Category Archives: healthcare

A Short, Humorous Look at the State of Healthcare

Comedy Central Illuminates U.S. Healthcare Status in Short, Humorous Clip

I have mentioned that I’ve been an ICU RN for the past 15 years.  This is honestly what I am seeing happen in my personal experience.  You can have all of the high -fallutin (yes, that is a word) ideas that you want, but I dare you to actually look into the eyes of these people in need and deny them what is needed, truly.  How we treat the each other defines us as a people.

A documentary titled “Remote Area Medical” is out detailing one crews mission to address this issue and I highly recommend you take a look, especially with your children or those you care about.

Let’s Talk: Community Promotes the Conversation About End-of-Life Care Wishes – CHCF.org

Let’s Talk: Community Promotes the Conversation About End-of-Life Care Wishes – CHCF.org.

 Re-blogged from: http://www.chcf.org/publications/2013/08/lets-talk-conversation-project

August 2013

Forty health care and community stakeholders from Contra Costa County, California, met in April 2013 to strategize ways to promote and support end-of-life conversations, with the goal of getting more people to express their wishes and empowering the medical community to honor patient preferences. The meeting was co-led by CHCF and The Conversation Project, a national initiative created to encourage and make it easy for people to talk with their families as well as with their doctors about the care they would want if they became seriously ill.

Improving end-of-life care in Contra Costa County is a shared goal of the local medical association, area hospitals and hospice organizations, and community and faith groups, all of whom gathered to:

  • Hear why our culture needs to change from one that does not talk about end of life to one that does
  • Learn from the parallels between social movements of the past (for example, civil rights) and the current movement to ensure that people receive the kind of care they want at the end of life
  • Learn about grassroots community organizing and how to leverage local organizations’ spheres of influence to spur change

Speakers included Judy Citco, executive director of the Coalition for Compassionate Care of California, and Ellen Goodman, Pulitzer Prize-winning writer and cofounder of The Conversation Project. Read the meeting summary to learn why personal stories are vital to cultural change, and why now is the time to have “the conversation.”

The meeting summary is available as a Document Download.

Read more: http://www.chcf.org/publications/2013/08/lets-talk-conversation-project#ixzz3G94OH4Yp

Website Glitches. Health Literacy Issues. How Navigators Navigated the ACA Launch

Link to article from California HealthLine by Heather Drost, California Healthline Contributing Editor

Obamacare (from Google Images:>)

“Challenging … frustrating … difficult … but worth it.” These are the words used by several organizations that served as navigators to describe their experience during the Affordable Care Act’s first open enrollment period.

Navigators not only had to quickly get up and running ahead of the Oct. 1 launch of the ACA’s health insurance exchanges, but they also had to contend with a host of technical problems that plagued HealthCare.gov. Even so, the Obama administration has touted the role of navigators and other enrollment assisters, arguing that they were a significant reason why eight million people signed up for coverage through the exchanges.

As the federal government prepares for the second open enrollment period, “Road to Reform” takes a look at the role of navigators and what worked and what didn’t.

Who Are Navigators?

The navigator program was created to educate consumers about the availability of qualified health plans being sold through the exchanges. The idea was that navigators would offer impartial information about the plans, federal subsidies and then help enroll consumers in those plans.

For navigators operating in states where the federal exchange was operating, CMS specified that workers must undergo at least 20 hours of training before they can be certified. In addition, navigator organizations cannot be affiliated with the insurance industry. States running their own exchanges were able to establish more rigorous selection and training requirements for in-person assisters.

In August 2013, HHS awarded $67 million in federal grants to 105 groups chosen to serve as navigators. Those groups included:

  • American Indian tribes;
  • Local food banks;
  • Hospitals;
  • Patient advocacy groups; and
  • Universities.

Overcoming Early Obstacles

About a year ago, facing just weeks before the launch of the health insurance exchanges, many groups struggled to hire, train and certify navigators.

Lisa Hamler-Fugitt — executive director of the Ohio Association of Foodbanks, which received one of the largest grants — told California Healthline that it was a race to get each of its 75 navigators trained, vetted and educated on time. By the start of the open enrollment period, Hamler-Fugitt said that her organization was the only Ohio-based grant recipient to have navigators in the field physically helping individuals enroll in coverage.

For some organizations, the short timeframe was further compounded by the passage of laws in at least 17 state legislatures — including Ohio — that require navigators and other assisters to obtain state licenses, complete additional training beyond what is imposed by federal law or limit what they can say to the consumers they are helping.

During the open enrollment period, navigators also struggled with the glitchy HealthCare.gov website, which crashed numerous times in the first few months of operation causing severe delays for enrollees.

The unanticipated technical glitches meant some navigators had to rely on the slower, more cumbersome paper-based processes, instead of the website’s easy-to-use design. In addition, Vicki Tucci — lead navigator at the Legal Aid Society of Palm Beach County, Fla. — in an interview with California Healthline said it was common for consumers to return several times to complete their enrollment because the system would shut down or crash.

However, the biggest obstacles navigators faced was being able to overcome “myth vs. fact” regarding the ACA and improve consumer literacy about health insurance, according to Hamler-Fugitt.

How Successful Were Navigators?

Beyond some federal reporting requirements, the level of oversight, data tracking and clear targets varied among organizations who served as navigators.

The federal government requires grantees to issue quarterly and annual progress reports to HHS detailing progress and compliance with required activities outlined in the Funding Opportunity Announcement.

For example, some organizations — such as the Pennsylvania Association of Community Health Centers — went as far as to create an online, HIPAA-compliant database to track enrollment data, while Tucci of the Florida Legal Aid Society told California Healthline that her organization compiled weekly updates to keep track of the number of people reached through in-person visits, education sessions and phone calls.

In an email to California Healthline, Cheri Rinehart — president and CEO of the Pennsylvania Association of Community Health Centers — said her organization was able to meet its goal of signing up 10,000 individuals and was able to use data from the database to track progress in various areas.

Laura Line, director of Resources for Human Development’s navigator program, in an interview with California Healthline said the total enrollment for Pennsylvania exceeded federal expectations, with about 318,000 individuals receiving coverage through the exchange. However, she said it is nearly impossible to know how many of those individuals were enrolled by a navigator or how many sought help from a navigator and then completed enrollment on their own.

However, Angie Remington, spokesperson at Planned Parenthood of the Heartland in Omaha, Neb., in an email to California Healthline said the various obstacles — including state licensing requirements, inadequate staffing levels and website glitches — prevented her organization from meeting its goal of enrolling 3,000 individuals.

Overall, a Kaiser Family Foundation survey estimates that navigators and other assistance programs helped to educate more than 10 million U.S. residents about their coverage options and apply for health plans during the first open enrollment period.

Looking Forward

According to the Kaiser Family Foundation survey, navigators and other consumer assisters will play a “key role” in the upcoming enrollment period, and several navigators appear to be ready to assist yet another batch of applicants. The Congressional Budget Office has estimated that 13 million people could enroll in coverage through the exchanges in 2015, including both those who will be renewing plans and enrolling for the first time.

In June, CMS announced that it would make $60 million in federal grants available to navigators in federally run health insurance exchanges, less than the $67 million in grants for the first open enrollment period.

CMS also has ramped up its standards for the program, and will now:

  • Require navigators to maintain a physical presence in their service area;
  • Encourage applicants to conduct criminal background checks on all staff that will be handling sensitive or personally identifiable information; and
  • Increase reporting requirements to include weekly and monthly progress reports.

July 10 was the deadline to apply for the new wave of funding. Despite the challenges and frustrations that accompanied the first round, several navigator organizations said they met the deadline and hoped to renew their efforts, including:

  • Legal Aid Society of Palm Beach County, Fla.;
  • Ohio Association of Foodbanks;
  • Pennsylvania Association of Community Health Centers; and
  • Planned Parenthood of the Heartland.

Rinehart told California Healthline, “The biggest reason we’re applying again is because we really feel like we are making a difference.” She added, “It was frustrating when we were ready and the system was not, but the enrollment assisters remained motivated because they saw faces, not just numbers, they felt strongly that they were making a difference in people’s lives and that they were living history.”

Around the Nation

Seeking Innovations: Ohio has applied for $98.6 million in grant funding under the Affordable Care Act’s State Innovation Model grant program to explore innovative payment models in Medicaid and Medicare, according to Columbus Business First. Officials at Ohio’s Office of Health Transformation say the funding, which would be divided equally over four years, will help bolster Medicaid and Medicare savings.

No failure here: Despite all of the negative reports surrounding the implementation of the Affordable Care Act, the law is “an immense policy success,” Paul Krugman writes in a New York Times opinion piece. He writes that the law is “improving the lives of millions of Americans,” citing a Commonwealth Fund report that found “the majority of the newly insured, including 74% of Republicans, are satisfied with their coverage.”

Attributing success: Recent data from polls and studies have attributed the decline in the uninsured rate at least in part to the Affordable Care Act, suggesting the law, and not the recovering economy, is responsible for the decline, according to the Wall Street Journal.

(“Source: California Healthline / iHealthBeat, article date.”). In both cases, include a live link to http://www.californiahealthline.org / http://www.ihealthbeat.org.

A Very Very Clear and PRESENT Danger!!!! It’s HERE!!!!

Hide Yer Kids..Hide Yer Wife…Aarrggh,  My bones ache.  No, I say..aaacchhe.  My gums hurt, I can’t think because there are thousands of little tiny frankensteins hammering my meninges. I’m stuffy, swollen..  Sounds hurt. Please don’t touch me.  I produce strong, loud expectorating coughs at inopportune times.  My eyes are puffy and red, my throat is scratchy and raspy. Get out the National Guard, screen for me at all the airports.  Git yer pitchforks and your lighted sticks and chase me yelling “Go back to…” um, “Alabama”. Woops, I am pretty much exactly like you, and I’ve got it…the (dum dum dum..) FLU !!!! Horrible, painful, contagious!  frankenstein    

Or, you could maybe be a bit rational.  Get a flu shot, exercise, wash your hands like a mad-person – including under your fingernails.  Avoid sick contacts.  Don’t play around in my personal blood and body fluids.  And I, considerate mush that I am, will stay out of public places for a minute, wallow about in bed, take cold meds, drink plenty of warm fluids, cough into my sleeve and not shake your hand, wash MY hands like a mad woman and draft my Last Will and Testament.  How about that?  A little sanity, please.

Um, seems like those in the know are saying Ebola is spread about the same way..blood and body fluids.  Direct contact with the same.  As a nurse or healthcare worker, I would necessarily come in contact with these things, but I have been taught – diligently – about the use of contact precautions. Gown and glove when I deal with people with infectious diseases, as do those who visit them, wash my hands diligently, treat the cause and the symptoms. Do not refer to those affected as “the Ebola nurse”, or “the Flu nurse”, etc.   What about HIPPA laws, people?  How about “Mr. Joe” or “Ms. Joe”.

I’ve got to tell you, right now, while I am feeling awful, the best thing I could have is dignity, human kindness while my nose runneth over. Please.  looney tune

Back to my Advance Directive/Living Will.  You know, that form I fill out while in my sort of right mind that tells my loved ones how I wish my health care to be handled should I not be able to express these wishes at the time.  I have already spoken with my son about the necessity to pluck any stray chin hairs that show up if I can’t handle it (hormones).  If, for some reason, I have to be placed on a ventilator (some refer to it as breathing machine, life support, #@!*), I must continuously, at all times, no matter what, be completely knocked out with Propofol – Propofol only, please (Michael Js’ drug of choice).  Not Versed, Not Precedex, PROPOFOL! – triglycerides be darned.  Under no circumstances am I to be awakened from my peaceful, ventilated slumber !!!   Im gonna knock you out. I am a proud control freak and if I am unable to speak to you and tell you what to do, I will go nuts! I do NOT wish to write notes, please don’t ask me a myriad of questions. If I am trying to talk to you while intubated, I am cussing, I promise!  Yank that sucker out post-haste.

My personal Living Will does not say “if I will improve, If there is hope, etc”. What the???  No one knows that but God.  I don’t think it is fair to place that burden on my loved ones or the medical staff.  I have seen what it actually looks like for a person to be on bedrest, ventilated, tube fed, etc for a long period of time. No thank you.  For me personally, this is definitely living.  No, no, no.  Not for me. 

I shall be laid on a beautiful bed of roses, liposuction has been provided prophylactically, me in the most beautiful gown, my toes are painted, flowing hair arranged attractively across the pillow, my IV infusion of dark chocolate running, Andrea Bocelli is playing at bedside (hey, this is my dream ), my Beloved is with me here on my cloud out of the hospital pledging undying love, my children are here also, happy, employed, telling me how they are going to travel the world in honor of me and find inner peace.  I slip quietly in to the sweet bye and bye. Jesus is right there waiting for me and we walk to Wonka Land (my personal view of Heaven).  sleeping me

The body that I no longer inhabit – having had any usable parts donated to those in need – will then be cremated and the ashes thrown onto..TBD (was Brad Pitt at one time, then Javier Bardem,, but my Beloved is soo much better than both of them) PETA-like. Okay?  Am I clear on this?  Hope so.  Oh, and could I please have one of those New Orleans-style funerals where folks wear cool clothes, strut through the streets playing drums and horns and celebrate my life?  Just asking:> new orleans funeral

Images from Google Images

8 Medical Bills Errors You Need to Watch For article link to First Avenue

(This article previously appeared on Nerdwallet.com.)

Millions of Americans are potentially overpaying on their medical bills because of eight common errors — from duplicate charges to incorrect insurance ID numbers. Inaccuracies with any one of them could result in thousands of dollars wrongfully added to your final bill.

In fact, mistakes on medical bills may be more widespread that many consumers realize, according to Pat Palmer, founder of Medical Recovery Services, a national organization that helps patients identify and correct medical bill errors.

“It’s astounding that eight out of ten hospital bills we receive contain numerous overcharges,” Palmer said.

(MORE: How to Negotiate Doctor Bills)

So, bring a healthy skepticism to any medical bill you receive by carefully checking for common errors to ensure that you are paying the right amount. By looking out for them, you can protect yourself from potentially paying thousands of dollars in unnecessary costs.

Spotting 8 Common Medical Bill Errors

After visiting your medical provider, you’ll receive an invoice telling you how much you owe. However, because errors are common, request an itemized bill or statement from the hospital or your doctor. This way, you can carefully check each service you are being charged for.

If you have health insurance, you should also receive an Explanation of Benefits (EOB) statement from your health plan. Compare the EOB statement with your medical bill carefully.

The EOB should provide details such as:

  • the type of service received
  • the date of service
  • the amount your health care provider billed your insurer
  • the total amount that was not covered
  • the total patient cost.

    (MORE: Be Your Own Health Advocate)

    Watch out for these eight common medical billing errors when you receive your itemized bill and EOB statement:

    1. Duplicate charges: Carefully check to make sure you were not billed twice for a single service or procedure. With an itemized bill, this error should be much easier to spot.

    2. Canceled tests or procedures: Review your itemized bill to make sure you weren’t charged for work that wasn’t done. If you think you were wrongfully overbilled, collect all the necessary documents to prove that you did not receive the service, so you can dispute the charge.

    3. Incorrect patient information: Small errors such as wrong name spellings or policy number misprints are common on medical bills. If your insurance ID number is wrong, that can lead to a claim denial or your being charged an inappropriately high amount.

    4. Upcoding charge: A hospital could inflate your diagnosis to one representing a more serious procedure, leading to a higher medical bill. For example, you could have received the lowest level of emergency room services but be billed at the highest level. This is an illegal, fraudulent practice and you should ask your health care provider to correct the charge immediately.

    5. Unbundling of charges: This mistake refers to the separation of charges that should have been billed under the same procedure code. It can be tricky to identify unless you’re a certified medical bill coder, but you can reference the National Correct Coding Initiative by the Centers for Medicare and Medicaid Services if you suspect such a mistake on your bill.

    6. Balance billing when in-network: Balance billing or extra billing is when a health care provider bills you for the difference between what your health insurer reimburses and what the health provider believes it should receive. It’s often improper when the care was provided by an in-network hospital or physician.

    Balance billing is most common when you are treated out-of-network for non-emergency care, since doctors can set the rate to charge you and bill you for anything over what your insurance covers. If you think you’ve been balance billed, compare the bill with your EOB.

    7. Incorrect quantity: Make sure you weren’t charged extra for the wrong number of medical items or medications. This mistake could be as simple as an extra “0” being placed at the end of a number by the billing department.

    8. Operating room and anesthesia time: If you underwent surgery, check your medical records to see how long you were in the operating room or under anesthesia. Because patients are usually billed in 15-minute increments in these instances, mistakes here can add up quickly.

    Andrew Fitch is a Senior Associate at NerdWallet Health, where he leads consumer engagement strategy.

Article reprinted from : http://www.nextavenue.org/article/2014-09/8-medical-bill-errors-you-need-watch?utm_source=Next+Avenue+Email+Newsletter&utm_campaign=07cb5947e3-10_07_14_NextAvenue_Newsletter&utm_medium=email&utm_term=0_056a405b5a-07cb5947e3-164934573

Ebola

Scary, right?  I would just like to add my two cents worth in as a nurse, a  mother, a child of God.  My mind immediately harkens back to the first days of the HIV crisis.  I am not sure why particularly HIV, but I think of the strength and beauty of Ryan White and his mother, the absolute ugliness of human fear and lack of knowledge and compassion that they were met with in the face of their personal tragedy.

Please reach down inside yourself and approach this newest issue with courage, compassion and realize that these are fellow HUMAN BEINGS who are being struck with this horrific disease.  Yes, hate the disease, even fear it – but use these emotions to propel you to find out how to actually protect yourself and those you love and do not ostracize those unfortunate enough to contract it.  They need intellect, compassion and love. Humanity is uplifted when we approach the unknown with our eyes and hearts open.  This is not the first, nor will it be the last frightening unknown thing to enter our world.  God’s got it.  We will make it.

I have looked directly into the eyes of so many people about to step over this threshold into the next – from heart attacks, massive infections that I sometimes have to completely glove and gown for to care for them (yes, throughout the US), various end stage diseases  They are you and me at the end of life.  I have comforted their loved ones, caregivers during this time, trying to smooth the transition.  What has proven to be the most important thing during this time is pain control, education of process, LOVE!!!!!  Is this not what you and I both hope for at the end of our days?

Imagine you are the one struck with Ebola, or MRSA or ESL or VRE or the mirage of infectious diseases that require everyone that you come in contact with the leave wear yellow gowns, gloves and masks each time they enter your room.  That is how you now experience the world.  The communication you would experience at that time is the expression in your loved ones’s eyes, are they willing to hold your hand?  You didn’t not ask for this, but here it is.  Pulease, please educate yourself on the disease, take every possible precaution, and empathize – not ostracize – those stricken.  Thank you.

Quick, Simple Way to Increase Your Joy

From the MEND – Meeting Each Need with Dignity website

” Soap – A Little Item With a Huge Impact

rev

It is because of this hygienic staple that I am getting on my soapbox this week, but I promise this from point forward that I will keep all soap related puns and metaphors to a minimum.

Admittedly, it is not an item that is often given much consideration in the average person’s day-to-day thoughts. It typically operates as nothing more than a fixture in your shower stall, or nestled beside the shampoo on the ledge of your bathtub. And yet, this little bar of lipids and lye can make a world of difference for our clients at MEND.

This seemingly inconsequential household item is firmly entrenched in our lives since it is used to bathe, to wash our hands, to wash our dishes, to wash our cars, to wash our clothes, to wash our dogs, and so forth. Furthermore, this hygienic ‘tool’ plays a crucial role in combating and preventing illness. Thus, there should be no question that soap is a basic human need, and a crucial part in gaining eventual self-reliance.

Now that vacation season is fully upon us, and many of you might have gone away in celebration of the Fourth of July weekend, we encourage you to bear all of this in mind. Furthermore, we implore you to donate any unused (we may be all for Reduce / Reuse / Recycle here at MEND, but even we have our limits) hotel soaps you happen to have accumulated. This one little bar that so easily fits into your suitcase – or pocket even – holds the potential to make a world of difference.

In conjunction with the shower facilities at MEND, that little item can wield a huge impact. For, it allows our clients to present the best of themselves at a job interview – or equally important occasions. The simple fact of the matter is that with cleanliness comes dignity.

And since the amazing efforts of groups like the Global Soap Project [www.globalsoap.org] are currently focused upon those in need in developing nations, it is up to us to lend a helping hand (or in this case, a bar of soap). So, while this might go against the time-tested adage, it is important to remember that sometimes we need to sweat the small stuff. Ultimately, not forgetting how lasting an impact the minor details can exert, and just how far a bar of soap can go.

By Volunteer Mattie Brehm”