Healthcare Reform: A Time To Wait, or Expiate?0

This article first appeared in Becker’s Hospital Review on April 12, 2012.

If Dante Alighieri had written an epic poem describing the recent evolution of American healthcare, it might have much in common with his famous Purgatorio.   As the nine U.S. Supreme Court Justices continue deliberation  on the fate of the 2010 Affordable Care Act, it is unclear whether our nation’s healthcare system is heading toward Inferno or Paradiso. While experts on both sides of the aisle attempt to divine the secret codes shared between Justices over a record-breaking three days of oral argument, the rest of us have little choice but to wait until summer for clarity.

In the 25 months since President Obama signed the Patient Protection and Affordable Care Act into law, the structure of our modern American healthcare system has changed dramatically, dividing the nation down political lines amid questions of constitutionality. With the bill currently under debate in our highest court, now is the time to consider the practical implications of an adverse ruling, and what the resultant ramifications may entail for the future of both the Affordable Care Act and the patients for whom the legislation was designed to protect. … Read more →

Administrative, Clinical, Community, Health Care Law, Health Care Reform, Historical, Hospitals, News

HAPPY ANNIVERSARY TO THE AFFORDABLE CARE ACT0

March 23 marks the two-year anniversary of President Barack Obama’s ambitious and controversial Patient Protection and Affordable Care Act. While the ultimate legacy of this landmark legislation remains to be seen, its fate will soon rest in the hands of the nine U.S. Supreme Court Justices, and then possibly the Electoral College.

With talk of constitutional challenges and potential repeal sharing headlines almost every day, now is the perfect opportunity to trace the changes in American health care over these past 24 months.

As our health care system continues to experience growing pains, certain basic tenets of reform have already made their mark, and may be difficult to retract in the event of the bill’s failure. The number of insured young adults under the age of 26 has continued to rise since 2010, as has the estimated 105 million Americans who no longer face lifetime limits on health benefits. Statistics also point to 50,000 newly insured who had in the past failed to qualify for health insurance due to pre-existing conditions.

Across the nation, individual states are gearing up for health insurance exchanges, while hospitals and physicians prepare for monumental changes in the Medicare reimbursement infrastructure as it transitions from a historically cost-based to a performance-driven platform.

Under the reform bill, the Federal Government has increased its presence with an unprecedented focus on eliminating health care fraud, abuse and waste.

Thanks to the Office of the Inspector General, Centers for Medicare & Medicaid Services and Department of Justice having procured health care fraud-related settlements and judgments in excess of $3 billion last year (capping the largest three-year streak in history with a total of $8.7 billion since January 2009), health care providers are now busy crafting or fine tuning their own custom-tailored compliance programs.  At the same time, providers must also fight off Medicare and Medicaid related audits from a number of newly created entities known only by their acronyms (RACs, MICs, MACs and ZPICs to name a few).

No matter what effects the Supreme Court’s decision and upcoming elections may hold for the Affordable Care Act, it is clear that American health care will never be the same.

Only time will offer any definitive perspective for us to evaluate the changes it has imposed upon the delivery of our nation’s health care.

Welcome to health care reform, year three, as it promises to be a busy one.

Administrative, Children's Health, Clinical, Community, Health Care Law, Health Care Reform, Historical, Hospitals, Miscellaneous, News, Non Clinical, Regulatory, Technology

Adjudicating health care reform by dissent0

This article first appeared in the Daily Journal on March 15, 2012.

The procedural infrastructure within which the nation’s judicial system operates is as important as the canons of law the Courts espouse. In many ways, the doctrine of justiciability affords the federal courts an opportunity to rule with finality in matters of the U.S. Constitution, while at the same time ensuring that an appropriate distance is maintained between the three branches of federal government. Given the numerous preconditions upon which certiorari is determined, rightful passage through the Supreme Court’s Corinthian columns can seem as improbable as procuring a return ticket across the river Styx.

However, those for whom certiorari is ultimately granted can count on a few basics from the Supreme Court, including a session each first Monday in October, quill pens on counsel tables, and the Court’s own general prohibition from issuing judicial advisory opinions. In commenting upon this most revered prohibition, Chief Justice Earl Warren noted: “When the federal judicial power is invoked to pass upon the validity of actions by the Legislative and Executive Branches of the Government, the rule against advisory opinions implements the separation of powers prescribed by the Constitution and confines federal courts to the role assigned them by Article III.”[1] … Read more →

Administrative, Community, Health Care Law, Health Care Reform, Historical, Hospitals, News, Regulatory

The Right to Strike vs. the Right to Care0

Modern day health care is a troubled industry. Enshrouded in a net of oft-conflicting regulations and entrusted with the safety of America’s sick and wounded, many of whom lack the necessary insurance to guarantee reimbursement to their providers, the financial stability of our nation’s medical facilities is called into question on a daily basis. Today’s hospital has the unenviable task of walking a fine line between caring for its patients and remaining solvent as a business, a laudable goal attainable at least in part by recognizing the inextricable connection between the institution itself and the nurses who form an infantry amongst its ranks. Even as these nurses form an ever-present “front line” on the hospital battlefield, their recent strike in California, threatened and averted strikes in New York, and a judicially-restrained “walk out” in Riverside County, California last month, shine a harsh if necessary light on certain issues plaguing our current health care system as it stands so precariously with one foot on either side of a dangerous fence.

The nature of the nurse’s role begs the question: does participation in a labor union extend to the right to strike? … Read more →

Administrative, Clinical, Health Care Reform, Hospitals, News, Regulatory

Health care reform experiences growing pains1

This article first appeared in the Daily Journal on January 27, 2012.

In its attempt to modify the basic structure of our nation’s health care system, President Barack Obama’s Affordable Care Act has understandably caused a series of rifts between competing factions within the health care industry.  As the entire nation waits to discover its ultimate fate, the fledgling program continues to promote conflict as it experiences growing pains, exemplified by recent modifications to federal regulations that push the invisible line separating church and state from a health care perspective. With an eye to the future, the Affordable Care Act must move cautiously in its attempt to revamp the foundations of health care, fending not only for its survival in the political arena, but in terms of constitutionality as well.

At its core, the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act (known colloquially as the “Affordable Care Act” or “health care reform”), promotes preventative measures designed in theory to eliminate health issues before they start. With such a sweeping directive, it is certainly understandable that constitutional challenges abound within, yet two of the more recent and most highly publicized concerns stand at opposite ends of the spectrum.

Last week, Health and Human Services Secretary Kathleen Sebelius issued a brief news release detailing a controversial August 2011 interim final rule that was specifically created to require health insurance plans to cover preventative services for women, including contraceptives, without charging a co-pay, co-insurance, or deductible.  Under this interim final rule, however, certain non-profit religious employers retained the option to omit contraceptive services from their employee insurance plan. Announced last week, the final decision now guarantees that women with health insurance as of Aug. 1, will be allowed access to all federally recommended preventative services, including contraception measures approved by the U.S. Food and Drug Administration. … Read more →

Administrative, Community, Health Care Law, Health Care Reform, Historical, Hospitals, News, Regulatory

Lessons From My Father0

This article first appeared on the PBS affiliated website This Emotional Life.

“Everything in moderation, including moderation.”  –Oscar Wilde, Irish writer and poet

When it comes to understanding what it means to be a man, little boys typically look toward one specific individual, Dear Old Dad.  What is not so consistent, however, is the manner in which a father chooses to undertake his role. Nowhere else is the drive to impart all that he has learned so strong and the possibility of instilling hard-won wisdom so pronounced as when a father looks at his eager young son. And yet, for this very reason the school of fatherhood boasts a subjective curriculum at best, as the competency of the teacher pales in comparison to the ways in which the student will go on to apply these lifelong lessons, many of which have been handed down through generations, whether knowingly or not.

Several thousand years of fiction tell us all we need to know about how tenuous the influence of a mature man upon his children can be.  From King Laios of Thebes (the biological father of Oedipus) to Wilbur Meecham (the tyrannical father of Ben) to Carlisle Cullen (the eternal father who adopted Edward), the most valuable lessons often emanate from the reactions of the son rather than the actions of the father. In truth, a man’s best intentions may fall upon deaf ears or be misinterpreted by a youth struggling to carve the foundations of his own identity, and sometimes the best we can hope for is that a little luck and our unspoken influence through way of example will provide the necessary navigational instincts for our children as they pass through whatever storms may confront them.

The relationship between father and son is always complicated and in each case unique, with every example of success or failure providing a new interpretation on what it means to be a father. If that was not enough, there is never a guarantee that an idyllic father will raise a comparable son, or that the child of an atrocious man will ultimately follow in his ancestor’s malevolent footsteps. This cumulative nature of fatherhood is in many ways for the best, as nearly every boy at one point or another finds himself determined to be anything but his father. Today, however, as I read that rhyming masterpiece of Dr. Seuss, Hop on Pop, to my 10-month old son on what would be my own father’s 75th birthday, I realize that not only am I deep into uncharted territory, but there is no way of knowing what aspects of history might repeat themselves. Without any guidance or source of direction, how will I ever know if I am a good father?

In looking for answers, I find it hard to gather much from my siblings on what it means to be a father, as both my brother and sister learned from the same role model I did. While fiction and history provide a number of cautionary tales, they are blueprints at best, to be relied upon loosely.  But even as I try to learn from the experiences of friends whose opinions I respect on this subject, there remains the ever-present fact that every case is different, from the point of view of both father and son.  Though one friend is in my opinion an exemplary role model for his children, I cannot help but wonder how much of his inspiration stems from his contentious relationship with his own father, the secrets of which are lost on me and my very different experiences growing up. An example in stark contrast does little more than cast an even brighter light on the many different facets that can shape the paternal instinct. … Read more →

Community, Miscellaneous, News, PBS This Emotional Life

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