Patient Abandonment – Home Health Care

Elements of the Cause of Action for Abandonment

Each of the following five elements must be present for a patient to have a proper civil cause of action for the tort of abandonment:

1. Health care treatment was unreasonably discontinued.

2. The termination of health care was contrary to the patient’s will or without the patient’s knowledge.

3. The health care provider failed to arrange for care by another appropriate skilled health care provider.

4. The health care provider should have reasonably foreseen that harm to the patient would arise from the termination of the care (proximate cause).

5. The patient actually suffered harm or loss as a result of the discontinuance of care.

Physicians, nurses, and other health care professionals have an ethical, as well as a legal, duty to avoid abandonment of patients. The health care professional has a duty to give his or her patient all necessary attention as long as the case required it and should not leave the patient in a critical stage without giving reasonable notice or making suitable arrangements for the attendance of another. [2]

Abandonment by the Physician

When a physician undertakes treatment of a patient, treatment must continue until the patient’s circumstances no longer warrant the treatment, the physician and the patient mutually consent to end the treatment by that physician, or the patient discharges the physician. Moreover, the physician may unilaterally terminate the relationship and withdraw from treating that patient only if he or she provides the patient proper notice of his or her intent to withdraw and an opportunity to obtain proper substitute care.

In the home health setting, the physician-patient relationship does not terminate merely because a patient’s care shifts in its location from the hospital to the home. If the patient continues to need medical services, supervised health care, therapy, or other home health services, the attending physician should ensure that he or she was properly discharged his or her-duties to the patient. Virtually every situation ‘in which home care is approved by Medicare, Medicaid, or an insurer will be one in which the patient’s ‘needs for care have continued. The physician-patient relationship that existed in the hospital will continue unless it has been formally terminated by notice to the patient and a reasonable attempt to refer the patient to another appropriate physician. Otherwise, the physician will retain his or her duty toward the patient when the patient is discharged from the hospital to the home. Failure to follow through on the part of the physician will constitute the tort of abandonment if the patient is injured as a result. This abandonment may expose the physician, the hospital, and the home health agency to liability for the tort of abandonment.

The attending physician in the hospital should ensure that a proper referral is made to a physician who will be responsible for the home health patient’s care while it is being delivered by the home health provider, unless the physician intends to continue to supervise that home care personally. Even more important, if the hospital-based physician arranges to have the patient’s care assumed by another physician, the patient must fully understand this change, and it should be carefully documented.

As supported by case law, the types of actions that will lead to liability for abandonment of a patient will include:

• premature discharge of the patient by the physician

• failure of the physician to provide proper instructions before discharging the patient

• the statement by the physician to the patient that the physician will no longer treat the patient

• refusal of the physician to respond to calls or to further attend the patient

• the physician’s leaving the patient after surgery or failing to follow up on postsurgical care. [3]

Generally, abandonment does not occur if the physician responsible for the patient arranges for a substitute physician to take his or her place. This change may occur because of vacations, relocation of the physician, illness, distance from the patient’s home, or retirement of the physician. As long as care by an appropriately trained physician, sufficiently knowledgeable of the patient’s special conditions, if any, has been arranged, the courts will usually not find that abandonment has occurred. [4] Even where a patient refuses to pay for the care or is unable to pay for the care, the physician is not at liberty to terminate the relationship unilaterally. The physician must still take steps to have the patient’s care assumed by another [5] or to give a sufficiently reasonable period of time to locate another prior to ceasing to provide care.

Although most of the cases discussed concern the physician-patient relationship, as pointed out previously, the same principles apply to all health care providers. Furthermore, because the care rendered by the home health agency is provided pursuant to a physician’s plan of care, even if the patient sued the physician for abandonment because of the actions (or inactions of the home health agency’s staff), the physician may seek indemnification from the home health provider. [6]

ABANDONMENT BY THE NURSE OR HOME HEALTH AGENCY

Similar principles to those that apply to physicians apply to the home health professional and the home health provider. A home health agency, as the direct provider of care to the homebound patient, may be held to the same legal obligation and duty to deliver care that addresses the patient’s needs as is the physician. Furthermore, there may be both a legal and an ethical obligation to continue delivering care, if the patient has no alternatives. An ethical obligation may still exist to the patient even though the home health provider has fulfilled all legal obligations. [7]

When a home health provider furnishes treatment to a patient, the duty to continue providing care to the patient is a duty owed by the agency itself and not by the individual professional who may be the employee or the contractor of the agency. The home health provider does not have a duty to continue providing the same nurse, therapist, or aide to the patient throughout the course of treatment, so long as the provider continues to use appropriate, competent personnel to administer the course of treatment consistently with the plan of care. From the perspective of patient satisfaction and continuity of care, it may be in the best interests of the home health provider to attempt to provide the same individual practitioner to the patient. The development of a personal relationship with the provider’s personnel may improve communications and a greater degree of trust and compliance on the part of the patient. It should help to alleviate many of the problems that arise in the health care’ setting.

If the patient requests replacement of a particular nurse, therapist, technician, or home health aide, the home health provider still has a duty to provide care to the patient, unless the patient also specifically states he or she no longer desires the provider’s service. Home health agency supervisors should always follow up on such patient requests to determine the reasons regarding the dismissal, to detect “problem” employees, and to ensure no incident has taken place that might give rise to liability. The home health agency should continue providing care to the patient until definitively told not to do so by the patient.

COPING WITH THE ABUSIVE PATIENT

Home health provider personnel may occasionally encounter an abusive patient. This abuse mayor may not be a result of the medical condition for which the care is being provided. Personal safety of the individual health care provider should be paramount. Should the patient pose a physical danger to the individual, he or she should leave the premises immediately. The provider should document in the medical record the facts surrounding the inability to complete the treatment for that visit as objectively as possible. Management personnel should inform supervisory personnel at the home health provider and should complete an internal incident report. If it appears that a criminal act has taken place, such as a physical assault, attempted rape, or other such act, this act should be reported immediately to local law enforcement agencies. The home care provider should also immediately notify both the patient and the physician that the provider will terminate its relationship with the patient and that an alternative provider for these services should be obtained.

Other less serious circumstances may, nevertheless, lead the home health provider to determine that it should terminate its relationship with a particular patient. Examples may include particularly abusive patients, patients who solicit -the home health provider professional to break the law (for example, by providing illegal drugs or providing non-covered services and equipment and billing them as something else), or consistently noncompliant patients. Once treatment is undertaken, however, the home health provider is usually obliged to continue providing services until the patient has had a reasonable opportunity to obtain a substitute provider. The same principles apply to failure of a patient to pay for the services or equipment provided.

As health care professionals, HHA personnel should have training on how to handle the difficult patient responsibly. Arguments or emotional comments should be avoided. If it becomes clear that a certain provider and patient are not likely to be compatible, a substitute provider should be tried. Should it appear that the problem lies with the patient and that it is necessary for the HHA to terminate its relationship with the patient, the following seven steps should be taken:

1. The circumstances should be documented in the patient’s record.

2. The home health provider should give or send a letter to the patient explaining the circumstances surrounding the termination of care.

3. The letter should be sent by certified mail, return receipt requested, or other measures to document patient receipt of the letter. A copy of the letter should be placed in the patient’s record.

4. If possible, the patient should be given a certain period of time to obtain replacement care. Usually 30 days is sufficient.

5. If the patient has a life-threatening condition or a medical condition that might deteriorate in the absence of continuing care, this condition should be clearly stated in the letter. The necessity of the patient’s obtaining replacement home health care should be emphasized.

6. The patient should be informed of the location of the nearest hospital emergency department. The patient should be told to either go to the nearest hospital emergency department in case of a medical emergency or to call the local emergency number for ambulance transportation.

7. A copy of the letter should be sent to the patient’s attending physician via certified mail, return receipt requested.

These steps should not be undertaken lightly. Before such steps are taken, the patient’s case should be thoroughly discussed with the home health provider’s risk manager, legal counsel, medical director, and the patient’s attending physician.

The inappropriate discharge of a patient from health care coverage by the home health provider, whether because of termination of entitlement, inability to pay, or other reasons, may also lead to liability for the tort of abandonment. [8]

Nurses who passively stand by and observe negligence by a physician or anyone else will personally become accountable to the patient who is injured as a result of that negligence… [H]ealthcare facilities and their nursing staff owe an independent duty to patients beyond the duty owed by physicians. When a physician’s order to discharge is inappropriate, the nurses will be help liable for following an order that they knew or should know is below the standard of care. [9]

Similar principles may apply to make the home health provider vicariously liable, as well.

Liability to the patient for the tort of abandonment may also result from the home health care professional’s failure to observe, examine, assess, or monitor a patient’s condition. [10] Liability for abandonment may arise from failing to take timely action, as well as failing to summon a physician when a physician is needed. [11] Failing to provide adequate staff to meet the patient’s needs may also constitute abandonment on the part of the HHA. [12] Ignoring a patient’s complaints and failing to follow a physician’s orders may likewise constitute a tort of abandonment for a nurse or other professional staff member.

1. Lee v. Dewbre, 362 S.W.2d 900 (Tex. Civ. App. 7th Dist. 1962).

2. Kattsetos v. Nolan, 368 A.2d 172 (Conn. 1976).

3. 61 AM. Jur. 2d, Physicians and Surgeons § 237 (1981).

4. See, e.g., Tripp v. Pate, 271 S.E.2d 407 (N.C. App. 1980).

5. Ricks v. Budge, 64 P.2d 208 (Utah 1937).

6. M.D. Nathanson, Home Healthcare Answer Book: Legal Issues for Providers 212 (1995).

7. See, generally, E.P. Burnzeig, The Nurse’s Liability for Malpractice (1981).

8. Sheryl Feutz-Harter, Nursing Caselaw Update: In appropriate Discharging of Patients, 2 J. Nursing L. 49 (1995).

9. Id., 53.

10. See, e.g., Pisel v. Stamford Hosp., 430 A.2d1 (Conn. 1980) (nurses were held liable for failing to monitor the condition of a patient).

11. See, e.g., Sanchez v. Bay General Hosp., 172 Cal. Rptr. 342 (Cal. App. 1981); Valdez v. Lyman-Roberts Hosp., Inc. 638 S.W. 2d 111 (Tex. 1982).

12. Czubinsky v. Doctors Hosp., 188 CAl. Rptr. 685 (1983).

Florida Health Insurance Rate Hikes and Quotes

Florida Health Insurance Rate Hike

Florida Health insurance premiums have touched new heights! Every Floridian has the common knowledge that most annual health insurance contracts will endure a rate increase at the end of the year. This trend is not new and should be expected. Every time this issue pops up it seems as though the blame game starts. Floridians blame Health insurance companies; Health insurance companies blame Hospitals, Doctors and other medical care providers, Medical care providers blame inflation and politicians, well, we really don’t know what they do to help the issue… No one seems to be interested in finding the real cause of the health insurance premium rate increase. Most individuals, self employed, and small business owners have taken Florida Health Insurance Rate Hikes as the inevitable evil.

Hard Facts

What are various reports telling us? Why do Health insurance premium have annual rate increases?

Rate of inflation and heath insurance premium rate increase.

America’s health expenditure in the year 2004 has increased dramatically, it has increased more than three time the inflation rate. In this year the inflation rate was around 2.5% while the national health expenses were around 7.9%. The employer health insurance or group health insurance premium had increased approximately 7.8% in the year 2006, which is almost double the rate of inflation. In short, last year in 2006, the annual premiums of group health plan sponsored by an employer was around $4,250 for a single premium plan, while the average family premium was around $ 11,250 per year. This indicates that in the year 2006 the employer sponsored health insurance premium increased 7.7 percent. Taking the biggest hit were small businesses that had 0-24 employees. There health insurance premiums increased by nearly 10.4%

Employees are also not spared, in the year 2006 the employee also had to pay around $ 3,000 more in their contribution to employer’s sponsored health insurance plan in comparison to the previous year, 2005. Rate hikes have been in existence since the “Florida Health Insurance” plan started. In covering an entire family of four, a person will experience an increase in premium rate at every annual renewal. If they would have kept the record of their health insurance premium payments they will find that they are now paying around $ 1,100 more than they paid in the year 2000 for the same coverage and with the same company. The same item was found by the Health Research Educational Trust and the Kaiser Family Foundation in their survey report of the year 2000. They found out that the premiums of health insurance that is sponsored by the employer increases by around 4 times than the employee’s salary. This report also stated that since 2000 the contribution of employees in group health insurance sponsored by employer was increased by more than 143 percent.

One business man predicts that if nothing is done and the Health insurance premiums keep increasing that in the year 2008, the amount of health premium contribution to employer will surpass their profit. Professionals within and outside the field of Florida health insurance, think that the reason for increase in Florida health insurance premium rates are due to many factors, such as high administration expenditure, inflation, poor or bad management, increase in the cost of medical care, waste etc.

Florida health insurance rate hikes affect whom?

Rising rates of Florida health insurance generally affects most of the Floridians who live in our beautiful state. The highest affected individudals are the minimum wage and low wage workers. Recent drops in the renewal of health insurance are mostly from this low income group. They just can’t afford the high premiums of Florida health insurance. They are in the situation where they can not afford the medical care and they can not afford the medical insurance premiums that are assosiated with adequate coverage. Almost half of all Americans are of the opinion that they are more worried about the high health insurance rate and high cost of health care, over any other bill they have on a monthly basis. A survey also finds that around 42% of Americans can not afford the high cost of health care services. There is one very interesting study conducted by Harvard University researchers. They found out that 68% of people who filed bankruptcy covered themselves and their family by health insurance. Average out-of-pocket deductibles for people filed bankruptcy were around $ 12,000 per year. They also found some co-relation between medical expenditure and bankruptcy. A national survey also reports that main reason for people not to take health insurance is the high premium rate of health insurance.

How to reduce Florida’s high health insurance cost? Nobody knows for sure. There are different opinions and experts are not agreeing with each other. Health professionals believe that if we can raise the number of healthy people by improving the lifestyle and regular exercise, good diets etc. than naturally they will need less medical care services which decreases the demands of health care and hence the cost.( This year in Florida the smoking rate has increased by 21.7 percent) One Floridian sarcastically suggested that there are ‘highs’ and ‘lows’ in health care that are needed to reversed. That the state of Florida is to ‘high’ in cost of medical care compare to other States and ‘low’ in the quality of health care.

Florida Health insurance rate hike has attracted many frauds. These frauds float many bogus insurance companies and offer cheap health insurance rate which attract many people to them. These companies usually through assosiations that are based in other states.

Meanwhile reputable Florida health insurance companies provide different types of health insurance like employer sponsored group health insurance, small business health insurance, individual health insurance etc. to vast number of employees and their families. Still there are many people in Florida that lack any health coverage. Today the employer also has found it challenging to decide how to offer employer sponsored group health insurance to their employees, so that both of them arrive at some point of agreement.

Small Business Health Insurance – The Best Policy Is A Great Agent

I have been a health insurance broker for over a decade and every day I read more and more “horror” stories that are posted on the Internet regarding health insurance companies not paying claims, refusing to cover specific illnesses and physicians not getting reimbursed for medical services. Unfortunately, insurance companies are driven by profits, not people (albeit they need people to make profits). If the insurance company can find a legal reason not to pay a claim, chances are they will find it, and you the consumer will suffer. However, what most people fail to realize is that there are very few “loopholes” in an insurance policy that give the insurance company an unfair advantage over the consumer. In fact, insurance companies go to great lengths to detail the limitations of their coverage by giving the policy holders 10-days (a 10-day free look period) to review their policy. Unfortunately, most people put their insurance cards in their wallet and place their policy in a drawer or filing cabinet during their 10-day free look and it usually isn’t until they receive a “denial” letter from the insurance company that they take their policy out to really read through it.

The majority of people, who buy their own health insurance, rely heavily on the insurance agent selling the policy to explain the plan’s coverage and benefits. This being the case, many individuals who purchase their own health insurance plan can tell you very little about their plan, other than, what they pay in premiums and how much they have to pay to satisfy their deductible.

For many consumers, purchasing a health insurance policy on their own can be an enormous undertaking. Purchasing a health insurance policy is not like buying a car, in that, the buyer knows that the engine and transmission are standard, and that power windows are optional. A health insurance plan is much more ambiguous, and it is often very difficult for the consumer to determine what type of coverage is standard and what other benefits are optional. In my opinion, this is the primary reason that most policy holders don’t realize that they do not have coverage for a specific medical treatment until they receive a large bill from the hospital stating that “benefits were denied.”

Sure, we all complain about insurance companies, but we do know that they serve a “necessary evil.” And, even though purchasing health insurance may be a frustrating, daunting and time consuming task, there are certain things that you can do as a consumer to ensure that you are purchasing the type of health insurance coverage you really need at a fair price.

Dealing with small business owners and the self-employed market, I have come to the realization that it is extremely difficult for people to distinguish between the type of health insurance coverage that they “want” and the benefits they really “need.” Recently, I have read various comments on different Blogs advocating health plans that offer 100% coverage (no deductible and no-coinsurance) and, although I agree that those types of plans have a great “curb appeal,” I can tell you from personal experience that these plans are not for everyone. Do 100% health plans offer the policy holder greater peace of mind? Probably. But is a 100% health insurance plan something that most consumers really need? Probably not! In my professional opinion, when you purchase a health insurance plan, you must achieve a balance between four important variables; wants, needs, risk and price. Just like you would do if you were purchasing options for a new car, you have to weigh all these variables before you spend your money. If you are healthy, take no medications and rarely go to the doctor, do you really need a 100% plan with a $5 co-payment for prescription drugs if it costs you $300 dollars more a month?

Is it worth $200 more a month to have a $250 deductible and a $20 brand name/$10 generic Rx co-pay versus an 80/20 plan with a $2,500 deductible that also offers a $20 brand name/$10generic co-pay after you pay a once a year $100 Rx deductible? Wouldn’t the 80/20 plan still offer you adequate coverage? Don’t you think it would be better to put that extra $200 ($2,400 per year) in your bank account, just in case you may have to pay your $2,500 deductible or buy a $12 Amoxicillin prescription? Isn’t it wiser to keep your hard-earned money rather than pay higher premiums to an insurance company?

Yes, there are many ways you can keep more of the money that you would normally give to an insurance company in the form of higher monthly premiums. For example, the federal government encourages consumers to purchase H.S.A. (Health Savings Account) qualified H.D.H.P.’s (High Deductible Health Plans) so they have more control over how their health care dollars are spent. Consumers who purchase an HSA Qualified H.D.H.P. can put extra money aside each year in an interest bearing account so they can use that money to pay for out-of-pocket medical expenses. Even procedures that are not normally covered by insurance companies, like Lasik eye surgery, orthodontics, and alternative medicines become 100% tax deductible. If there are no claims that year the money that was deposited into the tax deferred H.S.A can be rolled over to the next year earning an even higher rate of interest. If there are no significant claims for several years (as is often the case) the insured ends up building a sizeable account that enjoys similar tax benefits as a traditional I.R.A. Most H.S.A. administrators now offer thousands of no load mutual funds to transfer your H.S.A. funds into so you can potentially earn an even higher rate of interest.

In my experience, I believe that individuals who purchase their health plan based on wants rather than needs feel the most defrauded or “ripped-off” by their insurance company and/or insurance agent. In fact, I hear almost identical comments from almost every business owner that I speak to. Comments, such as, “I have to run my business, I don’t have time to be sick! “I think I have gone to the doctor 2 times in the last 5 years” and “My insurance company keeps raising my rates and I don’t even use my insurance!” As a business owner myself, I can understand their frustration. So, is there a simple formula that everyone can follow to make health insurance buying easier? Yes! Become an INFORMED consumer.

Every time I contact a prospective client or call one of my client referrals, I ask a handful of specific questions that directly relate to the policy that particular individual currently has in their filing cabinet or dresser drawer. You know the policy that they bought to protect them from having to file bankruptcy due to medical debt. That policy they purchased to cover that $500,000 life-saving organ transplant or those 40 chemotherapy treatments that they may have to undergo if they are diagnosed with cancer.

So what do you think happens almost 100% of the time when I ask these individuals “BASIC” questions about their health insurance policy? They do not know the answers! The following is a list of 10 questions that I frequently ask a prospective health insurance client. Let’s see how many YOU can answer without looking at your policy.

1. What Insurance Company are you insured with and what is the name of your health insurance plan? (e.g. Blue Cross Blue Shield-“Basic Blue”)

2. What is your calendar year deductible and would you have to pay a separate deductible for each family member if everyone in your family became ill at the same time? (e.g. The majority of health plans have a per person yearly deductible, for example, $250, $500, $1,000, or $2,500. However, some plans will only require you to pay a 2 person maximum deductible each year, even if everyone in your family needed extensive medical care.)

3. What is your coinsurance percentage and what dollar amount (stop loss) it is based on? (e.g. A good plan with 80/20 coverage means you pay 20% of some dollar amount. This dollar amount is also known as a stop loss and can vary based on the type of policy you purchase. Stop losses can be as little as $5,000 or $10,000 or as much as $20,000 or there are some policies on the market that have NO stop loss dollar amount.)

4. What is your maximum out of pocket expense per year? (e.g. All deductibles plus all coinsurance percentages plus all applicable access fees or other fees)

5. What is the Lifetime maximum benefit the insurance company will pay if you become seriously ill and does your plan have any “per illness” maximums or caps? (e.g. Some plans may have a $5 million lifetime maximum, but may have a maximum benefit cap of $100,000 per illness. This means that you would have to develop many separate and unrelated life-threatening illnesses costing $100,000 or less to qualify for $5 million of lifetime coverage.)

6. Is your plan a schedule plan, in that it only pays a certain amount for a specific list of procedures? (e.g., Mega Life & Health & Midwest National Life, endorsed by the National Association of the Self-Employed, N.A.S.E. is known for endorsing schedule plans) 7. Does your plan have doctor co-pays and are you limited to a certain number of doctor co-pay visits per year? (e.g. Many plans have a limit of how many times you go to the doctor per year for a co-pay and, quite often the limit is 2-4 visits.)

8. Does your plan offer prescription drug coverage and if it does, do you pay a co-pay for your prescriptions or do you have to meet a separate drug deductible before you receive any benefits and/or do you just have a discount prescription card only? (e.g. Some plans offer you prescription benefits right away, other plans require that you pay a separate drug deductible before you can receive prescription medication for a co-pay. Today, many plans offer no co-pay options and only provide you with a discount prescription card that gives you a 10-20% discount on all prescription medications).

9. Does your plan have any reduction in benefits for organ transplants and if so, what is the maximum your plan will pay if you need an organ transplant? (e.g. Some plans only pay a $100,000 maximum benefit for organ transplants for a procedure that actually costs $350-$500K and this $100,000 maximum may also include reimbursement for expensive anti-rejection medications that must be taken after a transplant. If this is the case, you will often have to pay for all anti-rejection medications out of pocket).

10. Do you have to pay a separate deductible or “access fee” for each hospital admission or for each emergency room visit? (e.g. Some plans, like the Assurant Health’s “CoreMed” plan have a separate $750 hospital admission fee that you pay for the first 3 days you are in the hospital. This fee is in addition to your plan deductible. Also, many plans have benefit “caps” or “access fees” for out-patient services, such as, physical therapy, speech therapy, chemotherapy, radiation therapy, etc. Benefit “caps” could be as little as $500 for each out-patient treatment, leaving you a bill for the remaining balance. Access fees are additional fees that you pay per treatment. For example, for each outpatient chemotherapy treatment, you may be required to pay a $250 “access fee” per treatment. So for 40 chemotherapy treatments, you would have to pay 40 x $250 = $10,000. Again, these fees would be charged in addition to your plan deductible).

Now that you’ve read through the list of questions that I ask a prospective health insurance client, ask yourself how many questions you were able to answer. If you couldn’t answer all ten questions don’t be discouraged. That doesn’t mean that you are not a smart consumer. It may just mean that you dealt with a “bad” insurance agent. So how could you tell if you dealt with a “bad” insurance agent? Because a “great” insurance agent would have taken the time to help you really understand your insurance benefits. A “great” agent spends time asking YOU questions so s/he can understand your insurance needs. A “great” agent recommends health plans based on all four variables; wants, needs, risk and price. A “great” agent gives you enough information to weigh all of your options so you can make an informed purchasing decision. And lastly, a “great” agent looks out for YOUR best interest and NOT the best interest of the insurance company.

So how do you know if you have a “great” agent? Easy, if you were able to answer all 10 questions without looking at your health insurance policy, you have a “great” agent. If you were able to answer the majority of questions, you may have a “good” agent. However, if you were only able to answer a few questions, chances are you have a “bad” agent. Insurance agents are no different than any other professional. There are some insurance agents that really care about the clients they work with, and there are other agents that avoid answering questions and duck client phone calls when a message is left about unpaid claims or skyrocketing health insurance rates.

Remember, your health insurance purchase is just as important as purchasing a house or a car, if not more important. So don’t be afraid to ask your insurance agent a lot of questions to make sure that you understand what your health plan does and does not cover. If you don’t feel comfortable with the type of coverage that your agent suggests or if you think the price is too high, ask your agent if s/he can select a comparable plan so you can make a side by side comparison before you purchase. And, most importantly, read all of the “fine print” in your health plan brochure and when you receive your policy, take the time to read through your policy during your 10-day free look period.

If you can’t understand something, or aren’t quite sure what the asterisk (*) next to the benefit description really means in terms of your coverage, call your agent or contact the insurance company to ask for further clarification.

Furthermore, take the time to perform your own due diligence. For example, if you research MEGA Life and Health or the Midwest National Life insurance company, endorsed by the National Association for the Self Employed (NASE), you will find that there have been 14 class action lawsuits brought against these companies since 1995. So ask yourself, “Is this a company that I would trust to pay my health insurance claims?

Additionally, find out if your agent is a “captive” agent or an insurance “broker.” “Captive” agents can only offer ONE insurance company’s products.” Independent” agents or insurance “brokers” can offer you a variety of different insurance plans from many different insurance companies. A “captive” agent may recommend a health plan that doesn’t exactly meet your needs because that is the only plan s/he can sell. An “independent” agent or insurance “broker” can usually offer you a variety of different insurance products from many quality carriers and can often customize a plan to meet your specific insurance needs and budget.

Over the years, I have developed strong, trusting relationships with my clients because of my insurance expertise and the level of personal service that I provide. This is one of the primary reasons that I do not recommend buying health insurance on the Internet. In my opinion, there are too many variables that Internet insurance buyers do not often take into consideration. I am a firm believer that a health insurance purchase requires the level of expertise and personal attention that only an insurance professional can provide. And, since it does not cost a penny more to purchase your health insurance through an agent or broker, my advice would be to use eBay and Amazon for your less important purchases and to use a knowledgeable, ethical and reputable independent agent or broker for one of the most important purchases you will ever make….your health insurance policy.

Lastly, if you have any concerns about an insurance company, contact your state’s Department of Insurance BEFORE you buy your policy. Your state’s Department of Insurance can tell you if the insurance company is registered in your state and can also tell you if there have been any complaints against that company that have been filed by policy holders. If you suspect that your agent is trying to sell you a fraudulent insurance policy, (e.g. you have to become a member of a union to qualify for coverage) or isn’t being honest with you, your state’s Department of Insurance can also check to see if your agent is licensed and whether or not there has ever been any disciplinary action previously taken against that agent.

In closing, I hope I have given you enough information so you can become an INFORMED insurance consumer. However, I remain convinced that the following words of wisdom still go along way: “If it sounds too good to be true, it probably is!” and “If you only buy on price, you get what you pay for!”

Rebuilding the Tower of Babel – A CEO’s Perspective on Health Information Exchanges

Defining a Health Information Exchange

The United States is facing the largest shortage of healthcare practitioners in our country’s history which is compounded by an ever increasing geriatric population. In 2005 there existed one geriatrician for every 5,000 US residents over 65 and only nine of the 145 medical schools trained geriatricians. By 2020 the industry is estimated to be short 200,000 physicians and over a million nurses. Never, in the history of US healthcare, has so much been demanded with so few personnel. Because of this shortage combined with the geriatric population increase, the medical community has to find a way to provide timely, accurate information to those who need it in a uniform fashion. Imagine if flight controllers spoke the native language of their country instead of the current international flight language, English. This example captures the urgency and critical nature of our need for standardized communication in healthcare. A healthy information exchange can help improve safety, reduce length of hospital stays, cut down on medication errors, reduce redundancies in lab testing or procedures and make the health system faster, leaner and more productive. The aging US population along with those impacted by chronic disease like diabetes, cardiovascular disease and asthma will need to see more specialists who will have to find a way to communicate with primary care providers effectively and efficiently.

This efficiency can only be attained by standardizing the manner in which the communication takes place. Healthbridge, a Cincinnati based HIE and one of the largest community based networks, was able to reduce their potential disease outbreaks from 5 to 8 days down to 48 hours with a regional health information exchange. Regarding standardization, one author noted, “Interoperability without standards is like language without grammar. In both cases communication can be achieved but the process is cumbersome and often ineffective.”

United States retailers transitioned over twenty years ago in order to automate inventory, sales, accounting controls which all improve efficiency and effectiveness. While uncomfortable to think of patients as inventory, perhaps this has been part of the reason for the lack of transition in the primary care setting to automation of patient records and data. Imagine a Mom & Pop hardware store on any square in mid America packed with inventory on shelves, ordering duplicate widgets based on lack of information regarding current inventory. Visualize any Home Depot or Lowes and you get a glimpse of how automation has changed the retail sector in terms of scalability and efficiency. Perhaps the “art of medicine” is a barrier to more productive, efficient and smarter medicine. Standards in information exchange have existed since 1989, but recent interfaces have evolved more rapidly thanks to increases in standardization of regional and state health information exchanges.

History of Health Information Exchanges

Major urban centers in Canada and Australia were the first to successfully implement HIE’s. The success of these early networks was linked to an integration with primary care EHR systems already in place. Health Level 7 (HL7) represents the first health language standardization system in the United States, beginning with a meeting at the University of Pennsylvania in 1987. HL7 has been successful in replacing antiquated interactions like faxing, mail and direct provider communication, which often represent duplication and inefficiency. Process interoperability increases human understanding across networks health systems to integrate and communicate. Standardization will ultimately impact how effective that communication functions in the same way that grammar standards foster better communication. The United States National Health Information Network (NHIN) sets the standards that foster this delivery of communication between health networks. HL7 is now on it’s third version which was published in 2004. The goals of HL7 are to increase interoperability, develop coherent standards, educate the industry on standardization and collaborate with other sanctioning bodies like ANSI and ISO who are also concerned with process improvement.

In the United States one of the earliest HIE’s started in Portland Maine. HealthInfoNet is a public-private partnership and is believed to be the largest statewide HIE. The goals of the network are to improve patient safety, enhance the quality of clinical care, increase efficiency, reduce service duplication, identify public threats more quickly and expand patient record access. The four founding groups the Maine Health Access Foundation, Maine CDC, The Maine Quality Forum and Maine Health Information Center (Onpoint Health Data) began their efforts in 2004.

In Tennessee Regional Health Information Organizations (RHIO’s) initiated in Memphis and the Tri Cities region. Carespark, a 501(3)c, in the Tri Cities region was considered a direct project where clinicians interact directly with each other using Carespark’s HL7 compliant system as an intermediary to translate the data bi-directionally. Veterans Affairs (VA) clinics also played a crucial role in the early stages of building this network. In the delta the midsouth eHealth Alliance is a RHIO connecting Memphis hospitals like Baptist Memorial (5 sites), Methodist Systems, Lebonheur Healthcare, Memphis Children’s Clinic, St. Francis Health System, St Jude, The Regional Medical Center and UT Medical. These regional networks allow practitioners to share medical records, lab values medicines and other reports in a more efficient manner.

Seventeen US communities have been designated as Beacon Communities across the United States based on their development of HIE’s. These communities’ health focus varies based on the patient population and prevalence of chronic disease states i.e. cvd, diabetes, asthma. The communities focus on specific and measurable improvements in quality, safety and efficiency due to health information exchange improvements. The closest geographical Beacon community to Tennessee, in Byhalia, Mississippi, just south of Memphis, was granted a $100,000 grant by the department of Health and Human Services in September 2011.

A healthcare model for Nashville to emulate is located in Indianapolis, IN based on geographic proximity, city size and population demographics. Four Beacon awards have been granted to communities in and around Indianapolis, Health and Hospital Corporation of Marion County, Indiana Health Centers Inc, Raphael Health Center and Shalom Health Care Center Inc. In addition, Indiana Health Information Technology Inc has received over 23 million dollars in grants through the State HIE Cooperative Agreement and 2011 HIE Challenge Grant Supplement programs through the federal government. These awards were based on the following criteria:1) Achieving health goals through health information exchange 2) Improving long term and post acute care transitions 3) Consumer mediated information exchange 4) Enabling enhanced query for patient care 5) Fostering distributed population-level analytics.

Regulatory Aspects of Health Information Exchanges and Healthcare Reform

The department of Health and Human Services (HHS) is the regulatory agency that oversees health concerns for all Americans. The HHS is divided into ten regions and Tennessee is part of Region IV headquartered out of Atlanta. The Regional Director, Anton J. Gunn is the first African American elected to serve as regional director and brings a wealth of experience to his role based on his public service specifically regarding underserved healthcare patients and health information exchanges. This experience will serve him well as he encounters societal and demographic challenges for underserved and chronically ill patients throughout the southeast area.

The National Health Information Network (NHIN) is a division of HHS that guides the standards of exchange and governs regulatory aspects of health reform. The NHIN collaboration includes departments like the Center for Disease Control (CDC), social security administration, Beacon communities and state HIE’s (ONC).11 The Office of National Coordinator for Health Information Exchange (ONC) has awarded $16 million in additional grants to encourage innovation at the state level. Innovation at the state level will ultimately lead to better patient care through reductions in replicated tests, bridges to care programs for chronic patients leading to continuity and finally timely public health alerts through agencies like the CDC based on this information.12 The Health Information Technology for Economic and Clinical Health (HITECH) Act is funded by dollars from the American Reinvestment and Recovery Act of 2009. HITECH’s goals are to invest dollars in community, regional and state health information exchanges to build effective networks which are connected nationally. Beacon communities and the Statewide Health Information Exchange Cooperative Agreement were initiated through HITECH and ARRA. To date 56 states have received grant awards through these programs totaling 548 million dollars.

History of Health Information Partnership TN (HIPTN)

In Tennessee the Health Information Exchange has been slower to progress than places like Maine and Indiana based in part on the diversity of our state. The delta has a vastly different patient population and health network than that of middle Tennessee, which differs from eastern Tennessee’s Appalachian region. In August of 2009 the first steps were taken to build a statewide HIE consisting of a non-profit named HIP TN. A board was established at this time with an operations council formed in December. HIP TN’s first initiatives involved connecting the work through Carespark in northeast Tennessee’s s tri-cities region to the Midsouth ehealth Alliance in Memphis. State officials estimated a cost of over 200 million dollars from 2010-2015. The venture involves stakeholders from medical, technical, legal and business backgrounds. The governor in 2010, Phil Bredesen, provided 15 million to match federal funds in addition to issuing an Executive Order establishing the office of eHealth initiatives with oversight by the Office of Administration and Finance and sixteen board members. By March 2010 four workgroups were established to focus on areas like technology, clinical, privacy and security and sustainability.

By May of 2010 data sharing agreements were in place and a production pilot for the statewide HIE was initiated in June 2011 along with a Request for Proposal (RFP) which was sent out to over forty vendors. In July 2010 a fifth workgroup,the consumer advisory group, was added and in September 2010 Tennessee was notified that they were one of the first states to have their plans approved after a release of Program Information Notice (PIN). Over fifty stakeholders came together to evaluate the vendor demonstrations and a contract was signed with the chosen vendor Axolotl on September 30th, 2010. At that time a production goal of July 15th, 2011 was agreed upon and in January 2011 Keith Cox was hired as HIP TN’s CEO. Keith brings twenty six years of tenure in healthcare IT to the collaborative. His previous endeavors include Microsoft, Bellsouth and several entrepreneurial efforts. HIP TN’s mission is to improve access to health information through a statewide collaborative process and provide the infrastructure for security in that exchange. The vision for HIP TN is to be recognized as a state and national leader who support measurable improvements in clinical quality and efficiency to patients, providers and payors with secure HIE. Robert S. Gordon, the board chair for HIPTN states the vision well, “We share the view that while technology is a critical tool, the primary focus is not technology itself, but improving health”. HIP TN is a non profit, 501(c)3, that is solely reliant on state government funding. It is a combination of centralized and decentralized architecture. The key vendors are Axolotl, which acts as the umbrella network, ICA for Memphis and Nashville, with CGI as the vendor in northeast Tennessee.15 Future HIP TN goals include a gateway to the National Health Institute planned for late 2011 and a clinician index in early 2012. Carespark, one of the original regional health exchange networks voted to cease operations on July 11, 2011 based on lack of financial support for it’s new infrastructure. The data sharing agreements included 38 health organizations, nine communities and 250 volunteers.16 Carespark’s closure clarifies the need to build a network that is not solely reliant on public grants to fund it’s efforts, which we will discuss in the final section of this paper.

Current Status of Healthcare Information Exchange and HIPTN

Ten grants were awarded in 2011 by the HIE challenge grant supplement. These included initiatives in eight states and serve as communities we can look to for guidance as HIP TN evolves. As previously mentioned one of the most awarded communities lies less than five hours away in Indianapolis, IN. Based on the similarities in our health communities, patient populations and demographics, Indianapolis would provide an excellent mentor for Nashville and the hospital systems who serve patients in TN. The Indiana Health Information Exchange has been recognized nationally for it’s Docs for Docs program and the manner in which collaboration has taken place since it’s conception in 2004. Kathleen Sebelius, Secretary of HHS commented, “The Central Indiana Beacon Community has a level of collaboration and the ability to organize quality efforts in an effective manner from its history of building long standing relationships. We are thrilled to be working with a community that is far ahead in the use of health information to bring positive change to patient care.” Beacon communities that could act as guides for our community include the Health and Hospital Corporation of Marion County and the Indiana Health Centers based on their recent awards of $100,000 each by HHS.

A local model of excellence in practice EMR conversion is Old Harding Pediatric Associates (OHPA) which has two clinics and fourteen physicians who handle a patient population of 23,000 and over 72,000 patient encounters per year. OHPA’s conversion to electronic records in early 2000 occurred as a result of the pursuit of excellence in patient care and the desire to use technology in a way that benefitted their patient population. OHPA established a cross functional work team to improve their practices in the areas of facilities, personnel, communication, technology and external influences. Noteworthy was chosen as the EMR vendor based on user friendliness and the similarity to a standard patient chart with tabs for files. The software was customized to the pediatric environment complete with patient growth charts. Windows was used as the operating system based on provider familiarity. Within four days OHPA had 100% compliance and use of their EMR system.

The Future of HIP TN and HIE in Tennessee

Tennessee has received close to twelve million dollars in grant money from The State Health Information Exchange Cooperative Agreement Program.20 Regional Health Information Organizations (RHIO) need to be full scalable to allow hospitals to grow their systems without compromising integrity as they grow.21and the systems located in Nashville will play an integral role in this nationwide scaling with companies like HCA, CHS, Iasis, Lifepoint and Vanguard. The HIE will act as a data repository for all patients information that can be accessed from anywhere and contains a full history of the patients medical record, lab tests, physician network and medicine list. To entice providers to enroll in the statewide HIE tangible value to their practice has to be shown with better safer care. In a 2011 HIMSS editor’s report Richard Lang states that instead of a top down approach “A more practical idea may be for states to support local community HIE development first. Once established, these local networks can feed regional HIE’s and then connect to a central HIE/data repository backbone. States should use a portion of the stimulus funds to support local HIE development.”22 Mr. Lang also believes the primary care physician has to be the foundation for the entire system since they are the main point of contact for the patient.

One piece of the puzzle often overlooked is the patient investment in a functional EHR. In order to bring together all the pieces of the HIE puzzle patients will need to play a more active role in their healthcare. Many patients do not know what medicines they take every day or whether they have a living will. Several versions of patient EHR’s like Memitech’s 911medical id card exist, but very few patients know or carry them.23 One way to combat this lack of awareness is to use the hospital as a catch-all and discharge each patient with a fully loaded USB card via case managers. This strategy also might lead to better compliance with post in patient therapies to reduce readmissions.

The implementation of connecting qualified organizations began earlier this year. To fully support organizations to move toward qualification the Office of National Coordinator for HIE (ONC) has designated regional education centers (TN rec) who assist providers with educational initiatives in areas like HIT, ICD9 to ICD10 training and EMR transition. Qsource, a non-profit health consulting firm, has been chosen to oversee TNrec. To ensure sustainability it is critical that Tennessee build a network of private funding so that what happened with Carespark won’t happen to HIP TN. The eHealth Initiatives 2011Survey Report states that of the 196 HIE initiatives, 115 act independently of federal funding and of those independent HIE’s, break even through operational revenue. Some of these exchanges were in existence well before the American Recovery and Reinvestment Act in 2009. Startup funding from grants is only meant to get the car going so to speak, the sustainable fuel, as observed in the case of Carespark, has to come from value that can be monetized. KLAS research reports that 54% of public HIE’s were concerned about future sustainability while only 35% of private HIE’s shared this concern.

Hospital Implications of HIP TN (A Call to Action)

From a Financial perspective, taking our hospital into the future with EMR and an integrated statewide network has profound implications. In the short term the cost to find a vendor, establish EMR in and outpatient will be an expensive proposition. The transition will not be easy or finite and will involve constant evolution as HIP TN integrates with other state HIE’s. To get a realistic idea of the benefits and costs associated with health information integration. we can look to HealthInfoNet in Portland, ME, a statewide HIE that expects to save 37 million dollars in avoided services and 15 million in productivity reduction. Specific areas of savings include paper or fax costs $5 versus $0.25 electronically, virtual health record savings of $50 per referral, $26 saved per ED visit and $17.41 per patient/year due to redundant lab tests which amounts to $52 million for a population of 3 million patients. In Grand Junction Colorado Quality Health Network lowered their per capita Medicare spending to 24% below the national average, gaining recognition by President Obama in 2009. The Santa Cruz Health Information Exchange (SCHIE) with 600 doctors and two hospitals achieved sustainability in the first year of operation and uses a subscription fee for all the organizations who interact with them. In terms of government dollars available, meaningful use incentives exist to encourage hospitals to meet twenty of twenty five objectives in the first phase (2011-2012) and adopting and implement an approved EHR vendor. ARRA specified three ways for EHR to be utilized to obtain Medicare reimbursement. These include e-prescribing, health information exchange and submission of clinical quality measures. The objectives for phase two in 2013 will expand on this baseline. Implementation of EHR and Hospital HIE costs are usually charged by bed or by the number of physicians. Fees can range from $1500 for a smaller hospital up to $12,000 per month for a larger hospital.

How You Can Save Up To 47 Percent On Your Health Insurance Right Now

Do Not Read This Unless You are Making a lot of Money!:

If you would like to know how you can save up to 47% on your current Health Insurance Coverage read on… this is going to be one of the most informative messages you will ever read. After reading this message you will never going to have words; expensive and health insurance in the same sentence.

As you already know health insurance costs are at highest they have ever been and there is no sign of them slowing down. More and more Americans are forced to cancel their coverage simply just because they cannot afford it.
Who are the uninsured?

o Approximately 46 million Americans, or 15.7 percent of the population, were without health insurance in 2004 (the latest government data available).

o The number of uninsured rose 800,000 between 2003 and 2004 and has increased by 6 million since 2000.

o The increase in the number of uninsured in 2004 was focused among working age adults. The percentage of working adults (18 to 64) who had no health coverage climbed from 18.6 percent in 2003 to 19.0 percent in 2004. An increase of over 750,000 in 2004.

o Nearly 82 million people – about one-third of the population below the age of 65 spent a portion of either 2002 or 2003 without health coverage.

o The number of uninsured children in 2004 was 8.3 million – or 11.2 percent of all children in the U.S. (1).

You might say that I have great coverage that I am happy with… that’s totally fine.

For past sever years average rate increase for health insurance was 16.2% and what if it keeps on going? If you are right now paying $500 per month for your health insurance in three years from now you would expect to pay over $780 for the same plan. Wait… we all know that insurance companies consistently decrease their benefits and increase co-pays and deductible. Therefore you will pay more for less coverage. By the way if you keep same plan for over five years you will pay over $1000 a month just for your medical coverage. What if you use your Health Insurance?… Chances are if it is not for a regular doctor visits or a check ups it would be considered pre-existing condition. That means your chances of changing to a more affordable coverage in the future will be nearly impossible. That is one of the main reasons people cancel their health insurance because they were diagnosed with something or taking a prescription medication and the insurance company kept raising their rate until they could not qualify for any other coverage and could not afford the one they had.

Now you are saying I do not need coverage my spouse works for a company and I have group coverage… Great.

What would happen if your spouse left that job or the company stopped providing benefits? Probably the most obvious things that you can see how much that group coverage is really costing you. Next time check how much is deducted out of the paycheck for health coverage, especially for dependents. Group plans do cost more money because by law they are what are called “guaranteed issue”. That means you can have serious medical conditions and still get coverage. Insurance companies have to follow the law and they know they have to accept everyone who works for a large company, therefore they do charge more money for coverage. The biggest problem is not the cost of group health insurance it is what happens if some one, while on the group plan, is diagnosed with a condition or starts to take prescriptions medications. We get back to same issues as mentioned before, unable to qualify for health insurance in the future. There are people that want to leave their job but they cannot because they are going through treatment and cannot to pay for it on their own.

There is another solution… Some might save, so what is the point of even having health insurance. Once you diagnosed with something and insurance company is going to keep raising rates to the point where I am going to have to cancel it anyway. Especially if something does happen and I have to use my coverage I might not be working and I might not have income. Is my insurance company is still going to keep raising my rates? YES.

Before you think about canceling your coverage consider this. Here are some statistics

o A recent study by Harvard University researchers found that the average out-of-pocket medical debt for those who filed for bankruptcy was $12,000. In addition, the study found that 50 percent of all bankruptcy filings were partly the result of medical expenses. Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem.

o Illness and medical bills caused half of the 1,458,000 personal bankruptcies in 2001, according to a study published by the journal Health Affairs.

o Average day in the hospital is $7500 per day.

How can you save up to 47% on your health insurance? Simple… You probably already heard of Health Saving Accounts. They are becoming more and more popular everyday. With the way health insurance prices are moving today Health Saving Accounts are the only way to keep your coverage, save hundreds per month on your health insurance and still have a peace of mind.

To this day I was not able to hear a good definition that everyone can understand. I will do everything I can to make it simple to understand. The easiest way to understand Health Saving Accounts is to think of them as Roth IRA or your Company’s 401k plan. Instead of giving your money away to insurance company you get to keep it more of it for yourself. The way HSA plans work is there health insurance combined with savings account which works in a similar way to your retirement account. There tremendous benefits to have HSA qualified health plan. First all the money that you put in to your HSA account is 100% tax deductible and it is your money that rolls over year after year. At the age of 65 and up if you have not used up all of your HSA money you can roll it over in to your retirement account. Second your health insurance costs are going to be cut almost in half. For example if you had Health Insurance plan with $2500 deductible now and it is costing you $300 per month the same plans with HSA qualified plan, now will cost you only about $160 per month. The reason you save so much money with HSA qualified health plan is because HSA qualified plans do not cover anything until the deductible is met. There are exceptions depending on the Health Insurance Company. Some insurance companies will pay for your once a year physical before you meet your deductible.

Let take an example of how HSA qualified plan could benefit you. Let take some actual numbers from actual health insurance company. In this example I am going to use HSA plans from company called Assurant Health. Assurant Health is leader in Health Saving Accounts and they one of the first companies to implement them. The main reason is that Assurant Health is part of the world’s largest financial company that sets up retirement accounts. In this example I am going to use a family of four, husband 46, wife 42, kids are 12 and 16. On a regular family plan with $2500 deductible, maximum out of pocket of $5500, co-insurance of 80% and doctor visits covered with $35 co-pay, they are going to pay $676.40. Something to keep in mind that all of the regular PPO plans that are available on the market today have family deductible which is double of individual deductible. That means that if you have a plan with $2500 deductible and $5500 maximum out of pocket that means that your family deductible is $5000 and your family maximum out of pocket is $11,000. When we are comparing HSA qualified health plans there is only one deductible, once you meet it you are covered at 100% on the most plans. There are some companies and plans that you still might be responsible for the percent age of the bill until you reach your maximum out of pocket. Most HSA plans do not have maximum out of pocket that meant once you met your deductible you are covered at 100%, it’s that simple. The same plan with $5700 deductible for the entire family with HSA qualified health plans will only be $491.64 per month. For the total monthly savings of 184.76 per month. Also your maximum out of pocket will decrease from $11,000 on a regular plan to $5700 with HSA health plan. That’s yearly savings of $2,217.12 and additional savings of $5300 on the maximum out of pocket. (that’s if you have had to use the plan for emergencies) The main reason for starting HSA health insurance is for Saving Account and being able to put money in to account, at your discretion, tax free. You can put money in to HSA qualified account up to your deductible and you do not have to put any money in to that account if you do not want to. Health Saving Accounts are as flexible as you would want them to be. TO get more information on HSA accounts and get quotes for HSA qualified health coverage see my bio.

Communicate Health Benefits Information More Effectively

All employers have responsibility of guiding their employees about the health benefit schemes offered by them. Even the employees on the other hand also have the right to receive information about the health benefit schemes offered to them. Therefore an employer has the right to inform the employees about certain information regarding the health benefit schemes. For this reason, organizations have created the position of Health Benefit Manager having communication as one of the responsibilities for health benefit related schemes and procedures.

Key information heads to be shared by employer

There is a plethora of information available for communication. It is the skill of the Health benefit Manager to present them in a structured manner on behalf of the employer.

– Employers need to provide a detailed list of information to the employees about what health benefit schemes are provided to them or the scheme they are entitled to.
– Providing information regarding cost sharing as well as arrangements
– To take up necessary steps to resolve problem as well as to deal with appeals.
– To provide and guide its employees about the status of accreditation, certification as well as licensure.
– Provide sufficient and necessary information about the composition of the provider network too.
– To use the emergency care services as when required by the employees of the organization.
– To obtain referrals to specialists
– Most importantly provide all the information regarding the quality, safety of the health benefit plan and the cost of the employer sponsored plan.

Regulatory directives
According to the Employer Retirement and Income Security Act of 1974, it is necessary to provide all detailed information that the employees are entitled to that includes plan rules, covered benefits, documents about the plan management and operation as well. The employees are also entitled to receive a document with the summary plan description, known as SPD. The SPD contains

– Information of the health care services that are covered in the plan.
– Description of what services are being provided by the plan and how these schemes function.
– It provides information also on how to calculate the benefits.
– Explanation on the cost that the plan covers and the cost that the beneficiary has to pay.

Tools and Methods for communicating
There are various methods by which the Health Benefit Manager, on behalf of the employers, can communicate health benefit information to the employees:

– One of the best ways is to communicate with the employees about the health coverage plan but providing too much information of it should also be avoided. The employees should be given the required time to understand the scheme and ask questions if any.

– It is best to explain the changes in simple terms to the employees to make them understand.

– Apart from the employees it is also necessary to explain the health benefit plans to the health benefit managers so that they can explain it to the employees to.

– Employers should be ready to face any questions asked by employees regarding the health benefit scheme and clear their doubts.

– It is equally important as well to be direct and honest when discussing about the coverage plan especially if employees face cost increase due to the coverage plan.

– Discussing the 5C’s too is essential with the employees. This 5C’s include cost, changes in plans, coverage of the plan, comparison of the previous year’s plan and also the current option.

– It is necessary to provide information the employees about the health care providers that are available in the revised and new plan option.

– Providing testimonials of other employees about the changes in health benefit plans can also be quite helpful for the present employees.

– Taking the help of various means like internet, face to face discussions, telephonic conversations, office intranet as well as printed materials can be helpful too. However it is also necessary to use materials that are easily understood by employees.

Using health communication campaigns

What are its advantages?

– It is important for the employers to conduct communication campaigns to educate the employees about the need of health benefit schemes and how they operate.

– The responsible manager’s aim should be to identify the objective and aim of the health care campaign.

– To develop health care message that meets the objectives and aim of the campaign.

– Setting up the criteria for evaluation of the campaign and also the degree to which it is getting conveyed among the employees.

– To implement and the campaign and make sure that the employees understand message that is being conveyed by the employer.

– It is also necessary to make sure that the employees also to address the education need of the employees with language barrier, literacy issues etc.

To conclude, an effective way to communicate about the health benefit scheme is the cornerstone of every business organization. In these schemes, employers can also guide and help its employees to select a scheme and explain every detail they should know. The authority should also explain the new health scheme option and also about the changes in the existing benefits. To improve the health plan costs the employer’s must keep in mind the factor of low health literacy. Health plans and employers should also be able to successfully communicate with employees. Lastly, employees and employers should also be able to communicate clearly about the health benefit plans.

What’s The Definition Of Physical Health and Does Good Health Naturally Mean All Natural Is Good?

Let’s begin with a good health definition in general. The WHO health definition (World Health Organization), albeit from 1948: “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. Assuming that’s true, what’s the definition of physical health and does good health naturally mean that “all natural” is good, especially as it applies to food?

What’s the definition of physical health?

Is there one?

Based on the WHO health definition as it applies to physical health, is it safe to say that simply because everything is working as it should in the absence of disease or infirmity (weakness or ailment), that we’re not necessarily in good physical health?

What do you think?

I personally believe there is more to being healthy in the moment. On the other hand, I also believe that because we are only guaranteed the present, if you’re healthy, don’t take it for granted. Enjoy it while you can.

I also believe the state of our physical health depends largely on our personal health plan. In other words, it depends on how well we take care of ourselves on a regular basis. That includes:

Eating habits
Exercise habits or lack thereof
Sleep habits
Spiritual habits
General living habits

Without seeming as though I am a pundit, expert or zealot about any of the aforementioned, that I am personally the definition of physical health, the definition of spiritual health, or anything that resembles the definition of good health, in a nutshell, what I’m saying is all the bullet points have a bearing on our physical health.

What do you think?

It’s about good health

One dictionary provides this definition of health:

“The general condition of the body or mind with reference to soundness and vigor: good health; poor health.”

The ancient Roman poet Virgil said, “The greatest wealth is health”.

I couldn’t agree more but I am a bit troubled by the amount of over-emphasis placed on physical health, as if it is mutually exclusive from the other aspects of health.

I believe health is about:

Physical
Mental
Emotional
Spiritual
Financial

The “soundness and vigor” in which we pursue and maintain these factors has a direct and indirect effect on each and every one of the factors.

Furthermore, I find it troubling that the word wealth is so overly associated with money and financial wealth.

It’s not to say that I don’t see the importance of physical health and financial wealth. They are both key components of overall health but they are not stand-alone concepts.

What are your thoughts?

All Natural

The “all natural” phenomenon, especially as it applies to food, is one of the biggest marketing ploys ever. If it’s not a scam, it’s a joke.

It means nothing!

There is a HUGE difference between organic and all natural. Don’t confuse the two and by all means don’t fall for the propaganda that leads you to believe they are one and the same. They’re not.

Organic, at least as it applies to food, is highly regulated. It actually means something. However, keep in mind that just because it’s organic doesn’t necessarily mean it’s healthy.

All natural can mean pretty much anything. As far as the food we eat is concerned, it is not regulated. It is a highly misleading tag.

Don’t be fooled.

I’m not saying don’t enjoy it. I’m not saying all natural is bad. I’m simply saying it’s about as superfluous term as there ever was. There is no depth to it.

My formula

For me, it all boils down to a few simple concepts and principles beginning with:

Honesty
Respect
Best Effort

These are indispensable. They cost nothing and should be applied at all times.

Next are the 5 F’s:

Food – Not just what we eat but includes anything we consume physically, mentally, emotionally, and spiritually. If we are what we eat, this says it all.
Fitness – Includes all the 5 bullet points mentioned above
Finances – Affected by the previous two and affects the previous and next two
Fulfillment – It’s about completion and includes all the bullet points mentioned
Fun – The importance of how it affects health and is affected by it is often overlooked

I have tagged the 5 F’s as the components of a bulletproof life.

To sum it up, all the above is important but the proper balance is the key. I believe too many of us are simply out of balance. Furthermore, there is not a one-size-fits-all balancing act.

Last but not least, from the late, great Redd Foxx:

“Health nuts are going to feel stupid someday, lying in hospitals dying of nothing.”

Agree? Disagree?

Leave comments.

Bob is a retirement planning and safe money professional who specializes in life insurance products and who has more than 20 years experience.

His company, A Bulletproof Life is the 5 F’s: Food, fitness, finances, fulfillment, fun. and is based on his motto: Honesty, respect, best effort

Plan Your Dream or Prepare for a Nightmare.

Different Sorts Of Health Insurance Plans

Health is the biggest asset for any human being and our motto of life must be to stay healthy so that we can enjoy our life till it comes to an end. However, our health is just like a machine, which is vulnerable for many damages with the advent of time. On top of these machines need occasional or regular repairing for their efficiency. Same goes for our health. Our body needs regular checkups so that the organs of our body can perform their task precisely. On the other hand, due to some external forces or influences, like – virus, parasites, etc. and due to some internal organ dispute (such as heart blockage or kidney blockage), we experience major, as well as casual health breakdown issues. Just like a machine, our health requires servicing and the process of servicing the health is call medical science.

Medical science has experienced so many changes due to the advent of technology and new inventions. Today’s medical technologies are pretty robust and highly skillful enough to provide seamless healthcare support to the patients. As the technology has been integrated with the healthcare management and treatment procedures, healthcare or medical treatments also have become quite expensive. This is why we need to plan for our healthcare even if we are not experiencing any health issues at this moment. For a major or minor operation, immense expenses may happen and one needs to be careful about it. To aid people with their finance planning regarding their healthcare or medical treatment, medical insurances have been introduced into the market by the insurance companies, banking organizations and other financial organizations.

Presently, in USA, having a insurance is must for every citizen. To avail medical insurance, buyers need to find a suitable company first. Once the suitable insurance company has been spotted, the next step is to select a good health plan. Now, selecting a insurance plan can be really critical. Several health schemes and plans are there for the buyers to choose, but the million dollar question is – which is the most suitable for you, according to your age, budget and needs? So, let us have a look on different kinds of health:

1. Short Term Health Insurance – This is quite suitable for those, who are presently undergoing economical crunch situations. For short term health, investment is low as the term is short. The benefit is that you can still avail a health plan, even if you are in economic trouble. When, things will be back in shape, you can move to a long term or more beneficial health plan.

2. Full Service Health Insurance – Well, this is kind of a long term health insurance with lucrative offers. This kind of health insurance would be a bit costly and suitable for young or mid-aged servicemen or businessmen.

Apart from these, supplemental health insurance, pre existing condition health insurance are two popular forms of health insurances available in the market.

Health And Wellness Products – How To Make Your Own

Health and wellness products will mean very different things to different people.

Wellness can be defined as ‘the pursuit of a healthy, balanced lifestyle.
For the benefit of this article, wellness products are being looked at in the context
of ‘over the counter drugs, health supplements and health remedies.

While for some people, wellness products might be viewed as an aid to recovery
from illness, for others it might be a means of further enhancing some
aspect of their current health. The variety of and uses for such products
are as numerous as are the the definitions of wellness products or wellness
programs, depending of course upon who is promoting them at any given time.

Whatever your reasons for pursuing alternative care health or health and wellness
products, a common goal is to achieve optimised health and well-being.

There are powerful media images hailing the benefits and safety of many over the
counter drugs, supplements and health and wellness products, every where you turn
these days. They have equally strong claims of being the one and only miracle cure
or solution for one ailment or another. How accurate are these claims though, and
what are the real costs to you in monetary and health risk terms?

Immediately after reading this article, go take a look and do a quick add-up of the
total cost of all the health and wellness products you currently have in stock. I’m
sure the figure will surprise you just as much as learning about the very real and
harmful side effects which can be caused by some of these drugs or supplements
that are supposed to be contributing to your overall state of wellness.

You may also be surprised to know that many of the ‘over the counter drugs you
buy on a regular basis, simply treat the symptoms and not the real health issue.
Needless to say, this approach of focusing on the symptom, side-steps
the crucial requirement of getting to the root cause of your condition or whatever
it is that ails you.

You’re most likely to pursue a wellness product either because you are becoming
wary of the adverse effects of chemically produced drugs or because you’re keen to
recover from ill-health and improve a specific health condition. In some instances it
might be that you just want to optimise your current state of good health.

While some health and wellness products can be an effective measure toward
improving your health, you should note that long-term use of certain over the counter
drugs and some supplements can cause you more harm than good, with the long-
term implications far outweighing any short-term benefits. You may well find that
you are paying far too high a price on the basis of a mere quick fix promise.

For thousands of years, people in lands far and wide have used natural homemade
remedies to manage their health conditions and wellness needs, without manufactured
health and wellness products, that can be detrimental to health. They have purely relied
upon attaining or maintaining health by plants or by other natural means.
It could be argued that with the emergence of chemical and pharmacological methods,
many forms of this natural means to health and wellness have declined. In fact, even
by today’s standards, there are many so-called under-developed countries where
inhabitants’ rely on nothing more than homemade health and wellness products,
gained via natural methods of plants or plant-based extracts.

While conventional medicine relies on scientifically backed research to substantiate
effectiveness and safety. In contrast, similar cannot be said about some alternative
medicines or health and wellness products. There is no such requirement but their
promotion as regard effectiveness are deemed sufficient in themselves as support
for therapeutic or wellness claims.

Herbal remedies in general are harmless, however, certain claims being made by
some health and wellness products promoters, (under the banner of being
‘natural’)) can insinuate their health and fitness products being the
exclusive answer to your health condition or wellness questions, thus putting you
at great risk. Secondly, how open are they being about what’s really inside? You
should always consult your physician over any health concerns, as well as discussing
with him/her your intention or choice of alternative means for treatment with any
health and wellness product or remedy.

Multi-billion-dollar industries have long weald their power by way of
lobbying to gain exemption from FDA regulation. This has been exactly the
case, according to the Skeptical Inquirer, who, on commenting on
the ‘dietary supplement industry back in 1994, states – “Since then, these
products have flooded the market, subject only to the scruples of their
manufacturers”.

The above point is an important one to note in that, while health and wellness
products manufacturers may list ingredients and quantities being used in
specific health and wellness products, there has been no real pressure on them to
do so, or to do so accurately. Furthermore, neither has there been any
watchdog body to ensure they are penalised for this failing.

So, what are the alternatives open to you? Increasingly, more and more people
are turning to do-it-yourself health and wellness homemade herbal remedies.
The distinct difference being that in making your own health and wellness products,
you are in the driving seat. Not only do you have a full awareness of exactly
what the ingredients are and the true quantities, but with the appropriate level of
guidance from a reputable practitioner, you’re more conversant with any health
implications, if any.

With the right know-how, you too can draw on the old-fashioned yet effective
sources to greatly improve your health. For instance, using naturally prepared
herbs, vitamins, minerals and nutritional supplements, essential oils and flower
essences to create real healing solutions that deal with particular health
conditions rather than just the symptoms.

It is in the interest of a health and wellness product manufacturers to promote their
products as being the only option open to you. They don’t want you to know about
the abundant natural resources and health-giving potent attributes of herbs and home
remedies which have been used effectively for thousands of years. You see, these
remedies cannot be patented because you can make them yourself and at a
fraction of the cost.

Whether your goal is to overcome illness, drugs intolerance, allergies or just to
optimise your already good health, with a little know-how, you can start making
your own health and wellness products and remedies, using nothing more than the
readily available natural resources in your home and garden. Not only will you
save your hard earned cash, you also alleviate the risk of serious or harmful
additives and side effects.

Are you interested in learning more about how you can treat numerous common ailments without the harsh side effects, using nothing but natural herbs, vitamins
and nutrients you prepare yourself at home? For instance, did you know that
placing yogurt on your face help to bring water from the deeper layers
of your skin to the surface, moisturizing your skin for the rest of the day and hiding
wrinkles?

Here are just a few more of the many quick and effective remedies you can learn
to make:

1. Natural laxatives

2. Beauty recipes

3. Skin care and cleansing preparations such as acne treatment

3. Herbal shampoos as well as how to treat hair loss

5. Dermatitis

6. Menstrual Pain and PMS Symptoms

Occupational Health: Core Areas of Knowledge and Competence, Part 1

It is not possible to describe a highly complex and dynamic process such as occupational health nursing simply in terms of core activities or tasks. Occupational Health Nurse (OHA) are constantly learning new skills, adapting current practices to meet new needs and developing new approaches to solving problems and therefore their practice is not static but is constantly improving based upon a core range of skills.

However, within this limitation it is possible to describe those core areas of knowledge and competence that occupational health nurses use. The following list is not intended to be exhaustive, but rather to give an indication of the wide range of competencies that occupational health nurses demonstrate in practice.

The Clinician

Primary prevention

The OHA is skilled in primary prevention of injury or disease. The nurse may identify the need for, assess and plan interventions to, for example modify working environments, systems of work or change working practices in order to reduce the risk of hazardous exposure. Occupational health nurses are skilled in considering factors, such as human behavior and habits in relation to actual working practices. The nurse can also collaborate in the identification, conception and correction of work factors, choice of individual protective equipment, prevention of industrial injuries and diseases, as well as providing advice in matters concerning protection of the environment. Because of the occupational health nurses close association with the workers, and knowledge and experience in the working environment, they are in a good position to identify early changes in working practices, identify workers concerns over health and safety, and by presenting these to management in an independent objective manner can be the catalyst for changes in the workplace that lead to primary prevention.

Emergency care

The OHA is a Registered Nurse with a great deal of clinical experience and expertise in dealing with sick or injured people. The nurse may, where such duties form part of their job, provide initial emergency care of workers injured at work prior to transfer of the injured worker to hospital or the arrival of the emergency services. In many instances, where hazardous conditions exist at work, or where the workplace is far removed from other health care facilities, this role will form a major part of an occupational health nurse’s job. Occupational health nurses employed in mines, on oil rigs, in the desert regions or in areas where the health care systems are not yet fully developed will be familiar with a wide range of emergency care techniques and may have developed additional skills in order to fulfill this role. For others, who are working in situations where the emergency services are on hand, they may simply provide an additional level of support beyond that provided by the industrial first aider.

Nursing diagnosis

Occupational health nurses are skilled in assessing client’s health care needs, establish a nursing diagnosis and formulating appropriate nursing care plans, in conjunction with the patient or client groups, to meet those needs. Nurses can then implement and evaluate nursing interventions designed to achieve the care objectives. The nurse has a prominent role in assessing the needs of individuals and groups, and has the ability to analyze, interpret, plan and implement strategies to achieve specific goals. By using the nursing process the nurse contributes to workplace health management and by so doing helps to improve the health of the working population at the shop floor level. Nursing diagnosis is a holistic concept that does not focus solely on the treatment of a specific disease, but rather considers the whole person and their health care needs in the broadest context. It is a health based model rather than a disease based model and nurses have the skills to apply this approach with the working populations they serve.

General Health advice and health assessment

The OHA will be able to give advice on a wide range of health issues, and particularly on their relationship to working ability, health and safety at work or where modifications to the job or working environment can be made to take account of the changing health status of employees.

In many respects employers are not solely concerned with only those conditions that are directly caused by work, but do want their occupational health staff to help address any health related problems that may arise that might influence the employees attendance or performance at work, and many employees appreciate this level of help being provided to them at the workplace because it is so convenient for them. In particular the development of health care services to men at work, younger populations and those from ethnic groups can be most effective in reaching these sometimes difficult to reach populations.

Research and the use of evidence based practice

In addition to utilizing information and knowledge produced by research in various fields to support activities that relate to the occupational health component of their role, occupational health nurses will also utilize fully research information available from many fields to help support the general health of the working population.

Specialist

Occupational health policy, and practice development, implementation and evaluation

The specialist occupational health nurse may be involved, with senior management in the company, in developing the workplace health policy and strategy including aspects of occupational health, workplace health promotion and environmental health management. The OH nurse is in a good position to advise management on the implementation, monitoring and evaluation of workplace health management strategies and to participate fully in each of these stages. Possibility to perform that role will depend upon level of nurse education, skills and experience.

Occupational health assessment

OHA’s can play an essential role in health assessment for fitness to work, pre-employment or pre-placement examinations, periodic health examinations and individual health assessments for lifestyle risk factors.

Collaboration with occupational physician may be necessary in many instances, depending upon exiting legislation and accepted practice. The nurse can also play an important role in the workplace where informal requests for information, advice on health care matters and health related problems come to light. The nurse is able to observe the individual or group of workers in relation to exposure to a particular hazard and initiate appropriate targeted health assessment where necessary. These activities are often, but not exclusively, undertaken in conjunction with the medical adviser so that where problems are identified a safe system for onward referral exists.

Health surveillance

Where workers are exposed to a degree of residual risk of exposure and health surveillance is required by law the OHA will be involved in undertaking routine health surveillance procedures, periodic health assessment and in evaluating the results from such screening processes. The nurse will need a high degree of clinical skill when undertaking health surveillance and maintain a high degree of alertness to any abnormal findings. Early referral to an occupational health physician or other appropriate specialist will be the responsibility of the occupational health nurse where any abnormality is detected. The nurse will be involved in supporting the worker throughout any further examination or investigation, and may help to monitor their health on return to work. Once alerted to the possibility of an adverse health effect the occupational health nurse is in a good position to co-ordinate efforts to re-evaluate working practices in order to help protect others who may be similarly affected.