JamesLHollyMD.com

	James L. Holly, M.D.

About SETMA Joint Commission Contact Information History Mission Statement Medical Home Scope of Services I-CARE Initiative Infusion Center The SETMA Way - What is it? SETMA's Model of Care Patient-Centered Medical Home The SETMA Approach to Patient Care	In The News Letters Vital Signs - Examiner Publication SETMA's Providers as of January, 2015 SETMA Knows - Abraham Lincoln and Healthcare Analytics SETMA – 1999 – Four Seminal Events PC-PCC Award January, 2015 Vital Signs Spring 2015 Vital Signs Q&A for PC-PCC Award Links to SETMA 2012 eHealth Innovator Award for LESS initiative Handout for Attendees eHealth Conference January 12, 2012 eHealth Initiative 2012 Award Program Application The eHealth Initiative's 2012 Award Letter 2012 National Quality Forum National Healthcare Improvement Award Effective prioritization of performance improvement goals Dashboard to Measure and Manage Whole System Performance Commitment to transparency Date-driven improvement of NQS priorities Demonstration of readiness to assume responsibilities of an ACO Demonstrated results on publicly reported performance measures Public Reporting Quality Metrics for 2009, 2010, 2011 Internally Tracked Reporting Quality Metrics for 2009, 2010, 2011 Complete Application in PDF Format SETMA's Medical Home Pilgrimage 2009 Medical Home Series I 2010 Medical Home Series II 2011 Medical Home Series Two 2009, 2010, 2011 Medical Home Miscellaneous Articles The Dr. and Mrs. James L. Holly Distinguished Professorship Universal American Letter of Transmittal for Support Dr. Holly's Acceptance Address for the 2012 Distinguished Alumnus Award CMS Medical Home Feedback Report Qualify & Cost SETMA questions Influenza Data SETMA I - October 2011 SETMA II - October 2011 Mark A. Wilson Clinic SETMA West - October 2011 SETMA and Fox 4 News - Healthy Living Videos SETMA Advertisements - Display and Video SETMA Announcements Featured Content Archive	Syllabus PC-MH Externship SETMA's MS4 Patient-Center Medical Home Selective Syllabus Introduction to SETMA's Senior Externship and Syllabus An Introduction to the Origins and Beginnings of Southeast Texas Medical Associates, LLP Patient-Centered Communication PC-MH Health Affairs August 15, 2013 Policy Brief -- Health Gap SETMA 8.20.13 Provider Training -- Health Affairs 2.14.13 -- Patient Engagement SETMA Provider Training 8.20.13 during First Senior Medical Student PC-MH Externship Medical Home Coordination Review Tutorial 2011 Medical Home Series Two Teaching Tool for PC-MH Course - Patient Care Activation, Engagement, Shared-Decision Making	Patient Information What Does Patient-Centered Medical Home Mean to You? What Does Patient-Centered Medical Home Mean to You? Health information exchange Patient Rights and Responsibilities Patient Directions Contact SETMA – Secure Texting What is HIPAA? Authorization To Release or Obtain Medical Records Complete Privacy Policy Website Privacy Policy	Presentations Invited Presentations SETMA Provider Training
Governance Board Governance Board Responsibilities Governance Board Leadership Training The SETMA Team and The SETMA Culture SETMA's Mission, Vision and Goals: Patient Safety and Quality Care Harassment, Neglect, Abuse, Exploitation - Role of HCAHPS & CAHPS Healthcare Provider Standards Providers Responsibility Medication Refills, Reconciliation and Maintenance Provider and Leadership Use of Data and Analytics Commitment To All Patients -- Ethnic Disparities Kaizen - Board Creates Culture of Safety and Quality SETMA's Policy and Practice for Advanced Directives SETMA's Policy on Completion of Medical Records Care Guidelines : Improve processes to evaluate and treat Integrated patient safety program (Sentinel Events) Effectively Manages all programs, services or sites Provides Patients with information about Primary-care Medical Home Organization-wide Planning to Maintain Focus on safety and quality Organization-wide Planning to Maintain Focus on safety and quality SETMA's Performance Quality & Safety Judged by CMS SETMA's Performance Quality & Safety Judged by CMS SETMA Awarded by HIMSS for Quality and Safety 2011 John M. Eisenberg Patient Safety and Quality Awards Application Healthcare Quality Award 2012 Principles of Quality and Metrics Principles Contacting SETMA & Secure Texting PC-MH Mission, Vision, Goal, Access, End-of-Life Communications and Public Reporting Change Existing Processes to Improve Performance Team Members Focused on Safety and Quality	Your Life Your Health View Articles by Subject Aging Well Behavioral Health Cardiovascular Disease Risk Care Coordination Care Transitions Children's Health COGNOS Project Diabetes Exercise Healthcare Reform:Public Policy HIPAA & Security Labor Day Less Initiative Medical Home Medical Records Men's Health Mental Health Nutraceuticals Nutrition Smoking Cessation Thanksgiving Weight Management Women's Health All Articles	Public Reporting Public Reports by Year (2009-2017) Public Reports by Type Fall Risk, Pain, Functional, Wellness, Stress Assessment Fall Risk, Pain, Functional, Wellness, Stress Assessment for 2011 AND 2012 Core Measures: SETMA & Baptist Hospital Core Measures for January to December 2011 PQRS Diabetes Measures - Blood Pressure Diabetes Measures - Glyco and LDL Diabetes Measures - Nephropathy Screening, Foot Exam, and Eye Exam Preventive Measures - Screening (BMI, Colorectal Cancer, Mammography, Osteoporosis) Preventive Measures - Influenza, Pneumococcal, Urinary Incontinence Preventive Measures - Tobacco Use NQF Care for Older Adults Comprehensive CHF Care Diabetes Measures Diabetes Measures - Blood Pressure Control Diabetes Measures - Glyco and LDL Diabetes Measures - Smoking Cessation Female Measures General Health Measures Medication Measures Persistent Medications Medication Measures Pediatric Measures HEDIS (NCQA) Effectiveness of Acute Care Effectiveness of Chronic Care - Clinic/Hospital Effectiveness of Chronic Care - Clinic Only Effectiveness of Chronic Care - Diabetes (Smoking Cessation) Effectiveness of Chronic Care - Diabetes (Glyco and LDL) Effectiveness of Chronic Care - Diabetes (Blood Pressure Control) Effectiveness of Preventive Care Effectiveness of Preventive Care - Older Adults Effectiveness of Chronic Care - Diabetes Measures Effectiveness of Chronic Care - Persistent Medications (MPM) NCQA Diabetes Recognition Program Audit LESS Initiative PCPI PCPI Hypertension PCPI Diabetes PCPI Chronic Stable Angina PCPI Care Transitions PCPI CHF PCPI Weight Management PCPI CKD Stages IV V SETMA Lipid Audit Lipids Treatment Audit Tutorial Lipids Tutorial AQA COGNOS Project SETMA Audit for CKD Stages I III Patient Satisfaction Survey	Accreditations/Awards Achievements which have Advanced SETMA: The Time-line, Philosophy and Principles which Underlie that Advancement Awards	Diabetes Center of Excellence Education Diabetes Order Referral Form Seven Stations 2011 Advances in Diabetes Diabetes Tutorial Diabetes Prevention
EPM Tools Association of Medication and Diagnosis Automated Team Function Behavioral Health Adult Weight Management Tutorial Annual Questionnaires: Fall, Functional, Pain, Stress, Wellness Behavioral Health in SETMA's Patient-Centered Medical Home Model of Care Depression Tutorial Fall Risk Tutorial Health Insurance Portability and Accountability Act (HIPAA) Privacy Tutorial Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive LESS Initiative Tutorial Medical Home Transtheoretical Model Assessment Stages of Change Tutorial Pain Management Tutorial Reduction of Antipsychotic Medications Toolkit Smoking Cessation Tutorial Stratifying End-of-Life Risk for Hospice Services Tutorial Chronic Conditions Tutorial Chronic Renal Disease Management Tool Tutorial Calculating the Stages of Renal Disease Proteinuria Disease Management Tools Acute Coronary Syndrome Tutorial Adult Weight Management Tutorial Angina Tutorial Cardiometabolic Risk Syndrome Tutorial Chronic Renal Disease Tutorial Congestive Heart Failure Tutorial Diabetes Tutorial Hypertension Tutorial Lipids Tutorial Lipid Quality Audit Tutorial Primary Pulmonary Hypertension Tutorial Framingham Cardiovascular Risk Cardiometabolic Risk Assessment Framingham Heart Study Risk Calculators Tutorial Frederickson Classification of Dyslipidemia LDL Level Lipid Disease Management Risk Assessment General principles about ICD-9 Codes and HCC/RxHCC Codes Charge Posting Tutorial Coding to Ensure Accurate Health Risk Scoring E & M Codes Tutorial HCC & RxHCC Risk HCC/RxHCC Risk Tutorial ICD-9 Code Training Manual Hepatitis Screening Hospital Based Tools Hospital Care Summary and Post Hospital Plan of Care and Treatment Plan Tutorial Admission Orders Tutorial Daily Progress Notes Tutorial Care Transition Data Set from PCPI Tutorial Using The Clinic and Hospital Follow-up Call Templates Respiratory Failure Tutorial Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS): Tutorial for SETMA's Internal HCAHPS Survey Master GP Suite of Templates Master GP Suite of Templates Tutorial Medical Home Support Materials Department of Care Coordination, Director of Care Coordination and Care Coordination Referral Template Electronic Tickler File Electronic Tickler File Tutorial Follow-up Calls Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Services Medical Home Coordination Review Tutorial Medical Home Plan of Care and Treatment Plan Medical Home Transtheoretical Model Assessment Stages of Change Tutorial Patient-Centered Medical Home Annual Questionnaires Patient-Centered Medical Home: SETMA's Medical Home Coordination Review (MHCR) Tutorial Patient Document for Coordination of Care Transitions of Care Management Coding (TCM Code) Tutorial Merit-Based Incentive Payment System (MIPS) Quality Metric Tool Tutorial Nursing Home Depression Tutorial Fall Risk Tutorial Hydration Assessment Tutorial Nursing Home Guidelines for Care Tutorial Nursing Home Principal Suite of Templates Nutrition Assessment Tutorial Reduction of Antipsychotic Medications Toolkit Skin Care Tutorial Outpatient Infusion Center for Intravenous Antibiotic Therapy and Other Meds Preventive Health Tools Adult Weight Management Tutorial CHF Exercise Tutorial Diabetic Exercise Tutorial Diabetes Prevention Tutorial Exercise Prescription Tutorial Hypertension Prevention Tutorial Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Initial Preventive Physical Exam & Annual Wellness Visit Tutorial LESS Initiative Tutorial Progression to Type 2 Diabetes Smoking Cessation Tutorial Progression to Type 2 Diabetes Quality Metrics ACO and Medicare Advantage Stars HEDIS: NCQA, History, Quality, Safety, STARS, ACO ACO Quality Measures Performance Tool ACO Quality Measures Performance Tool Tutorial STARs - A Tutorial for Utilizing SETMA's Deployment of the STARS MA Program Specialized Tools Annual Questionnaires: Fall, Functional, Pain, Stress, Wellness Association of Medication & Diagnosis Chronic Conditions Tutorial Chronic Care Management Code (CCM) Tutorial Depression Tutorial Drug Interactions Tutorial Electronic Tickler File Tutorial Evaluation Lower Urinary Tract Symptoms in the Male Fall Risk Tutorial Future Labs Tutorial Hydration Assessment Tutorial HCC Risk Training Tool Hypertension: Fulfilling Quality Metrics for the PCPI Program Laboratory Results - Signing Off: Why and How Medication Module Tutorial Medication Reconciliation Tutorial Nutrition Tutorial Pain Management Tutorial Problem List Reconciliation Tutorial Progression to Type 2 Diabetes Referral Skin Care Tutorial SOAAP Opioid Risk Assessment Stratifying End-of-Life Risk for Hospice Services Tutorial Texas State Reportable Infectious Diseases Tutorial Transitions of Care Management Coding (TCM Code) Tutorial	Transforming Your Practice Library Introduction to SETMA's TCPI Library Transforming Your Practice (TCPI) Summary Document of TCPI CMS Quality 12.2015 TCPI Leadership and Governance Care Coordination HIPPA and Security Data Analytics Care Transitions LESS Initiative Medical Records Clinical Decision Support Hospital Care Tools Disease Management Tools Preventive Health Tools Behavioral Health Transformation Tools New Transformation Tools Patient-Centric Care Nursing Home Medical Home Display and Explanation of SETMA's Patient-Centered Medical Home Tools	Medical Home The Story and the Ideals Introduction to Preventive Health Tools PC-MH Patient Engagement & Alternative Payment Models Preventive Care: The Best Way to Treat Illness is Don’t Get it Coordination of Care Patient-Centric Care Population Health Transition of Care - One form of Care Coordination HCAHPS - Hospital Consumer Assessment Of Healthcare Providers and Systems CAHPS - Consumer Assessment of Health Care Provider and Systems Teaching Tool for PC-MH Course – Patient Care Activation, Engagement, Shared-Decision Making Display & Explanation of PC-MH Tools SETMA's Medical Home Pilgrimage Concierge Medicine not Medical Home Medical Neighborhood Security & HIPPA Referrals Patient Web Portal Health Information Exchange Medication Reconciliation The Automated Team Coordination of Care Medical Home Description & Standards AAAHC Joint Commission NCQA Planetree URAC NCQA Interview February 14, 2014	Facebook	Letters

Your Life Your Health - Why I Like Getting Older

James L. Holly,M.D.

November 05, 2009

Your Life Your Health - The Examiner

How old is old? How do you know when you are old? Is it a "frame of mind," or is it a certain age? The nice thing about being a teenager, and it may actually be the only nice thing, is that you can be absolutely sure of when you are one. What about adolescence? How many "middle-aged men" have been told by their wife, "You are so adolescent." No one ever says, "You're such a teenager," to a 50 year old. What is middle age? We know it's a historical period but what about for a human?

And, then there is old age. In our politically correct era, no one can quite figure out what is least offense to "old people." Do they want to be called, "Elderly?" What about senior citizens or "getting on up there?" This week I turned 66 years of age. My mind knows that but my emotions say, "That's not my age; that's my grandfather's age." I can't figure out though whether I am old or not. In June of this year, The New York Times published a piece entitled, "How old is old? It depends on your age." Don't you love that title? The following is from that article:

"Most adults over age 50 feel at least 10 years younger than their actual age, the survey found. One-third of those between 65 and 74 said they felt 10 to 19 years younger, and one-sixth of people 75 and older said they felt 20 years younger.

And at what age does old age begin? Most people in the survey said old age starts at age 68. Are they kidding? That seems way too young to me. Not surprisingly, most people over 65 have a different idea about old age. Among those getting the senior citizen discount, most say old age begins at 75. Now consider the answer given by people under 30. Most of them think you're old by the time you hit 60."

Surely, I personally can't be old; I still think like a teenager or ask my wife and she'll tell you that most of the time, I am "so adolescent."

Exercise at any Age

When I was 55, I walked at a 12-minutes-a-mile pace. I hoped that as I got older I could continue walking 5 miles a day and that the only difference would be that in my sixties, I would do it at 13-minutes-a-mile; in my seventies I would do it at 14-minutes-a-mile and in my eighties I would do it in 15-minutes miles. That was not to be. For my sixty-sixth birthday, I will walk 6.6 miles and in anticipation of it, have repeatedly walked 5.5 miles in 66 minutes. That's a 12-minutes-per-mile pace. I wonder if when I am ninety whether I will be able to walk nine miles or not. As the old adage goes, "time will tell."

Remember, only people who are not moving are dead; so, if you don't want to be dead, keep moving.

Whether I am old or not, I am glad that I am getting older

Rather than spending too much time trying to decide whether I am "old,: I have been thinking about why I am enjoying getting old, of course, what that really means is, "Why I will enjoy getting old when I 'really' get there." I wonder if I will know that I am old, when I am.

Recently, I realized that one of the greatest benefits of getting old is that as I age, I am much more aware of what I don't know. And, this happens before dementia, senility, or Alzheimer's sets in. Age has a way of making us aware of how much we don't know ant have never known. And, more importantly, as we get older, we have the humility to admit that we don't know. As we get older, it is easier to accept who we are and to find value in what we are rather than being preoccupied or fretting over what we're not. The child's sense of invincibility and of limitlessness is finally gone.

Humility is a gift most often given to those who have attained "senior status"

In the New Testament, in the eighth chapter of the Gospel of John, the story is told of Jesus being confronted by a group who had caught a woman in adultery. They brought her to Jesus and expected Him to pronounce judgment upon her, which according to the Law would be stoning to death. Jesus did not object to the Law but provided a new standard for who could execute the sentence. He said, "Let he that is without sin cast the first stone." The Bible says, "And they which heard it, being convicted by their own conscience, went out one by one, beginning at the eldest, even unto the last." (John 8:9)

The old men went away first; they had lived long enough to know that they were not qualified to execute judgment upon another. The elderly are not comfortable with or complacent about their imperfection, but they are immediately aware of it. It takes the young a little longer to figure out that by whatever standard they are judged, perfection is not a trait with which they have to deal. It is not that older men cannot recognize evil or error, or that they have changed the standards of righteousness, but older men and women recognize that they are not qualified by Jesus' standard to be the judge, the jury and the executioner.

The new standard of excellence in "old age"

As we age, we still have passion but it is not as mindless as it once was. I like getting older because the passions which drove me when I was younger, along with the insecurities and the ambition, have been replaced with a commitment to a new standard, which can be summarized by one of my personal mottos, "I want it done right and I want it done right now." Yet, the desire for things to be done right is balanced by the wisdom of knowing that it is possible to be right and not to be righteous, or said differently, "it is possible to be right without having the right motive or intent." Whether we believe in a final judgment of our lives or not, we all know that our lives will be weigh in a balance and it is our desire "to be weighed and found not to be wanting." The weights which will most effectively counterbalance the deficiencies of our lives are compassion and mercy. It is the elderly who intuitively understand the Beatitude, "Blessed are the merciful for they shall receive mercy." This does not invalidate truth but as we get older, being acutely aware of our own inadequacies, we are less inclined to reject others because of theirs. That is a good thing about getting older.

Rediscovering what I know

I like getting older because I find that I increasingly have more pleasure in rediscovering old experiences than in having new ones. The things which fix my attention are more often the familiar rather than the new and unusual. Mental images are the substance of our memories and the most powerful images are the first formed when our old experiences were new. Reliving the content of those earliest mental pictures and keeping them sharp, clarifies what we value and what gives our life meaning.

This is why we celebrate anniversaries. While anniversaries are measured in years, it is not that we only celebrate endurance, but we relieve those earliest steps we took into new relationships. Now, that which was once new and which is now old, warms our heart and brings a smile to our face. The endurance of those relationships enhances their meaning and the reliving of them allows us to cherish the realities which created our mental images. One of the sadnesses of getting older is that those we love who are new to our circle of intimacy, such as grandchildren, do not share our mental pictures and experiences, and try as we might, they will never. In this regard, our greatest hope is that their own mental images will be as rich and as power to them as ours are to us. The caution for me, as I get older, is not to reject new experiences because of the pleasures of old ones.

Giving and receiving

I like getting old because increasingly I find more pleasure in giving than in receiving. One of my greatest frustrations in life was what to buy my father for Christmas. It was not because I didn't want to buy him something but because there was no THING which would bring him pleasure and delight. Now that I am the grandfather, I understand. Getting is not nearly as much fun, or as satisfying as giving. Again, the foundation of the pleasure of getting older is the increasing wisdom which guides your decisions and actions and which replaces the joy of getting with the delight in giving.

It is as I get older that I have those in my life to whom giving brings me such joy: a wife, children, spouses of children, but then the ultimate object of joyful giving, grandchildren. If you have them, you can skip this section because you already know. If you don't have them because you're too young, read on and salivate. If you don't have any of your own, adopt someone else's. Gene Perret said, "What a bargain grandchildren are! I give them my loose change, and they give me a million dollars' worth of pleasure." In reality, the great thing about giving is that it is in giving that we get. As we get older, we have the wisdom to know and act on that reality.

Poignancy

I like getting older because the older I get the richer my memories become, as more of those who are the substance of those memories are available only through mental images. The "golden years" are such because of the treasury of our memories which gleam and enrich us. This reality is celebrated in the lyrics of Sigmund Romberg's composition, "Golden Days":

"Golden days in the sunshine of our happy youth
Golden days full of innocence and full of truth.
In our hearts, we remember them all else above,
Golden days full of youth and love."

Many great universities adopted Gaudeamus Igitur as their graduation anthem. The Latin words of the song declare:

"Gaudeamus igitur
Iuvenes dum sumus;
Post iucundam iuventutem
Post molestam senectutem
Nos habit humus..."

The words mean:

"Let us live, then, and be glad
While young life's before us!
'After youthful pastime had,
After old age hard and sad,
Earth will slumber o'er us...

Brief is life, and
Briefly shall be ended..."

Wise words! Solomon wrote such words in Ecclesiastes, when he said: "Remember now thy Creator in the days of thy youth, while the evil days come not, nor the years draw nigh, when thou shalt say, I have no pleasure in them."

I like getting old because it is my turn to teach another generation to seek happiness within the constraints of duty, honor, responsibility and decency, and with the content of faith and truth. Perhaps we can all remember our Creator in the days of our youth, and when the days of our youth are gone, we can remember those Golden Days, which will then warm our hearts and lives always.

I like getting older, except for that pain in my right knee.

About SETMA	In The News	Syllabus PC-MH Externship	Patient Information	Presentations
Governance Board	Your Life Your Health	Public Reporting	Accreditations/Awards	Diabetes Center of Excellence
EPM Tools	Transforming Your Practice Library	Medical Home	I-CARE Initiative	NextMD