For those thinking that reforming health care is about making it work more cost effectively and no simply working to deny access to most people, the article below shows that once again Third Way corporate democrats led by Obama set parameters for reform that sound good buy never happen.....think the financial reform bill. They lay out all the problems, they know the solutions, but because their goal is to increase profit and not making the system work efficiently, it punts on all the good policy and allows the environment for worst case scenarios. You see here that the problem we all know exists with entitlements and health care in general is the fee to pay and the excessive use of procedures that are unnecessary and/or coded in a way that makes the bill considerably higher. This is the massive fraud in which trillions of dollars were lost from entitlements. People are literally dying from this lack of planning as all things stop and then all things are sent to individual states to handle. THIS IS WHAT WAS DONE FOR MEDICAID AND NOW THEY ARE DOING IT FOR MEDICARE. THIS IS THE REPUBLICAN PLAN TO SEND THESE TO STATES WHERE THEY BECOME VOUCHER PROGRAMS. This shows you the plan is to dismantle entitlements.....not save them. You see below Medicare is starting to look like Medicaid which is starting to look like public health in third world countries.
RUN AND VOTE FOR LABOR AND JUSTICE NEXT ELECTION!!!
The Obama Administration has stopped paying the bills from hundreds of health care companies, and it has nothing to do with sequestration.
This is a story of bureaucratic mismanagement at the Centers for Medicare and Medicaid Services, and the harm it’s visiting on the diagnostic testing industry.
At issue is the way that Medicare reimburses everyone from the big laboratory companies such as the Laboratory Corp of America (LH:NYSE) and Quest Diagnostics Inc. (DGX:NYSE), to the molecular diagnostic labs inside academic hospitals, and especially smaller firms that make proprietary tests used by doctors to more effectively target treatments to patients with conditions like cancer.
Hospitals Are Going On A Doctor Buying Binge, And It Is Likely To End Badly Scott Gottlieb Contributor The New Obamacare Insurance Is Looking More Like Medicaid Scott Gottlieb Contributor
Some of these proprietary tests — focused around the more accurate diagnosis of prostate cancer — are profiled in today’s edition of the New York Times. The incompetent manner in which Medicare has handled a change in the reimbursement of similar tests has the potential to stymie one of the most important and potentially cost-saving technologies in the pipeline.
The molecular diagnostics in question are used to screen for everything from genetic markers that predict disease to proteins that help diagnose illnesses and guide peoples’ response to treatments. These tests are transforming the treatment of cancer, among many other maladies.
The Medicare agency decided to change the way it reimburses these sorts of diagnostic tests. But it’s been slow to decide on its new approach. So in the absence of a policy, the Medicare program is simply not paying its bills.
Previously, these diagnostics were reimbursed through a method called “code stacking.” Under this old approach, adding up the “cost” of each discrete step needed to perform a particular test derived the price paid for molecular tests.
This “cost plus” approach to setting payment rates was familiar to government actuaries. But it had many problems. Not least of which, it didn’t necessarily correlate payment rates with value – but merely the complexity of the test.
Some labs grew more adept than others at exploiting the payment scheme. A handful of crafty labs would create more complex tests, or “stack” additional steps in their molecular panels in order to game higher reimbursement.
The result was a lot of variability in what was paid for similar diagnostics, depending on which lab ran the test, and how good it was at “stacking” codes.
Moreover, private insurers that reflexively piggy backed on the Medicare payment scheme complained that the bills they got only identified a series of molecular testing steps. These bills didn’t pinpoint the actual test that was being performed. So insurers often didn’t know what they were paying for.
The private health plans could have fixed this on their own, by demanding that labs provide more information. But many health plans, looked to Medicare to fix the billing system. Under pressure, the agency said it would develop a new scheme.
The prior payment system was far from optimal. But so is Medicare’s approach to replacing it. Moreover, under the new payment schemes, even when Medicare starts to pay its bills again, the rates for individual tests are likely to come down. That was the overriding impetus for changing the scheme in the first place – to save the government money. It’s another reason why big lab companies that make a lot of their margin on the complex, molecular tests could get pinched going forward.
To move away from the “code stacking” and to a system that paid diagnostics based on what each product was testing for, in 2010 Medicare asked the American Medical Association to come up with specific codes for the most common (and important) molecular tests. There were 116 of these new codes in the first tranche. These test-specific codes became effective in 2011. But Medicare chose to retain the existing “stacking codes” and not convert to the molecular codes until 2012.
Why wait? The idea was to give Medicare time to set prices for each of these new codes. Medicare was urged by the labs to cross walk some average price being paid to existing tests to the new codes (perhaps a median or weighted average of the stacks being used, which CMS would be able to measure).
But Medicare didn’t trust the current prices. It didn’t want to import any relic of the flawed stacking system into the new codes.
But instead of coming up with a new system, CMS took the full year to do largely nothing. The agency sat on its hands. Then, only after winding down the clock, the agency announced that it would let the local Medicare carriers figure out what prices to assign to each of the different diagnostic codes (through a byzantine process called “gap filling”). In other words, Medicare punted.
It basically means that the local carriers, which contract with CMS to administer the Medicare program for different regions of the country, now have wide discretion to come up with their own prices. The entire punt gave the local Medicare contractors no time – and no clear direction – on how to assign prices to the different diagnostic codes. The result is that no prices have been established for the vast majority of the marketplace. And so many tests simply aren’t being paid for.
This is having a profound impact on the market for developing new tests. Investors are shunning new investments as this gets sorted out. It says nothing about how these rates are ultimately going to be established, and whether the prices that the government assigns will reflect the value and innovation that these products offer.
There has also been little transparency around how the local Medicare carriers are coming up with their price schedules. There’s no right of appeal from affected companies. And no clear methodology on how this all gets done.
MARYLAND DOES NOT OFFER EVEN THE BASIC PROTECTIONS FOR PEOPLE AS IT DECONSTRUCTS ALL HEALTH CARE AND ENTITLEMENT COVERAGE FUNDING WE WILL SEE MORE NEGLECT AND ABUSE IN THE HEALTH SYSTEM. THIS IS JUST THE START!!!
FIRST ON FOX:
Sex Offenders Living and Working in Local Nursing Homes
Updated: Wednesday, March 27 2013, 10:37 PM EDT
No one expects a registered sex offender to be residing inside the same nursing home as their loved ones. But that is exactly what a Fox 45 Crime & Justice investigation uncovered. We found dozens of offenders living in nursing homes across the region. Under Maryland law, nursing homes as well as assisted living facilities don't have to disclose to residents or their guardian that a sex offender also resides there. Montgomery County Delegate Ben Kramer has been fighting on behalf of Maryland's aging population. Kramer's tried to have restrictions put in place but has faced opposition by colleagues as well as the Department of Health and Mental Hygiene. So far 41 registered sex offenders have been tracked to addresses that belong to nursing homes or assisted living facilities.
Read More at: http://foxbaltimore.com/news/features/featured/stories/first-fox-sex-offenders-living-working-local-nursing-homes-829.shtml#.UVRANXeyKHs
If Maryland media would share with the citizens of MD the goal of all these takeovers and reforms the people would be able to stand and fight what we all know no one wants....the privatization of America's public education system...that is what is happening with these policies. As much as the Md Assembly pretends to be supporting public education all of its policies and all the education appointees by O'Malley have been education professionals trained in the policy of privatization.
We know that is what is happening in Baltimore City right now as charters and private funding of schools have completely upended any semblance of Brown vs Board of Education and public education. Rawlings-Blake handed Baltimore schools to the state so O'Malley could turn Baltimore's school board into a business board with Alonzo leading the school as business mantra. In Baltimore County the new superintendent shouts for technology in the classrooms and language in elementary school while promising this is not about eliminting teachers and cheapened classrooms. Languages for elementary is not bad, but the objective of American citizens as emmigrants..shipped abroad to work as third world labor does now is not attractive.
The goal of Obama's education reform is a Wall Street privatizing that will tie all schools to businesses with vocational lessons and testing for tracking. NO ONE WANTS THAT!
Say no to Prince George's schools takeover Our view: Handing over authority for Prince George's County schools to county executive would set a regrettable precedent for Maryland
Baltimore Sun Opinion March 28, 2013
With its financial woes, low test scores, frequent leadership turnover and underperforming schools, Prince George's County's school system is failing its approximately 125,000 students, and its elected school board appears highly dysfunctional. Under these dire circumstances, it's not surprising that County Executive Rushern L. Baker III wants to intervene.
But what Mr. Baker seeks — direct control over the district's day-to-day operations and authority over its next superintendent — would be unprecedented in Maryland. The carefully constructed wall between public K-12 education and electoral politics would be torn down with potentially troubling, precedent-setting consequences for the state's other school systems.
Making matters worse, the county executive wants the General Assembly to authorize this historic shift of local authority in a matter of two weeks. That unreasonable timetable alone (authorizing legislation was submitted Monday, and the legislature's 90-day session ends April 8) should cause lawmakers to summarily reject it.
Mr. Baker and his allies have portrayed the bill as a local issue pertaining only to Prince George's County. But it's hard to believe that no matter how unique the circumstances of the state's second-largest school system, other county executives won't be watching anxiously to see if they may be able to seek similar authority.
After all, rare is the county executive who has not wanted to assert his or her will over the local school system. County governments (and Baltimore City's) must finance school systems but have limited opportunities to tell them how to spend that money or even hold those systems accountable. The arrangement is the bane of most every top elected official's existence.
Had anyone but Mr. Baker suggested such an accommodation, we seriously doubt it would go far. But as a former delegate and with powerful allies like Senate President Thomas V. Mike Miller and the clout that comes with managing one of Maryland's largest Democratic strongholds, Mr. Baker might be able to pull this off.
Those who doubted his political acumen last year may have been shocked when he and his allies virtually rewrote Maryland's gambling laws by advocating for a casino with table games at National Harbor. It required a special legislative session and a voter referendum, but Mr. Baker succeeded in both.
That's not to suggest Mr. Baker is engaging in some self-serving power-grab. It would be difficult not to share his frustration with a school system that has seen seven superintendents during the last 14 years. He wants a say in who is hired to be the next one, and we do not blame him. But there are also larger issues at stake.
Our preference would be to negotiate a compromise that would give Mr. Baker a say in who gets the top job (perhaps making it a joint appointment with the school board) but stops short of giving the county executive control of schools. If he wants to pursue this further, Mr. Baker would be better served advocating for new school board members who are sympathetic to his point of view in the next election.
What's a little scary is that Mr. Baker actually wants even more authority than the legislation pending in Annapolis would give him. He would like to have control over the budget, too, and leave the school board with a substantially smaller role. He has called making the superintendent a part of his staff (albeit one confirmed by the county council) a "nonnegotiable" position.
What's to stop some future county executive — one who may not have the interests of schoolchildren in mind — from abusing that authority? Or what if similar authority is granted county executives elsewhere who simply want to shrink school budgets or impose their will on curriculum or divide school resources like spoils to those who elected them? Individual school board members, whether chosen by voters or appointed by the governor, at least can't take such action unilaterally.
Ideally, Prince George's County could find itself a strong, reform-minded CEO like Baltimore has in Andrés Alonso and give that person the latitude to make the tough choices — and the time to see them through. This might be a good time for Maryland Superintendent of Schools Lillian Lowery to get off the sidelines and help the legislature find a better solution than to invest so much authority into the hands of someone who was never elected to run a single school, let alone a couple of hundred. Turning over an entire school system to a county executive is a precedent that must be avoided if at all possible.
I would also like to remind people that the state of education achievement in America was a direct consequence of education policy by the same elite institutions bringing us this education reform. As an educator first coming out of college and hitting the classroom in the early 1990s (alright, I'm that old!) I was shouting with all teachers just as they are today that education policy that had teachers taking textbooks out of lesson plans because they 'stifled creativity' and that allowed calculators in math classes for the very youngest of students would bring education achievement down as it did. THIS IS WHY ACHIEVEMENT IS BAD AND TEACHERS WERE TRAINED IN COLLEGE TO USE THESE BAD EDUCATION POLICIES. So, this problem is not a teacher-created problem, it is an elite institution policy to transition from a powerful and top in the world public education with strong democratic education for all to what they are now trying to build....a Chinese-style vocational K-college job training program to build workers.
Now, if media explained this overall movement of education policy to people do you think you would see protest and politicians voted out of office? Of course you would. We want to move America back to being a democratic, Rule of Law country and we need well-educated people who know how to be citizens to do that!
Let's see, we have a bill to raise the minimum wage out of the stone ages so people can pay for housing; you have massive mortgage fraud that took tens of thousands of Maryland homes to foreclosure yet to have justice as billions more need to come to Maryland and then to the victims of the fraud.....giving them homes; you have charter schools in underserved schools and development corporations using schools and housing to gentrify large swaths of urban communities all of which violates all equal housing/education laws. You have Enterprise Zone contracts that detail requirements for underserved families being built into projects being totally ignored by developers with no followup by justice because no oversight is given.....
WHO THINKS THIS BILL FORCING LANDLORDS TO TAKE SECTION 8 IS JUST A CAMPAIGN GIMMICK FOR MONTGOMERY COUNTY POLS WANTING HIGHER OFFICE? EVERYONE!!!!!
Senate sends housing discrimination bill back to committee
March 27, 2013 at 7:40 pm
By Ilana Kowarski
A bill that would prohibit landlords from screening prospective tenants based on their source of income was sent back to a Maryland Senate committee after three days of floor debate over whether landlords should be allowed to exclude those on public assistance. The 23-22 vote likely dooms the bill this session.
Advocates of the legislation said that it would encourage poor Marylanders to move out of ghettos and into communities with greater resources and superior schools, giving them a head-start in the race towards the American Dream.
The law’s opponents said that it would herald an era where businesses were forced to participate in voluntary social welfare programs and that a universal mandate to accept government housing vouchers like those in the Section 8 program would place a heavy financial burden on landlords.
The vote to return SB487 to the Judicial Proceedings Committee was extremely close, with 23 in favor and 22 opposed. Senate President Mike Miller took the side of those who thought the legislation was not ready for passage.
“Members of my party are not happy with me right now,” Miller said, “but this is not the time to decide on this legislation.”
Sen. Thomas Mac Middleton
Bill needs work, Miller says
Miller said that senators needed to work out kinks in the bill, and that it was probably too late for them to correct all the problems with it, since the session ends in less than two weeks. He also questioned whether it was appropriate to pass statewide legislation requiring landlords to participate in Section 8 and other public assistance programs.
Charles County Democrat Thomas Mac Middleton said that the goals of the bill were laudable but that he could not support it in its current form, because landlords would not be allowed to evict Section 8 tenants if the federal government refused to pay rent increases, reduced housing payments, or halted the distribution of rent checks during the sequester.
Middleton said that the bill might even be counterproductive.
“If an apartment complex owner has 100 units and 100 people show up with Section 8 vouchers, the owner would be required to accept all of them, and you’d end up with a building that was 100% Section 8,” he said. “One of the goals of this legislation is to decentralize poverty, but if this scenario happens, haven’t you defeated the purpose?”
Sen. James Rosapepe, D-Prince George’s, said that the authors of SB 487 set out to accomplish their goal in a backwards fashion. He acknowledged that needy Marylanders frequently had difficulty finding landlords that would accept their housing vouchers but argued that there is a better solution.
“The housing authority needs to find ways to attract landlords to the Section 8 program,” Rosapepe said. “Instead this bill uses a very blunt instrument, forcing businesses to take part in a government program, and that’s unprecedented. We don’t force doctors to participate in Medicaid, and we shouldn’t do this either.”
Bill not likely to return
The bill’s sponsor, Sen. Jamie Raskin (D-Montgomery), said that he was disappointed by the resistance of his fellow senators.
“The bill is unlikely to resurface this session because of the time crunch,” he said.
Raskin argued that his opponents’ arguments were misleading.
“The unfortunate part of the debate was that it was cast as a conflict between tenants and landlords, and we heard testimony from landlords in Montgomery County and other places with laws like this one, and they had positive experiences with Section 8.”
There were other senators who tried to stop SB 487 from being referred back to the Judicial Proceedings Committee, including committee chairman Brian Frosh, who urged senators to take a stand on the law rather than sending it back.
Sen. Roger Manno, D- Montgomery, also objected to the bill’s return.
“This bill is about discrimination,” he said. “It’s unconscionable to send it back to committee.”
Read more: http://marylandreporter.com/2013/03/27/senate-sends-housing-discrimination-bill-back-to-committee/#ixzz2OqsOhC8v