Affordable Care Act Archives - Page 6 of 7

Year-End Take: A Hopeful Trend in U.S. Health Care?

Less Is Sometimes More
A hopeful trend that’s gained some serious momentum this year—and may be connected to both the recession and some provisions of the Affordable Care Act—is that we’re beginning to question whether we really need quite so many tests and drugs. By ‘we’ I mean researchers, some journalists, some nurses and physicians, and of course patients. The answers aren’t always clear, and there’s plenty of room for disagreement on many such issues, but at least we’re asking the right questions more often, rather than retreating in fear and simply hurling around the word “rationing”:

Who really benefits from prostate and breast cancer screening and who is more likely to be harmed, and why? When are you too young or too old to be likely to benefit from a certain type of screening? When does aggressive care at the end of life cease to make sense? Are we confusing a risk factor with a disease, an association with causation, relative risk with absolute risk?

Does that drug you see relentlessly marketed in advertisements during breaks in the network news actually help you? Which physicians are being paid as consultants in support of various drugs, tests, or treatments, and does this compromise their objectivity? And so on. The latest example of this kind of analysis I’ve stumbled across can be found here: “Disease Creep: How We’re Fooled Into Using More Medicine Than We Need.”

The Many Faces of Nursing
So, that’s […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:11:06-05:00December 27th, 2011|health care policy, nursing perspective|3 Comments

Bad News, Good News: Berwick, a Casualty of Politics, Succeeded at CMS Helm by a Nurse

By Shawn Kennedy, MA, RN, editor-in-chief

When Donald Berwick steps down from his post as administrator of the Centers for Medicare and Medicaid Services (CMS) on December 2, he’ll turn the reins over to Marilyn Tavenner, MHA, BSN, RN. Tavenner is not a new face at CMS—she served as acting administrator prior to Berwick’s July 2010 appointment by President Obama and has been principal deputy administrator at CMS since February 2010.

As noted by an article in The Washington Post, Berwick is stepping down in the face of organized opposition to his nomination by Republicans in Congress, who have vowed to block the confirmation he’d need to continue after his recess appointment expires on December 31.

On November 23, President Obama announced his intent to nominate Tavenner for the top post. In her e-mail to CMS staff (carried on the Kaiser Health News site), Kathy Sebelius, secretary of Health and Human Resources, says of Tavenner, “Her career as a nurse, hospital administrator, and Virginia Secretary of Health and Human Resources give her unique insights that position her well to serve as Administrator.”

I certainly hope so. Berwick’s reputation and track record for pinpointing problems in our health system—and more importantly, working to do something about them through the Institute for Healthcare Improvement—was stellar, and he carried this zeal into […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:11:20-05:00November 30th, 2011|Nursing|2 Comments

Getting Nursing News (Whether You Like It Or Not)

By Gail M. Pfeifer, AJN news director

During a recent public radio interview between Anita Dunn, a Democratic strategist and former senior advisor to President Obama, and Republican strategist Frank Luntz (author of Words That Work: It’s Not What You Say, It’s What People Hear), Dunn remarked that folks “increasingly seek people they already agree with to get their news from.” (Here’s the show’s transcript.)

That is a sad commentary on the state of news journalism today. By definition, a journalist’s report should be fair and unbiased. And news reporting, above all, should be held to that high standard.

If you read AJN’s news department regularly (here’s the current issue’s table of contents; scroll down to find links to the new articles), and we hope you do, we should tell you how we try to maintain such standards. […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:12:44-05:00June 10th, 2011|healthcare social media, nursing perspective|0 Comments

Health Care Reform Works—If You Work It

By Gail M. Pfeifer, MA, RN, AJN news director

My husband and I both recently had preventive screening colonoscopies, which are now covered under the Affordable Care Act (ACA) as preventive care for adults over 50. That coverage, if you purchased a new health insurance plan on or after September 23, 2010, which we did, means you do not have to pay a copayment or coinsurance or meet a deductible if you use an in-network provider (here’s a full list of preventive services covered under the new law). You would think that medical office billers and insurance companies would know that by now.

Although some plans have clauses that let them off the hook on this rule, ours does not—these tests should have been covered. Lucky for us, we knew it when the bills came in. To make a long story short, I was billed for the “surgery” and for the anesthesia. So I first called the billing department of the GI specialist’s office and asked them to rebill the procedure correctly, as preventive screening. No further bills from them, for me, but shortly afterward, my husband was billed by the same office for “surgery” occurring months later—same doc, same procedure, same billing office. He’s following up with phone calls as I write.

I next called the anesthesia billing office, which said our insurance company had denied the claim. I called the insurance company, which looked at our plan […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:13:25-05:00April 22nd, 2011|health care policy, nursing perspective, patient engagement|2 Comments

On the Web: A Tragic Choice, Wasting Berwick, Cost Control, A Nurse’s Comfort Zone

An estimated 60% of American bankruptcies result from overwhelming medical costs. My uncle’s tale illuminates the dual tragedy of suffering catastrophic illness and being uninsured.

Read the rest of this troubling post at The Health Care Blog by surgeon John Maa if you doubt that we need health care reform in this country.

A measure of how unserious we are about fixing the problem of health care quality and costs in the U.S. can be found in reports that Don Berwick, President Obama’s choice to run the Centers for Medicare and Medicaid Services (CMS), continues to have an uphill battle for confirmation, despite being widely acknowledged within the medical community as the best choice for the challenging job.

Since we’re talking policy, there’s an incisive post at the Health Affairs Blog on where our energies should—and should not—be going in controlling costs. Here’s an excerpt:

The current cry to reduce Federal deficits and debt growth by reducing Medicare and Medicaid entitlements is totally missing the key issue: the need to moderate all health care inflation. This should be the time for a national debate on how to best tackle the underlying cost problem, for the sake of our future, the economy, and access to health care.

The June 13-19, 2009 Economist editorialized: “America has the most wasteful […]

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Jacob Molyneux, senior editor/blog editor2016-11-21T13:13:54-05:00March 8th, 2011|Nursing|1 Comment