Untangled Health

Consumers Unite To Drive The Changes We Need

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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

Not an insurance company, just an empowered consumer.

Hopeful

Hopeful

My report for today:

Helped one more person register his family for an affordable insurance product using Healthcare.gov

Sequence

Met friend at 4:00 for dinner prior to our club meeting. Turn’s out he is lost in acronyms and asked for help.

Over the course of the next four hours we improved his ability to self-advocate, submitted an application and lessened his anger and fear of OBAMACARE.

My objective was met by my friends eloquent ability to inform his teacher of the many reasons OBAMACARE should have never been named OBAMACARE and his understanding of healthcare as it differed from earlier in the day when he could only think of it as “the monthly premium “or the cost of a subspecialists co-pay”; or “a communist scam”.

We ended the night with one happy conservative family man receiving a quote for his silver policy for a family of three. The monthly premium is $200 less than last years and his services have increased.

As we concluded the evening he asked if I ever thought of inventing a software program that would track all important health information for patients.  He had evidently been responsible for a $4000 co-pay on an $18,000 ER visit for chest-pain. This was mostly due to his inability to articulate a thorough history to the doctors on staff.

I described to him the importance of maintaining a relationship with a primary care physician and then logged on to MyHealthRecord at Duke and MS Health-Vault to demonstrate the rather rough but much better communication I had with my physicians and interoperability of pharmacy and EMR systems. Then I described how these data could be used to empower a person in an emergency with timely and acurate information. His conclusion: Jeesh, I probably would not have needed the expensive work-up if the doctors had access to all these studies!

One more convert.

So little time….

But one more convert.

Tomorrow’s agenda: Meet with ophthalmology practice to organize diabetic eyesight preservation program for non-Medicaid, uninsured folks in NC. So far, I have the cost of a vitrectomy reduced from $12000 at a local hospital to $4800. Not bad for a days work!

Jeff Harris

Not an insurance company, just an empowered consumer.

Donald Berwick | The Health Care Blog

We are dropped from the universe into loving hands (unfortunately not for all though)

 

 

 

 

 

Donald Berwick | The Health Care Blog.

I am losing hope. Dr. Donald Berwick has been an individual that I have followed since 1996 when I lived in Boston. He is foremost a dedicated servant to efforts involving improving the quality of healthcare in our country. I am not using the term quality as a market strategy here but from the perspective of a person with diabetes who would trust this man with his life. Dr. Berwick IS Dr. Safety. He is the founder of the Institute for Healthcare Improvement where many of us policy and quality wonks spend our time learning new strategies to decrease medical error rates and prevent morbidity and mortality in hospitals. Dr. Berwick launched the save 100,000 lives campaign that focused on the National Institute of Medicine report from 2000 titled Crossing the Quality Chasm. In it they cited hospital acquired preventable infection, and many other issues as being unacceptable. We learned to quickly diffuse treatment guidelines for the prevention of ventilator acquired pneumonia and empowered fast response teams all over the country in demonstration hospitals. The fast response protocol allows any observant (family member, housekeeping staff etc. to hit a panic button if they sense a patient is in danger). Trust me folks, thousands of people have died who could have been saved if the patient’s family or nursing assistant who know the patient better than the attending physicians and charge nurses were allowed to activate a multidisciplinary rapid clinical evaluation.  I have experienced this as a clinician and personally when my niece Marianna passed away from  an asthma exacerbation that was observed hours earlier and reported by a respiratory therapist whose request to call for an emergency evaluation was disregarded by the local hospital’s charge nurse. She was 32 years old and NO ONE should die from asthma these days.

So Dr. Berwick was appointed to direct the Centers for Medicare and Medicaid Services in 2009 due to his international respect and knowledge of our healthcare system. According to NPR he was asked to step down this week as congress would not re-confirm his appointment. Why? Because he had made a positive comment about the UK National Health Service.

Once again we have a completely biased and uninformed group of bureaucrats drawing conclusions that we are commie, pinko socialists using antiquated references and experiences from the cold war: branding individuals with outdated labels, selling their fear to the ignorant voter who by no means is stupid but simply uninformed as to the corruption and shell games that drive health care practice in our country.

I am having flashbacks from Archie Bunker in the All in the Family series from the 1970s.

Meanwhile, we have republicans and democrats (all of whom you and I elected) being exposed for their million dollar hypocritical business deals and appear to not care as we re-elect, re-elect and re-elect. So we are headed to slaughter.

I am not giving up: I have been screaming for consumer rights as a patient, provider and program manager for thirty years. I have evidence of direct commentary from State officials demanding a termination of my contract with one of my customers three years after I left the State’s employ. The information presented was false, I confronted the issue with proof which discredited the spurious information by my personal patents and documentation; received a tearful apology and had no recourse since the NC law has a one year statute of limitations on defamation of character. By the way, my client whose board member instructed her to beware of me immediately informed me of the conversation and kept me on to perform my strategic contract which they were quite pleased with.

The issues that we have here refer back to the discussion on finding the gold that we all have to offer as opposed to presumptive guilt of our industrial colleagues. I am disgusted at our species and sometimes wonder if we shouldn’t hit the reset button.

So, we have fired one of the most dedicated professionals in our clinical world who has given thousands of free lifetime hours during his most productive time in life as a simple act of service.  He was the wrong brand… for those who continue to believe that 2011 is no different from 1776 and use such arguments to convince you my friends that they actually know what they are doing.

I am begging you to take your country back in a peaceful manner by understanding where the shadow people are, following the dollar and asking yourself if it is working for you. I ask that you not blame a single party, institution or person but own the responsibility yourself and find strength in your numbers.

As history usually points out I imagine that nothing will change, the occupy wall street and tea party movements will become nothing more than marketing tools for democrats and republicans next year and all will be diluted when we experience some form of economic recovery and we continue to not engage the homeless “eye to eye”.

Are you familiar with the behavior of Tasmanian Devils AND have you seen the movie 13.

With love and respect to my readers:

Jeffrey Harris   Communitarian Republicrat with fiscal conservative beliefs.

So you all know: every one of my wealthy and successful friends who agree with my opinions keep telling me to shut up as they are frightened for my career. You see I presently have no job and they want me to keep a low profile. My defect of character here is that I can’t as to do so would be to abandon my hope for eliminating disparities in health outcomes.

Dr. Berwick, I apologize for every vote I cast save for the President in 2008. I have hope and will continue to follow you in your efforts to teach us all that we actually have a heart. Perhaps quick 2D echos on every citizen to help them identify with that piece of themselves that miraculously works itself to death to maintain each persons life.

So, here is my theory on why we are stuck in an evolutionary steady-state

Imagine that you are holding the responsibility for providing healthcare to 100,000 people.

Lets say it is at a fixed cost per life if 12,000 per year and you are not allowed to deny coverage to those with pre-existing conditions.

So: you cast a broad net over a relatively affluent area but KNOW that their will be “highly dependent persons on hospital care” and 20% of the population will account for 70% of your expenses.

You know that unless you can estimate the cost of hospital care you will underbid the contract.

For those of you who are new to these terms: The money you spend on care / The money you collect in premiums should always be less than 1.0. In the future, the ACA requires risk bearing entities to spend at least 90% of premiums on actual care (perhaps to keep CEO bonuses down). This calculation: $ spent on care/$ collected in premiums is called the MLR or Medical Loss Ratio.

So, how do you approach the problem. In the past, insurance companies used actuarial science and this is where you get age, gender and smoking questions from on your insurance application. The insurance companies with the largest population of cross gender, multi-age group folks would make the highest profits due to dilution of risk factors. For example: If you had two people: 1 non-smoking athletic 40-year-old female and 1 58-year-old obese hypertensive smoking male chances are your share holders might be a bit perturbed at their negative dividends at year-end.

So today I learned about a physician organization that has launched a $3,000000 competition to the team that creates the model with the highest predictive value. The rules require that the competition sticks to claims databases that describe demographics, diagnosis, lab test, medications and hospitalization length and procedures to the variables allowed for analysis.

Here is the website if you want to apply:  More to come shortly