Thursday, October 20, 2016

(28) National Eye Health Education Program (NEHEP)

Join us and learn more about diabetic eye disease.  Health Train Express is pleased to be a sponsor as well as a proponent of managing diabetic eye disease.

The progress in treatment of early diabetic retinopathy has  improved immeasurably.

A key component for diabetics is to monitor your blood sugars.  An annual eye examination or an annual fundus  photo of the retina  will often find undiagnosed diabetic retinopathy.  This can be accomplished by your regular vision provider, optometrist or ophthalmologist. An annual fundus screening using photography provides an excellent means for screening and it provides a permanent record for comparison from year to year. Often the earliest changes from diabetic retinopathy are not symptomatic. Diabetics who experience blurring of vision may have the earliest form of macular edema.  Any diabetic who has vision problems or changes in vision should be examined immediately.

The treatment of late diabetic retinopathy (proliferative) has evolved from laser photocoagulatioin to medical drug therapy using intraocular inhibitors of new vessel growth (Avastin).  This new treatment minimizes retinal damage and often restores lost vision.

The NEHEP provides an excellent presentation, which was featured on 'Facetime'. In this video Dr Emily Chu a prominent eye research scientist at the National Eye Institute..

The progress has been amazing.  When I began my ophthalmology practice in 1975 most patients with proliferative diabetes were blind within five years.  It was very disheartening.

Today there is no reasnn why anyone with diabetes should go blind from diabetes.

Sam Omar,,M.D. a fellow ophthalmologist has this to say,

" During my training at UCLA in 1997 I was speaking to one of my mentors Dr Straatsma. I was particularly excited one day because I had assisted the retina fellow in repairing a detachment for a patient. My mentor had told me when he was in training in the late sixties he had attempted to surgical reattachment repair for a detached retina and was unsuccessful in three out of three patients. Those patients all went on to becoming permanently blind. Fast forward - 2015 the technology has improved so much in my short life span of Ophthalmology over the past 20 years. The first picture shows a retina specifically the central retina detached with fluid floating underneath it that's the black in the lower part of the picture. The next picture shows the retina completely reattached so perfectly that the organization of the photoreceptors and the retinal pigment epithelial cells is entirely intact. There is normal organization of the retinal layers and the retina is set up perfectly to heal and function properly. This repair was done by a particularly skillful surgeon. Technology is everywhere and I even used it to dictate this Facebook post with no mistakes in all of the above technical terms."

(28) National Eye Health Education Program (NEHEP)

Sunday, October 16, 2016

Lessons I’ve Learned from Patricia Bath, MD F.A.A.O.

The title seems ordinary enough, but hidden in it's meaning is the life of the first woman ophthalmologist of color.  One who broke through  'the glass ceiling' as early as 1974.

For those who speak of breaking through a glass ceiling for are a bit late !  Medicine however offers an undeniable metric for advancement, achievement and dedication. In other disciplines such as business financial measures, leadership ability or political persuasion are more amorphous measures for a 'glass ceiling.

Patricia Bath's career path runs very similar to Ben Carson, MD (former Presidential candidate for President of the United States. She was born in poverty, and went to what some would call a second rate School of Medicine.  That was the last step in 'second rate' institutions. From there she was accepted to a major world class ophthalmology training program, eventually earning faculty status.

For me as the average white male  American I don't think I can fully appreciate her journey. With all the   privilege of being white I still had challenges pursuing my education. The competition to become accepted to medical school is extremely high,  the competition to be accepted into an ophthalmology training program is even more intense, and becoming the chair of an ophthalmology training program one of those 'never events' we speak of in complications of surgery.

The graphic below  succinctly maps her progress to recognition

The Career path of Patricia Bath M.D. F.A.A.O.

Her inspirational thoughts will fuel the desire of many more women and men of color.

When she chould not  penetrate an impregnable barrier, she went around it,  preferring to not waste energy  and to pursue her own interest.  All of which is evident from her outcome.

My favorite motivational saying is "Believe in one-self"  Ask  few for opinions (be sure who you ask in t he first place.  Don't listen to negative answers.  Remain committed to your goals. Find people who believe in  you and will assist you, or at least not stand in your way.

I salute all the 'suffragettes who strive to improve humanity with their standards, goals.

This post gave me great pleasure, one of the most enjoyable as well as satisfying, to recognize a great physician (ophthalmologist)  I have written (in my humble opinion)

Gary M. Levin M.D. F.A.A.O.


Lessons I’ve Learned

How Government Solved the Health Care Crisis - Animation

The Lodge and Fraternal Society Model for Health Care was the forebearer of our present dilemna, of inadequate access to health care.  Those who do not know history are doomed to repeat it.

Government solved the last crisis !

How Government Solved the Health Care Crisis

Family Practitioner Awarded Family Physician of the Year

Family medicine has always been at the heart of medicine. If you ask a patient they willl usually say 'Our family doctor is .....  It bespeaks much of the complexity of credentials, board certification and the rest of it. Most patients are not that aware of what all those diplomas are on the wall. And with  the general training all young physicians obtain, and are licensed as MDs in all states, not as a specialist most MDs are capable of handling routine complaints and treat simple disorders. If they can't then they should not be practicing medicine (in my opinion)

My perspective may be a bit skewed by the fact that I did general medicine after internship in t he Navy and practiced family medicine for three years afterward.  When I had a major heart surgery, I relinquished my scalpel for several years, returning to family medicine with a colleage who  used to refer to me.

This announcement caught my eye and is well worth recognition.

At just 11 years old, Karen Smith, M.D., went on the trip of a lifetime.

Smith's mother wanted to visit Walt Disney World with her children. In 1972, the family made the trip to Orlando, Fla., and it's where a young Smith learned the power of imagination, belief and creativity. Walt Disney's famous saying, "If you can dream it, you can do it," resonated with her.
Smith's mother died from sarcoidosis not long after the trip, but the memories they created inspired her daughter to pursue a career of medical service.
"It's amazing what a mother can instill in her children," Smith told AAFP News. "Those memories are in us, and those memories are what have allowed me to do what I've done … with the grace of God."
For her efforts, Smith has been named the Academy's 2017 Family Physician of the Year. The award recognizes a family physician who stands out among his or her colleagues for providing compassionate and comprehensive care, enhancing the quality of the community, and acting as a credible role model. Today, 43 years after her first trip to Orlando, Smith has returned to the city to accept this award during the AAFP Family Medicine Experience.
Another example of the unsung, underpaid, overwhelmed primary care internists, pediatricians and family medicine physicians...In today's world primary care providers take a residency as long as most other specialtlies.  

  • Karen Smith, M.D., of Raeford, N.C., has been named the 2017 Family Physician of the Year.
  • The award recognizes a family physician who stands out among his or her colleagues for providing compassionate and comprehensive care, enhancing the quality of the community, and acting as a credible role model. 
  • After more than two decades in rural practice, Smith says she still is driven by the power of touch -- physical, emotional and spiritual.

Compassion, Imagination and Belief Inspired 2017 FPOY

Tuesday, October 11, 2016

How those pharmacy coupons may increase your health care costs

How drug coupons 'undermine' payers' efforts to limit healthcare costs

Consumer drug vouchers for pricey pharmaceuticals--like Mylan’s EpiPen--may lead to market failures that dissolve the incentive for powerful pharmaceutical firms to reduce prescription drug prices, hurting payers' cost-control efforts.

Here are five ways, according to a article published in the Annals of Internal Medicine, that vouchers to help offset the cost of drugs like EpiPens interrupts the proper functioning of the market--and subsequently contributes to higher future healthcare costs:

  • Co-pay assistance placates “public outcry.” Public pressure, such as articles about the high cost of EpiPens, seemed to be correlated with a “reduction in the magnitude” of price hikes by Mylan, the authors note. Appeasing consumer anger can circumvent such processes, and therefore lessen pressure on companies like Mylan to reduce prices.  
  • The vouchers subvert insurers' strategies to limit healthcare utilization for low-premium, high-deductible enrollees. Low-premium, high out-of-pocket expense health insurance plans shift the burden of healthcare utilization onto consumers, nudging them to use fewer healthcare services--which lower total healthcare expenditures. The co-pay assistance programs “undermine” this effort, pressuring insurers to increase premiums across the board, the authors say.
  • They create an artificial price distortion. High prices are supposed to encourage consumer shrewdness in the marketplace, according to the authors, which theoretically should “include scrutiny” of product price and quality. The researchers thus conclude copay coupons “keep patients from acting as consumers,” reducing the incentive for consumers to factor price into their decisions and further decreasing the incentive for pharmaceutical firms to lower their prices.
  • The tactic handcuffs insurers’ leverage during negotiation with drug companies. Insurers that reach price concession agreements with drug producers reflect this in their formulary tiers with lower out-of-pocket costs--and vice versa for manufacturers that insist on high prices. Pharmaceutical companies like Mylan, which offered patients $300 coupons, are able to sidestep this mechanism by keeping out-of-pocket expenses lower for consumers when insurers aim to keep them high.
  • Co-pay assistance programs don’t live up to their promises.Pharmaceutical companies don’t provide financial assistance to all filled prescriptions, only for patients who haven’t hit their deductible to have their insurer prescription benefit kick in. Insurers can’t ascertain payments made by patients versus those covered by the co-pay coupons, ultimately helping patients hit out-of-pocket maximums quicker. For specialty drugs that can cost up to $10,000 per month, insurers can be left to foot the bill much earlier in the year.

Medicare Part D spending on EpiPens grew more than 1,150 percent over a seven-year period from 2007 to 2014 while the number of beneficiaries receiving the treatment increased a disproportionate 164 percent. The ensuing public frustration resulted in CEO Heather Bresch to testifying at a Senate hearing to defend the 400 to 500 percent price hikes.

Most health cost containment programs just shift the burden or cost to another segment of the health industry.  There is one big pot, which we must all share. And the partcipants do not play fair.

Thanks to Fierce Health Care Payer for most of this article.

Thursday, September 22, 2016

Anthem, Cigna Have Accused Each Other of Merger Breach - WSJ

The ink has barely made it to the paper, and Anthem and Cigna have gotten cold feet regarding their proposed merger.

The blowback from the public and the DOJ, FTC are working, even without a formal filing or restraining order. In order to save face....blame each other. It's a no lose situation for counsel for either company.  What the heck, those guys are on multi-mllion dollar retainers either way...A nice cash flow for the junior non  partner attorneys for the big law firms in the health and insurance niche.  They most likely reasoned it would cost more money to litigate than to simply carry on as they are now. (that is how obscene the amount of money is at stake and how much money these companies have under their mattresses. How long is the American public going to put up with these rules that bankers and insurance companies write for themselves ? Are we a ship of fools ? Yes

Sometimes it makes me wish I had gone to law HMOs no ObamaCare, no EMRs Meaningful use, MACRA, MIPS, Accountable Care Organization, getting paid for volume, not outcomes....etc. Now that I am retired (I am young only 73 and my life expectancy is still pretty good according to the latest stats. I could retrain here at my local Western law school and make some really big bucks !

Doctors don't seem to have time anymore for Wednesday (or is it Thursday) afternoon golf..but since I am retired I do. Even though I don't play golf I am willing to give up my afternoon nap time to study for my new profession.

Anthem, Cigna Have Accused Each Other of Merger Breach - WSJ

The Top Gun of Health Train Express Blogs for 2016 (so far)

Our readership fluctuates quite a bit, averaging a paltry 200-300 users/day. Most of the readership is from the U.S. and the U.K.

This year we had several posts that went well above 1000 readers/day.  Like most internet publications readership depends heavily upon Google searchs.  Readership continues for days, weeks months and even years.  We network our contributions on facebook, twitter Newsana, Digg, Redditr and a list of email subscribers. We have an RSS  feed as well.

Top Gun Posts: