Tips from gaining health

Looking through the MRI

In a prior posting, the Disease Management Care Blog was reminded that the U.S. health care system  is exceptionally complex and non-linear. Thanks to its many overlapping, contradictory, shifting and often non-medical inputs, it defies the simple logic of a single-cause-leading-to-a-single-effect. If economics is the dismal science, health care economics is its dubious spawn.

However, that doesnt mean that multiple coordinated inputs combined with some good luck wont push the health care weather vane in the right direction. For the latest example of this fundamental truism, check out David Lee and Frank Levys Health Affairs article The Sharp Slowdown In Growth Of Medical Imaging: An Early Analysis Suggests Combination Of Policies Was The Cause.

By way of background, medical imaging has been a high profile issue for policy makers and a headache for insurers because, until recently, the rate of costly "high dollar" imaging studies has been growing much faster than other medical costs.  It has been blamed as one technology-laden driver of health care inflation.  In the meantime, physicians have pointed to a variety of causes (and, by the way, left others unmentioned).  

In this study, the authors examined 10 years worth of insurance claims for advanced imaging MRI and CAT scans from two multi-state commercial insurance plans and another smaller single state plan.  These data were then pooled with a 5% national random sample of imaging claims from Medicare beneficiaries.  The authors also interviewed radiologists, health administrators, radiology benefit managers and physician recruiters.

The results?  From 2000 through 2005, CT scans grew at a whopping rate of 14.3% but then slowed to 1.4%. MRI slowed in the same periods from 14% to 2.6%. At the same time, starting salaries for radiology specialist physicians significantly declined.
 
What happened?  According to the authors:

1. An industry sprung up.  In another example of the adage that "need is the mother of invention," companies that prior authorize imaging studies for medical necessity (for example) were hired by many commercial insurers.  They had an impact.

2. Skin in the game. Deductibles, co-insurance and co-pays made consumers think twice about agreeing to a study that was going to result in some out-of-pocket spending.

3. Unilaterally imposed fee reductions. Medicare cut the amount it paid for CAT and MRI studies performed in freestanding centers and physicians offices. Hospitals were left untouched.

4. Glow in the dark.  Media reports on the amount of radiation prompted patients to worry about the long term impact of all those x-rays.

In other words, there was no single lever. Instead, the reduction of high utilization of pricey imaging was due to the confluence of at least four mutually reinforcing trends.

As further evidence of the overlapping trends that extended beyond simple cause-and-effect, Medicare never relied on prior authorization, didnt alter the out of pocket testing expenses for beneficiaries and left the payments for hospital-based imaging untouched. Yet Medicare saw an across-the-board reduction. MRIs dont involve ionizing radiation (they use relatively harmless magnets), but their overall rate went down in concert with CAT scans..

This has important implications for other laudable policy targets.  Based on this experience, waiving out of pocket costs alone are unlikely to increase the use of preventive health care services. Simply paying for the medical home may not make that big a difference.  Quoting the DMCB may not be enough to convince your skeptical friends.  So on and so on.

The obvious implication for the population health management service companies is that if theyre going to have a significant impact, the likelihood of a successful outcome is far greater if it is implemented concurrently with other supportive interventions.

Health for human | congratulated for celebrating Christmas. Christmas time is usually filled with a variety of foods that contain lots of calories and can add weight. Apparently it took 3 months to lose weight back to normal.

A study found the average person consume 2-3 servings of dinner at Christmas or equal to 2300 calories. This means 115 percent more than the recommended daily intake for women and 92 percent for men.

A survey found about three-quarters of participants who were questioned admitted that he was very pampering yourself at Christmas and not think about the consequences of the food they consume.

The study found the food consumed at Christmas as turkey, pies, puddings and other foods with high calories takes about 3 months to remove it from the body.

"The key to reducing the amount of weight increase is to avoid eating it greedily, but after that crazy diet is also not good because it can make people not getting a healthy weight," says nutritionist Dora Walsh, as quoted from Mirror.co. uk, Tuesday (27/12/2011).

Walsh said a person can prevent excess weight gain by eating slowly and enjoying every food consumed, and remains active during Christmas to help burn calories.

"The plan is carried out after Christmas diet should be reasonable and balanced, because it was too fast to lose weight will not make a person able to maintain ideal body weight," he said.

Here are some things you can do to help burn calories into the body, namely:

1. If you ate 100 grams of pudding usually contain 329 calories, then it could be eliminated by running for 30 minutes due to burn 450 calories
2. If you consume 1 serving (90 grams) of roasted turkey, then it could be eliminated by cycling for 40 minutes at medium speed for burning 180 calories
3. If you eat two sausages usually contain 108 calories, it can be eliminated by doing housework for 35 minutes due to burn about 110 calories
4. If you eat a sweet pie typically contains 215 calories, then it could be eliminated by jogging for 15 minutes due to burn 220 calories.