Columns & Blogs

Gee, what could go wrong here? State offers bounties in python hunt

12/06/12 Palm Beach Post

Columnist Frank Cerabino has great fun with the state's latest idea, a big snake hunt. Amateurs can watch an online video to learn how.

FL and other stubborn states ready to forfeit billions

12/05/12 Our Health Policy Matters

The states that are leaning against expanding Medicaid, including Florida, are the ones that already have built a reputation for neglecting the health of their citizens.

Reluctant states should go for federal exchanges

11/28/12 Our Health Policy Matters

Consultant Paul Gionfriddo writes that states with a history of underspending on residents' health will have a lot of freedom shaping benefits – perhaps for worse – if they take on state exchanges instead of deferring to the federal government. 

2 small steps coud fix Medicare long-term

11/20/12 Our Health Policy Matters

Consultant Paul Gionfriddo writes that if Medicare beneficiaries gave a little on benefits and workers gave a little more to withholding, it would be easy to close the gap for good.

The Drs. Patel know how to think big—really big

11/18/12 Tampa Bay Times

Columnist Daniel Ruth writes about Drs. Kiran and Pallavi Patel, who are building an opulent set of mansions totalling 63,000-square-feet for their extended family on 17 acres in Tampa.

Health-spending cuts should take aim at waste

11/13/12 Medscape's Care & Cost Blog

Consultant Brian Klepper of Fernandina Beach says 30 to 55 percent of health spending is bloat that pays for too much of the wrong things.

Anti-science party loses credibility—and election


Dr. Marc Yacht writes that anti-government, anti-science, anti-health reform extremists in the Republican Party simply frightened away the electorate.

What a relief! The campaign is over

11/07/12 Florida Voices

Columnist Florence Snyder says the campaign "hype and tripe" is being generated at the expense of genuine news reporting.

Preventing ‘health care Armageddon’

11/07/12 Our Health Policy Matters

Consultant Paul Gionfriddo writes that "health care Armageddon" can still happen, but not if low health care inflation continues to change the picture of health policy. 

An election wasted: Demagogues appeal to selfishness

10/31/12 Our Health Policy Matters

Consultant Paul Gionfriddo writes about the conversations we should have had on jobs and Medicare and much else during this wasted campaign.

Aging doctors find bonanza in FL pill mills

10/29/12 Reporting on Health

Former investigative journalist, now a blogger, William Heisel notes that after a pressure-filled career, some doctors gravitate to Florida pill mills to make more than a million dollars a year just for signing their names.

Health-sector waste threatens U.S. economic security

10/28/12 Medscape's Care & Cost Blog

Fernandina Beach-based health consultant Brian Klepper says that overspending and blatant waste can go on no longer, but the industry isn't yielding, which means we're in for an ugly fight.

One doc has a fresh perspective on ‘ObamaCare’

10/26/12 Palm Beach Post

Columnist Frank Cerabino writes that one doctor with throat cancer sees "ObamaCare" differently after learning he'd be taken off the reject list when looking for insurers.

Gov. Scott, don’t play politics with Floridians’ health

10/21/12 Special to Health News Florida

Dr. Marc Yacht, retired Pasco County Public Health Director, offers a long list of reasons why this state needs ObamaCare more than most.

Stop discrimination against those with mental illness

10/17/12 Our Healthy Policy Matters

Consultant Paul Gionfriddo says psychologists aren’t reimbursed nearly enough to treat those with mental illness, and the expansion of Medicaid under the ACA that would have given coverage to many is being blocked by several states.

Stop politicizing breast cancer

10/14/12 Miami Herald

Miami Herald's Andrea Torres, a breast cancer survivor, tells the story of a young mother who is dying, contrasting her courage to the shabby politicization of the issue by opportunists.

FDA warned Congress about compounding pharmacies

10/14/12 Ocala Star-Banner

Managing Editor Tom McNiff writes that it's a bit rich for Congress to be outraged about the source of the fungal meningitis outbreak, after ignoring repeated warnings.

Are Medicare cuts avoidable?


With a budget crisis looming in Medicare, consultant Paul Gionfriddo says action is clearly needed. But cuts -- either Obama's or Romney's -- aren't the only answer.

Fan of flossing has lots of time for it

10/07/12 Palm Beach Post

Columnist Frank Cerabino says that in observance of National Dental Hygiene Month, jail inmate Joel Flores is suing the sheriff for failing to provide dental floss.

Luvs enters the breastfeeding-in-public fray

10/07/12 Miami Herald

Columnist Ana Veciana-Suarez says many are congratulating the diaper company for casting public breastfeeding in a positive light. But many still want women to hide in a closet or under a blanket.

Hospital records: works of fiction?

10/07/12 Sarasota Herald-Tribune

Columnist Tom Lyons says he's finding lots of cases in which ER records don't match reality -- like the woman who was said to be "ambulatory," picked up by her husband, when she had a broken ankle and her husband is long dead.

How insurer punished my patient for being a woman

10/05/12 Tampa Bay Times

Dr. Mona Mangat writes about a patient who now faces $30,000 in bills for surgery because her insurer said menopausal bleeding episodes were evidence of a pre-existing condition.

FL must remove barriers to HIV testing

10/03/12 Florida Times-Union

A doctor writes that a patient could have been saved, but by the time they knew her HIV status, it was too late. Her case underscores the many shortfalls of Florida's policies when it comes to HIV.

Scott says no to $8B, leaving the rest of us to pay for uninsured

10/02/12 Our Health Policy Matters

Health consultant Paul Gionfriddo says Gov. Scott's dislike of the health law means the taxpayers of Florida will have to come up with the $8 billion he's turning down for Medicaid expansion.

Primary care providers need to unite

10/02/12 The Doctor Weighs In

Health policy analyst Brian Klepper of Fernandina Beach outlines a structure that would pull the fractured caregivers together into a strong "congress" with  more influence.

Duval health director was ‘fall guy’ for DOH

09/28/12 Florida Times-Union

State Sen. Audrey Gibson, D-Jacksonville, faults Department of Health and the Scott administration for the mismanaged communications on the TB outbreak.

The wrong battles

09/20/12 Care and Cost

Consultant Brian Klepper writes that pitting physicians and nurse practitioners against each other won’t solve the problems in primary care.

Sorting out facts on future of Medicare

09/18/12 Florida CHAIN

The  advocacy group Florida CHAIN says a lot of nonsense is being spouted about both the Affordable Care Act and the Medicare "premium support" proposal.

Advisory board is not about rationing, and Ryan knows it

09/17/12 Tampa Bay Times

Columnist Robyn Blumner explains what the Independent Payment Advisory Board will do, and how far that is from the way Paul Ryan has painted it.

Jeb Bush: Expanding Medicaid isn’t the answer

09/14/12 USA Today

Medicaid is dysfunctional and costly. Instead of an exponential expansion, the former governor writes, why not allow states to implement consumer-driven options that could be less costly with better health outcomes?

Romney’s claim about private-plan savings isn’t so

09/14/12 Washington Post

The fact-checking team looked at Romney's claim that taxpayers would save money if more seniors enrolled in private Medicare Advantage plans.

Haley Marie survives, thanks to government-funded project

09/12/12 Our Health Policy Matters

Health consultant Paul Gionfriddo welcomes his granddaughter into the world, all 2 pounds, 11 ounces of her, and notes that neonatal intensive-care units would not be here if it were not for taxpayer dollars.

Finally, Democrats defend health care act

09/06/12 Tampa Bay Times

Two years after passage of the Affordable Health Care Act, during which Republicans have freely trashed it and soured public opinion, the Democrats are finally speaking up.

GOP forgets to mention its $16-trillion sop to seniors

08/30/12 Managed Care Matters

Consultant Joe Paduda says the political party that claims to be fiscally responsible forfeited that title when a Republican Congress and president passed the Medicare drug plan; it added more to the deficit than the Affordable Care Act.

Planned Parenthood a lifesaver for cancer patient

08/30/12 Tampa Tribune

Joe Henderson writes about Susan McPartland, who, with a small sign outside the GOP convention, is letting Republicans know that Planned Parenthood saved her life through a mammogram.

Ryan’s speech exaggerates Medicare threat

08/30/12 PolitiFact

Paul Ryan’s comments about Medicare Wednesday night were highly misleading. Neither President Obama nor the health-care law literally cut funding from the Medicare program’s budget.

Worst state for health: Oklahoma

08/29/12 Our Healthy Policy Matters

Paul Gionfriddo writes that the three worst states in the country for health all have all rejected a Medicaid expansion. While Florida escaped the bottom of the list overall, it ranked 43rd for how it directs its current Medicaid funds.

Health law claim in RNC speech ‘mostly false’

08/29/12 PolitiFact

PolitiFact ruled that a former Democratic congressman’s comment during the Republican National Convention that the health law requires people to purchase insurance even if they can’t afford is “mostly false.”

Schools can help end hunger

08/28/12 Tampa Bay Times

Bill Maxwell writes that Americans should be ashamed that some 16 million children regularly go to school with empty stomachs. Many teachers are using their own money to help their hungry students, but the the bipartisan Child Nutrition Improvement and Integrity Act should help with funding.

PolitiFact: What you’ll hear at the convention

08/28/12 PolitiFact

As the Republican Convention begins tonight in Tampa, many things will be said about the current administration regarding everything from the economy to health care. How many of them are true?

Best state for health? Not FL

08/22/12 Our Healthy Policy Matters

Paul Gionfriddo writes that while Florida leads in Medicare billing for elder care, the state ranked 33rd for overall health.

Scott backs Surgeon Gen. into corner with Docs vs. Glocks

08/08/12 Special to Health News Florida

If you enjoyed watching the Scott administration botch the TB outbreak, Dr. Marc Yacht writes, stay tuned for its next mess: the appeal of Docs vs. Glocks.

Patients must be protected from abuse at brain-injury center

07/30/12 Florida Voices

Rosemary Goudreau, editor of Florida Voices, says the governor should immediately appoint a monitor to the brain-injury facility in Wauchula, where patient abuse is horrific. Part of the problem is fragmentation of responsibility among three health agencies.

FL reporters got it wrong on Medicare cuts

07/27/12 Columbia Journalism Review

CJR columnist Trudy Lieberman says that Miami Herald reporters added to seniors' suspicion of the health law by getting the facts wrong.

Elton John chides FL’s chintziness on AIDS funding

07/19/12 Palm Beach Post

Columnist Frank Cerabino says Florida's health funding plan appears to be inviting rock stars to do charity concerts.

With no TB hospital, maybe Publix could spare one of its stores

07/11/12 Palm Beach Post

Frank Cerabino writes that since the state has given Publix tax credits to remodel its stores, maybe the grocery chain could donate one to take in contagious, homeless TB patients.

Make Medicaid expansion a deal states can’t refuse

07/10/12 Our Health Policy Matters

Health consultant Paul Gionfriddo suggests that the court decision leaves room for Congress to encourage states to cover the poor by, say, cutting balkers' payments by 1/4 of 1 percent.That would cost states more than they'd pay to expand Medicaid

Scott’s falsehoods show he’s blinded by the Right

07/09/12 Orlando Sentinel

Former State Rep. Dick Batchelor says Gov. Rick Scott keeps misleading the public about the Affordable Care Act, placing many of Florida's poorest citiens at risk of going without health care.

Medicare doctor pay is a mess that we must fix

07/08/12 Care and Cost

Consultant Brian Klepper says former federal health chiefs from both parties agree the AMA-run process for setting doctor pay is wildly flawed, yet no one has the political will to fix it.

Why is no one shocked at pimping of foster kids?

07/02/12 Miami Herald

Fred Grimm said he can't understand why no one noticed that four of six teen-age kids in one foster home were turning tricks instead of going to school.

Ruling won’t come close to fixing a sick system

06/25/12 Palm Beach Post

Randy Schultz writes that however the Supreme Court rules on the health law, what happens at the polls will matter less than what happens in doctors’ offices.

Public health losing jobs, insurance bureaucracy grows

06/19/12 Our Health Policy Matters

Health consultant Paul Gionfriddo writes that public health, which has doubled our life expectancy over the last century, accounts for just 3 percent of our nation's health spending, while insurance administration is 6 percent and growing.

DCF paid hush money in sex case

06/13/12 Florida Voices

Florence Snyder writes about how a political appointee at Dept. of Families and Children sexually harassed an office chief who will now collect $150,000 from taxpayers.

UN declares Florida a ‘rogue state’ (satire)

06/13/12 Borowitz Report

Humorist Andy Borowitz writes that the United Nations, upset with FL Gov. Rick Scott's purge of voter rolls, may dispatch a team of observers from such democracies as Egypt and Libya.

Study shows dramatic abuse of opioids in workers’ comp

06/06/12 Managed Care Matters

Workers' comp expert Joe Paduda says there really is no rationale for doctors to prescribe narcotics -- intended for breakthrough pain in cancer cases -- for short-term injuries.

Environmentalists win victory on fertilizer bans


Nursing-home care at risk


Backing away from the MRSA crisis


Health care reform package a major step forward for U.S.


Florida KidCare is key to kids’ health, our state’s future


Keep hope alive: Fund cancer research


Brit says: Congratulations on health reform! About time


Why does Florida allow pseudoscience?


How you can be a better patient


Obama’s private doctor army? Really?


Elder-care housing must improve ratings to compete


Health care bill of rights needed


A child’s life could depend on you


‘We are the people’s health care system’


Strength through advocacy


Health law will be costly for Floridians


Medicare recipients know they’ll pay


McCollum exaggerates Medicaid burden


Price, politics propel GOP rush to transform Medicaid


At end of life, somebody decides, but are they right?


Priest was protected, not the children


How the health-care law will affect you


State workers wear a bull’s eye


Don’t hurt those with kidney disease


Greer scandal shows GOP cares about coverage: their own


Heath reform galvanizes both left and right


Mica-Kosmas duel on health care legislation


Red light or green light for traffic cameras?


Pay cuts to doctors will hurt seniors


FDA policies threaten innovative drugs


AARP explains its support of health-reform bill


GOP, condemn the violence


Florida tried to reform health care and flopped


Looking for humor in the health-care debate


Newt should know better


Health reform has champs, chumps


When will we know if health reform worked?


Taking health care reform to next step


How much is that lawsuit costing Florida?


He has a healthy interest in our votes


This bill is truly bad


Medicare was bitterly opposed at first


McCollum’s health-care suit: savvy or risky?


Health bill scores A- on cost containment


Grayson makes cable TV host look like a fool



Medicare doctor pay is a mess that we must fix

By Brian Klepper
7/7/2012 Care and Cost 

On May 10th, the US Senate Finance Committee, co-chaired by Senators Max Baucus (D-Mont) and Orrin Hatch (R-Utah) convened a remarkable panel of four former Administrators of the Health Care Finance Administration (HCFA) and the Centers for Medicare and Medicaid Services (CMS): Gail Wilensky, Bruce Vladeck, Thomas Scully and Mark McClellen. (See the video here.) Against a backdrop of intensifying budgetary pressures, the roundtable was to provide perspectives on Medicare physician payment, including several controversial issues: the Sustainable Growth Rate (SGR) formula, the Resource-Based Relative Value Scale (RBRVS), and the RVS Update Committee (RUC). 

Ironically, the day before, a Maryland Federal District judge dismissed a suit brought against HHS and CMS by six Augusta, GA primary care doctors over CMS' longstanding relationship with the RUC, based on a procedural technicality and without weighing the substance of the complaint. The physicians challenged CMS' refusal to require the RUC to adhere to the public interest rules of the Federal Advisory Committee Act (FACA) that typically apply to federal advisory bodies. The suit described the harm that has accrued to primary care physicians, patients and purchasers as a result of the RUC's highly politicized process. To a large extent, the plaintiffs' concerns closely reflected those of the former CMS Chiefs. 

This was a deeply experienced and dedicated group, all with long government-involved careers. Surprisingly, independent of their divergent political perspectives, there was broad agreement on the direction that physician payment should go. All believe we need to move away from fee-for-service (FFS) reimbursement and toward alternative reimbursement paradigms, like capitation or bundled payments. All agreed that FFS would likely remain present in various forms for many years. There was a general sense that the RBRVS system was built on a series of errors, and that CMS' relationship with the RUC started off, to use Dr. Wilensky's term, "innocently enough," but has become increasingly problematic over time.

 Here is Dr. Wilensky's description of how the CMS-RUC relationship came about.

 It [the RUC's formation and relationship with HCFA] happened innocently enough. Once you had the Relative Value Scale in place you needed to have a way to update relative values and to allow for a change. The AMA, as best we can tell...- sometime after I left to go to the White House, after he -[Bruce Vladeck] was sworn in, there was a lot going on, it was relatively new, in its first year - the AMA approached the Agency about whether it would allow it or like to have the AMA be the convener that would include all physician groups and make some recommendations which initially were very minor adjustments that hardly affected the RBRVS at all. The Agency accepted the offer.

Tom Scully, CMS' Administrator under George W. Bush, took responsibility for helping facilitate the AMA's involvement and was perhaps the most passionate that it had been an error.

One of the biggest mistakes we made ... is that we took the RUC...back in 1992 and gave it to the AMA. ...It's very, very politicized. I think that was a big mistake...When you go back to restructuring this, you should try to make it less political and more independent.

I've watched the RUC for years. It's incredibly political, and it's just human nature...the specialists that spend more money and have more time have a bigger impact...So it's really, it's all about political representation, and the AMA does a good job, given what they are, but they're a political body of specialty groups, and they're just not, in my opinion, objective enough. So when you look at the history of it, CMS is starting to push back more, which is a good thing, I think it would be much better to have an arms-length transaction where the physician groups have a little more of an objective approach to it. And, look, that is the infrastructure of $80 billion of spending. It's not a small matter. It's huge.

But perhaps the most striking statement was made by Bruce Vladeck, HCFA Administrator during the Clinton Administration. In speaking about the problems generated by RBRVS (and by inference, the broader issues of SGR and the RUC as well) in the face of severe budgetary pressures, he called for the leadership and will required to simply do the necessary course correction.

In a policy environment less susceptible to influence and more responsive to real world problems, the gravity of consensus on display at this roundtable would justify a call to action. As it was, it validated what many know: that we are rushing headlong down a catastrophic path, steered by forces other than reason and responsibility. The best we can hope for is that someone with authority and courage is listening.