Are ProDrugs the Next Generation of ADHD Medications?

By Douglas Cowan, Psy.D.  |   Submitted On January 14, 2008

Just as 2006 and 2007 saw an increase options for delivery systems of medications for ADHD, the next generation of medications for ADHD may be just around the corner in 2008 and 2009. These NextGen medications are known as ProDrugs, and they have the potential to change the way medications are prescribed to individuals with ADHD.

Since there has been a recent explosion of new ADHD drugs such as Strattera, or new delivery systems such as Daytrana, or "old drugs in new dresses" such as Concerta, why in the world is it necessary to develop any more new drugs for ADHD? Why should we care?

ProDrugs: The Next Generation of ADHD Medications

To the extent that new drugs are just "old drugs in new dresses" for a pharmaceutical company to make money, we don't care. But to the extent that this NextGen of ProDrugs might actually make a difference in people's lives, we are very interested in learning more.

And given that between 30% and 40% of patients cannot tolerate the side-effects of current stimulant medications, and given that today's ADHD medications range from about 60% effective (Strattera) to 80% effective (Ritalin), there is a lot of room for improvement in this field. This is why we like Attend, which is not a drug, but is about 70% effective and with few or no side-effects. It is just not well known.

By developing this next generation of drugs, pharmaceutical companies are betting huge sums of monies that they can develop ADHD drugs that are more efficient for a given individual, and with fewer side-effects. Since there are different types of ADHD, different types of drugs, or drugs that will work on different parts or systems of the brain, will be more efficient than just broad acting CNS stimulants.

What is a ProDrug?

A ProDrug is an inactive precursor of another drug, an inactive precursor to a particular pharmacologic agent. It is a drug that is given in an inactive, or greatly less active form. But once taken, the person's body metabolizes it into an active form. The person's body becomes the "delivery system."

A ProDrug is designed to be more efficient in treatment, by being better absorbed and better utilizied by the body, with less side-effects.

The goal of ProDrugs is for the drug to be highly targeted to a specific system or region of the body, a specific site of action, rather than just impact the entire body or CNS.

Shire Pharmaceuticals, a company that we have been very critical of in the past, is one of the companies leading the way in ProDrug development. Well, actually they are not, but they did by New River Pharmaceuticals for $2,600,000,000 (yes, that is 2.6 Billion dollars). And New River Pharmaceuticals was leading the lay in ProDrug development for ADHD with their drug Vyvanse (lisdexamgetamine dimesylate). The FDA approved Vyvanse as a "novel treatment" for ADHD in February of 2007, and the DEA will classify it as a Schedule II controlled substance.

From the Shire press release of Feb. 2007:

"VYVANSE is a prodrug that is therapeutically inactive until metabolized in the body. In clinical studies designed to measure duration of effect, VYVANSE provided significant efficacy compared to placebo for a full treatment day, up through and including 6:00 pm. Furthermore, when VYVANSE was administered orally and intravenously in two clinical human drug abuse studies, VYVANSE produced subjective responses on a scale of "Drug Liking Effects" (DLE) that were less than d-amphetamine at equivalent doses. DLE is used in clinical abuse studies to measure relative preference among known substance abusers.

"The FDA approval of VYVANSE is exciting news for Shire as well as for patients, their families, and healthcare providers as it's an important, novel approach for the treatment of ADHD," said Matthew Emmens, Shire Chief Executive Officer. "The label we received with the approval letter includes information about the extended duration of effect and abuse-related drug liking characteristics of VYVANSE which illustrate benefits that differentiate this compound from other ADHD medicines. The addition of VYVANSE to our ADHD portfolio reaffirms Shire's commitment to continue to address unmet medical needs and advance the science of ADHD treatment. Beginning with product launch in Q2 2007, Shire will make VYVANSE our top promotional priority within our ADHD portfolio."

The big selling point of Vyvanse is that it may reduce the potential for abuse, as ProDrugs are not favored by those intending to abuse stimulants.

In regards to ADHD ProDrugs, admittedly Vyvanse is the only ProDrug that I have heard any lectures on or read anything about, but I don't want to assume that it is the only ProDrug in development for ADHD. In the studies on Vyvanse, the researchers found that among all of the subjects, the ProDrug was metabolized very consistently in terms of time to optimum therapeutic levels in the body, and in terms of the predictability of the degree to which the ProDrug was utilized by the body.

To put it better, put ten kids in a room who each weigh 100 pounds. Let's say that they each need treatment with methylphenidate (Ritalin, et al.). The variety of optimal doses in those ten children could range from 5mg per dose to 40mg per dose. But with the ProDrug, the study indicates that nearly everyone of that body weight will be taking the same size does to get the optimum dose.

To put it even more simply, it will be easier for doctors who aren't paying attention well to get the right dose for the right child the first time. And the response to the drug will be more predictable. Everything will operate more efficiently with a more efficient drug.

To learn more about medication and treatment for ADHD, or to learn more about attention deficit hyperactivity disorder visit http://newideas.net for the ADHD Information Library. This information is not to be considered medical advice, but is for information only. Consult your physician.

Article Source: http://EzineArticles.com/expert/Douglas_Cowan,_Psy.D./64601

2007 Year-End Health Savings Account Strategies

By Wiley P Long  |   Submitted On December 12, 2007

A Health Savings Account can be an important part of your tax and money-management strategy. Not only can you reduce your health insurance premiums, but when you fund your account you get a nice tax break. If you stay healthy, that money grows tax-deferred like an IRA, and can amount to a lot of money in retirement.

Every year around this time you should assess your finances and see what you need to do to optimize your situation. Making the most of your Health Savings Account (HSA) is one area that can really make a difference. Here are the key things you need to know to get the greatest tax reduction and the most growth out of your HSA.

Maximizing Your Contribution May Reduce Your Taxes By $1836 or More

If you own an HSA-qualified health insurance plan that has an effective date no later than December 31, 2007, you qualify to make a tax deductible contribution to your Health Savings Account. This will immediately reduce your tax bill come April 15.

The contribution limit is not pro-rated based on the number of months in 2007 in which you had coverage, as it was in the past. However, you do need to remain an HSA-eligible individual throughout 2008, or the extra amount contributed will be counted as income and subject to an additional 10 percent tax.

The maximum HSA contribution in 2007 is $5650 for families, and $2850 for individuals. If you are 55 or older, you may also contribute an additional $800.

Your HSA contribution is deductible on your federal income taxes, and every state (except AL, CA, NJ, and WI) also gives a deduction on state income taxes. So by maximizing their HSA contribution a family in a 28 percent tax bracket, paying 4.5 percent state income taxes, will reduce their April 15 tax burden by $1836.25.

Though your HSA-qualified health insurance must be in place before the end of the year, you do have until April 15 to make your 2007 contribution. Though you cannot put any more 2007 money in if you miss this deadline, you can reimburse yourself in later years for qualified expenses incurred in 2007, even if you do not currently have the money in your account.

Strategic Withdrawals

You can withdraw money from your HSA at any time to pay qualified medical expenses. Keep in mind that this includes over-the-counter medications such as aspirin or cough syrup, dental and vision expenses, and even alternative care such as acupuncture or homeopathy.

One strategy that many of our members take is to save their medical receipts, but to delay reimbursement from the HSA so that the funds have the opportunity to grow tax-deferred. There is no time limit in which you must withdraw the money. Since most people will face larger medical bills during their retirement, it is quite likely that the withdrawals would never be subject to taxes.

If you are not fully funding your Roth, another strategy would be to reimburse yourself for medical expenses from your HSA, and to deposit it in your Roth. Your HSA reimbursement is tax-free, and placing it in your Roth would also give you tax-free growth while enabling you to withdraw the money in retirement tax-free for any reason, including non-medical expenses. You would also avoid any extra state taxes in the states that currently tax Health Savings Accounts.

Remember to Keep Good Records

You should keep a record of any qualified medical expenses you incur. This will ensure that you have documentation substantiating any tax-free withdrawal you make from your HSA. In order to pay for a medical expense from your HSA, it must be a qualified expense.

You can go low-tech and just put receipts in a file, or get a little more organized and track your records online.

2008 Contribution Limit and Deductible Changes

In 2008 the maximum annual HSA contribution limit will again go up, this time to $2900 for individuals and $5800 for families. Those over age 55 will be allowed to contribute an additional $900 to their accounts.

The maximum deductibles will be going up next year to $5600 for individuals, and $11,200 for families. If you've now got some money socked away in your HSA, it might make sense to move to a higher deductible to further reduce your premiums.

Health Reimbursement Arrangements

If you are currently set up as an S-corp, you should strongly consider setting up a Health Reimbursement Arrangement (HRA). An HRA enables your S-corp to reimburse you as a tax-free fringe benefit for the cost of your individual health insurance. This is the only way an S-corp can legally pay for individual health insurance, and is saving our average S-corp member over $3000. The HRA must be established by December 31st in order to take advantage of it in 2007.

It may also be beneficial to set up an HRA if you have a spouse who works in your business. Also, many small businesses use an HRA to reimburse their employees for individual health insurance premiums (which is much less expensive than getting group coverage). More information and a simple online application is available on our Health Reimbursement Arrangement page.

What to Do Now

Here are the steps you should take now:

1. To maximize the potential growth of your funds, you should try to fund your account as early in the year as possible. Every month of tax-deferred growth does add up over time. You can keep the money in a savings account, or invest it in stocks or mutual funds.
2. If you have your health insurance in place but do not yet have your HSA set up, you can do so online or possibly your local bank.
3. If you do not yet have an HSA-qualified health insurance plan, you should apply for coverage as soon as possible. Your plan must be effective before January 1 in order for you to qualify for the 2007 tax deduction. By getting your HSA-qualified health insurance in place by January 1, not only will you be able to maximize your tax benefits, but you also may be able to lock in 2007 rates for the next 12 - 24 months.
4. If you have a small business with employees, are set up as an S-corp, or have a spouse who works in the business with you, you should set up a Health Reimbursement Arrangement.

Through HSAs and HRAs, individuals who pay for their own health insurance have some powerful tax reduction strategies at their disposal. December 31st is the deadline for obtaining 2007 tax deductions, so you should act quickly if these ideas make sense for your situation.

By Wiley Long - President, HSA for America (http://www.health--savings--accounts.com) - The nation's leading independent health insurance firm specializing in HSA Plans that works with a Health Savings Account.

Article Source: http://EzineArticles.com/expert/Wiley_P_Long/46226

Cancer Screening-What Should Women Know in 2007?

By Steven Vasilev MD  |   Submitted On January 31, 2007

We have all had friends get diagnosed with cancer. These are often friends who have lived the healthiest possible life, eating nothing but the best quality foods. We are talking about non-smoking, regularly exercising people who have lived the perfectly healthy lifestyle. Why did they get cancer?

The truth is that almost all cancers are caused by some genetic switch or another inside of us that flips on or off. Whether or not this occurs does depend to some degree on what we expose ourselves to, whether that be cigarette smoke, over exposure to the sun or some type of food additive. This is very over-simplified, but science is advancing rapidly and in the next five to ten years we may know exactly what the risk will be for any given environmental vice that we choose to engage in.

Until then, we do have knowledge about what kind of cancer we are most likely to come down with, and how effective cancer screening is against some of these. The point is that you have the power to take control and minimize the risk of cancer happening to you !!

The most common types of cancer in women living in the United States are:

breast (213,000 new cases, 40,970 deaths per year, with a 1 in 34 lifetime risk of dying from it),
lung (81,770 new cases, 72,130 deaths per year, with a 1 in 20 lifetime risk of dying from it),
colorectal (75,810 new cases, 27,300 deaths per year, with a 1 in 45 lifetime risk of dying from it),
endometrial (41,200 new cases, 7,350 deaths per year, with a 1 in 196 lifetime risk of dying from it),

skin (30,420 new cases, 3,720 deaths per year, with a 1 in 500 lifetime risk of dying from it),
ovarian (20,180 new cases, 15,310 deaths per year, with 1 in 95 lifetime risk of dying from it),

cervical (9,710 new cases, 3,700 deaths from year, with 1 in 385 lifetime risk of dying from it).

In general, in addition to taking care of yourself, a yearly examination with screening for cancer or precancerous conditions is highly recommended. Unfortunately, the cancers for which there are no effective screening tools are: endometrial, lung and ovarian.

The good news is that endometrial cancer tends to show itself early by abnormal bleeding, usually postmenopausal, which leads to a high cure rate. The additional good news for preventing endometrial cancer is that the vast majority occur in people who are overweight. So, paying attention to symptoms and keeping your weight in the normal range go a long way towards preventing endometrial cancer. Also, if you are taking estrogen, make sure you discuss the risk vs. the benefit with your physician.

Lung cancer is most often associated with smoking. Screening techniques have been ineffective in reducing mortality. Enough said. You know what to do for this one.

Ovarian cancer is a silent killer with no early symptoms and no reliable way to screen for it; at least not yet. There may be a blood test that is on the horizon that will change that in the near future. However, for today, the tests popularized in the lay literature as screening tools, particularly CA-125, are simply not effective. The best strategy is to pay close attention to persistent symptoms of increased bloating, indigestion, unexplained weight loss, pressure, abdominal or pelvic pain, or other intestinal symptoms. Having said that, these kind of symptoms are far more likely to be caused by something other than ovarian cancer, so don't panic. Just be vigilant if these symptoms don't go away. Also, although there are genetically predisposed women who get ovarian cancer in their reproductive years, the vast majority of ovarian cancers are diagnosed in the post-menopausal years. If you do have first degree relatives who have come down with breast or ovarian cancer, seek genetic counseling. Testing may be recommended.

Screening options do exist for cancers of the skin, cervix, colon-rectum and breast.

Women over the age of 40 should get mammograms every 1 to 2 years, and yearly after age 50. In addition, ask for a breast exam during your annual physical. Finally, although breast self-examination has not been proven to be effective, there is enough medical information to consider doing it regularly. You know your body best and may detect a lump earlier than anyone else. Finally, as far as preventive measures, a low fat diet , which you religiously adhere to may reduce your risk, especially if you have been on a high fat diet. Being overweight definitely increases your risk of cancer.

There has been a lot of press lately regarding cervical cancer screening. The best news here is that the combination of Pap smear and HPV testing is highly effective in detecting PRE-cancerous conditions of the cervix. This means that treatment can be effective very early and relatively non-invasive since the treatment is for pre-cancer rather than cancer. The recommendations are rather complex, vary with age and the details can be found on the American Cancer Society website. However, in general, make sure you are getting this combined test at least every 3 years.

After age 50, there are several options for colo-rectal cancer screening. Similar to cervical cancer screening, the most effective situation is detection of pre-cancerous polyps, but early cancer detection is also life-saving. The options include yearly testing of patient collected stool samples, sigmoidoscopy (examining the lower part of the colon) every 5 years, a special kind of x-ray study called a double-contrast barium enema every 5 years or colonoscopy (looking at the entire colon) every 10 years. Discuss these options with your doctor to determine what might work best for you.

Finally, especially if you are a sun-worshiper, ask your doctor to look at every inch of your body for signs of precancerous or cancerous skin changes. Make sure you use sun protection lotions which have a SPF (sun protection factor) rating of at least 15. Your risk will depend upon what type of skin you have, but these days you should pay attention to what the reported UV Index is wherever you live. This is a measure of the sun's damaging ultraviolet radiation you are exposed to on any given day when you go outside.

It's your life. Make sure you're looking out for number one!

Steven A. Vasilev MD, FACOG, FACS is a fellowship trained and board certified gynecologic oncologist, which means he is specially trained and certified to take care of women with gynecologic cancers using a broad spectrum of skills. He has practiced at academic as well as private centers, has been on the faculty of three universities and continues to be involved in research and education. You can visit http://www.gyncancerdoctor.com to learn more about screening, prevention and treatment of gynecologic cancers.

Article Source: http://EzineArticles.com/expert/Steven_Vasilev_MD/63426

Electronic Medical Records - The Pros and Cons

By Katt Mollar  |   Submitted On March 27, 2009

In this digital age, more and more bulks of information which used to be paper-based, from library catalogs to telephone books, are digitized and stored in a central location for easy access. The idea of EMRs started about 40 years ago.

The main proponents of EMRs cite the following advantages:

(1) The use of EHRs supposedly reduces errors in medical records. There is no doubt that handwritten records are subject to lots of human errors due to misspelling, illegibility, and differing terminologies. With the use of EMRs standardization of patient health records may eventually become acheivable.

(2) Paper records can be easily lost. We have heard how fires, floods and other natural catastrophes destroy physical records of many years, data which are lost forever. Digital records can be stored virtually forever and can be kept long after the physical records are gone. EMRs also help keep records of health information that patients tend to forget with time, i.e. inoculations, previous illnesses and medications.

(3) EMRs make health care cost-efficient by consolidating all data in one place. Previously, paper-based records are located in different places and getting access to all of them takes a lot of time and money. In a systematic review, Kripalani et al. evaluated the communication transfer between primary care physicians and hospital-based physicians and found significant deficits in medical information exchange. The review recommended the use of EMRs to resolve these issues and facilitate the continuity of care before, during and after hospitalization. EMRs translates into better treatment for patients. Take the example of one asthma center's experience with EMR: "A major benefit associated with EMR implementation was the increase in the number of children who were hospitalized with an asthma exacerbation and received an asthma action plan upon discharge. Prior to the EMR system, [only] 4% received an asthma action plan upon discharge. After implementation of the EMR system, 58% received an asthma action plan upon discharge."

(4) EMRs can save lives. VeriChip, developed by VeriChip Corporation is the first one of its kind ever approved by the US FDA. It enables rapid identification of at-risk patients and access to their medical history, thereby enabling rapid diagnosis and treatment especially in emergency situations. Classic examples are people with diabetes and/or heart problems who have high risk of collapsing and having attacks. VeriChip is also useful in vehicular accidents and other trauma incidents where the victims aren't capable of answering questions. In cases of large-scale catastrophes, VeriChip facilitates tracking and identification of victims. According to a coroner in Mississippi, VeriChip helped identify victims during the Hurricane Katrina incident.

Earlier this year, Google Health was launched, an online personalized health records service. Google Health is based on the principle that since it's the patient's medical record, the patient should control it, decide what should be in it, and who gets access to it. One of the features of the service includes records from hospitals and pharmacies that are Google Health-enabled or are registered Google Health partners.

The HealthVault is another online health information storage service offered by Microsoft with features similar to Google Health. Keith Toussaint, senior program manager with Microsoft HealthVault recently stated " leading hospitals like Beth Israel Deaconess Medical Center are actually integrating their systems with both us and Google -- because some people like one or the other. It's a Coke or Pepsi thing."

What are the disadvantages of EMRs? Not surprisingly, privacy rights advocacy groups are the main opponent of EMRs. Here is what they have to say:

(1) EMRs threaten our privacy. In this day and age when people's mantra is "I need my privacy", not many people are comfortable about having their entire medical history recorded and digitized for almost just anybody to see - in other words, incursion into people's privacy. The confidentiality of doctor - patient relationship is still sacrosanct. Besides, medical data can be used against a person in some cases - be it for a job application, insurance coverage or a college scholarship. Although it is against the law to discriminate against people with illnesses and disabilities, it is a fact of life that the fitter you are, the more competitive you are in the job market. The planned incorporation of genetic data in EMRs further adds to people's fear of incursion into their private sphere.

(2) EMRs can lead to loss of the human touch in health care. In the process of digitalization, the interpersonal aspect in health care may be lost. In handwritten hospital charts, doctors and other health care practitioners may write what they think and they feel based on their personal observations in their very own words. EMR is simply about ticking off boxes and crossing out things in electronic forms. The doctors are forced to think in categories and can seldom express a personal opinion on an individual case. Because of the lack of flexibility of many electronic reporting systems, cases of misclassification of patients and their conditions have been reported.

(3) EMRs are not that efficient. Despite efforts in digitalization and standardization, EMRs are actually far from being standardized and not as efficient as it is purported to be. It often happens that one clinic's EMR system is not compatible with that of a general practitioner or another clinic's system, thus belying the claim of added efficiency. In addition, not all users of EMRs are satisfied with the current state of the art. Although the objective is mainly efficiency and healthcare quality, one study showed that nurses in the Netherlands are not completely satisfied with their EMR implemented in 2006-2007.

(4) EMRs are not safe and secure. Google Health and HealthVault are quick in assuring patients of the safety of their online health accounts. Access to the patient's account is only possible using log ins and password. In addition, HealthVault assures that "all health information transmitted between HealthVault servers and program providers' systems is encrypted" and that Microsoft does it best to use the "highest standards of security to safeguard consumer health information from theft, loss, or damage."

However, there are cases wherein passwords and encryptions do not seem to be adequate as data protection tools. Stories of data hacking, stolen identities and blackmail abound. Even high security databases such as those run by banks and credit institutions are often compromised. This impression was aggravated by the many well-publicized incidences of data loss or breach. A few examples are listed below:

November 26, 2007, Canada. Hackers accessed medical information on HIV and hepatitis from a Canadian health agency computer. - September 22, 2008, UK. The National Health Service (NHS) reported the loss of 4 CDs in the mail containing information on 17,990 employees. - September 30, 2008, US. The company Blue Cross and Blue Shield of Louisiana confirmed breach of personal data, including Social Security numbers, phone numbers and addresses of about 1,700 brokers. The data was accidentally attached to a general email.

In addition, there is criticism over Google Health not being a "covered entity under the Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated thereunder (HIPAA)" under its terms and conditions and is therefore not subject to HIPAA privacy of individually identifiable health information. The HealthVault terms and conditions do not mention HIPAA privacy laws so it is not clear what its status is regarding this issue.

(5) VeriChip is not for humans. It is to be expected that although many of us are amenable to the use of RFID chips in pets, the idea of implanting similar chips in human beings is bound to raise hackles in humans, no matter what the US FDA says. A big opponent of the VeriChip and similar chips of its kind is the consumer advocacy group Spychip.com. In a position paper, Spychip and many advocacy and consumer awareness groups see RFID tagging (be it on your person or on the items you buy) as a major threat to privacy and civil liberties. They see the tagging as some kind of "Big Brother" operation. Another group, the No VeriChip Inside Movement, likens VeriChip as "cataloguing" humans similar to the way the Nazis have tattooed numbers on the skin of concentration camp detainees. Popular Hollywood films on privacy incursions (e.g. The Net, Public Enemy No. 1) increased further people's paranoia about personal data.

Where do we go from here? Without doubt, we have the technology to make EMRs standardized and efficient. Google Health, Microsoft HealthVault and similar online personalized health information accounts are enabling patients to take control of their medical records. The main issues that need to be overcome are data security, protection of privacy and gaining the confidence of the patients. It doesn't seem evident that the use of RFID and similar tagging chips will become acceptable or popular anytime soon. However, we live in a digital world and we cannot hold back progress indefinitely. With improved technology and data protection tools, let us hope the EMR issue will be resolved soon.

The article Electronic Medical Records - The Pros and Cons may be found in its entirety with references and links on http://HealthWorldNet.com

Article Source: http://EzineArticles.com/expert/Katt_Mollar/295862

Better Medical Reports for Life Insurance

By Michael Challiner  |   Submitted On August 21, 2006

In about every four in ten cases when someone applies for Life Insurance, the insurer has to obtain a medical report from a General Practitioner.

They need the reports when someone has declared that they have a medical condition on their life insurance application form. The applicant then has to give consent that the insurance company can gain a medical report from their GP. The GP gets called on to supply information about the specifics of that medical condition and any other relevant information.
But despite the fact that these are often costly to get hold of for insurance companies, there have been cases where GPs have not been supplying the quality information that they need. In some cases, they simply print out the computerised records of their patients and send them to the insurers.

This is not just a problem because insurers have paid the doctors to supply specific reports, but that this approach means that they often do not get the specific information they need. And on top of this, the GP winds up breaching their patient's confidentiality because the insurance company gets extra information about the applicant's medical state that they do not need to know. It is a situation both the British Medical Association (BMI) and the Association of British Insurers (ABI) would not want to occur and goes against the agreement between both parties that medical information could be obtained for the purpose of Life Insurance applications.
But because of concerns, a new agreement between both the BMI and ABI has been made where GPs have to provide high quality reports to the insurance companies for fees that will consistently rise by 6% over five years.

The fees were re-set as part of the negotiation process for reports, supplementary reports and medical examinations.

An ABI spokesman for health insurance says that the reports help people to gain much needed health insurance, such as life insurance policies that they would otherwise not normally be able to obtain.

"This agreement is good news for customers because again the BMA has pledged to uphold high standards from doctors. This includes making sure that doctors fill in forms personally and accurately, rather than simply sending printouts of medical records, which does not give the insurer the information that it needs," he says. "The deal provides both stability and certainty."
For a GP report that needs to be obtained in the year from 2006 -2007, the cost is £74.70. That increases to £79.20 for the next year and £84.00 after that. For a supplementary report the cost increases from £19.10 this year, to £20.20 the year after that and £21.40 for the year after that again.

And medical examinations will this year cost £82.20, increasing to £87.10 in the year after that and then £92.30 in the following year.
The BMA tells GPs as part of the guidance in the new agreement that they need to recognise that life assurance is a "social good" and of benefit to patients at significant points in their lives.
And that, as with other fee paid work, the reports should be completed thoroughly to justify the fees.

Get great articles based around life assurance [http://www.life-insurance-underwriters.co.uk] from the life insurance underwriters.

Article Source: http://EzineArticles.com/expert/Michael_Challiner/18343

Medical ID Bracelets - Knowledge is Power

By Lisa Hobyak  |   Submitted On March 03, 2009

There is no better example of" knowledge is power" like wearing a medical ID bracelet. These bracelets are designed to quickly notify emergency responders of a patient's condition. Vital information engraved on the back of the bracelet allows the medical community to assess life saving information without the patient's response.

Despite the benefits, many people opt not to wear their medical ID bracelet because it is ugly or "not cool." Teenagers and young adults are particularly sensitive to their image. They don't want to be labeled as "different" and certainly don't want to wear jewelry advertising their condition. Undeniably and without a doubt, wearing a medical ID bracelet saves lives.

Fact: It is estimated that more than 150 people die a year from a severe allergic reaction (anaphylaxis) to food. At least 40 deaths occur annually in the United States from reactions to insect stings. A severe allergic reaction occurs in .5-5% of the U.S. population as a result of insect stings.

Fact: The prevalence of food allergy among children under the age of 18 increased 18% from 1997 to 2007.
Fact: As many as 15% to 24% of people in the U.S. will experience acute urticaria (hives) and/or angioedema at some point in their lives.

Fact: Many diabetics suffering from hypoglycemia (low blood sugar) have been treated as being drunk.

Fact: Over 400 Americans die annually from an allergic reaction to penicillin.

Manufacturers of medical ID bracelets have been striving to design bracelets that mix fashion and style with function and purpose. Wearing an ID bracelet on your left wrist identifying your specific medical information, can speak for you when you can't.

Hope Paige Designs offers a trendy and fashionable alternative to the traditional medical ID bracelet. Visit http://www.hopepaige.com

Article Source: http://EzineArticles.com/expert/Lisa_Hobyak/284487

Mandatory Medical Transcription Credentialing

By Kathy Nicholls  |   Submitted On December 15, 2010

Much has been said lately about the AHDI House of Delegates resolution last August to support mandatory credentialing for anyone who accesses patient health information. That would mean mandatory credentialing for medical transcriptionists. While many do feel it may be a good idea, I want to explore this a bit more. How does it come about? In the end, I believe it's about having a compelling story.

What's the Compelling Story?

AHDI has started a campaign for speaking to legislators and talking about the need for mandatory credentialing. So what's the compelling story that might make that happen? Without a compelling story of why this should happen, I don't see legislators buying it. The lobbying power of our industry just isn't that strong.

A compelling story must give a reason for doing something. It should have solid, logical facts behind it. It should also show a benefit for doing something. If you think about the story behind something like the Amber alert laws, you can see a compelling story. Children were being kidnapped. The facts were pretty easy to put together. The benefit? If notices were put out faster, perhaps the child could be found faster and returned home with less harm done to them. A compelling story. So what's our compelling story? Get out your thinking caps here because I want to challenge your thinking a bit. I'm putting on my devil's advocate hat as I believe these are tough questions we need to have answers for.

Patient Safety

We can stand up and loudly proclaim "it's health records, it is the patient's story! Surely something of that importance should have a credentialed person working with it to assure correct information and patient safety!" The mantra of patient safety is a big one in the healthcare industry. Perhaps attaching to that would help the cause. If we use this one, we also need to be prepared to explain what kind of harm has been done because of a medical transcriptionist who wasn't credentialed. I'm just not sure we have that data. Because so much of health care documentation is done after the fact, it's unlikely to get anyone to really believe that the documents were used in real-time to provide patient care. In addition, there's documentation out there where we have loudly proclaimed that no documentation is complete until it is authenticated by the physician who dictated the report. If that's the case, isn't it the physician's responsibility to be sure that what is reflected is accurate? In addition, with the move to using medical scribes to document healthcare encounters, we now have an entire industry that has no credentialing process and no standards of practice. If they can do that successfully, where's our compelling story?

It's all About Privacy

The argument could be made with all of the new regulations from HIPAA and the HITECH Act that the information is more secure with a credentialed person. After all, that knowledge would be a part of what is tested in the credentialing process. Hmmm, but what about the HIPAA rules that say all persons must have training and education in privacy? And while the HITECH Act is new, HIPAA certainly isn't. Those rules became effective five years ago and we weren't banging the drum of privacy needing a credentialed workforce at that time. Was the MT who threatened to release medical information over the Internet several years ago credentialed? Have any of the data breaches that have been reported been by a medical transcriptionist, and if so, was that person credentialed? I frankly don't know the answer to that. So, where's the compelling story here?

It Will Save Money in Health Care

In The Case for a Credentialed Workforce published by AHDI in 2007, the case is made that having a credentialed workforce can save money. Here's the quote:

Every time a report is transcribed by an MT with a low level of knowledge and interpretive skill,
the healthcare system as a whole takes the following risks:
• That the MT will misinterpret key clinical data being dictated, resulting in the potential for this to be overlooked by the provider at the authentication point, and for the error to become part of the patient's permanent record, upon which ongoing care decisions are based.
• That the MT will miss or fail to hear critical information, resulting in omitted words or phrases that the provider may not recognize are missing at the authentication point.
• That the MT will fail to recognize dictated errors and inconsistencies and therefore neglect to flag them to the dictator's attention, again with the potential of those errors becoming part of the patient's permanent record.
• That the MT will struggle with challenging dictation or unfamiliar terminology, leaving blanks in the record that have to be routed back to and filled in by the provider or forwarded to a QA department for review and correction - processes that suspend the forward progress of that record.

All of the above scenarios represent widespread impact and immeasurable cost to healthcare on a daily basis. How much does it cost a healthcare facility for records to be suspended in QA and correction rather than being coded and processed for reimbursement? Great attention is often paid to how long dictated reports sit on the dictation system before they are transcribed, but how closely are healthcare facilities and providers watching the delay between transcription and the release of that document for continuity of care and reimbursement?

What seems to be missing is how often those things happen with CMTs and RMTs vs. those who don't have a credential. There is also no discussion about whether it may cost more to employ a credentialed MT compared to one who isn't credentialed.

It's About Efficiency

One thing we have to be prepared to answer is how will this increase efficiency in health care? As leaders speak to legislators, they often share their own story. That will lead to questions about whether they are credentialed themselves. Then we'll go to the bigger question. How many MTs are there currently? Estimates several years ago were at around 250 to 300 thousand. The next logical question will be and how many of those are credentialed? The last numbers I saw showed there were around 3,000 CMTs, and I'm not sure how many RMTs. Still that represents less than 1% of the workforce, allowing for a growing workforce (based on the US Department of Labor information that projects growth in this industry through 2012). Will requiring a credential lead to greater efficiency, or will it lead to the industry scrambling to figure out what other ways they can utilize to get the documentation done? Again, what's the compelling story?

Is There a Compelling Story?

When speaking with legislators in an attempt to make this kind of change, you have to have data. You also need that compelling story about why it's necessary. Do we have a compelling story or simply a wish to see this happen?

What's your take? What IS our compelling story here?

Kathy Nicholls has been involved in the MT industry for over 30 years and is currently the president of the Medical Transcription Training Alliance, which offers guidance on available MT training programs. She also operates the MT Tools Online [http://mttoolsonline.com] website, which provides continuing education for healthcare documentation professionals. Nicholls is also the published author of the "Stedman's Guide to the HIPAA Privacy Rule."

Article Source: http://EzineArticles.com/expert/Kathy_Nicholls/500712