Posted in Affordable Care Act (ObamaCare), Capers, Disease Prevention, Economic Issues, Employee Benefits, Employer-Sponsored Health Plans, Essential Benefits under the ACA, Government Regulations, News From Washington, News From Washington, DC & Related Shenanigans, Policy Issues, Prevention, Progressivism, Rule of Law, Subsidies, Uncategorized

Obama Sues Companies for Complying with Obamacare – Michael Schaus – Townhall Finance Conservative Columnists and Financial Commentary – Page full

2014-12-04T171733Z_1_LYNXNPEAB30V0_RTROPTP_3_USA-OBAMAHoneywell International Inc., and two smaller firms, are being sued for taking advantage of a specific provision in the ACA that allows them to lower their out-of-pocket medical expenses. Deroy Murdock at the National Review explains:

These firms are complying with Obamacare, which lets them offer wellness programs to their employees. These activities help workers lose weight, quit smoking, receive regular checkups, and otherwise become healthier. As an incentive, Obamacare offers participating employees as much as a 50 percent reduction in out-of-pocket medical expenses… The comically titled “Affordable Care Act” requires that employees in these programs undergo medical tests to qualify for lower premiums. Unfortunately, such exams violate the Americans with Disabilities Act.

So, let’s make sure we understand this: Employers can offer their workers “wellness programs”; but following the regulations for such programs result in a violations of the ADA. Well, Nancy Pelosi, I’m certainly glad we’re finally figuring out what’s in this thing; because Obama’s Equal Employment Opportunity Commission would be three case-loads lighter if we hadn’t passed this reform.

via Obama Sues Companies for Complying with Obamacare – Michael Schaus – Townhall Finance Conservative Columnists and Financial Commentary – Page full.

Posted in Disease Prevention, Evidence-based Medicine, FDA, Government Regulations, Influence peddling, Medical Costs, News From Washington, News From Washington, DC & Related Shenanigans, Patient Compliance, Patient Safety, Patient-centered Care, Policy Issues, Protocols, Quality, Uncategorized, Unsettled Science

The Dark Side of Quality

Nobody stands up to argue against quality and value in healthcare. You might as well argue against motherhood, or puppies. Yet many physicians are inherently skeptical of definitions of “quality” that are imposed from above, whether by outside evaluators like The Joint Commission, or worse by the government.

There’s good reason for skepticism. Some of the “evidence” behind “evidence-based medicine” has turned out to be flawed, tainted by financial conflict of interest or outright fraudulent. Any experienced physician knows that there are fads in healthcare just as there are in fashion, and today’s evidence-based medicine may be tomorrow’s malpractice. Let’s take a closer look at what’s really going on in the world of quality metrics, and why it matters if payments to you and your hospital are increasingly linked to how you score.

via The Dark Side of Quality.

Posted in Accountable Care Organizations, Consumer-Driven Health Care, Disease Prevention, Government Regulations, Medicaid, Medicaid Expansion, Medical Costs, News From Washington, News From Washington, DC & Related Shenanigans, Organizational structure, Patient Choice, Patient-centered Care, Policy Issues, Quality, Reforming Medicaid, Uncategorized

Mars and Venus on Medicaid | Health Policy Blog |

download (11)In 2012, over 26 million Medicaid dependents were enrolled in MCOs and 8.8 million were enrolled in PCCM. However, enrollment is not randomly distributed among the Medicaid population. Although they comprise two thirds of Medicaid dependents, they only account for one fifth of Medicaid spending, “because disabled and elderly beneficiaries, who account for most Medicaid spending, largely remain in fee-for-service FFS…” This means that MCOs and PCCMs mostly cover pregnant women, children and their parents.

States have been using private plans to provide benefits to healthier Medicaid dependents and leaving sicker ones to the FFS system, where governments pay providers according to bureaucratically determined fee schedules. That seems to be the wrong way around and may explain why outcomes are very bad for the sickest Medicaid dependents, as discussed by Roy and Gottlieb. Paradise and Garfield, on the other hand, are likely discussing evidence from private health plans serving Medicaid patients. So, we should not be surprised that some outcomes are similar as they are for other privately insured.

via Mars and Venus on Medicaid | Health Policy Blog |

Posted in CDC, DC & Related Shenanigans, Disease Prevention, Economic Issues, Government Regulations, Government Spending, Leadership, News From Washington, News From Washington, DC & Related Shenanigans, NIH, Organizational structure, Patient Safety, Policy Issues, Progressivism, Protocols, Representative Republic vs. Democracy, Rule of Law, Uncategorized

Budget Cuts and Ebola | National Review Online

It is true that spending for the CDC has dipped ever so slightly since 2011, but the cuts followed years of massive increases. Overall, since 2000, CDC outlays have almost doubled, from $3.5 billion to $6.8 billion in 2014 constant dollars. Moreover, in January, the Republican-controlled House actually passed legislation that increased CDC spending for 2014 by $567 million — $300 million more than was requested by President Obama.

It’s not that the CDC hasn’t had money, it’s that the money has been spent on things that have little or nothing to do with the agency’s mission of protecting Americans from health threats.

As the agency’s mission statement says in part, “Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights disease and supports communities and citizens to do the same.” Seems straightforward enough. There is, after all, a reason for the disease in the CDC’s name.

Yet, while the agency still might not have been prepared for an Ebola outbreak, President Obama did restart its push for gun control. Over the last decade, in fact, the CDC has spent much of its time — and money — studying seat-belt use, infant car seats, and obesity. These may or may not be worthy topics, but this focus makes it somewhat harder for Democrats to turn around and blame budget cutting for a lack of attention to the things that the CDC is actually supposed to do — like protect us from contagious diseases.

Read the Full Story at:

via Budget Cuts and Ebola | National Review Online.

Posted in Disease Prevention, Evidence-based Medicine, Nutrition, Pain, Patient Choice, Patient Safety, Quality, Uncategorized, Unsettled Science

Glucosamine Drink Flops in Knee Osteoarthritis Trial



This is a well-done study that shows, in the short-term, that oral glucosamine alone does not reduce pain or improve cartilage loss in patients with knee Osteoarthritis. Keep in mind, this was a 6 month study. A longer study may or may not show benefit. But, would you take a prescription or any medication for longer than 6 months with no clear sign of improvement? The study could have been better if the authors would have studied the more common form of Glucosamine-Chondroitin-MSM. If they do that for one year, I think we could have a conclusive verdict on this.

Not sure why Medscape chose a pelvic x-ray for a story about knee arthritis, but you get the idea…

Glucosamine Drink Flops in Knee Osteoarthritis Trial.

Posted in Direct-Pay Medicine, Disease Prevention, Doctor shortage, Economic Issues, Employee Benefits, Employer-Sponsored Health Plans, Health Insurance, Medical Costs, Medicare, Patient-centered Care, Price Tansparency, Quality, Self-Insured Plans, Uncategorized

Who Will Pay For Proactive Medicine?

Todd Hixon
Todd Hixon

“Proactive Medicine” refers to medical services that focus heavily on engaging patients while they are healthy or early in the disease process, developing strong relationships, and providing early treatment or driving behavior change that prevents or delays serious illness.

Intensive primary care is important because 1) primary care impacts almost 100% of the population and 2) the benefits are big. Jorgensen reports that MDVIP has seen reductions of 80% plus in ER and hospital utilization and in hospital readmissions among a large group of Medicare patients that benefit from MDVIP’s particularly intensive primary care service. 

via Who Will Pay For Proactive Medicine?.

Posted in Consumer-Driven Health Care, Deductibles, Direct-Pay Medicine, Disease Prevention, Doctor-Patient Relations, Doctor-Patient Relationship, Economic Issues, Employee Benefits, Employer-Sponsored Health Plans, Health Insurance, Medical Costs, Patient Choice, Patient-centered Care, Quality, Third-Party Free Practices, Uncategorized

The 7 Types of People Direct Primary Care Works Best For – by Richard R. Samuel, MD


The modern movement towards direct primary care integrates the advances of medical science over the last 50 plus years with the qualities that made the old-fashioned family doctor so beloved.

In addition to the benefits we’ve detailed in previous lessons, this hybrid approach is an ideal approach for the following types of people:

1.  Patients with lower cost, large deductible insurance policies “catastrophic plans”, as these products typically do not pay for outpatient visits.

2.  Patients who value wellness and want to stay healthy.

3.  Patients with complex medical histories typically requiring frequent medical visits and needing more time with their provider.

4.  Patients who want to take charge of their own health care, without government or insurance interference.

5.  Patients who make too much income to qualify for Affordable Care Act ACA subsidies.

6.  Patients who are self-employed, and those who receive no or little insurance from their employer.

7.  Patients who are between jobs and have no insurance coverage, or those whose insurance coverage has been cancelled.

Busy working professionals, small business owners and their employees as well as active families find the convenience, affordability and accessibility attractive in their daily routines, and once they discover the benefits of direct primary care, they rarely go back to the “traditional” model.

To your health,

Richard R. Samuel, MD, ABFP

via The 7 Types of People Direct Primary Care Works Best For.

Posted in Disease Prevention, Employee Benefits, Employer-Sponsored Health Plans, Medical Costs, Organizational structure, Patient Choice, Patient Compliance, Patient-centered Care, Quality, Self-Insured Companies, Third-Party Free Practices, Uncategorized

Why Employers Are Being Fooled by Engagement | The Institute for HealthCare Consumerism

By Russell Benaroya, Co-Founder & CEO, EveryMove

Secret: engagement is the wrong metric, and it is masking what you should really care about.Let’s look at the positives first. For one thing, engagement is an acknowledgment that if employees don’t access services, there will never be any downstream benefits. We need to at least get people paying attention, and that’s a good thing. We have generally acknowledged that outcomes in the form of verifiable lower health care costs is an important but longer term investment that should not hinder the desire of an organization to promote the myriad of benefits of living a healthy lifestyle today. Let’s talk about the downside of the term engagement.

via Why Employers Are Being Fooled by Engagement | The Institute for HealthCare Consumerism.