Comments on: My take: Overcrowding, prevention, digital mammograms http://www.kevinmd.com/blog/2008/04/my-take-overcrowding-prevention-digital.html medical blog Tue, 24 Nov 2009 19:56:19 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2008/04/my-take-overcrowding-prevention-digital.html/comment-page-1#comment-84961 Anonymous Fri, 11 Apr 2008 00:21:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-overcrowding-prevention-digital-mammograms.html#comment-84961 drsam - can we nominate you for surgeon general? I think those are very true words. <br/><br/>The best things in life are free, but you have to want them. <br/><br/>We're a sorry nation that someone has to be paid to tell us to take care of ourselves! drsam – can we nominate you for surgeon general? I think those are very true words.

The best things in life are free, but you have to want them.

We’re a sorry nation that someone has to be paid to tell us to take care of ourselves!

]]> By: Stark Raving Med http://www.kevinmd.com/blog/2008/04/my-take-overcrowding-prevention-digital.html/comment-page-1#comment-84959 Stark Raving Med Thu, 10 Apr 2008 23:08:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-overcrowding-prevention-digital-mammograms.html#comment-84959 Kevin, I normally agree with you on nearly every topic. However, your take on digital mammograms increasing call-back rates is inaccurate. I can't decide if this due to only a cursory reading of the article, which very clearly and fairly explains the issues with digital mammograms, or from the fact that you have never experienced the pleasure of sitting down in front of a completely full screening board. I imagine it's a little of both. The article plainly states that the increase in recall rates is due to the TRANSITION between digital and analog mammograms, not the digital mammograms themselves. The striking difference between the two techniques complicates the biggest tool a mammographer has in his arsenal - stability. A digital mammogram looks completely changed relative to it's analog counterparts of prior years, thus increasing call backs for "developing densities. My guess is that the call-back rate will come back down to normal once digital-to-digital comparisons are the norm. Unlike MRI, this is not an example where the sensitivity of the technology itself is responsible for increasing costs. Kevin, I normally agree with you on nearly every topic. However, your take on digital mammograms increasing call-back rates is inaccurate. I can’t decide if this due to only a cursory reading of the article, which very clearly and fairly explains the issues with digital mammograms, or from the fact that you have never experienced the pleasure of sitting down in front of a completely full screening board. I imagine it’s a little of both. The article plainly states that the increase in recall rates is due to the TRANSITION between digital and analog mammograms, not the digital mammograms themselves. The striking difference between the two techniques complicates the biggest tool a mammographer has in his arsenal – stability. A digital mammogram looks completely changed relative to it’s analog counterparts of prior years, thus increasing call backs for “developing densities. My guess is that the call-back rate will come back down to normal once digital-to-digital comparisons are the norm. Unlike MRI, this is not an example where the sensitivity of the technology itself is responsible for increasing costs.

]]> By: Alison Cummins http://www.kevinmd.com/blog/2008/04/my-take-overcrowding-prevention-digital.html/comment-page-1#comment-84958 Alison Cummins Thu, 10 Apr 2008 22:09:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-overcrowding-prevention-digital-mammograms.html#comment-84958 Again, this goes to who is paying. <br/><br/>Preventive health care might cost more to the health care system but be cheaper for all social services and result in increased tax revenues. Again, this goes to who is paying.

Preventive health care might cost more to the health care system but be cheaper for all social services and result in increased tax revenues.

]]> By: Ian Furst http://www.waittimes.blogspot.com http://www.kevinmd.com/blog/2008/04/my-take-overcrowding-prevention-digital.html/comment-page-1#comment-84949 Ian Furst http://www.waittimes.blogspot.com Thu, 10 Apr 2008 17:33:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-overcrowding-prevention-digital-mammograms.html#comment-84949 Good points Kevin but regarding ER overcrowding. The research north of the border is that the overcrowding is mostly due to the elderly population lacking family doctors and chronic care beds. Every minor problem ends in the emerg. I don't know if the same data holds true in the US but I wouldn't be surprised. I understand a recent study confirmed that it was people with insurance that represent the biggest increase in users of ER services because of lack of access to the GP's. I don't agree with the open-access scheduling (same day appointments). There's a fine line between block booking, priority booking and OAS but my understanding is that in OAS there can be 30-50% of time slots open at the beginning of the day. Nor is it a given that the no show rate drops. Here's a link.<br/>http://www.aafp.org/fpm/20060300/59impl.html<br/>It's a good academic look at OAS being used for 3 years. If Mass has a shortage of primary care even though OAS can only decrease wait times in conjunction with increased time slots to make up the backlog first than unused time slots second. I do agree that when used with block booking or on a homogenous patient pool that it's a powerful tool.<br/><a HREF="http://www.waittimes.blogspot.com/" REL="nofollow">www.waittimes.blogspot.com</a> Good points Kevin but regarding ER overcrowding. The research north of the border is that the overcrowding is mostly due to the elderly population lacking family doctors and chronic care beds. Every minor problem ends in the emerg. I don’t know if the same data holds true in the US but I wouldn’t be surprised. I understand a recent study confirmed that it was people with insurance that represent the biggest increase in users of ER services because of lack of access to the GP’s. I don’t agree with the open-access scheduling (same day appointments). There’s a fine line between block booking, priority booking and OAS but my understanding is that in OAS there can be 30-50% of time slots open at the beginning of the day. Nor is it a given that the no show rate drops. Here’s a link.
http://www.aafp.org/fpm/20060300/59impl.html
It’s a good academic look at OAS being used for 3 years. If Mass has a shortage of primary care even though OAS can only decrease wait times in conjunction with increased time slots to make up the backlog first than unused time slots second. I do agree that when used with block booking or on a homogenous patient pool that it’s a powerful tool.
http://www.waittimes.blogspot.com

]]> By: drsam http://www.kevinmd.com/blog/2008/04/my-take-overcrowding-prevention-digital.html/comment-page-1#comment-84948 drsam Thu, 10 Apr 2008 16:22:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-overcrowding-prevention-digital-mammograms.html#comment-84948 Excellent Post Kevin.<br/><br/>I agree with you on all three points.<br/><br/>Increased access to outpatient primary care is indeed a needed part of addressing the overcrowded E.R. problem.<br/><br/>From personal experience, I can say that Open Access Scheduling can have a tremendous impact.<br/><br/>Also, getting away from 3rd party payers (including govt) and letting patients personally feel the financial effects of inappropriate ER visits (for minor problems) would likely help the problem I think.<br/><br/>Regarding the costs of preventative medicine, I agree that it is not necessarily a big money saver as far as what gets delivered on our end.<br/><br/>The reality however is that by far the most effective preventative medicine is free and doesn't really need intervention from the medical profession. Not smoking is free. Not overeating is free. Turning off the television and going for a walk is free. Etc.<br/><br/>The studies show that it is expensive to provide patient education to tell people to not smoke, to eat right, to exercise, etc. and that the return on these expenses (in terms of lives saved/prolonged, decreased healt costs, etc) is a financial loser.<br/><br/>As a society, I think we need to be honest with ourselves however. Do we really need expensive programs to tell folks not to smoke, to eat right, to exercise, etc.?<br/><br/>Let's get real here. Overwhelmingly, people already know this stuff. They simply choose to do the wrong stuff anyway. When they do, their health suffers and as a result their (our) finances suffer.<br/><br/>People don't want to hear all this however. They just want a politician who will say "Let's raise taxes and get you the free healthcare you deserve."<br/><br/>If the voters really truly want to lower health care costs in this country, they should address their horribly unhealthy American lifestyles before they demand that our taxes be raised and that the medical profession be taken over by the government, or that corporations (who make huge political contributions) receive the gift of government mandated comprehensive health insurance for all. Excellent Post Kevin.

I agree with you on all three points.

Increased access to outpatient primary care is indeed a needed part of addressing the overcrowded E.R. problem.

From personal experience, I can say that Open Access Scheduling can have a tremendous impact.

Also, getting away from 3rd party payers (including govt) and letting patients personally feel the financial effects of inappropriate ER visits (for minor problems) would likely help the problem I think.

Regarding the costs of preventative medicine, I agree that it is not necessarily a big money saver as far as what gets delivered on our end.

The reality however is that by far the most effective preventative medicine is free and doesn’t really need intervention from the medical profession. Not smoking is free. Not overeating is free. Turning off the television and going for a walk is free. Etc.

The studies show that it is expensive to provide patient education to tell people to not smoke, to eat right, to exercise, etc. and that the return on these expenses (in terms of lives saved/prolonged, decreased healt costs, etc) is a financial loser.

As a society, I think we need to be honest with ourselves however. Do we really need expensive programs to tell folks not to smoke, to eat right, to exercise, etc.?

Let’s get real here. Overwhelmingly, people already know this stuff. They simply choose to do the wrong stuff anyway. When they do, their health suffers and as a result their (our) finances suffer.

People don’t want to hear all this however. They just want a politician who will say “Let’s raise taxes and get you the free healthcare you deserve.”

If the voters really truly want to lower health care costs in this country, they should address their horribly unhealthy American lifestyles before they demand that our taxes be raised and that the medical profession be taken over by the government, or that corporations (who make huge political contributions) receive the gift of government mandated comprehensive health insurance for all.

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