5. Gorback’s Thoughts by Michael Gorback MD
Alaska isn't unique in having bridges to nowhere. I recently read where there are "numerous" organizations that can help physicians defray the costs of adding EMR to their practices. Yay! Most of what I read suggested that I check our a site called bridgestoexcellence.org. Off I went to the Bridge to Excellence site. They mention several different ways to qualify for assistance.
One way is to practice in certain regions. Another is to be in a certain specialty. A third way is if your patients are enrolled in participating health plans and then there is something about "Rewards". I like the idea of being rewarded for what I do. It would be a new experience for me.
Ok, off we go. First stop, service area. I click on Texas, only to get the message "More information coming soon." That's ok, I still have several more options to explore.
I click on the link for "eligible specialists" and wait for the PDF file to download. Dang, not on the list. Keep on truckin'.
I click on the link for the participating health care plans. This looks promising as I recognize some plans that I am on. However, they are not participating in Texas.
Down, but not out, I go to the rewards page. This gets murky. It says, I must "Play the role of primary caregiver for BTE eligible patients as identified by Bridges to Excellence based on physician to patient attribution data supplied by the participating health plans on behalf of participating purchasers." I'm not sure exactly what this means but the general gist seems to be, "Go away Texas Specialist Boy".
Ok, I try one more thing. I read about a program in Texas to promote EMR use. I track it down and find that the legislature did indeed pass a law creating an organization to do this, but it is still in the formative stages.
So here's how this will play out for many of us: CMS will force us to use EMR by paying less to those who don't use it. Those who do use EMR will pay through the nose for it but hopefully recapture the cost from the "bonuses" that CMS pays. If you are lucky it will be budget-neutral, but don't get your hopes up. As I understand it, you'll get 2% of your billing as a bonus. So if you receive $200,000 in Medicare payments they will give you back $4,000 - enough to buy the laptop you'll need and pay for the service contract on the software.
Such a deal.
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6. Psyche and Go
I thought it was interesting when the old Veteran's Stadium in Philadelphia had a jail and courtroom in the bowels of the stadium because there were so many arrests during football games. They thought a quick prosecution would work well to curb the violence and it did. Now a court building in Washington D.C. is putting a psychiatric urgent care center on the first floor of its facility. They received a large grant to do this "in response to judges who say they see too many people in their courtrooms because of undiagnosed mental disorders". I applaud any effort to get help for these people but I am not sure that these patients were undiagnosed. The problem, for many of them, is compliance and it is unclear how an urgent care psychiatric center will help with that. The major issue is that most of these patients have no insurance or are on Medicaid. Psychiatrists who take this payment are few and far between so it seems to me that follow-up is going to be a huge issue. I guess they can keep getting arrested over and over again so they can get into the "Psyche and Go" for that lithium refill? "Sorry, officer, I only stole that car because I couldn't get a doctor's appointment".
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7. Holy Mackerel!
I remember as a kid hearing the term mackerel being used as another way of saying money. Maybe it was because I grew up in NY, with organized crime being part of the culture, that it was acceptable to use these weird terms to describe how much some things cost. Remember on The Sopranos they used "boxes of spaghetti" as their secret code? Anyway, a recent article in the WSJ discusses how prisoners actually now use mackerel as their form of currency. For those not in the know, cigarettes were the currency of choice but that changed as prisons started prohibiting smoking. Today, mackerel sales are only popular to prisoners as no one else really wants to eat the darn thing! In other words, they are basically just a symbol. Each item or service in prison has a mackerel rate that can be bartered for. This whole prison mackerel economy proves that the free market can even work for criminals. Here is another form of currency that you may have heard of - relative value unit or RVU. The RVU or WRVU is a form of currency used by the federal government to value medical services. It is an example how the free market is ignored and the value of services are skewed when determined by the ignorant. Personally, I have been using the WRVU system for years and it is so complicated and slanted to proceduralists that I would rather use mackerel - and risk getting a shim in the ribs or violated in the shower. Wait a minute, that is already happening with today's medical payment system.
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8. Medical Joke of the Week - Henny Youngman
A man is at the bar. I pick him up off the floor, and offer to take him home. On the way to my car, he falls down three times. When I get to his house, I help him out of the car, and on the way to the front door, he falls down four more times. I ring the bell and say, "Here's your husband!" The man's wife says, "Where's his wheelchair?"
9. CON(e) of Silence
Hospitals compete against each other all the time. Even in a small town in Maine I have been a part of that for the past 12 years. Competition is healthy and breaks up monopolies. Controlling the healthcare dollar is a very powerful thing. I always felt the CON or Certificate Of Need that hospitals apply for was part of that competition. A new article in the AMNews, however, has opened my eyes.
The CON require "physicians and hospitals to demonstrate a community need for new projects and services before receiving state approval to offer them". It can cost upwards of $80K to work the legal system and get it passed. For a hospital, that is nothing. For a physician, that is a lot. As it turns out, hospitals actually love the CON. I never would have thought that after all the controversies and debate I have seen in Maine as different hospitals try to expand. They have to go through hurdle after hurdle which they whine about all the time. It turns out I was wrong. As the article points out, with an example of a nephrologist trying to open a dialysis center, hospitals use the CON to keep him out of the game. So hospitals may not like the CON but they dislike physicians getting power even more. The enemy of my enemy is my friend, I guess.
If you think I am exaggerating too much on this point, check out what Howard Peters, the Illinois Hospital Assn.'s senior vice president of government relations, said:
"Profiteers can come in and cherry-pick by engaging in only those services where people can pay using private insurance. That leaves community hospitals with the burden of covering indigent and uncompensated care, and it can undercut hospitals' ability to subsidize emergency or charity services."
You don't have to read between the lines to realize that the biggest fear for hospitals is for physicians get power and gain control over the healthcare system again. It turns out that managed care companies have that same fear. Now if only the doctors would just realize this and work together? I know, I know...I'm dreaming again.
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10. Rodney Dangerfield of Medicine
The article was called Crises of Care on the Front Line of Health. The writer was Jane Brody of the New York Times. The content was a common theme written about all the time - the loss of primary care physicians. It was an easy read and not all that enlightening to me as I am in the field. There was something wrong with it, however. Then it hit me. I reread the article and couldn't believe my eyes. If you have time, please read this article closely and see if you pick up the glaring mistake from a very respected and highly regarded writer of the NYT.
Don't cheat. Go read the article. Even my two medical partners didn't pick this up!
If you are wondering what I am talking about then bear with me. Primary care docs are the Rodney Dangerfields of the healthcare field. We get paid the least because we don't make a living doing procedures. We are, however, the true grunts of medicine and are the front line of our healthcare system. One of our biggest problems is that we are misunderstood. The government doesn't get it. The insurance companies don't get it. Even patients don't understand our significance. And this article is proof.
Jane Brody wrote an article about the crisis in primary care and NEVER INTERVIEWED A PRIMARY CARE PHYSICIAN! Here is her list of doctors she quoted:
- Dr. Byron M. Thomashow, medical director of the Center for Chest Diseases at New York-Presbyterian Columbia Medical Center.
- Dr. Alan J. Stein, an infectious disease specialist
- Dr. Michael Stewart, chairman of the department of otorhinolaryngology at New York-Presbyterian Weill Cornell Medical Center
- Dr. Allen Bowling, a neurologist affiliated with the Rocky Mountain Multiple Sclerosis Center in Englewood, Colorado
- Dr. Drossman, co-director of the Center for Functional Gastrointestinal and Motility Disorders at the University of North Carolina
So did you pick this omission up? How can an article be written about a subject when the people involved are not even interviewed? It is like writing an article about the financial crisis on Wall Street and only interviewing the people that water the plants at Lehman Brothers and AIG.
11. Ridiculous Study of the Month: Affection
A study of 34 young, married couples found that massage and touch lowers their stress hormones and blood pressure (especially in men). The Journal of Psychosomatic Medicine released this earth-shattering information two weeks ahead of their release date.
Twenty couples, all married at least six months, participated in a four-week intervention that promoted emotional and physical closeness. They were brought into the lab for training and testing, but the bulk of their actions were at home, including a 30-minute massage (neck, shoulder or forehead) three times a week. Participants wore portable blood pressure monitors for 24 hours to supply a number of readings. They also completed questionnaires about how often they hugged, kissed, held hands or were otherwise affectionate. The 14-couple control group had testing but not the intervention.
First of all, who cares? Not that I am against affection or anything but aren't these results kind of intuitive? Second, only twenty couples were examined. That is not a huge amount so how they got significance in this study is beyond me. Third, the couples were from Utah. I grew up in New York and trust me, those results may not cross over to the east coast. Lastly, these were young and freshly married couples. A lot of older women I treat would rather have their husband NOT bother them and a lot of older men I treat would rather get the massage from the faux nail shop at their local strip mall. How is that for a happy ending?
12. Good Heart, Bad Science
In an affront to the scientific method, a judge in NJ recently ruled that a terminally ill teenager with muscular dystrophy should be allowed to use an experimental drug treatment despite objections from the drug’s developer. In a era where validity of these scientific trials are being questioned, one has to wonder how this ruling will effect the future of medication research. These studies are set up in advance with strict inclusion guidelines to make sure the results are statistically significant. You can't just add a patient on a whim no matter how much it tugs at your heart strings. The risk of ruining the whole experiment is too high.
“We’re very pleased with what has happened,” said Marc E. Wolin, a lawyer for the Gunvalson family. “This was the relief that we sought. It’s a big step in the right direction.”
Big step in the right direction for whom? Does one patient outweigh the benefits of many patients? Call me a maverick but I don't think lawyers and judges should decide who gets on a study. This may open to floodgates for other lawyers to do the same thing which will end up destroying many of the ongoing studies throughout the country.
13. Free Day Care At Your Local Hospital
People are smart. They understand most of the laws and how to use them to their benefit. It's just human nature and the American way. For example, Nebraska expanded its "safe haven" law that allows parents to leave a child at a hospital without explaining why. All states have this but it is usually to protect infants less than a year of age. Unfortunately, Nebraska thought they would expand this to all ages and now they are going to pay for it. Read the USA Today article and you will be amazed at the examples listed.The law just took effect this July and already there have been multiple cases. One parent dropped off nine of his kids due to what investigators felt was parental fatigue instead of financial woes. The best part is the new Nebraska law actually protects these parents from prosecution. I think it was Forrest Gump who said, "Life is like a box of chocolates, you never know what you are going to get". Exactly. Imagine extrapolating the above situation to a law that socializes medicine. Imagine giving everything away for free and nothing is rationed for fear of being sued by the ACLU. What would happen? It would be a government bailout like we are seeing on Wall Street --- times a thousand.
