Posted by Warm Southern Breeze on Saturday, March 11, 2017
The Patient Protection and Affordable Care Act (PPACA, aka ACA, or more often as “ObamaCare”) might be analogized to an onion, insofar as:
1.) It has many layers, and;
2.) Peeling back the layers may cause tears.
Enacted in 2010, it has been decried primarily by Republicans, none of whom voted for the bill’s passage, either in the House, which approved it 219-212 with 34 Democrats voting “NO” – or in the Senate, which approved it 60-39 along party lines, with 1 Republican (Jim Bunning, KY) “Not Voting.”
The Patient Protection and Affordable Care Act contains nine titles, each addressing an essential component of reform:
1.) Quality, Affordable Health Care For All Americans
2.) The Role Of Public Programs
3.) Improving The Quality And Efficiency Of Health Care
4.) Prevention Of Chronic Disease And Improving Public Health
5.) Health Care Workforce
6.) Transparency And Program Integrity
7.) Improving Access To Innovative Medical Therapies
8.) Community Living Assistance Services And Supports
9.) Revenue Provisions
Immediate improvements through reform included:
• Eliminate lifetime and unreasonable annual limits on benefits
• Prohibit rescissions of health insurance policies
• Provide assistance for those who are uninsured because of a pre-existing condition
• Require coverage of preventive services and immunizations
• Extend dependent coverage up to age 26
• Develop uniform coverage documents so consumers can make apples to apples comparisons when shopping for health insurance
• Cap insurance company non-medical, administrative expenditures
• Ensure consumers have access to an effective appeals process and provide consumers a place to turn for assistance navigating the appeals process and accessing their coverage
• Create a temporary re-insurance program to support coverage for early retirees
• Establish an Internet portal to assist Americans in identifying coverage options
• Facilitate administrative simplification to lower health system costs
While no law is perfect – and the ACA is not perfect – there are provisions within it which many think worthy of keeping, notable among them, provisions for guaranteed coverage, prohibiting cancellation, extending dependent’s coverage, removing annual & lifetime limits, Read the rest of this entry »
Posted in - Do you feel like we do, Dr. Who?, - My Hometown is the sweetest place I know, - Politics... that "dirty" little "game" that first begins in the home. | Tagged: ACA, Adiministrative Code, Affordable Care Act, AL, Alabama, Centers for Medicare and Medicaid Services, Children's Health Insurance Program, CHIP, CMS, Code of Alabama, Congress, GOP, health, health insurance, healthcare, House, insurance, law, Medicaid, Medicare, Obama, Obamacare, Patient Protection and Affordable Care Act, politicians, politics, PPACA, public health, reform, Republicans, senate, sunshine laws | Leave a Comment »
Posted by Warm Southern Breeze on Thursday, August 6, 2015
UPDATE: Tuesday, 11 August 2015
In my first & earlier calculations, I inadvertently overlooked multiplying the Annual Medicaid Spending in Alabama figure (which is a TOTAL of $5,241,269,869) by 70%, which would represent the portion paid for by the Federal government. Alabama’s 30% share of that figure (the share paid for by the state) would be $1,572,380,960.70. It would also be reasonable to expect that Expanding Medicaid in Alabama to 138% of the Federal Poverty Level would increase total economic activity (through Medicaid spending) in the state at least 38%. So to Expand Medicaid, the baseline figure for TOTAL Medicaid spending (combined Federal and State funds) would approximate $7,232,952,419. According to the provisions of the law, Alabama’s sharing portion (if Governor Bentley chose to Expand Medicaid) would still be 2016-100%; 2017-5%; 2018-6%; 2019-7%; 2020 and beyond-10%. The corrections to the figures herein are dollar amounts only (based on the $7,232,952,419 total expanded figure), not the %ages. Data & figures are now also shown in table format.
Folks, it may (or may not) surprise you to know a sampling of the collective thoughts of our wrong-wing friends, and relatives on matters political in Alabama, especially as they pertain to Medicaid.
Here’s a verbatim excerpted sampling of what I came across today.
• No one want increased entitlements. Too much waste and abuse. get a job folks. no to medicaid
• Medicaid is a lifestyle
• scare tactic. nursing homes overcharge. working people of Alabama are tired of taking care of lazy people
• ask any hospital administrator or physician in private practice. Medicaid devalues services. Reject medicaid
I dare say, MOST are clueless about the genuinely tangible economic and public health benefits Medicaid provides to this state, and the revenue and jobs it creates. All they hear are the wails and moans of representatives and/or senators – mostly of whom, if not exclusively, are Republican.
Where does Alabama’s Medicaid money come from?
Where does it go?
Source: Alabama Medicaid Agency Annual Report – FY 2012
Medicaid is a Federal/State matching/sharing program which provides (pays for) healthcare services for the impoverished wherein states pay a minority matching portion, while the Federal Government through CMS (Centers for Medicare and Medicaid Services) pays the majority portion. Within reasonable guidelines, the states have broad discretion and liberty to operate Medicaid according to the way they see fit, and the needs of the residents they serve. There are, however, certain minimums standards to which every state must adhere.
Under the provisions of the OLD law, the states that do NOT Expand Medicaid pay a higher %age rate for their services than they would if they were to Expand Medicaid to provide services to those whom are at 138% of the Federal Poverty guidelines – which is what the PPACA provides. The PPACA is the Patient Protection and Affordable Care Act- though it’s more often called the ACA “Affordable Care Act,” and colloquially referred to as “ObamaCare.”
Under the provisions of the PPACA, states that choose to Expand Medicaid will have 100% of those costs paid-for by the CMS beginning 2014, until 2016. The incentive for expansion is based upon Read the rest of this entry »
Posted in - Did they REALLY say that?, - My Hometown is the sweetest place I know, - Politics... that "dirty" little "game" that first begins in the home. | Tagged: Alabama, Centers for Medicare and Medicaid Services, children, Children's Health Insurance Program, CHIP, CMS, Expand Medicaid, GOP, government, governor, Governor Bentley, healthcare, kids, legislature, Medicaid, money, politics, poverty, Republican, Robert Bentley, taxes | 2 Comments »
Posted by Warm Southern Breeze on Friday, December 20, 2013
Did you know? (No, you probably didn’t.)
In a report dated August 2013, the Department of Health and Human Services Office of Inspector General (HHS OIG) conducted a criminal and administrative investigation and found that Alabama claimed, and was paid millions in unallowable performance bonus payments under the Children’s Health Insurance Program Reauthorization Act (CHIRPA).
This FRAUD was because of INCOMPETENCY in Alabama governance.
The HHS OIG found that the Alabama state agency overstated its FYs 2009 and 2010 current enrollment in its requests for bonus payments. The State agency overstated its current enrollments because, rather than Read the rest of this entry »
Posted in - Business... None of yours, - My Hometown is the sweetest place I know, - Read 'em and weep: The Daily News | Tagged: abuse, ACA, Alabama, Alabama Legislature, Associated Press, Barack Obama, Bentley, budget, Centers for Medicare and Medicaid Services, children, CHIP, CHIRPA, CMS, Crimson Tide, defraud, federal, Federal government of the United States, fraud, GOP, government, governor, health, HHS, incompetence, incompetency, insurance, Medicaid, Mississippi, money, Montgomery Alabama, news, Obamacare, OIG, Patient Protection and Affordable Care Act, politics, PPACA, quiet, Republican, Robert Bentley, Robert J. Bentley, State Children's Health Insurance Program, United States, waste | 2 Comments »
Posted by Warm Southern Breeze on Friday, February 22, 2013
Realistically, what does that mean for you, your loved ones or friends if – God forbid – they’re hospitalized at Huntsville Hospital?
It means that when you, your loved ones’ or friends’ are a patient in the hospital, you or they could get an infection, or some other serious bug or problem while being treated for something else entirely different. And by so doing, it could make your stay more unpleasant, and in fact, could increase the risk of complications of your treatment – up to, and including your death – was well as increase the length of your stay, among other factors.
What does that mean for the Hospital?
Because insurance companies and Medicare/Medicaid have STOPPED paying for the treatment of preventable problems that are a direct result of hospitalization, it means that Huntsville Hospital will be stuck with the bill (the costs of treating their own mistakes upon you while you’re there)… and will try to pass the cost along to you to recoup the cost of the loss, which is a DIRECT result of their own sloppiness.
Huntsville Hospital has essentially become a monopolistic monstrosity of an enterprise, gobbling up numerous hospitals in the North Alabama region, including BOTH hospitals in Decatur, the only hospital in Athens, the only hospital in Red Bay, Helen Keller Hospital in Tuscumbia area of the Shoals, and the only hospital in Lawrence county.
Meanwhile, Huntsville hospital has fought tooth-and-nail to keep other hospitals OUT of competition in the Huntsville market, and spent untold millions of dollars in a protracted legal battle against Crestwood Hospital – and continues to spend millions to prevent Crestwood Hospital from offering services that would benefit the entire city and county.
Such anti-competitive practice has all been accomplished by and through the state of Alabama‘s Certificate Of Need Board.
The commentary of Mr. Burr Ingram – Huntsville Hospital’s official mouthpiece – which is contained in this article is entirely and wholly unwarranted, and weasel-like.
Not only that, but Huntsville Hospital is NOT a Nursing Magnet Hospital.
There are many things Huntsville Hospital is not.
And sadly, quality is one of them.
Watchdog Report: Consumer Reports gives both hospitals in Huntsville low safety ratings
Published: Thursday, July 12, 2012, 9:06 AM Updated: Thursday, July 12, 2012, 9:30 AM
HUNTSVILLE, Alabama — Consumer Reports magazine ranked the two hospitals in Huntsville as the least safe in Alabama. But the magazine’s list of hospitals is far from complete.
“We were kind of perplexed at some of what it reported,” said Burr Ingram, spokesman at Huntsville Hospital. “When you think about it, it’s fashionable for everyone to rate hospitals. And Consumer Reports is the latest to use public data that is available.
“But at times, it’s difficult to know how these ratings come about.”
Huntsville Hospital, The Huntsville Times
The magazine’s August edition lists scores in four safety categories. Both Huntsville Hospital and Crestwood Medical Center received low marks for poor communication with patients and for high rates of infection. Both received mediocre marks for high rates of re-admission and unnecessary scans.
Yet the report ranked Read the rest of this entry »
Posted in - My Hometown is the sweetest place I know, - Politics... that "dirty" little "game" that first begins in the home., - Read 'em and weep: The Daily News | Tagged: AL, Alabama, battle, Burr Ingram, CEO, Certificate of Need, CMS, CON, Consumer Reports, court, Crestwood, Crestwood Medical Center, David Spillers, disease, doctor, fight, greed, health, Health Reimbursement Account, healthcare, hospital, Huntsville, Huntsville Hospital, Huntsville Hospital System, Huntsville Times, infection, insurance, law, legal, liars, MD, Medicaid, Medicare, money, monopoly, news, Nurse, patient, physician, publicity, reimbursement, RN, sick, sickness, sicko, spokesman, state, United States, wellness | Leave a Comment »
Posted by Warm Southern Breeze on Monday, April 16, 2012
What would it be like if you were paid for your success?
What would it be like if you were rewarded for high efficiency?
Is it possible that successful patient outcomes could be correlated to compensation?
How would one measure non-compliant patients, or those with poor prognoses?
Medicare moves to tie doctors’ pay to quality and cost of care
By Jordan Rau, email@example.com Published: April 14
CMS plans to base the 2015 bonuses or penalties on what happens to a doctor's patients during 2013.
Twenty-thousand physicians in four Midwest states received a glimpse into their financial future last month. Landing in their e-mail inboxes were links to reports from Medicare showing the amount their patients cost on average as well as the quality of the care they provided. The reports also showed how Medicare spending on each doctor’s patients compared with their peers in Kansas, Iowa, Missouri and Nebraska.
The “resource use” reports, which Medicare plans to eventually provide to doctors nationwide, are one of the most visible phases of the government’s effort to figure out how to enact a complex, delicate and little-noticed provision of the 2010 health-care law: paying more to doctors who provide quality care at lower cost to Medicare, and reducing payments to physicians who run up Medicare’s costs without better results.
Making providers routinely pay attention to cost and quality is widely viewed as crucial if the country is going to rein in its health-care spending, which amounts to more than $2.5 trillion a year. It’s also key to keeping Medicare solvent. Efforts have begun to change the way Medicare pays hospitals, doctors and other providers who agree to work together in new alliances known as “accountable care organizations.” This fall, the federal health program for 47 million seniors and disabled people also is adjusting hospital payments based on quality of care, and it plans to take cost into account as early as next year.
But applying these same precepts to doctors is Read the rest of this entry »
Posted in - Did they REALLY say that?, - Read 'em and weep: The Daily News | Tagged: Accountable care organization, Centers for Medicare and Medicaid Services, CMS, Donald Berwick, health, health care, healthcare, Jonathan Blum, Kaiser Permanente, Medicaid Services, Medical Group Management Association, Medicare, medicine, National Committee for Quality Assurance, Nurse, patient, physician, Washington | Leave a Comment »