I wanted to end for now the talk on health care and how the private non-profit complex is capturing these policy issues to their financial gain. As I showed there was a network created for Maryland Health Care for All in existence since 1999. Maryland ended with not only a private health system but one that makes health institutions more profitable than anywhere in the nation......at our loss. Below you see we are organizing again for this same issue......WE WILL NEED TO WORK HARD AT KEEPING THESE NON-PROFITS FROM AGAIN USURPING THE ISSUE BECAUSE THEY ARE GOING TO TRY!
One of the ways they intend to take the issue this time is by framing Universal Care with the Medicare or Medicaid for All label. Now, anyone who has either understands how these programs have already been gutted, especially Medicaid, so as to have seniors unable to pay co-pays so WE DO NOT WANT A MEDICARE FOR ALL THAT EXTENDS WHAT WE HAVE NOW. THAT IS WHAT THEY ARE TRYING TO DO;CAPTURE THE ISSUE BY STICKING US WITH AN ALREADY INADEQUATE PLAN. Please fight hard for a universal care that matches the quality of care we are used to receiving. Remember, the problem was waste and fraud......not access.
What the Affordable Care Act outlines in a tiered level of insurance that they cleverly named Platinum, Gold, Silver, and Bronze level of coverage and goes from 90% insurance coverage, 80%, 70%, 60%.
Healthcare is a Human Right - Maryland Healthy Lives. Healthy Community. Join Healthcare Now-Maryland and members of our campaign on March 4th 7-9 pm at the Diocesan Center in Baltimore (N. Charles & University Parkway) for a presentation by Dr. Walter Tsou, past president of the American Public Health Association and former Health Commissioner of Philadelphia, on the pressing need to improve our healthcare system beyond the Affordable Care Act. Specifically, Dr. Tsou will be sharing the crucial moral and economic reasons why we must work towards universal healthcare in Maryland and throughout our country.
This event will provide an opportunity to educate ourselves further in preparation for the Community Dialogues we are beginning to organize across the state. Beginning in April, counties around Maryland will be organizing large public forums where Marylanders from diverse communities will share their health care stories, realize they are not alone, and join the growing grassroots movement to ensure this healthcare crisis does not continue!
We hope y'all can join leaders from throughout the state on March 4th to learn details of why we must fight for our human right to health care, and why we cannot afford to settle for current "reform" that exacerbates inequality and emphasizes profit over people.
When: Monday, March 4th . 7-9 pm Doors Open & Snacks Start at 6:30
Where: 4 E. University Parkway, Baltimore, MD 21218 (Intersection of Charles St. & University Parkway)
THIS ARTICLE DOES A GOOD JOB OUTLINING THE CONCERNS AND LAYS QUESTIONS AS TO THE REAL INTENT OF THIS ONLINE PUSH. IT DOESN'T MENTION ONE MAJOR CONCERN AND THAT IS THE SALE OF MEDICAL DATA FOR PROFIT......
YOU SEE THERE IS NO THOUGHT BY PEOPLE IN THE TECHNOLOGY INDUSTRY THAT THIS PROCESS WILL SAVE MONEY....FRAUD AND ABUSE GUARANTEED TO GO UP!
THERE IS NO HEALTH FRAUD SAYS DEPUTY DIRECTOR FOR MARYLAND HEALTH AND MENTAL HYGIENE!!!!
Electronic medical records probed for over-billing Critics question credibility of federal panel charged with investigating
By Fred Schulteemail 6:00 am, February 14, 2013 Updated: 10:59 am, February 14, 2013
Dr. Farzad Mostashari is the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services. hhs.gov
Thousands of doctors and other medical professionals have steadily billed higher rates for treating elderly patients on Medicare over the last decade — adding $11 billion or more to their fees and signaling a possible rise in medical billing abuse, an investigation by the Center for Public Integrity has found. The Obama administration is forging ahead with a multi-billion dollar plan to shift from paper to electronic medical records, despite continuing concerns the program may be prompting some doctors and hospitals to improperly bill higher fees to Medicare. An investigation into those billing questions — which convened a hearing Wednesday — has yet to produce much in the way of results, and critics are questioning the seriousness of the efforts.
Some digital records software marketed to medical professionals may be encouraging use of elevated billing codes that pay fatter fees, according to the nation’s top health information technology official. That could undermine cost savings the government expects to achieve by adopting the digital systems.
“There is a lot we don’t know about that,” Farzad Mostashari, the National Coordinator for Health Information Technology, said Wednesday at a hearing of policy experts studying the billing issue. “We don’t know if the shift (in higher billing) reflects appropriate coding or inappropriate coding.” He added: “We don’t know if this leads to an increase in costs … or has other impacts.”
In October, Mostashari directed the panel of experts to investigate whether the digital systems allow doctors to cut and paste records from prior encounters with a patient, a practice known as “cloning.” Many experts say this process can raise the size of a patient’s bill, even though it reflects little in the way of added or necessary medical service.
Mostashari’s called for the review in the wake of the Center for Public Integrity’s “Cracking the Codes” series, which found that thousands of medical professionals have steadily billed higher rates for treating seniors on Medicare over the last decade — adding $11 billion or more to their fees. The investigation suggested that Medicare billing errors and abuses are worsening as doctors and hospitals switch to electronic health records.
Mostashari said at the start of Wednesday’s daylong hearing that it is “pretty clear” that if digital health records are “documenting care that didn’t occur, that’s not just fraud, it’s really dangerous medicine.”
But the policy panel spent less than an hour listening to four witnesses discuss the billing issue, suggesting that officials aren’t likely to quickly resolve concerns about potential fraud and abuse even as they commit up to $30 billion in government funding to encourage doctors and hospitals to purchase electronic records.
Ivy Baer, representing the Association of American Medical Colleges, recommended in her testimony that use of the “copy/paste” functions be limited and that doctors only document services “pertinent” to treating the patient’s current medical problem.
Michelle Dougherty, director of research and development from the American Health Information Management Association, said in prepared testimony that digital records can produce “volumes of redundant data” that are “very difficult to use and understand.” She said policy makers need to be aware of “red flags” that could produce inaccurate records — for instance, software that allows doctors with a single mouse click to check a box indicating that all body systems were examined and found to be normal, even though that not all were actually examined. Since doctors are compensated for the total amount of service they provide, these systems can improperly generate higher fees.
Dougherty also said that “cloned” documentation produced by cutting and pasting information from previous patient visits “continues to be a significant problem” that creates “unnecessary redundancy and at times inaccurate information.”
There was little talk of how wiring up medicine might raise doctor billings when President George W. Bush in 2004 set the goal of creating a digital medical record for every American within ten years. In early 2009, the Obama administration added billions of dollars in stimulus funds in the hopes that electronic health records would both enhance the quality of medical care and hold costs in check.
At the hearing’s conclusion panel chair Paul Tang, of the Palo Alto Medical Foundation in California, said that the group had little information about whether digital records improperly contributed to rising health care costs.
“We don’t have any data, positive or negative, that would be useful,” he said.
In all, the Obama administration expects to spend more than $30 billion helping doctors and hospitals purchase the gear and use it to improve health care. More than half the nation’s hospitals have received some payments, and so far more than $10 billion has been spent. Just over half the doctors now billing Medicare are using digital records.
But critics of the initiative have claimed for years that the office of national coordinator (ONC) has been more aggressive as a cheerleader for the technology industry than regulator and steward of billions of dollars in taxpayer money.
Donald W. Simborg, a California physician who participated in two government groups that studied the billing fraud issue, said on Wednesday that Mostashari’s review relies too heavily on panel members with close ties to the burgeoning health information technology industry. He questioned its effectiveness in determining if the digital equipment contributes to Medicare billing fraud.
Simborg likened the situation to “asking the NRA to investigate gun violence.” Simborg noted that the policy committee consists of strong supporters of electronic health records “who could hardly provide an unbiased and objective view on this.”
Ross Koppel, a sociology professor at the University of Pennsylvania, said that officials face a difficult balance in making sure that the software programs accurately reflect the services a doctor rendered and are not just maximizing payments.
In a brief interview on Wednesday, Mostashari bristled at the suggestion that his office is doing little to ensure that digital medical records don’t take taxpayers for a ride. “This is just the beginning of the conversation,” he said. An ONC official said that the Centers for Medicare & Medicaid Services plans to investigate the “upcoding” issue in regard to digital records, but could provide no details. The ONC panel is set to resume its deliberations today.
Criticism of the initiative also has come from Republicans in Congress concerned about its costs and from within the federal government.
In a Sept. 24 letter, Department of Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder warned five hospital and medical groups of their intent to ramp up investigative oversight, including possible criminal prosecutions, of doctors and hospitals that use electronic health records to improperly bill for more complex and costly services than they actually deliver — a practice known as “upcoding.”
In an Oct. 4 letter, four Republican House members urged HHS Secretary Sebilius to suspend government payments to hospitals and doctors, arguing the program may be wasting tax dollars and doing little to improve the quality of medical care. They argued that tax dollars spent so far have failed to ensure that the digital systems can share medical information, a key goal. Linking health systems by computer — called interoperability — is expected to help doctors avoid costly duplication of tests and medical errors. The House members have yet to get a response, according to a spokesperson.
The HHS Office of Inspector General also is investigating what it called “fraud vulnerabilities” related to use of electronic health records. The report is “currently in process” and is expected to be released sometime this year, according to agency spokesman Donald White.
While many experts believe that digital records will eventually prove their worth and help doctors keep people healthier, the government program has spawned an aggressive sales push by technology companies, which typically stress that their products can significantly boost the bottom line for doctors and hospitals. One company predicts an increase of one Medicare coding level for each patient visit to the doctor, potentially adding $225,000 in new revenue in a year, for instance.
Federal officials lack any system to monitor the accuracy of hundreds of billing and medical software packages in use across the country. That shortcoming caught the eye of the American Medical Association, which helped develop the billing codes and favors stricter government standards. In May, the doctors’ group urged officials to require testing that assures digital devices bill accurately and “do not facilitate upcoding.”
The information technology industry generally agrees that computerized medical records can lead to higher costs. But it argues that the software makes it easier for doctors and hospitals to more efficiently document all of the work they do — which they often failed to do on by hand on paper.
AS SOMEONE WHO HAS HAD ALL KINDS OF HEALTH PLANS.....FROM CORPORATE BENEFITS PACKAGE, TO INDEPENDENT CONTRACTOR SELF-INSURE, TO BEING UNINSURED AND SEEKING HEALTH CARE.....I HAVE A WIDE EXPERIENCE. I CAN SAY THIS ABOUT THE PLANS OFFERED BELOW......HEALTH CARE IS A RIGHT....IT ISN'T CAR INSURANCE.
WHAT THEY HAVE HERE IS A PLAN THAT CLEARLY LAYS OUT THE EVER LOWER LEVEL OF ACCESS ACCORDING TO INCOME. CAN YOU IMAGINE WHAT LEVEL OF CARE YOU WILL GET WITH A 60% COVERAGE MOST PEOPLE WILL HAVE TO TAKE AS IT WILL BE ALL THEY CAN AFFORD? ONE MAJOR INCIDENT AND YOU WILL BE BANKRUPT.
REMEMBER, YOU WILL BE REQUIRED TO BUY ONE OF THESE AND UNLESS YOU EARN AS A FAMILY $100,000 YOU WILL NOT BE ABLE TO ACCESS MAJOR CARE.
VOTE YOUR INCUMBENT OUT OF OFFICE!!!!
News Release FOR IMMEDIATE RELEASE
February 20, 2013
Contact: HHS Press Office
Health care law allows consumers to easily find and compare options starting in 2014 New rule will expand mental health and substance use disorder benefits to 62 million Americans
Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today announced a final rule that will make purchasing health coverage easier for consumers. The policies outlined today will give consumers a consistent way to compare and enroll in health coverage in the individual and small group markets, while giving states and insurers more flexibility and freedom to implement the Affordable Care Act.
“The Affordable Care Act helps people get the health insurance they need,” said Secretary Sebelius. “People all across the country will soon find it easier to compare and enroll in health plans with better coverage, greater quality and new benefits.”
Today’s rule outlines health insurance issuer standards for a core package of benefits, called essential health benefits, that health insurance issuers must cover both inside and outside the Health Insurance Marketplace. Through its standards for essential health benefits, the final rule released today also expands coverage of mental health and substance use disorder services, including behavioral health treatment, for millions of Americans.
A new report by HHS, also released today, details how these provisions will expand mental health and substance use disorder benefits and federal parity protections for 62 million more Americans.
In the past, nearly 20 percent of individuals purchasing insurance didn’t have access to mental health services, and nearly one third had no coverage for substance use disorder services. The rule seeks to fix that gap in coverage by expanding coverage of these benefits in three distinct ways:
- By including mental health and substance use disorder benefits as Essential Health Benefits
- By applying federal parity protections to mental health and substance use disorder benefits in the individual and small group markets
- By providing more Americans with access to quality health care that includes coverage for mental health and substance use disorder services
The rule additionally outlines actuarial value levels in the individual and small group markets, which helps to distinguish health plans offering different levels of coverage. Beginning in 2014, plans that cover essential health benefits must cover a certain percentage of costs, known as actuarial value or “metal levels.” These levels are 60 percent for a bronze plan, 70 percent for a silver plan, 80 percent for a gold plan, and 90 percent for a platinum plan. Metal levels will allow consumers to compare insurance plans with similar levels of coverage and cost-sharing based on premiums, provider networks, and other factors. In addition, the health care law limits the annual amount of cost sharing that individuals will pay across all health plans – preventing insured Americans from facing catastrophic costs associated with an illness or injury.
Policies in today’s rule also provide more information on accreditation standards for qualified health plans (QHPs) that will be offered through the Health Insurance Marketplaces (also known as Exchanges), one-stop shops that will provide access to quality, affordable private health insurance choices.
Together, these provisions will help consumers compare and select health plans in the individual and small group markets based on what is important to them and their families. People can make these choices knowing these health plans will cover a core set of critical benefits and can more easily compare the level of coverage based on a uniform standard. Further, these provisions help expand choices and competition on the Marketplaces.
For more information on today’s rule, visit: http://cciio.cms.gov/resources/factsheets/ehb-2-20-2013.html
To view the rule, visit: http://www.ofr.gov/inspection.aspx
For more information on how today’s rule helps those in need of mental health and substance use disorder services, visit: http://aspe.hhs.gov/health/reports/2013/mental/rb_mental.cfm
Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.
You can follow HHS on Twitter @HHSgov and sign up for HHS Email Updates.
Last revised: February 20, 2013