Wednesday, October 24, 2012

California Scores High In Quality Of Hospitals!

It's always a good thing to know that our hospitals are good ones! And ... it looks like California is doing well in that category!  Given the costs of healthcare, it's especially good to know that we have the best care in our local access.   
Get the details in this article just reported in the California Healthline as written by  Lloyd in USA Today:

Report Finds California Among States With Best Hospitals
California is among the states that scored highest for hospital care related to conditions and treatments commonly linked to mortality, according to a report released by Healthgrades, USA Today reports.
Details of the Report

The report ranked states and individual hospitals based on data released by CMS between 2005 and 2011.
Researchers examined data on 4,500 hospitals nationwide, focusing on four key conditions and procedures commonly linked to mortality:

  • Coronary artery bypass graft;
  • Heart attack;
  • Pneumonia; and
  • Sepsis.

The four conditions and procedures account for 54% of all hospital-related deaths in the U.S.
Main Findings

According to the report, states with hospitals that provided the best care for those conditions and procedures were:
Illinois; and
States and areas with hospitals that provided the worst care related to those conditions and procedures were:

Washington, D.C.; and
West Virginia.

According to the report, patients had a 55% lower risk of dying and a 42% lower risk of having complications when treated in the best hospitals.
Evan Marks -- a lead author of the study -- said that the differences in hospital quality in various states are "substantial."

Researchers also found that the quality of care can vary widely among hospitals within a single state.Nancy Foster -- vice president of quality and patient safety policy for the American Hospital Association -- said that individuals also need to know how factors not accounted for in the study affect health outcomes.She said, "People come to [hospitals] ... far sicker if they're from a low income area," adding, "They might have multiple complications" and "might struggle to find healthy food" or "a safe place to exercise." She said, "All are important components of good health outcomes" (Lloyd, USA Today, 10/23).

Wednesday, October 17, 2012

It's Medicare Open Enrollment!

It's Open Enrollment from now until December 7, 2012! 

So what? It's a pretty big what as this is the time you can increase, decrease, change, delete, adjust your medicare coverage! Beyond this window of time you are stuck!  It's that simple. 

If you still have questions and/or concerns you should contact your insurance agent. I also found this posting written by Marilyn Tavenner, Acting Administrator at The Medicare Blog.  Think she says it pretty well in very readable language. Hope you enjoy. 

Per the words of Marilyn Tavenner:  

"It’s picking season – pumpkins, apples, Halloween candy…and a Medicare health or drug plan." 
"In my work with Medicare, one of the questions people ask me often is which plan is the best one. That’s not something I can answer, because picking a plan is an important and personal decision. Each person has a unique set of priorities. How do you weigh your options? Now’s the time to think about what matters to you, and pick the Medicare plan that meets your needs.

When you sit down to review your Medicare health and drug plan choices this year, keep track of the things you may want in a plan, and pick one that’s right for you. Here are some things to keep in mind while you consider your choices:

You should look at your current health care costs to find coverage that works with your financial situation. How much are your premiums and deductibles? How much do you pay for hospital stays and doctor visits? Just like with everything else, the lowest-premium health plan option might not be the best choice for you.

Are the services you need covered? We know future health care needs can be hard to predict, but changes happen. Maybe your doctor changed your prescriptions this year or you have different health concerns. Make sure you understand what services and benefits you’re likely to use in the coming year and find coverage that meets your needs.

Your time is valuable. When comparing plans, make sure you check which doctors and hospitals you’ll be able to use. Where are they located and what are their hours? Check which pharmacies you can use. Can you get prescriptions by mail? Remember that even if you’re happy with your current plan, these answers might change from year to year.

Quality of care
Ask yourself whether you’re truly satisfied with your medical care. Not all health care is created equal, and the doctors, hospitals and facilities you choose can impact your health. Look for plans with a 5‑star performance rating — the right expertise and care may help speed your recovery and improve your outcomes."

Marilyn also invites you to call 1 800-medicare.  I also invite you to call me here at if you have questions or need to discuss alternatives to your existing coverage.   You can find me at 800-792-9114    714-840-0047 

Thursday, October 11, 2012

Who Is A Full Time Employee Under The New Healthcare Act

If  you've been listening to the news the last couple of days, you've probably heard that the owners of Lobster House and the Olive Garden are changing some employees to part time workers vs. full time to save costs on the reformed healthcare laws.  Think we will see more of this as the days go forward and businesses need to see how adaptations can affect their bottom lines both positively and negatively.     

If you are in a position of reviewing who is full time and/or part time you may benefit from this article written and posted by Tina Bull on October 9th, 2012 in the PSA Perspective, by  PSA  Insurance and Financial Services.  
"The Affordable Care Act (ACA) requires employers with 50 or more full-time equivalent employees to offer affordable, valuable minimal essential coverage to all full-time employees or pay a penalty. This requirement is referred to as the employer shared responsibility requirement and is effective January 1, 2014.

ACA defines a full-time employee as one who has an average of at least 30 hours of service per week. Proposed regulations are expected to provide that 130 hours of service in a calendar month will be treated as the monthly equivalent of 30 hours of service per week.

The IRS has issued Notice 2012-58 to describe safe harbor methods an employer may use to determine if current employees and new “variable hour” employees must be treated as full-time employees for purposes of the shared responsibility requirement. An employee may be considered a “variable hour” employee if, based on facts and circumstances, it cannot be determined that the employee is reasonably expected to work on average at least 30 hours per week.

Ongoing Employees

For an ongoing employee (i.e. an employee who has been employed at least one standard measurement period as described below), full-time status may be determined under the safe harbor by calculating the employee’s actual average weekly hours of service during a specified look back period. This specified period is referred to as the standard measurement period and is a defined length of time between three and 12 consecutive calendar months.

If the employee averaged 30 or more hours of service per week during the standard measurement period, then health coverage must be offered to that employee during a subsequent stability period (of at least six months and no shorter than the standard measurement period). This coverage is provided to the employee for the entire stability period without regard to the number of hours of service the employee has during the stability period. However, another measurement period will commence for purposes of determining whether health coverage must be offered during the next stability period.

Between the measurement period and the stability period, an employer may use an administrative period of up to 90 days to notify and enroll eligible employees.

Employers will likely establish a standard measurement period immediately preceding annual open enrollment, an administrative period that coincides with open enrollment, and a stability period that matches the plan year. This means that the first standard measurement period may start as early as October 2012.

New Employees

For new variable hour and seasonal employees, the safe harbor method is similar. However, the initial measurement period and the administrative period combined cannot extend beyond the last day of the thirteenth full calendar month of employment. The initial stability period must be the same length as the stability period for ongoing employees.

In addition, certain hours of service during the initial measurement period will also be counted toward the next standard measurement period that begins after the new employee’s date of hire. A variable hour employee who is determined to be full-time during the initial measurement period must be offered coverage during the full initial stability period, regardless of the average number of hours of service during the first standard measurement period.

If a new employee is reasonably expected to work full-time at the date of hire, then the safe harbor method for variable hour and seasonal employees does not apply. The employee must be initially classified as full-time and coverage must be offered to the employee at or before the conclusion of the employee’s initial three calendar months of employment.

Reliance and Comments

Employers may rely on the safe harbors for measurement periods that begin through 2014 and related stability periods that may extend into 2016. The IRS has asked for comments on the following: other safe harbors for categories of employees that present special issues, other guidance that may be needed to determine full-time status, measurement/stability period issues during a merger or acquisition and how seasonal worker should be defined.

While the safe harbor methods are optional and may be administratively challenging for employers, use of them will provide certainty that an employer will not be subject to the ACA penalty for failing to offer coverage to all or substantially all full-time employees."

Monday, October 8, 2012

New CA Laws Preparing State for New Healthcare Insurance

It is all rolling along at a fast clip!!  CA is getting ready for Obama Care!  Gov Brown just signed into CA law the following items ... probably just the first of many??  

Here is the list as published in the LA Times and written by Scott J. Wilson
October 7, 2012

"Gov. Jerry Brown signed into law last week a set of measures aimed at preparing California for coming changes in how consumers get healthcare insurance. Some of the laws:

• To head off deceptive marketing attempts, AB 1761 bans unauthorized individuals and businesses from claiming to represent the California Health Benefit Exchange, the new central marketplace for buying insurance that goes into effect in 2014.

• Beginning in 2014, under AB 792, Californians who lose their health insurance because of job loss, divorce or legal separation will receive information about reduced-cost plans available through the health exchange and no-cost coverage from Medi-Cal.

• Self-employed people will be covered, under AB 1083, by California's law governing small business health insurance. Previously, businesses had to have at least two employees to qualify. Backers argued that the change, effective in 2014, will expand the availability of affordable coverage to entrepreneurs.

• Insurers hoping to sell policies through the state exchange will have to meet minimum coverage standards as established by AB 1453 and SB 951. The new laws, supported by Consumers Union and other groups, designate two Kaiser HMO plans as the state's "benchmarks" for benefits and services.

• The state's Managed Risk Medical Insurance Board, which oversees plans that help those who cannot get health insurance elsewhere, will get increased subsidies under AB 1526 to lower rates consumers pay. Legislative analysts estimated the bill will cost the state $16 million in 2013."

Wednesday, October 3, 2012

Privacy Rights .... When On Parent's Health Insurance Policy!

Thought this article written by Michelle Andrews and provided by Kaiser Health News was especially interesting.  Generally the ability for young adults up to the age of 26 to remain on their parents health insurance has been received as an excellent enhancement. BUT ... what about the privacy rights of the young adults??  Hmm... read on!  Here is some input from Michellel Andrews.
Elizabeth Nash was 21 and just finishing her junior year at the College of William & Mary when she had a miscarriage. She planned to tell her parents about it in person, but her insurer beat her to it when, as a matter of routine, it mailed them a form that described the medical treatment she'd received.
Nash says the experience "caused a rift that took a while to repair."
Nash, now 38, recently co-authored an analysis of state laws on health-care confidentiality for insured dependents for the Guttmacher Institute, a reproductive health organization, and was surprised to find that state laws in this area are "so lacking and vague and mushy."
Under the Affordable Care Act, which allows adult children to stay on their parents' plans until they reach age 26, breaches of privacy such as the one Nash experienced may become a growing problem. Since the law passed, more than 3 million young adults have gained coverage, according to the Department of Health and Human Services.
Although parents must give consent for most care provided to children younger than 18, many states allow minors to consent on their own to such potentially sensitive services as testing and treatment for sexually transmitted infections, prenatal care and delivery, contraception and outpatient treatment for mental health and substance abuse.
The privacy rule of the federal Health Insurance Portability and Accountability Act (HIPAA), which took effect a decade ago, generally prohibits the unauthorized disclosure of individuals' medical records and other health information. But there's a catch. Health-care providers and insurers can generally use such information when trying to secure payment for treatment or other services.
And that can be problematic. Providers submit bills to insurers, which process them and generate a document, often an Explanation of Benefits (EOB) form, that tells the insured or the policyholder how much the insurer paid and what, if anything, is owed on the bill.
These communiques are important to combat fraud and identity theft, and many states require that they be sent, according to Nash.
But the documents do not always go to the person who was treated. "The notice could go to your parents or to you, depending on state law, insurance contracts and insurance policy," says Abigail English, director of the Center for Adolescent Health and the Law, and lead author of the analysis published by the Guttmacher Institute.
English says it's "extremely common" for insurers to send EOBs to the policyholder rather than the patient.
Under federal privacy regulations, patients can request that insurers not disclose confidential information or ask that they send it to an address of their choosing. Insurers are required to comply if not doing so would endanger the patient, says English, for example, if it posed a threat of domestic violence.
"Plans typically do have procedures in place to deal with the disclosure of sensitive information," says Susan Pisano, a spokeswoman for America's Health Insurance Plans, a trade group.
Some insurers have made strides in addressing confidentiality issues related to billing and other communications. Cigna, for example, redesigned its EOB forms to strip out specifics about the treatment or services provided, says Joe Mondy, a spokesman for the company. The form, which typically goes to the policyholder, does name the facility and the provider, however.
In addition, unless the law requires it, the insurer sends an EOB only if there's a balance due.
Policy experts say strategies such as Cigna's make sense. That's especially true given the expansion in free preventive services under the Affordable Care Act. Starting in January, for example, many women in new health plans or in those that have changed their benefits enough to lose grandfathered status will be eligible for such services, including contraceptives, counseling and screening for sexually transmitted infections, and screening and counseling for domestic violence.
"With more insurance coverage of contraception, there will be more issues of whether insurers are protecting confidentiality," says Tina Raine-Bennett, an obstetrician-gynecologist at Kaiser Permanente Medical Center in Oakland, Calif., who is chair of the Committee on Adolescent Health for the American College of Obstetricians and Gynecologists.
Although protecting young women's privacy poses a challenge for insurers, "I do believe there will be a net gain in having those services," she says."

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.