Last-Minute Delay for Medicare Pay Cuts

"June 18, 2010 — In a surprise turnabout, coming the day after it had rejected the same measure, the US Senate reached a last-minute deal today to delay a planned 21.3% Medicare fee cut for 6 months. The legislation also provides a 2.2% payment increase."  From Medscape Medical News

The entire article is listed in our "Files for Download."  Another article is the "Doc Fix" article online. 

The problem is not fixed, but they have at least given us a reprieve for a few months.  We still need you to contact Congress to express your concerns about the need to fix this problem once and for all.

Thank you!

Dr. Shay

Medicare Cuts in Reimbursement

On June 1, Medicare cut all physician reimbursement by 21.3%.  This cut is the last straw in  series of cuts in insurance reimbursements over the past decade.  I do not normally ask you, my patients and families, to become politically involved, but right now we need your help.  I am faced with a dilemma:  If these cuts are not taken back and the reimbursement rates corrected, then I am faced with the need to stop taking Medicare & TRICARE.  Unfortunately "where Medicare goes, so goes MaineCare and eventually all other insurance companies."

At the end of April this year, the AOA (American Osteopathic Association) did an online membership poll and found that if this law is not stopped then almost one out of every four (24%) DO's will stop taking any Medicare patients at all and another one out of every three (33%) DO's may or may not stop taking Medicare patients.   This will have a HUGE impact on our community.  This could potentially destroy private practices (those of us not employed by one of the local hospitals), not to mention the potential damage to our local rural hospitals.

Would you please copy the letter written below and send it to Senator Collins and Senator Snow?  If you click on the "Write to Congress" button at the left, it will direct you to your appropriate representatives by zip code.)  Another option would be to copy the letter and put it into the letter space on the AAFP website or use the generic letter already on the site.  Feel free to personalize the letter in any manner that you see fit. (Change it to personalize it for your own doctors!)

(If you would like to read the "fix" that is on the docket, it is H.R.3961)

Thank you for your support and thank you for choosing Well Spring Health Center for your wellness care.

Eva B. Shay, DO

Senator Susan Collins

Caribou State Office:

25 Sweden Street, Suite A
Caribou, ME 04736
Main: (207) 493-7873

Senator Olympia Snow

Presque Isle State Office:

169 Academy Street
Suite 3
Presque Isle, ME 04769
Main: (207) 764-5124
Fax: (207) 764-6420

Dear Senator:

I am a constituent from Aroostook County, Maine.  I vote.  Today I am asking for your immediate assistance.  

Congress made a promise to elderly and disabled Americans when they created Medicare 45 years ago. The promise: That this "greatest generation" would not go without needed health care. Yet today, you and your colleagues on Capitol Hill are breaking that promise. And you are jeopardizing the health care security of millions of elderly and disabled Americans who depend on Medicare, as well as our servicemen and women and their families who rely on TRICARE.

I have learned that on June 1, Medicare cut my Osteopathic Physician's pay by 21.3%. This means that she is earning less today than she earned a decade ago. Yet she is paying her staff with 2010 wages. Her office rent, electricity, internet access, heating and water costs have gone up, and so have the prices of medical supplies and equipment.

Furthermore, I have learned that it is Congress who sets the fees that Medicare and TRICARE pay physicians, and that it was Congress's inaction that allowed this 21.3% pay cut to happen. As a result, my Osteopathic Physician is now faced with the difficult decision to no longer provide care for Medicare and TRICARE patients.  She is also concerned that "where Medicare goes, so goes MaineCare and eventually all other insurance companies."

I have worked hard, paid my taxes, defended my country, educated my children. I have helped build this great nation. What do I ask in return? That you honor the promise made by Congress when they created Medicare and that you ensure my access to physicians who can help maintain my quality of life to the end.

Please be aware that if she no longer takes Medicare and TRICARE, then I will need to travel out of Aroostook County, at least 1.5-3.5 hours. to the next closest physician who might provide her specialty.  

I am asking you to support legislation that rescinds this pay cut now!  I am also asking you to support legislation that permanently changes Medicare and TRICARE payment so your constituents served by these programs will have reliable access to the doctors and health care they need.  Please get this done.

Respectfully,

Your name

Update on Thursday, June 17, 2010 at 8:50PM by Eva Shay, DO

I've personalized the letter and sent it to all four (Senators Collins and Snow, Rep Michaud and President Obama).  Have you voiced your legal right to speech and told them what you think yet?  We fight for this right of speech with wars, please exercise that right.

Do You Have Headaches?

Many people struggle with all forms of headaches, constantly looking for relief.  Your family doctor may have tried you on a lot of different medications with varying levels of success.  Here are a few different things that I might add from a different perspective. 

PLEASE keep in mind:  ANY headache that changes in character NEEDS to be evaluated by your family doctor to be sure that nothing more serious is going on.  The following measures are to be tried ONLY AFTER you know that your headaches are not due to a more serious condition.  As always, talk with your doctor about any significant changes you may make in medications and treatments.

1. Do you take Magnesium on a regular basis?  This works well as a preventative (daily supplement to prevent the onset of a headache).  I recommend it for a wide variety of problems:  stress, muscle cramps/spasms, bronchospasms/asthma, headache prevention (tension and migraine for many people), constipation, fibromyalgia syndrome and restless leg syndrome.  It works due to actings as a key to open the gate and allowing the calcium into the cells and relaxing the muscle fibers. It may not be the only treatment for these problems, but it certainly helps.  Usual dosing is 200-2000 mg by mouth a day.  You can't over dose on it because you'll get diarrhea long before it can happen.  Take it till you are on the edge of loose stools for maximum benefit.  This dose may vary from day to day as stress levels and physical activity levels vary daily.

2. Do you have adequate Sea Salt in your diet?   I have several patients who have cut salt out of their diets due to the cardiovascular hype of a low sodium diet, but then have cut out the minerals needed from the sea salt.  Adequate water is key (1/2 oz per lb of your weight as a baseline) but then add in 1-1.5 tsp of sea salt (I just put some in my hand, take it like a pill and chase it with a glass of water every morning.)  I have found that using table salt (refined) triggers edema/swelling in legs due to the lack of minerals needed to keep the fluid inside the cells and not outside the cells (edema).  Sea salt has not caused the same problem for many people, in fact, I found that leg edema often does better once the patient started using the sea salt and ditched table salt altogether (I recommend iodine supplements for iodine instead of table salt.)

*** If you have a reason given to you to restrict your salt intake, be careful with this one! ***

3. Are you eating something in your daily diet to which you may have a low grade allergy?  Tracking a food diary often shows up foods that we eat daily that are the culprit.  Pick a food that you eat on a regular basis (wheat, soy, eggs, dairy, etc) and eliminate it for a month.  It may take several days to a week or more to be out of your system before you clear it completely.  After 3-4 weeks off of the food, try re-introducing it to your diet.  Keep in mind that it may take a few days before you have the full reaction to the reintroduction and get a headache again.  

   Check your pulse as well.  If your pulse increases by 10-15 beats per minute within about 20-40 minutes of eating something, you are probably allergic to it (IgG, not IgE reaction.)  (I found that my baseline pulse dropped from the mid 80's to the low 70's within two weeks of eliminating wheat, where as it could jump to >100 after eating wheat... along with a host of other reactions.)  I have one patient who found out that bakers yeast was the cause of her 24/7 headache, thus elimination gave her huge relief.

   There are also many migraine triggers that are not allergies: red wine, smoked cheeses, foods with MSG, chocolate, nutrasweet, etc....  Any artificial sweetener may be a key trigger.  Nasty stuff!

4. If you take an abortive medication (meds to STOP the headache, even tylenol or ibuprofen) daily, you may actually be experiencing rebound headaches.  A bugger to treat... you need to go cold turkey off of all headache meds for a time to see how you do for that one.

5. Have you tried a high quality 5-HTP?  I typically recommend it as a preventative.  This is an over the counter supplement, but I usually recommend working with your family doctor with this one.  5-HTP is a building block for the body to make serotonin in the brain, so if you are on ANY antidepressants, you MUST work with your doctor as you could have a VERY BAD reaction, called serotonin syndrome, if you use the two together without proper monitoring.  Many headaches respond to serotonin, thus a constant supply via the 5-HTP is really helpful.  Dosing varies between 50mg to 300mg daily. Go up gradually, by 50-100mg every 3-5 days if needed. When properly monitored, I have found this to be a very safe way to prevent headaches, even in children.

6.  Have you seen a DO who does Cranial Osteopathy?  Many headaches (tension and migraine and any variation therein) are triggered by old head or sacral/tailbone traumas that need to be worked upon and released.  Just keep in mind, it often takes a lot of work to unlock "jammed heads and sacrums."

7.  I have some handouts here on the website that might be helpful.  Look for the "Upper Back/Neck Stretching Exercises" and the "Lifestyle Basics" handouts.  On the left side of this page, go to the "Educational Materials" -> "Files for download" and find the pages in PDF files.  There's a handout for lower back exercises too... in case you ever need it.