Issue: 46

November: Let Us Give Thanks!
Despite the recent horrible senseless killings in Paris, Beirut, and Mali, we have much to be grateful for, especially the selfless veterans who have safeguarded our homeland against those who would deprive us of our fundamental freedoms. It was Thanksgiving in 1945 that my dad arrived in Regensburg, Germany, as an 18 year old, fresh-out-of-high school MP. His post was the underground Messerschmitt factory which had become a refugee camp for the displaced workers of Europe. "It was horrible," he recently told me. Like most of his fellow GIs, he returned home to marry well, start a family, and resume his education under the GI bill, in reverse order of what is commonplace today.
Speaking of freedoms, we would be wise to recall the four basic freedoms eloquently enunciated by FDR on Jan 6, 1941, as the United States prepared for war: 1) freedom of speech and expression-everywhere in the world; 2) freedom of every person to worship God in his/her own way, everywhere in the world; 3) freedom from want, meaning economic understandings which will secure to every nation a healthy peacetime life for its inhabitants; and 4) freedom from fear of would-be aggressors. The speech was powerful because it was a rallying cry for both a military and moral victory, exactly what our veterans accomplished and we need today!

John A. Schmidt, MD 
My Practice Has Connected to Jersey Health Connect!
When I worked at Sanofi, a global pharma company, I marveled how data generated in Budapest, Hungary, was available in Bridgewater, New Jersey, not the next day but the same day!  Returning to the practice of medicine, I was shocked! Obtaining data from your medical and surgical specialists often takes weeks, if they respond at all! Fortunately, a new secure information sharing system called Jersey Health Connect (JHC) promises a solution. Jersey Health Connect is a Health Information Exchange (HIE) that gathers your personal health information (PHI) from most of the major medical centers in New Jersey and converts it to electronic protected health information (ePHI). When you come to my office, I will scan Jersey Health Connect, examine the results, and import important health information into your Electronic Health Record (EHR), giving me a comprehensive picture of your medical history.  Similarly, every visit to my office generates a continuity of care document (CCD) that is sent to JHC. Suppose you urgently visit the emergency room at Jersey Shore University Medical Center or any ER in North/Central Jersey. The ER physician will have access to the comprehensive CCD from your last office visit and have all the information at his/her fingertips to give you prompt, safe, and effective care. Pretty cool, huh? I am grateful to Meridian Health for funding this important project! 
Have you heard the expression: "Invention favors the prepared mind"?  If my mind is prepared with your personal health information, you are the beneficiary!
Please Note: Participation in Jersey Health Connect is automatic. This means that all of my patients will have their PHI sent to Jersey Health Connect immediately after their next visit unless they choose to opt out. You will be given a brochure describing Jersey Health Connect as you arrive for your next visit. If you choose to opt out, please notify Valerie or Morgan right away. The privacy policy on my website has been modified to alert you to our participation in Jersey Health Connect. None of my patients have opted out so far.

Also, please let Valerie know if you would like an invitation to access your PHI  in Jersey Health Connect. All she needs is your email address!
My Practice Also Participates in HealtheRegistry!
Jersey Health Connect is a Personal Health Information (PHI) sharing tool which offers important advantages to my patients as described above. Another type of registry uses your PHI to assess performance against quality measures designed to improve your health. HealtheRegistry collects data for traditional Medicare patients enrolled in the Meridian Accountable Care Organization (ACO). Currently, about one hundred and twenty-five of my traditional Medicare patients are enrolled. Like JHC, HealtheRegistry collects data from all of your providers. In addition, it measures how your providers are working together to comprehensively improve your care. Medicare gives bonuses to ACO providers depending on performance, providing a (modest) financial incentive to doctors to meet the measures and improve your care. This is an example of one of the Merit Based Incentive Payment Systems established by the Medicare Access and CHIP Reauthorization Act of 2015 known as MACRA.
Medical Insurance Update!
Thanks to the Affordable Care Act, we live in the Age of Medical Insurance. Everyone acknowledges that medical insurance is desirable. But at what cost? As reported by the New York Times on Nov 14, insurance companies are trying to lure more "invincibles" into the insurance market with smaller front-end premiums. However, as the article points out, higher deductibles and co-pays are forcing many with low incomes to weigh lower front-end premiums against higher, uncovered back-end costs. Insurance companies are also reconsidering their options as reflected by United Health Care's announcement on November 20 that they may withdraw from the exchanges after 2016 because of higher than expected losses. Putting these reports together, it appears that the medically vulnerable are opting in and the invincibles are opting out, undermining the actuarial assumptions underpinning the Affordable Care Act. This hypothesis jibes with a report by the Washington Post on Oct 16 that the administration predicts meager growth in new enrollees in 2016.
I reported last month that premiums for part B would rise dramatically for certain groups in 2016 as a result of a zero Social Security Cost of Living Allowance (COLA) increase in 2016. The budget resolution approved by the House and Senate and signed by President Obama on November 2 kicks this increase down the road such that premium increases will be modest for all concerned in both 2016 and 2017.
I also reported last month that the new health insurance plan launched by Horizon Blue Cross of New Jersey known as OMNIA excludes disadvantaged Catholic and other safety-net hospitals.  As reported by NJBIZ on November 19, eleven NJ hospital systems including CentraState, a non-denominational hospital based in Freehold, have sued the New Jersey Department of Banking and Insurance (DOBI) arguing that DOBI violated rules that were designed to provide services to a broad demographic. Horizon responded by explaining details about how hospitals earned OMNIA Tier 1 status on November 24 in NJBIZ.
Affordable Health Insurance
The Health Insurance Marketplace is open until January 31 to purchase an affordable plan for 2016. Visit the site now to see if you qualify for one of the lower cost, non-Medicare plans offered through Obamacare or if you should apply for Medicaid. The Marketplace call center is open 24/7. Call 1-800-318-2596.

Remember that open enrollment for Medicare part D (Drug) coverage ends December 7. The Kaiser foundation projects that 2016 part D premiums will increase on average from $36.68 to $41.46 per month, a 13 percent increase. Visit to shop around for a lower cost plan after typing in your medications and zip code.
Food, Glorious Food!
Many of us remember the opening of the wonderful musical, "Oliver," when Oliver Twist says, "Please, sir, I want some more." While more was good for little, lovable Oliver, less is better for most overweight Americans. As reported in the November 10 issue of the Annals of Internal Medicine, Body Mass Index (BMI) is one, but not the only, relevant measure of adiposity. The authors demonstrated that waist-to-hip ratio (WHR) is also a very important risk factor for cardiovascular mortality. Even among those with normal BMI, elevated WHR predicts poor outcome. The study reinforces the notion that not all fat is equal. Fat around our midsection is the worst kind!
Blue Apron
For those who like to cook but hate to shop, consider Blue Apron! The recipes are extremely tasty and the portion size is conducive to ideal BMI and WHR. There is no waste and the variety is amazing.  Reasonably priced, the perfectly prepared ingredients are mailed to your home on your schedule.  View the video and give it a try (and add no salt!).
Valerie, Morgan, and I wish you a Happy Thanksgiving and we especially give thanks for you, our patients!
In This Issue
Let Us Give Thanks!
Jersey Health Connect
Medical Insurance Update!
Affordable Health Insurance
Food, Glorious Food!
Blue Apron
John A. Schmidt Jr., M.D.
Dr. Schmidt is one of the leading internists in Monmouth County offeringMedical Home services.  

He is an Associate Attending in the Department of Medicine, Jersey Shore University Medical Center, and  Clinical Assistant Professor in the Department of Medicine, Rutgers Robert Wood Johnson Medical School.

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"Gratitude can transform common days into thanksgivings, turn routine jobs into joy, and change ordinary opportunities into blessings."

William Arthur Ward

John A. Schmidt Jr., MD
Meaningful Medicine in Your Medical Home
709 Seventh Avenue
Belmar, NJ 07719
Phone:  732-282-8166  
Fax:  732-280-0147 
Disclaimer: The articles in Healthy Living are for general information only and are not medical advice.
Discuss all medical concerns and treatment options with your physician.