Dr. Brian Casull’s Blog
WELCOME TO THE AMERICAN HEALTH CARE GAME OF BASEBALL
Healthcare is not a “system” in the United States. Rather it is like a game of baseball where your perceived and actual coverage is determined in large part by where you sit in the ballpark of healthcare.
Read my posts below to discover … learn … realize … understand what you can do about
American Healthcare in Transition.
Decision Makers
The DECISION MAKERS ... Are you listening? Previously in my POSTSCRIPTS for the Consumers and Providers, I mentioned that we have come full cycle to the place where I as a Physician Executive will ask some questions. But this time my comments will be directed to the DECISION MAKERS of our FOR-PROFIT HEALTH CARE INSURANCE MODEL. Do not consider American health care in transition in the current vacuum in which previous tectonic plates were conceived. In other words, remember the Prime Directive! NO DECISION MAKER IN THE ROOM SHOULD KNOWINGLY INTERFERE WITH THE NATURAL PROGRESSION OF AMERICAN HEALTHCARE IN TRANSITION [...]
Providers of Healthcare
There's the ‘first’ party — the PROVIDER who provides the service. Are You Listening? As I said in the first POSTSCRIPT for the Consumer of Healthcare, now we have come full cycle to the place where I as a Physician Executive will ask some questions. This set of information is only for you the “first party” of our FOR-PROFIT HEALTH CARE INSURANCE MODEL. THE PROVIDERS OF HEALTHCARE. Physicians could recapture the moral high ground and advocate for equitable access to patient-‐centric care. A career in medicine makes physicians uniquely able to see how tragically easy it would be to [...]
Consumers of Healthcare
There's a second party, the CONSUMER OF HEATHCARE, who receives the service. Are You Listening? Now we have come full cycle to the place where I as a Physician Executive will ask some questions. This set of questions is only for you the “second party” of our FOR-PROFIT HEALTH CARE INSURANCE MODEL. The generally disenfranchised participant of our Healthcare Insurance Model. Do you know where you sit in our health care ballpark? Are you aware of the TECTONIC PLATES are at your feet? How does the COST of the FOR-PROFIT [...]
Recommended Resolutions For Our Current Healthcare Issues
This week Poppy Tweets: “At the end of the day, think out of the box!”In last week’s blog, I reviewed the Healthcare issues you may not be aware of. This week I offer my suggested resolutions.First of all, no decision maker in the room should knowingly interfere with the natural progression of American Healthcare in Transition:Don’t be the victim of hear-say and evidence of that ilk.It is like the placebo effect in medical research.These data results are false.There is an actual hierarchy of proof.So what should we do to repair this “American Healthcare in Transition”? Here are my suggestions:1. [...]
Healthcare Issues You May Not Know About
Poppy Tweets: "Watch out for those other tectonic plates ... the out-of-your-control occurrences in today's American Healthcare System." In the American Healthcare “system”, these are the tectonic plates with caprice ebbing and flowing (the ground moving under our feet) which lead to earthquakes. Here is my list of these "tectonic plates" issues that you may -- or more importantly -- may NOT know about ... making your health care at risk: ADMISSION or OBSERVATION: Decided by the “Two-Midnight” Rule. This refers to the likelihood that without a higher level of care, the patient’s health and safety would be compromised. “ALL-CAUSE” HOSPITAL READMISSION REDUCTION PROGRAM: Any [...]
Changes are Coming to the Affordable Care Act (ACA) – What is at Stake?
Poppy the Cockatoo tweets about the ACA : “I’m hiding here because the feathers are going to hit the fan.” When the Affordable Care Act was enacted, its purpose was to: Improve affordability and accessibility Oversee, coordinate, and govern the many pieces in play It did, and it didn’t. What it did do was: Stretch across both the private and public payor structure Add more Americans to the roles of the insured Bring controversy and the immediate call for repeal and replacement “So what happens now -- what is at stake?” PRE-EXISTING CONDITIONS - Short term insurance policies and other [...]
Addressing Current Concerns of the Healthcare Consumer
Poppy tweets “I’m worried about losing my treats!” 1. LOSING MEDICARE AND MEDICAID-DEFICIT REDUCTION MASQUERADING AS HEALTH CARE REFORM HUMANS are worried about $554 billion in cuts to Medicare as this impacts you the 55 million Americans who are over age 65 or living with disabilities. This impact may be felt through decreased access to healthcare providers. The greatest impact would appear to be on the cost of prescription drugs. The cost of Medicaid expansion has led to calls for BLOCK GRANTS to replace the Federal portion of Medicaid coverage. Opponents argue that this will decrease access to care. [...]
The Big Picture-The Current American Healthcare in Transition Model
POPPY THE COCKATOO TWEETS HEALTHCARE: “Hi. I am Poppy and I am a Cockatoo. My human has asked me to introduce the subject.” The Big Picture Today, the for-profit health insurance model drives american healthcare in transition (non-profits make money, they just don’t share it with stockholders). This model is broken! What does the model look like? It is a three- party system. There's one party — the provider who provides the service Have their own master list of charges for different services Different from provider to provider There's a second party — the patient, who receives the service. [...]
HEALTH CARE CONSUMER’S CONCERNS ABOUT THE AFFORDABLE CARE ACT — THE LAW OF THE LAND (Part C)
In my two previous posts, I wrote about the Affordable Care Act (ACA) and about the three components of that major driver of consumer concern. In this blog we will continue to discuss the tectonic plates which remain and discuss the potential for dying due to the lack of health care coverage. TAX PROVISIONS [1] The ACA levies hefty taxes on pharmaceutical manufacturers, medical device manufacturers, health insurers, and wealthy citizens. These taxes have been helping to pay for the law's coverage expansions and such expenses as the Center for Medicare and Medicaid Innovation (CMMI). Similarly, the ACA reduced [...]
HEALTH CARE CONSUMER’S CONCERNS ABOUT THE AFFORDABLE CARE ACT — THE LAW OF THE LAND (Part B)
This blog begins where the PART A left off as we continue to walk through the various provisions of the ACA and how repeal might impact you the health care consumer. OTHER INSURANCE MARKET REFORMS PROVISION INSURERS MUST PROVIDE SERVICES IN TEN ESSENTIAL BENEFIT CATEGORIES ESSENTIAL HEALTH BENEFITS WHAT: TEN CATEGORIES OF SERVICES health insurance plans must cover under the Affordable Care Act. Specific services may vary based on each State’s individual and particular requirements. [1] [2] [3] [4] [5] LIFETIME OR ANNUAL PAYMENT LIMITS WHAT: “Insurers are prohibited from limiting the amount of health care dollars for these [...]