Primary Care Physicians Take Note Of Reform Possibilities

Physicians everywhere generally seem most concerned with the managed care aspects of healthcare reform. There is a fear that, with the movement into a marketplace where there are more insureds (either through employer mandates or Medicaid eligibility expansion) and the growth of risk based compensation, panic is close at hand. Physicians, especially primary care physicians, need to be more circumspect and look for a silver lining.

First of all, the sky is not falling. It is changing, as it always does, but it is not falling. It is axiomatic to think that change in health care is inevitable. Of course it is. It is foolish, however, to think one knows precisely what it will consist of. That said, it is fairly predictable that, if the healthcare reform laws are even just a sign of what’s ahead, the future may have the following characteristics in the insured (governmental or commercial) market:

1. A movement over time away from fee for service payment;
2. Growing integration of information technology (e.g. EMR) into healthcare;
3. Increased outcome-based measurement and connection to reimbursement; and
4. Healthcare businesses and physician practices combining in various ways.

Some experts have said “we’ve been here before.” Remember the capitation, IPA and PHO explosion of the 90s? True enough, but there was never any discussion about tying reimbursement to quality measures of any kind back then. The things they are unified about, however, are the need to develop compensation methodologies which accomplish three things:

1. Get more patients insured;
2. Slow the rate of increase in healthcare expenditures; and
3. Measure quality.

Though the fears about the methods proposed for accomplishing those three objectives are understandable, and while physicians do have to explore how they are doing business (in the insured marketplace) and do need to consider alternatives (e.g. IPAs, practice mergers), there is little conversation about the more proprietary opportunities presented to physicians in the face of reform.

Healthcare reform will likely create tremendous opportunities in the “proprietary marketplace,” where business opportunities abound. Some experts even say that the reform changes will amplify a growing two-tiered system that already exists in our culture. What that looks like is impossible to predict, but there are at least two signs and signals that exist today.

Patient centered medical homes (PCMH). The term was first coined by the American Academy of Pediatrics in 1967. Since then, the concept has morphed with the input of the American Academy of Family Physicians and the American College of Physicians. Simply put, the PCMH or simply Medical Home is not home health care. It is an expanded concept of how to deliver primary care and ensure patient participation in their care and outcomes. The concept includes some basic elements:

1. It is located in a lower cost environment closer to patient populations to ensure access;
2. It has expanded hours to accommodate patient schedules;
3. It is primary care led, using both physicians and others;
4. It expands on the concept of care delivery to include relevant and necessary services such as serving as a nexus between patient needs and the community;
5. It uses enhanced communication techniques, like texting patients about appointments and online scheduling;
6. It takes into consideration patient lifestyle to ensure enhanced patient participation;
7. Evidence based medicine and outcome demonstration is at the core.

Regardless of how the model is interpreted or implemented, one thing is clear: there is a business opportunity here!

Concierge practices. Many experts agree that the already existing two tiered medical system in our culture will expand as the insured market grows. More and more patients, they say, will want greater access and “non-covered services” (especially as the definition changes of what is covered what is not). Again, opportunity!

Physicians have a tall order now: Consider new ways to adapt and prosper in an expanding insurance market. They also need to keep in mind the opportunities the market changes present.

What is Pediatric Congestive Heart Failure?

Within the United States, congenital heart defects are the main cause of pediatric congestive heart failure. Other causes include; infections, exposure to toxins and damage caused by drugs. The American Heart Association (2008) defines congestive heart failure (CHF) as a medical condition in which the heart can not pump enough blood to the rest of the body. Blood flowing out of the heart slows; causing the blood returning to the heart to back up into other tissues of the body. The severity of symptoms can vary, depending on the degree of the heart defect.

This condition results in fluid build up in the child’s tissues, including the lungs. Breathing becomes more difficult and the child experiences shortness of breath and may start using more of their chest muscles to breathe. This added exertion uses up vital energy that should otherwise go toward helping the child grow and develop; the very act of breathing and crying can leave them feeling exhausted. As a result, these children can fail to grow and thrive; compared to children their age, they may be slower in meeting their developmental milestones.

Symptoms of pediatric congestive heart failure may not be evident until a few weeks after birth. The child may have a pale or gray complexion. Due to their breathing difficulties, they can take almost an hour to finish a feed that should ordinarily take only about 15 minutes. The added exertion associated with each activity can cause them to perspire excessively, even at normal temperatures. A lack of energy, a fast heart rate and fast breathing are common signs of pediatric congestive heart failure.

Older children and adolescents may have more specific symptoms, such as feeling shortness of breath whenever they are active or exercising. Depending on the severity of their heart condition, they can experience difficulty breathing even at minimal exertion, such as climbing stairs or taking a walk. Some children develop abdominal pain; clinicians may find an abnormal accumulation of fluid in the child’s abdomen and swelling in their extremities.

Their appetites may be diminished, which can lead to weight loss. On the other hand, they can also gain weight, due to the amount of fluid that is being retained. It is important to note that older children can be at risk of fainting during strenuous activities; this can subsequently lead to a serious injury.

Treating children with pediatric congestive heart failure has become safer in recent years, due to high-definition imaging technology, advanced patient monitoring systems and high tech robotic operating tools. Operative procedures have also become safer and less invasive.

In some cases both the heart surgeon and the heart catheterization specialist will treat the child, at the same time. These combined elements have contributed to improved survival rates and improved health outcomes for children. Early and focused surgical treatments have saved many children from an otherwise debilitating or fatal defect. Referral to a pediatric cardiologist is appropriate whenever a diagnosis of pediatric congestive heart failure is suspected.

Help Your Grade-Schooler Overcome Their Fear of Dentists

Is this your home? ‘Your grade-schooler throws tantrums, screams, complains or even cries every time you bring up the thought of visiting a dentist.’ Or, maybe he or she retreats into a sullen smoldering.

With the relative sophistication of today’s kids, we forget sometimes that they are still little kids.

And, at their age, it is STILL normal for them to be a little frightened about the bright lights, the hats and gloves and that big dental chair they not normally part of their day-to-day life.

As a matter of fact, a large percentage of school-aged children round-the-globe share the same fear. Come to think of it, a lot of adults still do too!

However, as a parent, you know how important it is for your grade-schoolers to regularly visit a dentist — especially, to keep those smiles bright and happy.

So how do you live up to that responsibility to help your kids overcome that fear?

You can’t just give up on them. You want the best for them. But, you are also busy and a little unsure of how to help them.

To help parents deal with this, here are a few reliable tips to help overcome the dentist ‘tantrum attack’ or doldrums:

Start Early

Start introducing dentists to your kids as early as two years old. Make it an adventure to go with stories and songs and plenty of hugs and kisses. Starting with the right attitude early prevents a LOT of later upset.

However, if it is already too late for that strategy, and your child is already school age — don’t think that it’s too late. In that situation, it is true that bringing them to a Dental Center won’t be as easy to sell to them as to a child of two.

Yet, you CAN still start preparing them for a visit day without trauma or fuss… it is all about re-framing the experience.

Use WIFM (What’s In It For Me)

Introduce the topic of dentists as something that they will get an immediate benefit from. cavities or oral health are not really something that affects what is important to them – their friends, school, other kids, acceptance and a loving environment.

Discuss with them what IS relevant and ‘in it for them’ by the visit (other than no cavities). Something like:

♦ How kids are nicer to kids with good smiles.

♦ How getting cavities would be very painful and a sealant will help protect them.

♦ How the dentist visit is their first line of defense against bad breath and teasing.

Read Them Stories

For early grade-schoolers, stories and fantasy are still very impactful. Reading them bedtime stories like the story of the tooth fairy is one effective way to help them overcome the fear.

Today, there are plenty of books telling stories about visiting a dentist and take note — they are all fun to read. So invest in a storybook or three and you’ll see you kids not only learn from them, but also enjoy the extra bonding time with you!

Bring Them With You

If you are going to your dentist for checkups, allow them to watch you while you are in a short procedure.

Talk to your dentist about the situation and set this up in advance. Most dentists will be fine with helping you show them that getting in and being checked by a dentist is never as scary as he thought it will be.

* However, make sure that you only bring your grade-schooler to watch you only during your check-ups and not in any other complicated dental procedures.

See A Children’s Dentist

Giving them a dentist who specializes in a pediatric practice is important to make the dentist visit live up to your preparation. The best thing to do is to consider a pediatric dentist or a children’s only dental center.

Just like you, children need dental treatments and care for them to have those healthy smiles and not affect their school performances. Taking your school age children to a dentist who specializes in a good experience for children will not only help them maintain those smiles — but also help you relieve any dentist visit anxiety.

You CAN eliminate pre-dentist visit trauma and tantrums… even if your child is already in grade school and past 1st visit. It just takes a little preparation and careful selection of a dental practice focused on your child’s positive experience.


Dr Karen Chu DMD

Cow’s Milk and Iron Deficiency: Why Cow’s Milk May Not Be Good For Your Child

As an expectant mother with persistently low haemoglobin levels, I was intrigued to discover from my own research that there is a link between cow’s milk and iron deficiency anaemia.

I grew up subscribing to the general wisdom that cow’s milk is a rich source of calcium and iron. I was even on the school milk programme, getting my daily dose of plain and flavoured milk in pyramid-shaped packs. Yet, after years of faithfully drinking milk, I am still iron deficient and borderline anaemic. When I looked up the literature, I discovered to my surprise just how much research there is that supports the finding that cow’s milk is associated with iron deficiency in children.

How can something conventionally regarded as indispensable to good health harm you?

Firstly, it has been found that for an infant under 6 months of age, over-consumption of milk irritates the intestines and causes the loss of blood in the intestinal tract. The exact reason for this blood loss is unclear, but it is postulated that the culprit is a particular protein found in the milk. Over time, this loss of blood stores results in iron deficiency. Thus, the American Academy of Pediatrics recommends that a child be at least a year old before being given cow’s milk.

Secondly, milk’s lack of bioavailability makes it hard for the body to absorb the levels of iron required for optimum health, thus causing iron deficiency. In mild cases, iron deficiency has been associated with a decrease in attention span (and a rise in incidences of Attention Deficit Hyperactivity Disorder), alertness and learning ability. If the iron deficiency is severe, it can lead to anaemia. Iron deficiency is also known to increase a child’s susceptibility to lead poisoning, especially for those living in older homes.

Thirdly, cow’s milk products are inherently low in iron, containing about only 0.1 mg per 8-ounce serving. When you compare this figure with the US Recommended Daily Allowance of 15 mg per day for an infant less than a year old, what it means is that an infant would need 150 servings of milk a day to get the required amount of iron! An over-reliance on milk as the primary source of iron also means that the child’s appetite for other iron-rich foods (which should form part of a balanced and healthy diet) is dampened.

What then is a conscientious parent to do? Thankfully, there are many good alternative sources of iron readily available commercially. Look out for them on your next visit to the supermarket:

For young children

  • Iron-fortified infant formula
  • Iron-fortified cereals

For the whole family

  • Liver and lean meats
  • Seafood such as sardines
  • Dried fruits, such as apricots, prunes and raisins
  • Nuts
  • Beans, especially lima beans
  • Green leafy vegetables, such as broccoli and spinach
  • Black strap molasses
  • Whole grains

The American Academy of Pediatrics notes that a young child can get iron deficiency anaemia if he is given cow’s milk too early, particularly if he is not given an iron supplement or iron-rich food. Most toddlers get all the calories and calcium they need from 16-24 ounces of milk a day, and no child requires more than 32 ounces of milk a day.

Making sure your child has a balanced diet is essential to his health and wellbeing as he grows. This includes a diet that contains adequate amounts of iron to help prevent iron deficiency and its associated problems.