In the late 1990’s the funding formula for Medicare reimbursements was first enacted in conjunction with the Balanced Budget Act. However, even at that time it was thought by some to be flawed. Today the formula is thought to be seriously flawed, and is growing more and more out of sync with its original intended purposes with each passing year.

Medicare Cuts Could Affect Quality of Care

Even though Medicare has instituted this drastic cut it too may stand to be on the losing side of the board as well, considering there are already a huge number of medical practices that currently do not take on Medicare’s elderly patient population.

Participating physicians will see a direct impact of the 21% cut with the average office visit now being reimbursed at about $8.00 less than what they were in 2007. Medicare may also feel the brunt of this unresolved state of affairs.

If a resolution is indeed reached, and the cuts reversed, they are looking at having to swallow about .30 cents per claim that is reprocessed. This translates out to a staggering potential of $15 million dollars for the first 50 million claims alone.

Only time will tell how it will all play out in the end, if there ever will be an end. In the meantime, there is no way for anyone, including physicians, patients and even Medicare to avoid the huge impact of this monumental move.

Positive effects of health care reform in California

When it comes to California, the federal overhaul would help those who can afford health insurance but are currently unable to get it. It will assist those who aren’t able to obtain coverage by providing them with a means to acquire health care benefits. Additionally, the bill will also go a long way in tackling the desire to provide Californians with the preventative means to uncover unhealthy conditions in the early stages, where they can be addressed promptly, and thus help everyone get more affordable California health insurance. There is a downside of this bill, however; read below to learn what it is.

Potential negative effects of health care reform

Instituting health care reform means that the federal government may need to finance the reform by lowering Medicaid reimbursements. Considering that the reimbursement rates are already thought to be low, health care providers may turn away people who have Medicaid. This means that although a person has coverage, they may not be able to gain access to care.

If the reform taps into federal monies that are currently used for the care of the uninsured at the local level, and diminishes the funding, there’s a chance that the individual safety-net systems at the county level would be financially burdened as they attempt to continue to provide care for the uninsured.

As Californians ponder the good or bad of this reform, it’s important that they look at where and how current care if provided, and that these programs remain financially sound in order to not defeat the intended purposes of the reform.

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CLASS Act

The CLASS Act is a national, voluntary insurance program that is designed to provide cash benefits if you have a disability or some form of limitation in your ability to function. The idea is to provide a way for individuals who fall into this category a way to help pay for their long-term care services.

Eligibility Requirements for CLASS Act

The plan will mostly be offered by employers and paid for by employees. Self-employed individuals may also enroll in the plan. You may enroll in the act if you meet the following criteria.

• If you are actively at work
• If you are 18 years or older
• If you are not living in a nursing home or a long-term care facility at the time of your enrollment.

You cannot be excluded from the plan if you have a pre-existing condition.

Benefits of the CLASS Act

Once you have paid into the plan for 5 years you are eligible to receive cash benefits if you have a functional impairment or disability that is expected to last more than 90 days, if you have a significant cognitive impairment such as Alzheimer’s or if you will need substantial assistance with at least 2 daily activities of daily living that is a direct result of your impairment.

Tax-exempt hospitals will be required to meet new requirements under health reform.

There has been so much back-and-forth debate about healthcare reform it can make your head spin. The Democrats say one thing, and it seems as if the Republicans claim the polar opposite. It doesn’t matter what piece of the reform is in question, it seems as if the two parties will never see eye-to-eye. In the midst of this ongoing debating (and sometimes arguing) the general public is more confused than ever about what the individual pieces of the health reform act mean. Here’s a brief look at how the health care reform will affect tax-exempt hospitals.

Accountability For Tax-Exempt Hospitals

Section 9007 of the Patient Protection and Affordable Care Act, which creates a new 504(r) of the Internal Revenue Code called “Additional Requirements for Charitable Hospitals,” is designed to increase the accountability of hospitals that fall under the tax-exempt status. It requires these establishments to adhere to the following conditions in order to maintain their tax-exempt status.

• At least once every three years they must conduct a community health needs assessment, and formulate a plan to meet those needs.

• Hospitals and health care providers must have a financial assistance policy that provides free or reduced health care for anyone who is eligible. They must also provide emergency care without regard to eligibility, and this policy must be made public.

• Hospitals must refrain from extraordinary collection actions before establishing eligibility of clients.

• Hospitals must place a limit on the amount charged to eligible persons in relation to the rates billed to persons who have insurance coverage elsewhere.

• If a hospital fails to meet the requirements of the statute they can have a $50.00 excise tax imposed on them.

Health Reform and You

These laws may change the way in which the government deals with hospitals, but the bulk of reform deals with you, the individual.  Health reform will require you to purchase health insurance by 2014. If you fail to acquire a health insurance plan, you will be levied with a fine. If you’d like to look into your options now, then you can explore the types of health insurance plans here.

photo credit: TheTruthAbout…

Is Your Teen Equipped for Health care?

Adolescence is a unique time in the human life span. Between the ages of 10 and 19, biological changes occur at a greater rate than at any other time barring prenatal development and infancy.

Teenagers aren’t just slightly bigger children – and once the childhood stage of preschool vaccinations, childhood checkups, and summer camp physicals is over, they’re much less likely to get regular preventative medical care.

In fact, a new report suggests that many teens are slipping through cracks in the health care system simply by virtue of their age, and the existence of an “in-between” stage in the health care system that means teenagers aren’t being provided for.

For most teens, adolescence is a time of not only change, but also of boundary-pushing and risk-taking that can involve anything from smoking cigarettes, to experimenting with drugs, underage drinking, reckless driving, sexually transmitted diseases, or teenage pregnancy.

Just as important, habits that are formed during these teenage years are very often the habits that persist throughout adulthood. That tends to be true whether it’s work ethic, social behavior, or health-related habits.

Health Care and Insurance System Not Set Up for Teenagers

The saying may seem a trite cliché, but children really are the future, and it’s not just insured children who are missing out on health care. When it comes to teenagers and adolescence, the health care system just isn’t designed to provide what they need. To make a bad situation worse, there are fewer doctors specializing in adolescent medicine than in most other specializations. Fewer than five hundred doctors registered as adolescence specialists between 1996 and 2005 – and some states have no registered specialists at all. To seal the deal, teens usually aren’t particularly enthusiastic about visiting doctors, often worrying that any information they supply during a checkup won’t remain confidential.

The result is that while the nation’s five million uninsured teens are most at risk, it’s during adolescence that people in general tend to begin making fewer health care-related visits, a trend which peaks during the 20s. Half of adult deaths are the result of unhealthy habits, and it’s during adolescence that such habits are typically formed.

What’s the solution? In the long-term, it’s difficult to say. There may be little incentive for medical professionals to specialize in adolescence medicine, and it may very well be a field few have an interest in. The answer to the problem may simply lie at home, with parents taking care to reassure their teens and help them find a doctor they can trust and feel comfortable with, at an age when these factors are particularly important.

A few key points you should know about acupuncture

It almost seems like an oxymoron doesn’t it? Stick needles into your skin to ease pain. You’d think that sticking needles into your body would produce pain, but that’s not what happens. The art of acupuncture has been around for more than 4000 years. Though it is still not completely understood how it works, and many remain skeptical, those who have had acupuncture treatments will attest to its effectiveness. Scientists have recently made a correlation between a molecule called adenosine and the effects of acupuncture.

What is Adenosine

A team of scientist as the University of Rochester Medical Center identified the molecule, adenosine, as a major player in the pain-relieving effects of acupuncture. The report was published online in Nature Neuroscience, and indicated that scientists were able to triple the pain-relieving effects of acupuncture in mice by using a chemical which makes it harder for body tissue to remove adenosine.

How do I obtain acupuncture health insurance?

Acupuncture coverage generally falls under the larger category of alternative therapy coverage. This is a type of health insurance that offers benefits that are tailored to patients who are interested almost exclusively in alternative forms of health care (whether it is natural health remedies, chiropractic care, hypnosis, energy healing, homeopathy, and more). You can request a free quote for health insurance here, which will get you on the right track.

How Adenosine Works With Acupuncture

Adenosine is a natural compound that is known to regulate sleep, and has anti-inflammatory properties. Adenosine also acts as a natural painkiller by inhibiting nerve signals which signal the brain to feel pain. Adenosine dramatically increases the effects of acupuncture treatments by almost tripling the amount of adenosine in the muscles where acupuncture treatments are administered.

Research already shows that acupuncture creates signals in the brain that cause the body to produce the larger amounts of endorphins; another natural painkiller found in the body. This study shows has revealed the role of adenosine in acupuncture treatments.

For many people, acupuncture is a mainstay in their fight to relieve pain. Although it isn’t completely understood just how it works, thousands of people will attest that it does.

photo credit: sushiphotos

For over a year, Congress has been squabbling over the health reform bill championed by President Barack Obama.  The long effort finally came to fruition last Sunday, when congress narrowly passed (by a 219 to 212) margin of victory.  Known as HR4872, the bill was revised from an earlier bill that was passed by congress on Christmas Eve of 2009.

As a result, the nation seems even more divided than it was before the bill, with Republican John Boehner vowing to fight the bill, and adding, “The American people are angry… Shame on us!”

So what should you know about the landmark health reform, and how will it affect you and your family? Health Care Today has gathered together some commonly asked questions and we’ve compiled them below.  We hope this FAQ will help you better understand one of the most complicated congressional bill in to hit the floor for quite a while.

What changes will happen after health insurance reform is passed?

HR4872 will mandate that every American purchases insurance. Of course, this won’t happen right away – many of the requirements will be enacted in 2014. However, some requirements will happen almost immediately, including:

• Insurance companies can’t put a lifetime “cap” on benefits. Additionally, there will limits on the “annual caps” that some companies are apt to use.
• Health plan providers can’t take away any existing coverage that you have, unless you intentionally lied or omitted information in your health insurance application.
• Children will be guaranteed coverage, regardless of any preexisting conditions.
• Children can be covered under their parents’ plan until the age of 26.

What benefits does the reform promise to Americans?

The major benefit is expanded government subsidization of health coverage. According to the Congressional Budget Office, somewhere around 20 million Americans will qualify for subsidized government coverage. Families are earn below 133% of the Federal Poverty Level can receive a plan that’s similar to Medicaid. Subsidies apply to individuals who earn as much as $44,000. Whatever the case, the government is going to ensure that you don’t spend more than 10% of your income on health coverage.

What happens if I decide not to purchase health coverage? Will I be penalized?

The short answer is yes. For individuals, starting in 2014, you will be penalized $695 for every year that you go without coverage. For families, you will be penalized $2085.

What if I currently have coverage? Will I need to change my plan?

No. If you like your current health insurance plan, then you won’t need to switch. However, the government will make finding new coverage easier by expanding the use of state-based health insurance exchanges. These will be sort of like open marketplaces, where you can shop for the most affordable and comprehensive health insurance that fits your needs.

How will this reform be paid for? Will there be taxes?

The government will levy a 3.8% tax on investments for individuals who make more than $200,000 ($250,000 for couples). The government will also raise the Medicare tax by 1.4%  for people who have the same income level. Of course, the higher taxes won’t go into effect until January of 2013.

Is There Any Way to Avoid the Requirement to Purchase Health Insurance?

The bad news is that it’s unlikely that you will be able to opt out of coverage. However, the HR4872 provides for certain extenuating exceptions, including people who oppose the reform for religious reasons, Native American Indians, illegal immigrants, and criminals who are serving prison time.

Even for the insured, the cost of copays and other out-of-pocket expenses add up quickly, whether you’re single or have a family. If you’re feeling the pinch, you’re not alone – according to a recent Kaiser Family Foundation poll, 53% of respondents said they had cut back on their health care to try and save money.

Many respondents reported an increased use of over-the-counter medications or home remedies, rather than scheduling a visit to their doctor. Others said they didn’t fill prescriptions to save money; some even skipped treatment or tests that their doctor recommended.

Ignoring your doctor’s instructions could prove risky if you have a serious medical condition. But no matter health status, you can cut down on some of the costs of healthcare without having to neglect your health. What can you do?

• When you visit a doctor, make sure you’re prepared. Take along all the information the doctor might need, including paperwork and medical records if necessary. Take note of whether your health has changed recently, including energy or weight fluctuations. If you have any questions you want to ask, make a note so you don’t forget them. Being prepared for a doctor’s visit cuts down on the need for repeat visits, and helps save on copays.
• Get your test results over the phone. Most of the time you won’t need to return to your doctor to get test results, so there’s no reason to spend money on the copayment when it’s not necessary.
• Consider setting up a flexible spending account when open enrollment comes around. Flexible spending accounts let you put pre-tax dollars aside to fund certain types of medical expenses.
• Call an organization such as the Patient Advocate Foundation (800- 532-5274) if you have a chronic disease and want some help with getting the most out of your insurance plan.
• If you’re uninsured, then consider visiting a store clinic. In some locations, retailers such as Target and Wal-Mart now run clinics where you can receive routine medical care for about half the price of a doctor’s visit.
• Try and track down locations where you can receive free medical screening. Organizations such as the American Cancer Society and the Centers for Disease Control and Prevention can help you locate such programs.
• Request a quote for affordable health insurance here. Our system is able to connect you with leading health insurance carriers from across the country, and it could save you a lot of money on premiums or health care costs.

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According to the results of a new national survey, less than 2% of American hospitals have completely switched to an electronic medical record-keeping system.

Between 8% and 11% of hospitals have partial electronic systems in place, with at least one department in those hospitals having converted to a digital record-keeping system.

Dr. David Blumenthal, head of the Institute for Health Policy at Massachusetts General Hospital, says that American hospitals are at a “very low stage” of adoption of digital technology as compared to other countries. But with less than 2% of American hospitals completely digital, this seems to be a massive understatement.

American hospitals – and doctor’s offices, for that matter, with just 17% of American physicians using digital record-keeping technology – have a very long way to go.

Health Records, Health Insurance, and Saving Money

Previously, the Bush administration set a goal of 2014, by which time the entire country would (theoretically) have transferred to an electronic medical record-keeping system. This goal got a much-needed boost earlier this year when President Obama signed the economic stimulus package which includes $19 billion for converting physicians and hospitals to an electronic system. (Interestingly enough, the majority of the money is earmarked for incentives to encourage doctors and hospitals to use electronic systems.)

The money is certainly needed. A small hospital to convert to an electronic medical record-keeping system, around $20 million in capital is required. For a large academic hospital, that figure can range up to $200 million. For around 75% of hospitals, lack of funding is the main barrio towards updating their record-keeping systems. Approximately 44% also cited maintenance costs as a significant barrier.

Given the enormous cost, the survey results that show 98% of hospitals, and 83% of doctors are in need of an electronic updage, are somewhat sobering. Will $19 billion be enough to update the country’s antiquated medical record-keeping systems?

Photo credit: David Boyle in DC

One of the great ironies of the insurance system is that when you’re sick and need the protection of health insurance the most, you can expect to pay a lot more for your premiums. It’s practically one of the certainties of life, like death and taxes, that are invariably true for everyone. But is that about to change?

Health Plan Companies Consider Removing Pre-existing Condition Penalties

For the first time, the health insurance industry has been talking about the possibility of ceasing its practice of charging much higher premiums for health insurance applicants with pre-existing medical conditions or a history of medical problems.

The offer comes from America’s Health Insurance Plans and the Blue Cross and Blue Shield Association, and – make no mistake – this is a big deal.

In the wake of the Obama administration’s plans to reform America’s health care system to provide coverage for the estimated 48 million who are currently uninsured, these insurance industry groups have stated their willingness to make a start at charging fair premiums for all Americans.

In their letter to key senators, the two organizations spoke of their willingness to “phase out the practice of varying premiums based on health status in the individual market” if health coverage becomes mandatory for all Americans.

Why is this so important? Because it means these organizations are willing to move away from the risk-assessment factor of insurance premiums – meaning that people who have a history of medical problems won’t be penalized when it comes to getting health insurance.

It’s not all sunshine and roses, however. Insurance companies will still charge different premiums based on other factors such as sex, age, and location. And certain groups, such as small business owners, have been left out in the cold. Small business owners are often hit hard by risk-assessment, because if just one worker becomes seriously ill premiums can sky-rocket the following year.

Financial Motives of Changing the Pre-existing Condition Health Insurance Policy

And, of course, the motive for all of this is purely financial. Insurers are simply trying to gain political support in an attempt to stall the creation of a government insurance plan that would necessarily compete with private insurers.

But whatever the motive, the outcomes could certainly be positive. The insurance industry has already discussed support of a national goal to prevent insurance costs rising, and, in its bid to fend off the competition, has also offered to end its practice of outright denying health coverage to people with pre-existing conditions.

photo credit: SavaTheAggie