Essential Health Benefits

All insurance plans purchased from the ACA Marketplace must include the following Essential Health Benefits. These benefits include,

·         Emergency Services

·         Hospitalization

·         Laboratory tests

·         Maternity and Newborn care

·         Management of chronic diseases, such as diabetes

·         Mental health and substance-abuse treatment

·         Outpatient care

·         Pediatric services including dental and vision care

·         Preventative services such as immunizations, mammograms and colonoscopies

·         Rehabilitation services

 

There are other protections in the Affordable Care Act that benefit all of us. No one can be denied healthcare insurance because of pre-existing conditions; there can no longer be annual limits on the benefits you receive; there is a ban on lifetime limits; preventive care and annual check-ups are free.

Current Clients

Who are you seeing at the clinic now? I am asked that question frequently. Now that everyone – in theory – has access to healthcare, who are we serving?

It has been an interesting journey – from anticipation to implementation – of the healthcare law. Connie and I became Certified Application Counselors in order to assist those looking to purchase healthcare insurance; we had very mixed results – some success, some who couldn’t afford to purchase the insurance that was offered. There were some who were skeptical about the whole process – they didn’t trust the system or didn’t understand what insurance would do for them.

Then, April 1, 2014 finally arrived and we were able to sign people up for the Healthy Michigan Plan (HMP), which is Michigan’s version of the Medicaid Expansion, a key part of the Affordable Care Act. It has been beyond our wildest imagination. From January to April we were seeing an average of 65 patients each week; we are now seeing an average of 31. And lately, that number is dropping.

So, who do we see? We see people who have fallen through the cracks – maybe they don’t qualify for Medicaid, but cannot afford insurance; maybe they were not aware of Medicaid expansion or the fact that this program is very different from the Medicaid of the past, so we provide them with healthcare, and we help them enroll in the Healthy Michigan Plan. We see immigrants, who have not lived in the country long enough to qualify for any of the programs; we see those who have enrolled in HMP, but have not received their insurance card in the mail – or who can’t get an appointment for another month; we see those that are new to our community and have no healthcare insurance. We are seeing fewer with chronic conditions and more with acute conditions. Most of the people we see are working and need to be healthy to keep their jobs.

We continue to help with enrollment; we are teaching those newly insured how to be healthcare consumers; we are offering smoking cessation sessions; we are going to start a program this fall or winter helping people make better lifestyle choices.

The clinic will be here as long as there is a need in our community. Our mission has always been to fill the gap in healthcare in our community. The gap has changed, but the fact that there is a gap has not.

Honestly, I feel like I can take a breath – we are able to be more present to those who walk through our doors when we are not so overwhelmed by the numbers. We can teach, we can listen, and we can provide a better quality service.

Smile!

I don’t know what made me think of Mark the other day, but something did. He was a patient here at the clinic from 2003-2006. He had a job – seasonal work with no benefits and not much income.

Mark had been in and out of trouble at times, but was a really nice guy. He’s a few years older than me, but had a mother who was supportive and worried about him. She and I became friends. We helped him get the medication that he needed, but that’s not the reason I remember Mark.

I remember him because of his smile. Not at first – he came in with dental issues the very first time we saw him here at the clinic.

Over the years here at St. Peter’s Free Clinic, we have tried to address the multitude of unmet needs that exist in our community. We have been fairly successful in providing healthcare services and medications to the low-income, uninsured residents of our county. But, not as successful in providing some of the other unmet needs – and dental care is a huge unmet need.

The importance of dental care has been expanded over time – we now know how important it is to maintain good oral health to protect physical health. Some of the disease processes affected by dental health are:

·         Diabetes: People with diabetes who happen to have periodontal disease may suffer excessive bone loss of the jaw or surrounding bone structure and have difficulties in healing.

·         Heart Disease: Experts have concluded that poor oral health caused by chronic dental infections may increase the risk for cardiovascular disease and stroke.

·         Stroke: Recent studies have linked periodontal disease with strokes.

Mark came in during a time when one of the local dentists was very eager to help our patients. Mark was one of the first patients to be seen by the dentist for the clinic. He came in, we made the referral, and then I didn’t see him for several months. When he came back to the clinic, he had a smile as big as the moon. His teeth had been fixed or replaced; he was no longer embarrassed to smile. He was grateful beyond words.

For many people, poor dental care is a barrier to jobs. No matter how smart, how personable, or how well-dressed a person is, if they have bad teeth, or no teeth, they are not going to get hired. Dental care can change a person’s life. It may also save a life!

I am so thrilled that the Healthy Michigan Plan (what Medicaid expansion is called in Michigan) includes access to dental care for adults (children on Medicaid have always had this benefit in Michigan). It will make a huge difference in the life of the working poor in our state.

Maybe we will see more people smiling?

Book Recommendations

When I am faced with a problem or a challenge, I tend to turn to books, both to gather information and as an escape.

Recent family health issues have led me to read several books that I highly recommend to anyone facing end of life issues. These books are much more about gathering information, but most of them are also about someone else on this journey at the end of life. Their stories have encouraged me, given me much-needed information and insight, and have helped me form the questions I have that need answers.

In no particular order, here are the books that have really spoken to me:

My Mother, Your Mother: What to Expect as Parents Age by Dennis McCullough, MD

 

Knocking on Heaven’s Door: The Path to a Better Way of Death by Katy Butler

 

The Best Care Possible: A Physician’s Quest to Transform Care Through the End of Life by Ira Byock, MD

 

A Bittersweet Season Caring for our Aging Parents – and Ourselves by Jane Gross

 

 

Planning Ahead: Durable Medical Power of Attorney

As you learn about making your way through the healthcare system, there are many things to think about. An important tool is the Durable Medical Power of Attorney.

A Durable Medical Power of Attorney helps to assure that the medical professionals and your family/friends are able to carry out your wishes if you are unable to communicate due to illness or injury.

A Durable Medical Power of Attorney is a document that you create. It grants the authority to a person of your choice to make medical decisions on your behalf if you are unable to participate in the care planning.

Durable Medical Power of Attorney is also known as Advanced Directives.

A Living Will provides instructions to doctors, hospitals and family/friends concerning the use of specific procedures designed to sustain life – such as ventilators, feeding tubes, or dialysis. A living will also authorizes medical facilities to withhold certain procedures if there is no reasonable chance for recovery. This document outlines YOUR wishes – there is no need to appoint anyone to carry them out.

You may have both a living will and a Durable Medical Power of Attorney.

To create a Durable Medical Power of Attorney, check the laws of your state. Often the forms are available at no charge online or at your healthcare provider’s office.

With a Durable Medical Power of Attorney, you are not giving up control; rather you are making sure that your wishes will be carried out if you are unable to make the decisions.

The person you choose does not have to be a family member, nor does it have to be the family member that lives closest. It should be someone who is readily available by phone in case of emergency. Select someone who knows you and is willing to carry out your wishes about your medical care.

Copies of your Durable Medial Power of Attorney should be given to your physician, your hospital, the person(s) you have chosen to represent you, and extra copies in a safe place such as a safety deposit box or a fire-proof cabinet. Make sure your emergency contact and at least one other person knows where you keep it and how to access it.

Often, we find it too difficult to think about these issues – we still have YEARS of a good life. But, if we don’t plan for the unforeseen, we could end up in a situation where our wishes are not taken into consideration. It is important to plan ahead, and to talk to those who will be making decisions on our behalf about what we consider to be quality of life. These conversations are much easier in theory than they are in reality, so plan ahead. Make your wishes known, and choose who will make those decisions if you can’t.

 

How to be a Good Healthcare Consumer

For the newly insured, there can be a learning curve about how to appropriately use healthcare services. Some of us who have had insurance for years could also use a refresher!

Once a person is insured, it is time to make an appointment with a healthcare provider. There are several options for care. Most insurers refer to a “Primary Care Provider” which is a healthcare provider who is chosen by or assigned to a patient and both provides primary care and acts as a gatekeeper to control access to other medical services.

The primary care provider can be a physician, either a DO or MD, but it may also be a Nurse Practitioner or a Physician Assistant.

There are actually two ways to achieve the title of doctor and practice medicine. One can become a medical doctor (MD) or a doctor of osteopathy (DO). Both licenses allow one to practice medicine and have equally rigorous testing.

Nurse Practitioners are registered nurses trained to be a primary healthcare provider. Their education is based on nursing model and philosophy. Master's degree with relevant experience + Certification + License to practice.

Physician Assistants are healthcare providers practicing medicine under the supervision of a physician. Their education is based on medical model. PA program + License to Practice.

Once you have an appointment with the Primary Care Provider you have chosen, it is time to focus on your appointment. First and foremost, this means turning your cell phone off. Paying attention to the visit with your primary care provider is important.

When you go to your appointment, make sure you have the following information:

·         Insurance card(s)

·         Driver’s license or other proof of identity

·         Any forms the office has sent you to fill out – and have them filled out

·         Health history for you and your family (any chronic diseases your parents, siblings, grandparents have or had)

·         A list of all medications you are taking – prescription and over-the-counter, including vitamins and supplements

·         A list of all allergies

It is important to be prepared to discuss your health with your primary care provider. You will have a limited amount of time for the appointment, and you want to leave with the information you need. Often it is helpful to bring a family member or friend along to be an extra set of ears.

Some tips for talking with your primary care provider:

·         Always remember that it is your body

·         Share your concerns and medical history quickly and accurately

·         Ask questions

·         Take paper and pencil to write down notes during the conversation

·         Make sure you understand any instructions that are given to you

·         If tests, procedures or new medications are suggested, ask some additional questions

o   Do I really NEED this test, procedure, medication?

o   What are the benefits and downsides?

o   Is there a simpler, safer option?

o   What happens if I do nothing?

o   How much will it cost?

Good healthcare is a cooperative effort between you and your healthcare provider. The best healthcare also involves family/friends/caregivers.

 

 

Healthcare: It's Personal

In the past 12 weeks, at one time or another, my dad, my husband, my aunt and my mom have been in the hospital. It has included 4 emergency room trips, 2 ambulance rides, 3 hospitals and countless hours.

This is my rant, my request for prayers, and my reminder to be grateful.

It is always frightening, anxiety-producing, and overwhelming to have someone you love in a life-threatening situation. Trust me – being a nurse does not make that any easier. I know enough to be terrified, but not enough to be helpful in most situations. I typically do not tell the healthcare professionals that I am a nurse – until either it is in the best interest of my loved ones, or if I am being treated patronizingly, then I will tell them.

My dad has been the most frequent inpatient – surgery, complications, a fall, more complications and a stay in rehab to regain strength from all the hospitalizations! He is 83, and as amazing as he has always been. His strength and determination are an inspiration to me – always, but especially now.

My husband ended up in the hospital for the third time in a year. “Ugh,” is all I can say. We are too young to be going through the things he has endured for the past year. I always hope that his health will stabilize, but there are no guarantees. New treatment options are in the very near future - exciting, and scary!

In the midst of my dad’s stint in rehab, my mother calls to tell me she has called the ambulance – she is having chest pains. I have to admit, I figured it was anxiety and stress. She has been through so much lately. But, I was wrong. She had a heart attack – the “widow maker” – her LAD nearly totally occluded. She was lucky – one stent – and she is feeling pretty good. Obviously, she started off exhausted, so it will take some time for her to recover. But, I am amazed at what can be done with minimal invasion and a short recovery time.

I have seen excellent care; I have seen awful care, and individuals I wanted to choke. As in any profession there are good people and there are those who just want to get by; those who are doing work that is meaningful and fulfilling to them, and those who just want a paycheck. It is too bad that people ended up doing work that they don’t like. It usually shows.

Our healthcare system is broken in so many ways – I have given the same information to a dozen people. The need for universal electronic medical records is one thing that jumps out for me – the emergency room and the cardiac care unit can’t even communicate with each other, so too much time is wasted asking the same questions again and again. Medications are changed due to the formulary each institution carries; referrals are not made; communication between the hospital and the primary care provider is incomplete; and, too often, there is not enough staff and response time can be long. It is frustrating and scary.

I don’t have any magic idea to fix things. But, I have a new appreciation of how hard it is to be the family of someone who is hospitalized. Some things would be easy to address: tell the family where they can get water, food, a restroom, and answers. Look at people when you talk to them – not at the computer or the paper in your hand. Answer questions in a manner that is understandable. Tell us the options – not just what you want us to do.

I also have a new appreciation for my family. Growing older is a bitch. It is not easy, it is not without issues and it is not the “golden years.” It is hard. I cannot imagine how people do it by themselves. I am exhausted and overwhelmed – and I have a brother, a sister, a husband, a son, a daughter who are all involved in the care of the various family members. I have the support of family and friends, and I am still overwhelmed and exhausted.

My cousin is dealing with the parallel issues with her parents; I can’t imagine how I could do this without her support, encouragement and presence in my life. We walk, whine, drink wine, laugh, talk and support one another on this journey.

So, this is my opportunity to say thank you to all the family and friends who have made this part of my journey easier – the kind words, the prayers, the time listening to my story, the glasses of wine and all the help. Thank you. I am so grateful to each and every one of you.