Aging Icon the song
Caryn Isaacs, OG, the original private professional patient advocate started using the term in 1976 on publications that advised employees about their benefits. The Health Line Directory, a model for Participating Providers, was published for 25 years, with an advertisement for The Patient Advocate which led to Caryn’s personal phone. She continues to work directly with people who seek answers that are not addressed by the established system.
Way before that, Caryn worked in dental practices training families to care for their health. For several years, she acted as an executive in a health insurance company, creating one of the first computerized systems to track and analyze physician services. Since many doctors looked to Caryn for advice managing their practice, she started a company that specialized in filling underserved patient needs. From the early days of health reform, Caryn held various leadership roles including the creation of the Follow the Money Chart that was used to explain the health financing system. Always believing that healthcare outcomes were directly related to people having appropriate information, Caryn co-founded a Physician-owned HMO. Finding that the health system was becoming more and more complex, Caryn started GetHealthHelp, LLC to advocate for people needing help navigating the health system. Aging Icon is Caryn’s latest project. It is a social media and improvisational campaign to raise awareness and appreciation for the wisdom of accomplished adults regardless of the limitations imposed by society.
Caryn Isaacs’ book Aging Icon and her programs. engage groups, in a fun interactive way to find the Aging Icon in you.
Will Patient Advocates go the way of the dinosaur?
“Greedy, Lazy and Cheap.” This was the title of a speech I gave to physicians back in the 1990’s when they had to decide if they would sign on to insurer panels. I pleaded with them to remember that if it looked too good to be true, then it probably was. But their greed clouded their judgement when the insurers told the doctors that they would give them an endless supply of patients, so that the doctors could just concentrate on being professionals and leave the business side to them. The physicians didn’t bother to read the contracts that said that the insurers could make any changes to the fees and terms at any time without notice. And they refused to hire people who could have helped them to understand the terms of the contracts. Even while the doctors would praise me for my interesting program, they ignored the warning as they marched off the cliff and lost not only their ability to set fees and define practice parameters, but even lost the title for which they had worked so hard, Doctor. Now they are known as Providers and their position as the trusted advisor to the patient’s health has been replaced by Physicians Assistants or Nurse Practitioners. No wonder people are turning to Patient Advocates to help them navigate the health care maze.
However, who is a Patient Advocate? I started my Private Professional Patient Advocate business in 2008 after using the title since 1976. Originally, doctors and hospitals paid for my services, but once the insurers took over their businesses, the ‘Providers’ and those paying for the insurance, mostly employers or Unions, were left hoping for the best or looking for lawyers. So, that’s when those who could afford it, looked for someone to help them when they couldn’t get the care they needed or found themselves stuck with unexpected bills.
Most advocates agree that over the past decade, few people knew that Patient Advocates existed. Also, there was no license or standard rate for their services. Just like the renaming and reassignment of roles for physicians, anyone could call themselves a Patient Advocate. Insurers and hospital systems took full advantage of the confusion and gave out these titles to advertise their customer service departments. Then, a group of Advocates got together and formed the Patient Advocate Certification Board. Here is the eligibility requirements for a person to call themselves a Board Certified Patient Advocate, which includes education, experience and a very difficult test. https://www.pacboard.org/eligibility Many nurses and social workers are adding the BCPA to their names after becoming frustrated with the limitations being placed on their decision making. Social Workers who have masters degrees and accept Medicare reimbursement make a fraction of what a Private Patient Advocate charges.
Just as the stakeholders in the payer world (when the health system was described as consisting of patients – providers & payers} used a bait and switch methodology to get people to accept that they no longer had doctors, there is a new effort to usurp the term Patient Advocate. A recent article in the NY Times praised the role of the Patient Advocate in the hospital setting. https://www.nytimes.com/2022/03/03/well/live/hospital-patient-advocates.html
Big pharma is promoting a Healthcare Advocate Summit. Notice the juxtaposition of the word Patient and Healthcare when talking about who or what is being advocated for. The website for the Summit states in their lengthy mission that “The Advocate is the connector between securing clinical treatment for the patient using the appropriate procurement methods that ensures reimbursement for their health care organization, all while offering emotional support to the patients.” This leads me to remember the same kind of verbiage that was used when managed care was trying to cloud their intent to steer patients to lower cost services.
I’ve spoken to a few of my fellow Independent Patient Advocate business owners who came out of the practice management world. We can understand that nurses, social workers and customer service people who work in various health systems (hospitals, insurers, professional organizations or government) might believe that adding a billing code for Advocacy will raise their salaries. However, we caution them to look at how managed care contracting worked for the doctors and for the patients.
Join Us for Professional Advocates Networking
| People for Patient Safety (PPS) The second Monday of each month 7:00 PM Eastern Time Networking and social gathering for patient advocates and caregivers March 14, 2022 – 7:00 PM Eastern Time |
| Network with others in the field. Introduce yourself, your business, your interest. Share your goals and let others help you reach them. Don’t travel this road alone. Pre-registration is required. www.PulsePPS.org People for Patient Safety Does Patient Safety Interest You as a Patient Advocate or Caregiver? If so, you might not want to travel this road alone. Patient advocates, caregivers, community are all welcome to this discussion group on the second Monday of each month at 7:00 PM Eastern Time. “Patient advocates can accomplish more with support from people they know, like and trust.” Working together to improve patient outcomes! Exchange contact information in the chat Planning Committee and Hosts: Ilene Corina, BCPA www.PulseCenterforPatientSafety.org Caryn Isaacs, BCPA www.GetHealthHelp.com Nancy Ruffner, BCPA www.nancyruffner.com |
Letting Go of Perfection
Earlier, at about 3AM I was awakened by a call from a nursing home that one of my clients had passed. It wasn’t unexpected because she had been suffering from advanced Alzheimer’s for several years and had been praying to be released from this terrible disease. Her family, friends and I were happy that she could spend several years at Atria Kew Gardens where she enjoyed continuing her lifelong passion of eating healthy, working out with her personal trainer, Val and walking to Church on Sundays. In her final months she found comfort in living with the sisters at Ozanamhall.
This isn’t my first call to Schwartz Brothers where I make pre-planned funeral arrangements for all my clients, including my husband who passed at this same time of year. Actually I have been making these kind of calls for the past ten years. Most times I am the only person at the funeral, besides a few friends and their home health aide. My practice focuses on elderly people who don’t have anyone to help them or they only have people who are just not available because they live far away or are elderly themselves, our elder orphans. It’s always comforting to know that their wishes will be carried out.
Regardless of how well you plan and how much you know that the person welcomed their release, it is still a time of grief and all that goes with it. I have been working with a Widow Coach to understand my own grief process for the past year. The most helpful thing I learned was that we can’t change what is, but we can change how we think about it. So, keeping in mind the 90 second rule, I let myself dwell on the fact that I hadn’t changed the beneficiary on her life insurance which was needed for her Medicaid application and that I hadn’t gotten to bring her the framed poster I planned to give her for Christmas, with a personalized message from the Pope.
Since I was now wide awake, I started my day as usual checking emails and Facebook Groups. Usually I am pretty stoic, but one of the posts was a copy of a Eulogy from a son about his father. It was written in such a loving. funny way, even though the topic of discussion was someone known to be loud, abrasive and aloof. It really touched me that even though this person was far from perfect, he left only the good memories and any hard feelings were buried with him. Reading now through tears, I opened a daily email I get called the Daily Om. It’s a short daily inspirational message. It’s one of the few things I do in a day that has nothing to do with seniors or patients. The title for today is Letting Go of Perfection. It was a reminder that being imperfect is human and that trying to be perfect only leads to frustration and unhappiness.
This is a time of year for celebration and joy, but if this year of Covid, Lock Downs and Economic Uncertainty have taught us anything, it is that nothing will be perfect. We can only hope for the best and do what we can under the circumstances. I wish the gift of forgiveness for yourself to all my friends, colleagues and clients. I send you forgiving thoughts for any one or anything you are holding in your head or heart. I promise to embrace all the imperfection I see in the world in a loving way.
If you ever feel down or upset about being less than perfect, give me a call, because I need all the imperfections I can find to help me to learn and grow. I hope you forgive me if I have done anything less than perfectly. I will try to do what I can to make it less imperfect.
2022 Changes for the Better ?
Seniors are buzzing about the news that social security is giving seniors a raise. The problem is that other things are going up and the raise doesn’t come near to covering them all. Groceries, gasoline, home heating and drugs are just a few of the things we can expect to pay more for in 2022. Many people are looking at Medicare Advantage plans to save some money on health costs. Advantage plans are advertising plenty of extra perks like no premiums, transportation, dental and vision care to lure seniors away from traditional Medicare. That’s the carrot approach, offer a treat. Then there’s the stick approach. NYC retirees are getting the stick. Either accept the Advantage Plan or opt out and pay a steep penalty.
Here is an article from Robert Intelisano, CSA, CLU, LUTCF aka The Insurance Doctor, Certified Senior Advisor
NYC Workers, Supplemental vs Advantage!
The BIG WINNER here is New York City, who has found some type of loophole and passed on the plan subsidy to the Federal Government. We estimate the city will be saving about $200 per person. I would not be surprised if there was some type of “class action” lawsuit against the city over the next 6-18 months.
For hundreds of thousands of retired NYC workers, a big choice is looming during open enrollment! Whichever path you take will determine how you get your medical care and how much it costs out of your pocket. The choice is not as simple as it appears. Most people would ask, which one is better? Answer is, “It Depends!”
The first decision is; do you want to enroll in Federally run “original” Medicare, or select a “Medicare Advantage” Plan? For foodies, think of it as ordering a “price fixe” meal (Medicare Advantage) where most decisions are already made for you or going to “the buffet” (original Medicare) where you need to decide for yourself what you want.
Both options will cover your “pre-existing conditions” and you will be able to obtain coverage for prescription drugs. Differences begin with going to the doctor. Original Medicare allows you to choose ANY doctor that accepts Medicare. A Kaiser Family Foundation survey said that 93% of primary care physicians accept Medicare. If you are looking for a new physician, research needs to be done to see which doctors are accepting “new” Medicare patients.
Under “Medicare Advantage,” you will be joining a “private health insurance plan” probably similar to what you had when you were working. Most of the common private insurance plans are HMO’s (In-network only Health Maintenance Organizations) or PPO (in and out of network Preferred Provider Organizations). Keep in mind, with the private plans you will likely need to see your PCP (primary care physician) first then get a referral to a specialist, which is more time consuming. This can also be an issue if you travel out of state and have a health issue as you will likely need to go out of network which will cost more out of your pocket.
See my 5 top tips below on how to address this new “predicament!”
- Do Research: Familiarize yourself with what Medicare Part A (hospitalization), Part B (physician and outpatient services), Part C (A Medicare Advantage Plan), Part D (prescription drugs) mean.
- Speak to a Licensed Professional: Insurance brokers must get “re-certified” every year, which consists of passing multiple tests of their knowledge. A trained Professional can guide you much more easily than trying to do it yourself.
- Don’t Wait Until the Last Minute: Waiting until the December 7th open-enrollment deadline increases the probability of making the incorrect decision. Doing “nothing” is a decision as you will automatically be put into the Empire Blue Cross (or Emblem) plan. Many people will see “FREE” and choose that option, which could lead to higher co-pays and more money paid “out of pocket!”
- Check With Your Preferred Doctors: Make sure your doctor still accepts Medicare, which is frustrating for doctor’s offices to deal with the Government, delaying reimbursements and many other issues to deal with. It is also important how much you utilize benefits and how many prescriptions you might be on.
- Determine Your Need for Dental, Vision and Other Services: Under Medicare Advantage, you will get all of the services you are eligible for under original Medicare. Some Medicare Advantage plans offer additional services such as vision, dental and some gym memberships. The Government has been adding some services over the years like home improvements (wheelchair ramps), transportation to doctor offices and getting meals delivered.
Remember, with the Advantage plan the insurance company and your doctor make your health decisions whereas with the Supplemental plan it is YOU and your doctors making these decisions!
Whatever you do, take time to do the proper pre-planning as these choices can have a big effect on your next 12 months of care.
You can see more about Robert Intelisano at https://insurancedoctor.us/
Updates End of Summer 2021
Many things have changed since my last post and many things have stayed the same.
Covid-19 has moved a lot of things to ZOOM. Overburdened email boxes made sending blog posts seem very intrusive since people were working from home and emails may be going to personal addresses mixed in with family photos and health care information along with business mail.
I have been doing most of my speaking about improving your life in the face of limitations. I post a lot of this on Facebook since that is the accepted leader for baby boomer communication.
As the summer comes to an end, so is a 30 day video challenge in which I tried to demonstrate the day in the life of a Patient Advocate. Here is a sample of the live videos that appear at http://facebook.com/GetHealthHelp and other places.
JOIN US March 2, 2021 9 AM – 10 AM
Caryn Isaacs, Board Certified Patient Advocate has over 40 years of experience helping people with chronic and hard to manage health conditions to find improvements in their lives. Caryn realized just how important her knowledge of and connections with the health, legal and financial systems were when her husband recently became ill and passed away suddenly. She will share how having all the important paperwork in place and knowing who to call during this stressful time saved her sanity and created a safe haven for her new role as a widow.
January 2021 Article Starting Over
I wish you all a very happy New Year. Here is the latest in a series of articles on people who started over after 50.
Starting Over at 70
Nothing ventured, nothing gained. As we enter the ninth month of contact-less networking, no get together for the holidays and binge shopping, I wanted to do something outside of my comfort zone.
Here are the first 3 articles I wrote for the North Shore Towers Courier after a conversation with Publisher Vicki Schneps of Schneps Media. I was thinking of doing this as a podcast, but Vicki suggested that I build an audience first to see if this resonated with the people I am speaking to.
Here’s what it looks like in the paper.
https://digital-editions.schnepsmedia.com/NST102020/page_11.html
Here are the November and December articles.
Visit our new Website
“Life is what happens while you are busy making other plans.” John Lennon
This is certainly true in the health care world. I haven’t been able to see many of my clients in person since April. In fact, since my last blog post when I said that we had big plans, everything changed.
I continue to see people in their homes but instead of going to doctors and out to fun activities, we work on projects like going through things to downsize and teaching the companions new recipes.
My clients who are living in assisted living are in quarantine. I can visit them by ZOOM and sometimes through the window. I bring care packages to show that there is still someone out there thinking of them. In some cases, I use my phone to connect to doctors and send it up to the resident’s room to have an online appointment, then follow up after with the doctor.
I’ve done a few webinars and SUN-Q is set up for our September annual kick off meeting on the 22nd to be on ZOOM at 9AM. Go to sunqueens.org to join or renew.
I would love to hear about what you are doing. Give me a call or send me an email. Visit me on Facebook or LinkedIn.
Navigating the Health System
Caryn Isaacs, Patient Advocate
This is my space for talking about health care and seniors. You can also see my “Almost Fiction” stories about people facing life challenges. For more about me and Patient Advocacy, go to my website, GetHealthHelp.com
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