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medicine

Medical groups clash over insurance coverage of herbal medicine


By Lee Hyo-jin

A pilot program rolled out by the government to include several types of herbal medicine in treatments covered by national health insurance was welcomed by practitioners of traditional Korean medicine. It, however, immediately provoked backlash from Western medical doctors.

As the government has plans to expand the coverage for more herbal medicine in the future following the progress of the trial program, the mixed reactions of the two medical groups may deepen into another dispute.

Under the pilot program, which started on Nov. 20, patients at traditional Korean medicine clinics who are prescribed treatments for menstrual pain, facial paralysis, or the aftereffects of cerebrovascular diseases, pay only half of the fee for the herbal medicine, as the rest is covered by state insurance.

The three-year test run is aimed at reducing the financial burden of patients and establishing a verified system to ensure the safety and effectiveness of herbal medicine, according to the Ministry of Health and Welfare.

Around 8,700 clinics providing traditional Korean medicine treatments across the country ― approximately 62 percent of the total ― have agreed to participate in the program.

Why Western medical doctors oppose

The announcement was immediately met with strong backlash from the Korea Medical Association (KMA), the largest Western medical doctors’ group in the country with more than 130,000 members. The association strongly condemned the government’s decision through a press release, calling it a “nationwide clinical trial using unverified medicine.”

They argued that easing public access to traditional Korean medicine and related herbal therapy will pose a risk to people’s health as they claim the safety of the treatments have not been adequately verified and there is no scientific evidence for their efficacy.

The association also pointed out that the program may lead to poor quality of herbal medicine, due to a shortage of certified herbal medication dispensaries and lenient control over them. While most small traditional Korean medicine clinics have own dispensaries, some large ones have outside dispensaries make the medicine.

“There are only five outside herbal medication dispensaries in the country certified by the government. This means that those five facilities will be preparing all the herbal medicines for over 8,700 clinics during the pilot program period,” KMA member Kim Gyo-woong said at a press conference, Nov. 23.

“The mass production system may lead to failure in quality control and safety issues, and considering the current lax control over dispensaries, the system may lead to illicit manufacturing of drugs,” he added.

In addition, the KMA stressed that the health authorities should focus more on the unresolved issues surrounding the side effects of traditional medicine.

More than half of medical disputes reported in relation to traditional medicine treatments were about herbal medicine, followed by Chuna manual therapy, acupuncture, and skin care, the association said, citing recent data from the Korea Consumer Agency.

“The government must immediately retract the policy which only puts public safety at risk, and launch a full investigation on all herbal dispensaries and prohibit the operation

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health

MDSAVE ECOMMERCE TOOL HELPS INSURERS MEET NEW FEDERAL “TRANSPARENCY IN COVERAGE” REGULATIONS

The October 29, 2020 Federal Rule requires that insurers offer patients a tool to research their financial responsibility and both in-network and out-of-network negotiated rates. The MDsave tool, available now, enables 24/7, consumer-friendly price research and allows patients to purchase their care upfront without fear of surprise bills.

BRENTWOOD, Tenn., Oct. 30, 2020 (GLOBE NEWSWIRE) — MDsave, the leading health technology company in transparent, shoppable medical care, announces its ecommerce solution to help insurers meet new transparency requirements issued in an October 29th Final Rule. The Rule, issued jointly by the Departments of Health and Human Services, Labor, and the Treasury, mandates the creation of “an internet-based, self-service tool” that provides “personalized out-of-pocket cost information, and the underlying negotiated rates, for all covered health care items and services,” according to the Transparency in Coverage Final Rule Fact Sheet.

The MDsave transparency tool provides a user-friendly, ecommerce interface that allows patients to instantly purchase a procedure of their choice directly from the website, in addition to enabling personalized cost searches for the required 500 shoppable services and hosting machine-readable files containing all negotiated charges. 

Because each procedure on the MDsave platform includes the most commonly related services and their fees, patients can pay for the entire episode of care upfront without fear of surprise bills.

“Our ecommerce transparency platform is already being implemented for hospitals meeting the January 1, 2021 transparency deadline, so the technology is ready for insurers who want to provide a great patient experience but don’t want to build a tool from the ground up,” explains Greg Born, MDsave President and COO. “We have the platform, the searchability and the transaction capability. All insurers need to provide is the data.”

Insurers must launch their online self-service transparency tools for plan years starting January 1, 2023 for the federally specified 500 shoppable services and plan years starting January 1, 2024 for any remaining services or items.

To learn more, visit MDsave.com/price-transparency. 

About MDsave

Co-located in Brentwood, Tenn. and San Francisco, Calif., MDsave is the world’s first online healthcare marketplace, bringing together patients seeking affordable, reliable care with providers offering high-quality services at fair prices. Using cutting-edge technology, MDsave simplifies the healthcare billing process for patients and providers alike through negotiated rates, bundled pricing and upfront payment. The MDsave marketplace also helps employers and payers offer more value to employees and policyholders with out-of-pocket deductible costs. For more information, visit http://www.mdsave.com.

CONTACT: Kate Steurer MDsave 615-814-6260 [email protected]

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health

Medicare and CPAP machines: Coverage, treatments, and costs

Medicare covers some durable medical equipment (DME), including a continuous positive airway pressure (CPAP) machine, when a doctor prescribes it for home use. Medicare Advantage plans may also cover CPAP therapy.

Medicare typically covers CPAP therapy for people who have a condition called obstructive sleep apnea.

This article discusses the types of sleep apnea and some of the treatments for the condition. It also looks at Medicare coverage.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

  • Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
  • Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
  • Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

Sleep apnea is a condition in which a person temporarily stops breathing while asleep. The pauses in breathing are usually at least 10 seconds long and may last for more than a minute, according to the American Sleep Apnea Association (ASAA). These pauses may occur hundreds of times a night.

Types of sleep apnea

The three main types of sleep apnea are:

  • Obstructive sleep apnea: This condition happens when a person’s airway becomes blocked during sleep. It can occur if the soft tissue at the back of the throat collapses and creates a blockage.
  • Central sleep apnea: This condition happens when a person’s brain does not send the appropriate signal to the muscles that play a role in breathing.
  • Mixed sleep apnea: This condition is a combination of obstructive and central sleep apnea.

Obstructive sleep apnea is the most common type of sleep apnea.

Causes of sleep apnea

According to the National Heart, Lung, and Blood Institute (NHLBI), the causes of obstructive sleep apnea include:

  • obesity
  • large tonsils
  • heart or kidney failure, which may cause fluid buildup in the neck
  • genetic syndromes that affect facial structure

A person with sleep apnea may not know that they have the condition. They might only become aware of it because a partner or family member notices that the person’s breathing is irregular while sleeping.

Sleep apnea typically prevents a person from having deep, restful sleep.

Symptoms of sleep apnea

According to the NHLBI, the signs and symptoms of sleep apnea may include:

  • excessive daytime sleepiness
  • loud snoring
  • gasping for air while asleep
  • morning headaches
  • trouble concentrating

Sleep apnea may also increase a person’s risk for certain conditions, including:

Read more about sleep apnea here.

The most common treatment for someone with moderate-to-severe sleep apnea is a breathing device, such as a CPAP machine. CPAP therapy delivers a flow of air through a mask to help keep the airway open while a person is asleep.

Other potential treatments for sleep apnea include:

  • Oral appliance therapy: A person wears a custom-fitted
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health

Attacks on Obamacare threaten coverage gains among minorities

Threats to Obamacare could deal a new blow to communities of color that have been disproportionately ravaged by the coronavirus pandemic as the nation is reckoning with generations of inequity.

The Affordable Care Act’s insurance subsidies, its expansions of Medicaid eligibility and its protections for preexisting conditions have especially helped Americans of color, narrowing historic disparities in access to health insurance and affordable care. The coverage gains are among the most significant since the passage of Medicare and Medicaid and the desegregation of American hospitals more than 50 years ago.

Now, President Donald Trump is again threatening to replace the law if he’s reelected. And exactly one week after the election, the Supreme Court, with its new 6-3 conservative majority, will hear oral arguments in a case brought by conservative states seeking to overturn the entire Affordable Care Act. If the law is dismantled, the communities it aided the most stand to lose the most.

“Health care could be ripped away from millions and the numbers of uninsured Americans of color could skyrocket—aggravating the health care disparities that already exist in this country,” said Sen. Tammy Duckworth (D-Ill.). “It’s especially infuriating that this is happening in the middle of a deadly pandemic that is disproportionately devastating so many seniors, Black, Brown and Native Americans and those with pre-existing conditions.”

Between 2013, the year before the Obamacare markets opened and Medicaid expansion began, and 2018, the rate of Latinx adults without health insurance plummeted from 40 percent to 25. The uninsured rate for Black adults fell from 24 percent to 14. For white adults, it dropped from 15 percent to 9, according to the Commonwealth Fund.

“There is no doubt that the Affordable Care Act, though it left millions uninsured, narrowed the racial gap in health insurance coverage and that’s a good thing,” said Mary Bassett, the former New York City health commissioner who is now a professor at Harvard’s School of Public Health. “Having millions suddenly lose their health insurance seems very likely to have an adverse impact.”

If the health law disappeared, the Urban Institute estimated that the gaps would widen once again, almost back to 2013 levels. And that assessment was in 2019 — before the devastation wrought by the coronavirus which is exacerbating inequality, in both health and the economy overall.

Especially affected would be people of color living in one of the 38 states that expanded Medicaid, the joint federal-state health program for low-income people. Without health coverage, many would lose access to much-needed care for chronic health conditions — and become more vulnerable to serious complications from Covid-19.

Trump says he wants a health system that will give people more choice, at less cost. “It’s in court, because Obamacare is no good,” he said at his second and last debate with Democratic challenger Joe Biden.

Even the Affordable Care Act’s backers admit it was not a panacea. Health inequities, some driven by generations of systemic racism, persist. Private insurance remains out of reach

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health

Coverage, tests, equipment, and more

The FreeStyle Libre flash glucose monitoring system allows a person to measure their blood sugar level continually. Medicare will cover some costs of FreeStyle Libre under certain criteria.

An estimated 33% of Medicare enrollees had diabetes in 2016, according to the Kaiser Family Foundation.

This article discusses FreeStyle Libre and diabetes. It also looks at Medicare coverage, additional costs, and where to find Medicare-approved suppliers.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

  • Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
  • Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
  • Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

Diabetes is a medical condition that affects the body’s ability to use or make insulin. There are two main types: type 1 and type 2.

In people with type 1 diabetes, the body does not make sufficient insulin and needs external insulin administration.

Type 2 diabetes means that the body cannot effectively use insulin to manage blood sugar levels. As a result, a person may need insulin injections or medications to improve their body’s ability to use insulin.

Monitoring and maintaining blood sugar levels is vital to a person’s health when they have diabetes. Medicare covers a variety of diabetes medications, testing supplies, and diabetes-related medical visits to help a person manage this condition.

Learn more about diabetes here.

FreeStyle Libre is a continuous glucose monitoring (CGM) system that allows a person to check their blood sugar in real-time without having to prick their finger.

The system has two components: a glucose sensor that the person applies to the skin and a digital reader. A person can apply the sensor to the back of their upper arm and leave it in place for a maximum of 14 days.

The sensor monitors a person’s blood glucose by measuring glucose levels in the interstitial fluid, which is the fluid between the cells and the blood vessels. A person can hold the digital reader over the sensor to obtain a blood glucose reading.

What other CGMs or insulin pumps does Medicare cover?

Medicare also covers the Dexcom G5 CGM, which is another continuous glucose monitoring system.

The Dexcom G5 and FreeStyle Libre are different than insulin pumps, which can monitor and administer insulin. Medicare also covers some types of insulin pumps. A person can talk to their doctor about what monitoring approach may be best for them.

The federally funded health insurance program called Medicare includes:

  • Part A, which offers hospital insurance coverage
  • Part B, which provides coverage for medical insurance
  • Part C, also known as Medicare Advantage, which offers an alternative to original Medicare (Part A and Part B)
  • Part D,
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Coverage, tests, alternatives, and costs

Original Medicare, and some Medicare Advantage plans, cover hernia surgery when it is medically necessary. Similar to other types of surgery, different parts of Medicare may cover certain aspects of care.

The care related to hernia surgery may vary depending on the procedure, the surgical setting, and any complications that develop.

This article describes hernias and hernia surgery, and looks at Medicare coverage, costs, and possible financial assistance.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

  • Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
  • Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
  • Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

A hernia involves a weakness in the muscular tissue that holds an organ in place. The weakness causes the organ to bulge, which creates a lump under the skin. In many cases, a hernia involves the abdominal wall.

Causes

Activities and factors that place pressure on the abdominal wall, and therefore increase a person’s risk of a hernia, may include:

  • chronic straining, such as coughing and constipation
  • strenuous activities that cause straining, such as weightlifting
  • pregnancy
  • being overweight
  • cystic fibrosis
  • enlarged prostate
  • peritoneal dialysis
  • poor nutrition
  • smoking

Types of hernia

There are several types of hernia, with the most common being an inguinal hernia, which involves the lower abdominal wall in the groin area. It is more common in men than in women.

Other types of hernia include:

  • Incisional hernia: A person who had abdominal surgery may get this type of hernia.
  • Femoral hernia: This bulge can appear in the upper part of a person’s thigh, and is less common in men.
  • Hiatal hernia: This hernia is seen in the upper part of the stomach.
  • Umbilical hernia: If the muscle around a person’s belly button does not close after birth, it can result in this type of hernia.

Symptoms

Some people may not have hernia symptoms, and the bulge may be painless and only appears when a person coughs or strains. However, where there are hernia symptoms, they may include:

  • increased pain at the lump
  • pain when lifting
  • increase in the size of the bulge
  • aching at the bulge

Hernia surgery involves repairing the weakness in the muscular tissue. The procedure may depend on the type and size of the hernia.

The two main procedures for hernia surgery include open surgery and laparoscopic repair.

During an open hernia surgery, the surgeon makes a cut over the hernia and places the protruding organ back in place. The surgeon may also put mesh in the abdominal wall to strengthen the area and then close the cut with surgical glue, staples, or stitches.

A laparoscopic repair surgery,

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Medicare finalizing coverage policy for coronavirus vaccine

WASHINGTON (AP) — Medicare will cover the yet-to-be approved coronavirus vaccine free for older people under a policy change expected to be announced shortly, a senior Trump administration official said Tuesday.

The coming announcement from the Centers for Medicare and Medicaid Services aims to align the time-consuming process for securing Medicare coverage of a new vaccine, drug or treatment with the rapid campaign to have a coronavirus vaccine ready for initial distribution once it is ready, possibly as early as the end of the year.

It’s questionable under normal circumstances if Medicare can pay for a drug that receives emergency use authorization from the Food and Drug Administration, as expected for the eventual coronavirus vaccine. Emergency use designation is a step short of full approval.

The administration official said Medicare’s announcement will try to resolve several legal technicalities that could conceivably get in the way of delivering free vaccines to millions of seniors, a high-risk group for COVID-19, the disease caused by the coronavirus. The official spoke to The Associated Press on the condition of anonymity to discuss a pending regulation.

President Donald Trump and lawmakers of both parties in Congress have spelled out their intention that all Americans will be able to get the vaccine for free. But the official said a series of potential legal obstacles that could get in the way of Medicare payment never got unscrambled.


Earlier this month, Medicare administrator Seema Verma said her agency was close to resolving the issue.

“I think we’ve figured out a path forward,” Verma said at the HLTH conference, a forum for innovators. “It was very clear that Congress wants to make sure that Medicare beneficiaries have this vaccine and that there isn’t any cost-sharing.”

“Stay tuned,” she added.

The $1.8 trillion CARES Act passed by Congress in March called for free vaccination for all Americans, from seniors covered by Medicare to families with employer-sponsored health insurance.

A White House-backed initiative called “Operation Warp Speed” is pushing to have a vaccine ready for distribution in the coming months. The government is spending billions of dollars to manufacture vaccines even before they receive FDA approval, thereby cutting the timeline for delivery. Officials at the FDA have committed that the program will not interfere with their own science-based decisions. Vaccines that don’t meet the test for approval would be discarded.

States have already begun submitting their plans for vaccine distribution to the federal government.

Initially, it’s expected vaccines will go to people in high-risk groups such as medical personnel, frontline workers and nursing home residents and staff. Older people are also high on the priority list because their risks of serious illness and death from the coronavirus — which has killed more than 225,000 people in the United States — are much higher. It could be well into next year before a vaccine is widely available.

Medicare’s impending announcement was first reported by Politico.

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Coverage, risk factors, options, and cost

Preventive screenings, such as bone density tests, can help identify potential medical problems. Medicare covers some costs.

Bone density tests may help prevent expensive reparative treatments. Medicare generally covers such tests, although there may be other out-of-pockets costs.

This article looks at bone density scans and osteoporosis, including risk factors. It also discusses Medicare coverage of the tests, along with costs.

If a doctor thinks a person may have osteoporosis, they may ask for a bone density scan, which uses an X-ray to measure bone mineral density.

The test may be done in a hospital setting or by using a mobile device. In general, a person will get the hospital test for a hip or spine X-ray, while the mobile test is done on a person’s finger, wrist, or heel. However, the type of test may depend on the community’s access to equipment.

According to the National Osteoporosis Foundation (NOF), if the test cannot be done on a person’s hip or spine, then it could be done on a person’s radius bone, which is in the forearm.

Osteoporosis is a medical condition that causes decreases in a person’s bone density, which can lead to fractures of the hip, spine, or wrist following a fall or other trauma.

After a doctor confirms a person has osteoporosis, recommended treatments may include medications and lifestyle changes such as getting more exercise and increasing intake of calcium and vitamin D.

Women are more likely than men to experience osteoporosis due to age-related hormonal changes. For example, after menopause, a woman’s estrogen levels drop. Estrogen is one of the hormones responsible for stimulating osteoblasts, which are cells that promote bone growth.

Other osteoporosis risk factors include:

  • lack of bone-building vitamin D and calcium in the diet
  • smoking cigarettes
  • drinking alcohol excessively
  • being sedentary
  • having a too-low body weight
  • having a medical history of a parent who broke their hip

If a person has several of these risk factors, a doctor may recommend a bone density scan.

A bone density test is also called a dual energy X-ray absorptiometry (DXA). The test is a non-invasive, painless X-ray scan of the hip and spine. A person does not need to do or wear anything special to get the test, and the entire scan typically takes 15 minutes or less.

Once a person has had a bone density test, a doctor trained in reading the scans will view the images and use calculations to assign a T-score, which compares a person’s current bone density to that of a healthy adult at age 30. Three T-score categories exist:

  • normal bone density: -1 or higher (such as 0 or +0.5)
  • low bone density: between -1 and -2.5
  • osteoporosis: -2.5 and lower

In addition to receiving a T-score, a person may also receive a Z-score. This is a score that compares a person’s bone density to someone of the person’s similar age and size. These scores are usually more effective in identifying bone density levels in children, teenagers, and younger men

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