LinkedIn is for…? http://ow.ly/i/gTB2
On this day in 1965, President Lyndon B. Johnson signs Medicare, a health insurance program for elderly Americans, into law. At the bill-signing ceremony, which took place at the Truman Library in Independence, Missouri, former President Harry S. Truman was enrolled as Medicare’s first beneficiary and received the first Medicare card. Johnson wanted to recognize Truman, who, in 1945, had become the first president to propose national health insurance, an initiative that was opposed at the time by Congress.
The Medicare program, providing hospital and medical insurance for Americans age 65 or older, was signed into law as an amendment to the Social Security Act of 1935. Some 19 million people enrolled in Medicare when it went into effect in 1966. In 1972, eligibility for the program was extended to Americans under 65 with certain disabilities and people of all ages with permanent kidney disease requiring dialysis or transplant. In December 2003, President George W. Bush signed into law the Medicare Modernization Act (MMA), which added outpatient prescription drug benefits to Medicare.
Medicare is funded entirely by the federal government and paid for in part through payroll taxes. Medicare is currently a source of controversy due to the enormous strain it puts on the federal budget. Throughout its history, the program also has been plagued by fraud–committed by patients, doctors and hospitals–that has cost taxpayers billions of dollars.
Medicaid, a state and federally funded program that offers health coverage to certain low-income people, was also signed into law by President Johnson on July 30, 1965, as an amendment to the Social Security Act.
In 1977, the Health Care Financing Administration (HCFA) was created to administer Medicare and work with state governments to administer Medicaid. HCFA, which was later renamed the Centers for Medicare & Medicaid Services (CMS), is part of the Department of Health and Human Services and is headquartered in Baltimore.
The Pre-Existing Condition Insurance Plan makes health insurance available to people who have had a problem getting insurance due to a pre-existing condition. The Pre-Existing Condition Insurance Plan:
- Covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs.
- Does not charge you a higher premium just because of your medical condition.
- Does not base eligibility on income
Exchanges are marketplaces where consumers can do comparison shop for health insurance, similar to shopping online for airline tickets.
Sliding subsidies for private insurance on the exchanges will be available for residents who earn up to 400% of the poverty level, about $43,560 this year. Those who qualify for Medicaid, the state-federal program for the poor, will be able to sign up for it through the exchanges. Proponents of exchanges claim that buying health insurance in a free market could possibly lower prices because of increased competition.
The following are answers to some common questions about exchanges:
What is an exchange, as envisioned by the health law?
It’s a marketplace where individuals and small employers will be able to shop for insurance coverage. They must be set up by January 1, 2014. The exchanges will also direct people to Medicaid if they’re eligible.
Will all states have exchanges?
States have the option of setting up their own exchanges, forming coalitions with other states to create regional exchanges – or opting out altogether. In that case, the federal government will run the exchanges for their residents.
Will anyone be allowed to buy from the exchanges?
No. Initially, exchanges will be open to individuals buying their own coverage and employees of firms with 100 or fewer workers (50 or fewer in some states). Most Americans will continue to get insurance through their jobs, not via the exchanges. The Congressional Budget Office estimates 8.9 million people will use the exchanges in 2014 and 23.4 million in 2018. Most will be people who are eligible for subsidies, which will average an estimated $4,600 per person in 2014. Undocumented immigrants will be barred from buying insurance on the exchanges.
What about federal workers?
Members of Congress and their staffs will be required to buy through exchanges if they want coverage from the federal government. Other federal employees won’t be required to use an exchange.
Will exchanges be like travel websites or some existing health insurance sites?
In some ways. People will be able to compare policies sold by different companies. Purchasing insurance is complex and can be confusing, so information on the plan benefits will be standardized in an effort to make it easier to compare cost and quality. Plans will be divided into four different types, based on the level of benefits: bronze, silver, gold and platinum.
What will the coverage sold on the exchanges look like?
Plans will have to offer a set of “essential benefits.” Those details, still being developed by the Obama administration, will include hospital, emergency, maternity, pediatric, drug, lab services and other care. Annual cost-sharing, or the amount consumers must fork over before insurance payments kick in, will be capped at the amounts allowed for health savings accounts — currently, nearly $6,000 for individual policies and $12,000 for family plans.
How much will the policies cost?
The premiums will vary by type of plan and location. Insurers won’t be able to charge more based on gender or health status. They will be able to charge older people up to three times more than younger ones.
Will the states negotiate premiums with the insurers?
The law doesn’t require states to set or negotiate premiums. However, states may have some influence over prices. For example, states can decide whether to open exchanges to all insurers, or to limit the number. State insurance commissioners will be able to recommend whether specific insurers should be allowed to sell in the exchange, partly based on their patterns of rate increases.
What if I can’t afford the premiums?
People who earn less than 133 percent of the federal poverty level, $14,484 this year, will qualify for Medicaid in all states, under the law. Above that, sliding scale subsidies for private insurance on the exchanges will be available for residents who earn up to 400 percent of the poverty level, about $43,560 this year. Most people will be required to have coverage of some sort beginning in 2014.
Will all insurers have to offer policies through the exchange?
No. Insurers won’t be required to sell through the exchanges.
Will all state exchanges be the same?
No. States can design their exchanges differently, an issue that’s sparking debate in statehouses nationwide. Some states may choose to set additional standards for insurers beyond the federal law. Another important issue: The makeup and power of the governing boards overseeing the exchanges. Some states, such as Maryland, are considering barring insurance industry and sales agents from their governing boards. Others, like North Carolina, have pending legislation that includes representatives from those groups on their governing boards.
Source: Kaiser Health News
Since the EHR incentive program opened in January of 2011, more than $158 million has been paid for both the Medicare and Medicaid EHR incentive programs. In total, the Federal government has paid:
- $75 million for the Medicare EHR incentive program
- $83.3 million for the Medicaid EHR incentive program
The following are notable differences between the Medicare and Medicaid EHR incentive programs:
|Federal Government will implement (will be an option nationally)||Voluntary for States to implement (may not be an option in every State)|
|Payment reductions begin in 2015 for providers that do not demonstrate Meaningful Use||No Medicaid payment reductions|
|Must demonstrate Meaningful Use Year 1||Adopt, implement and upgrade option for 1st participation year|
|Maximum incentive is $44,000 for Eligible Professionals (10% bonus for Eligible Professional in Health Professional Shortage Area)||Maximum incentive is $63,750 for Eligible Professionals|
|Meaningful Use definition is standard for Medicare||States can adopt certain additional requirements for Meaningful Use|
|Last year a provider may initiate program is 2014; Last year to register is 2016; Payment adjustments begin in 2015||Last year a provider may initiate program is 2016; Last year to register is 2016|
|Eligible Professionals include:
…and subsection (d) hospitals and Critical Access Hospitals (CAHs).
|Eligible Professionals include:
…and acute care hospitals (including CAHs) and children’s hospitals.
In order to receive the Medicare or MediCaid EHR incentive payments, follow the steps below:
- Successfully register for the Medicare EHR Incentive Program;
- Meet meaningful use criteria using certified EHR technology (Check to see if your software is certified under the EHR incentive program at: http://onc-chpl.force.com/ehrcert); and
- Successfully attest, using CMS’ Web-based system, that you have met meaningful use criteria using certified EHR technology.
The following is a listing of the 20 free iPhone medical applications (apps) for health care professionals which was compiled by iMedicalApps. Not only these apps could be useful but they could also be used to obtain CMEs.
Medscape is an app with 7,000+ drug references, 3,500+ disease clinical references, 2,500+ clinical images and procedure videos, robust drug interaction tool checker, CME activities, and more.
This is a prescription medical reference app.
3. New England Journal of Medicine
The NEJM app allows access to the last 7 days worth of published articles, along with images of various medical conditions and videos on how to perform procedures such as LPs and chest tubes. NEJM has weekly audio summaries and the selection of four full text audio reads of clinical practice articles which can be accessed via a podcast format as well.
Epocrates is one of the best medical reference tools in the mobile format. The free version of Epocrates, Epocrates Rx, provides great content: Drug monographs and health plan formularies, drug interaction tool, pill identifier, medical Calculator, and a new addition: Medical News and handpicked clinical articles.
5. Calculate (Medical Calculator) by QxMD
Medical calculator app.
6. Radiology 2.0: One night in the ED
This is a case learning radiology tool based on content organized by Dr. Daniel Cornfeld, an Assistant Professor of Diagnostic Radiology at Yale University School of Medicine who specializes in Body and Emergency Medicine Imaging.
7. Skyscape: RxDrugs and OCM (Outlines in Clinical Medicine)
The free offerings from Skyscape are in the form of RxDrugs and OCM. RxDrugs is basically a drug reference tool, while OCM(outlines of Clinical Medicine) contains information on disease pathology.
8. Living Medical Textbooks
There are actually 5 Living Medical Textbooks, ranging in topics from Diabetes to Multiple Sclerosis. The chapters are updated when noteworthy new medical data or research is introduced in medicine.
9. Medical Radio
ReachMD has an XM Satellite Radio broadcast (XM 160) stationthat allows medical professionals to do CME activities and keep up to date on new literature.
Neuromind is a production of Pieter Kubben, a Dutch neurosurgeon who is a clinician, researcher, and software engineer. His application is a simple reference tool for neurologists, neurosurgeons, and other clinicians who need reference material for neuro based pathologies.
11. Prognosis: Your Diagnosis
Prognosis is an app from Medical Joyworks — produced out of Sri Lanka, where one of the goals of the developers of the app was to “make medicine fun”. The level of clinical content is more suited for medical students and paramedics, and is not advanced enough for residents and those in higher training.
12. Harvard’s Public Health News App
The Harvard School of Public Health News app features news articles from the School of Public Health.
13. Radiopaedia – Radiology Teaching Files – Lite
The application is based on the website, Radiopaedia.org— a free radiology resource written by the radiology community.
14. Ahrq ePSS
This is a public health tool provided to health care professionals by the US Department of Health and Human Services (HHS) — from the Agency for Healthcare Research and Quality (AHRQ) — the nation’s lead federal agency for research on health care quality, costs, outcomes, and patient safety. The application allows to input a patient’s age, along with other key demographic information, and gives back the basic screening and public health information pertinent for the patient. Much of the content is based on the recommendations made by the United States Preventative Services Task Force (USPSTF). The app also provides great links to screening calculators and reference tools available on the web.
15. Dragon Medical Search
Dragon Medical Search allows a user to say the phrase of a drug or clinical disease, and the user is given a roulette of resources, including ICD9 codes, to read. The aggregated data is from Medscape, Medline, and others sources.
16. Epocrates – Calculators
Epocrates offers the following calculators for free: GFR calculator, BMI tool, STAT cholesterol, CardioMath Tool and Seattle Heart Failure Risk Calc. A useful app for specialists.
17. MedPage Today
MedPage Today is a resource for medical professionals, and a lot of the content is in partnership with the University of Pennsylvania School of Medicine.
Doximity — The “Facebook for doctors”. Doximity is a private network exclusively for physicians and medical students. Technically, the app allows the user to connect with old classmates to reminisce old times via its secured text message server, but its aim is more serious in nature.
19. Drop Box
Drop Box is technicallynot a medical app — but it can be used to help in the medical workflow. It is basically an online storage that could be accessed from anywhere.
20. 3D Brain and Lose it
3D brainis an app derived from the Genes to Cognition Online website, funded by the Dana Foundation and Hewlett Foundation.
Lose It is a great application to use when counseling patients on their diet and exercise.
The Center for Medicare & Medicaid Services (CMS) issued a proposed rule that makes significant changes to the e-prescribing penalty program by adding more exemptions categories so that physicians are not unfairly penalized.
The previous rules required physicians in individual practices to submit at least 10 Medicare Part B claims with the electronic measure code eRx G8553 and an eligible encounter code by June 30, 2011, or face a claims payment reduction of 1 percent in 2012.
Physicians are still required to e-prescribe using a qualifying system and electronic measure code; but, through an online web portal, will have an opportunity to show eligibility for one of the following exemptions:
- Physician’s practice is located in a rural area without high speed internet access;
- Physician’s practice is located in an area without sufficient available pharmacies for electronic prescribing;
- Physician is registered to participate in the Medicare or Medicaid electronic health record incentive (EHR) program and has adopted certified EHR technology;
- Physician is unable to electronically prescribe due to local, state or federal law or regulation (e.g., prescribes controlled substances);
- Physician infrequently prescribes (e.g., prescribe fewer than 10 prescriptions between January 1, 2011, and June 30, 2011); and
- There are insufficient opportunities to report the e-prescribing measure due to program limitations
Physicians will have to apply for an exemption from the 2012 e-prescribing penalty via the online web-portal by October 1, 2011.
The proposed rule can be viewed at the Office of the Federal Register website. It will be published in the Federal Register on June 1, 2011. The comment period closes July 25, 2011.