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The following comes from Medical Tuesday. I am reprinting it because it probably reflects the ennui of physicians better than any article I have read in a long time.
"Editor's
Note: In the past, our medical societies met on Tuesday evenings, which then
became known as "Medical Tuesdays." Mondays and Fridays are busy days
in any practice, which precludes evening meetings on those days. Many doctors
take a half-day off on Wednesdays or Thursdays in order to compensate for
working the nights and weekends required to cover their practice. Hence, that
left Tuesdays for collegial and professional meetings. In our community, the
Medical Society met on the third Tuesday of each month. Huge turnouts occurred, filling
the largest meeting room at the convention center, to discuss the professional
and practice issues of the day. The Internal Medicine Society met on the fourth
Tuesdays to discuss their unique problems; the family physicians, surgeons,
pediatricians and obstetric-gynecologists also met on Tuesdays.
As
Managed Care became more assertive in telling doctors how to practice, the
agenda at the medical society meetings changed and attendance dropped. Meetings
were reduced from monthly to quarterly. Patterns were broken. Doctors could no
longer rely on meeting times or the month that meetings were scheduled.
Gradually, the professional meeting began to disappear. It was
counter-productive to the interests of Managed Care for doctors to assemble and
discuss issues since it increased resistance to compliance. On two occasions in
the past several years, the medical society, in a community of more than 3,000
physicians, had less than 30 attendees (1%). Effective physician leadership
disappeared. The once noble profession was gradually being de-professionalized.
Meanwhile,
Managed Care Organization (MCO) meetings took over the vacuum and were required
for all doctors to attend or their reimbursements would drop. Five, ten and even
25 percent of their payments were with held and paid out at the end of the
quarter. This payment was based on your attendance at the meetings, your holding
the line on referrals, writing prescriptions for the lowest price
pharmaceuticals, and writing your prescriptions on line. The MCO came into your
office and copied the charts, reviewed them and gave you a grade on your cost
performance. The notice of their coming into your office included a notation to
not tell the patient since by the HIPAA statute, they have a right to review the
confidential patient records without the patient being aware of it. Thus HIPAA,
touted as necessary to force confidentiality, caused wide disbursement of the
private medical record to the government, insurance industry, and made the
sharing of patient records among the physicians caring for the patient more
difficulty. Thus HIPAA was another perverse infringement on medical privacy.
"
____________
"Dr.
Edwards: We had our Managed Care Organization meeting last night and received
the directives for our practice for another month.
Dr.
Ruth: Well, how did it go?
Dr.
Edwards: We were told to do a psychological survey of our patients to determine
how many were depressed. Then there was a lecture on which drugs to use, whether
SSRI or SNRI.
Dr.
Dave: I asked the people at my tables for examples of the latter and none knew
any.
Dr.
Ruth: So it's one of those situations that the speaker thought he was talking
everyone's language and everyone was reticent to speak up and show his
ignorance.
Dr.
Edwards: That's probably accurate.
Dr.
Dave: I think another reason was a distinct lack of interest. Don't do anything
to delay the end of the meeting.
Dr.
Edwards: We were also told of the Medicare Rule to sign our degree after our
name. We were requested to review our charts since January first and put MD or
DO behind every signature.
Dr.
Dave: Some of us took that as another rule that if it wasn't followed exactly,
would allow them to withhold more money and pay us even less at the end of the
quarter.
Dr.
Sam: We were also given notice to upgrade our billing codes to the max to earn
more Medicare money.
Dr.
Edwards: Isn't it interesting in the efforts to reduce health care costs, they
throw carrots at us which are primarily for the public to chew on to make them
think we are getting paid even more.
Dr.
Sam: But upgrading has some serious down side risks. Remember we had a doctor go
to jail in our community who thought an office visit was one code and Medicare
said it should have been another.
Dr.
Ruth: Yes I remember that one. After he apologized and said he was unaware of it
and wouldn't do it again, the federal attorney had him sign an affidavit to his
admission, and then had the judge call the bailiff to take the doctor to jail
where he stayed for two years.
Dr.
Yancy: See I've told you all dozens of times, "Never trust the government
in anything. They are never your friend. Don't
even talk to your congressman or senator. You'll just incriminate
yourself."
Dr.
Sam: Now that's sound advice you can take to the bank.
-
Dr. Dave: If you must deal with your Medical Board of any
branch of the government, have your attorney make the contact and write the
response. The $2,000 legal fee per response letter is a bargain considering the
alternative. "
Specialty physicians compensation is just keeping up with inflation. During the past year the MGMA reports that actual increase after inflation was 0.31% and that primary care physicians compensations went up 3.35% after inflation. Within specialties there was great variation with invasive cardiologists going down 0.18% before inflation whereas non invasive cardiologists had a 11.72% increase before inflation. Inflation was pegged at 2.85% during this time period. It should be noted that ED physicians and oncologists lost ground to inflation and anesthesiologist kept pace with inflation but my favorites, urologists, were over 5% above inflation.
Since Medicare has changed the way it reimburses oncology physicians for taking care of patients, a study has shown only slight changes in the access to care with some longer waits and some having to travel farther to get care. The major changes were in the rural areas.
Pharma has decided that starting in January, 2009, to stop giving away pens, notepads, coffee mugs and the like. They will still provide free office lunches for the physician and the staff. There will be no more restaurant meals, however.
The government is experimenting with paying physicians more in hopes they will spend more time with patients and order less costly tests, or send the patients to costly specialists.
The physicians in the People's Republic of Massachusetts are contesting the findings of a law school that their premiums have gone down as adjusted for inflation. At the same time, Health Affairs has come up with research that settlements have increased in amounts dramatically in the last 30 years. The Republic has been listed by the AMA as one of the worst in the country for med mal premiums, which may account for the difficulty in retaining physicians in the Republic.
Kaiser of Northern California and the Mid Atlantic Permanente Group will become one soon and will be headed by the head of the Northern California Group.
South Florida now has about 1/4 of the Broward and Palm Beach county physicians and over 1/3 of the Miami area physicians without med mal insurance. Florida does not require insurance but if one does not have it they need to put up a bond for $250,000. This is a one time thing versus yearly payments. Florida's insurance premiums are the highest in the country. When the uninsured physician gets sued he has the option to go bankrupt which in Florida allows you to keep your home no matter how many millions it is worth. Top
There are some hospitals that are so bad that even when they fold they continue to make bad news. LA's King Harbor is the prime example. After they closed do to mismanagement by the LA County Board of Supervisors, they were supposed to get rid of the bad employees. They somehow overlooked that. They now have suspended 16 employees for either poor performance or flat out lying.
Children's Hospital of Oakland, California suddenly laid off many employees, cancelled and then uncancelled many appointments to save $10 million per year. The hospital also either cancelled or severely cut back many outpatient programs. This is after the hospital failed to raise money in the last election for a new building program as well as the infamous 10% Medicaid cutback that went into place on July 1.
The San Francisco private hospitals are now joining the city's health plan. They need to join in order to continue to show charity and get their tax exempt status. The patients will pay between $0 and $250 per hospital admission to the city and the non profits will receive nothing for caring for the patients. This so far does not include Kaiser hospitals.
Deaconess Hospital in Cincinnati is forging a pact with physicians. The physicians will own 40% of the hospital and this will include about 100 primary care physicians and specialists. This is to stave off the physicians from starting their own hospital and to stem the losses in the present hospital. This is also to help those physicians that want hospital directorships and do not want to be owned by hospitals.
Arlington Texas' JPS Diagnostic and Surgery Hospital is having publicity problems. They have no ICU or Labor and Delivery Suite. They do not accept transfers in and only do scheduled procedures. Sounds like a terrible physician owned hospital but it is owned by the citizens of the area (taxpayors).
The AHA continues its push to ban physicians from putting up their own hospitals and surgical centers even in the face as the above story. They have continued to pay Senator Grassley to do their bidding (lobbying). The bought Senator again tried to get a bill to pass the Senate banning physicians from owning hospitals. He attached it to the Rural Hospital Assistance Act.
To no one's surprise Detroit Medical Center has paid Wayne State physicians $2.7 million for their work at the Center. The Center had gotten terrible advise by their East Coast attorneys and are now having to pay the piper. They still owe $4 million more. Looks like they may be paying some now to get some federal funding. Top
Baptist Health in Arkansas has notified 1800 patients of potential ID fraud after an employee was found to have accessed patient files to get Wal-Mart cards for her own use.
The University of Utah Hospital stolen medical files have been found. The records had information on over one million people.
Hawaii has erroneously released a list of people taking medical marijuana. The newspaper asked for some information but was given the names of the people. The newspaper did not print the names but did mention in the article that the names were released.
Two nurses at New Jersey's South Jersey Healthcare Regional Medical Center were fired for undisclosed HIPAA violations.
St. Mary's Medical Center in Reno, Nevada, has notified 128,000 patients that their personal information may have been compromised. There was am unauthorized access in April but the notification was sent out now. The hospital will pay for a year of credit monitoring.
Ohio State University put the names and SSNs of about 500 physicians and nurses on line in a screw-up. They are offering credit monitoring services for one year.
Ain't electronics in healthcare marvelous. When it was done with no electronics it was slower but so much safer. The example is yet another major mistake by a company that should know better. The Georgia Blues sent about 200,000 personal information containing letters to wrong addresses. This could lead to identity theft. The problem was blamed on a computer system but all know it was the human who designed and send out the wrong information. The Blues are now removing all SSNs from all mailings.
The Heartland Institute has blasted the DHS subsidiary Office of National Coordinator for their concept of government trying to change the healthcare information systems. They state that the government has a poor tract record as compared to the private sector in implementing information systems. The report goes on to state that all systems designed today will be outdated in five years and the government can not change quickly enough to keep up. Top
A new report by The Fraser Institute on Canadian wait times was interesting. They found only a slight increase in overall waiting times over the past year. However, when the waiting times to see a specialist are already almost 10 weeks and many can not work during this time the monetary loss is way up there. This again proves that the Canadian Supreme Court was correct, Canadian Healthcare does not mean access to care but only to a queue for care.
The European Union is considering allowing all the 27 nations to have people seek treatment anywhere in the Union without having to obtain prior authorization. This would only apply to procedures that are publicly financed in EU home countries and reimbursement would only be what the reimbursement would have been in the home country. All non EU people would still need prior authorization to get care. The people would need to pay all upfront costs and then could get reimbursed. Some Europeans travel to other countries to get care either quicker or better quality care. The British are the ones who may go abroad the most due to the long queues in their home country.
In Great Britain, physician will have their practice appraised every year for patient assessments, prescribing habits and personal issues. They will also get license renewals every five years and be assessed by senior physicians. This seems somewhat unfair but consistent with British medicine where senior physicians can do no wrong.
The Mail has a story about a high level ENT surgeon who states that the executives at the NIH are blunderers. They run the NIH as a supermarket but with massive money waste due to poor management. He also stated that patients are worse off than they were 30 years ago. The senior physicians are taking early retirement and newly qualified medics are leaving the profession. He goes on to state the morale is at an all time low and getting worse. When he started 30 years ago it took a week or so to get a hearing aid and now it is up to several months.
The OP-ED in the New York Times rightfully chides Congress for failing to change the way CMS pays for services. The op-ed uses the example of a CT scan that will increase the profit of a physician owner of the equipment. There is minimal if any profit in a Medicare office visit but if the physician can send the patient for a test, he/she can now see another patient and get another small profit. If one adds those up Medicare is paying for alot of expensive tests instead of what could be a much less expensive office visit. This is shown by the stats between 2000 and 2005 of a 8.3% increase in Medicare patients but a 14% increase in services. The article was written by a physician employed by Memorial Sloan Kettering and a prior administrator of CMS between 2000 and 2005.
The scans are expensive. They are so expensive that Wellpoint and Magellan are rejecting almost 30% of the ordered scans. This is done with prior authorization usually by clerks and not physicians. Time is then wasted by appeals and an additional 15% are then covered. Therefore 85% of asked for scans are approved and no one speaks of the cost paid to the radiology benefit managers vis a vie just doing the tests.
Even the left leaning New York Times doesn't believe Senator Obama's numbers of how much he can save the average American family in one year. This is even if all his programs are passed which is highly unlikely, since there is no way to pay for them. Maybe if he learns to raise his right hand to his heart during the Pledge of Allegiance or the Star Spangled Banner it would help.
In a OP-ED in the Wall Street Journal a physician at the Manhattan Institute talks about how much better we are in the US versus other countries for serious illnesses. It uses breast, prostate and male and female colo-rectal cancer. In Britain there is a 20% less five year survival rate for cancer in men than in the US. This is due to earlier screening in the US and more time between diagnosis and treatment causing potentially curable cancers to become incurable. It also is due to the use of albeit expensive but effective meds in the US as opposed to countries where the government pays the bills.
In the People's Republic of Massachusetts the insurers are now paying for drug store medicine as performed by mid level practitioners. It is cheaper but not better than physician medicine. There is a large deficiency in the Republic of primary care physicians since many physicians are leaving the state as soon as they get out of residency.
Speaking of the Republic, they have always been thought of of being the Mecca for hospital and patient care. They seem to be overblown. In the past year or so there have been 11 wrong sided surgeries performed on the patient's back alone. There have been other blunders on other parts of the body. I think if I were a member of the Republic I would go elsewhere for care.
Surgical errors in general in the country cost almost $1.5 Billion a year. This was the findings of the US Agency for Healthcare Research and Quality. They count as errors Nursing errors. on surgical patients such as allowing pressure sores and uncontrolled blood sugars. They also counted post op infections and post op respiratory failures, not necessarily errors. 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
information presented.