When our model hits home–the proof is in the pudding.

 

pudding

Pudding Proof

I recently had the opportunity to experience the pitfalls of my own commercial health
insurance.  I tell patients all the time “the proof is in the pudding.”  Well it was my turn to see how this pudding really was in the health insurance world.

 

 

Recurrent Streprapid_strep_pos

This past fall my daughter was hit with yet another bout of strep throat.  She has fought it throughout her young life.  At the age of seven I made the call to consult with one of my favorite ENT docs.  It was an easy decision that she would do better if we proceeded with tonsillectomy and adenoidectomy.

 

High-Deductible-Health-Plan-paired-with-a-Health-Savings-AccountHigh Deductible

I, like so many of my patients, have a high deductible plan that I have married with an HSA(Health Savings Account).  I knew the bulk if not all of the cost of the procedure would be my responsibility.  I did not hesitate to ask for cash pricing.

Insurance Negotiated Pricing vs Cash Pricing

Pricing for any surgical procedure needs to include the following fees:

  1.  Surgeon’s Fee
  2.  Anesthesiologist’s Fee
  3.  Surgical Facility’s Fee

INSURANCE NEGOTIATED PRICING:  

Surgeon $372.51
Anesthesiologist + Facility $2624.00
Total Cost $2996.51

CASH PRICING: 

Surgeon $402.50
Anesthesiologist $578.00
Facility $879.83
Total Cost $1860.33

FINAL PRICING AND SAVINGS:

I was actually able to pay the insurance negotiated pricing for the surgeon and the cash pricing for the anesthesiologist and the facility.  My final pricing was $1830.34 for the entire procedure.  And there lies the proof in the pudding:

Almost $1200 in Savings

Happy Healthy Kid at Great Cost Savings by Paying Cash

alliej.jpg
Bear was Free!

Ann Riggs, DO

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Patient-Driven Affordable Healthcare

 

Beckie Moore, APRN Brings “More” to DMC

Direct Medical Care Introduces Beckie Moore, APRN

BeckieFB

Beckie Moore, APRN was born in Wichita, Kansas and raised in Platte County, Missouri. After 12 years in Platte City, Missouri, she and her family settled just north of Dearborn, Missouri, where she enjoys her time away from patient care on her farm.  Beckie graduated valedictorian from North Platte High School in 1983.  She has been an RN since 1987.  Beckie went on to earn her Master’s degree in nursing from the University of Missouri, Kansas City in 1999.  As a Family Nurse Practitioner in the Northland for over a decade, Beckie noticed patients interested in and seeking alternative options that were not taught in her traditional western medicine education.  Seeking answers and education for herself, she discovered that the University of Arizona offered a two year medical fellowship in Integrative Medicine. Beckie completed her fellowship in 2016. She hopes to compliment patient care with her new knowledge base. Her passion is treating root causes of illnesses and promoting wellness at every turn.

The Calorie Creep

But Doctor I am not eating that much…

While there are always exceptions rarely does one become overweight by not eating.

The balancing act of  creating a calorie deficit is key for weight loss.  Please see my prior blog post regarding the fundamentals of weight loss:

Calories Consumed < Calories Expended= Weight Losswtmgt4

It can be one misstep in your day that will sabotage all your good efforts.  Stealing the term introduced to me by an inspiring patient, I would like to bring “the calorie creep” to life in the pictures below:

Keep in mind it does not have to be junk food that can be your calorie creep–avoid the creep in whatever form!

Ann Riggs, DO

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare

 

Richer in More Ways than One…

Smoking Cessation

Smoking0No 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.

 

Health Benefits
  • Smoking4decrease 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

 

Non-Health Benefits

We never seem to have enough of either time or money and smoking cessation recaptures both.timeandmoney

  • Money
  • Time
  • Time=Money

 

 

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:Smoking5The 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.  Smoking7

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.

Smoking8Over-the-counter options:

  • Nicotine patches
  • Nicotine gum
  • Nicotine lozenges

 

 

Prescription options:

  • Nicotine inhalerssmoking9
  • 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.

Alternative options:

  • E-cigarettes–long term safety has been unclear but recent studies identify significant concerns on safety and effectiveness
  • Hypnosis
  • Acupuncture
  • Support groupsSmokingQuit

No better time than the present to kick the habit as you will be richer in more ways than one!

Ann Riggs, DO

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare

To Flu or Not to Flu

“I have the flu…”Flu3

Influenza strikes every year and leaves much to be discussed.  The flu statistics reveal that the highest risk groups are those 65+ years of age followed by those 0-4 years of age.  The other high risk groups include pregnant women and those with chronic respiratory illness or those with weakened immune systems.

Seasonal influenza is typically the following with rapid onset:

Flu2
Symptoms of Influenza
  • fever
  • chills
  • profound fatigue
  • headaches
  • joint pain
  • runny nose
  • cough
  • sore throat

 

Seasonal influenza is not typically:

  • nausea
  • vomiting
  • diarrhea

Diagnosis

The only absolute is a positive influenza swab.  Unfortunately the test can children doctorbe inaccurate.  Some studies suggest the influenza swab is only 30% accurate while others suggest 70% accuracy. The best case scenario it misses 3 out of 10 individuals with influenza.  This makes clinical suspicion and evaluation by your physician key in diagnosis.

Treatment

Tamiflu or other antivirals are the only prescription form of treatment but have their Flu1limitations.  They need to be started within 48-72 hours of onset of symptoms. Antivirals when started early in the course of the illness can decrease the severity of symptoms and length of course but are not a cure. Large families or those with high risk individuals may opt to take antivirals as preventive or prophylactic care when a known influenza carrier has been diagnosed.

Supportive care is the true mainstay of care for anyone with influenza:

  • fluids
  • rest
  • acetaminophen

Flu Vaccine

There are always lots of opinions regarding vaccination.  While it is not a perfect vaccine as far as guaranteed coverage for influenza, it is safe.

Flu4The CDC recommends annual vaccination for everyone 6 months of age and older.

Vaccination is one way to protect yourself from influenza and can reduce the severity of illness if contracted and prevent hospitalizations in addition to doctor visits and time off work.

Common questions:

  • Does the flu shot cause the flu?

            No but can cause a flu-like response with mild headache, joint pains, and fever

  • How long until I am covered after receiving the vaccination?

           2 weeks

Common Sense Prevails

  • avoid contact with those with symptoms
  • wash your hands
  • eat healthy
  • exercise
  • rest

Stay well!

 

Ann Riggs, DO

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Patient-Driven Affordable Healthcare

 

 

 

 

 

As the Sun Sets…Vitamin D Deficiency


Vitamin D Deficiency

I often joke with patients that we never checked Vitamin D levels until Dr. Oz brought it to the forefront.  Thankfully he did and we are identifying more and more individuals with vitamin d deficiency and treating appropriately.

VitD8

The Centers for Disease Control and Prevention (CDC) reports that 32 percent of children and adults throughout the US are vitamin D deficient. Estimates of over 95 percent of elderly are deficient. 

 

Vitamin D Deficiency SymptomsVitD5
  • Fatigue
  • Bone pain
  • Muscle pain
  • Memory issues
  • Depression
  • Cardiovascular Disease
  • Diabetes
  • Hypertension
Vitamin D AKA the Sunshine Vitamin

VitD3

How much sun is enough?  You need your skin exposed without sunscreen or protective clothing interfering to be able to convert/produce Vitamin D.  There is an interesting calculator here to shed some “light” on it: Sun Exposure Calculator.  Keep in mind there really are so many factors(skin color, time of year, cloud cover, time of day, etc.) and to depend on the sun for your vitamin D is not ideal.

 

Vitamin D in our DietsVitD2
  • Fish
  • Egg yolks
  • Fortified dairy
  • Fortified grains

 

 

 Risk Factors for Vitamin D Deficiency
  • VitD0Diets limited in the above food sources
  • Limited sun exposure due to occupation, climate, or darker pigmented skin
  • Age
  • Obesity
  • GI issues that impact absorption

 

Vitamin D Supplementation

First and foremost check your levels before supplementing above the daily recommended allowances.  Vitamin D is a fat soluble vitamin and too much can lead to toxicity issues.  Basic guideline for baseline supplementation is 800-1000 International Units daily.   Multi-vitamins often fall short of the baseline supplementation.  Verify how much you are truly getting.   If you are found to be deficient supplementation would be much higher.

 

Ann Riggs, DO

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare

 

Tired, Foggy, and Numb?

Vitamin B12 deficiency May be Making you tired, foggy, and numb…
b12def5

 

TIred?

B12fatigueFatigue is one of the most common complaints I hear from my patients that unfortunately can be caused by many things. Vitamin B12 is one of those causes and it is quite common.  Vitamin B12 plays a crucial role in energy as it aides the conversion of our foods to energy for the body.

 

Foggy?b12def6

Patients often complain of difficulties focusing, forgetfulness, and just a general fuzziness.  Vitamin B12 helps in cognition with overall brain health. Deficiencies can also lead to general mood disorders, depression, and insomnia due to its role in production of certain natural brain chemicals.

 

Numb?b12def3

The classic presentation of B12 deficiency is a “stocking-glove distribution” of numbness.  The hands and feet are described as numb or tingling.   Vitamin B12 is utilized by the body in the maintenance and repair of the nervous system.

Other Symptoms?
  • pale skin
  • tongue changes–smooth, burning, or red
  • heart palpitations
  • shortness of breath
  • diarrhea or constipation
  • vision difficulties
Am I deficient?

If you have any of the above mentioned symptoms it is worth getting a simple blood test to evaluate your levels.

Risk Factors:

  • age
  • vegetarian/vegan
  • medications that decrease absorption–classically antacid medications
  • disease processes that affect absorption such as pancreatitis and inflammatory bowel diseases like Crohn’s Disease or Ulcerative Colitis
  • gastric surgery for weight loss
Vitamin B12 Dietary Sources

b12def4The human body doesn’t make vitamin B12 so dietary sources are essential.  Common dietary sources:

  • meat
  • poultry
  • seafood
  • dairy
  • eggs
Vitamin B12 Supplement Options

Vitamin B12 supplements come in pill form, sublingual tablets, nasal sprays, and injectables.  Many people can’t absorb vitamin B12 through the gut so nasal absorption, oral absorption, or injections are often preferred.

Vitamin B12 deficiency is easily detected and easily treated if you look for it…

 

Ann Riggs, DO

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare

 

 

Cold Laser Therapy

ColdLaser1Cold laser therapy is a novel, non-invasive approach to treating inflammation and promoting healing.

It is FDA approved and has been utilized in America for over 16 years.

Contrary to its name it is not cold at all–it is a pulsatile, low-level laser that will not burn.

 

Cold laser therapy has also been referred to as:

  • low-power laser
  • low-light therapy
  • soft laser
  • biostimulation laser
  • therapeutic laser
  • laser acupuncture

We introduced cold laser therapy in our office over 6 months ago.  We have been impressed with its results for back pain, shoulder pain, elbow pain, heel pain AKA plantar fasciitis, and much more.

The cold laser is thought to work by decreasing inflammation and thus pain by decreasing the following:

  • ColdLaser3prostaglandin E2
  • prostaglandin-endoperoxide synthase 2
  • interleukin 1-beta
  • tumor necrosis factor-alpha
  • neutrophil granulocytes
  • oxidative stress
  • edema
  • bleeding

The greatest advantage is that there are NO serious side effects.  It is a great option to try to avoid medications and surgery.

While insurance is variable on recognizing cold laser therapy as a reimbursable treatment, we are pleased to announce we have had patients receive reimbursement for this service at Direct Medical Care.

 

In as little as 2-4 treatments per week, we have seen 80-90% improvement in symptoms.

 

If no improvement by the 4th treatment alternate treatments can be utilized. Combining therapies can maximize healing and return to health.

Ann Riggs, DO

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare

 

Sun…friend or foe?

skincancersunscreen
So it’s summertime right?  …time for the beach, lake, swimming pool, water park, and baseball games.  You pack up all your gear and head out to have some fun in the sun.  And sometimes it’s hard to remember to pack the sunscreen, apply it, not to mention reapplying it all-day-long.  Then there’s that nice tan glow we all love to have in the summer.  But…..

“More than 3.5 million cases of non-melanoma skin cancer are diagnosed in the US each year, and more than 73,000 cases of melanoma are expected to be diagnosed this year.”

skincancerribbonOne in five Americans will develop skin cancer in their lifetime, melanoma being the most deadly form.  In fact, an estimated 9,940 people will die of melanoma in 2015.  Prevention is obviously key when it comes to skin cancer.  Daily use of a sunscreen with SPF 15 or higher reduces your risk of developing squamous cell carcinoma by 40 percent and melanoma by 50 percent.

skincancerpreventIt’s an easy thing to over-look…I mean it’s the sun, we go outside, we go inside, it’s our world, and therefore easy to forget.  But trust me, for those of you that have been blessed to not have gone through it in your life, there’s nothing scarier than hearing that your best friend, your 36 year old sister, has been diagnosed with Stage II Melanoma.  And there’s no time that is longer or goes by slower than the time it takes for lymph node biopsy results to come back.  There’s no exposure, from the sun or tanning bed that is “better” for you or less harmful than the other.  Sunless or “spray tan” is a good option to consider if you feel like you need some color or that summertime glow.

Skincancer6Another important step is having annual skin checks, as well as watching for any changes to existing or new moles on your body.  This one, to me, is a no-brainer.  Skin cancer is the one form of cancer that allows you to see your tumor…right there, in plain sight, on the outside of your body.  The woman with the lump deep in her breast, guy with a tumor on his kidney or deep in his brain, or child with cancer in their bone marrow didn’t have that chance.  It was hidden inside, not able to be seen, causing harm, just waiting to be found.  So take advantage of the chance to have this particular cancer identified and stopped in its tracks as soon as possible.

“Each year there are more combined incidences of skin cancer than the combined incidence of cancers of the breast, prostate, lung, and colon.”

There are some key characteristics, known as the ABCDEs of skin cancer, that you can look for to help identify a potentially dangerous mole.

skincancerabcde

 

 

  • Asymmetry
  • Border
  • Color
  • Dimension
  • Evolving

 

 

 

So get outside this summer and have a blast enjoying this time of year and all the activities that go along with it!  Just remember to drink plenty of water and make sure to wear sunscreen to protect yourself from the harm that our sun’s rays can cause….and hey, take heart in knowing that you’re preventing all those future wrinkles.

beach

Submitted by Kim Moppin

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare

Much Needed ICD-10 Codes

ICD-10 codes: Making the practice of medicine “better”

 

ICD10Engine

V97.33XD: Sucked into jet engine, subsequent encounter

How does one survive to even have a subsequent encounter?  I guess it has been done before: Jet engine survivor.

 

ICD10inlaws

 

Z63.1: Problems in relationship with in-laws

We see the applicability here…this will be used often.

 

 

 

ICD10duck

W61.62XD: Struck by duck, subsequent encounter

Watch out for ducks–especially during migration…

 

ICD10spacecraft
W22.02XD: V95.43XS Spacecraft collision injuring occupant, sequela

Just saw this last week…

 

 

ICD10bucket
W16.221 Fall in (into) bucket of water causing drowning and submersion

…why? just why??

 

 

ICD10bizarre
R46.1: Bizarre personal appearance.

All a matter of opinion…

 

ICD10skating
V00.01XD: Pedestrian on foot injured in collision with roller-skater, subsequent encounter

Beware of the roller skater this summer!

 

 

ICD10WaterSkiBurn

 

Y93.D: V91.07XD:  Burn due to water-skis on fire, subsequent encounter

One of my greatest fears!

 

 

Floods2015

 

X38.XXXA Flood, initial encounter
X38.XXXD Flood, subsequent encounter
X38.XXXS Flood, sequela

Using all three codes this year!  

 

 

Ann Riggs, DO

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare