- Crazy and Free
- Some Great Financial News
- Placebo Journal Update
- Gorback’s Thoughts by Michael Gorback MD
- Meaningless Call for Help: Geriatric Care is Facing Crisis
- Out and Out Fraud: Medicaid Money Laundering
- Thanks to Our Sponsors
- Ridiculous Study of the Month
- Bacharach’s Beliefs by Ted Bacharach MD, retired
- The Vig On Medicine
- Can’t Walk The Talk
- RomneyCare and the New Big Dig
- Medical Marijuana Conviction
- Feedback About The Placebo Gazette
1. Crazy and Free
How do you get out of a crime or at least get some leniency? It’s easy; just claim you have some mental issues. Using a medical diagnosis can be a shield for many things nowadays. Don’t get me wrong, I am not putting down any disability or accurate diagnosis. My problem is with the continued manipulation of physicians by others to use their medical diagnoses for secondary gain. Did you know that the number of accused felons being declared mentally incompetent to stand trial has risen in 10 of the nation’s 12 largest states? Because of this trend, the cost to treat them is costing hundreds of millions to the taxpayer. Here is the question of the day. Is this increasing trend occurring because:
- There is a lack of mental health care available in the community?
- Judges are more open to the claim of mentally incompetency?
- Lawyers are using this strategy more often to try to avoid harsh punishment?
Send us some feedback via our blog or through our review process below and let’s see what you think.
2. Some Great Financial News
Once again there is good news in the healthcare financial market. This will put a smile on your face and make you feel good about our system. The CEO Compensation Survey of 2007 in the WSJ lists all the nice salaries and incentives that these “leaders” make on the backs of the sick. For example, H. Edward Hanway made over $13 million working for Cigna. Richard T. Clark made over $14 million working for Merck. Isn’t it nice to see that most of the money in healthcare is going to the people that truly deserve it?
3. Placebo Journal Update
We seem to be gaining some popularity out there in the real world. Recently, the Placebo Journal has been mentioned:
Isn’t it time you start getting the only medical journal that you will read from cover to cover? If you want a print magazine that will make you laugh sent to right your home, then subscribe below:
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4. Gorback’s Thoughts by Michael Gorback MD
"You go first, Max"
I recently read a news release that reported that Max Baucus, who is NOT the physician's friend by any means, plans to introduce a bill that halts the 10% pay cut in July, maintains a 0.5% increase, and offers bonuses on the order of 1-2% for adoption of quality reporting and e-prescribing. How about this Senator: you and your colleagues go several years without a raise, and then give yourselves a measly 0.5% raise.
If you expect thanks for this, don't hold your breath. We've had enough of this nickel and dime BS. You have to fix the SGR mess once and for all, and the raises need to be at least enough to keep up with inflation. Max, do you ever buy your own gas? Do you think 0.5% is going to cover our increased expenses?
I also note that the AAFP, American College of Physicians and American Osteopathic Association met with Senator Baucus prior to this news release. Members of these societies need to let their leadership know in no uncertain terms that they will be the only members left in their organization if they sell us out so cheaply. The PCPs have the real power here, since most practices are busy enough to limit Medicare patients and there is already a shortage of PCPs accessible to Medicare patients. To have AAFP, ACP, and AOA sell us down the river for a 0.5% raise and no fix of the SGR formula would be a travesty of epic proportions.
Time to draw a line in the sand. Let Congress know that you won't settle for this pittance and that you will drop Medicare patients or refuse to see new ones, and make sure you copy your correspondence to AARP.
5. Meaningless Call for Help: Geriatric Care is Facing Crisis
With the graying of America, there is much needed demand for doctors to train in treating the elderly.There are 78 million baby boomers and the US health care system is not prepared to take care of them. Not only can we not afford it but we also don’t have the geriatricians available to meet their needs. The Institute of Medicine has put out a report proclaiming to fix this travesty. Currently, just one doctor specializes in geriatrics for every 2,500 Americans over the age of 65. The report does mention the financial disparity on this shortfall of geriatricians. No kidding. First of all, family doctors and internists can do the job almost as well as geriatricians so I am not convinced that increasing the amount of geriatricians is an answer in itself. That being said, all these specialties are in crisis because of the same reason. The government pays more for procedural care than cognitive care regardless of the time spent performing that care. Until that changes there will be a constant flow of these “sky is falling” articles being published for years to come. And no one will do a thing about it. But we will keep paying a gastroenterologist $1000 a colonoscopy as he runs 15-20 through a day at his outpatient center.
6. Out and Out Fraud: Medicaid Money Laundering
It finally clicked with me. I remember a neurosurgeon friend of mine explaining the problems of Mainecare (Maine Medicaid) to me. Even though his bills to Mainecare were pennies on the dollar, he was still never getting paid. When he did get paid it would come in the form of a check that didn’t even make sense. There would be no reference to what patient the money was to be applied. I also heard from other doctors, as well as read in the local paper, how the state government had overpaid physicians for Mainecare. Again this didn’t make sense as they owed doctors and hospitals so much that there was no way they could “overpay” them. I kept thinking to myself, “How stupid can our state government be?” as the headlines announced that they were asking doctors for the money back. Then I read this piece about Medicaid Money Laundering in the WSJand I got a pit in my stomach. The scam is this: the federal government will match as high as 83% of each state’s Medicaid tab each year. Each state determines eligibility for this entitlement program. The state then overpays doctors, hospitals, etc and gets the federal government to reimburse it. Once they get this money they ask the health care providers to pay it back the overpayment.
Why isn’t anybody screaming about this method of gouging the taxpayer? The Governors of each state won’t because they get to use this cash to meet their budget as well as make themselves look good. All attempts at controlling this scheme have led to roadblocks in Congress. No, my state government wasn’t stupid in their payment methods to my friend or any other doctor or hospital. They were just crooked and we are all paying for it. I just wonder how Congress can discuss the concept of Medicare and Medicaid fraud and abuse by doctors and hospitals with a straight face while they continue to allow states to do it right under their growing noses.
7. Thanks To Our Sponsors
I want to thank our sponsors for their support of the Placebo Gazette, the most popular medical newsletter on the internet. The Placebo Gazette is read by thousands and goes out biweekly. If your organization is interested in a ridiculously cheap sponsorship opportunity, please email debra@placebojournal.comfor rates.
8. Ridiculous Study of the Month
Remember the impending legislation to make all doctors use electronic medical records? Well it seems like the Congressional Budget Office is questioning the big savings that was estimated earlier by the RAND analysis. That savings of $77 billion a year is basically a pipedream and should give all those brilliant advocates of EMR something to chew on. Unfortunately, they aren’t giving in just yet and they are standing behind their initially claims. It seems that the evidence to support or refute the benefits of EMR is in the eye of the beholder. So what happens now? Probably nothing. Senator John Kerry of Mass is still pushing a bill that would “encourage” electronic prescription by initially giving doctors a bonus but later on would penalize them if they fail to adopt it. Great plan. As if doctors need more “sticks” to keep them on the right track in their profession. Who needs evidence when you have legislation?
9. Bacharach’s Beliefs by Ted Bacharach MD, retired
Dangerous Medical Care??
I thought medicine as well as its delivery had been progressing in a gradually improving manner. Apparently I missed several things. The dangers inherent in the implementation of medical care seem to be getting greater if we are to believe the propaganda we are being exposed to. The patient going to see his physician or going to a hospital can expect the road to be covered with pitfalls many of which could prove fatal.
The dangers involved in hospital care seem to be growing rapidly if we can believe the reports we are subjected to in newspapers, magazines as well as radio and television. You may be given the wrong medication because of packing and labeling mistakes or because of nursing procedural deficiencies. In addition to these dangers exposure to the hospital environment is a danger as well. Hospitals are repositories of dangerous infections, selectively cultivated in the hospital environment by extensive antibacterial treatments that have allowed resistant organisms to flourish. The hospital air, medical supplies as well as professional uniforms provide the means of transportation that these organisms need to get around.
In everything that pertains to medical care it is wise to look for financial incentives. All information provided by medical corporations should result in a financial reward. The propagation of information that would discourage patients from seeking medical care and hospitalization can mean large monetary rewards for medical insurance companies as well as HMO’s.
There is no question that all results of medical care are not 100% but the results of the our efforts continue to reflect very favorably on the medical profession. Delays, deferrals, postponement of needed care all provide considerably more danger to the patient than the timely implementation of needed medical care, even in our “dangerous medical environment”.
10. The Vig On Medicine
I really enjoyed the article The Health Insurance Mafia in the WSJ because it emphasizes how much the middle man is skimming off the top. Dr. Jonathan Kellerman makes a nice comparison of these third parties to the mafia as they rake in profits but provide little benefit at all. What he is talking about is the health insurance industry. He calls them parasites and I agree with them. “Once they affix themselves to the host – in this case dual hosts, both doctor and patient – they systematically suck the lifeblood out of the supply chain with obstructive strategies”. I love it.
Dr. Kellerman makes reminisces about the medical visit where the patient directly paid the doctor and therefore the cost was kept reasonable. “A hefty proportion of health-care services – office visits, minor surgeries – would be affordable to most Americans if the slice of the health-care dollar that currently ends up in the coffers of insurance companies was eliminated.” He forgot to mention the army of administrators that was spawned to deal with the insurance companies. They should be removed as well. As Michael Gorback once told me, if all the doctors would just tell the insurance companies that they are opting out and to “go fish”, they would cease to exist. Both Dr. Kellerman and I agree. Now that would be a more pleasant and affordable world.
11. Can’t Walk The Talk
Peter Orszag is an economist and director of the Congressional Budget Office. His job is to show the relationship of impending bills to the federal budget which may in turn lead to the sinking of that said bill. An article in the WSJ explains how he is increasingly focusing on health care issues. Why not, it’s like shooting fish in a barrel? He is becoming a popular speaker as well as writing pieces for the NEJM. He even has his own blog. Good for him. As the article states, he wants to drive home the point that Medicare and Medicaid cannot sustain its current growth rate. What is amazing to me, however, is that the same article points out that he is boosting his staff from 31 to 47 and is seeking to add more. Dude, how about walking your talk? This is the part about administrators that drives me crazy! They continually “boost” their staff and ignore the cost of doing so. If Medicare and Medicaid could trim the fat and leave the healthcare system to doctors (with a minimal amount of administrators/staff), it may have a fighting chance. There just seems to be more and more people on the sidelines going to meetings, talking about statistics, and analyzing the world to death instead of actually doing anything meaningful and productive
12. RomneyCare and the New Big Dig
In the Review & Outlook section of the WSJ, there was a nice piece about the problems Massachusetts is having a year after instating their required healthcare initiative. The individual mandate which required everyone to get health insurance is tanking. There are still 350,000 uninsured in the state. Though there was a sizeable reduction from the year before, 2/3 of these “newly insured” came from the low- or no-cost public insurance option. Ouch. In other words, no one is paying for this except taxpayers, I guess. This year the Commonwealth Care was supposed to need $472 million but they upped that to $625 million. Next year they are asking for $869 million. Ouch again. Other than taxing people more, how is Massachusetts going to pay for this? Simple. There is a recipe in place that the government has used for years. First, pay the doctors and hospitals less. Second, penalize businesses more for not using this system. Third, tax something else like tobacco and beer. Maine, that has a 400 lb elephant in the room called the Dirigo Health Plan, continues to do the last one. Turns out it doesn’t work.
The article makes some interesting points on the mistakes of this program. The goal was to connect individuals to private insurance but the problem is that there are so many “low income” people that the low cost insurers are avoiding the state. Add to this the restrictions and mandates on what the insurer must cover (chiropractic care, infertility, etc.) and you have no incentive for them to stay. The article concluded is that if Obama or Hilary get their way for the country, the same results would come to this country. A low cost insurance plan that pays for everything does not exist. Add to this the fact that the majority won’t pay for it and you will find that the taxpayer will be gouged to death once more.
13. Medical Marijuana Conviction
It looks like the “Compassionate Use” law in California may not be so, well, compassionate. For example, how about those two poor providers of “mary jane” in Modesto who were convicted on federal trafficking charges? These simple folk were, according to their defense lawyers, in compliance with state law as they turned a $9 million profit selling weed. They even paid $1 million in taxes. Sure, all medical marijuana dispensaries are meant to operate as nonprofit entities. Okay, so they kind of messed up on that tiny detail. They were convicted as basically acting as drug dealers selling pot with the supposed excuse of treating medical symptoms. Can’t a company exaggerate a little on their marketing claims? I mean look at Vioxx or Vytorin. I think it is high time we stand up and allow all supposed practitioners to sell whatever herb or diet pill they want without the constraints of having any scientific proof or legal ramifications. All kidding aside, I hear these same salesmen and sales pitches on the “Dr. Bob” radio show all the time. He is the host who I have never heard tell his audience what his degree is (check out his picture with stethoscope here. Don't most chiropractors use a white jacket and stethoscope?) or the conflict of interests that his guest(s) may have. Why hasn’t he got trouble for that?
14. Feedback About The Placebo Gazette
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Until next time, keep smiling, keep laughing and keep out of the sample closet.
Doug
King of Medicine
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