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Patient engagement may not decrease costs

[preamble]Our government wants us to believe that by engaging and educating a patient will reduce costs. Of course they have no data to back this up or any idea how it will decrease anything. The retail realty is simple, when a patient/customer knows about a product/procedure/disease, they are more likely to ask more questions and seek additional advise and come to the office/store with impossible to dispel pre-conceived notions that are usually not accurate. Hence, by doing the impossible that our government wants us to do, we create a patient society that believes they know more about their health and treatment than physicians. Whilst this on the surface may seem like a good thing, and it is to a certain degree. However, it actually erodes the doctor/patient trust and has patients demanding to stay in the hospital longer and requesting specific drugs and seeking other options. All this does is increase the costs – nor reduce them and does not make for a healthier patient.
Patients want and need to trust their doctor -period – anything that gets in the way of this costs more and is not effective – plain and simple. [backtopost]

Importance  Patient participation in medical decision making has been associated with improved patient satisfaction and health outcomes. However, there is little evidence concerning its effects on resource utilization. Patient participation in medical decision making has been hypothesized to decrease excess utilization but might be expected to increase utilization when other decision makers have incentives to reduce utilization, as under prospective payment systems for hospital care.

Objective  To examine the relationship between patient preferences for participation in medical decision making and health care utilization among hospitalized patients.

Design and Setting  Survey study in an academic research setting.

Participants  A survey that included questions about preferences to receive medical information and to participate in medical decision making was administered to all patients admitted to the University of Chicago Medical Center general internal medicine service between July 1, 2003, and August 31, 2011, and completed by 21 754 (69.6%) of admitted patients.

Main Outcomes and Measures  The survey data were linked with administrative data, including length of stay and total hospitalization costs. We used generalized linear models to measure the association of patient preference for participation in decision making with length of stay and costs.

Results  The mean length of stay was 5.34 days, and the mean hospitalization costs were $14 576. While 96.3% of patients expressed a desire to receive information about their illnesses and treatment options, 71.1% of patients preferred to leave medical decision making to their physician. Preference to participate in decision making increased with educational level and with private health insurance. Compared with patients who had a strong desire to delegate decisions to their physician, patients who preferred to participate in decision making concerning their care had a 0.26-day (95% CI, 0.06-0.47 day) longer length of stay (P = .01) and $865 (95% CI, $155-$1575) higher total hospitalization costs (P = .02).

Conclusions and Relevance  Patient preference to participate in decision making concerning their care may be associated with increased resource utilization among hospitalized patients. Variation in patient preference to participate in medical decision making and its effects on costs and outcomes in the presence of varying physician incentives deserve further examination.

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We need business stimulus – what we get are bikes!

[preamble]Ah yes Citibank wants to change their image. The bank that made billions off of the housing crash, the bank that than completely pulled out of the lending market, the bank that treats any small business or individual like a second class citizen. That citi bank wants us to eat bikes! Bikes that are not even free but cost money to rent. This will certainly provide the much business stimulus our economy needs to generate jobs. When this folly ends….. Perhaps Citibank should make loans and mortgages more easily available to us or better yet GET BACK IN THE US LENDING MARKET! [backtopost]

How the financial crisis spawned Citi Bike

The roots of Citigroup’s sponsorship of New York’s new bike share program grew from the 2008 financial crisis and a Bloomberg official’s call to Ed Skyler, a former deputy mayor.

By Updated:

New York City may have the financial crisis to thank for its new bike share program.

In late 2008, some feared Citigroup might be headed toward a Lehman Brothers-like demise. But after two federal bailouts, the bank is now on the tip of every New Yorker’s tongue as the long-awaited bike share program bearing the company’s name gets rolling.

It’s no coincidence. Since the financial crisis, it has been a top priority at Citi to fix the bank’s image in the consciousness of New Yorkers and to undo any perception that banks are more interested in serving themselves than their clients.

“One of the mandates has been to increase our visibility in New York, the entire U.S. and globally—and to do it creatively,” said Ed Skyler, executive vice president for the bank’s global public affairs and a former deputy mayor under Michael Bloomberg. “We have about 20,000 people in New York City, which makes us the second largest private employer. We’re the largest employer in Queens. If you thought about Citigroup a few years ago, you might not have experienced our presence the way we thought you should for a company as big as we are here. We have done a lot to fix that since the crisis.”

Citi has made a $41 million commitment to bike share over six years. That’s a sliver of the reported $20 million to $25 million annual price tag for its Citi Field naming rights, but arguably much more cost-effective. With 10,000 logos roaming the streets and on thousands of fobs in New Yorkers’ pockets, Citi is hoping to attract new customers.

“Hopefully we’ll see an uptick in New York City,” Mr. Skyler said. “Visually [the bikes are] eye-catching. They really pop in the urban landscape that tends toward darker, grayish tones. Our consumer marketing team and [program vendor] Alta’s NYC Bike Share worked hand-in-glove since signing the deal to make sure it reflected Citi’s branding.”

Mr. Skyler, a former deputy mayor for Mayor Michael Bloomberg, left the administration in 2010, but has maintained an open line of communication with City Hall. Mr. Skyler served as the original point person for the public-private partnership.

“The Department of Transportation commissioner initially reached out to me,” said Mr. Skyler, referring to Janette Sadik-Khan. “I recommended the program to our consumer marketing team and they ultimately decided to do it. Among other things, we looked at the experience Barclays had in London [sponsoring bike share], where they are known as ‘Barclays bikes.'”

As for glitches and complaints surrounding the roll-out, Mr. Skyler—who served as the mayor’s press secretary in 2003 when the city passed its initially contentious smoking ban—said he’s not worried. “I think a little bit of controversy isn’t a bad thing. It means people are talking about it. Time will show it’s a successful program.”

If it indeed is, Citi figures to have competitors for naming rights come 2019. “In a sense, it’ll be a good proxy for whether it’s successful or not,” Mr. Skyler said. “If it’s really successful, which I think it will be, you’ll have a competitive field [for naming rights] in six years.”

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Just a little bit more……….. tales from our government!

To shrink the deficit, our president does NOT cut spending, Does NOT reduce the fat, Does NOT reduce the government – instead he taps the ATM machines aka – We The People!

Yes my friends our president wants to charge each and every one of us $14 every time we purchase a plane ticket – which will directly go to reducing the deficit – yea ok!

Lets see what else they can tax – this mantra “just a little bit more” is turning into “juts a LOT bit more”

I cant afford this president!

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IRS steals 60,000 medical records

Lets say you are a doctor and lose a laptop with your patient files on it – did you know you can be charged $1000 per patient file for breaking HIPPA rules? Did you know you must contact each patient stating their medical data may be compromised? Well you do.

Of course this does not apply to our government. The IRS STOLE 60,000 medical files from individuals. Now what does the IRS need with medical data? Why are not they held accountable for the theft? Are they ignoring or exempt from our rules?

I will tell you what they are doing – they are secretly comiling a lis tof al medical records from every American so they can tell us what procedures we can and cant have and trend our behavior to penalize us.
Wake up people – this is not fantasy – this is realty.

Its happening faster than you are aware yet you are unaware of it.
The inevitable creep of socialism brought about by our president. We can only blame ourselves.
Wait in 15 months all i say will be realty.

Its almost tooo late – MAKE THIS FOLLY END!

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Obama-Gate Continues

Watching a news show this sunday, some sanctimonious government spokesperson was on tv smirking in his self righteous telling us that we are making to much out of the irs scandal.

How Obama acted presidential by firing the head of the irs.

Are we kidding here? Obama fired no one. The current head of the IRS was not involved in the scandal and was leaving office in several weeks – this was a scape goat. The real person at the head of the scandal and that orchestrated it is STILL at the IRS and was promoted to head of Obama care.

When this folly ends……………………..

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Overruns Forcing Lower Payments to Some Providers in Stopgap Health Program

[preamble]Lets pay careful attention to the specified highlighted paragraphs:
1. The feds froze enrollment but costs continued to grow – Obama care failure. NO matter what they tell us, “Affordable care, they cannot control the costs all this means is we “the people” will be forced to pay more for less with no end in sight.

2. Forced acceptance of payments in “full”. So now the government is in full control of what doctors make – hence doctors are NOT private people they are government employees – i don’t see a provision that the government be LIABLE for any malpractice suits – do you? Of course not – they will limit how much doctors make YET still hold them 100% accountable. Obaman plan to remove all traces of “rich people”

3. Harm to patients to pay for a service? I am confused. Its harmful NOT to be able to afford something? Since when? Since when is everyone ENTITLED to something? The government tried ti with housing – look what happened. The government tried it with schools – no child left behind – look what happened.

4. Obama care at its core and at the presidents core – socialism – healthy people paying for the sick. Rich paying for the poor – socialism plain and simple. Europe failed on these policies yet this president is taking us down the failed road.

And the doctors are still quiet – amazing.


Published: May 20, 2013

WASHINGTON — The Obama administration said Monday that it was cutting payments to doctors and hospitals after finding that cost overruns are threatening to use up the money available in a health insurance program for people with cancer, heart disease and other serious illnesses.

The administration had predicted that up to 400,000 people would enroll in the program, created by the 2010 health care law. In fact, about 135,000 have enrolled, but the cost of their claims has far exceeded White House estimates, exhausting most of the $5 billion provided by Congress.

Under a new policy issued by Kathleen Sebelius, the secretary of health and human services, “health care facilities and providers will get paid less” for providing the same services to patients in the federal program, known as the Pre-Existing Condition Insurance Plan.

In most cases, payments to health care providers will be capped at Medicare rates, which are substantially less than the commercial insurance rates they have been receiving. The new policy generally prohibits doctors and hospitals from increasing charges to consumers to make up the difference.

Michael T. Keough, the executive director of the North Carolina Health Insurance Risk Pool, said the new policy was one of several steps taken recently by federal officials to control spending.

“They are trying to stanch the hemorrhaging,” Mr. Keough said.

The federal government notified some states last month that it was setting a ceiling on costs that would be reimbursed from June through December of this year. In effect, state officials said, the new limits shift the financial risk of the program from the federal government to those states.

Congress established the program to provide coverage to people with pre-existing conditions who had been uninsured for at least six months, and Ms. Sebelius has said, “It literally saves lives.”

The program provides a transition to 2014, when most consumers will be able to obtain insurance regardless of their pre-existing conditions.

Federal officials froze enrollment in the program in February, but costs continued to grow rapidly.

Linda E. Fishman, a senior vice president of the American Hospital Association, said: “We support people getting access to health insurance, especially those who are extraordinarily ill. But we have concerns about the secretary of health and human services mandating Medicare rates for most services.”

Administration officials said that doctors and other health care providers did not have to accept the lower payment rates and could decide that they would no longer treat patients in the Pre-Existing Condition Insurance Plan. But the administration said, “We believe and are hopeful that most facilities and providers will accept the new payment rates.”

Federal health officials said the alternatives were worse. If the program runs out of money, they said, some sick people will lose access to health care, and others will be unable to pay for the treatments they receive, forcing doctors and hospitals to write off large amounts of “uncompensated care.”

Kevin Simpson, the federal official who supervises the program, declined to comment on the changes. Richard A. Olague, a spokesman for the Centers for Medicare and Medicaid Services, said, “These actions will help ensure the program’s smooth transition to 2014, when the new market reforms will be implemented and insurance companies will no longer be able to deny coverage because of pre-existing conditions.”

In a regulation to be published Wednesday in the Federal Register, the administration says that doctors and hospitals must accept the amounts set by the government as “payment in full” for services in the high-risk pool administered by the federal government. Providers can still collect co-payments from patients, but cannot bill them for more than the “cost-sharing amounts” allowed by the government.

The administration said the restrictions were necessary to prevent “irreparable financial harm” to patients, who might otherwise be “forced to pay substantially higher out-of-pocket costs.”

The government will not set payment rates for prescription drugs, organ transplants or kidney dialysis. Officials did not say why those items and services had been exempted.

When the federal program for people with pre-existing conditions ends on Jan. 1, 2014, many of them are expected to go into private health plans offered through new insurance markets being established in every state. Federal and state officials worry that an influx of people with serious illnesses could destabilize these markets, leading to higher premiums for other subscribers.

For this reason, federal and state officials say, they will try to recruit large numbers of healthy young people to buy insurance. Their premiums would help pay for the care of less healthy people.

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Scandle in our government – The coverup

Deny and project, Protect their own, Defend themselves against the people they represent, deny the truth, tell the truth as a LAST option – our governments policy.
Seems this president is engendering corruption and coverup at every level.
Now dont get me wrong, every government has corruption and problems hence why we have a constitution, laws and the power to vote. Revolution historically comes about when government “pushes” the corruption envelope to far.

Our governor attacks Vito Lopez because he is low level and easy – but ignores Sheldon Silver – why? How bout we get our $150,000 from silver. The money he used to p[ay off prostitutes for his friends protection.

They all have to go. Be3leive nothing they say – its all smoke and mirrors – Cuomo, like his father, is not out for you/us.

When this folly ends…………..

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Obama-Gate Continues

President Obama in his latest attempt at a cover up continues to deny and project realty. He had the current IRS head resign today – a step toward reform he says – really? Hmmm this person’s tenure with the IRS ends next week and he was NOT in charge when this happened – hence its a distraction, a faint move by our president to try to show he is “doping something” when in fact he is protecting himself.

The true facts:
The person in charge of the IRS when this was taking place has been given a promotion! Yes you heard it a promotion. Guess what kind of promotion? She is now in charge of the IRS Obama care division – wow! So we have a political presidential crony that trumps our constitution and turns our government against its own people in charge of the biggest debacle in American history with enough power to destroy each and every person in America.

This same person was directly involved with, knew about, ordered its execution and was directed to turn the dogs of her organization the IRS against Americans for policital gain.

Fact: Last year before the election, numerous senators wrote to the IRS stating there are unfair practices going on in the agency against specific political groups that appose the president.
Fact: These warnings were ignored
Fact: The president was fully aware and probably quietly directed this to happen

I don’t believe in such coincidences. I don’t believe he was unaware of this and the Benghazi issue that magically occurred during his election campaign.

Blaming low level people on doing this on their own?


When this folly ends….
Be afraid – be VERY Afraid
Obama-gate is just the tip!

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Todays Medicine – not as we have been told

Salt is not as bad as we have been told
Hysterectomy Does Not Raise Heart Risk
Coney Island Hospital is still shut down with no reduction in care to the population
LICH is still begin pushed to stay open and continue to cost us money

Ah yes the realty of the world – seems everything is NOT as we are told.

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Obama-Gate: our country against thee

Obama-Gate – using the IRS to attack and destroy his political adversaries. Interesting how the papers are not screaming about it more. Will we let this rogue president get away with it? Possibly – he has done a good job of watering down our Constitution and what makes us great – same as he has done for Benghazi – you remember – it was because of the video not terrorists. Its like a bad joke – we cant make this up – Obama, Clinton and the entire white house were telling us that its because of a video and its all ok – meanwhile our ambassadors and Americans were SCREAMING for help in the background – their cries fell on deaf ears and they lost their lives. That is the truth of the matter. Our president and his staff shut off their TV and went to bed whilst Americans were under attack and died – that is treason and conduct un-becoming a president and an administration – or can it be considered worse?

Of course they all deny it – it seems this president has made it more popular to NOT tell the truth  – it seems to be the last thing that we ever hear and when confronted with the lies, he simple says – “i heard it on the tv”. There really is not more to say about this  – what other words can be used to describe the “new” government that we elected. Thats the real problem “we – the people” elected this. Its now time to remove it.

When this folly ends.