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Optimism and longevity

Dov Michael wrote an informative article on this topic. (Hats off to The Doctor Weighs In) Optimism  provides a mortality advantage. Optimists live longer than pessimists it seems. Writes Dov, “There is real scientific evidence, accruing at an accelerating rate, that optimistic disposition leads to

ACA enabled health insurance cooperatives suffer huge losses

According to a WSJ article (subscription required) written by GRACE-MARIE TURNER and THOMAS P. MILLER, ACA enabled health insurance cooperatives “suffered an estimated $377 million in net underwriting losses.” Whoa! That’s big. One cooperative has closed down completely and others will need massive subsidies to survive. Why?  “…most

Guest article on future of nurse practitioners by Kathleen Bartholomew, RN, MN

The article below was written by Kathleen Bartholomew, RN, MN, who is one the most popular guest writers for Cracking Health Costs.  In this artifice she describes the coming shortage of primary care doctors and how nurse practitioners are well suited to fill in many of the gaps. Tom

Are You at Risk for a Heart Attack After Exercise?

This is the title of a WSJ article written by Ron Winslow (subscription required). Writes Ron, “…rigorous exercise, whether on a treadmill, a road race or a basketball court, does elevate risk for sudden cardiac arrest, a typically fatal event that can be triggered by a

At Last: doctors are catching up with science on prostate testing

According to an article in Common Sense Doctors clinical doctors are starting to cut way back on prostate screening. The author is Kenny Lin, MD, MPH. In other words, more and more are following science on prostate screening. Per the article, “…the road to the U.S. Preventive

Optimism and longevity

Dov Michael wrote an informative article on this topic. (Hats off to The Doctor Weighs In) Optimism  provides a mortality advantage. Optimists live longer than pessimists it seems.

Writes Dov, “There is real scientific evidence, accruing at an accelerating rate, that optimistic disposition leads to better health; the converse is true for pessimism.”

Optimists are twice as likely to be in ideal cardiovascular health, according to a new study led by Rosalba Hernandez, a professor of social work at the University of Illinois.”

In recent posts we’ve explored how loneliness is a killer, as is anger. Resilience is important to longevity too.

Problem is your doctor can’t do much to make you more optimistic. in fact sometimes they inadvertently do the opposite. They can’t make you a less angry person nor a less lonely person.

In many ways your health too important to trust to a doctor.

 

Cheers,

Tom Emerick

Watch for Tom’s latest book coming to Amazon soon: An Illustrated Guide to Managing Your Health—HOW TO IMPROVE YOUR HEALTH IN 40 COMMON SENSE STEPS.

 

 

ACA enabled health insurance cooperatives suffer huge losses

According to a WSJ article (subscription required) written by GRACE-MARIE TURNER and THOMAS P. MILLER, ACA enabled health insurance cooperatives “suffered an estimated $377 million in net underwriting losses.” Whoa! That’s big.

One cooperative has closed down completely and others will need massive subsidies to survive.

Why?  “…most co-ops have significantly underpriced premiums and grossly underestimated medical claims. Many seek significant premium increases for 2016: 58% for individual plans in Utah, 38% in Oregon and 25% in Kentucky, for example.”

Further, “Iowa’s CoOportunity Health…was the first to confront the hard reality of insurance economics as medical claims far outpaced premium income. After the co-op burned through $145 million in federal loans, an Iowa state court in February ordered the organization to be liquidated”… creating yet another layer of tax burden for taxpayers.

Designing a health insurance plan is easy. The hard part is pricing it correctly. That’s why actuaries make big bucks. Why in the world did anyone think amateurs could do a better job of running and pricing health insurance, a most complex and nuanced endeavor, than health insurers?  The co-ops just foolishly underpriced the premium rates. Period.

Cheers,

Tom Emerick

Watch for Tom’s latest book coming to Amazon soon: An Illustrated Guide to Managing Your Health—HOW TO IMPROVE YOUR HEALTH IN 40 COMMON SENSE STEPS.

 

Guest article on future of nurse practitioners by Kathleen Bartholomew, RN, MN

The article below was written by Kathleen Bartholomew, RN, MN, who is one the most popular guest writers for Cracking Health Costs.  In this artifice she describes the coming shortage of primary care doctors and how nurse practitioners are well suited to fill in many of the gaps.

Tom Emerick

NURSE PRACTITIONERS: The Time Bluff by Kathleen Bartholomew

Anyone I’ve ever met who has been treated by a Nurse Practitioner is extremely happy with the care they have received. And as a nurse, I’ve heard numerous stories from family and friends that all drop a reference about the amount of time that an NP spends with a patients vs. the typical physician interaction. Is this observation Reality or Perception?

The vast majority of studies about Nurse Practitioners come from the UK and are a decade old. Even then, the last study which involved time amounted to four minutes more with an NP. But a lot has happened in the last decade in America. What do we know?

“Patients now spend more time with physicians, not less, than they did 20 years ago. The average length of visit to a physician in 2006 was 21.8 minutes; in 2002, it was 18.4 minutes and in 1989 it was 15.9 minutes”(1) Yet people constantly state that doctors are spending less time.

The autonomy that NP’s have today has allowed many to spend the amount of time they deem needed with their patients- especially in hospice, oncology and palliative care or when working closely with a physician partner. But there are also just as many NP’s who have watched the amount of time they have spent with patients steadily decline with each year.

Melanie is an NP who used to spend 45 minutes with each patient. Now, she laments, “The corporate expectation is 20 minutes, but in reality, I spend 15 minutes charting and only 5 minutes hand’s on.” The clinic in which she works needed to ramp up their efficiency in order to generate more revenue – yet patient satisfaction remains high and these patients keep returning for their five minute encounter. Anecdotal? Hardly. She works in one of 600 clinics. What is going on here?

Is the time an NP spends with a patient relevant if the outcomes are par? In our culture, time is equated with caring. Patients feel that NP’s care about them for a few very good reasons.

Physician training has not changed significantly over the years- education has been historically diagnostic and focused on treating symptoms. What is the problem and how can we fix it? With the increase in chronic disease, obesity and diabetes, diagnoses is more challenging than ever. This is not to say that physicians do not care! It’s just that the mental model from which they practice asks for facts more than circumstance, and data more than story. The result? Patient’s perceive NP’s care more and that equates to spending more time with them whether fact or fantasy.

NP’s have a broader theoretical framework based on caring that emphasizes relationships, wellness, and discovering the cause of illness. The words chosen and manner in which an NP asks questions are founded in holistic nursing principles. Why do you think your blood pressure has gone up lately? Last time I saw you, you were worried about your daughter – how is she? The perception from the patients POV (point of view) is that NP’s care because their words validate context, relationships, and thereby demonstrate caring.

There will be a shortage of 60,000 primary doctors by 2025. We need more research for both NP’s and Physicians so that we can both learn how to best help our patients change their behaviors. Perceptions not need match reality, but the current perception gives NP’s the upper hand.

1. (National Ambulatory Medical Care Survey, CDC’s National Center for Health Statistics.)

 

 

 

 

Are You at Risk for a Heart Attack After Exercise?

This is the title of a WSJ article written by Ron Winslow (subscription required).

Writes Ron, “…rigorous exercise, whether on a treadmill, a road race or a basketball court, does elevate risk for sudden cardiac arrest, a typically fatal event that can be triggered by a heart attack…”

While there is an abundance of data showing the advantages of regular exercise, “ ‘Exercise is not a vaccine against heart disease,’ says Michael Joyner, an exercise physiologist at Mayo Clinic, in Rochester, Minn.” (emphasis mine)

Wellness vendors need to show a much more balanced point of view regarding vigorous workouts. They pose a risk, even if a small one.

 

Cheers,

Tom Emerick

Watch for Tom’s latest book coming to Amazon soon: An Illustrated Guide to Managing Your Health—HOW TO IMPROVE YOUR HEALTH IN 40 COMMON SENSE STEPS.

 

 

At Last: doctors are catching up with science on prostate testing

According to an article in Common Sense Doctors clinical doctors are starting to cut way back on prostate screening. The author is Kenny Lin, MD, MPH. In other words, more and more are following science on prostate screening.

Per the article, “…the road to the U.S. Preventive Service Task Force’s 2012 ‘don’t do it’ recommendation on PSA-based screening for prostate cancer was long, arduous, and full of political pitfalls.”

The U.S. Preventive Services Task Force “…took heat from screening advocates in the mainstream media and in social media.”

At last clinical doctors are cutting back risky and needless screenings. “The past two weeks have offered the first definitive evidence that the USPSTF’s controversial stand has spared thousands of men the harmful interventional cascade that results from prostate cancer screening.”  (emphasis mine)

Now, if company-sponsored wellness will get on the ball, even fewer men will be needlessly harmed.

Personally, I told my doctor years ago, way before the USPSTF decree, to do no more PSA tests on me.

Cheers,

Tom Emerick

Watch for Tom’s latest book coming to Amazon soon: An Illustrated Guide to Managing Your Health—HOW TO IMPROVE YOUR HEALTH IN 40 COMMON SENSE STEPS.

Ho Hum: The FBI arrested 46 doctors and nurses…largest Medicare fraud bust ever

That title is from a headline in a recent CNN story. Seems the thieving doctors and nurses got away with $712 million before getting busted.

Per the story, “In total, 243 people were arrested in 17 cities for allegedly billing Medicare for $712 million worth of patient care that was never given or unnecessary.”  

Note the word unnecessary. If they are doing this to Medicare patients they are defrauding self-insured benefit plan patients too.

This has been getting worse and worse every year for 20 or so years. I put “ho hum” in the title because almost no one in the private sector takes stopping this kind of thing seriously. There is a lot of talk and little action.

I urge readers to start taking steps to stop this mess.

 

Cheers,

Tom Emerick

Watch for Tom’s latest book coming to Amazon soon: An Illustrated Guide to Managing Your Health—HOW TO IMPROVE YOUR HEALTH IN 40 COMMON SENSE STEPS.

What makes us get sick? Look upstream (must read article)

This is the title of a TED conference speech by Rishi Manchanda who has worked as a doctor in South Central Los Angeles.

After about ten years, he came to realize “…His job isn’t just about treating a patient’s symptoms, but about getting to the root cause of what is making them ill—the ‘upstream’ factors like a poor diet, a stressful job, a lack of fresh air. It’s a powerful call for doctors to pay attention to a patient’s life outside the exam room.” This story has a big WOW factor.

Let me repeat: Dr. Manchanda came to realize it’s not enough to treat a patient’s symptoms, but to get to the root cause of what makes people sick. Regular readers of Cracking Health Costs will know this is a familiar message. Of all the things that cause us to die too early, medical care can only deal with about 25%. The rest is about how you live your life.

This also explains why typical corporate wellness programs fail. They’re trying to ameliorate symptoms but ignore the root cause of syndromes such as high blood pressure, high cholesterol, etc. It’s not enough to walk into a smoke filled house and turn on the exhaust fan. You need to put out the fire too.

Wellness buyers, e.g. benefit managers, need to have the same epiphany as Rishi Manchanda.

I’ve been writing a series of posts about root causes of illness: loneliness, job stresses, life dissatisfaction, etc.  I also firmly believe the time is right to start thinking about employee ailments in an entirely different way.

My next book, An Illustrated Guide to Managing Your Health—HOW TO IMPROVE YOUR HEALTH IN 40 COMMON SENSE STEPS, could well be called, “For better health, look upstream”.

 

Cheers,

Tom Emerick

Watch for Tom’s latest book coming to Amazon soon: An Illustrated Guide to Managing Your Health—HOW TO IMPROVE YOUR HEALTH IN 40 COMMON SENSE STEPS.

A cure for a significant health risk, loneliness

Loneliness is both sad and a major health risk. More and more people are professing loneliness in their lives, and more and more evidence is piling up that loneliness, like dissatisfaction in life, is a killer.

Here are some personal observations:

  • Why do many people have so few friends as they age?  Maintaining long-term friendships takes a lot of work and investment of time. Don’t let your career stand in the way. Don’t wait for someone to befriend you; reach out.
  • Some people have invested their time and energy solely in a spouse, who may       predecease them by 25 years, or in children who fly the nest in time.
  • Many people have invested much in work-related friendships, which, while genuine at the time, can wilt almost immediately when they retire.
  • In friendships, one has to give more than he or she takes.
  • Make yourself likable. Who wants to spend time with someone who complains all the time? People like that are often avoided by people around them.
  • Be a good listener.
  • If you’re lonely, try joining something…a church, a book club, a hiking club, anything.

In the end, a true measure of wealth is the number of lifelong friends we have. Having lifelong friends is a joy and a great cure for loneliness.

 

Cheers,

Tom Emerick

Coauthor of Cracking Health Costs, available on Amazon.

Watch for Tom’s latest book, coming to Amazon soon: An Illustrated Guide to Managing Your Health—HOW TO IMPROVE YOUR HEALTH IN 40 COMMON SENSE STEPS. 

 

Low Life Satisfaction Linked To Increased Mortality Risk

An article in Science World Report says that dissatisfaction with life is a big mortality risk. The author was Kathleen Kees.

A study was done at Chapman University. Kees wrote, “Throughout the course of the study, researchers discovered that as participants’ life satisfaction increased, their mortality risk was reduced by up to 18 percent. Furthermore, greater variability in life satisfaction was associated with a 20 percent increased risk of mortality….”

This is what I’ve been saying all along. Humans are complex and dissatisfaction is a huge health risk, one of a hundred or so health risks we all have.

This is one of the big reasons wellness doesn’t work. Wellness is much too narrowly focused. While wellness tries to deal with certain medical metrics, it simply fails to get at the root cause of the vast majority of health risks. But it is profitable to the vendors.

Cheers,

Tom Emerick

Why get a second opinion on pathology?

Wall Street Journal recently carried an article by Laura Landro on the topic. (Subscription required)

This article highlights yet again the high rate of misdiagnoses in reading biopsies.

Writes Laura, “Pathologists are the most important doctors that patients never meet.”

Yet, “A study published in March in the Journal of the American Medical Association indicated as many as one in four breast biopsies are initially misdiagnosed.”

Further, after a high quality second opinion of cancer tumors, “... the stage of cancer was changed in 22% of cases....” Wrong stage means wrong treatment plan.

These errors are common, and can lead to patient harm and death.

The kinds of centers of excellence I promote, what Harvard’s Michael Porter calls integrated practice units, do a great job of getting the diagnosis right. The worst “quality” error is misdiagnosing a patient. When that happens, what follows is gross medical harm. Bad diagnosis equals bad outcome.

Tom Emerick