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Tag Archives: Insurance

Government Declares War on Doctors

I was going to include this article in the rest of the Healthcare Update, but pulled it out and made it a separate post after reading this related article in the Christian Science Monitor – “Justice Department declares war on doctors” Five orthopedists sued for antitrust violations and settle case. Workers compensation in Idaho wasn’t paying enough, so these orthopedists allegedly colluded to refuse to treat any workers compensation patients until the state raised the rates that were being paid. In addition, several of the physicians allegedly threatened to stop seeing Blue Cross Blue Shield patients because Blue Cross payments were insufficient. Orthopedists across Idaho even published articles in the newspapers regarding the Blue Cross dispute. Now, as a result of the settlement, the orthopedists won’t be able do this same thing in the future. Other documents from the antitrust case are contained here. The assistant attorney general stated that “The orthopedists who participated in these group boycotts denied medical care to Idaho workers and caused higher prices for orthopedic services.” No word on when this brainiac is going to file suit against all the state and government hospitals that deny care and cause higher medical prices. Oh. Forgot. States and insurance companies are exempt from antitrust actions, so no one can sue them for colluding to deny care. I think I’ve discovered how patients will be guaranteed care under the new health care proposal. If too many doctors stop seeing Medicare and/or Medicaid patients because the reimbursement is too low, the Justice Department will just step up its antitrust enforcements. Watch what happens to speed and quality of care then …

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Free Market Medicine

If you read this blog regularly, you know that I am an advocate of free market medicine. Force medical providers to advertise their prices like all the other businesses, let insurance cover catastrophic costs instead of everyday costs, and let market forces go to work. In order for the free market concept to work, though, we have to get rid of the third party obfuscation, though. Right now, not many people care about the cost of a product because they aren’t paying for it. Third party “middlemen” are paying for the product. I read a post on Kevin MD’s blog that puts free market principles into play. Take all of those who are suffering from low back pain. You want to know if something might be wrong. Do you need an MRI? That depends. Is the pain acute or chronic? Are you having any “red flag” symptoms? Will you be willing to undergo surgery if something is wrong? You may need to see a primary care physician to see whether an MRI is warranted. That’s another thing I would change with the system, by the way. Do away with the concept of requiring a physician’s order to obtain testing. You want an x-ray? Go to the radiology department, plop down your credit card, and get your x-ray. We can buy pregnancy tests, HIV tests, and glucose testing supplies over the counter, why can’t be buy urinalysis test strips or tests for strep throat? Why do we need a doctor’s order to have blood testing done? Don’t give me the song and dance about the dangers of x-rays, either. We allow tobacco companies sell lung rockets to any patient with a nicotine addiction as long as the packets have a label stating that the surgeon general has determined that cigarette smoking is bad for your health. Everybody is hereby warned that the surgeon general has determined that excess radiation is bad for your health. Done. It would make the practice of medicine a lot easier and a lot less expensive if we didn’t erect so many barriers for patients to get testing done. Sorry about the tangent. Off the soapbox and back on topic. Let’s say you get the prescription for an MRI of your low back. You lost your job and lost your COBRA coverage. You have to pay for everything out of pocket and you know how expensive MRIs can be. Where do you go to have your back MRI done? According to LesliesList.org, you can have your MRI done at Northwestern Memorial Hospital in Chicago for$3800 plus the cost for the radiologist to interpret the films. Or, if you want to have the exact same test done at the Lincoln Imaging Center in Chicago, according to LesliesList.org the test and reading fee together would cost you $325. That’s more than a twelvefold difference in price … in the same city … for the same exam. Now maybe you want the university radiologists to read your scan and you’re willing to pay extra. Or maybe the Lincoln Imaging Center sees that the prices it is charging are too low and increases them to reflect the market pricing. The whole point is that prices will take care of themselves once customers begin voting with their feet and their wallets. Hopefully LesliesList.org will be one of many resources that patients can use to decrease the costs of medical care. Thumbs Up. We need more sites like this.

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Insurance For All

While many legislators praise this vote as an historic event, it is a pyrrhic victory. I went looking for the final text of the health care bill and performed several internet searches. Came up with lots of results. Noted that the number of hits to this blog increased substantially looking for health care bill highlights. During my searches, one result that came up persistently was here. . . . . . . . I don’t think that this is the final version of the bill, but I’m not sure. One thing that I did notice was that since HR3200 was introduced in the House, there have been more than 1000 changes to the bill. More than two thirds of the bill has changed and the word count from the bill has more than doubled. Only 22% of people voting on the site stated that they supported the bill. Is there any wonder why most Americans don’t like the bill? No one can figure out what it contains. I’d venture a guess that most members of Congress don’t know what it contains. There were deals being brokered and changes being made shortly before the bill was passed, and less than an hour after it was passed, it was amended again. I think that the final wording in the bill is here, but I’m not sure. One summary of the contents of the bill (posted at 6:30 PM on the evening of the vote) can be found here. The more commentary I read about the contents of the bill , the more worried I become. No insurance companies can “deny coverage” for people for pre-existing conditions – effective 2014. Why the wait? What happens when, instead of “denying coverage” for people with pre-existing conditions, the insurance companies just hike the insurance premiums for those patients? Then those with pre-existing conditions end up with no coverage because they can’t afford the premiums. It is already happening. When 16 million people are added to Medicaid ranks when the Medicaid system is already imploding due to lack of funding throughout the country, should we consider it a victory that those people now have “insurance” but little access to health care? When patients in Massachusetts received insurance but couldn’t find physicians to take care of them, the amount of emergency department usage increased. You know – that cheap inexpensive care. Illegal immigrants are no longer eligible for Medicaid. Denying illegal immigrants health care insurance won’t keep them from becoming sick. Where will they go for health care? You guessed it – to the emergency department. Now instead of receiving a pittance for providing care, the hospitals will likely receive nothing for providing that care. Who will end up paying for care to the uninsured? What happens when all the projected “savings” aren’t realized in the future and the feds start cutting benefits and cutting payments to providers even more? Your payments into the system won’t go down, but what you get out of it sure will. The only way to make up for the gargantuan health care deficits is for the government to pay out less than it takes in. How does that happen? Either increase taxes or decrease benefits. The bill already cuts Medicare spending by $500 billion and increases taxes on investments. Look for even more taxes and less benefits in the future. Remember: Health care insurance does not equal health care access. Never has. Never will. If you want to see how your representatives voted on the measure, the New York Times has a rundown on each elected official’s vote. Don’t know if ...

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Healthcare for Some

On one hand, times like these try mens’ souls. On the other hand, times like these can show you the goodness in people’s hearts and the desperation that some patients face with medical illness. As the number of rural health clinics has fallen from 500 to 316 in Texas, here’s a story about a small group of docs who do their best to care for patients in rural Texas. They even have a van packed with portable medical supplies that they use to perform house calls on patients too frail to make the trips into town. The story is both somber and heartwarming. Then there is another story about a group called Remote Area Medical that organizes events to provide free medical care to uninsured and underinsured patients. In Tennessee, the lines for free health care begin the night before the doors open. A school serves as the venue. Bleachers are full of patients waiting for care. Patients get evaluated and treated in classrooms. Dental chairs fill the gymnasium floor. Most patients either need to see a dentist or an eye doctor. But as the dentists evaluate patients, they note that some have medical problems that must be addressed first. One has a blood pressure of 200/120. Insurance doesn’t do much for patients who cannot afford – or who are unwilling to purchase – medications. Many patients who are “unable” to afford basic prescriptions for as little as $4 a month have packs of cigarettes sticking out of their shirt pockets. In two days, the volunteer staff evaluated 701 patients, extracted 852 teeth, performed 345 eye exams, and provided 87 medical exams. The total cost of the “free” care provided in two days amounted to $138,370. Think things will change with the current health care bill? Think again. Dental and vision care are not covered for adults under the current House or Senate bills. As the article states, “to fix health care inequities, expanding insurance alone may not be enough.” “May” not be enough? Try “will” not be enough. “Insurance” doesn’t equal access and it doesn’t equal health care. Never has. Never will.

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Legal Malpractice Insurance in Texas? GASP!

Texas attorneys are up in arms because the Texas Supreme Court is again considering whether or not to require Texas attorneys to disclose their malpractice insurance status to their clients. The measure apparently was previously vetoed by a state Supreme Court task force. The Texas Bar Blog is soliciting comments from attorneys. So far, there are nearly 100 comments such as … I think it is a bad idea. All attorneys have clients who are never satisfied even when they have reached a good settlement to their case. Mentioning liability insurance to this sort of client will only encourage malpractice suits for them to see what else they can get. and I think it is a bad idea. Clients could simply inquire about it if necessary. Clients come to us for litigious reasons in the first place, to make this disclosure offers them another avenue of recourse – against the attorney. In other words, we would just be planting a seed in their minds. Plus, smaller offices may not have the insurance for financial reasons and to force the disclosure carries a sense of not being a good lawyer. and Malpractice insurance breeds claims. and Being forced to let the clients know that we have a deep pocket if they want to get some money “without hurting anyone but the insurance company” will also make grievances in support of the malpractice case more prevalent. and Let me get this straight. We cannot tell a jury that a defendant has insurance because the assumption is that they will award a run-away verdict, knowing that the insurance company will have to pay the judgment. Why do lawyers not deserve the same privilege against said disclosure? Have any of the Supreme Court justices ever paid a malpractice premium for themselves, or was it paid by some firm administrator in their ivory tower? I could go on cutting and pasting, but I’m getting all choked up. [Sniff] Of course, if we changed the operative subject in the article from “attorney” to “doctor”, you know they’d all be whistling a different tune about what a good idea it is for patients to have recourse against all the incompetent medical practitioners in Texas. Hat Tip to Examiner.com

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Here is the Problem

ERP here again while WC recovers from the revelling in Boston Personally, I agree with medicare and insurance regulations that require that someone receive some REAL benefit in order to be covered for an admission to the hospital. Even the “social dispo” admits usually serve a purpose – preventing elderly or the otherwise helpless or nearly helpless from injuring themselves or insuring they get proper medical treatment like antibiotics or seizure medications. However, if you can be safely discharged from a medical AND social point of view (ie no admit-able diagnosis exists AND you can either care for yourself or someone is there to care of you (like in a nursing home), you should have to pay out of pocket if you (or your relative) demand you be admitted. You can’t just come in for “tests” or to see a “specialist” or to “recuperate”. I am sorry, if you are demanding and non-indicated admission, prepare to ante up. The other day I had several situations where elderly, demented, bedridden, and or chronically ill elderly people from nursing homes were admitted solely because the entitled relatives refused to allow them to be transported back to the home. They had no acute diagnoses requiring admission but their relatives had such a fit that the PMD’s acquiesced and admitted them. Now, the hospital has to try to recoup payment from medicare. This is an epic waste of resources and public health care dollars. Here is what I did. I documented that the patients had NO indication for admission and recommended the patient (ie family) be charged fully for the admission, thus destroying the hospital’s ability to bill medicare. My hope is that the hospital not even try for medicare reimbursement and instead submit their entire bill to the entitled family, and if they refuse to pay, send them to collections. Hopefully they will learn that there is no free medicare lunch. Who knows, maybe the hospital will reprimand me. Regardless, I had to do it.

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