Survey finds that 93 percent of hospital executives think Obamacare will improve systems and save costs

While there has been much grumbling about federal health reform, at least one very affected group of people think it's a great idea. A survey by Health Affairs found that 93 percent of hospital executives believe the Patient Protection and Affordable Care Act will make health care better, and cheaper, Ezra Klein reports for The Washington Post.

The magazine surveyed 74 senior executives at hospitals that had an average of 8,520 employees, and annual revenues of $1.5 billion, Klein reports. The survey found that 65 percent felt that by 2020 "the healthcare system as a whole will be somewhat or significantly better than it is today," and "93 percent predicted that the quality of care provided by their own health system would improve. This is probably related to efforts to diminish hospital acquired conditions, medication errors, and unnecessary re-admissions, as encouraged by financial penalties in the ACA." (Health Affairs graphic)

Executives also responded to favorably to other questions about reform, with 91 percent forecasting "improvements on metrics of cost within their own health system" and "85 percent expected their organization to have reduced its per patient operating costs" by 2020, Klein writes. "Overall, the average operating cost reduction expected was 11.7 percent, with a range from 0 percent to 30 percent. Most executives believed they could save an even higher percentage if Congress enacted legislation to accelerate the shift away from fee-for-service payment toward models like bundled payments. In such a case, the executives projected average annual savings of 16.0 percent, which, if applied across the healthcare system, would amount to savings of nearly $100 billion per year."

Respondents said savings can be achieved "through a combination of greater administrative efficiency, price reductions, and reduced reliance on hospital services," Klein reports. About 54 percent said this can be done by reducing the number of hospitalizations, 49 percent by reducing, re-admissions, 39 percent by reducing emergency room visits, 36 percent by reducing costs for medical devices, 27 percent by reducing costs for drugs, and 23 percent by improving office efficiency.

About 31 percent of respondents said another goal is to set "a specified timeline for transitioning Medicare reimbursement off of the fee-for-service payment system as a policy change that would facilitate cost control," Klein writes. "Another 30 percent supported aligning payment policies between Medicare and private insurers, and 28 percent supported separating funds for training and research from Medicare payment and maintaining current funding levels." (Read more)

Life Lessons from Cancer encourages those with cancer to build a network of support

By Melissa Patrick
Kentucky Health News

The fight against cancer requires not only a personal commitment to mind, body and soul; it also requires the support and physical help of family and friends.

That's one of the key messages in Life Lessons from Cancer, a book written by cancer patient Keen Babbage and his sister-in-law and caretaker, Laura Babbage.

Keen, a teacher and native Lexingtonian who has written 17 books about education, said at the first promotional event for the book in October, that he hopes the lessons in this book will be an inspiration and guidance for other patients with cancer as well as a resource for health-care providers.

Kentucky has both the highest rate of new cancers as well as the highest death rate for all cancers in the U.S., according to a report from the Kentucky Cancer Consortium. With a 2013 census report saying 27 percent of Americans live in one-person households, many cancer patients are likely fighting this battle largely alone.

Keen was one of those.

Two days after he was diagnosed with a rare form of nasal cancer, in October 2010, he began an aggressive, three-month regime of radiation and chemotherapy at the University of Kentucky Markey Cancer Center.

His mother died of widespread abdominal cancer after his first round of chemotherapy. As she lay dying, Laura promised her that she would look after Keen.

Here's a video clip of the authors talking about the book at UK:
With great insight, Keen knew he couldn't battle cancer by himself and immediately set about building a network of people who could support him both physically and emotionally. He even enlisted the love and affection of Laura's family dog. "Cancer, we have learned, declares war," Keen said at the promotional event. "It's not a battle, it's a war."

This cancer-fighting network, according to Keen, must not only include family, but also friends and your faith community if you have one. "Put together a network and never let it go, " Keen said at the promotional event.

When building this network, Keen advises in his book that "this is the time to abolish, delete, overlook and eliminate any animosities or disagreements."

Cancer patients' needs are many. Physically, they need help with shopping and food preparation, caring for pets, laundry, cleaning, transportation, making appointments and keeping up with insurance to name a few. Emotionally, they need support that comes with companionship and encouragement.

There are times cancer patients can't leave home or the hospital for long periods; it is in these times that life must come to the patient, Keen writes.  It is only with the help and support of others that this can happen.

You must fight with every possible resource available to you, including prayer. "When someone is praying for you, it means you are not alone," Keen writes.

In response to a question about how to battle depression at the promotional event Keen said, "Small victories.  Hold onto what you believe, hold onto the people you love, eliminate every limit, find something to look forward to that can be done and then realize that it is done with a multitude of people. An individual might feel discouraged, depressed, regret. Surround yourself whenever possible with a lot of people."

Keen and Laura at Bluegrass
10,000 race, July 2011

Laura Babbage is a registered nurse who has worked as a health-care executive and is a chaplain for both UK HealthCare and St. Joseph Hospital.

Laura maintained a website on CaringBridge.com during Keen's treatment to keep family and friends informed of his condition, care and needs. The entries are included in the book and are both forthcoming and explicit. They also offer insight into the role of the caretaker.

"The caretaker needs care as well," Laura said at the promotional event. "Caretakers need to recognize their limits" and put systems in place to make sure the patient is being cared for while also taking care of themselves, she said.

Life Lessons from Cancer offers insight and encouragement to those battling cancer as well as the caregiver. It is full of lessons that not only apply to those who have cancer, but can also be applied to life.

One of the sayings for which Keen is known is his message to his students at Henry Clay High School: "Read. Read More. Keep Reading."

His motto while battling cancer came to him in a card from one of his students: "Fight. Fight more. Keep fighting."

Here are the basics of buying health insurance on the state exchange that opens Tuesday

On Tuesday, Americans can begin buying health insurance through state exchanges created by federal health reform. Journalists have spent months trying to understand the reform law in an attempt to explain it to their readers, but unraveling the act can be a confusing and tiresome process. With open enrollment knocking at the door, Trudy Lieberman of Columbia Journalism Review asked for advice from Elisabeth Benjamin, a vice president at the Community Service Society in New York, which runs an insurance counseling program. She suggests looking at enrollment as a four-step process that she hopes will make the process easier for people. 

Step 1 is looking at the health insurance buying cycle, Lieberman writes. Initial enrollment is from Oct. 1 through March 31, and can be done at HealthCare.gov. Those eligible include anyone who doesn't have employer coverage, Medicare, Medicaid, or the Children’s Health Insurance Plan, also known as children's Medicaid. Kentuckians can also enroll at the state health insurance exchange, Kynect, by clicking here. Questions about the act can be directed to a call center at 1-855-459-6328 from 8 a.m. to 7 p.m. Monday through Friday, and Saturday from 9 a.m to 4 p.m.

Read more here: http://www.kentucky.com/2013/09/29/2850843/answers-to-frequently-asked-questions.html#storylink=cpy

Step 2 is the mechanics of enrolling, which includes having an email account and information about your household, residency, immigration status and income, which will let people know what insurance they qualify for, Lieberman writes. "People with employer-provided insurance may still need to visit the exchange to see if they’re eligible for exchange coverage. Employers with more than $500,000 in annual sales that offer group coverage must give all workers a document that tells them about the existence of the exchanges, and the premium that a worker would pay for the lowest-priced plan the employer offers for single coverage. This form lets workers know if their employer coverage is affordable according to the government. If it isn’t, they can shop in the exchange and receive a subsidy. Their families, however, cannot receive a subsidy."

Once a person has entered the information, he or she will find out how much of a subsidy they can get, Lieberman writes. Subsidies can either be applied to each insurance payment, which means lower monthly costs for coverage, or the purchaser can wait and collect it at the end of the year like a tax refund. Kentucky has five providers: Anthem, UnitedHealthcare, Humana, Bluegrass Family Health and the Kentucky Heath Cooperative. Not every company is offering a policy in every area of the state. Rates will be available starting Tuesday.

Read more here: http://www.kentucky.com/2013/09/29/2850843/answers-to-frequently-asked-questions.html#storylink=cpy

Step 3 is choosing a policy from options given the names of precious metals. "The platinum policies not offered on some exchanges cover about 90 percent of someone’s medical costs; the gold plans 80 percent; the silver 70 percent; and the bronze 60 percent," Lieberman writes. "As a point of reference, the gold plan is basically the old Blue Cross model that most Americans had for the last four decades and was considered good coverage." From there, people have to decide, "Do they want to pay a high premium up front in return for lower co-pays; a set amount for a service; lower coinsurance; a percentage of the bill; or, a lower deductible?"

The premium is calculated on four factors: age, where you live, how many people are on your policy and whether you use tobacco. Depending on the state, tobacco users can face a surcharge of up to 50 percent; Kentucky's is 40 percent.

Read more here: http://www.kentucky.com/2013/09/29/2850843/answers-to-frequently-asked-questions.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/09/29/2850843/answers-to-frequently-asked-questions.html#storylink=cpy

The final step is finding and reading the disclosures, which is something consumers have to take the initiative to find on their own, Lieberman writes. "Shoppers can find out about the policy elements, deductibles (and what they apply to), coinsurance and co-pays for different services (especially common ones like diagnostic tests and outpatient surgery), amounts for different services, and fees. It also spells out some services that are not covered and provides sample charges for common conditions." (Read more)

People who don't sign up for insurance will face a fine of 1 percent of their annual income, or $95, whichever is higher. The fee increases every year. There also is a penalty for not providing coverage for children. (Read more)