Dr. Emily's Blog

GODZILLA HAS RISEN:   THE INSURANCE INDUSTRY UNDER THE AFFORDABLE CARE ACT When inquired if Godzilla was "good or bad", producer Shogo Tomiyama likened it to a Shinto "God of Destruction" which lacks moral agency and cannot be held to human standards of good and evil. "He totally destroys everything and then there is a rebirth. Something new and fresh can begin.”  (Godzilla, Wikipedia)   Despite all the hopes many of us had for the Affordable Care Act, the current system of medical insurance is a twisted and dysfunctional nightmare.   I should know, because I am in the unique position of experiencing it from three perspectives simultaneously:  that of a patient who uses an insurance plan, that of a small business owner who purchases insurance for a group of employees, and that of a physician who contracts with and gets paid by insurance.   As a patient, I am tricked by the insurance plan I bought.  Even though the card says “HSA 2000”,...

PRESERVE POLIO SOCIETY Whenever one of my patients refuses vaccines for their child, I cringe.  Why turn down one of the best medical protections available?  Vaccines have prevented massive numbers of deaths and uncountable lives of anguish.  Refusing them makes as much sense as refusing clean water or sanitation systems.  For those of us with basic medical and scientific knowledge, this decision is incomprehensible.     However, for the average parent, vaccines may seem incomprehensible.  Medical science has advanced to the point where many people can’t understand how vaccines work, and don’t appreciate the benefits they have brought about.  Most parents don’t have a scientific education, so in decision-making they rely on the loudest voices that jive with their inner sense of values.  The collective memory of children in iron lungs or infants coughing themselves to death from pertussis is gone, so fear of disease has been remove...

WHAT TO DO WITH THE VACCINE REFUSERS? This month at our office we have been bandying about the thought of taking a stronger stance against parents who refuse to vaccinate their children.  In a recent article in the Daily Beast entitled “Pediatrician:  Vaccinate Your Kids-Or Get Out of My Office” Dr. Russell Sanders takes the hard line 1 .  He points out the tremendous health benefits that vaccines have engendered, the overwhelming evidence to support their safety, and the irrationality of declining one of the most beneficial medical treatments available.  He focuses on the issue of trust:  ..“for immunizations to be as malign as their detractors claim, my colleagues and I would have to be staggeringly incompetent, negligent or malicious to keep administering them” ...“as a parent myself I wouldn’t trust my children’s care to someone I secretly thought was a fool or a monster”.  He concludes by emphasizing that if parents can’t trust his medical advice o...

Premiere Access Every year in January we make new year’s resolutions.  We take a fresh look at what we are doing, and make a decision to do something better the next time round.  The Affordable Care Act (ACA) is our national resolution to improve health care, and this is the last year before it goes into effect. In this historic year, the way we  prepare for this change will affect its success and shape the future of medicine. While most of  the changes included in the ACA will dramatically improve our medical care system, a few of its aspects feel like the same old slide downhill.  Our medical office has been receiving letters from various insurance plans asking if we intend to participate in the products they will offer on the insurance exchange, the new “marketplace” for buying and selling insurance plans.  One company sent us an invitation to contract differently for each of their tiered products:  gold, silver and bronze.  Their plan was ...

The Topsy Turvy World of Vaccines In 1993, after a failed attempt at health care reform, the Clinton administration passed the Vaccines for Children (VFC) program, a federally funded program that provides vaccines for uninsured and low income children at no cost to participating medical facilities. In a way, this program was a consolation prize for legislators who had to give up a much bigger vision for health care, and within its scope of action, the program has been a success. The support it has provided for clinics and private offices struggling under the burden of vaccine overhead has been invaluable. The way the program works is that the Center for Disease Control (CDC) buys vaccines at a discount, and distributes them to public health agencies who in turn give the vaccine to local clinics or private practices for distribution. The nurses and public health officials involved in the program are passionate about children’s health, and the program is run in a way that is helpful...

I heard on the radio that the first week of June has been designated national "Give-Someone-a-hug-Week". At first this sounds like it should be a good idea. Hugs are warm, fuzzy, touchy-feely things that allow us to break through inhibitory social barriers. However, upon further reflection, it becomes clear that indiscriminate hugging is not necessarily good. For example, an employer hugging an employee could be interpreted as sexual harassment and lead to a lawsuit. Hugging in the workplace could distract employees and decrease productivity. Hugging someone who doesn't want to be hugged can be a daunting proposition. He or she may be hard to catch, and may require a surprise hug. Certainly there are people who will take hugging to extremes.....hugging the mailman, the garbage man and so forth. Suppose Safeway (our local “friendly” grocery store) were to get wind of the hug craze? Can you imagine being asked "Paper, plastic, or a hug?" Others may stand in line...

Over the past 8 months, our office has successfully made the transition from paper to an electronic medical record (EMR). It has been exciting, but at times painful. All of us have had meltdowns, but we have also had a few delightful "ah-ha" moments. We are finally through the proverbial tunnel, almost into the light at the end of it, and that feels great. One impetus that helped trigger our decision to take the electronic plunge, was the promise of reimbursement through the American Recovery and Reinvestment Act of 2009 (ARRA), otherwise known as the stimulus plan. Starting in less than one year, physicians who demonstrate meaningful use of an EMR and have a significant population on Medicaid or MediCare will be eligible for large reimbursements from the federal government. If you are interested in taking advantage of this unique and generous program, I suggest getting started as soon as possible. Some of the criteria that constitute "meaningful use" are technol...