Hahn and Nelson Family Medicine Update

Well, it's just how we roll.

2012-01-18T12:03:00.000-08:00

Yes Virginia, doctors still DO make house calls... and more. Here's the text you'll find under the link:
January 13, 2012, Morgan Messenger

Dear Editor:

I would like to let everyone know about an act of Christmas kindness by one of your neighbors.

I’m from Arizona and recently spent the holidays at my sister-in-law’s farm in southern Morgan County. Just before Christmas, recurrent kidney stone pain caused me to plan an emergency return to Tucson to get treatment from my doctors.

As I was making flight reservations, Dr. Matt Hahn, a friend who was visiting my brother-and sister-in-law, interrupted and offered to arrange local treatment. Not only did he go out of his way to arrange an ER visit, he took several hours out of his Christmas Day to drive us to the hospital and stay with my wife and I during the visit. Afterward, he lined up an appointment with a local urologist to have the stone removed the following day.

I was blown away by the amount of time and effort that Dr. Hahn put out. He and his wife, Bibi, who was especially gracious even though we occupied much of her husband’s Christmas Day, are incredibly generous people. You’re very lucky to have such people active in your community.

Jim Delaune
Tucson, Arizona

Yoga in Berkeley Springs

2012-01-16T10:09:00.000-08:00

Winter is a great time to start or re-start your yoga practice. We tend to sit a lot more in the winter time, whether it's because we don't like the cold, or there just isn't as much going on this time of year. Yoga is a wonderful way to get back in touch with your body, and to still the mind. I've been trying to fit a few more Yoga workouts into my week lately. It feels good, and anybody who thinks Yoga is for sissies hasn't done it. Plank pose alone strengthens your core, your back, and of course, your arms. Downward facing dog and pigeon pose feel like heaven after you've been sitting all day.
For those of you who haven't been exercising regularly, yoga would be a good place to start. Yoga naturally makes you aware of your body, and helps you remember to breathe while you move. A good instructor will make gentle corrections to assure that your poses are good for you.
And for those of you who already have an exercise routine going, good for you! But don't forget, cross training is key to a strong, healthy body. Yoga will help you stretch your muscles and further strengthen them.
In Berkeley Springs, we are blessed with several really great instructors, all offering different techniques. A good instructor will be able to teach most levels of yoga to one class, but you should always let your instructor know if you're a beginner. Here's a list of all the Yoga classes I was able to find out about in our area:

Joyce Morningstar and Lee Barrons Classes are held at their home studio. Call 304-258-6247 for information. Individual classes $10 / 8 classes $55

Tues Gentle Yoga 7:00-8:15
Thursday Vigorous Yoga 7:00-8:15
Friday partner yoga 7:00-8:15
Sat Gentle Yoga 9:00-10:15

Marcie Fleeharty Classes are held at the Board Office Annex Building. Must sign up by registering with Morgan County Adult and Community Education. Contact Laura Hovermale at 304-258-2430 ext 19 or 20. Classes are $50 for 10 weeks beginning January 23.

Monday Basic Yoga 4:30-5:45
Monday Yoga Fusion 6:00-7:15

Christina Page Classes are held at the inMotion Dance Center. Call (540)535-6188 for more information. Classes are $15 for drop ins, or multiple class cards are available at a discount. Private classes available as well.

Thursday Alignment based Yoga 9:00-10:30

Evelyn Garcia Classes are held at the Presbyterian Church Social Hall. Please call (304)258-9069 before attending. Classes are $8 in advance or $10 at the door. Evelyn is also available for private classes.

Monday 5:30-7:00

You can also find tons of Yoga workouts on DVDs, and on Youtube. Personally, I wouldn't use these until I had taken Yoga from an instructor and got confident with the poses. I do have a few that I like. I'll post these later on. If you have some favorites, please let me know! I might want to give yours a try.

Namaste!

E-Reading for your health

2012-01-05T08:47:00.000-08:00

We could open our own medical library at our house. Medical journals are piled up on the coffee table, brochures for health products languish on the kitchen counter with the rest of the mail, and yes, health magazines are stacked in the bathroom too. Maybe that's what happens when you're married to a doctor.

As most of you know by now, I love technology. Those journals and magazines? They're my husband's. I prefer to read current events, including health and fitness news, online. I love how I can use links in an article to explore a topic in more depth... or open a new browser window and Google an author to find out what else they've written.

I make sure I read at least little bit of health news every day as I scan all the international and national news, entertainment gossip, the weather, and politics. Being in the know about new health and fitness developments and discoveries is exciting and useful.

There are many ways you can make any kind of reading more available on the web. Of course you can always bookmark your favorite news sites, blogs, and other sources.

Google and Yahoo both use widgets to make information appear automatically on your personalized Google or Yahoo page. I've added a "widget" to my Google page called The World's Healthiest Foods. (If you don't use iGoogle, you can also just read The World's Healthiest Foods by itself.) Every week this widget focuses on a healthy food (this week's is broccoli), and usually includes at least one recipe for that food.

Many news sites allow you to customize what kind of news you see once you've created a (usually free) account. Today while reading the news on the MSNBC website, because I've added the Health section to my customized page, I found an article on getting the starch out of my dinners.

In addition to links found on web pages, there are lots of websites that will email free subscription newsletters. Shape Magazine, a mainstay of the fitness reader, has many email newsletters to help you stay motivated and smart: Just go to this website, check the boxes for the newsletters you want, and fill in your email address.

If you got an iPad or other tablet for a gift this holiday season, there are so many apps out there that it'll require a whole new article to explore just a few of the health and fitness-related. But here are some links to get your started:
iFit: 50 Coolest Fitness and Health Apps for the iPhone (most of these can also be used on an iPad as well)
Top Ten iTunes Health Apps of 2011
For example, I was excited to find a Yoga app that lets me design my own routines. The tablets open a whole new exciting dimension and lots of possibilities.

I think keeping health and fitness news in my digital life can't help but be a reminder to stay on a healthy track. If you're reading this blog, chances are you like to get your information online, too. Please share with us if you find something interesting!

Online Appointment Scheduling!

2011-11-28T09:35:00.001-08:00

Just a quick note to let you know that online appointment scheduling is now available. If you're interested in registering for this new feature, you'll need to request an access code to get started. Email bibi@hahnandnelson.com. I'll send you an access code and a guide to Patient Ally.

Try a Little Tenderness!

2011-11-23T16:44:00.000-08:00

As you go about your Thanksgiving holiday, I'm sure you're feeling grateful thoughts for everything important to you. It's good to be grateful! Gratitude is a light that can shine through the days you're feeling blue, the days you're feeling forsaken, or those times you feel you don't have enough of whatever. However, gratitude goes even further if you express it, especially if your gratitude target is a person. You may be glad that you have a wonderful teacher, or an efficient accountant, or a thoughtful assistant. But maybe, as time goes by, you take that person for granted; you may even allow negative thoughts to cloud over what a gift that person really is. Perhaps they came in late one day, or forgot an appointment, or acted grouchy one morning; that sort of thing seems to cling to our consciousness more so than the good things. It's probably out of some kind of primal defense mechanism -- our brain wants to protect us against bad things and feelings, so recalling those things first will allow us to react quickly to a possible repeat behavior. Now is a great time to recall, instead, all the good things, even the mundanely good things, people do for you every day. Maybe they simply come to work every day without fail, or maybe the teacher drew a smiley face on your child's homework. Give gratitude and you will surely get it back doubled. Tell your assistant that she's doing a great job -- pick something specific so she knows you're paying attention...Give your office cleaning person an unexpected raise....ask your postal worker what she's doing for the holidays. And smile when you do....for all you know it may be the only smile someone sees all day.
Happy THANKSGIVING!

Making Time for Patients

2011-11-10T12:52:00.000-08:00

We've come so far!

Hahn and Nelson Family Medicine is committed to spending quality time with patients. We're always looking for ways to cut down on the time that we must spend other than seeing patients in the office: billing, filling prescriptions, answering the phone, getting referrals, stocking our supply room. Instead of simply throwing money at a problem, or hiring more people, we like to try to find creative, innovative solutions. Many times, technology is the answer: for example, we recently implemented electronic fax retrieval which saves time and paper. Other times, a low tech solutions such as altering a schedule, may work just as well to solve a problem. Some of these improvements may take a little getting used to, both for our patients, and for us.

It seems that our phone is always ringing! Most calls are for one of several common issues. One of those is patients needing refills. We recently asked Rick, our Teleplus representative, to add an option to our phone line to allow you to leave your refill information as a message.
New Refill Line!
Refills should ideally be handled through your pharmacy. You should be able to call your pharmacy for any refills you have available; if there are none, the pharmacy should call us directly to make arrangements. However, if this is not possible (in the case of prescriptions that must be on paper), when you call us, just press "1" when prompted and you'll be greeted with the questions you'll need to answer in order for us to refill your prescription. Please remember, it usually takes at least one business day for prescriptions to be taken care of from the time we receive your message until the pharmacy completes the order.

The other common reason patients call us is to get an appointment. We know that a lot of our patients would love to book appointments online, and we're getting ready to make that happen.

Online Appointment Scheduling Coming Soon!
We already enjoy Oxbow, our state-of-the-art EMR software (Electronic Medical Record) and the advantages it gives us over old-fashioned paper charts. We use PracticeMate software to schedule patients quickly and easily and file our insurance claims electronically. Now we're getting ready to extend the ability to schedule appointments to our patients with the online PatientAlly service. PatientAlly allows enrolled patients to register their information, and then schedule an appointment. Patients can also send their provider messages. We're looking for some patients to "beta-test" this new service, so if you're interested, please email us at bibi@hahnandnelson.com to setup a training session.

Walk Across Maryland Redux

2011-11-10T06:43:00.000-08:00

We love it when people copy us! What's that saying.... "Imitation is the highest form of flattery..."? Right. Two years ago we got a phone call from a group that makes a hobby of doing "Walks" all around the region. They had heard about our Walk Across Maryland, but were unable to attend on the weekend we traditionally have the Walk. They wanted to know the route, and whether they could perhaps have a few t-shirts. We usually have a surplus of shirts, so we said "sure!". Again this year they had the same request. As they walked past our office, which is on the route Across Maryland, they noticed that both Dr. Hahn and Dr. Nelson were in the office despite it being Saturday, so they stopped in to say hello. Enjoy their pictures, and if you're one of the Walkers, thanks, and enjoy!

An Apple a Day...!

2011-10-18T10:14:00.000-07:00

We can't promise you that eating an apple a day will keep your visits with us to a minimum but you won't be disappointed when you stock up on these lovely, go-to fruits. From the time the apple orchards grace us with acres of blossom clouds to the time we find them at the market, apples make me happy. Here in Berkeley Springs we have our Apple Butter Festival, where we celebrate the velvety outcome of some of our apples. And I love going to the Farmers Market this time of year, and seeing the apples piled sky high in their bins. The satisfying crunch when one bites into an apple, the smell of applesauce as it cooks down on the stove, my mother's apple pie baking in the oven.... ah!
Of course you can find apples at the grocery store. But when I was at the Farmers Market this weekend, I was reminded that there are apples, and then there are apples! Glascock's at our Market has Staymen apples right now, and these are terrific for cooking. While I'm thinking of my mother's pies, I'm reminded that she always uses this snappy variety anytime she makes a pie, or oh my, her dumplings. I love the Ginger Golds for eating. So if you're one of those who thinks apples are rather pedestrian, try reaching for a variety you haven't tried next time.
So let's say you've bought a bushel or so of apples. Now what? Ok, they are great for packing in lunches because they don't take up much room and they're easy to eat. But let's move on. Apples are so versatile. I'll give you a recipe for every course!

Curried Apple and Squash Soup I haven't made this particular recipe yet, but I want to try it.
Apple and Endive Salad I make this. It's a refreshing change from the standard greens/red peppers/cucumber salad that I usually make! Apples are good thrown into almost any green salad, or try shredding them into your coleslaw.
Apple Stuffed Pork Chops I am the only fan of pork in my house, so I don't ever get to cook it. But I order it when I go out, and this sounds like something I would definitely order in a restaurant. Go for it!
Apples Bean Bake reminds me of something I used to make when I was a vegetarian. The apples rather mimic the texture and taste of pork. Try it even if you're a meat eater. It sounds good.
My family recently discovered that we love brussels sprouts. Here's a recipe I'm going to try soon: Warm Brussels Sprouts with Apples and Red Onion.
Apple Beer Bread benefits from a double shot of apples: once with the Granny Smith apples, and again with a shot of hard cider.
And how about some lovely sauteed apples? I like to melt butter in my cast iron skillet, and then caramalize some brown sugar and cinnamon. Then I lay down the apple slices, and cook them until they're nice and soft, turning them once. These are great for breakfast, or as a side to chicken.
Now, what about dessert? Well, you could take the healthy route, and offer your dinner companions a nice platter of assorted apple slices and a variety of cheeses. Cheddar goes particularly well with apples. Port wine is so lovely with this if you like wine.

Of course, there are so many decadent things you can do with apples I don't know where to start. There are those apple dumplings that my mom makes, and her apple pie is beyond comparison. She makes these the old fashioned way, with Crisco shortening. And those sauteed apples are wonderful with vanilla ice cream. So I'll leave the dessert up to your imagination!

Bras for the Cause

2011-10-13T06:44:00.000-07:00

This month, in honor of Breast Cancer Awareness month, Rankin Fitness Center is collecting your gently used bras! For every bra collected, Shockley Honda will donate $1 to the FMH Regional Cancer Therapy Center Breast Cancer Unit. We at Hahn and Nelson Family Medicine will be more than happy to collect your bras here and deliver them to Rankins. Last year, $10,000 was raised with bra donations. So go home, look in your closets and drawers and bring them in! Please bring them in by October 23rd. Thank you!

Quotes about Walking

2011-09-16T16:40:00.000-07:00

The best remedy for a short temper is a long walk. ~Jacqueline Schiff

An early-morning walk is a blessing for the whole day. ~Henry David Thoreau

My grandmother started walking five miles a day when she was sixty. She's ninety-three today and we don't know where the hell she is. ~Ellen DeGeneres

Me thinks that the moment my legs begin to move, my thoughts begin to flow. ~Henry David Thoreau

I have two doctors, my left leg and my right. ~G.M. Trevelyan
Make your feet your friend. ~J.M. Barrie
Thanks to the Quote Garden!

Walk Across Maryland!

2011-09-15T09:16:00.000-07:00

In case you haven't heard, Hahn and Nelson Family Medicine's now famous Walk Across Maryland will be held this Saturday. So far the weather looks perfect, which is good news considering we could use a rest from all this rain. But we won't be resting until we've crossed the state of Maryland! Granted, we will be walking across the skinniest part of our beautiful state, but hey, it's all for fun. We'll have our new bright yellow Walk Across Maryland t-shirts available free for the first 200 walkers who show up. As in years past, we'll meet beginning at 8:30 at the Assembly of God parking lot (just keep driving up Pennsylvania Ave past Pittman's Grocery), and take a quick walk up to the Pennsylvania line. You can stop at our office about halfway and greet the staff from Hospice of Washington County, who will be accepting donations. From there, we'll walk all the way down Pennsylvania Avenue to the great Potomac River where we'll dip our toes. We'll have a shuttle available to drive folks back to their cars if you like. Once again Mike Cligerman will entertain us with his squeezebox, our loyal Hancock cheerleaders will cheer us on, and the Boomtown Hoop will join us too! I heard that some of those wild Zumba ladies might come along too, so watch out! All the office at 301-678-7007 or email bibi@hahnandnelson.com if you have any questions. See you there!

KISS! (Keep It Simple, Stupid)

2011-09-05T15:05:00.000-07:00

We often wonder why health care in the United States is so much more expensive than in other countries. A large part of the answer is that administrative costs in the US system are far higher than in other countries.

A survey of physicians and their staff found that the administrative costs of and time spent interacting with multiple payers in the United States far exceeded time spent and costs in Canada with its single-payer system.

Specifically, U.S. physicians typically spent $82,975 a year administering claims to insurers. In Canada, where health providers only have to deal with one payer - the government - they spent $22,205.

One reason I can see for this discrepancy is that there is very little standardization among our payers. Sure, they all have to use the same codes for procedures (CPTs) and diagnoses (ICD), but from there, the similarity in how a claim is handled disappears. Each insurer has different rules about what diagnosis can be linked to what procedure, what fields on a claim form must be completed or left blank; even the Explanation of Benefits are all different so it's hard to zip through them when processing payments. Each provider is paid differently, according to whatever fee schedule they have negotiated with the insurer. I get bulletins from all our insurers periodically (we accept almost every insurance out there) with "edits" to how claims should be submitted. Do I have time to read all of them? Never. There is a whole industry out there for medical coders to learn the ins and outs of how to successfully code a claim because of all the mystery and confusion.

Another reason is that the rules and regulations governing health care billing and payment are extremely complex and cumbersome. For any office visit, hospital charge, or other simple service, there are multiple sets of codes, complicated documentation rules, and multiple decision points. Furthermore, many bills are divided into an upfront co-pay, an amount that the insurer pays, and then a third amount, to cover the difference between the allowable charge, and the amount that has been paid between the co-pay and the insurance payment. Sound complicated? It is, and this complexity is the cornerstone of a huge bureaucracy necessary to administer its ins and outs. It is also the foundation of a great deal of health care fraud, which can hide for years behind the tangle of complicated rules.

Even within a payer, things get tricky. I'm sure you're all tired of hearing me wail about Carefirst of Maryland, but it really is the bane of my existence. Almost all of our Blue Cross/Blue Shield claims must go through Carefirst of Maryland. The rules are not always the same for all of those BC/BS claims, so there are problems. However, I can't call a patient's "Home plan" to get answers: I must call Carefirst of Maryland, who then "wires" the home plan for a resolution -- that can take literally months.

The time I spend figuring out why a claim isn't paid very often cancels out the amount we end up getting. That $82,975 figure is very easy for me to believe; actually, I'm surprised it's not higher.

And those who shiver when they think about the government telling doctors how to do their jobs? Guess what. Private insurers tell providers how to do their jobs every day. Would you rather a profiteer be deciding on your health, or the government?

Are you a citizen who thinks that health care costs are too high in the United States? This is one of the reasons, my friend. If your doctor has to pay $82,000 a year to deal with insurance companies, who do you think the cost is getting passed on to?

It is obvious to us that a simplified billing system, with standardization across the board and streamlined billing and payment rules and regulations would be the key to better and less expensive health care.

September must be his month.

2011-08-31T17:20:00.000-07:00

Jim McCoy and Matt Hahn

What other doctor do you know that not only is recognized by his peers (2005 - Maryland Family Physician of the Year, 2006- finalist for American Family Physician of the Year), loved by his patients, and also gets inducted to TWO Hall of Fames in one month (and have both of them announced on the same page of the Morgan Messenger).

Dr. Matthew Hahn will be inducted into the Troubadour's West Virginia Country Music Hall of Fame this Sunday afternoon, during the Troubadour's famous Patsy Cline celebration. Come on out and enjoy the day and cheer for Dr Hahn! The afternoon is free, full of great LIVE music, and food. Bring a covered dish, the Troubadour supplies the meat. If you weren't aware, Dr. Hahn recorded a CD of Jim McCoy's music in 2007, "The Real McCoy." You may have seen him around town, performing this beautiful, old-style country music wearing Jim McCoy's original red sequinned suit.

Jeanne Mozier (the Voice of the Festival) and Matt Hahn

Then on Wednesday, September 21st, he will receive the honor of becoming an Apple Butter Festival Hall of Fame inductee for his work as MC of the Hog Calling Contest. If you haven't been to the Hog Calling contest, held the Sunday of the Apple Butter Festival, you've been missing out. People come from all around with their lively versions of hog-calls, co MC-ed by Dr Hahn and Jeanne Mozier.

Congratulations, Matt!

The power of art...

2011-08-26T05:52:00.000-07:00

How do you feel when you look at a beautiful picture? Did you know that the pleasure you feel is actually very real? A study shows that looking at beautiful works of art effects the brain exactly the same way as falling in love does! And we all know how good that feels. In fact, looking at artwork can cause the blood flow in the brain to increase by as much as 10 percent.
We didn't know about this when we started collecting artwork for our office. We just knew that we have a lot of local talent, and so much inspiration from the beauty we have all around us. Why buy an anonymous, mass produced print from an equally anonymous mall store when we are so lucky?
One of our friends, Tom Darden, served as photographer in the Maryland State House under six governors. He very graciously framed and mounted in our office some of his beautiful photography that depicts our extraordinary natural surroundings here in Western Maryland. Be sure to check them out next time you're in the office if you haven't enjoyed them already. You can also view his art work on his website.

This weekend, we were at Art in the Park in Berkeley Springs where we live, and came upon the Artists of Merrywoods. Their photography captivated us. We loved the way the photographs are printed on canvas, and then, rather than being framed, were stretched over a beveled surface, giving it an "infinity" feel. The photographs are of all our favorite places: Cacapon State Park, the Cacapon River, and even Dolly Sods. The light in all of them is magnificent. We bought a piece, and then asked them if they'd like to hang some of their pieces in the office. So now our office doubles as a gallery! Come by and see it. All of them are for sale if you fall in love with them as we did.

Understanding your Explanation of Benefits (EOB)

2011-08-18T08:31:00.000-07:00

Patients sometimes receive a bill from us and don't understand why they're getting one at all, or have questions about how their insurance paid a claim. (See also: When Claims Don't Get Paid). They may not realize they have a deductible to satisfy before their claims are paid in full, or that they have a co-pay. One question I usually ask them is whether they've reviewed the Explanation of Benefits (EOB) that they receive from their insurer. When a claim is considered by your insurance company, an EOB is sent to the patient to show how a claim is paid (or not paid), and we get a copy at the office along with a check (if there is one). Patients often disregard these, especially when they see "NOT A BILL" across the top of it! However, you should always pay close attention to these. Everybody makes mistakes, from the way the claim was billed at our office, to the way it was paid by the insurance. We are always happy to help patients review these, realizing they can be confusing.

The EOB usually consists of several columns:
Patient Name
Date of Service
Procedure: This could just be a code representing an office visit or procedure, sometimes accompanied by a brief description
Charges: This would be the actual charge for the procedure(s) from our office
Allowed Amount: This is the amount the insurance company has contracted to pay us for the specified procedure(s)
Co-pay/Deductible: Sometimes also called the Patient Responsibility, representing what the patient owes after the insurance has paid and discounted the bill
Contractual Adjustment: Not always included, but represents the amount the doctor's office has agreed to discount through the contract with the insurance
Amount Paid: Total amount paid to the doctor
Sometimes there are codes appended to any of these columns; explanations of what the codes are for are usually at the bottom of the EOB.

The Patient Responsibility is the only amount you should have to pay. We are not allowed to bill you more than the insurance has contracted for our services.

If you ever have any questions about your bill, or your EOB please call us! We'll be happy to help.

Walking in Sunshine with Tori

2011-08-17T09:09:00.000-07:00

The music world, especially our local music scene, will become a bit less bright soon. Recently our friend Tori Anderson decided to retire from singing after 17 years with Possum Holler, a local treasure, due to her health.
Although she is saying goodbye to her musical career, she isn't one to surrender so easily. She will remain on air as a DJ and music director at radio station WAYZ. She has also made a commitment to do what she can to fight a disease she shares with all too many others.
Tori has organized The Walk with Tori To Find a Cure for Scleroderma. Every penny collected will be donated to the Scleroderma Research Center. The Walk will be on September 11 at Doub's Woods Park in Hagerstown, Maryland. Registration will begin at 1:00 and the Walk will start at 3:00. Many wonderful silent auction items are available for bid.
Hahn and Nelson Family Medicine is a sponsor of this event, and some of us will be walking. We would love to see you there, but if you can't come, your donations are welcome. To find out more about the walk, or to register, email walkwithtori@gmail.com or call (301)733-tori.
Click here to find out more about Scleroderma.

Boot Camp for Women Begins Again at Rankins Fitness Center

2011-07-27T13:00:00.000-07:00

So it's the middle of summer, and you're just hanging by the pool. Do you like what you see? Do you like how you feel? Or have the barbecues and lazy days caught up with you? Well, it's not too late to do something about it! Rankins Fitness Center is once again offering its Boot Camp for Women, with lots of times to choose from, so "I'm too busy" is not going to cut it as an excuse! Check it out. You can even get there at the crack of dawn and get your workout out of the way!
Every Tuesday & Thursday Starting NEXT TUESDAY
6:15am-7:00am
7:15am-8:00am
9:00am-9:45am
...
Monday/Wednesday (if we have at least 10 people!) START UP DATE TO BE ANNOUNCED
6:15pm-7:00pm
Sign up online www.rankinptfc.com and while you're at it, check out their other programs.... something for everyone - Judo, swimming lessons, tumbling!

Bring it on, American Beverage Association

2011-07-23T08:08:00.000-07:00

So it's being reported that the American Beverage Association is suing New York's Health Department for running ads that link drinking soda to obesity. Really? Really, ABA? Because, guess what. DRINKING SODA CAN LEAD TO OBESITY. When we get overweight patients in our office, we always encourage them to lose weight. They ask us, "How? I really don't eat that much." We ask them what they drink. When told that the typical can of soft drink contains at least 140 calories, they are flabbergasted. Some of our patients take a Big Gulp to work and drink it throughout the day. Guess how many calories? 800! Guess what happens when they stop drinking soda, and switch to diet, or even, better, water? THEY LOSE WEIGHT!!!!
I'll ask it again. Why can't these companies realize that they are contributing to the illness, and sometimes, death, of millions of people and either offer smaller sizes of their product, or simply offer healthier products? And/Or, why don't we tax these unhealthy products so we can use the taxes to support these people when they develop diabetes, or have heart attacks? Oh. Your blogger is so angry right now! All I can think is that they really don't care. All they want to do is pump your body full of junk so they can pump their bank accounts full of money.
But you know what? People have to start caring about themselves, too, enough to tell Coke and Pepsi that they don't want to die of foot infections caused by diabetes, or have to buy two seats on the airplane because one isn't big enough. They have to tell Pepsi and Coke that they don't want to take medications every day for an illness that is totally preventable, that they want to spend their money on their grandkids that they will live long enough to entertain.
In the meantime, American Beverage Association, I guess you'd better just come on over to Hancock and sue Hahn and Nelson Family Medicine. Because we, too, believe that your products lead to obesity. And we're not going to stop telling our patients the truth!

Home sweet home

2011-07-20T15:33:00.000-07:00

Read about Hahn and Nelson Family Medicine's participation in Maryland's pilot Patient Centered Medical Home project!

Happy Hour

2011-07-08T17:03:00.000-07:00

It's been a stressful week. Today is Friday and I've had my nose to thecomputer for about 24 hours off and on, or at least it feels like that. It's billing statement time, and this always gives me a headache. Each time I generate a bill, I feel the story of the bill almost haunting me. If it's an unpaid co-pay, I wonder: Did we just forget to collect it at visit time? Or was the person at the end of their paycheck and couldn't afford the $25? If it's a balance that's been carried over for several billing cycles, I feel the muscles in the back of my neck tensing up and I find myself wondering if the non-payer is a deadbeat, or just can't afford to pay. Regardless, all those little scenarios that I play to myself end up in the muscles of my neck and my back. I had to get out for awhile.
I hadn't exercised yet, and I knew that a Zumba class was happening in just about an hour. But I looked outside.It had been storming most of the day, but now the sun was filtering through the trees, and a light mist covered everything. It looked downright magical. I'm spending a few days here at my mother's in Shepherdstown while our daughter is interning at the Contemporary American Theater Festival, and she lives in a subdivision right on the Potomac River. It's a great place for walking, and I was feeling a distinct invitation. So I went out and walked for an hour.

I took my phone, which has a camera. I realized as I walked, that I wasn't thinking about all the week's problems, or all the small ones I had perhaps imagined hiding in the billing statements. I was looking at things. I started taking some pictures. I'm not a photographer, but that didn't stop me from seeing wonder in everything around me. The simple majesty of a giant tree... the juicy wild raspberries waiting along the road for me to pick...the yard of the neighbor who makes "stone people" and has enchanting wooden sculptures hidden in her forest....the loneliness of a tractor, abandoned for the weekend even made me feel a bit melancholy. The cascade of maple tree seed pinwheels, and the lazy descent of one unlucky enough to get blown away... it all became a lovely collage of images that slowly calmed me as I walked along. I realized as much as the stress points in my life became a physical part of me, the beautiful things also do. I don't know why I never thought of it that way before. But now that I know, I vow to consciously seek out the ordinary beauty that lives all around us and allow it to become a living part of me.

If you're reading this on a blog feeder and want to see the pictures, come to the blog.

When Claims don't get paid

2011-06-28T07:18:00.000-07:00

I'm getting ready to send out another cycle of billing statements, which means I'm going to get a few phone calls from patients who are anxious to know why their insurance didn't pay for something that they think it should've. Let me tell you what we do when a claim is denied:

If it's denied because the service is supposedly not covered under the patient's policy, and I see that they've had similar services covered previously, I always call the insurance company. Often this straightens things out, and the claim is "reconsidered." This can take up to 6 weeks, believe it or not. If it turns out that whatever it is isn't covered, the patient gets billed.
If the service is denied because the patient has received the service within a period too short to be covered (ie, a complete physical within 2 years when the policy only covers one every 3 years), we have to bill the patient for the service. It's the patient's responsibility to know what their insurance plan covers.
Sometimes a claim is denied because the patient is no longer covered by that insurer. I always check this online - almost every insurer has a website where providers can at least check eligibility. If I get the information that the patient's insurance has been terminated before the "date of service," I attempt to call the patient to get their new insurance information. If they don't have any coverage, or they never return my call, we bill the patient for the visit.
Insurers are very wary about whether an office visit covered a "Pre-existing condition." This refers to a health condition that existed before you started coverage with them. Often we are required to send your medical records to the insurer so they can investigate it further. This can hold up your claim for literally months, and then, it can be denied. We have no choice but to bill you for this visit.
Sometimes a claim is denied because we made a mistake. Read this article (which prompted this post, by the way) and you'll see some of the coding errors that can happen. In our office, Dr. Nelson and Dr. Hahn code their own office visits in what we call an "encounter". In order for an encounter to be sent as a claim to your insurance company, they translate their visit notes into CPT (Current Procedural Technology) codes describing what they did during the visit that are linked to ICD (International Statistical Classifications of Diseases) codes that indicate what conditions they were treating. If these don't make sense when they're linked on a claim, it's rejected. Sometimes a CPT code hat's not appropriate for a patient might be used by mistake-- maybe they used a CPT for a preventive visit for a 12-17 year old when they were actually seeing an 18-year old. Usually this is a simple mistake on the provider's part. We fix it, send it back, and it's paid. This, too, can take 6 weeks for the insurer to correct.

There are other things that can happen, too. It comes down to this. It's the patient's responsibility to know whether or not they have insurance, and what is covered. When you check in at our office, you are asked "Has your insurance changed? Have you received a new card?" Before coming in to any doctor's office, you should make sure you're covered for what you're going in for, especially if it's a new office, or something you haven't had done before. It's also your responsibility to review the Explanation of Benefits that the insurance company sends you following any visit where you used your insurance. If there's something on there that you don't understand, you can call them and they should explain it to you. And it's our responsibility to send in correct claims, and to follow up with those that don't make it through for whatever reason.

If you get a bill from us that you don't understand, we will always discuss it with you. We keep copies of the Explanation of Benefits that we receive when your claim gets paid, and we can help explain those to you as well if you're having trouble understanding why an insurer didn't cover something. We know how confusing it can all be.

Hot Fun in the Summertime

2011-06-27T13:44:00.000-07:00

Ah Summer! Look at the jewel-like rows of gorgeous fruits and vegetables at the Farmers Market. Even the produce in the grocery store looks better than ever. But what happens if you just don't feel like cooking? It's too hot. You're too busy having fun. Unexpected company drops by and you'd rather chat than be stuck in the kitchen. It's too hot to eat! I know all the excuses! Well, here are some ideas to get you out of the kitchen while maintaining a healthy diet.
Look in your garden and pick the biggest, juiciest tomatoes you can find. Surely you've planted some basil along-side? Cook some couscous, and then while it's cooling a bit, cut the tomatoes into cubes and slice the basil very thinly. You can mince some garlic too. If you have some fresh mozzarella, cut it into small cubes and let it join the party you have when you toss it all together. Here's a recipe if you're feeling unsure. You could also use orzo or even regular pasta if you didn't have couscous.

Or, take those same tomatoes, garlic and basil and chop them all together. Slice your fresh mozzarella, and then slice some french bread very thinly. Toast the slices until just golden brown, and then heap the tomato mixture and fresh mozzarella on top. Instant bruschetta! You can also broil it for a moment to melt the mozzarella if you like. I could personally live on bruschetta all summer if I had to. Unless, of course, gazpacho were an option.

Gazpacho is a family favorite. In case you've never had this chilled soup, it's basically a tomato broth with lots of finely chopped vegetables. I usually take 2 cups or so of tomato juice, blend in a handful of cucumber, red pepper, small amount of onion and garlic, a teaspoon or so of balsamic vinegar, some olive oil, and whirl it in the blender until I've created a delicious broth. Then, I add chopped cucumbers, any kind of peppers, tomatoes, oregano, until it looks and tastes good. If I'm short on time, I stick in the freezer for 30 or so minutes; better still is letting it sit in the refrigerator for a few hours so the flavors can all blend. If you're new to making gazpacho, or feel like you need a recipe, either google "Gazpacho" or look at Cooking Light's offerings. The fact that you'll get practically all your daily requirements from this wonderful soup is just a bonus to the wonderful taste.

What's your favorite hot weather recipe?

This Just In: US Life Expectancy Lags Far Behind

2011-06-22T06:46:00.000-07:00

I wasn't surprised to read this article on WebMD last week about a study that shows that life expectancies in most U.S. counties are lagging far behind other countries. I understand the four reasons given that we're behind Spain, Norway, France, and Canada to name just 4 of the 36 countries that have a higher life expectancy than men and women in the United States: Income and education, access to healthcare, quality of healthcare, and preventable risk factors.

After I finished obsessing over the amazing animated map that shows, among other things, that in 2007, Morgan County WV men on average can expect to live to 74.1, and that Slovenia and Oman have better life expectancies than that, I decided to read the PDF of the study for more detail. I browsed through, reading that the geographic disparities in life expectancies vary more in the US than in Canada (which has a lot more wilderness than the US), more than 85% of US counties have fallen behind instead of catching up or doing better than other countries between 2000 and 2007, and despite all this, we outspend every country on healthcare. I finally reached the end where I read the sobering words "Given the poor performance of the US on health outcomes, a performance that is worsening each year, it is time for new thinking targeted to where the biggest impact can be made on health outcomes." Well, duh!

Preventable risk factors, according to the study summarized in the article, is the number one reason we are so behind. Smoking and obesity are the biggest risk factors that could prevent chronic illnesses such as diabetes, cancer, and heart disease. Other countries are doing much more than we are to encourage their citizens to give up bad habits, sometimes to the point of enforcing good health habits. For example, when obesity rates in France started to climb, the French passed laws that prohibited the sale of junk food in their schools, levied a tax on food companies that didn't encourage healthy eating, and banned misleading food advertising. French politicians considered the obesity rate to be so critical that they got local communities to govern their overweight and obesity levels in a program called Epode (this is a translated page, so excuse some of the awkward language!). Epode, from what I can gather, made everyone in a community a stakeholder in their fight against obesity. Leaders were held responsible for their community's progress. Allowing communities to direct their own program also allowed for cultural differences, so there was no directed format from the national government. Obesity was lowered by 25% in some communities in the 6 years the program's been running, and is considered a success.

The fact that we are finally putting really scary warnings on cigarettes makes me hopeful that perhaps our health leaders are paying attention. I hope states will go further and jack up the tax on these cancer sticks. And the next time I see one of those ads decrying possible taxes levied on soda, I just might write a letter to Congress encouraging them to do so. The woman in this ad insinuates that the government is telling us how to eat and drink with taxes. Americans Against Food Taxes, the organization that paid for the ad, is made up of all my love-to-hates: Burger King, Coca-Cola, Domino's Pizza, Wendy's.... who of course don't want you to spend your dollars on healthy food! Why these companies don't start offering more healthy food, with the unhealthy stuff as a minority of the menu, only makes me think they really are the devil that's trying to fatten us up so we can sizzle better in Hell in the name of "the gov'munt can't tell me what to eat!"

Realizing that most citizens are against government intervention makes me realize, sadly, that we have become a country that really does not care about each other. Being healthy doesn't just benefit the individual. Being a healthy individual has a profound ripple effect. Remember that elementary school teacher that missed more than half a year because she was sick all the time? Remember how miserable your kid was when substitute after substitute was marched in to babysit the kids? And what about the cost of taking care those patients chronically ill with a preventable illness? According to the study, the US outspends every single country in healthcare. I'm sure we can all think of someone in our community who smoked themselves into the lung cancer ward, or lives on oxygen. Or needs a scooter because they're too obese to manage the supermarket aisles. Who do you think is paying for that? It's us, folks. Us. Our tax dollars pay for Medicare and Medicaid; our health insurance premiums go up with the cost of healthcare. I'm not saying we should begrudge these victims their healthcare. I'm saying let's have fewer victims. We should be throwing some of that money into prevention, and enacting some real regulations that prevent poor health.

Healthcare providers can only do so much. You can lead a horse to water, but you can't make it drink water instead of soda pop. And, believe it or not, there isn't a pill that can fix everything. Until people start taking their health seriously, we will continue to outspend every country on the globe and die earlier from preventable diseases before most of them.

Rankins wants to get you ready for summer!

2011-06-03T13:17:00.000-07:00

It's easy to let your workout schedule get off-track in the summer with so much going on. Some of us have less structured schedules once school is out, relatives come and visit, and then there are your own vacations! Making a commitment to your exercise routine is sometimes easier when you join a class. Now Rankins is offering a great range of classes for you to participate in:
Bootcamp 1

Entry level cass to build endurance
This class is for someone who is new to exercise , has had an extended break from exercise (child birth, lack of fitness, etc), or does not exercise regularly.

Mon & Wed 7:00-7:45AM with Rachel (starts 6/20)
Tue & Thu 6:15-7:00AM with Morgan (starts 6/7)

Bootcamp 2

Build Strength & Lose Inches

This class is for someone who exercises regularly, but would like to improve their metabolism, strength, and fitness level.

Mon & Wed 6:15-7:00PM with Morgan (starts 6/6)
Tue & Thu 9:00-9:45AM with Tracy (starts 6/7)

Bootcamp 3

Final level class burn fat and tone muscle

This class is for someone who exercises regularly, is used to prolonged physical exertion and is ready to step up their workout!

Mon & Wed 5:30-6:15PM w/ Rachel (starts 6/20)

Cardio 1

Fitness Walking-suggested to be taken in conjunction with Bootcamp 1

This class is for someone who is new to cardiovascular exercise and would like to begin a regimen that will strengthen their heart and raise their fitness level

Tue & Thu 7:15-8:00AM w/ Rachel (starts 6/21)
Tue & Thu 4:15-5:00PM w/ Rachel (starts 6/21)

Cardio 2

Fitness walking/jogging-suggested to be taken in conjunction with Bootcamp 2

This class is for someone who regularly exercises, but is looking for a new regimen that will aid in fat loss and overall heart health.

Tue & Thu 8:00-8:45AM w/ Rachel (starts 6/21)

Ladies Circuit Training

New kind of workout 30 seconds on/off machines

This class is designed for all ladies regardless of experience in the gym. The circuit is always set up but the following times are when an instructor will be there to aid you through your workout.

Monday through Friday 8:00-8:45AM w/ Morgan
Mon, Wed, & Fri 1:00-1:45PM w/ Tracy

***This class is FREE for our members $6 drop in rate for Non-members

Speed & Agility

Designed & Trained by Andre McDonald

Andre McDonald is a professional football player who has come to Rankin fitness Center to personal train you! He has taken his football experience and designed a speed and agility class that is suitable for all sports! Get in shape/stay in shape before sports camps!

Monday & Wednesday 4:00-5:00PM w/ Andre

Healthcare in the Age of Zombies

2011-06-01T19:14:00.000-07:00

After two years of working in a medical practice, I'm still shocked when a patient is unwilling to try a diet and/or exercise plan to deal with their health issue before going on a prescription drug. I can sympathize with the patient who, despite a healthy lifestyle, has to go on medicine, as well as the patient who has a condition that can't be treated without medicine. They have no choice. But patients with chronic issues like diabetes, high blood pressure, and obesity owe it to themselves to try natural, self-driven methods of controlling their health problems. For one thing, it's less expensive, both for the patient, as well as the population at large. When patients have to get expensive medicine, insurers pay the price, and guess who they pass that price onto? Yep. All of us.

And while we're talking about money, do people really like taking money out of their pockets to make the pharmaceutical companies even wealthier than they already are? Sales of pharmaceuticals in the US amounted to $289 billion dollars in 2009, accounting for more than half of all international sales. How about taking care of yourself, and if you want to give your money away, fund the skatepark or your local Arts Council instead of those pharmaceutical companies :)

Also, why would anyone want to depend on something if they didn't have to? "Being healthy" might mean just 300 fewer calories a day, and 30 minutes of exercise. Wouldn't that be better, and healthier, than relying on medicines? Do people go on welfare before trying their best to get a job and take care of their families themselves? Because that's what drugs are like if you haven't tried a healthy lifestyle first: welfare for your body.

Enough of the sobering realism. What if we have a Zombie invasion? The CDC has even prepared a document to prepare us for this event! And sure, it just makes sense to stock up on your medications, but they can't last forever. What do you think will happen when your meds run out? By then, the pharmaceutical companies have probably shut down, and all the workers have been eaten. Are you going to be fit enough to run from a Zombie? Or are you going to be getting sicker and sicker, unable to run from the Zombies because you can't have your pills and you've ignored your fitness?

I'm just sayin'.

Addendum to yesterday's rant

2011-05-27T12:28:00.001-07:00

Of course I had to google and see if my blog made it to the search engines yet. It didn't, but I found this. It kind of made my day!

My day to vent

2011-05-26T14:28:00.000-07:00

This blog is for you, patients and fans, but sometimes I just need to vent, ok? One of my jobs is making sure that Hahn and Nelson Family Medicine gets paid. Usually things go pretty well but today was my day to go through unpaid claims and figure out why we didn't get paid. I have to tell you, Carefirst and Blue Cross Blue Shield patients: your insurance is a big headache for many reasons. But today was a killer.

Maryland just passed a law last year as part of healthcare reform that allows providers to bill insurance companies a small extra charge whenever they see a patient outside of "regular" business hours. Regular business hours are after 6 on weekdays. We see patients until 7 on Tuesdays and Thursdays, and as you know, our doctors will occasionally see patients on the weekends (and even make a house call now and then!). The law was passed partly to encourage providers to see patients in the office rather than have them go to the more expensive emergency room. If you've ever had to go to an ER, you know it's way more expensive than your friendly physician's office, and well, not nearly as friendly.

So we saw a young patient in our office one recent Saturday. We billed the extra $10. Whoopee! Ten dollars doesn't seem like a lot does it, when you consider the provider interrupted his busy Saturday, drove 6 miles to and from the office....? Anyway. Carefirst didn't pay it because this patient is "self-insured" and apparently the law exempts self-insured policies. This made me angry. They didn't *have* to pay it so they didn't. Well, guess what Carefirst? We didn't *have* to see that patient in our office. We could've sent her to the ER, or told her she'd have to wait until Monday to see a doctor. So I wrote a letter to the Senior Vice President. Here's what I said:

M. Bruce Edwards
Senior Vice President, Network Management
Carefirst

We recently filed a claim containing the CPT 99050. It was returned with that part of the claim unpaid. After filing an appeal, we received a letter stating that those patients who had self-paid policies would not be getting that CPT reimbursed, and that it is not required to be reimbursed by law.

Just because you aren't required by law to reimburse this doesn't mean you shouldn't. We are saving your company significant money by not directing our patients to emergency rooms and urgent care facilities after hours. In this case, a young patient was very ill on a Saturday, Instead of the office visit we billed Carefirst, she could've gone to an ER and been billed much more. Furthermore, she would've had to deal with a strange doctor, which is not ideal especially when dealing with a small child. Or, she could've stayed home until Monday and gotten worse.

We are not required by law to provide after-hours services but we choose to do it, in part because it's a symbol of how much we care for our patients. We do this regardless of what kind of insurance our patients have, or even if they have no insurance. It isn't always economically advantageous to do so, especially given that we practice in a rural area. We think it makes us a better practice. We're disappointed in you as an insurer that you don't strive to do the same for us and our patients.

So there. I got to blow off steam. And by the way, don't worry. This is not a charge we're planning on passing on to our patients if your insurance company decides you're not important enough to pay it. Because you are important enough to us.

Take an Art Drive this weekend

2011-05-23T08:15:00.000-07:00

Take the Berkeley Springs Studio Tour this weekend to indulge in our area's unique beauty, both natural and man-made. As you meander through Morgan County, admiring the wildflowers, lush green foliage, and the rushing of Sleepy Creek, you can stop by a multitude of art studios and see what our local artists are up to. There's nothing like gazing at a beautiful work of art, trying to imagine what inspired the artist, and understanding the hard work that went into a masterpiece; many of the artists offer demos of their work and intensive tours of their studios. For example, walking into the Hsu Studio is like walking into fairyland; there are sparkles of light everywhere as the sun dances over the amazing anodized aluminum works. Best of all, Jean Paul and Carol Hsu offer a guided tour of how their jewelry is made. Or check out Frog Valley Artisans, an artists' collective where you can see high-end metal sculpture, stained glass, pottery, photography, and more all in one place. Warning: after you fully appreciate the work and thought that goes into artwork like this, you may not ever be able to buy mass-produced items again!

"Archaeologists have not yet discovered any stage of human existence without art. Even in the half-light before the dawn of humanity we received this gift from Hands we did not manage to discern." Aleksandr Solzhenitsyn from his Beauty Will Save the World: The Nobel Lecture on Literature

Art is good for the soul. Looking at any kind of beauty is relaxing, inspiring, and revitalizing; it's especially so when you get to meet the artists responsible for the work. So take some time out this weekend for this special opportunity.

Healthy eating when dining out

2011-05-21T07:44:00.000-07:00

More and more meals are being eaten outside of the home these days. In fact, the typical American consumer now is almost as likely to spend just as many dollars on food away from home as on food prepared at home. The fact that the obesity rate is climbing just as fast as the rate of dining out may or may not be linked; regardless, it's even more important that you scrutinize your choices when dining out. When you're eating at a restaurant, you are much more likely to make impulsive, unhealthy choices than when you're carefully planning your family's menu at home. You're not always sure about what undesirable ingredients, or method of preparation, has gone into an entree when you order from a restaurant. So here are some simple rules of thumb to keep you on track while dining out:

First and foremost, order small! I love Five Guys but their regular burger is just way too big. So I order a Little Burger, which still packs 480 calories (vs the regular, which clocks 700).
One of my favorite ideas comes from my mother and her beau, Dan. Instead of ordering two big entrees, they order one to split, sometimes with appetizers or a salad to round out the meal. My family also really enjoys sharing a dessert.
If you're dining by yourself, or your dining partner doesn't want to share an entree, have the waiter box half your entree right away. You can have it for lunch the next day.
A little advanced planning can go a long way. If you're eagerly anticipating a date night, but you're concerned about overeating, try going to the restaurant's website and check out the fare beforehand. You can plan a few healthy choices instead of being overwhelmed when you get there.
Start with a salad and send the bread basket away. The vegetables will tell your belly it's getting full, but it'll be full of vitamins instead of relatively empty simple carbs. Always order dressing on the side.
If you're choosing alcoholic beverages for your celebration, remember that 1 gram of alcohol has 7 calories! Mixers usually have a lot of sugar so be careful when considering a mixed drink. A glass of wine or a light beer are better choices because you know exactly what's in them. Also remember that alcohol in general lowers your inhibitions, and those inhibitions could include a bad decision about bingeing on something you wouldn't normally consider. Check out this article on WebMd for more.
And always, always, always, allow yourself to indulge now and then! Indulging in a favorite delicious meal with good friends or family is a wonderful way to celebrate a special event. Restricting yourself too much is just going to make you feel deprived and could lead to bingeing later. And sometimes it really does make sense to eat dessert first!

Salad days are here!

2011-05-18T12:12:00.000-07:00

The approaching warmer weather (it's really coming, believe me!) means you're going to want to spend less time cooking over a hot stove. It also means a plethora of wonderful sun-ripened produce, either at the Farmers Market (every Sunday in Berkeley Springs!), from a roadside stand, or even from the good old grocery store. Why not try some main dish salads for dinner over the next few months? You already know how to toss a salad, using whatever looks good. But ramp it up a notch, and make your own dressing. A simple vinaigrette can be nothing more than 3 parts oil to one part vinegar, or you can get fancy and experiment with different flavored vinegars such as balsamic, fruit-flavored (raspberry is really nice), or one of the wine-flavored vinegars (try to match it to whatever meat or other main ingredient that you're using). Add some herbs, fresh if you have them, some salt and pepper, taste and correct the seasoning, and you're done.

Besides tossed salads, you might try a composed salad. One of our family's favorite composed salads is the Salad Nicoise. You don't have to use fresh tuna like this recipe does; just use a good quality canned tuna if that's what you have. But the vegetables should definitely be fresh....Serve with a nice homey bread and maybe a glass of wine, and it's suitable for company.

Or try a chopped salad. You'll literally load your chopping board with whatever you have on hand and chop it all into uniform, small pieces. Here's some ideas to get you started:

Lettuce, avocado, red onion, bacon, red pepper, spinach, chives, cheddar cheese, tomatoes, cucumbers. If you want to see a demo of how it's done, check out this video. I find that when the ingredients are chopped, you often don't even need dressing, since the ingredients meld together so nicely on their own.

Salads are fresh excuses to get creative with your ingredients, creating a healthy meal in the bargain. Have fun!

Zumbathon for the Bikers/Skaters

2011-05-13T12:16:00.000-07:00

Happy Friday the 13th!
The blogger is back. She's been out of town, and then, as soon as she got home, she got sick! But that's all behind us now, and it's time to start writing again!
I wrote awhile back lauding the benefits of having a bike/skate park in the area. Bikers and skaters need a safe and legal place to practice their sport just as much as kids who play soccer and football. Giving them a safe place to practice makes the sidewalks and streets safe for everyone. Entrepreneurs will have a chance to profit by opening businesses that cater to the sport and existing shops can stock items for the bikers and skaters that are sure to flock in droves to check out the new park. Enthusiasm for the park is building, evidenced by the number of people who have shown up on workdays to help plant a rain garden and install ramps. And now that enthusiasm is growing in new ways: watch for a plethora of fun fundraisers coming up this summer.

One of those events is a Zumbathon that I plan on participating in on June 26th. Zumba mamis will be asking for people to sponsor them to do Zumba for 2 hours! If you're interested in sponsoring me or anyone else, shoot me an email and I'll get you set up. Also coming up is a Blender at the skatepark on June 18, featuring bands and skater demonstrations for just a $5 donation. If you're thinking of joining Rankins Fitness Center, they recently posted that they will donate 15% of any new memberships to the Park.

OK we'll be back to our regularly scheduled blogging next week. Tune in and watch for new recipes, fitness ideas, and health tips.

What's for dinner? Ask Google.

2011-04-18T08:19:00.000-07:00

Monday is recipe of the week day here on the blog. But what happens in real life when you're trying to get inspired to make something for dinner and can't think of anything? Right. That's what happened to me today. Luckily, I have some things to fall back on. One of them is my computer where I have iGoogle as the default home page in my browser. iGoogle allows users to choose which "Gadgets" to display within its frame, including news, weather, stocks, sports, and recipes! I love looking for recipes online, but I love it even better when a good recipe greets me when I turn on my computer. One of my iGoogle gadgets is "The World's Healthiest Foods," which each week features a healthy food. This week's "healthiest food" is lamb, and there on my iGoogle page is a recipe for 10-minute Rosemary Lamb Chops. Yum!

To get started, go to igoogle.com. If you don't have a Google account or an iGoogle page, you can click on the Get Started link. Once you've created a page, you can click the "Add stuff" link on the upper right part of the page and find interesting "gadgets" to add to your page and they'll be there everytime you go to this page.

So what am I making for dinner tonight? I thought I'd save the lamb chops for the weekend when we can relax and really enjoy them, but tonight I'm going to try these Southwestern Turkeyburgers. I love anything with avocado in it, and it's under 350 calories, so it's sure to be a winner. Bon appetit!

Fitness and Technology Update: Podcasts!

2011-04-15T09:09:00.000-07:00

Did you ever wish you could have a fitness coach in your pocket, or even better, right in your ear, telling you what to do? Well, you can. If you have an iPod or other device that plays MP3 files, you should check out podcasts. Podcasts are recorded programs and you can find one for just about any interest you might have. I download podcasts of my favorite NPR shows such as This American Life and Radiolab. But lately I've been letting my iPod guide me through my Pilates and Yoga practice.

Admittedly, using an audio podcast is probably not the best introduction to a new fitness program. To learn Yoga or any other technique, you probably want to start with classes, or at the very least, a DVD program. You need to learn proper technique by watching and doing, and ideally, getting corrections from a real instructor before doing any kind of exercise. I've been taking Yoga and Pilates for years, so I feel very comfortable, for example, when a voice in my ear prompts me to get in to the "plank" pose, or instructs me to do "the hundred." However, I don't always feel motivated or organized enough to put all those poses and exercises together to form a routine. That's when I pick up my iPod and get to work. I love this set of under-30 minute routines by Phoebe Kelly. Phoebe has a very successful practice in New York, especially with private clients whose complaint was only that they couldn't meet with her as much as they wanted. Her answer to them was this set of podcasts to keep them limber in between her visits. Her gentle (but firm!) voice flows through each exercise, reminding you when to breathe and other helpful hints. You might find it helpful to perform the exercises in front of a mirror so you can relate what she's saying to what your body is doing. I always feel strengthened, lengthened, and relaxed after doing these routines!

The website that hosts Phoebe Kelly's Pilates and Yoga podcasts has a plethora of exercise options. Do you have a stationary bike sitting idle in your house? Get that thing spinning by checking out one of the cycling podcasts. Going out for a walk and you want to stay focused on your fitness? There are a ton of podcasts to keep your arms and legs swinging. The podcasts in iAmplify are reasonably priced, from $2.95, and there is no membership required.

You can find podcasts easily if you have iTunes. In iTunes, click the Store link, and use Search to find the type of exercise you're interested in (eg Strength training). Then click the "Podcasts" link to filter your results to show only podcasts (rather than music or movies, etc) for that topic. Note that there are also video podcasts here; this would be great if you have an iPad or computer in your exercise space. Best of all, most of these podcasts are free. Once you subscribe to a podcast, depending on how you have iTunes set up, each time a new podcast is created, it will automatically download to your computer. Then you just sync them to your iPod or other device and it's all yours.

Podcasts are becoming a regular feature on some websites as well. Try using whatever search engine you like to find one. For example, I typed "workout podcast" into Google, and look what I found.

So don't just lie on your couch plugged in to your iPod! Find a podcast and start moving today.

Healthy for the planet=healthy for us ALL

2011-04-07T05:28:00.000-07:00

So it's Thursday and I've completely missed my regular Monday-Wednesday columns. I'll write my fitness column (usually on Tuesdays) tomorrow. In honor of Earth month, I'm going to try to stay on track and feature earth-friendly practices on "random Thursdays". After all, if the planet we're living on is healthier, wouldn't you think it would be good for the beings that live on it?

There's a new kid in town. Haulin' Glass is offering a service that I've wanted since I moved from the DC area to Berkeley Springs: recycling pickup. When I first moved here in 2000, there wasn't any recycling at all. However, within a few years, we were able to gather up our recyclables and haul them to our closest school on a Saturday every month. Then a couple of years ago, the Charles Biggs recycling center opened on 522S, and we're able to bring them there anytime they're opened. That was a bit more convenient, but still, the recycling has a tendency to pile up on the weekends when we're not able to get there when they're open. I recently discovered Haulin Glass on Facebook and, much to my delight, read that they were offering pickup service! I subscribed, and got in touch with Ashley Jones and got to ask her a few questions.

How has response been so far? We've been receiving really great feedback from residents and the community in general. Most of it is along the lines of "it's about time!" We gave a presentation to the town council and they are totally on board, Morgan Sanitation supports the idea, various publications and media avenues (such as yours) have offered free publicity. It's just been really great knowing that so many Berkeley Springians are happy to have this service and are as passionate as we are about doing some good.
What made you decide to offer this service? Just like many of our customers, our recyclables kept piling up and eventually took over the basement. Who knew it would be such a hassle to get them to the center? One day I (Ashley) called Adam and said, let's just start picking up recycling, there has got to be more people like us out there! Within a few weeks we sorted out details, advertised, and hoped people would respond. Thankfully they did.
Have you had a business like this before? Never. This was entirely new to us. I knew a bit about starting a business but that's where our experience ended. Needless to say it's been quite the learning experience, but a surprisingly smooth one.
Where are you from? Adam is from a little southern West Virginia town called Fraziers Bottom. Although I haven't always lived in Berkeley Springs, I've been here for most of my life and claim it as my hometown.
What's your background? I knew this question would get asked. One facebook friend sent us a message that simply said "who are you?" I'll admit I wanted that stuff to stay in the background, but realized it's good for people to be able to know the people behind the business. I - Ashley Jones - have been in Berkeley Springs most of my life and graduated from BSHS in 2006. Although I moved around a bit, I ended up attending Shepherd and graduating with a business degree in December 2010 and decided to stay in Berkeley. I currently take care of Haulin' Glass and work for Mountain View Solar & Wind here in Berkeley Springs. My boyfriend, Adam Keeling moved here in 2006 when he was offered the job of kindergarten teacher at Pleasant View Elementary School, where he continues to work today. He's the face of the company and does all of the collecting. He's a super friendly guy so if you see him emptying your bins feel free to start a conversation, I promise you'll be entertained. We have no kids, just a little dog named Belle.
Anything else you want to tell the people?: I really want to stress that our goal is to encourage recycling by making it easier. It's amazing to see how much trash can be saved from the landfill and reused in an unbelievable amount of ways. Although we do have a few guidelines, we want to work with anyone who is willing to work with us. Need different sized bins than what we offer? We'll work around that. Do you really want to recycle but can't afford our prices? Let us know. Wish we would do this instead of that? Tell us about it. We're absolutely open to suggestions, because you probably know as much about this business as we do, and may have some better ideas. We're aware that the relationship between collector and customer is a negative one, if you will. What makes things easier for the customer makes it harder for the collector and vice verse, so we're constantly looking for ways to find the best balance between the two.

I think it's great that these young people have found it in their guts and heart to start this business. You can get in touch with them via their website or give them a call at 304-258-6351 for more information.

Healthy hint of the week: Make the natural choice

2011-04-01T13:38:00.000-07:00

Artificial dyes are in the news again. You've probably seen the pictures of the child's handwriting before and after he stopped eating foods with artificial colors by now (and by the way. How's this for irony: the news video linked above included an ad for Pillsbury Toaster Strudels. Yep, they have Red 40, Blue 1, Yellow 5.)
The FDA has decided not to ban these artificial colors, citing lack of evidence that there is a link between the dyes and hyperactivity in children. So it's up to us to decide whether or not to buy foods containing them.
I prefer not to purchase foods with artificial ingredients. Why would I want to eat something manufactured, when the real thing is so delicious, usually cheaper, and really, not that hard to prepare? I mean, am I really going to spend $2.99 on a 9 oz packet of Welch's "Fruit Snacks" which contain corn syrup, sugar, modified corn starch, natural and artificial flavors, carnauba wax, red 40, yellow 5 and blue 1 when I can just buy the grapes for $2 a pound? It doesn't make economical sense, or healthy sense.
My rule at home is, if it's got more than 6 ingredients and I can't pronounce at least one of them, it stays on the grocery shelf for some other sucker.
Here's what's in my house right now for snacking:

bananas
apples
oranges
Nature's Choice (Martin's brand of "natural" and organic foods) tortilla chips, pretzels, and microwave popcorn
OK, I'll admit to the two boxes of Girl Scout cookies in the freezer.
Almonds (my favorite cheat food)

Now and then I absolutely crave those orange Doritos. And as far as I'm concerned, now and then is when those things should be eaten. I'm not going to be a nut about it. But I'm not going to fill up my grocery cart with boxes of "food" instead of bags of good, juicy produce, healthy cuts of meat and fish, and beans and rice. If you don't like to cook, or are too busy, there are plenty of books and online resources for easy to make recipes. I like the rule for grocery shopping: shop the outer aisles for the majority of your food (dairy, produce, meat) and skip entirely the snack aisle. And I pretty much stick to my 6 ingredient rule.

So that's my rant for the day! See you at the grocery store!

Random post of the week: Our patients are Royalty!

2011-04-01T11:08:00.000-07:00

Dr. Hahn may think he's the King of Wellness, but our patients are the real Royals. Enjoy this picture of one of our wonderful patients, Herman Parks getting the royal treatment at one of his visits. We have a crown to fit you!

Fitness post of the week: Tech week!

2011-03-30T08:44:00.000-07:00

Technology is wonderful and I am a nut when it comes to new gear. I'm now eagerly awaiting the arrival of my iPad! However, when you think of technology, it's not always something you associate with health and fitness. Video games, iPods, smartphones: images of people glued to their computer screens and their iPhones just make my mind reel with obesity statistics.

However, consider this. I've had a Wii for about a year now and I haven't played any video games where I sit still. I bought it specifically to try out some of the fitness modules. After trying a few, I'm now using The Biggest Loser module. I've been following this program at least loosely for about a month. (Note: I am not good at compulsive behaviour - has my family ever done anything exactly the same for the holidays, ever? No). I needed something new and different, because especially around this time of year, I get incredibly bored with exercise. Too nasty outside to hike. My exercise DVDs are all old. My Zumba class isn't happening tonight. And to top it off, this month has been incredibly, ridiculously busy. You know all the excuses!

So, I created my profile, weighed in, answered all the questions, and got started. It took me awhile to get used to the menu, but as I worked it, now I know what I'm doing. At first, I elected full body workouts at the "Challenging" level, 4 times a week for 60 minutes. I included the Fitness ball and exercise bands as options. As I scanned the workout calendar, I saw that I'd be doing various workouts ("Box-Fit", "Full body", and "Yoga) throughout the week. However, as I worked my way through, the workouts all seemed pretty much the same combination of exercises, with emphases on certain ones. For example, when doing the "Yoga" workout, I was doing more planks and downward facing dogs, but I was also doing side leg-raises and boxing. Box Fit included lots of strikes and punches, but also some bicep curls. Although I enjoy most of the exercises themselves, they became a bit repititious, and the fact that my "trainer" kept repeating the same encouraging words whether I was working my butt off, or sitting on it, was a bit un-encouraging. At the "Challenging" level, they're probably not as strenuous as what I'd get from a machine at the gym or from lifting free weights but I had to admit I felt pretty good when I was done. I also liked the weekly feedback of weighing in, and some of the Challenges were fun.

I didn't participate in the recipe section, since we already eat very healthy meals. I liked most of the Health and Lifestyle hints, and even tried a few. However, after about 2 weeks, I realized I was getting bored, and I had to change things up a bit.

So, I went back into the profile information and changed my workouts to 30 minutes each. I decided since I did enjoy the exercises, I should keep doing them just to assure that I was working out all my muscle groups at least 4 times a week. But I needed to supplement those 30 minutes in order to get the 60 minutes I need in order to maintain my current weight. Also, I wanted to get more Pilates and Yoga workouts....

So I went back to my Wii's "Home" menu, where I can access all my Netflix watch-instantly videos to stream to the Wii. This is available to current members for no additional charge, or, if all you want are the instant movies, you can join for just $7.95 a month. I've found a plethora of exercise videos available there. Willa and I really like the videos that are divided into 10-minute sections such as "10 solution: Kickbox Boot Camp." I've found that mixing it up, either with these Netflix instant-watch videos, or videos in my current DVD library, keeps me interested enough to push myself a bit more than I might.

Next week I'm going to post about another technological option: podcasts! Stay tuned.

Recipe of the week from Hahn and Nelson Family Medicine: SPRING rolls!

2011-03-28T08:23:00.000-07:00

When I was shopping at the Martin's in Hagerstown, I noticed that they're stocking the rice papers used for spring rolls. I was so happy to see this; I used to have to order them from an online Asian grocery.

Fresh spring rolls are so versatile and healthy. Unlike their fried cousins, fresh spring rolls are made by softening the rice paper in hot water. Then you wrap up whatever delectable filling you like. There are a lot of good recipes on the web for fresh spring rolls. Or get creative and take a look in your refrigerator; you'll surely find something to roll into a delightful appetizer.

Don't be afraid of the rice papers. They aren't quite as delicate as they look. You will want to take care of them when you get them home, because they can break easily.

When you're ready to make your rolls, first have all your ingredients ready to go. Rather than chopped, your ingredients should be very finely sliced. Aim for very fine matchsticks approximately 1/2" long. You know those carrot shreds you can buy in the grocery store? They're the perfect size. Don't use anything too wet. It might help if you give the wetter ingredients, such as cucumber, a light pat with a paper towel after chopping them. Here are some things I've wrapped: almost ripe avocados, cucumber, raw asparagus, the packaged coleslaw cabbage, shredded lettuce, spring onions, chopped, cooked shrimp, cilantro, the aforementioned carrot shreds, and peppers. You can also fill the rolls with those bean thread, or cellophane noodles after they've been soaked properly. They give your rolls a nice texture. I like to have each ingredient in a separate dish; some people just throw them all together.

When you're ready to roll (!), fill a pie pan or other shallow dish with very hot water. I also keep my tea pot full of hot water to refresh it if I'm making a big batch of spring rolls.

Then here's how it goes:

Dip one rice paper in the pie pan of hot water, count to five or six, flip it with tongs, count again, and then use the tongs to deftly lift it out and onto a large, clean plate.
Smooth it out a bit, and then put in a few tablespoons of filling near the middle. Try to keep the filling so all the matchsticks are vertical -- otherwise they might poke through the rice paper.
Then fold in the ends and starting at the bottom, roll it up nice and tightly. There are numerous videos on Youtube that demonstrate this; here's one that doesn't have any smutty comments after it!

As you wrap your rolls, occassionally you may rip the wrapper. Don't worry -- just keep rolling. If the roll falls apart, just cut it in half, or eat it! Just go slow. This is not something you're going to want to rush, so make these on a day you can relax and enjoy the experience.

You'll probably want to make a dip. The dip can be spicy, sour, or sweet. Try experimenting with combinations of soy sauce, rice wine vinegar, chili garlic sauce, or sesame oil or just use one of the recipes in the link above.

Once you're done, you have the perfect picnic food, or party appetizer. I usually cut the spring rolls in half with a very sharp knife right before serving; otherwise they get eaten way too quickly! I've put a plateful of these down at a buffet, and by the time I got to them in the line, they were completely gone. So one final hint: If you want any for yourself, put some in the refrigerator!

Random post of the week from Hahn and Nelson Family Medicine

2011-03-25T17:28:00.000-07:00

What's going on at Hahn and Nelson Family Medicine? Well, plenty, actually. We have just been chosen to participate in Maryland's pilot Patient Centered Medical Home project. What does this mean?

Basically, it means that all patient care is coordinated through your primary care provider while making sure certain quality measures are being met. So when you come and see Dr. Nelson or Dr. Hahn for a problem that needs a specialist's care, we will follow that care closely. The specialist becomes part of the team that takes care of you.

Hahn and Nelson Family Medicine was one of only 50 family practice offices in Maryland chosen to participate in this pilot program. In order to be considered for this pilot, a practice had to meet a number of requirements. Partly because we're already a state-of-the art practice, we were able to qualify. One of the requirements was that we use Electronic Medical Record (EMR) software to maintain patient records. The EMR had to meet criteria such as providing decision support, tracking of labs and other tests, and implement e-prescribing. The Oxbow EMR (described as "Coolest Product of 2010" by Health Management Technology!) that we use more than satisfies these and other requirements. Other requirements, such as always having same-day appointments available for acute illnesses, offering round-the-clock phone response from a provider and re-visit planning and after-visit follow-up for care management are already part of our mission to provide compassionate, highest quality medical care in an efficient and professional manner. So although in many ways we already meet the requirements of this program, we will now be implementing them using measures to prove that this team-based, patient-centered care could be a model for the future.

If you'd like to read more about the Maryland PCMH pilot project, including the exact criteria for becoming part of the project, just follow this link.

Healthy hint of the week: Sleep more, eat less

2011-03-23T13:56:00.000-07:00

Of course, the more you sleep, the less you might do of anything. That doesn't mean you should sleep all the time just to lose weight (Although, look what happens to a fat little caterpillar when he curls up in his cocoon! Hmmmm....)
But think about it. What do you do when you're sleepy, and you want to watch the last 1/2 hour of that movie? Your tired brain might even trick you into thinking it's hungry instead of tired. You might grab some popcorn to munch on, or a soda to keep you awake. And eating something might even work for a little while when your mind is distracted from being tired. People don't always make the best choices when they're fatigued, either -- when you're tired, you're more likely to choose the easiest thing to eat or get ready to eat, and that's not always going to be that bag of baby carrots, believe me. In a recent study, 13 men and women were kept on the same diet for 4 days for two sessions each. For one of those sessions, they got plenty of sleep. For the other session, they were only permitted to sleep for 4 hours. At the end of the 4 days of both sessions, they were allowed to eat whatever they wanted. On the 5th day, people consumed about 300 more calories when they hadn't slept as much. Furthermore, most of the calories they chose to eat came from fat! Just imagine what a steady diet of sleep deprivation could add up to. Very interesting! Here's something else interesting: did you know that some foods can prevent you from sleeping? Watch this slideshow for more information. Good night! ZZZzzzzzzzzzzzzzzzz

Fitness Pick of the Week: Ladies Boot Camp!

2011-03-23T08:29:00.000-07:00

I realize that my last week's fitness post was mostly directed to the women. And so is this one. If any of you guys would like to donate some thoughts on your favorite fitness activities, please email me! I'd love to feature guest writers from time to time.
Rankin's Fitness Center test ran a Boot Camp for women a few months ago and it was a huge success. I went to the gym one night for what I thought was going to be a quick, quiet workout, and the whole place was buzzing with Boot Camp women. I felt inspired and invigorated just watching them! Now Rankins is running this as a regular program on two levels:

Level 1 for those who are new to boot camp: Classes are designed to be completed between 30-45 minutes

Level 2 for those who have already taken one of our boot camp classes or are regulars at Rankin Fitness Center; these classes are designed to be completed between 45-60 minutes.

Level 1-Tuesday & Thursday from 6-6:45pm

Level 2- Tuesday & Thursday from 2-2:45pm

Monday & Wednesday from 5-5:45pm

Sign up online at www.rankinptfc.com or stop by the front desk! The cost is only $55.00 for all 8 weeks/16 classes.

Spaces are limited to 15 per class and fill up quickly, so don't delay!

Recipe of the week: Roasted Cauliflower with Pasta

2011-03-22T13:09:00.000-07:00

We all love cauliflower at my house, but I know some people who don't care for it. Could it be because when they've had it, it's been boiled out of recognition? Roasting vegetables takes the taste to new heights, especially when you add your favorite herbs. I haven't tried this recipe from my favorite website yet, but I plan to tonight. I'm going to add some fresh Campari tomatoes, and make the olives optional since a certain person in my family can't tolerate them! I'm also going to add some rosemary (because I like it better than parsley) to the cauliflower while it's roasting. I don't usually tweak recipes until I make the recipe "straight" the first time; however, I already have a family favorite cauliflower pasta recipe that uses fresh herbs and tomatoes (but the cauliflower is steamed instead of roasted), so I feel pretty safe playing with it this first time. I'll post the results tomorrow. In the meantime, what's your favorite way with pasta?

Free for all day! Skate parks are good for the community

2011-03-17T17:38:00.000-07:00

Did you know that skateboarding is one of the fastest growing sports in the US today? Yes, I said "sports." Some people still don't realize that this exciting activity is athletic in nature if you can believe that. Communities have realized the benefit skateparks serve to the effect that 3 new parks are built every week in the United States. These forward-thinking communities realize that providing kids (and some adults!) a place to skate is a lot safer than allowing them to ride in the street or in other public spaces. When kids get a public place to skate, not only is damage to property diminished, but kids also develop a sense of ownership and pride in the place designated for them to skateboard. This is especially enhanced when the skaters are given a role in planning and creating the park. Building these athletes a skatepark provides them a safe place to practice with their friends, realize accomplishments and improvement, and grows their self esteem.

Skateboarding is not a traditional team sport, which could be why it's not seen by some as important as sports such as football or baseball. It's relatively easy to get a community to support the local football team. But not all kids are interested in team sports, and that should be respected. Think about it: what if kids that were passionate about soccer didn't have a soccer field? Don't you think they'd be playing soccer in the streets, in the parking lot, wherever they could? Some adults seem to think there's something wrong with kids who want to skateboard; they see it as a rebellious movement. "Why can't those kids just be like all the other kids, and join the football team? Why can't they just play video games?" Society has always had a problem with people who don't want to join the familiar and choose to be outsiders; skateboarders seem to fall in to this category whether by design, or default.

The point is this. If they had a place to practice their sport, they'd be off the street. The police could turn their attention to more important issues. We could go watch the athletes, and support them. Some young entrepreneur would notice all the area youth gathering there, and open up a skateboard store, maybe a cafe. Our town could attract skateboarders for miles around, and those skaters and their friends and family would come here. It can happen. Here are some links to other community skateboard parks:
Carroll County Skatepark
Charles County Skatepark
Berkeley Springs could be on this list. You can call the Morgan County Parks and Rec at 304.258.8540 and/or check out the Facebook page for the growing community of people who are trying to make it happen and get involved!

Health tip of the week: PETS!

2011-03-16T16:54:00.000-07:00

Buster and Max chillin' after their walk

I was just thinking about how fun my life is because of my dogs and cat, and I saw this article on the WebMD site about how people who walk their dogs are healthier overall. Let me tell you about Max, our almost-8 year old Humane Society dog. He's about 45 pounds of loveable mutt, and he goes with Matt on his 8 mile runs at least 3 times a week. I know there have been mornings when Matt would've loved to sleep in, but as soon as his eyes start to flicker, Max is all over him, tail pounding the bed as if to say "Let's go! Don't wimp out on me! I know you're going to work all day and I'll be stuck in this house all day, so get going NOW!" I'm not a runner, but I take Max and our newest fur baby (Buster) out for walks at least 3 additional times a week, at least now that the weather's getting better. We enjoy walking the relatively flat surface of the canal trail in this mud season, but when the weather looks a bit better, we'll be joining Anne and her dog Gracie at Cacapon Park for some more strenuous walks on those beautiful trails. It's rather obvious to me that one of the responsibilities of having a dog is providing exercise for her/him; it's just a nice coincidence that this is also good for us!

Besides the exercise benefit, did you know that owning a pet can help lower your blood pressure? Petting and brushing your best friend's coat, having someone that loves you unconditionally and is waiting for you at the door without any other demands besides perhaps a treat and a pat on the head, and playing with your pet, is a proven stress-buster.

For probably many of the same reasons, pets can help battle loneliness and depression. According to an article on WebMd, researcher Judith Siegel, PhD. reports in her study that pet owners with AIDS are far less likely to suffer from depression than those without pets: "The benefit is especially pronounced when people are strongly attached to their pets,"

Did you know that kids raised with pets are far less likely to suffer from allergies and asthma than those raised in a pristine, non-animal environment? According to this article on the CNN website, 5.5 percent of kids without pets were allergic to cats compared with almost 12 percent with one cat or dog. That number dropped to just under eight percent when two or more pets were in the home.

Sure, pets take a lot of time and care, but with all these benefits and more, it just might be worth a trip to your local Humane Society! If you absolutely can't have a pet, why not think about volunteering at a local shelter, or offer to pet-sit for a friend. And if you already have pets, give them an extra pat on the head tonight.

Bellysima!

2011-03-15T20:14:00.000-07:00

If you're looking for something completely different, something you definitely would not call "routine," have you ever considered taking a belly dancing class? Belly dancing (and I'm talking mostly to the women here, guys), is a great way to tone your abs and get in touch with your inner grace and femininity, among other things. Belly dancing is based on natural movement, and exercises every part of your body (not just your abs!). Because it's low impact exercise, women of every shape, size, and age can enjoy it. Depending on how vigorously you exercise, you can burn lots of calories, too. The longer you practice belly dancing, the more you'll begin to appreciate your strong core muscles, and understand how they work with the rest of your body. It's not unlike yoga (in fact, many belly-dancing classes use yoga stretches as a warm-up) in that way.

Angela Petry has been teaching her unique bellydancing technique called Bellysima for more than a year in Berkeley Springs. She offers a beginners' class on Tuesday evenings at the Ice House, and a more advanced class on Thursday mornings at the inMotion Dance Studio. She also offers occasional Tribal Bellydancing classes ("Tribal" refers to an American-style of bellydance that is more folkloric than the cabaret style that you might be thinking of.) We dance mostly to Middle Eastern music, but occasionally mix it up with club music. Comfortable clothes are a must: generally, anything you'd wear to a yoga class would be fine here. Of course, you must have a hip scarf, with jingles or not -- what good is a hip shimmy without something pretty to show it off?! She has also been teaching us to dance with veils and zils (finger cymbals).

A typical class starts with an extensive warm-up using a good mix of gentle and more intense yoga stretches. We spend a lot of time working on muscle isolations: this means moving one part of your body while keeping the rest of your body still. Hip circles, rib circles, chest circles.... when you're all done with those, it feels so good to shimmy! Shimmying shakes everything out. Shoulder shimmies, hip shimmies....big shimmies, little shimmies. It's all good. Then we might practice a new technique such as dancing with a veil, or learn a short piece of choreography. Learning choreography is good exercise for your brain, too, by the way. We usually spend a bit of time working on our Tribal Odyssey moves, which is a fun way to dance together. Then we cool down, and end the session lying on our yoga mats just relaxing and letting our muscles melt! I always leave this class feeling better than when I went in.

If you want more information about these classes, contact the Ice House at (304)258-2300. Shimmy on!

Recipe of the week! Chipotle Bean Burritos

2011-03-14T13:40:00.000-07:00

We made these for dinner last week. I think it took all of 30 minutes. We had our burritos with a green salad with avocados, and a (small) handful of tortilla chips to scoop up whatever falls out of the burrito. Really really good! This Cooking Light website is really useful. You can store your favorite recipes in a web-based cookbook, check out the nutritional content of the recipes, print them, or email them. It's easy to find recipes, too. You can search based on what course you're looking for, vegetarian or ethnic options, and many more criteria. Last week I mentioned that I like to shop for later in the week by buying canned and frozen foods that won't spoil. This is one of the menus I saved for later in the week, since it uses mostly canned food. I love to buy the Campari tomatoes at Costco instead of the "plum" tomatoes. They usually have a large 5 lb box for $5 or so.
By the way, if you're in the office this week, wish Lindy a happy birthday! Her birthday was on Sunday.

Tip of the week from your practice manager

2011-03-10T12:47:00.000-08:00

Many of you may have changes in your insurance here in the early part of the year. If so, please take a few minutes to familiarize yourself with your plan's rules and guidelines. Do you need to choose a primary care provider? If so, please do call the number on your card and specify your doctor; otherwise, there can be problems billing your claim and you might be responsible for the visit if the insurance doesn't pay because of your neglect to take care of this. Your co-pay may have changed; be sure to find out so that you'll be charged appropriately. Also, thanks to healthcare reform, if you are covered under a new plan, your preventive visits must be covered with no co-pay. (Read more about healthcare reform and how it effects you here.) Our front-office staff should always ask you if you have any changes in your registration, including your insurance. Please be sure to have your insurance card with you when you come for your visit so we can make changes when necessary.

Health tip of the week!

2011-03-09T16:02:00.000-08:00

I've been working hard all day! But I always have time to read WebMD. It's a great resource for all kinds of health news and tips. Take a few minutes to look at this slideshow of fat-fighting foods.

Fitness tip of the week: Get Classy!

2011-03-08T13:26:00.000-08:00

Planning your exercise schedule is a lot easier if you know you have to be somewhere at a certain time. I notice when I don't have an exercise commitment, it's a lot easier to skip it. However, I am lucky enough to have several classes from which to choose during the week. If I know there are classes on Monday, Wednesday, Thursday and Saturday, I can plan the rest of my week around those classes. And even if I miss one or two, I still have at least 3 opportunities for exercise. I work my individual workouts around those classes and usually end up with a fairly successful week.

Rene Kesecker offers Zumba on Monday and Wednesday evenings at 6:00 PM at the Ice House in Berkeley Springs. On Thursday nights at 7, she is at Rankins Fitness Center. And on Saturday mornings at 9:00, you can find her at the Hancock Town Hall. Classes are attended by (mostly) women of all fitness levels and we have so much fun!

If you don't like classes, make an exercise commitment with a friend or two. Agree that you'll always meet at the same time at least twice a week at the gym, or at the C&O for a brisk walk. The motivation to exercise will be enhanced by knowing that letting yourself down by not showing up will also let down your friend! The time will pass by a lot more quickly, too, when you have someone to chat with and compare notes.

Two posts on one day!

2011-03-07T16:33:00.000-08:00

Since I was so remiss in my posts, I thought I'd share a recipe that I'm going to try tomorrow from the Cooking Light website (one of my favorites). I'll let you know how it turns out, since I've never made it before, next Monday!

New Blog Features!

2011-03-07T12:31:00.000-08:00

Ok, it's been so long since I've been posting regularly that I've guilted myself into ramping up the blog overall. I've decided to schedule a different feature for every day of the week. Here's what I'd like to do:
Monday: Recipe day
Tuesday: Fitness tip day
Wednesday: Health tip
Thursday: Free for all!
Friday: I've been using the Biggest Loser program on my Wii. I'll provide an update on how this is working for me. It'll be my personal workout journal that you can follow along. Maybe you've been thinking of using an interactive program like this, or maybe you already are. We can share information about how useful programs like these are.

How's that sound?

And, since this is Recipe Day, let me start off with something simple but healthy that I did for lunch today. I was working at home today and realized I hadn't been to the grocery store lately. What to do? I reached into the freezer and pulled out a box of the Green Giant Healthy Heart vegetables. I popped a potato into the microwave (after pricking it with a fork) and let it cook. Took it out, popped in the vegetables for a minute or two, and poured them over the potato. It was delicious and filling! Best of all, it was healthy and I was back to work in 5 minutes.

Fresh vegetables taste best, but it's good to keep some options in your freezer for those times you just can't get to the store. When I shop, which I try to do only once a week or every 10 days, I plan my menus so that I can use all fresh vegetables/fruits in the early part of the shopping cycle, and then use canned/frozen vegetables later. So I might have my fresh salads and steamed fresh veggies early in the week, and then chili with canned beans, or soups with longer-lasting vegetables like carrots and potatoes later in the week. That way I use everything up before it spoils.

OK, tomorrow it's fitness tips! In the meantime, if you have a favorite healthy recipe, send it to me at bibi@hahnandnelson.com and maybe I'll feature it here!

Out of touch but not out of mind!

2011-02-09T09:48:00.000-08:00

Your faithful blogger has not been so faithful lately. I've been flitting off into other areas of our practice and rather neglecting the blog! I'm so sorry -- not just for that, but because it is one of the more enjoyable features of my job. Believe me, I'd rather be carrying on here than sitting on hold with one more insurance company. In light of that, I'm going to pledge that I'll be on here more than ever, bringing you recipes, fitness tips, news about health and fitness events in our area, and other good stuff. Stay tuned!

Sigh. If only this didn't actually happen!

2010-12-09T20:16:00.000-08:00

Getting ready for the holidays!

2010-12-03T21:11:00.000-08:00

Join Hahn and Nelson Family Medicine for our open house on December 15. Take a few moments to relax, have a friendly chat and some light refreshments with us. We'd like to take this opportunity to express our appreciation of our patients.

Oxbow EMR named a Coolest Product of 2010 by Health Management Technology

2010-11-30T09:42:00.000-08:00

Hahn and Nelson Family Medicine is a proud user of the innovative Oxbow Electronic Medical Record (EMR) software. Our mission of "A new way to practice old-fashioned care" is made possible at least partly by this cutting-edge software that allows your doctor to do everything from get your telephoned messages, to sending your prescriptions directly from your electronic chart to the pharmacy. Your doctor and nurse also get automatic reminders when you're due for an appointment, or when you should be scheduled for a test such as a mammogram. When you come to our office for an appointment and see your doctor peering at the computer, they are not checking out their Facebook! They're reviewing the easy-to-read screen to see if perhaps you need any refills, and updating your medical record with new information. Gone is the roomful of easily misplaced paper charts with stuck-on Post it notes reminding your doctor to return your call.

I suppose a disclaimer is in order here. Years ago, Dr. Hahn and his friend Dr. Shawn Moyer realized that soon most medical offices would need an EMR in order to carry out sophisticated reporting, as well as the every day medical record management that every doctor needs. As they reviewed the available EMRs, they realized most were poorly written, hard to learn, and had inadequate reporting capabilities. So what did they do? They decided to build a better mousetrap. And now the rest of the world is taking notice. In this month's online edition of Health Management Technology, Oxbow was selected as one of 2010's Coolest Products. So now you can rest assured that not only are your doctors the coolest in town, but they are using one of the year's coolest products to keep you healthy! Oxbow's motto is "Patients, not paperwork" and we like that too. We will continue to explore ways, using technology as well as low-tech solutions, to bring you the best in healthcare.

Royally healthy!

2010-11-15T13:18:00.000-08:00

If you've been following our blog, you might be disappointed that we haven't been updating it as much as we usually do. We've been focusing on the Health Olympics since it started in October. Please check out our Health Olympics blog for healthy tips, and news on local fitness events. In the meantime, check out pictures of our award-winning float from the Hancock Halloween Parade!

We'll be updating the blog with news of our new Patient Portal that will allow you to book your own appointments. Stay tuned!

Front Desk Reflections

2010-09-30T20:12:00.000-07:00

So Lindy has been on vacation all week and I'm doing my best to fill in for her. This is a daunting task. It seems as though every third or fourth phone call I answer has one question. "Is this Lindy?" And then the disappointed momentary silence when I answer, "No, it's Bibi. Lindy is on vacation." Similarly, then, other phone callers ask "Is this Robin?" And I have to answer "No, it's Bibi. Robin is with a patient."
I offer my help, but very often, it's often Robin or Lindy who hold the answer. When some people walk into our office, they may only perceive two women answering our very busy phones, and doing things on the computers in front of them. What they will learn as they visit us, or call us, is that these two care very deeply about our patients. They also have very specialized knowledge about how to wend their way through the byzantine labyrinth of insurance referrals, what to tell a mom who is worried about the proper dosage of ibuprofen for their child, and how to say just the right thing to a woman newly diagnosed with cancer. This is amazing to me, as I sit trying to figure out how to book an appointment while 2 other calls are holding, and a patient is standing in front of me at the check-in desk. I smile at the phone, and ask the patient in front of me if he would mind being placed on hold... I realize it takes a very special kind of person to manage this job day in and day out.

Most of the time I'm in the back office, saying bad words about Carefirst and trying to get a patient's claim paid for. Having the chance to see our patients out front, greeting them by name and getting to know them, is a real treat, despite the stress. I love seeing the kids come in and look at the photographs taken by local artists and recognize a scene from the C&O Canal, or read one of the books I've left in the waiting room. My heart melts when a daughter brings in her ailing elderly mother, and I see how they care for each other. I realize we have our own little community right here in this office and I am so happy to be a part of it.

Before I forget, here's a link to a nice story that mentions the Walk Across Maryland and our upcoming Baby Talk! Thanks, Anne Weatherholt.

Health Olympics sign-ups going strong!

2010-09-26T16:36:00.000-07:00

2010 Health Olympics sign-ups are under way, and continue for another 2 weeks, through Friday, October 8. At the time of this writing, close to 90 participants have registered, and picked up their free tee shirts. Sign-up locations for the 2010 Health Olympics include, in Hancock, the offices of Hahn and Nelson Family Medicine; and in Morgan County, Rankins Fitness Center.

Participation in the 2010 Health Olympics is easy. Participants make a simple plan that includes: one food to avoid; one unhealthy eating habit to avoid; and a daily exercise goal. They are then asked to maintain a daily calendar to track and record when they achieve their daily goals. Participants are weighed at the beginning and end of the program.

Free tee shirts will be available for the first 200 participants who register for the 2010 Health Olympics. This year's shirts are kelly green, and are provided by Washington County Hospital.

Exercising daily is a key component of the Health Olympics approach to weight control and healthy living. Many Health Olympics participants get their exercise by walking or using home exercise equipment. Rankins Fitness has also become a popular spot for Health Olympians. Not only is Rankins a sign-up location for the 2010 Health Olympics, but Rankins has regularly promoted the Health Olympics by providing discounted memberships to Health Olympics participants, as well as free memberships to the top Health Olympics weight losers each year.

For more information regarding the 2010 Health Olympics, please contact Hahn and Nelson Family Medicine at 301-678-7007, or email through the hahnandnelson.com website.

And keep watching our blog for exercise ideas, inspiration for healthy meals, and ongoing information about the Health Olympics.

Thanks to our the walkers!

2010-09-20T06:52:00.000-07:00

Thank you everyone who walked on Saturday! The Walk was a huge success. People often ask "What's the cause?" since so many walks and runs are to benefit organizations (and that *is* wonderful!). We are just as proud to say, "The cause is YOU." It's to remind ourselves that our area is rich in fitness resources. Not only do we have the C+O Canal and the Rail Trail right here in Hancock, and beautiful hiking trails available within a short drive, we have talented fitness instructors such as Rene Kesecker teaching Zumba, Angela Petry teaching her Bellysima, and Boomtown Hoops offering workshops in hula-hooping. As the Health Olympics begins, we'll be reminding you to get off the couch and partake of any/all of this, and letting you know of other exercise opportunities available in our area. Please let us know of any of your favorites so we can share with all.
Thanks to John Harper for these beautiful images! There are more pictures on our Facebook page. I cannot get the captioning to work well here, so here goes, clockwise from top right: Dr. Matt Hahn gets the walkers round up for the start of the Walk; and they're off!; the walkers enjoy some hoops; Angela Petry in her Bellysima splendor; and finally, the end brought about in style by Brice Williams, Walker Williams, Aiden McDaniel, and Mike Cligerman
What a day!

Childrens cold medicine... really?

2010-09-15T12:36:00.000-07:00

Did you know that there are new FDA guidelines for kids' cold medicines? Bottom line: Never give cold medicine to children under 4. And, this little nugget:

"The good news about colds? Children get over colds and coughs as quickly without cold medicines as with them."

Read more and decide for yourself. Spend money on medicine that probably does nothing, or maybe just a spoonful of honey!? Remember to consult your medical professional if you have any questions!

Walk Across Maryland on Morgan County USA

2010-09-13T12:26:00.000-07:00

Check out the video on Morgan County USA!
And for your reading pleasure, our latest press release:
FOR IMMEDIATE RELEASE

Contact: Matthew Hahn
voice: 301-678-7007
fax: 301-678-7009
mhahn@oxbowemr.com

2010 Walk Across Maryland This Weekend; Sign-Ups for Health Olympics Begin

Maryland's skinniest town, Hancock, will play host to the 4th annual Walk Across Maryland, this Saturday, September 18, starting at 9 AM (participants should arrive at 8:30 AM), at the Maryland-Pennsylvania border on Pennsylvania Avenue.

Participants will walk across the entire state of Maryland (1.7 miles), along the length of Pennsylvania Avenue, from the MD-PA border to the C & O Canal. Local police will serve as escorts. Parking will be available at the Hancock Assembly of God, which is a short distance from the starting line.

The first 200 participants to arrive will receive free 2010 Walk Across Maryland tee shirts, provided by Washington County Hospital.

One of the event organizers, Dr. Marilyn Nelson, commented, “Everyone is welcome. Walking is a form of exercise available to almost all people. Regular exercise is a necessary part of a prescription for good health. We hope people will use the Walk Across Maryland to jumpstart their fall exercise programs.”

There will be entertainment throughout the Walk Across Maryland. There will be musicians, cheerleaders, hoola hoopers, skaters, bellydancing, and a Zumba demonstration. Local media and politicians have been invited to participate as well.

The Walk Across Maryland will also serve as the first official sign-up day for the 2010 Health Olympics. A sign-up table will be located outside Hahn and Nelson Family Medicine offices, along the Walk Across Maryland route, at 131 N. Pennsylvania Ave.

For more information, call Hahn and Nelson Family Medicine at 301-678-7007 or email mhahn@oxbowemr.com.

Ready, Set, GO!

2010-09-10T07:56:00.000-07:00

For Immediate Release

Contact: Dr. Matthew Hahn, Hahn and Nelson Family Medicine

2010 Walk Across Maryland – An Entertaining Affair

What has 400 legs, 200 free tee shirts, cheerleaders, marching bands, belly dancers, country music, and amazing feats of endurance? Is the circus coming to town? No! It's the 2010 Walk Across Maryland.

The 2010 Walk Across Maryland will be held on Saturday, September 18, at 9 AM, in Hancock. All are welcome to participate. Participants are challenged to walk across the entire state of Maryland, along the length of Pennsylvania Avenue, from the MD-PA border to the C & O Canal (1.7 miles). Local police will escort the walkers.

This year's event will feature more entertainment than ever before. “People had so much fun last year with the entertainers, that we decided to bring even more this year,” commented one of the event organizers, Dr. Marilyn Nelson. “It's great to make exercise fun, and this year's event may seem as much a parade as a hike.”

The Walk Across Maryland will also kick off registration for the 2010 Health Olympics. The Health Olympics, the Tri-State area's popular annual community health program, will take place this year, October through November. Sign-ups for the Health Olympics continue through Friday, October 8. Participants can register at Hahn and Nelson Family Medicine in Hancock, and also in Berkeley Springs, at Rankin Fitness Center. (Note that you can also use this link to download the forms you need to get started!)

For more information regarding the 2010 Walk Across Maryland or the 2010 Health Olympics, contact Hahn and Nelson Family Medicine, at info@hahnandnelson.com or call 301-678-7007.

*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!**!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*!*

JUST ANNOUNCED! Boomtown Hoops will be demonstrating this fun way to exercise. Also, look for the Zumba class, taking place outside of the Community Center. Information about both will be available at Hahn and Nelson Family Medicine's office.

Great News for Hancock!!!!

2010-08-27T18:15:00.000-07:00

If you love to dance and and you're looking for a new workout, you just have to come to the new Zumba class that's starting on September 11th! Come to the Hancock Community Center at 9:00 a.m. that Saturday morning and get ready to boogie. Led by the vivacious Rene Garcia, this Latin-infused class will slim you down while you're having fun. The hour will pass before you know it! All exercise levels are welcome, because there's something here for everyone. You can find out more about Zumba in general at the Zumba website, and you can get in touch with Rene about her class specifically at her email address (rgnjk694 at aol.com). Wear some good aerobic shoes and comfortable clothes. Come find out why Zumba is the hottest new exercise! (Hint: it's fun!)
And by the way, Rene's ongoing classes on Monday and Wednesday nights at 6:00 at the Ice House are more caliente than ever! Come on down!

Check out the Health Olympics on the radio

2010-08-23T08:32:00.000-07:00

Tuesday August 24th Dr. Matt Hahn will be on the Health Matters radio show, broadcasting on WJEJ 1240 AM in Hagerstown and on WCHA 800 AM in Chambersburg at 9:30. He'll discuss this year's Health Olympics which will feature an emphasis on getting more Omega 3 foods in your diet. If you miss the broadcast, go to the Washington County Health System's website and listen online. And as always, watch this page for updates on this and other exciting updates from Hahn and Nelson Family Medicine!

Now here's some news you can use! Stay tuned for more.

2010-08-17T06:59:00.000-07:00

Chocolate may cut heart failure risk
More good news: The Walk Across Maryland is officially scheduled for September 18! Join us while we all WALK ACROSS THE STATE OF MARYLAND in just 20 minutes! Fun for all.

Welcome to our 2000th patient!

2010-07-29T20:03:00.000-07:00

We registered our 2000th patient today! Jeremy Reese thought he was just going to come see us, fill out some paper work, and go on his way. Instead, he was greeted by the staff with a big bouquet of balloons and plenty of smiles.

Whether you're our first patient, or our 3,000th one: we want to give you the best care possible. We schedule all of our appointments for 30 minutes, and almost always have same-day appointments available, even if you're new to us.

A new way to practice old-fashioned care!
Pictured: Robin Waseleski, Dr. Marilyn Nelson, Jeremy Reese, Dr. Matt Hahn, Bibi Hahn, and Lindy Morris

Lyme Disease on the Upswing

2010-07-09T09:32:00.000-07:00

Morgan Messenger Article
We've been seeing an alarming number of Lyme Disease cases this summer. Ticks are evil little creatures and should be taken seriously! If you have been outside for even a moment, and are experiencing any of the symptoms -- even if you don't have a rash -- it's time for a trip to your healthcare provider.

Image from http://www.schohariecounty-ny.gov/CountyWebSite/Health/lymedisease.html

Good deeds done dirt cheap

2010-06-24T17:36:00.000-07:00

I apologize for the quality of the reproduction of this newspaper article: The Hancock News does not publish an online version, and Blogger doesn't allow me to insert PDFs. But it demonstrates how just a little bit of thoughtful behavior can translate into a bigger meaning. Thank you Dr. Nelson!

Nice MSNBC health plan and a little local color

2010-06-22T10:17:00.000-07:00

This Be Well Be Healthy plan is simple and fun to use! Its simplicity reminds me that the Health Olympics will begin again in September. Why not get started now so you'll be in great shape for the Walk Across Maryland, which kicks off the Health Olympics.

I just want to share a little story that illustrates just one more reason why I love living in this area so much. It's the contrast of the high-tech and the low-tech that impressed me (much like our motto "a new way to practice old-fashioned care" - implementing computers and other high-tech strategies so we can deliver high quality care to our patients the old fashioned way: spending lots of time with them and listening). I had two UPS packages in my car that needed to be dropped off. But I didn't know where any drop-off boxes were located. So I used a high-tech strategy, my amazing smartphone, to locate a drop-off box and was pleased to find that Roy's Service Center has a box. I drove to Roy's, and saw Virgil pumping gas out front where he usually is. I opened my window and asked him where the box was. Before I could park my car, he had opened my trunk, retrieved the two boxes, and dropped them in the box (the low-tech, "quality" care). That's not going to happen at the Sheetz across the street from Roy's, and it's not going to happen at the UPS store. I think I'm hereby going to designate Roy's Service Center the "official service station of Hahn and Nelson Family Medicine" because they exemplify the same kind of service that we strive for.

Vitamin D Deficiency in Adults

2010-05-14T06:34:00.000-07:00

By Marilyn Nelson, MD

Most of us are aware of the association of Vitamin D with bone health. Supplements of Calcium and Vitamin D help maintain normal bone density. Unfortunately, this is often not addressed until there is already significant loss of bone density, and increased risk of fractures. Vitamin D deficiency is also associated with muscle weakness, muscle aches and increased risk of falls. It may cause low back pain, or bone pain. These symptoms are often vague, nonspecific, and may be misdiagnosed as fibromyalgia, CFS (chronic fatigue syndrome), arthritis, or side effects from other medications such as statins (cholesterol lowering medications). Vitamin D deficiency may also play a role in increased risk of Heart Disease, Colon Cancer and Depression, but more research is needed.

Vitamin D deficiency is becoming more common. There are estimates that 50% of adults age 65 and older in North America, and 66% of persons internationally have failed to maintain healthy bone density and tooth attachment due to inadequate Vitamin D levels.

Risk factors for Vitamin D deficiency

1. Increasing age

2. Decreased sun exposure -

Increased use of sunscreen (does decrease risk of skin cancer)

Shift work - 2nd and 3rd shift workers tend to sleep during the day

Religious or other beliefs that require covering all skin when outside

Living more than 40 degrees latitude from the equator

north of NYC, or south of Wellington New Zealand

3. Being overweight - more Vit D is bound by body fat, and less available for use

as needed by the body

4. Dark skin - produces less Vit D than light skin

5. Fat malabsorption syndromes - cystic fibrosis, many forms of liver disease,

Gastric bypass surgery, inflammatory bowel disease

6. Some Medications - many anticonvulsants (seizure medications),

glucocorticoids, or rifampin (medication to treat Tuberculosis)

General recommendations are for 200 IU Vit D3 for adults under 51yo, 400 IU for those 51 to 70yo, and 600 IU for adults over 70. However, the best indicator of vitamin D status is a blood test, 25-hydroxyvitamin D. This should be checked in anyone with unexplained symptoms, or increased risk factors, such as those listed above. Recommendations can then be based on your Vitamin D level. It is possible to get too much Vit D, and this may cause nausea, vomiting, headache, kidney stones, pancreatitis, or vascular calcifications. People with uncorrected hyperparathyroidism, metastatic bone disease, sarcoidosis, or Williams Syndrome should not take Vitamin D supplements.

More information about Vitamin D from WebMD, a trusted source of health and medical information:

Dangers of Low Vitamin D Levels

Low Vitamin D Levels in Americans

Kids and Vitamin D

Stay tuned to Hahn and Nelson Family Medicine for more health and fitness news!

Making that hour count

2010-03-30T21:38:00.000-07:00

So the latest news is that women need to work out at least an hour a day EVERY DAY to keep from gaining weight in their middle-age years, according to a study recently published in the Journal of the American Medical Association. And that's for women who are already at an optimal weight, just to keep from gaining the average 5.7 lbs over 13 years. Women who need to lose weight should exercise even more.

So when do we find the time to do this? I was feeling a bit ... jiggly ... two weeks ago and reflected on what had devolved into a very unstructured, haphazard exercise routine. Usually, I would go to work in the morning, planning on leaving at an early enough time to work out in the afternoon. (I'm fortunate that I can work a flexible schedule.) But what was really happening -- I'd end up sitting at my desk trying to solve that one last problem, make that one last phone call, and the next thing I knew, it was evening, time to pick up my daughter, make dinner, and by then, too tired to work out. I'd try to do an exercise video, or go to a class, but if the least little thing came up, I opted out. So I decided to re-schedule myself. Now, I exercise in the morning, and then go to work. If there's an exercise class after work that I'd like to go to, and I make it, it's a bonus workout. I realize not everyone has the flexible schedule that I do. But even when my life was at its most complicated - living in the city with a baby and a teenager, working a full-time job -- I was able to get my workouts in. I really believe morning is the best time to workout. But whether morning or evening is your time, and that time is not happening, it's time to look at your schedule and make *it* work for *you*.

I also realized that my exercise routine was not really a routine. It was a jumble of exercise DVDs, some classes, and some free-weight lifting, all done at home. I thought about going back to the gym, but I really do enjoy working out at home, so I decided to do the P90X thing again. P90X may not be your cup of tea, but whatever plan you follow, be sure it includes cardio, strength, and flexibility training. Check out fitness magazines such as Shape, most of which also have a web component. I remember when I first wanted to start lifting weights, I didn't know how to get started. I found an awesome workout routine in a Shape magazine, and stuck to it for about 3 months until I knew what I was doing. The web versions of the magazines usually even have video clips to show you how an exercise should be done.

So I think two important elements in getting your exercise to work, is to fit it realistically within your schedule, and have a plan. Good luck!

#1500!

2010-03-11T19:59:00.000-08:00

Pictured above: Lindy Morris, Arlene, and Dr. Marilyn Nelson/Arlene and Dr. Matthew Hahn
Arlene Lemmert registered as our 1,500th patient this afternoon! We thought that was worth celebrating. Although she may be our 1,500th, our patients should know that they are all important and precious to us. We'd like to thank everyone for helping to make this opening year an exciting and fulfilling venture. We look forward to celebrating our first anniversary on July 6, and then many more to come! THANK YOU THANK YOU THANK YOU!!!!!!!!!

Getting Active - Politically

2010-02-25T06:09:00.000-08:00

I hesitate to post this next entry because I know not everyone will be happy to read it. You can either ignore it, or let me know how you feel. But to me, there is no middle ground to be found. As long as people are falling into the fissure that this middle ground has become, there is none.

We see mostly insured people in our practice. They either have Medicare, some form of medical assistance, or commercial insurance. Part of my job is to check each patient's eligibility before their upcoming appointment. Most of the time, everything is fine. I don't even have to bother checking Medicare eligibility, since everyone over 65 is eligible. Once I find a patient, usually using an insurance company's online website, I check them off my list and go on to the next patient. But sometimes there's more to the story.

What if a patient "has" insurance, but has a huge deductible? What if a patient "has" insurance, but no mental health coverage? What if the patient is responsible for supporting a family? And what happens when that patient becomes depressed, through no fault of his/her own? They fall into a crack...

A patient "has" insurance but just barely. What happens when this patient who is trying desperately to get over a drug dependency loses employment? The patient has successfully kicked the habit; the job was lost through company downsizing. The health insurance can be continued through COBRA, but the premiums are becoming too much for the meager unemployment to pay for. The patient doesn't know how much longer they can continue paying. Maybe another job will come through, but it's a toss-up whether the new company's insurance will cover the patient, given the "pre-existing condition."

Those patients "have" insurance. What happens when a man is found on the street and brought into our practice, found to have a horribly debilitating chronic condition, but has no health insurance at all? What happens when he is taken care of initially, sets out to get the medical assistance that he surely qualifies for, applies for it, but then finds out that it's going to take 4 months to get the card? (Hint: he died. Another hint: Poor people have pride too. They don't want to come if they can't take care of their bill).

These are three typical scenarios that play over and over again in some form at our little family practice office every week. Today our government will try to come to some resolution over the healthcare reform bill. I don't have a lot of confidence that the bill they come up with is going to help our patients. It will require that more people buy insurance. If "having" insurance can yield the results we see, it doesn't seem like such a bargain.

Think of yourself. You may be covered by a great plan by your employer. Next time you get your paystub, look at how much your employer is paying for your coverage, and add in what you contribute. Try to imagine paying that whole thing yourself, especially if you were to lose your job (God forbid). What is your biggest health problem? What if you found out your insurance company wouldn't pay for it?

Until we are willing to stand in each other's shoes, and agree that we are here to take care of each other, nothing meaningful is going to happen with healthcare reform. I like to compare the right to healthcare to education. As a nation, we have agreed, more or less, that every single child in our country should be educated through the 12th grade. We test our kids to make sure they're learning at least the minimum required. This is good for the whole country, and we are mostly happy to pay the taxes that make it possible. Imagine if families had to pay tuition? I think we'd be a pretty sorry country. And I think, as far as healthcare is concerned, we are currently a pretty sorry country. Having healthy citizens is good for the whole country, and I personally would be happy to pay the taxes to make sure we were all healthy. Of course, this would be in lieu of the $600 a month I'm currently paying for my family's health insurance, so I would probably not even notice it.

Something has got to give.

They're Your Kids Too

2010-02-19T06:42:00.000-08:00

We almost all have young people in our lives; whether they are our children, people who wait on us in restaurants, kids sitting in the same movie theater as we are, or working out in the gym with us. They are all around us, and each one of them is precious in their own way whether they know it or not. You may moan as you observe them with their odd piercings, or yell at them when they skateboard on the street. Or you may feel a beam of pride when you pick up the sports section of the paper and see that the team has scored another victory, even though you don't know a single player. They are all our kids. Our kids. We are all responsible for them.

That's why I'm writing today. Some of our kids are getting into things they shouldn't. Back in my day, it was marijuana and LSD. I don't remember anybody dying from either one; I know some lives were messed up, but I can still look on Facebook and see those kids grown up into functional adults. This is something much more dangerous, and from what I'm hearing, all to easy to obtain: I'm talking about prescription painkillers.

The rate of death from prescription painkillers has grown from 11,000 in 1999 to 20,000 in 2004. Researchers believe that the increasing misuse of prescription drugs among those 15-24 years of age accounts for the majority of the statistic. This problem is rooted in rural areas rather than the inner cities: West Virginia has the highest death rate from drug overdoses than any other state and it is now the number one cause of accidental deaths for our young people in West Virginia.

Why are kids taking these dangerous drugs? Like some of their illegal counterparts, painkillers can create a feeling of euphoria and calm. And if one can make you feel calm, I suppose a young person might think that two or three will make you feel even better. They might not even realize they're doing anything wrong: look at all the commercials and ads for drugs. Most of them feature happy butterflies, sunny skies, smiling people. Nobody ever reads the small print on those ads, or listens to the whispered disclaimer. Maybe their parents take the prescriptions legitimately; maybe they've even seen their parents share their prescription with a friend themselves. (There are reasons that you should never take someone else's prescription. You might have an adverse reaction to it.) Unfortunately, some kids are not only taking pills that aren't prescribed for them, they're taking them in combination with others, or intentionally overdosing on them.

I have a very good friend who commited suicide by taking an overdose of prescription drugs. That was sad enough. But when I think about all the young people who will die this year accidentally from a drug, it's beyond sad. I think of their mothers and fathers, sisters and brothers, who will forever have that hole in their lives, always asking whether they could've done something different. There must be so many questions.

What can we do? I have two kids, one of whom is a teenager. We have had all the discussions about drugs that parents should have with their kids, and more. I like to use "teaching moments" so when something comes up, we use it (Heath Ledger, ie.) to drive home a point. We try to set a good example by not over-using pain medication: actually we never take anything stronger than Tylenol. We take care of ourselves, and we take care of each other.

Kids need to know how important they are. I myself plan on making sure the young people in my life know how precious they are to me. I'll be sure to smile when I see them, and ask them how their day is going. If they look sad, I'll ask them if everything is OK. Sure, they probably won't tell me, but maybe they'll feel better knowing someone cared enough to ask.

What else can we do?

Set good examples. Don't share your prescription drugs with others if you take them. Don't suggest that pills are the only answer to your problems -- if you have pain, are you also seeking out physical therapy and other solutions? How do you handle your own depression? Do you drink more, or do you try to talk about your problems, or seek professional help when needed?
Get involved in your community, especially where there are young people involved. Teenagers are full of ideas and energy! They will keep you young. The schools in Morgan County always need PASS volunteers to mentor young people.
If you're a business owner, give those young people a chance. Maybe you could offer one or two the chance to "shadow" your employees for a few weeks in the summer, as an opportunity to discover whether your industry might be a choice for them someday. Sometimes they can earn community service points doing this type of work, if it's required by their school district.
Know your kids' friends. My daughter has grown up and had the same friends for 10 years. Now she's going to a different school in a city an hour away, so it's hard to get to know who she's hanging out with. But it's important. Always insist upon talking to the adult in charge of group activities, whether it's at their home, or in a public place.
If it turns out a friend of your child's is having a problem, what do you do? I've had to confront this myself. I'm interested in hearing how other parents have handled it. In my case, I let the parent know that there might be a problem. And in another case, another parent let me know that my child might be having difficulty handling something, and I was very grateful. This can be very touchy, especially living in a small town.

Let me know your thoughts. How can we help our kids avoid making a dangerous mistake with prescription drugs?

Working in Working Out

2009-12-30T14:46:00.000-08:00

Everybody is either busy, or worn out from being busy. When, oh when, do we have time to exercise? But we must. Exercise is good for your heart, your muscles, your flexibility, and for maintaining a healthy weight. It's also great for your mood, especially important during these gray, cold days. Try exercising to music; the beat can't help but make you feel better.

Make a commitment to exercise, and then find time to do it. Signing up for a class, or joining a gym may make it easier to commit; once you've paid for a class, it's more of a motivation to stick to it. And exercising with friends makes it fun!
Even in our small community of Berkeley Springs, you should be able to find a class to suit your exercise level. Here are some that I've taken and can personally recommend; and by the way, music is used in all three classes to help you move and groove and improve your mood!

Zumba, taught by Rene Garcia Kesecker, is a high-to-medium impact aerobics class with a Latin beat. You'll need a good pair of training shoes, some loose clothing, and an attitude! Zumba is fun and will bring out your sassy streak. Rene teaches Zumba at the Ice House on Monday nights at 5:30 and Wednesday nights at 6:00. Call her at 304.258.6747 for more information.
Bellysima, taught by Angela Petry, uses the technique of bellydancing isolations to strengthen your core, improve flexibility, and burn calories. Shimmying is good for the soul! Since beginning Bellysima this summer, my back feels stronger and I feel more balanced. You'll need some comfortable clothing to start out, and a yoga mat for the warm-up and cool-down; you'll probably also want to buy a jingly hip scarf and a veil to dance with. Beginners are welcome, especially to her new Tuesday class at 6:30 at the Ice House. Call (304)995-5832 for more information.

The Ice House hosts several other exercise classes (I haven't taken these myself):
Gentle Yoga with Joyce Morningstar, Saturdays at 9:00. Call 304.258.6247 for more information
Tai Chi with Michael Pushkin, Thursdays 11am & 5:30pm. Call 304.258.4653

Marcy Fleeharty, through Morgan County Adult and Community Education, is once again offering her awesome Yoga classes. Both classes are at Widmyer Elementary School in Berkeley Springs. You'll need comfortable clothing and a yoga mat. Yoga Basic begins on January 4 for 10 weeks at 4:30. Yoga Fusion, an intense workout that combines Pilates and Yoga, begins on the 4th at 6:00. I can personally attest that the Yoga Fusion class will kick your butt! Call 304-258-2430, ext 19 or 20, to register.

Do you have a favorite exercise class in the area? Please let me know. We're happy to put flyers advertising exercise or wellness classes on our office bulletin board. Post your favorite exercise class on our Facebook page. If you're reading this on Blogger and you don't belong to Facebook, feel free to comment here.

Coming up next: Favorite workout videos. What's yours?

Happy Holidays to Everyone! And a Healthy New Year to All

2009-12-20T15:59:00.000-08:00

Coming next... exercise opportunities to burn off that Christmas surplus!

Just in Time for Open Enrollment: Navigating the Medicare Website

2009-11-24T11:00:00.000-08:00

Open enrollment for Medicare recipients began November 31 and ends on December 31. During this time, people with Medicare can add, drop or change their prescription drug coverage. They can also select a health plan for their 2010 coverage.

Whether you are new to Medicare, and feeling bewildered by the choices you have, or if you’ve had the same plan for years but are curious about what else is out there, the Medicare.gov website is a great tool. Using customized searches, Medicare recipients can search for a health and drug plan that’s right for them.

Pam Mann of the Morgan County Library and Bibi Hahn of Hahn and Nelson Family Medicine will conduct a workshop at the Library on December 9 from 1-3 pm on using the Medicare website. This workshop is meant to raise the comfort level of using the website so that participants can make an informed decision on their own. In order to use the personalized searches, participants will need to bring a list of their prescriptions, their Medicare number, and the name of their preferred pharmacy.

Please call the Library at (304)258-3350 to register for the workshop. The workshop is free of charge and will be limited to 10 participants.

A Bitter Pill or a Better Choice? Is a Concierge Practice Right for You?

2009-11-23T07:56:00.000-08:00

There has been a lot of news about a new type of primary care practice, sometimes called a "concierge" practice. In this type of practice, a patient pays somewhere in the neighborhood of $1000 a year for access to a primary care provider. The patient in turn, is guaranteed coverage of all primary care routine visits, with no co-pay. I have to disagree with the link's headline that it has to be a "bitter" choice. For a relatively healthy person, paying $1200 a year for personalized basic healthcare dictated by that patient and his/her doctor vs paying thousands of dollars to an insurance company that really, only cares about the bottom line, might make sense. For $1200 a year, I can go to my primary care doctor for routine blood pressure checks, occassional colds or allergy shots, and not have to face an office co-pay. Nor will there be any unpleasant surprises in the mail if my insurance company decides it shouldn't have to pay for something like a a flu vaccine.

The physician, with the assurance of a steady income rather than being bogged down by the fits the insurance claim process can cause, can take the time that a primary care provider should devote to every visit. Most patients don't understand how long it actually takes to bill for that $88 office visit. To them, they may be with the doctor for 20 minutes. But behind the scenes, the work starts even before the patient arrives in the office. Does the patient still have insurance eligibility? Once the patient gets into the office, the provider then has to spend time trying to decide how to "code" the visit so the claim gets paid. Should that wart removal be a surgery, or something else? Will we get paid for the EKG by this insurance company, or should we just bill for a more comprehensive visit? If the claim is rejected, someone has to figure out what went wrong. This often means countless time on the phone with a claim representative. The claim is resubmitted, hopefully, to get paid this time. Patients often don't realize that it's not just their insurance company the provider is dealing with; it's often 20 or 30, many of them with different rules and nuances.

Time and other resources should be spent on the treating the patient, not worrying about how to get paid. Time spent with a patient is especially important in the Family Practice, where the emphasis is on treating the whole patient rather than specific body systems as in a specialized practice.

So, would a concierge practice, perhaps backed by a lower-cost catastrophic insurance policy, be right for you? One of our friends, Dr. Shawn Moyer, offers his Pinchot Plan to his patients. It's also a great idea for small businesses. What do you think? Would this be right for you and your family? In this age of rising premiums, and minimal healthcare reform in the future, maybe it's time to think of alternatives.

Coming Soon: Navigating the Medicare Website Workshop

2009-11-20T12:12:00.000-08:00

Just in time for Open Season! The Morgan County Library and Hahn and Nelson Family Medicine will conduct workshops for seniors interested in learning how to navigate the Medicare website, especially during Open Enrollment season. Stay tuned to this blog for times and places. Call (301)678-7007 or email if you're interested in attending.

Medicare Open Enrollment Begins

2009-11-19T06:02:00.000-08:00

Beginning November 15, our patients eligible for Medicare coverage can review their plan and update it according to their needs. For many, this can be bewildering. However, if you're able to read this blog, you're already on your way to some helpful information.

I went straight to the Medicare website and found some helpful links. First of all, if you want a primer on using the page itself, the Help link on the upper right hand side of the page will get you started. On the right side of the page, you can find general topics such as "Original Medicare" and "Medigap Policies." This is great information especially to those new to Medicare. Be aware that if you choose to "Learn More," your browser will want to open a pop-up window so be sure you have your pop-up blocker off. Note that the pop-up window is divided into tabs, so you can look at a Glossary, learn how a plan works, or even learn more about how to choose a plan.

One very useful tool is found on the left side of the page. Find the section headed Learn More about Health Plans and Medigap Policies in Your Area. You can open the listbox within, choose your state and click View Plans. A chart displays showing you all the plans available in your state, and you can easily see how much the premiums are, and what is covered. You can also see how it's rated. There are links to plan websites, and phone numbers for further contact.

Take your time, ask questions, and talk to friends before choosing your plan. Consider cost, convenience (can you use your local pharmacy and physician?), quality and performance, and benefits. You have until December 31st.

earn More About Health Plans and Medigap Policies in Your Area

United, more.

2009-11-11T08:16:00.000-08:00

Yep. I am seriously going to consider shopping around for insurance... I currently carry United, and now I'm wondering: why am I paying these people $600 a month?

They are living proof of why we need a public plan. Why can the government afford to pay us more than they do?
They denied a claim of Willa's because her problem occurred within 6 months of buying the policy. Too bad for her. She should've waited to get sick!
They refuse to realize that we do not participate in their capitated plan: which means I have a small pile of rejected claims. Each of these takes approximately 20 minutes on the phone. I've spoken to the provider representative at least twice, and called about each mis-calculated claim to the claims department.
See my previous insurance rant.
Now I've been on the phone for 20 minutes for an $88 claim that was rejected because, supposedly, the member's plan "does not cover this visit, consultation, evaluation and management." I was able to find the member online on United's website (which is actually, surprisingly, quite good.) and find that her coverage is 100%. But, I couldn't find her claim status anywhere. So I reluctantly picked up the phone. The phone number on the top of the EOB was, I find out after sifting through the voice response system, only for customers. I was connected to the provider number and got a very nice young man who could, after awhile, finally pull up my patient. But he couldn't find any claims matching the one that we have that was rejected. He looked and looked -- we used every number on the EOB that could conceivably be used to retrieve a patient's records. Nothing. He put me on hold. He looked some more. Finally he decided to transfer me to a "claims specialist" who he was sure would be able to resolve the problem. I sat on hold for about 2 minutes, and then -- I was disconnected.

Ooooof. So now what do I do? Is it worth $88 to start all over again? Do they want me to just forget it, and maybe bill the patient?

Let me state here that every single person I've talked to at United Healthcare has been very nice. I have nothing against them personally. But they need to do something about this mess they call "healthcare."

1000 strong! AND H1N1 vaccine is HERE!

2009-11-05T17:58:00.000-08:00

11/5/2009 5:05 pm: Hahn and Nelson Family Medicine, after being open for barely four months, registered our 1000th patient! We can't reveal the name of the patient because of HIPAA regulations, but let's just say she was happy to receive the bouquet of beautiful flowers that were presented to her.

We'd like to say right now that every single one of our patients is special to us, no matter when we registered you. We love and care for you all.

Actually, we care about everyone regardless of patient status. In fact, we're getting a shipment of H1N1 vaccine that we are happy to administer to anyone in the community. We prefer that you meet the criteria specified by the CDC and preference will be given to those who meet it. Just call us at 301-678-7007 or email us at hnfm @ verizon.net (you'll have to type this into your email software -- we're not linking to it because of spammers) to make sure we have some left and to find out the best time to stop by. We will be charging a small $10 fee to administer the vaccine - the vaccine itself is free. You will need to fill out a form.

OK, that's enough good news for now! Stay healthy.

Ode to the Front Desk Staff

2009-11-03T21:23:00.000-08:00

Next time you go to your doctor's office, take a really close look at the people sitting behind the desk. They probably appear fairly calm, although they may be surrounded by paperwork, ringing phones, and a computer demanding that they click something. I never really thought much about what goes on there until this week. Robin is this minute somewhere on a cruise ship, probably enjoying one of those round-the-clock buffets and endless fancy drinks, while I've been attempting to fill in for her and help Lindy run the front office.
Monday could best be compared to sitting in a room with 5 tiny babies. As soon as one of them goes to sleep, another starts to cry. As you pick up the crying baby, another one needs its diaper changed, and another one rolls off of the changing table. It goes like this: The phone is ringing, sometimes 2 or 3 lines at once. Someone is waiting to check in and pay a co-pay, someone else is waiting after their appointment to schedule another appointment. Then, just as you think it's quieting down, someone walks in and wants to register as a new patient. Or one of the doctors needs to be shown how to do something on the computer, or asks you to make a phone call.
I'm used to working in the back office, calling insurance companies about claim denials, posting payments (when we're lucky enough to get a check!), calling patients with appointment reminders, creating billing statements, and lots of other little tasks. I enjoy working on one thing at a time, with occasional breaks to stretch my achy neck. Working up front was a shock to this extremely introverted soul!
I tried to recall any time when either Lindy or Robin had seemed overwhelmed, cross, or even mildly upset. I wasn't able to summon up one negative peep out of either one of them! As I cruised through my mental image library, all I could see were two calm, usually smiling faces, talking gently to patients, answering the phone professionally and politely. How do they do it?
I think it's because they genuinely care about doing a great job, and because they really love our patients. I hope it's also because they've found a place where they feel valued and like they're making a difference. Because they are.

I blog so I do not scream.

2009-10-20T09:32:00.000-07:00

It might frighten the patients.

United Healthcare is right now on the top of my sh*t list. This is terrible, because they are currently my insurance company (but if I can help it, not for long). First of all: they pay doctors terribly. There is at least one Medical Assistance payer that pays better than they do. Then, they can't seem to get anything right. I keep getting back EOBs (Explanation of Benefits, to those of you fortunate enough to not know) that claim we have a capitation agreement, meaning the insurer is supposedly paying us a monthly fee to care for their patients instead of paying a fee for service. We do not. So I have to call them, spend at least 10 minutes on the phone waiting for the insane Muzack to just STOP already and have someone pick up the phone.

This morning I got back an EOB with the capitation problem. I called United, punched in the numbers for the patient and our providers, got put on hold for about 10 minutes and finally got "helped" by a representative that claimed he couldn't help me because my patient's policy was held by a different group. I protested, saying that the patient's card had this phone number to call, as well a the EOB. He didn't cave, and gave me another number to call.

I called the number.... on hold for 5 minutes this time. Really bad Muzack, couldn't even tell what genre it was supposed to be ruining. Now I'm told that my patient must have an outdated card; the representative can't even look up my patient. I decide to call back the original United number I have, since I was able to get claim information using the automated system. So, after being on hold for 15 minutes, someone answers, takes all my patient's information and our provider's information and told that I don't have the claims department and get transferred. After being on hold for another 10 minutes, the call is answered by someone with a very strong accent who sounds like she's talking underwater..... but I finally gathered that she was also the wrong department... this after she took all my patient's information as well as our provider's. I have now been on the phone for 30 minutes with no results. This for a charge of $118, which United, if we're lucky, will end up paying $60. Seriously.

OK. I've got someone on here who speaks English and I can actually hear her. I've given her my patient information. She can resolve the issue of the capitation but not why we're not getting paid for the office visit and just the procedure we did. So an initial charge of $118 will probably end up getting paid $30 if we're lucky. People with United HealthCare, your insurance company stinks!

If we had a single-payer system, I would be able to always call the same phone number, enter the same kind of information each time, and get help. I would be able to type the same kinds of numbers on my telephone's keypad. My providers would have one set of ID numbers instead of 15. We would only need to credential with one entity instead of 13 or 14. I would only have to access one website to get claims and benefit information. Robyn and Lindy would only need one access point to make referrals and get benefit information....Medical students could graduate and open their own little offices like ours without having to have an entire team of billing specialists to worry about all this stuff.... Dream on.

Flu/Pnemonia clinic

2009-10-14T15:38:00.000-07:00

Hahn and Nelson Family Medicine and Pharmacare/Optioncare administered approximately 100 seasonal flu vaccines on Saturday October 10. A number of pneumonia vaccines were administered as well. If you were unable to attend our flu vaccine clinic and you still want a vaccine, Pharmacare has several additional clinics coming up. You should call to make sure the clinic is still scheduled, as the seasonal flu vaccine is in short supply.

Laughter is the best medicine

2009-10-12T09:39:00.000-07:00

...and we can serve that up, too, apparently! It's good to know that your doctor has a good sense of humor, right!?

Dr. Nelson to be Guest Speaker at Breast Cancer Awareness Day

2009-10-03T13:30:00.000-07:00

Make some time for yourselves this Monday, ladies. Come to War Memorial Hospital in Berkeley Springs at Noon on Monday, October 5 for a light lunch and find out the latest on breast cancer screening guidelines from Dr. Marilyn Nelson. The lunch and talk are sponsored by the Morgan County Community Educational Outreach Service, the Morgan County Health Department, and the Morgan County War Memorial Hospital. Everyone is welcome!

Insurance Rant #99887789999

2009-09-30T06:57:00.000-07:00

I'd just like to preface this little rant with a disclaimer: I love most of my work at Hahn and Nelson Family Medicine. However, it seems to be the work of our insurers to suck every little piece of joy out of life that they can. Once in awhile, though, I'll talk to someone who seems to really care. That happened today, after almost an hour speaking to other not-so-caring sheeple.
So one of our patients was told that she had to pay an out-of-network deductible because Aetna told her that the physician she saw was not an Aetna participant. Well, we are, and have been since at least July 15. Of course, this is after months and months of filling out forms and sending in duplicates of duplicates of licenses, etc. for the 12 or so insurance companies we wanted to cover. Don't even get me started on the incredible inefficiencies of the credentialing process (like, why isn't there ONE form, ONE set of standards, to credential physicians?)
So I called Aetna this morning... first thing on my to do list.
8:30 Called Provider Services and made my way through the maze of what number to press, inserted my Tax ID, etc. etc. and got someone on the line who said they couldn't help me because my providers were not linked correctly. We are credentialed, yes, considered participating, yes, but we're not linked correctly to our "service area." What does that mean? My head is just starting to spin. The trip to insurance world has begun. OK, so what number do I call? Got it.
8:45 Called the number I was given, which turns out to be claims, typed in the correct numbers for our tax ID (is there any way to put that on speed dial?) and my patient's ID number, blah blah blah. Got "Jen" on the line who looked up the claim and said that the claim had been processed under an incorrect Tax ID. I replied that that's strange, because the correct tax ID is on my Explanation of Benefits that came back from the claim. She replied that it must be a problem with my biller (yeah, right, let's pass the buck! quickly!). I sighed (deeply) and agreed to call Office Ally to get them to check things out.
8:55 Called Office Ally. They are so nice to work with... someone picked up the phone immediately -- I only had to press one number on my phone's keypad. Nobody even asked me for an ID number. The representative assured me that the claim contained the correct Tax ID. I asked him if there was anything else that might've caused this to happen, but he was mystified. But he did ask me to call back if there were any other issues. OK, I called them, now back to Aetna.
9:00 Called Aetna back. After having to type in the patient's ID, Date of Service, etc. again, I had to listen to the claim details before pressing "0" to get a representative. It's now 9:10 because I accidentally asked for a fax of the claim to be sent.... duh. But that kind of stuff happens when you're in the altered universe that is the Insurance phone call.
9:10 OK now I have a very competent person on the phone, Sonya. She has the claim information already that I've typed in, but asks a few identifying questions. She tells me that the Tax ID number is fine. It's ours and she doesn't know why both the patient and myself have been told that it was incorrect. But she also verifies that the patient was billed for an out-of-network provider when she shouldn't have been, and gives me a resubmittal tracking number. I'm still concerned about why both the patient and myself were told about the incorrect Tax ID number, and ask to speak to the representative that told me about it. She tries to get my friend Jen on the phone but she's busy. I leave Sonya with my phone number and email address because I'd really like to know why it is that Jen was seeing something completely different from Sonya. Sonya is now my new best friend. Sonya gets busy trying to investigate the mystery herself. She's very thorough, and finds the provider that Jen said the claim was mixed up with but cannot figure out why someone thought it was linked to this claim. Now it's 9:33 and I've been on the phone for an hour. I have a stack of payables and checks on my desk along with some other more fun projects...
9:42 So I called the patient to just kind of wrap things up. She had originally gotten an email about the claim so she's sending that to me. I don't want to become obsessed with this. Blogging about it really helps. Not only will it help me journal my way through this learning process, it also helps me blow off steam!

Update: Sonya called back to tell me that Jen was, for some inexplicable reason, looking at two claims from JUNE. JUNE. We weren't even open yet. Hmmmmm. Hey, I don't know want to hear anything from people who claim the *government* can't run healthcare when this kind of stuff is happening in the private healthcare industry where people are paying dearly for their coverage. Of course, let's see what happens next week when we start filing our Medicare claims! Stay tuned....

Walk Across Maryland is a Huge Success!

2009-09-19T14:50:00.000-07:00

Thanks to all who came out to walk today. Leading up to the event, people frequently asked me "What is the walk for?" The answer was, YOU! The Walk Across Maryland is a way to make people aware that exercise is easy to access. Most people just have to walk out their door and there it is: a sidewalk. Others (like me) jump in their cars and drive a short distance. My favorite destination is Cacapon State Park. I go out there every couple of weeks and follow my favorite hiking trail. It's a bit wild, and the trail is far from perfectly flat, but it's a great workout. Part of the attraction is watching the environment change through the seasons. Some of us stop along the path and leave stacked stone sculptures. It's a jewel of a place.
Other days, it's just as easy to drive to the C&O Canal in Hancock. There, the trail is paved and flat. I can go a bit faster here and I don't have to be on the constant alert for branches, snakes, and bears. I love sneaking peeks of the river; sometimes I'm startled to hear one of the small airplanes that use the airstrip that runs alongside the railroad tracks on the West Virginia side of the river.
There are a couple of other walking alternatives here in Berkeley Springs: a cross country trail runs around the Intermediate and Middle Schools, and there is a new trail on the north end of town but I don't know a lot about that yet. I know there are still a lot of fans of the track, but this just isn't my thing. I suppose if I put on my iPod I could make it around a few times without falling asleep. But that's ok -- everyone needs to find their own thing and "just do it!"

Oxbow to the rescue

2009-09-12T09:14:00.000-07:00

I was just eavesdropping on my husband's phone conversation with his Oxbow colleagues. They're deep in discussion about how to bring their Electronic Medical Record (EMR) software to market. He was reading them a Journal of the American Medical Association (JAMA) article
(sorry, unless you have a membership you'll just be able to see the extract here) about how the current EMRs on the market don't provide good querying capabilities since most of the record is in "free text" format. This gives OK information on an individual patient, while you're looking at the patient record. But what happens, if in the case of our practice yesterday, your practice receives a limited number of flu vaccines? Shouldn't your EMR allow you to run a query and find those patients who should receive the vaccine because of existing health reasons such as COPD? Apparently most EMRs on the market wouldn't allow a physician to do that. Ours does. So that's what Dr. Hahn did yesterday. He ran a query to find those patients in the practice with certain health conditions that should prioritize them to receive the flu vaccine and called them up. It took a few minutes.

Compare that to the practice with paper charts. Have you ever seen a medical records room? It's a room with nothing but shelves and shelves, or cabinets and cabinets, of folders containing patient records. Can you imagine going through all those hundreds of records to find 50 patients to receive a vaccine? Would you bother? Probably not. Our EMR allows us to care. And that's what it's all about: a new way to practice old fashioned care.

Announcing Flu Clinic October 10

2009-09-04T05:55:00.000-07:00

Hahn and Nelson Family Medicine and Pharmacare would like to announce a community flu clinic at the Hahn and Nelson office on October 10, 2009 from 10 a.m. to 2:00 pm. You do not need to be a patient to participate. Medicare will be billed directly for all Medicare patients; all other insured patients will need to file for reimbursement on their own (Pharmacare will provide you with the necessary paperwork). Please call Hahn and Nelson for other details: (301)678-7007. The cost of the vaccine will be available in early October.

Who should get the flu vaccine? The Centers for Disease Control (CDC) website has some excellent information on how to protect yourself from the flu.

Please note, this is NOT the H1N1 (Swine) flu vaccine. For information on H1N1 vaccine, please consult the CDC website.

Nice story....

2009-09-01T12:39:00.000-07:00

I'm not going to moan about insurance companies today, even though it's been months since we started credentialing with Medicare and United and are still not able to bill all of our patient visits with those companies! No, today, I'm going to share with you the story of Jim McCoy and Dr. Hahn. Matt and Jim wrote the story for the American Academy of Family Physician's "Closeup" section in its August publication. I can't link to the story, so I'm going to post it here as a Jpg -- just click on it to make it big enough to read.

We love Jim and Bertha McCoy. I'll never forget the year Matt planned my surprise 50th birthday out at the Troubadour, Jim's famous roadhouse out on Highland Ridge. I didn't suspect a thing, not even when we pulled into the parking lot on a weeknight, to find it full of cars. I was so shocked when I walked in and saw all my friends, and even my mom! that I ran into Bertha's arms and gave her a big hug. I just wanted to hide at first! Since then we've had many wonderful nights of music and friends out there. In fact, we've had so much fun out there that we've decided to have our 20th wedding anniversary party out there later this month. Ya'all come by: it's gonna be fun!

Walk Across Maryland article

2009-08-26T08:37:00.001-07:00

click on the article to make it big enough to read!

No EMR can fix this

2009-08-26T07:42:00.000-07:00

2 hours on the phone today. 45 minutes on the phone to various phone numbers for help with a claim to Maryland Medical Assistance. Same annoying MIDI muzak for every single wrongly connected call. Talked to one human who told me that my patient was a "Priority Partners" patient and transferred me to another number where I was on hold for 15 minutes. Finally talked to another human who told me someone would have to call me back. So I went onto the next rejected claim, this one from Mountain State Blue Cross Blue Shield. I decided to go online and try to find some answers using their website.... but they just had a phone number (their fancy name for it is Interactive Voice Response System). And they had listed a special number for providers. So I called it, and realized as the robot listed all the choices I could make using my telephone's numeric keypad that this was a number for patients, not providers. So I started hitting random keys on my phone while muttering invectices under my breath, which sometimes leads me to an operator, but that didn't work (and, in this case, it relieved some stress!). Back online to find another number.... under the contact link, there it is, a number for providers! After 10 minutes on hold, I'm told that everyone is too busy to talk to me; do I want to call back in half an hour, or have someone call me back after 4:00? Well, neither of those choices is exactly a dry martini, so I get off the phone and so now it's 10:50 a.m. and once again, I feel like I've gotten very little done. How do people manage this job every day and not pull all their hair out?! I know, I'll move on to something positive, something good.

I want to blog about our next big event, The Walk Across Maryland, which will kick off the 2009 Health Olympics! The Hancock News has an article about it this morning, but I don't believe they make their paper available online, so once again as I did with the Journal article, I will post it seperately as a jpg. Basically, the Walk Across Maryland is just that -- we found a stretch of Maryland that is just one mile across here in Hancock. Many of our local businesses get involved, and post themselves along the route with water stations, apples, and other healthy offerings. Washington County Hospital is making up our t-shirts this year. The Walk will take place on September 19 as part of Hancock's Canal-Apple Days Festival. It only takes about 30 minutes to complete and it's a lot of fun! We'll probably have a table at the Festival where people can sign up for the Health Olympics. The Health Olympics is a very simple program to help people get started, or maintain, a healthier lifestyle. For 2 months, they'll track their exercise and eating habits each day, and attempt to give up one unhealthy habit. We give you a calendar where you can mark your progress, we weigh you in and note your goals. At the end of the 2 months, you come back, we re-weigh you. In years past, we've done some type of drawing to reward those who have met their goals. Rankin's Fitness is one of our partners -- they always donate some awesome prizes such as free memberships at their wonderful gym. We're still in the process of getting everything wrapped up, so stay tuned for more details!

August 17 Journal Article

2009-08-21T12:16:00.001-07:00

Insurance woes

2009-08-19T11:16:00.000-07:00

So I came into the office the other day at 1:00, full of energy and good intentions. I had a lot to do -- scads of files to be scanned and saved onto our network drive, billing statements that haven't been done since we started up, some promoting of our Health Olympics, and little things like getting new signs made... instead, I have been on the phone now for almost an hour now trying to figure out why one $132 claim hasn't been paid. A combination of waiting on hold just to find out I was waiting for the wrong person, and then finally getting only a voice message box to leave my patient's information and what I'm calling about has made this ordeal quite frustrating. Having left the information, I can only hope I'll get a call back -- and that I'll get the answer to my question.

But on the whole, the problems haven't been that bad. Now that we're credentialed with most of our insurance companies, as long as I have our patient information, and the EOB (Explanation of Benefits) handy, I can usually get problems resolved. One of the big frustrations, however, is trying to figure out who to talk to. Because payers are usually managed by great big companies, just because a patient has, say, a CareFirst card, doesn't mean a simple phone call to the phone number on the back of the insurance card. Oh no. When you get the automated voice, you're asked to choose between 4 options -- none of which sound like what you're looking at on the card. So what I usually do is just punch a number on the phone at random. This usually works after awhile. I used to be careful about this, and listened with rapt attention to the robotic voice on the other end of the line. But as my eyes started to cross and my brain twisted into irretrievable little rivers of sweat, I figured out what plan I wanted to reference and pressed the correct key on the phone. After waiting for 15 minutes to talk to a live human being, I recited the patient's ID number, only to be told that I was speaking to a customer service representative of Carefirst's National Plan -- not the plan that my patient had. So I figured it doesn't really make any difference.

Today we got our first sizeable insurance check. That almost made all of this seem worthwhile. Real pay day will come the day we can bill for Medicare, and we actually get a check. I think we'll all go out for a big happy hour that day!

Matt and Marilyn had a nice article in the Martinsburg Journal about how they're using Oxbow. Unfortunately, it's not linked for some reason. So I'm going to upload a JPG of the article -- not the best, but until I can get it on the hahnandnelson.com website, that's what I've got....

Our friend Russell Mokhiber appeared on the Greta Van Susteren's show on Fox Cable News last night to talk about his rally today against the Whole Foods CEO who has come out against Obama's healthcare reform plan. Russell, of course, is the organizer of Single Payer Action. Things got pretty heated... this woman is a barracude and I don't think Russell realized what he was in for. At any rate, they disagreed to put it mildly. We talked to Russell today, and he told us that not only had he received 500 hate emails, his family received threatening phone calls. Classy, right? I don't care if you disagree with someone, but you don't call up a guy's kids and act like a caveman. It reminds me of those Neanderthals that are showing up at healthcare town halls with their shotguns. What's that about? I get that you're against healthcare, but acting like you're going to kill someone is a bit out there!

I had my own little moment of fame last Friday when myself and 4 friends decided to make a show of support for Healthcare Reform. Our US Representative, Shelley Moore Capito, was in town for a celebration of our town's Streetscape project.

Alright that's enough rabble rousing for one day. More later!

No communication breakdowns here!

2009-08-14T09:44:00.000-07:00

I got my laptop the other day and am now happily connected to our practice's network and the internet. I have Quickbooks loaded along with the practice's data. The only thing I need now to be a one-woman show is Oxbow. By the way, be sure to look at the new website! It's got video screen captures showing the software at work.

At home I don't even really need the laptop unless I want to do accounting chores. For example, this afternoon I will log on to Office Ally, and make reminder calls to our Monday patients. I'll be able to file claims to the insurance companies, and if I wanted to, I could even print billing statements right from home.

I've been looking at ways to keep our small staff in touch with one another. Throughout the day we're all so busy doing our various jobs, but there is a lot of information that we really need to share. Our good old-fashioned whiteboard is in the back with lists of things to remember there; we have a bulletin board to post those many insurance company updates, our HIPPAA policy, workers comp, and other employee-type notices. But I'd like something electronic to use that we'll all see as soon as we turn on our computers. I've pretty much decided on going the Google route. I've designed a home page for each of us that displays our shared Google calendar, the user's inbox, and some good health news sites such as WebMD and Google's health news. For fun I included a weather gadget and something called "the world's healthiest foods (this week's focus is grapes!) I like the shared calendar so far; Lindy and Robyn have been using it too. It even syncs with my Sprint Palm Pre along with my personal calendar at home, so I can see my entire day in a glance!. One gadget that shows promise is the "Things to Remember" gadget. I created it using the Make your Gadget page. This gadget can be shared, and it allows me to post things like "Always collect co-pays upon checkin!" and "Dr. Nelson is now par with Mountain State." The only drawback I can see is that only one person can update it, but that's not horrible.

So once we play with this setup for awhile, I'll configure Google home pages for the providers, and configure gmail to import all their email from their previous email addresses. Between this and the good old-fashioned whiteboard, we can keep better touch with one another. Just another example of a New Way to Practice Old Fashioned Care!

It's been a month...

2009-08-08T09:46:00.000-07:00

We've been open for a whole month now... and it's been mostly good. Many many of our old patients have followed us to our new home, and we've gotten a few brand new ones as well. Our motto is "a new way to practice old fashioned care." Because we are a micropractice -- keeping low overhead with a tiny staff and a no-frills office -- we can afford to spend 30 minutes with the average patient. We don't need to see 25 patients a day, nor do we want to. Oxbow, our amazing EMR (electronic medical record) system, keeps our charting time down, reminds us of important health maintenance for our patients, sends out prescriptions and lab orders. We use an online scheduling and billing system that's free and easy to use so we don't have to pay a full-time billing or front office staff. Lindy and Robyn, our nurses, do an incredible job of taking the stacks of new patient records and digitizing them so we can use them in the EMR. Their high-tech expertise is a wonderful complement to the caring attitude they always have towards our patients.

Dr. Nelson is new to the area. She had been practicing in Cumberland in a family practice center, but was eager to try something new. She especially loves seeing children, and is looking for ways to expand our pediatric base.

Dr. Hahn is happy to be back with his former patients. His forte seems to be the older patient. He loves hearing their stories, especially those involving secret fishing spots!

The only problem we've been having is with insurance companies. We decided to embark on this adventure over the holidays last year. We found some support, especially through a local health system, who, among other extremely helpful things, offered us a credentialing specialist to get our insurance participation going. This can be an especially daunting experience, since every insurance is different, and they all need endless documentation; if just one "i" is not dotted, or "t" crossed on an application, it can send a provider's credentialing back to square one. So the credentialing started probably in February. I started sending Dr. Hahn's documents to our angel Amanda, who in turn, would send me reams of documents to read and sign. We started receiving contracts in May.

The average patient doesn't realize that every insurance company pays its participating providers something different. Some insurance companies are notoriously bad at payment fees as well as service, others are better. It was very interesting to us that none of the contracts we received included fee schedules! We were being asked, in essence, to sign a contract with no specific agreement on what we'd be paid for each type of office visit. We would call the company, which could often mean 2 or 3 hours on the phone just trying to figure out who was the right person to talk to about this. So we would get the fee schedule finally, and either sign the contract, or try to negotiate some of the more pitiful fee schedules.

Now that we have been open for a month, and it's been almost 7 months since we started the credentialing process, we are still not totally "on par" with several companies. We have signed the contracts, received information in the mail, etc., but still when our patients call and request the change of provider, it's like we don't even exist. This, I suppose, will just take time, to "load" our record into their Byzantine system.

I had some real fun yesterday. The day before, a representative of the West Virginia Medicaid system came into our office to try to explain how they worked. I have only so much patience for the absurdity of unneccesarily complex systems, so I started tuning her out until I heard her mention that there were 3 entities, not just 1, involved in WV Medicaid. It seems that if a patient has "UNICARE" following the date of birth on their card, we bill something called Unicare, rather than UNISYS, which is one of the other entities. And then there is something called PAAS. Now, I knew that Amanda had credentialed us with Unicare and UNISYS, but I didn't know anything about PAAS. I also didn't realize that Unicare administered WV Medicaid; I thought it was a totally private insurance company, and I figured that we probably had already seen some patients that participated in that program. So yesterday I got to work. I had to figure out if Unicare that we were participating with already was the one that ran WV Medicaid, or if we had just been par with some other private company that also had the same name. It took me 2 hours. I had a credentialing letter from a company named "Unicare" and when I went to their website mentioned in the letter, I saw that they had state-sponsored programs, one of which was West Virginia. But, when I called the number on the letter, the representative I talked to declared that she had never heard of the West Virginia program and that it must be some other Unicare. And, furthermore, she said that she couldn't find either of our doctors in her system! So, I called one of the phone numbers on a patient's Unicare card (from WV Medicaid), and was told that they, too, thought that this Unicare had absolutely nothing to do with the "commercial" Unicare, but that both providers were, yes, credentialed. I still thought they were wrong based on what I'd seen linked to their website. To make a long story short, I finally called another phone number from the patient's ID card, and finally finally finally found some happy-sounding woman who declared that, yes, you should file all Unicare claims under the Unicare billing number, including WV Medicaid, and Yes, allelujah! she has both doctors as credentialed providers in her system.

Sorry if that is so rambling. But this is the sort of thing I've been doing since we opened. I had pictured myself going in to the office for a few hours each day to follow up on claims, happily depositing checks, calling patients to remind them of their next-day appointments, helping Lindy and Robyn up front, and then going on about my day. But instead, I've been doing stuff like my previous paragraph. I'll have a letter from an insurance company acknowledging that our doctors are credentialed, but then when I call with a question, it's like the letter was mailed from Mars or, maybe I'm in some weird altered universe. I cannot imagine that this is the best way to run healthcare! Why does each insurance company have such different credentialing requirements? Why does it seem like they don't know what's going on within their own companies? Why are they so mysterious about what they're going to pay us? Why does it take 7 months to push some paper around?

If there were one payer, it might take awhile to get credentialed. But then it would be done. As it is now, we will have to stay on top of what -- 11? insurance payers and their constantly changing policies. It's our responsibility to read each of their bulletins on changes in how they're paying, and initiate changes in our procedures to keep up with it. What other industry has this burden? We are responsible for people's lives. That should be our focus, not having to constantly read fine print, or risk not getting paid.