<p>dstark, I finally got an email late this afternoon from the Director of Sales, Anthem Western Region. We are going to talk tomorrow. I do have some good news for you. He indicated in the email that a member in a PPO region can go to a EPO provider as long as the EPO provider is part of the Anthem Blue Cross of Ca network. So I think this will include UCLA and UCSF. I probably need to parse this answer somewhat to make sure he means in network, not out of network. I will be asking him about specific providers tomorrow as well as the other questions we have discussed.</p>
<p>GP, </p>
<p>I appreciate the update. </p>
<p>Yes…I agree there is a big difference between in network and out of network coverage.</p>
<p>I hope the news is good tomorrow.</p>
<p>I hope you have UCLA in your network.</p>
<p>I hear on TV that Missouri and Texas have passed laws imposing a lot of restrictions on people who give guidance on Obamacare and the purchase of health plans. When I read some of the restrictions, it seemed to me they were so broad and general, they might in fact apply to health care consultants, not just their real targets, the navigators. </p>
<p>Is anyone in that business? Does anyone have any thoughts on whether Texas and Missouri have outlawed health care consultants, or did they carve that industry out?</p>
<p>GP, that may cover why UCLA appears on my provider list- which seems to encompass PPO/EPO (another detail I haven’t had time to hunt down.)</p>
<p>3b- the ex wife will get 100k in alimony and can’t afford Medicare payments? Did she tell you how much she was quoted? I ran a fast check earlier and it was not a large number-- but what do I know?</p>
<p>I enrolled tonight. (Almost posted while I waited.) Had a very positive appointment. If there are family specific questions, such the mom and baby example- well, wondering if anyone contacted the exchange for clarification. </p>
<p>ps. the records transfer Emily noted can depend on the two docs or facilities being linked. I do have some docs not on my primary’s network. In my case, they don’t email them. But it was very cool when I watched one doc pull up a screen copy of an x-ray, from the site that performed it.</p>
<p>Lookingforward: Ordinarily Medicare plan B coverage costs about $104 a month. But because she never worked, they told her that she would have to pay a much higher premium until her ex husband reaches 65. That’s at least seven years away. I’m not sure exactly how much, but between that and the supplemental policy I think she’s looking at about $1,000 a month. So she’s just wondering if it would be cheaper on the exchange.</p>
<p>3b, if she actually spoke with them, I’d guess that trumps what I saw. Maybe one of the small details changed this, for her. For the record (I found it interesting, for myself) <a href=“http://www.medicare.gov/MedicareEligibility/home.asp[/url]”>http://www.medicare.gov/MedicareEligibility/home.asp</a> 2013 costs. She looked into COBRA? If I am mis-remembering something, sorry.</p>
<p>I don’t think some of you are getting it. Some of the EHR systems as implemented today are getting in the way of patient care. There is a fantasy here that doctors are resisting this. Let me be clear, doctors LOVE the concept since everything else we do are already electronic or have been made easier by technology. Why wouldn’t we love it? It would make record keeping great, optimize billing, and eliminate so much administrative headaches. Most systems hinder these goals because they just can’t handle the needs of all specialists well. The first EHR I used was in the VA back in 1999. It was fantastic for managing hospitalized or office patients. It might not work well for other specialists.</p>
<p>I used one at a hospital that required me to scroll through multiple menus in order to be updated on my patients and erase multiple outdated hospital protocols that were potentially harmful to my patients. The nurses loved the system. While it was great for them, it was horrible for me and other specialists. In the OR, I have seen anesthesiologists scrolling through bad EHR systems for several minutes ignoring their anesthetized patient because the hospital’s EHR wasn’t anesthesia friendly. How would you like your anesthesiologist spending a lot of frustrating minutes paying more attention to menus than your care? I promise you, you wouldn’t tell them to just “get over it”. But that is the heart of the problem.</p>
<p>I now use a hospital EHR that is PC friendly but not Mac or Android friendly. So, I have to be at the hospital to use the features. But then, the hospital only gives computer access to their nursing staff. So, I have to interrupt a nurse from patient care to access the computer, so I can then log onto the software to do my work. But then, I can’t email the record or transfer it to my office. Sometimes we can’t even find other physician notes. It was so bad that the hospital reintroduced paper charts to go along with the EHR. It gets better, the ER is on a diffetent system that is wonderful for them. I get an emergency patient to the operating room and guess what? I have no access to the info I need because the OR EHRs don’t access the ER EHR system. This was a multi-million dollar EHR system that the hospital has to replace because it sucks.</p>
<p>These are the reasons why doctors aren’t enthusiastic. They aren’t all working well in real life. Can you imagine having WIFI optimized for a few computers that causes havoc for others? That analogy sums up the EHR issue.</p>
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<p>Not entirely a fantasy. When I took the Coursera course on the ACA, some doctors also took the course. And some of them complained about EHR. Not the implementation, but the idea. One doctor complained that he had to learn to type. </p>
<p>frugaldoctor, you talk about horrible software, and indeed the software you describe sucks. But the answer is not to complain about the idea of EHR, but the crappy execution of EHR.</p>
<p>No technology is good unless it properly serves its users’ needs. Sound like some systems need revamping. </p>
<p>My issue- not jumping on any bandwagons, just commenting- was that the counter and chair set up meant my doc had his back to me, while typing. They resolved that.</p>
<p>At my follow-up visits, my surgeon used a small mic to make notes on his computer. He would just speak them and it would type.</p>
<p>Actually, I don’t think any of my docs use the written pad anymore. Most use a tablet of some sort. My eye doctor uses a laptop and types as she goes. </p>
<p>It’s unfortunate that there’s issues with the EHR. I think it will be temporary and I think we can pretty much all agree that it will be for the better in the long run.</p>
<p>Maybe, but at my last visit there was more interaction with the laptop than the patient. I don’t know that any of it was necessary for a simple prescription and don’t remember that happening ever before. It was almost rude.</p>
<p>^And that’s whose fault?
How did we get on this detour? I can think of some jokes-
(after all, I made my decision tonight.)</p>
<p>Btw, some schools are training med students on tablets, how to better interact with patients and more.
<a href=“http://www.fiercemobilehealthcare.com/story/ipads-apps-new-learning-tools-harvard-yale-med-students/2011-09-06[/url]”>http://www.fiercemobilehealthcare.com/story/ipads-apps-new-learning-tools-harvard-yale-med-students/2011-09-06</a></p>
<p>“the records transfer Emily noted can depend on the two docs or facilities being linked.”</p>
<p>No link between the two doctors or the practices.</p>
<p>I am a former electrical engineer and I absolutely welcome EHRs. I have to read other doctors’ handwriting too and I have to admit that most are horrible. I believe that to solve the implementation problem requires standardization of the database fields, data base language, and communication. Then you will see more enthusiasm from the physician outliers who aren’t so fond of these changes.</p>
<p>Right now, several companies are vying for market domination and they cater mostly to the hospitals. The hospitals are much more profitable than individual physician offices. But these companies implement proprietary algorithms, focus on inpatient nursing charting, and include the physician portals as an afterthought. I’ve seen great physician office software among some bad ones. But I am free to pick the one I want in my office but not at the hospitals. </p>
<p>We are seriously at the infancy of EHRs and I believe these issues will be resolved by either government mandated standards or a monopolizing software company. There was a time that we had over 50 word processors in the 1980s. Almost all were not portable. Now, we have 3 dominant ones and they are, for the most part, portable. The public need to realize what obstacles physicians face and why we have been slow to adopt these changes. If a physician or a hospital is lucky and picks the right sotware, great! However, the facts show that more than 50% of the time they are unlucky.</p>
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Sounds like the issues with the healthcare.gov website!</p>
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Yes, I’ve read about this, too. Has anyone actually consulted a navigator for help with the exchange? I’m wondering just how useful they really are. Are they going to point out all the things that have been pointed out to us on this thread? </p>
<p>I haven’t seen anything more about the security issues of the healthcare.gov website. I did see an article just the other day about how 1/3 of the applications have errors. In the nickel and dime thread, someone pointed out that it’s not good to be in the hospital over New Year’s Eve/Day when there is a new insurance. Wonder what will happen January 1 of this year?</p>
<p>^I heard a tidbit about the security issues on NPR the other day. They are put on the backburner while the user issue is being addressed.</p>
<p>[Texas</a> proposes new rules for Obamacare ‘navigators’ | State | News from Fo…](<a href=“http://www.star-telegram.com/2013/12/03/5388531/texas-proposes-new-rules-for-obamacare.html]Texas”>http://www.star-telegram.com/2013/12/03/5388531/texas-proposes-new-rules-for-obamacare.html)</p>
<p>Here is what is being proposed in Texas. Until it becomes law, it can’t be discussed any further.</p>
<p>In some respects, I do live in a bubble. But I also try to advocate people freaking think before they rely on an anecdote or assume something is an issue, before putting it out there as a universal. So be it. I made my choice; I can change it, under various circumstances. If you have questions, in addition to sifting through your own research, call your exchange and insurer. I also had a sit-down, last night. I’m not a pushover and have been pleased by the attention, time- and consistency of the answers. Of course, that’s only my anecdote.</p>
<p>Thanks, Tpg, for keeping us in line. This is a great thread.</p>
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<p>Bill Gates should fix this and keep his nose out of education. At least he knows something about software.</p>