Let us say for example you are a young female with a middle income and you contribute the maximum tax free $3000 per year towards your HSA. You have a catastrophic health insurance with $1500 yearly premium that kicks in when your health expenses exceed $2500 per year.
Under my plan you only pay a yearly capitation fee of $1500 to your PCP that comes from your HAS. This is all you will pay and your PCP will cover you for catastrophic illness under the group insurance the PCP has purchased for all members registered in his practice. You will NOT pay for office visits to your PCP clinic, to any referrals to specialists he may advise or to any lab works and/or procedures. In other words the $1500 you pay initially will cover you for all your health needs.
The only instance you have to pay in access of the $1500 you initially paid is when your health expenses exceed is the $2500 deductible and you are admitted to a hospital. You pay the $1500 of the deductible from your HSA savings, if this is the first year you are in the program. The balance of $1000 will come from your personal account. This is only for the first year, the second year you are in the program you would have accumulated $3000 in your HSA and all the $2500 deductible for a hospital admittance will come from your HSA account.
Critics will say why should individuals be allowed to save $1500 a year if they are not admitted to a hospital? The answer is the HSA account is also needed to purchase medicines and dental expenses not included in this program I suggest.
Tuesday, September 22, 2009
Thursday, September 10, 2009
Obama's Healthcare Plan
It is a disappointment to say the least. I do not understand why a brand new plan to reform Healthcare does not incorporate in it the elements of the present Healthcare system that works well today.
Why is President Obama trying to reinvent the the wheel??
Why is President Obama trying to reinvent the the wheel??
Friday, August 21, 2009
Why Suggest this Plan?
In order for the US government to reign over the runaway health care cost they need to:
1. Eliminate waste
2. Keep health care providers well paid
3. Make health care delivery universal
4. Take advantage of the electronic age to simplify billing and record keeping
5. Encourage geographic redistribution of health care providers so no patients are left behind. And Above All
6. Make health care affordable to all health care consumers, in other words All Citizens
My plan utilizes available health care tools like HSA, managed health care software and new software for billing and record keeping. The plan revives the old fashioned way of proving health care.
How?
Make the PCP, primary care physician, in addition to being responsible for patients sicknesses, he should be responsible for the overall well being of the patient health and otherwise. This means making the PCP responsible for the wellness of the members of his practice plus keeping their cost down and their quality of health care top notch.
All this can be achieved in my reform proposal to the US President.
The problem is how can I get the president to read and understand this proposal??
Maybe blogger enthusiasts can help??
1. Eliminate waste
2. Keep health care providers well paid
3. Make health care delivery universal
4. Take advantage of the electronic age to simplify billing and record keeping
5. Encourage geographic redistribution of health care providers so no patients are left behind. And Above All
6. Make health care affordable to all health care consumers, in other words All Citizens
My plan utilizes available health care tools like HSA, managed health care software and new software for billing and record keeping. The plan revives the old fashioned way of proving health care.
How?
Make the PCP, primary care physician, in addition to being responsible for patients sicknesses, he should be responsible for the overall well being of the patient health and otherwise. This means making the PCP responsible for the wellness of the members of his practice plus keeping their cost down and their quality of health care top notch.
All this can be achieved in my reform proposal to the US President.
The problem is how can I get the president to read and understand this proposal??
Maybe blogger enthusiasts can help??
Wednesday, August 19, 2009
On Healthcare Reform
In Short
1. Standardize billing and allow only electronic billing
2. Standardize record keeping and allow only electronic record keeping. Standardization alone can save hundreds of billions of dollars.
3. Make HSA universal and mandate holders of HSA's to contribute 50% of their maximum allowed HSA to their PCP.
4. Mandate of HSA members to make two wellness visits per year to their PCP clinic for check ups, necessary tests, procedures and vaccines.
5. USA government will guarantees all unemployed, uninsured, welfare recipients 50% of their HSA to be paid directly to PCP.
6. Should a PCP refer a patient, the PCP will pay for all referrals, tests and procedures done away from the PCP office.
7. Mandate PCP's to purchase Catastrophic Health Insurance(CHI) for the registered members in their clinics.
8. Mandate employers with more than 5 employees to contribute towards employees HSAs 50% of the Maximum allowed for each employee. That is the employees will pay 50$ only of his maximum allowed HSA and the employer pays the other 50%.
Overall Effect
Returning the power of decision and cost of healthcare to the Primary Care Physician(PCP) and to the patient, like the olden days when health care worked for all. Let the PCP deal with insurance companies for the catastrophic illnesses exceeding $2500.
1. Standardize billing and allow only electronic billing
2. Standardize record keeping and allow only electronic record keeping. Standardization alone can save hundreds of billions of dollars.
3. Make HSA universal and mandate holders of HSA's to contribute 50% of their maximum allowed HSA to their PCP.
4. Mandate of HSA members to make two wellness visits per year to their PCP clinic for check ups, necessary tests, procedures and vaccines.
5. USA government will guarantees all unemployed, uninsured, welfare recipients 50% of their HSA to be paid directly to PCP.
6. Should a PCP refer a patient, the PCP will pay for all referrals, tests and procedures done away from the PCP office.
7. Mandate PCP's to purchase Catastrophic Health Insurance(CHI) for the registered members in their clinics.
8. Mandate employers with more than 5 employees to contribute towards employees HSAs 50% of the Maximum allowed for each employee. That is the employees will pay 50$ only of his maximum allowed HSA and the employer pays the other 50%.
Overall Effect
Returning the power of decision and cost of healthcare to the Primary Care Physician(PCP) and to the patient, like the olden days when health care worked for all. Let the PCP deal with insurance companies for the catastrophic illnesses exceeding $2500.
My Plan to President Obama
I was watching Larry King today and the show was about the healthcare reform being put together by President Obama. My response to the President is why reinvent the wheel.
I wrote a letter to the President offering a clear cut plan on how to deal with the disastrous US healthcare system today.
Dear Mr. President
I am a 67 year old retired healthcare executive with 35 years experience in managed healthcare.
The following is a short road map on how to reform healthcare in America. I think you will find it workable and agreeable to the American people.
1. The US government already has the HSA program in place.
2. Electronic health record keeping and the transfer of records electronically is already in place, although some standardization is required.
3. Software for paperless run clinics, hospitals and health institutions is already in place but requires standardization.
4. Healthcare manpower in the US is adequate, but requires government incentives to to redistribute the manpower to make accessible to all US citizens. Require the government to give incentives to Healthcare providers to increase efficiency and eliminate waste.
5.Equitable distribution of Healthcare requires the government guidance and incentives to redirect Healthcare providers to rural America and to provide the rural areas with improved access to major health centers.
The above are the essential ingredients for an efficient Healthcare Delivery System (HDS)
Healthcare Delivery System (HDS)for the US
When my father started his general practice in 1938, patients who did not have the cash paid in farm produce or farm animals. Bartering was an acceptable practice. Some doctors in the ‘olden days’ required their communities to pay them a lump sum per month for taking care of the constituents of the community (a capitation fee).
In our day and age if we keep the doctors well paid and the institutions in which they practice profitable, efficiency in Healthcare Delivery can be achieved.
REMEDIES, THE PLAN:
Require from doctors and hospitals:
1. Mandate the usage of only electronic claims, Paper Claims constitute close quarter of a trillion dollars in waste. Require medical schools to train doctors on standardization of paperless record keeping and the use of electronic bill paying systems.
2. Hospitals and Doctors should be required to use a universal standardized record keeping and billing systems.
If medical schools can teach standardized basic science courses, they should be able to teach standardized medical record keeping and bill paying systems
3. Require PCPs to purchase catastrophic health insurance for their clinic members/participants.
Required From Patients
1. A. Each HSA holder, whether individual or part of a couple or family, will be required to pay 50% of their maximum HSA contribution to the PCP’s office. The 50% contribution will entitle the patient to two free annual physical checkups, the AMA recommended vaccinations and all the AMA recommended lab work, X-rays, ultrasounds for a wellness checkup.
B. The PCP will be required to do all the referrals to specialists, admittances to hospitals, ordering procedures and providing all other reasonable healthcare needs when he deems necessary for his patient. The PCP will oversee the quality of care given to referred patients.
C. In case of major health problems requiring hospitalization the PCP’s office will pay up to $2,500 of incurred expenses before the government or private Catastrophic Illness Insurance kicks in.
Required From Insurance Companies and Third Party Payers (TPA’s)
1. Insurance companies will handle all Catastrophic Illness Insurance paid by the the PCP offices.
2. Insurance companies will continue selling indemnity insurance for interested buyers.
3. Insurance companies will be required to use standardized billing software for settlement of claims and will be forbidden to use paper claims. TPA’s likewise will be required to settle claims electronically.
Required from Employers
1. Employers with more than five employees or more will be required to contribute 50% of the maximum HSA of each employee.
Required from US government
1. The US government will pay the 50% of the maximum HSA for all non-insured and/or all non-employed eligible patients. Patients who get government assistance will be required to file for health benefits in the same way as unemployment benefits, which will be paid back as soon as they are employed or acquire assets. Illegal immigrants will be entitled to the same benefits as US citizens or permanent residents as long as they pay taxes and employment benefits.
Conclusion:
It is best to take the elements of healthcare that work and put them together with additional innovations to maximize efficiency rather than reinventing the wheel.
Sincrely
Allen Rafeh MD/PhD
I wrote a letter to the President offering a clear cut plan on how to deal with the disastrous US healthcare system today.
Dear Mr. President
I am a 67 year old retired healthcare executive with 35 years experience in managed healthcare.
The following is a short road map on how to reform healthcare in America. I think you will find it workable and agreeable to the American people.
1. The US government already has the HSA program in place.
2. Electronic health record keeping and the transfer of records electronically is already in place, although some standardization is required.
3. Software for paperless run clinics, hospitals and health institutions is already in place but requires standardization.
4. Healthcare manpower in the US is adequate, but requires government incentives to to redistribute the manpower to make accessible to all US citizens. Require the government to give incentives to Healthcare providers to increase efficiency and eliminate waste.
5.Equitable distribution of Healthcare requires the government guidance and incentives to redirect Healthcare providers to rural America and to provide the rural areas with improved access to major health centers.
The above are the essential ingredients for an efficient Healthcare Delivery System (HDS)
Healthcare Delivery System (HDS)for the US
When my father started his general practice in 1938, patients who did not have the cash paid in farm produce or farm animals. Bartering was an acceptable practice. Some doctors in the ‘olden days’ required their communities to pay them a lump sum per month for taking care of the constituents of the community (a capitation fee).
In our day and age if we keep the doctors well paid and the institutions in which they practice profitable, efficiency in Healthcare Delivery can be achieved.
REMEDIES, THE PLAN:
Require from doctors and hospitals:
1. Mandate the usage of only electronic claims, Paper Claims constitute close quarter of a trillion dollars in waste. Require medical schools to train doctors on standardization of paperless record keeping and the use of electronic bill paying systems.
2. Hospitals and Doctors should be required to use a universal standardized record keeping and billing systems.
If medical schools can teach standardized basic science courses, they should be able to teach standardized medical record keeping and bill paying systems
3. Require PCPs to purchase catastrophic health insurance for their clinic members/participants.
Required From Patients
1. A. Each HSA holder, whether individual or part of a couple or family, will be required to pay 50% of their maximum HSA contribution to the PCP’s office. The 50% contribution will entitle the patient to two free annual physical checkups, the AMA recommended vaccinations and all the AMA recommended lab work, X-rays, ultrasounds for a wellness checkup.
B. The PCP will be required to do all the referrals to specialists, admittances to hospitals, ordering procedures and providing all other reasonable healthcare needs when he deems necessary for his patient. The PCP will oversee the quality of care given to referred patients.
C. In case of major health problems requiring hospitalization the PCP’s office will pay up to $2,500 of incurred expenses before the government or private Catastrophic Illness Insurance kicks in.
Required From Insurance Companies and Third Party Payers (TPA’s)
1. Insurance companies will handle all Catastrophic Illness Insurance paid by the the PCP offices.
2. Insurance companies will continue selling indemnity insurance for interested buyers.
3. Insurance companies will be required to use standardized billing software for settlement of claims and will be forbidden to use paper claims. TPA’s likewise will be required to settle claims electronically.
Required from Employers
1. Employers with more than five employees or more will be required to contribute 50% of the maximum HSA of each employee.
Required from US government
1. The US government will pay the 50% of the maximum HSA for all non-insured and/or all non-employed eligible patients. Patients who get government assistance will be required to file for health benefits in the same way as unemployment benefits, which will be paid back as soon as they are employed or acquire assets. Illegal immigrants will be entitled to the same benefits as US citizens or permanent residents as long as they pay taxes and employment benefits.
Conclusion:
It is best to take the elements of healthcare that work and put them together with additional innovations to maximize efficiency rather than reinventing the wheel.
Sincrely
Allen Rafeh MD/PhD
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