Cynthia Marcotte Stamer Caregivers, Eldercare, employer, fitness, health, health care, health care provider, Health Care Providers, health insurance, health plans, human resources, Patient Empowerment, Physicians, public health, Resources, safety, Uncategorized, wellness, Wellness Programs

Practice Pool Safety

Summertime means pool time.  

Splashing around in the water provides a wonderful opportunity to stay cool and have fun … as long as everyone stays safe.

News reports of an Ohio lifeguard saving a toddler the first day on the job is a timely  reminder of the importance of knowing and constantly practicing pool safety when you or someone near you is in or near a pool or other water.

Downing & Near Drowning Very Common

Centers for Disease Control (CDC) data shows the importance of water safety and vigilance:

  • Drowning ranks fifth among the leading causes of unintentional injury death in the United States.
  • 10 people die from unintentional drowning every day on average.
  • Children are particularly African American children 5-19 drown in swimming pools at rates 5.5 times higher than those of whites. This disparity is greatest among those 11-12 years where African Americans drown in swimming pools at rates 10 times those of whites. are children 14 and younger.
  • For every child who dies from drowning, another five receive emergency department care for nonfatal submersion injuries.
  • More than 50% of drowning victims treated in emergency departments (EDs) require hospitalization or transfer for further care (compared with a hospitalization rate of about 6% for all unintentional injuries).
  • Near drownings are a leading cause of permanent brain injury.  These nonfatal drowning injuries can cause severe brain damage that may result in long-term disabilities such as memory problems, learning disabilities, and permanent loss of basic functioning (e.g., permanent vegetative state).

While anyone in or around the water may get into trouble under the right circumstances, the victims overwhelmingly tend to be young children and are mostly males.  According to the CDC:

  • Children ages 1 to 4 have the highest drowning rates. In 2014, among children 1 to 4 years old who died from an unintentional injury, one-third died from drowning, most of which occur in home swimming pools.
  • Male and minorities have a higher likelihood of becoming victims.  CDC statistics show:
    • Nearly 80% of people who die from drowning are male; and
    • African American children 5-19 drown in swimming pools at rates 5.5 times higher than those of whites. This disparity is greatest among those 11-12 years where African Americans drown in swimming pools at rates 10 times those of whites.

Factors Influencing Drowning Risk

CDC data also reveals the main factors that affect drowning risk:

  • Lack of swimming ability,
  • Lack of barriers to prevent unsupervised water access,
  • Lack of close supervision while swimming,
  • Location,
  • Failure to wear life jackets,
  • Alcohol use, and
  • Seizure disorders.

Preventing Drowning Injuries

CDC data also provides helpful tips about steps people can take to reduce the risk of drowning or near drowning deaths and injuries including the following key safety measures:

  • Close supervision and vigilance is critical whether or not an individual can swim. Drowning can happen quickly and quietly anywhere there is water (such as bathtubs, swimming pools, buckets), and even in the presence of lifeguards.
  • Swimming lessons are a key tool to reduce the risk of drowning in young children.  The CDC reports participation in formal swimming lessons can reduce the risk of drowning among children aged 1 to 4 years.
  • Barriers, such as pool fencing, prevent young children from gaining access to the pool area without caregivers’ awareness. A four-sided isolation fence (separating the pool area from the house and yard) reduces a child’s risk of drowning 83% compared to three-sided property-line fencing.

CDC demonstrates that age or location may increase the need for added diligence and supervision.  The data shows that people of different ages drown in different locations.

  • Most children ages 1-4 drown in home swimming pools.
  • The percentage of drownings in natural water settings, including lakes, rivers and oceans, increases with age.
  • More than half of fatal and nonfatal drownings among those 15 years and older (57% and 57% respectively) occurred in natural water settings.
  • In 2010, the U.S. Coast Guard received reports for 4,604 boating incidents; 3,153 boaters were reported injured, and 672 died. Most (72%) boating deaths that occurred during 2010 were caused by drowning, with 88% of victims not wearing life jackets.
  • For persons with seizure disorders, bathtub drowning is not uncommon.  Drowning is the most common cause of unintentional injury death, with the bathtub as the site of highest drowning risk.

The data also makes clear drinking and water sports are a dangerous cocktail.   According to the CDC, among adolescents and adults:

  • Alcohol use is involved in up to 70% of deaths associated with water recreation;
  • Nearly 1/4 of emergency room visits for drowning; and
  • About 1/5 of reported boating deaths.

Alcohol influences balance, coordination, and judgment, and its effects are heightened by sun exposure and heat. Of course alcohol consumption by others around a swimmer who has been drinking undermine the awareness of those that would be available to rescue and impaired swimmer too.
The bottom line:  Alcohol and water don’t mix.

Water Safety To-Do List

In light of the known risks, Americans, and their employers, health plans, health care providers, and communities should take steps to keep themselves and others safe while enjoying pools, lakes and other rivers this Summer.

Practice water safety and urge others to do the same by taking the following common sense steps:

  • Supervise When in or Around Water 

Designate a responsible adult to watch young children while in the bath and all people swimming or playing in or around water.

Supervisors of preschool and other young children should  be close enough to reach the child at all times (@touch supervision”).

Because drowning occurs quickly and quietly, supervising adults should not be involved in any other distracting activity (such as drinking, reading, playing cards, talking on the phone, or mowing the lawn) while supervising children, even if lifeguards are present.

Parents considering authorizing swimming field trips led by childcare providers or allowing their children to swim under the supervision of others should investigate the adequacy and training of staff to meet these guidelines.

  • Use the Buddy System. 

Always swim with a buddy. 

  • Lifeguards

Select swimming sites that have lifeguards when possible.  When hosting a social or workplace event near or involving swimming or other water activities, consider hiring one or more lifeguards to monitor the activity and be prepared to respond in case of an emergency.

  • Seizure Disorder Safety

If you, a worker or a family member has a seizure disorder, provide one-on-one supervision around water, including swimming pools. Consider taking showers rather than using a bath tub for bathing. Wear life jackets when boating.

  • Learn to Swim & Make Sure Others In Or Near The Water Can Swim

Formal swimming lessons can protect young children from drowning. However, even when children have had formal swimming lessons, constant, careful supervision when children are in the water, and barriers, such as pool fencing to prevent unsupervised access, are still important.

  • Learn Cardiopulmonary Resuscitation (CPR)

In the time it takes for paramedics to arrive,  CPR skills could save someone’s life. Many free or low-cost options for learning CPR are readily available from the American Red Cross and others.  If you host people around your pool or other water related event, consider hosting a CPR training at one of your upcoming gatherings.

  • Use Life Jackets, Not Air-Filled or Foam Toys.

Provide an wear Coast Guard approved life jackets in good condition as needed.

Don’t use air-filled or foam toys, such as “water wings”, “noodles”, or inner-tubes, instead of life jackets. These toys are not life jackets and are not designed to keep swimmers safe.

  • Don’t Mix Water & Alcohol

Avoid drinking alcohol before or during swimming, boating, or water skiing.  Do not drink alcohol while supervising children.  Do not serve or control the consumption of alcohol by guests when hosting events involving boating, swimming or other water sports.

  • Guard Against “Hypoxic Blackout”

Teach your children and don’t let swimmers hyperventilate before swimming underwater or try to hold their breath for long periods of time. This can cause them to pass out (sometimes called “hypoxic blackout” or “shallow water blackout”) and drown.

  • Prevent Recreational Water Illnesses

Learn how to and act to prevent recreational water illnesses by following the CDC’s recommended 12 Steps for Prevention of Recreational Water Illnesses.

  • Watch For Hazardous Weather And Conditions

Know the local weather conditions and forecast before swimming or boating. Strong winds and thunderstorms with lightning strikes are dangerous.

  • Practice and Maintain Home Pool Safety

If you have a swimming pool at home, consider the following special safeguards:

  • Install a four-sided pool fence at least four feet high with that completely separates the pool area from the house and yard. The fence should be at least 4 feet high with self-closing and self-latching gates that open outward with latches out of reach of children. Also consider additional barriers such as automatic door locks and alarms to prevent access or alert you if someone enters the pool area.
  • Remove floats, balls and other toys from the pool and surrounding area immediately after use so children are not tempted to enter the pool area unsupervised.
  • Stay vigilant at all times.  Supervise your family and guests.  Require adult guests to provide touch supervision for their children in the pool.   Hire a lifeguard during parties or at other times when your ability to provide touch supervision isn’t sufficient.
  • Don’t swim or allow others to swim after or while consuming alcohol.

Keep in mind that a drowning or near drowning of a family member or guest in your pool presents both a substantial legal exposure as well as risks an irreversible personally devastating experience for all involved.  Don’t let fun get ahead of common sense or safety.

  • Practice Natural Water Safety

If you are in and around natural water settings:

  • Use U.S. Coast Guard approved life jackets regardless of the distance to be traveled, the size of the boat, or the swimming ability of boaters.
  • Know the meaning of and obey warnings represented by colored beach flags. .
  • Watch for dangerous waves and signs of rip currents such as water that is  discolored  choppy, foamy, or filled with debris and moving in a channel away from shore.
  • If you are caught in a rip current, swim parallel to shore. Once free of the current, swim diagonally toward shore.

Also plan ahead and take some common sense steps to prepare for the possible need for a timely rescue before pushing off the boat from the shore or entering the water. Among other things:

  • Let at least a couple people not participating know where you are, where you are going, what you plan to do and when you should be back or checkin;
  • Confirm that at least one cellphone has service and keep it with you and working;
  • Consider using the share my location or other feature on your cellphone or other device to help emergency or other rescue personnel find you in the event of an emergency;
  • Discuss safety rules with all participants before getting started;and
  • Enforce safety throughout the activity.

Remember and remind guests that a drowning or near drowning isn’t worth the risk.

  • Be Prepared: Know CPR & Plan Ahead

Since seconds matter when a drowning or near drowning happens, be prepared for a possible emergency before anyone gets in the water.  At minimum:

  • Know CPR and encourage others to do the same;
  • Prominently your address and keep a telephone available in your pool area; Drop a locator pin on your cell phone or otherwise take note of your location if you were on natural water.

Cooling off in the pool or lake can be a fun way to stay comfortable in the summer. Plan ahead and practice water safety as you and your friends enjoy the fun.

Cynthia Marcotte Stamer Alzheimer's, Assisted living, Caregivers, Disabilities, Eldercare, Employee Benefits, employer, health, health care, Health Care Providers, Long term care, nursing home, Patient Empowerment, physician, Physicians, safety, Skilled nursing facility, Uncategorized, wellness

When A Loved One Needs Assistance With Daily Living

While living in a well-run assisted-living or other support of residential living arrangement can provide many positive social, safety and healthcare benefit for patients with declining physical or cognitive abilities, most elderly and disabled individuals dread and resist moving from their home to an assisted living or other supportive care living environment.

When transitioning a patient to an assisted living or other care environment, caregivers often must override and understand what preference by the patient to live independently in order to provide support to patient needs to be safe.

Like the surrender of driving privileges, the loss of choice that results from compulsory relocation to a new living environment for an elderly or disabled person forces the patient concurrently to confront his declining functionality and his declining self-determination.

Recognizing this, caregivers should seek to involve the patient as much as possible in making the new living arrangements.

Talking about the possibility of a future need her assisted living care well in advance at the onset of disabling condition can help.

Planning ahead can help patients and their families to be prepared to pick up a facility where the patient may already have friends for siding will be familiar with the staff or the facility reputation.

Many assisted-living providers also sponsor social or other community out reach events for members of the community living independently.  Others offer daycare or other intermittent care opportunities.  Still others may offer temporary assisted-living or stay arrangements following episodes of chemotherapy or other intensive inpatient care.  Participation in these opportunities for involvement gives a patient an opportunity to try out the facility in their services before the patient actually needs to relocate as well as gives the family and the patient the opportunity to check out the facility before making a choice.

When relocating the patient to an assisted living or other facility, careful planning can help ensure that the patient’s room and other living quarters are as home like as possible.  To the extent that space allows, try to bring to the facility some furniture, photographs and other special possessions that will make the new living space feel more like home.

It often also helps if family members participate in the daily flow of activities such as going to lunch or dinner or participating in social gatherings often on for the first few weeks to help encourage the patient to participate in acclimatize them to the new opportunities and friendships.

The best way to head off problems is to detect issues early and intervene.  Even after the patient as well settled family members and friends should drop by often and at varying times to check on the patient’s physical and emotional status, keep the patient engaged and to check up on the care and service that the patient is receiving.

Family members and friends should learn and watch for signs of abuse or neglect.  Many excellent sources of education and resources are available through state Agency responsible for oversight in care of the aging and disabled like this list of elder neglect warning signs  published by the State of Idaho.

To help safeguard your loved one, make sure you and others with a close relationship to the patient check in on the patient regularly.  Set aside time to check in on the patient as well as to talk to the patient to detect signs of abuse, neglect, deterioration in the patient’s physical, cognitive or emotional status or other signs of possible concern.  Even something so seemingly minor as a recurrent failure at the facility staff timely to assist the patient to make her bed or with other schedule services should be monitored and addressed.  Beyond the actual assistance with the performance of the designated chores, the interactions scheduled with staff to perform these chores are critical monitoring activities for the facility.  Failing to timely perform the services means the facility is not keeping on top of their monitoring and other care duties for the patient and should be addressed.

Be A Healthcare Hero: Join Project COPE

Follow, like and share our articles and resources in this ProjectCOPE.blog, and follow, like, share your comments and ideas, and participate in our Facebook @ProjectCOPECOALITION or on LinkedIn to:

  • Learn tips, tools and other information on how you and your family can manage your health and wellness needs?
  • Get ideas on how to understand, shape and use your healthcare and coverage?
  • Share your ideas and input about health and health coverage issues and policies with elected leaders and regulators?
  • Monitor health, wellness and other developments?
  • Help your providers, family, friends and community cope with health care, disability, aging and wellness challenges?

Despite an endless stream of well-meaning market and governmental reforms over the past 25 years, the U.S. health care system is in crisis. American patients, their families and other caregivers, their employers, their health benefit programs, their health care providers, the communities and even our federal health care budget increasingly are burdened and overwhelmed by the mounting obstacles to caring for our ill, disabled, and aging citizens within our health care system and the extraordinary expense of maintaining and using that system.

As Congress takes up reform again, it is critical that Americans act to protect their own and their families’ health care and control the financial burdens of health care by getting informed, providing clear and consistent direction to Congress and other reformers and taking other actions to empower and care for themselves and their loved ones within our evolving health care system.

©2017 Cynthia Marcotte Stamer. Non-exclusive right to republish licensed to Solutions Law Press, Inc. For information about republication of this or other materials and programs of the author, email the author here.   All rights reserved.

Cynthia Marcotte Stamer Alzheimer's, Asperger's, Assisted living, Caregivers, Disabilities, Eldercare, employer, health, health care, health care provider, Health Care Providers, Health Care Quality, health insurance, health plans, human resources, Long term care, Mental Health, nursing home, Patient Empowerment, physician, Physicians, Psychiatry, public health, Public Policy, Rehabilitation hospital, Resources, Skilled nursing facility, Uncategorized

Protect Your Loved One From Abuse

Millions of elderly and disabled Americans live in nursing, assisted living and other care facilities. 

While patients and their families admit patients to these facility rightly expect these care providers to appropriately and safely care for their patients, unfortunately and too many instances the care that their family member receives not only is disappointing, but actually harmful.

And alarmingly long list of negligence and other liability judgments as well as oversight and enforcement work by the Department of Health and Human Services, States’ department of aging, watchdog agencies, nursing home litigators reveal commonly recurring problems account for many of these tragedies   Problems range from overmedicating residents, or patient abuse or neglect. 

Patients and their families need to recognize the need to carefully select and oversee the care of their family member in these facilities   Many resources are available to help educate family members and friends search as this YouTube video about nursing home abuse recently shared by the Department of Health and Human Services.  

Careful investigation and credentialing at the facilities your love will stay in before and during their stay is an important part of the process.  No matter how good the facility looks in this credentialing, families and caregivers and patient must keep in mind that even the best facilities can experience problems of neglect, unawareness, miscommunication, miss perception and even abuse.  For this reason, families should keep in mind that frequent visits from family members and other visitors familiar with and loyal to the patient at different times can make a huge difference in helping the patient to get the best care possible, identifying potential issues services or quality and detecting more quickly service disruptions or deficiencies, changes in their family members conditions that need attention, signs of abuse or neglect and other concerns.

To learn more about what you and your family can do to be more effective participants in your healthcare and help improve health care for others, follow, share input and resources and get involved in our Project COPE initiative by following and sharing our updates in this ProjectCOPE.blog, on Facebook @ProjectCOPECOALITION or on LinkedIn.

Call To Action: Become a Project COPE Healthcare Hero

Despite an endless stream of well-meaning market and governmental reforms over the past 25 years, the U.S. health care system is in crisis. American patients, their families and other caregivers, their employers, their health benefit programs, their health care providers, the communities and even our federal health care budget increasingly are burdened and overwhelmed by the mounting obstacles to caring for our ill, disabled, and aging citizens within our health care system and the extraordinary expense of maintaining and using that system. 

 As Congress takes up reform again, it is critical that Americans act to protect their own and their families’ health care and control the financial burdens of health care by getting informed, providing clear and consistent direction to Congress and other reformers and taking other actions to empower and care for themselves and their loved ones within our evolving health care system.
©2017 Cynthia Marcotte Stamer. Non-exclusive right to republish licensed to Solutions Law Press, Inc. For information about republication of this or other materials and programs of the author, email the author here. All rights reserved.

Cynthia Marcotte Stamer Alzheimer's, Asperger's, Caregivers, Disabilities, Employee Benefits, employer, health, health care, health care provider, Health Care Quality, Mental Health, Patient Empowerment, physician, Resources, Uncategorized, wellness, Wellness Programs

Empowering Dying Patients Through Choice

The self-composed obituary of Sonia Todd is a touching reminder of the power and importance of patient choice even for patients facing death.  

The success of our health science and the ever extraordinary miracles it achieves to delay death often dupes Americans into forgetting that life is a process that ultimately leads to death.   Regardless of the ultimate pathway traveled from life to death by any particular person, health care ultimately is mostly about delaying death and hopefully, wringing out as much joy and functionality for the afflicted individual with the minimum of pain and suffering. 

Aging, illness, injury and disability often disempower those afflicted and those who love and care for them.   Eventually, everyone runs out of options to keep living. The realization that this time has come for a patient often is devastating for patients and their families. 

When the fight for life becomes futile, loved ones often don’t know what to do next to help the patient.

When death ultimately can not be avoided, empower the patient by supporting reasonable choices about their death and dying.  Allowing patients to make choices about how to live out their last days or moments, their treatment, and other details of their impending death and to plan and talk about what will happen after their death can empower many patients and their families through the process of death and coping after death.  

About The Author

Recognized by LexisNexis® Martindale-Hubbell® as a “AV-Preeminent” (Top 1%/ the highest) and “Top Rated Lawyer,” with special recognition as “LEGAL LEADER™ Texas Top Rated Lawyer” in Health Care Law and Labor and Employment Law; as among the “Best Lawyers In Dallas” for her work in the fields of “Health Care,” “Labor & Employment,” “Tax: Erisa & Employee Benefits” and “Business and Commercial Law” by D Magazine, Cynthia Marcotte Stamer is nationally and internationally known for her 29 plus years’ of work as a practicing attorney on health care, health benefit, health policy and regulatory affairs and other health industry concerns as a practicing attorney as well as her lifelong involvement as a health, disability  and retirement and workforce thought leader, management consultant, author, public policy advocate and lecturer.

Throughout her adult life and nearly 30-year legal career, Ms. Stamer’s legal, management and governmental affairs work has focused on helping health industry, health benefit and other organizations and their management use the law, performance and risk management tools and process to manage people, performance, quality, compliance, operations and risk. Highly valued for her rare ability to find pragmatic client-centric solutions by combining her detailed legal and operational knowledge and experience with her talent for creative problem-solving, Ms. Stamer supports these organizations and their leaders on both a real-time, “on demand” basis as well as outsourced operations or special counsel on an interim, special project, or ongoing basis with strategic planning and product and services development and innovation; workforce and operations management, crisis preparedness and response as well as to prevent, stabilize and cleanup legal and operational crises large and small that arise in the course of operations. Her experience encompasses helping health industry clients manage workforce, medical staff, vendors and suppliers, medical billing, reimbursement, claims and other provider-payer relations, business partners, and their recruitment, performance, discipline, compliance, safety, compensation, benefits, and training ;board, medical staff and other governance; compliance and internal controls; strategic planning, process and quality improvement; change management; assess, deter, investigate and address staffing, quality, compliance and other performance; meaningful use, EMR, HIPAA and other data security and breach and other health IT and data; crisis preparedness and response; internal, government and third-party reporting, audits, investigations and enforcement; government affairs and public policy; and other compliance and risk management, government and regulatory affairs and operations concerns.

The American Bar Association (ABA) International Section Life Sciences Committee Vice Chair, a Scribe for the ABA Joint Committee on Employee Benefits (JCEB) Annual OCR Agency Meeting, former Vice President of the North Texas Health Care Compliance Professionals Association, past Chair of the ABA Health Law Section Managed Care & Insurance Section, past ABA JCEB Council Representative, past Board President of Richardson Development Center (now Warren Center) for Children Early Childhood Intervention Agency, past North Texas United Way Long Range Planning Committee Member, and past Board Member and Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has worked closely with a diverse range of physicians, hospitals and healthcare systems, DME, Pharma, clinics, health care providers, managed care, insurance and other health care payers, quality assurance, credentialing, technical, research, public and private social and community organizations, and other health industry organizations and their management deal with governance; credentialing, patient relations and care; staffing, peer review, human resources and workforce performance management; outsourcing; internal controls and regulatory compliance; billing and reimbursement; physician, employment, vendor, managed care, government and other contracting; business transactions; grants; tax-exemption and not-for-profit; licensure and accreditation; vendor selection and management; privacy and data security; training; risk and change management; regulatory affairs and public policy and other concerns.

As a core component of her work, Ms. Stamer has worked extensively throughout her career with health care providers, health plans and insurers, managed care organizations, health care clearinghouses, their business associates, employers, banks and other financial institutions, management services organizations, professional associations, medical staffs, accreditation agencies, auditors, technology and other vendors and service providers, and others on legal and operational compliance, risk management and compliance, public policies and regulatory affairs, contracting, payer-provider, provider-provider, vendor, patient, governmental and community relations and matters including extensive involvement advising, representing and defending public and private hospitals and health care systems; physicians, physician organizations and medical staffs; specialty clinics and pharmacies; skilled nursing, home health, rehabilitation and other health care providers and facilities; medical staff, accreditation, peer review and quality committees and organizations; billing and management services organizations; consultants; investors; technology, billing and reimbursement and other services and product vendors; products and solutions consultants and developers; investors; managed care organizations, insurers, self-insured health plans and other payers; and other health industry clients to establish and administer compliance and risk management policies; comply with requirements, investigate and respond to Board of Medicine, Health, Nursing, Pharmacy, Chiropractic, and other licensing agencies, Department of Aging & Disability, FDA, Drug Enforcement Agency, OCR Privacy and Civil Rights, Department of Labor, IRS, HHS, DOD, FTC, SEC, CDC and other public health, Department of Justice and state attorneys’ general and other federal and state agencies; JCHO and other accreditation and quality organizations; private litigation and other federal and state health care industry investigation, enforcement including insurance or other liability management and allocation; process and product development, contracting, deployment and defense; evaluation, commenting or seeking modification of regulatory guidance, and other regulatory and public policy advocacy; training and discipline; enforcement, and a host of other related concerns for public and private health care providers, health insurers, health plans, technology and other vendors, employers, and others.and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns.

Past Chair of the ABA Managed Care & Insurance Interest Group and, a Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation, Ms. Stamer also has extensive health care reimbursement and insurance experience advising and defending health care providers, payers, and others about Medicare, Medicaid, Medicare and Medicaid Advantage, Tri-Care, self-insured group, association, individual and group and other health benefit programs and coverages including but not limited to advising public and private payers about coverage and program design and documentation, advising and defending providers, payers and systems and billing services entities about systems and process design, audits, and other processes; provider credentialing, and contracting; providers and payer billing, reimbursement, claims audits, denials and appeals, coverage coordination, reporting, direct contracting, False Claims Act, Medicare & Medicaid, ERISA, state Prompt Pay, out-of-network and other nonpar insured, and other health care claims, prepayment, post-payment and other coverage, claims denials, appeals, billing and fraud investigations and actions and other reimbursement and payment related investigation, enforcement, litigation and actions.

Heavily involved in health care and health information technology, data and related process and systems development, policy and operations innovation and a Scribe for ABA JCEB annual agency meeting with OCR for many years who has authored numerous highly-regarded laws, regulations, policies, programs, publications and training programs on HIPAA and other data security, privacy and use, EMR, billing and reimbursement, quality measurement,  privacy and other health , HIPAA, FACTA, PCI, trade secret, physician and other medical confidentiality and privacy, federal and state data security and data breach and other information privacy and data security rules and many other data, technology and systems concerns.  

A former lead consultant to the Government of Bolivia on its Pension Privatization Project with extensive domestic and international public policy and governmental and regulatory affairs experience, Ms. Stamer also is widely recognized for regulatory and policy work, advocacy and outreach on healthcare, education, aging, disability, savings and retirement, workforce, ethics, and other policies. Throughout her adult life and career, Ms. Stamer has provided thought leadership; policy and program design, statutory and regulatory development design and analysis; drafted legislation, proposed regulations and other guidance, position statements and briefs, comments and other critical policy documents; advised, assisted and represented health care providers, health plans and insurers, employers, professional. and trade associations, community and government leaders and others on health care, health, pension and retirement, workers’ compensation, Social Security and other benefit, insurance and financial services, tax, workforce, aging and disability, immigration, privacy and data security and a host of other international and domestic federal, state and local public policy and regulatory  reform and enforcement.      Her work includes both regulatory and public policy advocacy and thought leadership, as well as advising and representing a broad range of health industry and other clients about policy design, drafting, administration, business associate and other contracting, risk assessments, audits, breach prevention and mitigation and other risk prevention and mitigation, investigation, reporting, mitigation and resolution of known or suspected violations or other incidents and responding to and defending investigations or other actions by plaintiffs, DOJ, OCR, DOL, HHS, FTC, Insurance Departments, state attorneys’ general and other federal or state agencies, other business partners.  Her advocacy and regulatory affairs and public policy work, involvement and participation also includes numerous client engagements, as well as as founder and Executive Director of the Coalition for Responsible Health Policy and its PROJECT COPE: the Coalition on Patient Empowerment, adviser to the National Physicians Congress for Healthcare Policy, leadership involvement with the US-Mexico Chamber of Commerce, the Texas Association of Business, the ABA JCEB, Health Law, RPTE, Tax, Labor, TIPS, International Life Sciences, and other Sections and Committees, SHRM Governmental Affairs Committee and a host of other involvements and activities.

A Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation, Ms. Stamer also shares her thought leadership, experience and advocacy on these and other related concerns by her service in the leadership of the Solutions Law Press, Inc. Coalition for Responsible Health Policy, its PROJECT COPE: Coalition on Patient Empowerment, and a broad range of other professional and civic organizations including North Texas Healthcare Compliance Association, a founding Board Member and past President of the Alliance for Healthcare Excellence, past Board Member and Board Compliance Committee Chair for the National Kidney Foundation of North Texas; former Board President of the early childhood development intervention agency, The Richardson Development Center for Children (now Warren Center For Children); current Vice Chair of the ABA Tort & Insurance Practice Section Employee Benefits Committee, current Vice Chair of Policy for the Life Sciences Committee of the ABA International Section, Past Chair of the ABA Health Law Section Managed Care & Insurance Section, a current Defined Contribution Plan Committee Co-Chair, former Group Chair and Co-Chair of the ABA RPTE Section Employee Benefits Group, past Representative and chair of various committees of ABA Joint Committee on Employee Benefits; a ABA Health Law Coordinating Council representative, former Coordinator and a Vice-Chair of the Gulf Coast TEGE Council TE Division, past Chair of the Dallas Bar Association Employee Benefits & Executive Compensation Committee, a former member of the Board of Directors of the Southwest Benefits Association and others.

Ms. Stamer also is a highly popular lecturer, symposium and chair, faculty member and author, who publishes and speaks extensively on health and managed care industry, human resources, employment and other privacy, data security and other technology, regulatory and operational risk management. She has authored, published and presented s hundreds of publications, programs and workshops on these and other concerns for the American Bar Association, ALI-ABA, American Health Lawyers, Society of Human Resources Professionals, the Southwest Benefits Association, the Society of Employee Benefits Administrators, the American Law Institute, Lexis-Nexis, Atlantic Information Services, The Bureau of National Affairs (BNA), InsuranceThoughtLeaders.com, Benefits Magazine, Employee Benefit News, Texas CEO Magazine, HealthLeaders, the HCCA, ISSA, HIMSS, Modern Healthcare, Managed Healthcare, Institute of Internal Auditors, Society of CPAs, Business Insurance, Employee Benefits News, World At Work, Benefits Magazine, the Wall Street Journal, the Dallas Morning News, the Dallas Business Journal, the Houston Business Journal, and many other symposia and publications. She also has served as an Editorial Advisory Board Member for human resources, employee benefit and other management focused publications of BNA, HR.com, Employee Benefit News, Insurance Thought Leadership and many other prominent publications and speaks and conducts training for a broad range of professional organizations.

For more information about Ms. Stamer or her health industry and other experience and involvements, see here or contact Ms. Stamer via telephone at (469) 767-8872 or via e-mail here.

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©2017 Cynthia Marcotte Stamer. Non-exclusive right to republish granted to Solutions Law Press, Inc.™ All other rights reserved. For information about republication or other use, please contact Ms. Stamer here.

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Everyone Has A Part In Making Healthcare Better

Improving health care, its quality and affordability is everyone’s responsibility and everyone has a role to play.  

Congress can do things to influence who provides care, how health care is accessed, how much it costs and how these costs are paid.  While this can ease or raise barriers to care, patients, their caregivers and their heealth care teams still need help well beyond the power of regulators, payers or others to deliver.  These bureaucratic “saviors” : 

  • Can’t prevent disease, illness or disabilities;
  • Can’t erase the personal disappointment, pain, fear, frustration or struggle of aging, illness, disability or death;
  • Can’t provide all the emotional support and encouragement patients and caregivers need to keep going;
  • Poorly provide the real time help to cover the babysitting, transportation and other help to organize or go the chores of daily living that patients and families need help with because they can’t get it all done; 
  • Support on a day to day basis individuals to eat right, exercise and live healthier; or
  • So many other realities of trying to live well, with or without aging, disease or illness.

We all eventually need this help and all can do something to help.  Step up and pass it along.  Someday it will be your turn!

Congress will never get health care policy right until regular people and health providers and the employers and communities caring for them get informed and involved and no matter what, policy can’t fix healthcare completely.

This is one Policy Debate too important to you, your family and your community to sit out or act on tag lines. Get informed and share your specific ideas and thoughts about the Act and your other input on what our health care system should look like going forward, how these proposals relate and the other reforms you believe Congress should make to build a better healthcare system for today that can survive into the future by joining the discussion in the Solutions Law Press, Inc. Coalition for Responsible Health Care Policy LinkedIn Group. 

©2017 Cynthia Marcotte Stamer. Nonexclusive license to republish granted to Solutions Law Press, Inc.

Cynthia Marcotte Stamer Alzheimer's, Caregivers, Disabilities, health care, Patient Empowerment, Resources

Check Out Alzheimer’s Caregiver Resources

Families struggling to care for Alzheimer’s patients should check out the Caring for a Person with Alzheimer’s Disease: Your Easy-to-Use Guide from the National Institute on Aging and the many other resources available for free on the National Institute on Aging website here.

©2017 Cynthia Marcotte Stamer. Nonexclusive license to republish granted to Solutions Law Press, Inc.

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Health care Quality: Different Meaning For Care Vs. Coverage

By:  Cynthia Marcotte Stamer, Publisher, Solutions Law Press, Inc.; Executive Director, PROJECT COPE:  Coalition on Patient Empowerment & Coalition for Responsible Healthcare Policy

American patients and their families need to be careful about mindlessly making health care choices for themselves or their family in reliance on healthcare “quality” data or guidance by private health plans and insurers, Medicare, Medicaid, or other government payers, and other public and private entities that allow the cost of care to shade their valuation of the quality of care.

The value of quality data – regardless of its source – in determining the quality and value of a proposed plan of care inherently depends upon how well a patient’s actual circumstance fits the assumptions upon which the quality analysis and conclusions rest.  Different treatment plans often impact differently patients diagnosed with the same condition for a variety of reasons.

Patients and their families making health care decisions for themselves or a loved one generally should use a two step approach when making health care provider or treatment decisions:

Patients and their families attempting to make decisions about the treatment plan for a patient affiliated with a life threatening or major chronic illness rightly should work with their health care provider to critically evaluate the options based first solely on the particular needs of the patient first without regard to cost, and then separately evaluate how cost barriers to securing the best treatment for the patient may require compromises or other tradeoffs.

When working with physicians and other health care providers, patients and their families need to understand the role and proper use of quality data – whether used by health care providers to determine care pathways, medical peer review, licensing boards or other quality assurance agencies enforcing quality standards for health care providers, or payers like Medicare, Medicaid, or other government payers or private insurers, self-insured health plans or other nongovernmental payers.

Because each patient’s medical and other circumstances are unique, very few patients fit cleaning the assumptions built into the clinical or payment pathways used to determine quality for a cost or medical efficacy determination.  In essence, each patient considered individually is an outlier at some level.  While these individual deviations have little material effect on the efficacy of proposed treatments in some instances, disregard of unique characteristics of the physical, emotional, psychosocial or other status of the patient significantly undermines or changes the likely efficacy of treatment. The assessment of the care and treatment needs and options of a patient without regard to cost inherently allows the patient, his family and his treatment team to evaluate the best interests of the patient, taking into account the unique physical, emotional, psychosocial and other realities of that patient.

Because the appropriateness of a proposed treatment plan inherently depends upon how closely the patient’s situation fits the underlying assumptions upon which the conclusions drawn from the quality data rests, patients and their families first should investigate and evaluate the needs of the patient and the care options available for treatment from a purely health care perspective without regard to cost based on the unique situation of that patient.   Review of these assumptions with the patient’s physician and other health care team helps determine not only whether the “standard” treatment fits the patient, but also what the patient and his caregivers need to be prepared to deal with the realize the benefits of the treatment proscribed and the likely effects of compromise or deviation from those expectations.  This analysis not only helps ensure the effectiveness of the plan of treatment but also reduces the risk that the patient will be hurt or his care or recovery undermined by the administration of a treatment plan that doesn’t fit the patient or performances that the patient or those supporting him in his care cannot reliably deliver.

Just as patients and their families should carefully question and evaluate assumptions underlying the quality and efficacy data behind treatment recommendations made by health care providers for the treatment of the patient, they also must carefully evaluate the health care “quality” determinations and decisions made by the public or private health plan that covers the patient.  Patients and families need to resist the urge to mindlessly accept without question the increasingly common practice by of private insurers and Medicare and other government regulators of accusing or suggesting that physicians or other health care providers are engaged in overprescribing, “fraud” or other bad medicine because the health care provider prescribes or delivers care supported by the medical quality literature in light of the needs of the patient which exceeds or deviates from the generic, one size fits all care plan selected by a payer to fit the cost containment goals of the payer.

Patients and their families need to understand that quality decisions by public or private payers for purposes of deciding what and how much treatment a payer will pay for inevitably both minimize the importance of the unique needs of the patient and adjust their notions of quality to fit the budget and profitability standards the of the payer based on the premiums or taxes the payer collects to fund the promised benefits.  These are statistical actuarial questions targeted on the amount of dollars that the payer is willing to spend for the dollars collected.  It is not unusual for a government payer such as Medicare or a private payer to try to limit the care that the insurer pays for to care that is less expensive without regards to the unique needs of a particular patient.  The outlier needs of particular patients have little value and receive little or no consideration in this analysis generally.  Consequently, it is not unusual for a Medicare, Medicaid, a private insurer or health plan or other payer to decline or resist paying for certain treatments that a physician orders in an effort to tailor care to the unique needs of a patient when the needs of the patient don’t fit the assumptions underlying the coverage design of the payer.

At the end of the day, patients and their families concerned about getting the best outcome for the patient should inform themselves and actively work with their physician and other health care providers, their health plans and other sources to familiarize themselves not only with the treatment needs and options of the patient, as well as the underlying assumptions behind the quality and efficacy findings underlying these treatment options.  By evaluating the assumptions required to achieve the reported treatment efficacy, patients and their providers can promote better care decisions and outcomes by helping their provider to anticipate and address the unique care needs of the patient, can better determine when and if to make tradeoffs in care for health care coverage or other cost or nonmedical reasons and can help improve the effectiveness of the care plan by better anticipating and arranging to meet the assumptions required to support the optimal outcome.

About Project COPE: The Coalition On Patient Empowerment &  Coalition on Responsible Health Policy

Do you have ideas about how to improve the understandability of medication warnings or research findings for patients or other ideas about how to improve healthcare or health care policy?  Share your ideas in the  PROJECT COPE: Coalition On Patient Empowerment LinkedIn Group.  If you have knowledge, experience or other resources that could help patients, families, communities, or the government better understand or cope with  Asperger’s or other health care conditions, costs of care, or other challenges affecting Americans and the American health care system, we encourage you to get involved and share your insights.

As American leaders continue to struggle to deal with these and other mounting problems impacting the U.S. health care system, the input of individual Americans and businesses and community leaders is more critical than ever.  Get involved in helping to shape improvements and solutions to the U.S. health care system and the Americans it cares for by sharing your ideas and input through the Coalition For Responsible Health Care Policy  and exchanging information and ideas for helping American families deal with their family member’s illnesses, disabilities and other healthcare challenges through PROJECT COPE: Coalition On Patient Empowerment.

Sharing and promoting the use of practical practices, tools, information and ideas that patients and their families, health care providers, employers, health plans, communities and policymakers can share and offer to help patients, their families and others in their care communities to understand and work together to better help the patients, their family and their professional and private care community plan for and manage these  needs is the purpose of PROJECT COPE.

The Coalition and its PROJECT COPE arise and run on the belief that health care reform and policy must be patient centric and patient empowering.  The best opportunity to improve access to quality, affordable health care for all Americans is for every American, and every employer, insurer, and community organization to seize the opportunity to be good Samaritans.  The government, health care providers, insurers and community organizations can help by providing education and resources to make understanding and dealing with the realities of illness, disability or aging easier for a patient and their family, the affected employers and others. At the end of the day, however, caring for people requires the human touch.  Americans can best improve health care by not waiting for someone else to step up:  Step up and help bridge the gap when you or your organization can. Speak up to help communicate and facilitate when you can.  Building health care neighborhoods filled with good neighbors throughout the community is the key.

The outcome of this latest health care reform push is only a small part of a continuing process.  Whether or not the Affordable Care Act makes financing care better or worse, the same challenges exist.  The real meaning of the enacted reforms will be determined largely by the shaping and implementation of regulations and enforcement actions which generally are conducted outside the public eye.  Americans individually and collectively clearly should monitor and continue to provide input through this critical time to help shape constructive rather than obstructive policy. Regardless of how the policy ultimately evolves, however, Americans, American businesses, and American communities still will need to roll up their sleeves and work to deal with the realities of dealing with ill, aging and disabled people and their families.  While the reimbursement and coverage map will change and new government mandates will confine providers, payers and patients, the practical needs and challenges of patients and families will be the same and confusion about the new configuration will create new challenges as patients, providers and payers work through the changes.

We also encourage you and others to help develop real meaningful improvements by joining PROJECT COPE: Coalition On Patient Empowerment and by sharing ideas, tools and other solutions and other resources. The Coalition For Responsible Health Care Policy provides a resource that concerned Americans can use to share, monitor and discuss the Health Care Reform law and other health care, insurance and related laws, regulations, policies and practices and options for promoting access to quality, affordable healthcare through the design, administration and enforcement of these regulations.

You also may be interested in one or more of the following other recent articles published on the Coalition for Responsible Health Care Reform electronic publication available here, our electronic Solutions Law Press Health Care Update publication available here, and/or our HR & Benefits Update electronic publication available here.

You also can get details about how to arrange for your employees or other communities to participate in training on “Building Your Family’s Health Care Toolkit,”  using the “PlayForLife” resources to organize low-cost wellness programs in your workplace, school, church or other communities, and other process improvement, compliance and other training and other resources for health care providers, employers, health plans, community leaders and others here.

NOTE:  This article is provided for educational purposes.  It is does not provide legal advice, establish any attorney-client relationship or provide or serve as a substitute for legal advice to any individual or organization.  Readers must engage properly qualified legal counsel to secure legal advice about the rules discussed in light of specific circumstances.ANY STATEMENTS CONTAINED HEREIN ARE NOT INTENDED OR WRITTEN BY THE WRITER TO BE USED, AND NOTHING CONTAINED HEREIN CAN BE USED BY YOU OR ANY OTHER PERSON, FOR THE PURPOSE OF (1) AVOIDING PENALTIES THAT MAY BE IMPOSED UNDER FEDERAL TAX LAW, or (2) PROMOTING, MARKETING OR RECOMMENDING TO ANOTHER PARTY ANY TAX-RELATED TRANSACTION OR MATTER ADDRESSED HEREIN.  ©2016 Cynthia Marcotte Stamer, P.C. Non-exclusive license to republish granted to Solutions Law Press.  All other rights reserved.