Opting out of Medicare

Following a long period of deliberate contemplation, we, the physicians of Lake Washington Sports & Spine, have decided to cancel our contract with the Center for Medicare Services (CMS).  This will take effect as of April 1, 2015.  

As board-certified Sports Medicine providers, with the primary mission of keeping people active (KPA!), we cannot in good faith continue this relationship as our mission no longer appears to align with that of CMS.

To clarify, this means that Drs. Hyman and Chimes will no longer process Medicare insurance claims in our office as of April 1, 2015.

We'd like to explain our decision, at least in brief.

The Medicare trust account is underfunded.  This is well established.  The fund is expected now to be depleted by ~2030.  Over a period of years, CMS has set in process several measures to reduce healthcare payments to providers caring for Medicare beneficiaries, or to eliminate coverage altogether for some effective and well-established services.  

For example, one spinal injection called a therapeutic cervical facet joint injection is no longer covered, despite its effectiveness for many patients.  Other procedures that show promise such as prolotherapy and platelet-rich plasma (PRP) injections for refractory chronic tendon and joint problems are not covered, while CMS continues to cover steroid ("Cortisone") injections even in light of very limited evidence to support them.  These policies make no sense, not for sports medicine providers, nor sports medicine patients.

Despite the many additional years of highly specialized training required to perform nerve testing, spinal injections and musculoskeletal ultrasound (above and beyond that necessary for our Board certification), CMS is reducing reimbursements for these services in dramatic fashion: nerve testing has been cut by >50%, >60% in cuts for certain cervical spinal injections and 2015 will bring cuts of nearly 75% on ultrasound guided injections.  In the past, physicians have absorbed the small incremental cuts in payment, but, because these cuts are so dramatic, the payments now in many cases are insufficient to cover the cost of doing business.

New similar policies are set in place each year.  These global policies are most certainly designed to limit access to care, deliberately to reduce costs.  

Our primary goal is to provide the absolute best care for patients who choose to seek our professional advice, and to restore those patients to optimal function using the best possible tools at our disposal.

And so therein lies the conflict.  We are focused on caring for and improving the health and wellbeing of our patients and our community.  CMS's goal is to reduce healthcare dollar spending in the United States. 

Additionally, Medicare has been hiring bounty hunters called RAC's to review charts to look for errors in coding (and medical coding is unnecessarily complex) to charge physicians with fraud, and fine hundreds of thousands of dollars or in some cases send physicians to federal prison.  So not only is CMS reducing our reimbursement, but it is placing physicians’ billing practices under a microscope, looking to recoup millions of dollars and to criminalize and make examples of physicians.  While we are certain that our clinic's practices would hold up to the greatest scrutiny, we would rather not continue on this booby-trapped playing field.

We are confident that this decision will positively influence our patients, and will more than ever, align patient and physician goals.  We recognize that our decision may cause anxiety or angst for some of you.  Should one wish to continue to treat in our clinic on a 'cash pay' basis, yet have concerns about ability to pay, we ask that they please contact us to discuss these concerns.  We will do everything possible to ensure patients receive the care they need.

For additional reading, please refer to : 
http://lakewass.blogspot.com/2015/03/ceasing-medicare-contract-frequently.html

http://lakewass.blogspot.com/2014/05/how-obamacare-forced-two-tiered-system.html

http://lakewass.blogspot.com/2014/04/promoting-mediocrity-through-medicare_10.html

 

great link on weight loss tips

http://www.vox.com/2014/11/27/7289565/weight-loss-diet-tips

An excellent link showing how Medicare bullies and abuses physicians

A colleague of mine forwarded me a great link from the excellent blog KevinMD

In the link, there is a video from a rural physician named Karen Smith, testifying about the harassment she received from Medicare for errors made by the organization administering Medicare, the Center for Medicare and Medicaid Services

An increasing number of physicians, including us, are realizing that the abusive tactics used by Medicare are preventing us from care from senior patients in the way they deserve to be treated.

Physicians Corner: Advantage of Single Leg Squats & Lunges

 

*Please pardon our video quality.  We specialize in musculoskeletal medicine, not video production.

The Main Factor Leading to Weight Loss Success!

In previous blogposts, we have underlined how being overweight can hinder a patient’s recovery and that weight loss is an integral part to their treatment plan.   Whenever discussing weight loss, two things often come to mind: nutrition and exercise. 

Now ask yourself this: which factor (exercise or nutrition) is the main determinant for weight loss success?  For those of you who guessed nutrition, you’re right!  Our society puts a huge focus on exercise as a tool for weight loss, and while exercise is essential to overall health, diet is the overwhelming key to weight loss.  Getting one’s nutrition on track (by using www.myfitnesspal.com or utilizing a top-notch nutritionist/dietician) is, hands down, the most critical component in order to achieve your weight loss goals.  

Here at Lake Washington Sports & Spine, we are huge advocates of exercise, consistently championing its overall health benefits.  However, if your specific goal is weight loss, we find that patients often prioritize exercise over diet, which is a mistake. We understand this.  Frankly, exercise is more fun than dieting.  Studies have shown that diet is 10-20 times more important for weight loss success than exercise. Many patients will counter with “I always was able to maintain my weight with exercise in college”.

For people under 25 years old, exercise is often the “go to” in order to lose weight, which allows for sloppy eating to continue.  However, after 25, this method is no longer sustainable and easily leads to weight GAIN.  This is because, as a person ages, the amount of exercise required in order to lose weight (without changing their diet) is unrealistic. In order to lose weight via exercise, a person has to do as much as 90 minutes of intense cardio per day (yes, that means seven days a week)!  For most people, this is clearly unsustainable, for a couple reasons: either a person does not have an extra hour and a half per day to devote to intense exercise or their bodies break down and physically cannot handle the demands of such a workout regimen. The only realistic way to achieve one’s weight loss goals is to concentrate on one’s diet and make sure they are eating clean. 

Now, before you go off and think that losing weight requires becoming a gluten-free, lactose-free, vegetarian, it doesn’t need to be quite so drastic (unless you have specific medical requirements, of course). There are even relatively small changes to one’s diet that can make a monumental difference and lead to weight loss success. 

One pound is equivalent to approximately 3500 calories.  That means that if a person removes 500 calories from their diet per day, every day, they’ll be down one pound after a week! Now that’s some serious progress made! 

What this comes down to is TRACKING.  Every morsel that goes into your mouth needs to be documented, for instance in an app such as www.myfitnesspal.com.  Just keeping this information in your brain is not enough.  First of all, humans forget things.  It happens.  Without proper documentation, a person will forget that tablespoon of peanut butter they ate or the several handfuls of trail mix that was scarfed down during their break. 

Second, people have a tendency to drastically underestimate how many calories are in different types of food.  That tiny cake pop from Starbucks? That can’t be more than 50 calories.  Wrong! Those will put you back about 170 calories.  Myfitnesspal is the diet buddy that keeps people honest about their diet choices and can make the difference between weight loss success and failure.

Here at Lake Washington Sports & Spine, our goal is to help our patients stay active and become the best possible versions of themselves.  If weight loss is part of a patient’s journey to staying fit and healthy, we want to make sure they are given the best tools and recommendations for success.  For those wanting to lose some pounds, diet changes are essential in order to attain that goal and, as always, our team is here to offer advice and encouragement on your path to weight loss success!

What to expect during your visit at Lake Washington Sports and Spine

What to expect at your visit at Lake Washington Sports and Spine

We have all made a new appointment with a doctor’s office. After making that appointment do you ever find yourself setting expectations or having a vision of how the office looks, how the staff and physicians will act or how the examinations goes? I know I have! Hopefully this article will give you a better understanding of what to expect when being seen at Lake Washington Sports and Spine.

Here at LWSS our goal is to KEEP PEOPLE ACTIVE “KPA” and provide the best possible care for our patients. From the moment you walk in the door, to the minute you leave we want you to have a warm, positive experience, leaving you wanting to come back (until you’re better, of course!)

When you walk in, you will be greeted by our friendly front office staff and they will guide you through the check-in process. Per our office policy, if you are a new patient they will expect you to have all your new patient paperwork completed and to arrive at your check-in time.  If you are here for a follow up appointment, they will help you check in and will have you fill out a follow up form. These need to be completed prior to being seen by the physicians.  Arriving 15 minutes early to all appointments is important. If you are a new patient with NO paperwork filled out PRIOR to the normal 15 minute check in time you are required to come in 30 minutes prior to your appointment time.  Besides simply filling out paperwork arriving early helps patients get themselves into the right state of mind for the visit. Just as you wouldn’t want to show up at a soccer game five minutes into the start of the game and immediately start running full speed, similarly arriving early allows time to stop thinking about traffic and work and mentally prepare for the visit. This really does make a huge difference. 

While filling out your updated information and forms you can take a seat and relax in the waiting room. You may be greeted by Nala, Dr. Hyman’s twelve year old Cockapoo who joins us in the office a couple of times a week, or hear a friendly bark from Wynnie.   You will have approximately fifteen minutes prior to being called back by the medical assistants to enjoy the positive atmosphere, upbeat music, and also have a moment to help yourself to some coffee or tea. By the time the medical assistants call you back, our hope is that you had a chance to relax, center yourself  and prepare your thoughts for your appointment.  This time is helpful to reflect on your chief complaint, your goal for the visit and/or how you’ve improved thus far.

The medical assistant will call you back at your scheduled appointment time. They will introduce themselves and lead you to the patient room. Their main goal is to determine what your chief complaint is for this visit and what your specific goals are. They will also advise you that the physician will focus on your main complaint. This is due to a couple of reasons. 1) We want to provide the best possible care and be thorough during exams to rule out any possibilities that could be causing the issue. 2)Appointment times for new patients are  45 minutes long and follow up appointments are 15 minutes. This is why it is important to be on time for your check-in time, stay focused and resolve the, most important issue. If more time is needed to address other concerns we will ask you to make a follow up appointment so the physician can have a thorough appointment for that particular concern.

After speaking with the medical assistant and vitals are obtained you will be advised that the physician will be in to see you (usually within a few minutes.)

By the time the physician comes in the room he will have a better understanding of your chief complaint and goals to focus on. This will allow more time for a thorough exam and explanation for what the plan of care should be. To get the most out of your visit it is important to allow your physician to use their tools in a way or order that works best for them. They have a certain technique and questions they need answered in order to make a clear diagnosis. At the end of your visit they will take the time to listen to your feedback, concerns and ask if there is any additional information that may be pertinent to your symptoms that was not previously asked or heard.

For example: Say you were on a flight to New York, you would not benefit from trying to give a pilot directions on how to fly a plane since you are not the one with the training, likewise, if you knew what your diagnosis was you would not need to come and be seen by a physician and you would be able to diagnosis yourself. So relax and trust that our physicians are guiding the conversation to obtain the most important information that will be needed to get you back to your normal function.

At the end of the appointment the physicians, medical assistants and front office staff will be sure you have all documents needed for your plan of care (Referrals, chart notes, procedure documentation, imaging reports…etc) and will schedule any further appointments needed. If you are graduating at the end of your appointment we will have a graduation ceremony for you and a surprise bag to celebrate your fitness success and all the hard work you have put in to reach your goal.

We look forward to assisting you in your journey to maintain a healthy and active lifestyle!

Getting Your Test Results In Office

If you’ve ever been to a doctor’s office, chances are you’ve probably had medical tests, labs and/or imaging done to rule out or confirm different diagnoses.  At LWSS, a follow-up with the ordering physician is required to receive your medical test results.  Some patients wonder why their physician requires them to return to the office to get their test results.  It can be easy to let impatience and worries take over regarding a result follow-up appointment; What if something bad is found?  Why should I have to come all the way to the clinic for a quick answer over the phone?  Why is my physician charging my insurance and me for a result on a test they ordered?

LWSS physicians and staff are dedicated to providing the best care possible to our patients and a follow-up appointment to review test results is needed for several reasons:

·     To provide details- While reports are generated for any test performed, often times they are confusing and hard to read for the patient.  Test results associated with imaging especially are important to be given in the office since the physician will go over the actual images with the patient.  The images provide a “visual medium” which the physician can use to help explain what the results mean.  This cannot be done over the phone since the physician will have the images pulled up on the computer for both of him and the patient to view during the follow-up appointment.

·     To provide context- The physicians at LWSS are specialized at interpreting test results to determine some “false positives” and “false negatives” that could appear.  A false positive is a result with an abnormal finding but the patient is not affected; a false negative is a result with a normal finding but the patient is affected.  By coming in for a follow-up appointment, the physician can contextualize the findings for the patient.  For example: You’re buying a new home and have a home inspection to check on the condition of the house.  Within the home inspection report, there are a lot of incidental findings but you as the home buyer need to know which findings need to be acted on before you purchase the house.

·     To provide security- The physician recognizes the importance of disclosing test results to patients in a warm, safe environment.  Certain test results may include difficult diagnoses that can prompt many questions from the patient.  The physician wants you in office so they can answer any questions you may have, in person.  They will provide explanations of your treatment options, creating a referral and/or appointment for your treatment choice and more.  Also, it protects the patient’s confidentiality; while it sometimes is more convenient to receive a test result via phone or email there is no 100% way to confirm the patient’s identity unless they’re in the office.

·      To provide your physician fair compensation- When any test results are received, the physician takes dedicated time to review the results and determine the next steps involved in the patient’s care.  When the physician has invested his time and efforts into your care, it's only fair that he be paid.  A medical claim can only be sent to health insurance when a patient is seen for an office appointment; by disclosing test results to you over the phone the physician is unable to bill the insurance for the services they’ve just provided to you.

It is important to come in for your results follow-up appointment.  As a patient, you need to understand what these results mean and discuss the next best steps with your physician.  I hope this provides a better understanding of the importance of attending your results follow-up appointment and as always our team is here to support you on your path to staying active!