Monday, March 31, 2008

Benefits of Tea


Tea is one of the most widely consumed drinks in the world and there have been numerous studies looking at the relationship between tea consumption and vascular disease.

Recent evidence from a French study supports the benefit of tea drinking and reduced risk of vascular disease

This study looked at the plaque build up in the carotid artery and involved 6597 persons aged 65 years or older.

The results showed that increasing daily tea consumption was associated with a lower prevalence of carotid plaques in women and directly correlated with the amount. The association was independent of age, education, and other dietary factors as well as blood pressure, use of antihypertensive medications, low-density lipoprotein cholesterol level, high-density lipoprotein cholesterol level, and use of lipid-lowering therapy.

Men did not show the same reduction and it is not clear as to why. Other studies also have shown benefits in women but not men.

The bottom line is there is growing evidence that tea consumption is associated with a reduced risk of vascular disease and is especially true for older females.

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MRI in Breast Cancer

Newest data on breast screening for cancer shows that MRI screenings have a greater rate of breast cancer detection (sensitivity) but a slightly lower percentage for specificity.

The data is recently published in the journal Radiology.

The study was conducted at different centers and included 171 asymptomatic, potentially high-risk women.

Each participant carried BRCA1 or BRCA2 genes or had a 20% or more chance of carrying mutations and they were screened with all three methods at no more than 90 days intervals.

Six cancers were detected on MRI screenings, two by mammography, and one by ultrasound.

In the general scheme of things, this is a small study and more research is needed.

The problem in everyday practice is that insurance companies balk at authorizing an MRI of the breast until you jump through the hoops and do the funky chicken dance to get it approved.

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Thursday, March 27, 2008

Medical Myths

There are many “old wives tales” and medical myths that are continually circulated by both individuals and physicians and many of these have little to no basis in medical fact.

Some of these unproven or untrue tales are as follows:

• Eating turkey makes you drowsy:
This is based on the fact that tryptophan is a chemical produced by the body that helps induce sleep. Turkey contains no more of this chemical than other protein sources. It could be that people eat far more of everything on thanksgiving and stuff themselves before they pass out.

• Hair and fingernails continue to grow after death:
This is untrue. When you’re dead, you’re dead. What really happens is that during the decaying process, the skin retracts and hair and nails may jut out more making it appear like they are longer.

• Reading in dim light ruins your eyesight:
You will have to strain more to focus on the object, but there is no evidence to support the thought it is damaging. This probably originated in the days when people read by candlelight.

• Shaving causes hair to grow back faster or thicker:
This is false. Shaving has no effect on the part of the hair shaft below the skin surface where growth and pigmentation occur. Although the hair may seem to grow faster after shaving, this is just an illusion. A small amount of growth on a clean-shaven face is much more noticeable than a small amount of growth on a bearded face and the blunt, stubbly ends of new growth can give the illusion of darker, coarser hair.

• People only use ten percent of their brain:
This has been repeated by numerous sources including some scientific magazines, but it is unsupported. Just as we only use certain muscles for certain activities, there are areas of the brain that may or may not be active at any one time. But try removing 90 percent of the brain and see how well you function. I’d even let you choose the areas to remove.

• Swimming right after eating will cause cramping and drowning:
This is another unfounded report based on the evidence. Swimming routinely uses muscles some people may not be accustomed to using which increases cramping but there is no evidence that it has or does lead to drowning risk. The thought about eating and cramping comes from the fact that when you eat and for a while after, blood is preferentially shunted to the digestive tract to assist in digestion which theoretically may cause less blood from reaching muscles and increasing risk of cramping. But this is only theoretical. The body compensates very well.

• Cell phones are dangerous in hospitals and airplanes:
There have been rigorous studies in both of these areas concerning the Radio Frequency emitted by the devices and there may in fact be a small risk in hospitals with interference of some medical equipment, but only at very short distances. And in a recent study conducted in 2003 by Carnegie Mellon University the results did appear to back the concerns expressed to the FCC. Researchers that RF activity from cell phones and other devices may be higher than previously thought on airplanes and these devices can disrupt normal operation of key cockpit instruments, especially Global Positioning System receivers., which are increasingly vital for safe landings,” said Bill Strauss, one of the study’s researchers

• People should drink 64 oz of water a day:

The number originally came from the National Academy of Sciences of the United States Food and Nutrition Board, which publishes recommended daily allowances of nutrients. The 1945 edition of the Food and Nutrition Board said "A suitable allowance of water for adults is 2.5 liters (about 8 cups) daily in most instances." This amount is based on the calculation of one milliliter of water for each calorie of food. There is water equivalent in the food you eat which counts toward this amount. There are still many studies and research that does support drinking more water. Opflow Question of the Month - Opflow - Publications - AWWA


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Wednesday, March 26, 2008

Pfizer loses another drug






Pfizer will be taking another financial hit soon.

The company has decided to discontinue the manufacturing and distribution of Exubera, an inhaled-insulin product.

They reportedly state it is because it has failed to gain acceptance among patients and physicians.

Pfizer originally thought this product would be much better accepted and help eliminate insulin injections but they evidently miscalculated patients dislike for shots.

It surely couldn’t have been the cost, poor formulary coverage, hassles to physician offices when trying to order it or the very inconvenient device itself as shown in this picture.


Patients currently receiving this product will need to transition to another medication to control their diabetes.

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Tuesday, March 25, 2008

Blood Pressure and Old man Winter

As with emotional and psychological problems that appear to have some seasonal variation, there is new data suggesting the cholesterol and hypertension also may fluctuate with the seasons.

In a recent five-year analysis of electronic records at 15 VA hospitals, the results revealed that antihypertensive medications are significantly less likely to restore normal BP in the winter than in the summer.

This effect was observed even in both cold and warm regions

The results showed that blood pressure systematically worsens in the winter and improves in the summer.

Every city in the study reflected a significant variation in return to normal BP in winter compared with summer.

The reasoning behind the variation is still unanswered, but some of the researchers believe the reason may be that people tend to exercise less and gain weight in winter.

Patients and physicians may need to be a little more aggressive and check blood pressures more frequently in the winter months to attain better and more consistent control

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Monday, March 24, 2008

Exercise and Chronic Pain

In a recent study presented at the American Academy of Pain Medicine 24th Annual Meeting physical exercise in chronic pain patients can have immediate and long-term benefits.

This really should come as no surprise but it seems we always need another study to reassure us of common sense.

A frequent co-morbid condition of chronic pain is being out-of-shape or if you prefer the medical term; physical deconditioning.

People with chronic pain don't want to exercise.


Decreases in pain, depression, and anxiety following treatment in a pain rehabilitation program have been well documented, but to date, no study has determined the immediate effects of brief exercise on these factors.


This study looked at the effect of a 3-week aerobic training program on physical conditioning and to assess the acute effects of a brief, 10-minute exercise protocol on pain, mood, and perceived exertion.


The final sample of 28 patients was lowered from 54 due to factors such as lack of motivation to exercise and fear of exercise.


All 28 who participated had an immediate perception change about exercise upon starting the program.


Measures of heart rate, mood, pain, and perceived exertion were obtained and on average, patients received 5 hours of conditioning per week, in addition to routine daily activities.


Patients showed a statistically significant reduction in exercise-induced heart rate increases from admission to 3 weeks into the study.


The brief exercise protocol also produced significant immediate antidepressant and anxiolytic effects.


So the bottom line was that the study suggests that relatively modest exercise leads to improved mood and physical capacity and also suggests that brief exercise is a safe, cost-free, nonpharmacologic strategy for immediately reducing depression and anxiety.


Thank God for those natural endorphins.


So what about the other 26 patients who lacked motivation or were fearful about exercise?

Can you say “couch potato”?

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Friday, March 21, 2008

Rude Straws

Wal-Mart is being targeted again. This time it is from a concerned mother who believes the $1.69 bag of fun straws she bought for her 3 year old daughter has some straws shaped like a male sex organ.

The mother reportedly said “There are two of them that are shaped like the male private area.”
But what really upset her was when she contacted Wal-Mart, she believed they were rude and treated her like she was lying or making it up.

Wal-Mart’s response was as follows:

"At Wal-Mart we take customer questions and concerns seriously. After being contacted on this matter, Wal-Mart pulled the product in question from our shelves and is investigating the claim. Of course, our customer is welcome to return the item for a refund, if they would like."
The straws in question are manufactured by Eagle Marks Corporation.

When a reporter searched three local stores, no fun straws could be found on any shelves.

So based on the above picture, are the straws a problem or is someone being oversensitive?

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Thursday, March 20, 2008

Inexcusable

As we have mentioned before, there are some things in Medicine that are just unacceptable and a Rhode Island hospital would be the poster child for this.

In November, the State Health department fined the hospital for operating on the wrong side of the brain in 3 separate individuals.

Two of these patients did fine, but the third died a few weeks later.

It is of note that all three cases involved 3 different physicians.

The Hospital stated it has implemented “corrective action”

I agree with others that there is no excuse for this and many checks and balances would have had to have failed for this to occur, but the physician is ultimately responsible and he/she should be!!

R.I. hospital fined for 3rd wrong-side brain surgery this year

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Wednesday, March 19, 2008

AMA joining as Plaintiffs

One of the economic credentialing cases in the US is taking place in Little Rock, Ark. I blogged about this issue several months ago this case is currently underway. NA Health: September 2007

The AMA and the Arkansas Medical Society have intervened as additional plaintiffs in the lawsuit and will be providing financial assistance to the cardiologists as well as other services in an effort to win this important case.

As you may or may not recall, this case challenges the economic credentialing policy of Baptist Health, the largest hospital system in Arkansas.

The current policy prevents physicians who have an interest in a specialty hospital which Baptist claims is a competitor from having privileges at Baptist. In Little Rock Cardiology Clinic v. Baptist Health. The cardiologist, AMA and the medical society argue that Baptist’s policy is overbroad and unnecessarily interferes with the physician-patient relationship by preventing patients from receiving care from their cardiologists.

AMA policy states that credentialing decisions should be made based on a physician’s qualifications and competencies, not on economic considerations unrelated to patient care.

The trial is expected to last through next week and we will await the final decision of the courts because it will have broad ramifications.

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Tuesday, March 18, 2008

AMA applauds new Senate bill to stop Medicare physician cuts

In a recent news release, there is effort to eliminate the proposed payment cuts from Medicare. As most know, these cuts have been proposed for the past 2 plus years and each time have been halted with a “band-aid” approach. It is time that a real and fair legislative act is executed.

The AMA welcomed a new bill introduced by U.S. Sen. Debbie Stabenow, D-Mich., this week that would replace 18 months of Medicare payment cuts to physicians with payment updates that better reflect medical practice cost increases.


In three short months, Medicare will cut physician payments by 10.6 percent. Right now, 60 percent of physicians say the cut will force them to limit the number of new Medicare patients they can treat. The 18-month timeframe in the Save Medicare Act of 2008 (S. 2785) will inject some stability into the system for seniors as well as physicians forced to make difficult practice decisions because of planned payment cuts. It will also give Congress time to begin working on a long-term solution to the broken payment system without having to take action to stop the cuts twice in one year.

Earlier this week, the Medicare Payment Advisory Commission made a recommendation to lawmakers to replace physician payment cuts with updates that reflect medical practice cost increases.

“Senator Stabenow’s bill is an important step toward implementing this recommendation, and we urge Congress to act before the cut begins this July and seniors’ access to care is negatively affected,” said AMA President-elect Nancy H. Nielsen, MD, Ph.D.

Next month, you can address this issue face to face with members of Congress at the AMA National Advocacy Conference, April 1–2. As part of the conference, members of the AMA and AMA Alliance will rally April 2 at Capitol Hill’s Upper Senate Park in support of the bill. Prior to the rally, attendees will hear from insiders about the political climate on Capitol Hill and get the latest on medicine’s legislative priorities.

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Monday, March 17, 2008

Easter Trivia


Easter is always the 1st Sunday after the 1st full moon after the Spring Equinox (which is March 20).

This dating of Easter is based on the lunar calendar that Hebrew people used to identify passover, which is why it moves around on our Roman calendar.

This year is the earliest Easter any of us will ever see the rest of our lives! And only the most elderly of our population have ever seen it this early (95 years old o r above!).

None of us have ever, or will ever, see it a day earlier!

Here's the facts:
1) The next time Easter will be this early (March 23) will be the year 2228 (220 years from now). The last time it was this early was 1913 (so if you're 95 or older, you are the only ones that were around for that!).

2) The next time it will be a day earlier, March 22, will be in the year 2285 (277 years from now). The last time it was on March 22 was 1818. So, no one alive today has or will ever see it any earlier than this year!

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Friday, March 14, 2008

Extended Stay

There is nothing like some strange news out of Wichita Kansas.

Authorities there are considering charges in a bizarre case of a woman who sat on her boyfriend's toilet for two years. She had sat so long that her body was stuck to the seat by the time the boyfriend finally called police.

Her boyfriend said she had a phobia about leaving the bathroom.

Her skin had apparently grown around the seat and the rescue workers pried the toilet seat off with a pry bar and then the hospital removed it.

The woman reportedly moved around in the bathroom during the 2 years, bathed and changed into the clothes her boyfriend brought her and she would eat and drink the food he brought. Their entire relationship evidently just took place in the bathroom and there was no mention of whether any intimate relations occurred.

Her boyfriend finally called police when she began acting groggy

Reportedly, EMS found her clothed and sitting on the toilet with her sweat pants down to mid-thigh. She was disoriented and had some muscle atrophy in her legs and she initially refused treatment.

She is being treated for an infection in her legs and some nerve damage

The prosecutor is debating on filing charges against the boyfriend. Some of his statements have been:

"She is an adult; she made her own decision"
"I should have gotten help for her sooner; I admit that. But after a while, you kind of get used to it."

"It just kind of happened one day; she went in and had been in there a little while, the next time it was a little longer. Then she got it in her head she was going to stay - like it was a safe place for her"

When asked how long she had been in there, he replied "time just went by so quick I can't pinpoint how long."

He insisted that he tried to coax her out of the bathroom every day but said that the beatings she received in her childhood caused her phobia. He said her reply was always “Maybe tomorrow”

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Thursday, March 13, 2008

More on EHR's

As a follow-up to the EMR/EHR (Electronic Medical Record/Electronic Health Record) post, there may be a trend starting from some malpractice carriers where they are beginning to lower premiums for doctors who use EHRs.

MHA Insurance in Lansing, MI, will discount premiums by 5 percent the first year and 2.5 percent afterwards for practices that have an EHR certified by the Certification Commission for Healthcare Information Technology.

As with anything, there are strings attached. The system needs to have been up and running for at least one year, and at least 75 percent of the doctors in a practice must use it.

MHA views EHRs as a patient safety issue but in actuality, it is probably the better documentation that is easier to defend against malpractice claims. It certainly improves the legibility problem that has plagued physicians since the beginning of time.

There is controversy, though, and many insurance carriers aren’t sufficiently convinced that EHRs translate into fewer malpractice suits. Some even believe that the technology can increase a doctor’s liability by too much documentation.

Why is it never easy??

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Wednesday, March 12, 2008

Do EMR/EHR's really help?

Contrary to conventional wisdom, EHRs could reduce the quality of care and increase costs, says a pioneer in healthcare information technology.

Donald Simborg is an internist who is credited with creating HL7; the computer protocol for sharing medical information.

In an article that will appear in the March/April edition of the Journal of the American Medical Informatics Association, he will be making an argument that EHR adoption may not be in our best interests.

Contrary to what many people believe, EHRs could reduce the quality of care and increase costs. They certainly do not save during a routine office visit. They do however make it easier to document more of what is actually done during the visit and that is its advantage.

Vendors promote the idea that their products will save them time and increase revenue through higher evaluation and management coding but this is somewhat problematic because higher E&M coding boosts overall healthcare costs.

Physicians have probably been undercoding for years because they were not able to document all that was necessary for the higher codes, but with EHR’s, you can create a 3-4 page office note with a relatively few clicks.

EHR’s typically default to provide maximum documentation in order to maximize coding. But if the system isn’t set up accurately, the documentation produced may record things that never really happened.

Dr. Simborg co-chaired a blue-ribbon IT committee that recommended to the U.S. Department of Health and Human Services that it build sufficient anti-fraud mechanisms into the national health-data network envisioned by the Bush administration.

This sounds like more government red-tape and how is this expense going to play into the overall healthcare dollars?

The doctors in my office would love to go back to pen and paper, cash at time of visit, no billing of insurance and minimal threat of malpractice, but that isn’t reality.

So we have invested more than $100,000 dollars into EHR’s and billing programs to try and stay ahead of the curve.

I agree that it has not really helped with patient care but has helped satisfy all the regulatory issues that government and the legal systems have created.

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Tuesday, March 11, 2008

The new trend in Hospitalists

There is a growing trend for Hospitalists. These are physicians who only take care of hospitalized patients. They have no outpatient practice and they provide no follow-up care.

Recent statistics show there are now about 20,000 hospitalists. This is four times as many as there were in 2002 and nearly half of all US hospitals have them.

If there weren’t a shortage of qualified individuals, these programs would be even more prevalent but the demand is well ahead of the supply.

Most hospitalists work in physician owned groups and others are actual employees of the hospital or teaching institution.

A few HMO’s actually employ their own hospitalists and they demand that patients who are members be cared for by the hospitalists even if their primary care physician has hospital privileges.

This, in my opinion, will not last long as patients typically want their own physicians. But as with all HMO’s, you get what you pay for.

Certainly hospitalists offer some advantages, but data on whether they actually save money is questionable and highly debatable.

The original thought was that if a physician is in the hospital all day, he can follow up on exams more expeditiously and discharge patients sooner ultimately saving money.

But the problem arises because every patient is a new patient to the hospitalist and minor problems that a primary care physician may know and have worked up previously is usually investigated much more aggressively adding to cost and length of stays.

It is not uncommon for a hospitalist to consult multiple other specialists in caring for patients again adding to the overall cost of healthcare.

This part of the equation is partly a defensive strategy fearing medical-legal problems for missing even a minor problem and not officially addressing it.

However you feel about hospitalists, they're not likely to go away.

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Monday, March 10, 2008

Recent Legislation

From the ISMA, there are two recent bills at the Statehouse concerning insurance issues. The first one unfortunately was allowed to die because of the intense opposition.

It would have been a very good bill for patient’s choice of physicians and also for payment to physicians.

Insurance
BILL: HB 1055 - Assignment of Benefits
AUTHOR: Rep. Charlie Brown, D-Gary
SPONSOR: Sen. Beverly Gard, R-Greenfield
ISMA POSITION: Support

THIS WEEK: No action.

The bill would have required insurers to honor a patient's request for assignment of benefits to an out-of-network provider. Due to intense opposition to the bill from the insurance industry, the business community and the AFL-CIO, as well as concerns expressed by the Daniels administration, Senate Republicans elected to let the bill die.

The ISMA Government Relations staff would like to thank all ISMA members who called or e-mailed state legislators on HB 1055. We will continue to educate the General Assembly on the issue this summer and debunk false claims by opponents that assignment to out-of-network providers would prompt the disintegration of provider networks and drastically increase health care costs.

The second bill is scheduled to be evaluated soon. It also would help physicians with the sneaky contract language that insurers place inside contracts and is detrimental.

BILL: SB 159 – Silent PPOs
AUTHOR: Sen. Beverly Gard, R-Greenfield
SPONSOR: Rep. Phil Hoy D-Evansville
ISMA POSITION: Support
THIS WEEK: The full Senate concurred on the bill.

SB 159 would require conspicuous language in a physician contract if a network wishes to sell a physician's discounted reimbursement rate to third parties. The network also would be required to maintain a Web site or toll-free phone number listing all networks to whom the contracting network has sold the discount.

In addition, the bill would require third parties who purchase the discount to include contact information on explanation of benefits statements for the network who sold the discount.

Finally, the bill would prohibit aggregators from selling or leasing physician reimbursement rates. SB 159 now awaits the governor's signature.

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Friday, March 07, 2008

The Question

THE SITUATION:

You are in Florida, Miami to be specific. There is chaos all around you caused by a hurricane with severe flooding. This is a flood of biblical proportions. You are a photojournalist working for a major newspaper, and you're caught in the middle of this epic disaster. The situation is nearly hopeless. You're trying to shoot career-making photos.

There are houses and people swirling around you, some disappearing under the water. Nature is unleashing all of its destructive furor.

NOW THE TEST:

Suddenly you see a woman in the water. She is fighting for her life, trying not to be taken down with the debris. You move closer. Somehow the woman looks familiar. You suddenly realize who it is. It's Hillary Clinton! At the same time you notice that the raging waters are about to take her under forever.

You have two options:

You can save the life of Hillary Clinton or you can shoot a dramatic Pulitzer Prize winning photo, documenting the death of one of the world's most powerful and brilliant (questionable) women.

THE QUESTION:

Here's the question, and please give an honest answer....


Would you select high contrast color film, or would you go with the classic simplicity of black and white?

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Thursday, March 06, 2008

So what is a Study?

We cite the results of numerous studies on a variety of health topics but not everyone understands what trials entail.

Clinical trials are research studies in which people help doctors find ways to improve health and cancer care.

Each study is designed to answer scientific questions and/or to find better ways to prevent, diagnose, or treat a disease or illness.

A clinical trial is one of the final stages of a long and careful research process. In cancer patients, studies are done to find out whether promising approaches to cancer prevention, diagnosis, and treatment are safe and effective.

There are a variety of different types of trials.

Treatment trials test new treatments

Prevention trials test new approaches, such as medicines, vitamins, minerals, or other supplements that doctors believe may lower the risk of a certain type of cancer.

Screening trials test the best way to find and diagnose a disease in its early stages

Quality of Life trials (also called Supportive Care trials) explore ways to improve comfort and quality of life for patients.

When studying drugs, there are typical phases that the research must go through before it can be submitted for FDA approval.

Phase I trials: These first studies in people evaluate how a new drug should be given (by mouth, injected into the blood, or injected into the muscle), how often, and what dose is safe. A phase I trial usually enrolls only a small number of patients, sometimes as few as a dozen.

Phase II trials: A phase II trial continues to test the safety of the drug, and begins to evaluate how well the new drug works. Phase II studies usually focus on a particular type of disease.

Phase III trials: These studies in patients test a new drug, a new combination of drugs, or a new surgical procedure in comparison to the current standard. A participant will usually be assigned to the standard group or the new group at random. Phase III trials often enroll large numbers of people and may be conducted at many doctors' offices, clinics, and cancer centers nationwide.

Double blinded studies mean that neither the patient nor the physician knows which treatment or drug the patient is receiving.

Valid studies use statistics to determine the confidence levels and any and all biases should be eliminated if possible.

There is no perfect study and it is rare that you find a published study that does not support the premise on which it was based.

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Wednesday, March 05, 2008

C-sections in the US

Do we perform too many C-sections in the United States? According to a recent article in Newsweek Magazine, you would be led to believe so. Birth, The American Way Newsweek Culture Newsweek.com

According to the article and supported by a recent study published in October's British Medical Journal, of 97,000 deliveries in 410 Latin American hospitals, it was found the risk of death for mothers who had Caesareans, while slight (.01 percent of the women who delivered vaginally died vs. .04 percent who had elective C-sections), was triple that of those who delivered vaginally.

There are several notable concerns with this study including the hospitals themselves compared with hospitals in the US and the health of the mothers who had C-sections in this study.

Everyone agrees that C-sections can and do save lives when medically indicated but when it is medically indicated seems to be controversial.

The article makes it sound at times that hospitals do more C-sections because it is more lucrative, but those who make statements such as these really do not understand the relationship of hospitals and physicians.

Physicians make the decision on when and if to do a C-section and the hospital has no part in that decision process and certainly no way of encouraging physicians to do more just because of finances.

I would admit some patients push their physicians for the procedure out of convenience and there is evidence that the drugs we use during labor may actually contribute to higher C-section rates, but doing them solely for the financial benefit of hospitals is pretty far reaching.

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Tuesday, March 04, 2008

Medicare Private Fee for Service

A group of individuals recently testified before the influential Senate Finance Committee and told the federal lawmakers that Medicare’s private fee-for-service plans, or PFFS, severely undercut their ability to deliver quality, cost-effective care.

They also reported that many providers are closing their doors to patients enrolled in such plans and stated that the Everett Clinic in Snohomish County, Washington that its network of physicians loses about $7.5 million a year because of its large base of Medicare patients.

The PFFS plans were the fastest growing and they informed 1,400 patients that starting in 2009 they would not accept the PFFS plans.

Even though PFFS plans get more federal dollars than traditional Medicare, the extra funding doesn't benefit providers.

The Medicare Payment Advisory Commission said that Medicare spends 17% more on PFFS plans than it does on regular Medicare and unlike Medicare Advantage HMOs and PPOs, the private fee-for-service plans do not share cost of care and quality information with providers.

So where is the money going??

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Monday, March 03, 2008

Where's the Justice

Once again, UnitedHealth Group faces more fines for alleged claims violations.

This time it is in California and the fine is reported to be up to $1.33 billion.

The fine stems from more than 130,000 alleged claims violations related to PacifiCare, which UnitedHealth acquired in late 2005.

The California Department of Insurance launched a joint investigation into the insurer in 2007 after receiving hundreds of consumer and provider complaints about claims payment problems.

They allegedly denied covered claims, provided incorrect payments, lost documents including medical records, failed to acknowledge receipt of claims in a timely manner, and failed to resolve provider disputes.

This is no surprise to any primary care physician that has dealt with United and one of the primary reasons we dropped them.

An audit of PacifiCare directed by the state already has resulted in $765,157 in claims and recoveries for patients and providers.

So with a fine of this magnitude, who do you think really pays for it?

I’ll bet the stockholders do not have to write checks to cover this cost.

Employers, patients, doctors and other healthcare providers will pay for this by reduced payments and benefits.

Where’s the justice??

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