What is Telemedicine?

What is Telemedicine?

The healthcare infrastructure is drastically changing, and one of the concepts that have emerged is telemedicine. Telemedicine is basically the use of information and telecommunication technology by healthcare professionals to diagnose and treat patients from another location. This concept was introduced to eliminate the distance barriers and make specialized health care services more accessible to the population. Bellaire ER gives more insight on Telemedicine.

History of Telemedicine

The Telemedicine concept was born when telecommunications technology came to be. Radio, telegraph and the telephone emerged late in the 19th century, but it was not until the early 20th century that the population started using these technologies widely. The concept was introduced in the field of medicine in the 1950s when some university medical centers and a few hospitals began sharing images and information using these systems. During the early stages of this concept, it was used to connect a doctor and a specialist working from different locations. It was a great way for people in the rural areas to access specialized medical services.

When the age of the internet came, telemedicine was revolutionized. The practice was characterized by profound changes like the proliferation of more advanced devices that were of offering better audio and imaging transmissions more effectively. Today, the field is constantly changing and at a much faster rate than ever before. With the advancement in technology comes more advanced equipment and more effectiveness in the field. In fact, telemedicine has grown to become an integral part of the US healthcare today.

The different ways Telemedicine can be used
The advancement in internet use has also changed how telemedicine is used. A simple connection to the internet can allow many patients in the remote areas to access to this type of medicine. There are three ways of connection that are used:

• Networked programs
Networked connections are basically used to link up health clinics in the remote places to the large healthcare facilities like the hospitals in the cities. At the moment, the United States has roughly 200 networked telemedicine programs that benefit over 3000 rural sites.

• Point-to-point connection
This type of connection links several small health centers in remote areas to one central health facility using high-speed internet. This type of connection allows small clinics or those that are understaffed to outsource medical care from other locations that are within the same system. This type of connection is particularly common with urgent care service, teleradiology and telepsychiatry.

• Monitoring Center Links
Monitoring center links are specifically used for remote patient monitoring. It works by creating a digital connection between the remote monitoring facility and the patient’s house allowing for the patient’s medical data to be measured at home and transmitted to the medical monitoring facility electronically. The links are usually in the form of SMS, telephone communication or internet. Monitoring Center Links are commonly used when monitoring cardiac, pulmonary or fetal medical data.

Types of Telemedicine

Real-time telehealth
Real-time telemedicine is also called synchronous medicine, and it is perhaps the first line of thinking when telemedicine is mentioned. Real-time telemedicine enables real-time interactions between that patient and the health professional via video and audio communication. The software is quite sophisticated as opposed compared to the video chat platforms people use. However, the concept is quite the same as the goal is for the patient and the health professional to communicate with each other.

Remote patient monitoring
Remote patient monitoring allows the medical practitioners to monitor the vital data of the patient from a distance. It is also called telemonitoring. The popularity of this type of telemedicine is quickly rising as more people realize the benefits of telemedicine on chronic care management. An example is a glucose tracker of a patient that is able to transmit the medical data of the patient with regard to their glucose level to the health official remotely.

Store-and-forward telemedicine solutions
This type of telemedicine, also known as asynchronous telemedicine, enables healthcare providers to forward the medical data of the patient from a different location. They offer a more sophisticated and more secure election platform that allows for a secure transmission of patient’s private data.

Pros of Telemedicine

1. Provides convenient and accessible medical care for patient
The idea of telemedicine is to make medical care accessible to more people particularly for those people in the rural areas. With telemedicine, typical geographical barriers are broken, and the healthcare delivery model becomes more convenient.

2. Cheaper health care costs
Telemedicine has the ability to slash the health care spending greatly by minimizing the need for unnecessary ER visits.

3. Establish better access to consultations from specialists
With telemedicine, health officials have a better platform to engage and consult with regards to the procedures for treating patients. As such, regardless of one’s location, they can access specialized treatments from the best specialists in particular fields.

4. Increased patient engagement
Telemedicine enables patients to connect with their doctors more frequently in a manner that is more convenient.

5. The patient care is also of much better quality given that access to specialized treatment is much easier.

Is Telemedicine Legal in Texas?

Is Telemedicine Legal in Texas?

Texas is one of the states in the US that has been in the limelight with regards to Telemedicine. Texas is known for having a huge segment of its population residing in the rural areas. Given the shortage of specialist in the medical sector, there had been a huge gap created with regard to access to specialized medical services for the rural population. What Bellaire ER and many other residents of this great state see as a step towards the right direction, the government has made changes in the legislation that paves way for telemedicine to bridge the gap that exists.

Telemedicine has been legal in Texas for years now but on a limited basis. For the last six years, telehealth providers have had a difficult time trying to cope with the legislation that initially existed. The emergency rules that were declared by Texas Medical Board required that there be a pre-existing relationship between the patient and the medical professional or a face-to-face communication medium in order to provide telemedicine services. The enactment of these new rules was met with great opposition from telehealth providers who went to court.

The court process has been ongoing for years with the telehealth companies having several victories that in the court against the Texas Medical Board. Sometime in 2016, the board agreed that they would promote legislation in the state parliament that would remove the many hurdles the previous rules created in the path of telemedicine. The legislation to be sponsored would permit telehealth practices, including asynchronous communication in the absence of telehealth presenters and live interactive encounters.

The negotiations resulted in the birth of SB 1107. The bill detailed the following:

A licensed Texas physician is allowed to establish a physician-patient relationship that is valid without having to conduct an in-person exam or the patient having to be in the presence of another health care provider. The bill allowed the physician to use telehealth exclusively in their interactions with their patients using real-time audio and/or visual platforms as well as asynchronous platforms.

The bill required the physicians rendering telehealth to provide their patients with close guidance and the appropriate follow-up care after they have been treated. Also, the physician must seek consent from the patient’s primary care physician – if they have one – and a report of the encounter should be sent to the primary care physician within a period not exceeding three days.

Medical prescriptions are part of treatment and the bill provided room for that. The Texas Medical Board, the Texas Board of Pharmacy and the Texas Board of Nursing are the ones charged with the mandate of establishing the specific rules that would validate prescriptions that are issued through this kind of physician-patient encounter.

The standards of care that govern in-person medical services were the ones that would be applicable for telemedicine and no other standards set by other agencies would not be set for telemedicine services.

With regards to insurance, bill SB 1107 clearly states that telemedicine services only rendered through facsimile or audio interactions will not be affected by Texas Telemedicine parity law. This means that insurance providers in Texas were prohibited from using telemedicine as a ground for restricting coverage with the exception of when the services have been rendered through fax or phone. The insurance providers in Texas were also required to post on their website their telehealth coverage policies as well as their payment practices to allow consumers to determine the amount of coverage available.

Earlier on this year, the Texas Senate approved the bill, and later in May, Texas Governor Greg Abbott put his signature on the bill and signed it into law. This marked a new era for telemedicine in this state and an end to years of legal battle between telehealth providers and the Texas Medical Board. Teladoc was the greatest winner given that it was one of the main parties that engaged the Texas Medical Board in years of court battle. While these companies are the ones that set the stage and triggered the amendments of the initial laws, the bill grants victory to the residents of Texas, particularly those from the rural parts of the state.

With the bill in place and the hurdles in the path of Telemedicine out, the Texas Medical Board is now charged with the task of ensuring that they set and adopt new regulations to govern telemedicine in the state. Some focus areas are:

• Ensuring that the patients who employ telemedicine services receive health care that is at par with the quality standards set.
• Preventing fraud and abuse through telemedicine by setting strong rules with regards to filing claims and keeping records of telemedicine encounters.
• Ensuring that there is adequate supervision of medical professionals to ensure that fraudulent physicians do not exploit unknowing patients.
• Establishing the maximum number of nurse practitioners and physician assistants a physician may supervise.

How Oversight of Insurance Companies can prevent Surprise Medical Bills

3 Sep 2017 Lifestyle, Medical

How Oversight of Insurance Companies can prevent Surprise Medical Bills

Surprise medical bills are one of the biggest problems that both patients and the physicians agree on. It is frustrating when you get an unexpected medical bill that will cost you up to thousands of dollars, yet you have health insurance. The surprise medical bills are usually a product of the doings of insurance companies. It is part of the business strategy insurance companies providing health insurance use to make them look more valuable.

A patient will purchase a health insurance package with the hope that it will help them pay for their medical care. But for insurance companies, it is a business. So what they do is that they create a sufficiently and irresistibly attractive plan, enroll policyholders then work around to ensure that the biggest chunk of the cash they receive stays with them instead of going to health care for the patients. Additionally, they will advertise and recommend specific physicians and medical facilities just to save more money. The end result is that the insurance companies end up benefiting while the patients are left having to bear the costs of their medical bills.

To get the burden of such bills off the back of patients, Bellaire ER advocates for the idea of oversight of insurance companies. This will help regulate the policies and actions of health insurance service providers to the benefit the patients. Most of the states, including Texas, have laws that require insurers to cater for the costs of non-contracted emergency health care and at the normal rates. The problem comes when you look at the guidelines. The guidelines that govern this law are not uniform, providing room to the insurance companies to determine their own rates. That is why you will find a good number of insurance companies having a payments percentage that is way lower than what the law stipulates. The result is the burden of surprise medical bills being created as the patients end up not receiving the full benefits they ought to receive from their health insurance provider.

Freestanding emergency rooms have been a popular target for health insurance companies. The model of freestanding emergency rooms is quite an innovative one and provides better access to emergency care for patients more effectively and efficiently. But they have been accused of misleading patients and lacking transparency; as per the narrative that insurance companies have. They use this as their basis for processing freestanding emergency center claims. As per the law in Texas, FECs are recognized as essential and are supposed to be processed at the same level as in-network benefit or the normal customary level. However, insurance providers use their “lack of transparency” excuse and the lack of clear guidelines in the law to charge out-of-network rates for freestanding emergency center claims. They end up denying the patient’s coverage access yet they are paying their insurance rates. The result is higher patient responsibility in the form of the surprise bills.

In a move deemed as a step towards the right direction for Texas, the Texas Association of Freestanding Emergency Centers passed a resolution that calls for the Texas Department of Insurance and the Texas Legislative arm to increase and improve data collection with regards to health insurance payment. With this data, it will be much easier for both the patients and the insurance providers to be certain as to what constitutes the customary reimbursement for Texas emergency room procedures. This is part of the efforts that are being made to improve the oversight and the transparency of health insurance companies and the health insurance industry in general.

Data from the Texas Department of Insurance clearly shows that there has been systematic attempts by a good number of insurance companies to slash the payments slated for freestanding emergency centers and have the costs channeled to their patients instead. In fact, some of these insurance companies go as far as keeping the freestanding emergency centers in the out-of-network category intentionally just to ensure that they pay the least amount possible in healthcare claims. This is a chronic practice that can only be stopped with increased oversight of these health insurance service providers to ensure that they are fair to their customers.

This behavior is becoming increasingly rampant and more people are not realizing the benefits of having a health insurance cover. To turn the tables in favor of the patients and against the “greedy” profit approach that insurance companies are employing, the legislative arm of the Texas Government should make it a priority to establish the appropriate laws and clear guidelines to regulate health insurance companies. They should come up with clear standards that are easily enforceable for reimbursements rates that can hold health plans accountable. The main goal is ensuring that all citizens get easy, affordable and reliable access to quality health care. A clear oversight of insurance companies will go a long way in ensuring the realization of this goal.

How Misinformation Prevents the Benefits of Freestanding Emergency Centers

How Misinformation Prevents the Benefits of Freestanding Emergency Centers

The rising healthcare costs are increasingly becoming a headache for citizens, lawmakers, healthcare providers and health insurance providers. Out-of-network healthcare and surprise billing are some of the major problems that the United States is struggling with. Freestanding emergency rooms have been proven to be quite effective and a possible solution to the problem of inaccessibility of healthcare, particularly for people in the rural areas. However, they have been the main target and have been blamed by insurance companies as being the main factor contributing to the rising costs of healthcare.

Freestanding Emergency Centers have grown in number in the last few years. Thanks to that and their increased popularity, more patients can easily access medical care and more conveniently as compared to emergency rooms in hospitals. But the growth has also resulted in misinformation from insurance companies. Bellaire ER argues that the amount of misinformation with regards to freestanding emergency centers ultimately clouds the loads of benefits that these facilities bring.

When you hear the view of a health insurance company, they will say that Freestanding Emergency Centers prefer to remain out-of-network for their own benefits. This is one of the lies that cloud them since freestanding emergency centers have always been open to contract insurance companies. They are often denied when it comes to negotiating their network status to in-network. The few that are lucky to gain the in-network status are usually offered rates that are considerably low as compared to what other licensed emergency facilities are offered.

Consumers are usually on the receiving end when it comes to the consequences of the greed of insurance companies. The freestanding emergency companies require the patients’ treatment bills to be paid for them to be operational. However, since health insurance companies want to ensure that they make bigger profits, much of the medical costs are channeled to the consumers. That is how patients end up with surprise medical bills.

Over the last five years, insurance premiums have increased by almost 20 percent and deductibles by over 60 percent. The same span was characterized by an inflation rate of only 6 percent. This shows the extent by which insurance companies have shifted their focus from ensuring that Americans receive affordable healthcare to generating maximum profits. The huge resistance to keep freestanding emergency centers in-network, increasing the deductibles and the predatory low reimbursements, have resulted in shifting of healthcare costs to the patients.

The federal law and the state law require insurance companies to pay the full in-network benefits for all licensed emergency rooms in the state. This is to be done regardless of whether or not the emergency room has been contracted with the insurer. However, insurers often go against these laws by processing freestanding emergency center claims at out-of-network rates. The result is that policyholders end up being inhibited from accessing their full coverage. The consequent result is higher patient responsibility in the form of a surprise bill. A patient seeking an explanation for the same will always be hit with the false excuse that the cost comes as a result of increase billing by the healthcare providers while the truth is that they have cut their coverage for profit purposes.

Another misinformation from the side of health insurance companies is that freestanding emergency centers confuse their patients with regards to the offered services. Again, this is just a blanket they use to cover the fact that they are driven by the desire to create profits as opposed to providing efficient health care coverage to their customers. The good thing now is that laws are being put in place to prevent this kind of misinformation. In Texas, the law requires freestanding emergency centers to post signage inside and outside of their buildings that clearly state that they are emergency facilities. Additionally, patients have to provide written acknowledgment of the same. This law has yielded very positive results. The Texas Department of Insurance has been receiving fewer insurance coverage complaints.

When the model of freestanding emergency centers was introduced into the United States healthcare system, there was a lot of excitement and optimism that the freestanding emergency centers would help in solving the health crisis in the country. The model helps make emergency health care more accessible to the citizens, especially those in the rural areas, helps reduce the pressure that full-service hospitals are subjected to and saves thousands of dollars of medical expenses since they admit patients at a much lower rate.

However, insurance companies have come to take advantage of the nonexistence of clear guidelines to govern the existing laws. Their focus has always been to make more profits resulting in the derailment of this innovative model of providing emergency care to patients. As such, it is important that lawmakers make it their priority to establish clear laws and guidelines that will ensure oversight of insurance companies. Otherwise, the potential benefits that freestanding emergency care facilities provide will never be enjoyed.

Do Freestanding Emergency Centers purposely saddle patients with surprise medical bills?

Do Freestanding Emergency Centers purposely saddle patients with surprise medical bills?

Freestanding emergency centers have experienced rapid growth in recent years. This only proves that they offer real value for money. Otherwise, patients would have shunned them by now and they would have died a natural death. Despite this growth and the real value, they offer patients, FECs have been the victim of numerous falsehoods. One of the myths that FECs such as Bellaire ER face is that they saddle patients with surprise medical bills. This article will examine this falsehood and seek to dispel it completely.

FECs could actually help to lower the cost of healthcare

A recent study by the University of Michigan, which was undertaken in 2010, found that the average cost of inpatient care was about $35,000 per patient. This is quite a lot for any one patient to bear, considering that they have other bills and that their insurer probably will not cover such a huge bill.

It was found that outpatient ER care could actually help to lower this cost. However, since traditional ERs have an interest in getting patients into inpatient care, this may not always work well. FECs are not bound to any hospital, and they thus do not have an interest in the patient being admitted. It is thus likely that patients will get to go home when there is no need for an overnight stay. This could help them to lower medical costs

Surveys show that it is not the case

Numerous scientific surveys conducted by TAFEC show that a huge majority of patients are well aware of the bills they are supposed to pay. Thus, they do not complain about being hit with unexpected bills. This is contrary to the myth that many patients usually end up with surprise bills.

It is the insurers who are at fault and not the FECs

Under Texas law, there is a loophole, which sometimes leads to predatory behavior by insurers. The law in Texas says that emergency care must be reimbursed to health care centers at a “usual and customary” rate. However, the law is silent about what “usual and customary” means. The insurers thus take great liberty when coming up with a definition for each case. Thus, while some insurers will give adequate reimbursement, others will not.

The FEC is left with the option to collect the debt from the patient or get in touch with the Texas Department of insurance. Some will go to the department, while others will go to the patient. In all honesty, it is the easiest decision as it helps to free them up to run the FEC. The patient can then take up the issue with the department if they feel their insurer acted in bad faith.

Some patients just do not understand the law

The Affordable Care Act makes it clear that all patients have a right to receive emergency care. Thus, a person cannot be penalized for going to an FEC for care. The ACA leaves the determination of what is emergency care up to the patient. Whenever the patient feels they have an emergency, they are at liberty to visit an FEC, whether it is in-network or not.

However, there are numerous health plans that are not compliant with these rules. When making a determination, they do not uphold the patient’s decision to visit the FEC based on their personal assessment. They make their own determination and pay less than they should. This is what leaves patients with surprise bills. However, if patients understood the rules, they would challenge this illegal activity by some insurers. The blame is thus unfairly laid on the FEC.

Billing mistakes occur

Sometimes simple billing mistakes occur. Remember that FECs are open 24/7, which means they are always handling new patients. There is no off peak time during which they can rest and get things in order. It is thus up to you to check the bill carefully to ensure that it contains no mistakes.

Many mistakes may occur including the wrong billing code, wrong procedures, or diagnosis being included, or even the wrong name. A few minutes checking the bill for problems could help to save you many problems associated with an incorrect bill.

The insurance company may be taking its sweet time to pay

Sometimes, some insurers will take their sweet time to pay the bill in the hope that you will pay it. It is morally wrong. It is thus important for you to pursue your insurer when you are hit with unpaid bills. Record every conversation with your doctor and the insurer and pursue them to the end. Eventually, they will fess up if they have no legal ground on which to stand. If your insurer is prone to such games, you may want to think about changing insurers. However, it goes to show that the FECs are not at fault. They cannot be held responsible for the mischievous actions of your insurer.

Are Hospital ERs required to treat all patients?

Are Hospital ERs required to treat all patients?

There are many healthcare providers in the American healthcare system. All of these providers have different functionalities and adhere to different rules and regulations that guide them. Due to this complexity in the healthcare system, it is easy for patients to be confused. Bellaire ER has decided to compose this article to enlighten patients on hospital ERs, how they function and how they differ from other types of ERs.

Hospital ERs

Hospital emergency rooms are the most common type ER. These are emergency rooms that are attached to a hospital and offer quality care to patients with emergency cases.

The hospital ERs differ from freestanding emergency centers (FEC) in that the hospital ERs are located at the site of the hospital while the FECs are physically detached from the affiliated hospital. An FEC also doesn’t have to be affiliated to a hospital as it can be independently run.

Despite these differences, hospital ERs as well as FECs, whether hospital owned or independently run, offer the same kind of medical care for their patients. The emergency rooms provide quality care to patients with a health emergency by prioritizing them an offering quality and timely care.

Hospital ERs also accept Medicare and Medicaid insured patients since they are recognized by the Centers for Medicare and Medicaid Services. This is unlike the independent FECs which are not recognized by this body, and hence they can’t accept the government-run health insurance plans. Hospital ERs are also required to put up notices to inform their patients that they accept Medicare and Medicaid.

Emergency care

The hospital ERs also have to abide by the federal regulations regarding emergency care. The Emergency Medical Treatment and Labor Act (EMTALA) is one of the most prominent federal regulations regarding emergency care. This Act requires the hospital ERs to offer emergency treatment to all patients regardless of their ability to pay. In other words, the hospital ERs are required to treat all patients who visit them with a problem that can be considered as a health emergency.

The hospital ERs should offer the emergency care without discrimination to all people regardless of their financial or insurance status, gender, age or race.

Hospital owned FECs are also required to adhere to EMTALA. In contrast, independent FECs are not required to follow EMTALA, and hence they can deny emergency care to a patient if he or she doesn’t have the ability to pay. However, in some states, such as Texas, there are state laws that mirror EMTALA and require the independent FECs to offer emergency care to all patients.

When a patient visits a hospital ER for emergency treatment, he or she has to undergo proper screening and be stabilized before the hospital can discuss payment with them. In Texas, the law mandates that insurers should reimburse for the cost of emergency care to a patient at an in-network rate even if the hospital ER is out of network. This law also applies to FECs.

Non-emergency care

When dealing with non-emergency care, hospital ERs might turn a patient away if he/she doesn’t have the ability to pay. This is for the privately owned hospitals. Patients with non-emergency cases cannot be turned away at a public hospital ER.

Access

Hospital ERs might be hard to access for many patients. This is because hospitals are usually located on the outskirts of cities. This is one of the reasons why FECs are a necessity. FECs can be located closer to where people are such as in neighborhoods and shopping centers. The quick accessibility provided by the FECs proves critical in emergency situations as every second counts. The FECs, therefore, help to reduce the travel time for emergency cases.

The only advantage when visiting a hospital ER compared to an FEC is in hospital transfers. In hospital ERs, a patient who needs to be admitted is ushered into the hospital with minimal effort. If the ER is an FEC, the patient will need to be transported to the hospital.

Overcrowding

Hospital ERs are notorious for overcrowding as many people come here to seek medical attention. The overcrowding causes a strain on resources the staff struggle to offer quality care to all patients.

Since ERs prioritize emergencies over other treatments, people with non-emergency problems can experience extremely long wait times, especially if there is are multiple emergencies.

This is one of the reasons why patients might prefer to visit an FEC instead of a hospital ER. FECs are rarely crowded, and they offer quality care. The wait times in FECs might be less than 10 minutes. Since the FECs are not overcrowded, the doctor can take some quality time to diagnose you correctly. Also, emergency cases can be attended to immediately with the full array of physicians and medical equipment on standby.

In summary, hospital ERs can treat all patients, but they are not required to unless it’s in a public hospital. The hospital ERs are, however, required to treat all emergency patients.

Are Freestanding Emergency Centers real emergency rooms?

Are Freestanding Emergency Centers real emergency rooms?

Freestanding emergency centers such as Bellaire ER in the US have experienced phenomenal growth in the recent past. They offer a model of health care that is committed to speed, quality, and ensuring patients get access to physicians. There have been many misconceptions around these FECs that need to be cleared. One of the popular myths is that they are not real emergency rooms. However, this is just a myth, as the facts presented here will show.

They are bound by the same rules as emergency rooms

The first state to license FECs was Texas, in 2009. Today, it has led to over 200 independent FECs in the state and over 100 hospital-affiliated ones. These FECS are usually found within neighborhoods, and they offer patients care in a timely manner.
The FECs are bound by the same rules as other hospital ERs. The rules that were drafted for the establishment of the FECs are similar to those that govern all ERs in the country. Thus, this cannot be true that they are not true ERs.

FECs cannot turn away any patient who needs emergency care

Just like an ER, an FEC is bound by the law to offer patient care to anyone who turns up at its doorstep. This is quite similar to what happens when you walk into an ER. Whether you are on Medicaid, Medicare or uninsured, you have to be stabilized at the FEC. This has led to millions of uncompensated hours spent stabilizing patients in different stages of distress. It is just more proof that an FEC is the same as an ER.

FECs must have a doctor trained in emergency care present at all times

One of the cardinal rules for any ER is that a doctor, trained in emergency care has to be present there at all times. Otherwise, it cannot be classified as an ER. There are also huge legal penalties for failing to uphold this rule. It is the same in an FEC; a doctor must be on call at all times to cater to patients who need their services.

FECs must be open 24/7, 365 days a year

Even when a hospital has to shut down some of its operations, the emergency room must always be open. This is the same rule as with an FEC. Patients must be able to gain access to it whenever they wish and whatever their situation. The only difference to a hospital based ER is that it does not need to be bound to a hospital. This makes an FEC the same as an ER but even more convenient. Patients do not have to worry about a ride to the hospital when the FEC is located within their neighborhood.

FECs can use the word “Emergency” in their signage and marketing material

This is quite significant proof that FECs are the same as an emergency room. If you check the law, it states that only an emergency room can use the word “Emergency” in its signage and marketing material. This is done to prevent confusing that may arise where patients are led to believe they are at an urgent care center. FECs have been allowed by law to use the word “Emergency.” This proves that they are indeed emergency rooms for purposes of legal definitions.

FECs must have a nurse trained in emergency care present at all times
This is another rule that makes them the same as any other emergency room. When you go to a hospital ER, you will usually find nurses present trying to offer quick care to patients and refer the rest to the doctor. This is the same with an FEC. However, one difference may be that FECs are usually less crowded. Thus, you will still get access to an ER nurse, but one who is under less pressure since they are dealing with fewer people.

FECs can only stabilize patients and refer them to hospitals for inpatient care

If FECs were just any other health facility, they would be allowed by law to provide inpatient care. However, that cannot be possible. They can only stabilize patients before letting them go to a hospital for inpatient care. It is just more proof that an FEC is no different from an ER. In an ER, only patients who are being stabilized occupy beds. Once they are stable, they are shifted to the hospital. This is also, what happens in an FEC. It just proves they are no different from an ER attached to a hospital.

FECs are required to have the equipment used to screen and diagnose emergency room cases

If FECs were indeed different from an ER, this rule would not apply to them. They must have the basic equipment present in an ER. They also have to have staff that can use the equipment to make a diagnosis and to stabilize patients.

What is the Health Insurance System Like in Texas?

What is the Health Insurance System Like in Texas?

Texas leads the uninsured rate in the US. Although the number of uninsured people is steadily declining, 17 percent of the population remains uninsured. The high uninsured rate partly reflects the insurance system in Texas. Bellaire ER sought to breakdown the Texas health insurance system for an in depth look.

Affordable Care Act

The ACA has a significant impact on the Texas health insurance system. Under this act, more people were able to get health insurance, and the number of uninsured people dropped to below 20 percent for the first time.

Part of the reason why there was a drop in the number of uninsured is that the ACA prohibited health insurers from refusing to grant people insurance due to a preexisting condition. Therefore, more people who had preexisting conditions were able to enroll.

The ACA also imposed a tax penalty for those who did not get health insurance. This incentivized people to get insured.

The ACA required states to create a statewide marketplace. Those that didn’t would use the federally facilitated marketplace. Texas is one of the states that have a federally facilitated marketplace. There are also private marketplaces for private insurers who don’t list their plans on the federal exchange.

CHIP

The Children’s Health Insurance Program (CHIP) insurance cover is meant for children whose parents might not qualify for Medicaid. This might be because the parents’ income exceeds the maximum required income for them to qualify for Medicaid. CHIP has seen most of the children in Texas get health insurance. This has caused a large disparity between the rate of uninsured adults and children. CHIP makes it easy for children to access medical insurance while strict restrictions on Medicaid make it harder for adults to enter the program.

Medicaid

Texas is also one of the states that rejected Medicaid expansion. The expansion was meant to increase the bracket of low income earners that would be able to get health insurance under Medicaid. The expanded bracket includes adults and parents who earn less than 138 percent below the federal poverty level.

However in Texas, since the state rejected Medicaid expansion, adults who do not have disabilities and are not caring for any child do not qualify for Medicaid. Adults who have dependent children only qualify if their household income is less than 18 percent of the federal poverty level.

Private insurers

Texas has a large number of private health insurance providers. Blue Cross and Blue Shield (BCBS) is the largest insurance provider in the individual market. BCBS holds more than half of the individual market share in Texas. Other insurers include FirstCare and Baylor Scott &
White.

There are also national carriers operating in the Texas individual market. These providers include Humana, UnitedHealthcare, and Aetna.

Market plans

There are various market plans for health insurance used in Texas. Exclusive provider organization (EPO), health maintenance organization (HMO), and point of service (POS) are the most common plans. EPO requires you to visit a certain physician or facility within the plan network. HMO covers in-network hospitals and doctors. POS covers healthcare providers within the network and requires you to get a referral to see a specialist.

Preferred Provider Organization (PPO) was a popular market plan before 2016. The plan does not require you to get a referral from your PCP when you need to see a specialist. You can also visit other out-of-network practitioners, but you will have to cater for more out-of-pocket costs.

In 2016 BCBS realized huge losses and decided to discontinue the PPO plan for its clients. Almost all other insurers did the same. Nowadays it has become difficult to find a health insurer offering the PPO plan.

All the plans listed above are mandated to cover emergency costs whether in-network or out-of-network.

Uninsured

Texas still has a large portion of its population that is uninsured. This might be partly due to the following:

Immigration
Texas hosts a large number of immigrants. This is a major factor for the state since it is located on the border with Mexico. 17 percent of the Texas population is made up of immigrants. Generally, immigrants have the lowest rate of health insurance. Among the immigrant population is the undocumented immigrants. These people cannot acquire health insurance legally, and hence the whole undocumented immigrant community doe not have health insurance.

Medicaid restrictions
Texas has some of the most stringent restrictions on joining Medicaid in the US. The state’s refusal to expand the Medicaid program means that a large portion of low income earners cannot enroll for the health insurance. The low maximum income limit of 18 percent below FPL also locks many people out of the program.

Lack of work insurance
Many small businesses in Texas do not offer health insurance to their workers. Most of these businesses are in the retail, agricultural, and service industries which are unlikely to offer health insurance. Since this is not one of the requirements of the ACA, the rates of the uninsured remain high.

TAFEC ADDRESSES TOP 5 MYTHS ABOUT FREESTANDING ERS

TAFEC ADDRESSES TOP 5 MYTHS ABOUT FREESTANDING ERS

The fast growth of freestanding emergency care centers such as Bellaire ER in the US is helping to transform how patients receive emergency care in the country. This model, which is focused on speed, convenience, and getting the patients optimal time with doctors has continued to thrive despite numerous misconceptions.

It is especially so in Texas, which in 2009, became the first state to allow independent FECs. Today there are over 200 independent FECs and over 100 that are hospital-affiliated. These FECs are located close to patients, which helps to save critical time that could be the difference between life and death.

According to TAFEC, this growth in FECs is a testament to the fact that they are beneficial to communities and patients whom they serve. In that regard, they wanted to dispel myths that have cropped up around these facilities.

FECs are not true emergency rooms
This is a popular myth that is basd on a misconception. FECs get the same licensing rules as hospital ERs. This is done to ensure that patients can get the same quality of service. For instance, each FEC has to have a physician trained in emergency care and a registered nurse on site at all times. Besides that, they have to operate 24/7 all year and have the equipment needed to diagnose and treat an emergency.

FECs often give patients surprise medical bills, popularly referred to as balance billing
The facts show that based on numerous patients surveys, most patients are well aware of the FEC billing they are likely to get. However, in instances where patients have been hit with surprise bills, it has been due to the predatory nature of their insurer or a lack of clear understanding of what they are covered for by the insurer.

This problem can be traced back to insurance laws in Texas that say health care providers should be reimbursed a “usual and customary rate.” Since this is quite ambiguous, insurers determine their own rates that ensure they pay the least amount possible. This leaves the FEC with few options; they can collect from the patient or file a case with the Texas department of insurance.

Another reason is that the Affordable Care Act makes it illegal to penalize a person for receiving emergency care. It is left to him or her to determine when he or she is suffering from an emergency. However, many insurers flaunt this rule. They thus pay much less for out-of-network care.

The other reason for surprise billing is that the patient may not understand his or her own insurance plan. Thus, the patient ends up with a plan that has high out of pocket costs as designated in their plan. It is for this reason that TAFEC is committed to educating people on their health insurance plans.

FECs, unlike ERs, do not have to attend to all patients
This is just a myth. FECs are required to offer critical care to every patient that walks through the door. That means Medicaid, Medicare, and uninsured people will all get care when they walk through the door. The law requires that they offer medical screening and stabilize every patient at the facility. This results to millions of dollars of uncompensated care every year, which makes them a crucial resource for their community.

FECs price gouge patients by deliberately making them believe that they are at an urgent care center

All FECs ensure they offer patients high-quality emergency care. They do not pretend to offer urgent care to their patients to price gouge them. Besides that, the law in Texas has provided guidelines to ensure that FECs offer the same level of care as hospital ERs. All of these facilities will have huge signs with the word “Emergency” clearly displayed on them. Besides that, it is in the billing disclosures, which patients have to sign showing they are in an emergency room. It is worth noting that the law makes it clear that only emergency care facilities can use the word “Emergency.”

The cost of healthcare rises when you use FECs

Studies have been done to show this is not true. For instance, a study in 2010 by the University of Michigan showed that average cost for admitted patients is $35,000. It has been shown by some studies that FECs could actually help to cut down the admission rates of patients. This can lead to more efficiency and reduce the cost of healthcare. The reason for this is that there is no incentive for them to push patients to hospital beds.

Who is TAFEC

It is an acronym for the Texas Association of Freestanding Emergency Centers. It is the only such statewide association in the US. It is an organization whose only role is to represent FECs. The organization works to ensure that its members offer patients timely and high-quality emergency care at all times.

How Telemedicine will Change how we see Doctors in Future

3 Sep 2017 General Health

How Telemedicine will Change how we see Doctors in Future

The wave of telemedicine is huge and still taking over the medical scene. Telemedicine has been with us for more than half a decade, but its impact has never been felt as it is now. The segment of the population that is in need of medical attention daily is huge and constantly growing. But then we have the internet and technology that provides avenues for people to interact and share. This opens the way for telemedicine and Bellaire ER thinks that how we see doctors will be completely different in the near future.

Life is hectic enough by itself. Having to put other things on halt for you not to miss your scheduled appointment with the doctor becomes another headache in itself. To make it even worse, most of the times one has to sacrifice their lunch break or their weekend time with their family and use that time for the appointment instead. These are some of the scenarios that telemedicine could eliminate in the near future. The future presents us with doctors who have schedules that are more flexible.

Virtual appointments with the doctor

One of the ways telemedicine will improve the interaction between doctors and their patients is through virtual in-person visits. It is estimated that by 2024, about 35% of the visits to the doctor will be exclusively on the online platform. At the moment, some doctors are offering online portals and video calls to their patients from where patients can get diagnoses and prescriptions.
As time progresses, it will be possible for one to gather their own personal health data using their basic home devices like a smartphone and relay the data to their physician directly. This will eliminate the need to visit the doctor physically unless the medical condition really requires a personal visit.

Instant access to doctors

With the availability of virtual appointments, the time taken for a doctor to serve one patient will be greatly reduced, meaning that doctors will be able to serve more patients. Telemedicine will allow for patients to access available physicians instantly without having to wait. This will be an improvement from the current situation where a visit to the physician is characterized by possibly long journeys to the medical facilities and even longer waits in line for your turn, to be served.

More efficient utilization of inpatient time

In addition to the improved access to doctors, the inpatient time will also be utilized in a much better way. This begins with the elimination of the time one would have to travel to the doctor and wait in the waiting room for their turn. Form completion will also be much easier since it will be filled prior to the virtual appointment. The more flexible schedules and time in the hands of the physicians add to the list of factors that will possibly make in-patient time be utilized more effectively in future.

Telemedicine creates room for much cheaper visits to the doctor

When you come to think of it, delivering healthcare via apps, phone, email or web cam makes more sense strategically and financially. The most obvious advantage is with regards to time. It is much cheaper with regards to time resource. On the aspect of finances, the patient has more control. This means that they do not have to cater for their travel expenses and possible extra charges that are currently charged when you visit a health facility. Research has shown that more than a half of the people who visit the ER go there for minor treatments that cannot be categorized as emergencies. They end up being charged the extra equipment fee that they could have avoided. Telemedicine provides a different way for patients to access the same medical diagnosis and treatment services without bearing such additional and unnecessary costs.

Easy follow-up with the doctor

In future, you can expect more effective follow-up services with your doctor. A simple internet connection and a smart device will be enough to allow your doctor monitor your condition more effectively. You can simply collect your own health data and relay it to the doctor immediately. Live examination is actually possible at the moment where the doctor can conduct follow-up examination in real-time via a video chat, although the technology is limited.

Preventive care to help maintain patients’ health

Another possible way telemedicine is going to change the medicine landscape and how we see doctors is by changing the primary focus of the doctors. As opposed to waiting for patients to fall ill, they can offer the resources to help keep them healthy instead. Doctors around the world have been practicing this for some time now. There are a good number of doctors who have online resources for their patients like yoga studios, health and wellness channels and many other resources that help promote the health of their patients. So instead of patients just going to the doctor for treatment, they can go to them for healthy living tips too.

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