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Lee Kirksey, MD  
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Cleveland , OH

Specialties: Peripheral Arterial Disease, PAD

Interests: vascular, specialist, treatment options
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Obama Administration to spy on Physicians

Jun 26, 2011 - 42 comments
Tags:

medicare

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Medicaid

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reform

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medicare reform

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obama administration



298583?1310326261
As we continue in what can only be characterized as a tumultuous time in healthcare the NY Times reports that the Obama administration is scheduled to role out a "secret shopping" program to investigate physician availability and whether there is any biased treatment against those with Medicare or Medicaid.

U.S. Plans Stealth Survey on Access to DoctorsBy ROBERT PEAR
Published: June 26, 2011
WASHINGTON — Alarmed by a shortage of primary care doctors, Obama administration officials are recruiting a team of “mystery shoppers” to pose as patients, call doctors’ offices and request appointments to see how difficult it is for people to get care when they need it.

The administration says the survey will address a “critical public policy problem”: the increasing shortage of primary care doctors, including specialists in internal medicine and family practice. It will also try to discover whether doctors are accepting patients with private insurance while turning away those in government health programs that pay lower reimbursement rates.

Federal officials predict that more than 30 million Americans will gain coverage under the health care law passed last year. “These newly insured Americans will need to seek out new primary care physicians, further exacerbating the already growing problem of P.C.P. shortages in the United States,” the Department of Health and Human Services said in a description of the project that it submitted to the White House.

Plans for the survey have riled many doctors because the secret shoppers will not identify themselves as working for the government.

“I don’t like the idea of the government snooping,” said Dr. Raymond Scalettar, an internist in Washington. “It’s a pernicious practice — Big Brother tactics, which should be opposed.”

According to government documents obtained from Obama administration officials, the mystery shoppers will call medical practices and ask if doctors are accepting new patients and, if so, how long the wait would be. The government is eager to know whether doctors give different answers to callers depending on whether they have public insurance, like Medicaid, or private insurance, like Blue Cross and Blue Shield.

Dr. George J. Petruncio, a family doctor in Turnersville, N.J., said: “This is not a way to build trust in government. Why should I trust someone who does not correctly identify himself?”

Dr. Stephen C. Albrecht, a family doctor in Olympia, Wash., said: “If federal officials are worried about access to care, they could help us. They don’t have to spy on us.”

Dr. Robert L. Hogue, a family physician in Brownwood, Tex., asked: “Is this a good use of tax money? Probably not. Everybody with a brain knows we do not have enough doctors.”

In response to the drumbeat of criticism, a federal health official said doctors did not need to worry because the data would be kept confidential. “Reports will present aggregate data, and individuals will not be identified,” said the official, who requested anonymity to discuss the plan before its final approval by the White House.

Administration officials said the survey would yield an enormous benefit to the government while imposing an extremely limited burden on doctors.

The new health care law includes several provisions intended to increase the supply of primary care doctors, and officials want to be able to evaluate the effectiveness of those policies.

Federal officials said the initial survey would cost $347,370. Dr. Hogue said the money could be better spent on the training or reimbursement of primary care doctors.

Most doctors accept Medicare patients, who are 65 and older or disabled. But many say they do not regard the government as a reliable business partner because it has repeatedly threatened to cut the fees paid to doctors treating such patients. Congress usually steps in at the last minute to avert such cuts.

In many parts of the country, Medicaid, the program for low-income people, pays so little that many doctors refuse to accept Medicaid patients. This could become a more serious problem in 2014, when the new health law will greatly expand eligibility for Medicaid.

Access to care has been a concern in Massachusetts, which provides coverage under a state program cited by many in Congress as a model for President Obama’s health care overhaul.

In a recent study, the Massachusetts Medical Society found that 53 percent of family physicians and 51 percent of internal medicine physicians were not accepting new patients. When new patients could get appointments, they faced long waits, averaging 36 days to see family doctors and 48 days for internists.

Source NY Times




New oral anticoagulant, Pradaxa, may replace coumadin lower stroke riks

May 30, 2011 - 0 comments
Tags:

atrial fibrillation

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Stroke

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warfarin

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coumadin



PRADAXA is a prescription blood-thinning medicine used to reduce the risk of stroke and blood clots in people with atrial fibrillation not caused by a heart valve problem. With atrial fibrillation, part of the heart does not beat the way it should. This can cause blood clots to form, increasing your risk of a stroke. PRADAXA lowers the chance of blood clots forming in your body.

The drug may prove a new option for patients who now use standard blood thinners such as warfarin to control the heart condition.

More than 2 million Americans have atrial fibrillation, which occurs when the heart's two upper chambers beat quickly and out of sync, the FDA said Wednesday in a news release.

Pradaxa (dabigatran) is an anti-clotting drug that inhibits an enzyme involved in blood clotting. Clinical studies of the drug found that when compared with warfarin, people with atrial fibrillation had fewer strokes on Pradaxa than those on warfarin, the FDA said.

One such trial was presented in February at the American Stroke Association annual meeting in San Antonio. It included more than 3,600 patients with atrial fibrillation and a previous stroke who were randomly chosen to receive warfarin, a low dose of Pradaxa (110 milligrams) twice a day or a higher dose (150 mg) of Pradaxa twice a day for about two years.

The rate of stroke or transient ischemic attack (TIA, often called "mini- stroke") in those taking warfarin was about 2.7% a year and 2.3% a year for those taking Pradaxa, not a significant difference.

However, the lower dose of Pradaxa caused less bleeding and was easier to manage than warfarin, a famously difficult drug to administer and monitor.

"In contrast to warfarin, dabigatran is given in a fixed dose twice daily independent of body weight, sex, food, whatever, and you don't need to monitor the coagulation system," study author Dr. Hans-Christoph Diener, chairman of neurology at University Hospital in Essen, Germany, said during a news conference held during the meeting.



More allegations of unneccesary use of coronary stents-Now in Texas

Nov 29, 2010 - 1 comments
Tags:

Heart Attack

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Coronary Stents

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Myocardial Infarction

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medical malpractice

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vascular surgeon

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vascular surgery



More controversial developments and allegations of unneccesary use of coronary stents are being raised in a Texas medicla community. The case is similar to an ongoing investigation in Baltimore and other areas. It raises great concern about who is responsible for the direct oversight of physician activities. Medicine is still an art and sometimes there are several ways to treat a patient. There are also wrong ways to treat.

Read the story and post comments about how you think patients should manage the uncertainty. I have been a patient and I have had the same concerns.

More 'unnecessary stenting' allegations—this time in Texas
November 25, 2010 | Shelley Wood
Austin, TX and Towson, MD - Questions about unnecessary stent procedures have reared their head again, this time in Texas. The Texas Medical Board alleges that Austin/El Paso interventional cardiologist Dr Samuel J DeMaio failed to meet the standard of care in his treatment of nine patients.


According to a Complaint filed by the Board on August 17, 2010 [1], DeMaio committed a number of standard-of-care violations by placing multiple stents in areas of insignificant or moderate disease; performing multiple angiograms in patients who were asymptomatic and had normal stress tests; unnecessarily implanting an ICD in two patients; failing to adequately inform patients of risks; and failing to obtain informed consent for the off-label use of a device in one patient.

http://www.theheart.org/article/1156973.do  To read the entire article visit heart wire and view

Low Vitamin D levels increase the risk of Heart attack

Jun 13, 2010 - 2 comments
Tags:

Heart Attack

,

Stroke

,

Prevention

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Chest Pain



202763?1292168598
Yet another worry for those folks who don't get enough sun exposure throughout the year. Low vitamin D levels may increase the risk for Cardiovascular disease ie heart attack and stroke

If you have low vitamin D levels, correcting the deficiency may reduce the risk for heart disease, new research suggests.

The studies build on the researchers' previous work linking low levels of vitamin D to an increased risk for heart disease.

The researchers, from the Intermountain Medical Center Heart Institute in Murray, Utah, presented the new studies at the American College of Cardiology's 59th annual scientific session.

Vitamin D vs. Heart Disease: Study Details
The first study involved more than 9,400 patients whose blood tests revealed low vitamin D levels during a routine trip to the doctor.  Their average vitamin D level was 19.3 nanograms per milliliter; levels of 30 are generally considered "normal," according to J. Brent Muhlestein, MD, the Institute's director of cardiovascular research.

At their next follow-up visit, about half had raised their vitamin D levels to above 30 nanograms per milliliter.
source