NEW HIPAA FAQ's FOR FAMILY MEDICAL HISTORY

The Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has published new HIPAA Privacy Rule frequently asked questions (FAQs) related to family medical history. These FAQs support the roll out of the Surgeon General’s family health history portal, “My Family Health Portrait,” a new version of the web-based tool that enables individuals to electronically record, save and email family medical information in formats that are compatible with electronic health records (EHRs). Individuals using this portal to assemble, download and transmit family history information may have questions about privacy and how family history can be used or shared by health care providers. The new FAQs provide answers to these questions.

These new HIPAA FAQs are available on the OCR Privacy Rule Web Site at http://www.hhs.gov/ocr/hipaa. For more information on the Surgeon General’s Family History Tool, see the press release http://www.hhs.gov/news/press/2009pres/01/20090113a.html or visit https://familyhistory.hhs.gov/.

THINGS ARE NOT GETTING BETTER

I had ear surgery about a month ago. The nurse assigned to prep me had been coughing continuously for about 15 minutes and then approached the bed. She reached for the IV kit and I had to stop her in front of several docs and ask her to wash her hands. She complied but apparently, it never occurred to her without my request.

At my follow-up appointment with the MD, he noticed the book website on my business card and asked about it. Following an explanation, he inquired as to how the hospital had performed prior to, during and after my surgery. I shared this experience with him. He replied, "We always struggle with this problem. That's why we have alcohol dispensers outside each room." I responded by saying, "And I'm sure you know that c. diff is not longer sensitive to alcohol." His eyes got big, as in "oops, she got me!" and he has since appointed me to the hospital's Otolaryngology Department's new Medical Advisory Board.

In last month's AARP bulletin, there was an article reporting out the results of a Case Western Reserve VA study:
Routine cleaning isn’t enough to protect you from C. diff. Researchers at Case Western Reserve and Cleveland VA Medical Center found that after routing cleaning at a hospital, 78 percent of surfaces were still contaminated. To kill the germ, you need to use bleach…

One study reported that 39 percent of medical personnel didn’t know that C. diff could be spread on stethoscopes, blood pressure cuffs and other equipment. About two-thirds of medical staff were unaware they should clean their hands with soap and water, because alcohol sanitizers don’t kill this superbug.

What can you do to protect yourself? Insist that everyone treating you clean their hands before touching you.

Clean your own hands thoroughly before eating. Do not touch your hands to your lips. Ask family to bring wipes containing bleach to clean the items around you bed.

When you leave the hospital, assume any belongings you bring home are contaminated. Do not mix clothes from the hospital with the family wash; wash with bleach. Regular laundry detergent does not kill C. diff.

If you are visiting someone in the hospital, be careful about eating in the cafeteria or a restaurant where the staff go in their scrubs or uniforms. These uniforms could be covered in invisible superbugs. More than 20 percent of nurse’s uniforms had C. diff on them at the end of a workday, according to one study.

AARP Bulletin, November 2008

Things are definitely NOT getting better!

CRABBY OLD MAN...

When an old man died in the geriatric ward of a nursing home in North Platte, Nebraska, it was believed that he had nothing left of any value.

Later, when the nurses were going through his meager possessions, They found this poem. Its quality and content so impressed the staff that copies were made and distributed to every nurse in the hospital.

One nurse took her copy to Missouri . The old man's sole bequest to posterity has since appeared in the Christmas edition of the News Magazine of the St. Louis Association for Mental Health. A slide presentation has also been made based on his simple, but eloquent, poem.

And this little old man, with nothing left to give to the world, is now the author of this 'anonymous' poem winging across the Internet.

Crabby Old Man

What do you see nurses? What do you see?
What are you thinking.....when you're looking at me?
A crabby old man, ...not very wise,
Uncertain of habit .......with far away eyes?

Who dribbles his food.......and makes no reply.
When you say in a loud voice.....'I do wish you'd try!'
Who seems not to notice the things that you do.
And forever is losing, A sock or shoe?

Who, resisting or not...........lets you do as you will,
With bathing an d feeding.....The long day to fill?
Is that what you're thinking?......Is that what you see?
Then open your eyes, nurse......you're not looking at me.

I'll tell you who I am,.........As I sit here so still,
As I do at your bidding, ..as I eat at your will
I'm a small child of Ten.......with a father and mother,
Brothers and sisters .........who love one another

A young boy of Sixteen.......with wings on his feet
Dreaming that soon now.......a lover he'll meet.
A groom soon at Twenty,.......my heart gives a leap
Remembering, the vows......that I promised to keep.

At Twenty-Five, now .........I have young of my own.
Who need me to guide ..And a secure happy home.
A man of Thirty, ...........My young now grown fast,
Bound to each other ......With ties that should last.

At Forty, my young sons have grown and are gone,
But my woman's beside me.......to see I don't mourn.
At Fifty, once more, Babies play around my knee,
Again, we know children ......My loved one and me.

Dark days are upon me. My wife is now dead.
I look at the future .............I shudder with dread.
For my young are all rearing......young of their own.
And I think of the years....... And the love that I've known.

I'm now an old man........and nature is cruel.
'Tis jest to make old age look like a fool.
The body, it crumbles..........grace and vigor, depart.
There is now a stone........where I once had a heart.

But inside this old carcass ..A young guy still dwells,
And now and again ......my battered heart swells
I remember the joys........... I remember the pain.
And I'm loving and living.............life over again.

I think of the years all too few......gone too fast.
And accept the stark fact........that nothing can last.
So open your eyes, people ......open and see..
Not a crabby old man. Look closer....see........ME!

AGE DISCRIMINATION IN EMERGENCY TRANSPORT

This was posted online today. The source was HealthDay News (http://health.usnews.com/articles/health/healthday/2008/08/18/older-patients-less-likely-to-be-taken-to-trauma.html)

"Older trauma patients are less likely to be transported to an official trauma center for immediate care than younger patients, a new study found.

The finding was based on a review of a decade's worth of Maryland's statewide emergency medical services (EMS) records. And it suggests that the difference in care first comes into play as patients reach age 50 and worsens again at age 70...

More patients older than 65 were undertriaged, or not taken to a state-designated trauma center, than were younger patients (49.9 percent vs. 17.8 percent).

After adjusting for other related factors, the researchers found that being 65 years or older was associated with a 52 percent reduction in likelihood of being transported to a trauma center. This decrease in transports was found to start at age 50 years, with another decrease at age 70.

'I'm not sure I would call it a bias, because that word has negative connotations, but in general, people do seem to have unconscious blind spots when it comes to the elderly,' said study lead author David Chang. He is an assistant professor in the department of surgery at Johns Hopkins School of Medicine and in the department of health policy and management at Johns Hopkins Bloomberg School of Public Health.

'So not only EMS staff but also those receiving patients at trauma centers are operating on subjective assumptions as to what elderly patients need, how aggressively they should be treated, and what hospitals can do for them, rather than on clear and standard protocol, codes and trauma recommendations,' Chang added. 'And as a result, as patients get older, they are less likely to get into a trauma center.'

Chang and his team reported their findings in the August issue of the Archives of Surgery."

While the author of the study may be afraid to call this discrimination, I'M NOT! I see this same age-related discrimination happening every day in the business world. My job seeking clients over 40 (and even more obviously over 50) absolutely MUST hide any indication of their age in order to even get an interview. Once granted an interview, there is often a statement made about them being "over qualified" as a way of turning them down for the job.

In the workplace, this discrimination occurs typically due to three assumptions:

1. older workers are inflexible and cannot "be controlled:"
2. older workers cost more and we can get the same work done for less; and
3. older workers will have health-related issues that will increase their absenteeism, decrease their on-the-job performance and raise our medical insurance rates.

In the general community, the job of an Emergency Medical Technician or Paramedic is a very emotionally and physically demanding job. I know. I was certified as an EMT in the mid 1970's. In support of my contention that this is a physically rigorous job, in an article entitled, "Physician versus Paramedic in the Setting of Ground Forces Operations: Are They Interchangeable?" (http://findarticles.com/p/articles/mi_qa3912/is_200703/ai_n18755588/pg_4), the author made the following statement - "Paramedics are generally more available than physicians and since their average age... is younger, they are generally more fit."

The average age of a paramedic today is:

1. Oregon Office of Rural Health, 36 - 45 years old (http://www.ohsu.edu/ohsuedu/outreach/oregonruralhealth/providers/upload/2007-EMS-Poster.pdf);
   
2. University of North Dakota - 40.5 years old (http://ruralhealth.und.edu/pdf/remsifs2.pdf);
3. Canada, National Human Resource Review - 37.1 years old (http://www.jibc.ca/paramedic/forms/paraShortage_CallForAction.pdf);
4. University of Western Ontario - 36 years old (http://www.fims.uwo.ca/olr/Apr0407/paramedics.html);
5. A Comparison of Rural and Urban Emergency Medical System (EMS) Personnel: A Texas Study - "The urban EMP,more than rural subjects, was younger (mean = 36
   years)..." and "directors of EMS in urban settings can expect to manage a labor force comprised of married males (mean age = 37.0 years)" (http://pdm.medicine.wisc.edu/Volume14/Chng.pdf)
   

If you review the above averages, you see that they reflect an "average of averages" of about 38 years old, under the age at which discrimination is typically experienced but perilously close to becoming a recipient of that discrimination. My personal experience is that discrimination and change resistance increases at direct proportion to the approach of the discrimination in one's own life. Fear is a clear driver.

More from the article - "A follow-up survey of 127 EMS workers and 32 medical personnel (including doctors, nurses, and medical students) revealed that the top three reasons for not transporting an older patient to a trauma center were: a lack of sufficient training for handling such patients (more than 25 percent); not knowing trauma protocols (12 percent); and potential age bias (just over 13 percent)."

Give me a break! A lack of sufficient training for handling such patients???? Here are the statistics for emergency transport - "In 2003, patients arrived by ambulance for 16.2 million ED visits (14.2%)... Of ambulance-related visits, 39% were made by seniors..." (http://linkinghub.elsevier.com/retrieve/pii/S019606440501989X). That translates to 6,318,000 "senior" transports! Since seniors are the fastest growing age group in the US based on the influx of Baby Boomers, we are in trouble!

As for not knowing trauma protocols, if emergency tranport personnel do NOT know trauma protocols, they should not be emeregncy tranport personnel since that IS their job description!

In a second study published in the same issue of the journal, "a survey from the University of Connecticut School of Medicine found that trauma patients and caregivers alike seem to prefer palliative care, rather than aggressive critical care, if doctors believe that the latter is pointless."

In the seniorjournal.com website (http://www.seniorjournal.com/NEWS/Health/2008/20080818-SeniorsMuchLessLikely.htm), additional information NOT shared on the government web site from the original study includes the following statement, “'The problem of age bias raised in this study may negate efforts to improve clinical care for elderly trauma patients within trauma centers if the system as a whole does not function properly and deliver patients appropriately to needed resources,' the authors write. 'However, it may be difficult to change attitudes of age bias and may require a broad societal campaign.'"

I agree. This study result reveals another symptom of denial in the United States about which I have previously blogged. And, the very fact that the government website did NOT post the statement regarding the need for a "broad societal campaign" is also denial. If we don't address this as a society, not only is our own mortality at risk but so is that of our country.

PREVENTABLE ERRORS NO LONGER COVERED BY INSURANCE!

According to the Journal of the American Medical Association, 2008; 299: 2495-6, there are 8 things that must never happen to you in hospital because, if they do, "health insurers say they will no longer pay out... To give you an idea of the scale of the problem, around 2 million people get an infection every year while staying in an American hospital, and a further 100,000 will die as a result.

The eight ‘no payout’ errors relate to:

1. air embolism
2. blood incompatibility
3. catheter-associated urinary tract infection
4. decubitus ulcer (pressure sores)
5. vascular catheter-associated infection
6. surgical site infection
7. mediastinitis (infection of the chest area)
8. falls and trauma
9. objects left in the body after surgery.
   

And that’s just a start. The Centers for Medicare & Medicaid Services (CMS) are planning on adding a further nine errors, including the hospital-acquired killer infection C. difficile and deep vein thrombosis.

Aside from digging deep into health insurers’ profits, the errors are also going unchecked, and it’s almost as though hospitals and doctors are being rewarded for making them, the CMS believes" (http://www.wddty.com/03363800368870404399/doctor-errors-the-8-things-that-must-never-happen-to-you-in-hospital.html).

Of these eight problems, my husband suffered from five of them (3, 4, 5, 6, 8). Additionally, the "upcoming" denials around "hospital-acquired killer infection C. difficile and deep vein thrombosis" would also have lead to significant cost shifting to us since he contracted c. diff the first month of an 8-1/2 month hospital stay and wore "pressure boots" to prevent deep vein thrombosis for 6+ months. This means that, should his hospitalation have occurred after this ruling, we would be responsible for a sizable chunk of $1.75 million in claims since several of these "errors" occurred more than once, with catastrophic results.

How will the hospitals respond to this?

1. By addressing the issues, with huge costs associated with prevention? I'm doubtful since they have been aware of these preventable mistakes for some time and only the better institutions have done anything to address them. That means the brunt of the exposure shifts to us to prevent the mistakes through our diligence or pay the price in loss of health, life and/or financial stability.
2. By ignoring culpability? Since they maintain the records for every hospitalized patient, I can envision an escalation in battles and delays over record requests and legal wrangling requiring us to "prove" they were the cause. And.if there are no "baseline" records proving our patient did not have the condition upon admission, we are at a loss.
3. By admitting there is a problem (huh!!!) and backing off of both passive and active resistance to advocates? VERY doubtful as admission of responsibility implies a "less than perfect or desirable" institution, something they believe most patients would avoid. I can't even get hospitals to carry my book in their bookstore since it implies their "less than perfect or desirable" status.

Since hospitals today are using a "business model" to guide their practices, let's see what businesses have done when the finger of culpability has been pointed at them?

1. bankruptcy to avoid payout - Enron. "Over the past decade, Enron has been listed for numerous spills of hazardous materials on the Environmental Protection Agency's Emergency Response Notification System Database (EPA, ERNS, respectively). Substances involved in these spills include: natural gas, crude oil, asbestos, arsenic, polychlorinated biphenyls, isobutane, sodium hydroxide, ethane and various other chemical substances. In 1998 Enron subsidiary, Wessex Water, was ranked by the UK Environment Agency as the fourth worst polluter with five prosecutions resulting in total fines of £36,000 ($56,000). Environment Agency director of operations, Archie Robertson said, 'The companies included in our Hall of Shame have let down the public, the environment and their own industry' (http://www.foe.org/WSSD/enron.html);
2. catastrophically slow response and payout - 1989 Exxon Valdez oil tanker spill of more than 11 million gallons in Prince William Sound, Alaska. "What did the company do? According to most observers, too little and too late. The action to contain the spill was slow to get going. Just as significantly, the company completely refused to communicate openly and effectively" (http://www.mallenbaker.net/csr/CSRfiles/crisis03.html). The company is still appealing a $2.5 billion USD punitive ruling, and has not paid any damages yet" (http://en.wikipedia.org/wiki/Exxon_Mobil);
3. "we were just cutting costs" (Union Carbide Pesticide Plant in Bhopal, India in 1984 resulting in "23,000 deaths... In 1989 Union Carbide, which is now a subsidiary of Dow Chemical, paid the Indian Government £470m in a settlement which many described as woefully inadequate. In November 2002 India said it was seeking the extradition of former Union Carbide boss Warren Anderson from the US. Mr. Anderson faces charges of 'culpable homicide' for cost-cutting at the plant which is alleged to have compromised safety standards" (http://news.bbc.co.uk/onthisday/hi/dates/stories/december/3/newsid_2698000/2698709.stm);
4. government culpability and public futility - Love Canal Chemical Waste Landfill site, City of Niagra Falls, NY and Hooker Chemical and Plastics Corporation (now a part of Occidental Petroleum or OxyChem). "Throughout the ordeal, homeowners' concerns were ignored not only by Hooker Chemical... but also members of government. These opponents argued that the area's endemic health problems were unrelated to the toxic chemicals buried in the canal. Since the residents could not prove the chemicals on their property had come from Hooker's disposal site, they could not prove liability. Throughout the legal battle, residents were unable to sell their properties and move away... both the school board and the chemical company refused to accept liability... [and] considerable public resistance from residents within the community: the mostly middle-class families did not have the resources to protect themselves, and many did not see any alternative other than abandoning their homes at a loss" (http://en.wikipedia.org/wiki/Love_Canal);
5. it's apparently cheaper to pay than fix the problems - "For the fourth time in the
   past year, a Resurrection Health Care hospital has been cited for violations and fined by the federal Occupational Safety and Health Administration (OSHA)... OSHA determined "the employer did not ensure that appropriate procedures were adopted to minimize injury and loss of life and implemented in the event of an emergency." As a result of the findings, the hospital received six serious citations and was fined $13,000... The health and safety violations at St. Mary of Nazareth Hospital are just the latest in a recurring pattern at Resurrection Health Care facilities... all [have] been cited and fined by OSHA since 2003. 'The irresponsibility of administrators at St. Mary's and its corporate parent, Resurrection Health Care, endangers both patients and employees,' said Henry Bayer, executive director of the American Federation of State, County and Municipal Employees (AFSCME) Council 31" (http://www.reformresurrection.org/st.-mary-of-nazareth-hospital-fined-for-mishandling-chemical.html). And this is a hospital!!!
   

These are just a few of the examples of business irresponsibility to which we have to look forward in the healthcare industry. I'd like to think that since hospitals are in the business of saving lives, they would not sink this low. However, since they have adopted the business model, we have no assurances...

Bottom line, GET IN THE HOSPITAL ROOM AND STAY THERE, 24/7! Life is too precious to subject it to this risk!

WE WANT WHAT WE WANT!

Here are some new statistics from Deloitte's 2008 Survey of Health Care Consumers:

• 93 percent of consumers say they’re not adequately prepared for future health care costs;
• 79 percent of consumers believe health care will be an important issue in the 2008 election;
• 46 percent described it as one of the top three issues that will affect their vote;
• 34 percent say they would use a retail clinic; 16 percent already have;
• 39 percent say they'd go abroad for treatment if quality was comparable and the cost was cut in half;
• 66 percent either strongly support (36 percent) or might support (30 percent) state-mandated health insurance;
  
• 60 percent want physicians to provide online access to medical records and test results, and online appointment scheduling;
• 1 in 4 say they would pay more for the service;
• 1 in 3 consumers say they want more holistic/alternative therapies in their treatment program;
• 3 in 4 consumers want expanded use of in-home monitoring devices and online tools that would reduce need for visits and allow individuals to be more active in their care;
• 66 percent strongly favor or lean toward state-mandated health insurance;
• 84 percent prefer generics to name-brand drugs;
• 29 percent support a tax increase to help cover the uninsured; another 37 percent say they would consider a tax hike;
• Only 52 percent of consumers say they understand their insurance coverage;
• 1 in 4 consumers maintain a personal health record.
  

According to Paul Keckley, executive director of the Deloitte Center for Health Solutions and co-director of the study, "American's no longer see themselves only as patients, but as consumers who want to take control of their health care,"

I hope so...

HOSPITALIZATION AND YOUR CREDIT SCORE

Last night, while relaxing, I read my monthly (June, 2008) Costco newsletter (The Costco Connection) in which I found the following headline, "Credit Check Could Make You Ill." In it, author and well known consumer credit advisor, David Horowitz, said the following...

"Many hospitals now investigate patient’s personal credit reports to figure out how likely they are to pay their bills. By accessing these credit reports, hospitals are peering at personal lines of credit, payment histories and debts. They say this helps identify which patients to pursue actively for payment because they can, in fact, afford to pay, which helps to minimize losses. They also claim it allows them to quickly identify which patients are eligible for charity care or assistance programs. If a hospital requests the information, be sure to ask them why and whether it’s absolutely necessary. Also, if a problem arises, make sure you ask how the hospital came by the information. By law, hospitals aren’t allowed to turn away patients in an emergency. And public hospitals (as opposed to private hospitals) are often required to give non-emergency care if it is considered medically necessary."

Guess what? I stopped relaxing and felt my blood pressure begin to rise...

I have often wondered why the hospitals in which my husband was treated were so incredibly aggressive in their debt collection practices when they had received virtually full pay from our insurance company on $1.75 million in claims. Finally, here is the answer! They came after us because we could afford to pay the difference!

• Another punishment imposed on working families who pay their bills and use money responsibly.
• Another example of rewarding poor behavior (irresponsible credit users) and punishing good behavior (responsible credit users).

I wish I could say this is atypical but, in my experience, it is not. Take heed, hospital-users. And, do you still think that healthcare is not a business???!?