Bagaimana Menulis Cepat Dan Berkulitas

Kamu tipe orang yang sulit menyeimbangkan waktu untuk mengerjakan proyek dan hal lainnya? Jika ya, kita sama loh! Sebagai seorang freelance writer sekaligus mahasiswa tingkat akhir sekaligus tingkat awal, saya memiliki kecenderungan sulit menyeimbangkan waktu untuk bekerja, menyelesaikan skripsi, mengerjakan tugas kuliah, dan waktu untuk menyenangkan diri saya sendiri *curhat. Saya seringkali terlalu fokus pada satu hal yang sedang dikerjakan sampai benar-benar selesai, baru bisa berpindah ke task lainnya. Bisa dibilang, sebagai freelance writer, saya tidak multitasking untuk keadaan tertentu. Membutuhkan waktu luang yang ekstra untuk membuat tulisan. Akan tetapi, dengan waktu yang tetap 24 jam, dengan pekerjaan dan tugas lain yang tetap harus dikerjakan, tidak mungkin memohon untuk menambah sehari menjadi 25 jam. Saya harus mulai berpikir bagaimana caranya bisa menulis lebih cepat di waktu luang yang terbatas tanpa menurunkan kualitas tulisan.Tetap kualitas harus diutamakan karena freelance writer memang bekerja untuk menulis.

Kamu mempunyai masalah serupa? Sebagai sesama freelance writer, yuk kita berbagi tipsbagaimana menulis cepat tapi tetap berkualitas!

Menulislah di Waktu Produktif

Pasti semua orang mengira pagi hari adalah waktu yang pas untuk menulis karena otak kita masih fresh. Akan tetapi, tidak semua orang menggunakan waktu paginya untuk menulis. Bisa jadi, freelance writer yang juga seorang pelajar, belajar di pagi hari. Atau malah tidur di pagi hari, bekerja malam hari. Untuk sebagian orang, waktu produktif untuk menulis bisa pada tengah malam, setelah makan siang, dll. Kapanpun waktu produktif Anda, tandai dan keepwaktu tersebut untuk dijadikan waktu menulis, tidak untuk hal lainnya. Saya biasanya memulainya dengan mengecek email, media sosial, dan artikel terbaru di internet. Misalnya saja, saya hanya bisa bekerja pada sore hari dan dilanjutkan malam hari.

Menutup Browser Internet

Begitu berada di depan laptop siap untuk bekerja, saya biasanya langsung menghubungkan modem untuk mengecek email, media sosial, dan artikel terbaru untuk dijadikan referensi. Setelah semuanya dilakukan dan mendapatkan artikel yang cocok, saya langsung men-disconnect-an modem internet. Lalu, membaca artikel-artikel yang menjadi referensi untuk tulisan saya. Ingat, freelance writer penting untuk suka membaca Dan, mulailah menulis.

Perencanaan itu Penting

Jika pada akhir hari tersebut kamu masih mempunyai waktu luang untuk menulis, biasanya sih termotivasi untuk menulis menyelesaikan deadline di hari berikutnya. Sebaiknya, jangan terlalu keras pada diri kamu sendiri. Kamu akan kesulitan memotivasi diri kamu untuk hari-hari berikutnya jika terlalu lelah. Buatlah perencanaan. Mulailah dengan pekerjaan/tugas yang mudah kamu lakukan, yang ‘bahan-bahan’-nya sudah siap sedia kamu gunakan. Apapun pekerjaan/tugas yang kamu lakukan, membuat perencanaan itu penting. Ketika segala sesuatunya sudah direncanakan, kamu tidak perlu kebingungan lagi ketika sudah waktunya memulai. Tidak ada waktu yang terbuang percuma untuk stuck pada pikiran tertentu.

Buat Kerangka Tulisan

Kerangka tulisan (outline) mempermudah kamu untuk menulis. Jika pedoman tersebut diikuti, tulisan akan selesai dengan cepat. Terkadang, kerangka tulisan tersebut sudah bisa dikatakan sebagai artikel setengah jadi. Jika pada hari akhir Tersebut kamu masih ingin menulis, lebih baik buat kerangka untuk 1-2 tulisan untuk hari berikutnya. Otak tidak akan terlalu berpikir keras tapi tidak juga mengabaikan inspirasi yang datang.

Atur Timer!

Sebuah timer penting untuk membantu kamu tetap fokus. Di sisi lain, timer bisa memaksa kamu untuk beristirahat. Istirahat penting untuk menjaga pikiran tetap segar. Pikiran itu aset berharga, harus tetap dijaga kecemerlangannya *hehe. Misalnya kamu set waktu untuk menulis 30 menit, istirahat 5 menit. Untuk pekerjaan lainnya yang ringan 10 menit, istirahat 2 menit. Kamu cukup mengatur berapa waktu yang terbaik yang kamu perlukan untuk pekerjaan tertentu.

Itu dia tips sekaligus sharingnya. Mudah-mudahan bermanfaat. Ada yang mempunyai tipslainnya? Yuk di share!

Artikel ini diambil dari website www.ruangfreelance.com yang ditulis oleh Puput Pebrianti Rusmana

Affordable Care Act-Pragmatic Implementation

Health care Reform Implementation-A Pragmatic View of the Affordable Care Act

This article addresses the implementation of the medical insurance mandate under the Affordable Care Act of 2010, which will be implemented next year. Federal insurance purchasing subsidies, health insurance exchange plan design, and tax penalty information is highlighted for businesses and individuals.

Small Businesses Eligible for Government Assistance to Purchase Medical Insurance

Small businesses with less than twenty-five employees who meet certain criteria are eligible to receive federal subsidies to purchase health insurance for their employees. One of the criteria is an average wage of $50,000 or less for the entire workforce in determining any federal subsidy for insurance.

How much is the subsidy?

Only employer sponsored health plans with an actuarial value of 60% or higher will be eligible to receive the tax credit subsidies, so this is important information for small businesses who are considering starting or modifying their health insurance plans. Also, if the employee’s share of the premium would exceed 9.5% of their income that makes them eligible for a federal tax credit subsidy. So there are two ways an individual may qualify for a federal subsidy to buy insurance through their employer, either through the plan design or the income level of the individual.

Penalties for Noncompliance

The penalty is $2,000 times the number of employees less thirty employees.[1]So, this means employers with fewer than thirty would not have a tax penalty. Also, $2,000 is less than half of what it would cost for a typical employer to provide medical insurance for a single employee, so some employers may still choose to opt out of the mandated coverage. The Kaiser Family Foundation has a nice algorithm of the PPACA and employer impact on their insurance reform web site.

Individuals

Government Assistance to Purchase Medical Insurance

You will be eligible for a government subsidy to purchase medical insurance if your income falls within 133% of the poverty thresholds, which are listed below for 2012. The government subsidy is 98% of the health insurance premium, which will be based on a Blue Cross Blue Shield calculation each year for people who fall within this threshold.

Single individuals-                                  No more than $14,856

Individual plus one dependent-               $20,123

Individual plus two dependents-             $25,390

Individual plus three dependents-           $30,657

Individual plus four dependents-             $35,923

Individual plus five dependents-              $41,190

Individual plus six dependents-               $46,457

Individual plus seven dependents-          $51,724

If your income is within 250% to  400% of the federal poverty level, the government subsidy, via a tax credit will be roughly equal to 93.7% to 90.5% of the national Blue Cross Blue Shield annual health insurance premium calculation. Here is what those income thresholds were in 2012:

Individual plus one dependent-                $ 80,492

Individual plus two dependents-              $101,559

Individual plus three dependents-            $122,628

Individual plus four dependents-              $143,693

Individual plus five dependents-               $164,760

Individual plus six dependents-                $185,828

Individual plus seven dependents-           $206,895

Insurance Exchange Coverage

For those whose income is within 250% of the annual federal poverty calculation, they will also have a cap on the total amount per year that the individual is expected to pay for health care, based on a government formula. For example, if your income falls within 100% to 200% of the federal poverty limits, then the total amount for which you are responsible for health care costs within your insurance plan is reduced by 66%. The thought here is someone who is of low income will not be able to access health care services if their out-of-pocket expenses are too high. This is also a concern for middle class people, which is why the government has also limited the maximum out of pocket charges for those who are within 400% of the federal poverty level as well. This subsidy impacts only those plans offered through the federal insurance exchanges. Using 2012 figures, a family within 150% of the poverty level would have a maximum for total out of pocket expenses for the year of $3,963, including co-payments and premiums.

Penalties for Not Purchasing Insurance

For individual tax payers who do not obtain medical insurance and submit proof with their income tax return, a monetary penalty will be assessed. Though there are no civil penalties associated for failure to obtain the insurance, failure to file income taxes can be considered tax evasion and is prosecuted as a crime in the United States. For those who are considering not obtaining health insurance, be prepared to pay the fine. The penalty will start at $95 per year and increase to $695 by 2016 for individuals.

Impact on Larger Businesses

Businesses which have ERISA exempt health and welfare trust plans AKA which are self-insured, will not have to comply with much of the insurance reforms as their plans are already exempted, however the limitations on pre-existing condition waiting periods and extension of coverage for adult children provisions do apply to these plans. Larger businesses will do what they have always done, which is using their broker/consultant to scout around and figure out ways to tweak their plans to meet budget.

For more information on the healthpolicymaven’s analysis of the Patient Protection and Accountable Care Act, please look for Unraveling U.S. Health Care-A Personal Guide, this summer. You can read more about the book and its reviews on Rowman & Littlefield Publishing Group’s web site by following this link: https://rowman.com/ISBN/9781442222984

And this is the healthpolicymaven signing off.

---

[1] http://healthreform.kff.org/the-basics/employer-penalty-flowchart.aspx

Medicaid Changes from the Accountable Care Act-Whether or Not Your State Adopted the Revised Eligibility Guidelines

What State Medicaid Expansions May look like in 2014

This article reviews the draft model for one state’s answer to the Medicaid Expansion under the Accountable Care Act. Washington State has posted the preliminary benchmarks and plan design for accommodating this act.[1]Warning to readers-this article may contain acronyms which are mind numbing, but part of the lumbering vernacular, and wherever possible the full name is cited.

Medicaid Eligibility

 To start with there are a dozen categories of “fast track” exemptions for Medicaid applicants and here is that list:

1. Health care for disabled workers
2. Family planning extension (more on this later)
3. Take charge family planning (whoa Nelly)
4. Psychologically indigent inpatient program (example-homeless folks)
5. Involuntary treatment act (hopefully this will apply to some of the nut-jobs who manage to obtain machine guns)
6. Kidney disease program (for those on dialysis)
7. ADATSA(Alcohol Drug Addiction Treatment Support Act)
8. Social Security Income qualifiers based on their low income status
9. Basic Health Plan qualifiers (subsidized medical insurance program for WA state residents with incomes no more than 200% of the Federal Poverty Level)
10. Medical Care Services Program (This is a managed care program run by the WA State Health Care Authority)
11. Medicaid qualifiers by virtue of low-income status
12. Children’s Health Insurance Plan Enrollees (CHIP)

Benchmark Plan Coverage

Next up are the definitions of the benchmark plan for insurance coverage mandates and here are those potential confounders:

1. Essential health benefits,
2. Essential health benefits reference plan
3. Base benchmark plan, benchmark
4. Alternative benefits plans

The benchmark plan must cover the following criteria in the benefit design:

1. BCBS-This refers to the bench mark equivalent coverage based on Blue Cross/Blue Shield plans
2. EPSTD-Early and Periodic Screening, Diagnosis, and Treatment Program which applies to children under 21 who are covered by the state Medicaid program
3. Non emergency transportation-What is this, a taxi to town?
4. Family planning services & supplies-AKA birth control options

People who are Exempt from the Benchmark Criteria and Eligible for Standard Medicaid Benefits include:

1. Pregnant women 
2.  Individuals who qualify for Medicaid based on being blind or disabled
3. Dual eligible enrollees, which is a category of people on both Medicare and Medicaid plans 
4.  Terminally ill hospice patients
5. Inpatients in hospitals, nursing home and ICF (assisted living facilities) who must spend all but a minimal amount of their income for the cost of medical care 
6.  TANF/Section 1931 enrollees, which is for parents and caretakers of incapacitated persons
7. Medically frail individuals, including those with disabilities that impair ability in one or more activities of daily living
8. Children in foster care 
9.  Individuals who qualify for LTC (long term care) services based on their medical condition
10. Individuals who only qualify for emergency care (?) 
11.  Individuals who qualify based on the  “spend down” of their total resources-such as senior citizens needing help with nursing home care.

Essential Health Benefits in 2014

The federal government has created ten essential health benefit plans for the states to adopt. Each state may have more than one benchmark Medicaid plan for eligible adults, which differs from the insurance exchange mandates, which are slated to have only one benchmark plan. Also, under current law, the mental-health-parity benefits for Medicaid only apply to Medicaid Managed Care Plans, and not the general Medicaid plans, but this is changing in 2014. According to federal mandates, essential health benefits must include the following insurance benefits:

1. Ambulatory services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services
6. Prescription drugs
7. Rehabilitative and habilitativeservices and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

With regard to the habilitative services and devices, this sounds like assistance for home living and a new word invented by the government order.

Benchmarking the New Medicaid Plan Design

Criteria which will be considered to establish a state benchmark for the Medicaid expansion plans include any of the following factors: the largest small group plan by enrollment (Blue Shield/Regence), the three largest state employee plans by enrollment, the largest three federal employee plans, and the largest commercial HMO in the state (Group Health Cooperative). The insurance companies will need to determine if their plans comply with the new criteria if they choose to participate in the Medicaid insurance offering, however, since so many of the state’s children are enrolled on the Children’s Health Insurance Plan (CHIP) it is expected that most carriers will. According to the Casey Foundation, 23% of the children in the United States live in poverty and in Washington State this metric was 18% in 2011.[2]In 2009, 57% of Washington’s Medicaid enrollees were children and this is true for other states as well.[3] The state with the most children living in poverty at that time was Mississippi at 32%.

Areas Not Affected by the Accountable Care Rules (ACO)

The ACA rules still allow Medicaid cost sharing in co-payments, deductibles, and contributions for services, which vary depending on the enrollee category. Medicaid does have the demonstration waiver provision under Section 1115, which allows states to petition for plan design changes which may have higher cost sharing provisions. Families with incomes equal to or less than the federal poverty level are allowed to have co-payments or cost sharing up to 5% of their income without any premium payments.  Allowable co-payments for 2012 are $3.80 for most services and $7.60 for none-life threatening-emergency room visits, as well as $3.80 for prescription drugs. There are also enrollees who are exempt from these co-payment requirements and they are as follows:

1. Pregnant women
2. Terminally ill people in hospice care
3. Medicaid enrollees who are already spending most of their income on health care costs during a hospitalization
4. Family Planning Services and supplies
5. Services provided by Indian Health Care entities for American Indians
6. Emergency services
7. All services are limited to one co-payment per service

Section 1115 Waiver Programs under Medicaid

Currently, forty states require some co-payment from parents enrolled on Medicaid and twenty-six states require co-payments for adults enrolled on their Section 1115 waiver programs. According to the Kaiser Commission Survey on Medicaid for the 2011 year, both Illinois and Wisconsin charge co-payments to Medicaid enrollees with incomes in excess of 150% of the federal level.

Bottom line, even for states not adopting the Affordable Care Act Medicaid expansion standards, there will still be an increase in their Medicaid enrollment for the following four reasons:

1. National insurance mandate requires insurance, so those who are of low income will become enrolled on Medicaid
2. Federal Subsidies through the insurance exchanges
3. Ease of enrollment process which integrates Medicaid and the insurance exchange offerings
4. In plain English, there will continue to be growth in Medicaid enrollment as long as there are so many people who are poor in this country

 And this is enough complexity and regulation analysis for a single setting so the healthpolicymaven is signing off.

This article was written by Roberta E. Winter, MHA, MPA and may be freely shared, with proper acknowledgement.

Additional sources for this article include the Center for Medicare and Medicaid- Medicaid Overview dated September 11, 2012 and the Kaiser Family Foundation Commission on Medicaid and the Uninsured report in November 2012.

---

[1] http://www.hca.wa.gov/me/documents/Bnchmrk_Benefit_Cost_Sharing_December_2012.pdf

[2] http://datacenter.kidscount.org/data/acrossstates/Rankings.aspx?ind=43

[3] http://www.statehealthfacts.org/profileind.jsp?cat=4&sub=52&rgn=49

Implications of Health Care Reforms on U.S. Trauma System

Up close and personal with the U.S. Health Care Trauma System

October 16, 5:17 P.M. I received the call, “Your son has been hit by a car. “At this point everything slowed down inside my head and all noise from the outside world was muffled. First, I breathe and then ask, is he conscious? Thankfully, he was alert according to the paramedic on the scene. He was being transferred to the local hospital emergency room for further treatment. By this time it is too late to make it down to the 5:30 ferry, so I was relegated to the 6:45, which means I wasn’t on the beach to see my son until 7:45P.M. I gave the paramedic my information and called the hospital giving them my E.T.A.

Traumatic Brain Injury

8:00 P.M. I arrive at the local hospital, a 262 bed facility with a Level III Trauma Center, and immediately found my teenager in the E.R. The treating physician informed me that he had multiple fractures, on his head and leg, the most worrisome of which was the skull fracture. (My son had just bought his new skateboard and did not have his helmet at the time of the accident.) The first thing Nathan says when he sees me is “I’m sorry Mom,” and then he starts asking for pain medication, yet he was calm, and composed. The doctor informs me the head trauma has caused a brain bleed, and Nathan needs to be transferred to a pediatric trauma center. At this point, I requested Seattle Children’s Hospital for the transfer, but it turned out that Harborview Medical Center had the pediatric –neuro-rotation for that night.  So off we went in the ambulance to the Level I Trauma Center, which is funded by the State through the University of Washington.

If you haven’t experienced the controlled chaos of an urban trauma center, it is reminiscent of a mental health ward, serves as a repository for the homeless in varying degrees of inebriated battle-weary skirmishes, and of course, is the collecting point for trauma victims. Some patients were on gurneys in the hallway while more urgent cases were treated in the E.R. suites, which were divided only by a curtain which runs two feet above the ground, and circles the bed like a shower curtain. Consequently you can hear everything in the ward, which can be somewhat disturbing.

Patient Safety Observations

Nathan was admitted to Harborview at 11:10P.M. October 16th. Throughout the night teams of specialists came in to examine him and he was not allowed to sleep until he could be fully evaluated, after the C.T. scan(s). Teams included pediatric neurological surgeons, general care pediatricians, orthopedic surgeons, and ortho/maxillofacial  surgeons.  Procedures which he endured included putting a cast on his leg and a second cast on his arm, which was later removed after it was discovered there was no arm fracture, and lots of tests. Unfortunately whoever installed the I.V. line did not removed the tourniquet after finding a vein and it was allowed to linger on his arm until the next day. This included some nurse actually attempting to put a blood pressure cuff over the tourniquet, which was high up on his arm and slipped under the cap sleeved gown. The tension of the tourniquet left a circular barbed-wire-tattoo on his arm. If he had circulatory problems this safety lapse may have caused severe problems. During his hospital stay, the phlebotomist came in to draw blood and asked if he was the patient in Bed A or Bed B, and I said I don’t know what bed this is, but he is my son and his name is Nathan. Again, isn’t it a better verification to use a patient’s name rather than the bed insignia?

Shortage of Beds for Patients

October 17, 5:30A.M. Nathan was transferred to the Intensive Care Unit where he spent two days for observation of his brain bleed, which had doubled in size but was stabilized. Yes, we spent the night in the E.R., with him on the gurney and me in a straight-backed chair, because we were waiting for a bed to become available anywhere in the hospital. This is not an unusual phenomenon for urban trauma centers, as they received referrals from all regional hospitals, for Traumatic Brain Injury (TBI) cases, burns, and other traumas. Children of course get top priority, so a bed was found. Literally, this trauma center does not have enough beds for its patients.  The Intensive Care Unit (I.C.U.) floor featured a shared ward with the burn victims and as it turns out, one mental health patient in the midst of an episode. Though the room was private and it actually had views of the harbor, the hallway between all of the other “rooms” in the ward was an open design, separated from the patient’s area only by a curtain. This meant that sound carried throughout the ward. Thankfully Nathan was loaded up on some pain medication and I crashed out on one of those folding bed/chairs.

Who Pays the Bill?

At both the local hospital and the regional trauma center, I was queried on where I worked, if I had full-time or part-time employment, and other insurance payment questions. Incidentally, evidence of employment in the United States does not mean that medical insurance is available to the employee or her family, as only about half of all businesses offer any type of group medical insurance. This payment interrogation is part of the follow-the-money-trail of all health care providers in the United States. Even though my son had insurance and I presented his insurance card, there is still the secondary payer inquiry, to allocate fault or payment somewhere else. Speaking of fault, the ambulance company billed me immediately and assumed that because my son was hit by a car that it was an auto insurance claim and asked for that information.  Of course these questions are routine and did not drive my son’s health care, but they serve as a constant reminder that our health care system is always about the money trail. Because the United States lacks a national health care program, we must concern ourselves with the ugly word, subrogation, which is an insurance industry term for assigning blame in order to obtain payment or reimbursement. In fact, at 12:04P.M., on October 18^th, I received a call from the man who drove the car which hit my child, asking for money to fix his truck. Aside from the ghoulishness and timing of the request, it too reflects on a predominant driver in the U.S. health care system, which is getting paid.

Follow-up Care

Fortunately our follow-up care at Children’s Hospital was a marvel, with concierge-type service from department to department, making fast work of the registration and verifying patient identity quickly, and with humor. Another marvel was the complete lack of any measurable wait time at Children’s Hospital as compared to the follow-up  care we also completed at the trauma center. While at the latter a hospital volunteer retrieved an unconscious man who was unable to speak from the “drive-up” and wheeled him to the X-ray and imaging department. Though I have difficulty imagining what family member would leave someone this vulnerable without an advocate, I was reassured when I saw him alert later in the day when he was waiting for his ride home. In conclusion, a patient advocate is always a good idea during a traumatic event as the family member and the patient may be too upset to make good decisions.

Implications for the Hospital Safety Net

With the implementation of the Affordable Care Act in 2014, more employees will have access to affordable health insurance through federal subsidies and insurance exchanges, regardless of what their employers are doing, so the full-time or part-time work question will become less important. But what remains is an acute shortage of hospital beds, especially in urban trauma centers and this will require an infusion of cash to overcome. Though Disproportionate Share or DSH hospitals like Harborview do receive additional funding from the federal government, it is not enough to finance a building expansion. The resourcing of health care falls to the local hospital district which will have to raise the money through a bond issue or some other means. We cannot afford to staff every hospital with the neurological and other specialty personnel required for Level I Trauma Centers, so surely we must do everything we can to preserve the ones we have. Since 2013 will focus on the budget crisis I hope lawmakers will consider the hospital safety net when they make their cuts.

And this is the healthpolicymaven signing off in real time.

This article was written by Roberta E. Winter, MHA, MPA, a health care journalist, consultant, and mother.