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Tag Archives: Policy

Charity Care Tax Exemptions

Was talking with a colleague about health care reform this weekend and an interesting question came up. If exemption from federal income and/or state property taxes for non-profit hospitals is based upon providing “charity care” to their surrounding communities, how will hospitals qualify for income tax and property tax exemptions if health care coverage becomes “universal” and there is no longer a need for “charity care”? With declining revenues, requiring hospitals to pay income and property taxes would probably bankrupt some smaller institutions and inner-city hospitals. We weren’t the first ones to consider the issue – a good discussion is here. Still, there aren’t any answers out there.

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Highlights from the Health Reform Bill

These highlights were sent to me in an e-mail. I have not read the entire bill. However, I did check some of the highlights against the text of America’s Affordable Health Choices Act of 2009 (H.R. 3200) and they are generally on point, although some of the commentary isn’t entirely accurate. As one example, the Advance Care Planning Consultation in Section 1233 does not permit the government to “order” your end of life care, but only requires that a physician discuss the matter with a patient and denote the patient’s preferences (Section 1233(a)(hhh)(5)(A)(ii). However, the government does plan to establish a “quality reporting initiative” for end of life care that will essentially coerce physicians into doing what the government wants under the threat of being deemed a “low quality provider” if the physician does not comply. If the government states that “quality care” for end of life involves removing life support on patients that show no improvement after 72 hours, any physician that keeps comatose patients on life support longer than 72 hours will get quality “demerits” from the government. The government may then use those demerits to dock the physician’s pay or to post the physician’s name as providing “low quality” end of life care on some web site. Think about a tremendous database of physicians similar to the “HospitalCompare.gov” web site now. Because of Hospital Compare, hospital administrators strive to be at 100% “quality” even though “good” care may sometimes cause excessive costs without benefit, may be more likely to misdiagnoses and wrong treatments (I commented on this issue previously and the link to the actual article on a government website mysteriously went bad), or may even be more likely to contribute to patient deaths. Draw your own conclusions after reading the sections in the bill. Commentary (from unknown source) is contained below. ————– • Page 22: Mandates audits of all employers that self-insure! (Section 142(b)) • Page 29: Admission: your health care will be rationed! • Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process) • Page 42: The “Health Choices Commissioner” will decide health benefits for you. You will have no choice. None. • Page 50: All non-US citizens, legal or not, will be provided with free health care services. • Page 58: Every person will be issued a National ID Healthcard. (Section 163(a) – not entirely accurate – potential action, not mandatory) • Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer. (Section 163(a) – not entirely accurate – potential solution, not mandatory) • Page 65: Taxpayers will subsidize all union retiree and community organizer health plans (read: SEIU, UAW and ACORN) • Page 72: All private healthcare plans must conform to government rules to participate in a Healthcare Exchange. • Page 84: All private healthcare plans must participate in the Healthcare Exchange (i.e., total government control of private plans) • Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens • Page 95: The Government will pay ACORN and Americorps to sign up individuals for Government-run Health Care plan. • Page 102: Those eligible for Medicaid will be automatically enrolled: you have no choice in the matter. (Section 205(b)(3)) • Page 124: No company can sue the government for price-fixing. No “judicial review” is permitted against the government monopoly. Put simply, private insurers will be crushed. (Section 223(f)) • Page 127: The AMA sold doctors out: the government will set wages. (Section 224) • Page 145: An employer MUST ...

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Does Medical Malpractice Affect Access to Medical Care?

In a recent post, I asked the question whether or not people would favor providing some type of immunity to emergency physicians if doing so would increase the availability of emergency medical care. So far, about 75% of people answering that question voted “yes.” Some of the attorneys that read this blog were all over me. In particular, Max Kennerly, an attorney with a plaintiff’s law firm and someone whose opinions are generally cogent, thought that immunity would do little good in improving access to emergency care since “There’s no evidence malpractice — which is at the very most 1.5% of healthcare costs — is a major contributing to the lack of access to emergency care in this country. You could eliminate malpractice liability entirely and barely dent access to emergency care.” In response, I cited an article listing several examples to support my assertion. Highlights from the article are below. A 2005 hospital ED administration survey also lists “malpractice concerns” as the principal factor discouraging specialists from providing ED coverage. Furthermore, because liability premiums have outpaced payments for their services, some surgeons have concluded that they simply cannot afford the added liability risk for a largely uninsured patient population. In addition, younger surgeons, who often take the on-call shifts at trauma centers, are leaving states with the most severe liability problems. For example, according to the Project on Medical Liability in Pennsylvania, funded by the Pew Charitable Trust, “Resident physicians in high-risk fields such as general surgery and emergency medicine named malpractice costs as the reason for leaving the state three times more often than any other factor.” Further, an American Hospital Association study found that more than 50 percent of hospitals in medical liability crisis states now have trouble recruiting physicians, and 40 percent say the liability situation has resulted in less physician coverage for their EDs. The crisis has even forced the closure of trauma centers in Florida, Mississippi, Nevada, Pennsylvania, and West Virginia at various times in recent years. Specialties that have experienced particularly high premium increases—including neurosurgery, orthopaedics, and general surgery—are also among those that provide services emergency patients most frequently require. According to a report from the General Accounting Office, soaring medical liability premiums have led specialists to reduce or stop on-call services to hospital EDs, seriously inhibiting patient access to emergency surgical services. Max then responded to the articles I cited by stating that they were biased “surveys and a summary for a hospital lobbying group.” After all, some of the data were based on surveys of *gasp* doctors. Max, you lost me, there. If you want to know about doctors’ liability fears or if you want to know why doctors are leaving one state for another state, who are you going to ask? Grocery clerks? School teachers? Attorneys? Would the surveys have been more persuasive if they asked a bunch of nuns what effect they thought that medical malpractice liability would have upon the access to medical care? Of course the survey participants were doctors. Those are the people whose opinions everyone is seeking. So I spent about 45 minutes doing some further research on the internet and on some paid medical web sites. I decided to make this a separate post so that if anyone else was searching the internet looking to find out whether malpractice affects access to medical care, you can pick up on the work I’ve done. Below the fold are some more “nonexistent” studies that support my assertion. Funny, but I haven’t seen one link to any study that asserts the opposite. Oh, and if you do ...

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Legal Immunity

Last Friday, Secretary of Health and Human Services Kathleen Sebelius signed a document that provides vaccine makers immunity when they produce swine flu vaccine. Since vaccines are “well known” (wink, wink) to cause such physical maladies as autism … neurologic disorders, hyperactivity, learning disabilities, asthma, chronic fatigue syndrome, lupus, rheumatoid arthritis, multiple sclerosis, and seizure disorders, a federal law provides legal immunity for manufacturers that produce the vaccines. Instead of going through the court system, there is a fund called the Vaccine Injury Compensation Program that is set up to compensate those who have been injured by vaccines. Many vaccines have a low profit margin. In addition, most vaccines have only one or two manufacturers. If you were a vaccine manufacturer and knew that you could potentially spend tens or hundreds of millions of dollars defending and paying out on one class action lawsuit about a vaccine you produced, would you continue to make the vaccines? By immunizing manufacturers from liability for producing vaccines, the public policy argument is that the public benefits vaccines produce far outweigh the potential public detriment to the point that the government wants to encourage manufacturers to make vaccines. Several of the attorneys that frequent this blog have stated that legal immunity for physicians is the equivalent of a “license to kill” but they are also quick to defend legal immunity for judges in performance of their duties. So based on the above, I have two questions related to this immunity topic: [poll id=”2″] [poll id=”3″]

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Healthcare Policy Roundup 7/22/09

The Mayo Clinic – touted by the Obama administration as a system that provides quality care at a reduced cost – turned around and smacked House Democrats in the face over the recent health care reform proposals. A Washington Times article quotes Mayo Clinic officials as stating that the plan will lower quality and increase costs because the outcomes are not patient-focused or results-oriented. “The real losers [with this plan] will be the citizens of the United States.” Ouch. In other news, President Obama mentioned in a White House press conference that he changed his mind and now thinks that the Mayo Clinic sucks. Comparing healthcare systems in different countries may help the US come up with a viable alternative to our current system. John Aravosis from America Blog describes a situation in France where his emergency department visit at a specialty hospital cost him a rocking $32. Something doesn’t sound right about that story. If it is really true, insurance companies would spend less money by purchasing an air fleet and sending patients with potentially expensive medical problems to France for emergency care. Anyone else have experience with the French system that could comment more about it? More violence in the emergency department. An ED admitting clerk was shot three times by her former boyfriend outside the hospital and then stumbles inside full of blood. I usually don’t believe that the number of malpractice suits against a physician should be used as a measure of a physician’s competence. I know several excellent physicians who have been sued 5-10 times. I have been sued several times myself. Unfortunately, when there’s no reliable way of measuring a desired metric such as physician quality, pencil pushers will take things that can be measured and try to make the argument that the data apply to the metrics. That being said, should an ophthalmologist who has been sued 50 times be subject to discipline just because of the number of lawsuits against him? The largest medical malpractice verdict in Tennessee history was just handed down against an OB/Gyn physician that allegedly ignored a patient’s complaints about an unusual breast lump, stating that the lump was probably a cyst or a fatty deposit. Instead, the lump was a cancer that later spread to the patient’s liver. The jury awarded almost $24 million to the patient and her husband. Here’s a WTF moment for you. Two nurses wrote a complaint with the Texas Medical Board after they became concerned with patient safety when a physician kept trying to sell patients herbal medications. Kind of like an IRS agents offering to sell you tickets to the IRS ball just before an audit? The nurses included patient identification numbers, but no names, with the complaint. The story isn’t clear, but apparently medical records were also sent to the Medical Board. When contacted by the county sheriff, none of the patients complained about their care. The District Attorney then filed criminal charges against the nurses after the doctor complained about being “harassed”. In other news, the Winkler County District Attorney could not be immediately reached for comment, but later was found at home taking a chamomile extract bath with vanilla bean infusion prescribed by the involved physician. Defensive medicine may not exist, but this doctor does a pretty good job of describing this figment of our imagination. Interesting that Congressional Budget Office statistics show that $30 billion was spent to defend against and pay malpractice claims in 2008, but that money was only 1.5% of the total 2008 healthcare expenditures. Also interesting that hospitals provided more than $35 billion ...

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Socialized Medicine Debate

This morning I read two competing views about whether our system should become “socialized.” One view was from Op-Ed columnist Richard Cohen in a piece titled “Socialized Medicine? Bring It On” in the Washington Post. He takes his experiences accompanying a “friend” to the emergency department and tries to generalize them to the medical system as a whole. There were “interminable” waits, there were not enough beds, and his friend had to wait “in agony” sitting in a wheelchair in a hallway for six hours. He then demonizes insurance companies who denied his friend’s claim for a return to the emergency department, saying that private enterprise makes “lots of money” on health insurance. He concludes that our privatized system has failed to the point that “everyone gets miserable treatment” and advocates for government-run health care because he doesn’t think that the government “could possibly do a worse job.” Unfortunately, Mr. Cohen’s view relies on many false assumptions. While Mr. Cohen is correct that our current medical system is “privatized” to some degree, our system is far from completely “privatized.” The government still has a significant impact on the care patients receive. Federal EMTALA laws require that every patient be evaluated – regardless of ability to pay. The threat of government fines and sanctions is hardly a “privatized” system. Through Medicare and Medicaid, state and federal governments control payments to physicians for a significant amount of the care that they provide. Hospitals have to meet their budgets or they will go bankrupt. When reimbursement from the governments declines, hospitals either need to cut staffing and services — which means longer waits and delays in care — or go out of business  — which means longer waits and delays in care. The number of hospitals emergency departments decreases each year.  As our administration struggles with a trillion dollar deficit, does Mr. Cohen or anyone else expect payments to hospitals to increase with socialized medicine? Money is a great incentive. People spend days searching online for the best deal on a new LCD TV. People drive across town to get a gallon of milk twenty cents cheaper from a grocery store. Most people would not think twice about switching jobs if they were able to earn a few dollars more per hour for doing the same work. When insurance stops paying for one doctor’s care, most patients abandon ship and find a doctor that the insurance company will pay for rather than paying out of pocket. Doctors and hospitals are no different. When people are provided with an incentive, they will work harder. When deincentivized, they will work less. At some point, they will leave the system. Look at the state of primary care in this country now. Doctors are leaving because the good aspects of helping patients are outweighed by administrative hassles, paperwork, and decreased reimbursement. Does Mr. Cohen think that there will be less administrative hassles and increased payments in a socialized system? One quote just keeps resonating in my mind: “The government that has the power to give everything to you has the power to take everything away from you.” The competing view I read was from a forwarded e-mail about an economics professor: An economics professor at a local college made a statement that he had never failed a single student before but had once failed an entire class. That class had insisted that Obama’s socialism worked and that no one would be poor and no one would be rich, a great equalizer. The professor then said, “OK, we will have an experiment in this class on Obama’s plan”. ...

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