IRS Warns: Obamacare Tax Must Be Paid with Tax Return |

Form 1095-A, 1095-B, 1095-C, 

If you pay taxes in the United Sates,by now the  feds have sent you a notice about the new tax form you must include with your 1099 or 1040 tax return. It is another obfuscation of the 'Paperwork Reduction Act" 

The Paperwork Reduction Act (PRA) of 1995 requires that agencies obtain Office of Management and Budget (OMB) approval before requesting most types of information from the public. "Information collections" include forms, interviews, and recordkeeping requirements, to name a few categories.

Information Collection / Paperwork Reduction Act | HHS.gov

Your 2015 tax refund will be less if you did not enroll in the Affordable Care Act Health insurance exchanges are one way of obtaining coverage.  If  you wanted a subsidy patients were required to obtain health insurance coverage patients had/have to apply via the federal Health.gov website or their state's exchange.Certain states opted-out and manage their own exchanges.

The prevention of Obama care tax penalties will require careful planning if you do not have a refund due. Tax penalties would be assessed at the time of your tax filing for the previous year end on or about April 15th.  It would normally be deducted from you federal tax refund.

If you have no tax refund due, then it would be assessed unless paid immediately. Exact statistics of how many tax payers this would effect have not been released.

According to federal statistics the number of  the uninsured has been reduced by 50 percent.  This would calculate to about 20 million uninsured.  The vast majority of these patients are in a very low income group.The group most at risk for penalties are those who don't qualify for medicaid and fall into the group with a premium that for them would be still unaffordable. Even if they qualify for insurance and pay for it,the deductible and/or co pays would still be unobtainable for them.  For these people the Affordable Care Act was and is a cruel promise for affordable and accessible care.

Here are the individual State run Health Information Exchanges:

Arkansas

State-Partnership Marketplace1

California	State-based Marketplace
Colorado	State-based Marketplace
Connecticut	State-based Marketplace
Delaware	State-Partnership Marketplace
District of Columbia	State-based Marketplace

Idaho	State-based Marketplace
Illinois	State-Partnership Marketplace

Iowa	State-Partnership Marketplace

Kentucky

State-based Marketplace3

Maryland	State-based Marketplace
Massachusetts	State-based Marketplace
Michigan	State-Partnership Marketplace
Minnesota	State-based Marketplace

New Hampshire	State-Partnership Marketplace
New Jersey	Federally-facilitated Marketplace

Maryland	State-based Marketplace
Massachusetts	State-based Marketplace
Michigan	State-Partnership Marketplace
Minnesota	State-based Marketplace

New Hampshire

State-Partnership Marketplace

New York

State-based Marketplace

Rhode Island

State-based Marketplace

Vermont

State-based Marketplace

Washington	State-based Marketplace
West Virginia	State-Partnership Marketplace

These  21 states opted-out of the federal administration of their health information exchanges, for what are  now obvious reasons.

While some states had severe problems initializing enrollment (Covered California being the most obvious one), most had a smooth enrollment process. most difficulties can be attributed to a poor selection of IT vendor.  This was true of Health.gov. The application process required a multi-task choice of insurance companies after completing an initial demographic, income and health evaluation.  The selection varied across all states, and in some cases were minimal.

Politicians (especially Democrats) seem satisfied by stating how fewer people are uninsured, totally ignoring other facts.

1. Still unaffordable premiums for many  patients.
2.:Lack of access to physicians
3  Limited number of providers.
4. The lack of transparency in regard to how the ACA discriminates against enrolled because the intended provider is contractually obligated to be reimbursed less for ACA patients.
5. During the past five years Federal funds were given to providers to implement poorly designed electronic health records. The amounts were in many  cases  inadequate and did not account for ongoing maintenance of their systems. Those who use EHR have found that maintenance costs exceed the cost of acquiring EHR.
6. The ACA includes many hidden features buried in bureaucratic wording,such as meaningful use,of EHR, interoperability, and features for  patient engagement via portals.  A three stage implementation  for meaningful use  added additional cost to providers. Many have not attested to stage II and never will due to cost. HHS and CMS on several occasions have delayed requirements for implementation.  For those providers who have not attested, the penalties will be unknown and they have already received a  check from the fickle HHS.

Anyone who is a serious businessman would not do business with our government unless their life depended upon it And unfortunately many are in that position .Not only are poor patients forced into continuing entitlement programs,Health institutions are as well.

 While  the EHR promises to bring gains to quality of care it drastically affects the ability of providers to work efficiently.

IRS Warns: Obama care Tax Must Be Paid with Tax Return | Americans for Tax Reform

AliveCor A big Thumbs up

How many mobile health apps are out there?  Too many to count.  The vast majority are for fitness and health improvement, many of which act as your virtual coach displaying the amount of physical activity the user has performed.

A heart beats 100,000 times per day. Along with blood, each beat is rich with information. Kardia allows you to quickly access, track and analyze your heart's health, giving you and your doctor a proactive, clinically-proven way to care for your heart.

Peace of mind in your pocket

FDA-Cleared

Kardia is the most clinically-validated mobile EKG available1.

EKG in 30-Seconds

Smaller than a credit card, Kardia allows you to capture a medical-grade EKG in just 30-seconds from anywhere, anytime.

Track and Share

Kardia's app-based service enables you to proactively care for the health of your heart. Now you can capture reliable heart activity data and relay it to your doctor to inform your diagnosis and treatment plan.

More Than EKGs

Kardia allows you to easily track palpitations, shortness of breath, dietary habits, sleep and exercise patterns.

Expert EKG Analysis and More

Kardia offers instant EKG analysis (using FDA-cleared machine learning algorithms), and consultations with board-certified cardiologists, so it's easy to know whether heart rhythm is normal or in atrial fibrillation.

1 Based on the number of published clinical studies using Kardia Mobile compared to other smartphone-based EKG devices.

AliveCor

Trump’s Drug Importation Plan Fails Safety Test—Turner for Forbes - gmlevinmd@gmail.com - Gmail

Are you still ordering drugs online?It is not safe. Unless there have been major changes  the two studies done by the FDA reveal that drugs from overseas have serious quality control isues.







Trump’s Drug Importation Plan Fails Safety Test—Turner for Forbes 

Greenery (or Even Photos of Trees) Can Make Us Happier

A growing body of research shows that people who spend time outside in sunny, green and natural spaces tend to be happier and healthier than those who don’t. A study from Stanford last year, for example, found that young adults who walked for an hour through campus parkland were less anxious afterward and performed better on a test of working memory than if they had strolled along a busy street.

Precisely what is going on inside our bodies as we move through the greenery is largely unknown, however. It hasn’t even been made clear that nature itself is responsible for the greatest health benefits — they may come instead from physical activity, sunlight or, if you stroll with others, camaraderie. Now a new study published in The International Journal of Environmental Research and Public Health takes a step toward sorting these interactions out by focusing on pictures of the outdoors rather than on the real thing.

The researchers, most of them affiliated with VU University Medical Center in Amsterdam, focused on the sympathetic and parasympathetic nervous systems. The first responds to stress by triggering a fight-or-flight reaction, raising heart rates and putting us generally on edge; the second counters those responses, bringing physiological calm. For this study, nearly four dozen university students were outfitted with sensors to monitor electrical activity in the heart and then shown photos on a computer screen. Half the pictures displayed urban spaces full of buildings and parked cars; the rest were green places — but homely ones, like empty pathways flanked by trees, not majestic wilderness.

Having viewed the photos, the students tackled a series of increasingly difficult computerized math problems while an on-screen assessment compared their results with the average performance and, whether accurately or not, showed them to be subpar. This test has proved to be a robust means of raising stress levels. Afterward, the subjects re-viewed the pictures, retook the math test, then looked at more photos.

When the students saw green spaces after the math stressor, their parasympathetic nervous systems kicked in, lowering heart rates, for example. (Pictures from the concrete jungle had no such effect.) Interestingly, though, the same green scenes when viewed before the math test did not lessen the reaction to stress: Their heart rates still rose as they struggled with the problems.

for further details...........click here  

• How Walking in Nature Changes the Brain
• Which Type of Exercise Is Best for the Brain?
• A ‘Dose of Nature’ for Attention Problems

Spring Ahead, It's Daylight Saving Time,and an 8% increase in chance for having a Stroke during the next two days.

Those of you who read my post of March 11, 2016 know that they are at higher risk for cardiovascular events such as stroke during the next two weeks.

The twice-yearly time change isn’t just an inconvenience, it may cause a variety of unfortunate health and public safety threats as our collective bodies reset to a new schedule.

Much of the research on the health effects of the time shift relate to the circadian rhythms, the body’s internal clock that, when in sync, helps people wake up, eat and sleep around the same time every day.

A 2013 study from the American Journal of Cardiology found that two Michigan hospitals saw more heart attacks in the week after “springing forward” than the two weeks before.

Preliminary research also suggests the same is true for strokes.

Finnish researchers presented a paper during the American Academy of Neurology conference in April 2015, in which they found the rate of strokes increased by 8 percent after the time change.

“Previous studies have shown that disruptions in a person's circadian rhythm, also called an internal body clock, increase the risk of ischemic stroke, so we wanted to find out if daylight saving time was putting people at risk," study author Dr. Jori Ruuskanen, of the University of Turku, in Finland, said in a statement.

To make matters worse, time shifts may trigger cluster headaches, according to Stewart Tepper, MD, headache pain specialist at the Cleveland Clinic.

For younger Americans, the biggest threat may be one less hour at a bar on a spring weekend, although Pacific Beach's Hookah Lab — one of several establishments that stay open past 2 a.m. — is ready for the disruption.

"When the time change happens, we move with it," said server Kyle Lias. "Usually it goes by smoothly when it happens."

The most widespread effect of the time change may be muddle-headed drivers.

***  Research published in the  New England Journal of Medicine suggests that groggy drivers make the roads more dangerous on the Monday following the time change. 

" Ischemic stroke is the most common kind of stroke, accounting for 87 percent of all cases. It is caused by a clot blocking blood flow to the brain.

"Previous studies have shown that disruptions in a person's circadian rhythm, also called an internal body clock, increase the risk of ischemic stroke, so we wanted to find out if daylight saving time was putting people at risk," said study author Jori Ruuskanen, MD, PhD, of the University of Turku in Turku, Finland.

For the study, researchers looked at a decade of data for stroke in Finland to find the rate of stroke. They compared the rate of stroke in 3,033 people hospitalized during the week following a daylight saving time transition to the rate of stroke in a group of 11,801 people hospitalized either two weeks before or two weeks after that week.

Researchers found that the overall rate of ischemic stroke was 8 percent higher during the first two days after a daylight saving time transition. There was no difference after two days.

People with cancer were 25 percent more likely to have a stroke after daylight saving time than during another period. The risk was also higher for those over age 65, who were 20 percent more likely to have a stroke right after the transition."

  A solution may be to avoid driving on the Monday and Tuesday after the time change Sunday A.M. Workplace efficiency is probably effected as well. 

As for me, I am returning to my bed for the next two days....so not call me until Wednesday 

Workplace injuries also jump after the change, according to research in the Journal of Applied Psychology. And that same journal has published research that indicates the grogginess translates to more “cyberloafing” the first Monday back.

The image did not transfer to the blog well. If readers will go to the New England Journal of Medicine  you will find it in mid article.  Clicking on the image will enlarge and refine the image.

However the studies make a good point

*** Two days after the time change, the rate returned to normal. Cancer patients and those over the age of 65 saw the greatest increase in strokes following the time change.

'Springing forward' may bring crashes, strokes |

"Spring forward" works as a mnemonic and a public-relations push for daylight saving time, but it’s just another term for "losing an hour of sleep."

At 2 a.m. Sunday, most of the country will set clocks forward one hour. For San Diegans, that means that the sun will rise at 6:59 a.m. on Monday, when the day before it rose a few minutes after six.

With most web-enabled devices switching time automatically, the task of adjusting a few analog timepieces isn’t as laborious as it once was. But it still irritates certain people, and may have broader health and safety implications as well.

In 2014, a survey of 14,000 Utahns found that they found the requirement to move clocks forward in the spring and back in the fall annoying.

"The strong, repetitive drumbeat in those comments was convenience," Michael O’Malley, a spokesperson from the Utah Governor’s Office of Economic Development, told National Geographic. "Many people don't want to move their clocks, whether it's backwards, forwards, or sideways. They just want to pick a time and stick with it."

San Jose Assemblyman Kansen Chu introduced a bill in February aimed at ending the practice in California.

The twice-yearly time change isn’t just an inconvenience, it may cause a variety of unfortunate health and public safety threats as our collective bodies reset to a new schedule.

Much of the research on the health effects of the time shift relate to the circadian rhythms, the body’s internal clock that, when in sync, helps people wake up, eat and sleep around the same time every day.

A 2013 study from the American Journal of Cardiology found that two Michigan hospitals saw more heart attacks in the week after “springing forward” than the two weeks before.

Preliminary research also suggests the same is true for strokes.

Finnish researchers presented a paper during the American Academy of Neurology conference in April 2015, in which they found the rate of strokes increased by 8 percent after the time change.

“Previous studies have shown that disruptions in a person's circadian rhythm, also called an internal body clock, increase the risk of ischemic stroke, so we wanted to find out if daylight saving time was putting people at risk," study author Dr. Jori Ruuskanen, of the University of Turku, in Finland, said in a statement.

Should daylight saving time be ended?

• Yes! It's a useless and unnecessary practice.
• No! The time switch is a welcome change.

SEE RESULTS

Two days after the time change, the rate returned to normal. Cancer patients and those over the age of 65 saw the greatest increase in strokes following the time change.

To make matters worse, time shifts may trigger cluster headaches, according to Stewart Tepper, MD, headache pain specialist at the Cleveland Clinic.

For younger Americans, the biggest threat may be one less hour at a bar on a spring weekend, although Pacific Beach's Hookah Lab — one of several establishments that stay open past 2 a.m. — is ready for the disruption.

"When the time change happens, we move with it," said server Kyle Lias. "Usually it goes by smoothly when it happens."

The most widespread effect of the time change may be muddle-headed drivers. Research published in theNew England Journal of Medicine suggests that groggy drivers make the roads more dangerous on the Monday following the time change.

Workplace injuries also jump after the change, according to research in the Journal of Applied Psychology. And that same journal has published research that indicates the grogginess translates to more “cyberloafing” the first Monday back.

So, go ahead and click that next U-T link.

Next: Sleep is elusive for more than a third

Lawmakers trying to get rid of daylight saving in Michigan

WSYM - Lansing, MI

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Daniel Wheaton

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More from Daniel Wheaton

• 'Springing forward' may bring crashes, strokes
• College degrees divide white GOP attitudes
• Who would Trump's wall keep out?

'Springing forward' may bring crashes, strokes | SanDiegoUnionTribune.com

Lemonaid Health - FAQs

Lemonaid Health - FAQs

The Affordable Care Act and Accountable Care Organizations (not your grandfather's Buick) or What is in it for the patient?

Building An ACO—What Services Do You Need And How Are Patients & Physicians Impacted?

The definition of an accountable care organization (ACO) involves two elements: organization and payment. First, an ACO is organized as one entity capable of taking both clinical and fiscal responsibility for care. Second, ACOs operate using a payment model centered on a budget target: if the ACO spends less than the budget target, it shares in the savings, while, in some models an ACO that exceeds its budget target might be required to pay more.

ACOs differ from past models like health maintenance organizations (HMOs) and preferred provider organizations (PPOs) in various ways. Most importantly, they are provider, not health plan focused. In ACOs, people are attributed to the model; they do not sign up as in insurance plan. Furthermore, ACOs, unlike insurance plans, do not set premiums, nor do they control benefit design.

In summary, patients will not at all be aware of transactions, and the overall effectiveness for cost containment are highly in doubt.

The strongest case for the ACO model may be that it allows organizations to capture the efficiencies if they can achieve them and thus succeed financially with lower revenue growth.Thus while it is not certain that organizations can make this transformative turnaround, the alternative looks particularly bad.



Blogger's note:

This post is part of a Health Affairs Blog symposium stemming from “The New Health Care Industry: Integration, Consolidation, Competition in the Wake of the Affordable Care Act,” a conference held recently at Yale Law School’s Solomon Center for Health Law and Policy. Links to all posts in the symposium will be added to Abbe Gluck’s introductory post as they appear, and you can access a full list of symposium pieces here or by clicking on the “Yale Health Care Ind



New Health Care Symposium: Building An ACO—What Services Do You Need And How Are Physicians Impacted?

Humans Trust This Emergency Robot more than Common Sense

Getting people to trust robots is as big a deal for the future of technology as building them. But, it turns out, acquiring that trust might not be that difficult. Test subjects at the Georgia Institute of Technology willingly followed an emergency robot to safety during a simulated fire, even when it led them away from clearly marked exit signs, New Scientist reports. The findings even surprised Paul Robinette, the graduate student in charge of the study: "We thought that there wouldn't be enough trust, and that we'd have to do something to prove the robot was trustworthy."

30 subjects started out the test by following the robot, a customized Pioneer P3-AT, down a hallway and into a room, where they were asked to fill out a survey. Eventually, a smoke alarm went off and simulated smoke filled the hall. The robot would then lead them through the smoke down a new path, and towards a doorthey've never seen before. All the while, the subjects could have easily exited through the clearly marked path they originally came through. 26 of the test subjects ended up following therobot, while two never left the room (the other two were kicked out of the study).


Humans trust this emergency robot more than common sense

Dueling Star Ratings May Confuse Some Home Health Patients | California Healthline

Dueling Star Ratings May Confuse Some Home Health Patients | California Healthline

Patients looking for home health care services will be impressed if they check out the federal government’s ratings of AccentCare. Two of the company’s home health agencies in California — in San Diego and Newport Beach and Rancho Cordova — each earned 4.5 or 4 stars, nearly the top quality score, primarily based on Medicare’s assessment of how often patients got better.

But further research may lead to confusion. Medicare also posts stars to convey how patients rate agencies after their care is over. There, these same three agencies earned two stars.

Such contradictory results between how patients view home health agencies and how the government rates them are hardly unusual. One in five agencies had clinical and patient ratings that differed by two stars or more, a Kaiser Health News analysis of government records shows.

In California, for instance, agencies were three times as likely to receive five stars for their patient reviews as they were for their clinical quality. Skilled home health services, where Medicare sends nurses, aides and physical and occupational therapists to people’s houses, are becoming more important amid pressures to keep homebound patients from going to the hospital. To help doctors and patients select among more than 12,000 agencies, Medicare last year published star ratings for clinical quality on its Home Health Compare website, and in January it added star ratings to reflect the views of patients.

Medicare was liberal in giving top marks based on patients’ opinion scores, awarding four or five stars to 74 percent of agencies it rated. Of those, 2,152 agencies got five stars.

Apparently Medicare is giving more attention to the "Patient experience". 

But in encapsulating clinical quality measures, Medicare used a different formula that ensured three-star ratings would be most common. Only 27 percent of agencies received four or five stars. Just 286 agencies received the maximum five stars.In a statement, the Centers for Medicare & Medicaid Service said the different star ratings should not be confusing. “CMS stresses that website users should look at all of the different types of measures available for a given provider type, including for home health care agencies,” the statement said. “By providing both clinically based and survey-based measures, CMS hopes to make available to the public a range of perspectives and information that consumers can evaluate to help inform their decision about an agency.”

As the number of quality metrics has proliferated, star ratings follow other Medicare efforts to distill sometimes complex quality assessments into a consumer-friendly format. Medicare also assigns stars for dialysis center quality, hospital patient experience and several aspects of nursing home care.

“We’re really talking about very different sets of metrics,” said Teresa Lee, director of the Alliance for Home Health Quality and Innovation, a nonprofit research group. “It’s unfortunate, but maybe it’s the truth that patient experience and clinical quality of care do not go hand in hand.”

Adding to the potential confusion, 41 percent of the star ratings summing up patient views are not reliable — by the government’s own admission — because fewer than 100 surveys were returned, records show. Home Health Compare warns consumers in footnotes to use the scores “with caution as the number of surveys may be too low to accurately tell how an agency is doing.” Medicare did not assign stars for agencies if fewer than 40 surveys were returned.

“It is important to point out that our patient population has an average age of 86 and often relies on family members, powers of attorney and/or guardians to complete” the survey, she said.

Some elder care experts have broader reasons to question the ratings.

While there is some confusion and questions about the validity of these surveys and the more objective Medicare quality measures,  patients' families now have somewhere to screen  possible caregiving agencies for their loved ones.