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Archive for September, 2013

Obamacare, Affordable Care Act, California

Ready or not here it comes. The first stages of implementation of the Affordable Care Act are only a few weeks away. Its goal is to provide health care coverage to some 55 million Americans who currently have no health coverage and to expand coverage to those who are underinsured. This monumental plan takes effect January 1, 2014.

Universal coverage is the goal of the plan and will be attained in two ways. First is the individual mandate which requires anyone without any type of health care coverage either through the government or an employer, to purchase an individual policy or face a financial penalty, referred to as a tax. The second way is that employers of more than 50 full-time workers will be required to provide insurance or pay a penalty of $2,000 per worker. If you are one of the millions covered by employer purchased insurance plans, Medicare or Medi-Cal you need not make any changes.

Those who have no employer offered health insurance and thus have to purchase their own coverage may see an increase in rates next year, but it is projected that almost half of these people will be eligible for tax credits to offset the increased premiums. Health insurance marketplaces called exchanges will allow consumers to compare costs and benefits among the available plans and to see if they qualify for tax credits to offset the price of their insurance premiums. These new plans are, for the most part, private (not public) and will compete to earn your business based on price, benefits and quality of service.

You can enroll beginning October 1 at the official website at http://www.coveredca.com, or by telephone at 888-975-1142 toll free.

People with incomes between $23,000 and $94,000 for a family of four, can receive financial help on a sliding scale to help offset costs. The same help is available to single individuals earning up to $46,000.

Those with very low incomes will be enrolled in Medicaid (Medi-Cal in California). As of January 1, 2014 Medi-Cal eligibility income levels will rise to $15,900 for individuals and $23,550 for families.

The first open enrollment period will last from October 1, 2013 to March 1, 2014. One may sign up via the internet, telephone, mail, or in person at designated centers. Once enrolled, it could take several weeks for the new coverage to take effect.

The law states that people cannot be denied coverage or charged higher premiums because of preexisting conditions. However, premiums may vary depending on age, tobacco use, geographic location and family size.

The new law requires that insurance policies cover the following 10 essential benefits:

– Hospitalization and rehabilitation services.

– Outpatient care (office visits) and emergency care.

– Prescription drugs and laboratory services.

– Preventative (wellness) care and mental health services.

– Pediatric and maternity/newborn care.

The law also eliminates lifetime limits on medical expenses, prohibits insurers from dropping or denying coverage, provides for your child to be covered on your policy until age 26, and caps annual out of pocket expenses up to an estimated $6,400 for individuals and $12,800 for families.

This is a monumental change in health care coverage. Soon there will be a significant change in health care delivery. Stay tuned.

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Dr. Terry Hollenbeck, Scotts Valley, San Lorenzo Valley

This month marks my 40th year of practicing medicine. I think back to my childhood living in Milwaukee, Wisc. with a father who was a family doctor in a solo practice on call 24-hours-a-day, 7-days-a-week. Our home phone rang day and night and Dad frequently left his comfortable home and much-needed sleep to go make a house call, admit someone to the hospital, or deliver a baby

I remember going with Dad on house calls, hospital rounds, and helping him treat patients in his office, which was conveniently located on the first floor of the duplex where we lived. I was absolutely fascinated by my early immersion into the practice of medicine.

I also heard stories about my Grandpa Hollenbeck who was also a family doctor  in the early 1900s and how he made house calls in a horse and buggy and often accepted chickens and garden produce as payments for his services. Grandpa’s brother, Henry Stanley Hollenbeck was a medical missionary in Angola Africa. He was named after the famous English journalist Henry Stanley who searched the African jungles for Dr. Livingston “I presume.” I heard fascinating tales of him practicing medicine in the remote jungles. With these influences I knew from an early age that I wanted to be a doctor.

After graduating from the Medical College of Wisconsin in 1971, I headed to sunny San Jose, Calif., to do an internship at Santa Clara Valley Medical Center. I found a calling in Emergency Medicine and stayed there as an emergency physician for almost 10 years. I then had an opportunity through the Christian Medical Society to go to Honduras in Central America, where I spent two years practicing medicine in the jungles along the Caribbean Coast working with the native Miskito Indians. Being the only Caucasian English speaking person within a 50-mile radius, living without electricity or running water and being among those wonderful people was one of the highlights of my life.

From Central America I returned home to California and began a career in the new field of urgent care medicine. I found this form of practice much to my liking and ended up working for the Santa Cruz Medical Clinic when it opened up its first satellite clinic in Scotts Valley. We opened our doors there on March 1, 1987 and I’ve been there ever since. I am privileged to work with a team of outstanding physicians at our Palo Alto Medical Foundation as well as a fantastic support staff made up of medical assistants, patient service representatives, nurses, physician assistants, nurse practitioners, and medical technicians.

What I love most about my current practice are the wonderful patients with whom I have had the privilege to treat. Having been here in Scotts Valley for the past 26 years, I have become quite familiar with many patients in our locale. I’m now taking care of people in their 20’s and 30’s who I first took care of when they were babies or toddlers. I feel that I have grown up, and older, with many of my patients over the years. I’ve shared in their joys and their sorrows.

It is a tremendous honor and pleasure to continue working with such wonderful patients. To be able to improve health, alleviate suffering and to sometimes save lives, is the ultimate of satisfaction for me. So thank you to all my patients for the privilege of working with you which makes me want to continue practicing medicine for as long as I am able to do so.

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ear wax buildup, hearing

I’m writing about a subject that may not be too appealing or romantic, but it’s something that pretty much affects all of us. I recently wrote about hearing loss and mentioned that a frequent cause of this was from blockage due to ear wax, also called cerumen.

Ear wax is actually not a wax but a mixture of skin cells and oil secreted by glands in the ear canal. Its purpose is to lubricate and protect the sensitive lining of the canal. It has some antimicrobial properties which means it can help to fight off infections.

Most of the time cerumen has a tendency, due to chewing and jaw movements, to move to the opening of the ear where it dries up and flakes out of the ear and disappears, causing us no problems.

When an ear canal is blocked up with cerumen, it is called an impaction. This can occur when one produces an overabundance of ear wax.Another cause of impaction is from the use of a Q Tip which more often than not forces the cerumen deeper into the ear canal rather than cleaning it out. The use of a Q-Tip can also scratch your ear canal and cause an infection. This is why it’s often said not to stick anything in your ear “smaller than your elbow”.

With a cerumen impaction, you will most likely feel a pressure sensation in your ear canal and usually some degree of hearing loss. These are the symptoms that will usually cause a patient to see their doctor.

Once your doctor looks in your ear and verifies the wax blockage he or she has several options to remove it. The most common method used is to flush out the ear with pressurized water. Another method your doctor may use is to take a small wire instrument and, under direct vision, remove the wax manually

There are ear wax removal kits found at pharmacies that contain wax softening drops and a bulb syringe to flush out the ear. Although not always successful, they’re probably worth a try.

I advise my patients after the wax has been removed, to do some home therapy to prevent further wax buildup. Once a week, perhaps when bathing, they should flush out their ears with luke warm water, using a common rubber bulb syringe found at any pharmacy. This method should clean out any wax before it accumulates.

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