To Tweet or Not to Tweet...

That is the question.

There can be little doubt that we are squarely in the midst of what historians will call The Information Age. I wonder whether the future Smithsonian exhibit will dedicate an entire room to social networking... or whether it will be faintly noted in small print under a small glassed-in case holding an ancient iPad and a screen showing the home page of Facebook or Twitter. Time will tell.

In the mean time, I continue to ponder the impact and importance of social networking. Most specifically, I wonder about Twitter. A few thoughts:

Following the movements of the elite is fun, for a while. But knowing that a famous actor is sipping a latte at the Starbucks on South Beach or that the rock god is partying in a hotel in Cleveland just doesn't thrill me the way it once did.

And just because they are a famous actor or a rock god does not mean they are well qualified to speak authoritatively about health reform, immigration law or the Gulf spill.

Getting news feeds on topics of interest is neat but there are now far, far better tools (such as Google Reader or the numerous mostly free RSS aggregators). These other tools allow you to more selectively filter content so that you pick up exactly and only what you're interested in. Twitter is still too much like the fire hose.

Which leads to the true reason for Twitter: to sell, to promote, to hustle. Most social networking experts are telling audiences that you have got to tweet in order to build awareness (i.e., business) and to gain customers. I wonder then whether Twitter is going down the path of infomercials and telemarketing. Need I say more?

I believe there's a legitimate role for social marketing in business but if the general public ultimately comes to regard it merely as the newest form of marketing, then it will be a short-lived revolution. And the future Smithsonian exhibit will be sized accordingly.

Now pardon me while I tweet about this...


- Posted using BlogPress from my iPad

Caring for everyone

Part 6 (of 9)...

through

Are all hospices the same?

In a word, no!

Here's part 5 in the series...

What's an ACO?

I've commented on numerous occasions here on the topic of Accountable Care Organizations (ACOs).  While the debate will continue regarding their viability and the likelihood of successful adoption across the industry, it's worthwhile understanding the basic concepts.  Health Affairs has developed a nice summary document on the topic.  Here's the intro:

The health care reform legislation enacted in March 2010 authorizes the Medicare program to contract with accountable care organizations (ACOs). These are networks of physicians and other providers that could work together to improve the quality of health care services and reduce costs for a defined patient population. This brief describes the ACO concept as set forth in the new legislation, discusses how ACOs might evolve over time, and reviews the challenges and opportunities facing health systems, physicians, administrators, insurers, patients, and policy makers as ACOs take shape.

More here.

How is hospice paid for?

Part 4...

"Finding Community in the Shadows" - photos by Andrea Star Reese

(photo by Andrea Star Reese)

This is photojournalism with empathy.  This is entering a true community and being respected enough to be able to completely approach without fear.  See the photo essay here from "Lens" and The New York Times.  Warning... not for the faint of heart.

There was a brief time once when I thought I might become a photojournalist.  Though I pursued a safer path, work such as this sends me back there.

Who is eligible for hospice?

Part 3...

Intrigued, mystified

Hope in Hospice

Part 2 in the series...

What is hospice?

This is the first in a series of nine videos featuring VNA Hospice Care medical director, Dr. James Baker.

Hospice is a service that people truly appreciate... yet it remains highly misunderstood.  I hope you find Dr. Baker's comments to be helpful.

The beautiful warm smile...

The posts here are often lighthearted and breezy, like cotton candy on a summer's day on the Vineyard.

But just a few weeks ago, one summer's day on the island turned tragic... and on this past Monday evening, an entire community gathered.  And we were there.

First, about Dina - click here and here.  A young mother on vacation with her husband and two young daughters, Dina rode her bicycle just a few paces behind her family.  It was one of those moments you remember, riding with your family in a beautiful place and on a beautiful day.  But now her children, ages 10 and 7, and husband, John, will remember that moment as the one that changed their lives forever.  Dina lost control, it is reported, and fell off her bicycle.  She was struck by a passing tractor-trailer and killed.

This past Monday, VNA Hospice Care (more information here) held a memorial service and community grief support program in remembrance of Dina.  VNA Hospice Care's David Quemere helped coordinate the service and our organization has provided support from social workers, nurses and chaplains, both that evening and on an ongoing basis.  We're continuing to offer ongoing support to those grieving.  For more information, please call us at 781-569-2888.

Love, hate... and the second experiment

It was always meant to be a grand experiment.  Me getting an Apple iPad, that is.  I'm an early adopter (I know, you noticed) and on the pages of this blog, I've written about the positives (such as here) and the negatives (here) of actually owning one of these groundbreaking devices.  Pros and cons aside, this was supposed to be a test.  And an easy one at that because I predicted that Apple's typically bare inventories would make selling off a mistake quite easy and painless.  Maybe even lucrative.

But the shorter and more immediate second version of the experiment was to simply stop using it for a week... a week that began seven days ago today.  I figured I'd simply stop using it.  Go back to life before, where I did quite fine thank you, and resume the simpler, iPad free existence.  So, I put it back into the box and tucked it away among the ruins of my basement office.  One week.  Piece of cake.

And though I wrote previously about how the gadget was fantastic, I just wasn't sure I needed it in my life.  It would not, after all, replace my cell phone or my iPod or my laptop.  It was, therefore, excessive and unnecessary.  A luxury item.

One week later, the iPad is right here in front of me.  I'm reading a book on it (finishing up "Tinkers" actually and getting ready to tackle ""The Innovator's Prescription"), managing my to dos, browsing the web, taking in the RSS feeds from Google Reader (highly recommended as a major league time saver), blogging, managing my on-line photo albums, and typing notes on it while in meetings. 

In short... I missed it.  I may not have needed it, but I missed it.  So, it's back.

If you see me, I'll be the one carrying the cell phone, iPod, laptop and now, the iPad... with all associated connectors, adapters and other periphery.  I know, I should be home cleaning that office.

It's always about balance

This is from Paul Levy, Beth Israel Deaconess CEO:

Kay Lazar writes in the Boston Globe today about an aspect of the Massachusetts universal health care law that has been developing recently. Under that law, an employer pays a penalty to the state if it choose not to offer health insurance. The lead: 

The relentlessly rising cost of health insurance is prompting some small Massachusetts companies to drop coverage for their workers and encourage them to sign up for state-subsidized care instead, a trend that, some analysts say, could eventually weigh heavily on the state’s already-stressed budget. 

The article notes:

The state’s landmark 2006 health insurance overhaul included regulations designed to discourage low-wage employees from opting for state health insurance over their companies’ often more pricey coverage. It denied eligibility to any one whose employer had offered him or her coverage in the past six months and paid at least 33 percent toward the individual’s plan. 

Most health care advocates and brokers had widely interpreted that to include even workers whose companies had dropped coverage. But recently, some companies that have terminated their group plans have tested those waters and found that their employees were accepted for state-subsidized coverage.

Additionally, company owners say, it has become far cheaper to pay the state penalty for not covering their workers — roughly $295 annually per employee — than to pay thousands more in premiums.

I well remember Jon Kingsdale, the first director of the Health Connector, the agency in charge of all these issues, discussing the delicate balance needed between the penalty to be set, the design of state-subsidized products, and other aspects of the health care market. Too high a penalty, and it is overly punitive to businesses. Too low, and employers would accept the fee to avoid the cost of health benefits and make a run to the state's plans.

The balance seemed about right for the first few years. Now -- if this article is to be believed -- things may have shifted. Politically, it would be very difficult during a recession to start to impose higher penalties on businesses. Likewise, it is would be difficult to make the state plans a less attractive option.

On the other hand, most employers still have an interest in offering an attractive benefit to recruit and retain staff. So maybe the reporter is picking up something happening at the margins that does not have tremendous significance. It is difficult to know, and will bear watching -- both for Massachusetts and for the country, as a similar national plan goes into effect.

It's always about balance.  I've written on this blog that the recently passed National Health Reform Bill was a compromise public/private measure designed to preserve, not eliminate, checks and balances in our system.  Paul's post above points out the importance of balance and that the cost of being out of balance can have possibly harmful effects on the overall system, throwing incentives haphazardly off in unintended directions.  Look for "balance" to be the watchword of our health care delivery and financing system for the next ten years. 

When marching bands are cool

I'm currently discovering Stephen Kellogg and the Sixers (or SK6ERS if you're a lot younger than I am), a band that formed at our own UMass earlier this decade.

Here's another hit that's going to be a hit.

And yes, that's UMass and their marching band.

Be the one for sea turtles

Good cause.  Many famous people.  Be the one...

Today's blip

Camera phones, once considered not serious, begin to get serious.

This shot while racing in the front door this morning...


- Posted using BlogPress via iPhone

Attleboro RN brings Congressman to work for a day...

I was forwarded this piece earlier today and present it here for a few reasons: First, the idea of showing our policy makers how powerful and effective home care can be is a powerful and effective advocacy tool and also to recognize Jim McGovern... our true Massachusetts champion when it comes to home health care.

BY SANDY LEGG-FORGIEL

It does not often happen that you get to explain to an elected official what you do for a living. Last week, I had that very chance when I took Congressman Jim McGovern to work with me - specifically to the home of a patient that I care for in my job as a visiting nurse.

The patient whom we visited suffers from congestive heart failure, hypertension, and other ailments. Before we admitted him to Community VNA for care, he had been in and out of the hospital and spent five weeks in a nursing home.

In addition to getting excellent nursing care, this patient's vital signs are monitored using state of the art telemonitoring technology, which transmits his vital signs, such as weight and blood pressure, to us so that we - and his doctor - can understand what aspects of his life are impeding his recovery and intervene immediately if needed.

It gives the patient and family the ability to interact with a nurse seven days week, allowing for more opportunities for teaching and asking questions. This technology has been proven to eliminate repeat hospital admissions, saving Medicare countless dollars - and giving the patients and families peace of mind. The problem is that the federal insurance program Medicare won't pay for it - which takes me back to my "bring a congressman to work day."

A picture - or, in this case, a face to face visit - is better than a thousand words. Congressman McGovern already knew a lot about home care - he is the founder and chair of the Home Health Working Group in the U.S. Congress. Seeing this telemonitoring technology up close, he immediately agreed to sign on to and support the Fostering Independence Through Technology legislation that home care agencies across the country are supporting. If passed, it would help us to bring this technology to hundreds more local residents.

It has been a privilege to work for Community VNA for almost 20 years and to know that we are making a difference in helping to keep patients in their own homes for as long as possible and teach them how to manage their own health care in the future - but it is also rewarding to know that our needs are recognized in Washington and will be championed, thanks to Congressman McGovern. SANDY LEGG-FORGIEL is a registered nurse and telemonitoring coordinator for Community VNA of Attleboro.

Boy meets wave

different

droplets

Back to in phone photography

I received an email asking why I no longer post photos taken and edited on my phone. And so, that got me to thinking...


- Posted using BlogPress via iPhone

Some people have way (way) too much time on their hands...

The Peril of the Middle

I often cite a quote I once heard regarding the "peril of the middle".  Not sure who originally coined this, but it's noted that: "In Texas, they say that the only things in the middle of the road are painted lines and dead armadillos".  Translation: you don't want to be in the middle.

Now being in the middle is something I'm familiar with, but I don't know you all that well and so we'll save those stories for another day.  On this day, I'm going to comment on the iPad as being right there, smack dab, in the middle.

First of all, many (myself included) have touted the greatness of this mobile device.  In short, I have never found anyone who doesn't have or want one.  The nearly mystical leader of Apple, Steve Jobs (I had to use this art above from Gizmodo) calls the thing magical and it truly is.  Truly.

When he initially announced the iPad, there was a graphic up on the wall behind him showing the smaller iPhone and the larger MacBook Pro and then right there, you guessed it - in the middle - was the iPad.  The iPad is not designed to replace your computer or your phone, but rather to stand on its own in the center of it all in a more complementary fashion.  Makes sense, right?

Well...

I've used it.  I've loved it.  And I've decided that I would never, ever let it go.  But, here's the problem (and one I've alluded to here on these pages): I have a work-issued blackberry.  A desktop computer.  A portable computer for mobile computing, presentations, etc.  An iPod Touch for music and other media content.  Then I have a computer at home.  When I go places, I feel like I'm carrying 300 lbs of technology with me, including chargers and other necessary accessories. 

On the one hand, each device has its place and serves its purpose.  On the other hand, there's the simplicity thing.  Traveling lightly.  Having just what you need and no more.

The Apple iPad does so much so well.  It's the one device that you'd keep if you had to keep only one.  But, therein lies the peril of being the middle.  I'm not keeping only one.  The iPad can't make phone calls.  It won't contend with the large files of my photographs.  It doesn't natively work on the network in the office.  It's a good music device, but try holding that thing while you're riding your bicycle.  And because the simplification bug is hitting hard, it's time to make a decision.  (A decision by the way, made much easier by the fact that the iPad is still in such demand and supplies are so low, used ones are going for the same or even more than brand new ones on eBay.)

And so, the best device of all... the one in the middle... is the one that has to go.

Waka Waka What?

I've written previously about the disaster in Haiti (here and here).

Came across this vid below which casts the aftermath in a more positive, even joyful, light.  Obviously choreographed, but the fractured surroundings and expressions of the locals is worth seeing.

Shocking and disappointing...

The audiotape of Mel Gibson that is being played across airwaves this week is shocking and disappointing.  And tragic.  The co-executive directors of Casa Myrna Vazquez (an organization I've volunteered for) present a powerful case today on Boston.com.  Here, in its entirety:

In 2008, as filming wrapped on Mel Gibson’s “Edge of Darkness’’ in Boston, he made a surprise $25,000 donation to Casa Myrna Vazquez, the city’s largest provider of shelter and supportive services to victims of domestic violence. It was not a random choice: his location scouts had briefly considered one of Casa Myrna’s shelters for some exterior shots in the film. We were grateful to him for supporting our work, and told him so.

Two years later, we’re grateful again — but for a very different reason. He’s making the case for our work, and proving our oft-repeated point that domestic violence crosses all socio-economic, ethnic and cultural divides. Gibson is making headlines for the violent, hate-filled litany of slurs and abuse he spews at girlfriend Oksana Grigorieva, which she recorded on tapes whose authenticity do not seem to be in question. When she references the fact that he hit her, not once but twice and while she was holding their infant daughter, he makes no attempt to deny it. Instead, he tells her that she deserved it.

Can there still be people who think this way, talk this way, behave this way? In a word, yes. Lots of them. Behind closed doors, they generate fear, misery and despair on a daily basis.

They don’t garner national attention like the Mel Gibsons, the Charlie Sheens or the Chris Browns. We’ll never see photos of the bruises they inflict on their victims, or hear audiotapes of their abuse. Their victims won’t be front page news unless they happen to die at the hands of their abusers. And yet the toll these abusers exact on their victims, and our society, is enormous.

According to the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control, nearly 5.3 million incidents of domestic violence occur each year among U.S. women ages 18 and older. Imagine Mel Gibson’s rant repeated over 5 million times. That’s the reality on the ground. Intimidation. Insults. Physical violence. Death threats. It will happen to one in four women in their lifetimes.

The financial statistics, also compiled by the CDC, are equally alarming. The costs of domestic violence against women exceed an estimated $5.8 billion every year. That figure includes nearly $4.1 billion in the direct costs of medical and mental health care and another $1.8 billion in the indirect costs of lost productivity. Victims of domestic violence lose a total of nearly 8 million days of paid work - the equivalent of more than 32,000 full-time jobs - and nearly 5.6 million days of household productivity each year as a result of the violence they endure.

Then there’s the moral question. What does it say about us as a society that we continue to view domestic violence as a problem that can’t be fixed? One of the things we’ve learned over the years is that, like so many of society’s deeply ingrained social problems, domestic violence is often an intergenerational problem. If it’s part of your life today, chances are it will be part of your children’s lives tomorrow. That means sons grow up to be abusers, daughters grow up to be victims. And the cycle continues, destroying lives, families and whole communities.

We can do better. Mel Gibson’s tape is a stark reminder that we still have a long way to go in embracing the simple but powerful message that domestic violence is wrong. Always. It’s also a reminder that we need to impart that lesson to our children, both in what we say and in what we do. It needs to be an ongoing conversation, because teaching lifelong lessons about respectful behavior in relationships is not a one-shot deal. Think the kids in your life are too young to be a part of this conversation?

Think again. You’re never too young to learn that there is a right way and a wrong way to behave toward a partner in a relationship. Babies, toddlers, and pre-schoolers learn from adults. If what they’re learning at home is violence and abuse, be prepared: those lessons last a lifetime. Instead of allowing the intergenerational cycle of domestic violence to be perpetuated in our homes and families, we should be teaching our young people that there is no excuse for abuse. Ever. Maybe our celebrities will get the message too.

Nathalie Favre-Gilly and Deborah Collins-Gousby are co-executive directors of Casa Myrna Vazquez. The SafeLink hotline is 877-785-2020.

Are all hospices the same?

A note from Diane Bergeron, VNA Hospice Care Executive Director:

In my last Director’s Corner (winter edition), I wrote about several things that set VNAHC apart from its competitors. Our JCAHO Accreditation, our donors (particularly our Winchester and Woburn Friends) and the longevity of our staff are a few examples of what differentiates VNAHC from our competitors.

In addition to these core attributes VNA Hospice Care also practices an Open Access policy toward patients. This means we accept all patients regardless of cost or acuity of illness. We accept patients that are receiving treatments that are traditionally viewed as curative including patients receiving chemotherapy, radiation, patients on IV’s and ventilators and patients receiving physical or occupational therapy. While this Open Access approach has inherent financial risks, as an agency we continue to be ethically committed to providing hospice care to all who need it.

VNAHC provides hospice care to individuals with intellectual disabilities. Since 2003 VNA Hospice Care has worked with the Department of Developmental Services (DDS) to meet MAP requirements and provide coordinated plans of care. VNA Hospice Care staff members have extensive experience working with intellectually disabled individuals, their caregivers, family members and friends.

VNAHC provides bereavement support to children and teens through our Children and Youth Grief Program called “Discovery”. Now in its fifth year, the Discovery program has helped hundreds of children and teens who are coping with the loss of a loved one.

Your donations, large and small, help us to continue to provide comprehensive hospice care to all who need it regardless of cost, acuity or ability to pay.

Thank you so much for your continued generosity and support,

Diane Bergeron

It's easy to think that all hospice programs are alike and that the entirity of the experience relates solely to the competency and compassion of the in home hospice staff.  But in reality, there's more to it than that... as Diane indicates above.  In future posts, we'll point out some of those differences here...

Back to a traditional, dare I say... Ansel Adams approach

I dare not say it.

More of the brilliant red sky

Meet the King of Anything

OFFICE WARNING:  If you're going to play this at work, turn the volume up... way up... first.  You want your boss and co-workers to hear it too.  They'll thank you later.

I saw Sara Bareilles about a year ago and was quite struck by her voice and poise.  This song is the first single from her new album.

They'll be playing it at the Labor Day cookout you're going to.  Put some pop into your life.  Prediction: it's going to be huge!

One of our nurses... 90 years ago!

More on reform and ER usage

I've written on this theme before, but here's some new information from health reform guru, economist and author, John Goodman.  In a nutshell, Dr. Goodman argues that the newly enacted reform law will not cut down on ER overcrowding and overutilization... much as I've stated here. 

According to the author:

In general, people with insurance consume twice as much health care as the uninsured, all other things equal. The trouble is that the new health insurance law has no provision for increasing the number of health care providers. As a result, when people try to increase their use of physician services, many will be disappointed and a large number are likely to turn to the emergency room when they cannot get their needs met at doctors’ offices:

• Whereas the uninsured make almost two physician visits per year, the number is more than 3.5 for the privately insured and almost 7.5 for Medicaid patients.
• On the average, we estimate the typical newly insured patient will attempt 3.6 additional physician visits.
• If, say, only one-third of these turn to the emergency room because of inadequate primary care supply, that would equal between 39 million and 41 million additional emergency room visits every year.

That's the bad news.  The good news?

Apparently, HHS Secretary Kathleen Sebelius plans to use $250 million targeted for “prevention and public health” in the Patient Protection and Affordable Care Act for physician training instead. The funds would train 500 physicians, 600 physician assistants and 600 nurse practitioners. Also, she plans to raid pots of “stimulus” money created under the American Recovery and Investment Act.

So, relief may be in sight in the form of a narrowing of the gap between supply and demand for health care personnel. 

Last night's sky

From an email to all VNAB employees....

Case managers, physicians, planners, and administrators routinely make decisions regarding where their patients obtain follow-up health care services. As you know and as we often discuss when we’re together, there are a lot of choices in home care, hospice and private care out there. Clearly, we need to demonstrate that the right choice is the Visiting Nurse Association of Boston & Affiliates.

But does extra effort actually matter?

Here are some examples of when the extra effort of our colleagues is making a difference… and demonstrates that we are the right choice.

Pat Miles, case manager at Harvard Vanguard, recently called to describe the efforts of Julie Kelly, RN. In Pat’s words, Julie has “done a really excellent job, following up consistently” and put forth a “herculean effort.” Maureen Verduccio, MGH senior health case manager, recently told us how much she appreciated the work of Maryanne Thibeault, RN and Robin Grossman at MGH Charlestown recognized the efforts of Tina Dalli, LPN. Barbara Renzullo, MGN Charlestown, called to give an overall “job well done” message, acknowledging the great care and compassion we provide to their patients.

Julie, Maryanne, Tina – thank you for all you do! To all our great staff who help differentiate the VNA of Boston and give health care decision makers good reason to entrust their patients to our care – thank you!

It does matter.

Rey

Downtown Ride

Why the hat?

Real or a miniature model?

When it's hot, hot, hot...

Yesterday topped 100 degrees here in the Boston area, prompting this piece on New England Cable News, featuring Visiting Nurse Association of Boston nurse, Yu Yang.

Peace and love, baby

In yesterday's post, I quoted Beatles legend, Ringo Starr.  To my complete surprise, I learned this morning that today marks his 70th birthday!  When asked how he'd like fans to observe the day, he suggested we offer each other the peace sign and wish one another peace and love.

Peace and love.

It don't come easy

First of all, I hope I evolve as well as Ringo has.  Even McCartney is beginning to look his age.  But that's not the point of this post.

In 1971, Ringo sang:

I don't ask for much, I only want trust

And you know it don't come easy
And this trouble vine keeps growing all the time
And you know it just ain't easy

Now, some forty years later, Massachusetts Senate President Therese Murray could be singing exactly the same lines.

As a result of growing concerns over ever increasing health care costs in Massachusetts, the Senate President has boldly taken the lead in crafting a revised payment system for physicians and hospitals.  At the front edge of this process has been a movement toward global payments whereby fixed populations would be allotted a fixed amount of reimbursement meant to cover all (or at least most) of their health care needs.  But, in a move worth understanding and fully considering, Ms. Murry has scrapped plans to overhaul the sytem for the time being.  She stated: "It’s like going around in circles.  Nobody is in agreement on anything."  Massachusetts Speaker of the House Robert DeLeo "shares a commitment to tackling health care costs, but doesn’t want to see any legislation that would limit patient choice," said his spokesman, Seth Gitell.

Herein lies the challenge.  If the central task is to have everyone in the industry agree and to provide full access to all services for everyone, then this will be an impossible task.  And it is worth nothing that this is also the fundamental challenge of regulators who are now tasked with implementing President Obama's ambitious health reform law... a law with overarching and ambitious goals but scant details on how to accomplish them. 

The public debate is now getting started.  If our government officials are looking for broad consensus and are not willing to limit choice, then it's going to be an uphill climb. 

Perhaps I should quote from the other surviving Beatles' song.  "The Long and Winding Road."  Or maybe from the group's catalogue.  "We Can Work It Out."  "Come Together."  I got it: "Help." 

Seriously, I could go on all day...

ER visits up... MA reform a bust?

During the push to enact universal health care coverage in Massachusetts during the 2005 to 2006 period, proponents argued that improved coverage would equate to a declining strain on the Commonwealth's emergency departments as un/underinsureds would have better access to primary and speciality care and, therefore, would need to avail themselves of ERs far less often.  It was a good argument, but early returns suggest that it may not have been correct.

On the 4th of July, the Boston Globe reported that ER visits have gone up, not down.  See the article here.  Citing Massachusetts Division of Health Care Finance and Policy figures, the article noted that visits are up 9 percent from 2004 to 2008 or approximately 3 million visits per year.  It's worth noting, as do those quoted in the piece, that this trend mirrors national numbers and that it probably has more to do with primary care shortages than anything else.  The newly insured may have coverage, but if they can't find a doctor...

My sense is that some may point to this information and claim that the Massachusetts universal health initiative has been a bust.  I argue that that would be unfounded or, more likely, irrelevant for the following reasons:

• The primary care shortage is getting worse.  And even if you have a primary care physician, the wait for a sick visit (or even a routine physical) can be extremely long.  Additionally, the days of developing a unique and personal relationship with one primary primary care doctor may be over, as obtaining appointments with other physicians or nurse practitioners is now the norm.  It's a well documented phenomenon nationally that primary care numbers are down and that ER visits are up as a result.
• Providing primary care and coordinated speciality services to many individuals who have not received such care historically may result in reduced ER visits by that population, but it will take longer than four years to prove the point.  Controlling my blood pressure today could prevent an MI in 10 or 15 years... probably not right away.
• It's politically irrelevant.  It's seems very highly unlikely that a universal health coverage reversal initiative could gain any real traction.  Imagine being that candidate pushing that agenda.

The solution to the growing ER utilization problem (the waits are getting longer and the costs are escalating upward) lies in addressing the fundamental underlying issue... not in concluding that universal coverage is a flop.

To World's End...

... in Hingham.  Seriously.

The view from my front porch

Manikins are creepy

I'm no longer texting while I drive...

... but still need something to do.

GREAT news on PECOS!

From an email to all staff:

Recently, Ginny Tritschler communicated a very troubling development from the Federal Government that could significantly and negatively impact our ability to care for a large proportion of our patients. The physician enrollment system (called PECOS) mandated that physicians referring to home health agencies for their Medicare patients be fully enrolled in the system so that the home health agencies could be reimbursed for those services. Although the impact of that regulation was directed toward physicians, their non-compliance would result in our not getting paid for services provided and/or our patients being unable to receive the critical health care services they require.

I’m very happy to report a positive outcome. The regulation will NOT go into effect this month, but rather has been postponed to October. For more details, please see my email to the Board below.

Ginny Tritschler, Mary Campbell, Bryan Kaplan, Keith Giannelli, and Jean Clive all deserve a special pat on the back. They all went way above and beyond in helping us to respond to this serious challenge. So… thank you to Ginny, Mary, Bryan, Keith and Jean. Feel free to flood their inboxes with notes of appreciation!

And if you ever wonder whether writing to your senator or representative actually makes a difference, know this: it does make a difference! Thank you to all of you who took the time to send an email or call. The voice of the VNA of Boston was loud and clear… and it was heard.

Finally, all of the professional associations to which we belong have been actively engaged in this effort, but a special acknowledgement of the National Association for Home Care (NAHC) should be made. NAHC took the lead and actively worked with the Federal Government to make this change possible.

Much work remains to be done on this issue and we all need pledge our support to those who are completing the critical next steps. Expect further updates whenever there’s anything worth communicating.

A holiday weekend is coming. I hope you have a great one.

Thanks,

Rey

EMAIL TO THE BOARD:

The VNAB has been notified that CMS will implement a review of the PECOS enrollment process, thus postponing the immediate issue of caring for patients whose physician is not enrolled in the PECOS system. Based upon a Press Release distributed by CMS and discussions that we have had with representatives from the National Association of Home Care (NAHC), our understanding of the CMS PECOS review process is:

• CMS will not reject claims for home health services where the ordering/certifying physician is not currently found in the PECOS record.

• Home health agencies will not be subject to a risk that the claim will later be reopened and retroactively denied because the physician was not in PECOS.

• Serving home health patients following the orders of a physician not in the PECOS record will not be considered a violation of any Medicare rule until such time as the CMS editing process is fully operational and public notice to that effect is given.

• This approach will hold providers harmless for PECOS-related matters until such time as CMS implements its editing and automatic rejection process (approximately October, 2010).

We are relieved that CMS has taken this position, however the VNAB will continue to implement a formal internal process to assure that referring physicians are enrolled in the PECOS system and that those who are not obtain information from the VNAB on how to successfully enroll.

Much work remains to be done on this issue, but the immediate threat has been thwarted. A special thank you to Ginny Tritschler for coordinating the many activities associated with our response. An acknowledgement to NACH is in order for the critical role they played as well. Finally, thank you for writing to our delegation and for your ongoing support of the VNA of Boston.

Have a wonderful holiday weekend.