Introduction: Storm's Coming

It is a bit late for the weather forecast for health reform.

In October 2013 the leading edge and eye of the hurricane was here.  After many forecasters warned of it's approach to health care, some chose to evacuate (retire early), join group practices (shelters) and some persisted in their old ways, unable or unwilling to adapt.  The tidal surge removed most of the laggards.

In health care the mantra "Move ahead or face extinction" has become reality Those who chose to change are still working as physicians.  Some medical practices faced insovency and ended in bankruptcy.

Nicholas Negroponte, co-founder of MIT's Media Lab quote:  "Computing is not about computers anymore, it is about living".

The storm eye is the affordable care act....a low pressure area with cyclonic winds drawing in each  component of the American health systemm. In the cyclone are violent thunderstorms and tornados..  These analogies are the large group and integrated health systems.  Unlike individual and small group entities they carry more weight and influence on the storm.  Each has it's own  niche in  the system.

The storm effects the entire country to it's core, economic, social and health.  The storm is about human survival, much like a hurricane bearing down on the community (metropolitan, or rural.). The most vulnerable are those living in the lowlands, near the ocean.  This  demographic is most vulnerable and require the most protection from storm surge and strong winds. They are  also   the least influential and require special protection as the storm advances.

These analogies are a powerful vision of what is and has taken place during the last four years.  The uninsured have been the center of this storm.  The effort to include them in our insurance system has effected the entire system.

The sheer  number, to include 40 million is an almost overwhelming increase in patients.  In practical terms resources are limited. The administrative burden (which includes planning and implementation of new organizations, financing...regulation, delivery of care and the change from fee for service to quality-based and value are considerable.

Breaking News: The F.D.A. has relaxed requirements on taking a medication to induce abortion, easing access and lowering costs - gmlevinmd@gmail.com - Gmail

Breaking News: The F.D.A. has relaxed requirements on taking a medication to induce abortion, easing access and lowering costs - gmlevinmd@gmail.com - Gmail

Newest Policyholders Under Health Law Are Sicker and Costlier to Insurers - The New York Times

Newest Policyholders Under Health Law Are Sicker and Costlier to Insurers - The New York Times

Health Care Fades Into The Background Of 2016 Election Cycle |

Health Care Fades Into The Background Of 2016 Election Cycle

Can a lame duck congress or the executive branch plan meaningful changes to the Affordable Care Act?

It would seem apparent no significant changes will occur until the new administration is inaugurated. 

Audio analysis from NPR and the Kaiser Health Foundation

Can’t see the audio player? Click here to download the file.

"Healthcare played starring roles in the 2008 and 2012 election cycles. President Obama's Affordable Care Act became the battle cry of politicians hoping to ascend to the highest office in the land. But Obamacare passed through the gauntlets of the U.S. Congress and Supreme Court, and came out in tact.

Whether it's fatigue with the topic of healthcare, a shift in the public's priorities, or other campaign year distractions, how we pay for our doctor's visits has fallen from the top of the nation's priorities list.

With Obamacare battles largely behind us, presidential candidates in 2016 seem focused on other issues.

Health care played starring roles in the 2008 and 2012 election cycles. President Obama’s Affordable Care Act became the battle cry of politicians hoping to ascend to the highest office in the land. But Obamacare passed through the gauntlets of the U.S. Congress and Supreme Court, and came out in tact.

Whether it’s fatigue with the topic of health care, a shift in the public’s priorities, or other campaign year distractions, how we pay for our doctor’s visits has fallen from the top of the nation’s priorities list.

This copyrighted story comes from WHYY’s The Pulse. All rights reserved.

Regardless, though, we wanted to check in on what politicians are saying about health care with Kaiser Health News correspondent Julie Rovner, who acknowledges that candidates this year aren’t really health care-focused, but she reminds us that it’s still an important topic.

“Health care is always going to be an issue in a presidential campaign if the economy is, because it’s kind of a proxy for people’s economic anxiety,” says Rovner.

Rovner spoke with The Pulse host Maiken Scott about the health care policy differences between the candidates."

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.