Experts estimate that 30% of the $2.3 trillion spent on health care is wasted, meaning it could be eliminated without reducing the quality of patient care. But before this waste in our health care system can be eliminated, it must first be identified -- where it is, why and how much.
Categories of Waste
- Failures of care delivery.
This category includes poor execution or lack of widespread adoption of best practices, such as effective preventive care practices or patient safety best practices. Delivery failures can result in patient injuries, worse clinicaloutcomes, and higher costs.
- Failures of care coordination.
These problems occur when patients experience care that is fragmented anddisjointed--for example, when the care of patients transitioning from one caresetting to another is poorly managed. These problems can include unnecessary hospital readmissions, avoidable complications, and declines in functional status, especially for the chronically ill.
This category includes care that is rooted in outmoded habits, that is driven by providers' preferences rather than those of informed patients, that ignores scientific findings, or that is motivated by something other than provision of optimal care for a patient.
- Administrative complexity.
This category of waste consists of excess spending that occurs because private health insurance companies, the government, or accreditation agencies create inefficient or flawed rules and overly bureaucratic procedures. For example, a lack of standardized forms and procedures can result in needlessly complex and time-consuming billing work for physicians and their staff.
- Pricing failures.
This type of waste occurs when the price of a service exceeds that found in a properly functioning market, which would be equal to the actual cost of production plus a reasonable profit. For example, Berwick and Hackbarth note that magnetic resonance imaging and computed tomography scans are several times more expensive in the United States than they are in other countries, attributing this to an absence of transparency and lack of competitive markets.
- Fraud and abuse.
In addition to fake medical bills and scams, this category includes the cost of additional inspections and regulations to catch wrongdoing.
How can we reduce this waste?
- Improve providers' capacity to collect and use digital data to advance science and improve care.
- Involve patients and their families or caregivers in care decisions. Increasing comparative effectiveness research may help physicians, patients, and their families make more informed decisions.
- Use clinical practice guidelines and provider decision support tools to a greater extent.
- Promote partnerships and coordination between providers and the community to improve care transitions.
- Realign financial incentives to promote continuous learning and the delivery of high-quality, low-cost care.
- Improve transparency in provider performance, including quality, price, cost, and outcomes information.
As always, thanks for reading and if you have any thoughts or suggestions on how we can help to reduce the waste in health care, feel free to leave a comment.
*REFERENCE: Health Affairs
Did you know that people with a spinal cord injury rarely sweat? How about reduced hair growth? Check out this week's video and get some surpising facts about life with a spinal cord injury.
Last month Caleb publised an article about his recent experience with stem cell treatments and how they are helping to rebuild his damaged spinal cord. I found the article extremely interesting and well written, as his always are. So I decided to do a little more research into stem cell treatments. To my suprise, I discovered that this technology seems to have almost limitless potentiental.
Case in point, an article published on huffingtonpost.com by Don C. Reed which documents research being done by stem cell researcher Renee Reijo-Pera and uro-gynocologist Bertha Chen. Both of these women are using their skills in order to develop a stem cell treatment that may one day defeat incontinence. The article sheds light on the research they are doing but also gives some pretty suprising information on the economic and phsycological effects of incontinence.
As a "male of a certain age", I have what are politely called prostate problems: more bluntly, urination situations. When the need arises, I have little warning; the time to go is now.
When I first understood what was happening to me, I was terrified. In the past I could wait all day between trips to the restroom -- what if I now had to use the facilities every 45 minutes? Would I spend the rest of my life chained to bathroom needs?
In supermarkets, I started taking sidelong glances at the adult diaper section.
Fortunately, medication (and a daily glass of pomegranate juice) brought the problem under control. If the situation gets too bad, there is an effective surgery available.
But for seven million women -- in California alone -- the inability to hold one's water is a far more serious problem.
Urinary Incontinence (UI) is a major reason elderly women are institutionalized. According to a study by the International Journal of Geriatric Psychiatry, "The most frequent caregiver complaint at the time of institutionalization was incontinence..."
Families are overwhelmed by the constant and chronic bathroom accidents.
Physical danger is involved: the rush to get to the bathroom is a major reason for falls, especially at night. As an elderly woman's bones become fragile, a sudden fall can shatter a leg, or a pelvis.
Why does Urinary Incontinence hit women roughly twice as often as it does men?
First, vaginal childbirth may damage bladder muscles; also, women live longer than men: in California, females reach an average age of 82.
The problem is huge. More diapers are sold for adult incontinence than for babies' use.
If one person goes through 3-5 diapers a day, think of the sheer trash-disposal problems -- diaper mountains for the landfills.
Nationally, the cost of incontinence exceeds $20 billion a year -- more than the expense of breast cancer, and comparable to the cost of chronic diseases such as Alzheimer's disease or arthritis.
Emotional depression from incontinence can be agonizing. When will leakages happen? Will others smell it? Some fear to leave the home; others may be too embarrassed to seek medical care. Isolation, loneliness, and depression can take over a person's life.
Surgery may help. But even when it does work, the relief is often only temporary, since leakage may re-appear as women age.
Two women scientists -- and the California stem cell program -- are challenging the problem.
Stem cell researcher Renee Reijo-Pera and uro-gynecologist Bertha Chen are working together on a research grant from the California stem cell program. The California Institute for Regenerative Medicine (CIRM) sprang from the citizen's initiative Proposition 71, and the wisdom of the California voters.
Bertha Chen, by the way, was the gynecologist for the famous gorilla Koko, of sign language fame.
"We were trying to figure out why she was not getting pregnant; turns out the problem was with the male, not her," said Dr. Chen.
The doctor and the scientist will combine their skills to ease a personal tragedy which affects millions of women, world-wide.
First, the problem: a healthy sphincter, the muscular valve of the urinary tract, stays closed because of quietly-operating smooth muscles; these keep the urine in during our daily activities. But as the muscle cells age, they weaken, and some die; if there are not enough active cells to maintain closure, the urine may spill out during activity, even a simple cough. Childbirth may over-stretch the opening, with damage to the cells. If the opening cannot close securely, the person will wet themselves, perhaps continually.
One way to diminish the problem is "bulking." Injections of fat, collagen, or ground-up bone into the sphincter will narrow the opening.
But while this lessens the leakage, it does not bring control. Further, it requires repeated injections, perhaps annually.
Other surgeries may enhance the strength of the woman's internal ligaments. But these decrease in effectiveness when they have to be repeated, as they often do.
But what if young and healthy muscle could be regrown inside the woman suffering from urinary leakage? The normal method of controlling oneself would be restored, and the problem would be gone.
The Pera-Chen technique would inject muscle cells grown from the woman's stem cells into the urethral sphincter. There, it is hoped, younger and healthier muscles would restore function.
If successful, the technique might well be useful for other conditions, including: "diseases of the blood vessels, respiratory tract (e.g., asthma), digestive system (e.g. gastric reflux, fecal incontinence) and others, with potential applications for secondary conditions relating to diabetes, neuro-degenerative disorders and other common health problems."
The cells would be delivered in a way that is "minimally-invasive", without the risks of surgery. This delivery method is "very familiar to physicians" because it is "currently used for injection of bulking materials to treat Urinary Incontinence."
Where will the cells come from? The patients themselves.
Remember last year's Nobel Prize winner, Shinya Yamanaka, who developed stem cells very much like human embryonic stem cells (hESCs)? His method is called induced Pluripotent Stem Cells (iPSCs) which are made from the patient's skin. These cells would be used, with a possible back-up from the standard hESCs.
Hopefully, since the Yamanaka-type cells are of the patient's own body, there would be little or no problem of rejection.
And the hoped-for outcome?
"Our research overcomes major limitations to provide a ready stem cell-derived target product that we anticipate will provide a safe and effective treatment of Urinary Incontinence resulting in improved quality of life for a significant fraction of our population." -- Bertha Chen and Renee Reijo-Pera
This week I would like to introduce a new employee of the week, Ben Thayer. Ben has been part of the BioDerm/Men's Liberty family for almost 2 years and he primarly works on selling the Men's Liberty and assisting patients with any questions and concerns they may have about the product. So without further ado, meet Ben!
Name/Nickname: Ben Thayer
Length of time at BioDerm: almost 2 years
Position: Sales Representative
I have been in sales the last 15 years of my life. I am currently a fulltime student studying medicine at St. Petersburg College (SPC). In the future I will be attending USF to finish my degree. I grew up in Boston Mass, where I lived for 30 years of my life until I decided I would never shovel snow ever again. Wouldn’t you rather sweat than freeze? Well I would. I suppose you have to be from New England to understand this. I was recently engaged over the last fourth of July weekend and we have 3 dogs.
1. What 3 items would you bring with you if were stranded on an island?
- A Boat
2. Top 3 movies of all time?
- Glengarry Glen Ross
3. How do you take your coffee?
4. What is your dream car?
5. What is your biggest pet peeve?
Being cut off (verbally)
6. What is your favorite color?
7. What is your favorite genre of music?
8. Who is your favorite sports team?
9. List some leisure activities you participate in?
10. Comedy or action movies?
Both. What About Bob, Total Recall, Crank, ect.
11. What is your biggest fear?
12. What do you enjoy most about working for BioDerm?
13. What surprised you most about Men’s Liberty/incontinence when you first started?
How many men actually suffer from incontinence.
14. What did you eat for breakfast?
15. What is your guilty pleasure?
16. If you could pick one person to meet, living or dead, who would it be?
17. If your life was turned into a movie, what actor would you play?
18. When you were young what was your favorite TV show?
19. Where would you go on your “dream vacation”?
20. If you were an animal what kind of animal would you be?
Hello again and Happy Thanksgiving from Men's Liberty and the BioDerm family. This year we have much to be thankful for; we are growing as a business, we have hardworking and dedicated employees, and we get to help men all over the world concur their incontinence and get their freedom back.
But let's not make this all about us. As you may know, it is National Family Caregivers Month and as a result we would like to give a big thanks to all of the caregivers worldwide. Thank you for all the sacrifices you make on a daily basis in an effort to help others. In fact, if you know a caregiver, take the time to thank them for all of the hard work they do. A little bit of acknowledgement and appreciation can go a long way. Additionally, Caregivers don't forget to enter to win a FREE spa day
We would also like to give thanks to all of our past, present, and future veterans. It is because of your sacrifice that we are able to remain free and for that we are forever thankful.
To that end, I wish all of our readers and patients a safe and fun-filled Thanksgiving. As always, feel free to leave a comment and tell us what you are thankful for this year!
In 19 years it has never ceased to amaze me how much behavioral psychology is at play around Spinal Cord Injury. There are always the personal, day-to-day battles with victories and losses a person in a chair faces just living life, but one of the greatest obstacles toward complete recovery from a spinal cord injury is often the sluggish and competitive community surrounding it.
This community of patients, doctors, therapists, trainers, caregivers and family make up a fraction of the global health care landscape, but the trickle-down effect of the recent trend in medicine to be the first across the finish line has had enormous implications. Everyone is vying for being the best treatment, most effective technology, the accurate results and the one to hold the trademark that the motivation for saving lives and truly finding a cure has taken a backseat to this materialistic ideal of "Look at me and what I did."
The ones needing the cure aren't helping either. Quads are jealous of Paras cause they're more independent... the Paras are pissed caused Quads get more attention... the men resent the women cause they can get a date easier and the women are sad because men can catheterize themselves safer. You think I'm kidding, I wish I was. I've received messages from spinal cord injured people telling me I was wrong to get stem cell treatment because I might be disappointed!
My all-time favorite line is when anyone, be they an industry professional or fellow spinal cord injury, says to me "I just don't think it's a good idea cause I don't want you to get hurt." Would someone please tell me how as a society did we become so passive-aggressive then have the unmitigated gall to pat ourselves on the back and call it compassion? At the risk of this post turning into a rant let me explain why I bring this up.
In order for healing of any kind to take place whether it is mental, emotional or physical it requires an environment. Think about disease, it festers in a climate suitable for its gestation. Health is no different. Why do we wash our clothes, vacuum our floors, bathe daily and brush our teeth? We want to create a healthy place for life to flourish.
The ultimate environment for anyone to make any headway in the face of spinal cord injury whether they have received stem cells, any other radically progressive treatment or not any at all there must be an equilibrium. Yes, a healthy skepticism can be a valuable thing as long as it fosters research and an honest exchange of information, but once we lose sight of the ultimate goal and the needs of those who have been injured to make a full recovery we negate any chances of true progress. I bring this to light today because we need to get on with the business of healing. I need to get on with it and so do you. We have to create a climate for a cure.
To those of us in chairs I am putting out a call... to cut the crap. Yes, being paralyzed really, REALLY sucks. It hurts and affects every single area of our lives, but we're not alone. There's not one spinal cord injury on this planet, there are thousands. All suffering the same fears and dreaming the same dreams. Someone may have more or less than you, but we all want to walk again. We may not all achieve it the same way, but who are we to dare criticize a fellow survivor for how they choose to reach that goal?
To the doctors, trainers, and therapists... I sure love you guys, and G-d knows we're grateful, but do us and everybody else a favor... get over yourselves. Just because you are doing research, helped someone in a chair learn to transfer themselves or got them to a certain level of independence does not mean you've solved the problem. Just because a task is easier doesn't make it better. Catheterizing is still catheterizing whether you do it on your own or someone does it for you. Learn to listen, really listen. You are an outsider and respect it. You will never be able to fully understand, so don't lull yourself into thinking you do.
Finally, to all of us... whatever role you play in this quest... get on the same team. Support each other. If you want stem cells, get'em! If you just want to do therapy, do it! If you want to go holistic, vegan, Chinese herbal, shamanic, yoga, and get naked around a bonfire I say go for it and more power to you! We have to build the environment for a cure.
The cure. The cure is our mantra. The cure is the goal.
Ask any caregiver to describe their scariest moment, and I will bet you, none of those moments will be about them. That's the thing about being a caregiver for one of your loved ones – mother, father, sibling, husband, child – their illness, their comfort, their happiness become your own. Yet there are no doctors, or specialists or medications for you. It's often a lonely and thankless task.
But don't think for a moment that we regret it. I know I don't. I spent three years as a full time caregiver for my younger sister. It was by far the hardest thing I've ever done. It took over my life and ate away at my personal time, my finances, my social network, my job. It all suffered under the strain of caring for someone who was unable to take care of herself.
My sister, let’s call her L, has several mental health challenges, including but certainly not limited to bipolar disorder. This meant a lot of different things – basically, L has intense rapid mood swings between manic euphoria and extreme depression. L has been hospitalized 10 times in the last 8 years for suicide attempts, including one which ended with her in a coma in intensive care for 4 days before regaining consciousness.
Back in 2010, I moved home after many years to take care of her after her latest suicide attempt. L shunned my parents support yet wasn't able to live independently, she couldn't even be trusted to take her medication without supervision. So I moved home, got an apartment and moved her in with me.
To say I had no idea what I was getting myself into is an understatement. I could give you a rendition of everything that happened in the next two years, but to honest that would be a book, not a blog post. So I'll just give you an excerpt –
My lowest moment as a caregiver was spent sitting in the psychiatric ER waiting room. I've never been more terrified than I was that night. Because I'd failed; everything I'd spent nearly a year working on was coming apart around me. It was my job to take care of her, to protect her and I failed. I couldn't protect her from the one thing that truly endangered her, herself.
The night began shortly after I got home from work, with L coming into my room crying, holding a paring knife. She was mumbling about the voices and keep trying to cut out her own eyes so that she could “get to the voices” that were trying to make her think she was crazy.
My first challenge was to get the knife away from her without getting hurt – it took a few minutes but eventually she dropped it and collapsed on the floor crying and rocking, seemingly unconcerned that she was repeatedly knocking her head into a wall. I cradled her and tried to get her to take her meds, to help calm her.
After nearly 20 minutes of this, I was getting even more concerned – I had never seen L like this before. The meds weren’t kicking in yet. I focused on calming L, holding her and speaking softly, telling her I loved her and eventually just begging her to calm down. It took about half an hour and the meds finally kicked in and she calmed. The crying stopped. But now she was withdrawn, she seemed terrified of me. She shrank to the other side of the room, convinced that I was working with the evil woman who put the voices in her head that I was trying to hurt her.
It took me another hour to convince L to go to the hospital. And that was how I found myself sitting in a waiting room, waiting for a doctor to come out and tell me that I had failed, that there was something I could have or should have done to prevent this. I find it hard to find words that adequately convey the level of guilt I felt. I was a failure at the only thing
that really mattered.
But he didn't. The only thing he said was that I should have called an ambulance; that I shouldn't have had to deal with this on my own. Where were my parents? I was barely older than L was. I didn't have an answer for him. Asking for help has never been my strong suit. It seemed like weakness. Taking care of L was my responsibility – why should I expect anyone else to help?
It's been several years now, but I can still recall every detail of that night, the feelings of guilt, of relief that L was admitted, that I could go home to a quiet apartment. Though I love L, in that moment, I didn't like her very much, and I resented her. I resented what I had given up
for her, seemingly all for nothing.
But the truth is, it wasn't for nothing. Because the next day I got up and went back to hospital, and again the day after that, and the one after that. Eventually, L came home. And while I can't say everything was better (it definitely wasn't), the feelings of failure abated, the guilt lessened. L lives on her own now. I don't know how much of that was because of me, but I take some small measure of comfort for having done something in my life that I know has truly mattered to another person.
And in the years since, the doctor's words have stuck with me. And in time, I learned something that I hope I never forget: needing help doesn't make us weak, the ability to ask for help, to be vulnerable, is the very definition of courage. I'm not perfect, no one is, certainly no caregiver. We need to be forgiven our failings, just like anyone else. But we also need to be courageous enough to ask for help – from doctors, from family, from friends. We can't do it all alone.
This November is National Family Caregivers Month. It's about recognizing the important role of caregivers – for anyone who has sat in that waiting room, counted pills and scheduled doctor’s visits, done the shopping and cleaned the house, provided physical, social, psychological or other assistance in the daily life of a loved one. Please know... there are thousands of other people out there with issues just like yours. Ask for help, ask for support. You deserve it and so does your loved one.
Pills, pills, pills.... most of us take them on occassion. But in addition to dealing with their intended issue, most pills have side effects. Did you know they could actually cause urinary incontinence.
Before you suffer needlessly, check out this video and see if changing your medication could help!
Just a few days ago (November 7th), we shared with you a story about a great man with a terrific mission – Bob Woodruff and his foundation, and of course, the benefit concert “Stand Up For Heroes”! http://bobwoodrufffoundation.org/sufh/
But there’s more to the story… You may recall that we mentioned that Roger Waters (Pink Floyd) was one of the many musicians and entertainers that evening, but we wanted to make sure you knew about Roger’s commitment to our veterans!
It turns out, Arthur is CONNECTED!
And since starting the program, Arthur’s brought in many accomplished and famous musicians – including Yo-Yo Ma, the world renowned cellist.
Here’s a terrific video of Yo-Yo Ma working with the “Band of Brothers” - http://www.youtube.com/watch?v=9tQT152fzp4.
It was also Arthur who introduced Roger Waters, famed band member of Pink Floyd to MusicCorps, where Roger was touched and inspired to work with the “Band of Brothers”!
Imagine feeling as if your life is “over” – and that you can no longer be a part of something significant when all of a sudden you are introduced to Arthur and HIS band of brothers – his network of fellow musicians equally inspired and committed to help our wounded veterans rediscover the fun, the excitement and the passion of music.
And the next thing you know, you’re on stage playing music right along with Roger Waters at the Stand Up For Heroes concert! We were inspired by every one of the band members, including triple-amputee Juan Dominguez playing drums and double-amputee Tim Donley singing “Hallelujah”! Here’s a CBS News clip featuring both Juan and Tim along with Roger and the “Band of Brothers” http://www.cbsnews.com/video/watch/?id=50158847n!
Here’s an inspiring clip of Tim singing “Wide River to Cross” at the 2012 Stand Up for Heroes benefit concert! Check it out! http://www.youtube.com/watch?v=yaU_JbkUvBM
As many “Band of Brothers” musicians will tell you, it is “therapy on steroids – helping us emotionally, physically and spiritually”!
Because RESOURCES are so important for us to be able to share with our Men’s Liberty “family” and friends, we want you to know that there are several resources available on Arthur Bloom’s “RIME” website, located right here: http://www.rimemusic.org/Resources.html. Check them out!
We continue our commitment to being a reliable connection for information and resources that you can rely on. We encourage you to post your thoughts and comments below! We love hearing from you!
In closing, let’s take the inspiration we get from Tim Donley and Juan Dominguez and apply the actions that they took to ourselves – to participate, to join, to donate and to COMMIT to our best life possible! Yes!
We express our sincere gratitude to the inspiration from every member of the “Band of Brothers”, including Arthur Bloom, Roger Waters, The Bob Woodruff Foundation, and all the people connected with these great missions! We appreciate you!
Today I bring you an article published on npr.com written by Nancy Shute. This article was written almost a month ago, however, it still has relevance this month because we are in the midst of celebrating National Family Caregivers Month.
This article highlights a recent study done by David L. Roth of John Hopkins University which found that family caregivers were 18% less likely to die than non-caregivers over a six year period.
The stereotype of caring for a family member is that it's so stressful it harms the caregiver's health. But that's not necessarily so.
Studies are conflicted, finding that caregiving can harm or help the caregiver. Here's one on the plus side. A study finds that people who care for a family member live longer than similar people who aren't caregiving.
The scientists didn't ask the caregivers why they might be healthier and presumably happier than similar people who weren't caring for someone. But the 3,503 people who participated represented a broad swath of the American public and may be a better representation of the caregiving experience overall.
Just 17 percent of the people surveyed said they had high levels of caregiving strain, and the majority put in fewer than 14 hours of care a week.
"The burden of caregiving certainly can be overwhelming and negative to health," says David Roth, director of the Center on Aging and Health at Johns Hopkins University and lead author of the study, which was published in the American Journal of Epidemiology. "But those are not necessarily the typical experience."
The study data was originally gathered for a big multiyear study on stroke risk, but the people being cared for in this study had a broad range of health problems. The caregivers themselves were age 64 on average, more likely to be female and either white or African-American.
Family caregivers were 18 percent less likely to die than noncaregivers over six years, the researchers found.
Something must have made life better for the caregivers. But what? To help find out, we called up Leah Eskinazi, director of operations for the Family Caregiver Alliance in San Francisco.
"There are people who find caregiving very rewarding," Eskinazi told Shots. "They feel really good that they can give back to Mom, for example, because Mom was really there for them when they were growing up. Maybe they weren't the best kid, but as they've aged they can have a more balanced healthier relationship and heal some of those wounds."
Context is everything, Eskinazi says. Caring for someone with dementia can be more stressful and depressing because the person is facing a long inevitable decline. "You're caring for someone who can't voice their preferences," she says. "You're making decisions for another person and for yourself, and that can last for a long time. It's tough."
But only about 10 percent of family caregivers are tending someone with dementia, other studies have found.
Caring for someone after a stroke, by contrast, can be very positive. "There's a lot of energy going into helping that person recover," Eskinazi says.
And in many cases the person being cared for is in a position to be grateful. "To have someone stick by you, or a group of people stick by you, that's pretty cool," Eskinazi says. "It gives you an opportunity to say thank you."
Spouses typically expect to be taking care of their mate in old age, but adult children don't always prepare for that possibility — or try not to think about it.
People tend to avoid the Family Caregiver Alliance's booth at health fairs, Eskinazi admits. "People don't really want to think about it. It's time, it's emotion and it takes energy."
But this latest study points out that caregiving isn't all a big minus for the caregiver — something to prepare for, perhaps, but a normal, often rewarding part of life.
Source: Nancy Shute. http://www.npr.org/blogs/health/2013/10/16/235384054/family-caregiving-can-be-stressful-rewarding-and-life-affirming