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1209717_19610439The focus of this web site is medicine. In this blog, you’ll read about patient stories. The situations have been changed to be HIPAA compliant. Factual statements may or may not be true. I may change ages, gender or presenting complaints about patients. I may even entirely make up complete patient encounters from my fertile imagination. Trust me, if you think I’m writing about you, I’m not. There are billions of people in this world and readers send me stories about patients all the time. It isn’t you.
You’ll also read a lot about health care policy. I may throw in posts about life lessons, computers, and will even throw in family stories once in a while. If you’re looking for articles about politics, sports, or celebrities, you’re in the wrong place – unless the topics have some relationship to medicine.
If you want to add a guest post or to cross-post something from your blog, or if you have a patient story you want me to write about, e-mail me. See more information in the “About Me” page.

Tax Incentives for Providing On-Call Care

Some states are having difficulty finding enough physicians to provide needed specialty care to patients who come to the emergency department. If a patient needs neurosurgery or trauma surgery and there is no one on staff that is able (or willing) to perform the necessary services, then the patient must be transferred to another facility. Sometimes the waits involved in arranging and performing the transfers can lead to bad outcomes for the patients involved. In a recent Healthcare Update, I mentioned an article about Oklahoma legislation providing tax credits to physicians to provide on-call care. A friend forwarded me an e-mail from ACEP that listed several states which are contemplating tax credits for on-call care. Hawaii has a bill that would provide physicians who provide at least 576 hours of on-call services per year with a tax credit totaling 5 percent of the physician’s liability premiums. For a policy premium of $30,000 per year, the credit would be $1,500. Another bill in Hawaii would waive medical licensing fees (usually several hundred dollars) for physicians who treat more than 20 percent Medicaid patients. Missouri considered a bill that would exempt Medicaid payments from a physician’s state income tax (currently 6%). Keep in mind that Medicaid reimbursements are generally low, so the benefit isn’t as significant as the bill would make it seem. In a chart I have from 2006, Missouri paid a whole $15 for managing a high complexity (life threatening) patient in the emergency department – the same as it paid for treating a kid with a runny nose. In the entire country in 2006, Missouri reimbursed the least for providing high complexity care in the emergency department. By 2008, the rates it paid were up to $20.23 for low complexity and $60.01 for detailed complexity patients – a little more than half of what Medicare paid for the same patients. Oklahoma’s Senate Bill 1604 would provide a $100 state tax credit per day for on-call emergency coverage in rural areas – to a maximum credit of $5000 per year. So what do you think? [poll id=”4″]

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On the Ground in Haiti: Notes from an Emergency Physician

The earthquake in Haiti has created a tremendous need for donations and support for the Haitian people. Emergency Physicians Monthly took the mission to heart. Editor Mark Plaster, MD went to Haiti and has been assisting in the relief effort since January 24. In addition to my posts, I’m going to add Mark’s notes and pictures to this blog. They are a captivating insight into what is happening on the ground in Haiti. The first edition is below. ———————————————————– January 25: Getting to Work When we got off the plane, Port-au-Prince was almost completely black. There is almost no light here. We unloaded the aircraft ourselves and it was just a giant scramble getting all the bags off. We had bags in seats and the inside of the aircraft was total chaos. It was shocking that we got all our gear off. We were met by a team Rubicon leader named Jake Wood, a 6′ 5″ ex-marine sniper who was now a medic. On his own, Jake had decided to come down to Haiti and help out. He’d grabbed a couple friends – some people he didn’t even know – grabbed some sleeping bags and flew to Santo Domingo, DR. They rented a car and just drove in to Port-au-Prince. They made a connection with a Jesuit Mission and just camped out in the mission yard and started seeing patients as fast as they could. They were cutting off limbs in the field . . . it was pretty chaotic when they first arrived. That’s when Jake Wood notified his father back in Michigan that they could use a second wave of team Rubicon. The team coalesced from all over the country – California, Texas, New York – and none of us know the other guys at all. We all just showed up and it’s been amazingly well organized. The team leader down here, Gary Cagle, is a medical logistics guy who worked with the U.N. He was able to put together a 501-c-3 in a matter of about four days and he raised about a quarter of a million dollars in order to bring a team down here and get the job done. So they showed up at the airport, we off-loaded all our gear and came over to the Jesuit Mission, everywhere was pitch black. They told us to throw our sleeping bags down on the ground and they’d introduce us in the morning when we could see everybody. All night long I could hear planes coming and going because the runway was so close. I could also hear babies crying, but it wasn’t until the next day that I learned that this was because the Jesuit mission is a refuge for the homeless. ******* The Jesuit Mission itself is a gorgeous old Spanish-style building, but it is unusable. It’s about to fall down and nobody can actually go in it. It’s a tragedy. Everyone is now living and cooking out in the yard. There are about 40 of us here now but there is a whole group that is leaving today, surgeons who have been here for a while and have to go home. People are coming and going all the time. But it’s moving into a different stage at this point. We are now seeing wounds that were handled by people 5-10 days ago. I just took care of a little girl, probably three years old, who had her leg amputated traumatically and we were just cleaning up and redressing her wound. Whoever handled it initially didn’t try to do a true amputation they just kind ...

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Healthcare Update — 01-25-2010

I split the update again this week. Go over to ER Stories to read some more if you’re interested. . According to a Canadian journalist who was recently hospitalized, one of the biggest problems facing hospitals in Canada is getting patients to leave. She describes some problems she had with her roommates hogging the bathroom and hitting the call light too often. But with a large amount of tax money going to fund Canadian health care, she’s calling for a two-tiered system similar to England and France. More evidence that insurance doesn’t equal health care. Rural senior citizens in Arizona are having difficulty finding physicians who accept Medicare. Doctors state that they are reimbursed about 55 cents of every dollar they bill for Medicare patients, and they have to hire additional office workers to deal with all of Medicare’s paperwork. Instead of dealing with the bureaucracy and the hassles, the doctors just stop seeing Medicare patients. Adding to the problems … Arizona has cut funding for graduate medical education, so less training spots are available. Result for the patients with “insurance”? Waits for 6 weeks to 10 months to see a physician. Some drive several hundred miles to Phoenix and pay for a hotel room to get sooner appointments. With the 21% Medicare reimbursement cut about a month away, seniors can expect things to get a lot worse. I won’t hold my breath for a 21% cut in Medicare taxes being taken out of our paychecks. Doctors make too much money to deserve further economic protection in Maryland. At least that’s the way the logic goes if you’re a partner in a Maryland law firm. Being 50% underfunded, the Indian health program in South Dakota boils down to simple economics: No funding, no health care. Delaware had one large pharmacy chain threaten to pull out of its Medicaid system due to … you guessed it … low reimbursements. Walgreens made the threat and got some changes to its reimbursement rates. CVS pharmacies and Rite Aid are also feeling the squeeze. Can being a party animal help you succeed as a doctor? Extroverts tended to struggle with studies early on, then excelled in their training as they spent more time with patients. Neuroticism was a “constant predictor” of poor academic performance. Hmmmm. This study explains a lot of things about my younger years. Kids may drive you crazy, but they keep your blood pressure under control. This study shows that adult parents have lower blood pressure readings than childless adults. Personally, I think it has to do with all the booze parents drink after the kids go to bed. What are hospital operating costs per patient? About $2800 if you’re in Oregon. That totals about $7.5 billion per year which is as much as is spent in Oregon on schools, universities, prisons, police and social services combined. More and more of that care is becoming uncompensated or undercompensated, leaving hospitals “very definitely in trouble.” The article even includes a breakdown of sample charges from Legacy Good Samaritan Hospital in Oregon including $203 to inject medication through an IV line and a $10.15 charge for a medication that costs less than 10 cents wholesale. The entire cost for a four day stay in the hospital for a colon infection was $12,674.

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HIPAA violation or political revenge?

Here’s a good one from WLBT News in Mississippi. Mississippi Governor Haley Barbour wrote this on his Twitter page, “Glad the Legislature recognizes our dire fiscal situation. Look forward to hearing their ideas on how to trim expenses”. An administrative assistant at the University Medical Center School of Nursing who had apparently heard from several UMC employees that the governor scheduled off-hour appointments for medical care then twitted back: “Schedule regular medical exams like everyone else instead of paying UMC employees over time to do it when clinics are usually closed.” Several days later, the administrative assistant was accused of violating HIPAA laws and was “encouraged to resign.” C’mon. The administrative assistant was passing on second hand information and didn’t even mention the governor by name. And besides, it’s not like she told the world that Haley Barbour was going to a psychiatric clinic appointment to learn how not to make stupid suggestions on his Twitter page. The hospital is stretching HIPAA laws way too far. False and/or uninformed allegations of HIPAA violations are becoming the new quick and easy way to get rid of employees. The lawyers providing the hospital with advice should be the ones fired. Am I violating HIPAA if I redisclose that Lindsay Lohan is in rehab? I am a covered entity and the fact that she is/was in rehab is protected health information. How is this different from the Haley Barbour case? Oh yeah, guess my job is in jeopardy because I mentioned that Conrad Murray provided propofol to Michael Jackson. Oh, and I saw a patient … in the gift shop at my hospital … buying … throat lozenges … for a sore throat! Shhhhhhh. Don’t tell. Then my car got hit in the parking lot, but I couldn’t call my insurance company to file a claim because, according to MUMC attorney logic, it is a HIPAA violation to disclose that the patient’s car was in the hospital parking lot. So when families call University of Mississippi looking for a patient, do hospital operators tell you “we can neither admit nor deny the existence of this patient in our facility” to avoid further HIPAA violations? Hey – rules are rules. [eye roll] P.S. Mississippi Governor Haley Barbour allegedly goes to the UMC clinics after hours and the University has to pay overtime to employees for his routine physical examinations. Pass it on.

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Had a couple of things come up and am going to be away from the computer until next week. Enjoy all the other great blogs on my blog links page in the meantime. If your blog isn’t on the list, drop a comment in the comments section on the page and I’ll add it when I get back. If you’re interested in doing a guest post in my absence, there’s an open mic. Whip something up and submit it to the editors at EP Monthly (editor@epmonthly.com). The jucier, the better. Let’s see what you’ve got.

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Healthcare Update 01-13-2010

The game of medical funding hot potato continues. Miami hospital system stops providing dialysis for indigent patients due to mounting budget losses. Instead, patients are encouraged to go to the emergency department so that Medicaid will be forced to pay the cost for the visits. Rather than risk crowding in their hospital emergency departments, three other Miami area hospitals contributed $100,000 to pay for outpatient dialysis for one month while seeking a longer term solution Boston Medical Center lawsuit accuses Massachusetts of illegally cutting payments to hospital for indigent care and of “financ[ing] its health insurance law, a model for national healthcare overhaul, on the backs of poor residents.” BMC President Elaine Ullian makes similar comments in a speech to hospital donors. Massachusetts Governor Deval Patrick gets offended and writes letter to hospital’s board of directors calling Ullian’s comments “wrong” and “unhelpful.” In other news, Ullian was then seen sneaking around Governor Patrick’s neighborhood at night carrying a carton of eggs and several rolls of toilet paper. Need to see a mental health counselor? OK, our next open appointment is January 2015. The average wait in Polk County, Iowa is about 14 months for mental health care and can be “up to five years before some people can receive care.” At last count, there were more than 500 people on the waiting list. Cuts in services are being made as the state tries to balance its budget. Medical malpractice judgments and settlements are now being posted online. The North Carolina Medical Board’s site is here. A story in Fox news about the innovation is here. According to the article, about two dozen licensing boards in several states publish malpractice information. A number of years ago, there was a public outcry when a group in Texas posted names of plaintiffs who filed malpractice suits against physicians. Everyone seems content when physicians are exposed to public scrutiny. Also interesting that the President of the NC Board, Donald Jablonski, was reprimanded by the Florida Board of Osteopathic Medicine. Amazing what you can learn on these sites. It is an emergency department or a hockey rink? Patient punches emergency physician in the face (link from Gladwin, MI now changed to subscription only, so article unavailable). Meanwhile, a different patient punches emergency department nurse in face. Then, a mother threatens to kill ED staff then grabs security guard by throat. I need me a stun gun. Then I read about a police officer being stabbed in the neck and killed while sitting in his car in an emergency department parking lot. What is wrong with people? More budget woes affect medical care. Cook County’s $75 million health care budget shortfall results in even more cuts in medical services. Nine hundred hospital positions were cut last year and an additional 450 positions will be cut this year. A patient notes that a 10 hour wait in the Stroger Hospital emergency department waiting room “isn’t bad” and that the longest wait he’s seen is 30 hours. Gunshot victim seeks emergency care from naturopath? And the naturopath agrees? Somehow, I don’t think herbal extracts and rolfing are going to cure internal bleeding. Increasing medical malpractice claims in Tennessee. Out of more than 3000 cases filed in 2007, only 7 went to trial and 492 were settled. The remainder “died on the vine.” Emergency department staffing company Team Health’s IPO was disappointing, as they only opened at $12 per share rather than the $14 to $16 they were expecting. Even so, Team Health’s net income last year was nearly $2 billion. Talk about “going green” …

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