Health Train Express has a special banner:
Webcina offers a unique vehicle for many topics about healthcare, disease, prevention, and credible sources for all of the above. Our banner for the next several weeks will be unique, embedded in the html for our site. Please be patient, it loads a bit slower than the rest of the blog. However it has rich content which I find very useful in my blogging and writings.
I trust you all had a ful-filling holiday.
Gary Levin MD
Windows Live Tags: BLACK,Health,Care,shoppers,Xers,data,Online,sales,consumers,device,retailer,conversion,Facebook,Twitter,fact,Digital,statistics,Last,Cyber,Mobile,Social,Network,Self,tablet,Apple,article,technology,families,decision,products,phenomenon,consumer,Here,dinner,abdomen,Nausea,breakfast,Severe,headache,Somnolence,Stimulants,Channel,Football,Google,Best,Target,Wal-Mart,Sears,mall,Sirius,Where,Developers,Challenge
What we need is a Health Care Black Friday ! Yes, fellow Friday shoppers here are the stats derived from a ‘big blue’ (IBM) for you Gen Xers) data dive. Why is IBM watching mobile?
- Online sales are up 20 percent for this same time period over Black Friday 2011.
- The number of consumers using a mobile device to visit a retailer’s site is at 28 percent, up from 18.1 percent in 2011.
- The number of consumers using their mobile device to make a purchase is 14.3 percent, up from 10.3 percent in 2011.
- Shoppers using the iPad led to more retail purchases more often per visit than other mobile devices, with conversion rates reaching 4.2 percent, higher than all other mobile devices.
- Shoppers referred from social networks like Facebook and Twitter generated 0.18 percent of all online sales on Black Friday.
So, you might be wondering how IBM gets all this i
In fact the internet humming (or is it buzz?) on Thursday, soon after that turkey/ham/prime rib) begins .
All Things Digital reported statistics from yesterday.
Last year, it was Cyber Monday — this year, it’s turned out to be Mobile Thursday. What’s next? Social Network Saturday? Self-Driving Car Sunday? (We still have Black Friday, by the way, which is today.)
And, indeed, the Mobile Thursday phrase got some big laps around the track, with numerous online shopping surveys — coming out faster than you can buy that new tablet — using it in their flash reports yesterday and today.
This year’s anecdotal meme: Apple iPads go well with pumpkin pie.
Black Friday is “SOCIAL” as evidenced by the following video.
The poignant focus of All Things Digital’s article,
“If you think about consumers, and you think about the amount of technology that they have at their hands, to reach out to read reviews and talk to friends and families, they’re incredibly empowered. There’s not one purchase decision that they make that is not impacted by some element of social networks. What does that do to the companies that have to deal with that by offering the best products and services, and you see companies are struggling to do that: To make the right offer at the right time with the right price. When they do it well, we all talk about how it went well; and when they do it badly, we talk about how annoying it was.” Is it this way with Health Care (YET) ?
Has this phenomenon spread to Health Care?
I would like to see IBM use their analytics on health consumer habits.
Here might be some of the things patients might search for after dinner.
1. Bloated feeling in abdomen
2..Nausea when thinking about breakfast the next AM
3..Severe headache after drinking wine with dinner
4..Somnolence after dinner
5 Stimulants after dinner
6. Channel line-up for Football
7. Channel line-up for sports reporting
8. Google maps for directions to home
9. Google maps for directions to Best Buy, Target, Wal-Mart, Sears or nearest mall.
Sirius most frequent question, “Where are the best deals today?”
So Black Friday and Health care have much in common. They are both social.
I have an idea for the next “Developers Challenge”
Guess which of these images are “clickable’ No prizes awarded !
Patient/provider interaction via electronic means was predicted to be a time saver as well as a cost reducing addition to providers.
“”Healthcare futurists have viewed online communication between clinicians and patients as a welcome substitute for low-level office visits and telephone calls, lightening a clinician's load. In addition, some studies have found that virtual visits make a waiting room a little less crowded.
However, a study published in the November 21 issue of JAMA showed that letting patients email their clinician and access their records online was associated with more, not fewer, telephone calls, office visits, and clinical services in general. In this case, the substitution theory did not hold.
Lead author Ted Palen, MD, PhD, MSPH, and coauthors studied the effect of an online Web portal for patients that was deployed by Kaiser Permanente (KP) Colorado, a group model, integrated healthcare delivery system. The portal, called My Health Manager (MHM), connects to KP's electronic health record system. MHM lets patients access test results, request medicine refills, schedule non urgent appointments, and exchange messages with their clinician on non urgent health issues.
However, Dr. Palen and colleagues do not consider their research the final word on the matter, especially because it remains unclear why online access was linked to a higher rate of clinical services.
Online access, Dr. Palen told Medscape Medical News, might have helped patients take more responsibility for their healthcare, which led them to use more services. Or perhaps patients who signed up for MHM were already likely to use more services because of clinical characteristics that the study failed to control for (simply put, they were sicker). Future research will try to tease out cause and effect, he said.
The latest KP study did not control for the type of health plan. KP Colorado offers a wide gamut of plans, including traditional health maintenance organization (HMOs), high-deductible HMOs with health savings accounts, and preferred provider organization plans.
Dr. Palen said that if future research continues to find a link between patient portal use and a higher uptake of clinical services, medical organizations will need to staff accordingly. The authors estimate that if office visits for a solo practitioner with 1000 adult patients increase by just 0.5 visits per patient per year, the physician will need to book 10 more appointments each week. “”
Author’s commentary:
This study is highly biased, because it took place in the Kaiser Hospital system, a mature integrated health system. Electronic access increases availability of providers to patient. It is also a ‘closed system’ whereby patients must use a Kaiser facility, and no other, thereby preventing a patient from going out of ‘network’ to obtain urgent care.
Dr. Palen is employed by the Colorado Permanente Medical Group. The other authors are employees of Kaiser Permanente Health Plan of Colorado. The authors have disclosed no other relevant financial relationships.
Windows Live Tags: Online,Communications,Results,Patient,provider,interaction,saver,cost,addition,providers,Healthcare,futurists,communication,office,room,November,JAMA,substitution,theory,Lead,author,Palen,MSPH,portal,Kaiser,Permanente,Colorado,system,Health,Manager,medicine,messages,colleagues,Medscape,Medical,News,characteristics,Future,gamut,maintenance,HMOs,savings,uptake,authors,practitioner,physician,commentary,Hospital,Electronic,Group,employees,Plan,relationships,patients,clinician
With the national health law’s political future now entrenched, a deluge of new rules is expected in the coming days and weeks as the Obama administration fleshes out the law’s complex components.
I expect my Twitter stream(s) to be flowing on many of these topics, as well as commentary on blogs, Facebook, the Wall Street Journal Health pages, and others.
States and insurance companies had put on hold the many changes necessary to comply with PPACA. The outcome of the 2012 Presidential campaign was murky enough for Secretary of HHS, Kathleen Sibelius to delay state decision making in regard to their intent to participate in Health Insurance Exchange organization and participation using Federal funds.
The anticipation so far has been focused on rules that determine how the new state-based insurance marketplaces called exchanges will operate. But also closely awaited are decisions about how the government will tax medical devices, allot the shrinking pool of money for hospitals that treat the uninsured, and determine how birth control insurance coverage can be guaranteed for employees of religious schools, universities and charities.
Other key decisions will be determined outside the rulemaking process, as the Obama administration selects participants in several experimental programs, including a new payment method for doctors, hospitals and other providers.
Medical Device Excise Tax. Last February, the Internal Revenue Service proposed a rule on how to apply this 2.3 percent tax, which kicks in at the start of January. The major unresolved issues concern which devices will be included and how the tax is applied and collected.
Among the questions: Should the tax apply to devices commonly used by veterinarians if the device is also used in human medicine? What about items sold in retail settings but also used in medical procedures, like dental instruments and latex gloves? Does the tax apply to kits—two or more medical tools packaged and sold together—even if the manufacturer of each individual component had already collected the tax when it was sold to the kit maker?
Brendan Benner, a spokesman for the Medical Device Manufacturers Association in Washington, D.C., said companies are making marketing and sales decisions based on what they expect will happen, but that presents problems. "When you don’t know what the answer to the question is, it’s hard to make a decision," he said.
Hospital Payments. Between 2014 and 2019, the government will cut $36 billion out of the money that goes to hospitals that treat large numbers of poor patients. The cuts were included in the health law under the rationale that many currently uninsured patients would be covered either through the expansion of Medicaid or through subsidized insurance.
The administration has to figure out how it will allocate those cuts among hospitals—a task made more complicated by last summer’s Supreme Court ruling that allows states to opt out of expanding Medicaid.
Insurance plans. For the administration, some of the trickiest decisions concern how insurance policies must be designed, priced and sold starting next October, when open enrollment begins for the new online marketplaces, called exchanges, that will offer plans to individuals and small businesses. For instance, the law allowed insurers to alter their prices for people based on their age, family size, where they live and tobacco use. The Department of Health and Human Services has to determine how insurers can go about setting those prices.
Bundled Payments The administration has already gotten off the ground two major changes to the way the government pays hospitals and doctors. One designates accountable care organizations that reward hospitals and doctors for working together to provide more efficient care. The other begins to pay hospitals on the quality of the care they provide through the value-based purchasing program. By January, the law calls for the government to launch another major initiative: bundled payments.
This report can also be found at Health Train Express
Follow the Web Health Awards on Twitter #whasf .
Today through Wednesday a series of important announcement occurs from Web Health Awards.
The awards program is organized by the Health Information Resource Center[sm] (HIRC), an 19-year old clearinghouse for professionals who work in consumer health fields.
The Web Health Awards, and the new Web Health Awards | MOBILE are extensions of the HIRC’s 19-year old National Health Information Awards[sm], the largest program of its kind in the United States.
Because of the dynamic nature of digital health resources, the Web Health Awards competition is held twice each year: Winter/Spring and Summer/Fall.
Entry Classifications
Organizations submitting entries for the Web Health Awards and the new Web Health Awards | MOBILE must select an Audience (Consumers or Health Professionals) a Division (type of organization that produces the entry) and a Category (type of entry being submitted). Web Health Awards | MOBILE features a subset of entry categories focused specifically on mobile devices.
(Click here for a detailed list of entry classifications)
All winners in the Summer/Fall 2012 Web Health Awards receive international recognition on webhealthawards.com, a colorful award certificate, a listing of all winners, national publicity from the HIRC, and a one-year license to use the awards program logo for marketing and promotional purposes.
The National Health Information Awards
Now in its 19th year, the National Health Information Awards program honors high-quality consumer health information. The awards program is organized by the Health Information Resource Center (HIRC), a national clearinghouse for consumer health professionals who work in consumer health education fields.
These awards reward developers of mobile health and other software application for healthcare monitoring, coaching, and tracking treatment plans.
Health Train Express and Digital Health Space share in congratulating and promoting the awardee’s innovative work.
2012 has seen the rapid development of mobile health applications and more public awareness of home based preventive medicine, mobile coaching and data tracking using smartphones, and table PCs.
Then in November, after a long and contentious presidential campaign health reform the PPACA became center stage, although it was replaced by the economic crisis, the Benghazi Embassy attack, and finally the General Petraeus scandal.
Public opinion remains deeply divided on how to initiate health reform. Some are exhausted by the battle which was lost by a very narrow margin in the closest Presidential campaign recorded in recent memory. Some now want to roll over and state PPACA is the ‘law of the land’, and ‘resistance is futile.
Significant professional and public reticence remains to initiate parts of PPACA, stemming from loss of local and regional controls, fiscal responsibility in a time of crushing debt and the partisan manner in which the law passed.
Those who still feel strongly will plan to stop or delay it’ implementation attacking the law on the basis of state’s rights, constitutional issues, restriction of free trade, and ethical issues during the bill’s promotion by Health and Human Services.
some of the most memorable quotes from healthcare leaders during the past year. Check out our favorite quotes and the leaders who said them:
Who said it: Michele Lloyd, vice president for Children's Services at NYU Langone Medical Center,
Who said it: Health IT coordinator Farzad Mostashari, M.D., discussing the problems with using paper records at CHIME's Fall CIO forum last month.
Who said it: Windsor Regional Hospital CEO and President David Musyi, a FierceHealthcare advisory board member, who has taken an unconventional approach to patient and staff communication, freely giving out his email, office number, home number and cell number to the public.”
Openness and transparency often simulate better communications with less time involvement. Many studies have shown that opening access leads to a paradoxical decrease in demand upon time, quicker resolution of challenges and increased efficiency. Organizational restructuring can lead to reduced costs and less bureaucracy.
Cut to the chase and the Bottom Line:
If you are an employer, or an employee here are undisputable facts that have been and are contributing to rising health care costs and absenteeism.
“An underlying premise of the Affordable Care Act provisions that encourage employers to adopt health promotion programs is an association between workers’ modifiable health risks and increased health care costs. Employers, consultants, and vendors have cited risk-cost estimates developed in the 1990s and wondered whether they still hold true. Examining ten of these common health risk factors in a working population, we found that similar relationships between such risks and total medical costs documented in a widely cited study published in 1998 still hold. Based on our sample of 92,486 employees at seven organizations over an average of three years, $82,072,456, or 22.4 percent, of the $366,373,301 spent annually by the seven employers and their employees in the study was attributed to the ten risk factors studied. This amount was similar to almost a quarter of spending linked to risk factors (24.9 percent) in the 1998 study. High risk for depression remained most strongly associated with increased per capita annual medical spending (48 percent, or $2,184, higher). High blood glucose, high blood pressure, and obesity were strongly related to increased health care costs (31.8 percent, 31.6 percent, and 27.4 percent higher, respectively), as were tobacco use, physical inactivity, and high stress. These findings indicate ongoing opportunities for well-designed and properly targeted employer-sponsored health promotion programs to produce substantial savings.
These are all good assumptions, now let’s put some of this into action (a Physicians story about himself)
Fit4Life Radio
John C. Goodman, PhD, is president and CEO of the National Center for Policy Analysis. He is also the Kellye Wright Fellow in health care. His Health Policy Blog is considered among the top conservative health care blogs where health care problems are discussed by top health policy experts from all sides of the political spectrum.
Don’t take my word for it. John Goodman argues with Paul Krugman regarding this issue. Krugman tells us that thousands will die if PPACA is refuted. Krugman bases his opinion on Mitt Romney wanting to let people die. I don’t think Romney ever said anything like that.
The economic profession also disputes Krugman’s theory. But there is something that does cause people to die: socialism. More precisely, the suppression of free markets (the kinds of interventions Krugman routinely apologizes for) lowers life expectancy and does so substantially.
Economists associated with the Fraser Institute and the Cato Institute have found a way to measure “economic freedom” and they have investigated what difference it makes in141 countries around the world. This work has been in progress for several decades now and the evidence is stark. Economies that rely on private property, free markets and free trade, and avoid high taxes, regulation and inflation, grow more rapidly than those with less economic freedom. Higher growth leads to higher incomes. Among the nations in the top fifth of the economic freedom index in 2011, average income was almost 7 times as great as for those countries in the bottom 20 percent (per capita gross domestic product of $31,501versus $4,545).
What difference does this make for health? Virtually, every study of the subject finds that wealthier is healthier. People with higher incomes live longer. The Fraser/Cato economists arrive at the same conclusion. Comparing the bottom fifth to the top fifth, more economic freedom adds about 20 years to life expectancy and lowers infant mortality to just over one-tenth of its level in the least free countries.
None of these facts really matter because a pre-conceived idea of ‘free health care"’ or universal coverage will negate underlying experiences throughout the world.
Riverside, California
November 11, 2012
A service of Digital Health Space for Providers
The re-election of Barak Obama was a cliff-hanger, and makes the implementation of the PPACA a likely scenario. It is possible there will be necessary amendments to the law. Many medical organizations are intent on this goal, including medical associations, hospital associations, provider organizations as well as many insurance companies.
At the time when this bill was passed into law it was not a bi-partisan agreement, leaving out advice and recommendations from almost half of the country's representatives.
The American Medical Association did a flip-flop at the last minute endorsing PPACA, however it may not have been a true representation of providers.
Digital Health Space curates information from many sources and publishes important opinions and observations from
iHealthBeat
California Health Care Foundation
American Enterprise Institute
Institute for Health Care Improvement
Institute of Medicine
Wall Street Journal (Health)
American Hospital Association
U.S. Dept of Health & Human Services hhs.gov
Centers for Medicare & Medicaid Services cms.gov
T.E.D. And T.E.D.M.E.D.
Association of Medical Colleges
HIMSS RSS feeds
HEALTH RSS feeds/US Government
Inside Health Policy
Health Access
as well as others:
This week's important events:
This week's top news is the re-election of President Obama.
Hospital mass layoffs for 2012 expected to match 2011’s numbers
Last Distraction Removed from California Health Reform
A service of Digitalhealthspace.blogspot.com
Susannah Fox remembers Tom Ferguson, MD who coined the term “participatory medicine”. Dr Ferguson passed away in 2006 but not before “ePatient” became adopted by bloggers and those involved in health care social media. The “e” relates to “engagement” rather than 'electronic'.
Think, for a moment, about the puzzle pieces of your own life. Think about the pieces you know well and the ones whose edges are blurry or indistinct.
Now think about how a clinician might view your life’s puzzle. How can you help them to see how the pieces fit together? Which pieces do you want to keep private and even hide from view, because they are too personal or scary or embarrassing to reveal? What self-knowledge do you wish you had and do you want to share it with anyone other than yourself?
These are the sorts of questions that the Pew Internet Project and California HealthCare Foundation considered as we went into the field with our latest health survey. I’ll give you a sneak preview of the results related to engagement, because I think our field is moving too fast for me to wait for publication.
We found that 60% of American adults track their weight, diet, or exercise routine. One-third of American adults track health indicators or symptoms, like blood pressure, blood sugar, headaches, or sleep patterns. One-third of caregivers – people caring for a loved one, usually an adult family member – say they track a health indicator for their loved one.
Putting that all together, 7 in 10 American adults are self-trackers.
But guess what? Half of them are tracking “in their heads.” These are my people. I’m calling this group the “skinny jeans trackers.”
In addition:
One-third of self-trackers use a notebook or journal.
One-fifth of self-trackers use an app, a device, a spreadsheet, or a website.
Half track on a regular basis
The other half track when something changes, when something comes up and triggers the need to track.
Given the rise of smartphones and online tools, should we expect to see the percentage of self-trackers
go up? Should it be our goal to see 100% participation in self-tracking among people living with chronic conditions? What about among caregivers? And the general public?
Mobile health apps provide a great opportunity for self-trackers. Many will purchase these devices and software with curiosity and the current popular culture of healthcare technology. The big question is whether this will be a permanent integrated habit.
Which brings us to the topic of sharing in general.
Adult Gadget Ownership over Time
I was surprised to learn how many people track data already. Much of it is manual or kept in 'heads'. Will HIT and mHealth automate this project without conscious interaction at some point. Will minute tattooed sensors replace blood pressure cuffs, and glucometers, or pulse oximeters. Surely we are only at the beginning of mHealth.
WATSON, What is the correct answer ? Your patient is in 'JEOPARDY'
Cleveland Clinic is the latest health care organization to work with IBM Corp. to enhance the capabilities of the Watson supercomputer. The clinic is seeking ways that Watson can support medical training.
Watson has accumulated knowledge of the medical field through its work with other health care organizations. Medical students at Cleveland Clinic will work with the supercomputer to further define its “Deep Question Answering” technology for medical purposes.
Medical students will use Watson to try to resolve challenging cases in hypothetical clinical simulations. Students will learn how to navigate content from Watson, consider hypotheses and find evidence to support answers, diagnoses and treatment options. The students also will be grading Watson’s performance to improve its language and domain analysis capabilities. “The collaboration will also focus on leveraging Watson to process an electronic medical record based on a deep semantic understanding of the content within an EMR,” according to IBM.
The expectation is that students will learn how to focus on critical thinking skills and leveraging information tools, while Watson will get smarter at medical language and assembling chains of evidence from available content.
Other organizations working with IBM to commercialize Watson capabilities include:
* Memorial Sloan-Kettering Cancer Center, to develop an oncology decision support system taking advantage of its own molecular and genomic databases, and its repository of cancer cases histories;
* Nuance Communications, Columbia University Medical Center and the University of Maryland School of Medicine, to embed Nuance’s natural language processing technology to enable a computer to read and understand text and abstract data; and
* Insurer WellPoint Inc. and Cedars-Sinai Medical Center in Los Angeles, to use data from patient medical histories, recent test results, recent treatment protocols and new research findings to help physicians identify best treatment choices.
More information on Watson is available here.
Common Sense has been replaced by Conventional Wisdom. A radical thought by Thomas Paine, one of the founders of the country.
[American Revolutionary leader and pamphleteer (born in England) who supported the American colonist's fight for independence and supported the French Revolution ]
Here we are less than one week to elections. After four years of executive leadership by the current administration we see a commander in chief who is able to set forth goals, but one who is unable to implement his plan effectively
With all the negative press regarding Obama's poor performance, why does he remain relatively popular. Even I when I listen to his oratory , become excited by his rhetoric...he is a hypnotic speaker, well versed in public speaking, performing much like a 'method actor' careful cadence, organized presentation, highly articulate, with symbolic hyperbole about America's perseverance. This comes after a history of much of his pre-presidential interest negative opinions of the United States. Michelle Obama summed it up when he was elected. “ This is the first time I am proud of the United States. Is “Obama an Equal Opportunity President” Has this been a fine example of the 'Peter Principle”?
In 2010 the accountable care act was passed, after two years of highly partisan wrangling, at the end of which no Republican legislator could be convinced to vote for the law. That in itself is a marker for voter disapproval with the law.
Whatever success this administration had with the 'war on terror' was left over from the Bush administration. Most of the work on finding Bin Laden had been done by the former . The boots on the ground were largely the same special forces teams and CIA intelligence operation that began the search.
We can look at the accountable care act from a new focused perspective now that some of the changes have gone into effect and some other large ones loom for January 2013 which is less than two months away, and also take place shortly before inauguration.
One thing is virtually certain, if the new president is Mitt Romney he will by executive order bring the process to a screeching halt for further review of implementation in a business like manner. Can the new President do this? Yes and no.
Not exactly, according to two Georgetown University professors writing this week in the online version of the Journal of the American Medical Assn. But there are some things President Romney would be able to do if he won, and more if he were joined in Washington by a Republican-controlled Congress.
Romney’s campaign website promises that the former governor of Massachusetts would make the undoing of the Patient Protection and Affordable Care Act — often referred to as “Obamacare” — a priority:
“On his first day in office, Mitt Romney will issue an executive order that paves the way for the federal government to issue Obamacare waivers to all fifty states.”
But any attempt by Romney to unilaterally repeal the entire law would run afoul of the U.S. Constitution, which requires that the president “take care that the laws be faithfully executed,” according to the authors, both lawyers who teach at Georgetown.
The ACA does allow the president to issue waivers to the states, but only so that they can implement alternatives to the law that are better, not worse, write John D. Kraemer and Lawrence O. Gostin. In any case, those waivers won’t be available to states until 2017.
Another thing Romney could probably do is effectively eliminate one of the most-criticized pieces of Obamacare: the individual mandate. Since the penalty for failing to buy an insurance policy is actually a tax, a Romney administration could direct the Internal Revenue Service not to collect that tax, sending a signal “that individuals would not be penalized for failing to purchase qualifying insurance,” they wrote. (This would be analogous to Obama’s decision to lay off deportations of nonviolent undocumented immigrants.)
Obama's project planners are way off in their implementation mandates. Perhaps business goals can be set and changed as stages progress. However our government's goals are usually set forth as mandates giving little or no chance for periodic adjustments. It dooms itself to guaranteed failure.
Here are some examples:
Grace Marie Turner writes a some significant length on Forbes “Health Matters” which are repeated here.
When Congress wrote 2,700 pages of legislation to create Obama Care, that was only the starting point in the government’s re-engineering of our health sector. Tens of thousands of pages of regulation –- or more -– are needed to provide detailed guidance dictating exactly how its maze of new programs must operate.
But deadlines are looming for Obama Care for programs that are required to begin in 2014. And the administration is significantly behind schedule, with insiders speculating the White House is waiting until after the election to issue an avalanche of rules, many of which are sure to be controversial.
Government re-engineering of the private marketplace is a complex task. So far, more than 13,000 pages of federal Obama Care regulations have been issued, but employers, states, and health companies say they need much more.
One recent rule took 18 pages to define a “full time employee.” That’s needed because a company employing 50 or more full-time workers must provide health insurance or pay a fine. But part-time employees working fewer than 30 hours a week are exempt. How the government defines a full-time employee has huge financial implications for a company. The rule describes the difference between “variable hour employees” and “ongoing employees,” for example, and how to determine what time period to measure with definitions of “standard measurement periods” and “look-back measurements.”
Employers are hiring battalions of lawyers to help them decipher the bureaucratese, and some companies already have announced they plan to cut the hours of many of their workers so they fit within the part-time threshold, arguing even the $2,000 to $3,000 per-employee fines would more than wipe out their profit margins.
States also are in a quandary. HHS claims it is giving states “significant flexibility” in implementing Obama Care, including the controversial health insurance exchanges, but even those supporting the law are increasingly alarmed because they say they simply don’t have enough information to proceed.
The law requires exchanges to be created as a funnel for hundreds of billions of dollars in new health insurance subsidies and also as a vehicle to implement significant new regulations of the health insurance market.
The exchanges are required by law to begin enrolling members on October 1st of next year, and a huge amount of work needs to be done to meet that deadline.
But first, states need information. For example, the law says that if states don’t set up an exchange, the federal government will swoop in and set up its own, and they want to know what a federal exchange would look like before they decide whether to set up their own exchanges.
The Republican Governors Association wrote a letter to President Obama in July saying, “As the exchange issue is currently interpreted, states are essentially being tasked with shouldering all the responsibility without any authority.”
The governors listed 17 critical questions just on the exchanges that they must have answered before they can determine best how to proceed so they can “have full and complete knowledge of all the implications of our decision.” They are still waiting for a reply.
Health plans also are in a dilemma. Health insurers that plan to offer policies through the exchanges need to know what benefits must be covered and at what price so they can design and price their offerings. And they must get state approval for the new plans before they can be offered in the exchanges, a process which can take up to a year -– or more in some states –- to complete. They also need time to contract with providers, develop marketing materials that meet as-yet-to-be-announced government specifications, and figure out how to navigate the complex web of subsidies, risk adjustment, and calculations for cost-sharing – for starters. They have hundreds of other critical questions.
Dan Durham of America’s Health Insurance Plans said in recent testimony before the House Ways and Means Health Subcommittee, “There is an urgent need for more regulatory clarity with respect to exchanges and insurance market reforms,” adding “there is a tremendous amount of work that needs to be done” if the law is to get up and running.
“Unless such guidance is forthcoming, it will be difficult for health plans to complete product development, fulfill network adequacy requirements, obtain necessary state approvals and reviews, and ensure that their operations, materials, training and customer service teams are fully prepared for the initial open enrollment period that begins on Oct. 1, 2013,” Durham said.
Administration officials are mum on when the regulations will be issued. A Health and Human Services official repeated that prediction in an email to reporters in October. “HHS has worked to give states maximum flexibility in implementing the law and consumers in all fifty states will have access to an exchange” by next October, the official said.
There is some speculation that the regs are being held back because of the elections, since the deeper one dives into the details, the more problems and conflicts are created. But Neil Trautwein of the National Retail Federation says it’s also an extraordinarily complex task.
“We know that many of the regs have been delayed,” says Trautwein. “Part of it I’m sure is the political calendar, but a large part of this, and I can say with some confidence because we’ve worked well with the administration on a lot of these questions, is that the subject matter is so infernally complex. They’ve got a lot of tough questions to answer.”
The fate of Obama Care is, of course, predicated on who wins the election on November 6. If Gov. Mitt Romney wins, he has vowed to begin immediately the process of working with Congress to repeal the law. And Congress will surely begin actively blocking any new rules that come out and working to unwind those already on the books.
But even if President Obama were to be reelected, his Rube Goldberg health law may well implode from the nearly impossible task of re-engineering one-sixth of our economy to fit his centrally-controlled archetype.
Organized medicine reports in AMEDNews, the plan devised by them and Medical specialty Societies for input from medical professionals and providers to place really meaningful health reform.
