UNDERSTANDING THE FINANCIAL LITERACY OF MEDICAL CARE MAY 2014
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STAFF Denise W. Barnes, Editor Shantella Y. Sherman, Assistant Editor Ron Burke, Advertising/ Marketing Director Lafayette Barnes, IV, Assistant Photo Editor Khalid Naji-Allah, Staff Photographer John E. De Freitas, Sports Photo Editor Dorothy Rowley, Online Editor Brian Young, Design & Layout Mable Neville, Bookkeeper Mickey Thompson, Social Sightings columnist Stacey Palmer, Social Media Specialist Angie Johnson, Circulation
Stacy Brown, Sam P.K. Collins, Michelle Phipps-Evans, Eve Ferguson, Gale Horton Gay, Elton J. Hayes, Njunga Kabugi, Stacey Palmer, Dorothy Rowley, Barrington Salmon, Margaret Summers, Charles E. Sutton, James Wright
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s millions of Americans celebrate their newfound status as medically “insured,” through the Affordable Care Act, they may still join the ranks of financially strapped patients facing the rising cost of medical services. Fifty-eight percent of Americans reported foregoing or delaying medical care in the past year because, even with insurance, they could not afford the portion of the bill that they were expected to pay. And while many are familiar with the vague concepts of costly prescriptions and expensive tests, the reality can be found in $300 tooth extractions, $200 office visit fees because deductibles had yet to be met, and insured patients who lose their homes attempting to pay the out-of-pocket portion of medical expenses. The New England Journal of Medicine announced in 2013 that physicians should be obligated to discuss out-of-pocket costs as a “side effect” to treatment when they make decisions about their patients’ care. The journal considered this discussion as imperative to reigning in the costs of care. The concern was that healthcare providers often neglected to discuss potential costs before ordering diagnostic tests, saddling the patient with “daunting and potentially avoidable healthcare bills,” wrote journal author Peter A. Ubel, M.D., a professor of business administration and medicine and public policy at Duke University in Durham, N.C. But how does one choose between receiving necessary tests and care on the front end and dealing with the resulting bill later or possibly exacerbating a condition by not having it firmly examined due to costs? The simple answer is: Get the needed services and suffer the consequences later. Several years ago while living in a state with average winter temperatures in the minus digits, I found myself laboring for breath and pretty scared about it. Upon arrival at an emergency room, I was told I had to allow them to monitor me for a span of 24 hours and given a room for the night. What would eventually be named and celebrated a “corrective bout of anemia,” almost caused a coronary when I received a bill for more than $30,000. The total balance of treatment, which consisted of me taking a stress test (I have the heart of a 20 year old), and lying in an uncomfortable bed watching soap operas overnight, was due within 30 days service – half of which had already expired when the bill was received. As a law abiding citizen who pays her taxes, votes regularly, and is pretty civic minded, I felt overwhelming embarrassment when a court deputy arrived at my door fifteen days later with a summons to appear in court and the phone number of the law offices handling the lawsuit against me. While I was happy to be healthy, I could not imagine coming up with $30,000 dollars. I was grateful my status as a broke graduate student classified me a “hardship case” with hospital administrators and allowed them to reduce the total to $400 -- to be paid in ten increments of $40 each. Others do not fare as well as I did and between hospital, office visit, procedure, and prescription bills, are further sickened by the stress of having to pay these bills. A recent survey found that 45 percent of people receiving prescriptions skipped filling them because of the cost (an increase of 19 percent); and 63 percent put off a doctor’s visit to save money (an increase of 16 percent). If stress is a major contributor to overall poor health, the costs of care has to be considered as more than a “side effect” when factoring in methods of diagnosis and treatment. This edition of the Informer Health Supplement, Understanding the Financial Literacy of Medical Care, is designed to equip readers with tools necessary to financing their healthcare needs. Read & Enjoy, Dr. Shantella Y. Sherman Editor, Supplements and Special Sections
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we buy, supporting the farmers in local communities. Since 2011, we have saved our customers $2.3 billion on fresh fruits and vegetables. The Great for You icon appears on select products in our stores, to make it easy for customers to instantly identify more nutritious choices.
Commitment to Healthy Eating At Walmart, our commitment to healthy eating begins by understanding our customers and fulfilling our mission of saving people money so they can live better. We strongly believe a family should not have to choose between food that is nutritious for them and food they can afford. This is why Walmart’s commitment to its customers includes offering Wild Oats organic food products, purchasing from local farmers, and supporting, organizations that are committed to nutrition education and healthy eating programs. Education is the cornerstone for driving any sustainable change – helping people understand what they are eating, what is healthy, what is not, so they can make informed choices. The Walmart Foundation have increased charitable support for nutrition education programs, resulting in $26 million of total giving nationally, including the funding of important programs from Share Our Strength, the American Heart Association, the National 4-H Council and the Alliance for a Healthier Generation. In addition to bringing the first two Walmart stores to H Street and Georgia Avenue, Walmart and the Walmart Foundation invested in D.C.-based not-for-profits like Brainfood, CentroNía, Martha’s Table, Food & Friends, and the Capital Area Food Bank. At Walmart, we are thrilled to collaborate with organizations that have such a positive impact on the
anyone who desires it. We are able to make a substantive difference in communities by supporting farmers and their communities, produce more food with fewer resources and less waste. The effort is ongoing, but we are committed and we will keep helping communities save money and live better.HS
communities we serve and are dedicated to ensuring that people have healthy and affordable choices. For example, CentroNía’s “Eat Healthy, Live Healthy” initiative is a multidisciplinary campaign devoted to improve the quality of life by providing nutritional education to children, parents, teachers and CentroNía‘s staff. Through the campaign, participants learn the basics in nutrition and wellness, and become role models for the community. When children and families are healthy and happy, they are best positioned to learn. CentroNía’s Food and Nutrition Department’s mission is to produce healthy meals for CentroNía’s community and to encourage children, parents and staff to adopt healthy lifestyles by making informed food choices. In 2013, the Chesapeake Bay Foundation’s Clagett Farm was awarded a $50,000 grant to help support two of its acclaimed programs. The Upper Marlboro farm grows sustainably-farmed vegetables for distribution through Community Supported Agriculture, and provides education about sustainable agriculture in its From the Ground Up program. In 2011, Walmart made the commitment to making food healthier, more affordable and accessible. That is why we are working with suppliers to reduce salt and sugar in key products, starting with our own Great Value and Marketside brands. We are also doubling the amount of locally grown produce
Extending our commitment to Washington, D.C. Creating jobs that offer career advancement. Donating meals to fight hunger in the community. Providing families access to healthy, fresh food choices. Walmart is excited to work with Washington, D.C. to help the District save money and live better. To learn more visit WalmartWashingtonDC.com.
Walmart is committed to providing healthier food at the most affordable price, so that as many people as possible can have access to nutritious options. We are fighting hunger in the United States, not only by making food more available to those in need, but by making healthier food more affordable for
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WWW.WASHINGTONINFORMER.COM | MAY 2014 | HEALTH WELLNESS & NUTRITION SUPPLEMENT HS-3
Calvary Women’s Services Encourage Long-term Health
By: Kristine Thompson, Calvary Women’s Services CEO
In the current economic climate, not only is there a critical need for jobs and affordable housing, but the need for adequate nutritional resources has also skyrocketed. At Calvary Women’s Services, we are excited that our corporate partners are stepping up to address those needs. With the holiday season far behind us, now is the time when nonprofit organizations encourage donors and volunteers to focus that incredible energy on helping to meet the city’s needs for the remainder of the year. Like many nonprofit organizations, we work
hard year-round to prepare women for long-term health and stability as they graduate from our programs and move into their own homes to live healthy and independent lives. When we made the commitment to expand our health and education programs for women in DC, we knew we had to build strong relationships with the right business leaders. Developing corporate relationships is critical to the expansion of our services, and we seek corporations whose values align with our mission to empower women to make lasting changes in their lives. Walmart and the Walmart Foundation have long demonstrated their commitment to women’s empowerment and
healthy communities, so when they offered to invest in our Nutrition Education Program last year, we knew the fit was a good one. Thanks to Walmart and the Walmart Foundation, the women in our programs have the opportunity to work closely with a nutritionist to learn foundational skills that will prepare them for good health once they graduate from our programs. Walmart and the Walmart Foundation continue to demonstrate their investment in Washington D.C., and the health of our community. Due to the generous $25,000 Walmart Foundation State Giving Program grant we are able to continue our Nutrition Education Program. Poor nu-
trition can spur a series of health issues, and our program is designed to encourage healthy eating, improve women’s wellness and better their lives. The Nutrition Education Course (the foundation of the program) is offered in 3-week sessions and meets 3 times each week. Two classes each week focus on nutrition and a third focuses on budgeting. During the course, topics include things such as reading food labels, understanding whole grains and healthy fats, and purchasing nutritious food at the grocery store. Women also receive the opportunity to have a handson approach to healthy food preparation. Armed with the knowledge and skills to make healthier choices, women
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make lasting changes that will last the rest of their lives. This is made possible by corporate sponsors such as Walmart, who demonstrate and fulfill a commitment to the communities they serve. Nonprofit organizations have long understood the value of strong relationships with corporate partners. When nonprofits form deeper relationships with the right corporate partners, the benefits are immediate, and both parties can create change together in their communities. In Walmart and the Walmart Foundation, Calvary Women’s Services has found a natural partner in the fight against hunger and food insecurity.HS
Walmart proudly salutes our
D.C. Hunger Partners for their extraordinary work in our communi�es
More than $3.5 million invested to in DC
WWW.WASHINGTONINFORMER.COM | MAY 2014 | HEALTH WELLNESS & NUTRITION SUPPLEMENT HS-5
Honoring Our Seniors by Protecting them from Hunger By Bishop Don DiXon Williams
This month we celebrate our seniors. Not only should we take the time to remember the great strides and accomplishments the generations before us have made and continue to make, but we also need to think seriously about their well-being. Like me, many baby boomers are making their way toward retirement after decades of hard work and fruitful contributions to society. At a time when we should be living out our lives in leisure, spending time with loved ones, and traveling, millions face the harsh reality of hunger. Sadly, hunger among older Americans has increased the last few years. From 2001 to 2011, the number of seniors experiencing hunger increased by an astounding 88 percent. An astonishing 8.8 million seniors now suffer
from food insecurity. I believe it’s time for a change. The first step is understanding hunger and its long-term implications on our health. Food insecurity leads to more health risks. Seniors who struggle to put food on the table are 2.33 times more likely to report fair or poor health. Thirty percent of seniors—including those who have worked their entire lives—now have to choose between feeding themselves or purchasing medication! This is a choice no one should have to make. The next step is learning what resources are available to help those who may have fallen on hard times to avoid hunger. There are programs like the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps) and Meals on Wheels that can help bridge the gap when times are tough. In one of the world’s wealthiest nations—one full of resources
“AT A TIME WHEN WE SHOULD BE LIVING OUT OUR LIVES IN LEISURE, , SPENDING TIME WITH LOVED ONES, AND TRAVELING, MILLIONS FACE THE HARSH REALITY OF HUNGER.” to prevent hardship—it is unacceptable that so many people go without. Finally, we must erase the stigma that prevents many older Americans from applying for these programs or talking about hunger at all. Many of us don’t participate
in the programs available to us for fear we may be judged for accepting a handout. But at Bread for the World, we look at these programs as a “hand-up,” not a handout. They exist to help vulnerable people get back on their feet after hardship, and to ensure
YOU CAN CHANGE
A LIFE Help End Hunger Every Month of the Year. Start your monthly gift at bread.org/go/monthlygift For every dollar you donate, Bread helps win more than $100 in poverty-focused assistance that is directed to hungry and poor people in the U.S. and around the world.
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that they receive the vital nutrients needed to live a healthy life, despite economic difficulty. One of the best ways to honor our seniors this Older Americans Month is to ensure that they have enough to eat. Help at soup kitchens and food pantries, and spread the word to ensure that those who need assistance are aware of available resources. Finally, it’s important that we let Congress know we value our seniors by protecting the programs that help in times of need. For more information on what you can do to help, visit www.bread. org. HS Don DiXon Williams is the associate for African American Church Relations at Bread for the World, a collective Christian voice urging lawmakers to end hunger domestically and abroad.
MEDICAL N O T E S WI Staff Report
More Blacks Have Health Insurance Because Of Aca The number of African Americans who lacked health insurance dropped dramatically in 2014’s first quarter compared to 2013’s fourth quarter thanks to the Patient Protection and Affordable Care Act, which Republicans threaten to repeal if they win control of both houses of Congress in November’s national elections. The Gallup-Healthways Well-Being Index reported on Monday that the uninsured rate for African Americans fell from 20.9 percent in 2013’s fourth quarter to 17.6 percent in 2014’s first quarter, a drop of 3.3 percentage points. When Open Enrollment began on October 1, 2013, 6.8 million African Americans lacked health insurance, according to the U.S. Department of Health and Human Services. Blacks reported the highest drop among ethnic and racial groups. The percentage of uninsured whites declined from 11.9 percent in the fourth quarter to 10.7 percent in the first quarter, a drop of 1.2 percentage points. As for Hispanics, the percentage of uninsured was 38.7 percent in 2013’s fourth quarter compared to 37.0 percent in 2014’s first quarter, down 1.7 percentage points. President Barack Obama announced on April 1 that 7.1 million Americans had signed up for health insurance plans through federal and state-run marketplaces by the March 31 deadline. Gallup-Healthways reported that the overall uninsured rate dipped to 15.6 percent in 2014’s first quarter, a decline of 1.5 percentage points compared to 17.1 percent in 2013’s fourth quarter. The overall decline in the uninsured is the lowest since late 2008. Gallup-Healthways Well-Being Index reached its results by conducting more than 43,500 interviews with U.S. adults from Jan. 2, 2014 to March 31, 2014.
Access To Dental Prevention About $64 billion is spent annually on oral health care, according to the Health Resources and Services Administration. Yet 108 million Americans have no dental insurance, the HRSA says. Choosing whether you should bite on dental insurance is a personal decision that only you’ll be able to answer — taking into consideration factors like costs, coverage, and choice. They are also more likely to have oral diseases detected in the earlier stages. In contrast, lack of access to oral health care can result in delayed diagnosis, untreated oral diseases and conditions, compromised health status, and, occasionally, even death. Unfortunately, access to oral health care eludes many Americans. Breaking Down Barriers to Oral Health for All Americans: The Role of Finance examines why people from all walks of life are increasingly facing financial barriers to accessing dental care and offers solutions to reduce these barriers. The ongoing economic crisis dramatically reduces the likelihood of significant reforms in the short term. But the economy will recover; Americans will return to work, and state and federal governments will be under less pressure to cut or underfund essential services. Economic recovery will present a terrific opportunity to bring tens of millions of dentally underserved — or unserved — Americans into a system of care that is capable of preventing most dental disease and intervening early when disease does occur. The utilization of dental services has declined significantly since 2007, eroding several years of gains. After peaking at 40.8 percent in 2007, the percentage of the non-institutionalized U.S. population who visited a general practice dentist declined to 38.6 percent in 2009. This represents a drop from 240.3 million general practice dental visits in 2007 to 226.3 million visits in 2009. The average number of annual dental visits per patient also has been declining over a longer period of time, from 2.07 in 1997 to 1.91 in 2009.
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WWW.WASHINGTONINFORMER.COM | MAY 2014 | HEALTH WELLNESS & NUTRITION SUPPLEMENT HS-7
Celebrate Mother’s Day and National Women’s Health Week by Staying Healthy From Karen Dale, Executive Director of AmeriHealth District of Columbia
You are used to taking others under your wing. Now it’s time to take some time for you.
Bright Start is free. You can reach AmeriHealth DC’s Bright Start Program at 1-877-759-6883. Being a mother is the best job there is. As caregivers and mothers, you always want to protect your child. Quitting smoking can reduce the risk of disease for you and your children. If you need help quitting, take advantage of smoking cessation counseling. It’s important for your unborn baby’s health. Whether you are a woman with no children or a grandmother of many, self-care is important. Preventive screenings, reducing stress and healthy living are key to staying well and being able to give back to the ones you love. There is no better time than now. Take some time for you. Care for yourself first. Then you can better take care of others. Sources: Centers for Disease Control and Prevention, and Office on Women’s Health at the U.S. Department of Health and Human Services. Women are caregivers at heart. They care for family, friends, and children big and small. They are nurturing and empowering. But women can be so focused on helping others that they can forget to look after themselves. It’s important to take a step back and look at your own health. Sunday, May 11th is Mother’s Day and the beginning of National Women’s Health Week. Thank a woman in your life. Then, in celebration of yourself, schedule an appointment with your doctor to check your body. Your health is important. And it’s important to others. Celebrate it by staying healthy! Being a caregiver is a hard job, but there is nothing more rewarding. That’s not to say that it can’t be stressful. It can be, but there are plenty of fun ways to reduce stress. When you’re not feeling well, it can affect the ones you care about. Learn ways to be active. Go for a walk. Try yoga with friends. You can go online and find beginner’s yoga videos. It’s fun, and it’s free. Moving more can lift your mood, improve your self-esteem and give you more energy. You can reduce blood pressure and cholesterol levels just by staying active and eating healthy. This can help fight against depression, and even prevent heart disease. Preventive screenings are especially important for women. But some procedures may be uncomfortable. Having a good relationship with your doctor can help.
Talk to your doctor about sexually transmitted diseases (STDs), preventive health screenings, breast cancer and your body’s changes. It’s important for women to see an OB/GYN. Make sure to schedule mammograms (X-ray of the breast) and clinical breast exams. These help doctors find early stages of breast cancer. Talk to your doctor about an early detection plan, especially if your family has a history of breast cancer. Again, finding a doctor you’re comfortable with is important. There are also ways to check your own body at home. Women of all ages should do a self-breast exam at least 1 time every month. This is the case for all women — women with and without children, and those who are expecting. If you are pregnant, your OB/GYN can help you and your child stay healthy. Your own health can directly affect your child’s health. AmeriHealth DC members who are pregnant can take advantage of the Bright Start® Program. Bright Start helps moms-to-be make healthy choices and control risk factors during pregnancy.
Today’s Caregiver: Juggling Real Life
Meet Zulma. She is a mother of 4, ages ranging from 2 to 8, and she works full time. She and her children are all AmeriHealth District of Columbia members. As a single mother, Zulma has little time for herself. Her 2 oldest children are involved in sports — tennis on weekdays and soccer on the weekends. But she knows it’s important to take time to care for herself. Zulma visits the doctor for annual check-ups, and also if any health issues arise during the year. She says she is very comfortable with her doctor. This makes it easy for her to talk about her health during visits. Zulma lives a healthy lifestyle for her family. “I am their support,” Zulma says about her 4 children. “I try my best to keep healthy. I eat well and go running, because when they see Mom doing those things, my kids know they can, too. I always keep my head up and stay active with my kids.” Through preventive screenings, family activities and a positive attitude, Zulma helps her family stay happy and healthy.
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Grandmother ‘Parents’ Should Take Care of Themselves, Too By Lavdena Orr, M.D.
Mother’s Day is a day for honoring all of the women in our lives who have guided us, including mothers, grandmothers and aunts. But in more than 1 million U.S. households, grandparents, including grandmothers, are also serving as the primary parent or guardian, taking on that role once again in their golden years. These women particularly deserve our admiration and gratitude. They also need to pay close attention to their own health needs. When you’re caring for children, it can be easy to forget about that. But it is still very important if you want to be there for the grandchildren you are now caring for. When you have a free moment, take a long walk, especially if it is nice outside. Something as simple as that can go a long way toward keeping you physically and mentally healthy. The weather is generally warm in May, yet not unbearably hot and humid, either. So make sure you take time to get exercise. You also need to make sure you continue to see your doctor regularly and get whatever health screenings you need. If you don’t already have a doctor you are comfortable with, you should find one as soon as possible. Older women particularly need to be on the lookout for breast cancer. According to the National Institutes of Health, the median age of women diagnosed with breast cancer is 61. More than 40 percent of new cases occur in women ages 65 and older. Make sure you have a mammogram, especially if your family has a history of breast cancer. At home, you should continue to do a breast self-exam at least once a month. The spring weather often brings allergy flare ups, which can trigger asthma attacks. While asthma is more commonly associated with children, it affects senior citizens, as well. If you think you have any allergies, speak to your doctor about whether or not you have asthma, and, if you do have it, talk about getting a controller medication and an asthma action plan. If pollen levels are high during the spring, make sure you take your medication before going outside. Also, wash bed linens regularly, and if possible use a vented dryer instead of hanging clothes on a line outside. Caring for children may make you feel young again, but you need to be careful not to push yourself too far. If you are 70 years old, your physical limits are probably going to be lower than they were when you were 30 years old. You are taking on a great responsibility by raising your grandchild. And just
like a younger parent, you want to be there for your grandchild down the road, as well. So make sure you get plenty of rest at night and know your limits during the day. On this Mother’s Day, we praise the grandmothers in the District who are filling the role of mother to a young child once again. We want you to take good care of your grandchildren, and we also want you to take good care of yourself. With a few easy steps, you can.
Dr. Lavdena Orr is medical director of AmeriHealth Caritas VIP Plans in the District of Columbia. AmeriHealth Caritas VIP Plans offers two products in the District – AmeriHealth VIP Select, a Medicare Advantage product with prescription drug coverage open to all of the District’s Medicare beneficiaries, and AmeriHealth VIP Care, a special needs plan for Washingtonians who are eligible for both Medicaid and Medicare (dual-eligibles). For more information, visit www.amerihealthvipdc.com.
WWW.WASHINGTONINFORMER.COM | MAY 2014 | HEALTH WELLNESS & NUTRITION SUPPLEMENT HS-9
HEALTH CARE SPENDING GROWTH SLOWED IN 2012, STILL CONSUMERS CONTINUE TO SPEND MORE OUT-OF-POCKET By F. Sia Turay WI Contributing Writer It can happen after a job loss, caring for a sick loved one or amid routine confusion over who owes what. A medical bill goes unpaid and ends up in collections, staining your credit for years—even if you pay or settle the debt. When a bill is beyond past due, some health-care providers sell it to debt collectors, who take a percentage of what they recover. That’s typically when the credit-reporting companies have information to act on. Medical debt is treated the same as any consumer debt when calculating credit scores. A debt of more than $100 referred for collection can lower an otherwise unblemished credit profile by more than 80 points, says Frederic Huynh, senior principal scientist for FICO in San Rafael, Calif. Lenders, employers and landlords use credit information to assess risk and price a wide variety of loans and insurance products. Collections can stay on consumers’ credit reports for up to seven years. But that soon may change. Some industry groups and consumer advocates argue that medical debt is a poor predictor of creditworthiness, and that the tarnished credit that results unnecessarily constrains economic activity. The Medical Debt Responsibility Act, introduced in Congress last year, would require credit firms to remove fully paid or settled medical debt from credit reports within 45 days. Supporters include the Mortgage Bankers Association, the National Association of Home Builders, the American Medical Association and Consumers Union. Another bill, titled Stop Errors in Credit Use and Reporting, or Secure, was introduced this month. It seeks to improve the accuracy of credit reporting and give consumers greater rights. It could help medical debtors. The 2012 Health Care Cost and Utilization Report provides a picture of health care spending for the nearly 156 million Americans younger than age 65 with employer-sponsored health insurance in 2012. This report, the third in an annual series, analyzes private insurance claims data from 2009-2012 representing over 25 percent of the nation’s privately insured population. Spending grew fastest for young adults, women, and for people living in the Northeast. As in past years, price increases rather than use of services remained the primary cause of spending growth for outpatient and inpatient facility claims. Prices rose 5.4 percent for inpatient services, and 5.6 percent for
outpatient services. For the first time since the end of the recession, increases in expenditures for professional procedures and generic prescriptions were due mainly to increased use, not increased prices. “Although average health care expenditures grew at nearly the same rate in 2012 as 2011, the causes of the 4 percent increase in spending each year were quite different,” said HCCI Executive Director David Newman. “In prior years, rising health care prices drove up spending. In 2012, we saw utilization start to change health care trends for prescription drugs and professional procedures. Preliminary evidence suggests this may be indicative of a larger shift in care as people search for lower cost care alternatives.” Outpatient Spending Continues Steady Climb For the third year, spending grew fastest for outpatient care compared to the other service categories, rising 6.5 percent to $1,315 per person in 2012. Prices also rose fastest for outpatient care, increasing 5.6 percent. The price of an outpatient visit, for example to an emergency room, averaged $2,457, and the price for other outpatient services, for example diagnostic imaging, averaged $192. Nearly half (43.4%) of all out-ofpocket dollars were spent on professional procedures, such as doctor visits and lab tests. Over a quarter (25.9%) of consumer dollars were spent on outpatient services. Unlike previous years, prices for generic prescriptions climbed, increasing 5.3 percent in 2012. Use of generic drugs has been steadily increasing, and rose by nearly 8 percent from 2011. As a result, spending on generic prescriptions jumped by 13.5 percent in 2012, rising $33 to $277 per person. In January, the Healthcare Financial Management Association, a professional group for health-care financial executives, released a set of voluntary best practices for resolving medical accounts. Among the suggestions it offers medical providers and their business partners: Make bills clear and patient-friendly, be consistent, track all consumer complaints and report back to credit-reporting companies when an account is resolved. Most physicians are open to working out a payment plan so collections can be avoided, said Paul Berkley, administrator and chief executive of Healthcare Associates in Medicine, a neurosurgery, orthopedics and pain-management practice in Staten Island, N.Y. “As long as you’re making a goodwill attempt and are up front and fair, most will go along with it.” But when a patient gets money
from an insurer’s out-of-network or worker-compensation settlement and chooses not to pay up, that’s grounds for collections, he said. When dealing with medical-bill problems: Communicate with the provider and your health insurer. Don’t ignore the bill. “What all too often happens is paralysis. People are stunned and take no action,” says Mark Rukavina, principal of Boston-based Community Health Advisors, which consults with nonprofit hospitals. Ask for an itemized bill and dispute any errors. “Do all your negotiations upfront before you pay for services, because once you pay it, then you lose your leverage,” said Pam Banks, senior policy counsel for Consumers Union, the advocacy arm of Consumer Reports., in Washington. Ask for financial-assistance guidelines and if you qualify for discounted or charity care. If it’s a hospital, ask to see its written collections policy. The Affordable Care Act is bringing more scrutiny to hospital billing practices, Rukavina says. If you move, don’t lose track of your outstanding balances. If you’re not easily found, a doctor may have to call in collectors, Mr. Berkley says. Don’t use health-care credit cards when paying for care, Ms. Banks says. “If you’re going to use a credit card to finance your procedure, use a general-purpose credit card rather than a health-care credit card, because chances are it will be cheaper in terms of fees and interest, and you get protections,” Ms. Banks says. Work out a payment plan that you can follow through on. If you’re already in collections, write a brief statement to attach to your credit file explaining why you had the debt. File a copy with each of the three credit-reporting firms. Even people with financial resources can find themselves in compromising situations when a child gets sick, for example. “You say, ‘Look, my son had cancer. We lived at or near a children’s hospital for 14 months and during that time bills were sent to collections but after that the bills were paid off,’ “Rukavina said. Check your credit reports from Experian, Equifax EFX +0.62% and TransUnion every year for free at Annualcreditreport.com. You can access all three at once or space them out, says Laura Adams, senior insurance analyst for insuranceQuotes.com. “What I recommend is you get one of the reports every four months,” Adams said. “That way you keep a better eye on your credit throughout the year for free.”HS
The Pros and Cons of
Dental Procedure Financing INDEMNITY PLANS An insurer pays claims based on the procedures performed, usually as a percentage of the charges. Advantages: Freedom to choose a dentist, although some indemnity plans may be paired with preferred provider organizations (PPO), which limit choices to lists of dentists. Disadvantages: Insurers usually do not disclose how they determine fee schedules, which often run significantly less than dentists’ fees. This shifts the cost burden to the patient, even as premiums increase. Annual maximum limits on benefits have not increased appreciably in 30 years, although costs of care and premiums have. As a result, a $1,000 maximum benefit set in 1980 had only one-quarter of that amount in purchasing power in 2010. PREFERRED PROVIDER ORGANIZATIONS A PPO combines a regular indemnity plan with a contracted network of dentists who agree to deliver specified services for discounted fees. Contracted dentists accept the maximum allowable fee as dictated by the plan, and benefit percentages paid are based on that plan allowance. Advantages: Patients can maximize plan benefits by seeing contracted dentists. Many PPOs allow patients to see dentists who are not contracted with the plan. Disadvantages: PPOs can drop dentists who provide care that exceeds what the plan considers necessary. This has the potential to discourage dentists from providing services that the plan doesn’t cover and can therefore interfere with the doctor-patient relationship. It also shifts costs to the patient, who often must pay the difference between what the plan
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covers and the actual cost of care. PPOs often reduce benefits when patients receive treatment from non-contracted dentists, effectively shifting the costs to the patients. As with indemnity plans, failure to increase annual maximum benefits increasingly shifts costs to the patient. DENTAL HMOs / CAPITATION PLANS Under these plans, contracted dentists are pre-paid a certain amount each month for each patient that has been assigned to that dentist. Dentists must then provide certain contracted services at no or reduced cost to covered patients. The model is supposed to be based on the average amount of care provided to plan participants and assumes that patients needing substantial treatment will be balanced out by those who require little treatment or do not seek any treatment. The plan usually does not reimburse dentists or patients for individual services and therefore, patients must generally receive treatment at a contracted office in order to receive benefits. Advantages: Preventive and diagnostic services generally require no co-payment. No need to submit claim forms. Disadvantages: Other covered services require copayments. This model is most prevalent among lower-income populations, whose disease rates may be greater. As such, providers can actually lose money in order to get a patient to a state of good oral health. This discourages provider participation and reduces the availability of care. This plan has not proven to be an effective means of decreasing the disease burden.
Be a V.I.P.
If you have both Medicare & Medicaid, join the plan that treats you like a V.I.P. 1-877-684-3271 (TTY: 1-866-428-7583) 7 days a week, 8 a.m. to 8 p.m. (Oct. 1-Feb. 14); Mon.- Fri., 8 a.m. to 8 p.m. (Feb. 15-Sept. 30)
AmeriHealth VIP Care is a HMO-SNP plan with a Medicare contract and a contract with the District of Columbia Medicaid program. Enrollment in AmeriHealth VIP Care depends on Medicare contract renewal. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Y0093_PRA_963_Accepted_10232013
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BOOKSRECOMMENDED BOOKS MoneyDriven Medicine (Google eBook) By Maggie Mahar Why is medical care in the United States so expensive? For decades, Americans have taken it as a matter of faith that we spend more because we have the best health care system in the world. But as costs levitate, that argument becomes more difficult to make. Today, we spend twice as much as Japan on health care—yet few would argue that our health care system is twice as good. Instead, startling new evidence suggests that one out of every three of our health care dollars is squandered on unnecessary or redundant tests; unproven, sometimes unwanted procedures; and overpriced drugs and devices that, too often, are no better than the less expensive products they have replaced. In Money-Driven Medicine, Maggie Mahar takes the reader behind the scenes of a $2 trillion industry to witness how billions of dollars are wasted in a Hobbesian marketplace that pits the industry’s players against each other. In remarkably candid interviews, doctors, hospital administrators, patients, health care economists, corporate executives, and Wall Street analysts describe a war of “all against all” that can turn physicians, hospitals, insurers, drug makers, and device makers into blood rivals.
Health Economics: Theory, Insights, and Industry Studies (Google eBook) By Rexford Santerre, Stephen Neun
In the constantly changing field of health care, HEALTH ECONOMICS, Fifth Edition, delivers coverage that is current, comprehensive, and complete--equipping your students with a solid understanding of the costs and benefits associated with various health care choices. Thoroughly revised, the new Fifth Edition addresses the many changes in both the public and private sectors as it equips students with a very practical knowledge of today’s health care systems. The authors bring a fresh, contemporary approach to the content, introducing real-world applications that make economic theory very approachable. With a lively and inviting writing style, the text presents topics in an easy-to-understand format. Its use of only the core foundations of economic theory makes it ideal for majors and non-majors alike.
The Price of Life: The Future of American Health Care (Google eBook) By Robert A. Blank, Robert H. Blank
How can America become a healthy nation, he asks, when it is beset by poverty, illiteracy, and crime? Blank calls for a more aggressive redistribution of social and public health resources to the poor and elderly; at the same time, he describes sanctions that would encourage individuals to be more careful about their own health, and limit or change destructive behavior.
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Economics of Health and Medical Care By Lanis L. Hicks The Economics of Health and Medical Care is an introduction to population-based health economics as well as the traditional, market-oriented approach to health care economics. The book examines economics through the lens of descriptive, explanatory, and evaluative economics.The Sixth Edition is an extensive revision that refines its approach to evaluative economics by focusing on the tools and methods used to inform decision making, with a particular emphasis on determining alternative approaches to addressing a problem, issue, or decision and comparing the relative benefits and costs of those approaches.The Sixth Edition also offers:* Expanded material on health insurance, to incorporate more theory regarding insurance markets and also on the substantial implications that insurance has for efficiency in the health care industry. * New coverage of health care reform and its impact on different sectors of the economy and on different individuals in the system.*
Care on Layaway TIPS TO PAYING OUT OF POCKET MEDICAL COSTS
tage credit card makes it another attractive alternative to paying medical costs.
Tips to Paying for Medical Procedures
By F. Sia Turay WI Contributing Writer To meet the rising costs of out of pocket consumer spending on medical care and prescriptions, many Americans have turned increasingly to alternative payment measures. The growth rate of health care spending among privately insured people under age 65 averaged $768 for each individual – increased by 4.8 percent in a single year. Patients pay about $45 billion worth of health care costs with plastic, according to a report from McKinsey & Company. By 2015, that number could more than triple to an estimated $150 billion. And big finance companies and medical providers have taken note. Companies like GE Money, Citibank and JPMorgan Chase have issued medical credit cards or lines of credit intended to be used specifically for elective health care expenses not covered by insurance, including certain dental procedures, Lasik surgery, some cosmetic surgery and even veterinary care. The cards
are not used for continuing medical care or emergency room visits. As many patients know, there are numerous dental procedures that may not be fully covered by insurance. While patients may be able to delay some procedures without experiencing harmful effects, patients may experience health consequences if they put off certain procedures for too long. Patients with gum disease who seek laser gum surgery early, for example, can reduce the damage done to healthy tissue and improve their likelihood of keeping their teeth. Similarly, patients who have lost teeth can receive dental implants to stabilize their bone density and tooth alignment, but if the procedure is delayed, changes in tooth placement and bone density may occur. Ava Roberson counted the CareCredit program a blessing when it was deter-
mined she needed a dental implants to remedy years of neglecting minor tooth discomfort. Despite having a full-time job and “good” medical benefits, Roberson faced a total procedure bill of more than $7,000. “It was ridiculous the way the insurance company wanted to assess my care. My root was damaged so the dentist recommended pulling the tooth altogether along with the root and doing dental implants. The insurance company said that pulling the tooth, which cost me $200 out of pocket, was covered; but the implants were ‘cosmetic’ and unnecessary,” Roberson said. Said Roberson, 30, procedures, which would take more than two years to complete, required a temporary partial,
fittings, and moldings, each averaging a few thousand dollars. “I was livid about paying that type of money out of pocket, but realized that it was only that much because I was too cheap to handle a cavity three years before that when it would have cost me roughly $300 total out of pocket. The line of credit was the only thing that made this happen,” Roberson said. A medical credit card is “one payment option among several a provider may offer and represents a very small component of health care financing for elective procedures,” said Stephen White, a spokesman for CareCredit, a medical credit card issued by GE Money told the New York Times. “Benefits to consumers include the ability to plan, budget and pay for certain elective health care procedures over time.” The CareCredit program offers patients may choose repayment terms ranging from six to 60 months. Others, like Wells Fargo, offer a Health Advan-
Always ask your caregiver what financing promotions are available to you. These promotions may allow you to spread the cost of your treatment out over time to fit your monthly budget. And remember, because the Wells Fargo Health Advantage credit card is a revolving line of credit, you can use it over and over again as you need it at dental, veterinary, vision, or audiology offices that accept the card. Medical savings account (MSA) -- a medical savings account program, generally associated with self-employed individuals, in which tax-deferred deposits can be made for medical expenses – is also an option. Withdrawals from the MSA are tax-free if used to pay for qualified medical expenses. The MSA must be coupled with a high-deductible health plan (HDHP). Withdrawals from MSA go toward paying the deductible expenses in a given year. MSA account funds can cover expenses related to most forms of health care, disability, dental care, vision care, and long-term care, whether the expenses were billed through the qualifying insurance or otherwise. MSAs are similar to health savings accounts (HSAs), which were established as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.HS
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Medical Care Costs by
Those consumers with health care coverage experienced a 7.2 percent increase in their share of health care costs between 2011 and 2012. Health care costs for American families in 2012 exceeded $20,000 for the first time.
Increasingly, Americans are having problems paying for care — 26 percent report they or a family member had problems paying medical bills in the past year. Fiftyeight percent of Americans reported foregoing or delaying medical care in the past year.
Escalating health care costs also are straining federal and state budgets, hindering the nation’s ability to pay for important initiatives needed to address other significant issues.
Wasteful spending likely accounts for between onethird and one-half of all U.S. health care spending. PricewaterhouseCoopers calculates that up to $1.2 trillion, or half of all health care spending, is the result of waste. An Institute of Medicine (IOM) report estimated unnecessary health spending totaled $750 billion in 2009 alone. The biggest area of excess is defensive medicine, including redundant, inappropriate or unnecessary tests and procedures.
The rate of increase has slowed in the past decade — from 9.5 percent in 2002 to 3.9 percent in 2010. But the rate of health care cost increases continues to be well above the general rate of inflation.
Insurance industry profits are not a significant driver of health insurance premiums. A Yahoo Finance analysis places the health insurance sector’s average profit margin in 2012 at just 4.5 percent. By comparison, major drug manufacturers have an average profit margin of 16.7 percent; medical instrument and supply companies, 13.6 percent; biotechnology, 11.9 percent; and medical appliance and equipment companies, 13.7 percent.
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Life expectancy in the U.S. reached 77.9 years in 2007, up significantly from 62.9 years in 1940. Individuals who are age 65 or older, who spend much more on health care services than younger people, will comprise nearly one-fifth of the population by 2050.
History & What is Sickle Cell Disease The existence of sickle cell disease was first reported around the beginning of the twentieth century when the medical world discovered microscopic oddly shaped red blood cells. In 1910, Dr. James Herrick in Chicago treated an individual with symptoms of pains in the stomach and joints, dizziness and general tiredness. Dr. Herrick examined the individual and discovered leg ulcers and acute chest syndrome. These symptoms were finally linked to a disease called sickle cell in 1917. Dr. Janey Watson observed infants who had normal fetal hemoglobin at birth who later showed evidence of sickling of their blood cells when they began to produce adult hemo-
globin at four to six months old. Dr. Linus Pauling in 1949 made the distinction between sickle cell disease hemoglobin (hemoglobin S) and normal hemoglobin (hemoglobin A). Research for the disease did not really begin until about 1952 when researchers discovered that the inherited disease resided in a defect of the hemoglobin. The Congress of the United States passed a National Sickle Cell Anemia Control Act in 1972. The Act formed the sickle disease branch in the Heart, Lung and Blood Institute of the National Institute of Health. It also established ten comprehensive sickle cell centers throughout the United States to develop programs for research, education, screening, counseling and
improved care of individual with sickle cell. Newborns that were found to have sickle cell were given prophylactic penicillin until they were five years old.
What Is Sickle Cell Disease Sickle cell disease is an inherited blood disorder. It is not a virus and is not contagious. An individual acquires sickle cell disease from genes passed to him or her by both parents, much in the same way as blood type, hair color and texture, eye color and other physical traits are inherited. Normal red blood cells are soft and round, flat and flexible; they can squeeze through tiny blood vessels with no problem. Hemoglobin is the protein in
blood cells that carries oxygen on as the red blood (capillaries) cell’s journey to all parts of the body. Ordinarily, the hemoglobin molecules exist as single units in the blood cell: much like beads inside a beanbag. Individuals with sickle cell disease have a small change in their hemoglobin. Because of this change, when the red blood cell loses its oxygen to parts of the body, the hemoglobin molecules begin sticking together like a beaded necklace. The stiff hemoglobin chains change the shape of the normally round blood cell to the “sickle” shape for which the disease is named. A sickle is a farm tool with the arc shape. It is used to cut weeds. When the sickle red blood cell returns to
the lungs and picks up more oxygen, the hemoglobin molecules become unstuck, and the red blood cell returns to its normal shape. With each trip through the body and back to the lungs, the cell eventually weakens and can no longer function. Red blood cells with sickle hemoglobin (also known as hemoglobin S), can sometimes clump together and obstruct tiny blood vessels that nourish muscle and organ tissues in the body. Organ tissues that have blood flow blockages may eventually become damaged. This causes many of the complications of sickle cell disease. HS
Sickle Cell Association of the National Capital Area, Inc. and
Ms. Iola Williams, Executive Director
Cordially invites you to join us for the 20th Anniversary Celebration Saturday, October eleventh
Two thousand and fourteen
One thirty until four thirty in the afternoon LaFontaine Bleue * 7963 Annapolis Road * Lanham, MD 20706 $50 per person
Reservations available at www.scancainc.org or call Oceola Briscoe at 301-996-2893
You can also make payments via mail payable to: SCANCA, INC. P.O. Box 41479 Washington, DC 20018-0879
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Feeding families. One community at a time.
Donating nutritious meals. Fighting senior hunger. Ensuring kids always have access to the healthy food they need to grow and learn. Our Foundation is working in local communities to create opportunities so people can live better. To learn more visit walmartfoundation.org
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