“States Flubbed the Rollout of Their Health Insurance Exchanges. Now They’re Ready to Try Again.” – Stateline
“A cancer patient receives treatment at the Hospital of the University of Pennsylvania in Philadelphia. Pennsylvania is among at least six states that are creating their own health insurance marketplaces or considering it.” Matt Rourke/The Associated Press
“The launch of President Barack Obama’s Affordable Care Act was marred by the performance of the newly created state health insurance marketplaces.
“With generous federal financial support, many states created these markets, also called exchanges, based on soaring promises: Individuals and small businesses could compare policies. They could get federal subsidies. It would be easy to sign up. And if people’s income declined, they could enroll in their state’s Medicaid plan.
“It didn’t work out that way. Websites didn’t work. Data couldn’t be accessed. Call centers were overwhelmed, and states spent millions on quick fixes, many of which failed.
“Hawaii, Nevada and Oregon abandoned plans to operate their independent marketplaces and instead relied on the federal marketplace, Healthcare.gov. Other states, including California, Colorado, Massachusetts, Maryland and Washington, spent millions of dollars to overcome problems with technology.
“The experience so rattled states that seven years later, only 11 of them, plus Washington, D.C., operate independent marketplaces. The rest either use the federal marketplace or a federal-state partnership.
“But now at least six states — Maine, New Mexico, New Jersey, Nevada, Oregon and Pennsylvania — are creating their own marketplaces or seriously considering doing so.”
Healthcare transition often can present a confusing scenario. This article is from The Buffalo News (Buffalo, NY) and is specific to New York, but the issue of transition applies everywhere.
“Staffing levels, health inspections and whether a facility has been fined for conditions that could harm residents are all public information and easily accessible through the federal Nursing Home Compare website that rates nursing homes. But many families don’t have the information at the very moment they need it most.”
“Already two hours late, Roberta Novack waits patiently in a corner for an ambulance team to arrive to transport her brother Henry Kostrzewa, 52, to his latest stay at the Buffalo Center for Rehabilitation & Nursing on Delaware Ave. in Buffalo This was on Saturday, July 28, 2018.” (Robert Kirkham/Buffalo News)
by Lou Michel
“The call from the hospital jolted Henry Kostrzewa’s sister. Erie County Medical Center was going to discharge the 52-year-old disabled welder and she needed to help him pick a nursing home.
“The clock was ticking.
“Kostrzewa had been informed he could end up personally responsible for his hospital bills because he had been ‘medically cleared’ to move into a nursing home.
“Roberta Novack told her younger brother not to sign anything. She feared he would end up in a facility unable to provide quality care for the bone infection in his spine that had kept him bedridden for months following a hip replacement surgery.”
“Long-term care hospitals tend to the sickest of patients, often near the end of their lives. Many will never return home.”
“Credit: Monica Jorge for The New York Times)
by Paula Spahn
“The Hospital for Special Care in New Britain, Conn., had 10 patients in its close observation unit on a recent afternoon. Visitors could hear the steady ping of pulse monitors and the hum of ventilators.
“The hospital carefully designed these curtained cubicles to include windows, so that patients can distinguish day from night. It also placed soothing artwork — ocean scenes and landscapes — on the ceilings for those who can’t turn over and look outside.
“All these patients had undergone a tracheostomy — a surgical opening in the windpipe to accommodate a breathing tube attached to a ventilator — when they arrived from a standard acute-care hospital. Some had since been weaned from the ventilators, at least for part of the day.”
“Americans have the right to access their medical records, but actually doing so is often complicated, slow and costly. – Sean Justice/Getty Images”
by Harlan Krumholz
“At a time when many insurers and health information technology companies are busily assembling databases of hundreds of millions of medical records, Americans find it difficult to get access to their own.
“If you try to get yours, be prepared for confusing policies, ill-informed staff, wasted time and high costs. Even then, you may not get the records you seek. And all of this is at odds with your federal rights.
“Last week a relative of mine relayed a typical story. She requested her medical records in digital format, a right endorsed in federal statutes. Now, two months later, she is still struggling to get them. The hospital had contracted with a third party, and evidently this company transacts only through snail mail.”
“Health care spending in the United States is expected to reach $6 trillion by 2027, up from $3.5 trillion in 2017, according to the Centers for Medicare & Medicaid Services. However, there are three areas where major savings are achievable:
- Avoidable hospital emergency department visits
- High-value physicians
- Hospital prices.
“woman’s story personifies failures in Medicaid waiver program” – A long read about “system failures” at the Pittsburgh Tribune-Review
“Fran Morgante moves her mom, Vilma Morgante, 100, to spend some time in the front room, Thursday, June 20, 2019, at the family’s Lower Burrell home. Fran Morgante, a professional musician lives in New York State and has moved back home to care for her mother.” – SOURCE: Pittsburgh Tribune-Review
by Deb Erdley
“Fran Morgante brushed back her mother’s hair tenderly as she offered the tiny elderly woman a drink of water on a hot June day.
“Vilma Morgante, who celebrated her 100th birthday June 21 in her Lower Burrell home, never asked much of the world.
“Her one desire: to die in the neat brick bungalow she and her late husband, Steve, scrimped and saved for and then built from the ground up seven decades ago.
“Frail, suffering from moderate dementia for the previous year and a half and forced to use a wheelchair, she relied on her daughter — a professional violinist with the Buffalo Philharmonic — to steer her through the complex web of rules and regulations that govern the safety net designed to protect the nation’s most vulnerable citizens.
“‘Years ago, I tried to talk her into coming to live with me, and she said, “Chica, I want to die at home,” Fran Morgante recalled.
“On July 4, Vilma died at home, one year and two days after qualifying for 24-hour home care — care that never arrived.”
Click here to read this Pittsburgh Tribune-Review article in its entirety.
HHS’s Proposed Changes to Non-Discrimination Regulations Under ACA Section 1557 – Kaiser Family Foundation
“Removing gender identity and sex stereotyping from the definition of prohibited sex-based discrimination could allow health care providers to refuse to serve individuals who are transgender or who do not conform to traditional sex stereotypes.”
On June 14, 2019, the Department of Health and Human Services (HHS) proposed what it describes as “substantial revisions” to its regulations implementing Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination based on race, color, national origin, sex, age, and disability in health programs and activities receiving federal financial assistance. Notably, it is the first federal civil rights law to prohibit discrimination in health care based on sex. The 60-day public comment period on the proposed changes closes on August 13, 2019. The proposal cannot change Section 1557’s protections in the law enacted by Congress but would significantly narrow the scope of the existing HHS implementing regulations, if finalized, by:
- Eliminating the general prohibition on discrimination based on gender identity, as well as specific health insurance coverage protections for transgender individuals;
- Adopting blanket abortion and religious freedom exemptions for health care providers;
- Eliminating the provision preventing health insurers from varying benefits in ways that discriminate against certain groups, such as people with HIV or LGBTQ people;
- Weakening protections that provide access to interpretation and translation services for individuals with limited English proficiency;
- Eliminating provisions affirming the right of private individuals to challenge alleged violations of § 1557 in court and to obtain money damages, as well as requirements for covered entities to provide non-discrimination notices and grievance procedures;
- Narrowing the reach of the regulations by only covering specific activities that receive federal funding, but not other operations, of health insurers that are not “principally engaged in the business of providing health care,” and no longer applying the regulations to all HHS-administered programs;
HHS also requests comment on whether to change certain provisions intended to ensure equal access for people with disabilities. It also proposes eliminating prohibitions on discrimination based on gender identity and sexual orientation in 10 other Medicaid, private insurance, and education program regulations outside Section 1557. If finalized, HHS’s proposed changes would substantially narrow, and in many cases entirely eliminate, the regulations’ existing protections against discrimination in meaningful ways.
“Complication rates are high among the oldest patients. Now a surgeons’ group will propose standards for hospitals operating on the elderly.”
Credit: Stuart Briers
By Paula Spahn
“People over 65 represent roughly 16 percent of the American population, but account for 40 percent of patients undergoing surgery in hospitals — and probably more than half of all surgical procedures.
“Those proportions are likely to increase as the population ages and more seniors consider surgery, including procedures once deemed too dangerous for them.
“Dr. Clifford Ko, a colorectal surgeon at the University of California, Los Angeles, recently performed major surgery on an 86-year-old with rectal cancer, for instance.
“‘Ten years ago, I’d think, “My god, can this person even survive the operating room?”’” Dr. Ko said. ‘Now, it’s increasingly common to see octogenarians for these types of operations.’
“Number of Cancer Surgeries Performed in Pennsylvania Hospitals” – Pennsylvania Health Care Cost Containment Council
An article in the May 23/2019 LNP – Always Lancaster states:
“Before scheduling surgery, experts say, it’s a good idea for patients to see how often the procedure is done at the hospitals they’re considering.
“Pennsylvania Health Care Cost Containment Council issues an annual report to make that process easy for cancer patients, and the latest version came out today, for July 2017 through June 2018.”
The report released Pennsylvania Health Care Cost Containment Council “provides information about the number of cancer-related surgeries performed at Pennsylvania hospitals. Hospital surgical volume is reported for 11 types of cancers including bladder, brain, breast, colon, esophageal, liver, lung, pancreatic, prostate, rectal, and stomach cancer. This information can be helpful to cancer patients, their families, and others when making decisions about cancer surgical care in Pennsylvania.”
At its Website, this question asks: Why is hospital surgical volume important? And according to the Pennsylvania Health Care Cost Containment Council, “There is strong evidence in the scientific literature that links hospital surgical volume and patient outcomes for the cancer surgeries included in this report. In other words, patients requiring one of these 11 surgeries are likely to have better results if their surgery is performed at a higher volume hospital. Lower volume hospitals are more likely to have worse outcomes, such as more deaths. While in general the volume of cases reflects the degree of experience a hospital has with performing each type of surgery, volume data should not be used in isolation when making conclusions about hospital quality since many other factors such as patient level of sickness (stage of cancer) or surgeon experience may also contribute to the overall outcome.”
Click here to see the report, Number of Cancer Surgeries Performed in Pennsylvania Hospitals State Fiscal Year 2018 (July 2017 – June 2018).:
“A.I. Took a Test to Detect Lung Cancer. It Got an A. | Artificial intelligence may help doctors make more accurate readings of CT scans used to screen for lung cancer.” – The New York Times
A colored CT scan showing a tumor in the lung. Artificial intelligence was just as good, and sometimes better, than doctors in diagnosing lung tumors in CT scans, a new study indicates. Credit Voisin/Science Source
by Denise Grady
“Computers were as good or better than doctors at detecting tiny lung cancers on CT scans, in a study by researchers from Google and several medical centers.
“The technology is a work in progress, not ready for widespread use, but the new report, published Monday in the journal Nature Medicine, offers a glimpse of the future of artificial intelligence in medicine.
“One of the most promising areas is recognizing patterns and interpreting images — the same skills that humans use to read microscope slides, X-rays, M.R.I.s and other medical scans.
“y feeding huge amounts of data from medical imaging into systems called artificial neural networks, researchers can train computers to recognize patterns linked to a specific condition, like pneumonia, cancer or a wrist fracture that would be hard for a person to see.”