The document discusses Medicare Advantage plans as an overlooked cornerstone of healthcare reform. It provides the following key points:
- Medicare Advantage plans allow beneficiaries to enroll in private health plans that provide all Medicare benefits, often including prescription drug and additional services. Over a quarter of Medicare beneficiaries have voluntarily enrolled in these plans.
- Medicare Advantage plans help control costs. Spending on the Medicare prescription drug benefit declined by nearly 40% compared to initial estimates, and average monthly drug premiums are far below what was originally forecast.
- Changing Medicare to provide subsidies to purchase approved private plans, as Medicare Advantage does, could help address the program's long-term financial challenges as the number of beneficiaries increases rapidly
Did you have time to read the 1,990 page healthcare bill that was recently passed through Congress? Have you since wondered about the impact that massive bill will have on the average American, health insurance providers, business owners and YOU? If yes, then join the Young Professionals of Chicago as we host a panel of diverse health care professionals that will be discussing current healthcare reform and taking questions on the impact of the United States' new healthcare policy. The distinguished panelists will also provide some insight and clarity into what this massive bill means for individuals like you. There will also be an opportunity for open networking with other young professionals before and after the discussion.
National Health Care Reform: The Proposals and the Politicssoder145
Presentation by Elizabeth Lukanen at the University of Minnesota Academic Health Center's Student Leadership Summit in Minneapolis, MN, December 5, 2009.
This presentation provides a comprehensive pro-active review of program development for long-term care patients in the SNF. The course outlines suggestions for how rehabilitation team members can strengthen the Medicare Part B programming in the nursing facility. An overview of the Medicare Part B Guidelines, Part B Caps, Functional Limitation G-Codes, and Manual Reviews is also provided. The presentation also discusses Medicare Part B documentation, goal writing and reasons for denied claims.
1. Gain an understanding of Proactive Medicare Part B Program Development and how to strengthen the program components.
2. Gain a better understanding of Medicare Part B documentation components, goal writing and potential risk for receiving denied claims.
3. Gain an understanding of Medicare Part B Guidelines, Medicare Part B Caps, Functional Limitation G-Codes and Medical Reviews.
Did you have time to read the 1,990 page healthcare bill that was recently passed through Congress? Have you since wondered about the impact that massive bill will have on the average American, health insurance providers, business owners and YOU? If yes, then join the Young Professionals of Chicago as we host a panel of diverse health care professionals that will be discussing current healthcare reform and taking questions on the impact of the United States' new healthcare policy. The distinguished panelists will also provide some insight and clarity into what this massive bill means for individuals like you. There will also be an opportunity for open networking with other young professionals before and after the discussion.
National Health Care Reform: The Proposals and the Politicssoder145
Presentation by Elizabeth Lukanen at the University of Minnesota Academic Health Center's Student Leadership Summit in Minneapolis, MN, December 5, 2009.
This presentation provides a comprehensive pro-active review of program development for long-term care patients in the SNF. The course outlines suggestions for how rehabilitation team members can strengthen the Medicare Part B programming in the nursing facility. An overview of the Medicare Part B Guidelines, Part B Caps, Functional Limitation G-Codes, and Manual Reviews is also provided. The presentation also discusses Medicare Part B documentation, goal writing and reasons for denied claims.
1. Gain an understanding of Proactive Medicare Part B Program Development and how to strengthen the program components.
2. Gain a better understanding of Medicare Part B documentation components, goal writing and potential risk for receiving denied claims.
3. Gain an understanding of Medicare Part B Guidelines, Medicare Part B Caps, Functional Limitation G-Codes and Medical Reviews.
Medicare Advantage, also known as Medicare Part C and MA Plan, is an additional health plan for individuals eligible for Original Medicare. Private companies approved by Medicare offer four types of Advantage plans: Health Maintenance Organization Plans (HMOs), Preferred Provider Organization Plans (PPOs), Private Fee-for-Service Plans (PFFS) and Special Needs Plans (SNP).
Some seniors are concerned about thier medicare advantage coverage and for good reason. Learn more about medicare advantage coverage in this presentation.
Richard W. Bank, MD, who is 67 years old, draws upon decades of experience in the medical field. Richard W. Bank, MD, is a medical consultant and business veteran who feels strongly that Medicare and Medicaid cuts would have a negative effect on elderly and poor communities.
60-Day Overpayment Reporting Final Rule – The Rule of Six: Part IIPolsinelli PC
The Polsinelli Reimbursement Institute presents Part II of its series regarding the final Reporting and Returning Overpayments rule (a/k/a the 60-day rule) published on February 12, 2016. The webinar will cover the basics of the rule, but will go more in depth regarding the practical application of the rule for providers and suppliers.
On our agenda:
-The basics of the rule
-The impacts of the rule on:
--Transactions
--Stark and AKS analysis
--Investigations and audits
--Other payers, such as Medicaid and Medicare Advantage Plans
--Cost report-based overpayments
CMS BlueButton On FHIR for Researchers - Presentation to NIH and PCORI Resear...Mark Scrimshire
This is a presentation given to researchers from PCORI and NIH (Precision Medicine Initiative) about the potential benefits to researchers that comes from letting CMS Medicare Beneficiaries share their Claims information with a research study using the Proposed CMS BlueButton data formats built on the HL7 Fast Health Interoperability Resources Specification.
While the health care reform bill is a step in the right direction, medicare for all or single payer is what is really needed to control costs and insure all.
Managed Care within Health Care covers a variety of information from nursing homes, policies, Medical, Medicare, out of pocket, and partial payment, management, contracts, government, and the Social Security State Fund. Within this working paper I will discuss a few of these mechanisms that are applied and utilized within ‘Managed Care’ today. A system within a system that brings in 25% of the United States debt.
This presentation discusses the impact of health reform. It begins by defining the problem, then provides an overview of legislation and the impact on business. It provides a contrarian view of the subject and explains why health reform is really insurance reform. It also introduces the concept of consumer sovereignty,
Medicare ReformThe government has tried to control healthcare .docxandreecapon
Medicare Reform
The government has tried to control healthcare spending mainly through Medicare reform. In 1997, Congress expanded Medicare’s managed care program and renamed it Medicare+Choice. By encouraging seniors to join a private plan, they would save money and have a more complete package of health coverage. President Clinton’s plan bought Medicare some time. According to the below chart, in 1997, Medicare began to make some remarkable strides. You see a positive trend until the baby boomers begin to retire around 2013.
(Bettelheim, 2003, p.14)
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 is the latest attempt to salvage Medicare from becoming extinct in 2026. Preventive benefits are to begin in 2005. For those enrolled in Medicare Part B, there will be a one-time initial physical exam. The physical exam includes screening for diabetes, various cancers, and cardiovascular diseases, as well as immunizations against the flu and pneumonia. Bettelheim (2003) stated,
Beginning in 2006, seniors will pay a monthly premium of $35, and an annual deducible of $250. In exchange, the government would pay 75% of drug cost from $250 to $2250, but seniors would pay drug costs from $2251 to $3600. Only after the senior paid $3600 will Medicare pay 95% of further drug costs (p. 6)
To help control government costs, drug discount cards will be available until the Medicare prescription drug benefits begin in 2006. “Seniors will save 10-25% off the cost of medicines” (p 26). Private health plans will compete for seniors’ business by providing better coverage at affordable prices. This helps control the costs of Medicare by using market-place competition. Seniors can choose to stay in traditional Medicare, or those who like the lower cost sharing and extra benefits often available in MCOs would be able to make that choice as well.
Medicare reform. The reform of Medicare and the addition of supplemental policies have lengthened the lifespan of the assistance programs, but at the expense of patients and society. Most seniors are on fixed incomes and the cost of supplemental programs impedes their ability to continue their quality of life. Additionally, baby boomers entering this realm will overburden the system, creating larger deficits, and destroying any remaining quality of care that is being provided.
Medicare Summary
Medicare is basically broken down into two main categories: the "Original Medicare Plan" and the "Medicare Advantage Plan." Each category is made up of four sub-categories: Part A, Part B, Part C and Part D.
Part A
Part A is hospital insurance provided by Medicare. Most people do not pay a premium for this coverage. Part A covers inpatient care in skilled nursing facilities, critical access hospitals, and hospitals. Hospice and home health ...
A health insurance roadmap takes a look at some simple solutions to the complex issues facing health insurance, medicare, medicaid, long term care insurance, and the high cost of health expenses in retirement.
This will work because so much of this is already in place and a lot of the rest would be quick and easy to implement. As in all areas, knowledge is power. Consumers can take control of your insurance portfolio by becoming educated about insurance. Better education and understanding will lead to positive results for consumers and for the insurance industry.
11 minutes agoJessica Dunne RE Discussion - Week 3COLLAPS.docxdrennanmicah
11 minutes ago
Jessica Dunne
RE: Discussion - Week 3
COLLAPSE
Top of Form
NURS 6050C: Policy and Advocacy for Improving Population Health
INITIAL POST
Economic Challenges of Healthcare Policy
The economics of the healthcare system in the United States is complex and fragmented. Costs associated with care and the prices healthcare consumers pay are determined by a wide variety of factors making it extremely difficult to find a one size fits all solution. Knickman and Kovner (2015) argue that healthcare is neither a commodity or a service, because of the high variabilities in need, cost, and consumption. The United States spends 80% of all healthcare revenue on just 20% of the population. Health insurance can be provided by the government, the private sector, or an employer. Some citizens do not have any form of healthcare coverage. Regardless of type, insurance coverage generally only pays a portion of the total healthcare cost leaving the consumer to pay the remaining balance. Moreover, reimbursement standards differ for facilities and providers. The government reimburses healthcare facilities, such as hospitals a fixed amount per patient, which creates a higher incentive to work efficiently. Healthcare providers, on the other hand, are reimbursed based on a fee for service model, meaning the more services they provide, the more money they are reimbursed (Knickman & Kovner, 2015).
Reindart (2010) maintains the passage of the Affordable Care Act (ACA) created more strain on the system by adding approximately 30 million uninsured Americans to the market. The projected cost to provide such coverage is around 8 billion to 1 trillion dollars over the next decade. However, the estimated expense of healthcare with no legislative intervention is 35 trillion dollars over the next decade (Reindart, 2010). Laureate Education (2012) contends that the human resources required to provide healthcare to an additional 30 million people is another consideration the ACA does not address. The United States is already experiencing staff shortages for key healthcare jobs like nurses and physicians. Additionally, with baby boomers retiring from the workforce and simultaneously needing more healthcare resources as they age will inevitably exacerbate the shortage of providers (Laureate Education, 2012).
Ethical Considerations
It is important to recognize that the private sector often follows the public sector when deciding what services will be covered (Knickman & Kovner, 2015). Therefore, the implications of Medicare deciding not to pay for a drug or service will likely affect the entire population. Stein (2010) asserts that cost should not be a consideration in determining if medications or services will be paid for by Medicare. Nonetheless, that is what happened with Provenge, a vaccine indicated for late stage prostate cancer patients. The drug prolonged the lifespan of patients by about four months. Provenge costs around 93,000 dollars per p.
Consumer-Centric Healthcare: 2015--The Tipping Point Has Arrived (Report by William Blair)
Consumers—in tandem with disruptive healthcare technology and healthcare services providers—are the key to solving many of US healthcare's woes, particularly the unsustainably high cost of care.
Public exchanges, private exchanges, and high-deductible health plans are growing quickly. Disruptive forces of competition will create a lower-cost system that promotes the growth of highly efficient, low-cost, and high-quality providers and technologies.
The continued movement of financial and quality risk back to providers (and increasingly to consumers themselves) is encouraging providers and consumers to seek preventive medicine, cost efficiency, clinical efficacy, and overall value in healthcare. In turn, this could drive significant change regarding the primary point of care delivery (rapidly moving outside the hospital), the overall cost of healthcare and investment decisions made by healthcare providers.
Consumer-centric healthcare providers will experience strong top- and bottom-line growth over the coming years. Investors in both the public and private-equity markets will achieve superior long-term returns by identifying and investing in these companies.
Health Reform in America: An Overview of the Patient Protection and Affordabl...Adam Dougherty
A lecture to the UC Davis School of Medicine community covering the basics of the health reform law passed in early 2010. Presented by Adam Dougherty, MPH, MS1
Similar to June 8, 2013 CAPG Presentation--Medicare Advantage (20)
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. Medicare:
Still basically the 1965 model
A “social insurance” program to help pay
for hospital and physician visits, diagnostic
tests, medical equipment, and many other
medical goods and services, paid on a
fee-for-service basis.
A prescription drug benefit was added 40
years later (decades after private plans
integrated drug and medical coverage).
3. Who gets Medicare?
Medicare will spend $600 billion this
year on health benefits
It covers 50 million people
–41 million senior citizens age 65 and over
–9 million disabled people
People with a physical or mental condition that
makes it impossible for them to work
People with End Stage Renal Disease receiving
dialysis
4. A & B: Medicare’s Original Parts
Part A helps pay for hospital, home
health, hospice care and other institutional
care for the aged and disabled
Part B is an allegedly voluntary program
that helps pay for physician, outpatient
hospital, home health, and other services
5. C and D: Medicare’s newer parts
Part C is an alternative to traditional Medicare.
Beneficiaries can enroll in private “Medicare
Advantage” plans that contract with Medicare to
provide medical, hospital and sometimes drug
coverage to those who choose these plans
Part D is a voluntary program that provides
subsidized access to prescription drug
coverage for all beneficiaries and subsidies for
premiums and cost-sharing for low-income
people
6. Part D: Such a deal!
The Congressional Budget Office said that
spending for the prescription drug benefit
declined by nearly 40% compared to initial
estimates of its 10-year cost
It is saving seniors money as well. The average
monthly drug premium is about $30, far below
the $53 forecast originally.
7. SOURCE: Kaiser Family Foundation analysis of the Bureau of Labor Statistics Consumer Expenditure Survey Interview and Expense Files, 2002-2009,
“Health Care on a Budget, The Financial Burden of Health Spending by Medicare Households, An Updated Analysis of Health Care Spending as a Share
of Total Household Spending,” June 2011.
Health Insurance
Spending
Prescription
Drug Spending
Average Health Insurance and Prescription Drug
Spending As a Share of Total Household Spending
by Medicare Households, 2002-2009
8. Part D: A model for Medicare reform
Seniors would get an annual subsidy to
purchase a Medicare-approved health plan.
The plan would allow seniors to pick the
health plan that meets their needs.
The older they are, the bigger the payment
they would get. Sicker people would get
more.
11. Medicare as a Share of the Federal Budget,
1980 - 2020
$591
$1,253
$1,789
$3,456
$4,932
$107 $216
$520
$889
$34
1980 1990 2000 2010 2020
Federal spending (in billions)
Medicare spending (in billions)
Medicare as a share of the federal budget
5.8% 8.5% 12.1% 15.1% 18.0%
SOURCE: Historical spending for 1980 – 2010 from Congressional Budget Office (CBO) Budget and Economic Outlook: Historical Budget
Data (January 2011); projected spending for 2020 from CBO Update to the Budget and Economic Outlook: Fiscal Years 2012 to 2022
(August 2012).
12. “I paid for my Medicare!”
Consider this…
A couple retiring today with both spouses
earning an average wage throughout their
careers would have paid $109,000 in
total Medicare payroll taxes during their
lifetimes.
Yet the expected spending by Medicare
on the couple will be $343,000.
13. Historical and Projected Number of Medicare
Beneficiaries and Number of Workers Per Beneficiary
SOURCE: 2010 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.
Number of Beneficiaries (in millions) Number of Workers Per Beneficiary
15. Medicare Advantage
Beneficiaries can enroll in a private plan, such as
a health maintenance organization or preferred
provider organization.
Plans receive payments from the government to
provide all Medicare-covered benefits, often
including drug benefits, vision and dental
services.
More than a quarter of all people in Medicare
have voluntarily enrolled in Medicare Advantage
plans.
16. Premiums and cost sharing
Medicare Advantage enrollees generally pay the
monthly Part B premium and possibly an
additional premium directly to their plan.
Premiums vary by plan type and are lower for
HMOs ($30 per month) than for PPOs ($64 per
month).
Medicare Advantage plans are required to limit
beneficiaries’ total out-of-pocket spending each
year (the maximum is $6,700 in 2013). Cost-
sharing requirements vary widely across plans.
17.
18. Medicare Benefit Payments By Type of Service,
2012
Skilled Nursing
Facilities
Hospital
Inpatient
Services
Physician
Payments
Hospital
Outpatient
Services
Home Health
Other Services*
Medicare
Advantage
Outpatient
Prescription
Drugs
Total Benefit Payments = $556 billion
NOTE: Does not sum to 100% due to rounding. Excludes administrative expenses and is net of recoveries. *Includes hospice, durable
medical equipment, Part B drugs, outpatient dialysis, ambulance, lab services, and other services.
SOURCE: Congressional Budget Office, Medicare Baseline, March 2012.
14%13%
4%
6%
26%
11%
22%
6%
Part A
Part B
Part A and B
Part C
Part D
19. Medicare
Advantage
25%
Other 3%
PFFS plans 5%
Regional PPOs 9%
Local PPOs 18%
HMOs
65%
Total Medicare Advantage Enrollment, 2011 = 11.9 Million
Distribution of Enrollment in
Medicare Advantage Plans, by Plan Type, 2011
Traditional
Fee-for-
service
Medicare
75%
SOURCE: MPR / KFF analysis of the Centers for Medicare and Medicaid Services (CMS) Medicare Advantage enrollment files, 2011.
20. Distribution of Medicare Advantage Plans
by Plan Type, 2007-2011
NOTE: Other includes cost and demonstration plans. Excludes SNPs, employer-sponsored (i.e., group) plans, demonstrations, HCPPs, PACE plans,
and plans for special populations (e.g., Mennonites). HMOs include Point of Service (POS) plans.
SOURCE: MPR/KFF analysis of CMS’s Landscape Files for 2007 - 2011.
21. Supplemental Coverage Among
Medicare Beneficiaries, by Income, 2008
NOTES: Numbers may not sum due to rounding.
SOURCE: Kaiser Family Foundation analysis of the CMS Medicare Current Beneficiary Survey Access to Care File, 2008.
$10,000
or less
$10,001-
20,000
$20,001-
30,000
$30,001-
40,000
$40,001
or more
5.9 million 8.9 million 6.8 million 6.4 million 7.7 million
All
beneficiaries
41.8 million
22. Major Medicare policy initiatives
Current Initiatives
ACO Program
– Medicare Shared Savings Program
– Pioneer ACOs (CMMI)
– Advance Payment ACOs (CMMI)
Hospital Value Based Purchasing & Readmissions Penalties
Medicare Advantage Five-Star Bonus Program
Comprehensive Primary Care Initiative (CMMI)
Partnership for Patients (CMMI)
Upcoming Initiatives
Bundled Payment Initiatives (CMMI)
Physician Value Modifier
23. Political dangers ahead
The ACA targets Medicare Advantage for a
disproportionate share of Medicare cuts.
UnitedHealth is cutting back on its Medicare
Advantage participation
UnitedHealth Group CEO Stephen Hemsley: Medicare Advantage rates are still
far too low and that the company may shrink its business of managing care for
seniors.
“We did not expect the fastest growing, most popular and most effective
Medicare benefit option serving America’s seniors to be underfunded to this
extent in 2014,” Hemsley said on a conference call with investment analysts.
UnitedHealth’s Medicare Advantage business, he added, “will likely experience
market exits as well as in market membership contraction as we reshape
Medicare networks and benefits to respond to the continuing underfunding of this
program.”
24. But it is the model for reform
Policy experts and many politicians
from the right and center-left see
Medicare Advantage as the platform for
reform in the future
It is not in political favor now, but
growing budget problems will force
Congress to act on Medicare spending,
and MA is the likely cornerstone
26. What we know for sure
• CHOICE: Americans value innovation,
diversity and choice to accommodate 300
million people
• VALUE IN HEALTH SPENDING: Break down
payment silos to realize the promise of
personalized medicine and achieve overall cost
saving
• FOCUS ON THE PATIENT: Doctors and
patients, not government, should make health
care decisions
27. Source: Frank Hill, “The High Cost Impact of More Regulation and Admin/Executive Staff on Health Care Inflation,” Telemachus, July 22, 2012,
http://www.telemachusleaps.com/2012/07/the-high-cost-impact-of-more-regulation.html.
28. A market-based solution
“Defined contributions” for health coverage
A system that puts doctors and patients in charge of
medical decisions
Slowing spending while preserving choice and quality
Restructuring financing for a 21st century health
sector
• Medicare
• Medicaid
• Private Insurance