Archive for November, 2018

Add Electronic Data Collection to the burdens the ACA has added to each of us. Now we must monitor our personal data for hacking, miss-use and mistakes.

November 29, 2018

The idea of maintaining one’s historical data in an easy to access place where it will always be available is appealing. Whether it is one’s financial records, tax information or family photos, list of friends and contacts or even entertainment it’s becoming easier to maintain any or all of that information in an easily accessible place.

Add to that list the collection, maintenance and storage of all our personal medical records and you have a life full of history at your finger tips. doesn’t that sound appealing? Can you imagine being able to easily look up every medical checkup you’ve ever had, every lab result or every x-ray you’ve ever had and every procedure and every prescription you’ve ever had or taken. Wouldn’t that be convenient not only for your own use but for family members who may be responsible for you, someday.

The ACA included provisions which mandated all providers move to electronic record keeping. The stated goal of the idea (mandate) was to improve efficiency and outcomes of healthcare encounters by being able to better maintain, track and share data between providers. Makes sense doesn’t it?

The implementation of this ACA mandate was not easy nor has it been completed by every provider in the United States. Many small providers or rural providers lacked the resources and capacity to quickly comply. Large providers may have had more resources or better access to technology to help them comply but they also had much larger patient base with huge amounts of data to input.

Your humble author has written and spoken many times about the concern we all should have about this vast collection of “very personal” medical data being stored in a single data base and the ease in which it can be shared. Why was I and still am concerned?

Events, briefly reported in the news, have proven that security is the reason why we should all be concerned or at least not surprised when our own personal data is stolen by hackers or internal evil-doers. Let’s face it, hackers have already demonstrated their ability to get into and steal data from the US Government Personnel Records as well as banks, credit card issuers, credit reporting agencies, Sony, Facebook, Google, and dozens of insurance companies.

Why would we think that our personal medical history, stored by our personal doctor, local lab or local hospital, would be better protected than the biggest tech companies, Insurers and banks in the country not to mention the United States government, itself?

Well, let’s add one more concern to collection and storage of our personal health information. That would be incorrect data.

That’s right, just simple mistakes of data input that might influence a provider to make a draw an incorrect conclusion which could lead to an incorrect diagnosis and worse treatment for a patient. Sounds too simple to worry about, I know. But think about the impact of adding or omitting a single word from the input of data in a patients record.

Let’s say that a Doc is trying to type or dictate that “The patient has a history of high blood pressure.” but instead it gets entered in the records as “The patient has no history of high blood pressure.” You can probably think of many other examples which could be more serious or at least more embarrassing.

Such as, a woman, age 34, goes to her doctor presenting symptoms of nausea, fatigue, and bloating. The doctor runs a panel of tests and after review enters his thoughts into the record “Blood tests reveal no blah, blah, blah but that the patient, Mrs. Jones, tested positive to being pregnant’. The potential problem is that Mrs. Jones’s husband had a vasectomy 5 years earlier. You can imagine the discussion that followed.

But, the doctor had an exceptionally high number of patients to see that day, was rushing to get through and in addition was trying to get finished in time to go watch his 14 year-old son play baseball that afternoon. The record should have stated “Blood tests revealed no blah-blah including pregnancy”. I don’t need to explain further the complications this mistake could cause Mrs. Jones.

Truthfully, we should be more concerned with hackers and evil-doers than mistakes in input. The hackers will use our information for evil and the results could be far more harmful, except maybe for Mrs. Jones.

So, what do we do?  There is probably little that any of us can do. If your general provider has a website on which patients are allowed to access their own data then we should access it from time to time. For instance, my provider’s group provides me access to what they call “My Chart”. I go there from time to time, generally after getting an email from them prompting me to do so. These records available on your provider’s website provide a good means to at least try to verify that your data is accurate. If nothing else you can verify what is says about the Rx you take, your next appointment or just the accuracy of your date of birth. These sites generally allow you to print your information which can be handy if traveling out of country or for a provider not able to access the data.

The easy access to helpful personal health information is a benefit when protected properly. It’s just that no one can guarantee us that they can protect our information. There’s nothing you or I can do about the security of our data or that our data is collected in the first place.

Over the past 30 years I’ve stated many times that the concept of Managed Care is really designed to provide Insurers a means to manage their cost and it’s up to us to actually manage our care. Electronic records are one more aspect of our care which we must manage if we want it to be accurate and safe.

In this case we all are subject to the same risks so once again I say; we’re all in this together.

Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf
It means “Walk the Faith”.

The Thanksgiving Holiday is not unique to the USA but we may enjoy it more than most. Given the way History is taught in schools, do younger Americans know its origin? Let’s review.

November 15, 2018

Next week is Thanksgiving so let’s take a break from discussing healthcare reform and the ridiculousness of Washington DC to pause for one of our most cherished of traditions.

Why is it that we have this Thanksgiving Holiday? It’s a national holiday and generally grants us a 4-day weekend, at least for many of us. If one searches the internet for Thanksgiving there is a plethora of good info. But why do we celebrate it?

Many Americans are not aware of the reason for some holidays and we are perfectly happy enjoying the time off from work. I say this as someone who is not useful in a kitchen and therefore generally banished from it so Thanksgiving Day has always been a full day of food, parades and football. (Except this year, it’s just food and parades since we can’t watch the NFL until the protests against our National Anthem stop.)
But that’s not the story for today.

Let’s take a brief look at the origin of Thanksgiving; courtesy of Wikipedia and the Internet.

Early thanksgiving observances

Thanksgiving
, or Thanksgiving Day, is a public holiday celebrated on the fourth Thursday of November[1] in the United States. It originated as a harvest festival. Thanksgiving has been celebrated nationally on and off since 1789, after Congress requested a proclamation by George Washington.[2] It has been celebrated as a federal holiday every year since 1864, when, during the American Civil War, President Abraham Lincoln proclaimed a national day of “Thanksgiving and Praise to our beneficent Father who dwelleth in the Heavens,” to be celebrated on the last Thursday in November.[3][4] Together with Christmas and the New Year, Thanksgiving is a part of the broader fall/winter holiday season in the U.S.

The event that Americans commonly call the “First Thanksgiving” was celebrated by the Pilgrims after their first harvest in the New World in October 1621.[5] This feast lasted three days, and—as accounted by attendee Edward Winslow[6]—it was attended by 90 Native Americans and 53 Pilgrims.[7] The New England colonists were accustomed to regularly celebrating “thanksgivings”—days of prayer thanking God for blessings such as military victory or the end of a drought.[8]

Setting aside time to give thanks for one’s blessings, along with holding feasts to celebrate a harvest, are both practices that long predate the European settlement of North America. The first documented thanksgiving services in territory currently belonging to the United States were conducted by Spaniards[9][10] and the French[11] in the 16th century. Wisdom practices such as expressing gratitude, sharing, and giving away, are an integral part of indigenous communities since time immemorial.

Thanksgiving services were routine in what became the Commonwealth of Virginia as early as 1607,[12] with the first permanent settlement of Jamestown, Virginia holding a thanksgiving in 1610.[9] In 1619, 38 English settlers arrived at Berkeley Hundred in Charles City County, Virginia. The group’s London Company charter specifically required “that the day of our ships arrival at the place assigned… in the land of Virginia shall be yearly and perpetually kept holy as a day of thanksgiving to Almighty God.”[13][14] Three years later, after the Indian massacre of 1622, the Berkeley Hundred site and other outlying locations were abandoned and colonists moved their celebration to Jamestown and other more secure spots.

Harvest festival observed by the Pilgrims at Plymouth

Americans also trace the Thanksgiving holiday to a 1621 celebration at the Plymouth Plantation, where the settlers held a harvest feast after a successful growing season. Autumn or early winter feasts continued sporadically in later years, first as an impromptu religious observance and later as a civil tradition.

Squanto, a Patuxet Native American who resided with the Wampanoag tribe, taught the Pilgrims how to catch eel and grow corn and served as an interpreter for them. Squanto had learned the English language during his enslavement in England. The Wampanoag leader Massasoit had given food to the colonists during the first winter when supplies brought from England were insufficient.

The Pilgrims celebrated at Plymouth for three days after their first harvest in 1621. The exact time is unknown, but James Baker, the Plimoth Plantation vice president of research, stated in 1996, “The event occurred between Sept. 21 and Nov. 11, 1621, with the most likely time being around Michaelmas (Sept. 29), the traditional time.”[16]  ] The feast was cooked by the four adult Pilgrim women who survived their first winter in the New World (Eleanor Billington, Elizabeth Hopkins, Mary Brewster, and Susanna White), along with young daughters and male and female servants.[16][17]

So, there you go, a brief history lesson for us all. Can you imagine our Congress declaring a day be set aside for honoring the Almighty who Dweleth in the Heavens in our current political climate? Someone might get burned at the stake.

Over 120 Pilgrims landed on Plymouth Rock but only 53 survived the first year, to celebrate and offer thanks, in the New World.   As we enjoy our Thanksgiving Holiday I hope we all  can benefit by knowing the first years of this celebration were precluded by great hardship and therefore were indeed a blessing for the settlers. They endured much and likely would have all perished if not assisted greatly by the Native Americans living in the region. We each need a little help in our lives from time to time!

There’s a lesson in history for each of us. Unfortunately it is quickly forgotten as the Monday following Thanksgiving arrives. Hey, maybe it will be different this year.
Next week we’re back to healthcare reform, tax reform and the unbelievable mess we call our US government.
Until next week, let’s remember what Thanksgiving is about and that like the Pilgrims in 1621, we’re all in this together.
Until then,
Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf
It means “Walk the Faith”.

Post Election Review: What’d we gain and what’d we lose. By “we” I mean the average premium paying American citizen!

November 8, 2018

It’s only 12 hours post Election Day as I write this so everyone is still playing nice and watching for the “first dig of the spur” from the other side. When you read this, in 24 hours, I wager that the language used in the political discussions will already have turned back to negative, divisive or worse.

Will the House be nothing but subpoenas, investigations, impeachment, and obstruction?
Will the Senate, as well as other conservative voices reciprocate.
Will anything meaningful for America get done before the 2020 election?
Will we see nothing but gridlock and scapegoating?
I’ll let you fill in the answers to those questions!

Here are a couple random thoughts both Nationally as well as here in good ol’ California.

  • I doubt that the Employer Mandate will be eliminated which we have discussed in previous Posts. That is not a bad outcome because the GOP tinkering with the ACA was not helping.
  • Will the Individual Mandate be re-instated?
    Probably not, even though it should be.
  • Will anything positive be done to improve the ACA’s adverse rating methodology and burdensome fees and taxes added to it?
    Probably not!
  • Will “Single Payer” or “Medicare for All” advance anywhere in the Country or in  any State?
    Probably not, though it will get a lot of press coverage.
  • Will the truth about coverage for “Pre-ex conditions” come out showing that the Dems and the Media were fear-mongering the issue?
    Probably Yes, but people will need to listen closely to hear the truth!
  • Will premiums start to go down on ACA compatible plans?
    Definitely not!

 

What about the Golden State: California?

  • Will AHPs or STPs be allowed to exist and help the tens of millions who could benefit from them?
    Nope, not without a insurrection?
  • Will Insurers be allowed to restrict small employers access to HRAs with subtle threats to insurance brokers?
    We’ll see but I know one Insurer that for sure will not be restricting HRAs.
  • Will Californians see their premiums continue to increase at each renewal?
    Yep, but the Media will state that the increases are lower due to the good-work of the ACA. We’ve discussed that  effort in subterfuge before, too.
  • Should employers continue to sponsor group health plans for their employees
    Absolutely and do so with the Employer Driven method proven so effective.

Am I concerned about the future for healthcare financing and delivery in California?
I have been concerned about this issue since 1985 so I will continue to be concerned but I will not give up hope. Sooner or later (probably later) the status will become so unbearable that the solutions will be so amazingly clear that even the Dems in California can see it.

Let’s allow them to think that independent-competitive insurance plans operating in a less government regulated environment is their idea! Maybe that will do it.

Regardless, we’re all in this together, so keep the faith and keep watching for more “common sense solutions” as we venture forth together.

Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf
It means “Walk the Faith”.

California Voters have a chance to lower healthcare costs plus improve access. But it will take the proper “Vote” in the Mid-term election on Nov 6th.

November 1, 2018

California voters have a chance to start taking back control of the crazy out-of-control,  high-premium, low-benefit healthcare system in California. Premium increases exceeding 300%, since 2010, have literally destroyed our citizen’s access to the healthcare we need.

We all know that the health plans offered in California are the among the most expensive in the land with killer high out of pockets and “way too skinny” PPO networks.
That’s not News, so why is that important?
Because, with your vote November 6th, you have a chance to set in motion for the real possibility of changing the healthcare delivery and plans available in Ca.
Be sure to VOTE!

To lower premiums, improve benefits, increase access to more providers and get more health plan options – Voters just need to vote:

 Insurance Commissioner  –  Steve Poizner

For Governor  –     John Cox

It’s that simple, REALLY!

Then, we can begin introducing the solutions that you have read about in previous Posts. Can you imagine a California in which you have:

  • Dozens of high quality health plans available.
  • Plans with benefits that fit your need – not the Government’s.
  • Rich plan benefits or narrow plan benefits.
  • Plans with huge provider lists.
  • Plans with narrow provider lists.
  • Premiums that are affordable and 50% lower!
  • Reasonable reimbursement for providers.
  • Transparency and better control.
  • Most of all: available when you need it!

I know what you’re thinking. How can two elected positions create such possibility for change? The truth is that it will take effort and a little time but my bet is that Ca. citizens would start seeing a difference within nine to fifteen months after these men take office.

Reports are projecting insurer premiums for 2019. Estimates are that premium may increase from 15% to as much as 100% depending on the state or region of the country. In Ca. we will see increases on employer sponsored group plans in the range of 10% to above 50% with further push toward Silver and Bronze plans.

Of course, we all know that the premiums we pay for Silver and Bronze don’t usually buy much in first dollar benefits and leave huge out of pocket risks. If they do provide copays then those copays range from $50 to $250 which of course means people defer their medical care.

Regardless if you are Republican, Democrat, Independent, Libertarian or Green; we all have been hurt by the changes brought about by the ACA. This Fall’s election, the so-called mid-terms, provide Ca. citizens a chance to make a difference.

And isn’t that something we all crave, “a chance to make a difference”?

I could spend another 10,000 words outlining the potential improvements that might become reality if we vote wisely November 6th.
But I’ll save that for future Posts.

Certainly we can all agree that elections provide a time when truly “we’re all in this together”.
Let me know what you think.

Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf
It means “Walk the Faith”.