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Tag Archives: Healthcare Access

Healthcare Update — 01-18-2016

As if stool transplants weren’t bad enough … Now some people are recommending urine cocktails to treat illness. Retiree in London was diabetic, had kidney problems, and swollen ankles. After starting to drink her own urine, she is suddenly cured and looks like Taylor Swift! OK, she really looks like Bea Arthur, but her kidney problems went away. Article tries to legitimize the urine drinking experience by noting that women already take medicine made from urine of pregnant horses – Premarin. Another person interviewed for the article rubs urine on his face every day as a skin treatment. Oh, and drinking urine is supposedly in the Bible, too. As I told my kids … “Urine BIG trouble if you ever try this.” Florida’s Medicaid managed care becomes more like Medicaid managed REFUSAL of care. With private companies now operating the system instead of the state, the added requirement of prior approval for many services and dealing with a myriad of billing procedures and rules are just two areas that are far more complex. “In this area, there are four different plans with four different sets of rules, four different provider handbooks, four different billing processes,” said Maggie Labarta, the president/CEO of Meridian Behavioral Healthcare, which provides mental health care and substance abuse counseling services in 10 counties. “For us, the administrative burden attached to billing has grown much more complicated. It is a lot of paper and a lot more bureaucracy.”  Some of the insurance plans will only pay for one day of the three days required for involuntary psychiatric admissions. Most plans require pre-approval for many routine services. As a result, Medicaid has become “more cumbersome and more difficult.” But don’t worry because the patients have INSURANCE! Award-winning screenwriter, producer, and director goes to Quebec hospital with abdominal pain. Later found unconscious in waiting room ultrasound showed ruptured aortic aneurysm. Newspaper claims patient was “denied potentially life-saving surgery.” Hospital reportedly revoked the privileges of its only vascular surgeon as part of Health Department reform and budget cuts. Patient was transferred to another hospital but died before he could make it to surgery. This patient had insurance, too. Interesting concept. When state laws become too onerous for doing business, companies close shop and leave. GE leaving Connecticut due to Connecticut’s high-tax, high-regulation, and anti-business policies and moving to Massachusetts which is presumably more business-friendly. California’s MemorialCare Health System wants to close a hospital and emergency department in San Clemente and replace it with an outpatient medical center and urgent care center – that wouldn’t be required to take ambulance runs. I wonder why that is. San Clemente residents fighting the proposed closure of the emergency department. California legislators refused to allow the new facility to operate as a stand-alone emergency department. As a result, there will be a 40 mile gap between the next closest emergency departments. Quite a bit of extra travel. Hope they have extra ambulances ready. When seconds count in a medical emergency, help will only be 30 minutes or more away. I’m sure a lot of those patients have insurance as well. Is that a hernia under your shirt or ….  Leicester patient finally has 8 in x 12 in hernia repaired. Before the repair, he was arrested for shoplifting when store clerks thought he had merchandise under his shirt. Yes, this patient had insurance, also. Shocked. Shocked I am. The Unaffordable Insurance Act continues to implode. 49 of 50 states will see premium hikes in 2016. The reporter is a little math-challenged, noting that “more than one in three states, or 17 percent” will see premium increases of 20% or more, but it doesn’t take away from the fact ...

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Healthcare Update — 06-06-2013

See more updates over at EP Monthly.com Patients gone really wild. 45 year old patient falls asleep in Harlem Hospital emergency department then wakes to find another patient sexually assaulting her. Assailant then stopped and began to urinate on her. Comments to the article equate the incident to the future of health care in this country. Schools requiring doctor’s notes to apply sunscreen on kids due to “possible–but quite rare–risk of being allergic”? We should probably require doctor’s notes to eat lunch, also. Food allergies are a big problem, you know. It would be amusing to turn the tables on these moronic school officials. “Sunscreen of 30 SPF or higher must be applied exactly 27 minutes prior to anticipated sun exposure. Sunscreen should be applied to all exposed skin areas including scalp and also applied to a 3.5 inch area of skin buffering any and all exposed skin areas. Sunscreen must be reapplied to these same areas every 30 minutes or fraction thereof. Application of sunscreen, times of application, areas of application, and reapplication efforts should all be clearly documented, signed by school officials and returned to this office for filing with the State. Any variation from these directions should be considered medically contraindicated and unauthorized by this practitioner.” Hat tip to Instapundit for the article link. Are US doctors paid too much? When this Forbes article compares US physician salary to physician salary in other countries without comparing the legal atmospheres, the regulatory atmospheres, the costs of training, the costs of malpractice insurance, and the costs of licensure, the article doesn’t effectively answer the question – even though it concludes that US doctors are underpaid. Show me another country where a specialist has to pay $150,000 in malpractice insurance each year and then we’ll talk. Kentucky needs 3,790 more physicians than it currently has – and that’s before Medicaid expansion and the UnAffordable Insurance Act take effect. With 25% of Kentucky’s primary care physicians at risk for retirement in the next 5 years, the problem will only get worse. Now it is looking at allowing nurse practitioners to prescribe non-scheduled medications as one way to combat the problem. Don’t worry, Kentuckians. You’ll still have insurance! Connecticut hospitals have serious problems obtaining psychiatric medical care for children. On many days, more than half of the beds in the Connecticut Children’s Medical Center ED are occupied by behavioral health patients. Many sit in the department for days because there are “no psychiatric beds available in the state of Connecticut.” Chicago’s Roseland Community Hospital threatened to stop taking new patients unless Illinois paid it more than $6 million in back debts. On Wednesday, the hospital recanted and stated that Illinois did not owe it any money – and got $350,000 in funding. Black Disciples gang members protested the possible closing of the hospital, stating that they deserve to be saved and that closing the hospital would amount to “genocide.” Closures of other area hospitals increased the ED volume at Roseland by 40%. Many of those patients were uninsured. I predicted this scenario years ago. When hospitals close, uninsured patients don’t stop getting sick. They find care at other open hospitals. Oh, and don’t forget … the UnAffordable Insurance Act increases the amount of insurance coverage to young healthy adults. The Rand Corporation also commented on the study, stating that “private insurance was acting as it should.” That is until workers are fired or their hours are cut so employers no longer have to pay for coverage to them or their families beginning on January 1, 2014. Don’t worry, though. Our elected representatives ...

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Healthcare Update — 05-15-2013

Also see more Healthcare Updates on my other blog at EP Monthly.com Pain pills make you impotent. Well, the study doesn’t quite say that but the headline sure catches your attention, doesn’t it? The study did note a 45% increased likelihood of using testosterone replacement or medications for erectile dysfunction when patients were taking long-term opioids. You think YOU’ve got it bad? In Pakistan, four children share the same ICU bed and machines such as MRIs have been out of order for more than 3 years – forcing patients to go to private hospitals and pay out of pocket to have the tests done. The Medical Marijuana Associates would have a conniption just thinking about this happening in the US, but the government that provides everything to you has the power to take everything away from you. Don’t worry. Nothing like this would ever happen in this country. On the other hand, according to the article, the tests cost about 20,000 Rupees – about $200 US Dollars – which is a fraction of the cost for the same tests in the US. Another bamblance stolen – this time the driver was still inside. Tennessee’s John Shanks jumped in the driver’s seat of an ambulance in Erlanger Hospital’s parking lot and drove away while the driver was in the back of the ambulance cleaning it. Driver tried to subdue thief who when jumped out of the ambulance and ran away in a serpentine pattern. He was later caught and charged with multiple crimes. Patients gone wild episode of the week. Intoxicated male “causing trouble” in Newfoundland ED. Police called to scene and patient now faces charges of causing a disturbance and assaulting a police officer. Remember the story about the brawl in the Georgia ED waiting room a few weeks ago? Now police have released pictures from surveillance video that shows the alleged perps and are looking for information identifying them. Identified so far include Quantavious Cortez Thomas, Altravious Antwan Thomas, Montravious Monque Gibson, and Cedrick Octavious Marshall. Tragic story. Twelve year old girl dies after taking grandmother’s used Fentanyl patch out of the garbage and putting it on her leg – possibly to help with a stomach ache. Richard Epstein eloquently explains how the Affordable Care Act is unraveling before our eyes. Insurance isn’t worth much if no one can afford it. How much will individual health insurance premiums increase under Obamacare? Estimates from 17 of the country’s largest health insurance providers expect 100-400% increases. In other words, 90% of individuals will be dropping their health insurance policies. Businesses will see a 50-100% increase in their premiums. Instead of calling it the UnAffordable Care Act, maybe I’ll start calling it the UnAffordable Insurance Act. Indiana man goes to hospital and shoots himself in hospital emergency department after shooting his former boyfriend at boyfriend’s place of employment. More “unnecessary” spending in medicine. Urologists at Henry Ford Hospital allege that emergency department treatment for UTIs alone cost $4 billion per year in “unnecessary” health care costs. I need to start publishing retrospective studies about wasteful procedures in other specialties. Irish emergency department so crowded and busy that it has to pull an ambulance up to the front door to act as an extra resuscitation room for a patient. To be fair, there were five patients all needing resuscitation at the same time. I actually think that the doctors were pretty resourceful in coming up with the idea. South Carolina parents sue hospital for performing corrective surgery on young child with ambiguous genitalia, stating that the doctors picked the wrong sex. Doctors created ...

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Healthcare insurance but no healthcare access

California doesn’t have enough doctors to provide healthcare to newly “insured” patients under the UnAffordable Care Act. California state senator Ed Hernandez asks “”What good is it if they [state citizens] are going to have a health insurance card but no access to doctors?” Wait. Health care insurance doesn’t mean that patients will have access to health care? Where have I heard that being said for more than 3 years? The government is going to give patients their medical “insurance,” but access to physicians is limited by government policies, payment cuts, and administrative red tape — which are driving many doctors from the primary care business and are, in effect, rationing care to patients. California’s grand plan is to allow physician assistants, nurse practitioners, optometrists, and pharmacists to provide primary care services. I liked one of the commenters who said that he went to see the doctor, but was referred to the janitor who gave him a bag of medications for $5. These other health professionals and their organizations seem to naively think that the patients they will treat only require management of simple medical problems. In reality, most patients have multiple interrelated chronic medical problems that must be managed together. Take diabetes, for example. Will it really be cost effective to have an optometrist manage a patient’s diabetes and perhaps monitor the patient’s diabetic retinopathy while the patient still has to be assessed and monitored for diabetic nephropathy, diabetic wounds and wound care, diabetic neuropathy, the increased risk of heart disease, oh and the impotence that often accompanies diabetes? Should the optometrist prescribe Viagra for a diabetic patient with heart disease or not? If the optometrist refers the patient to a bunch of physicians to make those decisions, then the government has just created an additional layer of bureaucracy which will cost more money. If the optometrist just blissfully monitors the patient’s glucose levels, prescribes insulin and doesn’t regularly evaluate the patient for diabetic complications, then the patients are receiving government-sanctioned poor medical care. That should make the trial lawyers happy … if the optometrists have insurance for the millions of dollars in damages when bad outcomes occur. These health care providers are begging to get in over their heads and we need to let them do so. The medical establishment should really stop fighting this idea. Allowing governments to implement a system that reduces access to doctors, increases complexity in medical care, and that will likely increase bad outcomes will eventually create patient outrage with government officials who adopt the idea. We all should be part of a team, but not everyone is able to play quarterback. I predict that these types of policies, if implemented, will ultimately increase the demand for physicians. Unfortunately, the underlying problem is that most of us will be expected to pay more in “taxes”, insurance premiums, and other fees … for less medical care. But remember that everyone will be insured, so things will be OK. In anticipation of hate mail from nurse practitioners, physician assistants, optometrists, pharmacists, and possibly even Lucy VanPelt expressing outrage at my unprofessional stance because there aren’t any studies showing worse outcomes in medical care provided by those with less medical training, I’ll quote a comment that I posted on KevinMD’s site a couple of months ago in response to a nurse practitioner who asserted that he had “the same ability to provide patient care [as physicians] based on the evidence.” You’re right about all the studies, I’m sure. In fact, I bet there aren’t any studies showing that treatment rendered by grade schoolers is any worse than ...

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CMS Offering Us Some Rope

Our beloved government is now seeking comments on how it can deny payments to hospitals through patient assessment of the emergency department experience. According to this entry in the Federal Register, the “Consumer Assessment of Healthcare Providers and Systems” (“CAHPS” for short) doesn’t address patients’ experiences with emergency department services. So the Centers for Medicare and Medicaid Services (“CMS”) is seeking “a rigorous, well-designed emergency department survey will allow us to understand patients’ perspectives on their experiences in emergency departments and how such experiences change over time” … and that will allow them to deny or reduce payments to emergency departments that don’t comply with its arbitrary and irrational standards. In other words, CMS is saying “Here’s a bunch of rope. See if you can form a knot that will form a big loop at one end and that will support the weight of an average human.” And I’m going to snap if I hear one more person say that “we need a seat at the table or the decisions will be made for us.” Newsflash: We’re not invited to be “at” the table, we’re what’s on the menu. They aren’t doing this to make medical care “better.” They’re doing this to find a way to justify cutting payments further. You want to see your emergency medical care funding dry up because you had to wait too long or because you didn’t get your Dilaudid shot soon enough, that’s your business. As more and more hospitals close because the government pays them less due to your bad scores, you are essentially rationing your own care. I’ve had people argue that emergency departments need to be evaluated and regulated. Stop for a minute and think about why you go to the emergency department. Do you go there just to be seen quickly? Do you go there just to get pain medication? Do you go there just so that people will respect your privacy? Do you go there so that people will listen to your complaints? If that’s all you’re rating, the medical system will adapt to meet solely those expectations. Look at how businesses are adapting to cope with the Affordable Care Act’s new requirements. If ratings are based solely on non-quality measures, you’ll get someone that sees you right away, gives you a pain shot quickly, makes sure that your gown covers you, holds your hand for a minute, maybe gives you a prescription for an antibiotic or two, and discharges you to some other doctor to find out what’s causing your problem. And you’ll pay more money for it because the hospital will need to make up its losses on those who pay for their care. Therein lies the problem. If surveys de-emphasize quality care, then hospitals will de-emphasize quality care. Think I’m wrong? Watch what happens when government pays hospitals based on capitation.  Remember the old HMO days? They’ll return with a vengeance. With decreasing reimbursements, there won’t be any way not to decrease the quality of care. Remember the engineer’s triangle? When the government comes up with a “Consumer Assessment of Government Providers and Systems” that allows us to pay taxes based upon how satisfied we are with our government providers, I’ll listen. Can anyone come up with any reasons why such a rating system will never happen? Now apply those same reasons to the hospital and emergency department rating system proposed by CMS. More patients, fewer hospitals, government mandated “insurance” that pays less than the cost of care, and more ways to cut payments to providers. What could go wrong? Boy am I glad I’m a doctor.

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Death Panels and Access to Care

I read an article in the New York Times that underscores my argument that health care insurance does not and never will equal health care access. Our federal and state governments are being crushed by debt. There are many reasons for that debt, and addressing the reasons for the debt are a necessary aspect of decreasing the debt. For example, if a family household had overdrawn its checking account by several thousand dollars and their credit cards were maxed out, most people would consider it foolish for the family to purchase expensive cars, to donate large sums of money to charity, to go out to eat at expensive restaurants, or to continue purchasing large amounts of weapons to stockpile in its basement. When in debt, there are two options – earn more money or reduce spending. Using the example of the family in debt, perhaps they sell their assets and move into a smaller house. Perhaps they eat macaroni and cheese for dinner. You get the picture. But if we assume that the family has cut all of its non-essential spending (and many would argue that this part of the analogy fails when applied to state and federal governments), yet is still in debt, then how can the family further reign in costs? That is the problem with which most governmental entities are now faced. Arizona has taken a drastic step to reduce costs. It is now refusing to pay for expensive medical care to some Medicaid patients in need of organ transplants. According to the article, the decision amounts to “Death by budget cut.” Patients such as a father of six (pictured at the right), a plumber, and a basketball coach all need various types of transplants, but are no longer eligible to receive them. The state estimates it will save $4.5 million per year by not providing these services to roughly 100 Arizona citizens. The state also warns that “there will have to be more difficult cuts looking forward.” Read that as Arizona being poised to cut funding for other types of expensive care. Going back to the analogy about the family – is it morally appropriate to just let family members die because you don’t want to pay for the cost of caring for them? This fairy tale about providing “insurance for all” is the biggest problem with the health care overhaul. We can strive to provide “insurance” for everyone, but “insurance” is only as good as what it insures you for. If you are on Medicare and need expensive care or if you live in Arizona and need a transplant, you still have insurance, but that insurance just doesn’t pay for your medical care. Even though patients pay into the system all of their lives, they get nothing out of it when they actually need the care. Ponzi medicine? If governments were serious about providing medical care for patients, they would create a system similar to the VA Hospital system that is available to every citizen in this country. You walk in the door, you get medical care. Perhaps the care wouldn’t be as good or as fast as care available at private facilities, but care would at least be available. As the implementation of health care reform takes place, it begins to appear that our new health care system may provide the most benefits to the people that use it the least. Don’t get sick and you’ll be just fine.

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