Untangled Health

Consumers Unite To Drive The Changes We Need

Category: Uncategorized

Waking to Trump: Healthcare is the least of our problems.

 Untangled Health was created to illustrate confusion in US health policy and give myself a place to vent my frustrations as just one more American caught in the routine of “Stay, Stay, Stay, Staying Alive”. The last eleven days have reordered my priorities. Since 1979 I have been fixed-on-fixing the vulnerable people using your health care system then as I was having my morning coffee today I saw a note from a LinkedIn Friend Maria K Todd MHA PhD. She was describing her inability to create words of sufficient magnitude to describe how she was feeling since the change of administrations. I  looked inside and emotions spilled-forth with the following imagery of life, family and purpose.

 

 

 

 

 

 

Waking to Trump (click here for trip to the Cheshire Cat’s den)

I wake:Breathless, exhausted,fearful,powerless; lost: A stranger in a strange land: Who are these men? My hackles are up and I can’t remember the dream: Something about a red-haired, bright bulbous nose dude with the stink of vodka on his breath screaming “WRONG”!

Waking each morning to the same reality. Memories of 50 years attending to diabetes; age ten; being told I might be blind and lose my feet if I didn’t care for myself. Memories of what it “took” to take CARE of myself; sometimes feeling ashamed to borrow money for insulin . Experiencing life on track Zero then again on Track number Ten. Attaching myself to groups of “loving-others”: finding the barriers to “well-being” and removing them; one-person-at-a-time.

Signs of my disease pointing to the Fall of my life: then Seizing 2008 with an army of friends and moving NC to the Blue as we were “tailed by skinheads” and protected by the FBI. Wondering if this is what my father felt as he was beaten up by classmates calling him “Stinky Saul the Jew Boy”; When his name changed from Halbstein to Harris so his family could keep their business. Choosing to put life on the line in WWII, he went on to live a life of patriotism he died an honorable man. One recognized for his contributions in our Space Race; Father of the Titan II Rocket.

Staring at his penciled drawing of the completed rocket, complete with team signatures : I hear his voice; shouting loudly to reject any form of bigotry. I miss his presence and the smell of his after-shave that day in July 1969 when he rescued me from the “Darker Side of America”; bar-fly’s and deviates and bourbon breath…the Department of Social Services and my fantastic Pop chased them away. There are reasons to keep the children in focus for what they inherit is their ability to thrive in the safe-space we leave behind.

I miss you “Saul Halbstein” remembering you in your prime; the Saturn V booster rockets on their test stands “shaking the windows from our home” ; hand on my shoulder, “have no fear Jeff; were going to the moon”. 

If you are out their Pop, the joke is on you. Not a believer; you now gaze down at a country you could barely recognize: Save the memories of your childhood, the War and the 1960s.

Now I know why you were still angry when you died. When you own best friend accused you of being another “New York Jew” ; broke your heart and left your side. Those last weeks of your life in December 2015 you kept reminding me of the forthcoming debate; you seemed to believe it was extremely important; you spoke of the “transparent man” who was in the next hospital room. You called him “Mr. Deal” and warning me about his ties to the bad guys. Were you by chance having a premonition?

I asked you today if I should publish this. Then the mailman came delivering an empathy card for your death:  One-Year-Late

My Pops in his prime!

Teaching others to teach others

Missing Pop

 

What is at risk if Obamacare is Rescinded

Reconciling data in my six health portals

What is at risk for all subscriber to commercial insurance programs if Obamacare is Rescinded?

This analysis with specific allegorical references was posted by my friend Wendy today. I find it accurate and far beyond my skills to interpret and describe What is at risk for EVERY-BODY

Obama Care is. . . The ACA (Affordable Care Act)
Last night as his first order of business the new president signed an executive order to repeal the ACA. Here’s what this means… even if you are safely covered behind employer-provided insurance, the protections set forth in the ACA (Affordable Care Act), apply to you too. And if those protections are repealed along with the rest (or any part) of the program, you will also be affected.
That means you may be trapped in a job, because your pre-existing condition may mean you will not qualify for new insurance offered by another employer, and the cost of private insurance would be prohibitive. If your employer shuts down, lays you off, or even changes insurers, well, you are out of luck. The Senate GOP voted this week that they would not require an eventual ACA replacement to protect against discrimination for pre-existing conditions, which was the standard before the ACA.
It means that you (a young adult under the age of 26) or your adult children (over 18) may find yourselves without the protection of insurance, as the Senate GOP voted last night that an eventual ACA replacement will not be required to allow young people to remain on their parents’ insurance up to the age of 26.
It means that if you have a high-risk pregnancy, or life-threatening illness such as cancer, you may not be able to afford all the care you need, because you may hit lifetime or annual caps. If you have an infant born with any kind of severe medical condition, or premature, they may hit their lifetime insurance cap before they are old enough to walk. The Senate GOP voted last night that an eventual ACA replacement program would not be required to prohibit lifetime insurance caps.
It means that if you are a struggling parent who is uninsured or under-insured, you will no longer be able to count on at least your kids getting the routine medical and dental care they need under the Children’s Health Insurance Plan (CHIP). The Senate GOP voted that CHIP is not required to be protected by an eventual ACA replacement.
These provisions of the ACA affect everyone in this country, not just those without insurance through their employers.
If you are not okay with these changes, call your representatives and let them know what’s important to you. Nothing has been set in stone yet, but our legislators have shown us a map of what they plan to do if constituents don’t make their voices heard loud and clear.
Hold down here to copy, paste, and post (do not share) on your timeline, if you feel this information needs to be passed on.

This is a comment from NORA on FaceBook
As a person with R.A. (pre-existing condition) Before ACA I was never able to purchase even basic insurance for under $1500 a month and thus went without insurance from the time I graduated University until I was 49 years old. It’s $2000 per visit to a Rheumatologist, so I only went once a year and could not afford medications. I lived with daily debilitating pain and exhaustion among other things. If you know somebody with RA you know is serious. ACA provided me with good affordable care at a price I can afford $359 a month. I responded very well to BASIC medications for RA that I could never afford before (but with ACA can) and am now able to live life normally and run my small business again. My great Doctors also noticed I had serious liver damage from years of taking OTC pain relievers like Tylenol and Aleve. They were able to fix that too. They said it may have killed me or become cancer without treatment, at the least led to early death. If I lose coverage for my Meds am already planning to go on SSD and Medicaid and close my business. True Story. #ACAWORKS PS Only deplorables don’t want people to have health insurance.
Like · Reply · 1 · 19 hrs · Edited
Wendy Lannon
Wendy Lannon I think of you Nora whenever I hear people say ACA doesn’t work. #ACAWORKS

From Obama to ObamaTrumpCare

someone-to-watch

Someone to watch over me…….
Dear Doctor, will you please make sure I receive the RIGHT CARE!
What do you know about me Doc?
Do you have time to spend with me today; perhaps discuss who I am in the world, what my goals are and what I think might help me feel better?
Are you interested in my Well-Being? Do you and your staff ever discuss Well-Being or is it all veiled in a pile of healthcare acronyms; where Well-Being is described by absence of symptoms and disease?
Do you have the opportunity to discuss my goals and interventions with my other doctors? Sometimes I am not sure you folks talk because my information: from religion and employment history to list of medicines varies between practices. I thought someone was fixing all of the electronic health record issues ten years ago?
I noticed that all of my personal physicians that I have chosen over the last fifteen years are selling their practice or merging into some sort of healthcare system that appears to be managed by the local hospital; is this a good thing? I am really not sure you see me because the person at the registration desk doesn’t recognize me and your Medical Assistant told me that you only had time for 10 a minute appointment today.
Actually, to be honest with you; I am concerned for your Well-Being Doc because you have dark circles below your eyes and tell me that you are up until 10:00 PM each night completing your records at home. I realize that the new electronic health records are cool but shouldn’t they increase your quality of life as opposed to drain any remaining discretionary time you have with your family?
Ya know Doc, I have learned allot about healthcare in my life: Yeah, some because of my training and work but mostly because I have these….”conditions”. The “conditions” have presented adequate challenge to require me to understand the “bits and pieces” that string this system together. I’ll bet you don’t learn much about being a patient in medical school. I am not sure how you could do it without adding another two years to your fourteen years of post-grad education.
Did you know that I have spent ten hours in the last month trying to get a prescription authorized? You know the prescription that makes living with RSD and diabetic neuropathy tolerable! It appears that someone didn’t install your e-prescribing system correctly; something to do with prescription received and filled acknowledgments? I don’t know Man; it seems like the fax machine and pharmacy calls worked better than this e-Rx stuff. The long and short of it is that between your practice, my insurance carrier, and my CVS pharmacy the most efficient transaction I can hope for when I am in pain is 48 hours. My “Well-Being” wasn’t so “Well” this month…..
BUT my A1c is 6.5, my blood pressure is 124/78, my immunizations and other measures of health process and management outcomes are all great. I am pleased to be one of the good data points on your quality report and certainly testify to CMS and Blue Cross that you deserve an extra 5% for your hard work. Might be nice though if I received a discount on my insulin copay for the snappy A1c that has kept my feet attached to my legs and my body out of the hospital these last 50 years.

So what is Right Care? How do we know if we get it? Is it through the Diabetes DM report? Is it through the patient satisfaction survey that I take at each and every service provider I see? They all are very similar, I wonder if anyone has ever considered a “whole system measure”; at least something better than the Service Excellence Survey that reminds me of the material sent to me by American Airlines after every business trip. By the way, I always give my providers 5 stars with the exception of the conglomerate that bought up the primary care practices; their employees seem miserable. I find it amusing that their employees all where buttons that say “Ask me about the “Name of Healthcare Institutions” WAY. I guess they all have some kind of culture that is supposed to make my experience less painful as a consumer? Perhaps more like Disney Land I suppose.
What I really long for is my diabetes pediatrician from 1965. Dr. Lipmann. He always asked me to discuss how I was feeling about school, whether I had enough to eat at home, did I have any dreams and whether or not my diabetes would prevent me from achieving my dreams. Heck, he called me on Sunday night to as how I was feeling when my urine sugars were running 4 plus. When I left his care at the age of thirteen he had illuminated an interest in human biology that has carried me through my life. On a darker side of my childhood life he also notified “Children’s Protective Services” when he discovered I was living in an alcoholic flop-house!
My friend Tony is from another country. His mom had a CVA last year. She was transported to the ER, hospitalized, transferred to a facility with real rehabilitation specialists and doctors on staff daily, discharged home with visiting nurses and therapists and returned to society as a healthy 75 year old woman who is now completely independent. Her cost? Well there was no cost to her and the average cost per person for health services in her country is 1/2 of what it is in the USA.
In meeting with my insurance adviser the other day I was informed that my healthcare cost will be more than $500,000 between now and my death; with my diabetes, RSD, neuropathy etc. I wonder how we will cover the services. I really don’t want to be one of those patients that I cared for early on in my career. You know….like the old man and WWII B17 Aviator that looked up at me shortly before he died and said “Ya know Jeff; I used to be somebody once”.
The end of his life was no different than my fathers. Dad died last year from pneumonia at the age of 87. We had just celebrated Memorial Day. He called me complaining of a chest cold and 48 hours later I found myself sitting at his bedside with new onset dementia, consolidated breath sounds, a temperature of 101 degrees and abdominal cramps. I asked the Nursing Assistant to get him a bed pan and she informed me that he “just got off the pan”. A few minutes later I overheard her complaining to her supervisor that she had no intention of getting my Pop out of bed because he was a difficult transfer due to his combativeness. Pop was angry for sure but not combative. Then I witnessed the IV nurse insert a 18 gauge catheter into my pops wrist. She never registered IV access and proceeded to deliver 500 cc of solution into the sub-cutaneous space. This was the only vein he had left since they had made the same error the night before in the opposite hand. By 6PM his hand was as large as a soft-ball and this was hours after I complained about her technique.
So the following day Pop got a PICC line. PICC lines are infection risks!

Three days later I took him to the SNF with his PICC line and met with the therapists. Dad was becoming more lucid but I had concerns. I met with the Charge Nurse and facility director to assure his good care. I was concerned about the additional risk for infection from his new PICC line. You see, this facility was part of his life-long $450,000 investment in a continuing care environment; supposedly the best available in Huntsville Alabama. I used to direct clinical services departments in these facilities earlier in my career and was aware of their financial strain as they attempted to deliver hospital level care for 1/3 the cost.
I saw Pop the next day while he was cycling on the recumbent bicycle in the rehabilitation department. He had 20 minutes of therapy to go but as soon as I showed up to watch his work-out the therapist terminated the session and quickly wheeled Pop to his room so we could chat. Dad looked horribly sad, I knelt down to say good-bye kissing him on the forehead I said “I love you Dad!”; he looked up and said “And I love you Jeff”. These were our last words.
Three days later I received a call at 3AM from a person who could not speak English. He mentioned my father’s name and I asked for someone who could speak more clearly. The second person I spoke with also could not speak English. Finally a paramedic picked up the phone…”Mr. Harris, your father is unresponsive and we are taking him to the hospital”.
After a quick dialog I was able to determine that Pop had explosive diarrhea several hours earlier and simply lost consciousness. I called ahead to the Emergency Department to inform them of my father’s forthcoming arrival and that I was worried he might be septic. I told the doctor that Pop was a DNR patient and he should call me when he arrived. When Pop was evaluated the ER Doctor called me with his lab results and it was quite evident that he was dying and most certainly had been allowed to dehydrate while at the Rehabilitation Hospital OOPS I mean Skilled Nursing Facility OOPS I am not sure what I mean. God did I weep as the ER doctor and I discussed his DNR.
I wrestle with the fact that I might have been able to save Pop if I had pushed for re-hydration, antibiotics and other therapy but I couldn’t help think about Pops state of well-being. You see my brother and I had spent years shuffling him around between neurosurgery in Birmingham and other clinical facilities. At one point I had imitated a physician to keep my father from being discharged prematurely after his brain tumor operation. He had been in the hospital for a week. The Medicare Prospective Payment was going to pay for eight days and the hospital was pushing him out to a skilled nursing facility. I watched my Pop eating and realized he had an aspiration problem. Fearful of aspiration pneumonia I asked to have him discharged to the rehabilitation beds at the University Medical Center. I wanted him to receive a speech language therapy evaluation for aspiration risk and rehabilitation services. To get the transfer to rehabilitation where a doctor and therapists would be available; I had to retrieve every clinical skill I had when meeting with the staff to justify his case. When they assumed I was a doctor, I let it ride. Feeling shame the next day I convinced myself that I would do whatever I needed to protect my father.
You know, to make sure he would receive the
Right Care.

As the ACA (Obamacare) was implemented I began to have hope. You see, this year 2017 is the beginning of Medicare’s observation of how well inpatient hospitals and post-acute care facilities integrate. One important measure they are watching is the frequency of readmission to acute care for the same diagnosis. This combined measure of how well institutions, nursing homes, home health networks and primary care communicate regarding a patient’s process as they are handed off between facilities is to prevent patients from becoming ill and requiring re-hospitalization. Trust me folks, it used to be horrible: I can remember turning patients around as they arrived at our rehabilitation hospital and sending them straight back to the Medical Center that had just discharged them. You see, some were still in heart failure and semi-conscious; not only could they not participate in rehabilitation; to attempt rehabilitation might have killed them. But you see, the hospitals were not linked to the rehabilitation and skilled nursing facilities through a common therapeutic goal and reimbursement mechanism. The hospital in Boston just wanted to discharge the patient prior to exceeding their Medicare reimbursement allotment. We however had marketing nurses out in the field accepting any warm body with a heartbeat that just might survive a 21 day Medicare stay in a Skilled Nursing Environment.
My friends had no idea why I never lost my job by reversing the trajectory of these patients. What they did not know was that I had a compassionate family owned corporation employing me who trusted my clinical intuition.
Alas… as of today….Obamacare is being repealed and we have yet to be informed about “TrumpCare”. My guess us that we will return to the past with the exception of mandatory care for persons with pre-existing conditions. Then we will see just how much our policies cost and what our end of year out of pocket expense will be.
For my wife and I,
We are searching once more for our peeps. This week I have looked at my well-being through the end of my life if we ex-patriate to Canada. My cost will be $0.00 for healthcare. My waiting time for a CAT scan will double but Canada’s outcomes for Cancer and Cardiovascular Disease and diabetes are slightly better than in the USA. So what do we have to lose? In fact, Canada doesn’t amputate many diabetic limbs. You know why? Because all of their diabetics have access to care!

Fondly thinking of you fellow patients and consumers;
Jeffrey Halbstein-Harris
• An advocate for those who feel lost
• Always watching
• Harnessing the compassion that surrounds you in a time of crisis
• Connecting you with the best science available
• Minding your pocketbook
• Working to return you home safely

A note to the NC Legislature on Compassion

 

 peace 2 you

 

A letter to the NC General Assembly

 

 

 

We seem to be evolving into a nation of binary people. Binary in the sense of our emotional, tactical and strategic response to our surroundings: On one end we have the Concerned and on the other we have the Unconcerned.

 

Of course you realize I say this in jest, but what if I was right? Are you willing to risk your comfort and explore a possible reality with me?

Please place your religious ideals aside for a few minutes and read on:

 

Hypothesis:

 

  • There is no God
  • No-one will inherit the earth, we have no idea what the future holds.
  • Human beings randomly crawled from the primordial soup some billions of years ago and have evolved to the most intelligent form of life on the planet. When I speak of intelligence I mean cognitive ability and nothing else.

 

 

 

Since we became self-aware we have been unable to escape our internal reality: That we are born alone and will die alone. All of the space in-between (a brief 70 +- years) is filled with experiences arising from the environment around us. We learn –or not that our actions influence our environment and well-being; receive –or not, instructions on how to behave in society and together: “Trudge the road of destiny”.

 

Non-sense you say: “we trudge the road together”!

 

Two weeks ago, as I flew home from a medical conference in Denver, this essay was tumbling around in my mind. I was not sure of the words, but I felt an overwhelming drive to write something about how I currently perceive my world: The one where I wake in Raleigh North Carolina each day, aching from diabetic neuropathy, reflexive sympathetic dystrophy and drained by my hepatitis C, a condition undoubtedly resulting from poor lifestyle choices in the 1970’s.

 

I am observing the adults in my Country of origin become firmly rooted in social belief systems. It appears they are evenly divided between the concerned and unconcerned. At the same time, few fall completely into one group as they seem to be willing to sacrifice their beliefs when under personal threat. The ruggedly independent who celebrate life, liberty and the pursuit of happiness in the absence of stringent regulation will sacrifice their black and white thinking to help a nephew or niece who has become dependent on drugs or alcohol. Those who consider themselves intolerant of in-equality and weep over those experiencing disparity in health-care or lack of opportunity will often appear to live up to their values until they too fear losing something of greater importance.

 

I have a friend who calls this: “Integrity in the moment”.

 

Since we are tolerant of a change in our own life circumstances to the point of willingness to think in numerous shades of gray when it comes to self-interest and the safety of our loved ones; how is It we cannot apply this flexibility to everyone?

 

My father asked me if I had ever sacrificed. His opinion at the age of 86 was that his was the last generation to truly be willing to have such willingness. He and his friends in WWII who walked from one end of the Philippines to the next risked their lives daily. I always thought this was for God and Country until I learned much-later that my Dad joined the Army –in his words “to find chicks”.

 

So what I consider the truth today is that few human beings are willing to strictly abide by their convictions. Yet, in my opinion; to ease the pain of ‘oneness’ we find some common characteristics that we share with others and join that group: Until we become threatened that is.

 

So, for all of you Republicans, Democrats, Tea Par-tiers; Independents; Christians, Jews, Muslims, Atheists, Agnostics, or (insert category here): Are you willing to try something new?

 

How about belonging to one group:

Human Beings.

 

 

How about owning some truth:

  • We are a fickle species.
  • We are capable of changing our behaviors and attitudes.
  • We are not God if there is one.
  • We believe in knowledge.
  • We believe that knowledge is best obtained through scientific methodology
  • We would like to live forever, never be hungry, never be lonely, and always be loved and recognized as an individual.
  • When we put our defenses down we realize that each one of us will die and we might experience times when if not dead, we will wish were dead.

 

Now, stop here for a moment. Yes I know you have an important business meeting but please stop for a moment and read on.

 

  • If you own these truths you might feel a bit uncomfortable right-now: Perhaps afraid for yourself, perhaps sad for others who might suffer. In fact, all of a sudden you realize that We All Suffer.
  • What separates you from those who you call entitled. What separates you from the arrogant wealthy movie star; very, very little; perhaps nothing at all?

 

 

So on the flight home from Denver, I met a guy who said his nephew had been living a year in North Carolina. He said he had just got a factory job but could not afford his medicine. He said he was a diabetic who did not have his insulin.

 

As my mind jumped between my judgment and intolerance of numerous human character defects; across a spectrum of political beliefs there was a man about to die from diabetic ketoacidosis.  He had lost 50 pounds in weight and for reasons that were none of my business no medicine.

 

I just hung up the phone after speaking with his aunt: I gave her the number of a community health center where the young man can access a primary care medical home and learn –if he desires- to take care of himself. That is the problem in the moment.

 

Realizing that I am one of those fickle human beings described above I needed to stop thinking and do the next right thing.

 

The next right thing will always be: To decrease suffering for another. When I am so sick that I am unable to help another or take care of myself then the next right thing is to?

 

Ask for help!!!!

 

So, as the North Carolina Legislature places health and well-being above all else, they will have my respect. That said, since they are human, and I am a human, if any one of them needs some groceries they are welcome to split what I have in my refrigerator.

 

You see:

 

At age 10 a man tackled my ‘entitled’ drunken mother as I jumped from our kitchen table on-to his back with a steak knife ready to cut his throat.

 

At the age of 13 I said “I will never drink alcohol or take drugs”

 

At the age of 19 I acquired hepatitis C (guess how)

 

At the age of 25 I had to borrow money for insulin (help of another)

 

At the age of 31 I stopped drinking and drugging (help of many and my higher power)

 

At the age of 36 I had asked a team of people to help people suffering with lung disease become more independent and comfortable: Literally healing people into their inevitable death. I did not have to ask: ten years later; the team simply told me how much they loved me.

 

There have been times in my life when others would throw me away and times when they called on me to feel safe. At what point should I be judged by others. Isn’t it our duty to love unconditionally in the moment: To believe in our truth that people change, life is precious and it is not ours to judge?

 

Moving forward NC Legislature, I hope you all will sit back and reflect on the importance of your actions. How many tomorrows are you sacrificing that do not belong to you.

diab expense nc cos

 

 

 

 

NC General Assembly Run’s Amuck

Here is what you can plan on seeing frequently in NC Emergency Departments as people with diabetes lose contact with the guidance of their primary care medical homes.
Dying a piece at a time diabetic vascular disease

This letter is to my neighbors in North Carolina, all of you:

I am presently at the Patient Centered Primary Care Collaborative, a national forum of Fortune 500 companies such as IBM, Anthem WellPoint, United Healthcare; Aetna; and clinical groups such as The American Academy of Family Physicians and others. My point is: This is a non-partisan, multiple perspective group of America’s best thinkers in business and industry that convened in 2006 to identify what works with regard to delivery mechanisms, payment reform and consumer engagement.

I am a member of PCPCC and serve as a co-chair on their health information technology committee and adviser to the Patient-Family and Consumers group. Yesterday I was a panel member discussing both topics. Why, because of my experience with my healthcare (diabetes for 48 years) and work with the folks that founded the current system.
After this meeting I will be attending the Colorado Patient Centered Primary Care Collaborative meeting at 1:00 PM this afternoon.

I am interested in Colorado’s perspective since they adopted North Carolina’s successful program: North Carolina Community Care Network which tethers Medicaid Patients to a Medical Home. Our program in NC has been evolving for twenty years: Starting as a simple demonstration and ultimately proving its capacity to manage a diverse population of patients coming through different payers including Medicare, Medicaid and Health-Choice. After joining what has become a national movement to bring patients closer to their primary care physicians Colorado’s pilot initiative has demonstrated reduced-cost per enrollee and improvements in health outcomes. The return on investment is well north of 2:1.

As these programs expand they will be using organizational ideas that originated among the talented North Carolina physicians and allied health professionals in the between 1994 and the present-day. NC tax-payers and the private sector joined forces; offering financial commitment and support staff to ramp-up the rate of adoption of Medical Home processes. Their support of Community Care is due to their effectiveness. This work is now being replicated across the country and is thought to be pivotal to the reduction in cost and the much-needed improvement in National Healthcare Outcomes.

Unfortunately, my neighbors and I in NC will no longer receive the benefit of our State’s recognized excellence in primary care delivery as the NC General Assembly has elected to ignore the desire of the public and take the next step toward the ‘outsourcing’ of Medicaid to a national HMO. “Sorry folks we have been hijacked by gorilla corporate tactics to influence a 3 trillion-dollar industry.”

I must inform you of your success and the magnitude of abandonment.

Here are the facts as described above:

NC has demonstrated wonderful cost savings with their community designed care coordination and case management programs. You may hear them referred to as Community Care of North Carolina. They are composed of 14 different not-for profit organizations assigned the task of providing care while controlling inflation in Medicaid. I worked with the team on assembling programs that would provide unbiased expert evaluation on their health and cost outcomes, those that become national benchmarks.

Your communities responded to the call for participation in Medicaid reform. Now, all of us that thought we were included have been abandoned: And believe it or not: Our Governor is one of the good guys: After he put a great deal of effort into learning about what works and listening to the feedback of local healthcare experts he supported the implementation of Accountable Care Organizations and the continued use of Community Care of NC as the service providers.

How do I know this? I had coffee with Fortune 100 executives yesterday who have been trying to help the Governor and NC Physician networks. I cannot disclose anything other than this. The detail is disgusting and speaks to issues that most in our country worked through in the 1970s. Suffice it to say that your elected officials were able to locate an HMO plan outside of NC that is able to tell a wonderful story. Since the legislature (as members have directly admitted to me) do not understand healthcare data and population analysis they have hired consultants to assist. These consultants pale in comparison to the experts that have recently met with Governor McCrory in an attempt to save the State of the Art system currently in place.

All systems of care need improvement today. Clinics and providers are not all the same. That said, we have plenty of successful models in NC to draw from.

Regardless of the following truths your General Assembly has decided to dispose with advice from the recognized experts in the field.

The Nations’s  industrial leaders are adopting your healthcare services design because they are confident that it works.

• Our State is a respected leader across the USA through the success of its bilateral Medicaid Managed Care model that evolved through your feedback and the constant vigilance on regional measures of cost benefit and cost efficiency.
• You have been abandoned while distracted by a conservative argument for small Federal government. The influence from outside our State is present and sizable.
• Through the invocation of States rights, our GA turned down sufficient funding to care for an extra 400,000 poor people in this State. Our uninsured would be insured otherwise and hundreds of jobs would be created to perform the needed individual health assessments, identification of clinical disorders and implementation of a course of treatment.
• You are handing over the health management of the woman next door: You know the one who works two jobs to feed her family to an external, antiquated delivery concept that demonstrates only two things:
o Reduced cost
o Reduction in health and wellness with loss of access to primary and specialty care.

Since no-one could imagine our legislature retreating from previous commitments I thought it might be a good idea to take this year and advance the treatment of diabetics by concentrating on our well-known problems with untreated diabetic eye disease among the poor. I was counting on the Community Care Networks to take our patients, established a collaborating group of eye doctors and created the program outline for a Diabetes Eyesight Preservation Initiative.

Due to the changes in attitude and changes in latitude expressed by the GA last week a program to treat diabetics at high risk for becoming blind at a cost roughly 50% of local hospital charges is being placed on hold. I can not ask my ophthalmology friends to plan on Medicaid reimbursement with the knowledge that the payers could change overnight. Two bad I guess for several hundred people who have been unable to receive specialty eye care.

I hope my readers understand what I am saying. I have difficulty describing such a complex and corrupt industry to my friends and family. The General Assembly has knowingly ignored your desire and taken action that will –in the eyes of our nations most published professionals likely do harm to the poor.

Additional note one day later:

I have been informed by my endocrinologist that the practice will no longer accept NC Medicaid. This is due to the uncertainty of the GA final budget.

I am retired today and have no reason to distort the truth. I am fortunate to have wonderful people in my life outside of NC who validate or challenge my conclusions. Without my friends I would question my sanity and think I was caught in the twilight zone.
\I am willing to work with others toward a system that is faithful to its original design requirement: Provide room for the poor and middle class (now the same, check your retirement account) to succeed in a country of opportunity. Have we lost it?

If anyone would like to publish detail, simple facts to expose the reality do not hesitate to contact me. I have data and information regarding this topic that will stand in court and my family has no fear to work with others in an attempt to expose the material prior to the 2014 election.

New Bumper Sticker Idea: NC General Assembly : Perfecting Legal Genocide

 

 

Trouble Across the Pond. Once again, no one to blame but everyone. Look at the entire system for your answers.

A good day

Once again my friends, any system which places organizational success in the media, executive bonus, or ridiculous ‘service excellence’ survey results over clear-cut measures of process, and medical outcomes first will lead to suffering. Suffering of patients, families…our identity?
Recently, in Raleigh NC a large hospital system has been cited for Medicare fraud (Wake Medical). As the story unfolds the CEO stated that a single mid-level manager from Patient Services changed physician’s orders to charge Medicare for multiple episodes of care as opposed to observation days only. I find the sacrifice of lower level employees horrific. I also know this to be a common behavior in the US.

These problems are systemic and global. They specifically speak to a decline in the humanity of ‘human services’.

There is a lesson in this video from across the pond.
Pay attention to the proposed Standards and compare to what we have or do not have at home.
Consumers of services (yes us patients):

Please do not accept lip service as transparent publications on safety and quality and cost are promised under the new health-reform act. Scream out for standard reporting, standard methods of measurement and reliable statistics.

Grieve please! Step out of your head and grieve.

cemetary at duskGoodbye little angels: Thank-you for the gift of sacrifice; providing one more opportunity for us to share common bonds.

Your day brings us together: BLOWING AWAY our capacity to…
Explain,
Politicize,
Theologize,
Secularize and
Personalize…

I hope.

Perhaps we will take this moment to sit together
And grieve…

Take a chance, dispense with our differences and share the love…

Yes, LOVE
The Glue of the Universe

Jeffrey Halbstein-Harris: December 14th, 2012

Would someone clean this mess up?  "Oh...that is our responsibility; never mind"

Would someone clean this mess up? “Oh…that is our responsibility; never mind”

Step-up and submit your ideas to the private sector : Healthcare Information Technology Optimizes Hospital Experience

Information Quest has created a $100,000 competition which solicits ideas which will optimize the in-patient experience. So…all of you e-patients, patient advocates; geek-patients; participating patients: We have opportunities to actually influence product design. If you have ideas, your submissions could be the most valuable in the market for the creation of products you actually want to use!

 

Obama Phones: We continue to justify our prejudice through cerebral intercourse – tidbit on health-care cost

YIKES!

I recently was involved in a discussion with a beloved friend. We were both upset about what we thought were inappropriate entitlements and the forthcoming ‘fiscal cliff’. The topic of choice was cell-phone entitlement programs and my friend stated that Obama had expanded a program for free cell-phones for the indigent; calling them ‘Obama-Phones’.

I said in our conversation, “people do scam these programs and it aggravates me as well but I need to look into it.” “I am aware of and FCC ‘life-line’ program that benefits many people like myself who have diabetes, asthma, heart disease and so on, so I cannot throw out the legislation without a careful review.” I further discussed antiquated FCC protection regulations for rural areas and how these original ‘anti-trust’ laws gave rise to local monopolies allowing community entrepreneurs to monopolize the telecom industry across multiple adjacent counties in NC. This is a real case that requires thorough investigation as it drives out competition from more efficient providers like Time Warner subsequently costing a former Health Center client of mine to spend $8000 per month in ISP fees. I could have purchased better technology for 50% of the fee if my client relocated 50 miles North. The legislation traces back to the Ma Bell days and like all population based protection and entitlement programs now requires review and appropriate action based on the current environment. ‘Zillions’ of influencing variables exist that drive up our cost and inefficiencies!

What troubles me is that the Web is being used to post video and text which propagates ignorance and judgment. Everyone is now an expert in tax-reform, the fiscal cliff, health-care and so on. The truth is: most Americans have no idea how these programs work; especially our elected officials who do not recognize the natural escalation of entitlement programs that are bound to public health standards yet provided by a self-defining ‘free-market’.

In my career I have seen organization CEOs sell company’s for $Millions$ that provided decision guidelines for denying insurance coverage. I have seen these guidelines be put to use to deny hospice coverage. I hope you get my point: In this case I was reviewing a denial on a dead-man.

The factors inflating healthcare and entitlement program costs over time relate to a natural human tendency to place self-interest above all else: After all didn’t Adam Smith use this as the fundamental driver for capitalism?

Of course we have a Fiscal Cliff! I suggest it is time we place the black and white (no-pun intended but interesting end-point) definitions of liberal and conservative  politics in the hopper. The extremists among us are using our ignorance and fear to further split our country in two. I welcome all to leave out names, political affiliations and institutions out of their commentary and begin speaking to the issues as human beings. Let me model a comment for you that brings an issue into the spotlight.

On free cell phones:
“I was informed recently that our free cell phone program is expanding and people are getting these that do not need them. I have also been told that these are old rules which expanded under the present administration. I do not believe America can afford this program. I fear the fiscal cliff may end our way of life. I hope someone can explain the details to me.”

You will note that I:

1) described ‘overheard’ data

2) made a judgment

3)pointed to a financial fear

4)asked for help.

Here is the best answer I could find on the Web:
Snopes Obama-Phones

Here’s to a collaborative future!

Jeffrey Harris aka ‘Halbstein’

 

 

Why is Untangled Health Here?

Because I believe that our Healthcare System will continue to sacrifice Thomas Jefferson’s vision of “a more perfect Union” as stated in the Preamble to the Constitution of the United States of America

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.    archives.gov

We propose that the Founders of our great Nation would undoubtedly agree that each citizen of the United States should have access to evidence based healthcare for the treatment of any disease or condition that threatens the person’s ability to maintain health related well-being through a government that promotes our general Welfare.

  • I perceive a confusion in healthcare reform; a critical issue that has not been addressed in the public arena with sufficient depth.
    • I judge the confusion to be an artifact arising from excessive input from multiple industries that look at Healthcare as a business opportunity.
  • I believe that the healthcare industry as a whole can provide successful, meaningful lives to its work-force but should never be commingled with other industries that add value to consumers in exchange for a return on share-holder equity.
    • UNLESS
      • The return on share-holder equity is expressed as an increase in the health related quality of life for ALL American Citizens at a cost that is defined and accepted by a consensus of citizens set forth through democratic process.
  • I suggest that the ‘elephant in the living-room’ is a barrier to change that must be addressed immediately, less we continue to spend excessive capital on a system that is unaffordable and inaccessible to a large percentage of our population.
  • I suggest that Affordable Care Act will not meet our Nation’s needs but respect the legislation as a major step toward our future goals.
  • I believe the elephant in the living-room to be a lack of agreement among our citizens that all persons should have equal access to healthcare services. Which I judge to be the equivalent of the statement that “Some individuals must sacrifice their lives and-or well-being for the greater good of society.”
  • I judge that individuals who do not agree that healthcare services are a “right” or “entitlement” for all Americans do not realize their own inability to express unconditional love.
  • I select “Fierce Love” as the branded method used in this blog to point out or “illustrate” the confusion described above and freely give tools to those individuals who are defenseless in our healthcare system and unable to gain access to the same care afforded to America’s upper-class.
  • The care I refer to does not include elective procedures to improve one’s physical appearance unless the patient is deformed as a result of a serious congenital defect or trauma-induced deformity.

 

Please feel free to review my work and comment (regardless of your opinion).