July 2003

I hope that you have all had a wonderful Fourth of July holiday. Holidays, like other memorable events, can be quite stressful.  It seems that with all the rushing around we can easily forget why we are celebrating at all.  I found it interesting while watching the news the other night that nobody knew who wrote the Constitution of United States! Some people thought Abraham Lincoln, others George Bush, and some didn't even know what it was! There were several contributors, but Thomas Jefferson was the key drafter of the document. (See, with ENews we are always on top of things!)

The point of this history lesson is that when people are not aware, bad things often repeat themselves.  If we as citizens and consumers do not pay attention to what is going on around us, things will happen that will be detrimental to our lives.  For example: 

• Do you know how your insurance premiums are broken down and what they cover?
• How much of the cost of a car is for the actual production and labor of that car?  What are the hidden costs?
• What is a subsidy and how does a 'free gift' to someone else affect you?
• Why does the Star Tribune report an increasing unemployment tally, when the opposite is actually true and median income (across the board) actually increased?
• Why does the media keep hyping an escalating cost of health care?  The Rand Corporation reported a study that said if all doctors "doubled" their fees (and actually got paid) it would effect health care costs "less than 1/2 of 1%".  Where is the cost of health care really at?  It is not with your doctor delivering care to you!!!!

These are just a few topics off the top of my head.  I'm sure you can think of many more.  The thing to remember is you have a responsibility to keep yourself informed.  The freedoms that we have in this country allow good people to do good things, but it also protects the rights of those people who have no intention on doing the right thing. 

You must be responsible first in order to reap the benefits second. The opposite order doesn't work.

I hope you enjoy this issue of ENews and, as always, you can call or write with any questions you may have. 

Dr. Glenn Frisch

The National Health Care Lie

I wonder how many of you have actually sat down and thought about health care?  Not about who your doctor or insurance company is, but how the health care industry really operates.

You can think of the health care industry as a square box.  Each corner of the box contains a component of the health care.  The four corners contain:

• You
• Insurance companies
• Doctors/Clinics/Hospitals
• Drug companies
• (Legislature could be a possible 5th)

All four components of the box are interrelated.  You require coverage for care in the event that you are hurt.  You pay the insurance company (who takes a risk) to offer you coverage.  They accept your premium as a promise for future care if you need it, but if you don't, they keep your cash.  They will sometimes put a penalty in place to keep you from seeking care. This is called a deductible.  They know that if you have to come up with 'out of pocket' money, the likelihood of you seeking care drops. 

Those of you who are old enough will remember when most major insurance companies offered health insurance.  American Family, Farmer's and Banker's Life were just a few.  HMO's came into the healthcare market in the 1980's and literally 'stole' health care out from underneath them.  Remember when HMO's were known for low premiums and restricted care?  They sold themselves as coverage for the healthy people.  Once they owned the market, what happened?  That's right!  The coverage was still restricted, but the premiums escalated!  Does this sound right or make sense?  No it doesn't, but because they aren't 'insurance companies', they don't have to follow insurance guidelines.  This is partly why health care is a mess in this state.  It kind of gets back to "Be careful what you want, you just might get it!"

When you go to a doctor/clinic/hospital they ask you what coverage you have.  They do this as a convenience to you.  They do expect to be paid for the work that they do, but if your insurance has coverage, they will contact them and have at least a portion of your bills paid by them directly.  This saves a you a step.  The insurance policy is taken out by YOU, not the doctor you are seeing.  Therefore, you need to understand what coverage you are paying for.  If you desire extra benefits or the 'Cadillac plan' you will pay more than you will with a 'bare bones policy'. This is your responsibility, be smart and take your time deciding what you and your family need for coverage.  When you go to a doctor/clinic/hospital and you want care, you need to make sure you have the right coverage.  They won't know if you have 'good coverage' or 'poor coverage' until they call your company.  It is not your doctor's fault if you have poor coverage.  You or your employer takes out the policy!

How do drug companies fit into your health care?  Drug companies give large amounts of money in the form of grants and scholarships to medical students as well as endowments to colleges.  This ensures that those students 'remember who took care of them' when they needed it and that colleges teach and stress 'drug protocols'.  I don't know whether this is good or bad, but it exists and you need to know about it.  We need to remember, however, that drug companies aren't bad entities.  They develop, research and sell 'chemicals' that benefit our lives in many ways.  Drugs are intended for good, even if they are sometimes used for the wrong reasons.  They have their rightful place in the healthcare picture.

Now that you understand a bit more about how the health care 'game' works we can more intelligently discuss to topic of National Health Care.

National Health Care is a proposal to let the Government take over the 'Insurance Company/HMO' part of your health.  You still would have to make premium payments to the government, but now they would tell you where you could receive care and what type of care they would let you receive.  If you think that your premiums are high now, just wait until a National Plan is enacted, they would skyrocket.  Every politician would use that National Plan as a running tool and make wild promises that could never be kept.  It would be expensive and dishonest.

A second aspect and probably a more important one involving a National Health Plan System is that of dependency.  When we allow someone to take control of our very health, we have turned over control of our personal well being to someone who doesn't know us or really care about us.  We have given up our freedom of choice.  If we get mad at Health Partners we can change to Blue Cross.  Even if their system is not ideal, there is at least some competition.  When the Government takes control of your health, it will never be the same.  Rates will go up, coverage will drop, responsibility for errors goes out the window (When was the last time a politician said they made a mistake and would fix it?) and research and development of new technology will move at a snail's pace. 

Health coverage of the future should be opened back up to a free market between all insurance companies.  The HMO's should be 'forced' to compete fairly and the Government needs to stay out of it other than to insure that a free market occurs.  The Government should stay out of health care!  They have shown what they couldn't do with Medicare and Medical Assistance .  Why should we think it will be any different with 'Regular Care'?

(Oh Boy, You've Got Me Wound Up Now!)

Hidden Shoulder Injuries

Shoulder injuries are sometimes difficult to correctly diagnose and treat.  It isn't that the trauma is so unique to the shoulder, but rather, that the biomechanics of the shoulder is so different.

Part of the shoulder is a 'ball-in-socket' while another part is a 'pivot' joint and still another is a 'flat pancake-like' joint that 'glides'.  These different motion joints make up the shoulder and they all work separately, but together as well.  If the shoulder complex sounds odd, that's okay, because it is.  That is also why shoulder injuries can be so difficult to treat.  There is often more than one thing going on.  Different joints and muscles are injured 'differently' in the same accident.

Another component of shoulder injuries is that of referred pain.  One of the more commonly referred areas of pain is the upper-middle back.  The patient enters the clinic thinking they have a mid-back problem when in fact it is merely a referral from a shoulder injury.  The other common referral area is to the neck.

               How is the Shoulder Injured?

Well, there are many ways to injure the shoulder but two ways stand out the strongest:

1. Abduction/External Rotation.  This is what occurs when you fall backwards on an outstretch arm and injure the 'rotator cuff' group of muscles.  This common injury responds well to chiropractic care, but sometimes does require surgical repair.  Falling and Sports injuries are the most common injuries of this sort.
2. Shear Impingement.  This type of injury is just what it sounds like, a shearing mechanism.  An example would be when you are hanging onto a steering wheel with both hands and your arms are outstretched at the same time you impact another vehicle (accident).  The arms 'freeze' as your body weight is thrown forward.  This causes a 'shearing' force across the shoulder joints with multiple joints being injured.  Automobile accidents and falling forward with both arms outstretched are the most common modes of injury.

Chiropractic care is recommended for both of these types of injuries.  The rehabilitation we use involves a 'structure and function' approach.  If examination reveals the likelihood of tearing and/or capsular damage, specialists are employed to aid in the treatment.

Shoulder injuries are initially very painful, but with time they can heal on their own.  The problem occurs when they heal wrong.  This begins the degeneration and arthritic process that can be hard to slow down.  Even chronic shoulder problems are treatable, but it is a lot easier to stabilize them early.

If you or someone you know is having shoulder problems let us know, or at least let them know about us.  If they live too far away for an evaluation at our clinic we will likely be able to find a qualified doctor for them in their area/state.

Reference

1.  Gorski, JM, Schwartz, LH. Shoulder impingement presenting as neck pain. The Journal of Bone and Joint Surgery 2003; 85-A(4): 635-638.

The Wonder Machines  

"Only 3 easy payments of $19.99." " I know a lady whose brother's, sister-in-law's cousin's, niece had a neighbor who bought one and it was like a miracle!"  "Money back guarantee.....some restrictions apply." When are we going to learn?  If it sound too good to be true, it likely is!  

The 'Magical Machine Syndrome' still runs wild in our society.  I suspect that all cultures fall prey to hucksters and great salesmen/saleswomen, but with the information available today it still surprises me how easily we are conned and misled.  I was reading one of the national chiropractic 'trade' journals recently and there were no less than 20 products designed to 'cure' your patients back pain.  You could be strapped & stretched, needled, rubbed, pulled, heated up and even tipped upside down, all in the name of corrective medicine/chiropractic.  One of these 'new-age' machines is even advertised in our popular state newspaper.  It is hailed as a miracle cure for back pain.

If these gadgets and creams worked so well, why wouldn't every doctor use them?  Why do only a select few have the answer?  Why is it you also need to go see them to get the cure?  The answer is fairly obvious.  They merely have a new spin on an old problem.  Unless they are the creator/inventor of the product and can document effectiveness,  the rest is 'fluff and hype' with someone else's machine and concept!  

People flock to the 'new and improved' concept the way they swarm to a carnival (When was the last time you actually believed the lady's beard was real?).  I'm not sure if people really expect the new gadgets to work or if they merely question, "what if?".  

Don't get me wrong, those of you who know me also know that I like 'new and novel' ideas, techniques and even 'machines'.  What I do require, however, is data.  When incorporating new and improved techniques and instrumentation there has to be a reason to change what I know already works!  To change what works means it must do three things:

• Speed recovery
• Treat a wider spectrum of injury/disease
• Allow recovery to be more complete.

Good doctors often forget that they already treat and correct pain.  They take it for granted that's what will happen!  Patients also take it for granted as well.  What patient doesn't expect to get better with care?  They don't even question the talent or knowledge it takes to accomplish that feat.

Doctors and patients both need to remember that if you treat and correct problems that cause pain, you are already doing the right thing!  How much fancy gadgetry is needed to do a better job than is already being done?  Some technical advances are good others are questionable.  The new Activator III adjusting instrument stimulates 74% of the neuroreceptors in the correction area.  That is a phenomenal advancement in patient care.  Implementing 'lasers' and other 'traction' equipment may have initial benefits with healing, but may do nothing for long term 'structure and function' improvement.  ( Notice I used the word 'may'.)

Be smart in your choices for care!  If it sounds to good to be true it often is.  You need to prove P.T. Barnum wrong! 

( P.T. Barnum said " there's a sucker born every minute")

Eileen's Corner

In keeping with my promise for a summer of desserts, this month I will share with you a 60 year old family brownie recipe.  I think you'll like these.

Chocolate Brownies

1/2 Cup Butter

1 Cup Sugar

1 Cup Flour

1 16oz Can of Hershey's Syrup

4 Eggs

Icing

6 Tablespoons Butter

1 Cup Sugar

1/3 Cup Milk

1/2 Cup Chocolate Chips

1 Teaspoon Vanilla

Brownie: First, cream together the butter and sugar.

Add the eggs, beat well after each one.  Fold in the flour.

When the mix is well blended, add the syrup.  Pour the complete mix into a greased 9 x 13 inch brownie pan ( I like the Calphalon brownie pan.)

Bake at 350 degrees for 20-25 minutes.

Icing:  Combine the butter, sugar and milk in a sauce pan.  Allow it to come to a 'boil' for one minute.  Then remove it from the heat and add the chocolate chips and vanilla.  Beat this mix until the chocolate chips are melted and blended.  Cool and spread over the brownies.

These brownies freeze well in a Tupperware container (if they last that long!).

Enjoy!

Eileen

Unfortunately, We Were Right!

I wonder how many of you recall all the work we were doing last year with our computer systems and patient privacy manuals and clinic requirements?  Well, as it turns out, we were right in our assessment of what was to come.  The State of Minnesota and the Federal Government now require all clinics and hospitals (and any other businesses that deal with your personal information) to have rules in place to provide for your privacy.

We worked for nearly a year to put in place tight, secure procedures to handle any and all future requirements that could possibly 'pop' up.  We were successful in doing it right the first time and we are not suffering like many clinics who didn't see mandated changes coming.  Our patients barely noticed a difference in how we do things around here.  For those of you who felt burdened or inconvenienced with the changes, I apologize, but those changes made the clinic flow smoother, more efficiently and it allows us to focus more on you, the patient, than shuffling papers around.

For those of you who had concerns with us using a clearing house to process claims, you can now be relaxed and confident that we did the right thing.  Aetna Insurance just released a memorandum that states as of September 13, 2003 all claims must be filed 'electronically' or they will be rejected.  Other Insurance companies will follow their lead in the very near future. This will include Medicare and MA.

As other clinics now 'scramble' to decide how to make the needed changes (think of the patient stress), you can relax knowing we have already gone through our growing pains.  Our growth, however, was at our own pace and the transition was relatively painless.

No one likes to depend on others to do the right thing.  We are no different.  We wanted to make sure that the processing of your claims would be accurate and painless for both you and us.  EDI has been exceptional in keeping in weekly (sometimes daily) contact with any matter that might arise regarding ANY claim they receive.  They are required by law to maintain the same privacy procedures we do.  Your personal information can never be sent anywhere without your direct approval and will never be sold.

There is occasionally some concern regarding the 'release of information' forms that all patients are required to sign.  This simply gives us permission to file your claim with your Insurance/HMO company, send records to your attorney and send records to someone who already has your signature to receive your records.  We do still follow our old rules of not sending records without a signed release by you.  The new procedure just makes the  process more accurate and insures privacy.  So if you are asked to sign a form, be confident that it is for your benefit and protection as well as ours.  The fines for doing it wrong are in the tens of thousands of dollars!  Those clinics that think they can ignore the new laws will be surprised, broke and likely jailed.  It is that serious!

If you have any questions, please ask Dyanna or myself!

Thank you for allowing me to do a little 'housekeeping' with this column.  I hope it helps.  Now, go eat your brownies!

Take care,

Dr. Frisch