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The HHS Secretary Visits Chicago

This week, U.S. Health and Human Services Secretary Kathleen Sebelius visited Chicago to speak about the Illinois Health Insurance Marketplace, a key provision of the Affordable Care Act.

Secretary Sebelius, accompanied by Governor Pat Quinn, announced on Wednesday that the Illinois Blueprint Application for a State-Partnership health exchange had been accepted by the federal government. The exchange will run as a federal-state partnership model until 2015, when the state may take over operations, depending on the State Legislature’s ability to pass a state exchange bill. Enrollment in the partnership exchange/marketplace opens in October, only eight months (229 days!) away.

Secretary Sebelius speaks to a full house at the Chicago Cultural Center

On Thursday, Sec. Sebelius spoke at the Chicago Cultural Center. Preceding her was Bechara Choucair, Commissioner of the Chicago Department of Public Health, who presented an overview of the Healthy Chicago program and its impact thus far. Sebelius delivered a call to action to those in attendance, citing the need for affordable, accessible health insurance for all as a crucial step in the national public health strategy. With only eight months before the state health marketplace is open for enrollment, and ten months before it is fully operational, promoting awareness of the health insurance exchange is the focus of HHS.

Baby Lion Cubs Playing at Omaha Henry Doorly Zoo (Picture/Video)

Mrs Happy and I took a stroll through the Omaha Henry Doorly Zoo yesterday and had an opportunity to check out the five new baby lion cubs on exhibit in the Cat Complex. These newborn kitties were born December 29th, 2012. These six week old cubs were so fun to watch with their playful innocence. It's hard to imagine how ferocious they may be become when they're all grown up. We stood there with a bunch of moms and dads and kids watching them roll around and claw at each other.

The adult lions were off in the corner doing their own thing. One female lion would occasional peak over and check on things. It was pretty cute to watch. Here's a YouTube video below I took of the five baby cubs running around and playing while two female adult lions look on. I'm not sure which is the mother or if these cubs will have a two mommy family.

I wonder what it would be like to be the lions behind the glass staring back at all the humans gawcking at you. Do you ever wonder what they're thinking? Perhaps, "Leave me alone"? Or, "There's nothing going on here. Feel free to go checkout the monkeys". We'll have to make a special trip back to the Omaha Zoo to check up on these little guys.

On a more serious note, I am concerned one of the adult males ate a zookeeper . I was able to snap an incredibly close up picture of the male lion with its big mane when it came right up to the glass. I've never had such an amazing close encounter with a lion. I was surprised at how content it was.

Until it turned around and I realized there was a hand sticking out of its bottom end. We were all petrified to see such a horrible thing. I'm shocked none of this has made the national news. I don't know who it was. I just wish I could have lend him a hand. But it was too late.

Some of this post is for entertainment purposes only and likely contains humor only understood by people with a sense of humor. Read at your own risk.

Sterile Water Irrigation Denied By Insurance. Patient Not Sterile Enough.

I feel bad for our patients.   Insurance economic algorithms are defining the patient and doctor experience regardless of situations unique to the patient experience. If our recommendations as physicians or your needs as a patient do not comply with your insurance company's economic algorithms, you and your physician will likely get denial of care letters. That means hours of headaches and delayed therapy for you and hours of headaches and uncompensated expenses for your physician's office in communication with your insurance company. It is no wonder many offices have started charging patients for their busy work.

That denial of care can come in the way of preauthorization headaches. I experienced that tragedy while trying to authorize a lidoderm patch for a patient of mine that was getting great pain relief in the hospital. That patient was denied coverage for the patch as an outpatient. We too have experienced the frustration. Mrs Happy was recently at Walmart. She learned our Blue Cross Blue Shield insurance would not authorize coverage on her medication refill required for our 9 week baby pregnancy related care last week because she was two days early to pick up the prescription..   That's right folks. BCBS algorithms are denying care to our unborn baby because Mrs Happy is too compliant with her therapy.

CMS would be thrilled at Mrs Happy's actions!    They actually have a program in place to track how compliant you are with your medication adherence. You think big brother isn't watching? Think again. This information will be used against you when the time is right. Follow this link for the crazy details.

If you need outpatient radiology imaging such as MRI or CT or ultrasound, more than likely your insurance company will require your physician's office to obtain preauthorization. Every insurance company is different. One algorithm may allow the scan while another may deny it. That formula will change from year to year and from company to company.    Some medications will be covered, some will not. It changes from year to year and from company to company.

Medicare wants hospitals to make our patients happy. They care so much about our patient's hospital experience that they are withholding money from hospitals that don't win the patient satisfaction game. We could spend hundreds of thousands of dollars a year training staff to be nice, but if a physician writes an order for that Lidoderm patch and the patient can't fill it, they aren't going to care about being AIDETized.

Then there's this patient below. They most certainly aren't going to give my hospital glowing patient satisfaction scores after experiencing a devastating denial of payment on their sterile water irrigation solution script. The insurance company said it wasn't on their formulary. More likely, I suspect the algorithm denied payment because the patient wasn't sterile enough to benefit from sterile irrigation.

The same insurance company that will pay $100,000 for seven smoking related COPD readmissions has decided to deny their patient insurance benefits to sterile water. In fact, I guarantee if this patient came to the ER saying they needed to be admitted because they couldn't get access to sterile water, I would bring them in under observation care just for spite. At least then they could get their sterile water irrigation flushes with a diagnosis of rule out lack of access to sterile water irrigation flushes and they will pay $3000 a day for the right to do so and I will get paid form my highly complex level 3 observation history and physical.

Denying sterile water irrigation flushes. This is what our life as doctors and patients have become. And it's only going to get worse from here. America has spoken. They are getting what they asked for. Algorithms rule our health care decisions. More and more decisions are going to be made based on computer models and actuaries. ObamaCare says we can't deny care based on preexisting conditions. From where I'm sitting, there's plenty of denying going on.   One solution is to stay healthy, exercise, don't smoke and hopefully you can live a long and happy life away from this madness. For the rest of you, you had better plan on saving lots of money to pay your physicians extra.   It's only a matter of time before patients who can afford to pay extra do and those that can't will be denied.

This post is for entertainment purposes only and likely contains humor only understood by those in a health care profession. Read at your own risk.

Navigators, Assisters, and Counselors, Oh My!

By now we know that upwards of 30 million Americans will have new, more affordable health coverage options available to them by January 1, 2014. But what many don’t realize is how incredibly difficult it can be to understand and choose the right health insurance on your own.

The Wizard of Oz’s Dorothy had guides along the way, and the Affordable Care Act (ACA) provides some as well – hopefully, with fewer pitfalls. But not everyone can counsel people about health insurance. There are complex public and private systems to navigate, and most people who will likely get insurance in the new Health Insurance Exchanges, or Marketplaces, will be more racially diverse, less educated, and earn lower income than people in private insurance now. Most will have a high school education or less, and as many as one in four speak a language other than English at home. So it matters that the people who guide consumers along the path to coverage are trusted members of the community and understand their circumstances.

Luckily, the ACA provides different options for guides along yellow brick road.

Navigators are outlined in the ACA as helpers for people to enroll in coverage through the Exchange, and refer or assist with Medicaid enrollment. Navigators are funded through Exchanges, and regulations from the Department of Health and Human Services (HHS) are clear that anyone who gets payments from insurance companies cannot be a Navigator. Navigators also must meet cultural competency standards and go through training and certification. States running their own Exchanges are developing Navigator programs now and must fund these with state Exchange dollars. For Federal Exchanges and Partnership Exchanges, HHS has said that it will fund Navigators directly through an upcoming RFP process. Be on the lookout for this announcement in the next few weeks.

To add even more help on the ground, HHS recently outlined in regulations another program,Assisters (or, In-Person Assistance). Like Navigators, Assisters must meet training and conflict of interest standards. They could fill in gaps in areas that need more enrollment assistance, or provide outreach and education about the ACA’s new options. Funding for Assisters is a key difference from Navigators. States running Exchanges or opting for the Consumer Assistance Partnership can apply for funds for Assisters through their Exchange Establishment grants. A number of states are applying now for these funds. Unfortunately, Assisters currently are not an option for Federal Exchanges.

And when you thought there were enough new health-related terms, HHS regulations added yet another helper to enroll people, Certified Application Counselors. Every Exchange must have a Certified Application Counselor program, with similar training and privacy standards as Navigators and Assisters. A difference in this program is that there is no funding mechanism. It is unclear who will serve this role – although the regulation suggests it could be community-based organizations or health care providers. Stay tuned for further clarification on this new option.

But even these multiple types of help will not be enough to spread the word about the ACA. Helping people understand and choose the right health plan, especially given the amount of misinformation in the media and elsewhere, is going to be a huge task. Nevertheless, these resources in the ACA provide a foundation to start building greater understanding of health care options to get people into the right coverage.

This post originally appeared on Health Policy Hub's the Community Catalyst Blog.

Written by Christine Barber, Senior Policy Analyst

Why Obamacare will ignite your startup life

This post originally appeared on Crain's Chicago Business.

Written by Coco Soodek

Obamacare is going to set you free to pursue your startup dreams. Why? Because finally you won't be chained to a big company for your health insurance.

If you want affordable, reliable health insurance in America, you have had to be over 65 so you can get Medicare, work for the government or work for a big company. That's because big companies, government and Medicare have enough people in their plans to improve the insurance companies' odds of making money. Small companies and solopreneurs don't, so their insurance rates are high or they can't get coverage at all.

As a result, business owners often don't have health insurance. Only 19 percent of business owners get insurance through their own companies. And 25 percent of small-business owners don't even have health insurance, according to the Kaiser Family Foundation.

The stakes of not having health insurance are catastrophic. You may not be able to get health care if you get sick or are in an accident. That means you or your loved one could die or suffer. If you do get care, the bills may drive you into bankruptcy — half of all personal bankruptcies result from huge medical bills. We're not talking people who live above their means. We're talking people who went to the doctor to stay alive until they cry uncle.

So, leaving your big employer to start your own business can be a life-or-death decision. If you have a spouse or kids, the decision could be downright stupid. So, you stay with your big company, you follow its rules and hope for good fortune from the layoff gods. It's a terrible, ugly, stupid, myopic system and it deserves to die an unpaid-for death.

Obamacare is coming. Imperfect, complicated, rough on midsize companies, sure. But it's the grace of God for your startup hopes. For the first time in American history, your health insurance is going to get unhitched from your oversized, shuffling, bureaucratic employer. You're going to be able to visit a virtual supermarket of health insurance plans and pick the plan you want, which probably won't cover less than 60 percent of your health costs. That supermarket of health insurance is going to pool you with thousands of others to improve the odds that the insurer will make money.

If you have a company of 25 employees or fewer, and you pay half of the premiums for your employees, you can deduct 35 to 50 percent of the premiums. If you make less than $92,000-ish for a family of four, you could get government help to buy your health insurance at the supermarket. Freeloaders on the health care system have to pay up, liberating the rest of us from paying for their emergencies and lowering costs. (If you're one of those freeloaders, you have it coming.) You never have to go back to work for someone just to get insurance.

Obamacare will be the difference that creates entrepreneurs out of thousands of people like you. Scholars have known for years that the lack of affordable, reliable or even available health insurance keeps people chained to their employers. In fact, when individual states create avenues for people to get affordable health insurance, the number of entrepreneurs increases. When New Jersey reformed its health insurance laws to create markets for individual insurance and guaranteed policy renewals and limited exclusions for pre-existing conditions, entrepreneurial activity soared. And so it will in the rest of the country. Because the United States is — by history and by nature — a land of shopkeepers, not shop workers. We dream, innovate, strike out, fail, try again and prosper. The health insurance market has incentivized people to live at the mercy of someone else's vision. Obamacare is going to tilt the market back to center.

Read more here.
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External Condom Catheters For Men Reviewed: Girth and Length Analysis!

Placement of a urinary bladder catheter comes with the territory for many hospitalized patients. Indwelling Foley catheters are often inserted through the urethra and into the bladder of men and women. An internal ballon is then expanded to prevent the catheter from falling out. These catheters have an appropriate role in the management of some hospitalized patients. Bladder outlet obstruction and urinary retention require internal bladder catheters to manage the problem. Sometimes the catheter is the cause of the problem. Here is an example of bilateral hydronephrosis from a Foley catheter.

Too often, hospitalized patients get indwelling urinary catheters ordered out of convenience, ignorance or because that's the way the doctor has always practiced. Patients or nurses may request them and doctors may order them for any number of reasons, some appropriate, some not. Far too often, these catheters get placed and forgotten. Many hospitals have implemented policies and procedures to reduce the incidence of prolonged catheter placement and the complications that are sure to follow. The best way to prevent a complication of an indwelling catheter is not to place one. Catheter related infections and hematuria due to catheter trauma are just two of the many bad outcomes.

What can hospitals do to limit complications from internal bladder catheters? Some hospitals think outside the box and use external catheters instead. For men, these external catheters are called condom catheters. Don't worry, I have verified these condom catheters are Catholic compliant. They are placed just like a condom. No more concerns about bladder infections. No more concerns about traumatic clots inside the bladder. No more concerns about dirty old men having unprotected sex in the hospital. Just place a condom catheter on them and be done with it. Or at least until they pull it off 32 times a day and ask the nurse for help putting it back on. I guess Uncle Eddie isn't so demented after all.

How do these condom catheters work? What about their length? What about their girth? Surely, one size does not fit all. So many questions, yet so few answers. I did what any hospitalist would do when they have free time on their hands. I commandeered the condom catheter directions for my review. Boy, was that a shocker. These things are definitely not one size fits all. Below are a couple of pictures from the folding insert, complete with directions, a 20 cm ruler (8 inches) and a girth sizing guide for the Coloplast Conveen® Optima external condom catheter. For best results, I suggest you follow their advice. I have provided a summary of their recommendations here as a public service announcement. If you ever find yourself hospitalized and need a urine capturing device, and a nurse calls you sport, I recommend you give them all zeros on your patient satisfaction scores.

Step 1 Prepare Skin: Make sure the skin is clean and dry, free from oils and moisturizers. A protectant wipe may be used. If necessary, trim pubic hair.

WOW! I don't know how many nurses or men can ever get past step one. A clean and dry penis in a 90 year old nursing home patient? Oils and moisturizers? What kind of nursing how is THAT guy staying in. And trimming the pubic hair? I'm sure nurses didn't graduate from nursing school with pubic hair trimmer expert in their job description. Certainly, hospitals MUST be considering a pubic hair trim as an add on amenity worthy of extra revenue.

Step 2 Size: Use sizing guide to measure circumference and length to determine correct catheter. Four circumference sizes are available in STANDARD length and four circumferences sizes in SPORT length for short/retracted shafts.

WOW! Call me crazy, but I'm certain becoming an expert in measuring penis girth was not an elective in nursing school. It's great that Coloplast has the girth and length measuring device available, but I think their good intentions may have unintended consequences. I can see it now, patient and nurse arguing over which girth size to pick. Don't even think about telling him he's a sport. You'll crush his manhood and force me to consult a psychiatrist for suicidal thoughts. Way to go Coloplast. Maybe these condom catheters aren't such a great idea. "Oh, to be 20 again..."

Step 3 Open it. Ok, easy enough.

Step 4 Apply the Catheter: Place the catheter on the head of the penis, keeping a 1/4 to 3/4 inch gap between the penis and the outlet tube. Hold the catheter in place with one hand, while gripping the double strip pull tab with the other. Then pull the double strip pull-tab, slowly un-rolling the catheter towards the base of the penis. Gently squeeze the catheter around the shaft of the penis for a few seconds to ensure adhesion.

OH MY! There goes my length of stay and 30 day readmission rate. With service like this, my patients will never want to leave the hospital.

Step 5 Leg Bag: Connect the catheter to the urine bag.

Step 6 Removal: Catheter should be exchanged daily.

Perform steps 1-5 daily to ensure great patient satisfaction scores! Expect longer lengths of stays and higher 30 day readmission rates as we trade excellence in one measured outcome for another.

I do have one suggestion for the folks over at Coloplast. I recommend you offer these condom catheters in an assortment of colors and designs. Think about it. How many crazy old men love their hunting. Camouflage condom catheters to the rescue. Since they haven't felt anything in the last 20 years, you might as well help them make it disappear. Favorite football team? The Chargers? The Jets? The Giants? The Packers? Come on. Offering an upgraded football catheter is a gold mine for you and your client hospital's amenity of services. Keep your marketing team active and we'll all get to WIN-WIN. Now, please enjoy this original Happy Hospitalist ecard, part of a collection of hundreds on Pinterest.

"Please stop flashing your penis at me. I'm not impressed. Except maybe like 1% of the time."

To view this card at The Happy Hospitalist Medical Humor store, turn off the "safe filter" on the left hand side" at the store landing page linked above.

Some of this post is for entertainment purposes only and likely contains humor only understood by those with a sense of humor. Read at your own risk.

Gram Positive Cockeye vs Cocci Explained.

Here's a letter I wrote to the National Academy of Nursing Vocabulary last week regarding my concerns about an epidemic of gram positive cockeye sweeping our hospitals. You think the flu was bad this year? You think C diff is bad. You have no idea how aggressive the cockeye has been.

Dear Academy,
I have been a practicing hospitalist now for ten years. I want to commend your organization's mission to improve nursing vocabulary. Helping nurses achieve proficiency in medical terminology is important for doctor-nurse and nurse-nurse communication of critical patient information. Quite obviously, some nursing schools do not make this a top priority. Your contributions to the field of nursing are important in many regards. I rarely hear mispronunciation of meto-pro-lol or at-in-ol any more. I understand your nursing organization has made an aggressive push into the field of cardiac pronunciation. Your efforts do not go unnoticed. You have nipped these mispronunciations in the bud.

However, I feel you have failed miserably in the field of infectious disease. I continue to experience grave concerns regarding correct pronunciation in the transfer of critical blood culture notification results from nursing staff to physician staff. I have specific concerns about gram positive cocci (pronounced kok-sahy). There should be no debate about pronouncing gram positive cocci. Unfortunately, patients and doctors have experienced grave harm when nurses inform doctors their patients have the cockeye instead.

When I tell my patients they have cockeye they look at me with shock and horror. I've had a few patients slap me silly. I apologize and tell them they must have caught cockeye from their nurse. In my decade of hospitalist medicine, I have been assaulted numerous times and faced dozens of lawsuits from patients claiming they got hospital acquired cockeye. Families are angry. Patients are scared. They want answers. Unfortunately, I have to tell them the only treatment for their gram positive cockeye is more aggressive intervention by national organizations like yourself. Unfortunately, that process takes years and they don't have years. Telling patieints they have gram positive cockeye in their blood is a drag on patient satisfaction and disrupts the trust patients have in medical staff. I believe your organization should make correct pronunciation of gram positive cocci a top priority for 2013.

Respectfully,

Happy

With that said, I once had an unexpected response from a 95 year old lady. When I told her she had cockeye, she thanked me for the opportunity to experience cockeye one last time before she died of unnatural causes at the hands of her cocci infested doctors. I think this medical ecard summarizes this epidemic of hospital acquired tragedy.

"Don't worry ma'am. I know what your nurse said, but I am 100% positive your husband did not give you the gram of cockeye we found in your blood."

Don't worry ma'am. I know what your nurse said but I am 100% positive your husband did not give you the gram of cockeye we found in your blood nurse ecard humor photo

This post is for entertainment purposes only and likely contains humor only understood by those in a healthcare profession. Read at your own risk.

HEALTH FOR ALL

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