ICD-10 Codes Go Into Effect on October 1, 2015

 

A recent article in The Wall Street Journal discussed the advent of the new International Classification of Diseases, commonly known as ICD codes. The federal government developed this system of classifying diseases and injuries. The codes serve as the universal language used by doctors and hospitals to describe diseases and injuries. For insurance and governmental purposes, the ICD codes are used rather than text, such as "broken right hip." The current version of the codes is ICD-9, which was adopted in 1979. Under the ICD-9 codes, there were about 18,000 different codes. Under the ICD-10 codes, which go into effect October 1, 2015, there are about 142,000 different codes. Proponents of so many more codes cite the fact that much more detailed medical data will be generated by these codes to help in research and treatment. Critics cite the huge additional cost of learning all these codes and then using them correctly, and the fact that they represent yet another paperwork problem for doctors and hospitals already buried under paperwork. Time will tell.  

A Recent Physician-Authored Book Highlights

Some of the Growing Problems in the Healthcare System

Elaina George, M.D., a Board Certified Otolaryngologist, has written a book which highlights some of the growing problems in the delivery of healthcare: Big Medicine: The Cost Of Corporate Control And How Doctors And Patients Working To Get Her Can Rebuild A Better System.

 

I am often asked how the Affordable Care Act and other new laws affect the patient-perspective advice I give in my book, Patient Confidential, Tips and Advice To Keep You Safe As You Navigate the Healthcare System. My answer is that being an informed, interactive patient will be even more critical with these new laws in effect. There will be many more patients vying for a static or perhaps even diminishing number of healthcare providers. The patient must make the very most of every healthcare encounter.

Dr. George says in her book, "There is no question among doctors that limiting healthcare access will become the future. Adding 30 million more people enrolled in government-paid Medicaid into a system now shackled by reduced resources makes it impossible to avoid limiting access."

 

She goes on to describe some of the consequences of this, "An unintended consequence of the Affordable Care Act is the sacrifice of the doctor patient relationship enshrined in the Hippocratic Oath. The pressure for doctors to practice medicine driven by government mandated cost control measures will ultimately affect an individual's right to determine the course of their own healthcare."

 

I advise people to study up now on how to influence the quality or their healthcare if they have not already done so.

The Rise In Second Opinions

The Wall Street Journal ran a recent article about second opinions. In interviews about my book, Patient Confidential, Tips and Advice To Keep You Safe As You Navigate the Healthcare System, the thing I am most often asked about is a second opinion. I say in my book, " . . . I believe most doctors think that [second opinions] are a good idea in the right circumstances." The article points out that second opinions may in many cases now be done on-line. This service is being offered by such well-known institutions as Massachusetts General Hospital and Cleveland Clinic, as well as stand alone businesses. The patient pays a fee and sends his medical records to the second opinion provider who then renders a second opinion. As the article acknowledges, this is especially valuable for patients who do not live close to major medical centers. I think that a face-to-face second opinion is better, but do not diminish the usefulness of the on-line second opinion when necessary.  However obtained, it is obvious that second opinions are being sought in increasing numbers. George Pauly of Massachusetts General estimated that its "online second-opinion service, which started about eight years ago, handled about 10,000 cases last year compared with fewer than 1,000 five years ago . . . ."

Richard on the Radio

 

 

I will be interviewed for a Bloomberg radio program which will air at 12 noon ET on Saturday, August 29, on 970WFLA Tampa.  There is also a live video stream at the same time.  The program can be accessed by going to: http://webeamtv.com/ and clicking on the American Medicine Today link.

Article Stresses the Importance of Being a Proactive Patient

An excellent article in The Wall Street Journal stresses the importance of managing one's own health care, which I stress in Patient Confidential, Tips and Advice To Keep You Safe As You Navigate the Healthcare System. The article contains many good tips and discusses programs being developed by The Centers for Medicare and Medicaid Services to help patients in this endeavor.

The article states, "'Conflicts between medications, and doctors that don’t talk to one another, is a big and common problem,” said John Piette, director of the Center for Managing Chronic Disease at the University of Michigan School of Public Health. 'People have difficulty managing both symptoms and side effects of multiple medications,' he added." It goes on to say, "The Department of Health and Human Services (HHS) in July issued a free curriculum for training health-care professionals and others in how to care for patients with multiple chronic conditions.

In Patient Confidential, I repeat many times that the patient needs to be educated and ask questions, and cannot be a passive object of medical care. The article quotes Dr. Victor Montori, a professor of medicine at Mayo Clinic in Rochester, Minnesota, "Patients must also educate themselves about the health care they need, said Dr. Montori."

In the Afterword to Patient Confidential, I say, "If you learned nothing else, I hope you learned how critical it is that you be proactive in your healthcare. If you don't understand something or it doesn't sound right, ask, ask and ask some more."

Recent Review of Patient Confidential

I was very happy to receive this favorable review of my book, Patient Confidential, Tips and Advice To Keep You Safe As You Navigate the Healthcare System, from Matt Cavallo, the prestigious author of 7 Steps to Living Well with a Chronic Illness and The Dog Story: A Journey into a New Life with Multiple Sclerosis. 

"I found the information in “Patient Confidential” to be a succinct, easy to read, invaluable resource of how to navigate the healthcare system. I would highly recommend this book to anyone seeking education on the healthcare system."

Take Charge of Your Medical Records

"It's your health. So it's time you took control of all the information about it." That is the opening sentence in an excellent recent article in The Wall Street Journal, titled "How To Take Charge of Your Medical Records." It goes on to say, "Studies show that 400,000 Americans die every year because of medical errors, including 80,000 because doctors don’t have in hand the information they need."

The article is an excellent guide to obtaining, managing, correcting and protecting your medical records. It lists five important steps: (1) demand your data, (2) organize it, (3) share it, (4) generate it yourself (measuring your own blood pressure, exercise data, etc.), and (5) protect it. It contains detailed advice on managing records, including computer and smart phone programs and applications, as well as discussing the privacy risks of using those.

In almost every facet of life, knowledge is power, and it is no different in healthcare, except that some of the healthcare knowledge a person acquires might save his or her life.

Communication Critical to Patient Care

 

 

 

A recent article in the New York Times, stressed the dangers of lack of communication. This article focused on lack of communication among a patient's physicians, but the lesson I stress in Patient Confidential, Tips and Advice To Keep You Safe As You Navigate the Healthcare System, about patient involvement, understanding and empowerment is a part of the solution. For example, if patients or their caregivers are constantly asking questions of every physician, nurse or technician who comes into their hospital room to do something, and not letting anything be done without an explanation, the effect of lack of communication among the doctors would be blunted.

 

Of course, asking questions and understanding what is being done and why before it is done, is important in all other medical encounters too, like office visits, tests, medications, physical therapy sessions and so on.

Richard's Interview On Cancer SOS Radio Program





I recently appeared on Joni Aldrich's iHeart radio show, Cancer SOS.  Joni is very experienced in dealing with medical issues, and her show is very helpful to patients, as I hope my book, Patient Confidential, Tips and Advice To Keep You Safe As You Navigate the Healthcare System, is. I think Joni and I, and co-host Chris Jerry, had a very lively discussion, which we hope is beneficial to patients and their caregivers. Much of the credit goes to Joni and Chris, who are deeply committed to helping patients and are skilled interviewers.  The link to the show is below.  One must "join" iHeart to listen, but it is easy and free.

 

http://www.iheart.com/show/Joni-Aldrich-SOS-Supporter-of/?episode_id=27259555

Seven Minute Podcast Sheds Light On Issues in

Patient Confidential, Including Getting Second Opinions

 

I was recently interviewed for a podcast on Jennings Wire regarding various tips I set out in Patient Confidential, Tips and Advice To Keep You Safe As You Navigate the Healthcare System.  Here is the link to the podcast.  I hope you find it helpful.



The Power of Second Opinions

On its Health Shots Health News Page, NPR recently posted an article about second opinions, citing the story about the actress Rita Wilson's cancer diagnosis and subsequent double mastectomy. As I wrote in Patient Confidential, Tips and Advice To Keep You Safe As You Navigate the Healthcare System, second opinions are important and beneficial. The article points out that second opinions are not always right, just as first opinions are not always right, but states: "That doesn't mean second opinions are a bad idea. By some estimates, diagnostic errors occur in 10 to 15 percent of cases."

 

Knowledge is power, including in the patient protection arena, and more knowledge is more power. So, get that second opinion.

Patient Knowledge Recognized by Hospitals

A recent Wall Street Journal article, reported that, "Patients are getting help from experts with no medical degrees but plenty of know-how: fellow patients who have faced the same health challenges."  The inset title of the article is "The Informed Patient." The core advice in my book, Patient Confidential, Tips and Advice To Keep You Safe As You Navigate the Healthcare System, is that the patient must inform himself. The article reports on the formalization of an informal process of informing patients which has gone on for years, namely patients mentoring others who have the same medical condition. Before several of my surgeries, I asked friends who I knew had undergone the same surgery to tell me about the experience and give me practical tips. I have done the same for many others.

 

But, finding a friend with the same condition is happenstance. Now healthcare providers are formalizing that process. Dr. Paul King, Director of the Center for Joint Replacement at Anne Arundel Medical Center in Annapolis, Maryland, is quoted as saying, "We have all these nurses and surgeons who haven't actually had a knee or hip replacement and don't know firsthand what it is like." So, Anne Arundel began a program and trains mentors. Mentors, of course, are not giving medical advice or developing physical therapy plans beyond what the therapist did. Their job is to tell patients what it's "really like" from the patient perspective, and to help them follow the instructions of the professional healthcare providers. With such a program, the patient simply signs up to have a mentor and the hospital matches her with one.

 

In a post to this blog on October 27, 2014, titled "Man Bites Dog," I wrote how I advised my cardiologist what it was like to be a knee replacement patient, and how much he said that helped him. He knew what he knew and I knew what I knew.

I hope healthcare institutions all over the country rapidly establish and support patient mentor programs.

Have Patient Confidential In Your Purse or Pocket

Patient Confidential, Tips and Advice To Keep You Safe As You Navigate the Healthcare System, is available not only in print, but also as an e-book which you can read on your e-readers and smart phones and easily take with you to medical appointments.  It is a great format to use Patient Confidential as a handbook during your medical encounters.

Amazon.com

Barnes & Noble

Richard On the Radio

At 1:00 p.m. CDT on Monday, April 13, I will appear on a radio show called CANCER SOS, which is hosted by Joni Aldrich and simulcast on www.W4WN.com and www.W4CS.com. A podcast will be posted after the live show on iHeart Talk Radio and UK Health Radio.

New Ways to Define Pain

A recent article in The Wall Street Journal highlighted the power of proactive patients. Patients complained about the familiar pain scale of 1 to 10 (remember the smiley and frowny faces?) because they never really knew what a 10 was or exactly what the other numbers meant. The doctors and patients had no way of knowing how each other rated pain either. Did the doctor and patient mean the same thing when they assigned a number to pain? A new system of pain measurement is being developed, related to daily activities. It is thought to be more significant what a patient can and cannot do in daily life, like cooking, getting physical therapy or sleeping, than what number the patient assigns to the pain.

 

What attracted me to the article is that this rethinking arose out of patients talking to doctors, not the reverse. Usually, if patients talk, doctors listen. This is a principle which can be applied to every health care encounter a patient has. Ask questions. Talk to the doc. It can pay big dividends.

Recent Article Reinforces the Need To Be an Informed Patient

A recent Special Report in Men's Journal, titled "When To Say No To Your Doctor," gives excellent advice to patients. It describes what patients need to know before agreeing to many different tests, surgeries and prescription drug treatments. It explores, among other things, what patients need to know about blood pressure screenings, use of statins (a type of cholesterol management drug) and getting a PSA test (a blood test which screens for prostate cancer). It also contains a section on "Surgeries You May Be Better Off Without."

 

The point is that having some tests or surgeries or taking certain drugs is not a one-sided "no-brainer." If you broke a leg and the bones were sticking out through your skin, you need surgery. There are many such cases, but there are also cases where experts differ on whether a certain surgical treatment is wise. As an illustration, the article discusses whether men should have the PSA blood test. "A suspicious PSA reading . . . might be caused by normal age-related enlargement of the gland [prostate] or an infection . . . ." The article cites research that found that "about three-quarters of the men who got alarming PSA scores and were subjected to the discomfort and infection risk of a prostate biopsy turned out to be false-positives - no cancer found." Dr. Gilbert Welch is quoted: "Roughly half of the elderly men in America have evidence of cancer in their prostate, yet only 3 percent will die from it." The PSA is just one example from the article. There are many more.

 

In my book, Patient Confidential, Tips and Advice To Keep You Safe As You Navigate the Healthcare System, I say, "you are not a bystander or an object of medical care. You must be an active participant, thinking, analyzing, gathering date, and asking questions."  In the Afterword to Patient Confidential, I say, "If you learned nothing else, I hope you learned how critical it is that you be proactive in your healthcare. If you don't understand something or it doesn't sound right, ask, ask, and ask some more." 

The Northbrook Tower Publishes a

Feature Article on Patient Confidential

The Northbrook Tower newspaper interviewed me and published a feature article on my book, Patient Confidential, Tips and Advice To keep You Safe As You Navigate the Healthcare System. This excellent article really captures the theme and intent of Patient Confidential. The article states that the book "instructs the readers on how to be active players in their healthcare and to get the most out of the system with the least amount of risk."

The article quotes me: "Knowledge is power . . . You're going to come in much better to understand the doctor's advice if you have read something about your illness when you are talking to them. Doctors I have talked to would much rather have a patient who asks questions and wants to know more."

The effect of the Affordable Care Act (Obamacare) was also discussed in the interview. The article reports, "In Lang's view, the ongoing implementation of the Affordable Care Act makes the advice in 'Patient Confidential' even more important." I am quoted as saying, "If I'm right, what is going to happen is there won't be a whole lot more doctors . . . but there will be a whole lot more patients because so many more people will be insured . . . ." Further, "the doctors are going to be pressed for time. You are going to be competing with a bunch of other people sitting in the waiting room to get in there and get that time with the doctor, and you better make good use of the time."

The importance of learning to be proactive in your healthcare in order to get the very best results cannot be overemphasized.



 

Shocking New Study on Surgical Errors

In Patient Confidential, Tips and Advice To Keep You Safe As You Navigate the Healthcare System, I identify two types of surgical mistakes. I call them "botched procedures," where the surgeon just doesn't do the operation well or leaves instruments in your body, and "wrong procedures," where for example, the surgeon operates on the wrong knee. I say, among other precautions "you should recite the procedure to the doctor when you are seen right before the procedure. 'Hi, Dr. Smith, you're replacing my left knee, correct?' Before the anesthesiologist asks if you are ready to be put to sleep, remind him of any drug to which you are allergic."

Johns Hopkins Hospital released a study recently which supports this advice. The study estimated there are over four thousand malpractice claims filed each year for what it calls "never events," that is things that just should never happen, like sponges or instruments left in the patient or operating on the wrong part of the body. These never events led to permanent injury in 32.9% of patients. These are big numbers and you can do a lot as a proactive patient to avoid being in those statistics.

Should You Get A Second Opinion

     “So you want a second opinion?” the doctor said. “Then listen up and I'll tell you again." As I point out in my book, Patient Confidential, Tips and Advice To Keep You Safe As You Navigate the Healthcare System, (for more information about Patient Confidential, please click here), that was not only a joke decades go, but too often a reality. Patients did not question the doctor. I believe the current reality is totally different, or should be. I write in Patient Confidential, "I think, and I believe most doctors think, that [second opinions] are a good idea in the right circumstances. The right circumstances include when a malady may be relatively serious and that there may be alternative treatments or perhaps even alternative diagnoses."

     The overarching theme I "preach" in Patient Confidential is that the patient is not a bystander. The patient must be an active participant, a partner with the healthcare providers, in order to maximize the diagnosis and treatment of the patient's medical problems and to minimize the risks of bad outcomes. Patients need to ask questions, do research and educate themselves. But, the ultimate medical judgment must be made by a medical professional. The way to insure that the diagnosis of a serious medical problem is right and that the treatment is the best available, is to get a second opinion. I have gotten many second opinions, and not once did the first doctor do anything but commend and support my decision. If your doctor discourages you from getting a second opinion, except if your situation is an emergency where there may be no time to get a second opinion, you need a new doctor, not just a new opinion.

 

"Patient Passports" Inform Doctors and Improve Outcomes

A recent article in The Wall Street Journal, discussed the developing idea of "Patient Passports." A Patient Passport is a written document which contains all the basic medical information about the patient, but also has a place for the patient to express concerns about quality of life, the need for medically related services, such as counseling, and many other matters. These important items are often overlooked in the brief visit with the doctor.

 

The article says, "Many patients are afraid to ask doctors questions for fear of appearing to challenge them [doctors], studies have found, and doctors often don’t take the time to listen to their input. Yet when patients and families are fully involved in medical decisions and able to express themselves, studies show it can result in better patient outcomes, lower risk of medical errors and fewer readmissions after discharge."

In the Introduction to my book, Patient Confidential, Tips and Advice To Keep You Safe As You Navigate the Healthcare System, I stress the critical importance of the patient's becoming informed. I say, "Careful patients and their caregivers now ask questions and smart doctors not only answer questions but give patients and caregivers full explanations up front, before the questions come." I then apply this principle to all the various healthcare encounters, the office visit, tests, hospitalization and so on.  Becoming informed is so important that in the Afterword, I say, "If you learned nothing else, I hope you learned how critical it is that you be proactive in your healthcare. If you don't understand something or it doesn't sound right, ask, ask, and ask some more."

Survey Supports the Principles in Patient Confidential

     The February, 2015 issue of Consumer Reports has an excellent article titled "How Not to Get Sick(er) In the Hospital," based on a Consumer Reports survey and other respected health care studies. I was happy to see that the article supports and reinforces several of the core principles and tips I have in my book, Patient Confidential, Tips and Advice To Keep You Safe As You Navigate the Healthcare System

     The article shows numerous cases where proactive, involved patients got better results. As I point out in my book, the patient is not a passive object of treatment, but must be an active partner in his or her health care. The survey found that "about 40 percent of patients  . . . did not feel staff always took a  personal interest in them." The article goes on to say, "Reminding people that you are more than a diagnosis can change that." The article suggests talking with medical providers about aspects of your life other than your illness, and taking an interest in anything they tell you about themselves, to create a personal and less sterile relationship. These ideas translate to real, tangible differences in care. The article notes that people who rarely received respect from providers were two and a half times as likely to be the victims of medical errors.

     The article also stresses another principle I write about in my book. Have a family member or friend accompany you to healthcare encounters, to be a second set of eyes and ears and to be an advocate when necessary. Survey respondents who did this were 16 percent more likely to feel respected and 12 percent more likely to recommend their hospital. When I have had surgery, my wife always plans her schedule to be at the hospital during and after the surgery, and the next day when the doctor is expected to come with more information and instructions. We both want her to hear what the doctor says.

     Another key tip in Patient Confidential and in the article, is to write things down. It is hard enough to remember complicated medical explanations when you are well, let alone when you are sick.  Listen carefully, always ask questions if you don't understand what the provider has said, and write it down.  If possible, have your loved one present and writing things down too.

     Learn how to get involved in your healthcare.  It pays huge dividends.