Re: Single ultrasound
From: ACF (evsono@pipeline.com)
Wed Aug 24 16:11:28 2005
Prescripition Drugs For Neonates!!!
art
Joe wrote:
> Dave: If we had a Ministry of Health I would hope that finally someone
> would realize that the future of our country is in our newborns and
> not on the old and dying on who we spend an enormous amount of money
> for a few extra days of life. Doesn't make sense. But newborns don't
> vote. Joe C
>
> Dave Berck wrote:
>
>> We may be de facto fiducial agents for our patients, but best I can
>> tell the system is run exclusively by market forces. The lovenox is
>> covered by plan A only because it's covered by plan B and for no
>> other reason. Notions of "cost-effectiveness" seem entirely misplaced
>> in American medicine. And let me tell you, I'd hate to have a
>> cost-effectiveness analysis done on lots of standard
>> medical/obstetrical practices, for example, 90% of ultrasounds that
>> we do, virtually all of prenatal care, rhogam administration,
>> diagnosis and management of gestational diabetes, most antepartum
>> fetal testing, to name a few. They'd be pretty far down on the list
>> of priorities for any Ministry of Health (if we had one) if a fair
>> analysis were done.
>>
>> -- Dave Berck, MD
>>
>> James Smeltzer <James.Smeltzer@wellstar.org> wrote:
>>
>> Hi Art!
>>
>> I just saw today a patient who was approved for enoxyparin
>> (Lovinox-R) which has no proven superiority for Rx acute DVT in
>> pregnancy over heparin. The former costs $2500 per month but has
>> become the de facto standard of care. The latter is $78 per month.
>> At term we have to switch back to heparin because of the shorter
>> wash-out and possibility of epidural anesthesia. Is this indicated?
>> WHo should pay the $2422 difference in cost?
>>
>> Physicians are de facto fiducial agents for their patients. Should
>> we guide them in the appropriate use of their scarce resources? The
>> rational indications for ultrasonography when the cost to the
>> patient is zero may be different than that when the cost is full UCR
>> price, and will be different for different patients for different
>> reasons. The "my way or the highway" approach to medicine is wrong
>> in a free society, IMHO, but then! I'm the guy who tapes on demand.
>> About 1 in 4 patients actually NEEDS a sonogram for a medical
>> problem in pregnancy... Unfortunately we often donot know which one
>> of the four unless we do the scan....
>> ;^) Jim
>>
>> >>> evsono@pipeline.com 8/12/2005 8:15:47 AM >>>
>> bouthina ibrahim wrote:
>>
>> > THANK YOU JAMES NUMBER OF FETUS AND VIABLITY.
>> >
>> > */bouthina ibrahim /* wrote:
>> >
>> > LADIES ABOVE 35YS AND THOSE ITH PREVIOUS CONGENITAL ANOMALS EARLY
>> > 11-14WS LOOK FOR NASAL BONE BRAIN SPINES AS THERE IS INCREASE OF
>> > TRISOMY ESPECIALLY T21.AT 20WS SCANNING GENERAL BODY PARTS FOR
>> > ASSOCIATED ANOMALIS.
>> >
>> > */James Smeltzer /* wrote:
>> >
>> > Hi!
>> > Here in Georgia we are faced with the prospect of medicaid
>> > cutting reimbursement for a normal pregnancy to one sonogram.
>> > Our policy has been two for a normal pregnancy, with a 12-14
>> > week dating, nuchal lucency and nose bone study, and a 20 week
>> > anatomic survey. I can understand medicaid's need to ration
>> > scarce resources with tax cuts and service increases,
>> > especially when some practices are doing four or five
>> > sonograms in a normal pregnancy.
>> >
>> > Which is most important for prenatal screening and diagnosis?
>> >
>> > Jim S
>> >
>> > James S. Smeltzer, MD, FACOG, SMFM
>> > Consultant, Maternal Fetal Medicine
>> > Wellstar Physicians' Group
>> > Northwest Women's Care
>> > 787 Campbell Hill St
>> > Marietta GA 30060
>> > James.Smeltzer@wellstar.org
>> > VM 678-290-3035
>> > Off 770-528-0260
>> > Page 404-318-3451
>> >
>> > >>> evsono@pipeline.com 8/10/2005 11:41:14 AM >>>*Allen
>> > Worrall wrote:
>> >
>> > > Unfortunately many large radiology departments cannot get the
>> > > administration to spend the money! getting new machines,
>> > space to put
>> > > the machines, and doctors and sonographers to examine the
>> > patients.
>> > > Resources are often less than required, particularly when the
>> > > radiology department is in a large hospital.
>> > >
>> > > I am sure Terry can expound on that subject much more than I
>> > can.
>> > >
>> > > Allen
>> > >
>>> > > ----- Original Message -----
>> > > *From:* Latha Natarajan
>> > > *To:* Multiple recipients of list ULTRASOUND-HISTORY
>> > >
>> > > *Sent:* Tuesday, August 09, 2005 8:44 PM
>> > > *Subject:* Re: consulting
>> > >
>> > > More number of cases, if unavoidable, should be tackled with
>> > > more machines and the appropriate man-power.
>> > > That is what my "guru" Dr. Suresh, mediscan sy! stems,
>> > Chennai does.
>> > >
>> > &! gt; Logical solution.
>> > >
>> > > LN.
>> > >
>> >
>>
>> ------------------------------------------------------------------------
>> > >
>> ------------------------------------------------------------------------
>> > >
>> ------------------------------------------------------------------------
>>> > > ----- Original Message -----
>> > > *From:* Allen Worrall
>> > > *To:* Multiple recipients of list ULTRASOUND-HISTORY
>> > >
>> > > *Sent:* Wednesday, August 10, 2005 8:11 AM
>> > > *Subject:* Re: consulting
>> > >
>> > > Terry, I think I saw you at that lecture in Orlando, a GE
>> > > supper event, in which a young woman radiologist from
>> > > Boston,(I think) related that her ultrasound department was
>> > > bogged down with too many cases, and one of the things that
>> > > helped them was 3D ultrasound. The volumes can be obtained
>> > > quickly, and looked at later by the radiologist.
>> > >
>> > > Has this speaker published her lecture anywhere? I thought it
>> > > was very good and very thought-provoking.
>> > >
>> > > Allen
>> > >
>>> > ! > ----- Original Message -----
>> > > *From:* Terry DuBose
>> > > *To:* Multiple recipients of list ULTRASOUND-HISTORY
>> > >
>> > > *Sent:* Tuesday, August 09, 2005 6:27 PM
>> > > *Subject:* Re: consulting
>> > >
>> > > Dr. De Lancer, you ask a question that many have asked.
>> > > In general sonography (Abdomen and OB/GYN) usually no more
>> > > than two an hour in peak rush times. It depends on how
>> > > detailed the studies are, but at bottom line, two an hour
>> > > average is too much if it is all day every day. This is
>> > > based on my experience of 29 years and not on any
>> > > scientific study.
>> > >
>> > > For you second question I would say anytime the
>> > > sonographer is rushed enough to not be able to focus on
>> > > the diagnosis, that is too many. There needs to be a bit
>> > > of fle! xibility to allow for the unexpected twins ! or other
>> > > ! detailed study.
>> > >
>> > > Also do not forget that over work, continuously over a
>> > > period of months or years can injure the sonographer.
>> > > Repeated Stress Injuries are well documented now. See:
>> > >
>> > > http://www.sdms.org/msi/default.asp
>> > >
>> > > Hope this helps. Terry
>> > >
>> > > */jose de lancer /* wrote:
>> > >
>> > > Hi, i am Dr. Jose De Lancer from Dominican Republic.
>> > >
>> > > I am obstetrician, gynecologist and sonologist.
>> > >
>> > > We have troubles in our hospital sonografy department
>> > > for the "overdemand" in ultrasound studies.
>> > >
>> > > What is your opinion in the following isues:
>> > >
>> > > 1-How many studies are reasonable for each sonographer
>> > > in one day?
>> > >
>> > >! 2-How afect the excesive number of patients in the
>> > > individual and department quality?
>> > >
>> > > Thanks for your cooperation!!
>> > >
>> > > */"DuBose, Terry" /* escribió:
>> > >
>> > > Congratulations to everyone on another landmark
>> > > event. Good work. Terry
>> > >
>> > > Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM
>> > >
>> > > Associate Professor & Director
>> > > Diagnostic Medical Sonography Program
>> > > University of Arkansas for Medical Sciences, CHRP
>> > > 4301 West Markham St. Mail Slot #563
>> > > Little Rock, Arkansas, 72205 USA
>> > > 501-686-6510
>> > > DuBoseTerryJ@UAMS.edu
>> > > http://www.io.com/~dubose/
>> > >
>> > > http://www.uams.edu/chrp/dms/default.asp
>> > > http://www.obgyn.net/us/panel/panel.htm
>> > > ---------------------------------------------------------------
>> > >
>> > > ---------------------------------------------------------------
>> > >
>> > > ---------------------------------------------------------------
>> > >
>> >
>>
>> ------------------------------------------------------------------------
>> > >
>> ------------------------------------------------------------------------
>> > > *From:* Dale R. Cyr [mailto:cyr@ardms.org]
>> ------------------------------------------------------------------------
>> > > *Sent:* Tuesday, August 09, 2! 005 7:18 AM
>> > > *To:* ALL STAFF; BOARD MEMBERS; All EDTF Committees
>> > > *Cc:* Thomas Magallanes; steve_tapp@promissor.com
>> > > *Subject:* Success in Hong Kong ARDMS Exam Delivery
>> > >
>> > > Hello Everyone:
>> > >
>> > > ARDMS began delivering examinations at the
>> > > University of Hong Kong on August 8th. Two
>> > > candidates sat for ARDMS examinations (Neuro and
>> > > CPI), which were routinely and securely delivered
>> > > with all data safely transmitted back to
>> > > Promissor as per normal procedure. The ARDMS Hong
>> > > Kong exami! nations and processes are exactly the
>> > > same as here in the United States and Canada.
>> > > Several other Candidates are scheduled to sit for
>> > > ARDMS examinations in Hong Kong over the next
>> > > couple of weeks.
>> > >
>> > > Congratulations everyone as ARDMS continues to
>> > >! increase the number of credentialed individuals to
>> > > promote qual! ity and patient safety through
>> > > credentialing and continuing competency of
>> > > ultrasound professionals.
>> > >
>> > > Also, a big thank you to Promissor who has been a
>> > > great partner in assisting ARDMS in meeting our
>> > > strategic initiatives, particularly in the global
>> > > expansion program.
>> > >
>> > > Regards,
>> > >
>> > > Dale
>> > >
>> > > Dale R. Cyr, MBA, CAE
>> > >
>> > > Chief Executive Officer/Executive Director
>> > >
>> > > ARDMS and the Breast Ultrasound Foundation
>> > >
>> > > 51 Monroe St., Plaza East One
>> > >
>> > > Rockville, Maryland 20850-2400
>> > >
>> > > 301-738-8406, x223
>> > >
>> > > cyr@ardms.org,
>> > > cyr@breastultrasound.org
>> > >
>> > > http://www.ardms.org
>> > > http://www.breastultrasound.org
>> > >
>> > > //You should always make sure. Verify the Registry
>> > > status of employees - current and potential.
>> > > ////ARDMS offers an _online directory of its
>> > > Registrants.
>> > > _//////
>> > >
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>> > > Espacio para todos tus mensajes, antivirus y antispam
>> > > ¡gratis!
>> > > Regístrate ya - http://correo.espanol.yahoo.com/
>> > >
>> > Allen
>> >
>> > Falling reimbursements and rising expenditures is not an optimal
>> > business model.
>> >
>> > Art
>> >
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>> James
>>
>> One of the specious exercises in medical logic today is "practice by
>> insurance." If a physician feels a procedure or scan is medically
>> indicated, then it should be performed. Conversely, if it is NOT
>> indicated, then it should NOT be performed. To the best of my
>> knowledge,
>> the fact that a procedure is covered by insurance is not
>> pertinent to
>> what should be medical decisions.
>>
>> Just my opinion - I could be wrong.
>>
>> Art
>>
>> >>>>>>>>>>>>> Confidentiality Disclaimer <<<<<<<<<<<<<<<<
>> This email and any files transmitted with it may contain
>> confidential and /or proprietary information in the possession of
>> WellStar Health System, Inc. ("WellStar") and is intended only for
>> the individual or entity to whom addressed. This email may contain
>> information that is held to be privileged, confidential and exempt
>> from disclosure under applicable law. If the reader of this message
>> is not the intended recipient, you are hereby notified that any
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>> ================================================================
>>
>> David J. Berck, MD, M! PH
>
