Tuesday, April 30, 2013

Did you slip and fall into your garbage can? There’s a code for that!

The Affordable Care Act has forced insurance costs higher, encouraged many employers to bail out of providing health plans for their employees or cut employees or reduce hours to below the full-time threshold to avoid the higher costs, and has unleashed thousands of pages of new regulations. But intrepid federal bureaucrats charge ahead with even more requirements for providers, one of which is a revamping of the codes used to identify the medical services that providers use to bill insurers.

Currently, there about 18,000 such codes and one might be fooled into believing that is enough. But the devoted folks who get paid to generate new codes have been hard at work revamping the code system and the new list contains nearly 8 times the former number, checking in at 140,000 medical codes. The feds reason that more specific information is needed to adequately communicate what doctors and hospitals do for their patients, as well as what patients may have done to require a visit to a provider.

New codes describe precisely what bone was broken, or which eye was blackened, and tell insurers whether your injury occurred in, for example, an opera house, an art gallery, on a squash court, or in one of nine locations in and around a mobile home.

Some of them push the limits of propriety. Code R46.1 is for "bizarre personal appearance," while code R46.0 is for "very low level of personal hygiene." Others tell insurers whether an injury caused by walking into a lamppost was the "initial encounter," or a "subsequent encounter."

There is a group of codes that clarify whether you were injured while sewing, ironing, crocheting, doing handcrafts, knitting, or my personal favorite, playing a brass instrument. (Brass players are now churning out imaginative scenarios for how these injuries might have occurred.) There is also a code indicating that a patient's injury occurred in a chicken coup.

Speaking of birds, there are 72 codes for patients who have run afoul of these creatures, and being bitten by a parrot has a different code than if said parrot flies into you, or if you are bitten or flown into by a macaw or a goose. There are nine different codes for each of the six different species of bird.

The folks that developed the system—generally known as ICD-10, for International Classification of Diseases, 10th Revision—say "the codes will provide a more exact and up-to-date accounting of diagnoses and hospital inpatient procedures, which could improve payment strategies and care guidelines," and their use is scheduled to be required in two years. Pat Brooks, senior technical adviser at the Centers for Medicare and Medicaid Services explains that "It's for accuracy of data and quality of care."

As a side note, healthcare reform, known more commonly as Obamacare, is deemed so important that the furloughs that befell air traffic controllers did not extend to Obamacare regulators and code generators, according to Gary Cohen, director of the Center for Consumer Information and Insurance Oversight, who said that his office has not cut its workers’ hours and pay as a result of the automatic budget cuts that went into effect in March. This information should help convince doubters that the pain of the sequester is a conscious political choice of the administration, and not a requirement of the sequester.

While federal bureaucrats are busy, busy, busy improving the healthcare system with mountains of new regulations and charge codes, some of the people who actually provide care are taking different approaches, some of them good, and some not.

A recent Deloitte Center for Health Solutions survey of over 600 doctors reveals that 6 in 10 may retire earlier than they had planned, and will do so in the next three years, due to the effects of the Affordable Care Act on how they practice medicine.

Further, many providers will leave the private sector to work for hospitals or accountable care organizations, and others are fighting back against massive government interference in the doctor-patient relationship by reverting to an older direct primary care model that eschews health insurance in favor of fee-for-services, such as an office visit for $20 or a house call for $100. Some offer a membership plan where patients pay a set fee per month for physician services.

Getting away from health insurance, government regulations and other requirements reduces costs substantially, allowing doctors to provide services at affordable prices, and has the further advantage of allowing doctors to escape "assembly line medicine," all of which may benefit the relationship between providers and patients. In contrast to Obamacare, this is a real improvement in the system.

Finally, even supporters of this Rube Goldberg-like contrivance are starting to realize its boundless weaknesses. Senator Max Baucus, (D-Mon.), one of the Affordable Care Act’s designers and strong backers, told Health and Human Services Secretary Kathleen Sebelius during a Senate committee hearing that he sees "a huge train wreck coming down."

It's a shame Sen. Baucus and the other blind supporters didn't do their homework before the measure passed the Congress, and save the country much pain and suffering. But perhaps it’s not too late to reverse course.

Tuesday, April 23, 2013

The Boston Marathon bombing shows that terrorism is still a threat

The Boston Marathon bombing shocked us back into the reality that terrorism is a serious threat today in America. Twenty-six year-old Tamerlan Tsarnaev and his 19 year-old brother Dzhokhar are suspected of executing the plot that killed three innocent people and injured dozens more near the Marathon’s finish line, and of killing a police officer and injuring another a few days later. Thus far authorities have not been able to present a clear picture of what may have motivated those responsible to commit this savage act.

The Tsarnaev’s, a Chechen family of six, came to the US about ten years ago to escape a bad situation in Russia, but the father and mother returned to Russia a year ago, while the brothers and at least one of their sisters stayed behind. By all accounts, the younger brother had many friends, but the older brother was less friendly and had turned increasingly to Islam, and went to Russia last year for a six month visit, during which time some believe he may have been prepared for jihad. Reports say, in fact, that police believe he was specially trained to carry out the devastating attack while there.

What is particularly troubling is what the UK's Daily Mirror online reported. "The FBI was last night hunting a 12-strong terrorist 'sleeper cell' linked to the Boston marathon bomb brothers. More than 1,000 FBI operatives were last night working to track down the cell and arrested a man and two women 60 miles from Boston in the hours before Dzhokhar’s dramatic capture after a bloody shootout on Friday."

The Daily Mirror quoted a source it said was "close to the investigation" as saying that "We have no doubt the brothers were not acting alone. The devices used to detonate the two bombs were highly sophisticated and not the kind of thing people learn from Google." The account went on to suggest that someone gave the brothers the skills, and investigators must find out just who they were. Agents think the sleeper cell has been waiting several years for the day to come for it to commit jihad, the report continued. Other sources claim that a mosque near where the brothers lived may have helped to radicalize Tamerlan.

The existence of homegrown and/or resident terrorist cells reflects on the US policy toward terrorism, which is a confused mess that has been corrupted by political correctness and weakness at upper levels. When US Army psychiatrist Major Nadal Hassan screamed "Allahu Akbar"  ("Allah is greater") as he went on his shooting spree at a processing center at Fort Hood, Texas, killing 13 fellow soldiers who were not allowed to carry firearms on the base, and injuring 30 more, it was an act of Islamic jihad.

But the Obama/Holder Justice Department and other federal agencies wimped out and idiotically termed the terrorism "workplace violence." And evidence suggests that the Marathon bombing is most likely another jihadist event. These are two of five incidents involving individuals for whom radical Islamic ties had been suspected, and about whom federal authorities had been forewarned, but did not connect the dots to prevent the terrorist atrocities.

James Jay Carafano, the vice president of foreign and defense policy studies at the Heritage Foundation, told NewsmaxMedia that the Obama administration is so eager to declare victory in the war on terror that it is “putting its head in the sand” and ignoring the rapid growth of non-al-Qaida terrorist groups. He said the post 9-11 homeland security effort was “very effective,” and cited some 54 al-Qaida-related instances where attacks and bombings were thwarted. But he criticized the administration's downplaying the war on terror as if it already had been won. He said the administration has “defined their way out of the problem” by focusing only on al-Qaida and ignoring other terrorist threats, like existing cells within the US and the Hassan attack at Fort Hood.

A terrorism-related “weapon of mass destruction” charge, which carries the death penalty, was filed against Dzhokhar Tsarnaev Monday afternoon.

“We’ve adopted a counterterrorism strategy which generally means that the United States is putting its head in the sand" and if you look at what’s going on in North Africa, Afghanistan, Iraq and Syria, the threat is not diminishing. To the contrary, he told Newsmax, the threat of terrorism is definitely growing. And he says the current administration “has adopted a counterterrorism strategy which really relies on ignoring a lot of the people who might potentially want to kill us.”

It is much more critical to focus on issues of national security, like terrorist activities from cells that reside here at home and the threats of nuclear war from the boyish North Korean dictator and Iran, instead of trying to nationalize the healthcare system, throwing billions of our tax dollars at failing green energy companies in a vain attempt to revamp how the nation provides for its energy needs, and imposing gun control measures that would have had no effect on the problems that spawned the efforts to enact them.

Tuesday, April 16, 2013

Clear thinking on mass killings and gun control is slowly emerging

Efforts to prevent future mass killings, like the Sandy Hook Elementary School shooting where 20 children and six adults died last year, continue on Capitol Hill. These efforts, however, are symbolic, not substantive, and focus too much on guns, magazines and related firearms issues, instead of on what causes people to commit these horrible crimes. The key element in these shootings is the mental condition of the killers and what things fostered their desire to kill people, and that must be addressed.

Whatever Congress comes up with will certainly put the liberties and privacy rights of Americans at risk, as limits on 2nd Amendment rights and invasions of private medical information will necessarily be under consideration.

We will not reduce mass shootings by limiting what law abiding gun owners can purchase, since they won't use them to hurt other people. Vice President Joe Biden's insulting implication that people don't really "need" an AR-15, and just want one because of how it feels ignores a basic tenet of the nation that elected him: we have personal liberties here, and that's all the reason we need to buy any gun.

Similarly, a blanket denial of 2nd Amendment rights to those with any record of treatment by or consultation with mental health professionals is excessive.

There has been strong support for the idea that guns, high-capacity magazines, etc. are responsible for mass shootings and should be restricted or banned, but that support is waning. More important is that this truly misses the point, and basing policies on missed points is a prescription for failure.

And now there is more compelling evidence that banning or restricting guns or magazines won't work, and even will make things worse, and it comes from a group that has instant credibility on this issue: police officers.

In March, PoliceOne, which serves police officers across the nation and has more than 450,000 registered members, "conducted the most comprehensive survey ever of American law enforcement officers’ opinions on the topic gripping the nation's attention in recent weeks: gun control," so states the introduction to PoliceOne's report.

"More than 15,000 verified law enforcement professionals [70 percent of whom are field-level law enforcers who are face-to-face in the fight against violent crime on a daily basis] took part in the survey, which aimed to bring together the thoughts and opinions of the only professional group devoted to limiting and defeating gun violence as part of their sworn responsibility," the introduction noted, in discussing the nearly-thirty question survey.

Here are some of the takeaway points from that survey:
** Ninety-five percent said that a federal ban on manufacture and sale of ammunition magazines that hold more than 10 rounds would not reduce violent crime.
** Seventy-one percent said that a federal ban on the manufacture and sale of some semi-automatics would have no effect on reducing violent crime. And, more than 20 percent say any ban would actually have a negative effect on reducing violent crime.
** Roughly 85 percent said passing the White House’s currently proposed legislation would have zero or a negative effect on their safety.
** They cited things they felt would help prevent mass shootings: more permissive concealed carry policies for civilians, 28 percent; more aggressive institutionalization for mentally ill persons, 19 percent;
more armed guards/paid security personnel, 15 percent.
** Nearly 90 percent believe casualties would be decreased if armed citizens were present at the onset of an active-shooter incident.
** More than 80 percent support arming school teachers and administrators who willingly volunteer to train with firearms and carry one on the job.
** More than half of respondents feel increased punishment for obviously illegal gun sales could reduce gun violence.
** The officers were about evenly split on whether citizens should be required to complete a safety training class before being allowed to buy a gun.
** They believe that cultural/societal influences promote gun violence: violent movies and video games, 14 percent; early release and short sentencing for violent offenders, 14 percent; poor identification/treatment of mentally-ill individuals, 10 percent. However, 38 percent cited a decline in parenting and family values.

The majority plainly does not support the ideas being pushed by gun-control advocates favoring restrictions on weapons and magazines, and many feel those controls will negatively affect their ability to fight violent crime. They also support enforcing existing laws before passing new ones.

The mainstream media openly supports restrictions on personal liberty, at least where guns are concerned, and suppresses news of gun owners stopping crimes. Many of our elected public servants, who prefer an unarmed and therefore compliant populace, also support gun control.

But the majority of police surveyed overwhelmingly favor an armed citizenry, would like to see more guns in the hands of responsible people, and are skeptical of any greater restrictions placed on gun purchase, ownership, or accessibility.

Police officers patrolling America’s streets have a legitimate interest in making sure that we make decisions about guns that support their work and do not make things worse. With this survey, their voice has been heard, and they disagree with the current mania.

Perhaps it would be smart to listen to them.