CT Center for Patient Safety Newsletter

March 2016

In This Issue

Taking Control of you Medical Costs

March is Patient Safety Month

The law of unintended consequences

Is your medical data YOUR medical data?

Introducing Shannon Church, CTCPS intern

Taking Control of you Medical Costs

by Shannon Church, CTCPS intern

Although you are paying for medical insurance, many of you are also paying more for cost sharing of your medical expenses than in the past. It is putting a heavy burden on many households. In many cases, higher co-pays and coinsurance for everything from x-rays to prescriptions are challenging our wallets. Ignoring these bills for necessary services is not the answer - that will only bring on its own set of problems. Not getting the care that you need will also cost everyone more in the long run - in more ways than just financial. So what can you do to take control?

Even before you choose and purchase you health insurance plan, and certainly once you have, make sure that you understand your plan: what it covers and how it is covered. Take the time to build your vocabulary and know what the following terms mean and why they matter to you: premium, deductible, out-of -pocket, co-pay, coinsurance, in-network and out-of-network and formulary. Know if you are looking at a high deductible plan (premium is lower but out-of-pocket is higher) or a low-deductible plan (premium is higher and out-of-pocket is lower) and why that matters to you. Evaluate the benefit of a personal savings account plan vs. the traditional plans, if you have that choice.

Understanding your plan and how it works is very important, but you should also look at the provider network and the difference in charges between getting care from someone or some facility that is in-network and out -of-network. If you have doctors who are important to you, then you want to see if they are in your network because the price of an office visit can vary greatly between the two.

In non-emergency situations, such as elective surgery, before you go to a hospital or doctor, call your insurance company and find out if the providers are in your network or not. And because a hospital is in-network, it does not always mean that all of the doctors who have privileges there are in your network. So if you are having an operation or procedure, ask about each person involved in the surgery or procedure.

Before having a planned medical procedure in an office, an outpatient center or a hospital, ask what all the charges that you will be expected to be responsible for will be and get the procedure codes for everything that you will be billed for by each clinician and facility involved. Then speak to your insurance company and ask them exactly what portion of that will be your responsibility. After, request a copy of the bill; don't pay on a statement. Look at the line charges and make sure that they match your expectations.

Unexpected charges are often billing errors which can include such things as upcoding - billing for something that is similar but more expensive that what was provided, unbundling - where services that should be packaged together are split and billed separately, and duplicate billing. Patients are often surprised by balance billing - the balance which is left over after the insurance payment is applied. Either through insurance or out-of -pocket, you are paying for your health care and it is your right to see the bill and to be able to understand it.

Negotiation is one of the ways that patients can save on medical bills. Often, by paying cash for a procedure or test, patients can negotiate discounted prices which many of these providers already have calculated. Sometimes these rates can actually be lower than your co-pay or coinsurance. It can't hurt to ask! Once you have received the bill, companies will often work with you to set up payment plans and sometimes reduce the price of the bill. Some patients, even with insurance, qualify for discounts from the billing party based on their income or circumstances, to further reduce what is owed. So being a smart and savvy consumer is an important strategy to manage the financial burdens of healthcare.

Additional information and more details: http://time.com/money/3938748/7-smart-ways-to-negotiate-your-medical-bills/; http://www.wsj.com/articles/how-to-cut-your-health-care-bill-pay-cash-1455592277; http://www.consumerreports.org/health/4-ways-to-get-insurance-to-cover-your-prescription-drugs/; http://www.cfah.org/prepared-patient/prepared-patient-articles/coping-with-the-high-costs-of-prescriptions

March is Patient Safety Month

In honor of Patient Safety Month

the narratives around us.

Each month, we include a feature where we write about a health issue that is relevant to the time of year. This month, we are going to diverge a little bit.

March is patient safety month and at CTCPS we work to advance patient safety. Since our beginning in 2004, we realized the immense power of narratives, real people's stories, to bring about change. To help emphasize the importance of patient safety and the need for change, we have shared stories of people who have experienced harm from their health care experiences. We have taken these stories of patient experiences to nursing schools, medical schools, to hospitals, the Capitol in Hartford, and to many others across our United States. We have told the stories of medical errors and the people who died from them, the stories of their families, the other heroes in healthcare and of the ones whose actions caused pain and suffering. Our stories have directly led to change.

Today we ask you if you know of someone who has suffered harm from medical error or who has suffered harm themselves, and who wants to share their story and become part of this movement, to write in and share their story with us. We will continue to use these narratives, one of the most powerful tools, to fulfill our mission to make healthcare safer.

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Dear Members,

Happy March to everyone!

March 13^th - 19^th is Patient Safety Week. Why do we designate a week to focus on this? Because today, even with the raised awareness and efforts on improving patient safety on a state and national level, the data tells us that one in ten patients still develop a health care acquired condition during a hospital stay. A 2013 study found that up to 440,000 people die each year as a result of medical harm making medical harm the 3^rd leading cause of death behind cancer and heart disease. These numbers are not acceptable!

Talking about it helps to raise awareness, but we need more than talk. We need substantive changes in the way health care is delivered. We want to see system changes that impact the patient safety culture within our hospitals and medical practices. We don't mean say that we have all the answers, however we would like to strongly suggest that patients need to be empowered and involved in their care in much more meaningful ways than they currently are. Person-Centered care, improved communication, patient education using terms that patients can understand and better clinician understanding of the patient perspective (empathy) are all strategies that can make a difference in patient outcomes. The CT Center for Patient Safety works throughout Connecticut to advance changes in the way health care is delivered to advance patient safety for everyone.

The National Patient Safety Foundation (NPSF) has several events coming up for all to participate in. For those who use Twitter, there will be a
Twitter Chat, Patient Safety in All Settings, March 15, 2pm ET. Use#PSAW16chat.

Let's see many patients on the call sharing our unique and informed perspective. For more details, go to

http://www.unitedforpatientsafety.org/twitter_chat_patient_safety_in_all_settings

For those who are interested in more activities that you can participate in, visit the website UnitedforPatientSafety.org to honor a loved one affected by medical error, download educational materials, post pictures, share your plans for Patient Safety Awareness Week, and more.

Finally, the NPSF is hosting a complimentary webcast on Thursday, March 17, 2016, Patient Safety is a Public Health Issue. Go to

http://www.npsf.org/events/EventDetails.aspx?id=773257&group

= to register.

So in memory of those who have been harmed or died from medical errors, we will focus our attention and energy on having our voice heard during this week - and always. We will work towards a day when health care harm is the rarity rather than an all to common occurrence.

Lisa Freeman

The law of unintended consequences. How did we ever get into this mess and are more drugs the solution?

By Jean Rexford, CTCPS Board Member and Sr. Advisor

May 10, 2007 -The company that makes the narcotic painkiller OxyContin and three current and former executives pleaded guilty to criminal charges that they misled regulators, doctors and patients about the drug's risk of addiction and its potential to be abused. To resolve criminal and civil charges related to the drug's "misbranding", the parent of Purdue Pharma, the company that markets OxyContin, agreed to pay more than $600 million in fines. That is the third-highest amount ever paid by a drug company in such a case. OxyContin is a powerful, long-acting narcotic that provides relief of serious pain for up to 12 hours. Initially, Purdue Pharma contended that OxyContin, because of its time-release formulation, posed a lower threat of abuse and addiction to patients than traditional, shorter-acting painkillers like Percocet or Vicodin.

And where are we today? Opioids "are passed out like candy in America," Vermont Governor Shumlin said. He cited federal data showing that health care providers wrote more than 250 million prescriptions a year for painkillers, enough for every American adult to have a bottle of pills.

In 2014, more than 47,000 drug overdose deaths occurred in the United States, according to the Centers for Disease Control and Prevention, and opioids - primarily prescription pain medicines and heroin - were the main drugs responsible for overdose deaths.

Now remember, every statistic has a story, a family and a human and financial cost and that cost is growing. In Connecticut:

2012: 357

2013: 495

2014: 568

2015: 723

Of 2015's 723 accidental overdoses, 415 involved heroin in some way. The previous year, 327 of the accidental overdose deaths involved heroin. The remaining deaths were caused by prescribed medicine.

The overuse of these drugs has now led the pharmaceuticals to market a drug to deal with the "special" constipation that is caused by their use.

This year the Connecticut legislature is considering many bills that address the problem.

The use of Naloxone is recommended as an effective opioid antidote - it must be made readily available across the state.

But providing a drug is not really a long term solution. We need to take a deep breath and address the complexity of the problem.

Strengthen the electronic prescription drug monitoring program to make it more accurate and available to all prescribers and to selected office staff
Require all prescribers to check the prescription drug monitoring program before prescribing
Require all prescribers to take a course on these drugs and the down side to creating dependence particularly in individuals under 25
Limit the number of pills prescribed. There is no reason dentists should be prescribing more than five or ten pills
Ask the Department of Public Health to create a state wide campaign on the dangers of these drugs and the consequences of addiction to them.
Urge the DEA to focus and act more quickly particularly when it comes to physicians who are prescribing in a pattern that is dangerous to the public
Ban direct to consumer pharmaceutical advertising
Ban pharmaceutical relationships with prescribers - doctors and nurses
Increase education of patients on the use of any drugs - yes - they all have side effects.
Increase access to addiction treatment.

When there is criminal activity that leads to such pervasive harm, let's hold those criminals more accountable. Fines are not a deterrent - what about house arrest or even incarceration? White collar crime is getting a pass.

Is your medical data YOUR medical data?

Years ago, back in the "good old days" when you went to see your doctor, most often your exam included them speaking with you to find out why you were there and maybe having a bit more of a conversation, their prodding you a little bit, looking in your nose, ears and mouth and then drawing on their knowledge and experience to determine what ailed you. Today, many appointments include lots of information gathering. Some from what a patient shares, and the rest from lab tests, different diagnostic imaging, and other more sophisticated testing. This, in turn produces the data that your doctor uses to determine what is going on inside of you.

In modern times, there is more interest in this data than just individual patient care. According to an article in Backchannel, scientists are using this data to study many things. Pharmaceutical companies use data to analyze their sales and they continue to study their drug's efficacy after it is released into market. Others use the de-identified data from electronic health records, lab test results, and insurance claims reports to discover patterns that may be new to them. This is a fast growing industry.

But having all of this data leaves us vulnerable as well. According to a recent study, "medical data thefts have more than doubled in the last five years; in 2015, companies like Anthem revealed breaches that together compromised the records of more than 112 million people."

The irony here is that it is often challenging for patients to obtain their medical records. The affordable care act provided money and other incentives for practices to move to electronic health records, yet many patient portals are extremely limited in what information they share with the patient. It has been pointed out by the Institute of Medicine that people who checked their own medical records often noticed errors before they resulted in problems. Furthermore, there are many studies that show that engaged patients experience better health outcomes and are more satisfied with their care. They are engaged and vested in what happens. When you think about it, it seems somewhat counterintuitive that all of this information should not be accessible to patients since it is entirely about them. "In the longer term, the goal is to change the culture of health care, and accelerate the trend in which patients are seen as partners," says Christine Bechtel, former vice president of the National Partnership for Women and Families (NPWF), a nonprofit that has pushed for easier medical records access. There are programs out there that have and are being designed to make a patient's records fully available to them, one of which is Open Notes.

Between 40% and 80% of what a healthcare provider tells patients is immediately forgotten, and half of what they do remember, they get wrong. So by allowing patient records to be fully open, patients feel more in control and understand their care plans much better. As Hugo Campos said, "We can empower people, and make them realize that they do have a right and a responsibility toward themselves." We can do this by allowing them access to all of the data that is being gathered in their name.

Introducing Shannon Church, CTCPS intern

Shannon comes to us from Goodwin College where she is in her last semester working on her bachelor's degree in Health Science. Her interest in healthcare began during Army boot camp when she was required to learn first aid with CPR and IV training. Her army career ended early when she broke a bone, but her interest continued. In 2009, she graduated from medical assisting school and went to work at Eastern Connecticut Health Network. Her work advanced her cardiac skills, ER skills, and patient assessment skills. After seven years she left ECHN to go back to school and is now interning at CTCPS. This internship has heightened her desire to become a patient advocate and a patient educator. It has exposed her to "the other side of health care" that she never really saw in all that she had previously done.

We are happy to have her working with us.

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