PNHP

CMS requirements for medical suppliers – a bureaucratic boondoggle?

CMS requirements for medical suppliers – a bureaucratic boondoggle?

Change in law costs medical supply firms

By Karen Shideler
The Wichita Eagle
January 8, 2009

Businesses that provide durable medical equipment, such as hospital beds and bottled oxygen, are being hit by more paperwork and new costs because of new federal requirements.

The Centers for Medicare and Medicaid Services are requiring most durable medical equipment suppliers to post a surety bond of $50,000 and to be accredited.

The federal requirements are, in part, the result of efforts to fight Medicare fraud and abuse. Medicare recently announced that it was revoking billing privileges of more than 1,100 medical equipment suppliers in south Florida and the Los Angeles area after an investigation found about $1 billion in improper payments.

In a news release, CMS acting administrator Kerry Weems said, “We know the majority of medical equipment suppliers and health care providers want to improve the health of Medicare beneficiaries, but we also know there are those who look for any opportunity to take advantage of beneficiaries and Medicare.”

“It’s more work and, let’s face it, it’s money out of our pocket,” said Leon Deaver, owner of Kimzey-Eilert Medical Supplies.

Bruce Schneider, owner and pharmacist at Hart Pharmacy & Home Medical Equipment, estimated the new requirements will cost him $20,000.

Brian Dechant, director of sales at Therapeutic Medical Supply, said the accreditation requirement doubles or triples the amount of paperwork required.

“If you’re running your operations like you should be, it’s not a real big thing,” Dechant said. He said his company was recently accredited for a three-year period. “It requires you to follow a certain set of standards… They review them, make sure everything’s kosher, then they actually look at our processes.”

Schneider said he has seen estimates that 28 percent of medical equipment suppliers nationwide could be out of business a year from now because of the new requirements.

But he and Dechant both said they expected the number in Wichita to hold steady. “We’re generally honest, good people,” Dechant said.

He, Schneider and Deaver all said the new requirements aren’t all bad.

For Schneider, they’ve resulted in some streamlining.

Deaver said they should help assure customers, too.

“We’re taking a very positive attitude, that it will help us do things better,” he said.

http://www.kansas.com/business/health-care/story/655455.html

Comment:

By Don McCanne, MD

A frequent complaint about government financing of health care is that government bureaucrats place an excessive administrative burden on the health care delivery system. This charge has already been refuted by studies demonstrating the much greater administrative excesses and waste of the private insurance industry when contrasted with a public program such as Medicare.

Nevertheless, when the government introduces a program to improve value in health care purchasing, such as this program to accredit medical equipment suppliers, howls of protest arise from the anti-government forces. This article on “more paperwork and new costs because of new federal requirements” provides these protesters with more support. Or does it?

It is only natural that honest businessmen who are trying to provide quality products and services would be annoyed with new government requirements. But they understand that the taxpayers should not be expected to pay a billion dollars to crooks that permeate their own industry. They also admit that these new requirements “aren’t all bad,” that they have motivated “some streamlining,” and that they will help “assure customers” of the integrity of this industry that has been given a black eye by the the nefarious element amongst them.

How would the private insurance industry have handled this? Would they have used their very large pool of administrative funds to require accreditation and surety bonds of the suppliers? No. They use their administrative funds to write and market innovative plans that don’t even cover these supplies and services. When they do provide this coverage with premium plans, they burn up more administrative dollars to be sure that they sell these more comprehensive plans only to those healthy individuals who would be less likely to need these benefits. An obvious irony is that these administrative costs for the private insurers are much greater than would be a program of accreditation and surety bonds.

Never fear. As with other Medicare administrative efficiencies, the private insurers will get a free ride by using the Medicare lists of accredited suppliers. Once again, the taxpayer foots the bill, while the private insurers take their spoils to the bank.

Conyers: Obama should not nominate Sanjay Gupta

By Sam Stein
Huffington Post
January 8, 2009

Rep. John Conyers has written a letter to Democratic colleagues urging them to join him in publicly opposing the nomination of Dr. Sanjay Gupta for Surgeon General.

Conyers, the veteran Judiciary Committee chairman, writes that Gupta “lacks the requisite experience needed to oversee the federal agency that provides crucial health care assistance,” and requests that fellow Democrats join him “in signing a letter to President-Elect Barack Obama that Dr. Sunjay Gupta not be nominated for the post.”

Here’s the bulk of the Dear Colleague letter:

“I join in opposition with respected Noble Peace Prize award wining economist Paul Krugman, who has very serious concerns with having Dr. Gupta be the nation’s Surgeon General. […]

“Also, there are highly experienced medical professionals who question whether Dr. Gupta has the necessary experience or even the medical background to be in charge of some 6,000 physicians or more who work in the United States Public Health Service. Gerard M. Farrel, executive director of the Commissioned Officers Association, stated in the January 7, 2008, Washington Post that Dr. Gupta will certainly face a ‘credibility gap’ because he never served in the National Health Service Corps, and furthermore, does not have the ‘experience or qualifications to be the leader of the nation’s public health service.’ Clearly, it is not in the best interests of the nation to have someone like this who lacks the requisite experience needed to oversee the federal agency that provides crucial health care assistance to some of the poorest and most underserved communities in America.”

Conyers’ letter represents one of the first critical takes on the potential Gupta nomination to come from the Hill. In most quarters, reports about the CNN medical correspondent have been greeted as a smart, if not provocative, pick. Howard Dean, a doctor himself, noted that Gupta’s responsibilities would be much the same as those in his current job: explaining medical issues of public concern in a manner that the public could understand.

Outside of government, however, some have begun questioning whether the CNN correspondent has the proper qualifications to be Surgeon General. Krugman, in his post noted that Gupta accused filmmaker Michael Moore of inaccuracies, “when the truth was that on every one of the allegedly fudged facts, Moore was actually right and CNN was wrong.” Gupta and CNN would later acknowledge making a mistake and apologize on air. Others have questioned whether he is the right conduit for Obama’s health care agenda, and whether or not he has ethical conflicts of interest stemming from the corporate sponsors of his show.

But while Conyers and these individuals have doubts, it’s unclear whether the post of Surgeon General will elicit much of a fight, since no Senators (who must confirm the nomination) have spoken critically of Gupta.

UnitedHealth's Evercare

Is Texas looking out for you? Health-care outsourcing is rolling on, but many patients suffer from silent treatment

By Gregg Jones
The Dallas Morning News
January 4, 2009
(UnitedHealth’s) Evercare of Texas was supposed to coordinate medical and long-term care for more than 80,000 elderly, blind or disabled North Texans. “We help make it easier to get the care you deserve,” the company promises on its Web site.
For many Texans, it hasn’t worked out that way.
“They ought to call them ‘Nevercare,’ ” said (Mary) Hunt, among the hundreds of people who have complained about denied or delayed medical care.
Evercare’s health management program is just one of a growing list of outsourcing efforts embraced by Gov. Rick Perry and the Texas Legislature as a way to save money while still delivering state-funded care. But rather than providing a surrogate safety net, private contractors have failed needy Texans and taxpayers.
Texas is near the bottom among the 50 states in per-capita spending on health and human services, but it is a leader in outsourcing these functions to private contractors. Since taking office in 2000, Perry has pushed some of the nation’s most ambitious outsourcing endeavors, going well beyond his predecessor, George W. Bush.
“We have a leadership that believes the private sector does things better,” said Celia Hagert, senior policy analyst and privatization expert at the Center for Public Policy Priorities, a nonpartisan research group in Austin.
“Whether it’s ideology or philosophy — simply believing that people shouldn’t be on these programs in the first place — these things have combined to create a very stingy social safety net system in Texas.”
Since 2000, the Texas Department of Insurance has fined UnitedHealth or one of its units seven times totaling more than $10 million for violations involving claims payouts, reporting requirements and other problems.
Texas doctors have long complained about UnitedHealth and its handling of claims under employer-provided insurance plans.
“They’re dishonest, and they’re sneaky,” said Dr. William Walton, a family doctor in North Dallas. “If you’re not really on top of it, you’ll lose lots of money working with United Healthcare.”
The fines haven’t changed UnitedHealth’s way of doing business, he said, adding, “That’s just a cost of business in their eyes.”
http://www.dallasnews.com/sharedcontent/dws/news/texassouthwest/stories/DN-son1mainbar_04pro.ART.State.Edition2.4a74df6.html

So, another ho-hum report on the bad behavior of a private insurer. And more fines that for these insurers are only a nominal and routine part of doing business.
Is this really the way we should be financing care in the United States? Set up rules for the private insurers and then rap their knuckles when they misbehave?
And the next step in reform? Not only more rules and more knuckle rapping for the private insurers, but now new rules and new knuckle rapping for the tens of millions of uninsured individuals who cannot afford to purchase private health insurance.
Does our new political leadership share the fantasies of Bush and Perry that the private insurance sector does things better? Hopefully not, but it’s looking more and more like they do. Establishing a single payer health financing infrastructure would automatically eliminate these perversities. Why has that been taken off the table?

UnitedHealth's Evercare

Is Texas looking out for you? Health-care outsourcing is rolling on, but many patients suffer from silent treatment

By Gregg Jones
The Dallas Morning News
January 4, 2009

(UnitedHealth’s) Evercare of Texas was supposed to coordinate medical and long-term care for more than 80,000 elderly, blind or disabled North Texans. “We help make it easier to get the care you deserve,” the company promises on its Web site.

For many Texans, it hasn’t worked out that way.

“They ought to call them ‘Nevercare,’ ” said (Mary) Hunt, among the hundreds of people who have complained about denied or delayed medical care.

Evercare’s health management program is just one of a growing list of outsourcing efforts embraced by Gov. Rick Perry and the Texas Legislature as a way to save money while still delivering state-funded care. But rather than providing a surrogate safety net, private contractors have failed needy Texans and taxpayers.

Texas is near the bottom among the 50 states in per-capita spending on health and human services, but it is a leader in outsourcing these functions to private contractors. Since taking office in 2000, Perry has pushed some of the nation’s most ambitious outsourcing endeavors, going well beyond his predecessor, George W. Bush.

“We have a leadership that believes the private sector does things better,” said Celia Hagert, senior policy analyst and privatization expert at the Center for Public Policy Priorities, a nonpartisan research group in Austin.

“Whether it’s ideology or philosophy — simply believing that people shouldn’t be on these programs in the first place — these things have combined to create a very stingy social safety net system in Texas.”

Since 2000, the Texas Department of Insurance has fined UnitedHealth or one of its units seven times totaling more than $10 million for violations involving claims payouts, reporting requirements and other problems.

Texas doctors have long complained about UnitedHealth and its handling of claims under employer-provided insurance plans.

“They’re dishonest, and they’re sneaky,” said Dr. William Walton, a family doctor in North Dallas. “If you’re not really on top of it, you’ll lose lots of money working with United Healthcare.”

The fines haven’t changed UnitedHealth’s way of doing business, he said, adding, “That’s just a cost of business in their eyes.”

http://www.dallasnews.com/sharedcontent/dws/news/texassouthwest/stories/DN-son1mainbar_04pro.ART.State.Edition2.4a74df6.html

Comment:

By Don McCanne, MD

So, another ho-hum report on the bad behavior of a private insurer. And more fines that for these insurers are only a nominal and routine part of doing business.

Is this really the way we should be financing care in the United States? Set up rules for the private insurers and then rap their knuckles when they misbehave?

And the next step in reform? Not only more rules and more knuckle rapping for the private insurers, but now new rules and new knuckle rapping for the tens of millions of uninsured individuals who cannot afford to purchase private health insurance.

Does our new political leadership share the fantasies of Bush and Perry that the private insurance sector does things better? Hopefully not, but it’s looking more and more like they do. Establishing a single payer health financing infrastructure would automatically eliminate these perversities. Why has that been taken off the table?

Memo to Obama: Seize the Moment for National Health Insurance

By John Geyman, MD
Tikkun magazine
January-February 2009

First off, congratulations to you and your party on your sweeping election results!

Together with a sizable majority of Americans, I am again hopeful for the future of our country. My special concern, however, is for our failing health care system and how it is pricing health care beyond the reach of ordinary Americans. Our system has come to the point where none of the many incremental reforms will work. The business model of insurance has failed, and we need to rebuild the system on a social insurance model.

Let me be direct. Although we have many dedicated health professionals, an abundance of the latest technologies, and many fine hospitals, health care has become just another commodity to be bought and sold in a deregulated market based on ability to pay, not medical need. As you well know, industry profits handsomely from the status quo, raking in money through insurance, pharmaceuticals, medical devices, and so on. Industry has a war chest to defend itself and demonstrates its political power each time any new reform is brought up.

But the situation has become dire. There is no end in sight in controlling health care costs as they soar upwards at three or four times the cost of living and family incomes. We have had three decades of incremental attempts to rein in costs, including managed care and consumer-directed health care. None have worked. We have a solution in plain sight — single-payer National Health Insurance (NHI). Market stakeholders are fighting it fiercely, but it’s the only real reform that has a chance to work.

Most of your advisers will likely caution you that NHI is too radical for Americans to accept, that you need to be more centrist, and that it is not politically feasible. But therein lies your trap. You will be persuaded to add one more incremental attempt to fix things, which will not work, will cost more than ever, will delay real reform, and will add to the pain of so many along the way. Your moment of opportunity will have been lost.

Beyond ideology, these facts support NHI as the treatment of choice in 2009.

* Premiums alone for private health insurance have grown by more than 100 percent since 2000, and are projected to consume all of average household income by 2025, clearly an impossibility way before then.

* According to the Milliman Medical Index, the typical American family of four spent $15,600 on total health care costs in 2008, fully one-quarter of the typical combined family income of $60,000; most consider 10 percent of family income to be the threshold of underinsurance.

* The administrative overhead of private insurers is five to nine times higher than not-for-profit Medicare (average for commercial carriers 19.9 percent, investor-owned Blues 26.5 percent, Medicare 3 percent).

* The inefficiency and bureaucracy of our 1,300 private insurers are not sustainable (e.g., according to the Blue Cross Blue Shield Association, there are 17,000 different hea1th plans in Chicago).

* Private insurers offer much less choice than traditional Medicare; there are near-monopolies in 95 percent of HMO/PPO metropolitan markets, enough to trigger anti-trust concerns by the United States Department of Justice.

* Because of costs, about 75 million Americans are either uninsured of underinsured, with large segments of the population forgoing necessary care and having worse health care outcomes; the United States now ranks nineteenth among nineteen industrialized countries in reducing preventable deaths from amenable causes.

* Wall Street is already questioning the future prospects of the private insurance industry; as of November 18, 2008, the average share prices of the top five private insurers were down by between 60 percent and 77 percent, compared to the Standard and Poor’s 42 percent.

I expect that none of this is news to you, but what is neglected by almost all economists, “experts” and pundits is that there is already plenty of money in the system, that we waste about one-third of our health care dollar on our inefficient multi-payer financing system and on unnecessary care, and that NHI will save money, not cost more. NHI is the most fiscally responsible thing we can do now about health care. The Conyers bill in the House (H.R. 676) will be financed by payroll and progressive income taxes that will be less than what individuals and employers now pay. The health insurance industry is being propped up by government subsidies to the employer-based system and to privatized public programs. NHI can save some $350 billion through administrative simplification, while offering coverage for all necessary care, full choice of provider and hospital, and mechanisms for cost containment through bulk purchasing, negotiated fees, and global budgets.

NHI by itself will not solve all of our health care problems, but it will provide a structure (as no incremental approach can) to enable other necessary steps. These include acceptance of health care as a right, transition to a not-for-profit system, reimbursement reform, rebuilding of primary care, evidence-based technology assessment, and quality improvement. None of this will be possible by using reforms that leave an obsolete private insurance industry in place, as is more fully discussed in my recent book “Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It.”

FDR almost went for NHI in the mid-1930s, but he backed off, mainly due to the AMA’s opposition. Today, the AMA is marginalized with a membership of no more than 30 percent of physicians, and a majority of American physicians now support NHI. Implementing NHI in your presidency can be your FDR-size legacy. It has become an economic, moral, and social imperative. Overnight NHI can bind us together as one society, all of us in the same boat. We can afford it. Yes, we can!

John P. Geyman, M.D., is professor emeritus of family medicine at the University of Washington, and past president of Physicians for a National Health Program. He is a member of the Institute of Medicine.

UnitedHealth’s Evercare

Is Texas looking out for you? Health-care outsourcing is rolling on, but many patients suffer from silent treatment

By Gregg Jones
The Dallas Morning News
January 4, 2009

(UnitedHealth’s) Evercare of Texas was supposed to coordinate medical and long-term care for more than 80,000 elderly, blind or disabled North Texans. “We help make it easier to get the care you deserve,” the company promises on its Web site.

For many Texans, it hasn’t worked out that way.

“They ought to call them ‘Nevercare,’ ” said (Mary) Hunt, among the hundreds of people who have complained about denied or delayed medical care.

Evercare’s health management program is just one of a growing list of outsourcing efforts embraced by Gov. Rick Perry and the Texas Legislature as a way to save money while still delivering state-funded care. But rather than providing a surrogate safety net, private contractors have failed needy Texans and taxpayers.

Texas is near the bottom among the 50 states in per-capita spending on health and human services, but it is a leader in outsourcing these functions to private contractors. Since taking office in 2000, Perry has pushed some of the nation’s most ambitious outsourcing endeavors, going well beyond his predecessor, George W. Bush.

“We have a leadership that believes the private sector does things better,” said Celia Hagert, senior policy analyst and privatization expert at the Center for Public Policy Priorities, a nonpartisan research group in Austin.

“Whether it’s ideology or philosophy — simply believing that people shouldn’t be on these programs in the first place — these things have combined to create a very stingy social safety net system in Texas.”

Since 2000, the Texas Department of Insurance has fined UnitedHealth or one of its units seven times totaling more than $10 million for violations involving claims payouts, reporting requirements and other problems.

Texas doctors have long complained about UnitedHealth and its handling of claims under employer-provided insurance plans.

“They’re dishonest, and they’re sneaky,” said Dr. William Walton, a family doctor in North Dallas. “If you’re not really on top of it, you’ll lose lots of money working with United Healthcare.”

The fines haven’t changed UnitedHealth’s way of doing business, he said, adding, “That’s just a cost of business in their eyes.”

http://www.dallasnews.com/sharedcontent/dws/news/texassouthwest/stories/DN-son1mainbar_04pro.ART.State.Edition2.4a74df6.html

Comment:

By Don McCanne, MD

So, another ho-hum report on the bad behavior of a private insurer. And more fines that for these insurers are only a nominal and routine part of doing business.

Is this really the way we should be financing care in the United States? Set up rules for the private insurers and then rap their knuckles when they misbehave?

And the next step in reform? Not only more rules and more knuckle rapping for the private insurers, but now new rules and new knuckle rapping for the tens of millions of uninsured individuals who cannot afford to purchase private health insurance.

Does our new political leadership share the fantasies of Bush and Perry that the private insurance sector does things better? Hopefully not, but it’s looking more and more like they do. Establishing a single payer health financing infrastructure would automatically eliminate these perversities. Why has that been taken off the table?

Headlines on slowing in health care spending miss the real story

National Health Spending In 2007: Slower Drug Spending Contributes To Lowest Rate Of Overall Growth Since 1998

By Micah Hartman, Anne Martin, Patricia McDonnell, Aaron Catlin the National Health Expenditure Accounts Team – Centers for Medicare and Medicaid Services (CMS) Office of the Actuary
Health Affairs
January/February 2009
In 2007, U.S. health care spending growth slowed to its lowest rate since 1998, increasing 6.1 percent to $2.2 trillion, or $7,421 per person. The health care portion of gross domestic product reached 16.2 percent, up from 16.0 percent in 2006. Slower growth in 2007 was largely attributed to retail prescription drug spending and government administration. With the exception of prescription drugs, most other health care services grew at about the same rate as or faster than in 2006. Spending growth from private sources accelerated in 2007 as public spending slowed; however, public spending growth has continued to outpace private sources since 2002.
http://content.healthaffairs.org/cgi/content/abstract/28/1/246

This annual CMS report on health care spending is being celebrated in headlines throughout the nation as demonstrating a slowing in the growth of health care spending. Such headlines are missing the terrible news in this report.

  • Most health care spending growth did not slow. The overall rate was lower partially due to decreases in drug costs, especially because many block-buster drugs came off of patent, and generic prescribing increased disproportionately. The increase in Medicare spending for 2006 was 18.5 percent, primarily because of the costs of the Part D drug benefit and the higher costs of the Medicare Advantage plans. Increases in Medicare spending for 2007 were still fairly high at 7.2 percent, but the decline from an extremely high percentage increase to a high percentage increase may be a decline in the rate of increase, but is still a very large increase. Next year’s report on the rate increases for 2008 likely will not reflect these downward distortions.
  • Even with the downward adjustments, the overall rate of increase was still 6.1 percent, well in excess of the rate of inflation. A smaller increase over the rate of inflation cannot be interpreted as good news when the problem of increased costs is growing progressively worse.
  • A very small but extremely important number in this report is that the percent increase in health care as a portion of our gross domestic product (GDP) was 0.2 percent, an increase from 16.0 percent to 16.2 percent. How can you celebrate a decline in the rate of increase in costs when those costs continue to encroach on our other spending?

Health care spending is in a crisis mode, and it only gets worse. Congress and the administration must act, but what do they intend to do? They are going to enact laws and regulations requiring us to give money to the private insurance industry to act as stewards of our health care dollars.
Yes, the insurers will be told to do a good job (through regulation), and when they fail (which they will), what will be their response? The same as now: Doctors and patients and hospitals and drug firms and tech firms keep running up the costs, and we can’t do anything about it.
Well, they’re right; they can’t. But the people can, by convincing Congress to enact our own single payer national health program – a program through which we can demand greater value in our health care purchasing.

Headlines on slowing in health care spending miss the real story

National Health Spending In 2007: Slower Drug Spending Contributes To Lowest Rate Of Overall Growth Since 1998

By Micah Hartman, Anne Martin, Patricia McDonnell, Aaron Catlin the National Health Expenditure Accounts Team – Centers for Medicare and Medicaid Services (CMS) Office of the Actuary
Health Affairs
January/February 2009

In 2007, U.S. health care spending growth slowed to its lowest rate since 1998, increasing 6.1 percent to $2.2 trillion, or $7,421 per person. The health care portion of gross domestic product reached 16.2 percent, up from 16.0 percent in 2006. Slower growth in 2007 was largely attributed to retail prescription drug spending and government administration. With the exception of prescription drugs, most other health care services grew at about the same rate as or faster than in 2006. Spending growth from private sources accelerated in 2007 as public spending slowed; however, public spending growth has continued to outpace private sources since 2002.

http://content.healthaffairs.org/cgi/content/abstract/28/1/246

Comment:

By Don McCanne, MD

This annual CMS report on health care spending is being celebrated in headlines throughout the nation as demonstrating a slowing in the growth of health care spending. Such headlines are missing the terrible news in this report.

* Most health care spending growth did not slow. The overall rate was lower partially due to decreases in drug costs, especially because many block-buster drugs came off of patent, and generic prescribing increased disproportionately. The increase in Medicare spending for 2006 was 18.5 percent, primarily because of the costs of the Part D drug benefit and the higher costs of the Medicare Advantage plans. Increases in Medicare spending for 2007 were still fairly high at 7.2 percent, but the decline from an extremely high percentage increase to a high percentage increase may be a decline in the rate of increase, but is still a very large increase. Next year’s report on the rate increases for 2008 likely will not reflect these downward distortions.

* Even with the downward adjustments, the overall rate of increase was still 6.1 percent, well in excess of the rate of inflation. A smaller increase over the rate of inflation cannot be interpreted as good news when the problem of increased costs is growing progressively worse.

* A very small but extremely important number in this report is that the percent increase in health care as a portion of our gross domestic product (GDP) was 0.2 percent, an increase from 16.0 percent to 16.2 percent. How can you celebrate a decline in the rate of increase in costs when those costs continue to encroach on our other spending?

Health care spending is in a crisis mode, and it only gets worse. Congress and the administration must act, but what do they intend to do? They are going to enact laws and regulations requiring us to give money to the private insurance industry to act as stewards of our health care dollars.

Yes, the insurers will be told to do a good job (through regulation), and when they fail (which they will), what will be their response? The same as now: Doctors and patients and hospitals and drug firms and tech firms keep running up the costs, and we can’t do anything about it.

Well, they’re right; they can’t. But the people can, by convincing Congress to enact our own single payer national health program – a program through which we can demand greater value in our health care purchasing.

Another middleman, with a Donald Trump wig!

Dallas’ American CareSource sees stock jump 120% in 2008

By Jason Roberson
The Dallas Morning News
January 2, 2009
American CareSource is the nation’s first publicly traded ancillary care network company. The company basically serves as a middleman, connecting payors, such as insurers, with the providers of such services as lab work and diagnostic imaging.
Ancillary services now represent 30 percent of health care expenditures, valued at $574 billion annually, according to U.S. Center for Medicare and Medicaid Services.
While most insurers can handle the 70 percent of health care dollars that go to hospitals and physicians, the largest insurers form networks with ancillary services. That’s where American CareSource comes in.
American CareSource targets smaller insurers, unions and employers that aren’t able on their own to purchase ancillary services in bulk.
(American CareSource) bills itself as a cost-saver to both payors and ancillary providers. It acts as the providers’ advocate by collecting hard-to-get payments from insurance claims; it serves as the insurers’ advocate by offering lower costs than they could get on their own.
“In some ways, we want to be the Wal-Mart or Target of health care,” said David Boone, CEO of American CareSource.
He maintains a small-company management style. Whenever a new client is secured, an old ship’s bell is rung in celebration. When the company hit $1 million in profit, Boone, as promised, strutted in the middle of the office and proceeded to do a “money dance,” wearing a Donald Trump wig, a comical green jacket and hat of dollar bills.
http://www.dallasnews.com/sharedcontent/dws/bus/stories/010309dnbuscaresource.38426b8.html

As long as we insist that health care continue to be financed through our dysfunctional, fragmented multi-payer system, we will continue to see more innovative middlemen organizations capturing and siphoning away dollars that should be directed to health care instead.
Now we have a for-profit, publicly-traded entity that adds an additional, expensive administrative layer between the health plans and the providers of ancillary services. American CareSource provides no health care products or services – only more administrative waste.
I don’t know about you, but I’ve grown weary listening to those who say that single payer advocates have failed to demonstrate that a single payer system would bring us more than only nominal, one-time savings in administrative costs. Go to the PNHP website (www.pnhp.org) and type in “administrative waste” in the search window at the top of the opening page, but be prepared to spend a lot of time.
Massive, middlemen administrative waste permeates our entire health care system. It is not limited to the excesses of the private insurance industry, though that industry is a major contributor, both directly in its own costs, and indirectly by the burden placed on the health care delivery system. There are a great many other innovative administrative organizations involved, often subsidiaries of the insurers.
These same individuals who discredit the potential for recovering administrative waste also fail to mention the other benefits of single payer such as true universality, equity, efficiency, improved value in health care purchasing, and humane methods of cost containment.
But I have to hand it to David Boone, CEO of American CareSource. What could be more appropriate for this entrepreneurial middleman organization than celebrating success with a ship’s bell, a Donald Trump wig, and a hat stuffed with dollar bills? How fitting!
This should inspire the insurance industry’s AHIP. When Congress passes health care reform based on private health plans, AHIP can pass out the Donald Trump wigs with the hats stuffed with money. But the bell? Shipping in that bell from Philadelphia won’t do since it has a crack in it. That’s okay. Piping in the opening bell of the NYSE would much more befit the occasion anyway.

Another middleman, with a Donald Trump wig!

Dallas' American CareSource sees stock jump 120% in 2008

By Jason Roberson
The Dallas Morning News
January 2, 2009

American CareSource is the nation’s first publicly traded ancillary care network company. The company basically serves as a middleman, connecting payors, such as insurers, with the providers of such services as lab work and diagnostic imaging.

Ancillary services now represent 30 percent of health care expenditures, valued at $574 billion annually, according to U.S. Center for Medicare and Medicaid Services.

While most insurers can handle the 70 percent of health care dollars that go to hospitals and physicians, the largest insurers form networks with ancillary services. That’s where American CareSource comes in.

American CareSource targets smaller insurers, unions and employers that aren’t able on their own to purchase ancillary services in bulk.

(American CareSource) bills itself as a cost-saver to both payors and ancillary providers. It acts as the providers’ advocate by collecting hard-to-get payments from insurance claims; it serves as the insurers’ advocate by offering lower costs than they could get on their own.

“In some ways, we want to be the Wal-Mart or Target of health care,” said David Boone, CEO of American CareSource.

He maintains a small-company management style. Whenever a new client is secured, an old ship’s bell is rung in celebration. When the company hit $1 million in profit, Boone, as promised, strutted in the middle of the office and proceeded to do a “money dance,” wearing a Donald Trump wig, a comical green jacket and hat of dollar bills.

http://www.dallasnews.com/sharedcontent/dws/bus/stories/010309dnbuscaresource.38426b8.html

Comment:

By Don McCanne, MD

As long as we insist that health care continue to be financed through our dysfunctional, fragmented multi-payer system, we will continue to see more innovative middlemen organizations capturing and siphoning away dollars that should be directed to health care instead.

Now we have a for-profit, publicly-traded entity that adds an additional, expensive administrative layer between the health plans and the providers of ancillary services. American CareSource provides no health care products or services – only more administrative waste.

I don’t know about you, but I’ve grown weary listening to those who say that single payer advocates have failed to demonstrate that a single payer system would bring us more than only nominal, one-time savings in administrative costs. Go to the PNHP website (www.pnhp.org) and type in “administrative waste” in the search window at the top of the opening page, but be prepared to spend a lot of time.

Massive, middlemen administrative waste permeates our entire health care system. It is not limited to the excesses of the private insurance industry, though that industry is a major contributor, both directly in its own costs, and indirectly by the burden placed on the health care delivery system. There are a great many other innovative administrative organizations involved, often subsidiaries of the insurers.

These same individuals who discredit the potential for recovering administrative waste also fail to mention the other benefits of single payer such as true universality, equity, efficiency, improved value in health care purchasing, and humane methods of cost containment.

But I have to hand it to David Boone, CEO of American CareSource. What could be more appropriate for this entrepreneurial middleman organization than celebrating success with a ship’s bell, a Donald Trump wig, and a hat stuffed with dollar bills? How fitting!

This should inspire the insurance industry’s AHIP. When Congress passes health care reform based on private health plans, AHIP can pass out the Donald Trump wigs with the hats stuffed with money. But the bell? Shipping in that bell from Philadelphia won’t do since it has a crack in it. That’s okay. Piping in the opening bell of the NYSE would much more befit the occasion anyway.

There's No Place Like Home for The Holidays, Until There is No Home

by Donna Smith
CommonDreams.org
Tuesday, December 23, 2008

A little box arrived from Chicago last week to my temporary digs here in Washington, DC. Inside were some of the trinkets of Christmases long past. Ornaments that used to hang on trees surrounded by mounds of gifts, plush Mickey Mouse stockings I used to fill with fruit and candy and little toys when my sons were younger, and a candle holder – absent the candle, of course, which had long since been burned on a holiday table brimming with food and with good cheer.

The box holds what is left of those middle class holiday memories. The box has become the only link to a home-for-the-holidays Christmas I can never again share with my children or my grandchildren. You see, like millions of other Americans, we lost our home. And with that loss goes not only the physical security of home and hearth but also the generational ties to stability and security and the sense of well-being that come with being home… with having a home to come to and a home in which to frame the happenings of our lives. We are the new economic refugees of this society. And no bail-outs are pending.

Who among us has not spent a time longing for the comforts of home? And that universal longing has little to do with square footage or amenities and much more to do with a place of comfort and clarity and sameness and steadiness that helps soften the twists and turns of life that we all must experience. But for those of us who become unwilling nomads with no permanent place to stash our stuff, home became a more elusive place – and not really a physical place at all, but a feeling, a memory, a fleeting image of happier days gone by.

Americans now losing their homes to the mortgage crisis and the millions more, like us, who have fallen prey to the healthcare crisis in this nation are losing far more than just an address or an extra bedroom or a driveway or a lifestyle. We are losing the boundaries of our lives – those intimate details of everyday living that make home a safe place to land and place to retreat when daily pressures are too great and – most vivid during this season – a place where our children and grandchildren can return for generational sharing and all the ups and downs that brings to a family.

One of the most heart-breaking losses we’ve felt in recent years as we tried in vain to cling to some semblance of middle class reality as health crises crushed us is the loss of holidays, the loss of traditions, the loss of intimacy and the loss of respect from our own children who see no home to come to – and no reason to interrupt more exciting holiday pursuits when we can no longer play host to any sort of Smith family soiree with the same sort of meaning.

Oh, folks will try to say that home is wherever the people you love are gathered, but don’t believe it. Our lack of financial stability and the lack of that home in which to gather have damaged far more than just the edges of our lives. When pushed, the grown kids say they don’t come to visit because we’re not grounded – “There isn’t exactly a place where we all grew up and you kept to come home to, is there?” asked one of our sons. No, son, there isn’t. So, this year, like the past few years, he’ll gather his children (our beautiful grandchildren) and take them to another state and another grandma’s house that sits on land that the family has owned for many years and to a home with a whole basement converted to play space that holds literally thousands of dollars worth of toys. No, son, I cannot offer that.

I can offer the little toy box I faithfully move from apartment to apartment and a place at my feet to play. I can offer love beyond what I could explain. But I cannot offer stability of place and the home I so hoped to have until I died – or at least until I could no longer handle the physical constraints of home ownership. But the things I have left to own are not things, and our culture thrives on the ownership of things. So, I am the grandma without enough. And my wonderful husband, the man who gave his body and being to creating a home for us for so many years, is now the grumpy grandpa without enough stuff and without a house.

This is what millions of Americans now losing their homes and their jobs are going to go through all too soon. The unbending cruelty of judgment that comes from having lost one’s home in the United States – or worse yet, having gone bankrupt in America.

You see, say what you will about forgiveness and love and peace on earth, but we Americans judge one another by our stuff and our attainment of things. Those who don’t have a lot must not have wanted it badly enough, we think, or we didn’t work smartly enough. And those who attain homeownership and then lose homes or go bankrupt just managed poorly, lived beyond their means, didn’t tighten the belt enough… on and on and on we go with our judgments. I just heard it again this week on a mainstream media news program… people who go bankrupt, they mused, are gaming the system somehow and need to learn to behave better. Going bankrupt was viewed as sinful and irresponsible. These old and ugly views are part of our middle class DNA. I know, because I was taught the same way.

But then the bottom falls out. Health insurance leaves you bare to huge financial burdens. Job loss strips your ability to have enough cash coming in to covers the basics, savings dries up, all the bartering and begging to stay afloat begins to give way, and the wealth it took years to build is gone overnight.

And with that wealth goes a great deal more in personal costs. Some relationships are damaged beyond repair while others are twisted and tinged with guilt, shame or anger. And the holidays are packed away in little boxes of trinkets where peace on earth and joy to the world still can dwell, if but for an instant.

Home for the holidays? Never again. It takes years to recover from bankruptcy or foreclosure and for some of us, there are not enough working years left to do so; the big banking interests we just helped bail out will view us as too risky for a very long time. And our government will not challenge that reality. The best we economic refugees can hope for is that we can hang on to that little box of ornaments, stockings and candleholders as we move from lease to lease to lease making sure our rent is paid and we are warm. There really is no place like home for the holidays, and for many Americans, that Norman Rockwell sort of holiday setting will never again be possible.

When home is no longer home for so many, the generational and cultural foundations are crumbling in ways that will forever alter our national being. The ground truly is shifting beneath our feet as 2009 dawns. And this year, home is even more elusive for many. For some of us, it’s carried in a little box.

Donna Smith is a community organizer for the California Nurses Association and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.

Single-payer health system preserves choice

Linda Mulka, MD
Summit Daily News (Frisco, CO)
December 27, 2008

I am a board-certified family physician unable to actively practice because of effects of bilateral breast cancer radiation on my immune system. When dealing with Los Alamos National Lab’s self-insured United Healthcare administered program, I was evaded throughout the appeal process until arbitration to pay for services that Medicare would have covered to determine the appropriate treatment for my breast cancer. These tests incidentally saved over $30,000 for my treatment while allowing me to avoid cytotoxic chemotherapy. Considering what happened to me as a physician in their system, I can only imagine what would have happened to a non-physician.

When my sister lost her job last spring, she was turned down by Kaiser to continue her policy because her husband had controlled hypertension and elevated cholesterol. She now has a $10,000-deductible plan. We save money now that my parents’ Blue Cross plan was canceled.

Fifty-nine percent of physicians now would support a single-payer system. Administration and profits make up about 30 percent of private insurance costs. Insurance companies do not provide or coordinate care; they just deny care, making choice in plans irrelevant. Plans do not encourage preventive care because the average insured person changes plans every two years.

Health spending per enrollee for comparable benefits grew at a rate of 7.3 percent a year under private insurance, compared to 4.6 percent under Medicare. Medicare’s administrative costs at 3 percent are well below the overhead of private insurers. This may change as the privately operated Medicare plans get bigger subsidies from the taxpayers than traditional government-run Medicare, about 17 percent more for fee-for-service plans often with less coverage.

HR 676 was introduced to implement a single-payer health care system that covers all Americans regardless of preexisting condition or employment status and preserves choice by including all licensed providers. Financing is through sliding-scale taxation rather than employer mandates. The cost of this plan would be less than what we are currently paying, with many uninsured now and worse health outcomes than most developed countries. It has gained the support of 94 U.S. representatives, many unions, state legislative bodies, cities, counties, faith groups and other organizations that believe that basic health care should be a right.

Sen. Tom Daschle does not feel that it is politically feasible to push the single-payer system despite its advantages, as I found out at the recent Health Care Reform Summit in Denver. The public option must be maintained to cut costs and insure the uninsured. Massachusetts has found it too costly to extend insurance significantly with its employer mandates.

If Republicans in Congress are going to stop any healthcare reform if it contains a public option, they should do the right thing and drop their own public plan and get their own private insurance.

Health Care for All Colorado has a very detailed single-payer plan for Colorado that may be introduced in the next legislature.

Health care reform comments can be sent to the Obama transition team at www.Change.gov.