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Saturday, December 04, 2010

Saving Lives and Saving Money

The following is a quote excerpted from a Public Citizen report that looked at the US health crisis.  As we move to the unfolding of health insurance reform in 2011 it is well worth everyone's attention to the issues addressed in this post.
"...the country is in a patient safety crisis, and that medical professionals, lawmakers and regulators must do significantly more to avert it.
The 1999 landmark report, “To Err is Human,” dropped the first bombshell, reporting that between 44,000 and 98,000 Americans die in hospitals each year from medical mistakes, costing an estimated $17 billion to $29 billion annually. HHS’ new finding that medical mistakes kill 15,000 Medicare patients a month equates to 180,000 Medicare deaths per year - more than the IOM’s estimate, which attempted to cover all patients in the United States. That means that the annual death toll in this country caused by mistakes in hospitals is well over 250,000 deaths a year! But perhaps the most startling finding by HHS is that a significant number of patients suffered injuries or died needlessly, as 44 percent of the medical errors were preventable."
One of my clients recently saw the writing on the wall when he went for his regular lab work, as he is an organ transplant recipient. transplant.  The lab removed many of the tests on his doctor's order, and he will not be able to get them routinely because of program changes.

As this moves further along we see that the "advance care planning" portion is in a rule from US Department of
Health & Human Services, Centers for Medicare & Medicaid (CMS) here:
[NOTE: link went inactive following 11/29. As of 12/1 the document is available at

SOURCE: Just when you thought the American people had dodged the death panel bullet (Section 1233 of the House bill), think again. Last Monday, November 29, 2010, /The Federal Register/ (page 73406) published a new funding rule for "voluntary" advance care planning consultations that changes US Department of Health and Human Services regulation pertaining to Medicare and Medicaid patients.

The new regulation states that advanced care planning consultations will now be offered (and funded) as part of the initial wellness visit for medicare patients and during all subsequent annual visits.

The Federal Register provides a uniform system for making available to the public regulations and legal notices issued by Federal agencies. Agency proclamations having general and legal effect are required to be published by act of Congress.

Has there been any media attention to this important change in health care coverage for all those receiving medicare and medicaid services" You will recall the uproar about death panels, but this week funding for these consultation sessions became part of general government regulations without fanfare.

Ione Whitlock is Chief of Research at LifeTree. On our current homepage she discusses these new Federal Regulations. Also posted there is her new essay titled "Heads up: Section 1233 again."

Ione discusses Congressman Earl Blumenauer's bill -- HR 5795 -- which was introduced this summer after passage of the health care bill, and two matching bills which were introduced in 2009 by Senator Rockefeller and Congressman Blumenauer. All these bills seek grants for programs to expand or enhance existing state programs for orders regarding life sustaining treatment (POLST).

One of the main goals of this legislation is to fully implement the POLST form into our health care system. POLST stands for Physician's Orders for Life Sustaining Treatement. It comes in many flavors including MOST, MOLST, POST and TPOPP, depending on the location.

Government funds will be used to educate "providers" who will work with the patients, their families and surrogates in filling out the POLST forms. They will learn the so-called "best practices" for discussing end-of-life care with dying patients and their loved ones. These funds will ensure that the POLST forms are recorded electronically.

Note: For more information on the history and implications of POLST, see "POLST: 'Self-Determination' or Imposed Death" in LifeTree's Resources section.

New CMS Rule Establishes "Voluntary" End-of-Life Consultations

Americans weary of "voluntary" TSA pat-downs and full-body scans will be delighted to learn that "voluntary" end-of-life consultations are in their future as well.

The US Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) has made it official: The "advance care planning" funding that would incentivize "voluntary" end-of-life counseling will be included in Obamacare. This funding was part of what was in the controversial "Section 1233" earlier this year. See more
extensive discussion in our alert below, posted last week.

The new CMS rule as printed in the Federal Register (Vol. 75, No. 228, Book 1) online at
Discussion on "voluntary advance care planning" begins on page 73406.

posted 12/1/10 by IW
Heads up: Section 1233 again.

Last March Nancy Pelosi told the American people that she and her colleagues "have to pass the bill so you can find out what's in it." Americans had already seen one part of the proposed healthcare legislation, and didn't like what they saw: The infamous Section 1233 of HR 3200 would have federalized "voluntary" end-of-life "consultations."
The section was eventually dropped.

It appears that Section 1233 is still alive and kicking.

The "advance care planning" portion is in a rule from US Department of Health & Human Services, Centers for Medicare & Medicaid (CMS) here:
[NOTE: link went inactive following 11/29. As of 12/1 the document is available at

The POLST part is included in pending legislation, HR 5795 "Personalize Your Care Act of 2010." See
which is a link to all the information about this bill and the actual text as a pdf at

CMS posted the preliminary rules on Election Day; formal rules are to be published in the Federal Register on November 29. The rules include a discussion of the definition of "voluntary," although some of the more nuanced meanings of "voluntary" may have been missed (just ask any recipient of a "voluntary" TSA pat-down). The rule also includes a discussion of signature requirements for "orders" versus "requisitions" in context of diagnostic tests. The American Bar Association's Charles Sabatino, who supported Section 1233, calls the new rules "a big step forward."

Congressman Earl Blumenauer (D-OR) introduced HR 5795 this past July. It is a revised version of the legislation that he and Senator Rockefeller (D-WV) introduced last year. Blumenauer introduced HR 2911, and Rockefeller introduced S. 1150 in 2009, both titled "Advance Planning and Compassionate Care Act of 2009". Both bills included:
    * Section 211 (Advance Care Planning) was almost identical to Section 1233 of HR. 3200 " the section that was dropped from the  final bill signed in March.
    * Section 112, which would have provided funding to expand POLST.

It is Section 112 of the Rockefeller and Blumenauer bills (S 1150 and HR 2911) that is now Section 3 of HR 5795. Portability of advance directives and standards for electronic health records are also addressed in HR 5795.

Blumenauer is the congressman most often associated with POLST He is, incidentally, an advocate of legalized assisted suicide, and Rockefeller has spent decades trying to push through legislation on behalf of the organizations that evolved from the Euthanasia Society of America.

Shortly before the election, Blumenauer told a radical pro-assisted suicide group that he had reintroduced what had been known as the "death panel" legislation. He complained that Section 1233 had been dropped due to "organized opposition" from "all of the Sarah-Palin-Fox-News-tin-foil-hat" people, but "it's not stopping us from moving forward." Over the summer he had reintroduced the bill with a new name: the "Personalize Your Care Act of 2010" (HR 5795).

"Personalize" leaves the impression that this bill might put medical treatment decisions back in the hands of the individual, keeping the discussion between patient and physician. It implies that the patient might as easily "choose life" as to forgo treatment. This is pretty slick marketing, considering it is coming from the same Oregon liberals
who pushed not only assisted suicide, but rationing for "equitable distribution of resources" for "the common good." The bioethicists at Oregon Health & Science University (OHSU) who devised the "citizen parliaments" that gave Oregon its rationing scheme are some of the same bioethicists who put the fine tuning on POLST.

Blumenauer, in his remarks to the Oregon activists, went on to say that Oregon leads the way in health reform. Well, yes. Oregon health care is infamous for two things: assisted suicide, and rationing. Blumenauer's bill would impose both on the whole country.

Note: For more information on the history and implications of POLST, see "POLST: 'Self-Determination' or Imposed Death" in LifeTree's Resources section.
posted 11/24/10 by IW, revised 12/2/10 by IW

The Six Parts of the Deficit Commission's Plan for Medicare Reform Through 2020
Part #1— Reform the Medicare Sustainable Growth Rate ($26 Billion Savings)
Freezing physician pay reductions through 2013 and a one percent cut in 2014. Additionally it recommends developing a new pay formula based on care coordination and quality instead of quantity of services.
Part #2— Reform or Repeal the CLASS Act ($76 Billion Cost)
The attempt as part of the health care overhaul to address the need for residential long-term care through a voluntary insurance program is criticized as financially unsustainable under its current format.
The recommendation is for complete overhaul or repeal (the preferred option) even with a price to be paid. This is because the collection of premiums over the first five years would have provided positive cash flow.
Part #3— Medicare and Other Health Care Revisions for 2012-2020 ($316 Billion Savings)
The commission proposes the following:
  • $9 billion in waste, fraud and abuse will be saved by increasing the authority and resources of the Centers for Medicare & Medicaid Services (CMS).
  • $110 billion by introducing a simple annual deductible of $550 for Part A and Part B and 20 percent Medicare co-pays, with a cap of $7,500.
  • $38 billion through Medigap supplemental insurance reform. Eliminating coverage for the first $500 and restricting coverage to 50 percent of the next $5,000 in cost sharing. As a stretch into dangerous political territory the commission recommends the same treatment for Tricare (military version of Medicare) and federal retirees.
  • $49 billion from treating Medicaid drug rebates in the same way as Medicare for those eligible for both programs.
  • $60 billion by reducing excess payments to teaching hospitals to 120 percent of the national average salary for residents.
  • $23 billion from ceasing payment for unpaid Medicare deductibles and co-pays.
  • $9 billion by bringing forward, by two years, plans to change reimbursements for home health providers.
  • $18 billion by introducing a change in the Federal Employee Health Benefit program and providing a fixed subsidy. The commission also recommends evaluation of the program to determine, based on the experience with FEHB reform, whether a voucher system could work for Medicare.
Part #4— Aggressive Implementation and Expansion of Payment Reform Pilots
The commission sees opportunities to expand programs aggressively where there is evidence of cost control, without need for additional Congressional approval. Note that this expansion will not be at the cost of providing quality care.
Part #5— Eliminate Provider Carve-Outs from IPAB
This recommendation allows the Independent Payment Advisory Board (IPAB) to include provider groups, such as hospitals, within its authority to recommend changes in revised payment policies.
Part #6— Establish a Long-Term Global Budget for Total Health Care Spending
This requires establishing a total federal health care budget and limiting growth to GDP plus 1 percent with a process to review spending. It additionally requires structural reforms if the spending exceeds the targets. The commission also said that if spending continues to grow, tax benefits for employer provided health insurance should be eliminated.

1 comment:

deal said...