The First Ebola Patient in the US

Many of you have been wondering just how much we are in danger of Ebola outbreak and just exactly how did we do in handling the first case in the United States. I was very disappointed and alarmed to see Texas Health Presbyterian Hospital, an affluent and well-funded Hospital in Dallas, send the first Ebola patient home with free antibiotics diagnosed with a sinus infection, even though they knew that the patient had come from Liberia. The danger, of course, was that he would infect numerous individuals over the few days he was home rather than hospitalized. For example, Dallas was scrambling to find the homeless man that rode in the ambulance to the hospital with Mr. Duncan upon his return. They found him and he is disease free but there could have been a different outcome. It will be up to the lawyers and perhaps a jury to determine if the delay in diagnosis and treatment resulted in Mr. Duncan's death. Fortunately, we know now that his family was not infected. This is common treatment of uninsured individuals in the United States. The Dallas hospital has received much poor publicity and has had to temporarily close their Emergency Room, which is now reopened but unpopular. Many potential patients are refusing to go their which has resulted in a loss of revenue. If you had a choice, would you go to a hospital that has allowed their staff to become infected with Ebola when you could to somewhere else? The economic loss to the hospital and its parent company, Texas Health, is a good thing for the rest of us, because this will motivate administrators of hospitals all over the country to be certain they are prepared for an Ebola patient walking in their door. The Affordable Care Act fines hospitals that have readmissions due to misdiagnosis or lack of follow-up, and this hospital had been fined in the past. The amount of the fine, evidently, did not act as a deterrent for this hospital. Hopefully, the economic fallout for a misdiagnosis or a transmission to staff will provide the motivation. If not for the failure of the hospital to protect its staff, we would be Ebola free in the US right now. Under CDC guidelines in place at the time of his admission, the department of health would have been notified. Under Dallas County regulations in effect at the time, Mr. Duncan would have been sent home due to the misdiagnosis of a sinus infection and the lack of awareness that the pregnant woman that he assisted in Liberia had Ebola. The CDC is tightening its guidelines and I hope the County of Dallas will do the same.

Obamacare Regulations

Three key sets of regulations needed to implement the Affordable Care Act have been issued. Insurers, consumer groups and the public have 30 days to weigh in with comments on two of the proposed rules {essential benefits and premiums) and will have until Jan. 25 for the third, which outlines how employers can structure wellness programs that offer discounts to workers who participate. The contents of the laws which authorize these regulations are summarized in my October 23, 2012 blog "Contents of Obamacare - Part 2". Here is a good article from Kaiser that summarizes the proposed regs: http://www.kaiserhealthnews.org/Stories/2012/November/20/administration-releases-new-rules-for-health-law.aspx?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+khn+%28All+Kaiser+Health+News%29

Contents of Obamacare - Part 11- Elders

The Elder Justice Act.This law, among other things, establishes forensic centers to determine elder abuse, neglect and exploitation. “Elder” is defined “an individual who is 60 years old or older!”. The law offers grants to the states to promote “adult protective services.” There will be a study on the usefulness of a “nurses aide registry”. (Each year, 5000,000 to 5,000,000 elders are abused, neglgected, or explited. Last year, financial exploitation robbed seniors of $2.9 billion dollars, per a MetLife Mature Market Institute study. 77 million baby boomers are now approaching retirment and old age. In Illinois, Financial exploitation is the most common type of elder abuse in Illinois. Improving Access to Innovative Medical Therapies. The law allows for FDA approval of “biosimilar” biologics, which are analogous to generic drugs, which are less expensive than proprietary drugs. The US Food and Drug Administration (FDA) is charged with implementing an abbreviated pathway to the market for biosimilars. A “biologic” is a “virus, therapeutic serum, toxin, antitoxin, vaccine, blood, blood component or derivative, allergenic product or analogous product, or arsphenamine or derivative of arsphenamine (or any other trivalent organic arsenic compound), applicable to the prevention, treatment, or cure of a disease or condition of human beings.” NEXT: FUNDING FOR OBAMACARE

Contents of Obamacare -Part 10 - Fast Food and Dental Care

Prevention of Chronic Disease and Promotion of Public Health: The law authorizes a “National Prevention, Health Promotion and Public Health Council, headed by the Surgeon General. The committee includes the Secretaries of Health and Human Services, Agriculture and Education, Federal Trade Commission, Transportation, Labor, Homeland Security, environmental Protection Agency, Office of National Drug Control Policy, and others. The purpose of the committee is to promote coordination among the federal agencies for the promotion of health-care related goals. The law also creates an “Advisory Group on Prevention, Health Promotion, and Integrative and Public Health.” The purpose of the committee is to establish policy and program recommendations on life-style based chronic disease and management. School-based health centers. The law provides grants to schools to establish these centers. Oral care. Not much is said about oral disease (dental care) in regards to health reform. The beloved state of Illinois recently cut adult dental care for Medicaid recipients, except for tooth extractions and emergency care. Indiana provides adult dental services under Medicaid under limited circumstances. The federal Affordable Health Care Act (”Obamacare”) doesn’t say much about dental care either. It approves a few grants to study the problem and intends to publish related studies. The New “Wellness” visit under Medicare includes the following: determination of medical history, a list of current health care providers and medications, determination of cognitive impairments, determination of a screening schedule, a list of personal risk factors for disease, and counseling as how to reduce the risk. The law then goes into particular details as to how funding under Medicare for mammograms, and immunizations. Fast-Food Restaurants: There is now a federal definition of a “food restaurant chain”: it is one that is part of a chain “with 20 or more locations doing business under the same name… and offering for sale substantially the same menu items”. These “chains” must now include caloric information on their menus. Federal regulations shall ensue as to standard menu items that come in different flavors, varieties, or combinations, but which are listed as a single menu item, such as soft drinks, ice cream, pizza, doughnuts, or children’s combination meals. The law goes on to strengthens public health surveillance systems through grants, including pain management and research and childhood obesity.

Contents of Obamacare - Part 9 - Women and Obamacare

Women and The Affordable Care Act (“Obamacare”). Erin Weir, the Manager of Health Care Access at “AgeOptions” an Oak Park, Illinois based Not-for-profit, says there are many reasons that women should be excited about Obamacare. Erin says that women visit the doctor more often than men and are usually the primary health care decision-makers in families. Women are less likely to get insurance from their jobs because they are often working part time or serving as family caregivers. They currently pay more for insurance premiums than men, and a greater share of their income is consumed by out-of-pocket health care costs. Women are more likely to lose their health insurance due to changes in marital status. Finally, access to health care is especially difficult for women of color, young women, and women in rural areas. Women’s Protections Against Pre-existing Conditions: Starting 2014, insurance companies can no longer deny coverage due to pre-existing conditions such as pregnancy, C-sections, cancers, domestic violence, or sexual assault. Prior law allowed them to do so. Consumer Protections for Women. Starting in 2014, insurance plans will no longer be able to discriminate against women by charging higher premiums due to gender. Women will also enjoy the immediate benefits of no lifetime limits on coverage and the upcoming benefit of no annual limits starting in 2014. Preventive Services for Women. Effective August 1, 2012, the law requires coverage of the following preventive services without a co-pay or deductible: annual well-women’s visits, gestational diabetes screening for women who are 24-48 weeks pregnant and high risk, HPV DNA testing (women 30 and over), sexually transmitted infection screening and counseling, including HIV, contraception and contraceptive counseling (excluding abortions), breastfeeding support and equipment, and interpersonal and domestic violence screening and counseling. Source: Erin Weir, “The ACA and Women”, Presentation at Chicago Bar Association, October 30, 2012. Agencies and Websites:Obamacare maintains an “Office of Women’s Health” within the federal Department of Health and Human Services, which is led by the “Deputy Assistant Secretary for Women’s Health”. In addition, the law maintains a “National Women’s Health Information Center”. Nancy C. Lee, MD, initially from the Center for Disease Control, is the Director, and the information center is at www.womenshealth.gov. The law also maintains an “Office of Women’s Health” within the Center for Disease Control (CDC). This office’s website is at www.cdc.gov/women.

Contents of Obamacare - Part 8 - The Donught Hole

Improving Medicare for Patients and Providers. New rules allow Physician Assistants to order post-hospital testing, allow funding for complex diagnostic testing such as genetic testing or cancer chemotherapy sensitivity assays, improved access for certified nurse mid-wife services, and extension of “hold harmless” provisions and other protections for small rural hospitals. Improving Payment Accuracy. This section includes adjustments to payment for Home Health Care, more modifications for rural care, hospice care payment modifications, procedures for reevaluation and modification of misvalued codes under the physician fee schedule, adjustments to payments for “power-driven wheel chairs”, payment rates for ambulatory cancer centers, and payment for biosimilar products (generic versions of biologicals). Medicare Advantage Payment (Part C): Covering someone on a Medicare Advantage plan used to cost 14% more than covering someone on the original Medicare. These payments are being reduced under the law which accounts for the savings in Medicare that are often referred to as “cuts” by Mitt Romney and his advocates. These savings to the government are actually being put back into the Medicare program. Medicare Part D (Prescription Drugs): The law phases out the “donut hole” by 2020. The “donut hole” was a coverage level in the original plan (signed into law by President George W. Bush) where seniors had to pay 100% of their costs for pharmaceuticals until their annual costs became so severe that they qualified for “catastrophic coverage”. Pharmaceutical manufacturers will now be paying 50% of the costs for brand name drugs purchased while the beneficiary is “in the donut hole”, and generic drugs will be offered with a 14% discount. Obamacare offers better prescription drug coverage for people with low incomes. Health Care System Delivery Research: The law directs the “Center for Quality Improvement and Patient Safety”, which is part of the” Agency for Healthcare Research and Quality”, to conduct studies and determine workable best practices for health care that can be promoted across the board to all providers. The center may identify certain health care programs that are particularly astute and successful in their delivery of services and develop methods for dissemination of such techniques nationwide. Grants are offered to conduct pilot projects for various health care delivery systems to determine the effectiveness and feasibility. The law promotes the availability of trauma care centers for all local areas. The law promotes grants to develop “patient decision aids” where patients, based upon their value system, provide input into the proper path for their own care; this includes the summaries of the risks and benefits of prescription drugs in a standardized format. NEXT: WOMEN AND OBAMACARE!

Contents of Obamacare - Part 7 - Linking Payment to Quality Outcomes

Improvements to Medicaid System: These include coverage for freestanding birth centers, more home health care, increased rebates for pharmaceuticals, coverage of drugs for smoking cessation, refusal to pay hospitals for treatment of hospital-acquired infections. Special Rules for Native Americans: Native Americans and Alaskans have no cost-sharing if they enrolled in a qualified state exchange and their income is less than 300% of the Federal poverty level. Maternal and Child Health Services: The states are to provide reports and the Federal government is to offer grants to enhance home visitation treatments for disadvantaged communities with higher than average levels of premature birth, child abuse, and other social problems. Postpartem Conditions: The act provides funding for the study and treatment of postpartum depression and psychosis. Personal Responsibility Education Programs: The act provides grants for innovative programs to promote individual responsibility in regards to sexual abstinence and birth control for the prevention of sexually transmitted diseases. Improving the Quality and Efficiency of Health Care: The preceding statement is the name of Title III of the Act. Subtitle A is called “Transforming the Health Care Delivery System” Linking Payment to Quality Outcomes Under the Medicare Program: This program pertains to five medical events: heart attacks, heart failure, pneumonia, surgical infections and hospital-acquired infections. Hospitals shall be given pay incentives for Medicare patients if they successfully treat and discharge the subject without a readmission. Likewise, payment to physicians will be based upon quality outcomes moreso that the number and cost of procedures that the MD performs. Hospitals shall be penalized in their payment amounts if their patients suffer from hospital-acquired infections. Intragency Working Group in Health Care Quality: The group contains senior executives from the Department of Health and Human Services , the Center for Medicare and Medicaid Services, the National Institutes of Health, the Center for Disease Control, Food and Drug Administration, Health Resources and Services Administration, Agency for Healthcare Research and Quality, Office of the Nation Coordinator for Health Information Technology, Substance Abuse and Mental Health Services Administration, Administration for Children and Families, Department of Commerce, Office of Management and Budget, Bureau of Federal Prisons, United States Coast Guard, National Highway Traffic Safety Administration, Federal Trade Commission, Social Security Administration, Department of Labor, United States Office of Personnel Management, Department of Defense, Department of Education, Department of Veterans Affairs, Veterans Health Administration, and “any other appropriate federal agency”. This “Justice League” of representatives from Federal agencies is supposed to coordinate activities to avoid duplication and maximize results for national health care priorities.