Monday, December 27, 2010

Impressive graphics on world health and income;

Some very exciting graphics on world health and income. His graphic techniques are particularly worth watching.

Sunday, December 26, 2010

End of life care mystery solved

thanks to paul elstein, determined that these rules came out on 11/29/10, physician payment rules for 2011. 
see federal register document.

I am amazed that it took a month for the press to become aware of this issue. 

NYT: Obama Returns to End-of-Life Plan That Caused Stir

This article will certainly stir lots of controversy. don't know if that is good or bad.  It indicates that a recent rule issued by CMS contains the optional end of life counseling

"the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment."

I don't know which regulation this refers to as I have not found it, perhaps it is something to be released that is not on an hhs web site, or something released recently but did not get attention until robert pear, author of this article at the NY Times wrote.  I cannot imagine that a controversial item like this went unnoticed before, so perhaps it is something that is about to be released.  In any event, this artcile will certainly stir up a great deal of attention. Since Pear is a very credible reporter that has worked for the NYtimes for years, this is not something that is written by a wild eyed reporter.  Unfortunately, the article does not indciate to which rule it is referring.

I personally think that such counseling is a very desirable practice, but also know that there are many folks that will be bitterly opposed to this provision.  If a person has a terminal condition and is suffering considerable pain, then it is worthwhile for the doctors to inform the patient and family as to the options there are to end unnecessary suffering.

Given my concern that the president has not sold this legislation to the public adequately, this will not help the cause. 

Thursday, December 23, 2010

kaiser health reform web site and reform timeline

the kaiser family foundation  has a very useful web site on health reform

the following portion of the site has a timeline as to what provisions go into effect, such as for 2011.
Looks like a very useful table

For 2011, some key changes are
  • Changes to Medicare coverage
  • Grants to states for the health insurance exchanges
  • National minimum medical loss ratios 
  • Elimination of cost-sharing for certain Medicare-covered preventive services
  • Changes to the Medicare Advantage payment system
  • Grants for small employers to establish wellness programs
  • Establishment of the Community Living Assistance Services and Supports Program (CLASS Act) 
  • Grants for states to develop alternatives to tort litigation
  • Disclosure of the nutritional content of standard menu items at chain restaurants and food sold from vending machines
  • Grants for chronic disease prevention efforts in the Medicaid program
  • Incentives for physicians to practice primary care through the Medicare program
  • Changes to tax-free savings accounts
  •  Medicare Premiums for Higher-Income Beneficiaries
  •  Medicaid Health Homes 
  • Chronic Disease Prevention in Medicaid
  • Provides 3-year grants to states to develop programs to provide Medicaid enrollees with incentives to participate in comprehensive health lifestyle programs and meet certain health behavior targets.National Quality Strategy
  • Requires the Secretary of the federal Department of Health and Human Services to develop and update annually a national quality improvement strategy that includes priorities to improve the delivery of health care services, patient health outcomes, and population health. Grants to Establish Wellness Programs
  • Provides grants for up to five years to small employers that establish wellness programs.Teaching Health Centers
  • Establishes Teaching Health Centers and provides payments for primary care residency programs in community-based ambulatory patient care centers. Nutritional Labeling
  • Medicaid Payments for Hospital-Acquired Infections
  • Graduate Medical Education
  • Medicare Independent Payment Advisory Board
  • Medicaid Long-Term Care Services

    Monday, December 20, 2010

    health stocks do well last week

    using, at a meeting of greekgods, I learned that health stocks had the best performance of all sectors last week. I wonder why.  Only major actions were the virginia court decision and congress passing the medicare physician payment fix.  Not sure that these actions would have resulted in increases in most major sectors within the health care industry.  However, there were some sectors that had negative returns so not all did well.

    Friday, December 17, 2010

    States save under health reform

    the urban institute has conducted an analysis of the impact of health reform bill on state expenditures.  The analysis shows states will save.  See report for details.

    Wednesday, December 15, 2010

    Tuesday, December 14, 2010

    mandatory insurance; chronic care

    Attorney General Eric Holder and HHS Secretary Sebelius had an excellent editorial on the mandatory health insurance requirement

    I definitely support for all the reasons they have stated

    o   People without insurance who get sick end up in Emergency Rooms and cost us all more money, plus they undermine their own health which is a cost to society
    o   Mandatory insurance lowers the cost for all of us.
    o   If states can mandate auto insurance, why can't health insurance be mandated

    HHS issues new strategic framework on multiple chronic conditions

    Sunday, December 12, 2010

    Community and Professional Activities

    This section contains 1) a brief summary of my community activities; 2) a story published by the Silver Spring Regional Center that describes my major accomplishments in Silver Spring, 3) my full professional resume and 4) a list of web sites related to my activities. 

    Organizing for Action: Health reform

    In 2008, I joined Organizing for Action (OFA), President Obama’s grassroots organization, and in 2010 I organized phonebanks for them as we lobbied constituents across the country to support the ACA.   This past year, I have served as OFA Deputy state lead for ACA and organized many enrollment events.  I recruited volunteers and worked with a number of elected officials to support these enrollment plans.  As part of this effort, I worked with many of the connector organizations in the Capital Region that served as enrollment centers.  In the process, I discovered a website that provides the best ACA consumer comparison info.  I shared this information with leading experts and had the site endorsed by the Commonwealth Fund and other leading experts.  My only regret is that more folks did not make use of it.  Another highlight was identifying a fraudulent site masking as the State's site.  I also conducted a number of training sessions for OFA volunteers especially with the Prince George's team. 

    Safe Silver Spring

    Founder and Chair from 2009-2017 of this community based crime prevention organization. In May, 2009, held a 120 person summit of representatives of Federal, State and local government and community organizations. Summit recommendations have already led to a number of key legislative and policy changes. The accomplishments for this organziation while Chair are listed here: 

    We are focused on criminal justice issues but are also concerned with a broad array of related social issues, such as affordable housing and jobs for minority teenagers.   We have successfully advocated for increases in county police officers, school police, and the truancy court program among others.  Last year, we played a significant role in the successful passage of gun safety legislation by the Maryland Assembly.  I helped organize and spoke at a large rally, organized letter writing campaigns, and lobbying efforts among other activities.
    Silver Spring Schools vs Greenblatt Board of Education

    Proposed successful legal appeal against board for racially discriminating against 6 Silver Spring schools and inspired voters to elect new Board.

    Traffic Coalition and Route 29 Coalition

    Led negotiations that resulted in Silver Spring/Takoma Park Traffic Coalition’s successful opposition to the Silver Triangle project. Coalition proposed alternative model which was the framework for successful revitalization of downtown Silver Spring. 

    Chair of Route 29 coalition which successfully opposed building of underpass at Four Corners. State adopted our alternative jughandle proposal, a cheaper and better traffic solution and preserved neighborhoods.
    These two battles resulted in significant changes in county's growth policies, and inspired voters to elect a new County Executive and County Council. 

    New Blair High School

    Organized several major community rallies that contributed to the successful battle to build a new Blair High School. 

    District 20 Organizer for Ike Leggett County Executive Campaign

    Organized literature distribution throughout district and very successful fundraiser.

    American Association of Individual Investors (AAII)

    Current Chair, Chapter Leaders Executive Committee.
    Current Program Co-chair and Past President, AAII DC Metro Chapter.  

    ---------- Forwarded message ----------
    From: Silver Spring Regional Center
    Date: Fri, Nov 6, 2009 at 1:19 PM
    Subject: CCS: A Silver Spring Story: Tony Hausner
    To: Silver Spring Regional Center

    CELEBRATE COMMUNITY SUCCESS:   A Silver Spring Story: Tony Hausner
     In the spirit of sharing – and getting to know ‘who we are’ beyond the confines and limits of our meeting rooms – here’s another personal story.
     My Silver Spring Story
    Tony Hausner
    My family of 4 moved to Silver Spring in 1977 to the Indian Spring neighborhood near the YMCA and the Beltway.   This included my wife, Toba, whom I had married in 1967, and our daughters, Deena, who was 4, and Ariele, who was 1.  Within a year of arrival, I became an officer of the newly revived Indian Spring Citizens Association and a year after, the President.   Once Deena entered East Silver Spring Elementary School, we became active in its PTA and I joined the Blair Area Advisory Council (now known as a cluster coordinating council).
    In 1982, the Montgomery County Board of Education voted to close Northwood High.  In the process, they redrew the boundaries of several schools and split up the pairing of two schools which had been designed to address racial balance.  The boundary changes significantly increased the minority percentages at 4 of the schools.  What they did was send the majority elementary schools in the Northwood cluster to a much further school, and sent the high minority schools to the Blair area.  They segregated the schools.  Hard to believe in 1982that a school board in Maryland would do such a thing.  
    I, and many in the county, were enraged at this action.  At the Blair Area Advisory Council, I proposed that we take legal action and we did.  About a month later, we and other groups organized a one day conference of 100 people where we formed action teams.  The Lawyers Committee for Civil Rights arranged for Peter Nickles of Covington and Burling (now the  Attorney General for Washington, D.C.) to file an appeal with the State Board of Education.   The State Board agreed that the County Board had segregated the schools and overturned the decisions.   The County electorate then voted out the County Board and the new board created the Blair magnet of Math, Science, and Computers.    This magnet program has been a tremendous success and both my daughters benefitted from it.   I believe that if we had not maintained racial balance at these schools, that there would have been major white flight from the area and Silver Spring would never have been revitalized.  
    In the latter part of the 1980s, I became involved in two major battles over transportation and growth issues:  the conversion of US29 into an expressway and the Silver Triangle project.    In the US29 project, I was the chair and founder of the Route 29 coalition, a group of 20 civic and other groups that opposed building an underpass at Four Corners.   We argued that the underpass would only shift the traffic congestion to the next intersection and would only make traffic worse by allowing the state and county to increase growth and traffic.  We provided a comprehensive set of alternatives, including the jughandle at Four Corners and ultimately, the State Highway Administration complimented us for our proposals and accepted them.  However, a change in county elected officials played an important part in this process, which is described below. 
    The other major battle was over the Silver Triangle Project by Lloyd Moore which was backed by then County Executive, Sidney Kramer and the majority of the council.   Moore wanted to build a shopping mall at Colesville and Georgia, and six 20 story office buildings.  This would have destroyed the 1938 movie theater which was unused at the time and the historic shopping center at the corner.  A group of us formed the Silver Spring/Takoma Park Traffic Coalition (STTC) which included historic preservation groups such as the Art Deco Society.  Much of our argument was that the Triangle project would result in way too much traffic for our area.  We also wanted to preserve history and create shopping which was street oriented and not in an enclosed mall.  Dorn McGrath developed an excellent design plan for the area and fortunately much of that vision has been realized by the ultimate development of Silver Spring.   I was a very active member of the leadership group, which was led by Pat Singer, and included Charles Wolf, Marc Elrich, Gene Lynch, the Gilsons and myself among others.   Marc and I set a limit on the amount of traffic that we would accept and the Council and Executive refused to accept our proposal.  I, once again, proposed legal action that played an important role in our fight against this project. 
    The county electorate was so upset with the overall growth policies of the Executive and the council majority that we soundly voted them out in the 1990 election and Neal Potter became County Executive.   Bruce Adams and Ike Leggett were the two council members who supported us the most in this effort.   After the elections, we ultimately killed the Silver Triangle project and the underpass proposals.   The rest is history for Silver Spring and many people, including Doug Duncan, had a hand in the ultimate incredible successful revitalization of downtown Silver Spring.   However, I believe the battle over schools and the Silver Triangle were keys to this success. 
    In the mid 1990s, I became involved in the efforts to build a new Blair High, either on the existing site or a new site.  The school was very overcrowded.  One of our goals was to keep the school population intact, primarily because we valued the diversity and also because we felt we needed the large population to support all the different academic groups of students. 
    I worked with a core group led by Laurie Steinberg and Jorge Ribas and included Dan Parr, Steve Silverman, Sally Sternbach and others.    We worked hard over several years to finally prevail in the battle.  I organized two rallies, one at the school and one at the council, in which we turned out between 1500 and 2000 people to pressure the council.   As is well known, the council agreed to our advocacy and built a new Blair on the Kay Tract at Four Corners that allowed the excellent programs to continue and expand intact.   Blair is a model for achieving diversity  and an outstanding educational program.
    Between 1976 and 2005, I worked for the U. S. Department of Health and Human Services with most of that time spent working in two different offices within the Centers for Medicare and Medicaid Services.   Some highlights of my accomplishments included:
    • Directed development of Medicare home health outcome measurement system, a national model for health care quality assurance systems. Led to 25% reduction in hospitalizations for home health patients.
    • Directed evaluation of prenatal care project which led to major expansions in Medicaid prenatal care program resulting in the prevention of birth defects in over 70,000 infants and savings of at least $3 billion. Project showed 33% reduction in low birth weight for demonstration group.
    • Directed a variety of projects that resulted in annual savings of over $7 billion per year to the Medicare and Medicaid programs.
    Toba has worked for the past 29 years as a medical social worker in kidney dialysis for Fresenius Medical Care.   She currently works in the Annapolis and Silver Spring clinics.  Deena graduated from Boston University Law School and is a supervising attorney with the House of Ruth, a Domestic Violence Program in Maryland.  She has been married for 3 years to Stephen Ronci, who works for Giant Foods as a meat cutter.  They live in Pasadena, Maryland.  Ariele graduated from the University of Delaware and is a paralegal in disability law and works for Andalman and Flynn in Silver Spring.  Ariele lives with her boyfriend, Dan Stromberg in Lexington Park, Maryland. Dan is under contract as an aeronautical engineer at Patuxent Naval Air Force Base.   So both daughters live within 90 minutes of us, which allows us the pleasure of seeing them often.
    I retired over 3 years ago and continue to be very active in a number of projects, such as Health Reform, American Association of Individual Investors, Safe Silver Spring,  three Purple Line organizations, Prezco, Indian Spring Citizens Association, and several Jewish Genealogy groups, among others. 
    I am thrilled to see how Silver Spring has been revitalized with an extremely successful Blair High, a downtown with a tremendous variety of restaurants, stores, and events, and that we retained our diversity.  What I am particularly conscious of is that when we come together as a community we are able to achieve major goals, for which I am grateful to have been a part.


                     TONY HAUSNER, Ph.D.   
    203 Brewster Avenue                                     
    Silver Spring, MD 20901                                 
    301-587-6943 (home)


    Managed Care, Drugs, Home Health              
    Management and Organization
    Policy, Research, Data Analysis                     
    Health Economics, Reimbursement, Quality of Care

    ¨       initiated and directed home health outcome project, which was adopted and embraced as a national system (OASIS) by HCFA and home health industry. Reduced hospital use by 25%.
    ¨       directed evaluation of prenatal care project which led to major expansions in Medicaid prenatal care program resulting in the prevention of birth defects in over 70,000 infants and savings of at least $3 billion.  Project showed 33% reduction in low birth weight for demonstration group.
    ¨       coordinated 23 workgroups which developed Medicare+Choice regulation.  This regulation, which represents one of the most significant changes in the Medicare program, was published timely 10 months after legislative enactment and ordinarily would have taken 3 years to publish.
    ¨       directed evaluation of home health prospective payment project which led to legislation passed by Congress. Involved extensive case-mix research.
    ¨       successfully directed over $30 million in grants and contracts, most of which have been cited nationwide and led to legislative changes.  Most involved multivariate statistical analyses.
    Annually, these projects save at least $7 billion and prevent birth defects in at least 6000 infants.


    Independent Health Policy Consultant           1/07 – present

    Organized phonebanks to lobby for health reform legislation and consulted on reform provisions. Contributed language to legislation. Provided consultations to major banking firm on projections of home health services.  Served as a lobbyist for Maryland health reform organization advocating for expansions of Medicaid program. 

    Senior Policy Analyst                                      1/93 – 12/06
    Baltimore, MD

    Co-coordinator, Medicare+Choice Program (see above). Wrote prescription drug benefit regulations. Developed legislative and regulatory proposals and comprehensive evaluation plan in managed care.  Specific areas include quality of care, physician incentive plans, employer coalitions, long term care, case management, vulnerable populations, cost-sharing, benefit plans,  electronic records, and access.  Work on quality of care included writing regulations and guidelines for managed care and prescription drug plans; developing pay for performance proposals; specifying quality measures for new plans, such as special needs plans; and developing performance measurement systems . Received numerous awards for this work.

    Research Fellow                                             9/00 – 3/01
    Washington, DC

    Fellow in HCFA’s New Perspectives Program. Directed research on home health prospective payment system and OASIS.  Performed analyses of legislative proposals. Published several articles, with recommendations that could potentially save home health several hundred million dollars per year.

    Senior Research Analyst                                9/79 ‑ 1/93
    Baltimore, Maryland

    Directed a number of grants and contracts totaling over $30 million which implemented or evaluated major Medicare and Medicaid demonstration and research programs.  Directed a $15 million task order contract of 25 projects that evaluated demonstrations in all areas within office, including HMOs, physician services, hospitals, and long term care.  Specific projects, which included over 300 clinics and $300 million, addressed prospective payment, competitive bidding, and quality for home health agencies; urban clinics; physician reimbursement; mental health and alcoholism centers; and maternal and child health services.  The evaluations focused on the impact of the demonstations on the cost, utilization, and quality of services.  Several reports were cited nationwide and led to significant legislative or policy changes resulting in savings of several billion dollars and reductions in 6000 birth defects per year.  Received numerous awards for this work.

    Professional Staff      7/90-11/90
    Washington D.C.

    Prepared report and generally assisted with arrangements for committee hearing on Medicare and Medicaid's 25th anniversary.  Worked on legislation dealing with Health Care Reform; Charity Care and Tax‑Exempt Status of Hospitals; Quality Assurance; Counseling of Medicare Beneficiaries; and Case Management.

    Health Statistician                                           2/76 ‑ 9/79
    Hyattsville, Maryland

    Policy development and evaluation research on the health of the disadvantaged, primarily with the health planning program.  Developed access guidelines and achieved agency approval through extensive negotiations.  Directed several nationally recognized publications.

    Management Analyst                                      6/75 ‑ 2/76
    Washington, D.C.

    Evaluated the impact of HUD and fair housing programs, particularly the FHA program, on minorities, women, and the poor.  Successfully negotiated for the development of management information systems.

    Director, Systems and Evaluation                  9/73 ‑ 12/74
    Cincinnati, Ohio

    Helped develop TASC by participating in negotiations with other organizations, recruiting and training of staff, program organization, and setting program objectives.  Specific responsibilities:  developed system to monitor clients' progress in treatment; directed development of computer‑based management information system; directed evaluation research.  These systems were cited nationally and locally for their accuracy and efficiency.  Proposed reorganization was cited as national model for TASC programs.

    Instructor, Psychology Department                9/68 ‑ 6/70
    Huntington, West Virginia

    Courses taught:  Introductory Psychology, Elementary Statistics,
    Experimental Psychology I & II (with labs), and others.


    UNIVERSITY OF KENTUCKY                     Ph.D. ‑ 5/75
    Lexington, Kentucky
    Major: Social/Community Psychology

    DUKE UNIVERSITY, M.A., ‘68         
    Durham, North Carolina                     
    Major:  Psychology                            

    Pittsburgh, Pennsylvania
    Major:  Chemical Engineering


    “Physician Incentive Plans in the Medicare Managed Care Program”, unpublished paper, Spring 2006.  Presented to the Managed Care Research Network, Fall 2005.

    “An Early View Of PPS.” NAHC Report, Numbers 899 and 900, February, 2001.

    “HCFA’s Quality Improvement Initiatives.” Caring, March, 2001.

    “Wound Care Supplies.” NAHC Report, December, 2000.

    “Comparison of Medicare Legislative Proposals.”  NAHC Report, October, 2000.

    “Summary of Medicare+Choice Program Regulation” Speeches presented to Urban Institute Seminar Series, and to State Health Insurance Counseling Programs Conference, Fall, 1998.

    “Medicare Managed Care and Persons with Disabilities” Paper presented at AAHP Conference, September 1997 and published on HCFA Internet Home Page,, September, 1998. (Co-author)

    “Physician Incentive Plans in Prepaid Organizations” Federal Register, March and December, 1996.

    "Purchasing Coalitions and Managed Care."  Managed Care Quarterly., vol. 3, Winter, 1995.

    Presider, Session on Quality of Care in Long Term Care Settings, American Public Health Association Annual Meeting, November, 1992.

    Speaker and Organizer, Session on "The Medicare Home Health Agency Prospective Payment Demonstration," National Association for Home Care Annual Conference, October, 1991.

    "Medicare and Medicaid's 25th Anniversary ‑ Much Promised, Accomplished, and Left Unfinished."  House Aging Committee Publication No. 101‑762, July, 1990. (co‑author).

    Presider, Session on Home Health Care in the 1990s: Public Policy Issues, Quality of Care, and Reimbursement, American Public Health Association Annual Meeting, October, 1990.

    Presider, Session on Quality of Home Care, American Public Health Association Annual Meeting, November, l987.

    "A Multidimensional Approach to Case Mix for Home Health Services." Health Care Financing Review, vol. 8, Summer, l987. (Primary author: Ken Manton).

    "The Impact of the Municipal Health Services Medicare Waiver Program." Health Care Financing Review, vol. 8, Spring, l987. (Primary authors: Gretchen Fleming, Ron Andersen, et. al.)

    Presider and Presenter at Session on the Medicare and Medicaid Alcoholism Services Demonstration, American Public Health Association Annual Meeting, November, 1985.

    "Low Birth Weight Rate Reduced by Obstetrical Access Project."  Health Care Financing Review, vol. 8, Spring, l987. (Primary authors:  Athole Lennie and Joseph Klun.) 

    Presider, Session on The Municipal Health Services Program:  Medicare and Medicaid Join Forces with City Governments to Provide Primary Care, American Public Health Association Annual Meeting, November, 1984.

    "Integration of Social Survey and Program Data to Evaluate the Municipal Health Services Program."  Proceedings from 1983 Public Health Conference on Records and Statistics. (co‑authors)

    "Evaluation of the Medicare Mental Health Demonstration."  Paper presented at American Public Health Association, November, 1981. (co‑authors)

    "Factors Affecting Representation of Minorities and the Disadvantaged in Health Planning Agencies."  J. Health Human Resources Admin., vol. 5, no. 2, Fall, 1982. (co‑authors)

    "The Use of Community Based Services in Long‑term Care by Older Minority Persons." Gerontologist, 19, 389‑397, 1979.  (Primary authors: M. Holmes, D. Holmes, L.  Steinbach and B. Rocheleau).

    "Are Health Systems Agency Boards Representative of Minorities and Women" in
    R. Alvarez (ed.) Discrimination in Organizations.  Josey‑Bass, San Francisco, Fall, 1979. (Paper presented at UCLA Research Symposium, April, 1977).

    Project Report ‑ Health Planning Agency Composition, 1976.  HRA 78‑610, Fall, 1978.

    Project Summary ‑ Board and Staff Composition of Health Planning Agencies.  HRA 78‑609, February, 1978.

    Health of the Disadvantaged ‑ Chartbook.  HRA 77‑628.  September, 1977.

    New Methods to Assess the Behaviorial Consequences of Delinquency Treatment Programs.  Unpublished Ph.D. Dissertation.  University of Kentucky, May 1975.  (See Dissertation Abstracts, 36/6, 1975).

    Several published papers can be seen at

    Web sites I manage or involved with 

    Tony Hausner
    Silver Spring, MD
    home: 301-587-6943
    cell: 301-641-0497
    skype: thausner
    on facebook and twitter