Psychiatry, It's A Killing.

How CMS Regs For ACOs Fall Flat

2012-02-03T10:01:00.000-08:00

The Heritage Foundation has;

How CMS's Final Regulations for Accountable Care Organizations Fall Flat

By John Hoff
February 1, 2012

Abstract: The Centers for Medicare and Medicaid Services (CMS) has issued final regulations for Accountable Care Organizations (ACOs). The outcome is disappointing: There are marginal changes only; the final regulations retain the same flawed structure set out in the proposed regulations. ACOs remain at the mercy of CMS’s determination of their savings target; its calculation will necessarily contain heavy doses of subjective judgment, leaving CMS with great leeway to favor or disfavor ACOs at its discretion. ACOs—whose creation is mandated by the Patient Protection and Affordable Care Act of 2010—will be a strange hybrid of fee-for-service and managed care, subject to ongoing control by CMS. This is a recipe neither for success nor for true accountability.

The Centers for Medicare and Medicaid Services (CMS) has issued final regulations governing Accountable Care Organizations (ACOs).[1] ACOs are part of the Shared Savings Program—required by the Patient Protection and Affordable Care Act of 2010 (PPACA).[2] The Shared Savings Program is based on the hopeful assumption that if providers join together in ACOs, they can improve the quality and reduce the cost of care for Medicare beneficiaries. ACOs can recover a percentage of the savings they make, in the form of “shared-savings payments” from CMS.

The final regulations maintain the intrusive and baroquely complicated scheme constructed by the originally proposed regulations.[3] While the final rule changes a few details, these do not fix the problems presented by the basic structure of regulatory control that CMS has imposed. It is doubtful that many providers, already skeptical, will be persuaded by these marginal changes to form CMS-sanctioned ACOs.[4]

Hybrid Assignment to ACOs

Under the proposed regulations, CMS would have retrospectively assigned Medicare beneficiaries to ACOs at the end of each year on which the ACOs’ annual performance is judged. Such a retrospective assignment meant that ACOs would have been held accountable for the care of beneficiaries providedbefore these beneficiaries had been assigned.

The final regulations are even more bizarre—a hybrid between retrospective and prospective assignment. CMS will make a preliminary assignment of beneficiaries to ACOs at the beginning of the performance year, based on the most recent data available for the preceding 12 months.[5] Quarterly adjustments are made on the basis of the most recent rolling 12-month period.[6] The only assignment that makes any difference in determining the ACO’s performance, however, will be retrospective, calculated at the end of the performance year.[7] While a beneficiary may, with or without her knowledge, have been assigned to more than one ACO during the course of the performance year, the ACO to which she is finally and retrospectively assigned at the end of the year is accountable for the cost and quality of her care during the full performance year.[8]

This process, CMS explains, constitutes “preliminary prospective assignment methodology with final retrospective reconciliation.”[9] “ACOs will,” the preamble of the final regulations says, “be provided with a list of preliminary prospectively assigned set of beneficiaries that would have historically been assigned and who are likely to be assigned to the ACO in future performance years.”[10] ACOs will have the option of notifying beneficiaries of the “preliminary prospective assignment and quarterly assignment list.”[11] Beneficiaries who receive such a notice will no doubt be puzzled, particularly if they are assigned to different ACOs during the course of the year.

The originally proposed regulations would have assigned a beneficiary to the ACO of the primary care physician who accounted for a plurality of the beneficiary’s charges for primary care during the year. The final regulations aggregate all the charges for primary care provided to the beneficiary by primary care doctors in an ACO. If the charges for a beneficiary’s care delivered by a particular ACO’s primary care providers are greater than those of all primary care providers outside that ACO, the beneficiary is assigned to the ACO with the most charges.[12]

ACO Accountability for Non-ACO Care

The foundational premise of the ACO scheme is that ACOs are accountable for all the care for their assigned beneficiaries. The proposed regulations did not explain how this obligation fits with the right of a beneficiary to consult non-ACO providers. The proposed regulations did not explicitly address whether the ACO is accountable for the cost and quality of care provided by non-ACO doctors—nor do the final regulations. The preamble of the final regulations, however, does address this question: In the context of discussing care received by “snowbirds” (residents of colder climates who reside in Florida during the winter) from providers outside the area of the ACO to which they have been assigned, the preamble states that the ACO is accountable for the care delivered by providers who are not part of the ACO, whether in the same geographical area or not.[13] Judgment on the ACO’s quality of care, CMS says, must reflect care provided by non-ACO doctors.[14] Inconsistently, then, in discussing assignment of beneficiaries in different years, CMS states: “We believe that ACOs should not be held accountable for the costs of patients for whom they are no longer to provide primary care due, for example, to a patient moving out of area during a performance year.”[15]

CMS Censorship of ACO Communications

CMS insists on approving ACO communications to beneficiaries (ostensibly limited to “marketing materials and activities,” but encompassing almost every communication). The final regulation eliminates the proposed requirement that CMS pre-approve ACO communications and replaces it with a file-and-use arrangement.[16] Five business days after submitting them to CMS, an ACO may publish and distribute materials to beneficiaries (if prepared in accordance with any available CMS template) if the ACO “certifies compliance with the applicable marketing requirements” and if CMS does not disapprove the submission during the five-day period. Materials that make it unscathed through the five-day review period are deemed approved, but CMS can un-approve them at any time in the future. ACOs are thus at risk of being found to have made false certifications if CMS claims that the materials do not comply with the regulatory requirements, and their ACO status (and eligibility to earn a Shared Savings Payment) could be terminated. This may cause ACOs to be more cautious in what they say to their beneficiaries than if the materials were subject to CMS pre-approval; prior censorship at least provides certainty. Keeping abreast of changing times, the final regulations include ACO statements made through social media in “marketing materials.”[17]

Provider Participation on ACO Governing Board

The proposed regulations would have required that ACO providers exercise proportionate control of the ACO through representation on the governing board. It was difficult to understand how the interest of a single doctor, for instance, would be proportionately represented. The final regulations introduce a more subjective standard: ACO providers must have “meaningful participation in the composition and control” of the governing body.[18] This gives CMS de facto control over the composition of the ACO’s board.

Many Changes, Few Differences

The final regulations tweak the proposed rules in several ways to slightly reduce the burden on ACOs.

CMS will fund, or be responsible for, conducting patient experience-of-care surveys in 2012 and 2013. In 2014, these surveys become the responsibility of the ACOs.[19]
ACOs are given a choice in their first contract period between a one-sided arrangement (they can receive payments for savings but are not responsible for refunding money to CMS if expenditures exceed the target) and a two-sided arrangement (with the possibility of shared-savings payments and payment to CMS for expenditures above the target). Under the proposed regulations, even an ACO that chose the one-sided track would still have been at risk of repayment of losses in the third year of the contract. The final regulations change: An ACO that signs up for the one-sided model is not obligated to return money to CMS if it does not meet its target for the third year. The final regulations maintain the requirement that the second contract period must be a two-sided arrangement.[20]
The proposed regulations offered various mechanisms to ensure that an ACO pays amounts due CMS as loss recoupment. The final regulations remove one of these mechanisms: CMS will not, as it had previously proposed, withhold 25 percent of any prior shared-savings payments.[21]
There is a “modest” increase in the limits on the amount of shared-savings payments an ACO can receive; elimination of a 2 percent corridor that an ACO had to exceed before it could receive a shared-savings payment; and an extension of the time an ACO has to repay CMS any amount due as a shared loss.[22]
The proposed regulations required that the ACO report, and then be judged on its performance, on 65 quality measures. The final rule reduces the number to 33 measures—but with the promise of more in the future.[23]
The proposed regulations required that at least 50 percent of an ACO’s primary care doctors be “meaningful” users of an electronic health record. This requirement is eliminated; in its place, ACOs are “encouraged to develop a robust EHR [electronic health record] infrastructure.” CMS will give double weighting to a quality measure that is based on the percentage of primary care doctors who qualify for an EHR-incentive payment.[24]

Conclusion

Except for marginal changes, the final CMS regulations for ACOs retain the structure set out in the proposed regulations.

ACOs are at the mercy of CMS’s determination of their savings target; its calculation will necessarily contain heavy doses of subjective judgment, in particular how it makes risk adjustments to reflect the nature of each ACO’s assigned population. CMS will have great leeway to favor or disfavor ACOs at its discretion.

ACOs are subject to intrusive regulatory control of every aspect of their management and operation. In many cases, they remain at risk of being required to make payments to CMS if their costs exceed CMS-imposed targets. They must report to CMS on their use of any shared-savings payments they earn.

Assignment of beneficiaries to ACOs is prospective; revised quarterly; and finally determined on the basis of a retrospective year-end reconciliation. No one knows who is actually assigned to an ACO for purposes of computing savings and determining the quality of the care provided until the relevant year is over. ACOs remain responsible for the cost and quality of care provided to their assigned beneficiaries by doctors whom they do not know and cannot control.

It remains uncertain what incentive ACO providers would have to reduce their Medicare reimbursements. Whether their ACO earns a shared-savings payment depends on the performance of all the providers in the ACO. Even if the ACO is successful, the provider who reduced his Medicare reimbursement would receive a share of the shared-savings payment only at the ACO’s discretion—and the amount he receives may well be less than the savings he effected.

ACOs, as described, are a strange hybrid of fee-for-service and managed care, subject to ongoing control by CMS. Like other hybrids, they are not likely to breed naturally. ACOs are a keystone of the PPACA, but they are unlikely to improve health care and reduce its costs. ACOs are further demonstration, if any is needed, that the PPACA is ill-conceived. CMS-directed change will not bring meaningful reform, but impede it.

—John S. Hoff is a health care lawyer, trustee, and founding board member of the Galen Institute. He served as a Deputy Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services from 2001 to 2005.[25]

Show references in this report

Thank You Heritage Foundation and Mr Hoff

Any Questions? Of course not. This is why we, excuse us, They, ..... Appoint only the best qualified Experts, excuse us, Party Loyalists, to Drive this behemoth of vote buying, confiscatory redistribution.

"Power corrupts. Absolute Power corrupts absolutely."

Lord Acton

And Dr. Seuss will get it All straightened out, excuse us, Implemented, in Her President's second term.

http://psychroaches.blogspot.com/search?q=Seuss

Sen Grassley Tells FDA Commish: "Whistleblowers Are Often Treated Like Skunks At A Picnic"

2012-02-02T10:31:00.000-08:00

Following the the dustup and Lawsuit (here) filed by employees of FDA:

Whistleblowers Expose FDA's Illegal Surveillance Of Employees

Sen. Grassley (R-Iowa) has written to FDA Commissioner Margaret Hamburg.

Which begins; (emphasis ours)

Dear Commissioner Hamburg:

I write to express my concerns over your agency's treatment of whistleblowers as a result of their disclosures to Congress, and specifically my office. Whistleblowers point out fraud, waste and abuse when no one else will, and while they do so while risking their professional careers, they are often treated like skunks at a picnic. Whistleblowers have played a critical role in exposing harmful government actions and retaliation against whistleblowers should never be tolerated. Thus, I am particularly concerned about the treatment of whistleblower P.J. Hardy by the Food and Drug Administration (FDA).

P.J. Hardy is one of 9 FDA physicians and scientists that wrote a letter to the Presidential Transition Team in 2009 advising that, "Managers at CDRH have ignored the law and ordered physicians and scientists to assess medical devices employing unsound evaluation methods " and "ordered, intimidated, and coerced FDA experts to modify scientific evaluations, conclusions and recommendations in violation of the laws, rules, and regulations. A week after that letter was sent I wrote to FDA expressing my concern over such troubling allegations, especially in light of the fact that more than 6 years ago I wrote to the Agency regarding similar allegations at FDA's Center for Drug Evaluation and Research."

There's more. 5 pages worth.

Thanks and a hat tip to Ed at Pharmalot.

Grassley Probes FDA Over Employee Whistleblowers

And Thank You Sen. Grassley

Southern California Hospital Accused of Doctor Retaliation

2012-02-01T07:39:00.000-08:00

Fierce Healthcare has;

Santa Clara Valley Medical Center Accused Of Doc Retaliation

January 31, 2012 — 11:23am ET | By Karen M. Cheung

Santa Clara Valley Medical Center allegedly harassed and forced four cardiologists out of their jobs for exposing patient safety issues that resulted in severe complications and even deaths, according to plaintiffs who are suing the San Jose, Calif., hospital, Mass Device reported.

Echocardiographer Geeta Singh and cardiothoracic surgeon Kai Ihnken, two of the physician defendants, said they had filed patient safety complaints for years but were ignored by hospital officials. When they took their complaints to county officials, the physicians alleged they were harassed, Mass Device noted.

After filing the lawsuit, Singh was moved to a satellite outpatient office, she said.

"The only thing they are allowing me to do is see outpatients. I have lost 90% of my previous job responsibilities. This is retaliation," she told heartwire.

Singh also said she was sexually harassed and filed complaints with Equal Opportunities at the hospital, although the department never investigated. However, she did receive a letter from the County Equal Opportunity Office acknowledging that the former chief of cardiology violated the county policy on sexual harassment, according to the article.

Santa Clara Valley Medical Center also is accused of using the peer review process to force the physicians out.

"It seems, at least at SCVMC, that when they want to get rid of an employee all they have to do is a sham peer HIPAA review," Singh told heartwire.

Ihnken's contract with the hospital was terminated in October 2010, that is, 7 months before it was due to expire.

"I can tell you that each and every patient-related safety issue that was reported was the subject of an investigation, both internally and by an outside entity that was specifically hired to look into those patient-related safety issues," said Gregory Sebastinelli, deputy county counsel for the County of San Jose who represents the defendants.

The Joint Commission in 2010 and 2011 put the medical center on "conditional accreditation" for six months, heartwire reported.

Recent state health department data, however, indicate that Santa Clara Valley Medical Center ranked higher than average in their medical or surgical critical care units with no central-line infections last year, the Bay Area News Group reported last week.

Even more, infection prevention manager Nancy Johnson said Santa Clara Valley Medical Center encourages employees to speak up if they see someone not following safety guidelines.

The lawsuit is scheduled to go to mediation at the end of February. If it is not settled, it will likely move to a jury trial.

For more information:
- here's the heartwire article
- read the Mass Device article
- here's the Bay Area News Group article

Related Articles:
Lawsuit alleges poor care killed patients
HMA ex-employee alleges fraud, sues for wrongful termination
Kaiser transplant exec sues for wrongful termination
Nurses file suit against Beverly Health

Thank You Fierce Healthcare and Ms Cheung

Right; When Medicine Screws up and Consumers Die, medicine Covers up.

http://psychroaches.blogspot.com/2011/05/drunken-incompetent-mds-professional.html

http://psychroaches.blogspot.com/2011/04/drunkenhung-over-physicians-in-surgery.html

When Consumers screw up by Talking to Medicine, they get Paperworked as Incurable, Drugged/Electrocuted, and Die.

Today's Medicine: It's not your Father's Marcus Welby

Whistleblowers Expose FDA's Illegal Surveillance Of Employees

2012-01-31T07:12:00.000-08:00

Whistleblower Protection Blog has;

Whistleblowers Expose FDA's Illegal Surveillance of Employees

Posted on January 30, 2012 by Lindsey Williams

TAKE ACTION!

FDA Spy Program Documents Linked Here

As reported in today's Washington Post, six current and former employees of the Food and Drug Administration (FDA) have filed a complaint against the FDA in U.S. District Court. The employees are seeking an injunction to stop the agency from illegally spying on employees' private communications to Congress and other oversight agencies.

Linked here are key documents related to this lawsuit and the FDA's spying program.

The complaint details how the FDA targeted its employees with a covert spying campaign that lasted for two years. The FDA began the program after learning that the employees wrote a letter to President-Elect Obama and his transition team in early 2009 detailing government misconduct in approving unsafe medical devices. The Agency installed (or activated) spyware on their workplace computers and used other technology that to monitor their password-protected Gmail-to-Gmail communications.

In addition to reading the whistleblowers' emails, the FDA took contemporaneous screen shots of the employees’ computer screens. Managers used the collected information to learn the identities of confidential whistleblowers and to obtain the details of the public health and safety concerns the whistleblowers intended to disclose to the Office of Special Counsel, Congress and the Agency's own Inspector General.

The FDA also intercepted email communications to and from staff members of the House Committee on Energy and Commerce and the Ranking Member of the Senate Finance Committee. These Congressional intercepts are linked here.

The FDA’s prolonged covert monitoring of the whistleblowers continued even after the HHS Office of Inspector General denied the FDA’s request to take any criminal and/or administrative action against the whistleblowers. In their letter of refusal, the OIG explicitly informed the FDA that the whistleblowers' communications to Congress were protected under law.

The managers who spearheaded the surveillance efforts were the same managers involved with the wrongdoing and corruption that the whistleblowers were seeking to report. Lawyers at the FDA and HHS Offices of General Counsel, who should have understood that the program breached the employees’ confidentiality, helped FDA managers with their obstruction and retaliation.

In their lawsuit, six FDA whistleblowers who were fired by the agency (including two highly respected medical doctors, a Branch Chief, a former Health and Safety Officer employed by the Public Health Service and a 23-year FDA career M.D./Ph.D Scientist) are requesting a nationwide injunction prohibiting the federal government from targeting whistleblowers with selected surveillance and monitoring.

The lawsuit alleges that such targeted monitoring of whistleblowers violates their First Amendment rights of freedom of speech and association.

Stephen M. Kohn, NWC Executive Director and attorney for six FDA whistleblowers, issued the following statement:

The FDA declared war on employees who were trying to warn Americans about threats to public health and safety.

The federal government cannot---and should not---spy on whistleblowers. The First Amendment prohibits targeting whistleblowers and selectively monitoring them using highly intrusive electronic surveillance without a warrant.

Targeting the employees who raise health and safety concerns---or who try to report waste, fraud and abuse to the proper authorities---will have a massive chilling effect on employees.

The FDA's illegal spying program is not just a problem for the six victims in this case. The day we allow the government to spy on employees based on their lawful whistleblower activities is the day we give up privacy for every honest public servant in America.

If permitted to stand, the FDA's whistleblower surveillance program will be used by government agencies throughout the United States to silence employees who want to report misconduct. Those who are not silenced will be subjected to years of intrusive covert spying designed to dredge up embarrassing information that the agencies can use to destroy the whistleblowers' reputations and careers.

Today, the NWC issued an Action Alert seeking public support for the FDA whistleblowers and demanding an end to the federal government's targeted and selective surveillance of whistleblowers.

The NWC obtained the intercepted emails as a result of a lawsuit filed under the Freedom of Information Act and from documents produced by the FDA as a result of administrative actions taken against three of the whistleblowers.

Links:

FDA Whistleblower Complaint

Intercepted Emails from FDA Whistleblowers

Letter from the HHS OIG

Support FDA Whistleblowers Page

NWC Action Alert

TAGS: FDA, News, federal employee, osc, whistleblower

Thank You, Whistleblowers Protection Blog

OIG; Barred Physicians Prescribe $15 Million In Drugs

2012-01-04T09:56:00.000-08:00

Fierce Healthcare has;

OIG Barred Physicians Prescribe $15 Million In Drugs

January 3, 2012 — 12:03pm ET | By Alicia Caramenico

The Centers for Medicare & Medicaid Services (CMS) has allowed physicians who are barred from prescribing under Medicare Part D to prescribe more than $15 million worth of drugs, according to the Office of the Inspector General (OIG).

On top of that, CMS accepted nearly $2 million for prescriptions that may have been written by providers excluded from Medicare part D because of past criminal offenses, according to a new OIG audit of prescription drug event data from 2006 through 2008.

Inadequate internal controls enabled excluded providers to prescribe millions of dollars in drug benefits. For example, CMS accepted state license numbers as prescriber identifiers instead of unique national provider identifiers. The agency also failed to establish an edit to reject prescription drug event data written by barred providers.

To recover the $15 million in improper payments, the OIG recommends CMS reopen final payment determinations from 2006 to 2008 and eliminate prescriptions written by providers excluded from Medicare Part D.

In response to the audit, CMS said it began giving monthly Medicare Exclusion Database updates, which include national provider identifiers, to private prescription drug and Medicare Advantage plans in July 2011.

However, OIG urges CMS to ensure the Medicare Exclusion Database includes all of the identifiers associated with every excluded provider in order for private prescription drug and Medicare Advantage plans to accurately identify those providers that have been barred from the program.

To learn more:
- read the OIG report (.pdf)

Thank You Fierce Healthcare and Ms Caramenico

Horse Ranch or Horse Shit? UCSF Citywide Case Management

2012-01-03T13:42:00.000-08:00

Return with us once again to those Golden Days of Yore, (as in Yore American Express Gold Card) where The Marx Brothers met The Invisible Psychiatrists and their Invisible Hospitals, at San Francisco City Hall.

Dr FG Lu and the San Francisco Mental Health Board June 13, 2007

Member of the Public: “Hi, my name is Sheri Erlinson. I’m from the Citywide Case Management Forensic and Forensic Linkage Project. When I came to San Francisco, I was homeless and everything else, you know. And I’ve been in 16 different programs here. I know what they’re all about. The ADUs I’ve been to are very nice programs. I’ve been in San Francisco General Hospital 38 times, and they’ve helped me each time I was there.

Why would they cut this budget down? Because, you know, I’ve even been in jail because they didn't know where to put me. My friends at Citywide Forensic are asking, what are we going to do when they’re going to close General. What are we going to do, you know? And I don't know what to tell them. You know, I’m just a client like they are. They’re just so worried about what happens. What are we going to do next, you know?

There’s going to be a lot of homelessness and then there’s like the pregnancy. I almost had my son in a program. They take care of programs very well and I don’t think they should be closing down General or any of the hospitals, you know. I already know that Davies closed their program now, which I didn't think was right, because I had an ex who used to go to that hospital, and they helped her out very much. I’ve had lots of friends of mine go to these different hospitals. They needed it. And I know they’re overcrowding hospitals and also boarding, ADUs because they’ve got so many people in jail now waiting to get into an ADU. Two to three months waiting. They’re in jail waiting for an ADU for two to three months, and it really just hurts me to see them. Every week someone goes to the judge, and the judge says ‘you can’t go to an ADU because they’re still trying to get the people out of General’. That’s how bad the system is now. What’s going to happen when General completely shuts down to these ADUs? It’s going to be overcrowded and more people are going to go to jail. There’s going to be more people who are homeless. They’re going to be all in the Tenderloin, you know. I’ve been in the Tenderloin. It’s no good. That’s all I have to say.”

[Ed; That’s actually Not all that Ms. Erlinson had to say because just a few minutes later she’s Back to tell everyone how she’d like to think of herself as “Not Just Another Criminal.”]

Dr. Turner: “Any other Board Members want to comment? Let me open this for public comment related to our presentation on the updated report. Are there any members of the public who would like to make a comment? There is a three-minute time limit.”

2.3 Public comment relevant to Item 2.0

Member of the Public: “Hi, my name is Sheri Erlinson. When I first came to San Francisco nine years ago, I didn't have food or housing. I made poor decisions because I didn't have the right psychiatrist or the right meds. I’ve been hospitalized. I got referred to Citywide by SOMA because I’ve been hospitalized too many times in another state. I have not been hospitalized since January – February 2005 because I’ve become stable on my meds.

I pled to a crime that I did not commit in 2004 so I could get out of jail. I got in trouble for violating my probation many times from 2004 to 2006. In May, I got arrested and sent to jail for two months, then I got into Behavioral Health Court (BHC) where I met Monica, my caseworker. I like Behavioral Health Court because they allow me to work on recovery and not as punishment. I can think about myself as a success and not just another criminal.

My goals right now are to become my own payee, to deal with my fears, to have my own housing, and to own a horse therapy ranch for people with mental illnesses. Citywide helps prepare me to do these things. I have been sober for one year, and I have accomplished more goals in my treatment plan this year than the year before. Thank you.”

Dr. Moses: “For the Executive Committee consideration, I’d like to see if we can invite Jeff Adachi, Public Defender, to come and talk about the wonderful program he has in expunging criminal records.”

[Ed: Is Mr Adachi’s program similar to the wonderful Statewide, 14^th Amendment Violating, California Physician Diversion Program (and CSAM) which Expunged the Records of about Half of the drunk, doped up and Incurably Sick in the Head Doctors Ca. had, until 2008 when it snuck off into the night rather than risk being ‘Interviewed and Diagnosed’ yet again as a 6 Time Loser rather than the 5 Previous Audit Failing Loser it already Was?]

see Anderson Cooper @ CNN:

Patients Say Their Surgeon "Butchered" Them

"Five audits of the program since 1982 found all kinds of failures. Even the drug testing of doctors wasn’t random. One auditor told me the doctors could anticipate on which days they’d be drug tested."

Dr. Turner: “Okay, thank you. We’ve got that noted for the record. Any additional things for us to consider? Okay, is there any public comment relevant to this item where we talked about new business? And then there’s going to be another opportunity for public comment about anything before we close.“

4.6 Public Comment to Item 4.0

Member of the Public: Hi, my name is Sheri Erlinson. I am going to be encouraging at Citywide all the patients who do not want PES to close the hospitals and stuff. I will hold a petition and bring it down to you guys and then next Wednesday or Thursday, whenever the public meeting is. I will bring a group of Citywide people.”

Ed; Ms Erlinson “Violated her probation Many times, and pled guilty to a crime she didn’t commit to get out of jail.”

“My goals right now are to become my own payee, to deal with my fears, to have my own housing, and to own a horse therapy ranch for people with mental illnesses. Citywide helps prepare me to do these things.”

And how much Public Money was Citywide contracted for, in the year following this pile of “Horse Therapy” they let Ms Erlinson feed herself?

It’s under Regents UC

Total FY07_08 Contract Amount

$4,778,496

Between 16%-18% of America can’t find a Job because of Waste, Fraud and Abuse of Tax Payer dollars by feel good Bloat like UCSF’s Citywide Case Management.

Where were the unemployment numbers Before our Current, Glorious President’s Debt Ballooning, “We Need a Government Takeover to Help Our Own” Compassionatarians took over both Houses of Congress?

US Dept of Labor yearly unemployment averages

Ms Erlinson had an actual Snowball’s Chance in Hell of ever owning a “Horse Therapy Ranch for People with ‘Mental Illness” (what Ever That is) and the Grifters at UCSF’s Citywide knew it, Unless of course Federal, State, & Local Governments created even More unemployment by raising taxes yet again to Buy her that Horse Ranch. (The way Sacramento's Special Interest owned Grifters Raised Taxes in Nov 2004 to buy More Piles of Horse Therapy: see Prop 63)

http://www.dmh.ca.gov/prop_63/mhsa/docs/Mental_Health_Services_Act_Full_Text.pdf

Prop MHSA/63 imposed a 1% Tax on Million Dollar Incomes. It was projected to take in $750 Million to ‘Diagnose’ & ‘Treat’ up to 2.9 Million Californians to a Serious ‘Mentally Ill’. At 2.5 Million that’s $300 per head per year. MHSA/Prop 63 also postures about Stigmatization of those 2.5 million, by the remaining 34.5 Million Californians.

$750 Million would provide a whopping $21.74 per head to Stigma Police those 34.5 Million potential Stigmatizers through all 365 days of potential Stigmatizing, with ZERO left over for Diagnosis & Treatment of the prime 2.5 Million Stigma Targets being sold a Serious “Mentally Ill.”

So what Happened with this thinly disguised Initiative?

Dr. Bob Cabaj’s CBHS has a Directors Report from Sept 10, 2008:

We Quote, bottom of pg 2 & top of pg 3

5. Mental Health Service Act (MHSA)

MHSA IN THE NEWS

“Rose King, a former member of the drafting committee of the original ballot measure

Proposition 63, has leveled some sharp criticism in the way the Mental Health Services Act

Has been, in her opinion, mishandled by the Department of Mental Health after its first four years following its passage (“Mental Health Act Doomed by Initiative Origin” – The Sacramento Bee, August 11, 2008). She blames the State for sitting on $3.2 Billion in new revenue while only $726 Million have been distributed to the counties due mainly to a “complicated, expensive and unnecessary bureaucracy invented by the DMH.” The other major ailment of the MHSA is “the DMH policy creating a two-tier mental health system, giving priority to funding new programs rather than improving the existing system,” according to Ms. King.”

And Ms. King never saw it coming. $300 per head to involve her Opinion in 37 Million Californian’s lives through Penalizing California’s Job Creating Millionaires.

And (2007-2008) at pg 4 paragraph 2 of;

http://argosysf.tripod.com/SFUSDbroch0708.pdf.

We find Prop 63’s Mission Objective being Redefined, ….. Right, ….. Out of the closet.

MENTAL HEALTH SERVICE ACT

Mental Health Service Act (Prop 63) Stipend Program Internship

….. A key objective of the MHSA is to increase the quantity and quality of trained persons available for employment in the public mental health system and encouraging development of a diverse workforce. Toward this aim, California’s Department of Mental Health has partnered with the California Social Work Education Center (CalSWEC) to establish competitive stipend program for graduate students enrolled in schools of Social Work across the UC system.

UCSF Citywide was contracted with Another $4,778,496 in FY07_08, ….. After, … it had Already Bought that pile of Horse Therapy it fed to just another criminal who Violated her Probation Many Times and was ‘Treated’ at SF General Hospital 38 times while being shuffled through 16 Programs, after being “Hospitalized too many times in another State”.

And how does one get “Hospitalized Too Many Times in Another State”?

Did that other State ask her to Leave because she used up her ‘Mental Illness’ Get out of Jail Free Cards?”

Or did perhaps Ms Erlinson also Violate her Probation Many Times in that other State to the point of that other State issuing a bench warrant to pick her up?

IF we knew what the Names of All of her 16 SF Programs were:

RAMS: Cultural Crapulence In San Francisco

along with all the SF General/Govt. Owned Hospital visit Behavioral, Mystic Psy-ence BILL padding added on, Ms Erlinson’s ‘Treatment’ probably cost more than Lee Majors himself, ….. as the $6 Million Dollar Man.

Just another criminal. And Who is Paying all those Other Public Money Mooches who would also like to think of themselves as “A success, rather than just another Social Justice peddling Judge Dredd?

I AM The Law! A Paramedic Has Them Locked Up

And the Content of Ms Erlinson’s 16 ‘Integrated’ Programs is?

San Francisco’s DBT: COMMUNISM, SWALLOW IT.

Any questions about Why 38 trips to SF General Hospital and 16 Programs completely failed to ‘Cure’ her?

I’ve been in San Francisco General Hospital 38 times, and they’ve helped me each time I was there.

SF General ‘Helped Her’ to do What? Give her 38 More ‘Dual Diagnosed’ ZiaLogic, Medicare and MediCal wasting excuses to keep her Out of Jail?

Now; The Purpose of City Hall’s having Ms Erlinson on board to enter Her remarks into the record becomes a question of tantamount importance.

Was she there commenting:

A: To illustrate how vitally important the “Important Work We’re Doing” to quote Dr Bob Cabaj, was?

Aa: And if so, must we assume that that “Doing” was to Illustrate that all of those Millions of everyone Else’s Money was a Life’s Blood/Funding Grubbing Therapeutic, “Important”?

B: Because she just Wandered in off the Street (or was delivered by SFFD EMS enroute to her 39^th visit to SF General Hospital).

Ba: Her turning up impromptu isn’t bloody likely, but we wouldn’t put BILLING the City for Ambulance delivery past them. Then again, the Fire Commission Minutes from August 9, 2007 don’t show the SFFD running into any parked cars in front of City Hall on June 13, 2007, but Unit E21 did hit a parked motorcycle (and unfortunately they didn’t divulge the address).

Now if you find it inconceivable that an E21 for Engine/Fire Truck could be involved; In SF at closing time, …… 1, Single, thrown fist in a nightclub Has summoned, as SOP, between 7-9 Police Cruisers, a Big Box Ambulance, … AND, …. A Full, Fire Truck. That's right: 2 Drivers: 1 on the back to steer the truck's rear wheels.

San Francisco Fire Commission Minutes from August 9, 2007

c. Accidents

Unit	Incident #	Date	Vehicle	Description
AP	607154	5/6/2007	725-093	While backing up, Rescue 93 struck a parked Police car.
AP3	607155	5/19/2007	725-084	While driving through an automated car wash, the light bar on Rescue 49 was damaged.
M19	708004	5/22/2007	145755	While driving, Medic 19 made struck a parked school bus.
M17	607157	5/27/2007	145743	While parked at General Hospital, Medic 17 was struck by a vehicle which left the scene.
T14	607158	5/29/2007	145611	While driving forward and turning right, Truck 14 hit a parked car.
M11	607159	5/31/2007	145749	While backing into quarters, Medic 11 struck apparatus door.
E22	607160	6/1/2007	145504	While proceeding forward to clear a driveway, Engine 22 struck a parked car.
M93	607153	6/5/2007	145720	While backing into a parking space without a spotter, Medic 93 came into contact with another vehicle.
T13	607166	6/5/2007	145621	While backing into quarters with spotters posted, T-13 misjudged clearance and struck a pole.
M39	607161	6/6/2007	145753	While parked at a medical incident, M39 was backed into.
E21	607167	6/13/2007	145526	While responding Code 3 and turning right, E21 struck a parked motorcycle.
D2	607162	6/15/2007	145378	While parked at an incident, Division 2 was struck by another vehicle.
M38	607164	6/21/2007	145744	While waiting to turn right, Medic 38 was struck by another vehicle.
M78	607168	6/23/2007	145748	While exiting from hospital and turning left, Medic 78 struck a pillar.
T10	607170	6/26/2007	145613	While responding Code 3, driver allowed Truck 10 to roll into another vehicle.
MP2	607169	6/28/2007	145807	While moving into position at a grass fire, Mini-pumper 43 struck a road stanchion.
FP	708003	6/28/2007	1459021	While waiting to proceed forward, BFP unit was struck from behind by a vehicle.
E11	607171	6/29/2007	145545	While proceeding downhill at 23rd Street, Engine 11 bottomed out causing front end damage.
M61	708001	6/30/2007	145731	While backing into San Francisco General hospital, Medic 61 stuck a patrol car.
E25	708005	7/4/2007	145537	While making a tight right turn, Engine 25 struck a parked vehicle.
E43	708008	7/5/2007	145554	While pulling over to allow Mini-pumper 43 to pass, Engine 43 struck a parked vehicle.
E24	708002	7/6/2007	145597	While traveling on Burnett Street, Engine 24 struck a parked car.
M64	708009	7/6/2007	145742	While traveling on Polk Street, Medic 64's mirror was struck and broken by a passing tour bus.
M65	708007	7/11/2007	145754	While traveling westbound through the Broadway Tunnel, driver of Medic 65 drifted into curb.

C: Because the SFMHB wanted to Illustrate that there truly Are such entities as the ‘Mentally Ill’? If That was their purpose they’ve succeeded beyond their wildest dreams, because AT THAT MEETING the percentages are 100% with Everybody in the Room being stricken Deaf, Dumb, or just plain NUTZ when Dr FG Lu made 2 hospitals and their staffs, non-exist.

Ca: Or, that her comments Illustrate that this entire Money Grubbing Skit owns a Shaky factor to rival the Loma Prieta earthquake.

Why would they cut this budget down?

Because we’re $15 Trillion in Debt and almost 1 of every 5 Americans are out of work from being Swindled for Decades to Feed this Socialist BLOAT and others like it infesting Every hamlet in America.

The next time, and Every time thereafter, you see ‘Behavioral Health’, ‘Investing in Preventative Medicine Saves Taxpayer Money’, ‘Life Counseling’, or anything even Resembling ‘Mental Health’, ….. Call and Mail your Congressman and Senators This Post, ….. and ask them When they’re going to shut down this Pile of,

Parting Thoughts:

You Might also want to have another look at Mr Mark Shurtleff’s – Attorney General of the State of Utah – gripes with yet 2 More contestants in this Day At The Races, ...... for Money belonging to your Grandchildren that they haven't even earned yet.

State of Utah v J&J/Janssen/Risperdal and AstraZeneca/Seroquel

Medicaid Fraud Watchdogs Under Fire At House Hearings

2011-12-29T14:35:00.000-08:00

Fierce Government has;

Medicaid Fraud Watchdogs Under Fire At House Hearing

December 13, 2011 — 12:31pm ET | By Molly Bernhart Walker

Medicaid issued $21.9 billion in improper payments in fiscal 2011, but the program's improper payment rate of 8.1 percent in fiscal 2011 was still an improvement from the 9.4 percent improper payment rate in fiscal 2010, according to a Centers for Medicare and Medicaid Services official. Angela Brice-Smith, director of CMS's Medicaid integrity program, was one of several oversight officials who faced sharp criticism from lawmakers Dec. 7, at a House Oversight and Government Reform joint subcommittee hearing.

"That's really nice; but what I'm trying to tell you is that your normal is not good enough," Rep. Elijah Cummings (D-Md.) told the panel.

Gary Cantrell, assistant inspector general for investigations within the Health and Human Services Department, said fiscal 2011 Medicaid fraud enforcement efforts set records across the board with over 400 criminal convictions and $1.1 billion in expected recoveries.

But lawmakers were unimpressed with Brice-Smith and Cantrell's testimony before the government organization, efficiency and financial management subcommittee and the healthcare, District of Columbia and National Archives subcommittee.

Rep. Paul Gosar (R-Ariz.) asked them to grade themselves on their performance policing Medicaid waste, fraud and abuse. Brice-Smith responded by giving herself a C, "in light of the youngness of our program." Cantrell gave himself a B, to which Gosar shot back, "On behalf of the American people and I doubt that they would give you above a D. Don't you agree with me? I think so."

Lawmakers said they were frustrated with the slow pace of progress to reduce improper payments, especially in light of increased funding to oversight programs under the Affordable Care Act.

Cantrell's office hired close to 100 new investigators with funding provided under the law. Brice-Smith said that with or without the law improper payments will continue to be an issue. A repeal of the law, however, would affect the growth and expansion of oversight programs, she said.

For more:
- go to the hearing page (included prepared testimonies and archived video)

Thank You FierceGovernment and Ms Walker.

CMS Inaction Leaves System Holes For Fraud, Abuse

2011-12-29T13:30:00.000-08:00

Fierce Healthcare has;

CMS Inaction Leaves System Holes For Fraud, Abuse

December 19, 2011 — 12:34pm ET | By Karen M. Cheung

The Centers for Medicare & Medicaid Services (CMS) has been slow to respond to contractor-identified weaknesses in the system that allow for fraud, waste and abuse, according to a report by the Office of Inspector General (OIG), issued Friday. CMS needs to take prompt action to fix potential leaks in the system, the OIG recommended.

As of January, CMS has not resolved or taken action on more than three-fourths (77 percent) of identified vulnerabilities--mostly having to do with coding/billing and provider identifiers--reported by Program Safeguard Contractors, Zone Program Integrity Contractors and Medicare Drug Integrity Contractors in 2009. Out of the 62 vulnerabilities, CMS has not resolved 48 of them, according to the OIG report. CMS said 20 of them are "currently under review," and three require more analysis. OIG determined that CMS either didn't take action or took insufficient action in the remaining 25 identified weaknesses, but the federal agency did take action on 14 of the total 62 potential vulnerabilities.

CMS' inaction on these vulnerabilities could cost $1.2 billion, according to contractors who reported the financial impact for only a third of the vulnerabilities.

"Because monetary impact was reported inconsistently or not at all, the actual monetary impact of the vulnerabilities reported in 2009 could be significantly greater than $1.2 billion," the OIG report states.

CMS noted that it's labor intensive for contractors to determine the dollars at risk for all vulnerabilities and not all vulnerabilities have a monetary impact.

Although CMS has started to develop procedures to consistently track and review vulnerabilities, it still lacks procedures to ensure they are resolved, according to OIG. Contractors have been submitting vulnerability reports for several years, but CMS did not begin developing procedures until June 2010.

CMS stated that it continues to actively manage reported vulnerability on a monthly basis and that it can establish time frames for resolution on a case-by-case basis.

To learn more:
- here's the OIG press release
- read the OIG report (.pdf)

Related Articles:
Feds' $5.6B fraud collection hits record high
Hospitals worried about Medicare RAC prepayment audits
Gov't saves $17.6B in waste and errors, launches new fraud preventions
CMS struggles to monitor Medicare contractors due to inaccurate data
Feds triple recovered money from Medicaid scams

Thank You Fierce Healthcare and Ms Cheung

But don't you Worry about CMS, because It's Been Fixed, (as the Congressional Fix Is In for Pfizer and J&J) by our Glorious President his very own self, who has never run a business nor met a payroll his Very Own Self.

Obama Taps Dr. Seuss To Run CMS

YessireeBob, we have Top People on the case, ...... only the Very finest. And we're Certain that Our Glorious President's Dr. Seuss can STOP all this Medicare FRAUD from inside CMS with just a single serving of her "Green Eggs and Ham" investigatory expertise.

She Ought to know how to Stop the FRAUD, ....... having worked for a company that Committed so much of the FRAUD.

photo cred of Jim Grinch Carry to Universal Pictures

"As of January, CMS has not resolved or taken action on more than three-fourths (77 percent) of identified vulnerabilities"

And you Wonder why we're $15 Trillion in debt.

Shell Companies Steal Millions In Medicare Fraud

2011-12-28T14:12:00.000-08:00

FierceHealthcare has;

Shell Companies Steal Millions In Medicare Fraud

December 22, 2011 — 1:10pm ET | By Karen M. Cheung

"Shell companies--sham firms on paper with no real operations--are a prime tool for fraudsters to scam Medicare out of millions of dollars, according to a Reuters investigation. Medicare's current pay-and-chase system has holes that allow providers (or imposter providers) to bill Medicare for services and then steal millions of dollars from the federal health program.

For instance, Florida authorities charged Michel De Jesus Huarte for his role in setting up fake AIDS clinics in Florida, but not before he billed Medicare for more than $4.5 million and formed at least 29 other shell companies in Florida, Georgia, Louisiana, North Carolina and South Carolina, Reuters reports. Huarte and co-conspirators formed clinics purported to treat HIV and AIDS patients and submitted claims for expensive drugs such as Infliximab and Rituxan, costing Medicare as much as $7,800 per dose.

"This is a 'Catch Me If You Can' environment," said Ryan K. Stumphauzer, a former assistant U.S. attorney with the Department of Justice in Miami who prosecuted Huarte. "We had no clue who Huarte was. We had no idea there was some mastermind out there."

The strategy of shell companies can go unnoticed for years. Scam artists use fake names and addresses for corporations or real information from others. In Florida, Federal Bureau of Investigation agents said almost every Medicare fraud case involved a shell company.

Florida, where the fake AIDS clinic scheme took place, is one of five states that tops the list for the most Medicaid fraud activity, according to a recent Office of Inspector General report issued in October; the other states are New York, Texas, California and Ohio.

The Centers for Medicare & Medicaid Services (CMS) last month announced that hospitals soon will be subject to prepayment audits, with aims to fix the traditional pay-and-chase method. Effective January 2012, Medicare recovery audit contractors (RAC) in 11 states will conduct reviews of inpatient claims before payment. Those states will be areas that have high fraud and error-prone providers (Florida, California, Michigan, Texas, New York, Louisiana and Illinois), as well as those states with high claims volumes of short hospital stays (Pennsylvania, Ohio, North Carolina and Montana).

Although the government has expanded its Medicare Strike Force with increased focus on acute-care and critical access hospitals, senators this week are pushing for better assessment of Medicare fraud detection.

CMS plans to launch a new predictive modeling program nationwide this summer, in which the analysis tool will flag common patterns of Medicare fraud, such as suspicious billing patterns or a great distance between the hospital where treatment occurred and the claimant's home address, reports Nextgov.

Senate Federal Financial Management Subcommittee Chairman Tom Carper (D-Del.), Ranking Member Scott Brown (R-Mass.) and Senator Tom Coburn (R-Okla.) on Tuesday requested CMS outline its plans to launch the predictive analytics technology and stated that CMS may not have sufficient metrics and processes in place as part of a comprehensive plan to ensure the success of identifying and preventing fraud.

For more information:
- read the press release on Huarte's charges
- read the Reuters article
- read the Nextgov article
- here's the Senate press release

Related Articles:
CMS inaction leaves system holes for fraud, abuse
Gov't recovers record-high $2.8B in whistleblower fraud cases
Home health owners plead guilty to $1M Medicare fraud
Feds' $5.6B fraud collection hits record high
Hospitals worried about Medicare RAC prepayment audits

Thank You Fierce Healthcare and Ms Cheung

And California made the list.

We´re Shocked, I tell you. Shocked and Amazed. Simply Shocked: when San Francisco blew $200 Million in 1 year dispensing Opinions of Mystic, Dual Diagnosed Incurables, .....

under the watchful eye of a Chief Psychiatrist, Dr Francis G Lu, who actually believes that his Movie Reviews, and disappearing brick and mortar Hospitals non staffed by non-existent Psychiatric Psychiatrists, qualify him to tell the world, ..... that he's an Illuminati.

You Might want to contrast San Francisco's $200 Million epidemic of Disease Mongering with the State of Illinois carping that it couldn't Afford to Investigate 85% of the Complaints it got, about Hospitals, ...... because it could only scrape up, ..... even WITH matching Federal Funds, ..... just under a $Half Million.

State Rarely Investigates Hospital Complaints

Fierce Healthcare has;

State Rarely Investigates Hospital Complaints

November 9, 2011 — 12:46pm ET | By Karen M. Cheung

"Due to limited state funds, the Illinois Department of Public Health declined to investigate 85 percent of the 560 hospital complaints it received last year, reported the Chicago Tribune this week. Some of the complaints included reports of serious patient abuse and poor infection control, according to the article.
"These are serious complaints," said Lisa McGiffert, director of the national Consumers Union Safe Patient Project. "If the regulatory system is collecting these complaints and not responding, that is a massive failure of oversight."
The state in 2010 spent $498,000 on hospital oversight with half the funds coming from the federal government and the other half from the state. Article

Thank You Fierce Healthcare and Ms Cheung.

Does anyone still have a problem spelling Protectionist?

Congressman Ron Paul Fights MANDATORY Mental Health Screening of Children

2011-12-15T11:37:00.000-08:00

Congressman and Presidential Candidate Ron Paul has;

No Mandatory Mental Health Screening For Children!

"Maryanne Godboldo, a mother in Michigan, noticed that pills prescribed by her daughter's doctor were making her condition worse, not better. So Mrs. Godboldo stopped giving them to her. That's when the trouble began. When Child Protective Services (CPS) bureaucrats became aware that the girl was not receiving her prescribed medication, they decided the child should be taken away from her mother's custody on grounds of medical neglect. When Ms. Godboldo refused to surrender her daughter to the state, CPS enlisted the help of a police SWAT team! On March 24 of this year a 12 hour standoff ensued and young Ariana was taken into custody. The drug involved was Risperdal, a neuroleptic antipsychotic medication with numerous known side effects. Ms. Godboldo had decided on a more holistic approach for her daughter. She is still engaged in a costly legal battle with the state over Ariana's treatment and custody.

This is one example of how government's increasing proclivity to medicate children with questionable psychiatric drugs violates the rights of parents. Just recently, the Government Accountability Office released a report on the astonishingly high rate of prescriptions for psychotropic drugs for children in the foster care system. It is absolutely astounding that nearly 40% of kids in foster care are on psychotropic drugs, some of them taking up to 5 different pills at a time. Some of these children are under one year of age - too young to safely take over the counter cold medication!

To fight this dangerous trend I reintroduced the Parental Consent Act of 2011, HR 2769, which prohibits federal funds from being used to establish or implement any universal or mandatory mental health or psychiatric screening program. The previous administration pushed hard for this type of federal intrusion into the medical decisions of families through its wildly misnamed "New Freedom Commission on Mental Health." Everyone interested in parental rights and true health freedom must fight to make sure the commission's findings and dubious psychiatric science are never used as justification to force mental health screening on American kids at school without their parents' consent.

There has been a persistent lobbying effort, funded by pharmaceutical companies, to increase the number of these prescriptions to even more children. A universal screening program is the stated goal of these lobbyists. I would not be at all surprised to see the recent attention to the issue of schoolyard bullying used as a tool towards these ends.

Imagine the potential ramifications of a universal, mandatory psychiatric health screening program in a public school, considering how some bureaucrats are wont to behave! The diagnostic criteria for many mental illnesses remain vague and subjective. Therefore it is all too easy for a bureaucrat in a white coat to label a child with some sort of psychiatric syndrome simply because they were having a bad day, or behaving as a typical rambunctious child. That label could follow them around the rest of their school career and come with a number of prescriptions attached, which the state, as in the Godboldo case, may try to force the parents to administer, whether they want to or not.

I plan to continue the fight to ban federal funding of any universal screening program that imposes mental healthcare screening on children without express informed consent from parents.

Thank You Congressman Paul

In San Francisco They're After EVERY Child.

There's only one choice in this election. America is a Constitutional Republic. Not a Democracy, and Not an Empire.

It's time to put America Through its Constitution back onto its feet.

Off Topic: Anyone But Romney in 2012

2011-12-14T11:24:00.000-08:00

Someone at Fox News is to be commended.

Medical Freedom Zones

2011-12-14T10:17:00.000-08:00

The problem with Psychiatry, aside from the fact that it's a FRAUD which Can't be fixed and shouldn't even Exist, is Government redistributing everyone Else's money. If those bowls of everyone Else's money weren't out on the table to begin with, the Psychiatric dispensers/inflictors of Political Illnesses wouldn't be scrambling to snatch up that money.

And since the Devil Invariably lurks in the Details, let's have another look at Why Government Healthcare Itself is a rotten idea.

MichiganCapitolConfidential has;

Medical Freedom Zones

Medical Freedom Zones

By JACK MCHUGH | Dec. 6, 2011

America’s health care system is a dysfunctional mess for a fundamental reason: There is no real market in health care. It was wrecked by a combination of incentive-skewing federal tax policies, innovation-killing “fee for service” payment systems in the two federal programs that pay for practically half of all health care consumed (Medicare and Medicaid), restrictive state policies that create limited cartels of health care professionals and facilities (reducing supply and so increasing price), and more.

It all seems a hopeless quagmire, in part because instead of going to the root cause of the dyfunctions to find solutions, politicians have instead “doubled down” on market-killing policies, most recently with the monumentally destructive Obamacare law, which comes on top of innumerable other counter-productive government intrusions enacted on a bipartisan basis at both the state and federal levels.

An interesting proposal from a Mackinac Center sister-think tank in Wyoming seeks to cut this Gordian knot of perverse incentives and pernicious restrictions with something called “medical freedom zones”: a “legally recognized geographic area where health care professionals may provide services and conduct research governed by professional associations and private contracts.”

Here’s more from the paper on the idea authored by the Wyoming Liberty Group:

Both the federal and state governments hamper doctors’ ability to innovate in medicine and to offer more affordable or alternative care. While the federal government delays innovative medicine, state governments make affordable care more difficult by limiting the number of doctors and saddling those who do practice with difficult liability rules. Similarly, the ability of care providers and patients to fashion their own agreements governing medical procedures is entirely hamstrung through state regulation. The result? More than 500,000 Americans fled the United States in 2008 for medical tourism. The time for innovative reform is now.

Alas, even this creative solution cannot get to the root of the problem, because the “freedom zones” don’t fix the two “original sins” primarily responsible for wrecking health care, and which can only be fixed in Washington: Allowing unlimited employer tax deductions for the cost of employee health insurance, and Medicare and Medicaid’s “fee for service” payment model.

The first of these, the tax code, is responsible for the third-party payment system under which, unlike areas where markets truly exist, consumers don’t behave like frugal, prudent value seekers, and providers aren’t forced by competition to respond by becoming innovative, efficiency-generating value-maximizers. The second source of the dysfunctions, Medicare and Medicaid’s payment system, imposes price controls in a way that mostly takes away any reward for providers reducing costs through innovation, destroying the incentive for them to even try.

Fix those two things, and our health care delivery system can finally begin to heal itself by becoming a real market. Leave them untouched, or worse yet pile a huge new layer of regulation, subsidy and rationing on top of them (Obamacare), and no fundamental improvement can ever be expected to occur in our health care system.

It’s in our hands to make this right — but this requires forcing the politicians in Washington to undo these core sources of dysfunction. If they did, medical freedom zones could have the potential to accelerate the healing process for our health care system.

Thank you MichiganCapitolConfidential and Mr McHugh

And if you think Psychiatry can even Be fixed, we refer you back to Professor Frederick Crews masterful deconstruction of the FRAUD of Psychoanalysis:

http://psychroaches.blogspot.com/search/label/Crews

ObamaCare Insurance Exchanges Graded "F"

2011-12-12T09:15:00.000-08:00

Andrew Breitbart's BIG GOVERNMENT has;

Independent Study:ObamaCare Health Insurance Exchanges Get A Grade of 'F'

by Dr. Susan BerryThe independent Mercatus Center at George Mason University has given a grade of “F” to the ObamaCare Health Insurance Exchanges regulation. The center studies the anticipated results and economic effects of proposed regulations. In other words, their researchers evaluate whether regulations are likely to accomplish what their supporters say they will.

The Mercatus center delivered its “Regulatory Report Card” on the Health Insurance Exchanges, the set of rules that states will use to set up online health insurance marketplaces. These virtual marketplaces will allow individuals and small employers to compare available private health insurance options on the basis of price, quality, and other factors. The Exchanges, which are scheduled to be in effect by January 1, 2014, are, next to the individual mandate upon which ObamaCare is based, crucialto the law’s ability to achieve its stated goal of expanding access to health insurance to the currently uninsured. Ultimately, they will be used to distribute $460 billion in federal health subsidies, through the year 2019.

The Health Insurance Exchanges regulation received only 42% of potential points (25 out of 60) on the Mercatus “Report Card.” The score of 25 points is the second lowest score the Mercatus Center has issued for 2011 regulations. The Exchanges were measured according to 12 criteria covering three broad categories: Openness, Analysis and Use. For each criterion, the researchers assign a score ranging from 0 to 5, with “5″ being the highest score on any given criterion. Some of the highlights are below:

In the Openness category, ObamaCare’s Exchanges received the lowest score of “2″ on the ease with which someone could find the regulation online. Verifiability of the assumptions used in the regulation’s analysis and the data used to support it were both given scores of “3,” with comments that the regulation relies heavily upon analyses performed by agencies such as the Congressional Budget Office (CBO). The regulation received a score of “4″ on its ability to be understood by an informed layperson. Interestingly, the researchers comment that the Health Insurance Exchanges regulation is “light reading” for someone who is “informed,” but due, in part, to the fact that there is little detail provided. However, as we have come to discover in ObamaCare, the devil is, indeed, in the details.

In the category of Analysis, the regulation received an overall score of “3″ on the criterion measuring how well the analysis behind the rule identifies desired outcomes and demonstrates that the regulation will, in fact, achieve them. HIgh and low points: a score of “5″ for the criterion reflecting whether the regulation’s analysis clearly identified outcomes that affect citizens’ quality of life, i.e., the intention to improve public health, to improve financial security of citizens, etc., but a score of “2,” for the criterion which measures whether the regulation’s analysis presents “credible empirical support for the theory” behind it. The study highlights that, in writing the rule for the Exchanges, the Department of Health and Human Services (DHHS) based evidence for its anticipated success on evaluation of an expansion of a 2008 Medicaid program, through a lottery, in Oregon, and a 2002 Institute of Medicine report that found that having health insurance improves health outcomes. Are we surprised that a far-reaching law like ObamaCare is based on two dinky studies?

On the criterion of how well the Exchanges rule analysis assesses the effectiveness of alternative approaches to addressing the needs of the uninsured, the overall score was “2,” with a subscore of “1″ given for the issue of whether the regulation addresses other methods, besides federal intervention, to fix the same problem. In other words, tort reform, competition among insurance companies across state lines, and other free market solutions were not even considered. No surprise again.

The ObamaCare Exchanges received an overall score of “2″ on the criterion of how well the regulation’s analysis assessed costs and benefits, with a “0″ given for the regulation’s ability to identify the cost-effectiveness of alternatives presented.

In the Use category, the regulation fared extremely poorly, with a “0″ score given for DHHS’s failure to indicate which data it will use to evaluate the regulation’s performance in the future. As we have come to discover with ObamaCare, DHHS will likely not evaluate whether the Health Insurance Exchanges work.

According to The Washington Post, about a third of the states have not progressed in setting up ObamaCare’s state-based health exchanges. Several states- Florida, Louisiana, and Kansas- have decided not to set up the exchanges at all, an interesting dilemma for the Obama administration. AsReason.com points out, if a state does not participate in ObamaCare, the federal government will have to move in and set it up, a situation which will give further credibility to the notion that the federal government is taking over healthcare.

Two other sticky problems with the exchanges: first, the federal government has no funds set aside to set up the health insurance exchanges in the states. Second, ObamaCare allows insurance subsidies to be given to those who purchase insurance through the “state-run” exchanges, so those in states that oppose ObamaCare will end up with the requirement to purchase health insurance, but no subsidies from the federal government.

Finally, the Mercatus Center evaluators note that the ObamaCare Health Insurance Exchanges rule expends “no effort to determine who ultimately bears burdens (taxpayers, consumers or producers). The implicit assumption appears to be that all citizens gain (lower insurance premiums, better public health), but this is never directly stated.”

Of course, we now know that the “assumption” is nothing more than a fantasy. Last summer, Medicare actuary Richard Foster told us the truth about ObamaCare: the president’s signature legislation will triple the growth rate of net insurance costs. That’s an “F” in any book.