HEALTH TRAIN EXPRESS
Mission: To promulgate health education across the internet:
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Ethan Lindenberger is getting vaccinated for well, just about everything.
"God knows how I'm still alive," Lindenberger wrote on Reddit last November.
In his Reddit post, Lindenberger goes on to ask for help figuring out how to get vaccinated. He got more than 1,000 responses. His post joins similar ones from other unvaccinated teenagers trying to get their shots, despite their parents' beliefs.
He's 18 years old, but had never received vaccines for diseases like hepatitis, polio, measles, mumps, rubella, or the chickenpox.
Lindenberger's mother, Jill Wheeler, is anti-vaccine. He said she has been influenced by online misinformation, such as a debunked study that claimed certain vaccines were linked with autism, or a theory that vaccines cause brain damage. Incorrect ideas like these have spread like wildfire, so much so that the CDC has explicitly tried to combat them, posting pages like "Vaccines Do Not Cause Autism"
Lindenberger's eldest sister is vaccinated, and his eldest brother is partially immunized, but once his mother found out that she had the right to opt-out of vaccinations, she chose not to vaccinate her younger five children.
Charlie Hinderliter wasn't opposed to the flu shot. He didn't have a problem with vaccinations.He was one of about 53 percent of Americans who just don't get one.
"I figured [the flu] was something that's dangerous to the elderly and the young, not somebody who is healthy and in their 30s," says Hinderliter, who is 39 and the director of government affairs at the St. Louis Realtors association.
"Turns out, I was wrong," he says.
An estimated 80,000 Americans died of the flu, or flu-related complications, last winter, according to initial estimates from CDC presented in September. It was the highest number of flu related deaths in decades, and Hinderliter was nearly among them. Now, after 58 days in the hospital, a week in a medically induced coma, two surgeries and three weeks in a nursing home, he's speaking out to encourage everyone to do something he'd never done before: Get a flu shot.
Health Information, Nutritional and Dietary advice is everywhere. We plan exercise, diets, eliminating food that is known to be associate with cancers, heart disease and other illnesses. We spend enormous amounts of money on food supplements, vitamins, and antioxidants, while we consume foods that are statistically associated with heart disease and cancers. Sadly economic incentives drive much misinformation. Multilevel internet business promotes sales for additional income. This is combined with an agribusiness mindset for profits and the recent downturn in employment and income. These combine with the retail environment of harmful foodstuffs displayed in supermarkets emphasizing foods high in sugars (fructose), and fats.
We read about all these facts and understand it, however in reality few of us practice good nutrition.
Perhaps "it takes a village" to accomplish this on an individual basis. I compare this to group therapy. Perhaps we need a new self help system of "Obesity anonymous' . No one says "I am fat". You are more likely to hear "I am a few pounds overweight", or "I could stand to lose a few pounds, or so".
Is the glass half empty or half full? Why do we all hesitate to confront obese people?" They have long been discriminated against by society. We have all stood behind a grossly obese person checking out at a supermarket with their cart filled with unhealthy items. Perhaps we need cashiers to refuse to sell harmful products to fat people, just like we do for alcoholic beverages for minors.
In all fairness I must give time to an article in NPR in which they state ,
About 2,000 Californians die from opioid overdose annually, according to the California Department of Public Health. This week in Chico, one person died and 12 were taken to the hospital after a suspected overdose on a powerful opiate called fentanyl.
The California Legislature looked at more than 20 bills last year designed to address the ongoing opioid crisis, passing 14. The laws cover a few approaches to bringing opioid death numbers down, including stemming over-prescribing practices, improving medication assisted treatment and saving people in the throes of overdose with an antidote called naloxone.
Here’s a roundup of what former Gov. Jerry Brown signed to tackle the problem.
Curbing Painkiller Prescriptions
In an effort to reduce fraud, AB 2789 will require doctors to write electronic prescriptions starting in 2022. Supporters argue this will make it easier for doctors to record prescriptions in the state’s CURES opioid database.
Expanding Treatment
Starting July 2020, AB 349 requires the Department of Health Care Services to adopt new regulations and update reimbursement rates for the Drug Medi-Cal Treatment Program
Naloxone Access
AB 2256 is designed to make it easier for pharmacists to give naloxone, an overdose antidote, to law enforcement officers who have completed special training. An individual pharmacist can already give the drug to a law enforcement officer, but wholesalers cannot. If law enforcement agencies want to acquire large amounts of naloxone, they must go through a local health department. Police departments and other agencies argue this process makes it unnecessarily difficult to get the life-saving drug. The U.S. Surgeon General said earlier this year that all people at risk for overdose, and community members who interact with them, should know how to use naloxone and keep it within reach at all times.
Patients at high-risk of overdose should have wider access to naloxone in doctor’s offices this year under AB 2760. The law requires doctors prescribing opioids to also offer patients for the overdose antidote, and educate patients and their loved ones on how to use it.
Strengthening the Opioid Database
Right now, patients can get an opioid prescription in California and then go get another in Nevada without anyone knowing they’ve double-dipped. AB 1751 authorizes the Department of Justice to share opioid prescriptions entered into California’s CURES database across state lines. The department must adopt regulations for interstate data sharing by July 2020.
Regulating Rehab
The Department of Health Care Services will be required to adopt the American Society of Addiction Medicine treatment criteria, or a similar standard, as the minimum standard of care for licensed adult alcohol and drug abuse recovery facilities when SB 823 takes full effect in January 2023. The law’s author, Democratic Sen. Jerry Hill, said in a statement that the law will help crack down on facilities that currently use “widely divergent methods of treatment” and often lack evidence-based standards of care
As it stands, counties run their own drug take-back programs and pay to safely dispose of opioids and other prescription medications. SB 212 will now require drug-makers to take on that burden by building collection sites and paying for disposal. CalRecycle must adopt regulations to enforce the law by January 2021.
And AB 2859 could help people keep opioids away from children by requiring community pharmacies that dispense opioids to display safe storage products on the premises.
None of these laws address the growing use of Fentanyl a powerful opiod drug that is smuggled into the United States. Fentanyl is ten times as powerful as Morphine and/or Oxycodone. It has become a preferred drug for users.
Large quantities have been seized at ports of entry worth as much as 100 million dollars.
Today is the first Monday of February 2019. By now I have broken all my New Year's resolutions.
How have health providers and patients coped with changes? Health providers have struggled to keep pace with electronic health records, and new tools such as outcome studies, data analytics, and a new 'buzzword' every other week.
Millennials probably need go no further, unless you want a wrap up of your nascent years. For the rest of us, please continue to see how different your children are from you. Most of the changes are due to the advances in technology fed by the internet, social media, and a distrust of formerly established routes of communications, purchasing, and socializing.
Gen Z has now entered the workforce.
A key feature of millennial thought process is they want in now, and perhaps yesterday. This is also true of healthcare access.
Part of Gen Z development has been a parallel process in technology, also driven by Gen Y and Gen Z, both in development and users.
Resourcefulness is at the top of the list. I’ve collected hundreds of stories from parents who have children between 11 and 17. They talk about how their children use YouTubeto figure things out themselves, without adult direction and even if they cannot read. From fixing cars to building model train sets, they know how to find the answers and directions they need.
Health providers have struggled to keep pace with electronic health records, and new tools such as outcome studies, data analytics, and a new 'buzzword' every other week.
Companies are starting to sell “risk scores” to doctors, insurers and hospitals to identify patients at risk of opioid addiction or overdose, without patient consent and with little regulation of the kinds of personal information used to create the scores.
While the data collection is aimed at helping doctors make more informed decisions on prescribing opioids, it could also lead to blacklisting of some patients and keep them from getting the drugs they need, according to patient advocates. Health insurance giant Cigna and UnitedHealth's Optum are also using risk scores.
There’s no guarantee of the accuracy of the algorithms and “really no protection” against their use, said Sharona Hoffman, a professor of bioethics at Case Western Reserve University. Overestimating risk might lead health systems to focus their energy on the wrong patients; a low risk score might cause a patient to fall through the cracks.
No law prohibits collecting such data or using it in the exam room. Congress hasn’t taken up the issue of intrusive big data collection in health care. It’s an area where technology is moving too fast for government and society to keep up.
“Consumers, clinicians and institutions need to understand that personalized health is a type of surveillance,” says Harvard University professor Eric Perakslis. “There is no way around it, so it needs to be recognized and understood.”
The justification for risk scoring is the terrible opioid epidemic, which kills about 130 Americans a day and is partly fueled by the overprescribing of legal painkillers. The Trump administration and Congress have focused billions on fighting the epidemic, and haven’t shied from intrusive methods to combat it. In its national strategy, released Thursday, the White House Office of National Drug Control Policy urged requiring doctors to look up each patient in a prescription drug database.
Health care providers legitimately want to know whether a patient in pain can take opioids safely, in what doses, and for how long — and which patients are at high risk of addiction or overdose. Data firms are pitching their predictive formulas, or algorithms, as tools that can help make the right decisions.
The practice scares some health care safety advocates. While the scoring is aimed at helping doctors figure out whether to prescribe opioids to their patients, it might pigeonhole people without their knowledge and give doctors an excuse to keep them from “getting the drugs they need,” says a critic, Lorraine Possanza of the ECRI Institute.
The algorithms assign each patient a number on a scale from zero to 1, showing their risk of addiction if prescribed opioids. The risk predictions sometimes go directly into patients’ health records, where clinicians may use them, for example, to turn down or limit a patient’s request for a painkiller.
Doctors can share the patients’ scores with them — if they want to, the data mongers say. “We stop really short of trying to advocate a particular opinion,” said Brian Studebaker from one of the risk scoring companies, the actuarial firm Milliman.
According to addiction experts, however, predicting who’s at risk is an inexact science. Past substance abuse is about the only clear red flag when a doctor is considering prescribing opioid painkillers.
But several companies POLITICO spoke with already are selling the predictive technology. None would name customers. Nor would they disclose exactly what goes into the mathematical formulas they use to create their risk scores — because that information is the “secret sauce” they’re selling.
Congress has shown some interest in data privacy; a series of hearings last year looked into thefts of data or suspect data sharing processes by big companies like Facebook. But it hasn’t really delved into the myriad health care and health privacy implications of data crunching.
Consumers have a “basic expectation” that the data they provide to websites and apps “won’t be used against them,” said Sen. Brian Schatz (D-Hawaii), who co-sponsored legislation last year barring companies from using individuals’ data in harmful ways. The HIPAA privacy law of the late 1990s restricted how doctors share patient information, and Schatz says “online companies should be required to do the same.”
A bill from Sen. Ed Markey (D-Mass.), S. 1815 (115), would require data brokers to be more transparent about what they collect, but neither his bill nor Schatz’s specifically address data in health care, a field in which separating the harmful from the benign may prove especially delicate.
How your health information is sold and turned into ‘risk scores’ - POLITICO: Information used to gauge opioid overdose risk is unregulated and used without patient consent. HIPAA regulations appear to prohibit personal information from release to the public, so 'bare statistics' are only available, unassigned to a particular patient. It is unknown at this time what PHI is transmitted to a provider.. Companies are starting to sell “risk scores” to doctors, insurers and hospitals to identify patients at risk of opioid addiction or overdose, without patient consent and with little regulation of the kinds of personal information used to create the scores. Over the past year, powerful companies such as LexisNexis have begun hoovering up the data from insurance claims, digital health records, housing records, and even information about a patient’s friends, family and roommates, without telling the patient they are accessing the information, and creating risk scores for health care providers and insurers.
Our health system has grown into a size that is no longer self supporting. Most of our care is in an outpatient setting which should be very inexpensive The chart below displays the huge diifferences in cost. Just by eliminating the administrative positions in an office decreases overhead by 50% or more
Paul Thomas MD, physician-owner ofPlum Health, a DPC practice in inner-city Detroit understands the needs of economically disadvantaged patients. “I intentionally selected a health professional shortage area as a place to start and grow my medical practice,” he says. “I believe that the DPC model gets us closer to the goal of truly affordable health care for our patients and communities.”
But DPC practices don’t just serve patients in inner-cities and suburbia. Donna Givens, MD, is the physician-owner of Grant’s Pass Family Medicine in rural Oregon. “Most of my patients are in the gap between qualifying for Medicaid and being able to afford insurance,” she says.
DPC practices can also provide a safety net for minority patients. Belen Amat, MD, the owner of Direct Primary Care of West Michigan, estimates that 70 percent of her patients are primarily Spanish-speaking.
Across this country, DPC practices are filling an important niche by providing care for underservedpatients. But rather than indenturing themselves to a government or corporate entity, physician-owners of DPC practices are providing care on their own terms, without bureaucratic headaches and red-tape frustrations.
Direct care cuts out third-party payers like Medicare, Medicaid, and insurance companies. Instead, patients pay the doctor directly, usually through a monthly fee, which averages $77 for DPC practices.
Because direct care doctors are not beholden to the insurance company, they spend less time on unnecessary documentation and more time on patients. And because doctors don’t have to spend a fortune trying to get paid by an insurer, they can often keep their overhead remarkably low, passing savings along to patients.
It is easy to criticize a new model if you don’t really understand what DPC doctors do. The Journal of the American Medical Association (JAMA) argued that DPC is structurally flawed, in that it incentivizes physicians to accept healthier patients.
But this argument does not match with the reality that many DPC practices experience. In my practice, most patients have multiple chronic illnesses — the very reason they see the benefit in paying a monthly membership for care. New patients have sometimes been without health care and off medicines for months to years, and require frequent visits to get stabilized.
And many times, rather than being “cherry-picked,” patients come to DPC practices because they have been dismissed from conventional practices. For example, Tiffany Blythe, DO, the owner of Blue Lotus Family Medicine in Kansas City, will accept unvaccinated children who are often unwelcomed into other doctors’ offices. “I’ve found that many anti-vax parents really are trying to do the best they can for their child. They just need education, patience, and support to find their way.” And with the additional time that DPC offers, Blythe has been able to convince some parents to vaccinate their children ultimately. “It takes time to overcome fear with facts,” she notes.
In my practice, I have several patients who were dismissed from their regular doctors. One 80-year-old Medicare patient came to me tearfully with a dismissal letter from her previous doctor in hand. She was “fired” from the practice, she said because she refused to talk to a chronic care coordinator. “I was just tired of them bugging me all the time,” she told me. “They kept calling me, and a nurse would come to my house and tell me the same things my doctor did.”
If you talk to DPC doctors, you will hear many stories like these. Inspirational stories not only of patients accessing affordable, quality health care but also of physicians who are happy to practice medicine again.
DPC offers an alternative practice model for doctors to regain the joy in practicing medicine. When medical students and residents hear DPC doctors talk, they get inspired to practice primary care. And studies are clear: more primary care docs equal better health care across populations.
Affordable care, better patient experiences, better patient outcomes, and physician well-being: the quadruple aim. And this is exactly what direct primary care provides.
PLUM HEALTH BENEFITS
A direct relationship with your doctor
Fewer patients = more time with your doctor
Your health and wellness are the priority
Call us at any time, email us, or text us
Save hundreds on labs, imaging, and prescription meds
The difference in cost is huge. These differences only apply to outpatient vs Hospital Cost. Hospital charges are difficult to analyze and are maximized because of the manner in which insurance companies reimburse them.
CONVENTIONAL HEALTHCARE
Rushed appointments
Doctor's have thousands of patients = less time
Sometimes you'll have to see a mid-level provider
Only available during business hours, typically 9 - 5
2-10x markup on labs and services
Services billed at the highest rate possible in order to maximize reimbursement from your insurance company
Pamela Wibble, MD started the Ideal Medical Clinic in Oregon some years ago before anyone knew what Direct Primary Model even existed. Dr Wibble created this practice model because of her own personal experiences with physician suicide. Many physicians 'burn out' because of the moral conflict between the Hippocratic Oath and the necessity of economic realism.
"Mrs Smith, this is a routine procedure, don't be nervous" How many times have I heard a nurse, or physician tell this to a patient in order to assuage their anxiety. Perhaps we as physicians are saying that to minimize our own anxiety when in fact we all know of the horrendous things that can go wrong during a 'routine procedure' ?
Martha Wright had her first colonoscopy at Missouri’s Cass Regional Medical Center. She died the next day of internal bleeding, an unusual outcome that has the hospital under extra scrutiny from regulators.
At 83, Martha Wright had never had a colonoscopy, even though government guidelines call for nearly everyone to be screened for colon cancer after age 50.
The Pleasant Hill resident was scared of the test, her daughter Dena Royal said, because she was petite — less than 5 feet tall.
“What she repeatedly said was, ‘I don’t want to have a colonoscopy; it will kill me,” said Royal, a former Kansas City paramedic and respiratory therapist. “We just kind of said, ‘Oh mom, it’s routine, it’s no big deal.’”
Wright had her first colonoscopy Aug. 2 at Cass Regional Medical Center, after a doctor recommended it because she was anemic.
She died the next day of internal bleeding.
Martha Wright celebrated her 80th birthday three years ago in Kansas City.
SUBMITTED PHOTO
It was a highly unusual outcome from a very common procedure that now has the Harrisonville hospital under extra scrutiny from government regulators.
State inspectors came out to investigate Wright’s death in late November after Royal filed a complaint. They found that Wright showed several signs of distress after the procedure, but Cass Regional staff didn’t properly respond. They also said 348 more colonoscopies had been performed there since Wright’s death, without addressing the deficiencies in care.
The inspectors passed their findings to the federal Centers for Medicare and Medicaid, which classified the situation as an “immediate jeopardy” that "placed all patients at the facility at risk.” It’s one of the agency’s most serious designations. If the situation is not promptly addressed, hospitals can lose their ability to bill Medicare.
THE TEST
In a colonoscopy, patients are under general anesthesia while a doctor inserts a small flexible tube with a tiny camera through the patient’s rectum and into the large intestine. It’s a key tool for detecting colorectal cancers, but according to the Centers for Disease Control, about one-third of Americans who should be getting the test aren’t.
Still, it’s one of the most common medical procedures in the United States and it’s usually safe. Serious complications occur in only about 1.6 percent of patients, though experts say that’s still too high, given that millions of colonoscopies are done each year.
Deaths are even more rare.
In one of the largest studies done on the topic, researchers examined 16,318 colonoscopies performed in Kaiser Permanente hospitals between 1994 and 2002. They found only one death they could attribute to the procedure — a rate of 0.006 percent. A 2008 study on Canadian colonoscopy patients came up with a similar number.
By contrast, the five-year death rate for people with localized colorectal cancer is about 10 percent, and it spikes to almost 30 percent once the cancer spreads to surrounding tissues or organs.
According to the inspection report and medical records provided by Royal, Wright’s colonoscopy was, at least at first, the type everyone wants to get.
There was no sign of colon cancer. There were no polyps to be removed. It was a “clean” test that was “completed without difficulty or complications,” according to medical records reviewed by the inspectors.
Wright was sedated for the procedure, and because she didn’t have anyone to drive her home and watch her for 24 hours, she had to stay at the hospital overnight per Cass Regional policies.
The test was in the morning. By 5 p.m. she was complaining of pain in her left upper abdomen, but said it was tolerable: a 3 on a scale of 1 to 10. By 10:15 p.m. the pain had increased to 7 out of 10 and had spread to her left shoulder. According to medical records, a nurse told her she probably had gas and gave her Tylenol.
The inspection report said this is when nursing staff should have contacted the surgeon to inform him or her of the change in Wright’s condition.
Instead, the doctor wasn’t notified until about 2:30 a.m., when Wright awoke complaining of nausea, clammy skin and shortness of breath, in addition to the abdominal pain. The doctor ordered some tests, including a CT scan, but Wright kept getting sicker.
She was taken to the intensive care unit at 4:50 a.m., but by then she was unresponsive, with no breathing and no pulse. Hospital staff tried CPR, but at 5:14 a.m. Wright was declared dead.
The radiologist who read the CT scan found a “large amount of hemorrhage ... within the abdomen and pelvis,” which the emergency room physician listed as her official cause of death .
“She basically bled to death,” said Aaron Woods, the Lee’s Summit attorney Royal hired.
Royal said she knew something must be wrong when the phone rang early in the morning. But it was still a “gut-wrenching” shock to hear that her mother was dead.
“I mean, my mom was 83 but I thought she still had a lot of life left,” Royal said. “This was just so unexpected.”
It wasn’t the incident itself that drew the most concern from government officials, though. Medical mistakes happen. Cass Regional rate of re-admitting patients after a colonoscopy is 15.5 per 1,000. That is actually slightly better than the national average (16.4 per 1,000 patients), according to federal data.
What was most concerning to regulators was the hospital’s response. They said Cass Regional officials should have recognized Wright’s death as a “sentinel event” that signaled potentially broader problems, immediately investigated to find out how it happened and then educated staff about how to keep it from happening again.
Instead it was more than a month before the internal investigation started, and “the facility also failed to educate nursing staff in a timely manner,” the federal report said. When staff were eventually trained more on assessing patients’ conditions, it “was informal and without documentation of who attended.”
Cass Regional correction plan includes many policy changes to keep that from happening in the future.
Upon reviewing the case it was apparent that staff failed to notify the surgeon of a change in her postoperative condition shortly after discharge in a timely manner.
Addendum
Several things readers should note:
1. There is no such thing as a routine procedure. Routine only means they do a lot of the procedure. If there is a problem the surgeon will make a note of it. If there is an abnormal postoperative course nurses must notify the responsible surgeon. The surgeon is responsible for making a decision, not the nurse
Familiarize yourself by watching the following videos.*******
Rooftop landing pad for Riverside Community Hospital
Or
Surface travel by EMS
A horseback ride accident leads to thousands in air ambulance medical cost Sonna Anderson was enjoying a horseback ride through the Badlands in North Dakota in September 2017 when her horse, Cody, got spooked, jerked toward a fence and tripped on a cow track in the dirt. The horse rolled onto Anderson, who hit her head, briefly lost consciousness and broke three ribs. The 911 transcript shows that an ambulance reached the 60-year-old judge from Bismarck within 20 minutes. Anderson was secured on a backboard and ready to go when an air ambulance, a helicopter with a medical crew, also landed at the scene. Anderson says her husband asked repeatedly whether the ground ambulance crew could take her by ground; there was a hospital less than an hour’s drive away “But he was told that [the air ambulance] was necessary. They never told him why it was necessary or how much it cost, but they insisted I had to go by air ambulance,” Anderson said. “But it’s so odd there is nothing in the record that indicated it was time-sensitive or that I needed to be airlifted.” For that one helicopter ride, to a hospital farther away in Bismarck, records show that Valley Med Flight charged Anderson $54,727.26. Sanford Health Plan, her insurance, paid $13,697.73. That left Anderson with a $41,029.53 bill.
There are large areas of rural America that have become health care deserts. In an effort to contain rising health care costs, CMS has made it economically unobtainable to provide adequate hospitals in rural areas. A number of alternatives are in use, telehealth, remote monitoring, access to lower level providers such as physician assistants and nurse practitioners
A slide of blood showing abnormal red blood cells (sickle cells). Note the bizarre shapes. Normal red blood cells are round or spherical. This is caused by abnormal hemoglobin which interferes with the transportation of oxygen to the cells of the body.
Success against sickle-cell would be “the first genetic cure of a common genetic disease” and could free tens of thousands of Americans from agonizing pain.
Employment can be difficult because the disease is debilitating. Yet many who apply for Social Security disability are denied, Dr. Tisdale said. They end up at emergency rooms when they are in crisis.
And treating the disease, with its complications, is expensive: annual costs per patient are estimated at $10,000 a year for children and $30,000 for adults. Those with the disorder go in and out of hospitals.
