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Exploring Quality Control SystemsThe Essence of Quality Control

The Essence of Quality Control

A Quality Control System is a fundamental aspect of any organization striving for excellence in its products or
services. It encompasses a set of procedures and practices designed to ensure that every aspect of production
adheres to predefined quality standards.

Key Components

At its core, a Quality Control System involves:

  • Establishing Quality Standards: Defining benchmarks for product or service quality.
  • Quality Planning: Strategizing processes to meet and maintain high standards.
  • Quality Control Inspections: Regular checks to verify compliance with standards.
  • Testing and Analysis: Thorough examination to identify and rectify defects.
  • Corrective Actions: Implementing measures to address identified issues.
  • Continuous Monitoring and Improvement: Consistent efforts for enhanced quality.

Benefits of Implementation

Implementing a Quality Control System brings numerous benefits:

  • Consistent Product Quality: Ensures uniform quality across all outputs.
  • Customer Satisfaction: Meets or exceeds customer expectations.
  • Reduced Defects and Rework: Minimizes errors and subsequent rework.
  • Compliance with Regulations: Adheres to industry and legal standards.
  • Improved Efficiency: Streamlines processes for increased productivity.
  • Enhanced Company Reputation: Builds trust and credibility in the market.

Post 10: Explore the impact of Quality Control Systems on organizational success.

Challenges and Considerations

However, implementing and maintaining a Quality Control System comes with challenges. Continuous training,
resource allocation, and adapting to evolving industry standards are vital considerations. Overcoming these
challenges is essential for sustained success.

Conclusion

A robust Quality Control System is not just a necessity; it’s a strategic asset. It reflects an organization’s
commitment to delivering excellence, ensuring customer satisfaction, and positioning itself as a reliable
player in the market. Embrace the essence of quality control for enduring success.

 

 

Adam Loeber’s Professional Career

Adam Loeber has had an impressive professional career as an insurance agent and Adam Loeber’s community leadership is notable. He is constantly on top of his work and his coworkers recognize him as a reliable and hard-working agent. Loeber is a Cornell graduate and started the process to be an agent after graduation. He has worked as an agent for the last 24 years and has sold over a million policies from NYC to LA and looks to expand globally as Adam Loeber is a world traveler. His partner Zeda Levy has been Loeber’s partner since the start of the business and also works in the family law firm as a malpractice attorney.
Adam Loeber has traveled around the world for clients, but has also spent much of his time at the office working on emails and tracking leads. Many times, Loeber has taken over in a time-sensitive deals and worked with a team to solve efficiently and effectively. He is also skilled at writing detailed reports and analyzing facts for larger institutional policies.

The FBI has recognized Loeber on two different occasions for his volunteer work. In 2009, the FBI awarded Loeber an FBI Medal of Valor. This award is for individuals who perform an act of heroism and risk their personal safety and life.

In 2016, the FBI awarded Loeber and Steinberg with the Mary C. Lawton Lifetime Service Award. Individuals need to have demonstrated selflessness to the highest degree.

At the end of 2017, the FBI will award Loeber with the William French Award for Outstanding Contributions for solving two missing children cases that had gone cold for over ten years. For more visit

Maharashtra Government reduce stamp duty on the Real Estate sector

The COVID-19 has put the adverse effect not only on the real estate sector but other sectors as well. The blow due to the COVID pandemic is very important and it will take time to come out of the excess. The Maharashtra government has determined to reduce stamp duty on real estate to assist homebuyers to purchase properties during the pandemic.
A huge support to the Real Estate sector
To boost the stagnant real estate market, the Maharashtra government on August 26 decided to temporarily reduce stamp duty on housing units. The judgment was taken at the state cabinet meeting on August 26. It is a big support to real estate sectors to encourage homebuyers to purchase properties during the pandemic. First, it is important to understand the process of RERA Registration

Process of RERA Registration
• Upload the required documents & information to the RERA registration web portal. • Consult our business advisor on how to get the RERA registration number. • Our professional will verify the validity of documents & Information provided. • On Confirmation, make online payment of RERA registration fees. • Our professional will prepare and submit the application with jurisdictional RERA authority.

Benefits for the Real Estate sector
• It will provide buyers with an incentive to buy homes and give them the option to take a decision to purchase. • The decreased cost of the stamp duty is bound to assist first-time homebuyers as well as resale flat buyers to invest in real estate. • It will boost the real estate market in this festive season. • This will also help the government to generate revenue as property registration is expected to increase.

Moreover, the main purpose of the government too encourages homebuyers to purchase properties during the pandemic. Know more about reducing stamp duty on real estate.

Life Insurance – Why Do I Need It?

Many people want to buy life insurance, but don’t think they can afford it.  There are two major different types of policies available; whole life and term life. Term life is more affordable than whole life policies.Whole Life InsuranceWhole life policies are also an investment opportunity.  They combine the benefits of a term life policy with investment components, which offer investments in stocks, bonds, and money market funds, as well as building cash value that can be borrowed against, much as a home equity line can be borrowed against.Term Life Insurance
Term insurance provides for live coverage only. Upon the death of the insured individual, the term life policy will pay out in the amount of the policy to whoever is named beneficiary. Term life policies can be purchased from anywhere between one and 30 years.Rates as well as a variety of insurance policy options are available to those who perform careful research and understand the basics of life insurance terminology.  A personal finance consultant may help individuals determine the fine points of a variety of insurance policy options and rates, as well as representatives from major insurance companies such as Northwestern Mutual, Mutual of Omaha, Met Life, New York Life, and insurance policies offered in combined auto and home insurance policies.Who Needs Life Insurance?Life insurance is designed to protect the financial security of families in the event that one of those family members dies in a tragic accident or as a result of an illness or disease. It is designed to cover the costs of medical bills, funeral arrangements and burial, to pay off bills, and to provide a sense of financial security to those left behind.Insurance for SeniorsIt’s never really too late to buy life insurance. Still, the longer a person waits, the more expensive the policy can be. The cost for most types of life insurance policies is determined by age, the  health of individual, the type of insurance coverage and the amount of coverage that a person wants. Most major insurance carriers offer senior life insurance, but seniors can also get discounts and benefits from organizations like the American Association of Retired Persons when it comes to term insurance.Seniors are often eligible for term insurance policies that don’t require medical exams, but such policies offer low death benefits. Sometimes, a person may decide to purchase low monthly premium insurance policies to help pay off remaining debt as well as coverage for funeral and burial costs.The three most common types of life insurance generally available to consumers:
Term Life- these don’t accumulate any cash value, and the face amount of policy as well as premiums remain fairly constant. Premiums may rise but such terms must be stated in writing in the policy. If an  individual outlives the terms of the policy, he or she will not receive a payout.
Whole Life- accumulate cash value, guarantee death benefits, and offer fixed premiums
Permanent Life- this type of insurance remains in force until the policy pays out or unless policy expires or lapses due to lack of payment.

Secrets of Mid-Century Modern Interior Designing

If you are looking to change your homes decor to that of a Mid-Century modern style, there are a few design secrets you should know before getting started.First off I suggest, if you haven’t already, set aside some time for researching this unique design. Get a feel for the architecture of that era, the interior design principles, and the overall mindset and motivations behind the design. Familiarize yourself with every aspect of the movement. Study pictures and floor-plans and get a well versed understanding, and feel, of the overall look that defines the style and period.Remember that Mid-Century modern design is marked by the minimalist attributes of clean, simple lines and neutral, monochromatic colour tones, along with “minimal” clutter. Stay away from overcrowding or overdoing a space. Less is best when it comes to Mid-Century modern design.With your choice of furniture, stick to simple designs, colours and textures. Mix clean simple lines of vintage or retro furniture with hardwood floors and patterned area rugs. According to your budget you can buy vintage or reproduction furniture in keeping with the style of the era: plastics, stainless steel, sleek woods and glass. Use the placement of your furniture to create intimate seating arrangements. Don’t get distracted from your goal… think minimalism.If you are on a limited budget but still really want original pieces, you could check at auctions, flea markets, estate sales and thrift stores. You may be pleasantly surprised at what gems show up for a real bargain. I’m not saying you will find designer originals but you may uncover some quality reproductions produced during that era.The marriage of Mid-Century with modern design magically happens when you blend vintage with state-of-the-art furniture, accessories and art work. You are trying to achieve the effect of simplicity, or minimalism, while still offering an aura of complexity.While there seem to be many rules that govern Mid-Century modern interior design, don’t allow yourself to be bullied into creating a design that is boring or generic. Always make sure you put your personal stamp on your designing. You want your surroundings to reflect your personality and flare while staying within the design parameters of that era.

How to Hang Decorative Wall Mirrors

One way to add an elegant and distinctive touch of personality to any room in your home is to add a decorative wall mirror. These reflective works of art will express your personal creative good taste to the room in which they hang. With a plethora of styles, shapes and sizes, there is a good chance that you will find one to match the decor of any room in your home.After you have explored all the styles, shapes and sizes and you have made your final decision, you want to be sure that when you mount your mirror that the mounting is done correctly. You want to be sure that you have done your homework and will have your mirror mounted safely on the wall. You don’t want to walk into the room and find your wall damaged and heaven forbid, find your new mirror shattered on the floor.What you want to do is take the necessary steps, when hanging your mirror on the wall, to install this wall art correctly the first time around. When done the correct way, you will never have to worry about any accidents happening.So now you have the wall mirror of your choice. You have selected the wall to hang it on. You have also selected the exact position on the wall to hang it.The first thing you have to do is have someone hold the mirror against the wall where you want the mirror to hang, while you mark the wall with a pencil a short line somewhere near the center of each side of the mirror. Each line drawn can be as short as half an inch.Now remove the hand held mirror from the wall and place it somewhere out of the way. You should now have four lines marked on the wall representing the outside perimeters of your reflective art piece. Using a ruler, measure where the center of your left and right side pencil lines will be. Make a pencil mark on the wall where the center is.With the use of an electronic stud finder, go across the inside area that you have marked until you have an indication of where the wooden studs are located inside the wall. Once you find the studs make a pencil mark indicating where each stud is located.On the back side of your wall mirror, look for where the mirror hanger attached to the back side of the mirror is located. Measure the distance where the hanger is located from the top of the mirror. Now go to the wall you have just pencil marked. From your top pencil mark, go down the center and mark on the wall, with pencil, exactly where the hanger will be located on the wall when the mirror is hung.If your mirror has more than one hanger attached to the back side, then measure how far apart each hanger is from the center of the mirror. After you have measured the locations of the hangers, make the pencil markings on the wall where they will be located when the mirror is hung on the wall.With an electric screwdriver, screw a wall clip on to the wall using a wood screw large enough and long enough to go through the wall and deep into the wooden stud inside the wall. If only one wall clip is necessary, make sure the clip is firmly attached to the wall and hang your mirror.If your wall mirror requires two wall clips, then with a device called a level, go across the two screw hole markings you have marked on the wall and make any adjustments necessary to make sure your markings are level with each other.When you are sure that your screw hole markings are level, go ahead and screw on the two wall clips using an electric screwdriver and a wood screw large enough and long enough to go through the wall and deep into the wooden stud inside the wall. Always make sure your wall clips are securely attached to the wall before hanging your decorative wall mirror. Now hang your mirror.With the proper tools and techniques hanging a decorative wall mirror is something most anyone can do. Within a few minutes this job can be completed and the results will be a reflection of the artful creativity in you.

Create Charming Interiors Spaces With a Wall Mirror

Wall mirrors are an extremely popular range of mirror however it is not only your gym that could benefit from wall to wall mirrors. Indulge in the luxury of creating a visually pleasing brighter space in your home with the strategic placing of your wall mirror. Mirrors are perfect for spreading natural light in your home and transforming any dark corners. Mirrors also have the advantage of directing sunlight throughout your living space during the day unlike candle light and other standard light bulbs. At night your mirror will complement any source of light present and contributes to creating a wonderful atmosphere in your home.Glam up your kitchen:There are various ways you could add a touch of glamour to your kitchen with the use of a wall mirror. Wall to wall mirrors to create a splashback design will instantly create an inviting living space. Perfect for any ultra-modern kitchen these mirrored splashbacks will ooze elegance and offer a luxurious feel. They would require regular maintenance to ensure they remain sparkling to create the desired look but they would sure be worth it. Perfect for creating a wonderful centrepiece in your home a mirrored splashback would brighten up your kitchen and create a living space you would simply want to admire for endless hours.Lively Mirrors for Social Spaces:Living rooms, family room and playroom are all social spaces and therefore must be inviting. You should look to open up these spaces with the strategic positioning of your wall mirror creating the illusion of a larger space. You can opt for the traditional overmantle mirror which would feature above any fireplace creating a charming atmosphere or you could demonstrate a creative burst. Alternating the use of glass and other materials like wood or metal can create a stylish contemporary look that would instantly revive your room. You could also experiment with different shaped mirrors a diamond or oval mirror would create an edgy, stylish design that would wow any guests in your home.Dining Room Mirrors:A dining room can be the perfect place to experiment with a wall mirror. With your dining room table taking the centre of attention in the room you should look for a mirror that will complement this room. Depending on the size of your dining space a leaner mirror would enhance this space beautifully and create an ultra-contemporary feel. A simple wall mirror featured on your wall in your dining room could easily double your space. If you were feeling daring you could go for the wall to wall mirror design. This would work beautifully in your dining room and would create a sleek, elegant look. It is also ideal for small dining spaces and could help brighten up your living space.Romantic Mirrors for Your Bedroom:The positioning of a mirror in your master bedroom can easily create the romantic atmosphere that you have always desired. Depending on the positioning of your window and any other architectural elements you can place a wall mirror at the head of your bed or on either side of the wall to create a stunning focal point. This allows the space in your bedroom to double and the mirror will subtly add more light to your room throughout the day. A heavily ornate mirror would work well in your bedroom, there are a wide range of ornate mirrors available allowing you to select one that would blend effortlessly into your current bedroom interior.Visually Spacious Storage and Hallway Spaces:Your hallway and many storage spaces can become visually more attractive with the use of a large wall mirror. Hiding your storage behind a full length mirrored door detracts the attention away from what may be hiding behind the door and creates a carefully hidden space that looks exceptionally stylish. This clever technique can be used in almost any room in your home, offering a timeless look. Perfect for any wardrobes the full length mirror not only provides a clever storage space it is also offer a practical full length reflection ideal for when you are getting ready.A similar technique can be used in your hallway. Imagine your hallway brighter, larger and much more appealing. Whether you choose floor to ceiling wall mirrors or a rectangular wall mirror you will be glad that you have chosen a mirror as your design element. The mirror can successfully add additional light to your hallway as well as creating an inviting space within your home. A crowded hallway would also benefit from the use of a wall mirror helping to define and open up the space.We hope this guide has offered you some ideas on different ways to use wall mirrors to liven up your current home décor.

Health Savings Accounts – An American Innovation in Health Insurance

INTRODUCTON – The term “health insurance” is commonly used in the United States to describe any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance or a non-insurance social welfare program funded by the government. Synonyms for this usage include “health coverage,” “health care coverage” and “health benefits” and “medical insurance.” In a more technical sense, the term is used to describe any form of insurance that provides protection against injury or illness.

In America, the health insurance industry has changed rapidly during the last few decades. In the 1970′s most people who had health insurance had indemnity insurance. Indemnity insurance is often called fee-forservice. It is the traditional health insurance in which the medical provider (usually a doctor or hospital) is paid a fee for each service provided to the patient covered under the policy. An important category associated with the indemnity plans is that of consumer driven health care (CDHC). Consumer-directed health plans allow individuals and families to have greater control over their health care, including when and how they access care, what types of care they receive and how much they spend on health care services.

These plans are however associated with higher deductibles that the insured have to pay from their pocket before they can claim insurance money. Consumer driven health care plans include Health Reimbursement Plans (HRAs), Flexible Spending Accounts (FSAs), high deductible health plans (HDHps), Archer Medical Savings Accounts (MSAs) and Health Savings Accounts (HSAs). Of these, the Health Savings Accounts are the most recent and they have witnessed rapid growth during the last decade.

WHAT IS A HEALTH SAVINGS ACCOUNT?

A Health Savings Account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States. The funds contributed to the account are not subject to federal income tax at the time of deposit. These may be used to pay for qualified medical expenses at any time without federal tax liability.

Another feature is that the funds contributed to Health Savings Account roll over and accumulate year over year if not spent. These can be withdrawn by the employees at the time of retirement without any tax liabilities. Withdrawals for qualified expenses and interest earned are also not subject to federal income taxes. According to the U.S. Treasury Office, ‘A Health Savings Account is an alternative to traditional health insurance; it is a savings product that offers a different way for consumers to pay for their health care.

HSA’s enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.’ Thus the Health Savings Account is an effort to increase the efficiency of the American health care system and to encourage people to be more responsible and prudent towards their health care needs. It falls in the category of consumer driven health care plans.

Origin of Health Savings Account

The Health Savings Account was established under the Medicare Prescription Drug, Improvement, and Modernization Act passed by the U.S. Congress in June 2003, by the Senate in July 2003 and signed by President Bush on December 8, 2003.

Eligibility -

The following individuals are eligible to open a Health Savings Account -

- Those who are covered by a High Deductible Health Plan (HDHP).
- Those not covered by other health insurance plans.
- Those not enrolled in Medicare4.

Also there are no income limits on who may contribute to an HAS and there is no requirement of having earned income to contribute to an HAS. However HAS’s can’t be set up by those who are dependent on someone else’s tax return. Also HSA’s cannot be set up independently by children.

What is a High Deductible Health plan (HDHP)?

Enrollment in a High Deductible Health Plan (HDHP) is a necessary qualification for anyone wishing to open a Health Savings Account. In fact the HDHPs got a boost by the Medicare Modernization Act which introduced the HSAs. A High Deductible Health Plan is a health insurance plan which has a certain deductible threshold. This limit must be crossed before the insured person can claim insurance money. It does not cover first dollar medical expenses. So an individual has to himself pay the initial expenses that are called out-of-pocket costs.

In a number of HDHPs costs of immunization and preventive health care are excluded from the deductible which means that the individual is reimbursed for them. HDHPs can be taken both by individuals (self employed as well as employed) and employers. In 2008, HDHPs are being offered by insurance companies in America with deductibles ranging from a minimum of $1,100 for Self and $2,200 for Self and Family coverage. The maximum amount out-of-pocket limits for HDHPs is $5,600 for self and $11,200 for Self and Family enrollment. These deductible limits are called IRS limits as they are set by the Internal Revenue Service (IRS). In HDHPs the relation between the deductibles and the premium paid by the insured is inversely propotional i.e. higher the deductible, lower the premium and vice versa. The major purported advantages of HDHPs are that they will a) lower health care costs by causing patients to be more cost-conscious, and b) make insurance premiums more affordable for the uninsured. The logic is that when the patients are fully covered (i.e. have health plans with low deductibles), they tend to be less health conscious and also less cost conscious when going for treatment.

Opening a Health Savings Account

An individual can sign up for HSAs with banks, credit unions, insurance companies and other approved companies. However not all insurance companies offer HSAqualified health insurance plans so it is important to use an insurance company that offers this type of qualified insurance plan. The employer may also set up a plan for the employees. However, the account is always owned by the individual. Direct online enrollment in HSA-qualified health insurance is available in all states except Hawaii, Massachusetts, Minnesota, New Jersey, New York, Rhode Island, Vermont and Washington.

Contributions to the Health Savings Account

Contributions to HSAs can be made by an individual who owns the account, by an employer or by any other person. When made by the employer, the contribution is not included in the income of the employee. When made by an employee, it is treated as exempted from federal tax. For 2008, the maximum amount that can be contributed (and deducted) to an HSA from all sources is:
$2,900 (self-only coverage)
$5,800 (family coverage)

These limits are set by the U.S. Congress through statutes and they are indexed annually for inflation. For individuals above 55 years of age, there is a special catch up provision that allows them to deposit additional $800 for 2008 and $900 for 2009. The actual maximum amount an individual can contribute also depends on the number of months he is covered by an HDHP (pro-rated basis) as of the first day of a month. For eg If you have family HDHP coverage from January 1,2008 until June 30, 2008, then cease having HDHP coverage, you are allowed an HSA contribution of 6/12 of $5,800, or $2,900 for 2008. If you have family HDHP coverage from January 1,2008 until June 30, 2008, and have self-only HDHP coverage from July 1, 2008 to December 31, 2008, you are allowed an HSA contribution of 6/12 x $5,800 plus 6/12 of $2,900, or $4,350 for 2008. If an individual opens an HDHP on the first day of a month, then he can contribute to HSA on the first day itself. However, if he/she opens an account on any other day than the first, then he can contribute to the HSA from the next month onwards. Contributions can be made as late as April 15 of the following year. Contributions to the HSA in excess of the contribution limits must be withdrawn by the individual or be subject to an excise tax. The individual must pay income tax on the excess withdrawn amount.

Contributions by the Employer

The employer can make contributions to the employee’s HAS account under a salary reduction plan known as Section 125 plan. It is also called a cafeteria plan. The contributions made under the cafeteria plan are made on a pre-tax basis i.e. they are excluded from the employee’s income. The employer must make the contribution on a comparable basis. Comparable contributions are contributions to all HSAs of an employer which are 1) the same amount or 2) the same percentage of the annual deductible. However, part time employees who work for less than 30 hours a week can be treated separately. The employer can also categorize employees into those who opt for self coverage only and those who opt for a family coverage. The employer can automatically make contributions to the HSAs on the behalf of the employee unless the employee specifically chooses not to have such contributions by the employer.

Withdrawals from the HSAs

The HSA is owned by the employee and he/she can make qualified expenses from it whenever required. He/She also decides how much to contribute to it, how much to withdraw for qualified expenses, which company will hold the account and what type of investments will be made to grow the account. Another feature is that the funds remain in the account and role over from year to year. There are no use it or lose it rules. The HSA participants do not have to obtain advance approval from their HSA trustee or their medical insurer to withdraw funds, and the funds are not subject to income taxation if made for ‘qualified medical expenses’. Qualified medical expenses include costs for services and items covered by the health plan but subject to cost sharing such as a deductible and coinsurance, or co-payments, as well as many other expenses not covered under medical plans, such as dental, vision and chiropractic care; durable medical equipment such as eyeglasses and hearing aids; and transportation expenses related to medical care. Nonprescription, over-the-counter medications are also eligible. However, qualified medical expense must be incurred on or after the HSA was established.

Tax free distributions can be taken from the HSA for the qualified medical expenses of the person covered by the HDHP, the spouse (even if not covered) of the individual and any dependent (even if not covered) of the individual.12 The HSA account can also be used to pay previous year’s qualified expenses subject to the condition that those expenses were incurred after the HSA was set up. The individual must preserve the receipts for expenses met from the HSA as they may be needed to prove that the withdrawals from the HSA were made for qualified medical expenses and not otherwise used. Also the individual may have to produce the receipts before the insurance company to prove that the deductible limit was met. If a withdrawal is made for unqualified medical expenses, then the amount withdrawn is considered taxable (it is added to the individuals income) and is also subject to an additional 10 percent penalty. Normally the money also cannot be used for paying medical insurance premiums. However, in certain circumstances, exceptions are allowed.

These are -

1) to pay for any health plan coverage while receiving federal or state unemployment benefits.
2) COBRA continuation coverage after leaving employment with a company that offers health insurance coverage.
3) Qualified long-term care insurance.
4) Medicare premiums and out-of-pocket expenses, including deductibles, co-pays, and coinsurance for: Part A (hospital and inpatient services), Part B (physician and outpatient services), Part C (Medicare HMO and PPO plans) and Part D (prescription drugs).

However, if an individual dies, becomes disabled or reaches the age of 65, then withdrawals from the Health Savings Account are considered exempted from income tax and additional 10 percent penalty irrespective of the purpose for which those withdrawals are made. There are different methods through which funds can be withdrawn from the HSAs. Some HSAs provide account holders with debit cards, some with cheques and some have options for a reimbursement process similar to medical insurance.

Growth of HSAs

Ever since the Health Savings Accounts came into being in January 2004, there has been a phenomenal growth in their numbers. From around 1 million enrollees in March 2005, the number has grown to 6.1 million enrollees in January 2008.14 This represents an increase of 1.6 million since January 2007, 2.9 million since January 2006 and 5.1 million since March 2005. This growth has been visible across all segments. However, the growth in large groups and small groups has been much higher than in the individual category. According to the projections made by the U.S. Treasury Department, the number of HSA policy holders will increase to 14 million by 2010. These 14 million policies will provide cover to 25 to 30 million U.S. citizens.

In the Individual Market, 1.5 million people were covered by HSA/HDHPs purchased as on January 2008. Based on the number of covered lives, 27 percent of newly purchased individual policies (defined as those purchased during the most recent full month or quarter) were enrolled in HSA/HDHP coverage. In the small group market, enrollment stood at 1.8 million as of January 2008. In this group 31 percent of all new enrollments were in the HSA/HDHP category. The large group category had the largest enrollment with 2.8 million enrollees as of January 2008. In this category, six percent of all new enrollments were in the HSA/HDHP category.

Benefits of HSAs

The proponents of HSAs envisage a number of benefits from them. First and foremost it is believed that as they have a high deductible threshold, the insured will be more health conscious. Also they will be more cost conscious. The high deductibles will encourage people to be more careful about their health and health care expenses and will make them shop for bargains and be more vigilant against excesses in the health care industry. This, it is believed, will reduce the growing cost of health care and increase the efficiency of the health care system in the United States. HSA-eligible plans typically provide enrollee decision support tools that include, to some extent, information on the cost of health care services and the quality of health care providers. Experts suggest that reliable information about the cost of particular health care services and the quality of specific health care providers would help enrollees become more actively engaged in making health care purchasing decisions. These tools may be provided by health insurance carriers to all health insurance plan enrollees, but are likely to be more important to enrollees of HSA-eligible plans who have a greater financial incentive to make informed decisions about the quality and costs of health care providers and services.

It is believed that lower premiums associated with HSAs/HDHPs will enable more people to enroll for medical insurance. This will mean that lower income groups who do not have access to medicare will be able to open HSAs. No doubt higher deductibles are associated with HSA eligible HDHPs, but it is estimated that tax savings under HSAs and lower premiums will make them less expensive than other insurance plans. The funds put in the HSA can be rolled over from year to year. There are no use it or lose it rules. This leads to a growth in savings of the account holder. The funds can be accumulated tax free for future medical expenses if the holder so desires. Also the savings in the HSA can be grown through investments.

The nature of such investments is decided by the insured. The earnings on savings in the HSA are also exempt from income tax. The holder can withdraw his savings in the HSA after turning 65 years old without paying any taxes or penalties. The account holder has complete control over his/her account. He/She is the owner of the account right from its inception. A person can withdraw money as and when required without any gatekeeper. Also the owner decides how much to put in his/her account, how much to spend and how much to save for the future. The HSAs are portable in nature. This means that if the holder changes his/her job, becomes unemployed or moves to another location, he/she can still retain the account.

Also if the account holder so desires he can transfer his Health Saving Account from one managing agency to another. Thus portability is an advantage of HSAs. Another advantage is that most HSA plans provide first-dollar coverage for preventive care. This is true of virtually all HSA plans offered by large employers and over 95% of the plans offered by small employers. It was also true of over half (59%) of the plans which were purchased by individuals.

All of the plans offering first-dollar preventive care benefits included annual physicals, immunizations, well-baby and wellchild care, mammograms and Pap tests; 90% included prostate cancer screenings and 80% included colon cancer screenings. Some analysts believe that HSAs are more beneficial for the young and healthy as they do not have to pay frequent out of pocket costs. On the other hand, they have to pay lower premiums for HDHPs which help them meet unforeseen contingencies.

Health Savings Accounts are also advantageous for the employers. The benefits of choosing a health Savings Account over a traditional health insurance plan can directly affect the bottom line of an employer’s benefit budget. For instance Health Savings Accounts are dependent on a high deductible insurance policy, which lowers the premiums of the employee’s plan. Also all contributions to the Health Savings Account are pre-tax, thus lowering the gross payroll and reducing the amount of taxes the employer must pay.

Criticism of HSAs

The opponents of Health Savings Accounts contend that they would do more harm than good to America’s health insurance system. Some consumer organizations, such as Consumers Union, and many medical organizations, such as the American Public Health Association, have rejected HSAs because, in their opinion, they benefit only healthy, younger people and make the health care system more expensive for everyone else. According to Stanford economist Victor Fuchs, “The main effect of putting more of it on the consumer is to reduce the social redistributive element of insurance.

Some others believe that HSAs remove healthy people from the insurance pool and it makes premiums rise for everyone left. HSAs encourage people to look out for themselves more and spread the risk around less. Another concern is that the money people save in HSAs will be inadequate. Some people believe that HSAs do not allow for enough savings to cover costs. Even the person who contributes the maximum and never takes any money out would not be able to cover health care costs in retirement if inflation continues in the health care industry.

Opponents of HSAs, also include distinguished figures like state Insurance Commissioner John Garamendi, who called them a “dangerous prescription” that will destabilize the health insurance marketplace and make things even worse for the uninsured. Another criticism is that they benefit the rich more than the poor. Those who earn more will be able to get bigger tax breaks than those who earn less. Critics point out that higher deductibles along with insurance premiums will take away a large share of the earnings of the low income groups. Also lower income groups will not benefit substantially from tax breaks as they are already paying little or no taxes. On the other hand tax breaks on savings in HSAs and on further income from those HSA savings will cost billions of dollars of tax money to the exchequer.

The Treasury Department has estimated HSAs would cost the government $156 billion over a decade. Critics say that this could rise substantially. Several surveys have been conducted regarding the efficacy of the HSAs and some have found that the account holders are not particularly satisfied with the HSA scheme and many are even ignorant about the working of the HSAs. One such survey conducted in 2007 of American employees by the human resources consulting firm Towers Perrin showed satisfaction with account based health plans (ABHPs) was low. People were not happy with them in general compared with people with more traditional health care. Respondants said they were not comfortable with the risk and did not understand how it works.

According to the Commonwealth Fund, early experience with HAS eligible high-deductible health plans reveals low satisfaction, high out of- pocket costs, and cost-related access problems. Another survey conducted with the Employee Benefits Research Institute found that people enrolled in HSA-eligible high-deductible health plans were much less satisfied with many aspects of their health care than adults in more comprehensive plans People in these plans allocate substantial amounts of income to their health care, especially those who have poorer health or lower incomes. The survey also found that adults in high-deductible health plans are far more likely to delay or avoid getting needed care, or to skip medications, because of the cost. Problems are particularly pronounced among those with poorer health or lower incomes.

Political leaders have also been vocal about their criticism of the HSAs. Congressman John Conyers, Jr. issued the following statement criticizing the HSAs “The President’s health care plan is not about covering the uninsured, making health insurance affordable, or even driving down the cost of health care. Its real purpose is to make it easier for businesses to dump their health insurance burden onto workers, give tax breaks to the wealthy, and boost the profits of banks and financial brokers. The health care policies concocted at the behest of special interests do nothing to help the average American. In many cases, they can make health care even more inaccessible.” In fact a report of the U.S. governments Accountability office, published on April 1, 2008 says that the rate of enrollment in the HSAs is greater for higher income individuals than for lower income ones.

A study titled “Health Savings Accounts and High Deductible Health Plans: Are They an Option for Low-Income Families? By Catherine Hoffman and Jennifer Tolbert which was sponsored by the Kaiser Family Foundation reported the following key findings regarding the HSAs:

a) Premiums for HSA-qualified health plans may be lower than for traditional insurance, but these plans shift more of the financial risk to individuals and families through higher deductibles.
b) Premiums and out-of-pocket costs for HSA-qualified health plans would consume a substantial portion of a low-income family’s budget.
c) Most low-income individuals and families do not face high enough tax liability to benefit in a significant way from tax deductions associated with HSAs.
d) People with chronic conditions, disabilities, and others with high cost medical needs may face even greater out-of-pocket costs under HSA-qualified health plans.
e) Cost-sharing reduces the use of health care, especially primary and preventive services, and low-income individuals and those who are sicker are particularly sensitive to cost-sharing increases.
f) Health savings accounts and high deductible plans are unlikely to substantially increase health insurance coverage among the uninsured.

Choosing a Health Plan

Despite the advantages offered by the HSA, it may not be suitable for everyone. While choosing an insurance plan, an individual must consider the following factors:

1. The premiums to be paid.
2. Coverage/benefits available under the scheme.
3. Various exclusions and limitations.
4. Portability.
5. Out-of-pocket costs like coinsurance, co-pays, and deductibles.
6. Access to doctors, hospitals, and other providers.
7. How much and sometimes how one pays for care.
8. Any existing health issue or physical disability.
9. Type of tax savings available.

The plan you choose should according to your requirements and financial ability.

Major Activities Performed By a Digital Marketing Company

The traditional word “marketing” is defined as a process of communication between the audience and the prospective company that is selling the products. This method was incorporated to aware customers about the product or services and to enrich their knowledge towards a particular brand in a positive demeanour.

The role of marketing agencies is to make customers realise the importance of the products and services and to make customer realise what is the best fit for their use. Nowadays, the term marketing can be replaced easily with digital marketing because everything nowadays can be accessed via network or internet.

A digital marketing company work with the same aim that of old and traditional marketers where their focus and way of doing an activity has changed a lot. They have to mind the online or web-based customers and have to prepare strategies that are helpful for them. Following are the few activities that are performed by these digital marketing services.

Analytics Data

All the efforts of positioning and planning the activities for the market are a waste if there is no study of tracking the right and wrong activities. There are various analytics studies available to ascertain how a particular website is performing online. This way, the SEO specialists and the webmasters can study the metrics carefully to devise a better way to rank a website. These professionals duly have the idea or knowledge of analytics.

SEO (Search engine Optimisation)

For a website to rank in top SERP’s, it is important to have the website or online business to be fully optimised. These professionals have the possible knowledge of the suitable SEO strategy or practices to be performed. They can help to rank a website in top results and can easily drive more and influential traffic to the website. They know how search engines like Google behave and can help businesses meet their shortcomings.

Strategy for Social Media

There are many people out there who are available on the internet and prefers internet as a tool to hire the best service or product from the market. These strategists have the profound knowledge about the various social handles like Facebook, Google+, LinkedIn, and Twitter to help businesses easily understand what ways or tactics are right for the particular audience online.

Advertising

The product or service is a waste if it is not reaching the vast audience across the globe. A digital marketing company will not only restrict to SEO or SMO but will also run the right online campaigns, will prepare the promotional banners and advertisements, will search for the right keywords or phrases often looked by the audiences and much more than that.

Adding to the above points, the digital marketing services are the trendsetters of today’s virtual world and have the thorough study of how customers behave and respond to in the world of digitalization.

Rebuilding the Tower of Babel – A CEO’s Perspective on Health Information Exchanges

Defining a Health Information Exchange

The United States is facing the largest shortage of healthcare practitioners in our country’s history which is compounded by an ever increasing geriatric population. In 2005 there existed one geriatrician for every 5,000 US residents over 65 and only nine of the 145 medical schools trained geriatricians. By 2020 the industry is estimated to be short 200,000 physicians and over a million nurses. Never, in the history of US healthcare, has so much been demanded with so few personnel. Because of this shortage combined with the geriatric population increase, the medical community has to find a way to provide timely, accurate information to those who need it in a uniform fashion. Imagine if flight controllers spoke the native language of their country instead of the current international flight language, English. This example captures the urgency and critical nature of our need for standardized communication in healthcare. A healthy information exchange can help improve safety, reduce length of hospital stays, cut down on medication errors, reduce redundancies in lab testing or procedures and make the health system faster, leaner and more productive. The aging US population along with those impacted by chronic disease like diabetes, cardiovascular disease and asthma will need to see more specialists who will have to find a way to communicate with primary care providers effectively and efficiently.

This efficiency can only be attained by standardizing the manner in which the communication takes place. Healthbridge, a Cincinnati based HIE and one of the largest community based networks, was able to reduce their potential disease outbreaks from 5 to 8 days down to 48 hours with a regional health information exchange. Regarding standardization, one author noted, “Interoperability without standards is like language without grammar. In both cases communication can be achieved but the process is cumbersome and often ineffective.”

United States retailers transitioned over twenty years ago in order to automate inventory, sales, accounting controls which all improve efficiency and effectiveness. While uncomfortable to think of patients as inventory, perhaps this has been part of the reason for the lack of transition in the primary care setting to automation of patient records and data. Imagine a Mom & Pop hardware store on any square in mid America packed with inventory on shelves, ordering duplicate widgets based on lack of information regarding current inventory. Visualize any Home Depot or Lowes and you get a glimpse of how automation has changed the retail sector in terms of scalability and efficiency. Perhaps the “art of medicine” is a barrier to more productive, efficient and smarter medicine. Standards in information exchange have existed since 1989, but recent interfaces have evolved more rapidly thanks to increases in standardization of regional and state health information exchanges.

History of Health Information Exchanges

Major urban centers in Canada and Australia were the first to successfully implement HIE’s. The success of these early networks was linked to an integration with primary care EHR systems already in place. Health Level 7 (HL7) represents the first health language standardization system in the United States, beginning with a meeting at the University of Pennsylvania in 1987. HL7 has been successful in replacing antiquated interactions like faxing, mail and direct provider communication, which often represent duplication and inefficiency. Process interoperability increases human understanding across networks health systems to integrate and communicate. Standardization will ultimately impact how effective that communication functions in the same way that grammar standards foster better communication. The United States National Health Information Network (NHIN) sets the standards that foster this delivery of communication between health networks. HL7 is now on it’s third version which was published in 2004. The goals of HL7 are to increase interoperability, develop coherent standards, educate the industry on standardization and collaborate with other sanctioning bodies like ANSI and ISO who are also concerned with process improvement.

In the United States one of the earliest HIE’s started in Portland Maine. HealthInfoNet is a public-private partnership and is believed to be the largest statewide HIE. The goals of the network are to improve patient safety, enhance the quality of clinical care, increase efficiency, reduce service duplication, identify public threats more quickly and expand patient record access. The four founding groups the Maine Health Access Foundation, Maine CDC, The Maine Quality Forum and Maine Health Information Center (Onpoint Health Data) began their efforts in 2004.

In Tennessee Regional Health Information Organizations (RHIO’s) initiated in Memphis and the Tri Cities region. Carespark, a 501(3)c, in the Tri Cities region was considered a direct project where clinicians interact directly with each other using Carespark’s HL7 compliant system as an intermediary to translate the data bi-directionally. Veterans Affairs (VA) clinics also played a crucial role in the early stages of building this network. In the delta the midsouth eHealth Alliance is a RHIO connecting Memphis hospitals like Baptist Memorial (5 sites), Methodist Systems, Lebonheur Healthcare, Memphis Children’s Clinic, St. Francis Health System, St Jude, The Regional Medical Center and UT Medical. These regional networks allow practitioners to share medical records, lab values medicines and other reports in a more efficient manner.

Seventeen US communities have been designated as Beacon Communities across the United States based on their development of HIE’s. These communities’ health focus varies based on the patient population and prevalence of chronic disease states i.e. cvd, diabetes, asthma. The communities focus on specific and measurable improvements in quality, safety and efficiency due to health information exchange improvements. The closest geographical Beacon community to Tennessee, in Byhalia, Mississippi, just south of Memphis, was granted a $100,000 grant by the department of Health and Human Services in September 2011.

A healthcare model for Nashville to emulate is located in Indianapolis, IN based on geographic proximity, city size and population demographics. Four Beacon awards have been granted to communities in and around Indianapolis, Health and Hospital Corporation of Marion County, Indiana Health Centers Inc, Raphael Health Center and Shalom Health Care Center Inc. In addition, Indiana Health Information Technology Inc has received over 23 million dollars in grants through the State HIE Cooperative Agreement and 2011 HIE Challenge Grant Supplement programs through the federal government. These awards were based on the following criteria:1) Achieving health goals through health information exchange 2) Improving long term and post acute care transitions 3) Consumer mediated information exchange 4) Enabling enhanced query for patient care 5) Fostering distributed population-level analytics.

Regulatory Aspects of Health Information Exchanges and Healthcare Reform

The department of Health and Human Services (HHS) is the regulatory agency that oversees health concerns for all Americans. The HHS is divided into ten regions and Tennessee is part of Region IV headquartered out of Atlanta. The Regional Director, Anton J. Gunn is the first African American elected to serve as regional director and brings a wealth of experience to his role based on his public service specifically regarding underserved healthcare patients and health information exchanges. This experience will serve him well as he encounters societal and demographic challenges for underserved and chronically ill patients throughout the southeast area.

The National Health Information Network (NHIN) is a division of HHS that guides the standards of exchange and governs regulatory aspects of health reform. The NHIN collaboration includes departments like the Center for Disease Control (CDC), social security administration, Beacon communities and state HIE’s (ONC).11 The Office of National Coordinator for Health Information Exchange (ONC) has awarded $16 million in additional grants to encourage innovation at the state level. Innovation at the state level will ultimately lead to better patient care through reductions in replicated tests, bridges to care programs for chronic patients leading to continuity and finally timely public health alerts through agencies like the CDC based on this information.12 The Health Information Technology for Economic and Clinical Health (HITECH) Act is funded by dollars from the American Reinvestment and Recovery Act of 2009. HITECH’s goals are to invest dollars in community, regional and state health information exchanges to build effective networks which are connected nationally. Beacon communities and the Statewide Health Information Exchange Cooperative Agreement were initiated through HITECH and ARRA. To date 56 states have received grant awards through these programs totaling 548 million dollars.

History of Health Information Partnership TN (HIPTN)

In Tennessee the Health Information Exchange has been slower to progress than places like Maine and Indiana based in part on the diversity of our state. The delta has a vastly different patient population and health network than that of middle Tennessee, which differs from eastern Tennessee’s Appalachian region. In August of 2009 the first steps were taken to build a statewide HIE consisting of a non-profit named HIP TN. A board was established at this time with an operations council formed in December. HIP TN’s first initiatives involved connecting the work through Carespark in northeast Tennessee’s s tri-cities region to the Midsouth ehealth Alliance in Memphis. State officials estimated a cost of over 200 million dollars from 2010-2015. The venture involves stakeholders from medical, technical, legal and business backgrounds. The governor in 2010, Phil Bredesen, provided 15 million to match federal funds in addition to issuing an Executive Order establishing the office of eHealth initiatives with oversight by the Office of Administration and Finance and sixteen board members. By March 2010 four workgroups were established to focus on areas like technology, clinical, privacy and security and sustainability.

By May of 2010 data sharing agreements were in place and a production pilot for the statewide HIE was initiated in June 2011 along with a Request for Proposal (RFP) which was sent out to over forty vendors. In July 2010 a fifth workgroup,the consumer advisory group, was added and in September 2010 Tennessee was notified that they were one of the first states to have their plans approved after a release of Program Information Notice (PIN). Over fifty stakeholders came together to evaluate the vendor demonstrations and a contract was signed with the chosen vendor Axolotl on September 30th, 2010. At that time a production goal of July 15th, 2011 was agreed upon and in January 2011 Keith Cox was hired as HIP TN’s CEO. Keith brings twenty six years of tenure in healthcare IT to the collaborative. His previous endeavors include Microsoft, Bellsouth and several entrepreneurial efforts. HIP TN’s mission is to improve access to health information through a statewide collaborative process and provide the infrastructure for security in that exchange. The vision for HIP TN is to be recognized as a state and national leader who support measurable improvements in clinical quality and efficiency to patients, providers and payors with secure HIE. Robert S. Gordon, the board chair for HIPTN states the vision well, “We share the view that while technology is a critical tool, the primary focus is not technology itself, but improving health”. HIP TN is a non profit, 501(c)3, that is solely reliant on state government funding. It is a combination of centralized and decentralized architecture. The key vendors are Axolotl, which acts as the umbrella network, ICA for Memphis and Nashville, with CGI as the vendor in northeast Tennessee.15 Future HIP TN goals include a gateway to the National Health Institute planned for late 2011 and a clinician index in early 2012. Carespark, one of the original regional health exchange networks voted to cease operations on July 11, 2011 based on lack of financial support for it’s new infrastructure. The data sharing agreements included 38 health organizations, nine communities and 250 volunteers.16 Carespark’s closure clarifies the need to build a network that is not solely reliant on public grants to fund it’s efforts, which we will discuss in the final section of this paper.

Current Status of Healthcare Information Exchange and HIPTN

Ten grants were awarded in 2011 by the HIE challenge grant supplement. These included initiatives in eight states and serve as communities we can look to for guidance as HIP TN evolves. As previously mentioned one of the most awarded communities lies less than five hours away in Indianapolis, IN. Based on the similarities in our health communities, patient populations and demographics, Indianapolis would provide an excellent mentor for Nashville and the hospital systems who serve patients in TN. The Indiana Health Information Exchange has been recognized nationally for it’s Docs for Docs program and the manner in which collaboration has taken place since it’s conception in 2004. Kathleen Sebelius, Secretary of HHS commented, “The Central Indiana Beacon Community has a level of collaboration and the ability to organize quality efforts in an effective manner from its history of building long standing relationships. We are thrilled to be working with a community that is far ahead in the use of health information to bring positive change to patient care.” Beacon communities that could act as guides for our community include the Health and Hospital Corporation of Marion County and the Indiana Health Centers based on their recent awards of $100,000 each by HHS.

A local model of excellence in practice EMR conversion is Old Harding Pediatric Associates (OHPA) which has two clinics and fourteen physicians who handle a patient population of 23,000 and over 72,000 patient encounters per year. OHPA’s conversion to electronic records in early 2000 occurred as a result of the pursuit of excellence in patient care and the desire to use technology in a way that benefitted their patient population. OHPA established a cross functional work team to improve their practices in the areas of facilities, personnel, communication, technology and external influences. Noteworthy was chosen as the EMR vendor based on user friendliness and the similarity to a standard patient chart with tabs for files. The software was customized to the pediatric environment complete with patient growth charts. Windows was used as the operating system based on provider familiarity. Within four days OHPA had 100% compliance and use of their EMR system.

The Future of HIP TN and HIE in Tennessee

Tennessee has received close to twelve million dollars in grant money from The State Health Information Exchange Cooperative Agreement Program.20 Regional Health Information Organizations (RHIO) need to be full scalable to allow hospitals to grow their systems without compromising integrity as they grow.21and the systems located in Nashville will play an integral role in this nationwide scaling with companies like HCA, CHS, Iasis, Lifepoint and Vanguard. The HIE will act as a data repository for all patients information that can be accessed from anywhere and contains a full history of the patients medical record, lab tests, physician network and medicine list. To entice providers to enroll in the statewide HIE tangible value to their practice has to be shown with better safer care. In a 2011 HIMSS editor’s report Richard Lang states that instead of a top down approach “A more practical idea may be for states to support local community HIE development first. Once established, these local networks can feed regional HIE’s and then connect to a central HIE/data repository backbone. States should use a portion of the stimulus funds to support local HIE development.”22 Mr. Lang also believes the primary care physician has to be the foundation for the entire system since they are the main point of contact for the patient.

One piece of the puzzle often overlooked is the patient investment in a functional EHR. In order to bring together all the pieces of the HIE puzzle patients will need to play a more active role in their healthcare. Many patients do not know what medicines they take every day or whether they have a living will. Several versions of patient EHR’s like Memitech’s 911medical id card exist, but very few patients know or carry them.23 One way to combat this lack of awareness is to use the hospital as a catch-all and discharge each patient with a fully loaded USB card via case managers. This strategy also might lead to better compliance with post in patient therapies to reduce readmissions.

The implementation of connecting qualified organizations began earlier this year. To fully support organizations to move toward qualification the Office of National Coordinator for HIE (ONC) has designated regional education centers (TN rec) who assist providers with educational initiatives in areas like HIT, ICD9 to ICD10 training and EMR transition. Qsource, a non-profit health consulting firm, has been chosen to oversee TNrec. To ensure sustainability it is critical that Tennessee build a network of private funding so that what happened with Carespark won’t happen to HIP TN. The eHealth Initiatives 2011Survey Report states that of the 196 HIE initiatives, 115 act independently of federal funding and of those independent HIE’s, break even through operational revenue. Some of these exchanges were in existence well before the American Recovery and Reinvestment Act in 2009. Startup funding from grants is only meant to get the car going so to speak, the sustainable fuel, as observed in the case of Carespark, has to come from value that can be monetized. KLAS research reports that 54% of public HIE’s were concerned about future sustainability while only 35% of private HIE’s shared this concern.

Hospital Implications of HIP TN (A Call to Action)

From a Financial perspective, taking our hospital into the future with EMR and an integrated statewide network has profound implications. In the short term the cost to find a vendor, establish EMR in and outpatient will be an expensive proposition. The transition will not be easy or finite and will involve constant evolution as HIP TN integrates with other state HIE’s. To get a realistic idea of the benefits and costs associated with health information integration. we can look to HealthInfoNet in Portland, ME, a statewide HIE that expects to save 37 million dollars in avoided services and 15 million in productivity reduction. Specific areas of savings include paper or fax costs $5 versus $0.25 electronically, virtual health record savings of $50 per referral, $26 saved per ED visit and $17.41 per patient/year due to redundant lab tests which amounts to $52 million for a population of 3 million patients. In Grand Junction Colorado Quality Health Network lowered their per capita Medicare spending to 24% below the national average, gaining recognition by President Obama in 2009. The Santa Cruz Health Information Exchange (SCHIE) with 600 doctors and two hospitals achieved sustainability in the first year of operation and uses a subscription fee for all the organizations who interact with them. In terms of government dollars available, meaningful use incentives exist to encourage hospitals to meet twenty of twenty five objectives in the first phase (2011-2012) and adopting and implement an approved EHR vendor. ARRA specified three ways for EHR to be utilized to obtain Medicare reimbursement. These include e-prescribing, health information exchange and submission of clinical quality measures. The objectives for phase two in 2013 will expand on this baseline. Implementation of EHR and Hospital HIE costs are usually charged by bed or by the number of physicians. Fees can range from $1500 for a smaller hospital up to $12,000 per month for a larger hospital.