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.

photo credit: pheezy

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…

What Are the Benefits of Electronic Prescriptions?

Adopting an e-prescribing system has a number of benefits for both doctors and patients. The system is more efficient, potentially saving millions of dollars in health care expenditure, and meaning shorter waits for people getting prescriptions filled. More importantly, it could completely eliminate the harmful errors that can result when a doctor’s handwriting is misread by a pharmacist. The biggest stumbling block in setting up an e-prescribing system for most doctors is the cost – around $3,000 to set up the system in a general practitioner’s office. In January, a Medicare bonus program was launched, with bonuses provided for doctors who convert to an e-prescription system. For the next four years the average doctor can earn a bonus of up to $1,500 per year for using such a system.

Obama Improvements to E-Prescribing

Further improvements are on the way thanks to President Obama’s stimulus bill, with approximately $19 billion earmarked for promotion and improvement of health care technology, including e-prescribing systems. Currently around 13% of doctors use an e-prescribing system. One recent report predicts that figure will climb to around 75% within five years, and to 90% by 2018. Health care research company Visante for PCMA also predicts that e-prescribing could save the federal government $22 billion over the next ten years – more than enough to cover the money spent. Where do the savings come from? PCMA says billions will be saved because the system will make it easier for doctors to prescribe cheaper generic drugs, thanks to on-screen computer alerts to let a doctor know when a generic is available for any given condition. And eliminating prescription errors will save money too. PCMA predicts that 3.5 million medical errors, and 585,000 hospitalizations due to errors, will have been prevented by 2018. photo credit: quinn.anya

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

Many of us are predisposed towards a mistrust of drug companies. The fact is, they make billions of dollars every year, and it seems like most would do anything for a buck. Recent news that AstraZeneca allegedly suppressed negative information about Seroquel, an anti-psychotic drug, is not helping the tarnished image that the pharmaceutical industry has earned.

A Washington Post article published recently outlines the study, known as “Study 15,” and reported that AstraZeneca had suppressed the study’s negative results, and at the same time promoted more positive results from other studies with less stringent protocols.

Also reported by the Washington Post: The shocking fact that one employee of AstraZeneca praised a colleague’s “smoke and mirrors job” in reference to the suppression of the negative results. Those suppressed results include a possible link between Seroquel and the development of diabetes. In addition, the study showed that Seroquel was no better than other anti-psychotic drugs at preventing psychotic relapses.

Who To Trust With Your Health And Prescription Drugs

Sometimes, it’s hard to know who to trust. And unfortunately, some doctors can’t be trusted when it comes to clinical trials either.

Dr. Scott Reuben, an anesthesiologist currently on leave from Springfield’s Baystate Medical Center in Massachusetts, has been accused of faking data in clinical trials for a staggering twelve years. According to the accusations, Dr. Reuben is responsible for faked data in no less than 21 published medical papers.

• According to news released by the Baystate Medical Center, a routine hospital review carried out in 2008 revealed that some of the doctor’s research had not been approved by the hospital’s review board.
• An investigation into the issue found that Reuben had made up some or all of the data in 21 papers published over the last twelve years.
• The data involves several drugs, including Celebrex, Lyrica, and Effexor, and Reuben attests to their effectiveness as painkillers in the published studies.

On the basis of the studies, Reuben had received numerous research grants from several sources, including drug company Pfizer, which makes and markets Celebrex.

As if the monetary rewards weren’t bad enough, the doctor has become widely respected in the field of anesthesiology on the basis of his fraudulent research, and many doctors have been basing their own use of pain relievers on Reuben’s results.

And even worse for patients, some of the drugs Reuben “studied” have been shown to delay bone healing – but Reuben’s work didn’t show up any of those problems. It’s now likely that many of the clinical trials Reuben published will be redone to ensure that accurate results are achieved.

photo credit: HA! Designs – Artbyheather

President-elect Barack Obama should take note – health reform is about the little things just as much as it is sweeping changes to the system.

Information gathered from a batch of more than 8,500 meetings held around the country in December will be compiled and used to help design the healthcare proposal that has been in the news as of late. Obama’s transition team plans to post some of the material at change.gov.

One particular meeting took place late December 2008, between newly appointed secretary of health and human services, the former Senate Majority Leader Tom Daschle, and more than two dozen seniors During this meeting, seniors told Daschle that they placed more importance on certain things such as waiting times to see their doctor, the increasing cost of prescription drugs, and the narrow range of Medicare coverage for certain medical procedures, equipment, and treatments.

An Example for Health Care Reform: Alzheimer’s

One woman at the meeting cited her family’s history of Alzheimer’s disease for her hope that the new administration will put heavy emphasis on medical research. A man said that helping people live healthier lives should receive more emphasis than it currently does – not only to improve health, but also to reduce medical costs for individuals and the nation as a whole. Another man says he wants medical providers to show more concern for the people they treat than whether or not those people will pay their medical bills.

Daschle says that lawmakers are more likely to get behind a new health care system if voters provide enough incentive pressure. And it seems that the transition team is listening: The Obama administration is encouraging seniors to submit their own stories about health care – and any other issues they think need to be addressed.

The team should also take one final note: The current effort to gather information about the health care system has been compared to the 2005-2006 attempt by the Citizens Health Care Working Group. More than 6,500 people participated in meetings across America, and a further 14,000 participated in online surveys. The Congress-sponsored group eventually recommended guaranteed health coverage for certain doctor’s visits, and some ways to protect people from high health care costs – but none of its recommendations were acted upon.

Let’s hope that this new round of meetings prompts some real change.

photo credit: woodleywonderworks

It’s not just the unemployed facing healthcare insurance problems, according to a new Robert Wood Johnson Foundation report compiling research carried out by the State Health Access Data Assistance Center at the University of Minnesota. Nearly 20% of American workers have no health insurance, up from around 14% in the mid-1990s.

During the mid-1990s, one in seven American workers had no insurance. Just ten years later, that figure has increased to one in five workers uninsured, or around six-million more people over the mid-1990s total.

What’s causing the high rates of uninsured workers?

What has caused the drop in insurance rates? The study notes that it’s likely due to an increase in the cost of insurance – premium costs for employer-sponsored healthcare have increased up to eight times faster than wages, meaning that fewer employers and fewer workers can afford the coverage.

Another fact the study notes is that many workers are newly uninsured, and the percentage of uninsured workers has risen sharply in the last couple of years. Finally, while up to 20% of workers no longer have insurance, around 90% of children are covered, as well as almost all retirees.

Criticism of the health insurance statistics

Some have criticized the statistics and the healthcare system on the basis of the disparity of insurance rates between workers and retirees – saying that workers are paying the bill for coverage for people who are no longer working. But is this really fair?

Today’s retirees – the people who are now on Medicare – are the taxpayers of the last generation. They’ve already paid for the healthcare they’re now receiving. And the current generation of tax-paying workers is paying now for the Medicare they’ll receive when they hit retirement age.

The real problem is that there just aren’t any insurance safety nets for working adults. SCHIP provides coverage for children and young people, while Medicare provides for seniors. For working adults, however, the options tend to be limited to employer-sponsored care, private insurance, or nothing at all.

More significant in terms of the study’s statistics is the fact that the mid-2000s figures were taken from Census 2007 results – and given current trends it’s likely that the number of uninsured workers is actually much higher than one in five.

photo credit: aflcio2008

The $787 billion economic stimulus package that was signed into law last week includes one or two health-related measures that haven’t been widely publicized, but which are no less important for it.

One of these is the $1.1 billion that has been assigned for a study to compare the effectiveness of a large number of medical treatments, drugs, surgeries, and other current standard medical procedures and devices. A council of fifteen federal employees will be set up to coordinate the research and advise the President and Congress on where the money would best be spent.

The program is a response to growing concerns that doctors have little solid evidence on which to base the value of many of the treatments that are currently considered standard.

Questions to Answer with the Stimulus Package Health Care Money

According to Dr. Elliott S. Fisher of Dartmouth Medical School, the study will help answer questions such as these:

• Should severe neck pain be treated with physical therapy, medication, and exercise, or with surgery?
• What is the best combination of prescription medication and therapy for the treatment of depression?
• Is it more effective to treat arterial blockage in the legs with medication or with surgery?
• Is medication alone an effective treatment for chronic heart failure, or are active health intervention measures also necessary?

Second Concern: Rapidly Increasing Health Care Costs

A second concern is the rapidly increasing cost of health care. Healthcare spending hit a total of $2.2 trillion in 2007. That’s 16% of gross domestic product – and it’s been estimated that figure will hit 25% by 2025. It is hoped that the research will save money by discouraging the use of expensive treatments that are largely ineffective and, at the same time, boosting the use of more effective treatments. During her years as a senator, Hilary Rodham Clinton was a firm proponent of such research and President Obama endorsed the concept during his White House campaign.

Not everyone is supportive of the idea of spending millions of taxpayer dollars on health care comparison studies. Critics say it may allow the federal government to be too intrusive when it comes to personal health care choices, and may jeopardize the doctor-patient relationship by put the government squarely between patients and health care professions. Others worry that insurance companies will use the data gained from the study as an excuse to deny coverage of more costly medical treatments.

photo credit: Emily Taliaferro Prince