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More than half the Americans have declared that they can only afford to spend $100 or less on medical insurance. The amount of money Americans are willing to spend on health insurance is way below the monthly cost of cheap health-care plans like Obamacare. The people claim that the premiums are too high and are opting for other individualized insurance plans that are within their budget.

The main problem is being experienced by those who need to buy medical insurance through Obamacare exchanges without subsidies. Americans are citing this difference for the second time in a row claiming they cannot pay more than $100 for medical insurance. The average premium cost for the most basic plan is above $300, and people are finding it more difficult to keep up with the rates. The difference in the rates and what people are willing to pay is enlarging the gap between privately purchased health insurance between the unsubsidized and the subsidized.

Americans who get a federal subsidy to buy insurance can fit the premiums for individual health insurance into their budget. The same applies for those who receive subsidized health-care through their employers. Individual health plans are affordable since they cost on average $94 per month. Those receiving a federal subsidy do not pay a lot from their pockets for the premiums. Premium costs are predicted to rise in 2017 for employer-sponsored plans to nearly $1500, and deductibles at small companies could go as high as $2000.

Americans are opting for individual health plans as they are more affordable. Most Americans have budgeted 4100 for their medical insurance, and the Obamacare premiums are not gaining popularity since they are way above the comfort level of the people. The difference in health-care premiums only tells part of the story when it comes to the affordability of health-care. If the premiums continue increasing, Americans will not have the ability to cater for their health care costs and people will drop out of the health insurance plan.

The Center for Medical and Medicaid Services (CMS) has received numerous calls from stakeholders to add telehealth service as Medicare-covered service. In response, it suggested an additional number of telehealth services eligible for Medicare reimbursement. Also, adjustment of Place of Service (POS) coding policies was proposed.

Eligibility for Reimbursement

For telehealth service to qualify for reimbursement, it must be:
• Listed as a defined set of service
• Rendered at an authorized location such as hospitals
• Administered by a licensed provider like physicians
• Provided using a particular telecommunication technology

CMS has acknowledged telehealth value through continuous additional of services that are eligible for reimbursement. In the Proposed Rule, CMS intends to add the following services to the list of those eligible for Medicare reimbursement:

• Consultations in critical care
• Advance care planning
• Services related to end-stage renal condition

Regarded but Declined

CMS received requests, which didn’t meet its set guidelines for reimbursable services. The following procedures were contemplated but they were declined:
• Emergency department services
• Observation services
• Physical therapy
• Speech-language pathology
• Psychological testing
• Occupational therapy

CMS referred to its cy2005 Physician Fee Schedule as its ground to reject psychological testing, emergency department, and observation services. It stated that occupational therapy, physical therapists, and speech-language pathologists are not approved telehealth practitioners. Therefore, those services offered by these specialists couldn’t be added to the list of reimbursement.

Policies of POS Code

POS codes are employed on professional applications to stipulate the site where services were provided. Currently, no POS code specifically for telehealth exists. However, with multiple requests to establish one, CMS has noted that the POS group controls the process and it isn’t dependent on Physician Fee Schedule decision-making. Meanwhile, CMS has suggested adjustments to the current POS policies, to act as guides for future rulemaking. For instance, telehealth providers report the POS code used when the service is rendered from a distant site.

In sum, CMS has shown through the Proposed Rule, its constant support and accommodation of the use of telehealth technologies as a way of rendering health care services.

Although the Affordable Care Act has helped the United States make significant strides insofar as reforming the health sector is concerned, the health sector still face some challenges that should be addressed. For instance, the law has seen the health insurers attenuate doctor network choices. As a result, the law has limited the access to healthcare services in rural areas and inner cities. Research shows that this challenge could be overcome by doing away with the regulations to give room for telehealth providers.

Telemedicine allows health care services consumers to have easier access to physicians via electronic gadgets such as phones and computers. This trend is becoming popular as consumers, employers, and private insurers seek to reduce the cost incurred through unnecessary trips to health centers. However, the narrow doctor network resulting from health insurance plans under the Affordable Care Act is leaving out patients in the inner cities and rural areas. Nonetheless, this is a weakness that telehealth providers network can exploit in persuading the regulators to accommodate them in the Obamacare-compliant network.

Robert Wood Johnson Foundation sponsored the Georgetown University research on network adequacy. According to the study, states limit access to telemedicine by insisting that patients have to meet doctors in person. Telemedicine also faces opposition from local medical practitioners who feels like they are being replaced systematically. In a statement accompanying the study, Kathy Hempstead of the foundation suggested that there could be ways for telehealth providers to prove that they offer adequate services to patients in the wake of stricter definitions of network adequacy in the states. According to Dr. Henry DePhillips, the chief medical officer at Telacod (a telehealth service provider), telemedicine should be valid for network adequacy rules under Obamacare.

Some health plans such as Aetna, Cigna, and United Health group are offering myriad benefits to employers including covering telehealth consultations. Unfortunately, they are not able to do the same when it comes to plans offered on the exchanges. In states like Ankara and California, patients have greater access to telehealth services. However, Professor Curtis Lowery of the University of Arkansas for Medical Services warns that having different network adequacy rules from state to state can create problems.

According to Hempstead of Robert Wood Johnson Foundation, it is imperative that telemedicine is recognized under the Affordable Care Act. He argues that the challenge relating to cost control has to do with making telemedicine a substitute rather than a complement to other more traditional health services. Hempstead believes that there are areas where telemedicine can help establish network adequacy and improve access, particularly to underserved communities.

Trend of Rising Cost of Prescription Drugs Expected to Continue in 2017

The ever rising prices of prescription drugs are among the main factors that push up health-care costs in America. Although prices are increased across the board, specialty drugs get more attention because of their high cost. In 2016 specialty drug prices rose by 18.9 percent, and another increase of 18.7 percent is expected in 2017.

Specialty drugs account for less than 1 percent of all prescriptions but contribute about 35 percent of the price trends of prescription drugs. The general cost of drugs prescribed to people aged 65 and below is expected to rise. In 2016, 11.3 percent price increase was reported while another 11.6 percent is predicted in 2017.

The rise in the cost of prescription drugs is very high and will have an effect on a majority of Americans. A report by Centers for Diseases Control and Prevention indicates that more than half of Americans take at least one prescription a month while one out of five Americans uses at least three prescriptions. It seems Americans are not discouraged by the high prices of the drugs.

In 2015, 4.4 billion drug prescriptions were issued to Americans. Out of the many drugs given out as a prescription, ten brands accounted for 20 percent. The report further indicated that Americans spent $44 per brand of prescription, a rise of 22 percent from the year before. Demand for the drugs does not seem to drop, and the manufacturers may be motivated to increase the prices.

The annual cost of prescription drugs for an individual per brand can exceed $500. This means the cost of prescription can be very high in families with many members depending on prescriptions.

Many Americans commonly use prescription drugs. The high demand may be the reason for the constant rise in prices. Although the price increases on all prescriptions, the attention is on the specialty drugs whose cost rises by a bigger margin than others. Current reports indicate that the trend of rising prices is likely to continue into the future.

Telemedicine has brought a lot of relief in the health sector by making available easy access, timely access and less expensive medical care. Technically speaking, Telemedicine can connect a patient in Idaho to experts in New York. However, it is impractical because of licensing laws that make such interaction impossible.

The Republican health policy reforms suggested by House Speaker Paul Ryan include the power of choice for health care consumers. They will achieve this by the use of health savings account. One of the major delimits of the plan is its lack of measures to address the government bureaucracy that inhibits the consumers’ choice of care. Fortunately, Congress has the power to do away with any such bureaucracies.

The current state laws are more inclined to meeting the interests of providers and not to make a much needed better environment. As they stand, the laws demand telemedicine providers to pay multiple licensing fees in all the states where they want to practice and keep up with the ever-changing rules of all the states. Patients, therefore, have no choice but to settle for the available in-state services.

Federal initiatives to deal with the problem are yet to bear fruits. The Licensure Portability Grant Program funding only served the interests of the board members of the Federation of State Medical Boards who do not want change. It is no wonder that the Interstate Medical Licensure Compact does not enforce license portability. Despite having 17 member states, the compact is yet to make things better for telemedicine providers internationally. Instead, the compact has inhibited actions that would make telemedicine achieve international development.

The Commerce Clause of the Constitution can pass a law to enable physicians to use a single license from their home state to practice in any of the 50 states. The physician will also be guided by the rules and regulations of the state awarding him the license.

It is possible to create a national healthcare market without having first to amass a lot of financial resources. We can stop denying Americans health care of high quality and affordable cost. Telemedicine revolution is the way to achieve all that.

Teladoc’s challenge of the Texas Medical Board’s telemedicine restrictions have been backed by the U.S. Justice Department as well as the Federal Trade Commission. It has been said that the rules are anticompetitive and that they weren’t evaluated in the appropriate manner.

The U.S. Court of Appeals for the 5th Circuit was instructed by the Justice Department along with the FTC to pay no attention to the appeal by the medical board of Teladoc’s case. The case of Teladoc was set to prevent the board from executing a rule that would hold back the practices of telemedicine in the state of Texas. They’ve felt that the court didn’t really have the right to examine the decision and the rule that was given should be thrown out.

There was a rule that was passed by the Texas Medical Board in 2015… this rule put in place the requirement that physicians needed to meet with a patient face to face prior to treating them via telemedicine. If this didn’t occur, the patient needed to have another provider present physically for a telemedicine visit. There was an amicus brief that was presented by federal regulators on Friday… in this brief it said the rule wasn’t properly reviewed and they felt that the board could be prejudiced.

The fact that there is federal support of Teladoc presents a negative signal towards the Texas Medical Board. There was a preliminary injunction that was granted by a federal judge… this injunction stopped the progress of the telemedicine rules while the case of Teladoc proceeds forward. This shows that the judge believes company that is based in Lewisville, Texas will more than likely succeed in its pursuit to dismiss the state rule permanently.

The state board was initially sued by Teladoc in April 2015. They felt the board was in need of state supervision if they wanted to pass the contentious rules. U.S. District Judge Robert Pitman refused to dismiss the suit in December. He also discarded the claims of the board that it was let off the hook from the supervision requirement from the state.

Teladoc along with the regulators feel that the 5th Circuit doesn’t need to make a ruling regarding this issue, especially since the case is still going on.

If a new study from the independent Kaiser Family Foundation is anything to go by, people will need to brace themselves for massive insurance premium increases under the Affordable Care Act. A quick examination of insurer plans indicates that steep premium increases have been requested for in 2017 in 14 major cities in the U.S. The request for premium increases have been slated to be nearly double of what was asked for this year. The average premium increase requests are slated to be around 10 percent.

It’s likely that the regulators and insurers will only decide final premium rates towards the end of the year for 2017, but the study corroborates the signs that consumers and the government are likely to pay higher insurance prices in several cities across the country. It appears that insurance companies are at a crossroads in terms of charges, so they are trying to cover their costs with these new price requests.

The projections made by the foundation are based on preliminary insurance rates filed with local state regulators. These rates remain subject to review by local and federal regulators before being passed to the people.

While it’s early days, Kaiser’s insurance premium projections will be closely monitored because data is currently only available for some states. The big states like Texas and Florida have been left out of the study for the moment because data hasn’t been made available yet.

The report indicates that consumers may want to compare between different providers to mitigate these insurance premium hikes. But they must be prepared to switch insurers and even their doctors to avoid burdening their wallets.

The Kaiser Family Foundation studied the most popular low-cost silver plans to calculate insurance premium rise requests. A clearer picture will arise towards the closing months of the year when the presidential election heats up. Democrat nominee Hillary Clinton wants to build on the plan, while Republican nominee Donald Trump wants to get rid of it. Since inception, Obamacare has reduced the rate of uninsured people to a low 9 percent.

On May 17, 2016, Arizona Governor Doug Ducey signed bill S.B. 1363 into law. This bill requires that all private health plans have to pay for telemedicine services in the entire state, rather than just the services in rural areas of Arizona.

The current telehealth coverage law requires that all commercial health insurers provide services to individuals in rural areas. This current law went into place back in January 2015. Because of this current law, all of the residents who live in non-rural areas wouldn’t be able to enjoy telemedicine services with their current insurance plan. Because of the new law going into effect, everyone will be able to enjoy getting telemedicine services, regardless of where they might live.

Thanks to this new bill, the coverage opportunities for Arizona residents has expanded exponentially. However, that doesn’t mean there isn’t ample opportunity to continue improving the way things are. This new bill only covers a portion of the telemedicine services, instead of covering all of the current services available via telemedicine to the extent that service is provided in-person. The law gives health plans the chance to limit the amount of coverage available to health care providers that are members of the provider’s network. This new statute will go into effect as of January 1, 2018.

The telehealth providers located in the other states can turn to Arizona for guidance when they advocate and draft their current telehealth coverage laws. Any contract that was delivered, renewed or issued after the January 1, 2015 date has to deliver coverage for services rendered through telemedicine if the service would have been covered through an in-person consultation between the provider and the subscriber.

Current services covered include trauma, cardiology, burn, mental health disorders, infectious diseases, pulmonology, dermatology and neurologic diseases. With 29 states and the District of Columbia having current laws about telehealth insurance, it will only be a matter of time before the rest of the states come on board and offer the same type of services as Arizona and countless others.

Global Telemedicine Market

Telemedicine means using telecommunications technology to deliver medical services or information to patients among other users far from the provider. The telemedicine market is divided into; telehome and telehospital/clinic markets. Telemedicine is experiencing a significant boost in the vast healthcare industry as a result of a dire need for improved clinical outcomes and better quality treatment. Increased awareness of patients’ readings has led to better clinical outcomes as monitored under telemedicine.

The primary trend is to move towards an integrated telemedicine to attain the highest reliability. Many organizations are working to capture all clinical signals. Data transfer speed has by far improved with the aid of IP-based acceleration and transmission control protocol (TCP). More organizations are adopting Web-based interfaces which provide global reach and high levels of interoperability.

The global telemedicine market is expected to reach $23.8 billion in 2016 and $55.1 billion in 2021 which reflects a compound annual growth rate of 18.3% spanning five years. Telehospital/clinic grossed an estimated $11.1 billion in 2015 as a segment while the telehome market division totaled almost $9 billion that same year. The telehome segment is expected to grow at a projected compound annual growth rate (CAGR) of 24% thus increasing its total market share by 15% from 45% in 2015 to 60% in 2021.

During the forecast period, the telehome technology market whose value was estimated to be over $5.3 billion in 2015 should dominate over the telemedicine technology. Telehome technology is expected to grow significantly by over 5% in the telemedicine technology market from 63.5% in 2015 to 68.7% by 2021.Telehospital/clinic technology is projected to reach $7.5 billion by 2021 which is 31.3% of the market representing CAGR of 17.3%.

While telemedicine is recommended as a pivotal technology to back up e-healthcare and significantly reduce costs, it’s absurd to learn that health insurance is increasing in many different markets. For instance, a business owner recently dumbfounded Hillary Clinton when she told her that the cost of health insurance had doubled as the premiums for her family increased by $500 monthly. This would mean trouble for her employees too and other business owners. Clinton alluded that insurance companies should explain their rising costs and that income cut-offs should be more lenient.

Recently, a business owner told Hilary Clinton that the cost of health insurance doubled. Needless to say, Clinton was quite dumbfounded by how the premium could have gone up so much. The campaign event in Virginia brought in a number of business owners and individuals alike. Clinton only said that she didn’t understand how her insurance could have doubled when there weren’t any terrible healthcare events that took place.

According to the voter, her insurance plan has a very strict income cut-off that is preventing her from being able to get any of the subsidies available to many other business owners. The same voter said that her own health insurance premiums for the family went up by $500 every month. They went from spending around $400 every month to over $900 per month now. With them struggling just to keep their own insurance in place, it makes it hard to be able to cover the added cost of the insurance for their employees.

Being able to give your employees the benefits they need isn’t at the forefront of your mind. However, you want to be able to keep your employees happy as well. It makes it difficult when the costs are so high to be able to provide benefits to satisfy your employees needs without straining your pocketbook. While Clinton did offer a number of solutions to the problem, she never really got to the heart of the problem to take care of it.

The cost of health insurance is going up in a number of different markets. While it might not be every market, it is a lot of them. Clinton believes that the Affordable Care Act is a major step in the right direction for the majority of Americans. However, they also have to look at the deductibles, premiums, copays and total out-of-pocket costs. Clinton believes that the income cut-offs should be more lenient and the insurance companies should have to explain their rising costs.