Monthly Matters:

• GreenField in the News...
• GreenField's eStatements- Saving Time, Money & Paper
• Eating Local--- Trend or Tradition?
• Dollars and Generic Medications
• Family Matters: Toilet Training

GreenField Health’s Health Matters

July 2009

GreenField in the News...

July 1, 2009- Are American’s getting their money’s worth from US healthcare? In our last edition of Health Matters, we shared with you that GreenField’s Dr. Chuck Kilo and co-author Dr. Eric B. Larson of Group Health in Seattle would explore this important question in their article Exploring the Harmful Effects of Healthcare in the July 1st issue of the Journal of American Medical Association (JAMA). We are very proud of the work of Dr. Kilo and Dr. Larson, and applaud them both for addressing this very important question. The article is available on our website at: http://securemail.greenfieldhealth.com/portal/About+GreenField/IntheNews/default.aspx

July 6, 2009- GreenField’s Dr. Chuck Kilo was one of four physician guests on the OPB radio show Think Out Loud, which focused on the impact of the disparities in physicians salaries. You can read more about this show or listen to it in full by visiting: http://www.opb.org/thinkoutloud/shows/rx-doctors-salaries/. 

GreenField's eStatements- Saving Time, Money & Paper

At the beginning of July, we sent approximately 1,000 patient statements out with the push of a button as we became the first medical practice in the country to use Kryptiq Corporation’s e-Statement product for patient billing. This saves time, paper and postage, and makes your response much easier. We are excited about this transition to e-statements which will allow you to view your entire statement online, pay your bill online, or even set up a payment plan if necessary.

Here is how our new e-Statements work:

• You will receive a secure email when you have a statement or new bill from us. (This means we’ve billed your insurance, and they’ve paid, so this is the actual part that you owe.)

• If it goes unopened, after 5 days, the system will send you another secure email notification that you have not opened your statement.

• The system will automatically drop the statement to paper and mail it to you, if neither of the emails are opened after a period of time, which will be approximately 2 weeks.

• In your statement, there is a link for you to pay your bill online.

• Please note - you will still receive a statement from us every month via secure email even if you are on a payment plan with us, but you may file it away if you are current on your payment plan.

Thanks for walking with us on the journey as we roll out this new technology. We will inevitably have some bumps along the way as we all get used to this new system. As always, we are here to assist you and answer any questions that you may have. You may also choose to opt out of receiving your statements from us electronically and we will continue to mail them to you. To opt out of receiving your statements electronically or for any questions please email Beth.Davis@GreenFieldHealth.com. 

Eating Local--- Trend or Tradition?

Contributed by New Seasons Market Customer Advocate, Allison McGillvray and New Seasons Market Nutritionist, Karen Seibert, MS

The trend is easy to spot—it’s highlighted in your neighborhood market, and splashed on storefronts and lamppost banners: Buy Local! We’re sustainable! Go green! Buying foods grown closer to home has become the latest trend in eating. The word “locavore” has even made it into the New Oxford American Dictionary, defining the people who choose to only eat food grown or produced within a certain radius—typically 100 miles.

WHAT DOES “BUY LOCAL” REALLY MEAN? As there is no federal definition of “local”, so the concept of buying local can have a variety of meanings.

• Grown at home (very local!)

• Grown in your community

• Made or produced within 100 miles

• Made in your state

• Made in the U.S.A.

• Your answer here:_____________ 

As our economy changes, many people are embracing creative ways to live more simply. There is an increased focus on sustaining our communities. Connecting with the people who share our space and grow our food is the foundation of transforming the “eat local” movement from a momentary trend into a deeply rooted tradition. As our habits change and we reorganize our priorities, choosing local goods and services goes beyond trendy—it quickly becomes a way of life.

Building relationships with the people who share your space, your air and your land is the first step towards preserving your community. When you buy milk that’s produced by the neighborhood dairy, the people who work there will continue to pay their mortgages and ideally, spend their dollars locally as well—perhaps even at the business that provides your own paycheck. Buying foods grown close to home helps to re-establish the long-standing relationships that exist between you and the people that grow the foods that you eat.

Consider one of the critical benefits of buying foods grown in your community. According to The Sustainable Business Network of Portland (SBNP at www.sbnportland.org  ) an alliance dedicated to fostering a sustainable local economy, “Locally owned businesses spend more money at other local businesses helping the local economy to grow – creating a ‘multiplier effect’. Rather than this money ‘leaking out’ through remote corporate headquarters and centralized purchasing departments, local businesses pay more in local and state taxes than outside corporations.” A locally owned independent business (LOIB) returns approximately 80% of each dollar spent back to the community through a variety of ways including, school funding, social services and donations to non-profit organizations. You could say that buying local is a gift that keeps on giving--- back to your community.

Becoming aware of where your food is grown and how far it travels (known as food miles), and whether or not items you purchase are grown or made in your community is the beginning of moving in a “local” direction. If you feel overwhelmed by all of the implications of your food purchases, but would like to step into the local movement, start small. For example you can choose one local food to focus on: What is popular in your area---Hood Strawberries, Columbia River Gorge Apples or Pacific Village Butter? Or, if you want to dive in, take your family to one of the many Farmer’s Markets that spring up this time of year or go picking at one of the local U-Pick farms. You can visit New Seasons Market website at www.newseasonsmarket.com  for our U-Pick Guide to local produce and our local farmer’s market guide, as well.

There are a lot of wonderful reasons to buy food that is grown close to home, not the least of which is freshness, but why is fresh food better? As with many things related to food and nutrition, there is no simple answer. If we peel back some layers we can look at the qualities local food brings to your plate and see that the impact of buying local food goes way beyond the amount of vitamins, minerals and antioxidants that arrive in that vine-ripened tomato.

One of the greatest accelerators of nutrient loss in produce is the time fresh food spends in shipping and storage before reaching your dinner table. For example, leafy greens such as spinach may lose up to half of their nutrient value within 8 days of harvest! The average conventionally grown fruit or vegetable travels 1,500 miles from farm to plate, while foods grown locally may have only spent 24 hours out of the ground and traveled less than 200 miles. Foods grown closer to home are often fresher and have suffered less nutrient loss, which indeed translates into “more nutritious.”

Local produce has more time to ripen on the plant. Tomatoes allowed to vine-ripen are higher in vitamin C than their conventional counterparts. Fruits and vegetables allowed to mature or ripen naturally generally have a shorter post-harvest life and cannot withstand being shipped the distances required of national markets. Minimizing transportation time means that food can be picked at its peak of freshness and ripeness, thus maximizing flavor, color and nutrient content.

Farmers who supply nearby markets have more flexibility in choosing crop varieties that would never make it to a distant supermarket. Since their produce does not have to withstand over-handling, extensive travel time and endless jostling, they are able to choose specific crops for their flavor and nutrient qualities over their sturdiness.

One more perk to eating locally: Studies show that an increased awareness of regional foods leads consumers to eat more fresh fruit and vegetables, which has a vast array of health benefits.

The idea of buying locally-grown products is not immune to misperceptions. Some may think it is cost-prohibitive. Farmers markets across the country are designing programs to increase the accessibility of market goods, making it possible for people to purchase fresh, local produce with food stamps. And with a set budget and a few sensible shopping tips, it’s easy to walk out of your farmers’ market or grocery store with an armload of fresh fruits and veggies.

Remember to shop seasonally: If you’re looking for tomatoes in February, chances are you’ll pay a premium for a relatively low-quality product. Shop when supplies are highest and prices are lowest. Not only will you pay the best possible price, but you’ll be getting fresh, locally grown food at the peak of its season. Another advantage to changing your menu to embrace the seasons is that you’ll eat a broader variety of nutrients than you would if you maintained your standard routine.

There are people who will embrace the idea of eating locally-made foods completely and enthusiastically: they will plant a large vegetable garden, buy a pair of goats and some chickens, swear off supermarkets and start counting food miles. As admirable as that is, it’s not a realistic approach for most of us. So start small: choose the apples from Hood River, Oregon, instead of the ones from New Zealand. Plant some herbs in a pot on your porch. Don’t deprive yourself of non-local foods that bring you joy in your effort to improve your life. Simply holding an awareness of where your food comes from is a step in the right direction. Once the value of locally-produced food is in your subconscious, your choices will lean that way, too. Before you know it, this “trend” will be a part of your family’s tradition.

Our thanks to our friends at New Seasons for their contribution to this month’s Health Matters! For more information about New Seasons Market please visit their website: http://www.newseasonsmarket.com/ 

Dollars and Generic Medications

Some people remain skeptical about generic medications – they question their effectiveness and believe that brand-named drugs must be, for some reason, better than generics. Some simply believe that a more expensive product must be better then a less expensive alternative. At GreenField, we would not advocate for and suggest generic medications, or any medication for that matter, if we did not have confidence in its effectiveness.

Because of the issues noted above, in particular the ever increasing expense of healthcare, we believe that it is prudent to provide you with the best care, but also with cost-effective care. We do believe that we should opt for a lower cost option over a higher priced option if they are equivalent – if they both lead to the same outcome. It is the inattention to such details that is leading US healthcare to be unaffordable to so many in our community.

We present three examples to you here. Three new medications have recently come onto the marketplace. However, being new, and thus expensive, does not mean that they provide any benefit over existing medications.

1. Cholesterol and Triglyceride Management

The FDA has recently approved the medication Trilipix (fenofibric acid, or finofibrate – Abbott Pharmaceuticals) to reduce triglycerides and increase HDL (good cholesterol) in those at risk for cardiac disease. The patent for Tricor, Abbott’s older formulation of finofibrate will expire in 2011. Generic forms of fenofibrate are already available at much lower costs than brand named alternatives. And, there is no medical evidence that Trilipix is more effective than any other fenofibrate including available generic formulations. Lastly, the use of any form of fenofibrate has not yet been shown to lower the incidence of heart attacks.

The cost per 30 days of treatment with the usual daily dosage of Trilipix is $123.30, and the generic alternative can be purchased for approximately $69.00 per month. This equates to an annual savings of $652.00.

2. Overactive or Spastic Bladder

Spastic bladder is a common problem in both men and women. It is associated with a sense of urgency and can be accompanied by incontinence. The FDA recently approved Toviaz (fesoterodine – Pfizer) for the treatment of overactive bladder. Five other similar medications already exist for this problem. Toviaz offers no clear advantage over the 5 existing medications.

The cost per 30 days of treatment with the usual daily dosage of Toviaz is $139.50, and the generic alternative can be purchased for approximately $65.40 per month. This equates to an annual savings of $889.00.

3. Gastroesophageal Reflux Disease (GERD, or Chronic Heartburn)

The FDA recently approved a new proton-pump inhibitor (PPI) called Kapidex (dexlansoprazole – Takeda Pharmaceuticals). It is a delayed-release formulation of Pravacid (lansoprazole, also produced by Takeda) which has been available for many years. Lansoprazole is expected to become available generically later this year and thus the motivation for Takeda to produce another related medication. PPIs are used to treat GERD and then include Prilosec (omeprazole), Aciphex, Nexium and others.

Kapidex is an effective PPI, but it has not been shown to be any more effective than existing PPIs, including generic omeprazole which is available over the counter as Prilosec OTC.

The cost per 30 days of treatment with the usual daily dosage of Kapidex is $136.88, and the over the counter generic alternative (omeprazole) can be purchased for $21.99 per month. This equates to an annual savings of $1,378.00.

As we continue to pursue cost effective care for our patients, you can expect that we’ll ask you about generics if you are currently taking a brand named drug. Please understand this is out of our desire to help you reduce your overall medical expenses, and not that we want to force a generic on you.

Family Matters: Toilet Training

Studies show that in the United States the average age at which toilet training begins has increased over the past 40 years from earlier than 18 months of age to between 21 and 36 months of age. Only 40-60 percent of children have completed training by their third birthday. Mastery of the developmental skills required for toilet training usually occurs after 24 months of age.

Many experts recommend not attempting toilet training until after 18-24 months of age when signs of toilet training readiness typically become more apparent. Such signs of readiness include the toddler’s ability to put on and remove garments, asking to use the potty chair or underwear, having predictable bowel movements, following simple directions, reporting soiled diapers, having a clean diaper upon awakening and indicating the need to urinate or have a bowel movement. Appearance of these readiness skills is associated with successful training. Some experts believe that pushing your toddler to train before he or she is ready may prolong the process.

Numerous toilet-training methods are available. Studies comparing the various methods of toilet training are limited so it’s not well-known which method works best. The discussion below is about two methods that are popular and considered to be successful.

The Brazelton method is a child-oriented approach which relies on the toddler’s ability to understand and respond to external feedback. This method involves lots of praise! Every little step in the right direction deserves praise. It is usually begun when the child is showing several signs of readiness as listed above. A gradual series of steps over many weeks moves the child from watching adults use the toilet, to sitting on the potty seat fully clothed, to sitting on the seat naked, to putting stool from dirty diapers into the potty chair. As the child makes progress, the parents take the child to the potty seat several times a day and praise any urination or bowel movements that result. Eventually the child can be transitioned to training pants. Don’t scold your child for mistakes or accidents. This method can take many months and involves parents, family and childcare providers working together as a team.

Toilet Training in Less Than a Day is a book which has made popular a method advocated by Azrin and Foxx. This method focuses on parent-oriented, intensive toilet training. This method is more active in teaching specific toileting issues and results in training in a much shorter duration compared to the Brazelton method. One study of this method showed the average duration of training was 3.9 hours, all done in one day. Training in a day also requires several hours in a row from dedicated parents and special equipment such as a training doll. Training in a day uses both positive and negative feedback in an immediate fashion. Positive feedback is given with rewards (favorite foods, parental affection) when the toddler performs desired behaviors. Negative reinforcement is given through punishment (verbal reprimands, asking the child to change his/her own wet pants) or decreased positive attention for behaviors which are not desired.

Although the process may seem frustrating at times, like all other developmental skills, toileting will be mastered. Please remember that we are here to help assist you as needed. If you have any additional questions or concerns about toilet training your child please feel free to discuss them with your GreenField physician.

As our temperatures begin to climb and our Oregon sun shines brighter, we wish you all a safe and happy summer - remember to stay hydrated in the heat and always remember your sunscreen!

Sincerely,

Alisyn Shaw, CMA, your Health Coordinator (email)
Angie Ashburn, CMA, your Health Coordinator (email)
Beth Davis, your Business Office Manager (email)
Bonnie Hicks, your Billing Clerk (email)
Carrie Destefano, CMA, your Health Coordinator (email)
Chuck Kilo, MD (email)
Connie Turner, MA, your Health Coordinator (email)
Cynthia Ferrier, MD (email)
Dana Lee, MA, your Clinical Supervisor (email)
Danika Pellicano, NCMA, your Health Coordinator (email)
David Hays, MD (email)
David Shute, MD (email)
Elizabeth Hays, MD (email)
Jill Arena, your COO (email)
Joel Swartzmiller, your IT Manager (email)
Kate Griggs, your Administrative Assistant (email)
Kim Walgraeve, your Marketing Manager (email)
Kristin Walker, your Program and Executive Assistant (email)
Malcolm McAninch, MD (email)
Marsha Box, MA, your Health Coordinator (email)
Meena Mital, MD (email)
Pam Mockenhaupt, CMA, your Health Coordinator and Biller (email)
Paula Koeller, MD (email)
Peter Casey, your Consultant (email)
Samantha Charles, your Clinic Administrator (email)
Todd Canon, MD, (email)

GreenField Health at Barnes Road
9427 SW Barnes Road, Suite 590
Portland, OR 97225

GreenField Health at NE Broadway
2606 NE Broadway, Suite C
Portland, OR 97232

Phone: 503.292.9560
Fax: 503.292.9510
Web: http://www.GreenFieldHealth.com

questions, concerns, comments always appreciated:
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