Patients of Wal-Mart medical?

OK, this is one I’m not really sure I want to think about just yet.

Wal-Mart (yes, Wal-Mart!) is getting into the health clinic business. The company that brought you $4 generic medications is planning to open walk-in medical clinics, usually staffed by Nurse Practitioners, in many of their new stores.

Before you start thinking I’ve lost my mind, look at this from the point of view of  Wal-Mart High Command: 130 million people a week visit a Wal-Mart store.

130,000,000 each week. If I did the math right, that’s almost Thirteen Thousand Wal-Mart visits per minute each week.

Wal-Mart plans to have 400 clinics open by 2011, and they expect 2,000 clinics to be open by 2014. With prices for a clinic visit expected to be about $55 (per visit), that’s a pretty good deal. And Wal-Mart is predicting that by 2014, there will be at least 11,000 patient visits to their clinics. These aren’t hospitals,  of course – they aren’t even Urgent Care Centers. But for low-level needs like Flu shots or when allergies get the best of you, they could be exactly what you need.

And Wal-Mart is a game changer. At one time the only “groceries” you could find in a Wal-Mart store was the candy located in the checkout aisle. Now they are one of America’s largest grocery retailers. So when Wally World gets involved, this might be the start of something very big.

Time will tell.

On today’s agenda: Vision 2020

I hold in my hands the future of Adult Congenital Cardiology: the Adult Congenital Heart Association’s (ACHA) Vision 2020 Phase 1 Report. The long-term goal of Vision 2020 is to make Adult Congenital Cardiology an established, recognized field that will deliver quality care to adults with Congenital Heart Defects throughout the United States.

Begun as an initiative of the ACHA in December of 2008, the goal of Vision 2020 is to ensure that every Congenital Heart Defect (CHD) Survivor be able to receive life long Adult Congenital Cardiac care after they turn eighteen. This care will be 1) High Quality; 2) Age Appropriate; 3) Research Based; 4) Coordinated and Integrated; and 5) Available in all regions of the country.

Although over one million adults in the United States live with a Congenital Heart Defect, it is estimated that 50% to 90% of them are not receiving regular care by an Adult Congenital Cardiologist. To reduce this number, four working groups have been created:

1) Program Accreditation – dedicated to creating policies and procedures that will create a legitimate credentialing systems for Adult Congenital Heart Defect (ACHD) programs.

2) Regional Care – will focus on determining the total number of Congenital Cardiology assets in a region of the country and determine the best way to transition a patient living in that region from Pediatric care to Adult care.

3) Workforce – tasked with determining and creating the educational and experience criteria needed to be certified to provide Adult Congenital care.

4) Business Model – most, if not all, Adult Congenital Heart Defect Programs will be part of a larger institution or hospital. The Business Model Working Group will help determine the best ways the ACHD program can contribute top the overall financial health of the larger institution.

It is an ambitious document, and the obvious question is – will it work? In its original form, almost certainly not. No plan is perfect from the outset, it will almost certainly be rewritten as time passes and new challenges emerge. Reality  2020 may very well be much different than what the Vision 2020 plan envisions.

But the number of adults with a CHD grows about 5% per year. There is already Adult Congenital Cardiology training going on, but almost all of it is informal. The doctors who have served us over the years are guiding younger Cardiologists who have shown an interest in Adult Congenital Cardiology. So with the patient population growing and informal training already taking place, it is only a matter of time before a medical school begins to offer specialized courses. And when you have formal medical training, you’ll soon have a specialty. And then you’ll need someone to decide what exactly makes a doctor a specialist; and how many specialists and what kind of services need to be offered to be accredited.

And in the long run, this isn’t really for adults. The story is told of the Country Music Superstar who was approached by a songwriter with a nifty little Christmas tune. At first he turned it down flat, but then his wife said “Have a heart, this song won’t make much money but just do it for the children.” So he called the songwriter back and made the recording. The singer was Gene Autry, and the song was Rudolph the Red Nosed Reindeer.

This isn’t for us –  it’s for the future generations. At Lobby Day 2010 yesterday, one of our older members (early 60’s) told a twenty-something year old CHDer “Remember what you have seen here today. One day, it will all be up to you.”

30 seconds

“…when you play at this level there’s no ordinary venue.”

– One Night in Bangkok, from the musical Chess, 1986

Legislative meetings can occur in an instant. I don’t mean just not lasting very long, but quicker than you can imagine. You almost have to be talking – and making your point – as you walk in the door because there is no guarantee how much time you may have.

Is this rapid pace fair? Probably not – but it is the way things are done, so if you plan to plead your case to your legislator, you had better learn how Congress functions. Your objectives are to 1) to make sure the Legislator knows that you are a constituent – Members of the House of Representatives are especially interested in hearing the concerns of the people they represent, since they are up for election every two years; 2) make an impression by telling your story; 3) make sure the Legislator knows what he can do for you (vote on legislation, fund a project, etc.); and 4) leave some resource material behind that they can refer to later. And because you don’t really know how much time you will have, you need to be prepared to do all this in 30 seconds.

Could you do it?

My 30 second story is below. I’ve moved it further down on the page so you can think about your own story, and then compare yours to mine.

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My name is Funky Heart, and I live in Funkytown, South Carolina. I was
born with a Congenital Heart Defect back in 1966 – I survived only
because I have great doctors and parents who would turn the world
upside down to give me a chance to live.

CDC’s new National Congenital Heart Surveillance System will compile
data on heart defects for researchers to sift through. Hopefully this
will lead to longer, better lives for those of us who have a heart
defect. All it needs is for Congress to fund it.

Everyone needs a hero – here’s your chance to actually be a hero: Fund the new Congenital Heart Defect initiatives.

“A big (bleeping) deal!”

You can always count on Vice President Joe Biden for a laugh. After introducing President Barak Obama at this morning’s signing of the healthcare bill, Biden turned to President Obama and commented, “This is a big (bleeping) deal!”

And even though the Vice President wasn’t particularly eloquent, he’s right: We’re living in a different world tonight. The plan isn’t perfect; I am personally concerned about the cost. Unless we’re very careful, this has the potential to backfire like a misused credit card, with costs snowballing and no chance to catch up because of the interest payments.

But it does a lot of good, too. Children with pre-existing conditions can’t be turned down for insurance coverage any more. A lot of parents of Cardiac Kids – and other children with Pre-existing Health Conditions – can sleep a little easier tonight.  In 2014 Adults with pre-existing conditions will be able to buy insurance too, but for the moment we have to wait 90 days before we can buy into an insurance pool or a subsidized program and obtain insurance. It’ll be more expensive than “normal” insurance, but we ought to be used to that by now. CHDers never seem to take the easy way out.

But with the stroke of a pen (several pens, actually. Presidents usually sign major legislation with multiple pens, giving most of them away as souvenirs. President Obama used 22 different pens in signing the Health Care bill earlier today.) the world changed.

It is a big bleepin’ deal.

Many Voices Speaking as One

I was in Washington, DC for Lobby Day 2009; attending as a member of the Adult Congenital Heart Association (ACHA). My original plan had been to blog the event for a little while, visit one or two of my Congressional Representatives, and then return and resume blogging. My hernia had different ideas; it flared up and I was pretty much out of the game. So I was asking some of the groups if they would be willing to call me with their results and giving my business card to those that said they would keep me up to date.

My card was accepted at that table and the lady paperclipped it to the file folder she planned to carry. A young woman – just a little younger than me – glanced at it and then her face lit up.

“You’re the Funky Heart! Way cool!”

Well… if you mean that I am the guy behind the keyboard, then yes; I am the Funky Heart. But I am not the only Funky Heart. You’ve got a Funky Heart too, young lady. I don’t know you – I had never even seen you until just a few moments ago, but you and I could sit down to talk and instantly be on the same wavelength. We’re fighting a common foe, both of us have war stories that are similar, yet different.

And we need to get out there and tell those stories. There are a little over one million adults living with a Congenital Heart Defect (CHD) and we don’t have a national spokesperson. No huge, well organized THINK PINK campaign generating awareness and donations. And even the group that you think would do these things, The Big Red Heart, focuses mainly on another issue. We’re all alone out here.

But when one million people start talking, it can generate a huge amount of sound. (This place holds 107, 500 people, that’s a tenth of the adult Funky Hearts in the United States!) And if we could all start talking about CHDs we’d make a heck of a lot of noise!

We need to start talking about how a Heart Defect is not a death sentence anymore. People seem to have that idea, but more than 90% of the children who have surgery for a Heart Defect survive to adulthood. A lot of Cardiac Kids grow up to become Heart Warriors, and we’re living full, useful lives.

We need to emphasize how important it is to get good Congenital Cardiac Care throughout our lives, to keep ourselves as healthy as possible. To do this, we’re going to need more Cardiologists trained to work with us, and it would be wonderful to have some kind of health care plan that will accept a pre-existing condition without draining our bank accounts or making us jump through hoops to get it. Wishing won’t make it so, if we want those thing we have to work for them.

We need to teach Heart Moms and Heart Dads how to care for their Cardiac Kids when they’re young; how to instill in them the need to seek out that good doctor when they grow up; and always, always, always keep up with their health. And it’s up to the Heart Warriors to teach them because we’ve Been There and Done That.

A lot of us grew up thinking we were the Only One. Now we know we aren’t, so it is time to start passing along what we’ve learned.

I do what I do to defeat the evil that lives within me;

Help yourself

Have you ever heard of the Index Medicus?

You probably haven’t, but it’s very important. The Index Medicus is a very large  series of books that contain an index of medical journal articles. If you have a problem that your doctor needs to research, the Index Medicus is the first place for him to look.

They stopped publishing the Index in 2004. It was just getting too big – all the volumes combined weighed an amazing 152 pounds! PubMed, an electronic database, could do the same job that the printed version did, without all the bulk.  So now instead of heading for the medical library to look up some information, your doctor sits down at his computer.

With all this information available, there is no way that your doctor can even hope to keep track of it all. And remember, you aren’t his only patient – he’s got dozens more, just like you. Unless he is specifically researching your medical condition at the moment, he’s probably not going to stumble across a journal entry and think “Hey! I really need to discuss this with Steve!”

This is part of the reason that you need to take control of your own healthcare needs. The only person you can rely on 100% of the time to watch out for you is… YOU.

So get involved. Learn your defect, top to bottom. Know what medications you are taking and what they are supposed to do. Read the medical journals (you can use PubMed, too) and keep up on the newest research. Read, read, read, and learn. Only use reputable sources – if you see something on the evening news, check it out. Those reports almost always present bad information, but learning how to detect bad information will keep you away from quacks who HAVE THE CURE!

But don’t walk into your doctor’s office waving a fistful of printouts. That’s an insult: He’s spent years in medical school, you’ve spent half an hour on the Internet. I bet that he knows more than you do! A better way to present your findings to him is to say “Doctor, I have been reading about ______, what’s your opinion?”

Most doctors appreciate active, engaged patients. Some don’t – they would prefer you sit quietly, do as your told, and if you are good, he’ll give you a lollipop when you leave. If you have a doctor like that, it’s time to find another doctor.

And those lollipops are bad for your teeth, anyway!

Hearts aren’t White

Here’s an article abstract from a recent issue of the journal Circulation: Cardiovascular Quality and Outcomes that compares prenatal diagnosis of Congenital Heart Disease (CHD) with socioeconomic position, their level of insurance, and even their race. Race was not a direct factor, but socioeconomic position and insurance was… the better off you are, the better the chances of a CHD being picked up during a prenatal ultrasound.

Which brings me to a subject that I’ve been wanting to discuss for a while but never felt comfortable approaching: By far, most of the CHD Survivors I have had the honor of meeting are Caucasian. And I don’t mean just more than 50%, the number has to be close to 85% and possibly higher.

One of the biggest points of Health Care Reform, in my opinion, should be equalizing care. This probably falls under the umbrella of making sure everyone is covered, but I have never heard the point expressed as I see it: A heart defect, we know, strikes 1 out of every 125 live births. It doesn’t care if you are White, Black, Asian, Native American,  rich or poor… if you are number 125, you’re it. And your parents better be able to generate a lot of resources because your treatment is going to be expensive. Not just right after birth, but throughout your lifetime.

We do need to control healthcare costs and we do need to make sure everyone is covered, and we need to make sure that everyone has a chance to get the medical care they need, no matter if they are born with a disease or acquire it later in life. Because hearts don’t have a race.

And every heart deserves to live a lifetime.

Think it through…

Commonwealth Care, the grand experiment in Mandated Health Care administered by the  Commonwealth of  Massachusetts, isn’t doing so well. So the administrators of the plan are being forced to cut $115 million dollars from the plan. One of the ways they plan to “save money” is to slow enrollment. If you qualify for coverage but forget to choose a health plan, no longer will one be chosen for you. You’ll just be dropped. The Governor wanted to “help” by canceling dental coverage, but the legislature shoved that back in. They have a better plan: eliminate coverage for 28,000 legal Immigrants. Hey, why not, that’ll save $130 million dollars!

Limiting access and cutting benefits sounds a lot like healthcare rationing… rationing? Under the Massachusetts system, one of the nationalized healthcare plans that President Obama says could save us all by fixing our broken health care system? No way, the Ghost of Paul Revere would rise from his grave and ride again before that happened!

It happened… and there is a 25% sales tax increase, too. Welcome to Massachusetts!

Meanwhile, over at the local Veterans’ Administration (VA) hospital (another example of Universal Healthcare) no one seems to be really sure what is going on. Four hospitals seem to have forgotten how to sterilize their equipment, leading to 46 new cases of Hepatitis and six patients testing positive for HIV. Even after repeated alerts from the VA itself and numerous media reports, fewer than half of the VA’s facilities could produce evidence of proper sterilization procedures or training during the “surprise inspection” that a blind veteran could see coming.  Ninety-two veterans at a VA Cancer Clinic in Philadelphia also received incorrect Cancer treatments over a space of six years.

And as already mentioned on Funky Heart, The Indian Health Service is another example of a failed government run healthcare system. Back in 1787, the United States Government promised to provide healthcare to Native Indians on their reservations, and current statistics show how well we’ve respected neglected our obligation: The 2nd lowest life expectancy in the Western Hemisphere is among men living on Indian Reservations in South Dakota.

So America, here are three examples of centrally administered healthcare, involving the Federal Government on a national scale (twice) and a state run mandated healthcare system. Are you sure this is what you want?

Make your decision carefully – because you can’t put this genie back in the bottle.

“Don’t get sick after June.”

That’s the very unfunny joke told on American Indian reservations, because June is when the federal money for health care runs out. And more cuts in Medicaid and Medicare could be coming.  Head Nurse shows us how that the economy affects patient care and Dr. Wes contends that health care has literally become the economy.  Add in people who like to game the system (like these folks) and the available funds are disappearing faster and faster. We’re not just talking about “fixing health care”, we’re talking about a major re-adjustment in our entire economic system.

So it’s time to stand up. Chronic Illness coverage is expensive, while “prevention” is not. Quitting smoking or drinking won’t help me a bit, I never drank and only took one puff (nearly coughed my lungs out and decided that wasn’t for me, right then and there!) I exercise and try to eat right – I don’t always succeed – and it hasn’t made my heart any better. Or cut out any of the medications I require.

Do your part to make sure Chronic Illness care isn’t forgotten.

They aren’t trying to kill you, just tax you to death

They are determined to get you coming and going – The Colorado House of Representatives recently passed a “Sick Tax“! But you’ll never see it – in fact the legislation allows the cost to be “hidden” in your hospital bill, not included in an itemized list.

We seem to have it backwards – rather than trying to encourage all Americans to pursue a healthy lifestyle, our government entities want to encourage unhealthy behavior – and then tax it to pay for healthcare! For example, Federal lawmakers want more taxes on alcohol and tobacco. Ummm… wouldn’t it seem that if you did what you could to protect your health, healthcare costs should go down? But hospitals have no real incentive to prevent readmission by promoting wellness – that’s a fast way to lose money.

There is even a move to add a tax on soda and other sugary drinks. Former President Bill Clinton says that is not the way to reduce childhood obesity, but rather focus on preventing obesity and promoting wellness. His Alliance for a Healthier Generation is doing just that by setting guidelines for beverages sold in schools. You want to cut obesity in school aged children? Limit the number of calories they take in. How do you do that? Start stocking the vending machines with water (0 Calories) and low calorie juices and diet drinks. You can still sell Coke and Pepsi – just reduce the size of the container. You’ve seen those 8 ounce cans, I’m sure.

No matter what happens in the healthcare debate, the best way to cut you own personal costs is to take care of yourself. Start an exercise program, with your doctor’s permission. Don’t drink to excess. Don’t make the bacon triple cheeseburger with fries and a pickle your main lunch choice.

Enjoy your life by living it to the fullest!