Friday, August 7, 2015

How Much Will That Cost? More Patients Checking Healthcare Prices Up Front


Practice Costs Increase, Budgets Decrease

When deciding whether or not to make a purchase in a store or online, knowing the price in advance is important for most people (I know a family with their own private jet, and I’m not including them here).

For the rest of us, buying airplane tickets, a new tablet or a car typically involves research on what it’s going to cost.

But what about healthcare? Most people do not know how much a physician visit, new medication or stay in the hospital will cost until after the fact.

That’s expected to change.

Consumer-driven healthcare is empowering more patients, especially those with high-deductible health plans. They’re going to want to control their medical expenses. This means, going forward, fewer people will likely just wait for the surprise charges when they receive an EOB or medical bill.

Tackling Cost Complexity
Just like it’s a good to know what medical information most patients search for online – because they to come to you with questions – it’s also good to know what they’re reading about cost of care. For example, the Healthcare Financial Management Association’s just issued a report “Understanding Healthcare Prices: A Consumer Guide” that aims to reduce a lot of the cost complexity for patients.

Highlights include:
* Questions to ask your doctor before elective surgery
* Advice on how to get a cost estimate in advance
* Follow-up questions to ask when a medical bill comes in higher than the estimate
The panel of consumers, hospital executives and industry experts who wrote the report also explain the differences between in-network and out-of-network provider care; information sources for Medicare beneficiaries; and make recommendations for patients without health coverage.

Clearer Prices
Greater price transparency is likely another result of the empowered patient movement, but it might not be easy. During a local NPR radio report, a hospital CEO in South Florida promised to reveal the contracted prices negotiated for many services with major health insurers. He later had to retract the offer.

For price transparency to work, patients need to show it makes a difference in where they go for healthcare. Physicians, insurers and hospitals also have to do their part. Price information will be meaningful to patients when they can use it to make a fair comparison, the HFMA states.

Patients might ask you for:
* Total price of care
* What’s included in your estimate
* What’s not included, and why

Quality Matters Too
The report also emphasizes that it’s not all about price — quality of healthcare matters too. Specific advice includes recognizing that prices and quality can vary depending on where care is provided; that more expensive care does not always mean better care; and that “shopping around” can be worthwhile whenever possible.

How do you answer patient questions about the cost of a future service or procedure?

Custom Business Cards

20% Off!

Linen Business Card Template (Sky)Appointment Reminder Cards (100 pack-White) Business Card Templates
Linen Business Card TemplatePearl Finish  Business Card Template
Platinum Business Card TemplateGold Finish Business Card
Iridescent Pearl Finish Business Card (Style 4)

Sunday, July 26, 2015

Musical Tastes a Predictor of Personality, Study Finds


Image courtesy of (stockimages) /
Researchers have discovered your musical tastes may reveal quite a bit about your personality and the way you think.

Why is that important? In this era of digital music, learning more about people’s musical tastes and how to better market to certain groups of listeners is pure gold for services like Apple Music and Spotify, especially as the market becomes more crowded.

Image courtesy of (imagerymajestic) /
Researchers from the University of Cambridge, led by PhD student David Greenberg, studied how our ‘cognitive style’ influences our musical choices. The researchers were able to measure if individuals scored highly on ’empathy’ or on ‘systemizing’ — or if they were a mixture of both, based on the music they prefer.

“Although people’s music choices fluctuates over time, we’ve discovered a person’s empathy levels and thinking style predicts what kind of music they like,” Greenberg said in a statement. “In fact, their cognitive style — whether they’re strong on empathy or strong on systems — can be a better predictor of what music they like than their personality.”

People who scored high on empathy were more apt to favor R&B, soft rock, and adult contemporary genres or country, folk, and singer/songwriter genres as well as contemporary music including electronica, Latin, acid jazz, and Euro pop.

By contrast, those who scored high on systemizing liked intense music, but disliked “mellow and unpretentious musical styles.”

Greenberg, a trained jazz saxophonist, said the research could have a whole lot of value for the music industry.

“A lot of money is put into algorithms to choose what music you may want to listen to, for example on Spotify and Apple Music. By knowing an individual’s thinking style, such services might in future be able to fine tune their music recommendations to an individual.”

The study can be read in its entirety, here.

Custom Business Cards

20% Off!

Linen Business Card Template (Sky)Appointment Reminder Cards (100 pack-White) Business Card Templates
Linen Business Card TemplatePearl Finish  Business Card Template
Platinum Business Card TemplateGold Finish Business Card
Iridescent Pearl Finish Business Card (Style 4)

Saturday, April 25, 2015

One of Those Days with Alzheimer's

There are times, not many, but there are times when you do some of the dumbest things.
I like to blame the disease in cases like this. Everything started out fine today. Until I was sweeping out my truck. I have a shop vac and I get so tired of those wheels coming off.
Every time I pick it up, one, two, sometimes three wheels come off. I fixed that. I got out my super duper gorilla glue. That stuff will stick to anything and once it's on there ain't no getting it off.
Things were going well. All glued up, I was done sweeping, so I just let it sit so it would set up good and proper.
Sam (my dementia service dog) and I had a couple of things to do, and when we got back I thought I'll put the shop vac back. It has to be set up by now.
It was. Now comes the part where "things happen." Somehow some of the glue had went from the wheel housing, to the wheel, to the floor.
It was stuck like Chuck to the garage floor. Three out of four wheels. Could have been worse, could have been all four.
And when they say gorilla glue works, they mean it. There was no moving the thing. Wouldn't budge an inch. So...I figure I would take a hammer and tap each wheel.
Break it loose, if you will. I suppose this is the part where I don't realize the difference between a tap, and a whack.
I got them loose but not before breaking the one wheel off. So now I have a tripod shopvac.
And that all happened before 10:00 am. I can't wait to see what the rest of the day brings...
Editor's note: Rick's journey with Early Onset Alzheimer's Disease was chronicled in "Fade to Blank: Life Inside Alzheimer's," an in-depth look at the real lives of families affected by the Alzheimer's epidemic. His story continues on his personal blog on

Reminder Aids

15% Off!

Friday, April 17, 2015

Caregiving is All about Love




In a comment on my recent post about Charlie's lack of emotional response to tragedy, someone felt I resented my husband for his inability to show compassion. That is far from the truth. I was merely bringing to other caregivers' attention the fact that this is just one more side of what happens to a person with dementia.
If your loved one is in the early stages of one of the mind-altering diseases, a lack of empathy is just one more thing that is probably in your future as a caregiver.
Actually, by a week after my daughter's fire, Charlie finally was able to listen to talk of the recovery and realize that something very serious had happened. He even was able to suggest that we should make a generous donation to the recovery fund that had been established. Now that's the Charlie I fell in love with.
But it took a whole week of talk about the fire before it became a reality to him. How long he will remain cognizant of the circumstances is questionable. Next week, he may not have any recollection that it occurred, or he may again suggest that we make a donation, not recalling that we already did that. That's the way of the disease.
I try not to be angry and disappointed by the things he doesn't recall or the things that no longer matter to him. I have to keep reminding myself of the man he used to be—the man he would be today if ischemic attacks had not affected his brain function. It isn't always easy, but it was what I signed on for when I said "in sickness and in health." If the situation was reversed, I know Charlie would be caring for me with everything he had to give.
Even now, if I am having a bad IBS day or my joints are aching, he is always ready and willing to wait on me, encourage me to "order out" or take a nap. The least I can do is keep any resentment I may feel for his inability to show emotion or his lack of memory under control.
By writing about the problems that occur on a daily basis I hope I can help another caregivers to feel they are not alone, and perhaps even give them a laugh at some of the craziness that goes on in the life of a caregiver. It helps me to stay positive and lighten up the situation in which I find myself.
Do I resent Charlie? Never. Do I get frustrated? Of course. But I will continue to care for him as long as I am physically and mentally able. That's what love is about. That's what caregiving is about.

Dementia Signage for the Home


Thursday, April 16, 2015

Taking a Moment to Celebrate the Good Things about Caregiving

 I, like most caregivers, need a sounding board to let off steam. It's either sound off to some anonymous computer screen or sound off to our loved ones. I choose the computer, and you, as the lesser of two evils. But today I am going to talk about the good qualities that Charlie has retained, so far, through this trip down the lane to never-never-land. Charlie had a career as a fighter pilot, and a second career as a U.S. Customs Officer. Those careers demanded that he be focused, precise and in complete control of his surroundings.These traits are things that he tries desperately to hang on to—thus his obsession with his calendar. This sometimes drives me crazy, but it means his mind is still trying to perform as required. From the time he was a young boy, Charlie was engaged in hunting, fishing and wildlife conservation. These are habits that have continued into his receding years. He sits in his recliner, near a window overlooking a large open field surrounded by trees. He never fails to alert me to a passing herd of deer, a fox with its pup, a mother bear and two or three cubs, or the darting presence of numerous birds, most of which he can no longer identify. He would be devastated if he had to move to a place where wildlife observation could not be a part of his daily entertainment. Charlie is a good eater. He never complains about the meals I prepare, even though, on occasion, he probably should. Even the worst meal brings the comment, "Another gourmet meal," from him. It is a pleasure to cook for him. There are times when I wish he would tell me what he would like for dinner, but his Swiss cheese brain is no longer able to think of something different to eat, so when the question is raised, he is likely to tell me to, "Just order a pizza." The only problem is that his appetite is no longer as robust as it used to be. This means that we often eat leftovers for several days until a casserole or roast is gone. But I'm not complaining—especially when I read about caregivers who have meals thrown at them. Charlie has always been a helpmate, doing any chore that I set out for him with no complaints.He still tries to help me with chores. It's just that he is no longer physically or mentally able to carry out many of the things he used to routinely perform. I have had to get used to lugging out the trash, learn to put air in the tires and deal with other "man chores" on a regular basis.I grumble about it, but I know it's one more step towards getting used to not having a man around, when the day comes. I'm grateful Charlie is still able to enjoy reading. His days are consumed with reading up on health issues. He is certain everything he reads in health magazines and flyers is gospel and suggests we look into the latest fad. I have to use my wiles to convince him that every vitamin or natural herb recommended by some "doctor" who has only his own bank account in mind, may not be in his/our best interest. At times I even agree to order something he insists will help him, and then forget about it, as will he.  Until the day comes when Charlie no longer knows I am his wife, recognizes the children, or is able to enjoy the few things left to him in his limited physical and mental state, I will continue to love him and care for him. I may grumble and wail about his frailties, but I will carry on and thank all of you for listening and commiserating.

After Shave Labels/ Rectangle Sticker Basement Door Sign/ Bumper Stickers

Bathroom Door Sign-Temporary/Reusable Wall Skins  

See all our products at Dementia Signage for the Home

Monday, April 13, 2015

Advance Directives to Hasten Death in the Event of Dementia

, Blogger
Diagnosed with Parkinson’s

Advance Directives to Hasten Death in the Event of Dementia

As an old man (86 next month) with Parkinson's, I want to maintain control over the way I die. Quality of life has always meant more to me than the length of life. My greatest fear is losing my cognitive function due to dementia, stroke—or whatever—and being unable to stop my medical care providers from putting my nearest and dearest through the emotional strain and financial drain of watching what's left of me slowly disintegrate.

Fortunately, a new way of dealing with this issue is being explored. Ethicists, lawyers, and older adults have begun a debate about whether someone can specify in an advance health directive that he or she wants to end their life by voluntarily stopping eating and drinking (VSED) if they lose their cognitive function.

How VSED works
My introduction to VSED came as I worked on a post about the death last June of John Rehm, the husband of NPR host Diane Rehm. His Parkinson's had progressed to the point where he was no longer able to use his arms or legs. He checked into a hospice and signed a paper with these instructions: no food or drink. He was kept sedated and died nine days later.

Talking with several friends, I learned they had been at the bedside of a friend who went through the same process in hospice. He suffered from kidney failure and didn't want dialysis.

The ethics of assisting in VSED
Hospice and palliative care organizations are debating the ethics of responding to patient requests for help in VSED deaths. Some view intentionally hastening death by fasting an act of suicide that should be discouraged. Others regard VSED as an ethically appropriate decision to forego unwanted life-prolonging measures...that forcing people to eat is as objectionable as imposing some unwanted medical treatment.

A discussion of the ethical and legal pros and cons of this option was presented in an excellent article in the Journal of Hospice and Palliative Nursing last year. That piece reviewed the case of a patient who requested hospice support for her decision to take the VSED exit.

The patient—a nurse who works for a home hospice agency—had a pelvic tumor that had metastasized throughout her abdomen. She was not in great pain or close to death. But she decided the burdens of living outweighed the benefits.

The hospice ethics committee reviewed clinical and legal opinions in the palliative and hospice care literature. They concluded that VSED was an option that should be available to any mentally competent, terminally ill and suffering patient. Here's a summary of that decision:

“After considering the prospective benefits and concerns about informing patients about this option, the committee concluded that, on balance, providing comprehensive information about VSED permits patients to make an informed decision that reflects their personal values and wishes.” The decision to stop eating and drinking was thought to be consistent with the ethical and legal right to forgo unwanted life-prolonging measures. And finally, it was thought that educating patients and families about "what to expect" as the VSED progresses, providing support as the patient dies, and providing a family with bereavement care after death were actions consistent with the hospice value of patient—and family—centered care. Their final report highlighted their concern about the absence of organizational procedures and guidelines to provide direction to clinicians, patients, family members and the hospice organization when future cases of requests for VSED support occurred.
The report also noted that as professional and lay journals run more stories about VSED experiences, future hospice patients may wish to know whether their local hospice has a VSED policy in order to make an informed choice about whether to begin a relationship with a particular hospice.

VSED and dementia
Many of us have advance directives attached to our wills declaring that—if we are terminally ill—we decline cardiopulmonary resuscitation, ventilator, feeding tube, and other life-sustaining devices and procedures.

But can we also specify that we want our healthcare proxy to arrange for VSED if we have dementia?
This issue was explored in a post, "Complexities of Choosing an End Game for Dementia," in the New York Times blog "The New Old Age." That piece noted that dementia—a terminal diagnosis—presents unique obstacles for those who want some control over the way they die. Dementia generally kills slowly, over years, and "there is often no plug to pull," says Dr. Stanley Terman, a psychiatrist who specializes in end-of-life decision-making. He estimates that several hundred people have requested copies of his Natural Dying Will, which we'll address a later post.

Even in the few states where physicians can legally prescribe lethal medication for the terminally ill, the laws require that patients be mentally competent and able to ingest those drugs themselves. But demented patients don't qualify for this so-called “death with dignity.”

These laws also require doctors to certify that death is expected to occur within six months. That's usually impossible to do in cases of Alzheimer's or some other dementia. Those same laws would also typically prevent those of us with Parkinson's from qualifying.

The question for proponents of VSED by advance directive is whether the practice can also provide a humane exit for people who, years later, no longer remember or understand why they wanted to use it. Proponents of the approach acknowledge that dementia patients and their health care proxies will face great controversy if they try to cut off food and drink; so will the professionals who care for them. From infancy, nourishment carries connotations that make stopping it feel different from rejecting medical machinery.

Questioning the legality of VSED
The legal status of VSED by advance directive remains untested.

A court case unfolding in British Columbia shows just how tricky these legal issues can be. The case involves an 83-year-old retired nurse with advanced Alzheimer's disease. Her advance directive specified "no nourishment or liquids" if she became incapacitated. When her husband and daughter attempted to honor her wishes, the care facility where she lives refused, sending the family to court.
Last February, a judge ruled that although a health care provider could legally honor such a directive, the feeding should continue in this case in part because the patient swallows food placed in her mouth. That constitutes consent, the judge ruled. The family has appealed.

If swallowing is all it takes to legally invalidate an advance directive, then few VSED directives will survive when challenged.

The moral and ethical aspects are even more dizzying. Can one's current and competent self make decisions on behalf of one's future demented self—who may find modest pleasure, years later in a life once deemed intolerable? What if that later self asks for, or points to, applesauce?

Clearly, we will see many more legal and ethical challenges to advance VSED directives for dementia.

Meanwhile, maybe I'll get a T-shirt that carries the motto of one of the proponents of these directives: