Doctors order more tests and consultations to protect themselves from liability, Dr. Anthony Youn says.

STORY HIGHLIGHTS

Editor's note: Dr. Anthony Youn is an assistant professor of surgery at the Oakland University/William Beaumont School of Medicine in Michigan. He is the author of "In Stitches," a memoir about growing up Asian-American and becoming a doctor.

(CNN) -- Coverage for 30 million uninsured. A ban on lifetime payout limits. No co-pays or deductibles on preventive medical services. Insurers prohibited from excluding patients based on pre-existing medical conditions.

The Patient Protection and Affordable Care Act (also known as "Obamacare") creates a massive, wide-scale overhaul of the heavily flawed and criticized health care system of the United States.

But for all of the Obama administration's work in creating this 906-page federal law, there is one glaring omission that could decrease the costs of health care and help relieve the upcoming physician shortage.

Medical liability reform.

How could the Obama administration create such a comprehensive overhaul of health care without addressing this issue? Although not a panacea for the health problems in the United States, the need for physicians to practice defensive medicine in order to avoid potential litigation has far-reaching consequences.

A 2008 survey of Massachusetts doctors found that 83% admitted to practicing defensive medicine. This study determined that 18% to 28% of tests, procedures and referrals and 13% of hospital admissions were performed for the sake of avoiding lawsuits.

In this one state alone, an estimated $281 million in unnecessary physician costs and more than $1 billion in excessive hospital costs was due to the practice of defensive medicine. Across the country, doctors are ordering tests and consultations as a way to protect themselves from potential liability.

The rest is here:

Health care act's glaring omission: liability reform

THE health-care-reform debate has been conveniently reduced to whether we can we afford its costs. The price of care is important. However, this debate ignores a crucial question: How much skin in the game should an individual have in managing his or her health?

Unless we ask that question, we will remain embroiled in a health care debate without any true progress.

The discussion we need to have is how to hold individuals responsible and to engage them in their own personal health. How do we get people to start eating foods that are good for them, not just convenient? How do we create communities that encourage people to walk, ride a bike, run and swim? And for people with chronic illness, what role do they have in managing their conditions?

Federal, state and local governments, in addition to creating healthier and safer communities, can play a big leadership role in creating healthy communities and rewarding personal responsibility for health.

Individual responsibility for ones health may seem radical, but King County employees, in partnership with the unions that represent them, are already doing it. As a part of King Countys nationally recognized Healthy Incentives program, each year employees take a written wellness assessment and complete an individual action plan to improve or maintain their healthy behaviors. Those who complete the wellness assessment and their individual action plan qualify to contribute less for health care cost sharing.

Under the current employee agreement for Healthy Incentives, employees are reducing costs to the public in four ways: They use health-care services less often; they pay higher co-pays; they choose less-expensive generic drugs; and more of them enroll in the Group Health plan, which his less expensive than the countys preferred provider plan KingCare.

Over the past six years, King County has saved the taxpayers tens of millions of dollars by engaging employees in their health and health-care choices. In the proposed 2013-2014 budget, the county expects to save $14 million in health-care costs.

King Countys Healthy Incentives program can be a model for engaging participants in other private- and public-employer health plans, including Medicare and Medicaid.

I want everyone to have health insurance, but those who blithely ignore the consequences of their lifestyle should not be totally subsidized by those willing to manage their illnesses, eat well and remain fit. Individuals should pay a higher price for poor decisions and personal indifference.

Personal responsibility and accountability cannot be demanded of individuals without the tools to make educated decisions, such as publicly reported data on the quality and price of health-care services. We love our doctors, but having detailed data will help individuals determine if their doctors are providing value-based care. If not, employers should have the right to ask individuals to pay more for doctors providing subpar care.

Visit link:

Op-ed: Individual responsibility in managing health-care costs

MICHIGAN CITY Human resource managers from businesses throughout the region on Tuesday learned important information about how federal law will impact the insurance coverage they offer to employees.

Presented by General Insurance Services, the Northern Indiana Human Resource Management Association and Strategic Management, the two-hour lunch-time seminar touched on the basic changes employers would have to adapt to to comply with the Patient Protective and Affordable Care Act. The Supreme Court recently decided in favor of the act, which goes into effect in 2014.

The discussion was moderated by Craig Menne, the vice president of General Insurance Services. Panelists included: Mark Rafalski, chief financial officer of Indiana University La Porte Hospital; Paul Houchens, a consultant with Milliman, Inc; Mark Schmidtke, an attorney with the law firm of Ogletree, Deakins; and Bruce McFee, chairman and CEO of Sullivan-Palatek, Inc.

Menne told those who gathered in the gallery at the Lubeznik Center that the event was meant to be an interactive round table discussion about the law and what would be required of companies in the near future. Its a large law with a lot of moving parts, Menne said. The panelists, he said, were selected to give a wide range of perspectives on the act.

Other changes that apply to plans which are not grandfathered in include: no pre-authorization on emergency services, no penalty on the use of out-of-network services, coverage of preventable care and immunizations; and patient choice in most service providers.

Houchens told the crowd that there were no easy answers in how businesses will address the changes and adhere to the requirements. Its complicated because each employer is different, he said. There are different plans and different makeup of employees.

One significant push at the federal level is a change in federal poverty rate scale, which is used to determine eligibility for programs such as Medicaid. The federal government is setting the eligibility criteria at 138 percent of the federal poverty level, which is about $11,000. This change would increase the number of Americans eligible for Medicaid by as much as 50 percent, Houchens said.

Each state is given the opportunity to accept the new levels or keep a lower eligibility level. If more employees meet this level, the employees could be covered by Medicaid, which means their employer would not have to provide coverage for them. This would reduce any penalties imposed by the government for a business not complying with federal requirements under the law.

The changes will drive up costs for medical service providers, Rafalski said. Some of these costs are incurred because of a requirement to move towards electronic storage of medical records. Another cost factor is inefficiencies in the processes, he said. As an example, he said patients who move between physicians may experience duplication in services or conflicting treatment methods.

A focus on wellness and keeping employees healthy is one component of these efforts, Rafalski said. When you do that the costs go down because you are not using as much of the services.

Read the original here:

Health care reform: Businesses learn how new federal rules will affect plans

Calling the states health care costs artificially high, N.C. Attorney General Roy Cooper says he will examine whether to use antitrust laws or new legislation to reduce them.

Im concerned about this issue, Cooper told the Observer. Health care costs are high enough without artificial boosts that could come from lack of competition.

Coopers announcement comes in the wake of antitrust investigations into hospitals in other states. It also follows an Observer story showing large nonprofit hospitals are dramatically inflating prices on chemotherapy drugs at a time when they are cornering more of the market on cancer care.

In a joint investigation published last month, the Observer and The News & Observer of Raleigh found hospitals are routinely marking up prices on cancer drugs two to 10 times over cost. At the same time, hospitals are increasingly buying the practices of independent oncologists, then charging more for the same chemotherapy in the same office.

A previous investigation by the two newspapers, published in April, showed consolidation has given hospitals leverage to demand higher payments from insurance companies. That investigation also found North Carolina hospitals are among the most powerful interest groups in state politics, a fact that could neutralize any push for legislative reform.

Cooper said theres little question health care costs too much. The issue, he says, is whether a recent increase in consolidation has contributed to that problem. His staff will study whether antitrust laws which are designed to prohibit monopolies and other anticompetitive arrangements are the right tool for reducing costs.

Cooper said his lawyers will talk with officials from the Federal Trade Commission and with attorneys general in other states who have used antitrust laws to investigate consolidation.

A number of hospital systems in North Carolina have grown into profitable, fast-growing giants. Carolinas HealthCare System, a $7 billion chain that runs more than 30 hospitals, has built more than $2 billion in investments and owns more than $1 billion in property. Now the nations second-largest public hospital system, it has posted average annual profits of more than $300 million in the past three years.

Novant Health, which owns 13 hospitals, generates more than $3 billion in annual revenue. The two systems own all hospitals in Mecklenburg.

The newspapers April investigation found Charlotte-area hospitals generate some of the nations largest profit margins. The regions hospital prices are about 5 percent higher than the national average, and comparable to those of larger cities, according to Aetna insurance company.

View original post here:

N.C. Attorney General eyes 'artificial' hospital pricing

Published: Saturday, October 6, 2012 at 11:03 p.m. Last Modified: Saturday, October 6, 2012 at 11:03 p.m.

A daily look at the constitutional amendments on the Nov. 6 ballot from the League of Women Voters of Florida Education Fund:

HEALTH CARE SERVICES

Synopsis: Amendment 1 is more of a political referendum than a meaningful change to the state constitution. Since the Supreme Court has upheld the federal government's right to impose the individual mandate, the legal standing of Amendment 1 is precarious. The passage or defeat of Amendment 1 may have no practical implications other than to send a message that a majority of Florida's voters are either for or against the individual mandate.

A vote YES on Amendment 1 would:

- Represent an attempt to opt Florida out of federal health care reform requirements.

- Add language to the Florida Constitution that could be found unconstitutional under the Supremacy Clause of the U.S. Constitution if determined by the courts to be in conflict with federal law.

- Prevent the Florida Legislature from passing health care coverage mandates independent of federal law.

A vote NO on Amendment 1 would:

- Mean that Florida should comply with federal health care reform requirements.

See the original post here:

Amendment 1: Health Care Services

Enlarge photo

Courtesy of VoteTipton.com

Rep. Scott Tiptons second television ad continues the theme of his first, attacking Democratic opponent Sal Paces positions on health care.

Courtesy of VoteTipton.com

Rep. Scott Tiptons second television ad continues the theme of his first, attacking Democratic opponent Sal Paces positions on health care.

Rep. Scott Tipton, R-Cortez, is out with the second television ad of his campaign, an attack on Democrat Sal Paces health-care positions.

Tiptons first ad also attacked Pace on health care.

In the new ad, a narrator calls out politician Sal Pace.

He supports the new health-care law, cutting over $700 billion from Medicare, hurting Colorado seniors, a woman says. Pace supports a single-payer government health-care system, a wholesale government takeover of health care.

Tipton has made the $700 billion claim before. It refers to President Barack Obamas health-insurance law, which limits future Medicare payments to hospitals and insurance companies.

Read more from the original source:

Tipton ad continues health-care attack

Madison - Health care is the inescapable issue in the tightly contested race to determine Wisconsin's next U.S. senator.

The issue has been at the heart of the political careers of former Gov. Tommy Thompson and U.S. Rep. Tammy Baldwin, and in this campaign the two candidates have clashed on questions of health care costs and coverage.

Thompson, a Republican, wants to repeal the health care law known as "Obamacare." Baldwin, a Democrat, voted for it and has advocated going further. The two also have opposing ideas about the future of Medicare, and they blame each other for contributing to the financial difficulties of that health care program for seniors.

Their disparate views were on display in their first debate and will likely be hammered home again in their second debate on Oct. 18.

"My opponent has been in Congress for 14 years. Has she ever introduced any legislation to fix the (Medicare) problem? No . . . Nobody solves the problem. I will. That's why I'm running," Thompson said during the Sept. 28 debate.

But the Baldwin campaign looks back on some of those same years and sees a different story because Thompson oversaw Medicare as health and human services secretary under President George W. Bush from 2001 to 2005. Citing congressional findings, the Baldwin campaign said that during the years Thompson led the agency, the projections for when Medicare would become insolvent were moved up to 2020 from 2029.

"The fact is that when he ran Medicare for four years in the Bush administration, it moved closer to going broke," Baldwin spokesman John Kraus said.

Nor is it just the two candidates' takes on their records on health care that separate them - the two also differ sharply on the country's health care future.

Thompson wants to remake Medicare so people have the option of staying in the traditional program or receiving federal money to help pay for private insurance. Baldwin wants to preserve Medicare as it currently stands, though she has not said how she would pay to do that.

Thompson wants to repeal the Affordable Care Act, the health care law often called Obamacare. Baldwin voted for the law and in the past advocated having the government pay for all health care costs.

Here is the original post:

Health care at center of Baldwin-Thompson Senate race