I just read an article in my daily Medscape review entitled, Uninsured, Medicaid Recipients Recieve Substandard Migraine Care. My immediate response was...Duh! Aparently, it took researchers at Harvard Medical School to uncover this mystery! I'm sorry, but the truth is: the federal government, through CMS (commission on medicare & medicaid) has made it so difficult for any provider...physician, hospital, home health company, nursing home, you name it) to meet their expenses by providing care for these patients that nobody wants to do it anymore. The reason many (if not most) physicians will not see Medicaid patients is that they earn somewhere between $15-$30 per patient. In his June 29, 09 article, David Burda, editor of Modern Healthcare Magazine told us that the standard Medicaid Margin for hospitals overall was (according to the American Hospital Association) Minus 17%. You heard it right...-17%. By the way, Medicare is much better, hospitals only lose 5.9% per year. Would you enter a business knowing up-front that you were going to earn -17% each year? I don't think so!
Is it any wonder nobody wants to see Medicaid patient. This system is unfair to all. It under-pays the providers and is demeaning to low-income people. This could all change if CMS would pay providers fairly for what they do. The part that is so depressing to those of us who deal so intimately with Medicaid is that in our new health overhaul, the "uninsured" who will in 2014 become insured will be insured by guess who...Medicaid. As my friend John Eads used to say, "What a goat rope!"
Thursday, April 15, 2010
Tuesday, March 30, 2010
Beating Diabetes
Recently, I have had a noticeable weight loss.Some may know that I am a diabetic so those who are struggling with diabetes and pre-diabetes have asked me what it is I am doing. So, I decided to write this so people can get a head start on reducing their glucose levels and consequently, on the road to losing weight. I also know how difficult it is to start and like me, you won’t until you are ready. At one point I really wondered if I would ever be able to do what I needed to do to lower my blood sugars. So, with this letter (blog)comes a prayer that if you are ready, you will start now.
First, go ahead and buy the book, The Diabetes Solution by Dr. Richard Bernstein. Also, you can check his website at www.diabetes-solution.net. I have been a diabetic for about 13 years. When I was first diagnosed, I took it very seriously and began to do what I needed to keep my blood sugar in check. I found Dr. Bernstein’s book and got to work. His concept, which seems very simple is…carbohydrates are bad for diabetics…ALL CARBOHYDRATES. The more carbs you eat, the more medicine you need to take to control your Diabetes. Sounds simple, but amazingly not many in the diabetic community follow this line of thinking. This includes the American Diabetes Association, whose low-fat, high carb diet has been the mainstay of many educators. Dr. Bernstien’s plan helped me tremendously. I adhered to the regimen for 2 years. I reduced my blood sugars, lost weight and felt better. But, as so often happens when weight loss is the goal, once you get there, or close, you go back to the old ways. Weight loss recidivism is extremely high, and I was not the exception.
For the next 10 or so years, I did my own thing. I was working hard to lose weight. All kinds of diets, cutting back, exercise, praying…which resulted in continuous frustration that I did not have the self-discipline to beat the weight. I had almost given up. But, as a healthcare worker I had witnessed the negative results of poor glycemic control-blindness, kidney disease, amputations, heart trouble, you name it. And here in the South, it’s hard to find someone who does NOT have Diabetes or at least is on their way to it.
On October 27, 2009, I’d had enough. But, I realized my most important fight now was not with the weight, it was with Diabetes. I did what I had dreaded for months, pulled out my glucometer and checked my blood sugar…350. Then I did the other thing I dreaded, had the lab work done. My Hemaglobin A1c, (HbA1c) a measure of long-term blood-glucose levels, was 9%.
A quick primer on blood sugars and HbA1c. Normal people have blood sugar below 100, usually around 80-90. Normal HbA1c is below 6. If your blood sugar is above 100, you are considered pre-diabetic. This is the condition that is most treatable, and easy to deal with if you do something about it NOW.
Anyway, I ordered the new and improved Diabetes Solution, twice as thick as before, and got to work. I decided that I would no longer worry about my weight—I would just concentrate on blood sugar. If I could control my blood sugars, I figured the weight would come off as a side effect. This has happened.
The Results:
When I started in October here’s where I was physically.
Blood Sugar 350; HbA1c 9%; weight approximately 240 lbs., (I had weighed more, but my blood sugars had gotten so bad that the Diabetes caused me to lose weight. This is not good!); Triglycerides were high, I also have high blood pressure & high cholesterol, although they are controlled by medicine.
Now, almost 6 months later, my blood sugar ranges between 98 and 125. My HbA1c is 5.8%. My triglycerides are below normal. I am working on my cholesterol and blood pressure to try to control them without medication, but I’m not there yet. My weight is 207. I haven’t seen 207 since high school.
Many people have asked me what I eat and what I don’t eat. The simple answer is “as few carbohydrates as possible.” I shoot for less than 30 carbohydrate grams per day.
Here is what I don’t eat.
Milk
Fruit (including tomatoes)
Bread
Potatoes (ugh!)
Sweet Potatoes (ugh! ugh!)
Rice
Grits (dang it!)
Dessert (man!)
Sweetener Packs, yellow, pink or blue (they all have 1g of carbohydrate, each pack is 96% sugar)
Here is what I do eat.
Cream
Butter
Beef, sautéed, broiled, baked, roasted
Fish, sautéed, broiled, baked, blackened
Pork, sautéed, broiled, baked
Bacon or Sausage fried
Chicken, sautéed, broiled, baked (and any other way I can think of)
Vegetables (the ones I like are below)
Cauliflower
Squash
Broccoli
Cabbage
Brussels Sprouts
Lettuce (any kind)
Cucumbers
Peppers (red or green)
Ranch Dressing
Mushrooms
Liquid Sweetener (EZ-Sweets)
Low Carb Tortillas
Pork Skins (I especially like Cinnamon flavored)
Diet Drinks
The most important thing is to read the labels on everything you buy. Never buy low-fat, they almost always have higher carbs, and usually higher calories. Use lots of spices when you cook. There are many more things to eat in Dr. Bernstein’s book, so get it and read it. If you are ready, it will change your life and help you beat Diabetes!
First, go ahead and buy the book, The Diabetes Solution by Dr. Richard Bernstein. Also, you can check his website at www.diabetes-solution.net. I have been a diabetic for about 13 years. When I was first diagnosed, I took it very seriously and began to do what I needed to keep my blood sugar in check. I found Dr. Bernstein’s book and got to work. His concept, which seems very simple is…carbohydrates are bad for diabetics…ALL CARBOHYDRATES. The more carbs you eat, the more medicine you need to take to control your Diabetes. Sounds simple, but amazingly not many in the diabetic community follow this line of thinking. This includes the American Diabetes Association, whose low-fat, high carb diet has been the mainstay of many educators. Dr. Bernstien’s plan helped me tremendously. I adhered to the regimen for 2 years. I reduced my blood sugars, lost weight and felt better. But, as so often happens when weight loss is the goal, once you get there, or close, you go back to the old ways. Weight loss recidivism is extremely high, and I was not the exception.
For the next 10 or so years, I did my own thing. I was working hard to lose weight. All kinds of diets, cutting back, exercise, praying…which resulted in continuous frustration that I did not have the self-discipline to beat the weight. I had almost given up. But, as a healthcare worker I had witnessed the negative results of poor glycemic control-blindness, kidney disease, amputations, heart trouble, you name it. And here in the South, it’s hard to find someone who does NOT have Diabetes or at least is on their way to it.
On October 27, 2009, I’d had enough. But, I realized my most important fight now was not with the weight, it was with Diabetes. I did what I had dreaded for months, pulled out my glucometer and checked my blood sugar…350. Then I did the other thing I dreaded, had the lab work done. My Hemaglobin A1c, (HbA1c) a measure of long-term blood-glucose levels, was 9%.
A quick primer on blood sugars and HbA1c. Normal people have blood sugar below 100, usually around 80-90. Normal HbA1c is below 6. If your blood sugar is above 100, you are considered pre-diabetic. This is the condition that is most treatable, and easy to deal with if you do something about it NOW.
Anyway, I ordered the new and improved Diabetes Solution, twice as thick as before, and got to work. I decided that I would no longer worry about my weight—I would just concentrate on blood sugar. If I could control my blood sugars, I figured the weight would come off as a side effect. This has happened.
The Results:
When I started in October here’s where I was physically.
Blood Sugar 350; HbA1c 9%; weight approximately 240 lbs., (I had weighed more, but my blood sugars had gotten so bad that the Diabetes caused me to lose weight. This is not good!); Triglycerides were high, I also have high blood pressure & high cholesterol, although they are controlled by medicine.
Now, almost 6 months later, my blood sugar ranges between 98 and 125. My HbA1c is 5.8%. My triglycerides are below normal. I am working on my cholesterol and blood pressure to try to control them without medication, but I’m not there yet. My weight is 207. I haven’t seen 207 since high school.
Many people have asked me what I eat and what I don’t eat. The simple answer is “as few carbohydrates as possible.” I shoot for less than 30 carbohydrate grams per day.
Here is what I don’t eat.
Milk
Fruit (including tomatoes)
Bread
Potatoes (ugh!)
Sweet Potatoes (ugh! ugh!)
Rice
Grits (dang it!)
Dessert (man!)
Sweetener Packs, yellow, pink or blue (they all have 1g of carbohydrate, each pack is 96% sugar)
Here is what I do eat.
Cream
Butter
Beef, sautéed, broiled, baked, roasted
Fish, sautéed, broiled, baked, blackened
Pork, sautéed, broiled, baked
Bacon or Sausage fried
Chicken, sautéed, broiled, baked (and any other way I can think of)
Vegetables (the ones I like are below)
Cauliflower
Squash
Broccoli
Cabbage
Brussels Sprouts
Lettuce (any kind)
Cucumbers
Peppers (red or green)
Ranch Dressing
Mushrooms
Liquid Sweetener (EZ-Sweets)
Low Carb Tortillas
Pork Skins (I especially like Cinnamon flavored)
Diet Drinks
The most important thing is to read the labels on everything you buy. Never buy low-fat, they almost always have higher carbs, and usually higher calories. Use lots of spices when you cook. There are many more things to eat in Dr. Bernstein’s book, so get it and read it. If you are ready, it will change your life and help you beat Diabetes!
Monday, February 8, 2010
"WHO DAT?!"
As I write this blog, it is the morning after the victory of our Saints in Miami. This was a victory over a super-talented, blue-chip foe by a group of guys, most of whom could not quite fit in with their previous teams--who fought hard and believed in themselves, and each other, enough to get the job done. And because they believed, we also believed. This morning in his daily Faith Forum,
Randy Smith enclosed the following acrostic for "Who Dat?!"
We
Have
Overcome
Destruction
And
Tragedy
What a terrific description of the team, the city, the state, the country--of us. We Have Overcome Destruction and Tragedy. We can be brand new. We can have a new lease. A new opportunity. Let's take advantage of every opportunity to be the very best--just as our Saints did.
Like He did for Drew Brees, God gives us all second chances. All we have to do is our part.
Most of us are not blue-chippers. We often don't quite fit in. Our lives are filled with ups and downs, even destruction and tragedy. But we have a second chance. God has provided that second chance to accomplish something great. Through his Son we can have a second chance. Drew Brees did it, so can we!
Randy Smith enclosed the following acrostic for "Who Dat?!"
We
Have
Overcome
Destruction
And
Tragedy
What a terrific description of the team, the city, the state, the country--of us. We Have Overcome Destruction and Tragedy. We can be brand new. We can have a new lease. A new opportunity. Let's take advantage of every opportunity to be the very best--just as our Saints did.
Like He did for Drew Brees, God gives us all second chances. All we have to do is our part.
Most of us are not blue-chippers. We often don't quite fit in. Our lives are filled with ups and downs, even destruction and tragedy. But we have a second chance. God has provided that second chance to accomplish something great. Through his Son we can have a second chance. Drew Brees did it, so can we!
Tuesday, January 26, 2010
Health Care Change
Well, with the Senate election in Massachusetts it looks like Health Care change as it was planned by the Democratic Congress is not going to happen. I, for one, am glad. But not for the reasons you might think.
What we really need is "meaningful--well-thought-out change!" If you ask almost any health care leader, "Do you want change?" the answer will be, "absolutely!" But the changes that need to be made cannot happen through politicians--who most likely learned what they know about health care from 20-minute briefings by 20-something staffers, who spent 20 minutes reading 20 articles on health care...how much could you learn?
I believe this is the origination of the idea, "Let's take $500 billion from Medicare to pay for health care for everyone." Where does that leave people on Medicare? Come on! Health care is THE largest, most complicated, confusing problem we have. Is it really something we want to trust to politicians?
Politicians legislated us into the health care red--what makes us think they can legislate us into the health care black? It's like asking Bernie Madhoff to solve thievery!
Politicians have caused the cost of heatlh care to increase through mandates--often un-funded--placed on insurance companies, employers, physicians and hospitals. Mandates that sound good, but cost much...like mental health parity, coverage for domestic partners, coverage for treatments that are scientifically un-proven. Maybe good ideas but every one increases the cost of health insurance. Politicians are anecdotal opportunists. They get one briefing by the 20-something and then legislate. That's why you wear loafers to the airport. Get ready for them to check your underwear! Sorry, I digress. Back to health care.
Here are a few of my ideas for change:
1. Stop Medicaid patients from going to the Emergency Room, where there is no deductible--because they won't (or can't) pay the $2 or $3 deductible to go to the doctor's office.
2. Give hospitals more discretion to stop drug-seekers from coming to their hospital with fabricated symptoms--sometimes 10-20 times per month. All at the hospital's expense.
3. Repeal the McCarran-Ferguson act and allow the sale of Health Insurance across state lines.
4. Allow people and employers to purchase health insurance that lets them choose what benefits they want.
5. If politicians want change, why don't they talk with people who know where the change needs to happen?
In conclusion, do I think real, meaningful change is going to happen in health care under the Democrats? No, I do not. Under the Repulicans? No, I do not. I believe things will remain pretty much the same and we will muddle through until the health care "tipping point" (what would we do without Malcolm Gladwell) is finally tipped--and things get really screwed up.
This is not very optimistic--but hey, this is the most complicated business in the world. You can't just solve the problem because you want to!
What we really need is "meaningful--well-thought-out change!" If you ask almost any health care leader, "Do you want change?" the answer will be, "absolutely!" But the changes that need to be made cannot happen through politicians--who most likely learned what they know about health care from 20-minute briefings by 20-something staffers, who spent 20 minutes reading 20 articles on health care...how much could you learn?
I believe this is the origination of the idea, "Let's take $500 billion from Medicare to pay for health care for everyone." Where does that leave people on Medicare? Come on! Health care is THE largest, most complicated, confusing problem we have. Is it really something we want to trust to politicians?
Politicians legislated us into the health care red--what makes us think they can legislate us into the health care black? It's like asking Bernie Madhoff to solve thievery!
Politicians have caused the cost of heatlh care to increase through mandates--often un-funded--placed on insurance companies, employers, physicians and hospitals. Mandates that sound good, but cost much...like mental health parity, coverage for domestic partners, coverage for treatments that are scientifically un-proven. Maybe good ideas but every one increases the cost of health insurance. Politicians are anecdotal opportunists. They get one briefing by the 20-something and then legislate. That's why you wear loafers to the airport. Get ready for them to check your underwear! Sorry, I digress. Back to health care.
Here are a few of my ideas for change:
1. Stop Medicaid patients from going to the Emergency Room, where there is no deductible--because they won't (or can't) pay the $2 or $3 deductible to go to the doctor's office.
2. Give hospitals more discretion to stop drug-seekers from coming to their hospital with fabricated symptoms--sometimes 10-20 times per month. All at the hospital's expense.
3. Repeal the McCarran-Ferguson act and allow the sale of Health Insurance across state lines.
4. Allow people and employers to purchase health insurance that lets them choose what benefits they want.
5. If politicians want change, why don't they talk with people who know where the change needs to happen?
In conclusion, do I think real, meaningful change is going to happen in health care under the Democrats? No, I do not. Under the Repulicans? No, I do not. I believe things will remain pretty much the same and we will muddle through until the health care "tipping point" (what would we do without Malcolm Gladwell) is finally tipped--and things get really screwed up.
This is not very optimistic--but hey, this is the most complicated business in the world. You can't just solve the problem because you want to!
Thursday, January 7, 2010
Getting Started
Happy New Year! As we start out a new year, I have been thinking a lot about how to better communicate with all the employees at Richardson Medical Center regarding what is happening with your hospital.
For this reason I have decided to publish a blog. This will allow me to keep you informed about what is happening and sometimes just what is going on in the world of hospital administration. I know that it is difficult for most to understand all that happens during my day, just like I am not sure of all that happens during your day. So, maybe we can communicate about that through this blog. So, here goes…
Since I began my time at Richardson Medical Center back in May, 2007, a lot of things have happened. We have had some very difficult times and some really great times. In my opinion, things are getting better every day. My only hesitancy is the unknown regarding the new Healthcare plan being batted around by our national leaders. One of the things they want to do is cut Medicare by $500 billion over 10 years. That’s BILLION not MILLION. As I have said in Employee Forums, 47% of the money we earn is from Medicare—so if these cuts take place, the impact will be severe. On the other hand, many people who have not had insurance previously may now have insurance and since over 7% of our patients NEVER pay, this could be a help. The unknown is how these things will work together.
The best way we can deal with things over which we have no control, is to make a difference in the things we CAN control. Here are some things we all can do:
Do everything we can to get people in our community to come to OUR hospital:
- Tell people what a great hospital this is
- Tell them about our great care
- Tell them about our great services
- Do everything we can to reduce waste
- Don’t wait for someone else to bring it up, if you see an opportunity for savings let us know
- Don’t waste items—be frugal with our resources
- Do everything we can to do the best job we know how
- Pray for this hospital—its people and their families
I really believe that if we can do all of the above—our success will continue in 2010 and into the future. I truly wish you and your family a Happy New Year!
To read future blogs, go to our website www.richardsonmed.org.
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