March 18th, 2009 by Gwen Mayes, J.D. in Better Health Network
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It’s definitely not your mother’s public health campaign.
When the National Heart, Lung and Blood Institute (NHLBI) launched the Heart Truth campaign seven years ago to raise awareness of women’s heart health their partners were your typical patient groups and professional medical societies.
Not anymore. Today, their front row partner is Coca-Cola. Diet Coke that is.
Dr. Val and I were among a small group of women’s health advocates who met last week to hear the latest on NHLBI’s campaign with Diet Coke and how the fashion industry is bringing an important public health message to women.
Diet Coke’s commitment to the Heart Truth campaign is unprecedented, one of the “largest public awareness initiatives we have ever undertaken,” said Celeste Bottoroff, VP Living Well, Coca-Cola North America.
Leading Diet Coke’s campaign? Endless-legs Heidi Klum and other fashion-conscious women who have revamped the little red dress campaign into a national symbol with guts, curves and most importantly results.
“In 2002, only 34% of the women in this country knew heart disease was the leading cause of death among American women,” Dr. Elizabeth Nabel, NHLBI director, told the group. “But we’re making progress. Today, as a result of the Heart Truth campaign and others like it, 65% of the women now know it’s the number one killer.”
Nabel led a discussion of the common myths associated with women’s heart heath and recalled her own experiences as a cardiology resident when women were caregivers who supported husbands, fathers and other male family members through heart ailments but often ignored or brushed aside their own symptoms for fear that treatment would interfere with domestic chores such as childrearing, cooking, and cleaning. “Even when older women came in with heart problems, they weren’t treated as aggressively as men,” Nabel admitted.
“Most women still need educating,” she remarked. “80% of middle-aged women still have at least one risk factor for heart disease. And just one, doubles your risk of actually having heart disease.”
Joining Nabel were Phyllis Greenberger, President and CEO of the Society for Women’s Health Research, Susan Bennett, MD, Clinical Director of the George Washington University Hospital’s Women’s Heart Program and Robyn Flipse, MS, RD, author and nutrition consultant to discuss the campaign’s most important messages. First, heart disease is not a man’s disease, a point often raised by group’s such as those headed by Greenberger who cited research indicating that only 17% of cardiologists and 8% of primary care physicians know that heart disease is the leading cause of death among women.
And it’s not just for the aged either. “When a 40 year old woman has heart disease it’s worse than a 40 year old man,” said Bennett recalling patients in their 20s and 30s in her practice. “It’s never too late to change your lifestyle,” Flipse added. “The body is very forgiving. Even a 10% drop in weight can have a positive impact on blood pressure, cholesterol and other important risk factors.”
The Heart Truth campaign, thanks to the vision of Dr. Nabel and the willingness of NHLBI to partner with a highly visible, social icon such as Diet Coke is just what’s needed to cut through the feel good messaging that most public health campaigns resort to. Having lived with heart disease my entire adult life (now well into middle age), it’s a welcome boost of energy and the visibility possible with this campaign is unparalleled. Along with it comes some very important information that can save women’s lives.
Look for the heart truth emblem on 6 Billion Diet Coke cans, at community public forms, at American Idol, and fashion shows across the country. Diet Coke, with Heidi’s help, has even designed a new red dress label pin which strongly resembles an hour-glass. And what woman doesn’t want that?
February 4th, 2009 by Dr. Val Jones in Primary Care Wednesdays
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Dr. Val’s note: My friend and co-blogger Alan Dappen is going to prepare a series of posts to expose the convoluted billing and procedural tactics that primary care physicians adopt to survive the ever decreasing reimbursements that would otherwise put them out of business. Below is his introductory post – others will follow each Wednesday morning here at Better Health. Enjoy!
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The Doctor’s Huddle
By Alan Dappen, M.D.
On the great gridiron of healthcare, the team of primary care providers is leaning inward, supportively embracing one another. They have huddled together for 15 years, calling plays against their opponent, the Insurance Team. The two-minute warning has sounded and the Physician Team is losing. The Physician’s play book pieces together strategies culled from cocktail party conversations, doctor conventions, office staff meetings, back hallways of hospitals, online blogs, and a plethora of practice management magazines; routinely circulated offering grand strategies to teaching doctors how to tackle the Insurance Team. The rising mantra is “Hit them again! Harder! HARDER!”
This game began in the 1980s, when concerns that rapidly inflating healthcare costs would consume all the U.S. gross national product within the foreseeable future unless something was done. Insurance companies lobbied regulators and advertised to the public not to socialize healthcare. Most people sighed relief when laws were passed granting insurance companies broad powers to regulate the price of care. Little did these politicians realize that they inadvertently were “socializing” care by handing the keys to the health care gold mine to Team Insurance’s privatized, for-profit model.
Up until this point, the healthcare system had experienced 40 years of run-away costs. Patients with insurance hadn’t worried about the costs of care. Inside of this cash rich environment, many important innovations occurred but employers, who subsidized most of the cost, questioned the sustainability of paying for it. All the while, physicians, hospitals, pharmaceutical companies, and medical suppliers eagerly reassured the patients: “Since you aren’t worried about the price, then no one else should worry about it either. We’ll pass the bill to the insurance company–they pay what we ask.”
This modus operandi came to a screeching halt in the late ‘80s, when the aforementioned game began, and Team Insurance was allowed to fix prices via preferred provider contracts. Insurance providers understood that the key to these contracts was not to change the rules for patients, who needed to perceive their care as virtually free so that they would continue to seek care.
Instead, Team Insurance spelled out new game rules in contracts for physicians, where the physicians “negotiated” to accept roughly 50% of their customary rate in order to be listed in the insurance company’s Preferred Provider Directories. These rules were never acceptable to physicians. Docs refusing to sign contracts rudely were awakened by the new world order when 95% of their trusted clients refused to return until they could say, “Yes we are preferred providers.” And, “Yes, all you have to pay us is your co-pay.”
Patient expectations remained unchanged. Quality of service, patience, time to explain oneself, attention to wellness, review of multiple issues, meaningful personal relationships, prescriptions, detailed explanations of risks and benefits of treatments, reviews of other possible ideas in a differential diagnosis, labs, call backs with results, and introductions to specialists were never connected to a price for patients before. After all, haven’t physicians had spent 40 years reassuring patients, “Don’t worry your silly little head about the price.” This time the boomerang came right back at physicians who suddenly were demanded to deliver all the same service for half the price.
The power of “owning” the patient for a $20 co-pay is not lost upon the insurance team. Every year, as they hand out new contracts, these insurance companies congratulate their preferred doctor players for their work, quality, and dedication and try to not rub in the following truth, “We own the doctor and we own the patient. Any doctor who dares not sign our next annual contract for less money will find themselves without patients. Remember, for the patient the big thing that counts is that you can say yes to the $20.00 co pay. Now sign on the dotted line.”
Every “negotiated” dollar saved from paying Team Physician means smiles all around for Team Insurance and their fans (shareholders.) Price fixing initially did control costs, but only for about five years. The U.S. now is back on the trajectory of health care pricing doubling every 7-10 years.
So what’s going on in those primary care huddles? The game plays are called out: “More work, less money, patient demands, protection from malpractice, keep smiling … Somehow we’re going to make somebody cough up our money …Hit them again harder! Let’s do it! On one, break.”
Up next, I’ll show you some of the plays physicians have put into place to survive. And why you the patient might feel like the football. Play along, with us. Hup one, Hup two, hike!
Until next time, I remain yours in primary care,
Alan Dappen, M.D.
January 21st, 2009 by Dr. Val Jones in Primary Care Wednesdays
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By Alan Dappen, M.D.
“Doc, you’re the best! You saved my life, and my wife’s. You delivered my kids and brought them through sickness — time and again. I trust you, and can confide in you … Hey, wait a minute … Are you still a Preferred Provider?”
This is a statement I heard all too often as a primary care doctor beholden to third-party providers. When a long-time patient asked this question, I felt like the mythological Damocles, who precariously sat beneath a sword suspended by a horse hair, for if I answered “No” to that question of “Are you a Preferred Provider” the sword would fall, swiftly.
No matter skill, knowledge, talent, caring, quality, experience, price or level of trust of their current primary care practitioner, 90-95% of patients who ask “Are you my preferred provider?” paradoxically will exit one primary care provider’s office to entrust the decisions of their day-to-day health care to another physician picked by their insurance company, even though this new doctor may be a stranger who signs a contract to do the job for less money.
For decades now patients have been led, like lemmings, by the belief that the vast majority of healthcare is virtually free because they have health insurance usually wholly and partially funded by someone else, like their employers of the government. Furthermore, patients trust that the providers of this health insurance know what is best for their care.
Because someone else is footing the bill, we as patients have absolved ourselves of the responsibilities associated with finding and consuming good care. Instead, the hope of getting what appears to be virtually free health care trumps all other considerations of care, whether it is quality, level of expertise, convenience or accessibility. Few of us are immune to wanting to get something for less, or better yet, something for nothing. This behavior leads to moral hazards, which are most easily explained by the WIFM (“What’s in it for me”) concept, and best exemplified by the way we eat at a buffet, drink at an open bar, or most recently by how the banks flocked to the sub-prime market to make easy, big money.
In health care, these moral hazards mean patients do not hold themselves accountable for finding the quality of care they desire at a price that makes sense. Instead, patients often rush for more health care believing that more care is better care; or to specialists because this means more competent care; or to more tests because this translates to more comprehensive results; and finally to more drugs and more treatments because these mean a longer, happier life. And patients do so because they believe their care is “free.”
Most patients are loathe to believe the numerous studies contradicting many of these beliefs. Due to the set up of the current “free” care healthcare system, patients are shielded from the actual costs of care, so they do not carefully consider these costs when assessing care. Take, for example, that a new chemotherapy drug for colon cancer cost $40,000, and yet only adds an average 1.5 months onto a patient’s life. Or that the newest brand name antidepressant costs 6 times more than its older, generic cousin (Prozac), with no evidence that it works any better. And finally, consider this example: a 70 year-old man with severe, irreversible chronic end-stage heart and renal failure, who has been bed-ridden for 3 months with numerous deep bed sores, and whose family demands “keep him alive no matter the cost.”
Unfortunately, the WIFM game doesn’t end with the patient. Imagine the beauty of running a business when all your customers say, “Don’t worry, just send the bill to Mom (the employer) and Dad (the government) and they’ll pick up the tab.” It is not rocket science to understand how this led physicians to a business model that guaranteed customers as long as they played by the providers’ rules; nor to understand how drug companies produce more and more “me too” drugs that offer no advantages over generic precursors but cost 6 times more; nor to see primary care physicians moving to specialization, with little difference in training compared to primary care while doubling or tripling fees; nor insurance companies keeping 30-40% of all collected money for “administration, policing, and profits,” and their executive team pocketing exorbitant rewards, like the United Health Care CEO who amassed almost $2 billion in just a few years. How dare he?!
This then is the systemic toxic effects of our health care system. The moral hazard of free healthcare binds us into one big dysfunctional family. Whatever happens, let’s make sure someone else is paying for care.
Here’s the rub: insurance has a social value for protection against large or chronic, recurring costs to help ensure your financial well-being. Primary care, on the other hand, is something all of us need, on average 1-2 hours a year and a can cost the patient as little as $300. What minimal cost to pay for staying healthy today, building for a healthy tomorrow, and ideally decreasing our need for more expensive healthcare later on. Yet few are willing to pay only a little bit today for their day-to-day care – no matter its level of quality, accessibility or convenience, unless it is “free.” So, in a world of moral hazards, what is going to happen to typical primary care?
Stay tuned and we’ll review the dirty little secrets primary care plays to survive and why it really does matter to you.
Until next time, I remain yours in primary care,
Alan Dappen, M.D.
December 3rd, 2008 by Dr. Val Jones in Opinion, Primary Care Wednesdays
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By Alan W. Dappen, MD; Steve Simmons, MD; Valerie Tinley, FNP of Doctokr Family Medicine
We are a family doctor, an internist and a family nurse practitioner working on the front line of the American health care system. We share a moral and ethical duty to protect the health of our patients along with all our colleagues who labor daily doing the same.We as Americans are proud of what has long been considered a first-rate health care system. Sadly, this system is broken despite our best efforts. Americans spend much more per capita for care as any other country. The World Health Organization has graded our care as 37th “best” in the world. Even worse, American citizens were the least satisfied with their medical care compared to the next five leading socialized industrialized countries, including England, Germany, Canada, Australia and New Zealand. There are many things wrong. Let’s examine a few:
Primary care medicine in America is gasping for its last breath. Internists, family doctors, pediatricians (whom health experts consider essential to a robust and cost-effective delivery system) are leaving primary care in droves. The number of newly trained generalist doctors has plummeted so fast that extinction of the generalist doctor has been forecasted within 20 years by both the American Academy of Family Practice and the American College of Physicians.
Patients are angry and exasperated with long delays, poor service and confusing and redundant paperwork. To date 17% of us are uninsured and this number will quickly grow in a deepening recession.
Employers face a huge cost burden as health insurance prices go through the roof. CEOs consistently say the runaway costs in health care benefits (which double in price every seven to ten years) threaten the viability of their companies. Since 2000, the number of small businesses offering health insurance has dropped 8%.
Health insurance companies are making so much money that several states have motioned legislation compelling insurance companies to disclose the percentage of premiums spent on actual medical care. Not surprisingly, their lobbyists are resisting. It is not uncommon for insurance companies to keep 30-40% of every dollar for “administration” and profits. Many of these companies are on record reaffirming their commitment to shareholders and short-term profits.
Doctokr (“doc-talker”) Family Medicine is a medical practice that was created to respond to the conflicts and problems listed above. We have worked to resuscitate the soul of the Marcus Welby-style patient-focused physician while adding technology to deliver fast, responsive and informed care. All fees are transparent and time-based and are the responsibility of our patients to pay. All parties that interfere with the doctor patient relationship or increase our costs have been removed from the equation. The practice delivers “concierge level” services: 24/7 access, connectivity to the doctor no matter where our patients are located, same day office visits for those that need to be seen, even house calls for those unable to get to our office. By removing the hurdles and restoring transparency and trust, 75% of our clients get their entire primary care needs met for $300.00 a year.
This post is written by three medical professionals who stopped waiting for someone else to find a solution and are actively changing primary care in ways that dramatically improve quality, convenience and access, while drastically reducing costs. The US deserves excellent health care and it must be done right. To understand why we would bother to “walk the walk,” we ask your indulgence and participation while we “talk the talk.” We hope this format will educate and inform you in ways that move you to participate in your care. Health care is about you, just as much as it about us, because we are all patients. We all have a stake in shaping the inevitable need for reform.
The next upcoming topics:
- Where did the Marcus Welby, MD-style of primary care go and how can we get it back?
- How have you as a patient lost control of your body and health?
- Turning the primary care model upside down: What does primary care need to do to reinvent itself so that it serves its patients without other conflicting interests?
- Begin the exploration of the unexamined assumptions of health care….
Until next week, we remain yours in primary care.
– Alan, Steve, and Valerie
December 1st, 2008 by Dr. Val Jones in Announcements, Medblogger Shout Outs
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This is one awareness day where your coffee habit can make a difference. Starbucks is donating 5¢ to the Global Fund for every Starbucks beverage sold on December 1, 2008 at participating US and Canada locations.
h/t Emergiblog
And Dr. Anonymous has a nice post about World AIDS Day, citing this letter from a survivor:
(This is an excerpt from a letter to the editor from the Cleveland Plain Dealer from November 30, 2008):
I am a 20-year survivor living with AIDS, and another World AIDS Day (Monday) is fast approaching. Food trays once left at hospital room doors of those dying from AIDS are now being served. The preventative measure of “gown ing-up” has come and gone. However, the stigma of AIDS has stayed unchanged. Sadly, there are conflicting AIDS transmission fears and infection rates spiraling out of control.
I am blessed in that I am still here, with thinning hair, bifocals and my AARP card in hand. I am living proof of the incredible medical strides made in managing HIV/AIDS. I am blessed in living to see nieces and nephews come into my world and bring forth great-nieces and great-nephews. I am blessed in that I continue to continue. I still grieve for the many friends I’ve lost to AIDS.
This year, another 56,000-plus Americans will become needlessly infected with HIV/AIDS. We know how to prevent HIV infection. We need to wage a War on AIDS in America. We know how to win it.
Robert W. Toth — Cleveland, OH
