Wiser Fitness and Health Blog

Group Quote Guide

Thu, 02 Sep 2010 20:11:19 GMT

How To Get The Best Group Health Plan Quotes

Medicare Dilemma . . . . Painted Into A Corner

Mon, 09 Aug 2010 22:12:30 GMT

Obama Administration officials in the Department of Health and Human Services have extended the projected financial viability of Medicare from 2017 to 2029. A miracle? Not quite. HHS officials just revised their cost projections based on the assumption that Medicare will cut payments to physicians.

Medicare payment rates for doctor services are scheduled to be reduced by 23 percent on the first of December, 2010. Existing law also requires a second cut of 6.5 percent on January 1, 2011. Despite the scheduled cuts in physician fees, HHS is blindly forecasting that healthcare service providers will increase their productivity so that Medicare will save billions more over the twelve year extension.

HHS projections ignore the dissenting opinion of the Medicare Actuary office that says the projected savings might not be realistic. The assumed increased productivity could be difficult to achieve and sustain in view of the lower fees and higher service requirements being forced on participating service providers.

Nowhere in the Medicare assumptions do the Obama officials account for the substantial resistance they are generating from medical professionals. Some surveys of physicians have indicated that more than half of doctors serving Medicare patients threaten to discontinue Medicare services if the scheduled fee cuts become effective.

The administration passed Obamacare by promising that Medicare recipients would be able to keep their physicians and by promising to reduce the costs of Medicare services to make the program feasible. These two conflicting positions are clearly pulling against each other.

HHS has painted itself into a corner. It can not deliver on both promises. In fact, it is unlikely to deliver on either promise. What is likely? Higher costs. Reduced and delayed service. And, Medicare patients scrambling for another doctor.

Deja Vu . . . What's The Point?

Fri, 06 Aug 2010 22:19:03 GMT

In my last blog contribution, I described the healthcare experience of an old friend and school mate. I knew his condition through a daily journal written by his children. His almost four month ordeal in the hospital was a testament to his faith and strength of character. He suffered due to mistakes in care. It did not end well because of a major misstep.

The experience of my friend brought back vivid memories my family experienced almost thirty years ago when we lost my father due in large part to errors in medical care.

So, what's my point?

I guess I have several. First, by no means do I indict the medical system. I believe America has the best medical system in the world. If you have a serious illness, this is the place to be. But, our healthcare system is not infallible. It makes mistakes. Too many mistakes.

US healthcare studies reveal that each year more than 100,000 patients die and more than one million patients have their hospital stays extended due to mistakes in medical care. Mistakes that should not happen, but do.

If you think that is a reason to advocate government controlled healthcare, you need to understand that the government systems - the VA, the Armed Services system, Medicare and Medicaid - are worse in mistakes, in poor care and in poor access to service.

What can a patient do? Two things. First, understand that when you go into the healthcare system, you are in harm's way and there are no guarantees. The practice of medicine is both science and art. The science side is more predictable, the art side is less. Maybe that's why they call it practicing.

Second, there is no substitute to minding your healthcare affairs. Pay attention. Do your homework. Have an advocate with you at all times to watch your back, especially when in the hospital. Ask questions, even uncomfortable questions, and demand good answers that make sense to you.

Of course, if you have spent much time on this website, you knew all of this already.

Healthcare Deja Vu All Over Again

Wed, 04 Aug 2010 20:05:09 GMT

Almost thirty years ago, my father entered the hospital for what the cardiac surgeons called "routine bypass surgery". It was at a prominent Atlanta hospital that had an excellent reputation for heart surgery. The surgical team was both qualified and experienced. The surgery went well.

However, the recovery kept running into small issues, nagging issues. Recovery lasted a week longer than expected, but finally the day of my father's release from the hospital arrived. I was scheduled to pick him up at 2:00 PM. About noon, the hospital called and said I better get there as soon as possible. That did not sound good.

I made the trip in record time, only to discover I was too late. I was too late before I started. While getting dressed to go home, Dad had suffered a blood clot going to his lungs. He died instantly. I was not prepared for that.

I remember it vividly because that was absolutely the toughest day of my life, so far. I have lost close family and friends, but no one closer than Dad.

A childhood friend and high school classmate recently had heart surgery. The surgery went ok, but the recovery was bothersome. Then came some infection issues and some additional surgery. To me, it just didn't feel right, but finally his condition improved and he was scheduled for release.

My high school class, which has always been very close-knit, kept informed about our ailing member through a daily email diary written by his daughter and son. Throughout their ordeal, the kids remained optimistic and upbeat. Last week, our class member was set to get out of the hospital on Tuesday. Finally, the end was in sight.

But, an emotional bomb dropped on Monday. The hospital staff discovered that some medication our patient had been given had destroyed his bone marrow, rendering his immunity system helpless. The medical staff offered no hope.

After a day, he was gone. Joy had turned to deepest despair. The family was not prepared for that. For the kids, I'll bet it was the toughest day of their lives. I remember that feeling.

What If . . . You Are Self-Insured Or Have A High Deductible And Need Affordable Care Options?

Mon, 02 Aug 2010 21:51:25 GMT

The premise of this webpage is that no one will mind your healthcare business better than you will . . . if you know how. A key element of the pursuit of such consumer-driven healthcare is the high-deductible health insurance plan with which the insured essentially self-insures the basic but affordable risk in return for reduced premium for covering the catastrophic, unaffordable risk.

This is a reflection of the underlying principle of insurance and is the most cost-effective approach to buying health insurance.

Studies have shown that consumers who direct their own healthcare effectively manage their affairs with lower costs and without reducing quality once they learn to be informed and savvy shoppers. This should come as no surprise, because Americans have been astute shoppers in every other retail venue. We just got out of the habit with healthcare.

If you have insurance, even though you have not satisfied deductible requirements, you may qualify for reduced fees and rates negotiated between your insurer and the service provider. In any event, negotiate for cash discounts. Healthcare providers that do not have to file for insurance and deal with the bureaucratic hassle are often very receptive to a quick but lesser cash payment.

If time and need are not critical factors, shop around for lower prices and better terms. You would do that to buy a car. Why not do it to get medical services or products. Even if you need a treatment or procedure that only a handful of physicians can provide, become an informed and savvy shopper before you leap.

The premise of minding your own business is most important in the hospital and healthcare facility sector. Expect hospital overcharges and phantom charges. Have the mindset that bills are confusing on purpose. Demand itemized bills that are clear and understandable. Keep you own records and compare them meticulously with invoices. Check our Medical Self Care Management section.

What If . . . You Are Between Jobs And Need Health Insurance Now?

Sat, 31 Jul 2010 12:02:44 GMT

If you have lost a job with which you had health insurance through your employer, you may be entitled to extended coverage for up to 18 months under the federal Consolidated Omnibus Budget Reconciliation Act, or COBRA. However, you have to pay the entire premium for such extended coverage. The cost is far more than most people have experienced as employees and is often beyond reach.

Because COBRA is usually so expensive, it can be a fickle remedy. Unless you, or a covered family member, have a preexisting health condition for which COBRA offers the only coverage, there are often better alternatives.

If you have are no pre-existing condition issues, a high-deductible medical benefits plan may be a more affordable permanent option. An even less expensive choice would a short term health plan. Short term plans can cover terms of 30 days up to one year.

Most short term plans are limited benefit plans, which means they are not as benefit rich as comprehensive major medical plans. That is a primary reason they are not nearly as expensive as comprehensive plans. In addition, a medical condition that develops during the short term plan period would be covered during that term but might be excluded or conditionally covered under a succeeding short term plan.

A combination of a short term plan and a supplemental plan that covers accidental injury and / or critical illness benefits can make for a very effect lower cost alternative while you search for a more permanent solution to your employment and health insurance dilemma.

Check out our information page on short term health plan considerations to see if a short term plan is a good option for you. One thing you will usually discover is that it will be better than COBRA.

What If . . . You Are Uninsurable Due To A Pre-Existing Condition?

Wed, 28 Jul 2010 20:20:40 GMT

People who have a pre-existing health condition may be rated up with a premium surcharge for some period, or may have the specific pre-existing condition excluded for a defined period, or may be declined outright for coverage. The coverage determination can vary with different companies, so it is best to apply to more than one insurer.

Impaired risk applicants who are denied private insurance coverage due to a serious medical condition have been forced to self insure or to seek relief through Medicaid, if they qualify, or through state-guaranteed high risk pools if that is available in their state of residence. All but eighteen states have such high risk pools.

With the passage of Obamacare in March, 2010, the Federal government is now offering another alternative called the Pre-existing Condition Insurance Plan, or PCIP. We have mentioned the PCIP in earlier blog articles before it even had a name. The PCIP is a four year program that will cover qualified uninsurable patients until the full implementation of Obamacare in 2014.

PCIP is a federally-funded program that calls for states to administer the fund in a manner similar to Medicaid. States are required to agree to partner with the federal government to implement the program. However, there are two major problems with the PCIP program. First, the plan was under-funded in the federal legislation. Second, any funding deficit in the plan must be borne by the partner states.

The funding issue was not accidental. It was done purposely to reduce the official cost of Obamacare in order to get it passed. The result of passing costs along to state taxpayers has kept some states from signing on to PCIP. As far as an individual patient is concerned, this does not matter. Residents of states that did not participate can apply through federal officials rather than state offices.

To qualify for the PCIP program, you must be a US citizen or lawfully present in the US. You must have been uninsured for at least six months. And, you must have been denied insurance due to a pre-existing condition. To learn more about PCIP and to apply, go to http://www.healthcare.gov/ and click on Pre-Existing Condition Insurance Plan.

Healthcare consumers who pursue the PCIP coverage should keep in mind that this is a government controlled program. As such, expect it to have all of the characteristics of a government program. Heavy on rules and regulations, but light on friendly service and responsiveness.

We have mentioned that the Obamacare plan was patterned after state insurance programs, such as Massachusetts and Tennessee. The state programs have encountered problems of funding and service shortfalls. PCIP already admits to a shortage of funding. And, anyone who expects the government to deliver good or prompt service simply lives a fantasy. Be prepared to wait.

Minding Your Healthcare Affairs - Longevity Guide: Summary

Mon, 26 Jul 2010 21:47:01 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

You cant change who you are, the fixed factors of your life. But, you can change the variable, fitness, dietary and life quality factors of how you live your life.

The Longevity Guide advisories can show you how to embrace good habits and healthy conduct that might extend your lifespan up to an additional thirteen to fifteen years. More importantly, these advisories can help you avoid or minimize harmful conduct and bad health habits that could penalize you by thirty years . That could be a potential swing of more than forty years. A lifetime of enjoyment.

Take charge of your health and your life. Nobody has more invested in it than you, and no one will do it better.

Minding Your Healthcare Affairs - Longevity Guide: Harmony

Fri, 23 Jul 2010 16:18:37 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

The Longevity Guide is an advisory to make you aware of the of the small things that you can do or avoid to improve your life experience and your lifespan.

Harmony in your daily life is vitally important to the quality and length of your life. A happy and harmonious relationship can add years to a woman's life, even more years to a man's. Compatibility and friendship are important, but so is an active and healthy sexual relationship.

For guidelines and tips that do not involve some little blue pill, check out our Life Quality Factors section.

Minding Your Healthcare Affairs - Longevity Guide: Life Quality

Mon, 19 Jul 2010 14:35:23 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

The Longevity Guide is an advisory to make you aware of the of the small things that you can do or avoid to improve your life experience and your lifespan.

For most, life quality issues become more important to us after we pass the mid-life level. Some experience a dramatic mid-life crisis. But, for most, we undergo a subtle, gradual physical deterioration. We probably notice it most in changes of clothing sizes and hair lines or color.

Eventually, we discover that we have new and more frequent aches and pains. And, at some point, we realize that we have don't recover from exertion as quickly. That's the stage at which most of us start to deal with the symptoms of aging and then the health causes that detract from life quality.

A few of our previous longevity topics have dealt with the two primary causes of reduced midlife quality - obesity and smoking. Related conditions can include diabetes and high blood pressure, which start to demand attention in our forties or fifties.

Another condition which takes on greater importance after mid life is sleep and rest. Sufficient quality rest benefits alertness, memory, problem-solving and overall health. Rest requirements that can be pushed beyond limits when you are young become much more necessary after midlife.

Our longevity guidelines on these life quality factors can offer some hints.

Minding Your Healthcare Affairs - Longevity Guide: Nutritional Factors

Fri, 16 Jul 2010 16:42:19 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

The Longevity Guide is an advisory to make you aware of the of the small things that you can do or avoid to improve your life experience and your lifespan.

Diet management primarily deals with eating the proper amounts of the right kind of foods for weight control. Nutritional management applies to eating and drinking the best food and drink for optimum health and wellness of your body, as well as avoiding intake of food, drink or diet substances that could be harmful.

Nutritional management can step on the toes of some of the popular and most abundant food products of our modern culture. That makes nutritional management even more difficult, because it's often less convenient and/or more expensive.

Check out our longevity nutritional guidelines.

Minding Your Healthcare Affairs - Longevity Guide: Diet and Weight

Tue, 13 Jul 2010 19:41:20 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

The Longevity Guide is an advisory to make you aware of the of the small things that you can do or avoid to improve your life experience and your lifespan.

Eating is one of lifes joys, if we control it. Everyone does it, so everyone has an opinion. In fact, there are so many opinions out there, it's confusing and hard to keep up with.

A fact that is not confusing, however, is the high cost of obesity. Obesity has a major negative impact on health quality, on life quality and on longevity.

Abstinence is the best course for avoiding smoking hazards, but it's not practical for avoiding obesity. To apply some common sense to the weight control issue, check out our diet management guidelines.

Minding Your Healthcare Affairs - Longevity Guide: Anti-Aging Fitness

Mon, 12 Jul 2010 21:53:08 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

The Fitness Culture Health Insurance.com website is, at its core, an information resource intended to help you know about, understand and be able to better utilize the healthcare system and health insurance options that are available to you.

As we age, the three primary issues of physical decline are reduced lung capacity, increased body fat and reduced flexibility. The short duration, alternating high intensity exertion with low intensity recovery that benefit body enhancement for younger bodies will offer similar results for older bodies.

It helps maintain higher lung capacity. It stimulates burning fat calories to maintain better body mass index. And, the recommended stretching routines before and after workouts help with the flexibility issues.

What about the longevity benefits? A Harvard study indicated that three or more workouts a week can have significant lifespan benefits.

Healthcare Reform Impact - The Coming Trainwreck

Fri, 09 Jul 2010 15:07:26 GMT

In a few previous blog comments, we referenced the Massachusetts state healthcare program which was the template used to write Obama's healthcare reform bill.

To summarize, Massachusetts healthcare officials made it mandatory for health insurers to unconditionally accept all applicants regardless of preexisting condition. Then, to control medical costs and health insurance premiums, Massachusetts political officials invoked insurance premium price controls that have no relationship to real costs.

We predicted that insurers underwriting the Massachusetts healthcare plan would be faced with the dilemma of withdrawal from the program or bankruptcy at the hands of the politicos. In the end, healthcare consumers will be left with limited access and reduced medical services, while taxpayers will face much higher taxes to pay for healthcare cost shortfalls.

On July 7, 2010, The Wall Street Journal reported on the condition of the Massachusetts healthcare plan, describing it as a "trainwreck" that foretells the future of Obamacare.

You can see the Wall Street Journal article by clicking on the following link . . .

Go to Healthcare Trainwreck.

Minding Your Healthcare Affairs - Longevity Guide: Body Enhancement Exercise

Wed, 07 Jul 2010 18:53:37 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

Recent research has revealed that long-term duration workouts in an endurance pattern often lead to overuse injuries that interrupt program participation. Exercises that alternate high-intensity exertion with short duration lower intensity rest or recovery routines offer greater benefits in burning fat, in building muscle and in developing better cardiopulmonary health.

Such alternating high-intensity, low-intensity routines also offer greater benefits with shorter workout periods as seldom as three times weekly.

Check it out.

Minding Your Healthcare Affairs - Longevity Guide: Stress Management

Tue, 06 Jul 2010 18:04:24 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

Some of the information here focuses on fitness and health as continual reminders of how to better manage those aspects of your life. The Longevity Guide is an advisory to make you aware of the of the small things that you can do or avoid to improve your life experience and your lifespan.

The Longevity Guide recognizes certain "Variable Factors" that you can embrace, or change or avoid to enhance your life experience. Variable factors can make up for many genetic, gender or age deficiencies and can constitute seventy percent or more of the weighted factor importance in the longevity and life quality equation.

Stress and anxiety are hard taskmasters that each of us face. Stress can erode our health. A variable factor is stress management, which determines how well we handle stress.

On the longevity scale, those who have a plan to manage stress and who do it well live longer. To discover more, check it out on our Variable Factors page.

Minding Your Healthcare Affairs - Longevity Guide: Retiring

Mon, 28 Jun 2010 14:12:58 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

Another variable factor is retiring. Retirement is a goal long anticipated by many people. Recent economic circumstances have forced many to change their retirement plans. Some, once retired, find that they don't like the reduced pace. They want to be more active, so they un-retire.

On the longevity scale, there is no penalty for retiring, but there is a benefit not to retire. Those who stay active, live longer. To discover more, check it out on our Variable Factors page.

Minding Your Healthcare Affairs - Longevity Guide: Smoking

Fri, 25 Jun 2010 22:15:08 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

Another prominent variable factor is smoking. Should you smoke or not? Smoking is one of the most harmful habits we inflict on ourselves. It's damage to heart and lung health are well established. In the US, smoking causes over 400,000 deaths per year. If you don't smoke, don't start. If you do smoke, abstention would be the healthiest step you could take. The benefits will begin almost immediately.

On the longevity scale, the penalty for smoking is severe. To discover more, check it out on our Variable Factors page.

Minding Your Healthcare Affairs - Longevity Guide: Alcohol

Wed, 23 Jun 2010 12:11:54 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

A prominent variable factor is alcohol. Should you drink or not? This is a moral question for some and a physical question for others. If there is history of alcoholism in your family, you should probably avoid drinking. Women with a family history of breast cancer should have reservations about partaking. If it is a moral issue, avoid temptation.

For others however, a good case can be made for the health benefits of moderate alcohol consumption. To discover more, check it out on our Variable Factors page.

Minding Your Healthcare Affairs - Longevity Guide: Family History

Tue, 22 Jun 2010 17:56:03 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

The Longevity Guide recognizes certain "fixed factors", such as your age, gender and family health history, that are facts you cannot change. They're genetic. You are born with them or have already experienced them. But, you can learn from these factors to improve your life quality and longevity by altering your actions to avoid habits or conduct that were detrimental to the health or well-being of your parents.

Taking charge of your healthcare affairs means being proactive. Check it out on our Longevity Fixed Factors.

Minding Your Healthcare Affairs - Get Help

Tue, 22 Jun 2010 17:49:46 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed.

Some of the information focuses on fitness and health. Some focuses on medical service providers and options. Some focuses on the healthcare and governmental systems. And, some focuses on information that you don't know you don't know.

When you're thrown into the healthcare system whirlpool, how can you know who to see, what to say or what questions to ask? How can you know what to do when your claim has been denied or your credit tarnished by unpaid medical bills you thought were covered? How can you find someone to be on your side in our complex healthcare system?

You could enlist an experienced and trained family member or friend. Or, you could use professional healthcare advocacy and concierge services. You can learn more about it in our Patent Care Plan section.

Minding Your Healthcare Affairs - Next, Be Proactive

Wed, 16 Jun 2010 11:40:05 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed.

Another program that offers early and continual benefits is the Medical Self Care Prevention program. This is an optional, low-cost information and advisory program that will help you evaluate and decide about health issues that you may encounter on an any day basis. A lot of money is wasted by uninformed and unmotivated patients who do not understand their symptoms. You don't have to be one of them.

You can learn more about becoming an informed healthcare consumer in our Medical Self Care Prevention section.

Minding Your Healthcare Affairs - First, Get Informed

Mon, 14 Jun 2010 19:39:41 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed.

A program that offers early and continual benefits is the Medical Self Care Affairs Management program. This is an optional, low-cost information and advisory program that will help you evaluate and decide about medical cost and value issues when you are seeking or using healthcare services. It can help you simplify options and determine the appropriate cost of services commensurate with value.

You can learn more about it in our Health Affairs Management section.

US Medical Care - What's Right? What Can We Expect?

Thu, 10 Jun 2010 22:14:33 GMT

The World Health Organization (WHO) ranks healthcare systems around the globe based on criteria a bureaucrat can love. Measurements such as average life expectancy, infant mortality, per capita health expenditures, and number of doctors relative to population. WHO also supports government-controlled health systems. Based on WHO standards, the US ranks down the list for quality at 37th out of 191 nations.

So, what has US healthcare done really well? It has the quickest, easiest access to care. It offers the greatest choice of healthcare providers. It offers the highest quality of care, especially for high tech and innovative treatment or surgery. It offer the most advanced medical research in the world.

WHO may rate American healthcare far down its list, but healthcare consumers here and abroad, who can afford the best, rate US medical care as the best. Affordability has been one valid knock on US healthcare, because we do have the most expensive medical care.

As Healthcare Reform Bill provisions take effect in the future, what can we expect? We can expect less access and longer waits for service. We can expect lower quality of care and less technical advancement. Finally, we can expect costs to go even higher, as we pay for all the government benefits and new insureds. In summary, we can expect to be more like everyone else in WHO's world. On the good side, we may rise higher on the WHO list.

Healthcare Reform Impact - Price Controls Arrive

Wed, 09 Jun 2010 14:09:20 GMT

In a previous blog comment, we revealed that the Massachusetts state healthcare program, which Obamacare copied, cost far more than projected, but the state healthcare regulators refused to approve insurer applications for premium increases. Massachusetts officials sought to force insurers to provide insurance coverage at huge losses in order to maintain premium rates at the level state officials arbitrarily thought was reasonable.

This is price control, pure and simple. It will have very predictable results. To avoid bankruptcy, the insurance carriers underwriting the Massachusetts healthcare program will withdraw, leaving no insurers and forcing taxpayers to cover the losses state officials have created by their manipulation of the free market.

In another blog comment, we mentioned that the Healthcare Reform Bill seeks to pay $136 Billion of Obamacare cost by reducing Federal government support for the Medicare Advantage program that serves more than twenty percent of seniors on Medicare.

According to The Wall street Journal, HHS Secretary Sebelius notified insurance carriers this week that she would not approve new Medicare Advantage plans that sought to increase premiums to offset the reduced Federal support of Medicare Advantage that was redirected to cover Healthcare Reform costs. In fact, Sebelius threatened insurers if they seek to pass on higher costs.

This is the same price control game plan that Massachusetts regulators followed. It will have the same result. Insurers will withdraw from the program rather than lose money on it. Higher costs will be borne by taxpayers. And, the only insurer left in the game will be the government.

Of course, many opponents of Obamacare always thought this was Obama's objective . . . government-controlled and monopolized healthcare.

If this program plays out, taxpayers will be left with higher costs, with reduced access to care and with lower quality of care.

Healthcare Reform Impact - Insurance Policy Changes

Mon, 07 Jun 2010 21:28:07 GMT

To date, June 7th, we have heard much conversation and speculation about the impact the 2010 Healthcare Reform Bill will have on insurers and insureds. Today, we got the first concrete step of change when we received notice from one of our insurance carriers that they are making an immediate change in underwriting policy, as follows:

"Effective immediately, we have implemented new underwriting guidelines for enrollees under the age of 19. For every offer we extend, we will no longer apply condition-specific deductibles or exclude coverage with special exception riders. Instead, premiums will be adjusted based on pre-existing conditions allowing these enrollees to enjoy full advantage of their policy benefits. "

What does this mean? Well, a provision of the Healthcare Reform Bill prohibits exclusions for dependent children under the age of 19 for pre-existing conditions beginning this month. So, enrollees under age 19 will be covered without special exception or exclusion riders, but premiums may be increased based on condition assessment by underwriters. This will have no effect on other underwriting standards for those up to age19.

Also, it will have no effect on any underwriting standards for individuals over age 19. What about pre existing conditions for those over 19? The Healthcare Reform Bill prohibits pre-existing condition exclusions for everyone else effective January 1, 2014. Even then, it does not prevent insurance companies from charging higher premiums to cover such pre-existing conditions. However, state and Federal regulators will have to approve future rate increases.

What about those with pre-existing conditions who can not secure insurance or who can not get coverage at an affordable premium until 2014? Beginning later this year, they can seek coverage through the Federal-subsidized high-risk pool, provided they have not been insured for at least six months.

Health Reform Impact - How Will Restrictions Affect Physicians?

Sat, 05 Jun 2010 15:43:12 GMT

As health insurance companies may be a favorite target for politicians, physicians may be a favorite target for government regulators, for insurance companies and for hospital and health management services.

Present administrative burdens forced on physician practices by government and insurance requirements already eat away more than 60 percent of the annual revenue generated by the average medical practice. Reduced fee rates for Medicare patients, as prescribed by the healthcare reform bill, could force many physicians to discontinue accepting Medicare patients.

The new healthcare reform bill requires that medical practices buy and implement Internet Technology systems to standardize and maintain more records. Such IT systems do not come cheaply and are not inexpensive to operate.

Medical malpractice insurance premiums have risen by ten to twenty percent per year. In the absence of liability reform, this is just another brick, although a large brick, that physicians must carry. Their burden is simply getting too heavy.

As a result, many experienced doctors are considering retirement or selling their practices and either going to a salary basis or just getting out of medicine. Who's buying? Hospital systems, healthcare management systems, maybe some insurance companies who see an opportunity to reduce and better control their costs for medical care services.

Five years ago, only about 25 percent of physician positions were salaried. This year, it is reported to be about 50 percent. By next year, it is forecast that 60 percent will be salaried.

Will salaried physicians, who have no vested interest in their practice, be less dedicated and involved in the care they provide? On the surface, I would say no. However, based on personal experience with government doctors compared to private practice doctors, I would take the private practice doctors every time. If you don't have the choice, you'll have to take what you can get.

Healthcare Reform Impact - How Will Restrictions Affect Health Insurers?

Wed, 02 Jun 2010 14:21:30 GMT

Health insurance companies typically need about eight percent of premium to cover administrative costs for group plans, maybe ten percent or more to administer individual and family plans. Insurers may spend another ten to twelve percent on marketing and promotion. The typical allocation for claims expense may be seventy to seventy five percent. Of course, there are taxes and government fees.

On average, health insurers operate on a profit margin of about four percent, give or take a little and depending on market conditions. The healthcare reform bill will squeeze that margin. New regulations and restrictions on health insurance companies will force the smaller and weaker carriers out of business or out of the health insurance market. Whether or not that was the intent of healthcare reform advocates is a topic of debate.

Healthcare Reform legislation requires health insurers to spend 80 percent of individual or family plan premium on medical expense claims, 85 percent of group premium on claims. It also requires insurers to broaden coverage to include costs of preventative and other services that may not previously have been covered.

These regulations will force insurers to become more efficient in their administration. They will also force insurers to cut services in other areas, to reduce profits and to eliminate non-required plan features. Some of these restrictive steps will be forced by future regulations built into the healthcare reform bill. If insurers can not spend the money necessary to implement and promote new plans, new plans will not be offered. Insurers will be forced to standardize health plan designs. This will result in narrower and more restrictive options for consumers.

Insurers are already beginning to take steps to reduce their physician networks and to restrict optional services. Expect insurers to offer fewer plans, fewer services that are not required and smaller, more restricted areas of coverage. All of this will mean lower standards of services and reduced access for consumers.

Will the new government exchanges fill the gap? In theory, perhaps, but government programs do not compare well with private programs. Given free choice, consumers almost always choose the non-government option. The problem will be that consumer choice will become limited. The ultimate problem might be the absence of any non-government option.

Healthcare Reform Impact - Higher Cost and More Restrictions - Why?

Mon, 31 May 2010 19:00:45 GMT

Many analysts of healthcare reform have concluded that this new government program, which had the expressed objectives of reducing medical cost and expanding health insurance coverage will have the opposite effects. Why is that?

The obvious answer to that question is that the healthcare reform bill provides for expanding health insurance coverage to people who have pre-existing medical conditions and/or who can not afford health insurance at normal rates. The law requires that those with health problems must be given insurance and provides for subsidizing premiums for insureds who would normally require higher rates. One effect of these demands is to increase cost of medical care because less healthy patients will be seeking it. A second effect is to spread the existing supply of medical services across a larger number of patients, thus requiring rationing of access to services or rationing of services themselves or both.

The lawmakers anticipated that their new requirements would cost more and that health insurers would offset such higher costs by charging more. So, the politicians sought to cut the insurance companies off at the pass by requiring them to reduce their non-medical expenses and to reduce profit margins while also paying for more medical and preventive services. They also required an additional future layer of governmental regulatory oversight to approve or disapprove future insurance premiums.

Lawmakers correctly assumed that the American public would not sympathize with insurance companies, So, they should have no problem turning the screws on insurers. Of course, the big problem with such a government control strategy is always those unintended consequences that both reduce services and drive up costs.

The insurance companies are certainly having to scramble in order to comply with new or coming government regulations. Their biggest challenge will be to maintain operational feasibility and financial survival. Smaller and weaker insurers will have difficulty. Some will bankrupt. Insurance plans will certainly become more restrictive. Fewer insurance companies will reduce competition, further restricting choice and increasing cost.

In seeking options for relief from restrictions imposed by healthcare reform, many insurers and large medical services providers are buying up medical practices and smaller suppliers of medical products and services. Their intent is both horizontal and vertical consolidation of services they routinely use and that are not cost restricted under healthcare reform. Their objectives are to better control and reduce their medical services costs and to increase permissible profit margins.

The net effects for patients, however, will be higher costs and more restricted services.

Healthcare Reform Impact - Individual and Family Plans

Fri, 28 May 2010 15:16:12 GMT

Healthcare consumers who buy insurance coverage in the individual or family plan market will see some coverage benefits beginning October 1, 2010, when insurers will be restricted from placing lifetime limits on the value of coverages and from revoking existing coverage.

Individuals who have preexisting conditions and who have been uninsured for at least six months will be eligible to enroll in an interim national high-risk pool which benefits from subsidized premiums through the Federal program. Beginning January 1, 2014, insurers must start accepting all applicants, including those with preexisting medical conditions.

The interim federal-subsidized high-risk pool which will be in effect from 2010 until 2014 will offer premium subsidies capped at $5,950 for individuals and $11,900 for families. It will be administered through states that agree to participate (see previous Blog entry on State High Risk Pools). It may be especially beneficial for residents of the 18 states that do not presently have high risk pools.

However, consumers with preexisting conditions who are now covered under existing state high-risk pool programs will be penalized by the requirement that they not have coverage for at least six months in order to qualify for the federal plan. The subsidy feature of the federal plan could leave those currently covered under high-risk programs trapped in a more expensive plan.

Healthcare Reform Impact - Still A Political Hot Potato

Wed, 26 May 2010 21:42:31 GMT

A Rasmussen Reports survey published on May 24,2010, indicates that 63 percent of US voters now favor repeal of the Healthcare Reform Law.

Perhaps the most interesting aspect of this survey report is that after two months of reviewing and digesting the healthcare reform features, opposition to the plan has increased from 54 to 58 percent to the present 63 percent. The more people know about the healthcare reform plan, the less they like it. In the current report, only 32 percent of Americans would oppose repeal of the plan.

What does this mean? Well, as long as Obama is in office, he will never agree to repeal his icon program. Unless the Republicans can gain and prevail with a veto-proof majority in the House and the Senate, Healthcare Reform is the Law of the Land. However, it is clearly not settled law. And, some or all of it could have difficulty getting funding by a Republican-controlled Congress. But, until November, all of this is a mute point, just fodder for discussion.

Healthcare Reform Impact: Mandates and Consequences

Mon, 24 May 2010 15:09:29 GMT

In their zeal to pander to voting consumers at the expense of the "villainous" insurance companies, the politicians who wrote the Healthcare Reform Bill took an easy path. They put a cap on the percentage of premiums that insurers can spend on expenses other than medical claims, and they limited insurer profit margin. At the same time, politicians promised voters that they could keep their health plans and their doctors if they wanted.

It is now becoming clear that all of those good intentions and promises are at cross purposes. Despite mandates, some can not and will not survive. An adage of a free marketplace is that a buyer always has the choice of balancing price, quality and delivery or access. A buyer can optimize two of those options but at the expense of the third.

Restricting the free market, as political planners favor in their pursuit of control, invariably upsets the market balance so that buyers rarely realize any optimization. Unintended consequences seem to take events in an adverse direction the planners never considered.

The unintended consequences are starting to take shape with the restrictions on health insurer operations and profits. Obamacare planners predicted that healthcare consumers would have more choice and more coverage at lower costs, all at the expense of the glutinous insurance companies everybody loves to hate. It's not going that direction.

The insurance companies are certainly under pressure because of the new restrictions on their operations. Insurers are limited to 20 percent of premiums for non-medical expenses with individual and small group plans and to 15 percent with large group plans. These percentages are below historical norms for health insurance operations and will jeopardize the financial viability of many insurers. Insurers are also being required to expand to full coverage in areas they have previously not covered.

To maintain profitability under the reform legislation, insurance carriers are focusing on reducing health insurance plan costs by limiting and standardizing the number of plans offered. Insurers are also reducing their costs for medical services by reducing and restricting their networks of physicians and service providers and by buying medical practices.

How will these events affect healthcare consumers? Reduced choice of insurance plans, more limited access to medical service providers, fewer doctors and restricted use of diagnostic services. Meanwhile, the additional requirements dictated by Obamacare will increase medical costs.

The net result? Consumers will not be able to keep their health insurance plans, because many plans will no longer be offered. Patients will not be able to keep their doctor, because the doctors will be out of practice or limited to a captive network.

Access will be more limited. Quality of care will be reduced. Costs will be higher. Instead of getting the usual free market choice of two out of three benefits, healthcare consumers are more likely to get none out of three.

Healthcare Reform Impact - Bad News For Seniors

Fri, 21 May 2010 18:27:19 GMT

Obama personally guaranteed that under Obamacare Americans would have the choice to keep their insurance if they wanted. The Centers for Medicare and Medicaid Services (CMMS) report that that is not going to work out for seniors, especially those with Medicare Advantage plans.

Service providers (hospitals and doctors) under Medicare will see their payments reduced. Unless they get relief that is not now provided, many medical service providers will be faced with the dilemma of either becoming unprofitable or of withdrawing from the Medicare program.

Restrictive provisions of Obamacare will have their greatest affect on Medicare Advantage plans. CMMS experts forecast that Medicare Advantage participation will be reduced by fifty percent by 2017. So much for keeping your favored healthcare plans.

Healthcare Reform Impact - Marriage Penalties

Wed, 19 May 2010 14:40:27 GMT

Obamacare provides that beginning in 2013 individuals who can't get health insurance from employers and who have income between 133 and 400 percent of federal poverty level (roughly between $14,000 and $43,000 per year) will qualify for government subsidies to buy insurance in government exchanges. However, the provisions harshly penalize married couples as compared to two single individuals living together.

Singles living together qualify with separate incomes up to $43,000 each. If they are married, their income limit goes down to $58,000 to still qualify for assistance. For a young couple, the marriage penalty can cost $3,451 in lost aid funds. For older adults below Medicare age, the marriage penalty could be as much as $10,425.

The highest marriage penalty falls on single mothers, one of the more unstable segments of American culture. Constituting 45 percent of households in poverty, these dysfunctional family units are a primary root of many of the social ills with which our nation now suffers. The Great Society policies nurtured the financial and cultural blight of fatherless families. Obamacare now proposes to prolong them.

Healthcare Reform Impact - Mandatory Health Insurance: When and How?

Tue, 18 May 2010 13:38:12 GMT

Healthcare Reform mandates that all individuals must have or buy healthcare insurance for themselves and their families. Failure to do so will invoke a penalty, possibly imprisonment. Politicians contend that no one will have to go to jail over this, but that condition is part of the provision.

What is not clear in the law is exactly when the mandatory insurance takes effect, how the government will know that you do or do not have coverage, and exactly what they will do about it. The only answers we have heard so far are that the Internal Revenue Service will be charged with enforcement, and that IRS is hiring 16,000 new tax agents to do the job.

Federal officials are now working on regulations to implement enforcement. The IRS says they will not audit taxpayers to see if they have bought health insurance. However, would anyone bet against IRS requiring that taxpayers substantiate that they have insurance before they can get any tax refund payment. Those new IRS agents need to have something to do.

Healthcare Reform Impact  on State High Risk Pools

Wed, 12 May 2010 15:01:04 GMT

Pre-Existing Conditions and High Risk Pools

As stated by advocates, a primary objective of Obamacare was to insure the uninsured. Those uninsured, publicized as being 47 million in number but actually closer to ten million, were described as people with pre-existing conditions, for which they could not get insurance coverage, or those who could not afford insurance.

To achieve the goal of insuring everyone, Obamacare prohibits insurers from denying coverage to patients with pre-existing conditions. However, except for dependent children under the age of 19, the pre-existing condition prohibitive requirement does not take effect until 2014.

Between now and 2014, Obamacare proposes to cover the uninsurable through a national high-risk pool administered through the states. However, the $4 Billion of funds allocated to cover the cost of this risk pool have now been estimated to be sufficient only through 2012. This shortfall of funding could dump a huge liability on state Medicaid budgets two years early. After 2014, Federal funding is proposed to be reduced, so the unfunded burden on states will become even more severe.

In view of the huge liability these unfunded mandates place on states, some states are refusing to participate. However, their withdrawal carries an unstated liability. Their state citizens will be forced to pay Medicaid taxes to the Federal government, taxes that would be used to fund the Medicaid burden for other states. We can probably count on this being challenged in court.

Many states already have high risk pools at generally high premium cost for uninsurable citizens. The Obamacare pools will be subsidized by Federal funds, so will have lower premiums for a few years. However, to qualify for participation in the new pool plans, applicants must have been without insurance for at least six months. That means that high-risk insured currently in a state pool plan can not qualify for the new Obamacare plan unless they drop out of the state plan for six months. That might make sense for government but certainly not for the uninsured.

So, in the end, the Obamacare plan to insure the uninsured falls far short of the promise, will cost far more than estimated and will leave the states with huge unfunded liabilities that will eventually break state budgets. What if many states bail out and refuse to participate? It all starts to come unglued.

Healthcare Reform Impact On Employers

Mon, 10 May 2010 19:18:16 GMT

For Employers - Confusion, Penalties, Bad News

For employers, Obamacare is highlighted by confusion over what the legislation says, what it means, what will federal regulators seek to enforce through regulations yet to be determined and what will courts ultimately decide was meant by all of this.

Several conclusions stick out. For employers, there are penalties over issues they can not control, over mandated taxes and over higher costs many can not afford. Recent surveys mentioned by The Heritage Foundation indicate that there is enough bad news to go around.

A Mercer survey indicates that 38 percent of employers have employees for whom coverage would be unaffordable under the Patient Protection and Affordable Care Act. Under regulations still to be determined by federal bureaucrats, employers could be subject to a fine of $3,000 per employee per year if that employee seeks coverage through a government insurance exchange . . . and if the employee's household income is in a certain range. Since employers have no knowledge of or control over an employee's household income, they are both blind and helpless to manage such penalties.

Employers must offer full comprehensive health coverage to any part time employees who work 30 or more hours a week. Now, 31 percent of large employers could be fined for not covering part time employees. Over 38 percent of employers with fewer than 500 employees would be candidates for such fines. The obvious option for employers here is to reduce hours for part time employees so that they never approach 30 hours a week.

So, we can expect that the bad news will not be limited to employers. Much of it will filter down to employees as employers scramble to unload their healthcare burden. That is why employees, in fact consumers of any or all descriptions, will have better results by taking charge of their own healthcare affairs and relying on neither an employer nor government.

Healthcare Reform Changes In 2010

Sat, 08 May 2010 17:53:07 GMT

Healthcare Reform changes to take effect in 2010 include:

* Prohibition of lifetime benefit limits;

* Restrictions on annual limits for essential benefits, as determined by HHS;

* Prohibition of policy recessions, unless fraud or misrepresentation is involved;

* Prohibition of cost sharing by insureds for preventive services;

* Mandated coverage for dependents up to age 26;

* Online portals by insurers to facilitate Internet shopping by consumers;

* Prohibition of pre-existing exclusions for dependent children up to age 19;

* New health plan disclosure and transparency requirements, as regulated by HHS;

* New premium rate filings by insurers will be subject to approval or disapproval by both states and HHS;

All of the above provisions are intended as consumer-friendly regulations imposed on the insurance companies. One can make a case for the need for a more consumer-friendly health insurance marketplace. However, there is no question that most of these requirements will increase the cost for insurance companies. That will drive up the cost of health insurance, not reduce it as healthcare reform advocates proclaimed was their goal.

If the state and HHS regulatory authorities do not approve premium increases through which insurance companies seek to recover their increased costs, we can expect insurers to start withdrawing from the health insurance market. Consumer choice will diminish. Fewer choices will, in turn, drive prices up even more.

We are already seeing this process take place in Massachusetts. State expanded coverage requirements have driven insurance costs higher. When insurers sought relief through premium increases, state government regulators have denied the increases. The health insurance companies are left with the choice of either going broke or withdrawing from the Massachusetts market.

Insurance carriers will not die for the benefit of pleasing state politicians. They will bail out of Massachusetts and consumers will suffer. And, we all know that the politicians will blame it on the greedy insurance companies rather than their own meddling in the free market.

Healthcare Reform Impact

Wed, 05 May 2010 16:40:09 GMT

Changes To Expect

Healthcare Reform prescribes some immediate changes in 2010 and more later in the year. Future changes will be formulated to take effect on January 1, 2011. More changes are scheduled to start on January 1, 2013. The biggest volume of changes will begin in 2014 and each year thereafter through 2018. There are no changes slated for 2012, but even that is subject to change.

Many of the provisions of the Healthcare Reform bill will be subject to regulations yet to be established by federal government bureaucrats. So, those regulations are not written, interpreted or enforced at this point Thus, they could turn the effect of the legislation in a course not presently contemplated. In addition, future legislation could radically alter the present provisions. The net result is that American healthcare consumers must be flexible until the reformed healthcare system becomes a settled issue.

Regulations effective in 2010 include the establishment of a small business tax credit to encourage small employers to offer employer-paid health insurance to employees. However, despite the tax credit, comments from small business owners, who are suffering under the current economic downturn, indicate that they cannot afford the added cost of expected higher health insurance premiums. If faced with the option of higher insurance costs or paying a lesser fine for not offering insurance coverage, most small employers expect to opt out for the fine. Employees will have to get their own personal insurance either privately or through the government exchange.

Another 2010 program will be the establishment of a National Risk Pool by the HHS Secretary to cover those with pre-existing conditions who could not otherwise get insurance. States will have the option of establishing such risk pools within their state jurisdictions and with initial funding support by the federal government. However, some states have declined to participate because they could not afford the burden once federal support expires. In the absence of a state program, the national pool will be the safety net.

Other provisions that will take effect immediately involve insurance rate review processes that will occur in both state and HHS offices. In our next offering, we will cover some of the provisions that take effect later this year.

Healthcare Reform Impact

Mon, 03 May 2010 22:49:37 GMT

Group Plans or Personal Plans?

Will healthcare reform stimulate the growth of employer-paid group insurance plans or of personal plans? Since the healthcare reform legislation was passed, much has been speculated on the probable impact of healthcare reform on employers, who have historically provided health insurance coverage for over half of America's insured.

The Reform Bill requires most employers to either offer health insurance to their employees or to pay a penalty in lieu paying the employee insurance premiums. In the past, employer-provided insurance was a recruiting benefit. However, no employer is in business to be a provider of a health benefit plan. Most view health insurance as a hot potato they would prefer to toss.

If employers can pay a penalty that is less than the health insurance premium they would dodge, many will recommend the government health insurance exchange as a much better deal for employees. That would take the onus of the health insurance burden off of the employer. And, whether the employee elects a government exchange plan or seeks private insurance coverage through another source, the employer can exit the health benefit circle with a clear conscience.

An additional factor is that most of the healthcare reform provisions will be formulated over the next few years before they take effect. Under current economic and employment conditions, the recruiting necessity of employers offering health benefits could be much less a factor in attracting employee candidates.

From the standpoint of the employee, the individual will probably be able to demand and get a higher pay rate, if the employer is not paying for health insurance. The individual is then free to select the health coverage that suits. While healthcare reform requires individuals to get health insurance, and guarantees issuance, the penalty for not get insurance is less than most premiums. So, many people may delay getting insurance until or unless they actually are ill or injured and need coverage.

This guaranteed issue requirement is an inequity that will drive health insurance premiums to much higher levels. It cries out for a fair resolution, but so far none is on the horizon. That is a flaw that will eventually have to be resolved.

Back to the initial question of will healthcare reform drive the growth of employer group plans or of individual plans, it's still a toss up. However, I saw a recent poll of professionals in the healthcare and health insurance fields. Almost three of four expect to see people moving to the personal health plan model as employers head for the exit.

Pseudo Group Health Plans

Sun, 02 May 2010 21:54:32 GMT

Pseudo Group Health Plans are low-cost substitutes

Affordable Group Health Insurance Plans

Mon, 19 Apr 2010 21:47:53 GMT

How to design an affordable group health insurance plan

Group Health Insurance Eligibility and Underwriting Factors

Mon, 19 Apr 2010 21:30:21 GMT

Manipulate group health insurance eligibility and underwriting factors to your advantage.

Group Health Insurance Cost Factors

Mon, 19 Apr 2010 21:12:26 GMT

How to control group health insurance cost factors

Dr. Appointments - Selecting A Healthcare Facility

Fri, 16 Apr 2010 14:49:28 GMT

Information by which doctors, hospitals, costs and quality of services can be compared will be better in the future than it is now. Improvements in health records and research information are under development. A medical self care service can assist in rating and selecting healthcare service providers and facilities.

In addition, you should seek to pre-determine the costs for the physician or surgeon and for the facility. How do those costs compare with area averages and with alternatives? If the costs vary from average standards, why is that?

Facilities and physicians charge different rates for different patients and plans. Think about hotels that have a published or street rate, a contract rate for volume users or special plans, and a late evening rate when they want to sell those last few rooms.

Healthcare providers also offer better rates to some patients than they do to others. Might they give you a lower price? As healthcare consumers become better value shoppers or engage better assistance services, they will gain strength in negotiating lower costs.

In regards to the medical treatment or surgical facility, professional standards reports have taken on more importance with the revelation that medical errors in the US harm 1,500,000 people and kill nearly 100,000 annually.

Federal Health and Human Services and state hospital authorities are seeking to control and reduce such medical errors. However, because such errors remain a significant problem, a prudent patient should check or have a reliable source to check Clinical Performance Reports and other compliance reports as a prerequisite when considering a healthcare facility.

Doctor Appointments: Quality and Value

Thu, 15 Apr 2010 14:23:31 GMT

Quality And Value: In healthcare, best quality might be defined as doing the right thing, at the right time, in the right way, for the right patient and having the best possible results. For a host of reasons, the quality of healthcare varies greatly.

Patients have often confused quality of services with likeability of the service providers. Patients have not had true, reliable and uniform ways to measure the services they actually received.

Healthcare value can be considered as a function of seeking the best quality services needed in a given case for the lowest possible cost. In considering healthcare value, a prudent patient must weigh the degree of quality of the service needed against its relative cost in the pursuit of optimum value.

In the past, patients have demanded highest quality services, whether or not that degree of quality was needed, without regard to cost or value. Patient perception that the cost was paid by someone else removed cost as an effective control factor in the healthcare marketplace. This has been a major contributor to inflated healthcare expenses.

In addition, when optimum healthcare value has been pursued by a patient, it was almost like chasing the wind. Quality of service has been subjective and difficult to measure, while healthcare cost comparisons have not been readily available to patients. Those circumstances are changing.

There are two standards for measuring healthcare quality Consumer Ratings and Clinical Performance Measures. Both are based on outcomes that measure results of practices and of treatments.

Consumer Ratings consider care from the patients point of view. Do the doctors and medical staff communicate well? Does the patient get the care needed? After treatment, is the patient pain-free? Can the patient carry out daily activities? Is the patient satisfied with care and results?

Clinical Performance Measures seek to rate how well healthcare service provider organizations and facilities prevent and treat illness. It applies more to facilities, such as hospitals or clinics. It relies more on compliance with professional criteria and less on patient satisfaction.

In effect, this provides a performance report card on how healthcare service providers and facilities measure up to the professional standards established by their peers. It can help you decide which service providers may, or may not, be better choices for you.

Doctor Appointments - Cost Consciousness:

Thu, 15 Apr 2010 14:19:04 GMT

Cost Consciousness: There have been two subjects that have been taboo in healthcare sex and cost.

Many patients have been reluctant to discuss sexual problems. Current culture and media practices are overcoming that timidity. Daily we see and hear more information on sexual dysfunctions and remedies than most people care to know.

If they can talk about it on TV, you ought to be able to discuss it with your doctor. If you have difficulty talking about it, try introducing the issue in a note or email, as earlier suggested.

Costs for physician fees and for medications have not been a part of patient-doctor discussions, primarily because patients have not been concerned with or liable for payment. With few exceptions, healthcare has been the only retail transaction in which the customer never asked the cost before buying, then left without paying the bill.

That has been a major reason that healthcare costs have risen so high. With the advent of consumer directed healthcare plans, patients will be much more attuned to cost factors. With Medicare patients, costs for prescription drugs are a major issue for seniors, because Medicare is a partial retail plan paid by patients.

Cost is an issue that can no longer be denied or ignored, but should be frankly discussed. Patients, or their caregivers or advocates, need to ask about it. They need to press doctors for the least expensive option that will do the job. Doctors may not be aware that cost is a problem unless they are told so.

As a patient, you should not assume that the doctor is aware of or not sensitive to your financial problems. Both patients and doctors should be prepared to discuss lower cost options if that better suits the patients. Should you encounter a physician who is not willing to help you act in your best interest, you may need to consider other options.

Addendum to Guaranteed Healthcare Loss Or Free Money

Tue, 06 Apr 2010 18:38:30 GMT

There is an addendum to our previous entry about the financial tug-of-war in Massachusetts between insurers forced to accept all comers and insureds who only seek insurance when they are ill or injured and a built-in claim. Six major insurers have filed suit against the Massachusetts State Division of Insurance which rejected premium rate increases sought by the insurers.

State officials claim that the insurers want double-digit increases that are not justified by the medical expense increases the government recognizes. In addition, the hard economic times make the requested rate hikes too difficult on the people and small employers. They think the insurance companies must sacrifice more.

The insurers complain that the insurance commission does not have the authority to unreasonably cap rates based on irrelevant information that does not recognize the losses the insurance companies have suffered from having to cover all applicants regardless of condition or circumstances. Insurers say they will lose hundreds of millions of dollars this year without rate relief.

Our question from the previous article bears repeating . . . What insurer wants to play in that game of guaranteed loss? Without relief, the answer will be none, only sooner.

Guaranteed Healthcare Loss Or Free Money?

Mon, 05 Apr 2010 19:21:03 GMT

A recent Boston Globe article gives us an insight into the type of problems we can expect with the the Obama Healthcare Reform law. The state of Massachusetts already has universal government-controlled healthcare that was a model for Obamacare. Like Obamacare, the Massachusetts version requires everyone to buy health insurance, provides for a penalty for not buying health insurance, and requires health insurance companies to offer insurance to all applicants regardless of pre-existing conditions.

The problem that has arisen in Massachusetts is that the penalty for not carrying insurance is much less than the cost of that insurance, in some cases less than twenty-five percent of premiums.

Savvy Massachusetts consumers have discovered that their lowest-cost course of action is to avoid health insurance until they are ill or injured and actually need care. Then, they apply for and must be immediately approved for coverage. They get the needed care, with the insurer paying the bulk of the cost. After recovery, the insured cancels the policy, leaving the insurance company with heavy bills and no further premium income.

For the insurer, it's a guaranteed loss. For the insured, it's free money. What insurer would want to play that game? None, a second time. That is the system Obamacare is setting up. Is it accidental, or purposeful?

To what end? No insurers will be willing to bear that burden. But, a benevolent government is apparently willing, because with it comes the control over all healthcare and all patients.

Doctor Appointments - A Failure To Communicate

Wed, 31 Mar 2010 11:50:21 GMT

Most patients are satisfied with their doctors. They feel that their doctors care about their physical and emotional well-being. However, the patient-doctor relationship is not always smooth.

There are complaints from both patients and doctors.

Patients complain that they . . .

. . . . have to wait too long in the doctors waiting room when they have an appointment;

. . . . cant schedule an appointment within a week, sometimes within a month;

. . . . dont get enough face time with the doctor during the appointment;

. . . . dont get prompt test results from the doctors office; and,

. . . . dont get prompt responses to their phone calls to the doctors office.

Doctors complain that their patients . . .

. . . . wait too long before seeking an appointment;

. . . . are reluctant to completely and candidly discuss their symptoms;

. . . . request unnecessary tests or prescriptions due to something they read or saw on TV or the Internet;

. . . . do not follow the doctors instructions and prescriptions for treatment;

. . . . ask doctors to misrepresent to insurance companies, seeking unwarranted reimbursement; and,

. . . . are not truthful in giving symptoms, in describing their actions that may have aggravated their condition and in claiming to have complied with doctor instructions.

Patients want to be good patients in the eyes of their doctors, so they tell the doctor that they are taking their medicine when they are not.

They often stop the medication because they dont like the side effects, they cant afford the cost, they didnt understand the instructions or they started feeling better and didnt complete the entire medication course.

Doctors complain that patients often lie about whether they smoke. Most patients understate how much they eat and how much they drink. They also overstate how much they exercise.

Are there health issues or symptoms that concern you but that are difficult for you to talk about or to remember to discuss with your doctor?

If so, consider advising your doctor by email a day or two before your appointment or by giving a note to the nurse prior to the doctors examination. With this pre-advice, the doctor can make a more effective and more efficient examination, while responding to your concerns.

If you are seeing a doctor for the first time, remember to bring a copy of your health record (which you should be able to get from your primary care physician or previous doctor with little or no cost), as well as any health diary and your pre-appointment work page notes.

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What If . . . You Are Between Jobs And Need Health Insurance Now?

What If . . . You Are Uninsurable Due To A Pre-Existing Condition?

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Minding Your Healthcare Affairs - Longevity Guide: Harmony

Minding Your Healthcare Affairs - Longevity Guide: Life Quality

Minding Your Healthcare Affairs - Longevity Guide: Nutritional Factors

Minding Your Healthcare Affairs - Longevity Guide: Diet and Weight

Minding Your Healthcare Affairs - Longevity Guide: Anti-Aging Fitness

Healthcare Reform Impact - The Coming Trainwreck

Minding Your Healthcare Affairs - Longevity Guide: Body Enhancement Exercise

Minding Your Healthcare Affairs - Longevity Guide: Stress Management

Minding Your Healthcare Affairs - Longevity Guide: Retiring

Minding Your Healthcare Affairs - Longevity Guide: Smoking

Minding Your Healthcare Affairs - Longevity Guide: Alcohol

Minding Your Healthcare Affairs - Longevity Guide: Family History

Minding Your Healthcare Affairs - Get Help

Minding Your Healthcare Affairs - Next, Be Proactive

Minding Your Healthcare Affairs - First, Get Informed

US Medical Care - What's Right? What Can We Expect?

Healthcare Reform Impact - Price Controls Arrive

Healthcare Reform Impact - Insurance Policy Changes

Health Reform Impact - How Will Restrictions Affect Physicians?

Healthcare Reform Impact - How Will Restrictions Affect Health Insurers?

Healthcare Reform Impact - Higher Cost and More Restrictions - Why?

Healthcare Reform Impact - Individual and Family Plans

Healthcare Reform Impact - Still A Political Hot Potato

Healthcare Reform Impact: Mandates and Consequences

Healthcare Reform Impact - Bad News For Seniors

Healthcare Reform Impact - Marriage Penalties

Healthcare Reform Impact - Mandatory Health Insurance: When and How?

Healthcare Reform Impact on State High Risk Pools

Healthcare Reform Impact On Employers

Healthcare Reform Changes In 2010

Healthcare Reform Impact

Healthcare Reform Impact

Pseudo Group Health Plans

Affordable Group Health Insurance Plans

Group Health Insurance Eligibility and Underwriting Factors

Group Health Insurance Cost Factors

Dr. Appointments - Selecting A Healthcare Facility

Doctor Appointments: Quality and Value

Doctor Appointments - Cost Consciousness:

Addendum to Guaranteed Healthcare Loss Or Free Money

Guaranteed Healthcare Loss Or Free Money?

Doctor Appointments - A Failure To Communicate

Healthcare Reform Impact  on State High Risk Pools