Brand New Day HMO: Drive-by Lab Appointment Hosted By Central City Community Health Center by and for Keith E Torkelson (M.Sci.)

[INSERT TorkMark Push Anime]
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Executive Summary

We will not address this lab results in depth in this section of our DriveBy Lab Report (DLR). At the end in what might be considered a Conclusion we list seven (7) Takeaways. We logged five (5) Phase Charts using our Structural/Structured Temporal Reconciliation (STR) Method. During 2017 we received two (2) Denial of Payment letters from of insurance provider Brand New Day. We have included many Reference Figures. Photos (Images) are both embedded and in the Gallery at the End.

Progress Not Perfection
From December 27, 2016 to February 9, 2018 we engaged in intentional weight loss using conventional and non-medication mediated means. A measure was taken 12/27/2016 at our Primary Care Physician’s Site. We weighed in at 165 pounds. After just over a year we recorded a new measure taken on the same scale on 2/9/18. We weighed 142 pounds We are now in a Normal Range for Weight and Body Mass. For this DriveBy Lab Appointment Served 20180209-F: We award a Super Satisfaction Score (SSS) = 50.0% for the Doctor in Charge and 61.9% for the clinical team. We find the Doctor in Charge for this encounter scores low with our Team Player Evaluation (TPE). Once again, we omit Diagnostic Lab Results because we feel they are better addressed in the body of this work. In general said results indicate net improvement. We are MSG. The test subject is Keith E Torkelson. Early on we briefly address: Community Partners, Consumer Computers, and Those that Died Too Young.

Paper Stats

Charter Information

Blogger Title
Drive-by Lab Appointment Hosted By Central City Community Health Center by and for Keith E Torkelson (M.Sci.)

Google Plus Information
Central City Community Health Center Interim Fasting Lipid Appointment February 9^th. 2018 – Satisfaction – Annoying – Frustrating for Our Principal Keith E Torkelson – A Step Back in Progress 2012-2017

List of Tables and Figures (Images Omitted)

All are tables unless indicated as a Figure

Figures – Partners Logos

Features of One Who Died Too Young (Mid-Late 50s)

Consumer Computing – Patient Portals - Route to Access

CBC Results – WBC – Raw List
White Blood Cell Count Results Update (Line Graph Longitudinal)

CBC Results – Neutrophils – Raw List
CBC Results – Monocytes – RAW Format
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Table – Evaluating for ProSumption Value

Results - Rate Your Doctor - Vitals-Plus Method Scores (Subjective)

Figure – Pre-Physical (2017) Test Recipe Taken form MyQuest Patient Portal

Key Events In Scope (Single Point Contact – Chester D Mojica MD)

Expected Outcomes From Drive-by Lab work (F2F)
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Weight Data - Weight Results (2017) – Kudos Deserved
Reference - BMI Chart for Men
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Figure - Blood Glucose Level (BGL) Results

STR Method – Phase 1 of 5

Figure – Measuring Up and Interpreting Our Blood Pressure Numbers

STR Method – Phase 2 of 5

TimeTable - Denial Of Payment (DOP) – Associated Key Events

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Figure – Letter BND Denies to Pay For Physical

STR Method – Phases 3-5 of 5

Table – DriveBy Lab with Doctor DDD – Takeaways: Last Reviewed: 20180212-M:

World Wafer – Re-Sell Promotion

Figures – Partners Logos

SSA

Medicare

CMS

Med-Cal

Google – Images & Blogger

24-Hour Fitness

Service Awards (HCA Model)

It might promote better service if Brand New Day and Central City Community Health Center recognize employee service. Awards might be posted on the wall so that the consumers can see who-is-who and their level of commitment to the Agency. In doing so it might also reflect the level of commitment of the Agency to its’ employees.

Special Feature & Dedication
Honoring Another Wounded Warrior – Mark Discovery
Features of One Who Died Too Young (Mid-Late 50s)

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Server	Mark’s Satisfaction	Mark Being Respected & Honored
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PCP	No	No
Life Coach	No	No
Case Worker	No	No
Psychiatrist	No	No
Landlord	No	SoSo
Buster D Right	Yes	Yes
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BND	No	No Mention
CCCHC	No	No Mention
MSG	Yes	Yes - Here
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Table – Service Profile & Satisfaction for Mark who Died Too Young (2018): Last Reviewed: 20180213-TU:

Mark Who Died Too Young V CalMHSA Suicide Prevention
We try our best to honor those in our cohort that Died Too Young (DTY). Above we list a few Indicators for Inappropriate Service (I4IS). We have not confirmed Mark’s death with the Orange County Coroner as we did with Raul Romero (Circa 2011). Yet hearsay about The Network indicates that he jumped to his death off a local freeway overpass. Over time the Brand New Day Network has De-sensitized about its’ consumer Deaths and Suicides. We met Mark about a year ago. He was carrying much Darkness. He was plagued with his Demons. We saw features he exhibited formally about those headed into the State Mental Hospital (Napa) as far back as the Mid-80s. We here at MSG choose a Defensive Position (DP) for Mark. Our plea for him is that he was Inappropriately Served. As Judge Judy says: “I defend those that cannot defend themselves (TV, Circa 2017)”. We hope to further penetrate his case. Below is a photo of Mark. Let us take a moment to remember another “Wounded Warrior”.

Mark Died Too Young

Consumer Computing – Patient Portals - Route to Access

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Access Point	PC Status 2018	Note
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Consumer Computer @ BND	Removed
Consumer Computer @ CCCHC	Never Had
OCHCA MHSA TN Kiosk	We helped deliver
PC at a Public Library	Viable
PC at Home	Time Limited
Personal SmartPhone	Time Limited
MHSA Wellness Centers	Viable
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Table – Routes and Methods to Access Patient Portals – Community Resources

List Formatting
Below are lists of tests performed by Quest Diagnostics and paid for by Brand New Day our insurer. The lists below were taken from Brand New Day’s (BND’s) Cerecons Patient Portal. We copied them over to MS Word and pasted them in Unformatted Text. There is method in our madness for keeping them as Raw as possible. In Cerecons’ test Reference Ranges are not provided. Since the data in Cerecons is generated by Quest Diagnostics we use the Quest Diagnostics’’ Reference Ranges provide in their MyQuest Patient Portal.

Assessments In Scope
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CBC Results – WBC – Raw List

WHITE BLOOD CELL COUNT 02/22/2017 13.2
WHITE BLOOD CELL COUNT 03/21/2017 10.5

WHITE BLOOD CELL COUNT 04/18/2017 11.6

WHITE BLOOD CELL COUNT 05/16/2017 14.0

WHITE BLOOD CELL COUNT 06/13/2017 10.9

WHITE BLOOD CELL COUNT 07/12/2017 11.6
WHITE BLOOD CELL COUNT 08/08/2017 15.4

WHITE BLOOD CELL COUNT 09/05/2017 11.0

WHITE BLOOD CELL COUNT 09/14/2017 12.9

WHITE BLOOD CELL COUNT 10/03/2017 12.0

WHITE BLOOD CELL COUNT 10/31/2017 9.5
WHITE BLOOD CELL COUNT 12/27/2017 13.3

List – White Blood Cell Count – Source Brand New Day Patient Portal – Last Reviewed: 20180211-SUN by Keith Torkelson M.Sci. – Pathology: RAW Format

Lab Notes

RAW Format Retained

Reference Range (Source MyQuest Patient Portal – Accessed 20180211-SUN)

WHITE BLOOD CELL COUNT
Range: 3.8-10.8 Thousand/uL
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Leukocytosis (Cyclical)

As far back as 2008 we detected a cyclical pattern between elevations and normality about our: White Blood Cell (WBC), Neutrophil, and Monocyte counts. At first it alarmed us because we thought we might be on our way to Leukemia. Only a few of our doctors ever tried addressing our elevations. For us because we take Clozapine elevated WBCs is preferable to low WBCs (Leukopenia).

CDM’s Take
Last year our Primary Care Physician, Doctor Chester D Mojica, took notice for the first time about our elevated WBCs. He had been privy to our WBC results for about five (5) years. When called us in on a stop everything drop-in he queried to find a cause. He attributed our latest elevation to a toe injury. We think the reason after five (5) years that he finally got around to interpreting our Cyclical Elevated WBCs is the lab information in Central City Community Health Center is presented differently in their (CDM’s) Electronic Health Record. Since 2008 we can only find one infestation that waxes and wanes. This would be the Red Complex Bacteria (RCB) in the roots of our teeth. We are lucky if we can find the $1000.00 plus dollar co-pay to have our roots treated by our dentist with Arestin.

FYI - Why ARESTIN for Periodontitis?

http://arestinprofessional.com/why-arestin

ARESTIN (minocycline HCl) Microspheres, 1 mg is a concentrated, locally applied antibiotic that remains active in the pocket for an extended period of time to reduce pocket depth. The microspheres release antibiotic over time, targeting bacteria to reduce pocket depth, so gums can heal better than with scaling and root planing (SRP) alone.

White Blood Cell Count Results Update (Line Graph Longitudinal)

20180211-SUN: Collection Date: 01/24/2018
Test Name: CBC (INCLUDES DIFF/PLT)

Figure – Time Series of White Blood Cell Count - Source MyQuest Patient Portal – Accessed 20180211-SUN

Reference Range (Source MyQuest Patient Portal – Accessed 20180211-SUN)

WHITE BLOOD CELL COUNT

Range: 3.8-10.8 Thousand/uL

Circa 2007

We were wisely put on Clozapine during the fall of 2007. Clozapine administration requires monthly CBC testing when you graduate to the maintenance phase. We track our dosage of Health Related Engagements. Having of CBC’s run currently accounts for 12 HREs per year. We are trying to leverage the cost to help others. Our elevated (cyclical) WBC’s in a manner for us constitute a Protective Factor. Next let us Drill Down to the WBC Class Neutrophil.

CBC Results – Neutrophils – Raw List

ABSOLUTE NEUTROPHILS 01/24/2018 7985
ABSOLUTE NEUTROPHILS 02/22/2017 9214

ABSOLUTE NEUTROPHILS 03/21/2017 7151

ABSOLUTE NEUTROPHILS 04/18/2017 7343

ABSOLUTE NEUTROPHILS 05/16/2017 10206

ABSOLUTE NEUTROPHILS 06/13/2017 7052

ABSOLUTE NEUTROPHILS 07/12/2017 7702

ABSOLUTE NEUTROPHILS 08/08/2017 11350
ABSOLUTE NEUTROPHILS 09/05/2017 6754

ABSOLUTE NEUTROPHILS 09/14/2017 8656

ABSOLUTE NEUTROPHILS 10/03/2017 7800

ABSOLUTE NEUTROPHILS 10/31/2017 5539

ABSOLUTE NEUTROPHILS 12/27/2017 9190

List – Absolute Neutrophils – Source Brand New Day Patient Portal – Last Reviewed: 20180211-SUN by Keith Torkelson M.Sci. - Pathology: RAW Format

Reference Range (Source MyQuest Patient Portal – Accessed 20180211-SUN)

ABSOLUTE NEUTROPHILS
Range: 1500-7800 cells/uL

LiveX – Hematology
How is it that Counting Neutrophils can be related to taking Lithium? As you will see later on we share data on Lithium Levels. Doctors have prescribed us Lithium on and off since 1989. In 1990 (Circa) after returning to UC Davis School of Veterinary Medicine after Medical Leave we enrolled in Vet Med Hematology. The doctor said our tremors we most likely due to Lithium (1200 mg/day). In one of our labs we were assigned to perform and blood smear for which were identified and count Blood Cells. We failed due to the tremor, which aggravated our self-stigma. Since this day and a wonderful lesson learned we have promoted Performance Based Treatment (PBT) with us and others.

Aside - Puzzle Out Eliminations

Other than our dental issues we suffer from periodic Foodborne Illness.

CBC Results – Monocytes – RAW Format
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ABSOLUTE MONOCYTES 01/24/2018 988

ABSOLUTE MONOCYTES 02/22/2017 594
ABSOLUTE MONOCYTES 03/21/2017 651
ABSOLUTE MONOCYTES 04/18/2017 940
ABSOLUTE MONOCYTES 05/16/2017 966
ABSOLUTE MONOCYTES 06/13/2017 894
ABSOLUTE MONOCYTES 07/12/2017 835

ABSOLUTE MONOCYTES 08/08/2017 1093
ABSOLUTE MONOCYTES 09/05/2017 803
ABSOLUTE MONOCYTES 09/14/2017 851
ABSOLUTE MONOCYTES 10/03/2017 936
ABSOLUTE MONOCYTES 10/31/2017 732

ABSOLUTE MONOCYTES 12/27/2017 971

List – Absolute Monocytes – Source Brand New Day Patient Portal – Last Reviewed: 20180211-SUN by Keith Torkelson M.Sci. – Pathology: RAW Format

Reference Range (Source MyQuest Patient Portal – Accessed 20180211-SUN)

ABSOLUTE MONOCYTES
Range: 200-950 cells/uL

UCD – Pathology
In 1987 after graduating with honors in Avian Science or Bird Biology we met with Doctor Donald L Dungworth (DLD) for an interview. For our masters’ work we had the choice of working for the Physics Department, the Masters of Preventative Veterinary Medicine (MPVM) program, or the Microbiology Department. We picked the Department of Pathology. We were to be the Departments Ace in the Hole. We made some promises to Doctor Dungworth that we keep today. We gather Doctor Dungworth offered the most important lesson learned from our tenure with the Department: While meeting with him is his office (chair at the time) He stated – “You do not have to be superb at everything”. In Scope: As burgeoning Pathologist we processed cases. Based upon WBC results of the likes we see here we could puzzle out likely etiologies (causes) and propose treatment(s) accordingly. We have since lost this skill. We plan to revisit DLD in our paper on COPD Risk Management and Chemical Dependency (Nicotine).

FYI - A Student's Tribute to Donald L. Dungworth - SAGE Journals

http://journals.sagepub.com/doi/pdf/10.1080/01926230600713418

By JR Harkema - ‎2006 - Toxicologic Pathology, 34:250–251, 2006

ISSN: 0192-6233 print / 1533-1601 online

The first time I met Professor Donald L. Dungworth, or. DLD as he was better ... accent, “Donald Dungworth, pulmonary pathology.” Since I ... one of DLD's former graduate students and head of pathology at LRRI, strongly encouraged me to consider the pro- gram at UCD.

FYI - Legacy Document - Monday, March 21, 2016
Keith Torkelson “Lived Experience" A Curriculum vitae In Pictures

http://the-torkel-saga-2059.blogspot.com/2016/03/keith-torkelson-lived-experience.html

Mar 21, 2016 - Donald Dungworth - (UCD Pathology Department Chair) - Favorite of Keith Torkelson, MS (Pathology).

Lithium Results

LITHIUM 03/21/2017 0.5 (Accessed Cerecons, 2018)
Range: 0.6-1.2 mmol/L (Accessed MyQuest, 2018)

Quick Interpret
When it comes to Lithium it is better to be low than toxic. Lithium is an indicator for compliance (adherence). The doctors that prescribed it had a tendency not to trust us. Whereas the doctors that omitted it had a tendency to trust us.

FYI – Lithium Sides
“Diarrhea, vomiting, drowsiness, muscular weakness, and lack of coordination may be early signs of lithium intoxication, and can occur at lithium levels below 2.0 mEq/L. At higher levels, ataxia, giddiness, tinnitus, blurred vision, and a large output of dilute urine may be seen.”

FYI - Unit Conversion
We predict the conversion would be direct because Lithium is Monovalent.

20180213-TU: Our Query “mmol/L versus mEq/L” Yields
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“Very often, the measure is used in terms of milliequivalents of solute per litre of solution (or milliNormal, where meq/L = mN) - For example, 1 mmol of Na+ is equal 1 meq, while 1 mmol of Ca++ is equal 2 meq.”

FYI - Lithium mEq/L mmol/L Unit Conversion - EndMemo

http://www.endmemo.com/medical/unitconvert/Lithium.php

Med Unit - Lithium Unit Conversion between mEq/L and mmol/L.

Ditto - Marker for Compliance

Lab Test: Lithium Level - EBM Consult

https://www.ebmconsult.com/articles/lab-test-lithium-level

Lithium. Description. Measurement of lithium levels in serum to facilitate therapeutic or toxicity monitoring.
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Reference Range
Therapeutic range: 0.6 mEq/L - 1.2 mEq/L (0.6 mmol/L - 1.2 mmol/L)

Toxicity: > 1.5 mEq/L
Concerning Risk for Toxicity: > 2.5 mEq/L (2 mmol/L)

“Symptoms of severe intoxication may occur at concentrations above 2.5 mEq/L to 3.5 mEq/L, and include grossly impaired consciousness, increased deep tendon reflexes seizures, syncope, renal insufficiency, coma cardiovascular instability, and death.”
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Lived Experience – Lithium [HELD OVER]

Now let us move forward to ProSumption.

Table – Evaluating for ProSumption Value

Metadata: HHS_ProSumer_WRAPAbout_10012002 V2018

Defining & Engaging A ProSumer (20 Item - Beta)

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	Value To ProSumer Score =		6/15 Scored 40%
	Star Equivalents =		2.0 Stars

Table – Doctor DDD’s Contribution to Our ProSumption Effort: Last Reviewed: 20180213-TU:

ProSumption is Team Work

Basically, Doctor DDD promoted reactivity about this appointment. Her score also indicates that she for us on this occasion was not a team player. Overall, Doctor DDD promoted ProSumption by providing us an impetus to report and share. 20180213-TU: We are now in publication sprint mode. Our deadline here is Wednesday, February 14 or Valentine’s Day.

Results - Rate Your Doctor - Vitals-Plus Method Scores (Subjective)

Satisfaction – Vitals Plus

Metadata: Assess_Vitals_18020702_CBC For IFL

20180209-F: Super Satisfaction Score (SSS) = 50.0% (Doctor): 61.9% (Team)

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Patient Ratings Service Experience Element	20180209-F IFL Doctor DDD	Team Martha Clinical	Sample CALC
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Items = 7	4.0/5 80%	4.5/5 90%	Sum/# Scored 4.5/5
Items = 18	6.0/15 40.0%	8.5/16 53.1%	Sum/ # Scored 13.5/15

Items = 25	10.0/20 50.0%	13.0/21 61.9%	Sum/# Scored 18.0/20

Star Equivalents (5.0 Stars is the Best)	2.5	3.1	4.50
With Bonus IF – THEN Add 1 to Numerator	Not	Not	(18+1)/20 * 100 = 95.0%

Table - Indications of Satisfaction: Actual Data from 20180209-F: Encounters (Lab and Scheduling): Last Updated: 20180210-SAT:

How Is It a Face-To-Face (F2F)?
How did this appointment differ from a ProSumer Health Related Engagement? Basically, our ProSumer plans went out the window. Much of our time in the appointment was spent reacting. The appointment was slightly frustrating and rather disappointing. The doctor announced her name yet we did not catch it. She failed to establish Rapport. In addition, she tanked Martha Gil Partnership numbers. Team Martha historically scores superior. Martha had to participate and deliver on this unexpected and possibly only partially warranted treatment (lab) plan. On the second stick Martha missed the target vessel in our right (reserve) arm. For Martha this is unusual. Martha seemed a bit decomposed.

Nurse Martha's Avatar

The Healthcare Effectiveness Data and Information Set (HEDIS)
HEDIS 2017 - Fulfilled

Figure – Pre-Physical (2017) Test Recipe Taken form MyQuest Patient Portal

Outstanding Risk(s)

For 2017 we Satisfied our HEDIS 2017 Criteria. Testing of the likes of this DriveBy Lab Appointment (20180212-F) with Doctor DDD is not warranted for us until August-September 2018. Our Outstanding Risk Factor (ORF) centers about decreasing our Chronic Obstructive Pulmonary Disease (COPD) Risk Factors (RFs).

Key Events In Scope (Single Point Contact – Chester D Mojica MD)


TimeStamp	Activity	Note

20170725-TU	Lipid Follow-up with Physician’s Assistant
20170914-TH	Pre-Physical Fasting Lab	Team Martha
20171003-TU	Routine CBC & Non-informed Consent Flu Shot
20171010-TU	Physical	20171108 - BND Denial Of Payment

20180209-F	IFL Appointment DriveBy Lab	Subject of this study
20180221-W	Routine CBC Scheduled Follow Up on DriveBy Lab Scheduled	Potential duplicate service issue

STR - TimeTable – Key Events Associated with Our DriveBy Lab Appointment Dated: 20180202-F: Last Reviewed: 20180212-M:

Risk Related to Clozapine Cycle – Brief

We will address this in the follow up report. Yet briefly, the CBC test out of cycle may through off our fined tuned Clozapine cycle that involves streamline coordination between and not limited to: CBC blood draw, Quest Lab testing and sharing the results, pharmacy getting the results at a time they will accept them, and Behavioral Health Doctor (BHD) getting the prescription correct and off electronically to the pharmacy and BHD ordering the CBC’s over a period of three (3) months at a time.
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Expected Outcomes From Drive-by Lab work (F2F)

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Test	Warranted	Expected	Note
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Urine	No	Negative for Everything
CBC	Redundant Duplicate Service	We hope within Range Next routine CBC set for 20180221-W	We have a hypothetical correlation Potentially could slip our Clozapine Cycle
Lipids	No	Even better than last time
BGL	For Us	Even better than last time
Lithium	Yes	Low as usual
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Table – Utility of a DriveBy Lab 20180202-F with Doctor DDD and Team Martha - Projections

Follow-up Preparation

Basically, our follow up preparation is to complete and publish this report. We will also prepare: “Whatever It Takes” to Satisfy our Criteria as a Meaningfully Engaged ProSumer.

Weight Data - Weight Results (2017) – Kudos Deserved (May have garnered suspicion)

Metadata - 11_REN_Nutrition_17102306-Celery Diet V2018

Weight Tracking – We are really proud of our weight data : o)

Subject – Keith E Torkelson, MS (Consumer)


TimeStamp	Weight (Pounds)	Note (Impact of Yoga Pending)

12/27/2016	165
1/27/2017	160	2017 Baseline
2/21	161
3/7	159
3/21	159

4/28	161	Baseline for Carbohydrate reduction
5/16	154
6/13	157
7/12	151
7/25	150	Physician Assistant
8/8	150
8/17	151

9/5	147	Martha was atypically Annoying
9/14	147	Pre-physical Fasting and no Coffee
10/10	147	Physical – Blood Pressure 126/71
10/20		Share in Report
11/1	147	Health Fair – Fecal
11/29	144	CBC
12/27	144	CBC
1/24/2018	145	CBC (2018 Baseline)
2/9/18	142	Unspecified Fasting Drive-by Lab with ANON MD (F-Cipher DDD MD)

Table - Results/Record of Weight for Keith E Torkelson: Last Update: 20180204-SUN: Associated with MSG’s Celery Diet.

Markers Of Health (MOH)
When we agreed to attend our 20180202-F appointment we did so hoping that our Blood Glucose Level (BGL) would be run. We need the BGL and related results for Proving our Celery Diet Concept. We feel that high on our list for Markers Of Health (MOH) is our Kinesthetic Performance (KP) as Indicated by Weight. Unfortunately Doctor DDD did not address our achievements about weight loss.

Special Topic - Featuring Our (MSG’s) Celery Diet
Metadata: TTS_Digital_Appointment_17072006_F2F 4 Energy
Our new and improved Celery Diet Approach (CDA) is not just eating celery. Celery is central to quite a few nutritional modifications that brought our Blood Glucose Level (BGL) under control within about three (3) months. We achieved satisfactory BGL without the need for any pharmacological intervention. We were reading on Sharecare that we made have been too aggressive. They indicate it may be OK to cheat 20% of the time. They call this 80/20. We decided not to give away our Celery Diet Approach (CDA) at this time. Below are measures that indicate our CDA was efficacious.

Reference - BMI Chart for Men

Figure – Generic BMI Reference Chart (Cropped)

Body Mass Index – Interpretation
Keith Torkelson, MSG’s Principal, is 5’7” in height. His Baseline Weight for 2018 (Established 20180124) is 145 Pounds. The table above indicates his BMI is 22. Our interpretation is that he is: “ Healthy” with respect to weight and some of the Indicators that go with Weight.

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Figure - Blood Glucose Level (BGL) Results
A Line Graph Longitudinal Presentation

20170914 Blood Draw Date for last data point

Figure – Blood Glucose Level Line Graph – Provide by MyQuest Portal of Quest Diagnostics

Graph Speaking for Self

If you draw an Average Slope Line (ASL) amongst the three data points we could be heading towards Hypoglycemia or Low Blood Glucose Level (LBGL). Unfortunately the last time we engaged in anything close to our New and Improve Celery Diet Approach (1983-1987) we never ran our BGL. When we worked for Hospital Pathologist Central Laboratory (HPCL – Circa 1990) we do believe we ran our Glycohemoglobin level. One day we might uncover the results stored deep at our Tustin Annex Facility (TAF).

UC Davis Kinesthetic Intensive Programs – [HELD BACK]

[FIND DAVIS FITNESS PHOTO CIRCA 1984]

Keith Upper Right

Form Might Be Recovered - Strength Unlikely

STR Method – Phase 1 of 5

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	Service Element		20180209-F Note Thought/Feeling/Impression
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	Nature of Appointment		Unilateral/Annoying

	Arrive Early		We do this religiously We had perfect attendance for 2017
	In On Time		9am for a 9am Appt
	Weight		142 @ 5’7.5”
	Blood Pressure		125/77
	Temperature		Insignificant

STR Method – Phase 1 of 5: Associated with Our Appointment: 20180202-F: Last Reviewed: 20180112-M: We are Satisfied with Our Numbers!

Structured Temporal Reconciliation (STR) Method
We here at MSG are still refining our STR Method. The table above and that follow our yields using STR.

Uninformed Consent

When we had our MOHS surgery with BND Network Provider Doctor TQN (Dermatologist) we received a hard copy of an Informed Consent. His staff gave it to us, gave us enough time to review it, and asked us if we understood it. After being served by Central City Community Health Center for just over five (5) years we still find that they prefer Uninformed Consent.

Figure – Measuring Up and Interpreting Our Blood Pressure Numbers

STR Method – Phase 2 of 5
Expected to Unexpected
ProSumption Becomes Reactive


	Service Element		20180209-F Note Thought/Feeling/Impression

	Diverted to Exam Room
	New Doctor		No firm identity
	Offers no business card
	Answer Her Questions
	Asks if I got flu shot		Should be in the record
	Did not ask if I was taking my medications		Strength
	Discusses flu and flu shot
	Says too long to boot PC for my record in room		Unwise not to weight Possible not up to par on navigation
	Goes away
	Martha says they are deciding what tests to run
	Martha asks if I took my Lithium yet		No – a good thing
	Martha mentions Leukocytosis		Irritated – Best no go there
	Martha gives me a sealed urine specimen bottle		Off routine cycle
	I go to restroom and pee in bottle		Fortunate cause I could go
	No review of the Lab Plan

STR Method – Phase 2 of 5: Associated with Our Appointment: 20180202-F: Last Reviewed: 20180112-M:

Doctor In Charge Anonymous

20180209-F: a doctor completely unfamiliar to us serviced us. It is usual and customary for a doctor to provide a business card. So because we don’t know the doctors name we have to assign a working identity cipher. For this and future reports let her be known as Doctor Triple D (DDD). [INSERT DOCTORS AVATAR BELOW]

Driven Unilaterally – Shared Decision Making

There is a progressive movement in Health & Human Service that Shared Decision Making is desirable. Whereas CCCHC’s clerical staff is coming around the clinical staff is falling short. CCCHC’s decision-making structure is Driven Unilaterally. If you try to have some input they label you as Non-Compliant or Non-Adherent. And once again we can find no quantitative evidence that their Unilateral Approach is effective.

Cost Containment – Person Served

Our records show that for last year (2017) we participate in 78 Health Related Engagements (HREs) with Brand New Day (BND) and their Network Providers. The biggest event was Retina Reattachment Surgery (Doctor Rol). We had gone blind in our left eye and we are very grateful for BND helping us out. After three months JAN-MAR (2018) we can predict our HRE rate (Events/Days). We had hoped to decrease costs this year with a Goal of 25% decrease in the cost for serving us.

TimeTable - Denial Of Payment (DOP) – Associated Key Events


TimeStamp	Activity	Note

20170725-TU	Lipid Follow-up with Physician’s Assistant
20170914-TH	Pre-Physical Fasting
20171003-TU	Routine CBC & Non-informed Consent Flu Shot
20171010-TU	Physical	20171108 Denial Of Payment

20180209-F	IFL Appointment DriveBy Lab
20180221-W	Routine CBC Scheduled Follow Up on DriveBy Lab Scheduled

TimeTable – Key Events Associated with Our DriveBy Lab Appointment Dated: 20180202-F: Last Reviewed: 20180212-M:

[INSERT EXAMPLE OF DENIAL OF PAYMENT]

Figure – Letter BND Denies to Pay For Physical

STR Method – Phase 3 of 5


	Service Element		20180209-F Note Thought/Feeling/Impression

	Brought into phlebotomy room		Back on routine
	Martha sets out four (4) blood sample tubes		OK This in going to cost us Increases risks for problems
	Left arm give three full samples
	The Lithium Tube comes up short		Problem created
	Martha transfers a urine sample to Quest DX vial
	She excuses me saying see you in two (2) weeks		Two weeks is not enough time for us
	As I am waiting of the printed appointment card Martha recalls me		Scheduling went OK Now we have three appointments on the same day
	Say the Lithium came up short
	We use our reserve right arm		Sticks 1 (L) for every 99 (R)
	Complete utter painful miss		Problem worsens Not usual for Martha
	Nurse Martha says she will say it was a “hard stick”

STR Method – Phase 3 of 5: Associated with Our Appointment: 20180202-F: Last Reviewed: 20180213-TU:

STR Method – Phase 4 of 5


	Service Element		20180209-F Note Thought/Feeling/Impression

	Make appointment for Follow-up
	Two week window		We prefer a month so we can review the lab results using MyQuest
	We leave a bit overwhelmed		Not quite right
	Decide to change direction with BND/CCCHC related reports		She basically gave us more work to do We expected close outs on last work order
	Go home and draw from BND Patient Portal
	Decide to charter standalone (F2F)		This
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Table - STR Method – Phase 4 of 5: Associated with Our Appointment: 20180202-F: Last Reviewed: 20180112-M:

STR Method – Phase 5 of 5
Phase 5 of 5 for this DriveBy Lab study will address our Follow-up Appointment scheduled for February 21^st, 2018 @ 9am.

Post-Discussion Elimination

Presenting Problems

When we planned for and attend our February 2, 2018 @ 9am Fasting Lab Appointment we had no Presenting Problems. Doctor Mojica (Our PCP) scheduled it without Informing us what it was about. On our Appointment Card the appointment was coded as IFL. When we asked Doctor DDD what IFL meant she said “Interim Fasting Lipids”. CCCHC has a terrible time with Informed Consent. They are weak with Consumer Generated History (CGH). Lived experience has shown us that people of times have very good reason to Refuse Treatment.

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Work Order – Compare with Dentist

We have a new dentist! His name is Dr. Neil Schultz of Brookhurst-McFadden Dental Group. On January 31^st, 2018 Doctor Schultz and his Teck spent one (1) hour diagnosing us. After his intensive work and work-up, his clerical-billing Rep formulated a Treatment Plan (TP). We are now in the negotiation phase. It is likely we cannot afford the TP as written. For the further testing that, Doctor DDD prescribed she might have better discussed it with us. The only items that make sense to us for testing were the Lithium and the Blood Glucose Level (BGL).

Brand New Day – Cerecons Patient Portal
We used our Brand New Day (BND) Cerecons Patient Portal to get some of the records for this report. BND Build 2013.01 has many major errors yet the lab data is accurate enough that it is useful. For better you worse the lab data does not contain Reference Ranges. We have attempted in the past to coach BND about how to correct all the errors in the Patient Portal. Because the do not solicit Consumer Input (CI) they just ignore us. It looks like what BND did with Cerecons was satisfy Meaningful Use (MU). I don’t think Meaningful Use specifies accuracy.

STR About 20180202-F @900am - F2F

When we got home many thoughts were going through our mind. We slept restlessly Friday night. When we woke up we knew that this DriveBy Lab Encounter was a candidate for our MSG Structured Temporal Reconciliation (STR) Method. Many times only addressing the TimeLine component is enough to put our concerns to rest. Just outlining the TimeLine was not enough for this incidence. As you could observe above we broke it into four (5) phases. The filter we select was our Structured Case Analysis (SCA) Cast Of Characters (COC) approach. More times than not when we transact with CCCHC we do not even know our characters.

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Two-Week Follow Up Window

We were scheduled for a Follow Up on February 21 (W), 2018 @ 9am. On that day we also have our routine monthly Complete Blood Count (CBC) and a visit to Doctor TQN our Dermatologist. If Doctor DDD ordered a CBC on her DriveBy Lab order let it be known it is redundant.
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ProSumption

Let us address an Innovative Education Analogy. On Monday the teacher (Appointment Card) states you are having a quiz on this Friday addressing addition. You get there (attend) on Friday all ready and prepared to do addition. The teacher gives you a quiz addressing all Orders of Operation (+|-|*|/|(x)|^). This is what Doctor DDD pulled on us. What the “F”.

Usual & Customary

Once again it is Usual & Customary to provide business cards.

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No Objective

Unfortunately with knowing a concrete identity for Doctor DDD we cannot perform our Usual & Customary Objective Evaluation.
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Assessments In Scope
Now here is the promising part. This DriveBy Lab fiasco propelled us to take our assessment methodologies to the next level including stepping up the pace. If we keep our pace this report with have a less that seven (7) day turnaround. And that we like a whole bunch. We expect this paper to come in at around thirty-five (35) pages.

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TA#	Takeaways	CCCHC Primary Care 20180202-F
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01	Informed Consent	Terrible Shortcoming
02	Private Pay	We would not have approved as much as 2/3 of the tests
03	Review Lab Order	We could have saved some money
04	No Mention of Successes Over Last Year (2017)	With overlooking this damaged our rapport
05	Expectations About Results Reporting	We would like them to hand us a copy of the lab report so we can discuss each item
06	Rate Your Lab	Some material here will not just go away
07	Rate Your CBC	Some material here will not just go away
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