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	<title>Comments on: Healthcare Update &#8212; 06-13-2011</title>
	<atom:link href="http://www.epmonthly.com/whitecoat/2011/06/healthcare-update-06-13-2011/feed/" rel="self" type="application/rss+xml" />
	<link>http://www.epmonthly.com/whitecoat/2011/06/healthcare-update-06-13-2011/</link>
	<description>A blog from inside the emergency department</description>
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		<title>By: Hueydoc</title>
		<link>http://www.epmonthly.com/whitecoat/2011/06/healthcare-update-06-13-2011/#comment-54192</link>
		<dc:creator>Hueydoc</dc:creator>
		<pubDate>Fri, 17 Jun 2011 04:52:13 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=6694#comment-54192</guid>
		<description><![CDATA[I have to ask- when the hell has an endocrinologist ever shown up in an ER to treat a patient ???!!!]]></description>
		<content:encoded><![CDATA[<p>I have to ask- when the hell has an endocrinologist ever shown up in an ER to treat a patient ???!!!</p>
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		<title>By: Jim</title>
		<link>http://www.epmonthly.com/whitecoat/2011/06/healthcare-update-06-13-2011/#comment-54147</link>
		<dc:creator>Jim</dc:creator>
		<pubDate>Thu, 16 Jun 2011 18:46:00 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=6694#comment-54147</guid>
		<description><![CDATA[As a practicing EM physician in Massachusetts Romneycare isn&#039;t the panacea the NYT would like to portray.  I&#039;m a well-educated person who has enough difficulty understanding the minutiae of some of these health care plans, so I&#039;m not at all surprised to hear tales of woe from my patients - many who lack an education and/or gainful employment - about how they were dropped from coverage for administrative reasons.  Of course we spend a lot of time with financial counselors in the ED to help these poor souls, file the paperwork for them, only to have yet another administrative burden unmet and another rejection by the time of their next visit - usually within a month.

I like the new &quot;never&quot; list especially when it includes all those diabetic issues.  Does this mean the noncompliant diabetic who presents with DKA, hypoglycemia, etc. can be billed directly?  Thank you Dr. Berwick - another product of academic ivory tower inbreeding.]]></description>
		<content:encoded><![CDATA[<p>As a practicing EM physician in Massachusetts Romneycare isn&#8217;t the panacea the NYT would like to portray.  I&#8217;m a well-educated person who has enough difficulty understanding the minutiae of some of these health care plans, so I&#8217;m not at all surprised to hear tales of woe from my patients &#8211; many who lack an education and/or gainful employment &#8211; about how they were dropped from coverage for administrative reasons.  Of course we spend a lot of time with financial counselors in the ED to help these poor souls, file the paperwork for them, only to have yet another administrative burden unmet and another rejection by the time of their next visit &#8211; usually within a month.</p>
<p>I like the new &#8220;never&#8221; list especially when it includes all those diabetic issues.  Does this mean the noncompliant diabetic who presents with DKA, hypoglycemia, etc. can be billed directly?  Thank you Dr. Berwick &#8211; another product of academic ivory tower inbreeding.</p>
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		<title>By: Ben S</title>
		<link>http://www.epmonthly.com/whitecoat/2011/06/healthcare-update-06-13-2011/#comment-54067</link>
		<dc:creator>Ben S</dc:creator>
		<pubDate>Wed, 15 Jun 2011 21:15:37 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=6694#comment-54067</guid>
		<description><![CDATA[On the hernia surgery, aren&#039;t waiver papers signed beforehand for things like that?  I had a laparoscopic resection a few years ago, and recall some documents of pretty fine text talking about potential negative outcomes that I had to sign.]]></description>
		<content:encoded><![CDATA[<p>On the hernia surgery, aren&#8217;t waiver papers signed beforehand for things like that?  I had a laparoscopic resection a few years ago, and recall some documents of pretty fine text talking about potential negative outcomes that I had to sign.</p>
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		<title>By: BinkRN</title>
		<link>http://www.epmonthly.com/whitecoat/2011/06/healthcare-update-06-13-2011/#comment-54066</link>
		<dc:creator>BinkRN</dc:creator>
		<pubDate>Wed, 15 Jun 2011 21:10:06 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=6694#comment-54066</guid>
		<description><![CDATA[Ok- the drunk man being given haldol, then punched a nurse? And he got away with it?! I wonder what would have happened if he had not been a US vet.  I give respect where respect is due, and recognize the sacrifice many service men and women have made.  However- that does not give anyone the right to be a drunken fool and act like that, assaulting a nurse, then getting away with it.

Wonder where the rest of the facts are- seems this biased article left out a few key details its readers may not know about care of the drunk and disorderly in an ER setting.  

Of course, if that were a clinic, he&#039;d be banned from it.  Thank goodness for EMTALA, we get to see these jerks again and again.  Sorry for the rant, just sick of the abuse of ER staff across the country.]]></description>
		<content:encoded><![CDATA[<p>Ok- the drunk man being given haldol, then punched a nurse? And he got away with it?! I wonder what would have happened if he had not been a US vet.  I give respect where respect is due, and recognize the sacrifice many service men and women have made.  However- that does not give anyone the right to be a drunken fool and act like that, assaulting a nurse, then getting away with it.</p>
<p>Wonder where the rest of the facts are- seems this biased article left out a few key details its readers may not know about care of the drunk and disorderly in an ER setting.  </p>
<p>Of course, if that were a clinic, he&#8217;d be banned from it.  Thank goodness for EMTALA, we get to see these jerks again and again.  Sorry for the rant, just sick of the abuse of ER staff across the country.</p>
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		<title>By: Joe</title>
		<link>http://www.epmonthly.com/whitecoat/2011/06/healthcare-update-06-13-2011/#comment-54018</link>
		<dc:creator>Joe</dc:creator>
		<pubDate>Wed, 15 Jun 2011 12:03:23 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=6694#comment-54018</guid>
		<description><![CDATA[I never had anybody tell me how a post op hip or knee dvt is a never event. I have not seen a study that reveals that NO DVT&#039;s have never occurred with anticoagulation.  The simple fact is they can and do. Just another example of cms making broad decisions that have nothing to do with evidence.]]></description>
		<content:encoded><![CDATA[<p>I never had anybody tell me how a post op hip or knee dvt is a never event. I have not seen a study that reveals that NO DVT&#8217;s have never occurred with anticoagulation.  The simple fact is they can and do. Just another example of cms making broad decisions that have nothing to do with evidence.</p>
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		<title>By: SeaSpray</title>
		<link>http://www.epmonthly.com/whitecoat/2011/06/healthcare-update-06-13-2011/#comment-53974</link>
		<dc:creator>SeaSpray</dc:creator>
		<pubDate>Wed, 15 Jun 2011 00:40:15 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=6694#comment-53974</guid>
		<description><![CDATA[I saw that article where they tried to storm the ED.  

WHAT is WRONG with people these days?  Really ...what is WRONG with them and society over all that these things are happening.  Unbelievable!]]></description>
		<content:encoded><![CDATA[<p>I saw that article where they tried to storm the ED.  </p>
<p>WHAT is WRONG with people these days?  Really &#8230;what is WRONG with them and society over all that these things are happening.  Unbelievable!</p>
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		<title>By: keltset</title>
		<link>http://www.epmonthly.com/whitecoat/2011/06/healthcare-update-06-13-2011/#comment-53940</link>
		<dc:creator>keltset</dc:creator>
		<pubDate>Tue, 14 Jun 2011 17:58:45 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=6694#comment-53940</guid>
		<description><![CDATA[&quot;So why should other people be subsidizing you. If your file came up in front of me and I see over a half dozen repeat specialist visits per year and a history of cancer, I’d say you’re not worth the investment.&quot;

Because that is the point of insurance?!?, to cross subsidize across different age and risk groups because in the past and for most here in the present this is a social compact that we value... If that is truly ones thought then lets just &quot;death panel&quot; everyone once they reach medicare age and entirely kill that program, palliative care only and that&#039;s it. I suppose we could go even further and do away with any and all &quot;insurance&quot; everyone will pay into their own health savings account and pay for all their healthcare with this fund and any other funds they can scare up, no money no treatment.]]></description>
		<content:encoded><![CDATA[<p>&#8220;So why should other people be subsidizing you. If your file came up in front of me and I see over a half dozen repeat specialist visits per year and a history of cancer, I’d say you’re not worth the investment.&#8221;</p>
<p>Because that is the point of insurance?!?, to cross subsidize across different age and risk groups because in the past and for most here in the present this is a social compact that we value&#8230; If that is truly ones thought then lets just &#8220;death panel&#8221; everyone once they reach medicare age and entirely kill that program, palliative care only and that&#8217;s it. I suppose we could go even further and do away with any and all &#8220;insurance&#8221; everyone will pay into their own health savings account and pay for all their healthcare with this fund and any other funds they can scare up, no money no treatment.</p>
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		<title>By: B.RAD</title>
		<link>http://www.epmonthly.com/whitecoat/2011/06/healthcare-update-06-13-2011/#comment-53865</link>
		<dc:creator>B.RAD</dc:creator>
		<pubDate>Tue, 14 Jun 2011 01:30:06 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=6694#comment-53865</guid>
		<description><![CDATA[I used to be on staff at Kenneth Hall Regional hospital, the one that closed it&#039;s E.D.  It&#039;s been years since I was there, and I&#039;m surprised it took this long to close, as it has been losing $5-6M per year.  Being the only hospital serving a city of about 40K, you can imagine the volume that came through there.  And being the only level 2 on the outskirts of downtown St. Louis, it got more than its share of trauma.  Really is too bad that the community, which has lost much of its infrastructure and half of its population in the last 40-50 years, no longer can use the facility for acute care and must go additional 5 miles to get to the nearest hospital.]]></description>
		<content:encoded><![CDATA[<p>I used to be on staff at Kenneth Hall Regional hospital, the one that closed it&#8217;s E.D.  It&#8217;s been years since I was there, and I&#8217;m surprised it took this long to close, as it has been losing $5-6M per year.  Being the only hospital serving a city of about 40K, you can imagine the volume that came through there.  And being the only level 2 on the outskirts of downtown St. Louis, it got more than its share of trauma.  Really is too bad that the community, which has lost much of its infrastructure and half of its population in the last 40-50 years, no longer can use the facility for acute care and must go additional 5 miles to get to the nearest hospital.</p>
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		<title>By: Anonymous</title>
		<link>http://www.epmonthly.com/whitecoat/2011/06/healthcare-update-06-13-2011/#comment-53864</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Tue, 14 Jun 2011 01:23:59 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=6694#comment-53864</guid>
		<description><![CDATA[So why should other people be subsidizing you.  If your file came up in front of me and I see over a half dozen repeat specialist visits per year and a history of cancer, I&#039;d say you&#039;re not worth the investment.]]></description>
		<content:encoded><![CDATA[<p>So why should other people be subsidizing you.  If your file came up in front of me and I see over a half dozen repeat specialist visits per year and a history of cancer, I&#8217;d say you&#8217;re not worth the investment.</p>
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		<title>By: Finn</title>
		<link>http://www.epmonthly.com/whitecoat/2011/06/healthcare-update-06-13-2011/#comment-53837</link>
		<dc:creator>Finn</dc:creator>
		<pubDate>Mon, 13 Jun 2011 20:26:21 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=6694#comment-53837</guid>
		<description><![CDATA[Mass. resident here, who needs access to health care on a regular basis (internist 2-3x/yr, cardiologist 2x/yr, gyn/oncologist &amp; retina specialist annually) who currently pays over $8K per year (more than 15% of my income) in premiums for individual insurance with a $1K deductible--and it&#039;s by no means a gold-plated plan. I support the law because without it I would not be able to buy insurance at all, thanks to my history of cancer. I am, however, very concerned at how rapidly my insurance costs are rising; if they don&#039;t put the brakes on, soon I will once again be unable to buy insurance because it will be too expensive--assuming I want to continue living indoors and eating regularly.

There&#039;s a glaring error in the Medical Economics article about &quot;RomneyCare,&quot; which states that &quot;35% of internists and 44% of family physicians accept Commonwealth Choice, a nonsubsidized health insurance program for uninsured adult Massachusetts residents.&quot; There is no insurance called &quot;Commonwealth Choice,&quot; which is why so few doctors accept it. Commonwealth Choice is the program through which individuals like me and small businesses, which are pooled for actuarial purposes, purchase health insurance plans from Harvard Pilgrim Health Care, Blue Cross Blue Shield, and several other insurance companies. Mine, for instance, is HMO Blue, which is what it says on the card. There&#039;s nothing on the card to indicate that I bought it through the Commonwealth Choice program. Therefore, it&#039;s likely that the reason so many doctors don&#039;t accept &quot;Commonwealth Choice&quot; insurance is because it doesn&#039;t exist. Those who said they accept it are probably the minority who are aware that Commonwealth Choice is simply a clearinghouse through which insurance is bought, not an insurance plan itself.]]></description>
		<content:encoded><![CDATA[<p>Mass. resident here, who needs access to health care on a regular basis (internist 2-3x/yr, cardiologist 2x/yr, gyn/oncologist &amp; retina specialist annually) who currently pays over $8K per year (more than 15% of my income) in premiums for individual insurance with a $1K deductible&#8211;and it&#8217;s by no means a gold-plated plan. I support the law because without it I would not be able to buy insurance at all, thanks to my history of cancer. I am, however, very concerned at how rapidly my insurance costs are rising; if they don&#8217;t put the brakes on, soon I will once again be unable to buy insurance because it will be too expensive&#8211;assuming I want to continue living indoors and eating regularly.</p>
<p>There&#8217;s a glaring error in the Medical Economics article about &#8220;RomneyCare,&#8221; which states that &#8220;35% of internists and 44% of family physicians accept Commonwealth Choice, a nonsubsidized health insurance program for uninsured adult Massachusetts residents.&#8221; There is no insurance called &#8220;Commonwealth Choice,&#8221; which is why so few doctors accept it. Commonwealth Choice is the program through which individuals like me and small businesses, which are pooled for actuarial purposes, purchase health insurance plans from Harvard Pilgrim Health Care, Blue Cross Blue Shield, and several other insurance companies. Mine, for instance, is HMO Blue, which is what it says on the card. There&#8217;s nothing on the card to indicate that I bought it through the Commonwealth Choice program. Therefore, it&#8217;s likely that the reason so many doctors don&#8217;t accept &#8220;Commonwealth Choice&#8221; insurance is because it doesn&#8217;t exist. Those who said they accept it are probably the minority who are aware that Commonwealth Choice is simply a clearinghouse through which insurance is bought, not an insurance plan itself.</p>
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