National Association of Free Clinics

I saw this posted over on the APRN Ham Radio blog and thought it was definitely worth sharing.

The National Association of Free Clinics (click on link to search your state) has listings of FREE MEDICAL CLINICS in each state.

Many are seeing rough economic times these days with reduced hours, lay-offs and job losses - this could be a resource you or someone you know might need in the future for medical care.

Chia Seeds - Excellent EFAs

Image courtesy of Natural Remedeez

We've recently discovered this fabulous little seed - Chia Seeds. Yes, these are the very same seeds used for those horrendous Chia Pets that make their way through the stores during this time of year for Christmas presents.

But don't let that discourage you. Keep on reading - you'll be amazed.

Research on these little seeds reveals what a truly wonder seed they are. We've long tried to figure out good ways to have long term storage for Omega 3 and Omega 6 fatty acids. Most things that are high in these oils go rancid quickly or it would be cost prohibitive to store.

Enter Chia Seeds. Here is some info for you:

From Wiki:

It is still widely used in Mexico and South America, with the seeds ground for nutritious drinks and as a food source.

Chia is grown commercially for its seed, a food that is very rich in omega-3 fatty acids, since the seeds yield 25-30% extractable oil, mostly α-linolenic acid (ALA). It also is a source of antioxidants and a variety of amino acids.

Historically, chia seeds served as a staple food of the Nahuatl (Aztec) cultures of Central Mexico. Jesuit chroniclers referred to chia as the third most important crop to the Aztecs behind only corn and beans, and ahead of amaranth. Tribute and taxes to the Aztec priesthood and nobility were often paid in chia seed.

Chia seed may be eaten raw as a dietary fiber and omega-3 supplement. Ground chia seed is sometimes added to pinole, a coarse flour made from toasted maize kernels. Chia seeds soaked in water or fruit juice is also often consumed and is known in Mexico as chia fresca. The soaked seeds are gelatinous in texture and are used in gruels, porridges and puddings. Ground chia seed is used in baked goods including breads, cakes and biscuits. Chia sprouts are used in a similar manner as alfalfa sprouts in salads, sandwiches and other dishes.

Another source for excellent info: BuyChiaSeed.com

Chia seed is high in calcium, 5 times the calcium of milk. 631 mg per 100 grams of seed.

Chia seed is also high in protein, with 18 grams per 100 grams of seed.

The optimum ratio of Omega-3 to Omega-6 should be 3:1

Chia seed provides that ratio.

Chia seed is hydrophilic. Absorbing up to 14 times (Mix @ 9-10 times) its weight in water. This helps extend energy and endurance.

Chia seed is rich in antioxidant oils.

Chia seed contains chlorogenic acid, and

caffeic acid as well as myricetin, quercetin, and kaempferol flavonols. These compounds are both primary and synergistic antioxidants that contribute to the strong antioxidant activity of chia seed.

Chia seed is also low in sodium, only 19 mg per 100 grams.

We buy ours here: Natural Remedeez

from their website:

Chia turns out to be the highest known whole food source of omega-3s. 3 1/2 tablespoons contains as much omega-3 fatty acid as a 32-ounce Atlantic salmon steak. Chia is an excellent source of calcium, phosphorus, magnesium, potassium, iron, zinc, and copper. It has as much magnesium as 10 stalks of broccoli, as much calcium as 2 1/2 cups of milk and as much iron as half a cup of kidney beans.... The Chia seed contain high levels of fiber, and more antioxidants than many berries. it can also help regulate blood pressure and other risk factors for heart disease. Chia stabilizes blood sugar levels by reducing blood sugar swings through its ability to slow down the release of carbohydrates and their conversion into sugar. Chia seed is considered to be nature's perfect food.

We've eaten ours by the spoonful, have ground them into smoothies, and I've ground them into a flour and put them in pancakes. We've sprinkled them on top of salads and waffles.

I encourage you to give Chia Seeds a try and add them to your long-term storage preps!

Health Care Pages 325 - 400

Ready to get started again? Not sure how much time I'll have tonight, but I should be able to get through a few pages. Here's the link to the Health Care Bill if you need it.

Okay, last time we were talking about the bill mentions physicians must let their patients know if they have any ownership or interest in any hospitals they refer to and if they don't they are subject to various and sundry civil fines not to exceed $10,000 per day and that hospitals cannot expand unless they apply to the Secretary.

Onward:

Page 328 - yet another study to be conducted regarding the "geographic adjustment factors under medicare".

(c) EVALUATION.—Such study shall, within the context of the United States health care marketplace, evaluate and consider the following:
(1) The effect of the adjustment factors on the level and distribution of the health care workforce and resources, including—
(A) recruitment and retention that takes into account workforce mobility between urban and rural areas;
(B) ability of hospitals and other facilities to maintain an adequate and skilled workforce; and
(C) patient access to providers and needed medical technologies.
(2) The effect of the adjustment factors on population health and quality of care.
(3) The effect of the adjustment factors on the ability of providers to furnish efficient, high value care.

Yes, this study is also funded, but this time they just say that they'll be funded whatever it takes to do the study.

Some time if I can stand it I need to go back through the whole bill and just write down how much money is going toward "studies" and "pilot programs" and "reports".

Page 331 starts the section that discusses Medicare Reforms.

SEC. 1161. PHASE-IN OF PAYMENT BASED ON FEE-FOR SERVICE COSTS.
SEC. 1162. QUALITY BONUS PAYMENTS.
SEC. 1163. EXTENSION OF SECRETARIAL CODING INTENSITY ADJUSTMENT AUTHORITY.
SEC. 1164. SIMPLIFICATION OF ANNUAL BENEFICIARY ELECTION PERIODS

Now, I don't know much of anything about the current Medicare program - but if my health care depended on it, I would be certain to read these sections of the Health Care bill, because it deals with tons of adjustments, amendments to the Social Security Act, establishment of benchmarks for payments, cost-sharing, beneficiary information, medical loss ratios, auditing authority, authority to reject bids, etc.

Page 353 - Regarding Special Needs and Medicare - the Social Security Act is amended as follows:

‘‘(C) The plan does not enroll an individual on or after January 1, 2011, other than during an annual, coordinated open enrollment period or when at the time of the diagnosis of the disease or condition that qualifies the individual as an individual described in subsection (b)(6)(B)(iii).’’.

Now previously, the bill discussed an ongoing open enrollment for Medicare, but apparently there is going to be some restriction for special needs based on the statement above and this section on page 354:

SEC. 1177. EXTENSION OF AUTHORITY OF SPECIAL NEEDS PLANS TO RESTRICT ENROLLMENT.

Page 356 starts talking about improvements to Medicare, again, not knowing much about Medicare some of these seem like they might be okay - but I'm not sure of the cost involved:

‘‘(B) INCREASE IN INITIAL COVERAGE LIMIT.—For a year beginning with 2011
‘‘(C) DECREASE IN ANNUAL OUT-OF-POCKET THRESHOLD
page 358: (b) REQUIRING DRUG MANUFACTURERS TO PROVIDE DRUG REBATES FOR FULL-BENEFIT DUAL ELIGIBLES.—

‘‘(1) IN GENERAL.—In this part, the term ‘covered part D drug’ does not include any drug or biologic that is manufactured by a manufacturer that has not entered into and have in effect a rebate agreement described in paragraph (2).
‘‘(2) REBATE AGREEMENT.—A rebate agreement under this subsection shall require the manufacturer to provide to the Secretary a rebate for each rebate period (as defined in paragraph (6)(B)) ending after December 31, 2010, in the amount
specified in paragraph (3) for any covered part D drug of the manufacturer dispensed after December 31, 2010, to any full-benefit dual eligible individual (as defined in paragraph (6)(A)) for which payment was made by a PDP sponsor under part D or a MA organization under part C for such period. Such rebate shall be paid by the manufacturer to the Secretary not later than 30 days after the date of receipt of the information described in section 1860D–12(b)(7), including as such section is applied under section 1857(f)(3).

So, this appears to mean that the government expects a rebate on medications they are providing to certain Medicare patients and the drug will not be allowed to be a covered drug by Medicare if a rebate is not offered to the govt. by the manufacturer - that's how it reads to me.

Wonder how this will play out with the formularies versus drugs that are just dropped from the plan????

Page 364 onward then discusses the requirements for these drug providers to give reports to the Secretary of incredibly extensive information with once again, a civil penalty of not more than $10,000 day for not reporting and not more than $100,000 for reporting false info:

‘‘(i) information (by National Drug Code number) on the total number of units of each dosage, form, and strength of each drug of such manufacturer dispensed to full-benefit dual eligible Medicare drug plan enrollees under any prescription drug
plan operated by the PDP sponsor during the rebate period;
‘‘(ii) information on the price discounts, price concessions, and rebates for such drugs for such form, strength, and period;
‘‘(iii) information on the extent to which such price discounts, price concessions, and rebates apply equally to full benefit dual eligible Medicare drug plan enrollees and PDP enrollees who are notfull-benefit dual eligible Medicare drug plan enrollees; and
‘‘(iv) any additional information that the Secretary determines is necessary to
enable the Secretary to calculate the average Medicare drug program full-benefit
dual eligible rebate amount (as defined in paragraph (3)(C) of such section), and to
determine the amount of the rebate required under this section, for such form,
strength, and period.

Page 368 starts the same wording, except now it applies to discounted drugs, instead of rebated drugs.

Page 380 starts the discussion about a Telehealth Advisory Committee:

to make recommendations to the Secretary on policies of the Centers for Medicare & Medicaid Services regarding telehealth services as established under section 1834(m), including the appropriate addition or deletion of services (and HCPCS codes) to those specified in paragraphs (4)(F)(i) and (4)(F)(ii) of such section and for authorized payment under paragraph (1) of such section.

Apparently this has something to do with Rural Medicare health services - the committee will have 9 members who will meet twice a year with the Secretary.

Page 386 starts the following section:

Medicare Beneficiary Improvements: Subtitle A—Improving and Simplifying Financial Assistance for Low Income Medicare Beneficiaries
(D) by inserting after subclause (II) the following new subclauses:
‘‘(III) for 2012, $17,000 (or $34,000 in the case of the combined value of the individual’s assets or resources and the assets or resources of the individual’s spouse)

What is so irritating about trying to read much of this bill is that they are constantly referring to other acts / codes and talking about "striking such and such paragraph and replacing it with..." or "changing the last sentence to read..." and if you don't have the other document, you have no idea what they are referring to.

Page 390 - eliminating barriers to enrollment for the low income subsidy program:

‘‘(iii) CERTIFICATION OF INCOME AND RESOURCES.—For purposes of applying
this section—
‘‘(I) an individual shall be permitted to apply on the basis of self-certification of income and resources; and
‘‘(II) matters attested to in the application shall be subject to appropriate methods of verification without the need of the individual to provide additional documentation, except in extraordinary situations as determined by the Commissioner.’’.

Not sure about this one good or bad or if it is new to this program - for the regular health care plan - applicants could have to show tax returns, etc in order for them to determine which level of care plan you qualify for (if I'm reading this right), but not for this section.

page 398 brings us: SEC. 1205. INTELLIGENT ASSIGNMENT IN ENROLLMENT

(a) IN GENERAL.—Section 1860D–1(b)(1)(C) of the Social Security Act (42 U.S.C. 1395w–101(b)(1)(C)) is amended by adding after ‘‘PDP region’’ the following: ‘‘or
through use of an intelligent assignment process that is designed to maximize the access of such individual to necessary prescription drugs while minimizing costs to such individual and to the program under this part to the greatest extent possible. In the case the Secretary enrolls such individuals through use of an intelligent assignment process, such process shall take into account the extent to which prescription drugs necessary for the individual are covered in the case of a PDP sponsor of a prescription drug plan that uses a formulary, the use of prior authorization or other restrictions on access to coverage of such prescription drugs by such a sponsor, and the overall quality of a prescription drug plan as measured by quality ratings established by the Secretary.’’

Which concludes our review for this evening. Picking up on page 400 starting tomorrow, where the topic will be:

Subtitle B—Reducing Health Disparities
SEC. 1221. ENSURING EFFECTIVE COMMUNICATION IN MEDICARE.

Marsha Blackburn Town Hall Meetings Aug 15th

Just received this email list of town hall meetings being held by Rep. Marsha Blackburn this Saturday, August 15th:

Friends,

I will be hosting additional town hall meetings this Saturday across the 7th District. I have listed them below and hope to see you at one.

My best,

Marsha

Hickman County
8:45 am - 9:30 am CDT
The Country Kitchen
9628 Highway 46, Bon Aqua, TN 37025

Perry County
10:30 am - 11:15 am CDT
The Commodore Hotel
114 East Main Street, Linden, TN 37096

Decatur County
11:45 am - 12:30 pm CDT
Parsons Municipal Building
535 Tennessee Ave South, Parsons, TN 38363

Wayne County
1:45 pm - 2:30 pm CDT
Emerald's Restaurant
122 Public Square, Waynesboro, TN 38485

Hardin County
3:00 pm - 3:45 pm CDT
Uptown Restaurant
390 Main St, Savannah, TN 38372

If you attend a Tennessee Town Hall Meeting, please share your experience with us!

More Healthcare Review Tonight

I'll be back later tonight with more of my readings on the Health Care bill, starting where we left off on page 325.

I've been busy as a bee today canning pear butter, hot peppers, doing some work for hubby - but things will settle down when little ones are sound asleep and we'll trudge forward!

Until then - keep prepping!

Rep Marsha Blackburn Town Hall Meeting - Nashville - Aug 14

Here are the details - if you make it, be sure to let us know how it goes!

Friends,

I will be hosting a town hall meeting on health care in Nashville this Friday. My special guest for the town hall will be nationally recognized health care expert Dennis Smith, former director of the federal Center for Medicaid and State Operations at the Department of Health and Human Services. All of the pertinent information is below.

I hope to see you there,

Marsha

WHAT: Health Care Town Hall Meeting

WHO: Congressman Marsha Blackburn and Health Care Expert Dennis Smith

WHERE: Embassy Suites Franklin, 820 Crescent Center Drive

WHEN: Friday, August 14th 10:00 – 11:00 AM

Continuing Our Healthcare Review - Pg 300-325

Page 299 starts with a section that talks about

SEC. 1152. POST ACUTE CARE SERVICES PAYMENT REFORM PLAN AND BUNDLING PILOT PROGRAM.

IN GENERAL.—The Secretary of Health and Human Services (in this section referred to as the ‘‘Secretary’’) shall develop a detailed plan to reform payment for post acute care (PAC) services under the Medicare program under title XVIII of the Social Security Act (in this section referred to as the ‘‘Medicare program)’’.

POST ACUTE SERVICES.—For purposes of this section, the term ‘‘post acute services’’ means services for which payment may be made under the Medicare program that are furnished by skilled nursing facilities, inpatient rehabilitation facilities, long term care hospitals, hospital based outpatient rehabilitation facilities and home health agencies to an individual after discharge of such individual from
a hospital, and such other services determined appropriate by the Secretary.
(b) DETAILS.—The plan described in subsection (a)(1) shall include consideration of the following issues:
(1) The nature of payments under a post acute care bundle, including the type of provider or entity to whom payment should be made, the scope of activities and services included in the bundle, whether payment for physicians’ services should be included in the bundle, and the period covered by the bundle.

Seems to me like this gives them the leeway to not only decide what dollar amount will be paid for PAC care, but to determine what services can be included.

Page 304 - And since this is yet another pilot program, they are going to fund it:

there are appropriated to the Secretary for the Center for Medicare & Medicaid Services Program Management Account $15,000,000 for each of the fiscal years 2010 through 2012. Amounts appropriated under this paragraph for a fiscal year shall be available until expended.

How much money are we spending on actual health care versus paying government or other employees to do studies and pilot programs and regulatory work?????? In just the past 2 sections of the bill we're looking at $40 million on 2 studies/pilot programs.

Page 309 talks about rebasing home health prospective payment amounts:

‘‘(IV) Subject to clause (iii)(I), for 2011, such amount (or amounts) shall be adjusted by a uniform percentage determined to be appropriate by the Secretary based on analysis of factors such as changes in the average number and types of visits in an episode, the change in intensity of visits in an episode, growth in cost per episode, and other factors that the Secretary considers to be relevant.

Now, does this read to you like the Secretary is going to have to be intimately involved in knowing about the types of visits, how those visits change, etc. for every home health provider???? How in the world do they think they can track stuff like this???

Page 311 incorporates productivity improvements for home health care payments.

Page 313 requires detailed disclosure regarding home health care providers to the "Secretary":

‘‘(f) REPORTING AND DISCLOSURE REQUIREMENTS.—
‘‘(1) IN GENERAL.—Each entity providing covered items or services for which payment may be made under this title shall provide the Secretary with the information concerning the entity’s ownership, investment, and compensation arrangements, including—
‘‘(A) the covered items and services provided by the entity, and
‘‘(B) the names and unique physician identification numbers of all physicians with an
ownership or investment interest (as described in subsection (a)(2)(A)), or with a compensation arrangement (as described in subsection (a)(2)(B)), in the entity, or whose immediate relatives have such an ownership or investment interest or who have such a compensation relationship with the entity.

Page 314-315 extends this disclosure requirement to physicians who have ownership interest in hospitals:

‘‘(A) submit to the Secretary an initial report, and periodic updates at a frequency determined by the Secretary, containing a detailed description of the identity of each physician owner and physician investor and any other owners or investors of the hospital;
‘‘(B) require that any referring physician owner or investor discloses to the individual
being referred, by a time that permits the individual to make a meaningful decision regarding the receipt of services, as determined by the Secretary, the ownership or investment interest, as applicable, of such referring physician in the hospital; and
‘‘(C) disclose the fact that the hospital is partially or wholly owned by one or more physicians or has one or more physician investors—
‘‘(i) on any public website for the hospital; and
‘‘(ii) in any public advertising for the hospital.

You got that, right - read carefully section "B" - the physician who tells you that you need to have surgery is now required to disclose to you if he is an owner or investor in the hospital where you'll be admitted. He is supposed to tell you the ownership and investment interest he has in the hospital, and he is supposed to do this with enough time for you to consider it all before you are admitted.

And on page 316 - it says that any person who fails to disclose to the Secretary - or to anyone as noted above in section "B" - can have a civil penalty of $10,000 per day:

‘‘(A) REPORTING.—Any person who is required, but fails, to meet a reporting requirement of paragraphs (1) and (2)(A) of subsection (f) is subject to a civil money penalty of not more than $10,000 for each day for which reporting is required to have been made.
‘‘(B) DISCLOSURE.—Any physician who is required, but fails, to meet a disclosure requirement of subsection (f)(2)(B) or a hospital that is required, but fails, to meet a disclosure requirement of subsection (f)(2)(C) is subject to a civil money penalty of not more than $10,000 for each case in which disclosure is required to have been made.

So, do you think this will have a positive impact on physicians desiring to establish hospitals / outpatient care clinics, etc in your community?

Page 317 clearly states that hospitals are prohibited from expanding:

‘‘(C) PROHIBITION ON EXPANSION OF FACILITY CAPACITY.—Except as provided in paragraph (2), the number of operating rooms, procedure rooms, or beds of the hospital at any time on or after the date of the enactment of this subsection are no greater than the number of operating rooms, procedure rooms, or beds, respectively, as of such date.

Here's the paragraph (2) they are talking about above - way over on page 321:

‘‘(i) ESTABLISHMENT.—The Secretary shall establish and implement a process
under which a hospital may apply for an exception from the requirement under
paragraph (1)(C).

So in other words, your hospital cannot make plans to expand without approval from the Secretary. Currently, this is done on a local basis in most areas, based on beds already in the area and the need the community has for additional services.

Now it will be up to the government to decide if your community can expand - although they do mention that they will allow community input. Well gee, if the community input is received as well as the community input they've been getting on this Healthcare Bill - do we really expect to have any say at all????

Page 323 - get this one:

‘‘(D) INCREASE LIMITED TO FACILITIES ON THE MAIN CAMPUS OF THE HOSPITAL.—
Any increase in the number of operating rooms, procedure rooms, or beds of a hospital pursuant to this paragraph may only occur in facilities on the main campus of the hospital.

So let's get this straight. The local hospital who wants to expand beds and wants to do so by opening another branch because they are land-locked in their current location would not be able to do so based on this rule??????

The next several pages go on to set limits and parameters that must be met for hospitals to expand, followed by this:

‘‘(H) LIMITATION ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of the exception process under this paragraph, including the establishment of such process, and any determination made under such process.

Am I reading this correctly? Your local hospital doesn't like the way their review went - they want to challenge some legal aspect of it - but this paragraph right here tells them they have no right to do so????

Gotta put a stop here for now and go make some pear butter with the last 50 pounds of pears I picked from my tree this week. Mull these things over in your head and I'll be back later this evening with more.

Back To Our Healthcare Bill Review

Wanted to backtrack just a moment before I move on from my review last night.

On page 19 of the healthcare bill it states:

A qualified health benefits plan may not impose any pre-existing condition exclusion (as defined in section 2701(b)(1)(A) of the Public Health Service Act) or otherwise impose any limit or condition on the coverage under the plan with respect to an individual or dependent based on any health status-related factors

Definition of Insurance from Wikipedia:

Insurance, in law and economics, is a form of risk management primarily used to hedge against the risk of a contingent loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for a premium, and can be thought of as a guaranteed and known small loss to prevent a large, possibly devastating loss. An insurer is a company selling the insurance; an insured or policyholder is the person or entity buying the insurance. The insurance rate is a factor used to determine the amount to be charged for a certain amount of insurance coverage, called the premium. Risk management, the practice of appraising and controlling risk, has evolved as a discrete field of study and practice.

So, when we allow everyone in with their pre-existing conditions and agree to automatically pay for things that are "known", technically it is no longer insurance.

Okay, now onward from page 200. You can join in for your reading pleasure if you like - Here's the link: Health Care Bill.

Page 241: The act provides for the designation of "service categories" There are 3 -

(i) services in the category designated Evaluation and Management in the Health Care Common Procedure Coding System
(ii) preventive services
(B) All other services not described in subparagraph (A)

Then catch this one:

Service categories established under this paragraph shall apply without regard to the specialty of the physician furnishing the service.

Does this mean they can determine what the provider will receive for reimbursement regardless of their area of specialty???

Page 253 - The Secretary appears to be able to put a value on the provider's time based on the following:

‘‘(i) IN GENERAL.—The Secretary shall establish a process to validate relative value units under the fee schedule under subsection (b).
‘‘(ii) COMPONENTS AND ELEMENTS OF WORK.—The process described in clause (i) may include validation of work elements (such as time, mental effort and professional judgment, technical skill and physical effort, and stress due to risk) involved with furnishing a service and may include validation of the pre, post, and
intra-service components of work.

Page 258: It appears that our professional service providers are going to be required to do additional paperwork regarding "quality measures" with perhaps some sort of incentive payment? It really isn't clear:

‘‘(H) FEEDBACK.—The Secretary shall provide timely feedback to eligible professionals on the performance of the eligible professional with respect to satisfactorily submitting data on quality measures under this subsection.’’.

‘‘(A) The development of measures, the reporting of which would both demonstrate—
‘‘(i) meaningful use of an electronic health record for purposes of subsection
(o); and
‘‘(ii) clinical quality of care furnished to an individual.

Page 260 - of course, California gets it's own special treatment:

‘‘(6) TRANSITION TO USE OF MSAS AS FEE
21 SCHEDULE AREAS IN CALIFORNIA.—
‘‘(ii) TRANSITION.—For services furnished on or after January 1, 2011, and before January 1, 2016, in the State of California, after calculating the work, practice expense, and malpractice geographic indices described in clauses (i), (ii), and (iii) of paragraph (1)(A) that would otherwise apply through application of this paragraph, the Secretary shall increase any such index to the county-based fee schedule area value on December 31, 2009, if such index would otherwise be less than
15 the value on January 1, 2010.

Page 267 - It appears to me that the government can decide the costs allowed and whether or not some of these options are allowed for items such as power-driven wheelchairs, brachytherapy, home infusion therapy - they are requiring a report to Congress on home infusion therapy:

Not later than 12 months after the date of enactment of this Act, the Medicare Payment Advisory Commission shall submit to Congress a report on the following:
(1) The scope of coverage for home infusion therapy in the fee-for-service Medicare program under title XVIII of the Social Security Act, Medicare Advantage under part C of such title, the veteran’s health care program under chapter 17 of title 38, United States Code, and among private payers, including an analysis of the scope of services provided by home infusion therapy providers to their patients in such programs.
(2) The benefits and costs of providing such coverage under the Medicare program, including a calculation of the potential savings achieved through avoided or shortened hospital and nursing home stays as a result of Medicare coverage of home infusion therapy.
(3) An assessment of sources of data on the costs of home infusion therapy that might be used to construct payment mechanisms in the Medicare program.

Page 270

SEC. 1144. REQUIRE AMBULATORY SURGICAL CENTERS (ASCS) TO SUBMIT COST DATA AND OTHER DATA.

Page 272 appears to allow the Secretary to determine if Cancer Treatment Hospitals are allowed or funded and at what rate:

‘‘(A) STUDY.—The Secretary shall conduct a study to determine if, under the system under this subsection, costs incurred by hospitals described in section 1886(d)(1)(B)(v) with respect to ambulatory payment classification groups exceed those costs incurred by other hospitals furnishing services under this subsection (as determined appropriate by the Secretary).
‘‘(B) AUTHORIZATION OF ADJUSTMENT.— Insofar as the Secretary determines under subparagraph (A) that costs incurred by hospitals described in section 1886(d)(1)(B)(v) exceed those costs incurred by other hospitals furnishing services under this subsection, the Secretary shall provide for an appropriate adjustment under paragraph (2)(E) to reflect those higher costs effective for services furnished on
or after January 1, 2011.’’.

Page 288 and a few pages before - best I can tell, they are going to withhold some portion of payments to hospitals who have "readmissions" for the same or similar illness, based on definitions set by the Secretary:

‘‘(E) READMISSION.—The term ‘readmission’ means, in the case of an individual who is discharged from an applicable hospital, the admission of the individual to the same or another applicable hospital within a time period specified by the Secretary from the date of such discharge. Insofar as the discharge relates to an applicable condition for which there is an endorsed measure described in subparagraph
(A)(ii)(I), such time period (such as 30 days) shall be consistent with the time period specified for such measure.

Another part of 288-289:

‘‘(7) MONITORING INAPPROPRIATE CHANGES IN ADMISSIONS PRACTICES.—The Secretary shall monitor the activities of applicable hospitals to determine if such hospitals have taken steps to avoid patients at risk in order to reduce the likelihood of increasing re-admissions for applicable conditions. If the Secretary determines that such a hospital has taken such a step, after notice to the hospital and opportunity for the hospital to undertake action to alleviate such steps, the Secretary may impose an appropriate sanction.

Can someone please explain to me how all these "studies" and all this "monitor" of activities by the government is going to be paid for? Who is going to do all this work? How much are they going to be paid? How many more levels of bureaucracy is this all going to create??? Are hospitals and providers going to be able to concentrate on treating patients, or are they going to be too busy worried about big-brother breathing down their neck?

Page 297 - they are going to conduct yet another study to see how they can apply the same "readmissions" definitions to physicians directly:

(d) PHYSICIANS.—(1) STUDY.—The Secretary of Health and Human Services shall conduct a study to determine how the readmissions policy described in the previous subsections could be applied to physicians.

Here's how:

(A) creating a new code (or codes) and payment amount (or amounts) under the fee schedule in section 1848 of the Social Security Act (in a budget neutral manner) for services furnished by an appropriate physician who sees an individual within the first week after discharge from a hospital or critical access hospital;
(B) developing measures of rates of readmission for individuals treated by physicians;
(C) applying a payment reduction for physicians who treat the patient during the initial admission that results in a readmission; and
(D) methods for attributing payments or payment reductions to the appropriate physician or physicians.

Now think about this - have you ever been treated in a teaching hospital? Yes, you have a primary physician who is "responsible" for your care, but how many different physicians come in and out and check on you, change things about your care, make notes on your chart, etc? How willing would you be to take on the role of the "primary" physician in this case, knowing that you could be financially penalized by something you didn't even do? At least, that's how it appears to me reading this. I cannot imagine how they'll be able to track this.

Page 298 - Am I reading this right??? They are going to allot $25 million dollars to conduct this oversight and these studies from this section about re-admissions we looked at above????

(e) FUNDING.—For purposes of carrying out the provisions of this section, in addition to funds otherwise available, out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services for the Center for Medicare & Medicaid Services Program Management Account
$25,000,000 for each fiscal year beginning with 2010.

This is all I can do tonight folks. Stick with me and we'll see what else is there. If you are reading this yourself, feel free to comment on anything that's made an impression on you.

Bob Corker In Covington, TN

Link:

WMC-TV 5 online

Excerpt:

Corker picked Covington to launch the first of 29 town hall meetings in different counties throughout Tennessee, and it didn't take long for the audience to hear Corker's stand on the President's proposed health care reform bill.

"My guess is the house bill will likely go in the trash can, okay? It's just not practical, and doesn't stand the test," Corker said.

Corker said he believes the proposed health care bill is too expensive, and has too much government control. Both points seemed to earn the senator a lot of support from the crowd of onlookers in Covington.

"Everything that the President has done so far is driving up costs," Corker said. "You know, when he began this debate, it was about driving down costs."

Let's Go Through It Together - Healthcare Bill

Let's go through this together, shall we? I'm not an attorney, I'm not a paralegal, I'm not a professor - I'm just a college-educated, former professional business owner, now stay-at-home, home-schooling mom who believes it is important that we know what our Representatives are trying to pass as the law of the land.

So let's get started:

GENERAL DEFINITIONS.
(a) PURPOSE.—
(1) IN GENERAL.—The purpose of this division is to provide affordable, quality health care for all Americans and reduce the growth in health care spending.

Well - right there on page 4 we have an interesting statement - reduce the growth in health care spending. When have you ever known the government to reduce costs in anything?

Here we are on page 9 - definition of a Dependent:

The term ‘‘dependent’’ has the meaning given such term by the Commissioner
and includes a spouse.

Okay - that's clear as mud.

Another on page 9:

EMPLOYMENT-BASED HEALTH PLAN.—The term ‘‘employment-based health plan’’— (A) means a group health plan (as defined in section 733(a)(1) of the Employee Retirement Income Security Act of 1974

Anyone have a copy of the Employee Retirement Income Security Act of 1974 lying around?

Page 10:

HEALTH INSURANCE COVERAGE; HEALTH
INSURANCE ISSUER.—The terms ‘‘health insurance coverage’’ and ‘‘health insurance issuer’’ have the meanings given such terms in section 2791 of the Public Health Service Act.

Seems we also need a copy of the Public Health Service Act. Same thing the lady on SurvivalistBoards was stating - there are tons of references to other Acts in this document. Do you think our Representatives have handy access to all these Acts to make the cross-references?

Page 22:

They are going to do a study and within 18 months of the start of this healthcare plan:

Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives
for small and mid-size employers to self-insure

This is done by examining "(C) The financial solvency and capital reserve levels of employers that self-insure by employer size." - how are they going to do this, audit every company? And this saves us money how?

Whomever this "Commissioner" is - he/she is going to have some incredible power.

Pages 30 - 33:

The Health Benefits Advisory Committee shall recommend to the Secretary of Health and Human Services (in this subtitle referred to as the ‘‘Secretary’’) benefit standards (as defined in paragraph (4)), and periodic updates to such standards.

and

BENEFIT STANDARDS DEFINED.—In this subtitle, the term ‘‘benefit standards’’ means standards respecting—(A) the essential benefits package described in section 122, including categories of covered treatments, items and services within benefit classes.

So a governmental Advisory Committee will decide what benefits (in other words, medical treatments) will be provided to members of this plan???

Another governmental agency is created - page 41:

IN GENERAL.—There is hereby established, as an independent agency in the executive branch of the Government, a Health Choices Administration (in this division referred to as the ‘‘Administration’’).

Another cost saving measure? No - more government, again. And the Commissioner is appointed by the President.

Page 42:

The Commissioner establishes the benefit standards.

Page 43:

The Commissioner can collect data (doesn't say what data) for the purposes of carrying out his/her duties.

Page 58:

‘‘(D) enable the real-time (or near real time) determination of an individual’s financial
responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card;

Gee, this sounds a lot to me like they'll be able to have a real-time look into your bank account to see your financial status and will have finally gotten the national ID card they've been after.

Page 107:

Now we have the appointment by the President of a "Special Inspector General"

Page 136 appears to be sliding scale determination of premium payments:

(2) PREMIUM PERCENTAGE LIMITS BASED ON TABLE.—The Commissioner shall establish premium percentage limits so that for individuals whose family income is within an income tier specified in the table in subsection (d) such percentage limits shall increase, on a sliding scale in a linear manner, from the initial premium percentage to the final premium percentage specified in such table for such income
tier.

Page 140 appears to require an income tax form as proof of income on the application:

(B) ALTERNATIVE PROCEDURES.—The Commissioner shall establish procedures for the verification of income for purposes of this subtitle if no income tax return is available for the most recent completed tax year.

Page 149 addresses the expected contributions of employers in lieu of coverage - it is 8% of their wages:

A contribution is made in accordance with this section with respect to an employee if such contribution is equal to an amount equal to 8 percent of the average wages paid by the employer during the period of enrollment (determined by taking into account all employees of the employer and in such manner as the Commissioner provides, including rules providing for the appropriate aggregation of related employers).

This is scaled down for smaller businesses on page 150.

Page 167: Individuals without "acceptable" health care coverage will pay a 2.5% tax:

‘‘SEC. 59B. TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE.
‘‘(a) TAX IMPOSED.—In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of—
‘‘(1) the taxpayer’s modified adjusted gross income for the taxable year, over
‘‘(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer.

Page 174:

‘‘(6) NOT TREATED AS TAX IMPOSED BY THIS CHAPTER FOR CERTAIN PURPOSES.—The tax imposed under this section shall not be treated as tax
imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55.

What???

Page 190:

‘‘(2) CREDIT NOT ALLOWED WITH RESPECT TO CERTAIN HIGHLY COMPENSATED EMPLOYEES.—No credit shall be allowed under subsection (a) with respect to qualified employee health coverage expenses paid or incurred with respect to any employee for any taxable year if the aggregate compensation paid
by the employer to such employee during such taxable year exceeds $80,000.

What? So now if you make $80,000 a year you are a highly compensated employee?

Page 195: Officers and employees of the Health Choices Administration have a right to review your income tax records:

shall disclose to officers and employees of the Health Choices Administration or such State-based health insurance exchange, as the case may be, return information of any taxpayer whose income is relevant in determining any affordability credit described in subtitle C of title II of the America’s Affordable Health Choices Act of 2009. Such return information shall be limited to—
‘‘(i) taxpayer identity information with respect to such taxpayer,
‘‘(ii) the filing status of such taxpayer,
‘‘(iii) the modified adjusted gross income of such taxpayer (as defined in section 59B(e)(5)),
‘‘(iv) the number of dependents of the taxpayer,
‘‘(v) such other information as is prescribed by the Secretary by regulation as might indicate whether the taxpayer is eligible for such affordability credits (and the
amount thereof), and
‘‘(vi) the taxable year with respect to which the preceding information relates

Pages 197-198 discuss the surcharges on high income individuals - somewhere between 1 and 5.4 percent of modified adjusted gross income for those at $350,000 and up.

Ugh. That's all I can do for now. More another day if I can stand it.

Cross References Needed So Far in Healthcare Bill

So I started going through the Healthcare bill tonight and got through page 200. It has been a daunting task - and I'll share my findings soon.

Here are the other Acts, Codes, Regulations, etc. that were referenced that one really needs for some of the items discussed on the first 200 pages so far:

• Employee Retirement Income Security Act of 1974
• United States Code, Chapter 57, Title 5
• United States Code, Chapter 89, Title 5
• Community Services Block Grant Act
• Public Service Health Act
• Title XIX of the Social Security Act
• American Recovery and Reinvestment Act of 2009
• Section 9802 of the IRS Code of 1986
• Federal Advisory Committee Act
• Code of Federal Regulations
• Intergovernmental Personnel Act of 1970
• Consumer Product Safety Act
  
• Federal Acquisitions Regulation
• Emergency Economic Stabilization Act of 2009

Quite a list, huh? Do you think that even if any of our Representatives bother to read this Health Care Bill they are going to rush right out and cross reference all of these acts / regulations? Yeah, right.

Do You Know What's In the Healthcare Bill?

Have you read it? Because you know that our Senators and Representatives haven't. They farm it out in sections to staffers to read and interpret and give them a quick review.

Why is it there is such a rush to pass through a 1018 page bill that no one has read? Because once it is a done deal, do you realize how difficult, if not impossible, it will be to take any of it away?

Would you sign a mortgage for a new house without reading it? Would you sign any other legal document without reading it?

Then why on earth do we allow for our elected representatives to pass laws that we must abide by when they not only didn't write them, but couldn't even bother to read them? And you realize that if they pass this health care bill, they don't even have to live with it themselves? They are exempt. Does this not make you stark-raving mad?

Doesn't it make you furious to hear the media and lawmakers say that those of us who are attending town hall meetings are part of a conspiracy - that we're part of an organized program to cause disruption when all we are there to do is let our feelings be known?

What ever happened to our elected representatives making laws based on the will of the people? If the will of the people across this country is saying NO to government-run health care, don't we think they should be listening to us instead of trying to come up with talking points to make us come on board with them? Instead of trying to cram it down our throats?

Do you know that Pelosi sent "talking points" home with her democratic peers because they were clueless about this bill?

Have any of you readers out there tried to read this 1000+ page document? Well, there is a member on SurvivalistBoards forum that is trying to get through the entire document and share her findings. So far she's read the first 100 pages and has posted information for us to know as she has gone along.

Here's a link to the first 100 pages she's read: Pages 1-100 of the Healthcare Bill.

She's going to post each 100 pages in a separate forum thread to make it easier to read. I encourage you to check this out. I strongly encourage you to try to read the entire document yourself, but at the very least follow along with us on the SurvivalistBoards forum.

Here's a link to the entire PDF file of the 1018 page Healthcare Bill.

Here's a link to the Liberty Counsel PDF file Overview of the Healthcare Bill.

If there is a town-hall meeting in your area - by all means try to go - get out there and hear what your elected officials are presenting on this health care bill. Find out if they've read it. Find out what they really know about it. Demand that they represent you - the people.

We cannot afford to stand by and be ignorant on this one folks.