June 20th, 2008 by Dr. Val Jones in Announcements
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I recently met with Tim Turnham, CEO for the Colon Cancer Alliance, to find out what’s been going on in his neck of the woods. He presented me with one of the best non-profit marketing pitches I’ve seen in a long time. His team is organizing a series of races designed to raise support and awareness for colon cancer. The theme? Running the race in your boxer shorts. The title:
The UNDY 5000: A Brief Run To Fight Colon Cancer (see image of Indy 5000 flags made of boxer shorts)
Become an UNDY 5000 sponsor today… because time is short.
I love it.
If you or your organization would like to sponsor a race, check out this website or contact Fran Campion Watson, Director of Events at the Colon Cancer Alliance. Phone: 202-731-0122.
I hope that proceeds will go towards research that will help friends like mine who are battling colon cancer.
For more information about colon cancer (from one of the nation’s prominent researchers) check out Dr. Heinz Josef Lenz’s colon cancer curriculum at Revolution Health.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 20th, 2008 by Dr. Val Jones in Health Policy
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I’ve collected a few reports from my fellow bloggers that perfectly exemplify healthcare improvement/payment strategies designed by committee.
A nonsensical quality assurance program in Britain, via GruntDoc:
Britain’s nurses are to be rated according to the levels of care and empathy they give to patients under government plans. Health Secretary Alan Johnson told the Guardian newspaper that he wants the performance of every nursing team in England to be scored.
But he ruled out rating individual nurses and also said it would not affect pay.
Ridiculous medical record documentation rules via the Happy Hospitalist:
The E&M rules of documentation state very clearly what type of information is required on follow up cognitive care visits. They state that you need to include things like character, onset, location, duration, what makes it better or worse, associated signs or symptoms.
This is all fine and dandy when you can quantify a complaint (like pain, rash, headache, or weakness). But what do you do when a chief complaint does not involve a qualitative or quantifiable entity? There are no E&M rules that allow exceptions to these circumstances. So you get the following garbage:
Chief Complaint: Hypercalcemia [too much calcium in the blood]
HPI: She presented with hypercalcemia. It is described as chronic, constant, and parathyroid. The symptom is gradual in onset. The symptom started during adulthood. The complaint is moderate. Significant medications include lithium. Important triggers include no known associated factors. The symptom is exacerbated by dehydration.
There is not a single piece of information in that excert that was clinically worth anything. In fact, it reads as if it is computer generated with key word insertion.
Character: Moderate (what does that mean?)
Onset: adult hood (what the hell)
Location: parathyroid (seriously?)
Duration: chronic and constant and gradual in onset.(what a bunch of garbage)
What makes it worse?: nothing and dehydration in the same paragraph, completely contradicting each other.
Imagine how much time was spent entering this worthless information. Not only asking them but entering them into the computer. Imagine multiplying this by 25 times a day. And you wonder why health care is so inefficient. Because we have to ask completely meaningless questions to get paid.
A new way to thwart physician compensation via the Physician Executive:
According to a June 11 CMS announcement, doctors will have to reconcile their NPI data with their IRS legal name data in order to get paid.
It is a befuddling regulation since, as an employed physician, 100% of my billings have gone to organizations that paid me a salary. Why check my provider identifier with my tax information? They don’t correlate. I can pretty much promise you that they never have and sometimes the discrepancies have been fairly substantial.
I am sure this will be a huge problem for docs in practice who bill under their name and get paid directly. Any discrepancy in any character in the field will ensure non-payment. This is not the kind of thing your laptop spell check will prevent. If this regulation is enforced to the letter, it will assure that services are provided free of charge.
I bet that this billing “error” can also be enforced as fraud and abuse, leading to criminal charges, financial penalties, and time in jail.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 19th, 2008 by Dr. Val Jones in Expert Interviews
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I recently discussed the emerging black market for raw (unpasteurized) milk and the FDA’s crackdown on California farmers. Soon after I posted my comments, a reader asked some detailed questions about heat, enzymes, and milk’s nutritional value. At the same time I received an email from the Vice President of Nutrition Affairs-Health Partnerships at the National Dairy Council, offering to connect me with a dairy product scientist to further the discussion. Isn’t it nice when all the stars align correctly?
I just interviewed Gary Rogers, Ph.D., the Editor-In-Chief of the Journal of Dairy Science and Professor of Animal Science and Dairy Extension Leader at the University of Tennessee in Knoxville. You may listen to the podcast, or enjoy my synopsis below:
Dr. Val: What is pasteurization?
Dr. Rogers: Pasteurization is the heating of milk to a specific temperature for a specified period of time to kill harmful bacteria that may be living in the milk.
Dr. Val: Raw milk enthusiasts argue that pasteurization decreases the health benefits of milk. What exactly is lost when milk is pasteurized?
Dr. Rogers: There are really no important changes that occur (from a nutritional standpoint) to milk when it’s pastuerized. Heat treatment is simply used to kill the bacteria that may present a health risk to those of us who consume milk. Research over the years has shown that there are no significant nutritional benefits to raw milk, but there are risks associated with exposure to bacteria.
Dr. Val: Some people say that raw milk is easier to digest than pasteurized milk. Is that primarily a myth?
Dr. Rogers: Yes, that’s a myth. There is no scientific evidence to suggest that raw milk is easier to digest than pasteurized milk. In fact, many people who have digestive difficulty with fluid milk can eat cheese and yogurt without any difficulty.
Dr. Val: I’ve heard some people claim that there are certain beneficial enzymes in raw milk that are destroyed in the pasteurization process. Is there any truth to that?
Dr. Rogers: There are dozens of enzymes in milk, but most of them are proteases that are involved in the break down of milk proteins and fats. While it’s true that heating can destroy some of these enzymes, they really have no role in human digestion. The enzymes are responsible for milk spoilage, so removing them extends the shelf life of the milk.
Dr. Val: Tell me about UHT milk (the boxed milk that is stored at room temperature) – does it differ -nutritionally and chemically – from pasteurized milk?
Dr. Rogers: UHT (or “ultra-high temperature”) milk undergoes a pasteurization process at a much higher temperature than regular milk. This increases its shelf life, but nutritionally and chemically it’s no different from regular pasteurized milk. It contains all the calcium, phosphorus, and protein of regular milk. However, UHT milk does have a different flavor that some Americans don’t like. In Europe, though, they really enjoy the flavor of UHT milk and often prefer to drink it over pasteurized milk. In the U.S. we use it for flavored milk products, and for military personnel who can’t keep their milk refrigerated as easily.
Dr. Val: I think the key confusion that people have here is that they think of heating milk like heating vegetables. We all know that when we boil vegetables for a long time the nutritional value decreases because their vitamins are removed in the water. However, with milk we’re essentially heating it without removing the “water” part.
Dr. Rogers: That’s exactly right. Pasteurization doesn’t add or subtract anything from milk nutritionally, it’s just a heat treatment to destroy bacteria like listeria and salmonella.
Dr. Val: Are US cows exposed to antibiotics and hormones that could find their way into milk?
Dr. Rogers: I know that consumers are very concerned about these issues, but they need to know that every milk tanker is required by law to be tested for antibiotics. There’s a huge incentive for milk producers not to include milk from cows that may have been sick and treated with antibiotics because any tanker that’s found to have any trace of antibiotic in the milk will have its milk discarded. Not only that, but since tankers usually carry milk from multiple producers, one small contribution of contaminated milk will cause all the neigboring farms’ milk to be destroyed. So there’s a lot of peer pressure to keep the milk supply clean. Farmers who contribute milk from cows on antibiotics are fined for the losses of other producers’ milk as well.
As far as “hormones” are concerned, you’re talking about RBST (recombinant bovine growth hormone) to enhance milk production in cows. Although no lab test was ever able to distinguish milk from RBST treated cows from non-treated cows, consumers expressed such concerns about the practice that few milk producers use RBST anymore. I’d say that maybe 10-15% of dairy producers use it, and then it’s not for fluid milk sale, but rather cheese and other dairy products. Those numbers are continuing to decline.
Dr. Val: What does it mean when milk is labeled “organic?” Given the high price of groceries, are there advantages to purchasing organic milk?
Dr. Rogers: I work with both conventional dairy producers and organic dairy producers in my “day job” so I have friends on both sides. As far as nutrition and healthfulness is concerned, organic and conventional milk are equal. The “organic” label has to do with the production practices on the farms that produce the milk, not the properties of the milk itself. On organic farms, they do not use chemical fertilizers or pesticides to raise the crops that they feed to their cows. Some people like the idea of supporting organic farmers and consumers have every right to do that. But both organic milk and conventional milk are safe and equivalent nutritionally.
Milk is heavily regulated and controlled so that even on conventional farms, the pesticides do not get into the milk. All milk is tested for pesticides, and in my experience it has always contained far lower levels than the standard set for safety by the FDA.
Dr. Val: But isn’t it possible that the organic milk might have an even lower level of pesticides in it than conventional milk?
Dr. Rogers: Actually the tests that I’ve seen have not been able to distinguish organic from conventional milk as far as pesticide levels are concerned. However, I haven’t received results from all the organic farms in the U.S. But keep in mind that pesticides exist in such small quantities in milk that usually we can’t even detect them with the most sensitive instruments that we have in the laboratory.
Dr. Val: Is soy milk a good substitute for cow’s milk?
Dr. Rogers: It’s really hard to replicate the nutrition that comes from traditional milk sources. The calcium absorption, amino acids, vitamin, and mineral contents of milk provide a distinct advantage over soy milk, unless you have a specific dairy allergy. In a large recent study on baby formula, for example, there was no advantage to using soy based formulas over cow’s milk. People may prefer to use soy milk for its flavor, or because they support vegetarian food sources. But most soy milk is processed by dairy farms anyway.
*Listen to the interview with Gary Rogers*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 18th, 2008 by Dr. Val Jones in Expert Interviews
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Currently, women make up about 15 percent of the active duty forces in Iraq and Afghanistan and by the year 2020 one in five young veterans will be female. Walter Reed and other Veterans Affairs (VA) hospitals are treating more and more injured women than ever before – but are these hospitals prepared to handle all the distinctively female health issues that will be coming their way?
This is the subject of a CBS news segment being released tomorrow night, June 19th. The producers gave me an early head’s up so that I could alert my readers to it, and I immediately reached out to Revolution Health expert, Dr. Iffath Hoskins, for comment.
Dr. Hoskins is well-versed in both military healthcare and women’s health. She completed an obstetrics and gynecology residency at the National Naval Medical Center in Bethesda, Md. and a maternal fetal medicine fellowship at the Uniformed Services University of the Health Sciences. (This includes the National Naval Medical Center and the Walter Reed Army Medical Center in Washington, D.C.). She has been the Chair and Residency Director of the Department of Obstetrics and Gynecology at the New York University Downtown Hospital, and the Chief of Obstetrics at Bellevue Hospital. She currently serves as the Senior Vice President, Chairman and Residency Director in the Department of Obstetrics and Gynecology at Lutheran Medical Center in Brooklyn, N.Y.
Dr. Val: What sort of gaps in care will women military personnel encounter at the VA?
Dr. Hoskins: First of all, the gaps in care are not only for women personnel, but there are gaps in care for all personnel due to resource constraints at the VA hospitals. When the VA system was originally conceived there was no need to support women’s health services as very few women worked as full time military personnel. Now about 15% of military personnel are women. Of course, women have many of the same sorts of health problems as men (migraine headaches, high blood pressure, heart disease, etc.) and the VA system is adept at handling those concerns. But when it comes to female reproductive health, contraception, pregnancy, and disorders of menstruation, the VA system is simply not equiped to handle that.
Dr. Val: How can the VA adapt to serve this influx of women veterans?
Dr. Hoskins: First of all the VA needs to recognize the unique needs of women and identify personnel within the VA system who are capable of meeting these needs. Even in the field some of the rules surrounding uniform requirements have not been adapted to suit the needs of women. During wartime and/or deployments, resources for menstruating women (eg private toiletries, contraception, etc) were scarce. So, the women often bled onto their uniforms and this created problems with personal hygeine.
Dr. Val: Does the VA treat military wives and daughters? What sort of care are they currently getting and could women soldiers benefit from those services?
The VA does not treat dependents because they were designed to meet the healthcare needs of individuals returning from serving their countries in a wartime model. TRICARE is the coverage provided to them and many large hospitals and clinics accept this insurance nationwide.
Dr. Val: Do you think that physical disfigurement affects women differently than men?
Dr. Hoskins: I don’t believe that this is an issue. Women soldiers are tried and true professionals. They know that they are in the military to serve their community, unit, battalion, company, and country and have accepted the potential consequences of death and disfigurement. After working closely with these women for 26 years, I know that they consider themselves soldiers, sailors, marines, and airmen first and foremost and are committed to doing whatever is expected and required of them.
When I was deployed in Operation Iraqi Freedom as one of the highest ranking Reserve Marine physicians, I conducted a research survey to explore the reactions of returning veterans to the large number of women involved in the operation. We asked them how they felt about having women living and working with them shoulder-to-shoulder in times of war, and whether it made a difference to the completion of the mission. We surveyed about 8000 military personnel, and 40% of them expressed concern about having women on the battlefield.
Dr. Val: What specific concerns did they have?
Dr. Hoskins: The respondents believed that the physical load and demand on the young men was greater than on the young women. Sometimes this wasn’t because of differences in physical strength but culturally the men wanted to help the women with their loads, and the women sometimes resented the help.The respondents noted that women who needed to retrieve their fallen comrades behaved differently than their male peers (the women were more likely to cry, which was frowned on by the men). Because the women and men were segregated in their sleeping quarters, accounting for everyone’s whereabouts became more difficult.
Overall the survey clearly showed that there was never a concern about whether or not the women were weapons-qualified. The respondents did not believe that the presence of women affected the success of their mission – but it certainly created distractions.
*Listen To The Podcast With Dr. Hoskins*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 18th, 2008 by Dr. Val Jones in Announcements
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I wanted to let you know about a wonderful new online resource for pregnancy education here at Revolution Health. I helped to develop the Advanced Answers Pregnancy Center along with a team of experts from Columbia University’s Department of Obstetrics and Gynecology. It is a comprehensive, multi-media educational tool to help women (especiallly high risk moms-to-be) learn about their pregnancy and birthing options.
I’m very proud of Dr. Mary D’Alton’s team for their outstanding work on this unique center. Where else on the Internet can you find cutting edge, consumer-friendly pregnancy information written by the top minds in maternal health? I guess you could say that I feel as if I’m the proud new mom of a pregnancy education center!
I also want to tell you about another exciting tool that I helped to build: the momScore. This is the first heatlhcare quality index targeted specifically for women. With the help of an interactive map of the United States, women can compare how their home states stack up against others on women’s health issues. How mom-friendly is your state? View the momScore tool to find out.
Thanks for checking out my two new “babies” – knowledge is power, so go get some!
*Advanced Answers Pregnancy Center*
*The momScore*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
