Integrated Health Care Delivery Systems: “The Wave of the Future?”

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.”

Read more here.

D.C. Instructs Insurance Companies to Cover Gender Reassignment Surgery

Mayor Vincent Gray of Washington D.C. announced that D.C. will now require insurance companies to provide full coverage to transgender residents, which includes gender reassignment surgery. The D.C. Department of Insurance, Securities and Banking stated its official position that treatment and gender reassignment surgery for gender dysphoria are covered benefits. The Mayor stated that transgender people should not be required to pay extensive out-of-pocket fees for treatment.

Read more here.

UPDATE: Man Forced to Undergo 3 Enemas and Colonoscopy by Police

David Eckert, from Hidalgo County, New Mexico, was subjected to numerous, highly invasive procedures, because police suspected him of hiding drugs in his rectum. Mr. Eckert had been convicted of methamphetamine possession in 2008, and the police suspected his continued involvement with drugs. However, the officers who searched both Mr. Eckert’s person and his vehicle, after pulling him over for a traffic violation, found neither drugs, nor weapons. One officer indicated that Mr. Eckert held himself in an “erect” position, and “kept his legs together,” which led the officers to assume that Mr. Eckert held drugs within him.

 After a local hospital refused forcibly to search Mr. Eckert, he was transported to the Gila Regional Medical Center (GRMC), 50 miles away. At GRMC, Mr. Eckert was subjected to two rectal exams, three enemas, forced bowel movements in front of officers and nurses, x-rays, and a colonoscopy performed under anesthesia. However, each search was fruitless. Mr. Eckert received a bill from the hospital for $6,000. Mr. Eckert filed suit against the hospital, and the parties settled for $1.6 million.

Read more here.

Plastic Surgeons Consider Stem Cell Therapy a Part of Industry’s Future

This week in San Diego, California, plastic surgeons will meet to discuss the future of their industry. The head of the American Society of Plastic Surgeons, Dr. Bob Murphy, states that stem cell therapy can be used in elective procedures, as well as reconstructive procedures. Dr. Murphy went on to say that perhaps, one day, stem cells might make it possible for patients to regrow breasts after mastectomies.

Read more here.

Kaiser Family Foundation Conducts Study on Efficacy of Obamacare

The Kaiser Family Foundation is conducting a long-term research project in California, in order to determine whether the Affordable Care Act (ACA) improves the uninsured population’s ability to obtain affordable health insurance. The Foundation selected 2,000 California citizens without health insurance. It will follow these citizens for two years as they navigate the insurance exchanges created by the ACA.

Read more about the study and the first wave of results here.

Obama Does Not End Health Insurance Subsidy for Congress

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.

Read more here.

SAIC Seeks to Curb Corruption in China’s Pharmaceutical Industry

China’s State Administration for Industry and Commerce (SAIC) is increasing its investigatory efforts into the Chinese pharmaceutical industry and medical services sector. The SAIC is focusing on the price of medicine, and whether companies are in violation of anti-trust legislation. The SAIC will severely punish those engaged in acts of bribery in the bidding process for pharmaceuticals and medical services because bribery inflates prices artificially and hurts consumers.

Read more here.

PPACA’s Limit on Consumers’ Expenses Delayed Until 2015

The PPACA incorporates mechanisms intended to protect consumers from insurance company abuses. One such mechanism limits patients’ out-of-pocket (OOP) spending for major medical coverage. However, as posted on the Department of Labor’s website, the cap on OOP expenses for consumers will not go into effect until 2015. Some claim that the delay is meant to help businesses and consumers adapt to the PPACA, while others claim that the Administration is catering to employers and businesses at the expense of consumers.

To read more, click here.

The “Wild West” of Emergency Care

Several states, such as North Carolina, Texas and Florida, are experiencing a surge in “stand-alone” emergency rooms.  Stand-alone ERs are aptly named, as they are not attached to hospitals, and they tend to offer speedier and more convenient service to their patients. Some argue that freestanding ERs alleviate overcrowded hospital ERs, and that it is impossible to have “too much care for patients.” However, others maintain that such ERs increase costs because they charge insurers up to three times more per patient than urgent care facilities or doctors’ offices.

The copay for insured patients at a freestanding ER is only slightly higher than the copay for a doctor’s visit or a trip to an urgent care facility. Often, patients use ERs for routine care, which would be less costly in another facility, and insurers do not have the power to stop this practice.  For example, pursuant to Texas state law, insurers must pay for coverage whenever a patient seeks treatment for a perceived emergency, regardless of whether the patient has experienced a true emergency. The rise of freestanding ERs is most notable in “affluent suburbs,” even though insurers strive to educate patients about the benefits of seeking less costly treatment.  To read more click here and here.

Vermont Doctors Claim the State’s Health Plans Will Be Detrimental to Medical Ethics

A group of doctors and Republican lawmakers in Vermont claim that the state’s plans to create a single-payer health care system will “’regulate the private practice of medicine in Vermont out of existence.”  The group’s principle argument against the health care reform measure is that doctors will be forced to reduce the quality of the health care in response to health care cost control initiatives.  According to psychiatrist Robert Emmons, “when you control how the doctor is paid, you control the doctor’s clinical decisions.” However, Mark Larson, Commissioner of the Department of Vermont Health Access, and Robin Lunge, Governor Shumlin’s Director of Health Care Reform, believe such complaints are “premature” as decisions about physician compensation have not yet been made.  In addition, physician compensation is already regulated by provider agreements with insurance companies, Medicare and Medicaid.  Read the original article here.