Medical Billing Denials - #1 Payer's Tactic to Reduce Costs at Provider's Expense

By Yuval Lirov  |   Submitted On July 02, 2008

A recent AMA study found that doctors spend 14 percent of the fees they receive from insurance companies and Medicare on the process of collecting those fees, adding more than $200 billion (about ten percent) a year to the nation's healthcare costs [Lisa Girion, 2008]. Sadly, about 30 percent of over 5 billion claims generated annually, are rejected, and surprisingly, only 50 percent of the rejected claims are ever resubmitted [Walker et al, 2004]. Note that physicians are giving up this revenue in addition to losing revenue because of the annual cuts of allowed fees. (Since 2000, health insurance premiums increased by 73 percent compared to cumulative increases in inflation and wages of about 15 percent. Yet physician's inflation-adjusted incomes dropped by 7 percent from 1995 to 2003 [Herzlinger, 2007].)

Why are the costs of collecting the earned fees so high and why, adding insult to injury, do providers often skip resubmitting rejected claims?

Insurance companies would like us to think that billing costs are high because of inefficiencies, and they are quick to blame the doctors for them [Lisa Girion, 2008]: UnitedHealthcare spokesman Gregory Thompson said, "Data show there is often a significant lag time between when services are provided and physician claims are submitted." Another often cited reason for delays and underpayments is the time that doctors take to resubmit claims or provide additional information upon insurer's request.

But a recent AMA's "report card" shows a wide variance between various payers in terms of payment accuracy and timeliness, ranging from 61 to 87 percent of the time [Bergen 2008]. Such a wide variance in payment accuracy and timeliness across the payers contradicts the "physician's inefficiency" theory. If this theory was true, then, the more efficient physicians should be losing less money on rejections than others, uniformly across all payers. Conversely, since the largest insurance companies are present in most states and are exposed to vast majority of physicians and their claim delays, the differences in underpayments and denials must be attributed first of all to the differences in payer's business strategies and processes and not - to inefficiencies in the provider's office.

For instance, a simple calculation following an example in [Walker et al, 2004] shows that systematic claim denial is beneficial to payers when the cost of rework outweighs the benefit of resubmitting the claim. Let us assume $130 for initial charge, $55 - allowed amount, $29 - service cost, $6 - claim preparation and mail, and $25 - claim rework cost. If the claim is paid in full after contractual adjustment ($75), practice total costs would add to $35 and income - $20. But if the payer denies a part of the claim, say, $30, then the provider has a choice between leaving it alone and losing $10 on the entire incident or reworking it and then taking a chance of losing even more - $35, in case of a repeat denial, or losing $5 if the payer chooses to pay the previously denied part of the claim.

In other words, depending on the claim rework costs, denial amount, and repeat denial odds or claim rework efficacy, it may be in the provider's best interest to minimize losses by abandoning the denied claim instead of working the denial. Therefore, a rational payer will deny a higher number of claims, counting on the good business sense of the rational provider who will only rework a small subset of the denied claims, specifically those claims that can be justified with a quick cost-benefit calculation such as the aforementioned example. Such rational payer's behavior explains the AMA findings much better than any inefficiency on the provider's side.

To justify rework of every denial and to eliminate a financial incentive for payers to deny claims, providers need systems with low claim rework costs and high rework efficacy. To "educate and empower physicians so they are no longer at the mercy of a chaotic payment system that takes countless hours away from patient care," (William Dolan, MD, member of AMA board [Japsen, 2008]) requires a leveled playing field for both providers and payers. And leveling the playing field with the payers requires equal footing in terms of strategies, processes, and resources [Lirov, 2007].

References:
1. Bergen, Jane M. von, AMA issues report card on health insurers, Philadelphia Inquirer, June 16, 2008
2. Girion, Lisa, "Failings by insurers and Medicare add more than $200 billion a year to the nation's healthcare tab, report says," Los Angeles Times, June 17, 2008.
3. Herzlinger, Regina, "Who Killed Health Care? America's $2 Trillion Medical Problem - and the Consumer-Driven Cure," McGraw Hill, 2007.
4. Japsen, Bruce, "AMA to rate business practices of health plans," Chicago Tribune, June 16, 2008
5. Lirov, Yuval, Practicing Profitability - Billing Network Effect for Revenue Cycle Control in Healthcare Clinics and Chiropractic Offices, Affinity Billing, New Jersey, 2007.
6. Walker, Deborah, Larch, Sara, and Woodcock, Elizabeth, The Physician Billing Process - Avoiding Potholes on the Road of Getting Paid, MGMA, 2004

Know any health care providers who complain about shrinking insurance payments and increasing audit risk? Help them learn winning Internet strategies for the modern payer-provider conflict by steering them to Vericle - Medical Billing Network and Practice Management Software, which powers such leading-edge billing services as Billing Precision (http://www.chiro-billing.com), Billing Dynamix (http://www.pt-billing.com), and Affinity Billing, and is home for "Medical Billing Networks and Processes" book by Yuval Lirov, PhD and inventor of patents in artificial intelligence and computer security.

Article Source: http://EzineArticles.com/expert/Yuval_Lirov/35366

Medical Terminology - First Step on a New Career Path

By Donna Swanson  |   Submitted On October 21, 2008

In these days of economic uncertainty, career change is a hot button issue. As baby boomers retire and leave the work force, employers are concerned about the shortage of skilled workers. In addition, corporate cost cutting, off-shoring, layoffs, and forced career changes leave many workers with difficult choices. Gone are the days of one job and one employer for life. Following a career path today can mean maneuvering many twists and turns, setbacks, side roads, and blind alleys. Where is the roadmap to a new career that provides enrichment, stability and growth potential?

One of the best ways to ease some of the uncertainty and increase your marketability quotient is to broaden your skill set. Since continuing education is often required to maintain licenses and certifications, make those education hours do double duty. The right training can mean more opportunities in your current field, and serve as a stepping stone to a new career. But which industries offer the best chance for job stability and advancement?

It is predicted that expanding healthcare and healthcare-related industries will require many additional skilled workers in the coming decade. According to Forbes Magazine, "As well-heeled baby boomers age, look to the health care industry... (B)etween 2004 and 2014, seven of the 10 fastest-growing jobs in the U.S. will be in health care." In addition to careers directly involved in patient care, demand for support professionals such as medical records and health information technicians, therapists, counselors, and medical transcriptionists will increase.

A basic requirement for entry into almost any healthcare-related career is a command of medical terminology. The ability to recognize, understand, spell, and pronounce basic medical terms, identify medical abbreviations, and decipher unfamiliar words using roots, suffixes and prefixes is a necessary tool to perform well in any medical setting. Medical terminology courses are widely available in online, home study and instructor-led formats. Because medical technology advances rapidly, medical terminology evolves to keep pace. To stay on top of new terminology, consider taking the course again if you've taken it in the past.

The Department of Labor database lists seven nontraditional careers that require medical terminology:

Medical Transcriptionists - To understand and accurately transcribe dictated reports, medical transcriptionists must understand medical terminology, anatomy and physiology, diagnostic procedures, pharmacology, and treatment assessments. They also must be able to translate medical jargon and abbreviations into their expanded forms.

Medical Records and Health Information Technicians - In addition to general education, coursework requirements for medical records and health information technicians includes medical terminology, anatomy and physiology, legal aspects of health information, health data standards, coding and abstraction of data, statistics, database management, quality improvement methods, and computer science.

Surgical Technologists - Surgical technologists receive their training in formal programs offered by community and junior colleges, vocational schools, universities, hospitals, and the military. In 2006, the Commission on Accreditation of Allied Health Education Programs (CAAHEP) recognized more than 400 accredited training programs. Programs last from 9 to 24 months and lead to a certificate, diploma, or associate degree. Programs provide classroom education and supervised clinical experience. Students take courses in anatomy, physiology, microbiology, pharmacology, professional ethics, and medical terminology. Other topics covered include the care and safety of patients during surgery, sterile techniques, and surgical procedures. Students also learn to sterilize instruments; prevent and control infection; and handle special drugs, solutions, supplies, and equipment. Most employers prefer to hire certified technologists.

Occupational Therapist Assistants and Aides - There were 126 accredited occupational therapist assistant programs in 2007. The first year of study typically involves an introduction to health care, basic medical terminology, anatomy, and physiology. In the second year, courses are more rigorous and usually include occupational therapist courses in areas such as mental health, adult physical disabilities, gerontology, and pediatrics. Students also must complete 16 weeks of supervised fieldwork in a clinic or community setting.

Radiologic Technologists and Technicians - The Joint Review Committee on Education in Radiologic Technology accredits most formal training programs for the field. The committee accredited more than 600 radiography programs in 2007. The programs provide both classroom and clinical instruction in anatomy and physiology, patient care procedures, radiation physics, radiation protection, principles of imaging, medical terminology, positioning of patients, medical ethics, radiobiology, and pathology.

Medical Assistants - Postsecondary medical assisting programs are offered in vocational-technical high schools, postsecondary vocational schools, and community and junior colleges. Programs usually last either 1 year and result in a certificate or diploma, or 2 years and result in an associate degree. Courses cover anatomy, physiology, and medical terminology, as well as typing, transcription, recordkeeping, accounting, and insurance processing. Students learn laboratory techniques, clinical and diagnostic procedures, pharmaceutical principles, the administration of medications, and first aid. They also study office practices, patient relations, medical law, and ethics. There are various organizations that accredit medical assisting programs, and accredited programs often include an internship that provides practical experience in physicians' offices, hospitals, or other health care facilities.

Court Reporters - Candidates for first level court reporting certification - the CVR - must pass a written test of spelling, punctuation, vocabulary, legal and medical terminology and three 5-minute dictation and transcription examinations that test for speed, accuracy, and silence.

In addition to these fields, many other professionals can benefit from an understanding of medical terminology. Lawyers, paralegals, legal secretaries and other legal professionals handling cases involving medical-related issues are better able to litigate these cases when they understand the terminology involved. Health insurance professionals, as well as those working in medical billing and coding positions also benefit from a working knowledge of medical terminology.

Many agencies require certification in medical terminology for pharmacy technicians. Professionals and technicians of biology, dentistry, hospital administration and many others must properly utilize medical terminology to communicate with patients, staff, customers and colleagues. Therapists, technicians, counselors and home health care providers can improve communication, increase the quality of care to patients, and reduce oversights and liability issues with a clear understanding of medical terminology.

A course in medical terminology is a widely accessible means to broaden your skill set, boost your marketability, and increase opportunities for advancement in your current career while helping you map a route to exciting work in the healthcare industry. Doubling the value of your time and education leads to better employment that will enrich your life.

This article was authored by Donna Swanson. Donna is a Registered Nurse and the CE Program Developer for Corexcel, a company specializing in online continuing education and workplace training. For more information about Corexcel and the training materials they offer, visit http://www.corexcel.com

Article Source: http://EzineArticles.com/expert/Donna_Swanson/141227

Electronic Medical Billing and Timely Payment - Fiction or Reality?

By Yuval Lirov  |   Submitted On November 10, 2007

Oligopsony (the market condition when few buyers can greatly influence price and other market factors) gives the insurance companies (buyers) tremendous negotiating power and prevents physicians (sellers) from addressing unfair payment practices. To solve this problem, all fifty states have instituted a law penalizing health insurers for late payments. In the past ten years, state courts have imposed at least $76 million in fines against insurance companies for failure to comply with prompt-pay laws, according to the AMA. The settlements between seven largest insurance companies and state medical societies amounted to more than $1.53 billion, with only $384 million for direct payments to physicians (see Dave Hansen, "The failed promise of prompt pay," AMNews, Nov. 5, 2007).

An oligopsony, according to Wikipedia, is a market form in which the number of buyers is small while the number of sellers could be large. It's a mirror opposite to an oligopoly, where there are many buyers but just a few sellers:

1. World economy: Three firms (Cargill, Archer Daniels Midland, and Callebaut) buy the vast majority of world cocoa bean production, mostly from small farmers in Third World countries.
2. American economy: tobacco growers face an oligopsony of cigarette makers, where three companies (Altria, Brown & Williamson, and Lorillard Tobacco Company) buy almost 90% of all tobacco grown in the US.
3. American healthcare insurance: a single insurance company commanded at least 30% of the market in 299 of 313 metropolitan statistical areas. One insurer had 70% or more of the market in 74 areas, while in 15 areas one company had at least 90% (AMA's 2007 update to "Competition in Health Insurance: A Comprehensive Study of U.S. Markets").

In each of these cases, the buyers (payers) have a major advantage over the sellers (providers). They can play off one provider against another, thus lowering their costs. They can also dictate exact specifications to providers.

Today, forty-nine states require claims to be paid in 45 days or less. AMA's Dr. Wilson's proposal to the House Small Business Committee's health panel in August 2007, listed multiple ideas for improved accountability, including:

• A strong federal standard. Require payment within 30 days for clean paper claims and 14 days for clean electronic claims.
• Stiffer fines than those in state laws to deter bad behavior. Assess interest on payment outstanding and increase the interest in step the claim's delinquency. Include litigation costs when they win a claims dispute with an insurer.
• Time limits for notification. Federal law should set a statutorily defined time limit for insurers to notify physicians that additional information is needed to process a claim. The notice should specify all problems with the claim and give an opportunity to provide the information needed. Insurers also should be required to pay any portion of a claim that is complete and uncontested.

But it takes years to pass new laws. Worse, the proposed standards ignore modern technology and lag behind other industries. For instance, the proposed 14-day healthcare insurance payment standard of clean claims is a far cry behind a Wall Street standard to settle massive volumes of trades within 24 hours, and a telecommunications standard to complete massive fee exchanges for phone calls between multiple carriers and customers within minutes of each conversation.

In addition to better accountability, comprehensive measurement and routine performance comparison must become integral to the payment process. Two physician and chiropractic billing and practice management companies, Athenahealth and Billing Precision, track and post payer performance statistics, including payment speed and percent of accounts receivable beyond 120 days:

• 
  Athenahealth (PayerView): the average days in accounts receivable 
  
  1. Aetna 29.8
  2. Humana 30.6
  3. Cigna 31.9
  4. WellPoint 35.1
  5. Coventry Health Care 35.1
  6. UnitedHealth Group 38.3
• Billing Precision Index: Percent of Accounts Receivable Beyond 120 days - September 2007 - 14.3
  
  1. Medicare Illinois 5.9
  2. Blue Cross Blue Shield Illinois 7.3 (up from 10 in August)
  3. CIGNA 11.2 (up to 16.4 in August)
  4. Aetna 11.7 (up from 12.7 in August)
  5. Medicare New Jersey 12.5 (up from 13.3 in August)
  6. United Healthcare 13.3 (down from 11.3 in August)
  7. Blue Cross Blue Shield Pennsylvania 14.8 (up from 28.3 in August)
  8. Blue Cross Blue Shield New Jersey 14.9 (up from 15.3 in August)
  9. GEICO 25
  10. Blue Cross Blue Shield Georgia 31.2 (down from 22.9 in August)

In summary, legal accountability, comprehensive measurement, and routine performance comparison must become integral to the medical billing and payment process.

Yuval Lirov, PhD, author of "Practicing Profitability - Billing Network Effect for Revenue Cycle Control in Healthcare Clinics and Chiropractic Offices: Collections, Audit Risk, SOAP Notes, Scheduling, Care Plans, and Coding" (Affinity Billing) and "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Medical Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com.

Article Source: http://EzineArticles.com/expert/Yuval_Lirov/35366

CMS 1500 Deadline Extended - The Deadline For CMS 1500 Forms Has Been Extended To June 1, 2007

By Alice Scott  |   Co-Author: Michele Redmond  |   Submitted On April 02, 2007

The highly anticipated CMS 1500 deadline for filing medical insurance claim forms has been extended. Originally April 1, 2007 was the deadline for submitting HCFA 1500 (12/90) claim forms to insurance carriers for medical insurance claims. The new CMS 1500 (8/05) forms were all that were to be accepted after April 1. The CMS now states that they are targeting June 1, 2007 as the cutoff date. HCFA 1500 (12/90) forms will not be accepted after that date.

The reason for this extension was due an error by (you guessed it) the Government. It is reported that they incorrectly formatted a version of the revised form and the incorrect format was released to some vendors. This resulted in some forms being printed with the incorrect format. It is a fairly minor difference, but the practice management systems would not be able to print the forms correctly on the incorrect format.

How can you tell if you have forms that were properly printed? The easiest way is to look at the top of the form. There is a small red arrow at the top right corner of the form. It should be approximately ¼" from the top edge of the form. On the improperly printed forms the arrow is touching or very close to the top edge. You will want to make sure your forms are printed correctly.

The new CMS 1500 forms are currently being accepted and processed by insurance carriers. Forms that are not printed to specification: off line, printing outside of boxes, etc. will be returned to the provider. This is intended to inform the provider of the problem so they can correct it.

Even though we've been given a reprieve, we suggest that you don't wait to make sure you are ready for the new forms. Go ahead and start using the forms as soon as you are capable to see if there are any problems printing them. The new June 1 deadline will come quicker than you think.

Copyright 2007 - Alice Scott

Alice Scott and her daughter / partner Michele Redmond are co-owners of a medical billing service. They offer an informational website for both physician's offices and the general public looking for information or help with their problems with medical insurance billing. Check out their website for more information, more about important changes now going on in Medical Insurance Billing, or to sign up for their free monthly newsletter.

Article Source: http://EzineArticles.com/expert/Alice_Scott/41651

India as a Medical Tourism Destination

By Manoj Gursahani  |   Submitted On November 22, 2007

This article answers all these questions buzzing in your head with insightful, helpful and up-to-date medical tourism information relevant to India!

India has fast emerged as the preferred choice of many foreign patients looking for quality, timely and professional health care services and wellness programs with affordable options offered to them from the leading hospitals and clinics in India. Medical tourism India today covers the whole gamut of health tourism needs for the rest of the world: so there's hope for those looking at top-class surgery options in India, be it best quality dental implants, lasik eye care, slick and safe cosmetic surgery or that elusive but not exorbitant tummy tuck or a spirit-booster with that breast lift/ face lift.

Even giving new life to that old ticker of yours with quality heart care and heart surgery is possible with the complete health check up package that can be combined with additional needs of a patient - or that of a companion for cosmetic surgery, orthopedic surgery or any other medical facilities India offers on a platter!

TMI simply acts as your professional and caring health care go-between and arranges matters so you breathe easy while deciding on which quality, affordable and customer-friendly services of ours suit you best when heading to India for availing premium hospitals, medical tours India and medical travel support that translates into time and effort savings for you - not to mention cash too.

India has an edge over other countries when it comes to offering comprehensive, cost-effective and timely medical care: it also offers an exotic, rejuvenative, adventure-filled or cultural -if you wish array of destinations to discover and revel in for the travelers!

These top Indian hospitals and nursing homes also reduce the long waiting lines prevalent elsewhere in Europe, United States and the Middle East while granting the very best in surgical, rehabilitation, post-operative and consultation advice in specialized fields such as cardiology and cardiothoracic surgery, joint replacement, orthopedic surgery, gastroenterology, ophthalmology, transplants and urology comes as a boon to global medical tourists.

India's advantages in the quality medical tourism sector: bargains, budget travel, professionally managed customized tour packages and best medical care courtesy capable networking between hospitals and travel operators!

Those willing to bypass the endless waiting list and prohibitive costs of health care back home are given the choice of combining quality wellness programs and medical care with sightseeing, holidaying and concept vacation packages courtesy an expanding and foreign-market oriented Indian tourism industry. Innovatively packaged and strategically built up to accommodate airport pick-ups with other facilities such as service apartment bookings, special dietary concerns addressed through arrangements for a personal chef and a customized holiday plan organized by the travel agents allows medical tourists to India to regain good health, explore India and take back more than just a fitter body and spirit: they take back a neat little package deal of professionally managed medical solutions and loads of happy memories!

Specialized and affordable solutions in many fields available in India: medical tourism is an expanding sector expected to post the highest year-on-year growth in earnings in the fiscal year to March 31, 2007, according to a report by Reuters. Here's why:

While India also has a wide network of professionally managed and marketed corporate hospitals that have tied up with leading travel agencies to offer low-cost, speedy and effective medical care to foreign patients, the wide range of specialties covered makes Indian solution providers hard to resist for those battling with serious medical problems, sky-rocketing medical bills and long queues. Since India's expertise includes specialties like Neurology, Neurosurgery, Oncology, Ophthalmology, Rheumatology, Endocrinology, ENT, Pediatrics, Pediatric Surgery, Pediatric Neurology, Urology, Nephrology, Dermatology, Dentistry, Plastic Surgery, Gynecology, Pulmonology, Psychiatry, General Medicine & General Surgery, it has many takers from all over the world, but most significantly UK and US, where the costs of health care solutions is very expensive.

Opting for medical tourism to India also empowers the traveler with the opportunity to avail the best of health care facilities in India such as a full body pathology, comprehensive physical and gynecological examinations, dental checkup, eye checkup, diet consultation, audiometry, spirometry, stress & lifestyle management, pap smear, digital Chest X-ray, 12 lead ECG, 2D echo colour doppler, gold standard DXA bone densitometry, body fat analysis, coronary risk markers, cancer risk markers, carotid color doppler, spiral CT scan and high strength MRI. Each of these tests is carried out by professional M.D. physicians, and is comprehensive yet pain-free; thus, a whole gamut of services is provided for fee that is a fraction of the cost patients would pay back home, making India a smart choice for quality, comprehensive and cheap healthcare packages.

India hospitals and medical centers conduct all medical investigations using the latest, technologically advanced diagnostic equipment while following stringent quality assurance exercises, which ensures that medical tourism patients receive reliable and high quality test results. Though, it is true that the biggest draw for foreign patients still remains the very minimal waitl ist that is common in European or American hospitals and many top-notch travel facilities have a business understanding for offering "priority treatment" arrangements that can be made in special cases by the Indian hospitals of the patient's choice.

So, is it any surprise when Reuters continues to report that the Indian health care sector concentrating on medical tourism inflow has bigger sales figures in mind and is set to post beyond 42 per cent rise in earnings recorded from 2006 to March 2007? Since these figures are driven by availability of quality health care and the huge rise in numbers visiting India for treatment, the surge in medical tourists to India can only be realized best in numbers: which have risen from 10,000 in 2000 to about 100,000 in 2005. The annual growth rate is expected to be 30 per cent for 2007-2008 with more attention being paid to helping India figure on the top choice list for foreign medical tourism patients currently being diverted to Singapore (the latter being an established medical care hub that attracts and envious 150,000 medical tourists a year).

Best solutions in India: names that promote India as a Top Medical Tourism Destination
Some of the best reports from satisfied patients and their referrals lead to further enquiries to the best names in quality and comprehensive health care in Indian hospitals such as The Apollo Group, Escorts Hospitals in New Delhi and Jaslok Hospitals in Mumbai.

Other top corporate hospitals like Global Hospitals, CARE and Dr L.V. Prasad Eye Hospitals in Hyderabad, The Hindujas and NM Excellence in Mumbai are steadily rising in popularity among foreign patients opting for affordable medical solutions while maintaining a high standard as these centers also have improved infrastructure, patient support systems (24hr call center help for anytime query and information exchange) as well as enhanced funding to develop further facilities.

High Success Rates keep the numbers flowing in for Quality, Speedy and Comprehensive Medical Tourism in India!

While it is an accepted fact that India has some of the best health care professionals in the industry and can offer a considerable cost advantage to keep this sector ticking, the reason for the boom in the medical tourism industry is also due to the consistently high success rate and the growing credibility of Indian medical specialists. Some of these Indian medical specialists have performed over 500,000 major surgeries and over a million other surgical procedures, which include complicated cardio-thoracic, neurological and cancer surgeries and achieved success rates at par with international standards (success rate in the 43,000 cardiac surgeries till 2002 was 98.5 per cent; India's success in 110 bone marrow transplants is 80 per cent and success rate in 6,000 renal transplants is 95 per cent).

Furthermore, India's independent credit rating agency (CRISIL) has assigned a grade 'A' rating to super specialty hospitals like Escorts and multi specialty hospitals like Apollo and even established centers like NHS of the UK and The British Standards Institute having indicated that India is a favored destination for surgeries (having accredited the Delhi-based Escorts Hospital) ease the decision-making process for many foreign patients particular about quality and cost-effective health care solutions India provides. Besides this, Apollo Group - the largest private hospital chain in India and Wockhardt Hospital are now JCI accredited and thus, the boom in the medical tourism sector in India is but, expected to get even bigger!

Click here to know more options for quality, affordable and timely health care options for you and your loved ones in India and the very best of budget India travel packages we bring your way!

Manoj Gursahani is the Chairman of India's first ecommerce travel portal - TravelMartIndia. Visit the blog for more travel related issues, travel tips and destinations [http://blog.travelmartindia.com].

Article Source: http://EzineArticles.com/expert/Manoj_Gursahani/33383

Are ProDrugs the Next Generation of ADHD Medications?

By Douglas Cowan, Psy.D.  |   Submitted On January 14, 2008

Just as 2006 and 2007 saw an increase options for delivery systems of medications for ADHD, the next generation of medications for ADHD may be just around the corner in 2008 and 2009. These NextGen medications are known as ProDrugs, and they have the potential to change the way medications are prescribed to individuals with ADHD.

Since there has been a recent explosion of new ADHD drugs such as Strattera, or new delivery systems such as Daytrana, or "old drugs in new dresses" such as Concerta, why in the world is it necessary to develop any more new drugs for ADHD? Why should we care?

ProDrugs: The Next Generation of ADHD Medications

To the extent that new drugs are just "old drugs in new dresses" for a pharmaceutical company to make money, we don't care. But to the extent that this NextGen of ProDrugs might actually make a difference in people's lives, we are very interested in learning more.

And given that between 30% and 40% of patients cannot tolerate the side-effects of current stimulant medications, and given that today's ADHD medications range from about 60% effective (Strattera) to 80% effective (Ritalin), there is a lot of room for improvement in this field. This is why we like Attend, which is not a drug, but is about 70% effective and with few or no side-effects. It is just not well known.

By developing this next generation of drugs, pharmaceutical companies are betting huge sums of monies that they can develop ADHD drugs that are more efficient for a given individual, and with fewer side-effects. Since there are different types of ADHD, different types of drugs, or drugs that will work on different parts or systems of the brain, will be more efficient than just broad acting CNS stimulants.

What is a ProDrug?

A ProDrug is an inactive precursor of another drug, an inactive precursor to a particular pharmacologic agent. It is a drug that is given in an inactive, or greatly less active form. But once taken, the person's body metabolizes it into an active form. The person's body becomes the "delivery system."

A ProDrug is designed to be more efficient in treatment, by being better absorbed and better utilizied by the body, with less side-effects.

The goal of ProDrugs is for the drug to be highly targeted to a specific system or region of the body, a specific site of action, rather than just impact the entire body or CNS.

Shire Pharmaceuticals, a company that we have been very critical of in the past, is one of the companies leading the way in ProDrug development. Well, actually they are not, but they did by New River Pharmaceuticals for $2,600,000,000 (yes, that is 2.6 Billion dollars). And New River Pharmaceuticals was leading the lay in ProDrug development for ADHD with their drug Vyvanse (lisdexamgetamine dimesylate). The FDA approved Vyvanse as a "novel treatment" for ADHD in February of 2007, and the DEA will classify it as a Schedule II controlled substance.

From the Shire press release of Feb. 2007:

"VYVANSE is a prodrug that is therapeutically inactive until metabolized in the body. In clinical studies designed to measure duration of effect, VYVANSE provided significant efficacy compared to placebo for a full treatment day, up through and including 6:00 pm. Furthermore, when VYVANSE was administered orally and intravenously in two clinical human drug abuse studies, VYVANSE produced subjective responses on a scale of "Drug Liking Effects" (DLE) that were less than d-amphetamine at equivalent doses. DLE is used in clinical abuse studies to measure relative preference among known substance abusers.

"The FDA approval of VYVANSE is exciting news for Shire as well as for patients, their families, and healthcare providers as it's an important, novel approach for the treatment of ADHD," said Matthew Emmens, Shire Chief Executive Officer. "The label we received with the approval letter includes information about the extended duration of effect and abuse-related drug liking characteristics of VYVANSE which illustrate benefits that differentiate this compound from other ADHD medicines. The addition of VYVANSE to our ADHD portfolio reaffirms Shire's commitment to continue to address unmet medical needs and advance the science of ADHD treatment. Beginning with product launch in Q2 2007, Shire will make VYVANSE our top promotional priority within our ADHD portfolio."

The big selling point of Vyvanse is that it may reduce the potential for abuse, as ProDrugs are not favored by those intending to abuse stimulants.

In regards to ADHD ProDrugs, admittedly Vyvanse is the only ProDrug that I have heard any lectures on or read anything about, but I don't want to assume that it is the only ProDrug in development for ADHD. In the studies on Vyvanse, the researchers found that among all of the subjects, the ProDrug was metabolized very consistently in terms of time to optimum therapeutic levels in the body, and in terms of the predictability of the degree to which the ProDrug was utilized by the body.

To put it better, put ten kids in a room who each weigh 100 pounds. Let's say that they each need treatment with methylphenidate (Ritalin, et al.). The variety of optimal doses in those ten children could range from 5mg per dose to 40mg per dose. But with the ProDrug, the study indicates that nearly everyone of that body weight will be taking the same size does to get the optimum dose.

To put it even more simply, it will be easier for doctors who aren't paying attention well to get the right dose for the right child the first time. And the response to the drug will be more predictable. Everything will operate more efficiently with a more efficient drug.

To learn more about medication and treatment for ADHD, or to learn more about attention deficit hyperactivity disorder visit http://newideas.net for the ADHD Information Library. This information is not to be considered medical advice, but is for information only. Consult your physician.

Article Source: http://EzineArticles.com/expert/Douglas_Cowan,_Psy.D./64601

2007 Year-End Health Savings Account Strategies

By Wiley P Long  |   Submitted On December 12, 2007

A Health Savings Account can be an important part of your tax and money-management strategy. Not only can you reduce your health insurance premiums, but when you fund your account you get a nice tax break. If you stay healthy, that money grows tax-deferred like an IRA, and can amount to a lot of money in retirement.

Every year around this time you should assess your finances and see what you need to do to optimize your situation. Making the most of your Health Savings Account (HSA) is one area that can really make a difference. Here are the key things you need to know to get the greatest tax reduction and the most growth out of your HSA.

Maximizing Your Contribution May Reduce Your Taxes By $1836 or More

If you own an HSA-qualified health insurance plan that has an effective date no later than December 31, 2007, you qualify to make a tax deductible contribution to your Health Savings Account. This will immediately reduce your tax bill come April 15.

The contribution limit is not pro-rated based on the number of months in 2007 in which you had coverage, as it was in the past. However, you do need to remain an HSA-eligible individual throughout 2008, or the extra amount contributed will be counted as income and subject to an additional 10 percent tax.

The maximum HSA contribution in 2007 is $5650 for families, and $2850 for individuals. If you are 55 or older, you may also contribute an additional $800.

Your HSA contribution is deductible on your federal income taxes, and every state (except AL, CA, NJ, and WI) also gives a deduction on state income taxes. So by maximizing their HSA contribution a family in a 28 percent tax bracket, paying 4.5 percent state income taxes, will reduce their April 15 tax burden by $1836.25.

Though your HSA-qualified health insurance must be in place before the end of the year, you do have until April 15 to make your 2007 contribution. Though you cannot put any more 2007 money in if you miss this deadline, you can reimburse yourself in later years for qualified expenses incurred in 2007, even if you do not currently have the money in your account.

Strategic Withdrawals

You can withdraw money from your HSA at any time to pay qualified medical expenses. Keep in mind that this includes over-the-counter medications such as aspirin or cough syrup, dental and vision expenses, and even alternative care such as acupuncture or homeopathy.

One strategy that many of our members take is to save their medical receipts, but to delay reimbursement from the HSA so that the funds have the opportunity to grow tax-deferred. There is no time limit in which you must withdraw the money. Since most people will face larger medical bills during their retirement, it is quite likely that the withdrawals would never be subject to taxes.

If you are not fully funding your Roth, another strategy would be to reimburse yourself for medical expenses from your HSA, and to deposit it in your Roth. Your HSA reimbursement is tax-free, and placing it in your Roth would also give you tax-free growth while enabling you to withdraw the money in retirement tax-free for any reason, including non-medical expenses. You would also avoid any extra state taxes in the states that currently tax Health Savings Accounts.

Remember to Keep Good Records

You should keep a record of any qualified medical expenses you incur. This will ensure that you have documentation substantiating any tax-free withdrawal you make from your HSA. In order to pay for a medical expense from your HSA, it must be a qualified expense.

You can go low-tech and just put receipts in a file, or get a little more organized and track your records online.

2008 Contribution Limit and Deductible Changes

In 2008 the maximum annual HSA contribution limit will again go up, this time to $2900 for individuals and $5800 for families. Those over age 55 will be allowed to contribute an additional $900 to their accounts.

The maximum deductibles will be going up next year to $5600 for individuals, and $11,200 for families. If you've now got some money socked away in your HSA, it might make sense to move to a higher deductible to further reduce your premiums.

Health Reimbursement Arrangements

If you are currently set up as an S-corp, you should strongly consider setting up a Health Reimbursement Arrangement (HRA). An HRA enables your S-corp to reimburse you as a tax-free fringe benefit for the cost of your individual health insurance. This is the only way an S-corp can legally pay for individual health insurance, and is saving our average S-corp member over $3000. The HRA must be established by December 31st in order to take advantage of it in 2007.

It may also be beneficial to set up an HRA if you have a spouse who works in your business. Also, many small businesses use an HRA to reimburse their employees for individual health insurance premiums (which is much less expensive than getting group coverage). More information and a simple online application is available on our Health Reimbursement Arrangement page.

What to Do Now

Here are the steps you should take now:

1. To maximize the potential growth of your funds, you should try to fund your account as early in the year as possible. Every month of tax-deferred growth does add up over time. You can keep the money in a savings account, or invest it in stocks or mutual funds.
2. If you have your health insurance in place but do not yet have your HSA set up, you can do so online or possibly your local bank.
3. If you do not yet have an HSA-qualified health insurance plan, you should apply for coverage as soon as possible. Your plan must be effective before January 1 in order for you to qualify for the 2007 tax deduction. By getting your HSA-qualified health insurance in place by January 1, not only will you be able to maximize your tax benefits, but you also may be able to lock in 2007 rates for the next 12 - 24 months.
4. If you have a small business with employees, are set up as an S-corp, or have a spouse who works in the business with you, you should set up a Health Reimbursement Arrangement.

Through HSAs and HRAs, individuals who pay for their own health insurance have some powerful tax reduction strategies at their disposal. December 31st is the deadline for obtaining 2007 tax deductions, so you should act quickly if these ideas make sense for your situation.

By Wiley Long - President, HSA for America (http://www.health--savings--accounts.com) - The nation's leading independent health insurance firm specializing in HSA Plans that works with a Health Savings Account.

Article Source: http://EzineArticles.com/expert/Wiley_P_Long/46226

Cancer Screening-What Should Women Know in 2007?

By Steven Vasilev MD  |   Submitted On January 31, 2007

We have all had friends get diagnosed with cancer. These are often friends who have lived the healthiest possible life, eating nothing but the best quality foods. We are talking about non-smoking, regularly exercising people who have lived the perfectly healthy lifestyle. Why did they get cancer?

The truth is that almost all cancers are caused by some genetic switch or another inside of us that flips on or off. Whether or not this occurs does depend to some degree on what we expose ourselves to, whether that be cigarette smoke, over exposure to the sun or some type of food additive. This is very over-simplified, but science is advancing rapidly and in the next five to ten years we may know exactly what the risk will be for any given environmental vice that we choose to engage in.

Until then, we do have knowledge about what kind of cancer we are most likely to come down with, and how effective cancer screening is against some of these. The point is that you have the power to take control and minimize the risk of cancer happening to you !!

The most common types of cancer in women living in the United States are:

breast (213,000 new cases, 40,970 deaths per year, with a 1 in 34 lifetime risk of dying from it),
lung (81,770 new cases, 72,130 deaths per year, with a 1 in 20 lifetime risk of dying from it),
colorectal (75,810 new cases, 27,300 deaths per year, with a 1 in 45 lifetime risk of dying from it),
endometrial (41,200 new cases, 7,350 deaths per year, with a 1 in 196 lifetime risk of dying from it),

skin (30,420 new cases, 3,720 deaths per year, with a 1 in 500 lifetime risk of dying from it),
ovarian (20,180 new cases, 15,310 deaths per year, with 1 in 95 lifetime risk of dying from it),

cervical (9,710 new cases, 3,700 deaths from year, with 1 in 385 lifetime risk of dying from it).

In general, in addition to taking care of yourself, a yearly examination with screening for cancer or precancerous conditions is highly recommended. Unfortunately, the cancers for which there are no effective screening tools are: endometrial, lung and ovarian.

The good news is that endometrial cancer tends to show itself early by abnormal bleeding, usually postmenopausal, which leads to a high cure rate. The additional good news for preventing endometrial cancer is that the vast majority occur in people who are overweight. So, paying attention to symptoms and keeping your weight in the normal range go a long way towards preventing endometrial cancer. Also, if you are taking estrogen, make sure you discuss the risk vs. the benefit with your physician.

Lung cancer is most often associated with smoking. Screening techniques have been ineffective in reducing mortality. Enough said. You know what to do for this one.

Ovarian cancer is a silent killer with no early symptoms and no reliable way to screen for it; at least not yet. There may be a blood test that is on the horizon that will change that in the near future. However, for today, the tests popularized in the lay literature as screening tools, particularly CA-125, are simply not effective. The best strategy is to pay close attention to persistent symptoms of increased bloating, indigestion, unexplained weight loss, pressure, abdominal or pelvic pain, or other intestinal symptoms. Having said that, these kind of symptoms are far more likely to be caused by something other than ovarian cancer, so don't panic. Just be vigilant if these symptoms don't go away. Also, although there are genetically predisposed women who get ovarian cancer in their reproductive years, the vast majority of ovarian cancers are diagnosed in the post-menopausal years. If you do have first degree relatives who have come down with breast or ovarian cancer, seek genetic counseling. Testing may be recommended.

Screening options do exist for cancers of the skin, cervix, colon-rectum and breast.

Women over the age of 40 should get mammograms every 1 to 2 years, and yearly after age 50. In addition, ask for a breast exam during your annual physical. Finally, although breast self-examination has not been proven to be effective, there is enough medical information to consider doing it regularly. You know your body best and may detect a lump earlier than anyone else. Finally, as far as preventive measures, a low fat diet , which you religiously adhere to may reduce your risk, especially if you have been on a high fat diet. Being overweight definitely increases your risk of cancer.

There has been a lot of press lately regarding cervical cancer screening. The best news here is that the combination of Pap smear and HPV testing is highly effective in detecting PRE-cancerous conditions of the cervix. This means that treatment can be effective very early and relatively non-invasive since the treatment is for pre-cancer rather than cancer. The recommendations are rather complex, vary with age and the details can be found on the American Cancer Society website. However, in general, make sure you are getting this combined test at least every 3 years.

After age 50, there are several options for colo-rectal cancer screening. Similar to cervical cancer screening, the most effective situation is detection of pre-cancerous polyps, but early cancer detection is also life-saving. The options include yearly testing of patient collected stool samples, sigmoidoscopy (examining the lower part of the colon) every 5 years, a special kind of x-ray study called a double-contrast barium enema every 5 years or colonoscopy (looking at the entire colon) every 10 years. Discuss these options with your doctor to determine what might work best for you.

Finally, especially if you are a sun-worshiper, ask your doctor to look at every inch of your body for signs of precancerous or cancerous skin changes. Make sure you use sun protection lotions which have a SPF (sun protection factor) rating of at least 15. Your risk will depend upon what type of skin you have, but these days you should pay attention to what the reported UV Index is wherever you live. This is a measure of the sun's damaging ultraviolet radiation you are exposed to on any given day when you go outside.

It's your life. Make sure you're looking out for number one!

Steven A. Vasilev MD, FACOG, FACS is a fellowship trained and board certified gynecologic oncologist, which means he is specially trained and certified to take care of women with gynecologic cancers using a broad spectrum of skills. He has practiced at academic as well as private centers, has been on the faculty of three universities and continues to be involved in research and education. You can visit http://www.gyncancerdoctor.com to learn more about screening, prevention and treatment of gynecologic cancers.

Article Source: http://EzineArticles.com/expert/Steven_Vasilev_MD/63426

Electronic Medical Records - The Pros and Cons

By Katt Mollar  |   Submitted On March 27, 2009

In this digital age, more and more bulks of information which used to be paper-based, from library catalogs to telephone books, are digitized and stored in a central location for easy access. The idea of EMRs started about 40 years ago.

The main proponents of EMRs cite the following advantages:

(1) The use of EHRs supposedly reduces errors in medical records. There is no doubt that handwritten records are subject to lots of human errors due to misspelling, illegibility, and differing terminologies. With the use of EMRs standardization of patient health records may eventually become acheivable.

(2) Paper records can be easily lost. We have heard how fires, floods and other natural catastrophes destroy physical records of many years, data which are lost forever. Digital records can be stored virtually forever and can be kept long after the physical records are gone. EMRs also help keep records of health information that patients tend to forget with time, i.e. inoculations, previous illnesses and medications.

(3) EMRs make health care cost-efficient by consolidating all data in one place. Previously, paper-based records are located in different places and getting access to all of them takes a lot of time and money. In a systematic review, Kripalani et al. evaluated the communication transfer between primary care physicians and hospital-based physicians and found significant deficits in medical information exchange. The review recommended the use of EMRs to resolve these issues and facilitate the continuity of care before, during and after hospitalization. EMRs translates into better treatment for patients. Take the example of one asthma center's experience with EMR: "A major benefit associated with EMR implementation was the increase in the number of children who were hospitalized with an asthma exacerbation and received an asthma action plan upon discharge. Prior to the EMR system, [only] 4% received an asthma action plan upon discharge. After implementation of the EMR system, 58% received an asthma action plan upon discharge."

(4) EMRs can save lives. VeriChip, developed by VeriChip Corporation is the first one of its kind ever approved by the US FDA. It enables rapid identification of at-risk patients and access to their medical history, thereby enabling rapid diagnosis and treatment especially in emergency situations. Classic examples are people with diabetes and/or heart problems who have high risk of collapsing and having attacks. VeriChip is also useful in vehicular accidents and other trauma incidents where the victims aren't capable of answering questions. In cases of large-scale catastrophes, VeriChip facilitates tracking and identification of victims. According to a coroner in Mississippi, VeriChip helped identify victims during the Hurricane Katrina incident.

Earlier this year, Google Health was launched, an online personalized health records service. Google Health is based on the principle that since it's the patient's medical record, the patient should control it, decide what should be in it, and who gets access to it. One of the features of the service includes records from hospitals and pharmacies that are Google Health-enabled or are registered Google Health partners.

The HealthVault is another online health information storage service offered by Microsoft with features similar to Google Health. Keith Toussaint, senior program manager with Microsoft HealthVault recently stated " leading hospitals like Beth Israel Deaconess Medical Center are actually integrating their systems with both us and Google -- because some people like one or the other. It's a Coke or Pepsi thing."

What are the disadvantages of EMRs? Not surprisingly, privacy rights advocacy groups are the main opponent of EMRs. Here is what they have to say:

(1) EMRs threaten our privacy. In this day and age when people's mantra is "I need my privacy", not many people are comfortable about having their entire medical history recorded and digitized for almost just anybody to see - in other words, incursion into people's privacy. The confidentiality of doctor - patient relationship is still sacrosanct. Besides, medical data can be used against a person in some cases - be it for a job application, insurance coverage or a college scholarship. Although it is against the law to discriminate against people with illnesses and disabilities, it is a fact of life that the fitter you are, the more competitive you are in the job market. The planned incorporation of genetic data in EMRs further adds to people's fear of incursion into their private sphere.

(2) EMRs can lead to loss of the human touch in health care. In the process of digitalization, the interpersonal aspect in health care may be lost. In handwritten hospital charts, doctors and other health care practitioners may write what they think and they feel based on their personal observations in their very own words. EMR is simply about ticking off boxes and crossing out things in electronic forms. The doctors are forced to think in categories and can seldom express a personal opinion on an individual case. Because of the lack of flexibility of many electronic reporting systems, cases of misclassification of patients and their conditions have been reported.

(3) EMRs are not that efficient. Despite efforts in digitalization and standardization, EMRs are actually far from being standardized and not as efficient as it is purported to be. It often happens that one clinic's EMR system is not compatible with that of a general practitioner or another clinic's system, thus belying the claim of added efficiency. In addition, not all users of EMRs are satisfied with the current state of the art. Although the objective is mainly efficiency and healthcare quality, one study showed that nurses in the Netherlands are not completely satisfied with their EMR implemented in 2006-2007.

(4) EMRs are not safe and secure. Google Health and HealthVault are quick in assuring patients of the safety of their online health accounts. Access to the patient's account is only possible using log ins and password. In addition, HealthVault assures that "all health information transmitted between HealthVault servers and program providers' systems is encrypted" and that Microsoft does it best to use the "highest standards of security to safeguard consumer health information from theft, loss, or damage."

However, there are cases wherein passwords and encryptions do not seem to be adequate as data protection tools. Stories of data hacking, stolen identities and blackmail abound. Even high security databases such as those run by banks and credit institutions are often compromised. This impression was aggravated by the many well-publicized incidences of data loss or breach. A few examples are listed below:

November 26, 2007, Canada. Hackers accessed medical information on HIV and hepatitis from a Canadian health agency computer. - September 22, 2008, UK. The National Health Service (NHS) reported the loss of 4 CDs in the mail containing information on 17,990 employees. - September 30, 2008, US. The company Blue Cross and Blue Shield of Louisiana confirmed breach of personal data, including Social Security numbers, phone numbers and addresses of about 1,700 brokers. The data was accidentally attached to a general email.

In addition, there is criticism over Google Health not being a "covered entity under the Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated thereunder (HIPAA)" under its terms and conditions and is therefore not subject to HIPAA privacy of individually identifiable health information. The HealthVault terms and conditions do not mention HIPAA privacy laws so it is not clear what its status is regarding this issue.

(5) VeriChip is not for humans. It is to be expected that although many of us are amenable to the use of RFID chips in pets, the idea of implanting similar chips in human beings is bound to raise hackles in humans, no matter what the US FDA says. A big opponent of the VeriChip and similar chips of its kind is the consumer advocacy group Spychip.com. In a position paper, Spychip and many advocacy and consumer awareness groups see RFID tagging (be it on your person or on the items you buy) as a major threat to privacy and civil liberties. They see the tagging as some kind of "Big Brother" operation. Another group, the No VeriChip Inside Movement, likens VeriChip as "cataloguing" humans similar to the way the Nazis have tattooed numbers on the skin of concentration camp detainees. Popular Hollywood films on privacy incursions (e.g. The Net, Public Enemy No. 1) increased further people's paranoia about personal data.

Where do we go from here? Without doubt, we have the technology to make EMRs standardized and efficient. Google Health, Microsoft HealthVault and similar online personalized health information accounts are enabling patients to take control of their medical records. The main issues that need to be overcome are data security, protection of privacy and gaining the confidence of the patients. It doesn't seem evident that the use of RFID and similar tagging chips will become acceptable or popular anytime soon. However, we live in a digital world and we cannot hold back progress indefinitely. With improved technology and data protection tools, let us hope the EMR issue will be resolved soon.

The article Electronic Medical Records - The Pros and Cons may be found in its entirety with references and links on http://HealthWorldNet.com

Article Source: http://EzineArticles.com/expert/Katt_Mollar/295862

Better Medical Reports for Life Insurance

By Michael Challiner  |   Submitted On August 21, 2006

In about every four in ten cases when someone applies for Life Insurance, the insurer has to obtain a medical report from a General Practitioner.

They need the reports when someone has declared that they have a medical condition on their life insurance application form. The applicant then has to give consent that the insurance company can gain a medical report from their GP. The GP gets called on to supply information about the specifics of that medical condition and any other relevant information.
But despite the fact that these are often costly to get hold of for insurance companies, there have been cases where GPs have not been supplying the quality information that they need. In some cases, they simply print out the computerised records of their patients and send them to the insurers.

This is not just a problem because insurers have paid the doctors to supply specific reports, but that this approach means that they often do not get the specific information they need. And on top of this, the GP winds up breaching their patient's confidentiality because the insurance company gets extra information about the applicant's medical state that they do not need to know. It is a situation both the British Medical Association (BMI) and the Association of British Insurers (ABI) would not want to occur and goes against the agreement between both parties that medical information could be obtained for the purpose of Life Insurance applications.
But because of concerns, a new agreement between both the BMI and ABI has been made where GPs have to provide high quality reports to the insurance companies for fees that will consistently rise by 6% over five years.

The fees were re-set as part of the negotiation process for reports, supplementary reports and medical examinations.

An ABI spokesman for health insurance says that the reports help people to gain much needed health insurance, such as life insurance policies that they would otherwise not normally be able to obtain.

"This agreement is good news for customers because again the BMA has pledged to uphold high standards from doctors. This includes making sure that doctors fill in forms personally and accurately, rather than simply sending printouts of medical records, which does not give the insurer the information that it needs," he says. "The deal provides both stability and certainty."
For a GP report that needs to be obtained in the year from 2006 -2007, the cost is £74.70. That increases to £79.20 for the next year and £84.00 after that. For a supplementary report the cost increases from £19.10 this year, to £20.20 the year after that and £21.40 for the year after that again.

And medical examinations will this year cost £82.20, increasing to £87.10 in the year after that and then £92.30 in the following year.
The BMA tells GPs as part of the guidance in the new agreement that they need to recognise that life assurance is a "social good" and of benefit to patients at significant points in their lives.
And that, as with other fee paid work, the reports should be completed thoroughly to justify the fees.

Get great articles based around life assurance [http://www.life-insurance-underwriters.co.uk] from the life insurance underwriters.

Article Source: http://EzineArticles.com/expert/Michael_Challiner/18343

Medical ID Bracelets - Knowledge is Power

By Lisa Hobyak  |   Submitted On March 03, 2009

There is no better example of" knowledge is power" like wearing a medical ID bracelet. These bracelets are designed to quickly notify emergency responders of a patient's condition. Vital information engraved on the back of the bracelet allows the medical community to assess life saving information without the patient's response.

Despite the benefits, many people opt not to wear their medical ID bracelet because it is ugly or "not cool." Teenagers and young adults are particularly sensitive to their image. They don't want to be labeled as "different" and certainly don't want to wear jewelry advertising their condition. Undeniably and without a doubt, wearing a medical ID bracelet saves lives.

Fact: It is estimated that more than 150 people die a year from a severe allergic reaction (anaphylaxis) to food. At least 40 deaths occur annually in the United States from reactions to insect stings. A severe allergic reaction occurs in .5-5% of the U.S. population as a result of insect stings.

Fact: The prevalence of food allergy among children under the age of 18 increased 18% from 1997 to 2007.
Fact: As many as 15% to 24% of people in the U.S. will experience acute urticaria (hives) and/or angioedema at some point in their lives.

Fact: Many diabetics suffering from hypoglycemia (low blood sugar) have been treated as being drunk.

Fact: Over 400 Americans die annually from an allergic reaction to penicillin.

Manufacturers of medical ID bracelets have been striving to design bracelets that mix fashion and style with function and purpose. Wearing an ID bracelet on your left wrist identifying your specific medical information, can speak for you when you can't.

Hope Paige Designs offers a trendy and fashionable alternative to the traditional medical ID bracelet. Visit http://www.hopepaige.com

Article Source: http://EzineArticles.com/expert/Lisa_Hobyak/284487