Wednesday, September 09, 2009

Now where did I leave off...

Page 501, lines 17 through 22 and Page 502 entirely and Page 503, lines 1 through 4:

This supports 'quality assurance' and the provision speaks for itself. There is no secret agendas, this provision supports research in seeking better quality to consumers.

TITLE IV—QUALITY
Subtitle A—Comparative Effectiveness Research
SEC. 1401. COMPARATIVE EFFECTIVENESS RESEARCH
(a) IN GENERAL.—title XI of the Social Security Act is amended by adding at the end the following new part:

‘‘PART D—COMPARATIVE EFFECTIVENESS RESEARCH
‘‘COMPARATIVE EFFECTIVENESS RESEARCH
‘‘SEC. 1181. (a) CENTER FOR COMPARATIVE EFFECTIVENESS RESEARCH ESTABLISHED.—
‘‘(1) IN GENERAL.—The Secretary shall establish within the Agency for Healthcare Research and Quality a Center for Comparative Effectiveness Research (in this section referred to as the ‘Center’) to conduct, support, and synthesize research (including research conducted or supported under section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) with respect to the outcomes, effectiveness, and appropriateness of
health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically.
‘‘(2) DUTIES.—The Center shall—
‘‘(A) conduct, support, and synthesize research relevant to the comparative effectiveness of the full spectrum of health care items, services and systems, including pharmaceuticals, medical devices, medical and surgical procedures, and other medical interventions;

This provision is to receive oversight with its own commission. It requires an independant commission because the topic is different requiring different qualification for its members.

Page 505, lines 5 through 14 and Page 506, lines 19 through 24, Page 508, lines 6 through 25 and Page 509 entirely. This is all self explanatory and placed here as reassurance of content.

‘‘(b) OVERSIGHT BY COMPARATIVE EFFECTIVENESS RESEARCH COMMISSION.—
‘‘(1) IN GENERAL.—The Secretary shall establish an independent Comparative Effectiveness Research Commission (in this section referred to as the ‘Commission’) to oversee and evaluate the activities carried out by the Center under subsection (a), subject to the authority of the Secretary, to ensure such activities result in highly credible research and infor14
mation resulting from such research....

...‘‘(G) make recommendations for policies that would allow for public access of data pro21
duced under this section, in accordance with appropriate privacy and proprietary practices,
while ensuring that the information produced through such data is timely and credible;...

‘‘(3) COMPOSITION OF COMMISSION.—
‘‘(A) IN GENERAL.—The members of the Commission shall consist of—
‘‘(i) the Director of the Agency for Healthcare Research and Quality;
‘‘(ii) the Chief Medical Officer of the Centers for Medicare & Medicaid Services;

and ‘‘(iii) 15 additional members who shall represent broad constituencies of stake16
holders including clinicians, patients, researchers, third-party payers, consumers of Federal and State beneficiary programs. Of such members, at least 9 shall be practicing physicians, health care practitioners, consumers, or patients.
‘‘(B) QUALIFICATIONS.—
‘‘(i) DIVERSE REPRESENTATION OF PERSPECTIVES.—The members of the Commission shall represent a broad range
of perspectives and shall collectively have experience in the following areas: ‘‘(I) Epidemiology. ‘‘(II) Health services research. ‘‘(III) Bioethics. ‘‘(IV) Decision sciences. ‘‘(V) Health disparities. ‘‘(VI) Economics.
‘‘(ii) DIVERSE REPRESENTATION OF HEALTH CARE COMMUNITY.—At least one member shall represent each of the following health care communities: ‘‘(I) Patients. ‘‘(II) Health care consumers. ‘‘(III) Practicing Physicians, including surgeons. ‘‘(IV) Other health care practitioners engaged in clinical care. ‘‘(V) Employers. ‘‘(VI) Public payers. ‘‘(VII) Insurance plans. ‘‘(VIII) Clinical researchers who conduct research on behalf of pharmaceutical or device manufacturers.

I can hear the complaints now, "Is all this necessary?"

Ahhhh, yep.

The USA is embarking on providing health insurance for everyone while tightening up the industry with provisions that will serve the best interest of the citizens of this country. Those best interests are a streamlined health care delivery system that is state of the art in quality. Health care is a complex issue, but, it can be made simple if there are experts developing the quality at every turn to be sure no dollars are squandered. Efficient health care delivery not only holds down costs it provides for better quality care. It is my guess each one of the commissions affiliated with the 'start up' of the Bill will dissipate over time and not be necessary.

This provision continues in the 'usual' manner of the Bill in that there are definitions and organizational structure, but, I found this interesting:

Page 520, lines 1 through 8:

‘‘(A) be designed, as appropriate, to take into account the potential for differences in the effectiveness of health care items and services used with various subpopulations such as racial and ethnic minorities, women, different age groups (including children, adolescents, adults,
and seniors), and individuals with different comorbidities; and—

This was also important. There is no direct link to reimbursement for services through the research provision, it is strictly fact finding to bring better quality to the citizens of the country while the Commission reviews any necessary changes to treatment modalities currently in place that research might prove prudent to change.

Page 524, lines 14 through 17:

‘‘(h) CONSTRUCTION.—Nothing in this section shall be construed to permit the Commission or the Center to mandate coverage, reimbursement, or other policies for any public or private payer.’’.

Page 525 begins a provision to increase transparency with Nursing Homes:


Subtitle B—Nursing Home
Transparency
PART 1—IMPROVING TRANSPARENCY OF INFORMATION ON SKILLED NURSING FACILITIES AND NURSING FACILITIES
SEC. 1411. REQUIRED DISCLOSURE OF OWNERSHIP AND ADDITIONAL DISCLOSABLE PARTIES INFORMATION.
(a) IN GENERAL.—Section 1124 of the Social Security Act (42 U.S.C. 1320a–3) is amended by adding at the end the following new subsection:
‘‘(c) REQUIRED DISCLOSURE OF OWNERSHIP AND ADDITIONAL DISCLOSABLE PARTIES INFORMATION.—

Page 527, lines 8 through 20:

‘‘(I) each member of the governing body of the facility, including the name, title, and period of service of each such member; ‘‘(II) each person or entity who is an officer, director, member, partner, trustee, or managing employee of the facility, including the name, title, and date of start of service of each such person or entity; and ‘‘(III) each person or entity who is an additional disclosable party of the facility.

It seems to me this would prevent double dipping by receiving payment through an establishment as an owner or physician while still billing in an individual capacity. Keeps everything honest. There is a provision to allow the Secretary to exempt such information where it is reported on IRS forms.

Just to example page 531, lines 21 through 25:


‘‘(i) a corporation, the officers, directors, and shareholders of the corporation who have an ownership interest in the corporation which is equal to or exceeds 25 percent;

There are directions to make such information available to the public. The transparency will make it easier to enforce the 'ethics' component to the Bill.

Page 536, lines 19 through 24 and Page 537, lines 1 through 7:

‘‘(iii) REQUIREMENTS FOR COMPLIANCE AND ETHICS PROGRAMS.—In this subparagraph, the term ‘compliance and ethics program’ means, with respect to a skilled nursing facility, a program of the operating organization that—‘‘(I) has been reasonably designed, implemented, and enforced so that it generally will be effective in preventing and detecting criminal, civil, and administrative violations under this Act and in promoting quality of care; and

Imagine that. Ethical standards no less. Well. This should be interesting. CEOs of health care industry factilities like to circumvent ethics while replacing it with 'customer care' rituals to distract from any adverse opinion of their institution. Soothing the public with 'customer service' in place of ethical standards allows for greater profits. Oh, yeah. Customer Service and Ethics are totally different dynamics. I mean there isn't strong ethical standards for the guy that changes the oil in your car, but, there certainly are high expectations of Customer Service.

Health Care Industry CEOs learned some time ago, if one can make a nurse and unit secretary to perform like Disney personnel there will be more satisfaction with the facility even when the actual care given is poor. As a matter of fact, there are hospitals in the country that bring in Disney Trained Customer Service experts to train their staff, professional staff as well as housekeeping and dietary workers. It isn't just a matter of making health care palatable, providing 'comfort' allows distraction from the severity of the purpose to hospitalization. Absolutely. Higher degrees of creature comforts and distractions allow for lax standards that aren't under the control of the CEO, prevents lawsuits and brings higher approval ratings by patients and family.

Proven paradigm.

Absolutely.

Why would they do it?

TO BE NICE?

You've got to be joking.

Have a Latte on us for any inconvenience !

There is a hospital in Wilmington, North Carolina that actually stocks 'Customer Care' items in their supply rooms. Why? Because it allows the professional staff the 'ease' of finding a Gas Card or $5.00 voucher for the coffee shop or a $25 Gift Card to Target to present to any disgruntled 'customer' (not patient necessarily mind you) regardless of the reason. And I do mean regardless of the reason. Preceived malpractice? Having to wait in the hallway for an x-ray. They even have 'suggestions based on severity of unhappiness' as to what to give a patient or family. It is unbelieveable. Now I am not talking about the annual Teddy Bear drive for plush animals in the ER to assist with children and their fears. No, no. That isn't it. These are ADULTS in care on the floors and units and their families. Amazing. Along with the paraphernalia to be presented to adults including "Beanie Babies," there is a sheet any professional has to write on regarding the infraction, the item presented and the outcome. Talk about adding paperwork to any professional's work day. Not only that, but, those items are all part of the operating budget of the unit. Spare no expense. I have a feeling all that will change. The health care system run by Capitalists is an amazing institution.

Stop to realize the level of UNETHICAL standard that is. Stop and think about it. It borders on criminality. There are 'strategies' put in place in hospitals by CEOs and Directors of Nursing, etc. to distract anyone receiving services, from their complaints or grievances, regardless of the severity or legitmacy. It is designed to 'undermine' the 'will' of the patient and/or family to achieve a goal. All this is put in place to EFFECT 'certain' opinions. I guess patients and their families are mindless idiots that can be manipulated like marrionets on a string. Talk about insulting. That is American Health Care compliments of Capitalists.

Page 538, lines 5 through 13:

‘‘(III) The organization must have used due care not to delegate substantial discretionary authority to individuals whom the organization knew, or should have known through the exercise of due diligence, had a propensity to engage in criminal, civil, and administrative violations under this Act.

Page 543, lines 1 through 16:

‘‘(iii) REQUIREMENTS FOR COMPLIANCE AND ETHICS PROGRAMS.—In this subparagraph, the term ‘compliance and ethics program’ means, with respect to a nursing facility, a program of the operating organization that—
‘‘(I) has been reasonably designed, implemented, and enforced so that it generally will be effective in preventing and detecting criminal, civil, and administrative violations under this Act and in promoting quality of care; and ‘‘(II) includes at least the required components specified in clause (iv).

I'll end for today after this.

Page 551, lines 6 through 22:

(c) GAO STUDY ON NURSING FACILITY UNDER CAPITALIZATION.—
(1) IN GENERAL.—The Comptroller General of the United States shall conduct a study that examines the following:
(A) The extent to which corporations that own or operate large numbers of nursing facilities, taking into account ownership type (including private equity and control interests), are
undercapitalizing such facilities. (B) The effects of such undercapitalization on quality of care, including staffing and food costs, at such facilities. (C) Options to address such undercapitalization, such as requirements relating to surety bonds, liability insurance, or minimum capitalization.

...until later...

Senator Arlen Spector stared down snarling Right Wing Extremists and now he is looking forward to the President's speech.

I think he says all that needs to be said. The President is speaking tonight and welcoming new ideas while seeking a resolve on the issue.



Posted: Tuesday, 08 September 2009 6:13AM
Specter Ready For Obama's Health Care Speech (click title to entry - thank you)
by KYW's Kim Glovas President Obama is preparing his speech for Wednesday night on health care.

A local Senator believes the president will stand by the public option as part of the package.
Senator Arlen Specter is looking forward to the president's speech before the joint session of Congress. He says the president will use this opportunity to regain control of the debate over health care:
"President Obama is going to lay it on the line that we really need to do something about the rising cost of health care and covering all Americans."
Specter believes the president's plan will include a robust public option, despite opposition from right wing critics. The senator says he hopes President Obama gives Congress guidance in getting a health care package completed soon.
The president's remarks to Congress on Wednesday at 8pm can be heard on KYW Newsradio 1060AM and at KYW1060.com.

To some extent the debate on Health Care and Health Insurance is over. There has been considerable implosion of insurance over the years since 1993. More Americans are uninsured and more have health insurance plans that don't work for them with high deductibles and unrealistic premiums.

There is a hidden PROFIT to providing quality health insurance to all Americans and that was captured by Institute of Medicine at the National Academies of Science in a report they issued in 2003 entitled, "Hidden Costs, Value Lost: Uninsured in America (click here):


Hidden Costs, Value Lost: Uninsurance in America, the fifth of a series of six reports on the consequences of uninsurance in the United States, illustrates some of the economic and social losses to the country of maintaining so many people without health insurance. The report explores the potential economic and societal benefits that could be realized if everyone had health insurance on a continuous basis, as people over age 65 currently do with Medicare.

In the report, the Committee concludes that the estimated benefits across society in health years of life gained by providing the uninsured with the kind and amount of health services that the insured use are likely greater than the additional social costs of doing so. The potential economic value to be gained in better health outcomes from uninterrupted coverage for all Americans is estimated to be between $65 and $130 billion each year.


In the report of 2004, "Insuring America's Health: Principles and Recommendations,: it is stated, "Lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States." It is difficult to believe of the USA, but, it is a fact to realize it is the only industrialized country in the world that allows people to die UNNECESSARY deaths preventable through adequate health insurance.

The report goes on:

"In Insuring America's Health (click here): Principles and Recommendations, the committee offers a set of guiding principles, based on the evidence reviewed in the Committee's previous five reports and on new analyses of past and present federal, state, and local efforts to reduce uninsurance., for analyzing the pros and cons of different approaches to providing coverage. The principles for guiding the debate and evaluating various strategies are:
1. Health care coverage should be universal.
2. Health care coverage should be continuous.
3. Health care coverage should be affordable to individuals and families.
4. The health insurance strategy should be affordable and sustainable for society.
5. Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable.
Although all the principles are necessary, the first is the most basic and important....

Is it such a 'leap' for all to realize there is lost productivity in people chronically left ill or profoundly disabled due to lack of health insurance coverage? I don't care what numbers of uninsured you want to abide by it is a large number of people. People that don't maintain an optimal state of wellness because they have no access to health care that works for them. People choose on a regular basis between health care and maintaining a home.

That is the American Dream?

No.

That is the American Nightmare and it is time to end it.

Current Manned Space Program, Constellation, unachievable.



Panel: No moon or beyond for NASA without new funds (click here)
...After a summer of public meetings and deliberations, the committee, led by former Lockheed Martin chairman Norman Augustine, also endorsed the international space station but offered less support for NASA's Constellation program to develop its next generation of rockets....

...The panel's review found a serious gap between the goals outlined by President George W. Bush in 2004 — to return to the moon by 2020 and eventually send humans to Mars — and the amount of money provided for the task.

And far from finding a way to shorten the gap in America's ability to launch astronauts beyond orbit, the panel said a more realistic time frame is probably seven years, at least.

“The U.S. human spaceflight program appears to be on an unsustainable trajectory,” the panel wrote in its summary report, submitted to the White House and NASA on Tuesday. “It is perpetuating the perilous practice of pursuing goals that do not match allocated resources.”
The panel found that, without $3 billion more annually beginning in next year's budget, NASA would be able to do little more than fly the shuttle through early 2011, extend the nearly completed international space station's lifetime through 2020 and begin planning a heavy-lift rocket that could blast humans and the equipment they would need to the moon....


...Discovery and its crew undocked today (click here) (Tuesday) from the space station, in preparation for their return to Earth Thursday evening. In the meantime, they will be flying more or less in tandem with the station....

One of the first cases Judge Sotomayor will participate is regarding Campaign Financing. See video at bottom of entry.

Should businesses be able to give to politicians? (click title to entry - thank you)
Since Teddy Roosevelt was president, corporate money in federal politics has been restricted by U.S. law. That could change. The U.S. Supreme Court meets Wednesday over whether to overturn two prior rulings. Sparking it all -- "Hillary: The Movie."

Corporate speech is no impediment to democracy

This law has been on the books for years. Why change it now?

The storms are pretty puny after Labor Day. The water vapor will always be an issue. Not enough of it to really maximize any storm.