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A Dime's Worth of Difference in 2012 Print E-mail
Written by Paul Gionfriddo   
Saturday, 07 January 2012 15:08

Our Health Policy Matters        
A column focusing on federal, state and local health policy   

"...the 2010 Affordable Care Act and the individual mandate were not really health reform. They were efforts to preserve health insurance as we know it, by getting more people who can afford it to purchase private insurance, and more who cannot onto the Medicaid public insurance program."

Click HERE to read more. 
 
Last Updated on Saturday, 07 January 2012 15:13
 
Feds Approve Extension of Medicaid Pilot Project Print E-mail
Written by Bernd Wollschlaeger, MD   
Tuesday, 27 December 2011 20:07

IN MY OPINION

On Thursday the federal officials agreed to extend Florida's five-county Medicaid managed-care experiment to 2014 but required the state to make significant improvements to the program. They include the denial of the medical-loss-ratio waiver requiring the participating private health plans to spend 85 percent of funds on patient care and the denial to cap benefit levels for Medicaid beneficiaries preventing the termination of Medicaid services because recipients had already met their $500,000 maximum for the year. These requirements will protect patients from arbitrary insurance service denials and will force private health insurance plans to manage taxpayers dollars efficiently and responsibly. Meanwhile, we should continue to oppose any expansion of the pilot project UNLESS the State of Florida can provide solid and indisputable data that the pilot project improves access and enhances the quality of care for all  Medicaid enrollees. So far I have not found any evidence to substantiate Governor Scott's claim that "we've seen higher quality in administration of care, produced cost savings and consumers in the pilot have found improved access for Medicaid recipients." Looking forward to your feedback. Click HERE to send a message to Bernd.  

 For more information click HERE and HERE

 
New Year's Malpractice Insurance Resolutions Print E-mail
Written by Matt Gracey, Jr.   
Tuesday, 27 December 2011 19:54

In working with doctors and practice administrators throughout Florida for years on their malpractice insurance placement, I have often hoped that these simple resolutions would somehow make it on their resolutions lists.  Even as important as malpractice insurance coverage is to the health of every practice, I am reasonable enough to know that the reality of this happening is as close as experiencing a white Christmas in Miami, but just for kicks here they are:
  1. We will not just shop price this year for our coverage. If you don't understand this one there is no explanation necessary. Just know that our next crisis is not too far away and this is not a great time to hunt out the weakest insurer with the cheapest price. Move to the best, strongest, most experienced insurer now.
  2. We will prepare now for the "hard market" leading to our next crisis by forming or joining a purchasing group or program. You will need some strength in numbers soon.
  3. We will make sure we are getting all possible discounts from our insurer of choice. Many practices do not get good advice and overlook discounts to which they are entitled.
  4. We will educate ourselves on the most important points of our malpractice insurance coverage. Not understanding the importance of shared versus separate limits, the claims trigger, and the common exclusions, such as medical directorship activities, can sink your practice.    
  5. We will review our own group's contract with our doctors to fully understand the obligations in the event one of our doctors leaves the group. Many lawsuits filed each year could easily be avoided if policy tail issues were fully understood.
  6. We will fully educate ourselves on the liability issues surrounding the possibility of joining a hospital. There are many issues, so get good advice.
  7. We will request a risk management assessment from our insurer. These are usually free and can provide invaluable insights into a practice's weaknesses, which may lead to lawsuits.
  8. We will find and engage an experienced, specialized, passionate insurance broker to guide us through the maze of malpractice insurance issues. A professional agent's services are free and will save you considerable money and time throughout the years.       

Matt Gracey, Jr. is a medical malpractice insurance specialist with Danna-Gracey, an independent insurance agency based in downtown Delray Beach with a statewide team of specialists dedicated solely to insurance coverage placement for Florida's doctors. To contact him call (800) 966-2120, or email:    matt@dannagracey.com. 

Last Updated on Wednesday, 11 January 2012 06:40
 
Controlling Healthcare Costs Print E-mail
Written by Bernd Wollschlaeger, MD   
Wednesday, 07 December 2011 13:03

Florida Docs Blog

A progressive viewpoint and healthcare vision as articulated by Bernd Wollschlaeger, MD

"Unfortunately, few people really understand how much we spend on health care, how much we need to spend to provide quality care, and the difference between the two."
 
The New York Times published three articles by Ezekiel  Jonathan Emanuel, MD PhD focusing on how to control the escalating health care costs in the United States.  I highly recommend reading the articles published so far and have attached the links to each article below:

Spending More Doesn't Make Us Healthier 

Less Than $26 Billion? Don't Bother 

Billions Wasted on Billing

We have to realize that there are no "magic bullets" to solve our health care cost crisis. Any solutions offered so far  to provide universal health care coverage will fail UNLESS they are being combined with meaningful and sustained cost control measures. This requires a total reform of our reimbursement system transforming it from a quantity to a quality focused service industry utilizing state-of-the-art information technology tools.  Unless we are willing to change, we are going to be forced to further ration medical services. What do we prefer? 

 
Increasingly Strained Relationship Between Jackson Health System and the University of Miami Print E-mail
Written by Bernd Wollschlaeger, MD   
Wednesday, 07 December 2011 12:44

IN MY OWN WORDS

An interesting Miami Herald article by John Dorschner titled "Finances strain the marriage between Jackson and the University of Miami" details the increasingly strained relationship between Jackson Memorial Hospital and the University of Miami. At the center of the dispute are insured patients seeking medical care at Jackson Memorial hospital. UM critics claim that UM physician direct these patients to the UM hospital across the street, and that Jackson Memorial hospital is left with treating the uninsured patients.

Miami-Dade taxpayers pay Jackson Memorial $330 million a year to treat uninsured people who seek treatment in the county-owned Jackson system. As part of the system that has evolved over the years, Jackson also pays UM when its doctors treat the uninsured at Jackson. UM critics also claim that once an uninsured patient gets insurance UM doctors are shifting their care to the UM hospital, which then receives the Medicare reimbursement money. UM calls that patient choice. Jackson counters that its paying patients shouldn't be siphoned off to UM facilities.

What troubles me is that patients are being considered as milkable cash cows and once they lose their production value they are being pushed back into Jackson Memorial Hospital. It's a sick system which encourages overutilization of medical services and drives up healthcare costs even further.

Last Updated on Tuesday, 27 December 2011 20:19
 
Personhood Amendment: Unnecessary Government Intrusion in the Physician-Patient Relationship Print E-mail
Written by Bernd Wollschlaeger, M.D.   
Wednesday, 16 November 2011 12:16

IN MY OPINION


On November 8th Mississippi voters will be asked to decide on a proposed amendment to the state constitution, which would define as a person "every human being from the moment of fertilization, cloning, or the functional equivalent thereof." For most voters it sounds like a good idea and it will most probably pass. Therefore, several other states, including Florida http://personhoodfl.com/, are preparing similar constitutional amendments. Florida Senate Majority Leader and former US Senate Candidate Mike Haridopolos recently signed the FL Personhood Amendment!! The ambiguous language in the Florida and Mississippi 'personhood' amendment are intentionally not being represented properly by the proponents of this ballot initiative.

A recent New York Times article correctly points out the following problems:

"First, what does "fertilization" mean? As embryologists recognize, fertilization is a process, a continuum, rather than a fixed point. The term "fertilization" - which is sometimes considered synonymous with "conception" - could mean at least four different things: penetration of the egg by a sperm, assembly of the new embryonic genome, successful activation of that genome, and implantation of the embryo in the uterus. The first occurs immediately; the last occurs approximately two weeks after insemination (or, in the case of embryos created through in vitro fertilization that do not get implanted, never). Thus, on some reasonable readings of the amendment, certain forms of birth control, stem cell derivation and the destruction of embryos created through in vitro fertilization would seem impermissible, while on other equally reasonable readings they are not."
 

Following the "logic" of the "personhood" advocates, doctors can be charged with manslaughter or even murder by prescribing morning after pills, because it can irritate the lining of the uterus (endometrium) so as to inhibit implantation of a fertilized egg, i.e. "killing a person."  A doctor could also be criminally charged by inserting an IUD because it adversely affects a new embryo as it enters the uterus, thus preventing it from implanting in the uterine lining. Again, according to the "personhood" advocates this constitutes the "killing of a person."Even though, abortions are still being protected by federal law women may still face criminal charges according to state law. 
 
Other unintended consequences include the question if the treatment of an ectopic or a molar pregnancy requires first a court order to overrule a "personhood" amendment in the respective state constitution.  Obviously any delay of these time sensitive treatment decisions may harm the mother and even jeopardize the life and well-being of a woman.

I urge all of you to speak up against any such ballot initiatives, to protect the physician-patient relationship and to guard against further state intrusion into our lives.

Last Updated on Wednesday, 30 November 2011 17:42
 
Pill Mill Update Print E-mail
Written by Jeffrey Herschler   
Thursday, 03 November 2011 09:14

A quick scan of the headlines reveals mostly positive news on the illegal pharmaceuticals front.

Pill Mill Busts from Around the State

However, there are some unintended negative consequences to the Florida clean-up. See Florida's Pill Mill Crackdown Leads to Crime Elsewhere.

Meanwhile Tara Pihn's contribution, I Read the News Today Oh, Boy went viral.

·         Web Visits to FloridaHealthIndustry.com up 48.4%

·         Story picked up by Health News Florida

·         Story read globally; Read in US, UK, Belgium, France, Thailand, India, Canada, Sweden and Switzerland

·         The story was #1 in organic, Google search (Pill Mill + Alt Weeklies) the week of Oct 10th

·         Two related video posts (posted by FHItv on You Tube) scored #3 and #13 respectively while the Health New Florida post garnered a #21 in an organic Google  search October 11

There is increasing evidence that Pain Management Clinics are complying with, at least, the letter of the law.    A review of advertisements and websites reveals that most are insisting on Florida State I.D.s from new patients.  Most clinics have minimum age requirements and some even have Mission Statements posted to their sites.  One clinic boasts that it contracts "a premier health care attorney, and a State of Florida Licensed Risk Manager to support and facilitate ongoing compliance."

Don't crack the bubbly yet.  A quick check of the Pill Mill Barometer (the back pages of Broward/Palm Beach New Times) reveals 36 ads for pain management related services.  This is the same count Tara got when she originally posted her story in late September.   And even more ominously, there is a new advertiser with this headline:  TIRED OF FLORIDA HASSLES.  The new sponsor is located in Tucker, GA.

Last Updated on Thursday, 03 November 2011 09:28
 
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