Advanced directives, such as a health care proxies, promote quality health care by allowing individuals to leave specific instructions on how others should make medical decisions on their behalf in the event they lose capacity to do so themselves. Yet, nearly two-thirds of Americans do not have an advanced directive in place, and even those that do are at risk that their advanced directives will not be easily located when needed, as most are not recorded electronically.
Currently, the Centers for Medicare and Medicaid Services (“CMS”) reimburses health care providers for discussing advance care planning with their patients, but advocates are pushing for additional measures that would encourage a greater dialogue about end-of-life care, promote the execution of advanced directives, and ensure that advanced directives are readily accessible to providers and health care proxies. Most recently, a bipartisan bill was introduced in legislature that would require CMS to pay Medicare beneficiaries a nominal amount in exchange for writing and electronically recording advanced directives. Advocates hope that the payment would encourage more individuals to execute advance directives. In addition, CMS would maintain all such documentation online and would ensure that it can be accessed by providers and health care proxies as necessary.
American medical schools have used a standard curriculum since 1910, influenced by the Flexner Report: two years of theory and science in the classroom followed by two years rounding on patients in the hospital under the supervision of an attending physician. This method is striking in that medical students forgo patient interaction in their first two years of training. However, this traditional model is being challenged by a handful of medical professionals whose efforts to expose medical students to patients in the first year of medical school is being endorsed by the American Medical Association.
At the forefront of this hands-on-educational model is the Northwell School of Medicine at Hofstra University. Cited in a recent article in Modern Healthcare, Hofstra’s medical school immerses medical students in patient care by assigning students to work as emergency medical technicians (EMTs) during their first year. Advocates for the new model of medical school claim that such exposure to critical patients early in the training will promote better empathy, compassion, and teamwork when treating patients.
Other notable programs bucking the original medical school model by exposing their students to patients earlier in their education include Vanderbilt University School of Medicine’s program coined Curriculum 2.0 and Icahn School of Medicine at Mount Sinai’s Longitudinal Clinical Experience courts.
Such changes appear warranted, for the physician-patient encounter is at the pinnacle of health care. While the positive outcomes are still being assessed, one thing is clear: the old guard has acquiesced to the new model: medical students interacting with patients early and often.
A federal review board has ruled that Medicare will now cover sex-reassignment surgery on a case-by-case basis. The review board decided that coverage for sex-reassignment surgery will no longer be automatically denied by Medicare.
The ruling does not create a right for Medicare recipients to receive payment for their reassignment surgery, but it does allow flexibility for doctors to use clinical evidence to determine if the cost should be covered.
The estimated cost for treatments is anywhere from $25,000 to $75,000 per person.
Health care delivery is undergoing a major change in the United States, and it is happening with little fanfare, due to the fervent debate over the viability of the Affordable Care Act (ACA). Hospital systems, such as Mt. Sinai in New York, are cutting out the middle man when it comes to insurance coverage, in order to retain more profits from services provided. Mt. Sinai, located in New York, is an example of a hospital system that is providing its own insurance options to patients who receive treatment within the system.
Both non-profit and for-profit hospitals can benefit from implementing such programs, as there are certain services that are not economically sustainable, but must be accessible to the public. For example, psychiatric care does not generate a lot of revenue, but is a necessary and important service. Ezekiel Emanuel was one of the creators of the ACA, and is chairman of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. He states that “the wave of the future is integrated delivery systems—integrating insurance with the delivery function.”
The Center for Medicaid and Medicare Services (CMS) administrator, Marilyn Tavenner, stated in a letter to Congress that Medicare Part D is working well, and a proposed rule change, which would have “substantially reduced patient choice,” is unnecessary. The Senate Finance Committee stated that, at present, the cost of the program is 45% below the projections of the Congressional Budget Office. In addition, Part D enjoys a 90% satisfaction rate by its beneficiaries. Under the Affordable Care Act the cost of Medicare Part D premiums has remained low, but the quality of care has improved. However, Ms. Tavenner wrote also that opportunities exist to improve the program, and CMS will continue to review Part D policies periodically.
The inspector general for the Department of Health and Human Services and Medicare compiled a report recently, which shows that Medicare pays “more than twice as much” for vacuum erection systems (VES) than either internet consumers or the Department for Veteran Affairs. According to the Mayo Clinic, VES is one of a few viable treatments for erectile dysfunction. However, at present legislators struggle to reach agreement on a $1 trillion spending bill, and government waste is a pressing concern. The report indicates that if Medicare had lowered its payments to match the cost paid by non-Medicare consumers it could have saved “an average of about 14.4 million for each of the last 6 years.”
As health care deductibles rise, some health care providers are demanding that patients pay either a portion of their deductible, or, in some cases, their entire deductible prior to being seen or treated. Hospitals claim that, in order to survive financially, they must charge patients prior to treating them. The hospitals assert that it is much more difficult to collect on patient debts after the patients have received treatment.
In order to avoid paying the penalty mandated by the Affordable Care Act (ACA), Americans should have active medical coverage by March, 1, 2014. The Congressional Budget Office projected that approximately 6 million Americans will pay the penalty in 2016.
The open enrollment period runs through March 31, 2014; however, the insurance plans require time to take effect after enrollment, and the ACA requires a citizen to have an active policy as of March 31. Thus, plans must be purchased by mid-March 2014 in order to avoid a penalty.
Recently, during attempts to resolve the budgetary deadlock, the Obama administration offered members of Congress continued federal funding towards insurance premiums under the Affordable Care Act (ACA)—provided that they enroll in a specified ACA plan. Currently, almost all federal employees are eligible for the Federal Employees Health Benefits Program (FEHBP). On average, FEHBP pays approximately 70 percent of the total cost of the enrollees’ insurance premium.
The Office of Personnel Management (OPM) issued proposed rules; the OPM reasoned that the ACA did not repeal the FEHBP, and stated that government subsidies for insurance premiums should continue for federal employees compelled to leave FEHBP. However, numerous commentators opine that those in Congress should be subject to the same rules as other U.S. citizens.
The Knight Foundation will grant shares of two million dollars in prize money to the winners of a contest that requires entrants to submit innovative, unique ways to analyze public health data. The winners must use the money in order to develop their ideas, and the ideas must be in by September 17, 2013. Among the entries already received, one asks patients to agree to the release of health care data after their deaths; one proposes a food poisoning tracker; and one proposes a new dataset to show “how doctors, hospitals, laboratories and other health care providers team together to treat Medicare patients.”