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Posts Tagged ‘Patient Advocacy’

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

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.

Real stories from real patients: A scary night in the ER

Thursday, December 31st, 2009

A new addition is being added to the blog. Our healthcare system is broken and fragmented and patients are usually the ones that receive the brunt of the abuse. Real stories from real patients will highlight the traumatic events that patients have to face in the wake of terminal illness, an accident or any other medical emergency.

Names have been changed to protect the innocent.

A scary night in the ER

“I have been watching my friend for the last 24 hours. First in the ER being monitored by a machine for his heart, oxygen and blood pressure – the alarm is turned off so it doesn’t make any noise – followed by a 6 hour wait for EMERGENCY surgery – hoping that he gets in the cue prior to the onset of internal rupture. I watched patient transport almost pull him out of the room without disconnecting the tubes from the wall – a frustrating reminder that the focus on reform is not about health.

After surgery I was watching him recover and yet again the $200 monitor has the alarm turned off. I thought to myself, ‘I wonder what would happen is there was no one in the room and he couldn’t call out for help?’

My friend received a 2mg narcotic through his IV around 6:00 pm. At 8:00 pm the nurse came back to evaluate for another .5mg of the narcotic. I watched his nurse place the injection on the table, take and enter vital signs into the bedside PC and while I was looking at my notes, the nurse left the room. I asked my friend, “Did the nurse give you anything?” He didn’t know. I looked for injection marks on his right arm – nothing. I walked out and asked the nurse, “Did you give him the injection?” The nurse’s response, “You were in the room the whole time, did you not see me give it to him?”

I took a step back – I am tired and need to turn off my fraud, waste and abuse examiner’s hat. However, I wonder on these points…

1. I believe the nurse stole the narcotic and did not give it to the patient. The next day the floor nurse let me look at the medical record. The patient received the narcotic at 8:00 pm IVP – which means the nurse would have had to ask me to move since I was sitting next to the arm with the IV.

2. The on call surgeon had to wait until the on call surgical staff finished operating on the patient’s rupture appendicitis. He was ready for surgery at 10:00 pm but could not get in until 1:00 am. So what would have happened if the bowel obstruction ruptured any time before 1:00 am? Would he have died in the ER? Been transferred to another hospital?

3. What would have happened on the snowy icy night if an auto accident had been admitted? Would he have been bumped? Did the hospital put their ER in bypass mode?

4. Now what about the ER nurse, did he take the narcotic himself? Was he feeling a little ‘happy’?

Maryland hospital fined for not reporting serious medical errors

Wednesday, June 17th, 2009

Doctors Community Hospital was fined $30,000 for violating a law that says all Maryland hospitals must report serious medical errors. The penalty was set at $95,000, but Doctors Community Hospital promised to set aside $65,000 to develop a safety program for patients.

Some of the unreported errors include: A patient being attacked by another patient’s visitor, an 8-day delay on IV medication for a man known to have heart failure, and a case where an antibiotic was mistakenly given to a patient after a technician thought it was plain IV fluid.

Read full article here.

This should be a warning to patients and healthcare providers. Reporting medical errors should be required because patients have the right to know what sort of medical care they will receive at any given hospital. Medical Business Associates, Inc. recommends that patients take charge of their own healthcare and well being by developing and maintaining a Personal Healthcare Portfolio.