April 15, 2011 Recent News
Dr. Pauline Chen wrote an op ed in the Wall Street Journal detailing the shift from bed side to computer for younger physicians. The young physicians have not had the art of physical diagnosis and therefore rely on the lab tests and x-rays whose results are on a computer. This is a trend whose time has come. One doctor, who should be ashamed of himself, wrote "Now we look at various factors that put a patient at risk, then calculate whether it is worth treating that patient." This, according to Dr. Chen, is going from bedside medicine to desktop medicine.
The New York Times had a long article on the new physician and their aversion to working long hours. They are very into life work balance and are willing to sacrifice money for this. This means more are going into ED and critical care medicine as they have the shortest work weeks of any specialties. The other major change is that the young physicians do not want to work for themselves. They want salaried jobs. In an interesting interview a young female physician going into ED medicine instead of her grandfather's and father's general practice stated that she wanted the action. She wanted to see people get well in front of her not years later. This also is reflected in the inability of older physicians to sell their practices. The same is true for the younger patients. They don't have or want the same close relationships with their physicians.
In view of the feds crackdown on the physicians who prescribe opiods, many physicians have gone to the bother of having their patients sign contracts before they prescribe for chronic pain. If the patient does not keep all the terms of the contract the physician may drop him/her as a patient. Top
The LA Times has a story about employers nationwide opting for limited network HMOs. These only care about cost and not quality. All expensive physicians and hospitals are rejected from the HMO. Since people see healthcare as fungible it does not matter to the patients. The patients also want less expensive and don't know the physicians in any case. If patients get very ill they will get care it just might not be at the best hospitals and with the best physicians for their problems.
The LA Times also has a story about Anthem Blue Cross and the individual policyholder. Most of the individual policyholders will get premium raise averaging 9.1% this year starting July 1. However about 150,000 people will get a rate increase of up to 26%. Those people are covered under the Department of Managed Care and not the Department of Insurance. Anthem's rationale is reasonable. The Department of Managed Health Care has mandates of coverage that the Department of Insurance does not have, such as mandatory maternity coverage for all.
The Wall Street Journal has a story that Medicaid is worse than no insurance at all. The reason is the patient with Medicaid can not be seen by physicians unless they use the ED as their primary care. This will become worse has more people enter Medicaid and the cash strapped programs will cut back payments even more. According to the op ed piece patients with no insurance fare better in the hospitals than do Medicaid patients. The piece surmises that the reason for putting so many more patients into Medicaid under Obamacare will force the government to spend more money on them.
The Ryan plan for changing Medicare would start in 2021, and effect those who are now under 55 years old. The rationale for the proposed changes is that Medicare is in trouble and is unsustainable at its current rate. There is no disagreement from anyone on this. The Ryan plan would give vouchers to those coming into Medicare in 2022 to purchase their own insurance. Lower income people would get more than those with money. There would be a means test, something that has been bandied around for years. This would mean, according to the CBO, that most would pay more than they pay under the current Medicare system. That would be true for some but not all. The plan also raises the Medicare start age to age 67 by 2033 to mimic the government raise in retirement age. The plan also uses the Obamacare idea of exchanges where the elderly could shop for the plan that fits their needs. Top
The community hospitals, the same ones that want the physician owned hospitals to be killed off, have up to ten times higher adverse events than has been estimated. This is a study in the Journal of Health Affairs. The study used actual patient records and not insurance reporting. The study also showed that actual hospital reporting of adverse events was only 4% of the total.
USC hospital is restarting its kidney transplant program that has been shut down since they transplanted a kidney into a wrong patient on January 29, 2011. The hospital has changed the way organs are tracked.
If anyone believed for a moment that EMR was not expensive and probably not worth the money, Singing River Health System in Mississippi has asked their county for a loan of $37.5 million so they can put in the system. They are doing this to get paid a pittance more when Obamacare come through. This is only an upgrade from what they already have so they can pick the low hanging fruit. They will also ge $11 million from the feds and will use that to pay down the county debt. Top
In his speech Obama stated he is implementing healthcare cost controls. He can do this without Congress since Obamacare gave the president the power to appoint the Implement Payment Advisory Board (IPAB). This Board has the power to advise Congress of ways to decrease healthcare spending. If Congress does not act to save as much as the recommendations the HHS will act in Congress' stead. Obama wand to decrease in half the projected Medicare spending limits starting in 2018. This is to help decrease the deficit by $4 TRILLION over 13 years. The other methods to reduce the deficit is to take away the Bush tax cuts for those with incomes over $250,000 and other spending cuts. He wants to reduce fraud and waste in the programs, a laudable goal but without direction.
Judicial Watch filed a freedom of Information request and received an answer that Obama's HHS received $200 million to promote Obamacare. A terrible waste of taxpayer money.
The British physicians really hate the NHS reforms. They hate it so much that they are considering a strike. The BMA states that local medical services are already being rationed or closed across the country. The last time there was a strike in England was in 1975 when the junior clerks went out for pay. That was the same year that the California physicians took vacation for med mal reforms. Top
DISCLAIMER: Although this
article is updated periodically, it reflects the author's point of view at the
time of publication. Nothing in this article constitutes legal advice. Readers
should consult with their own legal counsel before acting on any of the