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CT Center for Patient Safety Newsletter
August 2012

Health Care Law Stands: What It Means For CT And You

By Magaly Olivero CT Health I-Team - The U.S. Supreme Court decision upholding the constitutionality of the nation's health reform law bodes well for Connecticut, where the Affordable Care Act has funneled $192 million in federal funds to implement the law and impacted the lives of millions of residents as of June 2012. 

In Connecticut, the Supreme Court decision means plans now underway - from establishing a state health insurance exchange to implementing community transformation grants to build healthier communities - can move forward with certainty. Since the law's enactment in 2010, millions of Connecticut residents of all ages have benefited from prescription drug discounts, free preventive care, business tax credits, community wellness initiatives and more.

Here's a look at the provisions already in effect, the steps Connecticut has taken to implement reform, and how these developments may impact you and your family.

Coverage for pre-existing conditions  

Insurers cannot deny coverage to children under the age of 19 who have a pre-existing condition. All discrimination against pre-existing conditions (children and adults) will be banned in 2014. Meantime, people with pre-existing conditions who have been uninsured for at least six months can get coverage with the Pre-Existing Condition Insurance Plan (PCIP) created by the law. As of April 20, 2012, a total of 322 previously uninsured Connecticut residents who were locked out of the coverage system because of a pre-existing condition are now insured through this new plan.

Expanded coverage for young adults  

Young adults up to age 26 who do not have job-based health insurance can stay on their parent's plan whether or not they live at home or attend school. As of Dec. 2011, an estimated 23,000 young adults in Connecticut gained insurance coverage under this provision. Connecticut law requires insurance companies to extend coverage to adult children up to age 26, but self-insured benefit plans are exempt. The federal law, however, applies to self-insured plans.

Prescription drug savings for older adults  

Older adults with Medicare who reach the prescription coverage gap receive a 50 percent discount when buying prescription drugs and a 14 percent discount on generic drugs. Known as the "donut hole," the gap is the point where people must start paying for their medications. Since the law's passage, Connecticut residents with Medicare have saved $44.8 million on prescription drugs. In just the first five months of 2012, 11,131 state residents with Medicare have saved $8.1 million for an average savings of $731 per person. The gap disappears by 2020.

Free prevention care  

Free mammograms, colonoscopies, flu shots, wellness visits and other preventive services are covered without charging a deductible, co-pay or coinsurance. In 2011, a total of 422,154 people with Medicare in Connecticut received free preventive services and another 195,297 people have received preventive care in just the first five months of 2012. A total of 710,000 Connecticut residents were among the 54 million Americans with private health insurance who gained coverage for preventive services in 2011.

Since 2010, Connecticut has received $23.8 million in grants from the Prevention and Public Health Funds created by the new law to prevent illness and promote health.


Consumer rebates

A total of 137,452 Connecticut consumers (individuals, small businesses and large employers) could receive up to $12.9 million in rebates from insurers that spent too much money on administrative costs rather than on health care. The average rebate is $168 for the 77,100 families in Connecticut covered by a policy. The law holds insurance companies accountable by requiring them to issue rebates unless they spend 80 to 85 percent of premium dollars on health care and quality improvements. Insurers who do not meet this standard - known as the "medical loss ratio" or MLR - must issue rebates by August 1. State officials expect the 1 million Connecticut residents who have private insurance will receive greater value for their premium dollars under this provision. The rebates do not apply to people with self-insured plans.

Scrutinizing premium increases
Insurance companies must publicly justify premium increases with rate requests of 10 percent or more triggering an automatic review to determine whether the increase is reasonable. Connecticut has received $1 million under the new law to help fight unreasonable premium increases. In May, Aetna Health submitted two 14 percent rate increases that are now under review by the Connecticut Insurance Department.

Removing lifetime limits
The law bans insurance companies from imposing lifetime dollar limits on health benefits. Already, 1.4 million Connecticut residents - including 525,000 women and 367,000 children - no longer need to worry about lifetime dollar limits on coverage. The law also restricts annual limits on coverage and bans them completely in 2014.

Consumer protections
Insurers cannot cancel coverage or deny payment for services because of a technical mistake on the application. Plus consumers can appeal coverage determinations with their insurance company and, if necessary, take an appeal to an independent reviewer. Easy-to-understand information about health care reform is available at www.healthcare.gov.

The Office of Healthcare Advocate (OHA), the independent state agency that helps consumers with health insurance issues, received $396,400 in federal funds to assist additional residents. OHA estimates it generated $1.7 million in savings for Connecticut health care consumers in the first quarter of 2012.

Business owners
An estimated 36,620 small businesses that employ 192,400 people in Connecticut are eligible to receive up to $166 million in tax credits to offset the cost of providing health insurance to employees. Small businesses are eligible for a 35 percent tax credit (up to 50 percent by 2014), while non-profit organizations can receive a 25 percent credit (up to 35 percent by 2014). More than a third of Connecticut's small businesses are eligible for the maximum 35 percent tax credit. To qualify, a small business must pay at least 50 percent of their employees' health insurance costs and have fewer than 25 employees with average wages of less than $50,000 per year. The Internal Revenue Service has no record of the number of Connecticut businesses that have applied for the tax credit so far.

Health insurance exchanges  

The law requires states to establish health exchanges by 2014 for individuals and small businesses to compare and purchase health plans. Most Americans will be required to purchase health insurance or pay a penalty beginning in 2014. State lawmakers established the Connecticut Health Insurance Exchange in July 2011. Connecticut has received $7.6 million in grants for research, planning, information technology development and implementation of its health insurance exchange. Connecticut is also among the New England states that received a $35.6 million federal grant to develop and share insurance exchange technology.

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Dear Members,


US Senate Hearing - Patient Safety 20120702On July 2, Senator Blumenthal, a member of the U.S. Senate Committee on Aging, held a Congressional hearing focused on Patient Safety, in Hartford.  We would have been excited just to have a hearing - but I was asked to participate in the panel discussion which made it even more exciting.  I feel as if we are at a tipping point.  The word is out - many of us may experience preventable health care harm when we are hospitalized or in nursing homes.  There was a general acknowledgement that we must and we can provide safer care. 

I estimated that there are likely 950 Medicare beneficiaries who die each year in our hospitals - unnecessarily.  This number does not include preventable deaths in nursing homes and the preventable medical harm that occurs in the general population.  I testified that behind each statistic there is a name, a family, a story of sorrow: for some it is medical bankruptcy, for others it is unemployment.  For all patients harmed by the healthcare system, there is physical and emotional pain, a profound broken trust and a disbelief that while being treated they had been harmed.

Progress in moving toward an accountable and transparent patient system of care seems incredibly slow.  Senator Blumenthal's efforts are greatly appreciated - he clearly understands our mission and determination.


In the Past Four Years....Consumers Beware! 

Subodh Varma, TNN | Jul 16, 2012, 03.52AM IST Big Pharma like GlaxoSmithKline, Pfizer, Johnson & Johnson, AstraZeneca, Merck, Abbot, Eli Lilly and Allergen have paid about $13 billion in fines to settle charges of misleading marketing, promising what drugs don't do, bribing doctors to get their drugs prescribed, causing sometimes fatal side-effects, and other crimes. The patients targeted by them ranged from children to dementia afflicted senior citizens. An analysis of their total revenues and the income from the drugs they are charged with shows that while huge, the fines are at best slaps on the wrist - their jaw-dropping revenues far outweigh the penalties.

Here are the facts: GlaxoSmithKline was fined $3 billion by the US justice department for marketing drugs for unapproved uses, paying kickbacks to doctors and Medicare system, downplaying known risks of certain drugs. They sold Paxil, an antidepressant, to children for whom it was not shown to work. They sold Wellbutrin, another anti-depressant, as a pill for weight-loss and erectile dysfunction. They sold the anti-diabetic pill Avandia concealing data that showed it increased cardiac risks. But in the years it took for all this to come through GlaxoSmithkline had made $11.6 billion on Paxil, $5.9 billion on Wellbutrin and $10.4 billion on Avandia. That's $27.3 billion - about 9 times the fine they are paying now to settle investigations.

Pfizer, the world's biggest Pharma company with annual revenue of over $67 billion last year, paid up $2.3 billion in 2009 to settle a similar investigation. The drugs involved were Bextra, Geodon, Zyvox and Lyrica. Pfizer had been using illegal methods to sell them, like giving junkets and cash to sales reps for pushing the anti-arthritic pain killer Bextra as an all-purpose pain killer.

Medicare announces updated, enhanced tools for patients to compare hospitals and nursing homes

Martina Dolan | July 23, 2012

"Two websites that help Americans make informed choices about hospitals and nursing homes have been redesigned and will make more information available to the public, the Centers for Medicare & Medicaid Services (CMS) announced Thursday.

The two sites - Hospital Compare and Nursing Home Compare - have been enhanced to make navigation easier by users, and have added important new comparison tools like findings from nursing home inspections.

"These enhanced tools give patients, their families, and caregivers the ability to make an informed decision on where to seek care by looking at how well hospitals and nursing homes are performing on important quality measures, and" said Acting CMS Administrator Marilyn Tavenner. "Anyone looking to compare hospitals or nursing homes - not just those on Medicare - can take advantage of these websites."

Both sites contain important data on how well these facilities perform on quality measures - such as the frequency of infections that develop in the hospital, how often patients have to be readmitted to the hospital, and the percentage of nursing residents who report having moderate to severe pain while staying in the nursing homes. Researchers will now be able to access the data on both of these sites through mobile ready applications.

On both websites, navigation has been improved for consumers, who will find large and easy to use maps for pinpointing hospitals, and new search functionalities that allow the user to input the name of a hospital. Glossaries and web resources have been enhanced to make the information easier to understand.

"These new updates to the Hospital and the Nursing Home Compare websites are the next stage of transparently sharing data to drive improvement in our health system," said Patrick Conway, chief medical officer for CMS.

In addition, new information is available on each of the websites. Updates to Nursing Home Compare include:

  • Narratives that detail specific findings from inspections of nursing home facilities;
  • Two new measures that report a nursing home's use of antipsychotic medications;
  • Updated data for quality measures previously available on the site; and

Additions to Hospital Compare include:

  • Two new measures that cover potential health risks of imaging services, such as exposure to unnecessary radiation; and
  • Updated data for existing quality measures.

These two consumer tools are highly popular with patients, their families, and caregivers. In the first half of 2012 there were over 1.2 million visits to the Hospital Compare site, and over 500,000 visits to Nursing Home Compare. The sites can be found online at www.hospitalcompare.hhs.gov/ and www.medicare.gov/nhcompare/

The Eldercare Locator can be found at www.eldercare.gov."


Health and Human Services Report that Hospitals are Ignoring Requirements to Report Errors.


Researchers report that the failure to report is not a sign of a cover-up but rather ignorance of the regulations.  Providers see some problems as the normal risk of doing business - the natural risk associated with some medical procedures.  Past reports show that about 27% of Medicare patients are harmed as a result of medical care.  Those errors cost Medicare $324 MILLION for just one month to say nothing of the toll of suffering for the patient and their family.  Hope for the future lies in electronic health records because hospitals may become far more aware of the impact of the care that is provided.  Paperwork can bury important information and documentation of the impact of preventable harm.

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ProPublica Journalists' New Initiative:


Responding to the case of Rory Staunton, the 12 year old who died of sepsis after being sent home from NYU's Langone Medical Center emergency room, veteran ProPublica reporters Tracy Weber, Charles Ornstein and Marshall Allen wrote: "As veteran health reporters, we wish we could tell you that this case will spur changes in emergency rooms across the nation, that never again will a hospital make such an avoidable mistake. But, sadly, decades of experience covering such incidents suggest the medical system may prove resistant to change. Forget about every hospital rewriting its procedures. History suggests it would be a victory if NYU Langone manages to follow its own new rules as we all hope they will. 

It's long been known that medical errors are a major problem-a national panel concluded more than a decade ago that nearly 100,000 people die each year as a result of errors in hospitals. Despite the resulting national focus on patient safety, patients continue to be harmed and killed by medical shortcuts, inadequate training and breakdowns in communication.

Unlike the airline industry, which relies on a safety net of checklists, the medical community has been slow to adopt them in all areas and often puts its faith in the outdated idea that doctors are infallible.

Time and again reporters have uncovered unfathomable lapses at medical facilities, often resulting in patient injuries and death. Time and again, hospital officials have put in place solutions that seem ridiculously obvious.

And, inconceivably, the fixes are frequently ignored or ineffective.

That's why we at ProPublica are working on a project to document cases of harm to patients.  If you or a loved one has been harmed while undergoing medical care, will you please share your story with us by filling out our Patient Harm Questionnaire


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