Annual exams vs. annual wellness visits

Happy New (Calendar) Year!

It’s the start of a new year or, in health insurance lingo, the start of a new calendar year deductible. I’m reposting this from last January, because this month is the best time to start trying to schedule that annual exam or annual wellness visit (it could take weeks, after all, to get an appointment!)

I usually advise people to get any screening tests or annual exams done early in the year, just in case an abnormality is found and more testing/treatment is necessary.

Especially with the current trend towards enormous deductibles (up to $14,300 for Continue reading

Life Line Community Healthcare and Life Line Screening

Buyer Beware

I’ve posted before about the limitations of Life Line Screening.

The screening tests they offer in their basic “wellness” package are either not recommended at all because they aren’t effective screening tools (carotid ultrasound), or are not recommended for the general public (abdominal aortic aneurysm ultrasound). Please read my previous post for more information on that: Don’t reach for Life Line Screenings

Screening tests are best discussed with your primary care physician. He or she will help you know which tests are right for you—based on your age, health history and family history—as well as how often they … Continue reading

Don’t reach for Life Line screenings

I first posted about Life Line screenings two years ago. I’m re-posting today as this post still gets a lot of traffic and I wanted to reopen the comments. 

life line screeningsOvertreating, overspending

I just received an invitation in the mail!

Not to a party or a wedding or anything fun, but to a Life Line Screening event being held at a local church. The letter says they’re holding a spot for me on this particular date, but I must call NOW to confirm and register, because spaces are LIMITED!

“These aren’t just routine medical procedures—they can help save your life”

Oh, … Continue reading

View Prevnar 13 ads with caution

prevnar 13Prevnar 13: As seen on TV

I was watching TV the other evening and, as usual, was forced to sit through multiple back-to-back prescription drug commercials.

One that caught my attention was for Prevnar 13, which is one of the pneumonia vaccines. (13 because it protects against 13 strains of streptococcus pneumonia.)

The commercial stated Prevnar 13 was for adults aged 50 and older.

That statement’s true, but needs some clarification.

Yes, Pfizer did get FDA approval a few years ago to market Prevnar 13 to adults over the age of 50. Previously, the vaccine was only used for … Continue reading

Be informed – Shared decision-making

Shared decision-making makes better informed patients, and better informed patients use less health care.

…as many as 20% of patients who participate in shared decision making choose less invasive surgical options and more conservative treatment than do patients who do not use decision aids.

Which lowers health care costs.

…a 2012 study…showed that providing decision aids to patients eligible for hip and knee replacements substantially reduced both surgery rates and costs — with up to 38% fewer surgeries and savings of 12 to 21% over 6 months.

[It’s] estimated that implementing shared decision making for just 11 procedures would

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Screening eye exams in older adults

Just yesterday I posted about the United States Preventive Services Task Force (USPSTF) and the fine line they walk between providing evidence-based recommendations for screening tests and making medical specialist groups happy.

Sometimes it just doesn’t happen.

The task force recently gave an “I” grade to vision screening in patients over 65. An I grade, or Insufficient evidence, means that the task force can’t definitively say that the benefits of vision screening in older adults outweigh the possible harms.

The American Academy of Ophthalmology (AAO) doesn’t agree.

Specifically, the task force reviewed the evidence for primary care doctors screening for … Continue reading

Heads up about Medicare changes

This post if for any of my readers who are Medicare age or about to be Medicare age.

I think it’s important to understand what changes are in the pipeline that will affect your doctors and their ability to be able to treat you.

Some doctors already refuse to see Medicare patients because of government red tape and poor reimbursement.

But starting in 2017 it’s going to get worse, and many physicians are wondering if they should follow their colleagues and drop out of the Medicare game altogether.

I recently read two posts by physicians on the health care blog … Continue reading

The high cost of dementia

November is Alzheimer’s Disease Awareness Month.

It’s hard to find anyone who isn’t aware of—and scared of—dementia**. Or who hasn’t had a family member or friend stricken by it.

Alzheimer’s is a horrible disease that damages not only the individual, but family and friends, as well, especially the primary care giver—most often the spouse.

Adding insult to injury is the incredible cost of getting help. A recent study published in the Annals of Internal Medicine confirms what many already know—Alzheimer’s disease and other forms of dementia cost families way more than almost any other disease.

Why? Cancer is one of Continue reading

The shingles (herpes zoster) vaccine

shingles herpes zosterA painful but common condition in older adults is shingles or herpes zoster. I’ve known several elderly people afflicted with this, and I will absolutely get the vaccine as soon as I turn 60!

The vaccine, Zostavax, is FDA-approved for ages 50 and up, but the Cleveland Clinic recently advised that it’s not cost effective for anyone under 60 to get immunized.

Why? Because Zostavax is too expensive. On average, it costs about $200, and that doesn’t include the cost for the office visit or vaccine administration that some clinics charge.

The vaccine is effective for 10-12 years, so … Continue reading

A horrific story of cancer treatment fraud

July 14—an update to this story: Cancer doctor’s fraud sends him to prison 

I read a news story out of Michigan yesterday that almost made me literally sick:

Whistle-blower: How doctor uncovered nightmare; Oncologist’s discovery leads to the downfall of a cancer treatment empire

[Dr. Farid] Fata’s Michigan Hematology and Oncology Inc. (MHO) was the state’s largest private cancer practice in 2013, with clinics in seven cities, its own pharmacy and diagnostic center, and 1,700 patients, virtually all of them assigned to Fata, the tireless physician. Those who needed proof of Fata’s dedication could look to the doctor’s work ethic

Continue reading

Medicare drug spending

A report published last week detailed how much Medicare spends on prescription medications.

In 2013, Medicare spent $103 billion on drugs. (I’m guessing the total will be more in 2014 and 2015, when they get around to publishing that data.)

Federal officials said they hoped that disseminating the data would lead to new revelations about the prescribing patterns of doctors and for particular drugs.

Dan Mendelson, the CEO of Avalere, a Washington, D.C., consulting firm, said the data could provide patients with new questions about their prescription history when they visit their physician. “It’s really important to stimulate conversations

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The high cost of getting old

The last few weeks have been stressful for my family as my 93-year-old father suffered a heart attack, a stroke and other medical problems that led to a 2-week hospital stay (I’m amazed he survived that), a 10-day stay in a skilled nursing facility, and—just this weekend—a move into an adult family home.

He needs round-the-clock care that my 85-year-old arthritic mother can’t provide in their home.

In a few weeks, I’m sure I will be helping her sift through an enormous pile of statements, explanations of benefits (EOBs) and invoices related to my dad’s care.

Sure Medicare will pick … Continue reading

The cancer reimbursement wars

It’s another case in which the right hand of a behemoth government agency doesn’t know what the left hand is doing: In Cancer Wars, It’s Doctors vs. Hospitals

Colliding federal policies are fomenting a nasty money war that’s pitting community oncologists trying to treat patients in less expensive clinic settings against hospitals trying to woo patients in through costlier emergency departments.

The agencies under discussion are the Centers for Medicare and Medicaid Services (CMS) and the Health Resources Services Administration (HRSA) [which both fall under the larger umbrella of the Department of Health and Human Services (HHS)], and their disparate … Continue reading

The Open Payments database

Lots of data, but not user friendly

Have you ever wondered if your physician receives a substantial amount of money from a pharmaceutical or medical device company?

Is your physician’s decision to write you a prescription for the newest brand-name drug, or replace your knee with a state-of-the-art joint, based on corporate influences? Conflicts of interest run rampant in health care, and it would be nice to know, wouldn’t it?

Earlier this fall, the Centers for Medicare and Medicaid Services (CMS) launched a new website called Open Payments. It’s part of the Sunshine Act, which in turn … Continue reading

Be informed – Medicare and “observation” status

When is a hospital admission not an admission?

Answer: When, for Medicare patients, it’s coded as “observation” status only.

Before the days of discharging patients ASAP (or not admitting them at all), doctors used to frequently admit patients “for observation.” It signified that a patient was not critically ill, but his or her condition warranted careful watching, i.e. observation.

Unfortunately for the last decade or so, that term has come to have a very specific meaning with very specific financial consequences. But most patients still consider it a casual phrase that doesn’t mean much, and that ignorance can end up… Continue reading