President Donald Trump replied to The Healthcare Consumer.
FROM THE BEDSIDE TO THE BOARDROOM, WHAT ABOUT HUMAN BEINGS?
By: Patient Name Confidentially Protected
About the author:
“I have always demanded excellence. That is the reason why I chose the United States Marine Corps - serving two (2) tours in Vietnam. Subsequently, I became Officer in Charge of Midwest recruiting. I had the overall responsibility for interviewing and approving candidates for serving in the United States Marine Corps. Thereafter; I attended Harvard Business School. Upon graduation, I chose to work with Baxter when it only had $100 million in revenues. Today, it has over $40 billion. After Baxter, I founded two healthcare companies which were subsequently acquired. As CEO of these companies, one of my responsibilities was making final decisions on personnel. I am now a quadriplegic at (name deleted) Hospital for the past 9 years.”
FROM THE BEDSIDE...
Patients are often referred to as "consumers or customers." What about human beings?"
For example: Nursing should include both physical and emotional/mental actions in their care. Unfortunately, there are far too many caregivers who do not understand this. Nursing care in many ways is robotic. * Over 80% of people in Japan hold positive views about receiving "nursing-care-robots."
What separates robots from human caregivers is "mental/emotional" care. More and more caregivers today are becoming "mechanical." The caregivers' first priority is often doing the required physical care, such as taking vitals, administering drugs, flushing Foley's, etc. Although it is understood that clinical care activities are necessary; Attention to the patient should be the first priority. Nursing care should include making the patient comfortable, asking them if they need anything, respecting them as people rather than as a "barcode or a body." Patients are humans. Oftentimes; patients are easily left wondering whether the caregiver cares about them or is working for a paycheck.
...TO THE BOARDROOM
And; when budgeting for nursing staff the amount of staff should be dependent upon the type of patient(s)- what our specific needs are. The assumption by healthcare corporate offices and/or the federal government is that since patients are all wearing a hospital gown, that we all are the same. This is so far from the truth. Patient’s individual needs should be considerations in the budgeting and staffing processes. Presently; there is little difference in the number of staff regardless of the patient’s requirements. Staffing should depend on the status of the patient versus the number of patients. And, mental, emotional, family dynamic concerns should be weighted in your acuity systems.
If the patient is alert, then 50% + is very important for keeping their mind healthy and preventing them from becoming depressed. If the patient is non-alert then, physical care becomes the predominant percentage – closer to 100%.
Patients are humans. Not a barcode, a staffing number, nor a payor reimbursement line item.
* The source for 80% of Japanese positive about robotic nursing care:Over 80% of Japanese positive about robotic nursing care | The Japan Times
“BOOK SENSE” AND THE BEDSIDE
By: Patient Name Confidentially Protected
About the author:
“I have always demanded excellence. That is the reason why I chose the United States Marine Corps - serving two (2) tours in Vietnam. Subsequently, I became Officer in Charge of Midwest recruiting. I had the overall responsibility for interviewing and approving candidates for serving in the United States Marine Corps. Thereafter; I attended Harvard Business School. Upon graduation, I chose to work with Baxter when it only had $100 million in revenues. Today, it has over $40 billion. After Baxter, I founded two healthcare companies which were subsequently acquired. As CEO of these companies, one of my responsibilities was making final decisions on personnel. I am now a quadriplegic at (name deleted) Hospital for the past 9 years.”
FROM THE BEDSIDE…
Nursing education and training is a problem.
With the advent of the computer and new technologies, caregivers are not being adequately trained. Maybe their being taught in theory but the application of that “book sense” is lacking. What’s showing up at the bedside is poor patient care.
As a long-standing patient, I have observed a lot of nursing. Over the years, I have become increasing frightened at what I’m seeing. For example; with the product introduction of Curo disinfecting cap strips, the lures (sterile caps) are designed to disinfect and be a barrier for up to 7 days if they aren’t removed.
Some caregivers were taking the tab directly off the strip, laying it on my (infected) patient bed before attaching it to my urinary Foley catheter, etc. This violates good sterile practice; the sterility of the product has been compromised. And, I am potentially exposed to a urinary tract infection. Is infection-control, really, a major issue and priority for hospitals?
This is true also for systems such as Sequential Compression Devices (SCD's). The purpose of this equipment is to improve leg circulation. I am a quadriplegic (and have no feeling in my legs). But; caregivers have confirmed the SCD NOT being turned on. This is to the detriment of the patient and violates the purpose. Otherwise; SCD's become just leg warmers!
And, the computer documentation has become an "enigma." Often, delaying patient care because the caregiver has to input information. At least this is the biggest excuse given by caregivers for the delay’s in my care.
Prior to introducing any new technology, patients should be involved.
Another real-life example, a reliable trach was replaced by a new brand and style. It caused the patients problems. The introduction of the new trach had to be rescinded.
Other half-cocked decisions:
"Slide-sheets" were eliminated, making it difficult to slide the patient into a new position. Moreover, more physical stress was put upon the caregivers.
Wipes were eliminated. Consequently, washcloths had to be used. These washcloths are recycled! Who wants a facial washcloth that has been used to clean a stranger’s diarrhea? Moreover, the friction of washcloths impacts skin condition.
…TO THE BOARDROOM
Why cannot there be trial-runs with selected patients to determine the viability and benefits of new products and technologies?
Why does hospital management implement programs that do not take into account the differences between acute and long-term patients? Many changes within healthcare are dictated by the acute patient universe, not taking into account the differing impact on other patient populations (rehabilitation, sub-acute care, long-term care etc.).
INVOLVING PATIENTS ON THE HIRING PANEL FROM THE BEDSIDE TO THE BOARDROOM
By: Patient Name Confidentially Protected
About the author:
“I have always demanded excellence. That is the reason why I chose the United States Marine Corps - serving two (2) tours in Vietnam. Subsequently, I became Officer in Charge of Midwest recruiting. I had the overall responsibility for interviewing and approving candidates for serving in the United States Marine Corps. Thereafter; I attended Harvard Business School. Upon graduation, I chose to work with Baxter when it only had $100 million in revenues. Today, it has over $40 billion. After Baxter, I founded two healthcare companies which were subsequently acquired. As CEO of these companies, one of my responsibilities was making final decisions on personnel. I am now a quadriplegic at (name deleted) Hospital for the past 9 years.”
FROM THE BEDSIDE…
Healthcare hiring is an issue for patients. We, the patients, have to live with managements hiring decisions. These decisions impact the quality of our physical and emotional health.
The 90-day probation is *perfunctory! The interview process is a "make a good impression" exercise. Managers, I don’t know if it’s the questions you’re asking or where the disconnect is but whatever is affecting your hiring decisions in the office is not impressing me at the bedside.
Why doesn't management get feedback of patients while the new hires are on orientation? Visit with us at the end of a shift of being cared for by the new hire. Why shouldn't management get comments from patients who will interface with new hires for the rest of their lives? The quality of the nursing staff impacts the quality of our health and healing.
(*hasty and without attention to detail)
…TO THE BOARDROOM
Not to mentioned after those 90 days; discharging incompetent or uncompassionate caregivers is apparently very difficult due to Human Resources, Union Contracts and Governmental regulations. Due to the costly expense of salaries, hiring and reimbursement restraints; You’d think that organizations would get as much help as possible to improve quality and reduce cost.
Healthcare Consumer Duties and Responsibilities
In 1972; during President Kennedy's term in office Consumer Rights became law. Anytime we access healthcare, we receive a stack of paperwork informing us of our rights as consumers. Buried in the print of these documents is a section called Consumer Responsibilities. Everyone seems to know their rights- or least what they believe they are entitled to, as it relates to healthcare. Far fewer people seem to be as knowledgeable about their consumer duties. And; frankly patients are oblivious to their physical health and healthcare system responsibilities:
- Do your best to get well and stay healthy, with healthy habits, such as exercising, not smoking, and eating a healthy diet.
- Clearly communicate physical changes, concerns, and what you want/need from your healthcare provider
- Be involved with your health care providers when making your health care decisions
- Work with health care providers in developing and carrying out treatment plans you all agree upon
- Avoid knowingly spreading disease. (Examples; Stay home when you are sick, wash your hands when you enter and exit healthcare facilities, cover your mouth when you cough/sneeze.)
- Recognition of risks in the science of medicine and the limitations of health care providers as human beings
- Be aware of a health care provider's need to fairly provide care to other patients and the community. Realistically speaking; Waiting twenty minutes after you call for assistance is acceptable. Don’t wait until the last moments to call for assistance for refreshments or to be escorted to the bathroom.
- Show respect for other patients and health care workers.
- Use the organizations internal complaint and appeal process to address concerns that may arise. This process is called a grievance. In order for a complaint to be considered formal you must state, “I would like to file a formal grievance.”
- If complaints are not resolved internally, then, contact your state Department of Health, Ombudsman, The Joint Commission or The Center for Medicare and Medicaid.
- Escalation of unresolved complaints to external regulatory bodies can help to improve healthcare organizations processes and care delivered. Report wrongdoing and fraud to the right resources or legal authorities
- Learn about your health plan coverage and health plan options (when available) including all covered benefits, the limits, what isn’t covered, the rules regarding use of information, and how to appeal coverage decisions.
- Make a good-faith effort to pay your health care bills.
- Follow procedures of the health plans and health care providers.
What consumers can expect in 2019: Health Care changes are coming
ACA under fire
By IRMA E. A. “ARNESE” STERN; MSN, BSNNearing the end of the first quarter of the year, Americans have many questions:
- What's going on in healthcare 2019?
- What is projected to happen in 2020?
- What should I think about doing to be a better informed healthcare consumer in 2019?
- Is medical insurance required by law?
- Will there be Obamacare during this year?
- Are preexisting conditions covered this year?
- Is Obamacare mandatory for 2019?
Perhaps the most looming concern is regarding the bickering going on in the high court system fueled by a Texas judge’s decision late last year that ruled the Affordable Care Act (ACA, also known as Obamacare) invalid.
Judge Reed O’Connor of the Federal District Court in Fort Worth (a George W. Bush appointee) said that the individual mandate that required people to have health insurance “can no longer be sustained as an exercise of Congress’s tax power,” according to the New York Times.
The judge took issue with the ACA’s insurance command that required people to buy coverage after Congress removed the cash penalty to zero dollars as part of the tax overhaul that President Trump signed in December last year.
O’Connor said that removing the fine made the plan not legal. In 2012, when the Supreme Court said that the ACA was constitutional, their decision was based on Congress’s taxing power—in other words, the fact that there was a penalty in the form of money for those who didn’t get health care, made Obamacare legal.
Congress could legally impose a tax penalty on people who did not have health insurance. Without that requirement, the plan is not lawful. New York Times, Texas Judge Strikes Down Obama’s Affordable Care Act as Unconstitutional, Dec 14, 2018
The stakes were raised again in late March when Trump’s Justice Department announced that they had changed their position and agreed with O’Connor that the entire law—not just three pieces of it—should be tossed, “from coverage for pre-existing conditions to the Medicaid expansion, and everything in between," said Steve Vladeck, a law professor at the University of Texas.
A partnership of states is appealing the ruling. A group of 17 democratic Attorney Generals have filed documents to get involved and defend the health law, highlighting health law conditions such as a requirement that prevents insurers from denying coverage based on existing medical conditions.
The lower court's ruling is on hold pending a decision by the higher appeals court.
The ACA touches the lives of most Americans, from nursing mothers to students
According to articles in the New York Times, millions of people could lose insurance if the ACA were struck down; millions more could face higher medical bills. Tens of millions more people will be affected than those who already rely upon the nearly 10-year-old law for health insurance.
Medicaid has been the support of Obamacare—it is the government insurance program for the underprivileged population which is funded by the federal government and individual states. If the health law were struck down, more than 12 million low-income adults who have gained Medicaid coverage through the law’s program expansion could lose it. What Happens if Obamacare is Struck Down? New York Times, March 26, 2019
According to heads of the Urban Institute, enrollment would drop by more than 15 million, including about three million children who received either Medicaid or the Children’s Health Insurance Program when their parents signed up for coverage.
Losing free health insurance will mean worse access to care and likely worse health for millions who are affected by its repeal. Among other things, studies have found that Medicaid opening up has led to better access to preventive screenings, medications and mental health services.
There are also many requirements in the law that are less well-known, such as menu labels with nutrition and calorie counts on items at chain restaurants. The ACA requires many employers to provide “reasonable break time” and private spaces for nursing mothers to pump breast milk. It also created a pathway for federal approval of biosimilars—near-copies of biologic drugs made from living cells.
What are resources to prepare if Obamacare is overturned?
Although huge policy changes aren’t expected this year, several trends, business deals and governmental changes might make the industry more consumer-friendly in the future, according to The Tennessean.
The ACA is the landmark health policy and still evolves. The biggest change this year is that there is no penalty for not carrying qualified health insurance. There is no longer a financial fine for going uninsured or choosing a health plan that does not meet the criteria for “qualified” coverage.
This fuels expectations that fewer consumers will sign up for ACA coverage now that there isn’t a penalty. This could lead to increased premium prices as younger, healthier shoppers look toward other insurance options.
Last year, the Trump administration changed the rules to expand short-term health plans. Although they don’t cover as much as all-inclusive insurance plans, they are a workable alternative for those who do not want or cannot afford traditional insurance.
Administration officials are reportedly creating a pitch to allow consumers to apply the ACA’s premium financial help toward these short-term plans. Currently, financial support can only be applied toward ACA plans.
Another change that may affect consumers in 2019 is a push for price clarity; there will likely be a new federal rule to require hospitals to post service prices on their websites with annual updated lists. The Tennessean, Three trends that could change health care for consumers in 2019, Jan 10, 2019
This is important; hospital prices are notoriously cloudy. Getting a close to accurate cost for needed medical services is typically very hard to get.
The list prices won’t necessarily represent what consumers will pay—these are dubbed the “chargemaster” price which is the amount often billed to uninsured patients and used for negotiation with insurers. But the figure is still useful to know whether the hospital you are considering tends to cost more than another, competing hospital.
Seema Verma, head of the Centers for Medicare and Medicaid, said that this is “just the beginning” of price transparency efforts in America. This drive is expected to continue throughout 2019 and the future.
In this special Speaker Series, Becker's Healthcare caught up with Arnese Stern. Ms. Stern will speak during the Becker's Hospital Review 4th Annual Health IT + Revenue Cycle Conference on "America's Healthcare: No Cookie-Cutter Solutions" at 2:45 p.m. on Wednesday, Sept. 19. Learn more about the event and register to attend in Chicago.
Question: Can you share your best advice for motivating your teams?
Arnese Stern: Because my employer has several potent political forces—unions—it is critical to engage and motivate the union to ensure contractual alignment and support. The union can make or break the perception, compliance, and motivation of teams. It is also helpful to have mutual respect. This healthy relationship allows the unions and leadership to work collaboratively to develop structured best practice rollouts (and) cutting-edge innovations, (as well as establish) motivators connected to milestone achievements.
Q: In the past 12 months, how have you adapted to new patient experience expectations in the age of consumerism?
AS: The website, Healthcareconsumer.info, was founded in 2017 to inform, engage, and empower America's healthcare consumers. This platform provides informational topics on healthcare reform, patient advisory boards, and patient experience best practices, to name a few. Physicians and medical experts respond to questions that the nation's consumers ask. And, the patients and consumers provide testaments of how they were empowered to apply those (teachings) and impact their healthcare experience and/or their efforts at reforming America's healthcare.
Q: What do you see as the most vulnerable part of a hospitals business?
AS: In my opinion, the most vulnerable part of hospitals business is the lack of homecare proactive technological innovations. For example, a sudden death vulnerability database to assess residential patient need for medical alarm or alert systems that are diagnosis specific (would be valuable). Or, an advanced system with the ability to detect more than if the patient has fallen at home, or one designed to detect substantial health changes for the elderly, diabetic, seizure, and shunt dialysis patients that live alone and may be unable to get to the phone to dial 911 quickly (would also be useful). This homecare safety device needs to detect status changes and notify identified clinicians. The need for this detector should be assessed at office visits and at hospital discharge similar to how abuse and suicide prevention patients are evaluated. These patients have a tremendous impact on death rates post admission and death within 30 days of discharge.
© Copyright ASC COMMUNICATIONS 2018.
The Reality About Healthcare Reform
By Arnese Stern, MSN, BSN, RN
- Provides universal access to healthcare for Americans
- Controls the rising costs of healthcare
- Regulates the private insurance industry through state-based private exchanges–an online marketplace that serves as a meeting point for consumers and state-approved insurance plans from multiple companies
- Improves the quality of healthcare
- Makes healthcare choices consumer-friendly and easier to understand
ACA under fire
- Obamacare — Forbids insurers from charging older people more than three times what is charged to younger people.
- Trump bill — Allows insurers to charge older consumers up to five times what younger consumers pay.
- Obamacare — Prohibits denying coverage for preexisting conditions.
- Trump bill — Insurers cover preexisting conditions, but could charge more if states allow.
- Obamacare — Must buy health insurance or pay penalty.
- Trump bill — Penalties go away, insurers can charge 30 percent more if consumer fails to maintain continuous coverage.
- Obamacare — Requires “essential benefits” coverage such as maternity, preventive care, mental health, and substance abuse.
- Trump bill — Lets states seek waivers for essential benefits rules.
- Obamacare — Provides subsidies to cover consumer’s costs for those making up to about $64,000.
- Trump bill — Gives tax credits up to $4,000 a year to those over 60, and as low as $2,000 for those under 30.
- Obamacare — Imposes taxes on insurance and health companies, and higher-income people.
- Trump bill — Repeals tax increases.
- Obamacare — Has reduced the number of uninsured people by 20 million.
- Trump bill — Congressional Budget Office said rates will rise up to 20 percent in the short term and
24 million will lose coverage by 2026
Intent behind both healthcare reforms is change
Bridging the communication gap
Where to go to choose services for now

- General information
- Survey of patients' experiences
- Timely and effective care
- Complications
- Readmissions and deaths
- Use of medical imaging
- Payment and value of care
Along the same vein of information is the Physician Compare Webpage at CMS located at www.medicare.gov/physiciancompare/ which provides consumers with material about physicians and clinicians in order to make informed choices about the healthcare they receive through Medicare.
Consumers who are patients would do well to remember that hospitals, doctors, and insurance companies are all services that they pay for. There is no need to feel "held hostage" to the healthcare system any longer.
Patients have become consumers
Positive Feedback Forms Are Vital to Keeping Facilities Open
By Arnese Stern, MSN, BSN, RN
- How well did the nurses explain things in a way that you could understand?
- How often was your pain well controlled?
- After you pressed the call button, how often did you get help as soon as you wanted it?
- How often did your doctor treat you with courtesy and respect?
- Were your requests for assistance answered in a reasonable amount of time?
- Was the area around your room kept clean and quiet?
- Would you recommend this hospital to your friends and family?
Rural hospitals are endangered
Welcome to the Hotel Hospital
The Prior Authorization Predicament
By IRMA E. A. “ARNESE” STERN, MSN, BSN
Battling with insurance payers about prior authorization for medical care can cost healthcare consumers time and money.
To protect themselves and avoid webs of red tape that can snare the unwitting, consumers need to be aware of the importance of prior authorization from insurance agencies for medical care and prescriptions.
What Does That Actually Mean?
According to Modern Medicine Network, insurance companies such as Medicare and Medicaid, HMOs, and pharmacy benefit managers, use prior authorizations as a way to hold down costs.
Dr. Damon Raskin, an internist and medical director of a drug and alcohol rehab center in Malibu, California, said that his goal is to act as the patient’s advocate and get whatever type of drug or level of care they need. He added that the goal of insurance companies is to maximize profits for their shareholders and that those things are oftentimes opposed.
What Exactly Is a Prior Authorization?
According to The Good RX Prescription Savings Blog, prior authorization is an approval from the insurance company, not a doctor. In other words, an MD decides upon a form of treatment outside of their expertise for a patient, or certain medications, and passes a referral through the insurance company first.
Prior authorization is a way for insurance companies to decide whether or not they will pay for certain medicines or care. This typically doesn’t affect cash payment for prescriptions and co-pays; it’s only required on prescriptions and care when billed through insurance at a higher rate.
If a patient is uninsured or decides to pay with cash, they don’t need to get prior authorization.
Certain types of prescriptions require prior authorization:
- Brand name drugs prescribed when a generic is available
- Drugs which are intended for certain age groups or conditions only
- Drugs used only for cosmetic reasons
- Drugs that are not preventative or used to treat non-life threatening conditions
- Drugs that may have adverse health effects including higher-than-standard doses or possible interactions, abuse, or misuse
- Drugs that are not covered by insurance but deemed medically necessary by a provider
In many cases, prior authorizations are intended to be a control to ensure drug use is appropriate and that the most cost-effective therapy is used.

Co-Pays for Primary Physicians Versus Referrals or Specialty Physicians
Referrals are an important part of an HMO plan because they help designated doctors and nurse practitioners as primary care doctors to keep track of the care patients receive and ensure that care is correct. They provide most medical care, which includes referring patients to specialists and other health professionals.
If a patient needs a referral and doesn’t get or wait for one, they will end up paying higher costs out-of-pocket for treatment and medications.
Like medication referrals, healthcare referrals have expiration dates; some have a limited number of visits allowed. If the patient needs to see a specialist after the expiration date or the allowed number of visits, they need another referral.

For example, if someone has a skin rash, they shouldn’t go straight to a dermatologist. The patient should first go to their primary care physician for an exam. If they can’t help you, they will give a referral to a trusted dermatologist in the patient’s HMO network.
Blue Cross/Blue Shield lists types of services that need referrals:
- Cosmetic procedures—removing scars or excess tissue from eyes or abdomen
- Physical, speech, and occupational therapies
- Weight-reduction procedures
- Bone marrow transplants
- Infertility services
- Breast reductions
- Durable medical equipment
- Services from out-of-network physicians or healthcare professionals
- Experimental or investigational procedures
- Out-of-network care
Without a referral from a primary care physician, the patient is responsible to pay for all the costs of out-of-network treatment—unless approved by an HMO or it’s an emergency.

Under Medicare, a doctor or other healthcare provider may recommend that a patient get services more often than Medicare covers or services that Medicare doesn’t cover; the patient may have to pay some or all costs.

The Cost of Using in Network Vs. Out of Network
According to Money Magazine, in network refers to providers such as hospitals and clinics that are covered by insurance. Out-of-network means limited or no coverage by insurance.
Health plans to contract with specific provider groups for group discounts. Others are out-of-network; they have different coverage rates or are not covered at all. Consumers should avoid out-of-network care if possible.

Brand Name Versus Generic Prescriptions
According to US Food and Drug Administration officials, nearly 8 in 10 prescriptions filled are for generic drugs.
Why are brand names more expensive? One reason is that the original pharmaceutical company pays for research and development and production. Generic manufacturers generally pay only for production.
Officials from Tufts Center for the Study of Drug Development estimated that the cost to develop and win marketing approval for a new drug is $2.6 billion. The brand name company also pays for research and development for medications that failed in trials and can’t be brought to market.
Grandparents.com via Huffington Post:

What Are the Responsibilities of a Healthcare Consumer?
The Advisory Commission on Consumer Protection and Quality in the Health Care Industry officials list consumer responsibilities to work with healthcare providers for the best outcome:
- Give providers all the information they need.
- Be involved in making healthcare decisions.
- Work with providers to develop and carry out the treatment plans.
- Learn about coverage and options, benefits, limits, and not covered services.
- Follow procedures outlined by health plans and providers.
https://medlineplus.gov/ency/article/001947.htm