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Lengthy hospital stays are often infamously derided for their seemingly exorbitant price tags, unsavory-yet-overpriced food, and general patient dissatisfaction with their perceived level of quality of care. In all honesty, these sentiments --while potentially valid-- are also often somewhat unfair, and worsened by a lack of transparency and understanding of the basic economics that go into maintaining a viable hospital system operational, particularly within our current medico-legal environment. All that notwithstanding, there are very legitimate reasons for someone to search for alternative solutions to long-term care that are better suited to both the patient and their family’s lives. One of these potential alternatives is “hospitalization” at home.
Many hospitals and emergency departments (EDs) across the country are facing serious shortages of available hospital beds for inpatient care. As a result, many ED’s are stuck “boarding” patients in hallways for days or even weeks while they await a hospital bed to open up. Obviously, this is less than ideal for myriad reasons: it is uncomfortable and unpleasant for the patient; it increases potential exposure to pathogens and the development of new hospital-acquired infections; it increases wait times in EDs; and so forth.
Fortunately, the Centers for Medicare and Medicaid Services (CMS) actually have expanded their Hospitals Without Walls initiative by creating the Acute Hospital Care at Home (AHCAH) program, which financially covers “hospitalization” at home. This program allows patients to remain in their homes with daily follow-up by healthcare providers, as the situation warrants. This daily follow-up can range from in-person nurse or physician visits (to administer medications, maintain intravenous (IV) lines, perform examinations, etc,), all the way to even virtual check-ins by a clinician to make sure everything is going well.
As one would assume, there are limitations to this program. The patient must be sufficiently ill to have otherwise warranted normal hospitalization. However, their condition must also be sufficiently low in severity and stable that they do not require immediate access to the lifesaving resources found in a physical hospital. The patient must be able to perform the basic activities of daily living, or at least have reasonable assistance available for certain limitations. Furthermore, admittance to the program requires an in-person evaluation from a physician. This can be performed in an ED or community clinic, where the physician determines the individual warrants hospitalization, but is safe to be admitted to the home hospitalization program. Alternatively, if the patient is already admitted to the hospital, their hospital physician may determine that they are stable enough to continue their “hospitalization” at home. The home must also be assessed to ensure it is a safe environment and meets basic criteria such as running water, indoor plumbing, heating and/or air conditioning, etc. A member of the clinical team must also meet with the patient at their home to go over the entire treatment plan and assess what additional steps might need to be taken (such as providing meals, for example).
Ideally, this program should offer greater convenience and comfort to suitable patients, while also reducing the inpatient costs and overcrowding burdens on the healthcare system. There are currently 53 health systems with 116 hospitals located across 29 states that have been approved for this program. To see if a hospital near you is participating in the program, you can check the following list published by CMS.
Theoretically, home hospitalization programs could help alleviate hospital crowding and extended ED “boarding” stays, in addition to possible savings on healthcare expenses. A study from Johns Hopkins found that home hospitalization cost roughly 32% less than traditional hospital care (an average difference of $5,081 vs. $7,480 for applicable hospitalizations). However, other studies have failed to show any significant difference in the average costs of home hospitalization vs. inpatient care. One might also worry about many possible unintended and unwanted consequences of a program such as this. For example, if it becomes easier for busy ED physicians to simply clear out patients by sending them back home under this program, you might find that the home hospitalization program becomes inappropriately overused, ultimately driving CMS costs up instead of down. The program might also be abused from the consumer side, where individuals seek out the comfort and/or benefits of this service inappropriately. Again, driving total costs up instead of down. However, for the time being, it is a potentially promising program that will undoubtedly need further tweaking as it matures.
If you or a loved one is facing a possible hospitalization --or are/is currently hospitalized-- consider asking your physician if their hospital is participating in a home hospitalization program and whether that is a suitable option for your treatment.
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Many Americans faced job losses this year. That means that a lot of families lost their health insurance. That leaves many wondering, can you make a doctor's appointment without insurance?
Doctors and healthcare facilities allow individuals to book appointments without insurance. When scheduling an appointment, patients are asked about who will pay for the services. Without health insurance, it is possible to pay out-of-pocket. If paying for treatment without insurance coverage, it is important to consider factors like necessity and cost.
Here's what you need to know when booking a doctor's appointment without insurance.
Healthcare providers, like doctors, treat patients' health concerns. When it is time to see a physician, the first step is to contact them for an appointment.
To make an appointment to see the doctor, patients will need these things:
Those who are not covered by a health insurance plan can still schedule an appointment. The doctor's office will charge the patient directly instead of billing an insurance company.
Making a doctor's appointment without insurance is just like making an appointment with coverage. In most situations, patients can receive the same treatment.
Sometimes a test or medication is very expensive without insurance. However, doctors will often discuss what treatments or procedures are necessary and how costly they may be. That is why it is good to talk with a doctor even if you don't have insurance.
A recent poll found that about 44% of Americans would not go to the doctor if sick or injured because of the cost.
Many providers offer discounts for cash-paying customers. Others may be able to arrange payment plans. There is nothing more valuable than your health. Skipping the doctor because you don't have insurance is a bad idea.
An average doctor's appointment costs between $68 and $234, according to Debt.org. The charge may change depending on how difficult the condition is and how much time the doctor spends with the patient.
One cost-saving alternative to an in-office appointment is telemedicine. Online doctors offer significant savings to patients, including the expense of time and travel. And some online doctors offer reduced visit fees as well.
Even those with insurance can benefit from saving money on gas and cutting the wait time by booking a virtual physician appointment. All of the top private health insurers offer some telehealth coverage.
My Virtual Physician offers the best in telemedicine services. They regularly add new insurance plans, but those without insurance can see a doctor today for only $49.99. Each patient at My Virtual Physician receives patient-focused, quality care with or without health coverage.
If you've experienced a job change or lost health insurance coverage, check with My Virtual Physician for a doctor near you. Book now with the secure patient portal. And get the care you need.
Did you know that My Virtual Physician is now accepting SilverSummit Health Insurance? That is great news for residents of Nevada’s Clark and Washoe counties. Members can now book an online doctor appointment with no out-of-pocket expense.
SilverSummit Healthplan provides the best Nevada Medicaid plans. Now they are adding even more value to their services by partnering with My Virtual Physician to give members virtual doctor visits. Residents of Nevada can access doctors to treat a wide range of problems, including:
My Virtual Physician’s caring doctors treat patients right in their own home through a video visit. The office provides appointments for Obstetrics/Gynecology (OB/GYN) or Primary Care Physician (PCP) services. And patients can book safely and easily through the patient portal.
Health insurance plans are similar because they usually cover the same services. But different plans may:
Some plans are Health Maintenance Organizations (HMOs). These give members a list of doctors to choose from in their network. Insurance will cover services from in-network doctors, but may not cover the same services with out-of-network providers. My Virtual Physician is thrilled to add SilverSummit to their accepted Insurance Plans lineup and accept new patients.
My Virtual Physician is still adding new insurance plans to the network. But even without insurance, visits are still less expensive than an in-office visit. And the office accepts many forms of payment. Patients also appreciate booking an online doctor appointment because it is more convenient. My Virtual Physician has late evening and weekend appointments for booking. Members of SilverSummit Healthplan can schedule an appointment now at www.myvirtualphysician.com or text the office staff with questions.
To meet the physicians, simply click “BOOK APPOINTMENT NOW” to book your visit. Or visitors can text message questions about the virtual/online doctor benefits.
Meet Dr. Aravinda Ayyagari! We are ecstatic she has joined our My Virtual Physician practice.
She is a board-certified pediatrician with almost 20 years of experience. She serves on several hospital committees and enjoys volunteering her time in different settings ranging from the local school to the board of Easter Seals, and even traveling to El Paso, TX as a volunteer physician at a migrant center. She also serves as the state of Delaware CATCH grant coordinator to increase children’s access to healthcare services.
In her free time, she enjoys traveling, cooking, exercising, and spending time with friends. She loves hiking with her husband and two children in various destinations both domestically and internationally - covering Asia to South America. As a family, they have been amazed at how people are much more alike than different. They are looking forward to their next adventure!
Dr. Ayyagari speaks Spanish and some Telugu. She enjoys caring for patients of different cultural backgrounds.
Most recently, she started Bridge Care Pediatrics, a direct primary care which provides all pediatric and newborn housecalls. www.bridgecarepeds.com
In 2018, about 10.5% of Americans were estimated to have diabetes. Furthermore, about one-fifth of those cases were undiagnosed. It is important that individuals know their risk, and talk to their doctor about screening when it comes to diabetes. So, why is early detection key in diabetes?
Early detection is key in diabetes because early treatment can prevent serious complications. When a problem with blood sugar is found, doctors and patients can take steps to prevent permanent damage to the heart, kidneys, eyes, nerves, blood vessels, and other vital organs.
With simple tests for early detection, patients can make changes to reverse diabetes and even go into remission. Read on to learn more.
Diabetic care often focuses on treatment of the condition. While treatment is important, early detection increases the potential for effective changes early in the disease process.
An article in the Current Opinion in Endocrinology, Diabetes and Obesity journal recognizes that there are many reasons why earlier detection of diabetes could be of benefit to the individual and the health system, because it creates the opportunity to treat the high blood sugar and the risk factors for heart disease that often show up with diabetes. Individuals who don't know that anything is wrong may suffer long-term effects such as cardiovascular disease and stroke.
Furthermore, undiagnosed diabetes often results in potentially preventable, costly complications. Hospital stays could be avoided if patients are aware of their illness and work to manage it.
Diabetes can be expensive. The estimated cost of living with diabetes is around $9,600 per year. This covers prescription medications, diabetic testing supplies, doctors appointments, and hospital care. Medical expenses rise drastically when emergency room visits are needed for unmanaged diabetic complications.
Diabetes is a disease in which your body is not able to efficiently turn the food you eat into energy. Sugar then builds up in the bloodstream. Therefore, two problems arise: the cells are not getting the energy they need, and sugar is accumulating in the blood. High blood sugar, known as hyperglycemia, causes damage to tissues and organs of the body. That is to say, this is why diabetes is a serious condition that can be dangerous.
Normally when you eat, your body breaks food down into sugar molecules, called glucose. After that, the particles get into the bloodstream and your blood glucose level rises, signaling the pancreas to release insulin. Insulin is a hormone that tells body cells to let the glucose inside.
In diabetes, either your pancreas does not make insulin correctly, or your body cells do not react to the insulin the way they should. As a result, glucose stays in the blood, which is why diabetics experience high blood sugar, also known as hyperglycemia. Over time, hyperglycemia can damage nerves and blood vessels.
A blood test can determine if a person has diabetes. Doctors commonly use two tests to check for diabetes.
A glycated hemoglobin test, known as a hemoglobin A1c (HbA1c) test, measures the glycated form of hemoglobin to determine the three month average of blood sugar. This blood test takes about a minute to perform, and results are generally available in two to three days. A normal HbA1c is below 5.7%. Prediabetes is 5.7 to 6.4%. A result of 6.5% or more is classified as diabetic.
Another way a provider can use a blood test to see if you have diabetes is a fasting blood glucose, or fasting blood sugar (FBS), test. This blood test measures the basal (base) sugar levels of the blood. Testing is usually performed in the morning after the patient has had nothing to eat or drink for eight hours or more. This test may take around ten minutes and results can be immediately available. A normal FBS is 70-100 mg/dl (3.9 - 5.6 mmol/L). The doctor may repeat the fasting blood sugar test or order additional tests to confirm an abnormal blood sugar reading.
Diabetes is a chronic condition which means it may not go away. It is possible, however, to reverse some of the effects of diabetes and go into a remission for those with Type II Diabetes. Remission in diabetes means that your blood sugar levels are within the normal range and you have not required medication to manage your blood sugar for six months or more.
Lifestyle changes like a healthy diet, daily exercise, and weight management can improve the way your body uses insulin and can improve the prognosis for someone diagnosed with diabetes.
Diabetes is a global health problem. Health officials expect that rates will only continue to increase. Risk factors such as family history of diabetes, obesity, and sedentary lifestyle increase likelihood that you may get diabetes and so it is important to be proactive in your health and talk to your doctor about your risk for diabetes. .
If you would like more information on diabetic screening, or want to talk about your risk with one of our board-certified physicians, click to schedule an appointment. My Virtual Physician treats conditions including hyperglycemia, diabetic screening, counseling and more. If you have any suggestions for additional topics you want to read about, let us know! Don’t forget to check out our podcasts for more and follow us on social media.
Colagiuri, Stephen; Davies, Daniel The value of early detection of type 2 diabetes, Current Opinion in Endocrinology, Diabetes and Obesity: April 2009 - Volume 16 - Issue 2 - p 95-99 https://doi: 10.1097/MED.0b013e328329302f
Harris, M. I., & Eastman, R. C. (2000). Early detection of undiagnosed diabetes mellitus: a US perspective. Diabetes/metabolism research and reviews, 16(4), 230–236. https://doi.org/10.1002/1520-7560(2000)9999:9999<::aid-dmrr122>3.0.co;2-w
Narayan, K. M., Chan, J., & Mohan, V. (2011). Early identification of type 2 diabetes: policy should be aligned with health systems strengthening. Diabetes care, 34(1), 244–246. https://doi.org/10.2337/dc10-1952
You trust your doctor with your health. So, is it right to get a second opinion from another physician?
There are times when you might need a second opinion. You may need a second opinion in cases where you receive a significant diagnosis or extensive treatment plan. You may also want to find out if there are other treatment options or you are not satisfied with the recommendations. In these situations, a second opinion is fair and prudent.
A significant study at the Mayo Clinic in 2017 found that second opinions are invaluable. Researchers evaluated charts of 286 patients who were seen for a second opinion. The results, published in the Journal of Evaluation in Clinical Practice, were compelling.
Your health is an important matter. When faced with a significant health problem, you have the right and responsibility to make informed choices about the treatment plan.
Consider a second opinion when:
Doctors are humans too. You may find that your doctor understands when you let them know you would like a second opinion. It is not offensive to let your physician know that you value their expertise, but you want to have the most information to make the best decisions for your health.
Moreover, patients may find it surprising that doctors frequently get second opinions of their own. When faced with a complicated or unusual diagnosis, they reach out to colleagues and specialists to get the best information that they can too.
It will be helpful to discuss a second opinion with your doctor. Let them know what your concerns are and ask if they can recommend someone to you.
The cost of a second opinion may be a factor in your decision to seek one, but when you consider the value to your health and the expenses you may save in the long run, it may be well worth it.
Some insurances cover the cost of a second opinion when treatment is considered medically necessary, and some payors cover a percentage of the cost. Uninsured or underinsured individuals paying out of pocket can expect to incur expenses starting at around $500. The Mayo Clinic study mentioned estimates costs for a second opinion at around $1,200 when the diagnosis is consistent with the first. However, costs increased to $4,000 when the diagnosis changed. A new diagnosis requires additional testing.
If you are lucky enough to have the option in your state of a virtual second opinion consultation, your cost may be lower.
You trust your physician to help you achieve health and avoid disease. When your trusted doctor gives you a severe or life-threatening diagnosis or recommends a costly or lengthy treatment course, it is reasonable to seek counsel from another source. If you are open and honest with your doctor, you can avoid any awkward feelings.
If you need a second opinion from our board-certified physicians, click below to schedule an appointment. My Virtual Physician offers a monthly Second Opinion Clinic™ with a $99 special consultation. If you have any suggestions for additional topics you want to read about, let us know! Don’t forget to check out our podcasts for more and follow us on social media.
On this Talk Tuesday, we are focusing on Postpartum Depression.
If you are suffering from Postpartum Depression, connect with us, and make an appointment with one of our Board Certified Doctors today! And if you like what you hear, make sure to follow us on Spotify. We upload a new podcast every Tuesday!
