Heat stroke, fire ants, and food poisoning…

Prevent and Treat Three Summer Ailments In Houston and Southeast Texas

Summer comes early here in the Houston area. With each summer comes several common and avoidable illnesses that can ruin a vacation,

a long weekend or any type of summer fun. Well known and respected Houston area neurologist and founder of the Houston Healthcare Initiative CO-OP, Dr. Steven Goldstein has this news for those who listen to his weekly podcast which is available from: iTunes, Soundcloud, or the CO-OP web site www.houstonhealthcareinitiative.org.

Summer Heat Exhaustion

Known as heat stroke, sun stroke or heat exhaustion, getting overheated in the Houston area is a common ailment, as so many people work and play outside in the extreme temperatures. “People whose work requires they be outside, or for those who like to jog, play golf or even mow the lawn when it’s hot, dehydration and heatstroke are often seen together,” Dr. Goldstein told his listeners. “To avoid dehydration that can lead to heat exhaustion, drink lots of water or water combined with beverages that contain electrolytes like Gatorade. A good rule to follow is to drink a 50-50 mix of these two for every hour you are outdoors.”

Summer Dehydration Symptoms and Treatment

According to Dr. Goldstein, the symptoms of dehydration can run from feeling thirsty to fatigue, headache and nausea. More serious symptoms from a headache are confusion and really serious indicators are delirium and even hallucinations. Really bad heat-strokes can cause the kidneys to shut down. If someone is working on an elevated space, like so many petrochemical plant workers do, operating heavy machinery, or driving a car or truck can lead to much more serious accidents and injuries.

According to Dr. Goldstein, mild dehydration can be treated by rehydrating. “Just drink some water, Gatorade or both and stay out of the heat for a while,” Dr. Goldstein said.  “Heatstroke is more serious. If you have heatstroke, you need to go to the emergency room so you can have intravenous fluids and observation to make certain it is not more serious.”

The Danger of  Fire Ants

Few things go together like picnics and ants. But the ants here are much worse than most because they are not native, and the way they bite and sting.  “Red or fire ants are especially bad because they signal each other via pheromones that an intruder is present, and they sting all at once,” Dr. Goldstein said. “They have a unique and much more painful way of biting as they first bite, then grip the victim and then sting.

Fire ant stings have poisonous venom that will cause raised welts and will itch and sting for several days.” Dr. Goldstein also described how these insects could really be dangerous to pets, and small children. He advised that children be kept from sitting or laying on the ground and emphasized this for infants especially. “We’ve all seen the big ant hills, and of course avoiding them is always the right thing to do. But some are hidden from site, so for those of any age, be mindful and aware of this hazard.” Treating ant stings is usually as easy as applying triple antibiotic or cortisone cream. But those who are allergic or suffer many stings should go to the emergency room where more serious symptoms like anaphylaxis can be treated.

Food Poisoning

Food poisoning cases increase in summer because higher temperatures cause microorganisms to multiply faster when it’s hot. Plus, preparing food outdoors makes safe food handling more difficult. “The symptoms of food poisoning are well known,” Dr. Goldstein stated. “Diarrhea, vomiting, flu-like symptoms, or any combination of these indicate the possibility of food poisoning.”  Dr. Goldstein also said that, for this ailment in particular, prevention is the best medicine. “If there is any doubt that something may have been at too high a temperature for too long, avoid it. However, if despite everything, you still come down with this, it is important to stay hydrated. To get the best and most appropriate treatment, consult a doctor. He or she can prescribe medicine to help control nausea, vomiting and diarrhea.”

About Houston Healthcare Initiative CO-OP

Awareness that leads to action and in this case prevention, is key. But if despite all those positive actions, you still need to talk to a doctor and fast, people can join the Houston Healthcare Initiative CO-OP and use the doctor’s hotline. The Houston Healthcare Initiative CO-OP is offering a three-month, $45.00 trial offer that includes the use of the hotline for consultation, and even prescribed treatments. The place to learn all about this and more is at the CO-OP web site which is www.houstonhealthcareinitiative.org.

Announcing a new Healthcare Consulting FREE SERVICE offered by the Houston Healthcare Initiative for companies providing health insurance to their employees.

HEALTHCARE CONSULTING

What we will do

1.Listen

Allow the company to explain what are the specific problems they face with the health of their employees and how they are currently addressing them.

2.Learn

What are the details of the current healthcare plan? What data are available concerning current costs and how are these costs broken down. What data are available concerning the health of the employees.

3.Analyze

Use the available data to develop a plan to both improve employee health and lower healthcare cost. We do this from a physician’s perspective.

4.Propose

Steps to accomplish the dual goals of improving employee health and lowering healthcare costs. These steps can be implemented at no cost to the company!

5.Educate

Provide education to employees on how to shop for healthcare services and what they can do to improve their health

To learn more send an email to info@houstonhealthcareinitiative.org

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Most recommendations will include
1.Financial incentives to improve both physical and mental fitness. These incentives could include lowering of employee’s monthly premiums for insurance; sharing the savings on healthcare expenses with employees; employee recognition for improvement in health e.g. awards for weight loss
2.Annual physical exam to identify disease at an early stage, collect data on employee health and use the data to develop the financial incentives for employees to improve their health. Use the data to develop other strategies to improve the overall health of the employee population.

Many complain about our current healthcare system but little has been accomplished to make it patient centered. I believe that a patient centered healthcare system can be accomplished by using a patient owned healthcare cooperative model that is free from the constraints of the CPT codes used for billing and by providing financial incentives to patients to be compliant and lead a healthy lifestyle. Physicians rather than insurance companies and administrators should be responsible for care and would be compensated based on results. Profits from the cooperative would belong to the patients rather than an insurance company. One vision of  healthcare in the future is described below. Changes could begin incrementally, starting out with a conventional healthcare cooperative. Utilization of these changes should be voluntary on the part of the patient.

Screening for disease.

An annual physical examination including physical and mental fitness, weight, vital signs and age appropriate screening tests would be performed. If disease is found, appropriate treatment is begun.

Acute Illness

Rather than making an appointment to see a doctor or go to the ER/ Urgent Care, the patient can tap an app on the smartphone and talk to a physician in a few minutes. The patient would grant access to the physician to his/her medical record. The patient would report the symptoms as well as vitals signs – Blood pressure, pulse and temperature. (every patient would have the means of measuring these.) The physician could take the history and do a telemedicine exam; order lab tests and imaging; summon an ambulance; supervise the EMT’s; order transport to the hospital as necessary and treat the patient during transport.

If patients are well enough, they can go to the imaging center that also has a drawing station for blood work by car or  “cabulance”. Alternatively, blood work, EKG, plain x ray and ultrasound can be performed at home. This would all be performed the same day or night.

Most patients will not be very sick and simply need a diagnosis, reassurance, oral medication or first aid instruction. If necessary, diagnosis can be aided by AI.

Simple procedures e.g. suture of laceration can be provided by skilled technicians that come to the home and supervised by the physician

Sicker patients can be cared for at home with an aide to help with routine care and food preparation. Nurses can administer intravenous treatment; oxygen therapy and medication.

They can draw blood and help physicians perform telemedicine exams. The original doctor can call in specialists that can consult via telemedicine or if necessary in person. If necessary, treatment can be guided by AI.

Patients with unstable vital signs will still need transport to hospital for treatment of major trauma, heart attacks, GI bleeding, pulmonary emboli, acute stroke. Hospitals will be better equipped to handle these patients in the ER by avoiding the clutter of patients that do not have a life threatening emergency.

Chronic illness  e.g. diabetes, obesity, hypertension, seizure disorder, mental illness

A treatment team supervised by a specialist would care for the patient. Members of the team would consist of the patient, dieticians, physical therapists, psychologists, social workers, clergy, personal trainers, medical assistants, nurses or other skilled people necessary to care for the illness. A physician designed algorithm would help guide treatment. Problems with treatment compliance could be addressed by team members as well as the physician. Visits to the physician office would be rare. Results of treatment would be measured in terms of end organ damage e.g. to the heart, kidney, brain,musculoskeletal system.

Diagnostic Problem Cases.

When a patient has a symptom that is not resolving with initial treatment or where the diagnosis

Is not clear e.g. cause of dizziness, cause of anemia, breast lump found on mammogram, a diagnosis should be arrived at in a few days and appropriate treatment begun. This can best be accomplished if the patient goes to a facility where tests and specialty consultation can be performed in a few days. This facility would not provide nursing care or overnight stay. But would have a quiet space for patients to study and read; other space for a gym, TV, video games or other entertainment. There would be Exam rooms for specialists. Laboratory and imaging would be available on site with a 24 hour turnaround. Specialists would see the patient the same day or next day. This is similar to a hospital without beds, nursing care and bedside food service. Once the diagnosis is made, a treatment should be established and begun in 24-48 hours. The center would be judged on accuracy of diagnosis as well as efficiency.

To learn more, visit our website.

A Brief Look at the Numbers: Average cost of hospitalization in 2018 was about $10K; the average charge with private insurance was about $20K (The average charge to the uninsured ranges from $40K to $60K) Average number of hospitalizations per year was about 9/100 for ages below 64.

Total annual payments for hospitalization/100 people= 9x20K= $180K

Annual outpatient charges are estimated at $500

Total annual outpatient charges/100 people= $500×100=  $50K

Annual drug costs across the population estimated at $1200. We can reasonably assume

that drug costs are higher for the over 65 population. We would estimate this to be $500

In the under 65 population.

Total annual drug charges/100 people =$500×100= $50K

Total costs of reinsurance with $50K deductible+purchase of PPO discounts=$20K

If we add these costs together, we find the total charges/100 people= $300000

Notice this is the total cost. Insurance typically pays about ⅔ of the cost; ⅓ of the costs are paid out of pocket in the form of copays and deductibles.

The very cheapest Blue Cross policy for a 31 yo male in zip code 77096 was $257/month or

$3084/yr. The cost for 100 people would be $308K annually but would have a $7400 deductible.( At age 50, the cost was $4000 annually.) The high deductible means that outpatient care is not paid for and that the insurance only pays for the reinsurance and hospitalization costs of $200K.

The gross profit for the insurance company is at least $100K (income per 100 patients of at least $300K less claims of $200K)

For more information, check out our website!

The EMR has several advantages over the paper charts that it replaced. It is legible, cannot be misplaced and it eliminated paper prescriptions and paper orders. However, the current iterations have several disadvantages. 

1. The information density is very low in that a physician trying to understand the clinical course of the patient finds it difficult to access the relevant facts. It is laced with legal documents, consent forms, appointment verifications and other administrative information.
2. The physician has become a data entry clerk. In addition to doctoring the patient he/she has to doctor the chart. It contributes to physician burnout and raises the cost of medical care.
3. The information quality is poor in that physicians are poor data entry clerks and much of the physician’s notes are copied and pasted to save time and are thus inaccurate.
4. As each provider be it doctor, hospital or imaging center has its own EMR, the patient’s medical record is scattered about. A physician trying to care for the patient almost never has full information. Much time and effort is necessary to acquire information from the various sources. This also increases the cost of care.
5. The EMR is expensive with monthly fees paid by providers.
6. The patient has no access to his records.                  

Why is this? It surely is not a technical problem. We can understand the problems better when we realize that the main purpose of the EMR is to facilitate billing. The rule is “If you did not document it, you didn’t do it.” and thus you will not be paid. We need an EMR that is patient centered and not connected to billing at all. Such an EMR will not work with the current insurance system. 

An employee owned healthcare cooperative can correct most of the problems of the current EMR. If the cooperative maintained the EMR, all patient records would be in one place. The various providers could access and add to the EMR with no cost to the provider. Patients could have access. The information could be arranged with ease of access by providers the primary goal. With modern technology, the office visit could be recorded including the Chief complaint (reason for the visit) and the history. The physician could orally record the pertinent positive and negative physical findings and the conclusions. The recorded discussion with the patient about further testing and procedures would complete the visit. A data entry clerk working for the cooperative can then enter the diagnoses on a diagnosis list and record new medications on a medication list; Vital signs can be entered by the doctor’s office as well as by patients. Sections for lab and imaging would be maintained by clerks. No longer would doctors be adding data; they would be free to spend more time with patients. The copy and paste repetition of data would not clog the record. Administrative data would not be part of the EMR and could be stored independently by each provider.

In regard to your recent article in the Wall Street Journal, “Why the Amazon, JPMorgan, Berkshire Venture Collapsed: Healthcare Was Too Big a Problem” and the reasons for failure.  Haven failed because it did not use first principles thinking. The people that ran Haven thought that by using technology, innovative ideas and big data they could lower the cost of healthcare.

Haven failed because it did not use first principles thinking. The people that ran Haven thought that by using technology, innovative ideas and big data they could lower the cost of healthcare.

But they neglected to ask and answer the question why do we need healthcare in the first place? Many would answer we need it to preserve health. If you think about it, health is preserved by clean air and water and a proper sewer system. Health is also preserved by an appropriate diet, adequate exercise, proper sleep and avoidance of toxins such as cigarettes, drugs and alcohol. Early detection of disease is also important as well as compliance with treatment of chronic disease. Thus any healthcare reform should focus on improving public health.

Nevertheless most of us would still like care when we get sick. Ok then, what should healthcare look like? If we treat healthcare as the commodity that it is, we know that the best way to insure an adequate supply at the lowest possible price is to permit the laws of supply and demand to work. Our current system is a highly government regulated system largely influenced by lobbyists who represent doctors, insurance companies, hospitals and drug companies. The consumers I.e. the public has little to say about it. But they could have a great deal to say.

For example, large groups of consumers or large companies, by organizing their workers and their families, can overcome this system. Companies that self insure can use the healthcare cooperative model with the “co-op” owned by the employees. Financial incentives based on lifestyle would result in lower healthcare costs by decreasing utilization. Ownership of the cooperative would pass the savings from the cooperative to the employees. It allows employees to remain members even if they leave the company. By transferring ownership of the cooperative to the employees, companies are no longer responsible for healthcare and can concentrate on their core business.

An innovative cooperative can educate its members to utilize independent providers of healthcare and avoid hospital systems as much as possible. They can publicize providers that offer transparent cash prices for services. Other savings can be achieved by the cooperative owning the electronic medical record (EMR) and granting access to providers as well as to patients. By owning the EMR, the cooperative would own the data.

The cooperative model encourages the use of technology, innovative ideas and big data to improve access, decrease bureaucratic inefficiency, improve diagnostic accuracy, improve treatment outcomes. The failure of Haven illustrates how the current insurance system is resistant to change in spite of the rhetoric to the contrary.

Steve Goldstein

How the Covid-19 pandemic will leave its mark on US health care

Covid-19 and the Need for Healthcare Reform

The New England Journal of Medicine 

Jaime S. King, J.D.,  Ph.D.

Weekly FDA COVID-19 update

07-May-2020 By Jenni Spinner

The agency continues to remain busy overseeing and approving potential treatments and tests for the virus behind the global pandemic.

To read the entire article please click the link below:

HTTPS://WWW.OUTSOURCING-PHARMA.COM/ARTICLE/2020/05/07/FDA-WEEKLY-COVID-19-UPDATES-AND-ACTIONS

Listen to Dr. Steven Goldstein’s interview with Dr. Laurie Betito on CJAD-AM in Montreal, Quebec. He is on the second half of the program. To listen, click here: CJAD-AM Interview