Category: Uncategorized

Insurance Fraud, Abuse and Waste Could Be Reduced With High Deductible Policies

Dec 1, 2018

By Stephen Schimpff, MD

There is huge amount of money expended in the American health care delivery system – 17% of the GDP. Some of it is diverted through fraud, some is garnered via abuses and a lot is due to waste.

Fraud, abuse and waste are words used by politicians frequently. How much of each is there? Are there straight forward ways to reduce them? Among the best approaches is to enlist the patient as the first line of defense – with high deductible policies.

Not surprisingly fraud is relatively common in healthcare given the huge amount of dollars involved. As Willie Sutton once said when asked why he robbed banks – “That’s were the money is.” A Dallas-area physician stands accused of systematically defrauding Medicare of $350 million largely by excessive or grossly inappropriate referrals to home health agencies. Given all of the rules and regulations, how is it possible that such a gigantic fraud could be perpetrated over a five year period with no one noticing until recently?

The extent of medical fraud is uncertain. Commercial insurers estimate about $60 billion and Medicare/Medicaid estimates about $72 billion or more per year. In 2010 the US government was able to reclaim about $4 billion and convict more than 700 individuals of Medicare fraud and abuse.

How to Win Facebook Friends and Influence People

Dec 1, 2018

By Lois Beckett

Instead of picketing outside company headquarters, an advocacy group is using Facebook ads to try to influence people whose profiles identify them as employees of Freddie Mac or JPMorgan Chase.

The anti-foreclosure ad campaign, which launches today, asks Freddie and Chase employees to talk to their CEOs about a veteran — a former Marine — who’s facing eviction in California.

“This is not any sort of attack on the employees there,” said Jim Pugh of Rebuild the Dream, which is running the ad campaign. “We’re trying to let them know what’s happening.”

The ad that targets Freddie Mac employees features a small picture of CEO Charles Haldeman’s face, and the message, “Freddie Mac did what???? Freddie Mac is evicting a former Marine who’s been trying to pay his mortgage. Tell CEO Haldeman to work out a fair deal with him!” according to a copy of the ad provided by Pugh.

The JPMorgan Chase ad is similar, but with a Chase logo instead of an executive’s face.

We’ve contacted Freddie Mac and JP Morgan Chase spokespeople for comment, and also reached out to Freddie Mac and JPMorgan Chase employees on Facebook. If you’ve seen one of these ads, please let us know.

Targeted online advertising is nothing new. (As anyone who has changed their Facebook status to “engaged” can tell you, a simple update can bring a deluge of new ads.) But political campaigns and advocacy groups are increasingly adopting the same microtargeting tactics that companies use.

Rick Perry’s campaign, for instance, targeted faith-focused ads to people in Iowa who listed themselves as Christians on Facebook, and ads featuring his wife to the state’s female conservatives, Politico reported.

According to FEC data, Endorse Liberty, a super PAC that supports Ron Paul, has led the way on Facebook expenditures, spending a total of $241,508 through January 2012.

And it’s not just Facebook and Google where campaigns and activists are doing microtargeting. The music site Pandora announced last year that it would be selling political ad space targeted to the zip codes of particular listeners, the Wall Street Journal reported.

There’s nothing inherently problematic about targeted ads. Campaigns have been using direct mail to target particular voters for decades. Digital targeting can be a cost-effective way of spending advertising dollars, especially for smaller groups, like Rebuild the Dream, which sees the ads as a great way to get more bang for their buck in terms of reaching their intended audience. (The group also launched a special donation drive specifically for the Facebook ad buy.) ProPublica even used Facebook ads to try to find sources for our 2009 series, When Caregivers Harm.

But as the ability to use data to reach particular people grows more sophisticated, targeting risks crossing privacy lines, as demonstrated by a recent New York Times article on how Target knew a teenage customer was pregnant before her father did.

What’s clear is that if all this microtargeting translates into electoral gains, the scale and sophistication of these efforts will continue to grow, and the data science that gained traction in 2008 will become a regular part of campaigning. In the meantime, the Obama campaign’s already substantial data team continues to hire statistical modeling analysts and analytics engineers.

The increasing ease and flexibility of online targeting also raises new questions about how politicians are presenting themselves to different audiences, how much campaigns need to tell their supporters about the personal information they collect — and what will happen to the massive databases of voter information collected during the 2012 presidential campaign. Will they be sold? Passed on to other politicians?

Rebuild the Dream, which focuses on economic issues, was launched by MoveOn.org in 2011, but has been independent since January, Pugh said. The group’s president is former Obama green jobs adviser Van Jones.

Pugh worked on the Obama campaign’s digital analytics team in 2008 while also trying to finish a Ph.D. dissertation in robotics, and later did similar work for the Democratic National Committee. He said he was not sure what kind of reaction the ads would receive.

“I would imagine that people are fairly used to targeted ads at this point,” he said. But while people who work in politics and advocacy may be used to receiving Facebook ads targeting specific causes, “It’s hard to know in advance how unusual it will seem to the employees of Freddie Mac and JP Morgan Chase.”

This piece first appeared at ProPublica.

Ask Not What Your Dog Can Do for You…

Dec 1, 2018

By Dr. Peggy Drexler

Every day, it seems I read about some wonderful thing our dogs do for us.

They cure our stress, they lower our blood pressure, they help our cholesterol. They find us when we’re lost, they sniff out our diseases, they wake us up in the middle of the night when the couch is on fire. One of them even helped us get Bin Laden.

And, really, I thank them for all of that. I love them dearly.

But love is a two-way street. Generally speaking, a little unreserved and unqualified affection is the least they can do.

With some notable exceptions — like people who shouldn’t even be allowed to own a houseplant and the occasional blood-sport sadist like Michael Vick (and no, I still don’t forgive), dogs have a pretty good deal.

We have two of them. I still find that interesting, because for much of my life, I happily assumed I would never have one. A very determined little girl changed that.

Neither my husband nor I had a dog growing up.

The closest thing to a pet in the home of my fastidious single mother were dust bunnies. I used to name them. My husband grew up in a Bronx apartment so small that his bedroom was a hallway. Not much floor space for a four-legged friend.

Hurdles to Accessing One’s PHI

Dec 1, 2018

By John Moore

What is a fair price to charge a consumer to provide them a copy of their records? That is a question I’ve been pondering since a friend of mine showed me the bill from the local Steward IDN which is owned by private equity fund, Cerebus.

My friend is switching doctors due to a change by her employer in health plans. As a result, she requested a copy of her records to bring with here to her new physician. Seems like a pretty simple, straight-forward request. Steward was more than happy to provide those 10 pages of records and following is the cost breakdown they wished to charge her:

Clerical fee: $18.04

Cost/pg: $0.61

Mailing cost: $1.16

Total Cost: $25.30

Two dollars and fifty cents a page – Outrageous!

When I asked for a full copy of my pet’s records, about 20pgs, the Vet was more than happy to oblige, for free. When I asked for full copy of my car repair records (5yrs worth) as I was selling the car, my local mechanic was more than happy to oblige, again for free. So why is that when one asks for a copy of their medical records, which frankly they already paid for in their office visit charges, a company like Cerebus/Steward feels they have the right to charge such an exorbitant sum? Creating such hurdles to a patient’s ability to access their own personal health information (PHI) does nothing to improve healthcare delivery. Its time to put an end to such charges once and for all.

Sad thing about this whole story though is that under Massachusetts statute, Steward is allowed to charge up to $25.00. They discounted the bill $0.30 and lowered the bill to $25.00 Needless to say, I advised my friend to ignore the bill.

John Moore is an IT Analyst at Chilmark Research, where this post was first published.

IPAB Is Not the Solution

Dec 1, 2018

By Rep. Phil Gingrey

Imagine that your loved one required surgery, yet you were told by the government that the procedure was unnecessary and wouldn’t be covered by Medicare. A Medicare program with the Independent Payment Advisory Board (IPAB) crafted by President Obama ensures that this dilemma will become reality for countless seniors.

Since “ObamaCare” was passed into law, the American people have taken former House speaker Nancy Pelosi‘s advice and looked into the bill — and they don’t like what they see. Broken promises and an enormous price tag merely scratch the surface. Like an onion peeling back, ObamaCare continues revealing new and dangerous layers.

Besides costing our economy $1.8 trillion, raiding the Medicare program and violating our constitutional rights with the individual mandate, ObamaCare’s “cost-cutting” IPAB panel has the power to ration Medicare services for millions of seniors. Unless Congress can find equivalent savings, this 15-member board will mandate automatic Medicare cuts.

As a physician with more than 30 years of experience, I consider the doctor-patient relationship sacrosanct. IPAB is dangerous for many reasons, but above all, it drives a wedge between physicians and their patients. Health care decisions should be weighed carefully by patients, their family members and their doctor — not by Washington bureaucrats.

Without full repeal, this unelected, unaccountable and undemocratic denial-of-care board will shift decisions away from physicians and patients, bypass congressional oversight and focus on slashing Medicare costs instead of improving quality of care.

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Dec 1, 2018

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Is Your Doctor Lying To You?

Dec 1, 2018

By D. Brad Wright

The doctor-patient relationship, like any good relationship, is built on trust. After all, the patient is naturally at the mercy of their physician in most cases, because the physician is the expert. Sure, the patient should have the ultimate say in their care, but the information they are basing their decisions on typically comes from the physician, and they must trust that what they are being told is the truth. Unfortunately, a recent study by Lisa Iezzoni and colleagues finds that doctors aren’t always so honest with their patients.

In a survey of a representative sample of physicians, more than a third of doctors fail to completely agree with the statement “Physicians should disclose all significant medical errors to affected patients.” Nearly one-in-five fail to completely agree with the statement “Physicians should never tell a patient something that is not true.” That’s right, more than 17% of doctors felt that there were times when it was okay to lie to patients.

As for their actual behavior, 11% of physicians reported rarely, sometimes, or often (in contrast to never) telling a patient something that was not true, and 55% reported rarely, sometimes, or often describing a patient’s prognosis in a more positive manner than warranted. Admittedly, the latter case could be perceived as compassionate rather than dishonest depending on the circumstances.

What are we, as patients, to make of these findings? Well, on the one hand, the truth could be even worse than the results suggest because of “social acceptability bias.” In other words, doctors know that admitting to being dishonest isn’t the “right” answer to give, so they may ironically be dishonest about reporting their dishonesty. At the same time, the framing of the results may actually be misleading. By taking four responses (never, rarely, sometimes, and often) and grouping them into two categories (never vs. not never), important information is obscured. If most of the doctors who admit to lying are in the “rarely” category, perhaps that’s not so bad. If, on the other hand, most of them reported lying “often” that’s a little scary. Unfortunately, the way the data are presented, it isn’t clear which is the case. I think it would have been better to put two responses in each category so that “never” and “rarely” were combined and compared to “sometimes” and “often.”

My sense is that doctors, like all people, sometimes lie–perhaps more often by omission rather than commission–but that we should not be too worried about the results of this survey. Don’t assume your doctor is lying to you or that they are always being honest. That’s what second opinions are for.

D. Brad Wright is postdoctoral fellow at Brown University and holds a PhD in health policy and management from the University of North Carolina. He has worked as the Assistant Director of Health Policy for the Association of Clinicians for the Underserved. You can follow him at his blog Wright on Health where this post first appeared.

5 Things Parents Should Look for in Their Children’s Medical Record

Dec 1, 2018

By Alan Greene, MD

Many of us are clueless about the valuable information contained in our children’s medical records. Knowing what’s there can help us make smart decisions; not knowing can leave us navigating in the dark. Getting ahold of your child’s records has never been easier – or more important. It’s powerful knowledge anytime, and all the more so during the holiday travel season when you might be seeing an unfamiliar face in a clinic or ER.

Here are five things I think parents should look for in their children’s medical record and have at their fingertips:

1. BMI Percent – Parents are often stunningly wrong about whether or not their children are at a healthy weight, highlighted by a study released December 2011 in the Archives of Pediatrics and Adolescent Medicine. We are so familiar with our kids – and so many of their peers are overweight – that they often look normal to us even when they are not. And more than 75% of parents of overweight children aged 2 to 15 report never being told the child is overweight by the pediatrician – it can be uncomfortable to talk about and difficult to hear.

But childhood obesity is the great epidemic of our time, one of the biggest threats to our kids’ health. What’s a parent to do?

Know your child’s BMI Percent. The Body Mass Index is a calculation that looks at appropriate weight for height for a given age and gender. If children’s BMI is below the 5th percentile, they are likely underweight. If they are at the 85th percentile or above, they are likely to be overweight. Above the 95th percentile? Obese. Knowledge is the first step toward health.

Republicans Run from Voucher Label

Dec 1, 2018

By Merrill Goozner

What’s in a name? Everything, it would appear, when it comes to describing Rep. Paul Ryan’s plan to privatize Medicare, which the Republican-controlled House of Representatives backed in its budget resolution late last month. The plan would subsidize seniors’ purchase of private insurance plans instead of enrolling in traditional government-financed Medicare, although that would be preserved as an option. The government would finance a portion of the purchase.

Architects of the plan call it “premium support.” Opponents call it a voucher, which they say will over time lag behind medical inflation and force seniors to pay an ever-growing share of their health care bills.

Ten Republicans joined every Democrat in voting against the resolution, which passed 228-191. The Republican apostates abandoned their majority colleagues largely because they were afraid of being tarred with the voucher label during this fall’s re-election campaign.

And it was that label that Republicans on the House Ways and Means health subcommittee repeatedly attacked during Friday’s hearing on the Republican plan, which has not yet been introduced as legislation. Its details have not yet been scrutinized by health care experts or, more significantly, the Congressional Budget Office. “Premium support is not a voucher,” Ryan, R-Wis., said at the hearing.

Will High Court Tamper with Cost-Cutting Reforms?

Dec 1, 2018

By Merrill Goozner

Spending on health care is slowing down – a much-needed development since the nation’s long-term deficit problem is largely tied to projections that spending on Medicare and Medicaid will remain out of control.

But slowdowns have happened before, and there’s no guarantee that this one will last. The Supreme Court in the next few weeks could rule the entire health care reform law unconstitutional, which would be a blow to cost-control efforts since at least some of the recent slowdown is being attributed to delivery system changes sparked by the law.

During the mid-1990s, in the wake of the Clinton administration’s failed health care reform effort, an insurance industry that perceived it had a public mandate to take radical steps to hold down costs switched millions of Americans into health maintenance organizations. They succeeded in holding down costs for a while, but the effort collapsed when patients rebelled against the industry’s ham-handed tactics in denying needed care.

In the 1980s, another period when health care costs were growing faster than the economy as a whole, Medicare switched hospitals to a new payment system known as “diagnostic related groups.” Instead of getting paid a fee for every service or product, hospitals received a set payment for an entire procedure – an appendectomy, for instance, or a heart transplant.