Intricacies of the Modern Health Care Behemoth0
California Healthcare News first published this article, Intricacies of the Modern Health Care Behemoth, on April 4, 2017.
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“For every complex problem there is an answer that is clear, simple and wrong.” – Henry Louis Mencken
Known by some as the 2010 Patient Protection and Affordable Care Act, others by the often sardonic alias “Obamacare,” and most recently highlighted through contentious “repeal and replace” rhetoric, health care reform has reemerged as a hot topic of discussion in households across the country. Those affected by this issue include anyone who (1) is currently sick or has been sick in the past, (2) has a friend or family member that is dealing or has dealt with an illness, or (3) is or knows someone who may one day receive that plastic bracelet bestowing the title of “hospital patient.” Basically, this refers to every American. And yet, so great is the divisiveness on how best to manage health care in the modern age, the Affordable Care Act (ACA) now finds itself in a paralytic state as advocates and critics tangle over the vast complexities at its core. The only commonality is the recognition that there is no simple solution.
Is Health Care Really So Complicated?
Complex by necessity, America’s current health care system may appear elaborate, ridiculous or even labyrinthine in turns, and changing even the smallest fraction involves delving deep into the belly of the beast. For example, Medicare disproportionate share hospital (DSH) adjustment provisions rely upon a statutory formula to calculate DSH patient percentage which is equal to the sum of the percentage of Medicare inpatient days attributable to patients eligible for both Medicare Part A and Supplemental Security Income (SSI), and the percentage of total inpatient days attributable to patients eligible for Medicaid by not Medicare Part A. With this in mind, even the health care layman is quick to realize that, in labeling DSH adjustments (DSH Patient Percent = (Medicare SSI Days / Total Medicare Days) + Medicaid, Non-Medicare Days / Total Patient Days), one is forced to learn the equivalent of a new language. … Read more →
Repealing the Affordable Care Act – What Could Possibly Go Wrong?0
California Healthcare News first published Repealing the Affordable Care Act — What Could Possibly Go Wrong? on January 9, 2017.
“Necessity is not an established fact, but an interpretation.” – Friedrich Nietzsche
Evolution or Devolution?
In a constant state of flux, the American health care system has struggled to exist in the present since the introduction of Medicare in 1965. Both in terms of medical care and its delivery, our nation’s health care system must continually evolve if it is to keep up with advances in science, technology and the treatment of disease, as well as the way we access these advances. As a result, each generation’s health care must balance providing that which has come to be expected with the need to expand coverage and modern methods of care. As a nation, we depend upon those in highest office to monitor such changes, adding provisions where applicable and paring down what is no longer practical. Much of the divided nation fears that come January 20, 2017, Barack Obama’s legacy, the Affordable Care Act, may find itself vulnerable to a single stroke of the pen, potentially leaving millions of Americans without meaningful access to medical care. Others will celebrate as Donald John Trump accepts the role of 45th President of the United States. The only immediate certainty for modern American health care is that both sides will continue to argue whether the Affordable Care Act is a frivolous luxury or a social necessity. … Read more →
PBS’s ‘This Emotional Life’: Mental Health and the Family Tree0
The Huffington Post first published this article on September 20, 2010.
“The two most powerful warriors are patience and time.”— Leo Nikolayevich Tolstoy
Thanks to the recent closing of many mental health facilities as a result of today’s tough economic times, the subject of mental illness has been getting a lot of attention lately. The National Institute of Mental Health estimates that 26.2 percent of Americans aged 18 and older — that’s one in four adults — suffer from a diagnosable mental disorder in a given year. Though no one likes to think of the possibility, the chances that a family will at some time face the specter of mental illness within its ranks are all too real.
While concern for those directly plagued by psychiatric issues is certainly a priority, surprisingly little information is geared toward the effect such an illness has on the loved ones and friends of the sick patient. Unlike cancer or heart disease, whose conditions can be qualified, psychiatric disorders continue to stand as an enigma to much of the modern world. This often leaves those closest to the patient wondering both how to feel and what to do when dealing with the ramifications that are sure to present themselves.
Why We Must Care About Medicare0
California Healthcare News published this article, Why We Must Care About Medicare, on October 11, 2016.
“It’s kind of fun to do the impossible.” – Walt Disney
A Federal Circuit Court of Appeal recently commented, “Medicare is, to say the least, a complicated program.” United States health insurance for people 65 and older has 37,000 separate guidance documents online at the Centers for Medicare & Medicaid Services (CMS), myriad federal regulations expounding upon 50 years of statutory direction, and a legion of Federal Court decisions adding even more detail. To be sure, health care providers should exercise great caution before sharing in Medicare’s $650 billion annual fund. Unfortunately for those ambivalent about Medicare with all of its complexities, not to mention anyone who outright hates the program, resistance is probably futile. … Read more →
Supreme Court Decision Adds More Confusion to False Claims Act0
This article, Supreme Court Decision Adds More Confusion to False Claims Act, was first published July 12, 2016 at California Healthcare News.
“The darkest places in hell are reserved for those who maintain their neutrality in times of moral crisis.” — Dante Alighieri
As modern medicine continues its attempts to bridge the gap between body and mind to provide more comprehensive care for patients, so too must the Federal Government address this gray area while endeavoring to regulate care for those less tangible medical issues of the mind. The already elaborate labyrinth known as the Medicare Act has recently grown even more chaotic under the recent Supreme Court decision Universal Health Services, Inc. v. United States (ex rel. Escobar), which further blurs the line between false and fraudulent claims.
Teenage Medicaid beneficiary Yarushka Rivera sought guidance at Arbour Counseling Services in Lawrence, Massachusetts. The facility diagnosed Rivera as bipolar, although the Arbour “Ph.D.” rendering this opinion failed to disclose that her degree was from an unaccredited Internet-based college, or that Massachusetts had rejected her application for licensure as a psychologist. Twenty-three other Arbour “clinicians” also lacked the purported mental health professional licensures Arbour professed to represent. Not surprisingly, the service’s “prescribing psychiatrist” was in fact a registered nurse who lacked the credentials to do so. Arbour also misrepresented various payment codes, such as “family” or “individual” therapy, and it was discovered to have lied in its attempt to garner National Provider Identification (NPI) numbers for its non-practitioners. Needless to say, Rivera’s mother Carmen Correa and stepfather Julio Escobar were not pleased upon learning of the facility’s transgressions from an Arbour counselor five years into Rivera’s treatment. … Read more →
Health Care’s Unfinished Bridge0
This article, Health Care’s Unfinished Bridge, was first published in California Healthcare News on April 5, 2016.
“We must be willing to let go of the life we planned so as to have the life that is waiting for us.” – Joseph Campbell
Every era relies on the intuition of a talented few in its search for scientific breakthroughs. Herodotus rejected the notion the Earth was flat, and in particular its description on the Shield of Achilles in Homer’s Iliad. Some 29 centuries later, science has reduced the labors of Homer to little more than myth, though philosophy still honors the epic, from its very first word (“μῆνῐν” or “wrath”) to its lesson addressing the value of balancing excessive pride with the fear of anonymity. Similarly, advances in technology have greatly benefited medicine in recent generations, as doctors increasingly approach diseases of the body from a tangible perspective. However, the treatment of diseases of the mind continues to be far more speculative in nature, serving to highlight the chasm between these two seemingly similar but ultimately disparate fields. This in turn presents a complex issue for both medical practitioner and mental health provider. … Read more →
Health Care Is Not One Word Or One Person0
This article, Health Care Is Not One Word Or One Person, first appeared in the Los Angeles Daily Journal on February 24, 2016.
“The truth is rarely pure and never simple.” — Oscar Wilde
With the passing of Justice Antonin Scalia, the Supreme Court has lost a brilliant legal scholar and formidable protector of the U.S. Constitution. Scalia both earned respect and instilled fear during his 30-year tenure supervising America’s political climate. While his legacy ought to take precedence during this time of mourning, widespread panic over the future of health care reform threatens to overshadow the passing of Scalia the individual in favor of highlighting the ways in which his unexpected death may advance partisan agendas.
History has shown that a single justice can have a dramatic effect on the formation and defense of policy. In 1896, Justice John Marshall Harlan disagreed with those Supreme Court justices who believed that the Constitution allowed “equal but separate” public transportation accommodations for black and white citizens. His solitary dissent in Plessy v. Ferguson argued otherwise, stating that the Constitution did not create a “superior, dominant, ruling class of citizens” in the United States, and that the Constitution was itself color-blind. Fifty-eight years later, a unified Supreme Court made history with Brown v. Board of Education of Topeka in holding that “separate but equal” had no place in public education. … Read more →
Health Care’s Adventures in Wonderland0
This article by Craig B. Garner[1] and Jessica Weizenbluth[2], Health Care’s Adventures in Wonderland: Provider Agreements for Electronic Records, was first published in February 2016 in California Health Law News.
“Now, here, you see, it takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that!”[3]
I. INTRODUCTION
Y93.J1: Activity, piano playing[4]
Today’s health care provides its own spin on the word “complex,”[5] while at the same time forging possible paths to what may be “unwinnable” scenarios.[6] For the modern physician[7], the universe within which he or she exists requires updated definitions for words such as “complex” and “challenging,” especially as that “perfect storm”[8] also known as health care reform continues to age. Somewhere in between the 2015 Physician Quality Reporting System (“PQRS”)[9], the Physician Value Based Payment Modifying Policies (“VBP”)[10] and tenth revision of the International Statistical Classification of Diseases and Related Health Problems (also known as ICD-10),[11] physicians find themselves still struggling to adopt electronic health records (“EHR”) in practice.[12]
As technology continues to evolve, there remains a general landscape with which those in the health care field must familiarize themselves. Even from this challenging vantage point, providers still have opportunities to bolster their position and practice their craft as they continue down the digital path and adopt an EHR system for which the Federal Government established incentive payments.[13] … Read more →
Killing HIPAA0
This article, Killing HIPAA, first appeared in California Healthcare News on February 8, 2016.
“When truth is buried, it grows. It chokes. It gathers such an explosive force that on the day it bursts out, it blows up everything with it.” -Emile Zola
The issue of confidentiality when applied to modern American healthcare is fraught with differing objectives, creating myriad complications as the needs of each attempt to merge together in their search for common ground and compromise. To arrive at a sense of clarity, we must look to those exceptions that define the fundamental system of rules at the heart of our nation’s health care structure, as the conflicting areas to be found within shed light on the vulnerabilities of the concept as a whole. The demands of federal statutes aside, gray areas abound, since attorneys can breach the duty of confidentiality in response to threats against life or to prevent substantial bodily harm, physicians must answer to certain matters of public health before protecting the secrets of the patient, and spouses can freely tell all when it comes to the actions of their partner, even if the words between them remain protected. … Read more →