Healthcare — the debate segment you weren’t paying attention to

Let’s be honest – by the time the Oct. 9 presidential debate turned to healthcare, most of us weren’t paying attention to the candidates’ words – we were just yelling comebacks and insults at the screen. So in case you missed it, here’s a quick recap of what went down on Obamacare:

Tara Courtland

Communications Director Tara Courtland

Based on what they said in the debate, Clinton wants to fix Obamacare by bringing the costs down and the coverage up – making sure that it’s cheaper for small businesses and that 100 percent of Americans have health insurance.

She did not offer details about how to do that.

Trump wants to repeal Obamacare and replace it with something less expensive and something that works. He did not offer details about what that would be, except to say that he’d do away with the lines that separate the insurance system into a state-by-state basis.

The bottom line is that neither candidate’s plans are likely to happen.

Any Clinton tweaks are going to have a hard time making it through Congress. Remember how long it took to get Obamacare passed in the first place? Even in a Democratically-controlled Congress, it’s unlikely that any changes will garner enough support to make it all the way through the system because the entire thing is just too controversial – no one wants to touch it to fix it.

And Trump’s offered no ideas on what he’d actually replace Obamacare with. Adding that to the fact that Republicans have been trying unsuccessfully for years to get it repealed, and he’s got nothing.

The whole exchange would have made for good entertainment though, if the entire “leaked video” (no, we’re not going to say the P word here) exchange at the beginning of the debate hadn’t already sucked all of the air out of the room.

So if you’re dying to analyze the Obamacare portion of the debate for yourself, here’s that segment in its entirety:

 

TRANSCRIPT

AUDIENCE QUESTION: “Affordable Care Act, known as Obamacare, it is not affordable. Premiums have gone up. Deductibles have gone up. Copays have gone up. Prescriptions have gone up. And the coverage has gone down. What will you do to bring the cost down and make coverage better?”

COOPER: That first one goes to Secretary Clinton, because you started out the last one to the audience.

CLINTON: If he wants to start, he can start. No, go ahead, Donald.

TRUMP: No, I’m a gentleman, Hillary. Go ahead.

(LAUGHTER)

COOPER: Secretary Clinton?

CLINTON: Well, I think Donald was about to say he’s going to solve it by repealing it and getting rid of the Affordable Care Act. And I’m going to fix it, because I agree with you. Premiums have gotten too high. Copays, deductibles, prescription drug costs, and I’ve laid out a series of actions that we can take to try to get those costs down.

But here’s what I don’t want people to forget when we’re talking about reining in the costs, which has to be the highest priority of the next president, when the Affordable Care Act passed, it wasn’t just that 20 million got insurance who didn’t have it before. But that in and of itself was a good thing. I meet these people all the time, and they tell me what a difference having that insurance meant to them and their families.

But everybody else, the 170 million of us who get health insurance through our employees got big benefits. Number one, insurance companies can’t deny you coverage because of a pre-existing condition. Number two, no lifetime limits, which is a big deal if you have serious health problems.

Number three, women can’t be charged more than men for our health insurance, which is the way it used to be before the Affordable Care Act. Number four, if you’re under 26, and your parents have a policy, you can be on that policy until the age of 26, something that didn’t happen before.

So I want very much to save what works and is good about the Affordable Care Act. But we’ve got to get costs down. We’ve got to provide additional help to small businesses so that they can afford to provide health insurance. But if we repeal it, as Donald has proposed, and start over again, all of those benefits I just mentioned are lost to everybody, not just people who get their health insurance on the exchange. And then we would have to start all over again.

Right now, we are at 90 percent health insurance coverage. That’s the highest we’ve ever been in our country.

COOPER: Secretary Clinton, your time is up.

CLINTON: So I want us to get to 100 percent, but get costs down and keep quality up.

COOPER: Mr. Trump, you have two minutes.

TRUMP: It is such a great question and it’s maybe the question I get almost more than anything else, outside of defense. Obamacare is a disaster. You know it. We all know it. It’s going up at numbers that nobody’s ever seen worldwide. Nobody’s ever seen numbers like this for health care.

It’s only getting worse. In ’17, it implodes by itself. Their method of fixing it is to go back and ask Congress for more money, more and more money. We have right now almost $20 trillion in debt.

Obamacare will never work. It’s very bad, very bad health insurance. Far too expensive. And not only expensive for the person that has it, unbelievably expensive for our country. It’s going to be one of the biggest line items very shortly.

We have to repeal it and replace it with something absolutely much less expensive and something that works, where your plan can actually be tailored. We have to get rid of the lines around the state, artificial lines, where we stop insurance companies from coming in and competing, because they want — and President Obama and whoever was working on it — they want to leave those lines, because that gives the insurance companies essentially monopolies. We want competition.

You will have the finest health care plan there is. She wants to go to a single-payer plan, which would be a disaster, somewhat similar to Canada. And if you haven’t noticed the Canadians, when they need a big operation, when something happens, they come into the United States in many cases because their system is so slow. It’s catastrophic in certain ways.

But she wants to go to single payer, which means the government basically rules everything. Hillary Clinton has been after this for years. Obamacare was the first step. Obamacare is a total disaster. And not only are your rates going up by numbers that nobody’s ever believed, but your deductibles are going up, so that unless you get hit by a truck, you’re never going to be able to use it.

COOPER: Mr. Trump, your time…

TRUMP: It is a disastrous plan, and it has to be repealed and replaced.

COOPER: Secretary Clinton, let me follow up with you. Your husband called Obamacare, quote, “the craziest thing in the world,” saying that small-business owners are getting killed as premiums double, coverage is cut in half. Was he mistaken or was the mistake simply telling the truth?

CLINTON: No, I mean, he clarified what he meant. And it’s very clear. Look, we are in a situation in our country where if we were to start all over again, we might come up with a different system. But we have an employer-based system. That’s where the vast majority of people get their health care.

And the Affordable Care Act was meant to try to fill the gap between people who were too poor and couldn’t put together any resources to afford health care, namely people on Medicaid. Obviously, Medicare, which is a single-payer system, which takes care of our elderly and does a great job doing it, by the way, and then all of the people who were employed, but people who were working but didn’t have the money to afford insurance and didn’t have anybody, an employer or anybody else, to help them.

That was the slot that the Obamacare approach was to take. And like I say, 20 million people now have health insurance. So if we just rip it up and throw it away, what Donald’s not telling you is we just turn it back to the insurance companies the way it used to be, and that means the insurance companies…

COOPER: Secretary Clinton…

CLINTON: … get to do pretty much whatever they want, including saying, look, I’m sorry, you’ve got diabetes, you had cancer, your child has asthma…

COOPER: Your time is up.

CLINTON: … you may not be able to have insurance because you can’t afford it. So let’s fix what’s broken about it, but let’s not throw it away and give it all back to the insurance companies and the drug companies. That’s not going to work.

COOPER: Mr. Trump, let me follow up on this. TRUMP: Well, I just want — just one thing. First of all, Hillary, everything’s broken about it. Everything. Number two, Bernie Sanders said that Hillary Clinton has very bad judgment. This is a perfect example of it, trying to save Obamacare, which is a disaster.

COOPER: You’ve said you want to end Obamacare…

TRUMP: By the way…

COOPER: You’ve said you want to end Obamacare. You’ve also said you want to make coverage accessible for people with pre-existing conditions. How do you force insurance companies to do that if you’re no longer mandating that every American get insurance?

TRUMP: We’re going to be able to. You’re going to have plans…

COOPER: What does that mean?

TRUMP: Well, I’ll tell you what it means. You’re going to have plans that are so good, because we’re going to have so much competition in the insurance industry. Once we break out — once we break out the lines and allow the competition to come…

COOPER: Are you going — are you going to have a mandate that Americans have to have health insurance?

TRUMP: President Obama — Anderson, excuse me. President Obama, by keeping those lines, the boundary lines around each state, it was almost gone until just very toward the end of the passage of Obamacare, which, by the way, was a fraud. You know that, because Jonathan Gruber, the architect of Obamacare, was said — he said it was a great lie, it was a big lie. President Obama said you keep your doctor, you keep your plan. The whole thing was a fraud, and it doesn’t work.

But when we get rid of those lines, you will have competition, and we will be able to keep pre-existing, we’ll also be able to help people that can’t get — don’t have money because we are going to have people protected.

And Republicans feel this way, believe it or not, and strongly this way. We’re going to block grant into the states. We’re going to block grant into Medicaid into the states…

COOPER: Thank you, Mr. Trump.

TRUMP: … so that we will be able to take care of people without the necessary funds to take care of themselves.

COOPER: Thank you, Mr. Trump.

 

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The audits are coming!

As business associates, we have not been high on the radar screen as far as audits go with the OCR. This year that is changing. Although not as many business associates will be audited as covered entities, we will be included in the audit process. In fact, some of the notifications to business associates should have already gone out.

NEMT President Linda Allard

Business associates will have to follow the same rules as covered entities where we will have a short time to provide the requested information for what will be considered a desk-type audit. It is critical that we are all prepared and ready to hand over whatever information is requested. There are plenty of reports on previous audits and where deficiencies were found. These are crucial areas to focus on.

There will also be absolutely no way you will do well if you do not have policies and procedures that you are actually following. Now is the time to review your procedures, and make sure they are being followed. Things change, so make sure your documentation has changed as well. How about all your training? Have you run an audit to make sure you have that documentation? A simple internal audit could save time and even fines.

Let’s show our covered entities and OCR that we business associates treat PHI and HIPAA the way we should.

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What in the world is that?

Have you ever wanted to search for an item, but you didn’t know what to call it?  Wouldn’t it be nice if you could just take a picture and search that way?  Now you can … in more ways than one.  It’s called image based searching, and it’s a lot of fun.  How you do it depends on what type of smart phone you have.

Andrew Clarke

Android phones have access to an app called Google Goggles.  Once you download and open the app, all you need to do is use the photo icon in the app to take a picture of the item you want to search for.  If Google recognizes the image, you will receive search information about it.  Google Goggles is not available on IOS, however.

If you have an iPhone, there’s an app called CamFind by Image Searcher, Inc.  I’ve tried it out, and it works great.  It works in a similar fashion to Google Goggles, and some users report even better search results.

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There’s more than one way to hack

A recent article in Healthcare IT Newsdiscusses “Visual hacking” – not something we perhaps are as conscious of as we should be. For example, someone is standing near your desk and not even facing your computer but how easy is it for the eye to stray for just a moment and if a patient’s name is visible . . . you’ve been hacked. Jessica Davis writes “When the Ponemon Institute released its 2016 Global Visual Hacking Experiment, the research firm found that 91 percent of visual hacking attempts are successful.”

NEMT CEO Linda Sullivan

Also termed ”shoulder surfing” visual hacking occurs on desktop monitors, laptops, any kind of mobile device, and of course, paper records as well. Attacks are stealthy, occur quickly, and usually are undetected unless and until the information is used maliciously.

Davis interviewed Kate Borten, a Visual Privacy Advisory Council member and founder of The Marblehead Group. According to Borten, “Although training employees to protect against visual hacking is not required under HIPAA, CISOs and CIOs should not overlook the threat.”

Since so much of hacking is through the IT venue, and given the fact that visual hacking is not addressed by HIPAA, it’s easy to see why it can easily be overlooked.

There are some simple ways that visual hacking can be addressed including simply educating staff to the problem. Borten suggests “walk-around audits” to identify areas of vulnerability. The angle of screens away from doors, privacy filters, and screen savers are all ways that can cut down on the opportunity for patient data to be visually hacked.

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Be prepared — part two

Last week, NEMT President Linda Allard blogged about preparing our business and home offices for recovery in the event of a natural disaster.

Tara Courtland

Communications Director Tara Courtland

At the same time, the Centers for Medicare and Medicaid Services released its federal disaster preparedness requirements for healthcare providers and suppliers.

In the healthcare documentation industry, we need to ensure that all of our transcriptionists, coders, IT specialists and others can continue to work — or have seamless coverage — if the power or Internet goes out.

For hospitals, nursing homes and other providers, it’s a lot more physical. The new rules — which providers will have a year to put into practice — are intended to make sure patients can be treated in the middle of hurricanes, floods, terrorist attacks or pandemics.

One of the major requirements involves testing generators because catastrophic generator failure has been a repeated problem in hospitals and nursing homes during major storms.

The government predicts it will cost more than $279 million to implement the preparedness measures. By this time next year, we’ll know if they’re right.

For those of us in the documentation field, the new measures are another reminder for us to check our own backup plan.

  • Is your data backed up to the cloud?
  • If you can’t work tomorrow or even call in to give instructions, can someone else pick up your job and keep moving?
  • If a disaster takes out power in your entire region, can you get enough people in an unaffected area to pick up the work seamlessly?
  • And our “hit by a bus” scenario — if you are hit by a bus on the way to work, can someone else find all of your files? Will they know what to do with them? Can they figure out what you’ve named your files and how you’ve saved them?

Disasters are inevitable. Surprise isn’t – plan ahead.

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