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Tag Archives: Insurance

Effects of Saving Money

In 2008, St. Johns Hospital and Mary Immaculate Hospital in Queens had a total of 119,883 outpatient department visits. In February 2009, the two hospitals went bankrupt and closed. In June 2009, the New York City Office of Policy Management published a paper showing that once St. Johns and Mary Immaculate Hospitals closed their doors, the patients that previously went to those hospitals didn’t just vanish. Instead, the patients flocked to other nearby hospitals which were already operating at capacity. Guess what happened? Those nearby hospitals – such as Jamaica Hospital in Queens, are now “overwhelmed.” According to the report, Jamaica Hospital’s daily census went up 50% — from 350 visits per day to “well over” 500 visits per day. On May 27, 2009, Jamaica Hospital had 663 visits – more than double its usual number. Other area hospitals such as Elmhurst Hospital, Queens Hospital Center and New York Hospital Queens noted increases of at least “an extra 100 patients a day.” The number of patients being boarded in the Emergency Department of nearby hospitals also “soared.” Jamaica Hospital, Queens Hospital Center, and Long Island Jewish Hospital all noted dramatic increases in the numbers of patients being boarded in their EDs. One emergency physician with twenty years of experience was quoted as saying “the state of emergency medicine in the borough of Queens is the worst I’ve seen it in my career.” At the heart of the hospital closures was funding. New York City was subsidizing St. Johns Hospital and Mary Immaculate Hospital to the tune of $61 million over the years leading up to the hospital closures. The City was unable to sustain that commitment. Without the city’s support, the hospitals went bankrupt. Availability of ambulance services is also now in question. When St. Johns and Mary Immaculate hospitals closed, the ambulance services operated by the hospitals also ceased operations. None of the remaining hospitals was interested in providing ambulance services to the area served by Mary Immaculate Hospital, so ambulance service in that area was temporarily taken over by New York City Fire Department EMS. NY City is cutting the budget for the EMS service by $3 million which will result less ambulance availability. One mother noted that it took 25 minutes for an ambulance to reach her home after her son had a seizure. A $60 million Medicaid reimbursement reduction anticipated in the near future will likely result in even less care being available. Whatever health care reform package that is chosen will necessarily involve an attempt to cut this nation’s health care costs. This country simply can’t sustain its current level of health care spending. But we need to be very judicious in where spending cuts are made. Many hospitals are not “rolling in the dough.” Cut funding for health care too much and we risk further hospital closures. The decrease in the quality and availability of care in Queens, NY is just one example of the impact hospital closures can have on the medical care in a community. Remember this point in the health care debate: We can talk all we want about providing health care insurance to everyone in this country. Health care insurance means nothing if there is no one available to provide the care for you.

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My Interview With Mass

Mass left some questions in the comment section that I thought were insightful and added to the discussion about health care policy. So I’m treating them like an interview. 1) I’d like to know how Dr Whitecoat is an “Independent Voice for Emergency Physicians”? Does that mean that all or most independent ER docs are conservatives or Republicans or anti-HR 3200? It would seem so as there are plenty of references in his blog to the loaded phrase “socialized medicine” as well as (at times indirect) links to groups like CAHI (the health insurance lobby) or the NCPPR (a conservative lobby) or to other conservative blogs. Either admit you’re a proud conservative or give some left-leaning blogs and groups some links. First, I’m not, nor have I ever asserted, the “Independent Voice for Emergency Physicians”. That phrase refers to the magazine Emergency Physicians’ Monthly, and you won’t find a better forum in emergency medicine for emergency physicians to express their views. You could even submit an article and have it published if it was germane to the practice of emergency medicine. Dis me, but don’t dis the mag. I actually had to go look up conservative versus liberal qualities on a web site before I could respond to your challenge. I’d have to agree that if I had to choose between personal responsibility and government intervention, I’d pick the former. However, the news is replete with stories about how people and businesses, when left to their own dealings with the public, take advantage of others. Government intervention is necessary to establish and enforce rules by which everyone must abide. 2) How would WC doc define “socialized medicine”? Are patients in the VA system, or those who have Medicare or Medicaid part of such a system? Does it matter that Medicare patients have higher satisfaction than other insured patients? I would submit that if WhiteCoat Doc would term universal healthcare as “socialized medicine,” then I can call the present system, “Darwinian every-man-for-himself medicine.” Unwieldy, but accurate. Socialized medicine = publicly funded health care. Period. I don’t think that anyone can draw a line between “socialized” medicine and “single payer” medicine (in which government pays, but does not participate in delivery of care). The “golden rule” always applies – he who has the gold makes the rules. Look at the Medicare system now. The government pays for care, but conditions payment on a plethora of byzantine rules. Fail to follow the rules – even if you provide the care – and you don’t get paid. Technically, even though the government is not “providing” the care, it is orchestrating the care – sometimes on an “ubermicromanagment” level. Many people are content with Medicare because they get what they want at no current cost to them. Don’t forget that most people receiving Medicare have paid into the system through payroll deduction for all of their lives. I think that people in stories like this or this or this would disagree with your general assertion that Medicare patients have “higher satisfaction than other insured patients”. Being “insured” by Medicare doesn’t mean much if no providers accept it. Our Medicaid crisis right now is what Medicare will look like 10 years from now unless the system changes. 3) Is this blog written from the perspective of a professional concerned about his income, independence, status, the overall health of his patients, or some mix of these? While I too am a physician, I don’t believe that physicians’ and patients’ interests always go hand-in-hand. There is no shame in defending our incomes and status – let’s just not ...

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My View

I started blogging because I enjoy telling stories. Always have, always will. I think that many people read what I write because they like reading stories. A recent comment by Max Kennerly, an attorney that frequently comments on this blog, made me sit back and think quite a bit. I don’t always agree with Max or with Matt, the other attorney whose comments drive me nuts sometimes, but I do respect their opinions. Another goal of this blog is to create an atmosphere of debate and debate runs deep on some posts. That’s a good thing. Max wrote: I still don’t understand your EMTALA obsession; the Chicago example makes quite clear an ER can cheaply and quickly comply, and still engage in profitable patient dumping. EMTALA isn’t a big deal from the policy perspective, you just find it personally annoying. Frankly, the ease with which you (and other physicians) conflate issues makes it very hard to take any of you seriously. Do you want to be treated like a private industry or like a public utility? In the same breath you complain that the state is not providing funding and that the state imposes too many limitations on you. Who you think you are, Wall Street? Normally, we do not give an industry state funding without substantial controls on it, including controls to ensure widespread availability of the industry’s services. But you apparently want the former but not the latter. Well, so do I. I want taxpayer money to go about my private business. Ain’t gonna happen. I, personally, favor the public utility route, and would be happy to pay the extra taxes to fund it. Where do you fall? After reading Max’s comment, I read back through my most recent posts on this blog (some imported to this blog – see Archives at right). Then I read back through the earlier posts on my old blog. Max is right. My mindset has definitely changed. Then I thought about why my focus has changed. I’m worried about health care in this country. I’m not worried for myself, but I am worried for so many hardworking people  who are denied health care or who have no access to health care. Policies like “never events,” agencies like JCAHO, misguided and medically unsubstantiated sites like “HospitalCompare,” and laws like EMTALA all start out with noble intent (I presume), but they all end up causing ripple effects that degrade the practice of medicine. So in answer to Max’s comment, my “EMTALA obsession” wasn’t intended to be focused on EMTALA. Rather, my focus is on the ability of every American citizen to access healthcare. I have several Google news feeds that arrive in my e-mail each day. One of them is for the term “emergency room.” I know. I know. I cringe when I type it, but people haven’t caught up with the times. “Emergency department” hardly gets any news … yet. Every day I read posts about how hospitals are closing or losing money because of unfunded medical care. At the heart of unfunded care is EMTALA. So many of my posts reference EMTALA because EMTALA is abused to the point that medical care in this country is doled out arbitrarily. Patients that need urgent care are often neglected or do not seek timely care because they cannot afford it while patients who want “free” pregnancy tests or narcotic prescriptions pillage the system. I have repeatedly said that a free market approach to medicine is the only way to save the system. Patients must have some “skin in the game.” Unfortunately there will never ...

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I'm Not Paying For It …

Gramma WhiteCoat is getting foot surgery this week. She’s in her Golden Years, so her care is paid for courtesy of the Medicare National Bank. I spoke to her last week and she stated that she was examined by 4 different doctors, 2 nurse practitioners and 3 nurses for preoperative procedures. Her primary care physician (not one of the 4 doctors providing a preoperative exam) saw her about a month prior to her surgery, cleared her for surgery, and ordered preoperative labs. Because the labs were more than 3 weeks old, the surgeon wouldn’t accept the normal results and ordered a second set of preoperative labs. Grandma WhiteCoat’s response: “I know they’re doing all these exams and blood tests to pad the bill. But I don’t care — I’m not paying for it.” From the mouth of my own mother. Just another example of why any system in which the consumer has no stake in cost containment is doomed to fail. FREE = MORE Patients must have some skin in the game in order for any medical system to work.

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Tightening The Thumbscrews

Another thought-provoking article was just published in EP Monthly about how Medicare is cutting more payments to physicians. It will be interesting to see the unintended effects of Medicare’s decision. Medicine is unique in that you can’t just leave one job on Friday and start another job at another hospital on Monday. Before you can get privileges to work in a hospital, you have to fill out a staff application, have all your references checked, go through committees, have the committees sign off on your application. Then you get your privileges. You also have to apply for all the new billing numbers, get insurance companies to change to your new location, yada yada yada. All of this takes time. Sometimes a lot of time. In emergency medicine, you used to be able to begin working at a new hospital a soon as you got your staff privileges – even if your billing paperwork had not been approved. You’d see patients, then hold your charges until you get your insurance approvals, then bill the insurance companies for all of the work you performed. Medicare is now changing the rules. According to the new Medicare Retroactive Billing Policy, Medicare will no longer pay for retroactive charges. This policy doesn’t even make sense. Provider payments are held up until Medicare gets around to approving the providers’ applications. Think this policy is going to make Medicare work faster at processing applications?

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More On Comparing Health Care Systems

I’m trying not to make this blog like a broken record, but I have several “Google Alerts” for medical-related articles and I keep receiving abstracts describing the difficulties other countries are having with their health care systems. I know that I keep using Canadian health care as an example of what could happen if a socialized system is implemented in the US, but Canada isn’t the only country having difficulty keeping its health care system sustainable. This in-depth article from the McKinsey Quarterly (free registration required to read the entire article – definitely worth doing so) [hat tip to Head. S p a c e] notes that Japan’s health care system “has come under severe stress” and that its “sustainability is in question.” Demand for health care in Japan is increasing and Japan is having difficulty allocating available medical resources. As a result, patients are finding it more difficult to “get the care they need, when and where they need it.” Japan’s emergency rooms turn away tens of thousands of people every year who need care – something which is beginning to happen in this country. There is also an “ER [cringe] crisis” in Japan – because too few specialists are available for ED consultation. Hospital reimbursements are low. There is no incentive to modernize treatments. Many poorly thought out cost-control measures Japan implemented have actually cost the system more money. Hmmmm. Where have I heard of that happening before? When we switch to socialized medicine, we must be very careful not to replicate formulas for a failing system. Giving people unlimited access to free care seems to be a common denominator in more than one floundering national health care plan. OK … as long as I mentioned Canada, I’ll throw in the latest article. This article in the Calgary Herald describes how median wait times for available hospital beds are now 16.6 hours. In other words, half of Calgary patients wait more than 16 hours to get a bed. There is a shortage of nursing homes, sick elderly patients get sent to hospitals, and there are little if any “funded” beds available. One story described an elderly patient who was experiencing a stroke and had to wait 24 hours to see a physician – by that time, the damage would have been long irreversible. As with many health care articles, I think you can learn a lot about the underlying issues by reading the comments section. Comments to this article painted a vivid and familiar picture. Many Canadians complained that nonurgent cases contributed to wait times and made statements such as “The emergency room [cringe] is for emergencies.” Other commenters blamed the state of affairs on elected political parties. Sound familiar? One of the ways that the hospital systems are apparently recouping some of the costs of care is by charging patients for parking at their facilities. Several commenters expressed their disgust with “paying for parking.” The comment that made the biggest impression on me was one that claimed the Canadian government is “cutting costs/services, and making it look like it is in the red by underfunding it, only to make a greater case for PRIVATIZATION.” I’m not sure if we should be telling Canadians to be careful what they ask for or if they should be making that statement to us.

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