Articles Posted in Accessibility of Healthcare

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Look out Baby Boomers and Gen Xers: Just when you or your elderly loved ones may be most vulnerable and needing nursing home care, the government is going back to allowing nursing home administrators to push a pile of documents for you to sign at you at admission time. And when you put your John Hancock on some of these, you will give away important legal protections.

The Centers for Medicare and Medicaid, overseer of 1.5 million nursing home residents and more than $1 trillion in Medicare and Medicaid funding, has posted notice that, under Trump Administration leadership, it soon will reverse its predecessors’ plan to halt agreements that forced patients and their families to give up their right to sue. Instead, Trump officials will push them to the alternative legal process known as arbitration. Officials insist they will require nursing homes to make arbitration requirements simpler, and to ensure they’re written in plain English.

But, in keeping with a recent U.S. Supreme Court ruling in a Kentucky case, regulators are yielding to the nursing home industry’s aggressive lobbying and point of view that arbitration is simpler, easier, and will keep down costs.

mitch-300x226bernieBernie Sanders recently offered on Twitter what he described as a display of all the Senate Republicans’ public considerations of the American Health Care Act, aka Trumpcare: a photo of a blank piece of paper.

Not a bad jibe, and a window into the deepening bipartisan dismay that Majority Leader Mitch McConnell and his  Republicans soon will try to jam through the next step in their long-sought effort to repeal and replace the Affordable Care Act, aka Obamacare.

Does McConnell have the 50 votes he needs so Vice President Pence can break a Senate tie and move Trumpcare closer to reality? Will this occur in just days, before Congress heads to its July Fourth recess? Or will it happen in the small period before the long August recess, when Trump Administration officials also want Congress to take up an increase in the debt ceiling and to tackle a budget and maybe some tax law changes?

Florida_Supreme_Court_Building_2011-300x266As congressional Republicans pursue their counter factual campaign this week to strip patients of their rights to pursue legal redress for harms they suffer while seeking medical services, the Florida Supreme Court has sent a powerful message to federal lawmakers about the wrongheadedness of some of their key notions.

The justices in Tallahassee have repudiated state lawmakers’ assertions of the existence of a “malpractice crisis,” in which dire action is needed to ensure doctors can get affordable liability insurance and be sufficiently protected to practice good medicine.

They also have rejected caps on patients’ claims for pain and suffering, finding that these limits on “non-economic” damages violate constitutional rights to equal protection under the law, and “arbitrarily reduce damage awards for plaintiffs who suffer the most drastic injuries.”

girls-300x208It isn’t a teary topic fit only for moody young adult fiction and sudsy afternoon TV dramas: Depression afflicts as many as a third of girls, becoming a rising problem for some as early as age 11 and increasingly separating out as gender difference in the mental health between boys and girls.

The higher incidence of depression in girls—found in interview research with more than 100,000 young participants from 2009 to 2014 in the annual, statistically representative National Survey of Drug Use and Health—has raised concern among mental health experts. They note that depression can cause patients to struggle with relationships and school. It can lead some to suicide and may require sustained treatment for those with more serious cases.

Researchers could not explain why girls are more affected by depression, and they were surprised to find the earlier gender divergence, with it occurring at younger ages than had been tracked before. This tends to undercut existing psychological theories, they said, that depression in girls may be triggered by hormone changes or other significant life shifts that occur in their teens.

clockYour time is precious, and when you are a patient, you may feel it’s more so, especially if you’re ill or even in the end stage of your life.

So why do health care providers keep us waiting, or worse, why must doctors and hospitals act downright oblivious to how valuable our time might be as opposed to theirs—and what might be done about it?

Take a look at a thoughtful piece on how one health system has tried to keep true to the idea that patients matter above everything else and the delivery of care needs to focus on them:

mitchPresident Trump and the Republican-controlled Congress haven’t repealed the Affordable Care Act. Yet.

Still, analyses show how, as one critic said, the GOP plans a big move of federal money from “health to wealth”—to take support from the poor and middle class, especially from the very voters who put Trump in office, to finance a $1 trillion tax cut for the rich, Big Pharma, medical device makers, and, yes, operators of tanning salons.

There’s been a huge amount of press coverage, but look at some key health care numbers—from the nonpartisan Congressional Budget Office, the White House, and health policy experts— and see if this motivates you to get in touch with your elected officials:

Diverse_doctors_3-300x201Some new research studies suggest ways to find a good doctor by focusing on demographics. Older doctors who have reduced their caseloads may not be an optimal choice, one study suggests, while another finds that, for seniors sick enough to be hospitalized, women MDs excel. And doctors who are immigrants can be solid patient choices, a third study reports.

Let’s be clear: These studies are observational, and they focus on select measures of care. But they are based on big data, analyses of hundreds of thousands and even millions of cases. Your own individual experience with a clinician counts a ton, and must never be ignored. A doctor with a brilliant resume, golden accomplishments, and a sterling reputation can still treat you badly, even blunder with your care.

Still, after examining three years of data on more than 700,000 admissions and the outcomes of 19,000 doctors, researchers from Harvard Medical School and prominent Boston-area hospitals found that as MDs aged, mortality rates of their hospitalized patients climbed. For doctors younger than 40, the rate was 10.8 percent, while for those older than 60, it hit 12 percent.

Donald_Trump-1-225x300The Trump Administration raised major weekend alarms among some of the biggest players in health care with the president’s reported willingness to try a risky gambit by cutting off crucial federal subsidies to help millions of poorer Americans afford health insurance. Some in the GOP see the move forcing opponents to endorse the American Health Care Act, aka Trumpcare. But critics say it will cost millions their coverage and blow up existing insurance exchanges.

Politico, the website devoted to political coverage, reported that President Trump told his top advisers that he wants to cut off for this year $7 billion that Uncle Sam pays to insurers to reduce deductibles and other out-of-pocket costs so an estimated 7 million poorer Americans can afford health coverage on exchanges set up under the Affordable Care Act, aka Obamacare.

Trump is said to think this draconian move will push Democrats to negotiate with the GOP to support Trumpcare. But opponents say it not only will wreck ACA health insurance exchanges, causing insurers to flee losses from participating in them, it will not save money. It will force Uncle Sam to pay $2.3 billion more in other related ACA costs, notably some tax credits.

nih_header-300x72Although its battles over health insurance have dominated the headlines, Congress also provided a glimmer of good news on funding for medical research. Lawmakers, at least for this fiscal year, shunned President Trump’s request to slash the budget of the National Institutes of Health. Instead of giving it the billion-dollar haircut the Administration sought, Congress boosted the NIH budget by $2 billion for the five months left in the current fiscal year.

The added fiscal support will be a boon for important research on: cancer, Alzheimer’s, precision medicine, the brain, and the battle against superbugs.

I’ve written how Congress earlier had, with much fanfare, decided to set aside partisan concerns to provide a steady increase in medical science research, which has been budget starved for some time. But the president had demanded cuts across the board, particularly so he could hike the appropriations for areas like the military and homeland security—notably his much promised border wall with Mexico.

It’s up to the U.S. Senate now whether tens of millions of Americans get stripped of the health insurance they obtained under the Affordable Care Act, aka Obamacare, or what kind of coverage they might have under some version of  the American Health Care Act aka Trumpcare.

News organizations have posted some good, factual summaries of Trumpcare vs. Obamacare, as passed by the House last week, including here and here and here. The Congressional Budget Office, the federal outfit that is supposed to provide lawmakers a nonpartisan, independent analysis of the costs and effects of legislation, will score the House bill sometime this week so Americans really know what the bill does and how much it costs.

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