1. Fraud or Funny?
A new report is claiming that Medicare is paying millions for medical supplies for patients that really don't need them. Congressional investigators looked at bills submitted from 2001 to 2006 and found over $1 billion in questionable claims. Examples include getting glucose-related supplies with the diagnosis code of bubonic plague or getting a walker with the diagnosis of paraplegia. The Senate Permanent Subcommittee on Investigations also found similar abnormalities. In one instance, a smiley face was drawn where the proper diagnosis code should go. I know congress is going to make a big deal out of this whole thing but there really is no proof that fraud actually occurred. Maybe those in the medical field are sick of the onerous paperwork because it is such a pain in the ass? Been there, done that. Maybe people filling this forms out are just sick of the nonsense because they know no one will be checking on it? Why spend time getting a proper code when you can just put a smiley face and get what you need? If there was fraud occurring then by all means, go get'em. For me, however, I just think it was funny that the government is that stupid. What kind of government makes a system of ridiculous codes that are so complicated that no one would understand them? Oh, yeah, forgot about the IRS.
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2. Misleading Name
It seems that those retail health clinics that I hate so much are now going for a new demographic - Hispanics. The MediGo clinics are located in some Miami pharmacies (Navarro) and the concept seems to match well with the Latino community. It also doesn't hurt that they are trying address some of the language barriers as well. Here's a little known secret that we were able to tease out. Their first attempt at opening a Hispanic women's retail health clinic didn't go so well due to the name - Taco Belle.*
*Due to the name infringement. Why? What were you thinking?
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3. Ridiculous Study of the Month: Empathy
A recent study on physician empathy came out and the media had a field day with it. Rita Rubin’s title in the USA Today was “Study: Physicians show little empathy”. Will Dunham in the Boston Globe entitled his piece as “US doctors offer patients scant empathy in study”. The actual title in the Archives of Internal Medicine was “Missed Opportunities for Interval Empathy in Lung Cancer Communication”. Can you see the problem already? This is just another example of the media jumping at the chance to doctor bash.
Though the study was a great way to get publicity, one has to look at the details to see if it merits that attention. This one doesn’t. All the authors did was look at 20 transcripts from recordings between oncologists and/or thoracic surgeons and patients with lung cancer. Twenty! All these encounters occurred at a Veteran’s Affair hospital. Anyone reading this knows the history behind these institutions and though they have gotten better over the years, one has to wonder why these authors picked this hospital to examine physician empathy. Anyway, now for some statistical gobbly-gook. Here was their method of proving doctors have little empathy:
Using qualitative analysis, we collaboratively developed themes and subthemes until saturation. Then, each transcript was coded, using grounded theory methods, until consensus was achieved, counting and sequentially analyzing patient empathic opportunities and physician responses.
Does anybody know what that means? Well, neither do I. What they state they found was that out of 384 opportunities to be empathetic, doctors only responded appropriately 39 times. This ridiculous study is flying around the airwaves because it is perfect fit for the media. Unfortunately, they legitimize a very small study. Here are some questions maybe media should ask.
-Could the doctors at that veteran’s hospital be a lot older and burned out?
-Are specialists (oncologists, thoracic surgeons) indicative of all doctors?
-Could lung cancer patients, who caused their own disease, be different than other cancer patients who didn’t cause their own disease (i.e. breast cancer patients) which may make doctors treat them a little differently?
I hate doctor bashing and though this study was small and ridiculous, I am more bothered by the media who jumped all over it. Even the titles from the USA Today and Boston Globe articles were exaggerated and this just makes doctors look bad. It is nothing more than perpetuating a stereotype that they think their readers want to buy into. Personally, I am sick of it. Anyone want to empathize with me?
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4. Placebo Journal Update
You have until September 29th or 5 days from this day to subscribe in order to get the October issue. You don’t want to miss:
- Grandma In A Ball
- How JCAHO Saves Lives Every Year
- Webinar on Celebrity Based Medicine
- And so much more!
SUBSCRIBE
5. Gorback’s Thoughts by Michael Gorback MD
The Pete Schmuck Laws: Time to give Congress a taste of their own, well, medicine.
- Every 6 months each member of Congress shall disclose by first class mail delivered to each of his or her constituent's place of residence:
- The amounts of each PAC or other political donation from each lobbyist or interest group
- The individual(s), businesses, or special interest group that donated the money
- Any personal consideration received from a lobbyist e.g., meals, trips, use of planes or other transportation, etc, and the identity of the donating party
- How the member voted on bills affecting each party listed in (b) and (c)
- A member of Congress may not accept gifts or other consideration in excess of $100. This includes political campaign donations and PAC money
- Since a member of Congress is in a position to vote for legislation that could enhance the value of their own investments, no member of Congress shall own any investments of any type of kind, active or passive, except for a blind trust.
- Each member of Congress shall be allowed to own ONE piece of real estate property in addition to their primary residence.
- If a given legislative issue affects the value of property owned by a member of Congress, that member shall recuse him/herself from any votes that affect said legislation
- Compensation for members of Congress shall be determined by the American Medical Association and annual raises shall be less than the rate of inflation
- Health insurance for members of Congress shall be equivalent to the HMO benefits offered by Aetna for a typical medium-sized corporation.
- All preauthorizations will be denied on the first request
- All treatment rendered will be considered experimental and therefore not covered by the policy
- No member of Congress shall be allowed to stay in the hospital more than 4 days
- If a member of Congress has a dispute with their health plan, he may only seek recourse through a federal lawsuit.
- If a member of Congress (1) votes for something that turns out to be extremely stupid and ill-considered, and that (2) results in harm to the citizens of the United States, then (3) she may be sued for everything she is worth.
- Every office for every member of Congress shall be inspected annually by JCAHO, CLIA, and OSHA. Any infraction shall be punishable by a 10,000 per occurrence and loss of voting privileges for 6 months.
- Each Congressional office shall be given a 300 page manual concerning citizen privacy rights and shall be in compliance with each and every regulation
- Any person, at any time, may file an anonymous complaint about a member of Congress
- The member of Congress shall be apprised of the fact that a complaint has been filed.
- The member of Congress shall have no right to know what the complaint is about until the day of the hearing
- The member of Congress shall have no right to present evidence or testimony in their defense
- The member of Congress shall have no right to a fair and impartial hearing
- The member of Congress shall have no ability to appeal adverse decisions.
- Never events:
- No member of Congress shall become intoxicated
- No member of Congress shall have sexual relations with anyone other than their spouse or significant other
- No member of Congress shall add non-germane amendments (riders) to any proposed legislation
- No member of Congress shall have any local transportation paid for by the federal government (in other words, no limousines). She can drive to work or take public transportation like everyone else.
- All members of Congress shall fly only coach, never first class, unless the difference is paid for personally
- No member of Congress shall vote for anything that turns out to be the wrong thing to do
- If any of the above never events occur, the member of Congress shall not receive any pay for the year in which the infraction occurred
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6. Crappy Job
Clostridium difficile is another "superbug" (like MRSA) keeping hospitals on their heels and taking its toll on patients. My friend's mother recently had a terrible bout of this in a Florida hospital and the infection hastened her death. A recent article in the WSJ states that there are now 500,000 cases annually which is up from 150,000 cases annually in 2001. I always ask patients who come to me with diarrhea whether they received antibiotics when they were in the hospital. Normally our body's own good bacteria keep C. difficile under control but antibiotic use upsets that balance unleashing this possible lethal infection. Here is the crazy thing. Life is not perfect. Wasn't it JCAHO who started demanding antibiotics quickly in the ER for patients with possible pneumonia? I believe it was the "4 hour rule"? This rule, by the way, has not shown to improve outcomes but who needs evidence when JCAHO is involved. Anyway, as you can tell, overuse of antibiotics can lead to this epidemic of C. diff. To make things crazier, this infection is on the "never event" list which means Medicare and insurance companies are not going to pay for care when patients get it. Doctors are stuck between a rock and a hard place deciding whether to make JCAHO happy or risk causing a "never event". Ridiculous.
The only thing that lightened my mood when reading the WSJ article was the ending. They casually mention the use of fecal transplants. It seems you can harvest stool from a relative and place it in the patients colon and it may help treat C. diff. Wow! Now that is a field I can sink my teeth into. Competition has got to be minimal for this. I could specialize as a fecal transplantologist. They could fly me around in a special medical helicopter with my coolers filled with stool ready to help patients with their C. diff. Maybe I could discover some genetically designed stool that I could grow in the lab and be the world's biggest stool supplier for the treatment of C. diff? Don't they do that with yeast starter kits where they keep the same original yeast bud for people who bake break? Think about it. I would not only be the foremost stool transplant surgeon but also own the material as well. I could take over the world! It may be a crappy job, literally, but I would be famous and rich.
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7. The Delivery Man Is Here
Once again we at the Placebo Journal have proven that we are ahead of our time. The pharmaceutical industry is playing a new game. Instead of coming up with novel ways to cure diseases they are spending a lot of time trying to find unique delivery methods for older medications. It is just a new way to save cash on research while also extending the patent on a soon to be expiring patent. Whether it be a patch, a powder inhaled via the lungs or even the "sci-fi" concept of nanotechnology, these companies are working hard to be the market leader. The funny thing is that almost eight years ago I came up with a similar concept. Why not make the patient motivated to take the medication? Seems simple, right? Take Godivaphage, for example. By combining chocolate and metformin you know that your diabetics will be compliant. Don't forget to check on some of our other great delivery system breakthroughs like: Cameloft, Alcoferon, and Accupringles. If you have any other ideas for compliant combinations, please send them our way. We may even put it in the next issue of the Placebo Journal.
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8. Medical Joke of the Week
A fellow walked into a doctor's office and the receptionist asked him what he had.
He said, "Shingles."
So she took down his name, address, medical insurance number and told him to have a seat.
A few minutes later a nurse's aid came out and asked him what he had.
He said, "Shingles."
So she took down his height, weight, a complete medical history and told him to wait in the examining room.
Ten minutes later a nurse came in and asked him what he had.
He said, "Shingles."
So she gave him a blood test, a blood pressure test, an electrocardiogram, told him to take off all his clothes and wait for the doctor.
Fifteen minutes later the doctor came in and asked him what he had.
He said, "Shingles."
The doctor said, "Where?"
He said, "Outside in the truck. Where do you want them?"
9. The Battle Of The Colon Is About To Begin
Do you think colonoscopy preps are messy? Well, you haven't seen anything until you see the fight that will occur over our collective colons. There is new evidence that the "virtual" colonoscopy may become an acceptable alternative to the regular colonoscopy. This super x-ray or CT of the colon still involves the good old clean-out the night before but there is none of that penetration action that patients have trouble getting past. The test is cheaper but any abnormalities still need to get removed via a regular colonoscopy. Medicare is considering paying for this as an alternative and that will get the managed care companies to jump on the bandwagon. The article in the USA Today, by the way, has quotes from people who have obvious conflicts of interest which is a little troublesome. So what’s next? War. The gastroenterologists (GI) have to strike back. Do you know how much money they would stand to lose if the insurance companies buy into this? There is no way they are going to sit on the sidelines. I remember when I was in my first few years of practice in family medicine and we got the go ahead from my hospital employer to do flexible sigmoidoscopies in the office. They spent a ton getting our room ready and it took months. The flex sig unit was ready to go and we were starting to train our staff in assisting with the procedure. One morning I walked into the room and the flex sig unit was gone! I thought it was stolen and called the administration. I was told that they "donated" it to the local GI group who does procedures in both hospitals in town. That was it. No more explanation. We made the flex sig room into a nice lounge. End of story. Oh, there will be war my friends. Expect the higher ups of the GI world to be working on a plan right now to show why colonoscopies are the way to go. This time, however, I get to watch from the sideline as the radiologists battle with the gastroenterologists. Got to get me some popcorn.
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10. Neither McCain nor Obama have A Health Plan That Will Work
The journal Health Affairs had some economists take a look at the healthcare plans put out by by both McCain and Obama. The Washington Post summarized it nicely. McCain's plan, they feel, would add more people to the insurance rolls but would lose as many due to employers who stop paying for it. They also think that insurance companies would move to states, if cross-state insurance shopping is allowed, that allow them to game the system. This again would screw over patients. They feel Obama's plan is basically one big government subsidy (isn't half of our healthcare system today?) which would skyrocket the costs because the concept of rationing doesn't enter his mind. My state chapter of the Academy of Family Physicians put out their newsletter, and though they are supposed to remain nonpartisan (yeah, right!), they obviously dropped hints that they love Obama's plan because they want all patients covered. They forget the ripple effect of what happens when there is not enough cash to cover this. Anyway, I like the concept of personal responsibility and teaching someone how to fish versus letting them eat at the free buffet every day. My patients are working me daily to try cheaper meds and I comply because they are right. I love their ownership and it proves to me that when they have to pay out of their own pockets, they will bring costs down. My next editorial for the upcoming October issue of the Placebo Journal, coincidentally, takes a look at this election topic again. You should check it out.
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11. Media Opportunities
Are you part of the media and need someone in the medical field to interview for a print or television piece? Are you in the medical field and interested in speaking about a topic about which you consider yourself an expert? I mentioned in my last Placebo Gazette that I am a board member of NAMC. The National Association of Medical Communicators has been around for a very long time and is made up of some very experienced and highly-esteemed people. How I got on, I have no idea.
Joining NAMC will allow you to connect with the media in your area of interest. Each day media queries are listed on the site for members to peruse and then they may contact the solicitor. Just recently I connected with a writer about "hospital price gouging". Other queries included social media, dealing with depression, and environmental health perspectives. The areas covered span all across the healthcare system. If you are a writer looking for a story and need to find expert then there is no cost for you to place your "media opportunity". Just go on the NAMC site and follow the contact information. If you a budding star, then for less than a $100 you may find your ticket to fame. Okay, maybe that is a little exaggeration, but you never know.
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12. Physicians Will Be Getting The Blues
Something small could turn out to be something big. Horizon Blue Cross Blue Shield of NJ is once again trying to morph themselves into a for-profit organization. Okay, that really is semantics because the term non-profit doesn't mean that they weren't making tons of money. It is a legal term for tax purposes and BCBS (and all managed care companies) is always thinking of how to better their position. According to an article in the American Medical Medical News, the conversion may eventually lead to Wellpoint buying Horizon which is bad news to doctors. Why? When these groups get bigger and get even more leverage, they tend to control the prices they will pay us. Trust me, they won't be trying to pay us more. As the article points out, other state BCBS plans are watching this "conversion" attempt very closely. They seem to be salivating knowing that if it gets the go ahead then it will open the door for them to do the same.
This story illustrates a major hurdle for physicians. Those companies and administrators that are in the "business of healthcare" spend part of their time figuring out plans to make more money and the rest of their time scheming how to execute these plans. Physicians spend all their time seeing patients or getting CME. We are outmanned and outgunned and as a result lose every time. I will say it again. When big business took over healthcare, it no longer became about health or about caring.
