Know Your Bones

To: My Patients/ Re: Your Health Insurance

Excellus Health Plan has required your doctors to sign a new contract in order to continue participating in their health insurance plans. The contract is not acceptable for many reasons.  Essentially, it

gives Excellus too much control over patient care, and demonstrates a lack of respect for Rochester’s doctors, the patients we care for and the community we serve.

The doctors at Westfall Orthopaedics are pleased to care for your bone and joint health.  Your insurance policy still covers your care at our office. 

However, we strongly recommend:

• If you receive health insurance through your employer, find out what other insurance options are available in the “open-enrollment” period coming up this fall.   Open-enrollment is the time of the year when you choose your health plan for 2007.
• “Vote with your feet”: Please consider buying your health insurance from a different company: 

• Preferred Care:  585-325-3113                                Aetna:  877-864-4583

• You and your employer pay about $10,000 EVERY YEAR in health insurance premiums.  Choose to do business with an insurance company that reinvests in Rochesterby paying its doctors fairly; not Excellus, which has raised premiums to increase its own reserves to $1 billion, and to buy three other insurance companies in Utica, Syracuse and Buffalo .

In the last six years the “Blues” have lost two major lawsuits, and were found guilty of unfavorable business practices.

• Contact Scott Ellsworth, Excellus’ Regional President at 585-231-6894to express your concerns about their dishonorable treatment of Rochester’s physicians, patients and the community.

Please feel free to discuss this matter with your doctor. Caring for your bones and joints, relieving your pain and restoring your function are our goals.  Thank you.

Water on the Knee Doesn't Count...

A recent story on NPR drew my attention to World Water Day, 3/22/06.  Yvonne at Lipsticking is also talking about it.

According to water.org, more than one billion people lack access to a safe supply of drinking water. Water-related diseases are the leading cause of death in the world. This killer takes the lives of more than 14,000 people each day and is responsible for 80% of all sickness in the world.

97.5% of earth's water is salt water; if all the earth's water fit in a gallon jug, available fresh water would equal 1 Tablespoon.  The average distance women in Asia and Africa walk to collect water is 6K!

90% of your joints cartilage is water--you must stay hydrated to keep your joints healthy.  But, don't take your "8 glasses" for granted.   Drink up (but not from single-serving plastic bottles!), count your blessings, and put your joints to good use.

Quicken to the Rescue!

Thanks to Mary and Terri at Attract-Her for sharing the news about Quicken's Medical Expense Manager.   Finally, a way to keep track of the reams of gobbledygook that arrive in the weeks and months after your medical treatment.  (Nothing is more confusing than a statement with "THIS IS NOT A BILL" stamped on it--so what the hell IS it?)

A Quicken employee designed this program to handle $1.2M medical bills from his newborn's rare illness. 

The trade-off when moving from Big-Brother's managed care to CDHP's is that patient's will have to keep track of freakish statements.    Thank you Quicken for designing a solution!

Walk 4 miles and call me in the morning!

So is the NCQA advocating that P4P include how many times I urge my patients to exercise?   In an article on their site from 7/04, their 2005 HEDIS measures claimed to value the doctor's opinion:

Physical Activity in Older Adults
      Physical activity among adults 65 and older has been shown to slow the functional decline associated with aging, reduce the risk factors for disease, and significantly improve overall health. This measure, developed with significant support from the Centers for Medicaid & Medicare Services (CMS), will evaluate whether Medicare recipients age 65 and over have been asked and advised about physical activity by a health care professional. Clinical practice guidelines for major chronic conditions such as hypertension, arthritis, and osteoporosis, all of which are prevalent among the elderly, strongly recommend that health care providers advise patients on increasing physical activity to the extent that their health allows.
      “A physician’s best healing tool is often good advice,” said Mark B. McClellan, M.D., Ph.D., Administrator, CMS. “For older Americans, good advice is often ‘stay active and get some exercise.’”

Finally!  Low-cost, low-tech, low-risk, common-sense medical advice that's guaranteed to improve your health and well-being:  regular exercise!  Not a pill, not a scan, not an operation, not a new-fangled payment scheme.  Just plain-old taking responsibility for your own strength, endurance, balance and resilience.  Finally, $1.7T/year later, we're getting somewhere!

$1.7T pays for too much

  Kevin, MD has a link to an excellent San Francisco Chronicle essay, Too Much of a Good Thing?   However, his position defends the inevitabiltiy of defensive medicine.  (On the other hand, the essay wants us to rely on "objective evidence-based guidelines" that simply don't exist...subject of another post!)

I'm a fan of the movement toward consumer-driven health plans.  How much of the runup to $1.7T/year was fueled by defensive medicine that was possible because "insurance will cover it"? 

In the near future, patients won't allow us that extra consult or test "just to be sure", because they'll have to pay more than their $10 co-pay for it. 

Has anyone faced this yet with their patients/doctors?  How about respecting the wallets of uninsured patients?

Why Surgeons Cut to Cure:

Visit my guest-blogger post at Third Age--I want to start a conversation about what patients expect vs what our fractured health system in prepared to provide. 

Follow the Trackbacks for more on my humble opinion (based on laws of nature and common sense!)

You have 2 breasts, but 206 bones!

Learn from 2 recent musculoskeletal awareness-raising events to remain strong, safe and independent for a lifetime:  The US Bone and Joint Decade Awareness Week and the National Osteoporosis Foundation “Virtual Fitness Day.” 

It seems like everywhere I turn, there’s a pink ribbon.  The Breast Cancer awareness-raisers have been incredibly successful in getting their point across.  Don't assume that because you had your mammogram, that you're safe from all those girl-diseases.

The lace ribbon symbolizes osteoporosis awareness—now we just need a line of frozen foods, shoelaces, coolers, and whatnot to compete with all the pink ones. 

USBJS Awareness Week

The US Bone and Joint Decade Awareness Week is upon us!  USBJD is a great source for learning about the latest research efforts to combat the problems that limit function and mobility.  You'll also find links to self-care tips about arthritis, tennis elbow, shoulder tendinitis, back pain, or whatever else is interfering with your fall yard chores. 

Order cool posters, stickers and pamphlets at their Resource Center. 

Fight the proposed Medicare cuts to protect our patients and parents

Between now and December 31 we must work tirelessly to  change the methodology by which physicians are reimbursed through Medicare. The focus of the difficulty is the sustainable growth rate (SGR) formula. If this flawed formula is not fixed by year end, effective January 1, 2006, physicians participating in the Medicare program will see a 4.3% cut in reimbursement. This is unacceptable.

The AMA is urging all U.S. physicians and medical students to work together and stop severe cuts to Medicare physician payments. Contact your representative and senators today: Tell them to stop the cuts!

Contact your Congressional representative and implore them to stop the Medicare cuts scheduled to begin on January 1, 2006 . You can accomplish this either by email to

http://www.ama-assn.org/ama/pub/category/13097.html

or by calling the AMA grassroots hotline at 1-800-833-6354. You will be immediately placed in touch with your Congressional representative's office to make your point.

Get Smart About Osteoporosis

So, Agent 86 passed away this week, from a lung infection about 1 year after he broke his hip.  Would you believe that up to 1 out of 3 patients who break their hip will be dead within 1 year,  usually from pneumonia?  It's time to let that statistic out of the Cone of Silence!

According to the National Osteoporosis Foundation:

• Osteoporosis and low bone mass are currently estimated to be a major public health threat for almost 44 million US women and men aged 50 and over
• A women’s risk of hip fracture is equal to her combined risk of breast, uterine and ovarian cancer
• The direct medical costs for the more than 1.5 million osteoporosis-related fractures can cost as much as $18 billion per year (in 2002 dollars) – with initial treatment of each hip fracture averaging from $30,100- $43,400 in medical costs.

Sorry about that, Chief, but hip fractures don't just happen to women.  Although most patients don't suffer serious complications from their hip fractures or the surgery required to fix them, my best advice is "Don't even go there!"  Know your bones and keep them strong.  Keep their muscles and ligaments resilient.  Use a cane or walker for safety and confidence.

So the next time you escape from KAOS and lose your footing from an ill-fitting shoe-phone, you'll be able to say "Missed it by that much...and loving it!"