Medical

Telehealth: Are We Ready for Better Healthcare at a Lower Cost?

Healthcare, specifically its cost and equitable delivery, is perhaps the most significant domestic social and political agenda of our times. According to the Centers for Medicare and Medicaid (CMS)[1], healthcare-related costs was 17.9% of US GDP (~$3.5 trillion dollars) in 2017. In a recent analysis by Fortune[2] U.S. healthcare costs are projected to become 19.4% […]

Healthcare, specifically its cost and equitable delivery, is perhaps the most significant domestic social and political agenda of our times. According to the Centers for Medicare and Medicaid (CMS)[1], healthcare-related costs was 17.9% of US GDP (~$3.5 trillion dollars) in 2017. In a recent analysis by Fortune[2] U.S. healthcare costs are projected to become 19.4% of GDP by 2027. While we have the most innovative healthcare system in the world in terms of discovering new treatments, we are ranked 27th in the world when it comes to overall healthcare outcomes[3]. To put things in perspective, we have the most powerful military in the world, and it costs us only 3.1% of our GDP. There are a number of reasons contributing to this massive disparity between investments in research, cost of care and outcomes and parsing that is beyond the scope of this article.

So where are we headed into the future?  Is there any hope for us to get quality healthcare at a reasonable cost?

Telemedicine/telehealth represents a growing sector within healthcare which has the greatest promise to bend the cost curve while providing better health outcomes. It intends to transform the current paradigm of care delivery through innovative internet-enabled technologies. According to the New England Journal of Medicine, [4] Telehealth is defined as “the delivery and facilitation of health and health-related services including medical care, provider and patient education, health information services, and self-care via telecommunications and digital communication technologies. Live video conferencing, mobile health apps, “store and forward” electronic transmission, and remote patient monitoring (RPM) are examples of technologies used in telehealth.” While some draw parallels to the holographic doctor in the 1990s T.V. series Star Trek, telemedicine is no longer science fiction. An example of a deployed telehealth solution is Project ECHO (Extension for Community Health Outcomes) that is currently in 130 sites in the U.S. as well as in 23 countries. Started in New Mexico by Sanjeev Arora M.D. in 2003, the goal of project ECHO was to extend access to specialists in the care of patients in remote locations, especially in rural areas. This resulted in reducing wait-times to see some specialist from 8 months to 2 weeks while also lowering the cost burden on the healthcare system and dramatically increasing the health and satisfaction of patients![5]

In every instance where telehealth solutions have been deployed, access to care immediately becomes more equitable, easy to get to, and less expensive. More excitingly, over the long run, with data gathered from individual patients, dramatic improvements in health outcomes are possible as it enables personalized medicine through artificial intelligence and machine learning.

The vision of the Affordable Care Act, the largest change to our healthcare system in 30+ years, was to move our entire healthcare model away from fee-for-service to evidenced-based care. In this paradigm, digital health is a critical component – starting with electronic medical records to link payers, providers, and patients seamlessly with data. While a number of states and private payers are investing, innovating and deploying telehealth-based care, there are many social, political and legal barriers that are continuing to prevent telehealth from reaching its full potential of providing Americans with cost-effective quality healthcare. It is important to emphasize that the barriers are not in technology! Here are some.

Resistance from incumbents: The current healthcare system is a physician and provider (hospital, clinic) centric model. This model ensures that a patients’ visit is private, safe, and secure. A physician, in addition to looking at objective data such as lab results, vital signs, and other measurements, also relies on subjective cues that have been honed from decades of training. Telehealth platforms disrupt this normal physician-patient interaction. Furthermore, physicians need to be re-trained on how to interact with patients who are at a remote location. What kind of video streaming is needed? How to perform a virtual patient examination? How does one keep this private? What are the liabilities involved? These are some of the questions that are being raised and actively debated.

Non-uniform national legislation: Because of the hesitation among care providers towards adopting telehealth, policymakers are at a loss on structuring workable rules and legislation around telehealth. A number of state-level pilots are ongoing around the country to determine what works best. These are, however, very ad-hoc local attempts occurring through regional grants with a focus on care accessibility and not so much on savings to the payers. As a result, the data and the lessons learned are spotty and un-coordinated.

Poor re-imbursement: Because the various pilot studies are not measuring true costs and accurately capturing return on investments (ROI), current re-imbursements for telehealth are a miniscule fraction of a physical visit. Neither the physicians, providers, or telehealth technology delivery organizations are able to capture sufficient and sustainable revenue. While a remote visit does cost less than a physical visit, the providers have locked in costs with their current infrastructure that is required to support a traditional physical visit. As a result, unless reimbursements are made higher at least on the outset initially, there is a disincentive to adopt telehealth.

Individual preference: Without elaborating this extensively, some people prefer to have a physical visit no matter how easy, convenient, or cost-effective a virtual visit may be. This is especially true in the generation group that is not digital-natives. The problem is compounded because individuals with insurance do not see the full cost of care, and this lack of transparency does not create any incentives to change to a lower-cost delivery model.

There are a number of organizations, including ours (www.chromologic.com) that are working on making telehealth a reality by focusing on reducing the friction in adoption, access, and cost. We work directly with the U.S. Department of Defense to address their needs for easy and rapid enrollment and verification of wounded warfighters and civilians at the point of need using a unique and dual secured biometric scheme. This technology is also making access to telehealth solutions frictionless in multiple civilian care delivery settings in the Los Angeles area.

The promise of telehealth in terms of reducing cost for better care is real. The adoption can be accelerated once we have a more focused national-level effort that is based on evidence gathered from the multiple pilots that have occurred/occurring around the nation. It is this authors belief that we are at a tipping point where a radical shift towards telehealth centric healthcare system is inevitable. But in this current political climate, we may have to be patient.


 

[1] https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

[2] https://fortune.com/2019/02/21/us-health-care-costs-2/

[3] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31941-X/fulltext#seccestitle160

[4] https://catalyst.nejm.org/what-is-telehealth/

[5] https://mhealthintelligence.com/features/is-project-echo-the-telemedicine-model-that-healthcare-is-missing

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Life Sciences: Understanding the basic differences between Validation and Calibration

The Life Sciences market is evolving at breathtaking speeds these days, and the rapid rise in product innovation and cell therapy technology across the life science market is calling for companies to have a more robust quality and compliance approach in order to meet regulation and produce safe and reliable products. Good manufacturing practice (GMP) […]

The Life Sciences market is evolving at breathtaking speeds these days, and the rapid rise in product innovation and cell therapy technology across the life science market is calling for companies to have a more robust quality and compliance approach in order to meet regulation and produce safe and reliable products.

Good manufacturing practice (GMP) regulators in the United States the European Union and other internationally recognized GMP regulators have sharpened their focus on quality and compliance practices. Driving this trend is a shift in regulatory thinking from quality-by-test to quality-by-design systems/processes with emphasis on the level of risk to product quality and patient safety.

There’s an increased emphasis by regulators in the Healthcare and Life Sciences (HLS) industry to comply with rules and regulations across all aspects of their business, such as development, design, equipment operation, processes, test methods, standard operating procedures, computerized systems, and data security amongst other things. Realizing there is an urgency for growth, leadership, and knowledge that can serve and grow with our ever-changing industry, I wanted to share some basic insights from within my profession that seem to come up more often as people enter the regulated space of the Life Sciences industry.  Validation, calibration, and qualification are extremely critical in Healthcare and Life Sciences processes. Understanding them is necessary in order to meet GMP guidelines.

I’m often asked; “What is the difference between calibration vs. validation – are they the same? Is one a subset of the other?”

“I am still struggling to separate the two from each other – Can you provide me with a definition of Calibration vs. Validation and how the two differ.”

At the most basic level, calibration indicates the error of an instrument and measurers for any lack of trueness by comparison against a reference standard and validation stands for a process of testing and documenting.

Many people in the Healthcare and Life Sciences industry know the terms, but not everyone is aware of the differences.

Just a little insight will help you understand the differences between them.

Validation is the documented act of demonstrating that a procedure, process, and activity will consistently produce results meeting predetermined acceptance criteria. Pharma & Biotech’s most common way of establishing evidence or documenting test results is through the implementation of Protocols. Protocols, such as Installation Qualification (IQ), Operational Qualification (OQ) and Performance Qualification (PQ), along with essential design and planning documents such as User Requirement Specification (URS) and Validation Master Plan (VMP) are the building blocks of the validation framework.

Why is this essential? ‘If it’s not written down, then it didn’t happen!’

The FDA requires establishing documented evidence that a specific process will consistently produce results meeting specifications and quality attributes. Without supporting documentation, one runs the risk of being out of compliance.

Calibration on the other hand specifically refers to measurement devices, instruments and tools that record, monitor, and control environmental conditions or parameters. Calibration can also be defined as a process that demonstrates a particular instrument or device to produce results within specified limits with reference to a traceable standard over a range of parameters. This process also includes the adjustment of an instrument to realign with the acceptable standard.

Taking measurements involving any GxP process requires calibration to ensure the accuracy of the measurement. Instruments that record, monitor, control critical environmental variables require calibration. Instrument calibration must be enforced on a regular basis to ensure reproducible results. GMPs require written procedures for calibrating, inspecting, and checking automated, mechanical, and electronic equipment.

Screen Shot 2019-10-22 at 9.52.00 PM

Understanding these generally basic concepts are an integral step to understanding quality assurance and the many different aspects of compliance in the Life Sciences industry. It all might seem like a long, drawn-out process, but there’s a good reason for it. If you can ensure your products perform consistently and meet all the requirements of the industry, the value of both the product and patient safety increases. Along with this increased value comes a greater need to understand that the work we do matters, and that helping Life Science organizations ensure compliance and consistency with current regulations when carrying out commissioning, validation and qualification projects in a safe and efficient manner ultimately leads to saving lives.

 

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Do You Use Protection?

Do you use protection? No, not the kind of protection you’re likely thinking of.  It’s a provocative question from the American Academy of Dermatology, designed to get you to think about and use sunscreen regularly.  It’s imperative to slather on the sunscreen during the summer but also important year-round. I’ve been a member of AAD […]

Do you use protection?

No, not the kind of protection you’re likely thinking of.  It’s a provocative question from the American Academy of Dermatology, designed to get you to think about and use sunscreen regularly.  It’s imperative to slather on the sunscreen during the summer but also important year-round.

I’ve been a member of AAD since I began my career as a board-certified dermatologist, and the need for sunscreen has never been greater.  Skin cancer is the most common cancer diagnosis in United States.  In fact, one in five Americans will develop some form of skin cancer in their lifetime. It is estimated that approximately 9,500 people in the U.S. are diagnosed with skin cancer every day.

By definition, skin cancer is an abnormal growth of skin cells. It most often develops on areas of the skin exposed to the sun’s rays. Skin cancer affects people of all colors and races, although those with light skin who sunburn easily have a higher risk. It’s why we encourage everyone to wear protective sunscreen daily. We also encourage annual skin cancer checks in our office.

Melanoma is the deadliest form of skin cancer, while basal cell and squamous cell carcinomas, are the two most common forms of skin cancer. Here are some basic facts about each:

Melanoma is the most serious.

  • Frequently develops in a mole or suddenly appears as a new dark spot on the skin.
  • Early diagnosis and treatment are crucial.
  • Is often treated surgically.  May also require chemotherapy.

Squamous Cell is the second most common form of cancer.

  • Squamous cell carcinoma often looks like scaly red patches, open sores, elevated growths with a central depression, or warts; they may crust or bleed.
  • Cases tend to form on skin that gets frequent sun exposure, such as the rim of the ear, face, neck, arms, chest, and back.
  • Most squamous cell carcinomas of the skin can be completely removed with surgery, radiation therapy or occasionally with a topical medication.

Basal Cell is the most common and slowest growing form of skin cancer.

  • Basal cell carcinomas often look like open sores, red patches, pink growths, shiny bumps, or scars.
  • Early diagnosis and treatment are important.
  • Doesn’t commonly spread to other parts of the body, but it’s still recommended to be removed.
  • Basal cell carcinoma that is superficial and doesn’t extend very far into the skin may be treated with creams or ointments.

While Mohs surgery remains the “go to” treatment for melanoma, it has also been the traditional choice for basal cell carcinoma and squamous cell carcinoma treatment. Depending on the severity of the case, it has drawbacks. Moh’s surgery, even when done by the best surgeon , can develop complications such as post-operative bleeding, infection or scarring   Patients must also stop taking their blood thinners before surgery, which  puts susceptible patients at risk for blood clots or stroke, especially in patients with AFib.  With that, we were looking for an alternative for patients who don’t need Mohs.

At Lehigh Valley Dermatology, we’re excited by the renewed use of superficial radiation therapy (SRT) for non-melanoma skin cancer.  Interestingly, it’s one of the oldest treatments, having been developed more than 100 years ago.  It’s been refined for use today.  In fact, we’ve just added this treatment back into our arsenal at the practice by bringing in SkinCure, a leader in this SRT Therapy renaissance.

SRT is a highly evolved technology that allows high resolution imaging of the tumor, and delivery of safe and precise doses of superficial radiation.  It’s a proven non-invasive procedure that has been used to treat non-melanoma skin cancer for decades.  Because the x-rays concentrate the superficial radiation dose on the skin surface, the treatment has several advantages over surgical procedures for skin cancer.  Cosmetic results are excellent and no cutting is necessary.  Most importantly patients are not put at risk by holding their anticoagulants!  It’s a painless, safe and highly effective non-surgical option for skin cancer treatment. We’re pleased to be putting the power of it to use again in the Lehigh Valley.    

The best offense is a good defense when it comes to fighting skin cancer.  Start with that sun protection and be vigilant with skin cancer checks.  If treatment is needed, technology is on your side.  We hope our provocative question prompts you to protect yourself this summer and year-round.

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MILD TRAUMATIC BRAIN INJURIES – A SILENT EPIDEMIC

We hear more about brain injuries than ever before.  After his tour bus was struck by a Walmart tractor-trailer in 2014, actor and comedian Tracy Morgan underwent daily speech, cognitive, occupational and physical therapy for his traumatic brain injury.  In an interview a year later, Morgan said, “I have my good days and my bad […]

We hear more about brain injuries than ever before.  After his tour bus was struck by a Walmart tractor-trailer in 2014, actor and comedian Tracy Morgan underwent daily speech, cognitive, occupational and physical therapy for his traumatic brain injury.  In an interview a year later, Morgan said, “I have my good days and my bad days, or I forget things,” as he also described recurring headaches.  And in sports, with the beginning of the 2013-14 NFL season, an independent neurological consultant stays on the sideline of each team for every game as part of the NFL’s concussion protocol.

About 85% of the time, symptoms from a concussion or minor head trauma (other names for mild TBI) resolve within a short time.  More than 50% of these cases result from falls or motor vehicle crashes.  Unfortunately, about 15% of those injured have more persistent effects, some permanent.

More Common Effects of Mild Traumatic Brain Injury

Mild TBI has been referred to as a “silent epidemic” because the signs and symptoms are often subtle.  Someone feels fine a few weeks after an accident, only to find out from a loved one, co-worker or friend that all is not the same.  Many people experience the most common signs of mild TBI, including nausea, persistent headaches, double vision, or dizziness.  Problems with concentration and recurrent headaches are common and are viewed by some as the brain “working overtime” to heal completely.

Within months, many generally feel better, but upon returning to the workplace or to school, some are overwhelmed.  Unable to remember the name of a co-worker or a simple chemical formula, they have problems with basic cognitive skills.  It becomes challenging to learn new material, to concentrate or to pay attention.  The injured person has a low threshold for confusion and thinks more slowly.  When using a computer screen, headaches return, often accompanied by problems with double vision or blurriness.  Complaints of disbelief range from, “I’ve forgotten my bank account PIN number,” to “I can no longer parallel park.”

Psychological Disruption

Not expecting what may have been a relatively mild car crash to cause long-term issues, the mild TBI patient often minimizes the deficits or tries to compensate.   In leaving notes all over the house or carrying an index card with the names of co-workers, there is an effort to both dismiss and to compensate.  If recall and concentration abilities continue to fail, then frustration and depression can set in.  The TBI patient feels socially isolated, not wanting the “secret” to be disclosed.  However, the deficits are often apparent to others, and they may encourage the injured to seek further medical evaluation and care.

The Clinical Setting

Because mild TBI can be difficult to identify objectively, medical providers look at the entire clinical picture, including the severity of the original blow to the head, whether there was a loss of consciousness, how the patient scores on basic tests of recalling numbers and words, and, upon reviewing test results, whether more subtle neuro-psychological symptoms emerge.  Vision disturbances, including subtle but rapid movement of the eyeball, may provide clues.  Even more recent developments in MRI imaging of the white matter of the brain can help the radiologist determine whether the axons (the connectors between the brain cells) have been torn.

Treatment and Support

When all of these tests, evaluations, and scans are considered together by a treatment team, then truly effective treatment can begin.  Eyeglasses with subtle prisms can help restore peripheral vision and re-train the brain to see.  Social workers, psychologists and concussion specialists are more in tune with the cognitive and emotional effects.  A mild TBI patient’s sense of mental wellness can be improved with acceptance and rehabilitation of the brain through mental and visual exercises.  Targeted medication can alleviate mood impairment.  Family, co-workers and friends can be educated to understand that a person with TBI may be irritable, experience mood swings or may simply zone out, but these are not intentional, and over time they can be better controlled.

Summary

The impact of a traumatic brain injury may not become apparent until long after the cuts and bruises have healed following an accident and blow to the head.  The feelings of isolation, depression, and frustration can only be lessened through an inter-disciplinary approach with the patient, the family, and health care professionals.   

While this collective effort can never lessen the blow to the head, it can make the

“new normal” easier to bear for the patient, as well as the injured’s friends, co-workers, and family.

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2019-massage

Massage Isn’t A Luxury Anymore; It’s a Necessity!

When you think of massage, do you think of special occasions like Mother’s Day or Valentine’s Day?  Do you think massage is just for people with injuries or people who have nothing better to spend their money on?  Well, think again!  In this day and age, massage is not a luxury anymore; it’s a necessity!  […]

When you think of massage, do you think of special occasions like Mother’s Day or Valentine’s Day?  Do you think massage is just for people with injuries or people who have nothing better to spend their money on?  Well, think again!  In this day and age, massage is not a luxury anymore; it’s a necessity!  Almost every person can benefit and needs a massage on a regular basis to prevent and help manage knots as well as overall tightness in muscle tissue throughout the body.  Whatever your walk of life, stay at home mom, a person who travels or who sits at a desk all day long; we are all prone to these issues.

So, what are knots? According to 1Healthline, “muscles knots are hard, sensitive areas of muscles that tighten and contract even when the muscle is at rest.” Knots can also radiate pain to another part of the body. These are called trigger points.  Skeletal muscle is made up of muscle tissue fiber, made of “small fiber like units called myofibrils, “as explained by 2Medeiros and Wildman, myofibrils break down into an even smaller unit which is called the sarcomere, the smallest unit of muscle tissue.  Messages are sent to the sarcomere through nerve impulses that allow muscles to contract.   Sarcomeres are stimulated by the regulation of calcium, both intracellularly and extracellularly.  3AMTA explains that when muscles are overworked, it can cause an “influx of calcium into the sarcomeres in the affected area which, in turn, causes the sarcomeres to contract.”  This ultimately causes undue tension in muscle tissue fiber forming knots, which can eventually become trigger points.

You may be wondering what you are doing that would cause your muscles to be overworked or overloaded?  It’s called life!  Overworking our bodies physically is a common reason for these knots to develop, but also emotional stress, poor diet, and reduced water intake can be a factor.  According to 4Medical News Today, common causes of muscle knots include “stress and tension, injuries related to lifting and repetitive motion, poor posture, prolonged bed rest or sitting without stretching.”  Who doesn’t have stress in their life, whether it be at home, work or otherwise?  Stress, among many other components, can deplete our body’s supply of minerals, which we desperately need for optimal organ and muscle function.  Another reason why drinking enough quality (filtered or purified) water throughout the day is so important.

Not only does stress affect our muscles adversely, but also repetitive motion.  Obvious examples of repetitive motion could include a worker on an assembly line or a builder using a hammer.  However, a hardworking mom uses repetitive motion when rocking her baby to sleep, over and over again.   A violinist uses her arms and shoulders in a repetitive motion performing in a concerto.   Athletes use the same muscles repetitively, as well as the average person that works out using various exercise programs such as weight lifting, cross fit, cycling, Zumba, Insanity or P90X!  The most overlooked way to develop knots is by just sitting at a desk without getting up to stretch and move around, which will reduce lymphatic flow and blood circulation, leading to muscle stiffness.

Now that we know what knots are and how we get them, let’s talk about how to manage them. Prevention is the best remedy!  Drink half your body weight in water in ounces, generally no more than 100 ounces a day.  Eat plenty of fruits and vegetables that will naturally hydrate you, not to mention provide essential antioxidants and phytonutrients.  Limit caffeine since this is a natural diuretic and causes frequent urination, which causes a loss of minerals.

Even with our best efforts to prevent knots, we will get them at some point.  Consistent massage with a licensed massage therapist is absolutely essential to help loosen the knots and allow the tissue to return to a normal state.  Massage therapists use various strokes and techniques, such as effleurage, petrissage, stripping, tapotement, as well as trigger point therapy and myofascial release.  Massage will increase lymphatic movement and blood circulation, allowing toxins to be filtered and released through the lymph nodes, spleen, liver, and kidneys.  5Athletico Physical Therapy agrees that “massage is not just some occasional luxury saved for vacations and spa days. Massage therapy can help keep your muscles healthy, pliable, and oxygenated.”  Licensed massage therapists are plentiful, whether in private practice or working at a spa and have hours and prices to accommodate anyone’s schedule or budget.

Start feeling better; schedule your massage today!

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Got Anxiety?

Odds are, you or someone you know probably does.  Anxiety disorders are the most common mental health diagnoses in the United States, affecting 40 million adults, or roughly 18% of the population (aada.org).   So, what is anxiety?  Anxiety is a healthy and normal emotion.  The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings […]

Odds are, you or someone you know probably does.  Anxiety disorders are the most common mental health diagnoses in the United States, affecting 40 million adults, or roughly 18% of the population (aada.org).   So, what is anxiety?  Anxiety is a healthy and normal emotion.  The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.”  Anxiety can remind us of our “to do” list, upcoming deadlines, or help us focus before that big presentation.  These are not necessarily negative things.  So, then what’s the concern with anxiety?  A person goes from feeling normal healthy anxiety levels to having a psychological disorder when they feel disproportionate levels of distress, worry, or fear over an emotional trigger.

Anxiety is an overarching, general term that includes several psychological disorders.  Some such disorders are: Generalized Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder, Phobias, and Obsessive-Compulsive Disorder.  These disorders are treated with a variety of methods.  Many are traditional, and some are newer concepts in the field of psychology.  The first traditional method of treating anxiety is with medication.  Several types of medications are used to treat anxiety, such as Selective Serotonin Reuptake Inhibitors (SSRIs), Benzodiazepines, and Beta-Blockers.  These medications can be prescribed by your primary care physician or a psychiatrist.  Another traditional method to treat anxiety is through outpatient therapy.  Therapy methods could include the use of Cognitive Behavioral Therapy, Exposure Therapy or even Hypnosis.

The treatment methods listed above may not come as news to many of you, as they have been in use for several years in the mental health field.  There are, however, some very new and interesting methods for people to learn to manage their own anxiety without the help of a doctor or therapist.  The first of which is through proper diet and nutrition.  There is ample evidence of causal links between certain vitamin and mineral deficiencies and anxiety.  Studies have shown lack of vitamins D, B6 and B12, magnesium and zinc can all be related to increased levels of anxiety.  Adding these vitamins to your diet through supplements or food intake can help reduce anxiety levels.  Other nutrients shown to help reduce anxiety include tryptophan, vitamin E, and omega 3 fatty acids.  Exercise is another effective way to manage your own anxiety.  When the body is active, the brain produces endorphins which are hormones that promote feelings of wellbeing and improve mood.   20 minutes of cardio 3 times a week can do great benefits for one’s mental wellbeing.  Higher level activities that require concentration such as playing an organized sport can also keep the mind occupied and limit racing thoughts.

Meditation is also an excellent strategy to manage one’s anxiety levels independent of a mental health professional.  Meditation is the practice of engaging in contemplation and reflection.  Through meditation, one tries to focus their thoughts in a specific direction and not allow the mind to wander.  Many people find the practice of meditation difficult at first, but with practice, it becomes easier over time.  In the fast-paced modern world, there are many distractions for our minds and many opportunities for thoughts to wander, but this practice can have great benefits in helping us to control the directions of our thoughts.  There are many options to help one who wants to begin the practice of meditation.  One of the most recent options is the use of smartphone apps.  These apps are convenient as your phone is always with you making them readily available to use over a lunch break or before bed to help you put your mind at ease.

Overall, anxiety is becoming much more prevalent in our society.  In the information age, we are aware of so much happening around us that it is not uncommon to feel overwhelmed and anxious.  If you or someone you know is experiencing unhealthy levels of anxiety, please do not feel ashamed or stigmatized, these feelings are all too common.  Please consult your physician and discuss the treatment options to find what method will work best for you.

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Peer Services, the Future of Mental Health

To be successful in business, it is imperative to evolve and adapt to meet the changing needs of your customers over time.  The mental health field is no exception.  I have seen many changes in the mental health field over my 15-year career.  One of the most exciting changes in Pennsylvania was the addition of […]

To be successful in business, it is imperative to evolve and adapt to meet the changing needs of your customers over time.  The mental health field is no exception.  I have seen many changes in the mental health field over my 15-year career.  One of the most exciting changes in Pennsylvania was the addition of Peer Support Services for adults.  Peer Support Services is an individualized, recovery-focused service that allows individuals the opportunity to manage their own recovery and advocacy process.  Peer Support staff serve to enhance the natural supports in the client’s life and improve their coping and self-management skills.  Peer Support Services began in the Lehigh Valley back in 2008 with few providers.  Peer Support Services are a radical departure from a traditional mental health service.  In a traditional mental health service, you have a professional often with advanced education and credentialing or licensure providing a clinical service to a person struggling with a mental health diagnosis.  Often times this professional is perceived by the client as an authority figure, with formal educational training, and can create an imbalance in the client/provider relationship.  The client does not and will not perceive the clinician as equals.   The fault in this dynamic is that clinicians often have no or limited personal experience with mental health struggles.  This is where the need for a new service was identified.

Peer Support Services are provided by Certified Peer Support (CPS) staff.  To be eligible to become a CPS staff you must have at least a high school diploma and a documented mental health diagnosis yourself.  You must be progressing well in your own mental health recovery.  This is quantified by having at least 12 months of employment or volunteer experience in the last three years.  If a CPS candidate does not meet the vocational requirements, they may also have 24 credit hours of post-secondary education in the previous three years.  If a candidate meets these requirements, they are eligible to register for the two-week Peer Support Certification course.  Upon successful completion of the course, they are eligible to be hired by a Peer Support provider and begin providing Peer Support Services to clients.

The Peer Support/client relationship is much different than the traditional provider/client dynamic seen in other mental health service lines.  Due to having their own mental health diagnosis, peer staff can say “I’ve been there,” or “I’m doing well, so can you” and are living proof that recovery is possible.  They can serve as a role model, mentor, and support to assist a client in managing their mental health symptoms.  This is much different than the traditional provider/client dynamic.  Clients often perceive their CPS worker as an equal through shared experience.  This creates a stronger bond and often better results than a traditional mental health service.

Peer support services are also much more cost effective than a traditional mental health service.  Due to the reduced educational requirements of the staff versus a service like outpatient therapy, the state can offer the provider a lower reimbursement rate for services rendered.  Therefore, this service is cheaper to operate from the state government’s perspective and often more effective than other mental health services geared toward serving adults.  Many agencies have decided to invest in Peer Support Services and also in their Peer Support Staff over the past few years.  The state has followed suit and done the same.  In December 2017, Pennsylvania began allowing providers to offer Peer Support Services to transitional-aged youth (ages 14-21).  We are now also seeing specialized Peer Support Services such as forensic Peer Support that works with clients involved in the criminal justice system, or Drug & Alcohol Peer Support which works with dually-diagnosed individuals who have a mental health diagnosis and co-occurring substance abuse problem.  Peer Support Services are growing exponentially. It is exciting to see where this service can go in the future and the positive changes these staff can help make in the lives of those they serve.

If you or someone you know is interested in becoming a CPS staff or would benefit from receiving Peer Support Services, please contact Pennsylvania MENTOR at (610) 867-3173, or visit our website at www.pa-mentor.com.

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My Insurance Doesn’t Cover Hearing Aids. Now What?

The purpose of this article is to inform the consumer of questions to ask when deciding whether to purchase a plan to cover hearing aids and when it may be beneficial to pay out of pocket.  If you find yourself in an audiology office and are ready to purchase hearing aids, you may want to […]

The purpose of this article is to inform the consumer of questions to ask when deciding whether to purchase a plan to cover hearing aids and when it may be beneficial to pay out of pocket.  If you find yourself in an audiology office and are ready to purchase hearing aids, you may want to ask some of the questions explored below as well.

When you are over the age of 18, Pennsylvania Medicaid doesn’t cover the cost of hearing aids. However, several Medicare/Medicaid supplement plans do cover hearing aids. Most customers don’t know that many of the extra benefits these insurance plans offer are also offered when you pay out of pocket for the hearing aids. If you are in a reputable office that is bundling their prices it’s common to have an extended and complimentary trial period, free batteries, at least five years of in-office service, and an extended warranty of 2-3 years on the hearing aid.  Often these plans list extra benefits as something you are getting because you have their plan. When reading these “extras,” it seems as though they are giving you something beyond what you would normally receive if you purchased the hearing aids out of pocket. As a consumer who has never purchased hearing aids, this may seem like a great deal. There are some things to consider when signing up or paying extra for this benefit if you are doing so because you plan to purchase hearing aids. Some of the things to think about is:  Where are you able to use your benefit?  Will you have access to an audiologist who can adjust your hearing aids?  Is your insurance going to cover additional visits to your audiologist?

Most insurance plans require you to go to a specific office for your hearing aids.  This takes the freedom of choice away from the consumer and may put limits on your satisfaction of the care you receive.  For example, this office may not be near your hometown. You may need to travel to get to one of these offices, and you may also not be happy with the provider you are assigned to in that office. As I talked about in previous articles, you can either buy a hearing aid from a dispenser or an audiologist. Regardless of whom it is the insurance is sending you to, it’s important that you have a positive experience and you trust they have your best interest at heart. The average person will have their new hearing aid for five years before replacing them. You want to make sure you buy them from someone who you want to go back and see for follow up appointments during that time frame.  Follow up appointments are usually a few times a year for cleaning, reprogramming based on changes in your hearing needs, cleaning wax out of your ears, and minor in-house repairs of the hearing aids.

Your insurance plan may also offer a hearing aid that you purchase over the internet.  If they offer that as an option, you may want to ask some details about the follow-up appointments.  Some examples are: will you have access to a local audiologist to help you if you need the hearing aid reprogrammed, cleaned, or if you have questions regarding use and wear of the hearing aid?

Lastly, you will want to consider whether or not the insurance is going to cover the cost of visits to the audiologist after your trial period.  It is a state law in Pennsylvania that you have at least a 30-day trial period with hearing aids. The law states that if you return the hearing aids within that 30 days, you are required to get your money back. The office you purchase them from is allowed to keep 10% of the cost up to $150.00.  Your insurance plan may state that they allow you an extended trial period, sometimes 45 days, with the option for a full refund. To be honest, often times you would receive that regardless of having an insurance benefit. It is an advantage to have this option. However, you want to make sure the insurance is going to pay for visits beyond that 45-day trial period. As I discussed above, it is common to go back for follow up visits in the years after purchasing the hearing aids.  As an audiologist, I want consumers to be informed as possible when making these important decisions about their hearing and quality of life.  If you or someone you care about is ready to try hearing aids, please consider the information and questions listed above to make as informed a decision as possible.

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America’s Continuing Autism Epidemic

Merriam-Webster’s dictionary defines autism as: “a variable developmental disorder that appears by age three and is characterized by impairment of the ability to form normal social relationships, by impairment of the ability to communicate with others, and by repetitive behavior patterns.”  On April 26th, 2018 the Center for Disease Control and Prevention released its most […]

Merriam-Webster’s dictionary defines autism as: “a variable developmental disorder that appears by age three and is characterized by impairment of the ability to form normal social relationships, by impairment of the ability to communicate with others, and by repetitive behavior patterns.”  On April 26th, 2018 the Center for Disease Control and Prevention released its most updated autism prevalence estimates for America’s children.  These estimates are pulled from data in a biennial report based off of the evaluation of medical and education records.  1 in 59 children are now estimated to have an Autism Spectrum Disorder.  Let that sink in.  1 out of every 59 children.  This new ratio is an increase of 15% from the last reported estimate in 2016.  This most recent increase in prevalence continues the trend that researchers have seen over the last twenty plus years.

When I began my career in the mental health field in 2004, the autism prevalence ratios were estimated to be 1 in every 166 children.  Throughout my career, I have witnessed this drastic increase in autism cases create the need for a plethora of new services and supports for children to address the social and behavioral needs associated with autism.  Many providers decided to implement autism specific variations of existing mental health programs.  One of the most popular of these services is Behavioral Health Rehabilitative Services or commonly referred to as BHRS.  BHRS services are intensive mental health therapies that are provided in the child’s home, in community settings and occasionally in the classroom.  These services are focused on identifying interventions to help achieve a child’s behavioral treatment goals and to transfer those skills from the provider to a parent, teacher, etc.  The increase in autism diagnoses has also created the opportunity for providers to create new programs to address this need such as afterschool groups that focus on improving social skills.  They have also begun to create support groups for parents and siblings of those with an autism diagnosis.

The mental health and developmental disabilities fields have successfully evolved and adapted over the years in an attempt to meet the growing needs of children diagnosed with autism.  There are additional supports in the home, community and the classroom for these children.  There are also government and private grants available to families to help manage the additional cost of needed sensory and adaptive communication devices for these children.  But what will happen to these children when they grow up, or “age out” of educational and children’s mental health services?  What supports are available for adults diagnosed with autism?  What supports are available to families to help with their adult child with an autism diagnosis?  The answers to these questions are pretty alarming.  Depending on your location, there are very few if any supports tailored to adults with autism in these fields.

For our nation to fully manage the continued autism epidemic; there will have to be some significant changes in our government and to the adult mental health system.  Our legislators and representatives will have first to acknowledge that the lack of supports, services, and funding for adults with autism is a current problem.  Second, they will have to acknowledge that the problem will only get worse in the future as the ever-increasing ratios of children with autism age out of services.  These adults will need assistance with housing, life skills, employment supports, and socialization.  Our legislators and representatives will need to increase funding for mental health services to allow providers to develop programs to meet the needs of these adults.  Providers will need to step up and use the increased funds to develop new programs, thinking outside the box to support this unique population.  Staff in these fields will have to become more educated on providing supports to adults with autism.  They say it takes a village to raise a child.  In order to support individuals with autism throughout their entire life, not just their childhood, we as a society will have to pull together to help our nation manage this continuing autism epidemic.

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Who Can Sell Hearing Aids?

In the state of Pennsylvania, there are two different licenses that will allow you to sell hearing aids, an Audiology License and a Hearing Aid Dispensing License. The training and education that you need to obtain these licenses are very different. These differences are often misunderstood by the general public and will be explored below. […]

In the state of Pennsylvania, there are two different licenses that will allow you to sell hearing aids, an Audiology License and a Hearing Aid Dispensing License. The training and education that you need to obtain these licenses are very different. These differences are often misunderstood by the general public and will be explored below.

In 2007, the degree requirement to become a clinical audiologist was changed.  A Master’s degree was no longer acceptable to obtain licensure and all audiologists were now required to obtain a clinical doctoral degree.  At this time, if one wanted to become an Audiologist or an Au.D., they would now need to first complete a bachelor’s degree in Speech and Audiology, Communication Disorders, or a related field.  Upon completion of a Bachelor’s degree, a candidate would then apply for a doctoral program which is an additional 4 years of school.  Doctoral coursework includes many topics such as: education, anatomy and physiology of the ear and hearing, the science of sound, the diagnosis and treatment of hearing and vestibular disorders, hearing aids and their progression from analog to digital devices, programming and adjusting hearing aids, and counseling and treatment of adults and children of all ages with hearing loss.  Within those classes you learn about candidacy for treatment options, one of the most common of which is hearing aids.  However, the treatment of hearing loss is not limited to just hearing aids but also includes cochlear implants, bone anchored hearing devices and implantable hearing devices.  Audiologists get the opportunity to do clinical rotations in a variety of settings which can help to determine one’s career path.  Some of these settings could include working with an Otolaryngologist or more commonly called an ear, nose and throat physician.  Another possible clinical training setting for doctoral candidates is in a hospital.  When doing clinical internships, a doctoral candidate would perform testing, fitting and dispensing hearing aids on adults or children.  They could also conduct inter-operative monitoring, vestibular testing & rehabilitation, might also work with outside businesses to adhere to Occupational Safety and Health Administration (OSHA) regulations.  The candidate may also choose to use the business management training and clinical experience to open up a private office in the community. When a candidate finishes their Doctorate of Audiology, they will then obtain their Pennsylvania clinical audiology license.  It is then in their scope of practice to dispense and sell hearing aids as stated by Pennsylvania medical guidelines.

The other way one can legally dispense hearing aids in the state of Pennsylvania is to obtain a Hearing Aid Dispensing license.  To obtain this license, there is a high school level educational requirement, and the candidate must find another licensed Hearing Aid Dispenser to conduct an internship with.  During the internship, the candidates are taught to program and adjust hearing aids.  They are also taught to instruct adults on the use and expectations of hearing aids. Most of the time, this internship is done with someone who was willing to hire the candidate work and sell hearing aids at the same office. When the internship is complete, that candidate must then sit for a written state test.  Upon passing that test, they are awarded a Hearing Aid Dispensing license for the state of Pennsylvania.

When choosing a licensed hearing aid dispenser, it is up to the customer’s discretion which of these two licensed dispensers to choose.   It is important for the customer to realize the different level of educational requirements and clinical knowledge between the two.  Not all hearing aid dispensers are created equal, and it is important for a customer to be able to distinguish between them.  If you are in the market for a hearing aid, I hoped this article helped you to be able to make a more informed decision on your purchase.

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