One more from the files of You Tube. BD
What is the answer? Having insurance didn't help this patient and she lost her life, but when the ER rooms are full and busy, I don't think anybody is taking any surveys on who does and who does not have insurance. A little technology could have also been of benefit here as some cities have ambulances set up with software that tells them where there is room and where to take patients for emergencies, and some by the nature of the emergency too. BD
Cynthia Kline knew exactly what was happening to her when she suffered a heart attack at her home in Cambridge, Mass. She took the time to call an ambulance, popped some nitroglycerin tablets she had been prescribed in anticipation of just such an emergency, and waited for help to arrive.
On paper, everything should have gone fine. Unlike tens of millions of Americans, she had health insurance coverage. The ambulance team arrived promptly. The hospital where she had been receiving treatment for her cardiac problems, a private teaching facility affiliated with the Harvard Medical School, was just a few minutes away.
The problem was, the emergency room at the hospital, Mount Auburn, was full to overflowing. And it turned her away. The ambulance took her to another nearby hospital but the treatment she needed, an emergency catheterization, was not available there. A flurry of phone calls to other medical facilities in the Boston area came up empty. With a few hours, Kline was dead.
She died in an American city with one of the highest concentration of top-flight medical specialists in the world. And it happened largely because of America's broken health care system -- one where 50 million people are entirely without insurance coverage and tens of millions more struggle to have the treatment they need approved. As a result, medical problems go unattended until they reach crisis point. Patients then rush to emergency rooms, where by law they cannot be turned away, overwhelming the system entirely. Everyone agrees this is an insane way to run a health system.
If this video doesn't constitute a need for a physician using a Tablet PC, I don't know what does! This is absolutely the last thing I would want to see as a patient interacting with a physician! The tablet is just like carrying around a patient chart, only electronic and has a format much easier to read and locate the desired information. BD
Finding an obstetrician in northeast Pennsylvania getting tougher all the time according to this article, making it a bit scary to having a baby these days in this part of the country. BD
Dr. Anthony Milicia has needed to find a new place to deliver his patients' babies three times in the past six years.
"Insurance is the gateway to access," Thall said. "Patients will follow their doctor [to a new hospital], but they have to hope that hospital takes their insurance."
The Northeast Philadelphia obstetrician and gynecologist feels fortunate to have found a new location each time. "I think they thought it would be easy to go out and find another hospital, but now they are starting to get panicky because there's nothing out there," he said.
Milicia said for now there is still an adequate supply of obstetricians left in Northeast Philadelphia. "Finding [an obstetrician] is not a problem," he said. "The problem is when you can be seen. Some women have to wait two months for a visit. I think what you are going to see is more women coming into hospital emergency rooms unregistered and in labor. The doctor won't know her and she won't know the doctor. It's a scary time to have a baby."
"I view this as a looming public-health crisis," Mankin said. "The problem is virtually no [hospitals] remain in the business of delivering babies in Northeast Philadelphia. It's not possible to be an ob/gyn unless you have a hospital, so the doctors have to move somewhere else.
Gordon Brown quietly slashed by a third this year’s hospital building and equipment budget in one of his last acts as chancellor.
Prompted by the tightness of the public finances, the new prime minister, who has placed the NHS as his “immediate priority”, cut the capital budget of the English NHS for 2007-08 from £6.2bn to £4.2bn. The move could delay the government’s hospital building and reconfiguration programme in England
More added pressure for patients...BD
"I'm not going to go any longer with physicians who are not associated with hospitals in our network," Weimer said. "I've made the decision."
Those doctors sent letters to patients saying they no longer will be able to accept Cigna insurance as of Aug. 8. In the letter, doctors say they believe Cigna is canceling coverage to pressure John C. Lincoln hospitals to negotiate a new contract with the insurer.
The two sides also are at odds over whether John C. Lincoln doctors are referring patients outside Cigna's circle to Lincoln's two Phoenix hospitals.
It's unclear how long Cigna and the network have been without a contract. Cigna says it's been eight years, while Lincoln officials say it's been more than 20.
"Because if you can't manage costs for less than the traditional Medicare plan, then why are we doing this?"
A health policy consultant said Thursday a popular Medicare health plan run by private companies amounts to "corporate wellfare," and should be scaled back by Congress.
Robert Laszewski, president of Health Policy and Strategy Associates, said Congress should limit how long health insurers like Humana Inc. and WellCare Inc. can operate health plans in rural parts of the country that cost more than government-run plans.
A letter to the editor regarding the health care system in Arizona missed the point of the real problems ("Medical liability is threatening Arizona's health care," Saturday).
There is a rapidly growing consensus that the primary problem with the practice of medicine today is clearly not the feigned "malpractice crisis" but rather the manner in which health insurers dictate and, in fact, intimidate physicians into accepting way too little reimbursement for the competent and beneficial care provided to their patients.
Insurance companies place physicians in completely untenable positions, namely, "Either go along with our pricing for your services or we will exclude you as a member of our physician panel." Studies over the past years have demonstrated that at the same time insurance companies are refusing reasonable reimbursements for physicians and medical groups, the insurance companies are reaping record profits.
This story also shows the big difference between a "negotiated" price and the actual bill for services from the hospital, which was around 10% of the entire calculated bill with full hospital pricing. BD
Helen Dorroh White thought she was doing the right thing when she called a health insurance company to question a nearly $1-million medical bill. Instead, she said, no one seemed to care.
White, a Glendale lawyer, was closing the financial affairs for a deceased client when she came across the insurance statement. It showed a $962,120 bill for her client, Dusanka Mlinarevich, who spent four days at Glendale Adventist Medical Center after suffering minor injuries in a fall at her Burbank home last year.
Actual billings and payments were not affected, Stanislaw said. She confirmed that Glendale Adventist's bill was for $48,106 and said that SCAN paid a negotiated rate of $4,350 and that Mlinarevich, who died in August at age 78, was assessed a $150 co-payment.
Not too long ago another story about diabetic shock made the news...is this an area of awareness that we might need to look at to distinguish a diabetic attack/shock versus being intoxicated? BD
PHOENIX -- A 65-year-old St. Louis man is missing after Amtrak personnel, mistaking his diabetic shock for drunk and disorderly behavior, kicked him off a train in the middle of a national forest, according to police in Williams, Ariz.
"He was let off in the middle of a national forest, which is about 800,000 acres of beautiful pine trees," Lt. Mike Graham said.
Police said there is no train station or running water at the crossing, which is about two miles from the nearest road, at an elevation of about 8,000 feet.
Amtrak personnel told police dispatchers that Sims was drunk and unruly.
The Sims family said Sims is diabetic and was going into shock.
Sims' brother, Brian Mason, said his family tried to call Sims on his cell phone that night, but Sims was incoherent.
Hat Tip: Kevin, MD
Study shows yet another increase for HMO care on the forefront. Employers taking an active role as well with aggressively negotiating with payors as well. BD
LINCOLNSHIRE, Ill.--(BUSINESS WIRE)--An analysis from Hewitt Associates, a global human resources services company, indicates that initial HMO premium rates1 will increase by approximately 14.1 percent in 2008 — the highest rate increase in four years.
As U.S. companies begin to negotiate HMO plan rates for 2008, data from Hewitt Health Resource™ (HHR) — a Web site that captures HMO rate information for nearly 160 large companies representing more than 1 million employees and annual premiums of nearly $3 billion — shows that initial 2008 HMO rate increases are averaging 14.1 percent, compared with 11.7 percent in 2007 and 12.4 percent for 2006. After plan changes, negotiations and terminations, final average HMO rates increased by 8.2 percent in 2007 (see chart).
Employer Response to Rate Increases
Employers are considering a number of strategies to help mitigate the impact of high HMO premium increases on their health care budgets this year, including:
Shifting Costs to Employees
Moving to Self-Insured Plans
Aggressively Negotiating With Health Plans
Implementing Strategies for Keeping Employees Healthy
HMOs Propose Highest Rate Increases in Four Years, According to Hewitt Analysis
Pharmacists nationwide are "bracing" for the July 2 release of a final rule by CMS that likely will reduce Medicaid reimbursements to pharmacies for generic prescription drugs, the Newark Star-Ledger reports (Cohen, Newark Star-Ledger, 6/24). The rule, mandated by the Deficit Reduction Act of 2005 and scheduled to take effect on Dec. 30, seeks to ensure that Medicaid can obtain prescription drug discounts similar to those obtained by private entities, such as pharmacy benefit managers.
Under the rule, pharmaceutical companies would have to offer Medicaid the lowest price offered to any purchaser -- which includes any "rebates, discounts or other price concessions" offered to PBMs or mail-order pharmacies. The rule also would redefine "average manufacturer price" for brand-name and generic prescription drugs. States use average manufacturer prices to calculate Medicaid reimbursement rates for prescription drugs. According to the rule, the federal government would post average manufacturer prices on a Web site that consumers could access. In addition, the rule would limit the federal share of the cost of prescription drugs when at least three generic alternatives are available. States would retain their current authority to determine Medicaid reimbursement rates to pharmacies.
Sound familiar, similar to what the CMS is doing here....BD
The NHS Alliance has welcomed the Department of Health's new website, NHS Choices (www.nhs.uk), which is being launched this week.
"This is another step towards helping patients to get the information they need. We believe patients should be empowered to make their own decisions and NHS Choices can be yet another avenue for them to find out about GP practices and hospitals in their local area," said Michael Sobanja, chief executive of the NHS Alliance.
He added: "However, we must ensure that the information given to patients is absolutely accurate and that the website is easy to use and works effectively. Only then it could become an invaluable source of information for patients."
The NHS Alliance also believes that patient feedback is extremely important and that by allowing patients to post comments on their hospital experience, to which hospitals will have the opportunity to reply, the site can potentially create a healthy forum for discussion.
The problem isn't confined to hospitals that serve mostly the uninsured. Wait times of several hours also occur at places like Hoag Hospital in Orange County, Calif., according to Carla Schneider, a registered nurse and director of the emergency care unit there.
"It does get frustrating," she said. "People deserve better care."
"It's clearly a national problem," said Dr. Ramon Johnson, a member of the board of directors of the American College of Emergency Physicians (ACEP), who was among the doctors who testified.
Doctors attribute the lack of hospital beds to cutbacks in hospital budgets. Many blame it on the growth of managed care in the 1990s, where hospitals were forced to cut costs wherever possible.
"We can get tests done…within the space of a few hours, even though we have more patients than we can handle," said Dr. Gabe Kelen, chair of emergency medicine at Johns Hopkins Hospital. "Patients themselves have now come to realize they are better off coming to the emergency department."
After waiting for 18 months for insurance, he can't afford his portion, and still has almost the same amount of time to go before his child will be eligible, so even though he works for a company that provides insurance, both remain on Medi-Cal. BD
Tony Mays, who cuts meat at the Vons in Echo Park, lets me into his apartment. When I don't see the son he told me about on the phone, I figure he must be in the bedroom. But then I realize there is no bedroom.
It's a studio apartment, says Mays, 31. His son, 3-year-old Tony Jr., is behind me, nodded out on a bed in a little cubbyhole. The room, in a former hotel near Washington and Main near downtown Los Angeles, is stuffy, and the small fan isn't doing the child much good on a warm evening.
What really bothers Mays, though, about the current contract is that he didn't even qualify for partial healthcare benefits until 18 months after he was hired. Even now that he would qualify to purchase company insurance, he can't afford his share of the cost. Tony Jr. won't be eligible until his dad has been on the job 30 months.
Right now both are on Medi-Cal, which means that despite healthy profits at Vons and the other supermarket chains, taxpayers are picking up the tab for employee healthcare. It's similar to the Wal-Mart story, in which low prices and huge profits are made possible in part by low pay and lousy healthcare benefits for employees, many of whom end up on the health insurance dole.
I know they are here to fill a need and have save money and enabled surgery procedures that folks could not afford here in the US, but I hope this doesn't become a main stay as I would like to have the medical attention here in the US and everyone I have spoken to feels the same. If we can just get back in the human business and take the price tags off the heads of our citizens, then the movie will have served it's purpose. BD
CALABASAS, Calif.--(BUSINESS WIRE)--Upon viewing the soon-to-be-released Michael Moore movie entitled SICKO, scheduled for distribution in movie theaters nationwide later this month, Americans will return home outraged and seeking alternatives for a respectable solution to their healthcare needs.
“PlanetHospital, a medical tourism pioneer and leader since 2002, is prepared to help,” offers Rudy Rupak, president and CEO. “Although PlanetHospital cannot offer Cuba as an alternative, the company has successfully sent over 500 Americans abroad for medical care to over 14 countries. We are currently developing insurance products to assist Americans who are in the most desperate situation with regards to their healthcare.”
“The movie SICKO exposes an unacceptable healthcare system here in the United States,” says Rupak. “I look forward to helping people find alternatives and assisting in the development of stories that document the value of traveling outside the United States for medical care.”
66% drop is huge...and those that change to computerized systems enjoy the most improvement too...maybe a link here..BD
WEDNESDAY, June 27 (HealthDay News) -- U.S. hospitals that switched from using doctors' handwritten prescriptions to computerized drug ordering systems had a 66 percent drop in medication errors, say the authors of a review that looked at the results of 12 studies.
The findings are published online in the journal Health Services Research.
Almost 25 percent of U.S. hospital patients experience medication errors, such as receiving an incorrect dosage, the wrong drug, medication at the wrong time, or no medication at all. Each year, medication errors injure or kill more than 500,000 U.S. hospital patients, according to background information in the review.
Illegible handwriting on prescriptions and transcription mistakes cause as many as 61 percent of medication errors, the experts said.
"These medication errors are very painful for doctors, as well as the patients. Nobody wants to make a mistake," lead author Tatyana Shamliyan, a research associate at the University of Minnesota School of Public Health, said in a prepared statement.
She and her colleagues found that hospitals with the highest rate of medication errors -- more than 12 percent -- showed the most improvement when they switched to computerized drug ordering systems.
As a comparison, things could be worse. From the sound of this story, money talks first and surviving is secondary. BD
When Karen Papiyants lost his leg in a road accident last year, his medical nightmare was only beginning.
Although, like any Russian, he was entitled to free treatment, he says the doctors strongly suggested he pay $4,500 into their St. Petersburg hospital's bank account, or be deprived of proper care -- and perhaps not even survive.
Faced with that choice, the 37-year-old truck driver's relatives scrambled to scrape together the money. But Papiyants said that did not stop the nursing staff from leaving him unattended for most of the night and giving him painkillers only after he screamed in agony.
In theory, Russians are supposed to receive free basic medical care. But patients and experts say doctors, nurses and surgeons routinely demand payments -- even bribes -- from those they treat. And critics say the practice persists despite the booming economy and the government's decision to spend billions to improve the health care system.
Kirill Danishevsky, a health researcher with the Russian Academy of Sciences' Open Health Institute, has estimated that up to 35 percent of money spent on health care consists of under-the-table payments.
At the Dzhanelidze Emergencies Institute where Papiyants was treated, spokesman Vadim Stozharov denied that doctors refused to provide free care. But he conceded the hospital has received so many similar complaints it set up a hot line to deal with them.
Medical care here is among the worst in the industrialized world, experts agree.
This is a great demonstration on how to use your mobile cell phone to tether for Internet access. Windows Mobile 5 can do as well, just a little different procedure. This is great for a user who needs occasional Internet access when mobile with their UMPC or Tablet pc. BD
Another quick-hit video since I'm getting ready to walk out the door: I've got a 2.5 hour drive to New York City for tonight's Digital Experience show and I'm not going to worry about WiFi availability. If they offer it, great; if not, I'll use the Internet Sharing feature in Windows Mobile 6. This feature is also available in WM 5 with AKU 3.
Canada may need US assistance in case of a health worker strike. BD
REGINA -- A looming strike by health-care professionals in Saskatchewan has officials preparing to move patients out of the province for care.
Saskatchewan Health has asked hospitals in other provinces and in the United States to accept patients if the 2,700 workers - including paramedics and respiratory therapists - hit the picket line.
If you see the movie Sicko, the physicians in the UK receive bonuses for creating better health care and I'm not aware of the criteria that is needed, but P4P seems to be something created to go in this direction, but again, administration of the criteria is the big question and HMO criteria administration tends to cloud the issues when bonus money is at stake for both providers and management staff. BD
CHICAGO, June 27 -- The American Medical Association wants third-party payers to put the brakes on pay-for-performance initiatives until there is evidence that such plans benefit patients.
Moreover, after five hours of debate -- often over the addition or deletion of a single word -- the AMA's House of Delegates said that it will "actively oppose" any pay-for-performance programs that do not meet the AMA's five pay-for-performance principles.
Adopted in 2005, those principles specify that programs should ensure quality of care, foster the patient/physician relationship, offer voluntary physician participation, use accurate data and fair reporting, and provide fair and equitable program incentives.
"We don't want a seat at the table," responded, Marcy Zwelling, M.D., a delegate from Los Alamitos, Calif. "We want to stand on the table."
Hat Tip: Kevin, MD
This is definitely a fine line on data mining and appears to be an additional query source of information. This response creates a number of unanswered issues on how the information could or would be used, especially without an option for anyone to "opt out". With drill down type queries created, the identity of an individual could very easily be narrowed down to a potential job candidate. Who would be the next user of this type of a data base, headhunters to perhaps financially gain in the process? BD
In response to Andis Robezniek's "Advisory groups to help with Blues claims database":
The Blue Cross and Blue Shield Association's illegal and unethical plan to sell data to large employers on all 79 million Blues enrollees against their will, without informed consent, and with no way to opt-out cannot be "cleaned up" by claiming that the data is "de-identified" or by adding unpaid advisers from government or private industry to contribute "research-based insights" to justify their theft and sale of sensitive health and claims data.
Forced participation in research is abhorrent. America is not yet a gulag. "Research" conducted in this fashion will drive people away from participation in the healthcare system. No one wants secret snooping in his or her most sensitive personal records of all: medical records.
First, it is critical to point out the obvious: It is impossible to de-identify health data. There are simply too many unique pieces of identifying information, dates and places that cannot all be removed from records.
A medical record of a 55-year-old person who had a CT scan at Seton Hospital in Austin on April 15, 2007, could easily be re-identified by his/her employer, even by other employers like Dell. How many employees were absent from work that day? How many employees submitted medical claims for that day? His/her data could be re-identified by other large employers who could easily match him/her up by using programs to match public voter registration databases with health databases for re-identification. Then they may not hire that person.
Sadly and criminally, the greatest use of Americans' electronic health data today is by the data-mining industry for profit. And not a single dime of this money from using and selling our stolen private property goes to improve the health of a single sick person. Even though HIPAA allows "covered entities" to use and sell electronic health data, the data-miners are still violating stronger state laws that require consent before access to and disclosure of medical records.
A story released 6/26 about 24-year-old Emily Rice and the HMO Health Care she received at The Denver City Jail resulted in her death in a cell.
On February 18 Emily was involved in a traffic accident was taken to Denver Health where she blew a 0.121 BAC was treated for a cut on her shoulder then sent to jail.
Not long after she was booked and in a cell Emily told a guard she wasn't feeling good and was allowed to speak to a registered nurse. The nurse looked at her records told her she was drunk and to go sleep it off.
After the nurse left Emily collapsed, the nurse was brought back then told Emily to " Stop Being Dramatic" and get up. An obvious graduate from the Florence Nightingale School of Nursing.
During the course of the nite other inmates began screaming and pounding on the glass to get the guards attention because of her worsening condition but to no avail.
Come morning Emily was dead. Her autopsy revealed a seven inch gash on her liver, a lacerated spleen and three broken ribs.
With a more thorough exam at Denver Health all of this could have been avoided and kept from court.
I might guess this may extend beyond New York as well...BD
"New York's hospitals face consistent, dramatic cost increases every year: for staffing, for operations, for upgrading equipment, and for providing the life-saving care communities demand," HANYS' President Daniel Sisto said. "Unfortunately, as these costs have skyrocketed, Medicare reimbursement rates to providers have lagged grossly behind the times."
"For years, health care providers in New York have struggled to break even, while at the same time the insurance industry has enjoyed record-breaking profits.
It's inexplicable that Medicare funding is used to subsidize an extraordinarily profitable industry, while the actual facilities that provide care, that are in dire need of federal resources, are neglected," said Mr. Sisto.
The failure of payments to keep up with costs has resulted in 56% of New York hospitals losing money, breaking even, or operating in a precarious condition with operating margins of 1% or less.
Pilot program in testing for Colorectal cancer. BD
Because more than six percent of CIGNA HealthCare members in Florida who participated in a pilot screening program for colorectal cancer last year had test results that revealed abnormalities -- signaling the need for follow-up tests with their doctors -- CIGNA HealthCare expanded the program significantly over the past year. More than 320,000 CIGNA HealthCare members received InSure(R) fecal immunochemical test (FIT) kits from CIGNA with the support of Quest Diagnostics Incorporated (NYSE: DGX). The test helped CIGNA members screen at home for gastrointestinal bleeding which is often an early indicator for potentially deadly colorectal cancer.
Barry Wilkins of Seffner, Fla., is one of the CIGNA HealthCare members whose life was changed when he took the test. "I feel extremely lucky to have been included in CIGNA's program last year. I had a colonoscopy three years ago and thought I was all set, so when I received the InSure test kit, I almost ignored it," said Wilkins. "At the last minute, I decided to take the test and to my surprise I ultimately discovered I had colon cancer.
Because CIGNA sent me the kit without my even having to ask for it, my cancer was caught early enough to be treated. I consider myself so fortunate because who knows what would have happened had I waited for my next colonoscopy in two years."
In the expanded program, 1,016 people, or 6.7 percent of the members who returned the InSure test kit had positive results and required follow-up testing from their physicians. "Most people do not realize that screening for colorectal cancer can be a simple process because of tests like InSure," said Dr. Dick Salmon, CIGNA HealthCare National Quality Medical Director. "Colon cancer is preventable and treatable and can be detected at a stage where effective treatments are available, which is why we want to encourage our members to undergo screening for colon cancer. This program can help save lives," he continued.
REDWOOD CITY —Despite pleas from workers to reconsider, the San Mateo County Board of Supervisors voted Monday to close one of two long-term-care wards in the county hospital.
The closure was approved as part of the tentative adoption of the hospital's budget for the next fiscal year, which begins Sunday. San Mateo Medical Center officials believe that closing the ward will save $1 million for the financially strapped facility.
Many patients who would have stayed in the closing ward, known as Unit 1B, will be sent to Burlingame Long Term Care, a facility on Trousdale Drive operated by the medical center. Sicker patients or those who refuse to move will be transferred to the remaining long-term care unit at the hospital, said Dr. Sang-ick Chang, the medical center's interim CEO.
And they accomplished this on a pretty conservative budget...BD
Hutchinson Community Hospital’s new electronic records system is improving patient care and safety while strengthening care providers’ peace of mind.
During a demonstration for the hospital’s governing board last week, trustees learned:
< Doctors on call can use the system from their own home to check a patient’s health status, and then advise nurses and other hospital workers by phone. “The physicians see this as a tremendous timesaver,” said Mary Ellen Wells, the hospital’s administrator and president/CEO of Hutchinson Area Health Care.
< The hospital’s pharmacy, therapy services and other departments use it to check a patient’s medical history and record additional information. “Once the information is filed, it’s accessible to anyone who has access to that patient,” said Linda Fairchild, the hospital’s acute care manager.
The new system, launched June 1, is designed to improve the hospital’s efficiency while ensuring continuity of care. Fairchild said time savings is a byproduct of the system, but was not a primary motive for purchasing it. The system’s computers and software cost an estimated $266,000.
Those capital improvements have begun. The changes at Des Peres Hospital, for example, will include upgrades to information technology systems.
Des Peres Hospital was nearly bankrupt when Tenet Healthcare Corp. acquired it in 1998. It was treating only about 2 percent of the patients visiting St. Louis area hospitals.
Since then, however, admissions at the hospital have more than tripled, helping Des Peres Hospital's share of the St. Louis medical and surgical market grow faster than any other area hospital.
The hospital's success is now being showcased throughout Tenet as the hospital system struggles to consistently boost admissions.
Dr. Linda Peeno, not much of a party woman to begin with, resented the festive atmosphere of a premiere party last week for Michael Moore’s new film, “Sicko.”
The Hodgenville native, who appears in the movie, left after just a few minutes — even before getting Leonardo DiCaprio’s autograph for her granddaughter. Laughter at the party bothered her.
Despite all the attention, Peeno seems despondent about the country’s health care situation. When Moore’s team called the 56-year-old, she told them not to interview her — “I don’t have anything good to say.” So the director used clips from her congressional testimony and another interview.
Peeno’s hopelessness became so bad last summer, she didn’t want to turn on her computer anymore, in part because of sad e-mails from patients pleading for assistance when nothing could be done.
The problems with health care, she recently told the California Legislature, are “unimaginably worse” than they were when she testified in Washington — when she explained to lawmakers how her insurance company career got a boost after she caused a man’s death by denying him an expensive heart operation.
While Peeno admits Moore can be over the top at times, she said he tackles “hard subjects nobody wants to think about.”
She thinks “Sicko,” which opens in theaters across the country Friday, will play a role in the health care debate.
“It’s going to have a shock effect,” she said.
The premiere is shown on the same street where "patient dumping" in Los Angeles had occurred. BD
Does this sound a bit familiar with some of what is occurring here? HCP would perhaps equal a nurse practitioner here with terminology. He has included some very good videos from You Tube as well, worth taking a look. Long and short of it, the NHS in England is also cost conscious these days and they are working on their own issues with "lean healthcare". One thing that the article points out though is that unlike here, they have a surplus of physicians and some of those could actually assume the roles of a HCP if they were not able to be employed as an MD, so if that is the case you may still be seeing a qualified MD, but working with lower credentials to earn a paycheck. I don't completely understand the difference between the private doctors and the NHS as far as payment goes and where insurance may play a role in this at this point. I might guess though that perhaps there might be a few less CEO millionaires in the insurance business though. BD
In many fields of medicine the only way to be sure of seeing a qualified doctor is to go privately. Take yourself to the “free” at the point of entry NHS and most likely you will find yourself managed by some sort of “Health Care Professional” (HCP = there is no doctor available today).
This is two-tier medicine. Only the wealthy and the “great and the good” see doctors. The riff-raff get the cheapo-cheapo productions HCP.
The nurse-specialists usually counter this argument by saying that “we are just as good as doctors”. But now a new strategy has emerged. Oddly it comes from the normally excellent, multi-authored Mental Nurse column.
They are saying that the wealthy and the great and the good are now being treated by HCPs as well. (see here). Even if this were true, and it is not, would that make it any better? Put this into educational terms. Why not let teaching assistants take over at Eton and St Paul's? Bring the education in those schools down to the level of the sink comprehensives. That would teach the toffs.
Hat Tip: Kevin, MD
Good article about nursing homes records and the scary side of this trend. It certainly doesn't make sense to me either. BD
There is a new, intentional and horrible trend in nursing home transfers to the ED, and it’s not the patients. It’s the records that come with them, or more specifically those that don’t. Allow me to explain.
The patient is sent with a chief complaint, a lot of weeks-to-month-old labs and a medication list, but all the administration times have been cut off from their typed MAR’s. (MAR stands for Medication Administration Record, and is the only written record of which patient got what medicine, when). Got that? A patient sent from a nursing home comes into the ED with a list of their medications, but the list has the times and dates of administration removed. Intentionally. They come in with little strips of paper with the medication names and doses, but the administration times are on the paper that wasn’t sent. That’s not an accident. Definitely not.
This intentional removal has happened often enough ( from different nursing homes and at different ED’s) that it’s clearly part of an organized effort on the part of Nursing Homes. I’m at a loss to think of a single innocent reason why this practice would have started. When I’ve called personally to have the information faxed (for patient care, the reason they sent the patient to the ED) the Nursing Home nurses routinely say that “It’s policy”, and then sometimes send the information, and sometimes they don’t.
This is, frankly, outrageous. A chronically ill patient is sent to a higher level of care for an acute problem, and without a complete information base; but not just that, information crucial to the care of the patient that’s being intentionally withheld.
Hat Tip: Kevin, MD
Surgeon operates with the wrong images as loaded by staff manually. Technology with having the data link versus relying on human hands to load the disc could have been a real help. BD
With her body still aching from triple bypass surgery, Sandy Baumgartner lay in a hospital bed talking with a nurse about her care.
In the same room at Memorial Medical Center, her surgeon was talking with her husband about something unusual that had happened during the surgery a few days earlier.
Her husband, Gary Baumgartner, couldn't believe what he was hearing. The surgeon said he had operated on his wife while using a different patient's angiogram films.
At Memorial, the pictures are put on discs in the cath lab and must be hand-delivered to the operating room. The patient's name appears on the films when they're opened on the computer.
According to Baumgartner, a hospital representative told her a catheterization lab employee had burned two discs of the other patient's angiogram and mistakenly put her name on the cover of one disc.
Fung wrote on the medical record of Baumgartner's surgery that the films of "a different patient had been loaded onto the computer."
In comparison, surgeons at Doctors Medical Center can access angiogram films from computers in the operating room. The surgeons click on the patient's name to call up the films.
A surgeon would have to click on the wrong name to make a mistake.
"Every frame of the film has a patient identity on it," said Debbie Fuller, chief information officer at Doctors.
The American Medical Association (AMA) announced that the nation's physicians today voted to approve a set of strategies for containing health care costs and achieving even greater value for health spending. Physicians at the AMA Annual Meeting asserted that successful cost-containment must focus on balancing costs and benefits.
"Health care spending has yielded substantial clinical, economic and quality of life benefits, but the overall growth in health care costs has outpaced general inflation," noted AMA Board Member Carmel, M.D. "While physicians play a key role in efforts to contain costs, problems like obesity, tobacco use, alcohol and substance abuse and violence will require action from coalitions of stakeholders from within and outside the health care system to drive major societal change.
The American Medical Association (AMA) announced today that it would call for investigations into potential conflicts of interest posed by joint ventures between store-based health clinics and pharmacy chains.
The AMA's call for investigations was driven by retailers who have stated that store-based health clinics help drive additional store traffic, which can increase sales of lucrative prescription drugs and other non-health related products.
"There are clear incentives for retailers to participate in the implementation and operation of store-based health clinics," said AMA Board Member Peter Carmel, M.D. "The nation's physicians want the AMA to ensure these incentives do not compromise the basic obligation of store-based health clinics to provide patients with quality care."
WHEN Jose Luis Cabrera had coronary bypass surgery after a heart attack five years ago, his wife had to bring food and clean sheets to him in the hospital.
But the operation itself didn't cost the Cuban couple a cent.
But Gail Reed, producer of a recent documentary on Cuban health care called Salud!, believes Cuba is a model for other developing countries that cannot afford costly medical treatment and where preventing illness makes good economic sense.
And Dr David Hickey, a transplant surgeon at Beaumont Hospital in Dublin, said Cuba is a world leader in primary health care based on preventive medicine.
He said: "It's a very sobering experience for someone coming from the affluent West to see what they can achieve." Cuba has developed the world's first Meningitis B vaccine which is available in Third World countries, but not in Europe or the United States due to US sanctions.
Could there be work on a sequel before Sicko even hits the mainstream release? BD
Commercial from the American Medical Association to block Medicare cuts and get in touch with Congress. BD
The American Medical Association (AMA) is spending $2 million on television ads this month in a campaign to get Congress to reject a looming cut in its Medicare payments.
The TV spots will run through the July 4th recess in Washington and in areas with large concentrations of older Americans. The AMA would not specify which markets outside of D.C. it is targeting, but the group is willing to extend the campaign to additional regions if Congress does not move toward stopping a 10 percent cut, set to take effect in 2008.
Reimbursement can and does get a bit confusing. Imaging equipment does not run cheap, nor does maintaining and servicing, thus offices outside of the hospitals who provide imaging services to help patients avoid the over crowding at the hospitals have the same expenses for maintenance and service. I do hear the argument that labor is less with an outside screening facility, but that is only one part of the total equation. Was labor the only consideration in reducing compensation? BD
WASHINGTON (AP) - Medical imaging equipment makers are lobbying to overturn Medicare cutbacks after weathering some of the worst sales numbers in recent memory.
Congress made the cuts following criticism that some health care providers were performing more tests than necessary simply to boost revenue. But equipment makers such as General Electric Co., and providers of diagnostic tests such as Alliance Imaging Inc., are waging a campaign to convince federal lawmakers that the six-month-old policy is having a negative impact on public health.
The reimbursement changes also affect companies that provide imaging services such as Anaheim, Calif.-based Alliance Imaging, which operates mobile centers that travel from site to site.
Although 90 percent of Alliance''s business is tied to hospitals, which are unaffected by the cuts, management warned that reduced payments would hurt earnings by $14 million in 2007. Alliance is a member of the Access to Medical Imaging Coalition.
The cuts took effect in January and reduce how much doctors are paid for running X-rays, medical resonance imaging and other tests on patients enrolled in the government-run health program for seniors. The Medicare payment changes, which are expected to save $2.8 billion over five years, sent sales of scanners made by GE, Siemens AG, Toshiba Corp. and others tumbling more than 20 percent last quarter, according to data provided by an industry group.
Opponents argue that if fewer doctors offer in-office imaging, patients will have to travel further and wait longer for medical scans that detect cancer, heart disease and other ailments.
Nice comment on "Running a Hospital", a blog from hospital CEO Paul Levy. From the various articles posted on the Internet and recent recognition for their CIO in the top 100 CIO list, they obviously have things going in the right direction with technology and it shows. BD
Note from a friend whose spouse was in for day surgery:
This is the best waiting room. I have wireless access, a quiet table to work at with an outlet next to it, coffee shop downstairs, and a harpist just started playing. I'd work from here anytime.
I post some of these comments in order to help bring the awareness of training to a new level hopefully as I see this all the time. Many offices are still creating huge files of Word documents, using antiquated faxing methods, and on top of all that, THEY ARE WORKING THEIR STAFF MUCH HARDER THAN IT NEEDS TO BE, and then complain about all the time electronic record charting takes. Saving a ton of Word Documents is not only not as secure, it creates a ton of non-reusable information that has to be manually manipulated, which takes time, when a data base does it for you easily with a couple clicks.
This is a real problem area as the physicians now complain about the EMR instead of the paperwork, and if they only invested some time in proper training, along with proper training of the staff, they would be miles ahead. Someday transporting those bulky Word documents to the hospital via a usb device are going to be gone soon as security issues heighten, so those who don't train and prepare will have something else to complain about as well. It's sad that so much time is spent on complaining and that proper training could have been the cure for a lot of the misconceptions. So many just don't get it and refuse the free training. One thing for sure though, much of the staff gets it, as they realize how much more work it requires to be employed by offices who decline and thus promote misconceptions of the true value of an EMR. From the comments below, this nurse certainly "gets it". BD
In response to a reader's comments on David Burda's "Reporter's notebook: EHRs put some docs on edge":
The debate rages on. Yes, some physicians may be too busy on a particular day saving lives to attend training classes on how to access and use the electronic health-record system. But there should be no reason they can't find a couple of hours on a day when they are not on call to attend training. What is the point of implementing any technology that may enhance quality of life if people won't use it? I have trained lots of healthcare providers, salaried and nonsalaried alike to use an EHR. The physician group is by far the lowest in motivation, attendance and recognition that this is a tool to make information flow across all healthcare team members. Sorry Sylvia—the excuse of being too busy doesn't wash. Get help; learn how to use EHR.
Hospitals are now posting surgery results and potential outcomes on their web sites. Excellent way for both the physician and patient to be informed up front on the potential outcome. One other nice item in the picture is watching him using his TABLET PC OR NOTEBOOK AS A DESKTOP REPLACEMENT with a regular mouse and keyboard connected. Not only is he prudent in searching surgery selections, he's also prepared to be mobile if needed, the prudent patient and shoot we can't even get some medical professionals to embrace this technology for use by physicians! BD
(CBS) After weeks of pain, Chuck Prigge is deciding whether to have back surgery, and he's making his decision online.
His hospital, Dartmouth-Hitchcock Medical Center in New Hampshire, puts surgery results on the Internet.
Chuck can see that 62 percent of Dartmouth's back surgery patients achieve symptom relief and that 85 percent would choose surgery again, CBS News correspondent Wyatt Andrews reports.
"I think it's excellent all this information available," said Prigge.
It's only a matter of time before most American hospitals post a lot more information about quality. What does surgery cost? How often does it work? Are the doctors at the hospital good at what they do?
Very nice review and video about the Sahara Tablet from Tablet Kiosk. For those wanting a unit with real power and portability, this one gets the job done. BD
The i440D captured lots of attention back at CES Las Vegas earlier this year and has even be en reviewed by one of our GBM frequenters Steve S. It is a device promising lots via its Dual mode Active Digitizer Pen and 4-wire resistive Touchscreen combo; with its internal SATA and external SATA capabilities; with its ability to accept up to 3Gb of RAM, and more. In this video I cover off several features and address some of the questions folks have been asking regarding this device. So if you're in the mood for something
other than UMPCdifferent, watch this video as TabletKiosk might be the right company to put on your radar!
Hotels and Spas are realizing the value of mobility, both in customer service and providing a live tablet PC for interactions. Those who sit in front of a PC all day have a hard time realizing how valuable mobility can be it appears. How long before hospitals and doctors offices embrace this and break away from the old traditional keyboard. A mobile experience instead of having to use a keyboard really enhances the experience and on top of that, its simple. As a patient, do I want to sit and watch my doctor type while he diagnoses - NOT! I don't think they can focus on me, the patient, while working a keyboard and the eye to eye contact is just not there. BD
SoftBrands, Inc. (Amex: SBN), a global supplier of enterprise application software, announced today that it has signed a distribution agreement with TabletKiosk for their portable workstation solution. SoftBrands has selected TabletKiosk's Sahara Slate PC line to launch this initiative. The units are blue-tooth/wireless Tablet PCs and run on the Microsoft Windows operating system, including Windows Vista, Windows XP Professional or Windows XP Tablet PC Edition.
Coupling the TabletKiosk product with the SoftBrands suite of products will provide SoftBrands' customers the freedom to move about the property and deliver services without being tied to a reception desk or service station. Using the Sahara Slate PC by TabletKiosk, SoftBrands' customers will be able to check-in a guest, book a spa appointment, make dining reservations, place food and beverage orders or reserve a tee-time, all the while un-tethered from a desk or station that uses a traditional PC workstation. In addition, as the units provide the full functionality of the Windows operating system, many third party applications can be accessed on Sahara throughout the property or enterprise.
"Hotels increasingly want their employees to be free to interact with guests without the confines of a desk or counter " said Steve VanTassel, senior vice president and general manager, SoftBrands hospitality. "We are very pleased to be working with TabletKiosk and Microsoft to provide the freedom and flexibility needed to help our customers further personalize their guest's experience."
"We are delighted to partner with SoftBrands and Microsoft to expand and explore new opportunities for mobile computing in the hospitality industry," said Martin Smekal, president of TabletKiosk. "The convenience of running the SoftBrands' suite of products on the Sahara Slate PC offers hospitality professionals newfound mobility while providing guests with an enhanced guest experience."
"Mobility enablement is becoming more and more important as hoteliers look for ways to increase employee productivity and improve guest service," said Matthew Shigenobu Muta, industry director for Microsoft's Worldwide Hospitality Group. "We are pleased with SoftBrands' and TabletKiosk's joint integration of Microsoft software into valuable mobility solutions that empower hospitality employees to strengthen guest relationships and generate new revenue streams." (Source: Press Release)
The Tennessean on Thursday examined how "as the volume of unpaid medical bills increases, hospitals in middle Tennessee and nationally are turning into more aggressive bill collectors." Hospitals "increasingly ... are using sophisticated computer models to screen the insured as well as the uninsured, estimate their ability to pay and ask more patients to pay some of what they owe up front or soon after treatment," according to the Tennessean. While hospitals "aren't denying patients critical care," they "may decline to perform elective procedures on patients who can't pay," the Tennessean reports.
Hospital companies say the more aggressive bill collection is necessary because "they can't afford to let even the smallest bills go unpaid" as the cost of care rises and "patients are responsible for paying more of their own medical bills," according to the Tennessean. Unpaid medical bills increased from $17.5 billion in 1995 to $28.8 billion in 2005, which corresponded with an increase in medical bills paid out-of-pocket by patients from $146.3 billion to $249.4 billion over the same time period.
However, patient advocates "say the practice can get out of hand, especially with people who have little insurance or high-deductible plans" and "can squeeze patients when they're at their most vulnerable," the Tennessean reports. Some hospitals have responded by offering discounts to uninsured patients who pay up front, on top of a charity care discount (Ward, Tennessean, 6/21).
IS THE PHARMACEUTICAL industry going to the dogs? In a way, the answer is yes.
A flurry of regulatory approvals for dog medicines in the past several months demonstrates a growing interest in prescription drugs for pets. These pets don't just have owners—they have people. And those people want their dogs and cats to grow old with them. In an increasing number of countries, people have extra income to spend on Fido and Fluffy to keep these companions healthy and comfortable through their geriatric years.
In response, drug companies are learning to comb their growing libraries of drugs for humans to find products that will improve pet health, bring in additional income, and possibly help advance R&D for human health.
Over the past decade, products for dogs and cats have been the biggest and fastest growing sector of the animal health market, says Nigel Chapple, an analyst with the consulting firm Wood Mackenzie. "A lot of new products are entering the marketplace—a very sizable marketplace—that is increasingly competitive and very dynamic."
More about United Health Care related to the PacificCare contract....BD
A radiology group in California has taken UnitedHealthcare to court after nearly a year of unsuccessfully wrangling with the insurance giant to honor PacifiCare Health Systems' contract rates it took over when the companies merged two years ago.
Radiological Associates of Sacramento Medical Group Inc. sued United in June for allegedly shortchanging the practice on payments for services it agreed to cover fully under a 2003 PacifiCare contract.
Among the complaints against United and its PacifiCare subsidiary, she said, are delays in processing new contracts and terminations, as well as failures to correctly input doctors' contract rates into their system -- all of which have resulted in reduced and delayed payments. In addition, she said there has been misinformation to patients about their doctors' participation status in either plan.
Though the CMA has worked with United to help resolve doctors' individual issues, "it does not appear that [United] has made a commitment to eliminating these problems on a systemic level," Wetzel said.
Faced with casual comparisons with Canada or Europe, many were ready with counterarguments: Americans don’t have to wait months for bypass surgery, like they do in Canada. Doctors here aren’t constrained by government interference. Unlike in England, American patients receive costly treatments such as hemodialysis even if they are old and infirm.
But now, the knee-jerk attitude that the United States is the best place on Earth to be sick, fueled by the reputations of great institutions like the Mayo Clinic and by America’s leadership in drug and technology development, is beginning to be challenged by rigorous international comparisons. There is increasing evidence that, despite justified pride in individual institutions and medical breakthroughs, the world’s biggest medical spender isn’t buying its citizens the longest, healthiest lives in the world.
It’s not just moviemakers and comics saying so. The dire message that the U.S. health-care system is, by some measures, an also-ran on the worldwide stage is being delivered by doctors, researchers – even insurance-industry giants.
“If a politician declares that the United States has the best health-care system in the world today, he or she looks clueless rather than patriotic or authoritative,” Emanuel wrote in the recent JAMA commentary.
Probably the area in which the United States uniquely falters by comparison with developed nations is in assuring that anyone who is sick can receive care. The Commonwealth Fund study found that half of Americans didn’t fill a prescription or skipped a medical test because of cost, compared with 13 percent in Britain; and 26 percent went to an emergency room for a condition that could have been treated by a regular doctor, compared with 6 percent in Germany.
That’s the rub – treating average, chronic diseases in the average masses. Insured or not insured, Americans can’t always count on the best, the most appropriate, the most error-free, or the most coordinated care.“The main thing that stands out is that we’re the only country that doesn’t have a universal health-insurance system,” says Davis, author of the foundation’s most recent study, which compared the United States with Australia, Canada, Germany, New Zealand and Britain. “So problems of access, cost, failure to get needed care are easily explained.”
We will have to wait it appears until the year 2012 before the ICD and CPT Codes could appear for this. BD
The American Medical Association this weekend will debate adding video game addiction to the list of actual psychiatric disorders.
Some experts believe it's a dependency as real as drug or alcohol addiction. Others say excessive video gaming is only a symptom of other problems. Either way it's sure to spark spirited debate at the AMA's annual convention in Chicago.
Even if the AMA adopts video game condition as a new psychiatric disorder, it won't be officially classified as such until the next revision of the psychiatric manual in the year 2012.
As one individual, you can use the service for free. If you require service for a network of computers, the product requires a purchase. Personally, I like the Outlook integration feature as it simplified the process. You can also just request a Digital ID from the site as well. Something to think about if you are not currently using any form of encryption. The software does allow you to select those recipients with whom you want to send encrypted messages, so you do not have to encrypt every email you send. BD
Izemail lets you encrypt and sign your email, just by pressing the "send" button in your mail program. All you need to know is your contact's email address: everything else is done by Izemail, automatically.
IZECOM hereby grants you a non-exclusive and non-transferable license to install and use the Software on a single computer or devise for use by one single user, or, if you have paid the appropriate License Fees, on a series of computers or on a internal network / server by the maximum number of authorized users to install, access and use the Software.
Izemail for Outlook
Izemail for Outlook is a plugin to Outlook that facilitates easy encryption and signing. It works only with Microsoft Outlook, all versions currently supported by Microsoft. It works only with Windows.
PORTLAND, Ore. --An Oregon surgeon has performed gall bladder surgery that removes the organ through the patient's mouth -- the latest example of surgeries that avoid major incisions and rely on the body's own orifices instead.
Dr. Lee Swanstrom of the Oregon Clinic claims the procedure, performed in May on a 35-year old woman at a Portland hospital, was the first of its kind in the United States. He said it had already been performed in Brazil.
Instead of cutting into the abdomen, tiny instruments were sent down the woman's mouth into her stomach. Swanson then cut a small hole in the lining of the stomach to reach the gall bladder, remove it and pull it out through her mouth.
Physicians in New York conducted gall bladder removals through the vagina earlier this year. A boy's brain tumor was recently removed through his nose in Pennsylvania. And doctors in India say they have performed appendectomies through the mouth.
Doctors say the majority of discomfort and recovery time after conventional surgery is due to the incisions.
With healthcare here in the US in the center arena, this is a good article telling a bit about how the Brits feel about their health plan, the NHS. One thing in common with the feelings here is that politics don't belong in healthcare. BD
The British Medical Association (BMA) said the incoming Prime Minister needed to find out why people were so dissatisfied with the health service.
Today's poll also found widespread support (93%) for continuing to fund the NHS out of general taxes.
But 53% also agreed that there should be a small charge for some services where resources were limited.
Seven out of 10 (70%) people questioned said decisions about local health services should be made by bodies elected by local people.
And 82% agreed that doctors should have a "major role" in deciding how money is spent in the NHS locally. "It is time to take politics and political meddling out of the NHS and allow an independent board to be responsible for the day-to-day running of the health service.
A Department of Health spokesperson said: "The BMA survey of 1000 people is interesting but last month the Healthcare Commission survey of more than 80,000 NHS patients showed that 92% rated the care they received as good or excellent - This is the public's real verdict on the state of the NHS today.
My kind of books...even though I am not a Medicare patient, the title seems to elude to the fact that this might simplify some of the very confusing rules and regulations today. BD
Complete Idiot's Guide to Social Security and Medicare, 2ndEdition (Complete Idiot's Guide to) Understanding SS and MedicareThis is a Guide chock full of information on the It updates all information on rules, coverage, benefits and more, providing tips on everything from timing retirement benefits to understanding how divorce and death affects social security benefits.
The federal government was failing Australians when it came to health by underfunding public hospitals and shifting the cost burden to individuals, the South Australian government said.
SA Health Minister John Hill was responding to the Caring For Our Health report released on Sunday which showed the federal government was underfunding public hospitals by $1.1 billion a year.
It also estimated that within 20 years the Commonwealth would only contribute 25 per cent of the money required to run public hospitals, leaving the states and territories to cover the remaining 75 per cent.
"The federal government is failing Australians - we have a shortage of GPs, and health costs are rising," Mr Hill said in a statement.
Interesting article on the mandatory health insurance law in Massachusetts. There are still a couple waivers available if you can't afford the insurance or "if your religion won't let you have health insurance". I have not heard this one before concerning religion so I guess anyone affected by this clause is taken care of under the system? They are making a stab at this ever growing problem though and you can't discount that portion. BD
What are the requirements of Massachusetts Health Care Reform?
All adults are required to have health insurance by July 1. Businesses with 11 or more employees must make a "fair and reasonable" contribution to employee health benefits.
What is the difference between Commonwealth Care and Commonwealth Choice?
Commonwealth Care is a state-subsidized insurance program for uninsured people who have incomes below 300 percent of the poverty rate, which is less than or equal to $30,636. Commonwealth Choice offers new health insurance options to individuals and small employers who do not qualify for Commonwealth Care.
Commonwealth Care plans are offered by Boston Medical Center Health Net Plan, Fallon Community Health Plan, Neighborhood Health Plan and Network Health.
Commonwealth Choice plans are offered by Blue Cross Blue Shield of Massachusetts, Fallon Community Health Plan, Harvard Pilgrim Health Care, Health New England, Neighborhood Health Plan and Tufts Health Plan. A Young Adults Plan is available for 19- to 26-year-olds.
What happens to people who don't get health insurance?
Any Massachusetts adult who does not have insurance as of Dec. 31 will lose their personal exemption on their 2007 state personal income taxes. That exemption gives you a Massachusetts tax savings of approximately $219. In 2008, the cost of the penalty goes up. The fine will equal half of the cost of the lowest-priced Health Connector-certified plan for each month that you don't have coverage.
Are there exceptions?
Yes. If your religion does not allow you to have health insurance, you can file a sworn statement with your state tax return. If you cannot afford health insurance that meets the state's standards, you may file for a waiver with the Health Connector.
What benefits will I need?
Until Jan. 1, 2009, any health insurance plan that is offered by an employer or that can be legally sold in Massachusetts meets the individual mandate. On Jan. 1, 2009, the standards go up. To meet the rules by 2009, you will need a plan that:
1. Covers prescription drugs;
2. Covers regular doctor visits and checkups before any deductible;
3. Caps the deductible at $2,000 for an individual or $4,000 for a family each year;
4. Caps out-of-pocket spending for health services at $5,000 for an individual or $10,000 for a family each year if you have a deductible or co-insurance;
5. Does not cap total benefits for a sickness or for each year; and
6. Does not cap spending toward a day in the hospital.
In addition, any high-deductible health insurance plan that allows you to have a federal Health Savings Account also qualifies.
Something that is happening all over the country as family practice physicians are getting smaller in number...BD
Dr. Jim Byrnes already has more patients than most family practices, yet every week his office is hounded by dozens more in desperate search of a doctor.
Six miles west of Byrnes' Delray Beach office, Dr. Robert Cohen is fast building a practice. The Pittsburgh transplant has attracted 2,000 patients in less than a year.
The shortage, though, could be worse than statistics show. The study did not account for the growing number of doctors who abandoned their traditional practice for "concierge medicine," charging patients about $1,500 annually for more personalized medical care. Their offices have a smaller patient load, Wiles said.
A typical office visit will bring a doctor about $30-45. In comparison, reading a stress test nets hundreds of dollars and takes less time, Multach said.
Such challenges are occurring at a national level. About 100,000 family physicians practice in the United States. In less than 15 years, about 140,000 will be needed.
Adding services, which often come with higher reimbursements, can help supplement a doctor's income, Multach said. Insurance and Medicare reimbursements have fallen in the past decade, leading doctors to squeeze in more patients per hour.
Family doctors average 2,000-2,500 patients but Byrnes has more than 3,500. His office has to turn away almost everyone who calls.
Byrnes works about 80 hours a week: He starts his day at 6 a.m. with his patients at the hospital, sees patients in his office during the day and finishes with paperwork by 7:30 p.m. On the weekends, he visits patients in nursing homes.
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Quants: The Alchemists of Wall Street Video Documentary - Why It Needs to Matter What Companies Do and Not Focus Only On the Price of Stock With So Called Value - Attack of the Killer Algorithms Chapter 44
This video digs in a bit further with how fictitious business models are used by banks and companies do this too. The models are so complex that CEOs don’t even understand them. “Quants, The Alchemists of Wall Street.
This is a video from PBS Frontline where Kathy O’Brien, a former Quant who worked for a Hedge Fund on Wall Street will tell you what is done with your 401k money and more.
The banks and companies use technology to take advantage because they can.
“Of course we are going to take advantage because our tools are our brains…if they could figure out a way to take advantage of pension funds they would, a very good interview with explaining smart money and dumb money.
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It’s a very good presentation about how some of the algorithms work and kind of finishes up with “if you’re an algorithm, life is looking pretty good, but can’t say the same for the human side”.
He gives you some every day examples of how we encounter algorithms every where we go.