Will Patient Advocates go the way of the dinosaur?
“Greedy, Lazy and Cheap.” This was the title of a speech I gave to physicians back in the 1990’s when they had to decide if they would sign on to insurer panels. I pleaded with them to remember that if it looked too good to be true, then it probably was. But their greed clouded their judgement when the insurers told the doctors that they would give them an endless supply of patients, so that the doctors could just concentrate on being professionals and leave the business side to them. The physicians didn’t bother to read the contracts that said that the insurers could make any changes to the fees and terms at any time without notice. And they refused to hire people who could have helped them to understand the terms of the contracts. Even while the doctors would praise me for my interesting program, they ignored the warning as they marched off the cliff and lost not only their ability to set fees and define practice parameters, but even lost the title for which they had worked so hard, Doctor. Now they are known as Providers and their position as the trusted advisor to the patient’s health has been replaced by Physicians Assistants or Nurse Practitioners. No wonder people are turning to Patient Advocates to help them navigate the health care maze.
However, who is a Patient Advocate? I started my Private Professional Patient Advocate business in 2008 after using the title since 1976. Originally, doctors and hospitals paid for my services, but once the insurers took over their businesses, the ‘Providers’ and those paying for the insurance, mostly employers or Unions, were left hoping for the best or looking for lawyers. So, that’s when those who could afford it, looked for someone to help them when they couldn’t get the care they needed or found themselves stuck with unexpected bills.
Most advocates agree that over the past decade, few people knew that Patient Advocates existed. Also, there was no license or standard rate for their services. Just like the renaming and reassignment of roles for physicians, anyone could call themselves a Patient Advocate. Insurers and hospital systems took full advantage of the confusion and gave out these titles to advertise their customer service departments. Then, a group of Advocates got together and formed the Patient Advocate Certification Board. Here is the eligibility requirements for a person to call themselves a Board Certified Patient Advocate, which includes education, experience and a very difficult test. https://www.pacboard.org/eligibility Many nurses and social workers are adding the BCPA to their names after becoming frustrated with the limitations being placed on their decision making. Social Workers who have masters degrees and accept Medicare reimbursement make a fraction of what a Private Patient Advocate charges.
Just as the stakeholders in the payer world (when the health system was described as consisting of patients – providers & payers} used a bait and switch methodology to get people to accept that they no longer had doctors, there is a new effort to usurp the term Patient Advocate. A recent article in the NY Times praised the role of the Patient Advocate in the hospital setting. https://www.nytimes.com/2022/03/03/well/live/hospital-patient-advocates.html
Big pharma is promoting a Healthcare Advocate Summit. Notice the juxtaposition of the word Patient and Healthcare when talking about who or what is being advocated for. The website for the Summit states in their lengthy mission that “The Advocate is the connector between securing clinical treatment for the patient using the appropriate procurement methods that ensures reimbursement for their health care organization, all while offering emotional support to the patients.” This leads me to remember the same kind of verbiage that was used when managed care was trying to cloud their intent to steer patients to lower cost services.
I’ve spoken to a few of my fellow Independent Patient Advocate business owners who came out of the practice management world. We can understand that nurses, social workers and customer service people who work in various health systems (hospitals, insurers, professional organizations or government) might believe that adding a billing code for Advocacy will raise their salaries. However, we caution them to look at how managed care contracting worked for the doctors and for the patients.
Join Us for Professional Advocates Networking
| People for Patient Safety (PPS) The second Monday of each month 7:00 PM Eastern Time Networking and social gathering for patient advocates and caregivers March 14, 2022 – 7:00 PM Eastern Time |
| Network with others in the field. Introduce yourself, your business, your interest. Share your goals and let others help you reach them. Don’t travel this road alone. Pre-registration is required. www.PulsePPS.org People for Patient Safety Does Patient Safety Interest You as a Patient Advocate or Caregiver? If so, you might not want to travel this road alone. Patient advocates, caregivers, community are all welcome to this discussion group on the second Monday of each month at 7:00 PM Eastern Time. “Patient advocates can accomplish more with support from people they know, like and trust.” Working together to improve patient outcomes! Exchange contact information in the chat Planning Committee and Hosts: Ilene Corina, BCPA www.PulseCenterforPatientSafety.org Caryn Isaacs, BCPA www.GetHealthHelp.com Nancy Ruffner, BCPA www.nancyruffner.com |
Letting Go of Perfection
Earlier, at about 3AM I was awakened by a call from a nursing home that one of my clients had passed. It wasn’t unexpected because she had been suffering from advanced Alzheimer’s for several years and had been praying to be released from this terrible disease. Her family, friends and I were happy that she could spend several years at Atria Kew Gardens where she enjoyed continuing her lifelong passion of eating healthy, working out with her personal trainer, Val and walking to Church on Sundays. In her final months she found comfort in living with the sisters at Ozanamhall.
This isn’t my first call to Schwartz Brothers where I make pre-planned funeral arrangements for all my clients, including my husband who passed at this same time of year. Actually I have been making these kind of calls for the past ten years. Most times I am the only person at the funeral, besides a few friends and their home health aide. My practice focuses on elderly people who don’t have anyone to help them or they only have people who are just not available because they live far away or are elderly themselves, our elder orphans. It’s always comforting to know that their wishes will be carried out.
Regardless of how well you plan and how much you know that the person welcomed their release, it is still a time of grief and all that goes with it. I have been working with a Widow Coach to understand my own grief process for the past year. The most helpful thing I learned was that we can’t change what is, but we can change how we think about it. So, keeping in mind the 90 second rule, I let myself dwell on the fact that I hadn’t changed the beneficiary on her life insurance which was needed for her Medicaid application and that I hadn’t gotten to bring her the framed poster I planned to give her for Christmas, with a personalized message from the Pope.
Since I was now wide awake, I started my day as usual checking emails and Facebook Groups. Usually I am pretty stoic, but one of the posts was a copy of a Eulogy from a son about his father. It was written in such a loving. funny way, even though the topic of discussion was someone known to be loud, abrasive and aloof. It really touched me that even though this person was far from perfect, he left only the good memories and any hard feelings were buried with him. Reading now through tears, I opened a daily email I get called the Daily Om. It’s a short daily inspirational message. It’s one of the few things I do in a day that has nothing to do with seniors or patients. The title for today is Letting Go of Perfection. It was a reminder that being imperfect is human and that trying to be perfect only leads to frustration and unhappiness.
This is a time of year for celebration and joy, but if this year of Covid, Lock Downs and Economic Uncertainty have taught us anything, it is that nothing will be perfect. We can only hope for the best and do what we can under the circumstances. I wish the gift of forgiveness for yourself to all my friends, colleagues and clients. I send you forgiving thoughts for any one or anything you are holding in your head or heart. I promise to embrace all the imperfection I see in the world in a loving way.
If you ever feel down or upset about being less than perfect, give me a call, because I need all the imperfections I can find to help me to learn and grow. I hope you forgive me if I have done anything less than perfectly. I will try to do what I can to make it less imperfect.
2022 Changes for the Better ?
Seniors are buzzing about the news that social security is giving seniors a raise. The problem is that other things are going up and the raise doesn’t come near to covering them all. Groceries, gasoline, home heating and drugs are just a few of the things we can expect to pay more for in 2022. Many people are looking at Medicare Advantage plans to save some money on health costs. Advantage plans are advertising plenty of extra perks like no premiums, transportation, dental and vision care to lure seniors away from traditional Medicare. That’s the carrot approach, offer a treat. Then there’s the stick approach. NYC retirees are getting the stick. Either accept the Advantage Plan or opt out and pay a steep penalty.
Here is an article from Robert Intelisano, CSA, CLU, LUTCF aka The Insurance Doctor, Certified Senior Advisor
NYC Workers, Supplemental vs Advantage!
The BIG WINNER here is New York City, who has found some type of loophole and passed on the plan subsidy to the Federal Government. We estimate the city will be saving about $200 per person. I would not be surprised if there was some type of “class action” lawsuit against the city over the next 6-18 months.
For hundreds of thousands of retired NYC workers, a big choice is looming during open enrollment! Whichever path you take will determine how you get your medical care and how much it costs out of your pocket. The choice is not as simple as it appears. Most people would ask, which one is better? Answer is, “It Depends!”
The first decision is; do you want to enroll in Federally run “original” Medicare, or select a “Medicare Advantage” Plan? For foodies, think of it as ordering a “price fixe” meal (Medicare Advantage) where most decisions are already made for you or going to “the buffet” (original Medicare) where you need to decide for yourself what you want.
Both options will cover your “pre-existing conditions” and you will be able to obtain coverage for prescription drugs. Differences begin with going to the doctor. Original Medicare allows you to choose ANY doctor that accepts Medicare. A Kaiser Family Foundation survey said that 93% of primary care physicians accept Medicare. If you are looking for a new physician, research needs to be done to see which doctors are accepting “new” Medicare patients.
Under “Medicare Advantage,” you will be joining a “private health insurance plan” probably similar to what you had when you were working. Most of the common private insurance plans are HMO’s (In-network only Health Maintenance Organizations) or PPO (in and out of network Preferred Provider Organizations). Keep in mind, with the private plans you will likely need to see your PCP (primary care physician) first then get a referral to a specialist, which is more time consuming. This can also be an issue if you travel out of state and have a health issue as you will likely need to go out of network which will cost more out of your pocket.
See my 5 top tips below on how to address this new “predicament!”
- Do Research: Familiarize yourself with what Medicare Part A (hospitalization), Part B (physician and outpatient services), Part C (A Medicare Advantage Plan), Part D (prescription drugs) mean.
- Speak to a Licensed Professional: Insurance brokers must get “re-certified” every year, which consists of passing multiple tests of their knowledge. A trained Professional can guide you much more easily than trying to do it yourself.
- Don’t Wait Until the Last Minute: Waiting until the December 7th open-enrollment deadline increases the probability of making the incorrect decision. Doing “nothing” is a decision as you will automatically be put into the Empire Blue Cross (or Emblem) plan. Many people will see “FREE” and choose that option, which could lead to higher co-pays and more money paid “out of pocket!”
- Check With Your Preferred Doctors: Make sure your doctor still accepts Medicare, which is frustrating for doctor’s offices to deal with the Government, delaying reimbursements and many other issues to deal with. It is also important how much you utilize benefits and how many prescriptions you might be on.
- Determine Your Need for Dental, Vision and Other Services: Under Medicare Advantage, you will get all of the services you are eligible for under original Medicare. Some Medicare Advantage plans offer additional services such as vision, dental and some gym memberships. The Government has been adding some services over the years like home improvements (wheelchair ramps), transportation to doctor offices and getting meals delivered.
Remember, with the Advantage plan the insurance company and your doctor make your health decisions whereas with the Supplemental plan it is YOU and your doctors making these decisions!
Whatever you do, take time to do the proper pre-planning as these choices can have a big effect on your next 12 months of care.
You can see more about Robert Intelisano at https://insurancedoctor.us/
Updates End of Summer 2021
Many things have changed since my last post and many things have stayed the same.
Covid-19 has moved a lot of things to ZOOM. Overburdened email boxes made sending blog posts seem very intrusive since people were working from home and emails may be going to personal addresses mixed in with family photos and health care information along with business mail.
I have been doing most of my speaking about improving your life in the face of limitations. I post a lot of this on Facebook since that is the accepted leader for baby boomer communication.
As the summer comes to an end, so is a 30 day video challenge in which I tried to demonstrate the day in the life of a Patient Advocate. Here is a sample of the live videos that appear at http://facebook.com/GetHealthHelp and other places.
JOIN US March 2, 2021 9 AM – 10 AM
Caryn Isaacs, Board Certified Patient Advocate has over 40 years of experience helping people with chronic and hard to manage health conditions to find improvements in their lives. Caryn realized just how important her knowledge of and connections with the health, legal and financial systems were when her husband recently became ill and passed away suddenly. She will share how having all the important paperwork in place and knowing who to call during this stressful time saved her sanity and created a safe haven for her new role as a widow.
January 2021 Article Starting Over
I wish you all a very happy New Year. Here is the latest in a series of articles on people who started over after 50.
Starting Over at 70
Nothing ventured, nothing gained. As we enter the ninth month of contact-less networking, no get together for the holidays and binge shopping, I wanted to do something outside of my comfort zone.
Here are the first 3 articles I wrote for the North Shore Towers Courier after a conversation with Publisher Vicki Schneps of Schneps Media. I was thinking of doing this as a podcast, but Vicki suggested that I build an audience first to see if this resonated with the people I am speaking to.
Here’s what it looks like in the paper.
https://digital-editions.schnepsmedia.com/NST102020/page_11.html
Here are the November and December articles.
Visit our new Website
“Life is what happens while you are busy making other plans.” John Lennon
This is certainly true in the health care world. I haven’t been able to see many of my clients in person since April. In fact, since my last blog post when I said that we had big plans, everything changed.
I continue to see people in their homes but instead of going to doctors and out to fun activities, we work on projects like going through things to downsize and teaching the companions new recipes.
My clients who are living in assisted living are in quarantine. I can visit them by ZOOM and sometimes through the window. I bring care packages to show that there is still someone out there thinking of them. In some cases, I use my phone to connect to doctors and send it up to the resident’s room to have an online appointment, then follow up after with the doctor.
I’ve done a few webinars and SUN-Q is set up for our September annual kick off meeting on the 22nd to be on ZOOM at 9AM. Go to sunqueens.org to join or renew.
I would love to hear about what you are doing. Give me a call or send me an email. Visit me on Facebook or LinkedIn.
2020 Where did the time go?
I can’t believe it’s been six months since I posted on the blog. Shame on me. So, what have I been doing that kept me so busy? Is a blog really relevant today or are my LinkedIn and Facebook posts taking their place?
Well, I think the blog is relevant as it stands as a permanent record, as opposed to my social media posts which are here today and gone tomorrow. So here’s my “top did this” list for the second half of 2019.
- July 2019 I signed up for the course PLAN FUTURE ME, from Carol Marak. There are 17 modules in this curriculum which walks you through the process of understanding who you are now and where you want to go as you age. I’ve finished 14 of the 17 modules so far. You really have to be honest with yourself and go back a few times as you think about what may happen if you have a change in your health care, financial or legal status. Carol walked me through the modules on ZOOM. She also offers the course to groups. https://www.carolmarak.com/PLAN-FUTURE-ME
Carol Marak Instructor, Founder Elder Orphan Facebook Group, and the creator of the Plan Future Me digital course for solo agers. Carol is the go-to authority on aging alone at home. - Two of my clients went into the hospital for July 4th Weekend. Luckily I was able to get them into the same hospital, so that visiting wasn’t too bad. The emergency room was fun, with me going back and forth between cubicles and the doctors getting confused. “Don’t I know you?”
- In August, I joined the first networking group that is outside of the elder care industry, since I last served as an Ambassador for the NY Chamber of Commerce in the 1990s. Step Ahead https://stepaheadnetworking.com holds small group meetings for business owners. I am really enjoying the spirited discussions from this seasoned group of entrepreneurs. So far, I’ve worked with Glenn Pollack of http://PGSPRINTING.com to upgraded my business cards and badge. I also found a CPA to handle my client’s taxes, many of them haven’t filed for years and Steve made it a reasonable seamless process. https://www.stevenhsilbermancpa.com/ I also worked with Ronit Rogoszinski, Certified Financial Planner http://womenandwealthsolutions.com who helped me with a complicated plan for one of my clients.
- In September, I moved two clients from Independent Living into Memory Care. One had been attended to by full time private aides since April, in an attempt to get her acclimated into the assisted living community from her home. When it became obvious that she was sleeping a lot and really not participating in activities, including not going to meals, we upgraded her care within the same residence. Now she is brought to eat meals on the same floor with people that she interacts with all day. She is doing much better, and the cost is one third of what she was paying for the private aides. The other client was taken to the hospital with dehydration and malnutrition. After four years at the same residence where she had been well known for being a walker and conversationalist, she was just not able to do those things anymore. For her 99th birthday, she asked me to let her die. I suggested that if she was planning on dying soon, she should prearrange her funeral. https://www.dignitymemorial.com/plan-funeral-cremation The funeral directors came to visit her for her birthday with cannoli’s and set it all up. We laughed and cried and she was happy to have things settled. Later that day, she called me to say that she wasn’t feeling well. After a few weeks in the hospital and rehab, we decided to change her room to where she would have more attention, especially for incontinence care. She recently told me that I did her a big favor. She especially likes the extra help with dressing and not having to go down in the elevator for meals.
- Also in September, I started with a new client who just needed a little help at home. She hired me as security because she was going on a trip to Paris and wanted to make sure there was an emergency contact, just in case. As it turned out, she had a fall in Paris and then returned home to be admitted immediately into the hospital for pneumonia. So, my second meeting with her was bedside where they told me that the patient was cleared for discharge. They assured me that she had all the equipment she needed at home. I asked her if she was comfortable with using her own nebulizer and had the medication she needed. She said, “I think so, I haven’t seen it in a few years, but it must be somewhere in my apartment. ” Needless to say, I told the hospital that she could not go home alone. They said, too late, we already signed her out and arranged for transport. They were no help when I asked them to arrange for someone to help her at home. They said someone would contact her in a few days. Luckily, I knew of a licensed home care agency who arranged to meet us in two hours at her home. https://www.seniorhelpers.com/ny/new-york/meet-the-office We’ve continued to use Senior Helpers several days a week, as it turns out that the client is more than a little forgetful and really likes the help of someone to shop, cook, clean and do laundry. The client also realizes that she should have someone to help her in the shower and to go with her on errands, especially since she has long term care insurance that will pay for it all.
- October brought more patient hospital visits. One patient who suffers from Alzheimer’s had a bad fall and required a hip replacement. What is a big procedure for anyone, became that much more complicated. It was a constant battle to make sure that her updated health care proxy and living will followed her from emergency room, to bedside, to the operating room and recovery. I probably spent as much time in administration as by her side, getting the computer to say that I was the emergency contact and agent instead of them calling who they last had down, when she went there twenty years ago. I realized that if I didn’t want to spend 24 hours a day there, watching that they didn’t try to give her anti psychotic medications or think that she required placement in a nursing home, that I needed to hire a home care agency to provide a companion in the hospital. The need for an intermediary continued into a long stay in a rehabilitation facility. The bottom line was that there was no training of the hospital or rehab doctors or staff to understand the various stages of dementia. To them, people were either independent, have family to tend to all their needs or they should be in a nursing home with pureed food. The patient is home in her residence now receiving physical therapy four days a week and enjoying her familiar surroundings and friends. The memory care unit is able to care for her without the need for the cost of private care.
- In between emergencies, I kept up with regular visits to my clients, including joint sessions with Helen Beegel, Clinical Social Worker who helps me to understand what my client’s are feeling about their situations. They all love Helen and value her advice. https://npino.com/social-worker/1932311594-mrs.-helen–beegel/
- At the end of October, one of my viral Facebook celebrity clients passed, on his birthday. I wish he had just stayed in his bed at the residence where he had private care, however the EMTs took him to the hospital even though the patient had a DNR and a MOLST form saying that he did not want any treatment. After admitting him, the hospital told me that since he had the MOLST on file there, he would be discharged. But, the residence he came from said they could not take him back because he required suction for his lungs, even though he was non-responsive and it was obvious that he was not going to recover. So, I was forced to write a check for $40,000 so that he could be sent to a private hospice instead of one for the indigent. I was assured any balance would be refunded as he didn’t last three days. I put a stop on the check and sent them a check for payment in full for the three days. The funeral was on a beautiful day and I’m sure he was happy that his friend and rabbi held a very moving service. His family, (except the one cousin who was my contact) who never visited or contacted him in the years I worked with him showed up, but left quickly when they heard he had left all his money to charity. https://www.health.ny.gov/professionals/patients/patient_rights/molst/
- November was a social month. There were health fairs from FrostBiz at the Council Center in Brooklyn and then the big fair at the Sid Jacobson JCC featuring Teepa Snow, Dementia Expert.
Ilene Greinsky who does all my Medicaid applications, https://www.eldercareresources.com joined me at our new tablecloth. These are always great events and lots of information is given and received. - December came up quickly with Thanksgiving being so late in the month. Holiday parties were a great time to catch up with old friends and make new contacts. In between the parties, Iris Bikel, Attorney https://irisbikelattorney.com and I held two big events. Pamela Glasner, Filmmaker was a big hit and almost a hundred senior service professionals attended the event. The audience was truly moved by Pamela’s story and crushed to see Mickey Rooney begging advocates to call their legislators, the district of attorney, adult protective services and everyone they can to let them know about elder fraud by family and friends.
- Then we held a workshop on December 12th with Susan Eisner, http://visionaryhealthsolutions.com which had over 30 social workers attending Atria Kew Gardens https://www.atriaseniorliving.com/retirement-communities/atria-kew-gardens-kew-gardens-ny/ to practice Mindfulness, Meditation and Guided Imagery for ourselves and how to use it for our clients. The program offered the first Continuing Education Credits for Board Certified Patient Advocates in NYC. https://www.pacboard.org/
- At these events, Iris and I talked about the fraud cases we have handled for our clients. When patients are brought to the hospital alone, without anyone accompanying them and in crisis mode, the hospital is left to decide where to “place” them. Often, they have no information regarding their agent under their health care proxy or power of attorney and many times the patient can’t communicate their wishes. Hospital staff then hounds the individuals into giving names of relatives simply in the hopes of getting rid of their problem. These family members may have little to do with their relatives. The person becomes an easy target for their supposed loved ones. The family member then preys on the patient’s weaknesses, as soon as they find out that money is involved. We help our clients gather their very necessary legal documents so that true advocates can protect them against fraud. We contact legal authorities and work together to retrieve lost property and assets, while also keeping the individual safe and secure for the future. We bring the discussion full circle to how well the clients are doing now.
That’s just the events off the top of my head for now. Here’s wishing everyone a very healthy and happy New Year. Please join me at Facebook https://www.facebook.com/carynisaacs and https://www.facebook.com/gethealthhelp and LinkedIn https://www.linkedin.com/in/gethealthhelp/ for daily updates and meeting notices.
Navigating the Health System
Caryn Isaacs, Patient Advocate
This is my space for talking about health care and seniors. You can also see my “Almost Fiction” stories about people facing life challenges. For more about me and Patient Advocacy, go to my website, GetHealthHelp.com
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