SILLY SARA PALIN, "Death Panels" in the STIMULUS BILL not the Health Care Bill

[jillian]

http://www.nytimes.com/2010/12/26/us/politics/26death.html?_r=1&ref=robertpear

OH hi everyone.....TOLD YOU SO! (although the snuck it back into the health care bill before final signing)

the link is to a sign in page.

 

[PLYMCO_PILGRIM]

http://www.nytimes.com/2010/12/26/us/politics/26death.html?_r=1&ref=robertpear

OH hi everyone.....TOLD YOU SO! (although the snuck it back into the health care bill before final signing)

the link is to a sign in page.

I just clicked it and it took me to a nytimes article by Robert Pear.

http://www.nytimes.com/2010/12/26/us/politics/26death.html?_r=2&ref=robertpear

Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.

Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democrats’ bill would allow the government to cut off care for the critically ill.

The final version of the health care legislation, signed into law by President Obama in March, authorized Medicare coverage of yearly physical examinations, or wellness visits. The new rule says Medicare will cover “voluntary advance care planning,” to discuss end-of-life treatment, as part of the annual visit.

 

[Greenbeard]

Read the following pages 445, 454, 479. Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.

The HITECH Act doesn't have anything in it about the federal government tracking your treatments. They don't get access to your medical records. But I agree, having electronic health records is going to be extremely beneficial.

442, 446. One new bureaucracy, the National Coordinator of Health Information Technology (lovingly referred to by conservatives as DEATH PANEL), will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective.

The Office of the National Coordinator is not new. It was created in 2004 through an executive order from President Bush. What HITECH did was establish it as a matter of law, such that future presidents couldn't simply eliminate it with a new executive order. And no, they don't monitor treatments, certainly not for cost effectiveness.

The meaningful use requirements do have quality reporting requirements, all quality measures endorsed by the National Quality Forum. These are percentages that the provider submits to Medicare to preserve his fee schedule and collect his bonus (or, in the case of the Medicaid incentive program, the provider submits this to his state government to get his bonus payment). These are very simple percentages, not intrusive and not containing information on individual patients. For example, one of the core clinical quality measures incorporated into the meaningful use criteria is NQF#0013: "Patients more than 18 years old who have a diagnosis of hypertension seen in at least two office visits, with blood pressure recorded."

The goal is to reduce costs and “guide” your doctor’s decisions (442, 446).

It's hard to tell if you were purposefully misreading what it says. The federal government isn't what guides clinical decisions; the text of the legislation says "...a nationwide health information technology infrastructure that allows for the electronic use and exchange of information and that— ... provides appropriate information to help guide medical decisions at the time and place of care." The NHIN is a set of standards and protocols for data transfer (being developed now) that will allow your doctor to get information from Point A to Point B. Health information exchange is what provides the guidance to your doctor, not a government bureaucrat or whatever it is you're imagining or implying.

These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.” [/COLOR]

What is the context of the statement? Is he saying doctors should be part of accountable care organizations? Or that they should use procedural checklists? Or that they should rely more on outside clinical decision support via HIT (like these doctors in Minnesota) to reduce medical errors?

Pages 511, 518, 540-541. Hospitals and doctors that are not “meaningful users” of the new system will face penalties. “Meaningful user” isn’t defined in the bill. That will be left to the HHS secretary, who will be empowered to impose “more stringent measures of meaningful use over time”

Meaningful use is being defined in three stages. The first stage definition was released in July and was discussed in this thread.

The penalties, by the way, could use some elaboration. HITECH sets up an incentive program for providers who start using electronic health records and have the capability to engage in health information exchange with other providers. That's what "meaningful use" is--the standard by which to judge whether or not a provider has qualified for an incentive payment. This incentive program is open to doctors and hospitals who participate in Medicare of Medicaid (since the government is acting in its role as a payer here). Medicaid providers don't ever face penalties for not becoming meaningful users; they can, however, receive incentive payments of up to $63,750 if they become meaningful users by the end of the program (i.e. 2021).

Medicare providers can receive payments of up to $44,000 if they become meaningful users. Medicare providers, however, also face penalties for not becoming meaningful users. Those penalties are a 1% (eventually growing to 3%, if I recall correctly) reduction in the fee schedule that reimburses them. So a Medicare-participating doctor who in ten years still uses paper records will be paid 97% of the standard payment for each procedure he provides to a Medicare patient (obviously payments he receives from private payers are unaffected).

pages 190-192. What penalties will deter your doctor from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment? The vagueness is intentional. In his book, Daschle proposed an appointed body with vast powers to make the “tough” decisions elected politicians won’t make.

The stimulus bill does that, and calls it the Federal Coordinating Council for Comparative Effectiveness Research. The goal, Daschle’s book explained, is to slow the development and use of new medications and treatments.

The Federal Coordinating Council for Comparative Effectiveness Research no longer exists, it's been supplanted. And you're conflating electronic health record incentives/penalties with comparative effectiveness research. The former is not a vehicle for the latter. They're both part of a larger health strategy but their interaction with each other is minimal.

Page 464. Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost- effectiveness standard set by the Federal Council
(Read Death Panel to many who don't trust the government)

Not only is this false, there's nothing that could even be misconstrued as that on the page you reference.