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 Every January, the NFH expands coverage on health care and related issues – in line with the No. 1 most popular theme surrounding New Year’s resolutions: get healthy! This year, we covered preventive measures to good health and a few physician-related facts regarding Obamacare.
New health care law: effect on providers
Complementary medicine could see a boom in business
By Jason Gray
The Patient Protection and Affordable Care Act of 2010, also known as Obamacare, was enacted in March 2010, and ruled constitutional by the U.S. Supreme Court in June 2012. The provisions of the law are being implemented over time until the entire law is in force in 2020. Proponents say availability of medical care will increase for the currently uninsured. Opponents say doctors and other health care providers could be negatively affected by the changes.
Most of the changes implemented through the end of this year have affected insurance companies and Medicare administration, according to healthcare.gov (the federal government’s website specific to the PPACA). Medical providers will start seeing direct impacts this year. Medicare reimbursements to doctors serving older patients will start being reduced.
A study published in September by the University of Minnesota’s Carlson School of Management broke down reductions in payments to health care providers by county nationwide. El Paso County doctors and facilities will collectively have their payments reduced by $5.3 million this year. Each year the reductions increase, until 2023, when the sum impact to doctors in the county for the 10-year period reaches $764 million in lost revenue.
The perception of losing money on additional Medicare and Medicaid patients under this new payment structure has led some doctors to consider reducing or eliminating their Medicare / Medicaid practice. According to a survey of Colorado doctors by the Physicians Foundation, a national group, 29 percent of Colorado doctors will place “new or additional limits on accepting Medicare patients.” An additional 29 percent said they will stop accepting Medicare patients altogether.
The combined impact of more patients and fewer medical doctors accepting government program insurance could result in more people seeking preventive and alternative care.
Dr. Stephen Kutscher, Falcon area chiropractor, believes that if the perception of the level of service in the medical industry declines, more people will look to chiropractic and holistic care to keep them out of what he calls the “sick care industry.”
“There will be absolutely no impact on our level of service from Obamacare,” Kutscher said. “If anything, it might finally make Thomas Edison's vision come true that the doctor of the future will give no medicine, but will instruct his patient in the care of the frame, in diet and in the cause and prevention of disease.”
Dr. Jeremy Case, a physician from Parker, Colo., weighed in on the effect the PPACA could have on alternative medicine.
"PPACA has ambiguous language that would seem to allow an ‘in’ for alternative providers to perhaps be paid as licensed or even certified providers,” Case said. “The issue is most of them are not regulated or licensed by DORA (Department of Regulatory Agencies). However, the state medical society's council on legislation expects that many of them will seek legislation this session to become ‘certified’ in some manner for that very reason. I also expect that they will receive sponsorship in the state Legislature but get resistance from physicians."
Separate from the alternative issue, many doctors believe the PPACA is a “step in the right direction,” according to a poll by the international Deloitte Center for Health Solutions. The report indicated that “44 percent of doctors believe the act is a good start.”
The report also notes that, much like the population as a whole, generational and ideological differences seem to have an impact on how doctors perceive the law.
Prostate screening
By Alli Griffin
To screen for prostate cancer is a decision men often make based on risk factors such as age, race and family history, according to the Centers for Disease Control and Prevention. The CDC has published a guide for men on when and how to make that decision.
According to the U.S. Preventive Task Force, prostate cancer is the most common non-skin type of cancer diagnosed in men. The task force estimates that 15.9 percent of men will eventually develop prostate cancer. More than 33,000 American men die from prostate cancer each year.
The CDC details two types of screenings: a PSA and a digital rectal exam. A PSA is a blood test that measures the prostate specific antigen – higher than normal levels can indicate prostate problems. During a digital rectal exam, the doctor inserts a gloved finger into the rectum to feel the prostate to check for lumps or any abnormalities in size.
The PSA has been under debate as a trustworthy measure of screening. The Mayo Clinic indicates on its website that PSA levels can be high for a number of reasons besides cancer. Medications can alter the results, as well as an enlarged or inflamed prostate.
The USPSTF conducted a study on the benefits of PSA testing, and John Hopkins University released the results in an article published May 21 of last year. “The U.S. Preventive Services Task Force released final recommendations against prostate-specific antigen (PSA)-based screening for prostate cancer, asserting that there is ‘moderate or high certainty the service has no net benefit or that the harms outweigh the benefits.’” The task force issued the test a grade D rating.
The “harms” mentioned by the task force include unnecessary procedures like a biopsy that follow a higher-than-normal PSA. “According to the USPSTF, evidence suggests the potential harms caused by PSA screening of healthy men as a means of identifying prostate cancer outweigh its potential to save lives and that routine annual screening should be eliminated in the healthy. Elevated PSA readings are not necessarily evidence of prostate cancer, and can lead to unnecessary prostate biopsies. In addition, even when biopsies reveal signs of prostate cancer cells, evidence shows that a large proportion will never cause harm, even if left untreated. The disease in older men often progresses slowly so that those who have it frequently die of other causes.” The possible side effects of surgery are also mentioned as deterrents to treating prostate cancer; impotence and incontinence.
Other organizations such as the American Urology Association argue that the benefits outweigh the negatives regarding testing.
“The AUA is outraged and believes that the Task Force is doing men a great disservice by disparaging what is now the only widely available test for prostate cancer, a potentially devastating disease. We hold true to our current position as supported by the AUA's Prostate-Specific Antigen Best Practice Statement that, when interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging or risk assessment and monitoring of prostate cancer patients.” The AUA also noted that there was no urologist on the task force.
The information is confusing, said Carolyn Kalaskie from the Penrose Cancer Center. “A general practitioner will quote the new guidelines to you, while a urologist will recommend testing,” Kalaskie said. She said the USPSTF “reviewed scientific literature on prostate cancer screening.” Because of the change in guidelines, the Penrose Cancer Center will not be offering free prostate screenings this September, which they had done in the past.
Danielle Oller from El Paso County Public Health said prostate screening is not available at their facilities. “Although we do not provide prostate screenings at El Paso County Public Health, we do refer patients to Peak Vista; and, if they are uninsured, they may also try Mission Medical Center or Open Bible Medical Clinic,” Oller said. The public health department recommends prostate screening for those age 50 and older; however, screening could be indicated for a younger person if there is a family history of prostate cancer.
A survivor’s story
Symptoms can vary with prostate cancer, from blood in the urine, pain during urination or low back pain. Robert Rodriguez said he had no symptoms when he was diagnosed in his early 50s with stage two prostate cancer.
Rodriguez said he was in a “haze” and “devastated” by the diagnosis.
He had gone in for a routine PSA test on the recommendation of his primary care doctor, who had lost a brother in his 30s to prostate cancer.
His doctors monitored him for a year before suggesting treatment, Rodriguez said. They offered two treatment options: radiation or total removal of the prostate. He chose removal of the prostate because “radiation had no guarantee of a 100 percent cure,” he said. An operation was not an option after radiation treatments, the doctors told him. And radiation treatments could affect other organs.
The surgery was done robotically, with only six incisions. Three years later, he is still in remission. Rodriguez said he has “no regrets, no second thoughts.
“You have cancer. This is what you have to do, and you do it.”
Mammograms and colonoscopies: when and why
By Lindsey Harrison
Mammograms: yearly or not?
A Nov. 22 article published by the New England Journal of Medicine caused some confusion about the accuracy of mammograms for diagnosing breast cancer, resulting in conflicting opinions of how often women should get them.
According to the study by Archie Bleyer, M.D. and H. Gilbert Welch, M.D., M.P.H., “We estimated that breast cancer was overdiagnosed (i.e., tumors were detected on screening that would never have led to clinical symptoms) in 1.3 million U.S. women in the past 30 years … . Although it is not certain which women have been affected, the imbalance suggests that there is substantial overdiagnosis, accounting for nearly a third of all newly diagnosed breast cancers, and that screening is having, at best, only a small effect on the rate of death from breast cancer.
In November 2009, the U.S. Preventive Services Task Force recommended biennial mammography screening for women ages 50 to 74 years.
The American Cancer Society, however, strongly recommends yearly mammograms starting at age 40 and “continuing as long as a woman is in good health.”
Dr. Pio Hocate, a radiologist with Colorado Springs Health Partners, agrees with the ACS. “I think it’s very important that women do understand that mammograms need to be performed annually once they hit 40 because it does save lives.” Hocate said. He said all CSHP doctors operate under the ACS guidelines.
“If you have risk factors, like a genetic component, you’re generally at a higher risk, so you should begin getting mammograms 10 years before (the age at which) your family member was diagnosed,” Hocate said.
Hocate said some women are concerned about the amount of radiation used when getting a mammogram. “The amount of radiation you’re getting from going outside, going on an airplane or living on the outside of a mountain that contains radon is much higher than what you get from a mammogram,” he said. “The benefits outweigh the risks.”
Some women who have undergone genetic screening and have the same gene that caused cancer in a relative opt for a voluntary mastectomy, Hocate said. “I’m not usually in that discussion and I don’t usually recommend it,” he said. “Once you know you have the gene and that (cancer) is a possibility, then it’s a personal choice. You have to weigh the options with an oncologist.”
Bottom line, Hocate said, “The earlier you catch the cancer, the earlier you can begin to treat it and beat it. Until other data says not to have a mammogram every year, that’s what we’ll recommend.”
Colonoscopies
According to the American Society for Gastrointestinal Endoscopy, “Colorectal cancer is the third most common cancer diagnosed in men and in women in the United States, excluding skin cancers. It is the third-leading cause of cancer-related deaths in the United States in both men and women and is expected to cause about 51,690 deaths (26,470 men and 25,200 women) during 2012.”
The American Cancer Society’s latest statistics estimate that 103,170 new cases of colon cancer and 40,290 cases of rectal cancer will have been diagnosed in the year 2012.
The ASGE recommends that both men and women of average risk for developing colorectal cancer should have a screening colonoscopy at age 50 and then every 10 years after that. Part of the rationalization for this recommendation is that 91 percent of new colorectal cases and 94 percent of deaths result in people older than 50, according to the ASGE website: “The incidence rate of colon cancer is more than 50 times higher in people aged 60 to 79 than in those younger than 40.
“Colorectal cancer screening saves lives in two important ways: by finding and removing precancerous polyps before they become cancerous; and by detecting the cancer early when it is most treatable.”
Screening is also important because colorectal cancer is frequently present in people without any symptoms.
Sleep more, be healthy
By Robin Widmar
In his play “Hamlet,” William Shakespeare penned the quote, “To sleep, perchance to dream.” If Shakespeare was writing in the 21st century, he might have said, “To sleep, perchance to rejuvenate body and mind, stave off weight gain and prevent heart disease.”
Millions of Americans don’t get enough sleep; whether by choice, because of work schedules and family demands or as a result of medical issues.
The National Sleep Foundation’s 2011 Sleep in America poll found that 43 percent of Americans between the ages of 13 and 65 said they rarely or never get enough sleep on week nights. Sixty percent admitted to having a sleep problem every night or almost every night, and 63 percent said they didn’t have their sleep needs met during the week. The Centers for Disease Control and Prevention called the nation’s chronic lack of sleep “a public health epidemic.”
In today's fast-paced world, sleep is frequently regarded as a luxury instead of a necessity. People view it as a commodity that can be sacrificed for money, lifestyle or recreation. In his book “Power Sleep,” Dr. James B. Maas described modern life as “a twenty-four hour society, a ‘rat race’ where sleep is not valued… we are cutting back on sleep to gain time for what seems more important or interesting.” Often, a person’s willingness to trade sleep for other activities can lead to serious consequences.
Why sleep is important
Every living organism operates on a circadian (from the Latin circa “around” and diem “day”) rhythm – a natural cycle of sleep and wakefulness. The circadian rhythm is primarily governed by a genetically programmed mechanism located in the hypothalamus of the brain. This internal clock controls rhythms of alertness, body temperature and hormone production over a 24-hour cycle and can be influenced by external factors such as temperature and light levels. Circadian rhythms direct humans to sleep at night and be awake during the day. Maas said this basic rhythm likely evolved from prehistoric times when it was safer for humans to bed down at night rather than wander around in the dark and become a snack for some predator.
Sleep reenergizes the body and allows the brain to store and reorganize information. It regulates the body’s gastrointestinal, cardiovascular, and immune functions. Researchers have discovered that a chronic lack of sleep can lead to serious medical problems such as hypertension, diabetes, depression and obesity.
Sleep: casualty of a 24-hour world
Before the invention of the electric light, people tended to wake at sunrise, go to sleep shortly after sundown and sleep an average of 10 hours per night. Over the past century, Americans’ sleep has decreased by about 20 percent, according to the Institute of Medicine Committee on Sleep Medicine and Research. In its 2006 report “Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem,” the committee concluded that “Americans are working more hours or multiple jobs and spending more time watching television and using the Internet, resulting in later sleep times and less sleep.”
The results of NSF’s 2011 poll support the fact that technology is supplanting sleep in many American households. Ninety-five percent of those surveyed reported using a television, computer, video game or cell phone at least a few nights a week within an hour of going to bed. The use of electronics before bedtime can have a negative effect on sleep.
“Artificial light exposure between dusk and the time we go to bed at night suppresses release of the sleep-promoting hormone melatonin, enhances alertness and shifts circadian rhythms to a later hour – making it more difficult to fall asleep,” said Charles Czeisler, M.D., of Harvard Medical School and Brigham and Women's Hospital. “Invasion of such alerting technologies into the bedroom may contribute to the high proportion of respondents who reported that they routinely get less sleep than they need.”
How much sleep is enough?
The amount of sleep an individual needs varies from person to person. Sleep requirements can change with age and health, and can be influenced by genetics. “Just like any other characteristics you are born with, the amount of sleep you need to function best may be different for you than for someone who is of the same age and gender,” according to the NSF. “While you may be at your absolute best sleeping seven hours a night, someone else may clearly need nine hours to have a happy, productive life.” Many sleep experts agree that the average adult requires between six and 10 hours of sleep every night, with 7.5 to 8.5 hours the optimum amount of sleep to function well. Each person must determine the amount of sleep necessary to function well during waking hours.
Maas observed that well-rested people are alert throughout the day, can endure boring tasks without drifting off, are sharp and focused and take 10 to 20 minutes to fall asleep at night. Signs that a person isn’t getting enough sleep: - Needing an alarm clock to wake up at the right time
- Struggling to get out of bed in the morning
- Often feeling tired, irritable and/or stressed out
- Experiencing trouble with concentration and memory
- Relying on caffeine or other stimulants to stay alert
- Needing a nap just to get through the day
- Often feeling drowsy while driving
- Falling asleep within five minutes of going to bed
How to get a good night’s sleep
The NSF and other sleep experts recommend a healthy lifestyle to ensure quality sleep every night. Eating healthy foods, exercising, limiting caffeine intake and quitting smoking all help the body maintain its natural circadian rhythm. Other tips for sleeping well:- Bedrooms should be dark and quiet. Remove telephones, computers, TVs and other electronics that emit light. Install room darkening curtains and soundproofing if necessary.
If soundproofing is not practical, try using white noise (such as a fan) to obscure outside sounds like traffic. - Don’t eat, read or watch TV in bed as those activities can stimulate the body and mind.
- Invest in good quality bedding for maximum comfort.
- Set thermostats to cooler settings during sleep times to encourage the body’s natural sleep tendencies.
- Go to bed and wake up at the same time every day, even on weekends, to keep the body’s internal clock on a consistent schedule.
- If working a second job or a shift schedule, plan sufficient sleep periods around the work schedule.
- Avoid caffeine within six hours of going to sleep.
- Don’t eat large meals within four to five hours before sleeping.
- Use relaxation techniques, not alcohol, to ease stress and invite sleep.
- For insomnia, avoid long-term use of over-the-counter sleep aids. See a physician to rule out underlying health issues.
For more information on the importance of sleep and the effects of sleep deprivation, check out the National Sleep Foundation website at http:// sleepfoundation.org.
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