Why are womens’ “free” mammograms costing so much $$?

The Affordable Care Act (Obamacare) required payers to completely cover a screening mammogram for each woman over age 40. This was intended to look for breast cancer in women with zero symptoms at average risk for cancer.

Sounds great, no?

But what happens when additional DIAGNOSTIC testing is needed: ultrasound or 3Dmammograms? The so-called “recall rate” averages up to 10% per screening mammogram, and each woman can anticipate up to a 50% personal risk of recall after one decade of regular screening.

My patient this week in clinic was LIVID when telling me about this scenario happening to her. She was given a bill for $1,000.00 by our large local hospital system. Some insurance payers cover the additional testing but many, including Medicaid do not.

Before ordering an annual or biannual mammogram with your doctor, ask if your #screening test should be a routine 2-D mammogram or a 3-D mammogram (tomosynthesis).

Consider requesting a “SCREENING 3-D MAMMOGRAM” if your last mammogram required additional testing or you have dense breast tissue. Even if the 3D is not covered by your payer for screening, the same local hospital system will only send you a bill for $90, according a local breast radiologist I asked this week. Sure beats $1,000!!


Most Americans Gain ZERO Benefit from Nutritional Supplements

What? Vitamins don’t help me? A nice plain English summary from the NY Times  explains how typical Americans without a previously diagnosed nutritional deficiency do NOT gain any health advantages from taking a handful of supplements each morning.

Save your $$$$.

Notice the American Cancer Society, the American Heart Association and the United States Preventive Services Task Force, among others, have ALL found no role for a once daily vitamin supplement to prevent cancer or heart disease; they recommend instead a balanced diet with a variety of foods to be MORE effective than any capsule. Reducing the plain white, high carb foods (bread, pasta, tortillas, rice, potatoes) and increasing the colorful red/orange/green/yellow/purple foods (vegetables, fruits, beans) will provide a wide range of excellent vitamin and minerals plus assist in keeping weight down.

Magnesium pill? Better to take spinach, nuts, legumes and whole-grain cereals.

Calcium pill? Try fat-free milk, yogurt, cheese and dark-green leafy vegetables.

Even more concerning, some vitamins INCREASE the risk of cancer. Based on early, suggestive evidence, a large government-sponsored study tested the ability of selenium and vitamin E to lower the risk of prostate cancer. Imagine the surprise when the men who took vitamin E developed significantly more cancers than those on a placebo.

Instead of spending money on unproven therapy, try a membership at the local gym. Exercise is outstanding for mental and physical health. See you at the Y!

Anxiety and Panic – New phone apps may help

Phone apps exist for many areas of our life now from hailing a ride to monitoring your sleep (sleep better, sleep time) to ordering dinner.

Now phone apps are available that can act as a portable counselor or coach to help with common issue of anxiety and panic disorder. They are available for Google and Apple phones.

MindShift app

SAM app

Pacifica app

SAM was developed by a university team of psychologists, computer scientists and student users. It offers a range of self-help methods for people who are serious about learning to manage their anxiety.

MindShift helps you learn how to relax, develop more helpful ways of thinking, and identify active steps that will help you take charge of your anxiety. This app has specific tools such as:

Pacifica gives you psychologist-designed tools to address based on Cognitive Behavioral Therapy, mindfulness meditation, relaxation, and mood/health tracking. It has been recognized as leader in the field: #1 – BuzzFeed’s Amazing Apps For Anyone Living With Anxiety, and #1 – Forbes’ 4 Technologies Innovating in Mental Health.

In addition to the phone apps, in person counseling, physical exercise and medications can help. TVFM has many helpful contacts for counseling across the Treasure Valley.

Dr Crownover also recently attended another national psychopharmacology update conference sponsored by the Nevada Psychiatric Association, in order to ensure the latest and best evidence-based medications are used to meet your individual needs.

Direct Primary Care- Wall Street Journal review


Direct primary care eliminates the insurance middle man. One third of health care costs are immediately saved. Voila! And it is SO simple.

Patients contract with their doctor directly, cutting out the premiums and deductibles paid to the insurance company which provides zero direct benefit to either the doctor or patient. By paying a monthly premium to their doctor (avg $50-75 per month), people can access their primary care physician as much or as little as needed. Think of your cable TV bill – you pay a set fee per month and watch as little or much as desired.

Direct Primary Care helps doctors by 1) eliminating the hundreds of hours spent on getting approval from non-medically trained clerks who decide what treatments your doctor is allowed to give you, 2) acknowledges that any time spent caring for you is valuable – in person visits, phone calls, video calls and emails – not just face to face visits, and 3) providing  a steady, predictable revenue stream to cover required overhead to give you needed services.

Direct Primary Care helps patients by 1) giving your doctor the freedom to offer the most medically relevant work ups and treatments, without asking “mother may I?” from non physician insurance employees, 2) saving $$$ on exorbitantly high premiums and deductibles, and 3) reduces costs by allowing doctors to provide lab tests at volume bulk discount pricing, not the higher insurance company negotiated rates.

When catastrophic (wrap around) policies are available at reduced rates to cover limited services such as hospitalization, expensive imaging tests and referral visits, then paired with direct primary care, overall costs to patients are reduced 20-30% and doctors have more freedom to focus on patients, not jumping through insurance company hoops.

Here’s hoping Idaho soon joins our neighbors Washington, Nevada, Oregon and Utah in offering catastrophic policies!


Influenza is deadly serious

Death of Teen Athlete a Reminder That Flu Can Kill Anyone


Flu usually hits the very young and the very old the hardest. Depending on the season, it kills anywhere between 4,000 and 50,000 people a year in the United States. It is still not too late to receive your flu vaccine shot. TVFM still has doses of vaccine and can help you now. Most insurance payers pick up the cost $$ for you, especially since the Centers for Disease Control  (CDC) recommends a yearly flu vaccine for everyone 6 months and older. It is not too late to get vaccinated. Flu vaccination can reduce flu illnesses and prevent flu-related hospitalizations.


People with egg allergies can receive any licensed, recommended age-appropriate influenza vaccine and no longer have to be monitored for 30 minutes after receiving the vaccine.

Flu shots are approved for use in pregnant women.  Flu vaccine in a pregnant woman can reduce the risk of flu illness in her baby by up to half. This protective benefit was observed for up to four months after birth.When more people get vaccinated against the flu, less flu can spread through that community.

A flu vaccine is needed every season for two reasons. First, the body’s immune response from vaccination declines over time, so an annual vaccine is needed for optimal protection. Second, because flu viruses are constantly changing, the formulation of the flu vaccine is reviewed each year and sometimes updated to keep up with changing flu viruses. For the best protection, everyone 6 months and older should get vaccinated annually.

Cough with common cold (URI)? Lasts a LONG time.

Most Americans surveyed will guess that a common cold cough should disappear after one week (7 days).

However, the AVERAGE duration of cough is 18 days!! In fact even by 28 days (4 wks), 1 out of 4 Americans will still have some residual cough.




So when should an otherwise healthy person worry?

  1. Double dip or roller coaster course: worsening cold symptoms x 3-7 days, then improve for a few days, then worsen again.
  2. NEW fever after the first week, after the initial round of fevers for the first several days have resolved.
  3. Severe illness or short of breath/cannot get enough oxygen.
  4. Failure to have at least SOME of your total symptoms (congestion, runny nose, sore throat, cough) BEGIN to improve by 7-10 days.

Sadly, none of the $Millions spend each yr in the cough/cold aisle at the drug store significantly help


The BEST evidence is for bee honey (after age 1 yo).

It is important to remember that cough is actually desirable. God gave us cough to get rid of the sticky mucus in our lungs caused by viral infections. If that mucus is NOT coughed up, then good chance bacteria can set up a more serious infection like pneumonia. I take care of some patients with disabilities who are unable to cough, and surprise….they get recurring pneumonia infections and end up in the hospital more often. Pneumonia is serious. It is the #1 cause of death worldwide in children and in the USA, it is the #8 cause of death for all Americans.

#chondroitin & #glucosamine fail to benefit in arthritis…again

Like many Americans, I am eager to use natural and safer medications that effectively treat diseases.

To promote them however, we need evidence.

Unfortunately for #chondroitin & #glucosamine, the evidence continues to collect for LACK of benefit.


A recent review from the journal Arthritis & Rheumatology (@rheumatology) evaluated 164 patients with moderate-to-severe degenerative arthritis, and compared once-daily chondroitin/glucosamine (1200 mg/1500 mg) with placebo.

After six months, mean pain scores decreased from baseline by 33% in the placebo group, but only 19% in the chondroitin/glucosamine group — a statistically significant difference, in favor of placebo!

We hope researchers continue to evaluate herbal and natural medicines, so we can find the ones that truly benefit and can promote their use.


Home Sleep studies to evaluate for Sleep Apnea are noninferior

#SleepApnea (https://goo.gl/FoTWLL) is a common cause of fatigue, poor sleep and high blood pressure.

Multiple screening tools are available to identify people who need testing. (http://www.sleepmedicine.com/files/files/StopBang_Questionnaire.pdf). @sleepinfo.

A review in Annals of Internal Medicine @annalsofim suggests that Home Sleep testing is NOT inferior to much more expensive testing at a formal sleep lab for most people. (https://goo.gl/DnwbtK)

Different companies such as @Novasominc or @VirtuOxSleep can express ship a kit to your home, which allows you to sleep in your own bed while performing the test. When completed, the results are sent back to your physician.

Multiple companies can provide #CPAP treatment, such as Medicap @medicapmeridianparma, Pacific Pulmonary, CPAP Now @cpapnowtv or Norco @norcomedical.

Also, mouthguards or oral splints are available for some folks. Clinics like the Center for Sleep Apnea and TMJ @sleepidaho can assist.



Not Too Late For Flu Shot

We still have #influenza #vaccine; it is not too late.


Primary Care Vaue And Incrementalism

Great article from #NewYorker on value of primary care and long term relationships