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by: Theresa Flaherty - Monday, November 30, 2009

There was a reader essay in my local Maine Sunday paper yesterday: a goodbye to a "much-loved" cat. The cat, a 16-year-old Siamese, was diagnosed with pancreatic cancer.

From diagnosis to death: a visit to the emergency vet; an ultrasound to reveal a grapefruit-sized tumor; a visit to a pet ultrasound specialist in New Hampshire; a visit to a veterinary cancer surgeon in Boston; scripts for kitty painkillers and appetite stimulants; a visit to a local veterinary cancer specialist; a holistic veterinarian acupuncturist; and finally a home visiting vet to put the poor thing to sleep—the cat, not its owner.

The cat, old and terminal (it's pancreatic cancer, for crying out loud) was hauled around New England in search of a happy ending that was never going to happen. Granted, it's the owner's right to spend her time and money on her pet however she wants, but honestly. Accept the inevitable already.

When it comes to people, I think many of us do the same thing. On 60 Minutes a few weeks ago there was a story about how patients, their families and the medical establishment just refuse to let people die. And, while those folks are in the process of trying not to die, they are subjected to numerous procedures, tests and specialists. I don't mean to sound heartless, but what a waste of money!

Earlier this year, there was a great hue and cry over "death panels." But, in the health care reform debate, there needs to be an honest discussion about when to let go. It helps no one to prolong pain and suffering and it certainly needs to be considered when talking about taxpayer dollars. Death happens everyday in the private insurance sector as well as for the uninsured. There's no reason the Medicare/Medicaid populations should get a reprieve.

If we are going to extend health care coverage—in any form—to a greater number of people, we have to start controlling costs across the board.

Stay healthy, Bruce.

Theresa Flaherty

by: Theresa Flaherty - Wednesday, November 25, 2009

So, I am reading some health care reform news today on Crain's New York and there is an article about how disease state management programs can reign in costs for diabetes patients. I don't belong to such a program, but I agree with the concept.

Apparently, UnitedHealthcare tested just such a plan this year with three national employers. What shocked me was that United says the average health care costs for an employee with diabetes (keep in mind, if they are employed, they aren't the blind, legless, dialysis patients) are $22,000 a year.

$22,000?! How is that possible? That's almost $500 a week. Does that seem high to anyone else?

I logged on my insurer's Web site to review my diabetes-related claims thus far for 2009. My total costs (both out-of-pocket and paid by the insurer) are roughly $4,586.71. That includes prescriptions (almost half), assorted bloodwork (standard for diabetes patients), one visit to the endo and two visits to the dietician.

Where on earth did the other $16,413,29 cents go? Am I just better than average at controlling costs? (Despite having insurance, I am always mindful of how much my insulin and test strips are if I paid retail). Do other people with insurance just say yes to everything cause someone else is paying for it? Do their doctors feel more free to order tests, etc? Are the costs just out of control?

Of course, I see the doc a little less frequently then others, stretch out my scripts longer than recommended, have skipped the eye exam so far this year and haven't gotten my $25 flu shot (Sorry Dr. B. they aren't available in Maine this season).

But I take care of myself, as recommended and try not to waste health care dollars—mine or the insurers. Isn't that what health care reform should be about?

Theresa Flaherty, Type 1, 10 years, 3 months

by: Theresa Flaherty - Monday, November 23, 2009

Dr. Earl Sunderhaus told an overweight patient she was fat. His medical license is now up for review.

Sunderhaus is an eye doctor. The patient complained that he poked her thigh and told her she is fat. Yes, this seems a bit, shall we say, inappropriate. He also scolded her as irresponsible for being unemployed and relying on taxpayers to pay for another pregnancy. Also inappropriate.

But, let's back up a minute, here. The patient is overweight, with diabetes and is pregnant. Is she insured? Uninsured? On Medicaid? If she is on government assistance, do taxpayers have the right to expect her to take personal responsibility for her health? And for the health of her child(ren)?

I suppose the point of this incident is that the doctor didn't behave professionally and that's where we should be concerned (concerned, but hardly outraged). But with trillion dollar health care reform looming, with a possible public health option included (for which I have no opinion yet), questions like this are going to continue to arise. Where do we draw the line between Big Brother and wasting money?

Theresa Flaherty

by: Theresa Flaherty - Thursday, November 19, 2009

Few people know about senseless government waste more than HME providers. But it seems beneficiaries might be taking notice as well.

A recent opinion piece on the asks "What is wrong with Medicare"? Written by a man name Joe, who turned 65 this year, it outlines his introduction to Medicare rules and regs regarding CPAP machines and supplies. Joe was diagnosed with a sleep study in 2006 and has been using CPAP ever since.

My sleep study was conducted at a sleep lab chosen by my insurance company, and the exam determined that I indeed suffered from sleep apnea after only 109 minutes of testing. However, despite being officially diagnosed with sleep apnea, Medicare rules require a sleep study lasting at least 120 minutes. Therefore, since I was 11 minutes short of their requirement, I must undergo another sleep study exam in order to qualify for the CPAP supplies that I have been receiving regularly for the past three years. The exam costs over $1,000, but I was told that I would not be billed for the sleep study because Medicare will incur all charges.

So, while Joe, the new Medicare beneficiary, has successfully gotten himself diagnosed and treated for three years, your government would like to shell out another $1,000 for him to retake the sleep study to recoup that extra 11 minutes. Meanwhile, we hear daily about soaring health care costs, soaring Medicare costs and millions of uninsured Americans. Undeterred, Joe attempted to reason with Medicare.

I called Medicare directly to advise them of this absurdity and spoke to two different customer service representatives in the hopes of convincing them that this was a unique situation that warranted an exception to the rule. However, I was told was that I needed to retake the sleep study or they would deny any CPAP supply claims.

The problem, of course, is that a bureaucracy offers no flexibility. It isn't, shall we say, nimble. Which should scare the beejesus out of everyone as all these unwieldy trillion dollar health care reform plans (although I haven't seen too much actual reform included) wend their way through Congress.

Why are Medicare costs so out of control? I think the problem starts with Medicare itself.

Theresa Flaherty

by: Theresa Flaherty - Tuesday, November 17, 2009

It isn't enough that a lot of Americans are overweight. Now, our pets are, too, apparently, a hefty 50% of them (disclaimer, I live with a rather large black cat, Bruce, but he came that way and is on a diet).

But, I digress. As I may have mentioned, November is National Diabetes Awareness month. It came to my attention this morning that it is also National Pet Diabetes Awareness Month.

Note: Not all overweight people develop type 2 diabetes, not all people with diabetes are overweight and I believe the same applies to pets.

Still, with 24 million people in this country with the disease, can I just say it is ridiculous that we now have to devote time and attention to the same common sense care and feeding of animals we should be taking with ourselves, and our (well, your) children?

Theresa Flaherty

by: Theresa Flaherty - Friday, November 13, 2009

Tomorrow is World Diabetes Day.  Have you ever heard of it? It started in 1991 as a way to,  you guessed it, raise awareness about diabetes. The date, Nov. 14, was chosen because it is the birth date of Sir Frederick Banting, who discovered insulin, which I personally think is one of the greatest discoveries of the 20th century.

The International Diabetes Federation, which created World Diabetes Day, issued a Blue Monument Challenge this year. More than 800 monuments will light up in blue. The monuments include: The Empire State Building, Niagara Falls, the London Eye in the United Kingdom, the Sydney Opera House in Australia, Place de la Concorde in France and Tokyo Tower in Japan, as well as monuments in South Africa, the United Arab Emirates and Germany.

According to the IDF, there are 285 million people with diabetes world wide.

Theresa Flaherty

by: Theresa Flaherty - Tuesday, November 3, 2009

This morning, the executive editor forwarded me a press release on American Diabetes Month and suggested I poke around and see what providers are doing to incorporate this national campaign into their marketing etc this month.

He does this every year.

It's not an unreasonable suggestion for a story but it's not one I am able to write because, well, most providers don't do anything special. I don't know why. The ones I talk to genuinely care about their diabetes patients but November just doesn't bring out the promotions the way that October does with National Breast Cancer Awareness Month.

Maybe they've tried in the past and haven't gotten much traction for their efforts. Maybe its because diabetes is kind of boring. Still, I would think any opportunity to position oneself in front of the community would be jumped at.

I was talking to provider Laurie Schneider of Great Lakes Home Healthcare last week. That company does specials each month, often tied into a bigger theme. This month, it's 10% off diabetes accessories like socks. Great Lakes customers, she says, are now quite accustomed to asking what the monthly special is.

"We always have a huge month when we offer discounts," she told me.

With so many people out of work or uninsured, what about offering free blood sugar checks? Sure, it will cost you a little out of pocket and yes, if these folks do in fact, have diabetes but no money or insurance, they aren't exactly going to look like a cash cow. But, they might remember you down the road. And really, customer loyalty is kind of priceless.

Theresa Flaherty

by: Theresa Flaherty - Friday, October 30, 2009

candy-cornWell, once again it's Halloween and I am trying to decide whether to give out candy (good candy, like Reese's or M&Ms as opposed to say, Bit o' Honey). Maybe a less, shall we say, sugar-chocked item would suffice?
It's not just because, as a person with Type 1 diabetes, I rarely eat the stuff any more and prefer to avoid the temptation (and calories). It's also because I see your kids out there and, well, they don't look like they need it. They're getting bigger everyday. And, before you parents of "husky" kids scream defensively "He's just big-boned!" let me just assure you, it's your fat kid that always gets greedy, groveling and grasping for two or three candy bars (Get those pudgy fingers away from me).
Coincidence? Not!
Do I sound like the Wicked Witch? Believe me, it's not the first time comparisons have been made.
But let's face it: People who don't take care of themselves wind up costing the health care system money. Lots of it. The younger they start, the more they cost. The fatter they are, the more they cost. The greater the co-morbidities, the more they cost. This is where I would normally insert rising rates of obesity and type 2 diabetes, but we've all see the statistics.

With all the focus on health care reform, the topic of personal responsibility comes up again and again, and rightly so.
Taken all together, stickers and pretzels are starting to look like a better alternative all of a sudden.

Theresa Flaherty

by: Theresa Flaherty - Thursday, October 29, 2009

[Posted 10/27/2009] Qualitest Pharmaceuticals and FDA notified healthcare professionals of a nationwide recall of Accusure Insulin Syringes. All syringes, regardless of lot number, are subject to this recall. These syringes were distributed between January 2002 and October 2009 to wholesale and retail pharmacies nationwide (including Puerto Rico). The syringes in these lots may have needles which detach from the syringe. If the needle becomes detached from the syringe during use, it can become stuck in the insulin vial, push back into to the syringe, or remain in the skin after injection. Consumers who have any Accusure insulin syringes should stop using them and contact Qualitest at 1-800-444-4011 for reimbursement.

by: Theresa Flaherty - Wednesday, October 28, 2009

Add prison inmates to the growing list of niche populations for sleep apnea.

Executive director Ed Grandi, executive director of the American Sleep Apnea Association, gave a talk at a conference attended by health care providers who work with incarcerated adults and adolescents.

In his talk, Grandi offered basic information on how to address this problem as well as suggestions on how to improve adherence to therapy.

I just wonder what kind of problems creep up in tiny prison cells when one inmate suffers from sleep apnea. Which is worse for his cellmate? The snoring?  A noisy CPAP machine? Can they even use CPAPs in prison?

Theresa Flaherty