Managing Managed Care

Our inequitable, inefficient, oftentimes uncaring health care "system," revealed. -- Jeffrey G. Kaplan, M.D., M.S.

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Hunched Backs (Kyphosis)

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Exercises Can Help Kyphosis, But.... Certain exercises may prevent or delay the progression of hyper-kyphosis or hunched back, but that cannot completely correct it; it normally progresses with age. For example, here's a YOGA pose that is recommended by Dr. Loren Fishman, a Physiatrist who is well-published on this and related topics. Locust Pose – Shalabasana: How to do it by Ann Pizer [See:About.com]

Healthcare Reform in the U.S.

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The United States is the only wealthy, industrialized country that does not ensure that all of its citizens have healthcare coverage. Insuring America's Health: Principles and Recommendations, Institute of Medicine at the National Academies of Science, January 14, 2004, last accessed Tuesday, February 2, 2010

The Incentive in Piecework is....

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...to generate pieces (Dr. Caldwell Esselstyne, circa mid '60's).  Specialists even more than primary care practitioners fractionalize care; that's costly; In the medical home, primary care treats the whole patient.  To explain the drastic shift needed to encourage primary care and discourage a further and unjustified overabundance of specialists, know that: 35% of visits for circulatory conditions are to family physicians, 27% of visits for musculoskeletal problems are to family physicians

Specialist Surfeit--Unaffordable!

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Do we pay too much for health care here in the US? Is there a plethora of specialists? And, what about the waste in the system? Yes, of course to all, but if you are the person who needs treatment, maybe the answer is "not really." If you can't get the medical help you need when you need it, maybe the fact that it is theoretically free doesn't mean anything.   We're going to discuss global payment and hit upon both sides--reducing inappropriate access and improving appropriate access.

Got Strept?

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Strept Cultures and Rapid Strept Tests Objective. The American Academy of Pediatrics recommends that all negative rapid diagnostic tests for Streptococcus pyogenes pharyngitis be backed up by culture, which creates a dilemma for clinicians who must make treatment decisions without complete diagnostic information at the time of visit. The use of a follow-up serial rapid antigen test instead of a follow-up culture would provide a more timely result.

The Phenomenon of a Captive Audience

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Off the record...health care is a mess. On the record...health care is a mess. From: A State Medical Director for managed entitlement programs, Justin We're a captive audience, stuck between the proverbial 'rock and a hard place'.... Big Pharma's making our drugs the most expensive in the world and getting Congress to protect their trade; it's a quid pro quo for support and TV adds in favor of health care reform.

Communication and Patient Satisfaction

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A survey of 262 physicians found that only 2/5 were satisfied with how they managed test results.It is noteworthy that efforts to facilitate communication with patients included: 1) the system automatically generating a patient notification letter, 2) the doc acknowledging receipt of the result and documenting that "communication will be made at a later time," or 3) they actually make a call to the patient.  Guess what happens most of the time? And: #1 and #2.

Shell Game or Real Reform

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Health care reform is merely a 'shell game.' It's a shame that we cannot, instead, manage the care so that it is affordable, accessible and effective.  Squeezing docs, patients, cost shifting and cost sharing is the wrong approach.

Negative Side of Supply-Side Economics

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Three poignant cases where over-supply (of docs) leads to over-testing or over-treating First Goodwin JS, Singh A, Reddy N, Riall TS, Kuo Y-K. "Overuse of Screening Colonoscopy in the Medicare Population."     Arch Intern Med Published online May 9, 2011.      doi:10.1001/archinternmed.2011.212

Cancer and Nutrition

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It's often difficult to maintain a good appetitie and nutritional status when fighting cancer. Here are some tips from cancer experts and dietitians that may help: Fresh ginger (not ginger flavoring), taken about 1/2 hour before eating can lessen or even eliminate nausea, but  common in many sodas. Eat more protein and less fat and/or fiber; eat smaller meals more frequently throughout the day--maybe 5-6 Drink more between meals than during them

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