...A survey by the Kaiser Family Foundation found that (click title to entry - thank you), once again, health insurance premiums rose faster last year than either wages or general inflation. A study by the Treasury Department found that almost half of all Americans below Medicare age have gone without insurance at some point over the last decade.
The Kaiser study, conducted jointly with the Health Research and Education Trust, an affiliate of the American Hospital Association, found that the average premium for a family policy offered at work rose above $13,300 in 2009 — up from $5,800 in 1999. The average employer paid more than $9,800 of that, while the workers contributed more than $3,500. The workers were also hit with larger co-payments and deductibles, while their policies often offered fewer benefits....
There is no way this can be allowed to go on.
The pages 650 through 653 of the House Bill are a completion of the previous provision and it is fairly routine. So the next topic is on page 654 entitled "Public Reporting on Health Care Associated Infections."
Page 655, lines 3 through 18:
‘‘(2) REPORTING PROTOCOLS.— Such information shall be reported in accordance with reporting protocols established by the Secretary through the Director of the Centers for Disease Control and Prevention (in this section referred to as the ‘CDC’) and to the National Healthcare Safety Network of the CDC or under such another reporting system of such Centers as determined appropriate by the Secretary in consultation with such Director.
‘‘(3) COORDINATION WITH HIT.—The Secretary, through the Director of the CDC and the Office of the National Coordinator for Health Information Technology, shall ensure that the transmission of information under this subsection is coordinated with systems established under the HITECH Act, where appropriate.
This is a change in the public reporting by the CDC. The infrastructure already exists through previous 'purpose' and legislation, it a matter of requiring public access to SPECIFICALLY "Nosocomial Infections."
Nosocomial infections are defined as "hospital acquired." See example below:
September 22, 2009
Tales from the C. difficile trenches (click here)
Admitted to hospital for pneumonia, the retired man was visited every day by his wife, who helped feed and care for him. Then he contracted Clostridium difficile from a roommate and had to be transferred to intensive care. His wife was later admitted to another part of the hospital – with C. difficile. She was too ill to visit him as he lay dying and too sick to attend his funeral.
A true story, one that Dr. Michael Gardam tells to bring home the human toll of an infection that is so often transmitted in hospital.
“Things like this happen in hospitals and telling them is how we recognize the impact that hospital-acquired infections can have on patients,” explains the director of infectious disease prevention and control at the Ontario Agency for Health Protection and Promotion....
The reason, of course, for reporting such events publically is to make all the services to patients better. Easy access to immediate information regarding trends in nosocomial infections will allow for better understanding of the pervasiveness in hospitals and how the hospitals that have low rates combat those problems. These efforts lead to lower health care costs and better patient outcomes.
C. difficile is a bacteria that CAN manifest when antibiotics are administered. The reason it occurs with some frequency in hospitals is due to IV antibiotics and the immediate effects on any bacterial infection. Sometimes it is due to the 'strength' of the medication as well and its overall 'spectrum' of infection fighting capacity. Broad spectrum antibiotics are good for 'immediate' care, but, should be substituted as soon as possible with antibiotics that 'specificially' treat the organism causing the infection. There is no need to treat all infections with broad spectrum antibiotics because that is what caused 'super bugs.'
The reason such measures haven't been conducted before is because it is also 'bad advertisement' for hospitals and health care facilities that have chronic issues with nosocomial infections. Where would you like to be treated? In facilities, including MD offices, where there are very low occurrences of these infections or a place with chronic 'sanitary' issues? You know. The 'persistent' dirt in the corners of public bathrooms, including patient rooms, carry all kinds of 'mess' with it. There are some 'dirty' health facilities in this country. So, those that would 'victimize' the public to promote sales of medications wouldn't want BETTER reporting, because, people might actually stay healthy and alive of all things.
You know the Republicans chronically complain about 'tort reform.' It isn't tort reform that is needed and this is a fine example. Why should any law regarding enforcement of high sanitary standards matter if there is no deterrent. Law suits for unnecessary deaths of patients, due to in this instance, hospital acquired infections are a means of deterrent. When the lives of people being treated mean nothing in the way of fiscal losses to practitioners and facilities because tort reform eliminates liabilty, what does that interpret into in 'the real world?' An ethics violation? So. No MD loses their license due to an occassional ethics complaint because a patient died due to a hospital acquired infection. No hospital is closed due to that reason either. BUT. They pay attention to malpractice costs and payments on lawsuits.
HENCE.
A person's life, no matter where they fall into the socioeconomic strata of the USA has definition. If anyone or any entity screws up and costs a person their life, they will lose millions with potential for billions depending on the extent of negligence or malpractice occurring. It is a 'safety' issue. Tort reform isn't about money. Not really. It is about providing a safety net to medical care.
National Briefing South: North Carolina: Settlement For Transplant Error (click here)
Published: Saturday, June 26, 2004
Duke University Hospital has reached an undisclosed settlement with the family of a Mexican teenager who died after being given a heart-lung transplant of the wrong blood type. The girl, Jésica Santillán , 17, died last year, 15 days after the botched transplant....
There are more words to this provision that insures high quality reporting, annual reporting to Congress, noncompliance and implementation.
So you know everyone is on the same page and this isn't 'just my take' on things, page 658, lines 1 through 12:
‘‘(e) HEALTH CARE-ASSOCIATED INFECTION.—For purposes of this section:
‘‘(1) IN GENERAL.—The term ‘health care-associated infection’ means an infection that develops in a patient who has received care in any institutional setting where health care is delivered and is related to receiving health care.
‘‘(2) RELATED TO RECEIVING HEALTH CARE.— The term ‘related to receiving health care’, with respect to an infection, means that the infection was not incubating or present at the time health care was provided.
Page 660. lines 1 through 4:
TITLE V—MEDICARE GRADUATE MEDICAL EDUCATION
SEC. 1501. DISTRIBUTION OF UNUSED RESIDENCY POSITIONS.
Page 666, lines 3 through 13;
‘‘(iii) CONSIDERATIONS IN REDISTRIBUTION.—In determining for which qualifying hospitals the increase in the otherwise applicable resident limit is provided under this subparagraph, the Secretary shall take into account the demonstrated likelihood of the hospital filling the positions within the first 3 cost reporting periods beginning on or after July 1, 2011, made available under this subparagraph, as determined by the Secretary.
"The devil is in the details." This provision allows for redistribution of 'effective' residency programs to hospitals actively engaged in conducting them. There is reporting to the Secretary the number of successful engagement of residencies, including, the inability of any hospital to have a successful program. There is opportunity for hospitals to expand their programs as well. Basically, the Secretary wants to be sure, beside quality programs in the USA existing, that they are actually producing the physicians and surgeons needed in the country. It is a quality assurance issue.
Same page, lines 14 through 20:
‘‘(iv) PRIORITY FOR CERTAIN HOSPITALS.—In determining for which qualifying hospitals the increase in the otherwise applicable resident limit is provided under this subparagraph, the Secretary shall distribute the increase to qualifying hospitals based on the following criteria:
Page 667, lines 1 through 5:
‘‘(II) The Secretary shall give preference to hospitals with 3-year primary care residency training programs, such as family practice and general internal medicine.
The provision is very lengthy. There are many quality assurances to implementation of the provision including increasing exposure of residents to non-hospital settings. It all seemed very appropriate, long overdue and carefully thought out. This is page 686, lines 6 through 10:
TITLE VI—PROGRAM INTEGRITY
Subtitle A—Increased Funding to Fight Waste, Fraud, and Abuse
SEC. 1601. INCREASED FUNDING AND FLEXIBILITY TO FIGHT FRAUD AND ABUSE.
Page 687, lines 12 through 16:
Subtitle B—Enhanced Penalties for Fraud and Abuse
SEC. 1611. ENHANCED PENALTIES FOR FALSE STATEMENTS ON PROVIDER OR SUPPLIER ENROLLMENT APPLICATIONS.
Both these provisions provide for increased 'enforcement' to stop abuse of the new health insurance system. There has to be such enforcement and as time goes forward there will be less and less need for it as it is realized there is little 'profit' in fraud as well as high consequences. This will also expose wasteful spending and will provide a means to lower costs of health insurance. Page 688, lines 5 through 16 provides an over view of the provision:
‘‘(8) knowingly makes or causes to be made any false statement, omission, or misrepresentation of a material fact in any application, agreement, bid, or contract to participate or enroll as a provider of services or supplier under a Federal health care program, including managed care organizations under title XIX, Medicare Advantage organizations under part C of title XVIII, prescription drug plan sponsors under part D of title XVIII, and entities that apply to participate as providers of services or suppliers in such managed care organizations and such plans;’’;
Page 689, lines 11 through 13:
SEC. 1612. ENHANCED PENALTIES FOR SUBMISSION OF FALSE STATEMENTS MATERIAL TO A FALSE CLAIM.
Page 690, lines 15 and 16:
SEC. 1613. ENHANCED PENALTIES FOR DELAYING INSPECTIONS.
Page 691, lines 1 thorugh 7;
‘‘(10) fails to grant timely access, upon reasonable request (as defined by the Secretary in regulations), to the Inspector General of the Department of Health and Human Services, for the purpose of audits, investigations, evaluations, or other statutory functions of the Inspector General of the Department of Health and Human Services;’’; and
The following is a fascinating provision. It regards hospice as a place where quality of care should exist. I remember one of the first 'rantings' of the Republican Right Wing Media was about how the government is going to kill off the aged and dying. Well. It would seem the government, at least the House of Representatives, are more interested in the 'quality of care' provided to those in hospice care. For those in the Right Wing Media that doesn't understand what 'hospice' is? It is the specialized care of the dying. Anytime the Republican Right Wing Media wants to apologize I am sure the nation would be eager to hear it.
Page 692, lines 8 through 24 and page 693, lines 1 and 2:
‘‘SEC. 1819A. ASSURING QUALITY OF CARE IN HOSPICE CARE.
‘‘(a) IN GENERAL.—If the Secretary determines on the basis of a survey or otherwise, that a hospice program that is certified for participation under this title has demonstrated a substandard quality of care and failed to meet such other requirements as the Secretary may find necessary in the interest of the health and safety of the individuals who are provided care and services by the agency or organization involved and determines—
‘‘(1) that the deficiencies involved immediately jeopardize the health and safety of the individuals to whom the program furnishes items and services, the Secretary shall take immediate action to remove the jeopardy and correct the deficiencies through the remedy specified in subsection (b)(2)(A)(iii) or terminate the certification of the program, and may provide, in addition, for 1 or more of the other remedies described in subsection (b)(2)(A); or
Now.
Whom exactly of the Right Wing Media provides QUALITY information? Whom is it that reads every line and understands every word? No one? That would seem to be the 'honest' answer. Whom is guilty AS SIN of lying and deception in the capacity of a licensed media outlet? Hm? Whom might that be? Murdock's tribe? Yeah.
The penalites for actions that jeopardize the care of a hospice patient might be what Murdock's tribe really objects to. Ready? It's interesting. Considering this is in ADDITIONAL to any and all payments a malpractice insurance company has to pay. These penalities aren't covered by insurance, now are they?
Page 693, lines 22 through 25 and page 694, lines 1 through 25 and page 695, lines 1 through 22:
‘‘(b) INTERMEDIATE SANCTIONS.—
‘‘(1) DEVELOPMENT AND IMPLEMENTATION.—
The Secretary shall develop and implement, by not later than July 1, 2012—
‘‘(A) a range of intermediate sanctions to apply to hospice programs under the conditions described in subsection (a), and‘‘(B) appropriate procedures for appealing determinations relating to the imposition of such sanctions.
‘‘(2) SPECIFIED SANCTIONS.—
‘‘(A) IN GENERAL.—The intermediate sanctions developed under paragraph (1) may
include—
‘‘(i) civil money penalties in an amount not to exceed $10,000 for each day of noncompliance or, in the case of a per instance penalty applied by the Secretary, not to exceed $25,000, (if it were me, I'd put no limit on it and put them out of business)
‘‘(ii) denial of all or part of the payments to which a hospice program would otherwise be entitled under this title with respect to items and services furnished by a hospice program on or after the date on which the Secretary determines that intermediate sanctions should be imposed pursuant to subsection (a)(2),
‘‘(iii) the appointment of temporary management to oversee the operation of the hospice program and to protect and assure the health and safety of the individuals under the care of the program while improvements are made,
‘‘(iv) corrective action plans, and
‘‘(v) in-service training for staff.
The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under clause (i) in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). The temporary management under clause (iii) shall not be terminated until the Secretary has determined that the program has the management capability to ensure continued compliance with all requirements referred to in that clause.
‘‘(B) CLARIFICATION.—The sanctions specified in subparagraph (A) are in addition to sanctions otherwise available under State or Federal law and shall not be construed as lim21
iting other remedies, including any remedy available to an individual at common law.
Page 698, lines 17 through 19;
SEC. 1616. ENHANCED PENALTIES FOR PROVISION OF FALSE INFORMATION BY MEDICARE ADVANTAGE AND PART D PLANS
Page 700, lines 21 and 22;
SEC. 1618. ENHANCED PENALTIES FOR OBSTRUCTION OF PROGRAM AUDITS.
Page 701, lines 15 through 17;
SEC. 1619. EXCLUSION OF CERTAIN INDIVIDUALS AND ENTITIES FROM PARTICIPATION IN MEDICARE AND STATE HEALTH CARE PROGRAMS.
Page 702, lines 1 through 25 and page 703, lines 1 through 22;
‘‘(4)(A) For purposes of this Act, subject to subparagraph (C), the effect of exclusion is that no payment may be made by any Federal health care program (as defined in section 1128B(f)) with respect to any item or service furnished—
‘‘(i) by an excluded individual or entity; or
‘‘(ii) at the medical direction or on the prescription of a physician or other authorized individual when the person submitting a claim for such item or service knew or had reason to know of the exclusion of such individual.
‘‘(B) For purposes of this section and sections 1128A and 1128B, subject to subparagraph (C), an item or service has been furnished by an individual or entity if the individual or entity directly or indirectly provided, ordered, manufactured, distributed, prescribed, or otherwise supplied the item or service regardless of how the item or service was paid for by a Federal health care program or to whom such payment was made.
‘‘(C)(i) Payment may be made under a Federal health care program for emergency items or services (not including items or services furnished in an emergency room of a hospital) furnished by an excluded individual or entity, or at the medical direction or on the prescription of an excluded physician or other authorized individual during the period of such individual’s exclusion.
‘‘(ii) In the case that an individual eligible for benefits under title XVIII or XIX submits a claim
for payment for items or services furnished by an excluded individual or entity, and such individual eligible for such benefits did not know or have reason to know that such excluded individual or entity was so excluded, then, notwithstanding such exclusion, payment shall be made for such items or services. In such case the Secretary shall notify such individual eligible for such benefits of the exclusion of the individual or entity furnishing the items or services.
Payment shall not be made for items or services furnished by an excluded individual or entity to an individual eligible for such benefits after a reasonable time (as determined by the Secretary in regulations) after the Secretary has notified the individual eligible for such benefits of the exclusion of the individual or entity furnishing the items or services.
Consumers have to be aware that if an individual or entiry becomes ineligible for payment, they could still be held liable for the costs that cannot be gained from a government program. The Secretary under this provision will notify the people receiving services, but, then they have to stop their patronage, or be personally liable for the cost. This will probably be a matter of a public reporting page on the website eventually. The tricky part is confidentiality and being sure there is accurate information in such an instance.
I am going to end it there. The next major section is on page 704, beginning with lines 17 through 18.
Subtitle C—Enhanced Program and Provider Protections
Regards.
