Driving High Value Behaviors in Medicaid Plans

In the Medicaid space, as in all of the health care system, a high-performing plan that improves health outcomes, optimizes risk adjustment and meets quality standards requires member engagement. More than just a buzzword you keep hearing, member engagement really is effective — consumers want to be engaged in their health care decisions, and those who are tend to be healthier as a result. Without an engaged population, Medicaid health plans will struggle to meet HEDIS quality measures, maximize pay-for-performance results and keep health care.

However, achieving such engagement and driving healthy behaviors is not a accomplished with a onesize-fits-all program. And when it comes to engaging Medicaid members, there are unique challenges. Medicaid members may face significant barriers to receiving the appropriate care—whether barriers of language or transportation, or simply being overwhelmed by the complexities of the health care system. How can we engage such members, close gaps in care and improve quality scores?

Medicaid performance ratings are unique to each state, but are generally based on three components: clinical quality management, member experience and plan efficiency. And now, such performance indicators are arguably more important than ever, as significant changes are on the way for Medicaid. Replicating what they’ve done for Medicare regulations, CMS is moving forward with the implementation of a mandatory quality rating system and a Medical  Loss Ratio of 85% for Medicaid managed care organizations (requiring that at least 85% of plan revenue be allocated to health care services, covered benefits and quality improvement efforts—such as rewards and incentives (R&I) programs).1 With these new regulations, and as more and more states loosen the rules and, in some cases, require wellness incentives, the stage is set for Medicaid plans to maximize their performance—and their economic returns—through the use of member engagement programs.

There are in fact a number of companies that specialize in this space, which will facilitate the change from FFS to a value based system.  In the past Medi-cal plans have been negligent, attempting to minimize what they perceived to be a waste of resources. The playing table has changed, largely thanks to HEDIS Scores and incentives.  It will be particularly effective in Medicaid Managed Care Plans.

Who are these people?

Medicaid provides health coverage to one in five people—that’s almost 70 million people with $440 billion in expenditures, and those numbers are only going to grow higher.2 Because they are comprised of distinct, diverse and hard-to-reach audiences, engaging these members requires a deeper understanding of their needs, behaviors and attitudes.

The largest and most recognizable groups within the Medicaid population are children, non-disabled adults, the dual eligible, individuals with disabilities, and pregnant women and newborns. And while, of course, no two members within these groups are the same, we can identify some general characteristics to give a better sense of who comprises these groups and the barriers they may face. We’ll start with the largest group: There are around 43 million children on Medicaid.3 Many of them are living in foster care, moving around between homes, guardians or parents. And a significant number of these children have special health care needs. Simply put, with such a large degree of movement and a lack of independence, these children can be very hard to reach. Creating a rewards program that anticipates and allows for changing residence and guardianship can be key to reaching children on Medicaid.

Close to 11 million non-disabled adults are Medicaid members.4 They are parents and caretakers, adults without dependent children, and low-income adults. Members of this population may be medically needy, and though it differs state by state, adults who fall 133% below the poverty line qualify for Medicaid in states that have adopted the Affordable Care Act Medicaid expansion.5 This tends to be the most active Medicaid population, in terms of health care usage. But while they may be more engaged in their care, it’s important to help guide their usage toward high-value behaviors. The next largest population is the dual eligible. These limited-income Medicare members comprise about 9.6 million of the total Medicaid population.6 They frequently have disabilities or comorbidities, and 21% are institutionalized.7 These members may not only have greater health care needs, but also may be housebound, increasing the difficulty in reaching them and encouraging them to make and keep doctor appointments. Including behaviors for your Medicaid rewards program that can be done in the home via in-home test kits can be an effective way to reach this population. Individuals with disabilities make up about 8.8 million of the Medicaid population.8 They tend to be the most diverse group, with a wide range of disabilities and, often, several different conditions. As a result, their health care needs may be more complex and a holistic approach is needed when reaching out to these members, whether as a provider or a plan offering a rewards program. Finally, 40% of US births are covered by Medicaid.9 Pregnant women on Medicaid may be adolescent, may not have planned for their pregnancies, and may not prioritize the importance of care. However, Novu data indicates this high-risk population can be effectively engaged with a rewards and incentives program.

Firstly, more than 61% of all adults on Medicaid have at least one chronic or disabling condition.10 These notable levels of chronic and comorbid illness—including physical conditions like diabetes, cardiovascular disease and respiratory disease as well as mental illness—indicate the considerable health care needs of these Medicaid members. Their needs are complex, and they require a holistic approach to their care. For plans and providers, it is essential to consider the whole member, not just the disease. Secondly, in a lot of cases, there is simply a lack of awareness of coverage and eligibility. Although members must first submit a Medicaid application, they are afterwards often auto-assigned to Medicaid health plans, and therefore may not even know they qualify for services or are a part of the plan. Even if they are aware of their Medicaid coverage, a member’s eligibility may vary over time if their income rises or falls, or they move across state or county lines. This can make reaching the right member at the right time—when they qualify for Medicaid and are enrolled in a plan—a more difficult proposition. Thirdly, low health literacy is compounding these difficulties. A large majority of Americans have trouble  using the everyday health information that is routinely available in our health care facilities, retail outlets, media and communities. Only 12% of American adults have proficient health literacy to manage their health11 and individuals with low health literacy have a 50% increased risk of hospitalization.12 On top of which, Medicaid is a notoriously complex program, with so many variances across state and county boundaries, that it can be difficult for members to understand and take advantage of the perks and plan benefits available to them.

In fact, 30% of dis-enrollments are the result of a lack of understanding of Medicaid and plan benefits.13 This goes to show that a Medicaid member who is confused or overwhelmed by the information and processes they encounter in the health care system is far less engaged with their care, if not actively disengaged. Consider also these various barriers a Medicaid member may face—members may not easily be able to make it to doctor appointments due to lack of transportation, childcare conflicts or working multiple jobs, and may have language or cultural barriers. These members may not have a consistent address, phone number, or Internet access, making it, logistically, more difficult to get—and remain— in contact with them. In addition, with economic hardships, taking care of their health simply may be less of a priority for Medicaid members. With these potential hurdles standing between your program and meaningful member engagement, it’s especially important to design an experience that meets members where they are, and makes it easy for them to participate. Of course, there is no one-size-fits-all solution for engaging Medicaid members. With different measures across different states and counties, the definition of success will vary depending on your plan’s location. The following are a series of essential steps to creating a successful Medicaid R&I program—one that will drive incremental performance, improve HEDIS or other quality measures, as well as reduce costs. However, as you continue reading, consider the following strategies and approaches in light of the measures that apply to your particular state or contract.

Conclusion

Member engagement is crucial to improving health outcomes, yet Medicaid members can be especially hard to reach. But as we’ve discovered, Medicaid engagement programs can be a remarkably effective way to break through those barriers to drive high-value behaviors, encourage a healthy lifestyle and improve HEDIS quality measures, ultimately affecting Pay-for-Performance. The proof? At Novu,  programs have driven a 70% increase in gap closure, a 7% increase in activation among the hardest-to-move populations and an impressive 83% participation rate.

To create a successful program with long-term results like these, Medicaid health plans need to cultivate and nurture relationships with members before and after activation. This means developing a simple and easy-to-use program, segmenting and targeting the appropriate members to activate, determining the reward types and values members respond to, and adopting an omni-channel approach aligned with the consumer lifecycle. Together, these strategies work toward driving member engagement because they hinge on treating members as unique individuals— understanding their needs and expectations, reaching out to them when and where they are, and personalizing the experience for their health journey.

Finally, the administrative and enrollment process must be simplified. Health education and literacy depends upon repetitive learning, like all education.   It should be a topic taught in middle and high schools.



Driving High Value Behaviors in Medicaid Plans

Not enough votes -- House delays health care bill to Friday -

What a difference a day makes ?  Twenty four little hours.

Time in Los Angeles -

What's inside the Republican health care bill?

The House will vote on the legislation, called the American Health Care Act, on Thursday. Republican leadership has already made several changes to placate both conservatives and moderates, but a number of members in both chambers remain concerned. So a lot may change before it reaches President Trump's desk.

Critics have ranged from conservative Republicans to insurers to the AARP. Conservatives complain that the bill does not fully repeal Obamacare and that many provisions are too similar to the health reform law. Insurers worry that Republicans would cut federal support for Medicaid and tax credits, leaving many of their customers without coverage. And the AARP fears that Americans in their 50s and early 60s would see their premiums skyrocket and federal assistance reduced, though lawmakers are now promising to provide this group extra assistance.

Proponents of the bill say it would save the individual health market from collapse. The legislation would create a patient-centered health care system that provides Americans more choice, greater control and lower costs, they argue.

Congress seems to believe cost savings is paramount in redesigning the Affordable Care Act.  That was the proposal with the Affordable Care Act, none of it came to pass.  Will an amendment such as the American Health Care Act transfer us from purgatory?

 Should the main metrics be who is insured, and cost ?  What about the internal workings of medical and hospital business.  Can the administrative overload be decreased ?  That is where the most savings can occur. Although health information technology has gained a foothold it has increased cost due to requirements of HHS and CMS. Their goal is to use EHR to extract data for population health management.  Physician and hospital goal is to increase usability and increase efficiency managing patients and to decrease personel costs.``

Not enough votes -- House delays health care bill to Friday - CNNPolitics.com

Is Your EHR Contributing to Physician Burnout? | Depression and Physician Suicide

Health and Wellness applies equally to patients and physicians.   Pamela Wible  focuses on physician suicide and the neglect of emotional illness in physicians points out the unusual stress placed upon medical students, trainees as well as practicing physicians.   She has presented at TedMed, and has published numerous books on the subject. The'Ideal Medical Practice" is taught at several prominent Schools of Medicine.

The concept of the Ideal Medical Practice was founded by Gordon Moore in 2001 well before the health information technology sea change.

Today there is an overemphasis on electronic medical records.  Unfortunately, as many adopters have learned the EHR may not contribute to improved medical care, but decreased efficiency and increased frustration to all health care providers.  Most of this has been inflicted by government and health insurance companies.

The work flow has been adapted to boiler plate electronic health record design, rather than EHR designed to the work flow.  At first glance this is the main reason for intense provider dissatisfaction with most current software design.  Another contribution is the rapid increase of requirements due to simultaneous demands of meaningful use, changing to the ICD 10 codes, new requirements for management of accountable care organizations and a finite limit to resources for the requirements.  The cost of these changes was partially offset by HITECH incentives, although they were inadequate for many providers. Ongoing maintenance requirements were totally ignored by HITECH.

All of these factors increase the likelihood of physician burnout.  Physicians are trained and inherently devoted to caring for  patients with complex problems.  EHRs create one more energy drain for doctors and nurses alike.  It has upset the balance of work-life, health and wellness.

The burden falls to providers facing diminished reimbursements.  Decreasing profitably and outright becoming insolvent in today's environment weight heavily upon physicians who are now locked in by obligations, ongoing professional responsibilities add to hopelessness, and despondency.  Physicians are trained to overcome difficult situations, and can manage problems.  EHRs and bureaucracy are often not manageable and greatly influence physician wellness.

Although physicians are proactive and outspoken, the administrators and regulators often do not listen. Congress does not listen.

Two weeks ago, the American Medical Association’s immediate past president, Dr. Steven Stack, chose what seemed like an odd venue to mention something called the “Quadruple Aim.”

He was giving remarks at the grand opening of the OSF Simulation Stage at healthcare startup incubator Matter in Chicago. The AMA supports Matter and has a lab of its own, the AMA Interaction Studio, in the same facility.  “We need to restore joy to the practice of medicine,” Stack said on the very day the Annals of Internal Medicine published an AMA-supported study showing that physician waste huge chunks of their day on administrative tasks. Notably, doctors in four ambulatory specialties were tied up on electronic health records and other desk work for 49 percent of the work day, the research found.   “We have got to get to the Quadruple Aim,” Stack said. That means the Triple Aim of safer patient care, better population health and lower costs, plus a fourth element, clinician satisfaction.

Is Your EHR Contributing to Physician Burnout? | EMR and HIPAA

Medical Practices of the Past QUIZ

Medicine in the 21st Century is based on scientific knowledge. Practices we use now have been reached by a wealth of knowledge gained over many years, tests and experiments and the study of data.


So, when you realize what practices were used as little as 50 or 60 years ago, it seems amazing that we’ve come so far ever since! It also makes you thank God you weren’t alive in those times, for the treatment may have been worse than the illness. Test your medical history I.Q. here.

Try our quiz and see if you can guess which practices are fact and which are fiction.



Medical Practices of the Past QUIZ Infographic

Trump Visa Changes Hit US Nursing Supply From Canada, Mexico

What !?

HENRY FORD HOSPITAL VS . NAFTA

vs.

Health care is now inextricably wound into the fabric of government. Even NAFTA's recision effects the availabllity of skilled health care professionals.  It goes something like this.

President Donald Trump's dislike of the North American Free Trade Agreement (NAFTA) is starting to affect the workforce in United States hospitals that rely on specialized nurses from Canada and Mexico to fill critical positions.

Under NAFTA, Canadian and Mexican registered nurses have for decades practiced in the United States on nonimmigrant professional TN visas, and each day many Canadian registered nurses (RNs) cross the border to work in US hospitals.

But under recent stricter interpretations by US Customs and Border Protection (CPB), advanced practice nurses and advanced clinical nurse practitioners are no longer eligible to work under the old RN category and must now apply for H-1B visas. The latter cover specialized positions for foreign workers from any country and can cost several thousand dollars per applicant for expedited processing.

Last week, a Canadian nurse practitioner working at Henry Ford Hospital in Detroit, Michigan, was denied renewal of her TN visa. "She was told by CBP that the reason for the denial was a change in interpretation of NAFTA and that advanced practice nurses, in their opinion, no longer qualified under the NAFTA registered nurse category," said immigration lawyer Marc Topoleski, who represents Henry Ford Hospital, at a March 16 new conference.  (Holy Moses, Batman !).  Nurse practitioners are no longer categorized as R.N.s.  Who makes that kind of decision ? Is it a fear of terror, or something else even more insidious and dark ? Did some negative factor for this particular person appear suspicious. In fact this policy has not been made official nor appear in any written policy documents. 

30 Canadian nurses at Detroit hospital pressured at border after policy change

The process could take as long as 3-4 weeks.

From left: Patti Kunkel, nurse practitioner, Henry Ford Health System; Marc Topoleski, principal attorney of business immigration services, Ellis Porter; Kathy Macki, vice president of human resources, Henry Ford Health System. (Dana Afana | MLive.com) (Dana Afana | MLive.com)

 HFH and others must file for a more complex and expensive H1B visa for those employees admitted on TN Visas.  Maybe an executive order from the Apprentice director would help

Trump Visa Changes Hit US Nursing Supply From Canada, Mexico

Primary Care: Some Good News Residency Match Day 2017 Sets More Records

In recent years several new medical schools have come on line.  Some of them are specifically designed to educate primary care physicians. (you know what we used to call GPs).  As a result that increase in medical school graduates along with the increasing emphasis on primary care by HHS, CMS reflected by better reimbursement rates gives hope that health care will become more accessible.





Residency Match Day 2017 Sets More Records

Common Blood Tests Can Help Predict Disease Risk :

By the time you finish reading today's Health Train Express you will be able to add one more metric to decreasing the liklihood of chronic disease.

It is not a guarrantee, nor an absolute predictor of your fate...all of these tests are readily available at you doctor's office.  Ask that they be done, when your physician asks you why....quote the following. Almost all plans now reimburse for preventive medicine.  If they deny you, appeal it to the health plan.  The squeaky wheel gets the ' oil '.

The research was presented Friday at a meeting of the American College of Cardiology and hasn't been published in a peer-reviewed journal.

"Our goal was to create a clinical tool that's useful, easily obtainable and doesn't slow the work-flow of our clinicians," said Heidi May, PhD, MSPH, principal investigator of the the study and a cardiovascular epidemiologist with the Intermountain Medical Center Heart Institute.

Dr. May and her team studied a primary care population consisting of both male and female patients who had no history of a chronic disease. ICHRON was developed among one set of primary care patients, then tested in a second, independent primary care population.

 The tests, done in Utah are not controlled and are biased heavily to the demographics of Utah, where the study was performed. ICHRON Score ( Intermountain Chronic Disease Score) is factored on several well known and routinely done lab tests.  Many of these are done annually, and are relatively inexpensive.

"It's a fascinating concept," says Wayne Dysinger, a preventive and family medicine physician and CEO of Lifestyle Medicine Solutions, a primary care practice in southern California, who wasn't involved in the study. "They may be on to something, but it's too early to say for sure." For one thing, the score would have to be shown to be accurate in a more general population outside Utah, which is largely white and has lower rates of smoking and obesity than other states.

Among women, those with a high ICHRON score were 11 times more likely to be diagnosed with a chronic disease than those with a low score. Women with a moderate score were three times more likely to be diagnosed. Men with a high score were 14 times more likely to be diagnosed than those with a low score, and those with a moderate score more than five times more likely to be diagnosed.

American Heart Association

Common Blood Tests Can Help Predict Disease Risk : Shots - Health News : NPR

Telehealth Outlook Under the Trump Administration | The National Law Review

 The Trump Administration is likely to drive telehealth advancement in a positive direction. use of telehealth technology.For example, President Trump’s plan to reform the Veteran’s Affairs Department includes improved patient care through the use of telehealth technology. There are also some indications that the newly confirmed Secretary of the Department of Health and Human There are also some indications that the newly confirmed Secretary of the Department of Health and Human Services (“HHS”), Tom Price, is “telehealth friendly.

Price also said he is interested in promoting telehealth because it “holds great promise, particularly for rural areas experiencing physician shortages and for patients with limited mobility.”

Despite the current focus in Congress on repealing and replacing the Affordable Care Act, telehealth legislation continues to gain traction and bipartisan support on the Hill. In February, a bipartisan group of 37 Senators sent a letter to Tom Price encouraging HHS to support telehealth and remote patient monitoring. Congress also has embraced telehealth advancement with a consistent stream of proposed legislation seeking to enhance the provision of telehealth services. Most recently, Rep. Joyce Beatty (OH-03) and Rep. Morgan Griffith (VA-09) reintroduced the Furthering Access to Stroke Telemedicine (“FAST”) Act that would expand access to stroke telemedicine (also called “telestroke”) treatment in Medicare. Congress also recently introduced HR 766 which would establish a pilot program to expand telehealth options under the Medicare program for individuals living in public housing. Additionally, Congress is poised to consider at least two bipartisan pieces of legislation focused on telehealth. The first is known as the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (“CHRONIC”) Care Act of 2016, which seeks to modernize Medicare payment policies focused on improving the management and treatment of chronic diseases using telehealth technologies. The second is known as the Creating Opportunities Now for Necessary and Effective Care Technologies (“CONNECT”) for Health Act, which seeks to mandate Medicare reimbursement for telehealth services (beyond the current, limited reimbursement framework). Finally, Senator Orrin Hatch (R-UT), the Chairperson of the Senate Finance Committee, recently released his “innovation agenda for the 115th Congress” which encourages the promotion of the “internet of things,” greater broadband investment, and increased device-to-device communication and cross-border data flows.

Telehealth will continue to increase in use despite proposed changes to the Affordable Care Act. Whether it will become a major player in health care will depend on studies to show if it cuts costs,improves care, or increases utilization as a redundant triage mechanism.  Telehealth does not . substitute for a visit to a physician, except for remote locations, where medical care would otherwise be lacking.

Telehealth Outlook Under the Trump Administration | The National Law Review

Seema Verma Confirmed by Senate as CMS Chief

Following a relatively benign debate about the new CMS Chief, Seema Verma is confirmed as the new head of CMS.

Seema Verma, nominee to head CMS, listens during a Senate Finance Committee confirmation hearing in Washington, DC.

Physicians seem to be  content that she is a governmental minimalist and favors voluntary participation in government programs rather than mandatory participation

Vice-President Pence was instrumental in recommending her to the position as he had worked closely with the Medicaid program in Ohio.

Verma has specialized in working with state Medicaid programs to improve care while lowering costs. The Trump administration will count on her to achieve those goals in a federal program that stands to shrink in a House Republican bill that repeals and replaces the 7-year-old Affordable Care Act (ACA). The measure would eliminate expanded Medicaid eligibility that 31 states chose under the ACA, and convert open-ended federal contributions to state programs to a fixed, per-capita amount, putting the program on a budget, as it were.

Verma's work with the Medicaid program in Indiana may be a preview of the program's future. She designed a "consumer-directed" version of Medicaid called Healthy Indiana Plan (HIP) that gives beneficiaries a Personal Wellness and Responsibility (POWER) account — similar to a health savings account — to apply toward a $2500 deductible. And while Vice President Mike Pence was governor of the Hoosier State, she helped created HIP 2.0, which expanded Medicaid coverage under the ACA. Beneficiaries who contribute a small percentage of their income to their POWER accounts are entitled to extra benefits such as dental and vision coverage.

Like the president that nominated her, the new CMS administrator espouses a small-government philosophy that many physicians may find refreshing. At her confirmation hearing, Verma said that physician participation in Medicare pilot projects for delivering and reimbursing medical care should be voluntary, not mandatory. She also decried federal regulations that might discourage physicians from participating in Medicaid and Medicare, and the burdens that electronic health records impose on clinicians in connection with the meaningful use incentive program.

Seema Verma Confirmed by Senate as CMS Chief

On Death's Door California To Permit Medically Assisted Suicide As Of June 9 :

Debbie Ziegler holds a photo of her late daughter, Brittany Maynard, while speaking to the media in September after the passage of California's End Of Life Option Act. Maynard was an advocate for the law.
Carl Costas/AP

Classic Version of the Hippocratic Oath

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant: hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

A Modern Version of the Hippocratic Oath

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

California will now permit assisted suicide.  

California Gov. Jerry Brown signed landmark legislation last October that would allow terminally ill people to request life-ending medication from their physicians.

But no one knew when the law would take effect, because of the unusual way in which the law was passed — in a legislative "extraordinary session" called by Brown. The bill could not go into effect until 90 days after that session adjourned.

The session closed Thursday, which means the End of Life Option Act will go into effect June 9.
If one carefully compares the classic version with the modern version the modern version contains a new phrase,  "But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

Physicians asked to . participate in legal executions have long been uncomfortable performing this function.  Physicians have quietly assisted in hastening death's approach surreptiously with medications.  Patients who are in death's grip are often sedated to diminish pain, and the use of opioids has many side effects on the cardiovascular system.  Now this can be pursued in hospital, or at home with family and/or friends in attendance.
It seems most merciful, and another evolution of medical practice.  Some physicians may refuse to participate, even if the family requests this act.  In such cases a new 'specialty' may emerge, Deathologist.  It no longer is such a horrific word.

Although physicians will be protected legally, the disconnect will remain. 

California To Permit Medically Assisted Suicide As Of June 9 : Shots - Health News : NPR

Clinical Trials, Can Social Media Help ?

ARE SOCIAL MEDIA SAVVY PATIENTS THE BEST-KEPT CLINICAL TRIAL RECRUITING SECRET

PATIENT ADVOCATES AS THE VOICE FOR CLINICAL TRIALS

Patients know how to appeal to other patients. We know what concerns about enrollment are, because we’ve had them. We know the barriers to enrolling, because we’ve faced them. Perhaps most importantly, we know what myths about clinical trials still exist, and can work from the inside out to get rid of them. These myths – that clinical trials are a last resort, that they’re not safe, or that they’re only for certain age groups – are preventing patients from receiving the most forward-thinking treatment available. Patients have a personal incentive to recruit patients to join clinical trials. The more patients who join clinical trials, the potentially faster that drug might come to market as a treatment option for their community. Thus, patients just might be the best-kept clinical trial-recruiting secret.

Cancer communities are forces to be reckoned with, both on social media and offline. Our respective tweet chats, local meet-ups, poster presentations at international conferences about patient reported outcomes, and at times even our own research studies speak to the credibility of our community reach and knowledge.

On Twitter, for example, the #BCSM (Breast Cancer Social Media), #BTSM (Brain Tumor Social Media), and #LCSM (Lung Cancer Social Media) communities share hundreds, if not thousands of tweets and articles related to cancer care each day. Searching through these hashtags turns up journal articles, recent press headlines, organized chats, personal questions and experiences.  It’s as simple as a tweet, really.

Searching for a clinical trial used to only be possible by patients Googling for answers or their physician presenting options in the clinic. Now, patients are flipping the script and searching through Twitter to find information from each other.

Let us not forget Facebook, or Google + and Instagram. All these social platforms provide a . huge network for disseminating information.

Are social media savvy patients the best-kept clinical trial recruiting secret? | Cure Forward

To Pay Or Not To Pay – That Is The Question |Affordable Care Act

K.A. Curtis gave up her career in the nonprofit world in 2008 to care for her ailing parents in Fresno, which also meant giving up her income.

She wasn’t able to afford health insurance as a result, and for each tax year since 2014, Curtis has applied for — and received — an exemption from the Affordable Care Act’s coverage requirement and the related tax penalty, she says.

This year, given President Donald Trump’s promise to repeal the ACA, along with his executive order urging federal officials to weaken parts of the law, Curtis began to wonder whether she’d even have to apply for an exemption for her 2016 taxes.

She also heard that the IRS recently flip-flopped on its previous decision to reject 2016 tax returns that don’t include the taxpayer’s health coverage status.

“I thought, ‘Maybe I won’t have to apply for the exemption again,’” says Curtis, 59. “The public debate about the law makes it confusing.”

Indeed, there’s widespread confusion among consumers about the status of Obamacare, and because of that, they are uncertain how to handle Obamacare-related tax requirements.

Since this article appeared the tax penalty has been overturned by the new White House resident, Donald Trump. And other features are being modified as this is being written.

Should you still submit your 1095 tax forms that show when you were covered — or, if you purchased a plan from an exchange, the amount of tax credits you received? Should you apply for an exemption from the Obamacare coverage requirement?

If you were uninsured in 2016 and don’t qualify for an exemption, should you pay the Obamacare tax penalty?

“Unfortunately, there are a lot of myths floating around,” says Lawrence Pon, a certified public accountant (CPA) in Redwood City. “Some of my clients ask me, ‘Does the law still exist?’”

It sure does.

As a result, California tax experts have some relatively simple advice for confused taxpayers.

“Until Obamacare is no longer the law of the land, we don’t have much choice other than to continue under the current rules and regulations,” says Janet Krochman, a CPA in Costa Mesa.

It is all open to argument and subject to change.  Given this state of chaos I would recomend holding off filing, and wait for a comment or notice from the IRS.  Recent events regarding the ACA have resulted in defacto postponements, or outright nullification of deadlines and other regulatory statement.

On the other hand, other experts make this recommendation.

Many tax preparers say they’d rather not deal with the law’s arcane and complex requirements. But every single one I spoke with says they will continue doing so as long as former President Barack Obama’s health law exists.

“I tell everybody I want all of their forms. We’re going to document everything,” says Rebecca Neilson, a registered tax preparer in Sheridan, about 40 miles northeast of Sacramento. “I’m not going to change what I’m doing because the law might get changed.”

However, a recent IRS switch has fueled hopes among some consumers that the agency won’t enforce the Obamacare tax penalty for 2016.

Then again to add to the confusion

How to dodge the Obamacare tax penalty -- legally

HealthCare.gov Exemptions 

There are many ranging from death in the household, eviction, bankruptcy, and more. Go to the Exemption screening Tool on HealthCare.gov

To Pay Or Not To Pay – That Is The Question | 

The Future of Medical Technology

Technology is improving at an exponential rate. What was once just a hope or a dream is now reality. Hospitals worldwide use complex machines to help diagnose and treat the human body. Advances in areas of technology have been applied to medicine on a massive scale, allowing practitioners to become more specialised in particular areas and revolutionising the way we use and store data.

So what lies ahead for our rapidly advancing technology? What ideas are now in process that could soon become a reality and how might it change our lives? Let’s take a closer look in the infographic below.

So what lies ahead for our rapidly advancing technology? What ideas are now in process that could soon become a reality and how might it change our lives? Let’s take a closer look in the infographic.

AI . Artificial intelligence can be used to detect Alzheimer's disease

Spare parts have been grown.  Brain, Esophagus, Liver, Kidney.

Prosthetics: 3D printing, Integration of processors and implanted brain electrodes

Advanced remote monitoring and televideo

Advances in rapid genomic assays will bring genomic study costs to less than $ 10.00 for focused analytics.

The Future of Medical Technology