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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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Prenatal care (or antenatal care), remains one of the most accessed preventive health services in the United States. Accessed by 4 million women yearly, the COVID-19 pandemic has made healthcare less accessible and unsafe for both healthcare providers and patients.
In the U.S., patients with low-risk pregnancies are expected to have 12 to 14 office-based visits. However, the COVID-19 pandemic has made it increasingly difficult for pregnant women to meet up with the recommended visits. Hence, the shift to telemedicine.
Telemedicine is a relatively new approach to prenatal care. However, through telemedicine, pregnant women can access several healthcare services including certain emergency services, specialist consultations, and psychotherapy.
Below are the benefits of telemedicine to both patients and their healthcare providers.
The following are advantages of telemedicine in prenatal care for patients and providers.
Improves access to care
Telemedicine makes you gain access to care while bypassing the time and distance it usually takes for an in-person visit.
With telemedicine, you do not need a day off for a 15 to 60-minute appointment. Likewise, patients with disabilities, those geographically isolated, or with one ailment or the other can easily get care from wherever they are.
Telemedicine helps you save costs from transportation, consultation, childcare, and time spent in the hospital. You can attend your appointment with a doctor from anywhere, including your home and workplace.
Research shows that using telemedicine helps save up to 30% from healthcare costs.
An in-person prenatal care appointment means you get in close contact with people who may be sick.
Pregnant women may be particularly susceptible to COVID-19, as they are more susceptible to respiratory pathogens. They made also be prone to other infections as the immune system undergoes several changes during pregnancy to accommodate mother and child.
With telemedicine, there is reduced risk and spread of infection, especially for pregnant women with underlying conditions or weak immune systems.
Improved access makes it easier for doctors to provide care to their patients. Patients and healthcare providers can easily connect via a voice or video call.
Telemedicine bypasses the somewhat tensed atmosphere of a doctor's office. Patients can relax in a more familiar environment and discuss their symptoms and concerns. This helps improve the care provided.
Additionally, research shows that telemedicine helped provide equal or better care to women with high-risk pregnancies.
Telemedicine allows you to book and have a visit from the comfort of your home or anywhere you may be.
It cuts off the need to leave your home or workplace, arrange childcare, take some time off work, drive through traffic or get a bus or cab to access care.
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Telemedicine helps providers cut down on overhead expenses such as paying for a big office space or facility, front desk support, etc.
Telemedicine allows healthcare providers to care for more patients outside of the hospital. Hence, telemedicine may serve as an additional stream of income.
Telemedicine eliminates physical or close contact with several patients. Hence, providers are less exposed to illnesses and infections.
Patients experience greater satisfaction with care rendered via telemedicine visits. Reasons include being able to involve their families, improved access to and delivery of care, lower costs, and at their convenience.
Doctors also appreciated that they were able to spend more time with their patients, and at their time. They could also give follow-up calls.
Study shows that telemedicine visits helped improve health outcomes. These included patients quitting smoking and gaining access to necessary high-risk obstetrical services.
You may enjoy the advantages of telemedicine with My Virtual Physician. At My Virtual Physician, our team is committed to ensuring that patients get the best of health care as needed.
We provide virtual care at any point in your pregnancy while you await your appointment with your local OB doctor. We are in network with many insurance health plans including Medicaid, Medicare, United HealthCare, and Blue Cross.
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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
Advanced practice nurses work alongside physicians in many settings. As more facilities employ nurse practitioners to work with their doctors, you may wonder: is care improved by a collaborative approach?
The truth is that care is better when physicians and advanced practice registered nurses (APRNs) or nurse practitioners work together in a collaborative care model. When these professionals come together to treat the patient, the result is a synergistic effect that improves care outcomes and increases satisfaction.
To find out how, read on.
A care approach by a doctor and APRN team improves:
A recent article on collaborative care between physicians and nurses found that outcomes improves in many areas. To sum up, the results were better compliance, lower symptom severity, and fewer hospitalizations.
There are many reasons for these findings. Firstly, when doctors and nurses work together on a treatment plan, they complement each other. Each brings a different set of skills, knowledge, and background. Putting these two views together gives a better picture of the patient and how to treat them.
Physician and APRN teams provide a more comprehensive treatment plan that addresses more factors affecting health and illness than each one could alone.
Certainly, a team approach improves satisfaction in many ways. Patients, family members or caregivers, and the healthcare providers themselves report more contentment from this care model.
One reason for increased satisfaction is the focus on health promotion. Nurse practitioners provide education. They can counsel patients and families, and they even perform care coordination. Patients and families get great benefits from this added care management. It makes them feel they are getting better care.
Secondly, when APRNs work with physicians in outpatient settings, they help to increase efficiency and optimize patient care. For example, clinics or offices that use nurse practitioners are able to give patients more appointments. These care teams can make same-day visits, walk-ins, and extended hours possible. APRNs can provide routine health care services, while letting physicians to treat the more complex cases.
Healthcare continues to change. Read more about in our article here. More doctors and patients are focusing on preventative care, health, and wellness.
Meanwhile, factors such as a growing, aging population and increased access to care under the Affordable Care Act have helped create a greater demand for physicians. The workforce is not able to meet the need. Moreover, the physician shortage is expected to continue. Nurse practitioners are one of the answers to this crisis.
Working with doctors, nurse practitioners can diagnose and treat patients in many settings from hospitals to specialty clinics.
Nurses provide health promotion and education. Consequently, APRNs complement the care that physicians provide. They are an integral part of the healthcare team. The results of this doctor-nurse collaborative care model include improved health outcomes and increased satisfaction.
To talk with one of our board-certified physicians, click below to schedule an appointment. My Virtual Physician treats health conditions, provides routine screening, counseling, and more. If you have any suggestions for additional topics you want to read about, let us know! Don’t forget to follow us on social media.
A urinary tract infection can be painful and bothersome. Perhaps you’ve heard that drinking cranberry juice is a simple effective cure to treat the infection without the hassle of seeing a doctor. Is this the case?
Many people believe that cranberries, or cranberry juice, can cure a urinary tract infection (UTI). However, the truth is that while cranberries may help prevent recurrent infections, they are not an effective cure for a bladder infection.
If you’re wondering why this is so, and what you can do if you do have an infection, read on.
There have been many studies on the effects of cranberries in urinary tract infections. Research has shown that an active ingredient in cranberries called “proanthocyanidins,” or PCAs for short, can affect bacterial growth.
The most common bacterial cause of urinary tract infections is an organism called Escherichia Coli or E. Coli. This bacteria usually lives in the intestines of healthy humans and animals and most are not harmful, however some strains can cause infection.
PCAs found in cranberries can prevent E. Coli from attaching to the bladder wall lining. In other words, they can help prevent infection.
While PCAs found in cranberries can help prevent infection, it is important to note that a cup of cranberry juice may only contain a small amount of this active ingredient. Moreover, cranberry juice cocktail drinks are loaded with sugar. Cranberry tablets or pills may be a healthier option for prevention.
For UTI prevention, a recent article in Pharmacy Today recommended two options:
The research shows some evidence that cranberry products may reduce the incidence of UTIs but the most effective amount and concentration of PACs that must be consumed and how long they should be taken are unknown.
Urinary tract infections are common, affecting approximately 50% of adult women during their lifetime.
In some cases, simple urinary tract infections go away on their own. One study found that approximately 25-42% of uncomplicated UTIs resolve without any medical treatment. However, in other cases, the body’s immune system is not able to kill and eliminate harmful bacteria on its own. Doctors may prescribe antibiotics for infections that require treatment.
There are some things you can do for relief, or even after you have seen your doctor while you are waiting for an antibiotic to work.
It is important to stay hydrated, drinking plenty of water flushes out the bladder. When going to the bathroom it is important to try to empty the bladder completely. UTIs can cause frequent urges to urinate or pressure in the low abdomen. Going to the bathroom frequently to empty the bladder can help.
Heating pads may provide some relief of low abdomen discomfort. And over-the-counter pain relievers such as Motrin or Tylenol can also be taken to help with discomfort.
Untreated infections could spread and become serious. Talk to your doctor as soon as you suspect a UTI. These can be signs of a serious infection:
If you need treatment for a UTI or want to talk about your symptoms with one of our board-certified physicians, click below to schedule an appointment. My Virtual Physician treats conditions including urinary tract infections, other urinary problems, sexually transmitted infections, and more. If you have any suggestions for additional topics you want to read about, let us know! Don’t forget to follow us on social media.
Much mistle-toeing and hearts will be glowing. It’s the most wonderful time of the year, right? For some, the holiday season brings to mind financial strain, complicated relationships, stressful schedules. The hustle and bustle of the holiday season cause worry for many. Coping with anxiety during the holidays can be a challenge.
Coping with anxiety during the holidays is essential to your mental and physical health. It is necessary to know how to cope with anxiety and depression and recognize when support or help may be needed to manage.
Here’s what you need to know.
The holiday season is upon us. It can be common and normal to have feelings of anxiety during this time. Financial pressures, excessive commitments, and unrealistic expectations can trigger stress, anxiety, or depression.
For some, the holidays are a time of memories, some good or some unpleasant. For those separated from loved ones, it can be a time of sadness or grieving. Many experience feelings of isolation and loneliness.
Furthermore, during the winter months, the days are shorter and less sunlight can cause seasonal mood changes.
Anxiety is defined as feeling worried or nervous that something terrible is going to happen. Many people have these feelings from time to time.
During the holidays, Americans may feel the financial strain as it can be a season of shopping and gift-giving. They may have to come together with family members who they don’t often see or grieve separation from loved ones, and relationships can be challenging or cause anxiety and worry.
Furthermore, many adults have unrealistic expectations for the holidays, and that can create anxiety. And already busy schedules can feel the burden of holiday events and activities that can make you even more busy, anxious, or restless.
In some cases, anxious thoughts or feelings can become intense and excessive.
Individuals may become overly focused on common everyday events or situations that should not produce fear or worry, or at one time did not make the person feel that way. This type of anxiety usually causes physical symptoms such as sweating, racing heartbeat, or even weakness and feeling tired all the time.
Signs and symptoms of an anxiety disorder could include:
This second more extreme anxiety may be out of the norm, and may require a healthcare professional evaluation.
Many people overlook self-awareness and self-care during this season that is often about giving to others. But don’t forget, it’s hard to pour from an empty cup. You must take care of your mental and physical health to give others your time, effort, and resources.
When unpleasant feelings of worry or restlessness seem magnified or more frequent, here are some things you should be doing to make sure you can effectively cope with anxiety during the holidays:
If you have tried these tips above and don’t feel any relief, or if you battle with intense anxiety that interferes with your daily life, it may be time to ask for help.
A primary care physician can talk to you about your anxiety or may recommend further treatment.
SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental or substance use disorders.
If you would like more information on anxiety or want to talk about your symptoms with one of our board-certified physicians, click to schedule an appointment. If you have any suggestions for additional topics you want to read about, let us know! Don’t forget to check out our weekly education series Talk Tuesday on our podcast page, and follow us on social media.
