When Illness Strikes – What To Do First

Any serious diagnosis thrusts patients and their families into an unfamiliar world of doctors, tests and treatment options.  They must simultaneously find information, make decisions under pressure, seek the best medical care, cope with family changes, and deal with insurance, financial, employment, caregiver or school issues.

Here are my suggestions as you begin the journey through illness.

 1.  Get smart fast.

Become a savvy, health literate advocate. Gather good information using only credible sources.  National advocacy groups often have excellent information, such as the Alzheimer’s Association.  For cancer research, start with the National Cancer Institute  and the American Society of Clinical Oncology.  An excellent site is UptoDate, a clinical database with many free patient articles.  The National Library of Medicine offers PubMed for academic research, articles and much more. Medscape is also a credible research site.

Beware of Dr. Google.  When evaluating health information on the internet, think about: Who operates the website? Who is responsible for the website’s content? Who funds the website? How does the website maintain your privacy? Where do they get their information? How current is the information on the website? Does the website have a linking policy? What does your doctor say?

Learn the vocabulary of your disease.  This will help you understand what medical professionals tell you and position you to be a better advocate for yourself.  Doctors respect that.

 2.  Get organized.

Take names and take notes from the very start.  It doesn’t matter if you use a computer program or a small notebook.  Develop a system that works for you.  Keep a chronology of conversations and doctor visits, diagnostic and lab test results, symptoms, treatment plans/options, medications and any reactions to them.  Collect business cards of your providers and keep them in a plastic sleeve.

Prepare a medical history and medication list.  You may be seeing many doctors or specialists.  Type up a clear, concise medical history.  Ask the nurse to put it in your chart and hand a copy to the doctor.  You’ll still have to fill out their forms, but they might pay more attention to your document than the form.  Keep an up-to-date medication list and bring it to every visit.

Read and understand your insurance policy.  Learn the definitions and differences between co-pays, deductibles, co-insurance, pre-authorization, out-of-network, formulary tiers, denials, appeals and all the rest.  Ask for an insurance case manager for complicated situations.  Always check to see whether the medical professional you want to use participates in your insurance.

 3.  Stand your ground, nicely.

Make friends and learn names.  You will need the help of front office staff, aides, nurses, and the billing office.  Especially in a big institution, it helps to know and ask for specific people.

Come prepared.  Bring questions to your doctor visits but don’t dump 12 inches of Google research on their desk.  Bring a note taker if possible.  Be mindful of the physician’s time but don’t let yourself get rushed out of the office if you haven’t finished.

 Get second or third opinions.  Don’t feel stuck with the treatment team that first saw or diagnosed you.  Ask for a full range of treatment options and research them yourself as well.  You are the center of the medical team you will be building.  Make sure you are satisfied with your doctors’ credentials, experience and bedside manner.  Verify that the doctor accepts your insurance.

Ask about medications or tests that you are being prescribed and why.  There may be alternatives, like a cheaper generic medication.  Or maybe you don’t need another MRI so soon.  Remember, doctors have no idea or concern about what things cost you, your insurance or Medicare.  Their “defensive medicine” can cost you a fortune.

 4.  Always follow up.

Never assume things will work as they should.  If someone tells you he or she will do something – consult with a colleague, order a test, fax a document, call you with results, talk to your insurance, phone in a prescription – make sure to follow up yourself.  All too often, these things fail to happen as promised, with sometimes serious consequences.

Schedule appointments as early as possible.  Many specialists are booked months in advance.  You can ask to be put on a cancellation list and call frequently to check for unexpected openings.  This is where the “making friends” advice can help.

 Continue your medical education.  Medical breakthroughs happen every day.  Once you have identified your credible sources, check regularly for new information.  Google Alerts are one useful tool that will send updates on the topics you request.

Posted in Cancer, Caregivers, Chronic Disease, Elder Care, Government Agencies, Insurance, Other health issues, Patient Centered Care, Problem Solving, Uncategorized, Women's Health | Tagged , , , , , , , , , | Leave a comment

Holiday Grief – Survival Tips

Many people experience depression during the holiday season. This is not surprising given that we are bombarded with loud Christmas music wherever we go, incessant advertising and a non-stop drumbeat to shop, buy, spend and create the perfect Hallmark holiday. It is hard not to feel stressed out if you then add the pressure of entertaining, houseguests and a long list of expectations.

Now imagine trying to face all this when you are grieving the loss of a loved one.

It is very hard. It is painful. It is unbearably sad.

I lost my mother very suddenly and unexpectedly in May 1990, when she was 63 and I was 31. I made the decision to skip Christmas entirely that year – no tree, no gifts, no decorations. I simply could not bear it.

Fortunately, my boyfriend (now husband) understood and supported me, and there were no children to worry about back then. It was the best I could do.

The pressure to go along with the holidays is intense. Here are my own tips on how to get through them if you are grieving.

1. Don’t let anyone pressure you or try to tell you what will make you feel better. Only you know what helps.

2. Remember your loved one in whatever way seems right – a walk in the woods, a prayer service, watching their favorite movie, setting a place at your table. You don’t need anyone’s permission or concurrence.

3. Don’t be afraid to tell people that it really is not a Merry Christmas or Happy Holiday for you. Let your colleagues at work know that the season is hard for you and ask them to understand if you are distant.

4. Learn to say no.

5. Give yourself permission to mourn. It is normal and necessary. And then tell yourself gently, over and over, that you will not always feel this way. And, in time, you won’t.

I’ve learned a great deal over the years about loss and grief. I’ve learned to grow from each loss in my life, but it has taken a lot of work and faith. If you are grieving this holiday season, you are not alone. But please know and believe, with all your heart, that you will not always feel the way you do now. Time does heal. Things will get better.

For more information on grief and the holidays, I suggest:

Therese A. Rando, PhD. Grieving: How to Go on Living When Someone You Love Dies. (Note: This book saved me as I grieved the loss of my mother).

GriefShare,  Surviving Grief During the Holidays

Wendt Center for Loss and Healing, Washington, D.C. Happy Holidays?

National Hospice and Palliative Care Organization, Grieving During the Holidays

Posted in Caregivers, Elder Care, Integrative Care, Mental Health, Other health issues, Patient Centered Care, Survivorship, Uncategorized | Tagged , , , , , , , , | Leave a comment

Patient Navigators – Who We Are and What We Do

The History of Patient Navigation, Healthcare Advocacy and the Creation of NAHAC

By Elisabeth Schuler Russell

Founder and President, Patient Navigator LLC

President, National Association of Healthcare Advocacy Consultants

What is the origin of patient navigator and advocacy?

Patient advocacy, or patient navigation, is gaining attention as an emerging profession, both in the media and in the popular lexicon, because it fills so many gaps in the current American health care system. This is especially true today as we begin full implementation of the Patient Protection and Affordable Care Act, which portends considerable change for consumers in how health care is delivered and paid for in this country.  Patient navigation was considered an important component in healthcare reform as discussed by oncologists in this article.

The original concept of patient navigation was pioneered in 1990 by Dr. Harold P. Freeman, a surgical oncologist at Harlem Hospital, for the purpose of eliminating barriers to timely cancer screening, diagnosis, treatment, and supportive care. Many individuals in medically underserved or minority communities were at risk because of financial, communication, health care system and cultural barriers to care.

In 2005, U.S. policymakers came together to support the Patient Navigator Outreach and Chronic Disease Prevention Act of 2005 (Public Law 109-18). With unanimous support in Congress, and under the leadership of Senator Robert Menendez (D-NJ), the Act authorized the Secretary of Health and Human Services to make grants through 2010 for the development of patient navigator programs. A total of $25 million was awarded over five years to develop community-based navigation programs. The Center to Reduce Cancer Health Disparities was created at the National Institutes of Health.

Over the years, data from Dr. Freeman’s programs and others began to prove how valuable navigation could be to improve cancer diagnosis and treatment outcomes. For example, studies found that patient five-year survival rates went from 39% (prior to the development of the patient navigator program) to 70% for breast cancer patients at Harlem Hospital.

These types of positive outcomes have given rise to other community-based navigator efforts. The American Cancer Society, The Susan G. Komen Foundation, and the National Cancer Institute have all supported various navigator research efforts based on the success of Dr. Freeman’s model.

Another part of the navigator landscape is now seen in hospital-based nurse navigators, particularly for breast cancer patients. In most cases, these hospital-based navigators primarily manage the patient’s needs during the hospital stay and discharge planning and they work for the hospital. They usually also only refer to services within the hospital system that employs them.

Most recently, the Affordable Care Act required that “insurance navigators” be available to help consumers research and enroll in health insurance through the law’s health insurance marketplace, the “exchanges.”

It’s no wonder that there is confusion about these definitions.  Since Dr. Freeman’s groundbreaking work in Harlem, the concept of navigation or advocacy has grown far beyond cancer and essentially now covers almost anything being done to help patients and families find their way through the maze of our healthcare system.

What are private patient advocates and navigators?

Even as the U.S. Government had begun to address the disparities in access to cancer care among specific communities and populations in the past eight years, the idea of private, one-to-one patient advocacy was born of necessity as a way to mitigate the complicated, inefficient, expensive and fragmented healthcare delivery system in the United States.

Since 2005, the concept of private patient advocacy has taken on a life of its own. More people are learning that they can hire an advocate or navigator to help them with their medical problems, to overcome obstacles in the healthcare system or to find resources in the same way that people now seek out personal trainers, life coaches, financial advisors or other “guides” whose expertise can help them solve problems and avoid pitfalls.

What kinds of things do patient navigators or advocates do?

Private patient advocates and navigators in most cases work directly with and are paid by individuals and families. Private advocacy or navigation services are not generally covered by insurance, despite the fact that many studies prove that better coordination of medical care saves money and improves outcomes. There have reportedly been some instances in which health flexible savings accounts were allowed to be used to pay for navigator or advocate services.

The names for this work may vary (patient advocate, navigator, health care advocate or consultant, medical advocate) but the basic idea is the same. We work with patients and families to help them at many points along the health care continuum: disease research, insurance problems, finding doctors, understanding treatment and care options, accompanying them to visits, serving as coach and quarterback of their health care team, working with family members and caregivers, mobilizing resources, managing medical paperwork and almost anything else you can think of.

Not every advocate does all of these things, and there is no single business model or list of services. Some advocates only work with senior citizens, others only with cancer patients or others only to solve medical billing problems. It depends entirely on the individual’s business and practice.

Who are these private advocates and navigators?

The majority of people who want to do this work come to it because they have been through a life-changing medical event, either for themselves, a friend or a loved one. They have learned the hard way how difficult it is to navigate and manage a complicated diagnosis, treatment or chronic condition. They experienced the confusion, lack of coordination, dangers and inefficiencies in our health care delivery system and now they want to share both what they have learned and how to avoid missteps along the way.  In many cases, these are laypeople with no prior medical experience or training.

Increasingly, more nurses and physicians are becoming private advocates, often after having worked within the healthcare system.  While hospitals will generally only hire nurses or other medically-licensed professionals to serve as their in-house navigators, most private advocates come from a variety of backgrounds.

The National Association of Healthcare Advocacy Consultants

In August 2009, the National Association of Healthcare Advocacy Consultants (NAHAC) was founded by Joanna Smith, the owner of Healthcare Liaison, in Berkeley, California.  A handful of early believers realized that individuals working as advocates (or navigators, healthcare consultants, etc.) needed to come together to begin to professionalize this emerging private patient advocate/patient navigator industry and to educate consumers about its existence and usefulness.

After holding two national conferences in 2009 and 2010, the NAHAC Executive Committee transitioned NAHAC into a non-profit organization whose mission is to professionalize healthcare advocacy and provide healthcare consumer education to the public.  NAHAC became a 501c3 non-profit organization in 2011. We subsequently held another national conference in 2012. Our members enjoy access to monthly educational events and professional networking opportunities.

Members of NAHAC must abide by our Code of Ethics, which in August 2012 was cited as a model by the American Medical Association.  In 2013, we are developing a model of Best Practices that we hope will be broadly adopted by the advocacy community.

Patient Advocacy Credentials

At present, patient advocacy/navigation is not a regulated profession. There is no national or state licensure. There is no nationally recognized credential for calling yourself a patient advocate or navigator.  Many organizations or schools now offer “certificates” in navigation or advocacy but none of these is a national credential.

To tackle the issue of setting standards and competencies for the profession, in January 2013 a group of individuals representing various advocacy constituencies came together to undertake the task of developing a national patient advocacy credential that will be substantive, accredited, recognized and adopted.  More information can be found on this group’s website.  Two members of the NAHAC Board of Directors are members of this group’s steering committee, and we foresee a confluence of interests and mandates as we collectively move to build an excellent professional credential.

As with any infant industry, there is a lot of experimentation that goes into charting new territory. But it should reassure consumers that as the need for advocacy services grows, they will have a reliable way to find and screen patient navigators and advocates and that they can rely on NAHAC to assist them.

What’s in store?

It’s clear that the concept of patient advocacy is here to stay.  Our challenge is to continue to build the profession, ensure its members adhere to specific standards, ethics and best practices and to help consumers who know we are and how we can help.

We can also expect the concept of guides/navigators/advocates to become an ongoing part of the healthcare delivery system, whether through private advocacy practices, new medical home models, accountable care organizations, or within the healthcare system itself.  Our goal is to be recognized and understood as integral members of a healthcare team with a unique “quarterback” role to play.

October 2013

 

 

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Medicare 2013 Open Enrollment Period October 15-December 7

Medicare’s 2013 Open Enrollment Period will run from October 15 through December 7.  During this period, people with Medicare can change their Medicare health and prescription drug plan coverage options.  Changes that are made on or before December 7 will take effect on January 1, 2014.  The official Medicare site is quite user-friendly and is a good resource to answer your Medicare questions.

This year, you may hear a lot about the Health Insurance Marketplace. The Marketplace Open Enrollment period (October 1, 2013–March 31, 2014) overlaps with the Medicare Open Enrollment period (October 15–December 7, 2013). The Marketplace is designed to help people who don’t have any health coverage. If you have health coverage through Medicare, the Marketplace won’t have any effect on your Medicare coverage.

This is also a good time to review your Part D Prescription Drug Plan coverage.  If your medications have changed, it may be worth your while to do some research which you can do by creating a drug list online through the Medicare site to see which plans cover your medications and to shop for the best deal.

If you are happy with your Medicare plan, there is no need to take action.

The official Medicare site has done a great job explaining the basics in a user-friendly way. The Medicare Rights Center has posted a useful article that sums up Part D Enrollment options.  The Center offers several useful newsletters that can help you stay informed.

You also have the option, through the MyMedicare portal, to set up your own account to track claims, providers, and manage your health and medications list.  The site offers tools to compare nursing homes and Medicare plans.

A word of caution about changing Medicare health (not drug) insurance plans:  Private Medicare Advantage Plans (Part C) can start marketing to you as of October 1.  These are private HMO insurance plans that contract to Medicare to provide your services; they are not traditional Medicare.

Before you make any decisions or changes to your Medicare, do your research. Don’t let a fancy marketing brochure fool you.  In our experience, patients with Medicare Advantage plans have often had problems with access and coverage for their healthcare needs.   We encourage our clients should stick with traditional Medicare:  Part A – hospitalization, Part B – outpatient, Part D – prescription drug plan plus a Medigap supplement policy to cover the 20% Medicare does not cover.

As always, we can help you research and analyze your insurance options.

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Obamacare Insurance Exchanges Launch Today

Here is an excerpt from my recent article on the Affordable Care Act. This excerpt focuses on the insurance mandate, exchanges and subsidies.

Workplace Health Insurance

About 50% of us get insurance through employers or the workplace.  For those people, not much will change although they will benefit from caps on out-of-pocket expenses and certain free preventive care.  (Note: Employers generally seem to be offering higher deductible plans which provide an incentive for consumers to be conscious of their health care spending.  But that trend toward high deductible plans is unrelated to any provision of the Affordable Care Act.)

A bigger change down the road will be for companies with more than 50 employees who do not get insurance coverage now from their employer.  As of 2015, the government will require these companies to cover full-time workers or pay a penalty. This provision is designed to get more employees covered.  One controversy arises over whether this requirement will force employers to stay under the 50 employee threshold or offer less than full-time work to avoid paying for employee health insurance.

Smaller employers won’t face the same penalties for refusing to buy insurance but as an incentive, the government will set up special small business marketplaces to make it easier.  Unlike now, insurance companies won’t be allowed to inflate prices for these small group plans if some employees are sick.

Purchasing Your Own Insurance – The Exchanges Open on October 1, 2013

In my view, one of the best things about the Affordable Care Act is that it will make health insurance available to millions of Americans who are now completely uninsured, and more affordable for the 14 million who buy their own coverage (because they are self-employed, a retiree under 65 or a part-time worker, for example).  In our advocacy practice, we have seen first-hand the often devastating financial and medical outcomes when an uninsured person gets sick.  If you purchase insurance through the exchanges between October 1 and December 15, you will be covered by January 1, 2014.

That being said, another controversy over the Affordable Care Act is precisely because there will be a mandate that everyone must be covered by some type of health insurance, whether through an employer, the Government (Medicaid, Medicare, the military) or through private purchase of insurance.  Those who are choose to remain uninsured will pay a penalty.

At the centerpiece are the Health Care Exchanges or Marketplaces that are being set up in each state.  There are 16 states plus the District of Columbia which decided to set up their own exchange.  34 states (generally with Republican governors and legislatures) chose not to set up an exchange and have defaulted to a Federal model. The remaining seven states will operate an exchange in partnership with the Federal Government.  You can learn more about your own state here.

The marketplaces are designed to be a virtual insurance shopping mall with approved plans competing for business.  The qualified plans that participate in the Exchanges will be required to offer a uniform minimum benefits package which would be offered at four levels of value (Bronze-Platinum), making comparisons across plans easier.

The essential health benefits in these uniform packages must include at least the following general services:  ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health benefits and substance use disorder services, prescription drugs, rehabilitation services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care.

Plans may offer catastrophic coverage that doesn’t meet one of the four levels of coverage, but only to enrollees under the age of 30 or those who would otherwise be exempt from the requirement to purchase coverage because the premium exceeds 8% of their income.

The National Patient Advocate Foundation has made a useful brochure on the marketplaces available here and you can learn more about shopping for coverage here.

You should note that insurance plans that existed before March 23, 2010, and have been “grandfathered” into the system may be exempt from some provisions.  You can learn more here.

Premium subsidies and tax credits to make insurance more affordable

Federal subsidies in the form of premium tax credits to make the coverage more affordable will be available to consumers meeting income requirements.  U.S. citizens and legal immigrants who purchase coverage in the new health insurance exchanges and who have income up to 400% of the federal poverty level ($43,320 for an individual or $88,200 for a family of four in 2009) will be eligible for Federal subsidies.

To be eligible for these tax credits, individuals must not be eligible for Government coverage – including Medicaid, the Children’s Health Insurance Program, Medicare, or military coverage – and must not have access to health insurance through an employer.

Cost-sharing subsidies that reduce a plan’s deductibles, co-payments and total out-of-pocket costs will be available to people with incomes up to 250 percent of the poverty level, or about $29,000.

You can use this subsidy calculator developed by the Kaiser Family Foundation to see what your costs may be. (There is an exception in cases when the employer plan does not cover at least 60 percent of covered benefits on average or the employee share of the premium exceeds 9.5% of the employee’s income.)

There will be insurance “navigators” available in each State to help individuals understand the marketplaces.  However, the amount of help available depends on how actively and publicly the State is moving forward with ACA implementation.  Some states have passed laws restricting navigators or other organizations from explaining the law to the public.

Good sources of information about the exchanges include a National Patient Advocate Foundation guide, the Department of Health and Human Services, and the Kaiser Family Foundation.

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The Affordable Care Act Explained

In the Autumn Edition of the Patient Navigator newsletter, we devoted an entire special edition to explaining the Affordable Care Act (“Obamacare”) and its key points.  We cover the patient protections, insurance mandates, subsidies and insurance exchanges, Medicare and Medicaid.  We provide many additional sources of credible information for your use.   In our view, everyone needs a clear explanation of the law and what it means.

Please read this important newsletter here to become an informed healthcare consumer.

Posted in Elder Care, Government Agencies, Health Care Reform, Insurance, Patient Centered Care, Problem Solving, Uncategorized, Women's Health | Tagged , , , , , , , | Leave a comment

Tongue-piercings: who knew they could help you get around?

You may love your tongue piercing, or perhaps you once made it clear to your kids that they wouldn’t have one as long as they were living under your roof. But they may someday be instrumental in helping folks who have lost the function of their arms and legs in getting around on a daily basis.

Scientists at Georgia Tech have developed the Tongue Drive System — it uses a magnetic tongue stud and a series of magnetic sensors, attached to an inconspicuous retainer held in the roof of the mouth, to allow the patient to use their tongue to pilot their motorized wheelchair. As the stud moves across the sensors, the retainer transmits the movement to an iPod or iPad. The Apple device then determines the stud’s position relative to the various sensors, and controls the wheelchair directly by either controlling the positions of a cursor on a touch screen or by substituting for the function of a joystick.

This gives the system several advantages over the current “sip and puff” technology:

  • · it allows the patient to be more discreet in controlling the chair
  • · it can be programmed with as many commands as the patient can remember
  • · all the commands are available to the patient at the same time
  • · patients usually become proficient and accurate faster

The scientists have created a universal interface so the Tongue Drive System can be attached to any motorized wheelchair. The system is currently in a clinical trial, and being tested among 11 patients.

Posted in Chronic Disease, Clinical Trials, Other health issues, Patient Centered Care, Problem Solving, Uncategorized | Tagged , , , , | Leave a comment

Study documents adverse effects of pitocin on newborns

On May 7, 2013 the American College of Obstetricians and Gynecologists released its comments on the results of a study of the adverse effects of Pitocin on newborns.  I can only hope that the doctors who routinely prescribe this drug for all their laboring moms actually pay attention, and try to practice evidence-based medicine.

The ACOG news release states that “Researchers say this is the first study of its kind to present data on the adverse effects of Pitocin use on newborns.

Are we seriously only now looking at the potential adverse reaction for the babies?  When a huge percentage of moms get induced and even more have their labor augmented with pitocin, shouldn’t we have looked at the effect on babies BEFORE we started using it routinely?

The findings of the study cannot possibly be brand new information.  Drugs.com currently states: “General side effects have included low Apgar scores at 5 minutes. Fetal death has been reported.” “Nervous system side effects… have included neonatal seizures and permanent CNS or brain damage has been reported.” “Hepatic side effects have included neonatal jaundice.”  “Overdosage with oxytocin… can lead to… variable deceleration of fetal heart, fetal hypoxia, hypercapnia, perinatal hepatic necrosis or death.”

How many mothers were told these potential side effects for their babies when having an informed consent conversation about administration of synthetic oxytocin?  Or were they told it’s for the good of your baby and it’s perfectly safe?  Do their doctors even know the risks of the drugs they are routinely administering or are they knowingly lying about safety?  How many moms have been told “pitocin is the same as the oxytocin your body makes?”

Pitocin is routinely administered in high doses that would be IMPOSSIBLE for the body to make on its own.  And it is forced into the bloodstream in a continuous flood, as opposed to the ebb and flow of the hormone that the body naturally synthesizes.

As a result, the mom’s own endocrine system is overwhelmed and prevented from synthesizing its own endorphins and its own oxytocin.  Synthetic oxytocin (Pitocin) blocks the receptors and prevents the body’s own oxytocin from doing its job of changing the neurological pathways of the brain so that you bond with the people around you.  Babies’ receptors will also be blocked interfering with the baby’s brain’s development of the ability to interact and bond with others.

Clearly, the short term negative effects on the baby of the routine administration of pitocin are documented.

But what about the long term effects?  What might result from interfering with the neurological and endocrine processes in the vulnerable and intense perinatal period?  When the brain and body are undergoing massive programming changes, isn’t it possible that, by chemically interfering with these changes, we are causing long-term disruptions? Is it just coincidence that the dramatic increase in autism spectrum diagnoses parallels the dramatic increase of routine pitocin administrations in the majority of births in the US?  There is a conspicuous absence of any mention of long-term effects both in the study and in the ACOG comments.

Why does our socio-medico culture accept the development of a drug, assume it’s safe without fully looking into short-term or long-term implications, and then say whoops sorry, we shouldn’t have done that, when it becomes clear that there are negative outcomes?

The doctors and drug manufacturers are not the ones who suffer the consequences.  The patients and their families are the ones who pay the price of just assuming that it is okay to use a drug, especially on the most vulnerable of our population, without really checking to make sure that it is, in fact, safe.

Unfortunately, the ACOG release falls short of criticizing this practice, stating only that: “The analysis suggests that [synthetic] oxytocin use may not be as safe as once thought and that proper indications for its use should be documented for further study.”

ACOG Release on the Study on the Effects of Pitocin on Newborns

http://www.acog.org/About_ACOG/News_Room/News_Releases/2013/Study_Finds_Adverse_Effects_of_Pitocin_in_Newborns#.UYkdLeDO_9s.facebook

Maternal Side Effects of Pitocin

http://www.drugs.com/sfx/pitocin-side-effects.html

Submitted by Guest Editor Debora Harvey, Patient Navigator LLC

 

Posted in Government Agencies, Integrative Care, Other health issues, Patient Centered Care, Patient Safety, Problem Solving, Uncategorized, Women's Health | Tagged , , , , | 1 Comment

Transportation Help After Medical Services

Connections to healthcare are critical for people managing a serious illness or condition. Often patients are unable to drive themselves to and/or from medical appointments. Many people depend on family, friends and neighbors for rides, but what if these resources are not always available? Transportation is a key part of a treatment plan.

Easter Seals Project ACTION and the American Medical Association have a new pocket guide for patients considering transportation options before or after a medical procedure.

The Planning for Transportation After Medical Services pocket guide is available in English and Spanish. It provides information and tips about planning for transportation, the types of transportation available, considering how your health status affects the type of transportation you choose, and also includes a place for notes and phone numbers.

You can download or order print copies of the brochure from the American Medical Association webpage for free.

Guest Editor:  Lucinda Shannon, Easter Seals

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Health Care Reform Changes in 2013

While many of the Patient Protection and Affordable Care Act of 2010 provisions have been implemented, there are some notable changes in 2013 that may affect you.  This year will be busy with States preparing to launch in 2014 either their own or a Federal health insurance exchange.

According to a useful Guide from Consumer Reports, here’s what to expect this year.

Standard disclosure forms. Beginning in September 2012, all health plans had to use a standardized, consumer-friendly form to provide a uniform summary of benefits and coverage, including information on co-payments, deductibles, and out-of-pocket limits. This will make it easier for you to compare plans.  Insurers will also have to calculate and disclose a patient’s typical out-of-pocket costs for two medical scenarios: having a baby and treating type 2 diabetes. See a sample form (PDF).

Caps on Flexible Spending Accounts (FSAs). Employers could still set their own limits (usually $2,500 to $5,000) on FSAs in 2012. But in 2013, the most you can set aside tax-free for medical expenses not covered by insurance will be $2,500, with the cap increasing by the annual inflation rate in subsequent years.  Plus you can no longer use FSAs to pay for over-the-counter drugs unless you have a doctor’s prescription. The cap takes effect January 1, 2013. For people with 2012-2013 health care plans that run on a fiscal (rather than calendar) year, the cap kicks in July 1, 2013. Read more about FSAs.

New Medicare tax for high earners. Two Medicare-related taxes will impact high earners in 2013. Individuals earning over $200,000 (or $250,000 for couples who file jointly) will see their Medicare payroll tax rate increase from 1.45 percent to 2.35 percent. They’ll also pay a new 3.8 percent Medicare tax on unearned income, including investments, interest, dividends, annuities, rent, royalties, certain capital gains and inactive businesses.  Read more about Medicare.

According to the Kaiser Family Foundation, other changes in this timeline include:

Phasing-in federal subsidies for brand-name prescriptions filled in the Medicare Part D coverage gap (reducing coinsurance from 100% in 2010 to 25% in 2020, in addition to the 50% manufacturer brand-name discount).

Establishing a national Medicare pilot program to develop and evaluate making bundled payments. The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care.  Under payment “bundling,” hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare.

For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care. It seeks to align the incentives of those delivering care, and savings are shared between providers and the Medicare program.for acute, inpatient hospital services, physician services, outpatient hospital services, and post-acute care services for an episode of care.

Increasing the threshold for the itemized deduction for unreimbursed medical expenses from 7.5% of adjusted gross income to 10% of adjusted gross income; waives the increase for individuals age 65 and older for tax years 2013 through 2016.

Increases payments to primary care doctors treating Medicaid patients and more funding for preventative services.

For a full timeline of all the changes, click here.

As always, you need to keep up with these ongoing changes.  Good sources are the  Government site and Kaiser Family Foundation.

 

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