Regina Holliday's Medical Advocacy Blog: Dark Willow and "73 Cents"

Pain and suffering are common to being human. It often seems to be the great catalyst that produces brilliance and genius in music, writing, painting and creative endeavour.


This is certainly true of Regina Holladay, a woman I have followed for many years. No, I am not a lurker, but a great admirer of this gifted lady who took lemons and made lemonade.


I hope you will feel what I feel every time I read her blog or see her paintings in The Walking Gallery. Every physician should see her exhibits.  Every physician should have one of her paintings on his back of his white coat, or in his office.


Regina Holliday's Medical Advocacy Blog: Dark Willow and "73 Cents"

My Most Popular Blog (As told to me by Blogger)

Every once in awhile (like every day) I look back over my shoulder to see who is following me. (No, I am not paranoid, just narcissistic). I don't rank very high in social media or the blogosphere, and I have been at blogging since 2005. Many bloggers have fallen by the way in these ten years...some of them very good. Why am I still here ? I am a creature of habit...bad ones as well as good.  After ten years of dedication, discipline, good will, offending some,  and encouraging a few I am somehow pleased that I have had a forum to collate and be creative at times.

I average about 75-110 'hits' each day. The numbers are less than what I would expect or desire. However the interesing data that sticks out on Feedjit is the global impact of my blogs, U.S.,Canada and the highest and Romania, Thailand, India, Russian Federation, Phillipines, and our friends in the U.K.

Yesterday my count was over 230. It doubled and I had to know why. It was not the content. I looked at the title "revolutionary","healthy, #wellness". I have used those terms before, but never had this kind of response. I use buffer, newsana, digg, reddit, Google + and Facebook at times. (all the SEOs and experts on social media marketing advise that avenue.

Then it struck me. I use many hashtags, my most popular ones are #hcsm #hitsm #mhealth #cms #medicare #doctors and a few others I cannot remember. Yesterday I looked at the trending hashtags of twitter. I used the highest hashtags in my buffer.

Voila!

#espy

Go look it up.....who wuda known?

Revolutionary Way to Be Healthy #10: See the Bigger Picture | Pilar Gerasimo

There are an overwhelming number of ways to maintain good health. The variations for maintaining good health  are as abundant as the number of people.

Your health effects those all around you. Good health and vitality influence your friends,family and co-workers.

Typically, when we want to check our health and fitness progress, we step on the scaleor look in the mirror. But when it comes to well-being, what you see isn't always what you get -- or at least, not all that you get.

We've been inclined to believe that pursuing health and fitness is predominantly self-focused, and that we alone stand to profit from the results.

Nothing could be further from the truth. Certainly, whenever we change our lives for the healthier, there's a lot in it for us as individuals: more energy, strength, confidence, vitality, mental clarity, better moods, improved appearance, lower disease risks, and so on.

But there's just as much in it (if not more) for all the people, places, and projects that we touch during the course of our daily lives.

They imply that the central rewards of health and fitness are largely derived from appearing healthy and fit, and by extension, from impressing others (or avoiding their judgment).

And so, within the vast and deep slipstream of positive results created by healthy lifestyle changes, we've tended to focus on only a comparatively narrow and superficial band.

Of course, there's nothing wrong with wanting to achieve appearance-related changes. In fact, the aesthetic rewards that go along with healthy body transformations have some very real superpowers. (I'll get to those in a moment.)

But in many cases, some of the biggest payoffs of our healthy changes have less to do with us than with the people, places, and things that matter most to us.

The reality: When you make even a modest improvement in your health status, or in even a single health habit, a whole bunch of people around you invariably benefit -- regardless of whether they (or you) happen to realize it at the time. And being even marginally aware of this dynamic can serve as a powerful intrinsic motivator.

Psychological research suggests that intrinsic motivators (those connected with our sense of enjoyment, value, or meaning) are dramatically more powerful and long lasting than extrinsic motivators (those connected with our desire to impress others, win material rewards, avoid punishments, or comply with social expectations).

By expanding your awareness of the potential intrinsic rewards embedded in the fabric of your life, you can tap into a new reservoir of motivation. The kind of meaningful motivation that comes in very handy on those days when bikini-body and flat-abs promises seem to have lost their luster, and the appeal of eating caramel corn in front of the television seems especially strong.

Revolutionary Way to Be Healthy #10: See the Bigger Picture | Pilar Gerasimo

Here are just a few bigger-picture factors to keep in view.

• Relationships. Your level of health, vitality, self-esteem, and equanimity all powerfully influence how you show up for other people. Reflect on what you are like to be around when you are healthy versus unhealthy. Think about how your needs, resources, and capacity shift, and the potential support or pressure that shift creates for others (family, friends, kids, coworkers). As you get healthier and happier, the people closest to you are the most likely to benefit -- and to be inspired by your example.
• Professional Chops. We tend to accomplish a great deal more when we are strong, clear-headed, and confident than when we are sick, tired, and "meh." Which is why most employers today are less concerned about absenteeism than"presenteeism" -- an increasingly common dynamic in which people physically show up at work but don't contribute much. The level of drive and focus you have available to bring to your career and creative pursuits depends heavily on your level of physical, mental, and emotional health.
• Community. The healthier you are, the more surplus energy and attention you can contribute to causes and community efforts. It's much harder to get out and volunteer, to be engaged with your neighbors, to focus on communal concerns, when you aren't feeling your best. Which is why health-motivated people are often the ones who start community gardens, launch local walking and yoga groups, advocate for healthier school lunches, and crusade for other healthy causes.
• Storytelling. As you shift your life, and as you share the story of your journey, you create a bread-crumb trail for others to follow. This can have surprising and long-lasting effects -- many you will never know about, and, likely, some that will outlive you.
• Silent Influence. As you go about your healthy business, other people notice and may begin to model their behavior on yours. The visible changes in your body can function as a superpower catalyst for others ("You look amazing! What are you doing differently these days?"), but ultimately it's learning what you know, and seeing what you do, that winds up having the biggest impact. And don't forget about your healthy diaspora: All the people you inspire will ultimately go out and inspire a whole bunch more people.

I had a neat experience recently that illustrated this last point for me. A woman I helped many years ago -- an overstressed nurse practitioner who was then going through a health and life crisis of her own -- wound up getting some coaching that I recommended based on my own experience.  She shifted her daily priorities and choices, started taking better care of herself, got trained in functional medicine, and, to my surprise, wound up becoming one of the first members of the medical team at Life Time's new LT Proactive Care Clinic. (For more of her story, see "The Nurse Who Learned to Heal Herself First".)

Nurses, care givers go the extra mile to help others, and they forget the most important person who requires nourishing. THEMSELVES. 

So go ahead: Look in the mirror -- and see the bigger picture. When you change your life for the better, everyone around you changes for the better too, even if only by having witnessed the changes you've made and realizing they are possible.

REVOLUTIONARY READING

"Get Your Groove Back" -- Dr. Frank Lipman on why finding your body's natural sleep cycle and circadian rhythms is the key to strength, vitality and wellness.

"Fearless Health" -- Worrying excessively about our well-being can do us more harm than good. Here's how to keep your health concerns in perspective.

"With Power, Responsibility" -- It's time for us to start taking better care of our amazing bodies -- and for healthcare to start raising its game.

"Fresh Start: A Spring Detox Guide" -- Say goodbye to internal grime and grunge. Your body is begging you to take out the trash!

Pilar Gerasimo is a nationally recognized healthy-living expert, author of A Manifesto for Thriving in a Mixed-Up World, and the creative force behind the 101 Revolutionary Ways to Be Healthy. She serves as senior vice president of Healthy Living for Life Time, the Healthy Way of Life Company, and is currently working on a book about the art of being healthy in an unhealthy world. Learn more about Pilar's work and connect with her via social media at PilarGerasimo.com.

Follow Pilar Gerasimo on Twitter: www.twitter.com/pgerasimo

Telemedicine Puts a Doctor Virtually at Your Bedside

In just the past three months telemedicine has grown exponentially. It has entered the main stream of medicine. Several hospital chains are using Teladoc. Some providers are concerned about remote diagnosis. Telehealth will meet specific guidelines for it's use.  In rural areas where providers are not available, it could make the difference between life and death. In instances where patients present in an emergency department with vascular emergencies, stroke in particular there is a very  narrow time window for treatment with drugs that prevent  clots or dissolve them.

In some situations such as academic medical centers the appropriate physicians are in hospital.   However in most community hospital settings they  are  not.  The video demonstrates availability of a neurologist in less than 6 minutes.  A nurse or  emergency department physician can conduct a physical examination while the consultant observes.  If indicated the treatment can  begin immediately. A history is already available or can be obtained in  real time. Time is then  available for the neurologisit or other specialist to arrive and see the patient face-to-face.  Telehealth will never replace a  physician visit, only augment his arrival at the scene.

Hospital and emergency department studies  reveal that only a few patients are now treated within the recommended time frame. The time difference can mean the difference between successful treatment or serious disability and even death.

The most significant barrier is that each state has it's own medical board, and it will require changes in physician regulations by 50 different state medical boards. It will also require Medicare and private insurers to cover this as a eligible charge.  While Medicare and private insurers have expressed concern about additonal costs during an era of cost containment in  the long run hospitalizations, and periods of rehabilitation as well as a decrease in permanent disability would offset the initial cost.  A 48-72 hour hospitalization is significantly less that a 7-10 admission.

Physicians must insist that their medical boards allow this to proceed without sanctioning physicians and/or hospitals for providing this needed service for patients.  State medical societies, and appropriate specialty societies also need to weight in with this as a standard of care.  The evidence is already present.

References

1: Zerna C, von Kummer R, Gerber J, Engellandt K, Abramyuk A, Wojciechowski C,

Barlinn K, Kepplinger J, Pallesen LP, Siepmann T, Dzialowski I, Reichmann H,

Puetz V, Bodechtel U. Telemedical Brain Computed Tomography Misinterpretation by

Stroke Neurologists Is Not Associated with Thrombolysis-Related Intracranial

Hemorrhage. J Stroke Cerebrovasc Dis. 2015 Jul;24(7):1520-6. doi:

10.1016/j.jstrokecerebrovasdis.2015.03.022. Epub 2015 Apr 11. PubMed PMID:

25873473.

2: Liebeskind DS. Response to letter regarding article, "art of expertise in

stroke telemedicine: imaging and the collaterome". Stroke. 2015 Jun;46(6):e152.

doi: 10.1161/STROKEAHA.115.009327. Epub 2015 Apr 16. PubMed PMID: 25882052;

PubMed Central PMCID: PMC4442038.

3: Uchino K, Rasmussen PA, Hussain MS; Cleveland Pre-Hospital Acute Stroke

Treatment Study Group. Letter by uchino et Al regarding article, "art of

expertise in stroke telemedicine: imaging and the collaterome". Stroke. 2015

Jun;46(6):e151. doi: 10.1161/STROKEAHA.115.009214. Epub 2015 Apr 16. PubMed PMID:

25882054.

4: Moloczij N, Mosley I, Moss K, Bagot K, Bladin C, Cadilhac DA. Is telemedicine

helping or hindering the delivery of stroke thrombolysis in regional areas? A

qualitative analysis. Intern Med J. 2015 Apr 22. doi: 10.1111/imj.12793. [Epub

ahead of print] PubMed PMID: 25904209.

5: Fong WC, Ismail M, Lo JW, Li JT, Wong AH, Ng YW, Chan PY, Chan AL, Chan GH,

Fong KW, Cheung NY, Wong GC, Ho HF, Chan ST, Kwok VW, Yuen BM, Chan JH, Li PC.

Telephone and Teleradiology-Guided Thrombolysis Can Achieve Similar Outcome as

Thrombolysis by Neurologist On-site. J Stroke Cerebrovasc Dis. 2015

Jun;24(6):1223-8. doi: 10.1016/j.jstrokecerebrovasdis.2015.01.022. Epub 2015 Apr

20. PubMed PMID: 25906936.

6: Choi YH, Park HK, Ahn KH, Son YJ, Paik NJ. A Telescreening Tool to Detect

Aphasia in Patients with Stroke. Telemed J E Health. 2015 May 5. [Epub ahead of

print] PubMed PMID: 25942492.

7: Yaghi S, Harik SI, Hinduja A, Bianchi N, Johnson DM, Keyrouz SG. Post t-PA

transfer to hub improves outcome of moderate to severe ischemic stroke patients.

J Telemed Telecare. 2015 May 10. pii: 1357633X15577531. [Epub ahead of print]

PubMed PMID: 25962653.

8: Torres Zenteno AH, Fernández F, Palomino-García A, Moniche F, Escudero I,

Jiménez-Hernández MD, Caballero A, Escobar-Rodriguez G, Parra C. Mobile platform

for treatment of stroke: A case study of tele-assistance. Health Informatics J.

2015 May 14. pii: 1460458215572925. [Epub ahead of print] PubMed PMID: 25975806.

9: Yuan Z, Wang B, Li F, Wang J, Zhi J, Luo E, Liu Z, Zhao G. Intravenous

thrombolysis guided by a telemedicine consultation system for acute ischaemic

stroke patients in China: the protocol of a multicentre historically controlled

study. BMJ Open. 2015 May 15;5(5):e006704. doi: 10.1136/bmjopen-2014-006704.

PubMed PMID: 25979867; PubMed Central PMCID: PMC4442242.

10: Bladin CF, Molocijz N, Ermel S, Bagot KL, Kilkenny M, Vu M, Cadilhac DA; VST

program investigators. Victorian Stroke Telemedicine Project: Implementation of a

new model of translational stroke care for Australia. Intern Med J. 2015 May 26.

doi: 10.1111/imj.12822. [Epub ahead of print] PubMed PMID: 26011155.

11: Zerna C, Siepmann T, Barlinn K, Kepplinger J, Pallesen LP, Puetz V, Bodechtel

U. Association of time on outcome after intravenous thrombolysis in the elderly

in a telestroke network. J Telemed Telecare. 2015 May 29. pii: 1357633X15585241.

[Epub ahead of print] PubMed PMID: 26026178.

12: Ward MM, Ullrich F, MacKinney AC, Bell AL, Shipp S, Mueller KJ.

Tele-emergency utilization: In what clinical situations is tele-emergency

activated? J Telemed Telecare. 2015 May 29. pii: 1357633X15586319. [Epub ahead of

print] PubMed PMID: 26026189.

13: Weber J, Ebinger M, Audebert HJ. Prehospital stroke care: telemedicine,

thrombolysis and neuroprotection. Expert Rev Neurother. 2015 Jul;15(7):753-61.

doi: 10.1586/14737175.2015.1051967. PubMed PMID: 26109228.

14: Lyerly MJ, Wu TC, Mullen MT, Albright KC, Wolff C, Boehme AK, Branas CC,

Grotta JC, Savitz SI, Carr BG. The effects of telemedicine on racial and ethnic

disparities in access to acute stroke care. J Telemed Telecare. 2015 Jun 26. pii:

1357633X15589534. [Epub ahead of print] PubMed PMID: 26116854.

more:

How Much Money You Can Save on Insurance When You Quit Smoking

Yes, it is true. You will save literally thousands of dollars within one year. The amount rises exponentially for each year thereafter.  Save for your next vacation, buy a gym membership (that will also extend your life, or save it.  You will be able to afford healthier foods, fish, complex carbohydrates and more.

According to NerdWallet, it takes about five years of being smoke-free for rates to be as low as non-smokers’ rates. A few other key findings and takeaways include:

• Switching to a different nicotine product won’t help. Most people who use nicotine gum, patches, lozenges, nasal sprays or e-cigarettes still pay smokers life insurance rates.
• Don’t lie on your life insurance application. Your medical records and your life insurance medical exam, which includes a blood and urine test, will likely reveal your smoking habit. And if you’re an ex-smoker, your insurer might verify the amount of time you’ve been smoke-free by checking past life and health insurance applications you’ve made. Misleading your life insurer is considered fraud and can jeopardize your beneficiaries’ death benefit payment.
• 
  
• You can ask your insurer for a rate review if you quit smoking after buying a policy at smokers rates. The company will re-evaluate your health and smoking status and might grant you a better, nonsmoking rate. There’s no risk to you. Even if you’ve developed other health problems in the meantime, your rate cannot be raised.

In another article on the cost of smoking, NerdWallet points to an eHealth study that foundsmokers pay 14% more for health insurance premiums on average. Bernard Health reports that many companies will lower your rate if you haven’t used tobacco in the last 12 months.

Life Insurance Savings from Quitting Smoking | NerdWallet

How Much Money You Can Save on Insurance When You Quit Smoking

Coming Soon: ProPublica’s Surgeon Scorecard

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Millions of patients a year undergo common elective operations – things like knee and hip replacements or gall bladder removals. But there’s almost no information available about the quality of surgeons who do them. ProPublica analyzed 2.3 million Medicare operations and identified 67,000 patients who suffered serious complications as a result: infections, uncontrollable bleeding, even death. Next week, we report the complication rates of 17,000 surgeons – so patients can make an informed choice. Sign up for our investigations email to be alerted when we publish our Surgeon Scorecard findings.


This information comes from the CMS data files available to anyone who knows how to access and utilize them.  ...

The report illumiates the drastic difference in complication rates of individual surgeons  The rate is unique for each surgeon, not hospital dependent.

Since the Propublica announcement regarding rates of surgical complications, Dr. Jen Gunter takes one case that proves how erroneous a statistic can be, as well as misleading.

Backlink to new article   POSTED BY DR. JEN GUNTER ⋅ JULY 12, 2015 ⋅

Dr. Gunter uses a personal case about her mother.  Readers can read the entire story at the backlink.

In summary she points out how some surgeons inherit or are referred other surgeon's (A) complications. Statistically the complication may show up on Surgeon B record. .  Statistics can be very misleading.  The devil is in the details

AMA and MAG to host EHR Town Hall on July 20 - gmlevinmd@gmail.com - Gmail

AMA and MAG to host EHR Town Hall on July 20 

On July 20 from 7 p.m. to 8:30 p.m. (EDT), the AMA and the Medical Association of Georgia (MAG) will be hosting a town hall meeting in Atlanta to discuss electronic health records (EHR), featuring Rep. Tom Price, MD (GA-6), and AMA President Steven J. Stack, MD. This event is being held for physicians who have concerns about EHRs with Stage 3 Meaningful Use regulations potentially looming just around the corner. Physicians across the country will be able to watch live online and join the conversation on Twitter. Meaningful Use is not working, but bureaucrats in Washington, D.C., still want to move forward with Stage 3 implementation. That could mean less time with patients, less practice innovation and costly penalties if physicians do not comply. Currently, physician participation in Meaningful Use Stage 2 sits at less than 10 percent, compared to 80 percent adoption of EHRs. Please join the AMA and MAG for a conversation with Rep. Price as well as national and local physician leaders about EHRs, the potential consequences of Meaningful Use Stage 3 and what you can do to stop it. This event will be streamed live online – please register today!

A 'Very Cruel' Medicare Rule - Golden Geezers Golden Geezers

Patients and providers are both caught up in Medicare's Catch 22 rules.  There are many, too many for 'whistle-blowers' and legislators to fix. Fix one and another pops up.



Here is one example of multiple conundrums.  What ever happened to 'Precision Medicine" and "Patient-Centered Care" ?  This is really all about money, and the aphorisms and politically correct mantras are a camoflage for what is embedded in the health system.  The only other similar situations is government contracting for Defense and  other agencies.  It costs more to file for a grant and accomlish the followup paperwork than to build a product.  Example: Federal Health Insurance Exchanges.



Now, on to Medicare Catch 22 rules and Skilled Nursing Facilities



It’s bad enough to be hospitalized. But thousands of seniors across the country are finding their medical problems compounded with financial frustration and large bills because of a Medicare technicality that can cost them dearly.

The problem starts when their doctors want them to go to a skilled nursing facility as an interim, rehabilitative step between the hospital and home. That’s fairly typical when a patient needs to regain strength but no longer requires hospitalization.

But if the hospital has not classified the patient properly for Medicare billing purposes, then Medicare, the government health insurer for seniors, refuses to pay the skilled-nursing bill. Even a short stay costs the patient thousands of dollars.

For Marilyn “Micki” Gilbert, 83, an assisted-living resident at Menorah Park in Beachwood, the bills came to $17,000 after more than four weeks of skilled nursing care. Following a hospital stay of several nights last August after she fell and was hospitalized “with a head broken open and sutures,” as she put it, she expected Medicare to cover her rehabilitative care.

But Medicare administrators refused. The problem was that when the hospital sent the bill to the Centers for Medicare and Medicaid Services, or CMS, for payment, it said that Gilbert was in the hospital for “observation” rather than admitted in the “inpatient” category.

That difference, which is many cases is a technicality, means the difference of thousands of dollars for every patient affected.

The hospital prefers to bill for observation the first 24 hours since Medicare will pay more than if the patient is 'admitted'.  In fact hospitals have developed an intermediary 'holding area' near an emergency room where a patient will stay  for 24 hours while a determination is made.  It is not about the diagnosis or  treatment...it's about the dollars lost to the hospital if the patient is directly admitted. And this is an issue over which  doctors have no say. The hospital does the facility billing.

The problem is a result of Medicare rules that only authorize follow-up, skilled nursing care after a patient has had inpatient hospital care for at least three consecutive days. Even splitting that classification – say, as one day for observation and two for inpatient care – will not satisfy the three-day inpatient requirement, regardless of the fact that the patient stayed and was treated in a hospital the whole time.

The inspector general for the U.S. Department of Health and Human Services said that in 2012, Medicare beneficiaries had more than 600,000 hospital stays that lasted three or more nights but did not qualify for skilled-nursing facility payment. In a small share of those cases, 4 percent, Medicare mistakenly paid for skilled nursing care anyway, costing $225 million. (sic)

The distinction – observation versus inpatient — has financial consequences for hospitals as well. That may be part of the problem, say several members of Congress as well as authorities from such organizations as the American Health Care Association and Center for Medicare Advocacy. Hospitals have their own financial reasons for classifying some multi-day stays as observational.

One is that hospitals with billing mistakes can be subjected to intense CMS audits with deep financial consequences. Since 2010, CMS has used outside contractors to aggressively review admission records and seek repayment for improper admissions, according the office of U.S. Sen. Sherrod Brown, an Ohio Democrat who has repeatedly expressed displeasure for the way seniors are winding up with large medical bills.

For healthcare providers, it may be safer for many to simply classify a hospitalization as observational. That usually means they’ll get less money in reimbursement than if they coded the bill with inpatient fees, and the patients may get stuck with more out-of-pocket costs for care and prescription drugs. But for hospitals, it is better than getting hit with an audit and facing claw-back demands from CMS, health professionals say.

Hospitals may also do this to avoid Medicare penalties they can face if they have an excessive number of in-patient re-admissions within 30 days of discharge.

Part of the Affordable Care Act, the Readmissions Reduction Program started in October 2012 and was supposed to result in better care the first time a patient is admitted. Excessive re-admissions now can cost a hospital money, and many hospitals are reporting that their readmission rates are, in fact falling.

But one way to get around the risk of readmission penalties may be to avoid as much as possible the inpatient classification.

Among those pushing to change these Catch-22 rules are Brown, the senator from Ohio, and Reps. Marcia Fudge of Warrensville

Gilbert, the 83-year-old woman in Beachwood, summed it up during a telephone interview in more impassioned terms. She described calling CMS, to no avail, and asking a lawyer what she could do.

“Everybody said there was nothing they could do. It’s the law,” she said.

“It’s bad enough as you start getting older. My husband passed away about two years ago, and I can’t tell you the loss I felt.” She and Leonard had been married for 64 years.

Then she fell and was hospitalized. And “no one knew how to help.”

CMS may have its reasons. Micki Gilbert can only surmise them.

“I think it’s very cruel,” she said

A 'Very Cruel' Medicare Rule - Golden Geezers Golden Geezers

Modern Doctors’ House Calls: Skype Chat and Fast Diagnosis - The New York Times

The same forces that have made instant messaging and video calls part of daily life for many Americans are now shaking up basic medical care. Health systems and insurers are rushing to offer video consultations for routine ailments, convinced they will save money and relieve pressure on overextended primary care systems in cities and rural areas alike. And more people like Ms. DeVisser, fluent in Skype and FaceTime and eager for cheaper, more convenient medical care, are trying them out.

But telemedicine is facing pushback from some more traditional corners of the medical world. Medicare, which often sets the precedent for other insurers, strictly limits reimbursement for telemedicine services out of concern that expanding coverage would increase, not reduce, costs. Some doctors assert that hands-on exams are more effective and warn that the potential for misdiagnoses via video is great.

Legislatures and medical boards in some states are listening carefully to such criticisms, and a few, led by Texas, are trying to slow the rapid growth of virtual medicine. But many more states are embracing the new world of virtual house calls, largely by updating rules to allow doctor-patient relationships to be established and medications to be prescribed via video. Health systems, facing stiff competition from urgent care centers, retail clinics and start-up companies that offer video consultations through apps for smartphones and tablets, are increasingly offering the service as well.

In Philadelphia, Jefferson University Hospitals now lets patients have video follow-up visits with internists, urologists, and ear, nose and throat specialists. Mount Sinai Health System in New York is starting to offer video visits for primary care patients. Mercy, a health system based in St. Louis, will soon open a $54 million virtual care center to house a number of telemedicine programs, including urgent and primary care video consultations for chronically ill and other high-risk patients who need frequent assessments and advice.

Advocates say virtual visits for basic care could reduce costs over the long term. It is cheaper to operate telemedicine services than brick-and-mortar offices, allowing companies to charge as little as $40 or $50 for consultations — less than for visits to emergency rooms, urgent care centers and doctors’ offices. They also say that by letting people talk to a doctor whenever they need to, from home or work, virtual visits make for more satisfied and potentially healthier patients than traditional appointments that are available only at certain times.

Modern Doctors’ House Calls: Skype Chat and Fast Diagnosis - The New York Times



Several Case Examples.

Hope Sickmeier, 51, a fourth-grade teacher in Ashland, Mo., used her Anthem insurance for a virtual urgent care visit one Saturday night, three days into a toothache that kept getting worse. A week earlier, she had gone to the emergency room with a migraine and owed a $200 co-payment.

This time she grabbed her iPad, downloaded the app for the visits and scanned a list of available doctors, choosing one with “a trustworthy face.”

When the doctor appeared on her screen, she told him her symptoms and, holding her iPad close to her face, showed him her painful tooth and the swelling in her jaw.

“I was in so much pain, I didn’t care that it was weird,” Ms. Sickmeier said. “He got right to the point, which was what I wanted. He prescribed antibiotics and called them into an all-night pharmacy about 20 minutes away.”

Hope Sickmeier, 51, a fourth-grade teacher in Ashland, Mo., used her Anthem insurance for a virtual urgent care visit one Saturday night, three days into a toothache that kept getting worse. A week earlier, she had gone to the emergency room with a migraine and owed a $200 co-payment.

This time she grabbed her iPad, downloaded the app for the visits and scanned a list of available doctors, choosing one with “a trustworthy face.”

When the doctor appeared on her screen, she told him her symptoms and, holding her iPad close to her face, showed him her painful tooth and the swelling in her jaw.

“I was in so much pain, I didn’t care that it was weird,” Ms. Sickmeier said. “He got right to the point, which was what I wanted. He prescribed antibiotics and called them into an all-night pharmacy about 20 minutes away.”

One night, when her face turned puffy and painful from what she thought was a sinus infection, Jessica DeVisser briefly considered going to an urgent care clinic, but then decided to try something “kind of sci-fi.”

She sat with her laptop on her living room couch, went online and requested a virtual consultation. She typed in her symptoms and credit card number, and within half an hour, a doctor appeared on her screen via Skype. He looked her over, asked some questions and agreed she had sinusitis. In minutes, Ms. DeVisser, a stay-at-home mother, had an antibiotics prescription called in to her pharmacy.

As recently as two years ago physicians and state licensing boards were skeptical about televideo since physicians ordinarily want to see and lay hands on their patients. Some state boards such as Texas even passed legislation to prohibit such visits. This case has now gone to apellate court when physicians sued the Texas Medical Board. The case is pending. Other providers, such as those in rural states can now reach out to far flung patients.  

In Philadelphia, Jefferson University Hospitals now lets patients have video follow-up visits with internists, urologists, and ear, nose and throat specialists. Mount Sinai Health System in New York is starting to offer video visits for primary care patients. Mercy, a health system based in St. Louis, will soon open a $54 million virtual care center to house a number of telemedicine programs, including urgent and primary care video consultations for chronically ill and other high-risk patients who need frequent assessments and advice.

But telemedicine is facing pushback from some more traditional corners of the medical world. Medicare, which often sets the precedent for other insurers, strictly limits reimbursement for telemedicine services out of concern that expanding coverage would increase, not reduce, costs.  Advocates say virtual visits for basic care could reduce costs over the long term. It is cheaper to operate telemedicine services than brick-and-mortar offices, allowing companies to charge as little as $40 or $50 for consultations — less than for visits to emergency rooms, urgent care centers and doctors’ offices.

With this in mind the future is clear.  When pharmacys opened "Minute Clinics" the same attitude prevailed, and today it is accepted widely. The pharmacy's  have set a high standard using only licensed nurse practitioners. It is fast and very efficient. In fact many of these clinics used EHRs  long before private doctor offices.

The convergence of wearables, remote monitoring, telemedicine, mHealth and smartphones make bed-partners for the new era in health care.

ObamaCare's Unbalanced Risk Pools

Health insurance companies are signaling huge health insurance premium increases ahead of the 2016 open enrollment period. This is due to the droves of older and sicker consumers who signed up for coverage on the ObamaCare Exchanges, according to a report from The New York Times.

Rate increases vary by state and health plans offered. Oregon has already announced premium increases between 8 percent and nearly 38 percent for a 40-year-old on a Silver plan purchased through the federal Exchange. The Times notes that Blue Cross and Blue Shield, which dominates the market in a number of states, is seeking premium increases for its plans that "average 23 percent in Illinois, 25 percent in North Carolina, 31 percent in Oklahoma, 36 percent in Tennessee and 54 percent in Minnesota. While the initial rate shock under ObamaCare came from the mandated benefits promulgated by bureaucrats in Washington, taxes and fees, and actuarial benefit requirements, the latest round of premium increases can be partially attributed to unbalanced risk pools. The risk pools have older and sicker enrollees, who utilize their coverage more often than younger and healthier enrollees, than insurers expected. 

Typically, state insurance regulators negotiate with insurers to bring down the requested rate increases. But with ObamaCare's requirement that 80 percent of premiums paid go to the healthcare of the insured, insurers, particularly those that have seen losses due to the higher utilization of care, may not have much of a choice other than to raise premiums to keep their reserves stable. It may not be ideal for consumers, who may have to change plans and risk losing their doctor because of premium increases, but this is the new normal under ObamaCare.