A few weeks ago, the Center for Medicare and Medicaid Services (CMS) passed a ruling demanding that healthcare institutions post the fees that they charge for various services on their websites.

“It’s about time!” was the general reaction.  In what other industry in the world do you obtain services and have no clue how much things are going to cost?

Unfortunately, as many have pointed out already, the new law will probably not do much to foster transparency. 

For one thing, the prices posted by hospitals are the “list prices” for various services.  List prices are prices that have nothing to do with reality.  They are highly inflated and unrealistic numbers that hospitals and medical groups use to start a price negotiation with health insurance plans.

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I had the pleasure of joining Anthony Diaz on The #PopHealth Show podcast. We had a wide-ranging conversation regarding my prior experiences, my views about health, and what currently excites me in healthcare. We discussed ideas that are dear to my heart. I hope you find the conversation informative and enjoy it as much as I did. You can listen to the episode here (~ 24 minutes)

–Dr. Accad

A few weeks ago, a decision by a federal district court judge stunned the healthcare community when he ruled the Affordable Care Act to be unconstitutional. 

The ruling is being appealed and will not be affecting the status of the law until it is reviewed the Supreme Court. But it was interesting to observe the reaction of various parties…

The American Medical Association (AMA), which claims to speak for all doctors, tweeted that the ruling would “strip health care from tens of millions of Americans and sow chaos into the healthcare system.”

Similarly, the American Hospital Association issued a press release saying that the ruling “puts health coverage at risk for tens of millions of Americans.”

Now, I can understand a reaction of shock among patients who are dependent on health insurance subsidies without which they would be unable to afford the exorbitantly expensive care currently being provided in most healthcare venues.

But doesn’t it seem a bit disingenuous for the most powerful physician and hospital lobbying groups to lament the financial harm that the ACA rollback could have on patients? Isn’t it their institutions that are not only setting the prices for healthcare at stratospheric levels, but also obscuring them so that no one can know with any real certainty how much the care is going to cost?

We are pleased to announce the addition of the “carotid intima-media thickness” test (CIMT) to the array of non-invasive diagnostic tools available at Athletic Heart SF.

The idea behind the CIMT is simple: an ultrasound image of the carotid artery can provide information about the health of the artery itself and, more generally, about the overall health of the cardiovascular system.

The ultrasound image can identify two conditions.  First, the ultrasound can detect if there is actual plaque build-up which, if advanced, can block the flow of blood and contribute to the risk of stroke.  Fortunately, advanced plaque build-up is relatively rare.

Second, even in the absence of plaque build-up, the thickness of the vessel wall (CIMT) can give a broad indication of cardiovascular health.  The intima is the name of the inner lining of a vessel wall, and the media is the middle layer.  Both are seen in the image below as the bright thin line and the thin darker band behind it.

Ultrasound image of a carotid artery. The thin intima-media layer is indicated by the arrow.

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Your Heart Health in a Heartbeat – Episode 7

* You can either read the transcript or watch the video at the bottom *

The direct care experience

Recently, a young man called my office wanting to be seen.  I spoke with him for a few minutes to better understand his concerns and plan for his visit.  It turned out that his girlfriend had been hearing a pulsating, “wooshing” sound whenever she would lean her head on his chest: woosh, woosh, woosh…Obviously, there was a concern that this had to do with his heart.  He was otherwise feeling well and was able to exercise without any difficulty.Read more

I had the pleasure of being interviewed by Sami Karam, the editor of Populyst, an economics and demographics blog and podcast.  Sami heard about Athletic Heart of San Francisco and decided to devote a show to the topic of heart screens.  We covered a lot of ground, but the focus was mainly on detection of coronary disease and on contrasting the early detection strategy to the strategy of managing risk factors.  I hope you will find our conversation informative.  To listen to the podcast, simply click on the play button below or on this link.

Dear Friends,

In an effort to make heart scans more widely available, I am delighted to introduce a new service:  AHSF’s Coronary Health Starter Kit.

This service consists of an affordable telephone consultation focused on a cardiac prevention.  As part of this service, I order the famed “mammogram of the heart“, the coronary heart scan that can detect the presence of coronary artery plaques in their early stage, before they cause complications such as heart attacks and sudden cardiac arrest.

I recommend this service for men over age 40 and for women over age 50 (or younger women  if they had premature menopause).  You may consider obtaining the service at an earlier age if you have strong risk factors, such as a family history of coronary disease at a young age. This is a screening service, so it assumes that you feel generally well and have no specific symptoms to report.

I cannot think of a better investment for your heart health than to take advantage of this service and obtain a heart scan.  Please do not delay.  It is as simple as picking up the phone and calling 1-415-567-1014 between 9a-3p to make time for a telephone consultation.Read more

Desta and I had the pleasure of participating in a heart screening day at Sequoia High School in Redwood City last Sunday.

Volunteers obtaining 12-lead ECG’s

The event was organized by Via Heart Project, a non-profit organization that equips California public schools with AED’s.   Via Heart recently decided to organize heart screenings, and they put a lot of effort and talent into this first event.

They were assisted by the folks at the EP Save-a-Life Foundation, who have been organizing heart screens in the San Diego area for several years and who provided some of the equipment we used, such as the cardiac ultrasound machines.  In total, 203 volunteers helped out, not including the Redwood City Fire Department.Read more

UPDATE (07/06/2015):  THIS MOVIE IS NOW AVAILABLE ON NETFLIX

Anyone out there concerned about heart disease in yourself or a loved one?

Do me a favor and watch The Widowmaker.  This is the best piece of medical investigative journalism I have ever watched.  It will make you understand what is wrong with heart disease prevention in our broken health care system.

The movie also has great drama, both in the personal testimonies of ordinary folks who have lost a loved one to heart disease, and in the depiction of the political power plays at the highest levels of the cardiology community.

The trailer is below, but it doesn’t begin to give justice to the richness of the movie.  To see the film, click on this link.  You can download it as a rental for $4.99 or buy it for $9.99.  You won’t regret it and I agree with their tag line:  IT COULD SAVE YOUR LIFE.Read more

We are delighted to have been featured in a San Francisco Chronicle article which highlights the rising interest in cardiac screening among athletes.  I was correctly identified as being among the growing number of cardiologists who believe that current screening tools are excellent and underutilized.

The article covered the subject of screening in general, so I would like to offer some additional information for clarification. Read more