19 July 2013

ATA Calls for USA Doctor Licensure

What are the problems of today that are standing in the path of telemedicine? It is state laws promoted by the different state medical boards. These state medical boards jealously guard the state borders and protect the doctors within their borders so that other doctors must become licensed to practice in that state.

This does not protect patients and often harms patients when they travel or are in another state on business. Can they pick up the telephone and order a prescription if they become sick with something they have been treated for before? No, they must see a doctor in the state they are in. The only exception is if they have a prescription issued by their home state doctor and use the pharmacy chain that fills the prescriptions at home. Example: At home, they have their prescriptions filled at Walgreens and obtain another prescription before they travel and when they have a repeat episode, take the prescription to a Walgreens wherever they are located during their travel. Walgreens can then check the records at the previous pharmacy and once verified they can fill the prescription. Otherwise, under current laws, they would be required to see a different doctor in the state where they are located.

I know of an executive from Minnesota that traveled to Illinois on business and became sick. The doctor there would not take him as a patient and sent him to the local hospital emergency room. There he was misdiagnosed and given the incorrect treatment and ended up almost dying because they would not listen to his wife and contact his doctor in Minnesota. During the transfer to another hospital, his wife recognized the airport they were passing and redirected the ambulance to the corporate jet and flew him home.

Using the jet's communications, she alerted the doctor and he had an ambulance waiting when the plane landed. The records were fortunately with the wife (the ambulance had given them to her), and she handed them to the ambulance personnel and they communicated with the hospital. When he arrive at the hospital, everyone knew what was wrong and they confirmed the correct diagnosis and had to give medications to blunt the previously given medications and then give the correct medications. Not everyone can be as fortunate as him and have this type of service. The hospital where this was started was notified that the diagnosis was incorrect and that they could forget billing for their services unless they wanted to be sued for malpractice.

This is just one more reason to support the American Telemedicine Association (ATA) in their campaign to change the licensure system for doctors in the USA. The U.S. military and Veterans Affairs (VA) Department have already acted to fix licensure barriers. So have the European Union and many other countries.  The American consumers, health providers, and taxpayers are being left behind.

Please read these three articles, two by the ATA, here and here, and this by the
Commonwealth Fund. This is an ongoing battle that the ATA has been trying to get resolved since August of 2011. Apparently, Senator Tom Udall (D-NM) is not interested in following his first promise and others are attempting to have federal legislation passed in the face of stiff lobbying by the different medical groups want to keep licensure for the states.

18 July 2013

Some Patients May Not Need Doctors As Often

Would this even be possible? Would the medical profession even allow this? I am talking about patients not needing to see a doctor just to receive a prescription and needing to see a doctor far less often than presently needed. Trisha Torrey is the first to bring this to my attention in her discussion here. Now the internet is picking up on this and more blogs may appear on this topic. The humorous part is that Ms Torrey's blog was written over a year ago and it is just now starting to gain some traction among empowered and participatory patients.

I personally feel this has merit with some legal safeguards. Not mentioned in any blog or article I have seen yet, is a requirement that the pharmacist be known, and report to the primary care physician. Understand that I am only writing this from the diabetes point of view and only for those that have type 2 diabetes (both those on oral medications and those on insulin).

I am talking about responsible empowered patients that are very knowledgeable about their diabetes being able to prescribe their own medications rather than see a doctor for every renewal or on a regular basis. Insurance would still be required to cover these medications and testing supplies. These approved (yes, you would need to be approved) patients could request lab tests at specified intervals and have the results sent to the doctor and yourself. Doctor could specify an approved list of tests or could add to the list if desired.

Ideas for rules:
#1. Patients would need approval from their doctor and their pharmacist.

#2. Patients would then have a prescription pad available at the pharmacy in a specific color to denote patient prescribed. Lime green has been suggested.

#3. Pharmacists would have a list of approved medications for the patient and dosage range (if any) that would be allowed. Doctor could update this because of evidence indicating medication under review or being pulled by FDA.

#4. Controlled drugs would not be eligible for this and doctor appointments would still be required.

#5. The patient could only write for himself or herself and any other use would end this privilege, permanently.

#6. Because the pharmacist can review records, a special request for additional medications for vacation could be evaluated and determined to be reasonable. Example: Patient has medication for 20 days before new prescription, will be going on vacation in 10 days for 30 days. Patient wants prescription to cover vacation plus 5 to 10 days. Under most circumstances, patient could get ninety day supply, but feels it is safer to carry smaller amount. Pharmacist can see that the request is reasonable and would fill the prescription. Now if the patient had just received a 90 day refill and wanted an additional 30 days for a 10 day vacation, the pharmacist would be justified in not filling the prescription as the patient already has about 90 days and won't specify when the vacation will happen.

#7. Self-prescribing cannot be moved to another pharmacy without the doctor's and new pharmacy's approval.

#8. Home A1c tests could be done quarterly and cost reimbursed by insurance, but legislation may be necessary at the state and federal level to force Medicare to reimburse and insurance to cover. Medicare and insurance could not stand in the way of approved self-prescribing.

#9. It may be necessary to have a meter that can connect to a computer to upload meter information to a doctor's office on a quarterly basis. This may require physician training or at least nurse training to read the reports and talk to the patient if necessary. Also, it may be required to have insurance reimburse physician or nurse for the time spent.

#10. If a new medication comes on the market, then a telephone conference may be required or an appointment to determine if the new medication can be substituted for an existing medication.

These are suggestions and there may be more rules needed. I am open for discussion and suggestions on this topic as it may become very interesting.

With the projected physician shortages predicted under the Affordable Care Act, this may well be a possibility. This could free up doctors that have patients that are microexperts in diabetes and allow empowered and participatory patients to be more in charge of their diabetes.

17 July 2013

July Calendar of Monthly Events

July has two worthy events, UV Safety Month and Eye Injury Prevention Month. Even with FDA regulations in place, many companies are choosing to attempt to sidestep the regulations and hope that they can gain profits at the expense of poor products. Some are advertising very heavily and getting their name out in front of people that hopefully will remember the name when they are shopping for sunscreen.

Many companies cover the UVA and not the UVB spectrum of the suns rays and other companies protect in the reverse. Many companies now just list UV and do not say which they protect you from, but according the FDA, you must be protected equally from each type if the manufacturer does not designate. UVB is responsible for sunburn, plays a major part in the causation of skin cancer, and affects the outer layer of skin only. UVA is less intense than UVB, but is up to 50 times more prevalent than UVB. It penetrates to the deeper layers of the skin, is the dominant tanning factor, and is linked to skin aging. While it may cause skin cancer, it can damage skin DNA.

Gone are terms of waterproof, sweatproof, and sunblock as per order of the FDA. Now it is suggested reapplying sunscreen after coming out of the water and regularly at approximately 20-minute intervals if you will be in the sun continuously.

Eye Injury Prevention Month is important and one of many months promoting different aspects of eye health. With eyesight being as important as it is, this is something to appreciate and celebrate everyday.

Eye injury prevention month focuses primarily on preventing eye injury in the work place and this is always important. However, eye injuries can happen any place and the home is responsible for more eye injuries than many people realize. In fact, nearly half (44.7 percent) of all eye injuries occurred in the home, as reported during the fifth-annual Eye Injury Snapshot (conducted by the American Academy of Ophthalmology and the American Society of Ocular Trauma).

Lawn mowers, weed trimmers and leaf blowers can throw dust and debris into the eye causing injury. Household chemicals such as drain cleaners, bleach, oven cleaners, and battery acid can splash into the eye. So please wear protective eyewear at home, at work, or where ever needed.

16 July 2013

The Patient Unprotection and Unaffordable Care Act

Not only are hospitals not safe for patients, they are not safe for physicians of any medical degree. Then consider how much money hospitals spend on lobbying and this starts to uncover the corner of a much larger problem that patients will face in the years ahead. Now add government agencies running and dictating policies, and healthcare will slowly slide down the sewer. If you doubt me, continue reading.

In a recent blog here, I laid out some of the problems covered by a doctor and I agree with them. This doctor has an ax to grind; however, he does so every eloquently and lays out some important facts that the average person may not be privy to or have any knowledge of what is happening. I have blogged about hospitals taking over many physician practices and hiring doctors away from other practices. Now some of the reasons are beginning to come to light as doctors are determined to prevent a complete hospital takeover and prevent a total hospital monopoly.

Much has happened that affects what we as patient pay for services for hospital doctor employees and many of the tests that they need for certain illnesses. They are much higher than when done formerly as part of a doctor visit at the doctor's practice. Patients are not as happy and waiting around at the hospital irritates patients. However, the hospital lobby has caused this and they were concerned that doctors were earning too much money and so they lobbied very falsely to get control so they could charge more for the same service.

Now the hospitals are charging about double what the doctors were able to charge and the patient is paying more for copay. In the meantime, the Center for Medicare and Medicaid Services (CMS) is severely cutting what they are reimbursing doctors. Hospitals are being well paid because of their lobby. What is fair?

Congress and Medicare now realize their mistake and want cuts in payments to hospitals for services that can be provided more efficiently and less expensively in doctors' offices. Unfortunately, the barn door was opened and things may not change as fast as wanted or desired. And the hospital still has their lobby in full out operation.

15 July 2013

A Wearable Defibrillator and RPM

Ever come across a blog that makes you want more? This blog by Westby G. Fisher, MD had me hooked from the start and I of course followed through to the answer. Very, very interesting Dr. Wes. Being a patient still has me concerned about what other devices are out there that we don't know about.

For some of this you will need to go to this website to get the full benefit and for a proper understanding. I am surprised that this was FDA approved in 2001. From what I am seeing and reading this device is possibly one that more heart patients should be wearing, and are not because their doctors don't know about it or have rejected it because it would require monitoring which many doctors will not do because of the cost and equipment needed. Yes, it is capable of remote patient monitoring (RPM).

Here are some of the images that may be of interest and convince you to read more.

The following is worth quoting for your attention. “The LifeVest wearable defibrillator is a treatment option for sudden cardiac arrest that offers patients advanced protection and monitoring as well as improved quality of life.

The LifeVest is the first wearable defibrillator. Unlike an implantable cardioverter defibrillator (ICD), the LifeVest is worn outside the body rather than implanted in the chest. This device continuously monitors the patient's heart with dry, non-adhesive sensing electrodes to detect life-threatening abnormal heart rhythms. If a life-threatening rhythm is detected, the device alerts the patient prior to delivering a treatment shock, and thus allows a conscious patient to delay the treatment shock. If the patient becomes unconscious, the device releases a Blue™ gel over the therapy electrodes and delivers an electrical shock to restore normal rhythm.”