The senate passed legislation Thursday night to expand the State Children’s Health Insurance Program (SCHIP) which provides health insurance to children whose families make to much money to get Medicaid, but can’t afford private insurance.

Under the new bill coverage of US children is expected to increase from 6.6 million to 9.8 million. The estimated cost of this expansion is almost 35 billion dollars to be funded primarily by increases in tobacco taxes.

Every industry from finance to technology is full of acronyms and healthcare is no different. Often people recognize the acronyms but may not actually know what it stands for and a HMO is prime example. HMO stands for Health Maintenance Organization and are the oldest form of managed care plan. HMOs offer members a range of health benefits, including preventive care, for a set monthly fee.

Pre-existing conditions were addressed as significant problems Michael Moore’s recent documentary, Sicko. While pre-existing conditions can present some challenges to patients, in the past decade Federal laws have been passed to limit the amount of latitude that health insurers have in denying care based upon a pre-existing condition.

Choosing a primary care physician(PCP) is a key decision in creating your healthcare plan. Some things you might want to find out are size of practice (large group of physicians vs. solo practitioner), whether the physician is affiliated with an academic medical center, the length of time in practice, number of patients he currently manages, and how much time the physician spends on average with patients during the first visit and for subsequent visits. Below are more questions you may want to ask. This is a short list of questions. You should modify it or supplement it with questions that are specific to your needs and interests.

In determining the values that you want to drive your healthcare planning and decision making, ask yourself what are the most important attributes of your healthcare providers and the healthcare process that you are looking for? What matters most to you? It is important to remember that you are the “customer”. In healthcare, often we feel disadvantaged. This feeling can be due to any number of issues including our lack of expert knowledge, feeling less powerful because we are sick, or feeling less powerful because our bill is being paid by the insurance company and not us (in many or most cases). Keep this in mind. You are the customer, and the customer “rules”.

Hospitalists are physicians whose main focus is the general medical care of hospitalized patients. The term hospitalist was coined in 1996, so it is a relatively new focus for primary care physicians. The hospitalist concept works like this. You become ill and your primary care physician determines that you need to be admitted to the hospital. If your physician admits to a hospital that employs hospitalists, he may have the option (or in some cases be required) to hand over your care to one of the hospitalists until you are discharged.

There are many methods and resources available to you to find a primary care practitioner(PCP). Using resources and referrals is important, but before you begin that part of your search, you should create a specific set of activities that you will follow to select your physician. For example, the following PCP search criteria will help you to get to your best choice without leaving out any important criteria:

1. Identify what is important to you in a physician
   
2. Create the list of credible resources you will use to check out possible physicians
   
3. Create your “short list” of physicians
   
4. Create a list of questions to ask the physician or office staff
   
5. Call their offices and create an even “shorter list” based on responses
   
6. Visit, if possible, to make an on-site inspection
   
7. Make your selection
   

Do you take the opportunity to give direct feedback to your healthcare providers? As Ken Blanchard says in his book Management of Organizational Behavior: Leading Human Resources, “feedback is the breakfast of champions.” We conducted interviews and collected data from almost 2,000 healthcare consumers. Most consumers had both positive and negative experiences with their health care providers. Most of their complaints were specific to a doctor—something he or she did or did not do, something they said, or the way they said it. In most cases, it was clear that these patients were still upset about the encounter and the way the physician handled it. In each case, when asked if they told the doctor how they felt, they said no. Perhaps if they would have given the feedback and had the physician attempt to resolve it or work with them on the issue, their feeling about the encounter would have been different.

People use acronyms everyday and often they become so commonly used that many people aren’t really sure what they stand for and may be embarrassed to ask. An earlier post discussed what an HMO is and a PPO is another good example of an acronym you may not fully understand.

Any medical school graduate who wants to practice medicine and become a licensed physician must complete an internship (1 year) and a residency (at least 3 years) in a US teaching hospital. Interns and residents are employees of the hospital. Their salaries are subsidized by Medicare and the Federal government, but their day to day instruction is managed by the hospital that employs them. The Accreditation Council for Graduate Medical Education (ACGME) governs residency education and training requirements. The ACGME competencies for resident training are in six basic areas:

1. Patient care
   
2. Medical knowledge
   
3. Practice-based learning and improvement
   
4. Interpersonal and communication skills
   
5. Professionalism
   
6. System-based practice
   

At 122 years old, Madame Jeanne Calment has the longest recorded lifespan. Her picture has been the focus of testimony before the President’s Council on Bioethics. Extending lifespan is considered an issue of ethics because of the issues that it presents today. In the past, average lifespan increased significantly because we virtually eradicated infant mortality and childhood diseases. Now, the focus on extending life is at the other end of the spectrum. On one hand, the concept of extending life to include more folks the age of Madame Calment is invigorating. On the other hand, if extension of life at the older end of the spectrum is accompanied by an increase in dementia, Alzheimer’s disease and an increased inability to live the end of your life with dignity, this research itself should be, and is, subject to ethical scrutiny. It is a topic to be aware of, especially as each of us and our parents and grandparents age. More information on the topic can be found on the President’s Council on Bioethics Web site: www.bioethics.gov.

Knowing when to get a second opinion can be difficult, below contains a list of common reasons why you may want to seek out a second opinion.

• Your doctor says you need major surgery
• You question whether surgery is the only option for your condition
• You have a chronic condition that seems to be getting worse, with no explanation for why
• Your regular doctor can't diagnose your problem
• You have trouble talking with your current doctor(s)
• Your medical condition isn’t improving
• You have been diagnosed with a life-threatening disease
• Your doctor recommends having a second surgery
• You have multiple medical problems
• Your physician recommends getting a second opinion
• You have a newly diagnosed chronic condition that will require long term medications

For the 15 percent or almost 47 million Americans who are not currently insured, there are a myriad of resources that can be tapped. These resources may also be available to you if you have insurance, but you will likely have certain limits or exclusions. And, some of these resources, like participation in clinical trials, are available to anyone who meets the clinical criteria, regardless of ability to pay.

Earlier posts discussed what an HMO and PPO are as a way to better explain some of the acronyms used in the healthcare industry. POS is another common type of plan that many of you may have heard of and are wondering what exactly is a POS plan?

Too many medical terminology seems like a foreign language. Just like any foreign language, it has its own vocabulary and methods for combining words in an acceptable and understandable format. One reason medical terminology is so confusing is that so many of the words spoken by your doctor are words that sound familiar to us. By understanding some basics of medical terminology and how to combine different prefixes, suffixes and root words you can decipher complex medical terms.

For example if you add –itis to the end of any word, it means “inflammation of”. The word Esophagitis then, means inflammation of the esophagus. Below is a listing of common prefixes, suffixes and root terms.