Obamacare analysis misses the point

There’s been a lot of news and analysis about Obamacare recently and most of it has been negative. One positive piece, however, spotlighted the way in which Obamacare may end up saving the healthcare system money in the long run. And yet it all ignores the original premise of Obamacare.

Tara Courtland

Communications Director Tara Courtland

The positive piece is from Sean Williams of The Motley Fool, who points out that a new study in JAMA Internal Medicine concluded that Obamacare’s Medicaid expansion has led to significant health benefits in states that adopted it. Obamacare provided every state with extra funds to expand Medicaid only 31 states took the administration up on the offer. Those that did added millions of new low-income families to the Obamacare network , providing health insurance to those who wouldn’t otherwise be eligible.

The study shows that the expansion led to increased access to primary care, fewer skipped medications, reduced out-of-pocket spending, reduced likelihood of emergency unit visits, and increased outpatient visits for low-income adults.

Williams points out that the financial implications there could be huge. While the expansion costs more federal dollars up front, it also means lower healthcare costs in the long run since prevention is cheaper than cure. And, he notes, since 5 percent of the population is responsible for about 50 percent of the nation’s healthcare expenditures, prevention and early intervention in that demographic is a huge cost savings on the back end.

There are plenty of negatives, of course. There aren’t enough healthy young people enrolling in Obamacare to bring the costs down and large insurers may start threatening to walk, as Aetna already has.

And yet all of the financial forecasts, positive and negative, ignore the point – in the most powerful nation in the history of the world, 33 million people still lack health insurance and therefore, healthcare. That’s 10 percent of Americans who can’t afford vaccines, antibiotics, a cast for a broken arm, an ambulance ride or insulin.

The financials are important – they make the system work. But amid the numbers and forecasts, let’s remember that the point is to improve the quality of health and life for millions of people. They are not just numbers and percentages — they’re human beings. The point is not to make healthcare cheaper. The point is to make healthcare cheaper in order to make people healthier. It’s about time we stop forgetting the second part of the sentence.

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What does HIPAA look like on the hospital floor?

I recently spent quite a bit of time on a med-surg floor and was shocked to hear medical staff discussing patients by name while standing in the hallway. Contrast this with the hyper vigilance which is brought to bear by medical administrators and vendors attempting to go by the letter of the law regarding protecting patient health information.

NEMT CEO Linda Sullivan

NEMT still receives emails from clients containing identifying demographic data on patients. Even an immediate response pointing out the impropriety seems often not to be understood. And then we have the cyberhacking phenomenon, which appears to be accelerating at a significant rate.

An article from the Institute of Critical Infrastructure Technology entitled Hacking Healthcare IT in 2016 states “Since 2009, the annual number of cyber-attacks against the healthcare sector has drastically increased; often the number of attacks exceeds the previous year’s count by at least 40%.”

So, why the disconnect with folks sitting behind a desk sending PHI in an unsecured email and hospital personnel discussing PHI within earshot of others? I don’t know the answer to that question but better and clearer communication might be the start of a solution.

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The bad guys are on the move

In the last few weeks, I’ve heard of a new form of ransomware called Zepto as well as an increase in spoofed emails. As far as the emails go, I get them daily. Sometimes they even come from me! Let’s tackle these subjects separately and include a reminder about staying safe.

Andrew Clarke

Ransomware

What is ransomware? Ransomware refers to the act of a hacker encrypting all the data on your computer or company network and holding it for ransom. You are given instructions on where and how to send the ransom in exchange for the key to unlock your data. This practice continues because there are those who pay, including some police departments. If no one paid, the bad guys would have to find another way to extort money from their victims.

While there are some so-called computer professionals who advocate paying the ransom, my answer is to just say no. Do not negotiate with terrorists, and that’s what these people are. Your computer has no real value, but your data does. They know this. The correct answer is to take precautions by backing up regularly and not opening suspicious email attachments. If you have adequate backups, you can recover most of your data without giving in to extortion. How often you backup is up to your comfort level. How much data can you afford to lose? Backups also protect you against hard drive failures, fire, theft and accidental deletions, so there are plenty of reasons they are a good idea. You should have multiple backups, and one should be off-site.

In addition to having a good backup system, you need to be suspicious of any email attachment. Remember that these attacks can appear to come from people you know as well as people you don’t know, and the bad guys are tricky. Social engineering is the number one way they gain access to your computer. You should not open any attachment you are not expecting.

If you become infected, you need to react quickly. Shut down your computer immediately, physically disconnect from any network you are connected to, and contact your network administrator or IT support immediately. Remember that the infection can spread to other computers on the network if it is not stopped. Share this information with everyone you know, especially the elderly and those who might be more susceptible to falling for this sort of scam.

Spoofed emails

A spoofed email is an email you receive that appears to come from someone you know when it actually doesn’t. Think of it like the return address on a piece of snail mail (aka old fashioned letter). In the upper left-hand corner, you put your return address. In reality, you can put any address there you want. Email is the same way. Even the least sophisticated hacker knows how to make the email look like it comes from a friend, relative or co-worker. They use this tactic to increase the chance of you opening the email and clicking on the attachment. That’s why you need to be cautious even if you think you know who the email is from.

Remember …

  • Be cautious when dealing with email. Do not open attachments you are not expecting.
  • Just because the email appears to come from a known source does not make it so.
  • If you’re infected, react quickly.
  • Share this information with everyone you know.
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What do you do after you audit?

I recently ran an audit on an area that showed some things we needed to improve.  We are required, as we all know, to do audits but what do we do with the data?  We are supposed to asses it and fix areas that have problems.  The real question is do we follow through?

NEMT President Linda Allard

In my case the areas of concern were not showing a security breach.  They were pointing out the fact that I needed some more education for my team and to change my policies so they were easier to understand.  These actions could prevent possible issues in the future. Those involved with the area we audited got together and discussed the findings and what we could do.  We agreed on a solution, made the changes, had education sessions outlining the changes and put the new procedure in place.

If I get audited I can now show, through documentation, my findings and what we did to correct the issues identified.  After all, the reason we audit ourselves is so that we can find areas of concern and fix things before they do, in fact, cause us an issue.  If we just audit and do nothing with what we find why do the audit at all?  Policies can always be improved, and this is a great way to help us find better ways to do things.

For us it’s been 30 days and the audit was done last week on what we changed.  I am very excited to see the results of my new audit next week.

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Where have all the doctors gone?

In case you missed it, a recent study commissioned by the Association of American Medical Colleges predicts that by 2025, the U.S. will face a shortage of 61,700-94,700 physicians.

Tara Courtland

Communications Director Tara Courtland

It’s not entirely surprising — the cost of education has been steadily rising anyway and the cost of medical degrees, even more so. Teens just finishing high school are thinking twice before embarking on the expensive eight-year journey necessary to practice medicine.

Of course it’s not just that there are fewer doctors — it’s also that there are more patients, since the aging Baby Boomer population has put a strain on the medical profession’s ability to handle the load.

The combined weight of the patient boom plus the doctor shortage has already started to become a problem and, the study concludes, will just keep getting worse.

So what’s to be done? Not surprisingly, the Association of American Medical Colleges, which funded the study, wants Congress to approve more federal funding for residency programs. It’s not an easy problem and whatever happens in the November election, it’s unlikely that Congress will direct a significant amount of money to fix it.

Until something changes for the better, the only answer may be for Americans to live by the “apple-a-day” adage to lighten the load on the healthcare system.

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