GET RID OF WALL STREET GLOBAL CORPORATE CLINTON NEO-LIBERALS AND BUSH NEO-CONS---ALL MARYLAND POLS ARE GLOBAL CORPORATE POLS!
Do you know if we brought back the trillion dollars in Federal, state, and local tax revenue Johns Hopkins has taken illegally over several decades to build its global corporation the citizens of Baltimore would have Expanded and Improved Medicare for All with public health facilities in all communities?
Improved Medicare for All
as per the
Expanded and Improved Medicare for All Act Questions and Answers H.R. 676 Text with Explanations H.R. 676 Table of Contents
H.R. 676 Summary United States House of Representatives Bill Number 676 is the proposed U.S. legislation to establish single-payer health care, improved Medicare for All, in the United States. It will establish lifelong health care: cradle to grave, womb to the tomb. The coverage will be complete; some people like to call that “comprehensive.” Every other free-market high-income country in the world automatically provides health care for its people with a largely or exclusively non-profit method of financing the health care. The best non-profit method is called “single-payer” because it is the simplest and most efficient. The specific funding details need to be established, such as the method(s) proposed in H.R. 676. What matters is not so much how we pay for it, since the costs will be dramatically lower, but what we will pay for:
— We will no longer be paying for a system that wastes $400 billion in excessive administrative costs.
— Much more of our health care dollars will be spent on health care.
— More of the doctors and nurses time will be spent on caring for people.
— The result will be more time spent on prevention and wellness and the U.S. dramatically raising its life expectancy, which is a dismal 30th in the world, having dropped from 28th to 30th in June 2008.
Obama has spent his entire time in office privatizing all remaining Federal agencies----health care and education the most. The Center for Medicare and Medicaid CMM has the most sophisticated, most efficient and effective operating systems network in the world. It has collected 50 years of all medical transactions for low-income and seniors with the range of data collection that would make any evidence-based care and cost analysis simple and equitable. There was no need to create large numbers of managed care groups with hospital, health insurance, and medical product people all working to establish what they think are best practice and cost. We all know they are simply trying to figure out how to divide the massive trillion dollars in public health funding between these three corporate groups and integrate global health systems into the mix. As with the financial industry consolidation that gave us global Wall Street.....and the complete ending of competition and free markets because of this consolidation-----Obama and neo-liberals are pretending these groups of insurance, hospital, and medical product executives have to come up with these evidence-based figures.
Below is part of a long article---please take time to read the entire article as it shows were things where things were and where they are going. The Federalism Act written by Bill Clinton and embraced by Obama states the Federal government can ignore all of its duties of oversight and accountability and that includes all of the monitoring for equal protection laws around health care for women, people of color, the poor, seniors, and the disabled. So, Obama has told his appointed agency heads to stop creating data that makes sure Constitutional rights and health regulations are enforced. This is why since Reagan Clinton the Medicare and Medicaid Trusts have been looted of hundreds of billions of dollars every year----dismantled and ignored Federal oversight. THIS IS WHY THE FEE FOR SERVICE FAILED---NO OVERSIGHT. DOCTORS GRADUATE KNOWING HOW TO CARE FOR THEIR PATIENTS---WE SIMPLY NEED TO HOLD THEM ACCOUNTABLE AND STOP PROFITEERING. Who was pushing hardest this profiteering---the very three groups at the table today working on health procedures.
Obama and Congressional neo-liberals are wanting to make it permanent by privatizing and dismantling the very Center for Medicare and Medicaid information system network-----outsourcing one well-working system to tons of private contractors to undermine the performance-----just as has been done with all Federal agencies....defunded and dismantled to the point of becoming dysfunctional----THE POST OFFICE EMPLOYEES WOULD GIVE AN AMEN TO THAT!
When you are developing a global health system information network race and ethnicity becomes vital for meeting the needs of many cultures around the world. It has nothing to do with Equal Rights and Protections of race, creed, and gender here in the US. So, private contractors are reworking the Medicare and Medicaid structure to fit global patients----forget silly things like equal protection here in the US----women, people of color, and the disabled are the supermajority of people that will be pushed to preventative remote medicine anyway.
5. Improving Data Collection Across the Health Care System Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement
U.S. Department of Health & Human Services
The White House
USA.gov: The U.S. Government's Official Web Portal
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
While a range of health and health care entities collect data, the data do not flow among these entities in a cohesive or standardized way. Entities within the health care system face challenges when collecting race, ethnicity, and language data from patients, enrollees, members, and respondents. Explicitly expressing the rationale for the data collection and training staff, organizational leadership, and the public to appreciate the need to use valid collection mechanisms may improve the situation. Nevertheless, some entities face health information technology (Health IT) constraints and internal resistance. Indirect estimation techniques, when used with an understanding of the probabilistic nature of the data, can supplement direct data collection efforts.Addressing health and health care disparities requires the full involvement of organizations that have an existing infrastructure for quality measurement and improvement. Although hospitals, community health centers (CHCs), physician practices, health plans, and local, state, and federal agencies can all play key roles by incorporating race, ethnicity, and language data into existing data collection and quality reporting efforts, each faces opportunities and challenges in attempting to achieve this objective.
To identify the next steps toward improving data collection, it is helpful to understand these opportunities and challenges in the context of current practices. In some instances, the opportunities and challenges are unique to each type of organization; in others, they are common to all organizations and include:
- How to ask patients and enrollees questions about race, ethnicity, and language and communication needs.
- How to train staff to elicit this information in a respectful and efficient manner.
- How to address the discomfort of registration/admission staff (hospitals and clinics) or call center staff (health plans) about requesting this information.
- How to address potential patient or enrollee pushback respectfully.
- How to address system-level issues, such as changes in patient registration screens and data flow.
Collecting and Sharing Data Across The Health Care System Health care involves a diverse set of public and private data collection systems, including health surveys, administrative enrollment and billing records, and medical records, used by various entities, including hospitals, CHCs, physicians, and health plans. Data on race, ethnicity, and language are collected, to some extent, by all these entities, suggesting the potential of each to contribute information on patients or enrollees. The flow of data illustrated in Figure 5-1 does not even fully reflect the complexity of the relationships involved or the disparate data requests within the health care system. Currently, fragmentation of data flow occurs because of silos of data collection (NRC, 2009).
No one of the entities in Figure 5-1 has the capability by itself to gather data on race, ethnicity, and language for the entire population of patients, nor does any single entity currently collect all health data on individual patients. One way to increase the usefulness of data is to integrate them with data from other sources (NRC, 2009). Thus there is a need for better integration and sharing of race, ethnicity, and language data within and across health care entities and even (in the absence of suitable information technology [IT] processes) within a single entity.
It should be noted that a substantial fraction of the U.S. population does not have a regular relationship with a provider who integrates their care (i.e., a medical home) (Beal et al., 2007). For some, a usual source of care is the emergency department (ED), a situation that complicates the capture and use of race, ethnicity, and language data and their integration with quality measurement. While health plans insure a large portion of the U.S. population, their direct contact tends to be minimal, even during enrollment. Hospitals, which tend to have more developed data collection systems, serve only a small fraction of the country's population. As a result, no one setting within the health care system can capture data on race, ethnicity, and language for every individual.
Health information technology (Health IT) may have the potential to improve the collection and exchange of self-reported race, ethnicity, and language data, as these data could be included, for example, in an individual's personal health record (PHR) and then utilized in electronic health record (EHR) and other data systems.1 There is little reliable evidence, though, on the adoption rates of EHRs (Jha et al., 2009). While substantial resources were devoted to this technology in the American Recovery and Reinvestment Act of 2009,2 it will take time to develop the infrastructure necessary to fully implement and support Health IT (Blumenthal, 2009). Thus, the consideration of other avenues of data collection and exchange is essential to the subcommittee's task.
Until data are better integrated across entities, some redundancy will remain in the collection of race, ethnicity, and language data from patients and enrollees, and equivalently stratified data will remain unavailable for comparison purposes unless entities adopt a nationally standardized approach. Methods should be considered for incorporating these data into currently operational data flows, with careful attention to concerns regarding efficiency and patient privacy.
Because hospitals tend to have information systems for data collection and reporting, staff who are used to collecting registration and admissions data, and an organizational culture that is familiar with the tools of quality improvement, they are relatively well positioned to collect patients' demographic data. In addition, hospitals have a history of collecting race data. With the passage of the Civil Rights Act of 19643 and Medicare legislation in 1965,4 there was a legislative mandate for equal access to and desegregation of hospitals (Reynolds, 1997). Therefore it is not surprising that more than 89 percent of hospitals report collecting race and ethnicity data, and 79 percent report collecting data on primary language (AHA, 2008).
This culture of data collection has limitations, however. Historically, the data were never intended for quality improvement purposes, but to allow analysis to ensure compliance with civil rights provisions. Additionally, hospital data collection practices are less than systematic as the categories collected vary by hospital, and hospitals obtain the information in various ways (e.g., self-report and observer report) (Regenstein and Sickler, 2006; Romano et al., 2003; Siegel et al., 2007). Furthermore, compared with the number of people who are insured or visit an ambulatory care provider, a relatively small number of people are hospitalized in any one year (Figure 5-2). Thus, while hospitals are an important component of the health care system and represent a major percentage of health care expenditures, they are only one element of the system for collecting and reporting race, ethnicity, and language data.
Below you see a directive from Federal Medicaid pushing the process of outsourcing Medicaid systems to US and International Information Technology corporations. This has been Obama's main job just as it was Governor O'Malley of Maryland-----rebuilding all Federal, State, and local public health systems that worked within Medicare and Medicaid are now all privatized corporate systems as public health dismantled and health care is deregulated and globalized.
Notice the Office of Civil Rights director-----this is the office that would have shouted that breaking down and outsourcing all of Medicare and Medicaid to privatized global health is NOT PROTECTING CIVIL RIGHTS. It is like the Obama Labor Secretary Perez appointed not to protect labor rights but to tie labor to corporations.
Remember, breaking up this Federal operating system not only has a goal of ending all civil rights protections regarding access to health care----it is exposing all of US health data to private global contractors who subcontract to subcontractors and we are told all of this is done with confidentiality required by US law......
AND NONE OF THESE PROTECTIONS ARE HAPPENING. OUR HEALTH DATA IS BEING SOLD AND DISTRIBUTED ALL OVER THE WORLD BECAUSE THAT IS WHAT CLINTON NEO-LIBERALS AND BUSH NEO-CONS DO.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
OFFICE OF INSPECTOR GENERAL
TO: Marilyn Tavenner Administrator
WASHINGTON, DC 20201
APR 1 1 2014
Centers for Medicare & Medicaid Services
Leon Rodriguez Director
Office for Civil Rights
FROM: Brian P. Ritchie
Acting Deputy Inspector General for Evaluation and Inspections
SUBJECT: Memorandum Report: Offshore Outsourcing of Administrative Functions by State Medicaid Agencies, OEI-09-12-00530
This memorandum report provides information about State Medicaid agencies' requirements for outsourcing administrative functions offshore. Outsourcing occurs
when Medicaid agencies enter into agreements with contractors to perform administrative functions. Outsourcing can occur inside the United States (domestic outsourcing) or outside (offshore outsourcing). In 2011, an Office oflnspector General (OIG) review found that one Medicaid agency was unaware that a contractor had sent electronic copies of Medicaid claims offshore for processing. This Medicaid agency inquired whether OIG had information regarding how States regulate offshore outsourcing. In response, we initiated the current study, obtaining information from all 56 Medicaid agencies regarding their requirements and practices for outsourcing administrative functions offshore. This memorandum report summarizes the information we collected from those States.
Only fifteen of fifty-six Medicaid agencies have some form of State-specific requirement that addresses the outsourcing of administrative functions offshore. The remaining
41 Medicaid agencies reported no offshore outsourcing requirements and do not outsource administrative functions offshore. Among the 15 Medicaid agencies with requirements, 4 Medicaid agencies prohibit the outsourcing of administrative functions offshore and 11 Medicaid agencies allow it. The 11 Medicaid agencies that allow offshore outsourcing of administrative functions each maintained Business Associate Agreements (BAAs) with contractors, which is a requirement under the Health Insurance Portability and Accountability Act (HIPAA). Among other purposes, BAAs are intended to safeguard protected health information (PHI). These 11 Medicaid agencies do not have additional State requirements that specifically address safeguarding PHI.
Here's Maryland leading the way to outsourcing our Federal Medicare and Medicaid long before it became fashionable because Maryland was the only state that sought exemption from all of Federal laws while the Clinton Federalism Act allowed for no Federal oversight and accountability. It doesn't matter if it was a neo-conservative Erhlich or a Clinton neo-liberal O'Malley----these global corporate pols are outsourcing and sending our medical data anywhere for any reason.
REPUBLICAN VOTERS ARE SHOUTING ABOUT LOST PRIVACY JUST AS PROGRESSIVE LABOR AND JUSTICE WHEN BOTH NEO-CONS AND NEO-LIBERALS ARE INSTALLING THESE POLICIES.
Having attended Maryland Assembly meetings this year I listened as all of these deregulation and outsourcing laws for Medicaid and Medicare came from Baltimore politicians working for Johns Hopkins which writes all of these global health laws and ignores all of Federal equal protection and health regulation laws anyway!
WHEN YOU KEEP SENDING BACK THE SAME BALTIMORE POLS ONLY WORKING FOR JOHNS HOPKINS----YOU ARE SENDING THE PEOPLE RESPONSIBLE FOR CITIZENS IN BALTIMORE NOT HAVING ACCESS TO CARE AND NOT BEING PROTECTED FROM HEALTH CARE ABUSE AND EXPLOITATION.
As you see once again----this is why there are no jobs in Baltimore and Maryland----the entire public sector that did these Federal and state jobs have been dismissed and these jobs are outsourced to anywhere in the world all under the guise of being done cheaper.
The kind of people wanting to bring the US to a third world status just so a few can get super-rich-----ARE ALL OF MARYLAND'S POLITICIANS! GET RID OF THESE SOCIO-PATHS.
As Medicaid grows, Maryland seeks help processing claims"
Publish Date 11/13/2009 Author CNSI
The state department overseeing Medicaid is planning to outsource its claims processing service in a move expected to save tens of millions of dollars and result in 100 lost jobs.The Department of Health and Mental Hygiene hopes to seek proposals early next year from information technology firms to develop and operate a new system to handle Medicaid claims, said Charles Lehman, executive director of the office of systems, operations and pharmacy at the state health department.As unemployment rises and people lose health care coverage, more people are qualifying for Medicaid. That, coupled with a recent expansion of the program and planned changes from the federal health care reform bills, is making the entitlement too big and expansive for Maryland to run.The number of Marylanders eligible for Medicaid has grown over the past few years from about 600, 000 to 800, 000, creating significant delays and backlogs for Lehman's 250-member claims processing department to work through. Complicating matters, Lehman cannot hire the 75 additional workers he would need to handle that increased workload because of Maryland's hiring freeze.So far, the proposal has drawn mixed reviews from the state's medical practitioners, said Gene M. Ransom III, CEO of the Maryland State Medical Society. Many doctors have opted to give free service to needy patients rather than try to wade through the time-consuming, complex process of submitting a claim.To that end, the system could be run more efficiently in the hands of a private company. But others are worried about their ability to to get help from elected leaders in challenging a denied Medicaid claim.The prospect could be lucrative for the dozens of IT firms in the state looking to compete for the contract. Potential bidders include Affiliated Computer Services, CNSI, CSC and Unisys, Lehman said. Avinder Singh, senior vice president of CNSI's health and human services division, said he is closely watching the process and his Gaithersburg company intends to bid for the contract when it is issued. CNSI already provides technical support for the aged Medicaid software program, and he believes the state is making the right choice in upgrading to a new system.But the practice has drawn its critics, who argue it has resulted in delays, glitches and a lack of proper oversight. Daraius Irani, an economist at Towson University's Regional Economic Studies Institute, said the state needs to make sure the Medicaid program continues to run efficiently and the confidentiality of patients is not compromised.It could then take about three years to transition from a state-run Medicaid program to one handled by an outside company.By then, federal health care reform being considered now could result in another expansion of Medicaid in Maryland and the rest of the states.Lehman said the state would look to shed about 100 employees in the department if it decides to outsource Medicaid.
Since the Affordable Care Act is about ending Federal Medicare and Medicaid Obama needed to defund and dismantle the Center for Medicare and Medicaid operating system and rebuild those on the state level to replace the Federal programs. How better to dismantle the world's best Federal public health system but by outsourcing all of its functions all over the world----global corporations are now replacing all of the Federal Medicare agency employees! THOSE CLINTON NEO-LIBERALS LOVING EVERY MINUTE OF UNION-BUSTING AND INSTALLING TRANS PACIFIC TRADE PACT TAKING AMERICAN WORKERS TO THIRD WORLD LEVELS.
Since the goal of the Affordable Care Act is to push over 80% of Americans onto these preventative care-----remote access care and out of the health care system-----they need to connect those 80% of Americans to global health corporations that will provide that service very cheap.
These ACO's-----the systems being created in your states consolidating health insurance, medical products, hospitals, and PHARMACY are already connected to overseas partners and that is what all of the hundreds of billions of dollars in Information Technology funding is paying to do.
When any Democrat having supported this Republican health plan Affordable Care Act then shouts they want to make it better----or shouts at the number of Americans losing their jobs and or being replaced by foreign workers-----THEY ARE LYING BECAUSE THEY KNEW THAT WAS WHERE THIS WAS GOING. ALL OF MARYLAND POLS AND ESPECIALLY BALTIMORE POLS HAVE BEEN PUSHING BILLS FOR YEARS BUILDING THIS STRUCTURE FOR THE LIKES OF JOHNS HOPKINS. Look below to see the biggest Wall Street Clinton neo-liberal----Corey Booker----pretending to be the defender of America's workers.
ObamaCare gets outsourced amid unemployment crisis
By Robert Oak
January 18, 2014 | 5:05pm
Modal Trigger Obama takes the stage for a speech about ObamaCare in 2013. Photo: Reuters/Brian Snyder MORE ON:
President Obama spent $831 billion of taxpayer money on a stimulus plan for the economy. He gave nearly $50 billion in aid to GM to keep it afloat. He lost $500 million on energy company Solyndra. All in the name of saving jobs.
Yet when it comes to his own signature initiative, the president doesn’t care about American workers. He’s outsourced ObamaCare.
After the disastrous rollout of HealthCare.gov, the administration hired Accenture as the new lead contractor. The deal is estimated to be worth $90 million and is now in the hands of the poster boy for global labor arbitrage and offshore tax havens.
Accenture has 80,000 Indian workers, 35,000 in the Philippines and only 40,000 in the United States. Over 40 percent of their worth comes from outsourcing. In all probability, the tech jobs awarded under this contract and paid for with US tax dollars are going abroad.
But even if the work is done locally, chances are the employees are foreigners brought in for lower wages using the controversial H-1B visa program — where companies are allowed to hire guest workers from abroad.
In 2012, Accenture ranked fifth among American companies in using H-1B visas. That year alone, Accenture brought into the United States 4,037 foreign workers on H-1B visas.
Modal TriggerAccenture is now ObamaCare’s chief contractor.Photo: Reuters/Mike Segar
Tech companies argue they need H-1B visas because there aren’t enough qualified American engineers, yet the facts do not bear this out. In truth there is no tech worker shortage or lack of skills and talent in America. The real motivation of offshore outsourcing companies like Accenture is cost. They use H-1B and other guest-worker visas to pay less wages than they would have to pay an equivalent American worker.
Accenture saves money by underpaying foreign guest workers they import — typically 25 percent less for their imported employees than the prevailing wage for a similar US citizen worker.
Ron Hira, an associate professor of public policy at the Rochester Institute of Technology, analyzed Accenture’s use of the H-1B program. In 2005, the company had 12,684 H-1B foreign guest workers earning an average of $53,042 per year. That’s far less than the median $80,000 salary the same job responsibilities and skills required would fetch for an American worker. Accenture is so bad, they paid a foreign guest worker $25,113 per year — for the title of “chief programmer.” Typically chief programmers make six figures in the United States.
It appears undercutting wages with H-1B visas is part of Accenture’s business model. Hira found that, in 2012, the median salary paid for Accenture’s new H-1B workers was $64,700, while Amazon paid their equivalent H-1B workers a median salary of $95,000. Google, who also uses comparable technical skills sets to Accenture and Amazon, paid a median salary of $110,000 to their new H-1B visa hires.
Accenture also avoids American taxes. The company is headquartered in Chicago, but it’s incorporated in noted tax haven Ireland.
It’s unclear how much money Accenture has avoided paying to the US. But the company caused a scandal in the UK last year when it was revealed it paid only 3.5% in corporate income taxes, when the going rate is 25%.
If you’ve never heard of Accenture, the largest consulting company in the world, that’s by design. Accenture used to be called Andersen Consulting, which was associated with Arthur Andersen, the accounting firm found to be complicit in the Enron scandal.
But hey, new name, new advertising campaign — who remembers?
And chances are Accenture has kept its nose clean since . . . Except no.
Modal TriggerUS Senator Cory Booker (D-NJ), left, and Senator Jack Reed (D-RI), right, hold a news conference with unemployed Americans.Photo: Reuters /Jonathan Ernst
In 2011, Accenture agreed to pay the government nearly $64 million after being accused by the Justice Department of making false claims for payment with agencies for information-technology services. That’s right, they falsely billed the government for IT work. And now they’re running the government’s health-care website.
Accenture also allegedly “falsely inflated prices and rigged bids in connection with federal information technology contracts.” This year, the USPS inspector general also called for suspension of Accenture postal-service contracts due to an increased risk of fraud. Oh, well, sure they can be trusted this time.
So how did Accenture land such a plum contract? The $5.5 million they spent in lobbying in 2012, in addition to the $1.2 million in campaign donations, likely has something to do with it.
America needs jobs. The labor participation rate in the US has dropped to 62.8%, the lowest level since 1978. That’s a record 91 million adult Americans, many who have simply dropped out of the labor force due to a lack of work.
It has been proved repeatedly there is no shortage of Americans with technical skills and talent. In a recent study, Hal Salzman, Daniel Kuehn and B. Lindsay Lowell found there were 50% more college graduates with technical majors than were hired in related technical positions. Every year only one in two science and technology college graduates obtains employment in their major.
Employment in the fields of science and technology are at 2001 levels, and these figures count foreign guest-worker visa holders!
The president says the biggest problem with the economy is that we’re not spending enough money. Yet Obama doesn’t care that the money he does spend is going to Mumbai, Shanghai and Dublin, along with American jobs. It’s no surprise America’s middle class is becoming extinct.
Robert Oak is the nom de plume of the editor of the website The Economic Populist.
This need for data analysis and collection that once was handled by the Federal government by Federal employees working career jobs and doing things as routinely as possible has now moved to state systems that are using health data for profit----they are simply following the money trail to assign profit to the right consolidated partner----and they are selling data globally for profit. So, all of the Federal funding to create what will be private global health system infrastructure all the while cutting funding to health services and access is what A CLINTON WALL STREET GLOBAL CORPORATE NEO-LIBERALS DOES---NOT A DEMOCRAT FOLKS!
Johns Hopkins was awarded hundreds of billions of dollars from its pols Mikulski and Cardin to build a super-computer just so Hopkins could service all of this global data as Hopkins takes over Baltimore City with its global corporation. Keep in mind----when these health systems outsource they are usually awarding these contracts to corporations they probably are invested in----so Federal, state, and local money going into this COMPLETELY UNNECESSARY HEALTH CARE REFORM is funnelled right into profit at every turn.
LOWER INPATIENT VOLUMES BECAUSE TIERED HEALTH PLANS AND GUTTED FUNDING OF MEDICARE AND MEDICAID KEEPS AMERICANS FROM ACCESSING ORDINARY HEALTH CARE? WELL THEN ----THEY HAVE TO BUILD THEIR GLOBAL HEALTH TOURISM WHILE AMERICANS DIE DECADES EARLY!
Remember, none of this is being done for quality service or care-----Americans have always felt safe and had the health care they needed----this is only about creatiing global, consolidated, and deregulated health corporations and the ending of Federal Medicare and Medicaid public health.
Outsourcing is Exploding in Healthcare — Will the Trend Last? Written by Heather Punke October 04, 2013
Several hospitals and health systems have begun to outsource more services as finances become tight. But, due to consolidation, the outsourcing trend may soon reverse.
Now, more than ever, hospitals and health systems are concerned about their bottom lines. The federal sequester took a 2 percent bite out of Medicare reimbursements, and healthcare reform and other forces have led to lower inpatient volumes for many provider organizations. While several hospitals have turned to layoffs to address their cost concerns, still more are turning to another cost-saving solution: outsourcing.
"Healthcare is becoming such a cost-driven initiative," says John Boland, director of healthcare at Navigant. "Everyone is focused on costs and driving them down and getting quality results for less money."
Adam Higman, vice president at Soyring Consulting, agrees. "The driver is the cuts in reimbursement," he says. "[Hospitals] know they have to be more efficient and have to save money. That's helping drive [outsourcing] decisions."
Areas of outsourcing growth Traditionally, hospitals and health systems have outsourced support functions, such as housekeeping, laundry services, food services and even supply chain management — areas that do not fall under many hospitals' core competencies. With outsourcing on the rise, however, other functions have seen outsourcing growth, including the following:
Information technology. The U.S. healthcare IT outsourcing market is expected to grow by 42.8 percent in the next five years, according to a report by MarketsandMarkets. Mr. Higman says many systems are outsourcing IT services to vendors for help with ICD-10 preparation. Another reason outsourcing in this area is on the rise is because of the new emphasis on data collection and analysis.
"So much of what's going on now requires effective data collection and analytics of the data," says Barry H. Ostrowsky, president and CEO of Barnabas Health in West Orange, N.J. When the functions are outsourced, systems have access, through the vendors, to the most up-to-date technology for data collection and analysis without investing capital.
Clinical services. There has also been growth outsourcing clinical or patient care services. According to Mr. Boland, the top five most-outsourced patient care services are: anesthesia, emergency department staffing, dialysis services, diagnostic imaging and hospitalist staffing. "We will continue to see outsourcing in these areas in the next two to three years," he says.
These areas are ripe for outsourcing because, while they are essential to full-service acute-care hospitals, they are not dependent on a long-term physician-patient relationship. "Each of these services extends the ability of the hospital to provide full service without having to attract [or] retain a full complement of specialty physicians in a particular community," says Augustus Crocker, executive vice president and general manager of The Greeley Company, a healthcare quality, credentialing and compliance company.
At Barnabas Health, emergency department physician and hospitalist services have been outsourced for years at several of the system's hospitals. Mr. Ostrowsky says more organizations are starting to outsource these services because of a combination of focus and expertise. For example, physicians who focus exclusively on ED medicine know how to run an ED in the most high-quality, efficient way possible, he says. "Their ability to focus on simply one area makes the vendor more effective than part of a management team that has many other responsibilities."
Outsourcing's future Though some forces in the healthcare industry are contributing to an uptick in outsourcing for hospitals, that does not mean the trend toward outsourcing is stable. "There is a fair bit of oscillation back and forth where [systems] will outsource a function and then in-source it later," says Curt Bailey, head of Booz & Company's hospital practice.
In fact, there are other forces at play that may soon lead hospitals to begin to "in-source" again. For instance, as hospitals consolidate with other hospitals or physician groups in their market, the use of outsourcing may drop.
"What I think is going to happen is as hospital systems get bigger, they may begin creating their own operations," Mr. Ostrowsky says. "Outsourcing may start to decline as companies are big enough to perform the services in an equally efficient way." He gives the example of outsourcing ED medicine. If a system has enough hospitals, it may be able to put together its own group of ED providers instead of outsourcing to a third party group.
Taking it one step further, Mr. Bailey sees the possibility of larger systems "outsourcing" services to other systems in the area. For example, if a system has a large laboratory facility, he says they can provide lab testing for physicians or other hospitals in the geographic area. "I think you'll see people asking not what they can outsource, but what they can provide in the marketplace," he says.
So, though many hospitals and health systems are looking into outsourcing now due to the sequester, healthcare reform and other forces, consolidation may well lead to more in-sourcing in the industry.
What Clinton neo-liberals and Bush neo-cons are doing is dismantling all of the Federal agencies tied to US citizens and national sovereignty -----and moving all of the government infrastructure to states with the goal of building CITY STATES----CORPORATE ENTERPRISE ZONES. So, Johns Hopkins is getting all that Federal money to build health information systems like the one below that will be used to create data for its own global health businesses and to operate its RFID remote medicine with all that computing need.
THIS IS TO WHERE BALTIMORE'S MEDICARE AND MEIDCAID FUNDING HAS GONE FOR YEARS AS BALTIMORE CITIZENS DIE 20 YEARS EARLIER THAN AFFLUENT CITIZENS DUE TO LACK OF ACCESS TO HEALTH CARE.
You can see why Baltimore's pols that run as Democrats but serve the very neo-conservative Johns Hopkins has not cared about Equal Protection or War on Poverty programs and funding----they have been working to undermine US citizens and their quality of life to build global corporations.
So, rather than have a Federal agency giving us statistics on health data and patient care through data collected by the Federal government-----we will have FOXCONN corporate factories like Johns Hopkins making data say whatever it wants. As citizens of Maryland and all of the nation's academic institutions across the US have known for decades-----LYING, CHEATING, AND STEALING NEVER BODES WELL FOR REAL SCIENCE.
This is why Baltimore is a city of global citizens coming and going using infrastructure paid for by Baltimore citizens and doing the work Baltimore citizens should be doing. It is why Baltimore operates like a third world city----Hopkins sees the Baltimore region as its own global corporate factory.
Is the Whitaker International Program For You?The Whitaker International Program sends emerging leaders in U.S. biomedical engineering (or bioengineering) overseas to undertake a self-designed project that will enhance their careers within the field. The goal of the program is to assist the development of professional leaders who are not only superb scientists, but who also will advance the profession through an international outlook. Along with supporting grant projects in an academic setting, the Whitaker International Program encourages grantees to engage in policy work and propose projects in an industry setting.
What this article is saying while making it sound like a huge collaborative adventure is that this computer needed to be this big in order to service global health tourism and microchip patient care and will share information with its global partners.
IBM Supercomputer at Johns Hopkins to search for roots of heart and brain disease Baltimore 10 January 2000At the end of last year, Johns Hopkins University has installed an RS/6000 SP supercomputer in its Center for Imaging Science at the Whiting School of Engineering to help find cures for diseases of the heart and brain via image analysis. Specifically, Johns Hopkins researchers will utilise the IBM system to try to discover why, so often, the brain degenerates with age, and what exactly causes illnesses, such as schizophrenia and dementia. In addition, researchers hope to find out how heart attacks can be avoided by testing different medication combinations on heart models in pre-arrhythmia condition.
RFID health products
The researchers will use IBM's deep computing technologies to construct 3D interactive computer models on the RS/6000 SP describing the body's anatomical structure and physiological behaviour. These models span from the model of a single gene up to the composite intricacies of organs, like the heart and brain. They may provide scientists with a better understanding of the relationships between microscopic structures and organ functions in both healthy and diseased brains and hearts. By conducting this pioneering research, scientists will seek to design new drugs and therapies, in order to help physicians and patients battle major organ disease. Using the RS/6000 SP, researchers aim at reducing research times and bringing drug therapies to market sooner.
"The RS/6000 SP supercomputing technology will allow us to analyse and access brain images from large numbers of individuals in databases, which provides an opportunity to make precise statistical statements about the onset of diseases related to the human brain", said Michael Miller, Director of the Center for Imaging Science at Johns Hopkins. This has not been possible until now because of the sheer complexity of the analysis, as Michael Miller stated.
Because of the human body's complexity and the enormous volume of data involved, computer modelling is currently emerging as both a powerful and necessary tool in understanding various cellular and tissue relationships, according to Dr. Raimond Winslow, head of the Center for Computational Medicine and Biology, a branch of the Whitaker Biomedical Engineering Institute. With computerised simulations, science is gaining understanding about the functions and processes of the human heart, and saving lives by managing the threat of heart attack and disease, as Dr. Winslow continued.
As part of the research programme, Dr. Miller and his colleagues will also have access to the IBM RS/6000 SP of NPACI, the National Partnership for Advanced Computational Infrastructure at the San Diego Supercomputer Center (SDSC), that was expected to be capable of one teraflop performance by the end of 1999. The system will have more than 1000 microprocessors and will be one of the most powerful supercomputers in the world. Computer modelling will be performed at both facilities, with the more computationally intensive work being done at SDSC.
Authorised researchers from around the world are invited to access SDSC's IBM supercomputer via the Internet. In this way, scientists at the University of California Los Angeles (UCLA), the Washington University, and Cal Tech can generate tissue samples, have them analysed by algorithms from Johns Hopkins, and distribute them nationwide through SDSC's Supercomputer Center. SDSC's supercomputing power combined with our own RS/6000 SP will allow us to pool the expertise and data of numerous investigators and labs all around the world, according to Dr. Miller. "Such a collaborative effort, with its rapid information exchange, can only help researchers make great strides against modern-day diseases."
SDSC is a research unit of the University of California at San Diego and a national laboratory for computational science and engineering. It is also the leading edge site of the U.S. National Science Foundation's (NSF) National Partnership for Advanced Computational Infrastructure (NPACI), which was established to build the environment for tomorrow's scientific discovery.
The recently formed $34 million Whitaker Biomedical Engineering Institute was established by Johns Hopkins University in part with a grant from the Whitaker Foundation. Using computer imaging technology, some researchers at the institute will bring together two inherently different disciplines, which are computer engineering and biological research to advance medical science and the understanding of both human cellular and physiological functions and relationships.
The RS/6000 SP is the foundation of high performance computing, as stated by Rod Adkins, general manager, IBM RS/6000. "It is able to provide the world's major research centres with mathematical algorithms, computing power, performance, speed and scalability, all which they need to tackle the most important scientific puzzles of our time. Thus, IBM's high performance computing technology is revolutionising medical research."
Over 850.000 IBM RS/6000 systems were shipped to more than 125.000 commercial and technical customers around the world. The RS/6000 family of computers features IBM RISC-based microprocessors and runs the AIX, IBM's UNIX operating system. RS/6000 products range in size and capacity from workstations, workgroup and enterprise servers, to the RS/6000 SP supercomputer. Ranging from businesses deploying advanced technologies to become more efficient and profitable, to governments and universities seeking to solve the grand challenge problems of our time, the RS/6000 computers support a wide range of applications and provide the reliability, availability and price/performance that today's information technology managers demand.