Healthcare IT News is reporting that the Health and Human Services Department has released a document that addresses the unique problems facing healthcare providers and patients in rural America. A crucial part of the Rural Action Plan involves distance or telemedicine, in which healthcare providers consult with patients over a two-way computer network.
Rural America has had a longstanding lack of readily available doctors and hospitals. People living outside of large population centers often must travel great distances to acquire face-to-face care. Telemedicine is one tool meant to alleviate that problem and get more healthcare services to underserved rural patients.
The federal government’s current budget proposal for Medicare would separately value telemedicine services from their equivalent face-to-face services. In this way purveyors of distance medicine will be more readily ensured reimbursement for their services.
The budget will also allow federally qualified healthcare providers and rural health centers to offer telehealth services, making permanent an arrangement that is temporary because of the coronavirus pandemic. The role of the Office for the Advancement of Telehealth will be elevated to become a focal point for coordinating telemedicine services across the government and the private sector.
One barrier to expanding telemedicine across rural America has been a lack of broadband internet services outside of big cities. Fortunately, the private sector seems to be stepping up, in particular Elon Musk’s SpaceX with the development of the Starlink satellite constellation. Starlink is designed to provide direct-from-space audio, visual, and data communications services to everyone on the planet, with services for North America (the United States and Canada) due to be available in 2020. The service will expand world-wide the following year.
Telemedicine’s expansion is thought to be a vehicle to expand healthcare services and enhance outcomes to millions of hitherto under-serviced people.
On this special edition of the Houston Healthcare Initiative podcast, author Gerald Posner discusses the history of the pharmaceutical industry and his new book “Pharma: Greed, Lies, and the Poisoning of America.” This book describes the history of the pharmaceutical manufacturing industry and how we and they got to the place we are now.
Among many shocking facts included are that many of the practices that were incorporated into marketing and selling heroin and cocaine in the early 20th century are still used today. And like before, those same companies are deliberately downplaying of the risk of modern-day medicines like opioids. Refer to www.houstonhealthcareinitiative.org and www.posner.com. Be sure to read “Pharma: Greed, Lies, and the Poisoning of America.”
An association healthcare plan is a method of providing the advantages of a large group health insurance plan enjoyed by larger corporations, the federal government, or state governments for small businesses and individuals. Associations based on a shared profession, a line of business, or even just a geographic location, such as a state or city, can offer group health insurance with the ability to negotiate savings from healthcare providers and pharmacies. Membership in an association health insurance program also provides cost savings for premiums.
Let us suppose that you are the owner of a mom and pop eatery and want to provide your employees some good health insurance, but the number of people who work for you does not rise above the threshold of a large group as defined by your state’s regulator. In that instance, a restaurant association might offer a health insurance plan for its members, with the number of premium-paying members easily being above the cutoff line of a large group, thus qualifying for savings.
If you happen to be self-employed or a freelancer, the same idea applies. Say an association of everything from accountants to freelance writers or musicians can offer an association healthcare plan, rendering tremendous savings over individual health plans.
Individual health insurance plans in the United States are very expensive and have such huge deductibles that often having such a plan is the equivalent of not having one, despite the member paying huge premiums. Association healthcare plans provide an alternative to paying through the nose for health insurance or doing without it for people who don’t work for large employers.
Health insurance reform has been a contentious political issue in the United States for decades. Association healthcare plans, in the view of many, provide at least part of an answer to getting more people affordable insurance.
Retracted Article Mischaracterizes Hydroxychloroquine. No one can un-ring a bell. No article can be ‘un-read’ or any eventual retraction definitely seen and understood. There are few more illustrative examples lately than when respected medical journals published information about the use of Hydroxychloroquine as a possible treatment for the Coronavirus/Covid-19 virus they later retracted.
On his podcast, respected, Houston based neurologist Dr. Steven Goldstein describes how the well-established, inexpensive drug Hydroxychloroquine was mischaracterized. To listen to the podcast please visit: SoundCloud, Libsyn,iHeart, and the Houston Healthcare Initiative web site.
Article Retracted But Damage Done
Early in the pandemic, Hydroxychloroquine looked like it could be a possible treatment for Coronavirus/Covid-19 ,but use of and studies about the drug quickly lost favor after articles in the Lancet and New England Journal of Medicinecast doubt. The later retracted study and reporting about it had an immediate impact. The World Health Organization (WHO) stopped their research into hydroxychloroquine. Multiple news web sites carried the message that Hydroxychloroquine was not effective, citing the New England Journal of Medicine as its source. One example was from the NBC News web site read, “Hydroxychloroquine fails to prevent COVID-19, large study finds.”
While the articles were retracted the information originally published, could not be ‘unseen.’ “The news media touted these articles, that falsely claimed there was no evidence that treatment with Hydroxychloroquine was effective,” Dr. Goldstein told his listeners. “A French study published March 20, 2020 suggested the drug helped people with coronavirus, reporting it “is significantly associated with viral load reduction/disappearance in patients with COVID-19.”
The article and its author, French physician and scientist, Dr. Didier Raoult, who authored papers showing favorable results, were personally and professionally attacked (The New York Times) among others. Suffice to say that way more people saw and continue to see these refuted articles, even though they were retracted. But the harm from them remains.
About The Houston Healthcare Initiative
Houston Healthcare Initiative is a group of physicians and health conscious patients that have joined together in a Healthcare cooperative to maintain and improve the physical and mental health of each member of the group. Visit online at https://houstonhealthcareinitiative.org.
When discussing the “right” to adequate healthcare, it’s beneficial to first define what sort of right that is. Generally speaking, there are two possibilities: civil rights, or human rights. Civil rights are those granted to all legal members of a certain political state, while human rights are those which can be expected simply by virtue of being alive. The right to vote in an American election, for instance, is a civil right provided to all American citizens. The right not to be murdered, however, is a human right, of which we should all (ideally) have a reasonable expectation.
Healthcare, in our current system, is not a civil right. That is an objective fact, as defined by our Constitution and the legislation currently in place. The question, then, is whether healthcare is a human right. Should all human beings expect that their physical and mental well-being will be provided for? That certainly hasn’t been the case over our evolutionary history. But need we constrain ourselves to that history? It could be argued that the right not to be murdered, almost universally accepted now, was a fairly recent addition to the list of human rights. Other rights that most of us take for granted, including the rights not to be raped, beaten, or enslaved, have only taken hold in last couple of centuries. It’s clear, then, that human rights need not be restricted to those that were inherent to our species 300,000 years ago. Which is good, as such ideas almost certainly didn’t exist at the time.
Our evolution as a species has been both physical and cultural, and there’s no reason that it shouldn’t continue to be so. Amongst all the species on the planet, we’re uniquely suited to choose how we should evolve. At some point, we determined that murder was wrong. We then determined that theft was wrong. Rape, assault, slavery…the list continues. Throughout our history, we’ve shown an ability to come together as a society and decide that certain acts are wrong, and that protection from those acts should be expected by every member of our species, regardless of gender, race, religion, or nationality. In a time of unprecedented abundance, with the power of decades of exponential scientific progress, it seems only reasonable that we add protection from sickness and disease to that list. Having thus defined this human right, what choice would any advanced society have but to make it a civil right, as well?
You have probably heard the term “healthcare provider” being used by insurance companies or on television. It is a broad term that may leave you wondering what a healthcare provider is.
Who Is A Healthcare Provider?
A healthcare provider is a professional or a company that provides you with care. Providers are dedicated to making sure patients are healthy. There are different kinds of providers. One of the more common ones you may meet is a primary care physician. Healthcare providers are divided into six groups:
Doctors are the primary care providers in the medical field. They can be general practitioners that treat the flu and make first-level diagnosis. Many doctors specialize in a specific field, such as a cardiologist or a dentist.
Nurses are often associated with hospitals, but there can also be registered nurses at a doctor’s office. Nurses constantly work with patients directly and help with their recovery. They pass patient information to the doctor.
Pharmacists study chemicals and medicines and are aware of their side effects. They provide you with medicine that has been prescribed by your doctor. They also advise about over-the-counter medicine.
An Administrative staff plays an important part in a doctor’s office or a hospital. They manage appointments, patient information, and insurance information.
Technicians are the ones who work in labs. They test blood or urine to analyze what is going on in the patient’s body. Some are responsible for taking x-rays.
Therapists work on helping patients recover from an injury or illness. They may work on physical areas such as walking or coordination. Three main types of therapists are physical therapists, occupational therapists, and speech therapists.
Healthcare providers are a part of a provider network. This means that they offer services that are partially or completely covered by your healthcare plan. Not every provider will accept certain insurance companies. It is important to find an in-network provider if possible.
The Houston Healthcare Initiative provides information and tools regarding physical and mental health. To learn more, visit our site and contact us today.
Dark Daily, a newsletter serving clinical labs and pathology groups, recently reported that a Walmart in Calhoun, Georgia has opened the second of the retail giant’s Health Centers. The Health Center offers low-cost doctor visits along with a number of other healthcare services such as lab work and x-rays. The prices for each service are listed at the entrance to the facility. The Walmart Health Centers are providing competition to traditional healthcare providers that they might find difficult to meet, at least for patients who lack health insurance.
For example, the cost of a typical doctor visit is about $106, though for people with insurance that is covered except for about a $25 copay. A Walmart Health Center doctor visit costs $40. The costs of other services are comparably cheaper than their traditional competitors.
Many proposed solutions to expanding access to healthcare for people who are uninsured involve variations of “Medicare for All,” a government-funded and -operated health insurance scheme that would either supplement or replace private insurance depending on which politician proposes it. The Walmart experiment suggests a free-market approach to providing healthcare, using price competition to lower the cost of certain services so that even the uninsured can readily afford them.
A recent article in Reason Magazine suggests that big retail-based healthcare services could provide a new model for private insurance. Instead of carrying insurance that would cover standard healthcare services such as doctor visits, a person might pay for those services out of pocket and carry insurance only for “catastrophic” healthcare services such as surgical procedures and cancer treatments.
Of course, a couple of questions must be asked about such an approach.
First, can traditional healthcare services learn to compete with the Walmart approach? The answer may depend on changes in government regulation that would make that easier.
Finally, how would people paying out-of-pocket for doctor visits be encouraged to go to the doctor for regular checkups? Standard health insurance provides such incentives. People paying out of pocket, even at a reduced price, may decide to forgo such a service if they feel healthy. This might mean that conditions whose symptoms are not immediately apparent would not be discovered until they are more advanced and thus harder to treat.
This week on the Houston Healthcare Initiative podcast, Dr. Steven Goldstein takes a deeper dive into a court decision where hospitals must reveal private negotiated rates with insurers starting this coming January 1, 2021. Plus, he will provide more insight into how hospitals decide what and how much to charge us, and man is that a story. It’s all more than a little complex. The podcast is available on all the popular podcast networks including SoundCloud, iHeart, and Spotify among others.
How Are Prices Now Assessed
Hospital prices are not based on the free market. Instead, prices are agreed on via secret agreements between hospitals and insurance companies. The truth is that pricing for medical services as paid by insurance companies are artificially set and not competitive at all. Prices are agreed to in advance by the hospital and the insurance company, not disclosed to the public. “We are led to believe that our insurance providers negotiate on behalf of their policyholders,” Dr. Goldstein told his audience. This is not the case. The court has ruled that this will no longer be permitted, that hospitals will have to reveal these negotiated rates and thus hospitals must reveal private negotiated rates .
Why Hospitals Object
One reason many hospitals do not list their actual prices is that, according to them, some cases are more complicated than others. “An appendectomy may go smoothly or may be complicated by other factors such as adhesions from a previous surgery that caused scarring,” Dr. Goldstein said. “This may require additional operating room time resulting in a higher cost. Thus hospitals claim they can only give estimates.”
Alternatively, this could be handled in one of two ways. 1). Publish the price for each procedure at what the hospital perceives as the average price. Then find ways to cut costs so that average cost is lowered resulting in increased profit for the hospital. 2). Alternatively, publish a price for operating room time by the hour that would include all the ancillary charges + publish the range of operating room times for each procedure.
How Prices Are Set Now
With the use of computer technology, hospitals are able to establish a charge for each product or service, no matter how small. “Every aspirin, every blood test, every x-ray, every bandage, every suture has a charge; Dr. Goldstein said. “Some of these charges beg credulity e.g. the $20 aspirin. All these charges are added up to give the total hospital charge. Of course, this doesn’t include multiple physician charges that are separate.” This all resulted in the Trump administration’s order that hospitals must reveal private negotiated rates to the public.
But the final charge is the “sticker price”. The insurance companies never pay this price. They have a secret, negotiated price based on the Medicare price for those services.
Transparency and the need for it in different industries is a word and requirement we hear a lot about. It should not surprise anyone that some insurers and hospital groups are working to block the implementation of federal rules that make hospital pricing transparent. They argue these will confuse consumers and potentially lead to higher costs. But there is good news. According to the New York Times, a federal judge has upheld a Trump administration policy that requires hospitals and health insurers to publish their negotiated prices for health services, numbers that are typically kept secret.
Most of us have our health insurance provided by our employers and we do not pay as much attention to the price of medical care as we do the cost of other consumer items. But maybe we should pay more attention? The fact that the charges for our visits to the doctor, hospital and pharmacist are mostly paid for by our insurance does not make us any less likely to get both overcharged and underserved. In fact, it is a lack of transparency that makes medical costs so high.
The issue is that patients do not know the actual price of services. The list price is the price charged to patients without insurance. Each Insurance company negotiates a discounted price. Thus there are multiple discounted prices depending on the insurance company plus a different price for Medicare and Medicaid. These prices have traditionally been secret. There is no competition between hospitals based on price. Medicare sets the price standard based on costs. Thus, hospitals are cost plus operations with little incentive to reduce costs.
Provided at no charge by the Houston Healthcare Initiative.
For Those Who Lost Their Employer Funded Health Insurance Resources Are Available
Because of the Coronavirus/Covid-19 pandemic, 25–43 million people could lose their jobs and their health insurance. People who had a serious illness before the outbreak and job loss could be dealt a literally fatal blow. Others who had symptoms and even serious accidents while unemployed and without insurance could suffer more than they would have if their insurance were in place. But there are resources available as described this week on the Houston Healthcare Initiative podcast. To learn more, go to www.houstonhealthcareinitiative.org. To hear about this on Dr. Goldstein’s podcast, please visit: Job Losses Equal Employer Funded Health Insurance Loss.
Testing for the Coronavirus/Covid-19 illness: testing for the Coronavirus/Covid-19 virus is free. But if the test is positive and you have the virus, the treatment for it can get expensive. Fortunately, most people recover at home. However, an estimated 15% of infected people may end up hospitalized, according to the Kaiser Family Foundation. Recent data suggests that patients who go to intensive care stay there for an average of 20 days. The Castlight Covid-19 test site finder will provide information on Coronavirus testing near you: https://my.castlighthealth.com/corona-virus-testing-sites/.
The Health Insurance Exchange: Open enrollment typically runs from November to January, depending on the state in which you live. But people are allowed a change in coverage when experiencing a life altering event. One such event is the loss of a job and employer sponsored health insurance. You can shop for health plans through your state’s insurance marketplace. But don’t wait around, there are 30 to 60 days to sign up after a qualifying life event before the end of that special enrollment period. Go to this link and find out if you qualify for coverage: https://www.healthcare.gov.
Medicaid: Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities in all fifty states. In some states the program covers all low-income adults below a certain income level. But do not assume that you do or do not qualify. There are online resources available from the U.S. Department of Health and Human Services along with state references to guide you. Visit the official U.S. government Medicaid site to see of you are eligible: https://www.medicaid.gov.
CHIP: CHIP stands for Children’s Health Insurance Program. If your children need health coverage, they may be eligible for the Children’s Health Insurance Program (CHIP). CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers pregnant women. Each state offers CHIP coverage and works closely with its state Medicaid program. Get all the details, go to: https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/.
Faith Based Cooperatives: Faith-based plans are designed to provide essential coverage for the good health and physical well-being of their members. In return they expect members to live faith-based lives in adherence to the principles behind such plans. As such, faith-based plans will not cover hospital costs that stem from activities they deem immoral or unessential. Faith based plans most often share expenses among members. Each member pays a monthly premium. When one of the members becomes ill or needs treatment for an injury, his or her contributions cover the expenses, in conjunction with the collective input of fellow members. As such, the premiums are lower in comparison to those of traditional health care. These operate with exemptions to the mandates of the Affordable Care Act, also known as Obama Care. There are several options. Here are a few:Medi-Share,Liberty HealthShare, Samaritan Ministries, OneShare, Christian Healthcare Ministries.
This is not an exhaustive list for those who lost their employer funded health insurance but is some go the most popular ones that are available.
About Houston Healthcare Initiative And Dr. Steven Goldstein
Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America.