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Health-Care Reform Rules Would Restrict Public Reporting

Last year’s health-care reform law promised to use Medicare billing data to increase public reporting about the performance of doctors and health-care facilities. Now, proposed government rules could prevent consumer groups from getting the data and would give medical providers the right to review any quality findings in advance.

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Health and Human Services Secretary Kathleen Sebelius at a press conference regarding the health care reform law. (File photo by Chip Somodevilla/Getty Images)

 It’s estimated that hundreds of thousands of patients die annually from preventable harm suffered while undergoing medical care. The infections, injuries and errors could rank as a leading cause of death in the United States.

Last year’s sweeping health-care reform law — the Patient Protection and Affordable Care Act — promised to improve the problem by allowing outside groups to use Medicare billing records to analyze and publicly report on the quality of care. But proposed rules that would guide the release of the data are being criticized by consumer groups that say the rules would make independent accountability impossible.

  

Agencies typically adopt rules to administer laws like the health-care act. The rules being developed by the Centers for Medicare & Medicaid Services (CMS) propose restricting the release of Medicare billing data to “qualified entities.” To qualify, a group would have to:

  • Pay up to $200,000 for the data.
  • Have its methods pre-approved before obtaining the data.
  • Already possess billing information from other sources to combine with the Medicare data — an advantage to insurance companies.
  • Limit public reporting to quality measures approved by the health-care industry.
  • Present its reports and findings to every doctor and facility being measured before they are released to the public — a requirement that would make large-scale reports difficult.

Medicare officials declined to discuss the proposed rules because they are being finalized after a public comment period ended Aug. 8. But interviews and a review of comments show that the rules have sharply divided consumer-oriented groups and health-care providers.

Lisa McGiffert, director of the Safe Patient Project run by Consumers Union, the nonprofit publisher of Consumer Reports magazine, said the new law was seen as “a real opportunity” because, for the first time, Medicare data could be used to tell the public about the performance of doctors. But the proposed rules would make it impossible for Consumers Union to use the data, she said.

“The best-kept secret in America is what doctors are doing,” McGiffert said. “People should be able to find out information about outcomes of care, whether their docs are using appropriate practices and whether they’re providing too much of something that people don’t need.”

Bruce Boissonnault, president and CEO of the Niagara Health Quality Coalition, a nonprofit that’s been independently measuring the quality of health care since 1995, said the rules are needlessly complex and designed to suppress freedom of information. He said the rules would make it impossible for all but industry insiders to access the new data, giving them control over what’s released.

“We will only see the scraps of information that the industry wants us to discuss,” Boissonnault said. “It’s advertising wrapped in a lab coat.”

Boissonnault and Consumers Union submitted public comments, urging Medicare to reconsider the restrictions.

The American Medical Association submitted comments mostly supporting the access limitations and in some cases urging more restrictive rules. For instance, the proposed rules say doctors would need 30 days to review any analysis before it’s publicly reported, but the AMA wants that review period increased to 90 days.

The AMA also wants Medicare to consider complaints by physicians against an organization before allowing the organization access to the data.

The Federation of American Hospitals, which represents investor-owned health-care facilities, said in its comment that it is “very troubled” by the proposed rules, despite the increased restrictions, because billing data have a limited ability to measure quality. The federation wants a limit on the number of qualified entities that have access to the data.

Barry Schmittou

Sep. 15, 2011, 10:27 a.m.

The Obama administration is already protecting criminal insurance companies and doctors that destroy many patients lives !! Numerous Federal Judges have written that Doctors’ paid by insurance companies endanger patients by ignoring Multiple Sclerosis, brain lesions, cardiac conditions of many disabled patients and a foot a new mother broke in five places !!

Obama’s DOL and DOJ Directors viewed the following evidence but did nothing to stop these dangerous crimes :

U.S. District Judge Richard Enslen wrote :

“Metlife and its henchmen should appreciate that such conduct may itself precipitate the suicide death of a person who has placed implicit trust in their organization. This record is an open indictment of MetLife’s practices and treatment of the mentally-ill and long-term disability benefits.”

U.S. District Judge Nancy Gertner won the Thurgood Marshall Award. She wrote this about Metlife:

“It misquoted Whitehouse’s doctors and cherry-picked or took out of context statements made. The denials continued to press factual inaccuracies even after being informed of the errors.”

“Perhaps most egregious of all, it misquotes Dr. Bhan as stating that Whitehouse “[was] able to function” AR 116 when, in fact, he said “she was not able to function.”

In the case of Wright verses Metlife U.S. Magistrate Judge Jennifer Guerm wrote these quotes :

“MetLife relied on clearly erroneous findings of fact in making its benefit determination. MetLife’s review of Plaintiff’s appeal consistently omitted or misrepresented relevant information in several ways. On October 18, 2004, Dr. Barnett wrote a letter to MetLife stating:

“I am gravely disturbed by your misrepresentation of the facts with regard to my discussion with your independent physician consultant and your lack of due diligence in collecting further medical information regarding Mr. Wright’s health condition. Indeed, Mr. Wright has ongoing cardiac disease including ischemia and loss of function due to previous myocardial infarctions.”

Judge William Acker asked Metlife this question about cardiac patient Frank Blankenship :

“Can a heart patient with angina, working under severe stress, be expected to earn up to 60 percent of what he earned before his heart condition, that is, until he drops dead?”

U.S. District Judge Malachy Mannion wrote provided these quotes from a company named Syncrony that conducted functional tests for MetLife in the claim of JAMES KNOBLAUCH:

“Unstable BP first day, said she had to call MD his pressure was so high. On the second day his heart rate was unstable and he was having abdominal pain, so limitations were more medical [than] strength factors…”

Judge Mannion wrote that MetLife and Syncrony withheld this evidence when they denied Mr. Knoblauch’s claim !!

Judge Terrence McVerry wrote this in SCHWARZWAELDER verses Metlife :

“Her treating/evaluating physicians assessed the stressful nature of that position, deemed it causal to her mental health symptoms and diagnoses, and concluded that (a) Plaintiff was unable to continue to perform under the conditions of that occupation and (b) to attempt to do so would risk serious further consequences to her health.

“The Court is also highly concerned by the Administrator’s rejection of evidence (a) MetLife had no basis for rejecting those observing-physicians’ conclusions”

MetLife ignored my LTD claim for right eye cancer and left eye surgery for six years while I often had no money for medical treatment and surgery. I was referred to a Psychologist who wrote an urgent letter to Obama’s Asst. Secretary of Labor Ms. Borzi. The letter had these quotes :

“In light of the violations Metlife has committed and Metlife’s awareness of the additional harm caused him, Metlife’s actions seem irresponsible, inhumane, dangerous, and reckless.I have conceptualized the severe and cumulative stress as traumatizing. Mr. Schmittou is in desperate situation”

This is about five percent of the evidence I’ve presented to Obama’s DOL and DOJ Directors.

I’ve also proven the same crimes are being committed in Workers Comp, Long Term Care, Life insurance, and injured War Zone Contractors insurance.

Obama received contributions from MetLife and they received three Non Prosecution agreements for rigging bids to increase sales of these policies. Two campaign contributors actually signed the Non Prosecution agreements for MetLife !!

I’m still shocked the Obama administration will not lift one finger to stop these crimes, while at the same time we often see Obama leading prayers and quoting the Bible on TV.

God please help anyone who becomes sick, injured or disabled in America !! God please help us all !!

Just the other day, I heard the term “policy laundering.”  And here we have a “healthcare solution” intended to force all of us to buy insurance with clauses that—surprise!—work to the benefit of the insurance companies and—literally, in this case—sell out the American people.

The most important part is the one listed first:  Pay up to $200,000 for the data.  In other words, you’re not allowed to access your data to determine if the system is working, but I’d be willing to bet that an insurance company can pay the money to get all your personal data to determine the rates you’ll be obligated by law to pay.  I’ll bet that medical firms can get your information so they can target their advertising.

Notice, by the way, that the consumer groups are actually wrong, here.  Those aren’t “restrictions.”  That’s an exclusionary definition of who has a license to report on the medical industry.  You can have an opinion, but only the well-connected elite who agree to censorship would be permitted access to the facts.

I have to wonder what facts and/or statistics the authors of the regulations envision coming soon that would be so damning that they need to enact a medical censorship board in advance.

Our tax dollars at work, paying to be treated like animals and children for the benefit of the rich.

I am so appreciative of those that not only understand the truth but actually do something about it.  I agree that the insurance companies will have an enormous amount of power to deny legitimate claims and that is what they will do – deny claims.  This is unconscionable and unsustainable as the people are starting to understand and finally object to this abuse at the hands of the organized crime industry called the LTD & the Health Insurance industry.

There is another piece to this debacle and that is the poisoning of the population by big pharma with impunity.  In trying to think of solutions I think one way would be to get the insurance industry to stop the poisoning for profits of the pharmaceutical and medical device and equipment manufacturers by doing the kind of analysis that needs to be done.  And there are plenty of examples of poisoning, GE’s malfunctioning CT scans which overdosed patients with radiation and GE’s product Omniscan, a gadolinium based contrasting agent used for MRIs and MRAs, that has poisoned millions and Levaquin, Vioxx and Avantia and the list goes on and on.  And we still don’t know what causes autism but I’ll bet it has to do with vaccinations.

The one thing that I remain hopeful and I truly believe is going to happen is this Ponzi scheme has lived its life and will end in the near future.  You can’t push negative externalities onto the government and insurance companies any longer while forcing the patient population to pay thousands of prescription drugs that should only cost a few dollars, the money just isn’t there and it is already crippling our society.  The banks were so arrogant in assuming they could steal everything in sight and get away with it.  Big pharma believes the same and they have a rude awakening coming their way.  This is also true of the AMA.  The current profit-driven take no hostages’ method of administering healthcare is unsustainable whether they realize it or not.

Barry Schmittou I know only too well that the story you tell is the truth.  Shame on Obama and shame on the DHHS for not doing something about all the abuses.

Human lives are of no importance but making as much money as possible is of extreme importance to the rich and powerful of this country.  American capitalism is legalized savagery when money is everything and ordinary people are of little to no value.  Shame on the American politicians for encouraging, supporting and defending greed.

I voted for Obama, but I am really getting sick of him.

To follow up on what Sharon said regarding claim denial, it’s worth pointing out the obvious:  The entire business model of the insurance industry is to get paid more (over your life, month by month) than the fraction of your medical bills they pay will ever cost them, plain and simple.

That’s why they worry so much over “pre-existing conditions,” since it means they didn’t charge you enough to cover costs.  It’s why they’ll deny your claims (and make you file them), since that conflicts with their business model.

Notice, though, that they don’t work to drive down the cost of care at the provider end.  That’s because it’s cheaper to just deny you and the high costs (created by the AMA’s artifical limit on the number of practicing doctors in a given region) make them necessary.

Now remember the point of the article:  There’s pending regulation (not legislation, which gets reviewed and voted on) to limit the spread of information on the healthcare industry…

The healthcare reform act was just another gift to the status quo.  Real reform would involve mandatory transparency, not mandatory buy in.  Real reform would have involved a non-profit, or public option, not govt payouts to private industry.  That’s all you see today from the Federal govt.  Propping up soulless, profit mongering industry at the expense of the general population.  Get rid of every pol in Washington DC.  Get rid of their staff and lobbyists.

Barry Schmittou

Sep. 16, 2011, 10:09 a.m.

John mentioned preexisting conditions, so I’d like to show some quotes that prove MetLife fabricates them to deny a Long Term Care claim of a very sick man.

Please remember my first comment above shows Judges quotes that prove MetLife also ignores life threatening medical conditions so they can deny disability claims.

Here are quotes from the U.S. Court of Appeals Judges’ in the case of METROPOLITAN LIFE INSURANCE COMPANY
v. Russell D. CONGER, Defendant-Appellant.

“Such a decision-making process is not deliberate or principled, and the explanation provided was far from reasoned, as it failed to address any of the contrary evidence. Instead, MetLife supported its decision to rescind only by its cherry-picking symptoms from Conger’s medical records, and then reverse-engineering a diagnosis. This is not the hallmark of a reasoned explanation.”

“MetLife reached its conclusion only by ignoring substantial contrary evidence in Conger’s medical records. For instance, MetLife did not address the doctor’s December 20, 1998 conclusion that Conger’s “brain demonstrated no significant abnormality, [and was] essentially normal for patient’s age,” or the doctor’s statement that he saw “no cerebellar abnormality.” Similarly, Metlife ignored Conger’s multiple brain MRIs that revealed no problems. MetLife’s communications to Conger (through LTCP) do not acknowledge these MRIs or even attempt to explain why they do not negate its conclusion regarding Conger’s condition. The same is true of the internal communications between LTCP and MetLife’s claim-review physician. MetLife also ignored multiple neurologists’ failure to diagnose Conger with a progressive neurological disorder or even to note an impression in their charts that he had such a disorder. Further, MetLife ignored Dr. Tillett’s impression that Conger’s ataxia was not “cerebellar,” which indicates that Conger’s symptoms were not caused by a neurological disorder.”

(End of quotes)

Please quickly compare this case the case of Jacquelyn Addis.  U.S. District Judge Timothy J. Savage wrote this about Dr. Greenhood who is paid by MetLife :

“Dr. Greenhood states that there were no objectively abnormal findings in the materials he reviewed, creating the impression that the absence of such findings rules out a disabling condition. He also ignores the MRI reports evidencing MS, November 2, 2000, and December 9, 2003. To the contrary, Dr. Tatarian documents a variety of spinal problems; and, MRIs consistently showed the presence of lesions and plaque on the brain. Dr. Greenhood ignores Dr. Tatarian’s report of a positive Babinski sign, which is indicative of nerve damage consistent with Addis’s complaints of stumbling and falling.”
(end of quote’s from the Addis case)

Please remember in the Conger case three Appeals Judges agreed :

“Similarly, Metlife ignored Conger’s multiple brain MRIs that revealed no problems.”

So MetLife ignores life threatening conditions in MRI’s and denies a disability claim, and they ignore MRI’s that reveal no problems to deny a Long Term Care claim !!!!!

Also remember the patient can die during the years it takes to appeal with the insurer (which is required by law) and then it may take years to get resolution in Court because MetLife loves to go all the way to the Appeals Court !!!

ALSO REMEMBER THE SAME DR. GREENHOOD IGNORED A FOOT THAT NEW MOTHER JOANNE VICK BROKE IN FIVE PLACES, HE IGNORED THE GREAT MAJORITY OF MY EYE CANCER SYMPTOMS ( WHICH IS WHY I DISCOVERED ALL THESE OTHER CASES WHILE I OFTEN HAD NO MONEY FOR MEDICAL TREATMENT AND SURGERY, FOOD OR HOUSING)

AND OBAMA’S DOL AND DOJ WILL NOT EVEN ASK DR. GREENHOOD TO STOP !!!!!

I’d like to thank Sharon for your kind comment above : )
and thanks to Dave and Will for writing so much truth in one paragraph !!

Rich, I almost voted for Obama, and he saddens me by destroying lives and justice while often praying on TV.

Obama’s hypocrisy can turn some people away from seeking God, just like many of the Republicans do when their actions destroy lives while they often promote their Christian beliefs on TV.

I will keep legally fighting, but I really believe God is our only hope !!

There is so much corruption it is overwhelming and devastating, so I would like to repeat John’s great thought :

“Now remember the point of the article:  There’s pending regulation to limit the spread of information on the healthcare industry”

lolll..makes me suspect that they’re going to solve the problem with the load put on the health care system by aging baby boomers the old-fashioned way.

Under Obamacare: Ohioans will lose their private health insurance and premiums will rise 55%-85% Study by Milliman Inc. http://www.cobrahealth.com/Obamacare.html

When the Federation of American Hospitals and Consumers Union - two organizations with extremely different agendas - strongly agree on something, the proposed rule is probably way off the mark and needs to be revised.  I have seen this happen before, i.e., some political appointee tells regulations writers to insert something in a proposed rule that no one really wants and the negative comments provide enough political cover to write a very different final rule.  In this case, the administration may be making an end run around the AMA.

So much for transparency.  This and other (many) reasons are why Obamacare needs to be thrown out, not just the mandate, but the entire 2400 pages. The US already has over 1 million laws!  http://www.slideshare.net/CraigJCasey/obamacare-and-cobra

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