Hi everyone -
Today as the Senate Finance Committee plays some more head games with American lives, I decided to do some research on a different aspect of universal health care - what I think I'll call The New Public Option.
I've been hearing very little scuttlebutt on what I'd consider a pretty good option in health care - medical tourism - traveling abroad for affordable, comprehensive health care packages. I find it particularly funny that I don't hear a whole lot of media or government officials discussing this particular option we now have as Americans. There are a lot of companies out there offering travel abroad for the needed affordable care that our own country is not offering our citizens. Of course, I've heard numerous party representatives talking about how Canadians or Britains come to the US for their care because they just despise their socialized medicine. But I find it quite interesting that a lot of Americans are going abroad as well as our own system is failing just way too many of our citizens.
At first glance, I think it would be pretty scary to go to some other nation, where I've always heard they give second rate care, you get what you pay for, no regulation or FDA approval, etc... But when I did a little research and also looked at numerous forums, I'm finding something quite to the contrary. People are getting affordable, top rated comprehensive care for their needed and elective procedures and care. And they're being treated like kings and queens during the process. I think the US has a lot to learn about medical care meets outstanding customer service.
Many of the larger hospitals in major metropolitan areas like India, Thailand, South Africa, Costa Rica, Argentina and Dubai offer medical tourism packages which include your surgery and a short recovery vacation. Some of these hospitals even have big names attached to them - like John Hopkins International Hospital in Singapore. Many have several accreditations including US endorsed. Many other citizens go across the borders to Canada and Mexico to save money on medications and treatment. It's estimated that anywhere from 150,000 - 1 million people cross the borders annually for their medical care. Some employers are now offering medical tourism packages to their employees as a way of saving big dollars for their employees needs.
I was surprised to read about the advanced technology and treatments for complicated diseases as well as world-wide known doctors these places have snagged. And surprisingly, I found most studies show that some foreign nations have about the same and even better patient outcomes as far as cure and remission rates for chronic illnesses like cancer and seizures. Also, the foreign country infection rates are far below some of the US facility rates.
Costs alone are a huge motivator in people going abroad for their care. With our 40 million plus uninsured and under-insured population, employers and people a like would be crazy not to take advantage of some of these packages. For instance, a hip replacement in the US costs approximately $65,000.00, only $8,000.00 abroad; a face lift costs approximately $20,000.00 in the US, only $1250.00 abroad and a heart valve replacement costs approximately $200,000.00 in the US and only $10,000.00 abroad. Keep in mind that these abroad costs cover everything - round trip airfare for two, all pre-op and post-op costs, a short stay-cation with a personal nurse and room service in a 5 star hotel setting. It's kind of like surgery meets spa day.
Click here to read a little bit about this publication - "Patients beyond Borders". Just look at the slide show that shows these amazingly aesthetic facilities.
Now I'd be irresponsible to think that all abroad care is up to "our" standards or safe, but I think it might just be something to look into, research, visit, compare, etc.. Fair Market anyone???? I think if the insurance companies and some of the US citizens are afraid of government run programs or getting control of costs through major reform, what will they think of outsourcing our health care as well??? Talk about something that could put all the insurance companies out of business. New Public Option anyone???
Let me know what you think ! Would you go abroad for an elective surgery, prescription refill, dental work. I think it would be pretty scary - but then on the other hand, if I weren't insured or weren't insured enough, I'd think I'd consider it. No waiting list, great doctors, great facilities, a spa week - you bet ch'a.
Take care until next time.
Tuesday, September 29, 2009
Saturday, September 26, 2009
Should we really send more troops to Afghanistan???
Hello everyone -
I'm going a little off track today because of something that piqued my interest
today. I was watching the Bill Moyers Journal today on PBS and saw this interview with Rory Stewart. I took a look at his credentials - he was in the British military and worked for the foreign ministry as a diplomat - but I think I'd call him more of a scholar and humanitarian. His demeanor, which was very calm and gentle impressed me. And his knowledge about the Afghans and their culture as well as his 6000 mile trek across their country and his humanitarian efforts there interested me. I think our government needs to entertain some of his ideas - just maybe a little bit. I think possibly we need more people like this consulting with our government and military leaders when we fight on foreign lands.
Now, granted I pretty much know nothing about war or policy on war. I've always buried my head in the sand about it. I even, as an ex-military wife, just despised the fact that my husband, my family or my friends would ever have to deal with the misery of someone I know and love being some place far away and in danger. Or worse yet, they would be captured, tortured and killed or come home in a body bag.
I am very concerned about our soldiers safety - but also don't know whether we doing more harm than good to the innocent citizens of this foreign country as well. Don't misunderstand me, I want to be able to protect our country, I want to get rid of Al-Qaida as much as the next person - but what I'm questioning now is - are we doing it the right way? Do we continue to go in full force, all in the name of national security and state building? - at the risk of not accomplishing a whole lot of national security and doing more state destroying because we aren't successful on our reasonably short time table. After hearing this interview - I'm concerned that we'll go in with a lot more troops, lose a lot of men/women and not stay in long enough to accomplish the task at hand. Then we'll leave suddenly when the US citizens get tired of it - and leave the country in more shambles.
Take a watch and listen to what the man says. Tell me what you think. Do we need to refocus our goals on what's more realistic and attainable - with some more practical short and long term goals - protecting our national interests, conquering Al-Qaida and starting some humanitarian efforts - with more intel, more special forces - less ground troops.
Copy and paste this link to your browser.
http://www.pbs.org/moyers/journal/09252009/watch.html
I want to say again that I don't know a whole about this subject and am still learning. I don't want to offend anyone or belittle at all what we've done so far and what it's cost anyone.
I'm going a little off track today because of something that piqued my interest
today. I was watching the Bill Moyers Journal today on PBS and saw this interview with Rory Stewart. I took a look at his credentials - he was in the British military and worked for the foreign ministry as a diplomat - but I think I'd call him more of a scholar and humanitarian. His demeanor, which was very calm and gentle impressed me. And his knowledge about the Afghans and their culture as well as his 6000 mile trek across their country and his humanitarian efforts there interested me. I think our government needs to entertain some of his ideas - just maybe a little bit. I think possibly we need more people like this consulting with our government and military leaders when we fight on foreign lands.
Now, granted I pretty much know nothing about war or policy on war. I've always buried my head in the sand about it. I even, as an ex-military wife, just despised the fact that my husband, my family or my friends would ever have to deal with the misery of someone I know and love being some place far away and in danger. Or worse yet, they would be captured, tortured and killed or come home in a body bag.
I am very concerned about our soldiers safety - but also don't know whether we doing more harm than good to the innocent citizens of this foreign country as well. Don't misunderstand me, I want to be able to protect our country, I want to get rid of Al-Qaida as much as the next person - but what I'm questioning now is - are we doing it the right way? Do we continue to go in full force, all in the name of national security and state building? - at the risk of not accomplishing a whole lot of national security and doing more state destroying because we aren't successful on our reasonably short time table. After hearing this interview - I'm concerned that we'll go in with a lot more troops, lose a lot of men/women and not stay in long enough to accomplish the task at hand. Then we'll leave suddenly when the US citizens get tired of it - and leave the country in more shambles.
Take a watch and listen to what the man says. Tell me what you think. Do we need to refocus our goals on what's more realistic and attainable - with some more practical short and long term goals - protecting our national interests, conquering Al-Qaida and starting some humanitarian efforts - with more intel, more special forces - less ground troops.
Copy and paste this link to your browser.
http://www.pbs.org/moyers/journal/09252009/watch.html
I want to say again that I don't know a whole about this subject and am still learning. I don't want to offend anyone or belittle at all what we've done so far and what it's cost anyone.
Thursday, September 24, 2009
Life in the ER - Another Day, An Uninsured
Hi -
I'm just sitting here, taking a break from my day - to think another time about how the health care crisis affects us every day.
I decided that once in awhile, I'll just write a short blip about events that come to mind.
So, today - although I know I've told this story to some people, it's worth repeating.
Not so long ago, I had a patient in the ER that I won't be forgetting any time soon. I was just infuriated at the cost this gentleman has to pay for not being insured.
I don't know a lot about him - except that he was a hard working middle class American. He hadn't had insurance for at least 10 years; he just couldn't afford it. He worked hard to support his family and just hoped that he wouldn't get sick.
Well, in July, 4 weeks from when his Medicare would kick in - he would soon be 65, he dropped a board on his foot at home. It left a little wound on the top of his foot. He cleaned it up and kept an eye on it. About 3 weeks later and only a week before his Medicare would kick in - he woke up having pain. He noticed that his foot was now red and painful and looking kind of bad. Of course, he proceeded to the ER where he knew he would get treatment - like so many other uninsured individuals.
Gangrene had already set it. He was probably diabetic for awhile and didn't even realize it.
Now this was and is very sad - not just for this man and his family, but for all of us.
The man will lose his leg, not be able to work or support his family and have a lot of medical
bills and emotional trauma to come for years - all because he was just trying to hang on for 1 more month. As a nation, we will also lose - this man and probably his family will be our dependents. We'll have to pick up the tab for his uncompensated care. This will also probably take him out of the work force, requiring us to help support his family through other public programs.
I don't know about all you - but I just do not understand why this happens in America and in the 21st century.
My thoughts are with him and his family and the other Americans who suffer needlessly due to the way our health care system is today.
I'm just sitting here, taking a break from my day - to think another time about how the health care crisis affects us every day.
I decided that once in awhile, I'll just write a short blip about events that come to mind.
So, today - although I know I've told this story to some people, it's worth repeating.
Not so long ago, I had a patient in the ER that I won't be forgetting any time soon. I was just infuriated at the cost this gentleman has to pay for not being insured.
I don't know a lot about him - except that he was a hard working middle class American. He hadn't had insurance for at least 10 years; he just couldn't afford it. He worked hard to support his family and just hoped that he wouldn't get sick.
Well, in July, 4 weeks from when his Medicare would kick in - he would soon be 65, he dropped a board on his foot at home. It left a little wound on the top of his foot. He cleaned it up and kept an eye on it. About 3 weeks later and only a week before his Medicare would kick in - he woke up having pain. He noticed that his foot was now red and painful and looking kind of bad. Of course, he proceeded to the ER where he knew he would get treatment - like so many other uninsured individuals.
Gangrene had already set it. He was probably diabetic for awhile and didn't even realize it.
Now this was and is very sad - not just for this man and his family, but for all of us.
The man will lose his leg, not be able to work or support his family and have a lot of medical
bills and emotional trauma to come for years - all because he was just trying to hang on for 1 more month. As a nation, we will also lose - this man and probably his family will be our dependents. We'll have to pick up the tab for his uncompensated care. This will also probably take him out of the work force, requiring us to help support his family through other public programs.
I don't know about all you - but I just do not understand why this happens in America and in the 21st century.
My thoughts are with him and his family and the other Americans who suffer needlessly due to the way our health care system is today.
Tuesday, September 22, 2009
The Old, The Sick, The Disabled - and Insurance Companies
Hi there everyone -
I have time for a quick note - one that I've been thinking about for a couple of days - one I'd like to get your opinions on.
So - what do you think the purpose of insurance companies are? And do you think they should be making money off of sickness and disease???
I was thinking about it. I think that the government has been providing them with a windfall.
If the government runs Medicare, then all people over 65 are covered under Medicare. If the indigent and disabled people of the country are covered under Medicaid, then the government pays for their health care as well. If you're in the military, your health insurance is covered by the VA or Tri-care - so if you were disabled while in the military, the government pays for your medical care.
Now on the flip side, if you have insurance with a private insurance company, and you're not sick or don't really use your insurance much - they keep you as a client. But if you get sick, they drop your coverage. If you meet your lifetime maximums, they don't pay any of your bills. They don't pay your medical bills until you reach your yearly deductibles, cost-sharing and co-pays. And if you have a pre-existing medical condition, you can't get insurance.
How much sense does this make to everyone???? We, or our employers buy insurance just in case we get sick, right???? Then what are the private insurance companies insuring if they aren't insuring us against sickness and disease?
And why are we all afraid of the government providing or running an insurance exchange or public option???? It sure seems like the government is the only one that is actually insuring the sick. I think I've concluded that Medicare, Medicaid, VA, Tri-care - all these government run programs have been a gift to the insurance companies. So while they are off making billions of dollars off of us - until we're sick - then we're all actually footing the bills of the sick. Because it's our tax dollars that are paying for the government run medical programs.
So what's up with all that? In closing, we're paying for insurance we don't need or use through the private insurance companies - plus we're actually paying for everyone else - including ourselves again - when we get sick. So we (the employers and the employees) are actually paying health care premiums, plus the cost of the government run programs (through taxes) - as well as the uncompensated care of the uninsured.
Sure doesn't seem right to me - how about to you??
I have time for a quick note - one that I've been thinking about for a couple of days - one I'd like to get your opinions on.
So - what do you think the purpose of insurance companies are? And do you think they should be making money off of sickness and disease???
I was thinking about it. I think that the government has been providing them with a windfall.
If the government runs Medicare, then all people over 65 are covered under Medicare. If the indigent and disabled people of the country are covered under Medicaid, then the government pays for their health care as well. If you're in the military, your health insurance is covered by the VA or Tri-care - so if you were disabled while in the military, the government pays for your medical care.
Now on the flip side, if you have insurance with a private insurance company, and you're not sick or don't really use your insurance much - they keep you as a client. But if you get sick, they drop your coverage. If you meet your lifetime maximums, they don't pay any of your bills. They don't pay your medical bills until you reach your yearly deductibles, cost-sharing and co-pays. And if you have a pre-existing medical condition, you can't get insurance.
How much sense does this make to everyone???? We, or our employers buy insurance just in case we get sick, right???? Then what are the private insurance companies insuring if they aren't insuring us against sickness and disease?
And why are we all afraid of the government providing or running an insurance exchange or public option???? It sure seems like the government is the only one that is actually insuring the sick. I think I've concluded that Medicare, Medicaid, VA, Tri-care - all these government run programs have been a gift to the insurance companies. So while they are off making billions of dollars off of us - until we're sick - then we're all actually footing the bills of the sick. Because it's our tax dollars that are paying for the government run medical programs.
So what's up with all that? In closing, we're paying for insurance we don't need or use through the private insurance companies - plus we're actually paying for everyone else - including ourselves again - when we get sick. So we (the employers and the employees) are actually paying health care premiums, plus the cost of the government run programs (through taxes) - as well as the uncompensated care of the uninsured.
Sure doesn't seem right to me - how about to you??
Monday, September 21, 2009
My First YouTube Video - Health Care Reform Circus
Hey all -
I finally finished my first Health Care Reform You Tube Video. It's the funny, making fun of people one. There will be a couple more. Hopefully they get easier. Enjoy !
Click here.
http://www.youtube.com/watch?v=PDqX5EXG7pc
I'll be back blogging in a couple of days.
I finally finished my first Health Care Reform You Tube Video. It's the funny, making fun of people one. There will be a couple more. Hopefully they get easier. Enjoy !
Click here.
http://www.youtube.com/watch?v=PDqX5EXG7pc
I'll be back blogging in a couple of days.
Saturday, September 12, 2009
Emergency Room Visits for Non-Urgent Medical Needs
Good Morning to Everyone !
Let's tackle another hot topic of health care - non-urgent use - abuse of ERs. I would like every one's opinion on why people use ERs for their primary care or non-urgent needs. I did a little research and have found that the media, the government, the patient population and medical personnel really have differing thoughts on this - which I find very interesting. As a health care professional, I do like to try to be convinced of the other sides' viewpoints.
So let's take a spin around the googling world. I read several forums and news articles on this subject and there are varying views on the reason people come into ERs and how these costs affect our already broken health care system.
The governmental agencies seem to realize that a big factor in ER use is the broken health care system. They think with broad reform and insuring the entire population, these numbers will decrease significantly. They feel that many more ERs would be able to stay open and the lines would diminish if everyone was insured. The President, the Democrats and Republicans alike all think that if we insured everyone, increased our funding in the public programs and rebuilt our infrastructure to include strong community-based and home-based medical services, we would all be much better off.
The media has an entirely different view of the subject. They claim that most people come to the ER with non-urgent needs for two reasons - that they either are uninsured or have Medicaid and don't have access to providers they can see - as doctors are refusing care in the clinic settings for nonpayment. So they trickle into the ER where they know legally they have to be seen due to EMTALA laws. Interesting concept and one I hadn't really considered. And secondly they feel that most patients do not know what is emergent or urgent or routine. They feel that in the moment any amount of pain or suffering that people are feeling is real and they can't differentiate between something that is life-threatening or not. Again, interesting.
Next on to people in general - what I found online is almost next to nil. People don't really weigh in too much online about health care issues. There are a lot of right wing and left wing spouting off about the health care system in general - but I didn't find a whole lot of people just asking general health care questions. I did find a few real life stories of the pay offs of going to the ER - and then some nightmare stories of private sector clinic care. Again, interesting enough, it seems we do too good of a job in the ER of giving patients just what they want and what they need. There were many stories of patients not being able to get into their doctor's office for routine or non-urgent needs - having to wait weeks to months to see their doctors. Plus there were many sightings of patients wanting a fast track to getting the xrays, CTs, MRIs and specialist referrals they have been having trouble getting from their own doctors. Plus, where else can you go to get IVs, medications, tests, etc.. - one stop shopping for your needs - in a relatively short period of time.
On the other hand, there were also several stories about how the general population feels they get the best care from the best trained personnel in the system. They talked of nightmare stories of their loved-ones dying from delayed treatment and missed diagnosis in the primary care setting. And they also expressed that they weren't sure when they should or should not use the ER. There seems to be a little confusion about what is emergent and what is not. Most people seem to know if you're having chest pain or shortness of breath, they should go - or if they have an ear ache or a sore throat, they shouldn't go. But with the Internet and the symptom checking on web sites, they are confused about is emergency in the abdominal pain, nausea and vomiting, back pain, headache, broken bone and laceration categories. And truthfully, there leaves a lot to desire with telephone triaging - if you can't see the patient, you don't know where to send them - so you send them all to the ER. Great ! I know, you're all worried about being sued for liability for missing something - but come on.
Now, let me just say, there are a lot of online forums from health care professionals. Some are constructive - some are just plain mean. Some people have definitely identified a lot of factors in the use/abuse of the ERs. And some people just get soooo frustrated about the piddly little things that come in.
Let me just give you some real-life examples from my friends and co-workers - you tell me what you think. Are they emergencies - could they be - or come on, should you just stay home for a day or two - go to urgent care - or wait for an appointment with your doctor? Let me know what you all think !
Examples:
2am STD check
Sore Throat for 3 Days
Knee Pain for 10 Years
Bug Bites
I need a Note to go back to work because I called in sick last Friday.
I had a Fever ....yesterday.
My Child was at a Party yesterday and was exposed to Chicken Pox. Is there a Shot for that?
Cold Sore
Dandruff
Pregnancy Test
Prescription Refill
Rash for 14 Years
The Cops or the Airport Security took my Prescription for Pain Medicines, Can I have Another?
I drink too much but I don't want to be here - but called the Paramedics anyway?
A Zit?
Someone concerned about getting AIDS from a Bite.
The ultimate and funniest and saddest one of the bunch - a Dialysis Patient was sent to the ER because of a necrotic belly button - OK, did any one look? It was a blueberry that missed his mouth in the morning. Come on !
OK - now, I know people aren't just feeble-minded - at least not everyone - but in all these cases, we all know - us and patients alike - these are not emergencies and do not belong in the ER. I'm not sure that even one of them, in the worst-case scenario would be urgent or emergent. OK - maybe one - the sore throat could be something cooking - I'll give them one - maybe - unless of course, it was just a sore throat with no other symptoms.
I want to tell you what I think about all this. I'll give the government, the media, the people and the health care professionals all kudos. Everyone has touched on at least one aspect of the system that is just all or partly wrong in the US.
But I think we're missing one important aspect - and I'm not sure how to fix it - well I have a few ideas that I'll touch on a little later. This is the generation of instant gratification - and not wanting to be inconvenienced by anything. It's all about me, me, me. And I can attest to this as I know, I have a little bit of that in me as well.
So let's be a little constructive and talk about how we can fix some of these issues.
#1 - Health Care Reform, Health Care Reform, Health Care Reform - can I say it any more??
We so need to refocus our infrastructure. We need to insure everyone in this Country - well everyone here legally. There is a certain sub-population that is always going to end up in the ER and not have coverage. With EMTALA laws, we have to see anyone who shows up in the ER. Sorry, that includes illegal aliens. There's no way to get around that - they are always going to cost all of us some money. But if we insure everyone else, then we cut down on all the uncompensated care we give to the poor and the homeless, uninsured and under-insured population. It just has to be done.
#2 - Let's rebuild - increase funding for our community health systems. We need more community health centers, more urgent cares, more primary doctors who see all people. We just really need more Primary Care Doctors - they need to be compensated more. People need more access to their doctors. There are not enough doctors to go around. We need to refocus our funding on the home-health field as well. People would love to stay in their homes if only they could afford to be taken care of there - or in residential homes.
#3 - Education, Education, Education. Patients need to be educated on where to get their care, how to get their care, the costs of their care, alternatives to care, what's emergent and what's not. Transparency is all too important. Maybe a big sign in front of the hospital with all this information would be good. Maybe simpler plan books or brochures with easily understandable language would be nice. Written instructions at discharge from the doctor's office, the ER, the inpatient setting could be mandatory. Maybe some big organization could take on this task - the American Heart Assoc., Blue Cross/Blue Shield, Kaiser Permanente, maybe the government could launch a big advertising campaign about this???
#4 - There needs to be some sort of sliding scale co-payment system in the ER- in my opinion.
If someone comes to the ER with a true urgent or emergent condition, the co-pay should be less. People should be charged more for non-urgent, routine ER visits to discourage them from coming in on just a whim. I don't know exactly how to restructure this, but I believe if people have to pay $200.00 + for an ER visit (if that's what the estimated cost would be to see an ER doctor), I believe that it would only take once to figure out that you shouldn't do it. I think that the pocket book hit would squash some of the instant gratification drive.
#5 -And lastly from me, I think that every hospital should have some sort of in-person triaging system. The ERs should have a triaging doctor in front - and the hospitals should have a system of deflecting patients to the clinics, PMDs, urgent cares and clinics. If everyone is insured, this should not be a problem. If your clinics don't have any openings, then the patients get sent down the street to a place where there is an opening. I like the idea of a concierge service. I feel it would help everyone involved. The ERs would be used for emergencies - the uncompensated care would go down and the people would get the care they want, deserve and need in a fairly short period of time.
And to Stan - I love your philosophy on our ER specialty - I'll call it your mantra -
"Common Sense is Not that Common"
"Job Security - There will always be plenty of "Emergencies""
So come on everyone - brain storm - what do you think? Do you have any other solutions to the health care crisis that is happening in our ERs???
Comments, Fixes, Bitches !
See Ya back here Later !
Let's tackle another hot topic of health care - non-urgent use - abuse of ERs. I would like every one's opinion on why people use ERs for their primary care or non-urgent needs. I did a little research and have found that the media, the government, the patient population and medical personnel really have differing thoughts on this - which I find very interesting. As a health care professional, I do like to try to be convinced of the other sides' viewpoints.
So let's take a spin around the googling world. I read several forums and news articles on this subject and there are varying views on the reason people come into ERs and how these costs affect our already broken health care system.
The governmental agencies seem to realize that a big factor in ER use is the broken health care system. They think with broad reform and insuring the entire population, these numbers will decrease significantly. They feel that many more ERs would be able to stay open and the lines would diminish if everyone was insured. The President, the Democrats and Republicans alike all think that if we insured everyone, increased our funding in the public programs and rebuilt our infrastructure to include strong community-based and home-based medical services, we would all be much better off.
The media has an entirely different view of the subject. They claim that most people come to the ER with non-urgent needs for two reasons - that they either are uninsured or have Medicaid and don't have access to providers they can see - as doctors are refusing care in the clinic settings for nonpayment. So they trickle into the ER where they know legally they have to be seen due to EMTALA laws. Interesting concept and one I hadn't really considered. And secondly they feel that most patients do not know what is emergent or urgent or routine. They feel that in the moment any amount of pain or suffering that people are feeling is real and they can't differentiate between something that is life-threatening or not. Again, interesting.
Next on to people in general - what I found online is almost next to nil. People don't really weigh in too much online about health care issues. There are a lot of right wing and left wing spouting off about the health care system in general - but I didn't find a whole lot of people just asking general health care questions. I did find a few real life stories of the pay offs of going to the ER - and then some nightmare stories of private sector clinic care. Again, interesting enough, it seems we do too good of a job in the ER of giving patients just what they want and what they need. There were many stories of patients not being able to get into their doctor's office for routine or non-urgent needs - having to wait weeks to months to see their doctors. Plus there were many sightings of patients wanting a fast track to getting the xrays, CTs, MRIs and specialist referrals they have been having trouble getting from their own doctors. Plus, where else can you go to get IVs, medications, tests, etc.. - one stop shopping for your needs - in a relatively short period of time.
On the other hand, there were also several stories about how the general population feels they get the best care from the best trained personnel in the system. They talked of nightmare stories of their loved-ones dying from delayed treatment and missed diagnosis in the primary care setting. And they also expressed that they weren't sure when they should or should not use the ER. There seems to be a little confusion about what is emergent and what is not. Most people seem to know if you're having chest pain or shortness of breath, they should go - or if they have an ear ache or a sore throat, they shouldn't go. But with the Internet and the symptom checking on web sites, they are confused about is emergency in the abdominal pain, nausea and vomiting, back pain, headache, broken bone and laceration categories. And truthfully, there leaves a lot to desire with telephone triaging - if you can't see the patient, you don't know where to send them - so you send them all to the ER. Great ! I know, you're all worried about being sued for liability for missing something - but come on.
Now, let me just say, there are a lot of online forums from health care professionals. Some are constructive - some are just plain mean. Some people have definitely identified a lot of factors in the use/abuse of the ERs. And some people just get soooo frustrated about the piddly little things that come in.
Let me just give you some real-life examples from my friends and co-workers - you tell me what you think. Are they emergencies - could they be - or come on, should you just stay home for a day or two - go to urgent care - or wait for an appointment with your doctor? Let me know what you all think !
Examples:
2am STD check
Sore Throat for 3 Days
Knee Pain for 10 Years
Bug Bites
I need a Note to go back to work because I called in sick last Friday.
I had a Fever ....yesterday.
My Child was at a Party yesterday and was exposed to Chicken Pox. Is there a Shot for that?
Cold Sore
Dandruff
Pregnancy Test
Prescription Refill
Rash for 14 Years
The Cops or the Airport Security took my Prescription for Pain Medicines, Can I have Another?
I drink too much but I don't want to be here - but called the Paramedics anyway?
A Zit?
Someone concerned about getting AIDS from a Bite.
The ultimate and funniest and saddest one of the bunch - a Dialysis Patient was sent to the ER because of a necrotic belly button - OK, did any one look? It was a blueberry that missed his mouth in the morning. Come on !
OK - now, I know people aren't just feeble-minded - at least not everyone - but in all these cases, we all know - us and patients alike - these are not emergencies and do not belong in the ER. I'm not sure that even one of them, in the worst-case scenario would be urgent or emergent. OK - maybe one - the sore throat could be something cooking - I'll give them one - maybe - unless of course, it was just a sore throat with no other symptoms.
I want to tell you what I think about all this. I'll give the government, the media, the people and the health care professionals all kudos. Everyone has touched on at least one aspect of the system that is just all or partly wrong in the US.
But I think we're missing one important aspect - and I'm not sure how to fix it - well I have a few ideas that I'll touch on a little later. This is the generation of instant gratification - and not wanting to be inconvenienced by anything. It's all about me, me, me. And I can attest to this as I know, I have a little bit of that in me as well.
So let's be a little constructive and talk about how we can fix some of these issues.
#1 - Health Care Reform, Health Care Reform, Health Care Reform - can I say it any more??
We so need to refocus our infrastructure. We need to insure everyone in this Country - well everyone here legally. There is a certain sub-population that is always going to end up in the ER and not have coverage. With EMTALA laws, we have to see anyone who shows up in the ER. Sorry, that includes illegal aliens. There's no way to get around that - they are always going to cost all of us some money. But if we insure everyone else, then we cut down on all the uncompensated care we give to the poor and the homeless, uninsured and under-insured population. It just has to be done.
#2 - Let's rebuild - increase funding for our community health systems. We need more community health centers, more urgent cares, more primary doctors who see all people. We just really need more Primary Care Doctors - they need to be compensated more. People need more access to their doctors. There are not enough doctors to go around. We need to refocus our funding on the home-health field as well. People would love to stay in their homes if only they could afford to be taken care of there - or in residential homes.
#3 - Education, Education, Education. Patients need to be educated on where to get their care, how to get their care, the costs of their care, alternatives to care, what's emergent and what's not. Transparency is all too important. Maybe a big sign in front of the hospital with all this information would be good. Maybe simpler plan books or brochures with easily understandable language would be nice. Written instructions at discharge from the doctor's office, the ER, the inpatient setting could be mandatory. Maybe some big organization could take on this task - the American Heart Assoc., Blue Cross/Blue Shield, Kaiser Permanente, maybe the government could launch a big advertising campaign about this???
#4 - There needs to be some sort of sliding scale co-payment system in the ER- in my opinion.
If someone comes to the ER with a true urgent or emergent condition, the co-pay should be less. People should be charged more for non-urgent, routine ER visits to discourage them from coming in on just a whim. I don't know exactly how to restructure this, but I believe if people have to pay $200.00 + for an ER visit (if that's what the estimated cost would be to see an ER doctor), I believe that it would only take once to figure out that you shouldn't do it. I think that the pocket book hit would squash some of the instant gratification drive.
#5 -And lastly from me, I think that every hospital should have some sort of in-person triaging system. The ERs should have a triaging doctor in front - and the hospitals should have a system of deflecting patients to the clinics, PMDs, urgent cares and clinics. If everyone is insured, this should not be a problem. If your clinics don't have any openings, then the patients get sent down the street to a place where there is an opening. I like the idea of a concierge service. I feel it would help everyone involved. The ERs would be used for emergencies - the uncompensated care would go down and the people would get the care they want, deserve and need in a fairly short period of time.
And to Stan - I love your philosophy on our ER specialty - I'll call it your mantra -
"Common Sense is Not that Common"
"Job Security - There will always be plenty of "Emergencies""
So come on everyone - brain storm - what do you think? Do you have any other solutions to the health care crisis that is happening in our ERs???
Comments, Fixes, Bitches !
See Ya back here Later !
Thursday, September 10, 2009
Miscellaneous Info., Statistics, Etc. - Food for Thought - a Pawn
Hi everyone -
Well another day, more policy reading. I tackled Max Baucus's Call to Action that he wrote back in November 2008. I'm going to talk a little about it today here - but I'm going to reserve my kudos for now. After reading some news posts today - I believe his health care proposal to the President is different from the Call to Action he wrote last year. So, I actually want to read the new plan before committing to it.
He did have some interesting statistics:
46 Million UnInsured Americans - 15% of Population
25 Million UnderInsured Americans
158 Million Americans are Covered by Employer-Offered Plans
U.S. spends 16% of GNP on Health Care - Over Twice as Much Averaged as Any Other
Industrialized Nation
U.S. is 19th in World in Unneccesary Deaths
U.S. is 29th out 37 Nations in Infant Mortality
Adults get Recommended Care only 55% of Time
Children get Reccommended Care only 47% of Time
People get Preventative Care only 41% of Time
At first look, I was pretty impressed. It's obvious he's coming at it from a Finance perspective.
The Call to Action had a lot of the same stuff in it that the House Bill 3200 has in it.
Here are just a few of the similar points:
You can Keep your Doctor if you Like Him/Her
No Pre-Existing Conditions Allowed
Electronic Records Integration
Preventative Services for Free
Subsidies to Individuals and Small Businesses who Need Assistance with Premiums
Expansion of the Medicaid Program and Indian Health Plan
No Waiting Period for Disabled or other Legal Immigrants (children and pregnant women)
Reform for Medicare/Medicaid to Control Fraud and Abuse and Quality vs Quantity HealthCare
Heath Care Exchange with a Public Plan
So a lot of similarities - but:
I did find a few interesting additions - although maybe they are in the House Bill as well - I haven't gotten all the way through the 1000+ pages yet. It's a bit boring after awhile and I needed a distraction.
I can entertain some other talking points.
He has proposed an early buy-in for Medicare for people between 55 and 65. This could work two fold. It could help those people in this age range that don't have affordable options to health care. Plus, it would also help the Medicare fund as these people would be paying premiums. Something to think about.
Plus, his plan also concentrated a great deal on expanding the community health programs. He thinks it would be cheaper to transfer some of the care of the elderly back into the community - ie) funded community medical centers, medical homes, home health programs, etc... as opposed to institutionalizing everyone in nursing facilities. He feels most people would prefer to stay in their homes - and he feels we need to train more health care professionals to care for these people - to give some relief to their families.
And he concentrates a great deal on quality care vs quantity of care. He calls for malpractice reform to get doctor's away from defensive doctoring.
Interesting, while reading his proposal, I found myself a pawn in someone's program - unknowingly so. It seems that some governmental agencies - I believe The Joint Commission and Medicare, in particular - has been experimenting with quality health care measures. It appears that that they have been creating what I'll call, well what they call core measures - which basically are best clinical practices for certain diseases. For example, making sure heart attack patients have aspirin given on arrival to the ER, making sure pneumonia patients have antibiotics started on them within 4 hours of arrival to the ER, making sure patients with CHF have certain tests and medications depending on the outcome of those tests, etc.... Well this is all great stuff - finally someone is making sure we're treating patients according to best clinical practices - practices that have produced better patient outcomes and decreased morbidity. Well that's all fine and dandy- wonderful for patients and the world in general. The only thing I was dumbfounded by was the comment in Baucus's proposal that said Medicare was actually paying hospitals for this. Well no wonder all our yearly bonuses are based on the adherence to these "core measures". Again, it's all good news - it's in the patients' best interest - but I wish at some point, the hospital that I worked for had some transparency on this issue.
So how would you feel if you found out that your yearly bonuses were based on the hospital's reimbursement by the insurance company???? instead of just the mere fact that the facility was on the cutting-edge of health care in best clinical practice???
I guess at first take, I felt a little betrayed for not being told - but in the end, if it's better for the patient, then it's better for us all. And if the new guidelines for payment are going to be based on quality outcomes, it's an interesting concept - and why not be one of the first systems that are using it.
Anyway - more later. Let me know what you'd like to hear about next?
Goodnight.
Well another day, more policy reading. I tackled Max Baucus's Call to Action that he wrote back in November 2008. I'm going to talk a little about it today here - but I'm going to reserve my kudos for now. After reading some news posts today - I believe his health care proposal to the President is different from the Call to Action he wrote last year. So, I actually want to read the new plan before committing to it.
He did have some interesting statistics:
46 Million UnInsured Americans - 15% of Population
25 Million UnderInsured Americans
158 Million Americans are Covered by Employer-Offered Plans
U.S. spends 16% of GNP on Health Care - Over Twice as Much Averaged as Any Other
Industrialized Nation
U.S. is 19th in World in Unneccesary Deaths
U.S. is 29th out 37 Nations in Infant Mortality
Adults get Recommended Care only 55% of Time
Children get Reccommended Care only 47% of Time
People get Preventative Care only 41% of Time
At first look, I was pretty impressed. It's obvious he's coming at it from a Finance perspective.
The Call to Action had a lot of the same stuff in it that the House Bill 3200 has in it.
Here are just a few of the similar points:
You can Keep your Doctor if you Like Him/Her
No Pre-Existing Conditions Allowed
Electronic Records Integration
Preventative Services for Free
Subsidies to Individuals and Small Businesses who Need Assistance with Premiums
Expansion of the Medicaid Program and Indian Health Plan
No Waiting Period for Disabled or other Legal Immigrants (children and pregnant women)
Reform for Medicare/Medicaid to Control Fraud and Abuse and Quality vs Quantity HealthCare
Heath Care Exchange with a Public Plan
So a lot of similarities - but:
I did find a few interesting additions - although maybe they are in the House Bill as well - I haven't gotten all the way through the 1000+ pages yet. It's a bit boring after awhile and I needed a distraction.
I can entertain some other talking points.
He has proposed an early buy-in for Medicare for people between 55 and 65. This could work two fold. It could help those people in this age range that don't have affordable options to health care. Plus, it would also help the Medicare fund as these people would be paying premiums. Something to think about.
Plus, his plan also concentrated a great deal on expanding the community health programs. He thinks it would be cheaper to transfer some of the care of the elderly back into the community - ie) funded community medical centers, medical homes, home health programs, etc... as opposed to institutionalizing everyone in nursing facilities. He feels most people would prefer to stay in their homes - and he feels we need to train more health care professionals to care for these people - to give some relief to their families.
And he concentrates a great deal on quality care vs quantity of care. He calls for malpractice reform to get doctor's away from defensive doctoring.
Interesting, while reading his proposal, I found myself a pawn in someone's program - unknowingly so. It seems that some governmental agencies - I believe The Joint Commission and Medicare, in particular - has been experimenting with quality health care measures. It appears that that they have been creating what I'll call, well what they call core measures - which basically are best clinical practices for certain diseases. For example, making sure heart attack patients have aspirin given on arrival to the ER, making sure pneumonia patients have antibiotics started on them within 4 hours of arrival to the ER, making sure patients with CHF have certain tests and medications depending on the outcome of those tests, etc.... Well this is all great stuff - finally someone is making sure we're treating patients according to best clinical practices - practices that have produced better patient outcomes and decreased morbidity. Well that's all fine and dandy- wonderful for patients and the world in general. The only thing I was dumbfounded by was the comment in Baucus's proposal that said Medicare was actually paying hospitals for this. Well no wonder all our yearly bonuses are based on the adherence to these "core measures". Again, it's all good news - it's in the patients' best interest - but I wish at some point, the hospital that I worked for had some transparency on this issue.
So how would you feel if you found out that your yearly bonuses were based on the hospital's reimbursement by the insurance company???? instead of just the mere fact that the facility was on the cutting-edge of health care in best clinical practice???
I guess at first take, I felt a little betrayed for not being told - but in the end, if it's better for the patient, then it's better for us all. And if the new guidelines for payment are going to be based on quality outcomes, it's an interesting concept - and why not be one of the first systems that are using it.
Anyway - more later. Let me know what you'd like to hear about next?
Goodnight.
Tuesday, September 8, 2009
House Bill - Health Insurance Exchange
Hi again -
Today's feature will be the first 215 pages of the House Bill. This is the part of the bill that focuses on the Health Insurance Exchange Program. The rest of the bill - about 800+ pages is about health care reform which we'll touch on later.
As you'll see - the key points of the House Bill pretty much match the key points of Obama's Vision, that we discussed earlier.
OK so here we go: Let's start with the basics.
The Health Insurance Exchange will offer an affordable health insurance option for the people who fall through the cracks in our system - those who don't qualify for any other plan whether it's Medicaid, CHIP, Tri-care, VA, Medicare or an Employers'-offered health plan.
It offers an affordable essential benefit plan package with some consumer protections. It would consist of private insurance companies and a public option. For those of you who don't know what a Public Option is - it's basically an insurance plan ran by a government agency - which would have to meet all the requirements of the private insurance companies so as to guarantee a fair playing field.
This health plan would make the individual, the employers, the insurance companies and the government responsible and accountable for insuring all Americans in one way or another.
If you like your current insurance plan, you can keep it. You can keep your doctor as well.
If at any time your employer decides not to provide insurance for you, or if you lose your job, there will be other options. You can shop for a more affordable plan - and odds are the company you're insured with already will have a package available in the Health Insurance Exchange.
Many companies will be grandfathered in - and they will have 5 years to meet the requirements of the Exchange.
The government will be offering subsidies/credits to individuals - those who can't afford the insurance premiums or the co-payments - those too poor to qualify for Medicaid, but those who still can't afford the premiums. Employers who qualify as small businesses who offer health insurance to their employees will also have some tax credits/subsidies - some as high as 50% of the premiums paid. Also a very nice incentive - if after the year is done and all the figures are in, and the Exchange finds out that we actually saved money during the year - ie) a low medical loss ratio - the money will be returned to the people. This is to insure that our health care dollars are used for health care - not going into some fat cat's pockets.
OK - interjection here: speaking of fat cats - did you know that Blue Cross/Blue Shield of Michigan's Executives -just 2 of them - CEO and CFO - gave themselves $1,286,000 in bonuses in 2008 - that's on top of their over $1 Million Salaries - right before laying off 1000s of workers and instituting salary freezes on lower employees in the beginning of 2009. Crazy huh?
Companies will also get money to help convert their medical records to electronic records. You know where I stand on this - everyday we struggle with those darn computers and it's software - but information technology will save so much money in duplication of services and a reduction in medical errors. It will also help us establish best clinical practice standards. Check out some of my figures on the previous subject - earlier in my blog.
Again the companies participating in the Health Insurance Exchange will have to abide by certain rules. They have to be licensed in the State they want to participate in. States can run their own Exchange if they like. They have to participate in risk pooling so that no one company will be burdened with the sickest or poorest population.
Companies must offer a basic plan and may offer an enhanced plan, a premium plan or a premium plus plan. The basic plan must include Hospitalization, Dr's Visits, Clinic Visits, ER Visits, Dr's Fees, Equipment and Supplies, Maternity and Free Well Baby and Preventative Services.
They can't drop or deny any one's coverage for health reasons - pre-existing conditions, use of insurance, age, race, lifestyle, etc... There won't be any lifetime or annual caps on amounts needed for coverage. There is protection for age, family size and geography ratings - at no time can the premiums be more than a 2:1 ratio. Benefits will not be taxed. And the rules can't interfere with Union contracts.
As of governance, there will be a Health Care Commissioner that will be in charge of running the exchange, enforcing rules and monitoring compliance. There will be an Ombudsman who will be there for the people if they have any questions, grievances, etc...
Everyone will have a medical ID card - that may be scannable - so that when someone shows up at a hospital or doctor's office, we'll know they're covered and what kind of coverage they have - who their doctor is, etc...
In year 1 - which is down the road, I think 2013 - only uninsured individuals and small employers with less than 10 employees can join.
In year 2, everyone above plus employers with less than 20 employees can join. Plus anyone who is paying more than 11% of their yearly income in premiums may join.
In year 3, everyone above plus larger employers as determined may join.
So I don't see that there will be a mass exodus of people leaving their current plans to run to the exchange - at least not in the first 3 years.
Now onto the responsibility part - every one sharing in paying for the system - which I'm all for.
The people, us, will have annual out of pocket expenses - a max. of $5000.00 for individuals and $10,000.00 for families. I, personally still think this is too much. I realize that a lot of families are paying much more than this in deductibles, co-insurances and co-pays. I guess I'm just spoiled by the plan I have. Now, this is not to say that your employer will then downgrade what you have already. If you don't have a yearly deductible now, you won't then. This is just a max. that the Exchange companies can ask for. If someone chooses not to be insured, there will be a tax penalty of 2.5% of their adjusted gross income for the year - or the premium amount they would have paid - whichever is less. Now, there is leeway with this penalty - if it's a hardship, there's a loophole.
Employers in the Exchange must pay at least 72.5% of the employee's premium and 65% of the family premium for full-time employees. It will be pro-rated for part-time employees.
There will be a tax penalty for those employers who don't cover their employees. If the employers have an annual payroll of between $250,000 - $300,000, their penalty will be 2%; if between $300,000 - $350,000, it will be 4%; if between $350,000 - $400,000, it will be 6%; and for any company with an annual payroll over $400,000, the penalty will be 8%. This penalty will help defray the additional costs of the Exchange having to insure the people.
And now the big question - where do we get the money to fund all this?
Well I know there is great discussion on this matter. There are some possibilities floating around out there - I think we'll save a great deal in reform - just in electronic records, there may be some redistribution of Medicare Advantage money, the drug companies may be offering to help with the donut hole money, the richest Americans may not get their big tax deductions - and the richest 1% people in America will have an increase in their taxes. According to the House Bill, the richest people in America will be taxed as follows: Now - keep in mind these percentages apply only to the money they make over this limit in Adjusted Gross Income. So, anyone making between $350,000 - $500,000 annually will be taxed an additional 1%; anyone between $500,000 - $1 Million will be 1.5% and anyone over $1 Million will be taxed 5.4%. So if someone makes more than $1 Million in Adjusted Gross Income in any given year, the amount over $1 Million would be taxed by 5.4%. Their first Million would not be taxed further. FYI - according to compiled figures, this tax would only affect 1.9% of Californians. And for my home state of PA, this would only affect 1% of the population. Oh and by the way, this percentage is just part of tax cuts that the Bush administration has given to the richest Americans since 2001 - and it extends until 2010. This richest 1% will receive over $700 Billion dollars in tax cuts before it's over - so I think they can afford to give some of it back. Do you know many of these people?? I sure don't.
OK so lots to process in only 215 pages. Again though, I don't see a lot of bad stuff - maybe the annual limits of $5000 and $10,000. All I know, as a health care professional, is that everyone has to be covered. I don't care exactly how we get there - but we need to. Not only do all Americans need coverage, they deserve it. Our companies and our nation can not continue to compete in the global market without taking the health care equation into account.
Any ideas? You know if anyone out there has any ideas - whether better or worse or how to get there - on paper or money-wise, speak up. Let's do it together.
Take Care - more later. I'm reading Max Baucus's Call to Action plan today. I must say I'm liking what I'm reading so far.
Today's feature will be the first 215 pages of the House Bill. This is the part of the bill that focuses on the Health Insurance Exchange Program. The rest of the bill - about 800+ pages is about health care reform which we'll touch on later.
As you'll see - the key points of the House Bill pretty much match the key points of Obama's Vision, that we discussed earlier.
OK so here we go: Let's start with the basics.
The Health Insurance Exchange will offer an affordable health insurance option for the people who fall through the cracks in our system - those who don't qualify for any other plan whether it's Medicaid, CHIP, Tri-care, VA, Medicare or an Employers'-offered health plan.
It offers an affordable essential benefit plan package with some consumer protections. It would consist of private insurance companies and a public option. For those of you who don't know what a Public Option is - it's basically an insurance plan ran by a government agency - which would have to meet all the requirements of the private insurance companies so as to guarantee a fair playing field.
This health plan would make the individual, the employers, the insurance companies and the government responsible and accountable for insuring all Americans in one way or another.
If you like your current insurance plan, you can keep it. You can keep your doctor as well.
If at any time your employer decides not to provide insurance for you, or if you lose your job, there will be other options. You can shop for a more affordable plan - and odds are the company you're insured with already will have a package available in the Health Insurance Exchange.
Many companies will be grandfathered in - and they will have 5 years to meet the requirements of the Exchange.
The government will be offering subsidies/credits to individuals - those who can't afford the insurance premiums or the co-payments - those too poor to qualify for Medicaid, but those who still can't afford the premiums. Employers who qualify as small businesses who offer health insurance to their employees will also have some tax credits/subsidies - some as high as 50% of the premiums paid. Also a very nice incentive - if after the year is done and all the figures are in, and the Exchange finds out that we actually saved money during the year - ie) a low medical loss ratio - the money will be returned to the people. This is to insure that our health care dollars are used for health care - not going into some fat cat's pockets.
OK - interjection here: speaking of fat cats - did you know that Blue Cross/Blue Shield of Michigan's Executives -just 2 of them - CEO and CFO - gave themselves $1,286,000 in bonuses in 2008 - that's on top of their over $1 Million Salaries - right before laying off 1000s of workers and instituting salary freezes on lower employees in the beginning of 2009. Crazy huh?
Companies will also get money to help convert their medical records to electronic records. You know where I stand on this - everyday we struggle with those darn computers and it's software - but information technology will save so much money in duplication of services and a reduction in medical errors. It will also help us establish best clinical practice standards. Check out some of my figures on the previous subject - earlier in my blog.
Again the companies participating in the Health Insurance Exchange will have to abide by certain rules. They have to be licensed in the State they want to participate in. States can run their own Exchange if they like. They have to participate in risk pooling so that no one company will be burdened with the sickest or poorest population.
Companies must offer a basic plan and may offer an enhanced plan, a premium plan or a premium plus plan. The basic plan must include Hospitalization, Dr's Visits, Clinic Visits, ER Visits, Dr's Fees, Equipment and Supplies, Maternity and Free Well Baby and Preventative Services.
They can't drop or deny any one's coverage for health reasons - pre-existing conditions, use of insurance, age, race, lifestyle, etc... There won't be any lifetime or annual caps on amounts needed for coverage. There is protection for age, family size and geography ratings - at no time can the premiums be more than a 2:1 ratio. Benefits will not be taxed. And the rules can't interfere with Union contracts.
As of governance, there will be a Health Care Commissioner that will be in charge of running the exchange, enforcing rules and monitoring compliance. There will be an Ombudsman who will be there for the people if they have any questions, grievances, etc...
Everyone will have a medical ID card - that may be scannable - so that when someone shows up at a hospital or doctor's office, we'll know they're covered and what kind of coverage they have - who their doctor is, etc...
In year 1 - which is down the road, I think 2013 - only uninsured individuals and small employers with less than 10 employees can join.
In year 2, everyone above plus employers with less than 20 employees can join. Plus anyone who is paying more than 11% of their yearly income in premiums may join.
In year 3, everyone above plus larger employers as determined may join.
So I don't see that there will be a mass exodus of people leaving their current plans to run to the exchange - at least not in the first 3 years.
Now onto the responsibility part - every one sharing in paying for the system - which I'm all for.
The people, us, will have annual out of pocket expenses - a max. of $5000.00 for individuals and $10,000.00 for families. I, personally still think this is too much. I realize that a lot of families are paying much more than this in deductibles, co-insurances and co-pays. I guess I'm just spoiled by the plan I have. Now, this is not to say that your employer will then downgrade what you have already. If you don't have a yearly deductible now, you won't then. This is just a max. that the Exchange companies can ask for. If someone chooses not to be insured, there will be a tax penalty of 2.5% of their adjusted gross income for the year - or the premium amount they would have paid - whichever is less. Now, there is leeway with this penalty - if it's a hardship, there's a loophole.
Employers in the Exchange must pay at least 72.5% of the employee's premium and 65% of the family premium for full-time employees. It will be pro-rated for part-time employees.
There will be a tax penalty for those employers who don't cover their employees. If the employers have an annual payroll of between $250,000 - $300,000, their penalty will be 2%; if between $300,000 - $350,000, it will be 4%; if between $350,000 - $400,000, it will be 6%; and for any company with an annual payroll over $400,000, the penalty will be 8%. This penalty will help defray the additional costs of the Exchange having to insure the people.
And now the big question - where do we get the money to fund all this?
Well I know there is great discussion on this matter. There are some possibilities floating around out there - I think we'll save a great deal in reform - just in electronic records, there may be some redistribution of Medicare Advantage money, the drug companies may be offering to help with the donut hole money, the richest Americans may not get their big tax deductions - and the richest 1% people in America will have an increase in their taxes. According to the House Bill, the richest people in America will be taxed as follows: Now - keep in mind these percentages apply only to the money they make over this limit in Adjusted Gross Income. So, anyone making between $350,000 - $500,000 annually will be taxed an additional 1%; anyone between $500,000 - $1 Million will be 1.5% and anyone over $1 Million will be taxed 5.4%. So if someone makes more than $1 Million in Adjusted Gross Income in any given year, the amount over $1 Million would be taxed by 5.4%. Their first Million would not be taxed further. FYI - according to compiled figures, this tax would only affect 1.9% of Californians. And for my home state of PA, this would only affect 1% of the population. Oh and by the way, this percentage is just part of tax cuts that the Bush administration has given to the richest Americans since 2001 - and it extends until 2010. This richest 1% will receive over $700 Billion dollars in tax cuts before it's over - so I think they can afford to give some of it back. Do you know many of these people?? I sure don't.
OK so lots to process in only 215 pages. Again though, I don't see a lot of bad stuff - maybe the annual limits of $5000 and $10,000. All I know, as a health care professional, is that everyone has to be covered. I don't care exactly how we get there - but we need to. Not only do all Americans need coverage, they deserve it. Our companies and our nation can not continue to compete in the global market without taking the health care equation into account.
Any ideas? You know if anyone out there has any ideas - whether better or worse or how to get there - on paper or money-wise, speak up. Let's do it together.
Take Care - more later. I'm reading Max Baucus's Call to Action plan today. I must say I'm liking what I'm reading so far.
Friday, September 4, 2009
Medical Personnel Roles
Hi again -
Well, I'm back after a couple of days off again. Seems like I'm starting to need a few days in between to gather my thoughts. I'd like to go off course a little bit from the health care reform issue today.
I think today I'm going to touch a little bit on medical personnel roles in the health care field - education level, job responsibilities, etc.... Then I want to wrap it up a little bit talking about the so-called nursing shortage - and my views on that. And in the end, I want to pay tribute to someone special who we recently lost, someone who had a calling to take care of others and did so so very well- in our ER.
I'll start with some of the ground level positions and work my way up the so-called ladder. Although, I don't want to imply that any position is any better or worse than any other position. It's important to remember that when a person is in the medical field, they land either where their heart lies or where they can afford to stay for the time being. That's why it's such a dynamic field - you can play where your strengths are and move around until you find what suits you best.
How many different hands-on patient care positions are there? To name a few, there are CNAs, Orderlies, EMTs, MAs, Psych. Techs., LVNs, Paramedics, RNs, PAs and NPs. Of course, these positions aren't all inclusive. There are still Techs in other departments - Radiology, PT, OT, Pharmacy, Cashiers, Clerks, Volunteers, etc... We all need each other to take care of patients.
I'll touch base on a few of these positions and their roles.
I suppose the entry level for many new people to the health care field would be the CNA - Certified Nursing Assistant. This is a very difficult job to do and one that requires a very special kind of person. These are the people who are most in touch with the patients - those who work at the bedside, taking vital signs, feeding, bathing, dressing and toileting patients. Although the hourly educational requirement isn't that high -usually around 75 + hours of classroom and clinical training - interpersonal skills are very important. I remember many a time a CNA saved my butt on the floor - coming to me to alert me that something was wrong with one of my patients.
Orderlies, though few and far between anymore, have similar educational requirements and job responsibilities of the CNA. Because a lot of orderlies are males, they also have the added responsibilities of working with equipment and lifting the patients. Ouch, my aching back.
Next we'll go to the pre-hospital side of the fence, the EMT, Emergency Medical Technician. The EMT certification class is usually around 140 hours of classroom, clinical and field training. EMTs in the field have varying tasks depending on what state you live in, where you work and how rural an area you live in. EMTs in the hospital mostly do task-oriented noninvasive procedures - splint applications, dressings, EKGs, lab draws, etc... EMTs in the field usually ride in the back of the ambulances and take care of the patients or assist the paramedics. Tasks may include splinting, dressing wounds, oxygen administration, spinal immobilization, CPR, etc... Many times, they are firemen or police officers as well. This field is very close to my heart. It's where I started - where the medical bug bit me. One summer I decided to take this class just for the fun of it. I thought it would be a great place to meet guys. True. I didn't even like blood, or couldn't imagine taking care of people, but that sure changed fast. It made me want more.
MAs - Medical Assistants again are an integral part of the health care team. Most vo-tech colleges and some nursing schools have MA classes. They can either go for a year - or two years and earn their Associates Degree. These are the people that usually work in clinics and doctor's offices. They are the ultimate assistant. They answer phones, schedule appointments, assist with billing, put patients in rooms, take vital signs, etc.... They can also do other tasks as long as they have been taught those tasks and the doctor they work for assumes responsibility for those tasks- ie) medication administration, blood draws, assisting with procedures.
Now, let's move over to another specialty field - Pysch. Tech. The educational requirement for these licensed personnel is usually around 1500 hours. This is a parallel field to a LVN/LPN with more emphasis in mental health. These people work in psychiatric facilities, spending time daily with the patients, handing out trays, doing classes and activities with the patients and looking out for the patients' ultimate safety when they're out of control.
Next, we'll move on to the LVN or LPN - Licensed Vocational or Practical Nurse - depending on which state you live in. The LVN actually has a license as well and is ultimately responsible and accountable for their actions. LVN School is usually 14 months long and includes classroom and clinical hours. LVNs have different roles in different states. I personally worked in 4 states as an LVN and each state is very different. In most states, LVNs do bedside nursing, have their own teams and are pretty much independent in their duties. There are some restrictions on medication administration - they can't do initial assessments, care plans, IV push or titratable medications. In California, the LVN role is more limited. LVNs usually work in clinics and doctor's offices as assistants. They usually work along side RNs doing more task oriented skills.
Some hospitals do use them at the bedside. Most patients don't realize there is a difference between LVNs and RNs.
Now back to the pre-hospital field. Paramedics, again, have different roles in different states. Some work in doctor's offices doing cardiac tests, some work in ERs or out of ERs as first response personnel. In big cities, paramedics usually run with the fire departments or private ambulance companies. Their course which includes classroom and clinical training varies from state to state again - usually anywhere from 600 - 1500 hours. Their skill levels are somewhere between a LVN and a RN - they can pretty much do everything a LVN is licensed to do, some things a RN is licensed to do, plus they can do advanced emergency procedures, airway management, intubation, needle decompressions, etc.. These people are usually the true adrenaline junkies. There is a high rate of burn out in this field due to all the tragedies they see.
OK, back to home base for me again. On to the RN - Registered Nurse. Now this is probably one of the most diversely educated and employed career of the bunch. RN's work everywhere - public health systems, schools, clinics, doctor's office, psychiatric facilities, hospitals, skilled nursing facilities, home health agencies; they work for private home care companies, private ambulance companies, air transport companies, the American Heart Assn., the American Red Cross, the military, the Motion Picture industry, private employers, etc.... There are so many endless possibilities out there for RNs. The education levels vary as well. You can go through a Diploma program, get your 2 year Associates degree, 4 year Bachelors degree - actually you can also have your Masters or Doctorate in nursing as well. One of the really nice things about nursing is you can find your own little niche, you can move around until you find what you really like, what fits you best. RNs have their own license and a lot of responsibility and accountability for their actions. They are the bedside nurse, the educator, the task oriented person, the assistant to the doctor. They often do research work or even work for the insurance companies. They are the telephone triage nurses. You see them, well, us, everywhere.
And when you want to move further up the ladder, you can - you can become a Nurse Practitioner, a Physician's Assistant or move into Administration or Education with your Master's or Doctorate Degree.
I think that sums up the roles and educational requirements. I hope I didn't put everyone to sleep - at least not yet.
Now, I want to talk about the nursing shortage - or what they call one anyway. Weigh in with me - do you really think there is a nursing shortage. I just listed all these positions - how can there be so many different positions -and be such a nursing shortage.
Well I may be wrong, but I have never really thought there was truly a nursing shortage. I've worked in 4 different states. They're all cranking out many, many classes of new graduate nurses. And nursing is a long career - well potentially anyway. You can be a nurse for 40 years at least - if you want. I've always felt like there are a lot of nurses and ancillary medical personnel. I just don't believe that we all stay in the field. I think we come and go as our lives change so that we can live our lives around that career. It's one that's easy to go in and out of. The pay is good. The hours are fairly flexible. I also am of the belief that facilities just can't afford to hire - or choose not to hire as much staff as they need. We've all worked in facilities where our ratios are ridiculous. I hope the days are gone on the floors where you're 7 - 10 - 15 patients to 1 nurse. It's not safe and I don't believe that it's that way too many places anymore. We all work short for one reason or the other - sick calls, vacations, budgetary restraints. And because of this, we lose a lot of nurses because they're just too overworked, stressed out and just plain tired. They feel under appreciated and choose to change careers. Such a shame we can't covet what we need the most - caring, trained and diligent patient care personnel. People taking care of people.
So they say we're in big trouble as time goes on, as we baby boomers become old - and as the nursing schools don't have enough funding or teachers. So what do you guys think? Is there a shortage - for real - or is it all just a figment of the countries imaginations?
And lastly, I just want to say nurses are not just numbers, we can't easily be replaced with the next one, any one - sometimes contrary to some people's beliefs. Once you find one or two or as many as you can find, you need to nurture them, connect positively with them, shower them with respect, listen to their concerns, and yes, complaints. You need to encourage them with positive reinforcement to get them to the next step. And sometimes, you need to pick them up off the floor and give them a hug and a kind word when things get tough. It's what keeps us here. It's what we need to keep going in such a highly charged emotional and stressful field.
And one more thing, we need to take care of ourselves first - before we can take care of our families, friends or patients. When our bodies are so tired and stressed, we sometimes get sick - physically or mentally - and we just can't go on without recharging. We can't minimize this - we must listen to what our bodies are telling us - and we must look out for each other and encourage self-care first. I fear we let one of our down recently - she just pushed herself too far - further than her body could handle. So to you Trisha, may you rest in peace. You had truly found your calling, your niche - you were a great person, a great ER nurse - good to your patients and co-workers alike. You'll be truly missed.
More on health care reform coming up. I've got to get back to reading that bill - next thing you know, there will be another out.
Well, I'm back after a couple of days off again. Seems like I'm starting to need a few days in between to gather my thoughts. I'd like to go off course a little bit from the health care reform issue today.
I think today I'm going to touch a little bit on medical personnel roles in the health care field - education level, job responsibilities, etc.... Then I want to wrap it up a little bit talking about the so-called nursing shortage - and my views on that. And in the end, I want to pay tribute to someone special who we recently lost, someone who had a calling to take care of others and did so so very well- in our ER.
I'll start with some of the ground level positions and work my way up the so-called ladder. Although, I don't want to imply that any position is any better or worse than any other position. It's important to remember that when a person is in the medical field, they land either where their heart lies or where they can afford to stay for the time being. That's why it's such a dynamic field - you can play where your strengths are and move around until you find what suits you best.
How many different hands-on patient care positions are there? To name a few, there are CNAs, Orderlies, EMTs, MAs, Psych. Techs., LVNs, Paramedics, RNs, PAs and NPs. Of course, these positions aren't all inclusive. There are still Techs in other departments - Radiology, PT, OT, Pharmacy, Cashiers, Clerks, Volunteers, etc... We all need each other to take care of patients.
I'll touch base on a few of these positions and their roles.
I suppose the entry level for many new people to the health care field would be the CNA - Certified Nursing Assistant. This is a very difficult job to do and one that requires a very special kind of person. These are the people who are most in touch with the patients - those who work at the bedside, taking vital signs, feeding, bathing, dressing and toileting patients. Although the hourly educational requirement isn't that high -usually around 75 + hours of classroom and clinical training - interpersonal skills are very important. I remember many a time a CNA saved my butt on the floor - coming to me to alert me that something was wrong with one of my patients.
Orderlies, though few and far between anymore, have similar educational requirements and job responsibilities of the CNA. Because a lot of orderlies are males, they also have the added responsibilities of working with equipment and lifting the patients. Ouch, my aching back.
Next we'll go to the pre-hospital side of the fence, the EMT, Emergency Medical Technician. The EMT certification class is usually around 140 hours of classroom, clinical and field training. EMTs in the field have varying tasks depending on what state you live in, where you work and how rural an area you live in. EMTs in the hospital mostly do task-oriented noninvasive procedures - splint applications, dressings, EKGs, lab draws, etc... EMTs in the field usually ride in the back of the ambulances and take care of the patients or assist the paramedics. Tasks may include splinting, dressing wounds, oxygen administration, spinal immobilization, CPR, etc... Many times, they are firemen or police officers as well. This field is very close to my heart. It's where I started - where the medical bug bit me. One summer I decided to take this class just for the fun of it. I thought it would be a great place to meet guys. True. I didn't even like blood, or couldn't imagine taking care of people, but that sure changed fast. It made me want more.
MAs - Medical Assistants again are an integral part of the health care team. Most vo-tech colleges and some nursing schools have MA classes. They can either go for a year - or two years and earn their Associates Degree. These are the people that usually work in clinics and doctor's offices. They are the ultimate assistant. They answer phones, schedule appointments, assist with billing, put patients in rooms, take vital signs, etc.... They can also do other tasks as long as they have been taught those tasks and the doctor they work for assumes responsibility for those tasks- ie) medication administration, blood draws, assisting with procedures.
Now, let's move over to another specialty field - Pysch. Tech. The educational requirement for these licensed personnel is usually around 1500 hours. This is a parallel field to a LVN/LPN with more emphasis in mental health. These people work in psychiatric facilities, spending time daily with the patients, handing out trays, doing classes and activities with the patients and looking out for the patients' ultimate safety when they're out of control.
Next, we'll move on to the LVN or LPN - Licensed Vocational or Practical Nurse - depending on which state you live in. The LVN actually has a license as well and is ultimately responsible and accountable for their actions. LVN School is usually 14 months long and includes classroom and clinical hours. LVNs have different roles in different states. I personally worked in 4 states as an LVN and each state is very different. In most states, LVNs do bedside nursing, have their own teams and are pretty much independent in their duties. There are some restrictions on medication administration - they can't do initial assessments, care plans, IV push or titratable medications. In California, the LVN role is more limited. LVNs usually work in clinics and doctor's offices as assistants. They usually work along side RNs doing more task oriented skills.
Some hospitals do use them at the bedside. Most patients don't realize there is a difference between LVNs and RNs.
Now back to the pre-hospital field. Paramedics, again, have different roles in different states. Some work in doctor's offices doing cardiac tests, some work in ERs or out of ERs as first response personnel. In big cities, paramedics usually run with the fire departments or private ambulance companies. Their course which includes classroom and clinical training varies from state to state again - usually anywhere from 600 - 1500 hours. Their skill levels are somewhere between a LVN and a RN - they can pretty much do everything a LVN is licensed to do, some things a RN is licensed to do, plus they can do advanced emergency procedures, airway management, intubation, needle decompressions, etc.. These people are usually the true adrenaline junkies. There is a high rate of burn out in this field due to all the tragedies they see.
OK, back to home base for me again. On to the RN - Registered Nurse. Now this is probably one of the most diversely educated and employed career of the bunch. RN's work everywhere - public health systems, schools, clinics, doctor's office, psychiatric facilities, hospitals, skilled nursing facilities, home health agencies; they work for private home care companies, private ambulance companies, air transport companies, the American Heart Assn., the American Red Cross, the military, the Motion Picture industry, private employers, etc.... There are so many endless possibilities out there for RNs. The education levels vary as well. You can go through a Diploma program, get your 2 year Associates degree, 4 year Bachelors degree - actually you can also have your Masters or Doctorate in nursing as well. One of the really nice things about nursing is you can find your own little niche, you can move around until you find what you really like, what fits you best. RNs have their own license and a lot of responsibility and accountability for their actions. They are the bedside nurse, the educator, the task oriented person, the assistant to the doctor. They often do research work or even work for the insurance companies. They are the telephone triage nurses. You see them, well, us, everywhere.
And when you want to move further up the ladder, you can - you can become a Nurse Practitioner, a Physician's Assistant or move into Administration or Education with your Master's or Doctorate Degree.
I think that sums up the roles and educational requirements. I hope I didn't put everyone to sleep - at least not yet.
Now, I want to talk about the nursing shortage - or what they call one anyway. Weigh in with me - do you really think there is a nursing shortage. I just listed all these positions - how can there be so many different positions -and be such a nursing shortage.
Well I may be wrong, but I have never really thought there was truly a nursing shortage. I've worked in 4 different states. They're all cranking out many, many classes of new graduate nurses. And nursing is a long career - well potentially anyway. You can be a nurse for 40 years at least - if you want. I've always felt like there are a lot of nurses and ancillary medical personnel. I just don't believe that we all stay in the field. I think we come and go as our lives change so that we can live our lives around that career. It's one that's easy to go in and out of. The pay is good. The hours are fairly flexible. I also am of the belief that facilities just can't afford to hire - or choose not to hire as much staff as they need. We've all worked in facilities where our ratios are ridiculous. I hope the days are gone on the floors where you're 7 - 10 - 15 patients to 1 nurse. It's not safe and I don't believe that it's that way too many places anymore. We all work short for one reason or the other - sick calls, vacations, budgetary restraints. And because of this, we lose a lot of nurses because they're just too overworked, stressed out and just plain tired. They feel under appreciated and choose to change careers. Such a shame we can't covet what we need the most - caring, trained and diligent patient care personnel. People taking care of people.
So they say we're in big trouble as time goes on, as we baby boomers become old - and as the nursing schools don't have enough funding or teachers. So what do you guys think? Is there a shortage - for real - or is it all just a figment of the countries imaginations?
And lastly, I just want to say nurses are not just numbers, we can't easily be replaced with the next one, any one - sometimes contrary to some people's beliefs. Once you find one or two or as many as you can find, you need to nurture them, connect positively with them, shower them with respect, listen to their concerns, and yes, complaints. You need to encourage them with positive reinforcement to get them to the next step. And sometimes, you need to pick them up off the floor and give them a hug and a kind word when things get tough. It's what keeps us here. It's what we need to keep going in such a highly charged emotional and stressful field.
And one more thing, we need to take care of ourselves first - before we can take care of our families, friends or patients. When our bodies are so tired and stressed, we sometimes get sick - physically or mentally - and we just can't go on without recharging. We can't minimize this - we must listen to what our bodies are telling us - and we must look out for each other and encourage self-care first. I fear we let one of our down recently - she just pushed herself too far - further than her body could handle. So to you Trisha, may you rest in peace. You had truly found your calling, your niche - you were a great person, a great ER nurse - good to your patients and co-workers alike. You'll be truly missed.
More on health care reform coming up. I've got to get back to reading that bill - next thing you know, there will be another out.
Subscribe to:
Posts (Atom)
