Wednesday, May 23, 2012

Abuse under health coverage plans amid upcoming high court decision

This article was originally published by the Viễn Đông on May 21, 2012. It was written by Vanessa White.

WESTMINSTER, California—A patient might be given a year’s worth refill on medication and sent away, told it is unnecessary to return for another visit in a month.
The doctor, then, might go on a vacation.

Or, a doctor might have a sicker patient visit monthly, receiving more money than if the patient were healthy and visited less.

It all depends on the plan, Garden Grove’s Tran Pharmacy Pharmacist Thư-Hằng Trần told the Viễn Đông in a 12 May 2012 phone interview explaining some of the differences between increasingly pushed managed care health coverage plans and fee-for-service health coverage plans. Aside from having a doctor as a close family member, Pharmacist Trần said that her knowledge on health coverage plans was gained from her own research and experiences.
After a “very bad” accident that put her in the hospital ten years ago, she said, she had to wait for approval from her health maintenance organization (HMO) each time she needed to see a specialist for follow-up treatment. An HMO provides or arranges managed care health coverage plans.

Fortunately, she added, her HMO quickly approved the requests and referrals that her family doctor wrote. Though, not all patients are so fortunate, she continued, adding that there are times when HMOs will take too long to approve a referral or request, upon which she advises the patients to demand approval.
“For some patients, if you don’t fight you don’t get the service,” she said.

ACA, Managed care vs. fee-for-service
Under the Patient Protection and Affordable Care Act (ACA), awaiting a June or July 2012 U.S. Supreme Court decision on its constitutionality, Medicaid will expand coverage to uninsured Americans who will be required to have health insurance by 2014. Medi-Cal is California’s version of Medicaid, which covers lower-income families with children, seniors, foster children, pregnant women, and people with specific diseases including breast cancer and HIV/AIDS.

The Viễn Đông has learned that the upcoming court decision could extend managed care plans to more patients, as more states are reportedly moving towards these types of plans. Such managed care plans are private, with the state paying the private HMO a fixed monthly payment.
When doctors actually receive payment for their services, they get about $120-130 monthly, even if their patients do not visit the doctors, Pharmacist Trần told the Viễn Đông.

Pharmacist Trần said that she generally likes the idea of managed care plans because they can save the state money if a patient’s care is adequately managed. Though, she has a problem when the health care system is abused.
For example, Pharmacist Trần said that HMOs can take advantage of the system by denying certain patient referrals and requests for services or choosing the route that costs less, regardless of the patient’s need. For example, if a patient feels in need of a wheelchair, an HMO might approve a $500 manual wheelchair for the patient instead of a $5,000 electric powered wheelchair.

Pharmacist Trần added that under managed care plans, doctors also will sometimes withhold services from patients who really need them because the doctors will have to spend more time and energy providing the services, while feeling like they are losing out on money they might have made from fee-for-service payments. With fee-for-service health coverage plans, doctors are paid per service.
Under Medicaid fee-for-service health coverage plans, Pharmacist Trần continued, patients can abuse the system by claiming to need an earlier mentioned $5,000 electric powered wheelchair or other treatment and medication that stay at the patient’s home, unused.

Or, she added, a patient might go to one doctor that prescribes a medication or treatment the patient does not want, so the patient will go to a different doctor. That doctor might prescribe another medication the patient does not want and the cycle continues, all the while costing the state money.
Both programs have their weaknesses and strengths, Pharmacist Trần suggested, with managed care plans being good for helping patients decide what care they need and fee-for-service plans allowing the patients a different level of flexibility in choosing services.

There are problems, she said, when the systems are abused.

Electronic prescriptions not federally mandated, local pharmacist says

This article was originally published by the Viễn Đông on May 19, 2012. It was written by Vanessa White.

WESTMINSTER, California—A newer form of prescribing medication has been touted as helping reduce errors and speed up delivery time, though the Viễn Đông has learned that the process might be slower.
E-prescribe is a system that allows doctors to “electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care,” according to the Centers for Medicare and Medicaid Services (CMS) website. Included in the 2003 federal Medicare Modernization Act, e-prescribing has become considerably popular and aligned with the government’s plans to make medical records electronic.

Garden Grove’s Tran Pharmacy Pharmacist Thư-Hằng Trần told the Viễn Đông in a May 12, 2012 phone interview that the e-prescribe process involves a doctor inputting prescriptions into a laptop instead of using a notepad.

To some extent, the e-prescribe system does reduce error, Pharmacist Trần said. For example, if done correctly, the pharmacy will receive the prescription right away and the patient can pick it up sooner than if the patient had brought in the prescription.
Also, if a doctor has poor handwriting, Pharmacist Trần added, electronically submitting the prescription can ensure that the pharmacist reads the prescription correctly and does not make a mistake with the order. Though, aside from ensuring patients receive their prescriptions in a timely and accurate manner, Medicare gives doctors bonuses for using e-prescribe.

Doctors who do not use e-prescribe, Pharmacist Trần continued, experience a 1-2 percent reduction in payments, even though the program is not federally mandated.
E-prescribe myths

Pharmacist Trần told the Viễn Đông that some doctors who use e-prescribe will tell their patients that they can only send prescriptions to certain pharmacies that accept e-prescribe.
A common trick, she said, is for doctors to say that the patient must pick up a prescription from one particular pharmacy and nowhere else. Though in reality, the doctor might have a wife or brother-in-law operating that pharmacy and the doctor is helping to benefit others in the business, she added.

Pharmacist Trần suggested to the Viễn Đông that she is not one of those pharmacists with connections, as some doctors do not send her prescriptions right away. When the patient shows up looking for their prescription and she has not yet received it, she said that she calls the doctors and they tell her that there must be a problem with her receiver.
Some doctors even tell their patients not to go to her pharmacy, she continued, adding that she shares with her patients that some doctors offer misleading information.

Another e-prescribe trick involves pharmacists who do not give their patients the entire prescriptions, she said. For example, if a patient is to pick up 10 medications, some pharmacists will give the patients eight or nine, because the pharmacists might be short on medication or even because they might want to keep it for themselves.

Though, one of the most upsetting tricks or  “lies,” Pharmacist Trần said, is for doctors to tell their patients that because they are using e-prescribe, the federal government has mandated that they cannot write out a prescription for the patient. Not only is it misleading the patient regarding their prescription, she added, but it leads to a dislike toward the federal government.
“Many doctors take advantage,” she said.

Fight for the prescription
Pharmacist Trần told the Viễn Đông that patients have the right to ask their doctors for hand-written prescriptions. In fact, they should do so before leaving the doctor’s office, even if the doctor uses e-prescribe, she added.

With a handwritten copy of their prescriptions, she continued, the patient will know if the pharmacist is withholding medication or if the doctor has failed to electronically send the prescription to the pharmacy.
Some patients will have to fight for their prescriptions, she said, adding that this has been the case with some of her patients and she feels sorry for them having to fight for their right.

Medicare does not mandate that doctors and pharmacists use e-prescribe, she reiterated.

Tuesday, May 15, 2012

Haiti’s rainy season brings floods, more cholera cases amid U.S. efforts to feed

This article was originally published in the Viễn Đông Daily News on May 13, 2012. It was written by Bạch Vân.

PORT AU PRINCE, Haiti—The annual rainy season has begun, already causing floods that have reportedly killed a dozen and displaced thousands while damaging crops and soil in the Western Hemisphere’s poorest country.
Haiti’s rainy season, from May-October, has heightened concern since after the 7.0 earthquake that hit the country in January 2010. Aside from the more than 316,000 people dying as a result of the quake, according to disputed Haitian government figures, more than 1.5 million people were left homeless with little if any stable shelter from the rains or flooding.

Contributing to the concern, in October 2010 cholera broke out in the country, reportedly killing at least 7,000 people and inflicting more than 500,000 more. As cholera is known to spread through water, floods serve as a heavy breeding ground for the bacteria, described by the World Health Organization (WHO) as an “intestinal infection” that results in “watery diarrhea,” and vomiting, quickly leading to “severe dehydration” and death if not treated.

While mainstream news outlets report that cholera-related deaths have been decreasing, a Haiti-based media outlet, Haiti Libre, reports that Haiti’s cholera-related fatality rate is increasing along with the number of cholera patients. Treatment centers in some areas have reached capacity while some medical staff members have not been paid since January 2012, the outlet adds.

Haiti Libre continues, reporting that when the rainy season is over, the funding recedes and there is little, if any, emphasis on cholera prevention, leaving the population vulnerable when the epidemic begins again.
Inside tent camps, where nearly 500,000 people displaced by the 2010 earthquake still reportedly live, less than one third have adequate drinking water and 1 percent of them have received soap, Haiti Libre reports.

“It is worrying that the authorities are not better prepared and keep reassuring speeches that do not correspond to reality,” Haiti Libre quotes Gaëtan Drossart, head of the Médecins Sans Frontières (MSF) humanitarian aid mission in Haiti. “There are many meetings between the government, the UN and its humanitarian partners, but few concrete solutions.”

Brief history of Haiti
Haiti is located in the Caribbean Sea, west of the Dominican Republic. Both countries share an island, which was called Hispaniola upon Spanish colonization.

The 1492 Spanish colonization killed off much of Hispaniola’s Taino Indigenous population by introducing foreign disease, warfare, and slavery to the island. To supplement the work of building a colony, the Spaniards brought Africans to Hispaniola as slaves.

The French also came to the western part of Hispaniola, breeding competition with the Spanish. In 1697, the island was divided in two: the western, or French, part of the territory was the area now known as Haiti, while the eastern, or Spanish, part is the area now called the Dominican Republic.
Uprisings among free and enslaved Blacks in the area now known as Haiti reportedly caused all French colonies to abolish slavery in 1794. While the French attempted to reestablish slavery in the area now known as Haiti, the country declared its independence in 1804, the French not recognizing the independence until 1825.

Part of France’s acknowledgement would mean that Haiti had to pay retribution to France for the French loss of “property,” including slaves, land, and equipment, etc.
While the retribution Haiti paid lifted a trade embargo placed on the country by France, Britain, and the United States, Haiti had to take out high interest loans to fully pay the retribution. This took the country until 1947 and Haiti is still plagued by perpetuated debt.

Help from U.S.
Upon the 2010 earthquake, humanitarian aid organizations from throughout the world rushed into Haiti, bringing dry foods, hygiene kits, school supplies and more.

Though, as Haiti was an impoverished country since before the earthquake, there were villages that were not hit by the quake yet the village people insisted otherwise so they could have access to aid they had needed for years, a Viễn Đông reporter learned from humanitarian aid organizations during a trip to Haiti in March 2010.

Before Fountain Valley’s Coastal Community Fellowship Pastor Kene Panas had heard of such stories, he was already helping to set up a food packing event for Haiti’s children through the organization Kids Around The World (KATW).

Pastor Panas told the Viễn Đông during an in-person interview that his congregation is one of many that is hosting such an event, contributing to 1 million packaged meals in May 2012.
The event will consist of a single two-hour shift, with about 200 people helping to package $25,000 worth of dried food stuff including protein and dehydrated vegetables,  Pastor Panas said. He added that the food will be packaged into bags that will go into boxes, each box holding 36 bags, enough to feed a single child for about seven months.

While Pastor Panas said that his church will think through their humanitarian aid plans more thoroughly in the future, he feels that packing up dry food and sending it to Haiti will help the people in his congregation and the general community to “think outside of themselves.”
He invites the community to the packing event on May 19, 2012 from 10 a.m.-12 p.m. at the Coastal Community Fellowship church lawn, located next to the Fountain Valley City Hall at 10460 Slater Ave., Fountain Valley, CA 92708.

Monday, May 14, 2012

Proposed Medi-Cal, Medicare partnership causing local confusion

*This article was originally published in the Viễn Đông Daily News on May 14, 2012. It was written by Vanessa White.

ORANGE, California—Orange County is among the first four California counties chosen to participate in a proposed demonstration project expected to integrate care for lower-income seniors and people considered to be disabled.
People eligible under both the state’s Medi-Cal program and the federal Medicare program, living in Orange County (OC), Los Angeles, San Diego, and San Mateo counties, could have coordinated care and services beginning on 1 January 2013, pending federal approval. The Viễn Đông has learned that California is among 15 others states that could participate in the proposed program.

Also part of Governor Jerry Brown’s Coordinated Care Initiative (CCI), the proposed project could include 10 other California counties aiming to improve health outcomes, promote more efficient health care, and allow more beneficiaries to stay in their homes and communities for as long as possible, according to an April 2012 California Department of Health Care Services (DHCS) press release about the project.

“Currently, most dual eligible beneficiaries access services through a complex system of disconnected programs that often leads to beneficiary confusion, delayed care, poor care coordination, inappropriate utilization and unnecessary costs, issues we are addressing with this proposal,” DHCS Director Toby Douglas was quoted in the press release. “The goal is to design a seamless system that helps dual eligible beneficiaries get the health care services they need and improve health outcomes in a more fiscally efficient manner.”

California has more than 1 million people enrolled in both Medicare and Medi-Cal, according to the press release, which adds that these people are among California’s “highest-need and highest-cost users of health care services” and account for nearly 25 percent of Medi-Cal spending.

Funded through the Patient Protection and Affordable Care Act (ACA), which is pending a U.S. Supreme Court decision on its constitutionality, the proposed project is expected to save California more than $678 million during the fiscal year (FY) 2012-2013 and $1 billion in FY 2013-2014.

“We will build upon California’s existing structure of managed care health plans, county mental health programs and home- and community-based social services to achieve the financial and service integration necessary to accomplish this goal,” Mr. Douglas was quoted.

CalOptima managed care plans
Under the proposed project, OC’s public health plan, CalOptima, would receive a combined monthly payment from Medicare and Medi-Cal to provide their enrollees all needed services, according to the DHCS press release. Beneficiaries would have a single health plan membership card and one care team that will help coordinate their services.

All medical and long-term services and supports are expected to be integrated as managed care benefits, the press release continues, though adds that Medicare beneficiaries who do not wish to participate in the proposed dual eligibility project could opt out. However, beneficiaries who do not choose to opt out by 1 January 2013 would be phased-in throughout 2013.

Garden Grove’s Tran Pharmacy Pharmacist Thư-Hằng Trần told the Viễn Đông in a 12 May 2012 phone interview that beneficiaries will receive notices in the mail, informing them of the proposed changes in September 2012. Until then, she added, beneficiaries are not required to sign any forms regarding the proposed project.

Pharmacist Trần continued, saying that some doctors will try and have been trying to mislead their Medicare patients, telling them that they must fill out an “opt out” form right away. Really, she adds, the doctors are having their patients fill out managed care applications because doctors tend to benefit from that type of plan.

“I don’t like the way they lie to the patients,” she said. “It’s totally wrong.”

Under managed care, doctors receive a single fixed payment of $120-130 monthly, even if the patient does not visit the doctor, Pharmacist Trần continued. If a patient is healthy, doctors typically try to convince them to enroll into a managed care plan because the patient rarely visits and doctors profit by doing the least amount of work.

Pharmacist Trần said that she generally likes the idea of managed care plans if doctors adequately manage their patients’ care, though she has a problem when doctors, and even patients, abuse the system.

“Be careful,” she said.