Approximately four million adults in the United States are homebound, and many of them cannot access office-based primary care. Home-based medical care can improve outcomes and reduce health care costs, but this care operates in a quality measurement desert, having been largely left out of the national conversation on care quality. To address this shortcoming, two of the authors created the National Home-Based Primary and Palliative Care Network, an organization whose members include exemplary home-based medical practices, professional societies, and patient advocacy groups.

This article describes the current status of home-based medical care in the United States and offers a brief narrative of a fictional homebound patient and the health events and fragmented care she faces. The article then describes the network’s quality-of-care framework, which includes ten quality-of-care domains, thirty-two standards, and twenty quality indicators that are being tested in the field. The same two authors also developed a practice-based registry that will be used for quality-of-care benchmarking, practice-based quality improvement, performance reporting, and comparative effectiveness research. Together, these steps should help bring home-based medical care further into the mainstream of US health care.

When you go to the dentist for your dental check ups, he or she may offer instructions for oral care at home based on the results of your exam. The dentist or dentist hygienist may demonstrate how to brush and floss your teeth properly if he or she feels you may need the additional instructions.

A new minimally invasive cell sampling device coupled with assessment of trefoil factor 3 expression can be used to identify patients with reflux symptoms who warrant endoscopy to diagnose.

Dental X-rays, are a important tool that your dentist uses in order to look for decay (cavities) or other oral health problems that cannot be seen during the clinical exam. X-rays also provide the best way for the dentist to see a need for root canal treatment, or bone loss that may indicate advanced gum disease.  More people are trying to limit how many times they get x-rays done in a year and generally dental will only do one  set of x-rays a year unless there are new dental issue that need to be address.

Surgeons increasingly use robot-assisted minimally invasive surgery for a variety of medical conditions. For hospitals, the acquisition and maintenance of a robot requires a significant investment, but financial returns are not linked to any improvement in long-term patient outcomes in the current reimbursement environment. Kidney cancer provides a useful case study for evaluating the long-term value that this innovation can provide. Kidney cancer is generally treated through partial or radical nephrectomy, with evidence favoring the former procedure for appropriate patients.

We found that robot-assisted surgery increased access to partial nephrectomy and that partial nephrectomy reduced mortality and renal failure. The value of the benefits of robot-assisted minimally invasive surgery to patients, in terms of quality-adjusted life-years gained, outweighed the health care and surgical costs to patients and payers by a ratio of five to one. In addition, we found no evidence that the availability of robot-assisted minimally invasive surgery increased the likelihood that inappropriate patients received partial nephrectomy.

A periodontal dental examination involves checking of the gums and supporting structures of your teeth. First, your dentist will look at the gums for signs of redness or puffiness. The dentist may poke your gums gently to see how easily they bleed.

These symptoms may indicate gum disease. Your dentist may use a special probe to measure the depth of the pockets between your teeth and your gums. Pockets deeper than 3 millimeters often indicate periodontal disease. If your dentist determines that you have periodontal disease, he or she may refer you to a periodontist. This is a specialist who treats diseases of the gums.

We examined Medicare national coverage determinations for medical interventions to determine whether or not they have become more restrictive over time. National coverage determinations address whether particular big-ticket medical items, services, treatment procedures, and technologies can be paid for under Medicare. We found that after we adjusted for the strength of evidence and other factors known to influence the determinations of the Centers for Medicare and Medicaid Services (CMS), the evidentiary bar for coverage has risen.

More recent coverage determinations (from mid-March 2008 through August 2012) were twenty times less likely to be positive than earlier coverage determinations (from February 1999 through January 2002). Furthermore, coverage during the study period was increasingly and positively associated both with the degree of consistency of favorable findings in the CMS reviewed clinical evidence and with recommendations made in clinical guidelines. Coverage policy is an important payer tool for promoting the appropriate use of medical interventions, but CMS’s rising evidence standards also raise questions about patients’ access to new technologies and about hurdles for the pharmaceutical and device industries as they attempt to bring innovations to the market.

During your dental visits, your dentist will check for any signs of decay by looking at each tooth surface. The dentist also will poke your teeth with a tool called an explorer to detect cavities. Decayed tooth enamel is softer than healthy enamel. If you have fillings, permanent bridges, crowns or other restorations, your dentist will check to make certain that they remain whole and sound and that the teeth around them have no sign of decay.

In December 2014, CHA and many other advocacy organizations sent a letter to the Dept of Health and Human Services, the U.S. Dept of Labor and to the Social Security Administration requesting them to inform people nearing 65 of their rights and obligations surrounding Medicare enrollment, including their options to enroll, when they can delay enrollment and consequences of not enrolling (such as life time late enrollment penalties). With 10,000 people becoming eligible for Medicare each day, it’s imperative that they are well informed as the maze of information and choices is complex. Making sure pre-eligibility education is clear and consistent can help many people avoid costly mistakes.

Our friends at Medicare Rights Center have put together this petition to urge the Centers for Medicare and Medicaid Services and Social Security to take action and create a comprehensive education/outreach to people nearing 65 and their Medicare eligibility

Many insurance plans have a coinsurance provision. That means the benefit plan pays a predetermined percentage of the cost of your treatment, and you are responsible for paying the balance. What you pay is called the coinsurance, and it is part of your out-of-pocket cost. It is paid even after a deductible is reached.

Study finds naps restore hormones and proteins involved in stress, immune health to normal levelsA short nap can help relieve stress and bolster the immune systems of men who slept only two hours.

Most dental PPO and Indemnity plans have a specific dollar deductible. It works like your auto insurance. During a benefit period, you personally will have to satisfy a portion of your dental bill before your benefit plan will contribute to your cost of dental treatment. Depending on the plan deductibles can very average range is between $20 – $50.00 per person.

Some dental insurance plan my have a max limit on the deductible if it is a family plan such as $50.00 per person up to $150.00 per year.  Therefore if you have more the three people on a family plan the extra members would not have a deductible if three family member has already paid for the year.  Read your plans terms and conditions.

California’s Hospital Fair Pricing Act, passed in 2006, aims to protect uninsured patients from paying hospital gross charges: the full, undiscounted prices based on each hospital’s chargemaster. In this study I examined how the law affects the net price actually paid by uninsured patients—a question critical for evaluating the law’s impact. I found that from 2004 to 2012 the net price actually paid by uninsured patients shrank from 6 percent higher than Medicare prices to 68 percent lower than Medicare prices; the adjusted collection ratio, essentially the amount the hospital actually collected for every dollar in gross price charged, for uninsured patients dropped from 32 percent to 11 percent; and although hospitals have been increasingly less able to generate revenues from uninsured patients, they have raised the proportion of services provided to them in relation to total services provided to all patients. The substantial protection provided to uninsured patients by the California Hospital Fair Pricing Act has important implications for federal and state policy makers seeking to achieve a similar goal. States or Congress could legislate criteria determining the eligibility for discounted charges, mandate a lower price ceiling, and regulate for-profit hospitals in regard to uninsured patients.

Most dental PPO and Indemnity plans have an annual dollar maximum. This is the maximum dollar amount a dental plan will pay toward the cost of dental care within a specific benefit period (usually January through December). The patient is personally responsible for paying costs above the annual maximum. When buying dental plan make sure to know what the maximum limitation is on average it can range between $500 – $2000 though plans can very.

With ongoing interest in rising Medicare Advantage enrollment, we examined whether the growth in enrollment between 2006 and 2011 was mainly due to new beneficiaries choosing Medicare Advantage when they first become eligible for Medicare. We also examined the extent to which beneficiaries in traditional Medicare switched to Medicare Advantage, and vice versa. We found that 22 percent of new Medicare beneficiaries elected Medicare Advantage over traditional Medicare in 2011; they accounted for 48 percent of new Medicare Advantage enrollees that year.

People ages 65–69 switched from traditional Medicare to Medicare Advantage at higher-than-average rates. Dual eligibles (people eligible for both Medicare and Medicaid) and beneficiaries younger than age sixty-five with disabilities disenrolled from Medicare Advantage at higher-than-average rates. On average, in each year of the study period we found that fewer than 5 percent of traditional Medicare beneficiaries switched to Medicare Advantage, and a similar percentage of Medicare Advantage enrollees switched to traditional Medicare. These results suggest that initial coverage decisions have long-lasting effects.

For your dental care some of the worst food choices are: Candy, cookies, cakes, crackers, breads, muffins, potato chips, french fries, pretzels, bananas, raisins and other dried fruits. These foods provide a source of sugar that certain bacteria can use to produce acid. The problem can be worse if the foods stick to teeth or get caught between them.