Vitamin K2: Heart and Bone Health

By Dr. Mercola

Most everyone, including many conventional physicians, have begun to appreciate the importance and value of vitamin D. Few, however, recognize the importance of vitamin K2, which is nearly as important as vitamin D.

Dr. Dennis Goodman,1 who was born in South Africa and trained at the University of Cape Town, has multiple board certifications in cardiology (and several subspecialties) and holistic integrative medicine.

After his internship at the Grootte Schuur Hospital—where Dr. Christian Barnard did the first heart transplant in 1967—he came to the US, where he did his cardiology fellowship at the at the Baylor College of Medicine in Houston, where Dr. Michael DeBakey performed the first bypass surgery.

“I was really very lucky to be in a situation where I had these two cardiac giants as mentors and teachers,” he says.

Dr. Goodman is also the chairman of the Department of Integrative Medicine at the New York University (NYU), and has authored the book, Vitamin K2: The Missing Nutrient for Heart and Bone Health. In it, he explains why vitamin K2 isevery bit as important as vitamin D.

“For 20 years I was putting stents in; running around day and night at the hospital. When I got called to the emergency room for someone having a heart attack, I was like a fireman putting out a fire in a house.

Sometimes, you were very lucky and could save the house from burning down, and sometimes not.

What I started to realize is that prevention is really the key for us to making the maximum impact. I’ve always been interested in the idea that everything we need to be healthy is provided by the Lord above –namely what’s out there for us to eat.

80 percent of these chronic diseases including atherosclerosis, heart attacks and strokes, diabetes, and obesity are preventable. So I got into the whole idea of learning integrative medicine,” he says.

He was the chief of cardiology at Scripps Memorial, and went on to Scripps Clinic for Integrative Medicine for many years.

“Obviously, when you understand holistic medicine, you understand that so much of what we’re doing, unfortunately, in traditional medicine is procedures, testing, and prescribing drugs, because that’s what we’re taught—and making diagnoses instead of taking care of people who basically may not have a disease, but are not healthy and well.”

As a cardiologist, it’s quite appropriate to delve into vitamin K2, as it has two crucial functions: one is in cardiovascular health and the other is in bone restoration.

It performs many other functions as well, but by helping remove calcium from the lining of the blood vessels, vitamin K2 helps prevent occlusions from atherosclerosis.

Vitamin K Basics

Vitamins K1 and K2 are part of a family, but they are very different in their activity and function. Vitamin K1, found in green leafy vegetables, is a fat-soluble vitamin involved in the production of coagulation factors, which are critical for stopping bleeding.

This is why when someone’s on a blood thinner such as warfarin, they need to be careful not to take too much vitamin K1, as it will antagonize the effect of drug. Vitamin K2 is very different. There’s a complex biochemistry that occurs with K2 involving two enzymes:

  • Matrix Gla-protein (MGP)
  • Osteocalcin

“Gla” is short for glutamic acid. Glutamic acid is imported into the cells in the wall of your arteries, where it binds to calcium and removes it from the lining of your blood vessels.

Once removed from your blood vessel lining, vitamin K2 then facilitates the intergration of that calcium into your bone matrix by handing it over to osteocalcin,. The osteocalcin then helps cement the calcium in place.

Vitamin K2 activates these two proteins. Without it, this transfer process of calcium from your arteries to your bone cannot occur, which raises your risk of arterial calcification.

“Vitamin K2 is like a light switch—it switches on MGP and osteocalcin, which takes calcium out of the arterial wall and keeps it in the bone.

There’s so much information showing this relationship between osteoporosis (not having enough calcium in your bones) and having an increased incidence of heart disease. What’s actually happening, I think, a lot of patients are vitamin K2-deficient,” Dr. Goodman says.

“So now, I tell all patients – especially when they have risk factors for calcification – ‘You’ve got to get vitamin K2 when you take your vitamin D, and your calcium, and magnesium.’ Because we need to make sure that the calcium is going where it’s supposed to go.”

Statins May Increase Arterial Calcification by Depleting Vitamin K2

Besides a vitamin K2-poor diet, certain drugs may affect your vitamin K2 status. Dr. Goodman cites a recent article2 in the Journal of the American College of Cardiology, which suggests statin drugs may increase calcification in the arteries.

Interestingly enough, another recent study3 published in the Expert Review of Clinical Pharmacology shows that statins deplete vitamin K2.

“For me, that is so huge because if that’s true, everybody that is put on a statin, you want to make sure they’re also taking vitamin K2,” Dr. Goodman says.

This is an important observation, considering one in four adults in the US over the age of 40 is on a statin drug. Not only do all of these people need to take a ubiquinol or coenzyme Q10, which is also depleted by the drug, it’s quite likely they also need vitamin K2 to avoid cardiovascular harm.

Sources of Vitamin K2

Vitamin K2 is produced by certain bacteria, so the primary food source of vitamin K2 is fermented foods such as natto, a fermented soy product typically sold in Asian grocery stores. Fermented vegetables can be a great source of vitamin K if you ferment your own using a specially-designed starter culture. My Kinetic Culture is high in strains that make vitamin K2. If you would like to learn more about making your own fermented vegetables with a starter culture, you can watch the video and read more on this page.

Please note that not every strain of bacteria makes K2, so not all fermented foods will contain it. For example, most yogurts have almost no vitamin K2. Certain types of cheeses, such as Gouda, Brie, and Edam, are high in K2, while others are not. It really depends on the specific bacteria. Still, it’s quite difficult to get enough vitamin K2 from your diet—especially if you do not eat K2-rich fermented foods—so taking a supplement may be a wise move for most people.

How Can You Tell if You’re Deficient in Vitamin K2?

The major problem we face when it comes to optimizing vitamin K2 is that, unlike vitamin D, there’s no easy way to screen or test for vitamin K2 sufficiency. Vitamin K2 cannot at present be measured directly, so it’s measured through an indirect assessment of undercarboxylated osteocalcin. This test is still not commercially available, however. “That’s our problem. If that was available, we could start testing and showing people that their levels are low,” Dr. Goodman says.

Without testing, we’re left with looking at various lifestyle factors that predispose you to deficiency. As a general rule, if you have any of the following health conditions, you’re likely deficient in vitamin K2:

That said, it’s believed that the vast majority of people are in fact deficient these days and would benefit from more K2. One reason for this is very few (Americans in particular) eat enough vitamin K2-rich foods. So, if you do not have any of the health conditions listed, but do NOT regularly eat high amounts of the following foods, then your likelihood of being vitamin K2 deficient is still very high:

  • Certain fermented foods such as natto, or vegetables fermented using a starter culture of vitamin K2-producing bacteria
  • Certain cheeses such as Brie and Gouda (these two are particularly high in K2, containing about 75 mcg per ounce)
  • Grass-fed organic animal products (i.e. egg yolks, butter, dairy)

Different Kinds of Vitamin K2

The vitamin K puzzle is even more complex than differentiating between K1 and K2. There are also several different forms of vitamin K2. The two primary ones—and the only ones available in supplement form—are menaquinone-4 (MK-4) and menaquinone-7 (MK-7). MK-4 has a very short biological half-life—about one hour—making it a poor candidate as a dietary supplement. MK-7 stays in your body longer; its half-life is three days, meaning you have a much better chance of building up a consistent blood level, compared to MK-4.

In supplement form, the MK-4 products are actually synthetic. They are not derived from natural food products containing MK-4. The MK-7– long-chain, natural bacterial-derived vitamin K2– on the other hand comes from a fermentation process, which offers a number of health advantages.

Research4 has shown MK-7 also helps prevent inflammation by inhibiting pro-inflammatory markers produced by white blood cells called monocytes. MK-7 is extracted from the Japanese fermented soy product natto, and since it’s longer lasting, you only need to take it once a day. With an MK-4 supplement, you need to take it three times a day. The duration of action is also much longer with MK-7.

As for a clinically useful dosage, some studies have shown as little as 45 micrograms per day is sufficient. Dr. Goodman recommends taking 180 micrograms per day, making sure the K2 is in the form of MK-7. If you’re eating natto, all you need is about one teaspoon.

That said, vitamin K2 is non-toxic, so you don’t need to worry about overdosing if you get more. Do keep in mind that vitamin K2 may not necessarily make you “feel better” per se. Its internal workings are such that you’re not likely to feel the difference physically. Compliance can therefore be a problem, as people are more likely to take something that has a noticeable effect. This may not happen with vitamin K2, but that certainly does not mean it’s not doing anything! Last but not least, remember to always take your vitamin K supplement with fat since it is fat-soluble and won’t be absorbed without it.  Read More

Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing and RCM, Medical Transcription, Pre-Certs with AzaleaHealth EHR.   We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information.  We have education programs in Medical Scribe Specialists. #medicaltranscription #azaleahealthEHR #revenuecyclemanagement #MDSofKansas #medicalbillingservice


Providence worker to serve 2 years for giving medical records to drug dealer

By Tulsi Patil for KTUU.comBehindBars-770x332

ANCHORAGE – An Anchorage woman was sentenced to two years in federal prison Monday for violations to medical privacy laws, U.S. Attorney Karen Loeffler’s office announced in a press release.

According to prosecutors, 33-year-old Stacy Laulu was a financial counselor at Providence Hospital in March, 2013 when she was contacted by Stuart Seugasala who asked her to access private medical records of two patients at the hospital.

Seugasala was a video game parlor owner at the time and was also trafficking drugs on the side. On March 13, 2013, Seugasala and two others kidnapped, tortured and sexually assaulted two men who owed them money. The condition of one of the victims was so severe that he was admitted to Providence Hospital for treatment.

Two days later, on March 15, in an unrelated incident, Seugasala put another person in the hospital when he shot at a person driving on Seward Highway. The victim suffered from a severed fingertip and a neck-graze wound and was also admitted to Providence Hospital for treatment.

Prosecutors wrote that Seugasala then contacted Laulu and asked her to take a look at their private medical records.

“Laulu determined the identity of one of the victims (one of whom was still hospitalized) and provided Seugasala with confidential information about the victims, including what they had told hospital staff about how they sustained their injuries, the severity of the injuries and what was reflected in hospital records about their cooperation with law enforcement,” prosecutors wrote.

Laulu communicated all the information to Seugasala via text messages and police seized her phone at the request of the Drug Enforcement Administration. Laulu admitted to sending the information to Seugasala and Providence Hospital terminated her employment.

“Evidence at the trial established that Laulu’s husband was a close friend and former co-defendant with Seugasala in a federal drug case,” prosecutors wrote. “Witnesses at Seugasala’s and Laulu’s trial testified that, at times, Seugasala would arrange to drop off drug proceeds for Laulu and her husband’s benefit.”

Laulu was sentenced to two years in prison for violating the Health Insurance Portability and Accountability Act (HIPAA). Prosecutors wrote in the press release that this case was the first felony HIPAA prosecution in Alaskan history and one of the few in the country.

Seugasala was sentenced to life imprisonment on May 18.

Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing and RCM, Medical Transcription, Pre-Certs with AzaleaHealth EHR.   We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information.  We have education programs in Medical Scribe Specialists. #medicaltranscription #azaleahealthEHR #revenuecyclemanagement

US House Bill Introduced to Stop ICD-10

Article by Chris Dimick, Editor-in-chief  at the Journal of AHIMA. This article was originally published on the Journal of AHIMA website on May 4, 2015 and is republished here with permission.

A bill has been introduced into the US House of Representatives that would stop the implementation of ICD-10-CM/PCS.

The bill, H.R. 2126, would “prohibit the Secretary of Health and Human Services from replacing ICD-9 with ICD-10 in implementing the HIPAA code set.” Introduced by Rep. Ted Poe (R-TX) on April 30, H.R. 2126 has been referred to the Committee on Energy and Commerce and the Committee on Ways and Means.

Rep. Poe is a long-time opponent of the ICD-10 implementation. In 2013 he introduced a nearly identical bill into the House of Representatives on April 24, 2013, H.R. 1701, that also called for prohibiting HHS from replacing ICD-9 with ICD-10.  That bill failed to gain traction and was never taken up by the referred House committees, according to

H.R. 2126 is co-sponsored by Rep. Blake Farenthold (R-TX), Rep. Mike D. Rogers (R-AL), Rep. Mo Brooks (R-AL), Morgan H. Griffith (R-VA), Rep. Tom Price (R-GA), and Rep. David P. Roe (R-TN).

AHIMA and the Coalition for ICD-10 have called on ICD-10 supporters to continue their advocacy efforts and contact their representatives and senators to prevent any future delay of ICD-10.

Posted by Traci Miller on May 7, 2015 

Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing and RCM, Medical Transcription, Pre-Certs with AzaleaHealth EHR.   We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information.  We have education programs in Medical Scribe Specialists. #medicaltranscription #azaleahealthEHR #revenuecyclemanagement

How Obamacare will creatively destroy primary care as we know it

What do you think about this statement:  “With the exception of the very poor and the very old, people will now need to pay for primary care out of their own pocket. That’s what high deductibles mean.”

This is well worth the read … 

As Obamacare is winding its way through a hellish bureaucratic labyrinth of its own creation, accompanied by cheers and boos from the blood thirsty spectator crowds, confusion, fear, trepidation, despair and exhilaration, are gripping America’s doctors all at once, because whatever else is accomplished in the next decade, medicine will never be the same.

At the confluence of cutting edge technology, great poverty and unimaginable fortunes, a new vision for the practice of medicine is beginning to emerge. Medicine was formed during times when sickness was never far from death. It was devised by old men who went to bed every night thinking that they may never awaken, and it was institutionalized by women who shunned life’s earthly pleasures. They understood the fears of old age, the loneliness of disease, and the comfort and serenity that come with putting your life in the hands of God, when all was said and done. They built houses for the poor and sick and downtrodden, with larger than life doctors as God’s emissaries, and pious sisters as angels of mercy.

Over the last century, science and technology changed hospitals from places of suffering, grief and death, to places of hope and new beginnings; from dreary spartan wards for the dying, to plush private suites for the soon to be healthy; from whispered footsteps in the twilight, to shiny instruments of mechanical shops; from final moaning and groaning, to humming of machines and laughing soundtracks of sitcoms punctuated by shrill alarms and flashing lights.

Dying in a hospital is now considered a failure of sorts, a preventable and costly mistake. There is no place for God in a modern hospital, and there is no place for special emissaries or angels. And when God vacates the premises, big business comes in to take His place.

Today’s technology driven medicine is shaped by young and invincible entrepreneurs, in search of fame and fortune. Masters of their own fate, bursting with self-quantified health, brilliantly educated in the intricacies of computerized logic, armed with stacks of data points, and carefully clad in black turtlenecks, hoodies, tee shirts and designer jeans, these modern knights of the business round table are engaging in the timeless quest of vanquishing death, or at the very least making it less expensive for the rest of us.

So where does all this leave primary care? Primary care is now considered routine care; routine, like changing oil on an automobile. Sticking a needle in your arm so you never, ever die from a plague is no longer a miracle, just like switching the lights on, or flushing the toilet is no longer deserving of thought. Miracles only happen in hospitals now, and not very often either. Primary care doctors are increasingly banned from hospitals, and asked to stick with routine care and leave the complex stuff to their betters. And primary care doctors agreed to this arrangement, mostly voluntarily, and explained (mostly to themselves) that routine care nowadays is pretty complex on its own, and arguably even more complex than the narrowly specialized interventions occurring in hospital settings. Maybe so, but routine complexity is what technology entrepreneurs eat for breakfast. Terminology is important.

When health care reformers say that primary care is foundational to reform, they mean routine care. They mean vaccines given on schedule, screenings done on time, lifestyles assessed and documented, educational materials handed out, and referrals coordinated to completion. They mean managing populations, stratifying risk, conducting outreach, dotting every BP and crossing every A1c.

Welcome to Lake Wobegon primary care where all patients come in correctly diagnosed and ready to be tracked. These things can be automated with the right technology and properly trained teams of workers, supervised by medical professionals providing spot checks and quality assurance. High tech and high deductibles will combine forces to turn routine primary care into the first medical service to become a retail product, with its Med Emporium, Osler 5th Avenue, and eventually, Hello Kitty Diabetes toolkits sold at The question is no longer how to stop the train; the question is where primary care goes from here.

Let it go!

When primary care physicians became overworked and underpaid, something had to give. Inpatient care, arguably the high end portion of practicing at the top of one’s medical license, was snatched away by hospitals oblivious to their mission statement, and a good portion of complex care had to be offloaded to secondary care, just so primary care can keep up with demand for routine care.

Primary care became literally broken, and with it, the entire system downstream was broken too. In a fool’s errand type of strategy, routine primary care now includes tasks aimed at gluing primary care together again (e.g. transitions of care management, exchange of clinical information across facilities). Furthermore, routine care is being expanded to include things previously in the purview of public health (e.g. health literacy, physical activity, safe sex), stuff that grandma used to do for us (e.g. eat your string beans, keep your hands out of the cookie jar) and new retail oriented things (e.g. online shopping, consumer experience, values and preferences).

Today, in a plot twist worthy of Beckett himself, tech entrepreneurs in concert with non-physician workers are vying for the business at the low end of primary care. The new routine care will be catalogued, standardized, sterilized, automated, delegated, computerized, transformed and reformed. If you hang on to it, it will drag you down to wherever it’s going. Let it go! Let it go to your “team” (read, staff), or (gasp) let it go to Med Emporium.

Insurers, who could not be made to understand the importance of continuous, comprehensive primary care, seem perfectly willing to support the low skilled, electronic strings and duct tape of the new and expanded routine care. If you have an entrepreneurial gene in your DNA, hire staff, promote your office manager to chief quality/compliance officer, your receptionist to care coordination manger, the triage nurse to director of resource allocation, and delegate the bejeebers out of your daily work. Become the CEO, and get a secretary (a.k.a. scribe), so you never have to click another box, or type another embarrassingly misspelled sentence. Double your patient population, and let your NPs see the f/u for diaper rash, sports physicals, strains and sprains, the new wave of statin seekers, and everything that your director of resource allocation deems routine.

Grab the fluctuating 25% or so of patients that are most complex and be their comprehensivist.  Hospitals are routinely inventing specialties, from hospitalists to intensivists to nocturnists, to further fragment continuity of care and increase profits. It’s time to learn from the experts.

Instead of waiting for the system’s other shoe to drop (on your head), proclaim yourself a specialist in the absolutely last remaining piece of what was once primary care. Grab it and hold onto it like dear life, because it will be nibbled on from below and from above incessantly. You will have to compete with the low prices of Med Emporium on one hand and with the natural expansionist tendencies of hospitals on the other. You will have to find a way to get paid for your new specialty services, and just like every other entrepreneur, you will have to take risk; the more complex the patients are, the bigger the risk and the larger the rewards.

Fortunately, the new health care law encourages precisely this type of advanced payment models. Go for it! Spend a leisurely hour with each patient needing comprehensive care, while your routine side of the business is humming along on its own.  With proper planning, you can collect the customary and usual fees for your greatly expanded panel, plus the special fees for comprehensive care, plus any shared savings you can generate from keeping these select folks out of hospitals and emergency rooms. You’ll have to do a bit of marketing and engage in some creative contract negotiations (get a lawyer), but the sky may very well be the limit.

Don’t let it go!

What if you have no entrepreneurial markers in your DNA? What if the previous few paragraphs made you sick, depressed or really angry? Fortunately, Obamacare is on your side.  For all the docs who argued that health insurance destroyed the doctor-patient relationship because it inserted itself in the payment process, and for all those who argued that insurance should not pay for routine oil changes, this is your lucky day, because it doesn’t anymore.

With the exception of the very poor and the very old, people will now need to pay for primary care out of their own pocket. That’s what high deductibles mean. A good portion of these people will become savvy shoppers and choose the technology enabled do-it-yourself method, or go to Med Emporium on an as-needed basis, but there will be more than enough patients (perhaps in higher income brackets), seeking quality over cheapness. The same folks that buy artisan bread and free range eggs from local farmers will bring their family to you, if you promise to provide hand-made wholesome and holistic primary care.

Direct primary care, whether concierge, or ideal or micro, or contracted by employers and even forward thinking insurers, will most likely explode in size during the next decade. There is a huge continuum of service definitions here, and you should be able to find your comfort zone. You can go back to being a country doctor in the midst of a bustling metropolis, and care for multiple generations at home, in clinic, at the hospital, nursing home and eventually hospice. You can dial back a little bit, or a lot, and contract with midsize employers to provide outpatient primary care. You can be a high-tech, electronic-everything doctor, or an old fashioned one, or perhaps a unique combination of both.  Here too, the sky seems to be the limit.

So what’s next for primary care? It seems that for physicians, the door is closing on the treadmill now known as primary care practice, but countless windows are being opened simultaneously. You just have to look up and find yours. Whether you choose to stay in the system, step half way in and half way out, or do it your way all the way, there will always be a need for good doctors. Whether you choose to run the patient mills at Med Emporium, or run your own exquisite Osler 5th Avenue, or start the Hello Kitty Diabetes Company, or care for people slowly and thoroughly, one at a time, from start to finish, primary care may just be the best place to be in right now.

Margalit Gur-Arie is founder, BizMed. She blogs at On Healthcare Technology.

Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Transcription, Revenue Cycle Management, AzaleaHealth EHR, and REAL-TIME solutions.   We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information.






Healthcare – everyone should have it but how to pay for it?

“Everyone should have access to healthcare, the question is how do we pay for it? The ACT has provisions to cut the costs of healthcare, but things like wellness and preventive care, which have the potential to reduce costs, will take years for a return on the investment.”

Are you looking for a practical explanation of the Affordable Care Act?  Many of us are and I believe that Mr. James McGahee, Jr. has done a nice job in this article.  Our friends at AzaleaHealth have many great articles on their blog.

(The Implementation of the ACT began October 1, 2013) 
Authored by: James McGahee, Jr.

The Affordable Care Act requires all eligible Americans to be covered by health insurance. Simultaneously it provides a way for that to happen by providing incentives, penalties, and options to individuals, and small and large employers, including tax exempt employers. As of October 1, 2013, the ACT requires that people who do not have health insurance, regardless of reason, apply for health insurance coverage either through their employer, an insurance company, or through an exchange established by the Federal Government. Coverage for those who apply no later than December 15, 2013 and are approved, will begin January 1, 2014. Open enrollment is available through March 31,2014. Working individuals who do not have insurance and have not enrolled in a health plan by March 31, 2014 will be required to pay a 1% income tax on their adjusted gross income for 2014 and continuing as long as they are non-covered. An individual will be exempted from the 1% tax if their income is below 133% of the Federal Poverty Level which for 2013 is $15,282 for a single person and $31,322 for a family of four. In fact if the individual’s income is below the Federal Poverty Level they will qualify for Medicaid and receive healthcare coverage free.

For individuals who have health insurance coverage as of October 1, 2013, either through an individual policy or an employer’s policy, the Affordable Care Act recommends these individuals compare their plan to the plans being offered through the Governmental Exchanges to verify that their plan meets the essential benefits that are required by the Affordable Care Act. The essential benefits required by the ACT include, coverage for dependent children up to age 26, no denials for pre-existing conditions, no lifetime limit on coverage, no co-pay for prevention and wellness programs. The ACT also recommends that the covered individuals compare the cost of their plans to the costs of the Governmental Exchange Plans. If individuals are covered by Medicare or Medicaid they do not have to do anything. As stated above, if an individual does not have health insurance coverage and does not apply for coverage by March 31, 2014, his or her income, if above 133% of the Federal Poverty Level, will be subject to a 1% income tax penalty. Individuals considering applying for health coverage through the Governmental Exchanges need to compare the premiums, deductibles and co-pays to non-governmental plans and employer plans. The Governmental Exchanges offer 4 different plans. The least expensive plan is called the Bronze plan. It pays 60% of the individual’s healthcare costs. The second plan is called the Silver plan and it pays 70% of the individual’s healthcare costs. It is more expensive than the bronze plan. The third plan is called the Gold plan. It pays 80% of the covered individual’s healthcare costs and is more expensive than the first and second plan. The fourth plan is called the Platinum plan and it pays 90% of the individual’s healthcare costs. It the most expensive plan. The actual costs (premiums) for each of these plans depends on the ages of the covered individuals, the size of the family, the location where they live and their medical history. For Individuals making no more than 400% of the Federal Poverty levels, which for 2013 is $45,960 for an individual and $94,200 for a family of four, the premiums can not exceed 9.5% of their income. As an example, for a person earning $45,960 annually, their premium can not exceed $4336 per year. For an individual earning more than 400% of the annual Federal Poverty Level but less than $200,000 annually the premiums are market based. For Individuals making over $200,000 their premiums are also market based but they have to pay a .9% tax on income above $200,000. These Individuals will also be subject to a 3.8% tax on interest and dividend income, and on capital gains, including any gain exceeding $250,000 on the sale of their home. The .9% tax and the 3.8% tax will be assessed on individuals making over $200,000 beginning in 2013 and thereafter no matter what insurance plan they are covered by.

The Affordable Care Act also includes provisions for small employers and large employers. A small employer is defined as a business with less than fifty employees. A large employer is defined as a business with 50 or more full-time equivalent employees. Only a few provisions of the ACT apply to large employers. Beginning in 2015 large employers must provide affordable heath insurance that provides minimum value to all employees or pay a tax of $2,000 per employee (for all employees except the first 30). Large employers, beginning in 2015, must file a comprehensive report with the IRS verifying, first and foremost, that they are providing health insurance. The employer’s plan must meet the ACT required essential benefits including the affordable care cost formula which sets thresholds on how much the employer can charge the employee for premiums, deductibles, and co-pays. Large Employers can opt out of providing health insurance to their employees by allowing them to join a Governmental Exchange. The employer will have to pay the $2,000 per employee tax if they do so! There is no guarantee that the Exchange premiums will be less than the employer’s plan premiums.

As of October 1, 2013, small employers who provide health insurance to their employees, cover at least 50% their full-time employee’s premiums, and have fewer than 25 full-time equivalent employees with average annual wages of less than $50,000 may be eligible for the Small Business Health Care Tax Credit. The credit for 2013 is 35% of premiums paid and is scheduled to increase to 50% in 2014, but in 2014, to qualify for the credit the small employer’s employees must be enrolled in a qualified health plan offered through a Small Business Health Options (SHOP) Exchange. If the small business employer qualifies for the tax credit and has no taxes due, the credit is refundable. Basically small business employers have an incentive to enroll their employees in a SHOP governmental plan by agreeing to pay half their premiums and receiving a tax credit of 50% of the costs of the premium. Between now and March 31, 2014 , the ACT focuses on getting people who do not have health insurance to get coverage. Those that do not, unless exempted by unemployment or Federal Poverty Levels, will pay a tax penalty. Individuals whose incomes are less than 4 times the Federal Poverty Levels will get subsidies or tax credits thus receiving a discounted premium. Those with incomes greater than 4 times the Poverty Levels up to $200,000 of income will pay market rate premiums. Individuals with income exceeding $200,000 will pay market rates plus an additional .9% employment tax, collected by the IRS.

Large business employers can access the Governmental Exchanges for their employees beginning the first of 2015. Large employers who opt to provide health insurance coverage to their employees through non-governmental markets have to be able to prove that their plans meet the Essential Benefits and Affordable Costs requirements of the ACT by the first of 2015 or else be prepared to receive significant penalties and taxes. Amendments and changes to the ACT will likely happen in 2014 but it is unlikely that the ACT will be overturned. The goals of the Affordable Care ACT are to provide health care insurance coverage to every eligible person in America while reducing the total health care costs. The Government is confident the Affordable Care Plans will help them achieve their goals. Looking at the average annual per person health care cost back in 2010 when the ACT was passed, it was $8402 per person in the U.S., according to the Kaiser Foundation. It is the number the Government will have to compare itself to in order to determine if the ACT has successfully reduced the cost of health care in the United States. Most employer plans historically have paid about 60% of the annual per person costs with the employee paying the other 40% through premiums, deductibles, and co-pays. Using these historical numbers, and assuming the average employer plan covers 100 employees, the combined health insurance costs for the employer and employee would be $8402 times 100. This plan would cost $840,200, with the employer paying $504,100 and the employees paying $336,080. If this employer decides to transfer his employees to a governmental plan and no longer offer a health care insurance benefit, the employer will be subject to an annual tax penalty of $2,000 per employee, resulting in a cost of $200,000 to the employer. In other words the bottom line of the employer’s business would increase $304,120. If it is the intent of the Government to hold the employee’s future insurance coverage costs comparable to the employee’s current costs the Government will have to subsidize the total costs of $840,200 minus the employer’s contribution off $200,000 and minus the employees’ costs of $336,080, to the tune of $304,120. Without the subsidy, the total health care costs per person of $8402 will have to be reduced 36%. Without this cost reduction, the Government has only four options. raise the employer’s contribution (penalty), raise the employee’s contribution (premiums, deductibles and co-pays), implement additional employment taxes on the employer and employees, or some combination of all of the above.

Everyone should have access to healthcare, the question is how do we pay for it? The ACT has provisions to cut the costs of healthcare, but things like wellness and preventive care, which have the potential to reduce costs, will take years for a return on the investment. Based on what is buried in the 2,700 page Law (the ACT) it is almost certain that all of the four options mentioned above have already been planned for.

About the Author
James McGahee, Jr. recently retired as Chief Executive Officer of South Georgia Medical Center, is a leader in the community. Mr. McGahee is a past member of the board for Valdosta-Lowndes County Chamber of Commerce, Healthcare Financial Management Association, American Institute of Certified Public Accountants, Georgia Hospital Association, and the American College of Healthcare Executives.

Smiling Physician near New Family


Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Transcription, Revenue Cycle Management, EHR technology, and REAL-TIME solutions.   We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information. 

Aging population, Obamacare causes increase demand in doctors by 2025

Aging population, Obamacare causes increase demand in doctors by 2025.


Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Transcription, Revenue Cycle Management, EHR technology, and REAL-TIME solutions.   We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information.