There is nothing about offering healthcare upstream, earlier, smarter, more connected, that is against the rules, the legislation, the CMS regs. There are in fact specific programs in the ACA that fund or facilitate such attempts.

As for “investors,” I assume here you are addressing the employers. This is not a problem, since the return on investment for propagating health among their own employees is high, immediate, provable in prospect, and measurable in retrospect. Working with healthcare institutions to help provide care, preventive care, public health, and healthy communities work is low in cost, and can be show to reduce the institution’s cost, and therefore the employer’s costs in turn. The level of cost involved goes down drastically the further from the institution’s threshold. The levels of expenditure are well within the scale that for-profit corporations already spend on do-good community work just to improve their image.

Hank Gardner. M.D.

I believe all patients have come to recognize the role of NP’s and DNP’s in the healthcare field. I along with many of my friends often opt to see the NP or if available a DNP instead of the MD when making an appointment for “small” ailments (I know every ailment could potentially be a symptom of something larger) like a sinus infection or other common ailments. Notice I said “opt” to see a NP or DNP. It is always my choice as to which member of my healthcare team I will see for that ailment.

When I opt to see the NP or DNP it is for the following reasons:
1. It is always quicker to get in to see the NP or DNP.
2. In my opinion and the opinion shared by my friends, both are very qualified to treat common ailments (see disclaimer above).
3. Given the choice I usually choose the DNP because it just makes sense the DNP has more education than the NP.
3. I know both my NP and DNP will consult with my MD on my treatment and care. I know that because it is made clear to me by my MD’s staff.

Sometimes I opt to see my MD. For things like my yearly physical and lab work I prefer my MD perform a comprehensive analysis of my overall health. Again, I don’t know if that is necessary but it is how I manage my own heath care. That is what gives me peace of mind. To each their own.

I do not confuse an MD with a NP or DNP. In my MD’s office the DNP is referred to as the Doctor-Nurse and the NP is referred to as the … well, NP.

I address my DNP as Doctor because that is what my MD calls her. That doesn’t mean I am a confused and consider the DNP to be the same as the MD. I recognize they have different skill sets. I consider it my MD’s job to ensure I am educated about the options I have for care while in her office.

For all the MD’s on this blog; thank you for your dedication to your field of practice. We need you and respect you for what you have done, not for your title. But be very clear, the days of seeing you as a demi-God are over. You are instead a cherished member of my health care team and I take your advice and counsel seriously, but not without using my own resources and common sense. That was my parent’s generation, not mine. (I am 49 yrs old).

One more thing then I will get off my soapbox. My parents live in a very rural area and were thrilled when a DNP opened a practice within 10 miles of their home. Even old as they are they are not confused about the skill set their new “Doctor” is bringing. They just like having someone close for common ailments rather than having to travel 40 miles to their “Real Doctor” as they call him. It’s a wonderful option for their small community.

For all the DNP’s on this blog; thank you for your dedication to your field of practice (nursing). Although I love my MD I sometimes want and need your extra level of caring for my whole health not just what I walked in the door complaining about that day. I know you are also very busy but I guess you are just better at bedside manner than my MD. Thank you for that.

For all the NP’s: Love you too and thank you for stepping outside the hospital and into my MD’s office to provide me with your knowledge and care.

So… that is what Ms. Average Patient has to say to this blog which by the way I came across because my friend said his daughter just got a medical degree as a Doctors Assistant. I admit I am still confused about what a PA is. LOL.
But I promise you I will figure it out. As will we all. Remember, we can be taught and we can learn.

Bottom line; do not under estimate your client base. We are much smarter than you think. I have been personally offended by Gern on this blog. Really, come on down from Mt. Olympus and join the rest of us when you are ready. My Doc is nothing like you even though she has the same credentials. She lifts up her “helpers” and shows them the upmost respect which in turn builds my confidence in their abilities.

Before you even start… I am not an MD nor a Nurse nor a NP nor a DNP nor a PA nor a… whatever else there is. I am a Project Manager with a Telecom company. I’m just a little tired of being an underestimated client/patient. I love having options managing my own healthcare. I don’t care what ANY of you label yourself. Just keep doing what you do.

Unless the entire ACA is overturned by the Supreme Court (which is extremely unlikely) the states have two choices: either they set up Exchanges, or the Federal Government will set up Exchanges for them.

To make the decision easier, the HHS recently announced that states could if they chose, partner with HHS to set up Exchanges. In the annoucement, HHS extend a hard statutory 2015 deadline for state exchanges to attain fiscal self-sufficiency to early 2018.. HHS also explained that exchange implementation grants would be available throughout 2014 and that states would have three years to spend money that they could receive up to 2015.

“What that suggests is that a slower ramp-up is permissible,” said Bruce Caswell, president and general manager of the health services segment for Maximus, a Reston, Va.-based government contractor.” (See Modern HealthCare

This means that even if a state has dragged its feet in planning for an Exchange, it would be able to meet a 2018 deadline, and at that point, take over the Exchange itself. .

Only 3 states have actually announced that they want nothing to do with
Exchanges– Louisiana, Florida and Alaska.

But the law is the law . As an Op-ed in Pennsylvania recently pointed out:
“Health Insurance Exchanges are mandated by federal law, and absent a ruling from the Supreme Court they will be implemented in Pennsylvania one way or another. The real issue is whether we set up our Exchange or whether we let HHS do it to us.” http://www.pennlive.com/editorials/index.ssf/2012/03/gov_tom_corbett_wants_health_i.html

Moreover, voters are becoming more aware of Exchanges, and the number who say that they want to shop for insurance in an Exchange is growing:
“More people looking to buy health insurance say they would shop for coverage through a health insurance exchange if they had the opportunity, according to a J.D. Power and Associates health plan study.”
See http://hr-benefit.com/2012/05/23/interest-in-health-insurance-exchanges-grows/

Who is spending the money, using the health care resources? This follows a Pareto distribution: 20 percent of the people spend 80 percent of the money; 5 percent of the people spend half the money; 1 percent of the people spend 20 percent of the money.

He’s being polite, but he’s mostly talking about us old folks. Here’s the link…
http://thehealthcareblog.com/blog/2012/05/23/save-the-country-with-preventive-care/

Since I’m here, take a look at my list of NON-medical costs overloading the economic train wreck we call health care in America.

http://thehealthcareblog.com/blog/2012/04/01/what-if-the-supreme-court-2/comment-page-1/#comment-213509

No, I haven’t read them, but in my post retirement work for eight-plus years in the so-called “senior care” sector I have watched and lived them. It has made me an evangelist for advance directives and palliative/hospice care.

My observation is that the problem lies more with family members in denial than the people running up the bills. It’s not always the case, but more often than not all that keeps old people hanging on is that those closest to them refuse them permission to leave.