Some studies that I like to quote

Wow! Very nice.

Press Ganey, meet Wong-Baker

For those not actively engaged in the practice of medicine, this will mean nothing to you. For those of us in the trenches:

IMG_0847

I cannot wait for the day the government realizes this misguided effort is costing them Billions (and harming patients and providers).

 

IRS: Cheapest Obamacare Plan Will Be $20,000 Per Family | CNS News

“Affordable” Care act.

Under Obamacare, Americans will be required to buy health insurance or pay a penalty to the IRS.

The IRS’s assumption that the cheapest plan for a family will cost $20,000 per year is found in examples the IRS gives to help people understand how to calculate the penalty they will need to pay the government if they do not buy a mandated health plan.

The examples point to families of four and families of five, both of which the IRS expects in its assumptions to pay a minimum of $20,000 per year for a bronze plan.

“The annual national average bronze plan premium for a family of 5 (2 adults, 3 children) is $20,000,” the regulation says.

via IRS: Cheapest Obamacare Plan Will Be $20,000 Per Family | CNS News.

Unbelievable. Enjoy the Sticker Shock.

Feds get specific on ACA individual mandate rules  : ACEP NEWS

After years of legal wrangling and a showdown in front of the Supreme Court, the federal government has finally begun to implement the Affordable Care Act’s controversial individual insurance mandate.

Starting on Jan. 1, 2014, Americans will have a choice: Buy basic health insurance, qualify for an exemption, or pay a penalty when filing federal income taxes, according to proposed regulations issued Jan. 30 by the Treasury Department and the Health and Human Services Department.

via Feds get specific on ACA individual mandate rules  : ACEP NEWS.

Go and read all the exclusions. For an incredibly intrusive and expensive mandate there sure are a lot of people that still won’t have to be covered.

Health Insurance Brokers Prepare Clients For Obamacare Sticker Shock – Forbes

(emphasis added):

By Dr. Scott Gottlieb, M.D.

A California insurance broker, who sells health plans to individuals and small businesses, told me that she’s prepping her clients for a sticker shock. Her local carriers are hinting to her that premiums may triple this fall, when the plans unveil how they’ll billet the full brunt of Obamacare’s new regulations and mandates.

via Health Insurance Brokers Prepare Clients For Obamacare Sticker Shock – Forbes.

You. Don’t. Say.  Thanks, Obamacare!

Don’t open wide: Annual check-ups are pretty much useless

I suspect this underestimates the problem. I think a lot of ‘chasing incidentalomas’ in medicine start here:

Two doctors in Colorado scanned through 14 randomized, controlled studies involving 182,000 patients. The articles spanned from 1963 to 1999. The doctors looked at whether those who had regular check-ups had higher mortality rates than their counterparts who dodged such visits. They could not find a difference.“General health checks do not improve important outcomes and are unlikely to ever do so based on the pooled results of this meta-analysis spanning decades of experience,” write authors Allan Prochazka and Tanner Caverly. ”There remains a belief in the value of general health checks despite the accumulating evidence. This belief is buoyed by screening advocacy groups and insurance coverage, and they have ramifications for patient welfare and health care costs.”

via Don’t open wide: Annual check-ups are pretty much useless.

They point out that Canada actually stopped paying for ‘routine checkups’ in 1979.

(Please understand I’m not including chronic condition maintenance in this category, like CHF or diabetes visits, as once you’ve got a chronic condition that’s where office visits probably really do help).

26 States Decline ObamaCare Exchange; ‘Administrative Nightmare’ Seen – Investors.com

So, this is an inauspicious beginning…

The federal government will likely be involved in running the ObamaCare exchange in at least 30 states, 26 of which expressly declined to establish state exchanges. One health-policy expert refers to it as an “administrative nightmare” for the Department of Health and Human Services.

Friday was the deadline for a state to let HHS know if it planned to establish a state exchange. Thus far only 18 states and the District of Columbia are planning on doing so.

Enrolling them will likely prove a daunting challenge for the federal government.

“HHS expected to be running zero exchanges,” said Michael Cannon, director of health policy studies at the libertarian Cato Institute. “They have been throwing money at states to bribe them to start exchanges. HHS maintains they’ll have these things up and running by October 2013. I don’t know anyone who is confident about that and I’m ready to predict that they will not.”

via 26 States Decline ObamaCare Exchange; ‘Administrative Nightmare’ Seen – Investors.com.

Why aren’t the States playing? They aren’t interested in being a conduit for plans they don’t run, the state gets all the blame for decisions they don’t make. (That, plus general opposition to the whole idea: it’s your plan, you run it…).

All this, by the way, projected to insure 25 million Americans through this plan in the next seven years. None of this controls costs, or spending.

CBS News: (some) ER Docs pressured to admit at a for-profit chain

For the record, nobody’s ever told me I need to admit more (or less).

Hospitals: The cost of admission

December 2, 2012 4:42 PM

Steve Kroft investigates allegations from doctors that the hospital chain they worked for pressured them to admit patients regardless of their medical needs.

 

First thoughts: this HMA company’s about to get an ugly look-at by the feds. I feel bad for the docs (and the admins) that blew the whistle.

Wonder if any of them filed a Qui tam action?

A physician takes his flu vaccine under protest

Good, well written rant-

A physician takes his flu vaccine under protest

by Doug McGuff, MD on November 27th, 2012in Physician

To hospital administration,

I am writing this letter to inform you that when I take my mandated influenza vaccine I will be doing so under protest and with the understanding that failure to do so could result in loss of my ability to earn income for myself and my family. Unfortunately, I do not qualify for any of the exemptions allowed by our facility. Since I am not religious, I have no religious objections, I am not allergic, and I have never had Guillane-Barre as a result of a flu vaccine. My objection to the vaccine is based on rational evidence and moral indignation.

via A physician takes his flu vaccine under protest.

UT-Austin Med School, and why they’re just getting one now

UT Austin is finally going to get a teaching hospital (built by Seton):

The medical school facility, which will include academic and medical research space, will be financed by UT-Austin.According to the university administration’s internal estimates, the cost of the entire endeavor is approximately $4.1 billion over 12 years. Central Health will cover about 10 percent, and Seton is expected to cover nearly half, including the clinical faculty and residency slots for graduate medical education.The rest will largely come from UT-Austin.

Good, I suppose. We’re going to be short doctors soon anyway, and more training slots are welcome. (Insert dichotomy between what society needs and what they’re willing to pay for and its distortion of the residency training market).

And now, Story Time with GruntDoc:

“I think people will look back and say, ‘How did this community work without having a major medical center here?’” Powers said.

via UT-Austin Med School Plans Proceed After Election — Higher education | The Texas Tribune.

A good question, now let me tell you they ‘why’ as it has been told to me*.

In the early ’70s, the Texas Legislature set aside the authorization and funding for a new medical school in Texas. All understood it would be a UT Austin school, right there in the backyard of the Texas Capitol.

For those unaware, the Texas Legislature is in session for 90 days every two years, and the last minute flurry of bill passage and amending is said to be quite remarkable. And, this is how a powerful legislator stuck a rider onto a somewhat unrelated bill that said ‘all the money from that other bill is for Lubbock’, and it was passed.

The UT Austin medical school was hijacked, and landed squarely in Lubbock. Reportedly powerful people were ticked but couldn’t do much about it, and Lubbock has supported the Med School well (I myself attended several generations past). Shenanigans in legislatures? Who’d have though.

Now, Austin will get a Medical School. Better late than never. Congrats!

 

*This was told to me as a tale when I was quite young, so I suspect the details aren’t spot-on, but it makes sense given how the Texas Lege works and how little Texas Tech would have been expected to get a Medical School over UT in the early ’70s. Let’s not use this for a Wikipedia entry, okay?

Oklahoma Doctors vs. Obamacare – YouTube

The title is theirs, and it’s unnecessarily inflammatory, really it should be “Price Transparency in Medicine vs the Traditional Model”.

Three years ago, Dr. Keith Smith, co-founder and managing partner of the Surgery Center of Oklahoma, took an initiative that would only be considered radical in the health care industry: He posted online a list of prices for 112 common surgical procedures.

via Oklahoma Doctors vs. Obamacare – YouTube.

More of this, please, much more.

ACEP 12 tweeting: Bukata and Hoffman

Those who don’t follow me on Twitter probably have calm, productive lives. Those who do wonder why I twitter at all. Because it keeps me busy and engaged, that’s why.

Here’s an edited compilation of two of the American College of Emergency Physicians Scientific Assembly 2012 lectures in tweets by me from Denver. These encompass about 3.5 hours of lecture by the same two legends, Jerry Hoffman and Rick Bukata reviewing the medical literature as it applies to EM.

I used Storify to put these together (it couldn’t have been easier). I left out a lot of comments from others, not as they weren’t interesting but as I’m trying to tell the story of this lecture.

At the end there’re some pictures of the Twitterers and Bloggers who get together after ACEP. Nice how we’re birds of a feather. For a bonus, at the end are Joe Lex’s 4 Rules of Emergency Medicine, which deserves its own compilation.

Movin’ Meat: Are low acuity patients congesting the ER?

Big big Kudos to MovinMeat for bringing data to an argument that seemed doomed to opinion-lock.


I have pointed out in the past that my BS-meter starts pinging when people start claiming that the ER is only caring for emergent patients and that non-emergency cases are rare. So this set me off, of course. My perception — and that of many of us in the trenches — is that we are absolutely beset by non-emergencies and that the ER is viewed by many as the "convenience clinic," if not the "vicodin clinic." But is this true? How can we quantify this?

via Movin' Meat: Are low acuity patients congesting the ER?.

It’s a terrific post. It’s worth your time.

Health Officials: No Need To Call 911 For Mosquito Bites « CBS Dallas / Fort Worth

Unbelievable.

FORT WORTH CBSDFW.COM – With hundreds of human cases of the West Nile Virus being reported across Texas and more than a dozen related deaths in North Texas it seems some people are overreacting and calling 911 when they’re bitten by a mosquito.In short, health officials say a mosquito is not a health emergency.“We understand peoples concerns regarding the West Nile Virus, but in the absence of any symptoms of West Nile then a simple mosquito bite is really not a reason for someone to call 911,” said Matt Zavadsky, public affairs director for MedStar Emergency Medical Services.One woman called Fort Worth 911 requesting assistance because her young nephew had a bump on his arm.

via Health Officials: No Need To Call 911 For Mosquito Bites « CBS Dallas / Fort Worth.

We’re seeing some of this in the ED, people with bug bites coming straight in ‘to get checked out’.

Sad.

More ABA Silliness – ProfessorBainbridge.com

Where have we experienced this before?

Christine Hurt reports on an American Bar Association effort to promote breed neutral vicious dog laws.

My question: WTF? Why is this the business of the ABA?

via More ABA Silliness – ProfessorBainbridge.com.

Oh, yeah. The AMA. Same political, and therefore membership trajectory.