HR3200 : Division B : Day Four

I’ve heard from several people since publishing yesterday’s second post who all had stories about Veteran’s Administration related health care. I am not going to go into each and every story, as there are enough of them to provide content for several weeks.

I get the feeling we’re all going to be in a lot of trouble if the new health care system is going to be as reliable as the VA and the Post Office.

“UPS and Fedex are doing just fine, it’s the Post Office that’s always having problems.”

I don’t know about you, but if it comes down to a choice of UPS or the USPS when it comes to delivering a new kidney or making sure my medical supplies arrive on time, I’ll take ol’ Brown everyday over the Post Office.

President Obama said it himself. So think about it. If the Post Office is having problems compared to UPS and Fedex, why on Earth would we want a government health care plan that is clearly going to be insufficient when compared to our current health system? I thought this bill was supposed to be about improving health care in America, not degrading it?

Anyway, I digress. Let’s move forward, shall we? Today we pick up with Division B, Title IV, Subtitle B, Nursing Home Transparency.

Upon passage of the bill, nursing facilities will be required to disclose all ownership and disclosable parties information. They will be required to retain such information on the effective date of the final regulations, and of course, they will be required to keep them forever.

Nothing in subparagraph (A) shall be construed as authorizing a facility to dispose of or delete information described in such subparagraph after the effective date of the final regulations promulgated under paragraph (4)(A).

Whether or not the facility is a publicly traded company, they will be required to make all of that information available to the public.

During the period described in paragraph (1)(A), a facility shall—

“(A) make the information described in paragraph (3) available to the public upon request and update such information as may be necessary to reflect changes in such information; and

“(B) post a notice of the availability of such information in the lobby of the facility in a prominent manner.

There is a lot more to this section, including more about the required components of the program, design of regulations, and evaluations. I am sure you get the gist though. Nursing facilities will be required to follow all of the new regulations and report all information and activity to Big Brother. Seriously, is this any different than any other section thus far?

Section 1421 shows us if a skilled nursing facility is found to be in noncompliance, the Secretary of Health and Human Services will once again have the authority to impose an arbitrary fine.

The Secretary may impose a civil money penalty in the applicable per instance or per day amount (as defined in subclause (II) and (III)) for each day or instance, respectively, of noncompliance (as determined appropriate by the Secretary).

Some of these penalties are defined in the bill.

In this clause, the term ‘applicable per instance amount’ means—

“(aa) in the case where the deficiency is found to be a direct proximate cause of death of a resident of the facility, an amount not to exceed $100,000;

“(bb) in each case of a deficiency where the facility is cited for actual harm or immediate jeopardy, an amount not less than $3,050 and not more than $25,000; and

“(cc) in each case of any other deficiency, an amount not less than $250 and not to exceed $3050.

Wow. $100,000. That’s what your life is worth (in fines) to the government. If you’re wondering how the government will fund some of the items in this bill, look no further than the arbitrary fines and penalties that will be imposed by the Secretary of Health and Human Services.

Section 1422 will regulate the “large intrastate chains of skilled nursing facilities” and provide a pilot program to monitor them.

The Secretary shall select chains of skilled nursing facilities and nursing facilities described in paragraph (1) to participate in the pilot program from among those chains that submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.

How much you want to bet they will add chains to their list, even if they don’t send in an application requesting it. Think about it. Who is going to request that the government monitor every move they make? Yeah, they’ll be beating down the doors, won’t they?

When has the government ever had a quality program that is efficient, disciplined, and well-run? Yeah. Well, it seems they are going to be defining exactly what quality is when it comes to health care. Section 1441 defines a quality measure.

The term ‘quality measure’ means a national consensus standard for measuring the performance and improvement of population health, or of institutional providers of services, physicians, and other health care practitioners in the delivery of health care services.

If they plan on enforcing the same quality measures imposed by the Veteran’s Administration, you may as well plan on hearing a lot of stories about people who died choking on sandwiches, falling out of their wheelchairs, being placed in a room and forgotten about, and maybe even released out the front door with no memory of anyplace else to go.

Sure, it sounds extreme. Sure, it sounds frightening. It’s happening now, with people under the care of the Veteran’s Administration. Don’t believe me? Just ask some of our elderly veterans about the care they receive. Just ask them what it’s like waiting months for a procedure that usually takes 10 minutes. Just ask them if they support a national health care plan modeled after the quality of care they currently receive. Don’t take my word for it.

The Secretary shall enter into agreements with qualified entities to develop quality measures for the delivery of health care services in the United States.

Oh Lord, here it comes.

Quality measures developed under agreements under subsection (a) shall be designed—

“(A) to assess outcomes and functional status of patients;

“(B) to assess the continuity and coordination of care and care transitions for patients across providers and health care settings, including end of life care;

“(C) to assess patient experience and patient engagement;

“(D) to assess the safety, effectiveness, and timeliness of care;

“(E) to assess health disparities including those associated with individual race, ethnicity, age, gender, place of residence or language;

“(F) to assess the efficiency and resource use in the provision of care;

“(G) to the extent feasible, to be collected as part of health information technologies supporting better delivery of health care services;

“(H) to be available free of charge to users for the use of such measures; and

“(I) to assess delivery of health care services to individuals regardless of age.

Wow. To assess the functional status of patients. Are you still able to perform as a productive member of society? If so, we’ll coordinate your care, assess the timeliness of that care, assess the efficiency of that care, and make sure your health care services are delivered no matter how old you are. Well, until you meet with the advanced care planning consultant anyway.

Section 1443 will allow multi-stakeholder input into the selection of quality measures. What does this mean? This means any multi-stakeholder in a facility will be allowed to help define what constitutes quality care at that facility.

A consensus-based entity that has entered into a contract under section 1890 shall, as part of such contract, convene multi-stakeholder groups to provide recommendations on the selection of individual or composite quality measures, for use in reporting performance information to the public or for use in public health care programs.

Let’s reflect on that section for a moment. Any multi-stakeholder will be invited to participate. Who might these multi-stakeholders be? Private investors, unions, community organizations, you get the idea. Remember though, physicians will not be allowed to increase their ownership in such facilities after the passage of this bill. (From Section 1156 of the Division B):

The percentage of the total value of the ownership or investment interests held in the hospital, or in an entity whose assets include the hospital, by physician owners or investors in the aggregate does not exceed such percentage as of the date of enactment of this subsection.

This means the “quality measures” decided upon will not be determined by anyone trained to know what quality health care is in the first place. That sure makes me feel confident about the level of care I would receive. (cough)

Never fear though. If the entity has not defined quality measures for a given procedure or area, the Secretary of Health and Human Services will determine what is appropriate. Section 1444 actually takes it a step further.

In the case of a specified area or medical topic determined appropriate by the Secretary for which a feasible and practical quality measure has not been endorsed by the entity with a contract under section 1890(a), the Secretary may specify a measure that is not so endorsed as long as due consideration is given to measures that have been endorsed or adopted by a consensus organization identified by the Secretary. The Secretary shall submit such a non-endorsed measure to the entity for consideration for endorsement. If the entity considers but does not endorse such a measure and if the Secretary does not phase-out use of such measure, the Secretary shall include the rationale for continued use of such a measure in rulemaking.

If a measure has not been endorsed by the entity or if one has been decided and the Secretary has given consideration to those measures, the Secretary has the authority to decide on the quality measures therefore overriding the entity endorsements. I honestly don’t think Josef Stalin had the kind of authority that the Secretary of Health and Human Services will have if this bill passes.

Division B, Title IV, Subtitle D, Section 1451 exposes the financial relationships between manufacturers and physicians, but does nothing to expose the relationships between those same manufacturers and representatives of our government.

The section covers approximately 18 pages and covers everything from reporting such relationships, making that information public, the accuracy of that reporting, and the penalties for not reporting or knowingly failing to report. The section also defines the term payment when pertaining to these financial relationships.

The term ‘payment or other transfer of value’ means a transfer of anything of value for or of any of the following:

“(i) Gift, food, or entertainment.

“(ii) Travel or trip.

“(iii) Honoraria.

“(iv) Research funding or grant.

“(v) Education or conference funding.

“(vi) Consulting fees.

“(vii) Ownership or investment interest and royalties or license fee.

Check out the terms I highlighted. Don’t those sound like items a Senator or Representative may receive from specific corporations for their support on certain legislation?

Why is there no “sunshine” clause for our elected officials and representatives of our government? Why are they exempt from the ethical standards being imposed on everyone else? What exactly do they have to hide?

That’s it for tonight. Tomorrow we will pick up on page 654, Division B, Title IV, Subtitle E, “Reporting on Health Care Associated Infections”. That should be fun.