Tuesday, September 29, 2009

Priorities, keep the straight!

Many years ago, my grandmother cut this poem out of a newspaper, made a notation,"how true," in the side column, sent it to her cousin, and eventually got it back.  Somehow it came into my possession.  I've treasured it.  My grandmother DID have her priorities straight in life when I knew her.  She was a lot of fun and admired by many friends.
Of Things That Are
    Lovely and Fleeting
The dust on the piano keeps better
    than the flashing
Of loveliness, keeps better than
    the clean slant of wings
Across the cool garden, where the
    honeysuckle berries
Call the brown song sparrow that
    balances and sings.
The undone ironing keeps better
    than the beauty
Of the star-hung plum tree in
    the drying yard,
And the undarned socks will out-
    last the radiance
Of a sunset's glory to its last
    bright shard.
The tarnish on the spoons keeps
    better than the mischief
In a wee girl's eyes or the sun-
    light on her hair,
And the stacked supper dishes will
    long outlast the clinging
Of a small boy's arms and his little
    whispered prayer.
Ah, life is so short and the earth
    is so beautiful,
And boys and girls are children for
    such a little while--
So we run n the orchard and look
    for the four-leafed clovers,
And we know a spotless house isn't
    worth a baby's smile.
By Leona Ames Hill

Wednesday, September 16, 2009

Work toward improving outcomes and don't spread lies.

This article is a physician's view of the arguing and division and contention about the health care issues among the politicians. Quote from the article:

In health care, we improve outcomes by working as an integrated team as well as through respectful and constructive competition. This never involves spreading lies about our colleagues' opinions or motivations. We are able to respectfully disagree, compromise and work toward the best interests of our patients, regardless of personal and philosophical differences.

Tuesday, September 15, 2009

Against Government Involvement in Health Care? Oh, are you really against Medicare?

While watching some of the news coverage yesterday, I saw the reporters putting the microphone in from of some of the protesters in Washington. Several of these people were clearly senior citizens, and several of them said that the government shouldn't be involved with our health care.

My reaction: YOU HYPOCRITES!

I think these people are taking for granted their Medicare benefits. They are potentially entitled to more financial compensation (Medicare as insurance payments) for their medical care then they have paid and are paying into the Medicare pot. The rest of the wage earners are paying with the Medicare deduction from their paychecks.

Senior citizens are more likely to need prescription medications than younger people. Now, thankfully, there is Medicare D, which helps pay for this benefit. One of my relatives was complaining about the "doughnut hole" in Medicare D. Yes, there is a significant out of pocket expense after a certain dollar amount is reached. But isn't she forgetting that in the previous years, after her husband lost his medical insurance, she was paying for ALL of these medications out of pocket? At one time she told me that she and her husband were paying about $500/month for prescriptions.

Patients who have certain conditions need to have lab tests periodically to make sure certain blood levels are in a healthy range. Medicare patients don't have to worry as much about the costs.

End of life illnesses often mean very high medical costs for the last year of life. Much of this is covered by Medicare, and if the patient also has a Medicare Supplement insurance policy, his family isn't stuck with a big debt after the patient passes away.

I think we take for granted a number of quality of life issues these days because of Medicare. Think of all the people you know who have had knee or hip replacements. The surgeries and hospital after care are expensive. The patients go to physical therapy to speed the recovery and increase the chances that the patients will have good mobility in the following years. They may get more enjoyment of life during their golden years if they can walk comfortably and play with their grandchildren. Joint replacement patients who are seniors can spend a few days in a rehabilitative nursing home immediately following release from the hospital if they wish, which often speeds the recovery and therapy. Who could afford these surgeries and therapies pre Medicare, when many people would have no insurance at all after retirement? One man I know, who is clearly "not poor" had an accident which severely injured his hip. He got by with reduced mobility so that he could wait until he qualified for Medicare before he had his hip replacement surgery.

Medicare patients who live in a nursing home are seen by a doctor every month, or in some practices, by a physician every other month, and a CNP on the off month. Those nursing home patients who are not on Medicare don't fall under a doctor visit requirement. Elderly nursing home patients get therapy evaluations when they enter the nursing home, paid for, of course, by Medicare.

Are there problems with Medicare? Of course. And we know that through the years the percentage of the costs paid for by Medicare has shrunk, which is a concern. But the purpose of this post is to highlight areas of care that we might be taking for granted after so many years of Medicare.

I am basing the above information on my own knowledge. I was a certified insurance counselor, helping senior citizens with coordinating their insurance coverage for several years. I have the personal knowledge of dealing with my mother's finances, especially with her medical bills. Actually, there have been no problems with the Medicare and supplemental insurance payments. I've seen my mother-in-law have a hip fracture, replacement, and nursing home care, and be able to have a very high quality of life afterwards. Actually, due to falls, she has been in the nursing home three times, gotten therapy, and moved back home each time. I doubt she would have recovered as well if there hadn't been the therapy paid for by Medicare.

And I've had extensive discussion with a Family Physican who is also board certified in Geriatrics and who has extensive experience with nursing home patients. His assesment of Medicare is that it requires care for a lot of people who would be neglected or overlooked without it.

Thursday, September 10, 2009

Interesting take on excluding illegal aliens from health care benefits.

According to this article, the 2005 law excluding illegal aliens from Medicare has had "interesting" consequences, including high costs as well as the *possible* exclusion of lots of the rest of us. This may be a bit of hyperbole, but it is good to remember that there are costs related to the administration of exclusion as well as to inclusion.

Health insurance company profits

Some people are old enough to get away with being blunt!

Just a taste of this:
Folks, let me tell you something about healthcare and health insurance. There are a couple of ways to make a buck in the game. One way is to systematically deny coverage to anyone with a propensity to get sick as evidenced by past occurrences. The other way is to spread the risk over the largest population possible effectively minimizing the impact of the most risky. But there is one way for sure to lose a buck – keep increasing the number of people who can’t pay their bill. It’s really quite simple. A public option means insurance companies will report profits using language like “impressive” and “satisfactory” rather than “awesome” and ”a buttload of moolah!”

Supposedly the CEO of the health insurance company that I use has a several million dollar/year salary, plus $95 million in stock options. But I don't even know what stock options are, so what does that mean to me? But it must be legal, because the attorney general of my state won a lawsuit against this company and already got them to clean up their act. How many people who get their applications rejected for pre-existing conditions would that cover?

And talk about pre-existing conditions.... a good friend's child had strep throat, about a year after switching insurance companies, due to a change of employment. Well, guess what? The child had had strep throat in the past, so they declared it a pre-existing condition and rejected the claim. Strep throat, dear claims examiner, is not a chronic condition normally, so it really can't be a pre-existing condition in the general meaning of that terminology.

My friend's employer (major health care delivery organization, meaning clinics and hospitals) deleted her department. She was hired by an independent small company. She doesn't earn health insurance there, so she is paying for COBRA coverage, meaning, paying independently for her previous insurance. She can't afford to let it go, given that she really does have a pre-existing condition, namely, two cancers that were cured. The premiums she pays now are HALF of her entire SALARY. She is a health care professional, so her pay isn't peanuts. What to do? Her husband may take on a part time job just to pay for the insurance.

Wednesday, September 09, 2009

Newscasters and Reporters

There are so many news shows on TV, 24/7, plus the network news show, plus the local news shows that, I believe, there are a lot of reporters who aren’t quite up to what I would consider a minimum professional level. 


On one of the morning shows, the renowned anchor constantly asked a “fact filled” question, putting words into the mouth of the subject, leading him in a preconceived direction rather than letting him speak. 


On another network, the anchor, who I really like personally, asks questions that solicit emotional answers, but the anchor shows his own bias by making sympathetic remarks to the subject at the end of the interview.  These remarks are not out of line on a human level, but don’t fit any kind of mold where the reporter is trying to be unbiased. 


On the 24/7 news networks, the so-called news shows have “personalities” who go back and forth across the line between giving the news and commentating on the news.  I don’t mind those who clearly state their biases and editorialize overtly; that’s fair to the viewers.  But on some of the shows, the news people don’t draw the line.  I don’t think they see the line.  I always wonder if these people, who come out so clearly on one side or the other, are speaking for themselves, or if they are speaking for the moneyed people who own the network.  I wonder how much independent research they do before giving their pronouncements. 

Monday, September 07, 2009

The Right, The Left, is there any Center?

Whose "right" anyway? Can you be right if you are Left? Can you be civil if you are Right or Left? Here's a good essay on the discourse of the day.

Thursday, September 03, 2009

Quotes that seem to sum up the news of the day. Darn it all.

Think twice before you speak, and then you may be able to say something more insulting than if you spoke right out at once.
- Evan Esar
There is no such thing as an underestimate of average intelligence.
- Henry Adams
The most merciful thing in the world, I think, is the inability of the human mind to correlate all its contents.
- H. P. Lovecraft

These quote were the quotes of the day on my Google page.

Electronic Medical Records, next

When I was at the consultant clinic recently, as mentioned in the previous post, I received a computer printout, handed to me as I left, of what had transpired during the visit. On that paper was written that I was to receive a new prescription, as discussed during the visit. It was never discussed. It was for a supplement that I've used for years, because my body doesn't processes this chemical efficiently. Too much or too little can cause a person to have major health problems. My intention has been to point out this error during my next visit, which won't be for another month and a half from the first visit.

Meanwhile, I went to my local pharmacy yesterday to pick up my normal prescriptions, which should include the supplement mentioned above. All well and good, until I realized that I was being given TWO additional bottles of this prescriptions. Fortunately, I knew better than to buy this and use it.

I know what happened. The admitting nurse at the consultant clinic had entered my prescriptions into the computer and inadvertently entered that this was a new prescription. The computer automatically, with no human oversight, sent the prescription to my pharmacy. To my dismay, there also seems to have been no human oversight in getting the "schedulers" at that clinic to call me to schedule future appointments and tests. Let's just say: Grrrrrr.

Wednesday, September 02, 2009

Electronic Medical Records

The topic of electronic medical records has been big in the news. Our governor is pushing for it in all state health care facilities. It might even be required. Supposedly, nationally, "EMR" will save a lot of money and make medical care more coordinated, thereby making it "better." All these things remain to be seen.
I like computers and I do think that, ideally, EMR would be an improvement, but like all things in life, it can be a mixed blessing. I've had several personal encounters with EMR that show the downside and pitfalls, but the previous system, all in all, was probably worse.
A couple of years ago, my son went to a clinic, had a cursory check up and test, and got a prescription. We got the bill, insurance EOB, etc, and paid our portion of the bill. Our son had to go for a few monthly rechecks, so there were more bills, but the next statements were for much higher amounts. We questioned the higher fees by asking him what exactly was done at each visit, and we also wrote to the clinic. The clinic manager replied that the fees were justified by what the doctor had done at the visits, based on the charts. Our son OK'd release of the records, which showed a complete history and physical at each visit, which my son said was not done. We had the records reviewed by a physician, who agreed that the doctor could not possibly have done what he said was done within the time frame that was electronically recorded on the records, plus the time frame on the records agreed with my son's recollections. And the supposed H&Ps were not justified. When confronted, the clinic and doctor agreed that the doctor had used the EMR incorrectly, that is, he just checked off that he had reviewed every bodily system completely. They refunded the charges and corrected the records, and stated that they were going to review all the charts from that doctor.
I have been a patient at the same clinic for many years. My paper record files are quite large, so that looking up any thing old is inefficient. Ideally, a physician will keep a record on the front cover or front page of the current medications and problems. Not all physicians are that organized. My clinic converted to EMR a year ago. My yearly visit was on the first day of the new system, so they hoped I would be patient, which I was, but it was easy to see the pitfalls. First, somebody had put some of the old records into the system. Imagine how expensive it must be to input lots of old files. I had to fill out a paper form with a list of my medications, over the counter meds, as well as past surgeries, etc. It was like just like the paperwork one fills out when going to a new clinic. This was then entered into the computer by a clerk. Obviously there is a great chance for error or omission in my memory. There is even a chance for deliberate omission. The good side of my clinic's system is that the computer sent me a letter after the visit listing the results of my blood tests as well as the meanings of the values. I also got a note from my doctor, so I knew that a real person had reviewed the tests.
Recently, I went to a certified nurse practitioner at another clinic. Before I saw her, I had to fill out papers, just like I mentioned above. Then nurse entered all the lists of medications, previous surgeries, etc. into the computer. Then the CNP did a very thorough history and checkup. She entered a number of things into her computer, which printed out a paper for me. It told what we talked about, what was recommended that I try, what tests were ordered, plus my list of medications, and notations about past immunizations, etc. I was impressed with this printout. For one thing, I can't remember the medical jargon or the names of tests I don't understand, but now I have them listed in writing. Secondly, it let me see that there might have been a couple of misunderstandings in my communication with the CNP. But since this isn't my primary clinic, there were gaps in my record. It looks like, for example, that I've way out of date on immunizations and certain types of normal yearly checkups.
The CNP is talking about a specific test that I may have, but it involves some medications. I believe I've had these medications in the past, but, of course, I don't know specific names, amounts, etc, but I know I've had some very uncomfortable reactions. I decided to write a request for past records so that I can be sure about what meds I'd rather not have. I received a packet in the mail for a company whose business is going through old medical records.(??) This contained photo copies of exactly what I asked for, so I expected it to be helpful. Well, the suspect medications were clearly listed. But there were no amounts given listed. On all the pages but one, the notations were in various handwritings, some quite messy, or barely legible. I really don't think this will be helpful.
The next point has to be handwriting vs. typing. Typed notes are clearly better for future use by other people. In the past, some doctors just wrote, or scribbled, notes into their charts. Some doctors dictated their notes, which were then transcribed by somebody else, and, if the doctor was compulsive, the notes were read and countersigned by him/her. Medical transcription is a dying art, not taught in schools as in the past. These days, the doctor has to type his own notes. The plus side is that they should be readable and they should be correct since he/she can see them as he/she types. [Yes, some doctors do use a program such as Dragon Speak to avoid the typing.] The down side is that we are paying doctor's salaries to the typist. EMRs do contain a number of features that can streamline the charting process if the doctor knows how to use them. Some EMR programs necessitate that the doctor must finish the record before signing off, which would mean that the doctor could be late for the next patient or, OTOH, that a particular doctor still uses old note taking methods and goes to the computer later in the day or week to finish the records, which, of course, undermines the value of the EMR system.
Lastly, to be at their best, either all clinics and hospitals have to use the same EMR system or the systems have to be compatible. When I was going to see the consultant/specialist, my basic records should go with me, but they didn't. I had to tell them about my history and my doctor had to include a few photocopied pages of tests with his introduction letter. Obviously, this is still very inefficient.
In the long run, if EMR is used by all clinics, hospitals, and doctors to the fullest extent, records should be more complete, efficient, and useable. Doctors should be able to look at charts showing trends of testing, for example, rather than just looking at a number of screens showing various values of test results. At this point, much of EMR is just using the computer instead of paper, the computer being a glorified typewriter. There are doctors still resisting using the computer for their recordkeeping. There are the usual computer hassles we all have run into that does make us suspicious of keeping important documentation in the never-land of digital information. EMR is far from an ideal system, but the thick stack of papers, possibly disorganized, in a tradtional medical chart, with many notes handwritten, seems to have even more drawbacks.

Tuesday, September 01, 2009

Need a job?

Three in my family are currently looking for work. I should send them to this place.