Protect Health Care For All Americans!
Responding to the tragic shooting in Tuscon, Congress has wisely postponed its House vote on repeal of the Affordable Care Act. The vote is now scheduled for Wednesday, Jan. 19th.
South Carolinians, please urge our congressmen to preserve the new Affordable Care Act ahead of next week's House vote! The new health care law contains too much good for us to abandon it. See below what South Carolina would lose with its repeal, and then please let your voice be heard!
Our partners at Families USA are hosting call-in days on January 18th and 19th to send the message to Congress: Vote NO on repeal. We encourage you to join us in this effort. Please feel free to use their toll-free number to the capital switchboard:
1-866-922-4970.
Without the Affordable Care Act:
- Critical Consumer Protections Would Be Lost:
o 18,100 young adults would lose their insurance coverage through their parents' health plans, sometimes just after they finish school and as they are looking for a job. Families across South Carolina would lose the peace of mind the Affordable Care Act provides by making sure that young adults can stay on their parents plan to age 26 if they do not have coverage of their own.
o Nearly 2.3 million residents of South Carolina with private insurance coverage would suddenly find themselves vulnerable again to having lifetime limits placed on how much insurance companies will spend on their health care.
o Insurance companies would once again be allowed cut off someone's coverage unexpectedly when they are in an accident or become sick because of a simple mistake on an application. This would leave 290,000 people in South Carolina at risk of losing their insurance at the moment they need it most, as one of the worst abuses of the insurance industry would become legal again.
o 290,000 residents of South Carolina would not know if they are receiving value for their health insurance premium dollars, as insurers in state would no longer be required to spend at least 80 to 85 percent of premium dollars on health care rather than CEO salaries, bonuses, and corporate profits.
o New insurance plans would no longer be required to cover recommended preventive services, like mammograms and flu shots, without cost sharing, nor would they have to guarantee enrollees the right to choose any available primary care provider in the network or see an OB-GYN without a referral.
o 714,000 seniors in South Carolina who have Medicare coverage would be forced to pay a co-pay to receive important preventive services, like mammograms and colonoscopies.
o Medicare would no longer pay for an annual check-up visit, so 714,000 seniors in South Carolina who have Medicare coverage would have to pay extra if they want to stay healthy by getting check-ups regularly.
- 39,717 on Medicare Would See Significantly Higher Prescription Drug Costs: In South Carolina, 39,717 Medicare beneficiaries received a one-time, tax-free $250 rebate to help pay for prescription drugs in the "donut hole" coverage gap in 2010. Medicare beneficiaries who fall into the "donut hole" in 2011 will be eligible for 50 percent discounts on covered brand name prescription drugs. Without the law, the burden of high prescription drug costs would hurt millions of Medicare beneficiaries nationwide.
- South Carolina Would Not Receive Additional Resources to Crack Down on Unreasonable Insurance Premium Increases: States would not have new resources to review proposed health insurance premium increases and hold insurance companies accountable for unjustified premium increases.
- South Carolina Would Not Receive Additional Funds to Plan for a Health Insurance Exchange: States would not have new resources to build a new, competitive, private health insurance marketplace for consumers that provides lower costs, one-stop insurance shopping, and greater benefits and protections.
- South Carolina Would Not Receive Additional Funds to Support a Consumer Assistance Program: States would not have new resources to help protect consumers from some of the worst insurance industry practices.
- 33 Employers Would Not Be Receiving Help from the Early Retiree Reinsurance Program: Businesses, schools and other educational institutions, unions, State and local governments, and non-profits would not be receiving much-needed financial relief to help early retirees and their families continue to have quality, affordable health coverage. Find a list of organizations in your state that would not have been accepted into this program here.
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State officials have fined 12 California hospitals for medical errors that in some cases killed or seriously injured patients, according to a report made public Friday.
California Department of Public Health officials have required all facilities - which may appeal the fines - to submit plans to correct the problems. Among the facilities fined are eight in Southern California.
USC University Hospital, east of downtown Los Angeles, was fined $50,000 after pharmacists and staff gave a female patient with cystic fibrosis five overdoses of medication in February, causing kidney failure and seizures and requiring dialysis.
The hospital has since retrained nurses to verify prescription orders, created a new pilot program to ensure medications are administered correctly and started randomly auditing medication orders, according to a plan of correction submitted to the state. It was the first time the hospital had been fined.
Citrus Valley Medical Center in Covina was fined $25,000 after state investigators found that a metal piece of a surgical sealing device was left inside an 80-year-old woman during bypass surgery in August 2008. The woman needed a second surgery to have the device removed.
Hospital officials notified the device's manufacturer, who replaced it with an upgraded model and retrained staff on how to use it, according to the hospital's plan of correction. It was the first time the hospital had been fined. It does not plan to appeal, a spokeswoman said.
Southwest Healthcare System in Murrieta, which includes Inland Valley and Rancho Springs Medical Centers, received its seventh fine, $25,000. Investigators found that surgeons left a retractor in a 22-year-old woman during exploratory surgery after she delivered a baby at the hospital in May 2008. The woman had to undergo a second surgery to remove the retractor.
Southwest has received more fines than any other hospital in the state. In April, it received three, including the largest fine ever issued, $100,000, after investigators determined that doctors performed caesarean sections using electrical cauterizing instruments in a delivery room with dangerously low humidity, which could have sparked a fire. A day later, federal officials said they planned to cut the hospital's Medicare funding, but they reached a settlement agreement in May that required the hospital to make improvements.
The latest fine will not jeopardize that agreement, state regulators said Friday.
Ken Rivers, Southwest's chief executive, said it does not plan to appeal the latest fine. "Since this incident, Southwest enhanced its processes, practices and training relating to surgical counts, which has resulted in 100% accuracy," he said in a Friday statement.
Western Medical Center-Santa Ana was fined $75,000, its third fine, after state inspectors found that the staff had used potentially ineffective vaccines to inoculate an adult against tetanus and 1,641 newborns against Hepatitis B, including some born to mothers who tested positive for the virus.
An investigator found that hospital pharmacists had stored the vaccines at temperatures below freezing, against manufacturers' recommendations. The hospital later notified the babies' parents and 661 patients who received tetanus vaccines, created a vaccine hotline and held a re-vaccination clinic.
Shelle Malm, a spokeswoman for the hospital, said it is "committed to ensuring quality patient care and patient safety" and that administrators have worked with state regulators and "have set up new policies and procedures as well as staff training and rectified the findings."
Kindred Hospital Westminster was fined $25,000 after an obese patient developed 11 bed sores and lost 64 pounds within four months of being admitted in April 2008.
Placentia-Linda Hospital was fined $25,000 after surgeons replacing a patient's left knee in February 2008 used a part designed for the right knee. The patient returned to the hospital five months later complaining of knee pain and had to undergo a second surgery to fix the knee, according to the state investigator's report. The hospital has since created a new policy for double-checking orthopedic implants during surgery, and it retrained staff and suppliers.
The state also fined two hospitals in San Diego County and four hospitals in Northern California.
Scripps Memorial Hospital La Jolla was fined $50,000 after a surgical towel was left in an 80-year-old man for four months after surgery, and Palomar Medical Center in Escondido was fined $50,000 after a woman in intensive care fell out of bed, became disconnected from her oxygen and IV, and later died.
The state issued two fines to UC San Francisco Medical Center for a total of $50,000; two fines to California Pacific Medical Center in San Francisco for a total of $125,000; a $25,000 fine to Hanford Community Medical Center and a $50,000 fine to Petaluma Valley Hospital.
The state has issued 170 fines since they were first required by law in January 2007, a spokeswoman said. In all, 112 hospitals have been fined and the state has collected $3.65 million. Of those fined, 39 hospitals have appealed, she said.
By Molly Hennessy-Fiske, Los Angeles Times November 13, 2010
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Updated and adapted from the book "1,001 Things They Won't Tell You: An Insider's Guide to Spending, Saving, and Living Wisely," by Jonathan Dahl and the editors of SmartMoney.
1. "Oops, wrong kidney."
In recent years, errors in treatment have become a serious problem for hospitals, ranging from operating on the wrong body part to medication mix-ups.
According toa report from the Institute of Medicine, at least 1.5 million patients are harmed every year from medication errors. One reason these mistakes persist: Only 15% of hospitals are fully computerized with a central database to track allergies and diagnoses, says Robert Wachter, chief of the medical service at University of California San Francisco Medical Center.
But signs of change are emerging. More than 3,000 U.S. hospitals, or 75% of the country's beds, signed on for a 2006 campaign by the Institute for Healthcare Improvement implementing new prevention measures such as multiple checks on drugs. In the first 18 months of the campaign, these hospitals had prevented an estimated 122,300 avoidable deaths.
While the system is improving, it still has a long way to go. Patients should always have a friend, relative or patient advocate from the hospital staff at their side to take notes and make sure the right meds are being dispensed.
2. "Getting out of the hospital doesn't mean you're out of the woods."
A study released last week by Resources for the Future, a nonprofit group that conducts independent research on public health issues, says that infections of sepsis and pneumonia acquired in the hospital may kill 48,000 people each year. What's more, the study shows, these infections cost $8.1 billion to treat and lead to 2.3 million total days of hospitalization.
Such revelations, along with the recent increase in antibiotic-resistant bugs and the mounting cost of health care, have mobilized the medical community to implement processes designed to decrease infections. These include using clippers rather than a razor to shave surgical sites and administering antibiotics before surgery but stopping them soon after to prevent drug resistance.
For all of modern medicine's advances, the best way to minimize infection risk is low-tech: Make sure anyone who touches you washes his or her hands. Tubes and catheters are also a source of bugs, and patients should ask daily if they are necessary.
3. "Good luck finding the person in charge."
Helen Haskell repeatedly told nurses something didn't seem right with her son Lewis, who was recovering from surgery to repair a defect in his chest wall. For nearly two days she kept asking for a veteran - or "attending" - doctor when a first-year resident's assessment seemed off. But Haskell couldn't convince the right people that her son was deteriorating. "It was like an alternate reality," she says. "I had no idea where to go." Thirty hours after her son first complained of intense pain, the South Carolina teen died of a perforated ulcer.
In a sea of blue scrubs, getting the attention of the right person can be difficult. Who's in charge? Nurses don't report to doctors but rather to a nurse supervisor. And your personal doctor has little say over radiology or the labs running your tests, which are managed by the hospital. Some facilities employ "hospitalists" - doctors who act as a point person to conduct the flow of information. Most hospitals now have rapid response teams - teams of specialized personnel that can rush to the bedside to assess a declining patient. Haskell urges patients to know the hospital hierarchy, read name tags, get the attending physician's phone number, and know how to reach the rapid response team. If all else fails, demand a nurse supervisor - likely the highest-ranking person who is accessible quickly.
4. "Everything is negotiable - even your hospital bill."
When it comes to getting paid, hospitals have their work cut out for them. Medical bills are a major cause of bankruptcy in the U.S., and when collectors are put on the case, they take up to 25% of what is reclaimed, according to Dr. Mark Friedman, founder of billing consultant Premium Healthcare Services. That leaves room for some bargaining.
If you're among the uninsured - who can pay up to three times more for procedures - it doesn't hurt to ask for a deduction. Some hospitals provide a 35% to 40% discount for uninsured patients, says Candice Butcher, CEO of Medical Billing Advocates of America. Hospitals frequently work with patients offering payment plans or discounts. But to get it, you have to knock on the right door: Look for the office of patient accounts or the financial assistance office.
If you don't have insurance and are scheduled for a colonoscopy in a week, Butcher suggests doing some research to find out how much that procedure typically runs in your area. The site healthcarebluebook.com lets consumers check health-care prices by zip code. You can use that as a negotiation tool. But remember, "if the hospital agrees to your price, you need to get it in writing and get it signed," says Butcher.
5. "Yes, we take your insurance - but we're not sure about the anesthesiologist."
The last thing on your mind before surgery is making sure every doctor involved is in your network. But since the answer is often no for anesthesiologists, pathologists and radiologists, what's a patient to do? Los Angeles-based entertainment lawyer and patient advocate Michael A. Weiss repeatedly turned away out-of-network pain-management doctors on a recent visit to the hospital.
If you're alert enough, ask for someone in your network. If you're seeing a physician or going to any medical facility, call your insurance company for a current list of network physicians, hospitals and labs. Also, if the referral appointment is being made by your primary-care physician, request the scheduling staff to find specialists, hospitals and labs in your network. Then verify that with your insurance company, says Mary Jane Stull, president and CEO of The Patient's Advocate, a South Bend, Ind., firm that helps people with medical insurance claims. Medical providers can drop out of a network between the preoperative appointment and the actual surgery date. And if you know your procedure will be out-of-network, call the medical providers: physicians, surgeon, anesthesiologist, and hospital. It might be worthwhile to try to negotiate a price and payment plan with the billing department, Stull says.
6. "Sometimes we bill you twice."
Crack the code of medical bills, and you may find a few surprises: charges for services you never received or for routine items, such as gowns and gloves, which shouldn't be billed separately. Clerical errors are often the reason for mistakes; one transposed number in a billing code can result in a charge for placing a catheter in an artery vs. a vein - which can come to a difference of thousands of dollars.
So how do you figure out if your bill has incorrect codes or duplicate charges? Start by asking for an itemized bill with a breakdown of all charges clearly defined, says Dr. Geni Bennetts, principal of Resolve Healthcare Billing Advocacy in Napa, Calif. Some telltale mistakes: charging for three days when you stayed in the hospital overnight, a circumcision for your newborn girl, or drugs you never received. Ask the hospital's billing office for a key to decipher the charges, or hire an expert to spot problems and deal with the insurance company and doctors (you can find one at billadvocates.com).
Their expertise typically will cost anywhere between $65 and $85 an hour, a percentage of the savings, or some combination of the two. If you want to be your own billing sleuth, talk to the highest-ranking administrator you can find in the hospital finance or accounts office to begin untangling any mistaken codes.
7. "All hospitals are not created equal."
How do you tell a good hospital from a bad one? For one thing, nurses. When it comes to their own families, medical workers favor institutions that attract nurses. But they're harder to find as the country's nursing shortage intensifies - by 2020, there will be a deficit of about one million nurses. Low nurse staffing directly affected patient outcomes resulting in more problems, such as urinary tract infections, shock and gastrointestinal bleeding, according to a 2001 study by Harvard and Vanderbilt University professors.
Another thing to consider: Your local hospital may have been great for welcoming your child into the world, but that doesn't mean it's the best place to undergo open-heart surgery. Find the facility with the longest track record, best survival rate and highest volume in the procedure; you don't want to be the team's third hip replacement, says Samantha Collier, chief medical officer of HealthGrades, which rates hospitals. (For information on specific hospitals, visit its web site at http://www.healthgrades.com/.)
The American Nurses Association's web site lists "magnet" hospitals - those most attractive to nurses - and a call to a hospital's nurse supervisor should yield the nurse-to-patient ratio.
A good tool to help consumers evaluate hospitals is a web site operated by the Department of Health & Human Services, which compares hospitals against national averages in certain areas. The site includes information about how well hospitals care for patients with certain medical conditions as well as the results of surveys given to patients asking them about their stay, says Anne F. Weiss, a senior program director at the Robert Wood Johnson Foundation, a health-care nonprofit.
8. "Most ERs are in need of some urgent care themselves."
A 2007 study from the Institute of Medicine found that hospital emergency departments are overburdened, underfunded and ill-prepared to handle disasters as the number of people turning to ERs for primary care keeps rising. An ambulance is turned away from an ER once every minute due to overcrowding, according to the study; the situation is exacerbated by shortages in many of the "on-call" backup services for cardiologists, orthopedists and neurosurgeons.
Nearly three-quarters of ER directors reported inadequate coverage by on-call specialists vs. 67% in 2004, according to a 2006 survey conducted by the American College of Emergency Physicians.
If you can, avoid the ER between 3 p.m. and 1 a.m. - the busiest shift. For the shortest wait, early morning - anywhere from 4 a.m. to 9 a.m. - is your best bet. If you're having severe symptoms, such as the worst headache of your life or chest pains, a triage nurse is trained to recognize if your symptoms constitute a medical emergency. Just know that emergency department staff are strained during busy hours, but giving "honest descriptions of your symptoms, and truly working with the staff is the best way to advocate for yourself and your family as a patient," says Darria E. Long, a doctor at Yale's department of emergency medicine.
9. "Avoid hospitals in July like the plague."
If you can, stay out of the hospital during the summer - especially July. That's the month when medical students become interns, interns become residents, and residents become fellows and full-fledged doctors. In other words, some of the staff at any given teaching hospital are new on the job.
Summer hospital horror stories aren't just medical lore: The adjusted mortality rate rises 4% in July and August for the average major teaching hospital, according to the National Bureau of Economic Research. That means 8 to 14 more deaths occur at major teaching hospitals than would normally without the turnover.
Another scheduling tip: Try to book surgeries first thing in the morning and preferably early in the week when doctors are at their best and before schedules get backed up.
10. "Sometimes we don't know how to keep our mouths zipped."
Contrary to what you might think, sharing patient information with a third party is often perfectly legal. In certain cases, the law allows your medical records to be disclosed without asking or even notifying you. For example, hospitals will hand over information regarding your treatment to other doctors, and they will readily share those details with insurance companies for payment purposes. That means roughly millions of entities that are loosely involved in the health-care system have access to that information. These parties may even pass on the data to their business partners, says Deborah Peel, the founder of Austin, Tex.-based Patient Privacy Rights Foundation.
If you want to access your medical records, you don't have to steal them like Elaine did on an old episode of Seinfeld after she learned a doctor had marked her as a difficult patient. You are legally entitled to see, copy and ask for corrections to your medical records. For your own "Patient Privacy Toolkit," visit the Patient Privacy Rights Foundation's web site at http://www.patientprivacyrights.org/.
Read more: 10 Things Your Hospital Won't Tell You (Page all of 3) at SmartMoney.com http://www.smartmoney.com/spending/rip-offs/10-things-your-hospital-wont-tell-you-20059/?page=all&hpadref=1#ixzz0hh4u5HuO
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A former top executive with Tustin Hospital and Medical Center has agreed to plead guilty to paying illegal kickbacks for patients recruited from L.A.'s skid row, according to papers filed Tuesday, February 9, 2010, in federal court in Los Angeles.
Vincent Rubio, 49, was the hospital's chief financial officer when authorities raided the facility two years ago during an investigation into an alleged multimillion-dollar scheme to defraud Medicare and Medi-Cal. Authorities contended that the hospital recruited thousands of homeless people to undergo unnecessary medical tests and procedures.
Rubio is the fifth person charged in the scheme, which involved street-level operators and hospital executives. He faces up to 15 years in prison.
Federal prosecutors and investigators are pursuing other targets in the probe.
"Mr. Rubio is cooperating with the ongoing investigation," said Consuelo Woodhead, assistant U.S. attorney. Rubio is due in court next month
In the plea agreement, Rubio admitted helping to orchestrate payments to Estill Mitts, a skid row center operator, and another unnamed person, who recruited homeless people and transported them to Tustin Hospital. The hospital, authorities said, would then run up thousands of dollars in bills, which were paid by Medicare and Medi-Cal.
Authorities said the hospital, under Rubio's direction, paid $2.3 million to the skid row recruiters for a guarantee of 40 to 50 patients a month. The hospital netted $10.6 million from Medicare and Med-Cal because of those patients, according to court papers.
Rubio also acknowledged that he pocketed kickbacks from the recruiters and that he failed to report the money on his income tax. In 2005 alone he failed to report $38,000 in extra income.
Mitts, 65, of Los Angeles, pleaded guilty in September 2008 to conspiracy to commit healthcare fraud, money laundering and tax evasion. He is scheduled to be sentenced June 21.
latimes.com/news/local/la-me-homeless-hospital10-2010feb10,0,4581861.story
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