Health Insurance

On Monday, April 28, 2008, President Bush signed into law  S. 793, the "Traumatic Brain Injury Act of 2008," which authorizes appropriations and will make changes to the Department of Health and Human Services programs. These programs provide grants for State programs for increased support for  tracking and reporting of brain injuries and resources for brain injury rehabilitation.

This law is a long time coming and is a huge step for the prevention and care of those suffering from a traumatic brain injury.

Like many physicians today, when James Morrow, MD, of North Fulton Family Medicine in Cumming, Ga., decided in 1998 to implement an electronic medical record, he heard the horror stories associated with EMR adoption.

But the four-physician practice, feeling financially drained by transcription costs running $9,000 per month, plunged ahead with a $200,000 investment. Ten years later, it has no regrets.

"People say we were early adopters, and I guess that's true," Dr. Morrow said. "But at the time we were just trying to survive."

The theme of survival is common among practices that decided the gamble of implementing an EMR was less frightening than continuing in their current situations.

Sometimes the gamble fails: Partners are resistant to using the system; employees aren't well-trained in it; the system itself fails to meet a practice's needs. This can result in a junked EMR and a lost investment.

But sometimes the gamble succeeds. Here, four physicians tell how they decided -- despite well-documented evidence of everything that could go wrong -- that an EMR was right for them, and how they succeeded in getting a return of their financial investment within the first year of operation.

Saving her practice
Solo family practice in Texas
8 months to recoup costs

In 2006, after five years in a shared family practice that serves mostly indigent, Medicaid and Medicare patients, Alicia V. Valdez, MD, of the South San Antonio Family Practice found herself facing life as a solo physician.

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Although some major health plans pledge to institute nationwide standards on how tiered networks are set up, Colorado isn't waiting.

A bill on the desk of Gov. Bill Ritter Jr. would require plans to disclose data and methodology in reaching physician grades and tiering, a process by which insurers group physicians based on purported quality, then offer a discount to members who only see doctors in the highest-rated tier.

The Colorado bill also spells out standards for data and how they are used, as well as asking for transparency. It says plans must use risk-adjusted data, and base grades and ratings at least in part on nationally recognized quality-of-care measures and not on cost alone. Physicians would have the right to review and appeal their ratings.

"Physicians their whole life have been graded," said Colorado Medical Society President-elect W. Ben Vernon, MD, a Denver transplant surgeon. "Getting stars is what doctors in our country are all about. We just would like those stars to be given in a way that makes sense and is correct."

The Colorado bill was based on discussions by the Physicians Advisory Council to UnitedHealthcare. The council was established by the state insurance commissioner as a condition of the United-PacifiCare merger in 2005, said CMS President David Downs, MD, an internist in Denver.

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Due to the recent recall of the drug Digitek, originally prescribed to treat heart failure and cardiac arrhythmias, the personal injury attorneys of my firm are now reviewing potential claims for individuals who have suffered a serious injury, illness or death due to a Digitek overdose.

Digitek was recalled in April after it had become known that some tablets may contain twice the amount of the approved active ingredient, which can lead to serious illness, injury and death. The US Food and Drug Administration is asking all pharmacists to notify patients who were prescribed Digitek of the potential risk to their health.

If you or a loved one has suffered a serious illness, injury or death due to a Digitek overdose please contact an experienced injury lawyer from my firm in order to have your claim reviewed.

With marketing campaigns complete with Beatles lyrics, vinyl records and classic cars, health plans are vying for the attention of a group that, by traditional logic, should be far-from-ideal customers.

Baby boomers, by virtue of their age, are more likely to have a "few chinks in their armor" that make them seem riskier to insure, said Jude Thompson, senior vice president for Indianapolis-based WellPoint and president of Anthem BlueCross BlueShield's individual business.

But despite their age, Thompson said, the group actually is the most profitable demographic among those who buy individual policies -- and perhaps more important, they have the potential to be valuable customers for the rest of their lives.

Whichever company they choose already has a leg up in the very competitive market for Medicare Advantage products.

To win their loyalty, insurers aren't waiting for boomers to turn 65 and become eligible for Medicare. They believe it's better to start now by capturing the attention of early retirees, business owners and others who need to buy their insurance directly.

"The competition for the senior today is greater than it's ever been," Thompson said.

Health insurance in general is a "sticky" product, meaning consumers are prone to keep the status quo, and Medicare Advantage has a retention rate "north of 90%," said David McNichols, general manager of individual Medicare products for Cigna.

At least so far, boomers are brand loyal, WellPoint's Thompson said.

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