Nursing News Online | HealthCMI

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The US House of Representatives has passed the ‘Health Insurance Industry Fair Competition Act’ by a vote of 406 to 19. This legislation repeals antitrust protections enjoyed by the health insurance industry. This is an overwhelming majority vote supporting the repeal of longstanding antitrust exemptions for insurance companies and the bill has over 70 cosponsors. Representing the 5th district of Virginia, Congressman Tom Periello sponsored this bill to end monopoly protections for health insurance companies.

The McCarran-Ferguson Act of 1945 gave insurance companies exemption from antitrust laws allowing them to legally fix prices, collude with one another, and to divide market turf amongst themselves. Spokesmen from several branches of the insurance industry oppose this legislation with many asserting that it will not help to control rising healthcare costs. The Consumer Federation of America (CFA) estimates that this legislation will save Americans approximately $5 billion per year. President Obama favors repealing antitrust protections for insurance companies.

In an interesting twist, the Senate has not stated whether or not it will consider this legislation despite its massive bipartisan support in the House. The ‘Health Insurance Industry Fair Competition Act’ (HR 4626) is only two pages of text in contrast to the enormous healthcare bill recently stalled in the US Senate. It seems the US House of Representatives has passed a simple, clean bill that anyone can read in a matter of minutes. A total of 253 Democrats voted in favor of the legislation joined by 153 Republicans. The only nays came from a small group of 19 Republicans. The act sailed through the House in merely two days providing easy passage. Surprisingly, the passage of this historic act has received muted attention by the press.

Opinion polls consistently point to frustration amongst Americans over the lumbering and inefficient process of passing legislation marred by corruption from lobbyists. Equally unpopular are amendments loaded with pork that weigh down legislation and drive up costs. This act moved swiftly and lacks any costly amendments. As a test to the Federal process, should this bill move through the Senate it would represent a breakthrough of the gridlock that hampers the US government and fosters rewards for special interest groups over US citizens.

The official US House of Representatives long title of this act is “To restore the application of the Federal antitrust laws to the business of health insurance to protect competition and consumers.” The exact text of the bill reads:

(a) Amendment to McCarran-Ferguson Act- Section 3 of the Act of March 9, 1945 (15 U.S.C. 1013), commonly known as the McCarran-Ferguson Act, is amended by adding at the end the following:

(c) Nothing contained in this Act shall modify, impair, or supersede the operation of any of the antitrust laws with respect to the business of health insurance. For purposes of the preceding sentence, the term `antitrust laws' has the meaning given it in subsection (a) of the first section of the Clayton Act, except that such term includes section 5 of the Federal Trade Commission Act to the extent that such section 5 applies to unfair methods of competition.'.

(b) Related Provision- For purposes of section 5 of the Federal Trade Commission Act (15 U.S.C. 45) to the extent such section applies to unfair methods of competition, section 3(c) of the McCarran-Ferguson Act shall apply with respect to the business of health insurance without regard to whether such business is carried on for profit, notwithstanding the definition of `Corporation' contained in section 4 of the Federal Trade Commission Act.

 

Learn more about healthcare and insurance issues affecting nurses, doctors, and patients at HealthCMI Online, http://www.healthcmi.com .

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2-17-10: The iPad is a generational shift from the laptop computer to the handheld computer and will directly impact online continuing education courses. Mostly, the use of a laptop requires the user to be in an upright seated position whereas the iPad sports enhanced mobility similar to that of smart phones. The iPad allows users to shift from semi-mobile laptop computing to highly mobile handheld device computing thus opening up new possibilities to easily study continuing education courses on subways, at bus stops, at a park, in vehicle passenger seats, while waiting in a line, etc….

The iPad will increase mobile online continuing education usage far greater than other eReaders such as the Amazon Kindle and the Sony Reader Touch.  The Kindle text readout is a form of eInk that is visible in daylight without backlighting and has extremely long battery life. The iPad features only up to 10 hours of battery time and does not have the eInk advantages in daylight. However, sharper text resolution and improved ergonomics are major reasons for the inevitable success of the iPad in the eReader market.

Online continuing education programs are provided in several ways including the eBook  format which is often purchased online then downloaded in the form of Adobe PDF files. The iPad supports high definition, full color text with images. This enhances courses delivered in the PDF format over the black and white readout of the Kindle. The iPad’s combination of color text, photos, and video allows for a greater diversity of course content and layout thereby making a more user friendly experience for learners.

Online continuing education courses are also delivered through streaming media and downloadable video files, often in Apple’s Quicktime format. The Kindle and several other eReaders will falter in comparison to the iPad’s 3G and Wifi ability to deliver streaming video content. More than this, the iPad has an intuitive touch screen display allowing users to flip through eBook content in much the same way as turning the pages in a book. The iPad brings the tactile experience of opening and flipping through a book to the end user. A major factor in the adoption of the iPad into the continuing education marketplace is familiarity. The touch screen hand gestures used by the Macintosh computer mousepad, iPhone, and iPod touch devices are employed in iPad navigation. Millions of end users are already familiar with the ergonomics of Apple touch-screen hand gestures thereby making the cross-grade from the laptop to the iPad an intuitive process.

More speculative is the likability factor of the iPad’s handheld usability. Apple’s intention is to have the iPad become as comfortable as holding a pad of paper, leafing through a newspaper, or reading a book. It is likely that the comfort level for end users will reach this goal based on the reasonable size, weight, and thinness of the iPad. More than this, the iPad is compatible with many existing online content delivery systems such that specialized programming and development is unnecessary. This makes the iPad an out-of-the-box educational solution for both end users and content providers. Moreover, it is probable that the popularity of the iPad will encourage publishers to provide more textbook titles in eBook format.

The iPad requires no additional programming for educational providers using most learning management systems (LMSs). An LMS is the server side software used to host online schools and universities. LMSs allow students to register for courses, download course materials, take quizzes, receive certificates of completion, view grades, interact with other students and faculty, and view streaming video and media content. The LMSs of providers such as the Healthcare Medicine Institute (HealthCMI) and Lynda.com are compatible with the Apple Safari internet browser. Currently, the Safari browser functions on the iPad, iPhone, iPod Touch, Windows computers, and Mac computers. Learners at HealthCMI and Lynda.com will be right at home with the iPad and the downloadable materials and streaming media content will behave exactly the same way on the iPad as on desktop and laptop computers.

The iPad can act as a virtual stack of books or as a streaming media portal for learners. Online educational environments will move beyond the laptop generation and find its way into the handheld environment. In other words, mobile usage can move from sitting to standing and moving. This puts the iPad in the same range of flexibility offered by books and newspapers and also makes access to continuing education online as ubiquitous as a Wifi or 3G connection to the internet.

Learn more about continuing education online at HealthCMI by clicking Nursing Continuing Education.

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1-01-2010, Soquel, CA: Poverty and environmental pollutants have a lot in common. Both contribute to adverse living conditions and ill health. The cure may be a prescription for green manufacturing jobs. There are no factories producing complete wind and solar systems in the USA. Major components for solar panels and wind turbines are assembled domestically but are manufactured oversees. In the wake of a job shortage and miles of rusting factories it seems logical for a national initiative to revive the domestic production of goods.

This requires a massive retooling project combined with powerful incentives for industry to come home to Uncle Sam. Our dear uncle seems to be on an oversees cruise at the moment. Ipods are produced in Malaysia, iPhones in China, many LCD TVs from Korea, and the list continues. The former technologies were pioneered in the USA and are manufactured overseas for domestic distribution. We’ve even lost our last Levi’s jeans factory. Apple computer and Levi’s jeans are about as apple pie as it gets! Yet, these companies cannot compete if they utilize domestic production. So, with a burgeoning industry of solar and wind energy production - why not push to have production at home?

Tax breaks and cheap loans are step number one. Current federal incentives often require mountains of bureaucratic paperwork for small and medium sized businesses to obtain loans.  This is an important area that needs to be streamlined.

Tax breaks are not enough. The government needs to work with industry to immediately build enterprise zones filled with factories to produce solar panels and wind turbine components. This, coupled with a program to put a solar panel on every sunny roof and wind farms in every state, creates the demand for these products. Current subsidies bring the cost of installing solar in the home down 50% in many areas. Nonetheless, most people will have a hard time coming up with the net cost of approximately $15,000 for a solar system. The federal government and state governments need to bring this price into the $5,000 range to make solar a realistic investment for home owners.

This is an investment and not an entitlement. Rebuilding the domestic manufacturing base creates wealth. If we plant a seed and grow corn we have created wealth. The government can incentivize industry to plant those seeds in domestic energy production to create wealth in our society. US steel and carbon fiber combined with American ingenuity can be tapped to create a wealth of green products needed to revive this economy, fight poverty, and provide for a healthier and self-sufficient society. The return on investment includes a reduction in healthcare costs associated with poverty and environmental pollutants. Another advantage to encouraging local solar energy production is solar’s independence from our aging national grid of power lines.

The power grid issue prevents wind farms from reaching their full potential. Many wind farms are hampered in their ability to transmit power because they will overload the power grid if they activate 100% of their wind turbines. Additionally, the fragility of the grid weakens our national defense by putting local, state, and federal agencies at risk and destabilizes the ability of our communities to function after disasters such as earthquakes, hurricanes, floods, fires, and tornadoes. The power grid needs shovels in the ground now. It seems that the government has an opportunity for job creation that will yield quick dividends.

Domestic manufacturing seems impossible in the face of cheap oversees wages in many factories without restraint from human rights protections and environmental & safety standards. Conversely, some countries provide healthcare coverage for workers unlike US industry which is bootstrapped to health insurance costs. It is reasonable to only allow imports from factories meeting the same standards as the demands placed on their US competitors.

The concept of federally mandating insurance coverage to employers is a well-intentioned yet unfunded mandate that has the potential to hurt the US production of goods. The disconnect with this approach is that jobs are tied to healthcare coverage. Healthcare costs often contribute to an industry moving oversees thereby reducing domestic jobs. Why do we want to burden the manufacturing base with healthcare costs if this may push jobs offshore? No jobs? This leads to poverty, malnutrition, and poor health.

Extending Medicare coverage to all US citizens is one fix. Industry will be freed from healthcare costs. If big government seems too scary with the fears of outrageous tax hikes associated with national healthcare coverage then perhaps the addition of competition may help bring down the costs associated with healthcare. This requires the federal government to repeal anti-trust protections from insurance companies and to provide a public option with competitive pricing. Looking to Congress for a streamlined and efficient healthcare package? On this one, the lobbyists have scored the first touchdown. Right, left, center, whatever the political solution may be… until we, as a nation, pull together and provide some kind of comprehensive healthcare coverage to all US citizens without forcing the burden onto the manufacturing base - we will not see the type of job creation needed to move this economy forward.

Green manufacturing is a great way to test our economic fortitude. The US must combine the knowledge base of US industry and universities with efficient financial structures to support the rebuilding of domestic factories for this to work. Are we to replace foreign oil with foreign wind turbines and solar panels? A sound domestic energy policy is one wherein the US can provide for its own power. Job creation, a cleaner environment, and a healthier populace are the rewards for this effort.

To learn more about healthcare and continuing education issues visit the Healthcare Medicine Institute (HealthCMI) at http://www.healthcmi.com .
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Palatal Myoclonus

Nursing Continuing Education Online

 

Palatal myoclonus is a spasmodic action of the palatal muscles which are located on the roof of the mouth. This often results in a clicking noise that can be heard both by the patient and people nearby.  Lesions of the central tegmental tract are often involved.  Once important and effective treatment is acupuncture to alleviate this disorder.

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Wet age related macular degeneration (AMD) is treatable with Lucentis. Wet AMD causes vision loss due to abnormal blood vessel growth in the eye. The blood vessels bleed, leak, and cause scarring therefore severely damaging vision. The FDA has approved Lucentis (ranibizumab) for the treatment of wet AMD but many physicians favor Avastin (bevacizumab) because it is significantly less expensive and yet chemically similar. Both products are made by Genentech, the biotech pharmaceutical division of Roche.

The use of Avastin for AMD is not approved by the FDA. This off-label (non-approved) use of Avastin generates significant controversy. According to Genentech, Lucentis is a superior treatment for AMD. Many doctors favor Avastin because it costs approximately $150 per treatment compared with that of Lucentis at $2,000 per treatment. The Lucentis-Avastin controversy will end in February 2011 with the completion of the National Eye Institutes’s (NEI) clinical trials that compare the two drugs for the treatment of wet AMD. The NEI study evaluates the safety and efficacy of both Lucentis and Avastin for the treatment of AMD.

The final data collection of the study is occurring now even though the final conclusions will be officially released next year. This is a massive study chaired and directed by doctors from the Cleveland Clinic, University of Pennsylvania, and Duke University. Over 55 medical groups from California to Florida participate in this effort. This includes centers such as the Mayo Clinic in Rochester, Minnesota; the Massachusetts Eye & Ear Infirmary in Boston, the Duke University Eye Center in North Carolina, the University of Wisconsin, the West Coast Retina Medical Group in San Francisco, California; the University of California-Davis Medical Center in Sacramento, and the Retina-Vitreous Associates Medical Group in Beverly Hills, California to name a few.

The study will determine whether or not Lucentis is safer and more effective for the treatment of wet AMD over Avastin. The financial stakes are high for the biotech giant Genentech whose profits from Lucentis over Avastin for the treatment of AMD are significant. More importantly, the study will determine what is the best course of treatment for patients looking to save their eyesight. The NEI study results have not been posted yet the information is vital for patients suffering from AMD. Looking forward, will doctors and participants from the clinical trials leak anecdotal information over the course of the next year?

A separate study conducted by researchers from the Boston University School of Medicine and the VA Boston Healthcare System which appears in the American Journal of Ophthalmology concludes that there is no difference between Lucentis and Avastin for the treatment of AMD. This is hardly the final word. This study was only conducted on 20 subjects for a period of six months. At best, this study is inconclusive and on the downside this study may be inadvertently steering doctors away from using the best possible treatment for AMD. As a result of this preliminary investigation, many doctors have already concluded that there is no difference between Avastin and Lucentis. We are a year out from knowing the answer to the Lucentis-Avastin controversy. Look to February 2011 to learn the answer to this very important question that will ultimately help determine the best course of treatment for patients suffering from AMD. Once the NEI study is published in 2011, the pharmaceutical controversy is over and patients will benefit from this knowledge.

Learn more about nursing and medical continuing education news at HealthCMI by clicking Nursing Continuing Education Online.

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1-25-2010: Apple’s iPhone is shining in areas not anticipated by continuing education providers. Online nursing continuing education and acupuncture continuing education courses at the Healthcare Medicine Institute (HealthCMI) were designed to function on Internet Explorer versions 6, 7, and 8 as well as Safari and Firefox for both Mac OSX and Windows PC users. HealthCMI developers were surprised to find out that some learners were accessing online courses with the iPhone. “The iPhone implementation required no planning or effort- it just works,” notes Allan Blake, HR Director for HealthCMI. He further notes, “We spent months getting our software to properly visualize IE (Internet Explorer) and yet the iPhone required no specialized programming or additional effort.”

HealthCMI developers did not anticipate cellular mobile computing to interest continuing education learners due to the small size of the iPhone display. However, users can easily magnify and therefore read the PDF course materials on the iPhone and are able to wirelessly transfer the course materials to laptop and desktop computers with simple iPhone apps. Others simply login to www.healthcmi.com at a later date from their home computers and re-download the materials.

The Apple tablet, the iPad, i
is now on the minds of HealthCMI developers. HealthCMI developers now expect Apple’s tablet to become a preferred mobile computing platform. Allan Blake  notes that the comfortable screen size coupled with high resolution and respectable dot pitch makes Apple’s new tablet a formidable mobile reading device. “It’s about the sharpness of the text,” notes Blake on the topic of reader preference and eye strain. “Learners will choose the Apple tablet based on ergonomics and reading comfort. They will experience less eye fatigue than other, less sharp, mobile devices and will therefore naturally gravitate to this technology.” Mr. Blake comments that he is expecting the tablet to be compatible with HealthCMI acupuncture and nursing continuing education online courses because it will be built on the Mac OSX operating system, the same system that both the Safari browser and the iPhone are built on.

About the Author: Adam White, L.Ac., Dipl.Ac. is an Acupuncture Continuing Education provider with the Healthcare Medicine Institute (HealthCMI). To learn more about medical news and medical continuing education visit http://www.healthcmi.com .

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December 23, 2009, Capitola, CA: The healthcare reform bill has passed in the US Senate. However both the US House of Representatives and the US Senate bills have yet to address important details affecting patient care. Oversight concerning the determination of medical necessity as well as provider network inclusion issues have greatly affected medical reimbursement and patient access to care.  Many insurance companies reimburse medical expenses based upon a determination of medical necessity by the carrier’s claims department. In the absence of external oversight or regulation, the insurance carrier is free to deny care solely based upon their on private internal review.

Another key issue not addressed is how provider networks create financial barriers to care. Many insurance carriers reimburse medical expenses at lower rates or refuse reimbursements for out-of-network providers. Medical practitioners may also be excluded from insurance company networks for a variety of reasons. Practitioners may be required to limit medical procedures for patients and the number of office visits as a precondition for inclusion in the insurance network. Medical practitioners may also be required to accept lower rates of reimbursement for services provided to patients as another precondition to network inclusion. Some medical networks charge medical practitioners a fee for inclusion in networks.

The patient’s right to choose their own medical practitioner is not federally guaranteed by law. Additionally, there is no guarantee an insurance company will pay for medical services and patients often have no way to determine what will be paid until after a claim is submitted and a response is generated the insurance company’s claims department. The federal government seeks to mandate health insurance coverage for all US citizens yet has not stipulated that insurance companies must reimburse patients for medical expenses nor is there language to address oversight of the determination of medical necessity.

The determination of reimbursements is often based on what is termed as ‘usual and customary.’ Insurance companies have sole discretion over this aspect of reimbursement for general health insurance policies and may choose to exclude many procedures, office visits, and medical tests whether or not teams of doctors agree that such medical services are vital to the patient’s survival, recovery, or comfort.

The US House of Representatives and the US Senate have not addressed these details which represent core issues affecting healthcare outcomes for patients. Until these unresolved issues are rectified, it is unclear whether or not US citizens with health insurance coverage will have adequate access to medical care.


About the Author: Adam White, L.Ac., Dipl.Ac. is an Acupuncture & Nursing Continuing Education provider with the Healthcare Medicine Institute (HealthCMI).  To learn more about medical news and medical continuing education visit http://www.healthcmi.com .

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