Factors that Decrease Inequities in the Healthcare System

Does healthcare inequities exist for minority populations and the poor in the United States?

The family of Thomas Eric Duncan thinks so. They are upset about the “unfair” medical care he received at Texas Health Presbyterian Hospital in Dallas, Texas. Mr. Duncan was from Liberia. He was the first person to die of Ebola in the U.S. after being infected with the Ebola virus.

Mr. Duncan’s nephew, Joe Weeks, told ABC News he felt Duncan had “unfair” medical treatment. Mr. Weeks suggested that Mr. Duncan did not get the same treatment being given to Ebola patient Ashoka Mukpo, in a Nebraska hospital. He did not cite the differences in care.

Although hospital officials told the family they were capable of managing Mr. Duncan’s care, the family questioned why Mr. Duncan was not moved to Emory University Hospital, where two American health workers had been successfully treated following an infection with the Ebola virus while in Liberia. Mr. Weeks said the family was also frustrated that Mr. Duncan was not given donated blood from Ebola survivors to pass on their antibodies of the virus to Mr. Duncan. The hospital officials told the family “that the blood wasn’t a match.”

The jury is still out regarding the facts surrounding Mr. Duncan’s case, and the major snafu that occurred when he initially went to the emergency room for care, but was released and sent home with treatment from antibiotics, thus culminating in his death.

What can we do, in the meantime, as healthcare professionals to ensure that all patients perceive the quality of medical care they receive as being excellent, regardless of their race or economic status?

The racial and ethnic health inequities don’t just reflect income. More African American, Native American, Latino and Pacific Islanders are in poor or less fair health than whites at practically every income level (although recent Latino immigrants report better health).

Ethnic differences highlight the need to further examine social support, socioeconomic status, access to care, and cultural factors to guide future health-related quality of life (HR-QOL). Health includes physical, mental, and social realms.

On the individual level, this includes physical and mental health perceptions pertaining to health risks and conditions, functional status, social support, and socioeconomic status. On the community level, HRQOL includes resources, conditions, policies, and practices that influence a population’s health perceptions and functional status.

HRQOL enables health agencies to legitimately address broader areas of healthy public policy around a common theme in collaboration with a wider circle of health partners, including social service agencies, community planners, and business groups.

The evaluation, diagnosis, treatment, and management of medical conditions will result in significant positive outcomes when there is a clear pathway regarding the objectives to promote healthy behaviors. The implementation of transparent programs and intervention services along with proper allocation of resources is necessary to close health care gaps and decrease priority disparities.

In addition to HRQOL elements, the cultural competency of health care workers is important, and includes five factors that influence health communication.

  1. Behaviors or the manner in which health care workers conduct themselves through their actions and responses with patients from varied demographics. Is the healthcare worker tolerant and attentive or standoffish and impatient?
  2. Language or methods used to ask questions and receive answers for the purpose of exchanging information in a clear and concise manner, which can be understood and recognized by all parties involved. This is extremely important for the purpose of providing medical care and treatment intervention. Does the healthcare facility have a language interpreter for patients that may speak English as a second language so that thoughts and ideas may be conveyed and received properly?
  3. Customs-Is the healthcare worker trained to recognize actions or ways of behaving that are common and traditional among people in a particular group. For example, it is a custom in some religious groups to never leave the woman alone with a male that is not her relative. Does the healthcare organization or facility make concessions for this?
  4. Beliefs or feelings of being sure that someone or something exists or that something is true. Does the healthcare organization have an Imam, priest, and rabbi present for patients and their loved ones who are spiritual believers seeking spiritual guidance and comfort from a ‘Higher Power?’
  5. Perspectives or mental thoughts, feelings, and emotions within and about the environment. Is there a meeting of the minds during the initial contact? Is the communication and explanation process regarding medical treatment between the patient and their family with the hospital staff comprehended? Are next steps going forward understood?

Clearly, these factors are important for achieving accuracy during triage and during the continuum of medical care. The takeaway from the events that transpired in Dallas, Texas is that if healthcare disparities are present, they will often result in suboptimal care, misunderstandings, the potential threat of legal action, and a public relations nightmare.


Hello Walgreens, Walmart, and CVS Health

Access to affordable and preventive health care is important. Retail clinics are surging and care is transitioning away from the hospital and doctors office to fill a void for many Americans who cannot afford to buy traditional health insurance. Some Americans can’t qualify for coverage under the Affordable Care Act, and others may have fallen between the cracks due to a lack of the Medicaid expansion in their state.

Although, biased about the care they’d prefer to receive and where they’d like to receive it, most consumers are on board with the concept of going to big box stores, grocery stores, and pharmacies for quality healthcare at an affordable price.

In a 2013 Oliver Wyman national consumer survey of more than 2,000 consumers, 77 percent were willing to receive at least one medical or wellness service from a retail establishment. For minor incidents, 36 percent of consumers were interested in receiving care at a drugstore and 20 percent at a grocery store.

Walgreens, Walmart, and CVS Health (formerly CVS Caremark) have each invested in a strategy, which incorporates a business model consisting of different mergers formed with hospitals, physician groups, and nurse practitioners to offer quality affordable healthcare directly to consumers. Health information technology (HIT) has helped to facilitate a smooth transition from traditional visits to the doctor’s office by providing a secure platform for partners to get access to, for the purpose of sharing patient data through electronic health records (EHR).

A new research study from Walgreens found the percentage of visits to Healthcare Clinic locations for preventive services, screening and chronic visit utilization (combined) increased from 4 percent in 2007 to 17 percent in 2013. The study also found the annual percentage of return patient visits to Healthcare Clinic climbed from 15 percent in 2007, to more than 50 percent in both 2012 and 2013. Walgreens has over 400 clinics that offer vaccines, physical exams, and screenings for blood pressure, cholesterol, diabetes, health risk assessment, and influenza.

Walmart has positioned itself to lead the healthcare retail price wars by partnering with hospitals and nurse practitioners from QuadMed to offer primary care services in their walk-in clinics seven days a week, inside Walmart stores. Services include preventive and routine exams such as cholesterol screenings, allergy care, and vaccinations. Employees enrolled in the company’s health insurance plan can pay four dollars for services.

CVS has more than 900 “MinuteClinic” locations, and it plans to expand over the next few years. CVS recorded $126.7 billion in sales during the last fiscal year, and is making headlines now because of the decision to stop selling tobacco products by October 1st. This was a brave proactive decision for preventive care.

Going forward, it will be interesting to see the primary care service line for each of the retail clinic chains. Perhaps, the next frontier could include possible alliances and partnerships with board certified sleep specialists and accredited sleep centers. Perhaps each company could consider offering sleep apnea screenings with portable home sleep study devices to consumers in rural and urban demographics where physician shortages exist, and where there are higher disparities for medical conditions such as diabetes, high blood pressure, heart disease, and cancer.

Has your sleep center team explored this prospect? I’d love to read your feedback, albeit positive or negative.


Venous Insufficiency and Obstructive Sleep Apnea

For the most part, you’re a healthy person. You get your annual wellness exams and live a reasonably satisfactory lifestyle. You manage a career, along with family matters and extracurricular activities that are important to you.

Lately, you’re experiencing swelling or edema in your legs, feet, or ankles, which is usually caused by an increase in interstitial fluid volume. Being the health conscious person that you are, you follow-up with your physician and the diagnosis is venous insufficiency, a condition in which the veins have problems sending blood from the legs back to the heart.

Your physician proceeds to order a complete workup to rule out cardiovascular disease, peripheral vascular disease (PVD) known to be linked to diabetes, and peripheral arterial disease (PAD). This may include a venous Doppler ultrasound to evaluate blood flow through blood vessels in the legs, to rule out a blood clot in the vein and leaking around the valves of the veins.

Your physician may also order a sleep study to determine if you have sleep apnea. Sleep apnea occurs due to a blockage in the upper airway and can cause pulmonary hypertension, which is a common cause of leg edema. The most likely cause of leg edema in all patients over age 50 is venous insufficiency. It affects up to 30% of the population. Another type of edema, idiopathic edema, occurs in women under age 50, and is usually associated with the menstrual cycle and conditions related to obesity, depression, and diuretic abuse.

The volume of fluid available for movement from the legs increases with sitting and leg edema. Fluid volume that is displaced from the legs overnight is directly proportional to the time spent sitting during the day, not to physical activity.

Patients susceptible to fluid retention, may have fluid movement from the legs while asleep during the night, which may cause or worsen obstructive sleep apnea (OSA). The fluid increases in the neck and limits airflow in the airway during sleep contributing to cardiovascular disease and other medical conditions.

You may be advised to decrease your salt intake, limit sitting or standing for excessive periods of time, and to wear compression stockings to gently improve the circulation of blood in your legs, and reduce swelling. If you are found to be positive for sleep apnea, you may be advised to use Continuous Positive Airway Pressure (CPAP).

The takeaway…Get moving!

The Rx for Reducing Pharmacy Compounding Risks

October 16, 2012

By Melissa Bynes Brooks

According to the International Academy of Compounding Pharmacists (IACP)the compounding industry now makes up an estimated 1 to 3 percent of the U.S. prescription market, which is $300 billion overall.

The Food and Drug Administration (FDA) is aware of a number of product quality problems associated with compounded drugs including contamination, poor compounding processes, and product toxicity. Unlike commercial drug manufacturers, pharmacies aren’t required to report adverse events associated with compounded drugs. Recent deaths from fungal meningitis associated with epidural steroid injections on or outside the outermost membrane covering the spinal cord to relieve back pain have shined a light on the regulation or lack thereof, of pharmacy compounding.

Clinical meningitis is defined as having one or more symptoms (e.g., headache, fever, stiff neck, or photophobia-sensitivity to light) and cerebral spinal fluid (CSF) pleocytosis (more than five white blood cells per µL or microliter), adjusting for the presence of red blood cells, regardless of CSF protein and glucose levels.

On September 18, 2012, the Tennessee Department of Health was alerted by a clinician regarding a patient with culture-confirmed Aspergillus fumigatus meningitis diagnosed 46 days after an epidural steroid injection at a Tennessee ambulatory surgical center. An additional eight patients with clinically diagnosed, culture-negative meningitis were later identified.

Patients had received one or more epidural steroid injections used to treat both peripheral joint and back pain from three lots of single-dose vials (17,676 single vials) with preservative-free methylprednisolone acetate solution (MPA), compounded at New England Compounding Center (NECC) in Framingham, Massachusetts. On October 4, 2012, the Centers for Disease Control (CDC) and FDA recommended that all health care professionals cease use and remove from their pharmaceutical inventory any product produced by NECC.

The states below received injections:

California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, Nevada, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, Texas, and West Virginia.

As of October 16, a multistate investigation led by CDC in collaboration with state and local health departments and the FDA have identified 233 cases and 15 deaths associated with this outbreak in 10 states, with 14,000 persons potentially exposed to medications from NECC.

Four categories of cases in patients who received an injection with MPA produced by NECC have been identified:

1) Fungal meningitis or nonbacterial and non-viral meningitis of subacute (recent) onset following epidural injection on or after May 21.

2) Basilar stroke following epidural injection on or after May 21, in a person from whom no cerebrospinal fluid (CSF) specimen was obtained.

3) Spinal osteomyelitis (inflammation of bone and bone marrow) or epidural abscess (pus-filled cavity) at the site of injection following epidural or sacroiliac injection on or after May 21.

4) Septic (infectious) arthritis or osteomyelitis of a peripheral (near the surface) joint (e.g., knee) diagnosed following injection of that joint on or after May 21.

What is pharmacy compounding?

Pharmacy compounding involves combining, mixing, or altering ingredients to create a customized medication. This is carried out by a state licensed pharmacist. It may involve taking an approved drug substance and making a new medicine when a traditional approved drug is not available to meet the medical needs of a specific patient as prescribed by a physician, veterinarian, or other prescribing practitioner. For these patients, customized medications are the only way to better health. For example, this may involve making a suspension or suppository dosage form for a child or elderly patient who has difficulty swallowing a tablet or a capsule. There is an increased need for pharmacy compounding due to drug shortages and the need to access drugs or dosage forms that have been withdrawn from the market.

Because traditional pharmacy compounding serves an important public health function, the FDA exercises enforcement discretion to allow legitimate forms of pharmacy compounding that is regulated under state laws governing the practice of pharmacy. Therefore, all pharmacies and pharmacists are licensed and strictly regulated at the state level.

How does pharmacy compounding increase safety risks in the public healthcare system?

Although state boards are constantly updating their standards and regulations, the safety and effectiveness of compounded drugs is not proven or established by supporting data which the FDA requires for approving new drugs. Compounded drugs are considered to be unapproved new drugs by the FDA. It is estimated that one fifth of all prescriptions written for FDA-approved drugs are for uses, for which they were not specifically approved.

One caveat is that the risk of obtaining a product of less than desired quality outweighs the benefits of obtaining a compounded drug. Other issues include large-scale drug manufacturing under the deceptive appearance of pharmacy compounding; compounding products containing an active ingredient not approved by the FDA; copying compounded products for economic gains; and selling products removed from the market by the FDA for safety reasons.

Similar circumstances no doubt contributed to the observed fungal contaminated steroid shots made by NECC and confirmed by FDA direct microscopic examination of foreign matter taken from a sealed vial.

More than 200 adverse events involving 71 compounded products since 1990 have occurred resulting in devastating consequences. For example, three patients died of infections stemming from contaminated compounded solutions that are used to paralyze the heart during open-heart surgery. The FDA issued a warning letter in March 2006 to the firm that compounded the solutions.

On October 8, 2012, Senator Richard Blumenthal (D-Conn.) called for stronger federal oversight of pharmacy compounding which manufactures drugs without a patient prescription in a letter to the commissioner of the FDA.

In the meantime, the public healthcare system would be better served if compounding guidelines set forth in the United States Pharmacopeial Convention (USP) were implemented by all pharmacy compounding companies. The USP is a scientific nonprofit organization that sets standards for the identity, strength, quality, and purity of medicines, food ingredients, and dietary supplements manufactured, distributed and consumed worldwide. USP’s drug standards are enforceable in the United States by the Food and Drug Administration, and these standards are developed and relied upon in more than 140 countries.

Validation from the independent Pharmacy Compounding Accreditation Board (PCAB) represents another gold standard benchmark. PCAB offers accreditation to compounding pharmacies that meet nationally accepted quality assurance, quality control, and quality improvement standards. When choosing a compounding pharmacy, PCAB suggests looking for the designation “PCAB Accredited® compounding pharmacy” or the PCAB Seal.

The PCAB evaluation includes:

  • An assessment of the pharmacy’s system for assuring and maintaining staff competency.
  • A review of facilities and equipment.
  • Review of records and procedures required to prepare quality compounded medications.
  • Verification that the pharmacy uses ingredients from FDA registered and or licensed sources.
  • Review of the pharmacy’s program for testing compounded preparations.

The New England Compounding Center (NECC), the company supplying the epidural steroid injections which resulted in the fungal meningitis outbreak, was not accredited by PCAB.

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Is Getting too Little Sleep Making You Sick?

Published Fall 2012 in Broward Health Magazine

Do you wake up with morning headaches or have high blood pressure? Do you have difficulty with acid reflux? Has your child been diagnosed with attention deficit hyperactivity disorder (ADHD)? If so, Obstructive Sleep Apnea (OSA) may be to blame.

OSA is the most common sleep disorder. It begins with a blockage in the upper airway that interferes with breathing normally when asleep. The blockage leads to loud snoring, followed by silence, then choking or gasping for air, causing one to arouse momentarily from sleep or to wake up completely.

The most recognized symptoms are daytime sleepiness, fatigue, memory loss, mood swings, trouble concentrating and poor academic performance in children.

OSA is a serious condition, because quality sleep influences the regulation of body weight and metabolism, and insufficient sleep can lead to obesity and contribute to medical problems such as high blood pressure, diabetes and cancer. In fact, less than seven hours of sleep may alter hormone levels that regulate the appetite, which can lead to overeating. Furthering the problem is that OSA reduces daytime energy, which results in decreased physical activity and, ultimately, weight gain.

In addition to weight problems, OSA can increase the risk of Type 2 diabetes and is associated with insulin resistance and a rise in insulin secretion to maintain normal glucose tolerance.

Lack of sleep is also linked to more aggressive breast cancers and may raise the risk of cancer recurrence in older women. Data on over 400 breast cancer patients revealed women who averaged less than six hours of sleep a night before their diagnoses had more aggressive tumors than women who slept longer.

Adults aren’t the only ones who can suffer from OSA. In children, there has been an increased association between ADHD and sleep apnea. OSA can cause mild inattention or hyperactivity. Sleep disordered breathing may contribute to some mild ADHD-like symptoms, including decreased attention span and learning problems.

If you are exhibiting OSA symptoms, a simple overnight sleep study can be conducted to diagnose sleep apnea. A sleep study should also be considered before starting long-term drug treatment for ADHD.

Sleep studies can be performed at Broward Health Coral Springs or Broward Health Medical Center and involve monitoring breathing patterns, as well as brain wave activity to determine light or deep sleep, blood oxygen levels, heart rhythm, legmovements and snoring.

For more information about sleep disorders, visit BrowardHealth.org/sleep.

Melissa Brooks, MBA, RPSGT, CRT, is the clinical coordinator of the Sleep Disorders Center at Broward Health Coral Springs.


Centers for Disease Control and Prevention (2012). Adult Obesity Facts. Retrieved August 28, 2012, from http://www.cdc.gov/obesity/data/adult.html

Chung, F., Yegneswaran, B., Liao, P., Chung, S., Vairavanathan, S., Islam, S., Khajehdehi, A., Shapiro C. (2008). STOP questionnaire. A tool to screen patients for obstructive sleep apnea. Anesthesiology, 108 (5), 812-21.

Institute of Medicine. Sleep disorders and sleep deprivation: An unmet public health problem. 2006. Washington, D.C.: National Academies Press;

Jean-Philippe Chaput*, Jean-Pierre Després*,†, Claude Bouchard‡ and Angelo Tremblay* Short Sleep Duration is Associated with Reduced Leptin Levels and Increased Adiposity: Results from the Québec Family Study. Obesity (2007) 15, 253–261; doi:10.1038/oby.2007.512

Kryger MH: Diagnosis and management of sleep apnea syndrome. Clin Cornerstone 2000; 2:39–47

Lack of Sleep Found to be a New Risk Factor for Aggressive Breast Cancers (2012). Retrieved August 28, 2012, from http://www.msnbc.msn.com/id/48802740/ns/local_news-peoria_il/

Pagel JF. Obstructive sleep apnea (OSA) in primary care: evidence-based practice. J Am Board Fam Med 2007; 20: 392–8.

Sushmita Pamidi, Kristen Wroblewski, Josiane Broussard, Andrew Day, Erin C. Hanlon, Varghese Abraham, and Esra Tasali. Obstructive Sleep Apnea in Young Lean Men: Impact on insulin sensitivity and secretion Diabetes Care published ahead of print August 21, 2012, doi:10.2337/dc12-0841

Walters AS; Silvestri R; Zucconi M; Chandrashekariah R; Konofal E. Review of the Possible Relationship and Hypothetical Links Between Attention Deficit Hyperactivity Disorder (ADHD) and the Sim- ple Sleep Related Movement Disorders, Parasomnias, Hypersomnias, and Circadian Rhythm Disorders. J Clin Sleep Med 2008;4(6):591-600.

Medicare and Obamacare: The Numbers Square

August 19, 2012

By Melissa Bynes Brooks

Despite the massive media hype portraying President Obama as being fiscally irresponsible, he has improved the solvency of the Medicare Program for beneficiaries while saving tax payers billions of dollars. He has also invested in the American people by expanding health care coverage for millions who are uninsured. The Affordable Care Act (ACA) has been a contributing factor to the Medicare program’s sustainability and enhanced financial outlook, albeit for a period of 8 more years. The Medicare debate is currently front and center in the upcoming presidential election. A  PEW Research Center poll conducted among registered voters in April 2012 shows that 74 percent of Americans rank health care as the fourth most important issue to their vote.

Output has exceeded input in the Social Security and Medicare trust funds. In 2011, 36 percent of federal spending was for Medicare and Social Security. The trend for rising costs is expected to continue due to the aging population of the baby boom generation coupled with decreasing population numbers in subsequent generations. According to the U.S. Census Bureau, life expectancy  has increased and people 90 and older now comprise 4.7 percent of the older population of people that are age 65 and older. This has increased from 2.8 percent in 1980 and is projected to be 10 percent in 2050.

Medicare’s costs under the Trustees’ current-law assumptions rise from their current level of 3.7 percent of GDP to 6.0 percent in 2040 and 6.7 percent in 2085. If the Sustainable Growth Rate (SGR) restraint were overridden, Medicare costs would rise to 6.5 percent of GDP in 2040 and 7.8 percent in 2085. Under the full scenario, in which adherence to the ACA cost-saving measures also erodes, costs would rise to 7.0 percent of GDP in 2040 and 10.3 percent in 2085. The SGR system compares the accumulated amount of actual physician- related spending to a specified target level.

The Affordable Care Act decreases Medicare spending in the following ways:

  • It permanently reduces Medicare payment updates for most categories of providers by the increase in economy-wide multifactor productivity. “Multifactor productivity” is a measure of real output per combined unit of labor and capital, reflecting the contributions of all factors of production. There are reductions in the annual updates to Medicare’s payment rates for most services in the fee-for-service sector (other than physicians’ services) which will decrease Medicare spending by $415 billion. Physicians’ services are based on a fee schedule, which reflects the relative level of time and effort required for each service and its relative complexity. Relative factors per service are translated into dollar payment amounts through a conversion factor, which is updated each calendar year based on the SGR. Medicare payment rates for physician services are scheduled to be reduced by approximately 31 percent in 2013.
  • The ACA Reduces Medicare Advantage payment benchmarks and permanently extends the authority to adjust for coding intensity. A new mechanism for setting payment rates in the Medicare Advantage program will decrease Medicare spending by $156 billion. A Medicare Advantage Plan is a type of health plan offered by a private company that contracts with Medicare to provide all Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. Premium subsidy amounts will be calculated for low-income beneficiaries to help ensure that the premium subsidy in each Part D region, provides low-income beneficiaries with a sufficient choice of plans for which they would incur no premium liability.
  • The ACA Reduces Medicare Disproportionate Share Hospital (DSH) payments and refines imaging payments. DSH adjustment payments provide additional help to those hospitals that serve a significantly disproportionate number of low-income patients. States receive an annual DSH allotment to cover the costs of DSH hospitals that provide care which is not paid by other payers, such as Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) or other health insurance. Federal Financial Participation (FFP) is limited and is not available for state DSH payments that are more than the hospital’s eligible uncompensated care cost. Unnecessary DSH spending will be decreased by $56 billion.

The estimated amount of deficit reduction from penalty payments and other effects on tax revenues under the ACA will be $5 billion.

Under Mitt Romney’s and Paul Ryan’s Medicare Plan, the CBO estimates that costs for senior citizens could increase by as much as $6,000.00 a year. Low-income beneficiaries who are not eligible for both Medicare and Medicaid would receive a medical savings account (MSA). This account will be used to pay premiums, co-pays, and other out-of-pocket costs. Low-income seniors would be offered the same range of plan options offered to other seniors. Whether they will be able to afford it is another issue since eligibility levels for low income beneficiaries are unspecified. Additionally, there are no price controls for out of pocket expenses for the coverage of essential benefits and unspecified prescription drug coverage. The specificities have not been clarified and senior citizens have expressed their concerns regarding the information provided or lack thereof.

“Our plan is very simple.  Which is, that for people 55 years of age and older there’s no change,” said Mitt Romney during an interview with ABC Green Bay affiliate, WBAY . “The only change I’d mention is we’d restore the $817 billion President Obama took out of the Medicare trust fund.  We’d restore it to Medicare.” 

I beg to differ. 

Mitt Romney’s plan to repeal Obamacare will be much more complicated. Several of the Medicare benefits and payments enacted by ACA will not be able to be retroactively adjusted. There are negotiated contracted payment rates and subsidized benefits in the Medicare Advantage program and the Part D prescription drug program. Likewise the Internal Revenue Service may not be able to collect revenues retroactively; relevant to provisions that have already been provided as new or increased tax benefits. If Mitt Romney repeals Obamacare, he will contribute to increasing federal budget deficits by $109 billion over the 2013–2022 periods. 

Clearly, Mitt Romney’s plan for healthcare is to transfer its ownership, finances, and accountability from the public sector to private enterprises. Read the fine print. The Romney- Ryan policies have the potential to fail to protect the poorest and most vulnerable citizens from social-economic injustices. Nothing happens by coincidence and efforts may be underway at this very moment, to promote their agenda by silencing the voices of those who will be impacted the most, with voter suppression laws. 

Melissa Bynes Brooks is the editor of BrooksSleepReview.

Contact information: melissabynesbrooks@comcast.net

Follow on Twitter @Mlbbrooks


“Obamacare: Win-Win for the Economy”

August 1, 2012

By Melissa Bynes Brooks

Theoretically, the cost of healthcare should decrease as the demand for products and services increase because the healthcare industry is the exception to the “basic economic” model of supply and demand. It is more complex. Health insurance costs are lower when larger groups of people are involved in the consumer pool thus increasing demand and lessening the costs of unhealthy or risky individuals with healthy or less risky individuals.

Despite looming promises of repeal by Republicans, the Affordable Care Act (ACA) is an essential component for cost containment and strengthening of the U.S. economy. This is especially true when 17 percent of the nation’s GDP is spent on health care with a GDP growth rate of only 1.5 percent.

Further analysis by the CBO, after the Supreme Court ruled that the ACA is constitutional, indicates that repealing the law would reduce direct spending by $890 billion and reduce revenues by $1 trillion between 2013 and 2022, adding $109 billion to federal budget deficits over that period. Additionally, an estimated 60 million nonelderly people would be uninsured.

Regulatory requirements have not eluded corporate leaders currently brainstorming and investing in new strategies and innovative technologies to position their companies for competition in a market place projected to expand health insurance coverage, to an estimated 14 million people by 2014, and 30 million people by the latter part of the coming decade.

Business mergers are forming between companies directly impacted by the ACA.

In early July, the first major health care sector merger occurred when health care giant WellPoint said it will buy Amerigroup, a managed health care company with 4.5 million customers of state sponsored health care programs, for $4.9 billion or $92 a share in cash.

“We believe that this combination will create an industry leader in the government sector serving Medicaid and Medicare enrollees,” said WellPoint CEO Angela Braly in a statement. Braly added that the merger, which focuses on Medicaid recipients like the poor and the elderly, is an opportunity to “position our companies for future growth as the health insurance industry changes and as we prepare for health insurance exchanges.”

Amerigroup shares increased 40 percent, to over $89.84 a share following news of the merger. WellPoint shares increased 3 percent, to $61.64 a share. Shares for both companies had decreased in value after the Supreme Court decision in June.

The ACA presents broad economies of scale for health information technology (HIT) companies specializing in the provision of secure platforms for accessing and sharing patient data through the installation of electronic health records (EHR), telemedicine, and mobile health applications. 88 percent of physicians said they would like their patients to track their health information and 40 percent of individuals said they would buy a personal health-monitoring device or pay for a monthly subscription to send health information to their providers.

Authentidate Holding Corp. provides secure web-based software applications and telehealth products and services that enable healthcare organizations to coordinate care for patients and enhance related administrative and clinical workflows.

Their alliance with hospitals, physicians, and consumers generated revenues for the quarter ending on March 31, 2012 of approximately $764,000, compared to $729,000 for the prior year period. Revenues were mostly from telehealth products and services. For the third quarter of fiscal year 2012, revenues increased approximately 16 percent compared to the second quarter of fiscal year 2012, due to higher telehealth revenues for the current period.

There are an estimated 5.9 billion mobile-cellular subscriptions. Mobile-broadband subscriptions have grown 45 percent annually over the last four years. PwC estimates the U.S. mHealth market opportunities will be $6.5 billion by 2017, for remote mobile-enabled services used to monitor symptoms and manage chronic conditions like high blood pressure and diabetes. Growth is expected to be driven in part by the ACA objectives of providing cost effective preventative care.

Administration of the U.S. health system alone accounts for 7 percent of total spending. ACA has established regulations to rein in costs. Health insurance providers are now required to decrease administrative costs. They must spend 80 to 85 percent of premium dollars on medical care and health care quality improvement or they will be required to provide rebates to their customers. This year an estimated nine million Americans may be eligible for rebates worth up to $1.4 billion.

There are reimbursement incentives for hospitals and healthcare providers busy implementing certified EHR technology to meet the Centers for Medicare & Medicaid Services’ (CMS) and Office of the National Coordinator’s (ONC) requirements for meaningful use by 2015. Health systems will see a decrease in their Medicare and Medicaid reimbursements if they are not able to demonstrate meaningful use relevant to e-prescribing, the electronic exchange of health information to improve quality care, and the submission of clinical quality and other measures.

Love it or hate it, the Affordable Care Act appears to be a win-win for the economy and healthcare industry stakeholders consisting of consumers, health systems, providers, and technology business enterprises.

“When you eliminate the impossible whatever remains however improbable must be the truth!”

-Sir Arthur Conan Doyle, Scottish author and creator of Sherlock Holmes.

Melissa Bynes Brooks is the editor of BrooksSleepReview.

Contact information: melissabynesbrooks@comcast.net

Follow on Twitter @Mlbbrooks