Healthcare

"Balance Billing" ruling

Fri, 04 Apr 2008 16:15:55 GMT

This is in reference to the recent ruling by the Department of Managed Health Care in California. To understand what the ruling is, let’s see what “Balance Billing” is all about.

Whenever a doctor provides a service, he/she can set the fee for that service. It does not mean that they are going to get paid the fee that they charge. There are many doctors who practice at different hospitals. They may not be hospital employees. The hospital may have a different contract with the HMO and a different contract with the doctors. In most cases, the HMO payment is less than what the doctor bills and sometimes less than the UCR (Usual, Customary and Reasonable charges). If the doctor does not have a contracted amount for the provision of that service, he/she can bill the patient for that portion not covered by insurance.

The ruling would prohibit hospitals and hospital-based physicians from billing patients for the cost of emergency department services that should be covered under patients' health plans. Looking at this from a patient’s perspective, the ruling is welcome. From a doctor’s perspective, this is not good and might prevent them from contracting with HMOs.

Aetna and Cigna to pay for online visits

Tue, 01 Apr 2008 23:32:52 GMT

This is a follow up on one of my earlier posts. I had written about paying doctors for emails they send to patients. But now, apart from paying physicians $25 - $35 for online visits, Aetna and Cigna are going to charge copays to patients. Personally I would not want to pay for an online service. What do you think?

U.S. Supreme Court declines challenge to retiree benefits rule

Wed, 26 Mar 2008 13:32:25 GMT

Retirement benefits has been a hot topic in recent times. This news adds to the fire. The Age Discrimination in Employment Act of 1967 (ADEA) protects individuals who are 40 years of age or older from employment discrimination based on age. The ADEA's protections apply to both employees and job applicants. Under the ADEA, it is unlawful to discriminate against a person because of his/her age with respect to any term, condition, or privilege of employment, including hiring, firing, promotion, layoff, compensation, benefits, job assignments, and training.

We all know that older people use many healthcare benefits than younger people. Employers have only a limited budget allocated for employee benefits. They are working with a fixed amount. The Equal Employment Opportunity Commission (EEOC) ruled that employers can create two classes of retirees - those younger than age 65 and those older than 65 -- and offer different benefits to each group. In addition, the ruling allows employers to eliminate or reduce benefits provided to spouses or dependents of retirees older than 65.

If employers spend too much on people over 65, they would not have enough money in their retirement bucket to provide these benefits for future generations. At the same time, is it ethical or legal to discriminate against people based on age? The only good thing about this is that by deploying this tactic, many employers would be able to provide retirement coverage for a little longer. The US Supreme Court declining the challenge to this rule is a little concerning though.

What do you think?

Critical: What We Can Do About the Health-Care Crisis

Tue, 25 Mar 2008 13:32:42 GMT

Currently reading "Critical". Very gripping and thought provoking indeed!!!

Here is a preview of the book by Publishers Weekly
The U.S. is the only industrialized nation that does not guarantee necessary health care to all of its citizens, and as former senator Daschle observes, Skeptics say we can't afford to cover everyone; the truth is that we can't afford not to because U.S. economic competitiveness is being impeded by the large uninsured population and fast-rising health costs. Daschle's book delineates the weaknesses of previous attempts at national health coverage, outlines the complex economic factors and medical issues affecting coverage and sets forth plans for change. Daschle proposes creating a Federal Health Board, similar to the Federal Reserve System, whose structure, functions and enforcement capability would be largely insulated from the politics and passion of the moment, in addition to a merging of employers' plans, Medicaid and Medicare with an expanded FEHBP (Federal Employee Health Benefits Program) that would cover everyone. There is no more important issue facing our country, Daschle asserts, than reform of our health-care system, and the book's health-care horror stories bring this immediacy home. (Feb. 19)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

How healthy lifestyle imitates chess!!

Fri, 14 Mar 2008 15:54:32 GMT

How healthy lifestyle imitates chess!!

I just finished this book and all I can say is "WOW!". One might think that this book is all about chess but it is not. You don’t need to know how to play chess to read this book though some background historical knowledge would really make this book gripping.

Rather than talk about how life imitates chess, I’m going to talk about how a healthy lifestyle relates to chess.

The game of chess has three stages – opening, middle game and end game. How you play the opening and the middle game decides how you end up with the end game. The objective of the game, of course, is to win. What is ‘winning’ in life? Many people would definitely have many things to say in response to this question. But think about it for a moment. What is it that you really need to have when you are old? I would say that being healthy is far more important than anything else during later years in our life. All the money in the world will not relieve you of the pain and suffering that people go through when they have kidney problems, arthritis, lung disease, diabetes, etc.

Unless you play the opening and middle game well in chess, your end game will not be in your favor. Relating this to life, if you don’t maintain a healthy lifestyle in your early years and in your 30s and 40s, you will not be happy and healthy in your later years. I’m no doctor. You don’t need a doctor to tell you to adopt healthy lifestyles and stay healthy. You can see that obesity and diabetes are killing people around the world. Let’s take a preventive approach. Let’s eat healthy and promote healthy lifestyles to people around us. If there is one good thing you want to do in your life, make sure you change someone else’s life to be healthy.

In short, play your opening and middle game in life well. Eat healthy and stay healthy. Staying healthy will not only bring happiness to you but for others around you as well.

Should doctors be paid to send emails to patients?

Thu, 06 Mar 2008 22:55:27 GMT

This is an issue that many doctors have been complaining about for the past 2-3 years. The complaint is that they need to be paid extra for sending emails to patients. What is the reason behind this?

Well, many healthcare organizations have started implementing Electronic Medical Records (EMR). Some of these offer the functionality by which patients can email their doctors and vice-versa. Doctors feel that they should be doing what they do best and what is good for their patients, which is taking care of patients and not sending emails.
Now let’s think about this for a moment.

Consider a mechanical design engineer. His/Her responsibility is to design good products and not send emails to their customers. Who are their customers? They could be internal or external to their organization. They don’t necessarily get paid extra for that. There is nothing mentioned in their employment contract that explicitly states that ‘email’ is part of the job. Email is a tool that helps them achieve their goal.

Consider an executive assistant. Few years back their responsibility was to manage phone calls for the executives. These days, it is both phone and email management.

Why do doctors think the medical profession is different than other professions?

Times are changing. I’ve heard many times that the healthcare industry is the last industry to adopt any new technology. Now do we see why this is? It is not the industry to be blamed but some of the doctors. Health Plans have adopted newer technologies to be competitive in the market. Why? Because members demand online access to their records and need other features that make their life easier. Many hospitals have also adopted newer technology. Why? Because they can provide better care to their patients and be more competitive in the market.

If doctors don’t adopt the simplest form of communication, which is email, then they are going to lose the newer generation of patients.

Personal Health Records: My personal problem.

Tue, 04 Mar 2008 05:13:00 GMT

I’ve never really realized the benefits of a Personal Health Record until I switched jobs earlier this year. In my previous employment, I had great coverage and all my information was stored in an Electronic Medical Record (EMR). I had access to my information such as lab reports and discharge summary. I could send emails to my doctor about non urgent questions and track my health profile including profiling how my weight was progressing over the course of years and how my vitals like BMI and blood pressure was changing as I progressed in age and wisdom. The only feature that was not available was the ability to see my radiology images. But for that, I had no other complaints.

Now that I’ve switched jobs, the coverage is great. I now have a PPO plan compared to an HMO plan before. I now have the freedom to choose any doctor, within the network of course. I can choose a doctor close to work or close to home. I have a lot more choices to choose from. But I am not happy with my situation. Why?

Apart from the lack of EMR, what I value most is the coordination of care. What many people don’t realize is that they lose the coordination of care that they could get by having a Primary Care Physician (PCP) who has the ability to store your information electronically. The availability of choice, though beneficial, also has disadvantages that patients don’t realize.

As part of my new plan, I decided to go and see a doctor. I called and set up an appointment. Later, I had a doubt whether this doctor had an EMR. So, I called again only to find that they use a computer only to register incoming patients. That was about it. I thought really hard and finally decided to cancel my appointment. I am not sure how many people are like me. But one things is for sure. Future generations will definitely seek electronic access to personal health information and those who cannot provide i will be left behind.