WhiteCoat

Healthcare Update — 03-25-2010

Florida’s legislature seeks to make all emergency medical personnel “agents of the state” and therefore immune from liability. Reckless mistakes would be paid by the state and payouts capped at $200,000. Trial lawyers are vigorously fighting the proposed legislation, arranging press conferences with patients and families who have been maimed by emergency department malpractice. The bills include a cap on attorney fees for lawsuits on behalf of the state Attorney General’s Office; protections for businesses against so-called slip-and-fall claims; and the ability for parents to waive liability, but not negligence, for children participating in dangerous activities.
In other news, the Florida Justice Association is going to open up its own emergency departments, businesses with potentially slippery floors, and forums for dangerous children’s activities to show all the other Florida citizens how to behave in a non-negligent manner in the future.

Unintended effects of the health care bill … companies are already telling their employees to “expect changes for the worse to your health care benefits.” Taxing prescription drug benefits will likely cause some companies to drop prescription drug coverage for their employees. Some companies may drop retiree coverage altogether. Others may raise costs for their health plans or decrease health plan coverage. Hmmmm. Decrease benefits or increase payments. Wonder where I’ve heard that before. Including the tax burden on long term retiree health benefits may have a significant negative effect on the earnings of many large corporations which may result in less tax revenue.
But at least everyone has insurance now. That’s a good thing.

Too little too late. Health care bill imposes requirements on states, but doesn’t provide states with needed subsidies until 2014. Arizona hospitals will have difficulty overcoming budget deficits until those subsidies materialize. Results: Less money for training physicians in Arizona, less doctors staying in Arizona, less care provided to poor people (including 310,000 adults and 39,000 children who will be dropped from Arizona’s Medicaid program), increases in emergency department usage, longer emergency department waits, and higher insurance rates for those with private insurance. “Costs have to be shifted somewhere, and that will be to private insurance.”
Arizona is also considering whether to increase taxes. When considering whether voters would approve of an increased tax rate, one hospital executives is quoted as saying “ultimately voters must decide whether they value things such as health care and education … we can’t cut our way out of this.”
Hmmm … provide less services or increase taxes. Sounds familiar.

Here’s some more reform for ya’ … Wyoming governor considers pulling whole STATE out of Medicaid program due to the onerous restrictions imposed by the health care bill. What would the 15% of all Wyoming residents who are Medicaid eligible do for health care then?
Doesn’t matter. At least everyone has health care insurance under this new health care bill.

Oh – and what about pregnant illegal immigrants? They aren’t eligible for insurance under the new health care bill. Nebraska was previously treating the unborn child as an individual eligible for services under Medicaid. Medicaid called it a violation of their rules. Now the illegal immigrant women may not be able to find prenatal care, which the government admits causes three times the incidence of low birth weight (meaning longer hospital stays) and five times the incidence of death. So who delivers the babies and is still on the hook for multiple millions of dollars in liability if something goes wrong with a child who has had no prenatal care? Sure as heck isn’t Washington.
Oh well. At least everyone else has insurance under this new health care bill.

John McCain blasts Obama … “You can put lipstick on a pig, Mr. President, but this [legislation] is still a pig.” Not one of the 2,733 pages of the health reform bill has anything to do with medical malpractice reform. “The dirty little secret in this body is that trial lawyers control the agenda, certainly as far as this legislation is concerned.”

Imagine that every one of your motor vehicle violations was recorded in a national databank. You get a speeding ticket? You’re reported. You get a parking ticket, you get reported. Don’t wear your seat belt? Add another report. Minor fender bender? You’re on there. Someone who doesn’t like you calls in a complaint about you? Maybe, maybe not. Then imagine that before someone could sell you a car, before someone could sell you insurance for that car, or before you could apply for a renewal of your driver’s license, they had to look you up on the databank. Too many reports and no one wants to sell you a car. Even a couple of reports and some companies may not sell you insurance. Obviously, you’d want to do whatever you could to stay off the databank – kind of like requesting “court supervision” and paying a larger fine for a speeding ticket so that the speeding ticket doesn’t get reported to the state and so that your insurance rates don’t get jacked up.
Medical providers already have such a system. It’s called the National Practitioner Data Bank. Malpractice payments (even those paid to just make frivolous lawsuits go away), adverse licensing actions, formal reprimands, and adverse actions on clinical privileges all get reported. Hospitals, insurers, and select other agencies have access to the databank and must query the databank regularly as part of their due diligence. Now add health care staffing firms to the list of entities who have access to the databank information. Good thing or bad?

Chronically ill patients benefit from online social networks. Quadriplegic man shares tips on which places have best wheelchair access. Multiple sclerosis patient says that being able to connect with other people “literally saved my life.”
In other news, a little known provision in the current health care bill states that in 2014, Medicare and Medicaid will only pay for access to online social networking as complete treatment coverage for all chronically ill patients. Beginning in 2016, Medicare and Medicaid will require a $50 co-pay each time patients log in to social networking services to discuss their problems. The scary thing is that I’m actually wondering whether I should even make this tongue-in-cheek comment to avoid giving insurers ideas.

Who uses the emergency department the most? Might not be who you think.
Those most likely to be “frequent fliers” (4 or more visits to the ED in a year) are African Americans and women, are either 25-44 years old or older than 65, and are likely to be on public insurance. Only 2% of frequent fliers were uninsured and only 15% of frequent emergency department users were uninsured. Sixty percent of “frequent fliers” in the emergency department had either Medicare or Medicaid for insurance. Frequent fliers represented 4.5% to 8% of all emergency department patients, but accounted for 21% to 28% of total yearly emergency department visits.

Bulgarians ask “what’s a plaintiff attorney?” Only 0.3% of alleged malpractice victims in Bulgaria seek compensation in court.

Pennsylvania hospital sued for calling itself a trauma center when it couldn’t provide complete trauma care to a patient then running out of blood. The patient was in a motorcycle accident and necessitated transfer due to a pelvic fracture with vascular injuries. During a delay in transport, he received received multiple transfusions of O-negative, O-positive and AB-positive blood. The patient died before the helicopter arrived to transport him to another facility.

$49 million judgment for patient whose spinal cord tumor initially went undiagnosed for one year. Six years and three surgeries later, the tumor was completely removed, but the patient was left with only partial use of her legs. The judgment may be reduced on appeal – to only in the $10 million dollar range.
In other news, the defendants are considering contribution actions against the tumor … that ate the patient’s spinal cord.

49 Responses to “Healthcare Update — 03-25-2010”

  1. first says:

    Whoo!! Made a comment before the lawyer troll!!

  2. SeaSpray says:

    This is horrible WC.

    Everything feels upside down in our country.

    I hate all of this. It seems obvious that this was the wrong way to go about it, seems like so many people are being hurt or will be and they are patting each other on the back, because ..well you know ..after all it’s a BFD.

    Consequences be damned ..we won! They are so out of touch with reality it is frightening. people are financially strapped now and they are forcing this financial disaster of a HC bill on us ..on our country when we can least afford to take on the added expense.

    I can’t believe so many people in all walks of life are going to be hurt by this. Why couldn’t they tackle the most important areas? Why did they have to trash what worked?

    I feel like every time I turn on the news ..something else is being taxed. And I am seriously concerned about my wonderful ins plan continuing to be affordable.

    And I can’t believe 16,000.00 IRS agents will be hired to follow up on the people ..private and business ..to enforce the taxes ..when Wrangle and Geithner don’t pay their taxes.

    And now.. it seems the dems are using violence for their talking points. They are trying to label conservatives /tea party people as angry, violent ..etc, but the way they are doing this alarms me because it feels like they are trying to incite something and then when some psychwack takes the bate (God forbid), they will then have more ammunition to try to paint conservatives with. It should be condemned across the board ..fairly and not left vs right. It’s infuriating the way they have tried to characterize everyday good Americans, all ages, from all walks of life,and different political parties who are standing up to express their disagreement with this administration. So insulting and condescending.

    Anyone can go back through the last few decades to see who actually has been responsible for inciting serious physical violence ..bombs, etc., and it’s not the tea party people. And yet ..it’s acceptable when public figures wish or express violent thoughts toward conservative figures. No outcry by anyone then. The double standard is sickening.

    Everything feels really off in this country. Its disturbing and I feel sad about it.

    We all need to get out and vote in November.

    And how could they vote for something when they don’t even know what is in it, understand it or know the long term consequences? And why are billions of dollars being spent on things in the HC bill that have NOTHING to do with medicine???

    Is there anyway at all to reverse any of this?

  3. Inthebiz says:

    Almost nothing is working well now. If not for the desire of healthcare providers to help the sick, the system would have collapsed long ago. What disturbs me is that so many in this country feel that it’s better to continue to leave things as they are and let private enterprise rape the system. The knot that is healthcare in this country will take a long time to untie. If we waited until we could do it all at once, it would never happen. I for one am tired of people who choose not to look at the many sides of this issue but still feel free to condemn those who are trying to make it better, without offering alternatives.

    • VA Hopeful says:

      “Almost nothing is working well”

      I take issue with this. I see the system working well quite often. I saw a 58 yo WF last week who was dxed with breast cancer at 46 by yearly mammograms starting at 40. She saw an oncologist and a surgeon within 10 days after the positive mammogram. She had surgery the next week and started chemo 2 weeks later. At 50, the cancer came back. Positive mammo, in to see both surgeon and oncologist the next week. Surgery a week later, chemo 2 weeks after that. Cancer free for the last 8 years.

      Sounds like the system is working fine for her.

      What about me? 10 years ago my allergies got so bad that my PCP suggested an allergist. 2 weeks later I was in, got the skin test, started injections. 2 years ago my knee started hurting when I ran. Called up the local university sports medicine fellowship clinic and was seen within 10 days. Sent me to PT, seen within a week, a month of therapy and I’m good as new.

      • Inthebiz says:

        I tend toward hyperbole, I have to watch that. I am glad both you and the woman you mention had positive experiences. I work on a small-town Illinois hospital. None of the doctors here accept new Medicaid patients. Our ER volume is now 30% Medicaid and climbing. Most of those patients are not emergent. Medicaid pays us about 20% of COST. We have a negative bottom line. There are no child psychiatrists anywhere in the state beside Chicago. There is not one neurosurgeon in the lower half of the state. We have been looking for a new OB-Gyn for three years. The one we have wants to retire.
        My sister in Iowa just lost her job. Of course she cannot afford the COBRA coverage at $400 a month. She needs certain treatments but will have to wait until she finds a job with either enough employees that their group plan will cover her, or at a high enough wage that she can pay for them herself.
        Quite often it is only through the charity of others that people get the care they need. What seems to have been lost in this country is the desire to help one’s fellow man. And the ability to delay gratification. A knee replacement is not usually an emergency. What exactly is wrong with waiting six months, as mentioned in other posts in this blog?
        And I agree about interstate competition for insurance companies. I can only guess that it was lobbyists who prevented that from being in the bill…

      • Matt says:

        “And I agree about interstate competition for insurance companies. I can only guess that it was lobbyists who prevented that from being in the bill”

        State insurance regulators probably wanted to preserve their power as well.

      • SeaSpray says:

        Inthebiz – “What disturbs me is that so many in this country feel that it’s better to continue to leave things as they are and let private enterprise rape the system.”

        It’s long been discussed in the medblogs how broken the HC system has been. Over regulated, unfair insurance policies/tactics, expense, under insured, etc. I have never heard anyone say it was good the way it was, but rather have seen some well thought out suggestions proposed. It had to be fixed. The status quo wasn’t acceptable.

        “The knot that is healthcare in this country will take a long time to untie. If we waited until we could do it all at once, it would never happen.”

        They should have worked together to target specific areas. Our economy is stressed to the max now and this bill is fiscally irresponsible. We and future generations will pay dearly for it. Not just financially, but in quality and availability of health care. They have billions of dollars to be given out as buy offs for votes that have nothing to do with helping people and medicine. I have had occasion to use my ins plan many times over the last four years and I have easy access and quality care at a reasonable cost. There is a reason people from other countries come to America to be treated for their medical conditions. Well down the road ..they can save the airline ticket if we truly follow the European model of HC.

        WC made the point that anyone can have insurance ..but not necessarily ACCESS depending on the quality of the plan/provider reimbursements… as you have already seen ..except in time ..that will be worse. Nothing is free and we will pay for this plan in many ways. there is always a trade off.

        They should have maintained what is good and target the worst things first. MDCD/MDCR are already reducing coverage/reimbursements. And now they’ve created this monstrosity ..that they don’t even KNOW what is in it or long term consequences. I would never sign does that? No intelligent person would ever sign my name to something they did not understand ..including understand the outcome of what they were doing. And this bill ..when they signed for it in December ..was supposed to be a *temporary* measure (they wanted to go home for Christmas) and *it was known* it needed further work. When something that affects the entire country (1/6 of the ntl economy and all the citizens – providers/patients/general public,ins companies, quality/availability of HC, taxes, businesses, etc, … you would think a bill this important would warrant more time to be *understood* and then worked on based on the KNOWLEDGE of it’s contents and the impact it will have. If the President had his way ..the plan (even worse then) would’ve passed in early August last summer. What was the rush?

        “I for one am tired of people who choose not to look at the many sides of this issue but still feel free to condemn those who are trying to make it better, without offering alternatives. ”

        You are right ..there are many sides to this issue. I believe we need to help the poor ..the less fortunate. But you don’t throw the baby out with the bathwater. Knowing social programs are already financially challenged ..you don’t then add more financial burden of this magnitude to the system. They could have targeted things to fix. If both parties would just stop the political games and eliminate the red tape. There are some good things in this bill. But why not just enact those and then target the worst problems in the already existing hc system? You can’t eat an elephant all at once, but you can eat it one bite at a time.

        It is a noble idea to give everyone free HC (which of course isn’t free), but at what cost? This plan is flawed from the foundation up.

        No one would condemn them for a noble idea and trying to make it a reality. It is the unscrupulous means they used to accomplish it. remember when they came out with that bill last year on a Friday night so no one would have time to read it over the weekend, before signed into effect on the following Monday? What was that?

        I wrote in a previous comment that the owner of a salon who has more than 50 employees and does not provide ins for them .. that the way the bill is set up now ..that employer is obligated to either provide ins or pay 2,000.00 per employee. So if he has 50 employees ..he will be fined 100,000.00 in taxes for not providing it. (I don’t know if that is yearly or a one time fine) I heard this issue being discussed on tv recently and this was being challenged. The democrat said ..”Well if fined ..it is still cheaper than paying for insurance for everyone.” WHAT? How about not fining them at all, let the business owner keep his money and put that into the economy, the paychecks, the business so it continues to grow ..ultimately supporting the economy? If I were him..I would regrettably lower the employee count to under 50 if that is the criterion for avoiding penalty taxes. So now more people lose their jobs. How does either solution ..multiplied across the country with sm business owners stimulate economic growth? That is just one facet of this. What about hard working people that do have insurance (last stat I heard was 75% of Americans ARE insured)who will be faced with 40% taxes if they have a cadillac ins plan? That is supposed to be a tax for those ins companies, but you know they will just reduce quality of benefits offered and raise premiums on an already financially strapped middle class. And because of the pre-existing conditions (which is a good thing),the ins companies will also have to raise their premiums. Taxes on medical equipment… things like canes, etc.

        They don’t have anything in the bill for tort reform. they could’ve opened up the borders to encourage free enterprise, cause ins companies to become competitive for better quality plan at competitive prices. They could’ve gathered more information ..speaking to people in the trenches of medicine. There are other ideas. Republicans have ideas and they were discounted and shut out.

        I do wonder why both parties didn’t try to tackle this sooner?

        It is absolutely appalling that they rushed this through without knowing it’s contents and ..skewing the budget numbers so they could make it work. Everyone knows they did it and that is acceptable?

        How is it *legal* to sign a bill into law that affects the entire country in the profound way that it does ..it’s tentacles reaching into seemingly everything (and it’s just beginning – government grows), and the signer does NOT know what they are signing?? And when it is public knowledge they skewed the numbers? How is that legal? How is that moral? It is certainly the height of stupidity. And how is it fair to enact something that will now cause millions of people to have increasingly higher private insurance premiums and be taxed 40% on top of that ..ultimately forcing them off the quality plan they had and forced onto a lesser quality of insurance? How is it fair to punish hardworking people already financially strapped to pay their bills? How is it fair to fine sm businesses that don’t provide insurance and create hard ship?

        They should have taken their time and targeted the most important issues… and they should’ve been transparent ..worked with the republicans and not given so much in bribes to get the bill passed. There are some good things ..but there are a lot of bad things. Even attaching college loans to a HC bill and now they will cost more too.

        If anyone sees the good in all of this ..please share your enlightenment and maybe those of us that feel awful about this will feel better about it.

      • SeaSpray says:

        “And the ability to delay gratification. A knee replacement is not usually an emergency. What exactly is wrong with waiting six months, as mentioned in other posts in this blog?”

        When a person has pain day and night ..every time they rise up or sit down ..with every step they take ..which exacerbates to 10 pain the longer they are weight bearing ..and NSAIDS no longer help or they can;t take them for some reason ..that kind of pain is emergent to a person waiting for reconstructive knee surgery. It is not life and death ..but quality of life is diminished because they can’t get out there and do all they would normally do.

      • Matt says:

        “I do wonder why both parties didn’t try to tackle this sooner?”

        You really wonder that?

      • SeaSpray says:

        I know Mat ..I was tired. Politics as usual – BOTH sides. Oh and right or wrong ..this past decade ..911 and getting into a war.

    • VA Hopeful says:

      Now, I also take issue with the commonly held belief (which you seem to subscribe to) that anyone who is against this new law is against any kind of reform. That is BS and you know it. Why couldn’t Congress have started with allowing interstate competition with insurance companies? They could have had that written up and passed within a few weeks. What about tax credits to smaller businesses if they get insurance for their employees? That, also, would have passed quickly. I still fail to see why it wasn’t done that way starting last year.

      So no, those of us against this monstrosity are not for the status quo. We just think smaller steps can work and allow us to analyze each new idea independently to see what works and what doesn’t.

    • Katherine says:

      Rape is not your metaphor.

  4. DensityDuck says:

    “Florida’s legislature seeks to make all emergency medical personnel “agents of the state” and therefore immune from liability.”

    It seems to me that this is what hospitals (and states) should have been doing all along. When the mechanic fixes your car wrong and it explodes into an oily mess in the fast lane of I-95, you don’t sue the mechanic; you sue the mechanic’s employer.

    • Matt says:

      You sue the mechanic. The employer is liable under the theory of respondeat superior, but the employer can always argue he was acting outside the course of his employment, so until they concede that point and agree to cover him, you sue the mechanic.

      However, you must actually be an employee. You can’t be an independent contractor. So the physicians have to give up their autonomy as such to get the benefits.

      • WhiteCoat says:

        It seems that the first year law student concept of apparent agency hasn’t made it to the courts in Matt’s jurisdiction yet …

      • Matt says:

        How many times have you tried to do this and how many times have you been made to look silly. I realize your arrogance knows few bounds, but you can’t practice law just by reading wikipedia.

        Apparent authority doesn’t exist unless the principal acted in a way that would lead one to believe an agency relationship existed. Our hypothetical hasn’t included any facts like that yet, so we aren’t to the point of discussing an agency.

        However, the point remains, you still sue the driver. Just like you still sue the agent as well as the principal until it’s established that there was an agency-principal relationship.

      • WhiteCoat says:

        “How many times have you tried to do this and how many times have you been made to look silly.”

        Um … “multiple” and “none” … in that order.
        P.S. Questions are usually ended with a question mark.

      • Matt says:

        It was so obviously rhetorical I didn’t think it was necessary. Evidently I was wrong.

        Stick to medicine, doc. You’ll look less foolish.

      • Densityduck says:

        Maybe, instead of being a dick, you could explain why apparent authority isn’t valid n the car-mechanic example I suggested. Then we’d all learn something.

    • Matt says:

      Because there aren’t enough facts presented.

  5. DensityDuck says:

    “So who delivers the babies and is still on the hook for multiple millions of dollars in liability if something goes wrong with a child who has had no prenatal care?”

    It’s going to be really funny, over the next few years, to watch people suddenly realize that America’s notoriously poor infant-mortality rate is the result of our extremely inclusive definition of “infant mortality” compared to the rest of the world.

    • Katherine says:

      Really? I’ve never seen a definition either way.

      • DensityDuck says:

        The WHO has a definition of a dead baby, and it has a different definition of a live baby, and these two definitions do not overlap. European doctors will often declare a fetus “nonviable”, which means “born alive but no chance to survive”. American doctors won’t do that–if the kid comes out alive then the Full Weight Of Modern Medical Science is applied, even for twenty-week preemies who don’t even have lungs yet.

        The catch is that European doctors don’t report nonviable fetuses as dead babies, but American doctors do.

  6. DensityDuck says:

    “Chronically ill patients benefit from online social networks. Quadriplegic man shares tips on which places have best wheelchair access. Multiple sclerosis patient says that being able to connect with other people “literally saved my life.” ”

    Well, but doesn’t the ADA require that everywhere have entirely-equal access in every way? Why should there be a need to “share tips”? The ADA makes it illegal to not have good access! Obviously we need more lawsuits to take care of this. (Thank goodness people like Jason K. Singleton are on the job!)

  7. Matt says:

    I just got off a phone call with Medicare, and it made me chuckle about government run healthcare and how physicians are going to become pawns in a bureacracy.

    Had a small case for a client, settled for around $15,000. Medicare paid some of the bills, and as such has an automatic lien against the proceeds. So a few months before it settles, I request a provisional repayment amount.

    Medicare sends over a provisional amount for $18,000. I review the bills and Medicare is including all sorts of unrelated medical problems (he’s elderly and has several of the usual elderly ailments). It appears to me they are entitled to about $4,000 based on the related bills.

    I send them a letter back explaining that certain ones are unrelated and can they please review. We are ready to settle the case. 90 days later I get a letter back saying they have reviewed the case and we now owe them $15,000. I call them. I wait on hold a half hour, finally speak to someone who, although Medicare has sent me a letter discussing the case, states she doesn’t have the proper form to discuss the case with me. What is the proper form? It’s a form with a title of something different altogether.

    So I send in this odd form, and 6 weeks later I get confirmation it was received. So I call, go through all the verification, and start to discuss. We discuss, she says they’ll send me a letter. Now, in the real world, my client has unfortunately passes on, and this is effectively the only asset of his estate, this case, which is settled at this point. So $15,000. Of which Medicare wants all, even though it only paid $4,000 for related injuries.

    Rather than re-send the same letter I sent previously, I send Medicare a letter asking to compromise and settle the case at $5,000. They send me a letter asking me to send a different form in, one you use if you’re requesting a waiver of the lien. I call to explain that I’m not requesting a waiver, merely a reduction, and the form isn’t necessary. I sit on hold thirty minutes, I go through the various verifications of my client, and I finally get to the real person, and she says she can’t talk to me because my client died. I say why not? She says because I don’t have authorization from the spouse. I say I sent you my contract which has both their signatures. She says I don’t have the death certificate naming her as the next of kin. I said you must know she’s the spouse because it’s in your system – I’ve seen your bills. She said we need a separate letter from her and the death certificate. I say, ok, if I get you that, how long until we can discuss resolution. She says, well, it has to go to Medicare regional office, and there is no timeline for that. I say none? She says none.

    So here we are, 8 months after settling, and no closer to resolution.

    So when I see the suggestion that physicians should run to become employees of the state (and effectively the feds, since it’s mostly fed money), it makes me laugh. It’s truly amazing that you would give up the last vestiges of autonomy you would have simply to save your insurer having to pay a claim when you might get sued at most once a decade, to go through the daily hell of being in the federal government’s healthcare system.

    It has to be the most impressive feat of brainwashing of a group of intelligent people in history that has resulted in physicians believing government is the way to go for their futures. Hell, even the AMA signed on to healthcare “reform”.

    Truly stunning. Good luck with it though. I hope it works out for you.

    • Fyrdoc says:

      So, to apply the logic you always apply to us, your client agreed to accept care from the government. You agreed to represent him, knowing this full well. Now the government wants it’s money (which, of course either reduces your take to nothing or leaves you having to charge the Widow $5000 when she will take home nothing). What’s the problem. You had a CONTRACT with these people and they had a CONTRACT with the government. If they, after review (twice – as you so love to point in WC med mal case, two experts agreed with the plaintiff) disagree with your assessment of the acuity and relevance of your clients injuries (after your YEARS of medical training), tough. This is the system you and your client agreed to work under. Pay Uncle Sam his due and quit whining.

      • Matt says:

        You need to read for understanding, little fella. Your “logic” is not that in the least.

        I don’t mind paying the government their money – I WANT to pay them the money due as a result of this accident. I fully expect to because if I don’t they can collect from my firm. In fact, I kind of like Medicare/Medicaid being involved because it reduces the bill collectors’ calls on my clients when they can’t work.

        However, in this case, my client’s visits for high blood pressure, a longstanding condition, are clearly not related to his knee injury in the wreck. In fact, if I tried to assert they were, and you were on the jury, you would find it laughable as he had been treated for high blood pressure for a decade prior.

        I’m simply commenting on the nature of dealing with the government, the speed, and the level of bureacracy.

        As to what the widow will receive, if Medicare gets what it is currently claiming, the widow gets nothing regardless. She probably goes in the hole on the filing fee alone of opening the probate estate. Again, this is the only asset of the estate, the rest of his property was held jointly with her. Why would she go to the trouble? If Medicare holds to its position, no one gets anything, and the taxpayers lose. Unless Medicare wants to start pursuing subrogation claims itself.

        Try not to overanalyze things you don’t understand.

      • Fyrdoc says:

        “However, in this case, my client’s visits for high blood pressure, a longstanding condition, are clearly not related to his knee injury in the wreck. In fact, if I tried to assert they were, and you were on the jury, you would find it laughable as he had been treated for high blood pressure for a decade prior.”

        Yep, and if we asked a jury if providing care to everyone, regardless of their ability or intent to pay, and not pursuing payment from those who haven’t paid the bill and are not covered by any insurance or government benefits plan is charity care, they would likely say it was.

        But why is it when your case was reviewed by two people in CMS, both of whom decided that your client’s visits should be repaid is it a travesty, plainly obvious to all. But when the plaintiff in WC’s case finds two experts to disagree with his care it is a legitimate disagreement? Believe me, as a physician, those “experts” (based on what we know of that case) are far more off base than CMS is in this one (based on what you’ve presented of this case).

        So if the widow receives nothing, what does she owe you big fella?

      • Matt says:

        Your desire to re-argue the meaning of the term “charity” doesn’t really make sense in this discussion. I can acknowledge you don’t agree with the standard definition and leave it alone.

        “But why is it when your case was reviewed by two people in CMS, both of whom decided that your client’s visits should be repaid is it a travesty, plainly obvious to all.”

        I’m not saying it’s a travesty. Again, if we don’t pursue the case, I’m out some time and a few expenses and that’s about it. The real loser is the taxpayer. The point is not about the merits of that, it’s about what your life is going to consist of shortly.

        ” Believe me, as a physician, those “experts” (based on what we know of that case) are far more off base than CMS is in this one (based on what you’ve presented of this case).”

        What makes you think they’re “experts”? And how would you POSSIBLY consider yourself qualified to determine that people who HAVE reviewed the facts of a case know less than you? Paging Dr. Frist.

        “So if the widow receives nothing, what does she owe you big fella?”

        Nothing.

    • Inthebiz says:

      We deal with this EVERY workday, and not just from Medicare but commercial insurances too. In fact around here work comp cases are by far the worst for bureacratic badminton.

      • Matt says:

        So do you think the recent healthcare reform bill will worsen or improve it?

        In my state, which is a smaller one admittedly, workers comp isn’t that bad to deal with. The insurers have a good understanding of their subro rights and you can speak with the person making the decision pretty quickly, at least on the legal end of paying claims out of a judgment or settlement. But that may be unique to being in a small state and having fewer adjusters.

    • Ramses II says:

      I guarantee you everyone you spoke to considered this case ‘resolved’ on the grounds that they were able to pass the buck and never deal with it again. It’s not about doing the right thing, or even grinding the maximum possible out of the victim, it’s about shuffling more paper around until all their cousins have jobs down at the office too. Government never gets smaller without blood.

      It’s impressive that you managed a post without being pointlessly snide. As someone external to both the industries involved in the little snit going on in these comments the last few weeks neither side is exactly covering themselves in glory or the raiments of rationality.

  8. Matt says:

    “Not one of the 2,733 pages of the health reform bill has anything to do with medical malpractice reform. “The dirty little secret in this body is that trial lawyers control the agenda, certainly as far as this legislation is concerned.””

    Yes, Mr. President. Why didn’t you address the tiny percentage of cost related to malpractice? WHY OH WHY? Why didn’t you enact reforms which after decades have not been shown to reduce the cost of healthcare or improve the delivery? Have you no shame, sir?

    Why didn’t you make it harder for people to sue physicians and hospitals for negligence, putting the costs of their past and future care on the liability insurers who insured that risk rather than the health insurers, the taxpayers, and the hospitals who will take care of these future charity cases when they can no longer work?!?!?! Do you have some love for health insurers that you WANT them to be able to subrogate against people who cause harm to their insureds? Are you sick, sir?

    Why Mr. President, why? Why do you want to keep having people responsible for causing harm PAY FOR THAT HARM!! Why should the companies charging to cover risks have to pay to cover when the thing their insuring against occurs? Have you no decency?!?!

    Oh, the humanity.

  9. Fyrdoc says:

    Matt,

    Why can you not understand that for a physician, the issue with lawsuits is not about the money? And if you don’t do something to at least reduce the perception of risk, there will continue to be exceptional costs related to defensive medicine?

    • Matt says:

      So how come all your reforms are about limiting how much MONEY the victim can get? If you don’t think the “reform” movement is about the money, you’re only fooling you.

      “And if you don’t do something to at least reduce the perception of risk, there will continue to be exceptional costs related to defensive medicine?”

      Why do you keep saying this when you’ve been proven wrong for decades? We did what you asked in a number of states, gave you the reform you wanted. The costs didn’t change.

      Try a new line.

  10. DefendUSA says:

    I am taking the liberty to post a link to my blog on health care. It is despicable that this has passed and I cannot believe that people I know think they understand what this means.

    Ran into a doc at the Rally in DC. He owned his own practice in FL. In a rather depressed area. after 8 years and never making his operating expenses due to reimbursement rates of medicare, he folded. And, now, if he does continue to practice, it will be along side the idiots who have not boarded but are needed. Remember, just because you graduate med school does not mean you are a good doc. I am guessing that a new law will be passed for them, too. A pass so that the government can pretend they care while raping the rest of the specialists like my neurosurgeon BIL. I hope he finds another Country to practice in…

    http://neestake.blogtownhall.com/2010/03/24/the_will_of_the_peoplean_aar_and_primer_on_the_bill.thtml

  11. docmomer says:

    Physicians who are in favor of this government take-over of an entire profession show their ignorance of basic economics. Which is probably why they are considered poor investors.
    Law of Scarcity = Universal Health Care IMPOSSIBLE

    ‘Let us start from the beginning. Medical care is a scarce good. That truth is fundamental to understanding everything else about its production and distribution. Someone must produce this good, and what is produced and who receives it (at least in a free market) are determined by the laws of supply and demand. We can rail all we want against the alleged unfairness of reality, but the fact remains that producing and obtaining units of medical care entail opportunity costs. Something of value must be given up.

    Yet in a single vote we heard members of Congress declare that they were going to “provide world-class health care” to needy Americans and save money! They will provide nothing. All they can do is to coerce someone to provide medical care for someone else. In his classic piece that I often quote, “7 Fallacies of Economics,” FEE President Lawrence Reed lists his seventh fallacy as The Fallacy of Economics by Coercion. Indeed, at the heart of this bill, with its mandates, fines, and arbitrary dates, is the attempt to impose a specific medical regime by force. Reed says this about such coercion:

    There’s an old adage which is enjoying new publicity of late. It reads, “If you encourage something, you get more of it; if you discourage something, you get less of it.” The good economist realizes that if you want the baker to bake a bigger pie, you don’t beat him up and steal his flour.

    Medical care will be no less scarce with the passage of this law. Insurance companies could find price ceilings on their premiums while, at the same time, they are expected to pay unlimited amounts on care for whomever wants it. This is not sustainable under any circumstances, and the framers of this law know it. In the end the government will turn insurers into “public utilities” while raising taxes to finance subsidies. The result will be long lines and less medical care than many people receive now. Thus the law of scarcity will impose itself even though Congress officially has repealed it.’

    In short, the health care bill has been, is and always will be an EPIC FAIL

  12. Matt says:

    “Imagine that every one of your motor vehicle violations was recorded in a national databank.”

    By the way, for the most part, they are. You get a DWI today, and with the exception of a few states, they’ll know if they need to charge you with a #1 or #2 or #3 pretty quickly.

    However, if the NPDB was this great deterrent to physicians getting jobs or insurance, you’d think more of the drug addicts and physicians with multiple judgments wouldn’t be getting jobs. Alas, that’s not the case.

    http://www.nypost.com/p/news/regional/item_AbBG651tZLQSPGAqdLpaIO

    http://www.washingtonpost.com/wp-dyn/articles/A39677-2005Apr9.html

    An example:

    “Over the past 20 years, John F. Pholeric Jr. struggled on and off with cocaine addiction, cycled in and out of rehab and was convicted of a felony. During that time, he also practiced medicine.

    Pholeric, 55, an ear, nose and throat specialist in Fairfax and Loudoun counties, admitted snorting cocaine “three to four times per week” in his office in 1999. He stole drugs from hospitals where he worked and wrote more than 40 fraudulent prescriptions for his own use, according to Virginia and District medical board records.”

    Now, if all that doesn’t keep him from being employed or practicing, how is being listed in the NPDB this horrible black mark on one’s career?

    • Fyrdoc says:

      “Now, if all that doesn’t keep him from being employed or practicing, how is being listed in the NPDB this horrible black mark on one’s career?”

      You are comparing apples and oranges. This is akin to pointing to a felon who has served their time and is now gainfully employed and asking “So what is the big deal about an innocent person getting convicted?”

      The problem that the NPDB is designed to track scum like this individual. Getting put into it lumps you with that company in comparison. That is how it is such a black mark.

    • Matt says:

      But that’s my point. If it’s not stopping him from getting a job, how is simply being named in a suit stopping anyone else?

  13. Fyrdoc says:

    ““So if the widow receives nothing, what does she owe you big fella?”

    Nothing.”

    So if the entirety of a claim that you have secured for a client is taken in subrogation, you get nothing? You don’t take your cut first? Maybe you are a better man than I’ve given you credit for in the past…

    • Matt says:

      I don’t know how you’d possibly rate anyone “as a person” based on anonymous Internet banter.

      Why would she pursue it, though? It makes no sense for her. If I had thousands of expenses in the case, I might ask the estate to pay some, or have her assign the claim to me so I might have a shot to at least recover those.

      Now, I have handled cases where people have, say $50,000 in medical bills, but the other driver only has $25,000 in insurance. The injured person will pay me just to negotiate with the insurer or providers so they don’t leave the accident in the hole.

      • Densityduck says:

        Matt, all we have to go on with you is what you’ve posted here.

        And remember: HR departments know how to use Google, too.

      • Matt says:

        You don’t have to believe me. I can’t give you any more details anyway due to privilege.

  14. Inthebiz says:

    Seaspray, I don’t discount the pain, but it is not, all of a sudden, an emergency. It is a farily predictable progression.
    And as far as those who say we didn’t even try to keep the parts that work, I am not so sure. How did ideas about gathering data and finding out what works get turned into death panels?

  15. SeaSpray says:

    In the biz – I said “When a person has pain day and night ..every time they rise up or sit down ..with every step they take ..which exacerbates to 10 pain the longer they are weight bearing ..and NSAIDS no longer help or they can;t take them for some reason ..that kind of pain is emergent to a person waiting for reconstructive knee surgery. It is not life and death ..but quality of life is diminished because they can’t get out there and do all they would normally do.”

    My point was not to say it is emergent as something life threatening ..but that to the person in pain ..in that kind of pain it *feels* emergent to them.

    We have always been able to schedule and get the surgeries we need in a timely fashion in this country. I loathe the idea that we may end up rationed and waiting for tests and procedures that we could always have when we were ready to schedule. I am extremely upset that we could end up with an inferior medical system in which we are denied prompt access to care or possibly denied altogether because of signing this debacle of a HC bill into effect. They did not read it. They do not understand it ..because they did not read it and because they did not read it, thus don’t understand it they also don’t know the long term effects of this bill and it is wrong that our availability of medical care should be compromised in anyway.

    I cannot believe the things I am hearing about regarding what will be the new HC over time in this country.

    I’m not sure what you mean about the gathering data and so perhaps I missed part of that story?

    But, I think the death panels are based on how Greece and Europe allocate care.

    I have read in medblogs where medical professionals do think we waste billions of dollars in keeping people alive on machines, etc, that do not and will not have any quality of life and would’ve died of natural causes ..old age, etc. I understand that.

    I read a comment by a doc from Greece last year who said that they do not spend money on keeping people alive who are severely injured or elderly and the prognosis is bleak, because the government does not have the money for that. I England ..there are women who have breast cancer, but not allowed to have certain drugs because they are too expensive and they die. maybe they would have ..but maybe not. Also, and I don’t recall the country ..but people can be diagnosed with colon cancer but then have to wait to have the surgery..cancer spreads and they die. In US, patients can get in quickly. Not wait 6 months.

    And is is foreseeable that for the sake of budget ..people empowered to make decisions to approve of expensive treatments will weed people based on certain criteria, age, preexisting conditions, etc., and one just has to hope they make the grade for approval. Subjective thoughts at this point .. but as WC pointed out ..having insurance with this plan does NOT mean one will have ACCESS to medical care and if they do ..it may not be QUALITY care.

    This is so disturbing and surreal ..I can hardly believe this has happened.

  16. SeaSpray says:

    And I am really angry that we have a quality PPO insurance ..that is affordable and they approved whatever I needed and now the premiums will go up. And on top of the premiums going up they government will tax the quality (Cadillac) plans 40%.

    FORTY PERCENT!!! (Except the favored union is exempt from it)

    My husband has worked hard all these years and like many Americans we are already financially strapped. I do not want to have to give up this insurance. I am livid. Seriously!

  17. Chelsea says:

    SeaSpray, if you are financially strapped already, then how affordable is your insurance, really? There is plenty of rationing here in the US already – just based on finances. Plenty of people work just as hard as your husband but cannot affort insurance, or afford cadillac plans etc. Or can’t get group insurance and are turned down for preexisting conditions. Even more who did have insurance have now lost it due to the economy. You are very lucky to have what you have and I can understand at being upset that it’s going to change. But it’s a selfish view. It’s amazing how much aide we can provide to other countries in times of crisis, or how much we all can spend on lottery tickets. But we refuse to take care of our own people first. We refuse to see them at all.

  18. SeaSpray says:

    Chelsea ..it is *not selfish* to believe you should be able to keep the insurance you have worked for and had access to all these years and then feel angry because you could lose it because this administration enacted a HC bill that the majority of the people did not want… because we all could see it had flaws and expenses tied to it in pork pay outs, etc. It was WRONG the way they did this.It is wrong on so many levels. Most Americans feel this way.

    I do believe we should help the poor. And this country does do a lot to help the poor. We always should.

    By financially strapped ..I mean we are paying our bills ..sometimes juggling and not a lot of room for extras at this time. But our ins premiums are automatically deducted from husband’s pay and we would pay our insurance before breakfast. Not an option ..it is a necessity. We are not financially strapped because of our insurance premiums. More like the high energy bills (oil,electric and gasoline) and and whatever. And even with insurance ..medical bills.

    But hearing how these premiums are escalating even now, hearing some people are already having to leave *their* doctors because they couldn’t afford the increasing premiums and switched to an HMO that *their* physician does not participate with. I watched Obama when he adamantly stated that people will not lose their doctors. And yet it is happening. How he can make blanket statements like that without knowing what is in the bill is beyond me. ? When a patient bonds and trusts a doc and they are familiar with the patient and their med hx ..it is a loss to lose that care.

    Regarding “Cadillac” plans, I believe the criteria for that is if it also has an eye plan, dental plan ..that kind of thing. I just consider that an insurance plan ..period. We’ve always had that and thought that was built into most plans.

    You are right ..there are people who can’t get those things ..that don’t have insurance. One night at work ..I saw a patient sign himself out ama because he didn’t want to be admitted over night for observation because he wasn’t insured. That is sad. And he worked but, no insurance.

    But the last stats I heard were that 75% of Americans ARE insured. And so is it fair to now make it more expensive for them and cause their care to be compromised in the future?

    How do two wrongs make a right?

    Again ..I am not saying things did not have to be fixed. There are some good things in the bill. We should help our poor.

    BUT…they should have looked at what they *COULD* fix or do away with systematically ..and not throw the baby out with the bath water. There are good things in the bill. I wrote more about this in the post put up after this.

    Why couldn’t they just enact separate smaller bill that said people stating pre-existing conditions don’t matter, college kids can stay on parents ins,etc. And why couldn’t they encourage free enterprise by opening state borders for product competition for lower premiums and quality of care? Why didn’t they write tort reform into the bill? Why didn’t they go after tort reform anyway ..before the bill? And I will ask that about republicans too? Why didn’t they do something about it?

    And as WC pointed out ..having insurance ..does not guarantee access.

    WC ..delete any of these things I’ve written if you wish. Repetitive Novellas. :)

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