Francine Hardaway - Serial entrepreneurship veteran
Posted: December 1, 2009 12:00 PM BIO Become a Fan Get Email Alerts Bloggers' Index
Looking For Waste in the Health Care System? Try Anywhere
Read More: Health Care, Maggie Mahar, Mammograms, Medicare Fraud Cost, Pharmaceutical Industry, Simivastin, Vitorian, Zetia, Living News
How much of our rising health care costs comes from fraud in the health care system by players who know how to game it for their own benefit? Enough to cloud the reform debate, that's for sure. And it can't be pinned on one player; it's up and down the value chain in medical care.
On the one hand, you have the recent 60-Minutes report on drug dealers in Miami who defraud Medicare by opening fake clinics and pharmacies. They get reimbursed for artificial limbs ordered for patients whose IDs they have bought on a black market for Medicare information.
Further up the line you have hospitals who bill Medicare for procedures that could be done in an outpatient setting where they would cost less, or for total care of a patient whose actual care is split between two hospitals, both of whom bill for the entire care. (Go look on the Center for Medicare and Medicaid Services web site for the Recovery Audit Contractor pilot program in which this was discovered.
And then there's the sweetheart deal the insurers got to participate in the Medicare Advantage program, which was started when CMS was afraid not enough providers would participate in Medicare. In Medicare Advantage, all the players get paid more than by regular Medicare for providing the same services. Medicare Advantage is targeted by the cost-cutting initiatives, but here's what the plans said: "many commenters contend that, if rates are reduced, MA organizations will have trouble maintaining their provider networks, because they will have to pay providers less, and will have to raise premiums, increase co-pays and deductibles, especially in rural areas, Puerto Rico, in the case of Special Needs Plans (SNPs), PACE plans, and plans that are in direct competition with cost plans."
Finally, we get to the pharmaceutical companies, where we learn that "by suppressing negative studies, relentlessly pursuing positive trial results, and paying academic researchers to promote their therapy, Merck Schering-Plough has managed to hold onto a $4.6 billion market for a drug that has never been proven to be better than cheaper generics in preventing heart attacks or death. "
That's a pretty shocking allegation from the HealthBeatBlog, where Maggie Mahar, maker of the film "Money-Driven Medicine," does her investigative work. It seems that Merck Schering-Plough holds the patents on Vitorin and Zetia, two widely advertised drugs that in studies have proven no more effective than the vitamin niacin and a generic statin, simivastin.
And this doesn't even begin to touch controversial issues like outcomes-based medicine, which might mean fewer mammograms, CT scans, and other procedures that irradiate us often unnecessarily as the doctor either tries to prevent malpractice allegations or perhaps even owns the imaging center.
Everywhere you look there is waste and downright fraud in the health care system, perpetrated by both payers and providers, public and private. I have no doubt that Obama is right that we could fund health care reform by cleaning up the waste, but the lobbyists for the staus quo don't want it cleaned up. They are profiting from waste and fraud, not from legitimate services, IMHO
Comment
cuppajoe
I would suggest that it is not all just out and out fraud. Here, in a community of about 80,000 where I currently reside, one can go to one hospital for a specific lab test, and Medicare is charged about $225.00; In a second hospital in the same basic community, the exact same test, bills Medicare approximately $80.00 for the same test.
And, to further look at this, there are an estimated 5,000 of these tests performed in this community each month; it is estimated that the more expensive hospital performs 75% of these tests. If my math is correct, 75% of 5000 is 3750. and the difference between $225. and $80 is $145.00 $145 x 3750 = $543,750 per month, or $6,525,000 per year, for one test, in one community. If these numbers apply, even remotely to the national picture, this one test, which is necessary, may well be costing Medicare more than a BILLION dollars more than it need cost.
It makes no sense to me. The test does not require the intervention of, nor the direct supervision of a physician, uses an inexpensive test strip, and one nurse can comfortably accomplish, with no rush, about 4 or 5 tests per hour. Without any degradation of nurses, is it really necessary to bill medicare approximately $1000 per hour for a nurse's time?
Tuesday, December 1, 2009
Loneliness can be contagious, new study finds
Feelings of isolation can spread through groups of friends as easily as a cold
Loneliness can not only make you feel more socially isolated, it can make you more anxious, more shy and cause you to believe you have poor social skills.
Ex-Miss Argentina dies after cosmetic surgery
Lone cop kills suspect in slaying of 4 officers
Some aren’t surprised by Tiger Woods mess
Rothstein charged in $1 billion Ponzi scheme
By Diane Mapes
msnbc.com contributor
updated 8:40 a.m. ET, Tues., Dec . 1, 2009
We’re used to hearing about people spreading colds and flu. But according to a new study in the Journal of Personality and Social Psychology, there’s another human condition that’s equally contagious: loneliness.
“Loneliness spreads across time,” says John Cacioppo, a neuroscientist and psychologist at the University of Chicago and one of the authors of the study. “It travels through people. Instead of a germ, it’s transmitted through our behaviors.”
The longitudinal study, conducted by the University of Chicago, the University of California-San Diego and Harvard, interviewed more than 5,000 people over the course of 10 years, tracking their friendship histories and their reports of loneliness. Participants were part of the Framingham Heart Study, which has studied cardiovascular risks in people in Framingham, Mass., since 1948 and has since been expanded to include other research topics such as loneliness and depression.
In the study, researchers found that lonely individuals tend to move to the fringes of social networks (and, no, we’re not talking about Facebook or Twitter here), where they have fewer and fewer friends.
But before they move to the periphery, they “infect” or “transmit” their feelings of loneliness to their remaining friends. With fewer close relationship, these friends then become lonely and eventually move to the fringes of the social network, again passing their loneliness on to others. Thus, the cycle continues.
“When people get lonely, they’re more likely to interact negatively with others they encounter,” says Cacioppo. “If you have two neighbors and they’re friends and one becomes lonely, they’ll start to treat the other less friendly. Ultimately, they’re less likely to be friends.”
Ironically, loneliness can not only make you feel more socially isolated, it can make you more anxious, more shy and cause you to believe you have poor social skills. Cacioppo says previous research also shows that loneliness can make people less trustful of others and can make the brain more “defensive.”
“Your brain tells you people are rejecting you,” he says. “Loneliness may warp the message that you’re hearing.”
A biological signal
While loneliness can be “contagious,” Cacioppo says it’s important to note it’s not a disease, nor is it a personal weakness. It’s actually a biological reaction, much like hunger or thirst or pain.
“Society tends to think of it as an individual characteristic — there are just loners,” he says. “But that’s the wrong conception of what loneliness is. It’s a biological signal motivating us to correct something that we need for genetic survival. We need quality relationships. We don’t survive well on our own.”
Studies, in fact, show loneliness can actually be harmful to both mental and physical health, leading to depression, high blood pressure, increases in the stress hormone cortisol, and compromised immunity.
Unfortunately, quality friendships can sometimes be difficult to find or maintain in our busy, BlackBerried society.
“I get lonely sometimes but I tend not to seek people out to do things because they’re all married or committed or need to find a babysitter and then it just turns into a circus,” says Tina Kurfurst, a 46-year-old database coordinator from Seattle. “I went out to dinner with some people from work the other night and one of the women kept saying, ‘Wow, you’re funny, why don’t we hang out more often?’ And I just thought, ‘Well, because you have a husband and a 12-year-old and a 17-year-old and it just doesn’t happen. You don’t have time for me.”
Stephanie Smith, a clinical psychologist with a private practice in Erie, Co., says she tries to encourage her lonely patients — which can range from college students to stay-at-home moms to high-powered CEOs — to find at least one friend in their same situation.
“If you have kids, know at least one other person who has kids,” she says. “Or if you don’t, find someone who doesn’t. It’s important to have people in your life who share your interests and your stage of life.”
But you don’t have to have a slew of BFFs.
“Sometimes people get overwhelmed and think ‘I need to have 15 best friends,’” she says. “But it doesn’t need to be that big. One friend, one relationship, can be very powerful.”
Click for related content
Why we can't remember who we've told what
Why memory lane is such a mortifying stroll
Sleepless in ... West Virginia?
Looking at nature makes you nicer
Facebook and Twitter are no substitute for the real thing, though.
“If you’re isolated due to a disability or a spouse with Alzheimer’s, then Facebook can be a real boon,” says Cacioppo. “But if you’re spending your time on Facebook rather than face-to-face with friends, it increases your loneliness. It’s about quality. Lonely people use social networks as a substitute; non-lonely people use them to synergize the relationships they already have. The person with 4,000 friends on Facebook may well be a very lonely person.”
The secret, says Cacioppo, is realizing loneliness is nothing more than your body sending you a signal.
“All normal humans feel lonely at some point in time, just like they feel hunger and thirst and pain,” he says. “But while we have cupboards filled with food, taps for water and medications for pain, we don’t have anything comparable for loneliness. I’m not saying you need a cupboard full of friends, but if you feel lonely, pay attention and take the time to repair it.”
Comment
I cant remember who said it but somebody said they judge ones mental health by the quality and quantity of their friendships.
Loneliness can not only make you feel more socially isolated, it can make you more anxious, more shy and cause you to believe you have poor social skills.
Ex-Miss Argentina dies after cosmetic surgery
Lone cop kills suspect in slaying of 4 officers
Some aren’t surprised by Tiger Woods mess
Rothstein charged in $1 billion Ponzi scheme
By Diane Mapes
msnbc.com contributor
updated 8:40 a.m. ET, Tues., Dec . 1, 2009
We’re used to hearing about people spreading colds and flu. But according to a new study in the Journal of Personality and Social Psychology, there’s another human condition that’s equally contagious: loneliness.
“Loneliness spreads across time,” says John Cacioppo, a neuroscientist and psychologist at the University of Chicago and one of the authors of the study. “It travels through people. Instead of a germ, it’s transmitted through our behaviors.”
The longitudinal study, conducted by the University of Chicago, the University of California-San Diego and Harvard, interviewed more than 5,000 people over the course of 10 years, tracking their friendship histories and their reports of loneliness. Participants were part of the Framingham Heart Study, which has studied cardiovascular risks in people in Framingham, Mass., since 1948 and has since been expanded to include other research topics such as loneliness and depression.
In the study, researchers found that lonely individuals tend to move to the fringes of social networks (and, no, we’re not talking about Facebook or Twitter here), where they have fewer and fewer friends.
But before they move to the periphery, they “infect” or “transmit” their feelings of loneliness to their remaining friends. With fewer close relationship, these friends then become lonely and eventually move to the fringes of the social network, again passing their loneliness on to others. Thus, the cycle continues.
“When people get lonely, they’re more likely to interact negatively with others they encounter,” says Cacioppo. “If you have two neighbors and they’re friends and one becomes lonely, they’ll start to treat the other less friendly. Ultimately, they’re less likely to be friends.”
Ironically, loneliness can not only make you feel more socially isolated, it can make you more anxious, more shy and cause you to believe you have poor social skills. Cacioppo says previous research also shows that loneliness can make people less trustful of others and can make the brain more “defensive.”
“Your brain tells you people are rejecting you,” he says. “Loneliness may warp the message that you’re hearing.”
A biological signal
While loneliness can be “contagious,” Cacioppo says it’s important to note it’s not a disease, nor is it a personal weakness. It’s actually a biological reaction, much like hunger or thirst or pain.
“Society tends to think of it as an individual characteristic — there are just loners,” he says. “But that’s the wrong conception of what loneliness is. It’s a biological signal motivating us to correct something that we need for genetic survival. We need quality relationships. We don’t survive well on our own.”
Studies, in fact, show loneliness can actually be harmful to both mental and physical health, leading to depression, high blood pressure, increases in the stress hormone cortisol, and compromised immunity.
Unfortunately, quality friendships can sometimes be difficult to find or maintain in our busy, BlackBerried society.
“I get lonely sometimes but I tend not to seek people out to do things because they’re all married or committed or need to find a babysitter and then it just turns into a circus,” says Tina Kurfurst, a 46-year-old database coordinator from Seattle. “I went out to dinner with some people from work the other night and one of the women kept saying, ‘Wow, you’re funny, why don’t we hang out more often?’ And I just thought, ‘Well, because you have a husband and a 12-year-old and a 17-year-old and it just doesn’t happen. You don’t have time for me.”
Stephanie Smith, a clinical psychologist with a private practice in Erie, Co., says she tries to encourage her lonely patients — which can range from college students to stay-at-home moms to high-powered CEOs — to find at least one friend in their same situation.
“If you have kids, know at least one other person who has kids,” she says. “Or if you don’t, find someone who doesn’t. It’s important to have people in your life who share your interests and your stage of life.”
But you don’t have to have a slew of BFFs.
“Sometimes people get overwhelmed and think ‘I need to have 15 best friends,’” she says. “But it doesn’t need to be that big. One friend, one relationship, can be very powerful.”
Click for related content
Why we can't remember who we've told what
Why memory lane is such a mortifying stroll
Sleepless in ... West Virginia?
Looking at nature makes you nicer
Facebook and Twitter are no substitute for the real thing, though.
“If you’re isolated due to a disability or a spouse with Alzheimer’s, then Facebook can be a real boon,” says Cacioppo. “But if you’re spending your time on Facebook rather than face-to-face with friends, it increases your loneliness. It’s about quality. Lonely people use social networks as a substitute; non-lonely people use them to synergize the relationships they already have. The person with 4,000 friends on Facebook may well be a very lonely person.”
The secret, says Cacioppo, is realizing loneliness is nothing more than your body sending you a signal.
“All normal humans feel lonely at some point in time, just like they feel hunger and thirst and pain,” he says. “But while we have cupboards filled with food, taps for water and medications for pain, we don’t have anything comparable for loneliness. I’m not saying you need a cupboard full of friends, but if you feel lonely, pay attention and take the time to repair it.”
Comment
I cant remember who said it but somebody said they judge ones mental health by the quality and quantity of their friendships.
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