Friday, August 25, 2006
Audit bureau confirms: state gov't for sale
A legislative audit of state business assistance programs released earlier this week mirrored findings in a 2005 Democracy Campaign study that, among other things, pointed out that companies whose executives made campaign contributions received grants, subsidized loans and tax breaks eight times greater than non-contributors.
State Commerce Department officials took sharp exception to WDC's report, calling it "a little off base."
Now the Legislative Audit Bureau has confirmed one of the Democracy Campaign's key conclusions – that oversight of state economic aid programs is so bad that it is virtually impossible to determine whether the assistance actually created any jobs. In fact, the auditors found situations where companies that received state help later laid off employees.
State Commerce Department officials took sharp exception to WDC's report, calling it "a little off base."
Now the Legislative Audit Bureau has confirmed one of the Democracy Campaign's key conclusions – that oversight of state economic aid programs is so bad that it is virtually impossible to determine whether the assistance actually created any jobs. In fact, the auditors found situations where companies that received state help later laid off employees.
VA system shows wisdom of integrated coverage
That fragmentation of the health care system lies at the root of much of the waste and fraud in our health care system. Each player tries to pump up profits and often waste through excessive billing of third parties. Each party avoids taking responsibility by shifting the increased costs onto government or other third party providers. Short-term profiteering means long term investments in preventive care or technology gets shortchanged.
A recent Business Week profile (read the whole article at the link) of the Veterans Administration health system emphasized that an integrated health care system like the VA can accomplish savings that the rest of the balkanized for-profit health insurance system cannot.
After reforms in the 1990s, the 154 hospitals and 875 clinics run by the VA now rank as best-in-class on health quality, on measures ranging from quality of chronic care to percentage of members receiving flu shots to having a prescription accuracy rate of 99.997% (compared to a 3% to 8% inaccuracy rate more generally). According to research by the University of Michigan, the VA now outranks private-sector hospitals in patient satisfaction.
And the VA delivers this quality at a cost of $5000 per patient versus a national average of $6,300.
How does it achieve these savings and quality? According to Business Week:
Not having to rely on piecemeal insurance payments means the VA can finance large-scale improvements such as the electronic medical-records system, up and running in all of its facilities since 2000-- compared to just 20% of civilian hospitals with computerized their patient records. When hospitals were evacuated from New Orleans during Hurricane Katrina, the VA's patients were the only ones whose medical records could be accessed immediately anywhere in the country.
Because the VA treats patients throughout their lives, it can invest in prevention and primary care, knowing it will reap the benefits of lower long-term costs. Because the government pays the bills, the VA doesn't have to waste time or money on claims-related paperwork.
Unlike Medicare, the VA is allowed to negotiate prices with drug companies and other suppliers, and it uses that power aggressively. The consumer group Families USA estimates that Medicare Part D enrollees, on average, pay 46% more than the VA for the same drugs.
And because its doctors are salaried employees, the VA can implement systemwide changes without having to persuade outside doctors to go along (and without doctors having a financial incentive to undermine reforms by self-referrals or other profiteering).
The VA uses the data gathered in its computers to pinpoint problem areas, such as medication errors. The network also allows it to track how closely the medical staff is following evidence-based treatment and monitor deficiencies.
States can and will continue to pursue piece-meal reforms, but as they seek to achieve more universal coverage they can take lessons from the VA and begin ending the fragmentation of health care systems in favor or encouraging more integrated and publicly-accountable health care systems.
States may not achieve the level of integration of a completely publicly-run system like the Veterans Administration, but by simplifying and integrating health plan options across employers and the public sector, states can create more of the accountability and cost savings that in turn can help finance those broader health coverage goals.
More Resources
A recent Business Week profile (read the whole article at the link) of the Veterans Administration health system emphasized that an integrated health care system like the VA can accomplish savings that the rest of the balkanized for-profit health insurance system cannot.
After reforms in the 1990s, the 154 hospitals and 875 clinics run by the VA now rank as best-in-class on health quality, on measures ranging from quality of chronic care to percentage of members receiving flu shots to having a prescription accuracy rate of 99.997% (compared to a 3% to 8% inaccuracy rate more generally). According to research by the University of Michigan, the VA now outranks private-sector hospitals in patient satisfaction.
And the VA delivers this quality at a cost of $5000 per patient versus a national average of $6,300.
How does it achieve these savings and quality? According to Business Week:
Not having to rely on piecemeal insurance payments means the VA can finance large-scale improvements such as the electronic medical-records system, up and running in all of its facilities since 2000-- compared to just 20% of civilian hospitals with computerized their patient records. When hospitals were evacuated from New Orleans during Hurricane Katrina, the VA's patients were the only ones whose medical records could be accessed immediately anywhere in the country.
Because the VA treats patients throughout their lives, it can invest in prevention and primary care, knowing it will reap the benefits of lower long-term costs. Because the government pays the bills, the VA doesn't have to waste time or money on claims-related paperwork.
Unlike Medicare, the VA is allowed to negotiate prices with drug companies and other suppliers, and it uses that power aggressively. The consumer group Families USA estimates that Medicare Part D enrollees, on average, pay 46% more than the VA for the same drugs.
And because its doctors are salaried employees, the VA can implement systemwide changes without having to persuade outside doctors to go along (and without doctors having a financial incentive to undermine reforms by self-referrals or other profiteering).
The VA uses the data gathered in its computers to pinpoint problem areas, such as medication errors. The network also allows it to track how closely the medical staff is following evidence-based treatment and monitor deficiencies.
States can and will continue to pursue piece-meal reforms, but as they seek to achieve more universal coverage they can take lessons from the VA and begin ending the fragmentation of health care systems in favor or encouraging more integrated and publicly-accountable health care systems.
States may not achieve the level of integration of a completely publicly-run system like the Veterans Administration, but by simplifying and integrating health plan options across employers and the public sector, states can create more of the accountability and cost savings that in turn can help finance those broader health coverage goals.
More Resources
HMOs sued for not paying MA providers
A dozen Georgia physicians have filed a suit against three private HMOs -- Peach State Health Plan, AMGP Georgia Managed Care Company and Wellcare of Georgia -- claiming that the plans owe millions of dollars in Medicaid reimbursements to doctors, hospitals and other providers. The providers allege that the HMOs knew before they bid on a $3 billion state contract that they'd be unable to reimburse physicians. Because the HMOs haven't paid them, the doctors say they've had to cut down on the number of indigent patients they accept. "These are doctors who have made a commitment to treat the less fortunate, and a substantial percentage of their patients are Medicaid patients," the plaintiff's lawyer, Rod Edmond, told the Atlanta Journal-Constitution. "And if they are owed $50,000 or $75,000 in outstanding claims, it could literally put them out of business." The physicians hope their suit will receive class-action status and that other providers across the state will join them. Remember: Gov. Doyle thinks HMOs are going to save our Medicaid program. To get more background on the suit check out this report from the Atlanta Journal-Constitution for details.
Gov wannabe breaking state rules
A Wisconsin Democracy Campaign review of contributions from special interest political action committees (PACs) to Republican candidate for governor Mark Green shows that most of the donations run afoul of the state law requiring PACs donating to state campaigns in Wisconsin to be registered with the state. The Democracy Campaign brought the new finding to the attention of the state Elections Board in a memo sent to board members. Last month, WDC wrote to the board that the PAC money Green has accumulated to help finance his run for governor exceeds the amount allowed under state law. The Elections Board has put the issue on the agenda.
Another exmaple of how HMOs work
In California, the SEIU has leaked an internal John Muir Physician Network (JMPN) memo that instructs doctors not to "refer patients for a screening colonoscopy if their life expectancy is less than five years." The memo orders doctors to deny the test to patients with AIDS, chronic renal failure, advanced cirrhosis of the liver, COPD, active hepatitis, obesity and other conditions. The memo also threatens "financial penalties" for doctors who don't comply with the order. Taken at face value, JMPN's blanket denial of colonoscopies for certain patients is a violation of several federal laws. Regulators say they are planning to investigate the matter.
For more on the controversy: check out this article from the Contra Costa Times and read the SEIU press release for more details from the memo. Remember: Gov. Doyle thinks guys like these -- HMOs -- are going to save Medicaid. Sigh.
P.S. And who gets to decide whether you "life expectancy" is less than five years? Doctors have enough trouble with the 6-month rule for hospice. I'm willing to bet that since this decision has "financial penalties" attached to it, that the docs have to figure out who the HMO expects to life fewer than five years. In fact, the HMO has already given them a starting point: the list of conditions for which they are prohibiting colonoscopy. I note, with personal interest, that the obese are on the list. I guess I have fewer than five years left to live. Idiots.
For more on the controversy: check out this article from the Contra Costa Times and read the SEIU press release for more details from the memo. Remember: Gov. Doyle thinks guys like these -- HMOs -- are going to save Medicaid. Sigh.
P.S. And who gets to decide whether you "life expectancy" is less than five years? Doctors have enough trouble with the 6-month rule for hospice. I'm willing to bet that since this decision has "financial penalties" attached to it, that the docs have to figure out who the HMO expects to life fewer than five years. In fact, the HMO has already given them a starting point: the list of conditions for which they are prohibiting colonoscopy. I note, with personal interest, that the obese are on the list. I guess I have fewer than five years left to live. Idiots.
Thursday, August 03, 2006
Thanks to Bush, Thompson and Tauzin
Medicare’s “doughnut hole” is starting to hit shocked and angry seniors. “They have just learned that their Medicare drug plans are maxing out on early coverage and that they must spend $2,850 from their own pockets before coverage will resume.”
This explains a few things
Only 1% of our representatives in Congress have family in service. Some 32, however, are apparently married to lobbyists. See the story here.
