For those living in Maryland know that Anthony Brown is leading this health reform written by Johns Hopkins and health businesses. O'Malley appointed all of the public officials pushing this privatization health reform.
Regarding the Affordable Care Act and Dan Rodricks:
This is what we will not hear on today's program......because all of Dan's guests are health care privatization and global market people. That is why the Business Journal is there. As Johns Hopkins recently noted.....health businesses have never been so profitable now that people cannot access health care!
Here in Maryland we have the strongest lobby against the public option and universal care in Johns Hopkins who for decades has used taxpayer money to expand its own campuses and grow globally and now will go private to sell health care patents and charge for consultant work and staffing all over the world. They also have flooded Maryland's health care businesses with immigrant health workers taken from around the world at a time when domestic unemployment is almost 25% and 40% if you look at part time workers. Doesn't make sense does it. The point is that immigrants can be exploited because they are not citizens and so work for ever lower wages and with no workplace protections. Hopkins loves a workforce that is impoverished! To make sure Maryland went with private health systems rather than that public health system rubbish, Hopkins had Beilenson head the Maryland Health Care for All, an organization that supported the Affordable Care Act even as we all knew it was all about health industry profits at consumer expense. So, we watch as this state health reform was written by the health industry and Hopkins and not surprisingly there are now several groups of Health Care for All in Maryland from United Workers to National Physicians to labor unions who now see it is killing their quality health plans.
Beilenson was key in keeping all of this public desire for strong public health care without voice. As Health Commissioner, just as with the Baltimore Health Commissioner, and the State Health and Mental Hygiene Commissioner we have a system of people who knew health care fraud was massive......$200-400 billion each year and billions in Maryland alone. They knew that almost half of Entitlements, Medicare and Medicaid was lost to health fraud and many of the institutions Beilenson was affiliated oversaw were these frauds were happening. But rather than fight and shout for strong health fraud and public protection laws as Maryland has the worst in the country.....all of these health commissioners are see no evil, speak no evil. Now we see Beilenson heading to the private non-profit that will be the public's last resort for affordable care.....the health co-op....and would we expect anything other than that he would make sure health businesses were not undercut by this agency, especially given that Hopkins is involved financially in all the health businesses that are expanding in Maryland. Of course that is his assignment.
While neo-liberals like Mikulski and Cardin gutted Medicaid funding at the Federal level, Maryland Assembly voted to gut it further at the state level and now we do not have a Medicaid program....we have what is comparable to third world clinic care for the low-income. Preventative care where huge bills for all kinds of work not needed will be billed causing health fraud to soar. Did you know that Kool Smiles, the children's dental chain that is being sued and prosecuted nationally for abusing and defrauding Medicaid is alive and well in Baltimore and that I am hearing already from my many contact across the city that the dental service coming to public schools are already subjecting children to these abusive money-making practices? Sound third world? It is third world and it is all done for enrichment at the top.
Labor unions are now aware that their health insurance is going to be gutted by the Affordable Care Act. OOPPS! The law was written in a way that large sectors of low-income people will not be covered as was the original reasons for this bill. OOOPPPS! The only parts of the bill that made health corporations pay any of the cost of reform has been taken out.....WAIT....Medicare Advantage was what cost the program the most because it was simply a money-maker for private health industries giving preventive perks while people needing basic care are denied access. That doesn't sound good, but that is what was expected by all of us that study public policy. Why didn't you know this would be the result......corporate media has control of even the public air waves and all this compromises free press!
So what is the answer? Well, lucky for us global markets are dying because no one trusts US businesses since they are criminal and corrupt. Africa is about the only place for these US corporations to go and even they are out en masse protesting to keep US colonialism away. There will be little opportunity. Second, we have International journalist and lawyers hunting down all the crime and money stolen through fraud including health fraud so our government coffers should be receiving trillions and trillions of dollars back reversing all this austerity. We will be electing politicians that will rebuild the democratic party and send neo-liberals packing with a goal of universal care in Maryland and institutions like Johns Hopkins who spent all that public money advancing their own interests rather than investing in the communities will be made a public hospital giving free care for all. This is all simple to do and only involves getting people back into political action mode.....which is happening at record speed!
Is your hospital leader committed to patient-centered care?
Robbin Dick, MD | Policy | July 11, 2013
Nearly every hospital leader in America will tell you their hospital is all about patient-centered care. Of course, we know this isn’t true in many cases, especially when it comes to hospital capacity management. Though many institutions will deny to its last dying breath that they have any priorities that supercede patient care, nearly all do.
They usually go like this: first priority is high margin surgical cases; second priority is high margin cardiac cases; third priority is lower margin surgical cases (or if it’s a tertiary care facility than transfers and directs). It sounds cold, but it is what it is.
Coming in last on the priority list is usually the emergency department.
Patients in the ED are ignored while patient beds are filled with higher priority patients. This accumulation continues to ratchet down the available beds the ED has to treat patients, usually during its highest volume periods, such as weekdays from noon to midnight. Mondays and Tuesdays in the ED are terrible, because those are the days that surgeons and specialists like to schedule their procedures (this would be physician-centered care), meaning there are fewer hospital beds available to admit patients from the ER.
This results in higher left-without-being-seen rates and unhappy patients in in the ED. Wednesdays and Thursdays the load lightens a little, until Friday finally arrives, with low volumes in surgery and cardiology, allowing the ED to start to decompress. Then the weekend arrives, hospital provider staffing shrinks and the volume of discharges from the hospital is cut in half. Then Monday comes and the cycle repeats.
This is hospital capacity management 101, which really isn’t capacity management at all.
Enlightened hospital leaders – and there are plenty of them out there, if you look – have embraced a different idea about capacity management. These leaders think of the ED as being the front door of the hospital. Accordingly, they move resources, implement new processes, such as well-run and resourced observation units, to address the capacity issues directly impacting patients waiting for a hospital bed. These leaders recognize that the emergency department interacts with more patients, family, friends and providers than any other area of the hospital, and as such can be the source of enormous creativity around capacity management, not just impacting the ED, but the entire hospital.
Good emergency management groups embrace creative problem solving to manage volume, using processes like provider in triage, bedside registration, diversion hours, geographic pod staffing, and a series of time-sensitive metrics that would put other areas of the hospital to shame. The ED manages natural variability on a daily basis, never knowing what the next minute or hour will bring. Staffing hours have to be demand mediated and have a high degree of flexibility.
Clearly if any one area of a hospital has a keen understanding of capacity management, it’s the emergency department. There, key metrics define care delivery, process improvement, efficiency, quality and cost.
True hospital capacity management anticipates the needs of the organization and adjusts and coordinates artificial variability so it provides optimal bed use for all the patients.
Much has been written about “leveling” – leveling out operating room schedules, leveling out the cath lab schedules, getting a consistent number of cases requiring specific bed types to leveled all week long. But leveling still isn’t about the patient. There are some instances in which it is—an acute myocardial infarction presenting to the ED or a triple AAA requiring the operating room.
But if the emergency department has 25 patients waiting for a bed at 3pm in the afternoon on a Tuesday, do you think anyone will suggest closing the operating room, or refusing directs or transfers? Not on your life. That’s because capacity management 101 by and large isn’t about the patients. It’s about surgeons and cardiologists – their lifestyle, or their needs, and where they sit on the totem pole of the organization.
This will only change when the organization determines that the most important thing in their hospital is the patient. In my decades of working in healthcare, I have seen physician-centered care, nurse-centered care, resident-centered care, or even administrative-centered care. Rarely have I seen patient-centered care.
So if you’re wondering whether a hospital and its leadership are enlightened, take a close look at its plans for capacity management.
Robbin Dick is observation medicine services director, Medical Emergency Professionals. He blogs at the EmergencyDocs Blog.
We keep hearing in Maryland that all kinds of health services for children are part of this state health reform and then we keep hearing that national chains are being used to service children and with that the fraud and abuse of these corporate entities. Two-tiers always mean that the lower tier will not only get less care and less quality, but for taxpayers, it means that Federal Trusts are depleted through fraud.
Wednesday, Jun 22, 2011 02:01 PM EDT SALON.com
How our two-tiered healthcare system hurts kids
A new study shows that children with public insurance have a lot more trouble getting the care they need
By David Sirota
At a legislative level, the political crusade to reduce government “to the size where they can drag it into the bathroom and drown it in the bathtub” is brilliantly self-sustaining. Both Republicans and conservative Democrats hold up the evils of “Big Government” (read: the non-military/security parts of government) as the rationale to reduce resources for popular programs and when those underfunded programs subsequently underperform, they cite the failure as reason to further demonize government, thus beginning the whole cycle anew.
This now-standard and now-bipartisan Neoliberal Formula is sophistry masquerading as tautology — and it has profound real world effects. The latest example of that truth comes from a new University of Pennsylvania report that exemplifies how the formula has helped embed an insipid “Separate and Unequal” doctrine within America’s healthcare system.
Published in the New England Journal of Medicine, the Penn study had researchers pose as parents calling physician specialists in Cook County, Ill. The only variable in the calls was insurance status — some callers said they had public insurance, others said they had private insurance. Here’s what they found:
Sixty-six percent of publicly-insured children were unable to get a doctor’s appointment for medical conditions requiring outpatient specialty care including diabetes and seizures, while children with identical symptoms and private insurance were turned away only 11 percent of the time… The study also found that [publicly]-insured children who received an appointment faced longer wait times to be seen.
These numbers are particularly striking, said the Penn researchers, “given the association between socioeconomic disadvantage and poor health status” -- an association which means kids covered by public insurance have a disproportionately greater need for specialty care than their privately insured counterparts.
The connection between the Neoliberal Formula and kids being discriminated against on the basis of insurance type is rooted in reimbursement rates paid to physicians.
As both parties have used anti-government arguments to slash taxes, public revenues have predictably dried up. With states under statutory obligation to balance their perpetually strapped budgets, Medicaid reimbursement rates have been regularly put on the chopping block in legislatures, creating ever-widening disparities between what physicians are paid by private insurance and what they are paid by public insurance. (For instance, in Illinois, where the study was conducted, researchers found “an office consultation visit for a problem of moderate severity is reimbursed at $99.86 by Medicaid-CHIP, whereas the average reimbursement for the same code by a commercial preferred-provider organization is approximately $160.”) Considering the ugly economics, it’s no surprise physicians are less eager to accept public insurance patients.
Hence, the Separate and Unequal disparities — disparities that will likely be cited by Republicans in Washington as proof that public insurance programs are inherently bad and therefore need to be even further defunded. Indeed, the infamous Ryan Budget proposes big cuts to Medicaid and the Children’s Health Insurance Program that would likely result in further reductions in reimbursement rates.
And so the cycle, the disparities and the Neoliberal Formula continue in perpetuity. As I said, it’s a brilliantly self-sustaining ideology, proving that in the era of paradox politics, self-sustaining and self-destructive often go hand in hand.
David Sirota is a nationally syndicated newspaper columnist, magazine journalist and the best-selling author of the books "Hostile Takeover," "The Uprising" and "Back to Our Future." E-mail him at email@example.com, follow him on Twitter @davidsirota or visit his website at www.davidsirota.com. More David Sirota.
I've spoken of health horror stories in Maryland hospitals and Med Star is always at the center of these stories. I was on public transportation downtown and overheard a group of riders talking between themselves about Harbor Hospital. This hospital is located in what is now a largely underserved community Cheery Hill. The consensus of the group of six.....DO NOT WALK INTO THAT HOSPITAL.....IT IS THE WORST EXPERIENCE. I spoke about MedStar and unnecessary surgery, MedStar and mother's released too early from childbirth dying from botched delivery. I'm speaking with a friend about health care and he tells me he would only go to Union Memorial MedStar if he intended to die. This is the fastest growing chain and Johns Hopkins is partnered with MedStar.
These views come from every socio-economic background. The quality of health care in Maryland is abysmal and it is because of the drive to make these hospitals profitable. You say....'but MedStar is non-profit'......they use all there income to expand new hospitals. That is profit differently allocated. It is just what Hopkins did in its capacity as non-profit....use all income in building new operations!
I am a devoted progressive and support immigrants in all ways......but I do not support the flooding of our workplaces with immigrant labor when we are experiencing record unemployment. We see the entire staff in this underserved community hospital are immigrant health professionals.
We have tried for decades to get medical schools to change their system to allow larger numbers of students from all backgrounds go through for free......they are doing some of this now.
Medstar Harbor Hospital
Location 3001 South Hanover Street, Baltimore, MD 21225
Dr. Fouad M. Abbas, MD Gynecological Oncology
2411 W Belvedere Ave Suite 206, Baltimore, MD 21215
Dr. Hatem S. Abdo, MD Neurosurgery
301 Saint Paul St Suite 310, Baltimore, MD 21202
Dr. Rifat K. Abousy, MD Cardiology
2300 Garrison Blvd Suite 280, Baltimore, MD 21216
Dr. Elizabeth O. Adegboyega-Panox, MD Orthopedic Surgery
3001 S Hanover St Suite 300, Baltimore, MD 21225
Dr. Adegboyega I. Adejana, MD Obstetrics & Gynecology
4660 Wilkens Ave Suite 205, Baltimore, MD 21229
Dr. Navneet K. Ahuja, MD Nephrology
516 N Rolling Rd, Catonsville, MD 21228
Dr. David B. Aiello, MD Cardiology
1417 Madison Park Dr, Glen Burnie, MD 21061
Dr. Gloria E. Akan, MD Pediatrics, Allergy & Immunology
203 Hospital Dr Suite 200, Glen Burnie, MD 21061
Dr. Salem I. Al-Naber, MD Pediatrics
3001 S Hanover St Suite 211, Baltimore, MD 21225
Dr. Eli B. Alegado, MD Pulmonology
4115 Ritchie Hwy Suite 105, Brooklyn, MD 21225
Dr. Rolando B. Alegado, MD Orthopedic Surgery
827 Linden Ave, Baltimore, MD 21201
Dr. Jose Amaya, MD Anesthesiology
3001 S Hanover St, Baltimore, MD 21225
Kandasamy Ambalavanar, MB BS Internal Medicine
7845 Oakwood Rd Suite 103, Glen Burnie, MD 21061
Dr. Robert C. Ammlung, MD Internal Medicine
516 N Rolling Rd Suite 204, Catonsville, MD 21228
Dr. Anouk Amzel, MD Pediatrics
8109 Ritchie Hwy, Pasadena, MD 21122
Dr. Spiro B. Antoniades, MD Orthopedic Surgery, Neurosurgery
615 W Macphail Rd Suite 210, Bel Air, MD 21014
Dr. Lino R. Arquillano, MD General Surgery
3001 S Hanover St, Baltimore, MD 21225
Dr. Fred C. Ashman, MD Diagnostic Radiology
7505 Osler Dr Suite 406, Towson, MD 21204
Dr. Kalpana Atluri, MD Internal Medicine
3001 S Hanover St Suite 412, Baltimore, MD 21225
Dr. Sridhar Atluri, MD Internal Medicine
3721 Potee St Suite 1, Baltimore, MD 21225
This is from North Carolina but is true across the country. Remember all the talk about gun control and mass murders and the link to mental health? We know that lack of access to mental health is what causes more and more of these incidences and yet, defunding of Medicaid and Medicare will see mental health cuts the most! Third Way corporate democrats made it easier to get more mental health PHARMA though!!!! THEY LOVE PHARMA!
Note that 2009 was when the supermajority of democrats came on board shortly after this change occurred.
Health Codes are the number one source of entitlement fraud so we know the coding system must change, but these changes don't address that, they simply change what service will be paid.
Wednesday, January 16, 2008
Part B Medicare (mental hlth): collapsing and defunded
Many citizens of NC utilize Medicare as their primary health care provider.
This post is a documentation of the difficulties of interfacing with this primary health care agency and it is intended to portray the severe problems experienced by providers who are attempting to provide mental health services for clients who have Medicare.
First of all, in NC, Medicare has for 2008 discontinued Behavioral Health CPT codes which placed mental health care rendered by a PhD psychologist into the 'medical' column of reimbursement which is 80%. No more. There is now only CPT codes associated with mental health which means that providers can expect no more than 62.5% payment for services.
The American Psychological Association worked a long time in order to put forward Behavioral Health Codes so that psychologists could be reimbursed in a professional manner.
You wonder why providers will not accept Medicare?
In 2008, Medicare reimbursement for therapy has been slashed by about 15% or more. A CPT code of 90808 (bill too many of these and you will certainly be audited) which is therapy for 70-90 minutes or more LAST YEAR was billable at $145.
THIS YEAR, 90808 is billable at $125.
90808 CPT code is not what most mental health care people will utilize as the top 10% of providers will receive a 'congratulatory' letter from Medicare telling them that they have to submit all of their paperwork, including patient notes, and if everything is not in order, then the provider has to re-pay Medicare.
So, without the Behavioral Health codes, which were an efficient mechanism for clients who had physical illnesses which were addressed in therapy, the provider is now stuck w/ the lesser paying, non-medical, mental health therapy codes which are paid at 62.5%.
You wonder why providers will not accept Medicare?
Not only that, but the North Carolina Psychiatric Association has 'discovered' that NC Medicaid (if the patient has dual eligibility which is very common, Medicare is billed first and then Medicaid picks up the rest) is not making up the difference and according to a NC Psychiatric Association member "this is legal." Its reportedly not done in any other state but 'it's legal.'
You might collect a few more cents off of the client in terms of their co-pay, which is not demanded by Medicare (you cannot avoid asking for the co-pay from clients but neither must you demand it from every client either)-----if you have the heart to try and squeeze that out of people who cannot feed themselves.
When a provider enrolls with Medicare, and pertinent to mental health services (Part B Medicare), you are given a 'Performing Provider Number.' This comes to you on a piece of paper which is your initial credentialing document. Psychologists are exempt from a UPIN number which physicians utilize. No other numbers are listed on this initial document. Over the course of billing and exchanging information with CIGNA Government Services, one is assigned, in no particular order, the following descriptors unique to the provider:
1. identifer #
2. Billing ID
3. Payor ID
This does not take into account any other identification sets which might be utilized by a billing entity (when the provider throws up their hands and cannot negotiate Medicare Claims Express software). The billing agency takes another chunk of the provider's money.
This does not take into account Medicaid identification data. Or Medicaid webclaims identification data. Or state funded clients identification sets of information. Or BCBS identification sets. Or any other third party payment identification sets.
A couple of years ago, providers were told they had to have an NPI number, which is a descriptor that is SUPPOSED to be usable across Medicare/ Medicaid. You might suspect that it takes a few years for this simple little NPI number to move into their process, but the real dilemma is that you can never get CIGNA GOVERNMENT SERVICES on the phone. NEVER.
Statewide Healthcare Speakouts Begin this Saturday! The United Workers is a founding member of the
Maryland Healthcare Is a Human Right Campaign. This Saturday, May 4, the Carroll County chapter of the campaign will kick off the first of several speakouts for healthcare throughout Maryland. The event will take place 2-5pm at St. Paul’s UCC, 17 Bond St., Westminster, MD. Hope you can make it! For more on the day and the state-wide organizing, you can check out this flier and this excellent front page article in the Carroll County Times.
“Just because you’re rich doesn’t mean that you are allowed to be healthy, and that the guy who’s busting his butt with two or three jobs or the woman who’s doing that can’t afford to have their children raised with goodhealth care. It’s just — it’s immoral. That’s the whole point of the campaign,” said Carroll County chapter member Frank Reitemeyer, in the article.
Above is a short video we have just produced about the Maryland Health Care Is a Human Right Campaign, particularly focused on Carroll County. In it, Carroll County resident Patricia Hollinger tells her experience within the medical field and having to fight to ensure her son receives the insurance he paid for.
Dates and locations of upcoming Speakouts across Maryland are below. Hope you can make them and share your story.
May 18th – Howard County
2-5 pm, Miller Branch Library
June 22nd – Frederick County
1-4 pm, All Saint’s Episcopal Church
July 13th – Calvert County
and more on the Way!
The Health Care Is a Human Right Campaign needs your participation! Email us at HealthcareisaHumanRightMD@gmail.com to get involved with your closest Organizing Committee, or to get help in starting your own. We are entirely funded by grassroots donations and would greatly appreciate your support.