When we allow corporate pols to control Congress----then our Federal agencies have APPOINTED leaders working for the corporations instead of APPOINTED leaders working to protect citizens rights. REAGAN/CLINTON----BUSH/OBAMA ARE GLOBAL CORPORATE POLS MAKING THOSE KINDS OF APPOINTMENTS. Same with Maryland----one of the most corporate-controlled states in America. That is why no matter who is elected----these agencies allow any fraud and corruption that moves money to profit.
IT IS CRITICAL TO GET RID OF GLOBAL CORPORATE NEO-LIBERALS AND NEO-CONS AT ALL LEVELS OF GOVERNMENT. WE CANNOT BE SIMPLY TRYING TO ELECT BERNIE SANDERS AS A SOCIAL DEMOCRAT----WE NEED STATE AND LOCAL GOVERNMENT OFFICIALS AS WELL.
So, neo-liberals and neo-cons turned our FED and SEC=====two financial industry regulation agencies into team players with Wall Street. GUESS WHAT?
THAT IS NOW HAPPENING WITH A PROFIT-DRIVEN AFFORDABLE CARE ACT HEALTH CARE REFORM.
CCOs are simply tasked with making a health industry look like it is complying with regulations when it is not-----like Wall Street CCOs created COMPLEX FINANCIAL INSTRUMENTS to pretend this business was not systemic fraud....it becomes too hard to prove. Individualized patient care----just as individualized student lessons in Race to the Top education privatization----IS SIMPLY DEREGULATION THAT GUTS OVERSIGHT AND ACCOUNTABILITY.
IF THE NAME IN THIS ARTICLE---FIERCE HEALTH CARE MAKES YOU THINK OF GLOBAL CORPORATIONS DOING ANYTHING FOR PROFIT----LYING, CHEATING, STEALING-----THEN YOU KNOW WHAT THE GOALS OF ACA ARE.
CCOs manage growing role in heavily regulated healthcare industry
September 19, 2014 | By Katie Sullivan Fierce Healthcare
Chief compliance officers (CCOs) can help heavily regulated hospitals manage risk and regulatory landscape in an ever-changing healthcare industry, according to new PwC findings.
The survey found that 86 percent of respondents in the industry have a designated CCO who reports directly to the board of directors or the CEO. Eighty-eight percent of respondents said their organizations had corresponding compliance committees to support the CCO.
About 60 percent of the respondents said their organization's CCO operates in a stand-alone role, and report the greatest risks to business are privacy and confidentiality, followed by industry-specific regulations, the survey found. Just over 40 percent of survey respondents reported their compliance staffing levels increased over the past year, while about 30 percent said their organization's compliance budget was $1 million or more a year.
As the industry shifts and changes, it's more important than ever to have an effective compliance function, and social media helps with that. More than half of respondents, up from 33 percent last year, said they communicate information about compliance and ethics through internal social media, which can improve access to content and changes to the industry.
As CCOs embrace technology, the trend will likely continue, the survey stated, which can help employees understanding of the role of the compliance function and their own individual roles and responsibilities in helping their organization remain compliant.
To learn more:
- read the survey findings
The term 'individualized plan' has hit the media these few decades as global corporate pols privatized and dismantled all of our Federal agencies and ignored US Constitutional laws and citizens' rights. You cannot provide oversight and accountability if there are so many pathways all with different measurements claiming to show these policies work. It is the mirror of Wall Street's COMPLEX FINANCIAL INSTRUMENTS. Remember when Obama and Congressional neo-liberals allowed the US Justice Department to tell us IT WOULD TAKE DECADES TO UNRAVEL ALL OF THESE COMPLEX FINANCIAL INSTRUMENTS TO PROVE FRAUD? This is the same structure these global pols are building for our education and health care systems---they next for dismantlement.
It is not the nurses' or teachers' fault when they adopt these reform policies everyone knows are bad. People need jobs and they need to follow direction from top administrators so they install all this mess everyone knows does nothing to improve education or health.
IT IS UP TO WE THE PEOPLE TO GIVE OUR TEACHERS AND HEALTH CARE WORKER ADMINISTRATORS WHO WORK FOR PUBLIC INTEREST AND NOT CORPORATE PROFIT. WE CAN REVERSE THIS EASY PEASY BY SIMPLY GETTING RID OF ALL GLOBAL CORPORATE POLS FROM STATE AND LOCAL DEMOCRATIC COMMITTEES.
It is the responsibility of the registered professional school nurse to develop an IHP and ECP for students with healthcare needs that affect or have the potential to affect safe and optimal school attendance and academic performance. The IHP is developed by the school nurse using the nursing process in collaboration with the student, family and healthcare providers. The school nurse utilizes the IHP to provide care coordination, to facilitate the management of the student’s health condition in the school setting, to inform school-educational plans, and to promote academic success. The ECP, written by the school nurse, is for support staff with an individual plan for emergency care for the student. These plans are kept confidential yet accessible to appropriate staff'.
Raise your hands if you understand that for centuries school nurses simply took care of students in a generalized fashion and knew enough to provide basic care with no complex system of data collection and plans! None of what is said is true-----we do not need individualized education and health care----we need everyone receiving the same access to education and Equal protection Rule of Law. At the same time these corporations are writing rules about protecting privacy and making sure data does not lead to discrimination----
CORPORATE POLS ARE SELLING OUR PRIVATE DATA AND USING DATA AGAINST PEOPLE IN ALL KINDS OF WAYS----FROM EMPLOYMENT TO GETTING HEALTH INSURANCE.
Individualized Healthcare Plans: The Role of the School Nurse (Revised January 2015)
Individualized Healthcare Plans:
The Role of the School Nurse
It is the position of the National Association of School Nurses (NASN) that the registered professional school nurse (hereinafter referred to as school nurse), in collaboration with the student, family and healthcare providers, shall meet nursing regulatory requirements and professional standards by developing an Individualized Healthcare Plan (IHP) for students whose healthcare needs affect or have the potential to affect safe and optimal school attendance and academic performance. Because health conditions can be complex and unfamiliar to school staff and the student’s requirement for nursing care can be frequent and sometimes emergent, accurate and adequate documentation of chronic medical conditions and individual needs is critical (Lyon, 2012). Development of IHPs is a nursing responsibility, based on standards of care regulated by state nurse practice acts and cannot be delegated to unlicensed individuals (National Council of State Boards of Nursing [NCSBN], 2005). It is the responsibility of the school nurse to implement and evaluate the IHP at least yearly and as changes in health status occur to determine the need for revision and evidence of desired student outcomes.
The IHP is a document based on the nursing process. Since emerging in the 1970s, the nursing process is the cornerstone of nursing practice, using a scientific approach in the identification and solution of health problems in nursing practice (Hermann, 2005). The American Nurses Association (ANA) and NASN define the nursing process as a “circular, continuous and dynamic critical-thinking process comprised of six steps and that is client-centered, interpersonal, collaborative, and universally applicable” (American Nurses Association [ANA] & NASN, 2011, p. 76). Documentation of these steps for individual students who have healthcare issues results in the development of an IHP, a variation of the nursing care plan. The term IHP refers to all care plans developed by the school nurse, especially those for students who require complex health services on a daily basis or have an illness that could result in a health crisis. These students may also have an Individualized Education Plan (IEP), a 504 Student Accommodation Plan to ensure school nursing services and access to the learning environment, or an Emergency Care Plan (ECP) for staff caring for these students (Hermann, 2005).
Development of the IHP by the school nurse provides a framework for meeting clinical and administrative needs:
Demonstrates Standard of School Nursing Practice
Development and implementation of the IHP is documentation of professional performance in accordance with standards of school nursing practice, the professional expectations that guide the practice of school nursing (ANA & NASN, 2011). The Standards of School Nursing Practice are “authoritative statements of the duties that school nurses, regardless of role, population, or specialty within school nursing are expected to competently perform” (ANA & NASN 2011, p. 4). These standards “describe a competent level of nursing care as demonstrated by the critical thinking model known as the nursing process” (ANA & NASN, 2011, p. 12).
Documents the Nursing Process
Creation of the IHP incorporates and documents the nursing process in student care in accordance with state nurse practice acts. The nursing process provides a framework for the nurse’s responsibility and accountability. “The RN may delegate components of care but does not delegate the nursing process itself. The practice pervasive functions of assessment, planning, evaluation and nursing judgment cannot be delegated” (ANA & NCSBN, 2005, p.2).
School Nursing: Scope and Standards of Practice (ANA & NASN, 2011) outlines how implementation of each step of the nursing process strengthens and facilitates educational outcomes for students. These steps parallel components of a well-developed IHP.
Standard 1. Assessment: The school nurse collects comprehensive data pertinent to the healthcare consumer’s health and/or situation.
Standard 2. Nursing Diagnosis: The school nurse analyzes the assessment data to determine the diagnoses or issues.
Standard 3. Outcome Identification: The school nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation.
Standard 4. Planning: The school nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes.
Standard 5. Implementation: The school nurse implements the identified plan.
Standard 6. Evaluation: The school nurse evaluates progress toward attainment of outcomes.
Provides Legal Documentation
A school nurse plans safe care for students and demonstrates an appropriate standard of professional care when the IHP is used as the foundation for student health interventions. “Judicious use of the IHP as a vehicle to ensure safe nursing services and continuity of care for students with special (health) needs is a standard of care against which a school nurse’s conduct can be judged in a legal proceeding” (Hootman, Schwab, Gelfman, Gregory, & Pohlman, 2005, p. 190). Along with applicable laws including state nurse practice acts, expert testimony, organizational policies and procedures, the standard of care is a significant factor used by courts in professional liability cases (Pohlman, 2005).
Clarifies Clinical Practice
The IHP’s clinical purposes include clarifying and consolidating meaningful health information, establishing the priority set of nursing diagnoses for a student, providing communication to direct the nursing care of a student, documenting nursing practice, ensuring consistency and continuity of care as students move within and outside school districts, directing specific interventions, identifying (safe and appropriate) delegation of care, and providing methods to review and evaluate nursing goals and student outcomes (Hermann, 2005). It is important to note that student-centered outcomes are developed early in the IHP process to guide interventions and provide a basis for evaluation to take place. The IHP is the document that combines all of the student’s healthcare needs into one document for management in the school setting (Zimmerman, 2013).
Provides Administrative Information
The IHP serves administrative purposes, which include defining the focus of nursing; validating the nurse’s role in the school; facilitating management of health conditions to optimize learning; differentiating accountability of the nurse from others in the school; providing criteria for reviewing and evaluating care (quality assurance); providing data for statistical reports, research, third-party reimbursement and legal evidence; and creating a safer process for delegation of care in the school setting (Hermann, 2005).
Serves as the Foundation for Health Portion of Other Educational Plans and Emergency Plans
The IHP provides the health information and activities that can be incorporated into the health portion of other school-educational plans to foster student academic success and to meet state and federal laws and regulations. These include the Individualized Education Plan (IEP) in accordance with the Individuals with Disabilities Education Improvement Act (P.L. 108-446, 2004) and a 504/ADA plan in accordance with Section 504 of the Rehabilitation Act (P.L. 102-569, 1992) and the Americans with Disabilities Act (P.L. 110-325, 2008).
The student Emergency Care Plan (ECP) is an emergency plan developed by the registered professional school nurse and is based on the IHP or is sometimes used instead of an IHP. ¬ The ECP is written in clear action steps using succinct terminology that can be understood by school faculty and staff ¬who are charged with recognizing a health crisis and intervening appropriately (Zimmerman, 2013). The ECP is distributed to these individuals with the expectation that the information will be treated with confidentiality. The names of the individuals who have a copy of the ECP should be listed at the bottom (Zimmerman, 2013).
It is the responsibility of the registered professional school nurse to develop an IHP and ECP for students with healthcare needs that affect or have the potential to affect safe and optimal school attendance and academic performance. The IHP is developed by the school nurse using the nursing process in collaboration with the student, family and healthcare providers. The school nurse utilizes the IHP to provide care coordination, to facilitate the management of the student’s health condition in the school setting, to inform school-educational plans, and to promote academic success. The ECP, written by the school nurse, is for support staff with an individual plan for emergency care for the student. These plans are kept confidential yet accessible to appropriate staff.
If all the acronyms below look like financial stock market jargon-----you would be right.
Anybody with students in school and or teaching school today knows that all of this individualization means nothing while you are defunding schools------firing teachers and administrators to make schools lean mean business machines. At the same time---the level of academic training is falling as most of these job categories are being outsourced ----as in school nurses, TEACH FOR AMERICA, and social workers.
Parents will tell you-----special education IEPs-----NO TEACHER CAN PROVIDE THAT AS SPECIAL NEEDS STUDENTS ARE SIMPLY MAINSTREAMED INTO CLASSROOMS HAVING HIGH STUDENT TEACHER RATIOS.
The students having all these acronym individualized plans are often the underserved and people needing the most attention----and guess what?
THERE IS NO OVERSIGHT AND ACCOUNTABILITY AS TO ANY OF THESE NEW BUSINESSES BEING CREATED TO MEET ALL THIS UNNECESSARY CATEGORIZATION OF AMERICAN CITIZENS.
This is simply an excuse to deregulate our schools and health care under the guise of being progressive. CLINTON WALL STREET GLOBAL CORPORATE NEO-LIBERALS AND REPUBLICANS COULD CARE LESS ABOUT GIVING INDIVIDUAL ATTENTION TO PEOPLE.
Teachers, nurses and health care providers, administrators, and parents of students and relatives of people tied to all this WORTHLESS PUBLIC POLICY-----all know it is window-dressing with no results intended.
BALTIMORE HAS BEEN GROUND ZERO FOR ALL THESE DATA-GATHERING POLICIES THAT LEAD NOWHERE FOR THE CITIZENS.
If you look all around the world----nations connected to neo-liberalism have this same system of data-collection and classifications----and here is what is attached to this article and we are supposed to think if they approve it ---it must be honest.
The Health On the Net Foundation (HON) promotes and guides the deployment of useful and reliable online health information, and its appropriate and efficient use. Created in 1995, HON is a non-profit, non-governmental organization, accredited to the Economic and Social Council of the United Nations. For 15 years, HON has focused on the essential question of the provision of health information to citizens, information that respects ethical standards. To cope with the unprecedented volume of healthcare information available on the Net, the HONcode of conduct offers a multi-stakeholder consensus on standards to protect citizens from misleading health information.
HON is funded by the State of Geneva, several European projects, the French National Health Authority (HAS) and the Provisu foundation. HON is also supported by the Geneva Hospital since its inception.
IHPs, 504 Plans, and IEPs: What’s the Difference?
Our thanks to Donna Noble for compiling the information below about the different tools available to help homePEN children overcome some of the obstacles they may face in obtaining an education. Donna is a patient advocate for ThriveRx, as well as a special education teacher and HPEN-consumer caregiver. Thanks, too, to Mary Patnode, an Oley board member, retired school psychologist, and HPEN consumer, for reviewing the article and for her input.
Additional information about these programs can be found at the Web sites listed at the end of the article.
Children on home nutritional support often have special medical needs that require attention during the time they would be at school. Or they may miss school for extended periods of time due to illness. Many of these children do not require and are not eligible for special education, but do require some special consideration or accommodations from their school systems due to medical needs. So the question becomes, how can these children successfully obtain an education but still have their special medical needs met?
There are several tools available to help make this possible. The three major supports are the Individual Health Plan (IHP), the 504 Plan, and the Individualized Education Plan (IEP). For children on home parenteral and/or enteral nutrition (HPEN), one or all of these plans might be useful.
What is an IHP?
An IHP is a plan that considers how to deal with what might happen with a student medically while the student is in school. It is designed to address medical issues that do not impact the student’s learning. An IHP is a formal agreement that outlines the student’s needs and a plan for addressing those needs. Parents or caregivers, the student, the student’s health care provider, and a multidisciplinary team of school staff work together to develop the IHP.
An IHP serves both the student and the school. It gives the student and his or her family the opportunity to discuss their concerns with school staff, and helps establish student, family, and school roles and responsibilities. It clarifies important things like how medication will be administered, how the student’s health status will be monitored, the location where care will be provided, and who will be providing the care. It should provide for staff training and specify who will provide that training. It can serve as the basis for ongoing teamwork, both between the family and school staff and among staff members. It also provides the school with an accurate, centralized source of information about the student’s medical needs, and with direction and authorization should a health need arise suddenly. To be sure the plan remains current, review dates should be written into the plan.
The IHP format varies from state to state and often from district to district. Unlike an IEP or 504 Plan, which has a standardized format, IHPs are developed by the school district. Certain health organizations, such as the American Diabetes Association, have also created boilerplate IHPs. No state or federal protection comes with an IHP. An IHP can be used alone or in conjunction with a 504 Plan (see sample IHP in word or
If your child’s circumstances change or you are not satisfied with the staff response, you can always request a meeting with the school. As an IHP is an agreement and not a legally binding document, there is no legal recourse if the district does not comply with the document.
Does my child need an IHP?
If your child has a health impairment or physical disability, he or she should have an IHP. It documents his or her needs and the services to be provided to that child. Remember: Even if your child is not receiving medication or infusing during school, it is important to have an IHP in place so the staff knows how to deal with any emergencies related to the feeding tube or venous access device. For the health and safety of your child, staff need to be prepared to deal with a tube/line emergency. I strongly urge parents to add an IHP to their child’s 504 Plan or IEP. The medical care component of the student is not addressed in the 504 Plan or IEP .
How do I develop an IHP?
The first step is to speak with your child’s health care provider(s). Discuss the school environment and together try to outline the health issues that might need to be addressed while your child is at school. This should include things you plan on, such as your child receiving medication, and things you don’t plan on, like an enteral tube getting caught on a doorknob and coming out. Ask your child’s health care provider(s) to document your child’s health needs and what he or she feels your child requires for support. Then speak with the school about developing an IHP. Bring all of the documentation with you when you meet with school staff.
As you think about whether your child would benefit from an IHP, or the 504 Plan or IEP discussed below, remember that parents are supposed to be a key component in the development of all these tools. You should make sure you are included in all steps of the process. As a parent you can have much power in advocating for your child. Usually the most effective way to use this power is to approach the school district in a collaborative and cooperative manner.
What is a 504 Plan?
A 504 Plan is a legally binding agreement between the parent(s) and the school district. It is a part of the Americans with Disabilities Act (ADA). Children who have disabilities that do not interfere with their ability to progress in general education are not eligible for special education services, but they may be entitled to the protection provided by a 504 Accommodation Plan. 504 Plans are used widely and for diverse needs. They can cover a single issue or several concerns.
504 Plans typically address accommodations in academic areas, but they can also be applied to nonacademic areas (such as band) and extra-curricular activities, to allow the student to have the whole school experience. The 504 Plan can follow the student to college and is also applicable in the workplace.
504 Plans are not as involved as, and do not cover all of the things covered in, IEPs (see below). A 504 Plan should provide for staff training and specify who will provide that training. The plan should also include review dates.
A 504 Plan can be requested by the family or school personnel. It is developed by the parents and a team of school staff. The school team usually includes an administrator and a case manager. In many cases where the issues addressed in the 504 are related to the child’s medical conditions, the medical team is also included as an active participant.
Does my child need a 504 Plan?
If your child’s medical issues significantly limit one or more major life activities, including school, then he or she should have a 504 Plan. The goal of a 504 Plan is to level the playing field by providing accommodations and modifications that allow the student the same opportunities as their “typical” peers.
When you are considering whether your child needs a 504 Plan, it is a good idea to think about all the concerns created by his or her home nutrition needs. If you have several concerns then a 504 Plan might be helpful. Before the 504 Plan meeting, think of what your child might need while he or she is at school, and what accommodations your child might require to meet those needs. If a student needs to empty an ostomy bag, for example, he may need access to facilities not usually available to students. If your child will need to have medication administered during a test, she may require extra time for the test. If your child misses school due to medical appointments or illness related to home nutrition therapy, accommodations may be required so the days missed will not count against him.
What is covered in the 504 Plan?
A 504 Plan can include adaptive equipment or assistive technology devices; an aide; assistance with health-related needs; school transportation; or other related services and accommodations. Specialized instruction is not covered in a 504 Plan. For children on home nutrition therapy, a 504 Plan is important to ensure, for example, they have frequent bathroom breaks, a clean place to change an ostomy bag, access to education if they must be home for long periods of time, and accommodations for any other special needs that may arise.
What is an IEP?
IEPs are generally for students who have documented gaps in learning beyond what might be expected based upon the normal curve. An IEP is an individualized learning plan, developed by a team, to address these gaps. However, an IEP can also be used when the gap is anticipated, such as with a child who will have difficulty keeping up due to frequent illness and absences, or a child whose hearing impairment, orthopedic impairment, or emotional disturbance necessitates modifications and/or accommodations in the curriculum. It is a legally binding document based on the Individuals with Disabilities Education Act (IDEA). IDEA ensures services to children with disabilities throughout the nation.
The federal government lays out the rules for IEPs, and states implement these rules. States may interpret the federal mandates differently and therefore IEPs are not exactly the same across state lines. Eligibility for special education (and therefore an IEP) also varies slightly between states due to differences in interpretation of the federal law. It is important to keep this in mind if you are moving and looking at school districts.
IEPs give you backing and guarantee procedural safeguards, such as due process. IEPs also call for mandatory progress reports.
Does my child need an IEP?
If your child has a condition or disability that interferes with or impacts his or her ability to learn and makes it that he or she cannot succeed in school without modifications to the regular curriculum, then he or she may qualify for an IEP. There are many specific disability categories covered by an IEP, such as cognitive disability or a hearing impairment. There is also a category for “other health impairment.”
Does my child’s home nutrition therapy need qualify him or her for an IEP?
In order for a child to be eligible for an IEP as “other health impaired” (OHI), the child’s strength, vitality, or alertness must be substantially affected. Examples include medical conditions that cause a student to miss many days of school, or fatigue issues that cause a student to need half days or reduced assignments. You should talk to your child’s health care provider(s) about whether you should seek an IEP for your child.
How do I get an IEP for my child?
Anyone can request that a child be evaluated for an IEP, including parents, teachers, or school administrators. Parents must be involved in the referral, assessment, and planning involved in developing an IEP.
Once a child is referred, the school district determines if the child is eligible through a multi-factored evaluation (MFE). The MFE is used to determine and describe eligibility issues. The data collected in the MFE also becomes the basis for the IEP; IEP goals and objectives should be directly related to the problems identified in the assessment process.
The MFE is conducted by licensed personnel hired by the school district. This might include psychologists, speech pathologists, special education teachers, school social workers, physical therapists, or others, depending on the child. Parents can add assessment results from another agency if they wish or if they disagree with the school district’s results. In many situations the information that parents provide from other agencies can be very helpful to school staff when determining eligibility and planning an appropriate IEP. All good assessment plans include information from the parent(s).
If parents do wish to provide additional assessment results, they may have to bear some or all of the financial responsibility for that assessment—unless the educational team agrees to the additional assessment ahead of time. There is no guarantee that using assessment from outside of the school’s resources will impact the decision of whether a child is eligible for an IEP.
After the initial evaluation, each child must undergo another evaluation every three years. IEP reviews are mandated by law and must involve the whole IEP team, including the parents. Any team member can also request more frequent reviews. If the IEP is not appropriate for the child, it can be revised.
What is included in an IEP?
An IEP can provide for modifications to the curriculum and accommodations in instructional methods and materials, assignments and classroom assessments, and time demands and scheduling. An IEP will also allow for accommodations during state testing situations, such as frequent bathroom breaks, extended time, and small group setting. Remember: any accommodations provided in the classroom must be available for standardized testing.
An IEP is developed by an IEP team. The team should include parent(s), the student if appropriate, a special education teacher, a general education teacher, a special education administrator, and related service providers as needed. Parents are a vital part of the IEP process. You need to advocate for your child and if you are not happy with parts of the IEP, you do not need to sign the document until you all come to an agreement. Parents must approve the entire IEP, including methods, materials, frequency of services, and so on. Further, any changes to the IEP (or any of these tools) need to be approved by the parents.
An IEP also comes with procedural safeguards, federal funding, and mandatory progress reports.
What happens if my child needs to be home for long periods of time?
This should be addressed in the IEP. Some families choose to have their child on home instruction exclusively, while other families send their child to school as much as possible but have provisions for home instruction addressed in the IEP. The number of hours provided weekly for home instruction is based on state law and regulations, as IDEA does not specifically address this. However, the IEP mandates the services that are provided to the student, whether the learning takes place in the school setting or at home, so the amount of home instruction needs to be adequate to ensure the child progresses on goals set out in the IEP.
What if I need more information or don’t think my school district is meeting my child’s needs?
Here are some great Web sites for general information on IEPs, 504 Plans, and “Other Health Impairments”:
If your child is in school and you do not feel his or her needs are being addressed, talk to your school administrator. If that does not yield the results you want, ask to speak to the district special education coordinator. If your child has an IEP, you are already guaranteed due process rights. Part of the IEP process includes providing parents with a book on the rights guaranteed by the IEP. In the handbook it will list the appropriate numbers to call at the state level. Another good source of information is your state department of education Web site.
THIS IS TO WHAT LOW-INCOME PEOPLE ARE BEING PUSHED UNDER THE GUISE OF HEALTH CARE ACCESS-----THINK HOW LONG YOUR FAMILY WILL BE ABLE TO AFFORD SILVER OR GOLD INSURANCE PLANS AND WILL FALL INTO THIS MESS BECAUSE----90% OF AMERICANS WILL.
Think about what Affordable CAre Act means-----what is the cheapest way to give health care----same with public education and schools than eliminating all the physical structures for health and education and do it all online with people staying at home.
THAT IS WHAT AFFORDABLE MEANS IN AFFORDABLE CARE ACT.
All of these 'individualized plans' are simply policy that creates all kinds of separate businesses to meet all those special needs with all kinds of online education businesses training people for jobs that are no longer even college degrees-----the entire process is being cheapened to a degree of worthlessness.
Will people want home health care or education at home they have to worry about who is being sent? Or will they want their children taught at home to online lessons that take away all the socialization of children in schools?
IT IS NOT PROGRESSIVE ----IT IS REGRESSIVE AND OPPRESSIVE BECAUSE PEOPLE ARE NOT GOING TO BE GIVEN CHOICES----THEY ARE GOING TO BE TRACKED AND REQUIRED TO DO THIS.
As any Baltimore citizen will tell you ------THE ENTIRE SYSTEM IS A MESS---FULL OF FRAUD, CORRUPTION, AND UNJUSTICE.
That is because Baltimore City is run by a very, very neo-conservative Johns Hopkins who has no moral, ethical, or legal boundaries----and Wall Street Baltimore Development. So, Baltimore is always ground zero for the most repressive and unjust of public policy. We are seeing nothing but all of these private non-profits-----small businesses breaking up public health and public education with the goal of complete deregulation with no oversight and accountability AND ALL FEDERAL AND STATE FUNDING GOING TO LOCAL PEOPLE AS SMALL BUSINESS AND NON-PROFIT WILL MOVE TO GLOBAL CORPORATIONS IN JUST A HANDFUL OF YEARS.
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It was never a secret that the Affordable CAre Act was the Republican health policy to end public health and regulations to super-size health industry profits.......the Clinton neo-liberals ---always the Republicans----simply installed their global corporate global market drive to these policies.
Blaming health regulations for cost to health care----when enforcing laws with oversight and accountability would have stopped trillions of dollars in health industry fraud and profiteering ----is like a wolf telling a farmer to take the lock off the hen house door because it slows him down having to unlock it every day.
ALL POLICIES INSTALLED SINCE CLINTON TOOK THE PEOPLE'S DEMOCRATIC PARTY HAVE NOT ONLY BEEN REPUBLICAN----BUT BECAUSE THEY ARE WORKING FOR GLOBAL CORPORATIONS THEY ARE EVEN WORSE FOR THE AMERICAN PEOPLE.
It is not hard to see how expensive it will be to try to provide oversight and accountability to hundreds and thousands of small health industry businesess and non-profits rather than having all health care under a public hospital and public health agency. WE THE PEOPLE have all access to our public agencies----when government is working right----NOT AS IN BALTIMORE. When we are dealing with transparency in all of this outsourcing---we have no way of verifying data honesty-----AND THAT IS THE POINT.
SO, WHERE DOES HIPPOCRATIC OATH AND DO NO HARM -----IN HEALTH CARE GO UNDER THESE CONDITIONS? OUT THE WINDOW.
Oh, it's just those poor people subjected to this-----NO, it will become what DARK AGES bring----WE THE PEOPLE AS PEASANTS WITH ANYONE POSING AS A DOCTOR OR NURSE WITH NO WAY OF KNOWING.
Commentary CATO INSTITUTION
To Expand Health Coverage, Deregulate Health Care
By Christopher J. Conover
This article was published in Investor’s Business Daily, October 7, 2004.
The soaring cost of health care has become one of this nation’s most pressing public issues. Politicians and pundits regularly talk of new programs and changes in law that could address this problem, and some have even discussed the implementation of a socialized health care system. Unfortunately, there is little discussion of one policy response that would significantly lower health care costs: doing away with outmoded and questionable health care regulations that raise prices but produce little if any benefit.
As one health economics textbook puts it, “the U.S. health care system, while among the most `market oriented’ in the industrialized world, remains the most intensively regulated sector of the U.S. economy.” Regulation is taxation by another name. Instead of taxing private resources to fund government spending, regulation directs how private individuals use those resources. The costs of regulation are the benefits we would derive from alternative uses of those resources.
To determine the costs of health care regulation and ascertain whether those costs are offset by benefits, my colleagues at Duke University and I have spent several years evaluating the economic literature to estimate the net burden that health care regulations place on the U.S. economy. Our preliminary results are published today (10/4) by the Cato Institute.
We examined five areas of government regulation that apply solely to the health care sector: regulation of health facilities (hospitals, nursing homes, etc.), health professionals (doctors, nurses and many other providers), health insurance (pricing restrictions, benefit mandates, portability requirements, etc.), pharmaceuticals and medical devices, as well as the medical liability system.
Our review of the literature on 47 different types of health care regulation suggests their total cost was roughly $339.1 billion in 2002. After subtracting the $170.1 billion in benefits that we calculate those regulations provide, we find that health care regulation places a net burden on society of $169.1 billion annually.
Broken down by component, the medical liability system appears to impose the greatest net cost, at $80.6 billion per year. We arrive at that estimate after accounting for the medical liability system’s benefits: averted mortality and disability, plus the compensation paid to injured patients.
We estimate that Food and Drug Administration regulation of pharmaceuticals and medical devices imposes a net annual cost of $41.8 billion. The lion’s share of that cost represents the value society places on the net number of lives that are lost while waiting for better pharmaceuticals to be approved, after subtracting the number of lives saved by FDA regulation.
In 2002, regulation of hospitals and other health facilities cost an estimated $25.1 billion. The two greatest costs in this category are hospital accreditation and licensure requirements (net cost $8.6 billion), and laws that tax hospitals and redistribute the revenues to those providing above-average amounts of uncompensated care (net cost $5.2 billion). Health insurance regulations cost Americans $14.4 billion annually, while regulation of doctors and other health professionals cost $7.1 billion annually.
This leads to some troubling realizations. Over the next 10 years, the net cost of health care regulations will be some three times more than the $534 billion cost of the new Medicare prescription drug benefit. By increasing the cost of medical care, regulation increases the cost of health insurance. We estimate health care regulation makes coverage unaffordable for approximately 7.5 million Americans.
Though one might suppose this added burden ensures better medical care, it is likely that it costs lives instead.
Several studies have established a tradeoff between income and mortality: As income rises, mortality falls because people are able to purchase more health and safety. We estimate that by making Americans $169.1 billion poorer each year, health care regulations induce approximately 22,205 deaths annually. That is over 4,000 more deaths than the Institutes of Medicine attribute to uninsurance.
If we are to get the most out of our health care sector, policymakers must address the high cost of health care regulation. In terms of priorities, it would appear that medical liability reform offers the most promising target for regulatory cost savings, followed by deregulation of the FDA, health insurance (e.g., mandated health benefits) and health facilities (e.g., accreditation and licensure).
What should be clear from even this rough picture of the health care regulatory landscape is that the potential savings from deregulation are far too large to be ignored.
Christopher J. Conover is an assistant research professor at Duke University and author of the Cato Policy Analysis “Health Care Regulation: A $169 Billion Hidden Tax.”
Voting out Blue Dog Democrats and installing Clinton neo-liberal New Democrats------moves the Democratic Party further into the hands of Clinton Wall Street global corporate neo-liberals....it replaces social conservatives with totalitarian far-right global corporate tribunal rule.
If you know ACA is about consolidation and deregulating health care just as Clinton did the banking industry----you know it is bad and not Democratic policy!
This is the sad news for Democrats-----a raging Obama Wall Street global corporate neo-liberal-----to the right of center Republican-----doesn't mind his name attached to the Affordable CAre Act----what happens when the American people are kept in the dark regarding public policy---- they simply vote against something----not knowing what that vote will bring.
Blue Dog Democrats in the south voted against ObamaCare because it is the worst of policies if you are either free market----or social Democrat---IT IS SIMPLY VERY BAD FOR EVERYONE EXCEPT GLOBAL CORPORATIONS.
Blue Dogs, like Tea Party KNOW these policies from Bush to Obama kill free-market---kill small business----kill the US Constitution. SO THEY VOTE AGAINST POLS THAT VOTED FOR AFFORDABLE CARE ACT----AND THEY WERE RIGHT.
Social Democrats who should be concerned with progressive public interest control of public policy----Equal Protection and Federal protection of equal rights came out for the very policy that kills all of this because---they had no one educating the Democratic base except Clinton neo-liberals.
Meanwhile, Clinton and Obama have national labor and justice organization leaders in their pockets-----bringing out the Democratic base in support of ACA not educating AT ALL on where these policy goals lead.
DEMOCRATIC BASE VOTERS ARE RELYING TOO MUCH ON PEOPLE WHO ARE LYING TO THEM.
'along comes another Blue Dog, Long Island corruptionist Steve Israel, with a policy of recruiting more Blue Dogs and their kissin' cousins, the New Dems, to replace the ones rejected by Democratic voters'.
Sunday, June 28, 2015
31 Of The 34 "Democrats" Who Voted Against Obamacare Were Ousted From Congress By Angry Constituents
I've never been a tremendous fan of the ACA (Obamacare)-- I favor letting everyone buy into Medicare (single payer universal)-- but I think it makes the dysfunctional American health care system a lot better than than it was before 2010. And I was gratified on Thursday, lying in a hospital bed at City of Hope hooked up to spinning machines taking out my blood to harvest stem cells and then recycling the blood back in me, when the Supreme Court voted 6-3 to uphold the subsidies that make Obamacare functional for the most needy families among us.
It should surprise no one, though, that right after Chief Justice Roberts, formerly a hero of the Tea Party, declared the ACA constitutional, far right extremists like Pat Toomey and Rick Santorum of Pennsylvania were rending their clothes and covering their bodies in ashes. As Philadelphia's KYW Newsradio 1060 reported: "For opponents of the Affordable Care Act, the fight switches back to repealing the law. Republican Senator Pat Toomey and presidential candidate Rick Santorum say that remains their mission."
Republican Party chairman Reince Priebus huffed and puffed that "today’s ruling makes it clear that if we want to fix our broken health care system, then we will need to elect a Republican president." (How about Maine's Republican Governor Paul LePage?)
To most Democrats, the health care law is government at its most promising. Millions of previously uninsured people have obtained coverage. Rejecting coverage applicants for pre-existing conditions, which were particularly onerous to women, is gone. People under 26 can stay on their parents’ policies... Republicans put health care on a list with other examples of bloated government-- regulation of businesses, efforts at gun control, requiring businesses to deal with people whose lifestyles offend their religious beliefs-- and see a highly useful campaign issue. ...Republicans were hoping the court would decide against this key part of the law -- and in turn give the party momentum as it argued for repeal during the 2016 election campaign.
Instead, Republicans now face huge hurdles.
Much of the public has had enough of this debate, now stretching into its seventh year. Since it was enacted, the Republican House of Representatives has voted more than 50 times to repeal it only to see its moves fall short; the court has ruled twice upholding the law; and President Barack Obama has won re-election over a GOP candidate who vowed to repeal and replace it.
A Kaiser Family Foundation survey earlier this month found 45 percent of Americans believe it’s time to move on, percentages generally uniform across party lines. A Pew Research Center survey in September found 54 percent of Americans said the law had not had an effect on them or their family.
Back on March 21, 2010, late into the night, the House voted on a complex, heavily compromised piece of legislation and it wasn't only Republicans who opposed expanding health coverage for poor people. The Affordable Care Act passed 219-212 and that 212 includes every single Republican plus 34 putative Democrats. All but 3 of those Democrats were subsequently defeated or forced to retire before facing certain defeat. Some were beaten in primaries, but some were defeated because Democratic voters just stayed away from the polls and left the election to whichever nutcase Republican was running. The three that haven't been beaten yet are Blue Dog Collin Peterson (MN), Stephen Lynch (MA) and Blue Dog Dan Lipinski (IL). This is the whole list of "Democrats" who crossed the aisle to vote with the Republicans against healthcare for the least well-off families in our country:
• John Adler ((Blue Dog-NJ)
• Jason Altmire (Blue Dog-PA)
• Mike Arcuri (Blue Dog-NY)
• John Barrow (Blue Dog-GA)
• Marion Berry (Blue Dog-AR)
• Dan Boren (Blue Dog-OK)
• Rick Boucher (VA)
• Bobby Bright (Blue Dog-AL)
• Ben Chandler (Blue Dog-KY)
• Travis Childers (Blue Dog-MS)
• Artur Davis (Blue Dog-AL)
• Lincoln Davis (Blue Dog-TN)
• Chet Edwards (TX)
• Stephanie Herseth Sandlin (Blue Dog-SD)
• Tim Holden (Blue Dog-PA)
• Larry Kissell (Blue Dog-NC)
• Frank Kratovil (Blue Dog-MD)
• Dan Lipinski (Blue Dog-IL)- needs a primary opponent
• Stephen Lynch (MA)
• Jim Marshall (Blue Dog-GA)
• Jim Matheson (Blue Dog-UT)
• Mike McIntyre (Blue Dog-NC)
• Michael McMahon (Blue Dog-NY)
• Charlie Melancon (Blue Dog-LA)
• Walt Minnick (Blue Dog-ID)
• Glenn Nye (Blue Dog-VA)
• Collin Peterson (Blue Dog-MN)- needs a primary opponent
• Mike Ross (Blue Dog-AR)
• Heath Shuler (Blue Dog-NC)
• Ike Skelton (MO)
• Zack Space (Blue Dog-OH)
• John Tanner (Blue Dog-TN)
• Gene Taylor (Blue Dog-MS)
• Harry Teague (Blue Dog-NM)
That was the biggest part of the Great Blue Dog Apocalypse. Good to see them go! But... along comes another Blue Dog, Long Island corruptionist Steve Israel, with a policy of recruiting more Blue Dogs and their kissin' cousins, the New Dems, to replace the ones rejected by Democratic voters. And he's still doing it-- recruiting Blue Dogs, recruiting New Dems, even recruiting "ex"-Republicans. Of course, they never advertise these candidates as Blue Dogs or New Dems.
So how is a voter or a contributor to know? Easy-peasy-- you will never find a Blue Dog or New Dem on this page. Because, never forget, today's Blue Dog or New Dem being pushed by the DCCC or DSCC can easily turn out to be this garbage:
When the American people take a look at what this Affordable Care Act insurance mandate will look like------and people are seeing that this is simply paying insurance without access to health care-----you will see why it has been for decades a Republican policy. They do progressive posing by pretending it is universal care-----everyone has insurance must be accessing health care after all. This is a Republican health policy because it is designed to make health industry profits soar.....AND THAT IS IT.
Think about which organizations and people came out hard fighting for Affordable Care Act---and which Democrats were shouting that NO REFORM IS BETTER THAN ACA. The Republicans in Congress are fighting ACA first because no one hates it more than Republican voters. Republican voters are the ones fighting the mandate their Republican think tanks wrote. So, that is why American politics today is kabuki theater......we have global corporate pols working against US sovereignty, Rule of Law, US Constitutional rights while tying us to global corporate tribunal and court rule----all while pretending to be Democrats and Republicans----DINOS and RINOS. All Clinton neo-liberal policy is far-right economic policy----it is Republican. The only difference is neo-liberalism is not free market-----it uses corporate subsidies and kills small businesses to send all business to a few global corporations and rich. WE MUST HAVE REAL SOCIAL DEMOCRATS REPLACING ALL CLINTON NEO-LIBERALS IN ALL DEMOCRATIC PRIMARY ELECTIONS---PLEASE STOP BELIEVING THESE LIES!
‘Obamacare’ Was Originally Proposed By Republicans
Sep 27, 2013
By Taylor Tyler
With the Affordable Care Act’s first big test starting Tuesday, and the Republican push to repeal the act due largely to their claims of the unconstitutionality of the individual mandate, it seems appropriate to note the history surrounding the controversial issue. The substantial amount of contrarianism that has occurred in the past two decades is nothing short of astounding.
The fact that the individual mandate has deep Republican roots cannot be denied.The idea of an individual mandate replacing the single-payer health care system was proposed in 1989 by the conservative Heritage Foundation and was published in a paper titled, “A National Health System for America.”
In the paper, the Heritage Foundation’s director of domestic policy strategies, Stuart M. Butler, proposed that “every resident of the U.S. must, by law, be enrolled in an adequate health care plan to cover major health care costs.”
The proposal was backed by a large number of Republican politicians and was strikingly similar to the Affordable Care Act signed by Obama in 2010, which was admittedly influenced by Heritage’s proposal.
Former Republican Presidential Candidate Jon Huntsman noted this fact on NBC’s Meet the Press, Sunday:
It should be noted that President George H.W. Bush supported the individual mandate and even before this, both Richard Nixon and Ronald Reagan supported various universal health care mandates.
The fact that the individual mandate has deep Republican roots cannot be denied.
By the time Bill Clinton was preparing his health care reform in 1993, many Republicans who backed the alternative individual mandate approach claimed it was a “personal responsibility” to have health care.
Former Republican Senator John Chafee formally introduced the proposal in a 1993 bill titled, “Health Equity and Access Reform Today Act of 1993,” which had 20 Republican co-sponsors and included an individual mandate and vouchers for lower income individuals.
A few Republicans who co-sponsored the 1993 Republican individual mandate bill, but more recently opposed Obama’s Affordable Care Act include: Senators Orrin Hatch and Chuck Grassley, along with former Senators Robert Bennet, Christopher Bond, and Richard Lugar.
And in 1994, another Republican bill, titled the “Consumer Choice Health Security Act of 1994,” initially included an individual mandate.
Republicans who co-sponsored the 1994 bill, but now oppose the Affordable Care Act include: Senators Dan Coats, Charles Grassley, Orrin Hatch, and former Senators Robert Bennett, Judd Gregg, Kay Bailey Hutchison, and Richard Lugar.
Senator John McCain once supported the individual mandate as well, when in the early 1990s he made a speech proposing the individual mandate as a counter to the health care reform Bill Clinton was proposing, according to the Miami Herald.
And former Speaker of the House Newt Gingrich worked with the Heritage Foundation on the individual mandate before changing his stance on the issue in 2011. Former Governor Mitt Romney also once supported a nationwide individual mandate, and got the idea for his Massachusetts health care reform from Newt Gingrich, but he also changed his stance on the issue during his 2012 presidential run.
But the Republicans are not the only ones to flip on the individual mandate. Even President Obama opposed the idea while he was running for president against Hillary Clinton and up until six months into his first term.
No concerns over the constitutionality of an individual mandate were raised by Republicans, that is, until Democrats began catering the idea. Most Republicans now claim that the idea of requiring every American to buy health insurance is the worst part of the Democratic health care agenda.
While it’s certainly possible for someone to legitimately change their mind on an issue, it also seems likely that the amount of flip-flopping is due to nothing more than political posturing by both sides to gain an edge over the other.
There we see---they are off and running. Only a few years of Affordable Care Act has Wall Street soaring. Remember, Republicans and Clinton neo-liberals have had these policies ready to unfold for decades so corporations were well on their way to taking the global Wall Street bank model.
The new laws creating all these categories for education and health care are not excessive regulations----they are designed to break down American health care standards and with deregulation. We'll need a business to do this----a business to do that-----another to monitor this and that.
Meanwhile, we have a Federal agency and Constitutional laws that already have a system that worked for centuries to the benefit of citizens.
Consolidation in healthcare will continue in 2015
Moody's reports other trends include more insured patients, slow patient volume growth
January 14, 2015 | By Zack Budryk
The healthcare industry will continue its unprecedented trend toward consolidation in 2015, according to a new report from Moody's Investors Service.
Healthcare will see a large number of mergers and acquisitions, joint ventures and affiliations this year, Moody's Healthcare Quarterly reports. While mergers and acquisitions are considered credit negative for the acquiring organization, Moody's reports that a hospital or health system joining a larger, more successful system to alleviate financial woes could be considered a credit positive. Mid-sized hospital operators such as LifePoint will look to expand into new markets this year, according to the report.
"The larger, for-profit operators HCA [Hospital Corporation of America], Tenet and Community are likely to continue looking for targets that fill out existing markets or provide opportunities to enter new ones," Moody's said in an announcement. "Hospitals in general will continue to benefit from a reduction in the number of patients without health insurance as the Affordable Care Act [ACA] continues to gain traction."
Barry Ronan, president and CEO of Western Maryland Health System, last week echoed predictions of increased consolidation in an interview with FierceHealthcare. Ronan specifically predicted forms of consolidation that allowed small- to mid-sized systems to maintain their independence. "I'm hearing more and more interest in strategic regional organizations and alliances, and I expect a greater momentum during 2015," he said.
In addition to continued consolidation, the year will also bring several challenges and opportunities for both nonprofit and for-profit hospitals and health systems. For example, the continued implementation of the ACA will increase the number of insured patients seeking care at hospitals. However, Moody's projects weak patient volume growth in 2015. This slow growth traces back to several factors, including changes in reimbursement and regulatory frameworks and the increased proliferation of high-deductible health insurance plans.
RAISE your hand if you understand that creating global corporations kills everything that has to do with free market----local economies-----and opens up this WE CAN DO ANYTHING WE WANT mentality behind all the lying, cheating, and stealing. EVERYONE.
Since the Affordable CAre Act is nothing but consolidation and deregulation of health industry sending it global to maximize profits----A VERY REPUBLICAN POLICY----we already know public interest is not involved and all public protects-----and access will disappear. People thinking they can afford a Silver or Gold plan today----will be joining what is becoming GUTTED OF FUNDING MEDICAID FOR ALL where preventative care is all in the imagination as corporations simply suck Federal funding away through fraud and corruption.
'But consolidation also carries the risk of reducing competition and raising prices. “The problem is, coordination and competition are kind of antithetical,” said Mark Pauly, a professor of healthcare management at the University of Pennsylvania'.
Consolidation creating giant hospital systems
By Melanie Evans | June 21, 2014 Modern HealthCare
Large regional and national healthcare systems are getting bigger and markets are increasingly consolidating, Modern Healthcare's annual survey of hospital systems shows.
Among the nation's biggest for-profit and not-for-profit systems, dealmaking in 2013 created giants with multibillion-dollar annual revenues that rival some Fortune 500 companies. Regional systems acquired nearby hospitals to strengthen their position as local players. And nearly all systems added more physicians to their payrolls: Among survey respondents, doctors employed by systems increased 39% to roughly 67,600 physicians.
The largest U.S. health system by revenue is HCA. The Nashville-based for-profit system ended 2013 with net patient revenue of $38 billion and the No. 1 spot in Modern Healthcare's ranking.
Ascension Health, the second-largest system by revenue, acquired regional health systems in Kansas, Oklahoma and Wisconsin, adding nearly $4 billion in revenue and 32 hospitals to the St. Louis-based system's portfolio. Not-for-profit Ascension ended 2013 with patient revenue of $15.3 billion.
For-profit Community Health Systems, which ended 2013 with 133 hospitals and revenue of close to $13 billion, ranked No. 3. Trinity Health, Novi, Mich., and Catholic Health East, Newtown Square, Pa., merged to create not-for-profit behemoth CHE Trinity Health with more than $12 billion in operating revenue, making it the fourth-largest system.
MH Takeaways The trend for health systems to acquire physician practices has the potential to raise prices, particularly under the current volume-based fee-for-service system.
The consolidation activity—likely to continue this year with a flurry of recently proposed unions—underscores the jockeying among health systems as public policy and market forces expand insurance coverage for millions of Americans, push providers to manage the health of enrolled populations and shift payment to new models that introduce greater financial risks for hospitals and doctors.
Systems are striking deals that deliver larger scale, more leverage and more diverse business lines that executives contend are needed to manage increased insurance risk and reduce wasteful fragmentation. Dealmakers say they hope to improve quality and reduce costs through greater standardization of care, more negotiating leverage with suppliers, and bigger investments to bolster providers' ability to communicate and coordinate care.
But consolidation also carries the risk of reducing competition and raising prices. “The problem is, coordination and competition are kind of antithetical,” said Mark Pauly, a professor of healthcare management at the University of Pennsylvania.
The wave of dealmaking has attracted regulators' scrutiny. In January, a federal judge agreed with the Federal Trade Commission's argument that Boise-based St. Luke's Health System gained too much market clout when it acquired a large local medical group; he ordered the system to unwind the deal. “Our job is to protect American consumers,” said Martin Gaynor, director of the FTC's bureau of economics. Mergers in highly concentrated healthcare markets can raise prices, which hits consumers with higher premiums, higher cost-sharing and slower wage growth, he said.
Market-share gainsExperts say the trend among health systems to acquire physician practices also has the potential to raise prices. Health systems that employed doctors and made market-share gains raised prices 2% to 3%, according to an analysis of market-share shifts and price changes between 2001 and 2007. The study was published in May in Health Affairs. Laurence Baker, a professor of health research and policy at Stanford University and author of the study, said the results suggest savings from employing physicians won't be “easy or automatic.”
Insurers lose bargaining power when hospitals and doctors jointly negotiate prices, said Dr. Ann O'Malley, a senior fellow with Mathematica Policy Research. The risk of increased costs because of consolidation is greatest under fee-for-service reimbursement tied to volume of services. “Hospitals … would like to garner more referrals to their specialists” by employing more doctors, she said. “In the short term, there's a real risk that costs could really go up.”
Modern Healthcare's rankings capture a sizable number of major health systems. But because the survey is voluntary, it does not fully reflect the U.S. hospital market. For some non-respondents, Modern Healthcare used publicly available financial data, such as for Tenet Healthcare Corp., which last year acquired Vanguard Health System. Tenet reported operating revenue of $11.1 billion in its regulatory filings, including Vanguard revenue for the final three months of 2013. Vanguard reported annual revenue of $6 billion before the deal. Tenet did not respond to the survey.
For systems that did not respond, details on physician employment and ambulatory growth were not available. Among the non-respondents that ranked among the nation's larger systems were Allina Health, Minneapolis; BJC HealthCare, St. Louis; Bon Secours Health System, Marriottsville, Md.; Partners HealthCare System, Boston; Texas Health Resources, Arlington, Texas; and UPMC, Pittsburgh.
The survey did not capture deals closed after the end of systems' fiscal 2013. Baylor Health Care System merged last October with Scott & White Healthcare after the close of Baylor's fiscal year. The newly created $8.3 billion Texas system is not included in this year's ranking. Also not included is the $3.9 billion deal by Community Health Systems, Franklin, Tenn., for Health Management Associates, Naples, Fla. The deal closed in January.
Dealmakers cite early success in cutting costs as evidence that bigger is better. Leaders of CHE Trinity Health said the combined system's larger size has yielded savings and new business opportunities. Greater efficiencies because of scale have shaved operating expenses by $128 million in the first year of the merger, while combined quality, clinical and information technology staff have allowed more rapid adoption of strategies to reduce waste and harm. “We just multiplied the ability to get good ideas and to replicate those good ideas across the system,” said Daniel Hale, executive vice president of the system's Institute of Health and Community Benefit.
Hale downplayed the risk that consolidation will reduce competition and raise prices. “Size creates a lot of possible, really positive opportunities for us,” he said. Operating in 20 states allows CHE Trinity to better compete for contracts from national insurers serving multistate employers, he said.
Catholic Health Initiatives, which ranked No. 7 on this year's list, grew larger as the system entered a new state. Last year's deal made by the Englewood, Colo.-based system for St. Luke's Episcopal Health System, Houston, added $1.2 billion in revenue to CHI's operations, to increase its revenue to nearly $9.9 billion.
Mergers between giant health systems are not the only deals taking place. Smaller health systems have merged to create formidable regional players, and more deals are on the way to reshape local markets. In May, University of Wisconsin Health System announced plans to merge with SwedishAmerican Health System in Rockford, Ill. In March, St. Anthony's Health System, Alton, Ill., announced a potential merger with OSF HealthCare System, Peoria. Beaumont Health System in Royal Oak, Mich., announced a possible merger with Botsford Health Care in Farmington Hills and Oakwood Healthcare in Dearborn to create a $3.8 billion system.
Strategy to diversifyIn addition, health systems continued to acquire physician groups as part of their strategy to diversify into ambulatory care. That trend also was reflected in the growth of freestanding outpatient-care centers owned by health systems, which increased 27% to 6,045 centers.
SSM Health Care, St. Louis, gained 500 physicians and 60 clinics last year with its acquisition of Wisconsin-based Dean Health System. That increased the 15-hospital system's roster of employed physicians by 46% to 1,300 doctors.
“From our perspective, we were purposely trying to move beyond a hospital system to truly being a system that's trying to keep people healthier, and hospitals are not the best place to do that,” said William Thompson, SSM's president and CEO. “To truly improve the experience and lower the total cost, we needed physicians to take the lead in the delivery of care and assume positions of leadership in all levels of the organization.”
SSM will seek to employ more doctors across its markets to prepare for contracts to manage the health and healthcare costs for enrolled patient populations, Thompson said. SSM's deal for Dean Health System gives it access to a profitable medical group's management expertise, which SSM leaders will tap as they expand physician hiring. “We recognized that hospital systems do not manage physician groups well,” Thompson said.
Ascension Health, St. Louis, reported a 93% increase in physician employment in 2013 to 5,252 doctors. But the tally for 2013 included hospital-based and academic doctors not counted in the 2012 total. The system's acquisition of three regional health systems boosted its total of employed doctors by 1,000 physicians.
Dr. David Pryor, president and CEO of Ascension Clinical Holdings, said his system tailors its physician employment strategy to each market, and will continue to work with independent doctors as it pursues a strategy of building regional networks. “There are very strong physician groups in many markets who are key to delivering high-quality care, but they may choose to stay independent,” he said.