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Title: Jeanne Scott


1
Changing Views of U.S. Health Care
How U.S. Citizens View Health Care
2
How Health Care Providers View Health Care
3
How Employers View Health Care
4
How Health Insurers View Health Care
5
How Our Pocketbooks View Health Care
6
How the Future Sees Health Care
7
The Perfect Storm American Health Care Needs a
Functioning FEMA You, Them, George Bush,
Bill Frist, Chuck Grassley, Nancy Pelosi, and the
Rest of Congress
Jeanne Scott talking head-in-chief health-politics
.com
8
The Perfect Storm
  • A perfect storm is a situation where, by the
    confluence of specific events, what might have
    been a minor issue ends up being magnified to
    proportions that are out of control. In such a
    situation, it is clear that if one element was
    removed from the mix, the whole matter would have
    collapsed, but because just the right things were
    in the mix, the situation balloons

http//en.wikipedia.org/wiki/Perfect_storm
9
The Confluence of Events
  • Healthcare Costs Rising at Annual Double Digit
    Rates Year After Year
  • The Number of Uninsured Americans Rises Almost
    Every Year, Despite Generally Low Unemployment,
    Reaching 46.8 Million in 2006
  • Employers Increasingly Passing Costs of Health
    Insurance onto Employees Through Higher
    Deductibles and Co-Pays
  • Employers Increasingly Begin to Drop Retirees and
    Others From Their Health Plans
  • Hospital Emergency Rooms with 12 Hour Waits
  • 1965-2006 Drug Costs Go From Less than 4 of
    Total Healthcare Cost to Almost 14
  • November 2006 Congressional Mid-Term Elections

10
And the Perfecting Factor
The Sorry State of US Health Care
  • The List of Horrors
  • Medicare Part A Bankruptcy by 2012
  • The Collapse of the US Employment-Based Health
    Insurance System, Making Employees Pay a Higher
    and Higher Proportion of the Costs
  • Medicaid Bankrupting the States
  • And the list goes on and on .

11
What Does President Bush Plan to Do About
Health Care?
12
Health Insurance Impact on US Jobs
  • 1975 General Motors was the largest single
    non-government employer in the USA 2.2 million
    employees, and everyone of them had full
    womb-to-tomb health care paid 100 by GM
  • 1985 ATT was the largest employer, 1.8 million
    employees, all with 100 employer-paid coverage
  • 2005 Wal-Mart is the nations largest employer,
    with 1.6 million US employees less than 500,000
    have health care and it costs them from
    120-190/month for a high deductible limited
    coverage plan
  • 2005 GM, Ford, Chrysler, Sears, J.C. Penney,
    Boeing Aerospace, the airlines, the steel
    industry, mineral companies, the energy industry
    all these and more are ending retirement coverage
    and making employees pay more

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Outsourcing of Health Care ????
  • Outsourcing is no longer limited to blue collar
    industrial and back-office white collar jobs
  • Software development and programming
  • Accounting and legal services
  • Health care claims processing (Northern Ireland,
    the Philippines)
  • And the latest new developments
  • Medical transcription
  • Radiology and other telemedicine services
  • Sending patients to India and other Asian
    locations for surgeries and specialty services,
    (already an option under the British NHP)
  • Blue Shield of California, HealthNet offering
    Mexican HMOs

15
Health care insurance, once an employment
benefit taken virtually for granted, has become
a bed-rock issue in todays American industrial
labor-management environment. As the employee
share of the cost has increased, people are
starting to become more aware of the actual cost
of health care and increasingly are seeing
the cost of health care insurance as a critical
political issue one upon which they will make
a voting decision.
A new study from the University of Michigan just
announced indicates that 27 of employers
surveyed would like to eliminate health care
coverage for their employees entirely. 85 said
that the employee share will have to go up by 50
or more.
16
  • Rising medical costs are taking a toll
  • on the auto industrys bottom line and
    ultimately are threatening American
    manufacturers' ability to compete in the global
    marketplace. Congress needs to apply some serious
    medicine to address the nation's severe health
    care problems.
  • -- General Motors chairman and CEO G. Richard
    Wagoner Jr.

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Cost Comparison - India vs United States of
America (USA) Significant cost differences exist
between USA and India when it comes to medical
treatment. India is not only cheaper but the
waiting time is almost nil. This is due to the
outburst of the private sector which comprises of
hospitals and clinics with the latest technology
and best practitioners.
Medical tourism in India may be worth US 23
billion by 2012PTIFebruary 02, 2005
                                                  
                                  With an
increasing number of foreign patients flocking to
India for treatment, the country could earn Rs
1000 billion (US 23 billion) through 'Medical
Tourism' by 2012, a study has indicated.
According to the study conducted by the
Confederation of Indian Industry and McKinsey
consultants, last year some 150,000 foreigners
visited India for treatment, with the number
rising by 15 per cent a year.

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  • "I fear that we may have already committed more
    physical resources to the baby-boom generation in
    its retirement years than our economy has the
    capacity to deliver."

"Congress in the future will have to weigh the
benefits of continued access, on current terms,
to advances in medical technology against other
fiscal initiatives."
Alan Greenspan November 25, 2005
21
The Ownership Society
  • Addressing the Nations Health Woes Maybe
  • Maybe Not

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Budget Deficits Projected 2005 572
Billion 2006 545 Billion 2007 495
Billion 2008 425 Billion 2009 650
Billion 2010 825 Billion 2011 1.1
Trillion 2012 1.4 Trillion
Whoever gets elected President in 2008 will
take the blame
24
The Bush Plan For Health Care
  • Saving Medicare -- President Bush has
    stated his support for raising age
    to70 and 72, privatizing Medicare
  • Ages 51gt, Ages 36-50, Age 35lt
  • (President Bush, April 20, 2005)
  • Coverage for Prescription Drugs for Americas
    Seniors
  • Controlling the Future Cost of the MMA, Now
    Predicted to Exceed 1.2 Trillion by 2011
  • Seniors Feel the MMA Falls Short of the Need. Can
    We Afford More? How?

theJeanneScottletter
25
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President Bush Puts His Eggs in the Health
Savings Account Basket
Expand Health/Medical Savings Accounts Allow
Individuals and Families to Set Aside as Much as
5,150 a Year, Tax Free Bushs FY2007 Budget
would increase the allowable amount to 10,300
27
CDHC Will Only Work If
  • Meaningful information is made available to the
    consumer your buzzword for the year
    TRANSPARENCY for both prices and quality
  • (b) The American population comes to accept it
    but were dumber than bricks

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TRANSPARENCY
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ACCEPTANCE
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Senior Sticker Shock
955.00 (plus) 37.00 992.00 (minus)
12.67 978.33 (minus) 32.00 946.33
  • 2005 Median Monthly Social Security Payment
  • Add the 2006 Estimated Social Security Increase
    Using Current Cost-of-Living COL (4.1) Formula
  • Subtract 2006 Monthly Medicare Part B Premium
    Increase (18) (from 78.20 to 90.67)
  • Subtract 2006 Estimated Monthly Part D Rx
    Premium

47
Oops, Now youve done it, youve made them angry
.
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49
  • Gosh Darn All Those Pesky Uninsured People
  • 46.8 Million officially Uninsured in 2005
  • 12.5M of which are children
  • 60 Million Effectively Uninsured
  • 29 Industrialized Nations,
    28 With NHI
  • EMTALA-Driven Uncompensated Care/Emergency Room
    Crisis
  • 37th Ranking in World
  • 15.9 GDP (going to 20 by) 2010
  • Movement Away From
    Employment-Based Coverage
  • Grass Roots Movements Oregon, Maine,
    Vermont, California, Maryland, Massachusetts,
    Wisconsin, Texas

theJeanneScottletter
50
Americas National Health Plan at Work
51
IOM Emergency Emergency Room Report
  • Some IOM Findings
  • From 1993 to 2003, the U.S. population grew by 12
    percent but emergency room visits grew by 27
    percent, from 90 million to 114 million. In that
    same period, however, 425 emergency departments
    closed, along with about 700 hospitals and nearly
    200,000 beds.
  • Hospitals, especially in rural areas, often
    cannot find specialists such as orthopedic
    surgeons and neurosurgeons willing to cover the
    ER.
  • In 2003, 501,000 ambulances were diverted from
    the hospital where they normally would have
    delivered a patient because the ER was full. In
    2004, 70 percent of urban hospitals reported that
    their emergency departments had been "on
    diversion" at least once.
  • ERs are notorious money losers. About 14 percent
    of ER patients are uninsured. About 16 percent
    are covered by Medicaid, and 21 percent by
    Medicare. More than half of hospitals report
    losing money on emergency care of both groups of
    government-insured patients

52
Add HIPAA to the Mix
  • The 3-Ton Hippopotamus that is HIPAA,
  • E-Prescriptions Phase 2 of HIPAA
  • Medical Errors and Phase 3 of HIPAA
  • Rationing Phase 4 of HIPAA
  • Medical Information Privacy and Security

53
The Future of Privacy
  • FDA Approves Implantable Chip for Medical Records
    By Diedtra HendersonAP Science
    WriterWednesday, October 13, 2004 205 PM
  • WASHINGTON (AP) -- The Food and Drug
    Administration on Wednesday approved an
    implantable computer chip that can pass a
    patient's medical details to doctors, speeding
    care. VeriChips, radio frequency microchips the
    size of a grain of rice, have already been used
    to identify wayward pets and livestock. And
    nearly 200 people working in Mexico's attorney
    general's office have been implanted with chips
    to access secure areas containing sensitive
    documents.

    Delray Beach, Fla.-based Applied Digital
    Solutions said it would give away 650 scanners
    to roughly 200 trauma centers around the nation
    to help speed its entry into the health care
    market. A company spokesman would not say how
    much implanting chips would cost for humans, even
    though chips have been implanted in some,
    including Scott R. Silverman, the company's chief
    executive officer.


    The company is targeting patients with
    diabetes, chronic cardiac conditions, Alzheimer's
    disease and those who undergo complex treatments
    like chemotherapy, said Dr. Richard Seelig,
    Applied Digital Solutions' vice president of
    medical applications.



    It's the first time the FDA has approved medical
    use of the device, though in Mexico, more than
    1,000 scannable chips have been implanted in
    patients. The chip's serial number pulls up the
    patients' blood type and other medical
    information.

    With the pinch of a
    syringe, the microchip is inserted under the skin
    in a procedure that takes less than 20 minutes
    and leaves no stitches. Silently and invisibly,
    the dormant chip stores a code -- similar to the
    identifying UPC code on products sold in retail
    stores -- that releases patient-specific
    information when a scanner passes over the
    chip.At the doctor's office those codes stamped
    onto chips, once scanned, would reveal such
    information as a patient's allergies and prior
    treatments.
    The FDA in October 2002 said
    that the agency would regulate health care
    applications possible through VeriChip.
    Meanwhile, the chip has been used for a number of
    security-related tasks as well as for pure
    whimsy Club hoppers in Barcelona, Spain, now use
    the microchip much like a smartcard to speed
    drink orders and payment.

54
Non-biased health insurance experts predict that
FFS Medicare will be overwhelmed with the older
and sicker patients, raising costs and
eventually pricing itself out of the market
theJeanneScottletter
55
National Integrated Electronic Health Care Data
Network
Consumers
Employers
Comprehensive Quality Measurement Data
States, Public Health Departments
Secretary of Health Human Services
DoD
Physicians
Compliance, Certification, Oversight
Clinics
Federal Health Care Programs
Hospitals
Home Health Agencies
Purchasing Cooperatives
Long Term Care Facilities
Health Plans
Rural Health Care
Center for Disease Control
56
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Bush Administrations Health IT Vision
  • Medical information will follow consumers so that
    they are at the center of their own care
  • Consumers will be able to choose physicians and
    hospitals based on clinical performance results
    made available to them
  • Clinicians will have a patient's complete medical
    history, computerized ordering systems, and
    electronic reminders
  • Quality initiatives will measure performance and
    drive quality-based competition in the industry
  • Public health and bioterrorism surveillance will
    be seamlessly integrated into care
  • Clinical research will be accelerated and
    post-marketing surveillance will be expanded

58
42 CFR Part 423 Medicare Program
E-Prescribing And the Prescription Drug
Program Final Rule
59
DHHS E-Prescribing Initiatives
  • New e-prescribing and electronic health records
    system rules from the Centers for Medicare
    Medicaid Services (CM2) and the DHHS Office of
    Inspector General (OIG), were proposed last fall.
  • CM2s rules would create exceptions to the
    physician self-referral (or Stark) law.
    Currently, physicians in Medicare are prohibited
    from referring Medicare patients for certain
    health services to health care entities with
    which the physician has a financial relationship,
    unless an exception applies. Health care entities
    are also not allowed to bill Medicare for
    services that are furnished as a result of a
    prohibited referral.
  • These new proposals would allow hospitals and
    certain health care organizations to furnish
    hardware, software, and related training services
    to physicians for e-prescribing and electronic
    health records, particularly when the support
    involves systems that are interoperable and
    thus can exchange information effectively and
    securely among health care providers.
  • In a parallel action, the OIG announced proposed
    safe harbors for arrangements involving the
    donation of technology for e-prescribing and
    electronic health records. Arrangements for the
    provision of items and services that meet the
    requirements of the safe harbors would be exempt
    from enforcement action under the Federal
    anti-kickback statute.

60
More About the DHHS E-Prescribing Rules
  • (1) The proposal would establish the conditions
    under which hospitals and certain other entities
    can give physicians hardware, software, or
    information technology, and training services for
    e-prescribing.
  • (2) The proposal would establish the conditions
    under which such entities may donate to
    physicians electronic health records software and
    related training services. This proposal would be
    relatively narrow until nationwide product
    certification criteria are established and
    approved by the Secretary. At that point,
    hospitals and certain other entities could donate
    a broader array of technology to physicians if
    the technology met the product certification
    criteria. CM2 is considering imposing a cap on
    the value of the technology that may be donated
    by a single donor. The cap would reduce the
    potential for abusive arrangements designed to
    pay physicians for referrals.
  • CM2 has also issue a rule containing the
    foundation standards for e-prescribing that all
    Medicare prescription drug plans must support.

61
"Health IT is a critically important health care
issue that both sides can and should agree on.
It's our belief that this legislation must be
crafted in a bipartisan manner to ensure
broad-based support."
-- House Democratic Minority Whip Steny Hoyer
  • "Information technology has the potential to
    improve the quality of care, strengthen the
    confidentiality of health information, and reduce
    errors and inefficiencies in the health system.
    It will help strip out untold millions of dollars
    in wasteful spending to control health care costs
    for our families."

-- House Ways and Means Health Subcommittee
Chair, Nancy Johnson (R-Conn.)
62
Health Technology to Enhance Quality Act of 2005
  • Health-TEQ
  • Frist-Clinton

63
Health-TEQ Frist-Clinton
  • Establishes (and most importantly funds) a formal
    Office of National Health Information
    Technology
  • Sets Goals for the Office, including quality
    improvement reduced errors promoting
    patient-centered medical care reduced costs and
    paperwork collecting accurate information on
    healthcare costs, quality, and outcomes
    coordinating care among hospitals, laboratories,
    physician offices, and other entities improve
    public health reporting (bio-terror attacks)
    facilitate new health research and ensure
    privacy protection and security
  • Office Director is to facilitate the adoption of
    a national system for the electronic exchange of
    health information
  • The bill would provide 500 million starting in
    fiscal year 2006 in annual 125 million
    increments in three-year 2-1 matching grants to
    help fund the development of regional or local
    health information technology plans, or RHITs, as
    well as such sums as necessary to fund the grant
    programs from FY 2007 through FY 2010. The funds
    also could be used to fund 10-year loans to
    develop RHITs.
  • The bill would require DHHS to certify that the
    networks complied with privacy, interoperability
    and other standards. RHITs would allow hospitals,
    doctors and nurses to quickly transfer patient
    information between facilities.
  • In addition, the legislation would provide 2.5
    million annually from FY 2007 through FY 2010 to
    the Agency for Healthcare Research and Quality to
    help doctors' offices make sound IT investments.
  • Under the bill, Medicare payment "adjustments"
    would be available to physicians and suppliers
    who participate in the networks, but an amount is
    not specified.
  • Establishes a Stark safe harbor for hospitals
    to provide physicians with IT systems

Remember, CSI says this will cost 285 BILLION
over ten years, where is this money going to
come from?
64
Reconciling House and Senate
  • The House Energy and Commerce and Ways and Means
    committees last Thursday each approved separate
    versions of a bill (HR 4157) that would promote
    the use of health care information technology.
    The bill passed the Energy and Commerce Committee
    by a vote of 28-14, while the Ways and Means
    Committee approved its version 23-17.
  • The legislation would codify the Office of the
    National Coordinator for Health Information
    Technology within DHHS and would establish a
    committee to make recommendations on national
    standards for medical data storage and develop a
    permanent structure to govern national
    interoperability standards.
  • The Senate passed health IT legislation
    (Frist-Clinton) in 2005.
  • Many Democratic lawmakers contend that funding
    sources are needed to help providers adopt the
    technology. Neither of the House committees'
    versions includes grant provisions for providers,
    while the Senate's version does.
  • In addition, the House Ways and Means version
    includes a provision that would increase the
    number of procedure and billing codes from 24,000
    to more than 200,000 by 2009. The Energy and
    Commerce version does not include the provision.
  • Opponents maintain that the deadline is too soon
    to adapt to a new system.
  • The two House versions will have to be reconciled
    before the legislation is considered by the full
    chamber, possibly as early as next week.

65
But Some Democrats Object
  • Essentially the Democratic objections boiled down
    to accusations that Republicans were not going
    far enough with this bill
  • Democrats said the bill was essentially toothless
    since it did not authorize funding and does not
    set a deadline for adoption of new technology
    standards
  • Some Democrats also blasted the bill for not
    including enough privacy safeguards such as
    patient consent for information sharing and
    requirements that patients be notified if their
    data security is breached

66
Changing Billing Codes ?
  • Also the House Ways and Means passed bill would
    increase the number of diagnosis and procedure
    billing codes that providers and insurers use
    from the current 24,000 codes to more than
    200,000. But insurers say the October 2009
    deadline for a transition to the new codes is too
    early to get adequate training. They would rather
    see such a move happen by 2012.

67
MMA Moving HIPAA to New Levels
  • Electronic Prescriptions
  • Systemic Interoperability
  • Electronic Health Record
  • Allocation of Resources

68
MMA Electronic Prescriptions
(HIPAA, Phase 2)
  • Electronic standards must be developed by
    September 1, 2005 and no later than September 1,
    2006 ---
  • Physicians, hospitals and pharmacies choosing to
    transmit electronically would be required to
    comply with the standards as of January 1, 2008
  • Warning Other changes, and requirements in the
    pending malpractice and already passed medical
    error legislation virtually mandate e-prescribing

theJeanneScottletter
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Systemic Interoperability (HIPAA,
Phase 3)
  • Establishes a Commission on Systemic
    Interoperability (CSI) (CBS may sue over the
    acronym)
  • CSI is to establish strategy to implement health
    information technology standards, including
    priorities and timeline for adoption nationally
  • Reported to Secretary and to Congress in October
    2005 its plan
  • The final CSI report estimates it will cost 285B
    over 10 years to build this system

theJeanneScottletter
71
Outcomes Research and (gasp) Health Care
Rationing
  • Secretary is authorized to show
  • the appropriate use of best practice guidelines
    by providers and services by beneficiaries
  • The reduced scientific uncertainty in the
    delivery of care through the examination of
    variations in the utilization and allocation of
    services,and outcomes measurement and research
  • achieving the efficient allocation of
    resources
  • the financial effects on the health care
    marketplace of altering the incentives for care
    delivery and changing the allocation of
    resources

( Trust me on this, Im a lawyer, allocation of
resources rationing)
theJeanneScottletter
72
National Integrated Electronic Health Care Data
Network
Consumers
Employers
Comprehensive Quality Measurement Data
States, Public Health Departments
Secretary of Health Human Services
DoD
Physicians
Compliance, Certification, Oversight
Clinics
Federal Health Care Programs
Hospitals
Home Health Agencies
Purchasing Cooperatives
Long Term Care Facilities
Health Plans
Rural Health Care
Center for Disease Control
73
If you would like to receive the
theJeanneScottletter -- send an e-mail
jeanne.scott_at_health-politics.com Make sure to
include your name and organization
Jeanne Scott (703) 371-4894 www.health-politics.co
m
74
Jeanne Scotts Top Ten Observations About Her
Pushing 65
  • 10. Feeling like my body had gotten totally out
    of shape, I decided to take an aerobics class
    for seniors. I bent, twisted, gyrated, jumped up
    and down, and perspired for an hour.
  • But, by the time I got my leotards on, the class
    was over.
  • 9.
  • 8. When I was young we used to go "skinny
    dipping," now I just "chunky dunk."

75
Jeanne Scotts Top Ten Observations About Her
Pushing 65
6. The good news is that even as we get older,
guys still look at our boobs. The bad news is
they have to squat down first.
76
Jeanne Scotts Top Ten Observations About Her
Pushing 65
  • 5. These days about half the stuff in my shopping
    cart says, "For fast relief.
  • 4. I've tried to find a suitable exercise video
    for women my age, but they haven't made one
    called "Buns of Putty.
  • 3.

77
Jeanne Scotts Top Ten Observations About Her
Pushing 65
  • 2. My memory's not as sharp as it used to be.
  • Also, my memory's not as sharp as it used to be.
  • 1. I think the following cartoon is funny, but
    you may not get it

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Thank You
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