Published: Sunday, September 23, 2012 at 7:23 a.m. Last Modified: Sunday, September 23, 2012 at 7:23 a.m.

LAKELAND -- Sticking with the status quo won't solve the woes of the United States health care system, Adil Khan said Friday, but he's not convinced the changes now being implemented will either.

Khan, chief administrative officer of Clark & Daughtrey Medical Group in Lakeland, sees more promise in proposed legislation -- languishing in Congress for years -- that would expand Medicare to cover all ages. It's H.R. 676, the National Health Insurance Act.

"This is not socialized medicine," he told members of the Lakeland South Rotary Club at their noon meeting.

"We're not talking about changing Medicare. It's already there. We're talking about expanding it."

Socialized medicine, he said, would be if the government owned all or most hospitals and medical practices, a change neither the current legislation approved by Congress nor the Medicare expansion would make.

Medicare already is in place, serving almost 10 percent of the population, Khan pointed out, and its 3 percent overhead costs are much lower than those of commercial health insurance plans.

Hospitals and most doctors accept Medicare.

In contrast, Medicaid, which the current health care reform effort would expand, isn't popular among doctors. Most don't accept it, Khan said, explaining that Medicaid "does not cover the cost of providing care."

A shortage of doctors, particularly acute in Polk County, already makes it difficult for people on Medicaid to have much choice when getting medical care.

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Health care administrator touts alternative legislation

21-09-2012 12:43 Health care has been in the national spotlight, as well as in New Jersey, with the passage of the Affordable Care Act and changes to hospital structures. Barnabas Health President and CEO Barry Ostrowsky told NJ Today Managing Editor Mike Schneider that while care has improved, the current state of health care is chaotic. For more New Jersey news, visit NJ Today online at

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Barnabas Health President Calls Current Health Care System Chaotic - Video

Although the overall increase in health care costs in the United States has slowed recently, there still is an overwhelming consensus that the cost of health care in this country is unsustainable and more must be done to improve the quality of care. In response to this growing crisis, public and private payers have launched scores of innovative health care delivery and payment models designed to reward the value of health care services instead of the volume of services.

"We all agree that family physicians are among the most valuable people on the planet," he adds.

Nichols, like other analysts, describes primary care as the "linchpin of patient engagement." Most of the emerging payment and delivery models attempt to strengthen and incentivize primary care as a way of controlling costs and improving care, he says.

In fact, many of the nation's largest health payers have launched initiatives, such as the patient-centered medical home (PCMH), in local, regional and statewide markets, either separately or in conjunction with state programs to form multipayer collaboratives. These private payers include UnitedHealthCare, CIGNA, WellPoint Inc., Aetna, Humana, and Blue Cross and Blue Shield.

The ability of primary care to deliver on the promise of improved care, greater access and better controlled costs is well known and documented, fueling increased interest and investments in primary care. North Carolina's Medicaid managed care program, Community Care of North Carolina (CCNC), serves as one of the most potent examples of how a primary care-based delivery model can restrain growth in health care costs and improve care.

CCNC uses physician-led networks and the PCMH to provide care to the state's Medicaid patients. The program started with nine pilot projects covering 250,000 Medicaid enrollees in 1999 and has since expanded to 14 physician-led networks, 4,500 primary care physicians, and more than 1,400 medical homes that cover the entire state and provide care to 1.1 million enrollees.

According to North Carolina officials, CCNC has saved the state more than $1 billion in Medicaid costs during the past several years, emerging as an influencer of quality initiatives in North Carolina and a model for other states to consider.

For example, the Affordable Care Act created the CMS Center for Medicare and Medicaid Innovation, (CMMI) to develop and test innovative health care payment and delivery models that slow Medicare and Medicaid cost growth, as well as costs for the Children's Health Insurance Program.

During the past several months, the CMMI has launched various innovations, including the Comprehensive Primary Care initiative, a pilot program that has CMS working with commercial and state health insurance plans to support primary care practices that deliver coordinated and seamless care based on the tenets of the PCMH.

The voluntary initiative is scheduled to begin as a demonstration project in seven health care markets across the country. The 500 participating primary care practices will be paid based on a blended payment model that combines fee-for-service (FFS) with a per-patient, per-month care coordination fee ranging from $8 to $40. Participating practices also have an opportunity to participate in shared savings from the project.

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Family Physicians Are 'Linchpin' of Health Care Reform Efforts

North Carolina businesses have formed a working group to look for ways to lower health care costs, as the expense of providing coverage continues to rise for both employers and employees.

The North Carolina Business Group on Health includes 45 companies, employing some 100,000 workers in the state. Charlotte-based companies such as Piedmont Natural Gas and Polypore are members of the group, which is modeled on health care business groups in other states, such as Rhode Island and Connecticut.

The group held a meeting last week in Greensboro. They plan to kick off a contest next year called Step Up Carolinas, which will encourage employees to lose weight and exercise.

They say North Carolina lags in measures such as the use of electronic medical records and the adoption of primary care-focused medicine. Part of the groups goal is to identify and share best practices, so members can try to keep their costs down.

Employers and employees share in the cost of providing health care, so anything we can do to lower costs of health care benefits both, said John Hulla, a Polypore executive and the business groups employee engagement chair.

Renee Metzler, a Piedmont Natural Gas executive and president of Step Up Carolinas, said the costs of health care are driving employers with greater urgency to cut costs themselves by trying to make their employees healthier.

Employers started going down this road because of the costs and because health care costs are just getting out of control, she said. Youve still got to try to impact the overall cost, either improving the health and preventing disease or better managing conditions when an employee does get a disease.

A recent survey from human resources consulting company Mercer, which is one of the sponsors of the North Carolina group, found employers expect their total health benefit cost per employee to rise 5.7 percent this year. Thats on top of a 6.1 percent increase in 2011, well ahead of both inflation and wages.

To help deal with the costs, Polypore is starting a program to give employees who take a health risks assessment discounts on their health insurance premiums and prizes if they sign up for programs such as Weigh Watchers or smoking cessation.

Metzler said Piedmont has seen its health insurance claims fall since instituting similar wellness programs for employees. Wellness now factors into the company scorecard that drives employee incentive payouts.

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Businesses join up to try to bring down health care costs

MADISON - Madisons health care systems will encourage patients and families to talk more about end-of-life care decisions, in an effort organized by the Wisconsin Medical Society and modeled after a pioneering program in La Crosse.

Instead of merely asking patients if they have living wills or health care power of attorney documents, hospitals and clinics will offer advance care planning discussions, generally led by nurses, social workers or clergy.

Questions range from whether to resuscitate and ventilate to what kind of music and lighting patients want to be surrounded by near death.

Were going to make sure these conversations are offered, scheduled, had, documented and brought into the medical record, said John Maycroft, a medical society policy analyst leading the project.

The effort is based on the Respecting Choices program started in 1991 at Gundersen Lutheran Health System in La Crosse. The goal is to get more people to sign advanced care directives and talk about end-of-life choices long before they become ill.

Doing that in the hospital is not the best time, said Sue Sanford-Ring, vice president for quality and patient safety at UW Hospital, where she said much of the focus will be on patients coming to primary care clinics.

Doctors are not particularly good at this, said Dr. Geoff Priest, chief medical officer at Meriter Hospital. The time never seems to be quite right.

UW and Meriter are joining Dean Health System, St. Marys Hospital, Group Health Cooperative of south-central Wisconsin and the Madison Veterans Hospital in training staff to lead the discussions. In March, theyll start offering the talks to select groups of patients.

Fort HealthCare in Fort Atkinson, Community Care Inc. in Milwaukee and ProHealth Care in Waukesha are also participating. Organizations in northern Wisconsin will be invited to join next year before a statewide community outreach effort is launched in 2014, Maycroft said.

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Madison health care to emphasize end of life care discussions

VOORHEES Whatever else they may think of the health care atmosphere, hospital executives agree that change is coming.

"We have a very tough period of adjustment," said John Sheridan, president and CEO of the Cooper Health System, which owns the hospital of the same name in Camden. "We all have our hands full."

Sheridan was one of five panelists discussing the state of the region's hospitalsas they face reforms imposed by the federal Affordable Care Act, the increasing costs of technology, and looming shortages in doctors and nurses.

The forum, "The State of Hospitals," was hosted by the Chamber of Commerce Southern New Jersey on Friday at the Mansion on Main Street.

About 150 people attended, a mix of business people that included bankers, engineers, lawyers and, not surprisingly, health care providers.

The executives agreed that there were many uncertainties flowing from the Affordable Care Act, which many consider the signature achievement of President Barack Obama and the Democrats in Washington. Many of the requirements will begin in 2014, such as mandatory insurance for all citizens.

"No matter what happens in the (presidential) election, we are in for a huge change in health care," said panelist Ron Johnson, president and CEO of the Shore Medical Center in Somers Point, Atlantic County.

Under the health care act, all Americans are required to have health insurance starting in 2014.

Johnsonreferred to the field as highly "schizophrenic" in terms of reimbursement for doctors and hospitals as well as spending.

"We're talking about cutting costs, but we're spending millions," he said.

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Hospitals face challenges as reform looms

Tim Garraty/CNN

President Barack Obama and GOP vice presidential nominee Paul Ryan on Friday traded sharp criticism over health care reforms and Medicare, with each telling a leading advocacy group for senior citizens that the other was being untruthful.

"Contrary to what you've heard and what you may hear from subsequent speakers, Obamacare actually strengthened Medicare," the president told the AARP Liffe@50+ event, using the nickname for the 2010 Affordable Care Act that passed with no Republican support.

In particular, he called the claim by Ryan and other Republicans that $716 billion is being cut from Medicare to fund the health care bill "simply not true."

Ryan spoke to the same event shortly afterward, saying that Obama's contention that the health care law strengthened Medicare was "just not true," adding that the legislation "turned Medicare into a piggy bank for Obamacare."

The debate over Medicare is a major issue in the November election campaign, especially in the vital battleground state of Florida with its large population of senior citizens.

Ryan headed to Florida later Friday, while Obama campaigned in Virginia, Vice President Joe Biden spoke in New Hampshire and GOP presidential nominee Mitt Romney headed to Las Vegas. All four states are considered up-for-grabs in the election less than seven weeks away.

In a separate development, Romney released details of his 2011 income tax return that showed he made $13.7 million last year and paid $1.94 million in federal taxes, giving him an effective tax rate of 14.1%, his campaign said.

The majority of the candidate's income last year came from his investments, Brad Malt, the trustee of Romney's blind trust, said in a blog post. The Romneys gave just over $4 million to charity.

In addition, the Romney campaign said his tax filings from 1990 to 2009 show that he and his wife paid 100% of the federal and state income taxes they owed and that their overall average annual effective federal tax rate was 20.2%.

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Obama defends health care reforms

Burmese opposition politician Aung San Suu Kyi, center, is presented with a U.S. Congressional Gold Medal by Speaker of the House John Boehner, left, as House Minority Leader Nancy Pelosi, second left, and Senate Minority Leader Mitch McConnell, right, look on during a presentation ceremony at the Rotunda of the U.S. Capitol on Wednesday in Washington. Aung San Suu Kyi was presented with the medal for her leadership and commitment to human rights and for promoting freedom, peace and democracy in Myanmar, also known as Burma.

Week in Politics: September 14 - 21

Week in Politics: September 14 - 21

Week in Politics: September 14 - 21

Week in Politics: September 14 - 21

Week in Politics: September 14 - 21

Week in Politics: September 14 - 21

Week in Politics: September 14 - 21

Week in Politics: September 14 - 21

Week in Politics: September 14 - 21

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Obama, Ryan trade charges on Obamacare and Medicare

Burmese opposition politician Aung San Suu Kyi, center, is presented with a U.S. Congressional Gold Medal by Speaker of the House John Boehner, left, as House Minority Leader Nancy Pelosi, second left, and Senate Minority Leader Mitch McConnell, right, look on during a presentation ceremony at the Rotunda of the U.S. Capitol on Wednesday in Washington. Aung San Suu Kyi was presented with the medal for her leadership and commitment to human rights and for promoting freedom, peace and democracy in Myanmar, also known as Burma.

Week in Politics: September 14 - 21

Week in Politics: September 14 - 21

Week in Politics: September 14 - 21

Week in Politics: September 14 - 21

Week in Politics: September 14 - 21

Week in Politics: September 14 - 21

Week in Politics: September 14 - 21

Week in Politics: September 14 - 21

Week in Politics: September 14 - 21

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Campaign trail

20-09-2012 08:02

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Rand Paul on health care - Video

Sprig Health, an Oregon-based online health care website, has jumped into the Seattle area. But when Obamacare starts in 2014, how well will their model blend with Affordable Care?

A crowd gathered to cheer the Supreme Court ruling and criticize Washington's attorney general.

Sun, Jun 24, 5 p.m.

The U.S. Supreme Court could be on the verge of a ruling on the Affordable Care Act. A look at one couple's situation.

Back in June of 2012, a small crowd gathered outside the Bank of America tower in downtown Seattle to celebrate the Supreme Courts upholding of the Affordable Care Act (ACA). Supporters shared stories about rounds of chemotherapy, the frustrations and uncertainty of living without insurance, and stressed the importance of universal health care when Affordable Care is implemented in 2014.

With that kind of dissatisfaction, the health-care sector is seeking to give consumers new options.

Washington consumers are starting to see one change with the entry of Sprig Health, a growing Oregon-based company offering an online market place providing customers with direct access to health care. In August 2012, they expanded into Washington, giving the 14.5 percent of Washingtons currently uninsured perhaps some relief until ACA takes effect.

Sprig, which runs under auspices of Regence BlueCross BlueShield, offers discounted medical services such as preventative care, therapy, chiropractic, vision, dental, fitness, nutrition, and diagnostic imaging.

How it works is simple: A customer schedules an appointment with a care provider partnered with Sprig on their website, pays a reduced upfront fee, then sees the provider.

By handling the insurance billing and administrative paperwork that typically the health care provider needs to process, Sprig Health says it is able to produce significant cost savings a boon to the approximately 75 percent of Sprig customers who are uninsured or face high deductibles.

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Is there profit in health care changes?

While voters assess the stark contrast between President Barack Obama and Republican challenger Mitt Romney over health care reform, a sea change is already underway in the workplace as employers scramble for affordable ways to offer health insurance to their workers.

A new survey by the business consulting firm Aon Hewitt finds that "consumer-driven health plans," or CDHPs, have overtaken health maintenance organizations, or HMOs, as the second most popular health plan offered by U.S. employers. While preferred provider organizations, or PPOs, still dominate with 79 percent of employers offering them last year, 58 percent of the 2,000 U.S. employers surveyed now offer CDHPs, while just 38 percent offer HMOs.

Haven't heard of consumer-driven health plans? You may know them as high-deductible health savings accounts (HSAs) or health reimbursement arrangements (HRAs).

Their warmer, egalitarian-sounding name (with the word "consumer" in there) is preferred on the campaign trail this election cycle. The health care reform plank of the Republican platform recommends them, and GOP presidential candidate Mitt Romney singled them out for expansion when he signed the Massachusetts health care reform legislation in 2006.

Caught between the recession and the rising cost of health insurance, a growing number of employers now offer HSAs and HRAs as sort of a gateway plan to whatever comes next under health care reform.

Employees, however, have been less enthusiastic about CDHPs. The survey found that 7 in 10 workers prefer PPOs rather than risk the potentially heavy out-of-pockets of a high-deductible plan. So to sweeten the deal, roughly a third of employers surveyed either subsidize premiums, cover preventive medications before the deductible, or contribute directly to employee HSAsand HRAs.

Conservatives maintain that rampant overuse of health care services has led to the skyrocketing cost of health care and that the only way to reverse the trend is for consumers to take more responsibility for their health. Certainly the obesity epidemic would seem to support this position.

But is (cost)shifting the nation to high-deductible accounts the answer?

A recent study published in the journal Medical Care found that employees who contributed to their own HSA were more likely to moderate their use of health care services than those with employer-paid HSAs. The researchers noted that having "skin in the game" significantly altered whether an employee seeks care.

But that study also expressed concern that if employees skip routine exams and avoid early detection screenings for cost reasons, consumer-driven health plans could have a negative impact on public health.

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Can HSAs reform health care?

BURLINGTON, Vt. -

Doctors in our region are looking at how they can and should impact the state's health care reform.

A conference set for Saturday in Burlington will join together the Vermont Medical Society, the UVM College of Medicine and other groups to look at the role physicians should play as the state works to reduce health care costs and streamline health care payment systems.

One topic up for discussion: a new effort to focus on just how useful certain medical tests and procedures can be.

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Health care conference set for Burlington

20-09-2012 09:40 Sept. 20 (Bloomberg) -- In "Street News," Bloomberg's Scarlet Fu reports on today's top stories including Bank of America is set to cut 16000 by the end of the year, Nike will buy back $8 billion in stock over the next four years, GM looks to buy the auto-lending units of Ally Financial in Europe and Latin America and 6 million Americans face a health care penalty for not having health insurance. She speaks on Bloomberg Television's "Bloomberg Surveillance."

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Bank of America to Slash 16000 Jobs by Year-End - Video

Benefits of the nation's health care law will not extend to undocumented immigrants given reprieve from deportation by the Obama administration.

STORY HIGHLIGHTS

(CNN) -- As word spread this week that some benefits of the nation's health care law will not extend to the thousands of undocumented immigrants given reprieve from deportation by the Obama administration, advocacy groups were reminded that the youths' status remains much in limbo.

The Obama administration earned the praise of immigrant advocacy groups when it decided to grant relief to young undocumented immigrants who came to the United States as children. But a new rule would keep those same immigrants from federal health insurance coverage, putting some in an uncomfortable spot where they have permission to be here, but can't take advantage of all the programs available for others.

Some who championed the new immigration policy expressed disappointment at the news, which was more in line with critics of the policy who say that this group should receive no benefits whatsoever because of their legal status.

Five things to know about the big change in immigration policy

As many as 1.7 million immigrant youths may meet the criteria to be spared from deportation for a renewable two-year period, according to an estimate from the Pew Hispanic Center.

The New York Times was the first to report about a little-noticed rule put in place by the Department of Health and Human Services, that excludes the beneficiaries of "deferred status" from the health insurance benefits.

The Obama administration was clear that those who qualified for deferred action did not gain legal status in the United States, but would have "lawful presence," which would allow them to work legally and opened the door for other benefits, like driver's licenses.

But the HHS directive, published in the Federal Register, specifically excludes this group from the "lawful presence" category.

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'Deferred:' No health insurance for immigrants

A health care forum held in Superior Thursday aimed to explain the Affordable Care Act and what it means for you.

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Health Care Forum in Superior

Ezekiel "Zeke" Emanuel, former Special Advisor for Health Policy to Peter Orszag, the Director of the Office of Management and Budget and the Diane and Robert Levy University Professor at the University of Pennsylvania (THE DENVER POST | Joe Amon)

A key architect and a sharp opponent of national health care reform clashed in debate Thursday over how much "Obamacare" limits consumer choice and holds hope of cutting costs.

The Affordable Care Act strips exactly the kind of freedom consumers need to make better care choices and reduce costs, health economist Linda Gorman argued at a panel sponsored by The Post and the University of Denver.

Gorman of the Independence Institute said the subsidies and patient-managing plans of "Obamacare" wipe consumer choice out of the picture. By contrast, Gorman said, procedures where buyers know the price and have real choice, like Lasik eye surgery and urgent care centers, have seen costs come down through true competition.

Linda Gorman, former academic economist and Senior Fellow and Director of the Health Care Policy Institute at the Independence Institute (THE DENVER POST | Joe Amon)

"Our health care system is the fifth largest economy in the world," and still tens of millions of Americans go without care, responded Dr. Zeke Emanuel, who helped write portions of "Obamacare" for the White House. The new state insurance exchanges will be a pro-consumer marketplace, he argued, allowing people to choose basic benefits or pay more for gold-plated plans.

Emanuel is a fierce advocate for going even farther toward universal health care, while Gorman has criticized reforms for blowing up state and federal budgets while restricting consumers with mandates.

Doctors and hospitals will join to manage each patient's care more efficiently, and win rewards from insurance funds if they save money and improve quality, Emanuel said. The 2010 reform signing was "historic," and marked an end to a system that pays for doing more procedures instead of providing good care, he said.

Americans have tried that managed-care system in earlier decades, and many wound up hating the "capitated" model where they were denied care they wanted in order to save money, Gorman responded. Such a system also pushes insurers to cherry-pick healthier patients to avoid high costs, she said.

Voters need to know Republican reform alternatives are draconian, Emanuel said. He claimed the Romney-Ryan budget proposals would cut Medicaid funding up to 75 percent, a disaster for states and poorer patients.

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Health care battle has plenty of fight left, Denver panel shows

19-09-2012 14:21 A major component of Bioscience Connecticut is the construction of a patient care tower on the UConn Health Center's Farmington campus. The new tower and renovations to John Dempsey Hospital will provide the region with the most advanced health care technologies.

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Bioscience Connecticut -- Patient Care Tower Video - Video

The CEO of the leading provider of healthcare business intelligence solutions will speak on the impact of Value-based Purchasing at an upcoming HIMSS conference and will lead a webinar focused on what health systems need to know to maximize reimbursements.Columbus, Ohio (PRWEB) September 20, 2012 Health Care DataWorks, Inc. (HCD), the leading provider of business intelligence solutions and ...

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Health Care DataWorks to Lead Educational Programs Aimed at Helping Health Systems Prepare for Value-based Purchasing

LOWELL, Mass. Even with her wireless microphone, it takes Michelle Ramalho a little while to get the attention of her Friday lunch crowd at the Lowell Senior Center.

Good morning everyone, calls Ramalho, the centers director. Good morning everyone, she tries again. How about a great big welcome for Sen. Scott Brown?

Brown enters a packed multipurpose room to applause. He weaves among tables shaking hands, pausing for pictures, and answering questions about his wife and daughters.

Medicare is a hot topic in the news these days, but what Eva Crawford really wants to know is: Why isnt Brown wearing a seat belt while driving his signature truck in a series of TV ads?

WBUR explores the issues in the race between Republican Sen. Scott Brown and Democratic challenger Elizabeth Warren:

It is on, Brown says, it definitely is on. Well, Crawford says, you got to show it to us. Brown waves. I always wear my seat belt, he says, moving to another table.

Brown is ready for a question about Medicare. Its a topic that comes up a lot on the campaign trail. The focus, Brown says, must be on getting rid of waste, fraud and abuse.

You probably heard of the doctor down in Texas, $300 million, one person, on Medicare fraud, Brown says. We can reform Medicare from within the system. But the message is: Anyone who is getting it or is about to get it should be grandmothered, grandfathered in, theyre not going to have any effect. We need to strengthen it from within the system for future generations.

Brown does not support the Romney-Ryan plan to turn Medicare into a premium support (some call it a voucher) program with seniors buying coverage on their own.

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How Brown, Warren Would Tackle Health Care