We are currently 9 months into the practice since my clinic opened and more than 12 months since I started doing house calls to spread the word about a new way of providing primary care. 

In the last 5 years, we have seen a shift in healthcare policy. Expanding coverage we all know does not immediately mean accessible and affordable care. In addition, we see people waving their Medicaid/Medicare or private insurance cards in the air saying, "we are insured so come see us" but there are less physicians to take care of them. More and more physicians as well as large health systems are not participating with Medicaid/Medicare or some private insurance carriers. 

So, before you start to feel comfortable having that plastic card in your pocket, you should spend the time to figure out exactly what you actually bought and which physicians participate with your plastic card. 

                                          WARNING: This blog is very geeked out, so it is NOT for the casual reader.

The health and fitness industry has grown to become a multi-billion dollar industry. A large part of this growth has been through selling supplements to the “busy” consumer who just does not have time to eat healthy. Or, these products target the average American who has the aspirations to have the body like their favorite athlete. This has led to an explosion of various products confusing the consumer as to what is really necessary to take. 

The goals of this post are:
1. Understand basic human physiology of muscle contraction and all the micronutrients that are involved
2. Educate regarding these micronutrients and how supplements aim to help, assist, or replace them
3. Learn about various supplements, including pre-workout drinks, branched chain amino acids (BCAAs), creatine, B vitamins, and much more!
4. Touch on the topic of probiotics and fiber. What's my colon got to do with all this? 
5. Touch on "detox" programs, juicing, and fasting. Which is better and do I really need to do this?

Throughout this discussion, there is one proven fact that cannot be dismissed: all the nutrients your body needs already exist in your environment. To eat and live healthy, all we have to do is be willing to learn, make healthy eating a priority, and surround ourselves with people who will support eating healthy. Easy as that. To learn more, check out Dr. Sommer White, a board certified physician who is a great resource for you to learn about how food can heal and facilitate healthy living. http://www.sommerwhitemd.com

Also consider reviewing my previous blog about the 7 essentials to live healthy.

Basic physiology of energy
We all need energy to do anything. This is a law of physics where energy that is kinetic (motion) is dependent on the weight of the object and its speed. So the faster it moves and heavier it is, the more kinetic energy it develops. 

                                                                     Energy = weight (kg) x velocity (m/s2)
​
In food, we measure energy in calories. Our sources of energy come from proteins and carbohydrates. 
1 calorie = 4.1868 Joules (measurement of energy in an object) 

There is international debate as to how much calories we should consume. But here is a general recommendation: 

Men = 2500 daily calories 
Women = 2000 daily calories

​Those who are sedentary, certainly these requirements will suffice. But, what about those who are active. Meaning, those who are working out 150 minutes per week or more? Active individuals have a higher demand for micronutrients and calories, especially if they want to maintain their weight and/or muscle mass. 

This means, that the more you exercise, the more you expend energy, then the more you need to invest in the recovery phase. 

The recovery phase means:

1. getting 7-8 hours of restful sleep per night
2. optimizing nutrition 
3. balancing workout with stressful and non stressful routines
4. stretching, yoga, and meditation to allow muscle fibers to heal

It is the recovery phase where you build muscle, not when you are working out in the gym. 
Remember, before a single muscle fiber moves, it needs to get a signal from the nervous system. This is called an action potential. This process involves sodium and potassium channels. This is why micronutrients are so important!

Basic muscle physiology

​Our muscles are important structures as they not only give us strength, make us look “buff”, but also strengthen joints and improve our balance as we age. To learn what an action potential is watch this video. I love this guy because this is what I probably would be doing if I didn't become a doctor.

Now that you understand the basic muscle physiology and realize all the micronutrients that are involved in the contraction, the following sections will make more sense. 
​
What about these pre-workout drinks? 
There are various drinks on the market. At the gym, I see few people still use Monster energy drinks and the like. More commonly, I see 5-Hour energy. The main component in many of these drinks is caffeine. 

*Depending on the brew, an 8oz serving of coffee contains anywhere from 60-120mg of caffeine. Tea averages about 20-90mg per 8oz cup. Soft drinks average 20-40mg per can. 

How much caffeine is too much?
According to the Mayo Clinic, up to 400mg of caffeine a day is safe in healthy adults. However, in adolescents and children, they should limit to no more than 100mg of caffeine per day. 

So, taking a pre-workout drink will get an adult close to or meet that maximum daily requirement. Remember, these recommendations are for healthy adults. If you have heart disease, high blood pressure, anxiety, high cholesterol, arrythmias, and many other health conditions, then these recommendations DO NOT apply to you. 
Here is where having a good primary care doctor can help. Have a good conversation about your workout goals and work together to reach those goals in a healthy way. If your current primary care doctor is not comfortable with this conversation or doesn't even workout…well, then give Dr. Ahmed a call! 

​Many energy drinks and pre-workout drinks are packed with B vitamins. Ever wonder why? 
​Check this out:

What about whey protein and branched chain amino acids (BCAAs)? Or, creatine and glutamine so I can look like those fitness models? Because clearly, if I take all those, I will look like them right? 
Um, no you will not look like those fitness models just by taking these supplements. It takes a good balanced diet and exercise. More specifically, 80% - 90% is diet and the rest is exercise. You read that right: diet is more important than your exercise regimen. 

​How about juicing, fasting, and all these “detox” programs?
Majority of these programs are sketchy and very dangerous. Regardless of which program you are following, you need to be followed by a physician. This idea of “detox” should be an ongoing program where you eat foods that help clear any toxins by allowing normal bowel movements, increasing the efficiency of our cellular enzymes and reactions to digest all the toxins we are exposed to in our foods, water, air, etc. 
Check out www.sommerwhitemd.com. Watch her videos and her explanation of detoxification approach through food. We had her at our clinic and support what she offers. 
​
Short intervals of fasting are healthy, but must be monitored by a physician. Juicing has similar advantages for detoxification with elimination of inflammatory markers and provide antioxidants. Again, this should not be a one time thing and must be monitored by a physician. The bottom line is, get a doctor to monitor and assure that whatever you choose to do, follow it up with eating a healthy balanced diet and exercising daily. At the end of the day, diet and exercise is what is going to give you the benefits. If a fast or a juice helps you transition or get you to diet and exercise, then do it I guess. 
​
Here is a breakdown of the most popular ingredients the average athlete is curious about?

How much protein do I really need?
The average person needs about 1g/kg of protein per day. Those who are not as active can probably be ok eating a little less than that. However, if you are trying to add muscle mass, then the usual recommendation is 1.5g/kg. Remember, muscle building happens at night when you are sleeping or when you are resting, not at the gym. Balance this with about 30g of fiber to prevent constipation and certainly anyone with kidney disease, high blood pressure, or the medical conditions must be monitored by a physician. 

To give you some idea of how much protein some common foods have:

• 3 oz meat = 21g protein
• 1 cup milk = 8g protein 
• 8 oz yogurt = 11g protein 
• 1 cup dry beans = 16g protein 

So, the point is, before you run to the store to get containers of whey protein and bottles of BCAAs, think about how much protein you already consume and if there is a deficit, THEN consider possibly supplement. Remember, many if not all supplement products are NOT FDA approved. This means, these supplements are not benign or harm free. We just do not know the long term effects of some of these supplements. That is why I recommend use supplements to help you fill in gaps and hopefully you can replace those supplements with actual food. Long term supplements are not a good idea since we do not have the data to support their absolute need for the average human being. Professionals athletes are a different category in this discussion. 

Probiotics and colon health
There has been more enthusiasm about probiotics recently without the support of much scientific evidence. All the trials that are done on probiotics are inconsistent with methodology or are small studies. The intestinal tract is a host to any bacteria and any change in these colonies can affect your health. In a sense our intestine has its own ecosystem with bacteria regulating certain toxin elimination and protecting the intestine from inflammation and other processes that can damage its lining. 

By definition, probiotics are microorganisms that have beneficial properties for the human being. Many of the bacteria in these tablets are available in foods, such as non-pasteurized yogurt and milk. Some of the benefits include suppression of growth or epithelial binding/invasion by pathogenic bacteria, improvement of intestinal barrier function, modulation of the immune system, and modulation of pain perception.  Reports for benefit have been seen in the following conditions:

1. infectious diarrhea
2. Clostridium deficile infection 
3. preventing antibiotic associated diarrhea
4. Possible benefit with IBS 
*Again, the data is limited here. As you can see, there are only a few things have shown moderate evidence of benefit

Fiber is a stool bulking agent that helps people stay regular. It is important to have one bowel movement per day. The bulking agent facilitates peristalsis, which is contraction of the intestinal tract to help move stool along to facilitate a bowel movement. You need to take in about 20-25g of Fiber daily. I usually recommend 30g given the poor American diet. You can get fiber in a balanced diet or supplement with any affordable over the counter powders. 

Colon health is important to eliminate toxins from our body. If you think about it, our body eliminates waste by sweating through our skin, urination, and stool elimination. The average American does not stay hydrated and nor do they stay regular with their fiber intake. So the body is left with only sweat as a mechanism to eliminate waste. There is something to be said as these toxins accumulate and are not released, this can lead to poor health outcomes. More evidence is needed for this statement to be completely accurate, but the basic physiology suggests this possibility. 

                                                                       What is the bottom line on supplements?
I take supplements to help with muscle development and recovery. However, supplements are there to do just that - supplement your diet! A majority of supplements I think are unnecessary long term. If you are working out for a competition or a sport, then short intervals are reasonable. The more I learn about various vegetables that I had no idea about: daikon, miso, wakame, dried shiitake, and the benefits of brown rice, I am starting to realize how silly supplements seem. 

​Every supplement, whether they claim to be “all natural” or not, need to be monitored by a physician who is comfortable with these products. 

I have tried many supplements and do so with the intent to taste what my patients or future patients are likely trying. I also read about these products, because for me, it is important to have a knowledgable discussion about these products in the right medical setting. Consumers who take these products are likely very in tune with their bodies and would appreciate a physiologic lesson as to why they should continue, adjust their dose, or maybe even stop what they are taking. 

So, bottom line, focus on your diet. Get a team together that will help you not only understand but hold you accountable to a good balanced diet. Food should be entertaining, enjoyed with company, and diverse to facilitate curiosity and enjoyment. The supplement industry makes billions off the human behavior of not sticking to a plan or climbing on and off the wagon. Save yourself money and put together a good team for yourself to help you take what you need and stick to a program for life. Finally, combine your healthy diet and supplements with the right exercise program. You do not need to work out 6 days a week and spend hours at the gym. 

After 1 hour in the gym of active working out, any more time is just increasing your risk for injury. Athletes are different in that they know how to recover in between training sessions during the day with the right nutrition to allow healing of those injured muscles. 

Don’t be swayed by these new years resolution gimmicks. Stick to what you know - great diet with 150 minutes of activity per week is all you need to see results. Finally, be patient and positive. Feed your soul with a good book, meditate, do yoga, and laugh. 

Please do no hesitate to ask any questions you may have. Better yet, if you don't have a primary care doctor, please consider joining my practice. 
​
To a great year full of happiness, health, and blessings,

​Dr. Ahmed 

The air was crisp this Sunday afternoon. The snow had already melted and the cold air brushed my face softly. My body was shaking from the cold, but my mind was too busy to really take notice. My shoes had managed to gather a layer of mud that was an inch thick. To my right and left, I was surrounded by sad faces. Many were people I have known from the community, my friends, and others I hope to know one day. 

As I looked around the muddy cemetery, I noticed the clean gray speckled tombstone blocks that were neatly organized in rows to identify where the deceased rested. However messy the grounds seemed, the tombstone blocks were clean as if it was a dry summer day. The trees were bare and the sun shined bright through a clear blue sky.

At the distance I noticed the large fresh dirt mound that had been created to cover the deceased body whom we laid to rest this afternoon. All the sons surrounded the mound for their last prayers for their father. I could not help the tears that started to fill up. Why am I crying? I did not know the man. This was a very captivating moment for me. Here I am, extremely emotional for a man I never met, whom I never said a single word to, never shook his hand, never saw a picture of him till the announcement of his passing. What is the deal? 

Who I did know were his sons. You see, his children have impeccable personalities. When you meet them, your soul is fed with calmness, a certain ease, your heart slows a bit, and you can feel genuine compassion when they speak to you. I have watched, listened, and simply enjoyed being part of his son's community charity events. Their message is always simple and food for the soul: Live with compassion and use your talents to better your community. At least that is what they have taught me. You see, that is the mark of compassionate leaders - their actions touch us all in different ways. 

During the funeral, one of his sons educated us about his father. Most importantly, he said and I am paraphrasing "all the things we as sons do in the community and good deeds you see us doing, has been taught to us by our father." It was at that moment, I grasped what kind of man their father was. He was amazing. After listening to those words, I knew he was a great man. A humble man. A man who probably never made himself known in a room with a loud bolstering voice declaring all his accomplishments. Instead, I sensed he was a man who promoted a sense of community, provide a lending hand to those in need, emphasized the importance of charity - which comes in many forms, even a smile. 

It is these thoughts that came flooding in my mind with tremendous force.  I could not handle the emotions that followed. It was a tsunami of thoughts and pictures of what I imagined him doing or saying to his adult children when they were young kids.  I must say, I did well in fighting back the tears. But, as I lay down to sleep that Sunday night, the tears flooded my pillow. I could not fight it anymore. Silence of the night made the thoughts not only return, but were uninterrupted by any other concerns. 

​The Abdullah brothers are an inspiration to me and to all of us.  I am honored to know them and our Kansas City community is privileged to benefit from their extreme compassion. As a physician, they have taught me and motivated me to take my talents and skills to the next level to help those who are uninsured and insured to receive accessible and affordable primary care. 

I hope to be an asset to the community as the Abdullah brothers are to our community. When I pass, if my good deeds come even close to what their father has accomplished in raising his kids alone, then maybe, just maybe, I will get a chance to meet him...and thank him for his gift to my community. 

Dr. Ahmed 

Employer wellness programs have become more popular in the last several years. Its popularity for implementation has its roots in the ever increasing concerns of rising prevalence of obesity, diabetes, heart disease, and many other chronic illnesses. In fact, based on recent surveys, almost 80% of companies offer some type of a wellness program. 

Vendors for these wellness programs have enjoyed their growth in the last several years to a point where it has become a $6 billion industry. 

So, it is only fair to ask the question: Are employers getting a significant rate of return on their investment?

The rationale for having a wellness program in the workplace is to create a organizational culture of wellness, improve the health of its employees, decrease turnover, increase productivity, reduce health care costs, and on a larger scale - improve the health of our nation. Nearly half of Americans get their health benefits from their employer and we all spend a majority of our time in the workplace. Thus, these goals and rationale make sense. 

But, has this $6 billion industry delivered on its promise? 

On average, employers spend about $693 per worker and larger companies who have 20,000 workers or more spend nearly $878 per worker. A large survey found that although some biometric markers like BMI, smoking cessation, and exercise had improved, these changes were not large enough to reduce health care costs nor provide the employer with a substantial ROI. 

In addition, one of the major challenges in offering a wellness program is employee engagement (industry talk for employee participation). Surveys have shown that even after a wellness program is implemented, employee engagement is low. Studies have shown that the lost productivity from employee disengagement costs between $450 billion and $550 billion annually in the United States. For each employee, disengagement can cost the employer $5,000 to $7,000 per year in lost productivity. 

What if a physician led an employee health benefit plan where it included resources like fitness trainers, physical therapists, nutritionist, chiropractor, acupuncture, supplements for healthy eating and weight loss, financial advisors, lawyers for estate planning, massage therapists, counselors, medical specialists, and educators?

What if the physician also had partners in imaging, laboratory, pathology, had wholesale medications in their office, did not charge for any office visits or in clinic procedures like EKG, joint injections, suturing, skin biopsies, wound care, breathing treatments, or spirometry?

What if each employee as part of this physician led wellness plan had 24/7 access to their physician, even during holidays? Certainly a relationship between the employee and the physician is inevitable.  So is there value in this relationship where the physician understands the stresses, aspirations, goals, as well as medical condition of the employee?

Finally, what if the cost is only $600 per employee that is fixed annually with no other out of pocket expenses for the employer? While the employee enjoys significantly discounted medications, imaging, laboratory, and other services. 

The answer to all these questions is not an ideal nor is it impossible to implement. I do it already with companies right here in Kansas City. Many physicians across the country who share my vision and mission have also aligned their practice with other companies of various sizes. 

In a study that reviewed insurance claims data from 2013 to 2014 showed that the employees who belonged to the Direct Primary Care model compared to those who did not saved $679,000 per 1000 employees. In addition, there were close to 20% less claims  from the DPC group. 

Isn't it time to be innovative and offer a more comprehensive program to your employees? My practice is NOT insurance. So to qualify for the ACA mandate, employers must have a high deductible plan or a self insured plan that can be paired with our practice to give the most value to your employees. 

Healthcare is changing. Costs are rising and the physician supply is decreasing. Employers can play an important role in changing this landscape with one decision: partner with a direct primary care practice. 

Our mission is to recruit more primary care physicians, retain more physicians in private practice to facilitate patient focused care, and bring back continuity and relationship medicine. We do this simply because the health of our nation depends upon it. 

Please contact us today if you would like to learn more about our primary care practice and how we can partner together to truly establish wellness in the workplace. 

To your health
​- Dr. Ahmed 

Recently, there has been much discussion regarding concussion and sudden cardiac death (SCD) in young athletes. Although this is rare in children and adolescents, they are so devastating when it happens. There has been a growing effort in finding evidence-based strategies that will prevent this in a cost-effective manner. 

How common is this?
The incidence for SCD ranges 0.5 to 20 per 100,000 persons-years. Interestingly, when we compare studies from 1980s to 2009 show a rise in survival, which is attributed to improvements in community-based EMS and changes in resuscitation protocols. 

What is the cause?

• Coronary artery disease (29%)
• Primary arrhythmia like Wolff-parkinson-White syndrome (WPW) and conduction defects (22%)
• Cardiomyopathy like dilated, hypertrophic, and myocarditis (20%)
• Congenital cardiac disease like tetralogy of ballot, hypo plastic left heart syndrome and transposition of the great arteries (15%)
• Other cardiac disorders like coronary arteritis, anomalous origin of coronary arteries, aortic dissection, and mitral valve prolapse (8%)
• Unspecified disease (7%)

Interestingly:
2 years old and younger - cause of death congenital heart disease (84%)
3-13 years old - No dominant cause - congenital (21%), hypertrophic cardiomyopathy (18%), long QT 
                                    Syndrome (14%)
14-24 years old - No dominant cause - Primary arrhythmia (23%), congenital (23%), and dilated 
                                       hypertrophic cardiomyopathy (14%)
25-35 years old - Coronary artery disease 

When should I be concerned?

• chest pain
• fatigue
• passing out or lightheadedness 

What is the role for screening?
The American Heart Association (AHA) and the American Academy of Pediatrics (AAP) recommend that the most cost-effective initial screening for children and adolescents for cardiac disease is a detailed history and physical examination - ALONE. That is right, no need for unnecessary expensive testing no matter how some of these organizations market their services. 

There NO evidence that a ECG or any other cardiovascular screening program would reduce the incidence of SCD in the United States. 

Even for young athletes, there is NO evidence for routine use of ECG, echocardiography, or exercise stress testing. However, athletes older than 35 years old, some experts recommend ECG. If the athlete who is 35 years and older has moderate-to-high risk of coronary heart disease, then some experts would recommend exercise stress testing. 

Bottom line: Be careful out there as consumers are inundated with advertisements for services that can prevent cardiac disease. The truth is that unnecessary testing not only is costly, but also leads to false-positives that lead to further unnecessary testing. As with every health care topic - have a GOOD PRIMARY CARE DOCTOR to discuss issues like this and build a relationship with them so that you protect yourself from unnecessary testing that can be costly or lead to further unnecessary procedures that might expose you to harmful agents like radiation. 

To your health my friends, 
- Dr. Ahmed 

Unfortunately, we give our cars, clothes, beauty/spa treatments, homes, or entertainment desires more attention than our own health. The realization of this neglect only becomes known when we become ill or injure ourselves. 

Therefore, just like anything else, there is tremendous value in prevention and education. One thing I hear a lot is, "I am very healthy and never see a doctor." Is that a good thing? Should we see a doctor only when we are sick and vulnerable? What about seeing the doctor to discuss life's stress, maybe you are traveling and need to learn about important vaccines, learn about any public health concerns, prevent future illness?  How about losing weight? Do you really need that supplement and if so is it safe? Isn't it more costly to go to an urgent care for every minor health issue than going to a doctor who knows you and can see you that day or next day? Finally, do you really need a specialist following your chronic condition? 

We have new testing modalities that enable us to prevent heart attack or stroke in those who do not have the traditional risk factors, like smoking, high blood pressure, diabetes, or high cholesterol. 

Here is a quick chart on how our patients save if you just look at the numbers. These numbers make the following assumptions:

*Single without any dependents
*Male
*Minimum use of health care (healthcare.gov estimates) 
*Cheapest plans are selected for this comparison
*Average income of $75,000
*No primary care visit costs as some insurances charge $25-50 for each visit
*No specialist vist costs

So, if you are a couple, go to a primary care doctor currently or urgent care for your needs, have dependents, you are female, or make more money, the cost is significantly more. 

Remember 2016 Annual HSA Limits per IRS:
Self-only coverage = $3,350
Family coverage = $6,750

What about Medicare you ask? Well, Medicare patients not only save money, but have a physician who can be a true quarterback for your health care. Coordinating with specialists, home care services, preventing falls, making house calls or assisted living/independent living visits are a tremendous value. 

This probably goes without saying, but these numbers are estimates. There are so many factors that can affect your final costs. Certainly, if you end up needing surgery or need medications, then the cost will be higher. This is simply illustrated to give you a general idea at the most basic level.

​I hope this blog really clears the air a little in how insurance works with our practice. Remember, at Health Suite, you can pick LiveActive Primary Care as your primary care service or KC Family Doc. Check us out or meet us for a free consultation today! 

To your health, 
- Dr. Ahmed 
​

We all read so many books throughout our lives, but there are only a handful that we find ourselves re-reading. For me, I literally have only 3 books on my shelf that I read multiple times.

The Present was a book I bought back when I was studying for my Masters degree. I was on a internship where I was learning basic managerial skills: motivating employees, establishing a teamwork culture in an organization, and increasing productivity. It has been recommended to me and I have learned that it continues to be shared in the workplace even today.

​This is a book that can be finished in a few hours, literally. It is very simply written, but demands one to reflect and contemplate. The Present is exactly what you make of it. We all are aware of it, but its implementation is what is so challenging. Carpe diem, as the Romans would say, is an ancient reminder that is illustrated in this book. 

The message is simple, yet difficult to implement on a daily basis. 

1. Live life in the present
2. Learn from the past to make the present better
3. Focus on the present to make a desired future possible
4. Live with purpose and intention 

The Present addresses these 4 core lessons through a story that is shared between 2 characters. The reader is asked to reflect upon the story and think how they can implement these lessons into their own lives. 

Living with purpose is central to my existence. I was taught by wonderful mentors and leaders who always put purpose before "work." The idea that our work must fulfill some personal purpose is key for self-motivation and focus in life. Consider following one of my favorite leadership scholars, John Maxwell, on twitter #intentionalliving. 

If you like books that are very descriptive and tell you exactly what to think, then you  may not like this book. But, if you like books that facilitate reflection, discussion, and allow you to reflect from your own  perspective, then you will enjoy this book. 

I love it and hope you consider reading this book. Share it with your young adults, discuss its principles as a family, and share it with others. 

- Dr. Ahmed 

Many of you know I am very passionate about the practice of medicine and am quite vocal about how to improve our national health care system. There is one question that seems to be brought up consistently by my audience: How has the Affordable Care Act affected your practice? Furthermore, some people will ask, I have insurance so doesn't that mean I am covered?

So, to clear the air on what is truly happening since the enactment of the ACA, I will attempt to explain it in simple terms in this blog post.

Prior to the Affordable Care Act (ACA) being enacted on March 23rd 2010, physicians and economists have been yelling at closed ears about how expanding coverage is not the only solution to this mess. The 2 major problems in addition to coverage is ACCESS and COST of health care. Simply put, here is how the ACA impacted these key components of our health care crisis:

COVERAGE: Although we have now insured an estimated 10 million of the 43 million who were uninsured, 18% of the US population uninsured down to 11%, we have accepted narrow provider networks, higher premiums, higher deductibles. The complexity of insurance products have increased, causing even more confusion as to what consumers are actually buying. In addition, there is confusion as to who is in your network and many consumers realized they have to travel significant distances to get care.

The Commonwealth Fund found that the rise in premiums for employer-based plans had slowed in several states but they continue to rise faster than median income. Therefore, as wages stayed stagnant, premiums continued to rise.

Finally, many providers do not participate in certain networks or insurance plans given their poor reimbursement.

COST: Insurers can decrease or maintain a premium by shifting the out of pocket costs to the consumer, co-pays, and deductibles. Medications continue to rise in cost by double digits. Medicare premiums continue to rise and out of pocket expenses on average are $5,400 annually for the 65-70 year old, but increase substantially as we age given increased hospitalizations.

The cost of medical devices and hospital stay continue to rise. Why do we have to negotiate these costs each time we review our hospital bills, which are full of vague charges? I have done outcomes research studies in a hospital setting where we try to show cost savings with a medical treatment.  To estimate and create a line item cost of a single unit blood transfusion is impossible.

ACCESS: Lack of understanding of networks, physicians not being part of poorly paying insurers, and the simple fact of increased demand with a decreasing supply of physicians has led to delayed diagnoses and even death.

So, how has the ACA affected my direct primary care practice? Single answer: it has helped me from a business standpoint as our solution is even more significant and patients enjoy their freedom. The ACA has made it harder for those who are in the "donut hole" and their states have not expanded Medicaid to get any type of care other than our practice. In effect, our practice is saving the ER and the hospitals from ever increasing accounts receivables to writing off large amounts as charity care.

From the PATIENTS PERSPECTIVE:
Our practice provides accessible primary care services, urgent care visits, and affordable services whenever they need it. In addition, this relationship in the long term will prevent illnesses that cost Americans thousands of dollars. Finally, patients are empowered with resources to take care of themselves, they have transparent imaging, laboratory, and pathology pricing. They can CHOOSE to use their insurance for any ancillary service if they want and compare cash pricing to what the insurance companies will cover.

From the PHYSICIAN PERSPECTIVE:
The ACA has increased the red tape and regulations on medical practice. For example, on October 1, 2015 ICD-10 came into effect. The previous ICD-9 had 17,000 codes and this newer version has 141,000 codes! Think about the direct costs of software update, hiring more staff, and the indirect costs of training, lost revenue from inefficiency and slowed practice. Since we do not contract with insurance carriers, these nuances have no effect on us.

The ACA has caused more physicians to leave the practice of medicine. There is an estimated deficit of 124,000 primary care physicians by 2025. Our practice has become more attractive where physicians can be sole owners of their practice and join Health Suite to share its resources and all of its community resources.

Finally, the ACA motivated us to seek more partnerships to save our patients up to 95% on imaging, medications, and pathology for being our members. 

Bottom line: Practices like ours will soon be paired with high deductible plans, as they are in Washington state. This is low cost and high value for consumers. So, spend the time to look at our practice, talk with us, talk with our insurance brokers, save thousands of dollars for yourself or your company by pairing the right insurance product with our practice.

Some good resources:
NY Times article
2015 Milliman Medical Index
Essay by Patrick Ishmael
More employers shifting cost to employees

So a couple of adventurous guys and myself thought we would head out to West Virginia to battle the infamous Gauley River. It is a 105 mile river that merges with the New River to form the Kanawha River, which is a tributary of the Ohio River. The Gauley River is the most popular advanced whitewater site in the country. It was a 2 day trip that involved piercing through challenging rapids that ranged from class 3-5. According to the American Whitewater Association, each rapid is ranked by the character of the rapid in terms of how violent and harsh it is, distance, technical difficulty to maneuver, and finally the difficulty of swimming in it. In other words, the higher the class of rapid, the higher the chance of something bad happening to you.

Check out the reviews: http://www.tripadvisor.com/Attraction_Review-g59234-d3330369-Reviews-New_Gauley_River_Adventures-Lansing_West_Virginia.html

As you can see from the pictures, the river beat me up bad! I strongly recommend trying new sports and activities. Prior to this trip, my workouts were truly at its peak. Those of you who workout know what I am talking about. It is a point where lifts seem easier, body responds to the workouts, and each session is better than the previous. We all experience set backs and for me this really sucks! Quite honestly, my immediate thought was about how I cannot workout my upper body for several months. It really stinks.

So you are probably wondering what happened? Well, it was the second day of the trip, the last class 5 rapid, and a huge rapid pushed me off the raft. This was the second time I was knocked off the raft and for some random reason, I thought I could grab a hold of the rope that was lining the outside of the raft to propel myself back onto the raft. The river, with all of its tremendous might kept pushing me away from the raft. The bicep muscle could not withstand the force and "pop" went the distal tendon.

Ouch.

Down I went with the river. If you have not gone rafting, this is the point of the story where all I remember is waves crashing on my face and seeing rocks zoom by as I continued to go down the river. This is where the only thoughts that go through your head is "I hope I don't hit a rock head first!"

Luckily, I swam and navigated to the nearest raft and was lifted up onto safety by friendly strangers. I was surrounded by laughter and smiles as each patted me on the back. But, I could not smile. The pain was too intense.

Life must go on. Today, at the clinic, I saw a few patients, ate lunch where I bumped into people I know who asked the obvious question after seeing my left arm in a sling "what happened?" It certainly makes for a good story.

I must say though, my practice has spoiled me rotten. I cannot help but smirk when I have to fill out so many forms prior to seeing the doctor, go into the "second" waiting room only to get my vitals checked, then wait another 10 minutes before the doctor comes. The funny thing is, after all that, I was told I had to see another doctor since my muscle was so high up my arm after the tear. Ahh! Another visit, more forms, and more waiting!

Will keep you posted on my progress. Please feel free to share your injuries with extreme sports or any sports injury.

Injured, but always there for my patients,
- Dr. Ahmed