Virtual Colonoscopy Anyone?

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Warren, I sent you my Private Message response. Thank you for giving us the information you are finding in your research. It is very confusing that a physician's organization would seem to "get it", but that apparently some of their members choose to overlook their own organizations guidelines.
 
messages forwarded to 60 minutes

messages forwarded to 60 minutes

i hope you all dont mind, but i have forwarded all of these posts to 60 minutes, the today show, local stations tv 4, 6, and 10 , and the columbus dispatch. dont know if they will understand the problems all of you valvies face when it comes to simple procedures, but hopefully at least one of them will get the big picture. i told them that if they understood that they would know what to do. i hope so :) :) :)

again, thanks for your responses

warren r mead
 
I am wondering how much influence health insurance companies have in the decision whether to hold Coumadin or use bridge therapy. Bridge therapy is much more expensive, by far, than merely holding.

If Heparin is used, it means that the patient has to be admitted a couple of days ahead of time to be hooked up to IV Heparin, Then there is the wait for the INR to get to the right level for the procedure. After the procedure, there are several days of additional hospitalization required for the INR to get back up to therapeutic range, so the patient can go home. This also might involve more than just the gastro doctor, because there might be monitoring by the cardiology team, and there will be additional monitoring by the gastro doctor.

If Lovenox is used at home, it is very expensive, and there are several days worh of shots prior to and post the procedure, and monitoring by a cardiologist, maybe.

Both of these methods will use additional labwork.

Most of the time in regular patients, these procedures are on an outpatient basis, in and out in one day. No additional medical monitoring.

If the patient is told to hold Coumadin and then resume after the procedure, everything is done outside of the hospital, unless the patient is admitted afterwards until they are therapeutic.

So we have the safer way to go which is much more expensive, versus the "dicey" way to go which is cheap and fast.

Is it just possible that the safety of patients is less important than the bottom line?

Is it possible that there is pressure to go the much cheaper route? I don't think many of us would ever know if that were the case, unless of course, we were in the medical or insurance field. These things aren't routinely discussed with the patient.
 
It is almost impossible to underestimate the power of the bottom line.

Think about what is the most money that a doctor could make in one year - just practicing medicine - no TV books etc.

Then find an insurance executive who would take a job that paid as little as that doctor makes.
 
No sooner did I finish posting the last message than I opened the paper and read that the Chairman of Anthem Insurance received a $42.5 million bonus for last year. Not a salary--- A BONUS.
 
I'd like to give him a bonus!
irate.gif
 
Al, I guess that proves your theory.
I agree with Nancy totally.
Will insurance companies even consider paying for virtual tests for patients like us?
Probably not unless the doctor is very insistant.
I think even a lot of the best doctors don't want to be bothered with all it takes to do bridge therapy.

Warren,
Thank you for all the information you have put together, I really appreciate it.
Hopefully this will help prevent more unecessary tragedies like what happened to your poor father.
 
Medicare

Medicare

I know that Medicare does pay for the extra days of Bridge
Therapy, but when your INR is back in range, the drs. kick
you out of the hospital pretty fast. Even if you aren't feeling up
to it. I think their actuaries figure it is cheaper to pay for a
few days more in a hospital, then pay the bills for months of recovery from a stroke. I would be very curious what
Warren's father's insurance company thinks about paying for his stroke,when a fews days of Bridge Therapy could have prevented it. We all owe a lot to Warren and his dad
for bringing this to our attention!
 
Medicare

Medicare

My fathers medicare complete will only pay for the first 100 days of longterm care, and that can be stopped before the 100 days if he does not continue to show improvement. By the way, the co pay with medicare complete is 75 per day. after the 100 days it is all out of pocket until his assests are depleated and then medicaid can kick in.
 
Reply from television station

Reply from television station

Got our first reply back from one of the local television stations


Date: Thu, 08 Apr 2004 10:03:12 -0400
From: "Andrea.Cambern" <[email protected]> Add to Address Book
Subject: RE: Colonoscopy or Russian Roulette
To: "'warren mead'" <[email protected]>




Hello Warren,

Thanks so much for thinking of us. I wasn?t aware of the problem and appreciate the information. This may be too complicated for a broadcast news story, but I will discuss it with my producer. It might be better told through print, since the newspaper has the luxury of space, where our time is limited.

Thanks again.

My best,

Andrea



-----Original Message-----
From: warren mead [mailto:[email protected]]
Sent: Wednesday, April 07, 2004 6:38 PM
To: Andrea Cambern (WBNS)
Subject: Colonoscopy or Russian Roulette


maybe the next one will be better :( :(
 
Warren - The first and last web site address you listed in your last post did not work. Is it possible the address was keyed incorrectly. The other two sites were very useful. Chris
 
If it quacks like a duck and walks like.................

If it quacks like a duck and walks like.................

Check this out- they don't call it "Bridge Therapy", but the FDA gave approval for something that sure seems like it.
At the very least, these drs. seem to be aware of the problem and are using a protocol- they are not cardiologist.


http://www.spotlighthealth.com/dvt/dvt_overview/preventingdvt.html

If the FDA approves it for some surgeries, why shouldn't it
be approved for bridge therapy?
 
RCB - Thanks ! Thats a good site and useful information. I agree - apparently there is a fine line somewhere but it escapes me. Maybe we don't have to focus as much on the approval of the drug, just how to get higher awareness with docs and patients.
 
Standards of practice Committee

Standards of practice Committee

Just sent this to allwodick

check it out, you may be amazed

allodwick,

more research tying some pieces together. thought i would look around in the insurance risk management area, and look what i found.
www.managedinsurance.com/riskmanagement.htm

look at Breach of Duty at this link. quote "it is incumbent upon you to kiip your medical knowledge current and updated. this will reduce your malpractice risk. guidelines of practice such as those promulagated by the american society for gastrointestinal endoscopy should be familiar to all endoscopists. encoscopists should practice within these and other appropriate guidelines in order to maintain a practice level at a reasonabel standard of car."

after you read this link, then link to

www.asge.org/gui/resources/manual/misc_anticoag_man.asp

look at the bottom of the link and see who it is prepard by "Standards of Practice Committee"

what do you think about that.

again, thanks so much for letting me lean on you

warren r mead
 
Today's Journal of the American Medical Association has an article concluding that virtual colonoscopy is not ready for widespread use. The compared results between 9 major medical centers and found major discrepancies. BUT AND THIS IS A VERY IMPORTANT BUT the study ended October 3, 2001. So by the time the results were analyzed and published, the study is 2.5 years old. I think that if you are convinced that thsi is what you want, and your doctor tries to talk you out of it, point out trhe time lag. The speed at which things develop today makes 2.5 years unacceptable for a reference point.
 
Hi Al,

I did catch that on TV. They stated that the conventional was 99% accurate in two various area of the scope. The virtual ranked 60% and 30% or so. Guess we better break out the Lovenox :eek:
 
I don't think that JAMA performed a public service by publishing results that are 2.5 years old in a rapidly emerging field. It is like selling you a 2001 model computer and telling you that it is the latest technology.

I think that virtual colonoscopies are much better than they were at the time the study was done. If everyone contacted their local TV station and pointed out this fault in the report maybe they would be less likely to spread this hogwash.
 
Question For Al

Question For Al

You state:
"What it boils down to is this.
Stopping warfarin 4 days before a procedure and then re-starting it 4 to 6 hours after the procedure means that there is little or no anticoagulation protection for about 7 to 10 days."

I take the above to mean warfarin goes from maximum INR for the dosage taken to zero, then back to maximum over a 7 to 10 day period, assuming no other changes (same diet). My question is what about vitamin K? If I normally eat a large spinach salad every day, then miss a day, how fast is the reaction due to the reduction in vitamin K (no other changes-same warfarin consumption)?
 
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