Month: August 2016

30 Days – CMS and Hospitals Share Risk – Input Desired

Posted on by Michelle Fritsch, Pharm.D.
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Technology is being developed to help you stay healthy and out of the hospital 30 days.

The Centers for Medicare and Medicaid Services (CMS) are striving to keep healthcare affordable. Healthcare is expensive. Healthcare is necessary. We all need it at some time or another. It is best if medical conditions that require hospitalization are fully treated while in the hospital. CMS wants to pay for these conditions just once. So, to help make sure they are fully treated and that patients are sent home with all they need to stay healthy, there is now a shared risk payment model. If someone returns to the hospital within 30 days of discharge, then CMS will not pay for that second visit. (Of course it is all more complex than this paragraph describes).

So, there are a number of very smart people working hard to increase the success of people going home from the hospital to help them not return. At least making sure people don’t return for the same problem within 30 days.

There are people working on tools to help keep medication regimens straight. Others are working on ways to monitor health so if it starts to get worse an adjustment can be made at home. This could prevent a need to go back to the hospital. These tools can monitor blood pressure, blood sugar, weight, oxygenation, and more. There are also tools to monitor in-home activity, measure falls risk, and respond when someone has fallen. Much of the follow up after a hospitalization can occur more frequently and simply with telehealth. This means talking with your doctor, nurse, pharmacist, or other provider over the computer.

There is an explosion of new technology. The issue now is to determine which types of technology are most effective. It is also to determine which types really help people get better. And ideally, the best technology will help people stay better for a long time.

Then there is the issue of how people, the patients, feel about the technology. Some are very excited to have new ways to monitor their own health. Look at the growth and acceptance of wearable devices. Some popular examples are Fitbit, Apple watch, and Garmin Forerunner, and TomTom. Spark.

  • I can find a lot of information about how the technology is proposed to help people safely go home and stay healthy enough to stay out of the hospital.
  • I can find some information demonstrating that these really do cut down on the number of people that bounce back to the hospital.
  • I can find very little data about how people feel about the use of such technology, especially for at least 30 days.

Hospitals are preparing to spend millions of dollars on these solutions. For the money saved by reducing readmission, the hospital and the solutions companies will share those dollars.

  • So what do you think?
  • Are you excited about the use of technology to help you stay healthy?
  • Do you see more advantages or disadvantages?
  • Have you experienced some of these technologies when you or a loved one has been discharged from the hospital?

I would love to hear your thoughts. Please send your questions, your ideas, and your opinions to us at www.medsmash.com/contact.

BIBLICAL APPLICATION

Another thing that I’ve been pondering about 30-day readmission rates is the usefulness of short term solutions. I might have to write about that next week.

I find that topic to be really relevant in my Christian life as well. I love the ‘mountaintop’ experiences. These are the times when you are absolutely on fire for God. They are the times when you are closest to God. They are the times when you most directly feel God’s presence.

At those moments, what do you plan to do? Do you agree with me that it feels like you’ll be able to stay in that intimate place for a long time? How long do those intentions really last?

Have you ever made plans during those times when you felt most intimate with God? Did you make some promises? Did you decide your were going to make big changes in your life? I know I have.

Even now, just two weeks back from a life-changing experience in Jamaica, I’ve fallen back into old habits. I’m putting my needs and desires before other people. I’m way less focused on all that I could be doing for others. I’m more focused on my own aches and pains again. This is not what I intended. It is not what I told myself or God I would do when I got back.

Romans 8:5 ESV

For those who live according to the flesh set their minds on the things of the flesh, but those who live according to the Spirit set their minds on the things of the Spirit.

I really, truly want to live according to the Spirit. Yet my progress often feels like two steps forward, one step back.

Do you have the same experiences?

So each day, I strive to stay focused. I try to keep my eyes on God.

Colossians 3:2 ESV

Set your minds on things that are above, not on things that are on earth.

Every day I fail at some point, or a lot of points. But, I also have more of those moments of intimacy. I feel better in every way when I make that time for God. (And knowing that, I still charge right past that time to get on with the to-do list of the day).

Proverbs 16:3 ESV

Commit your work to the Lord, and your plans will be established.

So today, I will strive again to stay focused on God’s plans. I will strive to keep my ‘spiritual eyes’ on and see the needs of those around me. I will keep working toward the long-term goal rather than a short-term solution.

Blessings,

Michelle

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Hate and Health – Surviving These Days

Posted on by Michelle Fritsch, Pharm.D.

Hate and ugliness can shape your life. It often comes out of nowhere. How you deal with it has a huge impact on your health.

You often can’t prevent it. You can’t predict. It hits you out of nowhere, so you can’t prepare for it. Yet, hate and ugliness touch most, if not all, of us at some time at least once.

What is the ugliest event that has occurred in your life? How have you been touched by hate? How did you handle it at the time? How have you handled it since?

As a nation and a global community we have seen and experienced acts of hate in so many forms recently. There is unrest stirred by fear, threats, and acts of terror. If this fear takes over in your life, your stress levels increase, your heart works harder, your risk of depression goes way up, anxiety increases, sleep is impaired, and your overall health declines.

Last week I talked about the health benefits of thinking about other people and their needs rather than focusing just on yourself. Altruism is very directly linked to improved health.

The other thing that was directly related to this particular medical mission to Jamaica from which I just returned was a tragic act of hate. The group with whom I worked, Teams for Medical Missions, www.t4mm.org, has been served for many years by long-term missionary couples in Jamaica. These couples have developed programs for children, programs for youth, programs to train ministers for local churches, built many houses, provided chronic and acute medical care by hosting medical mission teams, and so much more. They are Christian missionaries with a real passion for the people of Jamaica, in particular those in the more rural and underserved area of St. Mary Parish.

At the end of April, the two men of these couples were riding their motorcycles on some trails at the top of a mountain known to have beautiful views of the island. Two young men were in that area and heard the motorcycle motors. They decided to wait in a particular place where the motorcycles were sure to pass and ambush them. Both missionaries were killed. It was not a targeted act, just a needless act of hate.

This shook the entire island. The young men who had been actively served by events hosted by these couples for years now stay close to the wife who remains, and they have been staying at her house so she is not alone. The Prime Minister, head of island security, and many others have come to show their respect. Many people have expressed their sorrow in many tender ways.

These medical teams typically provide care in provisional clinics in four local churches once a quarter. People are given a 3-month supply of medication for chronic illnesses, and acute illnesses are treated. Many people in that Parish rely on those clinics for their medical care. I had the humbling experience of seeing the love and gratitude shared with the missionary wife and all of the team members. (All had been on these teams several times and knew the slain missionaries well. This was a very emotional trip for all who were simultaneously grieving and expressing the desire to keep moving forward.) Many residents expressed surprise the clinics were continuing. There was an expectation the mission would fold and return to the US after these deaths.

In spite of these acts of hate, the hope continues. Teri, an incredibly strong and faithful woman is staying and planning what the future can hold in this completely new scenario. Her grief is real and raw. Yet, she is not curled in a corner refusing to move forward.

Health in the midst of hate

The elements that are associated with maintaining health in the midst of hate are:

  • friends to talk to
  • people who care about you
  • a sense of self-worth
  • forgiveness
  • security
  • conflict management skills
  • religion/spirituality

These have all been linked with improved health.

And I will add having a source of HOPE. I believe hope is powerful in the midst of difficulty.

So, knowing that hate and ugliness can strike at any time, the best you can prepare is to take care of yourself, cherish your friends and family, develop your conflict management skills, and forgive others. Find your personal source of hope.  Like Teri, find ways to find hope and stay positive and undeterred in the face of hate.

For more information about hate and health, contact us at www.medsmash.com/contact.

BIBLICAL APPLICATION

Hate, terror, oppression, racism, and other ugliness are all around. And, the Bible gives us indication this will only get worse.

2 Timothy 3:1-5 MSG

Don’t be naive. There are difficult times ahead. As the end approaches, people are going to be self-absorbed, money-hungry, self-promoting, stuck-up, profane, contemptuous of parents, crude, coarse, dog-eat-dog, unbending, slanderers, impulsively wild, savage, cynical, treacherous, ruthless, bloated windbags, addicted to lust, and allergic to God. They’ll make a show of religion, but behind the scenes they’re animals. Stay clear of these people.

I believe our role in these days is three fold:

  1. Be prepared

1 Peter 3:14-16 ESV

But even if you should suffer for righteousness’ sake, you will be blessed. Have no fear of them, nor be troubled, but in your hearts honor Christ the Lord as holy, always being prepared to make a defense to anyone who asks you for a reason for the hope that is in you; yet do it with gentleness and respect, having a good conscience, so that, when you are slandered, those who revile your good behavior in Christ may be put to shame.

  1. Be discerning

Matthew 24:4-8 MSG

Jesus said, “Watch out for doomsday deceivers. Many leaders are going to show up with forged identities, claiming, ‘I am Christ, the Messiah.’ They will deceive a lot of people. When reports come in of wars and rumored wars, keep your head and don’t panic. This is routine history; this is no sign of the end. Nation will fight nation and ruler fight ruler, over and over. Famines and earthquakes will occur in various places. This is nothing compared to what is coming.

  1. Be reaching out

Philippians 2:1-4 MSG

If you’ve gotten anything at all out of following Christ, if his love has made any difference in your life, if being in a community of the Spirit means anything to you, if you have a heart, if you care— then do me a favor: Agree with each other, love each other, be deep-spirited friends. Don’t push your way to the front; don’t sweet-talk your way to the top. Put yourself aside, and help others get ahead. Don’t be obsessed with getting your own advantage. Forget yourselves long enough to lend a helping hand.

And another version of my favorite verses of the year about hope!

Romans 5:3-5 MSG

There’s more to come: We continue to shout our praise even when we’re hemmed in with troubles, because we know how troubles can develop passionate patience in us, and how that patience in turn forges the tempered steel of virtue, keeping us alert for whatever God will do next. In alert expectancy such as this, we’re never left feeling shortchanged. Quite the contrary—we can’t round up enough containers to hold everything God generously pours into our lives through the Holy Spirit!

Blessings,

Michelle

To feel better – do for someone else – altruism

Posted on by Michelle Fritsch, Pharm.D.
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Altruism helps others and improves your health

I am just back from Jamaica, and I need to write about altruism. I was working with a mission group called TEAMS. You can learn more about them at www.t4mm.org. This medical mission group included 3 physicians, 1 nurse practitioner, 2 nurses, 3 pharmacists, 3 for registration, 2 to be with the children while their parents received care, and 2 to provide prayer and emotional support to those coming for care.

We were serving in St. Mary Parish, one of the poorest of the country. Clinic was held in churches in four different areas of the Parish. A Parish is similar to a state in the United States. Sheets draped over ropes often separated exam rooms for physicians. I counseled people about their medications as they sat among many other people. So this was not a private setting. But, excellent practitioners provided individualized care with great compassion.

Each clinic served a particular community. Within that community you could look out at all who were waiting and see the way they cared for each other. Babies would be passed around, older members would be assisted with steps, others in nearby seats would assist with understanding when I was struggling with the Patois (English with a thick dialect spoken very quickly).

It was very hot. Fans helped to stir the air. There was no running water. (I am so thankful for hand sanitizer). Some children had lice or scabies yet they waited patiently with their family. You know they had to be miserable between the heat and the intense itching. Some people had to wait from early morning until mid afternoon to be seen.

Yet, I didn’t hear one person complain. No one was demanding to know why their wait was so long. No one was complaining about the conditions. No one was asserting their needs or rights before someone else’s.

On the medical team, several people were struggling with their own health issues. One was on crutches due to a broken leg; one was recovering from bronchitis; one had a cold; several had various aches and pains. The age range of the care team was 22 to 82. Personally, my leg is still recovering from a ripped calf muscle, and my back has been hurting from all of the time that I was on crutches and a boot.

What struck me was how none of that mattered! Rather than thinking about our issues, we were completely focused on all of the people who had arrived to receive care. My leg did fine the entire week, even carrying heavy tables and boxes and fans to set up and take down clinic every day up steep hills and steps. I didn’t do my back stretches or sit around rubbing my back the way I do at home. That is because I wasn’t even thinking about my back.

Altruism

Altruism is, ‘feelings and behavior that show a desire to help other people and a lack of selfishness’ as defined by Merriam-Webster. I have read several articles linking altruism as a factor in happiness, health, and how long you live. In general, studies have shown that people who focus on others are happier and even live longer, in general. In 2005, Stephen Post published an article in the International Journal of Behavioral Medicine entitled, ‘Altruism, Happiness, and Health: It’s Good to be Good’. A quote from the article is, ‘The article concludes, with some caveats, that a strong correlation exists between the well-being, happiness, health, and longevity of people who are emotionally and behaviorally compassionate, so long as they are not overwhelmed by helping tasks.’

I have seen truth in this in many instances. While I was doing post-graduate training in Wisconsin a study demonstrated that home-bound elders who were in a calling circle.  Those who called to check on each other and remind each other to take medications felt less isolated and more valued. A project called the Eden Alternative long ago demonstrated the value in having daily purpose for everyone in a nursing home setting. Depending on ability level residents would care for a cat or dog, garden, water plants, feed birds, feed fish, or other activities. It was a huge success and continues today! Everyone needs to be needed. That sense of purpose and belonging plays a big role in overall health, including anxiety levels, pain, and depression.

When was the last time you focused on the needs of someone else? I encourage you to find a way each day this week to meet someone else’s needs. Some examples are to check on an older neighbor; take a meal to someone who recently had surgery; call a mom with small children to see if you can grab some things for her when you go to the grocery store and save her a trip.

For more information about how altruism is connected to health, contact us at www.medsmash.com/contact.

BIBLICAL APPLICATION

It is no surprise that altruism is linked to enhanced health. Jesus told us many times about the importance of selflessness.

John 15:12-14 ESV

“This is my commandment, that you love one another as I have loved you. Greater love has no one than this, that someone lay down his life for his friends. You are my friends if you do what I command you.”

Daily devotions, a lot of singing, and prayer with each community were cherished parts of this mission.  The care was among providers, among recipients, among those at the church helping with coordination, and among those providing protection.  My visual each day was being filled up with the Spirit to be completely poured out by the end of the day.

Some say Christian selflessness is not true altruism because we will be rewarded for such care and compassion. Ultimately, eternally a reward is waiting. But while here in this life, you might not see a reward. In fact, your giving isn’t meant to be for show.

Matthew 6:2-4 MSG

“When you do something for someone else, don’t call attention to yourself. You’ve seen them in action, I’m sure—‘playactors’ I call them—treating prayer meeting and street corner alike as a stage, acting compassionate as long as someone is watching, playing to the crowds. They get applause, true, but that’s all they get. When you help someone out, don’t think about how it looks. Just do it—quietly and unobtrusively. That is the way your God, who conceived you in love, working behind the scenes, helps you out.

Paul, Peter, Luke, John, and many other writers in the New Testament extol the virtues of giving to others.

Philippians 2:4 ESV

Let each of you look not only to his own interests, but also to the interests of others.

Luke 6:35 ESV

But love your enemies, and do good, and lend, expecting nothing in return, and your reward will be great, and you will be sons of the Most High, for he is kind to the ungrateful and the evil.

1 Peter 3:8 ESV

Finally, all of you, have unity of mind, sympathy, brotherly love, a tender heart, and a humble mind.

What can you do today to help someone else?

Proverbs 19:17 ESV

Whoever is generous to the poor lends to the Lord, and he will repay him for his deed.

Blessings,

Michelle

Vaccines – Important part of your travel plans

Posted on by Michelle Fritsch, Pharm.D.
Flu vaccine CDC
Ask your doctor or pharmacist about vaccines needed before international travel.

What are your views about vaccines? Are you up-to-date? When was your last check-up appointment with your primary care provider?

What exotic locations are on your bucket list?

There has been a lot of discussion, many articles, and many opinions shared about vaccination.

Vaccines protect you from communicable diseases. Vaccines also protect other people. For each kind of vaccine, there are some people who have medical conditions that prevent them from receiving the vaccine. So, they rely on those around them to not have the disease and spread it to them.

The Centers for Disease Control (CDC) monitors diseases across the country and the world. Viruses and bacteria can change over time. If these changes make a former vaccine less effective, then guidelines change. So, your vaccine needs change based on these recommendations.

Then there is the issue of travel. Different parts of the world pose risk of various diseases.

I have been updating my understanding of the importance of travel vaccines as I prepare for this medical mission trip to Jamaica. The vaccines recommended for Jamaica are different than those recommended for other areas.

I heard a very sad story recently about two very charitable and successful brothers who traveled to Ghana. One chose to not take precautions for malaria. Once home he acquired a fever and felt poorly.   He saw his doctor who gave him some self care strategies. His condition then declined further. Once it was realized he had malaria, it was too late. So, when you do travel abroad and become ill, immediately tell healthcare providers exactly where you have been. In the US we so rarely see some diseases that we don’t look for them.

I encourage you to travel and explore the world! I also highly encourage you to talk with your doctor and your local pharmacist about any travel vaccines you should obtain prior to your travels. You can learn more about CDC recommendations at this link.

As fall approaches we will talk more about flu, pneumonia, and shingles vaccines in more detail. These are important even if you don’t travel.

For more information about vaccines, please contact us at www.medsmash.com/contact.

BIBLICAL APPLICATION

Vaccines protect you against disease. And God provides you with protection against evil dark forces. We are reminded again and again of His constant love and protection.

Isaiah 41:10 ESV

Fear not, for I am with you; be not dismayed, for I am your God; I will strengthen you, I will help you, I will uphold you with my righteous right hand.

Doesn’t that sweep over you like a big wave of calm? Fear not. God has your back.   God has plans for you. God is with you in each and every circumstance. God is with you no matter where you are or what is happening.

2 Timothy 4:18 ESV

The Lord will rescue me from every evil deed and bring me safely into his heavenly kingdom. To him be the glory forever and ever. Amen.

We all make mistakes. We all sin. These promises and assurances of rescue are so comforting.

2 Thessalonians 3:3 ESV

But the Lord is faithful. He will establish you and guard you against the evil one.

James 4:7 ESV

Submit yourselves therefore to God. Resist the devil, and he will flee from you.

You have a God who loves you and will protect you.

Blessings,

Michelle

Image source: Centers for Disease Control, Department of Health & Human Services, US Public Health Service