April 9th, 2009 by DrRob in Better Health Network, Quackery Exposed
No Comments »
I got this in the mail today.
The spam filter didn’t work 100%. I know.
Why even post it? Just to comment on a society where people ask me “is it safe?” when I prescribe a medication for them and yet value the fact that people in Hollywood do something. Most of the people in Hollywood are idiots and are surrounded by more idiots.
Let me reassure you:
- Your body is not “full of toxins.” When it is, your liver and kidneys are designed to handle those “toxins” and will do so far better than anything someone tries to sell you.
- Diets only work when they restrict calories.
- Your colon is fine and does not deserve to be regularly “cleansed.” Colonics have been around since the early 1900’s (maybe earlier) and the fact that they are still being used is only evidence of the gullibility of humans.
- Never trust something that claims to “strengthen the immune system.” It is an impossible claim to prove or disprove, and so is made with impunity.
- Look for the word “supports.” Phrases such as “supports prostate health” or “supports a healthy immune system” are big signs that you are being BS’d.
- I never give patients medicines I would not take myself in the same circumstance. I know no doctors who do. It is fine to say “why do I need this medicine?” or “Is this medication really necessary?” but to ask “is it safe?” or “doesn’t this destroy the liver?” is kind of insulting.
- I guarantee that any plan like this one will cause significant weight loss…in your wallet.
Sorry. Had to rant about this. People believe many dumb things and will until the world’s end. I feel bad for the people brought in by this and am angered at the hucksters that are fattening their wallets and misleading the uninformed.
End of Rant
*This post was originally published at Musings of a Distractible Mind.*
April 8th, 2009 by KevinMD in Better Health Network
1 Comment »
Almost 30 percent of Medicare beneficiaries have trouble finding a new primary care doctor.
Expect that number to rise dramatically in the near future, as the number of Medicare beneficiaries balloons, and the amount of primary care physicians plummets.
The whole scenario is a perfect example of how poor physician access makes medical coverage practically worthless.
Contrary to popular belief, Medicare’s paperwork requirements and pre-authorization obstacles are just an onerous as those of private insurers. Combined with the continuing threat of downward physician reimbursements, and the baseline complexity of a typical Medicare patient, it is no wonder that doctors are dropping Medicare in droves.
This phenomenon with Medicare is likely going to spread nationwide, if the current plans for universal coverage go through without first addressing the primary care shortage.
**This blog post was originally published at KevinMD.com**
April 8th, 2009 by Dr. Val Jones in Expert Interviews
No Comments »
Marty Prahl is the lead contracted health IT architect at the Social Security Administration (SSA). His personal experiences have led him to become a passionate advocate for digital data sharing. Several years ago one of his uninsured relatives was diagnosed with a devastating disease. She applied for disability benefits through the SSA but the process took over a year for her approval. During that year her medical condition caused her to lose her job, and she had no means by which to pay her soaring medical bills. The bank repossessed her home, her husband left her, and she had to move in with Marty’s family. As they waited for her disability benefits to be approved, Marty tried to make payment on her bills, which put enormous financial stress on his family.
Living through this nightmare galvanized Marty into action – he decided to devote his IT career to speeding up and streamlining the disability determination process. Thanks to Marty’s work, and the many people who created the Nationwide Health Information Network (NHIN), the SSA is now participating in an electronic medical record and data sharing network. This means that transfer of the records required to make an individual disability determination (if everyone sending data to the SSA is part of NHIN) can occur in under a minute. If the information supports the disability claim, an approval could be made within 1-2 days.
Prior to becoming part of the NHIN network, the SSA had no choice but to receive information by fax and paper. In order to make a disability determination, all medical records (from all healthcare professionals involved in the patient’s are) had to be gathered and analyzed by hand. If a doctor’s office didn’t send in the patient’s medical record in a timely manner, then the process would halt. Of course, compensation for sending records to the SSA didn’t generally cover the cost of doing so for the doctor, so the financial incentive to get the documents in was low. It’s no surprise that this resulted in wait times of 3 months to 2 years.
But some people simply can’t afford to wait – disability determinations are the gateway to Medicare and Medicaid funding, and there are other programs available for those who don’t qualify for Medicare and Medicaid. But those programs cannot be accessed until an official disability determination is made by the SSA. There are approximately 3 million new disability claimants annually in the United States – and without electronic data sharing, those people will have to wait for the paper process to run its course.
However, early adopters like MedVirginia, in Richmond, VA are already members of NHIN and can easily share medical records with the SSA. If more hospital systems and providers joined the network, disabled patients would gain rapid access to much needed government insurance benefits, and hospitals would no longer be offering them potentially bankruptcy-inducing “charity care” while they wait for a determination from SSA.
So what should Americans do about this? Spread the word about NHIN, and ask your hospitals to join the network. The software is free and available online (the CONNECT “open-source” code is here). As for me, I guess I hope that if I’m ever in a terrible car accident I’ll be taken to a NHIN participating hospital. A couple of days seems like a much better wait time than 2 years for disability benefits. I think Marty would agree.
April 8th, 2009 by Dr. Val Jones in Medblogger Shout Outs, News
No Comments »
Tim Cromwell’s mother-in-law is 86 years old. Her husband is a Korean War veteran who developed Alzheimer’s disease, and receives care from both the VA and private healthcare providers. Because she and her husband take so many medications, they actually replaced their dining room table centerpiece with a collection of orange and white pill bottles. Mrs. Spencer keeps a hard copy of all of her husband’s medical records in a large file box that she carries with her on a cart with wheels. She has no alternative for keeping all her husband’s providers up to date with his complex care, and lifting and transporting the records has become more difficult for her in her eighth decade.
If this story sounds all too familiar, then you’ll be glad to know that the government is facilitating electronic medical and pharmacy records portability. One day it may be possible for Americans to dispose of those hard copy files, knowing that any provider anywhere can access their records as requested.
Tim Cromwell is passionate about alleviating his mother-in-law’s need to carry medical records around, and believes the way to do this is through the US Department of Veterans Affairs’ participation in the Nationwide Health Information Network (NHIN). Working in compliance with NHIN standards, the Federal Health Architecture group recently oversaw the creation of software (called CONNECT) that creates a seamless, secure and private interface with hospitals, and over 20 federal agencies’ medical records systems (including the Social Security Administration, Department of Defense, Veterans Affairs, the Centers for Disease Control and Prevention, and the National Cancer Institute).
On April 6, 2009, NHIN released the CONNECT software necessary to make Electronic Medical Records systems interoperable. The software is “open-source” and free to all who’d like to incorporate it into their EMRs. Those who add the free software will be able to share data with NHIN’s member groups, which include early adopters like the Cleveland Clinic, Kaiser Permanente, Beth Israel Deaconness Medcial Center, and MedVirginia.
This means that if Mrs. Spencer and her husband receive their care from participating hospitals and federal programs, they’ll never have to tote paper records again. But it may take some nudging from patients and healthcare professionals like you to grow the network. If you’d like your hospital to participate in the NHIN network, encourage them to view the NHIN website here.
April 8th, 2009 by AlanDappenMD in Primary Care Wednesdays
No Comments »
Back in 1983, as a third year medical student, I read a study stating that 80% of medical visits were not needed. After finishing the text, I remember thinking, “Hmm, there aren’t that many hypochondriacs in our office!”
It wasn’t until I had practiced medicine for 20 years that I finally understood this statement for what it really meant: doctors were not helping patients through remote means, instead insisting on seeing patients in the office for all medical issues, even the most routine of issues out of habit, out of fear, out of how to get paid.
In 1996, I set out to prove that allowing established patients to remotely access doctors for care would improve their medical outcomes. I convinced my medical partners to let me conduct an experiment: I would work a few half days on the phones, fielding medical-related calls from our HMO patients. Since HMO plans paid us a flat rate to take care of them, bringing these patients to the office cost us money and offering these patients medical consults by phone instead, for routine issues, would be more cost-effective for us and a lot more convenient for them.
At that time, the front desk fielded over 500 patient calls a day. I sat next to the four receptionists, and the HMO screened patients with straightforward medical problems would be triaged to me. I then would speak to the patient, review their medical history and address their medical issue and get them what they needed. I was able treat 90% of the screened patients I spoke over the phone, while determining that the other 10% needed face-to-face appointments. During a typical 3.5 hour shift, I routinely spoke to 25 patients, and immediately helped 23 of those patients with their medical issues thereby avoiding an office visit.
Unfortunately, the experiment didn’t last long. To the business managers of the practice, we lost $500 in co-pays while I logged half days on the phone, not billing a single dollar for the practice. Where I saw opportunity and a new paradigm, they saw lost income.
Thus, I returned to my routine day, seeing 25 patients a day in person, day after day. But drudgery of this led to deepening despair. So many unnecessary office visits, patients upset with their delays, apologies for running late, and meetings about how to see more patients, see them faster, charge the insurance companies more. In some cases all the delays had led to a complication that could have been avoided with more timely care.
Not undeterred, I discretely planned a study in 1999. For two weeks I collected data on each patient I saw. Recording data on a laptop during each visit, I analyzed three questions: How long did we talk, how long did the exam take, how often did I already know what to do through history alone and not due to findings from the face-to-face exam.
Here are the results: I saw an average of 23 patients a day. The longest office visit was 45 minutes, and the longest physical examination of a complicated patient took 10 minutes. Sixty-six percent of my patient visits had no reason to be in the office, with my diagnosis relying on patient history and not being influenced by my physical exam.
On reflection of the data, the implication of the data awoke me to a new realization. I must step outside the “Matrix” that I had been a part of: a healthcare system that often delayed and even held hostage 2 of 3 patients I saw each day.
But making the decision to step outside this system was not easy: why should I risk my medical career as I knew it, and my financial security to do what is best for my patients and deliver them the quality they care they needed?
It was my wife, who, in 2001, finally convinced me to move on. She wrote a resignation letter to my medical practice, a practice filled with respected friends and colleagues. As I sat pondering the risk I’d confront by handing in the letter, my wife reminded me of a familiar refrain, “Ships are safe at harbor, but that’s not what ships are for.”
And so, in 2002, I founded doctokr Family Medicine, a practice that does step outside the typical paradigm of healthcare. My patients control how and when they are seen by our medical team. At doctokr, all of the patients establish their care through a face-to- face visit at the office. We gather their history, review their records and do an exam. After that, all established patients are free to email or call the doctor directly, 24/7. Over half of patients’ issues are resolved remotely, via phone or email. Our medical team also sees patients if they want to be seen, or if we feel we need to see them 7 days a week.
As a medical practice with 3000 pioneering patients, we sail on empty oceans but with full faith that we will not have done so in vain. Our experience has shown happier and healthier patients, providers with a mission and passion again and pricing that is 50% less than the current system price of healthcare.
For doctors and patients, staying “safe” behind the many unexamined assumptions in health care makes such harbor risky indeed.
Until next week, I remain yours in primary care,
Alan Dappen, MD
