health care reform in the united states

HEALTH CARE REFORM IN THE UNITED STATES

By Craig B. Garner, Esq.

An overview of the 2010 Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act

1Copyright 2011 Craig B. Garner, Esq.

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THE FIRST HOSPITALS IN THE UNITED STATES

Many of America's initial medical services grew from the desire of charity based organizations to assist the poor and sick. In 1736, the New York City Almshouse designated six bedrooms as a “ward” that would eventually grow to become Bellevue Hospital, followed closely that same year by what would later be known as Charity Hospital in New Orleans, Louisiana.


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MEDICINE IN THE NINETEENTH CENTURY

Through the 1800s, access to the delivery of care rendered by the few elite hospitals (totaling fewer than 200 in 1873) in cities such as New York, Boston and Philadelphia went hand-in-hand with status in society.

The Medical Laboratory, University of Pennsylvania


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At the turn of the twentieth century, hospitals were few and far between, and their amenities were sparse. With the l imited medica l technology and crowded, often unsanitary conditions available in the early 1900s, a hospital was not a place to be if you were sick.


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THE BEGINNING OF THE TWENTIETH CENTURY

By the 1920’s, the hospital had become a national institution in America, with more than 5,000 facilities appearing in towns across the country. This trend brought with it advances in technology, more doctors, and greater quality of care.

As conditions in health care improved, the practice of medicine in the United States shifted from home to hospital. People went to a hospital to get better, benefitting from these advances.

St. Vincent Hospital, Los Angeles


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HOSPITAL AND COMMUNITY WORKING TOGETHER

In 1946, the Hospital Survey and Construction Act (the Hill Burton Act”) disbursed approximately $3.7 billion to hospitals so they could meet the needs of the nation. The Hill Burton Act sought to create 4.5 hospital beds per 1,000 people nationwide.

Harold H. Burton

Lister Hill

The Hill Burton Act forced hospitals and their communities to work together, combining federal funds with local monies to cover expenses.


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By the 1960s, health care in the United States was at a

crossroads. Access to treatment had increased, but so

had the corresponding price tag. With the passage of

Medicare in 1965, our nation solidified its commitment

to government sponsored health care.


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Since the creation of Medicare in 1965, health care in the United

States has faced a multitude of challenges on virtually all possible

fronts. Today, critics contend that health care is overregulated,

underfunded, and the system fails to reflect the expectations and

demands of modern society.


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As health care expenses in the United States approach 18% of the

nation’s GDP, as many as 50 million Americans are still without health

insurance, and medical bills are one of the leading causes of individual

bankruptcy today. After many failed attempts at reform over the

decades, 2010 marked the year for change.


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The Cost: $940 billion over ten years.

Would expand coverage to 32 million Americans who arecurrently uninsured.

In 2014, everyone must purchase health insurance or face a $695 annual fine. There are some exceptions for low-income households.

Expands Medicaid to include more families who did not previously qualify.

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act into law (followed by the Health Care and Education Reconciliation Act).

HEALTH CARE REFORM BY THE NUMBERS*

* Estimated projections at the time of passage.


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WHO PAYS?*

Drug manufacturers would pay a total of $16 billion between 2011 and 2019.

Health insurers would pay $47 billion over this same period.

Medical device manufacturers would pay a 2.9 % excise tax on sales, beginning in 2013.

A 10% tax on indoor tanning services is expected to raise about $2.7 billion.

Starting in 2012, the Medicare Payroll Tax will include a 3.8% tax on investment income for families making more than $250,000 per year ($200,000 for individuals).

Beginning in 2018, businesses will pay a 40% excise tax on so-called "Cadillac" high-end insurance plans worth over $27,500 for families ($10,200 for individuals).

* Estimated projections at the time of passage.


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HEALTH CARE SPENDING

National Health Expenditure Accounts (NHEA) measure the total annual dollar amount of our nation’s health care consumption.

This information also tries to identify the amount invested in the future of health care (such as medical structures, equipment, research, etc.).

Growth in U.S. National Health Expenditures (NHE) over the next ten years is expected to be slightly higher due to PPACA.

Average annual growth in NHE for 2009 through 2019 is expected to be 6.3%.

NHE as a portion of the nation’s GDP is expected to be 19.6% by 2019.

Source: CMS, Office of the Actuary (April 2010).


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HEALTH CARE SPENDING (continued)

The following information was compiled for fiscal year 2009:

■ NHE grew 4.0% to $2.5 trillion, or $8,086 per person, and accounted for 17.6% of GDP.

■ Medicare spending grew 7.9% to $502.3 billion, or 20% of total NHE.

■ Medicaid spending grew 9.0% to $373.9 billion, or 15% of total NHE.

■ Private health insurance spending grew 1.3% to $801.2 billion, or 32% of total NHE.

■ Out of pocket spending grew 0.4% to $299.3 billion, or 12% of total NHE.

■ Hospital expenditures grew 5.1% in 2009.

■ Physician and clinical services expenditures grew 4.0%.

■ Prescription drug spending increased 5.3%.Source: CMS, Office of the Actuary (April 2010).


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HOW WILL PPACA SLOW THIS TREND IN HEALTH CARE SPENDING?


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THE HEALTH INSURANCE EXCHANGE

Under Health Care Reform, the health insurance exchange is a marketplace created to offer affordable, high-quality health insurance options. The exchange is designed to help families who have no insurance or do not get adequate insurance at work and cannot afford to buy it in the costly individual or small group market. It is also for small businesses that cannot afford small group health insurance.

When federal guidelines were released in the summer of 2011, the comparison was made between purchasing health insurance online and employing the Internet to buy airline tickets and make hotel reservations.


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In 2010, PPACA established temporary, high-risk pools in each state to provide health coverage to individuals with pre-existing medical conditions and who have been uninsured for at least six months.

By 2014, state-based health insurance exchanges should provide consumers with a variety of private health insurance plans to consider. This would include comparisons of covered services, premiums, co-pays and deductibles, as well as out-of-pocket limits on expenses.

Each exchange will focus on individuals and small employers with 50 to 100 employees.

In 2017, states will have the opportunity to opt out of the federal requirements establishing an insurance exchange if they can show the ability to provide coverage comparable to the new Federal law.

Illegal immigrants will not be eligible to participate in any State exchange..

THE HEALTH INSURANCE EXCHANGE (continued)


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Platinum, with coverage at 90% of the full actuarial value of the essential benefits package.

Gold, with coverage at 80% of actuarial value.

Silver, with coverage at 70% of actuarial value.

Bronze, with coverage at 60% of actuarial value.

Catastrophic, a high-deductible plan available to people under age 30 and to people who qualify for an exemption (because other coverage is not affordable).

THE HEALTH INSURANCE EXCHANGE (continued)

FIVE CATEGORIES OF STATE EXCHANGES


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The Exchange will be governed by a five-member board appointed by California’s Governor and the legislature.

California will also set up the Small Business Health Options Program, which will assist qualified small employers in facilitating the enrollment of their employees in qualified health plans offered.

California will be active in establishing a competitive process to select participating carriers.

California will require plans to make available to the general public claims payment policies and practices as well as periodic financial disclosures. California will also require public disclosure of data on enrollment, dis-enrollment, and denied claims, among other things.

CALIFORNIA’S PROPOSED HEALTH INSURANCE EXCHANGE


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Utah’s e-Find system enables eligibility workers to search multiple databases through a state “data warehouse” to verify eligibility for health coverage.

Louisiana renews coverage for a majority of children without requiring families to submit a renewal form and by checking available databases to verify continued eligibility. The percentage of children who lose coverage at renewal has dropped from 16 percent to less than 1 percent.

Wisconsin is among the 32 states that allow individuals to apply for health coverage online. The state’s ACCESS system includes the ability to complete the application with an electronic signature and features a personal account function so beneficiaries can report changes and renew coverage.

HEALTH INSURANCE EXCHANGES IN OTHER STATES


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HEALTH CARE REFORM -- COVERAGE UP TO AGE 26

Dependent (Adult/Child) Coverage to Age 26:

For plans that provide coverage for dependents, the plan must now cover dependents (adults/children) to age 26 (this is generally tax free to the employee).

This is effective for plan renewals beginning on or after September 23, 2010.

This also applies to employers with cafeteria plans, as well as self-employed individuals who qualify for the self-employed health insurance deduction.

“Grandfathered plans” are not required to cover adults/children to the age of 26 if the adult/child is eligible to enroll in another eligible employer-sponsored health plan.

This limited exemption ends on the first plan renewal beginning on or after January 1, 2014.


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NEW PROTECTIONS FOR INDIVIDUALS

PPACA ensures that insurance companies and health plans provide simple summaries of what is covered and for what services individuals must pay directly.

By March 2012 PPACA will require a uniform glossary of terms commonly used in health insurance coverage such as “deductible” and “co-pay.”

Federal tax credits and cost-sharing reduction payments will also reduce the cost of insurance for low income individuals, leading to the expectation that more people will obtain coverage on their own. In some cases, this may reduce the need for employer provided health insurance.

The Congressional Budget Office estimates that when PPACA is completely phased in, the premium tax credit will help 20 million Americans afford health insurance.


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NEW PROTECTIONS FOR INDIVIDUALS (continued)

The Reform Law is designed to make individual health insurance policies more affordable and available by: (1) mandating “community rating” so that individual rates can only vary based on location or rating area, age of the insured, and tobacco use; and (2) by barring the exclusion of coverage for preexisting conditions.

In 2011, new federal regulations require health insurance companies to disclose and justify any rate increase of 10% or more. For an insurer to increase rates in excess of 10% for any insurance product sold to individuals (or small groups), it must first file a “preliminary justification.” If state or federal officials disagree and find the increase unreasonable, the insurer must then file a final justification.


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THE INSURANCE MANDATE FOR INDIVIDUALS

Individual Penalty for Not Obtaining Coverage:

Individuals who do not obtain or retain qualifying health care coverage will be required to pay a penalty as part of their income tax returns. Many low income individuals who are not required to file income taxes are exempt from the mandate.

In 2014, the penalty is $95 or 1% of the individual’s income, whichever is greater.

By 2016, the penalty increases to $695 or 2.5% of income.

For families, the maximum penalty is three times the per-person flat-dollar penalty. The penalty for dependent children without coverage is half the cost of the individual flat-dollar penalty.


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THE INSURANCE MANDATE FOR INDIVIDUALS (continued)

How Individuals Can Meet the Health Insurance Mandate:

By enrolling in a government program such as Medicare, Medicaid, TRICARE, or Children’s Health Insurance Program (CHIP).

By participating in qualified insurance offered by your employer.

By purchasing a qualified insurance policy through a state exchange or directly from an insurer.

To be qualified, a plan must cover certain “essential health benefits” at least up to at least 60% of actuarial value.


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IS THE INSURANCE MANDATE CONSTITUTIONAL?

Legal Challenges to the Individual Requirement are Pending:

There is a split between the Circuit Courts of Appeal.

The United States Supreme Court may soon render the final decision.

Stay tuned. The mandate could be replaced with another means to encourage participation, as universal coverage through insurance is viewed as central to the program.


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BE MINDFUL OF HIGH DEDUCTIBLE PLANS

As many as three million Californians are enrolled in health plans requiring deductibles in excess of $5,000.

For members enrolled in preferred provider organizations (PPOs), 28% reported plan deductibles in excess of $1,000, and in health maintenance organizations (HMOs), the number was 14%.

Many Californians cannot afford higher-premium plans, but the alternative – high-deductible plans which may cost less initially – can cost thousands of dollars when health care is needed.

Catastrophic, a high-deductible plan available to people under age 30 and to people who qualify for an exemption (because other coverage is not affordable).


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HEALTH CARE REFORM FOR BUSINESSES IN 2014

The new law does not require employers to offer health insurance coverage to their employees.

For “large employers” (those with 50 or more full-time employees) the law imposes a penalty ($2,000 per employee) if any of their full-time employees qualify for and receive federal subsidies.

The large employer penalty does not apply for the first 30 employees.

For small businesses that are not required to provide health coverage, generous new tax credits will be available to those businesses with low-paid employees to encourage them to provide qualified health insurance for their employees.


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HEALTH CARE REFORM FOR BUSINESSES (continued)

Limitations on Pre-Existing Conditions and Plan Limits

Currently, group health plans are not able to impose pre-existing condition exclusions on children under age 19.

Additionally, group health plans are not able to impose lifetime or restrictive annual limits on benefits under the plan.

Beginning in 2014, a group health plan will not be able to impose any annual limits.

In addition, effective in 2014, group health plans will be completely prohibited from imposing pre-existing condition exclusions on plan participants.


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HEALTH CARE REFORM FOR BUSINESSES IN 2018

There will be a 40% tax on expensive heath care plans, dubbed "Cadillac plans."

These high cost health plans are defined as having a value of $10,200 for a single employee or $27,500 for a family.

There are exclusions for high risk jobs and other special occupations.


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SMALL BUSINESS HEALTH CARE TAX CREDIT

The Health Care Insurance Reform legislation seeks to expand coverage by providing generous tax credits to small businesses with low-paid employees (which historically have not provided employee health insurance). This change has already led to a significant increase in the number of such businesses providing insurance.

Must cover at least 50% of the cost of health care coverage for some of its workers based on the single rate.

Must have less than the equivalent of 25 full-time workers (for example, an employer with fewer than 50 half-time workers may be eligible).

Must pay average annual wages below $50,000.

The credit is worth up to 35% of a small business’ premium costs in 2010 (25% for tax-exempt employers). On January 1, 2014, this rate increases to 50% (35% for tax-exempt employers).


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HEALTH INSURANCE PLAN CHOICES FOR SMALL BUSINESSES

In November 2011, the federal government released a new tool for small business owners to compare the benefits and costs of health plans, and even research locally available products, so they can choose the best options for their employees.

At www.HealthCare.gov, small business owners can research:

Insurance product choices for a given ZIP code, sorted by out-of-pocket limits, average cost per enrollee, or other factors.

A summary of cost and coverage for small group products that shows the available deductibles, range of co-pay options, included and excluded benefits, and benefits available for purchase at additional cost.

The ability to filter product selection based on whether the plans are Health Savings Account eligible, have prescription drug, mental health, or maternity coverage, or allow for domestic partner or same sex coverage.


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CHANGES TO FLEXIBLE SPENDING ARRANGEMENTS

Effective January 1, 2011, the cost of over-the-counter medicine or drugs cannot be reimbursed from Flexible Spending Arrangements or health reimbursement arrangements unless a prescription is obtained.

This does not affect insulin, even if purchased without a prescription, or other health care expenses such as medical devices, eyeglasses, contact lenses, co-pays and deductibles.

A similar rule went into effect on January 1, 2011, for Health Savings Accounts.


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HEALTH SAVINGS ACCOUNTS

As of January 2011, more than 11.4 million people have health savings accounts (up from 10 million in January 2010).

Health Savings Accounts typically include a tax-preferred savings account where money is set aside by the consumer (employers can also contribute) to pay for medical expenses and prescription drugs.

Health Savings Accounts also usually include a high-deductible health insurance plan. In 2012, that deductible will be at least $1,200 for an individual and $2,400 for a family (and as high as $6,050 and $12,100, respectively).

Any adult with a high-deductible health plan and no other form of health care coverage can establish Health Savings Accounts.


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HEALTH SAVINGS ACCOUNTS (continued)

Individual contributions into Health Savings Accounts are tax deductible.

Employer contributions into Health Savings Accounts are not taxable income.

At the end of the year, funds in Health Savings Accounts roll over, and even stay with the individual if he or she changes employment.

Health Savings Accounts can be used for general retirement expenses when a participant turns 65.

The IRS determines what medical expenses qualify (i.e., the IRS recently dropped over-the-counter medications from the list).


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“OPTIONAL” EMPLOYER REPORTING REQUIREMENTS

Starting in tax year 2011, the new law required employers to report the value of the health insurance coverage they provide employees on each employee’s annual Form W-2.

However, to provide employers the time they need to implement these changes, the IRS deferred the reporting requirement for 2011, making it optional for 2010 filings.


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THE FUTURE OF HOSPITAL REIMBURSEMENT?

In April 2011, CMS published regulations that provided a roadmap for the future of hospital reimbursement.

Authorized within PPACA, CMS will start paying hospitals Medicare “bonuses” based upon overall performance, adherence to quality measures, and patient satisfaction.

This hospital value-based purchasing program is another step toward shifting the reimbursement infrastructure from cost-based to performance-driven.


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THE FUTURE OF HOSPITAL REIMBURSEMENT (continued)

Beginning in October 2012, hospitals can share bonus money from an $850 million fund based upon their performance scores.

The following year, hospitals will face a 1% reduction overall on Medicare payments under this system.

By 2015, hospitals with poor performance ratings may be excluded from the bonus pool and face additional cuts in reimbursement.


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THE FUTURE OF HOSPITAL REIMBURSEMENT (continued)

Also effective October 2012, hospitals with the highest rates of readmission can lose as much as 3% of reimbursements.

"The incentives we're putting into place have created a whole new way to think about hospital care." --Jonathan Blum, deputy administrator of CMS


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HOSPITAL PERFORMANCE MEASURES

Hospitals must closely track their performance on various measures of quality, patient experience, and operations. This includes the following examples:

Readmission rates for cardiac cases

Readmission rates for pneumonia patients

Mortality rates for cardiac and pneumonia patients

Average waiting time in the emergency department

Patients who would recommend a hospital

Patients who were happy with their levels of communication with doctors and nurses


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Bundled Payments for Care Improvement Initiative

In August 2013, CMS released the Bundled Payments for Care Improvement Initiative, a program designed to encourage a team of providers to work together to treat certain episodes of care for one bundled payment per patient.

Instead of separating Medicare payments for each service involved in treating a patient, a “bundled system” is a single payment for a defined group of services, irrespective of the nature of the entity providing the care (i.e., a single entity, such as a hospital, or several different, multidisciplinary providers).

CMS has defined four models of care:

Model 1 (inpatient stay only)

Model 2 (inpatient stay plus post-discharge services)

Model 3 (post-discharge services only)

Model 4 (inpatient stay only with a prospectively determined bundled payment rate)


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HEALTH CARE REFORM AND THE HOSPITAL

The federal government has enlisted individuals to help fight Medicare fraud, and Medicare beneficiaries are encouraged to report the following:

If you spot unusual or questionable charges, contact your health care provider. It may just be a mistake.

If your complaint is not resolved by your provider, report the questionable charges to Medicare.

If you suspect Medicare fraud, contact the Department of Health & Human Services Office of Inspector General.

If you think someone is misusing your personal information, contact the Federal Trade Commission.


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HEALTH CARE REFORM AND THE HOSPITAL (continued)

The trend of multi-hospital systems replacing freestanding community hospitals picked up speed after 1965. The

five hospital consolidations noted in 1961 ballooned to upwards of 50 per year in the 1970s. By the 1980s, an

estimated thirty percent of the hospital beds in the United States existed within hospital systems. In 2008, the

American Hospital Association estimated that almost half of the nearly 6,000 U.S. hospitals belonged to a hospital

system.

Even many of the non-profit, faith-based hospitals directly descended from the original almshouses and charity

hospitals of the 18th and 19th centuries have come to seek refuge in consolidation. By 1872, there were

approximately 75 Catholic hospitals in the United States. Today, most of these institutions have been incorporated

into regional “systems”.


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HEALTH CARE REFORM AND THE PHYSICIAN

In 2015, roughly 750,000 physicians in the Medicare program will be asked to revalidate their individual enrollment records during a massive anti-fraud effort mandated by PPACA.

CMA intends to weed out only those people who should not have billing privileges, but physicians are concerned that legitimate health professionals may face disruptions in their practices.


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HEALTH CARE REFORM AND THE PHYSICIAN (continued)

The new law also requires a value-based purchasing modifier that would adjust physician fees based on quality and efficiency measures.

Although the adjustments will not start until 2015, CMS may start measuring physician performance in 2013.

Although the adjustments will not start until 2015, CMS may start measuring physician performance in 2013.

2013: CMS may start measuring physician services to determine modifier adjustments in the future.

2015: CMS starts applying the modifier to specific physicians and groups.

2017: CMS starts applying the modifier to all physicians and groups.


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ACCOUNTABLE CARE ORGANIZATIONS

In April the Federal Government released anticipated details defining Accountable Care Organizations (ACOs).

PPACA encourages the formation of ACOs to monitor the collective quality and efficiency of doctors and hospitals alike, while at the same time creating an entirely new set of standards for compensation.

The Pioneer Model released by CMS is designed for health care organizations that are already experienced in coordinating care for patients across such care settings.


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ACCOUNTABLE CARE ORGANIZATIONS (continued)

The original regulations faced a strong pushback from the health care industry, including concern that ACOs triggered well-established violations of law without the benefit of any new, expected safe harbor provisions or other comparable exceptions, especially in California where the corporate practice of medicine is prohibited.

Additionally, proper formation of ACOs under the regulations necessitate a significant capital commitment, notwithstanding other financial burdens in the health care industry already:

! Electronic health records! Seismic Safety Standards! State budget and Medi-Cal


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Rather than a retrospective assignment of patients, the modifications focus on a preliminary prospective-assignment method with beneficiaries identified quarterly (there will still be a final reconciliation after each performance year based on patients served by the ACO).

33 quality measures in 4 domains rather than the original 65 measures in 5 domains.

Program establishment date is now January 1, 2012, with the first round of applications due in early 2012. In the beginning, ACOs will also have some flexibility within each of the performance years, rather than the original uniform 3-year agreement based only on a calendar year.

EHR is no longer a mandatory condition of participation, although it is retained as an important quality measure.

Flexibility on marketing guidelines for ACOs.

In response, the federal government published revisions governing formation of ACOs in October 2011. Some of these changes included:


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The Office of the Inspector General clarified the implications of physician self referral laws and the federal anti-kickback statutes.

The Federal Trade Commission clarified that entry into the Shared Savings Program will no longer require mandatory antitrust review, and there will be an antitrust “safety zone” for ACOs approved by CMS to participate in the Shared Savings Program.

The Internal Revenue Service clarified the ways in which a charitable organization can participate in the Shared Savings Program without compromising its tax exempt status.

In addition to modifications surrounding formation, other federal agencies have clarified issues of concern in the revised regulations:


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HEALTH CARE REFORM AND PREVENTATIVE CARE

“The Affordable Care Act helps stop health problems before they start.” --HHS Secretary Kathleen Sebelius

PPACA is about:

Pilot Programs

Preventative Health Care Services

Forward Thinking Research


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HEALTH CARE REFORM AND PREVENTATIVE CARE (continued)

Last summer’s regulations required all new private health plans to cover several evidence-based preventive services l ike mammograms, colonoscopies, blood pressure checks, and childhood immunizations without charging a copayment, deductible or coinsurance.

PPACA also made recommended preventative services free for Medicare beneficiaries.

Regulations also focused on preventative care for women to ensure a full range of recommended preventative services and screenings without cost sharing.


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Beginning in 2014, employers may use up to 30% of their employees’ health insurance premiums for outcome-based wellness incentives.

Employees can receive rewards such as a discount or rebate on a premium, a waiver of a deductible or copayment, or some additional benefit not included under the plan.


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PPACA also created the Patient-Centered Outcomes Research Institute (PCORI) to produce groundbreaking, evidence based information pertaining to health care that will be easily accessible to both doctors and patients.

PCORI will focus on several areas of interest, including ways to deliver health care “without bias” and identify existing gaps affecting women, low-income populations, minorities, children, and the elderly, among others.


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This also includes the National Prevention, Health Promotion, and Public Health Councils, charged with the task of developing health care prevention strategies for large-scale future use.

A report issued by the PPACA’s Prevention and Public Health Fund estimates that a $10 per person investment each year in community-based, preventative health programs could result in an annual savings of more than $15 billion over the next five years.


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Regardless of its emphasis on our nation’s future well-being, PPACA now finds itself in the crosshairs as Congress tries to repair America’s global credit score.

How will the debt ceiling legislation impact the government’s ability to fund health care in the future?


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OPERATING DIVISIONS WITHIN HHS

■ Administration for Children and Families (ACF)

■ Administration on Aging (AoA)

■ Agency for Healthcare Research and Quality (AHRQ)

■ Agency for Toxic Substances and Disease Registry (ATSDR)

■ Centers for Disease Control and Prevention (CDC)

■ Centers for Medicare & Medicaid Services (CMS)

■ Food and Drug Administration (FDA)

■ Health Resources and Services Administration (HRSA)

■ Indian Health Service (IHS)

■ National Institutes of Health (NIH) and the National Cancer Institute (NCI)

■ Substance Abuse and Mental Health Services Administration (SAMHSA)


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HHS STAFF DIVISIONS

■ Assistant Secretary for Administration (ASA)

■ Assistant Secretary for Financial Resources (ASFR)

■ Assistant Secretary for Legislation (ASL)

■ Assistant Secretary for Public Affairs (ASPA)

■ Assistant Secretary for Planning and Evaluation (ASPE)

■ Assistant Secretary for Preparedness and Response (ASPR)

■ Center for Faith Based and Neighborhood Partnerships (CFBNP)

■ Departmental Appeals Board (DAB)


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HHS STAFF DIVISIONS (continued)

■ Office of Intergovernmental Affairs (IGA)

■ Office of Civil Rights (OCR)

■ Office on Disability (OD)

■ Office of the General Counsel (OGC)

■ Office of Global Health Affairs (OGHA)

■ Office of the Inspector General (OIG)

■ Office of Medicare Hearing and Appeals (OMHA)

■ Office of National Coordinator of Health Information Technology (ONC)

■ Office of the Assistant Secretary for Health (ASH)

■ The Surgeon General


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MAKING A HOSPITAL “GREEN”

The EPA estimates that hospitals use twice (maybe 2½ times) as much energy per square foot as regular buildings.

Hospitals in the United States use 836 trillion BTUs of energy yearly (over 2½ times the energy intensity and CO2 emissions of commercial office buildings), while producing 28.575 million tons of CO2 and over 30 pounds of CO2 emissions per square foot on an annual basis.


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THE DIGITAL MEDICAL RECORD

As our nation continues to increase its drive toward electronic health care records, including the protections afforded under the Health Insurance Portability and Accountability Act (HIPAA), we must be mindful of the speed with which technology changes, as well as the dilution of privacy expectations progressing from generation to generation.


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WHAT IS A MEDICAL EMERGENCY?*

Possible Medical Emergency

Heart Attack

Uncontrolled Bleeding

Altered Mental Status

Difficulty Breathing

Seizures

Physical Trauma

Chest discomfort; discomfort in other areas of the upper body, including one or both arms; shortness of breath.

Just about all bleeding can be controlled, but shock or even death may result if left unattended.

The individual may be unresponsive. This may include fainting, unconsciousness or any other sudden change in mental status.

Commonly known as “respiratory distress,” this may include sudden breathlessness and/or severe shortness of breath.

In some cases, a person makes a sound, followed by unusual stiffening, progressing to possible jerking of the arms and legs.

Serious or body-altering physical injury, including blunt force trauma to the head, neck, spine and/or abdomen.

Potential Symptoms

*This list is not a substitute for an examination by a medical practitioner. If you are ever in doubt of whether a situation is an emergency, call 9-1-1 immediately.


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Anaphylaxis (life-threatening allergic reaction) Stroke

Chest pain Sudden blindness

Drug overdose Serious burns

Heart attack Bleeding that will not stop

Shortness of breath Broken bones with an open wound

A few examples of medical emergencies when it is imperative to call 9-1-1:

For information To get a ride to a doctor’s appointment

When the power goes out For paying tickets

To report a broken fire hydrant For your pet

When your water pipes burst As a prank

A few examples of when 9-1-1 should not be called:

*This list is not a substitute for an examination by a medical practitioner. If you are ever in doubt of whether a situation is an emergency, call 9-1-1 immediately.

CALLING 9-1-1 DURING A MEDICAL EMERGENCY*


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Craig B. GarnerCraig is an attorney and health care consultant, specializing in issues surrounding modern American health care and the ways it should be managed in its current climate of reform. Between 2002 and 2011, Craig was the Chief Executive Officer at Coast Plaza Hospital where he was responsible for administration and oversight of this general acute care hospital providing services to the City of Norwalk and surrounding communities in southeast Los Angeles County.

Craig is also the founder of a health care sustainability non-profit, Not So Much Foundation (www.notsomuch.org). Last fall, he published his book Hospital Stay: Health Care Made Simple, a guide for patients and family members who find themselves in the confusing confines of a hospital environment.

Craig serves on the advisory board for the College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, the Board of Directors of the Los Angeles Opera, and the Board of Visitors of Seaver College at Pepperdine University.

Craig regularly writes specialized articles for various health care publications, and in January 2012 he will be teaching a Hospital Law course at Pepperdine University School of Law.

1299 Ocean Avenue, Suite 400Santa Monica, CA 90401T. (310) 458-1560E. [email protected]. www.craiggarner.com


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health care reform in the united states

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