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Getting Ready for The Affordable Care Act

Small Organizations in the Wake of the Affordable Care Act 144Understanding the ways in which the Affordable Care Act (ACA) will affect small organizations and change the shape of the health care market isn't easy, especially with the large amount of misinformation that has been spread about the law. To help make the picture clearer, Donors Forum’s Chicago Grantmakers for Effective Organizations hosted a session on Small Organizations in the Wake of the Affordable Care Act.
Stephanie Altman, Health and Disabilities Advocates, Kathy Chan, EverThrive Illinois, and Judith Haasis, Community Health, provided detailed information about what organizations can expect in the new environment and how the coming changes will affect them as individuals and employers.
Two key things nonprofit employers need to know about the ACA:
  • Organizations with fewer than 50 full-time equivalent employees are not required by the law to provide insurance for their employees
  • ACA provides an increased range of options for insuring employees.
The Small Business Health Options Program, or SHOP, can be accessed through healthcare.gov, and it can connect businesses with fewer than 50 employees to insurance options that might work for them.
Smaller nonprofits can also benefit from available tax credits. Organizations with fewer than 25 employees and annual average wages of less than $50,000 that pay more than 50 percent of the cost of health insurance premiums for their employees, may be eligible for a tax credit equal to 35 percent of their expenses. Organizations must obtain insurance through the SHOP marketplace to get the credit.
The many variables affecting an organization's health insurance decisions are best served by working with an expert. Navigators or assistors have been trained to work with small businesses and individuals to help them connect to benefits for which they might be eligible.
Businesses and individuals can also work with brokers, who can tailor recommendations to them in ways navigators cannot. Brokers are paid by insurance companies, so they will not add to an organization's expenses, and they can help businesses find plans that work for them.
It is important to note that navigators and brokers are prohibited from charging for their services.
The Individual Market
Along with providing possible subsidies for small businesses, the ACA makes significant changes to the insurance market for individuals. Changes from the ACA can be generally grouped into two areas:
  • Changes that affect the quality of insurance policies
  • Changes that provide more access to health insurance
Some of the provisions in the former category have already taken effect, like the provision stating dependents can remain on an insurance policy until they are 26 and the removal of lifetime limits on benefit amounts. Many major provisions, including the health insurance marketplace, are now starting up, with the marketplace accepting applications in anticipation of a launch in January 2014.
Other provisions will take effect at the beginning of 2014. They will describe a basic level of health insurance that all people should be able to access. There will be far fewer variables insurers can use to adjust premiums. Factors that were used in the past, such as gender or pre-existing health factors, cannot be taken into consideration. The only factors that will affect individual prices are age, geography, and tobacco use.
GetcoveredlogoOn the quantity side, the ACA expands Medicaid eligibility in states that opt in to the expansion, including Illinois, while also providing subsidized insurance options through the marketplace for individuals. This presents several possible challenges for organizations.
First, there is already a shortage of Medicaid specialty care providers, and having more individuals using Medicaid could make this shortage more pronounced. For primary care, Medicaid reimbursement rates are being raised to Medicare levels, which should help shortages in that area. Building specialty care capacity will be a challenge.
Another challenge is that as many as 1.5 million state residents will have insurance they didn't have before, and many of them are not familiar with the best ways to make use of access to preventative care. Helping people use their new resources to best improve their health will be important.
While ACA implementation is expected to significantly lower the numbers of uninsured in Illinois, undocumented immigrants are not covered by the ACA.Organizations committed to providing health care to uninsured, low-income individuals will still be needed. They must figure out how to adapt, including whether they should introduce new revenue streams by doing things such as taking in Medicaid patients.
The new environment presented by the ACA will be challenging, but it also presents opportunities for organizations and funders to enhance the health of people throughout the region as they work together.
Resources for individuals and organizations:

~ Jason Hardy, Member Services Associate, Donors Forum

The ACA and Millennials: Time Will Tell

Recently, the media has delivered polarized opinions regarding how the Affordable Care Act (ACA) affects or will affect young adults. When reading news and op-ed headlines like “Why Obamacare is good for young people” (Klein, 2013) situated next to “Obamacare is really, really bad for you, especially when you are young” (Basu, 2013), it seems that young people should expect to feel lost when approaching such complex legislation. As these headlines demonstrate, the media has misrepresented the ACA as being either fantastic or detrimental for Millennials. Upon further investigation and review, it seems the reality is somewhere in-between “good” and yet to be seen “bad.”


The Good: This is easier to explain, because much of it is based on factors that can be measured or already enacted provisions within the ACA.
  • “The percentage of young adults without health insurance has fallen by more than 4 percentage points since 2009, declining from 31.4 percent to 27.2 percent in 2012, or more than 1 million individuals” (Commonwealth Fund, 2013). Additionally, “The law has helped 6.6 million young adults who have been able to stay on their parents’ plans until the age of 26, including 3.1 million young people who are [now] newly insured” (Office of the Press Secretary, 2012). This provision prevents young adults from aging out of insurance coverage as they graduate from high school or college and has reduced the percent of young adults without insurance.
  • There is always the option to opt out of ACA coverage and pay a penalty. This allows individuals to exercise their freedom and not buy coverage if it proves financially challenging or if their circumstances change. However, it allows people to risk not planning for accidents or unforeseen health needs that may require them to use healthcare services that are unaffordable without insurance. 
  • There is more transparency. Under the ACA, insurers have to provide understandable information to consumers. “All consumers, for the first time, will really be able to clearly comprehend the sometimes confusing language insurance plans often use in marketing,” said HHS Secretary Kathleen Sebelius. “This will give [consumers] a new edge in deciding which plan will best suit their needs and those of their families or employees” (Department of Health and Human Services, 2012).
  • All FDA approved birth control options are covered without copays, coinsurance, or deductibles (Centers for Medicare and Medicaid Services). This already existing provision immediately removes the barrier of up-front costs allowing for greater consumer choice and access--particularly for health services like birth control that young women are more likely to utilize.
  • “Nearly 13 million Americans will receive a rebate this summer because their insurance company spent too much of their premium dollars on administrative costs or CEO bonuses” (Office of the Press Secretary, 2012). This benefit seems fairly obvious as it will allow a large portion of insured Americans to reinvest or reallocate those savings into goods and services they otherwise may not have been able to afford without the rebate (e.g., childcare, energy saving home appliances, or healthy foods/activities).
The Bad: The negative views regarding the ACA are often related to one of two ideas: the “what-ifs” and the “myths.” In this discussion, only the “what-ifs” causing apprehension among readers will be covered. Much of what is presented as “bad” about the ACA is speculative, and has yet to be seen. Prior to condemning or celebrating the law, time should be allowed to observe its enactment.
  • 22 states are not expanding Medicaid at this time (Kaiser Family Foundation, 2013). Young adults that cannot get coverage under their parents’ plans might slip through the cracks. If they have to purchase insurance from the marketplace, budgeting premiums into an already stretched budget is not easy, even if premiums are kept under $100 per month. Honestly: affordability is largely subjective and may vary despite attempts like cost-sharing subsidies and tax credits attempting to control costs.
  • Young adults may end up paying more for health insurance coverage than the health services that they consume and need. Some media sources have stipulated this is a bad thing because young adults could be subsidizing services they may not have the fortune of utilizing. Much like what is speculated about Social Security benefits, it is also difficult to know that there will be enough money in future generations to assist with cost-sharing for the millennial generations’ health benefits as they age. As former US President Bill Clinton recently said, “This only works. . . if the young people show up" (Taranto, 2013).
  • With the unemployment rate being almost twice as high for young adults as for the general population—13% for young adults aged 20 to 24, and 7.3% as stated by the US Bureau of Labor Statistics--and living in a rapidly changing economy, the ability to pay premiums for marketplace insurance policies may vary from month to month, potentially creating financial insecurity for young adults. 
Overall, the Affordable Care Act is not a two-sided coin for Millennials. As with all large policy implementations, there will undoubtedly be challenges and hurdles to address over time. Since the ACA was enacted in 2010, we've already seen some successes. In proceeding to evaluate the Affordable Care Act implementation, it is important consider how both the positive and negative consequences will unfold for individuals.

Let's allow time to see if the “what-ifs” become "what is" before jumping to a conclusive or alarmist opinion.

Emily Gelber MSW, LSW
Illinois Health Matters Analyst
Health & Disability Advocates




99223 vs 99233: Coding Hospital Inpatient Initial Care Encounters.

When should I code a 99223 vs 99233 for the hospital inpatient initial care encounter?   I was recently asked by a busy hospitalist to comment on this scenario as it relates to their consultative role on post operative surgical patients on the orthopedic service.  Here is their question in detail:

We see a lot of orthopedic consults on our service. Sometimes 6-8 new consults per day piled on to our starting census. They often have no acute medical condition that we are commenting on. However, they usually have 4 medical conditions and are on opiate PCA as per orthopedic admission orders. In these situations would I do better to do a 99233 or go to a 99223 due to the 4 diagnoses and the IV PCA? I am already planning on going to a 99233 or less on the less complex ones... I want to maximize return but minimize the documentation work load so I can get thru them and see the other 16+ ( including ICU).

For reference, I am a practicing clinical hospitalist with over ten years of experience. I have studied billing and coding for years and have an excellent foundation for applying coding decisions to real life scenarios.  Before I begin my discussion I think it's important to define what these numbers mean.  CPT® stands for Current Procedural Terminology.  If you don't understand CPT®, I have provided insight here.  CPT® codes are used by medical professionals to bill insurance for their service.  Evaluation and Management (E/M) codes are a subset of CPT® codes.  Evaluation and Management codes include office visits, hospital visits and nursing home visits. There are many CPT® codes that are appropriate for hospital based billing.  I have detailed many of them in my post on CPT® admission codes.

The hospital inpatient initial care codes are CPT® 99221-99223.  The hospital inpatient subsequent care codes are CPT® 99231-99233.  This hospitalist is asking me if they should bill the highest level initial care code or the highest level subsequent care code for their initial encounter as a consultant.  I have previously reviewed both CPT® 99223 and CPT® 99233.  Understanding the key components for both levels of service are critical to understanding this lecture.  I recommend all readers obtain their own copy of the American Medical Association's CPT® manual for their own reference.  You can find one by clicking on the CPT® graphic to the right.


Answering this question requires further discussion on some basic coding decisions.  Is coding a hospital inpatient initial care encounter (99221-99223)  appropriate?  Is coding a hospital inpatient subsequent care code (99231-99233) appropriate?  Are there alternative codes that are more appropriate?  Is choosing the highest level of service appropriate in this described scenario?

IS IT APPROPRIATE TO CHOOSE A HOSPITAL INPATIENT INITIAL CARE CODE (99221-99223)?


The answer is yes.  It is appropriate to choose a hospital inpatient initial care code for the first encounter as a consultant (or as the attending).  While some insurance companies may still recognize consult codes,  Medicare stopped doing so in 2010.   They don't recognize inpatient consult codes (99251-99255) and they don't recognize outpatient consult codes (99241-99245).  For hospital inpatients, Medicare guidance says to choose a CPT® code from the  hospital inpatient initial care code group 99221-99223.  Here is the CMS guidance (on page 16 of the document):
Effective January 1, 2010, the consultation codes are no longer recognized for Medicare part B payment. Physicians shall code patient evaluation and management visits with E/M codes that represent where the visit occurs and that identify the complexity of the visit performed. In the inpatient hospital setting and the nursing facility setting all physicians (and qualified nonphysician practitioners where permitted) who perform an initial evaluation may bill the initial hospital care codes (99221 – 99223)...
Most hospitals require a preoperative history and physical (H&P) to be on the chart before a patient goes to surgery.  These H&Ps may be done the the operating surgeon or the patient's primary care physician several days to several weeks before surgery.  This has no relevance for the hospitalist asked to see the patient for medical management after surgery.   All physicians are directed to utilize the hospital inpatient initial care codes for their first encounter whether or not the primary care physician did a complete history and physical before surgery.


IS IT APPROPRIATE TO CHOOSE A HOSPITAL INPATIENT SUBSEQUENT CARE CODE (99231-99233) INSTEAD?


The answer is yes.  It is also appropriate to code a hospital inpatient subsequent care code as the initial encounter as a consultant (or as the attending) instead.  I know I just got done explaining why hospital inpatient initial care codes are the correct choice for the first patient encounter.  However, hospital inpatient subsequent care codes can also be used for the first encounter by a physician or other non-physician practitioner (NPP).   The Centers for Medicare & Medicaid Services (CMS)  says they can.  Page 3 of MLN Matters document MM6740  specifically says:
In all cases, physicians will bill the available code that most appropriately describes the level of the services provided.
That means if the physician or other NPP only provided documentation to support a hospital inpatient subsequent care visit, they should bill for a subsequent care visit, even if it was their initial inpatient hospital encounter.  In fact, one Medicare carrier specifically states that in this Q&A document:
If the documentation for the initial visit does not support one of the initial inpatient procedure codes, CMS has instructed contractors to not find fault with the physician billing a subsequent care procedure instead.

IS IT APPROPRIATE TO CODE THE HIGHEST LEVEL OF SERVICE?


Now that I've established physicians and other NPPs can code from either the initial care or subsequent care code groups, the question specifically referred to coding the highest level of service in both code groups, the level three visit.  Some readers may find themselves asking whether billing the highest level of service (99223 for initial care or 99233 for subsequent care) is appropriate, ethical,  fraudulent or irresponsible given the lack of  acute medical conditions in the presented scenario.  These readers do not understand the nature and complexity of the E/M rules.  These readers fail to appreciate that any post operative orthopedic patient IS an acute patient with profound implications on the stability of their multiple chronic medical conditions and a thorough history and physical will always be medically reasonable and necessary.

The threshold for payment by Medicare is "reasonable and necessary" services.  Managing patients with multiple chronic stable medical conditions such as diabetes (DM), hypertension (HTN), coronary artery disease (CAD) and chronic obstructive pulmonary disease (COPD) can be complex in the post operative state.  Just because all of their medical conditions were stable before surgery does not mean they will be stable after surgery.  Part of the post operative evaluation is to verify stability or to search for clues on history or physical that may indicate an acute or subacute risk of decompensation.  Just because the patient's medical conditions are stable post operatively does not mean medically reasonable and necessary care can't rise to the highest level of service code encounter.   Remember, choosing the correct code is not a magic trick.  The rules are highly complex, but well defined.  I have created my own E/M pocket cards (see below) to help me stay compliant with correct coding decisions on every patient encounter.

Is it medically reasonable and necessary to do a complete review of systems (ROS) or a complete physical exam on a stable post operative orthopedic patient with multiple stable chronic medical conditions.  The answer is yes.  These are systemic diseases with systemic complications being managed with medications that have systemic side effects.  Just because the patient had stable disease before surgery does not mean their chronic medical conditions will remain stable after surgery.  Doing a complete ROS or complete physical exam will always be medically reasonable and necessary for patients with multiple chronic medical conditions.

If medically reasonable and necessary care documentation supports the highest level of service 99233 vs 99223, then the highest level of service should be billed.  The E/M medical decision making rules contain elements that can achieve high complexity even with no acute change in medical condition. For example, if you are managing intravenous PCA opiates and their potential for systemic side effects or complications, you should consider this high risk on the E/M risk table and bill your E/M code appropriately.  If you are managing Coumadin in the post operative orthopedic population, I have previously explained why I believe this is high risk drug therapy on the E/M table of risk table and the correct code should be based on that assumption.

No where does guidance tell us that having only stable chronic medical conditions excludes the physician or other NPP from billing the highest level service codes.  In fact, it's just the opposite.   E/M rules specifically tell us how to define medical decision making (MDM) complexity for patients with multiple chronic medical conditions. Having four stable chronic medical conditions provides four points in the diagnosis section of MDM.  Managing a PCA or Coumadin is considered high risk on the risk table.  That means these post operative ortho consults can be a level 3 visit if the medically reasonable and necessary history and/or physical exam documentation supports it as well.    What if the patient is not on a PCA or they are not on Coumadin?  Always consider the work you do in the data component of MDM as well.  Did you personally document that you reviewed the pre operative EKG tracing?  Did you personally look up old records to compare the EKG or to find evidence of a previous cardiac stress test result?  Did you review the patients CXR report or their lab?   All of this work adds to the complexity of care and can rise to the level of the highest service code group, if you just remember to document the work you are providing.

RVU COMPARISON


Medicare uses relative value units (RVUs) to determine value for all services.  I have previously written posts explaining RVUs and the RVU to dollar conversion.  What is the RVU difference between the highest level hospital inpatient initial care code (99223) and the highest level hospital inpatient subsequent care code (99233) in 2016?
  • 99223 (initial care) -  3.86 work RVU and 5.71 total RVU
  • 99233 (subsequent care) -  2.0 work RVU and 2.93 total RVU
The RVU to dollar conversion rate for 2014 is $35.8043.  That means billing a subsequent care code instead of an initial care code will be worth 1.86 less work RVUs (around $66 dollars less) and 2.79 less total RVUs (around $100 less) in my home state.

Since doing a complete history and complete physical exam in patients with multiple medical problems will always be medically reasonable and necessary, the question the provider then must ask is whether they wish to provide such an intensity of service.  Some readers may ask if the provider believes they don't need to provide a complete history and physical, then doing so would not be medically reasonable and necessary.   This is just not true.  Failure to provide thoroughness does not make it unreasonable and unnecessary.  At the end of the day, its not up to the patient to determine the level of service a physician provides.  It's up to the physician and their medical judgement about what they feel is the appropriate level of care and to make sure their documentation supports the work they do.

THE FINAL ANALYSIS


The hospitalist asked the question whether they would do better billing a 99223 or a 99233 for their 6-8 orthopedic consults per day.  Economically, the answer is obvious.  Billing the hospital inpatient initial care codes provides nearly $100 per encounter more of additional revenue, but that benefit comes with a time cost, the value of which can only be determined by the hospitalist making the coding decisions.   At eight consults a day, that's $800 per day of additional revenue by coding a 99223 instead of a 99233.  This assumes a 100% Medicare service and all encounters support  the highest level of service within the code group (99223 or 99233).  Assuming the same high complexity MDM for both code groups, the decision to bill a 99223 vs 99233 comes down to how much additional time the physician wants to spend performing a complete review of systems and a complete physical exam and a past medical, family and social history.    All of these elements are required to correctly code a 99223 encounter but not a 99233.    All are medically reasonable and necessary for patients with multiple relevant chronic medical conditions in the post operative state.  I would never find fault with a physician for providing this high intensity of service.  The question, eluded by the reader, comes down to time management triage decisions.

Physician time is not unlimited.   Not all doctors have time to provide the highest intensity of service for every encounter and I would never fault them for failing to do so.  Being understaffed is a common theme for many hospitalists and they must triage their time to the sickest patients.   That means the intensity of service provided to some patients may decline.  This will presumably be reflected in a lower coding curve.  Whether that is a good thing or a bad thing is a matter of debate.  Physicians should bill for the medically reasonable and necessary service they provide.   The correct code is the code that is supported by their documentation of medically reasonable and necessary care, without regard to the coding distribution curve of their colleagues.   If they choose to provide a lower or higher intensity of service, that's their decision to make, as long as the care they provide  is also reasonable and necessary.


LINK TO POCKET CODING CARD POST

EM Pocket Reference Cards Using Marshfield Clinic Point Audit

Click image for high definition view






No, Health Reform Doesn’t Give Congress Special Treatment

Some health reform opponents claim the Obama administration is giving members of Congress and their staffs special treatment under the Affordable Care Act. The claim, which a number of media stories have repeated uncritically, is simply false: Although they will be required to enroll in health plans offered within the new health-insurance exchanges established under the law, members of Congress and their staffs will not receive extra financial help to pay for their medical care.

Critics are angry because the administration has confirmed that members of Congress and their staffs can continue to receive employer contributions to cover part of their premium costs. But that’s not special treatment. Today, most large employers do the same — the federal government, which provides coverage for members of Congress, their staffs and other federal employees, is no different.

In reality, it’s the critics — as part of their ongoing assault on the health care law — who are seeking special treatment for Congress, by proposing to make members and their staffs the only workers in the United States whose employer is barred by law from helping to cover their premiums. There’s no reason to discriminate against members and their staffs in this way, especially when doing so would make it more difficult to recruit and retain high-caliber congressional staff.

Here’s the issue: Under a provision authored by Sen. Chuck Grassley (R-Iowa) and added to the legislation during the Senate Finance Committee’s health care deliberations in 2009, members of Congress and their staffs won’t be allowed to continue buying coverage through the Federal Employees Health Benefits Program, which offers a variety of health insurance plans to federal employees. Instead, congressional staffers and members will only be able to enroll in plans offered in the ACA’s new exchanges, with the government continuing to make an employer contribution. (Grassley himself has confirmed that he intended for the federal government to continue making employer contributions under the provision.)

Critics claim this is special, gold-plated treatment because other people can’t get an employer contribution and use it to help buy coverage in the health exchange system. That’s incorrect. The ACA explicitly allows small businesses with fewer than 50 employees (up to 100, at state option) to offer their employees health plans through the exchanges and to help cover the premiums. This is essentially the same treatment that members of Congress and their staffs will receive.

Nor is the setup for Congress double dipping, as some mistakenly charge. Members of Congress and their staffs, just like the small-business employees, will be ineligible for federal tax credits to help cover the cost of their exchange health plans — unlike people with low and moderate incomes without employer coverage who buy health plans in the exchanges on their own.

There is one way in which health reform’s treatment of members of Congress and their staffs is unique — but it doesn’t involve preferential treatment. They are the only people in the country working for a large employer that is allowed to offer health plans exclusively through the exchanges. Unlike all other federal employees, they will not be able to enroll in plans offered through FEHBP. That’s because of the Grassley amendment.

Some members of Congress who oppose the ACA propose to prohibit the federal government from contributing toward the insurance premium costs of members and their staffs. Now that would be special treatment — the health care law does not prohibit the employer of any other workers in the country from making such a contribution.

If critics truly wanted to make sure there is nothing unique here, they would propose dropping the Grassley amendment and treat members of Congress and their staffs the same as other federal (and private-sector) employees, by allowing them to continue to enroll in plans offered through FEHBP, with the federal government continuing to make a contribution to help cover the costs. That’s how health reform treats other employers: It allows them to maintain current insurance arrangements and contribute on their employees’ behalf.

Why aren’t opponents of the health care law trying to do that? Presumably because there’s no political advantage in doing so. It’s time to get beyond political firefights and get on with responsible governing, including making health insurance coverage under the ACA work as effectively as possible for the American people.

Robert Greenstein is president of the Center on Budget and Policy Priorities
CBPP

This post was posted first on Politico and reposted with permission from the Center on Budget and Policy Priorities.

Medical Mispronunciations and Misspelled Words: The Definitive List.

Hearing medical mispronunciations and seeing misspelled words are an under appreciated  joy of working in healthcare.  Physicians often forget just how alien the language of medicine is to people who don't live it everyday.  The best part about being a physician is not helping people recover from critical illness. The best part is not  about  listening and understanding with compassion and empathy.  Nope, the best part about being a physician is hearing patients and other healthcare providers butcher the language of medicine and experiencing great entertainment in the process.   Doctors can always count on a few patients (and other doctors and nurses) to say something in just the wrong way to bring a smile to their day. The Happy Hospitalist Facebook Page asked its thousands of daily readers to describe their funniest or most irritating medical mispronunciations and misspellings for medications, procedures, interventions and diagnoses.    They didn't disappoint.   Below is a detailed collection of responses provided by readers like you.  I also found a few other hilarious language misadventures from the internet to bring a smile to your face. 

What were the top ten most commonly mispronounced or misspelled medical words in this survey?  Leading the charge where Amiodarone, atenolol, colonoscopy, Coumadin, diabetes, Dilaudid, hydrocodone, hysterectomy, metoprolol, and Phenergan.

If you happen to stumble across this post describing funny medical mispronunciations and misspelled words, make sure to search the alphabetical list below describing both the correct (bold words) and the  incorrect references to common medical terms.  If doctors, nurses, patients and family are going to speak the same language of medicine, it's  important to stop confusing ammonia with pneumonia and blood clogs with blood clots.

Once you are done studying this definitive resource of misspelled medical lingo, make sure to review The Happy Hospitalist's  extensive collection of funny  medical slang and acronyms, funny fake diagnoses, signs and symptoms and funny patient quotes.  You obviously don't have anything else to do with your time or you wouldn't still be reading this!  Tell all your friends.  Print and post this definitive reference in your hospital break room or bathroom  for eternal enjoyment with the funny side of medicine.  Make sure to leave your own examples in the comments below.  If you have lists in your hospital, take a picture and email it to me at happyhospitalistATgmailDOTcom  and I will update this list to include your own nuggets of great daily hospital humor.  But before you see the list, make sure to check out the gruesomely funny video about mispronunciations in the work place!



THE MISPRONOUNCED OR MISUNDERSTOOD WORLD OF MEDICINE.

 

A

  • abdominal pain -  abominable pain, abominal pain
  • Achilles tendon -  akilese tendon
  • acid reflux -  acid reflex
  • acidophilus -  Sid and Phylis
  • ADHD -  HDHD
  • anesthesia -  anesceasia
  • astigmatism - a stigmatism
  • accurate I/Os  -  accurate eyes and nose
  • acute angina -  a cute vagina
  • albuterol -  albootaral, albooteral, buterol, albuteral
  • allergic reaction -  allergic erection
  • Alzheimer's -  alltimers, alztimers, old timers disease, oltimers,
  • Ambien -  ambria
  • Amiodarone -  amiroaderone, am-knee-darone, amniodarone, amarodorone, amiorodarone, amidrone
  • ambulance -  ambleeance, ambalance, ambulambs
  • aneurysm -  amarysm
  • antecubital -  anticubical 
  • anthrax -  amtracks
  • antibiotics -  antibygolics 
  • appendix -  APNDX, pendix, appendicks, ipendics
  • appendectomy -  appleectomy, add-a-dick-to-me
  • arthritis -  The Arthur, arthuritis
  • ask -  axe
  • aspirin -  assburn
  • asthma - assma, azma,
  • Assmatack -  instead of asthma attack
  • Atenolol -  atenol, atanol, atenenol, atenotol, antennanol
  • atrial fibrillation -  aerial fibaration
  • Augmentin -  augmentum, augiementim

B

  • barbiturates - bar-bit**-uates, bar-bi-tirades
  • Bartholin gland -  bartholomew gland 
  • below the knee amputation -  baloney amputation
  • between -  bequeen
  • bipolar -  bipolo
  • bisacodyl -  biskadill
  • bladder cancer -  ladder cancer
  • blood clot -  blood clog, blood clock
  • blood pressure cuff -  blood pressure cup
  • Botox -  buttocks
  • bowel obstruction -  bowel destruction
  • bowel impaction -  bowel compaction
  • bronchial asthma -  broccoli asthma
  • BUN -  bunt
  • bupropion -  buproprion
  • Buspar - badspar

C

  • CABG -  cabbage
  • C-section -  sea section
  • calcium -  kalshium 
  • callus -  callous
  • candida infection -  Canada infection
  • capnography -  capneography 
  • carbon monoxide -  carpet monoxide
  • cardioversion -  cardio conversion
  • Cardizem -  cardiazem, cardliazem
  • carotid -  care-ih-toid
  • carpal tunnel -  corporal punishment, carpal thunnel, car trouble, carpool tunnel
  • cataract - Cadillac
  • catheter -  Catholic, capiter
  • cecum -  secum
  • cellulitis -  cellulititis
  • cerebral palsy -  Sarah palsy, celebral palsy,
  • chicken pocks -  chicken pops
  • Chiropractor -  choirpracter
  • cholesterol -  chlorolesteral
  • ciprofloxacin -  ciproflucloxacillen
  • cirrhosis of the liver -  psoriasis of the liver, sclerosis of the liver, scoliosis of the liver, six roaches of the liver
  • cocci -  cockeye
  • Colonoscopy -  colonsclopy, colostomy, colonostomy, colonostrophy, coloscopy
  • concussion -  concrussion
  • constipation -  constickation
  • contractions -  contraptions
  • congestive heart failure -  congested heart failin
  • Coumadin -  coodamin, coumanin, coudamin, cummin, cooligan, cumiden
  • coxsackie virus -  coxsuckie virus
  • CPAP - C-Pak 
  • cryo -  Cairo

D

  • D&C -  DNC
  • dependent -  dependant
  • dehydrated - dehydrinated
  • depo provera -  depo primavera
  • diabetes - diabetis, suga' diabetes, the sugar, diabettys, diabeets, dabeets, da' suga
  • diabetic -  diabetical, "sugar pill"
  • diagnoses -  diagnosises
  • diarrhea -  diarear, diareah
  • dialysis - dinealysis, dryalysis, dialogy
  • dialyze -  dialasize, diagnalysis
  • dilated -  delighted 
  • disoriented -  disorientated
  • defibrillator -   defibulator, defibrillizer, fibulizor, fibalator
  • Diflucan -  diflunkin
  • Dilaudid -  di lada,  duodenum, dilautin, dialauda, dilauda, dilaudin, dilala, dilauden, diladeed, dilila, dilidad, dulauda, dilada, dilauntin, dilopadid, diladoo, dilauscious, lidaudid, dilowdin, dilautin, dilaudah, laudedid, diloodid, dahlonega, darvonidad, dull adam, dillydad, diladid, dialed in, diddlyadid, mili of dili, delightful, delighted, dddd, dilapida, diludid, the d one, dilaudemerol, delawtid, dolobid, dildemerol
  • diltiazem -  ditazolam
  • diverticulitis -  diberticulitis
  • dominant -  dominit
  • doppler -  gobbler, dobbler
  • donepezil - donzepril. 
  • dry weight -  dry wall
  • Dulcolax -  dookielax

E

  • eczema -  exema, eggs and ma
  • edematous -  edeminous, ah-did-ah-mus
  • EKG -  heartmagram
  • Elavil -  elaville
  • electrolytes -  electric lights
  • elephantiasis -  elephantitis
  • elicit -  illicit
  • emphysema -  infazima
  • encephalitis - syphilitis
  • epidural -  epidermal
  • epigastric -  epic gastric
  • epileptic seizure -  epileptic Caesar, eucalyptus seizure
  • erectile dysfunction -  reptile dysfunction
  • esophagus -  asophagues
  • exacerbation -  exaspiration, asserbation, exagerbate
  • excercise -  ectercise
  • excruciating -  cruciating
  • extubation -  excavation

F

  • fibroids in my uterus -  fireballs in my Eucharist (or universe or Eucharis), thyroids in my uterus
  • fibromyalgia -  ibromyfalgia, fibermalgia, fibermanalgia, fibro-my-algia, fibroidmyalga, fibermyallergy
  • fibroplastic breast -  fiber optic breast
  • Flomax - flowmore
  • folic acid -  fostic acid 
  • foramen ovale -  foraminal valley
  • Furosemide -  forcemide, fersamide

G

  • gabapentin -  gabbagantin
  • gallbladder  -  gullbladder, jawbladder, gallblatter
  • gangrene - gang green
  • generic -  genetic
  • Glucophage -  glucasausage
  • GoLYTELY -  gollytelly
  • gout -  goat, gouch
  • grand mal seizure -  grandma seizure, grand maul seizure, grand mall seizure
  • Guillian-Barre syndrome -  gougane barra syndrome

H

  • Haldol -  hound dog, haldog
  • heart catheterization -  heart cardization
  • heart murmur -  heart mummer
  • Heimlich maneuver -  hindlick maneuver, Heinekin maneuver,  
  • hemoptysis -  hymnoptosis
  • hemorrhoidectomy -  hermitrectomy 
  • heparin -  hefarin 
  • heroin -  heroine
  • herpes -  hair piece
  • HCTZ -  HTCZ
  • hernia - hyena
  • hiatal hernia -  hi herny, hymenal hernia, high anal hernia
  • HIPAA -  HIPPA, HIPPO
  • high bilirubin - hi Billy Rubin
  • hill -  heel
  • hospitalist -  hospital list
  • hydralazine -  hydrazaline
  • hydrocodone - hydrocodeine, hydrocordone, hydracodeine, hydrocordrone, hyda coda done
  • hydromorphone - hydramofo
  • hypertension -  the pressure, high blood
  • hypoxic -  hypopnic
  • hysterectomy - hickerectomy, histamyrectomy, hykterektomy, hicktorectomy, hikorekomy

I

  • ibuprofin -  I-B profin, I-B-U rofin, ibupropylene, ibubufferin
  • I have sinusitis -  I have sinuses
  • impetigo -  infantigo
  • induced in L&D -  instead of reduced in L&D,  seduced in L&D
  • intractable -  intrackable
  • inflammation -  inflamminated
  • inhaler -  inhalator
  • intubated -  incubated
  • ipratropium -  ipatropin
  • irritable bowel syndrome -  durable bowel syndrome, herbal bowl syndrome

J  

K 

L 

  • laparoscopic -  laptoscopical
  • larynx -  larnix
  • Lasix - Lasik, latex
  • lisinopril -  lisopril
  • Lorazepam - razorpam
  • Lortab - Loratab, lowtads
  • Lyme disease -  lime disease
  • Lyrica -  lycra
  • lymph nodes -  lymph noides, limp noids

M

  • maggots -  magnets
  • mammogram -  mammy o gram, mammiogram, mammeogram
  • melatonin pills -  melanoma pills
  • MRSA infection - merser infection
  • malnutrition -  maltrishoning
  • mastectomy -  masectomy
  • menopause -  many paws, menapause, minipause
  • menstruation -  minstration
  • Methotrexate -  mexotrexate
  • metoprolol -  meto-prolol, metaprod, me-prot-olol, met-RO-polol, meta-pro-lol, metopropolol, metopotol, matropalol, metepropol, metoprol, metopropol, meta-topro-lol
  • migraine headache -  migratin headache, my brain headache
  • milligrams -  thrilligrams
  • mitral valve -  micral valve
  • morphine -  mo phine, mophy, mofeen, mofeem
  • MRSA - MERCA
  • multiple sclerosis -  multiple scoliosis, multiple neurosis
  • mupirocin -  mop-u-rock-in
  • muscle -  mustle
  • "My bone wasn't broken, only fractured"
  • myocardial infarction -  myocardial infraction, cardio fart

N

  • nauseous -  nauseaouas
  • nauseated -  nauseation
  • nebulizer -  nibulator, febulizer, nebalizer, mebulizer
  • Nissen -  neesan
  • Norvasc -  norvasac
  • NSAIDS -  nay-sayds
  • nuclear test -  nuculer test, nook-ya-lar

O

  • omeprazole -  o-mee-pra-zo-lee, o-mep-ra-zo-le, om-nep-praz-olol, "o something"
  • ophthalmology - opthalmology, optamology, optomology
  • orient -  orientate
  • oriented -  orientated
  • osteochondral -  osteocondo, osteocondom
  • osteoperosis -  osteosperosis
  • Oxycodone -  oxycordone
  • Oxycontin -  oxycotton
  • oxygen -  oxgen, octagon, oxcuagen

P

  • pacemaker -  peacemaker
  • palpate -  palpitate
  • pancreatitis -  pancreitis
  • pap smear -  pepper smear
  • paraneoplastic panel - perineal plastic panel
  • patients -  patience
  • Percocet -  purpocet, percostat, purpacet, perpocet
  • perfusion -  profusion
  • pericarditis -  periocarditis
  • perineal -  peroneal
  • peripheral -  peripherial
  • pharynx -  pharnix
  • Phenergan - finnagin, phenergrin, phen-a-kin, phenergun, phenegren, pheneegan, phenagrin, phenegram, phenygen, phennygin, phenergran, vinegar, phenegran, fingin, fennigan
  • phenobarbitol -  peanut butter balls
  • phlebotomy -  lobotomy
  • pitocin - potassium
  • Plavix -  playvix, pavlix
  • pleural -  plural
  • pneumonia -  ammonia, lamonia, numonia, phemonia
  • polyps -  plopps, pollits
  • Port-A-Cath -  portacast
  • prednisone -  presinone, pregnisone
  • prescribe -  perscribe
  • prescriptions -  perscriptions
  • Prevalon boot -  provolone boot
  • Prilosec -  prolosex
  • Propofol -  propothol, propathal
  • propranolol -   propanolol
  • prostate -  prostrate, prospate
  • Protonix - protronix
  • Prozac -  prosack 
  • PSA -  PSI
  • pseudoseizures -  sudo seizures
  • pulmonary -  plumbinary, pluminary
  • pulmonary embolism -  pulmonary emblems
  • pneumonia -  ammonia, lemonia, pamonia, p moan ya
  • pyelonephritis -  polynehpritis

Q

R

  • Ramipril -  ram-per-il
  • rectal pain -  rektical pain
  • reflux -  reflexin
  • reflux on my esophagram -  reflexes on my coffeegram
  • rhabdomyolysis -  rhabdomyolitis
  • rheumatoid arthritis -  rumatard arfritis, rumortard arthritis
  • ringworms -  wingworms
  • Risperdal -  risperidal
  • Rocephin -  rocepherin
  • rotator cuff -  rotor cup, rotary cuff, roterer cuff, rotator cup, rotary cup
  • RSV -  RSVP

S

  • saddle pulmonary embolism -  saddled pulmonary embolism
  • sats -  stats  (an in oxygen stats)
  • Schizophrenia -  schitzophrenia 
  • sciatic nerve -  psychotic nerve, exotic nerve, psychiatic nerve, sanotic nerve
  • seizures -  skezures
  • Seroquel -  sequel
  • shotty lymph nodes -  shoddy lymph nodes
  • sickle cell anemia-  sick as Hell anemia
  • sleep apnea -  sleep apney, sleep napia
  • something -  sompin
  • smoking cessation classes -  smoking sensation classes 
  • spayed -  spaded (for the vets out there!)
  • specific pain -  Pacific pain
  • spinal meningitis -  smiley mighty Jesus
  • spironolactone -  spy-ra-lone-a-lack-ta-tone
  • Staph infection -  staff infection
  • stent -  stint, splints, stimps
  • Strep throat -  strip throat , script throat, scrip throat
  • stroke -  scroke
  • sulfa -  sulfur
  • suppositories -  depositories  
  • Synagis -  synergist

T

  • telemetry -  the lemon tree, telepathy
  • tendonitis -  tendernitis
  • testicles -  technicals
  • tests - testes
  • Tetanus shot -  technical shot
  • Theophylline -  thee-o-fi-lean
  • throat -  instead of throak
  • thrombocytopenia -  instead of thrombocytopenis
  • thrush -  thrash
  • TIAs -  teeahs
  • topical nystatin -  tropical nystatin
  • Toprol -  topal 
  • trachea -  trachlear
  • Trazodone -  tray-za-done
  • trichomonas infection -  tracheotomy infection, trick infection, trick a monkey infection
  • troponins -  patronins
  • tubal ligation -  tubal langee-on, tubal litigation, tubolization
  • Tylenol -  tylol, tylenoids, time in all
  • Tysabri - tysaybri

U

  • uvula -  vulva
    umbilical -  umbiblical 

V

  • vagina -  vajinga, Virginia, pajama
  • vaginal discharge -  virginal discharge
  • Valium - vacuum
  • vegetations -  vegetables
  • ventilator -  emulator 
  • vertigo -  vertical, vertago
  • vesicle -  vesical
  • Viagra - viagry
  • Vicoden - vickoden, vi-code-an, vicodan, vicaden
  • volatile -  voluatable
  • vomit -  vomick
  • vomiting -  vomicken, vomicking
  • Vulva -  instead of uvula

W

  • warfarin -  wahfehrn, warafin
  • Wenckebach -  winkyback  
  • welts -  whelps
  • wheezing -  weasel
  • whopping cough -  woofing cough

X

  • Xopenex -  zofenex
    x-ray -  x-tray, x-ration

Z

  • Zofran -  jofrain 
    Zosyn -  josin

Now, please enjoy these medical E-cards from The Happy Hospitalist.

"It's hysterectomy, not hickterectomy.  What the hick is wrong with you?"

Hysterectomy not hickterectomy ecard humor photo




"Nurse, it's been a week since we incubated the patient. Let's excavate the tube from their throak and turn off the emulator. And do it sat, please."

misspelled and mispronunciation doctor funny ecard humor


"I don't always go to Canada. But when I do I get Canadiasis."

I don't always go to Canada. But when I do I get Canadiasis humor meme photo.


"In need of a mebulizer breething machine that taked albuteral medicine for  my friends mom she has copd and infazima if you have one please let me know."


medical misspellings facebook example humor


This post may contain humor that is only understood by those in certain healthcare professions. Read at your own risk.


ACA: More Than Just Healthcare for People With Disabilities

For people with disabilities finding a job has always been a one-two punch. It's not just the salary and financial independence they're looking for; they also are in greater need of health benefits than say, a nondisabled 30-year old.

October 1 marks the first day that people with disabilities can finally get both needs met. Under the provisions of the Affordable Care Act, many of the barriers to private health care for persons with disabilities will disappear. Americans can now shop for benefits in the new health insurance marketplace, for coverage beginning January 1, 2014.

For the first time ever, people with disabilities cannot be denied coverage due to a pre-existing condition, denied particular services or charged more for coverage based on their health status. Many health plans have to cover certain preventive services like routine vaccinations. And the ACA limits the ability of insurers to cap annual services on patients.

The ACA undeniably changes the paradigm for working-age people with disabilities, who now do not need to choose between healthcare and a job. If an employer doesn't offer insurance, the Marketplace will, with plans starting at less than $100 a month. No longer does a person with a disability need to rely on Medicaid, the free state healthcare program for low-income people where the income requirement is so stringent that not even a full-time McJob would be allowed.

The new law also takes some of the burden off employers, too. Employers hiring people with disabilities can be assured that rates will not rise. All health insurance plans will be required to offer a standard set of benefits like hospital care and doctors' visits, as well as cover services like medication, therapy and rehabilitation services, which people with disabilities need throughout their lifetime. There will be limits on rate increases and co-pays. Small employers with fewer than 50 full-time workers can also purchase coverage through the Marketplace.

What's more, 25 states and the District of Columbia have kicked in with their own programs to provide extra coverage to workers if the benefits a company offers are too "basic" for a person's unique disability needs. These special plans wrap around private employer-based coverage.

And an optional program known as Medicaid Buy-In allows workers with a disability in 42 states and the District of Columbia to retain Medicaid coverage and pay health premiums on a sliding fee scale based on their income. Medicaid buy-in programs are geared toward higher-paid workers, for whom a salary truly trumps federal assistance.

As always, our mission at Think Beyond the Label is to increase the percentage of working-age Americas with disabilities in the workforce. The ACA will help us to be more successful at connecting qualified workers to the employers that want to hire them. No longer will a job seeker need to ask: Does my employer offer insurance? Is the plan comprehensive enough to take care of my disability? Will my health needs be better met through federal and state programs that discourage work?

The ACA makes business and economic sense, too. Less reliance on federal disability insurance programs that limit work (and cost billions of dollars a year to run). Less concerns from employers -- especially small employers -- about how to pay for coverage for a person with a disability. More opportunity for all Americans to achieve financial independence and make a significant economic contribution -- to pay for important life goals like starting a family, buying a house and sending kids to college.

Though the law may have passed under President Obama, it was Ronald Reagan who asked, "How can we love our country and not...reach out a hand when they fall, heal them when they're sick, and provide opportunity to make them self-sufficient so they will be equal in fact and not just in theory?" The ACA does just this, providing an innovative approach that will give millions of people with disabilities a chance to live the American dream, without sacrificing their critical healthcare needs.

Barbara Otto

Principal, Think Beyond the Label
 Follow Barbara Otto on Twitter: www.twitter.com/@beyondthelabel 

This post was published first on the Huffington Post blog

Strong Interest in Illinois: State is Meeting Demand



 
Chicago – A stronger than expected showing for the Get Covered Illinois website, GetCoveredIllinois.gov, dominated the State’s storyline on the opening day of the Illinois Health Insurance Marketplace.  The following is an operational update:

WEBSITE:

The Get Covered Illinois website opened on time at 12:00 a.m. Monday, October 1.  As of 3:30 p.m. CST, more than 69,840 visitors had come to the online marketplace. 65,043 of them were unique visitors; and the page views totaled more than 412,580, with visitors viewing an average of six page views per visit.

“With a project of this magnitude, there was no accurate way to predict what our web traffic would be,” offered Jennifer Koehler, Executive Director of Get Covered Illinois. “But with that said, today’s numbers certainly validate the strong interest in healthcare in Illinois, and we’re glad to be able to service it. It also validates our strategy of education, since all this has come with basically no advertising. So we are overall very, very pleased.” 

Only a handful of early and minor glitches were reported, impacting a very limited number of consumers. All minor glitches were reported and fixed by early afternoon. “The site has performed incredibly well, the way we designed it to,” added Koehler. 

Additionally, the State received more than 1,100 online applications submitted on the ABE (Application Benefits Exchange) portion of the Get Covered Illinois site. 

HELP DESK:

The Help Desk received more than 350 calls as of 3:30 p.m.  Calls were answered in an average speed of six seconds, and callers were on line with Help Desk specialist an average of six minutes.

FIELD OPERATIONS:

There is steady interest, as judged by customers at our grantee community organizations today.  Most consumers are reportedly doing exactly as State officials hoped – coming in to be introduced to the process, the website, the Navigators and making appointments over the next few weeks as they become educated themselves on the site, and come back with prepared questions, and more ready to enroll.

“We know this is not nearly the same as buying a gallon of milk, a new pair of shoes, or anything in daily life,” said Director of Outreach Brian Gorman.  “Shopping for health insurance is brand new for more than a million Illinois residents, and it will take education and time to get comfortable with this new process.  But we are thrilled to see, today that process of understanding the right plan for them and their families started in earnest in locations all across Illinois. Consumers responded to our ask – which was to meet their community partners, understand the resources available and get an appointment when they are ready to get covered.” 

SOCIAL MEDIA:

Follow us on >>

Facebook: www.facebook.com/coveredillinois
Twitter: @CoveredIllinois
Hashtag: #GetCoveredIllinois

Posted with permission from GetCoveredIllinois.gov

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