SEPTEMBER 2017  INSIGHT

Over the years our firm has periodically sent out a newsletter to advise our clients and friends about recent changes, trends and happenings in the healthcare field.  We are pleased to share the August issue of our newsletter with you.  Periodically, we will do our best to share with you "insight" that we find helpful in our practice and that should be helpful for you in yours. 

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Sincerely,
Jay B. Umansky
The Law Offices of Jay B. Umansky PC
jumansky@stllaw.net 

NEWS WORTHY NOTES AND OPINIONS 

As 2018 Obamacare deadline nears, U.S. states believe every county covered

By Caroline Humer 
Reuters
September 27, 2017

Washington (CNN)Senators may seek a bipartisan compromise next month on health care reform. President Trump hits the road to plug tax reform. And comments by a GOP elder may complicate Trump's trip to Missouri.

It's all part of this week's "Inside Politics" forecast, where you get tomorrow's headlines today.NEW YORK (Reuters) - U.S. states have negotiated to the bitter end to keep health insurers selling Obamacare plans in every county next year, in some cases taking a hard-line to prevent exits that leave residents without access to health coverage.

But states cannot rule out a last-minute pullout by an insurance company.

Insurers must sign government contracts detailing where they will offer 2018 coverage by midnight on Wednesday. In recent months, dozens of U.S. counties risked having no insurer offering subsidized individual insurance next year after national players including Anthem Inc, Aetna Inc and Humana Inc announced plans to pull out.

Many insurers have lost money on their Obamacare business. Others fear exposure to a program targeted by President Donald Trump and the Republican-controlled Congress for repeal. Trump has also threatened to cut billions in subsidy payments to insurers to undermine predecessor Barack Obama's healthcare law.

Still, insurance commissioners in Republican-leaning states such as Tennessee, Missouri, and Virginia spent months negotiating with insurers to see who might pull out of their markets and either convince them to stay, or find a replacement.

By Tuesday, it appeared they had succeeded in keeping every county covered in all states. But individuals will still face challenges. Nearly half of U.S. counties have no choice, with only one insurer offering individual plans. And many insurers filed price hikes of 20 percent or more to offset the political uncertainty

Hospice in Crisis
The most important end-of-life movement in a generation struggles in an era of changing families and prolonged deaths.

By Joanne Kenen 
September 27, 2017
Politico 

It might seem odd to talk about "innovations in dying," but in recent decades the hospice movement has become an important new pathway for the most difficult phase of life. As American health care has become ever more high-tech and expensive, the hospice model of home-based care for terminally ill patients has enabled millions of Americans to die peacefully in their own houses, without painful medical procedures-often greatly reducing stress on both the families and the health care system.

Now, however, the hospice model is coming under stress of its own. Some of that's because the industry has changed, with a lot more for-profit hospice agencies and investor-owned chains, which are coming under scrutiny from regulators. But much of the stress comes from shifts in how we die, how we live-and with whom. These are big demographic changes that make the original conception of hospice harder to carry out as it was once intended.

With baby boomers aging and likely to live with serious illness for several years, understanding how best to take care of the aged and the dying is becoming an ever more pressing issue in America-emotionally, morally, and financially. "We need to address this very quickly," said Joan Teno of the University of Washington, a prominent geriatrician who both practices and researches end of life care. "The tsunami of frail elderly people with complex multiple illnesses is coming."

In theory, hospice would be an ideal system to deal with this tsunami. From the time it was developed in Britain in the 1960s and '70s, it represented a pushback against the over-medicalization of death, emphasizing comfort care and emotional support over disruptive medical interventions. It put great emphasis on family; hospice care is often delivered by close relatives rather than medical staffers. And it was originally designed with cancer in mind, at a time when cancer killed quickly.

Nowadays, however, dying itself has changed. Cancer isn't the death sentence it was, and thanks to new waves of drugs that prolong life in late-stage disease, it can be hard to know when it's time to stop treatment and emphasize pain relief. More than half of hospice patients have dementia, heart disease, and other slow-progressing disorders-and most of those have more than one such diagnosis, and a panoply of symptoms. That makes it harder to prognosticate just how much time someone may have left to live. Given that hospice care is generally available only to people likely to die within six months, prognosticating is important. Even to the practiced medical eye, it's not always clear exactly when a patient is crossing that almost imperceptible line between "very sick" and "dying."

Families, too, have changed since hospice took root in the U.S. health system. They tend to be smaller, and live farther apart. More women work-making it harder for them to take on traditional roles as full-time caregivers. And millions of old, frail Americans-divorced, widowed, or never married-now live alone without family nearby, or without family at all. The most isolated are sometimes called "the unbefriended."

Editorial: Healthcare's nonprofit status belongs in the grave

By Robert Cyran
Reuters through Nasdaq.com
September 13, 2017 

NEW YORK, Sept 13 (Reuters Breakingviews) - A $3.75 billion takeover shows how the nonprofit status many healthcare firms enjoy belongs in the grave. The price publicly traded Centene is paying for New York-based health insurer Fidelis is not so much the problem. It's the fact that the seller's priest-chief executive, Patrick Frawley, was paid an ungodly $2.7 million in 2014, the latest year public data is available for.

Some of the compensation packages make it look like Fidelis's Frawley is wearing a hair shirt. Ascension, a Roman Catholic hospital chain that has gobbled up rivals, paid its CEO $17.6 million three years ago.

Sure, these institutions provide lots of care to the poor. And running a big hospital with a teaching program is difficult. So pay at these institutions tends to run higher than at small community operations, according to a 2014 study of nonprofit hospital CEO compensation in the Journal of the American Medical Association.

Some of the compensation packages make it look like Fidelis's Frawley is wearing a hair shirt. Ascension, a Roman Catholic hospital chain that has gobbled up rivals, paid its CEO $17.6 million three years ago.

Sure, these institutions provide lots of care to the poor. And running a big hospital with a teaching program is difficult. So pay at these institutions tends to run higher than at small community operations, according to a 2014 study of nonprofit hospital CEO compensation in the Journal of the American Medical Association.





Associate Attorney Andrew Babitz was named a 2017 Rising Star by SuperLawyers Magazine.   Mr. Babitz has received the honor, awarded to less than 2.5% of all the attorneys in Missouri, the last three years, from 2015-17.  Please join us in congratulating him! 



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