I just got an urgent cold call from a Financial Advisor recommending I buy warrants  in UBER since it is about to announce the opening of  a system of  “gig” urgi-care, UBER HEALTH.

You will be able to get a doctor to make a house call within ten minutes using a new UBER HEALTH APP. . If the doctor prescribes an MRI an imaging van will be sent to your house within one hour. Read by a radiologist somewhere in the ethernet.

There will be surge pricing and competition from LYFTparamedic.

Further research disclosed:

IBM WATSON DX will enable you to self-diagnose your health problems and treatment plans through secret proprietary algorithms, while the doctor is on the way.

APPLE MEDICAL SCHOOL will have virtual clinical rotations in medicine, pediatrics, surgery and obs/gyn, where students will deliver virtual babies.

WALMART HOSPITALS will become the anchor hospitals in many communities, right across from Walmart stores.

BLACKROCKdoc will employ 75% of physicians, with practice purchases funded by creating clinical derivatives.

AMAZONrx will dominate the mail order prescription medicine market.

MICROSOFTcare will capture 50% of the health insurance market driving Aetna, United and the Blue Cross plans out of business.

YAHOOlitigator will be do malpractice trolling akin to reverse mortgages.

To quote President Trump “nobody knew that healthcare could be so complicated”…

So I am going to sell all these stocks short.







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It’s okay and important to ask your doctor “DID YOU WASH YOUR HANDS?”

Recently after a doctor’s appointment I went to a nearby lab to have blood drawn for routine tests. I asked the phlebotomist to wash her hands to which she replied she already had. She had washed her hands in another room after the last patient, done some other work, come into the room, put gloves on, then went and used a shared computer*, before finally drawing blood. When I asked, she refused to wash her hands in front of me. So I refused to let her proceed. The same with the second tech. Finally the third washed her hands correctly in front of me.

“Most patients wouldn’t dare to ask their doctor to wash his or her hands..” It’s a simple enough request, but for patients and families who feel vulnerable, scared or uncomfortable in a hospital room, the subject can be too intimidating to even bring up with a doctor or nurse…” (A)

Some hospitals post signs in each examination room encouraging patients to be vigilant about doctor hand-washing; one even gives patients a card stating “Your care provider should clean their hands: 1) Before contact with you; 2) Before a procedure; 3) After a procedure; and 4) After contact with you.” (B)


Some background on Hospital Acquired Infections:

Hospital infections affect almost two million people in the United States every year, 100,000 of whom die. Up to 70 percent of these infections could be prevented if health care workers follow recommended protocols, which include hand hygiene. (C)

“…this sobering truth. When bacteria lurking on, for instance, a medical device, a bed rail, a bandage or a caregiver’s hands find their way into a patient’s body via a surgical wound, a catheter, a ventilator, or some invasive procedure, the disturbingly frequent result is a serious, sometimes devastating, infection.” (D)

“Hospital-acquired infections (HAI) cost $9.8 billion per year, with surgical site infections alone accounting for one-third of those costs, followed closely by ventilator-associated pneumonia at 31.6 percent….” (E)

“Hands are the most common vehicle for transmission of organisms and “hand hygiene” is the single most effective means of preventing the horizontal transmission of infections among hospital patients and health care personnel. “ (F) (G)


Protect yourself! Start by asking your doctor, nurse, phlebotomist, physical therapist and others –



* “It turns out that your computer keyboard could put a host of potentially harmful bacteria — including E. coli and staph — quite literally at your fingertips.” (H) “A study… suggests that dangerous bacteria may be spread by health care workers’ clothing.” (I)



(A)    Why Hospitals Want Patients to Ask Doctors, ‘Have You Washed Your Hands?’ by Laura Landro  http://online.wsj.com/news/articles/SB10001424052702303918804579107202360565642?KEYWORDS=hospital&mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424052702303918804579107202360565642.html%3FKEYWORDS%3Dhospital

(B)   It’s okay to ask your doctor: “Did you wash your hands?”, by Paul Taylor, http://healthydebate.ca/personal-health-navigator/okay-ask-doctor-wash-hands

(C)   Hand Washing Stops Infections, So Why Do Health Care Workers Skip It? ,  by Sanjay Saint, http://labblog.uofmhealth.org/industry-dx/hand-washing-stops-infections-so-why-do-health-care-workers-skip-it

(D)   What Zero Looks Like: Eliminating Hospital-Acquired Infections, http://www.ihi.org/resources/Pages/ImprovementStories/WhatZeroLooksLikeEliminatingHospitalAcquiredInfections.aspx

(E)    Hospital-acquired infections rack up $9.8B a year, by Julie Bird, http://www.fiercehealthcare.com/healthcare/hospital-acquired-infections-rack-up-9-8b-a-year

(F)    Guidelines for prevention of hospital acquired infections, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963198/

(G)  Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene, http://www.jstor.org/stable/10.1086/677145

(H)   How dirty is your Qwerty? by Dan Childs   http://abcnews.go.com/Health/Germs/story?id=4774746&page=1

(I)     Do white coats, scrubs, stethoscopes, cell phones and computer keyboards collect dangerous hospital germs?, by Joe Graedon, https://www.peoplespharmacy.com/2016/11/03/are-doctors-and-nurses-transporting-deadly-hospital-germs/

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Non-compliance with prescription drugs can lead to clinical complications

The last DOCTOR post was about overmedication with prescription drugs and how to talk to your doctor about “DESCRIBING”. “Describing” is tapering off of drugs no longer needed. *

This post is about a related problem, the non-adherence to prescription drugs and the often severe and adverse consequences of non-compliance.

Non-Adherence refers to those who: Failed to fill or refill a prescription; Missed a dose; Took a lower or higher dose than prescribed; Stopped a prescription early; Took an old medication for a new problem without consulting a doctor; Took someone else’s medicine; or Forgot whether they’d taken a medication. (A)

Physicians should confirm that each patient:
– Understands their medications by reviewing: brand or generic name; function; how, when, and length of time the medication is taken; possible side effects; foods, liquids and activities to avoid while on the medication; refills (if necessary); and medication storage.
– Physicians can ask: “This medication will be an additional expense, how does it fit into your finances?”
– Have family members or caregivers be part of the team to help with administration and provide reminders
– And finish with: “I have given you a lot of information, let’s review your understanding of the prescription(s). (B)

Here are some details on the non-adherence epidemic.

The numbers are staggering. “Studies have consistently shown that 20 percent to 30 percent of medication prescriptions are never filled, and that approximately 50 percent of medications for chronic disease are not taken as prescribed,” ….“This lack of adherence….is estimated to cause approximately 125,000 deaths and at least 10 percent of hospitalizations, and to cost the American health care system between $100 billion and $289 billion a year.” (C)

“Within two years of having a heart attack, nearly 1 in 5 people stop taking lifesaving cholesterol-lowering drugs known as statins, according to a new study. And nearly 2 in 5 end up taking the drugs in lower doses or less often than they should…” (D)

“Medications are dispensed with the expectation that they will be taken exactly as prescribed. However, most patients do not follow their doctors’ orders. Excuses take many forms: “The medication was too expensive,” “If 1 pill is good, then 2 pills should be twice as good,” or “I didn’t understand the directions on the label.”” (E)

“… Patients may be no adherent during different stages of their treatment. They may decide not to fill their prescriptions in the pharmacy and not start their treatment at all. Patients may use more or less than the prescribed treatment or use their medication at the wrong time. They may also discontinue treatment prematurely.” (F)

* “DEPRESCRIBING” – Is there an epidemic of prescription medicine overtreatment? Start CHOOSING WISELY http://doctordidyouwashyourhands.com/2017/04/deprescribing-is-there-an-epidemic-of-prescription-medicine-overtreatment-start-choosing-wisely/

(A) Medication Adherence in America:2013, http://www.ncpa.co/adherence/AdherenceReportCard_Abridged.pdf
(B) Teaching Patients about their Medications: The Keys to Decreasing Non-Compliance, https://healthcarecommunication.wordpress.com/2009/02/06/teaching-patients-about-their-medications-the-keys-to-decreasing-non-compliance/
(C) The Cost of Not Taking Your Medicine, by Jane Brody, New York Times, https://www.nytimes.com/2017/04/17/well/the-cost-of-not-taking-your-medicine.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
(D) Many people stop taking life-saving drugs after heart attacks, by Andrew M. Seaman, Washington Post, https://www.washingtonpost.com/national/health-science/many-people-stop-taking-lifesaving-drugs-after-heart-attacks/2017/04/21/705a28e8-253e-11e7-a1b3-faff0034e2de_story.html?utm_term=.14225b93cfe6
(E) Medication Nonadherence: Finding Solutions to a Costly Medical Problem, by Harold Gottlieb, Medscape, http://www.medscape.com/viewarticle/409940
(F) Definitions, variants, and causes of nonadherence with medication: a challenge for tailored interventions, by Jacqueline G Hugtenburg et al, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3711878/


Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

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DEPRESCRIBING – Is there an epidemic of prescription medicine overtreatment? Start CHOOSING WISELY

It is up to you to ask your physician if you, or a family member, are on too many medications.

“If a patient were to hear something to the effect of ‘let’s get some lab tests,’ I would ask the clinician: How many and why?” …. “Once you order six or seven individual lab tests, the odds of one of them being a false positive already is about 20 percent. Just statistically. So if there are a lot of vials of blood being drawn [ask] ‘Why are we doing this? Why are each of these lab tests needed to help in my care?'” (A)

Too many meds may be caused by defensive medicine, different physicians prescribing without considering what the patient is already taking, and patient failure to remember all prescriptions.

Here’s what you can do.
(1) Start by carrying a list of your prescription with you and show it to every physician every time, as well as others who prescribe like dentists and podiatrists. Include on the list over-the-counter supplements such as allergy medicine, probiotics, and pain relievers.
(2) Next, there are many drug on line interaction checkers to use e.g. WebMD http://www.webmd.com/interaction-checker/default.htm RxList http://www.rxlist.com/drug-interaction-checker.htm Medscape http://reference.medscape.com/drug-interactionchecker
(3) Then go to CHOOSING WISELY http://www.choosingwisely.org which seek to reduce overtreatment, and incorporate these recommendations into practice guidelines, local best practices, and decision support systems.
And, most importantly, tell your primary care practitioner every time you get a new prescription from another doctor or start a new over-the counter product.

NOW read the rest of this post to understand why this is so important!

“The point of prescription drugs is to help us get or feel well. Yet so many Americans take multiple medications that doctors are being encouraged to pause before prescribing and think about “deprescribing” as well.
The idea of dropping unnecessary medications started cropping up in the medical literature a decade ago. In recent years, evidence has mounted about the dangers of taking multiple, perhaps unnecessary, medications.” (B)

Here are some examples:
“When it comes to treating seniors with diabetes, new research suggests that doctors often don’t cut back on medications, even when treatment goals are surpassed.
The study found that when people had potentially dangerous low blood sugar levels, just 27 percent had their medicines decreased. And when blood pressure treatments lowered blood pressure levels too much, just 19 percent saw a reduction in their medications.” (C)

“….efforts to curb excessive antibiotic use toward outpatient and long term care settings. As many as 70% of nursing home residents receive at least one course of antibiotics each year, but up to 75% of those prescriptions are unnecessary, or the wrong drug, dose or duration of treatment is given, according to the CDC. UTIs are a commonly over-diagnosed in seniors, relying on vague symptoms of confusion or bacteria in the urine, leading to antibiotic overuse. “(D)

“The study…, found that in older adults aged 70 or older, taking blood pressure medication was linked to a higher risk of serious falls. (Serious falls as in, falls that caused an ER visit for a fracture, a dislocated joint, or a brain bleed. Serious stuff indeed!)” (E)

“Avoiding overdiagnosis and overtreatment also means letting go of some longstanding notions, such as the doctor always knows best; more treatment is better; and that improved technology and early screening will definitely lead to better outcomes..”
“How can we decrease overtreatment? Reducing the use of screening or diagnostic testing that relays more information than requested, increasing the use of surveillance or watchful waiting when small or lower-risk abnormalities are detected, and performing studies to determine the extent of benefit (if any) of treating abnormalities…(F)

(A) Signs of Overtreatment: How to Avoid Unnecessary Care .What to know before saying “yes” to more tests, procedures or prescriptions, by Michael O. Schroeder, http://health.usnews.com/health-news/patient-advice/articles/2015/08/18/signs-of-overtreatment-how-to-avoid-unnecessary-care
(B) How Many Pills Are Too Many? by Austin Frakt, New York Times https://www.nytimes.com/2017/04/10/upshot/how-many-pills-are-too-many.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
(C) Too Many Seniors With Diabetes Are Overtreated by Serena Gordon, http://www.webmd.com/diabetes/news/20151029/too-many-seniors-with-diabetes-are-overtreated-study-suggests#1
(D) CDC warns of overdiagnosis and overtreatment of UTIs in seniors, https://www.univadis.com/viewarticle/cdc-warns-of-overdiagnosis-and-overtreatment-of-utis-in-seniors-316988?s1=news
(E) Blood pressure medications linked to serious falls: What you can do, by Leslie Kernisan, http://betterhealthwhileaging.net/falls-blood-pressure-medications-elderly/
(F) Improving Quality by Doing Less: Overtreatment, by Jessica Herzstein and Mark Ebell, http://www.aafp.org/afp/2015/0301/p289.html

Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

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LET’S MAKE AMERICA ALTRUISTIC AGAIN! National Volunteer Week – April 21-29.

As our economy takes off, there are still many left behind or in need of a helping hand – including veterans with disabilities, those with behavioral health and addiction challenges, the undocumented without access to health services, refugees seeking a new start, and many, many more.

Not-for-profit health and social service agencies are often the only source of case management services for these people are major contributors to our communities. They always need our support but perhaps more so now than ever with the “soft” program cuts proposed in the Trump administration budget to pay for increased military spending.

“If you are not part of the solution, you are part of the problem.” And part of the solution is to volunteer.

We celebrate the selfless individuals around our country who channel their civic virtues through volunteerism… devoted to a cause bigger than themselves….. ~Barack Obama

“Volunteering offers vital help to people in need, worthwhile causes, and the community, but the benefits can be even greater for you, the volunteer. Volunteering and helping others can help you reduce stress, combat depression, keep you mentally stimulated, and provide a sense of purpose. (A)

The smallest act of kindness is worth more than the grandest intention. ~Oscar Wilde

Don’t expect someone to come knocking on your door asking you to volunteer. You have to do it yourself.

Where to begin? “We live in a world where technology can connect us with new opportunities in almost every area of life, from who to date to what to have delivered for lunch. And while these choices can enhance and enrich our lives, people with time, skills and a desire to do good are also looking to technology to help them make a difference in the lives of others.” (B)

Here are some links to get started: web sites that match organizations looking for volunteers with folks look for nearby volunteer opportunities.
Catchafire https://www.catchafire.org/
VolunteerMatch https://www.volunteermatch.org/
boardnetUSA™ http://boardnetusa.org/public/home.asp
Create the Good http://createthegood.org/
Idealist https://www.idealist.org/en/?type=VOLOP
AllForGood http://www.allforgood.org/
Do Something https://www.dosomething.org/us/about/who-we-are

Even if it’s a little thing, do something for those who have need of a man’s help, something for which you get no pay but the privilege of doing it. For, remember, you don’t live in a world all your own. Your brothers are here too. ~Albert Schweitzer

(A) https://www.helpguide.org/articles/work-career/volunteering-and-its-surprising-benefits.htm
(B) http://www.huffingtonpost.com/2014/01/13/volunteering-websites_n_4551665.html

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I CAN’T DECIPHER MY EOBs. It is rocket science to unravel the complexity.

I usually toss my Explanation of Benefits (EOBs) into a basket, then later throw them out without any review.
I have Medicare with secondary coverage from United, and I get sequential Explanations of Benefits (EOBS) from each.
Here are some of the reasons I can’t figure out whether or not my claims have been processed correctly.
– The Medicare and United EOBs are different and it is difficult to try to link them
– Each has a separate deductible and it’s hard to track
– Some secondary insurers “outsource” certain categories of service such as rehab/chiropractic generating additional EOBs
– I also get a periodic Medicare Part D report, for the Prescription Drug benefit
– If Medicare doesn’t pay then United won’t either even if United would pay if it was primary. For a given provider the secondary co-pay is different depending on whether or not the provider is in or out of network, no matter that Medicare pays
– Every provider codes claims differently so similar service at two providers may be coded and billed differently.
– When I got PT in two different places one charged me $20 per visit, the other calculated a co-pay for each visit.
– I am going to a chiropractor who accepts Medicare and is out-of-network for United so I will not know my out-of-pocket costs until I get both EOBs.
– Medicare and United have different appeal procedures. If I can’t link the EOBs it’s impossible to know where to appeal

Here’s a personal frustrating example:
In early December I received a bill and paid $205 for a lab test done at a reference laboratory. No insurance claims had been processed.
After I followed up, in March I got an email: “I contacted XXX and spoke with ZZZ. Per ZZZ Medicare processed and made payment on one of the charges but denied the other (processed the $82.00 charge denied the $123.00 charge). He is confirming the reason for the denial for the second charge and will work with Medicare regarding processing it for payment. Currently you have a credit of $73.38 however Empire has not processed and paid for the $8.62 coinsurance applied by Medicare. ZZZ will submit that as well.”
As of April 9th, still not resolved.

We are “collateral damage” in a war between hospitals and insurance companies. *
The obvious but unlikely solution is universal coding/ claims/ EOB by all providers, integrated to simplify tracking of a claim through primary and secondary insurers.

to learn more about EOBs you might look at:
What is an EOB? http://www.medicalbillingandcodingu.org/what-is-an-eob/
Understanding Your Explanation of Benefits http://www.patientadvocate.org/index.php?p=441
Understanding Your Explanation of Benefits (EOB) – How to Decipher Your Explanation of Benefits https://www.verywell.com/understanding-your-eob-1738641

Two “must read” articles:
Markups On Care Can Fatten Hospital Budgets — Even If Few Patients Foot The Full Bill, by Chad Terhune. Kaiser Health News. http://khn.org/news/markups-on-care-can-fatten-hospital-budgets-even-if-few-patients-foot-the-full-bill/
Those Indecipherable Medical Bills? New York Times. by Elisabeth Rosenthal. https://www.nytimes.com/2017/03/29/magazine/those-indecipherable-medical-bills-theyre-one-reason-health-care-costs-so-much.html

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Let’s prohibit Congressmen from insurance reimbursement for Prostate Screening and Treatment

Living in the rarified world of VIP access to health care maybe it’s time for a non-randomized clinical trial, with Congressman being in a study group where they have to pay out-of-pocket fee-for-service with no reimbursement, for prostate screening and treatment.

So they can experience what life was like for 20 million Americans before Obamacare.

Some specifics of the trial. They must get care in their districts. No “professional courtesy” from local physicians. No free PSA. Go to the ER if further tests are needed and become “self pay”, or apply for “charity care” and/ or work out a payment plan for the hospital charges, radiologist, urologist +++

THEN in a year come back to Washington and revise the Obamacare algorithms to assure its sustainability.

For which they might start be reading How to Build on Obamacare by Paul Krugman of the New York Times.
“Actually, though, health care isn’t all that complicated. Basically, you need to induce people who don’t currently need medical treatment to pay the bills for those who do, with the promise that the favor will be returned if necessary.
Unfortunately, Republicans have spent eight years angrily denying that simple proposition. And that refusal to think seriously about how health care works is the fundamental reason Mr. Trump and his allies in Congress now look like such losers.
But put politics aside for a minute, and ask, what could be done to make health care work better going forward?”

To see some solutions read the rest of the article by clicking on https://www.nytimes.com/2017/03/27/opinion/how-to-build-on-obamacare.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
To understand why “Repeal and Replace” was a flop click on LESSONS LEARNED: TrumpRyanCare Obits at http://doctordidyouwashyourhands.com/2017/03/lessons-learned-trumpryancare-obits/

And, worth reading:
Is Obamacare a Lifesaver? By Ross Douthat, New York Times https://www.nytimes.com/2017/03/29/opinion/is-obamacare-a-lifesaver.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

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