Healthcare Shopper Blog

Video gamers have been known to develop Nintendinitis, a diagnosis coined by a medical journal back in 1990 to describe a patient with pain in a thumb tendon after excessive video gaming. That's old hat now, with the introduction of the Wii game, doctors have started to see patients with what they called "Wiiitis" which is characterized by more serious symptoms like fractures, contusions, dislocations, and head injuries.

The ubiquitous Wii interactive game get's the whole body involved, not just the thumbs so it can cause more damage than soreness and tendinitis. In addition, Wii games allow players to participate by moving their hands and arms to swing virtual sports equipment like tennis rackets. These games allow 2 players to play simultaneously, so it's pretty easy to hit the other player in the heat of a competitive match.

Karen Eley of Oxford Radcliffe Hospitals in Oxford, England, writing in the New England Journal of Medicine, reports, "Other reported Wii-associated injuries have included traumatic hemothorax (from a fall while playing), dislocations, and head injuries (from being struck accidentally by a gaming partner)."

The Wii Fit game has been touted as a way to get exercise without leaving the living room. It gets people into calorie consuming action that burns calories by using a balance board for the player interface with the game. Wii Fit handheld controls with a pressure-sensitive board about 2 inches off the ground that lets the user try to improve balance. The little device, which resembles a skateboard, allows players to control movements on-screen via balancing movements, twists, and turns. But people can actually take a fall off this board. A healthy 14-year-old girl in the UK suffered a fracture in her right foot when she fell off a Wii Fit balance board.

I see a marketing opportunity for Wii here. Watch for Wii elbow and kneepads and Wii helmets on next years Christmas must-have list.

Popular misconceptions about health insurance reform can be costly. For instance, one-in-three Adults surveyed (33%) believe new health reforms will be implemented within one year, with one-in-ten (11%) expecting new reforms within six months, and two-in-five (22%) expecting reforms to be implemented within the first year. The fact is that most health insurance reforms will not go into effect until 2014.

We've noticed that over the past few months, as the debate over health care reform has dominated the media, many of the uninsured Americans that we've talked with are delaying the purchase health insurance "until Obamacare passes".

A recent poll conducted by the Opinion Research Corporation and sponsored by eHealth, Inc. confirms what we've heard.

Key findings of the poll include the following:

• 24% of respondents said that if they had no health insurance today they wait for health reform legislation to pass before seeking new health insurance coverage.


• If they had no access to health insurance through an employer, spouse, parent, or relative, almost one-third of Americans surveyed (30%) would go without insurance for the following reasons: they can't afford it (15%), they would wait for health reform legislation to pass (13%) or don't think they need it (2%).


• When asked what they would expect to pay for a government-provided health insurance option, over a quarter (29%) of Americans said that they would expect it to be free or cost up to only $75 per month. Of those, 14% expected it to cost $25 or less. Separately, 31% expected it to cost between $76 and $250 per month, and 14% expected it to cost more than $250 per month.


• Overall, when you include those who thought it would be free, the mean dollar amount that Americans expect to pay for a government-provided health insurance option is $121 per month.


• One-in-three Adults surveyed (33%) believe new health reforms will be implemented within one year, with one-in-ten (11%) expecting new reforms within six months, and two-in-five (22%) expecting reforms to be implemented within the first year. Separately, 60% expected health reforms to become available only after one year, with many (21%) expecting changes in three or more years.

Misconceptions Can Cost You

For example, one in three Adults surveyed (33%) believe the new health insurance reforms will be available to consumers within 12 months of the legislation being passed. In fact, key elements of the current Senate bill such as guaranteed issue for adults or premium/cost-sharing subsidies in the individual health insurance market would not be effective until 2014.

A health reform bill will probably pass within the next few days and I believe it will lead to a better system. But don't risk going without coverage. There are already a number of affordable health insurance options in the individual and family health insurance market.

Physicians Can Receive Federal Incentives for Switching To Electronic Medical Records

Beginning next year, physicians will be eligible for extra payments from federal health insurance programs upon implementing an electronic medical record system. The enhanced reimbursements were made possible by the federal stimulus bill signed into law last year by President Barack Obama.

Under terms of the federal legislation, physicians can receive more than $40,000 in Medicare payments over five years beginning in 2011 for implementing an electronic health record system. The Obama administration last week announced it was seeking public comment on new regulations officials say "lay a foundation for improving quality, efficiency and safety through meaningful use of certified electronic health record technology."

Obama officials and consumer groups say electronic medical record systems are critical to eliminating paperwork, reducing costs and creating a more efficient health care delivery system. Doctor groups have said one of the obstacles slowing the implementation of electronic records has been cost.

Though 3 out of 4 Americans receive their medical care from doctors in small practices, less than 15 percent of the physician groups are using an electronic record system, according to a 2008 New England Journal of Medicine article.

Doctors soon may have fewer excuses for not getting their offices equipped with electronic medical records.

CT scans sent by smart phones are clear enough for accurate diagnoses.

Let's say, your daughter is away on a school trip. she's having abdominal pain. The ER doctor at the local hospital suspects appendicitis, but wants a radiologist to look at the CT scan images. There isn't one available at the moment. Using a $19.95 iPhone app, downloaded from iTunes, the images are sent to the radiology department of a teaching hospital more than 300 miles away. Within minutes the appendicitis diagnosis is confirmed and the appendectomy performed without further delay.

Study Proves Accuracy

This scenario mirrors a recent study in which researchers (Asim Choudhri, MD, a fellow in neuroradiology at Johns Hopkins performed the study while at the University of Virginia) took CT images of 25 patients suspected of having appendicitis and sent them via iPhone to five radiology residents. Then, the residents were asked to make a diagnosis based on what they could see on their phones. Only one reader failed to make the right diagnosis. In every other case, the residents correctly determined that 15 of the patients were suffering from appendicitis and that 10 of the patients did not have appendicitis and did not need treatment.

Elliot Fishman MD,, director of diagnostic imaging at Johns Hopkins University, says ,"The promise is that we can look at anything anywhere. The technology can expedite diagnosis and, therefore, treatment."

There's a shortage of primary doctors and it's getting worse. Sen. Chuck Schumer says he has at least a partial solution. He will introduce an amendment to the Senate health-care bill that would add 2,000 new medical residency slots.

While well-intentioned, Schumer's idea seems unlikely to make much of a difference. There isn't even enough interest among qualified young docs to fill existing residency slots. Hundreds of slots went unfilled this year and graduates of foreign med schools filled many of the available positions.

Docs Tend to Follow the Money

Furthermore, doctors who go through residencies in internal medicine often choose do further training in a sub-specialty, rather than practice as primary-care internists. They do so, in large part, because many sub-specialties have higher pay, higher status and, in some cases, better hours. Adding more residency slots won't change that.

$50,000 Educational Loan Repayment Could Help

The shortage of primary-care doctors is especially acute in underserved rural areas. Doctors finishing up their residencies tend to gravitate to places where there are already lots of other doctors, not to places where physicians are scarce. Pointedly, there are other provisions of the health-care legislation that could encourage more young doctors to go into primary care and to move to the places where docs tend to be scarce. The Senate bill increases funding for the National Health Service Corps, which helps repay student loans for docs and other providers who work in underserved areas. Primary-care doctors who participate can get up to $50,000 of loans repayment.

This subject matter will seem self-serving, coming from a health insurance broker, but I'll risk it. This article appeared in the Los Angeles Times yesterday, Uninsured trauma patients are much more likely to die by Karen Kaplan. I cited the article on twitter and it got so much attention that I thought that many of my blog readers would be interested.

The point is this: Patients who lack health insurance are more likely to die from car accidents and other traumatic injuries than people who belong to a health plan -- even though emergency rooms are required to care for all comers regardless of ability to pay, according to a study published on Nov. 17, 2009.

An analysis of 687,091 patients who visited trauma centers nationwide from 2002 to 2006 found that the odds of dying from injuries were almost twice as high for the uninsured than for patients with private insurance, researchers reported in Archives of Surgery.

Trauma physicians said they were surprised by the findings, even though a slew of studies had previously documented the ill effects of going without health coverage. Uninsured patients are less likely to be screened for certain cancers or to be admitted to specialty hospitals for procedures such as heart bypass surgery. Overall, about 18,000 deaths each year have been traced to a lack of health insurance.

But insurance status isn't supposed to be a factor for trauma patients. The Emergency Medical Treatment and Active Labor Act, passed by Congress in 1986, guarantees that people brought to emergency rooms get all necessary treatment no matter what kind of insurance they do -- or don't -- have.

The research team from Harvard University and Brigham and Women's Hospital in Boston used information from 1,154 U.S. hospitals that contribute to the National Trauma Data Bank. The team found that patients enrolled in commercial health plans, health maintenance organizations or Medicaid had an equal risk of death from traumatic injuries when the patients' age, gender, race and severity of injury were taken into account.

The risk of death was 56% higher for patients covered by Medicare, perhaps because the government health plan includes many people with long-term disabilities, said Dr. Heather Rosen, who led the study while she was a research fellow at Harvard Medical School.

The risk of death was 80% higher for patients without any insurance, the report said.

The researchers also did a separate analysis of 209,702 trauma patients ages 18 to 30 because they were less likely to have chronic health conditions that might complicate recovery. Among these younger patients, the risk of death was 89% higher for the uninsured, the study found.

Rosen, now a surgical resident at USC's Keck School of Medicine, said the group expected to find at least some disparity based on insurance status. But she said the group was surprised at the magnitude of the gap.

Dr. Frank Zwemer Jr., chief of emergency medicine for the Hunter Holmes McGuire VA Medical Center in Richmond, Va., said he was "kind of shocked."

"We don't ask people, 'What's your insurance?' before we decide whether to intubate them or put in a chest tube," said Zwemer, who wasn't involved in the research. "That's not on our radar anywhere."

Possible Explanations

The researchers offered several possible explanations for the findings. Despite the federal law, uninsured patients often wait longer to see doctors in emergency rooms and sometimes visit ERs at several hospitals before finding one that will treat them. Other studies show that, once they're admitted, uninsured patients receive fewer services, such as CT and MRI scans, and are less likely to be transferred to a rehabilitation facility.

Patients without insurance may have higher rates of untreated underlying conditions that make it harder to recover from trauma injuries, the researchers said. They also may be more passive with doctors and nurses because they don't interact with them as often. All of these factors could influence whether a trauma patient is able to recover.

Coincidence?

But the link could also be coincidental, the authors acknowledged. Perhaps the hospitals that have fewer resources at their disposal also happen to see the most uninsured patients, they said.

The types of injuries may differ too, Zwemer said. Gunshot and stabbing victims -- frequently younger people involved in crime -- were much more likely to die from their wounds than other trauma patients tracked in the study. These people are generally uninsured, but the type of injury -- not insurance status -- is the reason for their higher fatality rates, he said.

More research is needed to figure out whether lack of insurance actually harms trauma patients or whether the data simply reflect a correlation, said Dr. A. Brent Eastman, chairman of trauma at Scripps Memorial Hospital in La Jolla.

The issue is particularly relevant as Congress and the Obama administration weigh various measures to reduce the number of uninsured Americans, Eastman wrote in a short critique that accompanied the study.

Perhaps you've heard stories in the media about mix-ups at fertility clinics where the identities of the parents of embryos become uncertain due to mislabeling of sperm, eggs, or resulting embryos. Statistically, these mishaps are rare, but you can imagine what a nightmare it is for the patients as well as the medical practitioners when mistakes do happen.

A new software technology is helping to reduce the risk of laboratory errors in infertility treatment, by electronically identifying the sperm, eggs, resulting embryos and other materials used in in vitro fertilization (IVF) treatment cycles. Non-invasive Radio Frequency Identification (RFID) can track a patient's sperm, eggs and embryos during the course of treatment. If the wrong material is introduced in the lab environment, RFID alerts the staff, via visual and audible signals, to help prevent mislabeling of any materials.

RFID tags contain a microchip that acts as a unique digital fingerprint, safely identifies samples at the outset and tracks them through the fertilization process. Each patient is given an RFID identity card, with a unique identification, that are used with all sample materials for that patient, including Petri dishes and test tubes used in a patient's treatment cycle. The entire system is electronically managed. By creating an automated system to minimize the chance for mix up, RFID safeguards the infertility treatment process and gives patients peace of mind.

Some fertility practices in the US and UK have already installed RFID. Since launching this new technology last year, over 20,000 infertility treatment cycles have employed RFID to ensure the safety and security of patients' genetic material.

The American Society for Reproductive Medicine (ASRM) recently pledged to work with patient groups, policy makers and other stakeholders to develop systems to reduce the risk of errors.

The House Bill would ban all abortions performed directly with public money in the new government-sponsored public plan and it bans abortions in private health insurance plans for women receiving public subsidies. This is where the dispute is. Backers of the amendment say insurance companies could still offer plans that provide abortion as a benefit to people who buy policies with their own money (read middle-class and above). But opponents say there are other provisions in the bill that would make that basically impossible. So, the net result is that there would be no plans in the insurance exchanges that offer abortion coverage at all.

Do women currently have coverage for abortion?

Many women have abortion coverage right now - somewhere between 50 and 80 percent. However, and this is admittedly a disputed statistic, only 13 percent of all abortions are billed to insurance. That's because the vast majority of abortions are done early in pregnancy in the first trimester. They're normally done in abortion clinics and they're cheap - a couple of hundred dollars. Probably, most of the insurance coverage used for abortions are for later abortions that are done for medical reasons, either fetal abnormalities or pregnant women with health problems. Those are abortions that are usually done in hospitals and cost thousands of dollars. Those are the ones that you'd want insurance for. The house bill has no provision for these abortions, no exceptions. They would be banned, too.

What now?

Now the debate switches back to the Senate bill that currently would ban direct federal funding of abortion. There are already some pro-life Democrats who are talking about adding the House language.

However, back in the House there are some 40 pro-choice Democrats who say they won't vote for final bill unless the abortion language is taken out.

They're going to have to find a compromise and it won't be easy.

Unicare, a health insurance company owned by Wellpoint, Inc., the largest health insurer in the US, has announced that it is exiting the health insurance market in Texas and Illinois by the end of the year. Unicare's 400,000 members in Texas and 180,000 members in Illinois will have to find coverage elsewhere.

It seems strange, what with health insurance reform legislation promising to add many new government subsidized customers to the health insurers' rolls, but Unicare admits that they can't cut it against big names like Blue Cross Blue Shield and United Healthcare in the Texas and Illinois markets. The brand was created in the early 90's by parent company, Wellpoint, in order to sell health insurance products outside of California. They expanded quickly, particularly in Texas, by offering low-rate, bare bones health plans. That strategy ultimately failed when competitors matched and bettered their offerings and could negotiate lower rates from providers due to their larger membership.

So are Unicare's customers hung out to dry as far as finding new coverage? Fortunately not. Unicare has collaborated with Hallmark Services Corp. to provide a soft landing for its customers in the form of a transition to Hallmark's Blue Cross Blue Shield plans in both Illinois and Texas. Unicare says its members will be offered BCBS plans of comparable benefits and at similar rates.

What about Unicare members who are no longer insurable because of pre-existing conditions? Thankfully, BCBS will guarantee acceptance of coverage for Unicare members who opt for the unique deal. Unicare members will transition without a break in coverage and without requiring proof of insurability, no questions asked. Offers and acceptance forms are in the mail. Please note, the deadline for acceptance of the guaranteed acceptance deal is December 1, 2009.

What are the options for those Unicare members who do not want the Hallmark BCBS offer? Unicare will stop offering health coverage in Illinois and Texas on January 1, 2010. Members who do not transition to BCBS will be allowed to continue coverage with Unicare until June 1, 2010. Unicare members are, of course, free to shop for replacement coverage with any other health insurance company if they are willing to go through the standard requirement of answering health questions to qualify for coverage.

What about ObamaCare health care reform legislation going on in Congress? Whatever the details of the final bill that becomes law, health insurance reform provisions - like eliminating pre-existing condition underwriting - will not take effect for 3 years, January 1, 2013. So we have to continue to play the game under the current rules until then.

Perhaps no single parenting trend more clearly defines the current generation of parents than the widespread elimination of spanking as a tool to decrease unacceptable behavior and to promote positive behavior. Science is proving them right. "The best kept secret of American child psychology is that kids who are not spanked are the best behaved and do the best in life,"says sociologist Murray A. Straus, PhD of the University of New Hampshire, "You won't find that in a single child development textbook, but it is true." Dr. Straus, has studied the impact of corporal punishment on child development for decades. He is a vocal opponent of the practice.

Spanking Linked to Lower IQs

While numerous studies have linked physical punishment to aggressive behavior, far fewer have examined the impact of spanking on intelligence. Dr. Straus of the University of Hew Hampshire and colleague Mallie J. Paschall, PhD, of the Pacific Institute for Research and Evaluation analyzed data from 806 children who were 2 to 4 years old at enrollment and 704 children between the ages of 5 and 9. The children were tested for intelligence when they entered the trials and again four years later. Even after accounting for factors that could influence IQ scores, such as parental education and socioeconomic status, spanking appeared to have a negative impact on intelligence. The IQs of the younger children who were spanked were 5 points lower on average four years later than those of children of the same age who were not spanked. Scores among the older children were an average of 2.8 points lower among spanked children than children who were not spanked. While these differences are small they are statistically significant.

Second Study Links Spanking to Lower Mental Development

At Duke University, research scientist Lisa J. Berlin, PhD, and colleagues also linked early spanking to reduced intelligence in one of the most rigorously designed studies to ever address the issue. The researchers questioned 2,500 racially diverse, low-income moms about their use of spanking as a discipline tool for their toddlers. They found that children who were spanked at age 1 were more aggressive than those who weren't by age 2 and they scored lower on tests to assess mental development at age 3. "The research as a whole really paints a picture of the detrimental long-term effects of physical punishment," Dr. Berlin says. "The message to parents is find other ways to discipline your children."

Other Negative Effects of Spanking

A 2002 analysis of 88 spanking studies spanning six decades linked spanking to 10 negative behaviors including aggression, anti-social behavior, and mental health issues. More than 90% of the studies found spanking to be detrimental, says developmental psychologist Elizabeth Gershoff, PhD, who conducted the analysis. "Parents spank to decrease bad behavior in the short and long term and to promote positive behavior," says Dr. Gershoff. "What the research tells us is that spanking doesn't seem to be doing either of these things."

Critics Still Doubt the Research Results

But critics say that research is highly suspect because it has largely been conducted by investigators like Straus, Berlin, and Gershoff who strongly oppose the practice. In addition, the studies are often criticized for lacking scientific rigor -- a charge Gershoff acknowledges is hard to counter. "We can't very well do experiments in which we tell some parents to spank their children and others not too," she says. Straus likens the criticism to that leveled at the early studies linking smoking to lung cancer. "For years the tobacco industry was able to destroy the studies one by one because they all had problems," he says. "No single study was truly definitive. But in the end the Surgeon General concluded that the evidence as a whole just couldn't be denied."