Kaiser program brings hospital care to the patient's home

Who says primary care is dead?  It is just relocating....house-calls of the 21st Century


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Frequent medical visits had become a way of life earlier this year for John and Audrey Stanton of Hemet in Riverside County.  

John, 86, suffered from serious eye problems; a painful skin infection called cellulitis, and more recently, repeated shortness of breath — all of which kept landing him in the hospital."It was one thing after another. Like the doctor said, 'Somebody is after you!'" Stanton laughs. And for his 81-year-old wife Audrey, the nearly two-hour drive to-and-from Kaiser in Riverside was a tough haul."I’m not a long distance driver so I had to be real careful," she says. "It was stressful." 

But that stress dissipated last summer when John was admitted to the hospital — at home.  

"I thought, 'Wow! This is amazing. I love this!'" he says. "This is what people need!"

Pneumonia, cellulitis or congestive heart failure  Stanton is one of about 125 patients who’ve been enrolled in an experimental hospital at home program run out of Kaiser’s Permanente’s Riverside Medical Center.  Launched two years ago, the program is designed for people who need treatment - typically only given in the hospital — for one of three conditions: pneumonia, cellulitis or congestive heart failure.

"Our goals are to have patients be safe at home and to have them recover at home and to have a high-quality experience," says Dr. Earl Quijada, one of three Kaiser doctors assigned to the program. Not every patient with one of the three conditions qualifies for the program. It's restricted to those who are not at risk for complications that could require more intensive care, says Dr. Nirav Shah, senior vice president and chief operating officer for clinical operations at Kaiser Permanente Southern California. 

"We ask if that patient wants to be admitted [to the hospital] or admitted at home," Shah says. "If they choose to be admitted at home, we'll send a truck home with them with all the equipment they need."

For John Stanton, the program saved two to three days in the hospital as well as a number of return trips for follow-up visits, Quijada says.   

"Things are just so much more relaxed"

Stanton’s at-home care for a pneumonia diagnosis involved an intravenous antibiotic; a phlebotomist to check his blood and house calls from a nurse and Quijada. Hospital rounds — usually done by the patient's health care team in the hallway outside the patient's room — took place instead on the phone. 

Kaiser program brings hospital care to the patient's home 

The Affordable Care Act is it Working ?

If you are a Republican chances are very good you say  Obamacare (ACA) is a failure. If you are a Democrat you talk about its successes. The corollary is if you don't like Obamacare you are a Republican and if you like it you are a Democrat.
Which came first is like the chicken and the egg conundrum.

Obamacare is entering it's third year of transition.  Some pundits have it as entering a holding area to be monitored as some of it's vital organ systems are struggling to survive.

The ACA was passed during a political firestorm, and a majority Democratic congress. The only people who knew what was written in the statute were those who wrote the actual Bill. Some prominent Democrats overtly expressed "you won't know what is in it until we pass it".  Enough time has passed that we know that to be  true, but we also don't know what is coming next.

The health landscape has changed dramatically in the past decade as has the economy. The calculus has changed in regard to reimbursement models and organizational stability.

Several things are happening that should set off warning bells (if congress even listens or cares) in the middle of world crises.

Politics and health care have been mixed,and patients now find their health is competing with ISIS, the war on terror and everything in the national budget.  Physicians have always known and saw this several decades ago in 1963 when Medicare was added to social security entitlements..  As health expenses were met with an 80% coverage, and with  the lack of cost containment  medicare fueled health inflation. For more than two decades health expenditures grew at more than twice the rate of the gross domestic product, fueled by the black hole of the federal government and it's ability to manipulate budgets by borrowing and printing more currency.  Now it is a part of the seventeen trillion dollar national debt. Annually health contributes to 17% of the GDP.

The ACA went into effect in 2013 and beginning then there have been enormous changes in health care financing, the administration and delivery of medical care.

Health insurance companies,  health plans, and related enterprises such as pharma are adjusting to the limitations on profitability for operations.

Mergers and acquisitions have long been part and parcel of the health business scene. However the rate and size of the shifting health space has increased in numbers and size.

Health care business will survive in this hostile environment, as a necessity of life, the demand for services is infinite. The balance between restricting necessary health care and it's availability is precarious


Aetna, Anthem reassure investors on forecast, exchanges   
Pfizer, Allergan announce $160 billion merger, 'inversion' deal would shift HQ overseas

LAO Finds Rapid Medi-Cal Enrollment

Health care mergers and acquisitions in 2015: Running list (89)

Some insurers are treading lightly and reassessing their involvement in health insurance exchanges

LAO Finds Rapid Medi-Cal Enrollment - capradio.org

LAO Finds Rapid Medi-Cal Enrollment - capradio.org

How Do Oncologists Use Social Media, and What Information Are They Seeking? | ASCO Connection

A new study in the Journal of Oncology Practice (JOP), explores how oncologists use social media. The study, “Social Media Use Among Physicians and Trainees: Results of a National Medical Oncology Physician Survey,” sheds light on the kind of professional knowledge clinicians seek when visiting sites such as Twitter and Facebook and identifies barriers to using social media. 

The study, published online, ahead of print, October 6, was carried out by a team of researchers from cancer centers across Canada and was designed to address a gap in the research: nearly all previous studies on the nexus of social media and medicine have focus on the challenges social media presents in terms of privacy and maintaining professionalism.

”The existing literature on social media was really just cautioning doctors, and wasn’t focusing on the opportunities social media was presenting,” said Rachel Adilman, BSc, first author of the study. “We wanted to highlight the fact that social media actually has opportunities for us. We can share knowledge, we can collaborate, and we can harness these opportunities to further our knowledge and cooperation.”

How are oncologists using social media?

The researchers sent surveys to 680 medical, radiation, and surgical oncologists; hematologists; and oncology trainees, asking about different aspects of social media use; Trainees were defined as pre-medical students, medical students, and residents. Two hundred and seven study participants sent back the surveys (a response rate of 30%). Analysis of the responses revealed these findings:

• Frequency of social media use: 72% of respondents use social media
   
• Differences in use of social media by age of oncologist: The study used age as an indicator of respondent’s career phase, whether trainees, fellows, or early-, mid-, or late-career oncologists. Among those age 18-24 (trainees) and 25-34 (fellows), 89% and 93%, respectively, use social media. However, among those age 35-44 (early-career), the percentage goes down to 72%. And among those age 45-54 (mid-career), the percentage of oncologists who use social media dips down to 39%, a rate that is significantly lower than the 89% and 93% seen among trainees and fellows. Interestingly, late-career oncologists (age 55 and over) have a higher rate of social media use (59%) compared to mid-career oncologists.
   

• What are oncologists’ goals in visiting social media sites for professional development?

Fifty five percent of respondents said their goal in visiting social media sites was to network with colleagues or professionals, 17% said their goal was to share research, and 13% said their goal was leadership development.

When separated by age group, differences emerged between users’ goals in visiting social media sites. Among the trainees and early-career cohorts, more than 53% of respondents reported a desire for professional networking, whereas among mid-career oncologists, the rate was 36%.

• What kind of professional information are oncologists seeking on social media sites?

Fifty three percent of respondents said they are seeking journal articles, 52% said they are seeking information about upcoming conferences and courses, and 51% are looking for updates on current oncology research.

 Search features on  all social media platforms allow users to search using a # hashtag. In essence this turns twiiter into a search engine for diseases, conferences, and specialty or other term of interest.





How Do Oncologists Use Social Media, and What Information Are They Seeking? | ASCO Connection

The Future of Work: Quantified Employees, Pop-Up Workplaces, And More Telepresence

The Future of Work: Quantified Employees, Pop-Up Workplaces, And More Telepresence

The 10 Most Important Work Skills in 2020

The 10 Most Important Work Skills in 2020

CDC’s Health IQ App | Mobile Activities | CDC

INFOGRAPHIC: Electronic Health Records History | Patients & Families | HealthIT.gov

INFOGRAPHIC: Electronic Health Records History | Patients & Families | HealthIT.gov

What Patients need to know about EHR and HIT

Putting the I in Health IT

This video provides inspiring patient testimonials and informational interviews with representatives from the government on how health IT makes a difference in consumers' lives.


Ensuring the Security of Electronic Health Records Video:



It is vital to do as much as possible to protect sensitive health information in EHRs. Find out more about how providers are keeping individual health information safe and secure through cybersecurity.

Health IT Stories:

The best way to understand the value of health IT can be through personal testimonials from consumers and patients who have personal experiences using it to improve their health and health care. These videos are a small excerpt which represent many personal stories of consumers using e-Health and health IT tools to manage their care.

“I’ve Seen the Disaster Averted”  

Dottie Bringle, R.N., is a hospital executive in Joplin, MO. Three weeks before Joplin's devastating tornado in May 2011, her hospital completed a switch to an EHR – so even though her hospital building was destroyed, doctors and nurses were able to provide care to Joplin residents in their time of need.

“I Want My Kids to Have the Best Care”

Lilianne Wright, upon hiking in the Grand Canyon, suffered from severe stages of diabetic ketoacidosis, which brought her to the brink of death. Ms. Wright recovered, but found that managing her disease was and still is complicated, because her doctors can't easily share her medical records. Today, her two children are reaping the benefits of EHRs.

“I Beat Cancer So I Could Dance at My Daughter’s Wedding”

A stage 4 kidney cancer survivor, Dave de Bronkart has learned first-hand that good health care depends on good information. Now he blogs as "e-patient Dave," writing about how health information technology and electronic health records can improve health care by empowering patients to access their health information and take an active role in their own care. This is his story.

Health IT, Advancing America's Health Care  pdf download

Health InformationPrivacy and Security  pdf download

Are You Depressed ? Take a Motrin

Depression has been linked to many other illnesses, genetics, lack of certain vitamins, poor nutrition, lack of exercise and more. 

About one third of people with depression have high levels of inflammation markers in their blood. New research indicates that persistent inflammation affects the brain in ways that are connected with stubborn symptoms of depression, such as anhedonia, the inability to experience pleasure.

The results were published online on Nov. 10 in Molecular Psychiatry.

The findings bolster the case that the high-inflammation form of depression is distinct, and are guiding researchers' plans to test treatments tailored for it.

Anhedonia is a core symptom of depression that is particularly difficult to treat, says lead author Jennifer Felger, PhD, assistant professor of psychiatry and behavioral sciences at Emory University School of Medicine and Winship Cancer Institute.

"Some patients taking antidepressants continue to suffer from anhedonia," Felger says. "Our data suggest that by blocking inflammation or its effects on the brain, we may be able to reverse anhedonia and help depressed individuals who fail to respond to antidepressants."

In a study of 48 patients with depression, high levels of the inflammatory marker CRP (C-reactive protein) were linked with a "failure to communicate", seen through brain imaging, between regions of the brain important for motivation and reward.

High CRP levels were also correlated with patients' reports of anhedonia: an inability to derive enjoyment from everyday activities, such as food or time with family and friends. Low connectivity between another region of the striatum and the ventromedial prefrontal cortex was linked to a different symptom: slow motor function, as measured by finger tapping speed.

As a next step, Felger is planning to test whether L-DOPA, a medicine that targets the brain chemical dopamine, can increase connectivity in reward-related brain regions in patients with high-inflammation depression. This upcoming study is being supported by the Dana Foundation.

Felger's previous research in non-human primates suggests that inflammation leads to reduced dopamine release. L-DOPA is a precursor for dopamine and often given to people with Parkinson's disease.

Inflammation linked to weakened reward circuits in depression

In 5 Minutes, He Lets the Blind See - The New York Times

HETAUDA, Nepal — WATCHING the doctor perform is like observing miracles.

 He has restored eyesight to more than 100,000 people, perhaps more than any doctor in history, and still his patients come. They stagger and grope their way to him along mountain trails from remote villages, hoping to go under his scalpel and see loved ones again.

A day after he operates to remove cataracts, he pulls off the bandages — and, lo! They can see clearly. At first tentatively, then jubilantly, they gaze about. A few hours later, they walk home, radiating an ineffable bliss.

Dr. Sanduk Ruit, a Nepali ophthalmologist, may be the world champion in the war on blindness. Some 39 million people worldwide are blind — about half because of cataracts — and another 246 million have impaired vision, according to the World Health Organization.

Dr. Sanduk Ruit, a Nepali ophthalmologist, may be the world champion in the war on blindness. Some 39 million people worldwide are blind — about half because of cataracts — and another 246 million have impaired vision, according to the World Health Organization.

 If you’re a blind person in a poor country, then traditionally you have no hope. But Dr. Ruit has pioneered a simple cataract microsurgery technique that costs only $25 per patient and is virtually always successful. Indeed, his “Nepal method” is now taught in United States medical schools.

In 5 Minutes, He Lets the Blind See - The New York Times

Rapper, Internist ZDoggMD on the 'Hard Doc's Life'

 In this segment of Medscape One-on-One, Editor-in-Chief Eric J. Topol, MD, interviews Zubin Damania, MD, a practicing internist who uses musical parody as a clinical teaching tool and to bring attention to the concerns facing practicing clinicians. Performing under the name ZDoggMD, Dr Damania has used music to broach many topics from conveying the need for a more humane approach to end-of-life care to the frustrations of using a less-than-intuitive electronic health record (EHR) system.

After spending 10 years in the "Hard Doc's Life" working as a hospitalist in the Silicon Valley, he was lured to Las Vegas by Zappos CEO Tony Hsieh, a former classmate of Dr Damania's wife. There, Dr Damania founded Turntable Health as part of Mr Hsieh's $350 million investment to revitalize downtown Las Vegas.

Rapper, Internist ZDoggMD on the 'Hard Doc's Life'

Many Say High Deductibles Make Their Health Law Insurance All but Useless - The New York Times

 Obama administration officials, urging people to sign up for health insurance under the Affordable Care Act, have trumpeted the low premiums available on the law’s new marketplaces.

But for many consumers, the sticker shock is coming not on the front end, when they purchase the plans, but on the back end when they get sick: sky-high deductibles that are leaving some newly insured feeling nearly as vulnerable as they were before they had coverage.

“The deductible, $3,000 a year, makes it impossible to actually go to the doctor,” said David R. Reines, 60, of Jefferson Township, N.J., a former hardware salesman with chronic knee pain. “We have insurance, but can’t afford to use it.”

In many states, more than half the plans offered for sale through HealthCare.gov, the federal online marketplace, have a deductible of $3,000 or more, a New York Times review has found. Those deductibles are causing concern among Democrats — and some Republican detractors of the health law, who once pushed high-deductible health plans in the belief that consumers would be more cost-conscious if they had more of a financial stake or skin in the game.

“We could not afford the deductible,” said Kevin Fanning, 59, who lives in North Texas, near Wichita Falls. “Basically I was paying for insurance I could not afford to use.”

He dropped his policy.

Sylvia Mathews Burwell, the secretary of health and human services, issued a report analyzing premiums in the 38 states that useHealthCare.gov. “Eight out of 10 returning consumers will be able to buy a plan with premiums less than $100 a month after tax credits,” she said.

But in interviews, a number of consumers made it clear that premiums were only one side of the affordability equation.

Exceptions, waivers and options are not known by most ACA enrollees.

Tax Credits are a false incentive for many enrollees

Many are in a category with income low enough they do not pay taxes, however if they have withold from their payroll they would be entitle to a full refund of their witheld taxes.  However, these refunds do not become available until after the early months of the following year. For the initial year of enrollment there are no excess funds for tax credits.

Health officials and insurance counselors cite several mitigating factors. All plans must cover preventive services like mammograms and colonoscopieswithout a deductible or co-payment. Some plans may help pay for some items, like generic drugs or visits to a primary care doctor, before patients have met the deductible. Under the Affordable Care Act, health plans must have an overall limit on out-of-pocket costs, to protect people with serious illness against financial ruin.

In addition, people with particularly low incomes can obtain discounts known as cost-sharing reductions, which lower their deductibles and other out-of-pocket costs if they choose midlevel silver plans. Consumer advocates say this assistance makes insurance a good bargain for people with annual incomes from 100 percent to 250 percent of the poverty level ($11,770 to $29,425 for an individual).

Dave Chandra, a policy analyst at the liberal-leaning Center on Budget and Policy Priorities, has some advice: “Everyone should come back to the marketplace and shop. You may get a better deal.”