...When polled, "nearly three-quarters of physicians supported some form of a public option (click here), either alone or in combination with private insurance options," says Dr. Salomeh Keyhani. She and Dr. Alex Federman, both internists and researchers at Mount Sinai School of Medicine in New York, conducted a random survey, by mail and by phone, of 2,130 doctors. They surveyed them from June right up to early September....
The majority in TWO physician opinion polls shows a consistency in favor of the Bill for Reform that includes BOTH private and public options. We need to get this done, the nation is waiting for it. Enough already.
...Overall, a majority of physicians (62.9%) supported public and private options (click title to entry - thank you) (see Panel A of graph). Only 27.3% supported offering private options only. Respondents — across all demographic subgroups, specialties, practice locations, and practice types — showed majority support (>57.4%) for the inclusion of a public option (see Table 1). Primary care providers were the most likely to support a public option (65.2%); among the other specialty groups, the “other” physicians — those in fields that generally have less regular direct contact with patients, such as radiology, anesthesiology, and nuclear medicine — were the least likely to support a public option, though 57.4% did so. Physicians in every census region showed majority support for a public option, with percentages in favor ranging from 58.9% in the South to 69.7% in the Northeast. Practice owners were less likely than nonowners to support a public option (59.7% vs. 67.1%, P<0.001),>
The squeakiest wheel gets the most attention. That would be the case with Health Care Insurance Reform in the USA. In more and more polls across the country there is considerable consent for reform. The poll above is from The New England Journal of Medicine's current issue of September 10, 2009. The country is reconciled to have reform, it is simply the noisest and least informed that are opposed to it.
...On health care reform Rasmussen reveals that a majority of people (51%) (click here) actually support reform as opposed to a minority (46%) that oppose. While Rasmussen still has a "large intensity gap" between the number strongly supporting reform and strongly opposing reform a ABC/Washington Post poll finds that gap closing. The Rasmussen numbers are nearly a new high for support and is tremendous jump from the lows of August when (53%) actually opposed reform...
I left off the review on Page 151, that is more than half way through the proposed legislation.
Page 151, lines 6 through 15 addresses the 'need to know' by the USA government of the nature of facilities that provide Long Term Care. This provision sets up the ability for the GAO (Government Accounting Office) to do so:
(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.
This is a transparency measure so the people of the USA are aware of the structure of their health care system. One cannot sufficiently administer correct policy to reduce costs while still maintaining high quality health care without this information. There isn't anything sinister about it. The tone of the legislature is to empower facilities that provide care to do it well and efficiently.
There are people that need us to pass these bills and provide quality care to them, it's time to get this done and stop procrastinating.
Following these surveys by the GAO, the Comptroller will have 18 months to prepare a report to Congress.
The Bill goes on with its usual definitions, the particulars on the website that will carry information to the health care community as well as the public.
Page 555, lines 20 through 25 state there is going to be important information (of which this is a sample) on the website for consumers to consider when chosing a Long Term Care facility:
‘‘(vi) Summary information on the number, type, severity, and outcome of substantiated complaints. ‘‘(vii) The number of adjudicated instances of criminal violations by employees of a a nursing facility—
The States will be contributing information to the website as well. The surveys will be required to be updated every six months. That means every SNF (Skilled Nursing Facility / Long Term Care Facility) will be required to not only report their facts with the initial survey, but, every six months to maintain and improve on quality of care. There will be no 'flash in the pan' in improvement of care of people just to look good on a survey only to return to bad habits and poorer conditions.
Page 560, lines 20 through 25 and Page 561, lines 1 through 6 states:
‘‘(i) Staffing data for each facility (including resident census data and data on the hours of care provided per resident per day) based on data submitted under subsection (b)(8)(C)(ii), including information on staffing turnover and tenure, in a format that is clearly understandable to consumers of long-term care services and allows such consumers to compare differences in staffing between facilities and State and national averages for the facilties. Such format shall include—
The Bill seeks to be helpful to consumers while empowering them with Federal laws that will require good quality care PERFORMANCE.
Page 568, lines 7 through 18 is to be sure there are provisions that allow the States and Federal government to communicate and develop together web-based information to close the 'gap' to consumers for well informed decisions:
(1) GUIDANCE.—The Secretary of Health and Human Services (in this subtitle referred to as the ‘‘Secretary’’) shall provide guidance to States on how States can establish electronic links to Form 2567 State inspection reports (or a successor form), complaint investigation reports, and a facility’s plan of correction or other response to such Form 2567 State inspection reports (or a successor form) on the Internet website of the State that provides information on skilled nursing facilities and nursing facilities and the Secretary shall, if possible, include such information on Nursing Home Compare.
There is provisions for protections for Whistle Blowers. too.
Page 575, lines 1 through 11:
‘‘(C) WHISTLEBLOWER PROTECTION.— ‘‘(i) PROHIBITION AGAINST RETALIATION.—No person who works at a skilled nursing facility may be penalized, discriminated, or retaliated against with respect to any aspect of employment, including discharge, promotion, compensation, terms, conditions, or privileges of employment, or have a contract for services terminated, because the person (or anyone acting at the person’s request) complained,
The provision is a lot longer than those 11 lines.
Within the reporting the facilities have to perform is the status of the 'staff' of the facility. That status is to be derived from recorded payroll data. The 'measure' of stating the reporting is to be from payroll data is to insure accuracy in reporting. It demands accuracy so a 'source' of auditing can be conducted to be sure the 'patient : professional staff ratio' is best for the residents of that facility. In other words the Bill states clearly where reporting information on exact type of staff is coming from to insure there cannot be any misunderstanding or misreporting. That is the only reason any mention is made of 'payroll data.' It isn't about monitoring what people are paid, so much as whom is getting paid in relation to the capacity they serve the residents.
Page 588, lines 14 through 25 and Page 589, lines 1 through 4 addresses monetary penalites any non-compliance with the law will be rendered. The Bill delineates that there will be penalities and not a suspension of payment of Medicare or Medicaid benefits so there is no undo outcomes to residents depending on the facility. I am sure of the facility is a chronic offender, the facility will face possible sanctions on accepting patients for care with potential of closing their doors. The line has to be drawn somewhere otherwise the Bill becomes meaningless.
SEC. 1421. CIVIL MONEY PENALTIES.
(a) SKILLED NURSING FACILITIES.— (1) IN GENERAL.—Section 1819(h)(2)(B)(ii) of the Social Security Act (42 U.S.C. 1395i– 3(h)(2)(B)(ii)) is amended to read as follows: ‘‘(ii) AUTHORITY WITH RESPECT TO CIVIL MONEY PENALTIES.—
‘‘(I) AMOUNT.—The Secretary may impose a civil money penalty in the applicable per instance or per day amount (as defined in subclause (II) and (III)) for each day or instance, respectively, of noncompliance (as determined appropriate by the Secretary).
This provision of hte bill is quite extensive and spells out all the particulars of the penalities, how the monies will be collected, the participation of the States and so on and so forth. The provision goes past page 606 and it is here I will end for now. I'll return to it later.
Write your legislators and ask to have this Bill moved forward. Thank you.
Have a good day.
