A Glimpse Into The Present

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A Glimpse Into The Present
Arie Friedman, M.D. Physicians Council for
Responsible Reform
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Unless we put medical freedom into the
constitution the time will come when medicine
will organize into an undercover dictatorship and
force people who wish doctors and treatment of
their own choice to submit to only what the
dictating outfit offers. Benjamin Rush
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Patient Protection and Affordable Care Act of
2010 Health Care and Education Reconciliation
Act of 2010
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Regulatory Process
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Centers for Medicare and Medicaid Services

• Directly manages Medicare
• Partners with states in managing Medicaid
• Writes the guidelines for all medical billing
• Controls much of medical education
• Will innovate new delivery systems
• Will innovate new payment systems
• Will innovate new guidelines and protocols
• Will incentivize providers to provide quality care

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Donald Berwick, M.D.
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Cynics beware, I am a romantic about the UKs
National Health Service I love it. All I need to
do to rediscover the romance is to look at health
care in my own country. Berwick DM, 2008
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We believe, and refuse to be dissuaded, that the
National Health Service, with its moral intent,
commitment to equity, and store of knowledge, has
the inherent capability to become the greatest
healthcare system of any nation. Berwick DM,
2006
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As Americans, we know dependence on market
forces for constructive change is playing with
fire. Berwick DM, 2006
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Young doctors and nurses should emerge from
training understanding the values of
standardization and the risks of too great an
emphasis on individual autonomy. Berwick DM,
2005
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An immense resource for progress in improving
the NHSthe key resource, in my viewhas been the
consistent focus of government, emanating from
the Prime Minister personally, on raising the bar
for NHS performance. Berwick DM, 2004
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The modernization process sought to establish
accountabilities, structures, resources, and
schedules in the NHS that no one at all is in a
position to establish in the pluralistic,
chaotic, leaderless US healthcare
system. Berwick DM, 2004
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The UK can decide, as an entire nation, to
improve its cancer care outcomes... Indeed, the
recent NHS Plan proposes exactly those
improvements and backs up the strategy with
specific plans, accountable management
structures, and major infusions of money.
Berwick DM, 2000
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UK Cancer Outcomes

• Breast Cancer 88 worse than U.S.
• Prostate Cancer - 604
• Worse in literally every other major form of
  cancer

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People are policy
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What are we talking about?

• Guidelines
• Incentive payments
• Penalties in ratings and payments
• Outcomes payments
• Hospital ratings combined with bundling
• State mandates for medicaid
• Etc, etc, etc...

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Privacy
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SEC. 4302. UNDERSTANDING HEALTH DISPARITIES
DATA COLLECTION AND ANALYSIS.
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Data Collection

• Begins within 2 years
• All federally funded or supported
• Health care, public health program, activity or
  survey
• Includes Dept. of Labor and Census surveys
• Measures sex, primary language, disability status
• Includes anything else deemed apropriate by the
  Secretary of HHS

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• ...sufficient data to generate statistically
  reliable estimates by racial, ethnic, sex,
  primary language, and disability status subgroups
  for applicants, recipients or participants using,
  if needed, statistical oversamples of these
  subpopulations
• ...any other demographic data as deemed
  appropriate by the Secretary regarding health
  disparities.

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Sources of Data

• Reported by applicant, recipient, or participant
• Reported by parents of above
• Health care providers
• How many have disability compliant equpment
• How many employees have been trained in
  disability awareness, etc.
• Will include at a minimum info on race,
  ethnicity, sex, primary language, and disability
  status

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Who gets it?

• Office of Minority Health
• National Center on Minority Health and Health
  Disparities
• Agency for Healthcare Research and Quality
• Centers for Disease Control and Prevention
• Centers for Medicare and Medicaid Services
• Indian Health Service and associated studies
• Office of Rural Health
• Anyone else the Secretary of HHS wants

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(2) REPORTING OF DATA.The Secretary shall
report data and analyses described in (a) and (b)
through (A) public postings on the Internet
websites of the Department of Health and Human
Services and (B) any other reporting or
dissemination mechanisms determined appropriate
by the Secretary.
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(3) AVAILABILITY OF DATA.The Secretary may
make data described in (a) and (b) available for
additional research, analyses, and dissemination
to other Federal agencies, non-governmental
entities, and the public,
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SEC. 4203. REMOVING BARRIERS AND IMPROVING ACCESS
TO WELLNESS FOR INDIVIDUALS WITH DISABILITIES.
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SEC. 5306. MENTAL AND BEHAVIORAL HEALTH
EDUCATIONAND TRAINING GRANTS.

• B.A.s, M.A.s, Ph.D.s, in social work
• Develop social work teaching faculty
• Higher learning degrees in all aspects of
  behavioral health
• Preservice or in-service training of
  paraprofessional child/adolescent professionals

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Eligibility

• (1) participation in the institutions programs
  of individuals and groups from different racial,
  ethnic, cultural, geographic, religious,
  linguistic, and class backgrounds, and different
  genders and sexual orientations
• (2) knowledge and understanding of the concerns
  of the individuals and groups described in
  subsection (a)
• (3) any internship or other field placement
  program assisted under the grant will prioritize
  cultural and linguistic competency
• (4) the institution will provide to the Secretary
  such data, assurances, and information as the
  Secretary may require
• INSTITUTIONAL REQUIREMENT.For grants authorized
  under subsection (a)(1), at least 4 of the grant
  recipients shall be historically black colleges
  or universities or other minority-serving
  institutions.

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And finally, don't complainI have visited
settings in Rwanda, Mozambique, Peru, and
Palestine where every person I met had 100 times
more reasons to complain than I do. And none did.
Complaint is waste. Berwick DM, 2004
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Controversy is only dreaded by the advocates of
error. Benjamin Rush