Affordable Care Act- 2013 Timeline

ImageWith President Obama at the helm for another term, you can be sure that the Patient Protection and Affordable Care Act is here to stay! Action by the federal government, hospitals and providers is underway to fully implement each phase of healthcare reform. With that said, you may be wondering what changes are on the horizon for the 2013 calendar year. There are four main directives of the Affordable Care Act that are set to be launched this year. Take a look at the key features for 2013 according to the timeline published by Learn how these healthcare changes will affect the U.S. patient population.

  • January 1, 2013: Improving Preventative Health Coverage

To expand the number of Americans receiving preventive care, the law provides new funding to state Medicaid programs so they can provide preventive services to patients at little or no cost. States are being given the option of whether to extend Medicaid benefits to all non-Medicare individuals under 65 with incomes up to 133% of the federal poverty level. You can check to see whether your state is expanding the Medicaid program or not.

  • January 1, 2013: Increasing Medicaid Payments for Primary Care Doctors

As Medicaid programs and providers prepare to cover more patients in 2014, the Act requires states to pay primary care physicians 100% of Medicare payment rates in 2013 and 2014 for primary care services. There is reportedly $250 million in new funding provided by the Affordable Care Act to expand the primary workforce. This funding is intended to help prepare the health system to meet the demand for health care workers as well as adding initiatives to train and support thousands of new doctors, nurses, and physician’s assistants. That’s good news…opponents of the Act are concerned about a physician shortage. Experts question if we have enough doctors to take care of a potential influx of 32 million American people.

  • January 1, 2013: Expanded Authority to Bundle Payments

The Affordable Care Act has established a national pilot program that encourages hospitals and providers to work together regarding patient care.  Under payment “bundling,” hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current system in which each service or test is billed separately to Medicare. For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment. This payment incentive is intended to increase efficiently while maintaining or improving quality of care. Those delivering care need to work together; in turn, savings are shared between providers and the Medicare program.

  • October 1, 2013: Additional Funding for the Children’s Health Insurance Program (CHIP)

Under the new legislation, states will receive two more years of funding to continue coverage for children not eligible for Medicaid. The Children’s Health Insurance Program provides low-cost health insurance coverage for children in families who earn too much to qualify for Medicaid coverage, but can’t afford to purchase private health insurance. Children up to age 19 in families with incomes up to $45,000 per year (for a family of four) are likely to be eligible for coverage. In many states, children in families with higher incomes also qualify. Learn more about CHIP.


Timeline of the Affordable Care Act

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Nurses & Providers: Get to Know the HITECH Act


The Health Information Technology for Economic and Clinical Health (HITECH) Act is an important part of President Obama’s stimulus package—known as the American Recovery and Reinvestment Act of 2009. This act represents the first significant commitment of federal resources to support the widespread adoption of electronic health records, or EHRs. As of August 2012, 54 percent of the eligible Medicare and Medicaid professionals had registered for the meaningful use incentive program. Meaningful use is still in the process of being defined on a state-by-state basis. However, the overall definition of meaningful use of EHRs embodies:

  • Improving quality of health care, safety and efficiency of health care
  • Engaging patients and family to review and inspect EHRs for accuracy
  • Improve care coordination among hospitals, providers and pharmacies
  • Maintain privacy and security of patient health information

What are the Benefits of Electronic Health Records (EHRs)?

When properly implemented, the benefits of EHRs far outweigh paper records. Care coordination is among the biggest advantages of EHRs. When all provider team members can communicate efficiently, patients definitely benefit. In a crisis, EHRs provide instant access to information about a patient’s medical history, medications and allergies. One study found that many emergency medics said they greatly benefitted from access to pre-existing health information through electronic records. Emergency personnel reported that this information was especially helpful for patients with frequent emergencies or those who were unconscious or otherwise unable to provide information. Other benefits include cost savings and accurate and complete information about a patient’s health. The U.S. Department of Veteran Affairs was one of the first to adopt health IT and exchange; they report that savings from preventing adverse drug reactions alone total an estimated $4.64 billion.

How Does the HITECH Act Specifically Affect Nurses?

The security of personal health records has always been critical within the healthcare industry. As healthcare professionals, the protection of personal health information (PHI) is just as important as the patient care delivered. In 1996, HIPAA (Health Insurance Portability Act) set national standards for the security of electronic protected health data. The HITECH Act widens the requirements of HIPAA to include the business associates of covered entities and includes a Breach Notification Rule. In a nutshell, the Breach Notification Rule requires health care providers to notify patients when there is a breach of unsecured personal health information.

Since nurses are often involved in the transmission of PHI, they need a basic understanding of the new security rules as they pertain to the HITECH Act. All PHI must be encrypted prior to transmission. Here is just one example: an emergency room nurse must send medical documentation to a patient’s insurance provider to validate the need for additional tests to be run. When transmitting that protected health information, the nurse must ensure that the information is delivered in an encrypted form, so that it cannot be used by an unauthorized party.

So, what this means is that nurses and health organizations have to answer key questions when requests are made for electronic health records.

  • Does the EHR have the capability to comply with requests for electronic access?
  • How will patients receive an electronic copy of the data?
  • What security protections will be employed to secure the electronic access (i.e. encryption, passwords)?
  • Will it be documented and time stamped when EHRs are issued to the patient?
  • Will the organization instruct patients on protecting this electronic information?

Learn more about the HITECH Act and the implementation of EHRs: Providers & Professionals resources

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Happy 2013! 10 Feel-Good Strategies for a Healthier You – Plus A Bonus Strategy

I do not know about you but around here December and the Holidays have gone by at warp speed.  Here are some ideas to decompress and start the New Year off with a little less stress:

Since the beginning of the millennium, scientists have been researching the connection between happiness and health. They can now conclude with a certain level of confidence that having a sense of peace, fulfillment, and purpose leads to a healthier and longer life.  One social scientist, Sonja Lyubomirsky, authored a book called The How of Happiness. She reveals that nearly every aspect of health seems to be affected by happiness (or lack thereof): physical and mental well-being, energy levels, immune function, relationships with others, and even our life-spans.

More and more evidence suggests that being happier can actually help you live longer! A study of 180 senior women revealed that two-thirds of the gloomy participants died before their 85th birthday, while on average the happy ladies lived 9 years longer. This small focus group may not be a predictor of the population and it’s obviously not the gospel. But, if it’s even possible that you can live longer just by being positive, isn’t it worth a try?

We put together a list of 10 simple strategies for a happier, healthier you. At MVLNC, we hope 2013 is your best year yet!

1.     Be an Optimist

Thinking optimistically is a very effective way to increase your well-being. Optimistic people are healthier, have more friends and are more successful at work. As the saying goes, it’s not the events in our lives that make us happy or sad—it’s our perception of them. Optimistic people see problems as temporary, which helps them to bounce back quickly after a hardship.

2.      Simplify Your Life

The “Simplicity Movement” is a newer way of thinking—it aims to achieve a less stressful, more meaningful life. To do this, we must slow down and be more balanced, deliberate and thoughtful.  This may mean de-cluttering your home, downsizing your career ambitions or not being so “connected” via the internet. Mental health professionals have joined the movement, focusing on how simple living can help alleviate tension-related reactions such as insomnia, nervousness, anxiety, neck and shoulder spasms and chronic fatigue. One of my favorite ways to simply is to take one day off a week from being “connected”  – it really makes a difference in feeling like I have taken a break.

3.     Develop Discipline

Manage your time and priorities because self-discipline creates happiness. Happy people tend to believe they’re more in control of their lives and take an active approach to solving problems. Using self-discipline can be difficult at first, because we don’t “feel like it.” If you wait to feel like it before exercising, working or paying your bills on time, it may never happen.

4.     Meditate

People who meditate often are usually happier than those who don’t. Not sure how to meditate? Choose a simple word such as “calm” or “peace.” Repeat the word to yourself for 10-20 minutes. Try to steer away from everyday thoughts and focus back on your repetition.  Meditation can also take place while walking or doing a favorite activity that allows you to not think about everyday stressors.  I find when cycling or running all of the sudden I find I am not thinking about daily life.  So be open to what can be considered methods of  Meditation.

5.     Change Your Breathing

When you are stressed out or angry, your breathing changes. Long patterns of unhealthy breathing patterns can cause a higher pulse rate and high blood pressure. When you feel stress or anger building, breathe in deeply and slower. Try the technique: in through the nose, out through the mouth. Within minutes, your bad mood will fade away.

6.     Laugh More Often

According to Dr. Oz, laughter can lower your heart rate and blood pressure as well as reduce the constriction in your blood vessels. It can also help with your mental health. We all know it’s fun to laugh and it feels good, but it may come as a surprise to learn that it has medicinal qualities. Studies have shown that laughter can help you work through emotional issues.

7.     Increase Sleep

It’s difficult to be happy if you’re constantly tired and struggling to find enough energy to get through the day. A good night’s sleep makes you feel energized and alert. Lack of sleep has been associated with worsening of blood pressure and cholesterol—risk factors for heart disease and stroke. Your heart will be healthier if you get between 7 and 9 hours of sleep each night.

8.     Balance Time Alone & Time with Others

Research studies suggest that people who spend most of their time alone experience higher than average rates of depression. However, spending all of your time with others can be overwhelming. You should place value on your alone time as much as that with others. Everyone needs balance in this area.

9.     Increase Omega-3

New research shows that Omega-3fatty acidscan improve moodand well-being. Already well known for their ability to protect against heart disease, cancer, and diabetes, Omega-3 fatty acids may be highly effective in preventing and managing depression and cognitive decline, according to a growing body of evidence. Foods high in Omega-3 fatty acids include fish oil, flaxseed oil, cereal, basil and broccoli.

 10.  Exercise

Of course…exercise is on every list, right? We left this one for last, but it’s probably the most important! Daily exercise can have a big impact on how positive we feel. After demonstrating that 30 minutes of exercise three times a week is just as effective as drug therapy for relieving depression symptoms in the short term, medical center researchers have concluded that continued exercise reduces the chances of recurring depression.

BONUS STRATEGY: Spend Time With Fido

Spending time with your dog or cat can really help change your attitude and might help you accomplish some  strategies 1 – 10.  Walking your dog will give you exercise and time away from those electronics.  Simply petting your dog or cat can help improve your mental outlook for the day. Don’t have a dog or cat ? Visit a friend that does or volunteer at the local rescue that needs help with exercising and caring for those pets looking and waiting for their forever home.


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Your Personal Healthcare Information – “Blue Button® it”

“Blue Button®” & You: 24/7 Access to Your Medical Record

We covered an overview of the HITECH Act in our last blog, and now we will delve into how it affects YOU—the patient. HITECH stands for the Health Information Technology for Economic and Clinical Health Act. It aims to encourage all medical practices and providers to embrace health IT, or information technology. This includes implementing electronic health records (EHRs) instead of the long-standing paper files. President Obama is pushing this initiative forward; as it falls under the Healthcare Affordability Act. The sooner a medical entity complies by maintaining and providing health records electronically, the more financial incentives they will receive through the year 2015.
Electronic Health Record Access for Patients
So, how does this act affect you? For years, individuals have been able to inspect and obtain a copy of their protected health information. Well, HITECH extends the requirements so that patients’ health information is more secure and protected. And at the same time— entities must provide electronic health records (instead of paper files).
In the near future, all organizations will be directed to give patients access to an electronic copy of their medical records. Patients can also designate that a third party gain access. This is a significant change in our healthcare system. The development of health IT should greatly streamline communication between your doctors, pharmacy, hospital, and other organizations. Most consumers should initially be offered their electronic health records at their doctor’s office or hospital. In addition, the Act states that only a fee equal to the labor cost can be charged for an electronic request.

Introduction of the “Blue Button”
So, what exactly is the “Blue Button”? It is a new icon that universally represents access to individuals’ electronic health records. The Blue Button on a computer screen will be a clickable button which will allow you to download your health information on demand. Healthcare providers and insurance companies are already starting to utilize the Blue Button. The actual details of how its functionality will work are still being ironed out. Being able to access your health information 24/7 can be lifesaving in an emergency situation, prevent medication errors, and improve care coordination between your medical practitioners. Doctors and pharmacists will now have your data at their fingertips, such as current medications and drug allergies, claims, treatment and lab results. Patients can also plug their medical data into mobile apps and other tools.
Benefits of EHRs and the “Blue Button”
The roll-out of EHRs being linked to all of your health care providers is designed to offer many benefits. Here are just a few:
• Coordination of care among doctors. If you see multiple specialists in addition to your primary care physician, it is important that your care is coordinated. Doctors may prescribe different prescriptions which could interact in harmful ways. EHRs can warn your care providers if they try to prescribe a drug that could cause a negative interaction.
• Reduction of unnecessary tests and procedures. Repeating medical tests can be unnecessary and costly. This can mean a greater deductible for you and increased insurance premiums. With EHRs, all of your care providers have access to your test results and records.

• Direct access for review of your health records. It is crucial to identify wrong and missing information on your medical record—also to make additions or corrections. Providers who have already implemented EHR systems are beginning to give their patients access to their health information online. This should enable you to keep better track of your care. If you have a question about a past procedure, you will have the information at your fingertips instead of having to wait days.

Do you Blue Button?Image

When you think of searching something in the web you hear people say “Google it.” I believe “Blue Button it” will someday be synonymous with downloading your personal healthcare information. If you would like to “Blue Button,” (or download) your health information, check with your healthcare provider to see if their system is in place—and if not, when it will be. Remember, many healthcare systems are still working on all of this new technology. However, many do have EHR in place but may not have be up to speed with Blue Button. I recommend you ask your healthcare provider if they have a way for you to securely download your healthcare information – even if Blue Button is not in place. Please remember if you are not yet comfortable with using the computer for this type of information you can always request a paper copy.

To learn more about the Blue Button and EHRs, visit Specific information for patients can be found at: Patients & Families resources.

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Understanding Healthcare Reform: Electronic Health Record Access & the HITECH Act. How Does this Affect You in the Near Future?

The Healthcare Affordability Act will continue to move forward. If you have not paid attention to it in the past you may be starting to now. Periodically  we will take some time to explain key aspects of this law and how it affects you.  The HITECH Act is a good place to start.

HITECH is an acronym that stands for the Health Information Technology for Economic and Clinical Health Act. It is part of President Obama’s stimulus package—known as the American Recovery and Reinvestment Act of 2009. The HITECH Act is designed to fulfill a promise that President Obama made in a speech in which he said: “To improve the quality of our health care while lowering its costs, we will make the immediate investments necessary to ensure that within five years, all of America’s medical records are computerized. This will cut waste, eliminate red tape and reduce the need to repeat expensive medical tests. But it’s not only about saving billions of dollars; it will save lives by reducing the deadly but preventable medical errors that pervade our health-care system.”

To help accomplish this goal, the HITECH Act creates a system of incentives to encourage medical practices to implement electronic health records (EHRs) and penalties for non-compliance. According to, “This is the future of health care.” The Department of Health and Human Services has also implemented a campaign to educate providers, professionals, patients, and families on health information technology. They want providers to learn the basics of HITECH; they want to offer patients help learning the benefits of IT as well as how to protect your personal health information (PHI).

All patients (individuals) currently have the right to access their medical health records, but up until now we’ve been limited to a “paper format.” In the very near future, we will all have access to electronic health records. Some hospitals and healthcare providers have already rolled out a system of providing their patients with an electronic version of their protected health information. There are a multitude of reasons you should obtain a copy of your medical records! We will go into all of these in next week’s HITECH blog post about patient access to PHI and your rights. Have you heard of the “Blue Button?” Blue Button is becoming a universal symbol as a way to get easy, secure, online access to your health information. These are all very important developments in our ever-changing healthcare system, so be sure to stay on top of this topic! Read about the latest developments on the HITECH Act and upcoming milestones by staying tuned to our blog.

Check back  next week to read more information on the HITTECH Act:

  • Tuesday- Dec. 18, 2012: Blue Button & You: 24/7 Access to Your Medical Record
  •  Friday- Dec. 21, 2012: What Does HITECH Mean for Nurses and Providers?

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Anatomy & Physiology 101 for Attorneys

Brain injuries can be complex. They can be caused by falls, motor vehicle accidents, any situation that cause sudden stops, and medical conditions or treatments.  When treating brain  injury  it is important to accurately diagnose and have a treatment plan.  It is important to know how the patient presented at the time of the accident – were they conscious or unconscious?  What is the patient’s medical history.

Brain injury can be mild, moderate or severe.  Treatment for brain injury patients may be complex and have several healthcare disciplines involved,  The patient’s treating physicians can include: a Physical Rehabilitation Medicine Doctor, a Neurologist and a Psychiatrist.  Additionally  Physical Therapy, Speech Therapy  and Occupational Therapy are often needed.  A Nurse Case Manager to be assigned to the case to manage the complex needs of the patient.  All of these healthcare professionals work together to help assure the best possible outcomes.

Want to learn more? Myself and several other healthcare professionals will be speaking  at the  Anatomy and Physiology 101 for Attorneys November 29, 2012 in Las Vegas. The link above will take you to the details of the conference.

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Millions Manage their Aging Parent’s Care Cross Country- are You Among the Ranks?

If you are a long-distance caregiver who is managing your aging parents’ healthcare from afar, you may be experiencing the same stress and anxiety as millions of other Americans. According to an article by the Associated Press, approximately 7 million Americans are long-distance caregivers. The term caregiver refers to anyone who provides assistance to someone else who is, to some degree, incapacitated and needs help performing the daily tasks essential to living a normal life. This includes many conditions, but among them-  someone who has suffered a stroke or has Parkinson’s disease, Alzheimer’s disease, cancer, a traumatic brain injury, heart disease, mobility impairment or an elder who is simply frail.

Family caregiver statistics

Many times, a caregiver is an unpaid family member who is involved in assisting a parent unable to perform certain activities on their own.According to the National Caregiver Alliance,

  • The average caregiver is age 46, female, married and working outside the home earning an annual income of $35,000.
  • Although men also provide assistance, female caregivers may spend as much as 50% more time providing care than male caregivers.

Long-distance caregivers all report roughly the same dilemma: managing doctor’s appointments and medications, coordinating between healthcare providers, and overseeing insurance and a parents’ overall well-being is nothing short of daunting. It often compromises a caregiver’s family obligations, career and overall quality of life. Many caregivers would prefer to live within closer proximity of their parents, but it is simply not an option. Economic factors often drive people far from their hometowns; we take jobs where we can get them!

A typical scenario of long-distance caregiving:

Kristy Bryner lives in Portland, Oregon and cares for her 80-year-old mom in Kent, Ohio.  She’s worried that her mother may slip and fall, miss her medications or have a medical emergency with no one there to help. Bryner reminds her mom to take her medicine, makes sure rides are lined up for doctor’s appointments, deals with problems with insurance coverage or financial issues and rushes to her aid if there’s a problem. Bryner knows her mom wants to stay in her home, but says someone needs to look out for her. That’s why Bryner talks daily with her mother via Skype. Many long-distance caregivers say they insist on daily calls or video chats to check up on their loved one. Often, they need to find another relative or paid caregiver who is closer and can help with some tasks.

Expenses of long-distance caregiving

Long-distance caregiving is expensive in and of itself. Whether it’s paying for prescription medications or doctor co-pays, installing a ramp for a wheelchair-bound parent, or purchasing other supplies, caregiving has a significant economic impact on a family. A 2007 report by the National Alliance for Caregiving and Evercare found that annual expenses incurred by long-distance caregivers averaged about $8,728—far more than caregivers who loved close to their loved one.

Over the next four decades, the number of people 65 and older is expected to rapidly expand. The result will be a far smaller share of people between 20 and 64—the age groups that most often is faced with caregiving.

Local caregivers under the gun

It’s not just the long-distance caregivers that are under pressure. Family members who live locally and are caring for a loved one can be the most overwhelmed! Often, because of their proximity, they are the sibling who’s expected to do everything for mom or dad- even when they have family and career responsibilities of their own. Local caregivers may not feel comfortable making all of the medical decisions alone and the hours required on a weekly basis may be more than their job allows. Many caregivers report losing jobs and/or a work demotion due to lost hours and taking leaves of absence from work.

What is a Private Healthcare Advocate & why do you need one?

What does that mean for those of us who have aging parents and are anticipating various forms of caregiving in the future?  A plan for the future is a great start! It’s not enough to hope for the best or leave it up to chance. One solid solution is a Private Healthcare Advocate. Advocates are health care professionals (such as RNs) who have intimate knowledge of hospitals and our medical system. A private healthcare advocate insures that you always have an expert on hand—and this is set up BEFORE you are in “crisis mode.” Advocates will help and guide you with all aspects of your aging parents’ healthcare needs—and you don’t have to worry, because they are experts. Here are the services that a private healthcare advocate will provide for your parent or loved one:

ü  Healthcare Planning: Develop a personal care plan: short-term & long-term.

ü  Unexpected Medical Events: They will help & guide you in an unforeseen medical event in order to make the best possible decisions.

ü  Research all Treatment Options Available: Help locate the best care and/or facilities. There are specific facilities for different types of necessary care.

ü  Act as a Liaison with Healthcare Providers:  Ensure they are communicating well.

ü  Resources: Advise you about your insurance and/or Medicare coverage. Need community financial aid? They can help you locate and secure it.

ü  Medical Bills: Review & negotiate for you.

ü  Home Visits: If the caregiver is long distance, many advocates will make periodic visits to ensure the patient is receiving the proper care and taking their medications.


California & Washington Residents: Contact Mid-Valley Legal Nurse Consulting

Get all the details you need about finding a Private Healthcare Advocate. A MVLNC Private Healthcare Advocate will help you navigate our health care system. We can take the added stress away and give you back your quality of life. Managing your loved one’s health & well-being doesn’t have to be complicated! You are still your parent’s caregiver, but now you can add the necessary expertise to make it all manageable. After all, everyone needs to be healthy—including the caregiver!

Give us a call, email any question or  contact MVLNC online to get started.

CA: (559) 862-1224     WA: (360) 450-3590

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