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Archive for September, 2007

A Breath of Fresh Air: Hyperbaric Medicine

Monday, September 3rd, 2007

September 2007

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Using hyperbaric oxygen treatment, Dr. Helen Gelly of Hyperbaric Physicians of Georgia has helped improve results in the healing of difficult or limb threatening wounds.

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Total Knee Replacement In The Obese Patient

Saturday, September 1st, 2007

September 2007

obesity-knee-postop.thumbnail.jpgThe most severe epidemic in America today does not involve a virus or bacteria, but is the epidemic of obesity. If you have been on an airplane in the past year you know what I am talking about, the person in the middle row is broader than the seat was designed and your room is being taken up by that person.

Obesity is defined medically by looking at what is called your body-mass-index (BMI). The marathon runner is a18-22 BMI. Most people of average BMI are 22-28. Obese is considered a BMI of 30- 39, morbidly obese 40-49 BMI, and greater than 50 BMI is something else. By the numbers, the situation is this; as of 2000, 30.5% of the American public was obese, an increase of 110% in 25yrs. In a registry of patients receiving total joint replacements, for 1990-1999, 47% of the patients were obese, for 2000-2006 that number jumped to 55%, and in my practice 65% of the patients that I see who need total knee replacement surgery are obese. Obesity represents an annual national health care cost of 117 billion dollars, about equal to smoking.

The effect of obesity on patients who require a total knee replacement is significant. They put a greater demand of the medical team; require more resources, longer operating time and length of time in the hospital. Their wounds heal slower and have a greater frequency of wound infections. They are more likely to develop pneumonia and phlebitis. Lastly, their prosthesis does not last as long and many need to be re-operated in 5-7 years for loosing of the ligaments about the knee.

obesity-arthritic-knee.thumbnail.jpgThe issue is one of body mass. The more the body mass the more stress is placed on the ligaments that hold the knee and the prosthesis together and the effect is a multiplier, or geometric, effect. Normally a total knee is expected to last 15 – 20 years with a very few failing in less than that time. In the obese total knee patients I am finding that 10-20% of these patients are requiring a second, or revision, operation 5-7 years after the original operation.

You ask, what is the solution? Obviously loose weight, but that is not easy. Most patients that I see are caught in the dilemma of already having an arthritic knee and being obese and unable to exercise to loose weight. My hope and effort is directed at providing the patient with a total knee and the ability to then exercise and loose their weight. The issue is what kind of prosthesis? I have been using a “stronger” prosthesis that will carry the patients increased weight, protect the ligaments and “share the load” more effectively. It is still early and we are not sure how much we will improve the failure rate, but feel confident that patients will do better than with the use of a “standard” total knee prosthesis.

obesity-knee-with-implant_illus.thumbnail.jpgHaving said the fore going, I feel that if an obese patient has an arthritic knee and is in need surgery to replace it, then they should look for a physician and hospital that performs a high volume of total knees on the obese patient. In addition, they should be able to take care of their patients “holistically”, have access to bariatric care, and have a strong interest and significant experience in care of the obese patient.

Richard W. Cohen M.D. is a physician with Resurgens Orthopaedics and focuses on Arthritic and Reconstructive surgery of the hip and knee. Dr. Cohen serves as Co-Chair of WellStar Total Joint Center and Chair of the WellStar Ethics Committee.

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Q&A with Glenna Masters of the Atlanta Medical Group Management Association

Saturday, September 1st, 2007

September 2007

By Robert Nebel

masters.jpgGlenna Masters, president of the Atlanta Medical Group Management Association and a healthcare professional for over 20 years, recently spoke with M.D. News-Metro Atlanta Edition about the organization’s mission and status in the medical community.

M.D. News: How long have you been President of AMGMA?
Glenna Masters: I have been serving since January 1st. It is a one-year term. The President progresses through the board. They start out on the committee, then hold an office and then are president. I joined Atlanta AMGMA five years ago.

MDN: Who is involved in AMGMA?
GM: It’s mostly practice managers, practice administrators. Depending on the subject manager, they have some of the billing staff come along.

MDN: What do meetings cover?
GM: We speak about legislative, personnel and billing issues. We talk about everything related to the medical practice.

Lately we have been discussing the changes with Medicare and Medicaid and how they pertain to all of our specialties.

MDN: Any specific changes?
GM: The only thing that has been changing is a new program where the doctors are reimbursed miniscule amounts for doing a lot of paperwork.

MDN: How does your organization keep abreast of changes?
GM: We have a program committee and a board that keeps everyone aware of these changes.

MDN: What billing issues do you discuss at your meetings?
GM: We have someone come occasionally and show us the proper way to code procedures and diagnoses and things like that. Sometimes we have the payers like Medicare, Medicaid, United Health Care and Aetna demonstrate they way they operate and make attendees aware of their changes.

MDN: How has Atlanta AMGMA addressed the transition from paper to electronic billing?
GM: One of our programs was on electronic medical records. Several vendors came to display their products.

MDN: What challenges do you face as President?
GM: The biggest challenge is finding programs that are of interest to managers so that they will attend. It’s difficult because you hear the same things over and over. I try to get differing viewpoints.

Sometimes just the title of the program pulls the managers in-most of the time if it has something to do with the financial end of the practice or a personnel issue. Those are big draws.

MDN: With so many differing opinions in the medical field, are there meetings where there are a lot of sparks flying?
GM: Sometimes there is a little controversy, but nothing major has happened. We have at least one program that has a roundtable discussion with administrators and managers who bring up one topic to discuss. It works really well. We had a big crowd this year.

MDN: What are the benefits of being the group?
GM: It is the knowledge that you pick up and the networking. Whatever specialty you are in, there is always someone who is in it. It is great because you can always compare notes.

MDN: Where are the educational seminars held?
GM: Ours are at the Ashford Club at the Glenridge Connector. With Georgia 400, 285 and 85 nearby, it is accessible for many of our members.

MDN: How long have you been a practice administrator?
GM: For over 20 years. Before that I worked part-time in a medical office doing transcription and posting charges. I also stayed at home with the kids.

The AMGMA works to foster and increase knowledge of and proficiency in medical practice administration. Member benefits include educational sessions and networking meetings, access to supporting member companies, continuing education credits and discounts. Educational seminars cover a range of topics. As an example, one recent meeting titled Ways to Reduce Costs in Medical Practices featured tips and anecdotes from on how to reduce annual spending.

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