Home Health Helps Heal

Did you know that most Medicare expenses are utilized in the last year of life?  This fact has become more recognized as patients find themselves financially unable to afford proper services to maintain an independent quality of life.  In addition, many over 60 years of age have multiple chronic conditions.  Aging plus chronic conditions that may have become disabling can make health diagnosis and treatment less effective yet more challenging to all healthcare providers.  This also includes family and non-family caregivers who must give up their time, job, etc. to help with care that is unaffordable on a fixed income.

Home based health care is on the rise as the population ages.  More patients than ever before are transitioning to healthcare in their homes including primary care provider visits, tests, and treatment. Studies have found that home health care keeps people healthier and out of the hospital.  It is only natural that the best place to heal and recover is home.


Hospital discharge planning has prepared you for your return home. Most of your care and treatment can be at your home. The old-fashioned housecall remains an important part of medical care.  Most of all it provides continuous continuity at a time when you are unable to physically go to your healthcare providers office.  This is further enhanced with modern technology such as telemedicine.  The convenience and quality time spent with patients in home care lets the doctor, nurse practitioner, physician assistant, nurse, and other ancillary providers see you in your natural environment of everyday living.


Home health care includes personal care, too.  Often this service is necessary for help with bathing, dressing and activities of daily living.  Cooking and light housekeeping are just a few of the other services that may be offered.  Patients are able to recover comfortably and quicker when this type of home assistance is included.  Though rarely covered by regular insurance, it is an important part of any home care plan.  Saving money over the years for home personal care should be included in your financial plan especially long term.


Many primary care providers do well care in the home, too.  Minor medical maladies and routine medical care are easily rendered during a house   call. Timely appointments can be made to fit your schedule. As this method of direct primary continues patients are seeing better health outcomes especially after hospitalization.  Readmissions within thirty days are less likely.  Best of all the patient feels better and recovers more quickly.  Home based health care provides greater continuity of care and active, current communication for the patient and all those involved. Get better, stay better at your house.  Best health!

Medicare Healthcare Scare

As health costs rise so do Medicare prices at a faster rate than cost of living increases can contain. During your retirement years good healthcare is as important as ever.  Medicare is primary health insurance during this time yet the cost may be too high.  Medicare is a health plan for the elderly and disabled. Much of this specifc population is on a limited income which is usually only Social Security.  The average Social Security monthly payment for 2019 is $1461.  The average amount for Medicare can be up to one third of this average leaving less for food, rent, and other necessary living needs.

The standard part A premium for inpatient care may range from $240 to $437 and depends on the amount of Medicare taxes you have paid. If you have paid less than 7.5 years in Medicare taxes, the higher price is the premium price.  The deductible for Part A hospital coverage is $1,364 for each benefit period.  Coinsurance is $0 for first 60 days, $341 for next 30 days, and $682 for each "lifetime reserve day" (up to 60 days over your lifetime).  The patient is responsible for all costs after lifetime reserve depleted. 

The standard part B premium for outpatient care starts at $135.50 and is higher depending on income.  The deductible for this part is $185 per year.  After this has been met, payment for services is 20% of Medicare approved prices.  This can be covered with extra insurance coverage through a Medicare Advantage Plan offered by commercial health insurance companies.  If you fail to buy during the eligible enrollment periods, the premium may go up 10%. 

Regardless of who is paid for what, the result is the same.  Prices continue to increase and cover less.  For example, many home health care costs are excluded.  Home health care is important for those that are homebound or disabled.  This cost should hardly be extra on a limited income.  

Then there is Medicare part C (Medicare Advantage) and Medicare part D prescription coverage offered by regular insurance plans for an extra fee of course.  The deductibles, copayments and coinsurance are part of this as well.  Each insurere has their own plans and rates that add to your health maintenance if you can afford it.  Payment for part A and B is too much for many; therefore, medication may be omitted especially if the choice is food or medicine.

The Medicare healthcare scare is real.  What began as a "free" low cost comprehensive health program for the elderly has become a high cost less inclusive health plan for limited income retirees and peopele with disabilities.  Medicare solvency concerns have led to predictions it will be in debt within the next fifty years or so.  In the meantime, price increases with less coverage seems to be the answer for over 60 million people in their retirement years.  Best health!

Medicare:  Will It Be There When You Need It? 

http://bit.ly/bhloV2

Shoppimg for Health Insurance Limited Time Only!

Health insurance open enrollment time is here again.  For something so important, it is quite a quandary instead of a clear, concise issue.  First of all, open enrollment implies that you must wait for a certain time once a year for a sixty to ninety day period when you can shop for insurance. This is exactly what it is.  Unlike most nonmedical services you need or want, you can only shop for and get it for a limited time.  Without it you could get sicker, and pay more for your healthcare.  It would be healthier, more convenient, and make more sense to have open enrollment all year long. At one time many years ago, you could shop and get health insurance all year. Time for shopping for your health and insurance should be like shopping for other things you need.  If you had to wait to buy a car during a once a year open enrollment period, and you were without a car, what would you do? 


Health insurance is too important to have such limited access. Though the cost is high for some, most are able to procure enough to prevent bankruptcy from healthcare costs.  Once you have health insurance, you know and feel what is like to have healthcare provisions.  This is a major issue if you have been without it.  The health insurance experience is a healthy way to learn about your healthcare, and what you can do to make yourself healthier.  Many find it to be a security blanket in case of catastrophic illness, but it is also a prevention guide.


If the objective is to insure more people, limited open enrollment time once a year seems to be a contradiction to getting more people insured.  This could better serve everyone if it were provided in a timely, sensible manner if open enrollment was ongoing.  After all, your health is your most important asset.  You should be able to shop, and buy what you need when you need it beyond a limited time.  Best health!


 

Family Health: Guide Yourself to Quality Healthcare

Consumer demand, new drugs and medical technologies, litigation, higher insurance premiums, and other factors have all been fueling rising healthcare costs. At the same time, many patients justifiably feel that medical services have become increasingly impersonal. Too often, quality attention from the proverbial family doctor has been replaced by the “assembly line” approach of faceless bureaucracies. How is a patient to successfully navigate this modern maze of providers, specialists, insurers, and so forth and at the same time get the attention they need to maintain personal (not to mention financial) health? 

Patient Handbook to Medical Care: Your Personal Health Guide
offers an overview of the healthcare system from a different point of view and advises patients on how they can take their health into their own hands by becoming both informed and proactive.

As Dr. Richardson eloquently puts it:

In our society we are accustomed to taking a doctor’s word on the state of our medical condition and treatment whether or not we understand it and either without asking any questions or without getting adequate answers to the questions we might pose. Today that might not be a healthy situation. It is necessary to be informed to get the most from your health plan and to get the best medical care from the medical resources available in the healthcare system. By reading this book, you will find out how to take charge of your most important asset—you.

This philosophical perspective is that the patient, insofar as it is possible, needs to take charge of his or her health care self care. 

The book is structured in a logical, reader-friendly manner, providing overviews of all the major topics related to healthcare, from effective record keeping to obtaining quality health coverage.

The first step toward taking charge of your health is keeping accurate medical records and a medical diary. Patients are offered a detailed overview of how their doctor visit should go educating readers about all the various aspects of a routine physical or checkup.  Patients will recognize whether they are receiving quality, comprehensive care, and will know what they should be getting.  The core philosophy is that knowledge offers patients more health options and better health.  Subsequent chapters educate patients about the importance of preventive checkups, common medical tests, the various kinds of doctors and specialists, and healthcare quality.

Patient Handbook to Medical Care: Your Personal Health Guide is essential knowledge in an easy-to-assimilate large print format bound paperback book (adjustable print on e-books). Readers will walk away from the book with a much clearer idea of what to expect from the healthcare system, and what to do to ensure the preservation of their own health.  Best health!

Health Care Fiscal Physical

Back in 2002 healthcare experts made it apparent that our healthcare system was unable to serve everyone. Analysis of the situation is outlined below.

Fiscal discipline is a must. Every penny should be accounted for. In 2003 health care spending is projected to be about $1.6 trillion. In 2000 it was about $1.3 trillion (13% of GDP) compared to $73 billion (7% of GDP) in 1970. Health spending costs for 2001 were 37% for hospital outpatient, 28% for physician services,21% for prescriptions, and 14% for hospital inpatient. According to the American Hospital Association (AHA), hospitals provided $21.5 billion in uncompensated care in 2001; however, the government pays for most of health care. About 20 -30% is administrative, much being attributed to redundancy and overhead costs ("Government Share of Health Care Expenditures" by Asaf Bitton, James Kahn, M.D., M.P.H. from University of California, San Francisco - March 5, 2003, msJAMA). The CMS
estimate for 1999 government health spending is 45.2% ($548 billion). The elderly, disabled, low-income children, and some low-income adults are covered by government. Medicare and Social Security gets 7% of this amount. This is expected to double in 10 years. The average monthly health insurance premium for an individual is $255 ($3060/yr.), while that of a family is $663 ($7956/yr.) which represents a 12% increase from 2001 to 2002.

The forecast for 2004 federal budget is a record $2.7 trillion. Payroll taxes comprise 38% of the federal revenue. Taxes collected for 2003 are expected to be about $1.9 trillion (Congressional Budget Office, CBO, current budget projection report, March 7, 2003 - (www.cbo.gov). Projected health spending for 2003 is $1.6 trillion. This is over half of the budget! Furthermore, the Office of Management & Budget forecasts that the federal government will run a deficit of about $316 billion for fiscal year 2003 reaching $385 billion for 2004. This is projected to decrease in 2005 with forward projections of a $10 billion surplus by 2012. The
government debt is actually an estimated $6.4 trillion (about
$70,000/ family).

So where does this leave health costs? The HHS expense alone for 2002 is greater than the deficit ($460 billion). The majority of this ($375 billion) is for the CMS. For 2004 the projected expense for HHS is expected to be $500 billion. Other basic government allotment proposals for 2004 are: $400B for Medicare prescription program (over 10 years); $35B for uninsured (federal and state funds); $5 B for SCHIP; $2B for FDA; $60B to Dept of Defense (about $15B for aid to other nations, $21B for military health care); part of estimated $20B to rebuild Iraq (starting with a $2.5B down payment this year). There is $9 billion of “other”. There is an extra $80B approved for war costs ($62.4B to Pentagon, $4B for domestic security, $2.2B for state and local law enforcement and emergency workers; $7.9 foreign aid; $1.1B for Jordan; $1B for Israel; $1B for Turkey; “and money for Afghanistan, the Philippines and Colombia”). This includes $2.9B for airlines (many have filed for bankruptcy or are on the verge in spite of funds given after 9/11), and "for other projects pushed by lawmakers". This is money for use up to the end of the fiscal year ending 9/30/03. What are these "other" projects ($16M for SARS research and $142 M for smallpox vaccine program are $158M of this $2.9B) ? Not included in this is extra 26 weeks of unemployment for employees which was requested by some lawmakers.

So what attention will health care get if a person is unable to get a stipend to live off of while seeking employment? All of this should be itemized and accounted for with more priority given to health and well being. How much can we expect to get for our ailing health system with these other "priorities"? Perhaps much of it can be put on the backburner, while more monies are allotted for remodeling the American health care system to provide health care for all.

Excerpted from "Building An American Health System" (2003) by J. L. Richardson, M.D.

Lose Your Wealth for Health...or Die Trying

Lose your wealth, lose your health? Is draining your finances the way to live a healthy life? Medication can cost thousands of dollars especially new non-generics and injectables. Recent news reports a new one at $30,000 for treatment for one person. This was a preliminary guesstimate, mind you. It was unclear how long the treatment would take or how many shots is a cure. Perhaps this is part of the pre-debut gimmick that medicine companies produce time and again. Regardless of this scene, it is up to you and your health care basic instinct to determine how much money your health is really worth.

Is it really worth debt? Should you have to suffer health loss and financial loss? Is $30,000 a year the magic number for health care expenses? Oh wait..."I don't even make $30,000!" That's near the poverty line. Government assistance like Medicaid usually requires more. For instance, to qualify for nursing home placement you must lower your net worth by decreasing your assets to $2000. Does that qualify one for a $30,000 drug?

Great health is true wealth, but how much are you willing to pay? Death and taxes are sure bets, and so is your health.

Medicare & You: Will It Be There When You Need It

If you are in your near retirement years, I am sure you are getting ready for Medicare to take over your health care. Will it be there? By 2030 there will be about 100 million persons receiving Medicare. This is twice as many as 2008. This comes at a time when the growing demand for doctors is at a critical point. Their numbers are dwindling, especially those that accept Medicare payments for services.

Medicare is a health program that is publicly funded by the government to care for persons over 65 who have been legal residents for five years.It is a single payor program. Medicare eligibility starts at 65 years of age. If you are a person with disability, end stage kidney disease (i.e. requiring dialysis or kidney transplant), or Lou Gehrig's disease you will get benefits before age 65.

For the past few years Medicare payments to doctors have been cut by as much as 21% in 2010, while Medicare premium payments by patients have risen (along with the cost of health care!)an average of 10% per year. In addition, Medicare taxes are being prepaid through every working persons' paycheck - 2.9% of your wages to be exact (more if you make over $200,000). It would make sense that doctors and health care providers would receive increases instead of sharp cuts (pun intended). Instead doctors are quitting and looking for second careers unrelated to clinical medicine. Hospitals are closing (the small reserves for hospitals may exhausted by 2017). Clinics are downsizing and closing.

Predictions abound that Medicare will be bankrupt by 2020 to 2030, . "The latest report on the solvency of the Social Security and Medicare trust funds reveals that these entitlement programs will likely run out of money sooner than expected." (reference: Brookings Institute, 2009) Medicare alone was 13% of the federal budget (almost $400 billion) in 2009. It is projected to be near the same in 2010 with a higher cost near $500 billion! The amount spent on Medicare is likely to exceed the payroll taxes collected from your hard earned wages. Astounding data! In spite of the fact that doctors must now accept what Medicare pays them versus what they charge (traditional from 1960 to 1980), this program will be in the red.

Health care rationing may become part of the plan to cut costs and be sure all get health care. Those over 60 and those with multiple chronic conditions many of which occur just because you get old like arthritis, high blood pressure, decreased vision with cataracts, decreased hearing will be put in the long line near the end. As we live longer more health care is needed especially if we inherited the family genes for certain things like diabetes, cancer, and heart disease. Add this to the "old age" diseases and you have the equation of a Medicare patient. Of course old age is much kinder to some than others, but it happens to everyone.

Where will you go for health and medical needs when you reach 65? Medicare was supposed to be there. You worked and paid for it. So you must look after it. First and foremost, you must realize that your health is everything. Loss of function of an arm or leg, your speech or vision almost renders you dependent until you "overcome" it, if you do.

Health maintenance and wellness are vital. You must be your best health advocate by taking the time to prevent as much as possible. Routine checkups by you and your healthcare providers are very important. Early detection will prove a lifesaver if some illness is discovered. This will help you get through the Medicare years. You will be able to see your premium payments and hard work pay off, just with less Medicare and more of your money out of your pocket.

Bottom line: cut Medicare benefits or increase payroll taxes? This is truly a "beast and burden" that needs taming.

by J. L. Richardson, M.D.

Dr. Richardson is a family medicine physician, independent medical record reviewer, and author of Patient Handbook to Medical Care: Your Personal Health Guide. This book provides 112 pages (large print) of health information that will tell you what your doctor should be asking you, telling you, and doing for you - as taught in medical school and used since Hippocrates.