Last week we discussed 'modern medical organizations and health care and poverty as it relates to long term health care and urgent/emergency care'. Well, I attempted to discuss these topics!
Please understand, I am not making assumptions or believing the hype. I am working on the front lines and have been doing this for five years. I have worked in different parts of the state, in different clinics. This is what I know and what I see every single day.
Are all of my patients taking advantage of the situation? No. Do I like my job? Yes. Are there problems with the system? Yes. How do we change it? I don't know.
Another issue this question didn't ask in a direct way but still factors in, is insurance companies. I do not have an intimate relationship with any company but they are acutely aware of every move I make with my patients. Insurance companies, or health plans for my patients, are the gatekeepers. They decide who you see, when you'll see them, and if you'll see them. Not me. So, call them and get mad at them, not me! You may have heard about the recent scandal at Aetna; a medical director admitted to never looking at patient charts before granting or denying care. If a patient had chronic low back pain, had completed physical therapy without improvement, and had x-rays indicating more severe problems that could be better diagnosed with an MRI or CT scan, this doctor would not even review the chart before approving or denying my request on your behalf for the MRI or CT scan. This is the problem. People who not at all involved with your care making decisions about your health. In a perfect world, you would be able to give me a perfect history of your injury or case, we would complete all the conservative treatment, physical therapy, x-rays, etc., we would make referrals for an MRI and maybe even a neurologist referral. The insurance company would have a reasonable medical professional review your case and approve the imaging and referral. There are many, many stories of doctors arguing with insurance companies because they are denying care to patients. Obviously there is a role for the insurance companies; someone does need to ensure the proper documentation is in order and resource utilization, but it's doctors against doctors; one fighting for you, the other fighting to save money on behalf of the insurance company.
Without getting political, the current system isn't working. I remember being told if I liked my doctor and health plan, I could keep them! This hasn't been the case. I want a hybrid system. I want access to my providers and am willing to pay. I want to help my patients who cannot afford to pay. I don't want my patients to wait 2 years for a colonoscopy. There has to be a better way than what we currently use. It is not fair to keep the poor waiting while the rich get to the front of the line. It's not fair that the poor have no financial investment in the healthcare while relying on the rich to pay for everything. Again, the insurance companies (and pharmaceutical companies (don't get me started there!)) are the ones determining costs. A CT scan should cost as much for the poor as it does for the rich. Should we have a sliding scale fee based on income? I don't know. Should there be a cap on annual income that if you fall below, you get free healthcare? I don't know. Should it take 2 years to get a colonoscopy? No. I fall into the category of a hand up as opposed to a hand out. As you can see, this issue is so much greater than healthcare. Poverty, economics, politics, and immigration all play a substantial role.
I believe my clinic is doing the best we can. We advocate for our patients to receive low-cost medications and free clinic visits; free womens' health and pediatric care. We are responsible for being good stewards of the federal and state money we receive. The patients are responsible for being good patients! For taking care of themselves, for educating themselves, for evolving as medicine evolves, and for being good stewards of the services being offered.
Ultimately, that is what The Total Patient aims to be; a resource and source of empowerment and encouragement for you and your family during these changing times. What can you do for your family? How do you make the most out of your visits? How does the system work? Can we influence change? Absolutely! Share this blog and Facebook page with your friends and family, comment on what you want to learn about, write your political representatives about the changes you need, ask the pharmaceutical rep who makes all the money (just kidding...not really).
Friday, February 23, 2018
Wednesday, February 21, 2018
Paperwork
A bonus mid-week post about paperwork! (Because this just happened and it's fresh on my mind)
While each office is different, I'm going to assume some basic standard principles.
When you need paperwork completed; DMV forms, SDI, General Relief, etc., please give ample time for the completion. Translation: Do not expect to walk in, get the forms completed, and walk out 20 minutes later. Some forms require review of your chart, assembly and review of reports from specialists, consults from other providers. If the forms have a due date, please make an appointment or drop them off at least 2 weeks before they are due. 2 weeks?! Yes, because even though we have a policy to have forms completed within 72 hours, things happen. People call in sick, forms get lost (not often, but it can happen), weekends, holidays, lag time, etc.
Call the office and ask about the policy; do you need an appointment or can you just drop it off? Do you need an appointment to pick up, or can you just come in? How long is it expected to take? Will the office fax/mail your form, or do you need to do that?
Finally, please, please, PLEASE make sure your part of the forms are completed. I cannot tell you how many times patients give me paperwork to complete that are completely blank. No name, DOB, medical record number, nothing. Most forms will require your name, address, DOB. Please complete this portion and sign if you need to. So much time is wasted in returning forms because the patient has not completed their portion.
Have you had a paperwork horror story? What about a great experience? How does your provider handle paperwork?
While each office is different, I'm going to assume some basic standard principles.
When you need paperwork completed; DMV forms, SDI, General Relief, etc., please give ample time for the completion. Translation: Do not expect to walk in, get the forms completed, and walk out 20 minutes later. Some forms require review of your chart, assembly and review of reports from specialists, consults from other providers. If the forms have a due date, please make an appointment or drop them off at least 2 weeks before they are due. 2 weeks?! Yes, because even though we have a policy to have forms completed within 72 hours, things happen. People call in sick, forms get lost (not often, but it can happen), weekends, holidays, lag time, etc.
Call the office and ask about the policy; do you need an appointment or can you just drop it off? Do you need an appointment to pick up, or can you just come in? How long is it expected to take? Will the office fax/mail your form, or do you need to do that?
Finally, please, please, PLEASE make sure your part of the forms are completed. I cannot tell you how many times patients give me paperwork to complete that are completely blank. No name, DOB, medical record number, nothing. Most forms will require your name, address, DOB. Please complete this portion and sign if you need to. So much time is wasted in returning forms because the patient has not completed their portion.
Have you had a paperwork horror story? What about a great experience? How does your provider handle paperwork?
Friday, February 16, 2018
Hot Topics 2.0
One of the comments on the last post was in regards to my thoughts on current healthcare, specifically, "modern medical organizations and health care. I would also love to know your thoughts on poverty as it relates to long term health care and urgent/emergency care".
Let's tackle it!
Anytime there is a transition, there are growing pains. I'm not an expert on any of this, but I can offer my insights and would love to hear your thoughts, too. With the implementation of Obamacare or the Affordable Healthcare Act (ACA), we have seen a lot of changes. Personally, I have seen my premiums increase, coverage decrease, co-pays increase, and time with doctors decrease. While we are "young and healthy", we're concerned with what our healthcare options look like in the future. Professionally I see (some) patients weekly, there are no co-pays, medications are free or very low cost, they demand specialist care or additional unnecessary services (x-rays, ultrasounds). I am spending my own tax dollars on my patients! The downside to some of these services is the wait. For example, a patient with a positive fecal blood test can wait up to 2 years for a colonoscopy. A friend with PPO insurance recently waited 6 weeks....so, the wait is substantial.
Personally, deciding to go to the Dr is a big deal. How sick are we? How long have we been sick? Do we really need to go? Do I want to pay the $30 co-pay? Thankfully, I'm a nurse (!), so I can triage us at home and have us wait it out as long as possible! Obviously, if something is imminently wrong we go to the doctor.
Having the financial commitment by paying for insurance at work, co-pays, medications, etc., definitely creates an investment in my health. Some of the patients who have no financial investment take advantage of the system. They receive over-the-counter medications for free, do not have co-pays for their visits with me or other specialists, no deductibles. Unfortunately, this has created a sense of entitlement among some. We firmly believe that even a $5 co-pay for visits or labs or medications would greatly improve their buy-in to the own health. They would not come in for a visit for a runny nose for 3 hours. They would be proactive with their health at home and we would have better utilization of services. Because patients are coming in for runny noses for 3 hours, they take a spot for a patient who needs a pap smear because she had an abnormal one 6 months ago and has history of HPV. They take the spot for a patient who is having chest pain on exertion that is worsening. They show up in the ER for these things, too, impacting our hospitals.
I work in a low-income, urban clinic and see the ACA in action all day long. Most of my patients are living in poverty, some work, some don't, some are illegal, some aren't, young, old, middle aged, healthy, sick, depressed, and in pain. Many of them come from Third World countries. Our healthcare system is different than where they came from, but it's also in transition. We're confused and we live here; imagine how they feel! There is so much education that is needed, where do you begin? The patients I see come from countries that seem to be about 30 years behind us, medically. Most patients still want penicillin for everything. It's an uphill battle. Do I spend time educating about proper antibiotic use? Or proper use of the emergency room? Or the availability of acetaminophen and ibuprofen over-the-counter? Yes. I do all of that. And teach about diabetes, hypertension, and bacterial infections. In 20 minutes. It is nearly impossible to change an entire cultural belief system. I say 'nearly' because I have hope I can influence my patients who can teach their families who teach their friends. It's exhausting and mostly unrewarding, but the few patients who report back are what make the efforts worthwhile.
Check back next week for part 2 where I, hopefully, answer the initial question!
Let's tackle it!
Anytime there is a transition, there are growing pains. I'm not an expert on any of this, but I can offer my insights and would love to hear your thoughts, too. With the implementation of Obamacare or the Affordable Healthcare Act (ACA), we have seen a lot of changes. Personally, I have seen my premiums increase, coverage decrease, co-pays increase, and time with doctors decrease. While we are "young and healthy", we're concerned with what our healthcare options look like in the future. Professionally I see (some) patients weekly, there are no co-pays, medications are free or very low cost, they demand specialist care or additional unnecessary services (x-rays, ultrasounds). I am spending my own tax dollars on my patients! The downside to some of these services is the wait. For example, a patient with a positive fecal blood test can wait up to 2 years for a colonoscopy. A friend with PPO insurance recently waited 6 weeks....so, the wait is substantial.
Personally, deciding to go to the Dr is a big deal. How sick are we? How long have we been sick? Do we really need to go? Do I want to pay the $30 co-pay? Thankfully, I'm a nurse (!), so I can triage us at home and have us wait it out as long as possible! Obviously, if something is imminently wrong we go to the doctor.
Having the financial commitment by paying for insurance at work, co-pays, medications, etc., definitely creates an investment in my health. Some of the patients who have no financial investment take advantage of the system. They receive over-the-counter medications for free, do not have co-pays for their visits with me or other specialists, no deductibles. Unfortunately, this has created a sense of entitlement among some. We firmly believe that even a $5 co-pay for visits or labs or medications would greatly improve their buy-in to the own health. They would not come in for a visit for a runny nose for 3 hours. They would be proactive with their health at home and we would have better utilization of services. Because patients are coming in for runny noses for 3 hours, they take a spot for a patient who needs a pap smear because she had an abnormal one 6 months ago and has history of HPV. They take the spot for a patient who is having chest pain on exertion that is worsening. They show up in the ER for these things, too, impacting our hospitals.
I work in a low-income, urban clinic and see the ACA in action all day long. Most of my patients are living in poverty, some work, some don't, some are illegal, some aren't, young, old, middle aged, healthy, sick, depressed, and in pain. Many of them come from Third World countries. Our healthcare system is different than where they came from, but it's also in transition. We're confused and we live here; imagine how they feel! There is so much education that is needed, where do you begin? The patients I see come from countries that seem to be about 30 years behind us, medically. Most patients still want penicillin for everything. It's an uphill battle. Do I spend time educating about proper antibiotic use? Or proper use of the emergency room? Or the availability of acetaminophen and ibuprofen over-the-counter? Yes. I do all of that. And teach about diabetes, hypertension, and bacterial infections. In 20 minutes. It is nearly impossible to change an entire cultural belief system. I say 'nearly' because I have hope I can influence my patients who can teach their families who teach their friends. It's exhausting and mostly unrewarding, but the few patients who report back are what make the efforts worthwhile.
Check back next week for part 2 where I, hopefully, answer the initial question!
Friday, February 2, 2018
Hot Topics!
Just for the fun of it I Googled (why is the verb still marked as misspelled?!) "Hot topics in medicine" to see what the buzz was. Here are the results: mental health, vaccines, antibiotic use, should providers educate patients via social media (!!!!), is parental smoking child abuse, should you advise patients to drink coffee, do you honor a DNR tattoo (Do Not Resuscitate), is it time to modernize medical organizations (uh....YES!), the Paleo diet being healthier for postmenopausal, overweight women, poly-pharmacy, and legal marijuana.
This year we will explore some of these and more! What do you want to hear about? Meds? Conditions? Lifestyle? Let me know!
Obviously the social media one caught my eye so I clicked the link. There was a 2-question survey asking the following questions: Should doctors and scientists take a more active role in educating the public about medicine and health via social media? and Are you concerned that using social media to educate the public is a professional liability?
The results were what I expected; 85% of respondents said YES! We should take a more active role in educating our patients via social media and 61% said yes, they were concerned about liability. Liability is a major concern; which is why I remind you to follow up with your PCP if anything I have mentioned encourages or concerns you!
An informal poll on the Total Patient Facebook group showed 100% of all 7 voters enjoyed discussing health/wellness/medicine topics! Great! So, what do you want to talk about? Any topics I mentioned above that resonated with you? Anything specific you want to discuss?
Let me know!
This year we will explore some of these and more! What do you want to hear about? Meds? Conditions? Lifestyle? Let me know!
Obviously the social media one caught my eye so I clicked the link. There was a 2-question survey asking the following questions: Should doctors and scientists take a more active role in educating the public about medicine and health via social media? and Are you concerned that using social media to educate the public is a professional liability?
The results were what I expected; 85% of respondents said YES! We should take a more active role in educating our patients via social media and 61% said yes, they were concerned about liability. Liability is a major concern; which is why I remind you to follow up with your PCP if anything I have mentioned encourages or concerns you!
An informal poll on the Total Patient Facebook group showed 100% of all 7 voters enjoyed discussing health/wellness/medicine topics! Great! So, what do you want to talk about? Any topics I mentioned above that resonated with you? Anything specific you want to discuss?
Let me know!
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