NCSD Announces Internet-Based Partner Services Webinar

NCSD Announces Internet-Based Partner Services Webinar WHAT: As part of NCSD's leadership in promoting best practices in STD prevention and treatment, we are pleased to offer the second of two webinars on internet-based partner services (IPS). IPS has the potential to expand the screening and treatment of STD's, including HIV, and has been successfully implemented in a number of jurisdictions. WHO: This IPS 201 webinar is open to all NCSD full and associate members, as well as other interested colleagues. WHEN: July 28, 1:30pm EDT THE DETAILS: Internet-Based Partner Services (IPS) 201 This webinar will provide participants with details on the topics such as protocol and guidance development, data management, training and will review tools and practices used in the daily tasks that involve IPS. Current IPS programs, Internet resources, and websites where IPS is performed will be reviewed.  To register please utilize the link below. https://cc.readytalk.com/r/j3qiogaq7885 National Coalition of STD Directors (NCSD) 1029 Vermont Ave., NW Suite 500 Washington, DC 20005 202.842.4660 202.842.4542 (Fax)www.ncsddc.org ,

Misteriosa muerte de niña de 5 años

Niña muere sin recibir un diagnóstico de su condición de salud

La madre de la pequeña Fabiana, Lizbeth Díaz Ortiz, y otros familiares esperan recibir en dos semanas los resultados de la biopsia que se le realizó a la niña para emprender una demanda contra el pediatra y la aseguradora MCS. (El Nuevo Día / Ramón “Tonito” Zayas)

Por Frances Rosario /frosario1@elnuevodia.com

La Procuraduría de la Salud emprenderá una investigación para poder esclarecer la misteriosa muerte de una niña de 5 años en medio de una controversia entre un hospital de la capital, el médico de cabecera de la menor y el programa de gobierno Mi Salud, a través de la aseguradora MCS, informó el procurador, Carlos Mellado.

Aún las causas del fallecimiento Fabiana Belén Forty Díaz no están del todo claras. En un inicio se le indicó a la familia que la menor pudo haber padecido de un linfoma o de meningitis.

Según sus familiares, la menor falleció el pasado jueves sin que se le realizaran una biopsia y un estudio especializado, el PTC, que le había ordenado su pediatra, Iván Pérez Dieppa.

Los hechos ocurren en medio de las controversias entre Mi Salud y la aseguradora MCS, que terminó con la cancelación del contrato entre las partes.

“Esto fue una conspiración. A mi hija me la mataron”, relató la madre de la menor, Lizbeth Díaz Ortiz, a El Nuevo Día.

Según informó, a principios de mes llevó a su niña a un hospital de Carolina con unas manchas en la piel. Allí, le dieron de alta aludiendo que eran lunares de sangre y que debía sacar una cita con un especialista.

“Le seguían saliendo las pintitas en la piel e influía en su ánimo. Nosotros como papás lo notábamos raro”, comentó el padre, Neil Forty Rivera.

Díaz Ortiz añadió que “al verla toda manchada, hasta en los genitales, corrimos”.

Los padres llevaron a la menor a la oficina del pediatra, pero las enfermeras recomendaron que fuese llevada a la sala de emergencia del Hospital Auxilio Mutuo en Hato Rey, donde el médico tenía práctica. Allí estuvo hospitalizada del 12 al 15 de julio.

Según los padres de la menor, Fabiana fue dada de alta sin que se le realizaran los estudios que requirió el médico, porque alegadamente la aseguradora MCS no autorizó las pruebas.

La tía de la menor, Wina Forty, expuso que Pérez Dieppa dio de alta a la menor al asegurar que de forma ambulatoria se le realizarían los estudios con mayor agilidad.

Como la condición de la menor se agravó y, presuntamente, MCS no aprobaba los estudios, la familia decidió llevar a Fabiana el pasado miércoles al hospital municipal de San Juan en el Centro Médico, donde Pérez Dieppa también tiene práctica. De ahí fue trasladada al Hospital Pediátrico en condición crítica, donde falleció la mañana posterior de hemorragias internas e inflamación en los órganos, explicó Díaz Ortiz.

Reaccionan el hospital y MCS

Ayer, Pérez Dieppa no pudo ser contactado para una reacción de la situación. De hecho, el director médico del Auxilio Mutuo, José Aguisado, dijo a este diario que tampoco había podido tener comunicación con el galeno.

Aguisada sí aclaró que a la niña no se le pudo realizar la biopsia ni el PTC requerido en el hospital, ya que no cuentan con ese equipo y no se especializan en atender casos de oncología pediátrica.

No obstante, señaló que el hospital hizo acercamientos a otros grupos médicos para realizar los estudios, pero que MCS no las autorizó.

“El hospital hizo el acercamiento con el grupo San Francisco. Ahí fue que empezó el tranque. Se espera varios días que se diera autorización, pero no llegó”, dijo, Aguisada.

En un comunicado oficial, el presidente de MCS-HMO, José Durán, se limitó a indicar que “los servicios para los pacientes hospitalizados no requieren preautorización del plan, por lo que, al momento de estar hospitalizada la niña, la intervención de la aseguradora no era necesaria”.

Pero no se aclaró porque no se autorizaron los estudios el miércoles pasado, cuando la menor estaba grave en el Hospital Pediátrico.

También quedó en el tintero la razón por la que Pérez Dieppa autorizó darle de alta a la menor del Auxilio Mutuo sin llevarla a recibir la atención que requería en otro hospital que diera servicios oncológicos.

Según Aguisada, “yo entiendo que él (Pérez Dieppa) como tenía cátedra en el Hospital Municipal, y él explicó que todo coordinado para atender la paciente allí, pues iba a ser atendida... Después que sale del hospital, yo no sé (qué sucedió)”.

La familia de la menor informó que esperarán que en dos semanas llegue el resultado de la biopsia para emprender un caso legal contra el médico y la aseguradora MCS.

No renuncia el secretario de Salud

El Secretario aseguró que Mi Salud continuará y rechazó nuevamente las propuestas para cambiar el modelo, a un pagador único. (Primera Hora/Gerald López Cepero)

No renuncia el secretario de Salud

jueves, 21 de julio de 2011
01:48 p.m. 
Rosita Marrero / Primera Hora

El secretario de Salud, Lorenzo González, rechazó los fuertes rumores sobre su renuncia al afirmar que continua al mando del Departamento, con el absoluto  poder sobre Mi Salud, independientemente de que la Administración de Servicios de Salud (ASES) ha sido puesta en sindicatura.

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“No estoy renunciando, para sacar eso del camino”, dijo el Secretario de Salud al contestar  rumores sobre su destitución durante una rueda de prensa improvisada celebrada hoy en  sus oficinas.

“Cada vez que voy a La Fortaleza a reunirme con el secretario de la Gobernación, Marco Rodríguez Ema, me preguntan si voy a renunciar”, agregó.

Explicó que si fuera el caso, su contrato estipula que tiene  60 días para hacerlo, y de inmediato aclaró: “ y no estoy diciendo que lo voy a hacer”, arrancando risas. Agregó que  va a La Fortaleza con regularidad.

Al preguntársele si habrá despidos en ASES, luego de que un equipo fiscal del Banco Gubernamental de Fomento asumiera la supervisión de las operaciones administrativas y fiscales de la entidad, fue parco.

¿Va a haber despidos?

“En este momento no hay planes de despido. Se está evaluando todo. Personal y todo”, dijo.

Y el  director de ASES, ¿le ha presentado la renuncia?

“No”.

¿La va a pedir?

“En este momento, no”.

¿Pero lo puede considerar?

En este momento no.

Rechaza sindicatura

González rechazó el término sindicatura ante la presencia del equipo del  Banco Gubernamental de Fomento,  señalando que no sabe quién lo utilizó. Se le aclaró que fue el propio secretario de la Gobernación, Rodríguez Ema.

¿Qué sucedió con ASES?, se le preguntó.

“Yo había dicho desde un principio mi preocupación  de que manejar  una cartera  de $2 mil millones era muy complejo y que ASES tenía que evolucionar la forma como acostumbraba a operar”, apuntó.

“En la medida que el año pasado pedimos una línea de crédito al banco Gubernamental de Fomento, un préstamo (que no precisó) para rectificar la deuda que siempre se carga para  resetear en cero. Como parte del Memorando de Entendimiento, el Banco Gubernamental se reservó su potestad de tener un grupo  fiscal”, dijo.

El Departamento tiene muchos recursos en ASES e indicó que se dieron cuenta que  se tenía que enmendar, porque “ASES seguía haciendo las cosas de la misma forma”, dijo.

“Marcos necesitamos un equipo”, dijo González que demandó a Rodríguez Ema.

“La petición viene de mi parte. La presunción que hay sobre la sindicatura es que pierdo poder”, mantuvo.

Se le cuestionó  si una figura como Alberto Velázquez, que fue motivo de controversia en el Departamento de Educación, está capacitado para dirigir el equipo fiscal. “El Banco presentó el equipo. No lo conozco. Es una persona estructurada, organizada, sistemática y puede producir cambios estructurales, con mucha disciplina y mucho foco”, dijo.

Aclaró que la junta de ASES existe.

Desde el 2009,  cuando comenzó González,  dijo que se le han estado  efectuando muchos cambios a ASES, como es el poner recursos administrativos y legales.

Relató que cuando comenzó Mi Salud, al noveno mes, se acabó el dinero y por eso consiguió dinero para subsanar la deuda. Indicó que el préstamo fue  de $180 0 $190 millones.

El Secretario aseguró que Mi Salud continuará y rechazó nuevamente  las propuestas para cambiar el modelo, a un pagador único.

González asumió toda la responsabilidad sobre el funcionamiento de la reforma.

 “Yo estoy en esto. Yo me quedo. Mi Salud sigue siendo mi responsabilidad”, dijo.

¿Y si colapsa?, se le insistió.

“Yo soy  responsable de todo lo que pase en Mi Salud.

¿Si colapsa?, se le preguntó nuevamente.

“Es cien por ciento mi responsabilidad. No puedo pasar la responsabilidad a nadie”, sostuvo

MCS and Mi Salud butt heads in contract negotiations

By Stefan Antonmattei

Of the Daily Sun Staff

santonmattei@prdailysun.net

Negotiations between the government and the private health insurers managing Mi Salud will most likely be extended to July 15. This fiscal year’s renewal of the three-year contract was scheduled to be completed by July 1. An industry source told the Daily Sun on Tuesday that two of the parties are in disagreement as to how much should be paid per each of the 1.3 million Mi Salud beneficiaries. The cost of the Mi Salud program is estimated at $1.7 billion per year.

According to the industry source, the deadlock is between the government and Medical Card Systems, the largest insurer covering 800,000 of the 1.3 million insured. MCS wants a higher per-person per-month fee, arguing that their original estimated costs for managing the program, factored back in October 2010, have far surpassed what they had budgeted. This, according to MCS, has been the reason why MCS owes more than $60 million to hospitals throughout the island, and another $60 million to preferred medical providers known as IPAs. By the time the Daily Sun went to press, MCS and an association of IPAs were meeting to discuss a way out of the debt mess.

The reasoning for government hiring the insurance companies is that they, and not the government, assume the all cost risk associated with providing health benefits to the insured.

Different health care industry sources have speculated about MCS walking away from the program, others have said they are just playing hardball in the negotiations with the government. The government contract brings MCS an estimated revenue of $1 billion per year.

The negotiators include the government’s health plan administration (ASES for its Spanish acronym) and the Health Department. The private sector parties include MCS, Humana, and APS, Inc. 

ASES has reinforced its negotiating team by including the Treasury Secretary, the director of the Office of Management and Budget, and the director of the government’s mental health administrator.

A senior government official confirmed to the Daily Sun that the only sticking point in the negotiations was MCS. Asked if other insurance companies could compete in the negotiations, the official said yes, but only if MCS opts out.

What if MCS walks away

MCS could opt out of its contract with the government if it wanted to. The process following a statement of intent to renege on the contract would take place in a period of about three months. The government could declare a state of emergency to avoid having to go through a long process of a request for proposal — estimated to take at least a year. By declaring an emergency, the government could contract directly with a number of insurance companies including companies that are not currently based in Puerto Rico. 

Several companies could be interested in competing for the billion dollar contract including Triple-S (and its subsidiary American Health), MMM Healthcare, and Centene Corp.

PRDH appealed the determination of HRSA disallowing $24,340,789 and loses

FYI- see conclusion below
*******
http://www.elnuevodia.com/saludfederalniegarembolsomillonarioallocal-1005928.html

Salud federal niega rembolso millonario al local

Lo castiga por no evidenciar buen manejo de fondos para pacientes de SIDA y VIH

Por Aurora Rivera Arguinzoni

El Departamento de Salud de Puerto Rico (DS) perdió más de $24 millones de fondos federales que le habrían sido rembolsados por no mostrar evidencia de que realizó de forma adecuada pagos por medicamentos para pacientes con el virus de inmunodeficiencia humana (VIH) y el síndrome de inmunodeficiencia adquirida (SIDA o AIDS por sus siglas en inglés) que éste causa.

El pasado 9 de junio la junta de apelaciones del departamento de Salud y Servicios Humanos (HHS) de Estados Unidos denegó una solicitud del DS para reconsiderar una determinación previa en la que la Administración de Recursos y Servicios de Salud federal (HRSA) desautorizó el rembolso de $24,340,789.

“Mantenemos la denegación completa basados en que el DS ha fallado en mostrar que utilizó los rembolsos de ADAP (AIDS Drug Assistance Program) para hacer pagos de medicamentos que no hubiesen podido ser costeados razonablemente bajo otros programas federales o estatales, o mediante cubiertas de planes médicos privados”, lee la decisión, publicada en la página electrónica del HHS.

“En resumen, concluimos que HRSA, basada en una revisión de recetas de ADAP seleccionadas al azar, descansó razonablemente en muestreo estadístico al calcular su determinación de no autorizar el rembolso”, agrega.

Indica además de los argumentos presentados por el DS en su apelación “carecen de mérito”.
El caso se relaciona con una auditoría realizada por la Oficina de Servicios de Auditoría del HHS en el 2006 y que cubrió el período comprendido entre el 1 de abril de 2002 y el 31 de marzo de 2005. EN la misma se determinó que el DS había pagado $24,340,789  de más con fondos federales porque había pacientes cuyos planes médicos cubrían medicamentos pagados con dinero de ADAP.
*************
Link para documento oficial-

http://www.hhs.gov/dab/decisions/dabdecisions/dab2385.pdf

PRDH asserts that disallowing this large amount of money puts it in "more than a
precarious position as it has no means to be able to claim or bill any entity which might
have had at the time the primary payment responsibility" for paying for these
prescriptions.  Id. at ¶ 15.  It asserts further that the disallowance "ultimately frustrates
the whole purpose of the Grant by preventing HIV/AIDS patients from access to life
saving medication as we cannot sustain a similar program with only State funds."  PRDH
Reply Br. at ¶ 14.  According to PRDH, this disallowance will put a "burdensome load on
the Agency" and force it "to put patients with HIV/AIDS medications necessities on
waiting lists further jeopardizing the health of this population." 

"HRSA does not dispute these allegations.  However, the Board lacks authority to grant
PRDH’s request for what is essentially equitable relief.  West Virginia Dept. of Health
and Human Resources, DAB No. 2185, at 20 (2008); Utah Dept. of Health, DAB No.
2131, at 23 (2007).  We must uphold a disallowance if it is supported by the evidence of
record and is consistent with the applicable statutes and regulations.  West Virginia, DAB
No. 2185, at 20, citing 45 C.F.R. §§ 16.14, 16.21.  As explained above, we conclude that
this disallowance satisfies those criteria.

Finally, to the extent that PRDH is arguing that the disallowance "ultimately frustrates
the whole purpose of the Grant,” we note that the purpose of ADAP was frustrated here
because PRDH did not comply with the payer of last resort requirement.  It needlessly
spent limited ADAP funds for prescriptions for which payment could reasonably be
expected to be made by other payers, principally GHIP.

Conclusion- For the preceding reasons, we uphold this disallowance in full."

Quality of medical care in PR questioned

Quality of medical care in PR questioned

By Stefan Antonmattei

Of the Daily Sun Staff

santonmattei@prdailysun.net

A study published in the Archives of Internal Medicine found that more people died in U.S. territories hospitals than in U.S. hospitals. According to its author, Dr. Marcella Nuñez-Smith, M.D., MHS, and a faculty member of Yale University’s Medical School, the differences are significant. More than 90 percent of the population from the U.S. territories are from Puerto Rico, so the study has significant meaning for the island.

In an exclusive interview with the Daily Sun, Dr. Nuñez-Smith said the statistical data was significant. Other health officials consulted in Puerto Rico concurred with her assessment.

“Virtually all of the territorial hospitals performed below the U.S. national averages,” read the study which was conducted from July 2005 to June 2008 and included 53 territorial hospitals and 4,595 stateside hospitals with data provided by the Centers for Medicare and Medicaid Services.

“Mortality rates were significantly higher in the territories … For acute myocardial infarction (AMI) it was 18.8 percent in the territories versus 16 percent in the states; for heart failure (HF) 12.3 percent versus 10.8 percent; and for pneumonia (PNE) 14.9 percent versus 11.4.

“The study cohort included hospitals in the U.S. territories and in the U.S. states, inclusive of the District of Columbia, that discharged at least one Medicare fee-for-service (FFS) adult patient with a primary diagnosis of AMI, HF, or PNE between July 2005 and June 2008. Additional patient inclusion criteria included at least 12 months of continuous Medicare FFS coverage prior to the index admission in order to accurately capture patient comorbidity.”

For the study, Puerto Rico’s population was estimated at 3.9 million, American Samoa at 57,000, Northern Mariana at 69,000, Guam with 155,000, and the U.S. Virgin Islands at 108,000.

The author’s grandfather emigrated through Puerto Rico and settled in the U.S. Virgin Islands. Nuñez-Smith was born in St. Thomas, part of the U.S. Virgin Islands and has visited Puerto Rico many times.  Calie Santana, M.D., MHS, a Puerto Rican physician also participated in the study.

Asked whether the populations of the territories were sicker than those in the states, Dr. Nuñez-Smith answered in the negative. “We are not sure why more people are dying in territories hospitals than in the states. There are differences but the variances are small,” she said. “The study suggests we should look into other variances such as access to medical providers, how soon patients get to a hospital, timely treatment, and how funding streams affect federal, state, and insurance reimbursements to medical providers,” said Dr. Nuñez.

Another fact noted in the study was the percentage of hospitals that were privately owned versus those who were publicly owned or managed by a not-for-profit organization. In the case of Puerto Rico, many more hospitals were privately owned in comparison to the states, where most hospitals are publicly owned or are managed by not-for-profit organizations. Hospital characteristics were derived from the 2007 American Hospital Association Survey.

Dr. Nuñez-Smith said that she could not make an assumption, but that it should be studied whether a for-profit hospital thinks and responds to patients in the same manner as a not-for-profit hospital would.

“Our findings reveal a marked geographic disparity that affects a subset of racial/ethnic minority populations in the United States. Hospitals in the U.S. territories, on average, have significantly higher RSMRs [Risk-Standardized Mortality Rate] than hospitals in the U.S. states. The magnitude of differences across these rates raises concerns about differences in the quality of care … We also found that risk-standardized readmission rates were higher in the U.S. territories for AMI and PNE prior to adjustment. Again, almost all of the hospitals in the territories performed worse than the average in the U.S. states, although these associations were not significant after adjusting for hospital characteristics and core process measure performance. Still, readmission rates for all the hospitals were high, and although the disparity was not as prominent as with the mortality measure, the need for improvement is clear.”

The conclusion of the study reads “Compared with hospitals in the U.S. states, hospitals in the U.S. territories have significantly higher 30-day mortality rates and lower performance on every core process measure for patients discharged after AMI, HF, and PNE. Eliminating the substantial quality gap in the U.S. territories should be a national priority.”

Puerto Rico’s Health Secretary

Earlier on Wednesday, The Daily Sun requested Puerto Rico Health Secretary, Lorenzo González’s reaction to the study.

González noted that “the article recognized the disparities in funds awarded to territories in comparison to those granted to states to address healthcare services.” He also stated the article “acknowledges how our territorial status limits our participation in any public policy discussion regarding the limited funds Puerto Rico receives in terms of healthcare.”

The article also mentioned a General Accounting Office study of 2003 which indicated that Medicare beneficiaries in the Continental U.S. receive an average of $6,300 per patient compared to $2,800 for U.S. citizens living on the island.

González, however, stated that “hospitals in the U.S. territories have to meet quality healthcare standards and be certified by the Joint Commission as well as CMS just like hospitals in the continental U.S.,” and argued that “the doctors working in these facilities around the island are as competitive as any you can find in other institutions abroad. We guarantee that Puerto Rico has a professional medical class dedicated to the well being of our patients and many of our professionals working in hospitals on the island are Board Certified,” said González.

González also noted that the study cited in the article had some limitations since it only analyzed Medicare patients, excluding the younger and healthier populations. He added that the study was also based on claims data and didn’t include a clinical review of the patients’ medical records to identify any other factors that could impact the findings described in the study.

Other experts comment

The Archives of Internal Medicine also published an accompanying commentary written by Nilsa Gutiérrez, M.D., MPH, in which she provides her opinion on Dr. Nuñez’s study. Dr. Gutiérrez document is titled, “Understanding Health Care Disparities in the US Territories.”

In her commentary Dr. Gutiérrez says: “Congress has played a major role in shaping the financing of health care services since the passage of the Social Security Act of 1965. Laws involving Medicare and icaid often include language about application in the U.S. territories. Typically, formulas used for territorial Medicaid allocations direct most funding to Puerto Rico, the largest territory. With a population of 4 million, Puerto Rico accounts for 90 percent of the total territorial population and has a larger population than 26 U.S. states and Washington, D.C. This leads the U.S. Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands, with population sizes between 70,000 and 170,000 people, to raise concerns about the impact of the current allocation methodology on their ability to strengthen a fragile health care infrastructure and respond to the changing demands of medical practice and service delivery.”

A health care industry expert who has worked in Puerto Rico for many years, but asked to remain anonymous, spoke about Dr. Nuñez-Smith study.

“The numbers in the study point out that the results are significant: that is, that we are worse than in the U.S. with respect to complications — mortality and readmission — after the person leaves the hospital. Complications can occur for several reasons: first, the patient had problems accessing services and the doctor was late in treating the patient; second, the service provider is giving a poor quality of care; and third, the patients did not have enough resources to control their condition and the condition itself worsened (lack of health education, lack of medicines, lack of a physician’s follow-up).”

The physician also said: “Any of these complications may be due to the financing of the health system (public and private) where the patient has a hard time accessing the services they need. Taking into account that the study is not just Reforma or Mi Salud (government health plans), but that it includes the entire population of Puerto Rico, one cannot rule that we are not doing good medicine on the island.”

Regarding the streams of health funds, the expert said: “It is important to know the source of fee payment for the patients, if it is Medicaid or a private plan. One has too see how they are distributed according to each health plan. A study on diabetics conducted in 2003-2004 showed that the drugs that are prescribed to patients [in Puerto Rico] were worse than those prescribed to diabetics in the U.S. The question then arises, what do doctors on the island prescribe to patients who have a good health plan? We never received an answer. For me the issue of quality of care, which demonstrates that there is poor quality medical care, has to do with the patterns of medical practice and not the health plan that the person has. There is a lot of pre-authorization and people get tired of the bureaucracy, arriving late [for treatment]. I think the government is second guessing what is really going on in Puerto Rico because they lack clinical information and feedback on the treatment of patients. This may be because physicians shy away from treating new patients because there are no guarantees that the insurers will pay them, or because there are insufficient resources for the patients to take adequate medicines to stay as healthy as possible, or because there is no tradition of visiting the doctor and maintaining a therapeutic engagement.”

http://archinte.ama-assn.org/cgi/content/full/archinternmed.2011.284
original study