Who pays your doctor and how might that affect your treatment? This is a question that the Physician Sunshine Act, (Patient Protection and Affordable Care Act section 6002, Transparency and Program Integrity) seeks to help consumers answer by creating a website that will begin reporting payments that physicians receive from manufacturers of drug devices, biologicals, etc.). The Act is a reporting requirement in order to promote transparency.
The website for consumers, beginning in September of 2014 and thereafter annually in the month of June, should be accessible through both the CMS website and the HHS website and will post payments that are reported by manufacturers and Group Purchasing Organizations to doctors so that consumers can better understand how a doctor’s decision-making and choice might be influenced by who’s paying him or her.
These are not necessarily illegal payments physicians receive. Penalties provided are for failures to report and are civil, in the form of fines, lower fines for unintentional failures to report by manufacturers, higher fines for deliberate failures to inform HHS and CMS (Health and Human Services and Centers for Medicare and Medicaid Services.
This is a VERY general overview designed to direct consumers towards tools to help them better choose physicians by following the money.
There are other laws, both state and Federal designed to address fraud and kickbacks and other illegal activities. This reporting is not making the assumption that payments are illegal but that the payments could influence a doctor’s prescription for patients and therefore should be available to patients.
(Section 1128 G notes that reporting requirements “…does not exempt applicable manufacturers, applicable GPOs, covered recipients, physician owners or investors, immediate family members, other entities, and other persons from any potential liability associated with payments or other transfers of value, ownership, or investment interests (for example potential liability under the Federal Anti-Kickback stature or the False Claims Act).” Find text by searching for Department of Health and Human Services, Centers for Medicare and Medicaid Services, 42 CFR Parts 402 and 403, Final Rule issued Friday, February 1, 2013.
As a consumer, it makes sense to take advantage of the transparency tools by looking up who pays your doctor to better inform you about possible influences on your doctor’s advice.
The American Medical Association has advised physicians that “Your patients may wish to know whether you have or have had financial interactions with industry.” They advise, “It is important that you discuss the matter candidly…” and that “Some of the issues you may want to address with the patient are what sources you rely on for information…” You can find this by searching the AMA website under “Advocacy Topics, Sunshine Act”.
Already there are guesses that patients won’t care. For instance, in an article entitled, “Who Paid for Your Doctor’s Bagel?” Dr. Thomas P. Stossel, professor of medicine at Harvard, on January 23, 2013 on WSJ.com asserted that “Few patients have the time, interest or competence to interpret the disclosures.”
Does money influence people’s decisions? Before you fulfill the good doctor’s prediction that you’ll have not enough time, interest or competence, consider another article entitled, “Doctors Who Don’t Speak Out,” by Barry Meier, for The New York Times, February 15, 2013 (look up the article for full story), regarding problems with an artificial hip sold by Johnson and Johnson, discussing physician’s who didn’t report problems they knew about for years before the product was recalled aside from to their employer, the manufacturer. In that article one of the reasons for failure to report by physicians was noted as because of “their financial ties to a drug or device maker.”
For purposes here, these financial payments would be disclosed to consumers through the website posting doctor payments under the Physician Payments Sunshine Act beginning in September 2014.
For all those people who still believe that malpractice claims contribute to our high costs, it should be noted that the lawsuits have begun in connection with the faulty hips. So who’s at fault for these suits? Not the patients and not the lawyers. Ask yourself, "If this is what’s done with the threat of lawsuits, what would happen if we did away with lawsuits?"
Showing posts with label Affordable Care. Show all posts
Showing posts with label Affordable Care. Show all posts
Tuesday, February 19, 2013
Tuesday, October 9, 2012
Fict-Facts, Essential Health Benefits, Affordable Care and My Opinion
The VP debate promises more of the cheap shot, misquote, fict-fact (fiction presented as facts), cheapening both the process and reducing the ability of Americans to choose leaders that will represent them and our country.
Still, in terms of Affordable Care, there is hope. There is hope for treating the behaviors exhibited during this behavior such as the inability to answer direct questions, the inability to deliver the entire truth, the inability to change behavior based on meaningful fact, the inability to overcome superiority complexes and any other number of psychological and psychiatric disorders that are being displayed by our candidates.
In 2014, as part of the Affordable Care Act, mental health services will be mandated to become part of coverage for insurance plans listed in health insurance exchanges. Naturally, these coverages, combined with the removal of the preexisting condition limitation means that our candidates, both of whom have enough money so that they can pay for the increased expense of such coverage, will have access to tools to help them overcome the behaviors delineated above that they have so shamelessly displayed during this campaign.
For the American people, the future is not as bright. We’ve been given fict-facts instead of truth regarding almost every meaningful aspect and “talking point” of the election, prepared, processed, sanitized and delivered to us in a fast food package that rarely reflects its original truth.
If you hear a “fact” upon which you’re basing your vote, go out of your way to find out more. Determine whether the mere election of a candidate means that what you’re basing your vote on will come to be.
If you hate Affordable Care, do not rely on its repeal as the basis of voting for Romney, for that will take Congress and even then, as in the instance of the Supreme Court Case, the approach may be consideration of specific provisions of the Act rather than its complete repeal. Medical systems have been working to implement Affordable Care for two years, and that work is not going to be erased to return to a time before Affordable Care. Several medical systems have already indicated that they will continue to move forward with modifications they’ve begun.
Similarly, if you’re voting for the President because you’re afraid of repeal of Affordable Care or because you’re awaiting the implementation of features of Affordable Care, remember that those features require funding or other action in order for them to be implemented.
What I will be looking for is Paul Ryan’s commitment to Mitt Romney, the Mitt Romney who spoke at the first debate, not the empty suit being led by the nose by the extremist elements of the Republican Party and by Paul Ryan, clutching a copy of his Ryan budget that though defeated he still hopes to shove down the throats of the American people.
If Ryan cannot fully support what Mitt Romney communicated during the debate, we’re left only with the impression that Mitt Romney cannot rise above the hostile, insular, rigid vein of the Republican Party known as the Tea Party that have left reasonable Republicans wondering about the disarray of their party.
What I will be looking for from Joe Biden is a deep understanding of the typical voter that he once was, decades ago when he began in politics that will allow him to put aside bumper sticker lingo such as, “Bin Laden’s dead and GM is alive,” and bring his expertise and intelligence to a discussion of the continued pain being experienced by Americans.
One liners and a “stay-the-course” message can only underscore how out of touch the Presidency has become, married to its own ideas about the glory of civil service, illegal immigrants, and unions dismissing seriously significant elements of the middle class that are none of those and that are asked to keep footing the bill for bills that at best help them in no way and that at their worst work against genuine middle class interests. In other words, it’s time for democrats to take a page from the flip-floppers and etch-a-sketchers and adjust their approach in the face of the dynamics of reality.
What I believe we’ll get is entertainment not information, which will reflect the arrogance and egotism of those in power, and a deep disrespect for those whose votes they desire.
Still, in terms of Affordable Care, there is hope. There is hope for treating the behaviors exhibited during this behavior such as the inability to answer direct questions, the inability to deliver the entire truth, the inability to change behavior based on meaningful fact, the inability to overcome superiority complexes and any other number of psychological and psychiatric disorders that are being displayed by our candidates.
In 2014, as part of the Affordable Care Act, mental health services will be mandated to become part of coverage for insurance plans listed in health insurance exchanges. Naturally, these coverages, combined with the removal of the preexisting condition limitation means that our candidates, both of whom have enough money so that they can pay for the increased expense of such coverage, will have access to tools to help them overcome the behaviors delineated above that they have so shamelessly displayed during this campaign.
For the American people, the future is not as bright. We’ve been given fict-facts instead of truth regarding almost every meaningful aspect and “talking point” of the election, prepared, processed, sanitized and delivered to us in a fast food package that rarely reflects its original truth.
If you hear a “fact” upon which you’re basing your vote, go out of your way to find out more. Determine whether the mere election of a candidate means that what you’re basing your vote on will come to be.
If you hate Affordable Care, do not rely on its repeal as the basis of voting for Romney, for that will take Congress and even then, as in the instance of the Supreme Court Case, the approach may be consideration of specific provisions of the Act rather than its complete repeal. Medical systems have been working to implement Affordable Care for two years, and that work is not going to be erased to return to a time before Affordable Care. Several medical systems have already indicated that they will continue to move forward with modifications they’ve begun.
Similarly, if you’re voting for the President because you’re afraid of repeal of Affordable Care or because you’re awaiting the implementation of features of Affordable Care, remember that those features require funding or other action in order for them to be implemented.
What I will be looking for is Paul Ryan’s commitment to Mitt Romney, the Mitt Romney who spoke at the first debate, not the empty suit being led by the nose by the extremist elements of the Republican Party and by Paul Ryan, clutching a copy of his Ryan budget that though defeated he still hopes to shove down the throats of the American people.
If Ryan cannot fully support what Mitt Romney communicated during the debate, we’re left only with the impression that Mitt Romney cannot rise above the hostile, insular, rigid vein of the Republican Party known as the Tea Party that have left reasonable Republicans wondering about the disarray of their party.
What I will be looking for from Joe Biden is a deep understanding of the typical voter that he once was, decades ago when he began in politics that will allow him to put aside bumper sticker lingo such as, “Bin Laden’s dead and GM is alive,” and bring his expertise and intelligence to a discussion of the continued pain being experienced by Americans.
One liners and a “stay-the-course” message can only underscore how out of touch the Presidency has become, married to its own ideas about the glory of civil service, illegal immigrants, and unions dismissing seriously significant elements of the middle class that are none of those and that are asked to keep footing the bill for bills that at best help them in no way and that at their worst work against genuine middle class interests. In other words, it’s time for democrats to take a page from the flip-floppers and etch-a-sketchers and adjust their approach in the face of the dynamics of reality.
What I believe we’ll get is entertainment not information, which will reflect the arrogance and egotism of those in power, and a deep disrespect for those whose votes they desire.
Thursday, September 6, 2012
2012 The Past that Never Quite Was to the Future that May Not Be
Our presidential candidates and their speakers are being decimated by fact checkers as their trustworthiness is put into question again and again. Why the bold-faced lying on topics from healthcare to values? It’s an old-style form of campaign that may not be suited to new technologies that provide fairly easy access to those looking into claims.
It’s asserted here that this election highlights the selective memory of the past and the possibilities of the future that both sides deem necessary to persuade the American public that something can be regained that has been lost, and something better can be achieved within our current system.
There is no way to make a persuasive truthful representation that supports the ability to duplicate the past through the selective attempts to reinstate old laws such as the glory days when abortion was illegal and marital rape was not.
There is no way to assure Americans that proposed or even enacted legislation such as the Affordable Care Act will achieve any positive results when it’s only effective, measurable result to date is that more young people are insured because more middle class parents are paying for their children’s insurance through the age of 26.
Even proponents of the Act have addressed the number of “ifs” that must occur in a certain way for any of the numbers presented at any point in time to reflect reality. (As pointed out in this blog in reference to the uncertain “ifs” described by Chief Actuary Robert Foster in his April 2010 memo which you can by searching Richard Foster memo April 22, 2010, “Estimated Financial Effects of the ‘Patient Protection and Affordable Care Act,’ as amended.)
The candidates and their staffs know this. So, what can we learn from the parties and spending and advertising? We can better understand what our real values are as a nation.
We can learn that in spite of our unhappiness, most people don’t want change to the things they view positively in their own lives. That’s why we’ve heard both candidates assure us that those over 55 won’t have their Medicare affected. Both candidates recognize that people value stability over change if they’re comfortable enough.
We value those who keep their promises as promised. The Democrats really ruined this one with the Affordable Care Act.
While the President touts The Affordable Care Act as answer to our most crushing healthcare challenges, it is not. Nor is the Act either as revolutionary nor as anti-American or “socialist” as the Republicans would have us believe.
The greatest examples of the Affordable Care Act’s “socialist” promises, creating a public option to better compete with the stacked deck of powerful business is not in the Act. The expansion of Medicaid is one of the “ifs” of the Act, it depends on the states. Nor are the Republicans being honest in supporting a return to the former system and allowing the “free market” solution because in fact there is not a free market in the healthcare industry, as illustrated by the billions of dollars free market supporters and their organizations spend on lobbying to create laws that benefit them. In other words, the use of government laws and policies to increase their wealth, hardly free market.
We like bumper stickers. Shortcuts, meaningful phrases representing limited truths or vague ideas such as “Job Creators” or “Forward,” both of which are subject to challenge by thoughtful and reasonable people.
Repetition works in overcoming truth which is why we’ll hear the question of where the President was born or the issue about Mitt Romney’s taxes played, played and replayed again until everyone wonders a little bit about where the President was born, and everyone wonders a little bit about what exactly is in Mitt Romney’s tax returns.
We don’t like thinking of ourselves as mean, prejudiced, or stupid. This one’s a lot more strongly represented on the side of the Democrats. “If you’re a good person you’ll support giving immunity to illegal aliens,” hardly logical but it does pull on your heartstrings. The Republicans focus on right to life because who in their right mind would support killing babies? The Republicans advocate allowing our smart citizens to make decisions for themselves rather than “needing” government to make rules about various subjects in spite of all the “rules” that bear the Republican stamp of approval.
We are likely not going to get a President who supports the middle class in spite of the promises, proposals, plans, and bumper stickers proclaiming the importance of the middle class. Mitt Romney does support the rich, and President Obama does tend to the poor, the illegal immigrants, the elderly, in a skewed view that truly indicates that he believes the private sector middle class is “fine.”
What we hate to hear but know is that the middle class is the go-to pocket for both Republicans and democrats to finance their priorities because for politicians it’s about votes and it’s easier to divide and conquer through special legislation and attention to specific blocs of voters than to create jobs and support policies that benefit the middle class.
Where we go from here…Regardless of who’s elected, as a middle class we should better prioritize and communicate as group regarding policies that will generally benefit the middle class instead of being used as tools by politicians, easily sliced and diced according to a hundred separate priorities that factionalize us along lines that ultimately further erode the middle class.
En masse we should define and prioritize what being private sector middle class is for us whether it’s job security, affordable health care or preserving the opportunity to end our work-lives and reaping the benefits of what we’ve paid into for decades. It’s not that all the other distractions aren’t worthy causes, it’s that they don’t represent the private sector middle class as a whole, and without a strong middle class, this country’s economic future will continue to be the story of the rich and poor, each supported and financed by the middle class.
All our politicians from local to state to Federal should hear the same message from the middle class based on priorities that reflect the belief that the entire private sector middle class must be protected and nurtured for the future of this country.
It’s asserted here that this election highlights the selective memory of the past and the possibilities of the future that both sides deem necessary to persuade the American public that something can be regained that has been lost, and something better can be achieved within our current system.
There is no way to make a persuasive truthful representation that supports the ability to duplicate the past through the selective attempts to reinstate old laws such as the glory days when abortion was illegal and marital rape was not.
There is no way to assure Americans that proposed or even enacted legislation such as the Affordable Care Act will achieve any positive results when it’s only effective, measurable result to date is that more young people are insured because more middle class parents are paying for their children’s insurance through the age of 26.
Even proponents of the Act have addressed the number of “ifs” that must occur in a certain way for any of the numbers presented at any point in time to reflect reality. (As pointed out in this blog in reference to the uncertain “ifs” described by Chief Actuary Robert Foster in his April 2010 memo which you can by searching Richard Foster memo April 22, 2010, “Estimated Financial Effects of the ‘Patient Protection and Affordable Care Act,’ as amended.)
The candidates and their staffs know this. So, what can we learn from the parties and spending and advertising? We can better understand what our real values are as a nation.
We can learn that in spite of our unhappiness, most people don’t want change to the things they view positively in their own lives. That’s why we’ve heard both candidates assure us that those over 55 won’t have their Medicare affected. Both candidates recognize that people value stability over change if they’re comfortable enough.
We value those who keep their promises as promised. The Democrats really ruined this one with the Affordable Care Act.
While the President touts The Affordable Care Act as answer to our most crushing healthcare challenges, it is not. Nor is the Act either as revolutionary nor as anti-American or “socialist” as the Republicans would have us believe.
The greatest examples of the Affordable Care Act’s “socialist” promises, creating a public option to better compete with the stacked deck of powerful business is not in the Act. The expansion of Medicaid is one of the “ifs” of the Act, it depends on the states. Nor are the Republicans being honest in supporting a return to the former system and allowing the “free market” solution because in fact there is not a free market in the healthcare industry, as illustrated by the billions of dollars free market supporters and their organizations spend on lobbying to create laws that benefit them. In other words, the use of government laws and policies to increase their wealth, hardly free market.
We like bumper stickers. Shortcuts, meaningful phrases representing limited truths or vague ideas such as “Job Creators” or “Forward,” both of which are subject to challenge by thoughtful and reasonable people.
Repetition works in overcoming truth which is why we’ll hear the question of where the President was born or the issue about Mitt Romney’s taxes played, played and replayed again until everyone wonders a little bit about where the President was born, and everyone wonders a little bit about what exactly is in Mitt Romney’s tax returns.
We don’t like thinking of ourselves as mean, prejudiced, or stupid. This one’s a lot more strongly represented on the side of the Democrats. “If you’re a good person you’ll support giving immunity to illegal aliens,” hardly logical but it does pull on your heartstrings. The Republicans focus on right to life because who in their right mind would support killing babies? The Republicans advocate allowing our smart citizens to make decisions for themselves rather than “needing” government to make rules about various subjects in spite of all the “rules” that bear the Republican stamp of approval.
We are likely not going to get a President who supports the middle class in spite of the promises, proposals, plans, and bumper stickers proclaiming the importance of the middle class. Mitt Romney does support the rich, and President Obama does tend to the poor, the illegal immigrants, the elderly, in a skewed view that truly indicates that he believes the private sector middle class is “fine.”
What we hate to hear but know is that the middle class is the go-to pocket for both Republicans and democrats to finance their priorities because for politicians it’s about votes and it’s easier to divide and conquer through special legislation and attention to specific blocs of voters than to create jobs and support policies that benefit the middle class.
Where we go from here…Regardless of who’s elected, as a middle class we should better prioritize and communicate as group regarding policies that will generally benefit the middle class instead of being used as tools by politicians, easily sliced and diced according to a hundred separate priorities that factionalize us along lines that ultimately further erode the middle class.
En masse we should define and prioritize what being private sector middle class is for us whether it’s job security, affordable health care or preserving the opportunity to end our work-lives and reaping the benefits of what we’ve paid into for decades. It’s not that all the other distractions aren’t worthy causes, it’s that they don’t represent the private sector middle class as a whole, and without a strong middle class, this country’s economic future will continue to be the story of the rich and poor, each supported and financed by the middle class.
All our politicians from local to state to Federal should hear the same message from the middle class based on priorities that reflect the belief that the entire private sector middle class must be protected and nurtured for the future of this country.
Subscribe to:
Posts (Atom)