Dr. Meredith Warner here –

Everyone makes mistakes, and doctors are no exception to this rule. Physicians aren’t perfect, and they can sometimes make mistakes in the diagnosis and treatment of your condition. When you get a second opinion, you may learn about an alternative treatment plan, and if the second physician has the same diagnosis and treatment plan, you’ll be assured that course of treatment is best for you. Sometimes, different methods to achieve the same goal are available and other factors might help with your decision. Ultimately, it’s for the best to remain informed about your healthcare, to make sure you know what your options are and how a treatment will affect you mentally, physically, emotionally, and otherwise.

Be sure to trust your instincts – if your doctor is recommending a treatment that you are unsure of, and/or wasn’t able to explain to you why they recommended it in a way that you fully understood the pros and cons, it may be time to seek out a second opinion. There are some other factors you should consider that may prompt you to seek a second opinion as well. Keep reading to find out what they are, and click below to make your second opinion appointment today!

Signs You Need A Second Opinion:

1. You are considering surgery. I strongly encourage my prospective surgical patients to seek out a second opinion. I want to be sure that they are comfortable with the procedure, recovery timeline, and more before they get to the operating room. When my patients seek out a second opinion, this also helps me be assured that together we chose the right course of action for treatment of their condition. And this helps manage your own expectations as well. Surgery can be expensive and difficult to recover from, some requiring months of physical therapy and prescription medications. It’s a long-term commitment, and should be treated as such.
   
   
2. You’ve already had surgery. Sometimes, your recovery time may be taking too long. You may still be experiencing negative symptoms from your condition. This can be frustrating if your surgeon didn’t fully address your expectations from the outset – surgery may not always be a cure-all; it may lessen the effects of your condition but not completely take them away. However, there may be a way to give you a better outcome from your treatment. I perform “revision” surgeries often (essentially, redoing surgeries and/or removing restrictive scar tissue from mismanaged recovery treatments.)
   
   
3. Sometimes, a second opinion after surgery can also simply put your mind at ease. We all have relatives that say only negative things; maybe seeking a second opinion who assures you that your recovery is normal is what it takes to calm that relative down. Or, you might simply be very anxious about how your recovery is going and you want reassurance that all is well.
   
   
4. Testing results were inconclusive. Imaging scans, biopsies, and other methods of diagnosis aren’t always perfect – and aren’t always interpreted in the same way. If your doctor seems uncertain about your diagnosis, it’s time to seek a second opinion. Always be sure to tell your current physician that you’re seeking a second opinion, so their office can share test results with the next doctor you visit. Most physicians will not mind this and will be helpful.
   
   
5. You feel anxious about your treatment plan. It’s normal to be nervous about a procedure, especially if it’s particularly invasive or would require a lot of time to recover. For your own peace of mind, you should seek out a second opinion to make sure you’re making the right choice. If you can get confirmation from a second doctor that your primary physician made the correct recommendation, you can move forward in your treatment with confidence and will be ready to face your recovery with determination.

Visit Our Clinic For Your Second Opinion – And Peace Of Mind

Ultimately, you should be able to leave every doctor appointment feeling like your concerns were heard, understood, and addressed. You should be able to feel that you are getting the best advice possible, and that your doctor considered every option for diagnosis and treatment before deciding on one course of action. Even though doctors have a medical degree, they may not always be right – and something as simple as a personality clash may make you feel uncomfortable. Positivity is important for recovery and it is good to feel comfortable with your physician.

At Warner Orthopedics & Wellness, we believe in a patient-led approach to medicine. Our practice is centered on you – what you’re worried about, what you’ve tried, and what you want your outcome to look like. 

If you aren’t fully comfortable with the options your doctor has presented you, make an appointment today so we can work on a treatment plan that works for you – together. Alternatively, if we have offered a recommendation and you wish to ask another’s opinion, we can help with that!

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The CVS Healthcare and Aetna merger could result in a shift in health care costs, where consumers are treated for emergencies or even how often they visit the doctor. It could also mean the beginning of similar mergers in the near future. While the deal has the appearance of being beneficial to consumers, many question if this is so.

A Threat to U.S. Hospitals

The proposed acquisition is designed to keep patients out of the hospital as a part of a move towards more value-based care. The plan includes a CVS service expansion in its pharmacies and retail clinics. In addition, CVS will begin to deliver services and care directly to a customer’s home. This is intended to possibly save Aetna money by putting patient care in a lower cost home-setting as opposed to outpatient clinics.

While this is a potentially positive move for patients, it comes as bad news for hospitals nationwide. Hospitals regularly see millions of patients in emergency rooms and provide care for issues that CVS and Aetna executives believe could be directed to an outpatient clinic or avoided altogether. The acquisition is believed to be filling the void in regards to convenience and coordination that healthcare is currently missing.

CVS and Aetna want to shift healthcare from a fee-for-service system that encourages treatment by volume and increases costs to a value-based care system. CVS/Aetna plans to heavily use mid-level practitioners to provide care. For example, nurse practitioners will provide care in CVS Minute clinics, a pharmacist administering vaccines in the pharmacy or a nutritionist in the home. The CVS/Aetna merger is the first integration of large systems that excludes doctors. All of these things could prove to be detrimental to the nation’s largest hospital operators like HCA Holdings, Community Health Systems, Tenet Healthcare and the nonprofit hospital industry as well.

Hospitals have not been oblivious to the possibility of radical changes that are now coming into fruition. Hospital operators have been forming partnerships with retailers like CVS and Walgreens-Boots Alliance and even expanding services into community-based urgent care centers. United Health Group is the most integrated system and owns everything from hospitals to PBMs to physicians. Unfortunately, they may not be making changes to lower cost services fast enough to compete with CVS’ $69 billion purchase of Aetna that gives the chain and its 1,100 retail clinics more than 22 million paying health plan members.

The Good, the Bad & the Ugly Truth

History may be a good indicator that the recently announced $69 billion CVS and Aetna merger may not be a win for consumers. If the insurance company and the pharmacy and pharmacy benefit manager (PBM) are allowed to merge, it may result in less choice and higher costs for both consumer and payor alike. CVS’ acquisition of Caremark, one of the nation’s dominant PBMs is evidence of this point. After acquiring Caremark in 2007, CVS formed exclusive pharmacy networks that prevented its consumers from accessing pharmacists of their choice and in the end increased their prescription drug costs. CVS claimed that consumers were rewarded with increased choice – a claim that would only prove to be true if the consumer only wanted to get their prescriptions at a CVS store or a CVS mail order operation.

Yet another example that insurer/PBM combinations do not benefit consumers or payors is proven in the 2015 UnitedHealthCare acquisition of CatamranRX. The deal allowed UnitedHealthCare, the largest insurer nationwide to acquire the then fourth-largest PBM into its OptumRX PBM, making it the third largest PBM in the United States. This merger has no evidence of its claims that greater integration and greater patient focus equating to improved care and lower overall costs for consumers. Rather, it has proven to result in fewer choices, higher drug prices, poorer services and an increase in fraud and abuse. The instances of decreased consumer welfare can be substantiated in the recent lawsuits against Optum for charging consumers co-pays that far exceed the costs of the medication itself.

PBMs are special entities that lack transparency yet dominate the pharmaceutical industry. The PBM market is controlled by only three PBMs. The lack of transparency and regulation provides ample opportunity for these PBMs to escalate their profits by way of rebates schemes that inevitably inflate the price of drugs. Typically, a PBM will receive a “rebate” from the insurance company for drugs provided. This allows them to pocket a large portion of rebates that far exceed any potential value that they can provide to consumers. Mergers such as the CVS/Aetna acquisition cement the role of such PBMs. A PBM will use its size and power to force a wholesaler to sell a drug for $200 per month. The $500 margin is returned to the PBM.

CVS may claim that the merger is necessary to gain increased bargaining power, which would in turn lower prescription costs, but unfortunately, the past history of PBM mergers has proven differently for consumers. The market is neither competitive or transparent, thus allowing rebates to be increasingly pocketed by the PBMs and consumers to continuously receive the short end of the proverbial stick.

And, In Comes Amazon

In the background to all of this change within the healthcare sector is the threat of online retailer, Amazon.com, entering the ring of the middleman business. Some analysts and consumers project that the online retailer giant would further disrupt the drug supply chain with a new business model and potentially simplify and make the drug-pricing system far more efficient. The idea of an online empire that has disrupted the way consumers shop becoming competition is found to be appealing for many.

Amazon has proven that information technology can and will produce benefits to companies that may not have appeared to be compatible in the past. As the online giant’s plans to enter the healthcare arena became more apparent this fall, healthcare companies across the spectrum began to assess the threat and scrambled to prepare for this perceived disruption. The CVS and Aetna merger is rumored to be a result of this.

Only Time will Tell

The CVS Healthcare-Aetna deal is being touted as a vertical merger and it is assumed there will be few regulatory obstacles in the way. However, the unpredictability of the current administration combined with the valid concerns of what impact the deal will have on patients could pose significant road blocks for the merger. If the deal quickly passes through regulatory oversight, only time will tell how such a concentration of power in the healthcare system will impact U.S. consumers.

While there is little actual business overlap between CVS Healthcare and Aetna, it is nearly impossible to properly gauge how its combined leverage could be used. On one hand, it could result in a plethora of innovative product and service offerings for consumers. On the other hand, the merger could prove to adversely impact the products and services being offered to its patients. There is also mystery as to how this merger will affect doctors.

Regardless of whether or not the CVS-Aetna deal closes, consumers can be assured that Sunday’s announcement will only fuel similar discussions between competitors. This proposed merger provides a template for a one-stop shop for healthcare services. This could inevitably open the door for greater consolidation in the healthcare sector. There are pros and cons to these highly concentrated healthcare service companies, but players like Amazon and Walmart may force groundbreaking changes in the battle in the healthcare sector.

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Despite popular belief, rest isn’t the quickest route to recovery.

New research out of Copenhagen shows immediately beginning rehabilitation after an injury may allow patients to recover faster and return to their daily activities much sooner than we once thought.

A study Dr. Meredith Warner recently stumbled upon in the New England Journal of Medicine took fifty athletes and separated them into two, randomly assigned control groups. Each athlete suffered an acute injury of the thigh or calf muscle and was then randomly assigned to begin an early (two-day post injury) or delayed (9 days post-injury) rehabilitation program. These patients didn’t receive any analgesic medications or nonsteroidal anti-inflammatory drugs throughout the study.

The researchers followed these athletes for 12 months during their recovery.

They all went through the same rehabilitation program, monitored closely by a physical therapist. During the first week of training they performed daily static stretching, and during the next phase, they practiced daily isometric exercise. In the final weeks, the athletes performed functional exercise combined with heavy strength training three times a week.

Following the rehabilitation period, results showed athletes who began rehabilitation two days after injury returned to activity about 20 days sooner than those who delayed therapy for nine days.

For even the average person, a delay in rehabilitation can prolong pain and delay recovery. At Warner Orthopedics & Wellness we advocate patients immediately begin the rehabilitation process, and our treatment process reflects this belief. Our goal with each patient is to restore, maintain and promote wellness while increasing quality of life.

During recovery, especially for acute muscle injuries, we advise patients begin rehabilitation as soon as possible. Muscles do not respond well to inactivity following an injury. Starting therapy sooner can help guarantee success and recovery throughout the treatment journey. Our team of physicians and physical therapists provides each patient with a treatment plan designed to produce optimal recovery.

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For more information about how soon to begin rehabilitation following your injury or to book an appointment click here.

The post Accelerate Recovery, Start Rehabilitation Today appeared first on Warner Orthopedics.

Why? Well, in short, team physicians misdiagnosed Delvin Breaux with an ankle bruise. A bruise that never fully healed and began to affect his performance. On the brink of being traded, he sought out a second medical opinion from a surgeon unaffiliated with his team. It was at this point he discovered he had a fracture, explaining why his ‘bruise’ was not healing in a timely fashion. Following this, the Saints promptly fired the team physicians.

Delvin Breaux’s experience is part of a bigger problem.

There are a vast number of conflicts of interest present in medicine today. Most patients are completely unaware that they have no control or choice in their care. Delvin Breaux’s team physicians obviously had a conflict between keeping the team happy but also keeping the players on the field.

Team physicians can’t sideline every player for every ache and pain. 

In the real world, conflicts arise in referral patterns and treatment choices. If a patient goes to see an orthopedic surgeon in a large group or hospital-based practice, they have automatically entered themselves into a narrow network of care. This eliminates the possibility of choice. If the first physician decides the problem requires different expertise, they’ll refer that patient to the hospital system or group. By doing this, patients are not informed about other options available to them. If that orthopedic surgeon decides further imaging may be necessary, they might order an MRI or CT scan. These studies may not be ordered if that surgeon is part of an Accountable Care Organization (ACO).

Accountable Care Organizations pay doctors and hospitals to limit care.

Each patient is designated a bucket of money by the insurance company per year. However, this money is shared with the physicians and hospitals in the ACO if there is money left at the end of the year. Doctors and hospitals are incentivized to ration the patient’s care. Fewer MRI studies are ordered, needed or not, as patient referrals to specialists may never happen. This conflict of interest is never revealed to the patient either. If the surgeon decides that surgery is necessary, there are even more conflicts. Perhaps the least discussed is the choice of implants or orthopedic hardware. Even if the quality or outcomes of more expensive implants are better for the patient, many facilities and board members will pressure surgeons to use cheap implants.

Medical facilities make more money when they use cheap implants.

There is a lot of impressive technology and products available to improve the quality of care. However, these are also more expensive than technology from 20 years ago. Again, the patients have no idea about this and certainly have no choice in the matter. Total joint arthroplasty is an excellent example of this problem. Many hospitals now sign an exclusive contract with a single manufacturer that agrees to a rock-bottom price. Surgeons at that facility are then forced to use that company’s implants even if they believe another to be superior. As this becomes standard practice for hospitals or facilities, patients become excluded from the discussion of what implants they put in their own body.

One of the worst conflicts regarding treatment and care stems from the insurance companies themselves.

Physicians are often forced to use a medication they do not believe in or know will work because the insurance company signed a contract with a pharmacy benefit manager involving a rebate with a different drug maker’s products. The patient and the care is secondary to cost. Insurance companies often dictate when an MRI is allowed to happen. Even in cases when an MRI is necessary, some insurance companies have a blanket policy to wait six weeks before allowing an MRI.

There have been many instances of a patient coming to our clinic with an injury that requires bracing, but we cannot get the brace because their insurance company requires prior authorization and the process can take 2-3 days. What has happened to Delvin Breaux is not good, but it is also not rare. Frequently, conflicts alter the care that people receive. As an industry, we must work to avoid these barriers moving forward. Networks of care cannot remain so narrow, as we should aim to give patients more choices and lessen the burden of treatment options and rationing put on physicians.

It’s time to start caring about care again.

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To learn more about how we’re solving this problem, read our philosophy on wellness and care or schedule an appointment today.

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