Posted on 07/30/2009 3:34:15 AM PDT by Man50D
The House health-care reform bill proposes to decrease hospital visits by establishing a “medical home pilot program” for elderly and disabled Americans.
Such a medical home would not require a physician to be on the staff, and therefore could be run solely by nurse practitioners and physician assistants. Medical homes also would practice “evidence-based” medicine, which advocates only the use of medical treatments that are supported by effectiveness research.
But physicians’ groups say the legislation could lead to restrictions on which treatments may be used for certain conditions, despite the fact that some patients might require a unique or unconventional approach. It also may lead to dumping Medicare/Medicaid patients in facilities that are not required to have physicians on staff.
The Center for Medicine in the Public Interest (CMPI) expressed its concerns in a report that explains why statistical evidence does not always reflect reality of effective medicine.
“‘One size fits all’ rarely does,” the report said. “From clothes to shoes to hats, few people find that items carrying that label work with their individual bodies. So why do we entrust the health of our bodies -- one of the most important assets we have -- to a one-size-fits-all mentality?”
According to CMPI and individual physicians, however, this one-size-fits-all mentality is just what congressional health-care reform suggests.
“Unfortunately, policies being advanced under the guise of ‘evidence-based medicine’ (EBM) could do just that,” the CMPI report said. “The idea behind EBM, empowering physicians with sound evidence to incorporate into their treatment decisions for individual patients, is a good one.
“Unfortunately, EBM now is being distorted by government bureaucrats and HMOs in ways that impose top-down, one-size-fits-all restrictions on patients and their healthcare providers.”
Rather than enforcing a formulaic approach to medicine based on statistical and clinical research, CMPI says health-care reform should preserve physicians’ autonomy to use the research in conjunction with their experience and knowledge of the patient.
”It is so critically important for the physician to maintain his or her ability to combine study findings with their expertise and knowledge of the individual in order to make the optimal treatment decisions. Evidence-based medicine in its present, distorted form emphasizes just one aspect of the clinical pie over all the others,” the report found.
Kathryn Serkes of the American Association for Physicians and Surgeons echoed the observation.
“There is no typical patient,” Serkes told CNSNews.com. “Every patient is different from a medical perspective. If we have evidence-based medicine that basically says ‘well, we start at treatment one, which leads you to treatment two, to treatment three to treatment four. In practice, that doesn’t work for the patient. That’s the ‘art’ part of the art and science of medicine. That’s what we still need doctors to do, is to figure out what’s right for the patient.”
In the long run, according to CMPI, evidence-based medicine may not even cut costs as Congress suggests it would.
“Evidence-based medicine may provide transitory savings in the short term, but the same patient who takes the cheapest available statin today may very well be the patient costing you -- the taxpayer, the policymaker, the thought-leader, the sister, the spouse -- big bucks when that patient ends up in the hospital because of improperly treated cardiovascular disease,” .
“The repercussions of choosing short-term thinking over long-term results and cost-based medicine over patient-based are pernicious to both the public purse and the public health,” the CMPI report said.
Provisions for the medical home pilot program are an amendment to the Social Security Act, which governs the administration of Medicare and Medicaid services.
The medical home is an approach to medical practice that “facilitates partnerships” between patients and physicians, according to the proposed bill.
The pilot program targets Medicare beneficiaries who have a high medical “risk score” or who require regular monitoring, advising or treatment. This currently applies to more than 22 million Americans, according to Kaiser Family Foundation statistics.
At least $1.5 billion would be redirected from the Federal Supplementary Medical Insurance Trust Fund to fund the medical homes, “in addition to funds otherwise available,” according to the bill.
The Senate health-care reform bill also includes provisions for medical homes, although to lesser detail than the House bill.
If this portion of the legislation passes through Congress, medical homes will be part of the greater health-care reform experiment known as "the public (health insurance) option."
According to the committee, the provisions for medical homes will make the public option a stronger competitor against private health insurance companies.
“The public health insurance option will be empowered to implement innovative delivery reform initiatives so that it is a nimble purchaser of health care and gets more value for each health care dollar,” the House Committee on Energy and Commerce’s summary says about the bill.
Medical homes are tied to “comparative effectivness research” via something called “evidence-based medicine.”
“It will expand upon the experiments put forth in Medicare and be provided the flexibility to implement value-based purchasing, accountable care organizations, medical homes, and bundled payments. These features will ensure the public option is a leader in efficient delivery of quality care, spurring competition with private plans,” the committee’s summary also said.
A statement by the American College of Emergency Physicians (ACEP) said that the effectiveness of the medical home model should be carefully evaluated before applying the model far and wide.
“There should be more research to demonstrate the benefits and continuing costs associated with implementation of the full (patient-centered medical home) model,” the ACEP statement said.
“Demonstration projects being conducted by the Centers for Medicare & Medicaid Services must be carefully evaluated. There should be proven value in healthcare outcomes for patients and reduced costs to the healthcare system before there is widespread implementation of this model.”
The proposal, meanwhile, specifically allows for facilities to be run by staff who do not possess medical degrees – including nurses and nurse practitioners.
this is what we have to look forward to? this crap?
“Thank you. I am sitting here trying to remember if I have ever read a more heart-stopping post...
God help us.”
This is so scary. G-d willing all of us reading this thread will be elders one day......This has to be stopped!
Young lefties can’t think beyond this afternoon....we all age; they obviously didn’t think in terms of themselves in the future.
This will be ALL of us someday.
Please G-d make the insanity stop! Our health care system may not be perfect but it is the BEST IN THE WORLD! It is not a broken sytem.
Zero et al , stop it....just stop it!
Then contact all of your reps and exercise a politcal free fire zone over this monstrosity.
Here are some of the things I have found so far.
Section 113 b-1 Page 22: Mandates an audit of all employers that self-insure to "ensure that the law does not provide incentives for small and mid-size employers to self-insure".
Section 123 Page 30: A government Health Benefits Advisory Committee will recommend what treatments and benefits are available. Once accepted and adopted by the Secretary of Health and Human Services, there is no appeal.
Section 141 & 142 Page 42: Establish a "Health Choices Commissioner" appointed by the Prresident who will establish qualified plan standards for the insured, establish a "Health INsurance Exchange", will administer "Health Insurance Credits" and determin who is eligible, will ensure compliance, conduct audits, administer penalites and remedies.
Section 152 Page 50: All healthcare services will be provided without regard to "personal characteristcs" which is not defined within the document as is understood to include immigration status.
Section 1173A a-2-D Page 58: Calls for a National Health Plan Beneficiary Identification Card for every person and the ability to determine a persons indivual financial responsibility and eligibility prior to, or at the time of service.
Section 1173A a-4-C Page 59: Requires the ability to have electronic funds tranfer from insured account to the federal government automate reconcilliation of health care payment.
Section 164 Page 65: Taxpayers will subsidize a retiree reinsurance health fund up to 10 billion dollars to assist participating employment-based plans (unions, community organizers, etc.) with the cost of providing health benefits to retirees and to eligible spouses, surviving spouses and dependents of such retirees
Section 294 b-7 Page 91: Government mandates culturally and linguistically appropriate communication and health services for all.
Section 205 a-1 Page 95-96: The Government will etsablish an outreach program to inform, educate, and enroll participants, directed at "vulnerable" populations and to be accomplished in person at "community locations", by mail, telephone, or electronically. Tailor made for ACORN and Americorps.
Section 205 C-3-3 Page 102: If you do not enroll in a "National Health Exchange Plan" and are eligible for Medicaid, you will automatically be enrolled in Medicaid. You have no choice in the matter.
Section 223 f Page 124: There will be no administrative or "judicial review" permitted for payment rates established under the National Health Care Plans.
Section 224 b Page 125: The Secretary shall design and implement the payment mechanisms and policies under this section in a manner that — (1) seeks to (B) reduce health disparities (including racial, ethnic and other disparities).
Section 312 a-4, c-2 Page 145-148: An employer MUST auto-enroll employees into a government approved plan, either the public plan or another plan, unless an employee makes an affiormative decision to opt out.
Seaction 312 b-3 Page 146-147: Employers MUST pay pro-rated healthcare contribution for part-time employees AND their families.
Section 313 b-1 Page 150: Any employer with a payroll of $400K or more, who does not offer the public option, pays an 8% tax on payroll, $350+-400K it is 6%, for over $300+-350K it is 4%, for $250+- 300K it is 2%.
Title IV Amendment to IRS COde Imposes a 2.5% income tax penalty to those individuals opting out, not to exceed what would be the National Average Premium, determined by the Secretary of Health and Welfare.
Section 1233 E & F Page 426-433 Establishes mandatory end-of-life counseling for senior citizens over age 65 every five years, or sooner if bebeficiary becomes ill.
Section 1302 a Page 460-482: Establishes a "Medical Home Pilot Program" for the elderly or "targeted high need beneficiaries" in urban, rural, and served areas. No physician nned be on duty, run by nurse paractitioners and physician assistants. Care for beneficiaries coordinated by a team of individuals at the practice level using "evidence based guidelines" which advocate only the use of medical treatments that are supported by effectiveness research.
Over The Hill To The Poor House
1. Oh how can it be they have driven
Their father so helpless and old
Oh God may their crimes be forgiven
To perish out here in the cold
Chorus:
I’m old I’m helpless and feeble
And the days of my youth have gone by
And it’s over the hill to the poor house
I must wander alone there to die
2. Long years since Mary was taken
My faithful affectionate wife
Since then I’ve been alone and forsaken
The light has died out of my life
Chorus:
3. I gave them the house they were born in
A deed to the farm and more
I gave them the place that they lived on
And now I am turned from its door
4. Oh me on the doorstep up yonder
I’ve set with my babe’s on my knee
No father so happy or fonder
Than I of my little ones three
A slain Rat a day, keeps Obamacare away
Then contact all of your reps and exercise a politcal free fire zone over this monstrosity.
Here are some of the things I have found so far.
Section 113 b-1 Page 22: Mandates an audit of all employers that self-insure to "ensure that the law does not provide incentives for small and mid-size employers to self-insure".
Section 123 Page 30: A government Health Benefits Advisory Committee will recommend what treatments and benefits are available. Once accepted and adopted by the Secretary of Health and Human Services, there is no appeal.
Section 141 & 142 Page 42: Establish a "Health Choices Commissioner" appointed by the Prresident who will establish qualified plan standards for the insured, establish a "Health INsurance Exchange", will administer "Health Insurance Credits" and determin who is eligible, will ensure compliance, conduct audits, administer penalites and remedies.
Section 152 Page 50: All healthcare services will be provided without regard to "personal characteristcs" which is not defined within the document as is understood to include immigration status.
Section 1173A a-2-D Page 58: Calls for a National Health Plan Beneficiary Identification Card for every person and the ability to determine a persons indivual financial responsibility and eligibility prior to, or at the time of service.
Section 1173A a-4-C Page 59: Requires the ability to have electronic funds tranfer from insured account to the federal government automate reconcilliation of health care payment.
Section 164 Page 65: Taxpayers will subsidize a retiree reinsurance health fund up to 10 billion dollars to assist participating employment-based plans (unions, community organizers, etc.) with the cost of providing health benefits to retirees and to eligible spouses, surviving spouses and dependents of such retirees
Section 294 b-7 Page 91: Government mandates culturally and linguistically appropriate communication and health services for all.
Section 205 a-1 Page 95-96: The Government will etsablish an outreach program to inform, educate, and enroll participants, directed at "vulnerable" populations and to be accomplished in person at "community locations", by mail, telephone, or electronically. Tailor made for ACORN and Americorps.
Section 205 C-3-3 Page 102: If you do not enroll in a "National Health Exchange Plan" and are eligible for Medicaid, you will automatically be enrolled in Medicaid. You have no choice in the matter.
Section 223 f Page 124: There will be no administrative or "judicial review" permitted for payment rates established under the National Health Care Plans.
Section 224 b Page 125: The Secretary shall design and implement the payment mechanisms and policies under this section in a manner that — (1) seeks to (B) reduce health disparities (including racial, ethnic and other disparities).
Section 312 a-4, c-2 Page 145-148: An employer MUST auto-enroll employees into a government approved plan, either the public plan or another plan, unless an employee makes an affiormative decision to opt out.
Seaction 312 b-3 Page 146-147: Employers MUST pay pro-rated healthcare contribution for part-time employees AND their families.
Section 313 b-1 Page 150: Any employer with a payroll of $400K or more, who does not offer the public option, pays an 8% tax on payroll, $350+-400K it is 6%, for over $300+-350K it is 4%, for $250+- 300K it is 2%.
Title IV Amendment to IRS COde Imposes a 2.5% income tax penalty to those individuals opting out, not to exceed what would be the National Average Premium, determined by the Secretary of Health and Welfare.
Section 1233 E & F Page 426-433 Establishes mandatory end-of-life counseling for senior citizens over age 65 every five years, or sooner if bebeficiary becomes ill.
Section 1302 a Page 460-482: Establishes a "Medical Home Pilot Program" for the elderly or "targeted high need beneficiaries" in urban, rural, and served areas. No physician nned be on duty, run by nurse paractitioners and physician assistants. Care for beneficiaries coordinated by a team of individuals at the practice level using "evidence based guidelines" which advocate only the use of medical treatments that are supported by effectiveness research.
more than that, this is what was able to be dug out, seniors are useless to the "progressive" movement...Soylent Green all over again........ with a twist
We already have such places and they are pretty effective in care for helpless elderly people.
There is a stage between the hospital and the hospice or grave that requires maintenance attention but little or no hope for recovery. It can last days or weeks or even years.
Such places are extremely depressing and are populated mostly by elderly women who are completely helpless but are alive. In my experience, they get care that is simply not possible were it not for such a facility
Childless Liberals hit hardest.
Soylent Green IS PEOPLE!
This is insane.
PING
Translation - these will be death camps in which the elderly and disabled will be prepared for becoming the next dose of Soylent Green.
However, there's a nugget of a decent idea in this....90% of (for instance) elder care, doesn't need to have a doc holding everyone's hand. A PA or nurse can handle it, easily.
Same with scratchy throats and runny noses. Kid doesn't need a trip to the ER, just needs someone that knows what they're doing to look in their ears and prescribe an antibiotic.
That's the thing I hate the most about the current healthcare bill. 98% is utter crap. 2% of it might actually do some good. But....rather than "tweaking" the HealthCare system with the good 2%....we need to swallow the whole damned thing. Stupid.
No it’s not insane....IT IS PURE EVIL. If people would do a cursory search of Nazi medical policies ...they should be OUTRAGED.
...see my post #54
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