Ramblings of an Emergency Physician in Texas

Archive for the 'Medicine' Category


Asymmetrical Information: a different idea for health insurance

Posted by GruntDoc on 5th July 2008

Health care

04 Jul 2008 04:02 pm

Kemp shocks me by pushing a project near and dear to my heart–switching America’s government provided insurance to catastrophic income insurance, rather than the current screwed up system. My proposal is that the government should pick up the tab after you’ve expended 15% of your annual income.

Now, that’s an interesting idea, and it combines a couple of things I’ve advocated before: insurance as being against catastrophe (rather than paying for routine care) and a requirement people spend some of their own money on their own health.

I wonder what that looks like, budgetarily?

Sorry that looks funny: I tried publishing from Word 2007.  Sticks in a LOT of extra HTML it doesn’t need to.

Popularity: 2% [?]

Posted in Policy | 5 Comments »

WSJ on Balance Billing

Posted by GruntDoc on 5th July 2008

In the WSJ Health Blog:

Hospital Company Sued for Billing Patients When Insurance Doesn’t Pay

Posted by Jacob Goldstein

Say you wind up in the hospital. The hospital bills your insurance, but the insurance company thinks the price is inflated and only pays part of what’s billed. So the hospital decides that you owe the portion your insurance won’t pay.

This is called “balance billing,” and it’s been debated in health-care circles for decades.

That’s also a very insurance-friendly spin.  What it actually represents is a company refusing to pay for services already rendered, and deciding unilaterally what they’ll pay.  When it’s “Out of network” care, there is no agreement between the service providers and the insurance companies (and, thus, the patients) on what’s paid for at what rate, so just deciding not to pay is a way to use the insured patient as political cover to not pay a bill.  Note this never works to the advantage to those actually providing services (hospitals, doctors) but is designed to leave money in the hands of insurance companies.

The insurance companies don’t want balance billing, and it’s not on noble principle, its because enough unhappy customers would cause regulatory changes that would cost them money (like, pay for services already rendered).

Popularity: 2% [?]

Posted in Policy | 2 Comments »

MedBlogs Grand Rounds, Vol 4, No. 41

Posted by GruntDoc on 1st July 2008

The Covert Rationing Blog » Blog Archive » Medical Grand Rounds, Vol 4, No. 41
Welcome to Medical Grand Rounds, Volume 4, Number 41, July 1, 2008. This week, bloggers from across the Internet have submitted articles that will help us celebrate the 232nd birthday of the United States of America. Their patriotic postings, organized according to their relationship to the Founding, follow:

Another nice job.

Popularity: 6% [?]

Posted in GrandRounds | No Comments »

HPSP now a LOT more lucrative

Posted by GruntDoc on 29th June 2008

That’s a much better deal than I got…

Military sweetens the deal to entice medical students

A beefed-up scholarship program now offers a $20,000 signing bonus as well as full tuition and an increased monthly stipend.

By Myrle Croasdale, AMNews staff. July 7, 2008.amednews.com


Katie Doyle could have borrowed $200,000 to get through medical school. Instead, when she enters Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale, Fla., this fall, she won’t borrow a dime.

Doyle accepted a military scholarship that will pay her tuition, books and other school fees. A monthly stipend will cover living expenses. The scholarship, called the Health Professions Scholarship Program, or HPSP, also comes with a new $20,000 signing bonus.

…, Congress authorized the three branches to bolster their recruitment packages, resulting in the $20,000 bonus, along with a $300 hike in the scholarship’s monthly stipend, which is now $1,900. The money comes from military appropriations earmarked for medical corps recruitment. In 2007, the Air Force recruited 211 medical school students; the Army, 242; and the Navy, which also recruits for the Marines, 181.

That’s got to be a BIG shortfall for the Navy.  My Intern class in San Diego had over 100, and that was only one of two big NAVHOPS’s, with several smaller facilities.  Thus, the enticements.

A reminder: the Navy HPSP Wki

Popularity: 10% [?]

Posted in Current Affairs, Deployed Docs, Policy | 4 Comments »

Texas Senators both choose to screw docs

Posted by GruntDoc on 27th June 2008

Update: I appear to have been drawn in by polemics from a group not prone to them.  See Health Care BS for details.

Both Texas Senators (both Republicans).  I’m reproducing the email I got today from TMA after the break.

Thanks for nothing, Senators.

Read the rest of this entry »

Popularity: 15% [?]

Posted in Policy | 7 Comments »

New Grad Advice 2008

Posted by GruntDoc on 27th June 2008

Shadowfax started a nice thread, and the impressive 10/10 added to it today, a list of advice for new EM grads. Read their advice, but here’s mine:

  1. Lease, don’t buy. Way more than half of new grads change jobs within two years. I know, it’ll never happen to you, but here’s the thing: I was you. I got my ‘dream job’, bought a beautiful home in a perfect neighborhood. I sold and moved in 10 months. It’s a really nice way to lose a lot of money. It can happen to you.
  2. Be humble. True, you’re at the absolute top of your game, you know the best literature on every subject, and can intubate with your off hand in the dark, blindfolded. Your new colleagues have been practicing EM for a very long time, and while they’d be interested in your incremental knowledge of the state-of-the-art, they’re not itching for you to enlighten them. Open your ears, listen, and learn. (Use your filter: there’s a pony in there somewhere). Read the rest of this entry »

    Popularity: 15% [?]

Posted in Emergency | 4 Comments »

Canadian Healthcare Author Writes a new Ending

Posted by GruntDoc on 27th June 2008

Investors Business Daily:

Canadian Health Care We So Envy Lies In Ruins, Its Architect Admits

By DAVID GRATZER | Posted Wednesday, June 25, 2008 4:30 PM PT

As this presidential campaign continues, the candidates’ comments about health care will continue to include stories of their own experiences and anecdotes of people across the country: the uninsured woman in Ohio, the diabetic in Detroit, the overworked doctor in Orlando, to name a few.

But no one will mention Claude Castonguay — perhaps not surprising because this statesman isn’t an American and hasn’t held office in over three decades.

Castonguay’s evolving view of Canadian health care, however, should weigh heavily on how the candidates think about the issue in this country.

Back in the 1960s, Castonguay chaired a Canadian government committee studying health reform and recommended that his home province of Quebec — then the largest and most affluent in the country — adopt government-administered health care, covering all citizens through tax levies.

The government followed his advice, leading to his modern-day moniker: “the father of Quebec medicare.” Even this title seems modest; Castonguay’s work triggered a domino effect across the country, until eventually his ideas were implemented from coast to coast.

Four decades later, as the chairman of a government committee reviewing Quebec health care this year, Castonguay concluded that the system is in “crisis.”

“We thought we could resolve the system’s problems by rationing services or injecting massive amounts of new money into it,” says Castonguay. But now he prescribes a radical overhaul: “We are proposing to give a greater role to the private sector so that people can exercise freedom of choice.”

Castonguay advocates contracting out services to the private sector, going so far as suggesting that public hospitals rent space during off-hours to entrepreneurial doctors. He supports co-pays for patients who want to see physicians. Castonguay, the man who championed public health insurance in Canada, now urges for the legalization of private health insurance.

In America, these ideas may not sound shocking. But in Canada, where the private sector has been shunned for decades, these are extraordinary views, especially coming from Castonguay. It’s as if John Maynard Keynes, resting on his British death bed in 1946, had declared that his faith in government interventionism was misplaced.

What would drive a man like Castonguay to reconsider his long-held beliefs? Try a health care system so overburdened that hundreds of thousands in need of medical attention wait for care, any care; a system where people in towns like Norwalk, Ontario, participate in lotteries to win appointments with the local family doctor.

Years ago, Canadians touted their health care system as the best in the world; today, Canadian health care stands in ruinous shape.

This had to be hard for him, and I respect any man who can see his life’s’ work not working as intended, and trying to change it, though this seems a weak start.

It reminds me of the 80’s Soviet Union farms.  5 year plans and Communist Agriculture consistently resulted in inadequate crops and food shortages.  In desperation farmers were allowed a small plot of land to grow food, the sale of which they got to keep the proceeds from.  Guess what sector of their farm economy was most productive?  This is now proposed for medicine in Canada.

I’m sorry for Canadians, and at the same time unsurprised.  Now, can we learn from others?

Popularity: 14% [?]

Posted in Policy | 6 Comments »

MedBlog Grand Rounds 4:40; ShrinkRap and the iPhone Grand Rounds

Posted by GruntDoc on 25th June 2008

Shrink Rap

Welcome to Grand Rounds, Volume 4, #40 (see future GR schedule). If you missed our first Grand Rounds last year, with our amazing Clicky Brain, then feel free to pause and enjoy.

This year, since the anticipated release of the Apple iPhone 3G is just around the corner (July 11), we asked for submissions to have some connection to the iPhone, no matter how twisted the logic is to make the connection. The medical blogosphere obliged. So we are including, free of charge, our Clicky iPhone, which will let you visually navigate this week’s Grand Rounds submissions (yes, the buttons on the phone really work).

I am in awe. Wow.

Popularity: 14% [?]

Posted in GrandRounds | 1 Comment »

Another thing I find amusing

Posted by GruntDoc on 20th June 2008

CNN has used this graphic before, and though it bugged me, I let it go.  Since I have a blog and nothing to say, I’ll point it out so it’ll bug you, too.

This graphc:
reverse Lead II

The EKG tracing in the photo is backward (meaning it reads incorrectly from left to right, which is the convention).  There’s nothing particularly interesting about it, but it’s backward, and it gets my (unpleasant) attention every time.

So, CNN, I’ll be glad to review your medical graphics, for an entirely reasonable fee. Or get someone else to do it, but please do so.

Popularity: 18% [?]

Posted in Amusements, Medicine, Rants | 10 Comments »

Brand new federal requirement: NPI needs to match IRS data

Posted by GruntDoc on 18th June 2008

Really, it’s like they don’t want docs to use the Government system…

Brand new federal requirement: NPI needs to match IRS data
Brand new federal requirement: NPI needs to match IRS data
Healthcare IT News
By Diana Manos, Senior Editor

06/17/08
WASHINGTON - Just when doctors thought things couldn’t get much worse, experts say, the Centers for Medicare & Medicaid Services has thrown another wrench into the already difficult transition to using National Provider Identifiers.

According to a June 11 CMS announcement, doctors will have to reconcile their NPI data with their IRS legal name data in order to get paid.

I read to there, and thought, ‘well, that’s not entirely unreasonable’.  What an idiot I am.

According to billing experts, this is a disaster waiting to happen. Every aspect of the data must match, including the exact spelling of names, the use of initials and even blank spaces in the data. The slightest discrepancy could send Medicare claims back to the drawing board.

Aah.  So, Medicare issues a NPI, which isn’t checked against the IRS name, then retroactively and apparently without notice announces they’re not going to pay for work already done in good faith, over yet another clerical gotcha, in which they were complicit.  Breathtaking, the hubris.

After a year-long contingency period, the use of NPIs was required by CMS as of May 23. Both before and since that deadline, doctors have had difficulty getting paid due to a host of complications with CMS and clearinghouse systems, experts say.

Cyndee Weston, executive director of the American Medical Billing Association, said the IRS matching requirement “has blindsided the whole industry.”

I might actually join the AMA if they said ‘no more’ to this crap.  Unfortunately, I suspect they’ll hold their hat in their hands, appoint a commission, and say pretty please.

Bait & Switch.  They’d never dare pull this crap on lawyers.

Popularity: 19% [?]

Posted in Policy, Rants | 9 Comments »

Nurses to be Evaluated for Compassion

Posted by GruntDoc on 18th June 2008

…just not individually…

From BBC, which focuses an unflinching eye on the reality of socialized medicine, and the astonishing weirdness within and without (though I should say that the eye sees without seeing…)

BBC NEWS

Nurses to be rated on compassion

Nurses are to be rated according to the levels of care and empathy they give to patients under government plans.

Health Secretary Alan Johnson told the Guardian newspaper that he wants the performance of every nursing team in England to be scored.

He said he believes compassionate care was as crucial to the recovery of patients as the skills of surgeons.

Nurse leaders welcomed the move and said they would work with ministers on developing the system.

But he ruled out rating individual nurses and also said it would not affect pay.

Group compassion? What the heck are they even pretending to measure?

Popularity: 16% [?]

Posted in Nursing, Policy | 4 Comments »

Marianas Eye: Grand Rounds from the South Pacific (4:39)

Posted by GruntDoc on 17th June 2008

Marianas Eye: Grand Rounds from the South Pacific

Welcome to this island edition of Grand Rounds. Yes, I really live and practice on a tropical island in the South Pacific. And yes, you can too. I’ll let you know how, in next week’s edition of Grand Rounds, which will be hosted by My Three Shrinks. But now, on to this week’s edition.

Hmm. Saipan. Sounds very nice.

Popularity: 15% [?]

Posted in GrandRounds | No Comments »

Cancer doctors dodge the death talk - CNN.com

Posted by GruntDoc on 16th June 2008

As I have suspected:

Cancer doctors dodge the death talk - CNN.com
…Only one-third of terminally ill cancer patients in a new, federally funded study said their doctors had discussed end-of-life care.

Surprisingly, patients who had these talks were no more likely to become depressed than those who did not, the study found. They were less likely to spend their final days in hospitals, tethered to machines. They avoided costly, futile care. And their loved ones were more at peace after they died.

I’m often shocked, and saddened, that as an EM doc I’m apparently the first to discuss end of life plans with patients having terminal diagnoses.  (Yes, life is a terminal state, but don’t change the subject).  I do, as it’s what should be done, but it’s often uncomfortable for everyone.

Still, not as uncomfortable as dying in an ICU.

Popularity: 18% [?]

Posted in Emergency, Medicine | 8 Comments »

A New Sign in medicine: the Tim Russert sign

Posted by GruntDoc on 14th June 2008

Mr. Russert has a negative stress test on April 19th and died suddenly of a heart attack on June 13th.

I therefore propose a new sign in medicine, the Tim Russert sign: death (or MI) shortly after a negative stress test.

Popularity: 21% [?]

Posted in Emergency, Family, Medicine | 9 Comments »

NHS Blog Doctor: Grand Rounds (4) 38

Posted by GruntDoc on 9th June 2008

NHS Blog Doctor: Grand Rounds (4) 38

From across the pond.

Popularity: 13% [?]

Posted in GrandRounds | No Comments »

 
Login