No better time to discuss smoking cessation than when we are at the new year and resolutions are starting to fade while the freezing temperatures outside continue. I tell my patients that are contemplating smoking cessation that if successful they will be richer in more ways than one. The health benefits of smoking cessation are clear. The often overlooked benefits of smoking cessation are the return of significant time and money.
decrease in bronchitis, COPD
decrease in blood pressure
decrease in heart rate
decrease in ALL cancers
decrease in diabetes
decrease in osteoporosis
decrease in rheumatoid arthritis
decrease in erectile dysfunction for men
decrease in ectopic pregnancies, miscarriages, small birth weight in pregnancy
decrease in second hand smoke decreases sudden infant death syndrome, ear infections, respiratory illnesses, and asthma
We never seem to have enough of either time or money and smoking cessation recaptures both.
The actual cost savings can be calculated here. The following depicts the savings realized when smoking 1 pack per day with a cost of $5.70 per pack:The amount of time spent smoking is estimated at 6 minutes and 20 seconds per cigarette. Calculations for smoking 1 pack per day equates to over 2 hours per day.
If you extrapolate the value of your time then your costs rise exponentially.
Smoking Cessation Aids
So you are ready but want some help. There are over-the-counter, prescription, and alternative options to help you be more successful.
Nicotine nasal sprays
Bupropion is a common anti-depressant medication that was once marketed as Zyban. This medication can diminish the cravings and withdrawal symptoms from the nicotine.
Chantix is for smoking cessation only and can diminish the cravings and withdrawal while also blocking nicotine effects from smoking.
E-cigarettes–long term safety has been unclear but recent studies identify significant concerns on safety and effectiveness
No better time than the present to kick the habit as you will be richer in more ways than one!
1—“Dr. Riggs your glow is back. You seem so happy!”
2—A patient gets access to care for $400.00 vs $2400.00 that literally saved his life
3—A patient is reimbursed $300.00 of his $500.00 annual membership with his first claim submission. “I feel like I hit the jackpot!”
4—Access to CT scan for cash at $350.00 vs hospital quote of $3382.00
5—The proof is in the pudding: a patient puts families expenses into a spreadsheet with previous year’s expenses and finds marrying his plan with our services would have resulted in over $7500.00 in savings in one year
6—Our Medicare patient not only gets it but loves our model–he knows how doctoring used to be and the true costs of using your health insurance
7—Wholesale drugs that offer convenience and lower cost of short and long term medications. $140.00 for one month of blood pressure medication dropped to $28.00 for the same medication. Annual savings of $1344.00.
8—“The nose doctor(AKA Dr. Riggs) is right next to sonic—that is genius!”
9—“I really feel like I should pay you more.”
10—Every time a patient says, “It just makes sense.”
“Oh, the good old days—the good old days when your doctor was accountable, accessible, and affordable to you.”
Grandpa remembers when Doctor Johnson used to make house calls. He also remembers seeing him at the local baseball fields helping his best friend David with his twisted ankle that hot July summer night after he slid into home plate. Grandpa says when Grandma was having troubles getting her medicines Doctor Johnson called the hometown pharmacy to ensure they got delivered on Saturday. Grandpa doesn’t recall ever having troubles getting in to see Doctor Johnson and certainly doesn’t recall being rushed through a ten minute appointment. He also said if their neighbor Judy couldn’t pay her bills, well good old Doctor Johnson just took care of her. Oh, the good old days—the good old days when your doctor was accountable, accessible, and affordable to you.
Here enters a new model of practice that is sweeping the country for primary care services—Direct Pay Care. Patients forego insurance to cover their preventive care for drastically discounted prices. Doctors spend less time on paperwork, compliance checklists, and coding issues so they can focus on spending time with and taking care of their patients.
Just the other day my six-year-old daughter asked me why I became a doctor. Well, it certainly wasn’t to argue with insurance companies over covering a test I felt was clinically indicated. It wasn’t to document for eight hours of my twelve hour day to justify my care. And it certainly wasn’t to be told whether I was a good doctor or not by a checkbox.
In this day of escalating healthcare costs and regulations, many family physicians are finding themselves turning back to their roots to practice medicine as Doctor Johnson did. Most family physicians went into family medicine because they like taking care of people. Unfortunately with the demands today in our current system, the focus has become less and less about caring for patients.
Imagine if your doctor was accountable to only you. Not to insurances nor government—accountable just to you. Some family doctors are doing exactly that and going back to focusing on their patients’ needs without excessive regulatory distractions. By avoiding some of the red tape imposed by insurance and government entities, the doctor becomes more accountable to the patient. It is estimated that the average family doctor spends only one third of his or her time actually with their patients. So what is your doctor doing the other two thirds of the time? He or she is charting, coding, and arguing with insurance companies. Clearly this does not improve your care.
Imagine if your doctor was accessible to you. A wise physician mentor once told me no matter how talented or nice I was as a physician, if I wasn’t “accessible” I was no good to my patients. It is commonplace to wait weeks or even months to see your “regular” doctor. It can be challenging to get a nurse to return a phone call let alone a physician. This has become the standard of care that is accepted by patients. This should not be the standard as the physician patient relationship is sacred, and the quality of care suffers because of it. Some family doctors are making themselves accessible by email, open access to charts, same day appointments, and even providing patients their personal cell phone number.
Imagine if your doctor was affordable. Direct pay family doctors are back to taking cash for their services at a fraction of the cost of insurance pricing. The average family’s annual health insurance premiums are over $13,000. That cost is shouldered by the employer and the employee and does not reflect co-pays or out of pocket expenses. The standard use of insurance outside of healthcare has been to cover catastrophes. We would never expect our car insurance to pay for an oil change or our house insurance to pay for a new carpet. Our expectation for our health insurance to cover our every day preventive medical care has made health care costs rise exponentially. By eliminating insurance usage at the primary care level, the cost of care and the potential savings to the patient and their employer are staggering.
It has been and is common practice for an employer to pay $500 monthly for an individual’s premium. While the employees don’t see that expense, it does affect them. If the employer were to move to a high deductible plan monthly premiums would drop to under $200. That is $300 in savings for the employer. That money could then be applied to a Health Savings Account that is tax-free money the employee can use for healthcare expenses now or later. In addition, a portion of the savings could also be used to supplement the employee’s salary.
The latest trend in healthcare coverage has been to provide these lower premiums and higher deductible plans combined with health savings accounts. This is a fundamental change that supports the direct pay model. Your dollars are maximized with heavily discounted rates for office visits, labs, and imaging while your remaining money is put into your health savings account rather than lost to insurance premiums.
Accountability, accessibility, and affordability are making a comeback and it is about time. “They just don’t make things like they used to,” said Grandpa. Well Grandpa, many physicians have listened and are trying to do just that with Direct Pay Care.
When we were just getting off the ground Call for Action with NBC 41 Action News in Kansas City, Missouri spotlighted our focus on shopping for prices for your medical care and on the direct pay model. Check out the news pieces:
The New Year often brings renewed commitment to weight loss or healthier choices.
I spend a lot of my time as a physician counseling patients on how to approach weight loss.
What is the key to successful weight management? It truly is simple. You need to have a calorie deficit. A calorie deficit is when your daily calories burned are greater than your calories consumed.
The difficulty is that the number of calories burned in a day is so variable from person to person. We each have what is called our basal metabolic rate which is the amount of calories our body uses just sitting around. A 200 pound muscular male may have a basal metabolic rate of 3000 calories per day while a 200 pound obese male may have a basal metabolic rate of 1200 calories per day. Comparing diet plans to your neighbor should never be done. Discovering the calorie deficit for you as an individual to successfully lose weight is the key.
I had a discussion with a registered dietician/personal trainer about a client who was gaining weight despite her great efforts in the gym. She had her on an 1800 calorie a day diet. I pointed out that her basal metabolic rate is probably too low to allow for 1800 calories. If she is working out one hour in the gym and burning 600 calories during that time and her basal metabolic rate is 1000 calories, she will gain weight. The proof was in her lack of weight loss, but she went ahead and pursued VO2 max testing. This test evaluates oxygen consumption at rest and estimates your basal metabolic rate. I was not surprised when her results came back at 800 calories per day.
There are always questions about tools to help with weight loss. Yes, there are many things that can be used to help aid in weight loss, but they are only tools to help you do the fundamentals. We all know individuals that have had success with surgery or medicine only to regain the weight and more. If you use the aids to help you eat good food in appropriate portions, you will have success. When surgery or medicine is used as the solution rather than the aid, failure is likely.
I am a runner and have learned fundamentally that it takes time and energy, methodically putting one foot in front of the other. I have tools to help make the process easier—good supportive running shoes, inspiring music, and an app on my phone to tell me good job as I go. The truth is I still have to run. Weight loss is the same. You still have to do the fundamentals—remember calorie deficit.
So what should a good diet plan focus on other than the number of calories? Real food and not processed food which includes fruits, veggies, lean meats, and dairy. This should be the mainstay of your diet.
Poor diet choices cannot be compensated for by hours in the gym—the math just won’t add up for an appropriate calorie deficit. Exercise is good and necessary for a healthy lifestyle, but it is not the key to good weight management.