Archives for July 2014

 What could go wrong if you never get around to end-of-life planning? Plenty.

“I’ll wait until I have to.”   That’s a huge gamble, since somewhere between 28-68% of patients at end-of-life lose the ability to make medical decisions for themselves.

No POA? You and your family are at risk. If you become unable to make medical decisions for yourself, and haven’t chosen a legal Power of Attorney for health care, Wisconsin law requires the court to appoint a guardian for you. This requires 3-5 business days (at best), costs about $1500 in legal fees (at best). Any family conflict? Well then, let’s make that more like a month’s delay and $5,000 in legal fees – and all this on top of an already upsetting situation.

Patients without end-of-life plans don’t do well. They suffer more. They don’t live as long. And their care costs much more.

Families suffer without advance directives. “My family knows me, and they know what I’d want.” Are you sure about that –I mean REALLY sure?

Have you ever bought a house jointly with anyone? Did you ever feel nervous about making an expensive decision without consulting your partner?

How often does someone you love call to double-check something trivial? Maybe I’m the only one, but my wife Sara calls me to double-check about a lot of things that: a) we’d already discussed, and b) aren’t very important. And I do, too.

Most of us don’t want to make the wrong decision on behalf of someone we love. How confident would you feel making end-of-life decisions for a loved one who’d given you only the most general instructions. Here are some examples of unhelpful directives:

• “No heroic measures”
• “If I’m going, let me go”
• “I wouldn’t want life support if things got too bad”

Making these kinds of decisions without guidance puts loved ones in a terrible position. No matter how well you know someone, it’s hard to feel confident you’re choosing correctly if you’ve never discussed their wishes. So it’s no surprise that families of patients without advanced directives suffer higher rates of depression and complicated grief.

You can’t afford not to think about dying-about the kind of medical care you would and wouldn’t want at the end of your life. And you can’t afford not to tell your loved ones about your wishes.

As a clinic, Green Bay Oncology has an obligation to follow the HIPAA rules set by the federal government. HIPAA is a federal law that protects the privacy of personal health information. It stands for the Health Information Portability and Accountability Act. It gives patients control over who, outside of necessary medical professionals and insurance companies, has access to confidential medical information. Physicians can share medical records with other physicians and clinics when referring a patient to them or communicating with other physicians already involved in the patient’s care. Insurers require basic information to process claims and approve procedures and medications.

When a patient completes the initial paperwork at the first appointment, a notice of privacy practices is given to let patients know that Green Bay Oncology will use and disclose health information for treatment purposes, payment activities and healthcare operations without written consent or authorization. This also explains patient rights related to protected health information. Patients are then asked to sign an acknowledgement of receiving a copy of these practices. Patients also receive a copy of the HIPAA form whose purpose is described below.

How can I or my loved ones obtain my information?

When a patient completes the initial appointment paperwork, a HIPAA release form is completed. This form allows patients to indicate who can receive verbal information from our clinic. This allows someone other than the patient to call into the clinic to get medical information, appointment information and/or billing information as indicated by the patient.

Patients have the right to obtain their written medical information from our facility. They also have the right to release their written medical information to family members, friends or others. In order to have information released, a patient must sign an authorization allowing this transaction. A medical records associate will then verify the information is complete and process the request. This form can be mailed or faxed for completion. In rare circumstances, a verbal authorization can be obtained via phone call with two Green Bay Oncology employees. This is only allowed by exception.

What happens if my loved ones need my information after I pass away?

Any rights granted by the above forms ends when a patient passes away. If records are needed from a deceased patient’s chart, the personal representative of the deceased patient’s estate must present the paperwork that gives him or her the authority to act on behalf of the deceased and then request the needed records.

The exception to this is if records are requested by a physician to treat another family member. The records would be released directly to the health care provider who is treating the surviving relative. Authorization for releasing records of a deceased patient are also not required when releasing health information to funeral directors, medical examiners, law enforcement and for research purposes.

While many of us are used to seeing the HIPAA paperwork in all of the healthcare facilities we go to, we often forget the reason for these laws. It is more than just paperwork to complete. At its essence, HIPAA protects each of us as individuals and gives us much tighter control over our healthcare information.

Lung cancer kills more people every year than breast cancer, prostate cancer, and colon cancer combined.

Unfortunately, lung cancer has historically been diagnosed at a more advanced stage; individuals typically do not have symptoms in the earlier stages of lung cancer. Up to 60-70% of people diagnosed with small, early stage lung cancer could be expected to be alive five years after the diagnosis; only about 10-20% of patients with more advanced lung cancer would be expected to be alive five years after the diagnosis. The United States Preventative Task Force 2013 recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in persons at high risk for lung cancer based on age and smoking history. This new recommendation came from the results of the National Lung Screening Trial (NLST). The NLST identified that screening current and former heavy smokers with low-dose CT scanning at least once yearly for three years resulted in 20% fewer deaths from the disease compared with a yearly chest x-ray. It is important to recognize that there are still potential risks that come along with the screening–a high potential for false positives (a screening test that is positive, but ultimately the abnormality is found to NOT be cancer); unnecessary follow-up procedures (with a risk of complications); radiation exposure; and anxiety related to an abnormal test result.

Green Bay Oncology is committed to the community and we are happy to provide a comprehensive High Risk Lung Screening Clinic, where individuals at high risk for developing lung cancer are able to receive the necessary education on the NLST data and make an informed decision on low-dose CT scanning.

Individuals at risk would include all of the criteria below:

• Between the ages of 55 and 80 
• Have a significant smoking history (30 pack/years). The formula is number of packs per day multiplied by the number of years smoked. For example, 1 pack per day times 30 years equals 30 pack/years; 2 packs per day times 15 years equals 30 pack/years. 
• Currently smoking or have quit smoking less than 15 years ago

The High Risk Lung Screening Clinic offers an appointment with one of our nurse practitioners. The appointments are offered at all of our locations. At this visit, the nurse practitioner will discuss the program and evaluate the individual.  If it is decided to proceed with a low-dose CT scan of the lungs, this will be ordered for a convenient date and time at the Prevea Radiology Department, Webster Avenue Site-Green Bay. A dedicated radiologist with knowledge specific to lung screening criteria will interpret the scan. A follow-up appointment with the same nurse practitioner will be scheduled to review the low-dose CT results and further outline an individual screening plan. All of the individuals entering the screening program will, at minimum, have three yearly screening scans.  This can vary based on the individual results.

To make an appointment or referral call 920-884-3135.