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by: Theresa Flaherty - Wednesday, June 19, 2013

The American Medical Association (AMA) today endorsed recognizing obesity as a disease, rather than a mere condition. The hope is that such a designation would maybe lead to better health insurance covereage, which in theory leads to better care, which is of course a good idea in theory.

There is also plenty of opposition. Critics say BMI isn't one size fits all and not everybody with certain BMI measurements needs aggressive treatment. This also makes sense.

There is also concern that this will lead to increased health costs, which is also true when reimbursement becomes available for treating disease or establishing a disability (have you read the latest on CPAP and the VA?). On the flip side, if treating obesity is successful it reduces costs, both to the healthcare system and the workforce, because let's face it, the obese population is a population that is faced with lots of chronic comorbidities. I write enough about them for HME News.

My first thought when I read the announcement was a bit pessimistic. Will the very people this is aimed at helping really get help, or will they just throw up their hands and say, I can't help it, I have a disease? and then reach for the doughnuts? Also, as some naysayers have said, and I kind of agree but try to be sympathetic, it's the result of lifestyle choices. Let me say here, that some people gain or lose weight far easier than others, I get that. Life is unfair. Having Type 1 diabetes is unfair, but I roll with it. I have no choice (see: disease).

And there are other sticking points: This blog I wrote last year focuses on a study about docs not discussing obesity with their obese patients. Will classifying obesity as a disease open up dialogue? Maybe. And what about this recent article on a study which found that overweight (23%) and obese (52%) doctor shop? The study couldn't however, determine why this was so.

At the end of the day, the only way to lose weight is to take in fewer calories than you put out, however you choose to do that. Period. Does that require education and willpower? Absolutely. One of the diabetes slogans that has been one of my mantras, and I have mentioned it here before, is nothing tastes as good as being healthy feels.

But Americans of all sizes like the easy way out, often in the form of an elusive magic pill. I have also been reading a lot of weight loss surgery horror stories lately and I am concerned this trend will grow.

Magic pills are a major reason why our healthcare costs are soaring.

 Maybe the place to start is in childhood.

Theresa Flaherty

Tags:
obesity, diabetes, Type 1 diabetes, sleep apnea
by: Theresa Flaherty - Wednesday, June 12, 2013

I am a bossy person by nature so when Editor Liz decides to travel halfway across the country for a hog roast, I welcome the opportunity to flex my authoritative muscles. Of course, that means making decisions that aren't always clear cut and inevitably leads to an internal asking of the age-old question: What Would Liz Do? (WWLD for short).

Fortunately, this week has been pretty quiet (dare I say a bit dull, even?). The biggest conundrum I have had, at least with regard to news reporting,was about 30 minutes ago when AAHomecare announced that Reps. Thompson and Braley plan to hold a press conference tomorrow at 10 am to discuss the delay letter which garned 226 bipartisan signatures. In the absence of anything more "newsy" for our daily web story I wondered, does an announcement about an announcement count as news?

I mentioned this to our web editor, Leif. His helpful response?
"What would Liz do?"

But honestly, competitive bidding and the delay letter are all anyone is talking about this week. Leif, Elizabeth and I have all fielded phone calls from "pins and needles" providers with questions about the delay letter, about HR 1717, about the legislative process. Mike from Chicago even asked where to get the most up-to-the-minute information. Here, of course. He's also monitoring twitter (thanks to everyone tweeting from the Heartland Conference) and probably subscribed to all the association newsletters that he can. He's got the right idea. 

Last week, I called a provider who I have spoken with many times over the years. He answered the phone with a hopeful, "Theresa, are you calling me to tell me there's a delay?"

Don't worry, dear reader. We will follow up on the conference, the Senate briefing yesterday and the VGM event. If there's a delay, we will trumpet it from the social media rooftops. After all, Liz and I have both been here long enough to remember when that happened before. The only difference is that time, we had to communicate the news via our now terribly old-fashioned seeming electronic newswire.

Fingers crossed.

Theresa Flaherty

by: Theresa Flaherty - Monday, June 3, 2013

Despite 90-degree temperatures over the weekend that made us hardy Mainers wilt like so many hothouse flowers, I managed to get my "crops" planted. I planted green and jalapeno peppers and a san marzano tomato plant which was supposed to be a roma plant but I grabbed the wrong kind. I also planted a few cilantro sprigs but didn't want to commit too much cause I heard it's difficult to grow. I may add a cucumber but the whole vining trail trellis thing is a little intimidating.

All that lugging of pots, plants and watering cans made for an active day, which made for some damn fine blood sugar readings. My fresh veggies, when harvested, will also contribute to good health.

I often like to use this blog to educate (and hopefullly, entertain) people on diabetes as well as clean, healthy eating.

Today, I spoke with provider Tom Wilson who also plans to use himself as a role model of sorts. He and his wife are building a state-of-the-art model aging-in-place home, which they plan to eventually move into and document and share the process as they go. Wilson said he's always believed that as a provider of HME he should also be a provider of information, a resource for patients and their caregivers and anyone else who's listening.

I think a lot of providers that I speak with would agree with that, but I am concerned that a lot of that will go away come July 1, along with a lot of providers. Still, as Wilson's story (when I write it) will illustrate, there are always new ideas cooking out there.

Speaking of cooking, what do the plants I've put in so far have in common? Salsa! Which means I still need to go back to the greenhouse and get a roma tomato.

I will, however, welcome input on what to make with san marzanos.

Theresa Flaherty

Tags:
diabetes, healthy eating, CareGiver Partnership
by: Theresa Flaherty - Thursday, May 23, 2013

If I had to put a label on the mood here at the AAHomecare Washington Legislative Conference, I'd use hopeful. Attendees are hopeful, dare I say confident even, that Round 2 will be delayed long enough to get the market-pricing program (MPP) implemented.

That hope was buoyed by a couple of updates on the number of co-sponsors on H.R. 1717. At last count, it was 90 and there's no way that won't swell after today's Hill visits (yesterday's too).

Of course, the folks that attend this event year after year tend to be more "can-do" rather than "oh woe is me." At lunch, one of my table mates sat down and announced, "I just got hit with a  RAC audit this morning." But, as I said, these guys weren't crying into their mystery chicken. They commiserated (and I am sorry, but the fact that these onerous audits are now as commonplace a part of business as, say, asking what mobile carrier you use is just wrong), and then they moved on to other things.

Provider Scott Soderquist has lost track of how many times he's been to Washington, D.C. He's taking the time even as grandfathering letters go out to his patients (like so many providers, he didn't get a single contract). I asked him why.

"It's many reasons—some selfish," he said. "The consumer is really going to be blindsided. But, somehow or another, I still believe Round 2 will be at least delayed. I can't see how it can't."

Delay is a big word around here this week. If he hasn't already, Rep. Glen Thompson, R-Pa., plans to introduce a bill to delay the program. Attendees will ask lawmakers to sponsor that, as well as H.R. 1717.

And there's no more pussyfooting around the issue, either.

"We need to start calling this a crisis," providekr Wayne Sale told me. "It's not a bidding issue any longer. It's a crisis. It's the only way they will listen to us."

And lawmakers will listen, Rep. Tom Price, R-Ga., told attendees yesterday afternoon. While licensure--or lack thereof--remains a hot issue, providers really need to get the patients or the caregivers to call.

"Inundate them with calls," said Price. "Inundate doesn't mean thousands. It means 20."

With July 1 right around the corner, things are tight. But, as Price said in closing:

"July 1st doesn't mean we'll just give up."

Tags:
aahomecare, HR 1717, competitive bidding
by: Theresa Flaherty - Wednesday, May 22, 2013

When I left my house at 4:30 this morning it was rainy and about 35 degrees. I breezed through check in and security--I was literally the only one in the line. And when I use the overused "literally" you know I mean it.

I arrived at the Capitol Hilton about 8 am for my 5th (think that's some kind of HME News record) AAHomecare Legislative Conference. It is hot and humid (or muggy, as we Mainers say) but I am in sort of cool comfort in the lobby. Unfortunately, I am still in the lobby. There's no room at the inn yet, so to speak. I even made friends with the desk clerk (we both spell Theresa with an H, unfortunately, that's not enough to move me up the wait list for a room).

I have managed to register upstairs for the conference and say hello to a few familiar faces. I've also eaten breakfast. Twice. (Hey, I've been up for ages).

Festivities kick off at noon and Rep. Thompson will give the keynote. 

Keep your fingers crossed I get a room before then so I can freshen up properly. Until then, I am keeping a low profile.

More later.

Theresa Flaherty

by: Theresa Flaherty - Monday, May 13, 2013

In our local newspaper today is a letter to the editor that made me laugh. The writer called out Congress on its hypocrisy when the sequester began to impact air travel.

The letter states:

For the first time in recent memory, both houses of Congress responded in prompt bipartisan fashion. And while the White House bemoaned the sequester, they announced the president would sign this legislation.

 

By coincidence, today I also clicked on a LinkedIn discussion (which I rarely do). The question: MPP alternative is relaunched. Does anyone think it has any chance to succeed this time? Many of those in the discussion were cautiously optimistic about the bill's chances. As one provider said: We've got to give it our best shot.

Another commenter pointed out that Congress remains in complete and utter gridlock, which I think will be a huge problem for MPP.

And then, this was depressing. www.govtrack.us keeps users updated on how the bill is progressing. Some lowlights: MPP has only a 3% chance of being enacted. Only 11% of House bills made it past committee and only 3% were enacted in 2011-2013.

Looks like the mountain the industry is pushing that bill up just got a little steeper. With bad weather looming overhead.

It will be interesting to see who attends the AAHomecare conference (is that next week already?!). My guess is it's the same providers who go every year. (BTW, there was a bit of association bashing on this thread as well. Are you listening, association leaders?).

Speaking of listening, provider Chris Rice suggested the industry's message on competitive bidding needs to cut to the chase. His suggestion? We just auctioned off your healthcare to the lowest bidder. Any questions?

He's got a point. Providers can talk to lawmakers until they are blue in the face but I think it's the beneficiaries who would have the most impact. 

Of course, it would still take an act of Congress to get Congress to act.

Theresa Flaherty

 

by: Theresa Flaherty - Monday, April 29, 2013

Against all odds, I found myself temporarily sucked in today by the video of last week's hearing on Medicare and DMEPOS, led by Sen. Claire McCaskill. Now I see what one industry insider, who attended the hearing meant, when I inquired how it went: "Sen. McCaskill is totally uninformed."

Now, to be fair, I didn't watch most of the hearing, just a snippet. While I understand (and support) McCaskill's concerns around shady marketing tactics, the snippet I saw showed a lawmaker getting caught in the weeds in my opinion. In referring to a company called Med-Care, she honed in the fact that, on the phone, it might sound like "Medicare." OK. I guess I can see that, now that she's pointed it out. Did the company do that to be deliberately confusing? I don't know, but neither does she.

She certainly talked about it a lot, though, going so far as to press CMS' Peter Budetti on why they would let a company name themselves as such. I gotta give Budetti credit for answering with a straight face when he told her he didn't think CMS has the authority to dictate what folks call themselves.

McCaskill then went on to question why physicians aren't supplying HME (this whole discussion cued off a beneficiary's letter about CPAP supplies)? I think she thought that would be better than the guy in the middle who stands to make all the money. (That would be YOU, the HME provider she was referring to).

I mean, is she suggesting scrapping the whole HME system? And what about drugstores? And labs? Should doctors do all of this?

I am still scratching my head.

Theresa Flaherty

by: Theresa Flaherty - Friday, April 19, 2013

You may recall my brief and failed attempt at using a diabetes app to record stats.

Well, I was reminded of that when I saw this study about how technology doesn't translate to lasting behavioral changes for people with diabetes. The study only focused on those with Type 2 diabetes but I bet you'd find similar results in the Type 1 population.

On the plus side, technology gave study participants better understanding of the disease but on the minus side, and this is kind of major, technology didn't promote changes in diet and exercise.

Let me tell you what works for me. A stack of nutrition reference books, cookbooks that list nutritional content, measuring cups, a scale, several sets of containers of varying sizes and cupboard full of spices instead of fats and sugars to add flavor. I also have sneakers and a gym membership I occasionally use. A subscription to Diabetes Forecast. You get the picture. And don't worry: I've been doing this long enough that a lot of this information is in my head, I am not constantly weighing and measuring. I can also identify a carb count at 20 paces but sometimes it helps to refresh my perception by measuring it out.

You can have all the technology you want but it can't cook for you, work out for you or go the grocery store for you (by the way, when are grocery stores going to change their layout so that the fresh food is together, not wrapped around all the aisles of processed stuff?).

There's no app for that.

Speaking of technology, I'd like to give a shout-out to Bryan who made my Monday with his email instructing me how to change the annoying beep on my new meter. My co-workers thank you, too!

Theresa Flaherty
Type 1

Tags:
diabetes, Type 1 diabetes, diabetes forecast
by: Theresa Flaherty - Tuesday, April 16, 2013

I am obsessed with a Slate advice column called "Dear Prudence." In fact, after I first stumbled upon it, I engaged in a few marathon sessions reading through the archives (not at the office, Liz). Sample headlines: I've been banned from my vegan grandbaby, how will she get her meat and cheese; Since starting on antidepressants, my wife has been cheerful and optimistic. I hate it; and this recent fave: Help! A neighbor has been poisoning our cat colony.

So imagine my joy at finding an opportunity to incorporate Prudie into an HME News blog. It's from about a year ago, I believe.

Q. New Job: Back in May of 2011, I decided to get back into truck driving. A large faith-based company agreed to hire me. I went through orientation, and was in the process of putting my belongings in a truck when I was called up to the safety department. The director of safety had found out that I have mild sleep apnea (my roommate snitched on me). He wanted me to travel back home, undergo another sleep study, and get a letter from my doctor stating that I could drive without any restrictions. Here's the problem: The safety department never had me sign any release for them to discuss this matter with me, or anyone else, let alone even look into it. I asked a lawyer friend about this, and he told me that it's a violation of my HIPAA rights. I am currently driving for this company, but I am tempted to quit, and file a lawsuit against them. To sue, or not to sue?

A: I often get chastised that I don't suggest more often that people just sue. But your letter beautifully encapsulates the litigious world we live in. You're considering suing over the fact that the trucking company that employs you discovered you have a medical condition that could result in your falling asleep at the wheel. I'm wondering whether in the papers you signed for your job there wasn't a line about disclosing relevant medical information that you neglected to note. In any case, your roommate snitched presumably not out of malice, but out of concern for the other people on the road. Instead of entering the legal system, enter the medical system and find out if pursuing this line of work could mean you're a danger to yourself or others.

Now, it's not the most interesting letter, but it does show how far there is to go in many cases, with understanding sleep apnea. In the May issues (coming soon to a mailbox near you) I have a feature on some soon to arrive guidelines from the Federal Motor Carrier Safety Administration geared to just this population.

Another thing about Dear Prudence, is because it's an online forum others will weigh in with their two cents. In this case, 2 cents that isn't worth the copper it's stamped on:

Q. RE: Sleep Apnea: Prudie, I believe that you are a bit confused as to what sleep apnea is. It is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur five to 30 times or more an hour. So, it would have no bearing on his ability to drive a truck, it is not like he has narcolepsy and is just going to fall asleep at the wheel!

Now this person obviously knows what sleep apnea is, but note the last sentence! Really?

By coincidence, Dana Voien, of SleepSafe Drivers, sent me a study link over the weekend. Sleep apnea patients are--wait for it--more likely to fail driving tests. So, there's obviously still room for growth in this market.

Meanwhile, if you want to check out Dear Prudence: "Help! My girlfriend kisses her cat and it grosses me out!" 

Tags:
sleep apnea, cpap, tired truckers
by: Theresa Flaherty - Thursday, April 11, 2013

So, I finally switched over to a FreeStyle meter after using the Lifescan products since, well, diagnosis. 

To start, I couldn't find the darn thing (I had packaging, instruction booklets, a testing log, lancets and even the dreaded lancing device). But, no meter so I went off to the (local) pharmacy to get another one for $19.49.

I am happy to report that, working on instinct (I loathe reading technical instructions), I was able to use the meter, although I did put the test strip in backward on the first try. I do have a complaint: the meter has an annoying high-pitched beep the likes of which I haven't heard since the early 2000s. It is especially annoying at 4 am.

I will also pay a compliment: the strip, once I turned it around, was much easier to use, a bonus here in still chilly New England, where somedays getting blood from my finger is akin to the old turnip saying.

It seems somehow appropriate that I switched over this week, right about the time CMS announced the names of the mail order contract suppliers. There were a few (very few) known names, which is an improvement over Round 1. A quick perusal of the manufacturers they carry shows that they are all offering at least one of the most popular brands, although, as one provider asked me: It's one thing to offer it, but will they stock it? That is not a question I can answer, my Mayan friend. 

I did speak with one winner today who said that he planned to be compliant with CMS rules about providing popular brand product but who also says he doesn't think that will last long for most of the companies.

It's simply unworkable, from a financial standpoint. So, while there are plenty of folks who will switch without giving it too much thought, I am sure there will be some unhappy customers, but I guess we will have to wait and see.

Theresa Flaherty
Type 1

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