TORONTO – As the debate over birth control rages in the United States, one columnist has made a suggestion that is gaining traction in Canada – make the drug available over the counter.
Columnist Virginia Postrel wrote in a March 8 post on Bloomberg.com that birth control should be made available over-the-counter because of minimal safety concerns.
“Nearly two decades later, birth- control pills look even safer than they did then, and recent research indicates that women are both able and eager to manage their own purchase decisions,” Postrel says.
Though Postrel does admit that birth control pills carry potential side effects, she notes they are not the only drug that does. Ibuprofen – a drug which is readily available over the counter – also has a significant amount of side-effects, Postrel points out.
Some doctors suggest that ibuprofen, if released today, would be only available by prescription.
Dr. David Kaplan, Deputy Chief, Family & Community Medicine at North York General Hospital, says that both ibuprofen and birth control have side effects, but only the latter requires more extensive review.
“There is some monitoring that needs to happen when we place women on birth control medications. We want to check their blood pressures, we want to ensure, based on their age, whether or not they are having annual breast exams, it is a medication that requires ongoing follow up and review,” Kaplan said.
Despite Kaplan’s hesitation about making birth control available over the counter, an editorial written by Dr. David Grimes and published in the journal Public Health Policy Forum argues that birth control is safe enough for over-the-counter sale.
“Thirty years of intense epidemiologic study have confirmed that oral contraceptives are very safe,” Grimes writes.
Read it on Global News: Global Toronto | Argument erupts over birth control being available over-the-counter
Dr. Kaplan’s interview tonight with Beatrice Politi on GlobalNews Family Health on why doctors are rethinking their approach to sinus infections.
Looming Physician Surpluses? Drs. Peter Walker & Michael Guerriere suggest conditional billing numbers – Everything old is new again
In their Longwoods publication today, Drs. Peter Walker and Michael Guerriere talk about looming physician surpluses? In the context of managing healthcare costs in Ontario they suggest that:
“There is also a serious physician distribution problem across the province, with oversupply in some locales and specialties, and significant shortages in others.
Today, newly qualified physicians receive an OHIP billing number automatically. A rookie doctor bills the same rates as a world renowned expert in an academic medical centre. Both of these policies need to be reconsidered. Perhaps new physicians should practice in areas of the province where there is a demonstrated need for their services and should receive conditional billing numbers. Differential pay based on demonstrated quality and experience would also allow the government to control cost increases while rewarding quality at the same time.”
I have argued all the way back to 1998 when I was still a medical student (having finished my graduate training in Health Policy and Bioethics under Dr. Bernard Dickens) that:
Before the government can adopt a regulatory policyof toying with restricting physician-billing numbers in over-serviced urban area or based on age, it must fully assess the ethical implications of restricting a physician’s ability to practice of medicine.
In 1998, I published the following in the University of Toronto Medical Journal (Moving Doctors north 1998 Kaplan): “Even though a constitutional right to practice one’s profession does not exist, an examination of government attempts to restrict physician billing numbers in urban areas has indicated a basis for such a moral right, at least a limited one. Employment is an essential vehicle through which society allows a person to become a constructive member of that community, and one who contributes to the overall good. While not constitutionally protected, the government must have good reasons for disregarding this moral claim. As Dr. J. Armstrong, then-President of the Canadian Medical Association (1996), put it: “The fiscal health of the nation should not be cured by detrimental changes to the health of Canadians.” According to Raisa Deber, the key problem in Canada is not the current or past fiscal austerity. The economy of Canada has been steadily collapsing since the 1960s; every year, the total GDP per capita has declined. Thus, even though health expenditures have increased, the GDP has decreased. While this ratio (health $/GDP), has become larger, closer examination of the data indicated that Canada spends less money per capita than Japan on health care. Yet, Deber (1996) asserts that, “If we don’t change soon we won’t be able to sustain our system.” The issue now is appropriateness; what are the appropriate measures that government and the medical community take in order to make the healthcare system more efficient. ‘Band-Aid’ solutions to fee-for-service medicine are inappropriate when the system has ‘cuts that needs stitches’ and ‘ limbs that need amputation’. We need to look for other forms of health care delivery; capitation, integrated system delivery or other managed care models need to be examined for their appropriateness.” It think it is time for me to revise this piece of scholarly work for 2011 (13 years later) and have it submitted for rapid publication!
Reprinted from http://www.cmaj.ca/content/183/12/E783.short?rss=1
CMAJ vol. 183 no. 12 First published August 2, 2011, doi: 10.1503/cmaj.109-3915
by Wendy Glauser
Advocates say Web platforms may revolutionize family medicine by allowing family physicians the ability to communicate with patients and provide medical services or advice online.
They also contend that by offering more comprehensive access to health information, the Web platforms empower patients to take more control of their health, and that online doctoring will save money for both patients and doctors. The former won’t have to take time off work to see their doctor for a form or test result, while the latter will cut reception costs by utilizing online booking systems and automatic patient notification services.
When doctors sign up to one of the Web platforms — such as mypatientaccess.ca, HealthConnex, mydoctor.ca or myOSCAR — their patients get access, to varying degrees, to such information as medical records, lab results and long-term health indicators like blood pressure and blood-glucose levels. The platforms also allow patients to securely email their physicians.
But the services typically involve a fee, because provincial insurers do not generally remunerate doctors for the time they spend providing patients advice on the phone or Internet.
For some, such fees raise questions around equitable access to health care.
The fees essentially give patients the option of paying for more expedient and convenient access to a doctor, which could violate the Canada Health Act, says Mike McBane, national coordinator of the Canadian Health Coalition. “It’s an area we’re going to demand action on.”
Patients who register with mypatientaccess.ca, for example, pay between $40 and $75 (the fee is set by the doctor) per email conversation with their physician.
Such fees offer more value than block fees (www.cmaj.ca/cgi/doi/10.1503/cmaj.109-3815) now being charged by many physicians, argues Moe Jiwan, president of Toronto, Ontario-based Canadian Patient Access Inc., which partnered with Nightingale Informatix Corporation to create mypatientaccess.ca. “Our offering gives patients access to a suite of services never before brought forward and at a very reasonable rate,” says Jiwan, who argues that the Web platforms promote greater accessibility for patients.
Patients who want to receive advice from their doctors via email will likely have to pay fees, which has raised questions of equitable access to health care.
“Image courtesy of © 2011 Thinkstock”
Jiwan also contends that econsults are rare and thus don’t limit time available for in-office visits. But they are “helpful for patients who travel a lot. One of the physicians had a patient recently email him, ‘Hey Doc, I’m in China and I’m finding that my sugar levels are all over the place. What should I do?’”
Doctors who subscribe to my patientaccess.ca can use the portal for free, and basic services like online appointment scheduling are free for patients as well. Patients who want additional services, such as comprehensive lab reports and medical histories, pay $6.50 or more per month. Separate fees are charged for econsults and online prescription refills. Jiwan says the bulk of the monies go to physicians, of whom about 3300 are using the portal, making it the most widely used platform now on the market.
At mydoctor.ca, which was launched in 2008 by the MD Physician Services, a division of the Canadian Medical Association, patients pay an annual fee of $19.95. About 200 physicians have signed on, says Lyndon McPhail, product manager of MD Physician Services.
The portal is helpful for patients with chronic diseases because they can track indicators like blood sugar levels and weight over time, McPhail says.
Some family physicians give the portals a definite thumbs-up. Providing patients more ready access to lab results reduces their stress levels, says Dr. David Kaplan, associate family physician-in-chief at the North York General Hospital in Toronto. “Before, if we left a patient a message on Friday and told them to come to the office, all of a sudden they’re anxious for the weekend. Now they can log in and access the results at any time.”
But there are risks to online doctoring, acknowledges Dr. David Price, chair of Department of Family Medicine at McMaster University in Hamilton, Ontario, who will launch a university-developed portal for his family health team in September.
Price says that providing patients with access to diagnostic results or health indicators is “empowering,” but some patients may misinterpret lab results that are uploaded onto the portal, for instance, and jump to the wrong conclusions.
While many believe that the portals will become more commonplace in the future and that physicians will likely be compensated by provincial governments for such services, the ramifications for health care remain murky. “I don’t think we understand how this technology is going to change how we provide care and how we receive care as patients,” Price says.
From the Medical Post: Eight simple ways to save money and boost revenue: Take advantage of technology to increase efficiency and optimize your billing
Written by Wendy Glauser on September 8, 2011 for The Medical Post
In the current economic climate, are you feeling the financial squeeze?
While the following tips offer advice on cutting costs, we’ve also included ways you can boost your revenue. Many physicians make the mistake of simply focusing on costs, says Jim Sweeney, a practice consultant at MD Physician Services, a Canadian Medical Association-owned company.
For example, it doesn’t make sense to cut staff salaries before looking into revenue-boosting methods that may lead to more patients and a greater workload. “Cutting costs is secondary until you look at your revenue,” says Sweeney. Read on to learn about how to both save and make more money.
1 Convert faxes to electronic documents
Dr. David Kaplan, associate family physician-in-chief at North York General Hospital in Toronto, was concerned not just about the trees but also the money that his clinic was wasting by printing faxes and then scanning them to upload into patient’s records.
“Between five doctors, we were wasting 30,000 sheets of paper a year,” he says. The paper costs weren’t breaking the bank, but Dr. Kaplan was concerned that the time the secretary had to spend in front of the printer, scanner and shredder was an inefficient use of her time. So he installed Nuance Communication’s Omnipage software, which automatically sends an electronic copy of faxes to his secretary’s e-mail.
Faxes can still be printed when hard copies are needed, but usually the secretary simply files an electronic copy of the fax in the patient’s record. (Alternatives to Omnibus include the products ABBYY FineReader or Free OCR.)
2 Get a new water heater
One way to save money over the long term is to replace your office’s old, inefficient water heater with a tankless water warmer.
Because the hot water is always circulating, you don’t have to wait 30 seconds for the hot water when you need to say, heat up a speculum, explains Dr. David Price, chairman of the department of family medicine at McMaster University in Hamilton and the head of McMaster’s Family Health Team. His network of clinics recently made the switch, and they installed a timer so the water heater turns off for the night. “That saved us a considerable amount of money,” says Dr. Price.
3 Read up on the fee schedule
Gaining a more thorough grasp of the codes and procedures of the fee schedule, and keeping on top of updates to it, is a no-cost and surefire way to boost revenue. “If a physician doesn’t know what’s available in the fee schedule, chances are very good he or she will not be maximizing income,” says Sweeney. He notes that many physicians miss billing opportunities, such as tray fees or injections, simply because they’re not well-versed on the fee schedule.
4 Switch to a VOIP phone system
After switching from land lines to Voice Over Internet Protocol (VOIP), which transmits audio over the Internet, Dr. Kaplan’s office now saves about $75 a month in phone bills.
But the cost savings haven’t been the only benefit. Previously, when all four lines were in use, a staff member would have to wait until a line became free to make a call—and patients would get a busy signal when phoning.
Those problems have been eliminated because VOIP offers an unlimited number of lines and simply charges per user. In addition, because the system can be used via smartphones or laptops, it’s more convenient and there’s no need to shell out for phones in every room. “You can call from your computer while in the exam room,” says Dr. Kaplan. “From a work flow perspective, it’s made a huge difference.”
5 Use the audit function of your clinical management software
Most physicians don’t use their clinical management software to its full potential, says Sweeney, and that’s unfortunate because many of the built-in report functions of the software can add to a doctor’s bottom line. “Certain reports should be done every month: what I billed, what I got paid and accounts receivable,” says Sweeney.
Through these reports, the clinical management software can flag rejected claims so the doctor can correct the information and re-send the bill.
Provinces only allow a certain window in which claims can be paid, and Sweeney says he’s seen some “pretty sad cases” of doctors losing thousands of dollars simply because they didn’t realize their claims were rejected before it was too late.
6 Spend money to make money
It doesn’t always pay to be cheap, warns Dr. Price.
He provides the example of a time early in his career when he and his partner were hiring a clinic administrative manager. One particular candidate had a track record of improving efficiency, but “to hire her was going to be an extra $5,000 a year, which seemed like a lot of money.” Upon doing further calculations, however, Dr. Price realized that amount only required them to see three extra patients per week per doctor, which didn’t actually seem like much.
Six months in, the new hire was saving so much time in administrative paperwork that the doctors were able to see an extra two patients per day.
As the saying goes, sometimes you have to spend money to make money.
7 Do your own billing
As electronic medical record systems continue to make billing easier than ever before, physicians can boost their incomes by doing their own billing. As Dr. Kaplan explains, “Only the physician remembers what they did in the exam room.” An extra $5 or $10 here and there adds up over the long run, and it’s often worth the 15 seconds it takes to do a patient’s billing at the end of an appointment.
8 Charge for uninsured services
You do the work, so why not get paid for it? “More and more physicians are charging fees for uninsured services,” notes Dr. Kaplan and, as a result, there’s been a growing awareness among patients that not all procedures are covered.
If charging individually is an administrative burden, consider offering block fees, which save costs in the time staff members spend sending and processing individual bills.
Wendy Glauser is a freelance writer in Toronto.
Rarely people ‘like’ visiting healthcare professionals. Children are no exception! We find that by the age of 15 months children associate visiting the MD with having a painful procedure, immunizations!
Most toddlers learn to experience high distress during these immunizations. Unmanaged pain can elevate both child and parent anxiety during injections. Children in Ontario receive a total of 11 to 12 vaccinations by the time they reach 15 months of age.
In the last year, the recommedation is to provide some sort of pain relief prior to injections. Examples include:
1. Provide tactile stimulation by rubbing or stroking the skin near the injection site before and during vaccine injections. This has been shown to reduce pain in children aged four years and older.
2. Breastfeeding is also a great option because several aspects of breastfeeding (holding the child, skin-to-skin contact, the sweet-tasting milk and the act of sucking) minimize the pain response. You need to have an adequate latch for about a minute before the injection.
3. Topical anesthetics are appropriate for older toddlers. They block the transmission of pain signals. We do not believe that they interfere with the effectiveness of vaccines. They need to be applied ahead of time, about 20–60 minutes before the injection. The cost per use (i.e. each patch) is $5–$10.
4. Distraction directs the child’s attention away from the procedure. Distraction is effective for children of all ages. The guidelines provide age appropriate examples of distractions strategies: toys (for infants), bubbles (for toddlers), video games (for school-age children) and music (for adolescents).
5. Finally, deep breathing or tummy breathing can be tried in children three years of age and older. You can have your child blow bubbles or spin pinwheels with the breath.
In the words of the guidelines published in the Canadian Medical Association Journal last December: “More positive experiences during vaccine injections also maintain and promote trust in health care providers.”
Finally, doctors can also examine the child on the parent’s lap instead of on the exam table. This is the method I teach my medical student and residents. Further comments and suggestions are appreciated!
The guidelines can be found at http://www.cmaj.ca/cgi/reprint/182/18/1989.pdf Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline