1. Platform Boredom
I am enjoying some of the summer Olympics when I get a chance to put it on the tube. Unfortunately, I realized pretty quickly how boring most of it is. Every four years I have to remind myself why I end up turning it off. It is not the Olympic games itself that are the problem. It is the damn network that shows only a few sports: swimming, gymnastics, swimming, track, gymnastics, men's basketball, and swimming. I actually saw them put on synchronized diving last night (a form of swimming in my book) and could not believe how ridiculous it was. I am sure the network spends years studying the habits of Americans and decides what to put on based on statistics and focus groups.
In another boring platform meant to please the masses, the Democrats shaped a set of principles recently that commits the party to guaranteed health care for all . Yeah, that's going to work. It will be as successful as pulling the troops out of Iraq, campaign reform and fixing the energy crisis; all of which they promised when they came in to power in Congresss. Anyway, they did give up on a government run, socialized medicine plan to instead state they are "united behind a commitment that every American man, woman and child be guaranteed to have affordable, comprehensive health care."
Here is a little secret: you can't have affordable, comprehensive health care. It is like that old sign hanging at a diner that states "Good, Fast, Cheap: Pick Two". If we want affordable health care then it can't be comprehensive. Sorry folks but the R word applies. It is called rationing and it's life. Any promise otherwise by either party is a load of crap. We shouldn't allow them to force feed us bogus content just because that is what they think we want to see or hear. That is why I hate watching the Olympics.
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2. LA Times Lists the Placebo Journal Blog
In a piece entitled “Medical blogs for doctors and patients alike”, the LA Times lists twenty of their choices, of which the Placebo Journal Blog is one of them. As Melissa Healy states, “The world of medical blogs is crowded, colorful and as diverse as the nation's population of doctors and nurses”. We are proud to be mentioned and thrilled that she thinks that “there’s funny stuff here” when describing our blog.
3. Placebo Journal Update
What is the Placebo Journal? Well, for one, it is not what you are reading now. Nor is it our blog. It is the only PRINT medical journal that survives on subscriptions rather than the pharmaceutical industry. The journal comes out ever other month and is chock full of things that will crack you up. You will not get this type of medical humor anywhere else. So, if you feel the need to find your smile again, then hit the subscribe button below. Isn’t it time you enjoyed a medical journal without all that big pharma aftertaste?
SUBSCRIBE
4. Gorback’s Thoughts by Michael Gorback MD
How To Make Balance Billing Work For Everyone
1. The insurance policy will be a contract only between the patient and the company, not with the doctor. Patients can see anyone they want but pre-authorization policies must still be followed.
2. When you buy a health insurance policy the carrier agrees to pay a certain amount for various health care services. Maybe they will have a fee schedule for each service. Maybe they will offer a percentage of Medicare fees.
3. The physician, not under contract with the insurer, charges what s/he thinks they can get in the prevailing market. The insurer will pay whatever they pay according to the fee schedule and the patient is responsible for the balance.
4. If you can find a doctor who will accept what the insurance pays, good for you. You don't get balance-billed.
5. If you can't find a doctor who will accept what insurance pays then you will have to shop around to find the lowest out-of-pocket cost.
In essence, the patient who buys a policy will have to decide how much extra they will pay to see a doctor who charges more than what insurance pays. Let doctors charge what they think they are worth, and let patients decide with their wallets whether or not they agree with the doctor's self-valuation. And just like other types of insurance policies the patient can decide on how much coverage they want to buy.
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The rest of the country has been watching to see how Massachusetts is doing with their socialized healthcare system. There have been tons of glitches including not having enough primary care doctors to treat all the "newly insured" as well as not nearly having enough money to pay for the behemoth. I also have been wondering what the state is going to do the keep the Commonwealth Care going. Now I know. The Boston Globe reports that Massachusetts is trying to get more and more from the federal government through Medicaid! It isn't unheard of for states to get waivers on how they spend some of that money but Mass is trying to funnel more and more into their new system, much of which will cover people who normally wouldn't get Medicaid in the first place. In fact, they already have been caught playing games by incorrectly listing kids under their MassHealth plan that were supposed to be on the SCHIP plan. That little mistake was done on purpose to squeeze more money out of the feds. Maybe they got greedy and saw this scam as a blueprint to do it again on a larger level. As more and more people joined Commonwealth Care, the state went back to the well to find more cash to pay for it. They are now asking for $1 billion more over the next three years. I guess they figure the rest of the country should cover Massachusett's experiment with their taxes?
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6. I Wish I Was Competent
Sometimes when I am running around seeing patients with all sorts of medical problems I sometimes find myself stopping and thinking, "Man I wish there were more state or federal laws that I could follow". I love OSHA, HIPAA and JCAHO but there has got be some new regulations out there that could be passed to make this job just a little bit harder. Right now it's almost too easy. Oh, sure I put tremendous hours in and risk a lawsuit every time I walk into an exam room, but I do have some extra minutes at the end of the day that I could take away from seeing my family. Thank goodness there are others out there that feel the same way. More and more states are mandating "culturally competent" healthcare according to a recent article in the Boston Globe. Hooray! There is nothing more reaffirming than government imposed requirements on my education. I just love it. With more and more cultures coming to our country, the number of courses forced upon me will be basically endless. Goodbye personal life. Hello cultural competency. Wait a minute, I think some cultures do not understand sarcasm and are offended by it. Sorry. I will look into finding a course on that.
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7. Joke of the Week
Mr. Smith was in his hospital bed and had been getting many tests done. After several days of hospitalization, a nurse finally came into his room and stated, "Mr. Smith, I have some bad news and some good news. Which do you want to hear first?"
Mr. Smith solemnly replied, "Well, tell me the bad news first."
The nurse said, "The bad news is that your HMO refuses to pay for you to have an enema. But, the good news is that your doctor will be in shortly to slap the s**t out of you."
8. Ridiculous Study of the Month
Managed Care Spy Games
Aetna is funding research to find out whether a daily lottery with cash prizes will get patients to be more compliant in taking their meds. They are giving the University of Pennsylvania $400,000 to see if a two-arm randomized trial will determine whether a 1-in-10 chance of winning $10 or 1-in-100 chance of winning $100 will get patients regular on their Coumadin. Brilliant. Why not give them real lottery tickets or cartons of cigarettes if they were really looking for appropriate incentives? I think the most ridiculous part of this study is the electronic monitor, Med-eMonitor, that tracks whether the meds were taken. It seems obvious that this study is more about trying to prove that this device is the best way for insurance companies to spy on patients. More and more managed care companies are becoming like big brother and trust me, it isn’t to make the patients healthier but instead to deny some future benefit. Think I am going too far? Can you see a time where patients who have a stroke while on Coumadin get denied for their bills because they weren’t complaint via the electronic monitor and therefore their INR was low (or blood not thin enough)? Yeah, they don’t call me Nostradougus for nothing.
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9. Bacharach’s Beliefs by Ted Bacharach MD, retired
HIPAA
The cost of medical care in the United States continues to escalate almost in inverse relationship to the quality of medical care available to the public. Governmental regulatory mechanisms designed for a variety of reasons have all contributed to the detriment of available medical care. One of the worst results of regulatory stupidity has been HIPPA. I have forgotten what these letters stand for but the result has been rapid escalation of the cost of medical care and it did nothing to accomplish the goals envisioned by the people who thought it up. I believe it was designed primarily to prevent insurance companies as well as financial institutions from gaining access to medical records. Someone forgot that these institutions are much smarter than the legislators who thought up HIPPA. All contracts or other paperwork that insurance companies as well as many financial institutions use contain many rows of size 9 or smaller type which gives them access to all of the individual’s medical records. The restriction of passing medical information ends up resulting in enormous difficulties for the patient who wants to have his physician get his laboratory work as well as his information about recent hospitalization which the patient thinks his personal physician should know.
In one instance a doctor who wanted to get his patient’s records after hours found that all of his office records were under lock and key and he did not know where the key was kept. If the records had been
unlocked he would have been eligible for a fine.
The patient required to go to the emergency room because he could not be seen by his primary physician arrives at the emergency without any record. The X-ray taken two days ago is not available nor is the blood count, the result is duplication and costly examinations that accomplish little or nothing except contributing to the Medical Tab incurred by the Insurance company, the patient or the government.
The patient recently released from the hospital where he was cared for by the Hospitalist or a Surgeon returns to his primary care physician for follow-up and the records are not available until the proper
release is signed. A phone call to the hospital is acknowledged appropriately by the hospital records department who are quick to inform you that HIPPA does not allow any information to be given over
the telephone and the proper release was not signed. In the meantime the insurance company has obtained a full report of everything that transpired because they had all of the proper forms filled out many
months or even years ago in the small print signed at that time.
Maybe the government can think of a few more regulations that will further escalate cost and do nothing to help the poor patient. So far they have done exceptionally well. No single party can claim greater expertise.
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10. Human Pawns
In breaking news, an LA hospital top executive was arrested for allegedly scheming to recruit homeless people as phony patients and then bill government programs for millions of dollars in unnecessary health services. FBI agents arrested Rudra Sabaratnam, the CEO of City of Angels hospital, and Estill Mitts, operator of a Skid Row health assessment center. This one blows me away. Wasn't it just the other day that a law was being passed in LA to stop hospital dumping? They were complaining that patients were literally threatening to contact the newspaper if they were dumped even though they had fully convalesced.
The case goes like this: The homeless people were picked up by recruiters who sent them to the 7th Street center, where they were given a phony diagnosis and forms were filled out justifying their eligibility for government medical programs. The hospitals in Los Angeles and Orange counties submitted phony Medicare and Medi-Cal bills for these homeless patients. The homeless shelters (and others?) would then receive kickbacks up to $20,000 a month from some of these hospitals as they were delivering between 30 and 50 patients a month.
How sad can this story get? I bought into the argument that these hospitals were being overwhelmed by homeless people and had no ethical way to discharge them. Now this story throws that scenario totally on its head. The hospitals and its executives were not scumbags for dumping patients. They were scumbags for somehow figuring a way to be worse than that. They concocted a plan to make extra money by using these patients as revolving kickbacks. There were hints in the article that some doctors are involved. Call me crazy but I don't think these acts are part of the Hippocratic Oath.
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11. Cut It Out
I live in a region with a large Somali population and have seen the results of female circumcision. It is disturbing to say the least. The fact that it continues today in many countries is also bothersome. About 63% of Egyptian girls 9 years old and under will be circumcised over the next decade. The numbers are lower in urban areas like Cairo — about 40% — but higher for rural areas in the south — about 78%. The USA Today reports on local grassroot efforts to get this practice to stop in Egypt. The women in small villages there are mutilated in the tradition, and that is all it is, of cutting out a girl's clitoris and sometimes other genitalia in order that it will help them find husbands. Where the heck are our crazy feminist Americans on this issue? Why aren't they over there helping? In fact, the article states that the locals "publicly play down any outside help or connections to Western aid groups" on this issue. Well, at least my physician brothers and sisters are trying to make a difference:
"Some doctors, midwives and even barbers make home visits, giving circumcision sales pitches — just to make money off the $10 for an operation."
Unbelievable. Are we that scared of criticizing that region of the world that we still let these atrocities be perpetuated forever? The answer it obviously yes.
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12. Tap That Vein
How sad is our society when lawyers can use obesity as a defense for execution? This guy above, convicted of raping and murdering two young women, is fighting to live by eating himself to death. His lawyer says they had trouble finding a vein on Richard Cooey five years ago which has been made worse due to the fact that he has been stuffing his face ever since. His attorneys also says that the drug Topamax, which he is taking for migraine headaches, could have created a resistance to thiopental, the drug used to put inmates to sleep before two other lethal drugs are administered.
First, the obesity excuse is not a new one for condemned death row inmates. It has been used before and is now an incentive for these guys to pig out. Why we allow them to eat so many calories is beyond me? Is it cruel and unusual punishment to have someone eat appropriate portions? Second, how the hell does a prisoner get an expensive name-brand drug like Topamax while the rest of the country can't afford healthcare? Lastly, Topamax, as a side-effect, actually affects appetite and makes patients lose weight. That is, I guess, unless you are on death row. Maybe the pharmaceutical company should put that in their package insert?
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13. Digging Deeper
Just when you thought it was safe to get a prescription comes a new terror like nothing seen before. Okay, maybe it isn't that bad but I do think it is a little scary. As you may know, our country is run more and more by technology. Heck, we leave a fingerprint almost every second of the day whether it be signing into a computer, buying gas, getting a cup of coffee, putting in an ATM code and on and on. We are used to it. On the other end, companies are making a business out of mining that data so no one should be surprised that our good friends at the insurance companies are on top of this. As stated in a Washington Post piece, they are tapping into prescription drug information as well as clinical or pathological laboratory information. Here is a nice quote:
"Ingenix and Milliman create the profiles by plumbing rich databases of prescription drug histories kept by pharmacy benefit managers (PBMs), which help insurers process drug claims. Ingenix, for instance, has servers in the PBM data centers, updating the drug files as frequently as once a day, said John Stenson, senior vice president of consulting for Ingenix, which is a division of UnitedHealth Group. The corporation also owns UnitedHealthcare, the nation's second-largest insurer."
There is our old PBM buddies again. Just another partner in the Medical Axis of Evil. This program sounds innocent enough but it is just another way for the insurance companies to save money.....for themselves. But what if the information is not completely accurate? What if a patient is taking a blood pressure medication for BPH? Or an antidepressant for ED? What if the patient no longer needed the cholesterol medication because she lost 80 pounds? The article mentions more examples and also details how doctors will have to get involved to try and make appeals for patients (an unpaid service).
At what point will doctors and patients finally get together and tell these companies to go #^**& themselves? Similar to the way we are finally cutting down on gas consumption, I think we are getting close.
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