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Tag Archives: Insurance

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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Is Obamacare Wonderful for America?

By DefendUSA … On Monday, July 15th, I had a “Holy Hell, Batman!! Sham-WOW! Ka-BOOM!!” moment when I read Harry Reid’s statement that “Obamacare has been wonderful for America.” Surely he isn’t claiming that all those CBO reports are fraudulent, is he? I actually took the time to read through Obamacare. HR 3200 took me three days to read and that included me skipping some stuff. HR 3200 then became HR 3590. So as I reviewed the law to see whether Obamacare is as wonderful for America as Harry Reid thinks it is, I looked at sections from HR 3590 and at parts of the reconciliation bill as displayed by the Rules Committee. By the way, this is the bill that Nancy Pelosi said we had to pass in order to “find out what is in it.” Here are some of the highlights that drive me crazy. Let’s say you are young and healthy and don’t want health insurance. Maybe you are starting up a small business and need to minimize expenses. One way to cut costs is obviously to drop health insurance coverage. If you’re healthy, chances are that you won’t need it anyway. Section 1501 of Obamacare says that you have to pay $750 annually for that “privilege.” I run a small business and I have already been priced out of the market. My family’s health care premiums increased more than 100% since Obamacare passed. From June of 2006 to September 2010, I paid $484/month for 6 family members. Then, our premiums increased to $636 and then to $897. I dropped coverage after the initial increase because I couldn’t afford to rob from my mortgage to keep our health insurance. Money has been tight and keeps getting tighter. That extra $400 could represent a second mortgage payment for some! On the other side of the income spectrum, suppose that you are a high earner. Section 9014 imposes an additional 0.5% payroll tax on any income over $250,000 for those filing a joint return and on any income over $200,000 for those filing an individual return. That amount will rise to a 3.8% tax if reconciliation passes and will also apply to investment income, estates, and trusts. (Section 1402). You are young and healthy and want to pay for insurance that reflects that status? Not quite that easy. Your premiums are also going to subsidize the guy who smokes three packs a day, drinks a gallon of whiskey a week and eats chicken fat off the floor. Section 2701 of Obamacare prohibits insurance companies from underwriting on the basis of a person’s health status. Auto insurers provide policyholders with rates based on their performance, and “good driver” rates have had at least some effect in modifying the behavior of drivers.  Under our new health care system, one can get a kidney transplant due to disease, become an alcoholic, get free dialysis and “medical holidays” and still be eligible for another transplant with insurance coverage to spare! Perhaps you are an employer and you would like to offer coverage to your employees and their minor children. No can do. Section 2714 of Obamacare requires that you purchase a policy covering ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative services and devices; laboratory services; preventive/wellness services; chronic disease management; pediatric oral and vision care for employees and all dependents age 26 and younger. Yes, you even have to provide coverage to the 25 and a half year old able-bodied son living in the basement and ...

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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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A Free Meal

“What’s their problem?” The nurse was both upset and frustrated. The patient was a 16 year old young man. He had a fever for a few days and was vomiting … like half the other patients in the emergency department this week. Unfortunately, his mother was a hospital lab tech, so she knew a little bit about a lot of things. Her requests started about 20 minutes after they were placed in a room. “Can’t you just line and lab him before the doctor sees him?” He didn’t look that bad. Membranes moist. Vital signs were acceptable except that his heart rate was in the 140 range. OK. Fine. Here’s some IV fluid and we’ll do a couple of labs. The nurse missed the first IV. The mom refused to let her try a second stick. “Nope. You get one chance only. Call someone with more experience.” So they had to call the IV team. Which took more than an hour to arrive because they were so busy. In that time, the mom requested two pillows, blankets, grape Gatorade, and some IV Zofran. When the IV team showed up, the mom wanted the patient to have D5 .45NS instead of normal saline. After all, he hadn’t eaten in a few days and could use the extra sugar. Then the patient’s father arrived. He was reportedly a physician from another country who hadn’t been licensed in the US yet. Why hadn’t we tested the patient for sinusitis? At least we needed an x-ray of the sinuses. After trying to reason with the doctor that sinus xrays are a poor method of determining sinus inflammation, that the patient had no symptoms or sinus infection, and that the treatment wouldn’t change anyway, we just ordered the x-rays. Press Ganey scores, you know. Oh, and in case you were wondering, the x-rays were normal. All the labs were also normal … except a WBC count of 14. Great. Doctor says “obviously that means he has a bacterial infection, what are you going to do to work it up?” So we went further down the rabbit hole. More fluids. Add urinalysis and a chest x-ray. “How do you know he’s not septic?” The fact that he’s sitting there smiling and texting people on his iPhone 5 was probably a pretty good indicator. I wonder if they’ve ever done a study about iPhone use in the emergency department and severity of illness. “He doesn’t really appear septic to me.” “But what about his elevated pulse and his fever?” Flashbacks of a certain New York Times article and wayward journalist came to mind. OK, we’ll add blood cultures and a lactic acid. The nurse mentioned that it almost seemed like they wanted the patient to have all this testing done. I agreed. The rest of the tests came back normal. Finally the patient’s pulse was in the 110 range. I broached the subject of discharge. “Did you do a flu test?” “He doesn’t have symptoms of the flu. And even if he did, he is outside the treatment window, anyway. Recall that his symptoms started a few days ago.” “Maybe you could prescribe him Tamiflu just in case.” “I’m sorry, but Tamiflu isn’t indicated for your son, the medication is expensive, and it has side effects.” “Oh, and can you at give him some Claritin D before he leaves?” “No. We don’t have Claritin D in the emergency department.” “So can you at least give us a prescription for Motrin and Tylenol?” “A prescription? You can pick that up at the dollar store over the counter, you ...

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The Individual Mandate For Dummies

This cartoon was sent to me in an e-mail. Overly simplistic, but illustrates the issue. Credit here.

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