Top Tips for a Successful Hospital Stay
Going to the hospital is certainly not something anyone generally plans on or looks forward to; however, if the time arrives when you do have to stay at a hospital for any length of time, there are definitely things you can do to make that stay less stressful and your recovery as successful as possible.
1. Reduce your stress by working with your insurance company ahead of time to let them know what procedures/tests you’re going for and determine what is covered and/or pre-approved.
2. Make sure you’ve notified business associates and family/friends about how long you’ll be absent, what obligations you’ll be unable to fulfill, and what your desires are for visitors during your stay.
3. Have required documentation and forms with you when checking in. This includes:
a. Personal photo ID
b. Health insurance cards
c. List of medications (prescription and non-prescription)
d. List of supplements (including herbs and vitamins)
e. Health Proxy forms and Advance Directives
4. Bring personal grooming items and cases for such things as glasses, hearing aids, and dentures.
5. Get to know the nursing staff and aids taking care of you; forming a rapport with these professionals can only benefit you in the long run with your care and progress.
6. Remember that you are the one in control of your treatment decisions. It’s fine to ask for a second opinion, if you feel it’s warranted. If you’re not comfortable with any treatments or procedures, do your due diligence before deciding to refuse the treatment.
7. Be your own advocate or have someone with you who can be, if you’re indisposed; make sure everyone is informed.
8. Be knowledgeable…don’t strictly rely on information given to you by others; know enough to ask good and appropriate questions…and don’t be afraid to ask them. Know your patient rights.
9. Communication (as always) is key, as in any “relationship”. Ask questions…find out who you can ask questions of when you have them; ask about your tests or procedure…what it will feel like, if there are risks and if so, are there alternatives.
10. Continue communicating as you are getting ready to be discharged. Know:
a. How long your recovery should be
b. The kind of care you will need
c. What medication you’ll need to continue taking and which to stop
d. Signs that your recovery isn’t progressing and when you need to see the doctor
e. Resources for help you may need and/or medical equipment necessary for recovery
11. Most importantly, keep a positive attitude and outlook for a healthy outcome!
Affordable Care Act of 2010 and Young Adults
For millions of Americans, the Affordable Care Act is a very timely and long-awaited action by our legislature. The group that is, perhaps, the most greatly affected is young adults between the ages of 19 and 26. Estimates by the U.S. Department of Health and Human Services are that 2.37 million will be impacted by this new reform, nearly two million of which are not currently insured.
Although just 17 percent of our overall population is made up of this segmented age group, they represent 30 percent of the total 46 million citizens under the age of 65 who are currently uninsured. One of the obvious reasons for this lopsided statistic is that the unemployment rate for the age group 20-24 has risen over the past year to approximately 17.2 percent. The other major contributor is that young adults are most frequently in employment situations where they are not afforded access to employer-based insurance, i.e. part-time jobs, entry-level jobs or jobs in small businesses.
Although many insurance plans made provisions to institute the new changes early in order to accommodate graduating students and avoid lapses in coverage between graduation and the Act’s September 23 effective date, if a plan did not offer that option, things are now in full swing.
To clarify, the definition of a “child” covered under this provision is:
“…an individual who is a son, daughter, stepson, or stepdaughter of the employee, and a child include both a legally-adopted individual of the employee and an individual who is lawfully placed with the employee for legal adoption by the employee. The term also includes an “eligible foster child” who has been placed with the employee by an authorized placement agency or by judgment, decree, or other order of any court.”
The Act requires coverage be offered for these adult children even if they no longer live with the parent, are not dependents on the parents’ tax returns or are not students. The adult children can be married or unmarried. If married, the coverage requirements do not extend to the spouses or children of the adult child.
Currently, the Affordable Care Act requires that an adult child take health insurance that is offered on his or her job instead of staying on a parent’s plan. However, effective in 2014, it is the option of the adult child to stay on a parent’s plan until age 26, even if offered health insurance through a job.
A couple of other provisions of the Act are that self-insured health plans must also adhere to these requirements; and if a plan does not currently offer dependent coverage, it is not a stipulation that it do so.
In explanation of how enrollment should be handled, the following is taken from the White House Fact Sheet regarding this Act provision:
All Eligible Young Adults Will Have A Special Enrollment Opportunity
For plan or policy years beginning on or after September 23, 2010, plans and issuers must give children who qualify an opportunity to enroll that continues for at least 30 days regardless of whether the plan or coverage offers an open enrollment period. This enrollment opportunity and a written notice must be provided not later than the first day of the first plan or policy year beginning on or after September 23, 2010. The new policy does not otherwise change the enrollment period or start of the plan or policy year.
Another important point in the Act provision detailed in the fact sheet is:
The value of the employer-provided health coverage is excluded from the employee’s income for the entire taxable year in which the child turns 26. Thus, if a child turns 26 in March but stays on the plan through December 31st (the end of most people’s taxable year), all health benefits provided that year are excluded for income tax purposes.
If you have other questions regarding this new Act and how it applies to adult children up to age 26, there is great information at these links:
United States Department of Labor FAQs
National Conference of State Legislatures Table of State Laws
The Commonwealth Fund’s Brief – Rites of Passage: Young Adults and the Affordable Care Act of 2010
Home Health Models and Case Management
A recent (2009) study by the Group Health Cooperative assessed the impact of a new health care model…the medical home model. The foundation of this model includes not only more quality time with physicians, but the added benefits of technology (electronic medical records), encouraged caregiver support, a health care “team”, and preventative care. According to an article at healthcareit.com, this care model
“…is a way that is expected to improve health outcomes, control costs, and help deal with the growing shortage of primary care physicians.”
Sound familiar? Improved health outcomes and controlled costs are all part of the benefits of case management involvement with patients, in particular those with chronic conditions or serious care issues (cancer, diabetes, premature births, and respiratory diseases). Brought in as part of a home health model, case managers can be valuable members of these new teams.
Addressing the needs of patients with chronic conditions is by far one of the most urgent goals of today’s health care system. Today seven out of ten deaths in the United States are attributable to a chronic illness and 75 percent of health care dollars are spent in treating these diseases. With the right team of health care professionals and incentives in place that will reward them for improvements in the health of their patients, medical home health models could be a much-needed answer to at least one prayer for rectifying what ails our current health care system.
Treating chronic illnesses is not always easy for a typical primary care physician’s office, which is one aspect of why the home health model appears to be advantageous at this point in time. These offices are often ill-equipped to carry out a full-blown, ongoing care program. For these reasons, in a home health model, the physicians are joined by teams that can take up where the doctors leave off in caring for the patient with an immediate health issue. These teams (nutritionists, case managers, etc.) can provide ongoing attention and education for chronically ill patients and their care givers that hopefully, down the road, will result in reductions in office and hospital visits.
This health care model is gaining popularity and is being utilized in at least 17 states across the country. Some programs, such as two currently under way in Vermont, get grants from the state to support the pulling together of the necessary teams.
Coordinating this care management so that the outcomes are increasingly positive was one of the topics addressed at the 8th Annual Health Care Quality World Congress in Boston in August. Keeping the care programs patient centered can’t be stressed enough in assuring that the outcomes and cost savings are realized in the end. With the skills and expertise of case managers added to the medical home health teams, transitions of care, along with patient/care giver education and support, are highlighted; and those improved outcomes that are being looked for begin to show up.
Health-Related Definitions Important to Patient Advocacy
In our last blog, we discussed health care reform and the recently passed Patient Protection and Affordable Care Act. The NTOCC (National Transitions of Care Coalition) and the CMSA (Case Management Society of America) worked diligently to positively affect the outcome of health care reform, most specifically in the area of transitions of care.
While transitions of care is one of the most critical aspects of case management that can improve patient care and well being, while also keeping a handle on costs, one of the other important elements of patient recovery that should be encouraged and supported is patient advocacy. Helping patients learn about and understand their disease, as well as how to speak up for themselves while hospitalized or when transitioning to rehab and/or home, is crucial.
In order to accomplish this, a basic requirement is that patients know and understand terminology that is used during their hospital stay, in regards to their treatment, and throughout their transition to a new location and level of care.
There is a great amount of very helpful information and tools on the NTOCC website that can make a patient’s course of treatment and doctor visits flow much easier and increase the benefits that can be realized. To help along the way, here are definitions taken from the NTOCC site (as well as the toolkit) that will, hopefully, dispel some confusion for patients and their caregivers, which should, in turn, help them to be more knowledgeable advocates for themselves during their treatment program and after.
ADVANCE DIRECTIVE – A legal document that tells your choices about the health care you would or would not want if you became unable to decide for yourself. An advance directive comes in two forms: Power of Attorney for Health Care and Living Will.
ACUTE ILLNESS – Illness or injury that lasts a short time.
CASE MANAGER – Case managers work with people to get the health care and other community services they need, when they need them, and for the best value.
CHRONIC ILLNESS – Illness that lasts a long time or throughout a person’s life. Chronic illnesses can be diagnosed in both children and adults and can often be managed with a variety of treatments.
EVIDENCE-BASED MEDICINE (EBM)- Medical treatments which have been shown by high-quality, published research to have the best results. EBM is practiced by clinicians to give each patient the most effective care and treatment possible, based on national standards and up-to-date medical research.
HOSPITALIST – Doctor whose primary professional focus is the general medical care of hospitalized patients. Activities include patient care, teaching, research, and leadership related to hospital medicine.
MEDICAL ERROR – Any preventable event (such as a mistake related to medication, a mistake in diagnosing or treating a condition, or a problem with medical equipment) that may cause or lead to unintended outcome or patient harm.
NURSE PRACTITIONER – Registered nurses who are prepared, through advanced education and clinical training, to provide a wide range of preventive and acute health care services to individuals of all ages.
NPs take health histories and provide complete physical examinations; diagnose and treat many common acute and chronic problems; interpret laboratory results and X-rays; prescribe and manage medications and other therapies; provide health teaching and supportive counseling with an emphasis on prevention of illness and health maintenance; and refer patients to other health professionals as needed.
PAIN INTENSITY SCALE – A communication tool to help patients explain the pain they are experiencing using pictures or other standard terms.
PALLIATIVE CARE – Serious illnesses can cause physical symptoms, such as pain, nausea, or fatigue. You may also have psychological symptoms like depression or anxiety. The treatments for your disease may cause symptoms or side effects. Palliative care relieves symptoms without curing your disease.
PATIENT ADVOCATE – A person who helps a patient work with others who have an effect on the patient’s health, including doctors, insurance companies, employers, case managers, and lawyers. A patient advocate helps resolve issues about health care, medical bills, and job discrimination related to a patient’s medical condition.
PATIENT AND FAMILY-CENTERED CARE – An innovative approach to health care that is grounded in effective partnerships among health care patients, families, and providers. Patient- and family-centered care applies to patients of all ages, and it may be practiced in any health care setting.
PHYSICIAN ASSISTANT – Health professionals who practice medicine as members of a team with their supervising physicians. PAs deliver a broad range of medical and surgical services to diverse populations in rural and urban settings. As part of their comprehensive responsibilities, PAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, and prescribe medications.
Case Management and the Patient Protection and Affordable Care Act
Patient Protection and Affordable Care Act…the title of the health care reform act that has been passed sounds a lot like the goals towards which case managers work every day. The Case Management Model Act of 2009 makes it clear that part of a case manager’s responsibility is to “promote optimal Consumer [patient] safety”, along with being aware of and enlisting resources or programs that can better help the patient, in turn helping costs stay down.
There is a lot of excitement within the case management arena in regards to the future of case management as an elevated career path for nurses and others looking for health care positions, as well as its future as an integral part of the success of health care reform. In an interview regarding the future of case management and its relation to the Patient Protection and Affordable Care Act, Jo Carter, Chair of the Commission for Case Manager Certification, stated…
“…what we see in the Act is that we’ll be utilizing case managers in more and more settings”.
She also commented,
“…When the programs are expanded under the bill, they’re going to be utilizing case management as a central component of the way they operate.”
When asked about the language within the Patient Protection and Affordable Care Act that was specific to case management, Ms. Carter answered…
“There are various provisions of the Act that refer to care coordination and case management. There are things that are specific parts of the Act, like the establishment of outcomes-based measures, that don’t mention care coordination and case management specifically but how those will get carried out through care coordination and case management”.
An area of care that is a cornerstone of case management is transition of care. The National Transitions of Care Coalition (in which the Case Management Society of America is a major player) helped to bring much needed attention to this function, as did the CMSA and the Case Management Model Act of 2009. Care coordination and transition of care outcomes will undoubtedly play a vital part in health care reform, which is where the skills and expertise of case managers can have a major impact.
Obviously, case management can greatly affect patient care and safety through its role in care coordination and transitions of care; but this new health reform act is also concerned with affordable care, so making sure patient care is also fiscally responsible is also its focus.
Carol A. Gleason, chair of CMSA’s Public Policy Committee, expressed her thoughts on the subject:
“Because case management promotes cost-effectiveness, it is essential to the success of reform. Case managers know how to maximize services for patients and make sure they are getting everything they are entitled to, based on their insurance coverage, and are transitioning successfully to the next level of care. This is key to reform.”
Case Management and the Patient Protection and Affordable Care Act seem to go hand in hand in their focus on what takes priority in health care and the outlook on how each will impact the other looks very positive.
Presenteeism and the Cost to Employers
As we’ve discussed in previous blog posts, case managers can have a very strong and positive impact on patients and/or parents of patients when transitioning care from a hospital or rehab setting to home. Part of this impact comes in the form of education and support that helps reduce repeated visits to the ER or doctor’s office. This same education and support can help to minimize “presenteeism” on the part of workers with sick children at home or who have chronic illnesses themselves.
Presenteeism, or the issue of workers being present on the job yet not productive, is a growing problem for employers and workers alike today. More and more research is being done on the cost of presenteeism. According to Walter Steward, Ph.D., M.P.H., director of the AdvancePCS Center for Work and Health,
“Most employers know there’s a link between health and productivity, but because the link has been difficult to quantify, they have chosen not to act.”
Information from the American Productivity Audit (APA) spearheaded by Dr. Steward, indicated that lost productive time (LPT) due to health-related issues costs US employers $225.8 billion per year. It’s estimated that over 70% of that time is from lack of productivity while actually “present” on the job. Six percent of that amount is from work absences related to family health matters, as in having to take time for children who are ill.
As continued research and studies are done in relation to the financial drain that presenteeism can cause, many are coming to the same conclusion…that it can have more of an impact on productivity than absenteeism or short-term disability. One such conclusion is that presenteeism can be over seven times more costly than absenteeism, taking into consideration subsequent time off for worsening health issues.
Enter here the case manager! An independent case manager, who can work closely with a family from the health care facility to the home, helps them gain the knowledge necessary for making improved healthy choices in their daily lives. The case manager can educate parents of a sick child on what things to watch for and how to be an advocate for the child, as well as how to be proactive, rather than reactive. Understanding the illness and feeling more in control can free up a parent’s mind when he and/or she has to get back to work, helping them to be more productive on the job. Working with an adult patient (or a young patient who is returning to school) to understand his or her disease or illness in such a way as to stay on top of it as much as possible, enables them to take more preventive steps to stay well and avoid complications down the road or future admissions to the hospital. Feeling confident about their health goes a long way toward preventing presenteeism AND absenteeism!
As stated by researcher Ron Goetzel, PhD, of the Cornell University Institute for Health and Productivity Studies,
“If a company’s health plan is poor, for example, disorders may not be well managed. Workers will continue to work and not be as productive. Employers need to weigh the costs of good medical care against the potential for on-the-job productivity losses, which we see are substantial in many areas.”
In the long run, investing in case management services for employees as part of a healthcare insurance plan, can mean bottom-line savings when assessing the cost of presenteeism in any business.
Employer Benefits 2009 Survey Summary
Health care benefits…health care reform…health care cost increases…all topics very much in the forefront of our lives and the media these days. Over the past 11 years, the Kaiser Family Foundation, along with the Health Research and Educational Trust (HRET), has surveyed non-federal private and public employers with three or more employees to find out what the trends are in our health insurance benefits world.
The survey was done through random selection of firms and included 2,054 companies who responded. Of the over 3,000 companies who were called, the overall response rate was 47%. However, of the 3,188 contacted, 73% did reply to the question as to whether or not a health insurance program was offered to any employees. This number was included in the estimate of what percentage of companies offer insurance (60% in 2009).
In the survey it was found that 46% of the firms with the least number of employees (3-9) offer coverage; of those with 10-24 employees, 75% offer insurance; 87% of businesses with 25-49 employees have coverage; and those companies who have over 50 employees offer insurance coverage 95% of the time. If union workers are employed within the company, the percentage of companies offering insurance is much higher (97% compared to 57%). It’s also more likely for a company with higher wage earners to be offering coverage than one that pays its employees less.
Below are some of the other findings from this survey, which we hope may be of interest in order to see what these employers offered to employees in 2009, as well as a few stats on changes over the past decade.
When comparing health benefit offerings by firm size for the last ten years, the most significant changes were in the firms with 3-9 workers. The number of companies offering health benefits to their employees in this group dropped from 56% to 46%. However, in companies employing 25-99 workers, health benefit offerings actually increased by 1% (from 86% to 87%).
The overall difference was obviously felt most by small firms (3-199 employees), decreasing 6% in ten years (from 65% to 59%), while large firms only decreased by 1% (99% to 98%). In fact, the percentage changes over the last ten years for the large firms never varied more than one percentage point. For all firms (small and large) over that same 10-year period, the decrease was also 6% (66% to 60%).
Health care premiums, although not rising drastically in the year from 2008 to 2009 (5%) have increased for family coverage by 131% in the past ten years; and the amount that the employees are responsible for has increased 128%. Whereas single employees in small firms contribute less than single employees in larger firms (200+), family coverage in small firms was higher than that of large firms.
Most plans have deductibles that need to be met before coverage kicks in and most cover certain services even without the deductible having been met. For instance, in companies with PPO plans, 88% of those covered who have annual deductibles get preventive care paid for prior to deductibles being met. Also, 93% of workers covered by PPOs do not have to meet deductibles in order to have prescriptions paid for. Eighty percent of workers have out-of-pocket maximums they have to pay, though not all plans include office visits, annual deductibles, and prescriptions in this maximum total.
Seventy-seven percent of workers covered do pay fixed-amount co-pays for doctor visits. Ninety-eight percent have prescription coverage and most do have to share the cost of those prescription meds.
An important part of health benefits offered these days are wellness programs. These programs include everything from wellness newsletters to smoking cessation programs to gym membership discounts. In a comparison between small (3-199 employees) and large (200+ employees) firms, 57% of small firms and 93% of large firms offer these wellness programs.
Until a survey is done in 2011 to see how things compared in 2010, we won’t know for sure; however, when companies made predictions for 2010, 42% predicted they would increase contributions by employees, increase deductible amounts, increase office visit co-pays and prescription drug payments.
When asked about the likelihood that firms were planning to drop coverage, the estimate was relatively low (6% or less); and close to the same percentage were planning to restrict eligibility for their coverage.
If you are interested in viewing the complete report, you can follow the link contained here.
Case Managers impacting patient adherence to medications
It’s a little hard to imagine, but it’s been reported that approximately half of patients don’t adhere to the drug regimen prescribed by their doctors, especially, it seems, if the patient is suffering from a chronic condition. The multiple reasons behind non-adherence run the gamut from lifestyle, health literacy (which we discussed last week), length of time required to take the medication, as well as cost and side effects. One study researched showed even those who don’t have any out-of-pocket costs for their medications had a non-adherence rate of almost 40%.
In a report published in the New England Journal of Medicine from April of this year, adherence to medication requirements was cited as a very important aspect of healthcare reform. Hospital admissions that could be pointed to as having been a result of medicines not being taken properly account for between 33 and 69% of the total, amounting to over $100 billion spent on this segment of healthcare. This is obviously a concern not only for the patients, but for their insurance carriers, as well.
This is where the services of a case manager can be of huge benefit. An important role of the case manager is being the “point person” for patients who need support and guidance that continues after they are released from the hospital and/or are given new, possibly different medications. Case managers have the training and experience that is vital in helping to improve adherence to a drug regimen.
Case managers also have another advantage that physicians and office staff do not have, and that is the fact that they are able to follow through with patients in their homes and work with them on the importance of adherence to their medication schedule, especially when they are suffering from chronic conditions. Once a patient is home, it is much easier for all those extenuating circumstances to take over, contributing to the non-adherence problem.
There are some great “models” out there in the community that are, hopefully, paving the way for improvements in the current “system”. One such example is Community Care of North Carolina, which serves patients on Medicaid, as well as those who are uninsured. Its “Pharmacy Home Project” pays the network doctors a fee each month to coordinate care through the use of case managers and clinical pharmacists who work for them on a rotating basis. With this project, CCNC has been able to increase its adherence numbers by rates of 5 to 7%.
Another excellent example of the use of case managers in helping with the issue of adherence is the Group Health Cooperative. Within its system, case managers help to determine whether or not patients are “managing their medical conditions”, which includes following up on whether they are adhering to their medication regimens. The role of the case managers for Group Health Cooperative follows the traditional routines, as well, including educating patients and assisting them in finding resources for more reasonably priced care options and medications. Savings of approximately $476 annually per patient has been seen by implementing this program.
Obviously, the issue of patient adherence to medications, including how case managers can help, is well worth considering when assessing healthcare costs and how to positively impact them without taking away from the quality of care for patients.
Case Management’s Role in Health Literacy
It won’t be long before health care reform begins to take effect and the ranks of the newly insured swell by tens of millions of people. Although this is potentially very good news for Americans who currently don’t have health insurance, it could spell financial disaster for health care providers, health care insurers, and employers, as well. It could turn into a very costly proposition for not only the state of Missouri, but the nation, as a whole, if the issue of health literacy isn’t addressed in a timely and effective manner. Some estimate that health literacy costs our country over $100 billion a year!
Even the smartest among us often have trouble understanding how to take their latest prescription or interpret insurance forms. In a recent St. Louis Business Journal article, author, Arthur Culbert, noted that
“…more than 90 million people in the United States have difficulty understanding and effectively using health information…”.
Health literacy encompasses not only how well an adult can navigate the healthcare system, but also how well he or she understands a doctor’s instructions and what constitutes better choices for preventive care. This trickles down to young adults (teens), as well, as they often take care of themselves when it comes to taking medicines or healthy lifestyle choices.
Along with organizations, such as Health Literacy Missouri (helping to rewrite patient materials), case managers can be of huge benefit to insurers and insured alike. Case managers can be the bridge to patients with health literacy issues. By helping them to navigate the maze that comprises our national healthcare system, case managers can, figuratively speaking, put a finger in the dike holding back billions of healthcare dollars from being wasted.
According to an example cited in the Business Journal article, a one percent decrease in calls to United Health Group’s service centers would save them approximately $24 million. Case managers can help divert patients from calling on overworked customer service and HR departments by transitioning patients from one level of care to another, advocating for patients to be sure they are taking advantage of the best resources for their disease or health condition and by insuring they take medications correctly.
Case managers not only make a difference for the patients, but also for the bottom lines of the companies insuring, employing and providing care for them. They can be an integral part of minimizing the difficulties and expense posed by health literacy in our country.
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Health Management Connect
(formerly Primary Pediatric Management Inc.)
Helping facilitate positive outcomes for patients, families and payers.
Toll Free: 877.734.7337
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