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patriciahaefeli · 4 years

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A Cautionary Tale? A Love Story? You Decide

It's been one of those rollercoaster weeks, one that began with a great deal of pain, which I tried to ignore at first, so as not to ruin my 17- year old’s already Corona-compromised birthday party. At some point during our 5 p.m. family Zoom celebration, I quietly left the room and went upstairs to lie down, writhe in pain, get back up, bend over, moan, repeat. This continued through the night Monday – and at one point, I remember thinking that labor wasn’t this bad and that I should probably go to the emergency room. In this new world we’re in, that thought was quickly dismissed by one word: COVID. I paced the floor at 3 a.m., alternately moaning and then bopping my head and sort of softly singing what kept running through my head, which was the chorus of The Knack’s 1979 hit song, “My Sharona.” Only my version went “My Corona.” Yes, even while suffering, I’m clever that way.

By Tuesday morning the pain had subsided. I was exhausted however, and slept throughout the day. “Tricia! Drink this! Jesus, she’s burning up.” It was the alarm in my husband’s voice that I responded to more than the command. I sat up, drank the water he was holding out to me, and when I caught my reflection in the mirror over the dresser I had the brief, feverously detached impression of someone who’d sat under a sun lamp for too long. Sun lamp, the words made me almost giggle out loud. Sun-lamp, sun-lamp, sun-lamp…Does anyone even know what that is anymore? A few hours later I had a virtual appointment with my regular GP, during which the decision was made for me to go to the office first thing Wednesday for a full exam. My instructions (my fever-addled brain again added the words “should I choose to accept them” - hehehe), for entering the building would come in the form a text.

My office exam was efficient and thorough. Upon arrival, I called the office and someone met me at a side door. As we were both masked and gloved, we nodded and murmured muffled greetings. Two PAs and an MD palpated my tender abdomen while I stifled screams. They decided that I should have a C-T scan that day, with the expectation that the offending culprit was a kidney stone. As many radiology facilities are currently closed, it took a few hours for them to locate one that would take me. My scan took place at 4:30. I was the last patient of their day.

Fast forward to 6:30 p.m. Wednesday evening. I picked up the call, which was remarkable in itself because anyone who knows me knows how irritating it is that, a) my phone is always on silent mode, and, b) I rarely answer numbers I don’t recognize. It was another doctor from Vanguard, calling to let me know that my C-T scan showed no evidence of kidney stones – “Yay!” BUT, he cut in, it did show acute appendicitis. What I needed to do, he said, was to go directly to the nearest ER.

So here’s where this story really begins, because I was about to get a reality check regarding the difference between the inconveniences of “social distancing” and quite literally, matters of life and death. For those of us who are shuffling around at home in our sweatpants, eating too much, complaining about the buffoonery of our President, laughing at all the funny memes, and who are, to one degree or another, COMPLETELY OBLIVIOUS to the fact that health care workers do not have the luxury of ANY of that, here’s the newsflash: The Corona virus has virtually SHUT down normal operations for hospitals and surgical facilities, so if you’re also laughing in the face of social-distancing guidelines, and just can’t wrap your head around the possibility of contracting this deadly disease, know this too: If you break your arm, or your spouse has a heart attack, or your child’s strange rash won’t go away and you’re just really concerned, good luck. We are NOT in Kansas anymore, peeps.

I considered doing a bit of a negative a rant on the first hospital that I went to here, but perhaps that wouldn’t be fair. “The nearest ER” for me would have been another hospital, but due to their somewhat dubious reputation, we opted to go just a bit farther away. The best thing I can say about that experience was that the safety protocols to enter the ER were impressive. Picture the scene in E.T. where the Hazmat-suited guys from the space program find out about him and “invade” the house in a tunnel of white - then picture the people standing six feet apart outside of say, ShopRite, only these people don’t look so great. They’re kind of bent over, or swaying, or leaning on someone else. Then count your blessings that your gut hurts and you’re not bleeding out…or struggling to breathe.

Three hours later, after they’d reviewed my scans and completed all of the necessary pre-op tests (blood work, EKG, urine analysis), I got the word that most of the ORs were being used as ICUs for COVID patients, and they were only doing “emergent” surgeries. They sent me home with massive doses of antibiotics, and a referral to see their staff general surgeon - outpatient.

I figured they were right, too. Must not be very serious. I was doing well with that notion until the following morning, when I heard the barely concealed shock in the voice of my regular MD.

“Did they see your scans?” his tone serving only to increase my anxiety.

“Yeah. But my appendix hasn’t exploded yet.” I said.

“Ah,” he sighed, “I know things are being handled differently in the ‘current environment,’ but last time I checked, acute appendicitis was emergent.”

Okay, pay attention now, because here’s where it gets really interesting: See if you can answer his parting questions:

“Do you have a general surgeon? Preferably one with their own facility?”

So, do you? And if you do, are you sure they’re even open right now? I sure as hell didn’t (and the name they gave me at the hospital turned out to be for a doctor whose answering machine told me he was not seeing new patients). And the idea that it was now pretty much my problem to solve was a little intimidating – especially for someone who generally needs to be told that they’re sick (enough) or in (enough) pain to seek help—but that’s another story. Now that doctor, who I respect and like a lot, said he’d be trying to find me one, but that I should do my research as well.

My husband and I made a fairly long list of people/places to call, and split it. Those we were able to reach at all offered possible solutions to my dilemma, but each dead-ended pretty quickly. I focused on the task now, trying to ignore what it might mean that the ache in my belly seemed to be spreading down my right leg.

As of this writing, I have yet to hear back from my regular GP and yet, here I sit, post-op, able to get this down mostly because of a Facebook message I sent to one of the nurses in the Belleville Public School district. The only real help I got came from her, a nurse, who responded immediately to an “in-boxed” message, and kept responding for the next hour, sending me the names and phone numbers of doctors (sometimes with their credentials!), links to possible facilities, and words of encouragement. She gave me her personal cell phone number and encouraged me to call it if I had questions and/or to let her know how it was going. I felt like she meant it, too. I also think she was responsible for the first in a series of serendipitous events that just may have saved my life. One of the names she gave me turned out to be the dad of one of my kid’s friends.

At that point, things happened pretty quickly. I called him (at home) and told him my situation. In a matter of 20 minutes, he had my scans and had booked a time slot for me for same-day surgery at Clara Maass. He’s a high-energy, outgoing kind of guy, and although I’d stood on sidelines with him and his lovely wife at many a sports event, I don’t know him well enough, nor did I think it was appropriate to laugh out loud when he laid out the plan: “With everything going on, I just really want to do you – and get you the hell out of there!”

So here I am, more grateful to him than I can possibly express and having some time to consider just how random and crazy and dangerous that whole situation was (turns out, my appendix had begun to perforate after all, and the real fun was just beginning) and how fortunate I am.

But the real heroes here - Oh, and God, aren’t we all a little sick of the “hero” thing? – well get over it, and listen up! From the minute I walked through the door of Clara Maass yesterday, my experience was the best it could possibly have been. The nurses! OMG the nurses - I was in pre-op for hours. Lucky as I was to have been squeezed in to an already crowded surgical schedule, the truth of the matter was that my presence had required a quick shifting of resources—stretchers and space and - nurses. My sudden appearance in the queue was inconvenient, possibly even annoying. And yet all of them, including the nurse who ran the OR, came by to check on me, to give me extra blankets, to chat with me, and laugh with me. A friend’s daughter-in-law, who is a nurse there, got a text from him and even she came from three floors below just to say hello and charm me with her Australian accent and tired-but-twinkling blue eyes. I swear, for me? The whole experience was a cross between a weirdly sterile spa stay, and – as mine all happened to be women - a girls’ sleepover with your best girlfriends—only these were women I'd just met (but they’d also pretty much seen me naked, so, there’s that…).

Most of them were nearing the end of a 12-hour shift. As I lay there, relaxed and warm, reading and texting, they race-walked back and forth among those of us who waited, or were recovering. I lost count of how many times one of them asked me if I was okay, or if I needed something. They ate their dinners on the move, taking bites and then sprinting off, tearing off one set of gloves, putting on another. These people Do. Not. Sit. The sink was right near my bed, so I saw a lot of hand-washing traffic too, and a lot of red, chapped, over-sanitized hands. They spoke in soothing voices to those who were waiting, and possibly scared, and loud-enough voices for those emerging from the cloud of anesthesia to understand. Sometimes they shouted good-natured complaints to one another, or teased one another – and me, as when one started repacking those bags they give you for your clothes, amusement in her voice as she yelled, “What the hell did you do here, shove it all in like a little kid? Your purse is open – Maria, come over here and see this – she’s a mess!” Hahahaha! One came by and pointed to the cover of the book I was reading entitled “The Silent Patient”, and joked “That’s the kind we like!”

I even began to wonder if what I was getting was “special treatment” reserved for those whose surgeries were personally called-in by the surgeon. Once he arrived, however, it was clear that not only did they not know he was the one who got me in, but they chided him in the same affectionate way. At a point, I said to one of them, “Doctors think they’re all that, but nurses really run the show don’t they?” She winked at me and elbowed me a little, “Like husbands, honey – they just think they’re in charge!”

I lounged, for over four hours while they stood on what had to be tired feet, hands on hips as they talked to me, telling me which part of the hospital they’d spent the morning in, or where they were headed next in this crazy, all-hands-on-deck environment. We chatted about jobs and kids, and only when the topic of this deadly disease came up did the lack of words become conspicuous. Then it was all a mime of sad shakes of the head and downward glances.

It occurs to me today that after all of this, I'm not sure I would recognize any of them tomorrow if I saw them on street – nor they me. Of course, we were all masked. But maybe I would – if I could see their eyes again. And I'm not exaggerating when I say that most of all, those eyes conveyed a profound kindness. And laughter, and concern, and compassion, and dedication—and a toughness that allows them to do it all.

I'll tell you a secret: I am a person who often has a weird response to unexpected kindness - it makes me cry. I welled up more than once yesterday afternoon. I may have been just one of many for them – this is just what they do - but for me, a bond was made. I will always remember them.

Make no mistake: it’s no hardship to be home in your sweatpants with your gel manicure looking a little ratchet, and your spouse and kids seeming more like houseguests who have overstayed their welcome. Today, I want you to feel really, really blessed and grateful, and if you’re like me, a generally healthy person who never really gave too much thought to the job that these people do, I hope I was able to convey just a little of it.

That school nurse who rescued me put it this way: “I took an oath when I graduated just as physicians do. I have followed it for 28 years and it has never let me or my patients down.” That whole oath thing is good and important and all, but the heart behind it gives it grace.

So, if you get an invitation to do one of those car processions where you beep your horn and cheer for the local health care workers as they go in to, or leave, work– get in your car and go. Or, just mail them each a check for a million dollars. Either way.

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flames-bring-a-ton-of-ash · 4 years

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What job do you have? I don't think I've seen you mention what you do in the short time that I've been following you. Is it rude to ask? You don't have to tell us if you don't want to.

I don’t mind :) I’m pretty open about who I am on here.

I’m a licensed social worker who previously worked as an outpatient mental health therapist. My current job is kinda hard to explain, so apologies in advance for the long and possibly confusing response. I’m always open to questions tho!

Basically, I work for the behavioral health insurance company for anyone on medicaid in Philly (so currently we could be working with any of the over 700,000 clients in the city who qualify for medicaid). Their physical health insurance under medicaid covers all their physical health costs, but my company covers the behavioral health costs (so mental health and substance use treatment). We’re the ones who pay the behavioral health facilities for the services they’re providing to clients, as well as us being the ones who do those dreaded audits on all our providers and make sure that they’re all running the way they’re supposed to.

There’s a bunch of different teams at my company (we have over 500 employees) and a lot of them are licensed clinicians and doctors who handle telephonic insurance reviews for members receiving behavioral health services, especially bed-based services (rehab, detox, psych hospitals, residential programs, etc). So we do reviews to decide if clients can continue to stay wherever they are, and if we’ll cover the cost. We also have more specific teams, such as a newly-formed forensic team and child-based teams.

My team specifically is labeled as “complex care” and is kinda unique (and newer) at our company, in that we’re out in the field a lot and working more directly with individual members, rather than just providers. I work with a certain physical health HMO and see only that HMO’s members, specifically those who are the highest utilizers of both medical and behavioral health services, in an attempt to bridge the gap and make sure both the physical health providers and behavioral health providers are working together to provide appropriate care. For example, I’m stationed at a hospital ER a day a week and seeing members who come through there and have a behavioral health history, and I’m out in the field doing client home visits and going to psych hospitals, rehabs, etc to see our members and ensure that they’re getting the appropriate care they deserve, and connecting them to other care levels as needed. So my team is in communication with just about any of the almost 200 providers in the city that my company funds, as needed based on our members. And we’re mostly dealing with members who have intense behavioral health and medical needs, as well as a good portion of my members being homeless (I follow on average about 60-80ish members at any given time and get new referrals every week). And my team is racing around the city a lot to meet with as many of these members as we can locate, so I figured we’d get shut down from doing that pretty quickly once the coronavirus hit here.

My team got told to stop going out to providers and client homes earlier this week, since we’d be the ones bringing back any sickness into the office setting, where most of the other teams are stationed full-time. But now today they’re pushing for all of us to just work from home and engage with our clients and providers telephonically. Which sucks for our members, because we can’t go see them and are going to have to do as much telephonic outreach as possible, which is so hard for our members who don’t have a phone and are on the streets. They’re the ones I’m super worried about, if the virus gets bad here. But I also am glad that I’m at home and not risking them by running around making contact and possibly becoming a carrier.

I hope that helped. Holy hell, sorry for the long response!

#personal #about me #Anonymous

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stephenmccull · 3 years

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As Pandemic Eases, Many Seniors Have Lost Strength, May Need Rehabilitative Services

Ronald Lindquist, 87, has been active all his life. So, he wasn’t prepared for what happened when he stopped going out during the coronavirus pandemic and spent most of his time, inactive, at home.

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“I found it hard to get up and get out of bed,” said Lindquist, who lives with his wife of 67 years in Palm Springs, California. “I just wanted to lay around. I lost my desire to do things.”

Physically, Lindquist noticed that getting up out of a chair was difficult, as was getting into and out of his car. “I was praying ‘Lord, give me some strength.’ I kind of felt, I’m on my way out — I’m not going to make it,” he admitted.

One little-discussed, long-term toll of the pandemic: Large numbers of older adults have become physically and cognitively debilitated and less able to care for themselves during 15 months of sheltering in place.

No large-scale studies have documented the extent of this phenomenon. But physicians, physical therapists and health plan leaders said the prospect of increased impairment and frailty in the older population is a growing concern.

“Anyone who cares for older adults has seen a significant decline in functioning as people have been less active,” said Dr. Jonathan Bean, an expert in geriatric rehabilitation and director of the New England Geriatric Research, Education and Clinical Center at the Veterans Affairs Boston Healthcare System.

Bean’s 90-year-old mother, who lives in an assisted living facility, is a case in point. Before the pandemic, she could walk with a walker, engage in conversation and manage going to the bathroom. Now, she depends on a wheelchair and “her dementia has rapidly accelerated — she can’t really care for herself,” the doctor said.

Bean said his mother is no longer able to benefit from rehabilitative therapies. But many older adults might be able to realize improvements if given proper attention.

“Immobility and debility are outcomes to this horrific pandemic that people aren’t even talking about yet,” said Linda Teodosio, a physical therapist and division rehabilitation manager in Bayada Home Health Care’s Towson, Maryland, office. “What I’d love to see is a national effort, maybe by the CDC [U.S. Centers for Disease Control and Prevention], focused on helping older people overcome these kinds of impairments.”

The extent of the need is substantial, by many accounts. Teodosio said she and her staff have seen a “tremendous increase” in falls and in the exacerbation of chronic illnesses such as diabetes, congestive heart failure and chronic obstructive pulmonary disease.

“Older adults got off schedule during the pandemic,” she explained, and “they didn’t eat well, they didn’t hydrate properly, they didn’t move, they got weaker.”

Dr. Lauren Jan Gleason, a geriatrician and assistant professor of medicine at the University of Chicago, said many older patients have lost muscle mass and strength this past year and are having difficulties with mobility and balance they didn’t have previously.

“I’m seeing weight gain and weight loss, and a lot more depression,” she noted.

Mary Louise Amilicia, 67, of East Meadow, New York, put on more than 100 pounds while staying at home round-the-clock and taking care of her husband Frank, 69, who was hospitalized with a severe case of covid-19 in early December. While Amilicia also tested positive for the virus, she had a mild case.

“We were in the house every day 24/7, except when we had to go to the doctor, and when he got sick I had to do all the stuff he used to do,” Amilicia told me. “It was a lot of stress. I just began eating everything in sight and not taking care of myself.”

The extra weight made it hard to move around, and Amilicia fell several times after Christmas, fortunately without sustaining serious injuries.

After coming home from the hospital, Frank couldn’t get out of a chair, walk 10 feet to the bathroom or climb the stairs in his house. Instead, he spent most of the day in a recliner, relying on his wife for help.

Now, the couple is getting physical therapy from Northwell Health, New York state’s largest health care system. Just before the pandemic, Northwell launched a “rehabilitation at home” program for patients who otherwise would have seen therapists in outpatient facilities. (Medicare Part B pays for the treatments.)

The program is serving more than 100 patients on Long Island, in Westchester County and in parts of New York City. “The demand is very strong and we’re in the process of hiring another 20 therapists,” said Nina DePaola, Northwell’s vice president of post-acute services.

Sabaa Mundia, a physical therapist working with the Amilicias, said Mary Louise can walk up to 400 feet without a walker, after doing strengthening exercises twice a week over the course of three weeks. Frank had been using a wheelchair and is now regularly walking 150 feet with a walker after more than a month of therapy.

“Older adults can lose about 20% of their muscle mass if they don’t walk for up to five days,” Mundia said. “And their endurance decreases, their stamina decreases, and their range of motion decreases.”

Recognizing that risk, some health plans have been reaching out to older members to assess how they’re faring. In Massachusetts, Commonwealth Care Alliance serves more than 10,000 older adults who are poor and eligible for both Medicare and Medicaid, the federal-state program for people with low incomes. On average, they tend to have more medical needs than similarly aged seniors.

Between March and September last year, the plan’s staffers conducted “wellness outreach assessments” by phone every two weeks, asking about ongoing medical care, new physical and emotional challenges, and the adequacy of available help, among other concerns. Today, calls are made monthly and staffers have resumed seeing members in person.

An increase in physical deconditioning is one of the big issues that have emerged. “We’ve had physical therapists digitally engage with members to coach them through strength and balance training,” said Dr. Robert MacArthur, a geriatrician and Commonwealth Care’s chief medical officer. “And when that didn’t work, we sent therapists into people’s homes.”

In California, SCAN Health Plan serves a similarly vulnerable population of nearly 15,000 older adults dually eligible for Medicare and Medicaid through its Medicare Advantage plans. Care navigators are calling these members frequently and telling them “now that you’re vaccinated, it’s safe to go see your doctor in person,” said Eve Gelb, SCAN’s senior vice president of health care services. Doctors can then evaluate unmet health needs and make referrals to physical and occupational therapists, if necessary.

Another SCAN program, Member2Member, pairs older adult “peer health advocates” with members who have noted physical or emotional difficulties on health risk assessments. That’s how Lindquist in Palm Springs connected with Jerry Payne, 79, a peer advocate who calls him regularly and helped him come up with a plan to emerge from his pandemic-induced funk.

“First, he said, ‘Ron, you should try getting up every hour and taking a few steps’ — that was the start of it,” Lindquist told me. “Then, he’d suggest walking another block when I would take my dog out. It was painful. Walking was not pleasant. But he was very encouraging.”

A month ago, Payne had a Fitbit sent to Lindquist. At first, Lindquist walked about 1,500 steps a day; now, he’s up to more than 5,000 steps a day and has a goal of reaching 10,000 steps. “I’m sleeping better and I feel so much better all around,” Lindquist said. “My whole attitude and physicality has changed. I tell you, this has been an answer to my prayers.”

Coming Monday: Tips for Older Adults to Regain Their Game

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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gordonwilliamsweb · 3 years

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As Pandemic Eases, Many Seniors Have Lost Strength, May Need Rehabilitative Services

Ronald Lindquist, 87, has been active all his life. So, he wasn’t prepared for what happened when he stopped going out during the coronavirus pandemic and spent most of his time, inactive, at home.

Use Our Content

It can be republished for free.

“I found it hard to get up and get out of bed,” said Lindquist, who lives with his wife of 67 years in Palm Springs, California. “I just wanted to lay around. I lost my desire to do things.”

Bean said his mother is no longer able to benefit from rehabilitative therapies. But many older adults might be able to realize improvements if given proper attention.

“Older adults got off schedule during the pandemic,” she explained, and “they didn’t eat well, they didn’t hydrate properly, they didn’t move, they got weaker.”

“I’m seeing weight gain and weight loss, and a lot more depression,” she noted.

The extra weight made it hard to move around, and Amilicia fell several times after Christmas, fortunately without sustaining serious injuries.

Coming Monday: Tips for Older Adults to Regain Their Game

USE OUR CONTENT

This story can be republished for free (details).

As Pandemic Eases, Many Seniors Have Lost Strength, May Need Rehabilitative Services published first on https://nootropicspowdersupplier.tumblr.com/

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onlyherefortheshowmances · 4 years

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TW: Mental Health

I have a lot of mental health issues. My main diagnosis is Bipolar (type II). I also have CPTSD (stemming from physical and mental abuse for the first 6 years of my life at the hands of my biological father and continued emotional abuse/manipulation by my mother afterwards). I also have Borderline Personality Disorder which is a trauma-response related disorder that basically means it’s more difficult for me to regulate my emotions than most people. I’m prone to meltdowns when angry or upset. I also have panic disorder, social anxiety, and generalized anxiety disorder. It took a lot of years to finally figure out what is wrong with me, but even knowing what’s wrong doesn’t mean there’re answers. Sure, I’m on meds, but they don’t really work. I see a therapist, but it doesn’t really help. Everything just furthers my abilities to hide my emotions entirely. To never say what I’m actually thinking. To never be allowed to exist in my true state.

I’m also physically disabled, but no one will believe just how much pain I’m in. I’ve gotten good at hiding that because what’s the bother if no one will believe me anyway. I’ve been in pain since I was 14 (2005). My freshman year of high school. Everything has gotten progressively worse to the point where walking more than a couple blocks is next to impossible. I used to be able to walk miles and miles with no problem, but that’s just not possible any more. A flight of stairs does me in, too.

In my early 20s a doctor finally listened enough to x-ray my knee, but the x-ray was normal, so they just gave me prescription strength naproxen (Aleve) and sent me on my way. Three years ago (2017), my knee was acting up and my family doctor finally gave me a referral to sports medicine. They took xrays and were able to see osteoarthritis in my joint this time. They had me do physical therapy which just gave me more pain and more reason/ability to pretend there wasn’t any. They also gave me a cortisone injection.

2 years ago (2018), I tore something in my right shoulder. It took an excruciating 2 months of physical therapy before I even got to see orthopedics. The first orthopedic doctor I saw, basically shrugged me off. He did a cortisone injection in my shoulder which made it worse. I requested a second opinion and finally found a doctor that would order imaging of the shoulder even though the physical therapist put in her notes that it should be MRI’d because of the symptomology following therapy. I had surgery in December for a tare that happened in June. I suffered through 9 months (including the 3 months of recovery after surgery) for something that could have been over in half that time if doctors would have just listened when I went to urgent care the day it happened. At my surgery follow up the doctor remarked that the inside of my shoulder looks like I’m at least in my 70s and that my rotator cuff is also slightly torn and will likely eventually need repaired.

It wasn’t until this year (2020); literally 15 years after the pain started, that I found a single doctor that would take me seriously. He finally ran blood work beyond the regular stuff and I’ve since been diagnosed with Rheumatoid Arthritis, but because the x-rays of my hands and feet look normal, it’s not “aggressive” and I’m just on meds. I still don’t have pain meds or muscle relaxers even though that’s all I want. I’m still not disabled enough.

The medical care I require is not cheap. Especially not when the insurance my employer offers has $60 co-pays for every specialty visit. My prescriptions cost $50+ per month even with insurance. My therapist is $45 per session which I can only afford every 3 or 4 weeks even though I should definitely be going more often. My psychiatrist is $50 per visit and he wants to see me monthly when he changes anything. I have to see rheumatology ($60 per visit) every 6 weeks for conceivably forever. I had to have a special eye exam ($105 total) every year and new classes are $50+ every year because you know my eyesight has to be complete shit on top of everything else, too.

I also have to live alone; in part because of my mental health condition and in part because I don’t have anywhere else to go. So, I have to pay my bills all on my own, too.

I’ve had a lot of jobs in my 29 ½ years of life.

I worked at Wal-mart in High School (2007-2009). I was a cashier first and then worked in the clothing department. I was fired because they refused to accept my doctor’s note absences even though their company policy says they should have. I got unemployment.

I did odd jobs in college (2009-2012). I was a tour guide for open house once a month which was probably my favorite job. I very briefly worked in the dining hall, but my mental health couldn’t take that for more than a couple weeks. Mostly my grandfather supported me through those three years until I had to leave school. I made it through 3 years of the social work program to realize my mental health wasn’t cut out for that profession. I didn’t have the money for 3 more years to get a different degree, so I left. Always with the intention that I’d go back some day, but I’ve never actually made it and now with the state of me, probably never will.

I worked at the Amazon Warehouse for the grand amount of 2 weeks after I left school (June 2012). I had a panic attack trying to do high levels on the order picker and didn’t have a psychiatrist to write an accommodation letter at the time, so I had no choice but to leave.

I then worked at Target (but for Radio Shack) selling contract cell phones (July 2012-. I enjoyed that job well enough, but it became physically taxing (standing for umpteen hours on end). It was that job that got me to transfer back to my city from where my grandfather lived. I lived with a roommate for a year. She no longer speaks to me because of a whole laundry list of misunderstandings (mostly my mental health).

After Target, I worked at CVS as a Pharmacy Tech. I think that was the job I had the longest before my current one. It was that job that lead to my first hospitalization(s) for mental health. When I finally had to leave (for my mental health), I was unemployed and essentially homeless for almost a year and then I had county funding to get a room for another year and lived off food stamps and medical assistance.

During that time, I met Shawn. He was the saving grace I needed to get out of what I thought would be the darkest time of my life.

I managed to get my anxiety under control enough to get a job again. I was a mail carrier for 7 months (May-December 2016). I lost that job again due to my mental health. I was hypomanic (the upswing of Bipolar II) and made a careless driving decision. I was then unemployed for 4 months (until April 2017). But I was living with Shawn at that time and everything seemed fine.

I then ended up working in the laundry room at the hospital for a few months (April-July 2017). I ended up needing to quit that job because my physical paid started getting too much to handle and I got tendonitis in my wrist. But during that time Shawn broke off our engagement and I restarted therapy (with my current therapist). We’ve always still been best friends. We’ve still done things together; in fact I moved into the spare bedroom and continued to live there for over a year after.

I started my next job a week after leaving the hospital. I was a receptionist at a major dental practice (July 2017-March 2018) until their company policies went to shit and I had to find a new job for my own sanity.

I started my current job on April 9, 2018. I work in Revenue Cycle for a group of dental practices doing mostly insurance billing and claims follow up. I moved into an apartment by myself in September 2018 and live there until August of this year. I recently moved into a new apartment (August 2020).

The past year has however been a living hell.

On October 24, 2019, Shawn died. I don’t want to go into details of how, but it wasn’t directly intentional, but he knew there was a risk in his actions that lead to the death.

It’s been year. Nothing’s gotten better. Everything is still broken. Everything still hurts. I’m only better at pretending. I don’t want to live in this world anymore. Intensive Mental health programs only make things worse (inpatient and intensive outpatient alike) and make me hide even more because I need to get out. I can’t handle it.

I need to quit my job. For my mental and physical health. I can’t handle it anymore. Especially not working from home like I’ve had to since June because of COVID. I don’t think another job would be any better. Maybe for a couple months, but then the same problems would happen again. I just can’t commit to doing something every single day. Not with my mental or physical health. But I can’t quit because I have bills to pay. I can’t get disability because I’m currently working and you can’t be working or have savings to get disability. You basically have to be homeless or live with someone that supports you completely to get it. So basically, I have no way out and I’m stuck in a perpetual hellscape.

#TW: Mental Health

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drowningwavez · 4 years

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I’m exhausted after today. I had another session witg my psych but I was hoping to just talk about all the stress of this week but it always just goes into deeper shit. I’ve been getting really bad anxiety like the complete physical feeling of being in that flight response my hands and legs were freezing but my face was burning hot and I was shaking and just could feel the adrenaline in my body.

I tried calling around the two hospitals that got back to me about a inpatient stay and they’re not what I was expecting or wanting. Even though my dr said I only want a one week admission they want you to do the 3 week program. One has beds next week maybe but she didn’t really tell me anything at all. I asked about outpatient groups instead but you have to do the inpatient program first to be able to do the outpatient one which is shit.

Then I called the other back and this lady did like a intake but it sounds just way too much. It’s groups all day and you have to attend AA I’m the evenings and me and my psych agree the AA model is not one that is good or helpful for me at all and I hate it. So both places run on that model. She then asked about any recent hospital stuff and I had to tell her about my overdose and she asked how many times I’ve done that and I just lied and said 10 and she was like oh wow hmmm then asked about self harm and I said again that it’s been bad recently but like the overdose I haven’t done it in 18 months and is like so do you often need stitches in like ummmm yeah... so she needs copies of my discharge summaries from public and private which I think will mean they won’t likely take me anyway even though my psychiatrist explained it in the referral.

That place has a 4-6 week wait at one location and 2-3 at their other one and the first tis the one I’d want to go to. Again I asked about just doing a outpatient group but I’d have to see one of their psychiatrists to do it. So would take weeks or months to see one of their drs outpatient and also cost a fortune when I already have a psychiatrist just to be able to do a outpatient program that I’d likely have to wait for too. If you go inpatient then you’d avoid doing that but like it’s just fucking ridiculous I didn’t think it would be so hard to just try and do a outpatient group to avoid going inpatient.

So I’m just left feeling really disheartened and I just don’t know what the fuck to do. I wanted help but it’s just so hard to get. To think that I literally got in to my last admission in 48 hours compared to now with covid. I understand it’s out of their hands but even just the outpatient groups. My only option really is to go into the second plaxe and discharge after a week and hope the dr I’m under refers me to the outpatient group. If I did it at the first hospital I likely wouldn’t qualify for the group as I’d say you have to do the entire 3 weeks. It was the same at the place I spoke with last week you can’t do the outpatient until you’ve done inpatient.

#personal #therapy #june #hospital

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mdvisualize · 6 years

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Leading Ten Tech Trends 2018: Are the Lines Between Provider and Payer Organizations Beginning to Blur? To Some, That Would be Progress

Top Ten Tech Trends 2018: Are the Lines Between Provider and Payer Organizations Beginning to Blur? To Some, That Would be Progress

TREND: The Complexity of Risk-Based Contracting

Editor’s Note: Throughout the next week, in our annual Top Ten Tech Trends package, we will share with you, our readers, stories on how we gauge the U.S. healthcare system’s forward evolution into the future.

As the shift from a volume-based to a value-based U.S. healthcare delivery and payment system moves forward—albeit unevenly and not as quickly as some would like—some of the lines between what providers and payers do are inevitably beginning to blur. Industry experts and observers say that blurring will necessarily have to occur, as provider organizations take on more risk. Indeed, many believe, the only way to wring significant savings out of the healthcare delivery system is to compel the acceleration of risk, headed in the direction of partial or full capitation.

These ideas are far from new; indeed, they’ve actively been discussed for decades, including by leading industry lights. What’s more, some industry leaders believe that full capitation will become necessary—among them Brent C. James, M.D. and Gregory P. Poulsen. Those well-known healthcare industry leaders argued as much in “The Case for Capitation,” which appeared in the July-August 2016 issue of the Harvard Business Review. Arguing forcefully for full capitation, they wrote in that article that, “[U]nder the prevailing payment models, which are based on volume of services, providers often don’t receive any of the savings from waste reduction, which undermines both their financial health and their ability to continue to invest in such efforts.” Instead, they said, “The solution to this quandary is to change the way businesses, government, and other purchasers pay for health care to population-based payment. Under this approach, providers receive a fixed per person (or ‘capitated’) payment that covers all health care services over a defined time period, adjusted for each patient’s expected needs, and are also held accountable for high-quality outcomes… It also ensures that providers receive enough of the savings that they can afford to fund the changes needed to bring down costs.”

How the shift to capitation plays out may in fact depend to some extent on what business combinations emerge in the next few years. That said, speaking of the metro Boston and Massachusetts healthcare market, which is in the midst of a great deal of consolidation activity right now, “I think there’s been a definite blurring of the lines” between health insurers and providers, says Barbara Spivak, M.D., president and CEO of the Mt. Auburn Cambridge Independent Practice Association (IPA), a 500-physician organization that participates in a variety of value-based contracts in the area. “You have Partners HealthCare buying Neighborhood Health Plan, a Medicaid plan, and they got rid of the Medicaid and made it commercial. And then it became the insurance plan for their 100,000 employees. That’s a blurring of the lines. And on top of that, they’re trying to buy Harvard Pilgrim, and you presume that they want the geographic distribution to help them to extend into Rhode Island, New Hampshire, and Maine, where Neighborhood isn’t licensed there.” The dizzying combinations and recombinations are scrambling markets like Boston’s, she notes, and forcing physician groups in particular to have to think proactively about how they will succeed in an emerging world of hybrid organizations. Indeed, in some markets, like Pittsburgh, where the 20-plus hospital UPMC health system dominates that market, the fact of that organization’s having a strong provider-owned health plan is helping the overall UPMC organization to innovate quickly around population health efforts.

Indeed, some of the moves that the leaders of patient care organizations have been taking have been in response to more aggressive moves by health insurers.

“Payers have ratcheted down hospital payments by creating policies with an eye toward providing care at less-costly locations, designing health plans that put more healthcare utilization costs on members and by replacing fee-for-service payments with value-based contracts. Providers have also teamed up with insurers in partnerships that look to offer better outcomes,” Les Masterson wrote in an article in Healthcare Dive online back in November. “Insurance companies have created policies, designed plans and narrowed provider networks to bring down healthcare costs. They’ve shown success. Expect payers to accelerate those programs and policies and search for more cost-saving levers in 2018. The most public example of health insurers cutting costs over the past year was Anthem’s policies to not pay for unnecessary emergency department visits or imaging services at hospitals. Anthem’s policies looked to nudge patients to less costly outpatient facilities, including urgent care centers and freestanding imaging centers.”

Provider Organizations and the “One Foot in the Boat, One on the Dock” Problem

In many cases, patient care organization leaders are creating provider-sponsored health plans, as well as diving into a variety of risk-based contracts, including accountable care organization (ACO) contracts, bundled-payment contracts, and others, in order to maintain some control over referrals, etc., while still moving ahead into enhanced efficiency and cost-effectiveness. Still, there is great complexity in managing the situations that arise as patient care organizations involve themselves in a variety of different contracts. Looking at the landscape around all this, Shawn Griffin, M.D., vice president, clinical performance improvement and applied analytics at the Charlotte-based Premier Inc., says, “We think that cooperating on price and quality should be the focus.”

What’s complex, Griffin says, is how some of the financial and contractual relationships impact productivity and output, he says, referring to value-based contracts. “With some of these combinations, you start to see mixed affiliations. If you have a payer who owns some providers, how do they treat the ones they employ versus the ones they don’t employ? The whole picking teams thing can be very divisive. And some of these groups have existed within silos in the industry. Now, when you combine providers, payers, etc.—a lot of organizations have concerns when they sit down with an insurer that owns a lot of providers, or owns an analytics shop. I don’t think that we necessarily believe there’s a silver bullet with one magical algorithm to save the day. I think it’s going to be people working together to work with innovative models and collaborations, so that we can help people, but not at the expense of the people delivering care.”

Another Piece of the Puzzle: Narrow Networks

Of course, all of these developments are taking place against a backdrop of attempts by the purchasers and payers of healthcare to rein in the escalating overall costs of the U.S. healthcare system. One accelerating strategy on the part of health insurers? The creation of narrow networks. “As much as we want the collaboration,” says Dr. Griffin’s Premier Inc. colleague Steve Valentine, vice president of strategy and advisory consulting for the company, “the competition is clearly heating up, and inpatient volume has gone flat, and more is moving to ambulatory side, and we’re seeing more payers creating and expanding narrow networks and tiered networks.” “Maintaining the network enables you to better collaborate on and coordinate care. It’s the collaboration to make sure you’re sending patients to a good acute-care space, not simply, here we have a coupon,” Griffin adds.

Meanwhile, it’s a challenge to support all of these different contractual arrangements with data analytics and clinical performance improvement processes. “I was at an organization with 2,000 physicians, and only 10 percent were employed, before I came to Premier,” Griffin says. “There are things that can be done to facilitate the transfer of care and efficient delivery of care, when you’re on a single platform, but that’s more because of the EHRs [electronic health records] being siloed.”

And, of course, this entire landscape may be altered by the decision of Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS) to announce, on August 9, a proposal dubbed “Pathways For Success,” which would remove the traditional three tracks in the Medicare Shared Savings Program and replace them with two tracks that eligible ACOs would enter into for an agreement period of no less than five years: the BASIC track, which would allow eligible ACOs to begin under a one-sided model and incrementally phase-in higher levels of risk; and the ENHANCED track, which is based on the program’s existing Track 3, providing additional tools and flexibility for ACOs that take on the highest level of risk and potential rewards. That proposal has received very mixed reviews among patient care organization and ACO leaders.

The jury is out as to whether that proposal will end up stimulating an acceleration in ACO participation, at least in the MSSP program, or cause providers to flee MSSP. But the signs are clear: the purchasers and payers of healthcare are determined to push providers further into risk.

The question, industry experts and observers agree, remains how quickly the leaders of patient care organizations can move into and through clinical transformation and organizational performance improvement, in the emerging heterogeneous landscape—the classic “one foot in the boat and one foot on the dock” environment that is being referenced constantly now—to navigate towards success in the next few to several years. And that is a question with no ready answer right now—only a laundry list of challenges and complexity.

St. Jude Children's Research Hospital

Chief Information Officer and Chief Digital Officer

Children's Mercy Hospital

Senior Director, Federal & State Affairs

Vice President, Ambulatory Services

SLA - Regional Development, Population Health, and Telemedicine

Tallahassee Memorial Healthcare

Founder and Chief Executive Officer

Vice President and Chief Information Security Officer

Director, Telehealth and Medicine

Office of Chief of Staff, Georgia Department of Health

Chief Information Officer

National Health Information Sharing and Analysis Center (NH-ISAC)

Vice President, Public Policy

American Medical Informatics Association

Group Vice President, Telehealth

Providence St. Joseph Health

‹›

/article/value-based-care/top-ten-tech-trends-2018-are-lines-between-provider-and-payer-organizations

/blogs/rajiv-leventhal/value-based-care/it-fair-question-cms-agenda-releasing-aco-results

Is it Fair to Question CMS’ Agenda for Releasing ACO Results?

It’s been a busy month for ACOs. As is often the case, results can be interpreted in many ways.

It’s been quite the eventful ACO (accountable care organization) month for healthcare folks. First, on Aug. 9, the Centers for Medicare & Medicaid Services released a proposed regulation on the future of MSSP (Medicare Shared Savings Program) ACOs, with the broad intent to push providers into taking on more financial risk. Then, on the 24th, CMS released a detailed evaluation on how its Next Generation ACO model performed in 2016. Finally, on the 30th of the month, the federal agency made public the 2017 data for MSSP ACO participants.

On these three dates, three stories were told, but within those three stories are even more layers to what exactly is going on with federal ACO programs and just how much the government is comfortable with disclosing.

As I always like to ask, what’s the story behind the story? Let’s do some digging.

Backtracking a bit, last October, CMS made public the data from year one of its Next Generation ACO model, which debuted in January 2016. The results showed that 11 of the 18 ACOs in this model were able to achieve shared savings in year one of the program, which was quite an impressive feat considering the amount of financial risk that Next Generation participants take on. According to CMS, “The Next Generation ACO Model involves the highest levels of risk in any ACO initiative offered by CMS.”

Fast forwarding to August 2018, as noted above, CMS released a 111-page report on the Next Generation ACO model while also issuing a press release on the model’s 2016 results. But to the sharp-eyed observer, it’s strange that CMS again released 2016 data for the Next Gen program, rather than 2017 data. When asked, a CMS official noted that ACOs participating in the Next Generation ACO model have received their embargoed individual financial and quality results for the 2017 performance year, adding that ACOs get time to review their results and report any issues with their data to the agency. But still, the “re-release” of 2016 data is the key, since it feels as if CMS wants to highlight the Next Generation model over the MSSP model.

Enter the MSSP model, as CMS decided to not issue a press release on the program’s 2017 data, instead opting to release the data on the 472 MSSP ACOs in raw Excel format. Again, this raised my interest level, especially considering the massive changes the government is proposing for this program. While the 2017 performance data for MSSP ACOs was certainly encouraging—in sum, the 472 ACOs achieved $314 million in net savings to Medicare in 2017 after accounting for bonuses paid from the government—it’s quite possible, if not probable, that CMS chose not to make a big to-do about these results since its leadership has been exceedingly critical about MSSP ACOs of late.

Indeed, CMS Administrator Seema Verma has been saying for months that one-sided risk ACOs—which comprise about 82 percent of the MSSP model—are costing Medicare money and have not nearly been effective enough. In a press call announcing the August 9th proposed regulation from CMS that looks to reshape the MSSP structure, Verma bluntly stated that “[Upside-only] ACOs have no incentive, at all, to reduce healthcare costs while improving outcomes, as they were intended. Thus, the program has not lived up to the accountability part of their name,” she said.

As such, in the proposal, CMS is suggesting to shorten the glide path for new ACOs to assume financial risk, reducing time in a one-sided risk model from the current six years to two years. This proposal, coupled with CMS’s recommendations to cut potential shared savings in half—from 50 percent to 25 percent for one-sided risk ACOs—will certainly deter new entrants to the MSSP ACO program. It’s a proposal that has so far been met with mixed reaction as stakeholders weigh the broad intent of CMS to push providers into two-sided risk models.

However, as the 2017 MSSP data began to be analyzed late last week by industry experts, the consensus seems to be that one-sided risk ACOs in the MSSP model are doing better than Verma and others are giving them credit for. As Farzad Mostashari, M.D., former National Coordinator for Health IT and current CEO of ACO company Aledade, pointed out on Twitter, “Track 1 ACOs more than held their own [in 2017].”

7/ the Track 1 ACOs more than held their own here

Best guess is that Track 2/3 generated 190M in savings (w 60% spillover) and received $95M (50%)

Track 1: $1.5B in savings, $685M in payments (44%)

(I'm still a believer in moving to 2-sided risk to help weed out ACO squatting)

So, the question that needs to be asked is, if MSSP ACOs—largely including one-sided risk ACOs—are performing as well as it seems they are, does CMS need to be so aggressive in its suggested overhauls to the program, with the agency’s primary logic being that one-sided risk models are not generating savings for Medicare? At the very least, it would be hard to argue that the timing is not fascinating—that just a few weeks after CMS released its proposed changes to the MSSP, the program’s results from 2017 disclosed terrific results.

What’s more, the fact that CMS did not formalize a press release around the MSSP data is also telling. One would be fair to ask, if the MSSP 2017 data did not shine one-sided risk ACOs in a positive light, would the government have taken the opportunity to formally publicize the undesirable results? Of course, these questions are merely hypothetical, but they are nonetheless important in the larger picture of ACO evaluation.

Regarding the question of how much one-sided risk ACOs are saving Medicare, on a recent Healthcare Informatics , Rita Numerof, Ph.D., co-founder and president of St. Louis-based consulting firm Numerof & Associates, noted that one key factor that sometimes isn’t calculated in an ACO’s cost is the amount of administrative overhead that’s required to operate such a model.

Nevertheless, there are different outlooks on ACO savings depending on where one might look. This research in Health Affairs found that in 2016, Medicare saw a net loss of $39 million for the [MSSP] program, after accounting for bonus payments made to those ACOs earning shared savings. Specifically, the research found, CMS paid out more than $600 million in bonus payments to 134 ACOs in Track 1, while only collecting $9.3 million in penalty payments from four ACOs in Track 3. Meanwhile, the 22 ACOs participating in Tracks 2 and 3 generated approximately $33 million in net savings to CMS in 2016. “In other words, while the program as a whole is reducing per-patient Medicare spending, the amount paid out by CMS in total bonuses is more than the amount taken in by CMS from ACOs in two-sided risk that spent more than expected. Thus, according to CMS’s benchmark methodology, Medicare is not, on net, saving money,” the researchers from KPMG concluded.

Similarly, an analysis from consulting firm Avalere found that from 2013 to 2016, MSSP ACOs fell short of initial Congressional Budget Office (CBO) by more than $2 billion. But on the other hand, also as noted by the KPMG researchers, in Health Affairs, “Some have argued that ACOs are indeed saving Medicare money that cannot be fully captured measuring performance against each individual ACO’s financial benchmark—a more accurate assessment of impact would consider the ‘counterfactual’ of Medicare spending in the absence of ACOs.” To this end, the Medicare Payment Advisory Commission (MedPAC) estimated that ACOs may have saved Medicare from 1 percent to 2 percent more than reflected by their financial performance relative to benchmarks. In other words, the benchmark savings methodology may underestimate the amount of money that program participants are saving Medicare, the researchers noted.

In the end, it’s clear that there is a large disconnect as to just how much money one-sided risk ACOs are saving Medicare. That’s why the purpose of this blog is to request a bit more transparency from CMS, as the agency should release ACO program results in an equal opportunity fashion. If this were to happen, perhaps there would be far fewer questions—and much more clarity—on the ACO landscape as providers and payers continue to make critical decisions as they move toward a value-based care future.

/news-item/value-based-care/industry-groups-urge-cms-reform-stark-laws-hhs-considers-reforming-anti

Industry Groups Urge CMS to Reform Stark Laws, HHS Considers Reforming Anti-Kickback Statute

On June 25, the Centers for Medicare & Medicaid Services (CMS) issued a request for information (RFI) for public input on how to address any undue regulatory impact and burden of the physician self-referral law, also known as the Stark Law.

When enacted in 1989, the physician self-referral law, also known as the “Stark Law,” addressed the concern that health care decision making can be unduly influenced by a profit motive. The Stark Law was enacted to help protect Medicare and its beneficiaries from unnecessary costs and other harms that may occur when physicians benefit from referring patients to health care entities with which they have a financial relationship, according to CMS. The law prohibits a physician from making referrals for certain health care services to an entity with which he or she (or an immediate family member) has a financial relationship. There are statutory and regulatory exceptions, but in short, a physician cannot refer a patient to any service or provider in which they have a financial interest.

In its RFI, CMS officials said that through internal discussion and input from external stakeholders, CMS identified some aspects of the physician self-referral law as a potential barrier to coordinated care.

Further, CMS stated it has made facilitating coordinated care a top priority and seeks to “identify ways in which its regulations may impose undue burdens on the healthcare industry and serve as obstacles to coordinated care and its efforts to deliver better value and care for patients.”

In a blog post published in June, CMS Administrator Seema Verma wrote that over the past year, CMS has engaged with the provider community in a discussion about regulatory burden issues. This included publishing a RFI soliciting comments about areas of high regulatory burden. “One of the top areas of burden identified in the over 2,600 comments received was compliance with the physician self-referral law (often called the “Stark Law”) and its accompanying regulations,” Verma wrote. “In response to these concerns, CMS undertook a review of the existing regulations to determine where the agency could consider potential areas for burden reduction. In coordination with HHS Deputy Secretary Eric Hargan, CMS is now soliciting specific input on a range of issues identified with the Stark Law to help the agency better understand provider concerns and target its regulatory efforts to address those concerns.”

Verma noted that the Stark Law and regulations, in its current form, may hinder value-based care arrangements.

The U.S. Department of Health and Human Services (HHS) also is considering making changes to the anti-kickback statute as the HHS Office of the Inspector General (OIG) is looking for stakeholder feedback, via an RFI issued August 27, on how to address any regulatory provisions that may act as barriers to coordinated care or value-based care. The OIG RFI contained a broad range of questions and topics the agency wants stakeholders to comment on, including potential arrangements that the industry is interested in pursuing, such as care coordination, value-based arrangements, alternative payment models, arrangements involving innovative technology, and other novel financial arrangements that may implicate the anti-kickback statute or beneficiary inducements civil monetary penalty (CMP). HHS OIG also wants to know what types of incentives providers and suppliers are interested in providing to beneficiaries and how those incentives would improve care quality, care coordination, and patient engagement. The RFI’s comment period ends October 26.

The deadline to submit comments on the CMS RFI was August 24. AMGA, the Alexandria, Va.-based organization that represents medical groups, urged CMS to reform Stark Law regulations to encourage the adoption of value-based payment models.

AMGA provided comments on the timing and availability of Stark law waivers, how the law should be applied to Alternative Payment Models (APMs), and how transparency can better inform Medicare beneficiaries’ decision-making.

“The intent behind the Stark law, as Congressman Pete Stark himself admitted, was to create bright line rules so physicians can police their own behavior and not get distracted from focusing on improving care delivery,” Jerry Penso, M.D., AMGA president and chief executive officer, wrote in the letter to CMS. “New innovative models of care present a challenge for regulators who want to improve care coordination and outcomes via incentivized value-based arrangements without creating legal uncertainty in advancing these goals. CMS is in a difficult position, but there are regulatory improvements, however incremental, that can be made to Stark.”

AMGA recommended CMS provide the time and flexibility needed to amend changes in practice patterns that were implemented as part of participation in an ACO. Rather than end waiver authority immediately upon an exit from the model, CMS should provide healthcare providers with additional time to come into compliance and should keep waivers in place if they participate in other, non-Medicare APM models that include Medicaid and/or commercial plans, AMGA wrote in its comments.

Another group of healthcare industry stakeholders also urged CMS to relax anti-kickback rules so that resource-strapped healthcare providers can accept certain donations or subsidies of cybersecurity products and services.

The Healthcare and Public Health Sector Coordinating Council's Cybersecurity Working Group (HSCC CWG), which is composed of 198 healthcare organizations, companies and associations from across the healthcare industry, wrote a letter to CMS recommending that the agency create a Stark exception that “allows for the donation or subsidizing of cybersecurity technology and services to help improve the cybersecurity posture of providers, better protect patient information, improve patient safety, and help fortify the healthcare sector from growing global threats.”

HSCC CWG member organizations span the health care sector and “have a vested interest in advancing the cyber posture of the healthcare industry and improving patient safety.”

According to the HSCC CWG letter, Stark Law regulations were enacted prior to the development of information technologies and the healthcare system has since evolved into a network that is heavily dependent upon data being stored and moved electronically. Further, the healthcare industry is the target of double the number of cyber attacks as other industries, the organization said.

Most providers are ill-equipped to combat cyberattacks, especially sophisticated attacks by nation states and criminals,” the organization wrote. One of the recommendations of the Health Care Industry Cybersecurity Industry (HCIC) Task Force Report, mandated by the Cybersecurity Information Sharing Act of 2015 (CISA), called for a regulatory exception to the Stark Law and a safe harbor to the Anti-Kickback Statute to protect certain donations of electronic health record (EHR) to effectively address management of technology between health care entities and support cybersecurity.

“Creating a Stark exception that allows providers to donate cybersecurity technology (both

hardware and software), training and tools to other providers (i.e. under-resourced or less sophisticated ones), will improve the overall cybersecurity posture of our industry and will help guard against cyber attacks that threaten patient safety. As the healthcare system is an interconnected and interdependent network, cyber threats are a shared challenge and a shared responsibility, which requires a team effort,” the organization wrote.

/news-item/value-based-care/mssp-2017-aco-results-touted-naacos-mostashari

MSSP 2017 ACO Results Touted by NAACOS, Mostashari

While the future of one-sided risk ACOs remains up in the air, healthcare leaders applaud the 2017 MSSP results

The Centers for Medicare & Medicaid Services (CMS) today released results for how the 472 Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) performed in 2017.

Although CMS released the data in raw Excel format, multiple industry observers have pointed out that it was a great year for the federal ACO program as a whole, in terms of both reducing costs and improving quality. Indeed, according to a review of the data from the Washington, D.C.-based National Association of ACOs (NAACOS), ACOs in the MSSP generated $314 million in net savings to Medicare in 2017 after accounting for bonuses paid from the government to ACOs.

NAACOS went on to note that in 2017, 472 ACOs caring for 9 million beneficiaries participated in the MSSP, generating gross savings of $1.1 billion based on the CMS methodology for setting financial benchmarks. According to 2017 CMS performance data, 60 percent of ACOs saved money in 2017 and 34 percent of ACOs earned shared savings, up from 56 percent and 31 percent, respectively, in 2016. And, in 2017, MSSP ACOs achieved a mean quality score of 90.5 percent under pay-for-performance measurement.

What’s more, the 2017 results reveal a continued trend of CMS’ ACO programs in that ACOs that are in the program longer are more likely to earn shared savings and save money overall for Medicare. Specifically, those MSSP ACOs that began in 2012 or 2013—when the program first began—generated net savings of $205 million, after factoring in bonuses paid. Those MSSP ACOs that started in 2014 generated $173 million in savings; ACOs beginning in the MSSP in 2015 generated $5 million; and MSSP ACOs that started in 2016 and 2017 lost Medicare a combined $68 million last year ($34 million each).

In Track 1 of the MSSP model, ACOs take on only one-sided risk, meaning they share in the savings they generate, but any losses fall entirely on the plate of the government. MSSP Tracks 2 and 3 involve downside risk, but participation in these tracks has been limited thus far. CMS leadership has reiterated in recent months that one-sided risk ACOs are costing Medicare money and have not been effective enough.

To this point, CMS now allows ACOs to stay in shared savings only programs for up to six years, to prepare for taking financial risk, giving ACOs time to build the infrastructure—the care coordination, information technology and data analytics capabilities—to transform practice and manage financial risk successfully.

But in a recent proposed regulation from CMS on the future of MSSP ACOs, the agency is suggesting to shorten the glide path for new ACOs to assume financial risk, reducing time in a one-sided risk model from the current six years to two years.

This proposal, coupled with CMS’s recommendations to cut potential shared savings in half—from 50 percent to 25 percent for one-sided risk ACOs—will certainly deter new entrants to the MSSP ACO program. It’s a proposal that has so far been met with mixed reaction as stakeholders weigh the broad intent of CMS to push providers into two-sided risk models.

Nonetheless, groups such as NAACOS adamantly disagree with how these ACOs have performed thus far. “These recent results show that ACOs have turned the corner and this evidence dispels confusion about ACO performance. The hard work of ACOs is paying off – for patients, providers and for the Medicare Trust Fund, and it’s essential we strengthen this program for the future,” Clif Gaus, president and CEO of NAACOS, said in a statement today.

Farzad Mostashari, former National Coordinator for Health IT and current CEO of Aledade, a Bethesda. Md.-based company that helps create and operate physician-led ACOs, tweeted out similar numbers about the 2017 MSSP ACO results, while also attesting that even the Track 1 MSSP ACOs are performing well.

2/ If you add up all the actual costs versus benchmarks, these 472 ACOs were collectively $1.1B under their benchmarks (more on whether that's the right counterfactual later).

7/ the Track 1 ACOs more than held their own here

Best guess is that Track 2/3 generated 190M in savings (w 60% spillover) and received $95M (50%)

Track 1: $1.5B in savings, $685M in payments (44%)

(I'm still a believer in moving to 2-sided risk to help weed out ACO squatting)

Meanwhile, CMS also announced the results of the two-sided risk Next Generation ACO model earlier this week, reporting that the first cohort of Next Gen participants generated net savings to Medicare of approximately $62 million while maintaining quality of care for beneficiaries for the 2016 performance year.

During the release of the Next Gen ACO results, CMS Administrator Seema Verma again stressed her desire to move providers into two-sided risk. “What this really shows is that these Next Gen ACOs are taking the highest levels of risk and they’ve managed to maintain quality while still lowering cost,” Verma said. “Much of the savings achieved by the Next Gen ACOs were largely due to reductions in hospital spending and spending in skilled nursing facilities, and that’s very consistent with what we’ve seen with how other two-sided ACOs have achieved savings,” she added.

See more on Value-Based Care

Source

https://www.healthcare-informatics.com/article/value-based-care/top-ten-tech-trends-2018-are-lines-between-provider-and-payer-organizations?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+healthcare-informatics+%28Healthcare+Informatics%29

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addictionfreedom · 6 years

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Addiction Treatment Raleigh Nc

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alexatwood86 · 7 years

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Xanax rehab cost

Estimating your personal cost

In this article, we help you estimate the average cost of Xanax rehab treatment. Then, we suggest effective ways you can finance your treatment. At the end, we invite your questions and try to provide personal and prompt answers to all legitimate inquiries.

We strive to help all of our readers understand addiction rehab. We also hope to ease some of your anxiety in the process. So, please reach out. Call or contact us. We try to respond to all comments personally and promptly!

—–

Are you done wasting your time with Xanax? We can help! Call 1-877-902-5376 TODAY.

—–

The average cost of Xanax rehab

The first step of rehab – medical detox – costs at least $250-500 per day, and maybe higher at some facilities or in some states. The cost of detox varies greatly from one facility to the next. Plus, some inpatient rehab programs will include the price of detox in their average cost.

Next, inpatient addiction treatment can range from free to several thousand dollars per week, with an average daily cost of $700-800. This brings the average price of a 28-day residential rehab program to about $19,000-$20,000. Reputable inpatient programs often partner with insurance companies to offset the cost.

Finally, the average price of outpatient treatment is about $135-200 per day, which adds up to around $9,000 for a 10-week intensive outpatient rehab program. However, many programs negotiate a reasonable price according to your attendance and needs, with an average 12-16 weeks less intensive price range of $2,000-$4,000 per treatment episode.

Is Xanax rehab expensive?

Yes, Xanax rehab can be expensive.

In fact, the cost of addiction treatment is among the top barriers that may prevent you from seeking the help you desperately need.

We get it. It’s a problem. In fact, you may be thinking, “What’s the point in trying to pay for rehab when it seems impossible to afford?”

But, ask yourself this: “Isn’t Xanax addiction costing you more in the long run?”

Especially when you consider the costs of:

buying the drug

paying for medical expenses related to its abuse

not advancing in your career due to Xanan abuse

missing out on time spent with family and friends

Be honest with yourself. Is the cost worth it?

We think so! If you’re ready to live the life you deserve, getting treatment is the first step.

Xanax rehabilitation process

Rehab for Xanax is like a combination of continued education classes, personal training, and summer camp. What can you expect during Xanax rehab?

1. Intake assessment. The first step of Xanax rehab is to evaluate and assess the nature of your addiction. This is done with an initial interview, an assessment of your physical and mental health state, and by administering a drug test. The battery of assessments will then help rehab staff to create your personal treatment plan.

2. Medical detox. If you’ve become physically dependent on Xanax you need to get the drug out of your system. This is usually done by weaning off of the drug under the supervision of a doctor. Be sure that you find a treatment facility with experience in Xanax detox. Medical teams should offer 24-7 monitoring, support, and administer medications to help manage withdrawal symptoms as they occur.

3. Addiction treatment programs. Afterwards, the main modalities of treatment can begin. You’ll need to decide between an inpatient or an outpatient program based on your wants and needs.

Inpatient Xanax rehab is a type of residential addiction treatment. This means that you reside in a rehab facility during treatment and attend therapy and counseling sessions in a structured and controlled environment. Inpatient rehab traditionally takes about a month to complete. More intensive inpatient rehab programs are available, however, and these can take up a few months to a year to complete.

Outpatient Xanax rehab does not require you to reside in the facility. Instead, you are expected to travel to the facility (usually daily or several times weekly) to undergo therapy, counseling, and other treatments. Oftentimes, outpatient rehab is used as aftercare following inpatient rehab, but it can also be used as a standalone treatment for Xanax addiction. Outpatient rehab can last several months to several years.

4. Aftercare. Finally, you can expect Xanax rehab staff to develop a custom aftercare plan and/or connect you with aftercare options in the form of counseling, support groups, alumni involvement, or residence in a sober living facility.

As you can see, the rehab and recovery process from Xanax addiction is long and complex…just like the condition itself. All of the services provided on your way to sobriety are expected to add to the end cost. But, paying the price of ongoing addiction and related health issues are much more expensive than paying for treatment.

Think of it this way: when you finance your rehab – you finance your sober future.

—–

Ready to start living the life you deserve? Confidential help available at 1-877-902-5376. Call ANYTIME: Day or Night!

—–

What influences the cost of your Xanax rehab?

The cost of rehab is difficult to estimate without targeting specific variables. In fact, there are a number of factors that will influence the end price of Xanax addiction treatment. These factors usually include:

Facility you choose = Luxury vs. basic.

Type of treatment = Inpatient (residential), outpatient, intensive outpatient (IOP), etc.

Duration of treatment = 30 days, 60 days, 90 days, or longer.

Treatment facility location = Close to your living area or far away (destination rehab).

Therapies included = Cognitive behavioral therapy, motivational interviewing, dual diagnosis treatment, family and couples therapy, educational sessions and career counseling, and more.

Additional therapies = Mindfulness training, yoga, Eye Movement Desensitization and Reprocessing (EMDR), Neurofeedback, art therapy, animal therapy, music therapy, acupuncture, and more.

Typically, the cost of Xanax rehab in an inpatient facility will be much more expensive than outpatient Xanax rehab. An inpatient facility’s room and board are the most obvious reasons for this. The cost of Xanax rehab on an outpatient basis is usually less expensive, due to the fact that you continue to live at home. However, there is a difference in cost depending on the type of outpatient care you require For example, Intensive Outpatient Programs (IOPs) that require several sessions each week will be more expensive than less intense programs that require one visit per week.

Additionally, luxury inpatient rehab facilities offer a resort-like atmosphere, which can additionally increase the price of your treatment. Locations close to the beach or in remote settings can also be more expensive. Some cities and states also tend to increase the price tag for rehab. Finally, the cost of Xanax rehab is also influenced by the duration of the program. Individuals who are in rehab for one or several months will pay less than those in need of recovery services for a year or more.

Paying for rehab

If you find yourself thinking:

“I cannot afford to go to rehab for my Xanax problem.” “How can I possibly pay for such expensive rehab programs?” “I can’t find ways to finance my recovery.”

…don’t despair! The actual price of a program and average cost of Xanax rehab for an individual can be covered with your health insurance or reduced with other forms of help that can ease your financial burden.

GOT INSURANCE? Health insurance companies, for instance, will usually cover a portion of the average cost of Xanax rehab. Call 1-877-902-5376 Toll-FREE to find out if your insurance provides coverage for addiction treatment.

NO HEALTH INSURANCE? Contact SAMHSA’s national helpline to get referrals to programs and get more information on state agencies that support low cost Xanax rehab in your living area.

QUALIFY FOR GOVERNMENT-PROVIDED INSURANCE? You can check out Healthcare.gov to shop for affordable health insurance and compare prices. Medicaid has expanded its coverage to at least 5 million adults who qualify for addiction treatment. Also, MediCare covers the cost of substance abuse treatment.

NO FINANCES? Look into a payment plan or sliding scale payment which allows you to pay for your treatment a little bit at a time. If you’re serious about getting better…invest in yourself! You can borrow from your savings account, 401(k), friends, or family. Health care credit cards also allow you to finance health care costs at lower interest rates and make monthly payments. Also note that you can claim the cost of Xanax rehab as medical expenses on your tax returns.

Cost of rehab questions

Studying the costs of Xanax rehab can be nerve wracking. However, when you understand that there are a number of resources you can use to help cover these costs, you’re one step further to recovery. If you’re still concerned about the cost of Xanax rehab, questions can be directed to our staff via the comment form below.

Reference Sources: SAMHSA: Alcohol and Drug Services Study (ADSS) Cost Study NIH: Principles of Drug Addiction Treatment: A Research-Based Guide Drug Abuse: Drug Abuse is Costly

Copyright © 2011 This feed is for personal, non-commercial use only. The use of this feed on other websites breaches copyright. If this content is not in your news reader, it makes the page you are viewing an infringement of the copyright. (Digital Fingerprint: f7a6e0cc3471137b83805a08cd727b99) from Addiction Blog http://prescription-drug.addictionblog.org/xanax-rehab-cost/

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integrativeaddiction · 6 years

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Addiction Treatment Centers Alberta

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