Medical Billing Industry Articles

ClaimTek Top Billing TODAY’S MEDICAL BILLING NEWS

The following industry-related articles and trends prove the amazing viability of the medical billing industry. Health care clinics must run more efﬁciently now or in the near future. Outsourcing to a professional billing service is key element towards that end. These developments deﬁnitely anchor the medical billing industry as a powerful place to be in going forward.

The Impact of Baby Boomers... Starting last fall and for the next 20 years, every day 10,000 people reaching the age of 65 and will qualify for Medicare coverage. Here are a couple of articles on the Baby Boomers effect.

Baby Boomers: Public Health's Biggest Challenge http://www.hufﬁngtonpost.com/susan-blumenthal/baby-boomers-health_b_843207.html

Written in collaboration with Katherine Warren

"Grow old along with me/the best is yet to be." Never has there been a time in human history when the words from the famous English poet Robert Browning have rung more true. More than a century ago, when Browning penned these words, the average life expectancy for Ameri- cans was 48 years. Thanks to the triumph of public health and medical interventions, today we live in a world very different from Browning's, where 20-somethings are the new adolescents and 50 year olds are in the infancy of their second adulthoods. Americans can now expect to live nearly twice as long than they did in the early 19th century, to an average age of 78, extending "the best" of years far beyond what Browning might ever have imagined. No one knows this better than the baby boomers. New Year's Day marked the 65th birthday of this generation. Each day after January 1, 2011, another 10,000 "boomers" will turn 65. As the 79 million baby boomers born between 1946 and 1964 march towards their 65th birthdays, our nation must face the challenges of how an already strained federal budget will provide Social Security and Medicare beneﬁts for future retirees. An increasing incidence of chronic disease in this population, growing ﬁnancial burdens on these federal programs, the declining number of primary care physicians and geriatric specialists in America, and the disappearance of pensions for many as a result of the economic crisis threaten this generation's "golden" years.

Against this backdrop, the American population is aging rapidly. In 2008, people aged 65 years or older represented 12.8 percent of the U.S. population, about one in every eight people. By 2030, one in five Americans will be over the age of 65. According to recent data from the U.S. Census Bureau, there are currently 79,000 people who have lived to be centenarians, (older than 100 years), in the U.S. today, a statistic that will reach more than 200,000 people by 2030. While these demographic shifts are a testament to socioeconomic development and public health improvements, with them comes the challenge of a concurrent chronic disease pandemic. There is an urgent need to effectively address the increasing prevalence of age-related illnesses including heart disease, cancer, diabetes and neurodegenerative diseases such as Alzheimer's and Parkinson's. Today, more than 75 percent of health care costs in the United States stem from chronic diseases, many of which are preventable. Over a million Americans die prematurely each year due to unhealthy lifestyle habits, including tobacco use, obesity, lack of exercise, and alcohol abuse. Although some of the secrets of longevity lie in our genes and biology, behavior is linked to as much as 50 percent of the cause of death worldwide. In fact, an important study of 3,000 Danish twins estimated that the heritability of human longevity was about 25 percent, with 75 percent of life expectancy attributable to lifestyle and environmental factors. Despite these trends, current government and private sector support for prevention and public health programs accounts for only 3 to 5 percent of the $2.6 trillion of U.S. health expenditures. The good news is that the recent health care reform legislation, the Patient Protection and Afford- able Care Act provides preventive care for older Americans, as Medicare recipients will no longer pay anything out of pocket for covered preventive services including yearly routine physical examinations, specific screening tests for heart disease, diabetes, some types of cancer, and bone density as well as smoking cessation programs. In the first two months of 2011, more than 150,000 seniors and other Medicare beneficiaries have received an annual wellness visit. These new benefits represent a critical step forward in making chronic disease prevention a reality for this population. But a real revolution in chronic disease care must include new models for management of these illnesses as well, including the delivery of innovative services through Medicare and private sector plans. Transformative changes are particularly critical for the baby boomer generation, of which nearly two-thirds (35 million people) have at least one chronic health condition.

When first established, Medicare was a hospital-based care system. Since then, outpatient services and medication benefits have been added. But this patchwork model requires modernization. Furthermore, the need for home based and long term care of the aging population must be addressed. The Patient Protection and Affordable Care Act established the Center for Medicare and Medicaid Innovation (CMMI), which will support new models to update Medicare's service delivery system. The law will also foster changes to payment and service delivery programs that increase access to health care, promote efficiency and effectiveness, as well as boost patient satisfaction. The new center will support pilot projects that if proven effective can be scaled up in communities across the country. One of the most promising chronic disease management models is the patient-centered medical

Copyright © 1996 – 2016 by ClaimTek Systems 2 Baby Boomers Continued home, with its focus on strengthening the primary care physician-patient relationship and coordinating care across all components of the health care system. Pilot projects are also evaluating new models of long-term care that foster clinical collaboration across multiple specialists with the increased use of health information technology. The economic downturn that began in 2007 has hit the baby boomers particularly hard as many have lost their jobs and employer-sponsored health beneﬁts. Access to health care is critical to promote health aging. Yet in 2009, about 8.6 million adults, ages 50 to 64, were uninsured, an increase of 1.1 million from 2008 as a result of record unemployment among this age group. Additionally, 9.7 million insured baby boomers have such high out-of-pocket costs relative to income that they are effectively uninsured. Through the Patient Protection and Affordable Care Act, 17 percent of the 32 million uninsured people projected to gain coverage by 2019 will be ages 50 to 64. Those living in 16 states with high- uninsured rates, mostly in the South and West, will see the most gains from the legislation. With stronger consumer protections, the new health legislation will provide affordable coverage and also help protect baby boomers from loss of insurance due to economic hardship. This will provide them with access to both preventive and treatment services. Another innovation available to improve health for baby boomers is the use of new media, tools that can bring important scientiﬁc knowledge to help consumers make informed health decisions. With more than 5 billion mobile phone users, 2.6 billion people on the internet worldwide, and 2.5 billion text messages sent every day in the U.S. alone, today's information revolution connects people to knowledge about healthy aging as well as to information about the prevention and management of diseases like never before.

Patient tools such as the CDC's "I Move U" for Twitter and Facebook-based sites including "Patients- LikeMe," where people can share information about illnesses and treatments, are important resources. Other sites provide information about medications and their side effects as well as with an interactive electronic medical record. There is an estimated 17-year science to service gap between the time of a new discovery in the lab to its widespread use in clinical settings. In today's information age, why shouldn't this dissemination of scientific information take a nanosecond? In addition to promoting prevention and chronic disease management, both the public and private sectors must make enhanced investments in research-medicine's field of dreams. Research is the foundation for all medical and public health interventions to promote healthy aging and to find cures for the diseases that affect the baby boomer generation. Aging is, after all, the major risk factor for all chronic diseases.

Age-related diseases, such as Alzheimer's or Parkinson's, rob people of their health, place a burden on families, the health care system and our nation's economy. In the example of Alzheimer's, if a discovery was made from research to delay the onset of the disease by just ﬁve years, it could save an estimated $50 billion per year and reduce the number of people with the illness by more than 50 percent after 50 years. But research doesn't just happen. It requires sustained investments in science and in the career development of researchers here in the United States and around the world. The aging of the baby boom generation represents the newest challenge for medicine and govern- ments but also provides opportunities for rejuvenation and responsibility. Promoting healthy aging requires both personal and social responsibility, mobilizing all sectors of society.

There is a recipe for healthy aging -- don't smoke, maintain a healthy weight, eat smart, be physically and mentally active, obtain lifesaving screening exams, enjoy strong connections to friends and family, and be an advocate for increased investments in research and establishing new health service delivery models. The aging of the world's population challenges America as well as other countries and their gov- ernments to create 21st century health care systems and policies that address the needs of seniors. The wave of aging worldwide with its tsunami of chronic diseases underscores why actions are needed now to provide hope for a healthier and more prosperous future for today's baby boomers and for future generations -- in a world where hopefully "the best is yet to be".

Rear Admiral Susan Blumenthal, M.D. (ret.) is the Public Health Editor of the Hufﬁngton Post. She serves as Director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress in Washington, D.C., a Clinical Professor at Georgetown and Tufts Uni- versity Schools of Medicine, and Chair of the Global Health Program at the Meridian International Center.

She served for more than 20 years in health leadership positions in the Federal government in the Administrations of four U.S. Presidents, including as Assistant Surgeon General of the United States, the ﬁrst Deputy Assistant Secretary of Women's Health, as a White House Advisor on Health, and as Chief of the Behavioral Medicine and Basic Prevention Research Branch at the National Institutes of Health.

Dr. Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the U.S. Public Health Service for her pioneering leadership and signiﬁcant contributions to advancing health in the United States and worldwide and was the recipient of the 2009 Health Leader of the Year Award from the Commissioned Ofﬁcers Associa- tion.

Admiral Blumenthal has been named by the National Library of Medicine, The New York Times and the Medical Herald as one of the most inﬂuential women in medicine and by GQ magazine and the Geoffrey Beene Foundation as a 2010 Rock Star of Science.

Katherine Warren, an undergraduate at Harvard University, serves as a Health Policy Fellow at the Center for the Study of the Presidency and Congress.

Millions of Baby Boomers...

With 10,000 people reaching the age of 65 every day and will qualify for Medicare coverage, it’s estimated that by year 2050 about 88 million Americans will be 65 or older. This means they need medical care and more medical claims ﬁled.

By Emanuella Grinberg, CNN May 9, 2011 8:13 a.m. EDT STORY HIGHLIGHTS Baby Boomers Will Redeﬁne Notions Of Age http://www.cnn.com/2011/LIVING/05/09/baby.boomers.retirement.legacy/index.html?hpt=C2 • Boomers are the reason for projections of 88.5 million Americans 65 and older by 2050 • They've redeﬁned each stage of life; retirement and aging will be no different • Boomers will still affect pop culture as they age, too

Editor's note: In 2011, the Baby Boomer generation turns 65. So what can the #Boomers expect in their retirement years? This week CNN will bring you special coverage of this generation. (CNN) -- They're the generation that came of age in the 1950s and 1960s, that remembers Beatle- mania and the Vietnam War, the assassinations of John F. Kennedy and Martin Luther King Jr., transistor radios and the novelty of the first color TV sets. Or ... they experienced their formative years in the 1970s, forced to choose between punk and disco as the Watergate scandal unfolded, hard drug use exploded, and television sitcoms intro- duced untraditional households such as "The Brady Bunch," "Three's Company," and "Sanford and Son." Numerous books, films and academic papers have been devoted to defining the impact of the 76 million people born between 1946 and 1964, known as baby boomers, boomies or the bulge. Their sheer volume in the United States fueled an unprecedented population boom, from 141 million in 1946 to 311 million in 2010, according to the U.S. Census Bureau.

1 Copyright © 1996 – 2016 by ClaimTek Systems  Millions of Baby Boomers Continued... The ﬁrst wave of baby boomers is turning 65 this year, but the youngest are 47. Deﬁning the entire group is a risky endeavor, given its almost 20-year spread. But there's one thing historians, econo- mists and pop culture junkies agree on: Baby boomers' numbers have allowed them to leave an imprint in each phase of life they passed through, a vast departure from their parents' generation. Next, the boomer generation will change the way we think about retirement and aging, experts and analysts say, just as they transformed notions of relationships -- with delayed marriages, fewer children, more divorces -- and ideas about careers, with more women in the workplace and adult learning.

"Boomers are all about exploration and transformation. Many of them reject the idea of retirement that they saw ﬁrsthand with their parents, where you stop changing and growing and become a ﬁxed entity," said Ann Clurman of The Futures Company, which tracks consumer attitudes that forecast lifestyle and behaviors, and author of "Generation Ageless: How Baby Boomers Are Changing the Way We Live Today."

"Boomers have a hard time giving up control. For them, control is a fundamental right born out of basic entitlement -- they grew up in a time of unprecedented economic prosperity and a basic feeling that the struggle for survival was over. Many have never been in love with the idea of retirement, but at least they felt like it was an option they could control. But now because of the economy and the hit their portfolios took, they're revamping their plans, and I don't think most boomers know what they're going to end up doing."

But the day is fast approaching for many. The boomers are the main reason for projections that the number of Americans 65 and older will reach 88.5 million by 2050, more than double the estimated 40.2 million in that group in 2010, according to a 2010 U.S. Census Report, "The Next Four Decades."

By 2030, when all of the boomers will be 65 or older, they will make up 19% of the population, up from 13% today.

The aging of the baby boom will have wide-ranging implications for the country, raising challenges for policymakers and programs such as Social Security and Medicare, said Ron Lee, director of the Center on the Economics and Demography of Aging at the University of California, Berkeley.

Baby boomers crowded classrooms and later, the labor force, boosting the economy and consumer spending while their taxes funded Social Security beneﬁts and Medicare for the elderly.

In 2010, 60% of the U.S. population was between 20 and 64 years old. By 2030, as baby boomers age, the proportion in those working ages will drop to 55%, according to "The Next Four Decades." Boomers are leaving the labor force at a time when health care costs are growing at a rate faster than productivity and per capita income growth, leaving a big gap, Lee said.

The average annual expenditure on health care in 2004 for people ages 45 to 54 was $2,695. When budgeting medical expenses, babyboomers should expect increased health care spending as they age; for instance, those ages 55 to 64 spent $3,262 and those 65 and over spent $3,899, according to the U.S. Bureau of Labor Statistics.

Copyright © 1996 – 2016 by ClaimTek Systems 2 "There's already a clear sense of what the situation is. We know that our social programs are not sustainable the way they're currently structured, and beneﬁts are going to have to be cut or taxes increased. But that doesn't mean the public has absorbed that fact or believe it, so it's difﬁ- cult for politicians to do anything serious to come to grips with the problems," Lee said.

But that doesn't necessarily mean the blame should be placed on the boomers, he said. Population aging is universal and inevitable -- the baby boomers merely postponed the day of reckoning.

"The problems we're going to have are problems we would have had without the baby boomers. They just happen to be the generation that's initiating them. The problem is real and serious but by no means catastrophic," he said. The baby boomers will continue steering American culture as they age, too.

They were the ﬁrst generation of children and teenagers with signiﬁcant spending power, economist Diane Macunovich of the University of Redlands said. That, combined with their numbers, fueled massive marketing campaigns and the introduction of new products targeted at their current stage of life, whether they were young families or looking toward retirement.

"Station wagons became the vogue in the 1950s in response to the needs of boomers' parents. Those mutated into 'vans' to accommodate 'Yuppie' boomers in their thirties and forties and then into 'SUVs' for boomers as empty nesters, many going through 'mid-life crisis,'" Macunov- ich wrote in a 2000 paper, "The Baby Boomers."

In this way, boomers essentially created the idea of pop culture and fed its symbiotic relationship with mass marketing and consumerism, said Gary West, a consultant who runs the website mrpopculture.com, a digest of the weekly zeitgeist back to 1950.

"The buying power of that generation set pop culture in motion. If you look back into the '50s, you can see where teen buying power got bigger and bigger and created pop culture: younger- skewing movies and television, rock and roll, pop rock, what we call soul music," he said. "The baby boomers really started the pop culture trend and it had to do with buying power, and as we've grown into the work force, we've kept creating those trends. Who were the ﬁrst to buy records, then CDs, then computers?

Despite Bill Gates and Steve Jobs, the boomers can't take all the credit for the advent of the Internet age, but they've been fast learners of how to leverage its beneﬁts. University of Okla- homa history professor and History Channel resident historian Steve Gillon, who wrote the book "Boomer Nation," said technology will continue to play a big role in boomers' retirement years.

"People with specific skills will use the Internet to take advantage of the breakup of hierarchies in the economy and remain involved in their fields, be it through consulting or using social media to find professional communities or networking groups," Gillon said.

"Many boomers have a desire to stay involved and connected; they're not going to give in to the dictates of age and accept the older model. They're going to ﬁnd ways to stay socially, intellectu- ally and physically active."

Medical Schools Can't Keep Up

SHORTAGE OF DOCTORS: This is a proven national dilemma. With higher claims being led there’s more pressure on doctors to perform more eciently though outsourcing.

Medical Schools Can't Keep Up http://online.wsj.com/article/SB10001424052702304506904575180331528424238.html

By SUZANNE SATALINE And SHIRLEY S. WANG

As Ranks of Insured Expand, Nation Faces Shortage of 150,000 Doctors in 15 Years First-year resident Dr. Rachel Seay, third from left, circumcises a newborn in George Washington University Hospital's delivery wing on March 12.

The new federal health-care law has raised the stakes for hospitals and schools already scrambling to train more doctors.

Experts warn there won't be enough doctors to treat the millions of people newly insured under the law. At current graduation and training rates, the nation could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges.

That shortfall is predicted despite a push by teaching hospitals and medical schools to boost the number of U.S. doctors, which now totals about 954,000.

The greatest demand will be for primary-care physicians. These general practitioners, internists, family physicians and pediatricians will have a larger role under the new law, coordinating care for each patient.

The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007. A shortage of primary-care and other physicians could mean more-limited access to health care and longer wait times for patients. Proponents of the new health-care law say it does attempt to address the physician shortage. The law offers sweeteners to encourage more people to enter medical professions, and a 10% Medicare pay boost for primary-care doctors. Meanwhile, a number of new medical schools have opened around the country recently. As of last October, four new medical schools enrolled a total of about 190 students, and 12 medical schools raised the enrollment of first-year students by a total of 150 slots, according to the AAMC. Some 18,000 students entered U.S. medical schools in the fall of 2009, the AAMC says. But medical colleges and hospitals warn that these efforts will hit a big bottleneck: There is a shortage of medical resident positions. The residency is the minimum three-year period when medical-school graduates train in hospitals and clinics. There are about 110,000 resident positions in the U.S., according to the AAMC. Teaching hospitals rely heavily on Medicare funding to pay for these slots. In 1997, Congress imposed a cap on funding for medical residencies, which hospitals say has increasingly hurt their ability to expand the number of positions. Medicare pays $9.1 billion a year to teaching hospitals, which goes toward resident salaries and direct teaching costs, as well as the higher operating costs associated with teaching hospitals, which tend to see the sickest and most costly patients. Doctors' groups and medical schools had hoped that the new health-care law, passed in March, would increase the number of funded residency slots, but such a provision didn't make it into the final bill. "It will probably take 10 years to even make a dent into the number of doctors that we need out there," said Atul Grover, the AAMC's chief advocacy officer. While doctors trained in other countries could theoretically help the primary-care shortage, they hit the same bottleneck with resident slots, because they must still complete a U.S. residency in order to get a license to practice medicine independently in the U.S. In the 2010 class of residents, some 13% of slots are filled by non-U.S. citizens who completed medical school outside the U.S.

One provision in the law attempts to address residencies. Since some residency slots go unﬁlled each year, the law will pool the funding for unused slots and redistribute it to other institutions, with the majority of these slots going to primary-care or general-surgery residencies. The slot redistribution, in effect, will create additional residencies, because previously unﬁlled positions will now be used, according to the Centers for Medicare and Medicaid Ser- vices. Some efforts by educators are focused on boosting the number of primary-care

doctors. The University of Arkansas for Medical Sciences anticipates the state will need 350 more primary-care doctors in the next ﬁve years. So it raised its class size by 24 students last year, beyond the 150 previous annual admissions.

In addition, the university opened a satellite medical campus in Fayetteville to give six In addition, the university opened a satellite medical campus in Fayetteville to give six third-year students additional clinical-training opportunities, said Richard Wheeler, executive associate dean for academic affairs. The school asks students to commit to entering rural medicine, and the school has 73 people in the program.

"We've tried to make sure the attitude of students going into primary care has changed," said Dr. Wheeler. "To make sure primary care is a respected specialty to go into."

Montefiore Medical Center, the university hospital for Albert Einstein College of Medicine in New York, has 1,220 residency slots. Since the 1970s, Montefiore has encouraged residents to work a few days a week in community clinics in New York's Bronx borough, where about 64 Mon- tefiore residents a year care for pregnant women, deliver children and provide vaccines. There has been a slight increase in the number of residents who ask to join the program, said Peter Selwyn, chairman of Montefiore's department of family and social medicine.

One is Justin Sanders, a 2007 graduate of the University of Vermont College of Medicine who is a second-year resident at Monteﬁore. In recent weeks, he has been caring for children he helped deliver. He said more doctors are needed in his area, but acknowledged that "primary-care residencies are not in the sexier end. A lot of these [specialty] ﬁelds are a lot sexier to students with high debt burdens."

800-224-7450

SHORTAGE OF DOCTORS: This is a proven national dilemma. With higher claims being led there’s more pressure on doctors to perform more eciently though outsourcing. Doctor Shortage, Increased Demand Could Crash Health Care System

By Jen Christensen, CNN Updated 5:37 PM EDT, Wed October 2, 2013 http://www.cnn.com/2013/10/02/health/obamacare-doctor-shortage/index.html

Some doctors worry patients who can't get in to see primary care physicians will clog up hospital emergency rooms.

STORY HIGHLIGHTS • Approximately 48 million people are currently uninsured in the United States • There is a physician shortage, and experts say more primary care doctors are needed • When Massachusetts mandated health insurance for residents, wait times increased • Technology, team care may help in handling the inﬂux of patients, doctor says

Lexington, Kentucky (CNN) -- Obamacare is expected to increase patient demand for medical services. Combine that with a worsening shortage of doctors, and next year you may have to wait a little longer to get a doctor's appointment. And the crowded emergency room may become even more so.

There are approximately 48 million uninsured people in the United States. When the mandatory insurance rules of Obamacare kick in next year, and a couple dozen states expand who is eligible for Medic- aid, you can bet more people are going to want to use their health beneﬁts.

In fact, so many people were anxious to get access to health insurance -- many for the first time -- when the insurance marketplaces opened Tuesday, more than a dozen of the websites experienced technical glitches. Obamacare open enrollment: Everything you need to know Dr. Ryan A. Stanton is worried that this coming flood of newly insured patients may crash the U.S. health care system as well. Stanton works at the emergency room at the busy Georgetown Community Hospital right outside of Lexington, Kentucky. While he sees trauma cases often, a good number of the patients he sees don't involve trauma. They're the uninsured who can't afford to pay for a regular doctor's visit -- so they use the emergency room instead. "People turn to the ER because they have no other place to go after hours or they don't have access to a level of appropriate primary care," Stanton said. "The ER has become the safety net of our health care system. We can't turn anyone away like a doctor's office could. ... I worry though with (Obamacare) this will significantly increase patient volume." There is already a national shortage of doctors, according to the Association of American Medical Colleges. We're down about 20,000 now, and the number is expected to get worse as nearly half the nation's physicians are over age 50 -- meaning many are at or near retirement age. And it's not just doctors who are in short supply; we also need more nurses, according to the American Medi- cal Association. "Keep in mind the Affordable Care Act didn't create this crisis," said Dr. Reid Blackwelder, president of the American Academy of Family Physicians. "We've got an aging population that needs more care and a growing population." Government shutdown forces clinical trial patients to wait. A study in the Annals of Family Medicine journal projected the country will need 52,000 more primary care physicians by 2025. Most of those extra doctors are needed because of projected population growth. But the problem also begins in training; only one in five graduating medical residents plan to go into primary care, according to the Journal of the American Medical Associa- tion. Stanton said he might have been interested in primary care rather than emergency care, but the lower pay kept him away. Doctors on average graduate with hundreds of thousands of dollars of debt. Specialists make more money. "Primary care is the backbone of our medical system, but most people I know in medical school can't afford to go that route," Stanton said. If the popularity of the insurance marketplaces on the first day they opened is any sign, there will be a lot more people in Kentucky fighting to get a doctor's attention. Problems plagued the Ken- tucky exchange site until midafternoon, but still more than 1,200 people had purchased policies or enrolled in Medicaid by the end of the day, according to a spokeswoman for the Cabinet for Health and Family Services. "I think of (Obamacare) as giving everyone an ATM card in a town where there are no ATM machines," Stanton said. "The coming storm of patients means when they can't get in to see a primary care physician, even more people will end up with me in the emergency room." What happened in Massachusetts in 2006 when the state's mandated health insurance rules went into effect illustrates the impending national problem. When the Massachusetts law kicked in, wait times to get an appointment at primary care physicians' offices increased significantly, and they've remained high ever since, according to an annual

Copyright © 1996 – 2016 by ClaimTek Systems  2 survey from the Massachusetts Medical Society. And Massachusetts has the second highest physician-to-population ratio of any state. When patients couldn't get doctor's appointments they once again turned to emergency rooms. A Harvard study found all 11 of the emergency rooms that researchers studied in Massachusetts became busier after the law went into effect. The Affordable Care Act does try to address some of the problems. There's an additional $1.5 billion in funding allotted for the National Health Services Corps, which provides support to health care professionals in exchange for their service in areas with a shortage (physician numbers are particularly stretched thin in rural areas). The law also puts more money toward training in hopes of increasing the primary care workforce. It offers more graduate positions for primary care doctors and more scholarships. It even offers a 10% bonus to primary care doctors who agree to see Medicare patients through 2015. The law's emphasis on coverage for preventive care may also mean fewer people will need to visit doctors for more serious issues down the road.

Blackwelder is optimistic that this problem will be the prompt the system needs to address these long-standing issues with our medical system. He admits, though, that he's a "glass-half-full kind of guy." He suggests existing technology could help. Not all patients actually need to see him personally; if there is a way to set up an online system so patients could access records, e-mail simple questions or request prescription reﬁlls that would cut down on the amount of time they'd have to spend in his ofﬁce.

Blackwelder also thinks a team approach would be more productive in health care practices -- something many hospitals are already trying to adopt.

"In Kingsport, Tennessee, where I work, I'm happy to see patients, but we also have a health department or retail clinics that people could go to for their ﬂu shots or other treatments," Black- welder said. "And if we maintained good communication with those other providers we could also avoid duplication of services and increase our overall effectiveness."

Qualiﬁed nurse practitioners might also be able to lighten some of the primary care physicians' load, as would physician assistants if such practices are allowed. But in some states that are already desperate for doctors, such as Mississippi, nurse practitioners must legally practice under the guidance of a physician. Why your waiter has an MD

Other solutions could include opening more residency slots for doctors. Blackwelder said he'd also love to see universities discount tuition for students who studied primary care. "I'd love for them to say to a student, 'I hear you are interested in primary care,' and present them with a bill with only zeroes on it," he said. "And then say to people who were going into a specialty, 'Here's your tuition bill,' with a number in front of all those zeroes."

People were worried the health care system would be overwhelmed when Medicare and Medic- aid started in the 1960s too, Kentucky Gov. Steve Beshear told CNN chief medical correspondent Dr. Sanjay Gupta, but the system adapted.

"I understand there is a sense of worry, and change can be scary, but our present system is broken," Blackwelder said. "We pay twice as much for our health in this country and have worse outcomes than other countries. "We will have to start coming up with creative solutions to this problem -- ones that won't have to wait for an act from Congress."

Part of the impact of the new Affordable Health Insurance Act is that more people will have health insurance, which means increased volume of medical claims ﬁled and more pressure on medical clinics. 48 Million Americans Without Health Insurance

By Tami Luhby September 17, 2013: 1:30 PM ET NEW YORK (CNNMoney) http://money.cnn.com/2013/09/17/news/economy/health-insurance-census/index.html The share of uninsured Americans dipped slightly last year, as more children and near elderly gained health coverage.

The share of uninsured people decreased to 15.4%, from 15.7% a year earlier, according to a Census Bureau report released Tuesday. Some 48 million people were uninsured in 2012, which was not statistically different from the prior year. Last year, the number of uninsured Americans fell for the first time in four years. Meanwhile, the share of people relying on the government for health insurance edged up slightly to 32.6%, from 32.2% a year ago. Those covered by Medicaid was not statistically different from a year earlier at 16.4%, while Medicare coverage rose to 15.7%, up from 15.2%. The Census report comes a few months before a major component of the Affordable Care Act kicks in. Starting in 2014, all Americans will be required to have insurance, whether through their employer or the individual market. Americans who don't have company-sponsored coverage can enroll in insurance plans on state-based exchanges beginning on Oct. 1. About 24 million people are expected to obtain insurance through the exchanges by 2023, according to the Congressional Budget But Obamacare, as the act is known, did not have a major impact on insurance coverage in 2012, Census officials and experts said. They don't expect to see any significant impact until 2015, when the 2014 figures are reported. The report does show that companies were not dropping coverage in 2012, ahead of health reform. Some 54.9% of Americans had employment-based plans, not statistically changed from a year earlier, though down from nearly 63% over the past decade. The two groups that did see coverage gains were children, who benefited from increased private insurance through their parents, and those age 55 to 64, who obtained plans through both employers and Medicaid, said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities, a left-leaning group. The growth in overall Medicaid slowed, however, likely because the poverty rate also remained steady at 15%, said Brett O'Hara, chief of the health and disability statistics branch at Census. Mean- while, the share of people on Medicare jumped as more Baby Boomers retired. Whether they have insurance or not, people spent more on health care last year than in 2011. Those with coverage shelled out $2,707 in out-of-pocket expenses, up 4.8%. The uninsured spent $627, up 4.3%.

More Young People Have Health Insurance Since Health Care Reform Legislation Was Passed Last Year. This Means Increased Volume of Medical Claims ﬁled. CDC: Health Care Reform Extends Coverage For Young Americans

From Tim Langmaid, CNN Updated 3:20 PM EST, Wed December 14, 2011 http://www.cnn.com/2011/12/14/health/health-insurance/index.html

STORY HIGHLIGHTS • NEW: The provision was also supported by GOP, a John Boehner spokesman says • The measure covering dependents up to 26 generally hasn't been a source of dispite • The new law lets people stay on their parents' health insurance through age 26 • Young adults are traditionally least likely to be insured, the government says Atlanta (CNN) -- About 2.5 million young people have received health insurance coverage as a result of health care reform measures that President Barack Obama signed into law last year, the Centers for Disease Control and Prevention reported Wednesday.

The Obama administration trumpeted the ﬁgure as a sign that the controversial legislation is succeeding.

Copyright © 1996 – 2016 by ClaimTek Systems  1 About 2.5 million more people, aged 19 to 25, have health insurance than had it before the law took effect because of a provision that lets young adults remain on their parents' insurance plans through age 26, the agency's National Center for Health Statistics said.

"Moms and dads around the country can breathe a little easier knowing their children are covered," Health and Human Services Secretary Kathleen Sebelius said in a statement.

Young adults have traditionally been the age group least likely to have health insurance, the Department of Health and Human Services said. The policy extending dependent coverage up to age 26 took effect for plan renewals beginning in September 2010.

The new estimates show that by the following June, the percentage of insured young people in that age group rose from 64% to 73%, Health and Human Services said. Based on census ﬁgures, that percentage change equates to about 2.5 million young people, the agency said.

Obama signed the health care reform package into law in March 2010 after the legislation made it through Congress with no Republican support.

GOP leaders argued the bill creates a government bureaucracy, burdens small business owners, and will prove costly.

The measure involving coverage for dependents up to age 26 has generally not been a source of dispute.

"This is the result of a bipartisan policy change that was also in our alternative -- there was no reason it had to be enacted as part of a job-killing government takeover of health care," Michael Steel, spokesman for House Speaker John Boehner, said Wednesday.

Impact of New Affordable Health Insurance Act This is article discussing how more people now have coverage they didn’t have before as a result of the new healthcare reform plan. More claims will be ﬁled as a result of it.

New Minnesota Health Reforms To Cover 16,000 More Children

By Joe Kimball | 07/26/12 http://www.minnpost.com/political-agenda/2012/07/new-minnesota-health-reforms-cover-16000-more-children

Ofﬁcials said today that changes coming in the state's MinnesotaCare health care program should provide health care to 16,000 uninsured children.

The changes began July 1 and will be implemented over the next few months.

They say that, with the changes, children from families with incomes below 200 percent of federal poverty guidelines ($30,264/year for a household of two and $46,104/year for a household of four) will no longer face barriers to coverage such as the four-month wait- ing period and access to employer-subsidized health insurance, and will be eligible for MinnesotaCare without premiums.

Elaine Cunningham of Children's Defense Fund-Minnesota, said: "These changes move us closer to covering every child in Minnesota. Reducing barriers for children under 200% of the federal poverty guidelines creates access to health care coverage for children in low-income working families. We want to ensure that every child grows up to be as healthy as they can be."

The state says an estimated 415,000 Minnesotans, including 71,000 children, didn't have health insurance in 2011. Those without insurance are often treated at hospitals, without payment, costing an estimated $311 million in 2010, according to the state Health Depart- ment.

The following article highlights how most software in the medical field do not readily have the ability to export data and cannot function, connect to, or work with other software’s seamlessly. This is a big problem, and the fact of the matter is we knew it would be a mainstream issue at some point, and that’s why we designed our MedOffice software with this exact issue in mind. MedOffice has the functionality to work with any other software through an HL-7 connection. This means you can link MedOffice to any EMR/EHR system or other software program that uses HL-7 connectivity such as lab, X-Ray…etc., meaning easy integration, from software to software. Healthcare's Big Problem With Little Data Dan Munro, Contributor. I write about the intersection of healthcare innovation and policy. 4/28/2013 @ 10:29PM |9,949 views http://www.forbes.com/sites/danmunro/2013/04/28/big-problem-with-little-data/

Every year, the analyst ﬁrm Gartner publishes between 90 and 100 “Hype Cycles” with insight on about 1,900 different technologies.

The Hype Cycle above is the one for Emerging Technologies for 2012 (published in August) and shows “Big Data” heading toward the “Peak of Inﬂated Expectations.”

According to Gartner, Big Data has about 2-5 years before reaching its ”Plateau of Productivity.” That’s the enviable point at which a technology ﬁnally delivers predictable value. The promise of Big Data, of course, is a treasure trove of high value across many industries – including healthcare.

Everything from predictive and prescriptive analytics to population health, disease management, drug discovery and personalized medicine (delivered with much greater precision and higher effi- cacy) to name but a few. Like many emerging technologies, the future here is brilliant and chock- full of headlines highlighting all the rich rewards ahead. In the meantime, however, ”little data” in healthcare continues to give us all peptic ulcers While it lacks any formal definition, one way to think of little data is anything that operates at the unit level. For example, one account, one patient, one customer, one transaction or one record. Healthcare billing data has evolved sufficiently that much of it has been standardized and automated – but clinical data is still years behind. Clinical data at the unit level is chaotic and dysfunctional because it’s not easily transferable or usable outside of the system that first created it. In a world of competing financial interests and an increasingly mobile population – every patient encounter represents an opportunity for technology vendors to lock-in providers. Word Processing had an equally chaotic start as well. You could export/import between competing word-processing applications, but the steps weren’t easy – or seamless. That’s the same dilemma facing the entire Electronic Health Record (EHR) software industry. Simply adding the word “cloud” to the marketing material (and pricing scheme) doesn’t change the underlying dysfunction. In fact, it’s often just a way to capture the allure of a new technology to sell antiquated ideas around the profitability of data that’s effectively held at ransom. It’s a classic innovator’s dilemma. On the one-hand, in order to support early (and often significant) development costs, commercial solutions need to be proprietary and protectable The challenge in healthcare is that the proverbial other hand is data that literally and figuratively represents our lives as patients inside our ossified healthcare system. Historically, the crutch that many software vendors have relied on is the format of the data itself. The sales process is designed to glamorize the feature and functionality – while obscuring the fact that the data format is 100% proprietary. Through the years, this cycle of customer acquisition and lock-in has now been repeated hundreds of times. By at least one estimate there are now about 500 independent EHR vendors. Out of that large group is a subset of about 400 with at least one customer that has applied for Federal stimulus dollars through the labyrinthine process of meaningful use attestation. That would suggest a “first-cut” of about 100 vendors who made some commitment around certification – but have no reported customers (at least to date). That’s a staggering number of single-purpose software vendors for any industry to support – even bloated healthcare. The simple fact is it can’t. While there have been a few high-profile cases of EHR vendors shutting down, this last week was the first high-profile example of a vendor that was effectively decertified by the Feds for both their “ambulatory” and their “inpatient” EHR products. From the HHS.gov website last Thursday: “We and our certification bodies take complaints and our follow-up seriously. By revoking the certification of these EHR products, we are making sure that certified electronic health record products meet the requirements to protect patients and providers,” said Dr. Mostashari. “Because EHRMagic was unable to show that their EHR products met ONC’s certification requirements, their EHRs will no longer be certified under the ONC HIT Certification Program.” One vendor out of 400 isn’t a trend, but it does suggest that as the rigors of meaningful use and certification increase, more and more vendors will likely not survive. With almost 400 EHR vendors and the certification process still in its infancy, we can expect a lot more chaos in this ecosystem of competing interests. There may come a point when a provider sees more value in adver- tising their EHR affiliation than ER wait times.

Big Data is clearly where all the excitement and headlines are, but it’s the little data that is likely to have the most effect on our individual healthcare. That is at least until Big Data gets well beyond its “peak of inﬂated expectations” and closer to its “plateau of productivity.” The question then is – which vendors are likely to be around in 2-to-5 years.