(September 23, 2010)

Since the government is going to take more control of the healthcare system in the US (despite all their claims to the contrary), you’re going to see more and more cost cutting measures in the delivery of healthcare to everyone.  One area where changes are going to take place is the expansion of procedures allowed to be performed by nurses, technicians, and other para-medical providers.

What brought this to my attention was the discussion in Colorado recently where the Governor, Bill Ritter, was trying to decide whether or not to opt out of the Medicare guidelines, which requires nurse anesthetists to work under the supervision of a physician.  In 2001, the Centers for Medicare and Medicaid Services (CMS) instituted a rule in the Federal Registry that permits a state to be exempt from Medicare’s physician supervision requirement for nurse anesthetists with approval by the state governor.  So far, 15 states have opted out of the federal requirement, instituting their own state requirements instead.

I’m not questioning the competency of the nurse anesthetist’s abilities to administer anesthesia within the scope of their practice.  Nurse anesthetists are licensed to practice independently in each of the 50 states, though the scope of practice does vary from state to state.  My point is: Now that the government will be footing the more of the healthcare bill in this country, there will be more procedures allowed by non-physician providers, to try to contain medical costs.  This effort will have its affect on physicians and patients both, and neither of them positively.

For physicians it will cut into the income levels by allowing lesser qualified medical personal to make medical decisions that have previously been permitted only by licensed physicians.  The argument that will be used by the government will be that many rural and inner city hospitals have difficulty recruiting doctors and specialists to adequately serve the medical needs of the area population.

By allowing nurses and technicians to perform certain routine medical procedures, the public will have access to more medical treatment, and the public will benefit.  I have no problem with this logic, up to a point.  While routine procedures and treatments can safely be performed by aids, nurses, or technicians, the person best qualified to make medical decisions is still the doctor. Medical Doctors are the only members of the medical team qualified and licensed to diagnose.  If, and when, non-qualified personnel are allowed to diagnose and initiate treatment protocols,  then the likelihood of increased problems will occur.

For patients who are not examined by physicians, but are diagnosed and treated by non-physicians, the quality of care may not be the quality of care that they have come to expect.  In most instances the diagnosis and treatment may be straight forward, but in the occasional case where the diagnosis is not so straight forward, or the treatment is not typical, the patient care will suffer.  Patient care will suffer if the scope of practice for non-physicians is expanded without requiring increased educational criteria.  There is a reason why all 50 states require doctors to be licensed, and that reason is to ensure quality patient care. The patient will certainly care who treats them, if they are misdiagnosed or mistreated by a non-physician. If the patient is not allowed to be examined or treated by a medical doctor due to budgetary constraints, then who is liable for any malpractice, if any occurs? The doctor, who didn’t examine and treat the patient, because this has been ‘usual and customary’ or the non-physician who examined and misdiagnosed the patient?  Will malpractice insurance decrease for the doctor, because they are not treating as many patients, or will it increase because the doctor is liable for the actions of their staff?

When healthcare gets rationed because of the healthcare reform bill, where will the liability fall as patient care decreases, yet patient expectations become greater, because of the promises made by the politicians during the healthcare debate?  As a physician in private practice you need to be aware of the assaults coming at you from all sides.  In today’s political climate; only the greedy insurance companies are a bigger villain than the greedy doctors in the healthcare field. 

Just trying to keep you informed on all the attacks that the private practice physician will be facing in the coming years.

Submitted by Dr. DG Comfort, CO

www.hna-net.com

http://www.physiciantrends.com

Urban sprawl never used to be an issue. Even though the latest development might be miles from where you work or the nearest shops, this was never a problem. Most families owned two vehicles. Some three or more. No-one walked. Everyone just jumped in the nearest vehicle and off they went without a second thought until the price of gas rocketed up. Now we have the credit crunch and a recession just bottoming out. Car ownership has become an expensive proposition. Too expensive for some who have been reborn as a one-car family to cut their losses. The first step in crisis management is to find out which of your vehicles is the cheapest make and model to insure. Now balance that against the likely costs of maintenance and repair over the next twelve months. And which will sell for the highest price? When you know which vehicle you are keeping, maximize the number of discounts on the policy, including bundling auto and home together with the same insurer. Except, one vehicle for a busy family may not be practical. What are the options?

Many families talk to their neighbors and work out a carpool. This is reasonably easy to organize for routine journeys. But there is one slight problem. If you are going to carry passengers, you should have insurance to pay their medical costs should they be injured in an accident. It is not safe to drive your neighbors around on the state’s minimum liability cover. Then we come to the always difficult question of sharing the costs of the gas. If the passengers always pay something towards the cost of the journey, many insurers treat this as a business arrangement and require the vehicle owner to take out a commercial policy as a taxi. Needless to say, this turns a friendly social service into an expensive excuse to argue with your neighbors over prices. Of course, you could all agree to lie about the arrangement. But the stories can change rapidly if everyone ends up in a hospital and big bills are presented.

The second option is the new rental plans which site vehicles for rent by the hour in local garages. You book what you want over the internet, travel to the garage for the pick-up and drop it off at the same garage when your time is up. The cost per hour on the standard plans are attractive and, assuming you do not want a vehicle more than an average of one hour every day, you will save money on car ownership. But you do need to look carefully at the insurance offered in the standard plans. Some have poor cover of medical expenses for you as the driver and passengers. Others do not include the loss of use charge if the vehicle is off the road being repaired. Always read the small print. Summing up, finding insurance for a single vehicle means getting multiple auto insurance quotes and finding the one that works for you. If you are going to use your car to drive neighbors around, you also need to get auto insurance quotes to cover the additional liabilities. If you use one of the new rental plans, consider paying extra for LDW which gives more comprehensive protection against loss.

Life is capricious. Its unpredictability makes living beautiful and fascinating. Its capriciousness, nevertheless, could also result in inconvenient predicaments, in addition to unfortunate accidents and loss of life. Accounts of flight cancellations, getting sick whilst in foreign lands, and mishaps on the road abound on papers. Travellers can get peace of mind and cushion the blows of life’s unpredictability with travel insurance.

Australia has a lot of travel insurance companies that individuals from Sydney, Brisbane, and Melbourne can go to. Before they buy this kind of insurance policy, however, below are some things that consumers need to find out.

Travel insurance is indispensible, whether or not the person is heading for an Australian destination or to any city around the world.

There are a lot of providers for this kind of insurance, so individuals should make sure they research rates before they buy.

Insurance providers can be easily found online.

The policy ought to cover medical costs for the policyholder, in addition to compensation for any stolen or lost property. Trip cancellations are insured.

Those who wish to buy travel insurance ought to read the agreement meticulously before signing it. They may have exclusions and conditions on activities that the insured should never be a part of. Breaking the contract would mean that the insurance policy holder would need to forfeit compensation in the event of mishaps.

Would-be policyholders will need to look at any issues with the insurance service provider directly.

In addition, here are a couple of the most common myths about acquiring (or not acquiring) travel insurance.

Australian tourists might think that a credit card would be good enough when they journey overseas when, in fact, it is not.

In some areas in developing nations, accepting credit card as payment is rare. In some instances, the insurance policy supplied by some credit cards includes only mishaps that will occur while travelling but not for sickness.
Many travel insurance policyholders think that the insurance service provider will instantly pay the insured’s medical bills when they are put in the hospital or if they need medical assistance in a foreign nation. Even though some providers are going to pay the expenses for the client immediately, others would require clients to pay their own fees first and reimburse clients after they get back to Australia.

Here are some tips on how to select a dependable travel insurance service provider.
Clients can look around and check out various insurance companies in the city where they live. They must research and they must not sign on to the firm just because it offers less expensive monthly premiums. They can do their own investigation and check if the firm is a member of any regulating body from the government.
The would-be policyholders should know about what scenarios their insurance policies would cover.
Clients must also consider what they need. Will they need cover for medical expenses, flight cancellations, or loss or theft of valuables?

While life is volatile, people can gain even a bit of security when they purchase travel insurance. Australia insurance providers can offer a comprehensive travel insurance if they want to have reassurance when vacationing abroad.

Prior to setting down your inventory of likely insurance companies, you require deciding in relation to what kind of insurance would go well with you best. For instance, a number of people wish for individual insurance, which simply covers them. Others choose family policies, in which every one of the members of their families is enclosed too.

There are many government funded alternatives obtainable as well. These could cover up children, people with disabilities, veterans, and other such social groups. Yet, comprehend; you must meet the criteria for these programs. Still, if you do, they could be extremely useful. One or more of them may be appropriate for you.

At any time you consider Medicare, you will frequently consider health advantages. But, if you are marveling regarding the dissimilarities between Medigap and Medicare, you must keep in mind that both of these two types of health insurance plans are extremely dissimilar.

It is significant that you ought to not confuse with both kinds of insurance as the similar.

Part A – This is typically named hospital insurance, although it covers up several other things too. The majority seniors ought not to pay a further premium.

Part B – This is frequently named medical insurance. It disburses for medical costs that Part A does not cover up. Doctor’s office visits are one model of this. The majority seniors do disburse a premium for this coverage, although it is taken from their social security checks, so numerous people are not even conscious of that.

Part C – no one calls Medicare Advantage plans Part C any longer. Medicare Advantage plans derive from private insurers. At times they need an extra premium payment, but at times they do not.

Part D – it is Medicare prescription drug coverage and it is quite new-fangled. It derives from private insurers. It typically has a premium for the senior citizen, although it gets tax dollars to complement it too.

Medicare is a federal program that gives health insurance to senior citizens regardless of their medical state. You could simply meet the criteria for Medicare if you are 65 years and over. Medicare would involuntarily enlist people who were in receipt of social security advantages once they get to the age of 65. People who make a decision not to retire at the age of 65, are qualified as well, everything you require to make is sign up.

It is a health insurance plan given by the government. It will be equipped cover up nearly all of your medical costs and it will give you extra profits for outpatient care as well. If you would be involuntarily enlisted into Medicare; Social security administration would send off you announcement, several months prior to your 65th birthday. By the time they are 65 years old the majority people meet the criteria for both social security profits and Medicare.

The truth of the matter is most of us will never truly be able to retire. Oh, we may leave our current job or vocation, but in this new global economy, true retirement the way your parents retired is just a fantasy for most of us. The average American will need to continue to work well into their reclining years.

As an investment advisor, I know first hand how hard it is to tell a client what they don’t want to hear. If it’s any consolation, this news didn’t start out as a lie. It has just become very hard to perpetuate in the current time period of which we live and work.

Here is why:

1. The historical rates of return your advisor used in your planning (example 8%-10%) are only true if your investment horizon is 50-100 years. However for most people, 20-30 years is a more normal period for active investment. Much of your returns over that period depend not on the length of your holding period, but the calendar period you were invested. For example for the period, January 1989-September 2009, the S&P has returned approximately 8.5%, including dividends, through both a wild bull and depressing bear markets. For the 20 years, 1962-1982, the S&P 500 returned approximately 4.5% annually after dividends, well below the inflation rate of the period. So, as with everything in life, timing is everything!

2. Social Security is a program that is doomed to fail. With the growing aged population here in the U.S., spiraling medical costs and a slower influx of new workers to fund Social Security, something will have to give with this program. According to the Heritage Foundation, the Social Security Trust fund ran a deficit of $4.3 Billion in September 2009 alone and that was on top of a $5.7 billion deficit in August. This is bad news for retirees and taxpayers. One of two things must happen here, benefits must be cut or taxes must be raised (or some combination of both). Under almost any scenarios, those approaching retirement will pay in more and receive less (possibly nothing). This will leave most retirees with a big hole to fill in their retirement planning.

3. Asset appreciation is fleeting. For most of us, the American Dream is to buy a house, live in it until we are content to move on and then sell it for a large profit. As retirement approaches, we may even downsize to a smaller place and pocket the extra funds to support our lifestyle. According to the economist Harry Dent’s Age Wave Theory (www.hsdent.com), U.S. and European populations are peaking, based on his findings that a human consumer’s spending habits peak by age 50. The implications of this are that, excluding the affects of immigration, retirees can expect there to be spikes in unemployment and decreases in housing demand and therefore prices. If you throw in the housing glut that remains from the financial crisis, it is unlikely we will see significant price appreciation for many years to come. This same Age Wave Theory will also likely affect the demand for equities and other financial products, but to a lesser extent.

4. Medical costs will continue to spiral or be rationed. Medical costs in 2009 rose by 7.4% (the seventh straight year of 7%+ increases) according to the Milliman Medical Index Report (www.Milliman.com). We have already seen the spiraling costs of medical care front and center in discussions about President Obama’s Health Care Reform Package. Of course, the President claims that care will not be rationed, but the evidence is clear that it will be when we look at the systems in Canada and Europe. If you are denied medical care, private pay will be your only route to such care, therefore putting a further strain on your retirement savings. Additionally, long-term care insurance will continue to escalate in cost.

5. Finally, people are living longer, requiring greater savings for retirement. In the 1950s life expectancy in developing countries was just 50 years for men and 53 for women. Today, the average life expectancy is now 77.7 years according to the Centers for Disease Control and Prevention (CDC). This added life expectancy puts a greater strain on savings, the social security entitlement system and increases the demand and cost for aged services.

So enough with the doom and gloom, is there a solution? The simple answer is the solutions are numerous and most involve sacrifice. Solutions like earning more on your investment assets, forgoing emergency room visits except in real emergencies, better diet, more exercise, higher taxes, substantially lower benefits, and so on, and so on.

Of course the real question is do we Americans have the fortitude to accept these solutions and make the necessary life changes? If we don’t we stand to endanger our way of life and the lifestyles of our children with unsustainable public deficits and out of control entitlement programs.