Great article in the New York Times, that brings light to the ‘behind the doors,’ deals made by insurance and pharmaceutical companies. Doctors and their patients need to unite to lobby lawmakers in order to stop these practices that are causing financial hardships to both parties.
To add insult to injury, insurance premiums are also going up. From the patient perspective, does one pay the mortgage, pay for doctor visit co-pays, buy proper groceries, or pay for medications?
From the physician and their staff perspective, does one provide top notch service or spend time sorting out prescription plans?
Despite patient premiums increasing, insurers are also requiring record number of prior authorizations which hinder delivery of prompt care. The need for prior authorizations for all cardiovascular testing and many medications are now taxing cardiology practices.
It is as if the insurers are testing the resilience and perseverance of physician practices to obtain prior authorizations. Can they push through and afford the staff labor to get approval for much needed cardiovascular testing? If we do not try, patients may be harmed. One cant help but wonder if insurers hope the physician staff gives on pursuing authorization for testing in an effort to save money. If a patient has a bad outcome attorneys purse legal action against physicians and not insurers who stood in the way of appropriate care.
Marked rises in labor hours/costs to fight insurance companies hinderances and documenting immense amount metrics that are required to be compliant with Medicare are slowing killing private, solo, physician practices. As a Cardiology practice participating in an Accountable Care Organization (healthcare organization that ties payments to quality metrics and the cost of care) we are required to document whether we screened a patient for depression. This takes physicians and staff away from direct patient care. Also, many physicians are forced to join large hospital groups or start concierge practices that only a few patients can afford.
This increasing need to investigate medication denials and looking into alternatives is causing an immense amount of labor hours to physician practices. Between staff calling the pharmacy, the insurance company and subsequently discussing with the physician and finally the patient takes hours worth of unpaid work. Again this redirects physician and staff labor to paperwork and jumping hurdles to prompt and appropriate care.
Recently, we had a cardiac patient who had muscle aches on atorvastatin. As directed the patient took the drug a second time at our direction. She previously had a reaction to pravastatin which has been documented. Hence after the second attempt we changed to rosuvastatin, which recently has become generic. After my staff spend
30 continuous minutes with insurance companies on two different days (for a total of 60 minutes), the medication is still yet to be approved. The patient currently has no statin medication for heart protection. Another attempt by my staff will be made for prior authorization.
Interestingly, we are also finding that older, generic medications prices are often surpassing the price of their more modern counterparts. If a patient cannot tolerate a new drug or their is a contraindication we reach to older drugs. When this change is made we are spending a lot time trying to get prior authorization for a generic drug. Again making multiple phone calls to the insurance company, the pharmacy, the physician, and then calling the patient with the outcome again takes in immense amount of resources.
There is no immediate solution to this problem. To start, patients and physicians need to start lobbying our local lawmakers to bring these issues to light by contacting your elected official and/or being vocal. The doctor patient relationship needs to transcend medical care and also focus on policymaking.
Thanks to AliveCor for sponsoring our walk and bringing their health care technology ————Blood pressure cuffs and personal EKG monitors that automatically upload to our online portal! This allows Hosmane Cardiology to remotely monitor our clients (See how it works below or come into the office for a demonstration). The Alivecor telemetry monitors are a great tool for screening for abnormal heart rhythms and to help us titrate your medical therapy.
SEE HOW ALIVECOR WORKS
These devices help treat and screen for hypertension and for atrial fibrillation both of which cause strokes.
Other risk factors for stroke include: Tobacco Use, Diabetes, Unhealthy diet, Lack of Exercise, Obesity, and High cholesterol.
780,000 strokes occur in the USA per year.
We ask that you and your loved ones remember the acronym FAST (from the American Heart Association)
F = Facial asymmetry
A = arm weakness
S = speech difficulty
T = Time to call 911 (Call 911 and don’t try to drive. Your EMS crew will know the closest stroke center which will give you the highest chance of survival and recovery)
Please discuss with your healthcare provider regarding screening for your risk factors for stroke.
Thank you again to everyone that came out.
Be Safe and Keep Walking
What is Optifast:
The Optifast program is a comprehensive obesity management program that combines the proven essential features of weight loss success to help patients conquer their obesity challenges and obesity-related comorbidities such as Hypertension, High Cholesterol, and Diabetes.
The program is committed to the patients:
- A medically monitored program that offers ongoing HCP and patient support to encourage success.
- Nutritional profile of Optifast 800 products includes increased protein, reduction in total sugars, and an addition of soluble fiber.
- Long standing legacy in clinical nutrition with more than 40 years of experience in weight loss.
- Supported by more than 80 publications and ongoing research.
What’s New at Optifast
- Optifast 800 Products
- New, contemporary packaging
- Easy to Read Benefit Icons
- Easy to Identify Flavors
- Color coded by item with cross-selling information on side panel
- Same size boxes and shippers will not disrupt clinic storage.
- New Product and new flavor options.
Nutrient Content of OPTIFAST 800 products:
- Reduction in total sugars
- Excellent source of protein, now with 16 grams per serving.
- Good source of fiber, now with 3 grams of soluble prebiotic fiber per serving.
- All OPTIFAST products remain nutritionally complete meal replacements.
- Excellent source of at least 24 vitamins and minerals (varies by product).
Dr. H recently attended a course at the Culinary Institute of America in California that was titled “Healthy kitchens and Healthy Lives,” which was a collaborative course between the Harvard School of Public Health and the Culinary Institute of America.
A major part of the treatment and prevention of cardiovascular disease is learning how to cook. The wave of the future is Medical institutions having teaching kitchens and trained chefs in order to train patients how to live healthy lives by cooking intelligently with simple meals.
Dr. H said “though it was a short three-day course, it was a great opportunity to learn from public health experts and experienced chefs. I hope to be able to share this information with my patients and one day have a teaching kitchen. Unfortunately, insurance companies and the government have truly not embraced this form of prevention. Patients need to take the initiative and pay out-of-pocket for preventive services. Little effort and cost are needed if one wants to cook healthier and prevent disease. We do know that in cooking at home and eating with family is much cheaper, healthier, and rewarding.”
A Visit to The Cleveland Heart Lab
by Dr. Hosmane
Just returned from a great trip to Cleveland where I visited with the Cleveland Heart Lab.
Great people. Great lab. Great Mission. They are a speciality lab and one of the things they measure for Hosmane Cardiology is inflammation through inflammatory markers.
50% of people who have heart attacks or strokes have normal cholesterol; the reason this occurs is that of inflammation. Lack of inflammation is why those with elevated cholesterol may not have a heart attack or stroke.
Check out Know Your Risk and discuss inflammation with Hosmane Cardiology.
Watch the Know your Risk Video in which you can learn more about how simple blood tests can help understand your inflammation and assess your individual risk for heart attack and stroke.
Thanks to the Cleveland Heart Lab Team and my fellow clinicians for the insight and exchange of ideas!!
Labor Day Weekend Hands International Trip to Trinidad
I recently returned from a four-day medical mission over Labor Day weekend to Point Fortin, Trinidad as part of the Hands International Team. The team was led by Dr. and Mrs. Reynold S. Agard (Internal Medicine) and Drs and Mrs. Lester Horrell (Pediatrics) and their families. Both families are natives of Trinidad. Dr. Agard is President of Hands International, which is a nonprofit agency dedicated to Health Care Delivery with compassion as well as Health Development around the world. This group has traveled to areas of natural disaster, most recently in Nepal and Haiti a few years ago. Also, Dr. and Mrs. Agard also kindly accompanied my Father and I to India for our Medical Mission in February 2016.
Having participated in planning and executing two medical missions to India in 2014 and 2016, I was glad to serve solely as a Cardiologist and leave all the planning, logistics, and politics to the Agards and Horrells! Though the country needed our assistance, there was tremendous of amounts of red tape. We heard that the week prior, a team from England that arrived was not allowed to practice as their paperwork was not in order.
The team consisted of about 70 people from the USA and Trinidad. Our Team included Doctors, Nurses, Pharmacist, and nonmedical volunteers. We had physicians from various specialties who are listed below; there were three cardiologists on the team, including myself.
We received tremendous support from the Point Fortin, 7th Day Adventist Church. This group welcomed us with open arms and provided much love and support, not to mention local cuisine. As someone who practices a different religion, I felt at ease with them and in their place of worship. They welcomed all those from our team with who had different faiths and religions.
Our team treated about 1,800 patients. We worked for 10 hour days, only with a few minute break for lunch. The temperature was about 96 degrees with 78% humidity. This made hydration essential. The team worked tirelessly without complaint.
Most patients were seen for the usual complaints seen in a primary care doctors office. We did have a few very sick patients. Though the patients have access to physicians, it seems their physicians lacked the time to truly educate them about their disease. This is the same issue we are faces in the US Healthcare system. Declining reimbursements and increased staff labor costs due to massive amounts of mandated paperwork and regulation. There’s also a large waiting list for procedures; we were told there’s a six-month waiting list for an elective hernia repair. Our general surgeon is likely to return soon to help with that backlog.
All of us found that the patients were very respectful. Many had waited for hours to be seen and had arrives at sunrise. We did not hear any complaints. They had a great command of the English language, not surprising given a 98.8% literacy rate of those over age 15. Most patients came prepared with a list of all their medications and dosages. They even brought medical records with them. Surprisingly a very high percentage of patients that I treated for hypertension owned home blood pressure kits and came with a bp log.
A highlight was working very closely with my fellow colleagues from Delaware. Normally, we chat on the phone or meet briefly in the hospital to discuss and co-manage patients. But, for four days we worked side by side and were able to have instant consultations. In addition, we had time to learn from each other.
Another highlight of the trip was being able to perform a cardiac ultrasound. Ultrasound is a special interest of mine but I don’t often get time to scan due to time constraints and the need for efficiency. Many thanks to Ava Horrell and Dr. Amar Sortur for helping me figure out all the new buttons on the portable ultrasound machine. Hands international’s ultrasound greatly enhanced our evaluation and management.
Of note, I was also able to scan and work with Cardiologist, Tony Furey who helped train me in echocardiography while I was a Cardiology Fellow at Christiana Hospital. Also, Dr. Kamar Adeleke was on this trip and he taught me in medical school. Working with my teachers made me realize how much I have progressed.
There’s talk of a new hospital in Point Fortin and the Health Ministry is looking for collaboration from abroad to help with setting up their departments and helping with healthcare delivery. Hands International is keeping abreast of the situation and seeing if they can help.
Now that I have a valid Trinidad medical license for one year, I am looking forward to returning. It was very refreshing to practice medicine without the restrictions imposed on our profession by our government and policymakers.
Trinidad and Tobago is a great melting pot of multiple cultures. This shows in the people, cuisine, and national holidays.
Thank you to the Agard (Ingrid, Rey, and Richard) and Horrell (Ava, Lester, and Carlyle) Families and the 7th Day Adventist Church in Point Fortin for making this happen and for a wonderful introduction to Trinidad.
More from Delaware Online
by: Dr. Vinay Hosmane
I have been asked this question many times and personally I have pondered this as well as it relates to my own health. My thoughts have changed many times over the years. Early on I felt why to take supplements, just eat a well-balanced diet.
But, then while away in Grenada for the first two years of medical school, I felt sluggish; the main change in my diet was a decrease in green leafy vegetables due to the fact the ones on the island didn’t agree with my GI tract. Hence, I actually started taking Centrum Silver Multivitamin (MVI) at the suggestion of my physician Father. I felt back to normal after a few weeks taking the VMI and I continued it for 1.5 years. Upon returning back to the States and completing the final two years of medical school in New Jersey, I stopped the multivitamin and went back to a lot of green leafy vegetables which I was able to tolerate. The reason for my intolerance to green leafy vegetables was likely due to the water used to wash them or the lack of washing.
As an internal medicine resident, I soon forgot my personal experience and resorted back to the view that people were wasting their money on supplements. All vitamins and nutrients are available in food so we should just eat properly. Subsequently, as I became interested in Cardiology, I learned about an Italian study that showed that Omega 3 Fatty Acid Supplementation decreased the occurrence of Ventricular Tachycardia (a life-threatening and often fatal heart rhythm). Now, this study was conducted in Italy in patients that presumably exemplified the Mediterranean Diet. So, I thought, despite having fish in their diet they were still benefiting from extra supplementation.
Over the past few years, more data has surfaced and more advanced testing has been developed to show the levels of various vitamins and nutrients and building blocks.
I have been reading and hearing quite of bit about the following supplements:
Omega 3 Fatty Acids
- Decrease the incidence of ventricular tachycardia in post-MI patients
- Alleviate dry eyes
- Decrease joint inflammation
- Decrease recurrence of atrial fibrillation (an irregular heart rhythm that causes strokes)
- Decrease vascular inflammation and thus atherosclerosis and heart attacks and strokes
- Decrease blood pressure (Learn More)
***Please talk to my staff regarding their preferred brand of burpless fish oil that has high concentration of Omega-3 FA (DHA and EPA)
Low vitamin D may be an independent risk for heart attacks and strokes. Data from dozens of studies over the past 30 years is now so robust that a 2014 comprehensive review concludes that vitamin D deficiency meets established scientific standards as a “causal” risk factor for cardiovascular disease (CVD), the leading killer of American men and women, often from heart attacks and strokes.
A 2015 study of more than 200 overweight middle-aged women who were low in vitamin D found that those who dropped pounds through diet and exercise, while also taking vitamin D supplements, had greater improvement in their levels of inflammatory biomarkers than that seen in women who only lost weight.
Many Americans are low in vitamin D, which plays a role in protecting against heart disease, stroke, diabetes, and several forms of cancer.
Has a role in prevention and treatment of the following:
- Cardiovascular disease (CVD). Recent studies show that CoQ10 supplements can significantly increase HDL-C and ApoA1 levels, even in people taking statins, and may help reduce risk for CVD. CoQ10 supplementation also lowers levels of inflammatory biomarkers shown to be risk factors for CVD, such as high-sensitivity C-reactive protein. Finally, low CoQ10 levels have been associated with greater tissue damage to the heart during a heart attack and the brain during stroke.
- Statin-related muscle symptoms. Although statin therapy can significantly reduce heart attack and stroke risk, up to 25 percent of patients quit treatments within six months due to side effects, such as muscle aches and weakness. In a 2014 randomized clinical study published in Medical Science Monitor ,75 percent of statin users with muscle symptoms reported reduced pain after taking CoQ10 twice a day for 30 days, versus zero improvements in the placebo group. The researchers concluded that combining statin therapy with CoQ10 supplements could lead to higher compliance with treatment.
- Heart failure (HF). CoQ10 was hailed as “the first new drug to improve heart failure mortality in over and decade” after a multi-center randomized study of 420 patients found that taking it reduced deaths in patients with severe HF by half, compared to a control group. The researchers tracked the patients for two years. The study was presented at the Heart Failure 2013 congress in Lisbon and later published in Journal of the American College of Cardiology Heart Failure
- High blood pressure. In an analysis of 12 clinical studies, researchers reported that CoQ10 has the potential to lower systolic blood pressure (the top number in a blood pressure reading) by up to 17 mm Hg and diastolic pressure by 10 mm Hg without significant side effects
The compound that gives the Indian spice turmeric (used in curry) its golden color, curcumin “shows strong anti-oxidative and anti-inflammatory activities when used as a remedy for the prevention and treatment of chronic diseases,” including cardiovascular disease, according to a study
So what’s my viewpoint now? I feel in certain cases we do need supplements to optimize our health despite having a well-balanced diet. The one caution is that this industry is not regulated and not all brands are created equal. So I continue to take my supplements daily:CoQ10, Omega 3 Fish Oil with Vitamin D within, Multivitamin. During winter months I add in my Echinacea with Vitamin C. Soon I will be adding in a teaspoon of raw turmeric into my diet.And I advocate specialty lab testing to help determine your risk and create a personalized approach to disease prevention and health. These labs can also help determine that the supplements actually contain what they report.
See a list of some other supplements, that I recommend.
Dr. Hosmane explains: Why Hint Water
Hint water is Dr. H’s drink of choice during the work day. Usually, a bottle can be found in his white coat………..”Over the past few years, Hint water has been my staple work beverage. Originally I started with Hint Fizz as a healthy substitute to soda, which I had started craving again, after having given it up for a few years. Hint water and Hint Fizz both are preservative, sugar, & artificial sweetener free. Simply, it’s healthy water infused with fruit. I highly recommend this zero calorie beverage.”
Celebrities and everyday people discuss Why Hint
Hosmane Cardiology brings Walking Non-Profit Walk with a Doc to Delaware
Dr. Hosmane and his office are proud to announce a partnership with Walk with a Doc with the goal to promote walking for a better health. Walk with a Doc is a non-profit organization that encourages healthy physical activity in people of all ages as it provides significant advantages over a sedentary lifestyle.
The idea behind Walk with a Doc was a simple one. Dr. Sabgir (Walk with a Doc Founder) got frustrated about the lack of physical activity his patients were getting so he invited them out for a walk. That first walk was in 2005 and evolved into Walk with a Doc and 160 chapters nationwide where doctors and patients walk together and talk about living the healthy lifestyle outside of the 4 walls of a doctor’s office.
You see her every day you walk into the office, but did you know that Alyssia is also the Optifast Weight Loss Program administrator for Dr. Hosmane? Being the administrator gives her a front row seat to the positive changes the patients that are going through the program make such as losses of greater than 50 pounds, discontinuing certain medications and an overall positive outlook on life. Don’t take her word for it, click here to learn about two patients’ journey on the Optifast Weight Loss Program.
Want to be part of the next informational session or just want to learn more? Send us a message!