Hospitals are Charging Medicare Profoundly Different Amounts

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Have you ever walked out of a hospital visit with a smile only to look at the medical bill and frown?

New data shows that you’re not the only one, and there are some interesting imbalances tilting against you in regards to health care billing and Medicare reimbursements.

This data, regarding more than 3,000 hospitals across the United States that receive Medicare Inpatient Prospective Payment System (IPPS) for the one hundred most common in-patient diagnoses upon discharge, has been analyzed and published.

The Medicare Severity Diagnosis Related Group (MS-DRG) of the 2011 fiscal year was used for this research with the explicit underlying goal of increasing the awareness of the public in a way that increases systemic accountability and ultimately improves clinical outcomes.

This emerging news is controversial and reveals a substantial disparity in medical costs for the same diagnoses and medical services both across the nation and even also between hospitals within specific communities. In other words, the White House has shared with the public concrete knowledge that similar diagnoses and disease managements are being charged differently by different institutions, a fact that is unlikely to be explained by quality-of-care or better health outcomes.

While these systemic inequalities may be interesting to know, it is also important to note that this new data is describing only charges and not reimbursements of Medicare to the different hospitals. Medicare provides relatively similar payments to all hospitals for similar procedures based on the MS-DRG. So some hospitals are charging more despite what Medicare reimburses.

Furthermore, there are certain diagnoses with more consistent charges and fee schedules nationwide (example: Heart attacks) than others (example: Hip replacement). The two major reasons for variable payment schedules among hospital are: 1. Being a teaching hospital and 2. Providing care to a higher percentage of individuals from a lower income.

Again, what is disclosed here is a demonstrative list of the charges of the top 100 diagnoses upon discharges. And when you, as a Medicare recipient look at the information and ask, “what does that have to do me?” the most important thing to do is to get contract with a health insurance provider that will advocate for your best care and quality of care with the smallest out-of-pocket expenses possible.

Financial Market News February 20, 2013

imgres-1Fed 1/30/2013 Minutes released today

Fed officials are split on future for Fed’s MBS and T-Bill purchase program.  Fed officials did state that program will continue until improvement happens in labor market. Specifically, unemployment rate declines to 6.5, as long as inflation remains below 2.5%.  However, minutes also reveal concerns of the cost of the program might end the program sooner then the labor market goals are reached.

5 Top Regrets People Have At the End of Their Lives

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5 Top Regrets People Have At the End of Their Lives | Alternet.

The Guardian / By Susie Steiner

A palliative nurse has recorded the top five regrets of the dying.

February 15, 2013

There was no mention of more sex or bungee jumps. A palliative nurse who has counselled the dying in their last days has revealed the most common regrets we have at the end of our lives. And among the top, from men in particular, is ‘I wish I hadn’t worked so hard’.

Bronnie Ware is an Australian nurse who spent several years working in palliative care, caring for patients in the last 12 weeks of their lives. She recorded their dying epiphanies in a blog called “Inspiration and Chai” which gathered so much attention that she put her observations into a book called  The Top Five Regrets of the Dying.

Ware writes of the phenomenal clarity of vision that people gain at the end of their lives, and how we might learn from their wisdom. “When questioned about any regrets they had or anything they would do differently,” she says, “common themes surfaced again and again.”

Here are the top five regrets of the dying, as witnessed by Ware:

1. I wish I’d had the courage to live a life true to myself, not the life others expected of me.

“This was the most common regret of all. When people realise that their life is almost over and look back clearly on it, it is easy to see how many dreams have gone unfulfilled. Most people had not honoured even a half of their dreams and had to die knowing that it was due to choices they had made, or not made. Health brings a freedom very few realise, until they no longer have it.”

2. I wish I hadn’t worked so hard.

“This came from every male patient that I nursed. They missed their children’s youth and their partner’s companionship. Women also spoke of this regret, but as most were from an older generation, many of the female patients had not been breadwinners. All of the men I nursed deeply regretted spending so much of their lives on the treadmill of a work existence.”

3. I wish I’d had the courage to express my feelings.

“Many people suppressed their feelings in order to keep peace with others. As a result, they settled for a mediocre existence and never became who they were truly capable of becoming. Many developed illnesses relating to the bitterness and resentment they carried as a result.”

4. I wish I had stayed in touch with my friends.

“Often they would not truly realise the full benefits of old friends until their dying weeks and it was not always possible to track them down. Many had become so caught up in their own lives that they had let golden friendships slip by over the years. There were many deep regrets about not giving friendships the time and effort that they deserved. Everyone misses their friends when they are dying.”

5. I wish that I had let myself be happier.

“This is a surprisingly common one. Many did not realise until the end that happiness is a choice. They had stayed stuck in old patterns and habits. The so-called ‘comfort’ of familiarity overflowed into their emotions, as well as their physical lives. Fear of change had them pretending to others, and to their selves, that they were content, when deep within, they longed to laugh properly and have silliness in their life again.”

Who's Not Happy About Paying For Increases in Health Insurance Costs!

urlWASHINGTON — Many young, healthy Americans could soon see a jump in their health-insurance costs, and insurance companies are saying: It’s not our fault.

The nation’s insurers are engaged in an all-out, last-ditch effort to shield themselves from blame for what they predict will be rate increases on new policies they must unveil this spring to comply with President Barack Obama’s health-care law.

Insurers point to several reasons that premiums will rise. They will soon be required to offer more-comprehensive coverage than many currently provide. Also, their costs will increase because they will be barred from rejecting the sick, and they will no longer be allowed to charge older customers sharply higher premiums than younger ones.

Supporters of the law counter that concerns about price hikes are overstated, partly because federal subsidies will cushion the blow.

The insurers’ public relations blitz is being propelled by a growing cast of executives, lobbyists, conservative activists and state health officials. They increasingly use the same catchphrase — “rate shock” — to warn about the potential for price surges.

Aetna chief executive Mark Bertolini invoked the term at his company’s recent annual investor conference, cautioning that premiums for plans sold to individuals could rise as much as 50 percent on average and could more than double for particular groups such as the young and healthy.

The danger of “rate shock” has also become the favored weapon of conservative opponents of the law, repeated in a drumbeat of op-eds and policy papers in recent weeks.

The argument is a powerful one because the success of the law, which was the signature domestic accomplishment of Obama’s first term, depends on enough people signing up for insurance, particularly healthy people. The issue is surfacing as the most recent significant challenge in implementing the health-care overhaul.

Supporters of the law complain that the warnings amount to a smear attack by special interests and political partisans, akin to earlier claims that the law would allow bureaucrats to deny life-saving care to save money.

” ‘Rate shock’ is the new ‘death panels,’ ” said Wendell Potter, a former head of communications for the health insurer Cigna who is now a critic of the industry. “They’ve chosen these words very carefully to scare people. It’s the ideal term for what is, at its core, a fear-based campaign.”

Yet even analysts who favor the law concede that it will result in higher costs for some young, healthy people.

Most of the new rules that could push up premiums will not apply to plans sponsored by large employers, only to those sold to individuals and small businesses. These policies will be available on insurance marketplaces, or “exchanges,” that the law sets up in each state beginning in 2014, and that are ultimately expected to serve about 26 million people.

Upgrade Senior Lifestyle with a Reverse Mortgage

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How do you envision your retirement years– pursuing hobbies, enjoying family gatherings, traveling, renovating your home? Or maybe you’re simply focused on achieving financial independence for the rest of your life. Considering your current goals and financial situation, you may still be deciding when you can actually retire if you haven’t already done so.

Lifestyle Up To Par

Even if you’ve planned, saved and invested carefully, circumstances beyond your control or a change in your priorities can result in a gap between your current retirement income and the funds you need to meet your goals. Now is the time to consider all of your options and make the right decisions to ensure your dreams are within your grasp. Fortunately, there is a solution that provides you with tax-free cash by tapping into the equity in your home: a Reverse Mortgage.

A Reverse Mortgage Can Help

A Reverse Mortgage is an innovative government-insured loan that enables you to tap some of your home’s existing equity to obtain cash to help fund your retirement needs. Reverse Mortgage’s have helped thousands of homeowners just like you remain in their homes (mortgage payment free), throughout their retirement years.

Is It Right For You?

To determine if a Reverse Mortgage is right for you, evaluate your finances and goals:

  • current budget
  • future finances
  • lifestyle needs and desires
  • personal goals
  • how long you plan to live in your home
  • how important it is to you to leave home equity to your heirs

The timing of your decision is important, since the amount of your loan will be based on the value of your home, your age and other factors. It is usually best to consult a trusted financial advisor and a licensed Reverse Mortgage loan advisor to help you determine the best option for you.

 

Is Love and Marriage Healthier?

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February being the month for the heart and Valentines Day still fresh in our minds.  Falling in Love stimulates 3 main neurotransmitters in the brain adrenaline, dopamine and serotonin.  Therefore, when you begin to fall in love, Love goes beyond lust and becomes scientific.

As everyone is looking for the perfect mate and then devotes their lives to one another for long-term.  The question then becomes:  Is marriage really healthy for one another long-term?

Increasingly, Americans are opting out of marriage. A fairly recent report from the Pew Research Institute revealed that the number of new marriages is down 5% from 2009 to 2010 and that barely half of all adults in the United States are currently married.

The median age at first marriage for brides has reached a new peak of 26.5 years and for grooms it is also at its highest point at 28.7 years. That is quite different from 1960 when median ages at first marriage for new brides was 20.3 years and for grooms it was 22.8.

According to the Pew Institute report, 72% of all adults over the age of 18 were married in 1960. Today that percentage is down to 51%.

If we look at the 50 years since 1960 while the number of marriages was on the decline, world-wide life expectancy went from 52.6 in 1960 to 69.4 years in 2012. In addition, since 1960, there have been reductions in death due to chronic diseases such as heart disease and stroke. Unfortunately, according to the CDC, we are seeing little decline or even a slight increase in deaths due to diabetes, chronic lung disease and chronic kidney disease. We all know that obesity is, well, spreading.

This short digression brings me back to my original question: Is marriage good for you? Here is what the research shows.

A 2006 article published in the Journal of Epidemiology and Community Health found that people who have never married have the highest risk of death in the United States. The study also found that compared with married people, people divorced or separated are 27% more likely to die, and people who have never married 58% more likely to die.

But what about couples who just live together. They cohabitate and seem to be just like married couples, but they aren’t married. That is certainly an increasingly common experience in the United States and worldwide. A recent study published in the Journal of Marriage and Family addressed this issue.

The study found that divorced, widowed and never-married white men had higher mortality rates than cohabiting white men, and never-married black men had higher mortality rates than cohabiting black men. In contrast, the mortality rates of non-married white and black women were not different from those of their cohabiting counterparts. Interestingly, the results also revealed that mortality rates of married white men and women were lower than their cohabiting counterparts and that these mortality differences tended to decrease with age. Married black men or women did not live significantly longer than their cohabiting counterparts. So gender and race do play a role, but in general, marriage increases longevity.

Additional studies have also found that married couples experience lower rates of heart disease, cancers, Alzheimer’s and depression and married people live longer if they get these diseases. All this does seem to say there is a marriage advantage.

Staying married also seems to be good for your health. A 2009 study in the Journal of Health and Social Behavior tracked nearly 9,000 men and women in their 50s and 60s. The researchers found that when married couples became single again by either divorce or death of a spouse, their physical health declined and they never fully recovered. In fact, they were 20% more likely to develop a chronic health issue like heart disease and diabetes than those still married to their first wife or husband by middle age. The divorced or widowed individuals also had more problems going up and down stairs or walking longer and in general aged less gracefully.

What happens if those widowed or divorced individuals remarry? The study above seemed to suggest that healed their increased risk of depression as much as staying continuously married, but the remarried continued to experience 12% more chronic disease and 19% more mobility problems.

This brings me to the subject of whether or not to get a divorce. There is a down side to remaining in a hostile, negative marriage. An article in JAMA Psychiatry proved that couples in these types of hostile marriages suffer emotionally and physically. Their immune systems become suppressed just as in any chronically stressful experience. It becomes the drip-drip of a stress torture test and that isn’t healthy or happy. The more hostile the relationship, the greater the impact on health.

So in the afterglow of this years Valentines Day, which the February 14th issue of the WSJ defined as an $18.6 Billion industry, what have we learned about the health benefits of marriage?

Here’s my advice. From a physical and emotional perspective, you are best off being happily married. No question about it. If you are unhappily married, try to work it out. If you either can’t or won’t work it out, it’s better to get out. But in order to not get to that point, don’t go for the jugular; don’t punch below the belt. Arguments are best recovered from if there is civility; some element of touch, some words of endearment rather than total hostility. “Sweetheart, you are making me mental!” is a much better retort than, “You %*$!#. Try to make up. Try to reconcile. Try to balance the emotional ledger. If both parties are committed, it’s never to late to repair. Marriage is good for your health. 

Full ArticleDr. Mache Seibel

Creative Communication? No, it is a Lie! Obamacare & Medicare Spending

imgresObamacare supporters tend to give credit to the law where credit is not due. In the latest attempt, Senate Budget Committee Chairman Patty Murray (D–WA) tried to link lower projections for Medicare and Medicaid spending to the Affordable Care Act.
During today’s hearing on the recent Congressional Budget Office (CBO) report, Chairman Murray said:
As I was reading through the report, one section really got my attention …which was the discussion of the change in health spending in recent years. In fact, I stopped and underlined one statistic because I found it so surprising. The statistic is that CBO has lowered its estimate of federal spending for Medicare and Medicaid to such a degree that spending for 2020—one year is now $200 billion lower than CBO thought back in 2010, an improvement of 15 percent.
And let’s be clear, that improvement has occurred since enactment of the Affordable Care Act.
It is unfortunate that Chairman Murray didn’t keep reading because the very next paragraph of the report states:
Spending projections also have been affected by legislative action—most notably as a result of the Affordable Care Act…. From 2010 to the present, those other types of revisions boosted the estimates of outlays for Medicare and Medicaid in 2020 by $72 billion, or about 5 percent. (The Affordable Care Act also created new subsidies for some people to purchase health insurance through exchanges, adding $115 billion to the estimate for federal outlays for health care programs in 2020, according to CBO’s current projections.)
So spending is estimated to decrease for Medicare and Medicaid in 2020 by $200 billion but Obamacare spends an extra $187 billion more than would have been spent in the absence of the law. Thus, whatever “savings” were projected have been gobbled up by Obamacare and its massive new spending.
And don’t let the CBO’s estimate distract from the major issue of health spending. As Heritage pointed out last week, in just two years, “[s]pending on Medicare, Medicaid, Obamacare subsidies, and the Children’s Health Insurance Program will be greater than all other spending—including Social Security and defense spending.” Obamacare alone contributes $1.6 trillion over the next 10 years towards this huge problem.
Furthermore, a future decrease in Medicare spending is contingent upon the continuation of Obamacare’s $716 billion in Medicare cuts—which is unlikely. In 2020 alone, payments to Part A providers are estimated by the CBO to be reduced by $75 billion. Lowering provider reimbursement rates to Obamacare’s levels will have severe impacts on seniors’ ability to access care, which is already being seen. Congress is likely to override these cuts to protect Medicare beneficiaries, much like they do with Medicare physician payment rates each year.
The bottom line is that Obamacare does not decrease spending on health care, no matter which pieces of information Chairman Murray leaves out.
Posted in Featured, Health Care
Full Article Featured Alyene Senge

Who? What? Where? Why? Retirement?

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Who?

Who do you want to be when you retire?  What does retirement look like for yourself ?  Who will you be enjoying your daily activities with?

Be proactive about your “Golden Years”!  Before you retire build a picture of the true YOU and  who you want to be!  Be sure to write it down as this is what you have been working all these years for.  More importantly stay focused on the new You!

Who will you be retiring with?   You will be leaving behind all your colleagues at work and after work social events.  Therefore, building a social network prior to retiring is essential.  Connect with those who you have known but could not catch up with because you were to busy with work.  More then likely they are in the same situation as you. They too, now find themselves having to rebuild their social part life back up. Who knows, your re-connecting will be a warm and re-energizing welcome.  Also, before retiring become members of clubs and/or communities.  Reaching out prior to retirement there is more of a likely hood that you will be successful at your own retirement!

What?

What defines exactly what retirement means to you?  Irrespectively of how old you are, you probably have a vague idea of what retirement really means to you.  Again, visualize exactly what you want your life to be so you will be able to plan carefully for it. What is the minimum income you will need to cover all your basic of expenses(medical, housing, travel, long-term care, insurance, lifestyle, etc)?

What activities will you do? What do you want to accomplish from your bucket list? What kind of lifestyle do you want?  If you intend to travel the world in style, find out how much it would cost and multiply that by two just to make sure that you supersede your intended financial targets.

What kind of senior citizen do you want to be?  Having a pre determined plan will help you to make this transition successful and exceeding all of your expectations into a wonderful retirement.

 Where?

You have been tied to a job and you will be free to go anywhere.  Where will you want to live?  When you get there, what will it look like? Will it be in some retirement friendly location with warm weather?  Its time to dream, but it is also time to get serious about where you see yourself.   Successful retirement begins with a vision and ends with a plan.

Why?imgres-3

Why do you want to retire? What motivating factors are influencing you to retire?  If your retiring early, why? Why, is making a plan early so important?

Most importantly, make sure your “Why’s” are answered before you take any steps toward retirement.

Plan

Do not fall into the trap of thinking that you still have time, irrespectively of your age.  That is a step toward failure to your senior years as it is also a recipe of disaster if the unexpected should happen.

Planning ahead makes it easier to  make necessary adjustments if needed.  Also planning ahead allows for time and inaccurate assumptions to be clarified.  Start today!

Dreams turn into reality by taking proactive steps forward, however, small they might be its to achieve your desired end.

 

Medicare Hearing Coverage: Hearing Aids, Auditory Implants and Medicare Coverage Policy

hearing-loss-medicare-imageAccording to a study in a  Journal of the American Medical Association (JAMA)  article from 2012, over 30% of adult older than 65 years sensorineural hearing loss, also called presbycusis and as many as 70% of those older than 85 years found to have it (Ann R. Punnoose, MD; Cassio Lynm, MA; and Robert M. Golub, MD.   JAMA. 2012;307(11):1215. doi:10.1001/jama.2012.185. jamanetwork.com)

What is the best, reasonable treatment for these serious hearing-related conditions? First, hearing can be improved with a hearing aid.

Hearing aids are amplifying devices that compensate for impaired hearing. Hearing aids include air conduction devices that provide acoustic energy to the cochlea via stimulation of the tympanic membrane with amplified sound. They also include bone conduction devices that provide mechanical energy to the cochlea via stimulation of the scalp with amplified mechanical vibration or by direct contact with the tympanic membrane or middle ear ossicles.

Certain devices that produce perception of sound by replacing the function of the middle ear, cochlea or auditory nerve are payable by Medicare as prosthetic devices. These devices are indicated only when hearing aids are medically inappropriate or cannot be utilized due to congenital malformations, chronic disease, severe sensorineural hearing loss or surgery.

The following are prosthetic devices:

  • Cochlear implants and auditory brainstem implants, i.e., devices that replace the function of cochlear structures or auditory nerve and provide electrical energy to auditory nerve fibers and other neural tissue via implanted electrode arrays.
  • Osseointegrated implants, i.e., devices implanted in the skull that replace the function of the middle ear and provide mechanical energy to the cochlea via a mechanical transducer.

Medicare contractors deny payment for an item or service that is associated with any hearing aid as defined above. See §180 for policy for the medically necessary treatment of complications of implantable hearing aids, such as medically necessary removals of implantable hearing aids due to infection.

Despite this high prevalence of hearing impairment and/or deafness and its impact on individual quality of life, and the fact that hearing aid are very effective, for the most part Medicare does not cover hearing aid.

Here is the policy:

Hearing Aids and Auditory Implants Medicare Coverage Policy

(Rev. 39; Issued: 11-10-05; Effective: 11-10-05; Implementation: 12-12-05)

Section 1862(a)(7) of the Social Security Act states that no payment may be made under part A or part B for any expenses incurred for items or services “where such expenses are for . . . hearing aids or examinations therefore. . . .” This policy is further reiterated at 42 CFR 411.15(d) which specifically states that “hearing aids or examination for the purpose of prescribing, fitting, or changing hearing aids” are excluded from coverage.

This problem is was featured in a CNN Health article less than a year ago, and indeed hearing loss an ‘invisible,’ and widely uninsured, problem.

Medigap Coverage of Pre-Existing Conditions

medigap pre-existing condition guaranteed issue enrollment picture of familyMedigap protections — or guaranteed issue rights — are rules that require insurance companies to sell you Gap insurance coverage even if you have pre-existing medical conditions. As a general rule you have about 60 calendar days to join a new gap insurance company after you had to drop a previous coverage. Below we have provided the details of seven different case scenarios that give you the right to buy a gap insurance and to be covered for past or present health problems, according to the Medicare website.

 

medicare medigap pre-existing conditions guaranteed issue coverage scenarios

You can also call or go online to your State Health Insurance Assistance Program (SHIP) to learn more about the administered laws and protected rights for attaining Gap insurance coverage in your state.