The Personal Pediatrics House call software and system and portal may play a critical role in easing gaps in insurance coverage for those just above and just under the poverty line...
Health insurance premiums rose faster than adjustments were made to the federal poverty level between 1998 and 2004, according to a report by the Kaiser Family Foundation. In that period, the federal poverty limit increased only about 20%, but premiums for family coverage rose 100% and single coverage increased by 86%. As a result, people who are just above the poverty limit are hit increasingly hard. Because eligibility of health care subsidies depends on personal or family income's relation to the federal policy level, the arrangement does not provide for consistent protection against rising health care costs, the group says.
Natalie Hodge MD CEO and Founder Personal Pediatrics, Inc.
Thursday, February 22, 2007
Monday, February 05, 2007
Doctor's innocent record transfer a hippa violation
Take a look... Innocent enough... an insurance company requests a file on a patient... This happens every day to doc's who accept assignment for insurance companies... ( For those of you that don't know that term it means docs who allow insurers to decide which of their services will be covered based on what the insurer decides ) Bottom line... Why not have secure access to your medical record and a doctor that you contract with directly for his or HER services?? Why not box out insurers from having ANY access to your medical record. In the future as genetic testing progresses, you do NOT want BCBS Aetna and UHC to know whether you're testing positive for diseases. As a physician why not utilize a system that emables your CLIENTS to have access to their own record and then they may do with it what they please. Incidentally, stop paying all this staff to DO something that is AUTOMATED via the web now??? Why not implement a service out of your office that PRINTS MONEY for you while providing a service families are DYING for??
Natalie Hodge MD
Founder and CEO Personal Pediatrics
A lawsuit involving HIPAA got the green light in December when the North Carolina Court of Appeals ruled that a patient could continue with her case. The patient alleges that a clinic "violated the rules and regulations established by HIPAA," but since she doesn't claim an actual HIPAA violation, she can keep fighting. The case had been dismissed by a lower state court, which ruled that the lawsuit was improper because HIPAA does not grant an individual a private cause of action. The plaintiff, Heather Acosta, was an employee of Psychiatric Associates of Eastern Carolina and was also the patient there, according to the opinion. She filed a suit in May 2005, against the clinic's owner, David Faber, M.D., alleging negligent infliction of emotional distress. The suit also alleges invasion of privacy and infliction of emotional distress against other defendants, including the clinic's office manager. At one point, Faber allegedly let the office manager use his medical record access number, and she "retrieve[d] plaintiff's confidential psychiatric and other medical and healthcare records," which she then gave "to third parties without plaintiff's authorization or consent," the opinion says. The plaintiff states that when Dr. Faber provided his medical access code, "Dr. Faber violated the rules and regulations established by HIPAA," the opinion continues. "This allegation does not state a cause of action under HIPAA. Rather, plaintiff cites to HIPAA as evidence of the appropriate standard of care, a necessary element of negligence," the court states. An attorney for Faber says that if his client's password was indeed used, it was done so without Faber's knowledge. "I don't see how he could be held liable for any kind of emotional distress claim," says attorney Nicholas Ellis, who is with Poyner & Spruill, LLP. Two defendants in the case have settled. The case against Faber and another defendant will proceed. Read the opinion for Acosta v. Byrum at www.aoc.state.nc.us/www/public/html/opinions.htm.
Natalie Hodge MD
Founder and CEO Personal Pediatrics
A lawsuit involving HIPAA got the green light in December when the North Carolina Court of Appeals ruled that a patient could continue with her case. The patient alleges that a clinic "violated the rules and regulations established by HIPAA," but since she doesn't claim an actual HIPAA violation, she can keep fighting. The case had been dismissed by a lower state court, which ruled that the lawsuit was improper because HIPAA does not grant an individual a private cause of action. The plaintiff, Heather Acosta, was an employee of Psychiatric Associates of Eastern Carolina and was also the patient there, according to the opinion. She filed a suit in May 2005, against the clinic's owner, David Faber, M.D., alleging negligent infliction of emotional distress. The suit also alleges invasion of privacy and infliction of emotional distress against other defendants, including the clinic's office manager. At one point, Faber allegedly let the office manager use his medical record access number, and she "retrieve[d] plaintiff's confidential psychiatric and other medical and healthcare records," which she then gave "to third parties without plaintiff's authorization or consent," the opinion says. The plaintiff states that when Dr. Faber provided his medical access code, "Dr. Faber violated the rules and regulations established by HIPAA," the opinion continues. "This allegation does not state a cause of action under HIPAA. Rather, plaintiff cites to HIPAA as evidence of the appropriate standard of care, a necessary element of negligence," the court states. An attorney for Faber says that if his client's password was indeed used, it was done so without Faber's knowledge. "I don't see how he could be held liable for any kind of emotional distress claim," says attorney Nicholas Ellis, who is with Poyner & Spruill, LLP. Two defendants in the case have settled. The case against Faber and another defendant will proceed. Read the opinion for Acosta v. Byrum at www.aoc.state.nc.us/www/public/html/opinions.htm.
Friday, February 02, 2007
HSA's further liberalized as of Jan 1st 2007
One provision of the new health savings account law is likely to have a particularly dramatic effect on the speed in which the HSA market evolves, according to industry observers. As of Jan. 1, the maximum allowable HSA contribution is no longer tied to the health plan deductible. Under a set of new rules, signed into law on Dec. 20, high-deductible health plan (HDHP) enrollees can contribute up to the full statutory maximum to their HSAs each year. Previously, the maximum contribution was "the lesser of" the statutory maximum or the deductible....
Families may utilize their new HSA credit card to make easy automated payments to their Personal pediatricsHouse Call affiliate Pediatrician
Natalie Hodge MD Personal pediatrics House call affiliate st louis
Families may utilize their new HSA credit card to make easy automated payments to their Personal pediatricsHouse Call affiliate Pediatrician
Natalie Hodge MD Personal pediatrics House call affiliate st louis
Wednesday, January 31, 2007
Insurer's look for cost savings utilizing Walmart clinic setup
take a look it is clear healthcare is heading in two ways:
1. See a nurse in Walmart. Insurers are tripping over themselves at this savings option. Remember stand alone nurses are billing at 80% of a doc's billings.
2. Go out of your insurance network and pay extra for a Personal Pediatrics affiliate pediatrician for come to your home with attentive pediatric care.
3. OOps I forgot the other option, which is the existing option and status quo... wait an hour in a busy office to see a nurse most of the time, within your insurance network.
Retail Health Clinics Grow, Insurers Eye Potential Savings
Reprinted from the Jan. 29, 2007, issue of MANAGED CARE WEEK, the industry's leading source of business, financial and regulatory news of health plans, PPOs, and POS plans.
Although many health insurers are adding retail health clinics to their provider networks, some observers say they're not convinced that the lower-cost clinics really will save costs.
Walk-in clinics in retail stores generally are staffed by nurse practitioners who treat a limited number of conditions, such as colds, allergies, strep throat and skin conditions. Nationwide, the number of retail-based clinics conservatively is expected to grow from about 300 clinics now to between 600 and 900 by the end of the year, says Tine Hansen-Turton, executive director of Convenient Care Association, a new trade group that represents such clinics.
BlueCross BlueShield of Tennessee recently contracted with MinuteClinic, the largest provider of retail-based clinics and a subsidiary of CVS Corp. "What we've chosen to do is contract with them as if they were a primary care provider," says Ken Patric, M.D., chief medical officer at the Tennessee Blues plan. The copayment structure is exactly the same as it would be in any other urgent care clinic for a general nurse practitioner or physician's assistant, he adds.
But whether it's cost effective remains to be seen. "We don't know yet," Patric says. "That's obviously the big question. Will this end up serving people who otherwise wouldn't have accessed the system?.Is this a less expensive alternative to going to the emergency room? The jury is still out."
The savings may be minor to the overall health care system, warns Joseph Paduda, principal of consulting firm Health Strategy Associates. Most health care dollars are spent on patients with chronic conditions, such as diabetes, who would not use a walk-in clinic, he notes.
Still, "the clinics are a lower-cost provider who can appropriately deal with 80% to 90% of the things that people have when they walk into a clinic: 'I sprained my ankle. Wrap it up. Here is your anti-inflammatory. Off you go,'" he says. He predicts that over time, insurers will try and motivate patients to go to these types of providers.
Among patients who use walk-in clinics, roughly 30% do not have insurance, although the percentage can vary from 20% to 40% depending on the provider, Hansen-Turton says. She says that the model makes sense to insurance companies. "Any insurer would be interested to send a patient to somebody after hours — or if they can't get an appointment with their primary care provider — rather than having them go to the emergency room, which costs the plan a lot of money."
One hurdle for clinics partnering with health plans involves the expense of dealing with billing, says Mary Kate Scott, a consultant who recently wrote a paper about retail clinics for the California HealthCare Foundation. "Insurance carriers are saying, 'Yes it's cheaper.' But it's very difficult for the insurance company's system to fit in with the billing system of the clinic," she says.
In the paper, "Health Care in the Express Lane: The Emergence of Retail Clinics," Scott asserted that health insurers typically have a "paper and people-intensive process" that includes multiple claims rejections and negotiated discount arrangements with providers. "That is why many of the clinics initially charged cash, because they didn't want the expense of the billing system," Scott explains. "A billing system can be up to 30% of a primary care physician's office. Put that 30% overhead on, and these clinics will never make it. It's tough for an insurance company to actually adapt its system to manage this."
In the report, Scott described a deal MinuteClinic worked out with some insurers to get around this issue. The two sides agreed to a "radically simplified system: 100% payment for 100% of claims within 10 to 14 days." The insurers instead used random claims audits to ensure that utilization was appropriate, rather than individual claims review.
Take a look at
Personal Pediatrics= House call Pediatricians and see how we are innovating pediatric healthcare. And remember we are coming up on an election year. Both parties are looking for innovative healthcare. The PP system can REPLACE our failed medicaid .
Natalie Hodge MD
1. See a nurse in Walmart. Insurers are tripping over themselves at this savings option. Remember stand alone nurses are billing at 80% of a doc's billings.
2. Go out of your insurance network and pay extra for a Personal Pediatrics affiliate pediatrician for come to your home with attentive pediatric care.
3. OOps I forgot the other option, which is the existing option and status quo... wait an hour in a busy office to see a nurse most of the time, within your insurance network.
Retail Health Clinics Grow, Insurers Eye Potential Savings
Reprinted from the Jan. 29, 2007, issue of MANAGED CARE WEEK, the industry's leading source of business, financial and regulatory news of health plans, PPOs, and POS plans.
Although many health insurers are adding retail health clinics to their provider networks, some observers say they're not convinced that the lower-cost clinics really will save costs.
Walk-in clinics in retail stores generally are staffed by nurse practitioners who treat a limited number of conditions, such as colds, allergies, strep throat and skin conditions. Nationwide, the number of retail-based clinics conservatively is expected to grow from about 300 clinics now to between 600 and 900 by the end of the year, says Tine Hansen-Turton, executive director of Convenient Care Association, a new trade group that represents such clinics.
BlueCross BlueShield of Tennessee recently contracted with MinuteClinic, the largest provider of retail-based clinics and a subsidiary of CVS Corp. "What we've chosen to do is contract with them as if they were a primary care provider," says Ken Patric, M.D., chief medical officer at the Tennessee Blues plan. The copayment structure is exactly the same as it would be in any other urgent care clinic for a general nurse practitioner or physician's assistant, he adds.
But whether it's cost effective remains to be seen. "We don't know yet," Patric says. "That's obviously the big question. Will this end up serving people who otherwise wouldn't have accessed the system?.Is this a less expensive alternative to going to the emergency room? The jury is still out."
The savings may be minor to the overall health care system, warns Joseph Paduda, principal of consulting firm Health Strategy Associates. Most health care dollars are spent on patients with chronic conditions, such as diabetes, who would not use a walk-in clinic, he notes.
Still, "the clinics are a lower-cost provider who can appropriately deal with 80% to 90% of the things that people have when they walk into a clinic: 'I sprained my ankle. Wrap it up. Here is your anti-inflammatory. Off you go,'" he says. He predicts that over time, insurers will try and motivate patients to go to these types of providers.
Among patients who use walk-in clinics, roughly 30% do not have insurance, although the percentage can vary from 20% to 40% depending on the provider, Hansen-Turton says. She says that the model makes sense to insurance companies. "Any insurer would be interested to send a patient to somebody after hours — or if they can't get an appointment with their primary care provider — rather than having them go to the emergency room, which costs the plan a lot of money."
One hurdle for clinics partnering with health plans involves the expense of dealing with billing, says Mary Kate Scott, a consultant who recently wrote a paper about retail clinics for the California HealthCare Foundation. "Insurance carriers are saying, 'Yes it's cheaper.' But it's very difficult for the insurance company's system to fit in with the billing system of the clinic," she says.
In the paper, "Health Care in the Express Lane: The Emergence of Retail Clinics," Scott asserted that health insurers typically have a "paper and people-intensive process" that includes multiple claims rejections and negotiated discount arrangements with providers. "That is why many of the clinics initially charged cash, because they didn't want the expense of the billing system," Scott explains. "A billing system can be up to 30% of a primary care physician's office. Put that 30% overhead on, and these clinics will never make it. It's tough for an insurance company to actually adapt its system to manage this."
In the report, Scott described a deal MinuteClinic worked out with some insurers to get around this issue. The two sides agreed to a "radically simplified system: 100% payment for 100% of claims within 10 to 14 days." The insurers instead used random claims audits to ensure that utilization was appropriate, rather than individual claims review.
Take a look at
Personal Pediatrics= House call Pediatricians and see how we are innovating pediatric healthcare. And remember we are coming up on an election year. Both parties are looking for innovative healthcare. The PP system can REPLACE our failed medicaid .
Natalie Hodge MD
Tuesday, January 23, 2007
Bush enables Personalized Medicine
Great to see President Bush vow to expand health savings accounts. This will further incent employers and business owners to spend less money on health insurance and more money on doctors directly with these pretax, easy to use dollars. Nice for the Personal Pediatrics affiliate pediatricians, as HSA's gain steam, clients will find it easier to pay doc's retainer fees coming out of pretax monies.
Natalie Hodge MD Personal Pediatrics House Call Affiliate
Natalie Hodge MD Personal Pediatrics House Call Affiliate
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