Michael.Massing + healthcare   246

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costs are pushing millions into extreme poverty. This outrage must end
health  Healthcare  from twitter_favs
march 2018 by Michael.Massing
Medicaid Planning: Pros & Cons, Costs and Strategies
To determine one's Medicaid eligibility or to find a Medicaid planner, please use the free service provided by the American Council on Aging.  To better understand the services Medicaid Planners provide and when it is appropriate or necessary to use their services, please continue reading.


What Medicaid Planners Do

Medicaid eligibility is very complex; the rules change frequently, they differ in each state, they differ by program within each state, the application is time consuming and the review process lengthy. The consequences of being denied by Medicaid are severe and can negatively impact the comfort, happiness and even the health of the individual applying and their entire family.

Medicaid Planners help clients structure their financial resources and prepare documentation to ensure the best possibility of being accepted into the Medicaid program. They create trusts, manage asset transfers and convert countable assets into exempt assets to ensure eligibility and preserve a family's resources. They can also protect a family home from Medicaid recovery. In addition, they manage finances to ensure a healthy spouse has adequate income and resources to continue living independently during and after the time when their partner is receiving care assistance.

Did You Know?  It is estimated that between 60% and 75% of Medicaid applicants, engage in some form of Medicaid planning prior to submitting their application. 
Medicaid  planning  healthcare  benefits  asset  spend-down  eligibility  conversion 
october 2016 by Michael.Massing
Adherence to Continuous Positive Airway Pressure Therapy (ATS Journals)
Claustrophobia
Although, in general, side effects have not consistently deterred use of CPAP, there have been reports that the sensation of claustrophobia may interfere with use (2, 11). In a prospective study, participants who used CPAP for more than 5 hours per night had a significant decrease in claustrophobic tendencies compared with those using it for shorter periods. Those using CPAP for fewer than 2 hours per night had the greatest variability in CPAP use and a higher level of self-reported claustrophobia on a measure of claustrophobic tendencies. A score greater than 25 on the modified Fear and Avoidance Scale predicted that the patient was twice as likely to use CPAP for fewer than 2 hours per night.
OSA  obstructive  sleep  apnea  CPAP  continuous  positive  airway  pressure  cost  benefit  healthcare  adherence  claustrophobia  initiation  adoption  embrace 
july 2016 by Michael.Massing
OSA as a Progressive Disorder - Dental Sleep Corner
The increased frequency of apneas further exacerbates the patient’s condition by promoting obesity, a key anatomical cause of OSA. In his 2011 book, The Sleep Doctor’s Diet Plan: Lose Weight Through Better Sleep, Breus outlines the connection between sleep deprivation and weight gain in four steps:

As patients become more sleep-deprived, their metabolic rate begins to fall.
Increased wakefulness leads to elevated levels of cortisol, the so-called “fight or flight” hormone.
This leads to increased levels of ghrelin, the hormone that tells us to eat, and a decrease in leptin, the hormone that tells us we’re full.
Patients begin to crave high-fat, high-carbohydrate foods, which elevates their serotonin levels.
Along the way, Breus adds, patients become more likely to develop atrial fibrillation, a common form of arrhythmia, and refractory hypertension, a type of hypertension that does not respond well to medication.
comorbidities  risk  progression  obesity  cortisol  ghrelin  endocrine  OSA  obstructive  sleep  apnea  CPAP  continuous  positive  airway  pressure  cost  benefit  healthcare  adherence 
july 2016 by Michael.Massing
CPAP Compliance—Fact and Fiction - Sleep Review
After a CPAP trial,48 70% to 80% of patients accept CPAP and 5% to 37% of those will eventually abandon CPAP. Lack of benefit was the main reason for abandoning CPAP in 25% of patients.66 Other reasons included anxiety, inconvenience, noise, difficulty falling asleep, mask discomfort, frequent nocturnal awakenings, and partner complaints.40 Price was a problem in 28% of patients and 10% stopped using CPAP mostly because of financial problems.63,67 Side effects were reported equally in both compliant and noncompliant patients. It seems that tolerance of these side effects is lower in patients with mild OSA (AHI <15).17

Compliance with CPAP usage with regard to patients with OSA may not be lower than in other diseases. It is known that compliance with inhalers in bronchial asthma and medication in hypertension is less than 50%.68,69 In a study70 of patients prescribed long-term supplemental oxygen of more than 15 hours per day, the compliance rate was only 45%. Epileptic patients were compliant with their medication only 39% of the time71 and similar results were noted with other chronic diseases.

A presumed CPAP compliance of well over 50%, at least in Europe, seems better than compliance for most chronic diseases.47 An important point is that it is much more convenient to take a tablet or use an inhaler than to use CPAP all night every night. To have to use CPAP “appears to be a life sentence to a bulky, unsightly, external appendage, rather like a colostomy bag—it may be necessary but it certainly isn’t romantic.”72 Nevertheless, while CPAP compliance can be improved, it may not be “low” after all.
OSA  obstructive  sleep  apnea  CPAP  continuous  positive  airway  pressure  cost  benefit  healthcare  adherence  flexible  bilevel  auto-CPAP  APAP 
july 2016 by Michael.Massing
CPAP Compliance, What is this stuff? - Sound Oxygen Service
There have been several studies showing that the medical costs of a patient with OSA drop by about 50% if they are compliant with their CPAP machine....

We will work with you to get you through your compliance period and beyond. As a matter of fact Sound Oxygen Service has a compliance rate of over 90%. The industry status quo has shown to have a compliance rate of as little as 40% in some places.

We go the extra mile so you don’t have to

Getting you compliant is what we do. Whether we have to set you up at your home, fit you with a new mask, come and show you how to fit your mask, or come and re-teach how the machine works; we will help you become compliant and get the most out of your CPAP therapy.
OSA  obstructive  sleep  apnea  CPAP  continuous  positive  airway  pressure  cost  benefit  healthcare  adherence  service  value-added 
july 2016 by Michael.Massing
Muhammad Ali’s peaceful death, surrounded by family and not doctors, shows his bravery in his final fight.
Most patients over 75 years old with one of many serious underlying medical problems have less than a 10 percent chance of surviving CPR. For octogenarians living in nursing homes or other skilled care facilities with even moderate cognitive disabilities, those suffering from a stroke, metastatic cancer, major trauma, or septic shock (which Ali developed), the survival rate is less than 2 percent. By 85 years of age, such patients have less than a 1 percent chance of survival. The few that do survive often die on respirators after prolonged stays in intensive care units. Yet sadly, patients such as these frequently receive CPR, which, if the patient has any brain function, is about as painful a procedure as one can possibly imagine. It often saddens me that the last substance to enter a patient’s bloodstream is a heart stimulant rather than medication to ease pain and suffering.
death  CPR  risk  benefit  aging  heroic  measures  intervention  mortality  dying  Muhammad  Ali  earnest  healthcare  hospitalization  institutionalization  palliative  care 
june 2016 by Michael.Massing
D-is-for-Diabetes: Medicare's Competitive Bidding Program Puts Beneficiaries' Lives at Risk
The Forum built upon the GAO's analysis by examining access to diabetes testing supplies for Medicare beneficiaries living with diabetes and requiring insulin therapy.  Working with some of the nation's leading endocrinologists,* the Forum's study found that the Competitive Bidding Program disrupted beneficiaries' ability to access diabetes testing supplies, and this disruption was associated with an increase in mortality, higher hospitalization rates and inpatient costs.

"Self-monitoring blood glucose supplies are a critical component of diabetes care among insulin-treated individuals and the value of safe, effective testing supplies cannot be underestimated," said Jaime Davidson, M.D., clinical professor of Medicine at the University of Texas Southwestern Medical Center, and an author of the study. "We are particularly concerned about the disruption we detected in our analysis given the predominant use of rapid- and short-acting insulin by Medicare beneficiaries, who are at significantly greater risk for hypoglycemia than younger individuals with insulin-treated diabetes."

"We are troubled that CMS failed to detect these 'unintended' consequences and, instead, reported that the program was a success," said Gary A. Puckrein, Ph.D., president and CEO of the National Minority Quality Forum and a study author. "Based on our findings and employing the safety monitoring protocols commonly used to protect human subjects, we believe policymakers should immediately suspend the program until CMS can demonstrate its ability to effectively monitor the effects of the program, correct the structural flaws causing this problem and ensure that the lives of America's greatest generation are no longer at risk." 

The ahead of print article "Impact of CMS Competitive Bidding Program on Medicare Beneficiary Safety and Access to Diabetes Testing Supplies: A Retrospective, Longitudinal Analysis" can be found online: Impact of CMS Competitive Bidding Program on Medicare Beneficiary Safety and Access to Diabetes Testing Supplies: A Retrospective, Longitudinal Analysis . The full article will also be published here: http://dx.doi.org/10.2337/dc15-1264.
watchdog  diabetes  insulin-dependent  SMBG  supplies  cost  benefit  mortality  hospitalization  competitive  bidding  Medicare  in  vivo  situ  human  peer-reviewed  research  health  disparities  healthcare 
may 2016 by Michael.Massing
The Healthcare Hashtag Project
@ShereesePubHlth @jamesian @CecilyWest @BitHealth @symplur Let's just say you should :) EXCELLENT resource #hcsm
healthcare  hashtag  reference  social  media  hcsm 
january 2016 by Michael.Massing
Monthly Breakfast Meet-ups - Healthcare in Social Media CT Meetup Group (Hartford, CT) - Meetup
We host regularly tweet chats every Wednesday at 3pm EST. Join us! You can find us on twitter, by using the hash tag #hcscmt
#hcsm  #hcsmCT  SoMe  media  healthcare  CT  care  social  health 
january 2015 by Michael.Massing
JAMA Network | JAMA | The Anatomy of Medical Research:  US and International Comparisons
RT : And oh btw China, has tripled health research $ in last decade; US research funding growing at approx zero %.
healthcare  from twitter
january 2015 by Michael.Massing
“Us” vs “them”: the under-served patient speaks up | Heart Sisters
“If healthcare conferences are going to host panel discussions about serving the under-served, can you invite people to speak who have nothing but a voice?
medical  disparities  poverty  healthcare  identity  service  ownership  empowerment  health  care  stakeholders  paternalism 
january 2015 by Michael.Massing
Lessons In the Art of Dying | Health | Washingtonian
“You might lay out how debilitating and expensive an intervention is likely to be when it will have only marginal benefit,” I say. “When you’ve established a therapeutic relationship, it is surprisingly easy to have that discussion. When you can honestly explain that only 8 percent of patients who have CPR survive more than a month, then patients can tell you they’ve had enough. What typically happens, though, is that patients aren’t asked if they want more treatment. It’s forced on them by medical staff or family members who mistakenly urge them to ‘fight.’ ”
healthcare  dying  mortality  treatment  doctor  patient  medicine  empathy  training  education  medical 
march 2014 by Michael.Massing
[no title]
RT @endocrine_witch: Institute of Medicine paper on health literacy & patient outcomes #HealthXPh @cebumd @giasison @bonedoc @PhRheumaJr
health  outcomes  healthcare  correlation  risk  benefit  literacy  HealthXPh 
february 2014 by Michael.Massing
30 Years Later, a Landmark Study Lives On: Diabetes Forecast Magazine
The trial ended about a year early because the results were so clear-cut. The risk of the development and progression of complications was significantly lower in the intensive therapy group; members had less than half the risk of developing retinopathy, nephropathy (kidney disease), and neuropathy (nerve damage).

Almost all of the benefit was accounted for by the difference in A1C levels between the two treatment groups. "You didn't have to get to a magic number to see benefit," says Gayle Lorenzi, RN, CDE, study coordinator at the University of California–San Diego. "Any improvement in glucose control resulted in risk lowering. If you went from an A1C of 10 percent to an 8, risk was still reduced."

The benefits weren't limited to those in perfect health at the study's start. The thinking used to be that once a patient had signs of complications, the damage would inevitably worsen, says Rose Gubitosi-Klug, MD, PhD, principal investigator at Case Western Reserve University. But DCCT showed that "even if you have complications, you can slow the progression," she says....

And though we now know intensive glucose control reduces the risk of complications, the health care system doesn't provide free, high-level care like the intensive group received. Many people see just a single provider for two to four visits a year.
diabetes  type  1  tight  control  intervention  behavioral  peer-reviewed  research  clinical  in  vivo  human  randomized  controlled  trial  self  care  blood  glucose  management  T1D  ethics  standard  of  healthcare  DCCT  behavior  treatment  benefit  self-monitored  monitoring  SMBG  retinopathy  nephropathy  risk  mitigation  prevention  symptoms  late-stage  complications  situ 
february 2014 by Michael.Massing
Will young invincibles buy into the ACA? | OUPblog
Persuading young people to reject coverage may be a difficult sell, however. Polling has found that young people “’value health insurance but cannot afford it.’” In a Kaiser Family Foundation poll, only a quarter of respondents between ages 18 and 30 said they were healthy enough not to need health insurance.
individual  mandate  demographics  Obamacare  ACA  PPACA  Affordable  Care  Act  young  invincibles  healthcare  economics  value  affordability  subsidies  research  social  politics 
october 2013 by Michael.Massing
Medicaid expansion gap could leave poor shortchanged
Many of the states not expanding, such as Mississippi, Louisiana and Alabama, have some of the highest chronic disease rates in the country, said Georges Benjamin, executive director at the American Public Health Association, an advocacy group for improving public health. Benjamin said between 18,000 to 44,000 people die prematurely every year because they don't have insurance. As a former emergency room doctor, he watched people come in because they had blood in their stools, which can be a sign of early cancer, but he knew they would not be able to afford follow-up care. Or people would come in with new-onset diabetes, but they have no regular source of care, and finding a doctor when a patient doesn't have insurance can be impossible.

"They could have a little ache, but they're not insured, so they can't afford care, so they delay going in and it ends badly," he said. "All of those scenarios I've seen repeatedly."

But that doesn't mean individuals shouldn't look for other alternatives — or for coverage for family members who may be eligible.

"Go to the exchange," Benjamin said. "Find out what you're eligible for. You may be eligible for existing Medicaid and not know it."

Those who don't go to the exchanges may find clinics that receive funding from the government to care for the uninsured, and may offer either free services or a sliding-fee schedule, he said. State and local health departments may also have niche care available, such as for tuberculosis, mental health or substance abuse.
Medicaid  gap  expansion  state  opt-out  Obamacare  ACA  PPACA  Affordable  Care  Act  insurance  correlation  healthcare  policy  diabetes  chronic  disease  prevention  intervention 
october 2013 by Michael.Massing
Medicaid gap to hit local clinics, hospitals | Pensacola News Journal | pnj.com
Pensacola area health care leaders say the state’s action not only will exclude several thousand uninsured local residents from coverage, but it also will cost this community jobs.

A recent study by researchers at the University of Florida concluded the Medicaid expansion would have created an average of 1,619 full-time and part-time jobs in Escambia County annually over the next 10 years.

The decision to opt out of Medicaid expansion will hit Escambia Community Clinics Inc. hardest.

The clinic has a staff of 120 physicians and its $13.8 million annual operating budget is funded by Escambia County, Baptist and Sacred Heart hospitals, and federal Medicare and Medicaid reimbursements.

“The consequence of Florida not doing the expansion is that the some 40,000 uninsured patients we see at the clinic on an annual basis will remain uninsured,” said Don Turner, executive director of the clinic.

“If they were insured through Medicaid expansion, that 40,000 visits would bring about $4 million more a year to this organization,” he said.
Obamacare  ACA  PPACA  Florida  Medicaid  expansion  opt-out  healthcare  economics  politics  resentment  spite 
october 2013 by Michael.Massing
MRSA: Methicillin-resistant Staphylococcus aureus Anita K Curvin, March 25, 2008
How can you help prevent the spread of MRSA?
1. Careful hand washing remains your best defense against germs. Scrub hands for at least 15 seconds with warm water or use hand sanitizer containing at least 62 % alcohol for times when you don't have access to soap and water.
2. Avoid sharing personal items (towels, sheets, razors, and clothing). MRSA can spread through contaminated objects as well as through direct contact.
3. Keep cuts and abrasions clean and covered with bandages until healed. The pus from infected sores may contain MRSA and keeping wounds covered will help keep the bacteria from spreading.
4. When you're prescribed an antibiotic, finish all of the doses, even if the infection is getting better. Don't share antibiotics with others or save unfinished antibiotics for another time. Inappropriate use of antibiotics, (not finishing the prescribe amount or overuse) can contribute to resistance of bacteria.
MRSA  risk  healthcare  transmission  infection  colonization  prevalence  incidence  morbidity  prevention  prophylaxis  hygiene  wound  care 
august 2013 by Michael.Massing
Methicillin Resistant Staphylococcus Aureus (MRSA)
Colonies of Staphylococcus aureus are found in the nose, armpits, groin, and on the skin of about 20% to 30% of healthy adults; about 80% of all people may be colonized with the organism at various times but not consistently (Herchline). Hospitalized individuals, hospital personnel, and healthcare workers generally have higher rates of Staphylococcus aureus colonization (Herchline). Although the presence of the organism does not result in disease in the majority of individuals, it may more easily overwhelm the immune system and cause infection in those who have an existing skin injury, other significant injury, chronic illness such as diabetes, or whose immune system function is compromised (immunosuppression).
MRSA  risk  healthcare  transmission  infection  colonization  prevalence  incidence  morbidity  mortality 
august 2013 by Michael.Massing
Medscape Nurses Questions About MRSA and Answers From the Experts Laura Stokowski, RN Nov 01, 2006
What precautions should healthcare workers, such as nurses, take if they have been treated for an MRSA infection? Is it safe for them to continue taking care of patients?
Nurses and other healthcare workers who do not have active infections or who have wounds that can be covered and controlled with dressings are permitted to work. Colonization alone does not prevent healthcare workers from working unless they are epidemiologically linked to transmission of an infection. The new HICPAC guideline recommends obtaining cultures of healthcare personnel for target MDROs only when there is epidemiologic evidence linking the healthcare staff member to ongoing transmission.
MRSA  risk  healthcare  transmission  infection  colonization 
august 2013 by Michael.Massing
There won’t be any GOP alternative to Obamacare
RT : WashPost | There won’t be a GOP alternative to because cornered Rs now oppose insurance itself.
Obamacare  ACA  PPACA  healthcare  reform  health  insurance  exchange  marketplace  from twitter
august 2013 by Michael.Massing
Study: Half who now buy health insurance to get subsidy | Hawaii Tribune Herald
The tax credits, available on a sliding scale based on family income, will be offered to people who don’t have access to affordable coverage through their jobs and buy policies through the new state markets.

Those making between 100-400 percent of the federal poverty level — between $11,500 and $46,000 for an individual and $23,550 and $94,200 for a family of four — are eligible for some level of help.

Families on the low end of the scale will pay 2 percent of their income for a benchmark plan, while those on the upper end will pay 9.5 percent.

It’s expected that a clear majority of customers in the new markets will be eligible for tax credits. That’s because the pool will also include uninsured people, who tend to have lower incomes than those who can currently afford to buy their own coverage. The share will vary from state to state.

HHS Secretary Kathleen Sebelius recently estimated that in Texas, as many as 9 in 10 people buying coverage in the new market will get a break on costs.
Obamacare  ACA  PPACA  healthcare  health  insurance  exchange  marketplace  premium  cost  estimate  subsidy  Silver  individual  private  income  threshold  criterion  from twitter
august 2013 by Michael.Massing
Florida Pharmacists Win $597 Million Blowing Whistle on Scheme - Bloomberg
RT : Truly appalling, and sadly what we all expected. Bloomberg | Pharmacists Win $597M Blowing Whistle on .
Pharma  healthcare  reform  from twitter
august 2013 by Michael.Massing
Health Industry Begins Marketing Blitz To Educate About Obamacare - Forbes
RT : How about educating GOP too? / Forbes | Health Industry Begins Marketing Blitz To Educate About .
Obamacare  ACA  PPACA  healthcare  reform  health  insurance  exchange  marketplace  from twitter
july 2013 by Michael.Massing
The Obamacare ad wars begin : Columbia Journalism Review
RT : Columbia Journalism Rvw | ad from conservatives scores low on honesty & reporters have noticed.
Obamacare  ACA  PPACA  healthcare  reform  health  insurance  exchange  marketplace  from twitter
july 2013 by Michael.Massing
Do Lifestyle Changes Reduce Serious Outcomes in Diabetes? — NEJM
The participants who received intensive lifestyle modifications experienced other benefits when compared to the diabetes education and support group, including decreased depressive symptoms, less self-reported retinopathy, and decreased risk of kidney disease. Compared to the diabetes support and education group, the intensive lifestyle intervention reduced the average number of hospitalizations per year and the average number of medications per year. Hospitalizations were reduced by 11.9% from 0.193 to 0.17 hospitalizations per year, which translated into savings of $294 per year and $2,600 discounted over 10 years. Moreover, the number of medications was reduced by 6.3% from 4.9 to 4.6 medications per year, translating into a savings of $278 per year and $2,487 discounted over 10 years. Average costs per year were $8,807 for the control group vs. $8,205 for the intervention group, leading to a significant reduction of $602 per year and $5,378 discounted over 10 years. Significant reductions in hospitalizations occurred mainly among CV and pulmonary hospitalization, and significant reductions in medications occurred mainly among diabetes, lipid-lowering and antihypertensive medications. The study ultimately shows that obese or overweight people with type 2 diabetes should increase the amount that they exercise and increase their weight loss.
peer-reviewed  research  cardiovascular  risk  diabetes  obesity  human  in  vivo  physical  activity  type  2  T2D  correlation  support  treatment  self  care  education  depression  comorbidities  intensive  lifestyle  intervention  retinopathy  kidney  disease  hospitalization  morbidity  healthcare  cost  economics  harm  reduction  behavioral  change  management  behavior  tight  control  exercise  body  fat  clinical  trial  stress  distress  factor  therapy  etiology  mitigation  prevention  symptoms  late-stage  complications  benefit  situ 
june 2013 by Michael.Massing
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