In a recent post entitled, “The Joys Of Health Insurance Bureaucracy” I described how it took me (a physician) over three months to get one common prescription filled through my new health insurance plan. Of note, I have still been unable to enroll in the prescription refill mail order service that saves my insurer money and (ostensibly) enhances my convenience. The prescription benefits manager (PBM) has lost three of my physician’s prescriptions sent to them by fax, and as a next step have emailed me instructions to complete an online form so that they have permission to contact my physician directly (to confirm the year’s refills). Unfortunately, page one of the form requires you to fill in your drug name and match it to their database’s list before you can continue to page two. For reasons I can’t understand, my common drug is not in their database. Therefore, I am unable to comply with my insurer’s wish that I enroll in mail order prescription refills. This will further delay receipt of my medication – and probably increase my cost as I will be penalized for not opting into the “preferred” mail order refill process.
Now, all of this is infuriating enough on its own, but the larger concern that I have is this: How many patients are not “compliant” with their medication regimen because of problems/delays with their health insurer or PBM? Physicians are being held accountable for their patients’ medication compliance rates, even receiving lower compensation for patients who don’t reach certain goals. This is called “pay-for-performance” and it’s meant to incentivize physicians to be more aggressive with patient follow up so that people stay healthier. But all the follow up in the world isn’t going to get patient X to take their medicine each day if their health insurer or PBM makes it impossible for them to get it in the first place. And shouldn’t there be consequences for such excessive red tape? Who is holding the insurers and PBMs accountable for their inefficiencies that prevent patients from getting their medicines in a timely manner?
Pay-for-performance assumes that physicians are the only healthcare influencers in the patient compliance cycle. I’ve learned that we only play a part in helping people stay on the best path for their health. Other key players can derail our best intentions, and it’s high time that we look at the poor performance of health insurers and PBMs as they often block (with intentional bureaucracy) our patients from getting the medicine they need. While insurers save money by having patients struggle to get their prescriptions filled, doctors are payed less when patients don’t take their medicines.
Not a great time to be a doctor or a patient… or both.
Since I started running (in earnest) a couple of years ago, I’ve been doing what I can to stay motivated. Running is a great sport because 1) it’s cheap 2) you can do it anywhere 3) it’s hard. So, because of #3 I welcome all opportunities to make running fun – and wearing amusing shirts during races seems like as good a strategy as any.
The idea for the “Does my butt look fast in these pants?” shirt came from a sign I saw at a recent marathon. A guy was cheering on the ladies with a homemade sign that read: “Your butt looks fast in those pants!” I laughed so hard it took me a quarter mile to recover. So I shamelessly stole his idea and made a Better Health women’s running shirt out of it. If you think it’s cool and want one too – I’d be happy to print you one. The larger the batch we order, the less expensive it will be.
So if you’re looking for a funny Christmas gift… or if you just want to thwart the race competition by making it impossible for them to pass you without sputtering out a laugh, let me know. Email me if you’d like to order a shirt and we’ll discuss details. My email is: email@example.com (They are made of Nike dry-fit fabric, come in the colors shown only, and are available in Ladies S, M, L – if guys show interest I suppose we could order a run of men’s shirts too?). Let’s prepare to GET BETTER HEALTH this season… and run our way to victory in the battle of the bulge.
The Boys & Girls Clubs of America (BGCA) are about to kick off their annual Fit Family Challenge. The goal is to support families as they commit to a lifestyle of healthy diet, regular exercise, and strong moral qualities. It’s called the “Triple Play” approach – a game plan for body, mind, and soul. I’m honored to be their “mind” coach again this year, and will help to shepherd 250 BGCA families from across the country. Five finalists will be chosen to compete in Los Angeles for the title of fittest family near the end of 2012. We have timed the competition to coincide with New Year’s Resolution planning, and hope that these fit families will inspire others to turn over a new leaf in 2013.
As part of my support for the competition, I’ll be publishing several blog posts (at Better Health and the Fit Family Challenge Blog) with evidence-based healthy eating tips for the families – and for anyone who wants to follow along with the Triple Play Fit Family Challenge. I can’t wait to see how lives will change – and how together we can tip the scales against obesity, disease, and unhealthy relationships. Please join the Boys & Girls Clubs in this important initiative.
Our annual “fall back” time change that gives us an extra hour of sleep is welcome news for most of us. But there are some unintended consequences of darker evenings, especially for drivers. According to the National Safety Council, traffic death rates are three times greater at night than during the day.
In a special rebroadcast of the Healthy Vision with Dr. Val Jones show, I interviewed Dr. Christina Schnider, Senior Director, Professional Communications for VISTAKON® Division of Johnson & Johnson Vision Care, about common nighttime driving problems such as dry eyes, headaches, and eye fatigue. I also spoke with John Ulczycki, Group Vice President – Strategic Initiatives, for the National Safety Council, about safe driving tips. You can listen to the show here:
Most people experience a drop in visual acuity in the dark, and this can cause difficulty seeing traffic signs, pedestrians and roadside objects. The primary reason why it’s difficult to see at night is that our pupils dilate to let in as much light as possible. The trade off with large pupils is that visual acuity suffers. It’s normal for the average person’s visual acuity to drop from 20/20 to 20/40 in low light conditions.
Because of vision challenges, driving in low-light conditions can fatigue the eyes and head and neck muscles as the driver strains to see the environment more clearly. Dry eyes can occur from reduced blink rates and motor vehicle heating and cooling systems. Glasses wearers may have a reduced field of vision which further complicates driving in the dark. In fact, in a recent survey one -in-three drivers reported that they didn’t see well at night.
Dr. Schnider and Mr. Ulczycki suggest that night time driving may be safer (and more comfortable) with these tips:
1. Update your eyeglass or contact lens prescription(s). Since darkness reduces visual acuity, wearing lenses that correct your vision to 20/20 in normal light conditions is extra important. Old glasses or contacts with outdated vision correction power can make driving in the dark more hazardous. If you experience significant challenges seeing at night, you may have a condition called “nighttime myopia” and should visit your eye doctor for advice.
2. Avoid driving long distances in low-light conditions. Since we already know that driving in the dark can cause eye fatigue, dry eyes, and reduced visual acuity, it’s best to minimize the time you spend behind the wheel during dark hours. Whenever possible, plan your travel so that the majority of your driving time occurs during daylight hours.
3. Take frequent breaks. Even though it’s tempting to push through your fatigue and finish driving those last miles to your destination, it’s safer to give yourself (and your eyes) a break. Stopping for gas or at a rest area may improve your alertness and visual fatigue. Remember that impaired drivers are more likely to be on the road at night, so vigilance on your part may prevent an accident.
4. Decrease your night-time driving speed. If you do need to drive in the dark, doing so more slowly may prevent accidents. Traveling at a slower speed can improve reaction time under lower-visibility conditions.
5. Check your headlights. It is estimated that 50% of all motor vehicle headlights are not optimally aligned. Potholes and bumps in the road can jolt the lights out of alignment. It’s important not to look directly at oncoming headlights. This can temporarily blind you as your pupils adjust to a quick change in lighting conditions.
Rock superstars Roger Daltrey and Pete Townshend of “The Who” have a new cause: sparking a franchise of teen-oriented cancer treatment centers across America. To kick off the launch of Teen Cancer America, Daltrey & Townshend were featured at a conference held at the National Press Club in Washington, D.C. I was fortunate to be invited to sit at the head table next to teen cancer survivor Sarah Sterner – a bright and confident young woman from Atlanta who was cured of brain cancer two years ago.
Sarah told the crowd what it was like to be a fifteen-year-old in a pediatric oncology unit populated by ukulele-playing clowns and screaming infants. The extreme age-related disconnect between her pscho-social needs and that of younger kids and babies served to make her feel even more isolated during her course of treatment. She longed for the companionship of others like her, but without any national cancer centers focused on the special needs of teens, she was on her own.
Roger Daltrey became interested in teen cancer when his personal physician took up the cause in the U.K. and turned to him for support. Daltrey’s decades of playing music to teen audiences made him keenly aware of their unique psycho-social needs. “When you’re a teenager, it’s horrifying if you have a spot on your nose. Imagine what it’s like if you have cancer!” said Daltrey.
Teen Cancer America began as a movement called the Teen Cancer Trust in the U.K. According to Daltrey, preliminary research (comparing teens treated in a typical NHS cancer ward versus a unit sponsored by the Teen Cancer Trust) suggests that there may be as much as a 15% survival advantage in being treated in the special units. Daltrey attributes this to increased morale that helps teens and families find the will to fight through life-threatening treatments.
When asked how American cancer centers compare to those in the U.K. Daltrey immediately responded that he believed the U.S. centers were far superior. He described the incredible resources available at UCLA and Duke, and how the facilities themselves were unbelievably beautiful, sporting plant-filled atria, massive skylights, and high tech imaging and radiation equipment. Nonetheless, he noted, “Teens don’t want to hang out in an atrium. There is just no place that appeals to teenagers at these centers.”
Whether specialized teen cancer treatment environments in the U.S. will dramatically improve survival rates remains to be seen, but there’s no doubt that recognizing the unique psycho-social needs of teenagers would be a boon for patients and families at pediatric cancer centers. Like post-traumatic stress disorder in military personnel, the psychological ravages of cancer may well be under recognized, especially in the teen and young adult populations.
Thank you Roger Daltry and Pete Townshend for bringing this to our attention.
Rock superstars Roger Daltrey and Pete Townshend of The Who have a new cause sparking a franchise of teen-oriented cancer treatment centers across America. To kick off the launch of Teen Cancer America Daltrey amp Townshend were featured at a conference held at the National Press Club in Washington D.C….
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