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Home Health SUMMER 2012

Aordable Health Care Act What it means for you

Electronic Medical Records

Sleepless Nights?

Living with Diabetes

How technology is keeping you secure & healthy

Tips on getting the best sleep of your life

Learn how to control your diabetes


CONTENTS Home Health 8 ABC’s of ZZZ’s

Learn how to fight sleeplessness

10 Conversations Medistar Home Health Chief Development & Strategy Officer, Quentin R. Graham, discusses Electronic Medical Records

11 Living with Type 2 Diabetes A dietician’s insight on managing your health with diabetes.

Cover Story

The Affordable Health Care Act & what it means for you

HOME HEALTH |SUMMER 2012 3


Home Health SUMMER 2012

VOL. 1 NO. 2

PRESIDENT & CEO

Beth R. Denton

CHIEF OPERATING OFFICER

Gina Creel

CHIEF DEVELOPMENT OFFICER PUBLISHER EDI SENIOR EDITOR CREATIVE DIRECTOR

Quentin R. Graham James Shackelford Roseann Wentworth Lauren McMillan

PUBLISHING COORDINATOR

Jeannie Stratton

CIRCULATION

Christi Bellizzi

CONTRIBUTING WRITERS

PUBLISHING OFFICES

EDITORIAL

Dr. Adam Powell, Dr. Moshe Lewis , Quentin R. Graham and Lauren Schmitt SomaComm, Inc. 3114 Swiss Avenue Dallas, TX 75204 214.296.4480

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OUR MISSION Medistar Home Health's mission is to make a positive dierence in the lives of our patients, our healthcare partners and our valued employees as we provide superior quality and compassionate care, while adhering to the highest standards of excellence.

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This publication is intended to provide accurate, authoritative, and detailed information in regard to the subject matter covered. All written materials are disseminated with the understanding that the publisher is not engaged in rendering legal or medical advice. Under no circumstance should the information contained herein be relied upon as legal or medical advice as it is designed to be a source of information only. Home Health strongly encourages the use of qualified attorneys or physicians with regard to the subject matter covered. Home Health does not guarantee the accuracy of the information and is not liable for any damages, losses, or other detriment that may result from the use of these materials.


Medistar in Action Medistar Home Health is always working to make a difference in home healthcare. This summer, Medistar was proud to open a new office in Natchitoches, LA. Now Medistar is able to increase its coverage area and serve even more patients across the state of Louisiana. Pictures of Medistar staff and guests at the Natchitoches open house are shown below:

There is quite a bit of “buzz” these days about electronic medical records (EMR) and electronic health records (EHR). Some may wonder if EMRs and EHRs are new concepts brought about by requirements in the Affordable Care Act. It may surprise you to know that the notion of EMRs has been around since the 1960s when Dr. Lawrence L. Weed first described an automated system as a way to enhance patient medical records thereby improving patient care. The Mayo Clinic also began developing EMRs in the 1960s. What can I say? Some wheels of progress move very slowly. Medistar Home Health has used some form of EMR since the 1990s and converted to a fully integrated HIPAA secure, point of care system in 2007. Our state of the art electronic tablets and StarPHISH portal allow physicians and other providers in the healthcare continuum to stay current on vital signs, all medications, and their patients’ compliance with the physicians’ plans of care, all while their patients remain in the comfort of their homes. And as the first post acute care provider selected to participate in the Louisiana Health Information Exchange (LaHIE),Medistar continues to set the bar as a thought leader for

efficient communications in the continuum of healthcare. Medistar’s early adoption of EMR, Medista and many years of experience using all aspects of such a system, has been instrumental in our achievement of low hospital readmission rates. According to a recently released report by OCS Homecare, a national leader in performance improvement reporting and analytics for home health and hospice organizations, Medistar has readmission rates far lower than the national average of hospitals as well as that of home health agencies. Integrated into Medistar’s EMR system, the OCS Predictive Modeling program, assigns patients a risk level for hospitalization and emergent care, which aids in customizing and adjusting care plans as patients’ health conditions change while under home health service. Medistar Home Health attributes our low readmission rates to our high standards of care and our experienced team of professionals using efficient practices in conjunction with EMR. We invite you to experience how Medistar Home Health is Making a Difference in Home Health throughout the state of Louisiana.

Beth Denton, Medistar Home Health Owner and Chief Executive Officer Follow Beth on Twitter:

@BethRDenton

HOME HEALTH |SUMMER 2012 5


Affordable Health Care Act The Impact of Obamacare on Senior Citizens By Adam C. Powell, Ph.D.

O

bamacare, more formally known as the Patient Protection and Affordable Care Act (ACA), has introduced a number of changes that will impact senior citizens. While a few of its provisions have already gone into effect since the law was passed in 2010, the majority of the law will become active after the next Presidential election. The ACA will have both a positive and negative impact on the lives of senior citizens, as it is a complex law that creates some new benefits and reduces spending on some existing benefits. The two main benefits senior citizens will experience are better coverage of preventive services and lower costs when filling prescriptions. To help pay for the law, there are some budget cuts on Medicare that may take effect. These budget cuts may impact seniors’ ability to access services, but should not increase out of pocket costs.

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Since January 2011, Medicare Part B (Medicare’s medical insurance program) has covered an annual wellness exam which includes the creation of a personalized prevention plan. Medicare beneficiaries do not need to pay any out of pocket costs to receive these services. The personalized prevention plan includes completion of a health risk assessment, creation of a schedule for appropriate preventive screenings over the next five to ten years, and personalized health advice as is appropriate. Before the passage of the ACA, these preventive services were subject to cost sharing. The ACA will also reduce the amount of money that some senior citizens have to pay for prescription drugs. Since 2006, seniors have been able to get prescription drug insurance coverage through Medicare Part D.

Adam C. Powell, Ph.D., is President of Payer+Provider Syndicate, a firm which provides consulting services to the health insurance and hospital industries. Over the course of his career, he has consulted for three of America’s five largest health America insurance networks. Dr. Powell holds a Ph.D. and M.A. in Health Care Management and Economics from The Wharton School of the University of Pennsylvania, as well as degrees from the Massachusetts Institute of Technology.


The ACA will also reduce the amount of money that some senior citizens have to pay for prescription drugs. Since 2006, seniors have been able to get prescription drug insurance coverage through Medicare Part D. However, the benefit structure originally defined by Medicare contained a “donut hole”- a gap in which no coverage is provided for drug spending between $2,930.00 and $6,657.50 (not all Medicare Part D plans have this design – this is simply the reference design provided by the government). In 2010, the ACA provided seniors with a $250 rebate if they had to spend money on prescription drugs within the donut hole coverage gap. Since 2011, the ACA has worked towards filling in the donut hole by requiring pharmaceutical companies to rebate money back to seniors as they purchase branded drugs while in the donut hole. The donut hole will shrink a bit each year until it disappears completely in 2020. In 2012, manufacturers of branded drugs are required to give seniors a 50% rebate on their drug spending while they are in the donut hole. Although seniors now spend half as much on branded drugs, they still receive credit for the rebated money towards reaching the other side of the donut hole, where 95% of the cost of branded drugs is covered. When buying generic drugs while within the donut hole this year, seniors receive a 14% subsidy. Unlike the rebate for brand-name drugs, this generic drug subsidy will not count towards escaping from the donut hole. The brand name drug rebate and generic drug subsidy provided within the ACA will get slightly larger each year, until 2020, when seniors are only responsible for 25% of the cost of brand-name and generic drugs while within the donut hole – effectively eliminating the donut hole. While the ACA provides some new benefits for seniors, the money necessary to do so has to come from somewhere. Some of the money necessary to cover the cost of the law is being obtained by reducing the amount that Medicare reimburses many types of health care providers, such as hospitals, physicians, and laboratories for

their services. These cuts could cause some providers to stop accepting new patients with Medicare coverage. In the past, Congress has taken action to stop Medicare cuts before they have taken effect, and it is possible that this will happen again. On the other hand, the law includes a number of some types of Medicare payment improvements for certain types of physicians, such as those in family medicine, general internal medicine and geriatgeriat rics. The government is also substantially reducing its payments towards Medicare Advantage plans as a result of the ACA. Medicare Advantage plans are Medicare plans designed and managed by private health insurance companies. To offset the reduced payments, the plans will have to reduce their benefits, increase their premiums, or do a combination of both. These changes in Medicare Advantage will not happen to any large degree until after the election, as the government is paying Medicare Advantage plans a temporary bonus to offset some of the reductions in 2012 through 2014 via the Medicare Advantage Quality Bonus Payment Demonstration. Unless the decreased payments to Medicare Advantage plans are canceled, or other more permanent workarounds are used to reduce the effective size of the payment reductions, it is likely that Medicare Advantage plans will have to be substantially redesigned. As a result of the provisions of the ACA, senior citizens are experiencing lower out of pocket costs for both their prescription drugs and their preventive care. These changes will be particularly helpful to seniors spending enough money on drugs to reach the donut hole in Medicare Part D. However, reduced payments to providers may cause some seniors to need to change where they access care. Likewise, seniors participating in Medicare Advantage plans may experience substantial changes in the design or pricing of their plans. HOME HEALTH | SUMMER 2012 7


HEALTHYTips

ABCs of ZZZs

Fighting sleeplessness as you age By Moshe Lewis MD

One of my senior patients made an amusing observation this week: as infants we sleep most of the time. Children and teens, on the other hand, often want to stay up as long as they can. By the time we enter college, pulling all-nighters by any means necessary is the norm. In adulthood, the shoe is on the other foot; it seems we just can’t find a way or enough time to sleep. So why is it so difficult for most seniors to get their required amount of sleep? Perhaps our sleep-starvation is partly because we forget just how important sleep is to our health and well-being. There is still significant debate about the reasons why we actually need sleep. However, medical science and practical experience have repeatedly demonstrated that in order for sleep to be effective, it must be deep and prolonged. This is so that the body can proceed properly through the different stages of sleep. The Stages of Sleep During a healthy night’s night rest, we cycle between four equally important stages of sleep. In stage one, or “drowsy sleep”, we are aware of noises around us and can be easily awakened.

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Often we will experience a rush of ideas and even light hallucinations as the body begins to relax and unwind. Generally, we spend about Generall five to ten minutes in stage one before proceeding to stage two, a deeper level of sleep. Here we lose consciousness and muscle tone. Our bodies start their reparative process and begin to relax. Though we quickly drop from stage two to stage three, we return to stage two over and over; in total, we spend about half of our night in stage two. As we progress to our deepest sleep level stage three, our relaxation, repair, rejuvenation and restoration increases. Skeletal muscles of the limbs lose their tension and go limp. Smooth muscle cells lining the blood vessels relax and dilate. Our blood pressure falls; our heart rate decreases; our body temperature drops; and our respiration becomes less frequent. This increases the blood flow to all tissues in the body, allowing them to get bathed with the oxygen and nutrients found in the blood. This influx of blood also removes waste products and toxins that have accumulated throughout the day. During stages two and three,our peaceful deep

sleep is periodically interrupted by a dramatic change. The brain becomes very active, sending nerve impulses throughout the body. As a result, blood pressure, heart rate, body temperature and respiration all increase. Our muscles begin to contract, even those that control eye movement. These eye movements give this active final sleep stage its name: REM, or the rapid eye movement stage. Try to establish a routine to let your body and mind know the plan beforehand, going to sleep at the same time every night might be a good way to start. But perhaps the most interesting feature of REM sleep is dreaming. Experts believe that dreaming is a means for our bodies to deal with stress at a subconscious level — a way to heal ourselves intellectually, emotionally, cognitively, psychologically and spiritually. spirituall This psychological rejuvenation can happen directly or indirectly through the symbolization and role-playing in our dreams. Without our REM stage dreams, many of the stresses that we internalize

throughout the day would continue to build.This might lead to irritability, poor concentration, emotional dysfunction and diminished physical performance. For this reason, insomnia and sleep disorders can have effects far beyond a few restless hours at night. Sleep deprivation affects our mental well-being as well as our physical acuity. What About Sleep Aids? It’s impossible to mention the devastating effects of poor sleep without a word about medical sleep aids. In the last ten years we’ve seen a boom of prescription sedatives, each with a television ad promising peaceful slumbers and bright mornings. Though these medications are helpful on a temporary basis, it’s important to remember that these products are not intended for ongoing use, and that they may have numerous side effects. This is doubly true for over-the-counter drugs like antihistamines. Though many of the newer formulations have been designed to minimize side effects, they simply should not be considered a permanent cure. It’s always best to discuss ongoing sleep problems with your doctor. docto


HEALTHYLiving Tips for a Good Night’s Sleep

It has been estimated that 90 million Americans suffer from a sleep disorder at one time or another in their lives. Those of us who are free of medical disorders are still susceptible to poor sleep habits. If you’re having difficulty capturing a full night of rest, try these simple tips to cultivate better sleep practices and happier mornings. 1. Darken the room so your brain releases more of its own melatonin for better sleep. 2. Try not to eat or drink much just before bed, and try not to take medications with stimulants—for example, avoid antidepressants, caffeine,Ritalin, and Straterra. Food and stimulants shorten the REM stage in unhealthy ways. 3. Turn off the television and radio an hour before bedtime. Decreasing stimulation will help to ease your brain into a state of restfulness.

The Melatonin Mystique One of the most provocative prescription sleep aids is melatonin. In its natural form, melatonin is a hormone produced in the body of most living things. Unlike other familiar hormones like serotonin, which can be produced at any time, melatonin only comes out at night—darkness affects the production of melatonin, and in turn melatonin seems to help entrain us to a 24-hour cycle of wakefulness and sleep.

Prescription melatonin is appealing because it isn’t a sedative– it simply boosts the melatonin present in our own bodies. Despite melatonin’s current popularity and notoriety in the press, it remains controversial and the effects of its long-term use are unknown. Melatonin also has side effects, which can include headaches and stomach problems. Therefore, it is important to talk to your healthcare provider to determine the right dosage for you.

Dr. Moshe Lewis, specializing in pain management, is an ivy league trained physician who graduated from Mount Sinai Medical School in New York.

Eat Well: Heathy Recipe Tuna Dijon Burgers 3 tbs. low-fat mayonnaise 1 tbs. dijon mustard 1 large egg white 3 /4 cup flax meal 1 /2 cup bread crumbs 2- 6.5 oz. cans of tuna in wate water, drained and flaked 1 /4 cup chopped green onions 1 tsp. tarragon

4. Incorporate restful practices into your waking life. For example, try yoga, or take time to pamper yourself at a spa or with a massage. 5. Take vacation time and use your paid time off, especially when it does not accrue year to year. Fatigue builds over time, so be kind to yourself. 6. Take naps, especially on the weekend when there is some extra timee

Combine first three ingredients in medium bowl, add remaining ingredients (reserving 1⁄4 cup of bread crumbs); stir well. Divide mixture into four equal portions, shaping into patties. Press remaining bread crumbs onto both sides of patties. Brown patties on both sides in a non-stick skillet coated with non-stick spray. Serve with hamburger buns and enjoy! This recipe was provided by Cancer Treatment Centers of America (CTCA). CTCA combines the latest, cutting edge medical technology with complimentary and alternative medicines, including nutrition. For more information 1-800-333-CTCA or visit cancercenter.com HOME HEALTH | SUMMER 2012 9


HEALTH Conversations Electronic Medical Records and the Benefit to the Healthcare Continuum By Quentin R. Graham

Electronic Medical Records (EMR) are often referred to as Electronic Health Records (EHR), although slight differences exist in the technical definitions of the two. Both are the subject of repeated conversations throughout the healthcare community. The technical side of EMR should probably be left to the computer software experts. But when it comes to the real benefit of EMR to the healthcare system, including providers of healthcare such as hospitals, physicians, post-acute care providers, and to patients in all phases of the Continuum of Care, the questions appear to be answered by looking at the specifics of the particular healthcare provider. Although EMR has been discussed and even implemented in a rather elementary manner for quite a number of years, the healthcare industry is just beginning to see the overall benefits of this important capability. EMR offers much more than just a reduction in, or indeed an elimination of, “paper” records. The true benefit lies in the ease of exchange of patient medical records across the health spectrum or “Continuum of Care”. Under the “old” system of providing the detail of a patient’s healthcare record, whether it be documenting a hospital visit, a visit to a Primary Care Physician, a healthcare specialist such as a surgeon or cardiologist, or any number of specific tests or exams, the individual healthcare provider who was next in the patient’s Continuum of Care often was seeing the patient before the results of the care or exam last performed were available via paper or other medium. EMR eliminates that delay.

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But it is more than just a delay that is being dealt with in the old system; it also, and very importantly, could include a lack of current information such as medication changes being updated in the patient medical record. A patient’s mid-night visit to the local hospital would never have all the current information. And relying on patient input to health questions in the midst of an emergency is at the very least dangerous. Therefore, tests are performed to get the answers to many of these important questions. And what does this cause? Further delays and a possible oversight of an important question. Having the capability to exchange healthcare records, electronically, answers all of these concerns….and eliminates duplicate costs. However, one healthcare provider having EMR and another not having EMR, in reality, doesn’t solve the problems of an incomplete health record. The solution must include ALL providers along the Continuum of Care. What the best vehicle for exchanging Medical Records is becomes another important question. Today the answer is clear. All providers along the Continuum of Care must “belong” to a statewide exchange or even a nationwide exchange. Here in the state of Louisiana there exists such a statewide exchange, the Louisiana Health Information Exchange, (LaHIE). Under the direction of Louisiana Healthcare Quality Forum, LaHIE brings together all of the medical records of any patient seeing a healthcare provider that is a member of the exchange (with the appropriate patient consent). Through a membership in LaHIE, any provider

has access to health records of their patients that are also patients of other member-healthcare providers. Medistar is proud to be first and only post-acute care provider to be a member of LaHIE. As the healthcare industry continues to investigate new and better methods to both provide quality care and keep the cost of healthcare manageable, it has become obvious that the implementation of Electronic Medical Records and the integration of patient health records though an exchange is a valuable tool in reaching both of these goals. Additional benefits of the use of EMR are also being recognized, including a clear reduction in the enormous problem of costly patient re-hospitalizations. Medistar Home Health and Louisiana Healthcare Quality Forum have made a commitment to offering a complete explanation of the details of EMR as both a provider and a member of LaHIE through a series of seminars throughout our statewide coverage area. Ask your local Medistar Representative about an upcoming seminar near you.

Quentin R. Graham is the Chief Business Development and Strategy Officer at Medistar Home Health.


HEALTHExperts

Living with Diabetes Eat Right and Exercise for Diabetes Control

By Lauren Schmitt

Living with diabetes is a reality for a large percentage of people. It may not be ideal, but with adequate knowledge, it can be managed and life can continue as planned. Approximately one third of individuals with diabetes who are over the age of 75 are hospitalized over the course of a year. Sixty five percent of those that are hospitalized are undernourished upon admission. With these facts, it’s easy to see the importance of nourishing one’s body, so here are some things to keep in mind if you’re living with diabetes.

On one quarter of the plate, include a serving of starch foods. Starchy foods are whole grain breads, high fiber cereal, brown rice, whole-wheat pasta, quinoa, corn, potatoes, peas, low fat crackers, or tortillas. Remember, this section is not allowed to overflow. In the last quarter of the plate, add a protein choice. This includes skinless chicken, turkey, fish, lean beef or pork, tofu, low fat cheese, eggs, or shellfish. With this, enjoy an 8 oz glass of milk or a piece of fresh fruit. And, do not forget to have some water.

People with diabetes can eat all types of foods, but it is important to…

Exercise: Combining diet, exercise, and medicine (if prescribed) can help control one’s blood sugar levels and weight. Exercise improves the body’s use of insulin and helps the body burn fat, which further helps diabetes control. It also reduces anxiety and stress, and instead promotes relaxation.

Control the amount of certain types of foods eaten, Eat consistent amounts of food, Eat at the same times each day Include snacks between meals so that blood glucose levels do not get too low. Diabetes Management Class: If a diabetes management class is taught in a doctor’s office or at a local hospital, I would highly recommend attending to get detailed information about carbohydrate counting to manage diabetes. The Healthy Plate Method: Divide your plate in half and then divide one side in half again. Fill up half of the plate with non-starchy vegetables. Some healthy choices include salad greens, carrots, broccoli, peppers, mushrooms, beets, green beans, cucumber, etc.

Just as it is important to have a food and medicine regimen with diabetes, it is important to have a consistent exercise routine. Initially, it is important to exercise with someone who knows about the diagnosis so that they can teach the individual how to help if blood sugars are too low. They should always wear a medical ID tag that states the diagnosis. Also, check blood sugars before, during and after exercise and adjust food/fluid intake if necessary. Carry a carbohydrate type snack in case your blood sugars drop. When in doubt about what type of exercise to engage in, begin with walking.

The most important thing is to simply move one’s body. Diabetes is a serious diagnosis with serious complications if it is not managed. Make sure you are one step ahead of it by planning your food intake and exercise. This will make a major difference in how this diagnosis will impact your life for the better!

Lauren Schmitt is a registered dietitian and certified personal trainer specializing in individual and corporate wellness, eating disorders, and weight management. Lauren currently owns her own business, Healthy Eating and Training, Inc., where she counsels individuals and gives them the tools to lead a balanced, healthy life through nutritious eating and physical activity. In addition to seeing clients in the private practice, Lauren has developed nutrition programs for major corporations including: Sony Pictures Entertainment and Dreamworks Animation. ���� ������ � ������ ���� 11


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Home Health Summer 2012