June 15, 2009 Recent News


Medical Choice


After Obama met with the healthcare leaders minus many important ones those who were there have come back with several suggestions.  These are general and without any specifics.  They recommend more efficient use of healthcare services, better management of chronic diseases and standardizing claim forms.  Yea Team! 

As the feds start to look at the economics of reform they need to also look at the rationing that comes with it.  An article from Reuters points out the long waiting times for carotid endarterectomy in England.  Only 20% of the patients make the two week time frame set out by the government.  Over 30% waited over 12 weeks for the surgery. Their operative statistics are comparable but they leave out those who have had strokes or death while on the waiting list.  The government is doing more in thrombolysis but ignoring the remainder of the stroke program.

The feds are also looking to bundling physician payments for a specific diagnosis and visit.  This would help cut out over utilization but would do nothing for the problem of over referrals.

Obama has decided to leave out the Republicans from the health care debate.  He wants and expects to get the government health plan and he wants the whole thing done by October.  The Dem Senators may go for a trade off if the Republicans will go for the public insurance.  This may include med mal reform but that would really tee off the Dems trial attorney masters.  The way to pay for the reform was not known but Obama does not favor taxing the health benefits of union employees.  He still wants to get the money by reducing itemized deductions such as charity and mortgage for "the wealthiest Americans." He has sent a letter to the Senate that he is receptive to making health insurance mandatory as in the failing policy in The People's Republic of Massachusetts.  This is the same idea he fought Clinton on in the primaries.

The AHA has just released an article on the People's Republic of Massachusetts medical plan and it is not complementary.  The article goes over the beginning and its successes and then it switches to the third year and the problems.  It talks about the original plan not to tackle cost containment, a sin in this context.  One must ration care.  There are now escalating costs, underinsured people and of course the refusal of physicians to take the low paying insurance.  The hospitals are still having to take the disproportionate share money but this will cease next year.  The hospitals are only being paid Medicaid rates at best and this is about 60% of costs.  This is not sustainable.  These problems are coming true in a state with a small number of originally uninsured.  Imagine when and if it hits Texas and California.  

The Republic has just found out that they have approved many plans with a loophole in their benefits.  They do not cover maternity benefits for the dependants of the policyholder.  Imagine that.  When the feds look at the Republic for guidance they can see how inept they are and how much more coverage will cost for all the benefits mandated.

When one thinks about paying for healthcare one thinks about pay as you go.  One does not include Obama.  He believes pay for care now in ten years from now.  Obama says its ok to run up large deficits now as long as Congress can pay for them in ten years.  The way to do this is to borrow money in the early years from other sources.  The Dems are convinced that taxes are needed to pay for the massive $3.5 Trillion program.

The Dems have come up with an idea to help pass the health reform plan.  They will give up the idea of a public insurance program and in its place put in cooperatives.  These will be funded by the patients.  I can not see these being long term solutions but instead short term bankruptcies.  However, it is better than Reid's threat of passing reform without any Republican input.  This would make for long term major problems.  The Republicans are pushing for some med mal reform to be part of the healthcare reform and this is being considered by the White House.

The New York Times had an article this past week that was titled "If All Doctors Had More Time to Listen".  The article focused on those physicians that have left the rat race of seeing a patient every few minutes and went to a somewhat concierge type practice.  Those physicians took more time with their patients and did what Obama wants to do with reform, head off ED visits and do preventive care.  It costs less for the patient and cuts out all insurance.  It's a win for all but the insurance companies.  With Obama's plan there will be more insurance and more forms and more "oversight", another name for rationing.  There will also be more patients seeing fewer physicians so less time spent per patient and less time to listen therefore more ED visits.  Is concierge medicine bad for the poorer patient?  I'm not sure since if one means those on Medicaid, there is already a limited amount of physicians and hospitals that contract with the system.  If one means those with insurance that can not or will not go to concierge medicine, then that is a possibility.  The new HHS head wants reform to cut out the marked differences n health care between the races and between those with money and those without but does not say how this will happen.  She has learned well from her boss.

The Wall Street Journal has an op ed by a physician originally from Canada and who now is at the prestigious Manhattan Institute.  He wonders why the US is moving toward federal healthcare with the onset of a public plan and the other socialized health countries such as Canada, Sweden and the UK are moving more toward private health care.  It is a fair question.

We are soon to find out what the feds believe meaningful use is in the electronic health record arena.  According to one person it means someone who uses a certified record, exchanges information and reports on quality matters.  I hope that they look at how easy the system is for the user in determining whether the system should be certified.

MEDPAC and the GAO have issued a report on the high cost of radiology.  This is especially true with the high cost imaging and across all specialties.  They recommend either prior authorization by the same bunglers that now give or more accurately don't give permission for care in the HMO settings.  Their motto is to delay as long as possible.  The other potential scenario is to decrease payments which will drive some radiology clinics out of business.  Not too bad in the cities but devastating in rural areas.  The GAO says that two major drivers of the high cost is the self referrals and the lack of knowledge of primary care physicians as to what to order so they order the wrong radiographs.  The lower payment scenario is based on the current belief that the machines are in use about half the time they are available.  In reality says the feds the machines are in use about 90% of the time they are available.  Since the payment is partly on the spread of the cost of the machine over the number of patients the feds believe they can decrease that part of the payments by almost a half.  Of course, the feds have done no studies to see if their assumptions are true.  The feds also do not believe that medical necessity includes defensive medicine.  They have never faced the wrath of a patient  harmed due to the refusal of a physician to do a test that may have found a tumor or other entity earlier.  They need to walk in the shoes of the practicing physician.

The administration is also looking at making the MEDPAC a part of the executive branch with the rule of law as to payments to health care providers. This take Congress and debate away from any equation.

Ingenix, the disgraced arm of UnitedHealth, is trying for a comeback.  They have purchased a medical bill auditor AIM Healthcare for about $430 million.  They hope to have a single source for payment accuracy that will reconcile payment inaccuracies.  They will no longer need to deal with multiple parties to get information.  

The nuclear reactor in Canada that supplies much of the world's MO-99 isotope used in diagnostic testing has sprung a leak and will be out of commission for at least one month.  This will cause problems for heart and cancer testing with less isotope available and that that is available will be much more expensive.  Some high users get shipments twice a week since the isotope has a half life of only 66 hours.   

The American College of Radiology is opening a voluntary databank for mammography.  Those that belong will get semi annual reports as to how they are doing versus their peers in such aspects as percentage of cancer detection, patient outcome, and recall rates.    

Walgreens, the largest pharmacy in Delaware, has stopped servicing Medicaid patients due to a 20% drop in payments by the state. 

In the same vein of not paying, the physicians of Indiana and Ohio are stating WellPoint is not paying their debts to them.  They accuse WellPoint's Anthem of massive delays and non payments and are asking the state regulators to investigate.  WellPoint acknowledges the problem but blames their own inaptitude in claims processing.  The states have to date done the same as the insurer, nothing.    Top

Medical Choice

A 33 year old woman has a tumor of blood vessels in her left temporal zone of her brain.  She gets seizures and hallucinations and the tumor may be fatal but she will not have surgery to remove it.  The reason is that she is an artist and the tumor hallucinations are part of her art and she was afraid that cure would change her art.        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.