Medicare elucidation with a summary of its parts A, B, C & D

Medicare is the national health insurance program, by the government for medical and health related services. These services are provided to the specific group of people. Medicare is administered by the Centers for Medicare and Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services. Since 1965, Medicare guarantees access to health insurance for Americans ages 65 and older and younger people with disabilities as well as people with end stage renal disease.

Medicare is providing services in four major parts. These parts are categorized according to the specific services in different sections of healthcare industry. These parts are known as A, B, C & D. Lets discuss each of them:
Part A: Hospital Insurance

• Helps cover inpatient hospitals care

• Helps cover skilled nursing facility, hospice, and other medical services

Part B: Medical Insurance

Part B includes other medical services & supplies that are not covered by Part A. It also helps the doctor to cater the medical bills from outpatient visits & care.

• Helps cover doctors' and other health care providers' services, outpatient care, durable medical equipment, and home health care

• Helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse

Part C: Medicare Advantage

Part C covers the element of choice. This plan allows you to select to receive healthcare services through a provider organization. This works incredibly to reduce your costs of receiving medical services. To enroll in Part C, you must have both parts A & B.

• Offers health plan options run by Medicare-approved private insurance companies

• Medicare Advantage Plans are a way to get the benefits and services covered under Part A & B

• Most Medicare Advantage Plans cover Medicare prescription drug coverage (Part D)

• Some Medicare Advantage Plans may include extra benefits for an extra cost

Part D: Prescription Drug Coverage

This part of Medicare is voluntary & provides outpatient prescription drug coverage. Part D is only available through private insurance companies that have contracted with government.

• Helps cover the cost of prescription drugs
• May help lower your prescription drug costs and help protect against higher costs in the future
• Run by Medicare-approved private insurance companies

Policies driven by Medicare help the private health insurance companies to utilize Medicare benefits & privileges. There are many Medicare plans like HMOs (Health maintenance Organization) or PPOs (Preferred Provider Organization). In general the benefits cover:

• Payment  for Doctor Bills
• Handling hospitalization charges/costs
• Prescription Drugs
• Settlement of other related medical services & products.

The meaningful use program by Medicare brings supplementary benefits in addition to the federal government financial incentives. It allows providers and practices enhance their services by reducing errors and quick access to information.

Meaningful Use with its Meaningful Results

Meaningful Use (MU) defines the use of certified Electronic health record (EHR) to improve quality care, reduce health disparities, and achieve better clinical outcomes within a healthcare organization. After the implementation of meaningful use, significant changes are done to transform a better healthcare system and following major changes will be seen:

    1.  Developed Quality, Safety, and Efficiency

    2.  Patient Commitment

    3.  Care Coordination between Clinics and Hospitals

    4.  Improved Public Health and Preventive Medicine

    5.  Complete Privacy and Security Protection

Physicians, after adopting electronic health records in a meaningful way, may have been awarded from the Centers for Medicare & Medicaid Services. More than 55,000 physicians received bonuses for meaningful use of EHRs in 2011 or 2012. Doctors or hospitals found ineligible for an EHR incentive after an audit would be asked to return the bonus payment.

Adoption of meaningful use program is now a fundamental requirement for the physicians, since two and half years is the rough time span left to implement Electronic Health Record (EHR) systems without facing any financial penalties. Practices should take serious notice on these deadlines and physicians need to focus all the essential elements necessary to meet the criteria of Meaningful Use (MU) bonuses.

For the ongoing success of EHR Incentive Programs, many billing companies have designed webinars and profound coaches that will walk physicians through solutions surrounding EHR issues and MU criteria. Each webinar with its training is interactive and featured. Identifying the key elements to achieve MU bonuses is the core objective. It will also provide an overview of related initiatives, incentives and penalties and how they will impact physician practices.

Meaningful Use Stage II - What You Should Know?

The final rules of meaningful stage two are finally debuted. Providers and practices have another challenge of complying to these rules in order to earn meaningful use bonus. According to the final rules, 2014 is the earliest effective date for stage 2. All the menu measures of stage 1 except ‘Syndromic Surveillance’ are made core measures in stage 2. In addition to prescriptions, now the computerized physician order entry (CPOE) also includes radiology and lab orders.  

As said by Farzad Mostashari, MD, national coordinator for health IT, stage 2 will take time, “to make the most meaningful use of meaningful use.” The stage 2 also reinforces importance of a patient portal so that they can access to their medical records easily.

Now physicians have to make sure that at least 5% of their patients view, send and download their clinical information. Similarly, over 5% of the patients should communicate clinical information with doctors through secure email. After each visit, clinical information must be available to patients within 1 day. The five new menu measures added to stage 2 includes family history, imaging results, progress notes, reporting to cancer registries and reporting to specialized registries. 

Now the electronic health record (EHR) vendors have another benchmark to enhance the EHR. The best EHR will be one that will help providers in complying with meaningful use stage 2 rules.

Meaningful Use Stage 2

Proactive Patients Seeking Healthcare Information Prefer Surfing The Web Over Turning Pages In A Reference Book

A new study, from the University of California, Davis shows that patients prefer using the internet to obtain healthcare information over asking friends or using reference books. This study, based on a survey of over 500 people, magnified the desire of patients to be proactive in managing their health. “The Internet has become a mainstream source of information about health and other issues,” said Xinyi Hu, who co-authored the study as part of her master's thesis in communication. “Many people go online to get information when they anticipate a challenge in their life. It makes sense that they would do the same when dealing with a health issue.”

Furthermore, the study pointed out that proactive patients do not mistrust their doctors; they simply want to gain personal control over their health. "The study revealed that patients are not turning to the Internet out of any doubt; more likely, Internet users are curious information seekers who are just trying to learn as much as they can before their appointment”, said co-author Richard L. Kravitz, a UC Davis Health System professor of internal medicine and study co-author.

The basic value of PHR platform is to embrace the patient-specific clinical information quickly, accurately, reasonably, and safely. We anticipate that many other medical institutions will probably face challenges, but the proactive approach with open and constant communication between the patients and doctors provides safe information which overcomes many inevitable issues that arise timely. Proactive approach for an individual clinical data is a very new conduct. It will take time to become common with substantial progress.

Seeing as this, PHR is an easy gateway in providing personal online portal from which patients can record, track and even save their important health related information at one secure online place. They can easily manage their personal health records like demographic information, appointment history, lab-test results, payment reports, outstanding balances and claim history, available 24/7 from any Internet-ready computer. Level of trust between a doctor and a patient gets more compact since online information-seeking is higher among the patients who get all the information from internet, recent survey (2012).

Almost 70% of the study subjects reported they were planning to ask their doctor questions about the information they found on the internet, and about 40 percent said they had printed out information to take with them to discuss with their doctors. More than 50 percent of subjects said they intended to make at least one request of their doctor on the basis of Internet information, recent survey (2012).

In February 2011, there were more than 12,000 groups listed in the support category of Yahoo! Groups Health and Wellness directory. Only 9% of Americans and 37% of patients with continual disease have participated in online support groups, so the doctors need to be attentive and alert to provide the same degree of reassurance, their patients expects from them, (2012). Moreover, majority patients feel much comfortable to get any sort of online information from their doctors. This has also developed trust and confidence among the patients, who prefer online health solutions. 

Personal Health Records (PHR) 

Can’t do it in real life? Let’s go with Online Patient Engagement

Donald Berwick, administrator of Centers of Medicare and Medicaid, predicted patient engagement to be one of the top concerns in 2011. Healthcare IT companies and EHR vendors are modifying existing products and introducing new products for online patient engagement. Patients are seeking such a system where they can have instant access to their medical records and history.  

According to recent surveys, most of the patients are seeking providers and practices that provide online access to patient data. The 2012 survey conducted by HealthLeaders Media demonstrated that only one in five practices is providing patients with advanced online patient portals with basic features.

Now patients are expecting quite more. They are losing patience with practices and providers who fail to deliver their expectations. 

The practices need to carve out a strategy to engage patients online. Using social media to enhance patient’s online experience is also a good idea. Healthcare companies should also appoint such innovative applications where patients can update their information and providers can respond them promptly and easily. This is an opportunity as well as challenge for Healthcare IT companies to do something about online patient engagement and to keep the patients and practices happy.

Centers of Medicare and Medicaid (CMS)