Hygiene (DHMH), the Office of Health Care Quality (OHCQ) licenses or certifies various health care facilities and services in Maryland. The OHCQ’s Hospital Unit is legally required to evaluate all hospitals, and to investigate and respond to all consumer complaints. OHCQ is responsible for licensing and certifying hospitals that participate in the Medicare program.
Well, another oversight commission looking to be actually doing its job! Imagine that. It states the need for evidence but looks to be producing none. That sounds familiar.
Indeed, what we are seeing is a growing crony system for health care as exists for the financial industry----let's do self-regulation so no one sees the decline in US health.
The Joint Commission Type Non-profit organization Industry Health care Founded 1951 Headquarters Oakbrook Terrace, Illinois, United States Area served North America Website jointcommission.org The Joint Commission (TJC) is a United States-based nonprofit tax-exempt 501(c) organization that accredits more than 20,000 health care organizations and programs in the United States. A majority of state governments recognize Joint Commission accreditation as a condition of licensure and the receipt of Medicaid reimbursement.
The Joint Commission is based in the Chicago suburb of Oakbrook Terrace, Illinois.
'There is growing concern, however, over the lack of verifiable progress towards meeting the organization's stated goals. Although the Joint Commission increasingly cites and demands "evidence-based medicine" in its regulatory requirements, there is a relative paucity of evidence demonstrating any significant quality improvement due to its efforts, while there is a growing body of literature showing no improvement or actual deterioration in quality despite the increasingly stringent and expensive requirements. Indeed, a facility requesting accreditation pays a substantial fee to the Joint Commission (the "accrediting" agency) and, upon receiving a "passing" grade is able to purchase associated momentos of accomplishment to display to the public. No other entity certifies the Joint Commission'.
The Joint Commission (TJC) approves all acute-care hospitals. TJC is an independent, not-for-profit group that evaluates and accredits health care organizations and programs in the United States. TJC surveys accredited hospitals every three years. It also evaluates nursing homes and home health agencies.
Once a hospital has received TJC accreditation, the federal government approves it to be a Medicare provider, and Maryland renews the hospital’s license. Maryland does not require the OHCQ to review a hospital that the TJC has accredited, unless a specific situation, such as a complaint, creates the need for such a review.
Now, we know that in Baltimore the underserved communities have a longevity 30 years less than affluent and health outcomes are some of the worst in the country so just where is that $1 billion going that Maryland allots for uninsured/uncompensated care? It appears not to be allowing access to hospital care for those without insurance. This commission provides the oversight yet Maryland has some of the worst of health care conditions. Nursing homes were given an 'F' in Maryland says government watchdogs.....veterans are not able to get appointments for care because the VA has been dismantled. These are two of the most needy and most expensive populations for care and they are not getting it. That $1 billion is not making it to its destination. I shared the experience of an uninsured that went to MedStar emergency and received no Xray for a severely broken leg and dislocated ankle and sent away with no ability for followup visit. This is what Maryland has created as cost effective and it is why hospital profits are soaring. They provide only the service that is paid for.
NO NEED FOR PUBLIC HOSPITALS THAT WOULD GIVE COMPLETE CARE TO SENIORS AND THE POOR WITH MEDICARE AND MEDICAID. PUBLIC HOSPITALS ARE OPEN TO PUBLIC INSPECTION AND ACCOUNTABILITY AFTER ALL!
Setting Hospital Rates
The Health Services Cost Review Commission (HSCRC) was established by the Maryland General Assembly in 1971. The seven-member commission reviews and approves rates that hospitals can charge for their services. The HSCRC also provides financial information about Maryland hospitals to the public.
In establishing the HSCRC, the Maryland General Assembly wanted to meet the following needs:
- Keep hospital services affordable.
- Expand access to hospital care for those without insurance.
- Provide accountability for hospital performance to the public and state government.
Hospital rate setting also enables Maryland to cover reasonable costs to those who cannot pay for health care services known as uncompensated care. In FY 2008, $1 billion was included in hospital rates for uncompensated care. As a result, Maryland has no need for public hospitals.
In 2008 alone, the HSCRC has saved Marylanders $2.9 billion in hospital costs by keeping the growth in cost per admission below the national rate.
Maryland is the only State in the country that has a Medicare Waiver. Under this agreement, Medicare reimburses Maryland hospitals according to HSCRC rates. To learn more about the Maryland rate setting system and the HSCRC, visit the HSCRC website.
Maryland Bills adding major costs to State Employees health care
by Dan Seiler on March 20th, 2011
This is a call for action: All State employees both active and retired need to contact their Delegates and Senators now. Communicate your concerns about provisions contained in HB72, SB87 and SB628. The following link is a good way to do that, http://mlis.state.md.us/mgaweb/mail32.aspx
Below you will find a copy of the letter that was sent to the Western Maryland Delegation Members. If you would like to use any of the talking points, please do so. You may copy and paste all or any part of the below letter onto your email that you are sending to your local State Senators and Delegates. If you would like your personal letter posted on this site, please send it to Dan Seiler at email@example.com
Here is a letter from a public employee.....A STATE TROOPER.... about state pension benefits. Keep in mind that O'Malley and Rawlings-Blake have for decades defunded these pensions with the knowledge that they would be renegotiated. As the letter writer says access to health care will be extremely affected......THAT'S FOR WHAT THESE THIRD WAY POLS ARE GOING ......FEWER PEOPLE GETTING ACCESS!
These policies are aimed at reducing access to reduce costs. The Maryland health policy is not working to make the system more efficient and affordable----it is simply designed to exclude and lower quality.
To: Maryland Legislature
From: Dan Seiler
I am a retired State Trooper who retired with the expectation and hope that the State of Maryland would abide by legal or at least moral obligations to continue providing the same or better health care coverage.
During the time I served the State of Maryland, I would have never believed that the Maryland Legislature would ever propose bills that would reduce my standard of living! My primary attraction to state service was a promise of life long health care. This is why I am opposed to several sections in HB 72, SB87 and SB628 involving proposed cuts to retired and active State employee health care.
For many years the State of Maryland has made implied guarantees to provide State employees with health care that does not cause financial hardship. The sponsors of these proposed legislative acts go against this promise. The people most affected by these proposed bills would be the retired State employees.
For example a proposed provision in HB 72 and SB 87 allows the State to establish separate health insurance benefit coverage for retirees that differs from those for active state employees. Proposed prescription drug coverage provisions in SB 628 show a drastically inequitable difference in coverage between active and retired State employees. This disparity would cause significant adverse financial impact on the retired State employees who are on fixed incomes and who do not receive full social security benefits.
As depicted in SB 628 any change in the current (COLA) Cost of Living Adjustment structure would aggravate even more the financial life altering burden on active and retired State workers making it difficult to keep pace with rising inflation.
I call on you as an elected member of the Maryland Legislature to find another way to balance the State Budget.
Sgt. Dan Seiler – Retired
401 Thames Street
Hagerstown, Md. 21740
Obama and neo-liberals cut almost $1 trillion dollars from Medicare to pay the costs of massive health industry fraud and profiteering from the Medicare Trust. He then gave these same health industry people the power to save money any way they want. That of course is now done by even less access to care and health professionals seeing their wages and benefits cut and staffing cut. So, the conditions for quality are disappearing as citizens are shouting that fewer and fewer doctors are handling Medicare and Medicaid patients. So does policy that says it includes all really mean it if the policy eliminates all venues for these people to access care?
OF COURSE NOT AND IT IS NOT MEANT TO. THE GOAL IS TO PUSH 80% OF PEOPLE OUT OF ACCESSING ANYTHING OTHER THAN PREVENTATIVE HEALTH CARE.
People are being told more and more that nothing can be done after one admittance does not solve a problem----ergo, re-admittance is down. GO AWAY!!!!------THAT MAKES RE-ADMITTANCE GO DOWN! It is of course often the sickest that need re-admittance. If co-pays and deductible costs do not keep you away----doctors refusing to admit you or not taking you as a patient will.
THAT WILL KEEP HEALTH COSTS DOWN WHILE ALLOWING FRAUD AND PROFITEERING TO CONTINUE!
'At its launch in 2009, doctors and hospitals raised concerns that the program might lead hospitals to try to avoid patients more likely to suffer complications – or refrain from testing for certain complications because the hospital’s ratings could suffer if too many were found'.
This is exactly what is happening. Where doctors used to pad bills by adding tests or procedures not needed now they are deliberately avoiding tests or procedures to save costs or hide data that will cut the money coming in. THIS POLICY PUSHES TOWARDS MALPRACTICE.
SURPRISE!!!!!!!! NO TRANSPARENCY IN MARYLAND AND THE PEOPLE WRITING THE LAWS ARE THE SAME PEOPLE SUPPOSEDLY PROVIDING OVERSIGHT AND NONE OF THE ABOVE IS HAPPENING!
Mar 19, 2013, 12:36pm EDT Updated: Mar 20, 2013, 4:20pm EDT
Maryland gets 'F' in health care price transparency Maryland received an "F" for health care price transparency, according to a new report.
Sarah GantzReporter- Baltimore Business Journal Email | Twitter Maryland received a failing grade in health care price transparency from two industry nonprofit organizations.
A report by Health Care Incentives Improvement Institute and Catalyst for Payment Reform evaluated state laws to determine how much price information is reported to states and how easy it is for consumers to get that information.
Maryland was among 29 states to get an “F.” Only two states, Massachusetts and New Hampshire, received top marks.
The report evaluated state laws regarding price transparency on a number of criteria, such as what charges and prices must be reported, whether data must be reported for all or some medical procedures, and which health care providers fall under the rules. The report also evaluated where price data is reported and its accessibility to consumers. For example, whether data is reported only to the state, available by formal public request or online, or compiled in an annual report.
Maryland might have scored better if the report had looked beyond state statutes, said Maryland Health Care Commission Executive Director Ben Steffen. For example a database regulated by the health care commission collects information on health care claims, such as the amount paid by insurers and the amount patients paid out of pocket. That's authorized by regulation, not law, he said.
Making information about quality and cost readily available to consumers is increasingly important, as more employers begin to offer high-deductible health insurance plans, according to the report's authors.
“States can play an important role in ensuring that consumers have access to both quality and price information by setting policies and implementing laws that advance transparency,” Francois de Brantes, executive director of the improvement institute; and Suzanne Delbanco, executive director of Catalyst, wrote in their introduction to the report.
The lack of transparency and the complete capture of policy and oversight by private commissions takes all control of policy from the citizens of Maryland and we do not know that the data we receive is accurate. We do know that too often outside investigations find Maryland data full of fraud and corruption. It is very important to stop this practice of closed commissions with people appointed who do whatever they want with no input. With O'Malley we have Wall Street appointees simply creating a system that maximizes profit any way possible. Below you see a ridiculous claim of accountability by Maryland Attorney General-----$12 million is a record when we know billions in health fraud occurs in Maryland each year.
As The Affordable Care Act consolidates and deregulates the health industry under the guise of efficiency we will see all of the fraud and corruption soar and patient care becoming worse all at the same time accountability of any kind disappears. No public health? Who holds them accountable? If a cap is placed on payment for care and much of it is lost to fraud----we will see less and less of actual care.
False Health Care Claims Act boosts fraud collections in Maryland
On behalf of Nathans & Biddle, LLP posted in Fraud on Tuesday, January 22, 2013.
Thanks to a law that provides incentives for people to report Medicaid and other forms of health care fraud, the Maryland Attorney General's Office has been able to collect an unprecedented amount of money from people convicted of fraud. In fact, the $12 million it's collected this fiscal year is more than six times the amount collected throughout the previous fiscal year. But this increase in collections should also serve as a reminder that state and federal authorities are making health care fraud cases an ever-increasing priority.
Below you see a well-researched paper on health fraud. Notice that the amount of fraud back in 1998 was $250 billion a year.....THAT WAS BEFORE CORPORATE FRAUD WENT ON STEROIDS
'It is clear to see why Americans consider this the biggest cause, when health care fraud was estimated to cost approximately $100 billion to $250 billion per year in 1998, or 10 percent to 25 percent of total health care spending'
An Undergraduate Honors Thesis by
Please remember----the # 1 cause of high health care costs in the US is health industry fraud and profiteering. All we would have to do is stop this and spending would be cut in half. Also, the Federal program Medicare has collected data on every aspect of health care needed to be assessed. Costs per procedure......kinds of procedures.....kinds of patients......
WE HAVE ALL OF THE DATA NEEDED TO DECIDE COSTS PER PROCEDURE ETC SO WHY ARE TEAMS OF HEALTH INDUSTRY EXECUTIVES FINDING THESE PRICING SOLUTIONS?
What is happening is a coverup for what is a very bad public policy of consolidating and deregulating the health industry and they are pretending to be doing things that will 'save' health care when in fact they are building structures that will deny access to most health care for most people.
The idea this is good policy is coming from corporate foundations! The relief for employers ------having only to offer preventative care. The relief for consumers---being made to buy insurance policies that will not allow you to access health care ----if you can't use it you will not spend it.
FORGET ABOUT THE FACT THAT PEOPLE HAVE PAID TAXES FOR DECADES WHETHER INCOME TAX OR PAYROLL TAX THAT GAVE ALL THE MONEY FOR HEALTH RESEARCH ------WE PROFIT BY EXCLUDING YOU SAY HEALTH CORPORATIONS.
For Maryland’s health spending plan, devil is in the details
Maryland officials have proposed what analysts call the most ambitious initiative in the country to control soaring medical spending, a plan that would bring relief to employers and consumers footing the bill while bluntly challenging the state’s powerful hospital industry.
The blueprint, which needs the Obama administration’s approval, would use Maryland’s unique rate-setting system to keep hospital spending from growing any faster than the overall economy — roughly half its recent rate of increase.
While some see Massachusetts as pushing boundaries by trying to establish health-spending ceilings, “Maryland has set hospital prices for more than 30 years” for insurance companies and Medicare alike, Joshua M. Sharfstein, state secretary of health and mental hygiene, said in an interview. “There are tools to accomplish this in Maryland that do not exist in other states.”
The plan also discusses sweeping measures to coordinate treatment and reward caregivers for efficiency instead of performing procedures.
“This is a really exciting proposal,” said John McDonough, a Harvard University professor and former state legislator who helped design Massachusetts’ health-care overhaul. “It’s nationally significant.”
The earliest the measure could take effect is January, but it is far from being adopted as written. Hospitals reacted coolly, and state legislators complained about how it was developed.
The proposal is a “tectonic change” and “the single most important event that’s affected Maryland hospitals in the last 40 years,” Carmela Coyle, chief executive of the Maryland Hospital Association, said at a General Assembly hearing last week. “The only thing that’s certain at this point in the application is the [spending] cap. We don’t know about the mechanisms that will actually get us there.”
Even the chief executive of Maryland’s biggest private health insurer, who has reason to welcome measures to restrain hospital spending, said the plan is short on details and long on risks for hospitals.
“It would be wonderful if [costs] could be slowed down,” said Chet Burrell, chief executive of CareFirst Blue Cross Blue Shield. “But then you have to turn to another question. And that is, what is the method by which they would decrease? How do you turn the system on a dime? That’s where our concerns with the proposal are greatest.”
The plan leaves many of these details to Maryland’s rate-setting Health Services Cost Review Commission. Two of the commission’s seven members are hospital executives, including Chairman John Colmers, a vice president at Johns Hopkins Medicine in Baltimore.
As a counterforce to industry skeptics, the proposal may have the backing of Obama administration officials who see Maryland’s tradition of rate control as a promising model, said Joseph Antos, a health economist at the American Enterprise Institute who sat on the commission for several years.
“People who favor rate-setting only have Maryland as the example,” Antos said. “The Obama administration believes that [such an approach] is an important strategy. I think this is the way they would want states to go in the future.”
The Health and Human Services Department, which must sign off on the part of the plan that affects Medicare, declined to make officials available for interviews.
“We’ve received the proposal from Maryland, and we look forward to reviewing it and working with the state,” HHS spokesman Alper Ozinal said.
While much of the blueprint focuses on hospital spending, it leaves the door open for a second phase after four years in which “our focus will broaden to all costs” in health care, according to the application, submitted to HHS on Tuesday.
For doctors and others outside the hospital systems, the second phase would create cost-control incentives such as shared savings among providers rather than direct rate-setting, Sharfstein said.
Maryland has set hospital rates since the 1970s, keeping spending per admission below national trends.
The rate commission’s “all payer” approach fixes hospital prices for everybody — commercial insurers, government programs and people paying cash — avoiding the cost-shifting from one payer to another that occurs elsewhere. The system also builds expenses for indigent care into statewide rates, ensuring that hospitals with high levels of uncompensated treatment stay in business.
Hospital costs have risen in recent years, however, threatening to break an HHS agreement that waives normal practice and allows Maryland to set Medicare prices. Maryland hospitals do especially poorly in the category of expensive readmissions of recently discharged patients.
The proposal submitted last week is part of Maryland’s attempt to renegotiate the waiver and create savings for Medicare.
Despite their reservations, hospitals have a potent incentive to maintain the waiver and approve a new cost-control system. Although the state has kept growth in Medicare spending on hospital admissions below the national rate, what Medicare pays per Maryland case is far higher than what it spends in other states. (IT'S THE FRAUD FOLKS-----IT'S THE FRAUD!)
Losing the waiver would mean foregoing roughly $1 billion in annual hospital revenue. But approving the new plan — cutting hospital cost growth to less than that of the long-term expansion of the state economy — would also shock a system accustomed to adding jobs, buildings and revenue for years, supporting Maryland’s economy as other industries declined.
“When you all of the sudden jam on the brake and say you’re only growing at state GDP, it’s like a two-by-four in the face of the health system,” said Uwe Reinhardt, a health economist at Princeton University. “And it causes a lot of stress.”
Over the past decade, Maryland hospitals have added jobs at nearly five times the rate of the state as a whole, according to Labor Department statistics. Hospital revenue per Maryland resident — the proposed new benchmark in the state’s HHS proposal — has grown nearly twice as fast as the economy over the same period, according to the cost commission.
A spokeswoman for the University of Maryland Medical System, one of the state’s health-care heavyweights, declined to comment. Johns Hopkins Medicine, which also would be hurt by stricter spending limits, is still evaluating the proposal, according to officials there.
The existing waiver caps the growth in Maryland hospital costs per inpatient case. The new test would track spending growth for both inpatient and outpatient care — but per Maryland resident rather than per case. The proposal would decrease incentives for hospitals to perform more procedures and direct the cost commission to adjust rates according to the state’s economic growth.
The proposal would also expand Maryland initiatives to reduce hospital readmissions, coordinate care among providers and share the proceeds of cost savings with caregivers.
Maryland Senate Minority Leader E.J. Pipkin (R-Cecil), a frequent critic of the administration of Gov. Martin O’Malley (D), complained that the proposal should have been drafted with more outside advice.
Sharfstein and other state officials seem to “regard themselves as the sole possessors of the requisite knowledge to decree what changes must occur to hospital reimbursement in order to keep Maryland’s . . . waiver,” he said in a prepared statement. “I hope they do — because they are imposing the most significant change in four decades on Maryland’s $15 billion health care industry and largest [private] employer.”
Reinhardt, who has written favorably of Maryland’s rate-
setting board, suggested that Sharfstein may indeed have something that looks like the answer.
“Intellectually, the Maryland health-care leaders are way ahead of the health-care leaders in the rest of the country,” he said. “It’s probably the most ambitious such thing I’ve seen.”
— Kaiser Health News
Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente. E-mail: firstname.lastname@example.org.