Assignment 3 for my students - The plot thickens

My personal learning network fed me many ideas recently. Tonight President Obama will make his annual State of the Union address. We will certainly hear more calls for cooperation between the political parties in Congress, particularly as related to healthcare reform. The major provisions of the Affordable Care Act are taking effect now. CMS (Centers for Medicare and Medicaid Services) and the Department of Health and Human Services (HHS) are quite fully engaged now in efforts to implement the new law.

http://www.cms.gov/

http://www.hhs.gov/>

This article in Modern Healthcare helps scope out the issues right now.

http://www.modernhealthcare.com/article/20140111/MAGAZINE/301119978/outlook-2014-obamacare-sgr-repeal-icd-10-and-payment-cuts-top-the

http://en.wikipedia.org/wiki/Medicare_Sustainable_Growth_Rate

The heat is on. Physicians and other providers are under financial pressure, legal requirements, and the need to integrate information technologies. People will begin to experience the new "system" as patients very soon. There will be problems. Anything this big and complex is going to have problems. Many states, including Georgia, are not expanding Medicaid coverage. Doing so was part of the "magic," but the Supreme Court ruled that the federal government cannot force the state governments to expand Medicaid, even if most of the money comes from the federal government.

Students, in commenting to this post, please review the information in this post (including the links above) and address at least one aspect of what is going on right now. Watch or listen to the President's address if possible. It will be available on YouTube. The President's concern has to be that a sufficient number of Democrats in Congress and going to get "cold feet" and begin to side with Republicans on some of these issues. It is difficult to "see the entire picture." At least take one aspect of it and comment about how you see things here, please.

Assignment Blog 2 for my students

"Modern Healthcare" recently reported the closure of Interfaith Medical Center in Brooklyn, New York. Interfaith Medical Center, like Grady Memorial Hospital in Atlanta, is/was a large "safety-net" hospital. Interfaith primarily treated patients on Medicaid and uninsured patients. It has been in financial strain for some time.

http://www.modernhealthcare.com/article/20140118/MAGAZINE/301189967?AllowView=VXQ0UnpwZTVDL1dXL1I3TkErT1lBajNja0U4VUMrZFZFQk1HQXc9PQ==

The question, of course, becomes, where will those patients now received needed medical care. At least two things catch my attention in this regard. The first is that this hospital may have survived had "Obamacare" been implemented sooner. In other words, by participating in the exchanges and tapping federal revenues available to help people afford health insurance, the patients served by Interfaith would have had more resources to be spent for medical care. Also, the hosipital itself apparently could have sponsored its patients by paying their premiums for insurance under the new laws and policies.

The article notes that hospitals with high debt, low occupancy and less acutely ill patients are more likely to close. Well, under the new law, if Interfaith Medical Center had become part of an Accountable Care Organization, perhaps more of its revenues whould have come through capitation and its low occupancy rates would not have been a major problem.

This bring up the question of the role of hospitals (and safety net hospitals in particular) in the future of healthcare delivery in the United States. Many people see hospitals as the "hubs" of Accountable Care Organizations (ACOs). Others see a more fluid situation in which ACOs are not dependent upon hospital systems as "hubs."

It seems to me that to effectively protest the closing of a major safety net hospital requires more than a wish to return to the past. An effective protest, I think, requires an understanding of the future of healthcare delivery in the United States. Without that understanding, then it is not possible to anticipate how existing institutions can fit into the new realities and survive.

Students, please see what you can find regarding safety net hospitals and Accountable Care Organizations and then reflect upon the situation reported in this recent article in Modern Healthcare. Comment here, as before.

New Post 1 for my new students

There was a report issued in Modern Healthcare yesterday titled, "AMA fears privacy loss as Medicare moves to reveal Doc pay." I became aware of this because my own personal learning network brought it to my attention this morning.

http://www.modernhealthcare.com/article/20140114/NEWS/301149951/medicare-to-disclose-physician-reimbursement-data?AllowView=VXQ0UnpwZTVDL1dhL1IzSkUvSHRlRU9vamtnZEErTmM=

In the article Joe Carlson discusses the balance between the privacy interests of physicians and the value of transparency regarding the incomes that physicians receive for services provided to their patients who have Medicare benefits. When values are in competion with each others reasonable people can certainly disagree about the nature of the "balance" between or among the values. The following statement in the news report caught my eye.

"The American Medical Association is warning that the Obama administration could violate physicians' privacy rights if it poorly implements its new policy for informing the public how much money Medicare pays to individual doctors."

The part of that statement that I notice in particular is the, "if it poorly implements" its new policy.

There is, of course, wide-spread and strongly felt opposition to the entire policy commonly known as "Obamacare." Some of that opposition is grounded in personal philosophies about the nature of freedom and the role of government. There is a substantial fundamental mistrust of central government that goes back to prior to the founding of our nation. A part of that is a pervasive belief that large governments do not have the capacity (ability and competence) to implement complex programs. Even those of us who generally favor what the new Affordable Care Act intends have concerns about the ability of "bureaucrats" to make it work well. The clumbsy roll out of the healthcare.gov website is an example that for various reasons government agancies often appears to be able than other kinds of organizations. Basically, what I see is a vicious cycle of public mistrust creating constraints upon agencies which cause agencies to appear inept that then feeds back into public mistrust and perceptions that government employees are less than fully competent.

The facts are that policy implementation is often very difficult and that implementation of "Obamacare" is a minefield of challenges because of its complexity.

I honestly don't know how to balance the privacy concerns of physicians with the need for the system to be "transparent." I do think that to the degree that being a physician is becoming more "bureaucratic," physicians are opting for early retirements. I am concerned that going forward the shortage of physicians is likely to increase.

I am here asking my students to repond to this post by sharing their opinions and insights about these things. How do the competencies of administrators affect the ability of medical providers to deliver care to large populations of people? Is it possible that "Obamacare" is so bold an initiative as to be impossible to implement effectively? I ask that my students include a link in their reply to some other relevant online resource.