Drilling Down on Dental Safety

I am writing this in a vicodin-induced haze. You know – that middle land where the pain is still there but you are so fuzzy you just don’t care. Only I do care and the longer this goes on the angrier I get at my dentist. I am in full-blown abscessed tooth misery. By the second day my cheek has swollen to the point where I could join them and make Alvin, Simon and Theodore into a quartet.

All this because my dentist didn’t see the extra nerve ending on my CT Scan when he did the original root canal several months ago. Now that nerve has come back to haunt me, resulting in infection, pain and the need for a second root canal on the same tooth. That first root canal was bad enough but the thought of having to endure this pain and go through a second one all because of my dentist’s oversight has me seething. Especially when I remember how much more it cost me to have that CT scan instead of the usual x-rays.

Oral health is one of those things we tend to not give much thought and priority to. Oh sure, we brush, some of us even floss, and go in for the annual (seldom semi-annual) cleaning. But other than that it is pretty much “out of sight, out of mind.” Until you wake up one morning, as I did this week, realizing your mouth hurts and it is radiating up into your jaw and cheek. First reaction = denial. If I ignore it, it will get better on its own. But it never does just miraculously disappear, does it?

I love a good medical mystery. Quincy ME and House were among my all-time favorite tv shows. And my bookcases are filled with Michael Crichton and Robin Cook mysteries. But as I sit here contemplating the unfairness of life and feeling sorry for myself, I wonder that there have not been any dental mystery/thrillers.  Or have there been and I just missed them?

In all seriousness, I began wondering about dental mishaps. How frequent are they? What are the most common? How many result in permanent damage or even death? (To the patient, not the dentist. Although right now it is tempting to do some bodily harm to my dentist!) Are there things we should be aware of and watch out for? Who keeps tabs on dentists anyway?

It turns out that according to research done by the Dallas Morning News, a dental patient dies every other day in our country. Startling! Oversedation or improperly administered sedatives are the leading cause of death among dental patients. However, there are other ways your dentist can endanger you including: inhalation, bleeding, stabbing, violence, infection, intoxication (the dentist not the patient this time), and fire. Imagine being lit on fire with any of those contraptions in your mouth!

Each state has its own regulatory agencies for dentists. Unfortunately, most do not keep good records of mistakes. Nor do they necessarily follow up on those mistakes. As you can imagine, this makes data extremely difficult to come by. Consequently, it also make it impossible for state dental boards to be effective regulators. Not to mention how it hampers any improvement efforts.

For more dental horror stories, check out this series of articles published in the Dallas Morning News.

February was National Child’s Dental Health month. Did any of the literature and events surrounding this address how to prevent your child from being injured or even killed by your dentist?

To end on somewhat of a positive note, here are a few tips to help keep you safe in the dental chair.

In the not-too-distant-future when I’m feeling better I will post about the benefits and importance of oral health. And there are some. Really. But for now, I’m off to plot my revenge. And pop a few more amoxicillin and painkillers……………………….

Safety First – Your Hospital Isn’t Starbucks

Thanks in large part to the Affordable Care Act, healthcare providers are becoming obsessed with patient satisfaction. Here’s what the famous Geisinger Health System is doing.

But shouldn’t healthcare providers realize that patient safety is far more important than satisfaction? Wouldn’t we rather they concentrated on safety checklists and handwashing and forget the satisfaction surveys? Maybe then we’d see a decrease in hospital-acquired infections and medical errors. This should be the priority over how quickly a call button is answered or what’s on the evening menu.

Geisinger’s CEO Feinberg states “………….I think our industry is going to be disrupted the same way the taxi industry is (with services like Uber) or the hotel industry (by services like Airbnb).”

Well it seems to me this is already happening. We have more and more physicians becoming concierge doctors. We’re seeing an increase in physician extenders (PA’s, etc.). And surgery centers are preferable to full service, acute care hospitals for patients and doctors alike.

The ultimate customer service in medicine is individualized, conscientious, patient-centered care where safety and quality come first.

Drowning in a Sea of Possibilities – Can Improving Health Literacy Save Us?

Healthcare in our country is a sea of information and tools. And we are drowning in it. So many possibilities. Too many choices. When I hear people say we should step up and take control of our health and well being, I wonder how most people are going to keep their heads above the information overload (water) while they try to swim toward shore (health). How can be “be empowered” when each new scientific breakthrough, such as the human genome project, swamps us with a new or altered set of concepts and terminology? Always more to learn and understand.

The Department of Health and Human Services has data that demonstrates that most health information is too difficult for the average American to use in making health decisions. Their National Assessment of Adult Literacy found only 12% of adults in this country had what is considered “proficient health literacy.” Further, they found that over one third of adults would have difficulty with common health tasks. These include things such as reading the instructions on your prescription label and understanding a childhood immunization chart. Even college graduates have limited health literacy.

Yet, we are expected to make health-related decisions every day of our lives? And who expects these decisions to help lower the staggering cost of healthcare in our country?

The Affordable Care Act defines health literacy as “the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions.”

Health literacy is necessary for:

• communicating what you need
• finding information and health services
• processing that information
• responding to information and service providers
• understanding your choices and consequences
• choosing what information and services meet your needs
• following through to get those services

The government and many nonprofit agencies are addressing the deplorable state of health literacy in the U.S. But most of their efforts are targeted at healthcare service providers – doctors, nurses, hospitals, clinics. etc.

Here is one small lifeboat. A website to add to your Favorites list for when you need help understanding health information. http://healthliteracy.worlded.org/healthinfo.htm

October is National Health Literacy Month. What is your state doing about it?How important do you think improving health literacy is to lowering the cost of healthcare?

Medigap: When Medicare Alone Isn’t Enough

Part 3 of 3 in Solving the Medicare Maze

Unless you have been living in a cave the past several years, you are probably well aware that Medicare does not cover all the medical expenses for even its healthiest enrollees. When Medicare was enacted, the average American only lived to age 65. So it was anticipated that very few beneficiaries would be using their Medicare benefits let alone need extra coverage. Along the way however, our health improved and life spans increased causing the need for what is commonly referred to as “Medigap” coverage.

Medigap plans are supplemental insurance plans, offered through private insurance companies, that cover costs not covered by Medicare. These include things like copayments and deductibles. In order to purchase a Medigap plan, you must have Part A and Part B Medicare. (See my previous post about the “Parts” of Medicare.) You cannot buy a Medigap plan if you are in a Medicare Advantage plan (Part C).

As if the four Parts (A, B, C, D) of Medicare weren’t fun enough to keep straight, when it comes to Medigap insurance, there are basically 10 plans. And they named them; a, b, c, d, f, g, k, l, m, n. Not terribly creative, right? Originally there were more plans available but, interestingly enough, Plans E, H, I, and J are no longer for sale. However, if you already have one of these discontinued plans, you are allowed to keep it. At least for now.

It seems that with so many plan options, everyone should be able to find a gap coverage that works for them. But here is the kicker – open enrollment for Medigap is a time-limited, one-time-only offer. (Sounds like an infomercial, doesn’t it?) Medigap open enrollment runs for 6 months beginning the first month that you are covered under Part B AND you are 65 or older. Federal law also states that you cannot be denied a Medigap policy, nor can you be charged more for the policy due to current or past health problems.

Now there may be exceptions to this open enrollment period. Your state may have additional times when you can pick up a Medigap policy. Check with your State Health Insurance Assistance Program (SHIP) to find out if there are other open enrollment periods in your state when you can add or change your Medigap plan.

Your SHIP is also the number to call to get help learning about the specific Medigap plans available to you to purchase. Here is a publication that explains the details of Medigap and gives a list of SHIP phone numbers for each state.

As you review plans prior to purchasing Medigap coverage, keep in mind what services the plans do NOT cover. These excluded services may include private duty nurses, vision and dental care, hearing aids and eyeglasses. Some of the plans do cover nursing home care and even emergency care while traveling out of the country. If these are services you think you might need, it may be well worth the extra money these particular plans cost.

One final note – the following are NOT Medigap coverage:

• Group coverage that you might be getting through your current or former employment, or through your spouse’s current or former employment.
• Liability coverage which come into play if you are injured in an automobile crash or other “accident.”
• Tricare for active duty and retired military.
• VA Benefits
• Medicaid
• Long term care insurance

For more detailed information on how these other insurance types coordinate with your Medicare, I suggest you download this helpful publication.

Just as with any other insurance plan – life, home, car – it is wise to do an annual review of your Medicare benefits and the changes in your life that may affect it.

Open enrollment period for Medicare runs from October 15 – December 7. Be a savvy health consumer and get ready by doing a health insurance review now! Contact me today to schedule your personal Medicare Check Up.

Medicare “Parts” – Pieces of the Puzzle

In my last post I kept referring to the Parts of Medicare – A, B, C, and D. (The government loves Alphabet Soup!) Each “Part” covers different benefits. And each Part has its own quirks.

Part A, also known as the original or traditional Medicare, covers inpatient hospital care, nursing home care, hospice, and home health services.

Part B covers two broad categories; services and supplies needed to diagnose and treat your condition, and preventive services. This includes things like crutches and wheelchairs as well as your glaucoma tests, mammograms, and diabetes screenings.

Part C is also known as Medicare Advantage. These are Medicare’s version of HMO’s or PPO’s. They cover everything that Parts A and B cover except for hospice care. And they often include extras such as vision and dental. They may also cover prescription drugs, so you won’t need to purchase Part D coverage if you are enrolled in a Medicare Advantage plan. Just keep in mind that they may be more restrictive than traditional Parts A and B when it comes to the doctors and other providers you can use.

Part D is prescription drug coverage. You will have to pay an additional premium for Part D along with annual deductibles. Part D does not cover the entire cost of all your drugs.

If you are getting Social Security, Part A and Part B activate and you are automatically enrolled when you turn 65 years of age. You already paid for Part A through all those payroll withholdings over the years that you worked. However, you will have to pay premiums for Part B. When you receive your notification in the mail about being eligible for Medicare, it will give you instructions for Part B.

When you receive your notification or when you enroll in Medicare, you will also be given the opportunity to chose between traditional Medicare Parts A, B and D, or a Medicare Advantage Plan. In Colorado, the Division of Insurance within the Colorado Department of Regulatory Agencies is the place to call for more information on the Medicare Advantage plans available to you. 1-888-696-7213.

If you are just approaching the milestone age of 65 and wondering about taking your initial leap into Medicare, check out this very easy-to-use diagram.

This has been a very short and quick look at the pieces of the Medicare puzzle. If you don’t already have it, I urge you to download the Medicare and You booklet and familiarize yourself with all your Medicare benefits.

Don’t wait! Open enrollment – when you can switch from traditional Medicare to a Medicare Advantage (Part C) and vice versa – is Oct. 15 – Dec. 7th. You can also enroll in a Part D drug coverage plan, switch between Part D plans, or drop Part D all together during this open enrollment period.

If you or someone you know feels lost in the Medicare maze and needs personalized help, contact me to schedule an appointment to review your benefits and your options. (719) 481-6440 or michele@medsavvyhealthadvocates.com

Solving the Medicare Maze (Part 1 of 3)

Thumbsup for knowing about Medicare.

Think you understand your Medicare benefits? Let’s test your knowledge. Pop quiz time!

True or false:

1. The costs of eyeglasses and contact lenses are covered by Medicare.
2. Medicare pays all the bills you may have for visits to a doctor’s office.
3. Medicare does not cover the cost of prescription drugs you buy at a pharmacy.
4. Medicare will pay the bill if you are in the hospital on observational status for at least 24 hours.
5. Medicare covers all the costs of a 6-month stay in a nursing home.
6. Medicare covers all the costs of a 5-day hospital stay, except for the deductible.
7. Medicare Part A covers diabetes screening and glaucoma tests.
8. Medicare Advantage is another name for an HMO.

Don’t feel foolish if these questions stumped you. You are far from alone. Studies done over the decades since Medicare was established under the Johnson administration in 1965 show that most Medicare beneficiaries really don’t know what the program can do for them. Or what it cannot. And if you don’t understand Medicare, how can you be expected to know whether or not you need additional insurance?

Answers (No, I won’t keep you in suspense or make you turn the page upside down.):

1.) True but only if you have Part B and then it is limited. Medicare will cover one pair of eyeglasses or one set of contact lenses after cataract surgery. But you must pay the 20% plus Part B deductible.

2.) True IF you have Part B.

3.) True ONLY if you have Part D.

4.) This is a tricky one! If you are admitted under “observational” status and are released from the hospital before you have been there for 2 midnights, Medicare will NOT pay.

5.) False. Medicare operates on benefit periods. You pay nothing for skilled nursing facilities for the first 20 days of a benefit period, then a coinsurance for days 21-100 of each benefit period.

6.) False. Medicare Part A covers hospital charges. But if you do not have Part B, any doctor charges for your hospital stay will be your responsibility.

7.) True but ONLY if you have Part B. Even then, you are restricted to one glaucoma screening and two diabetes screenings annually, you must be “high risk”, and you will have to pay 20% and the Part B deductible.

8.) True. Advantage is Medicare’s name for Part C. These plans, which include almost all original Medicare benefits, are based on the HMO or PPO model of care. So while they may be less expensive, there are restrictions on which providers you can go to. They also do not include hospice care and some clinical research studies.

Confused yet? And that was just a small sampling of the ins and outs of Medicare coverage!

Medicare is a government program and so (unfortunately) it shouldn’t surprise us that it has become more convoluted and multi-faceted as it has evolved. There are four “Parts” of Medicare. For some Parts you are automatically enrolled when you turn 65 and the little red, white, and blue card shows up in the mail. Other Parts you must sign up and pay for separately. To help confuse things further, there are even different open enrollment periods for the various Parts.

I keep referring to these various “Parts.” Can you name the different Parts of Medicare and what each covers? In the next post I’ll give you a short rundown on the various Medicare Parts, what they cover and when and how to sign up for them.

To be continued…………………………………..

Would you like some professional help deciphering your Medicare benefits; what you have and what you need? Through MedSavvy Health Advocates, I am offering Medicare Check Ups. (We do NOT sell insurance.) Call (719) 481-6440 or email michele@medsavvyhealthadvocates.com today to schedule your personal, confidential Check Up. Be ready for open enrollment season and enjoy peace of mind knowing your Medicare benefits are working for you. Better Savvy Than Sorry!

Shared Decision Making: How to Get the Treatment Option You Really Want

Unfortunately, there are still physicians out there who continue to insist that patients don’t want to be involved in their own healthcare decisions or that patients lack the ability to make such decisions. But if you are the type of patient who wants to take charge of your own health and what you need is some caring guidance, then you want a physician who practices what is called “shared decision making” (SDM). In SDM, the physician brings her professional knowledge and experience to the discussion. You (the patient) bring your personal knowledge, experience, goals and values to the table. And together you and your doctor form a working partnership to make the best treatment choices for you as an individual.

Basic steps in the shared decision making process include:

• The doctor tells you all the treatment choices for your condition with all their various pros and cons. She also includes the “do nothing” approach. All choices are presented in an unbiased manner.
• The doctor also describes all the expected and possible effects of each treatment option; good and bad, long term and short term.
• You tell the doctor about any personal circumstances, values, issues, goals, factors, and preferences. When you lay all these out on the table, it might be clear that you want to rule out one or more treatment options right away. Your personal circumstances might also reveal that one option is more appealing to you than the other options.
• You and your doctor discuss the choices and make the decision about treatment based on what matters most to you.

Doctors have a tendency to want to go all out in their treatments. They have all kinds of scientific knowledge and amazing medical tools at their disposal. But your personal goals and values may not agree with such aggressive approaches. That’s why the bottom line is that your decisions should be based on what is important to you, not on what wonderful equipment the local hospital has to offer.

These are often difficult conversations for both physicians and patients. So several organizations have developed shared decision making tools to help in this process. The Mayo Clinic and the U.S. Agency for Healthcare Research and Quality offer SDM resources on their websites. But you will find one of the most user-friendly websites at http://www.med-decs.org.

When you are shopping for a new primary care physician or a specialist, ask your prospective new doctor for her opinion on SDM. The constructive guidance that SDM provides can be just what you need to avoid information overload and make the best decisions for your health and well being.

You should also seriously consider hiring an independent health advocate to help you and your doctor work through the shared decision making process, particularly if the decisions you must make involve a life-threatening or chronic illness. A neutral third party (advocate) can ensure that your wishes are heard and considered. And she can make sure that you understand everything the doctor has shared about all options. She’ll help you get what is right for you.

Your Doctor’s Communication Style: From Grunts and Information Overload to Shared Decision Making

I met my friend Kaye for lunch recently. She had just come from a doctor visit and seemed a little distracted,  not her usual vivacious self. I didn’t want to pry but was concerned so I asked in a very general way if everything was alright.  She looked at me with wide eyes, not really focusing and said; “I am so confused! My new doctor just threw so much information at me in such a short visit that I don’t know what to think. How can I decide which treatment to choose when there are so many things to consider?” That explained the deer-in-the-headlights look.  She was in information overload mode and had the shell-shocked facial expression to prove it.

It made me think back to my early adolescence when healthcare first caught my attention. Back then we had doctors who didn’t bother us with details. They literally patted us on the back, told us not to worry, and moved forward with treatments that they never bothered to fully explain.

Consumers have gone from living in that medical knowledge vacuum to being deluged with facts, data, opinions and reports. Meanwhile, we have people telling us we need to take control of our own health, become empowered, take charge and demand what we need. Easier said than done in health and medical care!

There are three broad categories of physicians out there. I am not talking about generalists and specialists. I am referring to communications styles. We have doctors who are:

1.) Paternalistic – ye olde Marcus Welby era. Instead of a conversation with explanations, they emit grunts and other small noises. Then they either “dummy down” telling you what they are going to do or don’t give you the full story, having decided you aren’t capable of understanding medicine. They are the experts and don’t have patience for any questioning or discussion; much like a parent not tolerating any backtalk. Paternalistic doctors are up on that pedestal and don’t see any reason to come down to your level. Or invite you up to theirs.

2.) Informative – Kaye’s doctor is one of these. Such doctors think overloading you with facts and data and medical terms gives us all the information you need. Then they expect you to make choices for yourself based on all that wonderful gobbledygibberish they just rained down on you. But they do not provide enough context or guidance for you to make a truly informed choice. And they don’t ask the kind of probing questions that would give them a more complete view of your real needs and desires. They leave you feeling like my friend Kaye and saying to yourself; “How should I know what to decide?  You tell me, doctor!”

3.) Interpretive – this is the type of physician most of us are looking for. It’s also the type that doctors find the most difficult to be. Interpretive physicians get to know their patients and they  provide information based not only on the doctor’s own technical expertise and scientific knowledge, but also on the patient’s goals. They present the choices in a context that takes into account the patient’s (and the patient’s family) culture, background, values, and wishes. But instead of just rattling off the various options as the informative physician does, the interpretive physician explains what the choices mean for this individual patient. They explain how each option will affect your life and that of your family and friends.  Going one step further, an effective, interpretive doctor also recognizes when you might be making a shortsighted choice and push for you to consider choices that move you toward your longer range goals. They practice what is referred to as “Shared-Decision Making” (SDM).  I’ll explain more about SDM in my next post.

Patient Advocate –Your Guide Through the Maze

How to Find the Help You Need to Navigate the Healthcare System

No doubt you’ve noticed that our healthcare system has grown into a confusing mishmash of services, providers, treatment options, research, drugs, insurance plans, and bills. Each year 100,000 Americans die in hospitals from medical errors and over 80,000 catch infections while in the hospital. Medical bills are the #1 cause for declaring bankruptcy. It’s no wonder that so many of us get lost in this healthcare maze; feeling overwhelmed and not knowing where to turn or how to get help!

Fortunately a new movement has taken hold––health advocates.

There are three broad categories of advocates each with its own advantages and limitations:

1.  Historically we relied on family or close friends to be our advocates in the medical realm. They are usually close, free of charge, and know us well. However, they also bring emotional baggage and family dynamics with them. And they may have very limited knowledge of the healthcare system.
2.  Medical staff such as nurses, case managers, and patient reps employed by a hospital, medical practice, or insurance company. They know healthcare and are paid by their employer so are usually free of charge to you. The downside is that their ultimate loyalty will be to their employer. And they are restricted to helping you while you are in the hospital or seeing their doctors, or within the confines dictated by your insurance company.
3.  Independent health advocates are professionals from a variety of backgrounds whose mission is to guide healthcare consumers through the bewildering, frightening maze by helping them get answers, find direction and ultimately, gain peace of mind. They know healthcare and how to get things done. They are impartial when dealing with family, insurance companies, or service providers. Their loyalty is to their patient or client. The only drawback is that you will have to pay them out of your own pocket.

For more information check here.

You might be asking: “Can’t I just take care of myself? Do I really need an advocate?” YES, you do! Anyone who is ill (hospitalized or not), facing tough medical decisions, trying to find answers and their way through the healthcare system needs an advocate.

You can advocate for yourself – and you should – to a certain extent. But keep in mind that when you are distracted and not feeling up to snuff, your mental capacity also suffers. You are not able to make the kind of clear-minded, well-informed decisions you normally could.

Where can you locate a professional advocate? Ask nurses at your hospital if there are navigators or case managers on staff. Check with your insurance carrier for patient reps on their payroll. If you choose to go with an independent advocate, they have a nationwide network to help you locate an advocate for yourself, a family member, or a friend whether you need someone near or far. You can visit this network’s website at http://www.advoconnection.com.

For personal help finding your way through the bewildering, frustrating, frightening healthcare maze, visit our website at www.medsavvyhealthadvocates.com today. Having health issues is stressful enough. Dealing with the healthcare system shouldn’t add to the anxiety. Please don’t wander through the healthcare maze alone. Being willing to ask for and accept help in the form of an advocate is the wisest decision you can make and will have a profound effect on your well-being.

Michele Hanley is a professional healthcare advocate and a member of the Association of Professional Healthcare Advocates, the Professional Patient Advocacy Institute, and the National Association of Healthcare Advocacy Consultants. She is founder and CEO of MedSavvy Health Advocates LLC