As a mother of three, the first thing on my mind when arriving to the hospital in labor was the anticipation of the safe delivery of my child.  Even for me, a woman well versed in the quagmire of healthcare, driven by rules and more rules, the nature of “mom” to protect is innately intuitive, no different than the brain’s mechanic response to fear — the flight or fight mechanism.

The story of April Saul, who was recently arrested for utilizing her assumed custodial rights of her child, quickly unfolds in a hospital setting.  After prematurely giving birth to a baby born with a heart defect, April Saul wanted to make sure her baby got the proper care. The hospital where she gave birth, Lehigh Valley Hospital in Allentown, Pennsylvania, did not have a specialist to treat the baby’s condition, yet the Children’s Hospital of Philadelphia did. Seeing the opportunity for better care for her child, Saul requested the hospital transfer her baby.

She and the baby’s father Danny Rivera acted as healthcare advocates for their child, trying to ensure the best treatment and best options for their baby. Having determined that the baby’s best option was being treated by a specialist, Saul was determined to make that a reality. A December 10, 2012 article from the San Francisco Chronicle quotes her as saying, “Danny and I pled, in meeting after meeting with Lehigh Valley, for months,. We kept saying, ‘We feel as though you lack expertise. We feel as though our child has issues you can’t address. We want her transferred. What do we have to do to get our baby transferred?’ For months we were just getting the runaround.”

The story progresses with Saul and Rivera being told that the hospital could not transfer her baby because Medicaid would not cover it. Feeling that doctors were not listening to their concerns or putting their daughter’s health first, Saul and Rivera took their daughter’s healthcare into their own hands, removing her from the hospital in order to bring her to the Children’s Hospital of Philadelphia to see the specialist on their own. The hospital alleges that the parents took the child without their permission.   I have yet to see a patient consent form that states you need to have “permission” in order to remove your child from a hospital.  The two parents were reported to the authorities by Lehigh Valley Hospital after removing their allegedly “medically unstable” daughter from the hospital, saying she had stopped breathing for short periods of time only a few days before the couple took her. The fact that this statement is even in the public record is of interest since they are releasing protected health information to substantiate their actions.

Yet Saul sees it differently. The article states, “Saul said she never would have placed her child in danger. She said Aralynn was breathing on her own and wasn’t hooked up to an oxygen machine or an IV pole when they left with her Oct. 23, intending to go straight to Children’s Hospital, about 60 miles south.” But Saul was stopped by the authorities before she was able to complete the trip.  The article quotes her as saying “We felt like we were backed into a corner, we had no recourse and we were given no other option. We are Aralynn’s advocates. If we don’t advocate for optimum health care for her, who will? That’s a parent’s responsibility.” Apparently after this incident the child was transferred to the hospital with the appropriate resources. The big question remains: would have the child been transferred if this incident did not occur?

The position that Saul and Rivera were placed in reflects the reality of healthcare in today’s world of medicine.  The hospital did not have legal custodial rights of the child and did not have a court appointed guardian to override the parents’ right to informed consent and options.  The second complicating factor is the rules that govern Medicaid or any other payer plan.  This story reflects the first and foremost ethical question to be answered: “When we advise patients and/or guardians of patients, are we presenting a clear ‘medical case management’ option and a clear ‘financial case management option?’” Managing a patient financially is a very different process then managing a patient medically.  Yet the ethical question to be resolved and to effectively address is how we, as healthcare providers and payers, convolute the two processes into one, leaving parents like Saul and Rivera lost and confused. Bottom line, was this incident about money or access to care?

If you find yourself in a tug of war with a healthcare provider, such as the parents in this story, consider the following steps to effectively advocate for yourself or a love one who is receiving chronic or extended hospital care.

1.    Request copies of your child’s medical records on a weekly basis. Read them; if you do not understand something ask for answers until you are blue in the face. Ask them to provide you an electronic copy. If the hospital is behind the times and does not have an electronic medical record system, then ask them to copy the records at their expense. Specifically ask for copies of all diagnostic tests, nursing notes, and physician notes.
2.    Address a formal letter to the primary care physician and copy the Hospital Unit Manager documenting your questions. Request that your letter be included as part of your child’s medical record.
3.    If you do not receive a response to your questions, ask the hospital for a patient advocate.
4.    If you do not receive a patient advocate and your questions or concerns have not been addressed, request in writing to see the compliance officer for the hospital.

Did Saul and Rivera go too far or did the hospital fail to effectively respond to the concerns raised by the parents?  Did the hospital clearly separate medical issues from financial issues? Getting the facts is the first step towards advocating for yourself and or a family member.

Saul and Rivera met with hospital officials to discuss their options and accuse the hospital of not actually asking for a transfer. The hospital states that Children’s Hospital of Philadelphia indicated their daughter was not medically ready for transfer. There was obviously a breakdown in communication between the two parties. A prosecutor says Children’s Hospital wasn’t ready to take the baby. The parents report that the baby did not have an IV or monitor (typically required on medically unstable children). The only clear fact is the lack of communication.  Communication is key in order to make accurate and helpful health decisions for a family member or for yourself. This breakdown in communication between the parents and the hospital could have endangered the baby’s life. In the meantime, as the healthcare market continues to define itself within the new mix of rules under the Affordable Care Act, if you have a child confined in any healthcare institution, control your rights as a parent by getting the facts and documenting your concerns in writing.

Thanks for reading!
 Have a story to share? Feel free to send me a note at rbusch@mbaaudit.com.

Rebecca S. Busch, RN,
Healthcare Advocate

http://mbaaudit.com/presentations/PHPbook.php

The New York Times Sept. 2, 2012 article “Health Care Where You Work” discusses a survey conducted last year by Towers Watson and the National Business Group which found that 23 percent of midsize and large employers offered on-site health services and 12 percent more planned to in 2012.

While this is not yet a majority, the results of the survey showed a 50 percent increase in companies offering on-site health services. This encourages preventative care, as employees have easy access to healthcare through their employers.

The article references Bellin Health, a not-for-profit health care system based in Green Bay, Wis. Bellin is contracted by other companies to run clinics on-site for the companies. Bellin keeps the clinics staffed part-time by nurses, nurse practitioners or physician assistants. The clinics treat minor ailments as well as conduct preventative screenings.

Companies report that this has lowered health care spending. The Foth Companies, an engineering and consulting firm, spends about $5.5 million a year on health care. Bellin saves them an estimated $250,000 a year through its on-site clinic and other preventative care.

The Fincantieri Marine Group builds ships for the Navy at its facility in Marinette, Wis. The company  spent about $17 million on health care. After Bellin set up a clinic in a trailer at the plant in early 2011, total spending was down to $15 million, despite a growing work force.

The article says that “Health experts have published research in journals like the Harvard Business Review and Health Affairs showing that every dollar invested in employee wellness programs saves multiple dollars by lowering a company’s health care costs, reducing absenteeism and increasing productivity.”

Preventative healthcare not only saves money, but helps patients. By focusing on staying healthy rather than fixing ailments, patients enjoy simpler, more cost effective care. As a patient, you can advocate to treat your health as something to maintain, rather than fix.

Thanks for reading!
Have a story to share? Feel free to send me a note at rbusch@mbaaudit.com.
Rebecca S. Busch, Healthcare Advocate

http://mbaaudit.com/presentations/PHPbook.php

Obamacare, officially known as the 2010 Patient Protection and Affordable Care Act, represents “the biggest overhaul of the $2.8 trillion U.S. healthcare system since the 1960′s,” according to a Reuters article from November 7 entitled “Obama wins clear health law hurdle, challenges remain.” Obamacare would provide some level of health coverage to more than 30 million uninsured Americans, beginning in 2014. The law will also expand Medicaid and introduce subsidized health insurance exchanges for individuals to buy their own coverage.

These last two provisions rely heavily on individual states. Each state is in charge of distributing their respective State Medicaid funds; as a result, Medicaid coverage from state to state varies greatly. The expansion seeks to even out coverage and “close the gaps” in the states with the least coverage. However, the new law doesn’t guarantee that such gaps will be closed. In the Supreme Court’s June ruling, Obamacare was upheld, but the court ruled that states had the option to opt out of Medicaid expansion. This may lead to as many as six states with Republican majorities and governors who oppose Obamacare to opt out of Medicaid expansion for their state, no matter how large the gap, according to the Reuters article.

In addition, some states are unprepared to expand their Medicaid programs, especially through setting up their own subsidized exchanges by 2014, as many states waited to begin the overhaul, knowing that a Romney win would have made any changes unnecessary. Obama’s second term puts these states on a short deadline – the states must say they will or won’t have an exchange ready by November 16 – may lead more states to opt out, simply because of lack of time to prepare, jeopardizing Obama’s goal of around the country Medicaid expansion. In order to have exchanges ready, the Reuters article says, most states would need to partner with the federal government to create an exchange.

Another major healthcare impact from Obama’s reelection is that Medicare as we know it will survive. Romney sought Medicare reform through changing the program from a set of guaranteed benefits to a payment program allowing seniors to purchase their own healthcare coverage, with the idea being that seniors could find more complete or customized coverage by shopping around. However, many feared that seniors wouldn’t be able to find coverage offered cheaply enough to match what was offered under Medicare, and seniors opposed Romney’s plan 2-to-1, according to Reuters.

The Obamacare plan includes cutting $716 billion in Medicare spending by slowing the growth of payments to providers and Medicare Advantage plans.  Congress has implied that they may not allow such deep cuts to take place. If this is correct then the process to begin reining in rising Medicare costs will not occur. If we mix in the money to be spent on subsidizing insurance exchanges the net result could cause the deficit to rise as high as $1 trillion in 2013, as reported in a Reuters article from August 22 entitled “Forget the cuts – Medicare spending is still on the rise.”

Obama’s reelection and the subsequent safety of Obamacare holds obvious implications for healthcare and our country as a whole, both through the healthcare available to Americans and through what debt we may end up with as a result.

Thanks for reading!
Have a story to share? Feel free to send me a note at rbusch@mbaaudit.com.
Rebecca S. Busch, Healthcare Advocate

http://mbaaudit.com/presentations/PHPbook.php

Referenced Article: http://www.politico.com/news/stories/0812/79984.html

http://www.reuters.com/article/2012/11/07/us-usa-campaign-health-idUSBRE8A60PF20121107

A Sept. 10, 2012 article from the American Medical News website discusses a study which analyzed a national survey of 1,504 primary care physicians to see how satisfied physicians were when treating patients with chronic, challenging conditions, such as obesity or nicotine or alcohol addictions.

The research letter, found in the Archives of Internal Medicine published on Aug. 27, 2012, found that physicians who saw medicine as a calling were more likely to feel satisfied when treating those disorders. This sense of enjoyment helped doctors from feeling burned out. Feeling burned out includes feelings of emotional exhaustion and depersonalization, and nearly half of all physicians have symptoms of burnout, according to an Archives of Internal Medicine study published on Aug. 20, 2012.

It is very important to understand why physicians burn out, given that the feelings can affect how the physician treats his or her patients. The article states that physicians who feel burned out are more likely to blame their patients for these conditions. As a patient advocate, I recently received a call from a wife who had oversight of her husband’s health.  The immediate serious “drama” was trying to decide what to do with a clot that was blocking blood flow to the leg. The wife was getting conflicting information from a variety of doctors.  My point is not to explain the medical information but the response of one doctor:

“Why do you want a second opinion,” the doctor lashed out to the wife standing next to her husband. She said, “because the other doctor told me his problem was a different diagnosis.” He replied, “Well if you don’t want to follow my direction you and your husband (bed ridden on all sorts of IV medications) can just leave and go to another hospital!”  The doctor glares at the wife and snarls “and by the way your husband has cancer as well!” and the doctor stormed out of the room.

Clearly this exchange represents a doctor who is not happy and clearly under stress.  As a patient, you want a doctor who will feel satisfied treating you. Doctors who feel more satisfied have better relationships with their patients. This can lead to more personal, effective treatment from your physician.

The article quotes study co-author John D. Yoon, MD, an assistant professor in the University of Chicago’s Section of Hospital Medicine and associate faculty member at the MacLean Center for Clinical Medical Ethics, as saying, “Previous research in calling has found that those who view work as a calling are more engaged with their work, spend more time working and view the job as more central to their lives.”

This in turn leads to higher quality of care from the physician and a more comfortable relationship between doctor and patient. Understanding how a physician’s reasons for going into medicine translate into how effectively he or she treats his or her patients can help lead to more effective, high quality care across the board. So if you want to enjoy, and truly benefit from, your trip to your doctor’s office, find a doctor who will enjoy treating you.
Thanks for reading!

Have a story to share? Feel free to send me a note at rbusch@mbaaudit.com.
Rebecca S. Busch, Healthcare Advocate

http://mbaaudit.com/presentations/PHPbook.php

Thomas Geoghegan, a Chicago labor lawyer and author, most recently, of “Were You Born on the Wrong Continent?” wrote an August 26, 2012 article for Bloomberg News entitled “Healthcare Saves Economy.” He credits hospitals with giving jobs to high school graduates and to those with limited college, ranging from security guards and cooks to respiratory technicians. He cites a 2011 Harvard research report entitled “Pathways to Prosperity” which states that health care by itself added a half-million jobs during the recession.

Geoghegan adds that because Medicare and Medicaid were not capped, the programs did not shrink or even stagnate. The programs generated as many jobs during the recession as in a good economy as Medicare spending continues to rise.

Geoghegan does a great job of showing how healthcare can further help the community. In addition to keeping people healthy, it keeps them employed. Payment for medical services puts money back into the economy and keeps hospitals open. This in turn ensures that patients have access to local healthcare.

As our healthcare system changes, it will continue to serve the community by treating illness and by employing local men and women, no matter who the president is.

Thanks for reading!

Rebecca S. Busch

Healthcare Advocate

http://mbaaudit.com/presentations/PHPbook.php

The “Ten Most Wanted Fugitives” list has been in existence since March 14, 1950 when a reporter asked the FBI for the names and descriptions of the “toughest guys” the Bureau would like to capture. 154 fugitives have been captured or located as a result of citizen cooperation. The list made these fugitives famous, making it difficult for them to continue committing crimes. The U.S. Department of Health and Human Services’ Office of Inspector General is hoping to head off health fraudsters the same way.

The U.S. Department of Health and Human Services’ Office of Inspector General created a list of the 170 “most wanted” health fraud fugitives in the U.S. The list is only a year and a half old, yet 18 people on the list have already been arrested.

In an Aug. 17, 2012 Huffington Post article entitled “Medicare Fraud: California Is Well-Represented On Federal List Of Health Fraud Fugitives,” Donald White, a spokesman for the inspector general’s office, is quoted as saying, “There are a lot of people who are really fed up with the fraudsters who drain money out of needed Medicare and Medicaid programs designed for some of the most vulnerable U.S. citizens,” White said. “It shows how serious the Office of Inspector General is in catching criminals who steal.”

It is very encouraging to see the government actively pursuing these criminals. The FBI estimates that health care fraud costs the country $80 billion a year. Health care fraud is a very serious crime with a very serious price tag. By creating a list of the “most wanted” fraudsters and informing the public of their scams, the U.S. Department of Health and Human Services is making it more difficult and more dangerous for these fraudsters to run their scams.

The government is saying no more fraud, waste, and abuse. This list is a step in the right direction towards eliminating these criminals who prey on the sick and helpless to satisfy their own greed. To see if you recognize anyone on the list, visit http://oig.hhs.gov/fraud/fugitives/index.asp. Help put an end to fraud, waste, and abuse in the healthcare system.

The Global Polio Eradication Initiative, partners with UNICEF and the World Health Organization, have been working to vaccinate children in these at risk countries. Health workers were planning to inoculate 161,000 children younger than 5 when international politics overpowered relief efforts.

Pakistani Taliban commander Hafiz Gul Bahadur has banned the polio vaccinations in North Waziristan in the tribal belt where these children live. The ban is following a 2011 U.S. vaccination campaign that also covertly collected DNA in order to try to locate Osama Bin Laden.

Before the C.I.A.’s involvement was discovered, the Taliban was in support of the vaccinations and allowed health workers to reach children in safety. Now Bahadur is refusing to allow vaccinations until the U.S. discontinues drone strikes in Pakistan.

Both the U.S. and the Pakistani Taliban are jeopardizing children’s access to necessary vaccinations in order to make political gains. While international relations between the two countries are both delicate and highly important, when access to healthcare is used for political gain, only the citizens suffer.

Both countries are allowing politics to get in the way of healthcare. Children in need of vaccinations are being used for political purposes. It is wrong to jeopardize their access to necessary, lifesaving healthcare in the name of politics. These organizations have the ability to provide lifesaving vaccinations to hundreds of thousands of children, and should not be stopped or used simply for political gains.

Thanks for reading!

Rebecca S. Busch

Healthcare Advocate

http://mbaaudit.com/presentations/PHPbook.php

However, it isn’t this way for everyone, especially not if you’re native to Alaska. At the Southcentral Foundation in Anchorage, patients are virtually guaranteed a doctor’s appointment on the day they request, there are high standards of care, and “the atmosphere is so welcoming that natives routinely congregate in waiting areas to swap stories and meet old friends even when they do not need medical care,” according to the July 21, 2012 New York Times article “A Formula for Cutting Health Costs.”

The Southcentral Foundation in Anchorage provides primary outpatient care to 55,000 Alaska natives and American Indians in the Anchorage area and scattered in remote villages, most reachable only by air. It does all this on a budget of only $200 million. The Southcentral Foundation was created in 1982 and replaced the federally run Indian Health Service. The article states that since the switch, 85% of asthmatic children receive high quality care, in comparison to 35%; over 90% of infants now receive the immunization necessary by age 2; and the percentage of diabetics with blood sugar under control ranks in the top 10 percentile of a standard national benchmark.

The Southcentral Foundation received the Malcolm Baldrige award, a Commerce Department national quality award, in 2011 for high efficiency rates: emergency room use has been reduced by 50 percent, hospital admissions by 53 percent, specialty care visits by 65 percent and visits to primary care doctors by 36 percent. This has translated into money saved. The article states, “Between 2004 and 2009, Southcentral’s annual per-capita spending on hospital services grew by a tiny 7 percent and its spending on primary care, which picked up the slack, by 30 percent, still well below the 40 percent increase posted in a national index issued by the Medical Group Management Association.”

Due to its small size and unique patients and location, the system is hardly “one size fits all.” However, the success the Southcentral Foundation is having proves that with innovative thinking, healthcare costs can be lowered and healthcare quality can be improved. A small Medicaid managed-care plan in Portland called CareOregon found that very idea to be true. After they adopted some of Southcentral’s tactics, they found that they had “greatly reduced the use of costly emergency departments and hospital admissions while improving health outcomes.”

The article points out some of Southcentral’s tactics that any healthcare facility can implement, including:

-  Changing from a reactive system in which a sick patient seeks medical care to a proactive system that reaches out to patients through special events, written and broadcast communications, and telephone calls to keep them healthy or at least out of the hospital and clinics.

- Focusing on the needs and convenience of the patients rather than of the institution or the providers. The facilities feature rooms where providers and families can chat as equals on comfortable chairs, in sharp contrast to examination rooms where a doctor looms over a patient. Every patient visit is carefully planned so the patient can get in and out quickly without being delayed because, say, a needed lab test result is not available.

- Building trust and long-term relationships between the patients and providers.

This is the type of healthcare change we should advocate for: putting the patient first. We are tired of being simply numbers. And as Southcentral proves, doctors take better care of patients that aren’t numbers, but people.

Thanks for reading!

Rebecca S. Busch

Healthcare Advocate

http://mbaaudit.com/presentations/PHPbook.php

These drugs are illegal for doctors to purchase, as they are not approved by the Food and Drug Administration. Foreign, unapproved drugs are often cheaper than their American counterparts. The article gives the example of a European version of Avastin, which could be as much as $600 less than the average U.S. manufacturer’s price.

The problem can be seen through that same example: CBS found that vials of Avastin sold by companies in the Barbados, Denmark, Switzerland, Egypt – and yes, even the U.K. – were fake. The vials contained none of the drug, rendering them useless for treating cancer. Yet unsuspecting patents were being treated with this fake drug by doctors they trusted.

Counterfeit, fake, and foreign medicine poses serious health risks to patients through contamination and adverse or no effects. However, there are medical practices and doctors willing to risk these dangers simply to save a little money.

This fraud highlights just how important it is for you to be your own patient advocate. You may be able to catch a counterfeit medicine simply by asking where it’s from. The article describes these medicines as having “foreign labels with no stamp of approval from the federal Food and Drug Administration.” Keeping an eye out could help you discover a clinic that is putting its patients at risk.

Beyond that, this fraud reminds us that some doctors are not trustworthy. You cannot always trust others to do what is best for your health, especially when money is a factor. While many doctors truly care for their patients, you must take care of yourself by being your own patient advocate, asking questions, and doing all you can to understand and be knowledgeable about your treatment. It may save your life.

Send me your thoughts and thanks for reading!

Rebecca S Busch

Patient Healthcare Advocate

www.mbaaudit.com

www.rebeccabusch.com