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Feeding Medicare’s Infrastructure

Mother Robin Feeds Young in NestMuch like a mother robin feeding her young, Medicare continues to ‘feed’ the infrastructure that serves our elderly – but, with a great deal of waste and inefficiency.

In their recent book, ‘Medicare Meltdown: How Wall Street and Washington are Ruining Medicare and How to Fix It,’ co-authors Rosemary Gibson (aka health care ‘rock star’) and Janardan Prasad Singh, spend a chapter on ‘Fifteen Medicare Facts That Will Astonish You.’ Learning astonishing facts can be fun. But when those facts relate to Medicare, they can be extremely sobering.

Perhaps you can use one or many of these facts to ‘wow’ guests at your next dinner party. Better yet, use them when meeting with those elected to Congress.

1. If Medicare were a country, it would be the 20th largest economy in the world.
That’s right, larger than the entire economy of Sweden – and double that of Ireland!

2. Medicare wastes the equivalent of New Zealand’s entire economy.
In 2011, Medicare spent $560 billion, yet about 30 percent ($170 billion) was wasted and did not benefit our seniors. Where did it go? Blame it on overtreatment, inefficiencies and poor management. (Source: Institute of Medicine)

3. Between now and 2030, Medicare will be adding population equivalents of Austria, Hong Kong, Israel and Switzerland to its rolls.
In 2013, about 49 million people were covered by Medicare, and in 17 years (2030), an estimated 33 million more Americans will be covered.

4. Ten thousand boomers sign up for Medicare every day.
That’s 10 thousand per day for the next 20 years!

5. During a lifetime of work, the average person pays $60,000 for Medicare.
Look at your pay stub, this is the money deducted for the Medicare payroll tax.

6. A new retiree can expect to receive about $180,000 in Medicare benefits.
A person pays in $60,000 and expects to receive, on average, $180,000 in benefits. Economics 101 can’t explain this type of math – unless we mortgage our future.

7. Your federal income taxes pay for a growing share of Medicare’s costs.
Subtract #5 above from #6 (answer: $120,000). From this amount, seniors pay for hospital outpatient care and doctor visits (Part B) and prescription drugs (Part D). The rest is paid by federal income taxes and borrowing – which raises the federal debt.

8. The number of corporate healthcare firms on the Fortune 100 list has increased from zero in 1965 to 15 today.
These firms have benefited greatly from the current Medicare infrastructure. According to Gibson and Singh, the ties that bind Wall Street and Washington in the healthcare industry are strong and their interests are often at odds with those of seniors and boomers.

9. The federal government borrows money from China to pay Medicare bills from hospitals, doctors and drug companies.
Currently, interest rates are low, but can (and will) change in the future. This is not good for our long-term debt problem.

10. President Obama and Rush Limbaugh agree on this fact.
Paying for Medicare is not sustainable at the rate these costs are growing.

11. Between now and 2035, the healthcare industry will reap from Medicare a larger share of the country’s gross domestic product.
As Medicare grows, the federal government will have less money to pay for the nation’s infrastructure, investments in science and technology, education and national security. According to the Congressional Budget Office, if we do nothing to curb this cost, Medicare will consume nearly 25 percent of the value of all goods and services our country produces by 2082. In 2006, Medicare spending was at three percent of GDP.

12. The number of doctors who specialize in caring for seniors is shrinking when more are needed.
The median salary for geriatricians is lower than almost all specialties, threatening the number of new doctors willing to fill this growing role.

13. Medicare’s money for hospital care begins to run out in 2024.
This fact about Medicare Part A comes from a non-partisan report by the Medicare trustees.

14. An estimated, 79,200 Medicare beneficiaries die each year because of preventable harm in hospitals.
This is just an estimate. We really don’t know because actual data of those fatally harmed is seldom reported on a consistent basis. Based on a 2013 report in the Journal of Patient Safety, this number could be much higher.

15. Annual Medicare fraud and abuse is equivalent to one million seniors’ lifetime Medicare contributions.
FBI fraud estimates can be up to 10 percent of what Medicare spends – about $60 billion. In addition, this amount does not include the mistakes made in coding payments and calculating the money Medicare owes to providers. In 2010, Medicare estimated $48 billion was made in ‘improper payments.’

‘Medicare Meltdown’ not only points out the problems but provides a road map on how Medicare can be fixed in the future. Much of what we need is the political willpower to make changes so that we can efficiently provide the necessary care to our seniors.

After all, a mother robin has only so much food to distribute.

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Seriously…Cleveland Clinic?

Sweeping Dirt Under RugHarvard, Yale, Princeton and Stanford – all are very prestigious universities.

Likewise, the Mayo Clinic, Johns Hopkins and Cleveland Clinic – are all are very prestigious medical facilities, right?

Having a stellar reputation takes years (and generations) to build, whether it’s institutions of higher learning, healthcare organizations or law firms, etc. Being ‘prestigious’ comes with many flattering adjectives like: celebrated, trusted, respected, prominent, great, important, imposing, influential, renowned, and exalted.

The Cleveland Clinic has enjoyed this elevated stature for years. But, unfortunately in healthcare, it may be easier (and cheaper) to ‘buy’ an image of quality than it is to consistently perform quality care practices day in and day out – especially when the image is protected by suppressing information from state and federal authorities regarding safety practices.

Believe it or not, Cleveland Clinic was on a “termination track” with Medicare between 2010 and 2013 (19 total months) for more than a dozen inspections that occurred due to patient complaints. Cleveland Clinic was threatened to lose its almost $1 billion annual Medicare reimbursements – quite a hit, even for a multi-billion dollar organization. After repeated Cleveland Clinic violations, the Centers for Medicare and Medicaid Services (CMS) took the unusual step to personally cite CEO Toby Cosgrove and the Cleveland Clinic Governing Board.

In June, Modern Healthcare reported that retired Air Force Col. David Antoon had accused Cleveland Clinic of withholding documents from federal authorities while the Clinic was being investigated for substituting Antoon’s authorized surgeon with a medical resident that resulted in a gross medical mistake. Mr. Antoon suffered serious disabling injuries resulting in the loss of his job as an airline pilot.

According to this article, and based on my correspondence with Mr. Antoon, the Cleveland Clinic hid important documentation from federal inspectors to avoid responsibility (and liability) for their derelict actions. If this can happen at a prestigious institution, you can be confident that it can happen anywhere.

As mentioned in previous blogs, Rosemary Gibson, senior advisor at The Hastings Center, did a splendid job of explaining in her book, “Wall of Silence,” how the ‘medical industrial complex’ in this country is conspicuously silent when it comes to medical mistakes that kill and injure millions of Americans.

U.S News & World Report recently published the ‘Best Hospitals Rankings’ and placed the Cleveland Clinic in the top position for Urology. In contrast, Healthgrades ranked Cleveland Clinic with the lowest possible score for prostatectomy outcomes; CMS data for Hospital Acquired Conditions (HACs) placed Cleveland Clinic in the bottom 7% of all hospitals with a score of 8.7 (scores ranging from 1- 10, with ten being the worst); and the independent Leapfrog Group gave the first ever “D” grade to Cleveland Clinic for patient safety. WDAF-TV (Kansas City, MO) recently reported that hospitals must pay US News to use the “Best Hospitals” logo in advertising. Many rating organizations charge hospitals to market their grades. So what can the public believe: “pay to play” advertising or independent reviews?

The Cleveland Clinic will continue to pay US News to market itself as evidence that they are a ‘prestigious’ medical organization, and yet quietly sweep the CMS action, and other independent negative reviews, under the rug.

Again, my point is simple. If this happens to the prestigious Cleveland Clinic, it can happen anywhere – and it does. Unfortunately, the Cleveland Clinic story is only the tip of the proverbial medical iceberg. The medical industry is unwilling and, quite frankly, unable to reform itself from within. Because of this reluctance, it is now time for the public to apply transparency measures. Our own lives may depend on it.

As the saying goes: “Fool me once, shame on you. Fool me twice, shame on me.” I think this easily applies to all of us who continue to allow the medical establishment to self-regulate with secrecy – resulting in unnecessary harm to unsuspecting patients.

I’d love to hear your thoughts.

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A Health Care ‘Rock Star’

In April, I had the pleasure to meet and host a health care ‘rock star’ in my office, Rosemary Gibson. Rosemary is a Senior Advisor at The Hastings Center, an Rock-star“independent, non-partisan, non-profit bioethics research institute” based in New York.

In addition to having a very impressive and powerful resume, Rosemary has written four books that provide critical insight into our health care system that is both disturbing and, quite frankly, outrageous. These extremely well-written books are co-authored by, Janardan Prasad Singh, an economist at the World Bank. After meeting with Rosemary, I quickly purchased all four books and challenged myself to find time to devour them in short order.

Rosemary Gibson’s books include:

  1. Wall of Silence: The Untold Story of the Medical Mistakes That Kill and Injure Millions of Americans.
  2. The Treatment Trap: How the Overuse of Medical Care is Wrecking Your Health and What You Can Do to Prevent It.
  3. Medicare Meltdown: How Wall Street and Washington are Ruining Medicare and How to Fix It.
  4. The Battle Over Health Care: What Obama’s Reform Means for America’s Future.

Using her extensive knowledge, Rosemary passionately speaks the unmitigated truth about a very complex and perverse health care ‘system’ in which we all participate. As an example, Rosemary shared with me this-alarming (if not mortifying) fact about health care spending in the U.S. that was generated by the Congressional Budget Office (CBO):

“If historical health care spending trends continue, the U.S. will be spending 99 percent of its Gross Domestic Product on health care by 2082.” That’s right – 99 percent in about 68 years! (Source: CBO. The Long-Term Outlook for Health Care Spending. Appendix D. November 2007).

Our country currently spends about 18 percent of our GDP on health care, which makes it nearly one-sixth of our existing economy. If accurate, the CBO estimate would essentially mean our entire economy would consist of health care – which is absolutely astounding!

Granted, the CBO report was published in November 2007, about three years prior to the passage of the Affordable Care Act (ACA). Yet, many experts argue that the ACA was more about covering additional people under different types of health care plans (both public and private), than attempting to control the cost of health care.

Rosemary was greatly interested in our recently published white paper, ‘Voices for Value,’ on how Iowa employers view the health care provider community. 

I’m looking forward to finding new ways to collaborate with Rosemary in the future and welcome her expertise here in Iowa. Rosemary’s background and critical insight into our fractured health care system is greatly appreciated as we strive to find new opportunities to make a difference.

You will hear more about this health care ‘rock star’ in future blogs – stay tuned!

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