Please be aware of changes in the Blue Cross insurance plans available on the Idaho Health Insurance Exchange

To our valued patients,

The following message is intended for those of you that purchase insurance on Idaho’s health insurance exchange (www.yourhealthidaho.org), especially those of you who subscribe to Blue Cross Qualified Health Plans (insurance on the exchange and individual plans).  This message does not pertain to those of you who participate through your employer’s Blue Cross group plan or Blue Cross managed Medicare.  Open enrollment on the health insurance exchange ends on January 31, 2017.  At this point, we are not sure if there is going to be a repeal or if a repeal and replace is waiting in the wings.  Either way, we want to share some things we have learned regarding health insurance sold on the exchange that affects our communities:

  • If you were enrolled on the exchange in 2016, you may have been automatically renewed under the same insurance plan you had last year.  If you are happy with that plan, carry on.  If not, please contact your insurance broker to review alternatives available to you.  Even though you automatically renewed, you still have until 1/31 to select your plan.

 

  • If you subscribe to a Blue Cross Qualified Health Plan, and you live in Bonneville or Jefferson Counties, you are automatically part of the Mountain View insurance network.  If your Primary Care Provider practices in Madison County, you have two options: find a new Primary Care Provider practicing in Bonneville or Jefferson Counties who participates in the Mountain View insurance network, or select a different insurance product sold on the health insurance exchange that has your provider in network.  If you stay with Blue Cross insurance sold on the exchange, you can be referred to Primary Care and Specialty (e.g. surgeons) Providers practicing in Madison County that are members of the Mountain View insurance network.  However, that referral must be approved by Blue Cross.  If you see a provider that is not in-network based on the county where you live, you may/will be subject to the Blue Cross out-of-network deductible of $50,000.

 

  • Madison Memorial Hospital is a “back-fill” hospital for the Mountain View insurance network.  This means you can have all the services offered by Madison Memorial Hospital, and not be subject to the $50,000 Blue Cross out-of-network deductible even if you live in Bonneville or Jefferson Counties.

 

  • If you subscribe to a Blue Cross Qualified Health Plan, and you live in Madison County, you are automatically part of the Hometown East insurance network.  If your Primary Care Physician practices in Bonneville or Jefferson Counties, you have two options: find a new Primary Care provider practicing in Madison County who participates in the Hometown East  insurance network,  or select a different insurance product sold on the health insurance exchange that has your provider in network.  If you stay with Blue Cross insurance sold on the exchange, you can be referred to Primary Care and Specialty (e.g. surgeons) providers practicing in Bonneville or Jefferson Counties.  However, that referral must be approved by Blue Cross.  If you see a provider that is not in-network based on the county where you live, you may/will be subject to the Blue Cross out-of-network deductible of $50,000.

 

  • Madison Memorial Hospital is in-network for the Hometown East insurance network.  This means you can have all the services offered by Madison Memorial Hospital, and not be subject to the $50,000 Blue Cross out-of-network deductible.

 

This is what we know for now, and we hope this information will be of assistance to you as the open enrollment period on Idaho’s health insurance exchange comes to a close for 2017.

 

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Nurse Egan's Miracle

Miracle

Nurse Egan Gives Thanks to the Team Who Saved Her Husband’s Life

I just wanted to express my profound gratitude and appreciation to the many people of this wonderful hospital for the love, concern, caring and support we have been the recipients of.

When Howard suffered his cardiac arrest, I couldn’t think of anything else. The ER staff jumped in and did a remarkable job, the CODE team. Everyone was “just” doing their job, but it was lifesaving and made all the difference.

We are so thankful for the donated hours, the calls, the support and the many other acts of kindness, known to us and those that were anonymous. You were all a blessing to us, taking care of us when we were so focused on Howard. You will never know how much that meant to us. We have had many tears of gratitude for your generosity.

I am so proud to be part of this institution and don’t know how I can ever pay back all the kindness. It meant everything to us, we felt all of your prayers and good wishes and encouragement.

Howard’s recovery has been miraculous. We feel so blessed.

 

Thank you all. You are all lifesavers!

Love,

The Egans

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LuAnn Dixon Receives Credential

LUANN DIXON EARNS CERTIFIED INFECTION CONTROL CREDENTIAL
Milwaukee, WI [Date] – CBIC has announced that LuAnn Dixon, Infection Control Prevention of Madison Memorial Hospital has earned the Certified in Infection Control (CIC®) credential and has demonstrated a mastery of infection prevention and control knowledge by taking and passing this comprehensive examination. Certification is maintained through successful completion of a re-certification examination every five years.
The Certification Board of Infection Control and Epidemiology, Inc. CBIC®) administers the exam certifying individuals as Certified in Infection Control (CIC”). The purpose of the certification process is to protect the public by providing standardized measurement of current basic knowledge needed for persons practicing infection control; encouraging individual growth and study, thereby promoting professionalism among infection prevention and control professionals; and formally recognizing infection prevention and control professionals who fulfill the requirements for certification. Individuals who earn their CIC® credential join approximately 5,000 practitioners worldwide who are Certified in Infection Control. The National Commission for Certifying Agencies (NCCA) accredits CBIC’s certification program, which signifies that CBIC has met the highest national voluntary standards for private certification. CBIC periodically conducts job analyses to assure that certification measures current practices and knowledge required for infection prevention and control and applied epidemiology.
The Certification Board of Infection Control and Epidemiology, Inc. (CBIC) is a voluntary autonomous multidisciplinary board that provides direction for and administers the certification process for professionals in infection prevention and control and applied epidemiology. CBIC is independent and separate from any other infection control – related organization or association. For more information about CBIC, visit www.cbic.org.

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Physician Privileges

Physician Privilege Determination at Madison Memorial Hospital

Rexburg, Idaho – December 12, 2016. For the community’s information, Madison Memorial Hospital provides the following information to the public about how the hospital determines which physicians and other healthcare providers practice medicine within the hospital, and the process by which those decisions are made.

Permission to admit patients to the hospital, or to provide treatments or perform procedures, is granted in the form of “privileges.” As this implies, practicing within the hospital is not a right, nor a guarantee, but a privilege, which must be applied for by the practitioner. Practitioners of various specialties are granted permission to provide treatments only within the specific scope of their training, education, and clinical competence, which must be proven prior to the granting of privileges. Applications for privileges are reviewed by a body of physician representatives, who are elected by their peers. After receiving information from physicians within the various departments of the hospital, this body, called the Medical Executive Committee, gives a recommendation regarding the applicant, and the final decision for the granting or denial of privileges is made by the Madison Memorial Hospital Board of Trustees, who are volunteer members of the community.

Once privileges are granted, they must also be maintained through a system of review and renewal which occurs, in our case, every two years. By meeting requirements for licensure and continuing education, demonstrating good outcomes, and following recognized medical protocols and standards of care, physicians prove the ability to keep their hospital privileges. Privileges can be placed in jeopardy when physicians fail to meet these requirements, or when they engage in disruptive behavior in the hospital. In nearly every case, exhaustive efforts are made to improve the level of the practitioner’s care or conduct through educational, rehabilitative, or disciplinary pathways, before the hospital resorts to the removal of hospital privileges.

If the Medical Executive Committee does recommend removal of privileges, the physician is entitled to due process, known as a “fair hearing,” before the Board makes its decision. While not the same, a fair hearing is similar to a court trial, in that the physician and the Medical Executive Committee each call witnesses to testify, introduce evidence, and present arguments. Each party is allowed legal representation. The evidence is heard by a panel of three individuals, typically composed of physicians and legal professionals. Care is taken to ensure that those on the hearing panel are impartial, unbiased, and free of conflicts of interest, such as competitive factors. Once all of the evidence and arguments have been heard, the panel deliberates together at length before issuing its written recommendation to the Board. The panel’s opinion may agree with, disagree with, or completely depart from the recommendation of the Medical Executive Committee. In any case, given this information the final decision then rests with the Board.

This process is set forth and governed by the hospital’s Medical Staff Bylaws, which we are legally required to follow, and which we do follow. The main intent of the privileging process is to protect the integrity of the practice of medicine in the hospital, and the patients we serve. It also helps to ensure a safe working environment for our staff, who work shoulder to shoulder with our physicians, day in and day out. Care is also taken during the process to ensure that physicians are treated fairly, and safeguarded against the possibility of bullying, anticompetitive campaigns, or “witch hunts.” It is a fair, private, and thorough process that we employ as an effective means of quality control. The details of a fair hearing are confidential under state and federal law. The ability to provide self-governance by the Medical Staff when granting and removing privileges is an essential and integral part of how any hospital functions.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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