Misc Useful Information
Obamacare
It seems Congress is still struggling with Obamacare.
The cost of a citizen buying Obamacare insurance is rising. This insurance products are sold by different insurance companies to the public. These are relatively inexpensive products for the consumer. My understanding is that the insurance premium that the insurance company receives are subsidized by your tax money. However even with the subsidy, most insurance companies are raising the premiums by 30%. Actually the subsidies are another reason for this agreement. One of the benefits of Obamacare has been that people can buy insurance without regard of preexisting conditions. People who have had a serious condition before were denied insurance by the insurance companies. This is another point of this agreement amongst the different members of Congress.
Interestingly, nobody seems to mention the rising costs of healthcare. In my opinion, unless this is addressed, universal healthcare is the real eventuality.
Drug Addiction
Drug addiction is so common now in Oklahoma that drastic measures are being taken. Of course, that can be treated as a disease or as a crime, especially for people who are dealing with drugs. It is not unusual that I hear from people that a Lortab tablet can bring $25 on the street so you can see that between legitimate patients, drug addicts, the facilitators and the drug dealers, Lortabs have become a huge problem. Not only in Oklahoma, but also in the nation. So now, how are we as a society to treat this affliction? Of course the easiest way is not to probably find the criminals, or treat the addicts, the easiest way would be to curtail the ease with which they can get this medication. This then turns back on the poor physician, who now is encumbered by having to check the background of every patient he writes a prescription for Lortab. The other difficulty also is that we now cannot give Lortabs to a patient without a written prescription. This means we cannot call it into a pharmacy, which we were doing up until 6 months ago. What happens is if there is a problem, like one doctor had, there was something missing from the prescription he wrote, the patient went home first, and then went to the pharmacist, and the pharmacist would not fill out the prescription. The patient is in pain, the doctor gets a phone call in the middle of the night from the patient, telling him they cannot fill their pain medication prescription, so the physician had to get up in the middle of the night, get dressed, and go meet the patient somewhere on the hospital grounds to give them another prescription. How can we fix these things? That will be left to our state and the bodies who take care of this problem.
Prescription Medication Prices
The prices for prescription medications keep rising. One patient was complaining to a doctor that another doctor had put her on this new medication for a leaky bladder. That would cost her about $600 a month. One medication called Ditropan, which does about the same thing. Now, this is the same family of medications that are used for this condition. It would cost $10 a month. It is unfortunate that most physicians do not get involved with how much a drug that they are prescribing costs. It looks like physicians need a disincentive for prescribing expensive medications. A lot of times, they recommend medications that are new, but not necessarily more effective.
One can save a lot of money as a patient to have a frank discussion with the physician concerning this issue. A patient can save a lot of money by not being bashful.
Healthcare Co-ops
One of the newer organizations that the new healthcare law started are the healthcare co-ops. These are organizations to take care of some patients with the help of government grants. These organizations are mostly managed by family physicians. Recently, a review has been done as far as how these set ups are working. It was discovered that a large percentage have already stopped functioning. It appears that no matter how hard one tries to improve healthcare reform, unless the individual physician has both incentives and disincentives (financial), most set ups will not be able to deal with overhead. The insurance bought through the exchanges have not done very well. The premiums have gone up. Of the ten million people who have signed up during the last year, 90% of the enrollees signed up for Medicaid.
Exchange Insurance
As more and more products of exchange insurance are purchased, some realities were discovered. One cannot buy exchange insurance anytime. Normally the months of the year that these exchanges are open for enrollment would be in November and December. What happens when somebody gets sick and he has no insurance yet?
One patient tried to buy insurance from an agent who sold him a product which would be good for four months. This would tie him over until exchange enrollment time. However, the agent did not tell him that this would not cover his pre-existing condition. I have had a patient who was in this situation but was able to enroll in the exchange even before the date by declaring his condition as urgent. It will take some work and patience, but with exchange products, we'll make exceptions if pursued.
What is a Colonoscopy?
This is a scope test to check on the large bowel. This is done to check on polyps and cancer. Normally, this is done in a clinic or an outpatient setting. The patient receives intravenous sedation as well as a narcotic. Some patients have had this without IV sedation. Recently, it was decided by the physicians and institutions to give the patient Propofol. This is an IV medication that will put the patient to sleep momentarily. It is short-acting and it should be given repeatedly to cover the 45 minutes that a colonoscopy may take. The problem with this is that the patient is not fully anesthetized with a mask or a tube, so he may end up by aspirating his stomach contents into his lungs. This can lead to severe complications. For that reason, the presence of an anesthesiologist is required. Physicians and outpatient healthcare facilities started doing this specially so they could charge the patient and the patient could leave the recovery room and the facility much faster, saving time and expenses for the facility. Well, at this time it appears that Medicare has decided not to pay the extra fees to the anesthesiologist and to the healthcare facility for the Propofol starting in January of 2016. I am predicting that the use of Propofol for colonoscopies will drop dramatically if the patient is asked to pay for all of that. By the way, it was Propofol that caused Michael Jackson's death.
Healthcare Exchange Program
A new program by the government to have hospitals connected for continuity of care.
Patient's History, Physicals and Encounters with different physicians and providers, as well as admissions to different health care facilities, present the provider with chaotic and sporadic facts that some patients even forget. To fix this, the government decided a master plan, whereby all healthcare providers will be on one network or several large networks where they can talk to each other by computers. The government even offers about $40,000 per physician to buy the computers and the software to facilitate this. As the rule of unforeseen consequences unfolded, things got worse than improved. Actually, a simple paper chart became a multipage cut and paste document that may enhance payment from the government and insurance companies. This, however, became very impractical for the treating physician as he/she tried to go through pages and pages of jargon, trying to look for maybe one sentence that makes sense. I had talked about this problem for a long time and finally, I came up with an idea of the Patient Journal. This is a booklet that contains almost all the major topics of the patient's health care. It includes patient information, names of physicians, facilities, medications, allergies, procedures, lab tests ordered, questions to ask the doctor, the last pages are blank pages for the patient to fill out the lines with notes from his/her encounter of the day.The patient is to fill the booklet out at home, before and after his/her visit. Then bring the booklet to every health care encounter. The booklet is made such that it can be copied and scanned into electronic medical records. One can simply divide a spiral notebook with these topics and start keeping track. This may be cumbersome for a lot of people. Instead you can let us know and, for the cost of $13.00, we can provide you with one which is ready to go. To order one you can email us at hrairkurk@gmail.com
Is PSA necessary?
Awhile back, the government task force decided that testing for a PSA may not be necessary. A lot of patients and physicians were not very excited about that. Some physicians and patients did just that. Recently, however, it was found that the number of patients with prostate cancer has increased. So, maybe it was not the right decision to not get PSA's.
