July 1st, 2008 by Dr. Val Jones in Expert Interviews
Tags: AARP, American Medical Association, Hospitals, Medicare, News
3 Comments »
Some 600,000 physicians are facing a 10.6% cut in Medicare payments beginning July 1.
Congress failed to pass a measure to block a steep reduction in the Medicare physician payment rate before adjourning for a weeklong July 4 recess. That failure allows a 10.6 percent cut to take effect on July 1 that could end up limiting or denying care to millions of Medicare beneficiaries. [
AAFP News Now]
I reached out to Dr. Nancy Nielsen, the President of the American Medical Association, for comment. [Listen to the podcast]
Dr. Val: How will the Medicare cuts affect seniors in this country?
Dr. Nielsen: Because the 10.6% cuts to all physicians who see Medicare patients goes into effect today, we are really on the brink of a meltdown. Physicians say that a cut of this size will force them to make terrible choices, just to keep their practices open. In a recent survey, 60% of physicians said that the cuts would cause them to limit the number of new Medicare patients that they treat. This is the last thing we need at a time when baby boomers are aging into Medicare. It’s not why any of us went into medicine – to shut doors and turn patients away. So this is really, really painful.
Dr. Val: What do you say to those who claim that doctors are simply protecting their own salaries when opposing this cut?
Dr. Nielsen: We’re really not hearing that argument because people understand that this is about whether or not payments keep up with the costs of rendering care. At least 50% – 65% of income that comes into a physician’s office is spent on overhead. That includes rent, liability insurance, staff salaries, equipment and supplies. None of the manufacturers of hospital gowns or exam table paper are cutting the cost of those supplies to us by 10%.
When you’re spending up to two thirds of your income on overhead, you simply can’t tolerate payments that haven’t kept up.
Dr. Val: What can patients do to protect themselves from being denied access to medical care?
Dr. Nielsen: Patients need to understand that this issue is about them. We physicians embarked on careers in medicine to serve them, and we’re hoping that Medicare beneficiaries and military families will reach out to the senators who did not vote with us and tell them that this is a critical issue that needs to be fixed. The AMA has a Patient Action Network available online or by calling a toll free number: 1-888-434-6200. Individuals should contact us to take a stand against these cuts. Patient groups have been very supportive – the AARP and representatives from the disabled community and assisted living were with us pleading with the Senate to block the Medicare cuts.
Dr. Val: What is the AMA doing to protect access to healthcare?
Dr. Nielsen: The Medicare crisis is an access issue. It is the insurance that seniors depend on and that our country has promised them. We do not want a Medicare meltdown. The responsibility for this crisis lies with the Senate. We are hoping that the Senate will come back from vacation and do the right thing.
Last year the AMA embarked on an unprecedented campaign to encourage all Americans to put pressure on politicians to find a way to cover the uninsured. This is the other major access initiative that we’re promoting.
Dr. Val: What do you make of the “concierge medicine” movement where doctors — who are fed up with insurance — simply stop accepting it?
Dr. Nielsen: It’s a symptom of doctors becoming frustrated with bureaucratic red tape and payment problems. Many don’t feel that they have enough time to spend with their patients, and can’t afford to practice the kind of medicine they want to with insurance-based payments. Concierge practice is not a big movement, but there are some good physicians who have made that choice. We’re hoping that more physicians are not forced to stop taking insurance, but those who choose this route report being very happy, and so are their patients. The problem is that for patients who cannot afford concierge medicine, it’s not a solution at all.
Dr. Val: What would you like to say to the American public today about the Medicare cut crisis?
Dr. Nielsen: We need your help and we need it immediately. Please call your senators over the long weekend and plead with them to do the right thing and help us avoid a Medicare meltdown – a crisis that is not in anybody’s best interest.
[Listen to the podcast]This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 25th, 2008 by Dr. Val Jones in Expert Interviews, Health Policy
Tags: Hospitals, News, Parenting, Police
1 Comment »
My husband’s brother is a police supervisor in Rochester, New York. I guess that gives new meaning to “brother-in-law?” Sorry, bad joke. But on a more serious note, I recently had the chance to interview him about his work experience with the mentally ill.
What surprised me about our discussion is that his perspective on life, as a law enforcement officer, seemed to mirror that of the physicians I know. He touched on the rampant lack of personal responsibility in this country, and how HIPAA rules can lead to unintended consequences (like endangering neighborhood children). I’m grateful that men like my brother-in-law are willing to put up with the seedier side of life every day, so that others can enjoy a reasonably safe existence. See what you make of his point of view. Do you see parallels with medical practice?
Dr. Val: What sort of interaction do you have with mentally ill individuals? Are you trained to handle them differently?
Sergeant Zlotkus: People call us all the time to complain about individuals with certain mental disorders – either for bizarre behavior or for being threatening and disruptive. We have daily contact with local mentally disturbed individuals so we generally know which ones have the potential to be violent. We also have an EDPRT (Emotionally Disturbed Person Response Team) that is trained to deal with the mentally ill. The usual police response of just “going in and getting yes or no answers” doesn’t work well with a disturbed person who doesn’t know how to handle emotions. There are times where reaching out to grab someone’s wrist can cause them to go berserk and bang their heads on your police car.
More and more people with mental health issues [that cause violent behavior] are being released into the public and officers are getting hurt. People often think that the police are not dealing with the issue because they see the same people on the streets again and again. The fact of the matter is that we take them into detention but once they’ve been evaluated in the hospital, the mental health professionals choose to deal with them as outpatients and they’re right back out in the community again. We can’t put these people in jail, and knowing what to do with them can be a really tough judgment call.
Where do you draw the line? Just because you’re annoyed with someone’s actions – is that enough to lock them up? If a person paces back and forth in front of your drive way four hours a day, does that mean they have to be taken away by the police? What if that’s their only offense and the other 20 hours of the day they are fine?
How do we make this situation better?
Sgt. Zlotkus: What would really help is community education – it’d be great if we could let people know about certain individuals, and whether or not their unusual behaviors should be cause for alarm. For example, a young man with autism might be treated with understanding and tolerance when he expresses unusual behaviors, but a person with a history of mental disorders and violence should be viewed with caution. People should have a lower threshold for requesting police intervention in that case. However, because of HIPAA, we’re not permitted to let anyone know anything about others mental health or potential risks to their family.
Dr. Val: Does HIPAA affect police safety?
Sgt. Zlotkus: Absolutely. We are not allowed to save data related to individuals’ health information – so that when known drug users (who have Hepatitis C) are arrested they may try to spit on us or bite us to transfer their infection.
We’re told to use “universal precautions” with everyone – but it’s simply not practical to go into every situation with face masks and rubber gloves. It’d be really helpful if we could protect ourselves and others with the knowledge of what the risks really are.
Dr. Val: Is burnout a problem in the police force?
Sgt. Zlotkus: I’ve been a police officer for 18 years. Two of my close colleagues committed suicide during that time period. There is a sense of burnout or frustration that we all get after a while because we see the same people committing crimes over and over again. Since I’ve been working the same beat for so long, I’ve actually seen three generations of dysfunction in certain families. The drugs and violence are transferred from parents to children and it perpetuates itself. Also, people call 911 for the silliest problems and we need to respond. One woman called us because her 5 year old was having a tantrum. I felt like telling the woman to put her child in the corner and give him a time-out – what are the police supposed to do about it?
The overuse of the police force by a small minority of people who know how to work the system can be frustrating. Some people bump their lip and then have EMS, the fire department, and the police department show up and take them to the ER. When you see the abuse of the system over decades, it can really wear on you.
Dr. Val: What would improve your work life? More funding for more police?
Sgt. Zlotkus: That’s a tough question. On the one hand it would be great to have more police helping with all the work, but on the other, if we doubled the police force and were able to arrive at every request within 60 seconds, there would be a whole new batch of people ready to call us for their every whim. More police would just mean more abuse of the system.
Dr. Val: What’s the biggest problem facing police today?
Sgt. Zlotkus: Nobody wants to take responsibility for their own actions. They want to blame others, sue anyone they can, or just let the government take care of them. Most people just don’t know what it means to be a good citizen anymore.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 19th, 2008 by Dr. Val Jones in Expert Interviews
Tags: Food and Nutrition, Milk, Podcast, Research
4 Comments »
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
Tags: Hospitals, News, Obstetrics And Gynecology, Research, Veterans Affairs, Women's Health
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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 17th, 2008 by Dr. Val Jones in Expert Interviews, Health Policy
Tags: Cancer, Chronic Disease, News, Weight Loss
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Ken Thorpe, Ph.D., is the Executive Director of the Partnership to Fight Chronic Disease, and is admired and respected by many of the “movers and shakers” in Washington. The outpouring of appreciation for his work was quite evident during the recent half day-conference entitled, “Fighting Chronic Disease: The Missing Link In Health Reform.” I had the chance to speak with Ken to get his thoughts on chronic disease and health reform.
Dr. Val: What are the most important things that the general public needs to know about chronic disease?
Dr. Thorpe: Two things. First of all, they need to know whether or not they have a chronic disease. For example, about a third of diabetics in the country don’t know they have diabetes. So Americans need to be screened appropriately for potential chronic diseases like cancer and diabetes.
Second, if you do have a chronic disease, there are simple ways to manage it. Management needs to be coordinated through a primary care physician. Basic things like blood pressure and blood sugar need to be monitored on a regular basis. Diet and exercise are also a critical compenent of chronic disease management. The good news is that most chronic illnesses are manageable, but patients need to be actively engaged in their health. Medication compliance and consistent lifestyle modification under the care of a PCP is the way to go.
Dr. Val: What should people know about the Partnership to Fight Chronic Disease?
Dr. Thorpe: We want to get patients (or “consumers”) involved as a voice for healthcare reform. Patients are the key to making our healthcare system simpler, less-expensive, and less administratively complex. We believe that health reform is possible. We must not become frustrated with our inability to fix everything today, but if we start with the right set of issues and really work collaboratively to solve them, we really can make life better for patients and physicians.
The patient community should go to our website and learn the facts about chronic disease and help to educate their local politicians and community leaders about it. I would encourage them to spearhead community-based interventions to promote weight loss and prevent obesity. We just released a book about “best practices” for achieving healthy behavior modifications. It is full of local program ideas to help prevent chronic disease – and it’s all based on initiatives that have a proven track record of success. Our best practices book is an ideal guide to community-based interventions that can make a difference.
Dr. Val: You say that we need a different delivery model to treat chronic disease. Can you explain that?
Dr. Thorpe: Chronic disease management requires a team-based model. Nurses, social workers, and mental health providers should work with patients at home. We need a more proactive model where we engage patients in managing their disease so that we can prevent unnecessary flare ups. For example, with diabetes, if you don’t control your blood sugars on a daily basis, you’re far more likely to go on to require a limb amputation. Our current delivery system does not allow this type of management – interacting with nurses at home, for example – because nobody pays for it. So we need a different payment model and a different delivery model.
Dr. Val: Do you think that online health websites can make a difference?
Dr. Thorpe: I think that online programs should engage people in education – so that they can understand the connection between weight, diet, exercise, smoking, and chronic illness. Only 15% of the population understands the gravity of these issues and how it affects the cost of their health insurance.
Online sites that allow people to track their progress (and chart how they’re managing their disease) may also help people to become more actively engaged in their healthcare.
Dr. Val: How can we encourage people to adopt healthy behaviors?
Dr. Thorpe: Incentives always work. We have to give better tools to people who want to change their behaviors. We have to make it easier for them to manage their health at their places of work. For example, some employers conduct health risk appraisals with their employees and then put together care plans and even have a nurse practitioner available at the work place to check on progress. That way the employees don’t have to take time off work to see the physician after hours.
We can also make a difference in schools – we need consumer advocates to continue to demand healthier school lunch programs and increased physical activity for kids. Consumer advocacy at the community level is critical to our success in the prevention and management of chronic disease.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
