When the Rules Don’t Quite Make Sense

Airplane ors.od.nih.gov
Interpretation of rules has created an airplane that has launched with no plans to build the runway in healthcare.

To finish a thought from last week’s blog, sometimes the rules create their own problems. The Centers for Medicare and Medicaid (CMS) created a new risk-sharing payment strategy with hospitals. If someone has health insurance through Medicare, and if they are readmitted to the hospital for the same condition within 30 days, then the hospital will not be paid for the second admission. (Of course it’s a bit more complex than that, but this is the gist).

This ruling has created a whole new ‘market’. A group of very smart technology experts and entrepreneurs have identified this as a place to create new ways to keep people healthy at home. Tools and solutions are created that help people be successful at home after being in the hospital.

  • Patients benefits by having new resources to help them maneuver their care at home and stay at home.
  • The hospital benefits by losing less money on readmissions within 30 days.
  • The new companies, technology gurus, and entrepreneurs make money by being paid through the hospital’s cost savings.

Rules (and solutions) – make sense?

These are the parts that are missing, in my opinion.

  1. Once we determine how to keep people home safely for 30 days, I anticipate CMS will expand the time window to 60, 90, or more days. So short–sighted solutions will not survive.
  2. What happens after 30 days? Many of these new solutions involve technology. Who pays for the technology and the monitoring after the 30 days? Will it just be removed from the person’s home? Then what happens? Is that cost effective? Does it even make sense?
  3. What about people who are fearful of technology? Again, most of the solutions I’m hearing and reading about are based on technology. What if the person doesn’t have internet access or land-line phone access? What if the person has no interest in learning how to use the technology? What if the person just can’t get the hang of the technology?
  4. As I mentioned last week, I am finding very little data on what users/people with chronic medication conditions want. Solutions are being developed with little to no input about whether people will actually want or use the solutions.

For some of these issues the answers I’ve received are that there will always be exceptions. Those will be dealt with one by one. The goal is to find solutions for the majority.

It was funny, in one of these conversations we likened the current technology solutions boom to the airplane that’s in the air but no one has thought yet about the runway. That seems like a fitting analogy to me right now.

Hope

There is hope. I talked yesterday to a company taking a MUCH broader view of helping people stay healthy in their homes. They are not even thinking about the 30 day readmission rules. They are looking at long-term solutions that are created and maintained around the person that is using them. I know that company is not alone. I’ll put my hope in these types of companies!

For more information about new technologies in healthcare, please contact us at www.medsmash/contact.

BIBLICAL APPLICATION

Do you ever feel like the ‘rules’ of Christianity don’t make sense? Are you left wondering why the Christians around you are doing things a particular way? Have you been instructed to do something that doesn’t make sense?

In these instances, I encourage your FIRST question to be, ‘Is it Biblical’?

1 John 4:1 ESV

Beloved, do not believe every spirit, but test the spirits to see whether they are from God, for many false prophets have gone out into the world.

2 Peter 2:1 ESV

But false prophets also arose among the people, just as there will be false teachers among you, who will secretly bring in destructive heresies, even denying the Master who bought them, bringing upon themselves swift destruction.

I’m not saying every pastor or spiritual leader who says something that is not Biblical is a false prophet. People, even pastors, do make mistakes. But we have A LOT of examples of people adding rules to what is in the Bible. These ‘human’ rules are just that. Each denomination has their ‘way of doing things’. Even these are often the result of people trying their best to understand and interpret the scriptures. So see if the item that you question is from people or from God.

Your SECOND question should be, ‘Did I understand correctly’? Never hesitate to ask clarifying questions. We are all guilty of making assumptions about the other person’s knowledge when we answer a question. This often leads to complete misunderstanding.

Proverbs 18:13 MSG

Answering before listening

    is both stupid and rude. 

1 Timothy 6:20-21 MSG

And oh, my dear Timothy, guard the treasure you were given! Guard it with your life. Avoid the talk-show religion and the practiced confusion of the so-called experts. People caught up in a lot of talk can miss the whole point of faith.

I encourage your THIRD question to be, ‘Does it glorify God?’ By this I mean, does it promote the type of life and interaction we are called to live?

James 3:17-18 MSG

Real wisdom, God’s wisdom, begins with a holy life and is characterized by getting along with others. It is gentle and reasonable, overflowing with mercy and blessings, not hot one day and cold the next, not two-faced. You can develop a healthy, robust community that lives right with God and enjoy its results only if you do the hard work of getting along with each other, treating each other with dignity and honor.

The real ‘rules’ and instructions are in the Bible. The rest are interpretations, good/spot on and sometimes misguided. So discernment helps us sort them out. I know I have trouble sorting through it all on my own. Bible reading, study, trusted people to talk with, and prayer help me through.

Blessings,

Michelle

Image source: Office of Research Support; National Institutes of Health; U.S. Department of Health and Human Services.

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30 Days – CMS and Hospitals Share Risk – Input Desired

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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