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Wednesday, May 10, 2017

Statin Use Increases Odds of Back Disorder: Cohort Study

This is not new news, however this is further evidence that statin drugs (cholesterol lowering drugs) are associated with back pain.  The article goes on to state that statins have now been shown to be related to a greater risk of "spondylosis, intervertebral disc disorders, herniated discs, and spinal stenosis,"  whereas before, the use of statins were associated with back pain without arthritis.  
Chiropractors, don't overlook the use of cholesterol lowering drugs when trying to find the cause of your patient's back pain.  

Statin Use Increases Odds of Back Disorder: Cohort Study

Marlene Busko
May 08, 2017
DALLAS, TX — In a large observational study of insured individuals in the military and their family members, statin use was associated with increased odds of having a back disorder, including spondylosis, intervertebral disc disorders, herniated discs, and spinal stenosis[1].
Specifically, for every 17 individuals who were prescribed a statin, one person had a diagnosed back disorder, in this study published online May 1, 2017 as a research letter in JAMA Internal Medicine.
"Some of these adverse effects [from statins] can greatly impact day-to-day quality of life for our patients," especially in those who are physically active, lead author Dr Una E Makris (VA North Texas Health Care System and UT Southwestern Medical Center, Dallas) told heartwire from Medscape in an email. "We hope that musculoskeletal adverse events will be part of the patient-provider discussion on the risk/benefit ratio" of these drugs.
"Our results provide additional motivation to further investigate the overall influence of statin therapy on musculoskeletal health, specifically if prescribed for primary prevention in physically active individuals," the researchers summarize.

 Can Statins Cause Back Pain?

Two previous studies based on NHANES data reported that statin use was associated with musculoskeletal pain including back pain among individuals without arthritis[2,3].
Severe back pain is both debilitating and costly. In 2005, it was estimated that back pain cost the healthcare system more than $100 billion, Makris noted.
The researchers retrieved data from 60,455 individuals who were at least 30 years old, lived in the San Antonio area, and were enrolled in the TRICARE health insurance system from 2003 to 2012. Of these, 17% were active military personnel and the rest were family members and veterans.
About one in six individuals (10,910) had been prescribed a statin, usually simvastatin (in 72% of prescriptions), and on average, they had been taking this drug for 3.7 years.
The researchers matched 6728 statin users with an equal number of statin nonusers. They had a mean age of 52 and 47% were women. A quarter were overweight or obese; 53% had hypertension; 20% had diabetes; and 40% had osteoarthritis.
Close to a third (30%) had a back disorder.
In the propensity-matched cohort, being prescribed a statin (as opposed to not being prescribed this drug) significantly raised the odds of having a back disorder (odds ratio 1.27; 95% CI 1.19–1.36).
In the overall cohort and in prespecified subgroups (such as nonobese individuals, healthy individuals, or those without musculoskeletal conditions at baseline, statin use was consistently associated with increased odds of being diagnosed with a back disorder.
In an analysis of the overall cohort, but with adjustment for propensity scores, the risk increase for a back disorder went from 30% among statin users to 47% among those taking high-intensity statins. It also increased with duration to as high as 59% with >4 years of use.
Adjusted* Odds Ratio (OR) of a Back Disorder, Statin Users vs Nonusers
GroupOR (95% CI)*
Overall cohort1.30 (1.23–1.38)
>2 y statin use1.47 (1.39–1.56)
>4 y statin use1.59 (1.47–1.71)
High-intensity statin1.47 (1.34–1.62)
*Adjusted for propensity score, medications used, and use of revascularization procedures during follow-up
"Further prospective studies are needed to better understand the mechanism of how statins can contribute to back disorder diagnoses," said Makris.
"We are not advocating for taking patients off statins if they have cardiovascular risk factors. As clinicians we should be aware of these potential associations and understand the spectrum of potential adverse effects."
The study was supported by grants and awards from the US Department of Veterans Affairs, the National Institutes of Health, the UT Southwestern Center, VA Health Services Research and Development, and the Agency for Healthcare Research and Quality. The authors report that they have no relevant financial relationships.

Wednesday, May 3, 2017

I hear THIS complaint about lawyers virtually EVERY DAY.

Biggest Complaint Clients Have About Their Lawyer...

The biggest complaint I hear from patients regarding their attorney is lack of communication. Multiple calls with no response.  The response from the lawyer's office is that the "lawyer is in court." Could be true or maybe it's not true, but either way, most clients can handle that, as long as they get a call back at some point.

But many times, the call never comes.

Now, I know that if you asked most lawyers, they would tell you that the number one question they get when a client calls, is "How is my case doing?"  And, I get it.  It's the same question over and over again, and its exhausting to have to be bothered with the redundancy of answering the same question over and over again.

But, come on.  As an attorney, you are getting paid very well to answer a few stupid questions.  It's not like it's that difficult.  What I am trying to say in a nice way, is that it could be worse, and for what fees that your client's are going to pay you, at least give them good customer service.   It's not so bad and it okay to take a few minutes out of your day to reach out to your clients...even if you just leave a message on voicemail.

So, I have a suggestion:  Take a little bit of time once every two or three weeks, and try and make a preemptive call out to your client.  Simply give a quick update.  For example, "Hey, its Attorney xyz, I just wanted to let you know that everything looks good on my end.  I sent out the letters of representation and requested policy information.  Just make sure you continue to take care of your injury, and I'll keep you posted in a couple of weeks if I have any updates.  But, don't worry, I'm on top of it."

If you did THAT, and that ONLY, you would be providing a great service to the client, and at the very least you will be easing their mind.  If you made a call like that one or two times a month, not only would you satisfy the client, but they would also be more inclined to stay more compliant with treatment, make referrals to you, and EVEN if the case did not turn out wonderful, at least the client would know that you were working very hard and staying on top of their case, and did the best you could do.

I have been treating accident patients in S. Florida for almost 22 years now.  If any of your client's need a treating doctor in the S. Florida area, please have them give me a call.

Thank you.

Dr. Alan Himmel

Thursday, January 19, 2017

Another Insurance Scam Story....I'm so tired of this.

I'm Fired Up

It's been a while since I posted, but yesterday something happened which fired me up, and not it a good way.  One of my patients came in and told me about some lady he heard of, who had a car accident a few weeks ago.  This person lives somewhere in Cutler Ridge, which is South West Dade County, FL.

So, she had an accident, and she is now treating at a chiro office with her boyfriend, who was the passenger.  So, for a few minutes we were discussing the way the PIP works, and difference between first party insurance, and the at fault party's insurance, etc.  And then, out of the blue, my patient asked me about the $2000 dollars that this woman got, and the $2000 her boyfriend got, UP FRONT for their "settlement", at the chiro office.  The reason my patient was asking about this, is because, as an ex insurance utilization employee, he was wondering why these two people were ALSO told to come in to the office five times a week, for what appeared to him to be a minor car accident.

Now, I am a pretty calm person 99% of the time.  Very mellow.  Maybe even too mellow.

Considering the unbelievable nature of this story, I actually think I controlled myself fairly well.  But, I think that by the end of the visit with my patient, he was a little rattled up, because he has never seen this side of me.

As a doctor who has been practicing chiropractic for over 20 years now, I feel I have a good grasp of the way these scams work.  And, if you are reading this and you are not either a doctor or a lawyer, and you are maybe a little naive, I will explain to you what is actually happening at this office in Miami with these patients, and probably also to lot of other patients who are coming in for treatment over there.

This is likely the sequence of events and facts that surround this crime:

The patients are in their car and are in an accident.  Maybe the accident was staged, maybe not.

The injured patients called one of the lawyers who advertise on TV during the time when the Jerry Springer Show, or similar is on.  Or, maybe they called 411-Pain, 1-800-NEED-HELP or one of the other ones that are popular these days. The patients THEN are referred to a doctor's office and are told that the office will take very good care of them.

The doctor's office looks at the "case"after also communicating with the lawyer's office and realizes the at-fault party has a small or bad insurance company, or maybe that at-fault vehicle has no insurance at all.   However, the patients have one of the larger carrier well known insurance companies like Allstate, Geico, State Farm, or Progressive.   From this very quick investigation, the office quickly learns that the patients have a very bad case because of the bad coverage on the other side, and the patient's policy has no uninsured motorist coverage, but the two patients do have $10,000 in coverage, EACH, in fact.

Since the doctor's office knows that if the patients find out they have a bad case, they won't come in for treatment, the office offers the patients up front cash to come in, and come in frequently and a lot, so the office can quickly bill through the entire insurance benefit until the insurance benefit is exhausted.

There is also a possibility that this inducement or kickback is also provided when the patient actually KNOWS they have no case.  YES, lots of times patients know about their lousy case, and these patients come in expecting this cash kickback, for simply becoming a patient, because they heard that some offices do this.  In other words, they shop around for it, until they find an office who will pay them, and an office that will pay the most.

Either way the kickback is provided because the doctor knows that the patient will have no "incentive to treat" because they really don't have pain, but they just want money.

So, the doctor's office pays out $4000 and then bills $20,000.  This leaves the office with $16,000.

Yes, this scam happens.  Not always, but it does happen.  For those who are reading this and are thinking that all personal injury is a scam, YOU ARE WRONG about that.  Please don't group the legit medical and legal offices with total scam insurance fraud scheme offices.  It is unfortunate, but there are bad players in every profession.

The truth is that there are patients who are injured and who are treated correctly, legally, professionally, and who are helped.  You just have to make sure you go to a good office, and if you are using an attorney to help compensate you for your injury, you go to a good, and legit attorney.

If you are a patient and are tempted to accept a kickback from the medical office or someone working outside the medical office, be aware, that not only is the office committing insurance fraud, but YOU ARE TOO.  This means that you will be subject to prosecution and face the possibility of jail time, the same as the person who gave you the money.  And if you think you will not get caught, THINK AGAIN.  The insurance companies and the insurance fraud task force know the offices who are doing this, and they are waiting for the right time to rush into the office with guns drawn, and with the news crew present, to make an example out of you, and place your face and name on the front page of the news paper and the 5 o'clock news, and RUIN YOUR LIFE.

I have been treating patients who have been injured in car accidents for over 20 years.  If you would like information, please call my office and I would be happy to discuss how I can help you, the right way.

Professionally yours,
Dr. Alan Himmel