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

Part II Voice of The Patient

“BOOK SENSE” AND THE BEDSIDE

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.).

Part III Voice of The Patient

INVOLVING PATIENTS ON THE HIRING PANEL FROM THE BEDSIDE TO THE BOARDROOM

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

What consumers can expect in 2019: Health Care changes are coming

ACA under fire

By IRMA E. A. “ARNESE” STERN; MSN, BSN

Nearing 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.

Healthcare's lack of homecare tech leaves it vulnerable, says Arnese Stern

Written by Staff | May 23, 2018 | Print | Email

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.

From Patient to Consumer

The Reality About Healthcare Reform

By Arnese Stern, MSN, BSN, RN

When President Barack Obama signed the Affordable Care Act (ACA/Obamacare) into law on March 23, 2010, two major changes took place: American citizens were single-handedly in charge of their own healthcare plans and health insurance agents could not deny coverage to anyone.

People across America found that instead of settling for whatever was available, affordable or acceptable, they had more choices; healthcare officials now could not say “no” to individuals and families. Discrimination went out the window: insurance muckety-mucks couldn’t charge more based on age, gender, or preexisting conditions.

Before the Affordable Care Act, patients were backed into a corner. Literally overnight, their role as customer became that of a consumer with freedom to choose from an astounding amount of options. Through health exchanges such as Health Insurance Marketplace on CMS.gov, consumers could shop directly for plans instead of relying upon what insurance agents handed them.

In fact, the vast amount of choices proved overwhelming for most people. As a result, according to an Elixir Technologies blog, the ACA mandated that health insurance companies must provide a Summary of Benefits and Coverage describing premiums, co-pays, and covered services in order to help consumers make apples-to-apples comparisons in order to make informed decisions.

In short, the Affordable Care Act:

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

Before President Donald Trump took office in January 2017, he promised American citizens that he would do away with Obama’s ACA and replace it with his own American Health Care Act (AHCA), also known in some circles as Trumpcare.

A quick look at differences between Obamacare and Trumpcare provided by the Palm Beach Post:

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

Officials from the senior advocacy organization AARP warn that people with preexisting conditions—including 3.1 million in Florida alone—could face costs of up to $25,000 more per year in high-risk pools, according to the Palm Beach Post.

In addition, people ages 50 to 64 who have lower incomes could pay up to $13,000 more each year in premiums and deductibles in what AARP officials call an “age tax.”

Intent behind both healthcare reforms is change

Whether it is Obamacare or Trumpcare, healthcare reform affects every American, old and young, working and unemployed, single and married. The ultimate goal of reform is to increase the number of insured and to boost the quality of care while steadying and/or reducing costs.

Obama’s ACA reform expanded coverage of young adults by allowing them to stay on their parents’ plans until they turn 26, outlawed lifetime limits on what insurance will cover, lowered the cost of drugs for seniors on Medicare, caused 13 million consumers to get premium rebates totaling some $1.1 billion, and expanded access to free preventive care for patients of all ages. (Consumer Reports March 2013)

A transformation in 2014 saw to it that nearly every American has access to essential care coverage in affordable health insurance.

According to Consumer Reports, changes brought about by the ACA included guaranteed coverage, health insurance marketplaces for ease of consumer choices, Medicaid expansion for low-income households, cheaper prescription drugs, and free preventative healthcare. It also introduced more consumer protections; insurance companies could no longer set lifetime limits on health coverage or cancel if the insured got sick.

For the half of the American population who get health coverage through employers, the ACA brought popular changes. Previous sticking points changed; now there was uncapped coverage, requirements that insurers cover primary care in addition to pediatric, dental, and vision care, mental health care, and preventive care without co-payments, according to The New Yorker.

The New Yorker writer Atul Gawande believes that Republicans probably won’t risk eliminating those provisions under Trumpcare—except for contraceptive coverage—but they dislike the measures that keep employers providing health benefits such as tax penalties for big companies that don’t provide and tax credits for small businesses that do.

Obamacare’s dramatic expansion of Medicaid to all Americans living near the official poverty line produced the largest reduction in the uninsured. Trumpcare vows to cut back the program’s funding and to send money to states as a lump sum, or “block grant.” However, this will likely throw millions out of coverage and many states into fiscal crisis, Gawande wrote.

Bridging the communication gap

Bridging the gap between healthcare professionals and communities under the ACA was a difficult task, according to Sally Hartley, a writer for the Community Eye Health Journal. If the ACHA passes, the learning curve may not be as steep.

Community participation was established with effective communication as a goal. As with the transition under Obamacare, if Trumpcare passes into law, the people concerned who often speak different languages, have different levels of education and competence, different priorities in life, and generally understand things differently, could struggle the most.

According to Healthcare IT News reporter Steve Whitehurst, today’s most successful organizations take steps to maximize patient engagement and retention efforts throughout the entire process. “The days of delivering purely episodic care and relying on patient volume to generate profit are fading,” Whitehurst wrote.

In fact, it seems that patients today have adjusted quite well to taking a consumer-oriented approach to their healthcare; as a result, future growth and success of healthcare organizations depend upon the quality of the patients’ overall experiences.

Because of Obamacare, patients now expect outstanding care experience from the moment they first contact a provider all the way through follow-up and beyond. It remains to be seen what the impact of Trumpcare could be in this area and whether or not it falls short in the consumers’ eyes.

Where to go to choose services for now

For consumers who are beginning to use or are still using healthcare through the ACA, the website for Centers for Medicare and Medicaid Services (CMS.gov) offers help sorting through the plethora of information and choices available.

Ever wonder how/why certain hospital physicians and clinicians recommend care for their patients be performed at specific hospitals?

Hospital Compare www.medicare.gov/hospitalcompare/search.html is a consumer-oriented website to help consumers make informed decisions about where to go. Hospital Compare allows the consumer to list and compare multiple hospitals in order to directly compare performance related to heart attack, heart failure, pneumonia, surgery, and other conditions. Results are typically organized by:

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

It stands to reason that people should take control over their choice of care if they are paying for more of it. Over the last decade, healthcare has changed from being about what is convenient to the insurance agencies to what is convenient for the consumer.

"Where we've moved…is self-service," said Mark Ehalt, senior director of revenue cycle operations for the University of Pittsburgh Medical Center.

For some, it’s a matter of semantics and splitting hairs. According to Forbes magazine contributor Dr. Robert Pearl, CEO of The Permanente Medical Group, a certified plastic and reconstructive surgeon and Stanford University professor, “…among passionate advocates on both sides of the argument, emotions run high.”

“What should we call the people who get medical care?” Pearl wrote. “Are they “patients,” the traditional term for anyone receiving medical attention from physicians, nurses, pharmacists, therapists, dentists, and other providers? Or are they “consumers,” people who purchase goods and services for personal use?”

When people are lying in a hospital bed with a nurse call bell in tow, many people view themselves as patients. But when comparing the costs and benefits of different health insurance plans, people are clearly consumers.

However, focusing on one versus the other is a false contrast and potentially dangerous to individuals’ health and bank accounts. Most of the time people are both patient and consumer.

Why Hospitals Have Shifted to Consumer-Friendly Centers

Positive Feedback Forms Are Vital to Keeping Facilities Open

By Arnese Stern, MSN, BSN, RN

If anyone has been a patient in any hospital over the last seven years, chances are that they were given a feedback survey to fill out. General questions would have included:

During your hospital stay;

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?

As innocuous as this seems, filling out the form and sending it back is vitally important to whether or not a facility stays open.

Society is inundated these days with requests for feedback from every corner; “Rate us” requests and other surveys are meant to boost customer service and increase sales. Most of the time, these forms end up in the garbage can or sent to email trash.

Such a laissez faire attitude is dangerous to those in the American healthcare system today. It can be the final nail to close the doors on a facility when their customers/patients pass the survey off as a waste of time.

Perhaps patients don’t realize that there is a lot riding on their responses. Since the Affordable Care Act went into effect March 2010, Medicare and hospital officials are paying close attention to the answers that do come in.

When the ACA began in earnest, Medicare officials decided that patients in hospitals are consumers, too, and should have a say in their overall experience. Facilities with the least amount of “likes” ranked underneath the 50 percentile in the nation—which led to non-reimbursement and eventually closure.

As of December 2016, since this plan went into effect, 80 rural hospitals have gone bust. Within the next decade, 673 hospitals across 42 states will be under threat, according to a report from iVantage Health Analytics, a firm that compiles a hospital strength index based on data about financial stability, patients, and quality indicators.

Sixty-eight percent of those vulnerable hospitals are critical access facilities. As such, certain conditions must be met, including being located at least 35 miles from another hospital.

Basically the new Medicaid plan gives patients a critical voice about the care they received, which in turn is used to rank and pay hospitals that meet and/or exceed patient care and comfort expectations.

Because of their positive or negative feedback, patients now play a vital role in whether or not a hospital is ranked at 50 percentile or better nationally—and whether or not they get the reimbursement needed to stay open.

Not every state has agreed to customer/patient follow-up. Those states whose leaders did not sign up for the new plan have suffered—mostly in the Midwest and South. Across the board, rural and urban hospitals earned more if they were in a state where more people had Medicare coverage; they also saw declines in the level of uncompensated care.

To put it another way: All hospitals generally fared better under the larger Medicare program—but there’s more at stake for rural hospitals that serve smaller communities.

Rural hospitals are endangered

According to Medicare.gov, the way hospitals are reimbursed for services provided to people with Medicare has changed. Instead of only paying for the number of services provided, Medicare also pays for providing high-quality services—as perceived by consumers.

In other words, Medicare officials also reward hospitals that deliver services of higher quality and value as experienced by patients who have said so in their feedback forms.

According to Jordan Rau for The Washington Post, consumer advocates say that tying patient satisfaction survey scores to payments will result in better care. But hospital officials argue that scores don’t necessarily reflect the quality of care and are often influenced by factors beyond their control.

According to Alexandra Robbins for The Atlantic, since October 2012, Medicare officials could withhold 1 percent of its payments to hospitals. That money—$850 million in the first year—went into a pool to be doled out as bonuses to hospitals that scored above average on several measures.

Not every state opted in for the new expanded Medicaid plan; as a result, hospitals in non-expansion states saw a very small increase in Medicaid discharges, a decline in Medicaid revenue—but growth in cost of care to the poor.

Patient scores can determine 30 percent of hospital bonuses, while clinical measures for basic quality care set the rest.

According to Congressional Budget Office researchers, several ACA provisions will affect hospital profitability for 3,000 rural hospitals over the next decade.

Unhappy patients have complained about a range of issues: someone waited for his coffee for more than an hour; a patient's flowers in ICU wilted and weren’t watered. Valid issues such as not having enough post-operative instructions or a doctor/nurse with a horrible bedside manner were just as important.

Low patient ratings often spring from real shortcomings, said Jodie Cunningham of Press Ganey, a company that administers surveys for many hospitals. Poor ratings can be caused by bad employee morale or bed shortages that force patients to remain in emergency rooms for several hours before being admitted.

Welcome to the Hotel Hospital

Some officials appear to believe that making people happy rather than well is a way to improve patient health.

Robbins observed, “When (modern) healthcare is at its best, hospitals are four-star hotels with nurses and personal butlers at the ready—at least, that’s how many hospitals seem to interpret a government mandate.”

Thirty percent of hospitals’ Medicare reimbursement relies upon patient satisfaction survey scores. Robbins surmised that officials likely figured that transparency and accountability would improve healthcare. CMS officials believe that, “Delivery of high-quality, patient-centered care requires us to carefully consider the patient’s experience in the hospital inpatient setting.”

Some would argue that patient-satisfaction surveys have their place; however, others fear that hospital officials are no longer focusing on patient health.

HCAHPS provides a 32-question survey that mostly addresses nursing care. The survey asks, “During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?”

Because hospital officials fear losing ranking and therefore, funding, some job postings advertise that institutions are looking for nurses with good customer service skills as a first qualification. For example, Robbins discovered that the University of Toledo Medical Center evaluates staff members on “customer satisfaction.”

A Scrubs magazine article written by Nurse Amy Bozeman points out that patients who are treated like customers tend to give way to the attitude that “the customer is always right.”

“Now we are told as nurses that our patients are customers,” Bozeman wrote, “and that we need to provide excellent service so that they will maintain loyalty to our hospitals. The patient is NOT always right. They just don’t have the knowledge and training.”

Robbins found that some hospitals have even gone so far as to hire customer-service representatives. However, empowering nonmedical employees to pander to patients’ whims can backfire, she wrote. “Comfort is not always the same thing as healthcare.”

Regardless of the reasons behind health facilities asking patients to fill out feedback forms, they are meant to collect critical patient feedback and serve as a tool to improve communication between healthcare providers/staff and patients.

Patients' detailed reports of what went well and what didn't are helpful; such information can be critical for healthcare facility survival. Richard Kravitz, MD at the Center for Health Services Research in Primary Care at the University of California, Davis, said, “If patient satisfaction measurement is not to be dismissed as one more healthcare fad, many challenges—philosophical, empirical, and practical—must still be addressed.”

Patient Awareness: The Real Cost of Healthcare Services

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.

http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/insurance-companies/prior-authorization-predicament?page=full

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. https://www.goodrx.com/blog/prior-authorization-what-you-need-to-know/

In most cases, the pharmacy or doctor will notify and provide information to the insurance company. Because the process takes several steps, it may take a day or two—sometimes longer—before the pharmacy has a response. If approved, prior authorizations are only valid for a set amount of time and may require periodic re-approval.

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. https://nhhealthcost.nh.gov/guide/question/if-i-need-referral-what-happens-if-i-don%E2%80%99t-get-one

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.http://www.bcbsm.com/index/health-insurance-help/faqs/plan-types/hmo/how-do-referrals-work-in-my-hmo-plan.html

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. https://www.medicare.gov/coverage/clinical-lab-services.html

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. http://time.com/money/3938748/7-smart-ways-to-negotiate-your-medical-bills/

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: http://www.huffingtonpost.com/2015/02/22/generic-prescriptions_n_6730194.html

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