Our Health California

Provider reimbursement is only a small part of what Medi-Cal pays.  It pays for indigent care, skilled nursing facilities, home health services. Providers receive only a small portion of the total budget for medi-cal patients.

The Affordable Care Act has made insurance available to many who live at or near the poverty line. However it does not assure access to providers who are the entry level into the system.

Contrary to prediction patient flows the emergency rooms have become even bigger since few providers accept medi-cal.  Medi-Cal's rates do not cover overhead for providers, and they are often seen at a loss unfortunately.

Insurance and access are two sides of the coin in regard to health care.

Click on the link to learn more about Medi-Cal and the Our Health California Community.  Join and get involved.







Our Health California

Cleveland Clinic suffers 71% operating income drop | Healthcare Dive

Cleveland Clinic suffers 71% operating income drop | Healthcare Dive

Here's the bipartisan path forward on health care: Andy Slavitt

This is the way to bringing a sensible and workable plan with bipartisan support.  No matter what the plan patients and providers need to get behind the plan . There is not perfect plan, and the perfect plan is the enemy of the good.

Trumpcare failure is an opportunity to end the divisiveness that hampered the Obamacare era.

The failure of Trumpcare last week can be seen as a rejection of policies that Americans judged would move the country backwards. But it also presents the opportunity to end the divisiveness that hampered the Obamacare era and move forward in a bipartisan direction that focuses not on destructive rhetoric, but squarely on reducing premiums and expanding access for all Americans.

The policies and the politics of Trumpcare were extreme and favored by only 17% of voters as compared with the Affordable Care Act (ACA), which enjoys support from 50%. The central plank of the bill cut care for the neediest children, elderly and disabled to pay for a large tax cut for the wealthy. The process, likewise, began with the most partisan approach possible. Republicans skirted Democratic input, avoided public hearings, and ended up rushing a bill without enough time for impartial evaluation.

The president has a chance now to turn this around. Last week, he invited Ezekiel Emanuel, a Democratic policy expert who helped craft the ACA, to the White House. Emanuel and I had dinner after his visit to the Oval Office, and he reviewed the commonsense ideas he shared with the president that were neither Democratic- nor Republican-leaning. The president had already chosen to head down a partisan path, but by inviting Emanuel, he might have signaled a potential interest in a bipartisan approach should that one fail.

Trump has an immediate opportunity to help Americans reduce their costs by choosing to enforce and properly steward what House Speaker Paul Ryan rightly called the "law of the land." The administration has the power to impact the cost of insurance by 25% to 30% with two simple decisions, according to a conversation I had with Mario Molina, CEO of Molina Health, one of the largest insurers in the exchange.

First, the administration, with support from Congress, should commit to permanently funding payments that reduce the size of deductibles for lower-income Americans (called cost-sharing reductions). Republicans need to drop a lawsuit they filed to stop these payments, or Trump needs to say they are going to continue. Second, the administration should enforce the individual insurance mandate until a different approach can be agreed upon. Those two actions will reduce costs for millions and need to be done now before insurers submit initial premiums for next year, or inaction will drive up premiums. Americans should watch this intently.

A third step would be to grant states the flexibility to increase competition and reduce costs. Non-partisan analysts such as Standard & Poor's confirm that the online exchanges that sell ACA insurance policies are stable, but in some states the cost of insurance is out of reach for those who earn too much to receive tax credits.

The administration has tools to do this, including a section of the ACA designed to allow states to pursue different approaches, including those more suited to their political philosophy, so long as they continue to meet the basic aims of covering more people with high-quality coverage. Alaska was the first to use this process last year by creating a statewide reinsurance pool. Such pools protect insurers against losses in high-cost cases, and the savings are passed along to consumers. In Alaska, the result was a dramatic reduction in premiums.

Obamacare is broken, and Republicans can fix it: Column

Medicare for All should replace Obamacare: Column

GOP should slow down and rethink health bill: Andy Slavitt

Here's the bipartisan path forward on health care: Andy Slavitt

Where are the Sexual Predators? | Kids Live Safe

A signifcant number of children are injured or are murdered by adult predators. It is a population management challenge.  Firstly to prevent these occurrences by identifying perpetrators, to identify where they live, and prevent them from contacting children.  Secondly to educate parents and children how to maximize their safety.

Attention is brought to us by large headlines, Amber alerts, missing person reports, and now on social media.  There are a wide variety of topics.  Sexual predators, Cyberbullying,Molestation, Pedophilia, Abduction, Social Media awareness, and online safety.  Kidslivesafe.com offers an online eBook which thoroughly covers all these topics.

Fortunately our system now registers all convicted sexual offenders. There is a registered database that anyone can use. For parents who want to learn where sexual predators live in their neighborhood Kidslivesafe offer a search by zip code service.












It is a public health problem, one that children are  particularly vulnerable.  Educate yourself and your children.

KIDSLIVE SAFE .  ZIP CODE SEARCH NOW

PUBMED REFERENCES



Who are Sexual Predators? | Kids Live Safe

Maine Voices: The problem isn't Obamacare; it's the insurance companies - Portland Press Herald

Only way to solve this is to fight fire.  Trumpism...negotiate from the . high point.  Write a letter to all your patients stating . you will no longer accept that company for their own good.  If 100,000 providers did that and sent a letter to the insurance company, they would back down really fast.

MILBRIDGE — With the recent news about increases in premiums for health plans sold through the Affordable Care Act marketplace, everyone wants to vilify the ACA. The ACA is but a symptom of the issue. Where are our policy dollars going?

As a primary care physician, I am on the front lines. Milbridge is remote. In good weather, we are 30 to 40 minutes from the nearest emergency room, so my office operates as an urgent care facility as well as a family medical practice.

ABOUT THE AUTHOR

Cathleen London, M.D., is a primary care physician practicing in Milbridge.

It can take 20 minutes for an ambulance to get here (as it did one time when I had a patient in ventricular tachycardia — a fatal rhythm). I have to be stocked to stabilize and treat.

We are also about two hours from specialist care. Fortunately, I am trained to handle about 90 percent of medical problems, as my patients often do not want or do not have the resources to travel. I have to be prepared for much more than I did in Boston or New York City, where I had colleagues and other materials down the hall or nearby. No longer do I have a hospital blocks away.

One evening I was almost home after a full day’s work. Around 7:30, I got a call on the emergency line regarding an 82-year-old man who had fallen and split his head open. His wife wanted to know if I could see him, even though he was not a patient of mine.

Instead of sending them to the ER, I went back to the office. I spent 90 minutes evaluating him, suturing his wound and making sure that nothing more sinister had occurred than a loss of footing by a man who has mild dementia. When I was sure that the man would be safe, I let them go.

I billed a total of $789 for the visit, repair, after-hours and emergency care costs. Stating that the after-hours and emergency services had been billed incorrectly, Martin’s Point Health Care threw out the claims and reimbursed me $105, which does not even cover the suture and other materials I used.

I called them about their decision, said that it was not right and let them know they’d lose me if they reimbursed this as a routine patient visit. They replied, “Go ahead and send your termination letter” – which I did.

That is real chutzpah !

Maine Voices: The problem isn't Obamacare; it's the insurance companies - Portland Press Herald

‘Obamacare will explode’ warns Trump after Republicans pull healthcare bill — RT America

More Hyperbole !

Despite the political backlash the GOP and Paul Ryan manned up by pulling a totally inadequate solution to replace the Affordable Care Act with the American Health Care Act.  (too many A 's in either law.

What will happen next is unpredictable.  The chances of building a coalition to approve a good (not perfect) solution is probably less than hitting a comet and landing at  less than 1 meter/second hundred's of miles away. (which we did)


Rosetta Mission's Historic Comet Landing: Full Coverage

New Format for The Health Train Express

Readers will notice our new format beginning today.  In the interest of decreasing noise and distractions we are eliminating all of the information on the side bar. Over the years it has become cluttered.  This will leave much more room for my rants.

Thank you for following Health Train during the past 11 years.  We were one of the first health blogs to appear.  Although the readership has not been huge, it has been slowly growing and noticed by health care professionals around the world.