May 5th, 2008 by Dr. Val Jones in Health Policy, Health Tips
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Do you know your state’s momScore? Revolution Health and I have teamed up with leading medical experts and mommy bloggers to create a new health index just in time for Mother’s Day: the momScore.
Check out this fun interactive map that ranks states by 10 key maternal health variables*:
- Access to prenatal care
- Availability of childcare services
- Number of insured moms
- Maternal mortality
- Affordability of childrens’ health insurance
- Air quality
- Family paid leave policy
- Infant mortality
- Risk of pregnancy complications
- Violent crime rate
We also created a combined average of these variables (weighted according to expert perceived importance) to get an overall ranking. So, do you know where it’s best to be a mom in the United States?
Apparently, Vermont ranks most favorably (on average) in all of these variables. Don’t live in Vermont? Check out how your state compares.
Would you like to discuss your state’s rankings with others or debate the momScore? You can post your comments in our interactive momScore community. This is a really exciting opportunity to discuss women’s health issues in a fresh new way. I hope that the momScore will challenge states to strengthen their efforts to keep moms and babies healthy. At the very least, we’ve made a lot of Vermonters quite smug.
*Variables are based on state reporting to the Environmental Protection Agency (EPA), the Centers for Disease Control and Prevention (CDC), and the United States Census Bureau, as well as leading non-profit organizations such as the Kaiser Family Foundation and the American College of Obstetricians and Gynecologists. For more information about momScore methodology, click here.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 17th, 2008 by Dr. Val Jones in News
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Most doctors are drawn to a career in medicine in large part because they sincerely wanted to help people, and most patients seek out doctors because they want and need help. Yet here we are, wanting to help (doctors) and needing help (patients), and somehow we’ve become disconnected and dissatisfied.
To take the pulse on how patients perceive their current physician relationship, Revolution Health offered this poll on our homepage (this is a sample of 642 respondents):
Q: Are you attached to your doctor?
- Yes, very much so – 24%
- Somewhat – 21.9%
- Not really – 20.4%
- Not at all – 33.5%
There are two ways to look at this, I suppose. The “glass half full” camp might say that 45.9% of people are very much or somewhat attached to their doctor, and that means that a large minority of folks are in a doctor-patient relationship that is meaningful to them.
The “glass half empty” perspective would suggest that 53.9% of people have no perceived personal caring physician in their lives.
I don’t know how people would have responded to such a poll 50 years ago, but I have a feeling that it would have skewed much higher towards the “very attached” end of the scale.
I know that this poll is limited in its scope and significance, but are you surprised by the results?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 28th, 2007 by Dr. Val Jones in Health Policy, Opinion
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MedPage Today issued a special report on a rising trend: cash-only medical practices. I guess I’m ahead of the curve, since I’ve been seeing a cash-only primary care physician for 2 years now – and I love it.
Dr. Alan Dappen is available to his patients 24 hours a day, 7 days a week, by phone, email and in person. Visits may be scheduled on the same day if needed, prescriptions may be refilled any time without an office visit, he makes house calls, and all records are kept private and digital on a hard drive in his office.
How much would it cost to have the luxury of a personal physician on-call for your every whim?
Would you believe only about $300/year?
What’s Dr. Dappen’s secret to success? He accepts no insurance, keeps his overhead low, offers full price transparency, has physician extenders who work with him, and charges people for his time, not for a complex menu of tests and procedures.
“I believe in doing what is necessary and not doing what is not necessary. The healthcare system is broken because it has perverse incentives, complicated reimbursement strategies, and cuts the patient out of the billing process. When patients don’t care what something costs, and believe that everything should be free, doctors will charge as much as they can. Third party payers use medical records to deny coverage to patients, collectively bargain for lower reimbursement, and set arbitrary fees that reward tests and procedures. This creates a bizarre positive feedback loop that results in a feeding frenzy of billing and unnecessary charges, tests, and procedures. Unlike any other sector, more competition actually drives up costs.”
After building a successful traditional family medicine practice in Fairfax Virginia, Dr. Dappen felt morally compelled to cease accepting insurance so that he could be free to practice good medicine without having to figure out how to get paid for it. He noticed that at least 50% of office visits were not necessary – and issues could be handled by phone in those cases. Phone interviews, of course, were not reimbursable by insurance.
“The physical exam is a straw man for reimbursement. Doctors require people to appear in person at their offices so that they can bill for the time spent caring for them. But for longstanding adult patients, the physical exam rarely changes medical management of their condition. It simply allows physicians to be reimbursed for their time. Cutting the middle man (health insurance) out of the equation allows me to give patients what they need without wasting their time in unnecessary in-person visits. This also frees up my schedule so that I can spend more time with those who really do need an in-person visit.”
Health insurance is certainly necessary to guard against financially catastrophic illness. And the poor need a safety net beyond what Dr. Dappen can provide. But for routine care, “concierge medicine” can make healthcare affordable to the middle class, and reduces costs by at least 50% while dramatically increasing convenience. For the right patient, this is a welcome relief from having to wait to be seen by in-network providers or from being billed non-preferred rates as an uninsured individual. I applaud Dr. Dappen for his efforts in healthcare reform, and look forward to a movement where costs are driven down by putting patients back in the payer seat.
October 4th, 2007 by Dr. Val Jones in Announcements
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Well, I had a great time at the Revolution Health booth at the AAFP meeting today. Hundreds of people stopped by for a chat and to get to know what Revolution Health is about. I handed out golf towels (well, they were little white hand towels that I used to give out as gym towels, but with the doctor audience I changed the pitch to golf. How cliche of me. Ha!) Some of the notable guests included:
Bob Rakel, MD – author of my most favorite medical textbook in the world: Saunders Manual of Medical Practice
David Rakel, MD – Bob’s son, and the author of my second most favorite medical textbook: Integrative Medicine
Len Fromer, MD – past president of the California Academy of Family Physicians. His wife is an actor – and we had a great chat about how we both miss New York City.
John Pfenninger, MD – author of the coolest book for outpatient medical procedures
Todd Dicus, JD – deputy executive VP of the AAFP and a really friendly lawyer.
Marianne Walters, MD – an urgent care physician in California who taught me that surfers’ wet suits are like Petri dishes for MRSA (a really nasty bacterium). Ew.
Allan Harmer, ThM – from the Christian Medical Association, who told me that the story of how he accidentally attended a medical conference about HIV and ended up involved in medical groups for the rest of his career (even with no previous medical training).
Joe Scherger, MD – the hardest working man on the Revolution Health expert team. He gave a lecture about how to use email and online help as an integral part of one’s medical practice – and the audience was riveted.
Tomorrow’s going to be fun, I can just tell. And the best part is that I can wear sneakers with my business suits – all the family physicians are doing it themselves! I’ve never seen more Birkenstocks in one place before… I think Michelle Au might have been right about family docs – see her cartoon.
See you tomorrow at Revolution Rounds.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 10th, 2007 by Dr. Val Jones in Health Tips
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A colleague slammed his thumb in a door recently and got a black and blue nail. He told me that he searched for how to treat it on the Internet, and was advised to stick holes in the nail to relieve the pressure. I gazed at his thumb nail, peppered with tiny little needle divots and cringed as I imagined bacteria being introduced into the soft fleshy part under his thumb nail. His thumb otherwise looked good – no mallet finger, no swelling – no blood under pressure that I could see.
I decided to do a little research on this issue, since all I’d ever done for a black and blue finger nail before is let nature take its course – it’s painful for a few days, the nail eventually falls off, and a new one grows.
However, in many cases creating a hole in the nail to let the blood escape can significantly relieve pain in the acute phase. Making the hole is tricky – it has to be large enough to let the blood out, and it has to be done with a sterile instrument so that bacteria are not introduced below the nail. Most physicians recommend a local anesthetic to ease the pain prior to making the hole. The hole can be made with a large bore needle (but you have to be careful not to place the needle in too deep) after swabbing with alcohol, or by burning through the nail with the tip of a paperclip that has been heated with a butane lighter. Creating the nail hole (known as trephination) is best done by a medical professional.
Routine antibiotic coverage is unnecessary. If the nail is loose, split, or a cut extends past the edge of the nail, the nail should be removed,
the cut closed with stitches, and the nail reapplied as a
dressing. It’s also important to make sure that the thumb bone is not fractured.
Bottom line: black and blue nails (subungual hematomas) are very painful and may be relieved by having a medical professional place a hole in the nail. But don’t try this at home, folks.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
