Healthcare Update 01-06-2010


Also check out Part 2 of today’s update over on ERP’s site at ER Stories.

Medicare on Rye, Hold the Mayo. The Mayo Clinic is no longer accepting Medicare patients at one of its primary care centers in Arizona as the reimbursements are too low and the system lost more than $800 million treating Medicare patients last year.
According to the article, 92 percent of U.S. family doctors participate in Medicare, but only 73 percent of those are accepting new patients under the program. When Medicare cuts its reimbursement by 21% in a couple of months, look for those figures to drop precipitously.
I know, it’s like a skipping record, but I’m going to say it anyway … it sure is a good thing that all those Medicare patients have insurance, isn’t it? Because according to all the health care reformers, making sure that everyone has insurance is the most important part of reform.
Hat tip to 911Doc at MDOD.

From Dr. Wes … a gerontologist who opted out of Medicare because he couldn’t make ends meet at the rates Medicare was paying.
Medicare’s response? “Medicare was only too happy to have me opt out, because to them, I’m no longer part of their problem.”
This will be the modus operandi of the future, folks. Take money from our paychecks to “pay” for everyone’s medical coverage, then diminish payments until most of the providers leave. End result: we end up paying more and more to receive less and less – or to receive the promise of more medical care that never materializes. Heck, at this rate, Medicare might be turning a profit in 5-10 years.

Europeans express surprise about the speed with which an appendectomy is performed in the US.

See? At least one of us docs isn’t a malevolent quack. An emergency doc pays a patient’s rent so the patient will stay in the hospital.

We’re already closer to national health care than we think. According to a chart posted by Daniel Mitchell at the Cato Institute, American consumers pay for less than 12 percent of their health care costs. I’m not sure that is entirely accurate as a large amount of health care costs are funded by Medicare taxes taken from our paychecks, but the impression that we “aren’t paying for health care” likely explains why few people care about (or even know about) how much health care actually costs and why the system will crumble when 40 million members are added to its ranks.

Family awarded $20 million when woman aspirates stomach contents during surgery and dies.

Family of 3 year old child awarded $15 million when child dies after eighth surgery “in a desperate effort to save his life” from a heart birth defect. Surgeon leaves position as chief of surgery after lawsuit filed. Don’t worry, though. Direct medical malpractice is only a “tiny fraction” of all health care costs. Lawsuits like this are nothing to worry about.

Suing hospitals that “didn’t plan well enough” for Hurricane Katrina. The hospital systems “met or exceeded applicable electrical codes and standards,” but they didn’ t withstand flooding from the hurricane. With 200+ lawsuits now pending, some hospitals are deciding whether to spend money on equipment for the intensive care unit or on upgrading the emergency electrical system so they don’t get sued again.
Some lawyers just need to be castrated with a couple of bricks.
In other news, JCAHO has now deemed hurricanes a threat to patient safety and cited God for causing them. God has 30 days to come up with an action plan or risk being decredentialed as a deity.

Maybe we can sue our way to better health care. Opponents of the health care bill argue that the “individual mandate” in the health care bill is unconstitutional.

Doctors Warn Cold Weather Causes Problems.” Phew. Glad they cleared that one up for me. Still have these nagging questions about loaded guns and intravenous drug abuse, though. Maybe they can do a follow up article.
The article states that “Flu, pneumonia, the common cold, even allergies can flare up, the problem arises when people assume they have these sicknesses and avoid finding underlying problems.” So rush to your doctors for all your snot noses boys and girls. Wouldn’t want to miss some underlying problem like nematode infestations or something.


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  2. “God has 30 days to come up with an action plan or risk being decredentialed as a deity.”

    Good one.

    But, you used used number 30 instead of the word thirty, as the 3 can be confused with an E and there is no decimal point. Clear JCAHO violation, so you better self report and have your action plan ready.

    This is how it is… folks. Really!

  3. “it sure is a good thing that all those Medicare patients have insurance, isn’t it? Because according to all the health care reformers, making sure that everyone has insurance is the most important part of reform.”

    This has baffled me from the beginning. It’s not like we don’t have the experience of the Commonwealth of Massachusetts to demonstrate what’s going to happen on a national scale. On the plus side, as a self-employed individual I’ve been able to buy health insurance despite being middle-aged and having a previous diagnosis of (successfully treated) cancer. On the minus side, my insurance, which cost me over $8K last year, is going up to over $9K next year, with small increases in copays for office visits, large increases in emergency and hospital admissions, and a change from copays to 50% co-insurance on brand-name prescription drugs (a health insurance feature known to bankrupt or kill people prescribed oral meds for cancer treatment).

    I can’t wait to see what happens in 2011.

  4. While it’s great that a doctor’s wife can get an emergency appendectomy that fast, what about all the uninsured who won’t be accepted at hospitals etc? I thought in America there are huge waits in EDs because that’s the only place the uninsured can get any medical care? Doesn’t jive with my understanding of America at any rate. Not sure what it’s like here though TBH, though I’d hope that people being unable to get emergency care would cause a huge uproar in the media. I know there are long waits for non-emergency stuff like hip replacements…

    • CrankyLitProf on

      The doctor’s wife got fast-tracked by virtue of the fact that her condition was…wait for it… emergent. As in, “the type of situation that you’re supposed to to go the ED for,” as opposed to hangnails, toothaches, fibromyalwhatever, runny nose, toe fungus and cranial hemmorhoids.

      Nothing whatsoever to do with her husband’s status, or even her insurance or lack thereof.

      If your condition is non-emergent, you wait. The idea is to discourage those using the ED as primary care and persuade them to go to an urgent care clinic, which is where they OUGHT to go.

      • (I should add that, thanks to EMTALA, there’s no such thing as “uninsured who won’t be accepted at hospitals.” )

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  7. Europeans express surprise about the speed with which an appendectomy is performed in the US…. A co-worker’s father was seen in another ER for severe abdominal pain, triaged low and waited hours. Finally left and came to our ER where they seen…perforated bowel. Bad docs and bad nurses everywhere maybe. Just playing devil’s advocate here.

  8. surprisingly level-headed comments on the globe page about that tet case. would agree with the consensus:
    1) it’s tragic that such a young kid died, whether or not there was actual malpractice committed
    2) there’s not enough info in the article to determine whether or not actual malpractice was committed
    3) all of our bills will now go up to pay for this $15M verdict

    • Also note the chilling effect that many people stated the verdict would have on willingness of these surgeons to operate on similar cases in the future.
      Would a judgment like this make it less likely that any of the surgeons who read this blog would perform risky surgeries?

      • “3) all of our bills will now go up to pay for this $15M verdict”

        Paul, your statement is inaccurate for a number of reasons:

        1. $15 million wasn’t paid. Read the article. They had agreed on a high-low settlement, most likely because the hospital and physicians knew they had screwed up. After all, as the article points out there wasn’t a lot of hard damages in this case with years of ongoing care.
        2. As far as bills going up, if you’re talking about patients bills, that’s unlikely, given how medical care is paid for in this country. One verdict of less than .01% of the total healthcare cost will have literally no effect.
        3. If you’re talking about malpractice bills, you have no clue what will happen since you don’t know who the carrier was, or if there was even a carrier since it seems there might have been some intentional tort allegations here which might not have been covered by insurance. Perhaps you missed this part of the article:

        “The board reopened the investigation last year after learning that the hospital may not have provided complete information about the treatment the doctors gave Jason.”

        4. Even assuming you’re right, if the allegations of “not providing complete information”, ie. lying about what happened, maybe about the piece of metal found in the child’s brain, are true, what would you suggest we do about them? A good scolding? Jail the liars?

        5. As to WC’s comment about a “chilling effect”, given that he knows only what this article says about the case, and has not seen the records or knows anything about the “incomplete information” or the metal left in the child’s brain, it would seem based on the article that the thing that would be chilled would be sloppiness with your instruments and lying about the medical records. Which would seem to be good things to minimize.

  9. I too feel the individual mandate is unconstitutional, but I think the bigger issue is that it doesn’t actually address the fundamental problems with the healthcare industry. It is amazing that going into the 21st century, America still is so backwards compared to most other “western” cultures.

  10. It’s funny to read this quote from WC about the doc who was sued for sexual assault:

    “I don’t know all the facts, so I can’t comment upon the merits of the case or upon the jury’s verdict.”

    and then read his comments about every other malpractice lawsuit. Commenting without the facts, based solely on conjecture and speculation, is normally his stock in trade when it comes to legal matters.

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