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Wednesday, July 11, 2012

What do industry experts think of the healthcare reform

In an article published at HealthcareITNews 4 different experts provided their opinions on what can be anticipated as a result of the healthcare reform. I tend to agree with most of the opinions and therefore highlighted the most significant in my opinion parts. Please see full body of the article enclosed below.

WASHINGTON – With the nation on the edge of its seat June 28, the Supreme Court ruled it constitutional for all Americans to obtain health insurance or face penalties. And with the remaining sections of the ACA staying in place, healthcare reform was deemed to be in full swing, resulting in another victory for the Obama administration.
With that said, we compiled four expert reactions to the Supreme Court's ACA decision.
1. It's a 'historic victory.' New York State Attorney General Eric T. Schneiderman felt the decision was a 'win' for all Americans who will be covered by health insurance. "The law's effects will be significant in our state, where over two million people are uninsured. Over a million uninsured New Yorkers will soon have access to affordable coverage," he said. "This law will continue to provide a spectrum of key consumer protections including keeping young adults on their parents' plans, ending pre-existing condition restrictions, and increasing consumer information about healthcare choices."
2. Healthcare continues to be in a state of change.  "It's about creating a sustainable healthcare industry," said Bruce Johnson, CEO of supply chain management company GHX. "Unlike most industries, healthcare is two-dimensional: delivering high-quality care to save lives while running efficient businesses. At the core, healthcare reform is driven by the need to reduce costs while delivering care of the highest quality." The business of healthcare needs to change, continued Johnson, to deliver cost-efficient and effective business processes. "It's all about quality and access -- and quality can be improved by healthcare businesses working together to standardize and streamline their processes."
3. The decision will impact all healthcare providers. "Those who were waiting to see what would happen with healthcare reform can now expect to see a number of changes to their practice," said Claire Marblestone, attorney at healthcare provider firm Fenton Nelson. "For example, there will be additional funds for rural healthcare providers, incentives to adopt electronic healthcare records, and mandatory adoption of compliance and ethics programs for certain facilities." Furthermore, she added, "The changes to Medicare and Medicaid will have an impact on provider reimbursement."
4. The focus will shift to implementing programs as soon as possible. Bart Stupak, former Michigan congressman, said now that the ruling has been made, "the focus within the executive branch, in the states, and throughout the healthcare industry will be on developing and implementing the programs as quickly as possible." The demand for healthcare is about to explode as baby boomers continue to age. "It will be critical for all parties involved in the healthcare system -- providers, hospitals, insurers, and the government -- to innovate and develop methods for reducing the costs of delivering quality healthcare,"Stupak added, "so the country will be able to afford expansion."

Gluten FREE? - Places to go to in NYC

I found an article posted by CBS New York on some of the best places in NYC that are Gluten FREE. As I explore each one I'll post comments to this post.

I have shared this with a lot of my friends, although I have not been diagnosed with Celiac, giving up gluten was the best things I have done for myself in a long while. I no longer feel tired, my energy level stays evenly high through the day. This results in me being more productive and enjoying my days more. Quality of life increase of sure. 

Suffer from Celiac disease? Going through life gluten-free poses its challenges, especially when cravings for comfort foods like pizza and cupcakes come knocking. Don’t worry – we’ve got you covered. Here’s a look at some of the top GF fare in town. 

Risotteria

gluten free breadsticks The 8 Best Gluten Free Food & Restaurants In New York City
Our favorite gluten-gree find in all of New York City may be Risotteria’s breadsticks (credit: Risotteria)

270 Bleecker Street (between 6th & 7th Aves.)
New York, NY 10014
(212) 924 – 6664 
risotteria.com
Reviews & More Info

If you suffer from a gluten intolerance, you’ll find a bit of heaven at Risotteria. From the minute they place the first round of gluten-free breadsticks at the table until you finish the last bite of your gluten-free apple pie at dessert. In between, you can sip on gluten-free beer! The menu targets those with Celiac Disease, and itemizes the options with markers for “gluten free,” “vegetarian,” or “dairy free.” The restaurant specializes in risotto and gluten-free baked goods, which you can order to go. On Tuesdays, order from a special gluten-free pasta menu. Yes, the place sounds too good to be true for those who normally can’t enjoy all of these foods – and the crowds that gather nightly prove the restaurant’s worth. Reservations aren’t accepted, wait time can be lengthy and the place gets crowded fast. But our tip? It’s worth it.

Bistango

bistango The 8 Best Gluten Free Food & Restaurants In New York City
(credit: bistangonyc.com)
415 3rd Avenue
New York, NY 10016
 (212) 725-8484 
bistangonyc.com
Reviews & more info
The gluten-free options here are limitless, and the staff is eager to please and ensure a safe and delicious meal for everyone. You’ll probably even meet the owner, Anthony, who often comes out to greet guests and chat about his restaurant. Start the meal off with warm, crusty gluten-free bread that puts most other GF bread to shame. For dinner, you can dine on creamy Spinach & Ricotta Ravioli, flavorful Wild Mushroom & Ricotta Ravioli,  or Cheese Tortellini from the gluten-free menu. For a $2 premium, you can make any pasta item on the menu gluten-free. They also offer two Green’s gluten-free beers, the dark and sweet Endeavor and the light and fresh Quest. During the summer, sip fresh gluten-free white wine sangria. Try the GF homemade cheesecake for dessert.

Keste Pizza & Vino

kestepizzeria2 The 8 Best Gluten Free Food & Restaurants In New York City
The pizza from Keste. (photo credit: kestepizzeria.com)
271 Bleecker Street
New York, NY 10014
 (212) 243-1500 
kestepizzeria.com
Reviews & more info
A good pizza can be tough to find – especially when you’re avoiding gluten – but Mondays and Tuesdays are gluten-free days at this West Village spot. Choose from the Mast Nicola, with lardo, Pecorino Romano (a hard, salty cheese), and basil, or sample the Marinara (tomatoes and oregano) or the classic Margherita. All pies come on a cruncy, brick-oven crust that will make you forget it’s gluten-free. The torta caprese, a flourless chocolate almond cake, is moist and dense, completely gluten-free, and a great way to finish off your meal.

S’MAC

 The 8 Best Gluten Free Food & Restaurants In New York City
(credit: S’mac/Facebook)
345 East 12th St
New York, NY 10003
 (212) 358-7912 
smacnyc.com
Mac’n'cheese is the ultimate comfort food (check out our Best Mac roundup) - but for not always for gluten-free lifestyles. That’s where S’MAC comes into the play. They’ve gone through a lot of effort to make their entire menu available in GF variations, charging a bit more depending on the size of dish you order. For GF mac, they use Brown Rice elbow macaroni, bechamel (no wheat flour), and breadcrumbs made from GF cornflakes.  With all that in mind, dive into their extensive collection of delicious mac flavors, including cheeseburger and cajun.

Lilli And Loo

 The 8 Best Gluten Free Food & Restaurants In New York City
Getty Images/Clip Art
792 Lexington Avenue
New York, NY 10065
 (212) 421-7800 
lilliandloo.com
Hungry for stick-to-your-bones, Chinese takeout – sans gluten? Check out this Lexington Avenue locale, Lilli and Loo. Their gluten-free menu boasts more than 50 items, including spicy General T’so’s chicken or tofu, which retains the crunch its gluten-filled counterpart is known for. We like the rice noodle pad thai, and the dumplings are delicious with GF soy sauce.

Candle 79

 The 8 Best Gluten Free Food & Restaurants In New York City
(credit: Candle 79)
154 E 79th St
New York, NY 10021
 (212) 537-7179 
candlecafe.com
Dimly-lit and perfect for date night, this Upper East Side venue boasts a thorough gluten-free menu. Their organic, vegan fare pairs fabulously with a thorough cocktail selection. The atmosphere is welcoming to those without dietary limitations, as well. We’re big fans of Angel’s Nachos ($16.00).

Tu-Lu’s Gluten-Free Bakery

 The 8 Best Gluten Free Food & Restaurants In New York City
Tu-Lu’s Vanilla Cupcake with Vanilla Buttercream (credit: Tu-Lu’s)
338 East 11th St.
New York, NY 10003
 (212) 777-2227 
tu-lusbakery.com
Time for dessert. Tu-Lu’s made our Best Cupcake list on the quality of its wares alone. It’s a bonus that they’re gluten-free. Tully Lewis attended culinary school at Le Cordon Bleu in Austin, Texas, before making her way up to NYC to continue her studies at NYU. Good thing for us it’s not all academic for her. Her chocolate chip cookies get rave reviews, and of course, we love the vanilla/vanilla cupcake.

Rice To Riches

 The 8 Best Gluten Free Food & Restaurants In New York City
(credit: ricetoriches.com)
37 Spring Street
New York, N.Y.
 212.274.0008 
ricetoriches.com
In a skinny city where venues like Pinkberry make a business of encouraging visitors to top their non-fat concoctions with healthy additions like fruit and nuts, Nolita’s Rice To Riches offers heaping portions of their trendy take on comfort food while encouraging the overindulgence (the walls are lined with phrases poking fun at thin girls and fitness freaks). It’s a bit pricey, but even the smallest size is big enough for two to share. The staff is knowledgeable about which flavors are gluten-free, and which ones aren’t safe for those with the allergy.

Monday, July 9, 2012

Managed Care News - WellPoint to aquire Amerigroup

A very big change in the delivery of healthcare is here. Healthcare reform makes an impact on all of the aspect of care delivery, from providers to suppliers, to pharmaceutical, to insurance companies. One of the big transactions will take effect in the first quarter of 2013.

WellPoint is acquiring Amerigroup along with some other companies, such as 1-800-Contacts, a Draper, Utah based contact lens retailer. Please see the article published in ModernHealthcare.com below:


WellPoint said it entered a definitive agreement to acquire Amerigroup, a Virginia Beach, Va.-based managed-care company, for about $4.9 billion.

The deal will expand the Indianapolis-based health insurer’s Medicaid managed-care business, including its share of the dual-eligible population. 

“We expect Medicaid spending under managed-care programs to increase by nearly $100 million by the end of 2014,” said WellPoint President and CEO Angela Braly during a conference call. “These opportunities will develop organically in addition to the Medicaideligibility expansion under healthcare reform.”


 
 
 
The combined company will serve about 4.5 million Medicaid beneficiaries, as well as have a Medicaid presence in 19 states. Amerigroup, which said its revenue is expected to double over the next five years, will operate as a wholly owned subsidiary of WellPoint. 

The deal is expected to close in the first quarter of 2013. 

WellPoint said last month that it planned to acquire 1-800-Contacts, a Draper, Utah-based contact lens retailer, for an undisclosed sum.

ACO - Accountable Care Organization - What is it all about

This morning I received my usual set of Healthcare related news. One of the articles published by ModernHealthcare caught my attention.

"CMS announces 89 new ACOs" - as I read about this news, I realized that many of those whose lives are affected by the changes in healthcare delivery do not know what ACO is and how does it change the delivery of healthcare for Medicare Recipients.

From the article I gather that CMS (Center for Medicaid and Medicare services) engaged more ACOs through out the country. See the body of the article below:

As of July 1, 89 new Medicare accountable care organizations (PDF) started to serve Medicare beneficiaries in 40 states and Washington, D.C., the CMS announced Monday.

These new programs bring the total list of ACOs to 154, which includes 32 ACOs in the Pioneer ACO model from the CMS Innovation Center that were announced last December and six physician group practice transition demonstration organizations that began in January 2011. 

“The Medicare ACO program opened for business in January, and already, more than 2.4 million beneficiaries are receiving care from providers participating in these important initiatives,” CMS Acting Administrator Marilyn Tavenner said in a statement.
On the official CMS website I found a detailed description of what the ACO is all about and what available programs for are available to get involved if you are a provider, or a Healthcare professional. Please see the explanation below:

Accountable Care Organizations (ACO)


What's an ACO?
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.
The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.
When an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, it willshare in the savings it achieves for the Medicare program.
Medicare offers several ACO programs:
  • Medicare Shared Savings Program—a program that helps a Medicare fee-for-service program providers become an ACO. Apply Now.
  • Advance Payment Initiative—a supplementary incentive program for selected participants in the Shared Savings Program.
  • Pioneer ACO Model—a program designed for early adopters of coordinated care. No longer accepting applications.Organizations across the country have already transformed the way they deliver care, in ways similar to the ACOs that Medicare supports.
Organizations across the country have already transformed the way they deliver care, in ways similar to the ACOs that Medicare supports.
As a healthcare provider, must I participate in an ACO?
Participating in an ACO is purely voluntary for providers. We realize different organizations are at different stages in their ability to move toward an ACO model. We want to try to meet you where you are. Our hope is to show you models of participation that will encourage you to participate in and begin this work, no matter your organization’s stage.
What are the rights of my Medicare patients if they see providers who participate in a Medicare ACO?
Fee-for-service Medicare patients who see providers that are participating in a Medicare ACO maintain all their Medicare rights, including the right to choose any doctors and providers that accept Medicare. Whether a provider chooses to participate in an ACO or not, their patients with Medicare may continue to see them.
Where can I learn more about ACOs?
CMS offers different learning opportunities for organizations interested in learning more about ACOs. Visit this page periodically to learn about the latest opportunities.
Included in those opportunities are ACO Accelerated Development Learning Sessions (ADLS). CMS hosted two ADLS this year (June in Minneapolis; September in San Francisco), and will host an additional session in Baltimore on November 17-18. The ADLS help executive leadership teams from existing or emerging ACO entities:
  • Understand their current readiness to become an ACO.
  • Identify organization-specific goals for achieving the three-part aim of improving care delivery, improving health, and reducing growth in costs through improvement.
  • Begin to develop an action plan for establishing essential ACO functions.
For more information about the ADLS and to view resources from previous sessions, visit the ADLS website.
How else is Medicare encouraging coordinated care?
The CMS Innovation Center offers a menu of alternative options, including:
We want to try to meet you where you are. Our hope is to show you models of participation that will encourage you to join in and begin this work, no matter your organization's stage.

Friday, July 6, 2012

Patient Health Records access for UnitedHealthcare members

Most of us working in healthcare know that any program, mandate or regulation first being implemented by the CMS (Center for Medicaid and Medicare Services). This is also true for the EHR implementation, followed by PHR (Patient/Personal Health Records). Most of the commercial insurance companies stay on stand by observing the outcomes of the CMS effort and join in later in the process to reinforce and adopt regulation, program or mandate at hand.

Some come forward and adopt innovation faster than others and it is always interesting to see who and how will participate first. Department of Veterans Affairs has always been on the forefront if implementation.

As stated in the article published by Healthcare IT News United Healthcare has launched their own Blue Button program. This program enables plan participants to access and print their PHRs  with just a click of a mouse.

 Although, as per UnitedHealthcare, the PHR have been available for almost 20 years, the importance and availability of it is now emphasized. By placing the Blue Button in a more visible position UnitedHealthcare plans to attract the attention of the users and enables them to download their records in a PDF or text formats as well as printing it out.


UnitedHealthcare members can view, print and download information such as claims data, health screenings and self-entry. An individual's PHR will include critical health information such as previous or current health conditions, vital signs and procedures, and personal information that allow easy sharing of important information.
By March of 2012 the Blue Button program went live on one website for 500,000 people enrolled in Health Plan of Nevada.  By the end of the year it is anticipated for more than 12 million employer-sponsored plan participants to have access. By 2012 nearly 26 million UnitedHealthcare enrollees will be able to access their records.

As per Karl Ulfers, VP of Consumer Solutions at UnitedHealthcare, "The technology encourages people to update their personal health records as well as print them, so they can take their records with them and discuss their health and treatments with their doctors."

Between government and private-sector organizations it is anticipated for as many as 75 million people to have access to their records via the Blue Button.

The full body of the article is quoted below:
MINNETONKA, MN – Taking a cue from the U.S. Department of Veterans Affairs, UnitedHealthcare has launched its own Blue Button program, enabling its plan participants to access and print their personal health records (PHRs) with the click of a mouse.
The Department of Veterans Affairs launched the Blue Button in 2010 to allow simple exchange of a patient’s personal health data in a standard, consistent format. Initially designed for use by veterans, the idea has begun to find footholds in the private sector.
“Blue Button puts patients in charge of their personal health information. It is central to our vision of patient-centered clinical encounters,” said Peter L. Levin, chief technology officer at the Department of Veterans Affairs. “The federal Blue Button initiative is a great example of public-private partnerships and open government. With Blue Button, the government created a framework that offers patients private and secure access to their data, and is a model for the private sector.”
For years, nearly 20 million people who log on to UnitedHealthcare’s health and wellness site (myuhc.com) have had access to a PHR. But officials say the addition of Blue Button to the site will make that access easier, promoting the importance of a PHR and offering users the ability to print their records in either PDF or text formats.
UnitedHealthcare members can view, print and download information such as claims data, health screenings and self-entry. An individual’s PHR will include critical health information such as previous or current health conditions, vital signs and procedures, and personal information that allow easy sharing of important information.
UnitedHealthcare’s support of the Blue Button initiative first began in September 2011, and in March 2012 the Blue Button went live on one website for 500,000 people enrolled in Health Plan of Nevada benefit plans. As the firm expands the use of the technology, more than 12 million employer-sponsored plan participants will have access by the end of the year, and by mid-2013 nearly all 26 million UnitedHealthcare enrollees will be able to access their PHR with the click of the Blue Button, UnitedHealthcare officials say.
“Blue Button is a new, convenient way people can access their health records securely and easily with just a single click,” said Karl Ulfers, vice president, Consumer Solutions at UnitedHealthcare. “This technology encourages people to update their personal health records as well as print them, so they can take their records with them and discuss their health and treatments with their doctors.”
About a half of million veterans and Medicare members, including nonveterans, have already downloaded their records using the Blue Button interface, according to Veterans Affairs CIO Roger Baker.
“By the end of 2012, we think as many as 75 million people will have access to their medical information through Blue Button,” said Baker. “We’re getting a lot of adoption by private-sector organizations.”

Thursday, July 5, 2012

Tuesday, July 3, 2012

Medicaid Expansion - Will your state be In or Out

Healthcare blog at the TheHill.com has published an interesting article - "Fifteen governors reject or leaning against expanded Medicaid program". This brings a very valid point, if the congress passed a law that has an option to opt out for the state how will the overall effort be effected, since we are talking about a federal law implementation. 

As much as I would like to stay out of politics, this is one topic where I simply cannot refrain myself from commenting. The implementation and acceptance of the Medicaid expansion can only work if it is implemented across all of the states, with the affordable option for healthcare insurance be available anywhere in the country. Should a state choose not to participate it may have far beyond reach implications on the migration of the population from one state to another.
At least 15 governors have indicated they will not participate in the expansion of Medicaid under the healthcare law, striking a blow to President Obama’s promise of broader insurance coverage.

Before Thursday’s Supreme Court ruling, states had the option of either increasing their Medicaid rolls or being penalized by the federal government. The high court struck down that offer as unconstitutional.


“You can make the political call real quick, but the actual decision is a complicated one,” said Matt Salo of the National Association of Medicaid Directors. “Governors are going to be looking at the numbers and asking: Does this make sense for us?”
Seven states with Republican governors have given a flat “no” to the Medicaid expansion since the Supreme Court ruling, according to reports and press statements.
States that will decline to participate include Florida, where Gov. Rick Scott (R) turned his opposition to the law into a political career, and Louisiana, where Gov. Bobby Jindal (R) has vowed to help elect Mitt Romney as president in order to repeal it.

In eight other states — seven with GOP governors — the Medicaid expansion seems unlikely, given comments from governors and their offices.

Texas Gov. Rick Perry (R) “has no interest in fast-tracking any portion of this bankrupting and overreaching legislation,” spokeswoman Lucy Nashed said in a statement Monday. “We will continue to call for the full repeal of the bill.”

Virginia Gov. Bob McDonnell (R), considered a contender to be Romney’s vice-presidential nominee, said his focus is on November. 
Some consider the expansion as "budget-busting":

“The only way to stop Barack Obama’s budget-busting healthcare takeover is by electing a new president,” McDonnell said in a statement following the court’s decision.
Interestingly enough, a lot of states already working on the Medicaid redesign and expansion even without a Federal mandate. But that doesn't apply to all.

Some states haven't made a decision as of yet, whether they will or won't participate in the expansion of the program.  
New Jersey Gov. Chris Christie (R), also the subject of VP speculation, has not announced what his state will do. His political position is trickier, since he leads a blue state where there is more support for the healthcare law.

In its original form, the Affordable Care Act would have pulled all federal funds for state Medicaid programs that did not expand as the law intended.

Chief Justice John Roberts strongly criticized that approach in his opinion for the majority.
“The financial ‘inducement’ Congress has chosen is much more than ‘relatively mild encouragement’ ” to expand Medicaid, Roberts wrote. “It is a gun to the head.”

Past estimates have found that, as designed, the law’s expansion would have provided healthcare access to an additional 17 million low-income Americans.

“States have a lot to consider,” said Robin Rudowitz with the Kaiser Commission on Medicaid and the Uninsured. “That is a lot of federal money sitting on the table.”

Alan Weil with the National Academy for State Health Policy said states that do not comply could raise the ire of some in Congress.

“If states turn down that offer, it leaves a lot of people uninsured. If we end up in that place, a lot of people in Congress are going to say that is a problem,” he said.

Several Democrats have expressed confidence that the bill’s intention to expand healthcare coverage can still be fulfilled.

Peter Orszag, who led the White House budget office during the healthcare debate and had a major role in shaping the legislation, said states might come around eventually.

He said the law’s coverage expansion would be significantly undercut if a large number of states opt out.

“There may be significant gaps that open up, and that would be unfortunate,” he said, noting that more than half of the coverage expansion was set to come through Medicaid.

But Orszag said there is plenty of precedent for states to expand their Medicaid programs when they don’t have to. About 60 percent of current Medicaid spending goes toward people or benefits that are not mandated by federal law, he said. States decide to provide those optional benefits because the federal government bears most of the cost — and it would cover an even bigger share of the Affordable Care Act’s expansion.

The federal government will cover the entire cost of the expansion for a few years. Its share begins to drop after that, but Orszag said it won’t fall far enough to be a bad deal for states.
“A 90 percent subsidy rate is going to be hard to resist,” Orszag said Monday on a conference call organized by Foreign Affairs magazine.
— Sam Baker, Lydia Nuzum and Gunnar Sidak contributed to this report.
You can find original article along with the list of states that already decided on their participation/non-participation here

Affordable Care Act - Let's Look Inside

In a very descriptive article posted by the ModernHealthcare.com Joe Carlos has explained the ruling.

With the new ruling in place those that will not have/purchase health insurance will be subjected to additional taxes.  
The court ruled that Congress has the power to compel individuals to purchase insurance as a tax on people who do not have health insurance.
...the court ruled that Congress has the power to compel individuals to purchase insurance as a tax on people who do not have health insurance.
The important piece of information is that with this legislation passed the number of affordable options to purchase an insurance coverage will hopefully increase. As part of the overall process to better healthcare NY State is already working through a Medicaid redesign program. The ultimate objective is of course to prevent illness from developing and spreading by implementing more of preventive measures. Annual visits as well as other precautions can result in decreased number of admissions into the hospital and shorter waiting time in the Emergency room. Having an insurance coverage enables every one of us as a patient to take care of our health not in the time of crises but continuously by maintaining a healthy lifestyle.
The landmark decisions end two years of legal uncertainty and clear the way for full implementation of the 906-page law. Doing so includes establishing insurance exchanges in each state, prohibiting insurance companies from discriminating against the sick, and requiring nearly all Americans to prove on their income taxes that they carry health insurance starting in 2014.

"Today's historic decision lifts a heavy burden from millions of Americans who need access to health coverage. The promise of coverage can now become a reality,” said American Hospital Association President and CEO Richard Umbdenstock in a statement. “The decision means that hospitals now have much-needed clarity to continue on their path toward transformation.”

The insurance industry's national interest group, America's Health Insurance Plans, released a statement reiterating its position that “universal coverage” was essential to avoiding significant increases in cost and decreases in choices for health insurance.
 There is a slight downside of course, as per Karen Ignagni, but with the absence of the pre-existing condition clause alone the disruption of coverage can be reinstated.
“The law expands coverage to millions of Americans, a goal health plans have long supported,” AHIP President and CEO Karen Ignagni said in a statement, “but major provisions, such as the premium tax, will have the unintended consequences of raising costs and disrupting coverage unless they are addressed.”

The court, however, did strike down part of the reform law's mandated expansion of Medicaid. Congress had aimed to expand the insurance program for the poor by at least 16 million people, but the court ruled that Congress did not have the power to cut off Medicaid funding for states that refused to comply with the law's eligibility rules.

The law said that states "must either accept a basic change in the nature of Medicaid or risk losing all Medicaid funding," Roberts wrote. "The remedy for that constitutional violation is to preclude the federal government from imposing such a sanction … As a practical matter that means states may now choose to reject the expansion; that is the whole point. But that doesn't mean all or even any will.”
For original Article - click here

To download 193 page opinion and dissent document (PDF) produced by the Congress - click here

Monday, July 2, 2012

Beware of the Medication that you take.


Beware of what is prescribed to you, not all medication is created equal and especially medication that you give to your children. Heavily regulated industry and we are still dealing with the consequence of misrepresentation and misuse. 


As stated in MedPageToday.com:
  GlaxoSmithKline has agreed to plead guilty and pay $3 billion in civil and criminal penalties in a deal with federal prosecutors over its marketing of paroxetine HCl (Paxil), bupropion (Wellbutrin), and other drugs, and for failing to report safety problems with rosiglitazone (Avandia), the government announced Monday.
 One of the medications that was misrepresented is Paxil. Paxil is a widely used in the outpatient treatment substance that controls anxiety and depression. By taking the medication a child not only did not receive any treatment, but was also subjected to "risk of suicidal thinking and behavior":
Paxil
GSK acknowledged that its labeling for paroxetine was false and misleading because the company allegedly promoted Paxil for treating depression in patients under 18, even though the FDA never approved it for use in children and adolescents.
GSK allegedly participated in the publishing of medical journal articles that stated paroxetine was effective in patients under 18, when, in fact, the data showed that the opposite was true. At the same time, the company withheld study data in from two other studies in which Paxil also failed to demonstrate efficacy in treating depression in patients under 18, according to a press release from the Justice Department.
The company also "sponsored dinner programs, lunch programs, spa programs, and similar activities to promote the use of Paxil in children and adolescents," the Justice Department said.
Paroxetine and other antidepressants have carried black box warnings since 2004, stating that antidepressants may increase the risk of suicidal thinking and behavior in patients under age 18.
 I am sure that this is a sad reality for  a lot of patients and providers that have prescribed and most importantly took the medication and suffered from side effects. 


...

Original article appeared in MedPageToday.com. Full body of the article along with the link to the source is listed below:

GSK to Pay $3B for Sales, Safety Violations



WASHINGTON -- GlaxoSmithKline has agreed to plead guilty and pay $3 billion in civil and criminal penalties in a deal with federal prosecutors over its marketing of paroxetine HCl (Paxil), bupropion (Wellbutrin), and other drugs, and for failing to report safety problems with rosiglitazone (Avandia), the government announced Monday.

The initial terms of the agreement were first announced in 2011. The government said this was the largest health fraud settlement in U.S. history.
"Today's historic settlement is a major milestone in our efforts to stamp out health care fraud," Bill Corr, deputy secretary of the Department of Health and Human Services (HHS), said in a press release. "For a long time, our healthcare system had been a target for cheaters who thought they could make an easy profit at the expense of public safety, taxpayers, and the millions of Americans who depend on programs like Medicare and Medicaid. But thanks to strong enforcement actions like those we have announced today, that equation is rapidly changing."

Paxil
GSK acknowledged that its labeling for paroxetine was false and misleading because the company allegedly promoted Paxil for treating depression in patients under 18, even though the FDA never approved it for use in children and adolescents.
GSK allegedly participated in the publishing of medical journal articles that stated paroxetine was effective in patients under 18, when, in fact, the data showed that the opposite was true. At the same time, the company withheld study data in from two other studies in which Paxil also failed to demonstrate efficacy in treating depression in patients under 18, according to a press release from the Justice Department.
The company also "sponsored dinner programs, lunch programs, spa programs, and similar activities to promote the use of Paxil in children and adolescents," the Justice Department said.
Paroxetine and other antidepressants have carried black box warnings since 2004, stating that antidepressants may increase the risk of suicidal thinking and behavior in patients under age 18.

Wellbutrin
The government also alleged that from 1999 to 2003, GSK promoted bupropion -- a drug approved only for major depressive disorder -- for a slew of conditions, including weight loss, the treatment of sexual dysfunction, substance addictions, and attention deficit-hyperactivity disorder.
GSK paid millions to doctors to promote the drug off-label during meetings sometimes held at swanky resorts, the government said. The company relied on pharmaceutical sales reps, "sham advisory boards," and continuing medical education programs that appeared independent but were not.

Avandia
GSK has agreed to pay $243 million for its unlawful conduct concerning the diabetes drug rosiglitazone, in part for failing to give the FDA required post-marketing safety data on the drug. According to the government, the company kept secret data on raised cardiovascular effects.
Since 2007, rosiglitazone has carried a black box warning alerting patients and physicians to the drug's potential increased risk for congestive heart failure and heart attack.
To settle all the criminal charges involving the three drugs -- Paxil, Wellbutrin, and Avandia -- GSK agreed to pay $1 billion.

Civil Settlement
In the civil settlement portion of the resolution announced Monday, GSK agreed to pay $2 billion to settle civil claims that the company promoted Paxil, Wellbutrin, asthma drug combination fluticasone/salmeterol (Advair), anti-epileptic medication lamotrigine (Lamictal), and anti-nausea medicine ondansetron (Zofran) for off-label uses, and that it paid kickbacks to doctors to prescribe those drugs along with migraine drug sumatriptan (Imitrex), irritable bowel syndrome medication alosetron (Lotronex), asthma drug fluticasone (Flovent), and herpes medication valacyclovir (Valtrex).
The civil settlement also levies millions in fines against GSK to settle false claims allegations related to use of Avandia.
In addition, the settlement also requires GSK to pay $300 million to resolve allegations that the company reported false drug prices under Medicaid, making it appear that its drugs were cheaper than what they actually were. As a result, GSK underpaid rebates due to Medicaid and overcharged the government, according to the Justice Department.

Corporate Integrity Agreement
In addition to the criminal and civil resolutions, GSK will participate in a 5-year Corporate Integrity Agreement with the HHS Office of Inspector General that will require the company to make "major changes to the way it does business, including changing the way its sales force is compensated to remove compensation based on sales goals for territories, one of the driving forces behind much of the conduct at issue in this matter," according to the press release.
"For example, company executives may have to forfeit annual bonuses if they or their subordinates engage in significant misconduct, and sales agents are now being paid based on quality of service rather than sales targets," HHS Inspector General Daniel Levinson said in a statement.
GSK CEO Andrew Witty said while charges originated in a "different era for the company," that they "cannot and will not be ignored."
"On behalf of GSK, I want to express our regret and reiterate that we have learnt from the mistakes that were made," he said in a statement.
He said the company has "fundamentally changed" its marketing and selling procedures, including firing employees and changing how sales representatives are paid.

Friday, June 29, 2012

I have found this article yesterday, and I am glad to say that I have been Practice Fusion Certified Consultant and Academic Partner for almost 3 years now. With a lot of skepticism from both providers and patients on the FREE software model, we have implemented it as part of our EHRS (Electronic Health Records Specialist) curricula and I am very happy we did. Having met with Ryan Howard in person, as well as key team members two years back at Practice Fusion user conference in San Francisco I was so moved and found by the whole idea of their business and the quality that they brought to the table. 
 
Implementation of EHR systems within small and medium size practices has always been a challenge, primarily for the users. Building the workflow for the practice and making sure that your staff is computer savvy enough to navigate a system that is being implemented is very hard. 

Interesting to see how in such a short period of time they were able to really build a presence for themselves in the healthcare community. 

Way to go!
 
Practice Fusion Pulls In $34M Series C led by Artis to crush the other eMeadical Record Startups
by Josh Constine. Original article is published by Techcrunch (full body of the article is enclosed below)

 

 

 

 

 


Practice Fusion Red Cross Logo
Practice Fusion is the frontrunner in the fevered race to become the electronic medical record platform, and today it finished raising a $34 million Series C led by hedge fund Artis Ventures to make sure it wins and lead it towards an IPO. Practice Fusion’s valuation is now around a half a billion dollars, it tells me. Startups trying to compete? “We’re squashing them” founder and CEO Ryan Howard tells me. It now hosts 40 million patient records of its 150,000 doctor and other medical professional clients, up from  25 million records and 130,000 clients seven months ago.
The money will fund a patient acquisition strategy, the build-out of its app platform, hires, and attracting more docs to ditch pen and paper for more efficient, accessible electronic records. Howard beams ”We’re excited to light it up. The company’s on fire, growth is maddening. The problem needs to be solved.”
Practice Fusion develops a free, web based electronic medical record platform for physicians that lets them chart data, schedule appointments, electronically prescribe medicine, work with labs, and distribute referral letters — all things that can get in the way of actually helping the sick. It makes money by letting labs, pharmacies, and other service providers to doctors pay to advertise within the platform. There’s both a Practice Fusion desktop interface and iPad app for doctors.
Howard was careful choosing Artis Ventures to lead the round, telling me “it’s a wedding. You’re married to that investor. Artis is a hedge fund with a venture fund. It’s preparing us. It’s who would be buyers in a public market” indicating the company has its sights on an IPO. Artis also backed YouTube.
Practice Fusion now has a total of over $64 million in funding, and Howard admits, “We have a lot of cash on hand.” The full list of investors joining the Series C round includes long-time investors Felicis Ventures and Band of Angels, plus Glynn Capital, Ali and Hadi Partovi, Founders Fund, Morgenthaler Ventures, Scott Banister, SV Angel, Ghost Angel, and several other institutional and individual investors. Practice Fusion now ranks amongst Castlight ($160 million), and ZocDoc ($95 million) as the most heavily funded health startups.
It needs it at the rate its growing. Howard tells me “we brought on about 20 people last month”. It’s got 170 employees now and expects to have 250 by year’s end. Hiring employees that quick is tough right now. “It’s more competitive than ever, especially for engineers” says Howard. But its applying its funding to becoming an attractive place to work, even compared to perked-up giants like Google and Facebook. That’s why it’s investing in a gorgeous San Francisco office, wellness programs, healthy food, and more.
Howard spoke candidly about how he views Practice Fusion’s competitors like Elation EMR. “I see them getting smaller in the rear view mirror. There’s no one in the Valley that keeps me up at night.” As for the big medical companies, “Our largest competitor is Allscripts, and we took on 4x as many new users as them last quarter.” While it wouldn’t disclose exact revenue numbers, the startup told me “in Q1 2012 revenue generation was comfortably in the seven figure range, an increase of more than 500% from the same quarter in 2011.”
With it pulling away from startups in the space, now it just needs to worry about huge, long-standing medical companies. Luckily it’s got a big headstart, and startup power. Howard explains “We’re making sure we can out-innovate anyone else.” And attracting the best talent to make that possible isn’t so hard thanks to its mission. “Someone could die because [a doctor] can’t get access to their chart. Understand, we’re saving lives.”

Launch Date:July 10, 2005
Funding:$70M
Practice Fusion provides a free, web-based Electronic Medical Record (EMR) system to physicians. With charting, scheduling, e-prescribing, billing, lab integrations, referral letters, unlimited support, Meaningful Use certification and a Personal Health Record for patients, Practice Fusion’s EMR addresses the complex needs of today’s healthcare providers and disrupts the health IT status quo. Practice Fusion is the largest and fastest growing EMR community in the country with over 160,000 users and 35 million patients. For more information on Practice Fusion,...