03.26.09
Posted in Uncategorized at 11:17 pm by ceo
I have never had a root canal before. I was told it may take three to four hours. I wish. Five hours, 45 minutes in the chair. I have toxic levels of novacaine and nitrous oxide coarsing through my veins.
I went in for my six-month visit last week. I wasn’t experiencing any pain. I was told I would need two fillings at best and possibly root canal. Once the dentist got in there she said the decay had reached the roots and they were infected. If the roots were infected why didn’t I feel any pain?
Is there any risk with using nitrous oxide for an extended period of time? I had the mask on for a LONG time. Initially they must have had the concentration turned up high because I was starting to go bonkers like I was on drugs (although, I have never done drugs so I have no idea what it feels like). There was someone monitoring the system but she did’t seem to know what she was doing. Someone else walked by and said ‘I think we should turn it down.’
I’m on antibiotics and motrin. My head is pounding right now. Does this sound like a typical root canal experience?
Answer 1: Whoa - 4 hours? I’ve had two and one took about an hour and a half total and the other might have taken 2 max.
The first one I had little or no pain during the actual procedure but had a lot of pain the next few days but they prescribed me vicodin (score!). The second one I had some pain during the procedure and absolutely none afterwards.
Answer 2: Depends who you talk to. Some root canals seem to go a lot smoother than others. I’ve had a few myself and was sore for a few days. Warm tea bags on the area you hurt helped as it served as a healing agent. Try it and feel better!!
Answer 3: I’m guessing a 1st molar & a relatively new general dentist. Tooth # 3/14 can have 4-5 roots to obturate. 5 hrs 45 minutes is not normal-she should have scheduled you for 2 appointments.
Answer 4: WTF kind of dentist did a 5 hour root canal??????? I’m in the field and there is NO WAY it takes that long, even if completely calcified. Here’s a lil something for all you folks who need RCT. Your General dentists are NOT endodontists. IF they choose to do a root canal, it’s usually on a cuspid or incisor. Easy for them, because only one canal. If it’s a molar they should send you to a specialist. General dentists take ONLY a weekend course here or there to learn how to do Root Canals. Endo’s specialize and NEVER EVER take 5 hours. Even if it’s 2 teeth.
As for the N2O on for that long? Maybe a lil nausea might be a side effect, but that would be immediate. Might take longer then 20 mins to wear off. I’m not too sure. I’ve never had a patient on it longer then 45 mins.
IMO, unless you’re a dental phobe, it’s not necessary and just a money maker for the doc. Also, your jaw is gonna be sore for a few days. Avoid using those teeth for about two weeks and use anti-inflammatories and you’ll be OK.
Answer 5: I had to leave disney to find a dentist on a family vacation. Then spent the remaining part of the day riding “Everest” over and over with my kids. You haven’t suffered until you subject a freshly carved up nerve to the G-forces of a roller coaster. I was actively praying for my death.
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03.18.09
Posted in Uncategorized at 1:00 am by ceo
Washington -- The recent economic stimulus package provides a significant investment in health information technology that could benefit many physicians. But the government is expecting doctors to do their part to implement health IT and is prepared to penalize those who don't.
Over the next decade, the federal government is projected to spend more than $35 billion on Medicare and Medicaid bonuses to physicians, hospitals and others that adopt certified electronic health records. Because of the Medicare penalties that eventually will apply to nonadopters, however, the net spending level will be only about $20 billion over 10 years.
Physicians with approved EHRs in place before 2011 or 2012 will be eligible for the maximum Medicare incentive payments allowed by the stimulus. They will receive bonuses equal to 75% of their allowed Medicare Part B charges -- up to a sliding cap -- in each of the five years after adoption. The maximum of $18,000 in the first year phases down to $2,000 in the fifth year for a total five-year bonus of up to $44,000 for early adopters.
Doctors who wait until 2013 or 2014 to have EHRs in place will be eligible for smaller bonuses. The 2013 adopters can capture a maximum of $39,000 over four years, while the 2014 adopters can claim up to $24,000 over three years. Medicaid will have its own five-year bonus schedule that will offer as much as $64,000 to eligible physicians who don't claim Medicare bonus money.
Once the chance for bonuses ends, Medicare starts penalizing physicians who have not responded to the incentives. Doctors who have not adopted an EHR before 2015 and who fail to obtain a hardship exemption will see a 1% cut to their Medicare pay, a reduction that phases up to 3% for 2017 and remains each year after that.
Simply setting up any paperless system is not enough to earn bonuses and avoid penalties. The stimulus package stipulates that physicians must adopt a qualifying EHR and use it in a "meaningful way." Meaningful users are defined as physicians who demonstrate to the Health and Human Services Dept. that they are using electronic prescribing; that their technology is connected in a manner that provides for electronic exchange of health data to improve quality of care; and that they submit information to HHS on clinical quality measures.
No longer a question of "if"
Some physicians already have begun to move away from paper, and they would rather act sooner than later to avoid penalties down the road. "The question now isn't if, but how and when, because physicians are feeling a sense of inevitability," said Todd Rowland, MD, executive director of HealthLINC.org in Bloomington, Ind., a regional health information exchange that covers a multicounty area. "We need to figure out how to implement it in an economical, management-oriented approach that requires as few work-flow sacrifices as possible."
Dr. Rowland added that he doesn't expect physicians to like the implementation process -- or the possibility of penalties if they don't do it right -- but that it makes sense for physicians younger than 55 in particular to get on board. He estimates that more than 50% of physicians in Bloomington's metro area and more than 75% in the rural area have adopted EHR systems.
Early EHR adopters can get up to $44,000 in a Medicare bonus or $64,000 in a Medicaid bonus.
While the stimulus also provides Medicaid incentives, physicians can't have it both ways -- they must choose either Medicare or Medicaid bonuses, said Heidi Echols, a partner at the law firm McDermott, Will & Emery in Chicago.
In an effort to prevent additional "double-dipping," physicians who report using an EHR system that is also capable of e-prescribing no longer will be eligible for the e-prescribing bonuses that went into effect this year under the Medicare Improvements for Patients and Providers Act. On the other hand, Medicare penalties for those not e-prescribing by 2012 will sunset after 2014, so that no physician will be subject to double penalties for failing to e-prescribe and failing to use an EHR.
Now that Congress has set up the incentive structure for adoption, President Obama and his administration also must promote interoperability of EHR data so the records don't become information "islands," said David J. Brailer, MD, in an article published online as part of a series on health IT in Health Affairs' March/April issue.
Dr. Brailer was the first National Coordinator for Health Information Technology at HHS from 2004 to 2007 and is now chair of Health Evolution Partners, a health care investment firm based in San Francisco. He said physicians particularly need to be wary of vendors from which they purchase IT services, as systems that become obsolete could set back progress.
"What it boils down to is, are you buying EHRs that you can use and keep for a long time, or is it a system that in two or three years goes kaput?" he asked. "We're trying to avoid doctors having to start over again with electronic records during their career."
The next steps
The stimulus act requires HHS by Dec. 31 to develop an initial set of standards, implementation specifications and certification criteria for EHR system adoption. It also authorizes the department to provide competitive grants to states for implementation loans to health care entities.
The national health IT coordinator also will be authorized to make available a qualifying EHR system to physicians and others for a nominal fee. Doctors who do not purchase the government's system can purchase a qualifying system from a vendor of their choice as long as it meets certain standards, including interoperability requirements.
The American Medical Association will seek clarification from HHS on the cost of the government system and when it will be available. The department must determine more details on how it will spend the stimulus dollars and how doctors can access them.
Once those details are available, physicians must examine the cost-benefit breakdown. According to a May 2008 report from the Congressional Budget Office, estimated total costs for implementing a typical office-based EHR are about $25,000 to $45,000 per physician. Each physician would then need to spend about $3,000 to $9,000 per year to maintain the system.
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Posted in Uncategorized at 1:00 am by ceo
Washington -- Representatives of physicians, health plans, hospitals, patients, businesses, medical researchers, drug companies, the elderly and many others appear to agree on at least one thing: The nation's health system should work better.
President Obama invited more than 100 health care stakeholders and lawmakers to the White House on March 5 to begin an effort to craft legislation aimed at controlling health care costs, improving quality and providing better access for the nation's 46 million uninsured. The goal is to enact a comprehensive health system reform measure this year.
"I'm confident if we come together and work together, we will finally achieve what generations of Americans have fought for and fulfill the promise of health care in our time," Obama said.
Representatives from several physician organizations, including the American Medical Association, attended the White House meeting. AMA President Nancy H. Nielsen, MD, PhD, said after the event that the attendees seemed to agree that every American ought to have health insurance and that the summit was a good start. "The devil is going to be in the details of what happens next."
Dr. Nielsen and other physicians also met again with the Obama administration on March 6. "We've actually had relatively unprecedented access" at the White House, she said.
That same day, Obama announced regional health reform gatherings scheduled for March and early April in California, Iowa, Michigan, North Carolina and Vermont. The governors of each state will host the events, which will include physicians, patients, policy experts and others. The Obama transition team in December 2008 asked Americans to hold community discussions on health care and report the results. More than 30,000 people attended 3,000 meetings in all 50 states and Washington, D.C.
Meanwhile, on Capitol Hill, two key Senate panels have been holding health reform hearings for months. Their House counterparts more recently began hearings on overhauling the health system.
Working group discussion
The White House summit opened with remarks by Obama, broke into five working groups moderated by White House staff, then ended with participants asking Obama questions and offering comments. Dr. Nielsen said her group met for 75 minutes.
The groups, according to press pool reports, avoided heated discussions. Instead, many participants stated their concerns and goals for reform legislation, including the urgency for quick action. Sen. Sheldon Whitehouse (D, R.I.) referred to the series of television advertisements that the health insurance industry used to help derail the Clinton-era health reform efforts. "This isn't a 'Harry and Louise' moment; it's a 'Thelma & Louise' moment. We're in the car, headed towards a cliff, and we must act."
Sen. Edward Kennedy (D, Mass.), who attended the summit despite his poor health, said he was as optimistic as he's ever been about finishing comprehensive health system reform legislation because everyone is involved this time. "You have the insurance companies, you have the medical professions, all represented in one form or another. That has not been the case over the history of the past, going all the way back to [President] Harry Truman's time," said Kennedy, who chairs the Senate Health, Education, Labor and Pensions Committee.
Sen. Mike Enzi (Wyo.), the highest-ranking Republican on the Senate HELP panel, said he agreed with Kennedy on 80% of his proposals for health system reform. The tough work will be finding common ground on the other 20%, Enzi said.
Strange bedfellows
Summit participants mentioned physicians in both critical and sympathetic terms. Sen. Jay Rockefeller (D, W.Va.), chair of the Senate Finance health subcommittee, said physicians stand in the way of nurses taking on greater responsibility in treating patients. Obama said he has close friends who are doctors and that he understands they are feeling tremendous strains from many sides. In addition, he said he recognizes that the cost of medical education is keeping medical students from choosing primary care as a profession.
Many attendees also spoke about the need for true bipartisanship and open-mindedness to different ideas. But advocates for single-payer health plans -- including Physicians for a National Health Plan -- were not invited until the last minute, said PNHP Director Oliver Fein, MD. The organization canceled planned protests once the invitation came through.
Karen Ignagni, president and CEO of America's Health Insurance Plans, said she understands that her organization, which fought health system reform when President Clinton spearheaded it in the early 1990s, must now fight to "earn a seat at the table."
Obama signaled some flexibility in his policy position. He said he would consider legislation that includes more private or public involvement in the health system than outlined in his campaign proposal, which calls for creating a national public health plan with competition from national private plans. Sen. Chuck Grassley (Iowa), the ranking Republican on the Senate Finance Committee, said he fears that a national public plan will erode private insurance coverage.
The president closed the event by addressing worries that Congress and the White House are taking on too much work at one time. "When times were good, we didn't get [reform] done. When we had mild recessions, we didn't get it done. When we were in peacetime, we did not get it done. When we were at war, we did not get it done. There is always a reason not to do it. And it strikes me that now is exactly the time for us to deal with this problem."
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Posted in Uncategorized at 1:00 am by ceo
Community hospitals may think twice before attempting to stifle competition from physician-owned hospitals, experts say, after a recent antitrust action by a state government official that is believed to be among the first of its kind.
Memorial Hermann Healthcare System on Jan. 26 settled allegations by Texas Attorney General Greg Abbott that the hospital systematically discouraged health insurers from doing business with a competing physician-owned hospital. Memorial Hermann, Houston's largest hospital system, allegedly used its leverage to punish -- with threats of contract terminations or rate increases -- insurers that signed on with what used to be Town & Country Hospital. The physician-owned facility went out of business in 2007.
Memorial Hermann denied any wrongdoing but agreed to pay the state $700,000 to reimburse the cost of the two-year investigation. The hospital also agreed to a five-year injunction prohibiting certain contracting practices, though the hospital said they are "practices Memorial Hermann has never employed."
"This is an instance where you have the government actually getting on board for the argument that physician-owned facilities cannot be frozen out of the managed care market," said Lorin E. Patterson, a health care regulatory expert and partner with law firm Reed Smith in Falls Church, Va. "The outcome is that it really should be a level playing field for all facilities."
The case also may offer physicians an alternate course of action against anticompetitive behavior other than pursuing what often are expensive private antitrust claims, he said.
The settlement is one of several legal battles across the country, sparked by doctors who allege that dominant hospitals are trying to protect themselves from competition at the expense of patient care. A separate lawsuit brought by the physician owners of Town & Country Hospital is pending in Harris County District Court and is set for trial in September. The doctors claim that Memorial Hermann's conduct drove their facility to close.
On the other hand, general hospitals argue that physician-owned facilities often choose more profitable treatments and patients, leaving the community facilities with the cost of emergency and uninsured care.
A trend at play?
Unlike more limited specialty hospitals, Town & Country was a general acute-care facility, noted Texas Assistant Attorney General Mark Tobey. "That was a fairly important distinction for us," he said, noting that Town & Country had an emergency department and had plans to offer a full range of patient services.
Competition is key to ensuring patient choice, and physician-owned hospitals have shown reduced costs and improved quality over community facilities, Tobey said.
Hospitals can contract exclusively with insurers without disobeying antitrust laws.
The case also signals that stronger state scrutiny is to come, he said. "The injunction in place should make it clear to Memorial Hermann and to the health care community at large that the attorney general is going to be watching this situation."
The attorney general's office also launched an early-stage inquiry into the possibility of similar antitrust violations in the Amarillo area. As part of the probe, state officials in November 2008 requested what they considered relevant information from Baptist St. Anthony's Health System. That included documents related to the hospital network's managed care contracts and communications, as well as a list of any competing physician-run facilities, legal records show.
Baptist was the subject of an earlier antitrust lawsuit brought by a group of Texas orthopedic surgeons who owned a competing surgical hospital. The Texas Medical Assn. and the Litigation Center of the American Medical Association and State Medical Societies contributed financially to the doctors in that case, Higgins v. Baptist, which ultimately settled.
Baptist spokeswoman Mary Barlow said the hospital complied with the request, but she had no further comment.
Tobey also declined to comment on the matter, but he said the attorney general's office was aware of the previous physician actions. Texas law requires parties to notify the attorney general's office upon filing any antitrust claim.
Policy questions
While antitrust laws generally favor competition, government officials and payers have kept a close eye out for overutilization and excessive costs when doctors refer patients to their own facilities, said John J. Miles, a former Justice Dept. attorney and partner at Ober Kaler in Washington, D.C. "The policy questions are very important in antitrust litigation" and are likely to be taken into account by courts, he said.
In addition, hospitals are able to contract exclusively with insurers without necessarily running afoul of antitrust laws. "There is no antitrust problem if a big hospital goes to a third-party payer to express concern [about a competing entity] and says, 'You decide,' " said Miles, who represents Baptist Health, a separate facility in Arkansas in a similar dispute brought by a physician-owned heart hospital. Little Rock Cardiology Clinic v. Baptist is headed to the 8th U.S. Circuit Court of Appeals after a trial court initially dismissed the case.
Memorial Hermann President and CEO Dan Wolterman said in a statement that his hospital had complied with the law, noting that nothing in the settlement prevents it from entering into exclusive contracts or negotiating appropriate rates and terms.
But Tobey said the hospital crossed the line when it imposed a significant rate increase on an insurer that included Town & Country in its network and when it pressured other payers. He said Memorial Hermann is permitted to seek rate increases under certain circumstances, but it first would need to show that it lost business because of any proposed changes by a managed care plan.
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Posted in Uncategorized at 1:00 am by ceo
Washington -- The end of a restriction on federal funding for human embryonic stem cell research and an increased amount of funding for all types of medical research are reopening an avenue toward finding cures for major diseases, some medical experts say.
President Obama signed an executive order ending the ban on March 9, more than 7½ years after President Bush enacted the restriction, which exempted stem cell lines derived before August 2001. Obama's order instructs the director of the National Institutes of Health to issue final guidelines within 120 days -- by early July -- to govern the funding of stem cell research as allowed by law.
"Today's action by President Obama will help scientists realize the potential of stem cell research to benefit the many Americans living with diseases such as diabetes, Parkinson's and Alzheimer's," said American Medical Association Board of Trustees Chair Joseph M. Heyman, MD.
Obama said federal funding is a key part of finding cures. "Medical miracles do not happen simply by accident. They result from painstaking and costly research, from years of lonely trial and error, much of which never bears fruit, and from a government willing to support that work." The $787 billion stimulus package enacted in February provides billions more to NIH through 2011 for research grants.
The change does not alter the Bush administration's policy on reproductive cloning. "We will ensure that our government never opens the door to the use of cloning for human reproduction. It is dangerous, profoundly wrong and has no place in our society, or any society," Obama said.
The economic stimulus bill provides billions to NIH for research grants.
The president also signed a memorandum instructing the White House director of the Office of Science and Technology Policy to write an additional regulation by early July with two goals: First, to ensure that executive branch hiring for scientific and technical positions is based on the candidates' scientific credentials; second, to direct federal agencies to make decisions based on well-established scientific and technical information while making available to the public the information that guided their decisions.
"Promoting science isn't just about providing resources -- it's also about protecting free and open inquiry," Obama said.
The move reflects criticism of the Bush administration's stances on global warming, family planning and stem cell research, among other issues. Some scientists felt that several of the former administration's decisions on these issues were not backed up by sound science, said Richard Marchase, PhD, president of the Federation of American Societies for Experimental Biology. "We want to see policy become more data-driven."
Others were disappointed by the announcement. "This is going to be wasted money. It's not going to give us any medical advances," said J.C. Willke, MD. He's the author of books on medical ethics and abortion and serves as the president of Life Issues Institute, an educational foundation in Cincinnati.
Dr. Willke said government-funded research should focus instead on adult stem cells. In the past year, scientists have been able to induce adult skin and nerve cells, for example, into pluripotency -- the state at which cells can form new cell types. Current research is focused on using these pluripotent cells to replace damaged cells in spinal cords. Meanwhile, embryonic stem cell research has progressed slowly, Dr. Willke said.
Rep. John Fleming, MD, (R, La.) said the adult stem cell advances mean sacrificing human embryos is no longer necessary. "Embryonic stem cell research provides no guarantee of scientific advancement, but it does guarantee the unborn have lost a critical battle."
But Marchase said examining human embryonic stem cells is still the best way to learn about the control mechanisms that lead to the formation of different types of cells -- and how that process goes awry when the body forms tumors. "You have to be able to understand these differentiation pathways."
Marchase said he's impressed that Obama has put distinguished scientists in key advisory positions in his administration. "I'm just very encouraged about an administration taking this attitude toward the importance of science in policy."
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