Monday Morning Musings

A new week; a clean slate; starting over.  All good things.  Let's see about the news:

If the Supreme Court strikes down the individual mandate, what will states do?   Some states -- the states that are already working on Exchanges and implementing other aspects of health reform -- may well enact their own individual mandates.  Surely, insurers will be pressing this issue if they are still required to cover people with pre-existing conditions since adding young, healthy people to the pool is necessary to spread the cost of insuring those with pre-existing conditions. 

I'm really upset about this one.  Nonprofit hospitals are paid by the federal government to provide charity care to the poor.  However, the hospitals are getting increasingly aggressive.  Here's one example of a woman who probably was eligible for charity care, but instead, the hospital sent her claim to collections, threatened to garnish her wages, and threatened to sue her over $1800.  These hospitals don't pay taxes because they are supposed to be operating for the public good.  The hospital says they try to determine whether the patient is eligible for charity care, but blames the patient for not providing all the necessary information or otherwise not following the rules.  At the very least, hospitals who do this should lose their tax exempt status.

Years ago, we learned that the company that was responsible for reporting "usual and customary" rates to insurers for calculating out of network reimbursement was owned by UnitedHealth Group -- a clear conflict of interest that was stopped by a settlement agreement with the NY Attorney General.  Now, as insurers continue to diversify, we have to look for these conflicts carefully.   For example, EHR is supposed to help hospitals and other providers fight with insurers to make sure they pay sufficiently and timely.  But EHR was purchased by UnitedHealth Group.  As diversification flourishes, we have to be careful to look for these sorts of problems.

Service dogs are helping soldiers returning from Iraq with PTSD.  We've been learning a lot about service dogs lately; we have a client who's autistic who uses a service dog to keep him calm and focused.  The article linked here is about service dogs who help Iraq veterans who use service dogs to keep them calm when triggers arise that previously would have freaked them out.  These are not your usual dogs; they are highly trained and serve a very specific purpose, depending on the patient's needs.  The more I learn about the use of service dogs, the more respect I have for them and for those who train them. 

Type 2 diabetes is increasing in America's children, associated with obesity and much harder to treat than in adults.  This type of diabetes is new in children -- rarely seen before 1990.  Although it's still rare, it's growing.  And although adults with type 2 diabetes usually get by with oral medications, kids end up needing injections of insulin.  And they're looking at a lifetime of disease.  We need to figure out why this is happening and stop it before it happens.  All of the pediatric patients studied were obese.  So take your kids outside to play.  Don't reward them with high-calorie snacks.  Make food about fuel rather than pleasure.  I know these things only because my parents did everything wrong when it came to my weight.  Be smarter.

Connecticut Children's Medical Center and Athem Blue Cross Blue Shield of CT cannot come to agreement on reimbursement rates.  So children enrolled in Anthem cannot get their insurance to cover their CCMC doctors.  This is disastrous for these kids.  If you are in this situation, contact the Office of the Health care Advocate at 866-466-4446.  They're keeping track of the problems, although none of us are sure what can be done.  I hope the parties can reach a compromise.  It's about the kids; don't forget that. 

Have a great day -- or try to.  Jennifer