In My Own Words

This feature is based on the author's own experiences, observations and thoughts, the articles may contain "opinions" and "methods" that the author believes facilitate better care for long-term care residents. These are not meant to reflect CALTCM official policy.

Check back often for more! If you have an "In My Own Words" article you would like to submit for consideration, please feel free to share with us.  


Coming to the finish line of my first 100 miler!
Congratulations to Mike Wasserman on his 100 Mile Run!
Michael Wasserman, MD, CMD, President of CALTCM, finishes 100 mile run in 40 hours!  In health he says quality has no finish line!  Watch the video here.  Join us in congratulating Dr. Wasserman!

“Coming to the finish line of my first 100 miler! Thank you for getting me into this Robert Key!”

In My Own Words
by Michael Wasserman, MD, CMD
(Social Media exchange, shared with permission.)
September 7 at 6:17 PM

I finally wrote my comments regarding the proposed changes to E&M coding, figured I'd share. This proposed change could destroy #Geriatrics and #HPM. Here are my comments:

I agree that the existing CPT coding system is inadequate. However, lumping together four E&M codes into one will have a serious unintended consequence. It will lead to clinicians spending less time with patients. When it comes to the care of older adults, this is profoundly disturbing. The simpler solution would be to pay physicians for the time that they take caring for patients. The risk of abuse of this methodology is very limited, especially because the patients themselves become the auditors! The greatest negative impact of this proposal will be its effect on the care of patients with complex problems, and frail older adults are the most obvious population that could be harmed by this change.

A Personal Perspective on Obesity and Bariatric Care
In My Own Words                                   
by Tim Gieseke MD, CMD

In my PA / LTC practice I have been admitting more young patients with complications of serious obesity.  In recognition of this emerging consequence of our obesity epidemic, our CALTCM Education committee has designed a half-day workshop for our 2017 annual meeting on Bariatric Care.  One exciting aspect of this workshop will be the emphasis on improving the health and wellness of not only our patients with obesity, but also our staff and ourselves.  A number of years ago, I had the privilege of learning motivational interviewing at an AMDA annual meeting under the instruction of Drs. Daniel Bluestein and Patricia Bach.  This has revolutionized how I approach difficult lifestyle problems integral to successful self-management of many chronic health problems like obesity, drug misuse disorders, diabetes, and most chronic diseases.

My experience from Hospitalist to SNFist
by John Hurwitz, DO
In My Own Words

Two years ago I made the transition from full time Hospitalist to full time SNFist.  I am quite satisfied with this change, for a number of reasons. It is very clear that the changes in the delivery of healthcare will make the post-acute space one of the most highlighted and focused places for improvement in the care continuum.

Physician Burnout

by Dan Osterweil, MD, FACP, CMD

Reflecting on the increase in physician burnout and attrition and my own struggle to balance the Industrialization of medicine with the old person-focused compassion, I stumbled upon this article in WSJ,  When Doctors Stop ‘Seeing’ Patients By Abraham M. Nussbaum, which resonated with me by a physician lamenting the loss of humanity from the practice of medicine. I am inspired by the quote of the last line of the Hippocratic Oath: "May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help". He believes, as do I, that "finest tradition of physician physician's calling are those moments when we look patients in the eyes, understand their pain and anxiety and help the resolve, relieve or endure it." That means not staring at the computer screen while talking to our patient in distress and saying everything is fine, but rather listening to the patient's concern who may be far removed from the numbers on the screen."

How come I did not know that? Pharmacogenomics, Pharmacy Consultants, and Adverse Drug Events
In My Own Words
by Dan Osterweil MD, FACP, CMD
CALTCM CEO and Past-President

A recent article in the WSJ (95% of people have genetic variations that affect if a drug will work for them or not points out an important phenomenon of gene variation and its effect on drug metabolism. The article points to variations in enzyme activity that impact clearance of various drug classes. While in many instances the variation has minimal clinical relevance, in selected cases, such as multiple drug use, lack of effect of certain medications used concomitantly with others or in smokers, there may be adverse effects or lack of effect. 

Will Aid in Dying become Assisted Suicide?
by Timothy Gieseke MD, CMD
Former Chair of Education at CALTCM

As a senior clinician working full time in the LTC setting, I am fully committed to an interprofessional approach that provides high value care to our vulnerable patients.  I am pleased that the Coalition for Compassionate Care of California recently updated the CARE Recommendations (Compassion and Respect at the End of Life) for SNFs.  I welcome their efforts to help my teams provide optimal care for those with serious illness.  Like Atul Gawande in his book, Being Mortal, walking with our patients, families, and colleagues during these troubling times has value not only for them, but also for us as caregivers.  To a large extent, palliative care advances have occurred as we learn from situations and strive to do better.  I realize there are moments in the care of some patients where patients are overly burdened with unrelieved suffering and the future looks grim.  However, with the extra layer of care that palliative care offers, and with time, sometimes unexpectedly, good things happen.

Measles Vaccination Decisions: What’s Best for the Health of the Most Vulnerable?

by Flora Bessey, Pharm.D., CGP

On May 6, 2015 my husband and I will welcome our beautiful baby into this world.  We haven’t found out the gender.  We call the baby Poppy since when we found out we were pregnant, the baby was the size of a poppy seed.  I am sure all the parents reading this can imagine the excitement, hopes and dreams we have for the baby.

With my husband and I both working in healthcare, we are at times overly cautious about things.  Imagine our alarm when we learned of the recent measles outbreak.  On further review, our Poppy can’t get vaccinated against measles until 9 months.  That is when an infant’s immune system can process and build a response to the vaccine.

Case Study: Guaranteeing Outcomes in an ACO/MCO World
by Ken Lund
CEO, Shea Family; CALTCM Board Member

Delivering care under the Affordable Care Act is changing the healthcare landscape, and requires that post-acute care providers think differently.

Few could have imagined a 50-70% cut in skilled rates, but that’s exactly what unfolded in Southern California. Today providers are contractually obliged to demonstrate measurable outcomes in exchange for volume from managed care organizations (MCO) and accountable care (ACO) partners.

At Shea Family, we re-structured to improve health care delivery and drive outcomes. The migration began four years ago, and the model has been in operation for the past two years.  Teams focused on five areas: care coordination, specialty education, strategic technologies, innovations in care delivery, and $15M+ in renovations.

Key innovations

·              Single point of entry for all post-acute services
·              Full continuum of care with skilled nursing, high-acuity assisted living, memory care,
               home health,home care, hospice, transportation, construction, and more
·              Ventilator and tracheostomy units
·              Medical home environment
·              Home and community-based medical services responding to the Affordable Care Act


Today our new model for care has a coordinated network with aligned values and a breadth of service lines across the full continuum. Referrals from partners flow in, because we were able to eliminate layers of management overhead the ACO/MCO would have had to absorb.  The model also aligns with acute hospitals and managed care payors.  


·       75% of Shea Family skilled rehab patients go home in less than 2 weeks, compared to
         the state average of 35%
·       50% lower readmission rates, compared to peers
·       75% of Shea Family Care Centers are now rated 4 to 5 Star by CMS, compared to
         just over 33% nationwide


Key to making the model work is the introduction of transition coaches, who follow the patient across settings after discharge.  It’s about engaging patients over their lifetime, not just an episode of care.

Changing the way business is done has resulted in enhanced outcomes, higher satisfaction from members and dramatically reduced expenses to payors.  Change is always tough, but our survival depended on it.