Upcoming doctor visit...PO Day 314

I have an appointment with my favorite physician this coming Monday. No matter what is going on, he always makes me feel like everything will be fine. When I see him I don't have that feeling of dread that usually accompanies me to a doctor visit.

But I am a little nervous this time. I went for my blood work today. I thought I could see little fat droplets mixed in with the blood as the technician filled the vial. Perhaps I exaggerate a little but I just know the Lipid panel part is going to be bad news. The numbers are usually fine amd I feel as if I have aced my SATs.

What is different this time? Since Christmas I have been baking and eating everything bad for you. Cookies are practically a food group all on their own, as if they belong right there beside fruits and vegetables. And I have not been exercising, the only way to reduce  one's bad cholesterol and raise the good cholesterol numbers. My "walking buddy" has been tied up with her own medical visits and tests, on top of which she has had house guests. Normally we walk two to three miles every morning.

At first, when I had no one encouraging me to "just do it," I felt guilty that I was being a slug. But I quickly realized that eliminating an hour of moderate exercise left me with more energy for home projects like gardening or cleaning. Why can't mopping floors or polishing wood furniture do the same thing for your health as traditional forms of exercise? But it doesn't and I fear the tale will be told when we see my lab results Monday.


My only hope is that the cookies I take to the doctor and staff help him understand my total lack of self control.

Value Based Purchasing.. PO Day 313

It has been very hard for me to wrap my brain around the new  health care concept, Value Based Purchasing, VBP for short.

This isn't going to be a good explanation but if we're going to understand what is happening in the hospital treatment we receive we need to grasp the concept.

The Affordable Healthcare Act looked at the way healthcare is meted out in this country and said it was inefficient. There has been no accountability for outcome and the old "Pay For Service" model encouraged more visiits, tests and procedures. Value Based Purchasing would standardize care, create protocals of efficiency and ensure better overall healthcare.

A greater emphasis would be placed on prevention. Hospitals would be financially rewarded for improving results and reducing costs. They would be penalized for not meeting goals. A big part of making this new system work is analyzing patient experience which is done through post inpatient surveys and the electronic health record system. A satisfied, happy, and healed patient is worth more than a disgruntled, carping healed patient in the greater picture.

This isn't just all about being in the hospital. In fact, keeping the patient out of the hospital is a big goal. Faster turn around, releasing the patient sooner after procedures, is desirable. Shorter hospitalization time exposes the patient to fewer hospital infection sources and cuts costs. Alternatives to inpatient care are being created. Pilot programs for in home health care are in operation in some big cities. Shifting elder care from hospitals to nursing homes is being investigated.  Virtual office visits, using Skype or Facetime, are likely to become part of healthcare.

CMS, Centers for Medicare and Medicaid, is the biggest force in instituting VBP right now but many employer sponsored healthcare prograns are following suit. The idea of healthier participants at a lower overhead appeals to not just government healthcare administrators but to private industry.  VBP is not a proven system. It is a theory being brought into practice since the implementation of the Affordable Health Care Act of 2012. It is in response to the out of control increases in medical costs in this country over the past ten to twenty years. How  well it works, whether it works at all, will determine what happens in the future.

I believe I am seeing the influence of VBP in my medical care in a small way. It seems to me that the frequency of seeing my doctors in routine follow up is changing. Doctors who used to ask me to return in four months now suggest that I come back in six months. A specialist I have been seeing for the past five years just told me I could be followed by my primary care physician and did not have to see her anymore. As a reverse total shoulder arthroplasty post surgical patient I was released from the hospital as quickly as I could have imagined possible, almost too fast. But as a readmitted sickie with a pneumothorax, to their credit, the hospital and staff went all out and there was no question of sending me home until I was totally ready and able.


Maybe this will work.

Price of privacy...PO Day 312

John Hancock was the first to sign the Declaration of Independence. His signature is bold and daring and announces to the world that he supports a new way for the future. So goes his namesake, The John Hancock Insurance Company.

In an unprecedented move, the insurance company is offering a financial discount to members in return for personal information. Not a survey asking the member's opinion or history, rather a way to monitor the subscriber's activities that affect their health and well being, John Hancock has partnered with Vitality, an employee wellness company, that will help them monitor and process personal information of members.

In addition to the discount, which can add up to thousands of dollars over a lifetime membershio, participants will be given a Fitbit. Wearing the fitbit will link the member with the company who can thentrack exercise activiity, blood pressure, doctor visits and  on line educational courses taken to add points to the members profitle. Personal goals can be set and members can succeed or fail.

On the surface it sounds like a good idea, Don't we all need a little help keeping our New Year's resolutions to exercise more, eat better, live a healthier liefstyle? But should it really be our  medical insurer doing it?

What if we don't hit our benchmark goals? Can they cancel our policy? Will they have access to our Electronic Health Record? Can they share the information with other companies, cancel our life insurance because we are living life in the fast lane? Willl there be a black list of names of people who are not good condidates for coverage?

Is this a great way to save 15% on our insurance and get a free Fitbit or is it an intrusive foray into our personal lives by a big brother who has a vested interest in our health and welllbeing?

The Other Shoe!...PO Day 311

It has beeen ten months since my rTSA surgery. It took several months for the bills to trickle in which did not surprise me. Being a medicare patient who had met her deductible, my interest was purely academic. I had read a lot about how much joint replacement surgery cost and I was curioius how much my procedure would be adding to the national debt.

Even though I have had a lot of experience with insurance EOBs (Explanation of Benefits) both personally and when I worked for a living, I was totally confused by the statements that arrived in the mail. I was embarrassed by how little Medicare approved for many of the procedures and there were several "items" that I never could find listed, like the cost of the artificial joint. I decided the latter must be included in some global charge and not priced individually. I wondered how my readmission would be handled, would Medicare pay for the iatrogenic incident? I couldn't tell what happened.

So, ten months and six days after my surgery a new This is not a Bill Statement arrived in the mail. All those surgical fees that I couldn't locate on previous statements magically appeared. Good thing I was sitting down when I opened it. I assume the item listed as Supply/Implants translates to "new metal shoulder hardware." Priced at a mere $34,168.67, the charge was denied for reasons DEandF (information was missing, I should not be billed for this (thank heavens!), and Medicare does not pay for this service).  The other bigggie was Prosthetic repair of a shoulder joint at $26,167.01. This, too, was denied for reasons EF and H (I should not be billed for this service -hooray-, Medicare does not pay for this service and this service cannot be paid when performed in this facility!).

Other lesser procedures run the bill up to a total of  $72,575.69.  What "cloud" have these charges been floating around on? Will these claims be refiled, corrections made, information filled in, amounts proportionately reduced, and ultimately some Medicare and some Medigap payments will be made? How can "this service cannot be paid when performed in this facility" be resolved? Is there more to come?

And finally, if a person was not insured they would be expectted to pay these charges in full! 

New Pet Peeve...PO Day 310s

Is it just me or has anyone else noticed how heavy doors are getting? I don't think it is just my post operative arm situation. Fortunately many entrance doors operate automatically. They don't single out anyone,  opening for the frail customer as well as the construction worker. The ones that are power operated but only if you push the big button on the wall work great but require you admit you are a wimp and  create that little side  detour to reach the button.

But the problem is the non power door and they are everywhere. The "Medical Screening" department at my local hospital has a door that requires a two handed pull to give way. My first orthopod's office door should have a security camera aimed at it. The footage would separate the genuinely handicapped from the malingerers. One fast food restaurant is designed with the double door air lock arrangement so you can't avoid having to use first your right arm, then you left, to get inside. Our local dollar store's doors look like they are powered but aren't. A good Candid Camera epiosode could feature all the customers who almost collide with the glass expecting the doors to part like the Red Sea for Moses.The double jeopardy situation is trying to exit a heavy door with a shopping cart. Only the moms with strollers can manuver with any skill.

I'm a kind of do-it-yourself person. I'm as likely to open the door for someone else as I am to let someone else open the door for me. But I am obviously sending out vibes or visual hints or have a virtual "Help Me" sign on my back because people seem to go out of their way to open doors for me. And, the fact is, I really appreciate it. It's just too bad that there isn't a burley roofer standing by as I give our sticky back door three tugs to get out.

According to the ADA (American Disabilities Act) there are all kinds of rules for door accessibilty. But of particular interest is their description of the Force required to open the door. They state:

"Interior accessible doors should require no more than 5 lbs. of force to open. This applies to interior hinged doors and gates, as well as sliding and folding doors.  The ADA Standards do not specify the opening force for exterior doors, though some state and local building codes may have requirements. Typical maximum opening force for exterior doors ranges from 8.5 to 10 lbs. Doors designated as fire doors must have the minimum opening force allowed by the local authority." 

These standards apply to construction post 1992 and corrective measures are limited by the economics of the business involved. I don't foresee any changes in the doors I encounter in life, not even my own back door. But it's nice to be able to complain!

Who's been busy?...PO Day 309

What in the world is keeping Willet from writing her blog? Has she lost interest in communicating? Is she too wrapped up in other projects? Gone back to regular employment, has a houseful of visitors, taken a lover? I don't know, no, maybe, no, no and no!

For one thing, I am sleeping better. Finally! I do still wake up at 1:00 or 2:00 (as evidenced by this writing) but I now am quite sleepy and go back to sleep easily. And I am not waking up at 4:00 AM, alert and ready to set the world on fire. I do miss the head start I got on the day but I am glad to be able to sleep until six or seven. My body and soul function better with a couple more hours of sleep.

That countdown clock has definitely gotten inside my head. I now feel the pressure of time like I never have before. All those projects that I was going to get to some day are annoyingly lining up and crying out, "me first." Today I tackled the job of altering a blouse, collecting clothes I don't wear to donate to the thrift shop, and cleaning my silver jewelry. Boy, do I sparkle now!

It's true, I don't have a lot to say about reverse total shoulder replacement surgery. After ten months I feel like I am pretty much over it. At nine months post op it seemed like everything just began to click into place. Oh, I do still have some discomfort, in some positions, doing some heavy work, but I think I have reached optimum improvement. I am very satisfied with the results. My right arm lifts and stretches as fully and well as the left. It is still not as strong as the left but I am making progress there too. Tincture of time. I will have a good report for my surgeon when I see him at twelve months
post op.

I am loving my artsy painting project. Please don't get the impression that I am an artist. I am a dabbler, a rank amateur, a graduate of the school of "art for the elementary school teacher." But this project is a true labor of love and I can spend a couple hours in painting rapture, easily ignoring life's real obligations. In an extreme display of self control I have put my paint and brushes away, temporarily, so as to not finish the job too quickly. Unusual restraint for me.

And finally, since you asked :) ... Computer problems! If I am going to write much on my iPad mini I enlist my wireless keyboard. It's easier typing, has key functions to move around that the iPad's screen keyboard does not have, and encourages proper typing form. I had to replace the batteries in the keyboard, no problem. But when I turned on the duo again the keyboard and my iPad mini did not "pair" up. For two days my iPad mini stubbornly refused to tell me why it was not talking to the keyboard. The keyboard would only say I should be sure it was turned on and within range (30'). I did, it was! Long story short, the keyboard had decided to take up with a previous partner (my old iPad) and Apple will only permit monogamous relationships. If the keyboard, for whatever nostalgic romantic reasons, was going to "pair" with my old iPad, nothing I did was going to restore everyone to their rightful stations. A hardware divorce was in order! That done, the keyboard snuggled up to the iPad mini and marital harmony was restored. And I am a ten finger typist again!

So, I'm sure that is more than anyone wanted to know but that's where I've been and where I am.

Montezuma's revenge...PO Day 308

We've all known someone who ignored the warnings to not drink the local water when in another country. There's usually a high price to pay. But here, at home,  we can drink the water in New York or las Angeles or Houston. No risk.

But the latest news is not good. According to The Washington Post and retold in The Week, shigella, the food borne bacterium responsible for Montezuma's revenge is spreading across the United States.
The United States! Normally responsive to cipro (an antibiotic), a new mutant strain resistant to cipro has appeared. At least 243 people have been infected, 20% required hospitalization.

Half the cases are related to travel but half are home grown. Groan. Something new to worry about.

The CDC is concerned. Shigella is easily spread. Symptoms include severe diarrhea, muscle cramps, nausea and vomiting. It could easily be misdiagnosed as food poisoning. I don't know how one protects oneself from exposure. Hand washing is always a good thing, of course. But is this spread through the water supply in this country as in Mexico? Or restaurant food? Does it pass from person to person through hand contact? A little guidance here, please!

This is going to require a little Google search...