Cash Only Health Care

Physicians are more strained than ever before to stay in business and are searching for new models to help them succeed. Physicians’ offices spend between up to $30 billion dollars a year in administrative overhead trying to get paid by insurance companies. Due to the increased burden of administrative overhead and cuts in payments for services, many physicians are weighing the benefits of cash-only practices — meaning they would stop accepting any form of insurance and leave patients to seek reimbursement from insurance companies themselves. Cash only is a type of payment where the patient’s own resources pay for the care. It is contract between the patient and the physician. Individuals pay for care with personal funds, health saving accounts, and other funds. Cash only is the basis upon which the healthcare financing system began. Patients paid physicians a fee-for-service. In its purest sense, the Cash Only model includes only the physician and patient in the exchange of compensation for medical care provided. Over the years as healthcare financing arrangements have changed, entities paying a fee-for-service includes all payers-public and private. Recently, the healthcare industry has referred to physician practices that do not accept health insurance as cash-only practices or Cash only offices. Cash only vastly reduces the traditional overhead expenses by not having to bill and abide by contractual requirements of third party payers. There are already millions of Americans who cannot afford private health insurance and have Medicaid coverage. Others self-insure due to their financial resources being such that they can pay out-of-pocket for their medical expenses.

Melanoma

Melanoma is a malignant tumor of melanocytes, which present in skin but also in the bowel and the eyes. It is one of the more rare types of skin cancer, but causes the majority of skin cancer-related deaths. Malignant melanoma is a serious type of skin cancer. Uncontrolled growth of pigment cells, called melanocytes cause cancer. Despite many years of intensive laboratory and clinical research, the sole effective cure for melanoma is surgical resection of the primary tumor before it achieves a Breslow thickness greater than 1mm. Each year doctors diagnose around 160,000 new cases of melanoma and it presents more frequently in males and Caucasians. It is more common in Caucasian populations living in sunny climates than other groups. According to a WHO report, about 48,000 melanoma-related deaths occur worldwide per annum.

Fake v. Real

The question of the difference between real vs. fake breasts has become common in celebrity media. The quality of the surgery results in much of the difference between real looking and fake looking breasts. A poor boob job can introduce an unnatural looks. Breast implants are silicone rubber sacs filled with either saline solution or silicone, which increase the size of the breasts. Saline implants are the most commonly used form of implants in the United States. Implants come in different sizes, shapes and textures and a surgeon may place them under or over the chest muscles. Breast implants often sit higher on the chest than real breasts, and they appear fuller and rounder on top than real breasts. Breast implants often have a noticeable gap between the breasts, while real breasts tend to be closer together. Real breasts also fill out more at the bottom and not at the top. When in motion, breast implants often do not move much and will appear to keep their round shape, whereas real breasts will jiggle, bounce or shift depending on movement. There is mostly fat in real breast tissues and is therefore soft, whereas breast implants are more firm and less pliable. Silicone breast implants are generally softer than saline implants because they are made of a thick, gel-like substance that feels similar to fat. Saline implants feel more like muscle instead of fat. When women with breast implants do not wear bras, their breasts tend to stay firm and round. Natural breasts will hang lower and will not jut out much without a bra. Real breasts are mostly fat, which gives them a jiggle quality, if breasts look more like solid muscle, they may fake. One often can identify if breasts are fake by comparing them to the rest of the body. Although there is the rare woman who has a hot body and unusually large natural breasts, more than a few women make the mistake of going too large and getting very big fake breasts. Fortunately, these women are easy to spot: if she has the body of a dancer and breasts like a porn star. Check breast shape and alignment with her movement. Fake breast do not follow body movements as well. Many people associate breast implants with a large cup size, such as a D or DD. However, many women who opt for breast implants choose more natural-looking sizes such as a C or B cup. It can be harder to determine whether a woman has natural or implants at these sizes. In addition, padded bras create a similar effect to breast implants by lifting the breasts and making them appear larger. It can be hard to tell the difference between real breasts and implants when a woman wears a bra.

Podiatry

Podiatry is a branch of medicine devoted to the study, diagnosis and treatment of disorders of the foot, ankle and lower leg. In the United States, two groups of physicians mainly provide medical and surgical care of the foot and ankle: podiatrists and orthopedists. Podiatrists are certified in Foot and Ankle Surgery or certified in Foot Surgery and certified in Reconstructive Rear foot/Ankle Surgery by the American Board of Podiatric Surgery and are specifically trained to diagnose and perform complex surgical treatments of the foot and ankle. They are an integral part of the health care team, and combined with all other podiatric physicians, currently treat the majority of foot-related medical issues in the U.S. Orthopedists are the second largest providers of foot-related medical care. Each board-certified Podiatric Foot and Ankle Surgeon has a professional doctoral degree, which requires the completion of four years of Podiatric Medical School. The Podiatric Medical School curriculum covers basic and clinical sciences, including, but not limited to: general anatomy, pathology, biochemistry, pharmacology, general medicine, surgery, pediatrics, behavioral sciences, and ethics. Unlike MD and DO medical schools, the Podiatric Medical School curriculum also provides intensive foot and ankle “specialty” specific education beginning in the first year. They have completed a post-graduate Podiatric Medicine and Surgery Residency. While current Podiatric Residency models range from two to three years, the majority of graduates complete three years of podiatric surgical training and some continue on to do fellowships. This training follows a four-year undergraduate college degree. The first year of podiatric medical school is somewhat similar to training that physicians receive, but with a limited scope on foot, ankle, and lower extremity problems. As a second entry degree, for admission an applicant must first complete a minimum of 90 semester hours at the university level and/or complete a bachelor's degree. A residency follows the four-year podiatric medical school, which is hands-on post-doctoral training. There are two standard residencies named Podiatric Medicine and Surgery. These represent the two- or three-year residency training. Podiatric residents rotate through all main areas of medicine such as emergency, pediatric, internal medicine, and general surgery and of course podiatry — both clinic and surgical. During these rotations, attending podiatrists train the resident physicians in medicine and surgery. Podiatric Foot and Ankle Surgeons certified have successfully completed an intense board certification process comparable to that undertaken by individual MD and DO specialties. Certification involves written, oral, and computer-based patient simulation questions, in addition to submission of surgical case logs. Prerequisites for board qualification in Foot and Reconstructive Rear foot /Ankle Surgery require successful completion of a three-year podiatric surgical program and passing a written examination. Board certification in Foot Surgery is a prerequisite for board certification in Reconstructive Rear foot / Ankle Surgery. A candidate must pass both the written, oral, and computer-based patient simulation questions in Foot Surgery as well as the written, oral, and computer-based patient simulation questions in Reconstructive Rear foot /Ankle Surgery. Certification requires submission of 65 cases for certification in Foot Surgery and an additional 30 cases for certification in Reconstructive Rear foot/Ankle Surgery, for 95 cases. Certification requires four years of post-degree clinical experience before taking the certification examination. Additionally, must re-certify every 10 years to maintain their board-certified status, although some members who were certified prior to 1991 undergo a "self-test" examination, essentially circumventing taking the written exam all others must take in order to become re-certified. In the United States, the previous titles used for the Doctor of Podiatric Medicine degree were Doctor of Surgical Chiropody (DSC) and Doctor of Podiatry. Podiatry in the U.S. currently encompasses a broader spectrum of practice than it used to. Podiatrists can now perform medical and surgical procedures in all 50 states, though the specific scope of practice varies slightly in each state. History The professional care of feet was in existence in ancient Egypt as evidenced by bas-relief carvings at the entrance to Ankmahor's tomb dating from about 2400 BC with the depiction of work on hands and feet. Hippocrates recognized the need to reduce hard skin, described as corns and calluses. He invented skin scrapers for this purpose and these were the original scalpels. Aulus Cornelius Celsus, a Roman scientist and philosopher, was probably responsible for giving corns their name. Later Paul of Aegina (AD 615-690) defined a corn as "a white circular body like the head of a nail, forming in all parts of the body, but more especially on the soles of the feet and the toes.” Until the turn of the 20th century, chiropodists—now known as podiatrists—were separate from organized medicine. They were independently licensed physicians who treated the feet, ankles, and related leg structures.