Monday, November 30, 2009
On George Stephanopoulos' Sunday show, Senator Bernie Sanders (VT) said: "I've got about ten separate amendments." Senator Sanders is not alone as the amendments begin to line up. The home health industry is hoping Senator John Kerry comes through with one that will minimize the negative impact on reimbursement for services. And interested parties everywhere are calling and writing their favorite senators asking for help. Reid, the President and other leaders will be busy over the next few days asking Senators to exercise caution for fear that the process may slow or even halt.
Much has been written and said about the demise of print media as the Internet with its instant access, real time delivery of information and flexibility in medium (computer, cellphone) takes over. Well, for the past few weeks, I've been experimenting with the Globe's new "GlobeReader" service. More info here. This is a paid service whereby every morning a fresh copy of that day's paper is downloaded to your PC (or Mac). Unlike www.boston.com, you have full access to the paper (including crossword puzzles), can increase or decrease font size, email links or full copies of articles, retain seven full days of content, easily navigate full articles, and "subscribe" on multiple home computers. You need Internet access for only the few minutes it takes to download that day's news.
Ultimately, we'll see if this service flies and whether the Internet generation, accustomed to reading news for free via web browsers, will find this a valuable way to get information. My own conclusion, after just a few weeks, is that this makes sense. Saving (i.e., clipping) articles is a snap, I can read the news wherever I can access a laptop (which is nearly most places these days) and I don't mind that this is environmentally friendly as well.
I'll let you know how it goes after another few weeks.
Saturday, November 28, 2009
Tuesday, November 24, 2009
- 216,000 children in Massachusetts have a diagnosable mental health disorder, 70,000 of which are deemed "severe"
- 32% of providers are not accepting new patients and another 39% have only 1-2 open slots available for new patients
And here's the one that caught my attention:
- 54% of providers of children's mental health services between the ages of 35 and 54 plan to leave direct care or Massachusetts within 5 years
Perhaps too much can be read into such statistics, but they do point out that the current problem of difficulty in accessing child mental health services is likely to get worse. Patients with untreated mental health concerns experience a greater number of health problems, a shorter life span, and suffer from a deterioration in quality of life.
What's the solution?
Friday, November 20, 2009
- Major provisions of reform (e.g., creation of health care exchanges, expansion of Medicaid to 133% of Federal poverty level) delayed from 2013 to 2014
- States can opt out of the government run public health plans (via individual state legislation)
- Beginning in 2014, most Americans will be required to purchase health insurance or face fines of $95 that year, growing to $750 by 2016; note that many worry that the fines are not stiff enough to motive enough to purchase insurance
- Employers are not mandated to provide insurance, but firms of greater than 50 employees who don't will pay a penalty if workers receive government subsidies to purchase coverage through one of the new exchanges
- New taxes? 5% on elective cosmetic surgery, an increase in Medicare payroll tax on individuals earning over $200,000 a year and couples over $250,000.
- High cost insurance plans (with yearly premiums of $8,500 for individuals or $23,000 for families) will be subject to a 40% excise tax - - a provision designed to reduce health care costs
- CHIP program not eliminated as some had speculated
- Rescissions (i.e., when insurers cancel policies once holders become sick) no longer possible
- Medicare will remove all copays and cost sharing on preventive services
The Senate could begin debate on this as soon as tomorrow.
Thursday, November 19, 2009
Wednesday, November 18, 2009
Tracking numbers such as these will become even more important as we head into next year's election cycle. The Senate is working feverishly to come up with a plan that will support the President's top domestic priority... but which won't prove too costly politically. And time is of the essence.
Tuesday, November 17, 2009
The more recent focus has been on the payer side of health care, hence the fact that many if not most discussions now describe this as health insurance reform. Big difference. The question is: why the change?
Cynics may answer that the powerful provider lobbies (AMA and AHA) and big businesses (i.e., the pharmas and equipment manufacturers) have found a way to successful apply pressure on legislators. Maybe that's true, but I wonder if the lawmakers have rediscovered the longstanding challenges associated with reigning in health care costs. The challenges pertain to the fact that while there are some excesses and inefficiencies in this sector (show me one where there are not), cost cutting efforts quickly get into the sticky issues of negatively impacting quality, limiting choice, and restricting care to some (aka rationing - and no public figure wants that association).
Early rhetoric, including the President's, centered around driving improved quality as a way to appropriately shift incentives and lower overall costs. Evidence strongly supports this general idea, but the current House reform bill and the pending Senate one don't seem to support these concepts as much as the early arguments indicated they might.
Monday, November 16, 2009
Thursday, November 12, 2009
- Some are speculating that the "real" deadline is mid-January, coinciding with the President's state of the union address; others, however, point to the intense pressure coming from the White House to get this done this year. Congressional leaders are stating a willingness to work seven days per week through the holidays in order to make this happen.
- Sticky items to watch are: the ability to opt out of the public option, the open funding questions, abortion and immigration issues
- Keep an eye on Maine's Olympia Snowe (she's not a fan of the public option); everyone is counting votes to see whether Democrats have the 60 votes necessary to break a filibuster
- Massachusetts Senator John Kerry is leading the charge to reduce the cuts to home health; he is working to gain bipartisan support
- The key issue relates to the offset provisions. Rules stipulate that to reduce cuts in one area, the proponent needs to come up with a plan to proportionately increase revenues or increase cuts elsewhere. This is going to be a tough proposition for Kerry.
- Look for a Senate version to emerge soon. Then the toughest work will begin - - melding the two bills together into something everyone will like.
- The likely Senate bill will contain fewer cuts to home health than the current House bill.
The VNAA is working to keep its members informed. And it looks as though perhaps not everyone will be enjoying the holidays this year.
Many of the posts here on this blog pertain to the current health reform debate. It strikes me that, ultimately, the likely impact on home health care will be painted with both of these broad brushstrokes.
Wednesday, November 11, 2009
I remember a recent tour of a brand new state-of-the-art ambulatory care center. I was directed to the set-ups in the patient care rooms and asked to consider the ergonomics of each workstation. A consultant had been hired to design the area where the clinicians sit and interact with the patients... and the computer monitors and keyboards that serve as gateways into an also state-of-the-art electronic health record system. Painstaking attention was paid to the placement of the large robot-like arms that allowed for optimal positioning of the technologies so that inputs and outputs could proceed unhindered. The chairs looked like they would have been at home in the finest Wall Street boardrooms and the tan oak desk was smart and attractive. It was an ideal environment.
Shawn and Nancy don't work in places like that. Shawn helped a woman recovering from knee replacement surgery navigate through a cramped bathroom and up and down a narrow flight of stairs as she stretched and pushed herself toward recovery. Nancy led me up three winding flights of stairs into a pleasant home where a newborn and his newmom were contending with the normal stress of the occasion and the not so normal stress of serious medical problems. Both clinicians bent over undersized laptops and entered critical medical information; Shawn hunched over his computer as he sat at the end of his patient's bed while Nancy leaned over and tapped onto the screen leaning against a pillow, inches from the baby's head.
Shawn told me that he had worked in a hospital for many years as a PT and that he would accompany his patients over to a designated spot where they could walk up and down a few steps. But now, he sees the actual steps where his patients live and the help he provides is real and impactful and immediate. Nancy explained, holding the actual containers that the mother uses to prepare the critical formula for her child, the precise proportions of water and powder. This is no classroom, no state-of-the art laboratory.
It is real. It is the ergonomics of life. And that makes a huge difference.
This raises some interesting questions regarding the individual clinician's right and responsibility to address patient questions and concerns about the future of health care coverage. Though many of the concepts being bandied about on the nightly newscast may be complex or nebulous for some, the general public is increasingly coming to understand that the system, love it or hate it, could begin to change drastically, and soon.
One could conclude that there's no place for politics in the exam room (or at a hospital bedside or in a patient's home) and so that the health reform topic is best left alone. Alternatively, one might decide that the conversation should focus merely on facts. Or, some may feel that it's entirely appropriate to bring personal opinions (and concerns, fears, etc.) into a dialogue with patients.
What do you think? Feel free to comment on this post.
Tuesday, November 10, 2009
Monday, November 9, 2009
Sunday, November 8, 2009
Saturday, November 7, 2009
Thursday, November 5, 2009
I worked out of our Southwest office in Braintree; this included a few business meetings, a lunch with the regional managers, and a nice informal get together with staff. The morning consisted of home visits and I was the guest of Ann Marie McGuire and Colin Highland. Ann Marie is a nurse and Colin is a physical therapist. We saw three patients
The first, a near 90 year old woman who lives with her sister, is experiencing CHF. She was gracious, vibrant and charming. Her sense of humor and spirit captivated me as I watched Ann Marie expertly enter information onto a laptop's touch screen, check vitals, and converse with her. The second patient, another near 90 year old resident of an assisted living facility, suffers from multiple physical conditions, requiring the expertise of both Ann Marie and Colin. I watched them interact with the patient and each other and was impressed with the hand-off of information between them. Colin and I stopped by the facility's nursing office and I heard from the staff nurse there that she appreciated the professionalism and exceptional communication she consistently receives from VNAB staff. She listened intently as Colin described what had happened with the patient and his recommendations regarding how he can continue to maintain his independence. The nurse told me that VNAB is distinguished from the other home health agencies by the comprehensiveness of its services and the quality of its clinical staff. Finally, Colin and I traveled to a senior residence and met a women recovering from hip replacement surgery. Colin walked with her to pick up her mail and spoke with her in a friendly and comfortable manner. It was obvious to me that this patient and Colin enjoy a trusting and warm relationship. When we departed, the patient thanked Colin and expressed her gratitude for the difference he and his PT assistant had made in her life. With the exception of having to contend with this patient's rambunctious Boston Terrier, it was an enjoyable visit.
I was not all that surprised to see the level of compassion and professionalism that Ann Marie and Colin brought to their jobs. Frankly, I expected that. What I was quite struck by, however, was how they were received by the patients. The three individuals we visited are vulnerable and overwhelmed by the complexity and burden of their ailments and treatment regimens. I saw that both Ann Marie and Colin had well established relationships with these patients and that their level of trust in their clinicians was extremely high. Ann Marie and Colin carefully explained what was happening and what was going to happen next. They described all of the positive observations as well as the concerns. They comforted and they lifted spirits. They offered hope and reassurance.
And I could see the effect of that in three glowing faces.
On some days, I set up shots, exercised great care and actually worked at it. Many days, however, I was flying around my normal day and just trying to grab a quick shot to check this off my to do list. The two pictures in the previous post are examples. Both were taken with an inexpensive point and shoot digital camera. Both were taken in the conference room near my former office. I set the camera to macro mode and in one photo, I pointed the camera up from the bottom of the vertical window blinds and fired away. The second, also on macro mode, was a close up of an ordinary office plant leaf. On my computer later, I jacked up the saturation, contrast and sharpening.
Wednesday, November 4, 2009
Tuesday, November 3, 2009
Here's the big problem. In the Senate bill, the fines are $200 in 2014, $400 in 2015 and $750 by 2017. When you compare these fines with the cost of coverage (i.e., the monthly premiums), it's almost a no-brainer: why buy the insurance? This is, in part, the logic behind the steeper fines in the House bill.
This will be one of the key issues debated in the coming days... expect fireworks.