Thursday, January 31, 2008

Family Meal Benefits

According to a recent study, teenage girls who eat meals with their families may develop healthier eating habits and avoid eating disorders like bulimia.

This is another excellent reason to share quality family time around the table.

The researchers found teenage girls who ate five or more family meals per week were less likely to resort to extreme dieting measures like using diet pills or laxatives, binge eating, and vomiting to control their weight.

The study was published in the January issue of Archives of Pediatric & Adolescent Medicine and surveyed 2,516 adolescents in 1999 and again in 2004.

Some examples from the survey found 26% of girls who ate family meals fewer than five times a week reported using self-induced vomiting and use of laxatives, diet pills, or diuretics to control their weight compared with 17% of those who ate five or more family meals per week.

The same results did not correlate with boys and may have been related to the possibility that adolescent boys and girls have different experiences at family meals where girls may have more involvement in food preparation and other food-related tasks, playing a protective role.

Another possibility is that girls may be more sensitive to and likely to be influenced by interpersonal and familial relationships than are adolescent boys.

Whatever the reason, family meals are good for everyone to strengthen relationships.

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Wednesday, January 30, 2008

Survey from the Courier

In this recent article in the Courier What do you want? Health care, security they reported the following:

“Given a list of 15 benefits and characteristics that may be important in choosing a job:
84 percent of Americans ranked health insurance at the very top”

They went on to say:

“Pay ranked 10th with 65 percent, trailing such matters as getting quick decisions on issues (69 percent); working with talented managers (68 percent); having the potential for promotions (66 percent); and being creative and intellectually stimulated (66 percent).”

I wonder how many of them surveyed would be willing to actually take a cut in pay in order to have better and more security in their health insurance.

It is easy to want all these things, but someone has to foot the bill.

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Tuesday, January 29, 2008

Strep Infections

Even though many of us take for granted how good healthcare is compared to the pre-antibiotic years, this report out of London places things back in perspective.

Two mothers died from an identical infection after giving birth at the same hospital on the same day in the London area and an investigation is underway.

Teachers Amy Kimmance, 39, and Jasmine Pickett, 29, gave birth to a girl and a boy respectively at the Royal Hampshire County Hospital, Winchester, just before Christmas and within days of being released they both died from complications relating to the group A streptococcal infection.

This is the common strep bacteria that causes strep throat.

According to the hospital, initial findings suggested Kimmance developed fatal toxic shock syndrome brought about by the infection before dying on Christmas Eve.

Similar findings showed Pickett died from a sudden onset of severe pneumonia almost certainly caused by the infection. She died on Dec. 23.

Both babies survived and are in good health.

There is an investigation into the deaths and to determine if staff were infected and gauge whether they had a part to play in the tragedy.

The maternity unit remained open.

A statement by a hospital spokesman said "The clinical facts so far suggest that these are two, separate, tragic incidents and are not directly related to the clinical care received at the hospital"

I think it is probably premature to make this statement.

We thankfully live in an age where deaths during or after childbirth are very rare and death from this common infection seldom occcurs.

Medicine isn't perfect, but we've come a long way!

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Monday, January 28, 2008

Prime Time TV



For all the prime time watchers of these medical shows, this survey from Medical Economics shows that Grey's Anatomy is the most annoying.
I am not sure if it is more annoying because it tries to be serious and fails, or whether it is the actors, acting, or general story line.
I personally find House the be the most enjoyable to watch and scrubs to be the most humorous in a satiric sort of way.

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Friday, January 25, 2008

The Joys of Manhood



Men Are Just Happier People-- What do you expect from such simple creatures?
Your last name stays put.
The garage is all yours.
Wedding plans take care of themselves.
Chocolate is just another snack.
You can be President.
You can never be pregnant.
You can wear a white T-shirt to a water park.
You can wear NO shirt to a water park.
Car mechanics tell you the truth.
The world is your urinal.
You never have to drive to another gas station restroom because this one is just too icky.
You don't have to stop and think of which way to turn a nut on a bolt.
Same work, more pay.
Wrinkles add character.
Wedding dress $5000. Tux rental-$100.
People never stare at your chest when you're talking to them.
New shoes don't cut, blister, or mangle your feet.
One mood all the time. Phone conversations are over in 30 seconds flat.
You know stuff about tanks.
A five-day vacation requires only one suitcase.
You can open all your own jars.
You get extra credit for the slightest act of thoughtfulness.
If someone forgets to invite you, he or she can still be your friend. Your underwear is $8.95 for a three-pack.
Three pairs of shoes are more than enough.
You almost never have strap problems in public.
You are unable to see wrinkles in your clothes.
Everything on your face stays its original color.
The same hairstyle lasts for years, maybe decades.
You only have to shave your face and neck. You can play with toys all your life.
One wallet and one pair of shoes -- one color for all seasons.
You can wear shorts no matter how your legs look.
You can "do" your nails with a pocket knife.
You have freedom of choice concerning growing a mustache.

You can do Christmas shopping for 25 relatives on December 24 in 25 minutes.

No wonder men are happier!!

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Thursday, January 24, 2008

Who should pay

Who is responsible for health care costs is an ongoing debate and a recent lawsuit is challenging this from another angle.

In this particular suit, the plaintiffs claim that if a drug is deemed medically necessary for a patient, the government should pay for it, even if it falls outside the parameters of off-label uses that it will cover.

This lawsuit is being filed in federal district court by the Medicare Rights Center, a patient advocate, on behalf of Judith M. Layzer, an elderly widow who has been taking Cetrotide since 1999 to treat her ovarian cancer.

The drug is not FDA approved or indicated for this treatment.

According to the complaint, Layzer had never paid more than $40 a month out of her own pocket for the medication, but soon after enrolling in Medicare Part D in January 2006, she was denied coverage for her prescription and her monthly tab shot up to over $7,200.

What is interesting in this case is that in 2006, Layzer's former employer was the City of New York.

They moved all of its retiree members to the City of New York enhanced Medicare Part D Program, which is administered by GHI, and is the same company that used to cover her medications as a retiree.

The suit seeks reimbursement of Layzer's out-of-pocket costs, which have totaled more than $100,000.

What the patient’s net worth, income, benefits etc. were not disclosed.

Who should pay??

The legal answer will be watched closely

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Wednesday, January 23, 2008

California's new requirement

California Governor Schwarzenegger and the Democrats say California residents should be required to have healthcare coverage.

But the two parties cannot seem to agree on how to pay for it.

The Democrats presented a revised bill on Nov. 8 that would lower the percentage of payroll that employers would have to give to help pay for the plan, from 7.5 percent to a range of 2 to 6.5 percent.

Gov. Schwarzenegger's proposal, on the other hand, varies from 0 to 4 percent of payroll.

Since neither of these are enough to cover the expenses, both parties' plans call for a tax on hospitals equivalent to 4 percent of patient revenues, subject to voter approval.

The Democrats also want to hike the tobacco tax by $2 per pack.

This proposal raises many questions and concerns.

  1. Should Government mandate individuals to have healthcare?


  2. Should employers be the one’s required to pay the significant part of this?


  3. What penalty is there for individuals who refuse to get insurance and who pays for them?


  4. Why should the hospitals be taxed and singled out?


  5. What happened to individual responsibility?

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Tuesday, January 22, 2008

Housing Market Blues



This recent newsletter is concerning if the statistics are true and Indiana really is 6th in the nation for home foreclosures.

Are we doing something different here than others are doing elsewhere?

Is our economy a lot different?

Are we just living beyond our means?

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Monday, January 21, 2008

New Board Members


The County Commissioners met recently and have appointed new members to the Board of Trustees for Floyd Memorial Hospital.

There were four positions up for reappointment. Two were the added positions that increased the number of Board members from seven to nine last year. These positions were held by Jerrol Miles and Guy Wall. They were both reappointed to their positions.

The two other board members that had been serving for the past 4 years were Mame Garner and David Atkins. Neither of these individuals was reappointed to a second term.

They were replaced with Mark McCormick and Bill Smith.

These two individuals add a finance background and a legal background to the current board makeup.

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Friday, January 18, 2008

Keep those parts inside the vehicle


Hormones may have cost an Australian man his arm after he waved out a car window at two young women.

His arm was severed by another passing vehicle and he was expected to lose it according to hospital officials.

The 20-year-old was reportedly a passenger in a pick-up truck when he waved at two women in a car wash.

But as he put his arm out the driver made a right hand turn and the man's limb was struck and almost torn off by an oncoming vehicle.

If this occurred here in the states, I’d bet we would have a lawsuit against the driver of the truck, the passing vehicle, or possibly even the attractive women that caused him to stick his body part outside the moving auto.

It surely wouldn’t have been the individuals fault!

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Thursday, January 17, 2008

New Expense Data

According to a recent survey in Medical Economics, the cost of running a medical practice keeps going up.

Physician expenses also vary according to specialty with pediatricians making less than most other physicians but having higher overhead than most primary care doctors. Their expenses came in second only to ob/gyns'.

Medical supplies and immunizations account for many of these expenses. Some insurance companies do not even cover the cost of immunizations, let alone the cost of giving the shots.

Pediatricians' median drug supply costs were a whopping $82,800 in 2006.

Other factors also contribute to practice expenses as seen in the accompanying charts.


Finding the balance between number of patients seen, hours worked, number of doctors and providers in the group is an ongoing strategy made more difficult by reimbursement factors outside of physician’s control

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Wednesday, January 16, 2008

Choosing no treatment

A friend asked me how we balance our belief and faith against our understanding of the advances of modern medicine in a situation like the one described in this article involving a 14 year old boy who refused life saving treatment because of his religious belief.
Devout boy dies after refusing transfusion - Health care- msnbc.com

I do believe every patient has the right to decline medical treatment or interventions that may or may not save their life.

I, on the other hand, do not believe patients have the right to actively take treatments they know will terminate their life specifically for that purpose.

I think there is a big difference between letting the natural consequences of an illness take its course compared to actively expediting a death by artificial means.

This case is interesting in the fact the parents did not have custody. There must be more to the underlying story as it is unusual for neither parent to have custody of a sick child. An aunt having custody would typically mean the parents had some issues of their own and their challenge in this case would probably have been futile.

Weighing the beliefs of patients with current advances in medicine is a daunting challenge but is specifically why religious beliefs need to be part of an overall history when talking with patients and families.

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Tuesday, January 15, 2008

Think twice at your next visit in a hotel

I have seen patients recently who believe they have become infected from staying in a hotel while traveling or vacationing.

Is this possible?

The recent patient I saw was diagnosed with a mite infestation and bites that I believe were a type of bedbug. This very likely was acquired in a hotel.

At this link MyFox Colorado Fox Files: Dirty Hotel Secrets you can get a much better idea of why you may become ill after staying in a hotel.

The take home message from this video is not to drink from glassware left in the rooms of the hotel. Disposable cups may not be as fancy, but they certainly are more sanitary.

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Monday, January 14, 2008

Diversity improved in this years Class

A little more information on the diversity of this year’s Medical School class.

The number of black and Hispanic males applying to US medical schools increased more than 9 percent in 2007. This data comes from the Association of American Medical Colleges.

Among black men, the enrollment rate increased this fall by 5.3 percent, which was more than twice the rate of first-year entrants overall.

More than 42,300 people applied to enter medical school in 2007 representing an 8.2 percent increase over 2006.

These stats bode well for stemming the serious physician shortage the US and it certainly helps with the diversity issue to help manage minority patients.

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Friday, January 11, 2008

Christmas Humor






Like many of you, I received numerous cards over the holidays. Some were serious and others were funny.

This particular card was one of my favorites in the "funny" category.

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Thursday, January 10, 2008

Medicare encouraging EMR's

Medicare is making announcements to entice physicians to go electronic in order to receive more in reimbursements.

Beginning in the spring of 2008, CMS plans to recruit physicians for a demonstration program that, by the end of 2009, will begin paying them bonuses for using EHRs to improve the quality of care for Medicare beneficiaries.

If this is like any other CMS program, it will be time consuming, paper intensive, and overall not worth the pittance in what they may pay as a “bonus”

The five-year pilot project will involve up to 1,200 small and medium-sized practices—mostly primary care—in 12 markets that have yet to be chosen.

During the first two years of the project, physicians will receive bonuses (the size is still undetermined) for acquiring and using the EHRs in quality improvement.

In year’s three to five, they'll have to meet specific quality goals to continue receiving extra payments. These really are not extra payments. CMS plans to cut reimbursement and then use the money they save from the cuts to pay a bonus to those physicians who choose to jump through the hurdles of the CMS nightmare oversight.

To qualify for the program, practices must use EHRs certified by the Certification Commission for Healthcare Information Technology although that list is not yet available in its entirety.

CMS says it will pay its first bonuses after collecting a year's worth of data but none of us are holding our breath!

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Wednesday, January 09, 2008

Minimize your auditing chances

As we finish the year end and head towards tax season, many always worry about getting audited.

No letter from the IRS arrives without much trepidation and a little fear.

When reviewing your return, if you can try and keep your deductions close to the average for your tax bracket, it will help minimize your chances of being audited.


The chart shows some typical deduction amounts.

Although there is never a guarantee of not being audited, trying to not be two standard deviations outside the norm is always good advice.

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Tuesday, January 08, 2008

Laws on Hunting



I read this front page article in the Courier on Monday and just wondered what other bloggers thought about the article. Hunting preserves in foes' crosshairs

As most of you know, I am a deer hunter and enjoy that season a lot. This article brings up mixed emotions for many and I was just curious about how other hunters and non-hunters view these types of hunts.

Here is some basic information on Whitetail deer:

  • Mating: Polygamous
    Peak Breeding Activity: Early to mid-November; begins as early as mid-October and runs through mid-January
    Gestation: 187-222 days; average 200 days
    Young are Born: Mid-May through July; peak in late May through mid-June
    Litter Size: 1 in first year; 2 and sometimes 3 in later years
    Young Leave Parents: Weaned at 10-12 weeks
    Number of Litters per Year: 1
    Adult Weight: Males-130-300 pounds; females-90-210 pounds
    Adult Body Length: 52-95 inches
    Life Expectancy: Up to 15 years, but the average is 2 years for males and 3 years for females in the wild
    Migration Pattern: Year-round resident; home range is 1/2 -2 square miles
    Typical Foods: Include wild crabapple, corn, sumac leaves and stems, grasses, clover leaves, jewelweed leaves, acorns, and dogwood fruits and stems

As can be seen, the life expectancy in the wild is only a few years. Deer in captivity or in these hunting compounds actually have the potential to live a much easier life because of the food sources being readily available.

What are the reader’s thoughts?

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Monday, January 07, 2008

Medicare Bill Approved

Once again, Congress has averted the 10 percent Medicare pay cut to physicians and opted to approve a 0.5 percent increase through June 20, 2008.

This is only a temporary fix and another bill will have to be negotiated for the period after June 2008.

This particular bill that was approved does not include the requirement that Medicare physicians are required to adopt standardized health IT as a condition for receving full reimbursements as had been discussed in previous sessions.

The real problem is that Congress still fails to revamp the flawed payment system which continually threatens the healthcare of many individuals.

These band-aid approaches continually jeapordize the solvency of the entire program.

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Friday, January 04, 2008

Rocket Boosters


Here is some information sent by a friend that I thought was interesting and humorous.

The US standard railroad gauge (distance between the rails) is 4feet, 8.5 inches which is an exceedingly odd number.

Why was that gauge used?

Because that's the way they built them in England, and English expatriates built the US railroads.

Why did the English build them like that?

Because the first rail lines were built by the same people who built the pre-railroad tramways, and that's the gauge they used.

Why did 'they' use that gauge then?


Because the people who built the tramways used the same jigs and tools that they used for building wagons, which used that wheel spacing.

Why did the wagons have that particular odd wheel spacing?

Well, if they tried to use any other spacing, the wagon wheels would break on some of the old, long distance roads in England, because that's the spacing of the wheel ruts.

So who built those old rutted roads?

Imperial Rome built the first long distance roads in Europe (and England) for their legions. The roads have been used ever since.

And the ruts in the roads?

Roman war chariots formed the initial ruts, which everyone else had to match for fear of destroying their wagon wheels. Since the chariots were made for Imperial Rome, they were all alike in the matter of wheel spacing.

Therefore the United States standard railroad gauge of 4 feet, 8.5 inches is derived from the original specifications for an Imperial Roman war chariot. Bureaucracies live forever.

So the next time you are handed a Specification/Procedure/ Process and wonder 'What horse's ass came up with that?' . . . you may be exactly right. Imperial Roman army chariots were made just wide enough to accommodate the rear ends of two war horses. (Two horses' asses.)

Now, the twist to the story:

When you see a Space Shuttle sitting on its launch pad, there are two big booster rockets attached to the sides of the main fuel tank. These are solid rocket boosters, or SRBs. The SRBs are made by Thiokol at their factory at Utah.

The engineers who designed the SRBs would have preferred to make them a bit fatter, but the SRBs had to be shipped by train from the factory to the launch site. The railroad line from the factory happens to run through a tunnel in the mountains and the SRBs had to fit through that tunnel. The tunnel is slightly wider than the railroad track, and the railroad track, as you now know, is about as wide as two horses' behinds.

So, a major Space Shuttle design feature of what is arguably the world's most advanced transportation system was determined over two thousand years ago by the width of a horse's ass.

And you thought being a horse's ass wasn't important?

Ancient horses' asses control almost everything . . . and CURRENT Horses Asses are controlling everything else.

Now you know the rest of the story

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Thursday, January 03, 2008

Prenup Problems

Here is another problem with prenuptial agreements.

Individuals wishing to sign prenuptial agreements have come up against a hurdle when dealing with pension benefits.

It is not uncommon to see two people get engaged and many times it may be a second marriage. Sometimes, both people are high-earners and already have significant assets, so they agree to waive the right to each other's pensions in the event of a divorce.

Setting this up takes care of the problem of an early death and allows the pension benefits to go to the spouse's children, a charitable organization, or whomever else they named as a beneficiary.

But according to the Employee Retirement Income Security Act (better known as ERISA), only a spouse can waive these rights, not a nonspouse. Legally speaking, a fiancé is not a spouse until the marriage is completed and therefore a prenuptial agreement related to this is not valid.

The legal papers can be composed and filed after the wedding is over and meet the legal requirements.

Not going into marriage with the assumption it is anything other than a lifelong commitment also helps and would minimize these problems, but we’ll never have a zero percent divorce rate.

I would however like to see it harder to terminate a marriage in our current system.

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Wednesday, January 02, 2008

FRAUD AND ABUSE

The latest report from the government and posted in Medical Economics describe where the government will be focusing their attention.

The current thinking is based on the results of the latest annual review done by the HHS Office of Inspector General. They have given their staff of 1,500 their marching orders to further detect fraud and abuse, in the following areas:

Coding. The government's fraud busters are going to look at claims for services performed in ambulatory surgical centers (ASCs) and hospital outpatient departments, since Medicare pays different rates depending on where the work is done. Higher amounts are paid for services provided in "non-facility" settings such as a doctor's office, so HHS will be looking to see that physicians are properly coding the place of service.

Medical necessity. In particular, HHS will focus on psychiatric services, to determine if they're reasonable and medically indicated. The same goes for payments for polysomnography—a type of diagnostic test for patients who have a suspected sleep disorder—and claims paid under Part B for services to nursing-home beneficiaries who live a significant distance from their physicians.

E&M services. Also under the microscope in 2008 will be the number of evaluation and management services provided as part of the global surgery fee. The permissible number of E&M services may have shifted since the global surgery fee concept came about in 1992, so HHS wants to reassess things.

"Incident to" services. This area has been in the Feds' crosshairs before. Again, the government wants to review physician claims for the "incident to" services of allied health professionals—NPs, PAs, and others—to make sure they're appropriate and of sufficient quality.


This is just more to look forward to for 2008!

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