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Walk-In Clinic Can Save Medical Expense for Uninsured without a Doctor

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Faced with increasing pressure from the number of uninsured patients in Texas County that seek care through the Texas County Memorial Hospital emergency department, hospital officials have implemented a new primary care walk-in clinic in Houston.

Wes Murray, chief executive officer at TCMH, detailed operations of the clinic to hospital board members at their monthly meeting on Tuesday.

“We now have the staff in place to run a walk-in clinic five days a week,” Murray said.

The walk-in clinic operates out of the TCMH Medical Complex in Houston and Chip Lange, PA and Jeff Blue, PA see patients of all ages Monday through Friday from 10 a.m. to 6 p.m.

“Over fifty percent of the patients seeking treatment in our emergency department are not able to pay for the care they receive,” Murray said. “The walk-in clinic provides a convenient and low-cost way to see a healthcare provider for primary care needs.”

In September TCMH had $612,997.05 on the books as “bad debt” from patients that could not pay their hospital bills. Fifty-three percent or $324,888.43 of the bad debt was generated through the emergency department.

“Increasingly, the emergency department is the primary care clinic for patients that are not established with a local healthcare provider,” Murray said, noting that sometimes patients can’t get in to see their healthcare provider when they are ill and need to be seen within a few hours.

TCMH is required by state and federal law to provide healthcare for anyone that comes to the hospital emergency department or to anyone that calls an ambulance regardless of his or her ability to pay for services rendered.

According to Murray, the TCMH clinics will work established patients into the daily schedule when they are ill, but it’s not always possible to fit everyone in that seeks care at a TCMH clinic, even if the patient is an established patient.

The mid-level providers at the TCMH Medical Complex—Lange and Blue–are keeping an open and flexible schedule to see patients that want to walk in for immediate care without an appointment.

“The billing for the walk-in clinic will be like the billing at any of our hospital clinics,” Murray said. “It will be at a much lower cost because it does not utilize the acute care staff, physician and services of our hospital’s emergency department.”

TCMH continues to remain hopeful that Medicaid expansion will provide relief for many residents in Texas County that are not able to afford the expanded healthcare coverage through the affordable care act. However, Medicaid expansion will not occur without action by the Missouri state House of Representatives and Senate.

“We believe this walk-in clinic will help us continue to address the healthcare needs of the communities we serve through a significant number of open appointment times that are available daily as well as helping us trim costs that we are not being paid for,” Murray said.

The TCMH October financial report provided positive numbers. Outpatient revenues were up $70,448.00 over budgeted expectations for the month September. Inpatient revenues were up $10,995.00 over budgeted expectation for the month, too.

For the second straight month, TCMH had a positive bottom line. September’s bottom line totaled $99,656.07, bringing the negative year-to-date balance up to $543,956.14.

“We have made up some of the ground we lost earlier this year,” Linda Pamperien, chief financial officer at TCMH, explained.

Pamperien attributed the increase in inpatient and outpatient volumes to the additional healthcare providers seeing patients at TCMH clinics and doing procedures at the hospital.

Pamperien also complimented the hospital physicians on their efforts to manage the patients they have in the hospital.

“Our physicians are being extremely conscientious about managing the length of stay for their inpatients,” Pamperien said.

TCMH has been recognized by the Center for Medicare and Medicaid Services as providing high quality patient care at a lower cost per patient than the state and national averages. According to Pamperien, properly managing a patient’s length of stay helps the bottom line of the hospital and affects the federal quality data that is collected monthly.

Amanda Turpin, quality management director at TCMH, compiles the monthly quality date and TCMH and submits it to federal and state agencies. In mid-October, Turpin passed her board exam to become an internationally board certified healthcare quality professional.

Turpin is one of 11 nurses in the state of Missouri to attain the certification.

“We are very fortunate to have Amanda here working for us,” Murray said.

Also returning to the area is Heather Ragsdale Lobough. Lobough grew up in Bado and graduated from Houston High School. She is a certified registered nurse anesthetist, and she’s been working for the past few years at CoxHealth in Springfield.

Lobough has signed an employment contract with TCMH, and she will provide surgical anesthesia services at TCMH beginning November 10th.

“Heather is planning to move back to her family’s farm in Bado with her husband and daughter,” Murray said, adding that Lobough is looking forward to the return to Texas County.

Jenny Sawyer of Houston, a registered nurse at TCMH, took over the duties as infection control nurse manager in September. Sawyer has been a nurse at TCMH for nine years, and in that time has increased her education
and licensure to grow her nursing career. She’s currently pursuing a bachelor’s degree in nursing in addition to working full-time at TCMH.

Sawyer made a brief presentation to the hospital board regarding Ebola preparedness at TCMH.

“From the beginning, we have adopted the most aggressive approach,” Sawyer said.

Sawyer began working with hospital departments to put Ebola protocols in place in early October. Currently, roundtable drills and personal protective equipment testing is being done at the hospital.

“We have the federal guidelines in place,” Sawyer said. “I feel like we are ahead of the curve of many other hospitals our size.”

Joleen Senter Durham, director physician recruiting at TCMH, reported that site visits with two family medicine and obstetrics physicians were planned.

“Both of these physicians are looking at the TCMH Mountain Grove Clinic opportunity,” Durham said. “They are seeking a small town family medicine practice where they can practice obstetrics and deliver at TCMH.”

In addition to hospital and clinic tours, the physicians will bring their families and spend time in the area looking at the communities in Texas County.

Present at the meeting were Murray; Pamperien; Sawyer; Durham; Doretta Todd-Willis, chief nursing officer; Dr. Schaun Flaim, chief of staff; Dr. Jonathan Beers, vice chief of staff; Dr. John Duff; and board embers Janet Wiseman; Mark Hampton; Dr. Jim Perry, OD, and Russell Gaither.

Board member, Omanez Fockler, was not present at the meeting.

The next meeting of the TCMH board of trustees is Tues., Nov. 25th at 12 p.m. in the hospital board room.


Grief Recovery Program to Begin at TCMH

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Registration is now being accepted for the “Grief Recovery Method Outreach Program” sponsored by Texas County Memorial Hospital Hospice of Care.

The seven-week Grief Recovery Method Outreach Program will begin Tuesday, November 11th from 5:30 to 7:30 p.m. at TCMH. Sara McDaniel, a certified grief recovery specialist and social worker with TCMH Hospice of Care, will facilitate the program. The class is held in the Timmons Education Room at TCMH.

“In coping with grief many people are told to ‘let go and move on in life’, but they don’t know how to accomplish that,” McDaniel said. “The Grief Recovery Method Outreach Program provides the partnerships and guidance that individuals need to be able to move on with life after a loss.”

The program will provide an action plan for moving beyond death, divorce and other losses such as job loss or health loss.

There is no charge for the program, and the group is open to anyone that is seeking support following a loss.

For additional information or to register for the program, contact McDaniel at TCMH Hospice of Care at 417-967-1279


TCMH Prepares for Ebola

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Like hospitals across the nation and around the world, Texas County Memorial Hospital has also prepared for Ebola should the disease surface in the community.

According to Wes Murray, chief executive officer at TCMH, the local hospital has reviewed all hospital protocols to insure that they follow Ebola guidelines set by the Centers for Disease control.

“Our hospital is focused on providing safe, quality patient care in an environment that protects our patients and our caregivers,” Murray said. “Since this disease surfaced in the US, we have been working with all of our hospital departments to update and plans and protocols to protect everyone.”

In addition to reviewing hospital protocols, TCMH has increased the inventory of personal protective equipment and refresher sessions on the use of personal protective equipment have been completed with the hospital staff.

Department managers have also participated in briefings by the CDC, the Missouri Hospital Association and the Texas County Health Department.

“We want to protect our patients, our staff and our community if there’s any possibility of an ebola care in our area,” Murray said.

Currently, all TCMH patients in the hospital and the clinics are asked the following questions:
• In the last 21 days have you, a member of your family, or any visitors to your home been to Africa?
• If “yes” to question one. Please answer if you have any of the following symptoms: fever, headache, diarrhea, vomiting, stomach pain, unexplained bleeding or bruising, or muscle pain?

The CDC is the national authority on Ebola. Healthcare providers and the public can access the most up-to-date information about Ebola on the CDC website at www.cdc.gov/vhf/ebola/.

If the public has any questions about Ebola or other infectious diseases, they may contact Jenny Sawyer, infection control nurse at TCMH at (417) 967-1388.

If you or someone you know may have been exposed to a potential source of Ebola, contact the nearest hospital emergency department.


Medicare Open Enrollment Underway

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Open enrollment for Medicare health and drug plans began on October 15. Between October 15 and December 7 Medicare recipients must decide if their current coverage will continue to meet their needs through the upcoming year. Changes must be made by December 7, 2014 to be effective in 2015.

The prescription drug coverage plan that is part of Medicare coverage can cause confusion. All Medicare recipients are required to sign up for a prescription drug coverage plan which is known as “Medicare Part D”.

Due to the required Medicare Part D coverage, many seniors find themselves looking at various insurance options.

Because Medicare covers about 55 percent of the patients seen at Texas County Memorial Hospital, TCMH offers to help area residents in the enrollment process, particularly with Medicare Part D.

Wes Murray, chief executive officer at TCMH, noted that Medicare coverage can be very confusing for the elderly population.

“Anyone in the market for supplemental Medicare coverage should contact his or her healthcare provider prior to purchasing the coverage,” Murray said. “Ask your healthcare provider if they accept the insurance you plan to purchase.”

Murray cautioned that some enrollees have been told that TCMH accepts certain insurance, but the information is incorrect.

“Before signing up for anything, please make sure the insurance is accepted by your healthcare provider,” Murray stressed.

Additionally, enrollees shouldn’t sign anything without knowing exactly what they are signing for. Copies of any signed papers should be obtained and retained by enrollees, too.

Anita Kuhn, controller at TCMH, is available to consult at no charge with area residents until December 7 each year. Kuhn will assist those interested in re-enrolling in Medicare Part A and B, if they left it for a Medicare Advantage Plan. She also can assist in determining the best Medicare Part D coverage for each individual.

Please contact Kuhn for a consultation appointment by calling her office at 417-967-1277 or 1-866-967-3311, ext. 4052.

If TCMH is a person’s hospital of choice, information about the insurance carriers they contract with can be obtained by calling the TCMH Business Office at 417-967-1298 or 1-866-967-3311.


Preparations Underway for Eighth Annual TCMH Healthcare Foundation Chili Cook Off

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The Texas County Memorial Hospital Healthcare Foundation is gearing up for the Eighth Annual Chili Cook Off on Sat., Nov. 8th at 11 a.m. in the Community Building at the Texas County Fairgrounds. The Foundation is hosting the event to raise funds to benefit TCMH Hospice of Care.

Jay Gentry, director of the Healthcare Foundation, is overseeing the chili cook off and related activities. “In 2013 the Foundation brought in over $46,785 for Hospice of Care,” he said. “We have a tradition of holding an event that provides fun and entertainment for all ages and raises much needed funds for a really good cause.”

The TCMH Healthcare Foundation Chili Cook Off will feature 16 teams competing for chili prizes and in raising money for Hospice of Care. The event will also feature music, a live auction, a chili dog eating contest, a cake walk and booths with special foods or games as well as the opportunity to sample all the chili.

Chili cooking teams are comprised of five people and are sponsored by businesses and organizations. Currently Intercounty Electric Cooperative; Landmark Bank in Houston; Big Country 99; Community Bank N.A. in Summersville; Raymondville United Methodist Church; Houston Walmart Supercenter; Mercy Clinic-Houston; Houston High School Administration; Kerr Healthcare Services; The Durham Company; Gentry Residential Treatment Center; Spearpoint, LLC; Drury University and Cox College Cabool Campus; Dr. Jonathan Beers; Dr. Lynn Hauenstein and Dr. Christopher Baldwin have sponsored chili cooking teams.

“There’s some healthy competition among our hospital departments, too,” Gentry said. “TCMH Home Health of the Ozarks team will be defending their “Judge’s Choice” title, and the TCMH EMS team will try to claim the “People’s Choice” chili title again.

Three TCMH departments are also participating in the cook off—the EMS department, the medical surgical department; Home Health of the Ozarks and Dr. Christopher Baldwin and Tracey Arwood, CNM of the TCMH Medical Complex in Houston.

Several handmade items that will be auctioned at the upcoming Eighth Annual TCMH Healthcare Foundation Chili Cook Off to benefit Hospice of Care.

Several handmade items that will be auctioned at the upcoming Eighth Annual TCMH Healthcare Foundation Chili Cook Off to benefit Hospice of Care.

A live auction held at 2 p.m. in the Community Building will be a major portion of the fundraising for the day.

The auction features several local artists. Russ and Joanne Biros donated a Noah’s Ark set that was carved by the Lake Ozark Woodcarvers. Alice Wells made and donated a needlepoint piece. Harold Mitchell made and donated a cedar blanket chest in honor of his mother who was in Hospice of Care service. A queen-size hand pieced quilt has been donated by Carolyn Mason.

Other donated items in the auction include one locally raised beef; a five-day stay cruise from New Orleans to Cozumel and Progresso in Mexico; a Branson holiday getaway for two that includes tickets to Silver Dollar City and to Disney’s Frozen on ice, and an overnight package to DownStream Casino Resort in Quapaw, OK.

Several large raffle items will also be awarded to winners at the event.

All of the chili cook off teams are raffling tickets for a Jayco Sport Series 10 Pop Up Camper and a Tikka T-3 Hunter .30-06 rifle. The raffle items will be immediately awarded following the live auction.

Brandon Beck, meteorologist at Springfield television station KY3, will serve as the master of ceremonies for the day’s events.

“Hospice of Care has a long tradition and a well known reputation for providing physical, mental and spiritual care for terminally ill patients and their family members in Texas County and the surrounding area regardless of their ability to pay for the services,” Gentry said. “Many people look forward to the annual Hospice fundraising event as a way to give back to a charity that has benefited them, their family or friends.”

Hospice of Care provides end of life care for patients and their families regardless of a patient’s ability to pay for the service. If insurance coverage is not available, Hospice of Care may use Chili Cook Off funds to purchase medications in addition to providing care at no charge.

“Our goal is to raise at least $50,000 for Hospice of Care through the raffles, cook off ticket sales, the auction and team fundraising,” Gentry said, noting that the proceeds from the Chili Cook Off remain in Texas County to benefit area residents.

The Healthcare Foundation has a special “Hospice Fund” for the chili cook off money and other hospice donations such as memorials. “A very important aspect of the annual Hospice of Care fundraising event is that all
money raised at the event will stay in the Texas County area to benefit area patients,” Gentry said.

“We want everyone to come out to our event, bring their kids, and have an afternoon of fun while raising money for a very worthy cause,” Gentry said. “Once again, the Foundation board of directors and Hospice of Care staff are excited to bring this event to the community.”

Tickets to the event are $10 for adults and $5 for children and are available through Hospice of Care and the Healthcare Foundation at TCMH.

For more information about a sponsorship or to make a gift in support of the chili cook off, contact the TCMH Healthcare Foundation, (417) 967-1377 or online at www.tcmh.org.


Hospital Offers Pre-Pay Program for Expectant Moms without Insurance

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The Texas County Memorial Hospital obstetrics departments has the “Baby-Land Express” program to allow expectant moms without health insurance coverage to plan ahead and pre-pay for part of their obstetrical care.

Angela Raymond, TCMH obstetrics department director, with one of Texas County's newest residents--Blake Brown.

Angela Raymond, TCMH obstetrics department director, with one of Texas County’s newest residents–Blake Brown.

“Baby-Land Express gives prospective parents a cost-effective way to handle their financial arrangements prior to the birth of their baby,” Angela Raymond, TCMH obstetrics department director, said.

The program covers hospital based charges and services including childbirth education classes; access to labor and delivery staff at TCMH; use of labor and postpartum rooms at TCMH; routine diagnostic services; access to an internationally board certified lactation consultant, and individualized education regarding care of mother and baby after delivery.

“With the addition of new obstetrics providers at TCMH, it’s important that area patients know that we want to work with them to have a hospital stay that fits their personal needs and desires,” Raymond said.

This summer Dr. Christopher Baldwin, a board certified obstetrician and gynecologist, and Tracey Arwood, a certified nurse midwife, joined Dr. Joshua Wolfe and Dr. Tricia Benoist, family medicine and obstetrics physicians, in providing obstetrical care at TCMH.

“At TCMH we have a variety of highly skilled and experienced professionals available to women that are pregnant or planning to become pregnant,” Raymond said. “Our obstetrics department staff takes pride in bringing the latest in birthing concepts to our community, too.”

Raymond added that all of the TCMH obstetrics department staff is trained in natural childbirth techniques as well as holding certifications in emergency care of mothers and their babies.

“Our team is committed to a family-centered childbirth experience that includes bonding before and after the birthing experience, and we want this experience to be available to all area parents,” Raymond said.

To participate in the Baby-Land Express program, expectant mothers must be pre-registered at TCMH; have their physician’s approval, and pre-pay for their stay prior to delivery.

Two pre-payment plans are offered—a 24-hour or less stay after delivery or a 25 to 48-hour stay after delivery. Both plans can include an optional epidural. Pricing is for hospital charges for a single infant delivery. Physician fees, multiple births, or cesarean delivery are not included in the pre-paid plans.

“Even if a delivery doesn’t go as planned, the pre-paid portion can go toward the overall cost of the hospital care,” Raymond said.

Payment options are available through the TCMH business office. Each patient can work with patient accounts staff to set up a plan that works best for them.

“Expectant parents have enough to think about without having to worry about the costs associated with having their baby,” Raymond said. “We want them to be able to make plans for the cost and concentrate on the joyous event coming their way.”

For additional information about the Baby-Land Express program, contact the TCMH obstetrics department at (417) 967-1275 or Sara Fields in the TCMH business office at (417) 967-1292.


Clayton Named Employee of the Month

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Texas County Memorial Hospital has named Alison Clayton of Licking the September employee of the month.

Clayton is a systems administrator in the TCMH information systems department. She has worked at TCMH since July 2012. Clayton was nominated for the award by Stuart Mitchell, information systems department director.

“Alison is an extremely talented employee that gives nothing less than her best to her position at TCMH,” Mitchell said. “Alison’s ability to communicate with others is very professional and sincere.”

Clayton is known for her ability to work on complex information technology tasks and for improving functions for many departments.

“Alison is the key to the everyday operation of many of our critical services,” Mitchell said, calling Clayton “focused and dedicated”.

As employee of the month, Clayton received a certificate honoring her achievement; a pin; $100 cash; a special parking place in the TCMH lot; one day of paid vacation; a membership in the TCMH Fitness Center; a $50 gift card, and gift certificates to Paws N Claws, D&L Florist, Janstiques and Blissful Nirvana Massage. A reception will be held at the hospital in honor of Clayton.

Clayton is eligible for the 2014 TCMH employee of the year award.

Alison Clayton, TCMH September employee of the month, with her supervisor, Stuart Mitchell.

Alison Clayton, TCMH September employee of the month, with her supervisor, Stuart Mitchell.


Missouri Foundation for Health Grant Helps with Hospital Readmissions

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House calls have returned for some Texas County Memorial Hospital patients thanks to an $110,567 grant from the Missouri Foundation for Health (MFH).

The MFH grant specifically targets chronically ill patients that have been inpatients at TCMH. Certain patients will qualify for a home visit from the TCMH healthcare provider following the patient’s discharge from the hospital with the hope of keeping the patient from being readmitted to the hospital within a short amount after discharge.

The grant funds will be divvyed out over the next three years to pay the wages and travel expenses of a TCMH healthcare provider, to purchase a portable ultrasound unit and a defibrillator, to provide additional critical care education and to pay for patient care supplies needed for patients in their home.

“Missouri Foundation for Health has a special projects funding opportunity available for grants like this one,” Jay Gentry, TCMH Healthcare Foundation director, said. Gentry pursued the grant on behalf of TCMH.

Based in St. Louis, MFH is an independent philanthropic foundation dedicated to improving the health of the uninsured and underserved in the region. TCMH has received grants for other project in the past.

“The goal of the project is to make 150 home visits per year, and decrease the number of readmissions of chronically ill hospital inpatients,” Gentry said.

The focus of the grant is on chronically ill Medicare patients with cardiopulmonary issues, but other classifications of patients are identified at TCMH and cared for in the home, too.

Statistics show that half of all Americans have a chronic illness, and 25 percent of persons with a chronic illness have more than one chronic condition. Chronic conditions include heart disease, diabetes, asthma, obesity and high blood pressure.

For many years, TCMH has been collecting data on hospital patients and hospital readmissions, and the information is reported to the Center for Medicare Services (CMS). Annual Medicare reimbursement levels at hospitals are based on a number of different criteria specified by CMS, including readmissions of hospital patients.

“Many of the inpatients at TCMH have multiple chronic conditions, so the potential readmission rate is high,” Gentry said.

Statistics show that chronically ill hospital inpatients have the most likelihood of readmission to the hospital within the first three days after discharge from the hospital.

“Following up with the patient in his or her home after they are discharged from the hospital is one way to slow or cut readmissions,” Gentry explained.

Candidates for the house calls are identified during their inpatient stay at TCMH.

Mary Barnes, a registered nurse overseeing case management at TCMH, and Angie Gimpel, social worker at TCMH, follow each patient’s hospital stay. They use a scoring tool that helps them determine if a particular patient is a candidate for follow up care in the home.

The scoring method takes into account the chronic conditions a patient has, how long the patient has been hospitalized, whether the patient in an inpatient or observation patient, and the number of emergency room visits by the patient in the last six months.

Patients that score 90 to 95 percent with the scoring tool are targeted for home visits. Barnes or Gimpel will connect with the patient asking him or her if a home visit would be okay after they are discharged from the hospital. When a patient approves the home visit, Chip Lange, physician assistant at TCMH, is contacted about making the home visit following discharge.

Lange tries to connect with his home visit patient prior to their discharge from the hospital.

“I try to give the patient a face to put with the name before I make the home visit,” Lange said. “Plus, if I see them before they go home, I have the opportunity to assess how they look and sound before they leave the hospital which gives me a baseline for their health when I see them in their home.”

Lange has already started seeing patients in their homes, a process he describes as going “very well”.

A typical home visit takes place 24 to 72 hours after the patient is discharged from the hospital. Lange noted that the most critical time for a patient’s readmission to the hospital is within the first three days of discharge.

Lange does a physical assessment of the patient, provides medication information and instructions, follows up with discharge information and assesses the patient’s home to determine if other resources such as a walker or home health are needed to improve the patient’s health and safety at home.

“A much more complete picture of the patient is available when you visit their home,” Lange said, adding that the patients he has visited at home like having Lange “on their turf”.

“There’s a lot less pressure for the patient because they aren’t worried about getting to the appointment on time, finding a ride to the appointment or the other stresses of leaving the home for an office visit,” Lange explained.

Lange noted that in addition to the comfort the patients find from the home visit, he’s able to spend whatever time is needed with the patient getting a clear look at the patient’s medications and the administration of the medication.

“The home visit is much more slow-paced, and we usually have pretty good discussion about the patient’s health,” Lange said.

The grant allows TCMH to make home visits to chronically ill inpatients following their discharge throughout the TCMH service area. The grant targeted Medicare patients at TCMH, but any patient that meets the criteria is eligible.

Jean Freeman-Crawford, program officer for the Missouri Foundation for Health, presented a ceremonial check to Texas County Memorial Hospital for the house call grant for chronically ill patients.  Shown with the check are (left to right) Chip Lange, physician assistant at TCMH; Wes Murray, TCMH CEO; Freeman-Crawford, and Jay Gentry, TCMH Healthcare Foundation director.

Jean Freeman-Crawford, program officer for the Missouri Foundation for Health, presented a ceremonial check to Texas County Memorial Hospital for the house call grant for chronically ill patients. Shown with the check are (left to right) Chip Lange, physician assistant at TCMH; Wes Murray, TCMH CEO; Freeman-Crawford, and Jay Gentry, TCMH Healthcare Foundation director.


Health Tips for Women over Age 50

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tracey arwoodBy Tracey Arwood, CNM

1. Continued pap smears at least every three years to screen for cervical cancer until age 65.

2. Colon cancer screening with a conoloscopy or sigmoidoscopy starting at age 50.

3. Yearly blood pressure screen with annual physical exam

4. Cholesterol/lipid screen every five years starting at age 45. This is a fasting blood test.

5. Annual mammograms to screen for breast cancer starting at age 40 until age 75.

6. Osteoporosis screen with a bone mineral density test every 2 years starting at age 65 or sooner based on risk factors.

7. Screening for Type 2 Diabetes based on risk and elevated blood pressure.

Other screenings based on risk may include screening for sexually transmitted infections, depression, genetic testing for breast cancer genes, thyroid disorder, hepatitis B and C, and HIV.

All adults should receive a yearly flu vaccine, a tetanus booster every 10 years, a shingles vaccine at age 60 or older and a pneumonia vaccine at age 65 or older.

For optimal health, I recommend: a yearly medical exam, daily moderate physical activity for at least 30 minutes per day. Eat at least five cups of fruits and vegetables of various colors per day, limiting fried and sugary foods, preparing most meals from scratch at home and switching to whole grain whenever possible. If you are overweight, losing just 10 percent of your body weight can significantly decrease your risk of heart attack. A daily walk outside for at least 15 minutes a day can decrease symptoms of depression, provide stress relief, and provide exercise to prevent chronic health problems. Stopping or decreasing smoking can decrease your risk of many cancers, heart disease, stroke, breathing problems, and chronic pain. Women should limit alcohol intake to no more than one glass per day. A daily supplement of calcium and vitamin D will help prevent osteoporosis in postmenopausal women.

For additional information contact Tracey Arwood, CNM at the TCMH Medical Complex in Houston at (417) 967-5639.


Preventative Screenings and Exams are the Key to Good Health

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The rise of preventative medicine has shown that a patient’s quality of life can be enhanced with regular healthcare screenings and exams. Preventative medicine can also save money for insurance companies such as Medicare.

Medicare was established in 1965 as an acute care insurance policy to cover illness and injury. Medicare did not pay anything to help keep Medicare recipients well when it was established, but the program has evolved with healthcare to include coverage for a preventative healthcare program for every Medicare enrollee.

Jeffery Kerr, DO, a nationally recognized geriatrician and the medical director of the emergency department at Texas County Memorial Hospital, sees a majority of Medicare-covered patients in the hospital and in his nursing home practice. He is a believer in the benefits of utilizing the preventative coverage provided by Medicare.

“Preventative medical services are the most underutilized part of the Medicare program,” Kerr said. “But preventative screenings and exams are the key component to the Medicare program and helping beneficiaries maintain their health and quality of life.”

For new Medicare enrollees, a first-time physical exam called the “Welcome to Medicare Physical” starts each Medicare recipient on the path of preventative healthcare. Eighty percent of the cost of this exam is covered during the first 12 months that a person is enrolled in Medicare Part B.

During the “Welcome to Medicare” exam, the healthcare provider will record medical history, check blood pressure, vision, weight and height. The healthcare provider will make sure the patient is up-to-date with preventive screenings and services, such as cancer screenings and shots. Depending on a person’s general health and medical history, further tests may be ordered if necessary. For example, a person at risk for an abdominal aortic aneurysm may get a referral for a one-time screening ultrasound at their “Welcome to Medicare” physical exam.

A screening lipid panel to evaluate cholesterol and triglycerides is covered each year for Medicare recipients. Good cholesterol levels decrease risk of heart attack and stroke.

“Our genetics play a big role in our cholesterol and triglycerides,” Kerr explained. “You can be thin and in shape and still have elevated cholesterol levels.”

Elevated levels of cholesterol and triglycerides in the arterial walls create sticky areas for blood to attach and create clots. These clots can proceed to clog arteries—usually in the brain, heart and legs.

Screening colonoscopies are covered every 10 years by Medicare. Colonoscopies can find polyps and tumors. Because some colon cancers originate in polyps, the polyps founds during screening colonoscopies can be removed during the screening exam.

Lipid panels and colonoscopies are two part of preventative healthcare covered by Medicare for men and women. There are also preventative screenings recommended and covered specifically for men and for women.

Men and women may also receive a bone mass measurement, medically referred to as a Dexascan, covered by Medicare. The criteria for Dexascan vary for men and women. Because women are more likely to experience bone loss or osteoporosis, a healthcare provider may order a Dexascan every two years as part of a preventative medicine program.

“Osteoporosis can creep up on a person, and many times is not recognized until that person fractures a hip or has a vertebrae crumble,” Kerr said.

Kerr noted that bone health can be improved with some medications or treatment plans prepared by a healthcare provider.

Specifically for men are the annual prostate screening antigen (PSA) with a digital rectal exam (DRE) and a testosterone level evaluation.

“Prostate cancer can be slow growing without symptoms,” Kerr explained.

Often, the first sign of prostate cancer is bone pain. At that point, the cancer has spread to the bone and is incurable.

“A PSA is a simple blood test, and the DRE is performed at the same time to evaluate the size of your prostate,” Kerr said.

A testosterone level test is also a blood test; checking for the level of androgen in blood. According to Kerr, a normal testosterone level can increase the quality of life for men of all ages.

Women enrolled in Medicare can receive screening mammograms, gynecologic exams and hormone therapy in the preventative portion of Medicare coverage.

“Screening mammograms have proven that breast cancer does not have to be deadly,” Kerr explained. “The benefits far outweigh the risks.”

Mammograms are covered every year in the Medicare program. A screening mammogram can find nodules that cannot be felt by a patient.

The annual female gynecologic exam includes a test to find abnormal cells in the cervix that are or may become cancerous, commonly known as a pap smear. This test can also determine the level of hormones circulating in a woman’s body. A rectal exam may also be included annually to evaluate the stool for occult blood, which can be a warning sign for cancer.

“A woman’s healthcare provider can determine the frequency of gynecological exams based on the needs of the woman and her health history,” Kerr said.

Hormone therapy may also be a part of a female Medicare recipient’s preventative health plan as evaluated and prescribed by a healthcare provider. Low estrogen levels can cause fatigue, vaginal dryness, urinary problems and decreased sex drive.

Kerr stressed the importance of each Medicare enrollee having a relationship with a primary care doctor. “If you don’t have a regular healthcare provider or have not seen your doctor about a preventative program, I encourage you to do so,” Kerr said.

As a long-time physician at TCMH, Kerr has worked closely with the hospital’s physicians and mid-level providers.

“TCMH has healthcare providers that can work with anyone who needs to set up a preventative care program,” Kerr said, noting that all of the preventative screening tools are available at TCMH, too.

“Many older adults do not like to travel far from home to get the healthcare they need, so we are very fortunate to have the staff and services available in Texas County to help our elderly stay healthy when they get started on a preventative healthcare plan,” Kerr said.


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