Prayers for Boston

Two things have finally pushed me to start blogging again.  The first is the terror in Boston and my prayers go to the victims.  The second issue is the failure of even the most watered down gun control measure to pass the senate.

Boston: Thanks to the tireless work of the police, ATF and FBI those responsible have been found.  But beyond the tragedy of those who lost their lives or a limb, I think of the chronic pain, rehabilitation and PTSD that will follow for those who survive with limbs intact.  I have seen minor trauma cause long term chronic pain and the long term need for pain meds, gabapentin, counseling, depression meds and terrible frustration.  I can only guess how the long term affects of this will reverberate through Boston.  Clearly our hearts are with Boston and the medical care is some of the best in the country - so God bless.

Gun Control: There is not much to say except that I hope we throw every single senator that voted against this out of office.  Including the democrats.  This is lunacy.  I will chip in dollars to Bloomberg and Gifford but I think it is important for those of us who care to find out the names of every senator and support their opponents.   more to follow on these subjects

Direct Primary Care

Direct Primary Care - Concierge Medicine - Retainer Medicine - Membership Medicine - you can call it a number of different things.  It can be high end or low end; in other words, you can take care of people who have LOTS of money and/or those who are uninsured.  The point is to create practice that satisfies both the patient and the physician and give great care.

http://www.npr.org/2012/05/30/154012196/direct-primary-care-a-new-option-for-the-uninsured

Call or Write Congress

There is a critical need to change the way we fund graduate (resident) medical education in this country - we need more primary care and fewer specialists. Not all hospitals or health systems are behind this - its not a money maker. Please see Hope Wittenberg's information below: Ask your representative to co-sponsor our GME pilot bill (H.R. 3667) Ask your representative to co-sponsor H.R. 3667 Take Action! Support family medicine's GME Pilot On December 14, Representative McMorris-Rodgers of Washington and Representative Thompson of California introduced the Primary Care Workforce Access Improvement Act of 2011 (H.R. 3667). The bill's introduction is the culmination of family medicine's efforts over the last three years to introduce reforms in the way Medicare funds graduate medical education. This bill is a budget-neutral way to test new models for the delivery of GME funding - the funding for the training of primary care physicians, particularly family physicians, will take a different path from traditional hospital GME payments. The pilot project introduced by this bill changes the stream of GME funding to make it directly available to medical education entities whose priority is training the primary care workforce. It provides a valuable opportunity to explore modern training techniques that could be useful for the production of the type of primary care physician needed now and for the future and allows for an increase in the number of primary care physicians. It is of critical importance that you contact your representative on behalf of your program or department and ask him or her to cosponsor this bill. Enter your zip code in the "call now" box above to receive talking points and information on who to contact, as well as links to FAQs and background information

Competition and Health Care Savings

Can someone point me in the direction of an article or any evidence (at all) that competition lowers health care cost? Where does this idea come from? Who shops around for the best price? Who clips coupons and scours the "ads" for a "cheap" doctor - no one. So why do the republican candidates keep talking about competition lowering the cost of health care. Here is my alternative for the "unfair" public mandate that has come out of the Afordable Care Act - lets just have medicare for all.

Know your FRAX risk; Docs -- USE the FRAX

On March 1 the USPSTF presented new guidelines on osteoporosis screening (1.). Yea, these were helpful. This guidelines states that women should look at a risk calculator called the the FRAX (Fracture Risk Assessment) tool (World Health Organization Collaborating Centre for Metabolic Bone Diseases, Sheffield, United Kingdom; www.shef.ac.uk/FRAX/) Women who are over 65 should get screening, we knew that. But women who are under 65 and have a risk equal to or greater than those that are 65 (based on other risk factors) should be screened.

In addition, a recent study from Canada confirmed that treatment based on 10-year risk of osteoporosis, ie., not treating women with low or intermediate risk did not result in higher rates of fractures. Yea for comparative effectiveness training.

So patients can take this FRAX test at home or be directed to take it while waiting for those physicals!





1. Screening for Osteoporosis: U.S. Preventive Services Task Force Recommendation Statement
U.S. Preventive Services Task Force, Ann Intern Med March 1, 2011 154:356-364
2. A Before-and-After Study of Fracture Risk Reporting and Osteoporosis Treatment Initiation, Leslie WD, et al Ann Intern Med November 2, 2010 153:580-586

Why medicare advantage plans will be cut - From Don McCanne

U.S. Department of Health & Human Services
Office of Inspector General
January 18, 2011
Rollup Review of Impact on Medicare Program for Investment Income That Medicare Advantage Organizations Earned and Retained From Medicare Funds in 2007

If Federal requirements had been established to delay prepayments to Medicare Advantage organizations (MA organizations) until after the beginning of the beneficiary's coverage period by the same number of days that we estimated that MA organizations held Medicare funds, the Medicare Part A and Part B trust funds (which finance the Medicare Advantage program) could have earned approximately $450 million of interest income in calendar year (CY) 2007. Alternatively, if Federal requirements had been established to require MA organizations to reduce their revenue requirements in their bid proposals to account for anticipated investment income, the Medicare program could have saved an estimated $376 million that the 457 MA organizations that were included in our sampling frame earned in CY 2007.

We recommended that CMS evaluate these audit results and either (1) pursue legislation to adjust the timing of Medicare's prepayments to MA organizations to account for the time that these organizations invest Medicare funds before paying providers for medical services or (2) develop and implement regulations that require MA organizations to reduce their revenue requirements in their bid proposals to account for anticipated investment income. CMS did not concur with our recommendation.

http://oig.hhs.gov/oas/reports/region7/71001080.asp


Comment: Simply stated, the private Medicare Advantage plans receive hundreds of millions of dollars by investing advance payments of taxpayer funds used to pay their health care claims. This is not unusual since all insurers work the float. The longer they can hold on to premiums before they pay out benefits, the greater the returns from investing those funds. It is so commonplace that the Centers for Medicare and Medicaid Services did not concur with the Inspector General's recommendation to pursue changes to recover that investment income.

The opportunity cost of interest-free cash advances to private insurers is yet one more cost of our flawed system of health care financing. It is a very real cost, amounting to hundreds of millions of dollars just for the private Medicare Advantage plans alone. This is just one more reason that we should establish our own public insurance program - an improved Medicare for all.

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the murder of a family physician

I know that abortion is a difficult and controversial subject. I know it gets people upset. But murder should not be controversial, and the murder of a licensed doctor who does legal procedures is not an act of god. We all need to work hard to see that reproductive health is safe and the doctors who provide it are safe. We need to teach and heal and prevent needless loss of life at all times and in all ways.