Photo: Washington Post
Photo: Washington Post

It’s doctors who usually know what’s best for your health. When President-elect Donald Trump nominated Rep. Tom Price (R., Ga.), an orthopedic surgeon, to head the Department of Health and Human Services (HHS), he must have thought the same thing. Trump is hoping that Price takes a doctor-oriented approach to reforming the nation’s healthcare system.

And that reform begins with repealing and replacing the Affordable Care Act (ACA), or Obamacare. To Trump, Price is the man to get the ball rolling. Not only is he a licensed and trained physician, but he’s also been a fierce critic of Obamacare and an advocate for overhauling the nation’s entitlement programs.

During his time in Congress, Price has been a leader on both projecting the disastrous impacts of Obamacare and developing positive solutions for improved access to healthcare for all Americans. He was one of the first representatives to draft his own plan to replace Obamacare, the Empower Patients First Act. After refining his plan, Price introduced it as a bill, which has been co-sponsored by several other representatives.

Price’s plan focuses on reforms that doctors care about. During his 12 years in Congress, he consistently argued for limited government and less spending. His legislation will likely mirror his actions as HHS Secretary: removing governmental red tape from doctors and giving Americans more control over their health care.

“As a physician,” he said in the House in 2007, “I know oh so well how the intervention of the state and federal government into the practice of medicine destroys the ability to take care of people. It makes it so you can’t provide quality health care for children and moms and dads.”

According to some, Price’s proposed replacement for Obamacare will offer tax credits to everyone, regardless of income, and help develop health savings accounts for beneficiaries who are not covered by their employers, Medicare, Medicaid, or other sources.

“We wanted to get away from the connection to income,” Price said in 2015. “I’ve become convinced over the past three to four years that it’s much more wise to relate the tax credits to age.” The legislation proposes tax credits of $1,200 per year for people aged 18-35, $2,100 for those aged 35-50, and $3,000 for those over 50.

Besides designing an innovative replacement for Obamacare, Price also wants to rework Medicaid and Medicare. Instead of entitlements, Price wants to convert Medicaid into block grants to states and require “able-bodied” applicants to meet work requirements to receive healthcare benefits. Regarding Medicare, Price supports the idea of moving from a “defined benefit” to a “defined contribution,” where the government would give older or disabled Americans financial help for them to buy private insurance policies.

While it’s still unclear whether Price’s ideas and legislation will receive the bipartisan support to become viable replacements for Obamacare, it’s clear that the nominated HHS Secretary has some thoughtful and innovative ideas on how to improve the nation’s healthcare system.

“There is much work to be done,” Price said in November, “to ensure we have a health care system that works for patients, families, and doctors; that leads the world in the cure and prevention of illness; and that is based on sensible rules to protect the well-being of the country while embracing its innovative spirit.”
To learn more about nominated HHS Secretary Rep. Tom Price and his doctor-oriented approach to reforming the nation’s healthcare system, visit mymedicareplanner.com and contact Tommy Chamouris. Tommy and his staff are committed to protecting senior citizens and helping them navigate through the “Medicare maze”—at no additional cost. See our ad on page 1 of Boomer magazine.

23975375121Since Trump’s election last November, there has been a lot of speculation over how the President-elect will overhaul and revamp America’s healthcare industry.

With his recent appointments of Seema Verma to serve as the Administrator of the Centers for Medicare and Medicaid Services, and Georgia Representative Tom Price as head of the U.S. Department of Health and Human Services, there is more clarity on Trump’s vision; and, despite the hysteria, many within the health industry are encouraged by what could be in store.

Throughout the election, Donald Trump declared he would “repeal and replace” the Affordable Care Act. Now that he’s elected, it seems highly likely that Trump will deliver on his promise. Although many predicted this would be a nightmare scenario, it seems that hospitals and health insurers are pleasantly surprised with the President-elect’s first steps.

Trump’s appointments of Rep. Price and Verma, along with his recent softening on some aspects of the Affordable Care Act, is a signal to some insiders that instead of chaos, he is preparing an orderly transition to replace Obama’s health program with a plan that healthcare companies may want.

Rep. Price is an orthopedic surgeon who has drafted legislation to replace the ACA. Meanwhile, Verma has close ties to Vice President-elect Mike Pence and helped design his ACA Medicaid expansion model, Healthy Indiana Plan 2.0. She has also advised several states on how to add elements such as health savings accounts and employment requirements to their programs. If both are confirmed, experts predict more power will be granted to states in crafting individual insurance plans and Medicaid programs.

“Pence and Trump have made a big deal about giving the states more flexibility and autonomy in managing their Medicaid programs and [Verma] would appear to be the perfect person, given her expertise, to manage that rollout of more state flexibility,” said Robert Laszewski, president of Health Policy and Strategy Associates.

Of course, some have been critical of Trump’s choices and his declaration to repeal and replace the ACA. There is a fear that millions of Americans will instantly lose health insurance and there will be even more uncertainty surrounding Medicare and Medicaid. However, lawmakers, including House Majority Leader Kevin McCarthy, have indicated that although they will work to repeal the ACA immediately, there will be a two-year transition period to phase out the law and citizens currently insured by the program won’t be left without a safety net.

One plan, proposed by House Speaker Paul Ryan, will offer individual insurance with a form of Federal subsidies, provide block grant funding for Medicaid, create vouchers for Medicare coverage, and the eliminate the advance paid premium subsidies for individual insurance. Many believe Ryan’s plan will serve as the foundation of the eventual replacement plan. In the meantime, members in Congress have been already asking healthcare companies for input and advice on functional alternatives for the ACA.

While the future of healthcare under the Trump administration is still uncertain, the President-elect’s recent appointments and proposals have excited many healthcare professionals, including Kathleen Harrington, chair of Policy of Government Relations for the Mayo Clinic. Harrington is pleased with what she has heard so far from the administration over the past few weeks. She notes, “We are very encouraged with the approach we’re hearing so far from President-elect Trump in terms of having a focused review and removing certain parts of it.”

To learn more about Donald Trump’s recent appointments and his plans to reform America’s healthcare system, visit mymedicareplanner.com and contact Tom Chamouris. Tom and his staff are committed to protecting senior citizens and helping them navigate through the “Medicare maze”—at no additional cost. See our ad on page 1 of Boomer magazine.

 


More than half of the nation’s hospitals –a total of 2,597—will be facing record fines once the federal government’s new readmission penalties go into effect in the next two months.

Beginning October 1, hospitals having more patients than expected return within a 30-day period will be subject to record-high penalties. The penalties are based on the readmission rate for patients with six conditions: heart attacks, heart failure, pneumonia, chronic lung disease, hip and knee replacements and — for the first time this year — coronary artery bypass surgery.

While the same number of hospitals as last year will face penalty, the fines will increase by a 20 percent, as Medicare withholds more than half a billion dollars in payments over the next year. According to Medicare, the penalties are expected to total $528 million, about $108 million more than last year.

Proponents of the Hospital Readmissions Reduction Program (HRRP), which began in 2012, believe that these higher penalties will help hospitals identify best practices and develop a quality-improvement infrastructure that will address readmissions in the context of other priorities. Research conducted by the Centers for Medicare and Medicaid Services (CMS) supports this notion. Data shows that national readmission rates have dropped as many hospitals pay more attention to how patients fare after their release.

However, there are others who oppose these penalties because of the challenges faced by hospitals that treat large numbers of low-income patients. They argue that these patients may have recuperating because they can’t afford their medications or lack the social support to follow physician instructions.

The American Hospital Association published a report asking several physicians for their reactions to the HRRP. Doctors Karen E. Joynt, M.D., M.P.H., and Ashish K. Jha, M.D., M.P.H. candidly disclosed that “the growing body of evidence suggests that the primary drivers of variability in 30-day readmission rates are the composition of a hospital’s patient population and the resources of the community in which it is located—factors that are difficult for hospitals to change.”

Despite the continued debate, hospitals with more unplanned readmissions than expected will receive a reduction in each Medicare case reimbursement for the upcoming fiscal year, which runs from October 1 through September 2017. These payment cuts apply to all Medicare patients, not just those with one of the six conditions Medicare measured for readmission.

According to Kaiser Health News (KHN), starting in October, more than 2,500 hospitals will receive lower payments for every Medicare patient that stays in the hospital. “The average Medicare payment reduction is 0.61 percent per patient stay, but 38 hospitals will receive the maximum cut of 3 percent. A total of 506 hospitals, including those facing the maximum penalty, will lose 1 percent of their Medicare payments or more,” KHN reported.

It’s important to note that under the Affordable Care Act, a variety of hospitals are excluded from readmission penalties, including those serving veterans, children, and psychiatric patients. Despite the more than 1,400 hospitals exempt from these fines, KHN determined that 1,621 hospitals have been penalized in each of the five years of the program.

To learn more about the Hospital Re-admissions Reduction Program (HRRP) and its impact on you or your loved one, visit My Medicare Planner and contact Tom Chamouris. Tom and his staff are committed to protecting senior citizens and helping them navigate through the “Medicare maze”—at no additional cost. See our ad on page 1 of Boomer magazine.

 

Anthem bought Cigna for $54 billion last week. Aetna bought Humana for $37 billion this month. What does that mean for consumers?

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This image is from ModernHealthcare.com.

 

In the last month, four of the five biggest health insurance companies have entered major mergers. The “Big 5” are UnitedHealth, Anthem, Cigna, Aetna and Humana; all but UnitedHealth (the largest) are involved in the deals. If the mergers are approved, the “Big 5” would become the “Big 3”, who would hold over half (52%) of the Medicare Advantage market. The companies insure approximately half of the entire insurance market.
Some speculate that prices will go up.
If there are fewer companies to compete with, rates could rise. Historically, mergers of big insurers have caused the price of premiums to increase.Some suggest that prices will go down.
Insurance companies say the deals would substantially reduce their own costs, allowing them to charge consumers less for their plans.

Some say the future of the deals is uncertain.
The mergers will be reviewed by the federal government, with special attention paid to anti-trust laws. Some believe they won’t go through at all. If the deals are upheld, they won’t go into effect until 2016.

Insurers aren’t the only ones joining forces. 

  • CVS, the largest drugstore company in the US, bought Target Pharmacy for $2 billion in June. The 1,660 Target Pharmacies nationwide will eventually be CVS pharmacies.
  • Centene, a Medicare and Medicaid health plan provider, bought Health Net, a health plan provider in the same industry, for $7 billion in early July.
  • The biggest generic drug producer in the world, Teva, bought Allergan, a manufacturer of generic drugs best known for making Botox, over the weekend for $40.5 billion.
Why is everyone merging?
  • Insurers are merging because they want to cover more of the market. With the influx of customers from the Affordable Care Act, and the revenue from Medicare and Medicaid, they are buying companies with these strengths.
  • When one subset of the industry begins merging and combining market power, the companies on the other side want to do the same. To maintain power in negotiations and stay afloat in the changing industry, companies see merging as the answer.

tom

Tom says:
“Generally speaking, when an industry like the insurance industry begins to see mergers of the largest companies, it portends less competition and more price control between the remaining behemoths. Such mergers will be examined closely by the government for anti-trust violation. I will leave you with these quotes.”

“In an environment where the scales are already tipped, we are extremely concerned about the market imbalance this creates for medical practices and patients,” said Dr. Halee Fisher-Wright [of the MGMA]… “This will do nothing more than inflate healthcare premiums and decrease payments to physicians in favor of insurance companies and shareholders’ profits.” – Forbes

“One of the main goals of the Affordable Care Act was to restore competition in the health insurance sector,” said David Balto, a former policy director at the Federal Trade Commission who is now in private practice in Washington. “This consolidation will reverse these gains of the Affordable Care Act.” – Forbes

Will the Anthem-Cigna deal cost you money?

To find out what other changes could come with the health insurance mergers, click here.

Medicare will reimburse doctors
who talk with patients about
end-of-life care

Yesterday, Medicare announced that it plans to pay for the end-of-life conversations between doctors and patients. The plan answers questions surrounding “Death Panels,” which have been debated since the passage of the Affordable Care Act.
Coverage for end-of-life counseling was not included in the Affordable Care Act, but some insurance companies have begun to offer coverage. More companies are expected to when Medicare finalizes the plan.
The proposal will be decided on November 1st.If this has been helpful, please feel free to forward this email to family and friends. Please contact us at [email protected] to be added to our email list.
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Medicare Proposes paying for end-of-life counseling in sweeping physician payment rule

Modern Healthcare
In a draft of Medicare’s first physician payment rule since Congress scrapped the sustainable growth-rate formula, the CMS proposes paying for end-of-life counseling and revises several quality-incentive programs that will be rolled into a new comprehensive program in 2019.

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Medicare Plans to Pay Doctors for Counseling on End of life

The New York Times
Medicare, the federal program that insures 55 million older and disabled Americans, announced plans on Wednesday to reimburse doctors for conversations with patients about whether and how they would want to be kept alive if they became too sick to speak for themselves.

Allergy“Achoo !” , “Achoo ! “,God Bless You! It’s allergy season, and the grass, air pollution, dust, and pollen  have got you sneezing. Well, hold on to your tissues…helpful allergy tips are on the way. Allergies aren’t just for Springtime, over 67 million Americans suffer from allergies every day. The most common  allergen is Pollen. Pollen is an airborne allergen transferred by the wind. Various trees, grasses, and weeds create pollen; which is the culprit that irritates your sinus passages, eyes, and skin.There are also Seasonal Allergies, which include grass, pollen and mold. These allergies have triggers which are tied to particular seasons.
Seasonal Triggers
Winter  –  Smoke

Spring & Summer – Insect bites and stings

chlorine from indoor / outdoor swimming pools

Holidays – peanuts, other nuts, or chocolate

Thanksgiving & Christmas – Pine trees and wreaths

For allergy sufferers it is recommended that you work with your doctor or allergist to treat your symptoms, and find a way to avoid triggers.

Tips To Avoid Allergy Triggers
Monitor mold and pollen counts

Keep windows closed during allergy season

Go out early morning to do errands when pollen count is low

Wash hair, clothes and take a shower after being outdoors working, or playing

Use the air conditioner in your home and car

Use a humidifier

Get Allergy Healthy by seeing your doctor  or Allergist today!

 

Since today is National Walking Day, today’s newsletter focuses on small, but significant, changes that can improve your health- like walking! Time Magazine recently did an in-depth review of aging and longevity, citing many studies with some surprising results. In summary, a little bit goes a long way. Here are some of Time‘s findings on how you can improve aging, disease and general health.

  • Diet

It’s common knowledge that cutting calories is good for your waistline, but one study, published last year, shed light on another benefit. Participants’ calories were cut by one-fourth, which brought a huge health change: blood pressure and cholesterol were slightly better, and their risk of heart disease decreased by 47% (almost half!).

Another diet study that cut calories, from as little as one-third to over one-half of participants’ normal diets, found that their risks were lowered in areas of “aging, diabetes, heart disease and cancer, including lower blood sugar,” and lower levels of a growth hormone that speeds aging.

  • Exercise

Walking isn’t the only activity that can lead to a healthier future- simply doing chores around the house is a way to stay active. One study tracked over a thousand seniors in their 70s and 80s who had limitations on their physical activity. The results? Those who exercised the least had the greatest chance of a heart event within the next decade. But even small activities, like household chores, lowered the risk.

A different study involved 1,600 seniors between ages 70-89. One group took a health education course and one group did activities like walking. After three years, the walking group could walk over an hour and a half more per week than the other group. Their rates for major mobile disabilities were “significantly less.”

  • Mindfulness

Thinking positive makes a big difference. Results of a study showed that men and women who had negative attitudes toward aging in their 40s, had greater brain loss in the region associated with Alzheimer’s. They had the same level of brain loss in three years than those with positive outlooks had in nine years.

Other studies have found that those with negative views on aging have a greater risk of heart problems in the next 40 years than those with positive views. People with “mindful dispositions” have less body fat and better heart health, according to a study by Brown University.

 

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For more than 24 years, The Medicare State Health Insurance Assistance Program (SHIP) has advised, educated, and empowered individuals to navigate their state-specific Medicare choices. In addition, SHIP helps beneficiaries resolve fraud and abuse issues, billing problems, appeals, and enrollment in low-income health assistance programs. In 2015, SHIP provided assistance to more than seven million individuals with Medicare.

The Medicare State Health Insurance Assistance Program (SHIP) network is a critical resource for the elderly, disabled and families needing help to make informed decisions about their Medicare coverage options and enrollment decisions. Today’s Medicare beneficiary must choose among more than 20 prescription drug plans, 19 Medicare Advantage plans, and various supplemental insurance policies, all with different premiums, cost sharing, provider networks, and coverage rules.

Last week the Senate Appropriations Committee targeted two critical programs for significant cuts, and/or elimination for Fiscal Year 2017. The two programs targeted are The Medicare State Health Insurance Programs,(SHIP)  which is slated to lose all of its $ 52.1 million in funding. The second critical program is The Senior Community Service Employment Program. (SCSEP)

Eliminating SHIPs would leave millions of older Americans, people with disabilities, and families who need help applying for benefits, comparing coverage options, filing appeals, and navigating a complex program stranded without assistance.  Max Richtman, President and CEO of The National Committee to Preserve Social Security and Medicare stated “Senate appropriators have turned their backs on a growing number of people who will need SHIP services to navigate the complexities of Medicare coverage by proposing to eliminate program funding.”

The Senior Community Service Employment Program, (SCSEP) which is funded by the Older Americans Act provides subsidized, service based training for low income persons aged 55 and older who are unemployed, and have poor employment prospects. Cutting this program could result in fewer seniors receiving services, and less income due to deceased working hours. It would be devastating to the seniors who work and depend on this program.

Final decisions to cut the programs have not been made. The full Senate is expected to vote on the budget bill in the fall. If this is important to you, please take action by contacting your congressman to reject the imposed cuts, and to take steps to secure The State Health insurance Assistance Programs and  The Senior Community Service Employment Programs are funded.

For more information on our featured article visit http://khn.org/topics/medicare/

What happens if you take your Social Security benefits before your full retirement age? This is the question many seniors are pondering.

According to a recent Associated Press Center for Public Affairs Research poll found that 44 percent reported that income from Social Security will be their biggest income source during their retirement years., and that Americans 50 and older have access to multiple sources of income, but Social Security is the most common source.

According to the Social Security Administration, if full benefits begin at 65 or 66 and you were born between 1943 and 1954; you can begin collecting social security at 62, but at a reduced benefit rate by up to 30 percent. The average age that most people expect to start or have started collecting Social security is 64.   If you could wait in this case past 66 years of age and even to 70 to claim your benefits, your benefits would rise around 8 percent more.

There are advantages and disadvantages to taking your Social Security early. One advantage is that you collect your benefits for a longer period of time. The downside to that option is your benefits are reduced.

Your circumstances are just like your fingerprints, no two are alike.
The average retirement age for men is 64, and for women 62. There is no set answer as to when it is best for you to take out Social Security, in that it varies across all ethnic groups.

Click here for further statistics and information regarding what your full retirement age would be, and important factors you should consider regarding your social security benefits and retirement.

June is Men’s Health Month.  The Purpose of Men’s Health Month is to heighten awareness of preventable  health problems, and to encourage treatment and early detection of diseases among men and boys.

There is a health crisis in America in Men’s health. The crisis references the management of medical diseases such as diabetes, hypertension, heart disease and high cholesterol. These common and treatable health issues are causing men to die prematurely in the prime of their life.

According to a recent poll by  the centers for Disease Control and Prevention. Men are 80 percent less likely  than women to use a regular  source of health care. Most men go to the doctor only when they feel sick  or have a medical emergency and that’s not nearly as often as they should.

Let’s focus on tips and ways for men to stay healthy at any age in celebration of Men’s Health Month. It’s never too late to take care of your health.  Six things that will help you maintain good health are : Getting 7- 9 hours of sleep,quit smoking, more physical activity, eating more fruits and vegetables, avoiding drugs and alcohol, taming stress by taking care of yourself , and connecting socially with family and friends on a regular basis.

For National Men’s Health Month, here are six recommended health screenings, most of which  can  be done in your local doctors office, that men should add to their list to ensure better health.

                                          
 Recommended Health Screenings for Men

Blood Pressure Test
Cholesterol Test
Prostate Cancer Screening
Colon Cancer Screening
Skin Cancer Check
Diabetes Check

National Men’s Health Month has a primary goal of educating and encouraging men and boys to feel better about taking steps to stay healthy. Not all men avoid there screenings or doctors appointments , but the disparity between  men seeking health care , and women has a large enough gap for a men’s health crisis to be declared. Take charge of your health today.
Check out https://www.men’shealthmonth.org for further information on details for screening and further statistics on men’s health.

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