Come see what is happening in Dr. Kordonowy's practice and see what the doctor is reading.  

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Health care staying current
Practice Updates and Interesting Health News
Fall Is Here:

I was shocked to see that it has been several months since I prepared a newsletter.  I have been busy posting regularly on my main website as well as on my Doctor Kordonowy MD facebook link.  At the bottom of the main webpage you will see updated blog posts.

Many of my patient's are aware I am serving as president for the Independent Physicians Association of Lee County. Our association posts a monthly newsletter. If you are interested in learning more about other "Patient Champion" doctors and see current health news blogs sign up for their newsletter as well

As we move into the last stages of our Presidential Election, I think it is very important that the public be aware of what the last 8 years of federal legislation has done to the health care landscape.  My first article is going to be a review and summary of what I think the future holds for us.  Much of that future will be determined in this election.  Please get out and vote. 

As always- I have a nutrition recipe at the end of this newsletter.  Doctor tested and doctor approved- this is my recipe mimicking the Joy Of Cooking Griddle Cake recipe. 

I hope you enjoy the newsletter and recipe. 

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The State Of Health Care In The US of A
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Consolidation and Big Is The Government Plan

Well here we are in 2016 and despite how drastically the federal government has disrupted our health care market, neither party is ready to discuss the fall out.  To refresh everyone's memory, Obamacare (currently known as ACA and prior to that PPACA) legislation has made it a requirement that all US citizen's buy health insurance from cradle to grave.  In the process of this mandate many sources of subsidy (payment provided from the collective) were created and one of the more obvious was cutting 740 billion dollars from Medicare.   That was money US citizen's paid in for Medicare services, moved/confiscated to fund the Patient Protection and Affordable Care Act (PPACA), now the Affordable Care Act (ACA)

I have blogged and explained in the past why this legislative act is unconstitutional based upon the rules our forefather's made for our Republic.   Additionally, I have explained how having Health Insurance doesn't equal Health Care

Seeing what was coming and anticipating even more heinous high crimes and misdemeanors, I decided to end my career-long partnerships in order to maintain the primary premise of my Hippocratic oath- to hold the patient as the highest goal in the practice of medicine.  

By going into private, solo practice I am allowed to make hard and rapid decisions as the socialization and overtake of the patient doctor relationship goes into full onslaught mode. Not all of us (in fact the majority of us) wish to give up our right to engage in commerce and seek the best health care at the best price. As a physician I am not willing to compromise my ethical obligation to my patients by allowing a 3rd party payer to dictate how we get the job done. 

So let's look at the health care landscape we are presently experiencing.  Our community is a microcosm of what is happening across the country, especially urban areas. 

Due to Price-Fixing, the system is favoring pricing towards hospital systems.  Private physician businesses are folding left and right. We have moved from nearly 80 % private doctor practice ownership to under 30% in one decade! In exchange for this the sold practices are subsidized from the extra money funneled to the hospitals conglomerates- now your doctors are working for the hospitals and not for you.

The biggest sub specialty decimated in the past 8 years from this price-rigging apparatus has been cardiology.  Diagnostic radiology has also been selected to be squeezed out of the market. Without private practice diagnostic facilities your private doctors will be further weakened, they hope to see the last stragglers come in off the range when this domino falls!

No physician evaluation service has been rewarded with improved reimbursement yet the requirements for data collection and entry from your doctor by the "powers-that-be" have resulted in at least a 30% reduction in efficiency for seeing patients.  Your primary care doctors (Internal Medicine and Family Medicine) can't make a break even business arrangement due to the added and increasing overhead.  All new physicians's being hired in the market are hospital salaried and the fastest expanding group are Hospitalists.  These doctors don't have a patient community outside of someone in a hospital patient bed.  

Our current hospital system, recently renamed Lee Memorial Health just this January created a closed Hospitalist Network. Your doctors in the hospital are now effectively employed by the hospital.  It is my understanding that these hired doctors have to sign "no compete" clauses as part of their employment contract. This means that if they chose to leave their present employment arrangement they will have to leave the community if they wish to practice medicine. Terrific news right?

Meanwhile back at the ranch, the insurance companies are cutting private practice and outpatient (non-hospital owned) reimbursement in order to pay for the now "fully-in-control" consolidated entities like the hospital systems.  They seem to be in cahoots with the consolidation plan. 

Now to the final contributor to this whole mess- the good old Federal Government.  It appears they have been convinced by the US Hospital Lobby, the Insurance lobby and perhaps less obviously the Health Care Academics lobby that we want this consolidated model. The latest "fix to the SGR crisis" was a legislated bipartisan act called MACRA-  Medicare Access and CHIP Reauthorization Act.  This law is a 5 year plan (now 2 years into enactment) to put all the Medicare patients into a model of payment and care called Accountable Care Organizations (ACO's).  This is a replicated payment scheme which was tried and failed during the First Clinton administration where they tried to put everyone into a Health Maintenance Organization (HMO).  HMO's failed miserably because the average American wouldn't stand for being treated like cattle when it comes their health care. 

Doctors are being coerced to put their patients' into an ACO model (it doesn't require your consent as a patient).  This model provides for bonuses as well as penalties if the doctor's panel of Medicare patients doesn't or does cost more in health care dollars then the average patient utilization and the past historical year of cost. They are going to have to collect all resource utilization data on their patients and prove to Uncle Sam they are cost effective doctors.  I hope folks can see how this will create conflicts of interest regarding providing individual patients the best treatment plan and service. 

Following are a few other items embedded in the MACRA legislation. The rules for this law now exceed 900 pages:

  1. Mandated regulatory changes adding to practice overhead- with no ability to change office prices for Medicare patients unless the doctor quits Medicare.  If a doctor quits Medicare, patients then can't get any reimbursement for services paid for in the doctors office.
  2. Future penalties to practices that fail to comply with regulatory requirements starting in 2014.
  3. Due to regulated price policies difficulty in getting patients referrals/access and even medications. We have been having shortages of even the most basic IV fluids. Most recently reimbursement for treating osteoporosis with IV infusion once a year is below what it cost to get the drug. 
  4. The New 2014 MACRA law is extending price-fixing an additional 5 years with plans to "restructure" physician and practice payment method- all while mandating further "to yet be defined" quality measure requirements and additional regulatory and bureaucratic policies. Who will be policing this is also to be determined. 
Upon reviewing what has happened historically as well as what is planned for the future of especially Medicare patients, I hope my readers can appreciate how important the upcoming election is. Mrs. Clinton was behind the 90's HMO failed policy and as stated the ACO model is the same pig with different lipstick.  What the system and the people of this country seem not to fully appreciate is how by regulating and price-fixing health care as well as designing archaic models of care we are going into a major backwards mode.  I will continue to try to convince people that the federal government's solution to the health care market is totally misguided as well as misrepresented from the patient's point of view. 

Dietitian Services
Nutritional Foods

We have unfortunately lost our dietitian this past quarter.  I will continue to seek a certified dietitian for our patients.  Meanwhile, I will serve as your dietitian.  Our Platinum membership package includes 3 dietitian visits. Dietitian appointments will be dedicated to dietary review, food log assessments and goal setting for caloric intake, exercise and weight loss. 

With the remote monitoring dashboard which integrates with the various Fit Bit devices, we can now have Fit Bit users log food intake on their smartphone or personal computer Fit Bit app.

When food and beverage intake information and portion sizes are documented and then interfaced with the IRemedyRemote account (free), I can then review that information which makes dietary appointments much more productive. 

The Direct Patient/Primary Care Model is Well Received.

Last quarter, Dr. Kordonowy has created different service packages to fit several different scenario's and budgets. The traditional fee-for-service model continues to be offered and as always Dr. Kordonowy  posts his fee-for-service prices.

There have been many new membership clients who have signed up,, both existing and new.  This model makes sense because it allows the doctor and patient to extend the point of contact beyond just the office visit with it's "coded" fee. 

This method of doing business frees us from the insurance model stranglehold which is ruining the patient doctor experience for all parties involved. 

Quality Supplements

What Is The Doctor Reading?

Many of you who are following my Dr. Kordonowy MD and The Doctor's Report Facebook posts have been getting regular posts throughout the week.  I have been known to twitter from time to time as well but this often has a slight political bent due to the audience at twitter. 

Below are a few of the more popular blogs posted from my Website recently:

High Protein Pancake
I have been working in my kitchen these past few weekends trying to create a high fiber, high protein pancake. When I take dietary histories and measure patients' lean body mass and fat percentage using a specialized scale, I see a common pattern of inadequate protein intake  (see my article on macronutrients mentioned above in the what is the doctor reading section). Breakfast in particular often lacks protein.

Breakfast & Protein 

Healthy breakfast or snack - whole grain pancake milk and cream on a dark wooden table
Protein Whole Grain Pancake

  • 1/2 cup all purpose flour
  • 1/2 teaspoon of salt
  • 1 tsp of double-acting baking powder
  • 1 teaspoon baking soda
Mix or re sift the above ingredients in a large bowel.

Stir in:

  • 3/4 cup of whole grain/wheat flour 
  • 1/2 cup of cold milled golden ground flax seed
  • 1/3 cup of protein powder (product of choice- I use PureLean, Diazyme, Rice or Pea protein). 
  • 1 tablespoon cinnamon

Combine and beat: 

  • 2 eggs and 2 additional egg whites
  • 1 tablespoon of honey
  • 1 tablespoon of molasses or agave syrup
  • 2-3 tablespoons of vegetable oil (Try the Spectrum Coconut and Canola Oil)
  • 2 cups of Greek vanilla or plain 2% yogurt
  • 1/2-1 cup skim milk (to get batter thickness you prefer)
Heat a griddle pan or skillet to medium heat.  Lightly brush your vegetable oil on the pan and cook your cakes like normal.

This recipe makes appx 16, 6 inch pancakes. You can freeze left-overs in baggies and reheat in the toaster for other breakfasts or as a snack.  I often use either vanilla yogurt instead of syrup or use real Maple syrup.

Science For Absorption
Raymond W. Kordonowy MD
Internal Medicine, Lipid & Wellness

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