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CCHF Health Freedom eNews

October 8, 2014


Between a Rock…and a Readmission

We're in a hard place. Last year, Obamacare initiated a program to reduce so-called "excess readmissions" in hospitals. Section 3025 requires all hospitals subject to the policy to pay a penalty, called a "payment adjustment," up to 3% if they readmit too many Medicare patients within 30 days of discharge.

Around 1,400 hospitals are exempt from the policy. But over the next year, 2,610 hospitals - three-quarters of those subject to the policy -- will be penalized by Obamacare's "Hospital Readmissions Reduction Program." They will be paid less for every Medicare patient, not just the readmitted ones.

Penalty payments are increasing. In 2013, 2,225 hospitals paid $227 million in penalties. Over the next year, Medicare expects to extract $428 million in "savings" through reduced payments. To determine penalties, Medicare reviewed hospital readmissions in five categories (heart attack, heart failure, pneumonia, elective hip and knee replacements and lung ailments--two more categories than in 2013).

What does this mean for patients? Hospitals and other concerned parties who opposed the rules chastised the administration for:

  • Penalizing hospitals for what happens during the 30 days patients are not under hospital care.
  • Extrapolating results using medical record data from only 25 patients, potentially leading to inaccurate conclusions.
  • Not excluding from readmission review patients with "extreme conditions" such as organ transplants, end-stage renal disease, burns, psychosis and chemical dependence.
  • Not taking into account socioeconomic conditions of patients (e.g. race, geographic location, occupation, income, lifestyle, language, literacy).
  • Not distinguishing between "related" and "unrelated" readmissions, resulting in penalties if patients are admitted for a condition unrelated to the first condition.

Some commenters worry patients will die. They pointed out death after hospitalization would improve a hospital's "readmissions" score (p. 53376). In a Comment and Response section of the final 2012 rule federal bureaucrats wrote:

Comment: Several commenters expressed concerns that the Hospital Readmissions Reduction Program may induce unintended consequences of overcrowding hospital emergency departments, as hospitals may believe they are compelled to avoid readmitting patients.

Response: We recognize that performance-based payment penalty or incentive programs may have the potential for unintended consequences. We are committed to monitoring the measures and assessing unintended consequences over time, such as the inappropriate shifting of care, increased patient morbidity and mortality, and other negative unintended consequences for patients. (p. 53376)

Considering the VA debacle, I'm not reassured. At least 40 veterans have died due to the VA's pay-for-performance incentive program. It took a retired physician to blow the whistle and expose the VA's "timely treatment" charade.

How will penalties be determined? The 2012 payment rule includes the following two-part "Excess Readmission Ratio Calculation" (p. 53380). Its "risk-adjustment coefficients" and "hospital-specific effect" wizardry will lead to inaccurate "findings." Bureaucrats admit imprecision: "The method produces an adjusted actual (or "predicted") number in the numerator and an "expected" number in the denominator." The bureaucratic chicanery will be difficult to counter.

Patients need patient- and pocketbook-friendly alternatives. Medicare is in crisis because it's an unsustainable Ponzi scheme. Those receiving Medicare are receiving three times as much in services as they paid in payroll taxes. Medicare has a $43 trillion unfunded liability. Creating meaningless algorithmic machinations to encourage rationing of care is not the answer to Medicare's woes. 

Removing government from health care is. Health care will be more affordable, ethical, charitable, accessible and patient-centered when the bureaucracy, the regulatory and reporting costs, the privacy intrusions, the prescriptive limits on care, the more than 150,000 pages of regulations, and the paperwork requirements are gone. Maybe South Dakots will begin the process (see CCHF news release below).

Planning for an Obamacare-free and a Medicare-free future,

Twila Brase, RN, PHN
President and Co-founder


News to Know:

Deadly Records; Dangerous Hospitals 

The Texas hospital that sent Thomas Duncan home with Ebola blamed the "flawed" set-up of its electronic health record (EHR), saying the nurse's note on Africa would not automatically be visible to the doctor. Later the hospital denied this was true but would not explain to news reporters why the contradiction. But, according to the safety director of Johns Hopkins, his hospital is "more dangerous than a hospital that was built 30 years ago" because of the EHR they just installed to comply with Obama's 2009 EHR mandate. (Politico, October 4, 2014)


Even Obamacare Not Enough 

Obamacare enrollees, particularly those with bronze plans, are using federally-funded Community Health Centers rather than private clinics because of unaffordable Obamacare deductibles. When they don't pay, the Centers try to get their Obamacare coverage to pay but are often turned down because these costs are to be covered by the deductible. The 1,200 centers received $3.5 billion in ACA funding, but are asking for more during the upcoming lame duck session.



Progressive Reporter Angry about Release of GOP Candidate's Medical Records 

Andrea Grimes, a senior political writer at a reproductive rights publication who calls herself a progressive and a feminist, is "appalled" by the GOP's release of, and then the Democrat's gleeful use of, Senator Dan Patrick's medical records. "There is no joy following the GOP down the low road..." The GOP found the records in a 25-year-old lawsuit and made them public to secure an incumbent's primary win. They failed. Dewhurst lost. Sen. Patrick won.

More Cancellation Letters Arrive

Obamacare insurance cancellations are still being issued. In Kentucky, 14,000 people were notified by October 1. About 800 Alaskans got their cancellation letters. And 2,000 people in Tennessee have been notified. In Colorado, 1,700 people were notified earlier in the year. And in New Mexico about 30,000 got the bad news that their plans are ending December 31. These are the "transitional" plans that Obama allowed states to continue temporarily.

WebMD Gets Millions to Whitewash Obamacare

The Justification document for the Obama administration's contract with WebMD states that WebMD is a "trusted source of information" and that a "consistent source of information is critical to the success of the ACA and Marketplace Exchanges." The $13.9 million is being spent to "encourage providers and consumers to turn to official information sources regarding the ACA and to create an accurate perception of the ACA among health care providers and consumers." But official or not, Chuck Todd at NBC News recently said the Obama administration has a "trust deficit."

Trouble at Tax Time

House Democrats urge better outreach by the administration about Obamacare tax issues - before next April. People who got large Obamacare tax credits (premium subsidies) in 2014, but then increased their income, for example, may have to pay part or all of it back to Uncle Sam.  U.S. Rep. Mike Thompson (D-CA) "sternly" told the IRS Commissioner, "I think we need to figure out how to better educate folks going into this." (Politico Pro Health Care, 9-15-14). 

PRIVACY LOST: 30.1 Million Patients Experience Data Breach

The HITECH Act in the 2009 Recovery Act (ARRA) essentially mandated that all medical records be digitized. It was the foundation on which Obamacare was built. Although the law does not require smaller data breaches to be reported, major breach reports have impacted 30.1 million patients in 944 incidents since 2009, according to The Washington Post's "Wonkblog." Breaches cost industry $5.6 billion each year...paid for by premiums, higher costs for care, and taxes.( Graphic by John Halamka, found at Chilmark Research)


EHRs Used to Push Minimum Wage? 

There's a move afoot to "improve the collection and use of work information in EHRs." The plan is to use it for clinical purposes, "population health" and amazingly, in one clinic, to "provide advocacy on behalf of low-wage worker populations." This initiative is starting in earnest in federally-funded community health centers. Interestingly, the Democrat-controlled Minnesota legislature refused to mandate collection of occupation data last session because the state health department objected.

Quotes of the Week:

"If only sick people show up, Obamacare is on a long walk off a short pier" -- Robert Laszewski, Health Care Policy and Marketplace Review ( blog) regarding the need for the healthy and young to go to exchange and sign up for Obamacare. October 1, 2014.





"There always is a good reaction. Ebola needs to be proaction," - Chuck Todd, NBC News, Meet the Press, questioning the Obama administration's lack of preventive actiona to protect Americans from Ebola, October 5, 2014. 

Stat of the Week:

$438.9 million - estimated value of the global newborn screening market in 2013, with expectations that its value will rise to $819.6 million by 2019.

News Release of the Week:

South Dakota Ballot Initiative Could Give Patients Health Care Freedom

ST. PAUL, Minn. - Next month, South Dakota voters will see an initiative on their ballots that could put health care decisions back in their own hands.

South Dakota's Initiated Measure 17 (IM-17) is premised on patient choice and will allow state residents to decide if they will have the freedom to choose their own doctors and hospitals, rather than choose from providers inside a limited network, pay extra out-of-pocket expenses to see doctors outside the network, and travel long distances to see specialists who are covered through the network but may be located far away.

Twila Brase, president and co-founder of Citizens' Council for Health Freedom (CCHF,, a Minnesota-based national organization dedicated to preserving patient-centered health care and protecting patient and privacy rights, says South Dakota's measure, if passed, could have far-reaching effects, as other states could decide to follow suit and offer their voters a similar option.

Continue reading

Featured Health Freedom Minute:

Hospitals, Not Doctors, Choose Drugs

Forty-two percent of doctors are salaried employees of hospital systems so drug companies no longer send sales reps to doctors. They send them to hospital administrators who decide what drugs are included on the list of approved drugs, otherwise known as formulary. Many hospitals forbid contact with doctors making it harder for doctors to learn about new drugs.

Continue reading

Twila Brase broadcasts a daily, 60-second radio feature, Health Freedom Minute, which brings health care issues to light for the American public. Health Freedom Minute airs on the entire American Family Radio Network, with more than 150 stations nationwide in addition to Bott Radio Network with over 80 stations nationwide.

Click here to listen to this week's features.

Citizens' Council for Health Freedom
161 St. Anthony Avenue, Ste 923
St. Paul, MN 55103
Phone: 651.646.8935 • Fax: 651.646.0100

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