Do you need an annual exam?

The yearly reminder

The other day I received in the mail a form letter from my physician’s office reminding me that I am due for my annual “well woman” visit. The letter also pointed out that if I have an ACA-compliant health insurance plan, the cost for the exam would be 100% covered as a preventive benefit.

I have three problems with this letter.

  1. Although my current physician is part of my new insurance plan’s network, the hospital she works out of is not. What if I needed to have surgery or be hospitalized? My care would then be given
Continue reading

Save money by Choosing Wisely

save money choosing wiselyUnnecessary care = unnecessary expense

Every day I see a new article about the high costs of health care.

A new study suggests that in a single year, up to 42 percent of Medicare patients got at least one medical procedure they didn’t need — overtreatment that cost as much as $8 billion.

Use of [Mohs] surgery has skyrocketed in the United States — over 400 percent in a little over a decade — to the point that last summer Medicare put it at the top of its

Continue reading

Screening for Alzheimer’s and dementia

Will there soon be a blood test?

My father-in-law recently passed away after suffering with Alzheimer’s for several years. I also have an aunt who is currently living with some form of dementia, probably vascular.

Few diseases strike more fear into those over the age of 50 than Alzheimer’s. Needless to say, both my husband and I worry when we find ourselves saying:

“Oh, what’s the word I want?”

or “Where did I put it?”

or “Why did I come in here?”

So when I read the prevailing health headlines this week about a blood test to predict Alzheimer’s, … Continue reading

Do you need an annual mammogram?

mammogramThe latest report

Most of my nursing career was in breast cancer, so I like to stay current on the most recent research on screening, diagnosis and treatment.

Earlier this week, the British Medical Journal released a pretty stunning report:

In conclusion, our data show that annual mammography does not result in a reduction in breast cancer specific mortality for women aged 40-59.

In normal language that translates to “annual mammograms don’t save lives.”

Aaron Carroll, MD, writes on his blog:

This study is going to make a whole lot of people upset. It’s a large, well designed

Continue reading

How often for a Pap smear?

Screening guidelines often don’t agree

One of the mandatory benefits of health insurance, thanks to Obamacare, is that preventive or screening services are covered without charging copays or coinsurance.

Preventive care is not really “free,” of course, because we pay higher premiums and higher copays and deductibles for other health care. It’s more like pre-paid.

(Oh, and make sure the doctor and testing facility (lab or radiology) are in your network, or the care won’t be covered.)

But I’ve found it more and more confusing to know which screening exams are covered, and how often, because different medical “authorities” seem … Continue reading

A follow up on vitamin D

What they said about vitamin D then…

A few months ago I posted about calcium supplements and vitamin D supplements. I’m not a big fan of taking a lot of pills (or any, actually), so I did a little more research into what the most current evidence-based studies recommended.

Regarding calcium, I found that it’s best to get calcium from foods in my diet, such as dairy products and certain vegetables. I’ve been trying to do that.

And what about vitamin D? Calcium supplements often include vitamin D because it helps with absorption of calcium. Low vitamin D levels … Continue reading

Pushing back against too much medicine

As someone who advocates for less medical care, I’m always thrilled to see physicians and others in the health care industry step forward to protest over-testing, over-screening, over-diagnosing, over-treating and over-charging.

Here are some of my favorite health care blog posts and news articles from the last week.

“Testing Wisely” by Dr. Rob Lamberts 

Dr. Lamberts is embracing the newest trend in primary care: the direct-pay model. He does not accept health insurance, but rather charges a modest (age-based) monthly fee per patient. Booting the insurance companies not only lowers his overhead costs considerably, but frees him from so many … Continue reading

Lowering health care costs: It takes a village

Physicians have a role in lowering health care costs

The Mayo Clinic has been busy this month.

Last week researchers published a report in the Journal of the American Medical Association (JAMA) titled “Views of US Physicians About Controlling Health Care Costs.”

Also last week,  Mayo Clinic Proceedings published its conclusion that nearly 40% of current medical practices are of no net benefit and needlessly contribute to high health care costs.

The first study surveyed physicians’ attitudes about their role in reducing health care costs. Do they believe they can and should help rein in the cost of health Continue reading

Perverse incentives: Where’s the outrage?

perverse incentives in health careThat’s a good question!

H. Gilbert Welch, MD, the author of Overdiagnosed: Making People Sick in the Pursuit of Health, wrote a recent op-ed in the New York Times in which he wonders at what point will the high costs—and profits—of medical care in America be considered “a crime”?

Medical care is intended to help people, not enrich providers. But the way prices are rising, it’s beginning to look less like help than like highway robbery. And the providers — hospitals, doctors, universities, pharmaceutical companies and device manufacturers — are the ones benefiting.

The crime of perverse incentives

Although … Continue reading

Weekly rounds July 5, 2013

Big companies get a temporary break from Obamacare

Other than Egypt’s turmoil, the biggest news this week was out of the Treasury Department, which announced that they were going to delay a key feature of Obamacare until January 2015.

Delayed one year is the mandate that large businesses (those that employ over 50 people) must provide health insurance for their employees or pay a fine.

Small businesses (under 50 people) are not affected because they are not mandated to provide health insurance. Of course, if they want to, they can, but will have limited options because of the previously announced Continue reading

Overscreening for hepatitis C

Baby boomers get another screening test

I was  annoyed when the  US Preventive Services Task Force (USPSTF) announced last week that baby boomers, those born between 1945 and 1965 (myself included), should be tested for the liver infection hepatitis C (HCV) regardless of risk factors.

I think my age group is already subjected to too many screening tests of questionable value.

Related reading: Check and check again

Just last November the USPSTF issued a statement that only people at an increased risk of HCV—mostly IV drug users and anyone who received a blood transfusion before 1992—should be tested. Anyone … Continue reading

Weekly rounds June 21, 2013

June 17-21, 2013The HPV vaccine works

Positive news was reported in the Journal of Infectious Diseases: Since vaccination for the human papillomavirus (HPV) was introduced in 2006, the rate of HPV infection has dropped by 56%.

The study looked at infection rates in girls age 14 to 19. HPV can lead to cervical cancer or throat cancer later in life, but only about 30% of teen girls and boys are being vaccinated.

This report will hopefully result in a much-needed boost in the numbers of kids receiving the vaccine. Visit the CDC website for more information about the vaccine.

No one

Continue reading

It’s all in the family (health history)

The high cost of genetic testing

Angelina Jolie and her preventive mastectomies are still making news, as is the business of genetic testing.

On May 14, the day Ms. Jolie revealed her story, Myriad Genetics, the company that holds the patents on both the BRCA1 and BRCA2 gene sequences, saw its share price rise by 4% to the highest point in its history.

How happy the company’s board must have been when Ms. Jolie wrote in her New York Times op-ed piece that “every woman” should have access to such information. She did acknowledge, however, that the $3,000+ price tag … Continue reading

Weekly rounds May 17, 2013

Stock up on DEET?

Any report that contains the word “deadly” gets the attention of the media, and this report by the Centers for Disease Control (CDC) was no exception. Last year 5,674 cases of the mosquito-borne virus were reported, and 286 people died. In comparison, only 43 deaths were recorded in 2011.

Weather conditions that favored the mosquito – warm and humid – were probably factors in last year’s increase in cases.

This news reminds me that I want to spend some time researching insect repellents and then write a post about them. Does anything work as well as … Continue reading

Equal rights for vision!

For the last 15 years, my family has purchased an individual health insurance policy. Individual plans, as opposed to employer-based insurance, usually don’t cover vision. We could buy a separate vision policy, but in an average year the premiums would cost more than our annual eye exams, glasses and contacts combined.

Even Medicare doesn’t pay for routine eye exams and corrective lenses, except one pair after cataract surgery.

Of course, eye diseases and injuries (your mother always told you not to run with pointy objects, didn’t she?) are covered as medical care.

But I’ve always wondered why screening exams for … Continue reading