Wellness Check

Bob had an appointment this morning for his yearly wellness check. That's apparently something we're doing now as a result of the Affordable Care Act.  It's done on a yearly basis I think. I did mine a week or so ago and all went well, I was in and out in about 15 minutes.

Bob's visit was well over an hour. Even the doctor was worn out by the time it was over. These doctors are inputting information into a computer the entire visit. There are many questions that have to be answered. It takes a very long time to see a patient like Bob. I almost felt the need to apologize.

The doctor drew a circle on a piece of paper and asked Bob to fill in the numbers of a clock. This is the second time she's done this. Apparently it's never dawned on her a very big clock is on the wall behind her. Bob just copies the numbers on that clock onto the paper and he always gets that one right and flunks all the rest. Sometime I may clue her in but Bob probably would prefer I not do that.

______________________________

Remember this pink Physician Orders for Life Sustaining Treatment (POLST) form that I wrote about recently?  I had turned Bob's in. It was scanned and entered into a registry, and I learned there's another purpose to this exercise. This morning the doctor handed Bob's back to me and told me to attach it to our refrigerator. She says emergency medical personnel are trained to look for this form attached to your refrigerator when they make an emergency call to your home.

I can do that. I wondered how emergency medical personnel were going to know what to do about life sustaining issues in emergency situations. Now I know.

_____________________________

I'm going to run something by you just to see what response I get given we're living in such heightened conditions about treating all people the same, as well as being super sensitive to anything that could be construed as racist.

The MA (nurse) this morning was from India. She had one of the heaviest accents I've run across. Bob couldn't understand a thing she said, and I had great difficulty. A watched her very closely, and as often as not I finally figured out what she was asking by context rather than the actual question. I was totally unsuccessful in having a phone conversation with her last week.

She clearly knows her job. I have no reservations about the quality of her work. I'm not quite sure what to do about this. I'm going to be in a meeting next month at the hospital where I can discreetly mention it to the man who oversees the hospital's four clinics and see what he thinks but I'm not sure if that's appropriate. I guess I don't know the politically correct thing to do in this situation. What do you suggest?

______________________________

If you need a laugh today I suggest you go to Time Goes By blog and read what to expect from the free Medicare Wellness Visit.

Frugal Healthcare

There are many blogs today about living frugally.  Do you ever hear anyone talk about spending healthcare dollars frugally?  Not a word.

At our house we have excellent health insurance and almost never have any healthcare expense.  It worries me when that happens to people because I'm of the old school that people don't value what costs them nothing.  Perhaps I am the exception.  I cringe at all the waste I see everytime I'm in a clinic or the hospital.

How about Medicare?  Spend those Medicare dollars you say.  Not me.  I have a chronic condition that lands me in an Urgent Care Clinic about every three to four months.  I don't know what that costs but I figured there had to be a cheaper way.  I set about to come up with a plan.

Why did Medicare and my insurance company need the expense of me visiting an Urgent Care Clinic when I knew, my doctor knew, and the Urgent Care Clinic knew what the problem was.  All I needed was a prescription.

I decided to approach my doctor about allowing me to keep on hand the prescription I needed, give me a limited number of refills and cut out the expense of the Urgent Care Clinic.  He agreed.

Have you noticed how wasteful hospitals and emergency rooms in particular are with supplies?

An elderly family member was recently prescribed a back brace that was terribly expensive.  She will never wear it.  It was a waste of Medicare dollars.  The doctor should have been smarter.

No wonder healthcare expense is out of control but if you said the word frugal in the same sentence with healthcare people would go all Sarah Palin on you.  Frugal doesn't mean cutting quality, it means cutting waste.

Let's hear it for frugal healthcare dollars!

Prescription Drugs Price War

The cost of prescription drugs is a big issue in providing healthcare in America.

"The chief medical officer, Steve Miller, at Express Scripts, the largest pharmacy benefit manager in the U.S., has been essentially auctioning off his 80 million customers to the drug companies that will give him the best deal.

Express Scripts and its rivals including CVS/Caremark and OptumRX manage prescription drug coverage for insurers and employers.  They're trying to spark price wars among drug makers by refusing to pay for some brand-name medications unless they get a big discount.

The result is that average costs for many drugs are falling.  At the same time, consumers are being forced to change medications, sometimes to brands that do not work as well for them."

This year more than half of all patients will have a prescription excluded from coverage.

"Express Scripts pioneered a strategy two years ago, when it announced it would no longer pay for 48 brand-name drugs.  Right out of the gate it took on some big-name products, such as Advair - the blockbuster asthma drug made by GlaxoSmithKline, now known as GSK."

"Advair's price had risen more than 20 percent in 2013... Then on Jan. 1, 2014, Express Scripts tossed Advair off its drug list and moved its customers to rival asthma drug. Symbicort."

"The results were immediate.  Sales of Advair dropped $1.8 billion that year.  The prices of both Advair and Symbicort fell 20 percent in 2014 and are still falling.  Advair was restored to Express Scripts' formulary last year."

What would you suggest is the best way to bring the cost of prescription drugs down?

Medicare vs VA Drug Formularies

Well rats, the Republicans are having another tantrum, this one involving the president's proposed budget. I'd like to call your attention to a few things that affect senior citizens that they're refusing to consider.

The Center for Medicare Advocacy laid out the impact the president's proposed budget, if passed, would have on Medicare drug policies.  I'm using the short version posted on Time Goes by.

~ Restore drug rebates for brand name and generic drugs to beneficiaries who do not receive the Part D Low -income subsidy (LIS)

~ Greater transparency in drug pricing

~ Negotiate prices with drug manufacturers for biologics and high-cost prescription drugs covered under Part D.

~ Close the Part D doughnut hole in 2018 - two years earlier than under current law.

This NYT article, titled "The Reason Medicare is a Lousy Drug Negotiator" is worth reading.

"The real problem is that Medicare can very rarely say "No way" to a drug company.  Medicare beneficiaries wanted the program to cover most drugs that older people would want to use.  So Congress put in place rules that strengthen the hand of the drug companies in negotiations."

"The government does have one program that can say "no" to drug companies, and it gets much better deals than Medicare.  The Department of Veterans Affairs negotiates hard with drugmakers. But it is also bound by fewer rules than Medicare, and one result is that it covers far fewer drugs."

From personal experience we have found the drug formulary for the military to be very different from the formularies of Medicare and private insurance companies.

Last year when Bob's twin was dying he needed a drug that was prohibitively expensive, more than $5,000 a month.  It was not covered by Medicare or his insurance company.  Fortunately he had served in the Navy and qualified to go to a veterans hospital.  He got the drug there for free. What if it had been his wife that needed that drug, where would she have turned for help?

I find all this troubling.  How about you?

Finding A New Doctor

When our Doctor changed his practice to concierge medicine we were left to find a new family practice/internal medicine physician.  I cannot begin to tell you how much I dislike the process of finding a new doctor.

I had had read doctors in private practice can refuse to see Medicare patients but hospitals cannot.  I was pretty burned by our experience and decided it would not be wise to choose another doctor in private practice.

The hospital in our community owns several clinics in the area.  I decided our safest bet would be to choose a doctor in one of those clinics. I don't know how these doctors are paid but I'm guessing they are paid a salary by the hospital.

Choosing a doctor in a hospital owned clinic meant we would likely be getting a different doctor from time to time as doctors entered and left hospital employment. 

It also meant chances were greater we would see a doctor of a different ethnicity than our own.  That's sometimes problematic for Bob.  He doesn't hear well and accents can be difficult.  The other thing we have to consider is humor.  Bob is a tease and humor doesn't always translate well.

Bob's hematologist is married to a doctor working in one of the hospital owned clinics.  I figured she was not likely to move as his speciality practice is well established.  She is Vietnamese.

She works great for me but was not as good a fit for Bob.  Eventually we switched him to a doctor with a geriatrics speciality.  She is from Slovenia. That situation seems to be working well.

Our community hospital also has some urgent care clinics.  One is located near us and I've used it a few times.  It's very nice to walk in and all your information already be in the computer.  All you need to do is have a seat and wait your turn.

I feel good about our decision to choose a hospital owned clinic.

Concierge Medicine

I noticed our family practice doctor had become frustrated and angry with the financial side of medicine in this country.  At the time I didn't think too much about that but I should have stopped right there and changed physicians.

We liked this young man, or at least we had at one time.  It became apparent once he went into private practice he was not capable of managing an office.  He began to blame others for his problems.  He felt he had been misled into family practice medicine when specialists were making a lot more money than he was seeing in his practice.  He was angry about Medicare, and insurance companies in general.

In time I received a phone call from his office inquiring if we would be interested in retainer fee/membership medicine.  Next came the letter informing us our doctor was changing his practice to this kind of medicine.

The thing that quickly grabbed my attention was he would no longer accept any forms of insurance.  Medicare/Medicaid claims cannot be filed by the patient so even if we'd been inclined to stay with his practice that alone would have been a deal breaker.

For a retainer fee he would be offering some services each year but anything above that the patient would pay up front and file their own insurance.

Knowing this young doctor I knew he was all about a more lucrative practice for himself but I also knew he preferred to practice preventive medicine.  He did not enjoy treating chronic conditions.

While I have no doubt the frustration level among doctors is high over insurance and Medicare I did not see the masses rushing to concierge medicine.  Doctors in our medical community were puzzled over our doctor's decision.

At this point I lost respect for our doctor.  I also felt bad for him because I felt his choices were going to disappoint him and lead to more anger and frustration.

If his choice worked he would have set up the following things:

1) Set in motion a two-tiered system that favored the wealthy.
2) He would no longer see the elderly or the poor as he would not accept Medicare/Medicaid.
3) His practice would be smaller allowing the time needed to care for his retainer patients.
4) He would not see patients with chronic illnesses as they must rely on insurance.  Why go to him and have to file your own when doctors' offices all over town file insurance for you?

We're now some two years out from all this.  His practice has gone bankrupt and my understanding is he's left the area.

My next post will be about choosing a new doctor.