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CMS clarifies when charging patients fees for records is appropriate

[preamble]AH HA! The EHR incentive money has caveats! You accept the money you lose more control over your practice and how you conduct business. The inevitable creep of socialism and government employed physicians. Nothing is FREE! and you doctors took the bait – yet again![backtopost]

The Centers for Medicare & Medicaid Services has issued new and updated Frequently Asked Questions (FAQs) about the Meaningful Use Incentive Program, including one that warns that is it not appropriate to charge patients a fee when they electronically view, download or transmit their health information pursuant to the incentive program, implying that the patients’ access is really for the provider’s benefit. CMS distinguishes this access from situations where records are provided to a patient in response to a request, and points out that fees charged in response to patient requests are governed by HIPAA’s Privacy Rule. CMS also published a new FAQ on secure messaging, and updated two FAQs on outpatient calculations and public health agencies.

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Doctors under attach by lawyers in commercials – Doctors say nothing!

Last night as I was watching the beginning of the destruction of NY as DeBlasio was touted as our new mayor, a commercial was played many times about a law firm showing a cute couple complaining about their baby was not delivered by cesarean fast enough and suffered a disability and how this legal firm got them money for malpractice  – Message? Doctors are bad sue them!

This plus numerous other similar TV commercials and radio ads are constantly touting how doctors hide behind their white coats and MUST be made to pay! SHOW ME THE MONEY!

And doctors say nothing – Do Nothing! Tort reform? Never since lawyers are making too much money on this!

Doctors need an advocate to counter each and every one of these detrimental occurrences.

YET – doctors are silent and continue on their failed course! You notice not one doctor has risen up and complained about Obama care publically – where are the rallying physicians showing the effects of this on their business? No – the physicians are blind to their own demise!

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The rise of socialism was faught against even in the 20’s

  • Back in 1927, an American      socialist, Norman Thomas, six times candidate for President on the      Socialist Party ticket, said that the American people would never vote for      socialism but he said under the name of liberalism the American people      would adopt every fragment of the socialist program.
    • But at the moment I’d like to talk      about another way because this threat is with us and at the moment is more      imminent. One of the traditional methods of imposing statism or      socialism on a people has been by way of medicine. It’s very easy to      disguise a medical program as a humanitarian project. . . . Now, the      American people, if you put it to them about socialized medicine and gave      them a chance to choose, would unhesitatingly vote against it. We have an      example of this. Under the Truman administration it was proposed that we      have a compulsory health insurance program for all people in the United      States, and, of course, the American people unhesitatingly rejected this.
      • Ronald Reagan Speaks Out Against       Socialized Medicine (recording (1961)
    • The doctor begins to lose freedom.      . . . First you decide that the doctor can have so many patients. They are      equally divided among the various doctors by the government. But then      doctors aren’t equally divided geographically. So a doctor decides he      wants to practice in one town and the government has to say to him, you      can’t live in that town. They already have enough doctors. You have to go      someplace else. And from here it’s only a short step to dictating where he      will go. . . . All of us can see what happens once you establish the      precedent that the government can determine a man’s working place and his      working methods, determine his employment. From here it’s a short step to      all the rest of socialism, to determining his pay. And pretty soon your      son won’t decide, when he’s in school, where he will go or what he will do      for a living. He will wait for the government to tell him where he will go      to work and what he will do.
      • Ronald Reagan Speaks Out Against       Socialized Medicine (recording (1961)
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CitiBikes – Successful BUT not making money

Amazing how we define success these days. Millions of rides – other cities want them – we are expanding the program! Yet – they have not made any money and are reportedly losing money! Hence, the prices will increase OR they will be subsidized in our taxes.

Success Is simple – COST-SELL=PROFIT.

a simple equation lost today on the “good of the few” and tax the rich

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Health-care ‘data hub’ is ready, White House officials say

[preamble]God help us all – notice where the data is going  – IRS – yea we can trust them![backtopost]

By , Published: September 10

Obama administration officials, facing criticism that they are behind schedule in implementing the president’s health-care law, said Tuesday that they have finished a major piece of the technology that will help millions of Americans sign up for insurance this fall.
Federal health officials said they have completed the “data hub,” a complex system that will verify people’s Social Security numbers, immigration status and other information when they log on to government Web sites to buy health plans and apply for government subsidies.

The milestone is a significant victory for the administration, which is battling growing skepticism that it will be ready Oct. 1, when people are supposed to be able to start signing up for health plans under the law, commonly called Obamacare. For months, officials have faced questions about whether the computer systems, which are exceedingly complex, would be up and running in time.A government watchdog warned this month that a critical security test for the data hub had been delayed and was not scheduled to be completed until Sept. 30. But on Tuesday, officials said they managed to finish that testing on time Friday, calling it a major turning point.

“After over two years of work, [the hub] is built and ready for operation, and we have completed security testing and certification to operate,” said Todd Park, chief technology officer of the United States. “This is an important step in being ready for open enrollment on Oct. 1.”

Officials described the data hub as a network of secure servers that route information. It will connect databases maintained by several federal agencies — including the Internal Revenue Service and the Department of Homeland Security — with other databases maintained in the states.

The security testing, though not as late as feared, nevertheless comes during crunch time for the health-care law, key provisions of which kick in over the next six months.

Starting next year, virtually every American will have to carry health insurance or face a fine; those who lack coverage will have from Oct. 1 to March 31 to meet that mandate.

Whether people comply will depend in part on how easy it is to sign up for an affordable plan, which is one reason why administration officials are aiming to make the process of signing up as simple as possible.

The computer system must also ensure people receive only benefits to which they are entitled based on their income and other factors. If it works properly, the system will be able to fact-check parts of a person’s application in real time, verifying their Social Security number, immigration status and other factors to determine their eligibility for subsidies or for Medicaid, the state-federal health program for the poor.

Critics have raised concerns about the hub, in part because so much of the work is being done at the last minute. Michael Astrue, a Republican and former head of the Social Security Administration who said he supports parts of the law, said it will be impossible for officials to work out the kinks and ensure that it is protected from fraud and hackers in the short time frame left.

“They got a very late start on this, and then they cut corners — and they knew they were cutting corners — to meet their deadlines,” he said. “Whenever you are doing something quick and dirty, the price you pay is problems down the road.”

Dan Schuyler, director of exchange technology at Leavitt Partners, a consulting firm affiliated with former Utah governor Mike Leavitt (R) that is helping several states get ready for Obamacare, called the White House’s news about the data hub “encouraging.”

Still, he said, “most individuals will still experience a rocky enrollment as they go through the online process. It won’t be the seamless and smooth process that had initially been envisioned.”

The hub will be the subject of a hearing Wednesday before a House homeland security subcommittee. Republicans say the hub could be vulnerable to international hackers and identity thieves, among others.

But administration officials said they submitted the hub to rigorous security tests required under federal law, such as ensuring that only qualified people have access to the information it contains, that there are systems in place to monitor it for unusual activity and that there is an ability to quickly respond to problems.

They would not disclose some specifics, however, for fear of revealing too much to potential attackers — including those who may be ideologically opposed to the health-care law and want to interfere with the Oct. 1 launch of the market­places.

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Debating a Fix for Hospitals in Dire Straits

[preamble]Perhaps a BRAVO to Cuomo. I believe our hospital system needs an overhaul. Pumping money into a failed system creates a “:status quoe” atmosphere. Unions are a massive deterrent to hospital closures. There really is no “crisis”. The crisis i made up by politicians and groups that want to push an agenda. If an institution that is failing is going to take my money, than they better change the administration or have an achievable plan for sustainability and payback. Sustainability is not defined as picking our pockets as our officials love to comment on:

“Mr. de Blasio and Ms. Quinn have also suggested that city taxpayers might ultimately have to spend money on the hospitals.

“You know, I think one of the most important things we in the public sector do is protect the public’s health,” Mr. de Blasio said at the recent debate, “and whether it takes some city funds, whether it takes state funds or whether it takes the Medicaid waiver that the state has called for which would bring in federal dollars explicitly for hospital restructuring, it’s time for the local governments to take responsibility.”

Seems out pockets are never ending.

Often it is the hospital medical staff, protecting its long-established patient relationships, its billing and perks like teaching, that fights the hardest to keep the facilities independent.

Two cases in point are Wyckoff Heights Medical Center in Bushwick, Brooklyn, which has refused a state commission’s recommendation to merge with two other hospitals, and LICH, where the doctors are making a bid to take over the hospital after an ill-fated merger with SUNY Downstate Medical Center.

Perhaps these doctors and institutions should “pay” for their failings on their own.

The bottom line could not have been said better:
“Years of state financial support and bailouts in the absence of real systemic reform has left Brooklyn residents with an unstable and unaffordable hospital system that falls short of delivering the real primary care that the community actually needs,” Bill Schwarz, a spokesman for the State Health Department, said. “The administration is seeking to end this unsustainable cycle.”

When money is ALWAYS available and there is no accountability we have chaos – look how Europe has failed with its citizens demanding unsustainable policies…. I never thought America would follow such failings.

Doctors should “doctor” nothing more. – WHEN THIS FOLLY ENDS……….[backtopost]

By Published: September 6, 2013

Christine C. Quinn, the City Council speaker, said during a debate last month that she would make sure “that the mayor isn’t sitting on the sidelines as it relates to private hospitals.”

William C. Thompson Jr., a former city comptroller, echoed her, saying, “The city can’t sit on the sidelines.”

And Bill de Blasio, the public advocate, who helped make the hospitals a main issue by getting arrested at a rally to save Long Island College Hospital in Brooklyn, said, “We have to end this epidemic of hospital closures.”

Despite the discourse, it is the state that regulates hospitals and gives the grants and loans needed to keep them from failing. And Gov. Andrew M. Cuomo is not throwing the hospitals a lifeline.

That the candidates are even talking about hospitals is, if nothing else, a testament to their vital role in the city’s ecosystem. More than just health care facilities, they are neighborhood institutions where local doctors take care of people they know from birth to death, where politicians can be heroes by providing taxpayer support and patronage, and where unions can count on employment for workers at various levels of schooling.

Hospitals in poor areas have been struggling for years; since 1990, 52 hospitals in New York State, half of them in the city, have closed or been converted into another type of medical center. In that time, the state has tried to keep remaining hospitals alive by authorizing hundreds of millions of dollars in bond sales or direct subsidies. But the Cuomo administration believes that New York State, especially in Brooklyn, still has more hospital beds than it needs and that some of the weakest facilities might have to shut down or be significantly reshaped.

“Years of state financial support and bailouts in the absence of real systemic reform has left Brooklyn residents with an unstable and unaffordable hospital system that falls short of delivering the real primary care that the community actually needs,” Bill Schwarz, a spokesman for the State Health Department, said. “The administration is seeking to end this unsustainable cycle.”

Over all, New York City has 3 hospital beds for every 1,000 residents, more than the national average of 2.6 beds, according to the American Hospital Association’s 2010 survey. (New York’s rate is still lower than that of some other cities, including Phoenix, with 4.7 beds per 1,000 residents, and Dallas with 4.4 beds.)

Brooklyn hospitals have a vacancy rate of almost 30 percent and, with more efficiency, could cut more than 1,200 beds — the equivalent of three or four community hospitals, according to a recent state report. A large portion of Brooklyn’s more affluent population goes to the more prestigious academic medical centers in Manhattan for care, further weakening the system. About 25 percent of health care spending for Brooklyn residents is on Manhattan doctors and hospitals, according to the state.

Generally, the Brooklyn hospitals that are in financial straits disproportionately serve patients with Medicaid, which pays less than private insurers, and the uninsured.

Kenneth E. Raske, president of the Greater New York Hospital Association, called Brooklyn hospitals “the poster child for the problems affecting safety net hospitals throughout the entire country,” and said the federal government should step in.

State health officials acknowledged that hospitals have become one-stop shopping centers for health care in poor neighborhoods, a pattern that is hard to break.

“If those hospitals simply disappear, you’ll have health care deserts,” Jason A. Helgerson, the governor’s Medicaid chief, said. “Individuals will have to travel extremely long distances for even the most basic forms of health care services.”

However, Mr. Helgerson added, the state does not favor the way those hospitals are operated today, each with a heavy emphasis on inpatient care that requires a costly staff and upkeep. In an effort to turn more money over to primary care — in part because the Affordable Care Act is expected to create a demand for it, as an estimated one million state residents gain coverage — health officials talk about turning some hospitals into what they call medical villages. Some of those villages, which might include some combination of emergency care, primary care and other services, but not the full array they now provide, would have to send patients to another hospital when they needed to be admitted.
So the state has pursued a policy of trying to persuade Brooklyn’s unlinked collection of charity institutions to coordinate their services and become more efficient, even if that means that some of them might have to scale down significantly, or even close. (Brooklyn also has three city hospitals.)

In the crisis of the moment, Long Island College Hospital, also known as LICH, in Cobble Hill and Interfaith Medical Center in Bedford-Stuyvesant are losing money and on the verge of closing. The state has propped up those and other Brooklyn hospitals for decades through loans and grants, but in the current fiscal climate shows little inclination to continue doing so.

Some of the hospitals have resisted consolidation, in part because their governing boards and doctors have a vested interest in keeping them as they are.

Often it is the hospital medical staff, protecting its long-established patient relationships, its billing and perks like teaching, that fights the hardest to keep the facilities independent.

Two cases in point are Wyckoff Heights Medical Center in Bushwick, Brooklyn, which has refused a state commission’s recommendation to merge with two other hospitals, and LICH, where the doctors are making a bid to take over the hospital after an ill-fated merger with SUNY Downstate Medical Center.

The doctors and other hospital employees, with hundreds of jobs at stake, have taken a lead in going to court to stop LICH from closing. Mr. de Blasio, the candidate for mayor who has been the most vocal about protecting the hospitals, has been endorsed by both 1199 S.E.I.U. United Healthcare Workers East, the hospital workers’ union, and another union, the New York State Nurses Association.

George Gresham, president of 1199, said that whether the state continued to invest in hospitals would reflect its social and political priorities. “This is an indication of the health care disparity that unfortunately exists on the national level and in New York, particularly with communities of color,” he said.

Mr. de Blasio and other mayoral candidates have called on the federal government to approve the state’s application for a $10 billion “Medicaid waiver” to redirect some money toward new ways of delivering health care. But while the candidates have suggested that the waiver could save the struggling hospitals, the Cuomo administration intends to use some of the money, $3.7 billion, to restructure hospital care in the state, particularly Brooklyn, through mergers, consolidations, expanding primary care and other changes.

Mr. Helgerson, the state Medicaid chief, noted a 2009 Commonwealth Fund study that ranked New York the second-worst state in the country, after Louisiana, in avoidable hospitalizations. “What we are asking for from the federal government is these dollars to be able to make those targeted investments, not money just to keep the same system afloat,” Mr. Helgerson said.

The Cuomo administration has also proposed inviting private capital to invest in the state’s nonprofit hospital system, a plan that has been rebuffed by legislators worried that it would lead to large for-profit corporations taking ownership of hospitals, which all states except New York allow.

Finally, it has proposed creating a public benefit corporation, with members appointed by the administration, that would become the parent organization for struggling Brooklyn hospitals, with sweeping authority to change their governance and how they deliver care. But the Legislature did not approve the proposal in the last session. Mr. de Blasio, Ms. Quinn and Mr. Thompson have called for some sort of regional planning entity.

Mr. de Blasio and Ms. Quinn have also suggested that city taxpayers might ultimately have to spend money on the hospitals.

“You know, I think one of the most important things we in the public sector do is protect the public’s health,” Mr. de Blasio said at the recent debate, “and whether it takes some city funds, whether it takes state funds or whether it takes the Medicaid waiver that the state has called for which would bring in federal dollars explicitly for hospital restructuring, it’s time for the local governments to take responsibility.”

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CLINT EASTWOOD AND A ONE SENTENCE EDITORIAL

This one sentence editorial appeared in the Peoria Journal Star  . . . . .

“A pen in the hand of this president is far more dangerous than a gun in the hands of 200 million law-abiding citizens.”

Then Clint Eastwood added his words  . . . . .

“We Americans are so tired of being thought of as dumbasses by the rest of the world that we went to the polls this past November and removed all doubt.”