Posts Tagged ‘Healthcare’

We’re going hopping…down Philadelphia way!

April 15, 2010

Live from Studio B of WFIL-TV, located in the heart of Philadelphia, Pennsylvania, this is American Bandstand!”  – 3:30 PM August 5, 1957

The schedule is set! I’ll be in Philadelphia April 19-21, helping the Adult Congenital Heart Association (ACHA) prepare for Lobby Day 2010. I won’t be speaking while in Philadelphia – this will mainly be “behind the scenes” work, setting up the meetings between our attendees and the members of Congress. No liveblogging is scheduled either, but I am planning to post regularly.

Then on April 21 we’ll start the day in Philadelphia, but we’ll ride the train down to Union Station in Washington DC. And Lobby Day is set for Thursday, April 22.  Feel free to surf to Adventures of a Funky Heart! on April 22 and look over my shoulder, so to speak!

The recently passed healthcare bill (known as The Patient Protection and Affordable Care Act) contains some exciting provisions for those of us with Congenital Heart Defects (CHDs). The law creates a Congenital Heart Defect Surveillance System – the CHD Registry that ACHA campaigned for at Lobby Day 2007 – to be maintained by the Centers for Disease Control (CDC). It will also give the Director of the National Institutes of Health (NIH) the authority to “expand, intensify, and coordinate research and related activities of the Institute with respect to congenital heart disease…”

But there is a catch – the programs are authorized, but not funded. So we’ll be heading to Capitol Hill to convince our elected officials to supply the funds. So keep us in your thoughts – this will affect every Congenital Heart Defect (CHD) patient, not just adults. So call or write your Representative, and ask him or her to fund the Congenital Heart Disease provisions of The Patient Protection and Affordable Care Act! (That’s Section 10411, Section 399-V2, and Section 425, should you be asked. )

This will be my third Lobby Day; I attended Lobby Day 2007 and 2009. In 2007 my Cardiologist and I teamed up to visit 12 different Senators and Representatives, all from the Carolinas and Georgia. In 2009 my hernia was acting up so I stayed at our HQ and blogged the event, you can read that account HERE. The blogging was fun and got our message out to the entire world, but I felt a little bit “out of the loop” so I think I am going to try to blog and lobby this year. You may have a “Guest Blogger” for an hour or so while I lobby my Congressman, but I think I have a workable plan. And don’t worry – I’ll leave you in good hands! If I have to use a Guest Blogger I’ll get a Champ, not a chump!

I will also have a small video camera with me! I’m not going to promise anything – you know how electronic gremlins like to crash this type of event – but I hope to get several short interviews during this upcoming week!

CHD History made at 7:00 AM Eastern?

December 23, 2009

The United States Senate plans to vote on their version of the healthcare bill at 7:00 AM Christmas Eve. Included in the Manger’s Amendment for the bill is a version of the Congenital Heart Futures Act, introduced back in March after a lot of hard work by CHDers from across the country.

But a lot still has to be done. Even though both houses of Congress have healthcare bills, the two bills do not agree (Assuming the Senate bill passes tomorrow; it should). The bills will have to be “reconciled” – a committee of both Senators and Representatives will meet and decide which parts of both bills are acceptable and then combine the two. Since there is no Congenital Heart Futures Act in the House version, it could be cut out. When all is said and done, we may have to go all the way back to the beginning.

But no matter what happens with the bill, we still have the IMPACT Registry. IMPACT stands for Improving Pediatric and Adult Congenital Treatment and Funky Heart! readers have read about it here before. An initiative of the American College of Cardiology Foundation, IMPACT is not reliant on Congressional approval and is still scheduled to begin in 2010.

Your government does not like you

November 7, 2009

Well, it certainly seems that way! The people who run Medicare have this brilliant idea to save money: If you are admitted to the hospital with Congestive Heart Failure (CHF), Medicare will not pay if you are readmitted within 30 days.

How mind-numbingly stupid is that? But it gets even better: There is a plan to tax the manufacturers of medical devices. What’s a “medical device”? Oh, things like pacemakers, ICDs, electric wheelchairs…stuff like that. Congress doesn’t see these items medical innovations, they see them as a cash cow. They’re even planning to tax bedpans and tongue depressors.

Nothing in the health care bills address the real problem: The looming shortage of Primary Care Physicians (PCPs). We’re already running short, and an analysis of the plans estimate that PCP workload would increase 29% over the next 15 years… and you thought getting an appointment was difficult now.

Meanwhile, back at the hospital, Cardiologists are facing a cut in Medicare payments. (The actual numbers have just been published.) But before you start thinking we’re finally saving money, think again: The money is just being shifted around. Payments to specialists are being cut, but payments to PCPs are being increased – the pie isn’t any bigger or smaller, it’s just being sliced  differently. The idea is to increase payments to PCPs to help offset their medical school debts. Since Primary Care doctors don’t make as much as specialists, their debt is relatively higher. But the government has managed to mess this plan up, too: PCP payments won’t increase very much.

The PCP shortage is causing doctors to be swamped and patients to be frustrated. The wait times for an appointment are getting longer and longer and there are so many patients that the doctor has less and less time to spend with an individual patient. We’ve all had doctors who seem to walk into the room leaving! Often patients who want to see a doctor ASAP go to the Emergency Room – they are almost as crowded as your “regular” doctor’s office. The EMTALA law (Emergency Medical Treatment and Active Labor Act) says that a patient who presents at an Emergency Department with a medical problem or in labor must be treated, regardless of ability to pay. It was designed to stop patient dumping (and for the most part, it has) but abusers use it as a direct route to a doctor. Since there are no payment provisions in EMTALA, guess who pays the bill of a majority of EMTALA patients? Medicare… in other words, you.

One option that is becoming more popular for PCPs is Concierge Medicine, sometimes called Executive Medicine. Instead of payment per service, the patient pays a set “fee”, usually yearly, for the services of a Primary Care Physician. In return, the patient receives longer appointments, better service, and access to the doctor by phone or well beyond normal business hours. (Here’s an example) This is often scoffed at as “Care for the rich” but the idea is catching on. In fact, Concierge Medicine is growing despite the recession. Even a former White House physician has entered an Executive Practice. Doctors offering this service have smaller practices and only see patients who are part of their group, although you can usually “buy in” at your first appointment. Costs can run anywhere from a few thousand dollars yearly for access to a smaller practice and more time with the doctor during your visits; up to tens of thousands of dollars per year for special access, 24 hour consultations, telephone contact with your doctor 24/7, and a super-intense yearly physical. The yearly fee eliminates many potential patients, basically creating a private physician.

By committing the doctor to care only for patients who are willing to pay a set fee, practices can avoid the red tape of dealing with private insurance or Medicare. Some Executive Medicine practices no longer accept Medicare or insurance, cash or plastic are their only acceptable payment options. The national population of working physicians is already low; when an Executive Medicine group offers a doctor better working hours, a smaller patient load, and better pay, it will be hard to get him to leave it.

The current healthcare plans will solve very few problems but have the potential to create many more.

Wanted: Primary Care Physicians

August 10, 2009

Let’s talk Healthcare Reform.

Don’t get discouraged, and please don’t leave. We’re going to stay away from the Red vs. Blue rhetoric, and (hopefully) neither side will be called a bunch of loons. Since we’re friends, you and I, we’re just going to take a look at something we really need. If we don’t fix this problem, any healthcare system could come crashing down like a house of cards.

Most of the plans being discussed formally establish a “Medical Home” for patients. We can go see any doctor we choose, but the Medical Home system would establish a Primary Care doctor as our automatic first stop – we see him/her first. If we need specialized care, they’ll refer us to a specialist. Chronically ill patients need a primary care doctor anyway; I write often about finding a good Cardiologist, and that is important, but life happens. CHDers turn ankles and slice our fingers while chopping onions just like everyone else. We need a Primary Care doctor for those times when the problem isn’t heart related.

Problem is, for the Medical Home plan to work, we need more Primary Care doctors. We’ve got a shortage on our hands now, so much so that older doctors can’t retire. They aren’t paid as much, so more doctors choose to be specialists. The Primary Care docs we have are already being asked to work harder and harder; some of them are choosing to relocate to facilities where the pace isn’t so frantic. One of the reasons the Universal Healthcare system introduced in Massachusetts is in such trouble is the shortage of Primary Care doctors. The system is simply being overwhelmed.

Even if we could somehow make Primary Care the most attractive job in the world, we’d still need six years or more before the number of new doctors would begin to climb. One way to deal with the problem now is to expand the role of Nurse Practitioners. NP’s are nurses, but they have had extra training and often have Masters degrees. Some states already allow a Nurse Practicioner to diagnose and treat patients; they can even prescribe medication. Some states don’t.

We need Federal legislation to get all the states on the same page, with a national standard of care. Then we can talk about Universal Coverage, insurance, coverage, and who pays. But let’s fix the doctor shortage problem first.

Hearts aren’t White

August 6, 2009

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…

July 2, 2009

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.”

June 15, 2009

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

May 18, 2009

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!

It’s coming – faster than you think

April 21, 2009

Any way you look at it, this can’t be good: Arizona is going to cut programs that help developmentally disabled children. Parents of these children aren’t happy,  and they are suing.

Why is the programs being cut? Two words: Arizona’s broke.  And they aren’t the only ones. President Obama just ordered his cabinet to find $100 million in budget cuts, and the budget experts started laughing. “Save” 100 million dollars when we just passed a $787 BILLION stimulus package? Somebody failed math class.

States are already cutting social programs. California has ended dental coverage for its residents on Medicaid. Just watch, in a few years California will have a “dental crisis”.

So, class, riddle me this: If we’re in this kind of financial trouble now, what will happen when Healthcare reform takes center stage? The Happy Hospitalist knows: rationed healthcare.

I love Happy; he often isn’t happy at all. But rather than just fuming and sputtering and screaming at the sky, Happy follows these “wonderful ideas” to their logical but not so wonderful conclusion, and he tells you exactly what he sees. Reading him will scare the pants off of you – but you’ll know what’s coming next.

The easiest way to control healthcare costs is to control access to healthcare. Services that aren’t rendered don’t cost anything. Covert rationing happens every day, it’s just not obvious – a case of tuna costs $5, a great price, and you happen to love tuna. But the $5 price only applies if you buy SEVEN cases, and you don’t like tuna that much, so you buy something else. The tuna has just been rationed, and you didn’t even realize it. Covert rationing.

This isn’t going to be covert rationing – it’s going to be out in the open. And if you have a chronic illness – if you need a doctor for any reason at all – it could get nasty.

It’s not broken, so why are we trying to fix it?

March 26, 2009

Before we do anything rash, let’s stop for a moment and think.

That wonderful Canadian Health Care system that the politicians keep telling us we need to emulate isn’t so wonderful… patients admitted through an Emergency Department in a Calgary hospital  have to wait an average of 16.6 hours to be assigned to a bed.

And in another “shining example” of Universal Health Care, a British hospital is so bad that conditions there have been called “Third World”. Receptionists are responsible for medical checks (!) and some patients have been forced to drink the water in their flower vases.

And if  80% of us are happy with our healthcare, why are we trying to redesign the entire system? (Ignore the headline and read the article… CNN focuses on the fact that as a whole we think too much is spent for health care, while ignoring the rest of the survey.) Dr. Wes looks around and sees that things here are really pretty good, despite the Gloom and Doom pouring out of Washington and your TV News. Yes, there are ways to improve our health care system, but aren’t anywhere close to drinking out of the flower vases yet. So let’s just tell the people in Washington to just calm down for a moment.