Thursday, May 31, 2012

Oh, Boy! It's Gonna Be One Of Those Days!

TWO hearings today, plus a short visit from a friend and then a conference call with a potential funder.  I have no clue how I am supposed to manage all this.  So I think I'll start with something I can manage -- the news.

MUST READDr. Pauline Chen talks about the problems patients have talking to their doctors, asking questions, mulling the research, seeking guidance. This must change, especially for people with chronic illnesses.  We are forced to manage our own care to a large extent, at least in between doctor visits.  So we need to understand.  And that means we have to be able to ask questions.  If your doctor gives you a hard time, bring a copy of this essay with you.  It's so right, so important.  If you read nothing else today, please read this!

The Social Security disability trust fund will be broke in 4 years.   This is astonishing and terrifying, at once.  And Congress does not appear to be interested in figuring out a solution, either.  Once the payroll tax doesn't cover the cost, the remaining reserves will pay only 79% of benefits -- a decrease of 21% for people already teetering on the brink of poverty.  Here's something to talk to your member of Congress about.

We're doing so many appeal hearings this week, most of which relate to mental health care.  So this article is timely.  Psychiatric patients who go to an ER for help languish there, sometimes for days, because there are so few inpatient psych beds left.  It cannot be healthy for a patient to sit in an ER exam room for a day or two waiting for a bed.  Nor is it good for patients to be turned away because they have nowhere to go.  On the other end, we see insurers doing all they can to limit mental health services -- terminating coverage of residential care only two weeks after a suicide attempt; refusing any residential care to a young girl who is violent and cannot be controlled; cutting off residential care for a patient in the last phase of her treatment plan, sparking an immediate and very serious relapse.  We have to figure out what we're going to do about mental health care in America.  It's not enough to pass laws requiring mental health parity if those laws are not going to be enforced.  This is a very serious problem that weighs heavily on me.

Medi-Cal -- Medicaid in California -- works for most enrollees.  However, there are problems finding doctors enrolled in the program, and recipients use the ER more often than patients with commercial insurance.  In Oregon, a new experiment with Medicaid sounds really exciting.  Each region of the state will get a coordinated care organization, umbrellas containing all of the core providers -- hospitals, doctors, mental health providers, dentists -- and patients can go wherever they want within that umbrella.  There also will be case managers to help coordinate care and counsel patients on their options.  The coordinated care organization will be paid a lump sum to care for each patient.  The hope is that this will save money and improve patient care.  There's always the concern with these kinds of managed care arrangements that there will be an incentive for the provider to provide less care -- you get paid $20/month to care for me, whether you see me once or you see me 5 times, meaning you make more money if you see me as little as possible.  Hopefully, though, Oregon will build protections into the program to avoid creating those incentives.

Finally!  An excuse not to exercise!  A new study says exercise may be bad for your heart.  Don't get too excited -- the problems were seen in only 10 percent of patients.  In general, exercise is a good thing.  Indeed, the researchers caution that nobody should see this as an excuse not to exercise.  Of course, that was my first reaction!

And there you go, the morning's news.  Have a great day.  Wish me luck!  Jennifer

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