Monthly Archives: July 2016

Home Health Care With Medicare

Medicare can be perplexing, all the more so when you combine complex health issues and the need for medical aids such as oxygen or hospital beds. While the insurance maze can be difficult to traverse, an estimated 47.5 million people received this program in 2010, which is more than a sixth of the nation’s population.

Here is a brief overview and some answers to some commonly asked questions regarding Medicare and home health care.

1. Who qualifies?

Medicare is a national health insurance program provided by the U.S. government for those who are:

– 65 and older

– Under 65 with certain disabilities

– Diagnosed with End Stage Renal Disease (ESRD), a form of permanent kidney failure requiring dialysis or a kidney transplant

2. What types of services does Medicare cover?

Medicare has four different coverage sections: Part A, B, C, and D. “Original Medicare” consists of Part A & B, while Part C is known as “Medicare Advantage Plan”. These four parts are summarized briefly:

– Medicare Part A: Hospital Insurance

* Part A covers care while in hospital as well as health care in skilled nursing facilities, home health care, and hospice.

– Medicare Part B: Medical Insurance

* Part B covers doctor’s visits as well as visits to other health care providers. Additionally, Part B covers hospital outpatient care, durable medical equipment (like intravenous infusion devices), and home health care services. Part B also covers specific types of preventative services, such as getting certain vaccinations.

– Medicare Part C: Medicare Advantage

* Part C combines health plan options you purchase from other private insurance companies approved by Medicare. Part C also integrates Medicare Prescription drug coverage (Part D) and can be tailored to include extra benefits at an extra cost.

– Medicare Part D: Medicare Prescription Drug Coverage

* Part D covers the prescription of Medicare-approved prescription drugs and can lower the cost of other medications. Similar to Part C, Medicare-approved private insurance companies also run Part D.

3. Why do I need to choose between Medicare plans?

The choice of “Original Medicare” (Parts A & B) entails payment of monthly premiums for part B and may necessitate additional coverage to pay deductibles and coinsurance to see physicians, hospitals, and other providers who accept Medicare. If you require Prescription drug coverage, you must pay a monthly premium to join the Medicare Prescription Drug Plan (Part D).

The “Medicare Advantage Plan” (Part C, which covers Part A & B), also requires the payment of monthly premiums in addition to the Part B premium & a copayment for in-plan doctors, hospitals. If prescription medications are not covered by your supplemental coverage, you have the option of joining the Medicare Prescription Drug Plan (Part D).

As with prescription medications, you can purchase supplemental coverage to cover services not covered by Medicare. The “Original Medicare” plan allows for the option of buying Medicare Supplement Insurance (Medigap), while the “Medicare Advantage Plan” does not.

It is prudent to always check if you can take advantage of other additional coverage through your employer or union, military, or Veteran’s benefits.

4. Is home health care covered by Medicare?

The Medicare website states, “Medicare only covers home health care on a limited basis as ordered by your doctor”. As reviewed earlier, Parts A & B are the Medicare options which cover the home health care services specified by Medicare.

Coverage of home health care by Medicare in New Mexico stipulates you must meet the following criteria:

– You are currently receiving regular services from a physician. This physician must also maintain a care plan unique to you, which is reviewed regularly.

– Your physician must certify a “need” for specific medical services such as requirements for intravenous medication therapy, physical therapy, occupational therapy, respiratory therapy, or speech-language pathology services.

– The home health care agency providing you services must be Medicare-certified (for more details see below).

– Your physician must certify your health status as homebound, which is indicated by the following:

* Your health condition limits you from leaving the house.

* You are unable travel from home without help (i.e. transportation assistance such as aids or individuals).

* Leaving your home takes considerable effort and may be detrimental to your health condition.

5. My home health company does not take Medicare, why is this?

The Medicare-approval process is lengthy and costly, so while it may appear that many companies may not take Medicare, they may actually be in the process of becoming Medicare certified.

Furthermore, the Medicare criteria for individual qualifying to receive home health care are very strict; the reality is that many people who may apply for coverage by Medicare for their approved home health company services will not actually receive coverage. Currently, Medicare pays only about half of all health care costs to seniors. Medicare very often denies payment due to not meeting criteria, so it is essential to be aware if you meet these criteria prior to restricting yourself exclusively to Medicare-approved home health care companies.

A Pound of Primary Health Care

Health care. Very few phrases envelope so many different aspects of an area of discipline. It can be confusing to know where to go to and when, and this issue has led to a cascade of health problems for our population and our population’s health care system. Emergency room or primary care? And where does preventative care fit in? Here’s an overview of a few facets of the system, and how they differ from each other.

Why Not Just Visit Emergency?

Most emergency departments offer a wide range of services available at all hours, without the requirement of an appointment. However, many ER visits are avoidable as patients are seeking non-urgent care or care that could have been treated and even prevented by primary health care. These avoidable visits result in higher costs, longer emergency department waits, and fewer resources available to the patients who actually require emergency services. Interestingly enough, misuse of the emergency department is equally committed across all ages, regardless of whether or not they are insured. This population-spanning issue has even spurred an “Urgency or Emergency” ad campaign in New Mexico coordinated by the Albuquerque Coalition for Healthcare Quality and funded by the Robert Wood Johnson Foundation.

It is essential to provide and spread education about appropriate times to facilitate emergency services, walk-in to an urgent care clinic, or wait to make an appointment with your general practitioner.

So when do you visit the emergency room?

Examples are incidences of:

– Difficulty breathing

– Uncontrolled bleeding

– Loss of consciousness

– Severe burns

– Chest pains

– Broken bones

When do you visit urgent care?

Any time that you experience a change in your health status which needs attention, but will not be an immediate threat to your health.

Examples of these incidents are:

– Migraines

– Back pain

– Earaches

– Sprains

– Rising fever

– Minor lacerations

Primary Health Care / Primary Care: The Same But Not!

Primary health care is an extensive and broad model designed to cater not only to the individual and their family but to their community as well. Primary health care is meant to be an accessible community based system, responding to the to social issues of the population it is serving.

Primary health care works to:

– Prevent illness and be promotive of health (as opposed to working solely in a curative manner as seen in primary care)

– Focus on maximizing individual and community involvement in the planning and operation of services as well as in the integration of health development with social and economic development

– Integrate rehabilitative and therapeutic care into patient’s daily lives

The presence of primary health care is essential to building healthy public policy and strengthening community action. This also allows for an equal distribution of care available to the local public. Individual and community involvement can also be seen through their participation through building beneficial public policy, creating supportive environments (such as in programs at community centers), and strengthening community action. It is the action of the local individuals as a group, which encourages increased community participation and support for each other, furthering positive health habits at the local level. Not only can primary health care’s focus on health promotion be seen on an external level through community action and public policy, this can also be seen on an internal level via the promotion of personal skills through education by medical professionals.

Primary care emphasizes the curative focus of medicine and mostly occurs in the clinical setting (i.e. your GP’s office, the local walk-in urgent care clinic, or the emergency department).

Primary care:

– Often is the initial point of contact between individual and medical personnel when the individual experiences a change in health status.

– Is not as comprehensive as primary care due to the acute nature of clinical visits

– Refers individuals to the services available through primary care as well as to home health care

The Take-Home, Part 1

There is a time and a place for preventative care, just as there is a time and a place for emergency medicine. The bottom line is that health statuses will always change. And when they do, stop and think. Is this something which requires long term care in my home? Can I wait until tomorrow to make an appointment at my doctor’s office? Can I drive to a walk-in urgent care clinic? Or should I call 911 and go straight to emergency? Your decision impacts not only you, but your community as well.

Telemedicine in the Affordable Health Care

Telemedicine is an important component of the robust and technology driven Affordable Care Act system (Obama care) and provides avenues for reducing costs in the new healthcare structure, because it offers options in how to access healthcare services.

The Affordable Care Act is the most comprehensive overhaul of the nation’s health care system in decades and it’s implementation and sign-ups will all be processed through marketplace exchanges.

What is the Meaning of Telemedicine?

Telemedicine is the use of telecommunication and information technology to provide clinical health care without a traditional face-to face consultation. It helps eliminate distance barriers and can improve access to supplementary medical services for people with:

  • Basic or No Insurance
  • High Deductible (HDHP) Insurance
  • Traditional Insurance

Tele-health Vs Telemedicine

‘Tele-health’ is an older, broader term for services such as health education and is not limited to clinical services, while ‘Telemedicine’ narrowly focuses on the actual curative aspect between the patient and healthcare professional. Examples of Tele-health are health professionals discussing a case over the telephone or conducting robotic surgery between facilities at different ends of the world.

Tele-Health has a broader scope than telemedicine and is sometimes called e-health, e-medicine, or telemedicine. Health care professional use tools like e-mails, e-visits, e-prescribing, after-hours care, e-reminders, health assessments, self-management tools, health coaching etc.

The State of the Market

The Affordable Care Act (Obama Care) Health Insurance Exchange (HIX) opens on Oct 1st, 2013. and goes into operation on Jan 1st, 2014. The Obama Care exchanges, are State, Federal or joint-run online marketplaces for health insurance. Americans can use their State’s “Affordable” Insurance Exchange marketplace to get coverage from competing private health care providers.

Steps to Sign up for Health Care Plans

  • Participants enter personal information into a web portal
  • Learn their eligibility for subsidies based on income, state-determined criteria or employer-based options.
  • Use a price calculator to shop, compare and choose a best benefit health plan.

Several major health companies have programs like TelaDoc in Aetna, KP-OnCall in Kaiser etc, trying to set up footholds in a market that is widely expected to grow rapidly. All participants have to do is research for telemedicine benefits through their health insurance plans or sign up for independent programs.

How Health Care Professionals Administer Telemedicine

Doctors can treat most everyday health needs by phone or a scheduled video consultation. A study by the American Medical Association shows that 4 out of 5 visits to a primary care doctor could have been treated over the phone instead. After each consultation, patients will receive a clinical report which can be emailed to a primary care physician.

Registered Nurses manage triage calls and act as health coaches. For some specific symptoms, they give guidance for the most appropriate care, and over 32% of the time will offer self-care options so patients avoid a visit to the doctor, ER or Urgent Care facility entirely.

Common symptoms often treated through Telemedicine

Respiratory Infections, Cold/Flu Symptoms, Urinary Tract Infections, Sore Throats, Headaches/Migraines, Sinusitis, Allergies, Insect bites, Certain Rashes, Sprains/Strains, Arthritic Pain, Stomach Aches/Diarrhea, Gastroenteritis, Minor Burns and many non-emergency medical conditions

By 2014, the law mandates that all non-exempt Americans have health insurance or face a tax penalty. The Affordable Care Act has far-reaching advantages such as prohibiting insurance companies from dropping a clients’ coverage if they get sick or discrimination against anyone with a pre-existing condition and extending children’s eligibility on parent’s plans.

For entrepreneurs, who will most likely be responsible for their own health insurance, knowing how telemedicine can supplement their health insurance plans, means they can take full advantage of the options, savings and benefits.

How to Choose The Right Health Care

With Health Care Courses around, there are many who update their knowledge and skills to be highly qualified so that they can work across a wide range of healthcare needs and environments. There are courses and training colleges or institutes which are specific and some that are customized, especially for health care assistants and nurses. With such a course in hand, professionals gain more information and knowledge over health care, caring needs, nursing skills, physical and mental health, illness and injury treatment too.

How it is designed

The main structure of the courses would be for professionals, so that they remain up to date with their skills and knowledge, which in turn would be a boon for patients who need qualified and professional help. Workers and assistants with the health care industry now have a range of courses to study and gain more information from, customized well according to the work nature they belong to. Degrees and qualifications are of many types and levels, with certificates that help the individuals prove their levels of professional development.

What it covers are;

  1. Home and community care
  2. Aged Care
  3. Disability Care
  4. Mental health
  5. Palliative care
  6. Studying how complementary or alternative medication can help

As a health care professional, one can choose or pick the best study manners which suit their nature of work. There are short healthcare courses and in house ones too, which are specific to the individual’s nature of work. If one would like to enroll with distance learning, they can do so and continue with their work and study at the same time too.

Social and health care training courses

Such health care courses help those who work for health and social care, where the training helps individuals with knowledge and skills that help treat patients and care for them. The training also helps the individuals grab a hold on other services, which helps patients get independent and self reliant, helping them make their own choices and have a control over their lives too.

Health care services

There are plenty of services through such courses which can help one promote preventive and curative health needs, palliative interventions too. One also would learn how to help patients who have suffered from abuse, at home or by society, neglect and trauma too. Individuals would work on the solutions, and also learn about the impacts working in teams through these courses.

Social work and care courses

These courses also help with social care learning and understanding the social care system too. There are courses for social carers and workers across the nation, which are of great help. Through such courses, one can care for patients, especially the elderly, the neglected and those who suffer from disabilities too. Such courses even have provisions for professionals to update their knowledge on child care and senior citizen care too. Finally, a course in health and social care would also empower the individual to specialize in counseling and caring, theories and law, also practices too.

Healthy and lifestyle courses

Amongst the many denominations of Health Care Courses, professionals can also update themselves on health and lifestyle courses. Right from Yoga to Acupuncture, making good health choices and lifestyle management, there is so much to learn from.