MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'insurance'. Sat, 03 Sep 2011 01:50:24 +0100 http://www.medworm.com/index.php?rid=5182150&cid=t_100419_131_f&fid=34989&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FGeneticsHealth%2F%7E3%2Fy40e0ba2MBU%2F Jeanene Harlick, 37, was at 65% her ideal body weight and needed a feeding tube, but her insurance company wouldn’t cover inpatient care at an eating disorder facility. Harlick lives in California, which has one of the nation’s strongest mental health parity laws—laws that say insurance companies must provide the same coverage for mental illness as they do for physical illness). So she sued—and won, for now; the U.S. 9th Circuit Court of Appeals in San Francisco just said that her insurance company, Blue Shield of California, must pay for her residential care. The ruling could make a difference in how insurers in other states cover mental health treatment, too. Forty-nine states and D.C. have mental parity laws, but they vary in degree widely, according to the National Conf... Genetics and Health blogs http://www.medworm.com/rss/comments.php?id=5182150 Thu, 01 Sep 2011 20:51:32 +0100 5182150 http://www.medworm.com/index.php?rid=5181735&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F09%2F01%2Fimplementing-health-reform-association-health-plans%2F The Affordable Care Act comprehensively reforms health insurance in the United States.  Its central reform provisions apply to “a group health plan and health insurance issuer offering group or individual health insurance coverage,” that is, to individual, small group, large group, and even self-insured coverage. In fact, however, the ACA does not cover all forms [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5181735 Thu, 01 Sep 2011 20:35:54 +0100 5181735 http://www.medworm.com/index.php?rid=5181737&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F08%2F31%2Fthe-challenges-of-payment-reform-and-administrative-simplification%2F As both a Canadian and an analyst who focuses on US healthcare, I have an abiding curiosity in comparisons between the US and Canadian systems, so it was with great interest that I read the recent Health Affairs article by Dante Morra and coauthors entitled “US Physician Practices Versus Canadians: Spending Nearly Four Times As Much Money [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5181737 Wed, 31 Aug 2011 16:57:12 +0100 5181737 http://www.medworm.com/index.php?rid=5181976&cid=t_100419_113_f&fid=38236&url=http%3A%2F%2Fwww.healthcareitnews.com%2Fblog%2Fwisconsin-insurer-creates-mobilenurse-app A managed care organization serving more than 100,000 members in southern Wisconsin is entering the wild, wild world of mobile health apps with its own urgent care solution – and offering it for free to anyone who might want it. The Physicians Plus Insurance Corporation, based in Madison, is making its MobileNurse app available for iPhones and will have an Android version available shortly. read more (Source: Healthcare IT News Blog) Healthcare IT News Blog blogs http://www.medworm.com/rss/comments.php?id=5181976 Wed, 31 Aug 2011 15:08:00 +0100 5181976 http://www.medworm.com/index.php?rid=5181789&cid=t_100419_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2FmU1-nyCeM44%2F By Rozalynn Goodwin. Everyone seems to be quoting and tweeting the tender line of Miss Aibileen in “The Help”, “You is kiiiind. You is smaaaart. You is important.” But there was another line in the blockbuster movie that moved me even more. I heard it and the heavens seemed to open. The light bulb came on. Hilly Holbrook’s new maid is $75 short on one of the college tuitions for her twin sons and asks Hilly and her husband for a loan so she doesn’t have to choose which son should go to college. Doing the ‘Christian thing,’ Hilly refuses, “God does not give charity to those who are well and able.” Twelve simple words from a fictional 1960’s character summed up our nation’s current political will regarding the poor. And allow me to condense this into just one ... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=5181789 Tue, 30 Aug 2011 19:43:53 +0100 5181789 http://www.medworm.com/index.php?rid=5181790&cid=t_100419_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2FFSpBgAwfDVs%2F By Mary Grealy. When we talk about people who don’t have access to healthcare, there’s a natural assumption that it’s because they can’t afford it.  A new study shows that’s not necessarily the case. According to the study published in the journal Health Services Research, 21 percent of American adults said they had delayed care for non-financial reasons compared to 19 percent that cited cost as the primary reason for not seeking healthcare. Those non-financial reasons included not being able to get to a doctor’s office during working hours, long commutes to the medical office, or not being able to get an appointment soon enough.  As the study’s lead author said, “In reality, there are all kinds of reasons why people can’t get the care they need when they need it.” Th... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=5181790 Tue, 30 Aug 2011 13:16:36 +0100 5181790 http://www.medworm.com/index.php?rid=5181751&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FQa2nPPR_42c%2F “Niche Blockbusters”: Pfizer’s newly approved lung-cancer therapy crizotinib, to be sold under the brand name Xalkori, represents a relatively new tack for the pharma giant: a drug aimed at a small group of patients with a serious disease whom tests show will likely benefit from the treatment, the WSJ reports. Drug makers can bring these potential “niche blockbusters” to market quickly and more cheaply than drugs aimed at a mass audience, and because the medical need is dire, insurers will pay up for them. Xalkori will sell for $115,200 per year. Asking the Uninsured: The Kaiser Family Foundation’s latest tracking poll finds only 31% of uninsured people think the health-care overhaul law will help them get coverage, NPR’s Shots blog reports. A full 37% of... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=5181751 Tue, 30 Aug 2011 12:20:05 +0100 5181751 http://www.medworm.com/index.php?rid=5182055&cid=t_100419_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002153.html We dodged a bomb. Here in New England, it always seems the greater the media coverage around weather events, the less dramatic the impact when the actual events hit. Fortunately Irene was no exception. That's not to minimize the impact... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5182055 Mon, 29 Aug 2011 23:00:00 +0100 5182055 http://www.medworm.com/index.php?rid=5174586&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F08%2F29%2Faco-101-the-basics-of-accountable-care%2F Regarding the subject of “health care reform” during the past year, it is certain that more has been written about, more conferences have been devoted to, and more consultants have been engaged for the topic of “accountable care organizations” (ACOs) than any other.  ACOs are in the spotlight both because of several provisions in the [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5174586 Mon, 29 Aug 2011 18:51:11 +0100 5174586 http://www.medworm.com/index.php?rid=5169545&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdo-physicians-have-a-role-in-controlling-healthcare-costs%2F2011.08.27 The Role of Physicians in Controlling Medical Care Costs and Reducing Waste by the RAND Corporation and David Geffen, University of California Los Angeles School of Medicine, Santa Monica was just published in the Journal of the American Medical Association (JAMA).  I do not think the JAMA should have published this article. 1.Why would the JAMA publish such an article? 2. Why are physicians blamed for all the waste in the system? 3. Why is it the physicians’ responsibility to eliminate waste when they are not the cause of the greatest percentage of the waste? “The amount of money spent on medical care is increasing faster than the gross domestic product (GDP), and the federal deficit is increasing.” The initial statement assumes that the government deficit is increasing because phy... Better Health blogs http://www.medworm.com/rss/comments.php?id=5169545 Sat, 27 Aug 2011 21:05:19 +0100 5169545 http://www.medworm.com/index.php?rid=5158920&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F08%2F25%2Frisk-shifting-in-health-care-and-its-implications-part-two%2F Yesterday, in the first installment of a two-part Health Affairs Blog post, Troyen Brennan and Thomas Lee discussed the shifting of risk they see taking place in the health care system, from insurers and employers to provider and patients. In part two below, Brennan and Lee discuss the implications of this shift for various health [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5158920 Thu, 25 Aug 2011 18:02:47 +0100 5158920 http://www.medworm.com/index.php?rid=5158921&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F08%2F24%2Fmedicares-looming-risk-transfer%2F Editor’s Note: Below, Jaan Sidorov analyzes the risk-shifting inherent in proposals for Medicare reform. Today, Health Affairs Blog is also publishing the first installment of a two-part post by Troyen Brennan and Thomas Lee, which addresses risk-shifting in the health care system as well. Suppose, despite my good health and lifelong habit of avoiding doctors, [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5158921 Wed, 24 Aug 2011 15:53:07 +0100 5158921 http://www.medworm.com/index.php?rid=5158922&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F08%2F24%2Frisk-shifting-in-health-care-and-its-implications-part-one%2F Editor’s Note: Below, in the first installment of a two-part Health Affairs Blog post, Troyen Brennan and Thomas Lee discuss the shifting of risk they see taking place in the health care system, from insurers and employers to provider and patients. In part two tomorrow, Brennan and Lee will discuss the implications of this shift [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5158922 Wed, 24 Aug 2011 15:50:18 +0100 5158922 http://www.medworm.com/index.php?rid=5158999&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fare-patients-considering-the-idea-of-medical-tourism-to-receive-health-care%2F2011.08.24 I must confess that I have a weakness for medical tourism. Patients have always been ready to go on a pilgrimage to find the world’s leading expert (we call it ‘key opinon leader’ now) hoping to find a cure. As long as traditional leaders in the field of Medicine have been the Germans, the French and the English -with some occasional Austrian and Spanish name in the mix- traffic of wealthy patients across Europe is nothing new. Since we entered the antibiotics era, these leaders started to be located mainly in the United States, the cradle of modern, technology-driven Medicine. Thus hi-tech centers got ready to welcome foreign patients, building strong International Customer Support departments. A random example -by no means the only one- would be the Mayo Clinic. On their website y... Better Health blogs http://www.medworm.com/rss/comments.php?id=5158999 Wed, 24 Aug 2011 14:00:07 +0100 5158999 http://www.medworm.com/index.php?rid=5159893&cid=t_100419_165_f&fid=36767&url=http%3A%2F%2Fabctherapeutics.blogspot.com%2F2011%2F08%2Fmachiavellian-win-for-nys-early.html Well I believe in equal opportunity blogging so when NYS does something correct with the early intervention program I have to herald the effort. On August 17 Governor Cuomo signed a bill that facilitates payment of claims by health insurers to municipalities for early intervention services. In a previous blog post I talked about the 85% denial rate that exists because the state government doesn't know how to collect from private insurance companies. This new law causes the IFSP to meet any precertification, preauthorization and medical necessity requirements imposed on benefits under any insurance policy. There are additional new rules that prohibit insurers from denying claims based on the location where services are provided, the duration of the child's condition or that the child's c... ABC Therapeutics Occupational Therapy Weblog blogs http://www.medworm.com/rss/comments.php?id=5159893 Mon, 22 Aug 2011 21:38:00 +0100 5159893 http://www.medworm.com/index.php?rid=5158923&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F08%2F19%2Ftoo-many-medicare-advantage-choices-can-decrease-enrollment%2F A new Health Affairs Web First study finds that increased choice among Medicare Advantage plans leads to increased enrollment in the program among elderly Americans, but only when beneficiaries are choosing among 15 or fewer plans. When Medicare beneficiaries have a choice of 15 to 30 private plans, increased choice does not result in increased Medicare Advantage [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5158923 Fri, 19 Aug 2011 14:20:41 +0100 5158923 http://www.medworm.com/index.php?rid=5139718&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F08%2Fnew-rules-will-make-health-insurance-documents-easier-to-understand.html Consumers dread shopping for health insurance and deciphering health insurance documents. We know, because Consumers Union conducted several studies in which we asked consumers how they shop for health insurance, and they told us so. One of the provisions in the Affordable Care Act is going to make this task a little easier by making insurance companies give you standard “health insurance facts”—written in plain English—for every private product they offer, starting in 2012. The information will have the same format for every product, just like the familiar Nutrition Facts label that looks the same whether you’re buying a box of cereal or a can of soup. Whether you get health insurance from your employer or buy on your own, you’ll see the same form. ... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=5139718 Thu, 18 Aug 2011 15:15:00 +0100 5139718 http://www.medworm.com/index.php?rid=5139672&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F08%2F18%2Fimplementing-health-reform-informing-consumers%2F One of the most important innovations of the Affordable Care Act (ACA) is that it dramatically increases and improves the information that consumers have available about health insurance and health care.  HHS has already implemented provisions of the ACA requiring insurers to disclose information regarding their medical loss ratios and to publicly justify unreasonable rate [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5139672 Thu, 18 Aug 2011 14:49:06 +0100 5139672 http://www.medworm.com/index.php?rid=5139679&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FrLMzI7Yssdo%2F Just as you might look at the label on the side of a cereal box to check its sugar content, starting next year you’ll be able to look at a summary of insurance-plan information to learn about the deductible or out-of-pocket spending limit — before you buy the policy. As the WSJ reports, the proposed summary form, which was part of the health-care overhaul law, could be unveiled as soon as tomorrow. It will be open to public comment before it’s finalized. (Update: here’s the proposed template.) And admittedly, the form isn’t going to be as compact as that nutrition label. The  summary will get into the nitty gritty of plan details, including deductibles for specific categories and an explanation of what a consumer would end up spending on three common medical ... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=5139679 Tue, 16 Aug 2011 21:06:23 +0100 5139679 http://www.medworm.com/index.php?rid=5139674&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F08%2F16%2Fthe-legal-battle-over-health-reform-analyzing-the-11th-circuit-opinions%2F Editor’s Note: Below, William Sage analyzes Friday’s federal appellate court decision regarding the Affordable Care Act. See Timothy Jost’s earlier post for more on this decision. On August 12, a divided three-judge panel of the US Court of Appeals for the Eleventh Circuit ruled in State of Florida v. Sibelius that the individual mandate contained [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5139674 Tue, 16 Aug 2011 19:40:18 +0100 5139674 http://www.medworm.com/index.php?rid=5130719&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F08%2F15%2Fappellate-court-individual-mandate-falls-but-rest-of-affordable-care-act-survives%2F Editor’s Note: Below, Tim Jost analyzes Friday’s appellate decision regarding the Affordable Care Act. Watch for more coverage of this decision and its significance on Health Affairs Blog. One August 12, 2011, in a case brought by 26 states and various private parties, the Eleventh Circuit Federal Court of Appeals handed down the first federal [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5130719 Mon, 15 Aug 2011 18:20:51 +0100 5130719 http://www.medworm.com/index.php?rid=5130720&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F08%2F13%2Fimplementing-health-reform-medicaid-and-exchange-eligibility-determinations%2F On August 12, 2011, the Department of Health and Human Services issued two notices of proposed rulemaking (NPRMs) in its ongoing efforts to implement the Affordable Care Act (ACA).  The first addresses eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) after the 2014 implementation of the ACA Medicaid expansions.  The second governs eligibility [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5130720 Sat, 13 Aug 2011 23:44:42 +0100 5130720 http://www.medworm.com/index.php?rid=5130721&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F08%2F13%2Fimplementing-health-reform-premium-tax-credits%2F On August 12, the Departments of Health and Human Services and Treasury (Internal Revenue Service) issued three notices of proposed rulemaking (NPRM) as part of their continuing effort to implement the Affordable Care Act (ACA). The proposed rules will be formally published in the Federal Register on August 17 for comment. One NPRM issued by [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5130721 Sat, 13 Aug 2011 17:57:55 +0100 5130721 http://www.medworm.com/index.php?rid=5125738&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-new-meaning-of-the-refrigerator-nurse%2F2011.08.13 Meet Nurse Prudence Perfect. She is the unit’s refrigerator nurse. It’s her job to make sure that everything is perfect and meets Joint Commission standards because you never know when the old JC will drop by for an unannounced visit. Insulin vials labeled and dated? Check. Refrigerator thermometer easily accessible and log up to date? Check. Hey, who put their lunch in here? There is to be no food in medication refrigerator! Prudence is gearing up. Stand by for one of her Joint Commission inservices. For you nursing history buffs, the term “refrigerator nurse” goes way back to a time when Prudence was a graduate nurse. The term was coined back when it only took one paycheck to support a family, and when nurses, typically women, quit working once they got married. A nurse who went... Better Health blogs http://www.medworm.com/rss/comments.php?id=5125738 Sat, 13 Aug 2011 12:00:50 +0100 5125738 http://www.medworm.com/index.php?rid=5125731&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F08%2Fis-obamacare-done-for.html Nope. Earlier today a federal appeals court in Atlanta struck down the most contentious part of the Affordable Care Act—the “individual mandate” requirement that everyone must have health insurance or pay a penalty. But it has no immediate impact on consumers. Here’s why. First of all, the individual mandate part of the law isn’t scheduled to take effect until 2014. And the overall fate of the law will almost certainly be decided before then by the Supreme Court, because another appeals court has previously upheld the constitutionality of the mandate. Indeed, the 2 to 1 decision by a three-judge panel of the 11th Circuit Court of Appeals is only the latest in a series of contradictory judicial rulings on the law. Meanwhile, the many parts of the law that al... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=5125731 Fri, 12 Aug 2011 21:05:00 +0100 5125731 http://www.medworm.com/index.php?rid=5118708&cid=t_100419_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F08%2F11%2Fannouncing-the-psych-central-drug-discount-card%2F I’m proud to tell you about a new, free benefit offered to Psych Central members and readers — a drug discount card. The Psych Central drug discount card can save you up to 80% or more off the cost of prescription medications, over-the-counter drugs and pet prescription drugs. The Psych Central Drug Discount Card is accepted at over 60,000 pharmacies, including major chains such as Walmart, CVS, Walgreens, Rite Aid and at regional chains and local stores. It is offered in partnership with NeedyMeds. The card may be used by those without insurance and by those who decide not to use their insurance — for example if the drug is not covered under their plan, the copay or deductible is high, the cap has been reached, or if they are in the donut hole. There are no income, insu... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=5118708 Thu, 11 Aug 2011 15:11:01 +0100 5118708 http://www.medworm.com/index.php?rid=5118599&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FrouRwKPghUc%2F We already know that health-care spending and use can vary wildly depending on where a person lives. But most of that evidence comes from Medicare data, notably reports by the Dartmouth Atlas Project. Those analyses don’t say anything about spending patterns for people covered by commercial insurance. A report out today from Thomson Reuters tackles that issue. It looks at spending for children, adults and seniors covered by employer-based insurance. And, like the Medicare analyses, it finds geographic variation. But the patterns for private and public insurance spending are different. McAllen, Texas, for example, has been pegged by Dartmouth as one of the top-spending areas in the country. When MedPAC, a commission that advises lawmakers on Medicare, conducted its own analysis of act... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=5118599 Wed, 10 Aug 2011 19:37:29 +0100 5118599 http://www.medworm.com/index.php?rid=5118593&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F08%2F09%2Fis-medicare-more-efficient-than-private-insurance%2F Of all the issues bandied about in the recent debate over the debt ceiling, none generated more contention, more TV ads and more unseemly rhetoric than potential changes to Medicare. Health economists generally believe that Medicare is on an unsustainable course and is desperately in need of reform. Yet public opinion polls show that most [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5118593 Tue, 09 Aug 2011 15:53:05 +0100 5118593 http://www.medworm.com/index.php?rid=5107514&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysician-discusses-the-confusing-aspects-of-medicare-part-d%2F2011.08.09 I have discussed Medicare Part B and Part F in recent blogs. A reader asked about Medicare Part D: Dr. Feld “Please discuss Medicare Part D, the drug benefit plan available to seniors. It is very complicated and completely confusing to me. My physician gave me a prescription for Levequin 500 mg once a day for 10 days. The pharmacist told me it would cost me $330 dollars. Medicare Part D would pay an additional $110 dollars for a total of $440 dollars. I asked the pharmacist if there was a generic equivalent. The answer was yes. It cost $10 dollars. This is unconscionable. It is highway robbery. Sincerely a.g.” Several issues are presented in this readers note. It is essential to understand these issues. The issues are an indictment against government “controlled” programs. (m... Better Health blogs http://www.medworm.com/rss/comments.php?id=5107514 Tue, 09 Aug 2011 14:00:44 +0100 5107514 http://www.medworm.com/index.php?rid=5107477&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F08%2F09%2Fjulys-most-read-ha-blog-posts%2F Timothy Jost’s series of posts on proposed new federal rules for state health insurance exchanges leads July’s list of most-read Health Affairs Blog posts. Jon Kingsdale’s article on Massachusetts’ efforts to control health care costs is also featured on the list, as are Jeff Goldsmith’s discussion of the effect of health reform on employer-based health [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5107477 Tue, 09 Aug 2011 13:44:43 +0100 5107477 http://www.medworm.com/index.php?rid=5107523&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-best-thing-a-patient-can-do-following-a-heart-attack%2F2011.08.07 I’ve been telling my smoking patients for years that nothing I do for them is going to make an ounce of difference until they quit smoking for good.  And the Italians are out to prove me right.  The American Journal of Cardiology reported July 11th, 2011 on the Effect of Smoking Relapse On Outcome After Acute Coronary Syndrome. In a study of just under 1,300 patients,  Reuters reports that just over 1/2 the patients started smoking within 20 days of hospital discharge, despite in-hospital smoking cessation consultation for all patients.   Researchers also found that resuming smoking increased  death 3-fold compared with those that did not relapse and quitting smoking had a similar lifesaving effect as taking cholesterol and blood pressure medications.  And I’m sure these ... Better Health blogs http://www.medworm.com/rss/comments.php?id=5107523 Sun, 07 Aug 2011 16:00:00 +0100 5107523 http://www.medworm.com/index.php?rid=5103336&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealth-care-attorney-discusses-the-use-of-disclaimers-on-facebook-pages%2F2011.08.06 This is the third part of a three part post addressing the legal concerns of social networking in the health care arena. In part one, legal expert David Harlow, Esq., Health Care Attorney and Consultant at The Harlow Group, LLC in Boston, answered questions regarding “The Legal Implications for Doctors, Nurses and Hospitals Engaging in Social Media?” In part two, Mr. Harlow answered questions related to the Pharma industry;  “Legal Concerns: What Steps can Pharma Take to Engage in Social Media?” The third part addresses a question from a follower on Facebook about the use of disclaimers. Q:  Barbara: A Healthin30 reader on Facebook writes:  “I’m looking for a good disclaimer to put on a couple of medical practices’ Facebook pages. The AMA social media guidelines aren’t h... Better Health blogs http://www.medworm.com/rss/comments.php?id=5103336 Sat, 06 Aug 2011 21:00:47 +0100 5103336 http://www.medworm.com/index.php?rid=5103335&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F08%2Fnew-labels-will-help-consumers-evaluate-health-insurance-plans-1.html A new form required by the health-reform law will help millions of consumers better understand how their insurance works, according to a report from Consumers Union, the publisher of Consumer Reports magazine and this web site. The law requires all health insurers in 2012 to explain the basic components of their coverage on a standardized form similar to the nutrition-facts label on foods. The form uses a simple format to explain common terms, such as deductibles, co-payments, co-insurance, and out-of-pockets limits. It also requires insurers to calculate and disclose total patient costs for three hypothetical patient scenarios, allowing consumers to better understand the “bottom line” of what they’d end up paying out of their own pocket if illness struck. The three sc... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=5103335 Fri, 05 Aug 2011 18:00:00 +0100 5103335 http://www.medworm.com/index.php?rid=5103323&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F08%2F05%2Fnew-health-affairs-u-s-docs-spend-four-times-more-on-payer-interactions-than-canadians%2F U.S. physician practices spend nearly four times as much per physician as doctors in Ontario dealing with health insurers and payers, says a new study in the August issue of Health Affairs, released yesterday. Most of the difference stems from the fact that Canadian physicians deal with a single payer, in contrast to the multiple [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5103323 Fri, 05 Aug 2011 14:36:24 +0100 5103323 http://www.medworm.com/index.php?rid=5103324&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F08%2F05%2Fa-heat-wave-health-wonk-review%2F Over at Managed Care Matters, Joe Paduda presents the Health Policy Heat Wave edition of the Health Wonk Review: The weather is hot these days, and so is health policy. Joe presents a great collection of health policy blogging, including Jeff Goldsmith’s Health Affairs Blog post on the impact of health reform on employer-based coverage. [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5103324 Fri, 05 Aug 2011 14:24:36 +0100 5103324 http://www.medworm.com/index.php?rid=5096209&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Feven-with-insurance-childbirth-is-an-expensive-undertaking%2F2011.08.03 Childbirth hospital costs these days aren’t cheap. Some studies suggest the cost of raising a child exceeds $200,000, not including education expenses.   Most insurance companies charge women of childbearing age more for their insurance because the actuarial tables say so.  Mrs  Happy and I now have a 3 month old Zachary in our wings.  He is a cute little peanut.  His two brothers, Marty and Cooper adore him. Forty-two days after his April 21st, 2011 delivery, we still had not received our explanation of benefits from Blue Cross Blue Shield for the midwife charge.  I had previously received a statement from them saying the charge was under review.  Perhaps they believed that delivering Zachary was not medically necessary.  I can’t explain it. When I called to ask them w... Better Health blogs http://www.medworm.com/rss/comments.php?id=5096209 Wed, 03 Aug 2011 18:00:00 +0100 5096209 http://www.medworm.com/index.php?rid=5086163&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F08%2Fhealth-plans-must-provide-birth-control-for-free.html Starting next year, all new health plans must cover 100 percent of the cost of contraception and a list of other women’s preventive services, with no deductibles or copays, according to the U.S. Department of Health and Human Services. With one exception (see below), HHS adopted all the recommendations made by an expert committee of the Institute of Medicine, which we wrote about when it came out a couple of weeks ago. To recap, here are the covered services: • All FDA-approved contraceptives. • Annual HIV test for all sexually active women. • Screening pregnant women for gestational diabetes. • A DNA test for human papillomavirus (HPV) in women over 30 who have a normal Pap smear (also covered), in order to identify women at higher risk of developing cervical cancer in th... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=5086163 Mon, 01 Aug 2011 17:35:00 +0100 5086163 http://www.medworm.com/index.php?rid=5086136&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FanILqyKbDn8%2F A few weeks back, the Institute of Medicine recommended that contraception and seven other women’s preventive health services be covered by insurers with no out-of-pocket costs. Today the U.S. Department of Health and Human Services signed off on those recommendations, saying the requirements would apply to new plans starting  starting on or after Aug. 1, 2012. Besides birth control, insurers will also have to cover the following services with no co-pay or deductible: Screening for gestational diabetes in pregnant women Testing for human papillomavirus in women age 30 and up Annual counseling about sexually transmitted diseases HIV screening and counseling Breastfeeding support, including pump rentals Domestic violence screening and counseling At least one preventive health visit p... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=5086136 Mon, 01 Aug 2011 16:58:16 +0100 5086136 http://www.medworm.com/index.php?rid=5086174&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealth-care-attorney-warns-about-hipaa-privacy-issues-in-social-media%2F2011.07.31 This is the first of a three part post addressing the legal concerns of social networking in the health care arena. Legal expert, David Harlow, Esq., Health Care Attorney and Consultant at The Harlow Group, LLC in Boston, addresses the legal issues. Q:  Barbara: What are the legal implications for doctors, nurses and hospitals engaging in social media? A:  David: Health care providers are concerned about HIPAA privacy issues – HIPAA violations may occur as a result of staff posts, or as a result of patient, family or caregiver posts – as well as potential liability for medical advice provided on line.  Physicians and nurses have been sanctioned and fired for privacy breaches via social media, so these are real concerns.  Some communications that folks think are OK may in fact be v... Better Health blogs http://www.medworm.com/rss/comments.php?id=5086174 Sun, 31 Jul 2011 16:00:39 +0100 5086174 http://www.medworm.com/index.php?rid=5077672&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F07%2Fwill-medicare-pay-for-dental-implants-needed-as-a-result-of-my-autoimmune-disease.html Q: I have Sjogren’s Syndrome, an autoimmune condition that has attacked my salivary glands. As a result, my teeth have been destroyed by the lack of saliva. Dentists say a bridge of false teeth will not stay in place because there is no saliva to form a suction lock. I must have implants instead. Can I get any help from Medicare with this expense, as it is a medical condition that caused the loss of my teeth? A: Probably not, but you should try anyway. In fact there is a class-action lawsuit currently pending that aims to get Medicare to change its no-dental-coverage policy for people in your situation. We contacted Sally Hart, an attorney for the Center for Medicare Advocacy, who filed the suit in a federal district court in Phoenix, Ariz., to learn more. She explained that by law... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=5077672 Fri, 29 Jul 2011 12:00:00 +0100 5077672 http://www.medworm.com/index.php?rid=5077642&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F07%2F28%2Fu-s-health-spending-projected-to-grow-5-8-percent-annually%2F All health care spending in the United States is projected to grow at an annual average rate of 5.8 percent for the period 2010 through 2020, 1.1 percentage points faster than expected growth in Gross Domestic Product (GDP). By 2020, health care spending is projected to be 19.8 percent of GDP, nearly one-fifth of economic [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5077642 Thu, 28 Jul 2011 13:48:45 +0100 5077642 http://www.medworm.com/index.php?rid=5069460&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F07%2Fwill-my-familys-pre-existing-conditions-be-covered-if-i-change-jobs.html Q. I am considering changing jobs but am concerned about insurance coverage for pre-existing conditions. My son had a transplant, I had a pituitary tumor, and my husband had open-heart surgery. If I change jobs and insurance, is the new insurance required to cover us? A. It most certainly is, thanks to a federal law called the Health Insurance Portability and Accountability Act of 1996, commonly known as HIPAA. This law makes it illegal for group health plans to deny coverage to employees (and their dependents, if the group health plan offers dependent coverage) on the basis of pre-existing conditions. And they cannot charge you more for your premium contribution than any other employee. A couple of things to keep in mind: You must start your new health plan within 63 days of leaving ... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=5069460 Wed, 27 Jul 2011 16:30:00 +0100 5069460 http://www.medworm.com/index.php?rid=5069475&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-is-the-most-costly-healthcare-expenditure%2F2011.07.27 The National Institute for Healthcare Management Foundation is a nonprofit, nonpartisan organization focused on healthcare. The foundation just published an excellent report on the distribution of  healthcare costs in the population. The results indicate that reducing healthcare cost is all about reducing and managing chronic diseases. U.S. healthcare spending has sharply increased between 2005 and 2009 by 23 percent from $2 trillion to $2.5 trillion per year. This is a result of a combination of factors. Chief among them is the increasing incidence of obesity. Who spends the money? (more…) *This blog post was originally published at Repairing the Healthcare System* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5069475 Wed, 27 Jul 2011 12:00:54 +0100 5069475 http://www.medworm.com/index.php?rid=5069429&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FiVxCAKiLNj8%2F Boding Ill?: For-profit hospital company HCA Holdings reported a 22% decline in second-quarter profit, in part because of fewer surgical admissions, the WSJ reports. An analyst tells the paper that doesn’t bode well for the results from other hospital companies; shares in Tenet Healthcare and Health Management Associates, among others, fell yesterday, though not as much as HCA shares. Reviewing a Review: Starting in September, the federal government will begin to scrutinize proposed health-insurance premium increases of 10% or more in states it says don’t have sufficient oversight of rates, the New York Times reports. One of the ten states, Iowa, says the Obama administration has not been consistent in its assessment of what constitutes an ineffective rate-review system, while ... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=5069429 Tue, 26 Jul 2011 12:34:53 +0100 5069429 http://www.medworm.com/index.php?rid=5062290&cid=t_100419_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F07%2F25%2Fneed-mental-health-treatment-in-2-weeks-fat-chance%2F This study demonstrates quite the opposite. Read the full article: Medical News: Barriers High in Mental Health Care (Source: World of Psychology) World of Psychology blogs http://www.medworm.com/rss/comments.php?id=5062290 Mon, 25 Jul 2011 20:15:01 +0100 5062290 http://www.medworm.com/index.php?rid=5062213&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F07%2F25%2Fha-blog-posts-on-exchange-regs-highlighted-in-health-wonk-review%2F Check out Julie Ferguson’s “Heatwave” edition of the Health Wonk Review at Workers’ Comp Insider. Julie presents a great selection of health policy blogging, including Tim Jost’s Health Affairs Blog series on proposed new regulations on state health insurance exchanges. Copyright © 2011 Health Affairs Blog. This Feed is for personal non-commercial use only. All [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5062213 Mon, 25 Jul 2011 18:11:25 +0100 5062213 http://www.medworm.com/index.php?rid=5062226&cid=t_100419_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FFGsoGrS2IEA%2F I’ve argued that the Dodd-Frank financial reform bill does not end “too-big-to-fail”, that is the belief that certain companies are implicitly backed by the government because policy-makers are unlikely to let said institutions actually fail. By naming some companies as ”systemically important” — as required by Dodd-Frank — the government is actually sending a signal as to who is likely to be bailed out. As evidenced by regulators’ behavior during the financial crisis, the prime beneficiaries would be the creditors of these companies, as even when shareholders and management suffered, creditors generally did not. This should allow such firms to borrow at a cost lower than firms not deemed systemically important. Given this funding... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=5062226 Mon, 25 Jul 2011 12:53:37 +0100 5062226 http://www.medworm.com/index.php?rid=5057708&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F07%2F22%2Fletting-go-of-employer-based-health-insurance%2F Other than the egg-laying exercise surrounding the ACO regulations, 2011 was a quiet year among Washington health policy experts until June 6 when McKinsey released the results of a survey of employer plans under the Affordable Care Act. The McKinsey study found that roughly 30 percent of employers were considering dropping their employee insurance coverage [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5057708 Fri, 22 Jul 2011 18:16:37 +0100 5057708 http://www.medworm.com/index.php?rid=5057727&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-importance-of-social-media-in-the-medical-field%2F2011.07.22 Recently,  I had the pleasure of being surrounded by brilliant health care thought leaders.  First, I delivered a social media presentation at the Eyeforpharma conference.  Secondly, I sat in the audience at the Social Communications and Health Care 2011 conference to listen to others present on social media, and participate in a round-table discussion on social media. It’s clear from the personal discussion that followed with folks from the pharma industry, medical device companies, and hospitals, that they understand the need for social media (or social networking), but they are cautious to dive in. A few concerns I’ve heard:  “social media can be paralyzing,” “senior leadership in the pharma industry is looking for the FDA to make decisions because it’s such a highly reg... Better Health blogs http://www.medworm.com/rss/comments.php?id=5057727 Fri, 22 Jul 2011 16:00:49 +0100 5057727 http://www.medworm.com/index.php?rid=5050499&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F07%2F21%2Flarsen-praises-state-progress-on-exchanges-at-ha-newsmaker-breakfast%2F States are making progress in varied ways toward creating the health insurance exchanges provided for in the Affordable Care Act, a senior official at the Centers for Medicare and Medicaid Services said at a Health Affairs Newsmaker breakfast this morning. The state exchanges, which must be up and running by January 1, 2014, will provide [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5050499 Thu, 21 Jul 2011 21:40:00 +0100 5050499 http://www.medworm.com/index.php?rid=5050512&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FMwkouMObLP8%2F The married-up Express Scripts/Medco will face off not only against incumbent CVS Caremark, but, it appears, against an emerging new rival: the pharmacy operation of UnitedHealth Group’s Optum health-services unit. With Medco’s announcement today that it will lose its UnitedHealth contract at the start of 2013, the rationale for selling itself to Express may also become a bit clearer. The UnitedHealth contract was its biggest, representing 17% of its 2010 revenues, or roughly 164 million claims, and a “mid- to high-single-digit percentage” of its earnings per share, according to J.P. Morgan analyst Lisa Gill. If UnitedHealth does take its PBM business in-house, it would establish OptumRx as a formidable presence in the industry, with serious heft because of its status with th... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=5050512 Thu, 21 Jul 2011 13:01:56 +0100 5050512 http://www.medworm.com/index.php?rid=5050558&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F07%2Fhealth-plans-should-offer-women-free-contraception-and-hiv-screening-iom-says.html All health plans should cover the full cost of contraceptives and an annual HIV test for all sexually active women, an expert Institute of Medicine panel recommended on Tuesday. Now it’s up to the Department of Health and Human Services, which asked the panel for the recommendations, to decide whether to accept them. Some background: The Affordable Care Act says that all new health plans must pay 100 percent of the cost a specified list of preventive services. But the law also instructed that the government should take a closer look at preventive care for women, and add more services to fill in any gaps that exist. That’s what the panel just did. The most hotly anticipated question was whether the expert panel would include birth control on their list. They did, emphatically... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=5050558 Wed, 20 Jul 2011 17:00:00 +0100 5050558 http://www.medworm.com/index.php?rid=5050535&cid=t_100419_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2F0FczLaTHxGI%2F At the Encyclopedia Britannica blog, I take on the argument made, for instance, by President Obama in his Friday news conference: We should not be asking sacrifices from middle-class folks who are working hard every day, from the most vulnerable in our society — we should not be asking them to make sacrifices if we’re not asking the most fortunate in our society to make some sacrifices as well. I call that a fundamentally flawed argument: The main thing our government does these days, despite the lack of any constitutional authority for it, is tax some people and transfer money to other people. …But there is no moral equivalence in the two sides of the transfer system. On the one hand, the government takes money by force from people who have earned it. On the other hand, it g... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=5050535 Tue, 19 Jul 2011 19:59:23 +0100 5050535 http://www.medworm.com/index.php?rid=5050505&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F07%2F19%2Fimplementing-health-reform-insurance-cooperatives%2F The exchange and the reinsurance, risk adjustment, and risk corridor (3R) proposed regulations released by HHS on July 11 were only the first two in a series of exchange-related notices of proposed rulemakings (NPRMs) that will be rolled out in the coming weeks and months.  A third NPRM dealing with the Consumer Operated and Oriented [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5050505 Tue, 19 Jul 2011 15:03:42 +0100 5050505 http://www.medworm.com/index.php?rid=5051307&cid=t_100419_175_f&fid=39258&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FInsidePaTraining%2F%7E3%2FOodOV5aCSh4%2Fpa-vs-md-malpractice-part-i The PA vs MD section of our site is not intended to cover debates; rather the “vs” in the title is meant to describe the issues that crop up when a student tries to decide between the two professions.  Today, however, debate at least enters into it.  I’m talking about physician assistant malpractice.  Better you should go into this field knowing the reality. Do PAs Get Sued? Yes.  It’s a common misconception that “PAs don’t get sued because they are the physician’s responsibility.”  Actually, there are three facts of medicine and law that govern who will be sued: PAs, though supervised by physicians, can and do make errors for which their supervising physicians are not responsible.  This happens when the PA consults with the physicia... Inside PA Training blogs http://www.medworm.com/rss/comments.php?id=5051307 Mon, 18 Jul 2011 07:40:13 +0100 5051307 http://www.medworm.com/index.php?rid=5036229&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-real-world-of-medicine-today%2F2011.07.17 The old joke in medicine goes, ‘don’t get sick on July 1st.’ That’s because it’s the day when new resident physicians, freshly graduated from medical schools across the land, begin their training programs. Although they have spent four years in undergraduate school and four years in medical school, it’s residency where physicians are made from the raw material of knowledge-rich, experience poor high achievers. However, even in residency physicians are seldom told the entire story of how the practice of medicine, and their lives, will look and feel as their careers evolve and they enter the medical work-force. Since our profession changes from year to year and administration to administration, it seems a good time to mention some of the things upcoming young physicians will face... Better Health blogs http://www.medworm.com/rss/comments.php?id=5036229 Sun, 17 Jul 2011 16:00:50 +0100 5036229 http://www.medworm.com/index.php?rid=5036215&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F07%2F15%2Fthe-insurance-exchanges-open-enrollment-and-switching-plans%2F The Department of Health and Human Services released proposed regulations this week on the new health insurance exchanges that the Affordable Care Act will set up.  While they don’t address all of the important policy issues related to how these new entities will work, they do lay out when people can sign up for exchange [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5036215 Fri, 15 Jul 2011 16:03:50 +0100 5036215 http://www.medworm.com/index.php?rid=5029035&cid=t_100419_136_f&fid=38061&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FBreastCancerReconstructionBlog%2F%7E3%2FAQO_1GKh8VE%2Fbreast-reconstruction-makes-breast.html Alarmingly, 70% of American women facing surgery for breast cancer are not told about the option of breast reconstruction. Perhaps one of the best things about breast reconstruction is that it can be performed at any time….  you can never “miss the boat” so to speak. Regardless of the timing of the procedure, breast reconstruction enables women to feel whole again, not just physically but also emotionally. There are several reconstructive options ranging from breast implants to using the patient’s own tissue. Tissue (or “flap”) procedures recreate a “natural”, warm, soft breast and are associated with fewer complications than breast implants. Breast reconstruction can be performed at the same time as the mastectomy ("immediate reconstruction") or any time after mast... Breast Cancer Reconstruction Blog blogs http://www.medworm.com/rss/comments.php?id=5029035 Fri, 15 Jul 2011 04:13:22 +0100 5029035 http://www.medworm.com/index.php?rid=5028118&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F07%2F13%2Fimplementing-health-reform-health-insurance-exchanges-part-3%2F Editor’s Note: Below, Timothy Jost continues his Health Affairs Blog series analyzing regulations implementing the Affordable Care Act. Health Affairs Blog will also offer additional perspectives on the newly released regulations governing the state health insurance exchanges established under the Affordable Care Act. Although the proposed exchange rule released by HHS on July 12 was [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5028118 Wed, 13 Jul 2011 15:03:23 +0100 5028118 http://www.medworm.com/index.php?rid=5028119&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F07%2F12%2Fimplementing-health-reform-health-insurance-exchanges-part-2%2F Editor’s Note: Below, Timothy Jost continues his Health Affairs Blog series analyzing regulations implementing the Affordable Care Act. Health Affairs Blog will also offer additional perspectives on the newly released regulations governing the state health insurance exchanges established under the Affordable Care Act. This is the second part of a three part analysis of the [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5028119 Tue, 12 Jul 2011 21:18:05 +0100 5028119 http://www.medworm.com/index.php?rid=5028159&cid=t_100419_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FrISi8iwgfnw%2F By Mark A. CalabriaThe House of Representatives is scheduled this week, as early as today, to consider an extension and “reform” of the National Flood Insurance Program (NFIP), administered by FEMA. Since Hurricane Katrina in 2005, the NFIP has been about $18 billion in the hole. And this is from a program that only collects around $2 billion a year in premiums, which barely covers losses and expenses in a normal year. So make no mistake, the NFIP is still on course to cost the taxpayer billions more in the future. Even before Katrina, the Congressional Budget Office estimated that the NFIP was receiving a subsidy of close to a billion dollars a year. Under CBO’s optimistic projections, the House’s reform bill would increase NFIP revenues by about $4 billion over th... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=5028159 Tue, 12 Jul 2011 16:21:28 +0100 5028159 http://www.medworm.com/index.php?rid=5028120&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F07%2F12%2Fimplementing-health-reform-health-insurance-exchanges%2F Editor’s Note: Below, Timothy Jost continues his Health Affairs Blog series analyzing regulations implementing the Affordable Care Act. Health Affairs Blog will also offer additional perspectives on the newly released regulations governing the state health insurance exchanges established under the Affordable Care Act. Yesterday, on July 11, 2011, the Department of Health and Human Services [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5028120 Tue, 12 Jul 2011 15:29:45 +0100 5028120 http://www.medworm.com/index.php?rid=5028191&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F07%2Fhealth-insurance-rate-hikes-to-get-government-review.html Increases in your health-insurance premiums will soon be reviewed by state or federal government agencies, the Obama administration announced late last week. Starting in September, increases of 10 percent or more in either individual or small business plans will trigger an automatic review to gauge the “reasonableness” of the increase. Premium rate review, as it’s known, is a major piece of health-care reform and the Affordable Care Act. In many states, premium increases for individuals and small businesses have risen by double digits every year. As a result, health insurance has become increasingly unaffordable even as the recession has taken a toll on people’s ability to pay the tab. DeAnn Friedholm, the director of Consumers Union's health reform campaign, sa... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=5028191 Tue, 12 Jul 2011 12:00:00 +0100 5028191 http://www.medworm.com/index.php?rid=5028194&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F07%2Fshould-we-sign-up-for.html Q. My husband and I are self-employed, with a two-year old son. We are considering joining the Samaritan Ministries health-care sharing ministry, which is a faith-based non-profit in which members help each other pay medical bills. Is that a good idea? A. Samaritan Ministries is one of three major health-care sharing ministries in the U.S. (the others are Christian Care Ministry’s Medi-Share and Christian Healthcare Ministries). The first thing you need to understand is that they do not provide the same degree of legal and financial protection as real insurance. “Health insurance is an actuarial contract,” says James Lansberry, Samaritan’s executive vice president and also president of the Alliance of Health Care Sharing Ministries, a trade organization. “Pe... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=5028194 Mon, 11 Jul 2011 19:41:00 +0100 5028194 http://www.medworm.com/index.php?rid=5028752&cid=t_100419_129_f&fid=36038&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Ftrevis-life-with-multiple-sclerosis-ms%2Fmultiple-sclerosis-and-the-question-of-disability-insurance%2F I’m not sure if the advancement of a post-holidays head cold into a sinus infection (and the associated MS issues related to a fever) had any part of my sensitivity to comments that circulated here on the Life With MS Blog and our Facebook Page but I thought that it might be time we discuss disability insurance and SSDI again. In this day and age of starkly divided political views many see “leaving work” because of MS as yet another way in which too many people are grasping at a government entitlement and suckling from the public teat. Others see SSDI as an insurance plan into which they have paid and, like any other insurance policy, when they need it they expect it to be there for them. There are many, many problems with the entire “disability” system (for lack of better termin... Life with MS blogs http://www.medworm.com/rss/comments.php?id=5028752 Mon, 11 Jul 2011 19:26:57 +0100 5028752 http://www.medworm.com/index.php?rid=5028121&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F07%2F11%2Fnew-health-policy-brief-legal-challenges-to-the-affordable-care-act%2F A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines the issues inherent in the lawsuits filed by state governments, organizations, and private citizens challenging the Affordable Care Act. To date, about 30 legal challenges have been filed. Federal District Court decisions have been split, with four judges ruling that the [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5028121 Mon, 11 Jul 2011 15:51:20 +0100 5028121 http://www.medworm.com/index.php?rid=5008124&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FbIP03PxkBXo%2F A new research paper gives the clearest answer yet to a key question: how are people affected by gaining health insurance? A study of people who got new Medicaid coverage shows that they received significantly more care, including preventive checks and hospital admissions, improved their financial situation, and felt better. “Having Medicaid made a big difference in many dimensions,” Amy Finkelstein, an MIT economics professor and lead author of the paper, tells the Health Blog. The issue is more important than ever, with a huge new influx of Medicaid beneficiaries and other newly-covered people expected in 2014 due to the health-overhaul law. But it’s always been tough for researchers to get a good picture of the effects of new health coverage. In the real world, there are li... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=5008124 Thu, 07 Jul 2011 12:59:04 +0100 5008124 http://www.medworm.com/index.php?rid=5008145&cid=t_100419_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FjXYSHkY0CKg%2F By Michael F. CannonThe Oregon Health Insurance Experiment is the first experiment since the dawn of time that randomly assigns some households to receive health insurance (Medicaid) for purposes of comparing their medical consumption, health outcomes, and financial security to similar households that do not receive Medicaid coverage.  Some of the nation’s top health economists have released the first batch of results from the OHIE. At National Review (Online), I summarize the OHIE’s first-year results and offer the following analysis: Supporters of President Obama’s health-care law may tout these benefits, but the OHIE does not provide the vindication they seek. First, despite being eligible for Medicaid, 13 percent of the control group had private health insurance — s... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=5008145 Thu, 07 Jul 2011 12:46:38 +0100 5008145 http://www.medworm.com/index.php?rid=5008200&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-massachusetts-experiment-analyzed-provider-payments-based-on-their-negotiating-strength-not-quality-of-care%2F2011.07.06 Massachusetts Attorney General Martha Coakley released her office’s second annual report, An Examination of Health Care Cost Trends and Drivers (PDF; see also press release), which contains a wealth of critical data analysis — and also highlights how little we know about certain things — providing some important context for the discussion of the proposed Part III of Massachusetts health reform, a bill filed by Governor Patrick which would create all-payor ACOs and a system of global payments. At this late date, few would argue against a move a way from fee-for-service reimbursement for health care, or adding quality metrics to the mix, and tying financial rewards to providers to their performance measured against these metrics.  (Consider the Massachusetts Blue Cross Blu... Better Health blogs http://www.medworm.com/rss/comments.php?id=5008200 Wed, 06 Jul 2011 23:00:08 +0100 5008200 http://www.medworm.com/index.php?rid=4997642&cid=t_100419_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Fhow-doctors-and-labs-fool-patients.html In this report, the Prior Risk ( risk prior to doing the test) of the patient having a baby with the chromosomal anomaly called Down syndrome is 1:140. This is considered to be High Risk - the baby has a 1 in 140 chance of being abnormal . Now, after doing the test, the Posterior Risk ( risk calculated after taking the test results into account) has dropped dramatically to only 1:7500 ( which means there is a 7499:7500 chance that the baby does NOT have Down syndrome ! ) This is a very reassuring report, which means the doctor can counsel the patient she does not have to worry.However , rather than do this, this doctor chose to highlight ( see the black arrow she has drawn with her hand in the right column) the 1:140 printed High Risk figure in this report. She has told her patient that th... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4997642 Tue, 05 Jul 2011 03:21:00 +0100 4997642 http://www.medworm.com/index.php?rid=4997518&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthere-are-only-four-ways-to-reduce-healthcare-spending%2F2011.07.04 Everyone agrees that national spending on healthcare is on a trajectory to bankrupt America during the lifetimes of even Old Farts like DrRich. And therefore, most folks* agree that we ought to do something to reduce our national spending on healthcare. ____ *The reason it’s only “most folks” who agree is that, apparently, some folks are still partial to the Cloward-Piven strategy, and continuing to spend on healthcare as we are doing today is the quickest and surest way to get there. ____ Unfortunately, our national “discussion” on how to achieve this reduction in healthcare spending has devolved into a spectacle of accusations and counter-accusations, vituperation, abuse, and scurrility. Accordingly, not much useful has so far been achieved. Worse, the back-and-forth contumelie... Better Health blogs http://www.medworm.com/rss/comments.php?id=4997518 Mon, 04 Jul 2011 18:00:51 +0100 4997518 http://www.medworm.com/index.php?rid=4992681&cid=t_100419_87_f&fid=38368&url=http%3A%2F%2Fwww.changehealthcare.com%2Fdownloads%2Fhcti%2FHCTI_Q42010.pdf My mama told me you’d better shop around, as Smokey Robinson also told us. We now know it pays to shop the prices for digital imaging. The price of an MRI of the brain ranges from a low of $825 to a high of $3,600 within the Southeast region of the U.S. In the Northeast, the low is $1,540 and the high, $3,500. There are similar price “spreads” in other regions of the country for the same imaging study, and across other imaging modalities such as PET and CT. The greatest regional variances by service type are for MRI scans of the brain, varying 747% between a low price of $425 in the Southwest to a high of $3,600 in the Southeast, based on an analysis from change: healthcare‘s Q2 2011 Healthcare Transparency Index. USA Today reported on this study on June 30, 2011. Christopher Park... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=4992681 Fri, 01 Jul 2011 15:47:47 +0100 4992681 http://www.medworm.com/index.php?rid=4984408&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F06%2F30%2Fin-first-appellate-case-a-significant-victory-for-the-affordable-care-act%2F On June 29, 2011, the Sixth Circuit federal court of appeals held that Congress has the power under the Constitution to adopt the minimum coverage requirement of the Affordable Care Act. The decision in Thomas More Law Center v. Obama is very significant for several reasons.  First, it is the first ruling by a federal [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4984408 Thu, 30 Jun 2011 11:22:04 +0100 4984408 http://www.medworm.com/index.php?rid=4975829&cid=t_100419_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FRiV-GAJmBbo%2F By Michael F. CannonHere we have the spectacle of a former Republican Health and Human Services secretary getting rich by helping states implement ObamaCare. Leavitt Partners (among other consultants) is helping states create the law’s health insurance “Exchanges.” Or the non-ObamaCare-compliant health insurance Exchanges that will by law become ObamaCare-compliant Exchanges.  Via Politico: More than $300 million in exchange grants has already flowed into the states since the Affordable Care Act passed. That number will grow exponentially in the coming months, as states move from the initial steps of passing exchange legislation to the more lucrative task of setting them up. For health consultants and information technology vendors, it’s already shaping up to be a gold mine&#8... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4975829 Tue, 28 Jun 2011 15:41:55 +0100 4975829 http://www.medworm.com/index.php?rid=4976206&cid=t_100419_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2FvinqO6QozGE%2F Hello, again. And how are you this morning? A beautiful day is unfolding here on the Pharmalot corporate campus - the birds are chirping, the official mascots are lounging about and the cup of stimulation is brewing. Meanwhile, we are looking forward to another day of R&D. We know you can relate. To help you along, here are some tidbits. Hope your day goes well and stay in touch… Vertex Tops Merck In Hep C Drug Launch (The Street) Glaxo R&D Chief Says Advair Is Safe From Generics (Reuters) J&J Plans To Market More Products Under The Janssen Name (Financial Times) New Prostate Cancer Drugs Are Expensive (New York Times) Amgen Sells $3 Billion In Bonds To Pay For Dividends (Bloomberg News) Diabetes Cases In Adults Worldwide Has Doubled In 30 Years (Reuters) India Suspend... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=4976206 Tue, 28 Jun 2011 11:45:08 +0100 4976206 http://www.medworm.com/index.php?rid=4975821&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FZzdnVg-ddDc%2F It’s no secret that there’s a shortage of physicians that will likely only get worse when the health-care overhaul law brings an estimated 33 million new people into the health-care system starting in 2014. To gauge the current access situation, the government is planning a mystery shopper program that is already raising the hackles of some physicians, the New York Times reports. Federal contractors will pose as potential patients and call more than 4,000 physicians to see if they are accepting patients, how long the wait for different types of care is and whether the answers vary depending on whether the “patient” has private or public insurance. (A fraction of the doctors will be called back by contractors asking similar questions but identifying themselves as HHS... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4975821 Mon, 27 Jun 2011 15:17:59 +0100 4975821 http://www.medworm.com/index.php?rid=4976034&cid=t_100419_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002121.html Remember the woman who sued McDonald's and won millions ($2.9 million to be precise) after spilling hot coffee on herself? Like millions of others, you may have been outraged at the award for something so trivial. There's a film on... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4976034 Sun, 26 Jun 2011 23:00:00 +0100 4976034 http://www.medworm.com/index.php?rid=4975869&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmore-employers-are-dropping-healthcare-insurance-coverage%2F2011.06.26 McKinsey Quarterly has reported its survey concluding there will be a radical restructuring of employer-sponsored health benefits (ESI) as a result of President Obama’s following the 2010 passage of the Affordable Care Act. Healthcare insurance rates have already skyrocketed as a result of anticipating the conditions of Obama care. President Obama has been powerless to do anything about the increases. Thirty percent (30%) of companies providing ESI to their employees will drop healthcare insurance coverage once Obama care takes effect in 2014. The survey included 1300 employers providing ESI across industries, geographies, and employer sizes. Other surveys have found that as we get closer to 2014, President Obama’s Healthcare Reform Act will provoke a much greater number of employers t... Better Health blogs http://www.medworm.com/rss/comments.php?id=4975869 Sun, 26 Jun 2011 21:00:51 +0100 4975869 http://www.medworm.com/index.php?rid=4968836&cid=t_100419_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F06%2Fmail-delivery.html Six days a week the mail shows up at our house In the summer it comes through the mail slot in the front door (which sometimes scares the cat when it wakes him up from his nap). In the winter, we seal up the mail slot and hang a little mail box in our front entry way. We get the usual assortment of bills, junk mail, catalogs, and sometimes real correspondence from people we know. But I get the medical stuff too. By medical stuff I mean the hospital bills, health insurance claim statements, and appointment schedules. Usually a few times a week.Yesterday was an unusual pile of mail. My husband got a letter from his mother. We got one catalog to recycle. I got: - one appointment reminder for an upcoming blood test- two hospital bills- eight insurance statements- one list of my next ten appoin... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4968836 Sun, 26 Jun 2011 10:25:00 +0100 4968836 http://www.medworm.com/index.php?rid=4968445&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F06%2F23%2Fimplementing-health-reform-the-appeals-process-amended-rule%2F Editor’s Note: This is the latest in a series of posts by Timothy Jost on the implementation of the Affordable Care Act.  Earlier posts have analyzed some important guidances, as well as provisions governing state waiver requests, student health plans, premium review (proposed rule and final rule), medical loss ratios, insurance exchanges, coverage for pre-existing conditions, appeals [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4968445 Thu, 23 Jun 2011 14:32:42 +0100 4968445 http://www.medworm.com/index.php?rid=4960335&cid=t_100419_151_f&fid=35818&url=http%3A%2F%2Frecoveryissexy.com%2Fselecting-a-treatment-service%2F What are some questions to ask in choosing an alcohol and drug treatment program? The US Substance Abuse and Mental Health Services Administration recommends asking the following questions when selecting a treatment program:Does the program accept your insurance? If not, will they work with you on a payment plan or find other means of support for you?Is the program run by state-accredited, licensed and/or trained professionals?Is the facility clean, organized and well-run?Does the program encompass the full range of needs of the individual (medical: including infectious diseases; psychological: including co-occurring mental illness; social; vocational; legal; etc.)?Does the treatment program also address sexual orientation and physical disabilities as well as provide age, gender and cultur... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=4960335 Tue, 21 Jun 2011 16:21:51 +0100 4960335 http://www.medworm.com/index.php?rid=4952832&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F06%2Fis-menopause-a-pre-existing-condition.html Q. I may have to change insurance companies soon, and I will also likely enter menopause. Will my new insurer consider that a pre-existing condition? A. Any middle-aged person contemplating a switch in health insurance plans has every reason to be concerned about pre-existing conditions. But menopause itself isn’t one of them because it’s not a disease, it’s a normal stage of life for women. “Just being a 50-year-old woman with no symptoms obviously would not be a problem,” says Mark Brown, a certified financial planner and longtime insurance agent in Naperville, Ill. But menopause can produce symptoms for which women do seek medical treatment—hot flashes, say, or trouble sleeping. In most states, Brown said, those might well trigger a rate hike or ... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=4952832 Fri, 17 Jun 2011 16:40:00 +0100 4952832 http://www.medworm.com/index.php?rid=4934105&cid=t_100419_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2Fs1ni4ltEjis%2F By Michael F. CannonThe New York Times reports on a study published in today’s New England Journal of Medicine: Children with Medicaid are far more likely than those with private insurance to be turned away by medical specialists or be made to wait more than a month for an appointment, even for serious medical problems, a new study finds… Sixty-six percent of those who mentioned Medicaid-CHIP (Children’s Health Insurance Program) were denied appointments, compared with 11 percent who said they had private insurance… In 89 clinics that accepted both kinds of patients, the waiting time for callers who said they had Medicaid was an average of 22 days longer. “It’s very disturbing,” [study author] Dr. [Karen V.] Rhodes said. “As a mother, if I had a kid who was havi... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4934105 Thu, 16 Jun 2011 14:25:21 +0100 4934105 http://www.medworm.com/index.php?rid=4934139&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F06%2Fshould-we-keep-our-federal-retiree-plan-or-sign-up-for-medicare-part-b.html Q. I’m about to retire at age 66 and will lose my employee health plan. I could sign up for Medicare Part B but I’m not sure I need it because my husband is a retired federal employee and we plan on maintaining his FEHB Blue Cross-Blue Shield coverage. On the other hand, our friends say that Part B helps with out-of -pocket expenses. Which is a better choice for us? A. You are in a position that many retirees would kill for, but you still have decisions to make. While most retirees must take Part B once they or their spouse are no longer actively employed, such is not the case for federal retirees. You basically have three choices, all with pros and cons. (I’m assuming that in all three cases, you will sign up for Medicare Part A. It’s free so there’s no reas... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=4934139 Wed, 15 Jun 2011 23:35:00 +0100 4934139 http://www.medworm.com/index.php?rid=4945245&cid=t_100419_165_f&fid=36767&url=http%3A%2F%2Fabctherapeutics.blogspot.com%2F2011%2F06%2Fnys-early-intervention-update-seicc.html The State Early Intervention Coordinating Council held a meeting on June 14 (yesterday) to accept or reject the new regulations regarding issues including the 15 minute increment billing and adjusted early intervention rate calculations.I just finished speaking with Holly Kennedy from the EIP and she confirmed that the current rulemaking was rejected and that there will be a new rulemaking (look for the new Rules proposals in the Register around the end of June).There will be another 45 day comment period (but no public hearings). Ms. Kennedy stated that some alternate proposals may appear in the rulemaking but she was not free to be specific about those at this time. I have some initial information about those proposals but won't publish my information until I can verify and source it. Fi... ABC Therapeutics Occupational Therapy Weblog blogs http://www.medworm.com/rss/comments.php?id=4945245 Wed, 15 Jun 2011 20:10:00 +0100 4945245 http://www.medworm.com/index.php?rid=4934150&cid=t_100419_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2FplhBb8PyW0Y%2F By Val Jones.  You probably see your primary care physician once a year, and your dentist twice a year. But how often do you see your eye doctor? Vision is the most valued of the 5 senses, and yet Americans don’t seem to be making regular eye exams a priority. A recent CDC survey suggests that as many as 34.6% of adults over the age of 40 (with moderate to severe visual impairment) believe that they don’t need regular eye exams. About 39.8% of the respondents said that they didn’t get regular exams because they were too costly, or because their health insurance didn’t cover the expense. Although cost may play a role in peoples’ thinking, a comprehensive eye exam costs as little as $45-50 at retail outlets. I suspect that the real reason why people don’t get regular eye exams i... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=4934150 Tue, 14 Jun 2011 12:56:58 +0100 4934150 http://www.medworm.com/index.php?rid=4921420&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysicians-must-do-their-part-to-reduce-unnecessary-hospital-expenses%2F2011.06.10 Hospital costs are out of control. We have an aging population living longer with more complicated presentation of disease. We have an insurance driven platform instead of a health driven accountability. The long term sustainability of that architecture is one of guaranteed insolvency. One way or another hospitals are going to find their lifeline cut off. Medicaid is bankrupt. Hospital profit margins from Medicare have been negative for almost a decade. In addition, the rapid rise in private insurance premiums and industry’s gradual but accelerating exit from the health insurance benefit market all tell me that hospitals must find a way to reduce the cost of providing care. There are many ways hospital costs can be reduced. Administrators are paid handsomely to make it happen. Either... Better Health blogs http://www.medworm.com/rss/comments.php?id=4921420 Fri, 10 Jun 2011 21:00:00 +0100 4921420 http://www.medworm.com/index.php?rid=4921408&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F06%2Fwhat-provides-more-reliable-drug-coverage-my-private-plan-or-medicare.html Q.When my wife recently became disabled we signed up for Medicare A and B, but passed up Part D drug coverage because I have a private plan through my job. I also worried that the government might drop coverage for her drugs. But our private plan has a $1,000 deductible and we have to pay her monthly $1,800 drug bill upfront and wait to get reimbursed. Did we make the right choice? A. You might be surprised that your risk of losing coverage for your wife’s drugs is probably greater under your private plan than under Medicare. Here’s why. Your private plan most likely has a formulary—a list of preferred drugs—and if it chooses to drop your wife’s drugs from the list, you’ll have no option other than having to pay a higher share of the cost, if the drugs... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=4921408 Fri, 10 Jun 2011 17:35:00 +0100 4921408 http://www.medworm.com/index.php?rid=4921423&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhigh-deductible-health-insurance-plans-incentivize-patients-to-skip-screening-tests%2F2011.06.10 Almost half of health plans in the US have deductibles of at least $1,000 according to a new study.  It’s called “cost shifting” and it’s a big part of the future of American health care. There are two major reasons why employers are doing this. First, higher deductible plans are cheaper, since there is less risk to insure.  Think of your car insurance – why would you make a claim for a ding on your door when it’s cheaper for you to just pay to have it fixed (or fix it yourself)?  The higher the deductible, the lower the premium, even if it means more out-of-pocket cost for you for the small stuff. Along these same lines is the second reason.  If employees spend more of their own money on health care, maybe they’ll be smarter about how they spend it. It sounds good – bu... Better Health blogs http://www.medworm.com/rss/comments.php?id=4921423 Fri, 10 Jun 2011 14:00:50 +0100 4921423 http://www.medworm.com/index.php?rid=4921376&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2Flmqf9LaNARY%2F “Non” and “Nein” on Actos: France and Germany have halted the use of Takeda’s diabetes drug Actos, also known as pioglitazone, after a study suggested it could raise the risk of bladder cancer, Dow Jones Newswires reports. The European Medicines Agency is doing its own safety review, and the FDA is conducting an observational study of the drug, DJN reports. Reuters notes that other individual European countries have not followed France’s and Germany’s lead. Unaware?: The health-care overhaul law entitles about 44 million people to an external review of denied insurance claims, but most plans won’t be required to tell them about that right until next year, Kaiser Health News reports. That means some consumers may stay in the dark about their a... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4921376 Fri, 10 Jun 2011 12:42:16 +0100 4921376 http://www.medworm.com/index.php?rid=4921393&cid=t_100419_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FPTxrRugA624%2F By Tad DeHavenThe Department of Labor has been added to Cato’s Downsizing Government website. Proposed spending cuts are $143 billion. The following essays examine the department’s activities: Failures of Unemployment Insurance. The UI system is costly to taxpayers and creates numerous economic distortions. Federal involvement should be ended and the states left free to design their own systems. Employment and Training Programs. Federal programs for unemployed workers have never worked very well, are relatively little used, and are unneeded in today’s economy because private markets provide many alternatives. Reforming Labor Union Laws. Federal union laws that mandate exclusive representation, union security, and prevailing wages are costly to the economy and restrict indivi... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4921393 Thu, 09 Jun 2011 17:17:19 +0100 4921393 http://www.medworm.com/index.php?rid=4921379&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FG-ljtAmqcGk%2F Lower Dose: The FDA says the 80-mg dose of Merck’s cholesterol drug Zocor, also known as simvastatin, shouldn’t be prescribed for new patients or those taking certain other drugs because of an increased risk of muscle problems, the WSJ reports. Simvastatin, available as a generic and also a component of Merck’s Vytorin and Abbott’s Simcor, is most frequently prescribed in 20- or 40-mg doses, the paper says. Uniquely Positioned?: Blue Shield of California’s move to cap profits may not easily be duplicated by other health insurers, Kaiser Health News reports. The company’s not-for-profit status means it’s not answerable to shareholders, and it has healthy reserves and higher-than-average margins. Other nonprofits may offer some form of policyholder r... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4921379 Thu, 09 Jun 2011 11:27:02 +0100 4921379 http://www.medworm.com/index.php?rid=4911444&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2Fq0AruYBDkxI%2F Proposed individual-policy premium increases have made California a flashpoint in the debate about rising health-insurance costs. Now, in an op-ed published by the San Francisco Chronicle, the chairman and CEO of Blue Shield of California, Bruce Bodaken, says his company will limit profits to 2% of revenue. If at the end of the year net income exceeds that threshold “because medical costs were lower or investment income was higher than we had projected, we’ll return that amount to our members and the community,” he writes. The policy will continue as long as “Blue Shield remains financially solvent, with sufficient funds to make the investments needed to stay competitive.” Blue Shield of California will make payouts this year based on 2010′s profits, whi... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4911444 Tue, 07 Jun 2011 17:09:55 +0100 4911444 http://www.medworm.com/index.php?rid=4902412&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F06%2Fshould-i-buy-a-low-priced-limited-benefit-health-insurance-plan-just-in-case-something-happens.html Q. My former employer went into receivership so my COBRA plan is terminating and I need to buy health insurance on my own. Money is tight, and I’ve found plans from Assurant and Lands Health that cost much less than the plans from big-name companies like Blue Cross and Aetna. Are these cheaper plans legit? I know they’re not major medical but it seems like there’s enough coverage to get in the door in case something happens. I’m thinking of buying the Lands Health Silver plan. A. I think you’d be making a potentially catastrophic mistake to rely on one of these plans for your sole health coverage. They are limited-benefit indemnity plans and both clearly state on their websites that they are “not major medical insurance plans.” Suppose the &#82... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=4902412 Mon, 06 Jun 2011 20:05:00 +0100 4902412 http://www.medworm.com/index.php?rid=4902423&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-myth-of-the-rich-doctor%2F2011.06.05 This is my column in June’s EM News. ‘But you’re a rich doctor, right?’ Have you had that conversation? There’s a certain expectation of physicians, that we’re all just filthy rich, overflowing with boxes of cash tucked neatly away beneath our gilded beds. When we were building our house, our builder talked with my wife: ‘Jan, I want you to meet me to look for counters and cabinets. Don’t bathe the kids. Put them in dirty play clothes and don’t wear anything nice. Don’t ever tell them your husband is a doctor.’ He’s a wise man. What he knew was that the word ‘doctor’ means ‘cash.’ Or at least, means ‘cash’ to the popular mind. I wonder if this perception is the reason patients come to the emergency department and say things like this: ‘I don’t have ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4902423 Sun, 05 Jun 2011 17:00:02 +0100 4902423 http://www.medworm.com/index.php?rid=4893370&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F06%2F03%2Fsuccess-factors-for-creating-accountable-care-organizations%2F Healthcare organizations across the country are learning how to adapt to the concept of an Accountable Care Organization (ACO). Having been closely involved in Intermountain Healthcare’s evolution as a prototype ACO, we offer our experience in making that transition. Intermountain Healthcare is a not-for-profit, integrated, healthcare system serving Utah and southern Idaho. With 23 hospitals, [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4893370 Fri, 03 Jun 2011 12:15:06 +0100 4893370 http://www.medworm.com/index.php?rid=4893435&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F06%2Fwhat-can-i-do-if-my-doctor-has-opted-out-of-medicare.html Q. My doctor has opted out of Medicare and has asked me to sign a form that says I won’t submit a claim to Medicare for his services. Do I simply submit that signed form to Medicare along with my bill? Can I assume Medicare will then forward that bill to my Medigap insurance company? A. The answer to both of your questions is no. While most doctors do participate in Medicare, they don’t have to. Medicare has set up a formal opt-out procedure that your doctor seems to have followed. This includes having you sign a contract acknowledging Medicare won’t pay for his services, and that you won’t submit a claim on your own to either Medicare or Medigap. If you do so, your claim will be denied. If you are not willing and able to pay this doctor’s bills in full fro... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=4893435 Thu, 02 Jun 2011 21:10:00 +0100 4893435 http://www.medworm.com/index.php?rid=4893388&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FIvoEVEAlUxE%2F A year ago some policy folks raised the alarm that the budget for the federal high-risk insurance pools would be sufficient to cover only about 200,000 of the several million folks who might be eligible to participate. Medicare’s actuary predicted funding for the pools would run out by this year or 2012. But as it turned out, many fewer people than expected signed up for the program, which was created by the health-care overhaul law and designed to insure people who couldn’t get affordable coverage on the individual market because of pre-existing conditions. Only about 18,000 people have enrolled. As Kaiser Health News and NPR reported last month, experts blamed high premiums and low consumer awareness for the tepid response. So now, as the WSJ’s Washington Wire blog repo... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4893388 Wed, 01 Jun 2011 13:51:46 +0100 4893388 http://www.medworm.com/index.php?rid=4883567&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F05%2Fcan-i-find-affordable-insurance-if-i-have-a-pre-existing-condition.html Q. Is there a health insurance plan that will take me if I have an existing health problem—at a reasonable price? A. The answer to your question got a little more encouraging today with the announcement by the federal government that it’s cutting premiums for its Pre-Existing Condition Insurance Plan (PCIP) program for the second time since it started last summer. Whether you, personally, can now afford such coverage is a question I can’t answer without looking at your bank balance. But in some states premiums for these policies will go down as much as 40 percent beginning July 1. The PCIP was set up as part of the Affordable Care Act, with the idea of offering stopgap help for people with pre-existing conditions until 2014, when the reform law will be fully implemented... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=4883567 Tue, 31 May 2011 20:50:00 +0100 4883567 http://www.medworm.com/index.php?rid=4872081&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F05%2Fvermont-establishes-road-map-for-single-payer-health-care.html Vermont made history today when Governor Peter Shumlin, a Democrat, signed into law a plan to create the nation’s first state-run “single-payer” health system. If fully implemented, every Vermont resident, including those on Medicare and Medicaid, would be entitled to enroll in the state’s own insurance plan, Green Mountain Care. Private insurers would still be allowed to operate in the state. The goal is to establish a system in which “health care is a right and not a privilege,” Governor Shumlin told National Public Radio. But the new law doesn’t establish the system right away. Instead, it creates a five-member board that is charged with coming up with options to pay for the system, which are to be presented to the legislature for approval by ... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=4872081 Thu, 26 May 2011 16:00:00 +0100 4872081 http://www.medworm.com/index.php?rid=4872049&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F05%2F26%2Fhealth-wonk-review-memorial-day-edition%2F If you’re traveling over the long weekend, you’ll want to take along some reading material. While some might reach for a good novel by John Grisham or Dan Brown, the health policy blogs in this edition of the Health Wonk Review tackle equally compelling mysteries. Was the Medicare Trustees report really that gloomy? If Workers [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4872049 Thu, 26 May 2011 13:29:21 +0100 4872049 http://www.medworm.com/index.php?rid=4862496&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FWumzS_Q0W4A%2F Kaiser’s latest health tracking poll focuses on Medicaid — and some of its findings may surprise you. About half (51%) of the 1,203 adults surveyed report a personal connection with the federal-state insurance program for low-income Americans, defined as receiving benefits themselves or having a friend or family member who has done so. Digging into who actually receives Medicaid explains how so many Americans have had a brush with the program. According to previous Kaiser research, a full 70% of nursing-home residents have Medicaid coverage. (As the NYT noted in a recent story on the impact of proposed Medicaid changes on the elderly, seniors who start out with savings often spend all their money on long-term care.) And according to Kaiser, 60% of low-income kids, 44% of HIV/AI... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4862496 Wed, 25 May 2011 13:48:36 +0100 4862496 http://www.medworm.com/index.php?rid=4862552&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmore-bureaucracy-quality-healthcare-measured-with-check-boxes%2F2011.05.24 With the news that Wellpoint, one of the largest insurance companies in America, will cut off annual 8% payment increases to about 1,500 hospitals if they fail to “test” high enough on 51 quality measures, they have officially defined “quality” health care as checkboxes. Yep, checkboxes. You see how do insurers know if we offer each of our patient’s nutritional guidance or exercise counseling? Well, they check to see of doctors have clicked on a yellow warning box advising we do this. If we have, then not only is that doctor a fine, “quality” doctor, but the hospitals (and it’s computer system and scores of administrative staff that compile and submit this data) are real, fine, “quality” hospitals. That’s all there is to it.... Better Health blogs http://www.medworm.com/rss/comments.php?id=4862552 Tue, 24 May 2011 11:00:00 +0100 4862552 http://www.medworm.com/index.php?rid=4872256&cid=t_100419_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002104.html UPDATE - this story gets ever more bizarrre; Business Insurance had a piece describing how employees at the party were snorting salt. Right, that was my reaction as well; wha...SALT?? UP THEIR NOSE?? what the heck were they thinking? And... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4872256 Mon, 23 May 2011 23:00:00 +0100 4872256 http://www.medworm.com/index.php?rid=4862725&cid=t_100419_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002104.html Just when you thought some company had gone just as far over the stupid line as humanly possible, someone pushes the envelope. The latest - and greatest - incident of unbelievably bad judgment came to light only yesterday, four years... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4862725 Mon, 23 May 2011 23:00:00 +0100 4862725 http://www.medworm.com/index.php?rid=4848060&cid=t_100419_129_f&fid=36038&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Ftrevis-life-with-multiple-sclerosis-ms%2Finsurance-and-other-woes-with-multiple-sclerosis%2F It’s not the first time I’ve heard the stories and pleas of someone who is about to lose (or has already lost, or never had) health insurance. This past week a member of our community contacted me via our Life With MS Facebook page with her dilemma and I thought we could have a conversation about the general topic and see if we can’t come up with ways to help her and others who may face the same issues. “Lucy,” we’ll call her, says that she’s been using one of the MS drugs with great success for the past several years. She’s been on her father’s insurance and just found out that she’ll be aging off next month. Lucy cannot pay for the drugs or her doctors’ visits out of pocket and is looking for help. Also, she has one of those relatives who is beating her up f... Life with MS blogs http://www.medworm.com/rss/comments.php?id=4848060 Fri, 20 May 2011 19:26:56 +0100 4848060 http://www.medworm.com/index.php?rid=4847948&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F05%2Fif-health-reform-was-supposed-to-bring-prices-down-why-has-my-premium-gone-up.html Q. If health reform was supposed to bring prices down, why has my health-insurance premium gone up…a lot? A. This question has come my way repeatedly, with only minor variations, ever since the Affordable Care Act became law in 2010. The short answer: insurers won’t be able to get away with this much longer. The several pieces of health reform that will bring premiums down haven’t been fully implemented yet and until they are, insurers are raising premiums as much as they dare-and earning record profits as a result. That’s about to change, and consumers will begin to notice it as early as this fall’s open enrollment season. Two things are going on simultaneously. Insurers will have to start spending more of their income on health care. Insurers have trad... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=4847948 Fri, 20 May 2011 17:40:00 +0100 4847948 http://www.medworm.com/index.php?rid=4847932&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F05%2F20%2Fimplementing-health-reform-the-preview-review-final-rule%2F Editor’s Note: This is the latest in a series of posts by Timothy Jost on the implementation of the Affordable Care Act.  Earlier posts have analyzed some important guidances, as well as provisions governing state waiver requests, student health plans, premium review, medical loss ratios, insurance exchanges, coverage for pre-existing conditions, appeals of coverage denials, coverage for [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4847932 Fri, 20 May 2011 14:34:47 +0100 4847932 http://www.medworm.com/index.php?rid=4847937&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FisB1v05wMw8%2F Justifying Increases: Health insurers must explain to regulators the math behind premium increases of 10% or more on individual or small-business policies, the WSJ reports. The federal rule released yesterday, which details a provision of the health-care overhaul law, says that insurers must provide information on planned increases to state regulators and the public. Federal regulators can also review planned rate increases if states don’t. Thumbs-Up: European drug regulators have recommended the use of Benlysta, a lupus drug from GlaxoSmithKline and Human Genome Sciences, the WSJ reports. An EU committee needs to sign off on the final decision. The FDA approved the drug, the first new therapy for lupus in decades, in March. Pricing Out Swimmer’s Ear: You wouldn’t think s... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4847937 Fri, 20 May 2011 12:24:38 +0100 4847937 http://www.medworm.com/index.php?rid=4841479&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmost-americans-dont-know-what-healthy-eating-means%2F2011.05.19 Only one in 10 respondents to a national survey could estimate how many calories they should consume in a day. Seventy-nine percent make few or no attempts to pay attention to the balance between the calories they consume and expend in a day. These and other piquant findings from the online 2011 Food and Health Survey fielded by the International Food Information Council Foundation (IFIC) struck home last week as I smacked up against my own ignorance about a healthy diet and the difficulty of changing lifelong eating habits. The confluence of my failure to gain weight after cancer treatment and a blood test suggesting pre-diabetes meant that as of last Tuesday, I have been on an eat-specific-types-of-food-every-hour-and-write-it-down regimen.  And despite a lifetime of recommending that p... Better Health blogs http://www.medworm.com/rss/comments.php?id=4841479 Thu, 19 May 2011 12:00:13 +0100 4841479 http://www.medworm.com/index.php?rid=4841420&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2F-SBqDeD6Q9A%2F Employers will likely face health-care cost increases of 8.5% in 2012, but they’ll mitigate that burden by pushing more costs onto employees and making other changes to benefits, a PricewaterhouseCoopers report finds. Taking those plan changes into account, employers will see their health-care costs rise about 7%. (The report is based on a survey of about 1,700 employers, plus interviews with hospital execs and health-plan actuaries, among others.) Putting upward pressure on costs will be provider consolidation, cost shifting from Medicare and Medicaid by providers, and — interestingly — post-recession stress. “Several health plans interviewed indicated they were seeing more claims for stress-induced illnesses,” the report says. “Specifically, as stress ... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4841420 Wed, 18 May 2011 16:08:33 +0100 4841420 http://www.medworm.com/index.php?rid=4841413&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F05%2F18%2Fhealth-policy-brief-the-class-act%2F The latest Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines the Community Living Assistance Services and Supports (CLASS) Plan, a voluntary, publicly administered insurance program enacted as part of the Affordable Care Act in 2010. It is designed to help people should they become disabled and need long-term services and [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4841413 Wed, 18 May 2011 15:45:27 +0100 4841413 http://www.medworm.com/index.php?rid=4828882&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-psychiatrists-approach-wrist-cutting-cries-for-help%2F2011.05.16 When Roy and I were on Talk of the Nation this past week, a called phoned in to ask about her sister. The question was about care in the Emergency Room/Department, so it was a perfect Roy question and he fielded it. I’ve been playing with it since, and wanted to talk more about this particular scenario, because the scenario was very common, and the question was more complicated than it seems. From the transcript of the show: ANN (Caller): Hi, thank you very much. I would like to ask Dr. Roy (oh, I gave him his blog name here) a question: My sister was admitted to emergency when she cut her wrists, and the doctor on call pulled me aside and said, do you think she was trying to kill herself? And I said – because my sister is very intelligent – I said, if my sister really wa... Better Health blogs http://www.medworm.com/rss/comments.php?id=4828882 Mon, 16 May 2011 21:00:00 +0100 4828882 http://www.medworm.com/index.php?rid=4828884&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcreative-semantics-used-by-health-insurance-companies-to-avoid-payments%2F2011.05.16 Insurance companies are supposed to pay for health care, although they do everything they can think of to avoid doing so. One company in particular (a small player here though a much bigger gorilla in other markets) does so by playing with words, even when another behemoth lost a lawsuit over the same issue. The topic involves paying for preventive services while a patient is in the office for care of an acute illness or management of a chronic condition. The way we communicate with insurance companies about what we do in the office is by way of codes; CPT codes, to be precise. There are separate codes to differentiate between preventive services and the so-called Evaluation and Management (E/M) services. The latter are your basic office visit codes covering all the “cognitive” service... Better Health blogs http://www.medworm.com/rss/comments.php?id=4828884 Mon, 16 May 2011 16:00:32 +0100 4828884 http://www.medworm.com/index.php?rid=4828844&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FI01GOVFm0So%2F Newt Gingrich, now officially a candidate for the Republican presidential nomination, is staking out some of his positions on the divisive issue of health-care overhaul. As the WSJ reports, the former Speaker of the House dismissed the plan to rejigger Medicare put forth by the current GOP House majority as “right-wing social engineering,” while also endorsing the individual mandate to buy insurance that is vilified by critics on the right. The Medicare plan spearheaded by Rep. Paul Ryan would essentially replace the government insurance plan with vouchers to help seniors purchase private coverage. (The change would apply only to Americans aged 55 and under.) But the value of those vouchers would rise only as fast as overall consumer inflation, which has been outpaced by the ri... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4828844 Mon, 16 May 2011 13:57:15 +0100 4828844 http://www.medworm.com/index.php?rid=4828845&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FQXnRY8uAjCs%2F Paying for Quality: WellPoint’s Blue Cross Blue Shield plans in 14 states will tie hospital reimbursement increases to quality of care, as measured by a 51-indicator test, the WSJ reports. The assessment is based 55% on health outcomes, 35% on measures of patient safety and 10% on patient satisfaction; the company’s chief medical officer tells the paper that using the formula can save both WellPoint and the overall health-care system money. Proposed Changes: Florida’s plans for its Medicaid program involve a $10 monthly premium for all beneficiaries not in nursing homes, plus a $100 charge for using the ER for non-emergency services, Kaiser Health News reports. The Obama administration, however, is likely to reject the proposed changes because they will make it harder for... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4828845 Mon, 16 May 2011 12:37:36 +0100 4828845 http://www.medworm.com/index.php?rid=4828888&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealth-insurance-coverage-and-leaving-the-hospital-against-medical-advice%2F2011.05.15 There is a huge myth being unknowingly  perpetrated against the general public when it comes to their rights and responsibilities as a patient.  It’s a myth that I can remember hearing as far back as my first few weeks of clinicals during medical school.  It was a constant presence during my residency training and even now, as a private practice hospitalist I hear misinformation being handed down day after day, month after month. This myth is perpetrated by doctors, nurses, and therapists of all kinds.  What is this myth?  That their health insurance company will not pay for the care provided if they want to leave against the medical advice of their physician. Will my insurance company pay if I leave against medical advice (AMA)? Yes.  They will pay.  Medicare and Medicaid pa... Better Health blogs http://www.medworm.com/rss/comments.php?id=4828888 Sun, 15 May 2011 19:00:00 +0100 4828888 http://www.medworm.com/index.php?rid=4820805&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FuRbAsorCGho%2F Mitt Romney is running for president. And he’s also running away from the universal health-care coverage he brought to Massachusetts when he served as governor, since that plan bears a striking resemblance to the none-too-popular-on-the-right health-care overhaul law passed last year. The Massachusetts law includes an individual mandate to purchase coverage, the element of the national plan that has become the chief target for those seeking to overturn the law. As the WSJ reports, Romney will give a speech today that he hopes will address critics of his role in the Massachusetts plan … without totally disavowing the whole thing. (After all, the program means that nearly everyone in the state now has insurance, and is popular with residents though it hasn’t done much to cu... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4820805 Thu, 12 May 2011 13:46:06 +0100 4820805 http://www.medworm.com/index.php?rid=4820806&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2F8wbChKAvWC0%2F The Profit Motive: With the health-care overhaul law requiring insurers to spend more on medical care, companies are pushing into new lines of business in pursuit of profits, the WSJ reports. Aetna, Humana and WellPoint are looking at health-care IT, partnerships allowing them to employ physicians and participation in the accountable care organizations encouraged by the health law, the paper says. Stem-Cell Finding: Research published in the New England Journal of Medicine suggests the existence of lung stem cells with the potential to develop into the different elements of the organ, the Boston Globe reports. The finding is likely to be controversial and must be replicated; it’s nevertheless expected to “energize” this field of research, an editorial accompanying the stu... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4820806 Thu, 12 May 2011 12:31:26 +0100 4820806 http://www.medworm.com/index.php?rid=4813689&cid=t_100419_165_f&fid=36767&url=http%3A%2F%2Fabctherapeutics.blogspot.com%2F2011%2F05%2Fperils-of-ex-post-facto-cost-reporting.html Cost accounting is boring, I understand, but I hope providers and families read this so that they can empower themselves to push back against the systematic dismantling of the NYS Early Intervention program.As previously blogged, NYS is engaging in a cost reporting process for the early intervention program. Cost accounting is a valid tool used by a business to establish actual cost for delivering goods or services.Unfortunately, the NYS government is going about this process in a backwards direction. Generally, the results of cost accounting projects are used to inform stakeholders about costs so that appropriate reimbursement rates can be set. However, in NYS, the rates to providers have ALREADY been cut 15% in the last year and an additional functional cut of 33% is proposed to begin on... ABC Therapeutics Occupational Therapy Weblog blogs http://www.medworm.com/rss/comments.php?id=4813689 Wed, 11 May 2011 19:30:00 +0100 4813689 http://www.medworm.com/index.php?rid=4813245&cid=t_100419_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FGSv73gL_4_A%2F By Michael F. CannonDefending ObamaCare in federal court yesterday, the Obama administration’s acting solicitor general, Neal K. Katyal, peddled the widely discredited claim that the uninsured increase your and my health insurance premiums by $1,000: “When people self-finance their health care,” Katyal contended, “that raises the cost of health care overall by $43 billion a year, and that raises the average family’s premiums by $1,000 a year. That will price untold numbers of people out of the market.” That estimate comes from two left-wing groups, Families USA and the Center for American Progress Action Fund. When President Obama himself made this claim, FactCheck.org reported: [Obama] said ”the average family pays a thousand dollars in extra premiums to pay for pe... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4813245 Wed, 11 May 2011 17:47:04 +0100 4813245 http://www.medworm.com/index.php?rid=4813277&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F05%2Fwhat-happens-when-cobra-coverage-ends.html Q. Our daughter’s COBRA coverage just expired and she’s been turned down for individual insurance policies in Ohio—probably because she smokes and is overweight. Does she have any other options? A. Yes, but tell her to act quickly. The Health Insurance Portability and Accountability Act (HIPAA) guarantees that anyone whose COBRA coverage runs out is entitled to purchase a specially-designated individual plan, without being subject to a waiting period or exclusions for pre-existing conditions. But to take advantage of this right, you must begin new coverage within 63 days after COBRA ends. States handle this guarantee in different ways. In Ohio, the program is called Open Enrollment, and it offers two plans, Basic and Standard. The Basic plan has lower premiums but less... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=4813277 Wed, 11 May 2011 17:15:00 +0100 4813277 http://www.medworm.com/index.php?rid=4813230&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F05%2F10%2Fhealth-reform-the-legal-fight-moves-to-the-next-level%2F Today, May 10, the Fourth Circuit federal court of appeals heard oral arguments in two Affordable Care Act cases (ACA), Liberty University v. Geithner and Virginia v. Sebelius. In the Liberty University case, Judge Norman Moon of the Western District of Virginia had upheld the constitutionality of the Affordable Care Act against a challenge brought [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4813230 Tue, 10 May 2011 23:57:38 +0100 4813230 http://www.medworm.com/index.php?rid=4803025&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F05%2F09%2Fpublic-coverage-programs-solving-the-enrollment-dilemma%2F Editor’s Note: In addition to Alain Enthoven and Leonard Schaeffer (photos and bios above), this post is coauthored by David Helwig and Phil Lebherz. Helwig retired as President and CEO West Region for WellPoint, Inc., and he also served as chief executive officer and president of Blue Cross of California. Lebherz is Chairman of LISI, [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4803025 Mon, 09 May 2011 15:33:55 +0100 4803025 http://www.medworm.com/index.php?rid=4797824&cid=t_100419_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F05%2Fhealthcare-unwired-health-insurance-and.html " PwC and India Health Progress (IHP) have released a whitepaper "Healthcare Unwired - Health Insurance and Healthcare Access" which recommends health insurance as one of the prime drivers behind increasing healthcare access in India. The whitepaper is the outcome of a roundtable meeting held on 24 January 2011 on Health Insurance at India Islamic Cultural Centre, Delhi. The conference was attended by various healthcare and health insurance industry leaders as well as policymakers who emphasized the need to bring in new health insurance schemes at different price points."I was disappointed that the Report did not talk about how health insurance companies can promote health by prescribing Information Therapy ! It makes business sense for health insurance to empower patients with information... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4797824 Sun, 08 May 2011 10:30:00 +0100 4797824 http://www.medworm.com/index.php?rid=4789235&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F05%2Fhow-should-i-handle-my-late-mothers-medical-bills.html Q. My mom recently passed away and I’m anxious about her medical bills. How do I figure out what to pay—and can I question any of the charges? Her Medicare statements are confusing (she had a supplemental Select plan) and I have no idea what procedures she was actually given. The thought of blindly paying every bill seems crazy. A. I’m going to assume your mother was single at her death, and that her estate has enough assets to pay her medical bills. From how you worded your question, it sounds as if you are the estate’s executor. Your instinct is right on: don’t even think of “blindly” paying bills as they come in, because if you do you may end up paying for services that are covered by your mother’s Medicare and Medigap plans. You can tak... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=4789235 Thu, 05 May 2011 20:09:53 +0100 4789235 http://www.medworm.com/index.php?rid=4789197&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2Fx9sVFi-kdc0%2F At a House subcommittee meeting today, medical societies weighed in on how to fix the much-maligned Medicare physician payment formula. The current formula, which absolutely no one thinks can continue in its present form, is (ironically) called the Sustainable Growth Rate, or SGR. It pegs the growth of Medicare reimbursement to the GDP — problematic, since GDP growth has famously been outpaced by the increase in health-care spending for years. Automatic, across-the-board reimbursement cuts kick in if spending reaches a certain level. But it’s so expensive to fix this problem — $298 billion just to wipe out accumulated debt — that nothing permanent has been done. Instead, we’ve seen a Chinese water torture of last-minute, short-term fixes. Scheduled to appear t... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4789197 Thu, 05 May 2011 17:16:47 +0100 4789197 http://www.medworm.com/index.php?rid=4789201&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FDTxWXyRdzdU%2F It’s often been said that if exercise were a pill, it’d be a mega-blockbuster, given the positive health effects  — from lower cholesterol to improved cognition to longer lifetimes — to which it’s been tied. An editorial just published in the Journal of the American Medical Association says research supports consideration of a wider policy of reimbursing for structured exercise programs, particularly in high-risk groups, such as diabetics. Currently, health-insurance plans don’t treat exercise as medicine; only some plans offer a fitness benefit, usually a partial reimbursement for gym membership. Marco Pahor, author of the editorial and a University of Florida professor and chair of the school’s department of aging and geriatric research, isn&#82... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4789201 Wed, 04 May 2011 14:00:12 +0100 4789201 http://www.medworm.com/index.php?rid=4780288&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FL5ois3Zdctw%2F Is price transparency for everyday health services an important tool for lowering health-care costs? Howard McClure, who was just named chairman of the board of change:healthcare (and will transition to the CEO role over the next few months) thinks so. Change:healthcare provides employees enrolled in high-deductible health plans at participating companies with personalized information on how they might save money on their care by changing providers. And McClure, a former president of CVS/Caremark Pharmacy Services, says that when consumers see that their work colleagues got the same drug or dental checkup at a lower price, they often switch to the cheaper provider. And even if the savings are only, say, $20 on an office visit or $15 on a prescription, “it does add up,” he tells... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4780288 Tue, 03 May 2011 14:04:55 +0100 4780288 http://www.medworm.com/index.php?rid=4780289&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2F9Yti_L8juzY%2F It’s Pfizer’s Turn: Pfizer said first-quarter profit rose to $2.22 billion, or 28 cents a share, from $2.03 billion, or 25 cents a share, in the previous year, the WSJ reports. Stripping out restructuring and other charges, earnings were unchanged from last year at 60 cents, a penny higher than analysts surveyed by Thomson Reuters had expected. Revenue was $16.5 billion; analysts had expected $16.63 billion. Medicaid Rules: The Obama administration is proposing a rule that would hold steady or even push up Medicaid payments to providers in order to improve access to health care, the New York Times reports. Some state officials tell the paper the proposed rule gives too much authority over the program to the federal government. State Medicaid programs are paid for with both fede... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4780289 Tue, 03 May 2011 12:38:47 +0100 4780289 http://www.medworm.com/index.php?rid=4780462&cid=t_100419_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F05%2Finsurance-is-only-part-of-it.html Having health insurance is only part of the solution. Here in Massachusetts we have state health insurance so basically everyone has access to health insurance. This is a good thing and one of the things that went along with this was the premise that people would go to their regular doctors instead of emergency rooms. Well that part didn't work. ER rates are higher than in the past.The problem was insurance was made accessible but we didn't create an infrastructure so that people could get into see their doctors. We need to make doctors more accessible. There are too many patients for each doctor (I don't have the numbers so you can just take my word for it) and often people resort to ERs for medical care because they can't get into see their doctor in a reasonable amount of time. If you c... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4780462 Tue, 03 May 2011 10:00:00 +0100 4780462 http://www.medworm.com/index.php?rid=4775384&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F05%2Fi-thought-colonoscopies-were-free-now-so-why-did-i-have-to-pay.html Q. I thought that Medicare now covered colonoscopies in full, without deductibles or copays. But my Medicare Advantage plan just charged me $125 for the one I had in March. I also had two polyps removed during the procedure. Was that not covered? A. It wasn’t, which is upsetting a lot of patients, not to mention the gastroenterologists who have spent years trying to coax people to get colonoscopies. Here’s what’s going on. You’re right that the Affordable Care Act now requires Medicare and all new (non-grandfathered) private insurance plans to cover specific preventive services with no deductibles, copays or coinsurance. One of those services is screening colonoscopy recommended for adults after the age of 50. About one in five colonoscopies find polyps, which th... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=4775384 Mon, 02 May 2011 14:20:00 +0100 4775384 http://www.medworm.com/index.php?rid=4767976&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2Fjcqu4XD2ilU%2F Merck Reports: Merck posted a larger-than-expected increase in its core first-quarter earnings, Dow Jones Newswires reports. Excluding special items, profits rose to 92 cents per share from 83 cents, higher than the 84 cents predicted by analysts in a Thomson Reuters survey. The company also increased the low end of its full-year earnings forecast to $3.66 per share, keeping $3.76 as the upper end. Botox Damages: A federal jury has ordered Allergan to pay $212 million in damages to a man who claims the company didn’t warn him that Botox could spark a dangerous autoimmune reaction, Bloomberg News reports. Allergan, which says Botox didn’t cause the man’s brain damage, hasn’t yet decided whether to appeal the decision, BN says. Thumbs Up: Two experimental hepatitis C ... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4767976 Fri, 29 Apr 2011 12:33:54 +0100 4767976 http://www.medworm.com/index.php?rid=4758748&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F04%2Fwill-my-formerly-bum-shoulder-be-covered-under-health-reform.html Q. When I signed up for a new health plan in 2002 it excluded any coverage of my right shoulder, which had been surgically repaired two years earlier. Under health reform, will my shoulder be covered—and can insurers use that as an excuse to raise my rates? A. What you have is called an exclusionary rider, and it will be illegal come 2014. That’s when the Affordable Care Act says insurance companies can no longer punish adults for previous injuries or illnesses. They’ll have to insure all your body parts regardless of your health history. And, to answer your second question, no, they won’t be allowed to charge you extra because of your surgically corrected shoulder. The change will bring relief to a lot of people: the Department of Health and Human Services estim... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=4758748 Wed, 27 Apr 2011 16:12:00 +0100 4758748 http://www.medworm.com/index.php?rid=4758731&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2Fbf9MA7O0VgA%2F It’s Deal Time: Johnson & Johnson is buying Synthes, which makes surgical devices used for orthopedic and traumatic injuries, for $21.3 billion in cash and stock, the WSJ reports. The boards of the companies support the merger, but some Synthes shareholders may think the company is worth closer to 165 Swiss francs ($189) per share than the agreed-upon price of 159 Swiss francs per share, the paper says. Earnings Rise: Health-insurer WellPoint saw first-quarter earnings rise a better-than-expected 5.7% to $926.6 million, or $2.44 per share, Dow Jones Newswires reports. The company increased its estimate for full-year revenue to $59.9 billion from $59.5 billion. Medication Misses: A study published in JAMA finds that about 58% of kids with newly diagnosed epilepsy don’t take ... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4758731 Wed, 27 Apr 2011 12:29:11 +0100 4758731 http://www.medworm.com/index.php?rid=4753629&cid=t_100419_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F04%2Frucing-about-conflicts-of-interest.html Since 2007, we have been writing about the secretive RUC (RBRVS Update Committee), the private AMA committee that somehow has managed to get effective control over how Medicare pays physicians. The RUC has been accused of setting up incentives that strongly favor invasive, high technology procedures while disfavoring primary care and other "cognitive medicine." Despite the central role of (perverse) incentives in raising health care costs while limiting access and degrading quality, there was surprisingly little discussion about the pivotal role played by the RUC until the formation of the "Replace the RUC" movement (see post here).  Recently, the leaders of Replace the RUC scored a journalistic coup by putting the current list of RUC members publicly on-line.  As we have di... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4753629 Tue, 26 Apr 2011 21:26:00 +0100 4753629 http://www.medworm.com/index.php?rid=4747607&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F04%2Fcan-we-get-health-insurance-if-we-move-back-to-the-us-from-england.html Q. My wife and are thinking of retiring back to her home state of Oregon. I’m 59 and she’s 53. What should we look for in health coverage in the U.S.? A. You are in for culture shock, coming from a country where the universal answer to the question “how do I get health care?” is “it’s free if you live here.” In the U.S., that same question has probably thousands of answers, depending on variables too numerous and depressing to list here. Make yourself a nice cup of tea and read on. You need to plan for your immediate needs and also lay the groundwork for getting Medicare affordably when you turn 65. First, the present. If you’re in excellent health you can try your luck buying private health insurance on the individual market. I searched ... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=4747607 Mon, 25 Apr 2011 15:56:00 +0100 4747607 http://www.medworm.com/index.php?rid=4747701&cid=t_100419_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F04%2Fwhat-american-health-care-system-can.html " In Denmark, we’ve developed communication thus far for almost all IT systems in the health sector. We have implemented all prescription and medication information, and all discharge letters and summaries from hospitals. This also includes outpatient notes, injury reports, x-ray reports, lab reports and lab orders. Reimbursements from health insurance have been made electronic, along with referrals to hospitals and private specialists, and referrals to psychologists. All private physicians have electronic health records today so they can communicate and transfer documents electronically, as well.From the beginning it was a grassroots effort; we thought it was a good idea to exchange information electronically. And now it has become mandatory that you must communicate electronically. The... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4747701 Mon, 25 Apr 2011 05:02:00 +0100 4747701 http://www.medworm.com/index.php?rid=4742385&cid=t_100419_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fshould-you-self-insure-against-medical-malpractice%2F2011.04.22 I wrote at some length yesterday about the prerequisites for a medical group to self-insure. What I didn’t go into in detail was the why — the benefits and the risks. I’m going to tackle that a bit today. Potential Benefits to self-insurance Those who have been around a few years can testify that the medical malpractice insurance market is highly cyclic. It seems that about once a decade a crisis hits. Whether this is a rational market is another question entirely. Some have attributed these crises to macroeconomic factors, like the market crash of 2002, after which insurers had to recoup investment losses, or hurricanes and natural disasters in which insurers cost shifted onto other product lines. Other obervers cite skyrocketing medical malpractice losses as the driver... Better Health blogs http://www.medworm.com/rss/comments.php?id=4742385 Fri, 22 Apr 2011 19:00:00 +0100 4742385 http://www.medworm.com/index.php?rid=4742378&cid=t_100419_87_f&fid=38113&url=http%3A%2F%2Fnews.consumerreports.org%2Fhealth%2F2011%2F04%2Fwhere-will-i-get-insurance-under-health-reform.html Q For those of us who have no health insurance, where do we get insurance from, exactly, in a few years when we either have to buy it or pay a fine? Is there some sort of government-subsidized insurance? A Yes, but not the kind you’re probably envisioning. Last year there was a huge political debate over the idea of setting up a new public insurance plan that would compete with private plans. It dominated the news for weeks but didn't make it into the final health reform law, the Affordable Care Act. However, the idea of “government-subsidized” insurance not only made it into the law, it’s the absolute centerpiece of how health insurance will work three years from now. As of Jan. 14, 2014, you’ll have to have health insurance or pay a fine. If you get adequ... Consumer Reports Health Blog blogs http://www.medworm.com/rss/comments.php?id=4742378 Fri, 22 Apr 2011 18:40:20 +0100 4742378 http://www.medworm.com/index.php?rid=4742360&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2Fo_wUPcC7lrY%2F High-deductible health policies and Rep. Paul Ryan’s budget plans for Medicare both assume that health costs can be kept down by treating patients more like consumers. The thought is that those of us with insurance are disconnected from the price of our health care — since we usually don’t pick up the bill — and that having more skin in the game would make us more fiscally careful about the goods and services we use. As one commenter, SLC, wrote in response to our recent post on high-deductible plans, “Let consumers take charge and be responsible, and stop assuming they are incapable of rational decisions.” In his NYT column today, economist Paul Krugman takes issue with that notion of patient as consumer, saying health care isn’t the same as other... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4742360 Fri, 22 Apr 2011 16:44:32 +0100 4742360 http://www.medworm.com/index.php?rid=4742362&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FtWAjGH3qLJc%2F Trial Data: Pfizer said four patients enrolled in a trial studying its oral rheumatoid arthritis drug tofacitinib died during or after treatment, but that only one death has been linked to the drug, the WSJ reports. Full results of the study are due to be presented May 27 at a scientific meeting in London. Brain-Injury Benefits: The chief of staff for Gabrielle Giffords, the congresswoman recovering from a January shooting, has urged HHS head Kathleen Sebelius to include high-quality brain-injury treatment and rehab in the list of essential benefits that must be provided by individual and small-business health-insurance policies, the Washington Post reports. Separately, staffers are urging the Defense Department to cover more comprehensive rehab for brain-injured servicemen and women throu... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4742362 Fri, 22 Apr 2011 12:27:35 +0100 4742362 http://www.medworm.com/index.php?rid=4747723&cid=t_100419_113_f&fid=34634&url=http%3A%2F%2Fwww.emrandhipaa.com%2Fneil%2F2011%2F04%2F21%2Fmore-unrealistic-expectations-from-the-public-this-time-involving-cds%2F Yet again, someone needs to educate the general public about healthcare in general and health IT in particular. HealthLeaders last week asked the question, “Does Decision Support Make Docs Look Dumb?” The story, apparently based on a 2007 study (not 2008, as HealthLeaders reported) in the journal Medical Decision Making, says: “Most clinicians would agree that evidence-based decision support tools have the potential to improve clinical quality. But patients’ perception of the tools—and the physicians who use them—might be yet another barrier to their adoption. The problem is twofold: Some patients are skeptical of docs who need a computer to help them make a diagnosis. And some physicians don’t want to be seen as being too reliant on technology.” We’ve... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4747723 Thu, 21 Apr 2011 20:05:53 +0100 4747723 http://www.medworm.com/index.php?rid=4734026&cid=t_100419_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F04%2F21%2Fwill-price-competition-lead-to-quality-competition%2F Editor’s Note: In addition to John Goodman (photo and bio above), this post was coauthored by Gerald Musgrave and Devon Herrick. In our third-party-payer health insurance system the price for care is typically set by entities external to the doctor-patient relationship.  As a result, providers rarely compete for patients based on money prices. Potentially they [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4734026 Thu, 21 Apr 2011 13:13:12 +0100 4734026 http://www.medworm.com/index.php?rid=4734036&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FwcwV_DcJQVM%2F Earnings Season: UnitedHealth Group’s first-quarter profits rose 13% to $1.35 billion, or $1.22 a share, from $1.19 billion, or $1.03 a share, Dow Jones Newswires reports. Analysts had expected earnings of 89 cents per share, according to Thomson Reuters. The health insurer also raised its full-year earnings forecast to between $3.95 and $4.05 share, up from a previous range of $3.50 to $3.70 a share. Gut Instinct: Research shows that the bacteria populations that live in our guts fall into one of three distinct patterns, the New York Times reports. The enterotypes, as they’re called, aren’t associated with the host’s ethnic background, weight, sex, health or age, raising the possibility that the makeup of the initial population of bacteria occurs by chance. Gut bac... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4734036 Thu, 21 Apr 2011 12:44:35 +0100 4734036 http://www.medworm.com/index.php?rid=4734501&cid=t_100419_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F04%2Fwho-should-decide-when-are-you-too-sick.html If you are sick, whether it is the garden variety flu or pregnant or coping with a medical emergency, who should decide when you are too sick to work:A. The patientB. The doctorC. The employerD. The employer's disability insurance companyShould it A and then B sometimes? How about when the employer and their disability company start making these decisions? This is a neglected area of health care reform. Companies are cutting back on short term disability insurance - so instead of 70% of your salary, you might only receive 40%. This is understandable during a tough economic times. But what if the insurance company decides you should go back to work and your doctor says you need to stay home still? And then they cut off your benefits and you are forced to sue? This whole thing appalled me. I... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4734501 Thu, 21 Apr 2011 09:42:00 +0100 4734501 http://www.medworm.com/index.php?rid=4734042&cid=t_100419_87_f&fid=36224&url=http%3A%2F%2Ffeeds.wsjonline.com%2F%7Er%2Fwsj%2Fhealth%2Ffeed%2F%7E3%2FvIGpHjyB02c%2F HIV Pill Disappointment: A study looking at whether high-risk women in Africa could take oral antiretroviral drugs prophylactically, to prevent rather than treat HIV infection, was stopped early because researchers can’t determine if there is any benefit, the WSJ reports. Last year that strategy showed success in preventing infection in gay and bisexual men; researchers speculate that a lack of adherence or physiological differences between males and females might explain these latest findings. Donor Dilemma: Living organ donors are sometimes considered by insurers to have a pre-existing condition, making it difficult or impossible to find affordable health coverage, Kaiser Health News reports. This, despite research showing that people who donate kidneys or other organs don’t ... WSJ.com: Health Blog blogs http://www.medworm.com/rss/comments.php?id=4734042 Tue, 19 Apr 2011 12:35:01 +0100 4734042