Tuesday, November 1, 2011

Medicaid Pay Cut in California Reflects National Trend

State Medicaid programs are dealing with the loss of federal stimulus funds in the current fiscal year with their favorite belt-tightening move: cutting rates for physicians, hospitals, and nursing homes, according to a
new survey by the Kaiser Family Foundation (KFF).

Case in point: the Centers for Medicare and Medicaid Services (CMS) yesterday approved a 10% pay cut for physicians and other providers sought by California's Medicaid program, called Medi-Cal.

Medicaid, which provides health insurance coverage to some 60 million Americans, is funded jointly by the federal government and the states, with the federal share currently ranging from 50% to 74%.

The recent recession strained the ability of states to fund their share in 2 ways — putting more Americans on Medicaid rolls, and reducing state tax revenue.

Even with the federal bailout, some states decreased physician reimbursement rates — 8 in fiscal 2009, 20 in fiscal 2010, and 14 in fiscal 2011.

At the same time, the number of states giving Medicaid raises steadily declined. Other states simply froze their rates. For physicians, such trends only made a bad reimbursement situation even worse — Medicaid typically pays less than Medicare and private insurers anyway.

Federal law requires Medicaid programs to pay high enough rates to ensure an adequate supply of providers who are willing to care for beneficiaries. However, since the program's inception in 1965, there always has been the fear that subpar rates would cause providers to turn away Medicaid patients,

Not all cost-cutting tactics such as chopping provider rates, tightening eligibility standards, or taking away benefits, are actually decreasing costs.

This emphasis on quality shows up in the increasing reliance on managed care. In fiscal 2012, 24 states are expanding their Medicaid managed care programs, up from 17 in fiscal 2011, according to the KFF report.

Managed care that was supposed to serve as a vehicle for pay-for-performance, which requires physicians to report quality measures such as preventive-screening rates and health outcomes for specific patient populations, has failed to either improve the quality of care or access to appropriate level of health care.

Another managed care tool is the patient-centered medical home, designed to better coordinate the care of those with chronic illnesses. Unfortunately, this  tool became yet another tool to deny access to care and to save money for managed care companies.

Interestingly, the Sunbeam Medical Association, aka American Medical Association (AMA),  a "Johny-come-lately" to physician-provider partnership cause, is silent on the mater? Shame on them!

This, yet another, cut in Medi-Cal reimbursements will further deny the access to appropriate care by causing more physicians and facilities to opt out of Medi-Cal.

We report, you decide!

Wednesday, September 7, 2011

Physician Nexus Appoints Prof. V. Dorodny to its Esteemed Advisory Board

Professor Victor Dorodny Joins Physician Nexus Advisory Board

September 6, 2011, Malibu, CA---Physician Nexus, (www.PhysicianNexus.com ) based in Silicon Valley, is the fastest growing social network dedicated exclusively to physicians.
This global communications platform was developed with a vision to transform the field of medicine, allowing physicians to connect with each other in ways that were not possible before.

Physician networking, consultations, referrals, career planning, and other vital and powerful physician-specific features are now at your fingertips with Physician Nexus. It also serves as uniquely user-friendly platform for Tele-Medical and Medical Tourism application.
Physician Nexus appoints Prof. Victor S. Dorodny M.D., N.D., Ph.D., M.P.H. (www.DrDorodny.com), a specialist with over 30 years of clinical and executive experience, as well as a Doctorate in Health Information Technologies (HIT) and over 17 years of hands-on HIT/Telemedicine experience, to its esteemed Advisory Board.

Prof. Dorodny is the former Chief Medical Officer and Global Practice Leader for US-TeleMedicine Company and currently serves as the President & CEO of TeleMed Partners --global Health, Information, and Technology Integrators. (www.TeleMedPartners.com)
Professor V.S. Dorodny enjoys international recognition for advancing electronic health record technologies (EHR, EMR, PHR), and promoting confidentiality and security of health information.

He has served as Advisory Board Member of: The Association of Medical Directors of Information Systems (AMDIS); National Association of Managed Care Physicians (NAMCP) and The IPA Association of America (TIPAA).
He was one of the creators of the current Health Insurance Portability and Accountability Act of 1996 (HIPAA).

He conceived, designed, and led development of Knowledge–based Health Information Systems (KbHIS©) operational databases for healthcare organizations. He served as consultant to the Economic and Social Council of the United Nations; Technical Advisor to the United States Department of Justice and the FBI.
Prof. Dorodny originated the revolutionary concept of health and pharmaceutical care value (HCV©) that continues to shape emerging health systems. He consults for: the Institute for Alternative he , National Association of Consulting Pharmacists, the Joint Commission for Accreditation of Hospital Organizations (JCAHO), the National Pharmaceutical Council, and the FDA.

Prof. Dorodny is an accomplished Healthcare/HIT Physician-Executive and has successfully introduced his concepts into the marketplace as the Chief Medical Officer (CMO) of Clark Information Services, Inc., a software, applications and data warehousing company for pharmaceutical industry and other health care organizations; as the Executive VP & Chief Medical Information Officer of Superior Consultant Company, Inc., an integrated health care, pharmaceutical industry and information technology management company; as the Executive VP of Business Development for ICN, Pharmaceuticals, Inc., Eastern Europe.
Prof. Dorodny is Board Certified by the American Academy of Pain Management, Diplomate and Distinguished Fellow of the American College of Ethical Physicians, Associate in Medicine of the American College of Legal Medicine (ACLM), Diplomate and Distinguished Fellow of the American College of Hospital Physicians, graduate of USC Executive Management Institute in Health Care, and Registered Arbitrator.

Prof. Dorodny made significant contributions on diverse topics in major mass media publications, peer review journals and trade publications. He authored monographs and books. Among his editorial board appointments: Managed Healthcare, US Pharmacist, ADVANCE for Health Information Executives. As Reuters Healthcare Expert he often presents at national and international conferences, and guests on national TV and radio.

Sunday, January 23, 2011

Prof. Victor Dorodny in the National Press

January 14th, 2011 issue of Self Funding Magazine publishes the "Killing Granny?" article by Prof. Victor Dorodny of rationing of health care. 



The December 2010 issue National Health Reform Magazine publishes Prof. Victor Dorodny's article "HIT $olutions for PPACA or Symbiosis between Telemedicine & PPACA".

Saturday, January 15, 2011

Killing Granny?

Abridged from "Killing Granny?", Self Funding Magazine, Jan.14, 2011 by Prof. Victor S. Dorodny.

In the article: Palin: Obama's "Death Panel" Could Kill My Down Syndrome Baby  posted on The Huffington Post  on August 7, 2009  its author Ms. Rachel Weiner pokes fun at former Alaska Governor Sarah Palin.

Earlier that month, Gov. Palin posted on her Facebook page that President Obama's health care plan might kill her child. Her statement came on the heels of renowned economist Thomas Sowell pointing out that,  in addition to the fact that this is not a health care reform but a health care insurance/payment reform, government reform will not reduce cost—it will simply refuse to pay for costs.

Gov Palin’s prognosticative assertion : “The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's "death panel" so his bureaucrats can decide, based on a subjective judgment of their "level of productivity in society," whether they are worthy of health care. Such a system is downright evil” at the time was considered extreme and far fetched even by the critics of health payment reform.

 Let's return to the  proceeding of the International Euthanasia Task Force, 1995 where this author, and than the President of the Pacific Division of the National Association of Managed Care Physicians was quoted saying that as the direct result of proliferation on managed care: Most ominous, is the possibility that facilitated suicide or simply withholding care might someday be viewed as a cost-cutting measure. I’m sure there will be pressure from the business side to turn to physician-assisted suicide or another form of rationing since something like 70% of expenditures occurs in the last six months of life.”

Further, I asserted that such rationing tools will be applied to the most vulnerable segments s of  a population:: the very young, the sick, the elderly and disabled, to begin with. My sentiment at the time was echoed by  Rev. Brad Karelius of Episcopal Church of the Messiah in Santa Ana, California, an expert on the issues of death and dieing: “Money will move the decision to kill people”,  he said. 

Fast forward to November 14, 2010: Paul Krugman, Princeton University professor and New York Times columnist who won the Nobel Prize in economics in 2008, said on November 14, 2010 that “death panels” may be needed to help curb the nation budget deficit.
Some years down the pike, we’re going to get the real solution, which is going to be a combination of death panels and sales taxes,” he said. “It’s going to be that we’re actually going to take Medicare under control, and we’re going to have to get some additional revenue, probably from a VAT. But it’s not going to happen now.” 

 “Health care costs will have to be controlled, which will surely require having Medicare and Medicaid decide what they’re willing to pay for — not really death panels, of course, but consideration of medical effectiveness and, at some point, how much we’re willing to spend for extreme care,” he later clarified on his blog.

Needles to say, adding approximately 45M patients to the system, while mandating extended coverage will exponentially increase costs of health care.

The system will be further burdened by increased consumption of health care by aging baby-boomers and medical complications from younger obese generation.

The rationing of health resources is here to stay for the foreseeable future!

Calling it utilization review, health assetmanagement, allocation of medical resources, gatekeeper, cost-sharing, means testing are all  health care rationing codes-limitating access to equitable distribution of medical services through various controls.

Inevitably, difficult decisions will be routinely made based on medical futility or survivability.

Futility is a concept that is inextricably bound to social understanding of the nature and purpose of the practice of medicine and the nature of the relationship between patient and health care provider.

Medical futility refers to the belief that in cases when there is no hope for improvement of an incapacitating condition where no course of treatment is called for. 

It is distinct from the idea of euthanasia because euthanasia involves active intervention to end life, while withholding futile medical care, in theory, does not encourage, nor speed the natural onset of death.

The issue of futile care in clinical medicine generally involves two questions. The first, concerns the identification of those clinical scenarios where the care would be futile. 

The second, concerns the range of ethical options when care is determined to be futile. Some people argue that futile clinical care should be a market commodity able to be purchased just like cruise vacations or luxury automobiles, as long as the purchaser of the medical services has the necessary funds and as long as other patients are not being denied access to clinical resources as a result.

With rising medical care costs and an increase in extremely expensive new anti-cancer medications, the same issues of equity often arise in treatment of end-stage cancer.

Because the issue of control within the physician-patient relationship is often understood in terms of competing or clashing values, there is a strong urge to find a value-free definition of futility.

Today, no such definition, and each and every Granny will be allowed to pass if she clearly and convincingly meets existing definitions of medical futility, or meets the stringent criteria for Physician Assisted Suicide.

The concept of social utility is also taken into consideration by healthcare providers. Mostly on subconscious level it's derived from patient’s real or perceived socio-economic status, physical or mental disability (real or perceived) and other incapacity.

In clinical reality, it's difficult to cleanly seperate moral and utilitarian arguments, and in practice they often appear together.

Obviously, no human or group of humans can assign social value to another human life. 

Unfortunately, from a practical standpoint, social utility determination process and that of medical futility for a member of hospital’s Board of Directors would vary if not outright discriminatory compared with similar considerations for a severely retarded homeless person sleeping in the hospital parking lot.

Soon, the issues of social utility will be much easier to resolve, at least in the City of New York. Starting January 2012,  New York City will begin charging private hospitals as much as $1 million a year for hospital ambulances dispatched by the city 911 system prompting hospitals to stop providing this service.

Most effected hospitals are in under-served areas, and are safety-net providers, operating on razor-thin margins or even running deficits, in vulnerable communities citywide. 

Once these hospitals drop out of the system patients will suffer because of longer waiting time and lack of access to appropriate timely care. The City of New York will benefit by collecting the exorbitant fees and by withholding proper care to its citizens.

It is clear that rationing of health care resources must not be left to Mr. Obama’s bureaucrats, hospitals or even individual physicians.

Such decisions must rest with a thanatology team of experts in death and dying.Thanatology team should consist of a panel of at least two independent specialists isolated from onsiderations of social utility, patient family/primary physician; pain management expert, home/hospice care provider, social worker, clergy/spiritual and legal advisers.

In the mean time, let's make sure Granny receives appropriate medical care regardless of age, race, financial condition, or social status despite Obama  "reform", better described as health deform!

We gripe, you decide!