U.S. Plans Stealth Survey on Access to Doctors

By ROBERT PEAR

WASHINGTON — Alarmed by a shortage of primary care doctors, Obama administration officials are recruiting a team of “mystery shoppers” to pose as patients, call doctors’ offices and request appointments to see how difficult it is for people to get care when they need it.

“This is not a way to build trust in government,” says Dr. George J. Petruncio of Turnersville, N.J.

The administration says the survey will address a “critical public policy problem”: the increasing shortage of primary care doctors, including specialists in internal medicine and family practice. It will also try to discover whether doctors are accepting patients with private insurance while turning away those in government health programs that pay lower reimbursement rates.

Federal officials predict that more than 30 million Americans will gain coverage under the health care law passed last year. “These newly insured Americans will need to seek out new primary care physicians, further exacerbating the already growing problem” of a shortage of such physicians in the United States, the Department of Health and Human Services said in a description of the project prepared for the White House.

Plans for the survey have riled many doctors because the secret shoppers will not identify themselves as working for the government.

“I don’t like the idea of the government snooping,” said Dr. Raymond Scalettar, an internist in Washington. “It’s a pernicious practice — Big Brother tactics, which should be opposed.”

According to government documents obtained from Obama administration officials, the mystery shoppers will call medical practices and ask if doctors are accepting new patients and, if so, how long the wait would be. The government is eager to know whether doctors give different answers to callers depending on whether they have public insurance, like Medicaid, or private insurance, like Blue Cross and Blue Shield.

Dr. George J. Petruncio, a family doctor in Turnersville, N.J., said: “This is not a way to build trust in government. Why should I trust someone who does not correctly identify himself?”

Dr. Stephen C. Albrecht, a family doctor in Olympia, Wash., said: “If federal officials are worried about access to care, they could help us. They don’t have to spy on us.”

Dr. Robert L. Hogue, a family physician in Brownwood, Tex., asked: “Is this a good use of tax money? Probably not. Everybody with a brain knows we do not have enough doctors.”

In response to the drumbeat of criticism, a federal health official said doctors need not worry because the data would be kept confidential. “Reports will present aggregate data, and individuals will not be identified,” said the official, who requested anonymity to discuss the plan before its final approval by the White House.

Christian J. Stenrud, a Health and Human Services spokesman, said: “Access to primary care is a priority for the administration. This study is an effort to better understand the problem and make sure we are doing everything we can to support primary care physicians, especially in communities where the need is greatest.”

The new health care law includes several provisions intended to increase the supply of primary care doctors, and officials want to be able to evaluate the effectiveness of those policies.

Federal officials said the initial survey would cost $347,370. Dr. Hogue said the money could be better spent on the training or reimbursement of primary care doctors. The White House defended the survey, saying a similar technique had been used on a smaller scale in President George W. Bush’s administration.

Most doctors accept Medicare patients, who are 65 and older or disabled. But many say they do not regard the government as a reliable business partner because it has repeatedly threatened to cut their Medicare fees. In many states, Medicaid, the program for low-income people, pays so little that many doctors refuse to accept Medicaid patients. This could become a more serious problem in 2014, when the new health law will greatly expand eligibility for Medicaid.

Access to care has been a concern in Massachusetts, which provides coverage under a state program cited by many in Congress as a model for President Obama’s health care overhaul.

In a recent study, the Massachusetts Medical Society found that 53 percent of family physicians and 51 percent of internal medicine physicians were not accepting new patients. When new patients could get appointments, they faced long waits, averaging 36 days to see family doctors and 48 days for internists.

In the mystery shopper survey, administration officials said, a federal contractor will call the offices of 4,185 doctors — 465 in each of nine states: Florida, Hawaii, Massachusetts, Minnesota, New Mexico, North Carolina, Tennessee, Texas and West Virginia. The doctors will include pediatricians and obstetrician-gynecologists.

The calls are to begin in a few months, with preliminary results from the survey expected next spring. Each office will be called at least twice — by a person who supposedly has private insurance and by someone who supposedly has public insurance.

Federal officials provided this example of a script for a caller in a managed care plan known as a preferred provider organization, or P.P.O.:

Mystery shopper: “Hi, my name is Alexis Jackson, and I’m calling to schedule the next available appointment with Dr. Michael Krane. I am a new patient with a P.P.O. from Aetna. I just moved to the area and don’t yet have a primary doctor, but I need to be seen as soon as possible.”

Doctor’s office: “What type of problem are you experiencing?”

Mystery shopper: “I’ve had a cough for the last two weeks, and now I’m running a fever. I’ve been coughing up thick greenish mucus that has some blood in it, and I’m a little short of breath.”

In separate interviews, several doctors said that patients with those symptoms should immediately see a doctor because the symptoms could indicate pneumonia, lung cancer or a blood clot in the lungs.

Other mystery shoppers will try to schedule appointments for routine care, like an annual checkup for an adult or a sports physical for a high school athlete.

To make sure they are not detected, secret shoppers will hide their telephone numbers by blocking caller ID information.

Eleven percent of the doctors will be called a third time. The callers will identify themselves as calling “on behalf of the U.S. Department of Health and Human Services.” They will ask whether the doctors accept private insurance, Medicaid or Medicare, and whether they take “self-pay patients.” The study will note any discrepancies between those answers and the ones given to mystery shoppers.

The administration has signed a contract with the National Opinion Research Center at the University of Chicago to help conduct the survey.

Jennifer Benz, a research scientist at the center, said one purpose of the study was to determine whether the use of mystery shoppers would be a feasible way to track access to primary care in the future.

The government could survey consumers directly, but patients may not accurately recall how long it took to get an appointment, and their estimates could be colored by their satisfaction with the doctor, researchers said.

OVERCOMING ACIDOSIS

Many Americans suffer from too much stomach acid. There are many products on the over-the-counter market to alleviate the symptoms, such as Tums etc. But is that the best way to go? There are better ways to deal with this problem, I believe. Below I will suggest some things you can to do.
1) Drink lots of water. Water is a universal solvent. It dilutes the acid so that it can be flushed from the body.
2) Eat more alkaline foods. All meats are acid forming. All dairy products are acid forming. Some fruits are acid. Caffeine drinks (coffee, teas, colas etc.) are acidic. All vegetables are alkaline forming, particularly in their raw state. To overcome an acid problem, make sure your diet is approximately 80% alkaline foods and 20% acid foods.
3) Don't over exercise. Strenuous exercise for long periods of time cause lactic acid to build up in the body. Immediately after exercising drink lots of water to flush the acid out.
4) For immediate help with stomach acid, take one teaspoon of baking soda in about four ounces of water. Stir until it is almost clear and drink it. Depending on how severe the acid or heart burn is, you may need to repeat it in about an hour or so.
5) Examine your thought life. Negative thoughts cause the body to become more acidic. Think on good, positive things and you will be at less risk for stomach acid. Controlling your emotions helps also!

OVERCOMING DONE LAP DISEASE

This condition is a precursor to heart problems, high blood pressure, diabetes and several other illnesses. What is done lap disease? It is when your belly fat "done lapped" over your belt! This morning driving to work I saw a shirtless man who was obese trying to jog. His belly fat was flopping in the wind. Not a pretty sight! But more than that, it was an unhealthy sight!

There is a rule of thumb that says for every 10 pounds of fat in the front around the waist, it causes 50 pounds of pressure in the low back. Have you ever known of a pregnant lady who had low back pain! This is the reason why.

So, how do we overcome it? The following list of things will help you overcome this condition:
1) Take your weight and divide it by two and drink that many ounces of water per day.
2) Start walking every day. Begin by walking 1/4 mile per day and gradually increase it to where you can walk up to 5 miles per day.
3) Quit eating after 6 p.m. or let there be at least 3-4 hours from the last time you eat until you go to bed.
4) Eat a limited amount of good fats. They include flax seed oil, and some fish oils (krill). The good oils are those with omega 3 fats. Animal fats should be excluded.
5) Eat a plant based diet instead of a meat based diet. You will loose the weight, feel better, sleep better and overcome most of your aches and pains.
6) Cut down on your starches and simple carbs.

I challenge you to begin to do these things and watch the Done Lap Condition go away!

LEAVE WELL ENOUGH ALONE

A report by National Physicians Alliance (NPA), published in the Archives of Internal Medicine, advises Americans to get less health care:

• For instance, the group discourages the use of blood and urine tests in healthy people, because they will probably yield few results and end up costing a lot.

• It also cautions against heart tests such as ECGs or CT scans in symptom-free, low-risk individuals, because there is scant evidence that spotting cholesterol buildups provides any benefit in these people.
• The NPA also recommends against imaging tests for lower back pain in the first six months, noting that such tests do not lead to better results.

For kids, the group urges doctors to hold off on antibiotics for a sore throat, unless the strep test comes back positive. Most sore throats are caused by viruses, which don’t respond to antibiotics, and using the drugs unnecessarily may fuel the spread of drug-resistant bacteria and expose patients to side effects, says Reuters.

LIsts of Prescription Meds' Side Effects

Mary Elizabeth Dallas

May 27, 2011

Much of this information has more to do with avoiding lawsuits than toxicity, researcher says

Lists of the side effects for prescription medications on drug labels, packaging and advertisements have mushroomed up to an average of 70 per medication, a new study reports.

Cautions about side effects were designed to inform doctors and consumers of potential hazards, but this expansion may have more to do with worries about litigation rather than actual health concerns, say the study authors, who argue the information could be presented much more efficiently.

"Having a high number of side effects on a drug's label should not suggest that the drug is unsafe. In fact, much of this labeling has less to do with true toxicity than with protecting manufacturers from potential lawsuits," the study's lead author Dr. Jon Duke, Regenstrief Institute investigator and assistant professor of medicine at the Indiana University School of Medicine, said in a university news release.

An analysis of more than 5,600 drug labels and more than 500,000 side effects found that prescription drug labels include an average of 70 different potential adverse reactions -- a number that jumps to 100 side effects for some commonly prescribed drugs.

Some drugs in the upper range even listed up to 525 reactions.

Duke pointed out that the large number of side effects listed could overload doctors who must sift through this information in order to make informed decisions about medications on behalf of their patients.

For the study, published in the May 23 issue of the Archives of Internal Medicine, the researchers compiled a list of the types of prescriptions drugs that were most likely to have a high number of labeled side effects. These drugs included antidepressants, antiviral medications, and newer treatments for restless legs syndrome and Parkinson's disease.

Despite the overwhelming amount of information found in current drug labeling, Duke argued that the data could be useful if presented properly.

"With current technology, drug labels could be transformed from lengthy static documents to dynamic resources, capable of delivering personalized patient information. Such labels could take into account the individual patient's medical conditions and highlight those side effects that could be especially dangerous," he explained.

"We can't stop the growing wave of drug information, but we can do a better job of presenting it efficiently to health care providers," Duke concluded.