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 Loss

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

 

Sneezing, Runny Nose, Itchy Eyes are Here

ALLERGY SYMPTOMS

• Cough
• Runny nose
• Sneezing
• Itchy nose
• Sore throat
• Watery eyes
• Puffey eyes
• Itchy eyes
• Asthma flares
• Difficulty breathing

TIMOTHY GRASS ALLERGIES

One of the most common allergens is grasses and specifically timothy grass.  We are seeing these right now. While preventive treatment is ideal, treatment is currently focused on relieving the symptoms. There is a new option for allergy sufferers of common grasses for future seasons.  The middle of freezing temperatures is when the grasses are dormant.  It is that time that preventive treatment needs to start.

The newest option to treat for the timothy grass allergen is Grastek.   This is immunotherapy in a pill. For those that have endured the weekly shots this is a novel, relatively painless approach to immunotherapy that can be done in the comfort of your own home.

Grastek covers Timothy grasses but also has cross coverage to other grasses.

It should be started for seasonal care 12 weeks ahead of pollen and throughout the season or taken consecutively for 3 years.

Click on the following link for more information on administration of Grastek.

RAGWEED ALLERGIES

Another common allergen that is on the horizon is ragweed.  Fortunately, our timing of discussing this form of treatment is ideal.  The same manufacturer of Grastek has developed a similar treatment for ragweed with the prescription drug Ragwitek.

Ragwitek like Grastek should be taken 12 weeks before the allergen season.  In this geographic area the typical ragweed season begins about August 15.  That gives an estimated start date of the medication in mid-May.

Ragwitek is taken similarly to Grastek with pre-seasonal and seasonal administration or continuous administration for 3 years.

TRADITIONAL ALLERGY CARE

Many other treatments remain the mainstay for allergy treatment: 

Oral Medications:

Antihistamines

• Cetirizine–Zyrtec
• Diphenhydramine–Benadryl
• Fexofenadine–Allegra
• Loratadine–Claritin, Alavert

Decongestants

• Phenylephrine
• Pseudoephedrine

Leukotriene Antagonist

• Montelukast Sodium–Singulair

Nasal/Ocular Medications:

Steroids

• Flonase
• Nasacort
• Nasonex
• Qnasl
• Rhinocort

Antihistamines

• Astelin
• Pataday
• Patanase
• Pazeo
• Zaditor

Decongestants

• Ephedrine
• Oxymetazoline–Afrin, Sinex
• Phenylephrine

Cromolyn

• Nasalcrom

Anticholinergics

• Ipratropium Bromide–Atrovent

Nasal Irrigation

• Navage
• NeilMed
• Neti-Pot

Avoidance:

While avoidance can be difficult here are some pointers that may help:

• Stay indoors when the pollen count is high especially between 5AM to 10 AM when pollen counts are highest
• Wear a mask when mowing or avoid mowing altogether
• Choose grasses for your lawn that produce less pollen–dichondra and irish moss are some examples
• Mow frequently to keep grass short
• Keep windows closed
• Avoid attic fans
• Bathe pets frequently
• Do not dry clothes outdoors
• Minimize alcohol intake as it leads to dehydration and increased sensitivity to allergens

Another topic to come…How do I know what I am allergic to?

Ann Riggs, DO

Patient-Driven Affordable Healthcare

To Flu or Not to Flu

“I have the flu…”

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:

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 be 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 limitations.  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.

The 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

Patient-Driven Affordable Healthcare

 

 

 

 

 

Family Docs Going Back to Their Roots

“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.

Accountable

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.

Accessible

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.

Affordable

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.

Ann Riggs, DO

Patient-Driven Affordable Healthcare

“My Personal Experience with Direct Medical Care and Dr. Ann O. Riggs”

Background

My name is Eric.  I am a 48 year old male.  I have a history of chronic back pain, pre-diabetes,
recurring respiratory infections (at least annually) and many other miscellaneous health issues.  Last year I was diagnosed with coronary artery disease and had a stent placed in a major artery in my heart.

Because of my long history of health issues, having a skilled medical team and good health insurance has always been important to me and my family.

So why would I change from a traditional insurance based primary care facility to a practice using the direct pay model?

Best Doctor but Direct Pay?

I first became a patient of Dr. Riggs in 2012 when she worked for a traditional medical practice.  I was impressed with her knowledge, skill, and bedside manner.  I was cared for as a friend not just another patient to be pushed through the assembly line.  When she left the practice and started Direct Medical Care, I panicked.

She is the best physician I have ever worked with but how could I afford to pay her direct without using insurance?

A Light Came On

I was motivated to find a way to continue to have Dr. Riggs be my doctor. I began to

research what I had been paying out of pocket, what my insurance options were and how I could incorporate the direct pay model.

What I learned opened my eyes to the true costs of medical care.  It was like I had been sitting in a dark room and someone turned on a light.

Oh… I Think I’m Going to be Sick

Being someone who prefers to make decisions based on sound analytical processes, I undertook the task to run a comparison between what my out of pocket expenses were with the standard medical insurance model and what they might be by marrying a High Deductible Plan with a Health Savings Account and membership at Direct Medical Care.  This is what I found out:

Out of Pocket Expenses
Actual(Standard Medical)	$6918.65
Comparison(HSA & Direct Medical Care)	$1863.45
SAVINGS	$5055.20

This realization hit me like a ton of bricks.  Not only could I afford to join Dr. Riggs’ new practice, I could have saved $5,000.00!

 

 

How Is That Possible?

• Changed to a High Deductible Plan with an associated Health Savings Account (my coinsurance dropped from 15% to 5%)
• Insurance automatically contributes $1,500 per year into the HSA
• Added another $2600 in HSA contributions (offset from prescription drug costs and change in dental plan)
• All co-pays, co-insurance, prescriptions and membership in DMC paid for by HSA
• Insurance reimbursed 65% of membership with DMC (net cost for annual family membership was $350.00)

Here Are The Numbers

DMC Membership, deductible, copay, co-insurance and prescriptions covered by $4,100.00 from HSA (no net change in monthly costs).

●     Save $700 family deductible
●     Save $475 on copays
●     Save $875 on prescriptions
●     Save $3,000 on co-insurance

Total Projected Savings $5,050.00

Not Just about $$

In 2013, after Dr. Riggs left the traditional practice (prior to getting DMC open) I began to see another doctor in that practice.  While this doctor was very capable, the assembly line medicine forced on physicians in these corporations caused my heart condition to be misdiagnosed for 6 months.

After joining DMC in December 2013, Dr. Riggs was able to determine that the symptoms I was having could be related to heart disease.  Her office scheduled an appointment with a cardiologist.  The condition was found and a blockage in my heart was repaired.  A potentially catastrophic heart attack prevented.

How Have The Numbers Worked Out?

In 2014,  I saved $7,522.23 compared to what I would have spent out of pocket on my old plan (that does not include the money DMC saved me by shopping prices and negotiating on my behalf for 2 tests – an additional $3,600.00 in savings).

My experience may be extraordinary, however, I am convinced that any individual or family will benefit from the superb medical care and cost savings found through joining Direct Medical Care.

Conclusion

Not everyone’s situation will result in the same savings that I have found.  But here are some examples of how DMC may make financial sense for you:

1. I don’t have an HSA option where I work.
   • You can benefit by joining DMC and saving on copays and coinsurance for primary care services.  Additionally, membership costs count towards your deductible or may be covered by your insurance.
2. I am in good health and never meet my deductible.
   • Fantastic, consider selecting a High Deductible plan and save on monthly premiums.  Savings will offset membership or you can join as a “non-member” and pay for a la carte services.
3. I have Obamacare with a high deductible plan already.
   • DON’T WAIT!  You can’t afford not to join.

Patient-Driven Affordable Healthcare