1,200 people are admitted to the hospital due to asthma.
9 people die from asthma.
The
sad fact is that none or very little of this needs to happen. What is obvious is that patients are not being
taught how to live with and manage these common condition. The facts on how to regulate a diabetic's
blood sugar have been around since the 80s and so has the prevention of asthma
attacks. Yet teaching patients these
facts and getting them to modify their lifestyles accordingly can be time
consuming and expensive and beyond the scope of the typical 12 minute doctor's
office visit. Besides, before ObamaCare
there was no financial incentive to treat a patient after they left the
doctor's office. Evidence pointed to the
fact that patients with chronic illnesses were suffering from a disjointed,
fragmented lack of care
And
you can't blame the patient. Care
instructions to patients with a non-medical background can sound complicated,
confusing and downright scary. "You just
take the syringe like this, see, and plunge it into your thigh!" They don't even know which questions to
ask. Worse, diabetic coma, insulin
shock and asthma attacks can happen quickly and at the worst times. If the patient can reach the doctor's office they
are advised to come in for an appointment or to call 911. Or if the doctor's office is closed, again,
no instructions or reassurance and the brain fog is rapidly approaching. Left to their own devises, what can the
patient do but reach for the phone? What
the chronically ill patient clearly needs is coordinated high quality care,
education and advice on a 24/7 basic.
Solution: The Case Manager
Modeling the program after techniques devised by health maintenance organizations like Kaiser Permanente and Humana to manage the care of their patients, after the first of the year, Medicare will pay 46$ a month for managed health care for each patient. Patients need to have two or more chronic conditions like diabetes and obesity or asthma and depression.
Drafting a comprehensive plan of care for the patient and having the patient sign a release for use of electronic records, federal rules then guarantee these patients access to health care providers 24 hours a day, seven days a week to deal with "urgent chronic care needs."
"Paying separately for chronic care management services is a significant policy change," said Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services. Officials said such care coordination could pay for itself by keeping patients healthier and out of hospitals." (CMS.gov)
And guess who these Care Managers are? Again, our Nurse Practioners and Physicians Assistants. I learned about this program the hard way. Early December of last year, I had a cold for about four days. Full of mucus, coughing and congested even after taking over-the-counter
decongestants,
one night around one AM I couldn't breathe! By the time I arrived at Emergency, my chest
and neck muscles were heaving in contortions, my lips were blue, and the
oximeter on my finger registered my O2 level in the high seventies. Low seventies and you're unconscious.
In
due time, IV cortisone soothed my inflamed lungs, Magnesium eased the muscle
spasms, and 8 liters of Oxygen brought my O2 levels up to the 90s as did sessions
of inhalation therapy. An MRI proved I
did not have pneumonia. What I had, the emergency room doctor told me
was "A condition that prevented my lungs from processing enough oxygen out of
the air to sustain my body." A viral
thing, there was nothing they could give me.
I just had to stay on Oxygen until my lungs healed, or not? It could take a few months!
Admitted
to the hospital, I sank in and out of sleep while I continued to get IV
cortisone, O2 and inhalation therapy sessions.
Awake I was too weak to make it to the bathroom alone or to sip the tea
on my breakfast tray. At 11AM I was in
for a rude awakening. In came the
feistiest doctor I have ever met. My
medical group's Hospitalist.
"You
gotta go home," he said. "You can't stay
here. It's dangerous. We're admitting
flu patients and if you get the flu in your condition you could die!" I stared at him. Did he understand that I couldn't even make
it to the bathroom alone? That I
couldn't breathe if I lay down? "But
what happened?" I asked. I've never been sick in my life. I didn't take any medications and swam 25
laps a day. But he was not one to
answer questions. Speaking to my
daughter, he handed her a bunch of prescriptions and suddenly I was blinking in
the sunlight, sitting in a wheelchair hooked up to an oxygen tank.
Soon I was uneasy in my easy chair hooked to an oxygen generator while my daughter, assuming I had had an allergic attack had my son ripping out all the old carpeting in my bedroom and shoving it out the bedroom windows.
That's when the phone rang and I first spoke to Christine, my case manager. We spoke for over an hour and she answered all my questions.
(Note: You can view every article as one long page if you sign up as an Advocate Member, or higher).
