Wednesday, October 23, 2019

The World Turned Upside Down

Children are society’s future. We have designed laws to protect children from harm, from fire proof pajamas to when a child is considered mature enough to make life altering decisions. As a Social Worker, my job was to protect children from unsafe home conditions. As a Medical Manger, my job is to protect both doctors and their patients from “never events”. A “never event” in Medicine is an event that, with proper safeguards, will or should never happen.

In Texas a Custodial Court Case over the gender transition of a 7 year old male child is, in my Professional Opinion, a travesty in regards to what is best for the child. The full account of the trial can be read here: “BREAKING: Dallas Jury Grants Mother Sole Custody of Purported Transgender Child”.

The case revolved around divorced parents regarding the medical care of their 7 year old son. The mother, a pediatrician, is maintaining that the child is a female and is desirous of allowing him to transition, up to and including hormones. The father is maintaining that the child is happy being male. The case rested on two questions: "First, did they think that the current joint managing conservatorship should change to a sole managing conservatorship? Second — if they said “yes” to the first question — did they think Younger should be the sole managing conservator?

The jury decided “yes” on the first question and “no” to the second, which results in the mother being the sole manager conservator.

Child rearing is the most difficult task a person can do, even in the best circumstances. Child rearing with an ex-spouse can add another layer of stress, especially if those opinions differ. In this case however, the issue is not whether or not the parents agree, but what is best for the child. An amicus attorney (one appointed by the court to be a neutral observer, recommended:

Contending that both parents loved James, as acknowledged by everyone who interviewed both Younger (father) and Georgulas (mother), he asked the jury to choose for the parents to remain joint managing conservators, and leave the rights and duties of that custody agreement for the judge to rule on in a way that would address the concerns of the father.

The attorney recommended a path that is considered the best plan for a child, whose parents are deemed appropriate to care for that child. In this decision, by allowing the mother full decision making powers, this child’s life could be permanently altered before he is mature enough to understand the consequences.

There are many things we do not let a 7 year old child do, that adults do, because these activities are either dangerous or beyond the comprehension of a child: driving a car, being alone for any length of time, voting, and - obviously -  making medical decisions. It is a parent’s responsibility to keep a child safe and healthy, live in an environment where the child is allowed to grow, and nurture their personalities so that they become a functioning member of society.

As a Social Worker, I can attest that these tasks are not always performed by all parents, but that is why Social Work was created. Helen Northern noted that in the early 20th century in America, there were laws protecting Animals from abuse, but not children. From hers, and many other individuals, laws protecting children were enacted. A major premise of these laws is to protect children from danger, be it from society or from their family situation.

Based on these laws, it is not appropriate to make such a drastic, life altering change to a child when that child is unable to have a decision. Especially, when one parent does not agree.

As a Medical Professional, there are two troubling aspects to this case, both of which revolve around the fact that the parent who wants the transition to be done is a Pediatrician.

In Medicine, it is considered unethical for a doctor to treat a family member. For example, a doctor cannot write a prescription for a family member or be the primary provider of a family member. This is especially important in regards to spouses, parents, and children. The reason is obvious: we as humans are not always objective when it comes to family members, and in the medical profession, it is necessary to be able to objectively make medical decisions. As a Social Worker it appears to be a clear conflict of interest, since the mother is a Pediatrician, between her medical decision making and parental love to give a child what they want. As a Medical Practice Manager, I view this as a doctor overly involved in a medical process with a family member. For the doctor who would perform the treatment, this could become a possible malpractice case by the child, or the objecting parent, over a “never event” being done.

Political correctness should never be a reason to overturn basic parental rights and responsibilities and standard Medical Ethical Guidance.

The Purple Squirrel in Healthcare Employment

In Human Resources, a “Purple Squirrel” is the perfect employee. The “Purple Squirrel” will have every box checked on the employer’s list, the degrees and certifications will match exactly, as well as previous job descriptions. As you, dear reader, may surmise, it is very hard to find the perfect employee.

In Healthcare, the Purple Squirrels are women in management positions. A new study has confirmed what we in healthcare already know, “While many women work in the healthcare services industry in entry-level roles, there is a scarcity of women in top health management positions, according to The Wall Street Journal.

"New data cited by the newspaper from LeanIn.Org and McKinsey & Co shows women in entry-level roles, such as nurses, home health aides and recently graduated physicians, represent 75 percent of employees in a sample of more than 20 companies. In those same companies, which includes hospital systems and other direct-care providers, women in C-suite roles represent 33 percent of employees, while women in senior vice president positions represent 41 percent. Women in vice president roles represent 47 percent."

Women over-represent men in all aspects of healthcare, with the exception being Medical Doctors. Women are the managers in the Medical Practices, nurses, medical assistants, clerks, mid-level providers, billers/coders, to name a few of the positions we occupy.

In a typical visit to a medical office, a patient will have a minimum of 3 interactions with a women and only one (the doctor) with a man. If that patient has a concern or a question, then the manager that they deal with will in 9 out of 10 occurrences be a women. So with so many women in all positions in Healthcare, why then such a lack of women in the Executive Level.

Janette Dill, PhD, a professor of health policy and management at the University of Minnesota, told The Wall Street Journal that in healthcare, one of those barriers may be not having the education required for certain management roles.

In healthcare, other than clinical, there is no formal training required or expected in order to do a particular job. Thus, women usually begin working at a Medical Office as a front desk check in clerk and if all goes well, will work their way up the ranks until many years later they are now in management. However, there was no expectation or opportunity for the women to improve their expertise through classes or training. Thus, when there is an opening in an Executive Level job, the women will have the work experience but lack the professional training to qualify. Men, on the other hand, will have the professional training without the work experience. In rare cases you will find a women in an Executive Level that worked her way up, but that is usually only found with a women who has worked in that organization her entire career. She is trapped in that organization, as she has no professional training to qualify for a similar position in another company.
Overall, LeanIn.Org and McKinsey& Co conclude that "women continue to be underrepresented at every level. To change the numbers, companies need to focus where the real problem is. We often talk about the 'glass ceiling' that prevents women from reaching senior leadership positions."
"In reality, the biggest obstacle that women face is much earlier in the pipeline, at the first step up to manager. Fixing this 'broken rung' is the key to achieving parity," researchers added.
I recognized that in order to move up the ladder in this career field, I would need to obtain the needed degrees and certifications in addition to my work experience. Even with my credentials, I have lost out on job opportunities to men (and to women who have worked in the organization their entire career, but do not have the educational credentials). While I always knew this was the case, it is nice to have it validated.

Tuesday, October 22, 2019

Imagine that: MVNHS© can't save a baby

On the other hand, at least this time the Much Vaunted National Health Service© isn't forbidding his parents from trying:

"The parents of a 10-month-old infant in the United Kingdom born with an extremely rare heart tumor plan to bring their son to the U.S. for surgery"

That's because Britain's government-run heatlh "care" scheme isn't capable of performing the surgery on the poor toddler. He'd been diagnosed with "a cardiac fibroma ... then fitted with a pacemaker" as a stopgap as his folks try to raise the necessary funds for a trip Across the Pond to "Boston Children’s Hospital for surgery, which is expected to cost $147,000."

Those so inclined can click here to help out.


Importing meds: A primer

So, a lot of folks buy their prescription drugs from Canada:

"We have found several reliable sources where you can get prescription drugs for a few dollars and in some cases, 100% free."

A lot of these folks also have either considered running the costs of these meds through their qualified plans, or have actually done so.

No harm, no foul, right?

Well, it's been kind of a gray area for a while, but thanks to our gurus of all things HSA/FSA/HRA at FlexBank, we seem to have some definitive guidance (of a sort):

"The Food and Drug Administration recently announced an action plan for allowing prescription drugs to be imported from Canada and other countries. However, employer plan sponsors and plan administrators must heed caution at this time as this is just the announcement that proposed rules are coming."

For now, one must weigh the tax savings of paying for these meds from one's HSA/FSA/HRA versus the potential tax consequences if the Federales decide to crack down before this rule is actually in effect.


Monday, October 21, 2019

Strides Against Breast Cancer 2019: Thank You!

Thank you to everyone who generated so generously:

Truly blessed.

Friday, October 18, 2019

Medicare Bait and Switch - Don't Get Conned - GA Medicare

Costs in Private Medical Practices

In any business, the largest two expenses are rent/mortgage and Payroll, with Payroll usually taking the number one spot. Thus, in private practices, both large and small, salaries are usually on the bottom of the pay range, meaning in a good economy it is difficult to retain good employees.

It seems that Hospitals are recognizing this fact. Cincinnati Children’s Hospital will increase its minimum wage in 2020 from $11.00 an hour to $15.00 an hour. According to CEO Michael Fisher,[t]o be the leader in child health, we need to be a leader in supporting and investing in our people. Substantially increasing wages is just one way we continue to attract – and keep – top talent at all levels.”

Other hospitals are also increasing wages:

The move follows recent announcements by other local hospital systems, including TriHealth and UC Health, that they would boost pay for entry-level employees. In addition, Christ Hospital is launching an ambitious pilot program focused on career development and improving the lives of such workers.

These raises will stress an already short supply of employees in the Greater Cincinnati area. This is happening across the country in Healthcare. Larger hospital groups are taking advantage by offering the types of salaries that privately owned practices cannot meet.

As medicine moves to Value Payments, organizations are recognizing that their staff is paramount to their Quality and Satisfaction ratings. In order to get the quality staff to ensure high satisfaction ratings, medical facilities must make the investment in staff.

Michael Fisher stated, “There’s no greater investment we can make than in our people.  Every day they contribute to our success through their talent, compassion, hard work and dedication.  In return, we offer valuable rewards that help them thrive.”  

As costs rise and reimbursements stay flat, privately owned medical facilities are feeling the pinch. This will impact many offices by being unable to retain competent staff. As their quality decreases, so will their patient load.

Thursday, October 17, 2019

Making Strides Against Breast Cancer v2019: TickTock

Once again, I am raising money to help in the fight against breast cancer with my team: Love, Hope and Faith. Our walk is only a couple of days away (Saturday, October 19th in Dayton, Ohio).

Will you please help out by making a donation - any amount helps:

Thank you!!

The GTL Experience: Coda [UPDATED]

And because of course:

  [click to embiggen]
[NB: It's unlikely that GTL bears any direct responsibility for this, just thought it was textbook ironic]

UPDATE (10/17/19 @ 12:30 PM):


Wednesday, October 16, 2019

Irresponsible Carrier Tricks (Or: You can't make a 2nd First Impression)

I recently had occasion to write my first ever Critical Illness plan. For a number of reasons, we chose Guaranteed Trust Life (GTL) as the carrier: they had a good plan, at decent rates, and their underwriting was a good fit for this particular client.

We eventually settled on a plan design and completed and submitted the application. The underwriting process was unremarkable (that's a good thing) and the policy was issued in a reasonable time frame.


At the time it was approved, they sent me an e-version of the policy (.pdf), which was nice, but we were also told that we'd shortly receive the printed version, as well. On October 3rd, we received this in email:

"Hello Henry,

We mailed the policy to the agent as indicated on the application

When a week or so went by with no policy appearing, I followed up, and received this:

"The policy was mailed on 10/8/2019."


Okay, so I sent this to our GTL rep:

"According to this email, you first told me that you'd mailed the policy to me no later than October 3rd.

You subsequently told me that it had been mailed on the 8th.

It is now the 14th, and I still don't have it.

I am appalled at your company's lack of transparency and accountability.

One of my hats is insurance blogger. I will be writing a VERY negative post on this and will send you the link once it's live.

I often say that you only get one shot at a positive first impression, and GTL has failed this miserably.

I wish you well in your future endeavors, which will most assuredly not include me

Pretty soon, I received an apology from the rep:

"Hello Henry,

I apologize for the inconvenience and the frustration. According to our systems, the policy was mailed on the 8th to the agent to the address we have on file for you. I have forwarded your email to our new business supervisor for handling. I am not sure why you have not received a copy of the policy yet but according to our notes, it was mailed on 10/8/2019

Again, this fails to address why I was told that it had already been mailed a week or so before.

And then I received this from her supervisor:

"Good afternoon Henry,

I’m sorry to hear of the troubles we’ve had getting a policy delivered to you. 

I have ordered a new policy, which we will be mailing to you via UPS today.  The tracking number is:

Tracking Number:
Service: UPS Ground Service
Guaranteed By: End of Day Wednesday, Oct 16, 2019

I have also attached an electronic copy of the policy for you in the mean-time.

Please let me know if there is anything else I can assist with

As I noted earlier, I'd long since received the e-version.

While I appreciate this last-ditch attempt to salvage some semblance of credibility, I see no indication that they've reviewed their processes to ensure that this doesn't happen in the future, nor that they intend to do so, nor that they even care if that happens. This tells me that this is not a carrier with which I should be doing business in the future: one needs to earn that second chance.

Tuesday, October 15, 2019

Chicken or Egg: The VA/CanuckCare Conundrum

So yesterday we noted that the American VA medical system continued circling the drain:

"Atlanta VA hospital suspends routine surgeries amid ... shortages in sterilized equipment and sutures, staff not showing up on time."

It's worth noting that the VA is a prime example of gocvernment-run health "care;" no less so than that "enjoyed" by our Neighbors to the North
©, who are quickly following suit (or have lead the way - tomayto, tomahto:

"Federal government cuts reimbursements for military health care, hospitals on the hook for millions ... The federal government has quietly rolled back what it pays hospitals to take care of military members."

 Oh, goody.


[Note from HGS: Please excuse the light posting - we've had a family medical emergency and things are pressed here. Thanks for understanding!]

Monday, October 14, 2019

When Socialized Medicine happens to Good People: Redux

Last month, co-blogger Kelley told us about some of the issues surrounding health care for our vets:

"She said that after spending two hours at the hospital without any change, two doctors advised her to go home and come back when she was five centimeters dilated."

Compassion: how does it work?

Well, that was then, and this is now:

It's what you get when the government is in charge of health "care."


Friday, October 11, 2019

Making Strides Against Breast Cancer: v2019

Once again, I'm raising money with my team: Love, Hope and Faith. Our walk is coming up soon (Saturday, October 19th).

Will you please help out by making a donation - Any amount helps.

Thank You!!

Thursday, October 10, 2019

More ObamaCare Shanda

They say a picture's worth 1,000 words.


Remember: Coverage Care

[Hat Tip: FoIB Ed S]

Wednesday, October 09, 2019

Medicare 20 Year Journey - Navigating the GA Medicare Maze

Cigna in the (HSA) News

Kudos to Cigna!

[Hat Tip: FoIB Beverly G]

Tuesday, October 08, 2019

Yom Kippur 5780

This evening marks the beginning of Yom Kippur, which we've come to call The Day of Atonement. Like Rosh HaShannah (New Year's) this Holy Day is commanded of us in the Torah in Vayikra (Leviticus):
"And this shall be to you a law for all time: In the seventh month, on the tenth day of the month, you shall practice self-denial; and you shall do no manner of work, neither the citizen nor the alien who resides among you."

We generally fast from sundown this evening until sundown tomorrow, and spend this time in contemplation and prayer.

If you observe, may your fast be meaningful.

L'shannah tova!

Monday, October 07, 2019

Social Media and Medicine: A HIPAA Primer

Businesses live and die by Social Media in today’s economy, and Medical Practices are not immune from bad reviews. Businesses have options regarding bad reviews: they can ignore them, fight them or respond, especially if the comment is especially grievous. However, due to HIPAA, Medical Offices cannot respond to any complaint other than the boilerplate:

We at ABC Medicine take all comments regarding our practice very seriously. We request that if you have an issue, please contact the office.”

Medical Professionals, being human, at times want to respond to a complaint. Elite Dental Associates, located in Dallas Texas, found out the hard way that this is a HIPAA violation: 

Responding to online patient reviews just cost a dental practice $10,000 after it was accused of disclosing a patients' health information in social media posts. 

Elite Dental Associates ran into trouble after a patient filed a complaint with the OCR in June 2016 alleging the practice responded to a social media review posted on Yelp, an online business review forum, by disclosing the patient’s last name and details of her treatment plan, insurance and cost information.” 

There is a thought that if a patient posts about their medical treatment, giving details, that it is now permissible for the Medical Office to respond. This is not true:

Experts on social media say that whenever doctors or healthcare professionals post on social media sites they need to be aware of HIPAA regulations and protect the confidentiality of patients.” 

As an Administrator, I once had to take down a facebook site because patients were posting pictures of themselves in the exam area, thus violating HIPAA privacy.

In medical facilities now, you may see signs posted requesting 'No Video or Pictures during the appointment.' This is because HIPAA clearly states that personal health information cannot be posted in any public area, including Social Media.

Friday, October 04, 2019

POMS Revisited: Good News!

Longtime readers may recall our (exclusive) series on how choosing to forego enrolling in Medicare puts ones Social Security benefits in jeopardy:

"Did you know that you can opt out of Medicare altogether? That is, once you retire, you can elect not to participate in Part A, at all?

Unfortunately, opting out of Medicare benefits also means opting out of Social Security benefits, as well."

A little known rule enshrined in Social Security's Program Operations Manuals (POMS) is responsible for this stupidity, which was actually re-affirmed by a Federal judge in 2011.

But that was then, and this is now, and we have some great news:

Now, one wonders how many folks actually go this route (my guess is very few), but for those who do, this restores something that had been unfairly taken from them (after all, SSA didn't send them a refund).

And it's fair to say that this is almost exclusively due to the great job that our friend Kent Masterson Brown did in bringing the initial suit that got this ball rolling.


Thursday, October 03, 2019

From the 'Stuff Happens' files: Timing is everything

For once this is really just one of those unhappy coincidence type stories, but it's a good illustration of how things outside of our control can have a big impact.

Got a call this morning from the admin for one of my group clients. She told me that "Larry" had initially waived coverage on their plan because he was covered under his spouse's employer's group plan. Okay, no big deal, how may I be of assistance?

Well, seems that Larry's wife took a new job, and this one doesn't offer spousal coverage at all. So, can he still get on their plan, or must he wait for Open Enrollment?

The good news is that losing coverage is a "trigger" for enrolling on his employer's plan, so no worries. Here's the kicker: his termination from the wife's plan isn't until the end of November.

The reason this is such a big deal is that it means that he'll be (potentially) subject to 3 deductibles in 32 days: his 2019 deductible for his current coverage until November 30th, then his own group's 2019 deductible for December, and then his group's 2020 deductible come January 1.


Now granted, the odds of him having to satisfy all of these in essentially a month's time is pretty slim, but I'd be taking a lot of time off and staying in bed.

Wednesday, October 02, 2019

More CMS Meh

Oh goody, another wonderful "innovation" from the Feds:

"Today, the Centers for Medicare & Medicaid Services (CMS), released an informational bulletin announcing the opportunity for 10 states to apply to participate in a wellness program demonstration project for their individual market."

Actually, it gives insurers in those 10 states the opportunity to increase premiums with little effort, and even less actual cost.

How is that, you ask?

Regular readers already know:

"Workplace Wellness Programs Don’t Work Well."

But I'm sure it just wasn't tried by the right folks....

Another HSA #Win

Seriously good news:

It's surprising primarily because it's under the radar.