Cookbook medicine...PODay 344

Copied from a news article:

")The U.S. Department of Health and Human Services (HHS) on Thursday announced a new payment model that aims to prevent one million strokes and heart attacks by 2017. Speaking at the White House Conference on Aging regional forum in Boston, HHS Secretary Sylvia Mathews Burwell announced the "Million Hearts" model, which seeks to reduce the nation's 610,000 deaths a year from strokes or heart attacks, as well as the $315.4 billion annual cost, according to the announcement. Research last year also found that cardiovascular events are the leading cause of death worldwide. Under the current model, the Centers for Medicare & Medicaid Services (CMS) pays providers based on specific goals relating to patient cholesterol, blood pressure or other factors. The new model rethinks this one-size-fits-all approach, opting instead for a data-driven predictive model that creates personalized risk scores for individual patients. Providers that participate in the initiative will collaborate with beneficiaries to determine a percentage that represents their heart attack or stroke risk within the next 10 years. Providers also will identify risk reduction steps that work best for an individual patient, such as taking cholesterol-lowering drugs, reducing blood pressure or quitting smoking, to create a personalized plan. CMS will pay participants that cut their high-risk patients' absolute risk of stroke or heart disease, according to the announcement." I understand the trend toward tying payment to results in the new afforable  health care paradigm. But I guess I am a bit of a fatalist in that I don't believe that a financial incentive can solve all the medical problems in the world. Is it really that simple...that paying the doctor or the hospital better or  penalizing them less will  incentivize the patient to  follow  the diet, loose weight, exercise more, all to make them healthier? Aren't there just people who are going to be sick, going to have high blood pressure, going to suffer a stroke or a heart attack in spite of sincere attempts to follow doctor orders? Is it the doctor's fault that the patient doesn't want to take a statin drug for his cholesterol? Should the doctor be penalized if the patient just cannot  stop smoking? It is said to be more addictive than heroin! If the doctor is going to paid less (or not at all?) for patients who are unable or unwilling to turn their medical situation around, won't that result in practices being unwilling to enroll chronically ill or unhealthy persons? Perhaps there is something that I don't get.

I did it!...PODay 343

Wow! This would not be what you or your doctor would like to see on an x-Ray. I copied this photo from a great resource on line. The article detailed possible "things that can go wrong."  According to the author,

"The risk of humeral fracture is increased in revision surgery, by falls and when the humeral component fixation results in an abrupt transition between a cemented or press fit diaphyseal stem tip and osteopenic bone distal to the prosthetic tip These fractures deserve a trial at closed management."

I believe what the author is saying is that when the surgeon goes back in a second time, revision surgery, the risk of fracturing the existing humerus is high. Also, a fall, as my surgeon has advised against :), can result in a break like this. And finally, an abrupt transition between the titanium shaft and the real bone is at risk if the bone shows osteopenic issues.

Obviously a fall is the easiest to understand and the most difficult to avoid. Since my initial injury was due to a fall I am absolutely paranoid about falling again. One day, feeling a little unsteady, I almost bought a walker at a garage sale! Me, a walker? Never! Unless it would save me from another disastrous fall. When I walk for exercise, as I have for several years now, I use two European style hiking poles. The good reason?  It increases the cardio- vascular workout and is good for toning your arms. The real reason? It adds stability which I am grateful for.

And if I encounter an angry raccoon I am armed!

Things can go wrong...PODay342

This is a perfect example of why I have to start a new blog...I have a great photo that I want to post but I haven't done it in a while so I can't remember exactly how. No problem, just read the directions. Well, I wish I could. But remember? My blog became corrupted some few months ago and everything written is just "0"s. Everything except what I write which appears in regular text.

Blogspot is a free service of Google. Google created the program but does not provide tech support. There are user established help sites which is a great service to us. But from what I have read the few suggested "fixes" don't work and the solution is to abandon the corrupted blog and start anew.

On top of that I try to limit my posts to reverse total shoulder arthroplasty AND medical news in general. It's true, I do stray frequently. And then there is a night like last night and I just didn't have anything to say. Oh, I could have talked about my latest sewing project or the over abundance of republican presidential candidates or how I figured out how to clean the floor of the freezer compartment in our french door fridge. But that's not what readers are looking for when they somehow stumble onto my blog.

So in just about 23 days I am going to open a new blog and start anew. I'm not going to delete this site...I don't even know if that is possible. But leaving it open preserves any useful information for any new folks who might stumble into it and benefit from some of the information.

So what was my photo? It's an X-ray of an arm with a rTSA implant and the humerus BELOW the implanted titanium shaft has fractured! Not a good day. I suppose this could be one reason my surgeon told me not to fall again. 

Hospital as insurer...PODay 341

"In a growing response to changes brought by the Affordable Care Act and the move to value-based payments rather than the traditional fee-for-service model, many hospital systems opt for a new strategy: launching their own health insurance plans.
In fact, a 2013 survey by the Advisory Board found 28 percent of hospitals hope to launch their own insurance plan within five years.
It's a dramatic shift, with health systems not just seeking reimbursement from insurance companies for services they provide, but also receiving and paying those insurance claims."

As I drive along I-95 I've been noticing billboard signs touting medical care plans sold by our local hospital. The plan replaces ones medicare and medicare supplement at a great savings..there are some limitations, of course. You have to use their staff physicians only, for instance. I think the deductible situation is different. Your primary care doctor is kind of a gate keeper, limiting visits to specialists, I believe.

It's so hard to really grasp the details of different insurance coverage. Until you have it and use it you don't really know how it works. Kind of like what Nancy Pellosi said about the Affordable Care Act. The House had to pass it before they would know what was in it. I continue to be confused by my medicare and medicare supplement. The "other shoe" dropped a few days ago when I received the supplement's denial of all those huge charges Medicare denied recently. I still don't know why it took almost a year for those bills to show up. And I choose to believe the EOB (explanation of benefits) that says I am not responsible for the exorbinate fees..

At any rate, I don't plan to change horses in the middle of the stream, or change insurers in the middle of a medical crises. Of course, that probably means I'll never change as it seems anymore life is just one health issue after another.

Big vs Small...PO Day 340

Exerpted from an article

By Zack Budryk

"The Centers for Medicare & Medicaid Services' patient satisfaction rating system puts large urban hospitals at a distinct disadvantage compared to their smaller urban/suburban counterparts, according to research published in the Journal of Hospital Medicine. CMS regards improving patient satisfaction scores as a major step in the transition from fee-for-service healthcare to a value-based model, and post-Affordable Care Act, scores are more heavily weighted in the formula the agency uses to determine reimbursements. Despite this, a recent report indicates overall patient satisfaction is nearing a 10-year low even as demand for services increases. Researchers, led by Randall Holcombe, M.D., chief medical officer for cancer at Mount Sinai Health System in New York City, studied survey data from 934,800 patients at 3,907 hospitals, and found that regardless of the organization's location, English as primary language and hospital size were major predictors of patient satisfaction. Overall, patients gave the lowest scores in densely populated regions such as the District of Columbia, California, New Jersey and Maryland. Conversely, more sparsely populated areas such as South Dakota, Maine, Vermont and Louisiana had higher scores, according to Holcomb." And yet...In Post 335 I reported how some of the big, well known hospitals are wanting to establish volume requirements for CMS to pay for the top ten most difficult surgical procedures. Their opinion is that large facilities where high volume surgeons prevail have better outcomes. And that may be true but it obviously does not translate to patient satisfaction. And patient satisfaction is a large factor in rating hospitals. Of course, being able to communicate is always an issue but can you imagine being sick or injured and not able to talk to the doctors or nurses? But how would that be different at a smaller rural facility than at a large urban hospital? I would think the large hospital would be more likely to have an interpreter available or even staff members who speak the same language. It has to be the size and imtimacy of the smaller hospital that tips the scale in their favor. I like my small local hospital. It has the advantage of being part of a large hospital system but is in the just fewer than 100 beds category. I know my particular procedure is probably not done there with the frequency at thelarge  city hospital 75 miles from here. I could have sought care there. But the proof is in the pudding, all's well that ends well, and I hope the Affordable Care Act and the need to  limit services does not put the small, community hospital out of buisness.

Should I worry...PO Day 339

I just read an article about rTSA that makes me concerned. The author said that if you were too active the implant would not last as long. The  patient who asked was into exercise and even suggested weight lifting was part of his athletic program. The doctor's reply was based on that kind of activity, I suppose.

But now that I am doing so well, now that my shoulder seems finally fully healed and functional, I am using my right arm in all the normal ways. The only things I can't do involve reaching behind my back.Lifting, stretching, pulling, pushing, all those activities are pretty much back to normal. I wouldn't claim to be more active than the average woman, just maybe more active than the average woman of a certain age.

The last time I saw my surgeon was my six month checkup. When I asked if there was anything I should not do he only said "don't fall." He didn't say "don't use a hand drill and a screw driver to install a shelf." He did not mention staying off a ladder to reach the glass flower frog collection. Trying to scrape up whatever it was that melted and refroze on the floor of the freezer under the pull out drawer didn't come up in conversation.   At six months post op I could not imagine ever doing any of those things again.

But now I can imagine and do it. So asking about those kind of activities will be at the top of my list when I see him in June for my one year post op visit. Now the question will be, if he says you are doing too much, cut back...am I willing? After almost two years (first year post fracture - second year post surgery) of such limited use, I am reveling in being able to use my arm again and don't want to play the invalid any more than I have to.

By the way, I am breaking my rule of no middle of the night posts. I hope this does not turn into a page full of gibberish.   

Meaning to say...PO Day 338

I've been noticing, just in the last couple weeks, somethng new and good about my operated shoulder. So I thought I should share it instead of always complaining about this or that.

I can reach out and very slightly back to pick up an object. For instance, to write my daily post I use a wireless keyboard with my ipad. I can just type better on a traditional keyboard. Anyway, it is awkward to try to balance a keyboard on one's lap and arrange the ipad so you can see it or touch it as you often have to do. So I have kind of a wooden desk box that lets the keyboard lay flat in front of the ipad which is standing upright. Dear Husband made it years ago as part of a project and has not used it in ages so I took possession of it. It is just perfect for my purposes.

It sets on the floor beside a chair beside my bed. With keyboard and ipad in place it probably weighs five pounds.Anyway, as I sit in the chair I can reach out and back slightly and grasp the tall back of the wooden box and pick it p and sling it around infront of me. I know it doesn't sound like much.. It's not like fighting tigers or anything. But it is quite a plus for me in my shoulder evolution.

I do still have to be careful going through a heavy door. I can't let the weight of the door grab my arm on its way back. So I am not all the way healed but doing very well. I think. I doubt I will ever have full use of my arm behind my back. I can live with that. The only time my arm hurts is when I try to do something behind my back, like tie an apron. Would not even think of hooking up a bra behind my back.

Nothing else to report. All is well.