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

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

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

Fibromyalgia is a devastating disease that causes chronic pain and other symptoms for those who are affected – but it’s a disease with no known cause and no standard treatment. Many people haven’t even heard of the condition, but if that’s the case it’s not because the drug industry isn’t trying hard enough.

Drug Companies’ Hundreds of Millions Help Raise Awareness of Fibromyalgia

Last year, drug industry giants Pfizer and Eli Lilly spent hundreds of millions of dollars in advertising to “raise awareness” of fibromyalgia. The companies donated more than six million dollars to non-profit organizations for educational campaigns and medical conferences, too.

That’s more than the companies donated for Alzheimer’s, and diabetes. And only donations made for cancer, depression, and AIDS were higher than the donations made to further the cause of fibromyalgia.

Why all this trouble for a disease nobody’s heard of, that some doctors don’t even believe exists? Simple. Pfizer and Eli Lilly are using their money and influence to “raise awareness” and get doctors prescribing fibromyalgia drugs for people with the disease.

Is Fibromyalgia Real? Why the Sudden Drug Company Interest?

Fibromyalgia is a real disease, especially to those people who are affected by it. But there’s no standard treatment – just a couple of drugs more commonly used to treat other conditions which improve symptoms for some people with fibromyalgia.

Pfizer markets a drug called Lyrica, which originally received FDA approval for the treatment of epileptic seizers. Eli Lilly’s drug, Cymbalta, was originally approved for depression. Both have now been FDA-approved to treat fibromyalgia symptoms and will probably soon be appearing on the formulary lists of prescription drug plans, if they haven’t already.

Sales of the Fibromyalgia Prescriptions since Big-pharma’s Campaign

Since the companies began marketing “awareness” for fibromyalgia, sales increased from $395 million to $702 million for Lyrica, and from $442 million to $721 million for Cymbalta, between 2007 and 2008. Each company spent just over $125 million in advertising its drugs in the first nine months of 2008.

Now this might not necessarily be a bad thing. After all, people with this chronic, painful condition are getting treatment that they need.

The problem, however, is that the underlying purpose for Eli Lilly and Pfizer is simply selling drugs, and some healthcare professionals are concerned that undue influence from the pharmaceutical industry will pressure doctors into diagnosing fibromyalgia more often, even if it might not be appropriate.

In addition, some doctors believe that fibromyalgia, while a real condition, isn’t necessarily physical – that there may also be a psychological or neurological component in the development of the disease. If that’s the case, the drugs that Pfizer and Eli Lilly are pushing may not be the best solution for people with fibromyalgia.

photo credit: ccox888

Many of us rarely ponder what our health and life are worth. It’s often assumed that life is priceless, but that doesn’t do justice to the stratospherically rising health care and insurance costs; in fact health bills are now the leading cause of bankruptcy.

One common way to calculate the value of our life is to use the same equation used by many health care providers. That cost was once $50,000 per year of quality life, according to the international standard for government-run health insurance plans across the globe. This number has been disputed by economists at Stanford and they were able to calculate that a year of quality life is actually $129,000! That is a lot of money for a year of life, but of course: life is priceless!

Calculating Costs with Kidney Dialysis

As a benchmark, economists at Stanford decided to use kidney dialysis for their research. One reason they chose dialysis is because hundreds of thousands of Americans in the United States are kept alive each year through dialysis while waiting for an organ transplant. The other reason is that Medicare has covered this procedure since 1972 without regard for costly innovations in the procedure.

“Assigning a dollar figure to Medicare patients’ lives may sound crass, but such valuations are routine in Americans’ daily lives.” As an economist, you must focus on the supply and demand of the market. In this case, the patients waiting for an organ transplant have a high demand for organs and unfortunately, a low supply of organs. Therefore, kidney dialysis is a temporary, but costly solution to this law of supply and demand.

How Economics Values Your Health and Life

Modern medicine has changed the way we look at life. We are continually trying to look younger, live longer and stay healthy. The only problem is that it is expensive to keep some patients alive especially for those waiting for a kidney. Hypothetically, Medicare coverage no longer can afford to pay $129,000 for hundreds of thousands of Americans each year based on new research done by economists at Stanford.

Some people waiting for an organ would not be able to afford to pay $129,000 a year to stay alive and would say farewell to their family. The miracle of life lies in our ability to receive the health and care that we deserve, when we need it most – all while staying alive, at least until an organ is ready.

The shocking truth is that nursing homes in America are not safe, and for-profit nursing homes are even less safe.  This comes from the latest report issued by the Department of Health and Human Services, Office of Inspector General.

In fact, 2007 saw a number of states report unprecedented rates of nursing home violations – Idaho, Alaska, Washington D.C. , and  Wyoming had a %100 violation rate. The most common violations included infected bed sores, inadequate treatment of urinary tract infections, deficient housekeeping, and improper nutrition. One in six nursing homes, posed “actual harm or immediate jeopardy” to residents.

Nursing Home Quality and Presidential Debates

The revelation comes just weeks before the Presidential election and could play a role in the debates, because the report points out that private facilities often overcharged or charged for services that were not performed — with the taxpayers footing the bill.

These findings could also be used in future ratings systems proposed by President Bush, who has instituted a five-star rating system for the 1.5 million people who live in the nation’s 15,000 nursing homes. The ratings should be made public around December of this year.

For more information on nursing home rankings, visit our list of the Top 15 Worst Nursing Homes in the U.S.