In my many articles on health care reform I have mentioned the can-kicking that is going on with HHS. From the Class Act to discrimination testing, these solutions to our Nation’s health care system have either proven too ill-conceived from the beginning or just too difficult or impossible to implement. HHS has chosen not to admit the lack of merrit in these plans and provide a solution but just to kick the can indefiniately down the road.

Now, the ICD-10.  68,000 new codes for medical providers to follow and be implement by the later part of 2013. HHS announced it is kicking this can down the road on this as well. Read more from Robert Laszewski

A recent WSJ article describes how premium subsidies may not be available to the federally run exchanges. It will ultimately depend on how bold the IRS wants to be interpreting the law. However, HCR only made subsidies available to state run exchanges not federal. There is the glitch.

Another ObamaCare Glitch

My wife religiously reviews the expiration dates of all medications in our cabinets before giving these to any member in our family. One day over the stamped date and out it goes.

Some studies have shown that the drugs in our medicine cabinets are much more stable than their printed expiration dates. I remember one study that discovered a stash of presriptions drugs in an old WWII fallout shelter. Those drugs were tested and were as stable as the day they left the factory 50 years prior.

Dov Michaeli MD PhD a basic researcher and writing at the Doctor Weighs In, contributes to to the topic of expiration dates in his article Some Thoughts on Expiration Dates.

Take the quiz. It’s short, only 10 questions. See what you know about health care reform relative to other Americans.

Kaiser Family Foundation Health Care Reform Quiz

I have known hundreds of people that have been advised to have a procedure called Angioplasty by their cardiologist. To the best of my memory, almost all had a triple by-pass within the year.

With angioplasty, a small balloon is pushed through a small incision in the groin and up to a narrowed coronary artery. It is then inflated to removethe plaque deposit that’s restricting blood flow and causing angina. Then, a stent is inserted to prevent renewed narrowing.

Turns out that nearly half of all angioplasty were unnecessary in the provided study.

Read more.

Health Affairs report on the U.S. health care spending since 1965.

Looks like we have reach 18% mark. But when did all this growth start? Charles Roehrig studies and reports on health care spending in the U.S. since the beginning of Medicare. Lot’s of good data for you analytical types.

Good read.

Please do not forget your limited rights under HIPAA. While you do not necessarily have complete control of your medical records, federal laws does provide you with some limited control over your personal health information (PHI). Two good questions for everyone to review are:

Can an individual revoke his or her Authorization?

Yes. The Privacy Rule gives individuals the right to revoke, at any time, an Authorization they have given. The revocation must be in writing, and is not effective until the covered entity receives it. In addition, a written revocation is not effective with respect to actions a covered entity took in reliance on a valid Authorization, or where the Authorization was obtained as a condition of obtaining insurance coverage and other law provides the insurer with the right to contest a claim under the policy or the policy itself.

The Privacy Rule requires that the Authorization must clearly state the individual’s right to revoke; and the process for revocation must either be set forth clearly on the Authorization itself, or if the covered entity creates the Authorization, and its Notice of Privacy Practices contains a clear description of the revocation process, the Authorization can refer to the Notice of Privacy Practices. Authorization forms created by or submitted through a third party should not imply that revocation is effective when the third party receives it, since the revocation is not effective until a covered entity which had previously been authorized to make the disclosure receives it.

What is the difference between “consent” and “authorization” under the HIPAA Privacy Rule?

The Privacy Rule permits, but does not require, a covered entity voluntarily to obtain patient consent for uses and disclosures of protected health information for treatment, payment, and health care operations. Covered entities that do so have complete discretion to design a process that best suits their needs.

By contrast, an “authorization” is required by the Privacy Rule for uses and disclosures of protected health information not otherwise allowed by the Rule. Where the Privacy Rule requires patient authorization, voluntary consent is not sufficient to permit a use or disclosure of protected health information unless it also satisfies the requirements of a valid authorization. An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.

An authorization must specify a number of elements, including a description of the protected health information to be used and disclosed, the person authorized to make the use or disclosure, the person to whom the covered entity may make the disclosure, an expiration date, and, in some cases, the purpose for which the information may be used or disclosed. With limited exceptions, covered entities may not condition treatment or coverage on the individual providing an authorization.

The Henry J. Kaiser Family Foundation (KFF) is usually very careful not to endorse public or political health policy.  However, a recent paper released by KFF regarding one of their surveys leaves little room for the reader to believe anything other than HCR is all good and somehow the public just does not understand.

The KFF states that ACA “is expected to expand coverage to 32 million of the uninsured”,  expected by who the reader should ask? The wildest estimates I have seen are 22 million or half the uninsured. The most conservative have been only several million. Remember that the high-risks pools were to have some 375,000 individuals enrolled by the end of 2010, however actual enrollment had not reach 12,000. (read more)

ACA has serious problems, impediments for the uninsured to become insured, and it’s not just public perception: 

• Consider that health care and premiums have doubled in about 10 years. Quick math: a 30% subsidy will put you back where you were three years ago. It was expensive then too. And it will be too expensive in 2014 for too many Americans even with subsidies.
• The individual mandate has very little teeth, IRS has almost no authority to go after noncomplying individuals. The Constitution argument is meaningless unless severability become the turning point.
• The Big One: how will people get enrolled in these subsidized options?  The concept of “if you build it they will come” is a bit naïve.  There are serious demographic concerns in this population and their access to go online, enroll, and pay.
• Health care reform appears to be alienating the community’s insurance broker so she will not helping with this education and enrollment process.
• Finally, any reference to the KFF study should be that the general attitude among people is that ACA  just will not help them.  No hope for real affordability.

KFF should demonstrate better respect for the real flaws of ACA and not spin it as if the public just does not understand. People have a sixth sense, KFF would be wise to respect it.