Category Archives: care coordination

Health Reform and Continuity of Care

In the chaos of health-care efforts both nationally and in Iowa, today I seek to go back to two basic beliefs: 1) the hope of future generations to learn from past generations’ mistakes and 2) the value of continuity of care for primary health care and, ultimately, health care in general.

The U.S. Senate is now debating a tax-cut bill that includes eliminating the Affordable Care Act (ACA) individual mandate for health-care coverage — a basic tenet for true health-care reform — and, in Iowa, the for-profit, managed-care Medicaid fiasco now has one managed-care organization (MCO) leaving the state and another MCO not able to take new patients. These actions leave the state with only one MCO left to serve Medicaid patients. Given these realities, I shift gears by presenting to you a guest blogger.

She is a third-year medical student who recently spent a month with me in my clinic. She plans to be a pediatrician. I choose not to provide her name. Although she would allow it, I am not sure her medical school would.

Continue reading →

Health Reform and Nick Bath

Nick Bath is the senior health-policy aide to Senator Pat Murray (D) of Washington. I met Nick several times when he was a health-policy aide to now retired Senator Tom Harkin (D) of Iowa.

Nick is a Harvard law graduate and a classical pianist (according to his bio), and he reminds me in both looks and mannerism of British actor Hugh Grant when Grant was a younger man.

Senator Murray is one of the primary health-care advocates and strategists in the Senate. Because of my previous association with Nick and Senator Murray’s important health-care advocacy, I compose the following letter to Nick regarding the current health-care crisis and unknown future of health care, which evolved from the recently failed partisan attempt to repeal and replace the Affordable Care Act (ACA).

Continue reading →

Health Reform and a $10,000 Neighborly Visit

A friend of mine, a family physician, told me about a visit he had with his 93-year-old neighbor recently. This neighbor had known my friend for more than 20 years and was my friend’s patient. His neighbor is a wonderful man and a big basketball fan. He grew up on a farm in northeast Iowa and remembers when his farm received electricity in the 1930s. He was the electric power supervisor for the district that included downtown Chicago in the 1960s and remembers the riots following the 1968 Democratic Convention there.

The neighbor had a heart-valve procedure earlier this year and, because of complications, had an evaluation with his cardiologist the day before my friend’s visit. At the cardiologist’s evaluation, the neighbor’s cardiac drug regime was significantly changed. My friend was called by the neighbor’s wife and asked to come over to her home when her husband, the neighbor, was having chest pressure and nausea. The wife had called First Nurse, a 24-hour nurse hotline, and was told to call for an ambulance. My friend, knowing the patient’s previous workup and having been told of the change in the cardiac meds, evaluated the neighbor. Based on the evaluation, my friend had the neighbor lower his cardiac meds and, by the next day, the neighbor was back to the baseline of his cardiac status.

Continue reading →

Health Reform and ACO Incentives – Getting It Right

We need to get this right. As I have said last month, I continue to be dismayed by the evidence that health-care costs are not being controlled. For example, in Minnesota, one of nation’s top health-care managed states, Blue Cross and Blue Shield announced that it would not sell individual insurance policies next year due to concerns over cost. Skyrocketing health-care costs will affect the affordability of private insurance and the existence of public health-care programs such as Medicare, Medicaid, and subsidized insurance sold under the Exchanges.

Continue reading →

Health Reform and Enhancing Patients’ Lives

Family medicine is creating and maintaining relationships with patients in order to enhance their lives.That is the definition I gave to the University of Iowa’s family-medicine residents at their resident retreat on Saturday. During my talk with this group of young physicians, I described my family-medicine team and how we help our patients to maintain their health, recover, and become healthy from an illness or improve their quality of life if diagnosed with chronic illness or a terminal disease. My team includes a head nurse, two health coaches who share a full-time position, a “roomer” nurse who seats patients in examination rooms and charts their vitals signs, and a “shot” nurse. Together, we are responsible for the family-medicine needs of 2,100 patients. I have described the use and value of health coaches in a previous entry.

Continue reading →

Health Reform and Wrapping Up

I should wrap up this blog with this post. This was to be the last entry. I said at the beginning, two and a half years ago, that I would chronicle the first two years of progress for health-care reform and the Affordable Care Act (ACA) in Iowa. Now, at the end of the second year of the ACA, we are able — to some extent — to count the successes, some sad outcomes, and end the blog.

Continue reading →

Health Reform and Family Medicine

On Thursday, July 22, I said goodbye to a University of Iowa third-year medical student. The student had been with me for a month.

One of my favorite professors while I was a student at the University of Notre Dame always said that the best way to learn something is to teach it. This was the seventh medical student I have had in my practice in eight years. I have learned so much about my belief in family medicine by teaching these students and sharing my patients with them.

Continue reading →

Health Reform and Patient-Centered Health Goals

Every other Wednesday morning, I attend our hospice interdisciplinary team meeting. This meeting is one of the highlights of my week. Four years ago, we began introducing each discussion of new and current patients with that patient’s stated goals. I always make notes directly on the printed list of patient names provided at this meeting when certain facts and information about a patient catch my interest. Often, it is the patient’s goals that I write down. The goals are many and varied. A common goal is for patients to stay in their own homes. Other goals include family events, such as attending a wedding or awaiting an upcoming birth in the family. I have heard goals including finishing a scrapbook, continuing to work on a classic car, taking a grandson to a basketball game, or traveling to see relatives. The personal nature of this way of starting the discussion of a patient’s status at the hospice-team meeting places the focus precisely where it should be — on the patient.

Continue reading →

Health Reform and the 2014 Iowa Senate Race

I ask the few remaining independent voters — those who have not yet decided for whom they will vote in the U.S. Senate race between Iowa State Senator Joni Ernst and U.S. Congressman Bruce Braley — to give me two minutes of your time.

I am Dave Carlyle, a family physician and hospice medical director from Ames. I grew up in Denison. This is where, during my summers home from college, I learned the value of hard work by sweating 10 hours a day at the Iowa Beef Packers slaughterhouse. After medical school at the University of Iowa and family-medicine residency in Waterloo, I practiced nine and a half years in Kossuth County. I have now practiced 21 years in Ames. My family has been serving Iowans for 160 years. My two daughters, both of whom are physicians, also care for Iowans.

Continue reading →

Health Reform and Health Coaches

Preparing for this blog entry and for an upcoming talk regarding health coaches, I asked one of my health coaches to share a memory she had about when she had connected with one of my patients in an especially meaningful way. To put this memory in perspective, my health coaches see my diabetic patients and patients who are having Medicare physicals before I see these patients. My health coach shared a memory from one of these preparatory visits with a diabetic patient who had recently learned of the violent death of her sister. My health coach spent a few minutes with this grieving patient before I entered the room. Because the patient had known and worked with this health coach for more than a year, they were able to connect, and I believe that the patient felt fully supported by my practice in the person of this health coach.

Continue reading →