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What the NFL Referee Debacle Can Teach Us About the Future of Healthcare

Written by Brandon Betancourt

Even if you are not a football fan, I’m sure you’ve heard about the NFL and referee fiasco.

If you haven’t heard, here is the scoop. The NFL owners have been unable to reach an agreement with the referees. As a result, the referees were locked out and the NFL owners replaced them with cheaper less experienced referees.

The result?

Although qualified to referee a game, these less than professional referees don’t have the experience, the full requirements and the practice of a professional NFL referee. Consequently they’ve made some really, really bad calls.

Some calls have been so bad, that they have cost teams games.

In healthcare, there is a lot of talk about filling the primary care physician shortages that we expect in the near future, with mid-level providers such as nurse practitioners and physicians assistance.

Mid-level providers are competent healthcare providers. But they don’t train as long as a physicians do. As a result, they have less experience. On the flip side, they’re cheaper to train, and they earn less than a physician does.

Naturally, if you are trying to reduce healthcare cost, and you are planning on having a labor force shortage, mid-level providers seem like a good solution.

Don’t you think?

I think this is a bad idea. The NFL debacle is great example of what happens when one chooses to settle for next best.

For the record, I’m not putting down mid-level providers. I think they are valued team members. If I didn’t believe that, we would have not hired a mid-level provider in our practice.

I believe mid-levels have a place in our healthcare landscape and they will play an integral role in the future of primary care. But what I’m saying is, they are less experienced. They don’t go to school as long as a doctor does and don’t bare nearly the same responsibility as a doctors do.

Here is the thing, primary care doctors are tremendously valuable. Although they may appear to be expensive to visit, when you compare it to the value they return, the cost is minimal.

Think about it this way. How much would you pay to be assured that your child is healthy? What is the value of having a person that has dedicated 100% of their professional career to learn about children so that each child can reach their full potential?

Don’t make the same mistake the NFL owners did by choosing a less expensive, quick fix solution.

I can almost guarantee you won’t regret it.

Brandon Betancourt is a practice administrator. He blogs regularly at PediatricInc

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1

What is a diaper rash and is it serious?

Written by Joanna E. Betancourt MD FAAP

A diaper rash is any rash that develops inside the diaper area.

In mild cases, the skin might be red. In more severe cases, there may be painful open sores.

It is usually seen around the groin and inside the folds of the upper thighs and buttocks. Miles cases clear up within 3 to 4 days with treatment.

What causes diaper rash?

Over the years diaper rash has been blamed on many causes, such as teething, diet, and ammonia in the urine. However, we now believe it is caused by any of the following:

  • Too much moisture
  • Chafing or rubbing
  • When urine, stools, or both touch the skin for long period of time
  • Yeast infections
  • Bacterial infection
  • Allergic reaction to diaper material

When skin stays wet for too long, it starts to break down.

When wet skin is rubbed, it also damages more easily. Moisture from the soiled diaper can harm you baby’s skin and make it more prone to chafing. When this happens, a diaper rash may develop.

More than half of babies between 4 and 15 months of age develop diaper rash at least once in a 2-month period.

Diaper rash occurs more often when:

  • Babies get older-mostly between 8 to 10 months of age.
  • Babies are not kept clean and dry.
  • Babies have frequent stools, especially when the stool stay in their diaper overnight.
  • Babies have diarrhea
  • Babies begin to eat solid foods
  • Babies are taking antibiotics or in nursing babies whose mothers are taking antibiotics.

When to call the pediatrician?

Sometimes a diaper rashes need medical attention. Talk with your pediatrician if:

  • The rash does not look like it’s going away or gets worse 2 to 3 days after treatment.
  • The rash includes blisters or pus-filled sores.
  • Your baby is taking antibiotic and has a bright red rash with red spots at its edges. This might be a yeast infection.
  • Your baby has a fever along with a rash.
  • The rash is very painful. Your baby might have a skin condition called cellulitis.
  • What can I do if my baby gets diaper rash?

If your baby has a diaper rash (and to prevent future diaper rashes)

  1. It’s important to keep the area as clean and dry as possible. Change wet or soiled diaper right away. This helps cut down how much moisture is on the skin.
  2. Gently clean the diaper with water and a soft washcloth. Disposable diaper wipes may also be used. Avoid wipes that contain alcohol and fragrance.
  3. Use soap and water only if the stool does not come off easily. If the rash is severe, use a squirt bottle of water so you can clean and rinse without rubbing.
  4. Pat dry; do not rub. Allow the area to air-dry fully.
  5. Apply a thick layer of protective ointment or cream (such as on that contains zinc a oxide or petroleum jelly). These ointments are usually are usually thick and pasty and do not have to be completely removed at the next diaper change.
  6. Remember, heavy scrubbing or burring will only damage the skin more.
  7. Do not put the diaper on too tight, especially overnight. Keep the diaper loose so that the wet and soiled part does not rub against the skin as much.
  8. Use cream with steroids only if your pediatrician recommends them. They are rarely needed and may be harmful.
  9. Check with your pediatrician if the rash a) has blisters or pus-filled sores; does not go away within 2 to 3 days; Gets worse.

Many parents ask me if a cloth diaper is better than disposable diapers. Research suggests that diaper rashes are less common with the use of disposable diapers.

However, what is more important than the type of diaper is how often it is changed. Whether you use cloth diapers, disposables, or both, always change diapers as needed to keep your baby clean, dry, and healthy.

Hopefully, this little bit of background on diaper rashes give you some good insight about this condition that many babies have.

Dr. Betancourt is a board certified pediatricians and a Fellow of the American Academy of Pediatrics. She has 3 kids and gets a little grumpy when she doesn’t get a chance to workout at the gym at least 3-times a week. 

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When The Joy Goes Out of Eating, Nutrition Suffers

The title of this post is a partial quote from pediatric nutritionist Ellyn Satter. Here is the entire quote:

“The secret to feeding a healthy family is to love good food, trust yourself, and share that love and trust with your child. When the joy goes out of eating, nutrition suffers.”

The quote comes from a blog post titled Constructing Snacks into Mini-Meals on Dr. Wendy Sue Swanson’s blog, seattlemamadoc.com.

I found the article very interesting. Particularly because in our house, snacking is a bit of an issue. In fact, for my kids, snacks seem to be more important than the actual meal.

I’ve come to the conclusion that the only reason my kids eat regular meals, is because otherwise, they won’t be able to have a snack or dessert. It is like they view it as a means to and end. This is what I assume goes through their heads:

“The only way I’m gonna get the snack, is if I eat my lunch. Might as well eat the lunch, so I can get to my snack.”

And apparently, my family is the not the only one with this issue. It is a growing trend in the US.

Over the past 20 years, the amount of calories consumed by children from snacks has increased by 30%. Kids eat a third more calories everyday from snacks! What kids snack on certainly can reflect how their diet is shaped and how they grow. Plain and simple: snacks make us fatter by packing in lots of calories in relatively small bits of food, the definition of “calorie dense” foods. They also discourage our eating of things like fruit and veggies because they fill us all up. One recent study found it was our over-consumption of snacks more than our under-consumption of fruits and veggies that is getting us into trouble.

Dr. Swanson says that there has a huge shift in the way children eat and get their nutrition in the US. She highlights some examples, such as:

  • The introduction of processed foods in the 1970’s transformed what we eat from fresh to packaged food
  • TV advertising of snacks directed at kids increases their desire for snack foods
  • The challenge for busy families to find time to sit down and eat meals together
  • Watching TV during meals in households
  • Ubiquitous availability (they are everywhere!) and easy access to snack foods
  • It is okay to be a little hungry. Dr Grow says, “Teaching kids it’s okay to get a little bit hungry (not ravenous) and work up an appetite for a regular meal” is a healthy way to learn to eat right.
  • It’s our worst fear that our kids will starve. It’s almost an instinct to offer and offer and offer food all day. Our kids won’t starve, especially if we offer 3 meals and 2 healthy snacks daily.
  • Red/Orange/Yellow packaging is dangerous. These colors are known to make you hungry and eat more. Advertisers know this! Think about leading fast-food chains, junk food, candy bars and soda containers. Red/Orange/Yellow is threat level alert for high-calorie foods that often have little nutritive value.

We’ve written about snacking before on Survivor Pediatrics. In the this post, Dr. Hackell ask: with the national alarm increasing about the rate of obesity in our children (and adults as well), what message are we giving our children about eating when we provide them with a continuous stream of things entering their mouth throughout the day?

Dr. Swanson does offer a possible solution. She mentions the idea of switching the snack for a mini-meal. So, anything that we would feel comfortable eating during a normal meal, but in smaller portions.

I like this idea. Except the part about preparing yet another meal, even if it is mini. Snacks in little packages are just so convenient. But I guess I’ll give it a try and see.

To read the rest of Dr. Swason’s post, click on the link.

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Top 10 Pediatric Post of 2011

We had some really great post this year. But only 10 made it to the top. Below are our TOP 10 post of 2011.  Hope you enjoyed them as much as we enjoyed writing them.

  1. Why Can’t Pediatricians Prescribe Medicine Over the Phone?
  2. If a patient can charge for her time, why can’t the doctor charge for his?
  3. She has a fever, her temperature is 99.2. Is It Normal?
  4. Michele Bachmann Is Not a Doctor (she reveals), But Pediatricians Are
  5. What I Wish Parents Knew About Medical Billing
  6. Things Your Mother Told You That Were Wrong
  7. In Defense of Cough
  8. Six Reasons You May Want to Bring Your Child to the Pediatrician’s Office Instead of a Retail Based Clinic
  9. Are High Fevers in Children Dangerous?
  10. What is the most important thing I can do to make sure my child is as healthy as possible?

Well, there you have them. Do you have a favorite one? We’d love to hear your thoughts.

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Paying for your restaurant bill and your doctor’s bill is not that different

Written by Brandon Betancourt

I got a call from a mom recently. She wanted to know why she was being charged for both a preventive wellness visit and an office visit on the same date of service.

For those that don’t know, most visits to a pediatrician’s office are either considered an office visit, which generally include visits where the patient is sick, and wellness visits – which are those visits where the doc does a more comprehensive head to toe assessment of the child otherwise know as a physical.

This particular patient came in for a wellness visit, but the doctor also documented and addressed a heart condition that the patient has. The heart condition assessment triggered an office visit in addition to a yearly physical. In other words, our office submitted a claim to the patient’s insurance stating that both an office visit and a physical occurred during the encounter.

Mom wanted to know why the two charges since she was under the impression that checking a patient’s heart should be part of the physical.

I understood where the mom was coming from. Medical billing is very complicated and in many instances doesn’t make any sense. Not because the doctor or her office makes it complicated, but because the insurance companies designed it that way.

Here is how I explained it to her.

When you go to a restaurant, and order a dish, generally the meal will come with side foods. So, let’s say one is ordering a pasta primavera. The expectation is that in addition to the pasta, the dish is going to come with vegetables, which are included in the price of the dish.

Let’s say one decides to add chicken to the pasta primavera and the server says, “sure, but that will be extra.”  Meaning, she will have to charge extra for the added chicken. When asked what you’ll like to drink, 9 out of 10 times, beverages will also be extra. And so will appetizers.

Healthcare is like an a la carte restaurant where some things are included in the price of the visit, but others are not.

But here is where it get a little complicated. Unlike the the restaurant, patients don’t pay for their bills directly to the doctor; insurance companies pay the doctor. And insurance companies, in an effort to provide more shareholder value, prefer to pay for the least amount of claims possible because the less they have to pay, the more money they make.

Thus, they require physicians to document everything that happened during the visit so they can determine how much they have to pay based on the policy purchased by the patient. In other words, they won’t take the doctor’s word for it. They want to see and review everything that was discussed during the visit  with the patient so they can decide what should and should not get paid.

During this particular patient visit, I explained to the parent, in addition to the wellness visit, the doctor also assessed the child’s medical condition, which required the doctor to prescribe medication, order x-rays and a consult with a specialist.

Just like the appetizers and the added chicken is billed as “extra” at a restaurant, the assessment on the child’s condition was extra work for the doctor that is not included with the wellness visit payment.

And in her documentation, the doctor described to the the insurance company that the patient had required an “appetizer” and “chicken,” thus they should pay her more.

Essentially, the doctor was simply documenting the visit with everything she did in order to demonstrate to the insurance company what was done. And the heart condition assessment documented by the doctor triggered an office visit.

The parent appreciated the analogy and said that it was perfectly reasonable explanation. I was happy. I was able to communicate without insurance jargon and was understood. In my world, this is considered a good day.

Brandon is a practice administrator, speaker and blogger. He blogs regularly at PediatricInc.com