Here is the article that was published online on 7/6/18: www.stltoday.com/news/local/govt-and-politics/st-louis-city-county-join-together-to-tackle-std-problem/article_c8adf797-3b1a-5bd3-a94b-a644ab2b6a5e.html
And below is the entire email that I sent to the reporter the previous day. I am not for one second suggesting that anything was taken out of context, but I do feel it is important in a free society to be able to communicate freely and without being edited by anyone who may have a different agenda.
Some points of clarification:
HAVING CLARIFIED THINGS, I do indeed wish the new consortium well as I stated in my email to the reporter. I have every confidence that, with their greater resources, bigger staff and stronger financial backing, the new contractors will able to absorb the cost of the STI program, better than we ever could.
I am especially grateful to the County residents who are essentially paying for the treatment of STDs in the City. It is this kind of partnership that will bring about much-needed change. The spirit of partnership is far more important than any efforts that some may make to be divisive or to make for a sensational story.
I believe the new physicians who have assumed this contract are good and professional people, and I fully expect them to effect great change, especially with the backing they have. No reporter is going to bait me into saying anything bad about any other physician or clinic in town. We physicians simply don't sink that low - leave that to the politicians.
Here are the two emails, the first from the reporter to me on 7/3/18, and then my response to he on 7/5/18.
Blythe Bernhard Jul 3 (5 days ago)
What are your thoughts on not receiving the latest STD contract from St. Louis city? Why do you think they went in a different direction?
What are your thoughts on the consortium that did receive the contract?
Is there any lingering animosity toward St. Louis County department of health over the handling of the STD problem in the region?
Pam Walker said North City Urgent Care will close without city funding. Is this true? What is the economic impact of losing the contract?
How do you respond to the state saying you were violating the contract and double dipping by charging $30 for STD office visits? Do you think that played a role in the contract decision?
You said not charging the $30 copay would "render the STI contracts illogical." What do you mean by that?
It seems like the payments for STD services were often delayed or otherwise complicated. Do you think the city health department was efficient or competent in its handling of the contract?
Are you working with the St. Charles County health department in any capacity?
Do you intend to bid for any contract again?
St. Louis Post-Dispatch
Blythe Bernhard Jul 3 (5 days ago)
Sorry, I forgot to send this yesterday. Happy Independence Day!
I went through each of your questions and talking points one by one. I hope you'll find my answers comprehensive and detailed. Please feel free to quote me in any way you deem appropriate.
1. My thoughts on not receiving the latest STD contract from St. Louis City, and why I think they went in a different direction:
I think such a contract should be reviewed at least every 3 years, if not annually, as I said when you asked me earlier this year. Thanks to your article in February, I think the City was reminded that it had a duty to the people to 'shop around' for the best possible contractor, not just for STI, but for all such contracts. It's perfectly reasonable to give someone else a chance to demonstrate their skill and efficiency with a task and it was high time that such a contract was awarded to someone else. I had gently mentioned this to the Health Commissioner several times but I don’t know if I articulated my concerns terribly well, at least not well enough to be taken seriously, so I was somewhat relieved that this 'course correction' arrived after some prompting from the media. Frankly, I don't think any organization should hold any contract for more than a year or two, but that's just the way I think.
I truly believe that the government, be it federal, state or local, should be afraid of the people, and not the other way around. Good journalism forces accountability in public officials and, although it may sometimes cause a little pain, it’s necessary in a progressive and civilized society.
2. My thoughts on the consortium that did receive the contract:
My staff and I are truly overjoyed that this consortium received this contract. It was long overdue that such a consortium contract was awarded. The City's new leadership has demonstrated wisdom in this choice. Each of the members of the consortium will have far superior financial backing than we had/have, more staff than we had/have, and vastly more equipment and resources than we had/have. If I was running the Department of Health, I would have awarded this contract to such a consortium years ago. I have no doubt that they will deliver on their promise to finally change Saint Louis' #1 position as STD capital of America for the past 50 years. I think people will applaud the results that I believe we will see very quickly and as a member of this community, I do sincerely wish the new contractors the very best, and so do all my staff.
Simply put, we did our best (actually for far longer than we should have done) wearing this STI mantle, and it’s high time for someone else (someone stronger, wealthier and better-equipped) to take it on. I have every expectation that they will succeed where we could not, especially as we only treated 16% of the entire St. Louis community. The fact that it is multiple clinics replacing just two clinics also speaks to the City’s realization that more resources and more locations were needed to meet the challenge. The City has demonstrated a rare wisdom in issuing this new contract.
3. Is there any lingering animosity toward St. Louis County department of health over the handling of the STD problem in the region?
I didn't realize there was any animosity toward them in the first place. I have heard some people make the observation that the County has 'dumped' STD patients onto the City, much like the allegation that it has done so with regard to the homeless, but I was not aware of anything that resembled animosity. I am a County resident myself and I believe the County does the best it can do, given its resources, with regard to STDs.
Also, it should be noted that the County is a willing member of the new STI consortium, the County taxpayer should be thanked for helping subsidize the regional problem of STIs. This will be a great step in the right direction toward an inevitable City-County merger, if only at the Health Departments level, which I wholeheartedly support.
4. Is North City Urgent Care (NCUC) closing without the STI Contract?
NCUC might sadly close later this year, but it is open as of now. You may recall that almost a year after we opened North City Urgent Care, the Post ran a story where I stated that the facility might close because of the lack of insured patients, and it also highlighted why no other healthcare organization had been willing to open in that neighborhood. Primarily, although NCUC didn't profit from the STI contract, the arrangement served to make people aware that NCUC existed in the first place, and that kind of intangible marketing effect certainly helped.
STI patients, their relatives and their friends would hear about NCUC, just by word of mouth, and then they would come back and use the facility for a large variety of non-STI problems. Unfortunately, because such an attention-getting situation has now ended, it is likely that NCUC will close by the end of Q3 or Q4 this year, but we are still analyzing the patient numbers and hoping that we can delay or even prevent such a closure.
As you may already know, we started a free urgent care at NCUC on Tuesdays a few months ago, and that has been remarkably popular. We’ve received over 100 applications from people wanting to volunteer there during the free clinic!
If there was a method to the madness of starting a free clinic, it was to raise awareness of the existence of the facility, much like the STI contract did.
If NCUC does see an increase in patient volume in the next few weeks then of course it won't close, but if we can't afford to pay our staff or keep the lights on, then we will have no choice but to close. I am feverishly working on any solutions to keep NCUC solvent and open. We are doing everything we can to prevent the elimination of jobs and worse, a return to the area no longer having a true urgent care center.
NCUC has proven itself to be a very important healthcare resource for people who live in the Northside, where transportation can be a major challenge. We love serving this community and have been working hard for them since 2013, seeing between 15 and 30 patients a day. NCUC is still open and we do hope to keep it that way. We are still glad to see STI patients and will work with them to identify another affordable payment option if they do not wish to go to the free clinics. However the City-funded free STI services ended at NCUC on June 30th.
I am optimistic that the new STI contractors will succeed with free care where we simply couldn’t because, as everyone knows, they have more staff, significantly more money and far more equipment and resources. The new STI contract ,which I personally believe was prompted by the call for public accountability sought by the Post article in February, also serves the St. Louis community by highlighting where people can go to get free care, of any kind, not just STI.
Awarding the STI contract to this consortium will also help the uninsured know where to go for all their other medical needs, and not just STI matters.
It’s not fair or accurate to label the individual members of this new consortium as ‘The STD Clinic’. It’s more accurate to portray them as grant-maintained and heavily subsidized, wonderful facilities that do go out of their way to care for the underinsured and the insured.
Not being a recipient of any grants (governmental or private) or indeed any other kind of subsidy, NCUC depends on patient numbers to keep it solvent, especially those with insurance, Medicare or Medicaid. NCUC has always embraced those on Medicaid (which includes many veterans).
It may be worth noting that perhaps the biggest financial constraint of any clinic operating in an underserved area, such as NCUC does, and their ability to stay open is the State's refusal to expand Medicaid.
As a physician, it is my opinion that a state’s refusal to expand Medicaid is a violation of trust and a dereliction of duty to the citizens of that state, and not just to those below a certain income level but to all of us. If the poorest in society get treated well, then everyone benefits. If the poorest are neglected, then we all suffer. I feel rather strongly about this as you can probably tell.
5. $30 for STD Office Visits:
The $30 ‘donation request’ was initiated reluctantly by us at the repeated insistence of Commissioner Melba Moore, who said to me that "the patients need to have a stake in their care and take some personal responsibility for their own actions".
Commissioner Moore suggested this $30 voluntary donation amount because we (being NCUC and DUC) complained that the contract awarded by the City did not cover the costs of testing and treatment and that we were losing money at both North City Urgent Care and Downtown Urgent Care as a result of the STI contract being honored at those two facilities.
Simply put, the DOH Commissioner was the one who directed us to request the $30 donation from every patient that presented with an STI. However, as I’ve said before, the patients were always aware that this $30 donation was entirely voluntary and we didn't even collect very much because most patients did not donate it.
As I said before, no patient was ever turned away and the vast majority of patients didn’t make this suggested donation to the clinic.
Even today, anyone is welcome to make a voluntary donation to our clinics, especially to NCUC, which is in difficulty. When a facility doesn’t turn people away, such as the poor on Medicaid or veterans on Medicaid, it does the right thing, but it also means that it’s always thirsty for financial assistance.
From when we first opened Downtown Urgent Care in 2009, we were determined to always put patients before profits, even if it meant we always just break-even. That is why we have always accepted patients on Medicaid and we always will, even if it costs us to do so. We know that some other companies won’t ever accept Medicaid, but we prefer to be able to sleep at night.
If you’re saying that someone from the state said that we were 'violating the contract' and 'double-dipping', then that someone is obviously unaware of the truth of situation and is probably just speculating or guessing for reasons unknown to me. Nobody from the state ever made any such ‘violation’ comment to me or to my staff, so I’m not sure this is actually a state position or just one person’s comments that may have been misunderstood or received out of context. Indeed, during the entire period that we held the STI contract, I don’t recall ever having been contacted anyone from the state about it.
It is also an unfortunate mischaracterization to use the word 'charging' with regard to the $30, when it was only ever merely a 'suggested voluntary donation' as directed by the Health Department Commissioner. The vast majority of patients did not even make this donation and they were always tested and treated appropriately regardless, and they were routinely told that not making a donation would not prevent us from providing testing or treatment. I am not sure why or how this entire $30 suggested donation thing has been taken out of context or mischaracterized as some of kind of crazy mandatory charge, which it never was. Meh, I just put it down to things being lost in translation I guess.
The City has always been aware of the truth of the $30 suggested donation, since they are the ones who asked us to put it in place, and so I do not believe such rumors played any role in the contract decision, although I suspect there may have been some attempt to placate the critics who misunderstood what was going on.
Ironically however, I do believe that the City will no longer repeat the suggestion that any contractor request voluntary donations of any kind from patients, and to be fair, I think the new STI contractors can more easily afford to absorb the losses they may experience during this contract, so it won’t be an issue.
6. Payments for STD Services:
The City Health Department has been nothing but super-efficient and competent in its handling of the contract with us, and they always met their contractual obligations. They were never late unless we issued our invoices late, so I have no complaints at all with regard to working with the City. Indeed, under the direction of the Commissioner Melba Moore, the contract was handled well from our perspective. She was always receptive to any concerns we had and, as I stated above, even when we had concerns about the financial viability of the STI contract, Commissioner Moore was quick to make suggestions and recommendations and to come up with solutions that would work.
7. St. Charles County:
No we have had no contact with St. Charles County Health Department and we are not working with them in any capacity. Our three facilities are not located in St. Charles County so I don't think they would have any interest in working with us either.
8. Future Contracts:
We will always be ready and willing to bid for any City contracts in the future if we feel we can handle them. As I stated earlier, it is a good and wise practice for local government to 'shop around' and reassess a contract every 1 to 3 years, under any capacity and in every department. The Post-Dispatch article that you wrote did a great job reminding us of the need for such a practice and I do believe such a policy will improve outcomes.
I do feel that good journalism promotes both public accountability and that citizens are kept well-informed. I think your piece earlier this year did exactly that.
Many thanks for giving me the opportunity to clarify some of the confusion that seemed to dominate the situation earlier this year.
So what's with the new logo eh? And why have I taken so long away from my blog eh? OK, I'll tell you.
As a physician, initially emergency medicine but now general internal medicine, I have had probably thousands of patients over the years with anxiety and depression. Sometimes they wanted no intervention at all. Sometimes they wanted to see a psychiatrist, or a psychotherapist and often they started on medication. Every case has been different.
Over the past 3-4 years, I have been regularly recommending meditation (that's mediTation, not mediCation) for my patients. Something simple, like downloading an app, such as Calm or HeadSpace and doing a 10-minute guided meditation just once a day. I even started it myself in the summer of 2015.
It was really intended for those people who had what's probably called 'normal stress', such as dealing with work or noisy kids and all the associated stressors. These people typically didn't want to start any kind of medication and were a bit stigmatized with the idea of visiting a psychotherapist or consulting a psychiatrist.
I have been constantly impressed with how a simple 10-minute guided meditation has not only helped my patients with mild anxiety and/or depression, but pretty severe cases of those diagnoses as well.
Not only that, I've also been happy to observe that meditation seems to help with other things too: hypertension, migraines, insomnia, even diabetes! So naturally, I've been routinely recommending it to almost all my patients. Maybe because I don't look like a hippie, just a regular doc in a white coat with a stethoscope, I get the feeling that a lot of my patients 'give it a go' and download the app and actually do a meditation. This results in them being converted quite quickly, often to their surprise. Indeed, many of my patients have been able to come off medication altogether, and not just anxiolytics and antidepressants. I've been able to stop antihypertensives, migraine meds, insomnia meds and even diabetic meds.
Now as we all know, and I'm generalizing here of course, women are a bit more enlightened about the benefits of meditation, yoga and mindfulness-related activities. Men, not so much.
So I wrote a book. Not a very good book, but it was cathartic nevertheless as many authors have experienced and it definitely got a lot of crap off my mind and into the printed word. The book was called UPWavers and it's on Amazon if you want it, but I don't recommend you get it unless you want yet another cure for insomnia. It's also on audible.
But I digress.
So in the spring of 2017 I started hosting mindfulness sessions for groups of patients. I didn't even charge for them, because it was so fulfilling for me to see the benefits of my patients being able to 'awaken' to themselves. To at least get a glimpse of their consciousness and to become more aware of the universe around them.
Then I had an epiphany. Nobody in the world seems to be able to cater to 'men and meditation'. Yoga and Mindfulness and all that jazz seems to have such an effeminate feeling about them that many educated and 'tough' men, who don't want to lose their 'manly image' wouldn't be seen dead meditating. What if, I thought.... what if I could make meditation fun. Maybe make it more appealing to men, but not less appealing to women.
I think I was at Disneyworld when it came to me. Lots of men would proudly admit to being Star Wars fans I thought to myself. Star Wars has Jedi, who wear robes, take vows of celibacy and are strictly vegetarian (or may I just made that last one up). Do Jedi meditate? Of course they do! Everyone knows that. Even Yoda talks about meditating in the movies.
What if, I thought.... what if I could make a 'mindfulness suite', called The Jedi Temple, where men (and women of course) could come along and have a group guided meditation? What if I could get yoga instructors, acupuncturists and meditation guides to come along and give them a 1-hour session? What if we could make this entire thing part of a wellness retreat, where people could even stay if they wanted? And yes, of course they'd be paying for all this, but I bet they'd want to. I mean, nobody else seems to be offering this kind of thing!
Indeed, if we made it mindfulness-enough, they wouldn't even need to take a class - they could just stay there and go catch a baseball or hockey game and then be together. Being together with others is also great for one's health. In fact, that's one reason I invented The DEN but that's another story altogether. So whether they're with friends, fellow alumni, family, fellow sports team members or fellow convention attendees, I figured this could be a wonderfully positive experience.
Fast forward to now and not only do we have The Jedi Temple, we also have Hogwarts Dorms, The DUGOUT (baseball themed space), DowntoWn Abbey, 221B and we're soon opening a golf-themed space. These suites are fully booked almost every weekend and they've been just awesome. The women of course, being so much more enlightened anyway, just go along with the whole thing and love the fact that it's not just another 'all woman retreat', but a thing they could bring their husband/boyfriend/dad along to, without him kicking and screaming. It was just a great thing all round! I was right.
Who knew Downtown Saint Louis could compete with Australia, California and Central America as a destination for a wellness retreat. Midwest employers love us because they can send 20 people to St. Louis, instead of on flights to San Diego - can you see the immediate savings that reduce stress?
Anyway, these suites are now an integral part of Downtown Health & Wellness. We still have traditional medicine, but unlike most facilities, we also focus on prevention.
Downtown Health is the traditional 'medical side' - the urgent care (Downtown, North City and Creve Coeur), the primary care (Downtown Medical), the work comp and the telemedicine (ContactADoc).
Downtown Wellness is the foo foo 'prevention side' - where you can do yoga, meditation, or just hang out with friends in a calm and relaxing atmosphere in a very interesting group travel suite. Many groups come for a 'business meeting' and don't even stay the night. Many teams do want to stay 1 or 2 nights. We're even hoping to somehow incorporate escape rooms and mystery dinners into these suites - can you tell how proud I am of what we've done?
I'm just writing today's blog piece because I feel like I've discovered a new side to being a doctor - and I LOVE IT. Once you've been an ER doc for years, Internal Medicine can feel so bland. I know that's not a very marketable thing for an internist to say, but I care more about truth than I do about optics - if you've watched me get sued for speaking my mind, you know this! Finally, I've made Internal Medicine and the honor of preventing illness a far more interesting challenge than just writing prescriptions and telling people to eat more fiber!
Anyway, if you want to know more, just drop me an email (firstname.lastname@example.org) or go and check out the website (DowntownHealthAndWellness.com aka dhwstl.com)
I’m going to pretend I’m in group therapy. I say pretend, but it’s actually true. I’m in group with all my fellow humans.
I’m a liberal. Probably a raging, bleeding heart liberal at that, but I need to confess something. I think I may have been wrong about healthcare.
I’m a physician, a business owner and arguably a real estate developer, so I’m often contacted by conservative groups who believe I’m a slam dunk for donations and believing that healthcare should be deserved not given, that taxes need to be lower especially for the rich, that inheritance tax is evil, that gun-ownership is some kind of God-given right, yada yada yada. And I have to constantly search for creative and courteous ways to gently let them down. I say gently, because I’m a liberal and we liberals don’t want to be like those angry, red-faced, uneducated and confused people. We want to be the epitome of loving-kindness.
So this is where I am wrong. Healthcare. As a physician, this is perhaps the most important thing to me, especially with how the weak, the poor, the oppressed and the vulnerable are treated. I have posted on social media, sometimes resulting in legal action as many of you are aware, about how every urgent care ought to accept Medicaid and that the clinics who don’t are greedy and bad physicians etc. Maybe I was a little harsh, but I needed to make a point. I needed to provoke a reaction. If I didn’t, then the status quo would remain. This is how to upset the status quo - you have to piss people off!
Is there a right to health care? Or is it a privilege? Or is it a duty? Or a necessity?
Many posts and articles about health policy frequently highlight this very question.
My fellow liberals have resoundingly said ‘yes of course it’s a right’, while the conservatives have typically said ‘no of course it isn’t’.
The questions keeps on coming up, so I feel the need to address it, by admitting that I was wrong.
The problem is, whether healthcare is a right vs a privilege is a terribly worded question. Every human I know agrees that all humans should have access to basic healthcare. Yes, even the conservatives.
When those conservatives say that ‘healthcare is not a right’, they don’t mean it in the way that my fellow liberals object to. And when we liberals say ‘healthcare is a right’, we’re often met with ‘but what about…’ questions regarding the responsibilities of the state or physicians in general. People go off on tangents about why med school isn’t a right as well and so on.
But that’s what badly worded questions cause: digression. Nobody stays on point and nothing is achieved.
Using the word ‘right’ means different things to different people. Freedom of speech is a ‘negative right’ for example, and it really means the right to speak without being muzzled and gagged by the state, meaning the government shouldn’t interfere and should refrain from doing something.
The right to social security if you’re 80 years old, on the other hand is a ‘positive right’, meaning the government should actively do something.
By calling healthcare a ‘right’, it implies the positive right, wherein the government has a duty to simply give each person the right to free healthcare. I put the word free in italics because, as we all know (liberals and conservatives alike), nothing is really free. It really just means taxpayer-funded, and this is what annoys the conservative the most. We can talk about that later. Whenever I use the word free, it implies ‘taxpayer-funded’, but maybe I’m wrong to even use that word too!
However, perhaps the ‘right to healthcare’ is better described as a government (federal, state, city, whatever) that has an obligation to the people to encourage and endorse market conditions and legislative strategies which result in everyone having all their genuine medical needs addressed. Notice, this is not saying that every poor person gets the right to go to the ER 50 times a year with a toothache or for a med refill. It’s that vision which really upsets my conservative brethren.
No, it’s saying that if someone has a real need, as defined by us physicians (because even conservative physicians don’t want that being defined by legislators), then it will be attended to and addressed by the state if it cannot be paid for by the patient. Obviously the definition of ‘ability to pay’ and ‘medical need’ are subject to lots of irritating debate, but I do feel it brings the two sides of the aisle closer together than we were before. Both the conservatives and the liberals use very good but opposing rationale about the best way to proceed, and the wise on both sides do indeed recognize such logic and are inspired by it.
The government can and should directly provide health services and health insurance in the form of universal healthcare. The government should also provide free medical care to the homeless.
How much freedom should an individual have to make her own healthcare decisions? Should a citizen have to worry about money problems that result from receiving necessary healthcare? As almost 2 million veterans use Medicaid instead of the VA for their healthcare needs should these people, who sometimes gave their limbs and compromised their health for the freedoms we enjoy, be denied medical care by an urgent care facility that whines that it’s simply not profitable enough to treat the veterans?
These discussions and the inevitable differences of opinion are important, but all of agree that we need to come up with a way to address the basic medical needs, and yes, I put that word in italics deliberately as I do for all loaded words.
I used to believe that a right to healthcare meant that it would only be possible if we had universal healthcare and a governmental guarantee that healthcare will be provided for free to each person no matter what their social and financial conditions are. I had that viewpoint because I grew up in England where I observed the NHS treat everyone equally and well, no matter how rich or poor they were, or what they looked like. But even the NHS is having its problems, because of the same right-wing vs left-wing rationales that go on over here.
I was wrong. There is a middle way.
The right to basic healthcare for every person’s needs is indeed possible without creating a welfare state.
Yesterday I posted on a closed Facebook group of Emergency Physicians, asking everyone whether they thought healthcare was a right or a privilege. Although a slight majority of the comments said it was a ‘right’, I was surprised to see so many post the word ‘privilege’, without even an explanation. Of course, there’s a posting bias at work here. Some folks won’t post their opinion because they [correctly] perceive me to be one of those crazy liberals. However, I realized that I was perhaps in the wrong because I’m asking the wrong question.
I write this piece on a beautiful rainy Sunday morning, which many in America are unable to enjoy because of a medical condition that they cannot afford to get seen. I write it so that my conservative brothers and sisters can see that I am willing to admit when I am wrong. I write it so that my fellow ‘bleeding hearts’ may consider changing the discussion from ‘healthcare is a right’ to ‘the right to healthcare’.
We won’t change the status quo unless we all realize that we are one country, no matter our color, creed or bank account, and that we are in this together. And we won’t change the status quo unless we are all willing to take baby-steps which means that we all need to be willing to admit when we are wrong.
So in case there’s any confusion, I’m a liberal-minded physician and I was wrong to call out those who disagreed with me when I said healthcare is a right. Instead, I’m going to do better by listening better.
Yes it’s true. Many physicians have sadly bought into the idea that practicing Medicine is no different from running a factory and all that matters is the bottom line.
Yes I know everyone’s gotta pay the electric bill, cover payroll and put food on the table. But what about when the physician’s covered all that? It’s a physician we’re talking about here - not a businessman. They have taken oaths to care for the weak, the oppressed, the vulnerable. No matter what color or creed. AND NO MATTER HOW RICH OR POOR.
Sure, they’ll pay lip service to the fact that “patients matter”, but they won’t mention the secret that, to them, profits matter more. Much more.
Yes it’s true: A physician who cares for a Medicaid patient gets paid little more than someone working in a soup kitchen. Little more than a volunteer helping rebuild a community after a hurricane. Little more than emceeing a trivia night for charity.
And that’s the point.
2 million Veterans on Medicaid.
9 million Children on Medicaid.
Refusing Medicaid is refusing them.
Don’t enable urgent cares that don’t accept Medicaid.
If you care about Veterans and Children. If you care about people on low incomes. Please consider where you take your family next time you need urgent care. Please use your private health insurance at an urgent care that does GIVE. At an urgent care that does treat Medicaid patients.
Please share this among friends and family, and ever so slowly we can change our community mindset.
If a restaurateur proudly says he doesn’t give food to the hungry but he will feed the poor as long as they pay him.......
It’s like an urgent care operator who proudly says he doesn’t accept Medicaid but he will treat the uninsured as long as they pay him.
Has any urgent care operator said that recently?
Think about that.
Have you ever wondered about the perfect crime?
Well they do exist. And the villains don’t usually appear with tall hats and twirling their moustaches. More often, they appear clean-shaven, wearing a white coat and a stethoscope, as well as a winning smile and the most articulate way of explaining things. Indeed, I might be one of those villains myself - at least I think I have a winning smile!
So these people, you know who they are, they’re called ‘doctors’, have these pieces of paper in frames, called a ‘medical degree’ and a ‘state medical license’, which is pretty much their way of telling the world: “you will not challenge what I say to you”. Fortunately, the vast majority of my patients (in fact probably ALL my patients) are smart and intelligent people. They always [quite appropriately] question my decision to order a particular test, such as a blood test, an x-ray, ultrasound, MRI, CT scan or specialty referral. When I say they ‘question’ it, I really mean, they ask me questions about it, such as “why do I need this?” and “what will it show?” and “is there something else that we could be doing instead?” and “can it wait?”, and stuff like that. You know, intelligent, reasoned questions that the good discerning patient would pose.
Now picture if you will, that same smart patient having pain or vomiting or trouble breathing, meaning the patient is now what is known as ‘acutely ill’. The threshold for getting a test automatically gets lowered, and it’s more of a “can we just get it done already?!” approach instead. To some people, this could be seen as a perfect opportunity for some good old-fashioned coercion...
Allow me to introduce you a physician who actually owns a testing machine and therefore makes money on it every time it’s used. Houston, we may have a problem…..
A conflict of interest is a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest. If the secondary interest is the clear profit being made by ordering, I dunno, a CT scan for example, then the ‘acutely ill’ patient is now ripe for being run through the mill, whether that ‘mill’ is needed or not, and several things happen next:
So to summarize, if you want to make a lot of money and you have a medical degree and you don’t really care too much about someone getting lymphoma or breast cancer 20 years from now, just open a facility that has zero regulation and requires no licensing, and where acutely ill patients will go, and then you can easily use your documentation skills to justify ordering a CT scan on most of them (at least the ones with good insurance plans) and bam: you’re rolling in it! Just make sure your clinics are really pretty and nice. Make sure the place is well-lit, and you have start of the art exam rooms. Make sure you have the appearance of a spa, but with all the medical personnel and the best customer service. You know, all those retail mantras that’ll make people love you! Any decent criminal mind knows all this and will exploit the innocence of the general public and CT scan everyone for all their worth. I mean, if they’ve got a pulse, just scan them and you’ve got more than a medical license: you’ve got a license to print money with that CT scanner of yours. And to get all your doctors on board, make sure you train them on how to document things ‘properly’, just to get the scan past the insurance company, especially as you own the scanner. It wouldn’t hurt to give all your doctors a share of the profits from all the scans they order, and throw in some excellent benefits for good measure. What a brilliant business model. And everyone in the community will love you, without realizing what you’re really doing. Amazing: fame, fortune and accolades - what’s not to love?
Now that LICENSE to practice Medicine, is also a LICENSE to Print Money, and it's also a LICENSE to Kill people, albeit slowly. It'll take years for that malignancy to present, by which time the physician is probably retired or dead, and other parasites have taken his place.
But surely, no self-respecting doctor would do this. Would they? I mean, who’s ever heard of doctors committing crimes like that? Nah - perish the thought!
All around the country, this scam is going on. What do we call these ‘acute care clinic traps’? They’re called ‘urgent cares’.
As an aside, here’s a simple example of the ‘staged documentation’ that such CT-scamming physicians are doing:
So you just flew in from Chicago, not Beijing - "long flight". You smoked 2 cigarettes in college - "history of smoking". You're a 38 year old woman on birth control - "increased risk of blood clot". You've got pain in your chest when you breathe - ignore that it's only been going on for a couple of hours. Aha: CT chest to rule out a pulmonary embolism! And the insurance company's case manager falls for it because the documentation (see above) is so compelling. They don't have time to dig deeper. Approved by insurance! Cha-ching!
The market plays right into the physician’s greedy hands when the big insurance companies suddenly announce that they’re advising all their members to go to urgent care for CT scans, rather than to hospitals. It makes sense for the insurer: even the CT-scamming small-fry physician is costing them less than the hospital CT scan. So the insurer is now actively and knowingly enabling the perfect crime.
Therefore, the only people who can stop this are YOU the patients, or rather, the potential patient, assuming you’re not sick right at this minute. You probably wouldn’t be reading this if you were. But anyway, what can you do to prevent getting unnecessarily CT-scanned, or rather ‘CT-scammed’?
There are actually some simple things you can do.
Another thing you can try is to say you’re in a rush and can you do the scan another day - if they release you (unlikely) then call back and say you’d rather have it done somewhere else, such as at the hospital or one of the many independent imaging centers in your town.
It should be stated here that the vast majority of physicians are not villains. They practice good medicine and they follow evidence-based guidelines and when done correctly, order a CT scan is both perfectly appropriate and often life-saving. This article is not about those doctors - it's about the tiny minority of physicians who own a scanner and use it frivolously, without a care for the guidelines or published recommendations with regard to when to, and when not to, order a CT scan. Unfortunately, overtesting is a national problem and it's the few doctors who practice overtesting make everyone else look bad.
Beware if you see the following signs and symptoms of an urgent care company:
This is a national problem, and it is almost definitely happening in your town. Nobody is going to risk litigation by naming a company that’s doing this in your town, but you can certainly tell your friends and relatives about this, so that it’ll become a ‘public secret’. Just like we all know what place has the best Chinese food, or where you can find the best frozen yogurt, we can also help one another get good healthcare.
So please, use caution when seeking medical care for an acute illness or injury, and keep your wits about you.
Poorer and middle-class Americans are more likely to donate than are the wealthiest people in the country, according to a report released by The Chronicle of Philanthropy in 2015. Hence the inspiration for writing this article: those without much, or anything, to give, seem to want to give more than those with lots to give.
The holidays are hard on everyone's budget, so don't feel bad if you can't write a big check to your favorite causes this year. Instead, give back without emptying your wallet with these nine great strategies.
1. Volunteer Your Time
One of the best and simplest things you can do to help a charity is give your time. Arguably, non-profits need people more than they need money. Everybody is good at something, and there is a nonprofit out there that’s looking for your skills.
Charities can always use professional services assistance such as people to help with legal work, accounting, graphic design, and writing. But even if you don't have such skills, many organizations just need people willing to give time to support their mission, whether that's being a mentor to a kid looking to get into college, offering free tutoring, or preparing food at a food bank.
2. Clean Out Your Closet
No matter what unwanted item you have lying about your house, there is probably some charitable group that will benefit from receiving it. Anything you can think of, nonprofits will be able to use, from books to old computers. Giving clothes, shoes, furniture, and the like to Goodwill, the Salvation Army, Oxfam or a local church's thrift store is an easy way to help out low-income families.
3. Get Crafty
Certain charities need items that you might not readily have at home, such as tiny sweaters for penguins affected by oil spills or booties for premature babies.
4. Give Blood
With fewer blood drives being held during the winter months, blood donations tend to drop this time of year. But the need for blood remains steady; donated blood has a shelf life of only 42 days. All blood types are wanted, especially type O or AB.
5. Swipe Your Credit Card
Yes I know I said “giving without spending”, but what I meant was “without spending any extra”. For every purchase you make, many credit cards will gift a small percentage to the charity. While it's nice that you can give back while making everyday purchases, be aware that the help tends to be minuscule. For example, Bank of America offers a card that gives 0.08% to the Susan G. Komen breast cancer organization, which means you'd have to spend $10,000 to donate $8. You also don't get any tax benefits from using a charity card.
6. Shop Online
AmazonSmile, a program the tech giant introduced in 2013, automatically donates 0.5% of your purchase to a charity of your choice. It costs you and the organization nothing. The only catch is that you must start your shopping at smile.amazon.com; buying through Amazon apps, Kindle, or through affiliate links won't count. You could also do your shopping through GoodShop, which works like AmazonSmile, gifting a small percentage of purchases to the charity of your choosing.
7. Only use healthcare facilities that treat the poor
Even though you may not love your private health insurance plan, at least it’s better than those who can’t afford any insurance. And even worse off than them are the people who are poor enough to qualify for Medicaid. Unfortunately, so many clinics and urgent cares are driven exclusively by profit margins, keeping their Medicaid-refusing policy secret, rather than by doing the right thing and focusing on people’s health, regardless of financial status. An easy way to give without spending any extra is to only use clinics that accept Medicaid and have other ways to help the less fortunate in your community. To find out whether your local urgent care accepts Medicaid, simply phone them and ask them if they accept Medicaid, as if you’re a Medicaid patient. By only taking your family to clinics that contract with Medicaid, you’re helping them help the poor. Find out more at MedicaidChallenge.com
8. Become an Organ Donor
Each day 22 people die waiting for transplants that can't take place due to a lack of donated organs, according to the Department of Health and Human Services. Help reduce that number by registering in your state to become an organ, eye, and tissue donor. By doing so, you could save up to eight lives and help several others through tissue donation. Last year, donors made more than 28,000 transplants possible, and helped another 1 million people receive tissue transplants.
9. Get a Haircut
Several organizations such as Locks of Love and Wigs for Kids will happily take your chopped-off locks to make hairpieces for patients who lose their hair due to medical treatment or a medical condition. You may need to wait a bit and grow your hair out before doing good; the minimum length requirement is 10 inches.
Ever since the first novel and subsequent films, millions of people around the world have fallen in love with the magical world of the Harry Potter franchise. But did you know that the lessons we take away from this magical experience can be applied to our lives as we pursue health and fitness? Dr. Sonny Saggar and special guests Amanda Canete and Amanda McMichael visit KPLR 11 News at Noon to discuss lessons and tips as they apply in your quest for a healthier lifestyle.
CT scans diagnose serious medical problems and often save lives, but this tool is OFTEN OVERUSED resulting in big doses of radiation and big medical bills that could’ve been avoided.
Absolutely they are a great tool. I don’t think anyone can dispute the value they have brought to humanity.
And yes, I do order scans every day, but that doesn’t mean I should be ordering them on people who don’t need them.
I, or any other physician, shouldn’t be ordering a CT scan on people with weak reasons to do it.
Only because it’s definitely needed - it’s definitely indicated according to the medical evidence - and not because “it’s easy - I have a scanner available - let’s just do it”.
CT scanning has certainly aided diagnosis and helped many patients avoid exploratory surgery, but it has also spawned concerns about misuse.
X-rays have been used for almost 120 years, but the introduction of computed tomography, or CT scans, in the 1970s, was revolutionary. The new tests, which use multiple X-ray images, allowed doctors to see with unprecedented precision the inner workings of the human body, and earned the inventors of the device the 1979 Nobel Prize in medicine. Use of the tests grew quickly, rising from fewer than 3 million per year in 1980 to more than 80 million now.
2. Don’t you have clearly laid out and written criteria for ordering a CT scan? So what are the concerns about CT scans?
Yes, we have internationally accepted very clear criteria for ordering say a CT scan of the head, or the chest or the abdomen and pelvis, but unfortunately, that doesn’t mean your urgent care or emergency physician will follow those guidelines.
Remember, these are just guidelines. They’re not rules and they’re not the law.
The ballooning costs of healthcare, including from duplicate procedures, the potential harm from the tests themselves and the overtreatment of harmless conditions found during scans. These are effects of overdoing it with the CT scans.
There’s such a thing in Medicine that physicians call “incidentalomas” — so named because they are found unexpectedly — include benign lung and thyroid nodules and other common conditions that can lead to even more unnecessary and expensive workups as well as treatment that can cause complications.
3. How many scans are done unnecessarily? Anyone watching this will probably think that their CT scan was actually necessary won’t they?
And many of them would be right.
Unfortunately, many patients have fallen prey to a sophisticated sales pitch.
Researchers know that doctors today order millions of radiation-based imaging tests each year, that many of them are unnecessary, and that the more radiation people are exposed to, the greater their lifetime risk of cancer.
Recent research shows that about one-third of those scans serve little if any medical purpose. And even when CT scans or other radiology tests are necessary, doctors and technicians don’t always take steps to limit radiation exposure.
4. OK so let’s say that some scans probably shouldn’t have been done. What are consequences of getting these so-called ‘unnecessary scans’?
All of that exposure poses serious health threats. Researchers estimate that at least 2% of all future cancers in the U.S.—approximately 29,000 cases and 15,000 deaths per year—will stem from CT scans alone.
No one is saying that you should avoid a CT scan or other imaging test if you really need it, and the risk posed by any single scan is very small.
But the effect of radiation is cumulative, and the more you’re exposed, the greater your cancer risk. So it’s essential that you always ask your doctors why they are ordering an imaging test and whether your problem could be managed without it.
15,000 : That’s the number of people estimated to die each year because of cancers caused by their previous radiation exposure from CT scans alone.
5. Given those risks, why are we—and our doctors—so scan-happy?
For one thing, patients aren’t necessarily aware of the danger.
A new Consumer Reports survey of 1,019 U.S. adults found that people are seldom told by their doctors about the risks of CT scans and other radiology tests.
It’s no surprise, then, that only 2% of those who had a CT scan thought they might have received the tests unnecessarily.
And only 4% ever told their doctor they did not want a CT scan.
That’s a bit worrying. Patients need to take the lead on this because their doctor may not.
Other studies show that doctors themselves often underestimate the dangers CT scans pose. Moreover, and this is a very worrisome situation, some doctors and clinics may actually have a financial incentive to order the tests.
“Health care professionals shouldn’t have the right to image children or adults unless they first show that they can do it safely and appropriately, and most of the time in this country, that’s not happening,” says Stephen J. Swensen, M.D., medical director at the Mayo Clinic in Rochester, Minn. “If the scan isn’t necessary or emits the wrong dose of radiation, the risks far outweigh the benefits.”
6. How much radiation can you get from a CT scan, and what are the risks of that?
CT scans can expose you to as much radiation as 200 chest X-rays.
CT emits a powerful dose of radiation, in some cases equivalent to about 200 chest X-rays, or the amount most people would be exposed to from natural sources over seven years. That dose can alter the makeup of human tissue and create free radicals, molecules that can wreak havoc on human cells. Your body can often repair that damage—but not always. And when it doesn’t, the damage can lead to cancer.
Cancers from medical radiation can take anywhere from five to 60 years to develop, and risk also depends on age and lifestyle. That’s why scientists struggled in early attempts to quantify the danger of medical radiation. Until recently, researchers often relied on evidence from the atomic bomb attacks on Hiroshima and Nagasaki. But now research shows that today’s medical patients are being harmed, too.
New evidence comes from a 2013 Australian study that looked at more than 680,000 people who had CT scans as children and compared them with some 10 million children who did not have a CT scan. Overall, people scanned once had a 24% increased cancer risk, and each additional scan boosted risk an additional 16%. Children who had one before the age of 5 faced a 35% spike in cancer risk, reflecting the fact that young bodies are more vulnerable to radiation.
Other researchers estimate that for every 1,000 children who have an abdominal CT scan, one will develop cancer as a result. And a 2012 study that looked at almost 180,000 British children linked CT scans to higher rates of leukemia and brain cancer.
All too often children are receiving adult-sized doses of radiation, which is many times the amount they need.
The dose directly increases the risk of leukemia or a solid tumor. And that’s not regulated today, especially outside the hospital setting. At least in the hospital, you will often have the academic input that prevents super-high radiation dosing, especially in kids.
7. And if you get one scan, does it increase the chances you’ll get another one?
That’s correct: one scan leads to another…
One of the insidious ways that unnecessary CT scans increase risk is that a single CT test often leads to another, then another. A disturbing example of that dangerous cascade was featured in an article in the September 2014 issue of the Journal of Patient Safety, co-authored by John Santa, M.D., medical director of the Consumer Reports Health Ratings Center.
An 11-year-old girl received a CT scan because of possible appendicitis. That was the first mistake: An ultrasound, which does not emit radiation, is the best initial test in such situations. The second error occurred when her CT showed a normal appendix but her doctors noted a spot on one lung and decided that it warranted a follow-up CT. Such incidental findings are so common doctors have a name for them: incidentalomas.
Expert advice is to ignore the vast majority of those results because slight abnormalities seen on scans are very common but rarely harmful. Yet many doctors find the urge to order follow-up tests irresistible. For the 11-year-old girl, the CT didn’t reveal a tumor or any other problem, but over the next two years her doctors recommended repeat scans of her lungs, all of which would further increase her cancer risk.
“Stories like this occur every day in the United States,” Santa and his co-authors wrote. “This unfortunate sequence of patient harm, waste, and needless anxiety could have been completely avoided with an ultrasound. None of this had to happen. None of this has to happen.”
8. So let me ask you again, why is there so much overuse of CT scanning?
The main reasons for excessive scanning are:
Some states allow almost anyone to work the equipment. The government relies on three outside accrediting organizations—the American College of Radiology, the Intersocietal Accreditation Commission, and The Joint Commission—to ensure the safety of advanced imaging facilities. But each group has different quality and safety standards.
9. So what can the public do to prevent unnecessary radiation from CT overtesting?
Here’s my advice on what to do before you get any radiation-based imaging test:
ST. LOUIS, MO (KPLR) – With the new year right around the corner, Dr. Sonny Saggar hopes you will set realistic goals for 2017. If you haven’t managed to get some quality time with family and friends this holiday season, he recommends making that your number one goal starting January 1.
Reconnecting and rediscovering one another, as well as ourselves, is good for your health, even better than exercise or quitting smoking.