Saturday, November 30, 2013

A New Worry Looms Online For The Affordable Care Act

Listen to the Story 3 min 16 sec Playlist Download Transcript   Enlarge image i

Insurance companies say they are finding numerous mistakes on a digital form that's essential for signing up through HealthCare.gov.

AP

Insurance companies say they are finding numerous mistakes on a digital form that's essential for signing up through HealthCare.gov.

AP

Saturday is the day the Obama administration promised it would have HealthCare.gov working smoothly for the majority of people who need to sign up for health insurance.

As the Obama administration scrambles to fix the glitch-plagued site, experts are beginning to worry about another problem that may further impair the rollout of the Affordable Care Act.

Health insurance companies say they're seeing numerous errors in a form that plays a vital part in the enrollment process. The problems are manageable so far, but many worry about what will happen if enrollment surges in the weeks to come.

The 834

It's safe to say that the vast majority of consumers have never heard of an 834 EDI transmission form, despite its crucial role in the process of signing up for health insurance. It's a kind of digital resume that tells an insurance company's computer everything it needs to know about an applicant, says Bob Laszewski, a health policy consultant.

"It contains all of the person's enrollment information, all the information that [an] insurance company needs to get this person entered as a policy holder," Laszewski says.

The 834 has been around for a long time. The architects of the Affordable Care Act intended for it to play a central role in the sign-up process, says Tim Jost, a professor of law at Washington and Lee University.

"The 834 information is information the insurers have to have to get people enrolled in coverage, which of course is the point of going through the marketplace," Jost says.

Multiple Mistakes Make Insurers' Jobs Harder

But health insurance companies say the 834s they are receiving from applicants on the federal and state exchanges have sometimes been riddled with errors, Laszewski says.

"Duplicate enrollments, people enrolling and unenrolling, inaccurate data about who's a child and who's a spouse, files just not being readable," he says.

Highmark Blue Cross Blue Shield of West Virginia has been steadily processing new customers ever since the launch of Obamacare this fall. But Highmark President Fred Earley says mistakes in the 834s are making the job harder.

"We've had some situations where the records don't track, or we've seen duplicates," Earley says. "We've had situations where we'll get a record to show that someone canceled coverage when we've never had a record to show they enrolled in the first place."

Earley says his firm has been dealing with the problems by calling up state and federal officials and correcting the mistakes. The exact cause of the problems is unclear. The Obama administration has been slowly making fixes, and officials say they're making progress. But Laszewski says the fixes are not fast enough.

"The error rates have been falling," he says. "HealthCare.gov has been making progress, but we're not to the point yet where people can trust that high-volume enrollment can occur and we won't have serious customer service problems."

Laszewski says the test will come over the next few weeks. People who want coverage to begin on Jan. 1 have until just before Christmas to sign up, and there's likely to be a surge of new applicants in the weeks to come.

"What happens if we start getting hundreds of thousands or millions of people signing up by the Dec. 23 deadline, and the insurance industry is receiving hundreds or thousands of these a day?" he says. "That's what everyone's worried about."

Share Facebook Twitter Google+ Email Comment More From Health Care Health CareWhite House Optimistic At Deadline To Fix ObamacareHealth Care3 Stories From HealthCare.gov UsersHealth CareHow Will We Know If HealthCare.gov Is Fixed?Health CareA New Worry Looms Online For The Affordable Care Act

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Tuesday, November 26, 2013

Part-Time Workers With Minimal Health Coverage Get New Options

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These Californians Greeted Canceled Health Plans With Smiles

More From Shots - Health News Health2009 Flu Pandemic Was 10 Times More Deadly Than Previously ThoughtHealthPart-Time Workers With Minimal Health Coverage Get New OptionsHealth CareThese Californians Greeted Canceled Health Plans With SmilesHealthEmergency Contraceptive Pill Might Be Ineffective For Obese

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Monday, November 25, 2013

FDA Tells 23andMe To Stop Selling Popular Genetic Test

More From Shots - Health News HealthYes, Your Toddler Really Is Smarter Than A 5-Year-OldHealthFDA Tells 23andMe To Stop Selling Popular Genetic TestHealth CareHealth Exchanges Brace For A December DelugeHealthIn Pregnancy, What's Worse? Cigarettes Or The Nicotine Patch?

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Health Exchanges Brace For A December Deluge

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Thursday, November 21, 2013

The U.S. Lags in Life Expectancy Gains

From Bloomberg Businessweek –

Life expectancy in the U.S. has been growing more slowly than in other developed countries and is now more than a year below the developed-country average, according to a new report (PDF) from the Organisation for Economic Co-operation and Development.

Even though Americans, on average, live to be almost 80, this is not good news. Life expectancy at birth is affected by trends in everything from infant mortality, accident rates, and violence to chronic diseases and care for the elderly, which makes it a highly sensitive indicator of a nation�s economic development.

U.S. life expectancy in 2011 was 78.7 years. That was an increase of a little less than eight years since 1970. Impressive, but not as big as the 10-year gain for the OECD as a whole. �Life expectancy [in the U.S.] is now more than a year below the OECD average of 80.1,� the OECD said in a press statement, �compared to one year above the average in 1970.�

Why has the U.S. fallen off pace? The OECD report sums up some American studies by the National Research Council and the Institute of Medicine that suggest some causes. None of the theories reflect well on the U.S.:

1. The highly fragmented nature of the U.S. health system, with relatively few resources devoted to public health and primary care, and a large share of the population uninsured;

2. Health-related behaviors, including higher calorie consumption per capita and obesity rates, higher consumption of prescription and illegal drugs, higher deaths from road traffic accidents and higher homicide rates;

3. Adverse socioeconomic conditions affecting a large segment of the U.S. population, with higher rates of poverty and income inequality than in most other OECD countries.

Ouch.

Saturday, November 16, 2013

Making Moves In Food Delivery, Chess And Health Care

Listen to the Story 3 min 55 sec Playlist Download Transcript  

The online magazine Ozy covers people, places and trends on the horizon. Co-founder Carlos Watson joins All Things Considered regularly to tell us about the site's latest discoveries.

This week, Watson tells host Arun Rath about a delivery service that allows you to track your food in real time, a chess master who is making the board game sexy and his recent interview with President Bill Clinton.

The New And The Next Shaking Up The Food Delivery Model Enlarge image i Radius Images/Corbis Radius Images/Corbis

"A couple of young guys who were UC Berkeley grads � food obsessed � were finding that they couldn't get their favorite foods delivered. So, they starteda new service called Caviar, that for a flat fee is creating quite the Uber-like stir around San Francisco and now in Seattle and New York. ...

"They've got a lot of your basics, whether it's fish tacos or pulled pork sandwiches, but they also have some of the higher-end restaurants who in the past have been a little hesitant about delivery who have agreed to do it."

Read 'Caviar: Like Uber For Eaters' At Ozy.com

Sexy Moves In The World Of Chess Enlarge image i Courtesy of Ozy.com Courtesy of Ozy.com

"Chess is not always the sexiest sport. But the No. 1 chess player in the world is a young guy from Norway named Magnus Carlsen, who is becoming quite the sensation. He is not only a champion chess player but he is also a male model and that's a very different look from Bobby Fischer or Garry Kasparov, who were two other famous chess champions of the past. ... Guys like Kasparov and others are saying, 'I hope he does really well and puts chess back into the larger mainstream conversation.' "

Read 'Meet the New Ambassador of Chess' At Ozy.com

President Bill Clinton Talks Health Care With Ozy Youtube/YouTube

"He reminded us that when President George W. Bush rolled out the Medicare Part D plan that there also were a number of hiccups in the early days. So, that was his way of offering context to the current troubles with HealthCare.gov. And saying, be a little bit patient. While there may be a number of troubles in the first couple months with HealthCare.gov, they ultimately should be fixable and this won't have been the first time that we've had to smooth over some things in the early going."

Read 'Assessing the Healthcare Rollout' At Ozy.com

Share Facebook Twitter Google+ Email Comment More From The New And The Next Pop CultureMaking Moves In Food Delivery, Chess And Health CarePop CultureDigging Into The Truth About Messages, Images And Hard TimesPop CultureA Male Belly Dancer, Social Activism On Instagram, 'Thriller'Pop CultureA Teenage Music Phenom, Infographics, Motorcycles In Vietnam

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New Medical Device Treats Epilepsy With A Well-Timed Zap

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Friday, November 15, 2013

Can You Keep Your Old Health Plan? It May Depend On Where You Live

More From Shots - Health News HealthFor Many People, Lowering Blood Pressure Will Take A VillageHealthCan You Keep Your Old Health Plan? It May Depend On Where You Live HealthFederal Brain Science Project Aims To Restore Soldiers' MemoryHealthConsumer Guide To Obama's Plan For Canceled Health Policies

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Can You Keep Your Old Health Plan? It May Depend On Where You Live

More From Shots - Health News HealthFor Many People, Lowering Blood Pressure Will Take A VillageHealthCan You Keep Your Old Health Plan? It May Depend On Where You Live HealthFederal Brain Science Project Aims To Restore Soldiers' MemoryHealthConsumer Guide To Obama's Plan For Canceled Health Policies

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Thursday, November 14, 2013

Insurers Aren't Keen On Obama's Pledge To Extend Coverage

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Wednesday, November 13, 2013

'Holy Cow' And 'Kangaroo Court': Panel Grills HealthCare.gov Officials

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Tuesday, November 12, 2013

Despite Health Law, Uninsured Rely On Prevention Care Patchwork

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Despite Health Law, Uninsured Rely On Prevention Care Patchwork

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Monday, November 11, 2013

The First Estimate On Insurance Signups Is Pretty Darned Small

More From Shots - Health News Health CareThe First Estimate On Insurance Signups Is Pretty Darned SmallHealth$4.2 Billion Deal Highlights Drug Profits From Rare Diseases HealthAid Groups Struggle To Reach Survivors Of Typhoon Haiyan HealthMovies Rated PG-13 Feature The Most Gun Violence

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Saturday, November 9, 2013

When Caregivers Are Abusers: Calif. Complaints Go Unanswered

Listen to the Story 6 min 2 sec Playlist Download Transcript   Enlarge image i

Jim Fossum holds a photograph of his aunt, Elsie Fossum, who died from injuries her caregiver said were the result of a fall.

Mina Kim/KQED

Jim Fossum holds a photograph of his aunt, Elsie Fossum, who died from injuries her caregiver said were the result of a fall.

Mina Kim/KQED

Nurse assistants and home health aides provide intimate care, bathing, feeding and dressing the elderly, disabled or ill. So what happens when an abusive caregiver hurts a patient?

Public health regulators in California have been letting many complaints sit for years � even when they involve severe injuries or deaths.

'Beaten To A Pulp'

Elsie Fossum's nieces and nephews say she was the aunt you wanted to have.

"She gave us our first car," Janet Flynn remembers. Her brother, Jim Fossum, chimes in: "A '59 Ford Galaxie 500, with massive fins on it."

Flynn says their aunt, a librarian and teacher who never married or had kids, always looked chic.

Enlarge image i

Elsie Fossum's niece, Janet Flynn, and nephews Jim Fossum, left, and John Fossum, say they never heard from California's Department of Public Health following their aunt's death.

Mina Kim/KQED

Elsie Fossum's niece, Janet Flynn, and nephews Jim Fossum, left, and John Fossum, say they never heard from California's Department of Public Health following their aunt's death.

Mina Kim/KQED

"She would come for the summer with this tiny Samsonite suitcase," Flynn says. "And she would be impeccably dressed, mixing and matching, and her hair was always done. Always looked wonderful."

But on the morning of July 3, 2006, Elsie Fossum lay in a pool of blood on the floor of her bedroom at Claremont Place, a Los Angeles-area assisted living facility. The 95-year-old Fossum had lived there for two years.

Her eyes were bruising black, her lip was badly cut, and her right arm was broken. But she was alive.

The lone caregiver on Fossum's floor that night said Fossum fell, but Beverlee McPherson, a registered nurse who supervised nurse assistants at Claremont Place, suspected abuse.

"She looked like she went four or five rounds with Muhammad Ali," McPherson says.

Unable to take much food or water through her swollen mouth, Fossum died of dehydration less than three weeks later. A Los Angeles County coroner could not rule out assault and called the manner of death undetermined.

McPherson is resolute.

"Oh, I'm 100-percent convinced she didn't fall out of bed, 100 percent," she says. "If you saw this woman's face, I mean, her entire face was beaten to a pulp."

'Staying On Top Of Complaints'

Emergency room nurses who treated Fossum at a nearby hospital also suspected abuse. The hospital quickly notified the California Department of Public Health, the agency responsible for decertifying nurse assistants who violate standards of care.

Cases Closed With No Action Taken

The number and rate of license revocations against nursing assistants and in-home health aides suspected of abuse have plunged, while cases closed without action have increased.

Enlarge image i Center For Investigative Reporting/KQED Center For Investigative Reporting/KQED

But internal documents obtained by the Center for Investigative Reporting show department investigators shelved Fossum's case for six and a half years.

CDPH Director Ron Chapman blames the delays in handling complaints on a backlog of more than 900 cases that piled up between 2004 and 2008.

"There were a number of reasons for that backlog, including poor management decisions during that time," Chapman says.

The department implemented a plan in 2009 to address the backlog, says Chapman, who was sworn in to his position in 2011.

"In the two years that I've been in the job, there's now new management from top to bottom, and we're staying on top of all the complaints as they come in," he says.

Yet the number of nurse assistants facing disciplinary action following complaints has dropped, from 27 percent a few years ago to 9 percent last year.

Chapman says he sees no evidence that addressing the backlog has undermined the quality of the department's current work, but Marc Parker, who headed the investigations section for nine years, says he was forced to cut corners.

"Hundreds of cases were closed, hundreds, with nothing but a phone call," he says.

'A Failure To Protect'

Parker says without visits to facilities, investigators are unable to see the layout of a room, conduct impromptu interviews, or assess a person's body language. Parker retired in December of 2011, earlier than planned.

"I could not protect the public any longer," he says. "There was just a failure to protect the most vulnerable people in our state from abuse and neglect."

A Sudden Drop



The California Department of Public Health is required to notify the attorney general's office when its investigators find evidence of crimes, especially violent acts, at health care facilities. After 2009, the department all but stopped sending patient abuse deaths to state prosecutors.

Enlarge image i Center For Investigative Reporting/KQED Center For Investigative Reporting/KQED

Public health regulators are required to report all suspected crimes to the state attorney general. In the seven years before addressing the backlog, the department referred an average of 37 deaths a year. Last year, they referred three. The year before that, two.

"We don't understand that decline in numbers," Chapman says. "It's very concerning to me and we are looking into it." He says his staff is drafting agreements with the attorney general's office to improve communication.

As for Elsie Fossum's suspicious death, department investigators closed her case this year, and decided no action was warranted against her caregiver.

Also this year, however, the Los Angeles County Sheriff's Department opened a homicide investigation into Elsie Fossum's death. Her caregiver is the sole person of interest. Chapman now says he's willing to review the case.

Elsie Fossum's nephews and niece say they never heard from the Department of Public Health. Flynn says their calls and emails to state agencies and local police have turned up little information.

"I would think that this would be very chilling to anyone who has loved ones in a facility, especially if you think safeguards are in place and you think that staff are qualified and that this is being regulated, and this I find chilling," Flynn says.

This story was co-reported by Ryan Gabrielson at the Center for Investigative Reporting.

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Thursday, November 7, 2013

How The Affordable Care Act Pays For Insurance Subsidies

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Doctors Slow To Embrace Recommended HPV Testing

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Wednesday, November 6, 2013

The President Wants You to Get Rich on Obamacare

From the New York Times –

Tom Scully bolted through the doors and up the stairs to a private dining room on the third floor of the �21� Club. Scully, 56, is slightly taller than average and has tousled graying hair, an athletic build and a lopsided smile. He typically projects a combination of confidence and bemusement, but on this rainy September afternoon, he was frenzied. Scully was scheduled to deliver the keynote address at an event hosted by the Potomac Research Group, a Beltway firm that advises large investors on government policy (tag line: �Washington to Wall Street�). Today�s discussion centered on the most significant change in decades to the nation�s health care policy, the Patient Protection and Affordable Care Act, a.k.a. Obamacare. As Scully walked to the front of the room, some 50 managers from hedge funds, mutual funds and private equity firms tucked into the round tables. Others gathered in the hallway. A hush of anticipation hung in the air.

During the past year, anxiety about the onset of Obamacare has created a chill in some parts of the economy. While large health care businesses � insurance companies, for instance, and hospital chains � have poured significant resources into preparing for millions of new customers, countless investors have appeared spooked by the perpetual threats to repeal, or at least revise, the law. According to Thomson Reuters, private equity investment, usually the lifeblood for entrepreneurialism, has dropped by an astonishing 65 percent in the health care sector this year.

Scully has been trying to assuage these worries, but the nervous questions keep coming at him. Before he even began his speech, one attendee said he feared that only three million new patients, far fewer than estimated, would be signing up for insurance. �No way,� Scully said. �Way more � way more. At least 15 million, maybe 20 million. The Democrats have a huge incentive to make this work.� Another asked if Scully was worried about Congressional repeal. �It�s just not going to happen,� he said. �Don�t pay attention to Rush Limbaugh.� When Scully finally began his speech, he noted that the prevailing narrative among Republicans � assuming that many in the room were, like him, Republican � was incorrect. �It�s not a government takeover of medicine,� he told the crowd. �It�s the privatization of health care.� In fact, Obamacare, he said, was largely based on past Republican initiatives. �If you took George H. W. Bush�s health plan and removed the label, you�d think it was Obamacare.�

Scully then segued to his main point, one he has been making in similarly handsome dining rooms across the country: No matter what investors thought about Obamacare politically � and surely many there did not think much of it � the law was going to make some people very rich. The Affordable Care Act, he said, wasn�t simply a law that mandated insurance for the uninsured. Instead, it would fundamentally transform the basic business model of medicine. With the right understanding of the industry, private-sector markets and bureaucratic rules, savvy investors could help underwrite innovative companies specifically designed to profit from the law. Billions could flow from Washington to Wall Street, indeed.

Scully, who has spent the last 30-some years oscillating between government and the private sector, is hoping to be his own best proof of the Obamacare gold mine. As a principal health policy adviser under President George H. W. Bush, he helped formulate many of those past Republican initiatives � like the shift to private-insurance programs � that Obamacare has put into law. Under George W. Bush, he ran the Centers for Medicare and Medicaid Services and oversaw a host of proto-Obamacare reforms, like Medicare Part D, which introduced competition into the government-supported health care market. After leaving C.M.S. in 2004, Scully began working simultaneously at Welsh, Carson, Anderson & Stowe, a leading health care private equity firm, and Alston & Bird, a law firm and health care lobbying organization. When the Affordable Care Act became law in 2010, he found himself in the rare position of being a lobbyist, private equity executive and former government health care official with access to a serious amount of capital. During the past three years, as other Republicans have tried to overturn Obamacare, Scully searched for a way to make a killing from it.

Continue reading…

Tuesday, November 5, 2013

In Colorado, A Couple Finds Relief In Obamacare

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