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Archive for the ‘Personal Healthcare Portfolio’ Category

Fight for Your Rights – Patient Advocacy at Its Best

Monday, August 29th, 2011

Recently an employee came to me terribly worried about her child. Her daughter had been finally diagnosed with a severe lactose allergy after months of testing, countless doctors’ visits, and numerous theories of the cause for her tiredness, chronic hives, and other symptoms. However, my employee’s daughter wasn’t out of the gate yet. She takes a few medications to help with her allergies and her Attention Deficit Disorder.

Lactose in Drugs Can Affect Allergies

Now, here is the problem. What happens when these necessary medications contain lactose or eggs – two ingredients the child is allergic to? First, you need to ask your doctor or pharmacists what ingredients are in your medications – all the ingredients. Many medications use lactose as a filler. You also need to be aware of vaccines as well – many (including the flu vaccine) contain lactose.

For my employee, she asked her pharmacist if her child’s medication could contain lactose. Her pharmacist firmly replied that is takes too long to look up the ingredients of drugs. (Subsequent calls to other pharmacies did not pose this same problem, so hopefully in her case it was a moody pharmacist). However, if you receive this reply, first indicate that your child has a severe allergy and could be seriously harmed or even die if the product contains any milk (or peanuts, eggs, etc.). Second, ask to speak with another pharmacist. If you don’t receive an adequate answer find a pharmacy that will accommodate your questions and go directly to the drug manufacturer’s site to look up the ingredients in your child’s medication.

The good news is, that with most lactose allergies, many people can continue taking medication that includes milk. According to Walgreens, “Most people who are lactose intolerant can tolerate the lactose in oral medication because it usually takes around 12 to 18 gm of lactose—about the amount in 8 to 12 oz of milk—to cause the symptoms that include gas, bloating, diarrhea, and abdominal pain. Most oral medications contain far less than this amount. However, some individuals may still experience those symptoms from very small amounts of lactose. In these cases, lactase enzyme supplementation may help. These supplements, available over the counter, help by breaking down lactose. Probiotics, which contain beneficial bacteria that may help break down lactose, are another possible remedy.” So for those of you that only have a mild lactose intolerance, medications including milk might be fine for you to take (please consult your physician or pharmacist before doing so).

Again, be the informed patient. Most people might not think that the medication that is supposed to be helping them, might actually be severely hurting them. Keeping a Personal Health Record will help you keep control of your allergies and inform your healthcare providers on changes in your health condition.

Thanks for reading!

Your healthcare resource – Rebecca Busch

Cutting Healthcare Costs through Patient Advocacy

Tuesday, July 12th, 2011

During a recent conversation with a colleague, she informed me how she has been responsible for taking care of her elderly mother, driving her to appointments, filling her prescriptions, etc. She mentioned that her mother’s previous doctor always ordered tests – looking at her bone density, mammograms, chest X-rays – the whole nine yards. Initially, this didn’t surprise me, her mother is 87 and has emphysema and osteoporosis – the doctor is just trying to keep her healthy. However, after my colleague enlightened me, I thought about the subject a little differently.

First of all, let’s look at the age. Her mother is 87. She has stated repeated that these tests hurt her (mammograms especially, and she has very sensitive skin that tears easily). Even if these tests were positive or showed some sort of abnormality, she would most likely elect not to have surgery, radiation, or other forms of treatment.  Her mother’s attitude, “I am 87, I want to live a pain free, non-complicated life. Going to the doctor every month isn’t fun for me, or my daughter who has to take work off in order to drive me.”

I mentioned previous doctor in the first paragraph because my colleague’s mother was so fed up with all these tests and appointments that she went to a new doctor. The new doctor was very candid. She said, “Yes, I can order these tests. Yes, I could see you once a month. However, you’re pretty healthy and these tests aren’t going to tell us anything that we don’t already know, or that we could fix.” Now, the doctor could have been reimbursed by Medicare and secondary insurance for these tests – the mother wouldn’t have had to “pay” out-of-pocket anything. But, in that sense, we all are paying for unnecessary tests and visits.

This is only part of the problem. Luckily my colleague and her mother were informed enough to understand that they can say, “No” to these unnecessary tests and procedures. Other individuals might be scared into participating. This is an instance were having a patient advocate on hand, informing the patient of his/her rights would be ideal. A second ear to listen to diagnoses and conditions, and a trained mind to realize that an elderly person who is sensitive might not want these tests because they hurt or the results won’t produce anything the person doesn’t already know.

The moral of this story is to speak up when communicating with your physician. If you find yourself wondering why your physician is ordering tests, consult with another physician. Patients can cut healthcare costs on the front end by being savvy consumers.

Thanks for reading!

Your healthcare resource – Rebecca Busch

Can Health & Wellness Programs Fight Obesity?

Friday, January 21st, 2011

According to a recent report titled, “Obesity and its Relation to Mortality and Morbidity Costs” almost 30% of the adult population is overweight, obese, or morbidly obese.

  • Overweight – 19.2% (Body Mass Index of 25.0 to 29.9)
  • Obese – 7.4% (Body Mass Index of 30.0 to 39.9)
  • Extremely Obese – 4.2% (Body Mass Index of 40.0 +)

Some other shocking finds concerning obesity and health from the New York Times:

  • Obese Americans spend about 42% more on health care than normal-weight Americans
  • Obese Americans spend about $1,429 more on health care each year than the roughly $3,400 spent by normal-weight Americans
  • The average American consumes 250 more calories per day than just two decades ago
  • Medical spending on obesity-related conditions is estimated to have reached $147 billion a year in 2008. A figure that represents almost 10% of all medical spending

How can health and wellness programs curb this epidemic? First, group programs and working with others on a common goal keep people on track (think Weight Watchers). If employees are accountable for their actions to others, they will more likely stay on task. This also builds comradery and teamwork skills.

Second, you can show your employees that you care for their well-being and want them to be healthy. You can also reduce absenteeism, increase employee loyalty and witness a major decrease in health insurance costs by offering health and wellness services.

What are some services you can offer? Weight management, healthy eating, healthcare financial services, patient advocate services, concierge visits, gym memberships, group fitness programs, counseling, etc. to name a few.

The major thing is to show your employees you care about their well-being and want them to be healthy and feel great. We can fight obesity by re-learning healthy eating/living habits and decrease healthcare spend exponentially.

When Do You Need a Patient Advocate?

Saturday, January 15th, 2011

Health and healthcare are private, yet extremely important issues that affect your life every day. If you aren’t feeling well, that affects your mood. If you have a headache, you’re less likely to be productive. If you’re worried about your health or that of a loved one, that stress can lead to more illness and frustration.

Who are you supposed to turn to when your healthcare situation gets out-of-hand, like you aren’t staying on top or your bills (even afraid to open them) or you haven’t researched adequate treatment options and you’re scared to confront the doctor? Patient advocates are an invaluable resource during troubling health experiences.

When might hiring a patient advocate make sense?

1.       You’re overwhelmed with your bills.

2.       You recently obtained power of attorney of the health of a family member or loved one.

3.       You feel “stuck.” You aren’t receiving answers to questions on care or insurance and are unsure of what to do next.

4.       You have a chronic condition that requires constant monitoring.

5.       You receive advice/an opinion and it doesn’t make sense to you.

6.       You are told that no options exist.

What is a patient advocate?

A patient advocate will help you sort through your bills and develop a personal health record or portfolio of all your important health information. A patient advocate will research treatment options with you and provide multiple physicians/other resources in your area or that best treat your condition. A patient advocate will also contact insurance carries and providers on your behalf to sort through your healthcare finances.

Remember a patient advocate can truly be a life saver. However, all patient advocacy services are not alike. Research the advocacy organization and know the credentials of your advocate.

Good luck and great health!

More on Employers Pushing the Rising Cost of Healthcare onto Employees, Families

Friday, December 31st, 2010

The Kaiser Family Foundation and the Health Research and Educational Trust (HRET) perform an annual survey regarding the nature of employer-sponsored health benefits at nonfederal private and public companies nationwide. This is the twelfth such survey. The results are grim, for employees at least.

It’s no longer news that healthcare costs are on the rise. Most have begun to brace themselves for cost increases as a result of healthcare reform. In our recent blog post on the NNNN survey we reviewed the plans of large employers to pass the cost increase onto employees in 2011. For the most part, we are prepared to see our healthcare costs rise after the reform takes effect. But we don’t have to wait to feel these increases. Across the board, the average employee has already seen these increases. The survey certainly shows increases- especially in premiums for family and individual plans. The most notable increase may be that seen in the employee contribution.

Historically, employers and employees have shared the burden of rising premium costs. In 2010, however, employers did not increase their dollar-amount contribution. As a result, employee contribution rose 14% from 2009. Employer contribution did not rise.

The survey reports that 27% of employees have deductibles of $1,000 or more for single coverage. This is up from 22% in 2009. The average deductible is considerably less for workers with PPOs or HMOs. Prescription drugs, physicians visits, and preventative care are usually covered (with, of course, a co-pay or coinsurance) before a deductible is met. The out-of pocket maximum varies considerably for workers and plans.

Where are you better off, a large firm or a small firm? For the most part, it’s hard to tell. But, if you’re hoping to pay less of your premium, start sending your resume to small companies. 35% of employees at small firms pay nothing towards single coverage premium and 13% pay nothing towards family coverage. Only 6% at large firms pay nothing for single coverage and 1% towards family coverage.

Employers were not shy about reporting the changes nor the reasons for them.  Increased cost sharing, reduction in the scope of coverage, and increased employee contribution were all responses to the poor economy.

Keep in mind that this survey was conducted from January to May 2010. After our previous post on Large Employers passing rising health costs onto employees, we can only imagine what the survey will show in 2011.

Attention Patients: Be Aware of Medical Errors this Holiday Season

Friday, December 24th, 2010

With the holidays right around the corner, many of us will be rushing around, finishing up holiday shopping, attending parties, eating too much… the list goes on.

However, people still get hurt and sick around the holidays and are in the hospital. Hospital staff is lighter around the holidays, giving providers some much needed family time. On the other hand, less providers and tired staff can lead to medical errors.

A recent article by Dr. Bialek of www.covermd.com looks at the top ten most common medical errors in the United States.

1. Technical medical error
Ex: Provider cutting the wrong artery in a heart surgery, leading to complications or death.

2. Failure to use indicated tests
Ex: Patient having chest pains, but doctor failing to perform an EKG and patient has a heart attack.

3. Avoidable delay in treatment
Ex: Patient complains of stomach pains, isn’t seen quickly by ER attendees because of more urgent manners, patient’s appendix erupts causing severe internal bleeding.

4. Failure to take precautions
Ex: Patient is weak and has a history of falling. Nurse takes patient from the bed to the bathroom, unaware of patient’s weakness. Patient falls and fractures hip.

5. Failure to act on test results
Ex: Patient feels dizzy and sick. Doctor orders blood test, believes it’s an infection and sends the patient off with antibiotics. Test results come back, but doctor fails to look at them thinking she just has an infection. Patient ends up in a diabetic comma.

6. Inadequate monitoring after a procedure
Patient has a routine surgery. After surgery, patient is on narcotics. Nurses fail to monitor the patient, although patient’s parents are in the room. They do not realize that the patient has stopped breathing.
Another important list is errors with serious consequences. These occur mostly in intensive care units, operating rooms, and emergency departments.

7. Inadequate patient preparation before a procedure
Patient goes in for surgery. The provider fails to check with the patient to see what medications the patient is taking before surgery is performed. The patient is currently taking a blood thinner. During surgery and bleed occurs and the patient dies.

8. Inadequate follow-up after treatment
Patient has surgery. After surgery the doctor tells the patient to call for any changes in temperature, feeling, etc. Patient feels drowsy and nauseous from anesthesia and blames it on that. When the patient calls the doctor, the doctor tells the patient to wait 24 hours. Patient comes down with a deadly infection.

9. Avoidable delay in diagnosis
Patient comes in after blacking out after being assaulted. Provider waits 12 hours for a CT scan. Patient’s brain is bleeding and never wakes up.

10. Improper medication dose and/or method of use
Ex: A drug mix up causes a patient to take 10 times the normal dose. Patient dies a result.

Employees Are the First Line of Defense

Thursday, November 4th, 2010

This past month I was double billed for tickets to a sporting event and charged for services at a health club that I did not receive. My credit card company did not “catch” this activity (nor did they have the information to know that the charges were incorrect – and perhaps fraudulent). I was able to reverse the charges because I understand how to read my credit card statement and can monitor it for inappropriate charges. Imagine if we empowered employees to look at healthcare the same way.

By recognizing how and when employees can add value, organizations can learn useful ways to influence their growth. With the challenge of increasing healthcare costs, employees can also help their organizations reduce their healthcare costs – and even prevent their organizations from being victims of healthcare fraud.

Knowledge Lowers Healthcare Costs

People are good consumers – of automobiles, home appliances, engagement rings and just about any other purchase that deeply affects their own “bottom lines”. Now that payors are shifting more expense to patients through co-payments, out-of-pocket expenses, deductibles, etc. and patients have greater access to healthcare information then ever before, it is the right time to get employees engaged in their healthcare expenditures. Clearly when an employee makes a better financial healthcare decision, their employer also benefits.

Because of the complexity of our healthcare system, it is important to teach employees how to be effective healthcare consumers and arm them with accurate information to make optimal decisions about their care. Patient Advocates help patients navigate our healthcare system – and can train employees to gather, assemble and use information to mange, control and reduce their medical expenses. Critical information that employees need to understand to make informed healthcare decisions include, but are not limited to:

1. Medical records

2. Beneficiary rules

3. Healthcare bills

4. Explanation of Benefits (EOBs)

5. Clinical quality outcome measures

The key is for organizations to explain to employees the incentives of being a conscientious healthcare consumer, including but not limited to:

1. Preventing costly clinically adverse outcomes

2. Preventing inappropriate payments for healthcare services and products

3. Safeguarding personal healthcare information from Medical Identity Theft

People know how to be conscientious consumers – we just need to teach them how to be conscientious healthcare consumers.

Healthcare 101: Explanation of Benefits (EOB)

Wednesday, September 1st, 2010

An Explanation of Benefits (EOB) is a document sent by an insurance provider to an enrollee and the enrollee’s healthcare provider.  An EOB is produced in response to a claim for healthcare service.  It contains important information regarding the payment responsibilities of both the insurance company and the patient.  Unless they cover the entire cost, an insurance company is required to send an EOB to both the patient and the provider.

An EOB usually includes:

  1. Identification of service rendered*
  2. Date of service (DOS)
  3. Name and address of subscriber
  4. Name of patient
  5. Name of healthcare provider who rendered service
  6. Provider’s tax identification number
  7. Provider’s charge/ total billed services
  8. Allowed amount
  9. Total patient responsibility amount
  10. Total payment made and to whom
  11. The amount payable (in dollars or percentage of total) after deductibles, co-payment, and any other reduction have been made
  12. An explanation of for any reason for not providing full reimbursement for the amount claimed
  13. Point of contact (telephone number or address) by which an enrollee may inquire regarding payment
  14. Information on the appeal process of a denial of benefits and timeline of the process

The first item, identification of service provided (marked with *) is the most important item on an EOB.  It is the reason for receiving healthcare and should be communicated via ICD (diagnosis) or CPT (procedure) codes. If you receive an EOB that is missing this, call your insurance company and ask for this information.  Keep track of the code – it represents what you received and why you received it.  Imagine that your EOB is a receipt from a store and that the ICD and CPT codes are the items you purchased.  Wouldn’t you want to know what you bought?

Unfortunately, EOBs are not standardized and can be difficult to read, especially after switching insurance providers.  In addition, an EOB is sent to both the provider and the patient, and it attempts to convey different information to each recipient.  This often produces a very confusing document.

When reading an EOB, don’t be hesitant to look for guidance.  Your insurance company may have an example EOB and accompanying information on their website.  And, of course, be sure to look at our Healthcare How To: Read an Explanation of Benefits (EOB).

Other Resources:
http://www.healthlink.com/tech_tip_eob.asp
http://www.ins.state.ny.us/website1/inshelp/c_eob.htm
http://www.cigna.com/customer_care/member/forms/explanationofbenefits.html

Your Money Matters – Rebecca Busch with Tips for Getting Your Personal Healthcare Portfolio In Shape

Tuesday, August 10th, 2010

On July 26, 2010 Medical Business Associates’ CEO Rebecca Busch was featured on Chicago’s own WGN Midday News with Steve Sanders. During the segment, Your Money Matters, Rebecca provided tips for getting your personal healthcare records portfolio in shape.

Rebecca’s appearance highlighted her latest book, Personal Healthcare Portfolio: Your Personal Health & Wellness Record. During the segment she offered viewers valuable time and money saving techniques when it comes to healthcare records and finances.

Tips for Your Personal Healthcare Records

Here are some tips she provided during the interview:

1. Get your records organized and separate medical from financial.

2. Learn the reimbursement lingo in healthcare — start asking your doctor “What CPT codes are you billing me for?” That is a procedure code — patients never see this. Did you know doctors charge in increments of 15/20/45/60 minutes procedure codes? This is why you have to ask what code they are charging.

3. Ask your doctor “What diagnosis code are they billing in MY name?”

4. Ask for itemized copies of your bills as you receive your care.

5. Make sure you collect your health records as you receive your care — or obtain them once per year (ask your provider what their policy is on retention of records).

6. If your insurance company provides you an EOB (explanation of benefits) without procedure codes — ask them annually to print a claim file with the information. This is the best way to avoid being a victim of medical identity theft.

7. Be vigilant — although we have a healthcare crisis there is lots of money floating around.

To view the entire interview please visit WGN’s site here.