Getting Healthcare Reform That Will Work for US

Moderators

How about a new start. However, only for those members willing to hear opinions that they will disagree with. Many of the posts that were removed should not have been removed. Breastcancer.org cannot have this level of disrespect on the boards. We invite a good, polite discussion.Thank you.  

07rescue

Sorry, this is a life and death issue to me and I am never going to be anything but straightforward and impassioned about discussing it. I have seen far too many people die, in a painful, humiliating, fashion, destitute from shocking and unjustifiable medical costs and denial of care. This is simply not a "polite" discussion for me, and probably is not for anyone who has experienced these issues up front and in person.

I am very sorry that the moderators of this board see fit to wipe out this entire discussion - it is a vital, critically needed discussion. Whatever time I have left on earth I cannot waste on composing my most heartfelt posts, only to see them erased within hours. I profoundly disagree with this action, I cannot imagine a greater disrespect.

Anonymous

This is a matter of life and death for all of us.  That is what makes us so passionate about it.  But, we do need to remember that this is first and foremost a breast cancer support thread, and while we can disagree and exchange ideas, and possibly change some minds along the way, we need to do that  without being hostile or demeaning to each other. 

Let's start with a relatively safe topic.  This story was on the local news tonight, (today was the first day of classes at Drexel) Do you think that these medical reference books on I-pods is the kind of thing the President envisions when he talks about finding savings by using technology?  I don't know that they will be less expensive than the textbooks, but they should be easier to update, and may help prevent medical errors. 

And it didn't even take any action from Congress to get it started.

 

By Matt O'Donnell

September 21, 2009 -- A local university has turned to the iPod touch to teaching the healing touch.

Drexel's College of Nursing and Health Professions handed out hundreds of the iPod Touch to students today. But this was not part of some goodie bag to get the school year kicked off right.

"The medical profession is quickly becoming electronically dominating so a mechanic without a wrench can't fix the car how can I help someone without I guess my tool," said Sal Zullo.

The iPod Touch, at $189 each, will replace the large, bulky medical textbooks the students usually have to carry. Instead, all the information they need in an exam room will be available on the device, through a program called Skyscape. And it automatically updates the info through a wireless internet connection.

"Textbooks are so heavy and too look through the index takes too much time and you have to figure out exactly what you're looking for," said Adrianna Musallam.

The technology is not new the iPod has been around for eight years. Rather, what is going on here is humans using existing technology to make our lives easier particularly in an industry that relies on the latest medical data, and precision.

"It combines everything the students like to do in their lives with learning," said Dean Gloria Donnelly of the College of Nursing and Health Professions.

What would you choose, 25 pounds of heavy textbooks, or the same amount of information in a pocket-sized wireless device? Drexel says it's a no-brainer.

Anonymous

I do worry about the network/server going down at a critical time.  The i-Pod stores the info on the device itself, so other than the initial download, and updates, the network being down shouldn't be an issue.  That does bring up an interesting question/concern when it comes to medical records like patient charts that need to be constantly available and are updated everytime a patient interacts with a staff member. 

AnnNYC

What's interesting is that in New York State, about 3 years ago, the State mandated that all prescriptions must be written on a pad provided to each practitioner by the State, with special printing that defies counterfeiting.  

You (I guess I should say me, as I had done this while working for a doctor!) can still phone or fax the initial prescription to get it ready for pick-up by the patient, but the patient MUST present the signed original in order to pick up the medicine. 

The intent is to prevent counterfeit prescriptions for controlled substances -- yet it applies to prescriptions for anything, not just "Schedule I" drugs.

http://www.health.state.ny.us/professionals/narcotic/

So, while much of the country is talking about paperless prescriptions, New York State has outlawed them!

Anonymous

I haven't filled any prescriptions in NJ pharmacies lately, so I don't know if NJ requires that the actual paper prescription be presented, but I have noticed that they have special prescription pads embossed with the state seal that all doctors and dentists in NJ have to use when writing prescriptions. 

pomegranate

I'd like to give two responses here. First, my medical care providers are all using computer technology to store my medical history. So far, this has been wonderful. I no longer have to relate operations I have had, medications I take, and why I am there to see the doctor. However, the use of ipod Touch (which is carried around--not in a permanent location) with patients' information on it that often includes id info could be at risk for identity theft(not that I would want anyone to have the health issues I have right now nor the many meds I take each day). Twice my id info has been on two different laptop computers that two different professors took home and were subsequently stolen from them. I believe this could happen with these Touch ipods.



Second, my prescription meds are in with my medical history in the medical foundation's computer system. When I need a renewal, I call the office, and the request is faxed to mail order company my insurance has a contract with, and that includes controlled substances--no paper document goes to the pharmacy. In 3-4 days, I receive my prescription. I like this system as I don't have to go down to the dr office, and sit and wait for him to sign a paper that I then have to either send snail mail or drive to the pharmacy to be filled. I hope there are no changes to this. Oh, and I live in a rural area with the mailbox 1/2 mile from the house. So far, knock on wood, we haven't had any mail taken from our box.



I lurked on the healthcare threads for a while, but didn't like all the negativity that was expressed by a few people. I hope this thread can achieve the true spirit of sharing and allowing each of us to express our opinions freely without rancor.



Pomegranate

pomegranate

Guess I also have a third response. I went onto Medicare Part A and B this year (due to disability, not being 65 years old), and I have not experienced any change in my medical benefits or insurance coverage. My primary insurance has now become my secondary coverage. There aren't any co-pays, and my lymphedema needs are paid for by my secondary insurance (Medicare does not pay for lymphedema equipment except bandages). However, I just received a letter from my recent employer, and for years our company has been absorbing the rising cost of our medical insurance (often 9% a year). The company is now working with the bargaining units (including the retired employees) to discuss various options that would reduce the company's costs by asking the employees and retirees to absorb some of the costs so we can still have the excellent insurance we have had for years. We may have to increase our co-pays at dr ofc, emergency, etc.; or pay a portion of the monthly premium. While it will be difficult as a retired person on disability to pay another bill each month, I'd rather pay the money and keep the excellent coverage we have.

And since Medicare is my primary, I have not had one problem with getting my bills paid or any difficulty in getting the necessary doctors to see me. Medicare is working well for many of us out here in California and isn't it government healthcare?

Pomegranate

rosemary-b

I really like the convenience of electronic medcal records. My onc, my PCP, and any other dr. in town can see test results ordered by any other dr. That certainly saves wear and tear on my arm and keeps my x-ray exposure down a bit without me having to call around to get records sent from one place to another  I think it is the local hospital network, because I am going to an out of town dr. and have about 20 pages of dr.'s notes and test results from everyone in town.

I have not really thought about the implications of having all of that floating around or being on ,laptops whicdh are portable and therefore capable of being lost. Hmmm...

CapeBretongirl

Thank you PatMom, for imparting the I-pod information. This is going to be fascinating. I think something similar is already in use, at some Ontario, Canada hospitals. A few times, when I was seen in emergency, I watched different Doctors, used hand held devices to look up drug info, ie., drug interaction, the best drug to use, etc. It looked like a palm pilot. These devices are also being used at my cancer clinic, by my onc & some of the other oncs. I'm so used to seeing these devices, that I have never really noticed them, If that makes sense. I have an appnt this morning at the clinic. I'll ask about the devices.   Sh$t, I'm going to be late. bbl

otter

Re: electronic medical records

It's not rocket science anymore. As others have said here, most doctors' offices and hospitals store their patient info electronically now, some to a greater extent than others.

Last spring I experienced what can happen when records are not maintained electronically. I switched GYN docs this year because of a falling-out with my previous one, whom I had seen for 25 years. (He misdiagnosed my grape-sized tumor as fibrocystic tissue--twice.) Anyway, I went to a different GYN at the same large practice in May. The "intake" (?) nurse checked my vitals and verified some things in my record, using a computer with a touch-screen. There were some unexpected errors and empty data fields. Later, the new GYN went over those same items. I could not recall the date of a procedure I'd had done 15+ years ago. I asked, "Isn't it in my medical record?"  He said, "Well, yes and no. It might be in the notes your previous doctor made, but it's not in the computer. Your doctor [who had founded the practice in the 1960's] refused to enter information into the computer system--he said he was too old to use it. So, nothing from that part of your medical history is in our system. We'll need to re-create it."

OTOH, at the cancer center/university hospital where my BC is/was treated, everything is stored electronically. Any doctor in any part of the center can access my medical record and see what meds I'm on, what my most recent lab work found, what my biopsy results were, etc.

However, nobody else outside that center has access to the information stored there, and vice versa. Sometimes I think it would be nice if there was a central storage bank for our medical info and it could be accessed by any of our providers, or by ourselves. I'd like my PCP to see the results of the serum chem panel my onco will order next month, so he doesn't order one a few weeks later. (I generally get a hard copy of lab results from each doc to share with my other docs; but I shouldn't have to do that.)

Something like universal access is in effect where my parents get their medical care. They go to a small, community clinic that was bought by a huge medical center a few years ago. (Think "big" like "Mayo Clinic".) Anything done at the small clinic or at the parent medical center gets stored in the same database and is available to the primary doctors or the referral doctors. And, my parents have personal logins so they can look at the reports from blood work, radiographs, biopsies, etc. (Ever get a phone call from an 85-year-old parent who is trying to interpret the results of an abdominal ultrasound or MRI herself, before seeing the doctor???)

Generally I favor expansion of electronic record-keeping, but someone needs to provide assurance of security of the records. No way do I want a health professional carrying my medical record around on his/her iPod, to read while riding the bus to work.  But, it's great that a home health nurse can access records remotely vial a personal data device, and can enter/update information at each home visit.  That's pretty commonplace now, I think.

Regardless of how the records are stored, our health providers have to be willing to use them. I went with my mom to the huge medical center one time (remember, think big like "Mayo Clinic"). She had been referred there by her PCP for investigation of chronic anemia. Mom and I sat in the exam room for 10 minutes while the hot-shot hematologist read to us, out loud, from his computer screen. What he was reading was mom's multi-year medical history and the reason why she had been referred there. He hardly looked at us and hardly asked her anything--he spent all of his time reading, out loud, word-for-word, from his computer. I thought that maybe he might have taken the time to brush up on her presenting complaint and her doctor's referral note before he walked in the room, since he already had them on his computer.

No system will be perfect. And, efficiency will not increase right away. Ask any health professional who has had to transition from paper records to electronic record-keeping lately. Then plug your ears, or you'll be subjected to the worst cursewords you've ever heard.

otter 

[P.S.: Glad to see this thread wasn't killed entirely. It's terrible that so much of its history has been wiped clean, though--like global amnesia. I was hoping a post or two would be restored.  <sigh>] 

pip57

A lot of the sharing of records occurs in Canada simply because it is coordinated by our GPs.  That is one of the good things about having to go through your regular doc for references to specialists.  I always wondered why the American drug adds kept saying "and tell your doctor if you have cancer or heart disease."  If the healthcare guidelines are followed, my doctor already knows this.

I love the idea about the IPods.  However it is scary to think about how much info can find its way into the wrong hands if it gets lost.  But when you think about it, there are lots of private info about each of us already floating around out there in cyberspace.  So far, Macs are well known for not getting viruses and being pretty hard to penetrate.  But that could change. 

crazy4carrots

Interesting about the sharing of info.  Whenever I have any tests, scans or bloodwork ordered by my onc, I'm always asked if I want the results to also go to my GP.  They're all connected electronically in my area so it's just a matter of emailing the results to him.

I know there is always the possibility of a breach -- info getting into the wrong hands -- but at the same time, there is far less chance of medical orders being incorrectly filled because handwriting is illegible.  And it saves a heck of a lot of time on the part of medical personnel.

CapeBretongirl

AAAAAwwwww I forgot to ask my Onc about the hand held device he's using.  lol  And I locked my keys in my car.  Couldn't reach the spare key that was hidden under the car. lmao. 

otter

Awwww is right.  How did you get your car unlocked?

This thread was gutted.  That's so sad. Everyone worked so hard to find information and present it intelligently for us, and now all that information is gone.  Vaporized.  All because a handful of people, or maybe just one or two of them, did not ... well, ... never mind. 

otter 

[Edited to add (and I'm tip-toeing here):  One thing I like about my current insurance plan is that I do not necessarily have to have a referral from my GP/PCP to see a specialist. Some specialists require a referral, but it's not an insurance requirement.  Many years ago, there was an insurance policy rule that we had to pick one doctor as our GP, and all other services had to be arranged through him/her after seeing him/her first. That caused all sorts of chaos for women who wanted a regular gynecologist who was different from their "family doctor".  The insurance policy was changed shortly after that, and now there are no restrictions. Sometimes I think ... no, I am certain ... that people under-utilize primary care docs (GP's) in the U.S.  They go to specialists for trivial things that could easily be managed by a GP.  But I'm glad it's not our government making up the rules about that.  There.  I said it.  Now, fire away! I'm going to bed.]

Anonymous

My insurance company has allowed women to us a gynecologist as our PCP for many years.  They switched the system from requiring referrals for every specialist visit to not requiring them the day before my surgery.  Having done it both ways during a time of heavy doctor use, I definitely like not needing the referrals better.

I understand the concept of having one doctor co-ordinating the care, but having to make extra visits to his office to get another referral every time another doctor ordered a test or referred me to another doctor was getting really old. 

Anonymous

One thing that could save billions of dollars that I haven't heard is being addressed is advertising by drug companies, hospitals and insurance companies.  The television commercials cost a fortune to produce and air.  That money could be re-directed to improving patient care and cost lowering. 

otter

PatMom, I forgot to mention that after getting pressure from policyholders, my insurance company decided women could designate their GYN docs as their primary care docs if they wished.  (They threw out the whole thing not long after that.)

For me, designating my GYN as my primary care doc would have been a huge problem.  My GYN did not want to do "primary care" (sore throats, ingrown/infected toenails, earaches, diarrhea, etc.).  His specialty was OB/GYN, which became GYN exclusively when he got tired of the cost of liability insurance for OB work.  (Lots of the older OB/GYN docs made that decision.)  Actually, IMHO, my GYN doc was not qualified to do primary care.  I heard several stories through the local medical grapevine about him putting patients on the wrong BP or cardiac meds, for instance, simply because he wasn't familiar enough with the meds available.  And, he and his colleagues at that OB/GYN practice were really busy with just the OB/GYN stuff.

Even though my current coverage seems really liberal with respect to referrals, my GP still gets ticked off at it.  For instance, if one of his patients comes in with abdominal pain and he rules out all the trivial stuff, he needs to have appendicitis, kidney stones, GYN problems, etc., on his list of differential diagnoses.  The standard-of-care now for diagnosing acute appendicitis includes a CT scan.  But, my GP cannot send his patient with the abdominal pain to the hospital's imaging center for a CT scan, or an MRI if that were indicated.  First, he has to get "approval" (authorization) from a GI specialist; or he has to refer the patient directly to the GI doc.  He hates that he needs another doctor's permission to order what is obviously the next step in the process of ruling out appendicitis.  He is quick to refer someone to a specialist if there is something going on that he's not equipped to handle -- like, if the person with the abdominal pain ends up needing to see a surgeon; or if the problem does end up being GYN territory (ovaries or uterus); or if the radiologist sees a kidney stone on the scan.

I guess the insurance company requires an intermediate step (authorization from a GI specialist) because some docs have "over-utilized" CT and MRI.  It just seems like we ought to be able to find middle ground somewhere.

BTW, I TOTALLY agree with you on the direct-to-consumer advertising.  I remember when prescription drugs could not be advertised to the general public.  We were not bombarded at dinnertime with ads touting the benefits of Cialis or Viagra, and we weren't reminded that Crestor was better at lowering cholesterol than Lipitor is (but be careful of all those SE's!).  Oh, and Sally Field wasn't in our face every night, telling us how she protected her bones with Boniva.  When did that change?

I just don't get it.  None of those things are available to us without a prescription.  We MUST go through our docs to get them.  So, why should they be advertised to us?  Why can't we go back to a time when prescription drugs -- especially new ones -- were advertised only to physicians and pharmacists?  That would be so nice, in many ways.

otter 

pip57

It sounds like the gp referrals were really confusing in America.  In Canada it is pretty simple.  Our gp can order whatever tests are needed.  We can choose whatever specialist that we want, in or out of our area.  And once we have seen that specialist it isn't necessary to go back to your gp before seeing him again.  All very easy.  And it keeps one person at the helm who will know if you are having duplicate tests or what conflicting medications you may be getting.  It makes a lot of sense to me.

But now I know why so many American women here refer to their gyn as their primary doctor.  I kept thinking how odd that was.

Anonymous

PIP, my PCP ordered my mammogram, and ultrasound, and referred me to the breast surgeon for a specific number of visits.  The breast surgeon ordered an MRI, bone scan, chest x-ray, and referred me to the oncologist and plastic surgeon.   BUT, I still had to go back to my PCP to get the (paper) approvals for the MRI, bone scan, chest x-ray, plastic surgeon and oncologist. 

If they hadn't changed the system when they did, I would have needed additional referrals from my PCP for my follow up visits with the breast surgeon. 

So glad they did away with referrals.

otter

PIP, what you've described makes sense.  That would give GPs a lot more authority than some of them have in the US right now. As usual, what happens here depends to a great extent on what the patient's insurance policy allows; and those regulations are not all the same (as we've heard here).

I do wish (and hope) incentives might be offered to increase medical students' interest in primary care (family practice/general practice).  Apparently, the numbers of new primary care docs are continuing to decline.  The hours can be brutal; the restrictions (as I've mentioned) can be frustrating; the paperwork is becoming overwhelming; and the reimbursements from private insurance and from Medicare are often inadequate. 

Many primary care docs, as well as some specialists, are no longer accepting new patients. My GP says this is becoming a huge problem, because people moving into a community or wanting to change doctors simply can't find a doc. Quite a few docs have decided not to accept Medicare as a form of reimbursement, because the reimbursements are so low (and getting lower).  That means Medicare patients going to those docs must pay the entire bill out-of-pocket, at the full rate rather than the Medicare-negotiated rate.  The endocrinologist I was seeing a few years ago had a sign posted in his window one day:  "We no longer accept Medicare patients."  That was that.

Wow.  I'm talking myself into thinking this is a train wreck, which is something I've been refusing to acknowledge.  I just wish there was a way to figure out a solution that would fit the peculiar politico-socioeconomic "culture" of the US.  Even Crocs come in different sizes and colors.  And, I wish it was possible to debate the issue and offer criticisms and ideas without the whole thing becoming so personalized.  (I don't mean just here on the boards--I mean in Congress, and on the radio talk shows, and at the community forums, and on the nightly news on TV.)

otter

pip57

So it would seem to me that some simple steps could help the situation.  It isn't that the idea of referrals is ineffecient, it is how it is implemented.  Pat, the process you describe sounds like a complete waste of time.  It doesn't have to be that way.

And what about making it illegal to decline Medicare or Medicade?  Even lawyers do pro bono work.

My friends nephew is a heart specialist in the Bahamas.  He is actually contracted by a Florida hospital to send his patients there.  There is another Florida hospital currently wining and dining him to get him to sign on with their hospital instead.  They have sent him on a couple of trips too.  IMHO this is a significant indication of what big business healthcare has become in America.  

So yes Madalyn, I have to agree that their is an extraordinary waste of medical resources all in the name of the almighty dollar.  I wonder how many people actually die while they are being tested and tossed around the system?

konakat

I've always considered my PCP as the conductor of the healthcare orchestra. I never had a gyn until my OOPH.  I always found it odd to designate a gyn as your PCP -- that person is trained for particular body parts.  If they wanted to be a PCP, that's what they would have interned in.  Your PCP is trained to know something about all parts and all about our day to day care.

Unfortunately I never found a PCP in Boston that I have liked -- but did find a not bad nurse practitioner. Maybe I would have eventually found one and built a relationship with her if cancer didn't take over my life within 6 months of arriving on American soil!  But then, for over 3 years the family care clinic has automatically renewed my prescriptions over the phone -- never a bother to have me come in, and I haven't bothered to see them either.  My Canadian doctor wanted me to come every year for a checkup before renewing my prescriptions for another year.  It felt that she actually cared.

I can't wait to get back to my family doc in Canada -- she knows me and takes excellent care of me.  If something's really wonky she refers me to a specialist.  It is comforting to know that there is one doctor that has the big picture, from colds to cancer. 

pip57

Konakat,  do you think it is a Canadian law that we need to be seen at least once a year for prescription renewals?  It is the same with my gp.  I know that it is law that veterinarians can't prescribe certain meds for animals unless they physically check them out.  Surely they have the same standards for human beings!

konakat

PIP -- I never thought of that.  Could very well be.  I find it strange that my current PCP would just keep renewing my thyroid meds without labwork.  I've been stable for over 10 years so it doesn't worry me that I haven't had it checked.  But you'd think the PCP would want to check it, especially one who doesn't know my history.

I used to think my Cdn doc held me "hostage" to give me my annual pap smear -- I couldn't get my birth control pills renewed otherwise!  If it is legislated in Canada, it's a great law.

pip57

Oh boy!?  I was just trying to check out about getting renewals in Ontario.  It looks like they will be passing a law, similar to PEI, that allows a pharmacist to renew prescriptions.  Very convenient, but open to a lot of abuse.  I hope that they will have strict guidelines.

otter

Wow, that's scary.

The same is true here in the US:  Pharmacists are taking over a lot of the primary care that physicians and nurse practitioners used to do.  Pharmacists conduct "wellness clinics," run blood tests for cholesterol and glucose, make recommendations about the appropriateness of particular drugs for a person's medical condition, etc. Depending on the state (the pharmacy practice laws differ among states), some pharmacists can "diagnose" and prescribe antibiotics for routine problems like sore throats and bladder infections...  All without the advice or supervision of an M.D.  Oh, and pharmacists give almost all routine vaccinations now.  I just had my flu shot at a Walgreen's today.  It was administered by a pharmacy student who was interning at that store.  My GP doesn't even give flu shots at his clinic anymore.

I do think (but can't prove) that in the U.S., prescriptions are effective for no longer than 12 months after they are written (less if the doctor writes them for less).  I have never had a pharmacy accept a prescription that was more than 12 months old.  I guess some pharmacies might call the doctor and see if he/she will renew the prescription over the phone, but my pharmacy won't if 12 months have elapsed.

My GP has decided he wants to see his regular patients every 6 months if they are on "maintenance medication" (BP drugs, statins for cholesterol, Synthroid, etc.).  So, he only writes prescriptions for 6 months at a time.  At those intervals he updates our medical history, does a quick physical exam, and runs blood work to check the appropriate stuff (liver enzymes, TSH, etc.). He only runs what's necessary to be sure no problems have developed and no dosage adjustments are needed.  The 6-month restriction on prescriptions is a nuisance.  Sometimes my pharmacy calls his office to see if they can get a 6-month prescription extended for another refill; and occasionally it gets approved but usually not.

So many details...

otter 

pip57

So it seems that it is left up to the doctor as to how often you need to be seen for refills.  Hmmm. 

Don't you wish that Canada and America would make federal laws about these things rather than leave it up to each province or state?  It must be really confusing when you have 50 different states with different laws.  Our ten are bad enough. 

konakat

PIP -- I hope the pharmacists have to at least do a call into the PCP.  I still think a prescription should only be renewed via a doctor's visit. Just as I like to have a relationship with my PCP, I like to have a relationship with my pharmacist -- that they have a record of all drugs I take. One time I had a pharmacist catch a prescription -- one of the components had an anti-biotic that I was allergic to. 

Anonymous

Like already mention, all insurance company's coverage are different.  Mine does not require an approval before MRI's or other tests are done.  They do require approval to be admitted into the hospital.  My PCP has us who are on maintenance drugs to come in (like Otter) to have blood work.  My dh's new doctor (our PCP recently passed away) emails his prescriptions.  Also, we have to use the mail order pharmacy for maintenance drugs.

I wanted to mention one thing and I'll be done.  The gals that were posting here did not have anything to do with having the other threads deleted.  We did not use the "report this button" option.  I don't know WHO was having posts deleted, but I do know WHO did not.  So, if it's us you are referring to as bullies...we aren't.

konakat

Hi Shirley -- I'm happy to see you!  I don't think it was the gals posting on the thread either -- they posted their thoughts!  I think it was some who disagreed and couldn't be bothered to say why.

Edited to add:  I'm happy to see you Shirley because I like you AND I want to read all viewpoints on this issue.