A Blast From the Past

In an effort to get wider audience I have transitioned to a stand-alone blog from my original blog at http://www.imswf.com.  What follows is the original material from my very first blog, the “Bulletin Board” at my first website.

Americans turning to emergency departments for care – 9/30/10

This article speaks to the shortage of primary care doctors and lack of incentives for doctors to extend office hours.

The new healthcare experiment – 9/27/10        

Here  is preview of the Federal governments vision of the new health care  system.  Massachusetts is the model the Federal Government is looking to  for its health care program.  Massachusetts has announced it is hoping  to stop the financial hemorrhaging from their “forced insurance” model  by paying the providers and hospitals globally- read about it.

Local internist publishes diet/weight loss book – 8/23/10

Our  esteemed colleague and fellow internist, Richard Torricelli, M.D., has  recently published an excellent book.  We are very proud of his  achievement.  We recommend you consider reading The Amino Slimming Effect. Medical Watch discusses how Metabolic testing is used to lose weight – 8/23/10 Recently Medical Watch discussed using metabolic testing to assist in weight management.  Internal Medicine of Southwest Florida has been providing this service since 2008.  To read further about the Metabolic testing service click here.

Read the government’s description of the Affordable Health Care Act – 8/23/10

There  continues to be a lot of articles in the press, as well as opinions  pieces, regarding the Affordable Health Care Act legislation (healthcare  reform legislation).  We recommend you follow this link to the government’s website explaining numerous aspects of the law. Bid to block state health care is off ballot  – 07/30/10 News-Press Article:   For now, the amendment that would have blocked any planned Florida  version of President Barrack Obama’s federal health care legislation is  off the November ballot.  Amendment co-sponsor Sen. Carey Baker,  R-Eustis, said Thursday its Republican backers will seek an appeal.  And  Dr. Ray Kordonowy, an internist and board member of the Independent Physicians of Lee County,  applauds the appeal.  While the group has no official position,  Kordonowy echoes that of the Louisiana State Medical Society:  Health  care reform as passed federally is a bad deal. “A  law or rule should not compel anyone to buy health insurance,”  Kordonowy said.  “I’m in favor of a more open market.  The insurance  method of paying for health care is inefficient.”

At present, the US spends some $210 billion a year on claims processing  – 06/17/10

AMA Morning Rounds (press summary) reports referencing the following article.   Dr. Kordonowy comments, “To give this sum of money perspective – the  government is planning to cut approximately the same amount from  Medicare’s budget as part of the new health care legislation.  Our  President is escrowing 20 billion dollars from British Petroleum to fund  the oil spill disaster to “cover our losses”.  We spend 10 times that  annually just doing the paperwork to pay your doctor!  Where is the  outrage?!?  Can we not see the forest for the trees?  We should be  paying for services directly and cut the 3rd party payer bureaucracy out  of the process.  Health care is expensive indeed, too bad so much of  the money doesn’t actually go to providing care.” 21%  and increasing Medicare payment cut goes through.  Payment from  Medicare to physicians suspended by law for 10 business days effective  June 1 – 06/03/10 Congress  failed to address the flawed SGR formula and future payment for  Medicare physicians’ services (for the THIRD TIME THIS YEAR).   Independent Physicians of Lee County, IPALC, posted a notice in the News-Press concerning these cuts.  Please Contact Your Representativesand ask them to replace the SGR formula with a truly feasible payment structure.  Allowing balanced billing to occur would be the easiest way to fix the problem.

21% Medicare payment cut goes through, only to be temporarily fixed – 03/01/10

Please urge  your Congressional Representatives to repeal the flawed Sustainable  Growth Rate (SGR), and provide adequate funding for Medicare so that we  are able to continue to be able to provide the best quality health care  available for our patients.

 Dr. Raymond Kordonowy Voices His Thoughts on the Health Care Debate – 12/13/09
Web  Site Readers – The following is an e-mail trail relating to an opinion piece I attempted to get into the News-Press in Fort Myers.  This was my  second attempt to send it to Mr. Plazas but it never was placed in the  Opinion section of the news-paper: “Today (December 12th, 2009), I  edited the October opinion to include my comments about General Surgery  reimbursement and the recent idea I have about a Health Care Trust model  as another possible model to capitalize health care.  As stated in more  detail in the opinion piece, a main issue of the health care crises is  how we as Americans presently capitalized health care through an  insurance model and how that has over time turned into a private  business monopoly which has indeed made health care unaffordable for the  majority of Americans.  I remain deeply critical of our government’s  desire to create a government monopoly to replace the current corporate  monopoly.  The opinion piece is my attempt to offer some different  ideas/models to make the cost of health care cheaper, more efficient and  properly balanced, and most effectively delivered.  I did not go into  how to take care of the truly impoverished and I think most American  citizens agree, we have a social obligation to not allow people to “fall  through the cracks”.  By allowing a more efficiently and more properly  aligned health care market, I am confident we would have both the human  capital as well as financial capital to solve that part of the problem,  likely though true (subsidized if impoverished) catastrophic insurance  options (real insurance) or perhaps through a totally different/unique  approach to hospitals than the present system is following. – Raymond  Kordonowy M.D.”

New Patient Registration and Service Request available online – 12/9/09
Internal Medicine of Southwest Florida makes health care more user friendly and accessible by launching an online Service Request Form for current patients as well as a New Patient Registration Form.   A newly revised Vitamins page offers patients unprecedented access to  in-depth information concerning PureCaps Supplements, a line offered at  Internal Medicine of Southwest Florida.

Shingles vaccine now available – 12/3/09
Internal Medicine of Southwest Florida now has Zostavax vaccines available to prevent Shingles.  Click to learn more about the physician recommended vaccination.

 IMSF joins MediBid – 11/28/09
Internal Medicine of Southwest Florida continues to improve patient access to healthcare by joining MediBid.  Click to learn more about this novel market approach to healthcare.

 IPALC publishes letter for patients concerning Medicare cuts – 3/07/09
An  excerpt: “Please understand that this won’t just affect Medicare  patients. Essentially all of the insurance companies now set their  reimbursement rates in proportion to Medicare fees. A reimbursement  reduction of 21% by Medicare will also result in a 21% reduction in  nearly all insurance reimbursement.

Physician practices may cease taking new Medicare patients. Employees will have to be let go and our fragile local economy will be further harmed. Understanding that medical care is the number one income generator in Lee County when you combine the hospitals and private practices together, the results for this community may be devastating.”  Read the letter here.

Tell us the insurance industry isn’t behaving like a monopoly – 3/06/09


Consumers  should be asking the insurance industry “where’s the beef”?  Providers  and hospitals are receiving lower reimbursements and consumers are being  asked to assume more out of pocket expenses, yet insurance rates are  jumping 20-40%?  Consumers need to consider – do I really want to  purchase health insurance?  Wouldn’t I be better off keeping my and my  employer’s hard earned money in my own Health Savings Account and shop  my health care?  The insurance industry is reducing payment to providers  and hospitals but the consumers are not seeing price reductions/savings  from the insurance industries actions- something is very much amiss!  This goes for Medicare Medigap plans as well. See Associated Press Article – Sebelius asks insurers to justify rate hikes

21% Medicare physician fee cuts will definitely be a deal changer for patient access – 3/06/09
If physicians don’t outright quit you can be assured our services will  have to diminish even further.  Such measures as : no more new Medicare  patients, shorter visits, no phone assistance and much more fees for non  covered services will likely result. Please read the link regarding recent quotes from Dr. Henricks in a recent news article.  Please inform  your federal legislators that the SGR formula is flawed.  The easiest  solution to the governments dilemma is to go back prior to 1994 and  allow providers to bill above the Medicare fee schedule.

Medicare payment cuts go through – 3/01/2010   

We have been educating and warning our patients that Medicare by law was  facing this potential outcome- it has, in fact, happened.  Congress  might still be able to change this but as it stands, effective March 1  all physician evaluation and services codes (office visits) will pay 21%! less per visit across the board. This will have a huge impact  on services provided and if not reversed, our patients can anticipate  radical changes in our office policy. The physicians will be analyzing  our business model and changes are likely to come quickly.  Be prepared  please and trust we will do what we can. Under this drastic pay cut  changes will be necessary.   See the following link  (NPR Article)  for some historical perspective that has led to this  cut.  Remember that with every government policy change regarding health  care, unforeseen consequences occur.

In the News-IMSWF 12/6/2009 Review/Update-
The FDA’s Arthritis advisory committee has voted unanimously in favor of a possible new treatment for Dupuytren’s contractures.  Dupuytren’s contractures result in limited motion of the fingers and is  commonly referred to as “trigger finger”. The treatment is a biological  treatment which results in the breakup of the contracture using an  injection procedure to the involved tendon/contraction. The active  ingredient is a collagenase (enzyme) from a bacterium named clostridium  histolyticum. In double blinded, placebo controlled trials the patients  treated with the active ingredient had significant (and dramatic)  improvement in the range of motion of their joint (64% vs. 7% in placebo  group). The manufacturer is Auxillum Pharmaceuticals Inc. They plan to  market the product as Xiaflex if/when the FDA formally approves it.
A new class of drugs in the anticoagulation therapy class are  getting a lot of attention. The implications are that we may soon have  an alternative to Coumadin  (warfarin) for some indications including  atrial fibrillation (one of the most common reasons we use warfarin in  Internal Medicine). The new drug class is called direct thrombin  inhibitors and the most promising product presently appears to be  dabigatran. This medication comes in a fixed dosage and does not require  blood monitoring. It is not yet FDA approved and thus isn’t available  for the market at this time. Frequent INR testing is now needed to  monitor the efficacy and safety of warfarin therapy and is a significant  drawback to this treatment. Another drug class known as factor Xa  inhibitors could also find similar indications but have had trouble with  liver toxicity in some of the initial drugs studied to date.
Spending on Alternative Medicine tops $33 billion as reported by Heidi Splete in Internal Medicine News. She refers readers to www.cdc.gov/NCHS/data/nhsr/nhsr018.pdf  for the full report. This is newsworthy in my opinion as it provides  evidence to me as a health care provider that the national statements  being made by the public that it “can’t afford insurance” is  disingenuous. It also is an indication that the public views traditional  health services as lacking or that perhaps we can “cheat” the system by  taking unproven supplements and use nebulous treatments such as  acupuncture and homeopathic physician products to treat medical  illnesses.
Statin use appears once again to be associated with less (yes, I said yes) incidence of dementia. Michele  G Sullivan reports that a study sponsored by the Alzheimer’s  Association indicated the incidence of dementia when analyzing for use  and non use of statin therapy as approximately half as frequent in  statin users over non users. The information came from a national  Finnish study where a Dr. Alina Solomon and her colleagues extracted  data from the national FINRISK study, a large population survey of  cardiovascular risk factors among Finnish citizens. The data included  17,257 citizens from 1997-2002 and disease incidence was followed  through 2007. Statins began to be used in Finland in 1995. The persons  studied were 60 years or older in age in 1995.