Viki will be presenting at the American Health Care Association Conference on 10/12/10

Viki will be giving a presentation at the American Health Care Association Conference on October 12, 2010 from 8-10am PST.

As the nation’s largest association of long term and post-acute care providers, the American Health Care Association (AHCA) advocates for quality care and services for frail, elderly and disabled Americans. Compassionate and caring employees provide essential care to one million individuals in our 11,000 not-for-profit and proprietary member facilities.

The ultimate focus is on providing quality care to the nation’s frail, elderly and disabled, who are served by the long term care professionals who comprise AHCA’s membership. These providers believe that the individuals whom they serve are entitled to a supportive environment in which professional and compassionate care is delivered. This belief compels AHCA, its affiliates and member providers to advocate for individuals who – because of social needs, disability, trauma or illness – require services provided in a long term care setting, while also advocating for the continuing vitality of long term care provider community.

AHCA believes this necessitates their commitment to developing necessary and reasonable public policies which balance economic and regulatory principles to support quality care and quality of life, and is dedicated to professionalism and ethical behavior among all who provide long term care.

Have a kind and respectful day.

Stop! The plan isn’t working as expected.

Sometimes, in spite of our best efforts, the plan we designed for the person in our care, doesn’t work or stops working. When this happens, it is important to reconsider the treatment plan. Otherwise, you’re driving down the wrong road: You can keep driving and driving, but you will never get to where you are going. You need to stop, ask for new directions and then start down a new path.

We may also need to help patients/families modify their expectations when things don’t work. Sometimes people are so desperate for the plan to work that they can’t bear to see the truth when the plan fails. You are not helping your your patient by continuing treatments that don’t work. You are only subjecting the patient to needless side effects and increased suffering.

One thing you may want to try more often is a time-limited trial of a proposed treatment option. Explain to the family, “Let’s try it for a few days or for a little while and see how it goes.” This is a really great option because it helps the patient/family feel like you are trying but it also gives them a reality check when it doesn’t work. You will want to give them specific symptoms to look for, (that they can understand), so they can see with their own eyes that the plan has failed.

After the set time expires, you can check to see if the decision is working. If it is not working, go back through the decision making process and make a better decision based on the new information about the patient’s changing condition. Don’t be stubborn and keep driving your patients in the wrong direction. Take this as an opportunity to turn around and get it right.

Have a kind and respectful day.

Viki will be featured on AskMomRN’s radio show on 7/26/10 at 10am

Viki will be featured on blogtalkradio’s AskMomRN’s radio show on 7/26/10 at 10am.

Tamara Walker, RN, the host of MomRN has advice, support, and encouragement to help you on your journey through parenthood. MomRN is walking right alongside you on this path, with two teenage kids of her own. Her eighteen years of motherhood, plus three years as a pediatric nurse, a dozen years as a professional child care provider, and growing up as the oldest sibling of six children has given MomRN a unique variety of parenting experiences and expertise. Her expertise has helped thousands of parents as they strive to be the best parents they can be.

In March 2007, Tamara appeared via video on the Rachael Ray Show providing a helpful parenting tip for a segment on children’s health. She also wrote and starred in “Safety Smarts”, quick safety tips for use between shows for the Smile of a Child television network. Currently, she is a featured writer for Examiner.com and writes articles as the Oklahoma Child Safety Examiner.

The Ask MomRN Show covers a wide variety of parenting, family, safety, and health topics and features several well-known expert guests. Parents are welcome to call in with questions and speak with MomRN and her guests during the show.

Have a kind and respectful day.

Patient’s Rights – Where do they start and where to they end?

What are our obligations to the patient? Keep in mind that autonomy only works with people who have the capacity to make their own decisions.

Here are some of the patients’ rights that come with using autonomy:
• Patients have the right to receive all the information they need to make a good decision.
• Patients have the right to make their own decisions.
• Patients have the right to refuse treatments they do not want.
• Patients do not have the right to demand treatments that will be medically ineffective or are medically inappropriate for their condition.

It is important to realize that there are limits to a patient’s rights. A patient is limited to asking only for treatments that will benefit her. This limitation makes sense. It would be pointless, and potentially harmful, to provide a treatment or medication that would not improve the patient’s condition. So, as a physician, you are able to say no to practicing bad medicine. If what the patient or decision maker is requesting would be inappropriate or non-beneficial you can say no and protect the patient. But if it is a medically valid option, even when you disagree with what the person wants because you think they are being foolish or it isn’t the best option to choose, we have to respect that it is the patient’s body and life.

I know this can be difficult as you watch people making foolish choices. But that is autonomy. All of us, including you, are allowed to make the decisions that make sense in the context of one’s own life. (Of course, there are different boundaries in pediatrics.)

One technique I use with patients is to say, “Here is the ideal plan. Now let’s talk about your plan.” That allows the two of you to partner together to build a plan, although it might not be ideal, it is something the patient is willing to consider and to try. And then perhaps in the future, the patient will be willing to consider the other options you would like him or her to try.

Have a kind and respectful day.

Teaching your Patients How to be Good Patients

Time is limited and the patient keeps talking and talking. What can you do? I realize that patients aren’t taught how to be good patients. So it is up to us to teach them. I have three recommendations for you.

Recommendation #1 Have them write out what they want to talk about before their appointment. Now I am sure you have heard this before, but the part that most doctors miss is to get them to prioritize their questions. I tell them to circle the most important 2 questions they want to discuss with you. Otherwise you just get a long list of random questions without any sense of what they truly want you to focus on. Patients understand that you can’t answer all of their questions but they will be satisfied if you take care of the most urgent issues. I have a questionnaire form, Viki Kind’s Office Form that you can download to help you help the patient. I encourage you to give copies to your patients to keep at home so they can fill them out before their appointment. If they haven’t filled one out before they arrive, then have them work on it while they are in your waiting room. In the medical practice I used to manage, we had a clipboard and form all ready for the patient when they checked. This is an easy way to be more efficient and to increase patient satisfaction.

Now some of you might be thinking, “Good, I don’t have to spend time listening, I can just read their list.” Well, you can if you want but your patient will be angry and non-compliant. If your patient doesn’t trust you or trust that you care about them, they won’t heal as fast or follow your instructions.

Here is Recommendation #2. It is up to you to build a caring relationship with them and you do that through compassionate dialogue, not a monologue. The act of listening has its own healing properties.

Recommendation #3 The other thing you need to educate patients about is to stop asking you the, “Oh by the way…” question as you are about to walk out the door. You need to tell them up front to ask you the most important questions at the beginning of the appointment or else you won’t have to time to address their concerns. Of course, this is a hard habit to break for patients and you will have to give them time to learn to be more direct with you.

Bonus Information: Unfortunately, some of these techniques will not work with certain cultures as they use a form of indirect communication which dances around the topic and takes longer as the only way they know how to communicate. But for most of your patients, these techniques will help you manage your time while caring for your patients.

Have a kind and respectful day.

3 Secrets to Getting the Most Out of Your Dr.’s Appointment

Do you feel like the doctor doesn’t have enough time to listen to your complaints? Is it frustrating to leave the doctor’s office and realize you didn’t get your questions answered?

Let me tell you what is going on and you aren’t going to like it. The doctor has about 12 minutes to listen to you, exam you, figure out what is wrong with you and put together a plan to help you get better.

I can hear you saying, “But 12 minutes isn’t enough.” Of course not, but that is the reality of medicine today.

You can complain but if you are smart, you can learn the three simple steps below to get the most out of your doctor’s appointment.

Here is Secret #1. You have to think like a doctor. Doctor’s think in an organized manner, so we have to give them our information in an organized way. Doctors usually play a guessing game with us as they try to figure out what is our “chief complaint”. But these questions are just wasting our precious minutes. The more organized and prepared you are for your appointment, the better.

Here is Secret #2. The doctor will make more time for you if he likes you better. And if your doctor likes you, you will get better care. I know it doesn’t seem fair but that is just the way it works.

Secret #3 is to make sure you are nice to all of the office staff. They can make it easier or more difficult for you to get in to see the doctor. They control his schedule. So, be kind to them and say, “Thank you.”

Now let’s make it easy for the doctor to help you.

Step 1. Write down all of your medications, occasional cold medicines, vitamins, herbal medicines, natural supplements, etc. And I mean everything. Even things you don’t think are important may be very important to your health. The doctor can’t protect you from things that he doesn’t know about, so write them down. If you don’t want to write them down, then bring all of them to the appointment with you.

Step 2. Write down how you are feeling. Why are you coming to see the doctor? Tell him what is hurting you, bothering you or any other physical complaints? Write down the new symptoms first and then write down the problems that are ongoing.

Step 3. Write down your questions and then circle the 2 most important questions. The doctor doesn’t have time to answer all of your questions so it is up to you to keep the doctor focused on what is most important to you.

And a Bonus Secret, if you want to make the doctor angry, keep your most important question a secret until the end of the appointment, and as the doctor is walking out the door say, “I have one more question …” If you wait until the end for this “Oh by the way” question, the doctor will only have one minute left to answer it. Please, write down this most important question so the doctor can spend time helping you.

If you would like, I have created a form for you to use each time you go to the doctor, Viki Kind’s Office Form for getting more from your doctor. Sign up for my newsletter and I will send you new support tools once a month.  Print out a couple of copies so you have them ready before your next appointment.

Have a kind and respectful day.

Healthcare Quality and Efficiency Report – For those who are interested in real numbers and information about global healthcare issues

A new, “Healthcare Quality and Efficiency Report” has been released. This report contains information for those of you who are interested in real numbers and information about global healthcare issues. This is not a political piece of information but a factual reference guide discussing how healthcare is measured and the financial issues that healthcare is facing. You may want to forward this to your local and national politicians, insurance company, your healthcare providers and/or your local hospitals.

http://www.soa.org/research/health/research-quality-report.aspx

Executive Summary:

Healthcare quality and efficiency play an important role for both the overall economy and healthcare consumers. Affordable healthcare is crucial to the financial stability of many workers and retirees, making quality and efficiency of programs particularly relevant during periods of economic challenges. Moreover, quality and efficiency are likely to occupy a prominent position in any healthcare system reform effort. This is particularly true given the fundamental issues in the United States, such as the decentralized nature of the healthcare system, often poorly-aligned payment structures and the complexity of roles assumed by service providers.

In light of the current overlap of political, economic, and other environmental factors, the healthcare industry is changing rapidly. As a result, the Society of Actuaries Health Section and Solucia Consulting have co-sponsored this research project. This report reviews and inventories the wide range of quality and efficiency measures currently available for hospitals and physicians.

Why isn’t the insurance company paying my bill?

Dear Viki,

I just got a bill from the hospital, but I don’t think it is right. It says I owe money but I have insurance. Why isn’t the insurance company paying my bill? What do I do next?

There are so many reasons your insurance isn’t paying the bill. And I know that it can get overwhelming as you receive bills from different offices, different doctors, different labs and from people you’ve never even heard of. Instead of getting frustrated, ask for help. If the person you’re working with is not helping you, ask for someone else in the department. Unfortunately many people who work in medical billing are often under trained, underpaid and overwhelmed. So it may take talking to many different people to get the help you need. For me the first thing I do is to take all the bills and organize them by date of service. Then I can match what was done to me with the bills I have in front of me. And then I begin following the instructions I have listed below.

Let’s start from the beginning of the story and find out what might have gone wrong.

1. When you went into the doctor’s office or hospital, did you give them your correct insurance information? Not the old card, but the newly updated card?
2. Do they have the right address for your insurance company?
3. Have you been paying your insurance premium so your insurance is still in place?
4. If you have two insurances, did you tell them which insurance is primary, so they billed the right insurance first? Do you know which insurance is your primary insurance?
5. Did the office or hospital ever send the insurance company the bill? Surprisingly, the billing staff does not always do their job so sometimes the reason the insurance doesn’t pay the bill, is because they never got the bill. Call your insurance directly and ask if they have a copy of the bill and if so, why they didn’t pay it? If they don’t have the bill, ask them for a direct name and fax number that the bill where the bill can be sent. Then give this information to the doctors or hospital’s billing department and then follow up with them in one week.
6. Now let’s talk about the referral/authorization process. For many people’s insurance, you have to have a referral before you see certain doctors or receive certain tests or procedures. Or if you are in the emergency room, have someone in your family call your insurance right away and get the authorization for you to be in the emergency room. Did you get that referral? Did the office staff call for your referral? Did you call the insurance company to make sure the referral was done before your surgery? And did you make sure that all of the doctors that would be working on you during your surgery are covered under your insurance plan? If you don’t get the referral, you may be responsible for the entire bill and you definitely don’t want this. Never assume that it is all taken care of. Make sure you call the insurance company and get the referral number yourself. They should also send you a piece of paper that tells you that you have been okayed to have the test or surgery or see the specialist that your doctor recommended. You have to be an active participant if you want the bills to get paid.
7. Maybe your doctor’s office did everything right, had the right insurance card, got the referral ahead of time, billed the right insurance but still there is no payment. Now it is time for you to get on the phone and ask the insurance company what the problem is and why there is a delay in sending out the payment. You may also want to go to the doctor’s office and have the billing person call the insurance company while you wait. That way, if there is a question, you can be there to help and to make sure it got done.
8. Now many doctors offices use outside billing departments and the person you need to talk to will only be available by phone. This is when you have to hold your temper. I know you are frustrated but if you yell at them they won’t help you and you’re going to get stuck with the bill. So calmly, talk to the billing person and find out what they think is going on. You can offer to call the insurance company yourself to help them solve this problem. Since you want them to be on your side, remember that they will be more willing to help a polite person than a screamer. Thank them for all of their effort even if the problem isn’t completely solved because you will probably be working with them again when they mess up your bill the next time.
9. Many times, the bill itself was not created correctly. There are codes and details that must be typed in and sometimes these are typed in incorrectly for whatever reason. This is when you need to ask for a billing manager to help you check that the codes that were used were the right codes and that the details on the form match your insurance and personal information. It may be as simple as your insurance number was typed in incorrectly or it was sent to the wrong address.
10. After you do everything you can to get the correct bill to the correct department of the insurance they still may not pay your bill. If they won’t pay the bill you can appeal their decision. You will need to ask the insurance company how to appeal their decision and what you will need to do to provide the information they will need to change their minds. Sometimes, the doctor needs to send more documentation or a different code needs to be used. Even after the appeal, you may still be responsible for this bill. The worst thing that happens is when you didn’t get the appropriate referral and now it is too late. This is why getting the referral is crucial before you go to specialist, go to the emergency room, have the procedure or have the surgery.
11. I want to caution you to not get frustrated and to stop working on this situation. The doctor’s office will eventually send you to collections and the collection agency will eventually report your delinquent bill on your credit report. Then you are in worse trouble. The collection agency knows even less about getting the insurance company to pay and they are not particularly interested in helping you, just getting the money from you. And they will sue you. This is when you have to take immediate action before the collection agency takes action against you. Call the insurance company for help and go back through the steps above. The doctor’s office will not help you at this point as they have referred you to collections. You can try begging the doctor to take your bill out of collections but that rarely works. The doctor’s office or hospital has already tried to get you to pay for months and are frustrated with you. Please try to take care of this problem before it gets to this point. If it gets to this point, it may be too late now and you may be stuck paying this bill.

If you really do owe the money after the insurance paid their part:

Now your insurance paid, but now the doctor is asking you for money that you don’t think you owe. There can be lots of confusion. You may be right or you may be wrong. The first thing you want to look at is something called the EOB or the explanation of benefits. This is the form the insurance company sends the doctor and hopefully you, which explains why they paid what they paid and who was responsible for the balance. When you look at the explanation of benefits you are looking for the word’s “patient portion” to figure out how much you owe. This is another place where the billing department may make mistakes. They may forget to do the write off that is required by the insurance contract with the doctor’s office. And they may be billing you for the wrong amount.

You may also be the problem. You may not understand what your policy requires and what your portion of the bill should be. Before you get really angry, call the insurance and have them talk you through it. If the doctor’s office is wrong, ask them to make the corrections and to let you know when it’s accomplished. Put it on your calendar to call them in a week to make sure it really got done. You don’t want a surprise letter from a collection agency in your mailbox.

If you do owe the bill, whether it’s to a doctor’s office or a hospital, if you call right away they may be willing to set up a payment plan. The longer you delay, the less likely they will be to work with you. They may also have a special program set aside for people who cannot pay their bills. Again, it is better to communicate directly and work with them to solve these issues. The billing department may also be able to help you sign up for services such as MediCal or MediCaid.

When you can’t understand your doctor’s accent, you may be in trouble.

As our country becomes more and more diverse, the issue of language and communication becomes an ever growing problem in healthcare. There are 329 languages being spoken in America, and with that comes many different accents. If you can’t understand your doctor, you may be in trouble. If you can’t hear the instructions for your surgery, how to take your medications or the information they are telling you about your disease, then how will you be able to get better? This is not about bias, this is about your safety and reality. And I’m not just talking about accents from other countries; it may be accents from different parts of the country. And if you add the increasing hearing loss with our aging population, it only compounds the problem.

So what can you do? If you have a choice, pick a doctor that speaks the same language that you do. The other good thing about picking a doctor who speaks your language and is from the same culture is that when it’s time to make end-of-life decisions, you will probably be in greater agreement. If you truly can’t get a doctor that you can understand, then ask for a professional medical interpreter, even if you are both speaking English. You are entitled by law to have a professional interpreter in a hospital. There is also a medical service that that is free called the A T and T interpreter phone line. You can get an interpreter on the phone and they can help you with your conversation with the doctor.

I was talking to a professional medical interpreter at Children’s Hospital and she was telling me about the different ways one gets into trouble when using the family as the interpreter. She told me that in one language, the words a doctor might say when a patient has died, “I am so sorry your sister has died” don’t translate very well. “I’m sorry” in that language means, “I’m responsible. I killed your sister.” Oops. If you had a professional translator in that situation, the interpreter could have stopped and asked, “Is that what you meant to say?” And of course when the doctor said no, she could then help put the words into terms that would be acceptable. The translator in this instance would say that what should be said is, “I’m so sad. Your sister has died.”

This is just one reason you should be using a professional translator. There are other reasons as well. Your family may not be able to translate some of the terminology because they’re medically illiterate. The language of medicine is complicated. Or they may have an agenda and only translate some of the information to you, the patient. Or they may be following their cultural rules about what can be spoken to their elder. Or there may not be a word for what the doctor is trying to say in your language. Did you know that in one language there is not a separate word for bacteria and virus? There is only one word to describe both. How is your doctor going to explain something when they don’t even have a word for it? Good luck without a professional interpreter.

If you do use an interpreter, make sure you thank the interpreter and respect that they are professionals and are there to help us. Using an interpreter may save your life.

Lastly, your local hospital may want to consider having the interpreters visit the patients throughout the day to make sure their needs are getting met and that they feel like they have a voice in their health care. Your hospital may also think about sending interpreters into the doctor’s offices to provide interpretation services in the outpatient setting. Some hospital systems in Los Angeles have already begun doing this and it is making a difference.

Have a kind and respectful day.

When you are standing alone in the hospital waiting room and don’t know what to do next, you can call me.

I remember when my mom was dying and I was sitting vigil with her in the hospital on the last day of her life. My brother, who I was close to, said to me, “There really ought to be someone who can help people with this.” And what he meant by “this”, it was the dying process. I said to him, “This is what I do, I am a hospice volunteer.” My brother knew me very well and knew that I worked with the dying, but he couldn’t imagine what that meant. And if he couldn’t imagine what a hospice worker does, then a lot of people may be confused or unsure.

But it is not just hospice that people have questions about. There are so many new things to deal with when a loved one is sick. There are specialists who can help you make your home safer for the patient, help you with applying for disability benefits or help you make decisions about both the short and long term plans.

I get called by so many people, whether it is for help during the dying process, help with figuring out what to decide when the patient can’t speak for themselves anymore or how to deal with a conflict in the hospital. You aren’t alone. I can help you when you are standing in the hospital waiting room asking yourself, “Am I doing the right thing? What do I do next?” You can run it by me and I will walk you through it.

Have a kind and respectful day.

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