Physicians (including a former CMS administrator) talk about their experiences with Medicare.
by Richard Peck
Contributing Writer, MedPage Today
This is the last in a four-part series, Medicare at 50, on the history and possible future of Medicare.
Focusing on the historic relationship of Medicare with practicing physicians, this series would not be complete without direct comments from physicians and policy experts familiar with physicians' issues. MedPage Today contacted practicing physicians and policy experts for their opinions on the program's achievements and problems. Some have already been cited elsewhere in these articles, some appear here for the first time:
Brobson Lutz, MD, Internal Medicine and Infectious Disease, New Orleans: "I've been in a partnership in practice since 1978, and we took a real hit with the fee freezes under President Reagan. I understand why they happened -- some specialists were increasing their fees to the stratosphere. Also, for something like back pain, a patient can't leave an orthopedic surgeon's office without studies of all kinds for something we treat all the time, and much less expensively. Physicians who do unnecessary tests have their consciences to live with -- I just won't send patients to them."
- continued at MedPage Today:
Wednesday, April 1, 2015
By NIHAL KRISHAN
WASHINGTON – The number of people with health insurance in Arizona rose even as the state economy was falling from 2007 to 2010, when both trends reversed direction, according to a recent report by the Census Bureau.
The report said the number of people with health insurance in the state improved slightly in the period from 2006 to 2013, going from 21.8 percent uninsured to 20 percent without insurance. That moved Arizona from fifth-worst in the nation to eighth-worst, the Census numbers showed.
Rural areas have higher mortality rates
BISBEE — So that emergency crews, nurses, doctors can provide the best treatment possible as quickly as possible, Copper Queen Community Hospital hosted a special training event in January.
Claudia Romo, RN and Emergency Department Infection Prevention Department with CQCH, arranged the special Rural Trauma Team Development Course (RTTDC) in connection with Banner Health and the AZFlex Program. The course was focused on developing a “trauma team” that would work together for the best possible outcome for injured rural residents.
Videoconferencing is Being Used to Broaden Services and Cut Costs
DOUGLAS — In its convalescence, the county-owned, long-struggling hospital in Douglas is expected to bring new services and value to hospitals, clinics, and institutions throughout Cochise County.
In the past year under new management, coming out of its most recent federal bankruptcy process, the facility has seen an overhaul among its administration and vendors. An array of new medical equipment has been installed, a groundbreaking telemedicine communications program is afoot, and the new managers are meeting the hospital’s payroll obligations.
Hospital's investments in equipment, staff widens range of available services
KINGMAN - When Melanie Reynoso temporarily moved here three years ago to work at the Kingman Regional Medical Center Cardiovascular Center, it didn't take her long to realize her traveling days were over.
Reynoso, a traveling nurse who spent 13 weeks each at various hospitals across the country before settling here, has been a full-time staffer now for three years. And the nurse educator and clinical leader for the cardiovascular center plans to stay right here in Kingman and continue her employment with the hospital.
By Stephanie Innes, The Arizona Daily Star, Tucson | March 16, 2015
March 16--A case under consideration by the U.S. Supreme Court could have a significant impact on health insurance coverage in Arizona.
Health policy expert Dr. Daniel Derksen of the University of Arizona’s Mel & Enid Zuckerman College of Public Health says if the individual and employer mandates (tax penalties for not having coverage) are found to be illegal in the 34 affected states, insurance rates could go up.
“Many economists argue that this would precipitate the dreaded ‘death spiral’ whereby insurers are required to cover everyone, are prohibited from excluding or charging more for those with chronic (pre-existing) conditions,” Derksen said.
“Without individual and employer mandates, the fiscal risk can’t be pooled, fewer get insurance, those that keep insurance are increasingly those with chronic illnesses, and the insurance companies can’t make the margins work and charge higher premiums, which makes insurance less affordable.’
And while the subsidies of 150,000 Arizonans would be directly affected, Derksen said the entire federal health exchange could fall apart with a ruling against the government, and “it would be prudent for states to prepare for their decision when it is announced before or in June.”
Access to primary care providers in rural AZ is a problem. Our National Health Service Corps Loan Repayment Program and the State Loan Repayment Program are part of the solution- recruiting primary care workforce resources in those areas. Still, there’s not enough providers in rural Arizona- and 150 rural communities in Arizona need access to primary care providers.
To help alleviate this problem and support recruitment of providers in rural areas, our Bureau of Health Systems Development recently developed a partnership with the Center for Rural Health and the Arizona Alliance of Community Health Centers to support the National Rural Recruitment and Retention Network (3RNet) Program. It’s kinda like a Match.com for linking health care professionals and jobs in rural and underserved areas.
The 3RNet Program is made up of members from state agencies and non-profit organizations that work together to help many health care professionals find jobs in rural and underserved areas. They also work collaboratively to provide technical assistance to clinics about this free recruitment tool. This provides clinics with no cost marketing including tools allowing them to post online photos, detailed descriptions, maps, and other materials to attract health care professionals.
For questions about the 3RNet Program, please email the representatives from each individual agency: Ana Roscetti at Ana.lyn.Roscetti@azdhs.gov, Joyce Hospodar at email@example.com, or Lourdes Paez at firstname.lastname@example.org. If you’re an employer or clinic, register to become a 3Rnet user here.
The Telemedicine & Telehealth Service Provider Directory is a service of the Arizona Telemedicine Program. The directory is a resource for hospital and healthcare administrators and other decision-makers who want to expand or improve their healthcare services to their patients, employees, clients, etc.
Jan 5, 2015 -- Describes efforts to increase Native American and Alaskan Native enrollment in the Affordable Care Act health insurance marketplace, including creating culturally appropriate brochures, using bi-lingual outreach workers, and having mobile technologies available in the field to process sign-ups instantly.
The Rural Assistance Center has published a new topic guide on Community Health Workers in Rural Settings. Resources include a Community Health Workers (CHWs) toolkit to assist in developing a CHW program, FAQs about CHWs, and links to relevant publications, organizations and funding opportunities. Access the guide here: http://bit.ly/1zOnNBO
(November 20, 2014—Parker, Arizona) Today, on National Rural Health Day, Agriculture Secretary Tom Vilsack announced that LaPaz Regional Hospital has received a Telemedicine Grant for $316,800 through the USDA Rural Development’s Distance Learning and Telemedicine Program.
La Paz Regional Hospital plans to use the funding to serve their main hospital in Parker, Arizona and four clinical outreach sites in Quartzsite, Salome, Bouse and Parker. The hospital is the only public access hospital in the county—a county with over 4,000 square miles…and yet only 25,000 residents. The grant funds will be used to expand videoconferencing connections to this large, sparsely populated area to provide more direct contact with physicians in the participating communities.
The project is located in the Colorado River Indian Tribe’s jurisdictional area and will benefit this underserved tribal area.
The Secretary also highlighted initiatives created by the Affordable Care Act that specifically address critical health needs in rural communities.
“Delivering these programs to rural communities that often do not have access to quality, affordable medical services has tremendous economic and social benefits,” Vilsack said. “They also mean that people who live and work in rural areas will not have to travel long distances for specialized health care services.”
In addition to today’s announcements, Secretary Vilsack encouraged rural Americans to take advantage of the Health Insurance Marketplace created by the Affordable Care Act and discussed the health care reform law’s specific benefits for rural communities.
“Rural residents have higher rates of chronic conditions. This can be exacerbated by a lack of doctors or clinics in rural communities,” Secretary Vilsack continued. “The Affordable Care Act is improving the health of rural communities and giving all families the security they deserve. No one should go without healthcare because of where they live, or be forced to leave the communities they love to get the coverage they need.”
Rural Americans suffer from higher rates of chronic conditions like diabetes, heart disease and high blood pressure. The Affordable Care Act has taken steps to address the unique challenges rural communities face when it comes to getting the health care they need.
One in five uninsured Americans lives in a rural area, and yet on average only 10 percent of the nation’s physicians practice in these communities. The Affordable Care Act has significantly increased the size of the National Health Service Corps, which offers scholarships and loan repayment to health practitioners in return for practicing in rural communities and other underserved areas. More than 3,500 Corps members now serve in rural areas, and an average of 86 percent of them will remain in their communities even after completing their service.
The Affordable Care Act also invests significantly in expanding services at community health centers, where 7.5 million rural Americans get access to primary and preventive care. That comes on top of the more than $3 billion USDA has invested since 2009 to strengthen health infrastructure in rural areas, building rural hospitals and health clinics and expanding access to health care in remote rural areas through telemedicine.
Not only can a lack of health insurance coverage help lead to high rates of chronic conditions, it threatens rural families’ economic health as well. Before the Affordable Care Act passed, the average rural family paid nearly 50% of all health costs out of pocket. One in five farmers is in debt because of medical bills. Uninsured individuals living in rural areas are able to use the Marketplaces to compare qualified health plan insurance options based on price, benefits, quality, and other factors with a clear picture of premiums and cost-sharing amounts to help them choose the qualified health insurance plan that best fits their needs.
Open Enrollment for the Health Insurance Marketplace began Nov. 15, 2014, and runs through Feb. 15, 2015. Those who have plans can continue them without re-enrolling. However, consumers are encouraged to visit HealthCare.gov to review and compare health plan options and find out if they are eligible for financial assistance, which can help pay monthly premiums and reduce out-of-pocket costs when receiving services. In order to have coverage effective on Jan. 1, 2015, consumers must enroll or update their coverage by December 15.
Consumers can find local help at: Localhelp.healthcare.gov or call the Federally-facilitated Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325. Translation services are available. The call is free.
To preview plans in your area, visit: www.healthcare.gov/see-plans/
For more information about Health Insurance Marketplaces, visit: www.healthcare.gov/marketplace
The Univ. of AZ Center for Rural Health will join the National Organization of State Offices of Rural Health (NOSORH) and other state/national rural stakeholders in celebrating National Rural Health Day on Thursday, November 20, 2014.
NOSORH created National Rural Health Day as a way to showcase rural America; increase awareness of rural health-related issues; and promote the efforts of NOSORH, State Offices of Rural Health and others in addressing those issues. Plans call for National Rural Health Day to become an annual celebration on the third Thursday of each November.
Approximately 62 million people – nearly one in five Americans – live in rural and frontier communities throughout the United States. “These small towns, farming communities and frontier areas are wonderful places to live and work; they are places where neighbors know each other and work together,” notes NOSORH Director Teryl Eisinger. “The hospitals and providers serving these rural communities not only provide quality patient care, but they also help keep good jobs in rural America.”
These communities also face unique healthcare needs. “Today more than ever, rural communities must tackle accessibility issues, a lack of healthcare providers, the needs of an aging population suffering from a greater number of chronic conditions, and larger percentages of un- and underinsured citizens,” Eisinger says. “Meanwhile, rural hospitals are threatened with declining reimbursement rates and disproportionate funding levels that makes it challenging to serve their residents.”
State Offices of Rural Health play a key role in addressing those needs. All 50 states maintain a State Office of Rural Health, each of which shares a similar mission: to foster relationships, disseminate information and provide technical assistance that improves access to, and the quality of, health care for its rural citizens. In the past year alone, State Offices of Rural Health collectively provided technical assistance to more than 28,000 rural communities.
Tuesday, Sept. 30, 2014
By CARLENE REYES
Access Across Arizona is an initiative to increase news coverage in Arizona communities often underreported by mainstream news media. Using advanced cellular broadcast technology, Cronkite News students travel to Arizona’s rural communities to produce broadcast, digital and live-television reports via Arizona PBS. This technology was made possible by a grant from the ASU Foundation and Women & Philanthropy.
Rural Health Professions Program:
• At the University of Arizona College of Medicine, of the 156 graduating participants between 2000 and 2010, 48 are practicing in rural areas of Arizona and 44 are in urban, underserved areas.
• In the 2013 calendar year, 870 health profession students from all three universities participated.
•152 medical students from Tucson and Phoenix’s UA College of Medicine campuses completed rural rotations (minimum four weeks) last year.
Source: University of Arizona
SNOWFLAKE – Dr. Darrell Brimhall knew from age 10 that he wanted to practice medicine in his hometown, but it wasn’t until high school that he realized just how important his role as a doctor would be to this small community.