Accountability: How to Achieve Your Goals

As we are approaching the annual “spring forward” this Sunday, I have begun reflecting on New Year’s resolutions.  Maybe it’s losing the extra weight they put on over the holiday season, maybe it’s training to run one 5K per month, or maybe, like me, they are planning on taking a graduate school entrance exam (MCAT here I come!)  When reading through your resolutions list, many may sound like the ghosts of resolutions past.  How many times have each of us said “Now THIS is the year that I do [enter resolution here]!”?  And yet, as late spring rolls around, our running shoes have collected dust, our pantry is filled with unhealthy snacks that we are not keeping track of, and our study supplies are packed away in storage.  We start to make excuses – “I’ve been overwhelmed with a project at work”, “I was busy with my kids”, “I don’t have the money for a gym membership”, etc.  These excuses allow us to relapse into old habits and forget the resolve we had in January.  I mean, there’s always next year, right??

Now for some of us (myself included) there comes a point when we desperately want to break away from this cycle and finally achieve these New Year’s resolutions, becoming the better versions of ourselves. When that time comes, accountability is a major asset.  Simply by having another person, whether it’s a couple of people, or your entire list of Facebook friends list aware of the goals you have set for yourself makes it a lot harder to skip that morning jog, opting instead for a muffin at Starbucks. 

Personally, I am absolutely guilty of “recycling” my resolutions.  I have found that accountability has become my ultimate sidekick, the most powerful tool that keeps me going.  Take the MCAT (the medical school entrance exam), for example.  I have told anybody who will listen that I plan to take the infamous exam at the beginning of this summer.  I have explicitly set up a study schedule and I text my mom every night after I’m done with my session.  If I don’t text her, she usually texts me (she’s very on top of her game.  Go Mom!)  Although I don’t want to disappoint myself by doing poorly on the exam, I certainly don’t want to disappoint her (or any other friends who have been patient and unwavering in their support through this journey). 

This same idea can be applied to the different treatment options that Drs. Hyman and Chimes recommend to their patients.  If 30 minutes of daily exercise is what the doctor ordered and you know that there might be days when the devil on your shoulder tells you to skip the gym and stay in bed, enlist a friend to come along! First of all, you’re much less likely to flake out on a friend than you are on yourself.  Second, the exercise will be much more fun with a friendly face right there, pounding the pavement with you, in turn, making it more likely that you’ll form a healthy new habit!  If one of the treatment recommendations is tracking your food intake, whether on paper or in a food tracking app like www.myfitnesspal.com, send a copy of each day’s intake to somebody, such as your spouse, your nutritionist, or personal trainer.

Another way to be held accountable is to have money on the line.  Spending $300 to take the MCAT definitely makes me only want to take it once, and that motivates me to stick to a strict study schedule. In regards to exercise, one can sign up for a paid class or a personal trainer.  It is much harder to miss a workout when you know it will cost you a $70 training session or a $25 exercise class.  Knowing that there is money on the line certainly makes each of us more likely to follow through.  You probably would not skip out on your massage appointment; so don’t skip out on your workout! 

Whichever method of accountability you choose, the doctors and staff at Lake Washington Sports and Spine are here to support you on the path to achieving those New Year’s resolutions and becoming the best version of yourself!

Ceasing Medicare Contract: Frequently Asked Questions

What Underpins Our Decision?

Our decision to stop contracting with CMS is based upon the simple premise that we wish to provide the best, unfettered, unobstructed care.  Care influenced only by what will best serve the patient.  We feel that CMS (and to a lesser extent, other insurers) continue to evolve and create policy with the goal being cost control, at times under the guise of improving quality.  

A very significant, though secondary reason, for discontinuing our contract with CMS is that the finances do not make sense.  Cuts in payments in many cases mean that our business liabilities exceed our reimbursements.  Our business certainly cannot sustain this trend of increasing costs and diminishing returns.  We aim to take control of and stabilize our financial circumstances, so we may continue to serve the sports medicine needs of the Eastside and greater Seattle community for many years to come.

What Does the Evidence Say?

It is a misnomer that scientific data, or "Evidence-Based Medicine" (EBM), is always available to guide us, the medical providers.  Even in the best of circumstances, when well-designed research studies are available to guide us, this is "evidence-informed medicine" -- meaning that one has to carefully interpret the research and apply deliberately as appropriate to the unique circumstances of an individual patient.  Moreover, CMS has manipulated the interpretation of data, selectively favoring research that restricts access for patients and conveniently disregarding research that favors promising techniques.  As cutting edge clinicians, this limits our toolbox for helping patients.

What Can You Do?

We would advise you to learn more about the evolving changes in healthcare and the risks posed to you as the healthcare consumer.  Then write your local, state, and federal representatives to express your opinions.  This impacts you, now, and your children and grandchildren in the future.

We also advise that when it comes to money and health that you budget for total health cost, which includes health insurance premiums, ancillary health insurance payments (copays, deductible, co-insurance), gym membership, and food.  Many patients only consider health insurance premiums and are caught off-guard by these other predictable expenses.

Can You Still Receive Medical Care from Us?

Yes.  Though you would have to sign some official paperwork consenting to receive treatment from a non-contracted Medicare provider, we would be happy to treat you in so long as we are the best fit to assist you.  We accept cash for our professional services.  Our goal is to restore you to optimal function as quickly as possible.

What if I'm Referred to Another Provider?  Can I Use My Insurance?

It depends.  If the provider to whom you are referred is a contracted provider through Medicare/CMS, then you may use your insurance.

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!