Dr. White Talks About Getting More Sleep

As a mother of 3 young children this post from Dr. White about healthy amounts of sleep really struck home. There are many factors that affect the amount of sleep we get on a regular basis. In many cases simple lifestyle changes could make a real positive impact. In other cases, a discussion with your physician may be an appropriate next step.

One New Year's Resolution Worth Keeping: Get More Sleep

Dr. David White, M.D.

Chief Medical Officer for Philips Home Healthcare Solutions

It's no secret that today's nonstop lifestyle is detrimental to our sleep. Whether due to work, television, stress or any number of other reasons, more Americans are staying up late and getting up early. The average American sleeps only six hours and 55 minutes per night during the week, according to the National Sleep Foundation. Additionally, 15 percent of adults and 7 percent of adolescents regularly sleep less than six hours per night. A lack of sleep is taking its toll. What's the price you pay for sleeping less than the currently recommended amount? Poor concentration. One early indicator of sleep deprivation is a loss of the ability to maintain attention or stay focused on a given task. Most of us can rise to the occasion and concentrate for a short period of time with generally good results. But, for activities like driving, or any task requiring over five to 10 minutes of serious concentration, inadequate sleep leads to poor outcomes. And, your cognitive impairment will get steadily worse for at least two weeks if you don't sleep longer at night. Many of us have jobs that do not require sustained attention, so we appear to function well with relatively little sleep. However, this does not mean that our brains are working optimally. It simply means that many of us are "on auto-pilot" at jobs that may not constantly challenge our minds. Memory loss. Another casualty of shortened sleep is your ability to retain memories and learn new skills. Memory consolidation (encoding or firmly implanting a memory in the brain) occurs the night after you learn something while you are sleeping. If you don't get a good night's rest after learning a motor task (like typing) or grasping an intellectual concept, your ability to perform that task or remember that concept is impaired. Bad choices and bad mood. Your ability to inhibit some risky behaviors is hampered by lack of sleep. Sleep deprivation is also well known to have a negative effect on emotions. Losing sleep flattens your mood and makes you a more dour, irritable and negative individual. Plus, the negative influence on your mood carries over to your ability to address personal or moral decisions effectively. Sleep experts are currently investigating whether inadequate sleep affects complex brain functions such as decision making, planning and goal-oriented activities. Certainly, a diminished ability to concentrate degrades cognitive ability. However, there is mixed evidence as to whether sleep loss specifically influences complex cognition apart from this loss of attention. It seems that some mental functions are more affected than others by sleep deprivation. Basic decision making, logical deduction and reading comprehension seem to be minimally affected by sleep loss. However, creativity and the innovative aspects of cognition decline. Whether sleep duration affects athletic performance is not as well studied. It seems quite clear that reaction time deteriorates with reduced sleep. To the extent reaction speed is important in an athletic event, worsening performance can be predicted. Most evidence suggests that short sleep reduces athletic prowess and that extending sleep duration may improve your performance in sports. Research addressing sleep and athletic performance indicates that: • Four hours' less sleep (eight to four hours) on a single night decreases accuracy and consistency in throwing darts. • One whole night without sleep yields slower times for short distance sprints, while an afternoon nap following a night of partial sleep deprivation improves sprint times. • Increasing sleep for 110 minutes per night for several weeks in college basketball players improves free throw and three-point goal percentage and results in faster sprint times. It seems pretty clear that there is lot of upside to getting enough sleep. A good night's rest goes a long way toward improving your reaction time, memory, complex cognition and probably athletic prowess. This year, resolve to create an effective nighttime routine and a positive sleep environment. Unplug from the TV or mobile devices before bed and limit your caffeine intake as it gets later in the day. Make sure you get those Zzzs; an adequate nightly sleep has a lot to offer. Article from Huffpost Healthyliving http://www.huffingtonpost.com/dr-david-white-md/need-sleep_b_1194893.html

Impact of Competitve Bidding Reported

Check out this survey reported on in HMENews. Patient access to diabetic supplies and patient choice has been drastically impacted by Competitive Bidding. Sadly, the results of this survey don't come as a surprise to many in our industry, but we're glad these groups have taken the time to bring this information to the forefront.

Survey: Bidding program really does limit access By Theresa Flaherty, Managing Editor 12.23.2011 CHICAGO - Beneficiaries in Round 1 competitive bid areas have limited access to the most widely used diabetes testing supplies, says the American Association of Diabetes Educators (AADE). A survey by the association found that mail order contract suppliers, on average, offered only 38% of the product brands that are listed on www.medicare.gov. Of the nine brands identified by the Office of Inspector General in a 2010 report as the top mail order brands by market share, contractor suppliers offered, on average, only 1.44 of the brands, or 16%. "We were getting all of these stories from our educators who were hearing about problems, or having their patients tell them they don't have a certain meter any more," said Martha Rinker, chief advocacy officer for the AADE. "When we talked to CMS about it, or any other party, they'd say it was just anecdotal. We thought this was the best way to get concrete information." With an average reimbursement cut of 56% for mail order diabetes supplies, it's not all that surprising that many suppliers are offering lesser-known--and less expensive--brands. Dr. Peter Cramton, a vocal critic of the current competitive bidding program, predicted providers would cherry pick and switch patients to different brands to try and squeeze out a profit. "It's in line with what I expected to see based on the current design of the program and the type of behavior it creates," said Tom Milam, a member of the Program Advisory and Oversight Committee (PAOC) and former CEO of mail-order diabetes supply firm AmMed Direct. For Round 2, which expands the mail order diabetes bid to all 50 states and several U.S. territories, CMS has implemented changes it believes will prevent low-ball bids: Contract winners must provide, at minimum, 50% of all the different types of diabetes testing supplies on the market by brand names; and contract winners are prohibited from influencing or providing incentives to beneficiaries to switch their brands. But unless CMS plans to police suppliers, stakeholders don't believe the provisions will work. "It's easy to bid and give a low bid and say you're going to do something and not do it," said Rinker. "I think it's going to be up to us who work with the patient community to get some congressional interest in this to make CMS take an interest."

Article from HMENews http://www.hmenews.com/?p=article&id=hm201112nviNI0

Bring Healthcare Back Home - Jack Resnick

This opinion piece was so spot on we felt it necessary to spread the message as much as possible.

Bring Health Care Home

By JACK RESNICK

Published: December 4, 2011

ONE of my patients called me with a high fever, chills and dropping blood pressure. He was 48 and had been a quadriplegic since he was shot during a robbery in the hardware store he owned. I called an ambulance and admitted him to the hospital, where we soon brought his urinary tract infection under control. But he developed a bedsore, which became infected with an antibiotic-resistant bacterium that breeds in hospitals. He didn't survive the hospitalization. This was in 1998. Ever since, I have struggled to treat my patients in their homes and avoid hospitals except when absolutely necessary. I practice general internal medicine on Roosevelt Island in New York City's East River, where many of my patients are elderly and homebound: survivors of the polio epidemic, people with multiple sclerosis, paraplegics, some on respirators. Patients who are treated at home by a doctor and nursing staff who know them intimately and can be available 24/7 are happier and healthier. This kind of care decreases the infections, mistakes and delirium, which, especially among the elderly, are the attendants of hospital care. And it is far more efficient. According to a 2002 study, for the patients treated by the Veterans Affairs' Home Based Primary Care program, the number of days spent in hospitals and nursing homes was cut by 62 percent and 88 percent, respectively, and total health care costs dropped 24 percent. I had one 83-year-old patient whose arthritis kept her from moving around, but she loved to talk about her career as a rocket scientist — working on weather rockets, not military ones. One day, a well-intentioned neighbor dropped by and called 911 after finding her feverish and dehydrated from diarrhea. My patient had never been treated before at the hospital she was taken to, and as a Russian immigrant, had no family here for the hospital to contact. She became disoriented; the hospital assumed she was demented and transferred her to a nursing home. It took me two months to track her down and many more to get her home, where, among well-known attendants and friends, she became lucid again. If she had lived out her days in an institution, she would have cost Medicare a great deal of money, and her life would have been shorter and far less happy. All too often, ambulances take people to the nearest hospital, not to the one where their doctor is on staff. State laws make it difficult to administer simple treatments in the home. Emergency rooms want to admit patients, and hospitals want to discharge them to nursing homes, rather than send them home. The good news is that last year's health care reform act included provisions for the creation of Independence at Home Organizations — groups of doctors and nurses who treat patients in their homes — and incentives to make that work appealing. The organizations can invest in extra services and home visits (for which Medicare typically will not reimburse them) because they will share in a cut of the savings that result from avoiding hospital visits and expensive procedures. The program is to go into effect no later than Jan. 1. However, Medicare is behind schedule and has not yet issued the rules or applications to begin the process. It has been focusing instead on another provision of the new law intended to deliver more efficient care, creating accountable care organizations — groups of hospitals, doctors and nurses who work together to treat patients. But Medicare should make getting the Independence at Home Organizations up and running a priority. We have the technology. Electronic medical records can give a doctor with an iPad as much information as any institution. With hand-held machines and a few drops of blood, doctors can get test results in seconds at a patient's bedside. Portable X-ray and ultrasound equipment can be wheeled into homes. Monitors can alert doctors to any change in a patient's heart rate. The fact that this care is possible at home means that the role of hospitals must change. Acutely ill patients who need operating rooms or intensive care will still be brought to hospitals. But they should be quickly discharged to the care of the doctors and nurses who know them best. For too long the institutions that make up our health care system — hospitals, insurers and drug companies — have told us that "more is better": more medicines, more specialists, more tests. To rein in spending and deliver better care, we must recognize that the primary mission of many an institution is its own survival and growth. We can't rely on institutions to shrink themselves. We need to give that job to patients and their doctors, and move health care into the home, where it is safer and more effective.

Jack Resnick has a solo internal medicine practice.

A version of this op-ed appeared in print on December 5, 2011, on page A27 of the New York edition with the headline: Bring Health Care Home.

http://www.nytimes.com/2011/12/05/opinion/bring-health-care-home.html

Traveling with oxygen this holiday season?

As the holiday season is upon us and people begin to make plans for travel, those utilizing medical equipment have a much more complicated task ahead of them. Are you or a loved one traveling with cumbersome oxygen equipment? Perhaps a rental Portable Oxygen Concentrator is a more convenient solution for you. A portable oxygen concentrator, (POC), is a portable device used to provide oxygen therapy to a patient at substantially higher concentrations than the levels of ambient air. It is very similar to a home oxygen concentrator, but it smaller in size and more mobile. The portable oxygen concentrator makes it easy for patients to travel freely; they are small enough to fit in a car and most of the major concentrators are now FAA approved. If you'd like help connecting to a medical equipment expert offering rental options contact HMEprovider.com online or by phone at 800-951-1213. HMEprovider.com can assist with other medical equipment needs as well.

New Study: HME saves billions

The following article is from HME News. We thought it was important to help in spreading this message to consumers and end users of medical equipment. New study: HME saves billions 'The return is so much greater than the dollars CMS is trying to save' By John Andrews GWCC - A new study that shows how the HME industry can save Medicare billions of dollars should have CMS, Congress and the general public intrigued and excited, its chief analyst says. Brian Leitten, a Florida-based consultant who, with the help of VGM Group, spent four months compiling data to make "The Case For Medicare Investment in DME," told Medtrade attendees Tuesday that CMS needs to "invest" in home medical equipment because it can save Medicare billions, along with generating handsome ROI for the program. To illustrate his point, Leitten presented cost savings figures for the mobility, respiratory and sleep therapy business segments. For mobility, the study looked at the impact of falls on the healthcare cost burden and came up with a staggering number: $20.5 billion. That figure represents how much beneficiary falls cost Medicare and the healthcare industry each year, he said, as falls cause severe injuries, resultant surgeries, extended acute care and sub-acute care stays. In calculating expenditures vs. savings, Leitten concluded that mobility saves Medicare $10.73 for every $1 dollar it invests and that the $1 invested is returned to Medicare in just over five months. The study makes the same assertions for respiratory therapy on COPD patients-an annual savings of $7.4 billion to $13 billion, and savings of about $6 for every $1 invested with a two month payback of that dollar. CPAP therapy saves Medicare nearly $11 billion by preventing the sleep apnea complications of coronary disease, congestive heart failure, atrial fibrillation and stroke, according to the study, which did not measure the other co-morbidities of hypertension, obesity and diabetes. CPAP's return on investment for Medicare's $1 investment is $6.21. "These findings should be intuitively obvious to the casual observer," Leitten concluded. "The return is so much greater than the dollars CMS is trying to save." http://www.hmenews.com/?p=article&id=hm201110wgitJT

Needing help getting in and out of your home?

Portable wheelchair ramps are a durable yet inexpensive alternative when a permanent ramp is not feasible or available. Most are designed for quick and easy use with scooters and all wheelchairs. Ramps are available in various types and sizes and are generally portable enough to be moved from place to place allowing for optimal mobility. Suitcase Ramp: Strong single fold ramp that provides a safe solution for accessibility while also being light weight. Trifold Ramp: Portable ramp used by scooters and wheelchairs to easily access steps, vehicles and raised landings. Threshold Ramp: Portable ramp to be used indoor and outdoor to assist in ground-to-sill transition. Pathway Ramp: Semi-permanent ramp with a no-skid surface ideal for scooters, walkers, wheelchairs, canes and crutches. Did you know a local home accessibility expert can also provide…

• On-site evaluation by a trained, certified ramp expert?
• Installation and removal of your ramp?
• A complete home safety and accessibility evaluation? Many experts also provide grab bar installation, recommendations on accessible fixtures and equipment and adaptive equipment to prevent injury and reduce construction costs.

Let your voice be heard!

At HMEprovider.com we have the pleasure of talking to many consumers of medical equipment products and services each day. Over the course of the last week we've again been hearing from frustrated Medicare beneficiaries unable to locate the products the need.... in same cases life sustaining items. It seemed appropriate to again share the contact information for the patient advocacy group People for Quality Care.  Unfortunately just being angry about this flawed program is not enough. The only way change will happen is to unite and share our stories of struggle as we work to stop Competitive Bidding. If you have a story to share about the affect Medicare's Competitive Bidding program has had on your access to equipment and quality service reach out to People for Quality Care at 800-260-7913