Obamacare will kill patients (Not kidding....if you can't see the doctor when you are sick...how can you recover?)

OK…Let me get this right…Longer wait for patients to see the doctor…Doctors will be paid less…Those of us who pay for their Health Insurance will pay higher premiums…Those on Medicaid will have to search for a physician that will accept Medicaid….So now all Floridians will be miserable…and The Government will try to tell us we’ll all be better for it! Thanks for nothing OBAMA!

Florida doesn't have enough doctors for Medicaid expansion, lobby group says

February 22, 2013|By Kathleen Haughney, Tallahassee Bureau

TALLAHASSEE Brace yourself for longer lines at the doctor's office.

Whether you're employed and insured, elderly and on Medicare, or poor and covered by Medicaid, the Florida Medical Association says there's a growing shortage of doctors — especially specialists — available to provide you with medical care.

And if the Florida Legislature goes along with Gov. Rick Scott's recommendation to offer Medicaid coverage to an additional 1 million Floridians — part of the Affordable Care Act that takes effect next January — the FMA says that shortage will only get worse

"Florida needs more doctors and it needs more nurses, and it needs them working together in teams," said Rebecca O'Hara, a lobbyist for the FMA.

About 15 million Floridians have health insurance today, and Obamacare, which requires most adults to have coverage by January, could add as many as 2.5 million more. One million would come through a potential expansion of the federal-state Medicaid program that Scott announced this week he was backing. The others would be the result of new mandates requiring employers and individuals to have insurance or be fined.

Currently, the state has 44,804 doctors, but about 5,600 of them are expected to retire in the next five years. And even though Florida has opened three new medical schools in the past dozen years, the state isn't producing as many doctors as it needs. Scott's budget this year has $80 million to fund programs to train 700 new residents a year, in hopes they'll remain in the state.

Of all patients, people covered by Medicaid may have the hardest time finding a doctor; only 59 percent of the state's physicians are taking new Medicaid patients, according to a Kaiser Health News study.

Committees in both the House and Senate have been meeting for the past two months to discuss implementation of the Affordable Care Act. On March 4, they expect to see two major studies by the Office of Economic and Demographic Research, one that looks at the overall economic impact of the health-care overhaul and another that simply examines Medicaid expansion.

Scott, however, has already made clear how he feels about that.

On Wednesday, he unexpectedly announced that he had reversed his earlier, adamant opposition and now wants a three-year expansion that would cover single adults and families earning up to 138 percent of the poverty line; the costs would be fully covered by the federal government. If the expansion is re-approved after three years, the federal government is committed to paying no less than 90 percent of the cost.

House and Senate leaders will begin their budget deliberations in the coming weeks, which will include the decision over new residency slots, along with the debate over whether to expand Medicaid. Many lawmakers have expressed opposition.

Sen. Joe Negron, R-Stuart, who chairs the Senate committee studying the AFA, said lawmakers have heard concerns about a potential physician shortage, but he said he did not believe that would be a "determining factor" in the committee's decision over whether to expand Medicaid.

One reason, he said, is the responsibility for coverage may soon be falling to private health insurance companies or physician groups.

The federal government this week gave Florida preliminary approval of a plan that would put most of Florida's current 3.3 million Medicaid recipients — and any added via expansion — in some form of managed care, either HMOs or doctor-run networks, by 2014. In order for HMOs or the provider service networks to get state-approved contracts, they must prove they can provide "adequate" care, which means patients must be able to see a doctor in a reasonable time.

"It's their responsibility to have network adequacy," Negron said of the private providers. "So, they'll be responsible for making sure people can get care with network physicians."

Negron also noted that the amount doctors will be paid for seeing Medicaid patients is rising, which may prompt more physicians to take them. As part of the health care law, primary-care doctors will be paid as much for a Medicaid patient as they are under Medicare, a 73 percent increase.

Health care advocates who back the expansion say they aren't worried either.

Greg Mellowe, policy director for health advocacy group Florida Chain, said the state needed to carefully watch the situation as it develops, but added, "We don't believe that there is a crisis brewing."

Mellowe noted that many uninsured already receive care — often in emergency rooms, which is more expensive — that hospitals aren't paid for. If many of these patients have insurance coverage, he said, hospitals may see an opportunity to shift resources to primary care settings.

Lawmakers are slated to return to Tallahassee the week of March 4 for the beginning of the 2013 legislative session. The studies from the state economists are also due at that time.

Negron said until the state can look at that information, it was impossible to say what direction the Legislature would take.

"It will be a judgment call to make on the right way to proceed for Florida's families and businesses," he said. "I just think it's too early to tell where either the House or Senate will come down on this."

khaughney@tribune.com or 850-224-6214

Doctor shortage

Number of doctors in Florida: 44,804

Number of people with health insurance coverage: 15 million

Number expected in 2014, including a Medicaid expansion: 17 million to 17.5 million

Percentage of physicians expected to retire in the next five years: 5,600

Concierge Medicine works for Physicians and Patients! Obamacare does Not!

Concierge medicine for the people! American patients seek concierge services from their physician at only $50 a month! Sounds Good!

Bruce Japsen, Contributor

Forbes

Pharma & Healthcare 1/30/2013 @ 9:30AM

1 In 10 Doctor Practices Flee Medicare To Concierge Medicine

As Medicare whacks away at what doctors are paid and health insurers move away from paying fees for service to bundled payments, more physicians who own their own practices will start direct pay or concierge medicine in the next one to three years.

New data from a national survey of nearly 14,000 physicians conducted by physician staffing firm Merritt Hawkins for The Physicians Foundation, analyzing 2012 practice patterns, found that 9.6 percent of “practice owners” were planning to convert to concierge practices in the next one to three years.

The movement is across all medical disciplines with 6.8 percent of all physicians planning to stop taking insurance in favor of concierge-style medicine or so-called “direct primary care.”

“Physicians have been running for cover for several years now,” said Mark Smith, president of Merritt Hawkins. “There is a lot of uncertainty in health care now and the only certainty is there is a lot of talk about cutting physicians fees. One way to get out of it is to go off the grid.”

The data release comes less than a month after Congress waited until the 11^th hour to avoid the fiscal cliff as well as the so-called “doc fix” on Medicare payments. Even though a cut of nearly 27 percent in Medicare payments to doctors was avoided, doctors remain upset at the lack of a permanent solution for dramatic cuts to doctor payments from the Medicare health insurance program for the elderly under the sustainable growth rate formula also known as “SGR.”

Already, one in five physicians is restricting the number of Medicare patients in their practice and one in three primary care doctors – the providers on the front lines of keeping the cost of seniors’ care low – are restricting Medicare patients, according to a 2010 AMA survey of more than 9,000 physicians who care for Medicare patients.

Under direct primary care, doctors contract directly with patients to provide all of their primary care needs free of insurance interference at a price generally between $50 and $60 a month per patient. It’s what the New York Times last spring called “concierge for the masses” because it was much cheaper than the historically high cost of concierge medicine some Congressional investigators found to be $5,000 to $15,000 a year or more.

“It’s not just for the rich and famous anymore,” Merritt Hawkins’ Smith said of concierge medicine and direct primary care practices. “If you can afford a gym membership, you can afford this kind of care.”

 

The direct primary care approach provides unlimited visits to a physician’s office plus 24-hour access to doctors through e-mail consultations. The primary care model has drawn insurance industry opposition in part because the health insurer middleman is cut out of the equation as doctors are no longer paid by the likes of Aetna (AET), Humana (HUM) or a UnitedHealth Group (UNH).

Under a proposal under consideration by Congress and Medicare officials, a pilot program  would provide “monthly fee-based payments for direct primary care medical homes” for certain Medicare beneficiaries, according to the legislation introduced by Rep.  Bill Cassidy, a Louisiana Republican and physician.

Supporters of the direct primary care approach see the pilots as a way to show Congress and an Obama administration eager to reign in Medicare spending that the concept can provide quality medical care and lower costs.

 

 

Obamacare...Patients wait for care....Just ask the Brits and the Canadians! Oh yeah...there goes our research and manufactoring industry...it was nice knowin' ya!

Here comes Obamacare....wait for it....wait for it....wait....wait.....wait...(that's what we will do when we need to see the doctor)

 

The take-away is that women (in Canada) face nearly double the mortality risk from breast cancer that American women face; British men face six times the mortality risk from prostate cancer than that faced by American men.

 

 

May/June 2009

Obamacare: Medical Malpractice

By

Edward H. Crane

Edward H. Crane is the founder and president of the Cato Institute.

The columnist Robert J. Samuelson had a perceptive piece in the Washington Post recently in which he stood back from the policy trees to look at the Barack Obama forest. What he saw was disturbing. He suggests that Obama is advancing a “post-material economy” designed to “achieve broad social goals” that will end up spending more to get less. The president proposes to radically restructure America’s energy industry through massive tax increases (“cap and trade”) in the name of fighting the problematic notion that mankind’s miniscule addition to greenhouse gases will create crippling global warming. But as the world-renowned scientist Freeman Dyson points out, “Most of the evolution of life occurred on a planet substantially warmer than it is now and substantially richer in carbon dioxide.”

Obama also proposes to make the failed public school model available to even younger children and make liberal arts college more accessible to hundreds of thousands of students who, as American Enterprise Institute scholar Charles Murray points out, would be much better off going to vocational schools or junior colleges. Obama would escalate George W. Bush’s efforts to essentially federalize education in America. Never mind that the word “education” in not to be found in the federal Constitution.

But perhaps most threatening to most Americans is Obama’s determination to nationalize health care in America. It’s a truly bad idea. But that is what the president has made clear he wants. Obama has publicly declared his preference for a single-payer system “managed like Canada.” His initial proposal, part of an ill-defined $634 billion “down payment” on health care reform, would create heavily subsidized federal insurance that would put private insurance at an unhealthy disadvantage. Some estimates suggest that private insurance would be reduced by more than 60 percent, leading ultimately to its collapse. Speaking of the Canadian system, Obama says of his approach that “it may be we end up transitioning to such a system.” Ya think?

That, of course, would be a tremendous mistake, a fundamental mistake. America is a land of free individuals. Socialized medicine is not what we as a nation are about—and with good reason, both philosophical and practical. Consider:

• Eight out of ten of the most recent major medical innovations, ranging from MRIs to hip replacement, have come from the United States.
• Americans have access, on a per capita basis, to three times as many CT scans as Canadians and four times as many as Britons. Had the actress Natasha Richardson had her skiing accident in upstate New York rather than in Canada, she might have had a chance of survival.
• According to Vancouver’s Fraser Institute, the average wait for treatment by a specialist in Canada is 18 weeks. As the Canadian Supreme Court ruled when eliminating the national health care monopoly in 2005: “The evidence shows that in the case of certain surgical procedures, the delays that are the necessary result of waiting lists increase the patient’s risk of mortality… The evidence also shows that many patients on non-urgent waiting lists are in pain and cannot fully enjoy any real quality of life.”
• According to a Cato study British women face nearly double the mortality risk from breast cancer that American women face; British men face six times the mortality risk from prostate cancer than that faced by American men.

Really, does it make any sense whatsoever to change our health care system to a nationalized system? None of which should suggest that we can’t improve on our employer-based, third-party payer approach. And we seem to be moving away from that. Cato published the first book on Health Savings Accounts, which bring about a major improvement by individualizing and making portable health insurance. The next great innovation is from University of Chicago finance professor and newly minted Cato adjunct scholar John Cochrane. His Cato Policy Analysis (no.633), “Health-Status Insurance: How Markets Can Provide Health Security,” is a brilliant solution to high insurance costs and issues such as preexisting conditions.

While left-wing coalitions like Health Care for America Now gear up to do battle, and more traditional opponents of socialized medicine like the business community and the American Medical Association prepare to essentially capitulate, all parties should pay attention to a recent front page story in the New York Times, headlined “Doctor Shortage Proves Obstacle to Obama Goals.” You don’t suppose that shortage has anything to do with the prospect of nationalized health care, do you?

 

Nurse Practitioners and Physician Assistants are in the cross-hairs of the Malpractice Lawyers industry! America...Here comes the PAIN!!!

As more Nurse Practitioners and Physician Assistants are used to fill the void in the Physician shortage Malpractice Lawyers will begin a campaign to sue the Mid-Levels. It is just beginning, but an aggressive field of Malpractice lawyers will begin the process of setting high award cases. Trail lawyers will be happy, patients looking to hit the “Jackpot” (and you all know who you are) will be happy, and the America will again seeing rising costs of its Health Care take place. Everyone loses except the trail lawyers!

 On the Defensive

More patients are naming nurses in malpractice suits

From Nurseweek.com

By Todd Stein
May 15, 2000
Illustration: Margie Paschke/
William Jacoby/Photodisc

 Not so long ago, the distinction between nurses and physicians was pretty clear: Physicians took care of the medicine, nurses took care of the patient. Today, as nurses take on more of the physician’s medical duties, they are increasingly exposed to a physician’s greatest fear – the malpractice lawsuit.

"Clearly, there has been a marked increase" in malpractice suits naming nurses as defendants, said William McDonough, senior vice president for health care at Boston-based Marsh Inc., the world’s biggest insurance brokerage firm. McDonough estimates that the number of malpractice lawsuits naming nurses as defendants has risen 10 percent nationally since 1995.

That number may be low, especially where highly skilled nurses are concerned. A study of nurse-malpractice lawsuits in Harvard University medical institutions found that claims against nurse practitioners jumped 16 percent between 1984 and 1992.

Insurance experts mostly blame the increase on overzealous lawyers lured by substantial jury awards. Lawyers blame managed care for axing hospital staffs and increasing patient loads – leading to more mistakes. But all sides agree the primary reason more nurses are getting sued is, ironically, that they are more skilled than ever before.

"Patients expect more of nurses, so when something goes wrong there’s less hesitation to blame them," said Marc Mandell, a Norwich, Conn., lawyer who specializes in nursing risk management.

More vulnerable

As their professional roles expand, nurses are naturally becoming more vulnerable to the types of lawsuits that have plagued physicians for years. Malpractice is the legal term for negligence by any licensed professional. Case law began recognizing nurses as professionals in the mid-1970s, and has lately come to see registered nurses as "assertive, decisive healthcare providers," according to a 1985 New York appellate court opinion.

"Unlike a generation ago, jurors are more likely to agree that if something goes wrong, the nurse should have picked it up just like a doctor," Mandell said.

The financial cost of malpractice is covered by most employers’ insurance policies, and few experts suggest nurses need their own malpractice insurance. But if malpractice is claimed, the cost to a nurse’s career can be staggering. Even if the nurse is a so-called "tag-along" defendant and not the primary focus of the lawsuit, once money is exchanged through an out-of-court settlement or jury award, the nurse’s name is automatically reported to the state Board of Nurse Examiners, to insurers and to the federal government’s National Practitioners Databank.

State nursing boards are increasingly likely to suspend or discipline nurses who are found guilty in malpractice suits. Even if the board is lenient, employers may not be. Nurses are required to report their involvement in a malpractice suit to each of their employers for the rest of their professional careers.

"The patient isn’t the only victim in a malpractice case," said Tom Packer, a San Francisco lawyer who specializes in defending nurses in liability cases. "The emotional and professional effect on nurses can be devastating because it’s forever on their record that one of their patients was paid money after they alleged malpractice, even if they only got one dollar."

Guides for protection

Not all the news is bad, though. Thankfully, there are clear guidelines for protecting yourself from a malpractice suit.

Nursing malpractice occurs only under two conditions: You make a mistake that can be proved to have harmed a patient, and the mistake is one that a reasonably careful nurse wouldn’t have made in a similar situation. The law doesn’t require you to provide the best or safest care humanly possible – only to meet a reasonable standard.

In court, that standard is your state’s Nurse Practice Act. So it follows that the primary way to prevent a malpractice lawsuit from being filed is to know the law.

"A nurse absolutely has to be familiar with the Nurse Practice Act, so if she’s asked to do something out of bounds, she knows to refuse it," said Elizabeth Higginbotham, RN, an Austin plaintiff’s lawyer and president of The American Association of Nurse Attorneys (TAANA), Texas chapter, who leads workshops on avoiding malpractice suits for both nurses and hospital administrators.

Many times, Higginbotham said, employers will put nurses in a catch-22 situation where they must choose between compromising their license and keeping their job. A long-term care facility, for instance, may have a policy that requires RNs to let unlicensed personnel hang IVs, even if the state’s Nurse Practice Act requires an RN to do the job. If something goes wrong and a lawsuit is filed, it’s the nurse who will be held responsible.

Similarly, a nurse who notifies a physician that a patient is in trouble is legally responsible for that patient even if the physician makes no response.

"You can’t just drop the ball," Higginbotham said. "You’ve got to go over (the physician’s) head and find somebody who’s going to give you orders to take care of that patient. Otherwise, you might find yourself in my office."

Many state nursing boards make available guidelines that outline a step-by-step process for determining which duties are outside a nurse’s scope of practice. Most can be printed from the Internet free of charge.

Documentation is key

Another way to prevent malpractice suits is to scrupulously document everything from disagreements with the physician to a patient’s noncompliance with medications. "Nobody’s going to protect you but yourself," attorney Mandell said. "And the best way to protect yourself is to document everything and to do it contemporaneously, not after the fact."

Adding to the medical record after a lawsuit has been threatened is one of the most common and costly mistakes a nurse can make, added Monica Mooney, RN, a San Francisco defense lawyer and president of TAANA’s California chapter. "As a defense attorney, that is one of the last things you want to see. Any time you alter the medical record after the fact your liability is huge because it ruins your credibility and the jury’s not likely to believe anything else you say."

Ideally, chart entries should be made at the time of an assessment or intervention and no later than shortly afterward. If you make a mistake in the record, draw a line through it, write "mistaken entry," include the correct information, and initial the changes. Never erase or obscure the record. Document forensics experts are commonly employed by attorneys to uncover such glaring indicators of error.

While other prevention tactics are advisable, perhaps the best technique to prevent a malpractice suit from being filed is the one that comes most natural to nurses. Being kind.

"Politeness is the best cure against malpractice," Mandell said. "If the patient likes you and you’ve been kind to that patient you decrease your odds of being sued immensely."

Politicians and their Lawyer backers are seeking to raise Medical Malpractice premiums! Forget the 30% recover fees, politicians and lawyers want much more!

….And you thought lawmakers were elected to represent the people! Well...you got it wrong! Lawmakers (generally and more often these lawmakers are lawyers seeing they can’t find a real job, so they get elected to something) are legislating for themselves and their current and former law firms. The story below shows how these lawmakers are seeking to make more money off the backs of Doctors and Patients!

Lawyer pol bids for higher malpractice fees

• By CARL CAMPANILE
• NY Post
• Last Updated: 12:37 AM, March 21, 2011
• Posted: 12:37 AM, March 21, 2011

A powerful state senator who is a medical-malpractice attorney has sparked a furor by pushing a bill to boost trial lawyers' pay by eliminating 2-decade-old limits on legal fees in such cases.

Sen. John DeFrancisco (R-Syracuse), chairman of the Finance Committee, is "of counsel" to the Syracuse medical-malpractice law firm DeFrancisco & Falgiatano.

And watchdog groups say his advocacy for an end to limits on contingency fees is a blatant conflict of interest, while health-care-industry officials claim giving more money to attorneys could dramatically increase malpractice-insurance premiums for medical providers and reduce payouts to patients.

"It's a conflict of interest for a lawyer to champion a bill that benefits his profession and his law firm," said Citizens Union President Dick Dadey.

The bill also undercuts Gov. Cuomo's bid to slash malpractice costs.

In response to medical-industry complaints about high malpractice premiums, Cuomo proposed a $250,000 cap on non-economic "pain and suffering" awards, to slash $700 million in costs.

In exchange, health-care providers and unions backed Cuomo's plan to trim Medicaid.

Current law caps fees for attorneys who earn a percentage of what their clients win. They're now paid on a sliding scale.

For example, lawyers can collect up to 30 percent on judgments of less than $250,000 but no more than 10 percent of awards of more than 1.25 million. DeFrancisco's bill would abolish those limits.

"This bill would drastically worsen hospitals' already oppressive medical-malpractice costs and threaten access to care. To enact it would be shameless," said Brian Conway, spokesman for the Greater New York Hospital Association.

DeFrancisco declined comment.