Health Care Reform’s Indoor Tanning Tax — One Year Later0

Under the Patient Protection and Affordable Care Act, indoor tanning salon owners faced a new, 10 percent tax effective July 1, 2010.  Recently, bills in the House and Senate have been introduced to repeal this tax.

Congressman Michael Grimm (R-NY) introduced H.R. 2092 and Senator Olympia Snowe (R-ME) introduced S. 1278, identical bills designed to repeal the tax.  According to the Indoor Tanning Association President Dan Humiston:  “This tax has been a serious hardship on our industry.  Because the industry depends on consumers’ discretionary income, the recession and this tax have had a profound negative effect on our businesses.   In reality, this tax takes money out of the pockets of some of those least able to afford it: working women, who are not only customers but also make up a majority of our business owners; and college students, who are both customers and employees.”

One year later, however, the American Academy of Dermatology Association (AAD) strongly opposes any and all attempts to repeal the indoor tanning tax. According to dermatologist Ronald L. Moy, M.D., president of AAD: “The indoor tanning tax sends a clear message to Americans, especially young people, that tanning is a dangerous activity and that a tan is not a sign of good health. As the medical doctors who treat more than 3.5 million cases of skin cancer in America every year, dermatologists are focused on increasing awareness of and protecting the public from the known skin cancer risks associated with UV radiation from indoor tanning.”   Dr. Moy continued: “The Academy is disappointed that the proposed repeal legislation ignores the serious public health impact of indoor tanning and the dramatic rise of skin cancer in young women,” said Dr. Moy.

Critics of indoor tanning contend it increases the risk of melanoma by 75 percent.  “The skin cancer risk inherent in tanning bed use cannot be ignored and similar to the tobacco tax, the indoor tanning tax appropriately reflects the cancer-causing effects of indoor tanning,” stated Dr. Moy. “It is the hope of the Academy that the current federal tax on this activity remains in place as a deterrent to this harmful behavior.”

Mystery Patients No Longer at a Doctor Near You0

Yesterday the Obama administration reported it would abandon its plan for for physician surveys with “mystery shoppers”. In a statement by the Department of Health and Human Services: “We have determined that now is not the time to move forward with this research project.” HHS spokesman Christian J. Stenrud explained: “Politics did not play a role in the decision.”


Mystery Patients at a Doctor Near You0

A new group of “shoppers” will soon be frequenting health care providers across the country. President Obama’s administration is assembling a team of “mystery shoppers” to pose as patients, contact doctors’ offices, and request an appointment. The objective is to determine the degree of difficulty in obtaining health care services.

According to the administration, the survey is designed to identify the scope of primary care physician shortages, including internal medicine and family practice. The survey intends to identify the physicians who accept federally funded health insurance (Medicare, Medicaid, etc.) and those who only accept private insurance.

According to a New York Times article, these patients will “call medical practices and ask if doctors are accepting new patients and, if so, how long the wait would be. The government is eager to know whether doctors give different answers to callers depending on whether they have public insurance, like Medicaid, or private insurance, like Blue Cross and Blue Shield.”
Physician reactions to this new survey has been mixed. In response to criticism, a federal official emphasized that the collected data would remain confidential. “Reports will present aggregate data, and individuals will not be identified,” said one White House official.

According to Christian J. Stenrud, a Health and Human Services spokesman: “Access to primary care is a priority for the administration. This study is an effort to better understand the problem and make sure we are doing everything we can to support primary care physicians, especially in communities where the need is greatest.”

Program costs are estimated at $347,370.


$500 Million Made Available to Health Care Providers for Improvements0

The United States Department of Health and Human Services (HHS) unveiled a new program with funding up to $500 million to help hospitals and other health care providers improve the quality of patient care, prevent injuries and facility acquired infections, and cut back on readmissions.

Called the Partnership for Patients, this funding made possible under the Patient Protection and Affordable Care Act will be awarded by the Centers for Medicare & Medicaid Services (CMS) Innovation Center.

“Since the Partnership for Patients was announced, we have had an overwhelming response from hospitals, doctors, employers, and other partners who want to be a part of this historic effort to improve patient safety,” said CMS Administrator Donald M. Berwick, M.D. “We are now looking to contract with local and statewide entities that can foster and support hospitals’ efforts to improve health care and reduce harm to patients.”

The Partnership’s two goals include the reduction of harm in the hospital by 40% while at the same time lowering readmissions by 20% over a 3-year period.The Partnership will seek to contract in part with large health care systems, associations, and state organizations in meeting these goals.  To qualify for funding, “Hospital Engagement Contractors” must do the following:

  • Design intensive programs to teach and support hospitals in making care safer;
  • Conduct trainings for hospitals and care providers;
  • Provide technical assistance for hospitals and care providers; and
  • Establish and implement a system to track and monitor hospital progress in meeting quality improvement goals.

In addition to the Hospital Engagement Contractors, CMS will also be working with other contractors to improve the delivery of care. This includes work with patients and families to understand what they believe can improve safety in the hospital as well as in transition from on facility to another.

Solicitations for proposals are available on the Federal Business Opportunities website here.  A copy of HHS’ Press Release is available here.


Searching for Attachment at Home0

This article first appeared on the PBS affiliated Website This Emotional Life. This content is provided in conjunction with This Emotional Life’s Early Moments Matter initiative. Early Moments Matter is dedicated to making sure that every child has the best possible chance at emotional well-being. Find out how to receive the Early Moments Matter tool kit and provide one to a family in need.

“Not until we are lost do we begin to understand ourselves.” –Henry David Thoreau

Yesterday I awoke feeling somewhat uncomfortable. Looking around the room, I checked the facts before me.  Yes, it was my home, my family, my face in the mirror, but something was still missing. Concluding this to be a typical morning sensation, I decided to follow tradition: Make some coffee and read the newspaper.  In recent years, however, the newspaper has been for me little more than a spring and summer luxury within which I can scan baseball box scores and statistics. Still, with nearly 80% of the season left, I thought I should have no problem catching up quickly.

With coffee and toast at the ready, I was soon armed with key baseball facts — the American League only of course — and ready to move on to the Wall Street Journal.   As I thumbed through page after page of news, digesting financial facts and perusing stock market tables from the day before, it suddenly hit me that I could not honestly answer my wife when she asked me why I still received the paper’s print edition. Returning to the local paper one more time, I finally understood what was so unfamiliar with my morning:  I had nothing to do, and I was restless.

It was only the other night that I joined forces with the other nine percent of our nation’s unemployed, but on this first wayward morning my overall sense of detachment proved uninspiring. For nine full years I had headed a community hospital in southern Los Angeles, and I was used to a little drama with my morning meal. The drive to find something new on which to focus had not yet overpowered the need to put out any potential fires that had erupted at the hospital overnight, and my instincts were still primed to react to quick moving scenarios where the balance between life and death hung fast, waiting for a reaction. Today, however, I had no crisis to manage, no dragons to slay, and no urgent phone calls or emails to return. The only real enigma I faced on this first morning was to ask myself why I felt like a stranger in a home where a three-month old infant served as the poster child in support of the very idea behind positive attachment. Warily, I considered my options, and quickly concluded that ignoring this situation until it escalated into something dramatic and life threatening that my health care focused brain could understand was not a healthy way of looking at this first new day. For nine years running I had proven that I could solve almost any problem with which I was presented, and today I was determined to find some attachment.

To my knowledge, there are five permanent “entities” and one guest living in my home, aside from myself, and so I decided to work my way up the ladder in reverse order, in search of attachment. I began with Max, an arrogant but often lovable Pekingese who was unfortunately busy with a mid morning nap.  Then came Amnesia and Segundo, two black cats full of kindness and compassion, who, like Max, were also sleeping, which was not entirely unexpected, as they are cats. I then proceeded to the more animated individuals in the home, those with whom I knew I could communicate, where I believed I would find the attachment I so desperately sought.

Jackpot. My wife and son were feeding, and I thought to myself that symbolically, at least, my quest was now complete.  My mother-in-law was telling what appeared to be a very engaging story, and I smiled to think that this moment reflected the positive domestic light of a home based on solid and secure relationships with free and easy conversation.  Unfortunately for me, however, the tale was told in Russian, and I simply could not follow. Still, I held my ground, and a few minutes later I made my move, scooping up my son to effectuate the necessary post-feeding digestive adjustments, and for a brief moment I was able to bask in the glory of this fleeting victory.

Sadly, my success was short-lived, as not twenty minutes later I was informed that my son, my wife and her mother were late for a class that I had neither business nor interest in attending. So I opted to stay put and lower my sights, still determined to find some attachment with the dog and cats.

But the animals proved fickle, as house pets tend to be, and their desertion had been at least in part expected. What was worse, though, was the fact that the desk in my office, my old battle-mate, brought no relief either. Just last week my computer stood as a portal to another world where healthy, meaningful relationships roamed in great abundance.  Today, however, this connection seemed lost, and I learned a hard lesson about the dangers to be found in errant, virtual attachments. Feeling abandoned and lost, with no point of focus, I left the house to complete some menial tasks, none of which were necessary, all of which proved unfulfilling. After completing every menial errand I could concoct, I returned home with the somewhat forced notion that I deserved to consume a well-earned lunch.

But then I stopped. Let it here be said that we all have fictional boundaries in our lives, boundaries of our own devising, some of which are more accepted and important than others.  For the record, I have many, most of which I break, but there is one hard and fast statute on which I simply will not budge.  I refuse to eat lunch at 10:30 am.

And so, with a grumbling stomach but without much choice, I resigned myself to the couch and watched a pre-recorded episode of the television show House.  As I relaxed and gave myself over to the drama unfolding before me, it hit me that this would be as close as I was going to get to a hospital for the rest of the week.  And just when I thought I had failed in my one and only objective for the day, Max the dog materialized from under a table, jumped on the couch, and rested his head on my leg with one eye fixed on the television. Together, we watched in silence.  Indeed, we bonded.

Still not quite lunchtime, I reflected on why I have had such a difficult time finding my attachment this Monday morning. While it is true that the past few months I have spent transitioning a hospital (with a 24/7 emergency department) between owners have made me a stranger of sorts in my own home, my thoughts have always been primarily with those who rest beneath my roof, and it is to them that I have sought to return. When it comes to my son, I feel at times that I have arrived late to the party, though I marvel at the energy my wife has spent building a safe and secure environment for him. In fact, the bond she has formed with my son during this period in which I was preoccupied is exactly what gives me hope for the free time which now stretches before me. It is in many ways a gift for which no amount of education, experience or desire can prepare me.  The key to any bond rests with time spent together. And I for one cannot wait to begin.

Go to to learn about attachment and to get an award-winning toolkit that introduces ways in which parents and caregivers can help their children build secure attachments.


How Will Employers Respond to Health Care Reform?0

The Patient Protection and Affordable Care Act (PPACA) is designed to reshape the nation’s health care system over the next decade. While parts of PPACA are already in effect, some of the greater milestones occur in 2014 and 2018.

Already the subject of several legal challenges, individuals who do not obtain or retain qualifying health care coverage by 2014 will be required to pay a penalty as part of their income tax returns.

For “large employers” (those with 50 or more full-time employees), PPACA imposes a penalty ($2,000 per employee) if any of their full-time employees qualify and receive federal subsidies after 2014. This provision exists in lieu of any requirement for employers to offer health insurance coverage to their employees, although the penalty does not apply for the first 30 employees.

The implications of this employer penalty have been widely debated since PPACA first passed. In an attempt to ascertain how businesses intended to respond to this health care reform requirement, McKinsey & Company commissioned a survey of 1,329 private sector employers.

According to the survey results, 30% of responding employers who offered employer sponsored health insurance indicated they would “definitely” (9%) or “probably” (21%) stop coverage after 2014. Although the survey noted it only captured current projections and was not entirely conclusive, the projections raised some industry concerns.

After facing questions and criticism, McKinsey & Company finally released the questionnaire and methodology of its survey. One White House official, Nancy-Ann DeParle (assistant to the President and deputy chief of staff) noted: “As we learn more, it’s become clear that this one flawed study from McKinsey is truly an outlier.”

Although the true impact may not be known until 2014, the concerns are nonetheless significant. A copy of the survey results can be found HERE. Additional articles on the subject also appeared in Monday’s New York Times and Wall Street Journal.


The House that Barack Built0

As the former CEO of a small community hospital, I am reminded daily of the frustrations set upon today’s sick as our nation’s health care system struggles to adapt to fundamental changes in its core structure.  In many ways it calls to mind the trials and tribulations inherent in former New York Yankee owner George Steinbrenner’s attempt to build a new home for his beloved team.

Steinbrenner first began campaigning for a new stadium in the 1980s, alleging that the House that Ruth Built was no longer sound and posed a threat to all those in attendance. When his idea was met with resistance, the Yankees considered several options, including a move across the Hudson to New Jersey as well as one to the West Side of Manhattan.  At long last, after myriad delays caused for the most part by New York City politics, the proposal for the new stadium was unveiled in 2004.

Groundbreaking ceremonies took place on August 16, 2006, the 58th anniversary of Babe Ruth’s death. Thanks to the proximity of the two fields, the Yankees were able to continue playing in their old home throughout the 2007 and 2008 seasons while their new stadium was being finished across the street.  As one would expect, Yankee fans stayed loyal to their team throughout, and the new stadium was officially opened on April 16, 2009.

Whether you loved or hated him, it was largely thanks to Mr. Steinbrenner’s business acumen that the Yankees could afford to play in the old stadium while the new one was being built.  It would be equally appropriate if health care reform could work this way, shifting from a dilapidated system to a fully functioning alternative on a specific day. However, the foundation of an innovative health care system is much more fluid than Bronx bedrock, and the necessary combination of time, logistics and money (trillions of dollars over decades) makes this an impossibility. Instead, we must “feel” the transition, painful though it may be.  As with any endeavor of this magnitude, patience is essential to success.

While the idea of a Yankee fan cheering for his team as a pile driver goes about its business in the next row may seem absurd, that is exactly what the American patient is currently being asked to endure.  That said, the growing pains felt by the effects of the Patient Protection and Affordable Care Act (PPACA) are an inconvenient yet vital step in the evolution of a solidly functioning health care state.

In their very first year in the new stadium, the Yankees won the World Series and the fans went wild.  Whether the citizens of America will be as appreciative of their new health care structure remains as yet to be seen.

This article was originally posted on

MedPAC Releases June Report on Medicare and the Health Care Delivery System

The Medicare Payment Advisory Commission (MedPAC) is an independent Congressional agency established by the Balanced Budget Act of 1997 (P.L. 105-33).  MedPAC must advise Congress on issues affecting the nation’s Medicare program. MedPAC must also analyze access to care, quality of care, and other issues affecting Medicare.

MedPAC issues two reports each year (March and June).  These report include the key recommendations by the Commission to Congress.  MedPAC also advises Congress through various comments on reports and proposed regulations issued by the Secretary of the Department of Health and Human Services, as well as testimony and briefings for the legislative branch.

On June 15, 2011, MedPAC issued its June report to Congress, along with the following press release:

Washington, DC, June 15, 2011—Today the Medicare Payment Advisory Commission (MedPAC) releases its June 2011 Report to the Congress: Medicare and the Health Care Delivery System. This latest report focuses on some of the key challenges facing the Medicare program today.

This report builds on MedPAC’s previous recommendations to change Medicare’s payment systems to reward quality and efficiency in the delivery of health care services, instead of rewarding increased volume and intensity. Examples of such payment reforms include making a single payment for larger bundles of health care services and linking payments to quality. According to MedPAC chairman Glenn Hackbarth, “The Commission believes payment reform is a necessary, although not sufficient, condition for reform of the health care delivery system.”

In Medicare and the Health Care Delivery System, the Commission complements those payment reforms with a set of recommendations to help motivate and support quality improvement among health care providers who treat Medicare patients. These recommendations would fundamentally restructure Medicare’s Quality Improvement Organization (QIO) program.  In doing so, MedPAC seeks to ensure that providers whose quality of care is lagging receive well-targeted and effective technical assistance.

The Commission also makes a set of recommendations concerning ancillary services, such as diagnostic imaging and other tests. In the last decade, ancillary services have reached high levels of use, fueled at least in part by unduly high payments. These recommendations improve payment accuracy to reduce providers’ financial incentives to order more ancillary services, while strengthening clinical support tools to improve appropriate use of these services.

In this report, the Commission examines the sustainable growth rate system (SGR), Medicare’s expenditure target system designed to link updates to Medicare’s physician fee schedule to service volume. For 2012, the SSGR prescribes a 30 percent reduction to physician fee schedule payments, unless Congress intervenes.

The Commission is concerned that the magnitude of this payment reduction, coupled with repeated short-term “fixes” to prevent the cut, undermine provider and beneficiary confidence in Medicare and raise concerns about beneficiaries’ access to physician services. The SGR in its current form is unworkable and this report describes a series of policies for further consideration that could collectively replace the SGR, reduce the volume incentives under fee-for-service, and increase Medicare’s valuation of primary care.

The report addresses other issues, including:

Medicare’s fee-for-service benefit design: This chapter reviews the elements of the fee-for-service benefit structure and its impact on beneficiary out-of-pocket spending.  The Commission is exploring options to better protect beneficiaries against high out-of pocket (OOP) spending while at the same time encouraging them to weigh their use of discretionary care without forgoing needed care.

Coordinating the care of dual-eligible beneficiaries: The Commission is interested in improving care for dual-eligible beneficiaries, a population whose care is both costly and frequently uncoordinated, resulting in poor outcomes. This chapter describes the characteristics of provider-based and managed care programs that have the potential to integrate and coordinate services provided to their enrollees.

Federally Qualified Health Centers: FQHCs are community-based organizations that provide comprehensive primary care and preventive care to persons of all ages, regardless of their ability to pay. This chapter describes their structure, funding, and services, including how FQHCs are paid by Medicare, and their potential role in providing primary care to Medicare beneficiaries.

Variation in private sector payment rates: This chapter examines the differences in private sector payment rates for hospital and physician services across and within U.S. markets.

For a complete copy of the June report, click HERE.


Lost Hospital — Homer G. Phillips Hospital, St. Louis, Missouri

Before 1920, the black population of St. Louis was not permitted inside the walls of the public City Hospital, even though their numbers had increased by 60% over the past decade. In response, leaders of the black community purchased a 177 bed hospital for use in 1919, named City Hospital #2. This facility was still inadequate, however, to treat the 70,000 black residents of St. Louis.

A local black attorney named Homer G. Phillips led a city-wide campaign to build a larger black hospital.  Although a bond issue was passed in 1923, it would be nine years later — and after the murder of Homer G. Phillips — before construction of the new hospital would begin.

The main hospital buildings were completed between 1933 and 1935, and the ancillary wings between 1936 and 1937. At the dedication ceremony on February 22, 1937, Secretary of Interior Harold L. Ickes told the community the new hospital would help them “achieve [their] rightful place in our economic system.”  In 1942, the hospital was renamed in honor of Homer G. Phillips.

By 1948, the resident physicians at the hospital included more than a third of the graduates from the only two black medical schools in the nation. In addition to schools for nursing, x-ray technicians, laboratory technicians and medical records staff, the hospital also allowed foreign doctors to train at the facility. The hospital also led the nation in developing treatments for gunshot wounds, ulcers, and burns.

In 1955 the City of St. Louis was ordered to desegregate its hospitals. Although the Hospital complied, it still remained mostly black in staff and patients. As early as 1961, the City started to discuss a merger between Homer G. Phillips and City Hospital. By the end of the decade, many of the services at Homer G. Phillips were reduced or eliminated altogether.

The merger efforts stalled for another decade.  On August 17, 1979, St. Louis closed all inpatient services at the hospital. This resulted in local protests and forced the police department to escort the remaining patients from the hospital. Even though a task force was charged with finding the reasons for the hospital closure, little results and the hospital did not reopen.  By 1985, and with a listing on the National Register of Historic Places, the hospital facility was closed completely.


Robert Koch Hospital, Koch, Missouri

Named after the German bacteriologist who isolated the microorganisms responsible for diseases like tuberculosis and cholera, the Robert Koch Hospital  for Contagious Disease is a lost hospital in a lost city.

Located in the former city of Koch (what is now Interstate 255 east of Route 231), the hospital was officially opened in 1875, with its land being purchased by the city of St. Louis in 1854. The location was strategically isolated so the hospital could treat patients with leprosy, yellow fever, typhoid, cholera, smallpox and diphtheria. Patients that did not survive were buried on the property’s cemetery.

The hospital eventually focused on tuberculosis patients, a disease which killed 10% of the residents in St. Louis in the early 20th Century. By 1939, the hospital property consisted of 19 buildings on 105 acres of farmland. There was a post office, a railroad stop, housing, and recreational facilities. The hospital also published its own newsletter from 1925-1947.  Financing through bonds helped the hospital grow to almost 500 beds, and that still could not keep up with the needs of the community.

In the 1950s, as public health started to win the battle against tuberculosis, the city tried to sell the property. In 1961 the City tried to refocus the hospital on the indigent elderly. Eventually, the hospital closed in November 1983.