Gyroscopic Investing

Pointedstick wrote:Interesting. You're right about their health, though. Incredibly high rates of alcoholism, domestic violence, and child abuse, too. If the Native community didn't exist, New Mexico would probably score a lot higher on pretty much everything.

WiseOne wrote:That's Medicare patients, meaning the population age 65 or older plus disabled and people with certain severe illnesses that allowed them to qualify for Medicare. The stats you posted are thus not that surprising. I dare you to find a person > 65 who hasn't been diagnosed with hypertension and hypercholesterolemia. Just one more condition and you've got the count up to 3.

The Navajo are way worse off than Hispanics. It's not about the obesity. It's their disposition to type 2 diabetes. They have the highest incidence of any ethnic group.

On the plus side of random medical news, today I managed to convince my PMD that mammograms are utterly useless, and I have no intention of getting one. I pointed out that massive screening has not reduced the death rate from breast cancer, and that likely all they do is find indolent tumors that would go away on their own, and to be really effective against the life-threatening ductal carcinomas you'd have to get a mammogram (with its huge radiation load) every couple of months. Take that organized healthcare! Maddy, hope you get to read this.

WiseOne wrote:On the plus side of random medical news, today I managed to convince my PMD that mammograms are utterly useless, and I have no intention of getting one. I pointed out that massive screening has not reduced the death rate from breast cancer, and that likely all they do is find indolent tumors that would go away on their own, and to be really effective against the life-threatening ductal carcinomas you'd have to get a mammogram (with its huge radiation load) every couple of months. Take that organized healthcare! Maddy, hope you get to read this.

WiseOne wrote:On the plus side of random medical news, today I managed to convince my PMD that mammograms are utterly useless, and I have no intention of getting one. I pointed out that massive screening has not reduced the death rate from breast cancer, and that likely all they do is find indolent tumors that would go away on their own, and to be really effective against the life-threatening ductal carcinomas you'd have to get a mammogram (with its huge radiation load) every couple of months. Take that organized healthcare! Maddy, hope you get to read this.

lazyboy wrote: WiseOne, how do you feel about CT scans? One was just ordered for me because a "little spot" was found on an ultrasound of my liver. So they want to get a closer look. Otherwise, my blood work for liver and kidneys is good. The ultrasound has been done each year for a while since being a sustained responder from treatment for Hep C, which was 12 years ago. I'm concerned about too much radiation and of course finding out some bad news that my blood work doesn't show. For the record, I'm 71 and have Senior Advantage Medicare coverage through Kaiser Permanente.

Maddy wrote:

WiseOne wrote:You've got to wonder just how those official recommendations come about. Do they simply reflect the study du jour? Are they the result of some form of lobbying on the part of the medical equipment industry?

MachineGhost wrote:

lazyboy wrote: WiseOne, how do you feel about CT scans? One was just ordered for me because a "little spot" was found on an ultrasound of my liver. So they want to get a closer look. Otherwise, my blood work for liver and kidneys is good. The ultrasound has been done each year for a while since being a sustained responder from treatment for Hep C, which was 12 years ago. I'm concerned about too much radiation and of course finding out some bad news that my blood work doesn't show. For the record, I'm 71 and have Senior Advantage Medicare coverage through Kaiser Permanente.

WiseOne can offer her own perspective, but I would never ever have a CT done under any cirumstance. They're the most dangerous, ordinary medical diagnostics you can expose yourself to. CT's cause the largest number of radiation-induced cancers -- about 250K a year, although there is legitimate dispute in the journals over that statistical finding (small comfort). But in my view, a much more serious problem is CT machines are emitting deadly high levels of radiation for convenience purposes; the technican doesn't want to be fiddling with the knob to have the lowest minimal effective dose for each and every patient so they just set it to max!!! There's even some horror stories of babies left in the CT machine and literally cooked [to eventual death] at such high doses for hours. But since it takes about 20 years for cancer to develop from a normal diagnostic, maybe you don't need to worry about it at your age?



A much safer alternative is high resolution MRI's which are different from the more common, normal, poor-resolution MRI's. You will have to fight against the dogma to be an advocate for your own health. No one wants to upset the $$$ gravy train.

You could also protect yourself ahead of time with certain supplements, namely chlorophyllin and other DNA-protective/repair bioagents. But I worry that will be misconstrued as security theatre justification. Bioloigcal systems and radiation just do not mix.

In a post from 2011, I discussed some clear indications of potential fraudulent billing. According to the Medicare database, there had been a 1400% increase in the utilization of the code for rotational chair testing. The primary provider of these services was primary care/internal medicine specialists that did not even have the proper equipment to perform this test. Subsequently, Medicare made a coding change that reduced the reimbursement by 75% for those practitioners legitimately performing rotational chair testing. For more details about this, click here.

About four years ago, I was contacted by a fraud investigator for a large insurance provider that followed Medicare guidelines. She had seen my previous post and had some questions about a pain clinic billing for rotational chair testing. I knew the specific pain clinic and knew they did not have a rotational chair. When I told the investigator this was a widespread issue, she asked if I would be willing to speak to a group of fraud investigators at an upcoming meeting. I agreed, and dates were arranged. As we discussed my presentation further, I explained how I felt fraud investigators were part of the problem.

I explained that the problem, from my perspective, is that insurance companies think they can stop fraud by changing coding language, or changing a coding rule. When they see a spike in utilization, or a manipulation of a loophole in the coding language, they make an adjustment to decrease utilization or close the loophole. Here’s the problem with that: Who is going to strictly adhere to changes in coding language that negatively affects their bottom line? My guess is that it will be the people that were already following the rules, trying to function in an ethical and legal manner. Who is going to ignore or manipulate the new rule? Most likely, the same people that were abusing the old rule.

My message to the investigator was that to deter fraud, you have to go out and find the abusers, convict them, drop them as providers, or whatever it takes to penalize them for the fraudulent activity. When you keep restricting legitimate practitioners and lowering reimbursement below sustainable levels, you create an environment where only the abusers can survive. I made the point that their approach discouraged good care, and would eventually limit access to qualified providers. A week later, I got a call dis-inviting me to speak at the upcoming meeting.

http://hearinghealthmatters.org/dizzine ... date-2016/

Currently, Medicare pays approximately a national average of $24,000 for a cochlear implant, but $0 for hearing aids (Table 1). Let's examine this coverage disparity from scientific, regulatory, and political viewpoints.



First, to be covered by Medicare, a device must provide a health benefit and “be determined to be reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body member” (Social Security Act http://bit.ly/2bgSJHc).

As early as October 1986, cochlear implants, both 3M/House single-channel and Nucleus-22 devices, were covered for adult Medicare beneficiaries. This was supported by a 44-page report on scientific and clinical evidence from the Office of Health Technology Assessment (OHTA), a federal agency that made Medicare policy recommendations at the time (Feigenbaum. NCHSR, 1986 http://bit.ly/2bgVhW9). The 1986 report determined that cochlear implants restored sound detection, improved voice modulation and lip-reading, and, in some patients, provided a considerable degree of open-set speech recognition.

In 1992, Medicare coverage of the cochlear implant was extended to children. In 2005, the Centers for Medicare and Medicaid Services (CMS) markedly expanded the audiological criterion to include individuals who received a pre-implant score of ≤40 percent open-set sentence recognition under the best-aided listening condition (CAG-00107N http://go.cms.gov/2bgTiB0).

Today, Medicare not only covers the cochlear implant, but also its accessories such as microphones and batteries. The surgery may include additional coverage from the use of operating microscope to intra-surgical monitoring.

The OHTA and CMS guidelines relied heavily on peer-reviewed publications; to a lesser extent, on data submitted by the manufacturers to the Food & Drug Administration (FDA) and on professional society position statements; and the least extent, on expert opinions. For example, the CMS responded to three commentators who provided solid but unpublished data that they “encourage parties with such data to pursue publication, and thereby enlarge the pool of published evidence.” Apparently, the CMS has determined that the published evidence on the health benefits of hearing aids is inadequate, and that, accordingly, hearing aids do not merit any coverage.

http://journals.lww.com/thehearingjourn ... ot.10.aspx

We're not going to take it anymore.

That's what around 200,000 physicians across the U.S. could be saying about Medicare. Two surveys confirm that many doctors are looking to either exit the federal healthcare program or quit taking new patients. Could this really happen, and if so, how could it impact you?

http://www.fool.com/retirement/2016/11/ ... ients.aspx

MachineGhost wrote:

We're not going to take it anymore.

That's what around 200,000 physicians across the U.S. could be saying about Medicare. Two surveys confirm that many doctors are looking to either exit the federal healthcare program or quit taking new patients. Could this really happen, and if so, how could it impact you?

http://www.fool.com/retirement/2016/11/ ... ients.aspx