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Friday, April 19, 2013

THE FUTURE OF HEALTH INSURANCE

 

Perhaps  the term “Health Insurance”  has become an oxymoron. Health Insurance now has become a waste-basket term that encompasses many different categories for medical bill reimbursement.

McCallister retiring Jan. 1Bruce Broussard, CEO of Humana Inc..

Here's what Humana's CEO has to say about the future of health insurance.

“The health care system of the future will likely come with fewer guarantees,In other words, rather than offering a health plan, employers will probably begin offering specified payments and telling their employees to buy their own insurance.

“Our role becomes a role around health more than just the financing of health care,” he said.

“What happened to retirement is probably going to happen to health care, The shift, from defined-benefit to defined-contribution plans, is exactly what happened when 401k retirement accounts replaced pensions.”

Broussard’s forecast reveals that the insurance companies no longer think of themselves as insurers based upon risk.  Risk is being removed from the underwriting of health events.

Broussard and the others in the C-suites of health insurance companies have a crystal ball far more accurate than the Washingtonians and academicians who don’t have a clue as to what the ACA is doing and will do in the next decade.

In one full swoop Congress has entangled the entire federal government and state governments in delivering health care, along with commerce, defense, and international relations. 

I have ‘such a headache' !”

Did President Obama miscalculate ?

 

Thursday, April 18, 2013

Celebrate the Success in Improving the Lives of Patients with Cystic Fibrosis

 

Each year the Cystic Fibrosis Foundation reaches out and has been successful in raising funds for research in cystic fibrosis to develop treatments for this terrible disease. And the progress has been enormous since 1990 in diagnosis, locating the exact gene that regulates the chloride transfer gate in the cell walls of the lungs and intestinal mucosa.

The extent of this fatal genetic flaw reaches far beyond what I can say in this blog. Cystic fibrosis kills slowly…first by starvation and wasting, and then by pulmonary insufficiency.  It is not a pleasant sight to watch a child to fail to thrive, struggle to breathe, and eventually look like a victim of famine.

There is no cure, but these successful treatments have increased the average life expectancy from 12-16 years old in 1990 to 37 in 2013. This generation has benefitted beginning in 1993 with the development of a genetically engineered enzyme that liquefies thick mucus in the lungs, and also enzymes that allow fat and proteins  to be digested and absorbed in the intestinal tract.

Cystic fibrosis is a family disease, not just by inheritance but also how it affects the finances, daily living, and resources for brothers, sisters and parents.  Untreated, it leads to a quick death, yet prevention is a daily task which can be very successful in significantly improving the quality of life for those with CF and their loved ones.

Robert J. Beall, PhD, President of the CF Foundation tell us,

“Last year was an incredible year at the CF Foundation. People like you have shown their support and dedication to finding a cure for CF. Your generous support paved the way for the groundbreaking treatment, Kalydeco™ , the first drug to treat the underlying cause of CF.


While Kalydeco is effective for about 4 percent of patients who have a specific gene mutation, this advance brings hope to all people with CF. Kalydeco has provided us with a “road map” that is already leading to the development of more promising treatments for all with the disease.


We have made real progress toward a cure, but our work is far from over.
We will not rest until a cure is found for all people with CF.
Right now, we are expanding our research partnerships with biopharmaceutical companies and laying the groundwork to develop new therapies.


As we continue to pursue every opportunity to help develop new lifesaving therapies for people with CF, it is more important than ever that patients can access these treatments. The need for our advocacy and patient assistance programs has never been greater.
To make sure that critical research and care initiatives continue we have set an ambitious goal for the 2013 Annual Fund: $2.5 million.”

Each year in localities near you there is a ‘Great Strides’ for Cystic Fibrosis Event. It is a wonderful opportunity to sponsor or be sponsored and keep fit while creating donations for the Cystic Fibrosis Foundation.  For specifics you can go to the registration page and log in.


Help make progress possible. Please join Partners in Progress.

 

Fitness and the Internet

 

 

Do you sit in an office chair for more than six hours a day? If so, your risk of heart disease has increased by up to 64 percent. Some users who are required to be on the internet most of the day use a stand-up desk and can walk or exercise in place. These handy add-ons will help remind you to get up and move around!

Mobile health applications have been around for some time already. Nike has their own remote monitoring devices, such as FitBit as well as several other provide incentives for exercise and fitness.

Mozilla has entered the arena now as well, with the announcement of several new browser add ons for their Firefox Web Browser that remind the user that it is time to take a break from computing.

Consider this, from the software developers at Firefox

“We are now a world of people who are plugged-in 24/7. We’re always looking at our computer screens and our mobile devices. It helps us stay informed, educated and entertained, so it’s a good thing!

But more and more stories are coming out in the media about how bad it is to sit at our computers/devices all the time. We need to stay active!

Guess what? Firefox gives me (and you) solutions, built right into my browser. That makes it easy to do something about it!

The easiest option is an add-on called Simple Timer. It is super customizable and allows you to select when you want to receive a notification. You can set as many as you want. I set it up to alert me every hour as my reminder to get up!

Then there’s the Take a Break add-on which flashes a little icon every 15 minutes to remind you to take a mini break – close your eyes, look away from the screen, etc. Then a pop-up box will remind you to take a bigger break each hour to stretch, get a drink of water, etc. You can adjust the timers to suit your schedule.

 

If you’re like me, you know you need to take a break but you don’t know what to do with yourself. That’s why StretchClock holds a special place in my routine. Not only do you get an hourly (that’s customizable) alert, but it gives you a suggested stretch or exercise to get that blood flowing!

 

Courage in Sports: Jerry Cahill - YouTube : CysticFibrosis

Courage in Sports: Jerry Cahill - YouTube : CysticFibrosis


"You cannot fail ! "

Wednesday, April 17, 2013

News-Analytics or Newsana

 

The impending demise of google reader has stimulated us to search for other sources of breaking newsworthy subjects.-`

Health Train Express and Digital Health Space curate news from many independent blogs, health publications, foundations, information technology resources.as well as official government sources.

We are pleased to announce we have been invited to join Newsana (beta). Newsana opens an entirely new and rich interactive resource for our readers.

In the next several weeks you will see content from Newsana. At the same time we will be feeding our blog postings to Newsana.

You may also request an invitation to the Newsana (beta). I invite commentary about our new relationsip with Newsana.

 

Gary Levin MD  Founder & Publisher

 

Technorati Tags: ,,,

Monday, April 15, 2013

Patient Centered Reception Areas

 

I don’t think many patients could resist interfacing with this ‘art’. They might even forgive the long wait to see their physician.

 

I cannot and won’t add much to this beautiful digital art.

 

Technorati Tags: ,,,

Sunday, April 14, 2013

Where is Your Center ??

 

Image

 

The patient is the center of our universe. Although pundits and bureaucrats emphasize this,  many of their edicts and actions run counter to this proposal.

I remember an event in residency when after a long night on call, one of my junior residents was complaining how tired and angry he was with patients calling in during the early morning hours with what he thought were ‘spurious’ and unnecessary calls.  Granted he and many of us were doing every other night call and working over 100  hours/week. (back in 1977).  

As it turned out the head of our department overheard his complaints about “foolish calls’ from patients.

It was as I like to call it ….a Bob Hope Moment’  as written in The Laugh Makers.

Our chief came back with his one liner, “That is why you have a job !”

For my junior resident it was probably a scary moment to be caught in the act of disparaging a patient in need.  For me it was a poignant moment in training which has  stayed with me for over 30 years of medicine.

It was my introduction to ‘Person-Centered Healthcare’, in 1976 long before the current shift from disease centered management to patient centric healthcare.

In an outpatient environment it is easier to maintain patient centered care and management.  In an inpatient setting it is far more difficult.  In the hospital environment compressing activities into a limited time frame is mandatory. Patients cannot just drop in for an MRI, lab work, or surgery.  Medical emergencies occur more often in hospital and the most critically ill patients are placed in an ICU so that their level of intense care is isolated and does not impact more routine hospital care.

Medicare and payers limit hospital length of stay according to diagnosis and/or procedures. Inpatient stays that are in excess of a standard length are not reimbursed, and require additional paper work for authorization and payment.

The centricity of patient care in the hospital requires some additional steps for providers, and their extenders (nurses, therapists, administrative clerks and others who have contact with a patient.  Many of these requirements apply to other businesses, and in many cases hospitals have adopted these subtle techniques.

Patients by and large are very unfamiliar and anxious about hospital admissions.  Anxiety can affect outcomes, if excessive.   Frequently patients may exhibit the worst of their personalities under this stress, requiring additional time on  the part of staff.

It helps me to remember

1. No one wants to be ill (even addicted drug dependent patients).

2. No one wants to go into a hospital, except perhaps to give birth, and then there is anxiety about pain, and a healthy newborn.

3. Illness brings out strange behavior in patients, that can only be measured in relation to the perceived threat by the patient.

4. I would be out of my job were it not for ill people. 

5. Few people will pay to stay well even though most of preventive medicine is relatively inexpensive. 

       a. Good nutrition, balanced diet, special attention to nutritional   

       requirement of some diseases, ie diabetes, hypertension, cystic

       fibrosis.

       b. Routine exercise programs, with special attention to

           physical challenges

       c. Risk evaluation for a patient related to family history, genetic    

           profile, and past medical history.

       d. Emotionally balanced life style.

6. The realization that Most of my stressors  are not driven by patient demands, but from bureaucrats, and payers. In other words it is not the patients’ actions causing difficulty.

Saturday, April 13, 2013

Direct Pay and Concierge Medical Practice

 

Many physicians as they continue to practice medicine in an increasingly hostile environment attempt to remove aspects of their business which increase work loads at diminishing yields. I use a term coined by T. Boone Pickens (the Oil Entrepreneur who now favors recyclable energy sources, such as wind, and solar power)

He coined the term “PEAK OIL” which defines the point at which it takes more energy to find, drill, and extract oil than the energy yield from the oil.

Health care and medical care has also reached “PEAK HEALTH”

Increased administrative costs are bleeding our health system, not just for Medicare and Medicaid but private insurance and private practices.

Some physicians eliminate much of the insurance bureaucracy by refusing to accept insurance companies. They accept only direct pay…via cash, credit cards, checks or barter.  By refusing to accept Medicare/medical/ and insurers many regulatory requirements no longer apply

In addition to direct pay many communities will have access to a cooperative payment method based on direct pay and administered and controlled by your local community.

MedAccess USA will provide such a structure. It is currently in development with a planned roll out in January 2014.

How would a Direct Care Practice Work For You?

The Direct Care Consulting Calculator

will analyze the results for your practice if you convert a portion or your entire practice to direct pay.

Instructions: Follow the three simple steps.

  • Step One is about your current practice
  • Step Two is about how many Direct Care Patients YOU want in your practice
  • Step Three is to calculate the Revenue Numbers

    Some Physicians choose to enhance their annual revenue by adding a per visit fee or a per minute fee for patient visits. Contact us Today! To learn how you can price your practice!

  • MedAccess is recruiting providers interested in enrolling in the cooperative. There is no obligation. Contact MedAccess at  mdtaber@mac.com  Also please support our effort to develop a CMS direct pay model by contacting your Congressman and ask  them to support Congressman Alan Grayson’s letter to CMS innovation program on Direct Pay and MedAccess.

  • Health Train Express Wheels

     

    My Wheels are coming off the bus !

    Patients undee the bus

    Like most of my readers we use RSS feeds to receive timely updates of blogs, news, and web sites.

    My favorite reader has been Google Reader, which depends upon ‘Feedburner’.  Google  has  deprecated Reader.

    In my mind this is much like the telephone evolving from a rotary dial to a push button interface.

     

    Much has changed in the past ten years, including the growth of social media on many platforms.  Some say RSS feeds are on the way out with less usage.

    I have not yet reached that point, and have researched several other RSS feeds.

    Here are my choices ranked in order.

    Old Reader

    Feedly

    Newsblur

    Over the next several weeks we will be experimenting with different RSS feeds.

    The important thing for my readers to know is that if you are following the blogs, check what RSS feed you are using…Health Train and Digital Health Space will be listed on Feedly, Old Reader, and Newsblur.

     

    Tuesday, April 9, 2013

    CMS SENATE COMMITTEE HEARINGS ON NEW HEAD OF MEDICARE

     

    This morning at 10 AM the CMS witness hearing will be broadcast. We are privileged to bring you the link for the live broadcast from the Senate Hearing Room on Capitol Hill.

     U.S. SENATE COMMITTEE ON FINANCE

    Marilyn Tavenner   Acting Administrator CMS

    Hearing Live:

    Transcript of Testimony:

    Chairman Baucus

    Orin Hatch

    Witness Testimony   Candidate Marilyn Tavenner (Currently serving at temporary Head of CMS) 

     

    Courtesy of the Hearing Channel of the U.S. Senate.

     

    Monday, April 8, 2013

    A Smorgasbord of Health News

     

    The Medical Minute brought to you from a variety of sources.

     

    Pentagon Struggles With High Cost Of Health Care WASHINGTON -- The loud, insistent calls in Washington to rein in the rising costs of Social Security and Medicare ignore a major and expensive entitlement program – the military's health care system.

     

    The Drug War And Mass Incarceration By The Numbers

    NEW YORK -- Despite an increased emphasis on treatment and prevention programs in recent years, the Obama administration in its 2013 budget still requested $25.6 billion in federal spending on the drug war. Of that, $15 billion would go to law enforcement, interdiction and international efforts.

    The pro-reform Drug Policy Alliance estimates that when you combine state and local spending on everything from drug-related arrests to prison, the total cost adds up to at least $51 billion per year. Over four decades, the group says, American taxpayers have dished out $1 trillion on the drug war.

    What all that money has helped produce -- aside from unchanged drug addiction rates -- is the world's highest incarceration rate. According to the Sentencing Project, 2.2 million Americans are in prison or jail.

     

    Health Care Curbing Government

    FILE - In this March 19, 2010, file photo, President Barack Obama speaks about healthcare reform at the Patriot Center at George Mason University in Fairfax, Va. Back when the big health care law was little more than a dream, and when he was a presidential hopeful, Obama spoke out against the idea of forcing people to get health insurance. He said that would be like solving homelessness by passing a law making people buy a house. (AP Photo/Charles Dharapak)

     

    Big Pharma Pockets $711 Billion in Profits by Robbing Seniors, Taxpayers  Here's an outrage that must be changed: Big Pharma has been systematically price-gouging the Medicare program for seniors and people with disabilities -- and raking in billions in excessive profits. The 11 largest global drug companies made an astonishing $711 billion in profits over the 10 years ending in 2012, and they got a turbo-charged boost when the Medicare Part D prescription drug program started in 2006, according to an analysis of corporate filings by Health Care for America Now (HCAN).

    Combined Net Profits of Top Pharmaceutical Companies Medicare Part D

     

    Ex-Felons Are About To Get Health Coverage 

    Newly freed prisoners traditionally walk away from the penitentiary with a bus ticket and a few dollars in their pockets. Starting in January, many of the 650,000 inmates released from prison each year will be eligible for something else: health care by way of Medicaid, thanks to the Affordable Care Act.

    A sizeable portion of the nearly 5 million ex-offenders who are on parole or probation at any given time will also be covered.

    The expansion of Medicaid, a key provision of the health care reform law, is the main vehicle for delivering health insurance to former prisoners.

     

    How Health Insurance Giants Can Avoid Obamacare Regulations For A Whole Year 

       Health insurance companies are looking to put off complying with health care reform rules that guarantee basic benefits and consumer protections -- and they've figured out how to do so for up to one more year.

    The health care law requires insurance plans sold to individuals who don't get benefits through their employers to cover a minimum set of benefits, prohibits companies from refusing to cover people with pre-existing conditions or to charge them higher rates than healthy people, doesn't allow health insurers to levy higher premiums on women than men, limits how much more older people can be made to pay, and guarantees customers can re-up their plans each year.

    But those rules don't take effect until January -- or whenever a customer's current health insurance plan expires next year, which could be later. According to the Los Angeles Times, some insurers are weighing a lawful scheme in which they would renew customers' plans before 2014, thus preventing them from having to meet Obamacare standards until as late as Jan. 1, 2015.

     

    Obama's Budget: Medicaid Would Be Spared From Deep Cuts 

    WASHINGTON — President Barack Obama's budget next week will steer clear of major cuts to Medicaid, including tens of billions in reductions to the health care plan for the poor that the administration had proposed only last year.

    Big cuts in the federal-state program wouldn't go over too well at a time that Health and Human Services Secretary Kathleen Sibelius is wooing financially skittish Republican governors to expand Medicaid coverage to millions who now are uninsured. That expansion in the states is critical to the success of Obama's health overhaul, which is rolling out this fall and early next year.

    The president's budget is to be released next Wednesday.

    Perhaps half the nearly 30 million people gaining health insurance under the law are to be covered through Medicaid. But the Supreme Court last year gave individual states the right to reject the expansion. A principal argument against the expansion in state capitals is that Washington cannot be trusted to keep its promise of generous funding for new Medicaid recipients.

     

    And Now a Word from Our Sponsors (Of yesteryear)

     

    With the Recent trend toward Health, Wellness and Prevention these advertisement would never make it in today’s world.

     

    Employers Adopt Stricter Health Care Policies In Face Of Surging Costs

    Faced with rising health care costs, employers are adopting stricter policies to keep workers healthy. Failure to comply with those measures could hurt employees' wallets.

    Employer Health Care

    Is it time for the Michelin ‘Marshmallow’ to go on a diet?

    Workers at tire manufacturer company Michelin could miss out on reducing their deductibles by up to $1,000 if they show unhealthy signs like high blood pressure or waistlines over 40 inches, The Wall Street Journal reports. Companies such as Wal-Mart and Home Depot have similar policies, designed to reduce surging health care costs. But often these new policies require employees to share personal health information, something critics say is both unfair and an invasion of privacy.

    With health care costs rising in 2012 to $12,136 per employee on average, according to a recent study, companies argue that the new policies not only help cut costs, but also contribute to the overall well being of their workforces.  Indeed, Michelin told The Huffington Post that The Wall Street Journal’s claim that the company is penalizing workers for showing signs of obesity is not accurate. Instead, the new policy set to take effect next year “helps us help our employees” by rewarding workers who meet standards for at least three of five health indicators, such as waist size, cholesterol and blood pressure.

     

    Sunday, April 7, 2013

    Marilyn Tavener and Senate Confirmation Hearing as Head of CMS.

    Marilyn Tavener

    Perhaps the most important position along side the Head of Health and Human Services is the long awaited appointment of a permanent Head of CMS (previously known as Medicare.  The name change was made to cancel out the previous effects of Medicare’s triumphs and failures. 

    Congress always seems to misstep approvals and/or denials to confirm this position. It would seem that this seat would be far less political than other cabinet seats, such as DOD, Commerce, State, etc.

    However given now that health consumes 17% of GDP, and also provides jobs to a large percentage of the employed the position now is crucial for budget planning and it’s indirect effect on debt.

    Health Train Express has prioritized these hearings for the week in lieu of our usual health care social media, health reform and health information technology news.

    The hearings are being carried live on the web, 7 AM PDT/10 AM EDT.

    During a time when so much is changing in health care it seems almost negligent to have had a temporary appointment for so long following Don Berwick’s resignation.

    Common sense would indicate this is a ‘hotspot’ for the Obama Administration, and Berwick’s honest appraisal of the British Health System was a ‘faux paux’ and created  a  nuclear exchange for policy makers.  Many brilliant minds have been ignored at the whims of political executioners . Dr Berwick’s signature comment,

    Donald Berwick MD

    "I am romantic about the NHS; I love it.  All I need to do to rediscover the romance is to look at health care in my own country." 

    With this one remark, Don Berwick relegated  himself to the chopping block. However it was not his final answer.  Dr Berwick has taken up a role in the NHS program for improving safety

    However despite that Berwick has been tapped to improve safety for the U.K. NHS.

    Stay tuned and don’t miss the Senate Hearings on April 9 2013 Tuesday, 7AM  PDT  10 AM EDT.