Author: Larry Schwingel

Home to thousands of older adults, the tropical paradise of Florida isn’t so sunny in terms of overall health care. In an age where more Americans have access to health care than ever before, Florida still has work to do compared to other states.

 

Determining the “best health care” among states is a result of findings generated by a diverse set of metrics and analytics, and costs vary from state to state based on a population’s overall need, access, technology, and other tangible factors.

 

The U.S. Health System Data Center publishes an annual “Scorecard on State Health System Performance.” This is a measure of access, prevention/treatment, avoidable hospital use and cost, healthy lives, and equity. Its average findings show Florida 39th, with its lowest marks in the category of access (41st.).

 

According to Aiming Higher: Results from a Scorecard on State Health System Performance, 2017 edition, The Commonwealth Fund, March 2017, Florida ranked

44th in prevention and treatment, 45th in avoidable hospital use and costs, 20th in healthy lives, and 33rd in equity The lowest-ranking indicators in the access category were uninsured adults (50th), uninsured children (45th), and adults who went without care due to cost (46th).

 

If Florida were to improve to the level of the best-performing state, the U.S. Health System says that 1, 893,354 more adults would have to be insured; 1,586,865 fewer adults would go without needed care because of cost; and 102,982 fewer emergency room visits would have to occur among Florida’s Medicare population. Its top five states for best health care were Vermont, Minnesota, Hawaii, Rhode Island, and Massachusetts.

 

The Uninsured: A Major Detriment

The number of Americans without health insurance is at an all-time low due to the Affordable Care Act, known as Obamacare, however Florida’s decline in national rankings is tied directly to its uninsured population. According to healthinsurance.org, the numbers of its uninsured continue to be among the nation’s highest.

 

On a political level, Gov. Rick Scott was a vocal opponent of the health care reform law. Florida rejected federal loans to evaluate a state-run exchange and was the lead plaintiff in the U.S. Supreme Court case challenging the ACA and rejected Medicare expansion.

Despite the opposition, the bill contained enough quality provisions that eight insurance companies sold plans within the state, and that generated a higher than expected enrollment.

 

One of the major legislative sticking points is that anyone without health care coverage, either through an employer or a public care program, is subject to a tax penalty. Portions of this politically controversial legislation are targeted for revisions and restructuring in 2018.

 

According to the Florida Policy Institute, Florida ranks 45th in the nation for its rate of uninsured residents. Based on U.S. Census Bureau statistics, 2.6 million are without coverage (13.3 percent of the population). Florida’s rate is three times higher than that of Vermont, where only 3.8 percent are without health care coverage. The only four states with higher rates than Florida are Texas (17.1 percent), Georgia and Oklahoma (13.9 percent each), and Alaska (14.9 percent).

 

Kimberly Leonard, a former health care reporter at U.S. News & World Report, commented on the effect of Obamacare. “The cost of Obamacare rose as millions of low-income people unexpectedly enrolled in public health care coverage rather than private insurance. The numbers indicate that the federal government fell far short in estimating how many people would enroll in government coverage rather than tax-subsidized, private health insurance.” She also reported that 68 million people were enrolled in Medicaid and Children’s Health Insurance programs in 2016—a jump of 16 million above the government’s anticipated figure in 2010.

 

More data…more differences

Another “Best States for Health Care” listing, published by U.S. News & World Report, used data compiled by McKinsey & Company. Its analysis was in the categories of overall health, access to care, availability of preventive medicine, and quality dental treatment. The top five states, according to U.S. News, were: Hawaii, Massachusetts, Minnesota, New Hampshire, and Iowa. Florida ranked 31st.

A broader set of variables, included overall health care, education, crime, infrastructure, opportunity, economy, and government provided a different outcome, with Florida ranking 24th with respective scores of 31, 29, 37, 11, 43, 7, and 9. However, eight hospitals in South Florida were among its Top 20 list: Baptist Hospital of Miami (6); Cleveland Clinic Florida (8); Holy Cross Hospital (10); University of Miami Hospital (12); and Memorial Regional Hospital (14). Boca Raton Regional, South Miami, and West Kendall Baptist were tied (16).

WalletHub.com (owned by Evolution Finance Inc.) is another example of how data and conclusions differ from source to source. Its findings showed Hawaii as the top state for health care (67.36), followed by Iowa (66.62), Minnesota (66.52), New Hampshire (66.54) and the District of Columbia (65.47). Florida ranked 43rd (46.07), and was near the bottom of “Lowest Percentage of Insured Adults Aged 18-64.” WalletHub used 35 different metrics, including cost, access, and outcome analysis.

The Department of Health and Human Services says health care spending will grow at a faster rate than the national economy over the next decade. Projections are $3.35 trillion, or more than $10,000 per person. Five percent of the population (mostly frail or ill) will account for half the spending in any given year.

 

Health care is the Great American Puzzle. How the pieces fall into place will have a long-lasting effect.

Ketamine is a powerful drug that has been around for 50 years. Much of that time it was used by veterinarians and even by medics as a surgical anesthesia on the battlefield. Today’s battlefield is a landscape comprised of everyday people suffering from a variety of chronic disorders ranging from depression, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), to fibromyalgia, migraines, and complex regional pain syndrome (CRPS). A major weapon in the battle is ketamine infusion therapy.

Board-certified Anesthesiologist and Infusion Specialist Douglas Kornreich, M.D., is a native of South Florida, and founder of KetaMed Health & Wellness in the Village of Rye Brook, NY. “I believe that ketamine infusions help people lead a more stable, less pain-filled life,” he said. “I’ve practiced for 20 years, and for 10 years, ketamine has been used to provide my patients with pain relief.” The doctor reports that the majority of cases using ketamine have proven effective, especially in treating CRPS, a condition that even Oxycontin failed to remedy. Ketamine
CRPS causes pain throughout the limbs, and is extremely debilitating. Many of the most powerful opioid medications have not provided relief, but ketamine has shown significant promise; some patients are pain free up to six months. “Ketamine treatments block pain receptors that lessen nerve sensitivity, and that enables the body to heal itself,” Dr. Kornreich said. “CRPS has no cure, but there are ways to manage pain and nerve sensitivity efficiently.” CRPS can be treated with a variety of protocols. One method is admitting a patient into the ICU and administer high does of ketamine continuously for several days. Most patients reported no pain for up to six months. “Another protocol is a series of daily four-hour infusions for 10 days, and that is the protocol that I use,” Dr. Kornreich said.

The Benefits of Ketamine
About 10 to 15 percent of the population experiences a depression disorder each year, but ketamine is not a first line of medical treatment for depression. Rather, it’s the last line of defense. About 50 percent of patients report a positive improvement after the first medication, but those that experience no improvement are placed on a second drug. If there is no quantifiable improvement after two medication cycles, ketamine infusion therapy can be used on those “treatment resistant” patients. Treatment resistant depression patients require six infusions over a two-week period. According to Dr. Kornreich, 60 to 70 percent benefit from the therapy.

The Federal Drug Administration has given its stamp of approval on ketamine as surgical anesthesia. Yet, despite the benefits of the treatment, it has not been granted approval as a treatment of depression-although the World Health Organization calls it an “essential drug.” The FDA has now placed ketamine on a “fast track” protocol for potential future approval.

Ketamine infusions have also been proven to be an effective treatment for people with suicidal thoughts. “It is so effective that it has greatly curtailed, and in some cases cured, thoughts of suicide in people after just one 40- to 60-minute treatment,” Dr. Kornreich said. “PTSD patients receive up to two weeks of relief from a single 40- to 60-minute session.” The cost of the drug is a minimal, but a host of other fees for nurses, administration, rent, malpractice, infusion pumps, vital signs monitoring, intravenous supplies, legal fees, professional dues, and miscellaneous expenses, can skyrocket the cost to $800 per infusion.

The Infusion Process
A physician and a nurse assistant continually monitor the infusion procedure. Patients are placed in a recliner in a dedicated treatment room and ketamine is infused via an IV tube that runs from the pump into the patient’s arm. During the process, the pump can be programmed to infuse precise amounts of the medication-and dosages can be altered immediately. Having used ketamine for more than 10 years, Dr. Kornreich is an expert in the pharmacological and physiological responses that cause changes in blood pressure and heart rate. EKG pads are positioned and a blood pressure cuff is applied prior to the infusion.

The Challenges
When administered by trained clinicians, ketamine has many potential benefits. In the wrong hands is potentially lethal. The opioid crisis is a result of illegally manufactured drugs being diverted onto our streets, and ketamine (often referred to as “Special K”) is popular. Using it as a recreational drug leads to addiction, cognitive impairment, bladder disease, and potential death. However, the clinical use of ketamine has a long and safe record. When administered properly, the intake of ketamine into the bloodstream can be properly monitored and controlled at significantly lower levels than if it were taken as a recreational street drug.

“Infusions maintain a lower level of the drug in the blood for a longer period of time and that is a great benefit when treating depression and other chronic issues,” Dr. Kornreich said. “Through the use of ketamine we have learned much about OCD, and PTSD and what is going on in the brain “This only leads to better medications that will work as well or better than Ketamine, and will not require an infusion.”
For more information about this topic, visit Ketamineadvocacynetwork.org or ketamedhealth.com.

Safety first. It is vital, it is important, and it is necessary.

A recent issue of the Parklander featured a cover photo of a woman operating a power tool without any protective eyewear, leather gloves, or long-sleeved shirt. The intent was for artistic purposes only, and meant to catch the eye of its readers. Based on the number of responses received, the magazine certainly accomplished that goal.

The use of the image opened the door for additional dialogue and input from readers who correctly pointed out that the cover photo was not compatible with the content contained in the article. We appreciate the valid input, and welcome constructive comments and suggestions from our community of readers.

One member of the community was Jerry Lozinski, a semi-retired engineer who worked in factories that adhered to strict OSHA guidelines. “I worked in product development, and it was our job to make sure they met the highest standards,” he said. “Sometimes people feel the product is the problem, but if you put a heater in a bedroom next to drapes and it starts a fire, you can’t blame the product. The same holds true for tools used when working around the house. Be sure you have the right tools and be sure you know how to use them.” He said that the cover photo was an example of how not to protect yourself when using a power tool.

“When you do a job, be protected,” Lozinski said. “Wear leather gloves, safety glasses, proper clothing and shoes (and in some cases head covering and a mask). Use common sense and make sure you are knowledgeable enough to perform the project.”

Sheets of plywood, ladders, drills, and saws were the order of the day as preparations were made for Hurricane Irma. The basic tools: a circular saw, a hammer drill (and charger), a regular wood drill, Tapcon screws, proper drill bits for the masonry, hex-head screws, and ladders. Note that it is important when drilling into cement, as masonry bits can overheat and sometimes break— depending on the density of quartz contained in the gravel composition of the cement.

Lozinski used a small electric chain saw to cut the root and limbs of a tree that had fallen in his yard. “I wore a complete shirt and long pants, heavy leather gloves, and steel-towed boots,” he said. “It’s important to cut at a proper angle so limbs fall in the right direction. If you don’t have the equipment you need, call someone who does. Don’t be afraid to ask for help.”

Joe Albers, a principal engineer at South Florida Water Management District, said men could be victims of their own machismo. “A lot of guys think they are supposed to know all this stuff about repairs, but it is better to be safe than sorry,” he said. “Don’t be too humble to ask questions about the right tool and the proper safety gear.” Albers, who does the bulk of his home’s repairs, said wearing personal protective equipment is vital. “Without the proper safety precautions you can easily end up in the emergency room,” he said.

The cover photo showed particles of wood flying dangerously close to the woman’s face. Albers said that circular saws could have a dust catcher or a vacuum connection to reduce the amount of exposure. “A dust respirator is good too, because once the dust gets into your nostrils it becomes a respiratory irritant,” he said. The woman pictured wore a chocker necklace and a tank top. The necklace didn’t necessarily pose a safety issue, but rings and bracelets do. “I came from a farming background and we didn’t wear rings,” Albers said. “Most famers and ranchers don’t wear wedding rings because they can be caught on something.” According to Albers, the photo didn’t convey the appropriate message.

Key questions to ask before any home project should be: What does the job entail? Do I have the skills to do it? Do I have the proper equipment required? What are the hazards? Albers admits he does not get involved with anything electrical, but he does simple plumbing. “When it comes to copper piping and soldering, I’ll hire someone,” he said. “I know my limitations.”

He advises wearing leather gloves for a better grip and hand protection, and to use a ladder planted on solid ground to prevent tipping. Also, use both hands when using a chainsaw. “It is one of the most dangerous tools you can own, so be sure there is a stable surface, and keep both hands on it to protect against kickback,” Albers said. He also said that hearing is also a part of safety, so wearing earplugs to listen to music when working isn’t advisable.

In summary, wear protective clothing, proper footwear, and glasses, use the right tools and drill bits, know the risks, know your strengths and weaknesses, and don’t be afraid to ask for help.