Christian Medical Bill Sharing and other ideas for health coverage

I came across this article on something called Christian Medical Bill Sharing (http://www.walletpop.com/blog/2010/06/24/christian-medical-bill-sharing-a-growin/).  The catch to this that you need to be Christian, adhere to Christian values for coverage (they do not cover abortions, sexually transmitted diseases which are considered un Christian like behavior) however, the premiums are considerably lower than traditional insurance.  Members like the plans because as long as they stay within the PPO network, they have a low co payment and it covers their needs.  Of course, there are going to be critics of plans like these, however, as people look for more affordable types of coverage, or are displaced from their current employment or start their own businesses, the cost of insuring you and your family can be a deal breaker (Many average plans can cost 16 thousand dollars for an average plan and just ok coverage).

The big idea here is everyone shares everyone else's health care needs for the greater good, a very Christian ethic.  Ethics seems to be a problem everywhere we look so an ethical type of healthcare plan with a strong belief system behind it that practices what it preaches is a good idea.  They also work with people to help them maintain a healthier lifestyle, a paradigm that has been abused in todays society and health insurance plans.  I can get into the healthier lifestyle area however, that is an entirely longer discussion since it encompasses what we eat, processed foods, the government helping corn growers with subsidies for corn syrup and other unhealthy foods rather than helping to keep the cost of good quality food affordable so even the poor can easily buy it and live healthier lifestyles.

I am currently shopping for new health insurance and quite honestly, the price increases over the past year have been incredible.  Also incredible, is Aetna just decreased our reimbursements for chiropractic services again (something they have done every few years) by up to 18 percent, yet their rates are some of the highest I was quoted.  Where is this money going if it does not go to providers who are already cash strapped by greedy insurance companies who have done this repeately over the years.  Unlike this shared plan idea, insurance companies, and their focus on bottom line and CEO bonuses in the millions is very un Christian like especially when they deny medically necessary care by a reviewer you cannot communicate with other than appeal letters which often go nowhere, especially with self insured plans that are administrated by plans like Aetna.

Ethical shared health care - perhaps this is an idea we need to explore not just in the Christian communities but for other people like myself, a Jewish doc trying to help people live a better quality of life.

What do you think?  I value your opinion

Salt and Heart Health - Know what you are eating and what is in your prepackaged food

I read an article that was reprinted in the Star Ledger today from Bloomberg News (http://www.bloomberg.com/news/2010-06-24/potato-chips-help-drive-up-salt-intake-for-most-american-adults-cdc-says.html) regarding problems in the american diet.  The Centers For Disease Control is sharing their concerns about food and the amount of sodium used in it.  Many junk foods such as potato chips are laden with salt, way to much for our bodies needs.  More salt means more electrolytes which means your body will retain water which means it can have an effect on blood pressure.  Many of the pre packaged foods we eat are flavor deficient and salt is used to get them to have flavor.  Many restaurants use salt, sometimes in abundance with soups and other dishes to give it flavor.  Better restaurants find foods that mesh well together and therefore do not require too much salt.

Lets face it, many of use like salt however, often less can add more.  Many times I have pushed away soup in a diner because of the salty taste.  It really is overkill and our health may suffer long term for this.  The answer is not your doctor or the blood pressure medication to control this.  The answer is for the public to refuse to eat food that has exorbitant amounts of salt.  You can check the packages and if the salt levels are way too high, dont buy that food.  French fries if they are really good and flavorful need minimal salt (as opposed to what Mcdonalds sells)

The solution really is public awareness, changing tastes (corporations will make that the public will buy) and a willingness to change.  This will be better for our health and should affect health care costs nationally if we make salt reduction a national priority.

What to you think.  I value your opinion.

Pressure on doctor pushes up costs, or does it

I was reading the opinion column in todays NJ Star Ledger regarding an article written by Stella Fitzgibbons MD, who is a hospital based board certified doctor in the Houston Area (http://articles.latimes.com/2010/jun/17/opinion/la-oe-fitzgibbons-health-costs-20100617).  She talks about her experiences and who health cost containment is difficult leading to unnecessary testing.  Apparently, many families pressure doctors to run many tests to rule out rare problems which the doctors experience had shown will respond well without the increase testing and intervention.  She mentions other sources such as web sites and magazines which tell the patient to literally bully the doctor into doing certain procedures and tests.

From the health care providers perspective,  what she has said is true from her unique perspective, however, people make many health decisions based on emotions and fear.  Fear is a great motivator and our healthcare system has used and in some cases abused this to push patients into doing things they may never have done to themselves, sometimes with horrible and disfiguring effects. People have also been talked into taking harmful substances they would never have taken with horrible side effects because of the false hope they saw on television or the education their doctor received from the local drug rep convincing the doctor that this medication was indeed good for their patient.

When people come to the hospital with symptoms they do not understand, fear is ever present and rational thinking often is scarce, especially around caring family members who found their distressed family member. Our broken healthcare paradigm has literally brainwashed the american public to expect all these tests  to leave no stone unturned even though a good exam and responsible recommendations are enough to stay within community standards of their medical specialty, which would protect them from malpractice lawsuits.   .

There are not clear protocol recommendations for patients who enter the ER which eliminate the unnecessary use of diagnostic technologies giving families and the one who is ill a greater sense of confidence with the healthcare provider.  The system is actually set up for people to want more because of the perception that more is better and the legal perception if liability if every last thing should be tested, even though in many cultures, it is not and people are in many instances are better off.  A better system that would save costs, suffering and over testing would be one that would force  the doctor to do certain protocols first. Then the patient has to wait a few days after following their home recommendations before further tests are done as they follow up with their own doctors.  This would make sense and eliminate some unnecessary testing but not all.  I doubt that would happen though because some lobbyist would likely call this rationing, some attorney would call it malpractice (which  they cannot if the doctor follows community guidelines which is the way the average doctor in that specialty would behave) and would get the public in an uproar by using the appropriate buzz words.

 Is it rational to steer patients down the most logical path based on the current science we have available?  I believe it is and our healthcare systems can certainly help patients better with more rational and concise  recommendations that take the patient and their families emotions out of the decisions.

In another case she mentions, she has a patient who just came into the IC unit after a huge stroke.  She mentions that the family wants everything done to save the life of someone who is also in kidney failure and also has pneumonia.  Again, failure of having concise protocols has the family making emotional demands that will prolong his suffering, are likely to fail on an individual with insufferable brain damage.  The outcome with or without tubes and procedures is the same - the loss of a loved one.  Our healthcare system needs to be able to council a family on the right thing to do which is prepare the patient and their family for the inevitable, rather than having these stressed and scared people make a decision they are likely unqualified to make in the situation that presents itself.  The loss of a loved one is awful, and we do not want to let go.  If the outcome is the same, and comfort rather than intervention is more humane, yields the same results and does not totally drain the persons bank account as well, shouldn't the best course of treatment be a protocol that leads the family down the right path, rather than giving them the right to push for intervention which clearly is wrong.
Some may say that this takes away freedom of choice and is rationing.  I call it rational health care policy.  As many studies are finding out, often less is more which is especially true in healthcare.  Many developed countries do more with less and the care is often excellent.  Their understanding on life, death and taking care of oneself is healthier as well (our country is #38 in the WHO for health care quality).  Yes, we americans can  learn from other countries healthcare systems and we should.

In life, we are born, we live our lives and at a certain time, our bodies will fail, while we used our lives to procreate and create our legacies.  Disney called this the great circle of life.  Disney had it right, perhaps our medical systems should learn from Disney. Its as simple as that!

What do you think.  I value your opinions.

Shocked by $9M Horizon CEO salary? N.J. Chiropractors Association has own Horizon horror stories

BY SIGMUND MILLER

COMMENTARY

The recent revelation that Horizon Blue Cross Blue Shield of New Jersey (Horizon) CEO William Marino's compensation package last year was nearly $9 million has come as no surprise to the tens of thousands of doctors and patients throughout New Jersey who have been cheated by the healthcare giant for many years; especially to the Association of New Jersey Chiropractors (ANJC), which represents over 1,600 chiropractors statewide.
As the outcry continues from the general public, legislators, and medical practitioners across the state for legislative hearings regarding Horizon's outlandish executive compensation packages, the ANJC, whose members have experienced first-hand the intransigence and audacity exhibited by Horizon, continues to pursue several strategies to rectify various injustices visited upon chiropractors in New Jersey and their patients by Horizon.
For example, on May 25, the United States District Court for the Northern District of Illinois upheld claims filed under the Employee Retirement Income Security Act of 1974 (ERISA) against 22 leading Blue Cross Blue Shield insurers across the country, including Horizon. The action was filed by a number of individual healthcare providers on behalf of a putative nationwide class of healthcare providers, and multiple state chiropractic associations on behalf of their members, including the ANJC, the Pennsylvania Chiropractic Association, the New York Chiropractic Council, the Florida Chiropractic Association, and the California Chiropractic Association.
The lawsuit challenges the BCBS defendants' abusive practices in using post-payment audits, improper repayment demands, and automatic recoupments, to pressure providers to repay substantial sums that have previously properly been paid on behalf of BCBS subscribers. In denying a series of motions to dismiss the case, the court validated the Plaintiffs' primary legal claim that even retroactive claim denials, including those made as a result of a post-payment audit, require proper appeal rights and other procedural protections under ERISA. The Court also upheld the rights of the state chiropractic associations, including ANJC, to pursue significant policy changes in these auditing and recoupment practices on behalf of their members.
Through the lawsuit, the ANJC hopes to level the playing field for chiropractors facing repayment demands from Horizon by requiring Horizon to fulfill its existing obligations under the law. "We are not challenging Horizon's right to audit claims to ensure payments are made appropriately," said John W. Leardi, Esq., of Buttaci & Leardi, LLC, Special Counsel to ANJC, and co-lead counsel in Pennsylvania Chiropractic Association et al. vs. Blue Cross Blue Shield Association et al., Case No. 1:09-cv-05619. "But too many chiropractors in this state have been unfairly subjected to inflated or otherwise illegitimate overpayment demands from Horizon and been forced to settle because of an inherently unfair process. What we want is a process that requires transparency and fairness; a process where a doctor is given a meaningful opportunity to understand and object to an overpayment demand before facing automatic recoupments from current claims."
The ANJC also continues to fight for fair reimbursement to its members by Horizon on the "front end." For years Horizon, unlike virtually every other private insurance carrier doing business in New Jersey, refused to pay chiropractors separately for patient exams and physical therapy modalities. Instead, Horizon "bundled" reimbursement for these services into payments for chiropractic adjustments. Last October, however, the Department of Banking and Insurance (DOBI) held that Horizon's chiropractic reimbursement policies violated the New Jersey Unfair Claims Settlement Practices Act and ordered Horizon to cease and desist from "bundling" payment for patient exams and physical therapy modalities into the reimbursement it pays for chiropractic adjustments. Nevertheless, it was not until April 15, 2010, that Horizon finally began processing and paying these claims separately in compliance the DOBI's order.
Certainly the DOBI order was a tremendous victory for chiropractors in New Jersey and, more importantly, their patients. And to Horizon's credit, they appear to have stopped bundling chiropractic services on all claims, including those submitted to self-funded plans, which fell outside of the DOBI order. But they have not addressed the thousands, if not millions, of chiropractic claims that were improperly denied in violation of the Unfair Claims Settlement Practices Act prior to October 7, 2009. And frankly we owe it to our members and their patients to explore all possible avenues of potentially recovering these amounts, which we believe are substantial.
The bottom line is that chiropractors and their patients in New Jersey have been subjected to unfair treatment by Horizon for years. So the recent news that last year, when health insurance premiums increased an average of 25% and the economy nearly ground to a standstill, top Horizon executives collected over $24 million in bonuses, came as no surprise to the ANJC, its members, and chiropractic patients throughout the state.

Dr. Sigmund Miller is Executive Director of the Association of New Jersey Chiropractors.

Foods that build muscle and proper nutrition

I was reading an article that was posted on AOL.com news (http://www.aolhealth.com/2010/05/07/8-foods-that-pack-on-muscle/) regarding foods that help build muscle.  One of the biggest problems in our current diet is the lack of protein when compared to simple carbohydrates such as pasta's and breads.  As I have gotten older, I have realized since my job as a chiropractor is quite physical, that without an abundance of protein in my diet, I tend to crash after the meal and feel tired and sleepy.  This is typical if I have a lunch abundant in carbs and light on protein.  Although I love food, during the work week, it is my fuel. I remember Michael Phelps talking about how his diet of in excess of 10000 calories a day was his fuel and at my own level, I need to use the proper fuel to make sure I have the energy to sustain my high level of function throughout the week while treating my patients.  As the casual reader, your needs may differ but food is still fuel.  It helps you maintain your edge during the week and in this competitive world, everyone needs to be at their peak while doing business.  As the saying goes, you are what you eat.  Read the article.  It has some great advice.  What are your thoughts?

AOL Reports Surgery for Back Pain Often Fails - Another perspective

I just read an article on surgery for lower back pain (http://www.aolhealth.com/2010/06/08/surgery-for-backpain-often-fails/) published on aol.  Since we treat many people for back pain, and handle many of the disasters that were mishandled, I believe a chiropractic point of view needs to be voiced.

When people are in severe pain and are scared and cannot sleep, they are willing to sometimes make decisions that are not in their best interest.  Back surgery and injections to the spine to numb the area (done at great cost) are often the medical procedures recommended by surgeons because they are by nature, surgeons.  You do not go to an orthopedic or a neurosurgeon to a conservative opinion, even though many are conservative in their recommendations.

The real problem in all this is that in our health care paradigm as it currently exists, we are obsessed with the site of pain being evaluated rather than evaluating the person, their body style and their gait, which are the most common reason for people having lower back pain and sciatica, as well as neck and shoulder problems and even headaches.

More and more primary care providers are sending their patients to chiropractors first.  The reason is that their methods are safe, effective, have high levels of patient satisfaction and in most cases, their way of thinking leans toward the cause of pain rather than the symptoms that resulted from a mechanical malfunction.

If you have or had lower back pain and visited a doctor, did they ever look at your feet?  Most people will say no which is why they never get relief.  Foot problems are the most common source of lower back problems. What likely happened is that you either were sent for an MRI, x rays or some other diagnostic test, referred to a physical therapist or more commonly a chiropractor and they worked on your back with exercises, or any number of regimens.

The problem is that back pain is a gait issue (an issue with the way you walk).  If your gait is irregular enough, you will get back pain, may have disc problems and are a likely candidate for sciatica  or sacro iliac problems and will not be flexible.  If you were unlucky enough to be sent directly to a surgeon because of your level of pain, you may make that rash decision for a surgery that is harmful rather than helpful because if does not correct the way you walk and instead, attempts to put stability in an area that is being torn apart by the way you walk.

In our office, we prevent many people from ever needing back surgery. The few who do are chosen well and generally do much better than they did prior.  The secret to successful back surgery is picking the person properly.

Before even considering surgery for a shoulder, back, neck or hip, you are better off seeing someone like me who will look at you, find out why the problem is occuring and resolve the cause, rather than just the symptom of back pain.  You are most likely to get better faster, have fewer problems in the future and enjoy a better quality of life.  Trying to identify every pain as its own entity is medical wack a mole, with often less than satisfactory results.  Chiropractic is a wiser decision. You can always have surgery....

Summer Back Pain Prevention With Better Footwear

Sandals and flip flops are going to be huge this summer.  The ugly secret though is that for most of our patients, the cheap flat sandals will cause your back to ache. Since your children are most likely built like you, they likely walk like you.  Never buy sandals without arches.  I will show you examples of what you should and should not buy.  A good sandal is worth the extra cash if you have to do any extended walking.  Your feet, knees, lower and upper back will thank you (trust me on this).

 

Reef Sandals (pictured above) are a great example of a terrific design, with a great arch and they look good too. Many local stores carry them and they are available on line.  Notice these have terrific arches.  Also to the right are Croc's which are a hot fashion item this year and they have good arches too.

Note below are examples of what not to buy.  While these flip flops are inexpensive at Old Navy, they are not appropriate for anyone with foot problems that causes back pain.  People without foot issues can wear these with minimal consequences.  To the right are a typical womens sandal again without arches.  These should be avoided by anyone with lower back problems.

 

There are many other companies that make well designed flip flops which are commonly sold at Nordstroms, Sports Authority, Dicks and have names such as NIke, Teva to name a couple.  Since it is the end of the season around here, you may be able to score big during sales and stock up on great summer flip flops and other styles of shoes.  

Lastly, dont forget to put your arches in your regular shoes and sneakers, especially when playing sports.