Posts Tagged ‘medical’

Natural Health Courses – Enhancing the Medical Practice Prospects

June 11th, 2011

Natural health therapy is the healthiest and the most natural healing aspect of good health and vigorous living methods. The future prospects in the career of natural health are outshining and masses are getting attracted to the benefits of natural health therapy. Naturopathy has been around the world for more than thousand years but the last few years have witnessed the remarkable increase in demand of natural medicine courses.

The aspirers are astonishingly inspired by the authentic treatments of naturopathy and are increasingly viewing their career prospects in this field. Natural health programs of study include courses in applications of natural health and philosophical approaches to natural health practices.

Natural health schoolsare providing the education in the field of alternative medicine and that is the reason why the natural medicine jobs are now being known as viable forms of the treatment of diseases. They educate the students with the most appropriate and effective natural healing techniques which includes the study of natural human body and how herbs, nutrition and natural methods can prevent illness and promote optimum wellness.

Natural health colleges are facilitating the knowledge for the general responsibilities of caring for one’s own health and to facilitate the health measures to the masses. They give the efficient education and practical knowledge for grasping the prospects of naturopathy and prepare the students to build a successful herbal nutrition consulting career.

The naturopathy programs that are provided by natural health schools are Bachelor’s, Master’s and doctorate degrees in natural health, holistic nutrition, oriental medicine, naturopathy and various alternative medicine specializations.

Alternative medicine colleges educate their students on the recommended bottom-line principle that healing of the human body occurs naturally when the appropriate quantity of fresh air, sunlight, pure water, proper diet and exercise are adequately provided.

An Alternative medicine degree program provides the best educational platform for the naturopathy career aspirers to develop the skills and knowledge needed to become a naturopathy practitioner. They provide the development of skills and knowledge needed to become a consultant for the integration of complementary medicine into traditional medical healthcare practices.

Choosing the career in the field can be the most gratifying experience as the modality of naturopathy lies in serving the humanity. Alternative medicine schools focus on natural medicine therapy to make you a specialized kinesiologist, acupuncturist, biofeedback therapist, massage therapist, energy healer, meditation leader or yoga instructor.

The naturopathy courses are wide spread and require in-depth studies that facilitate the graduates to begin the new life with the advance and successful career prospects!

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Health Care Reform: an Opportunity for Insurance Industry Participation in Sierra Leone’s Medical Care System

May 22nd, 2011

The socialized system of healthcare delivery and financing, a relic of the British colonial era, still practiced in Sierra Leone has glaringly failed and any efforts at resuscitating it without implementation of major structural and systemic reform will only serve to prolong the inevitable.

Throughout the world, total state control and management of industries, services, markets and the means of production are gradually becoming a relic of the past. This model as practiced in the Sierra Leone healthcare system has empirically been proven to have served only to stifle innovation, growth, productivity and quality output with a resultant decline in overall living and healthcare standards of the citizenry. The current state of the hospitals and health centers glaringly highlights the systemic problems endemic in the entire government owned, managed, financed and operated health care system.

The continued operation of such a decadent and dilapidated delivery and financing system, lacking in even the basics of a modern healthcare infrastructure continues relegating Sierra Leone to the very bottom of the human development index.

The transformation thus of the medical healthcare delivery and financing system into a private insurance or a national insurance based system offers opportunities not only for insurers to develop market-based medical insurance plans and policies but also serves to effectuate the Ministry of Health & Sanitation’s desired policy goals, as espoused in the 2002 National Health Policy Paper.

Both policy and regulatory officials, healthcare providers, the insurance industry and other stakeholders must be engaged to effectuate implementation of fundamental systemic reforms if the country is to avert an even greater catastrophe.

Privatization:

 

Under the proposed privatization plan, the Ministry of Health & Sanitation will be transformed from ownership and management of hospitals, clinics, and employer of last resort for all physicians, nurses and ancillary healthcare providers into a health agency with only policy and regulatory functions.

The goal will be for the health agency to serve as a policy and regulatory watch dog mandated with ensuring that adequate and quality medical care is provided at the various private hospitals, clinics and pharmacies that will inevitably be established with the break-up of the current government owned facilities.

With the break-up and subsequent purchase or leases of these hospitals, clinics, health centers and other facilities, investors and entrepreneurs in an effort to realize maximum returns on investments, will economically be compelled to upgrade quality and standard of care, introduce state of the art equipment and technologies and engender a type of market forces competition which will inure only to the betterment of health consumers in the country.

A much needed infusion of capital into the health care industry by such a privatization plan will clearly spur additional economic activities in ancillary industries, as the dynamic forces of privatization and market mechanism forces of demand and supply will ensure competition for the healthcare pie.


Divestiture of Government Ownership:


The dismantling of the current mammoth and highly inefficient government owned healthcare delivery and financing entity must from a public policy perspective be designed and restructured to ensure governmental ownership and management divestiture from hospitals and other health care facilities.

Under such a scenario the government’s current enormous but woefully mismanaged capital outlay for health services will be substantially decreased as inefficiencies of corruption, salaries of providers, infrastructure maintenance, costs of medications and diagnostic equipments and other overhead operating costs will no longer be recurrent expenditures from the nation’s depleting coffers.

A system based entirely on a private market-based national health insurance plan with private enterprise and market competition at its core appears the most logical reform policy route to ensure a future sound, efficient and profitable health care infrastructure.

 Health Insurance Plans:

The cog which the proposed new system must revolve around is a nationwide network of affordable health insurance plans creatively designed to ensure a greater pool participation of a majority of the population. In such a system health insurance companies and provider organizations will be established to market various health plans, with minimum services and premiums based on market conditions. The responsibility for monitoring compliance by the various plans would fall under the ambit of both the Ministry of Health and Sanitation and the Sierra Leone Insurance Commission.


Multi-Payer System:


A major plank in this proposed health care delivery and financing privatization hinges on the enactment of health insurance legislation providing for employers to provide health care for their employees and dependants as part of a standard benefits package with concomitant tax incentives and governmental subsidies to ensure compliance. With such legislation the virtual free socialized medical care system, the costs of which have been borne exclusively by the government will now be based on a multi-payer system in which government, employees and employers will all participate.

With the system as currently structured however, only the government has a financial interest and stake and when other programs conflict with the financing of health care, politicians have only been too willing to sacrifice the health of their citizens on he alter of their greed and personal aggrandizement.

It is envisaged that health insurance providers will introduce concepts and plans, such as Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO), through alliances of health providers and insurance companies and marketed to employers, labor unions, governmental ministries and corporations on an annual premium basis.

The competition engendered by such health organizations for the medical insurance pie will subsequently result in competitive rates, coverage, deductibles, co-payments and premiums to make health care costs affordable for all.


The Unemployed:


As unemployment and underemployment are perennial problems in the Sierra Leonean economy, the provision of health care benefits to this category of the population must remain the responsibility of government. Medical services provided to this category of citizens in a private enterprise environment must be reimbursed by the government on a negotiated and pre-determined fee schedule or an insurance mechanism established in which government negotiates with providers and carriers for the provision of services.

As an example a fund established by levying taxes on the private health care providers, envisaged to emerge with such privatization, could be instituted and utilized to pay for these indigent services.

Further, since the hospitals, medical clinics and other medical facilities will be operated as businesses, either for profit or as non-profit organizations, the market forces of demand and supply will certainly ensure that patient quality care, improvements in diagnostic technologies, competent personnel and a general responsiveness to the demands of the clients will drive the new marketplace. The lethargic and inefficient atmosphere witnessed at most government hospitals today with customer service virtually non existent would be a philosophy of the past.

The economic viability of healthcare businesses will depend largely on the clientele they can attract and maintain utilizing the above yardstick. Providers of lousy health care plans and services will inevitably loose business to competitors as every year participants will have an opportunity to change health insurance plans.

Since a large population of Sierra Leone resides in rural areas, the proposed privatization plan will ensure the expansion of health care facilities into areas currently inadequately serviced. This plan will ensure that clinics and doctors put up shop in every part of the country in order to tap into the healthcare services available in these rural areas.


Challenges to Insurance Companies:


Designing an insurance system and plan to cater to the needs of the rural population who often are self employed in farming and mining activities posses a challenge to insurers in Sierra Leone, who in the past have been largely passive and unimaginative in policy design to meet the challenges and risks confronting the nation’s socio-economic landscape.

Proactive and creative underwriting of risks must be undertaking by underwriters, actuaries and marketing specialists to design, tailor and price health insurance coverage to meet the diverse needs of the insuring public. For example, the creation of pools by occupational categories could be one method by which insured’s, engaged in similar trades could be encouraged to form co-operatives for purposes of obtaining health insurance coverage at affordable rates for themselves and dependants. Premium payments through the pooling together of the co-operatives commodities can be an alternative payment method for the medical services. Health insurance companies could possibly establish subsidiary or ancillary companies solely for the handling of payments made by cash crops.

The current system under which nearly all doctors and related health care providers are employed by the government while at the same time owning private practices would be changed with a concomitant government savings on salaries, productivity and other fringe benefits. As privatization takes over in the hospitals, physicians, nurses and other providers will no longer be on the government’s payroll but will rather be independent contractors with their own practices.

Conclusion:

Whilst a micro version of the proposed reform has mushroomed in an ad hoc manner over the years with some large companies and corporations contracting with individual physicians and clinics for the provision of health care to their employees and dependants, the kind of systemic and structural overhaul needed to forestall a total collapse of the system and extend similar services to all could only be realized by a comprehensive approach along lines of reforms proposed in this policy paper.

 




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Non Medical Home Health Care Employment? What Do I Care?

April 5th, 2011

The need for home health care in the United States is growing at an exponential amount. Even during the economic downturn, people are still getting older. The home health care sector has seen steady gains even in the midst of the bailout plan rejection. The 25 businesses that are in the IBD home health care sector are up 25% since the middle of March. During the week’s turbulence, the top stocks have all held strong. The strong hold on stocks has been due to the aging baby boomers. In 2007, more than 9000 home health care agencies provided care to more than 3 million patients.


Home health services are expected to grow each year ending at 119 billion dollars by 2017.The figure could be anywhere from 10% to 15% growth each year over the coming years. The industry is incredibly fragmented with the top four earners only making up 12 to 15% of the industry’s revenue. This means that there is plenty of room for companies to come in with reasonable barrier of entry.


Part of the growth is due to acquisitions. There is a favorable exchange rate that allows publicly traded companies to use their stock and buy off private firms.


Because the government has such a hold on the funding of home health care options, changes in legislation are a major concern for stock holders of publicly traded companies. Medicare and Medicaid account for 55% of the funding toward home health care services. Reimbursement issues are always a concern for home health companies.


Home health care companies are in a unique position as insurers are trying to hack away at healthcare costs. For tax payers, home health care is a more favorable option because it is so much cheaper than having to foot hospital bills.


Many chronic diseases such as diabetes, chronic obstructive disease, and renal disease can be treated effectively at home making it an attractive option. These companies market to occupational therapists and hospital discharge planners. It is important for these companies to gain referrals from these trusted health care sources.


This also means the non medical home health care employment will be more in the market. It will give caregivers and certified nursing assistants another opportunity to employ their skills. The truth is we as a nation are growing older. With the baby boomer generation growing older and retiring, there is a great strain on the squeeze generation ages 40-60 who need to take care of their parents as well as their children.


More and more people are moving to home health care as an alternative to nursing homes. There is also an increase in the number of people seeking their own caregivers independently. This gives people the advantage of determining their own set of responsibilities and the type of service they require right out of the gate.


Whatever the case, more and more people are turning to care for their chronic disease instead of acute care. This will shift the insurance burden from term life insurance and accident insurance to long term care insurance as more people will require long term health care.

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Health public relations specialists help medical practitioners maintain unimpeachable reputations

March 11th, 2011

In today’s fast paced and ever changing world, perception is everything.  The way people think about a particular product, service, institution, or even an individual person can affect its intrinsic value.  A reputation can take years of careful and painstaking work to cultivate, but it can be destroyed in an instant.  This is why it is so important to stay on top of how people perceive things.  This is especially true in the field of health services.  If a particular institution such as a hospital or a private medical or dental practice starts to generate a negative reputation, it can be the death knell for that particular entity.  People have to believe that a health care provider business can provide all the necessary goods and services to maintain healthy patients.  If people don’t feel this way about a particular health care institution, they will not return for future visits.  This is obviously unacceptable.  This is why many corporations of all shapes and sizes have retained a health public relations firm to help them shape public opinion about their particular business or institution.

A well regarded health public relations firm can ensure that information regarded a particular health care provider is controlled.  This helps to prevent the dissemination of false, harmful, damaging or otherwise unwanted information about a particular institution.  In this way, a health public relations firm can help to regulate the flow of information so that public perception can be monitored and can be assessed in a clear an efficient way.  Therefore, the health public relations firm can determine the next course of action to effectively ensure that a particular institution has a good reputation and business can continue as expected.

The field of health public relations is a tricky one.  There are numerous factors for businesses of all shapes and sizes to consider.  For starters, the health field is ripe with technological advances that make it difficult for the everyday person to understand.  In the health field, practitioners have years of experience in their particular field and can therefore understand any new advancement or breakthrough with the greatest of ease.  The same cannot be said for the average person on the street seeking medical treatment.  Therefore, a health public relations firm has to pass along information about a firm in a clear and concise manner so that it can be understood by everyone.  This is often easier said than done in the complex realm of health public relations.  An effective health public relations firm has to have a firm grasp on their clients expectations so that there is no miscommunication that can result in a negative perception of the client’s business or practice.

Also, the field of health public relations is often rife with emotion.  People’s judgments can easily become clouded when the health and well being of their loved ones is at risk.  This is completely understandable, as reason often plays second fiddle to emotions when a traumatic experience threatens a person’s well being.  Keeping this in mind, a health public relations office has to be able to paint a particular practice or institution as being open and being focused on the human aspect of the health field.  If the firm presents an appearance that is too clinical, this can have the opposite effect.  It is absolutely imperative that the human side of health and human services become apparent.  The health public relations can do this by presenting a welcoming and friendly atmosphere.

For more information visit to http://www.makovsky.com

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Medical Billing Software Takes Health Care Systems into the Computer Age

March 1st, 2011

Medical Billing Software, this can be done instantly and the medical biller will submit the claim electronically.

Insurance companies access the information sent via the medical billing software and analyze the claim. They will then approve or reject the claim and send the new information back to the health care provider. This process is adequately called a cycle because it can go on for an extended period of time, as claims are re-submitted and re-analyzed until both parts agree on the billing terms.

The use of a medical billing software does speed up the process, as it bypasses all the filling in by hand of forms, archiving files and transporting those files from one end to the other. This allows both parts to efficiently manage the insanely large amount of claims that are submitted every day.

Health care providers and insurance companies can, therefore, install a medical billing software for these administrative purposes. They can either choose a licensed software package of medical billing software or prefer to work with web interfaces, both of which require specialized training for employees.

Many patients have been faced with difficult financial contexts after being treated for a health condition and finding out later that the insurance company won’t be paying for the treatment. Medical Billing Software has also allowed for changing this situation, as it allows for the health care provider to assess the patient’s eligibility for treatment beforehand. The patient can be informed of the approval or rejection of the process and manage his or her decisions from that point on.

Of course, the introduction of personal information into medical billing softwares is a privacy issue that has been dealt with by most countries. There are laws that health care providers and insurance companies must follow to guarantee that no breaches of confidence will occur.

In the United States, for example, the Health Insurance Portability and Accountability Act (HIPAA) has been in place since 2005, requiring all parts involved in the billing cycle to manage, send and receive claims according to the legal specifications. Any leak of information will be subject to litigation.

In conclusion, there is the disadvantage of privacy matters, but medical billing software has come to stay, as the efficiency provided for the billing cycle is invaluable. Health care providers and insurance companies speed up the process in a cost-effective manner and, most importantly, the patient’s treatment and billing is significantly bettered.

More information on Medical Billing Software can be found at http://www.healthtec-software.com/Medical-Billing-Software.htm “>Over the years, health care providers and insurance companies have had to deal with mountains of paperwork to decide on one patient’s treatment and consequent billing. And though it is still a process that might take days, weeks or even months, medical billing software has emerged to take the billing cycle into the computer age.

The process starts with creating or updating a medical record of a patient that required health care. Doctors or health care providers’ staff will enter information into the patient’s file that will be sent to insurance companies in order to determine what and how much will be paid for. With a Medical Billing Software, this can be done instantly and the medical biller will submit the claim electronically.

Insurance companies access the information sent via the medical billing software and analyze the claim. They will then approve or reject the claim and send the new information back to the health care provider. This process is adequately called a cycle because it can go on for an extended period of time, as claims are re-submitted and re-analyzed until both parts agree on the billing terms.

The use of a medical billing software does speed up the process, as it bypasses all the filling in by hand of forms, archiving files and transporting those files from one end to the other. This allows both parts to efficiently manage the insanely large amount of claims that are submitted every day.

Health care providers and insurance companies can, therefore, install a medical billing software for these administrative purposes. They can either choose a licensed software package of medical billing software or prefer to work with web interfaces, both of which require specialized training for employees.

Many patients have been faced with difficult financial contexts after being treated for a health condition and finding out later that the insurance company won’t be paying for the treatment. Medical Billing Software has also allowed for changing this situation, as it allows for the health care provider to assess the patient’s eligibility for treatment beforehand. The patient can be informed of the approval or rejection of the process and manage his or her decisions from that point on.

Of course, the introduction of personal information into medical billing softwares is a privacy issue that has been dealt with by most countries. There are laws that health care providers and insurance companies must follow to guarantee that no breaches of confidence will occur.

In the United States, for example, the Health Insurance Portability and Accountability Act (HIPAA) has been in place since 2005, requiring all parts involved in the billing cycle to manage, send and receive claims according to the legal specifications. Any leak of information will be subject to litigation.

In conclusion, there is the disadvantage of privacy matters, but medical billing software has come to stay, as the efficiency provided for the billing cycle is invaluable. Health care providers and insurance companies speed up the process in a cost-effective manner and, most importantly, the patient’s treatment and billing is significantly bettered.

 

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Health Insurance Reform Weekly Medical cost trends for 2012

February 22nd, 2011

PricewaterhouseCoopers and Medco Health Solutions released two new views of cost trends in health care during the past week, building on the release of the Milliman Medical Index.   PwC Health Research Institute’s “Behind the numbers: Medical cost trends for 2012,” examines the medical cost trends for employers in 2012.  This new report found “Medical cost trend is expected to increase from 8 percent in 2011 to 8.5 percent in 2012.”  And two main drivers identified by PwC are provider consolidation and cost-shifting to the private sector.

Providing a view of prescription drug utilization and pricing trends, Medco’s Annual Drug Trend Report showed this week that while the overall growth of prescription drug prices is at an historic low (as a result of increased use of generic drugs), the cost of specialty treatments is still increasing at an alarming rate.  According to Medco’s report “Specialty drug trend was 17.4 percent in 2010, fueled by unit cost growth of 11.5 percent.”

Federal

There is no Federal report for this week.

States

ARIZONA: The Department of Insurance (DOI) held a public hearing on rate review as part of its Health and Human Services (HHS) grant activities. The DOI has retained Mercer Consulting to assist in performing a gap analysis to identify areas that need to be addressed in order to comply with the requirements of the Affordable Care Act (ACA). During the hearing, it was noted that the state’s current statutory scheme does not authorize the DOI to review a health insurer’s medical loss ratio, potentially not allowing the state to meet the HHS requirement of having “an effective rate review process.”

The Director of Insurance and the Governor’s office also hosted their first workgroup on the implementation of an exchange. Despite the legislature’s refusal to pass an exchange bill, there is concern at the executive level about a lack of preparedness in the event the ACA is not repealed or found unconstitutional. This week’s topic was the qualified health plan certification, and participants focused on not adding requirements beyond the ACA minimum benefit requirements.

CALIFORNIA: The Appropriations committees of both houses are wading through many bills that would have varying impacts on state finances.  Bills meeting certain dollar thresholds are sent to “suspense” filing for consideration at later hearings.  Most of the legislation that Aetna and other allies have opposed has been sent to the “suspense” filing, including a bill on rate regulation and all bills on benefit mandates, because of the fiscal impact of each bill and potential conflicts with federal guidance on essential benefits. These bills may be revived at a later date, or they may be held by the committees.  We expect the majority of the bills to be voted off the suspense file by the end of the month, including.

Rate regulation – According to Appropriations, there would be an annual fee-supported special fund cost of at least million to DMHC and CDI.
Rate regulation – According to Appropriations, there would be an annual fee-supported special fund cost of at least million to DMHC and CDI.
Autism mandate – According to the committee analysis, this bill would result in annual costs to the following state entities:
CalPERS: million
Medi-Cal, for enrollees in managed care plans: 4 million
MRMIB plans (Healthy Families, AIM, MRMIP): million

In state budget news, the governor will release his May revision to the state budget next week, taking into account new revenue figures that show the state taking in more than billion in unanticipated new tax dollars. The governor still believes that asking voters to extend the higher tax rates set to expire this summer is the right thing to do because the higher revenue forecasts would not close the entire budget shortfall.  Republicans, however, have been quick to argue that higher revenue forecasts mean that extending tax rates is not needed at this time.

CONNECTICUT: The legislative session adjourns June 8, but the legislature has yet to reach a conclusion on several major issues, including an exchange bill, a rate review bill and the SustiNet bill.  Although the SustiNet compromise bill language is not public, the Administration and press reports have said that the bill does not include a public option but would create an advisory board on health reform implementation and examination of future state reforms. In addition, an anti-most favored nation clause bill has passed the House and now goes to the Senate for its consideration. Aetna supported the bill with amendments. The bill is expected to pass. Additionally, the recently released HHS rate review rule may push legislators to advocate for adoption of the federal 10 percent trigger for rate review in Connecticut, just in case the federal law is repealed.

DELAWARE: The Department of Insurance (DOI) submitted a medical loss ratio (MLR) waiver application to HHS for its individual health insurance market. The DOI-requested adjustment proposes a three-year phase-in of the MLR as follows: 65 percent for 2011, 70 percent for 2012, and 75 percent for 2013.

GEORGIA:  Governor Deal has signed legislation that applies state prompt-pay standards to self-funded plans.  Aetna will be working with self-funded customers who have questions about the validity of the new law and its application to their plans, which are generally covered by ERISA.

INDIANA: Insurance Commissioner Stephen Robertson submitted an MLR waiver request to HHS seeking relief from the MLR regulation for the individual market and for consumer-directed health plans in both the individual and small group markets.  Specifically, for the individual market, Indiana is requesting that the MLR be waived for the individual market through 2014, or, as an alternative, that it be phased in as follows: 65 percent in 2011, 68.75 percent in 2012, 72.5 percent in 2013, 76.25 percent in 2014, and 80 percent in 2015, with an exemption from the MLR requirement until 2014 for new market entrants (defined as those that have not previously sold individual major medical health insurance products in Indiana for the previous 10-year period). For consumer-directed health plans in the individual and small group markets, Indiana is requesting a permanent waiver from the federal MLR requirements.

MAINE: Governor LePage has signed into law an Act to Modify Rating Practices for Individual and Small Group Health Plans. The new law is designed to open up Maine’s individual and small-group insurance market to competition. It also is supposed to:

help lower health insurance premiums by broadening Maine’s community rating system and allowing insurance companies to base their premiums on a more flexible set of criteria.
allow Maine residents to purchase insurance in four New England states beginning in 2014.
set up a reinsurance pool to cover individuals with serious illnesses. The pool would be subsidized by a covered lives assessment capped at per member per month.

The Maine People’s Alliance (a progressive advocacy group), the Maine Democratic Party, and others are looking into the feasibility of initiating a referendum on the new law. In order to get a referendum on the November ballot, opponents would have to file approximately 60,000 signatures with the secretary of state no later than 90 days after the enactment of the bill on May 17, 2011.

MONTANA: Governor Brian Schweitzer has decided to reconsider his amendatory veto of legislation that prohibits the state from enforcing the individual responsibility requirement contained in the ACA.  Noting the critical role that the individual mandate plays in lowering the cost of coverage, the Governor’s amendatory veto argued that the prohibition against enforcing the mandate in Montana should be contingent on whether residents have access to affordable coverage.  However, on May 13, the Governor reversed his position and signed the bill into law, as permitted under Montana’s statutory procedural guidelines.  The provisions of the law include legislative findings stating that the ACA individual coverage requirement will cause unnecessary expense and inconvenience to individuals and employers, and therefore the legislature prohibits any agency of the state from enforcing the provisions of the ACA and subsequent federal regulations that relate to the individual coverage requirement. The law specifies that the prohibition extends to requiring public employees to purchase or maintain coverage and state officials or employees from participating in boards, commissions, or entities of the NAIC that are assigned to recommend provisions that implement the individual mandate.

NEVADA: HHS informed the Nevada Division of Insurance that the state’s application for a transitional waiver from the MLR provisions contained in the ACA has been denied and amended.

In its response letter, HHS admits that application of the ACA MLR standard could in fact lead to destabilization of the state’s individual market but argues that the transitional waiver requested by the state (72 percent) exceeds the amount necessary to prevent destabilization and would ‘deny consumers an excessive amount of benefit.’  For this reason, HHS determined that Nevada should be granted a one-year transitional waiver under which the MLR for the state’s individual market will be 75 percent in 2011.

SB 440, which would create the Silver State Exchange, had its first hearing on March 18 in the Finance Committee, but no action to advance the measure was taken.

NEW JERSEY: Last week the Department of Banking and Insurance (DOBI) announced that Horizon Blue Cross Blue Shield of New Jersey has officially withdrawn its application to convert to a for-profit entity.

In the final round of public budget hearings, the non-partisan Office of Legislative Services (OLS) and State Treasurer, Andrew Sidamon-Eristoff, testified that state revenue is now expected to exceed forecast by 0 to 0 million due to higher income tax collection. This was welcome news as the legislature and the Christie Administration wrestle with various program cuts under the current budget proposal. Leadership in the legislature has called for restoration of property tax rebates and reconsideration of the proposed changes to the Medicaid program.  It has been reported the Administration is seeking to change Medicaid eligibility to 33 percent of the federal poverty level. Democratic legislators have come out en masse opposing this change.

NEW YORK:  James Wrynn will be the deputy superintendent for Insurance under the Department of Financial Services (DFS) after the consolidation of the New York State Insurance Department, of which he is currently superintendent, with the Banking Department. Benjamin Lawsky was nominated to be the superintendent of the DFS. At packed confirmation hearings, Lawsky appeared before the Senate Insurance Committee and then the Senate Banking Committee. Lawsky said he understands that prior approval has become “overly politicized.”  He said he would make addressing this his “number one priority.” He also said he planned to meet with all stakeholders on this issue in the coming months. He was unanimously approved by both Insurance and Banking Committees but must still appear before the Senate Finance Committee for its approval.

The NYS Department of Insurance held public hearings on exchanges that reports say were not well attended. The New York Health Plan Association testified that the success of any health insurance exchange boils down to the affordability of coverage it can offer.  The HPA said the best way to preserve affordability is through an independent authority, which could be created by passing very limited exchange legislation before the end of the legislative session. Such legislation could establish the governance and infrastructure of the exchange and charge it with conducting research to make recommendations regarding the policy issues that need to be addressed by 2014. A key issue to address is how to ensure that the exchange is financially sustainable by 2015, as the law requires.

NORTH CAROLINA: Legislation implementing an Exchange Advisory Board met with some consumer opposition last week.  Opposition centered mostly on the way in which the exchange will be funded.

OKLAHOMA:  In the final week of the legislative session, leadership in both chambers announced the formation of a special joint legislative committee to study how the new federal health care law affects Oklahoma. Senate Pro Tem Brian Bingman and House Speaker Kris Steele ordered the formation of the joint committee and announced that “studying this issue in more depth makes for healthy legislative process. The scope of this law is vast, so we need to make sure we are prepared to address this law in a conservative way that is best for Oklahoma.” The committee will have bipartisan membership. The joint committee will hold a series of public meetings over the legislative interim focusing on how the ACA affects Oklahoma. The committee will also explore how to best approach the law as the state awaits the outcome of its lawsuit challenging the law’s constitutionality. The committee will then make recommendations on how the state should address the federal health care law.

As a result, legislation that would create an Oklahoma health insurance exchange will not be heard this year.

TEXAS: The health care collaboratives that would be set up by pending legislation (Senate Bill 8) authored by Senate Health and Human Services Chair Jane Nelson are intended to promote higher quality of care at lower cost. The collaboratives would allow groups of providers, such as hospitals and doctors, to bargain collectively with the people who pay them. The goal is to give providers more leverage in price negotiations with an eye to cutting overall health care costs. But staff at the Federal Trade Commission (FTC) say giving these collaboratives antitrust protection could have the opposite effect and could harm consumers. Staffers have flagged this key provision of the Lieutenant Governor’s health care agenda for the session, indicating that a tool intended to improve the efficiency and quality of care in Texas might in actuality “lead to dramatically increased costs and decreased access to health care for Texas consumers.” To get around any antitrust issues, SB 8 specifically gives collaboratives exemption from antitrust laws. The bill is in the final stages of passage and could be headed to the House floor at some point in the last 10 days of the legislative session.

Meanwhile, uncertainty hung over the Texas Capitol at the end of last week as budget negotiators worked to bridge the gulf between the House and Senate spending plans and avert a special legislative session. What had been a billion difference Wednesday was narrowed to a few hundred million dollars as the House agreed to the Senate’s proposal on public education. To help pay for the billion added into the budget, the House relies on the .2 billion of additional state revenue announced by Comptroller Susan Combs this week. Lt. Gov. David Dewhurst said he was optimistic that a deal was in the offing. Negotiators are taking it down to the wire trying to complete their work by the end of the legislative session on May 30.

WISCONSIN: The Wisconsin Office of Free Market Health Care’s (OFMHC) survey to gather stakeholder input on the design of a potential Wisconsin Health Insurance Exchange closed last week.  Now, the OFMHC will develop its plan for the exchange.  OFMHC has been tasked to design and implement a Wisconsin Health Insurance Exchange that utilizes a free-market, consumer driven approach.

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Health Care Staffing Agencies Add Value in Promoting Medical Assistant Careers

February 3rd, 2011

Whether you’re a seasoned health care professional, or just embarking on a new career, health care staffing agencies may be a viable solution for finding the career of your dreams. Staffing agencies can provide reliable solutions for both employers and job seekers who are looking to break into the medical assisting field. Employers are able to find a pool of experienced job seekers, while applicants can benefit by finding placement in well-respected health care facilities.

Health Care Staffing Agency Benefits

There are other excellent benefits associated with a health care staffing agency affiliation. Often, health care professionals and medical assisting program graduates can find permanent, temporary, short-term and long-term positions in health care, private or public organizations. These venues include, but are not limited to, health care centers, home health care agencies, nursing homes and more. Both domestic and international candidates may also benefit by the placement services of a competitive health care staffing agency.

Medical jobs for qualified medical assistants may include such benefits as short-term disability insurance, professional or paid housing allowances, 401(k) retirement savings plan, travel allowances, health care and dental insurance, and in some instances a continuing education program. However, benefits will vary from employer to employer. For the individual, finding a job or career is quite often the result of an individual’s own hard work, personal experience, work attitude and local labor market conditions.

Health Care Staffing Agencies Provide Needed Employment Solutions

To deliver needed health care industry recruitment solutions, staffing agencies maintain a staff of skilled professionals adept in recruiting procedures, which include sourcing candidates, and initial employee assessment and interviewing. They are skilled in knowing and matching a candidate’s qualifications with the requirements of a job position.

As a direct result of having an outside agency source out candidates, health care industry employers can save time and money by eliminating monotonous and expensive recruiting efforts. This can help a medical facility reduce bottom line expenditures.

Through health care staffing agencies, Certified Medical Assistants can leverage their experience and skills by working in engaging and challenging environments alongside skilled and knowledgeable experts from other medical disciplines. For health care facilities, finding the right job candidate is extremely critical.

Thus, it makes perfect sense to partner with a reputable health care staffing agency that can provide a ready pool of qualified and industry-ready applicants who can hit the ground running on day one of employment.

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Health care public relations firms can help New York medical offices stay in business for years to come

December 14th, 2010

The state of New York presents a number of challenges to prospective medical practitioners. The problem is that people in New York do not suffer fools lightly. While this may be a good attributes in other parts of life, it creates a unique sets of problem of medical practitioners of all stripes and in all different kinds of practices. Not to over generalize a group of people, but in general, New Yorkers tend demand a lot for their money. This is especially true when it comes to matters revolving around health care. The thinking of an average New Yorker goes something along the lines of: if a large amount of money is going to be spent, then there had better be a significant payoff, otherwise, what is the point? Thus, up and coming medical and dental offices practicing reparative and preventative medicine in and around the New York/ New Jersey area have to step up to the plate and deliver the goods, so to speak. It is for this reason, and for this reason alone, that such a large percentage of New York medical offices have retained the services of a health care public relations firm, like Makovsky and Company.

When a medical provider hires a Health care public relations firm, like Makovsky and Company, they expect results. They hold the view that if they are going to spend a fair percentage of their operating budget on hiring a public relations company, they had better see some results for their effort. They do not want to hire a less than reputable, fly by night company to handle an incredibly sensitive and delicate enterprise, such as the highly specialized and diversified field of public relations. That is why so many medical offices, of varying size and budget, have started to hire an experienced health care public relations firm, like Makovsky and Company. There are numerous benefits with going with an established named in the field of health care public relations. For one thing, if a particular medical office or dental practice goes with a health care public relations firm, like Makovsky and Company, or a similar company with a track record in public relations that speaks for itself, then these companies will not have to worry unnecessarily about whether or not they are getting a good deal. The main reason for hiring a health care public relations firm, like Makovsky and Company is to get results.

So what can a health care provider expect when they retain the services of a stellar Health care public relations firm, like Makovsky and Company? They can expect the public’s view of their particular practice to increase exponentially. This may seem like an abstract achievement, but in reality, the results will become immediately apparent by a noticeable uptick in patients who visit the medical offices for treatment. This in turn, results in increased revenue, which is the ultimate goal. Hospitals and medical offices, regardless of their status in the community and regardless of the number of pro bono cases they take in a given fiscal year, are businesses that are out to turn a profit. This may leave a sour taste in the general public’s mouth, but it is a hard truth, and one that a health care public relations firm, like Makovsky and Company should work day and night to make more palpable by highlight the positive attributes of their clients work. In this way, health care public relations firms can serve the greater good.

 

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Elderly Care – Medical Vs Non-Medical Home Health Care – Discover What You Need

December 12th, 2010

Medical Home Health Care vs. Non-medical Home Health Care…if you are reading this, you are likely among the thousands of caregivers needing help caring for a loved one at home.

What is the difference?

One significant difference is who pays the bill… you or insurance?

You may also want to consider how your care may be affected by the way your home care team is paid.

With a doctors order and insurance that is accepted by the agency and covers home care, these services are generally covered.

Medical home care provides skilled medical services such as:

Registered Nurse
Physical Therapy
Occupational Therapy
Speech Therapy
Home Health Aid
Medical Social Worker

These medical personnel can only come to your home by an order from the doctor. This can be initiated by a trip to the doctor, a call to the doctor and sometimes a call to a home care agency explaining your difficulty. They can then contact the doctor.

Several questions need to be answered at this point to help you decide what you need.

Is the patient recently home from the hospital?
Is the patient falling at home?
Are you confused about what medications to give the patient?
Is there a significant change in functional ability or decline in activity level recently?
Is the patient frequently going to the ER?

Yes to 2 or more of the above questions may indicate a potential need for medical home health care. Discussing your felt need with your doctor will help you understand the issues and the answers.

You may want to learn how your care is likely affected by how your physical therapist or nurse is paid.

Non-medical home care

If you and your doctor have ruled out the need for medical home care but you still feel you need some help, consider non-medical home care.

Non-medical care means just that. Non medical. These services are often referred to as companion services. Your best bet is to Google “home health assistance” or the like.

You can always call a business and ask if they provide non-medical home care assistance. Beware though, most medical home care company’s WILL provide solely a home health aid but at a ridiculous price.

You may find better rates by hiring a company who provides only non-medical home care assistance. This is what they do best and they generally do it well.

Do your homework and use your phone. Ask the agency how long their workers have been there. Don’t be afraid to pay a little more if you feel you are following your gut. You are depending on these people to give you or your loved one the proper care and respect that they need and deserve.

You may qualify for home health care physical therapy under Medicare – it’s worth a look!

http://www.home-health-care-physical-therapy.com/

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The Health Care Bill and Your Medical Practice?What the Experts Say

November 18th, 2010

While many of the people who fought the health care bill called it “socialized medicine,” the fact is that the bill as passed maintains a capitalist system in which most of the health care industry will be able to set prices as it sees fit.

Even the health insurance industry itself is facing only weak price controls while one of the biggest contributors to skyrocketing medical costs—the pharmaceutical industry—won’t have to reform pricing at all.

This combination could end up being a disaster for primary care physicians. Why? Because one of the biggest selling points for the health care bill was that it would keep costs down. And what sector are the cuts going to come from if not from the pharmaceutical and health insurance industries? That’s right—a lot of them could well come from your bottom line.

Let’s look at the facts. The health care bill does provide for some weak controls on the prices that health insurers can charge by prohibiting insurers “with a pattern of excessive rate increases” from selling health insurance on the new exchanges, according to the White House website.

And while the pharmaceutical industry is being billed a one-time assessment under the reform bill, that is the only financial hit being taken by those companies.

So we’re looking at a situation where drug companies can charge whatever they want, health insurers have to at least appear to be careful about rates, and the government will be guaranteeing insurance to millions of people while at the same time looking to keep costs down.

Primary care physicians already work harder than just about anyone else in health care while still being the lowest-paid physicians. Now your patient load is set to go up by 10%–20%, while at the same time every one of the players except the drug companies are going to be searching for ways to cut costs.

What do you think is likely to happen? As a former medical sales representative who now works as a wealth management advisor to primary care physicians, I don’t think the future is looking that promising.

The health insurance industry is facing weak price controls on one side and the end to their discretion in which subscribers to take on the other. Our government has taken on a huge share of the responsibility for providing health insurance coverage at a time when we’re facing historic levels of federal debt. Meanwhile, you know that the pharmaceutical industry isn’t going to do a thing to keep costs down.

I think this is going to add up to more work for the same or even less pay for primary care physicians. And while there is a way for you to protect your lifestyle, the time to act is now if you want to come away from the health care bill with your wealth intact.

As a primary care doctor, you spend your entire workweek taking care of other people. Now that the health care bill has passed, you must start looking out for yourself at least as well as you care for others. That way you can have the lifestyle and retirement that you’ve earned no matter what happens to the health care industry in the future.

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