But doctors are the Human Element and the Factor you need to use your individual Health and life resources! Doctors are third line of life savers to 1) Public Health and sewers and 2) Research and antibiotics. While Doctors are a distant 3) over all to society’s life saving they are number one for each individual.If Your Doctor” were your, friend, and trusted doctor they could advocate and guide you to stay well and use your social, financial and insurance resources wisely.If Your Doctor is a trusted friend, then the doctor is the Best, Most Cost Effective choice to guide you how to use your money to remain Healthy, Wealthy, and Happy.Bill Gates 2.0 is doing 1 and 2 COST EFFECTIVELY! Making sewers and using already proven research through vaccines. Donate to Bill and Melinda.
Why I will donate to the Bill and Melinda Gates Foundation. Bill is not just throwing money at the advertisers who legally take 80% of the moneys donated in most charity. He is personally active in this. He uses not only his money but his time. That is the type of leader I want supervising any project.We all can help for free! Share, click, make suggestions. I hope you can all make this viral and it gets back to Bill but here are some added ideas to help Bill’s Cause. Please everyone add your ideas to help out. Ideas, comments and shares might be more powerful than money. Don’t forget Doctors. My suggestions and 2/3 of Aging is Good!
Doctors are the best resource any individual can use to remain healthy, wealthy and happy. 2/3 of Aging is good! That is right for most people two thirds of aging gets better with age. The three big parts of aging are Financial, Socially and Health. Financially most are better off as they age. They have forced saving as Social Security, some small pension, and still Seniors are the biggest group of home owners. Many have a small pension. Socially, most people are more aware of who they are, what to expect out of life, and are more patient and tolerant. Bill Gates reflected on his own growth and maturity in the 60 minute pieceHow to use doctors to help the lowest 2 billion and help all people in the individual and global health care crisis.
You cant practically develop your own sewer system or research new medicines but you can choose the best personal doctor you can. Choosing your doctor in not choosing your insurance. When you choose your insurance they give you a doctor. Don’t be confused by the statement you can choose any doctor there is always and implied in our network or that we influence, etc. Instead look for and value a doctor who is part of your social community. Take the time to know that doctor and you and the social community might have to pay something that the insurance does not pay to keep that trusted, socially aware doctor, your doctor, as your independent voice. When you don’t have insurance that doctor can still help you. That doctor can go with you to what ever insurance you do have and be your second opinion. Imagine how hard it would be for another doctor who represents Medicare, Medicaid, or any insurance or ER to say no when they have to defend the reason for no to another doctor, your friend. It is easy to say no to you, the patient, since you don’t know the words, vocabulary, meaning of one phrase vs the next. You wont be able to write down what transpired but another doctror is going to know what they are saying and not saying. Your doctor will have a higher duty, a social duty, to defend your interests. Unlike law and need for a friend who is a lawyer, we cant know we will get in trouble with the law but with medicine we all know we will get old and when we need even a little assistance we will increasingly need the health care system. Your doctor is your lawyer for the rest of your life. If you choose wisely the verdict might be very different for you.Your doctor is in the best position to be a gate keeper but one who values your interests first and the specialists second. That saves money and provides better care. Patch Adams said it best, if you treat the disease you win or lose but if you treat the person you win NO MATTER WHAT THE OUTCOME. You win even if you die because the person had independence, dignity and remained connected to their social system as an example that life is good even in death. Being connected, friends, family are more powerful medicine than any pills. Seniors teach us many things and we need to re evaluate how we value those more social things. What do you think? Share comments, like, make this viral. Your doctor needs to be a part of that process from the minute you need even minor assistance. The doctor, feeling like you have a friend with some access, knowledge, and skills and one who will visit and sit with you if that is all he does is invaluable. Your entire social system benefits from the seniors and that doctors example. In essence and old fashioned doctor. Continuity of Care the Cure for the individual and Global health care crisis!
We all will need Assisted Living, as we grow old. As we approach that time of older age, needing any amount of assistance, I believe CONTINUITY OF CARE is the cure to the global and individual health care crisis. I would love to have the opportunity to speak to Bill and Melinda Gates about why that is true. What we see now is the lack of leadership of a persons’ care from the doctor. The many sub segmented forces of hospitals, insurance company, Medicare pushing continuity of your chart instead of care, all of which segregate and divide any relationship, sense of duty, that once existed between doctor, patient and the local social community they lived in. We can change that right now by choosing care settings like Tender Loving Care Senior Residence, and Tender Loving Care Senior Residence, Costa Brava or doctors you pay a little extra to help them stay in private practice. Yes, if you want them to be your independent voice, or the voice of you and your social system you might have to pay them something since the insurance does not cover that. Insurance wants them to work in their office, with their rules, so they pay for the office, insurance and “help out”. What we all give up is an independent Doctor who is more of “Our Doctor”. To have duty, sense of commitment both sides need to help the other. We can get that right now but we need to read about continuity of care and then look for it. Meet the entire care team you are hiring when you buy senior care, Assisted Living, or Home Care.Don’t forget the value of a doctor in a third world county.
The 60 minutes story highlighted a person who was doing public service who was abducted. Imagine a single doctor who was working other there and helping to do something as simple as triage for many people their practical health care options including to educate on why the society needed to protect the toilets and vaccine cooler. The doctor would not be able to say bypass for everyone but could have a practical list of care alternatives and facilitate care while helping to protect the most valuable resources of the community. That to me is a powerful idea. If the public care agencies could offer a pension like the military we might see more doctors “volunteering” or serving abroad. Again a small cost to improve the Gates Plan.Cost effectiveness is drastically reduced when the system gets to sub segmented but the doctor can give a good menu of prices, outcome, and plans for those to use their existing resources. The doctor could give anti biotics to all as a free first lawyer of help and a way to get them to come for more education. The big benefit over there of empowering the community to protect its vaccine and toilets might help the Gates Foundation buy the local police force of the community they need to further protect their awesome plan. That works at all levels and the bigger the budget the more you save which is how continuity of care and re organizing and re valuing the role of “your doctor” can save the Individual and Global health care system. Continuity of care the human element that is NEVER INCLUDED IN ANY STUDIES! The doctor is the human element that sewer and research cant provide!
The third level of heath care is the human level. That is not a public health issues but an individual and local community issue. A human element is essential to help balance dollar cost and human benefit, socially and emotional. That is how most people choose and calculate their individual values before they buy or act. Like it or not the doctor is a part of the social fabric of each community!Many will be shocked to know that most studies specifically control for or remove as variables feelings, social issues, and caring from all treatments. Most of us know that feelings are the final expression of all disease and of life! We buy because of feelings, Mary and live because of feelings. Feelings matter. Because science cant study or quantify them or control them they specifically remove them from all studies. The studies doctor’s quote when the doctor says the study showed is helpful only at the minimum data level. It is not a treatment, not a total care plan at all. Just because the study showed this or that it does not mean that will make you feel better. The doctor is the person who adds humanity and practical use of those studies back for you. You are in no position to evaluate how much the study helps and how much emotion, social or financial value there are on the alternative uses of time and money. The doctor is. He is your best guide to use your insurance, social system, and feel good. The doctor can make you feel good himself. That is the value of a visit. While insurance companies won’t pay for just seeing a friend to feel better we all know that has value. We need to value continuity of care and our guide to using health care in our own individual social system with our individual unique resources and emotional needs. All of that is part of how continuity of care can save individual and global health care. There are levels that vary for each individual and we need to make continuity of care the main variable and then let people choose how they value an independent option which is what doctors provide. Topics you can help with. Lets make this viral to help those who use Bills waterless toilet and vaccine cooler to show those around them that stealing these community resources will be social suicide. We all know that we can better police our own streets by reporting abnormal behavior. Without being vigilantes we need to report and look out for our neighbor and helping empower our neighbors to watch out for us can spill over to helping those lowest 2 billion to look out for their Gates Toilets and Vaccine Coolers. Please share any ideas on how to protect the vaccine cooler socially through social pressure or more traditional methods? Help me get this out there so I can get Bills and Melinda’s attention. We invite Oprah, TV shows, and anyone to pick this up and share! Free Ways to Help! Dr Shawn McGivney
- Value people and they will provide many in-kind servcies and levels of compassion and effort you cant buy for dollars.
- Value your doctor, your family, your friends and their extended soical systema and they will value and help you when you and yours needs it.
- this cant be legislated but legislation can adjsut the playing field. We have to act, we the people need to value continuity of care and our doctors. Many do not know that all doctors get paid the same for an office visit. Your doctor who knows you, does extra inkind service gets the same as the guy who you dont know who says call anohter specialist. Second, did you know that specialists get paid much more than your doctor but specialists often say I can’t decide on treatment, accept responsiblity for you as a person, that is your doctors job. Seems unfair to me. paid less as pcp but expected to do socially the right thing. I assue you doctors have feelings too. It is less about the money and more about the value people plance or give to their doctor.
- Senior Care settings, Assisted Living, Residential Care homes, hospitals also delegate care. I for one would be suspect of a place that says I want you to come but the people who work here are not my responsiblity.
- Do not criticise the current system. We all have allowed and fueled its growth. The cure is still right here. We need to value each other, people, our extended social systems to fix a problem that affects all today indirectly by affecting someone in our own extended social system right now and us tomorrow after an accident or expeceted medical issue, and 5-10 yrs from now when we age ourselves.
- did you know we all get medicare!! Yep, if you get hurt right now you get medicare disability. There is so much you dont know and I cant do it all in one post. If you invest in me, send comments, I can invest in continuing the discussion.
Change is part of living! Feel Good that you took the time to look at several places and then made a choice instead of just accepting the first persons suggestion or suggestions of a person you may never see again. Big Institutions like Assisted Living Facilities or Nursing Home VS a Smaller, Single Family Home. While both Big and Small say they are Home-Like you have to decide how at home you feel in a small studio apt with a kitchenette VS a real house with a family of friends and the familiar set up you have lived in for your entire life. Assisted Living or Nursing Home Institutional Hall Way Choose people over things when choosing Senior and Health Care.
Food for Thought If the sales person promises work that will be done by someone else, it is usually a good idea to meet the person who the sales person is promising for. Health care, Senior Care are Personal Services and are not sales of an inanimate object. Services do require a relationship, social skills, and continuity of care. Consider those when choosing any Health Care service including Assisted Senior Living Services.
Big Institutions like Assisted Living Facilities or Nursing Home VS a Smaller, Single Family Home. While both Big and Small say they are Home-Like you have to decide how at home you feel in a small studio apt with a kitchenette VS a real house with a family of friends and the familiar set up you have lived in for your entire life. Nice furniture without a family of caregivers and other residents to interact with is a lonely place. Assistance, Care and Caring require a relationship for All people to feel needed and welcome. Take the time to find the best care team for you. Spend time meeting all the care team in any care setting. How do you feel when you think of living in a studio apartment with a kitchenette, the standard setting in a Big Assisted Living Facility? Compare that to how you feel when living in a house, like the house you have lived in for your entire life, with the same private room but now access to the “house”. Which makes you feel safer, better, happier, more independent, more involved in day to day life? IN ALL CASES “THE CARE” IN ANY SETTING OF ASSISTED LIVING, NURSING HOME OR A SINGLE FAMILY HOME CARE COMES FROM THE PEOPLE YOU CHOOSE TO ASSIST YOU IN THAT SETTING. While the idea of care in your old home is a nice thought, consider how likely it is that the caregiver takes over to some degree? If you need assistance you might not be at your best, coordinating your care and that care giver. Look for some management, with the in home care options, to ensure you will maintain as much control over your life as possible. We recall a quote from Patch in the movie Patch. If you treat the disease you win or loose but if you treat the person you win no matter what the outcome. Believe, trust in, and develop relationships with those who you now live with and who help you day in and day out as friends and caregivers. Senior Care and Health Care are services in any care setting Home Care, Hospital, Rehab, Assisted Living, Memory Care, Dementia Care, Alzheimer’s Care, Hospice care. In all cases look beyond the furniture and the pills to see the care and people who are directly implementing the care and treatments. For seniors cognitive care, depression, sense of loss, are present in all cases and one of the best treatments for that is to find the home like setting and family like staff. Help us spread the word. Click for Free Ways to help. Click for The Best, Most Cost Effective, Assisted Living and Senior Care Alternatives Dr Shawn McGivney
Do you know how much Medicare pays your doctor on your behalf? How will the 25% Doctor Pay cut affect care for the Frailest Seniors including those living in an Assisted Living Institutions or Assisted Senior Care Settings?How do you think the 25% pay cut doctors are getting will affect care in Senior Living Settings like Assisted Living, Residential Care Homes, Home Care, or Hospice Care?
New Medicare fee schedule for 2013 99215 complex office visit, Medicare fee scheduled amount, for participating doctors 2012 $144.67 2013 $108.43
Do you think doctors will be thinking about doing more, providing more continuity of care, building stronger relationships, take extra time to listen and assist in navigating the increasingly complex health care system or might they react differently? How have doctors reacted for the last Decade? I have observed they have quit private patient centered practice and taken jobs as institutional, or hospital controlled employees. Is that what you observed? Do you think Assisted Living, and any care home will have an easier time getting medications, refills, follow up for you, and the patients they offer protective supervision for? Did you know that all doctors get paid exactly same for a 99215 or complex office visit? That is right, if they spend one hour, or two hours and if they make lots of extra phone calls, if they answer the phone at night for you, they get the exact same pay from Medicare as the clinic doctor you do not know, have little hope of ever seeing again, and who might have not investigated your full story as completely as someone who you have an longer term relationship with. Health Care is more of a unknown “Service” or “Product” than other services or products. Did you know that based on the Medicare CPT Code payment system all doctors are “the same”? The CPT code system pays all doctors exactly the same for a 99215 no matter what they do, or how much extra they do. The terms of “% “are very misleading. For Example, Medicaid as primary coverage (Not Medicare) pays 100% of a doctor visit, but they only pay 10 dollars for that doctor visit. 100% of $10 = $10. For advertising purposes 100% sounds much better. Likewise, what a doctor is doing, or could do, are largely unknown to most. How many feel confident they know what one doctor does compared to another doctor and how that is cost effective for their private pay dollars? Indeed, patients and now many doctors may have widely varied descriptions of what they could do and why it is cost effective for a senior and their family to spend private funds on that. 25% pay cut or new price for complex visit and all follow up until the next visit – $108 dollars. What is a CPT code? See link to a cms Medicare Description of a complex office visit code. http://www.cms.gov/medicare-coverage-database/staticpages/cpt-hcpcs-code-range.aspx?DocType=LCD&DocID=32001&ver=12&Group=1&RangeStart=99201&RangeEnd=99215 Relative Value of a Doctor’s Visit vs. Women’s Hair Stylist Visit, and DVD or Blue Ray Player purchased from Best Buy. Doctors 99215 office visit. One might ask what does a visit mean? The following are just a few very general, things you may not think that are part of providing this service to you. Keeping/storing your records for a 5-7 year period and being responsible to retrieve them in a timely manor. Once they are “your Patient” even for one visit, the doctor is responsible to answer phone calls from patients, families, Assisted Living, Residential Care Homes, Nursing Homes, and other care settings regarding their care including refill of medications. Recall, the doctor only gets his 108 dollars if you visit him, if you do not visit him and he refills medications on the phone then that is “included” in the 108 dollar visit he got on the last visit. Do you know that it is not required for Doctors to have Malpractice insurance and that 20-30% of out patient doctors may not have it? How does that affect you or the care they are providing to you? Doctor, Hair Stylist, DVD Player Hair Stylist VisitHow much does a women’s haircut
and style cost? $50 -100. What type of risks and long term commitment does she assume with her one hair cut visit? Does she keep records? What are the overhead costs to a Hair Stylist visit and how do those compare to to the overhead costs of a Doctor’s visit? DVD Player at Best BuyHow much do you pay for a DVD Player at Best Buy? 50-100? How much service do you really expect if it breaks? What type of customer service do you practically expect to get when it breaks or does not work? A basic policy of bring it back within 30 days and we will refund your money and that is it?How do you determine what services, amount of personal attention is important to you? Questions you might ask.
What “assistance” do you get from any care setting? What is “Assistance”? Does it include medically related care? Does the management have any medical care experience; do they “need” any medical care experience? What do you need and want and how do you define Assistance, Assisted Living, and Assisted Senior Living? The examples above are intended to show us that health care is a service, and like all services it depends highly on the individual people providing it. We need to meet all of the people involved: management, owner, administrator, caregivers, medication technicians, and doctors if there is a house doctor to know what we are getting. While we will still may not know it all, by meeting the individuals in the team, we are much better able to decide on the value for our private care dollars.Impact on Senior Care and All Senior Care Settings.
How does all of this affect Senior Care, and most importantly, Care for seniors who are really sick, have multiple chronic diseases, and are likely to need assistance. This will further reduce continuity of care by further pushing doctors out of medicine. Some doctors who are unable to do anything else will just accept the new roll as a salaried employee/ doctor or the institution. We believe that all people who get a salary will start to behave more like employees than old fashioned doctors. The respected role of “Doctor” is changing and it is up to both doctors and patients to reevaluate what type of care they want and in what type of care setting they get it. Do residents and families choose a Big, Institutions with hundreds of residents or do they choose smaller care settings where you know the owner, administrator, staff and they all know you are another choice. Finally, do not under estimate knowing and working with one doctor when you are older, and have many care needs and health concerns. Continuity of the Care is the care. In all cases, the care team including the doctor, in each setting big or small, will determine the value you are getting for this very expensive item of Senior Care. Senior care costs more than a new car every year and is a product most do not know as well as a car.Is this the fix? Is it fixed? or do we need to value people, doctors, and continuity of care? Then this news Alert, http://www.medscape.com/viewarticle/776955?src=nl_newsalert They may be pushing the Medicare cut back one year. Now Doctors can just expect that cut next year. They have one more year to plan their escape from Medicare. Or Doctors, Patients, and Society can embrace Continuity of Care especially for the frail Elderly and those living in an Assisted Care Setting. One must wonder how these constant changes and proposed “fixes” to the payment system without addressing the care system are suppose to help care and caring? It is unclear that any one has changed their relative value for Continuity of Care which we believe is essential to get and provide High Quality Care. But only time will tell if it helps continuity of care and care or not. Health Care is about Continuity of Care and relationships. Be cautious not to apply the six sigma standard of assessing business efficiency, and quality control when looking for health care services. By Shawn McGivney MD, RFA Thanks for reading this post . If you liked this post please help us by sharing the message of Care, Caring, and Continuity of Care by likeing, friending, and following our works on Facebook (tlcsr.kerrymcgivney), Twitter ( TLCSRLasVegas), Youtube (TLCSRLV), Joining our Email List and this Blog, and sending this to any sons, daughters, or seniors you know. Here are links to make it easy! Like Our FaceBook Page: Friend Us On FaceBook: Follow us on Twitter: Like our videos on Youtube: Join our Free Blog and Email List: Contact: Shawn McGivney MD, RFA [email protected] www.tlcsr.com www.tlcsr.com/blog/
How are “Care” and “Caring” different? Care in Assisted Living might be just the physical act of giving a shower and caring might be something more emotional and personal, that is shared between the two people while that service is provided. We believe continuity of care and a professional relationship are the main factor that determine how care is appreciated, felt, and perceived by both care givers and residents in all care settings including Assisted Living, Residential Care Homes, Dementia Care, Alzheimer’s Care, Memory Care, Hospice and Home Care. The care setting does allow or impede how the care is provided. For example A La Cart Care vs Live in more Family Style care will affect the continuity of care. However, in the end even the care system can be over come by the individuals providing that direct care and direct patient management and protective supervision. Big, Institution, Nursing Home, or Assisted Living Facility VS Small, Single Family Home Home VS Institutional Hall ways ?
The physical setting does matter. A small, private room with a kitchenette is not a home no matter how you phrase it. A single family home is well known to most seniors and offers all the comforts they are use to. While a hotel is a flashy place for vacations it is not what a person in need of Assistance really wants or needs. If a Senior were well enough to dress up in a suit or dress and go out on the town they would not need an Assisted Senior Living Setting. In fact, people prefer care in a single family home that has many of the senior modifications they need to accommodate their care needs. Do not just accept the old phrase “home is everywhere you are” In fact, when you are older you want a home to be steady and not changing and in many case Assisted Living Facilities will force you to change your “home” at least one more time after you move in. Most are priced out or the level of care increases and they are asked to move to a more or real Assisted Senior Care setting. Recall a recent post where they said about 1/3 can remain in Assisted Living until they die. While that sounds good, 2/3 are forced to move again!! That is more common outcome statistically. Conversely, family style of care and hands on management all will improve the quality and intimacy of the care one does receive. In any care setting Assisted Living, Residential care, Home Care , Nursing Home, Hospice Care, meet the entire care team and especially the management since their interest in direct care, relationship building will most likely be reflected in the importance care givers place on that, personal aspect of the care they offer you.
Assembly Line Care VS Family Style, Live in, Continuity of Care models of care VS Assembly line, A La Cart Care On a highly scheduled Basis VS Individualized, Family Style, Live in Care, Like Mom provides her kids. Are “Care” vs “caring” the same thing? What is the difference? Is care provided in an assembly line style, that does the physical care tasks, the same as Family Style, more live in care, where the staff live and work with the senior day in and day out the same? Is the “caring” that comes with the care different depending on the style or system in which the care is provided? Care and Caring require the senior and caregiver know each other and have continuity of care and a professional relationship. Which do you want? Which system of care Assembly line, like you see in a Big Facility, Nursing Home, or Institution, or a more family-style, live in care system provides a Higher Quality of care? Everyone says we offer High Quality of Care but it is up to each senior and their family to meet the entire care giving team before they make their choice of a senior care setting. The choice of a Big,Less personal Institution or Facility over a small, single family home and a choice between more assembly line care or a more live in, continuous style of care, complete with the most continuity of care you can get, is often difficult since many times, especially in the Big Institution or Facility you never meet the direct care staff and management that you are hiring. You often times meet the sales lady but may not really meet the people you are hiring the care team from the administration down to the care givers. Many people see the nice sofa and then Assume the care. They assume the name “Assisted” Living Facility means you get the type of Assistance most of us would want. In fact, that often times is a bad assumption. The choices of the type of physical building ( Big, studio room, or Institution) VS ( smaller, single family home with a private room) and the system of care ( Assembly line Vs Live in, Family Like) do affect how the care is perceived after they sign up. Delegated Care Management VS more hands on Care and interaction of management with all staff, residents and families. Another major factor in distinguishing Care, Caring, and Continuity of Care is that Care in any setting is heavily influenced by the management. If the management knows you, the senior and the family, it is much harder for them to skimp on the care and caring. When care is impersonal it is easier to decide to make more money and provide less care, hire fewer staff, and maximize the Institutional Bottom line. Everyone has a bottom line, but if the management, owner, and caregivers all know you the client you are likely to get the best over all value including caring and continuity of care. Assisted Living, Home Care, Hospice Care, Dementia Care By Kerry Mcgivney Thanks for reading this post . If you liked this post please help us by sharing the message of Care, Caring, and Continuity of Care by liking, friending, and following our works on Facebook (tlcsr.kerrymcgivney), Twitter ( TLCSRLasVegas), Youtube (TLCSRLV), Joining our Email List and this Blog, and sending this to any sons, daughters, or seniors you know. Here are links to make it easy! Like Our FaceBook Page: Friend Us On FaceBook: Follow us on Twitter: Like our videos on Youtube: Join our Free Blog and Email List: Contact: Shawn McGivney MD, RFA [email protected] www.tlcsr.com www.tlcsr.com/blog/