WhiteCoat

Healthcare Update 07-11-2011

Wicky sticks making a comeback? Kids ingesting enbalming fluid with marijuana to enhance their “high.” Bad news is that formaldehyde can cause headaches and psychosis and who knows what the hell other symptoms. Remember: The only controlled studies on the effects of formaldehyde on human beings have been on DEAD PEOPLE.

Ten Texas patients called EMS 831 times in a one year time frame. So how do we address EMS frequent flyers? One Texas EMS service is using paramedics to troubleshoot patient needs and get patients plugged into the system. As a result of one paramedic’s efforts, EMS calls by ten frequent flyers fell by 79 percent. With 367 frequent flyers costing taxpayers more than $1 million in EMS charges alone, these paramedics may be on to something …

High risk insurance pool in Colorado running out of money and may have to “raise premiums, lower benefits and add waiting lists.” You don’t say. One analyst commenting in the article stated that those who created the plan “don’t have a clue about health care, and they don’t have good solutions.” You don’t say. Welcome to health care of the future.

More patients gone wild. Nineteen year old intoxicated patient drinks himself into oblivion, passes out, then wakes up in the emergency department, starts disturbance, tries to leave. Po po called and patient has an “electrifying” experience.

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Another story about ambulance abuse – this one in West Virginia

Elderly patient walks into Pittsburgh area hospital, goes to bathroom and shoots himself in head.

Most South Carolina specialists won’t deal with it. Primary care physicians accept only one new patient with it per month. What is it? “It” is that insurance millions of patients are going to receive under Obamacare: Medicaid.
The article cites a NEJM study showing that 66% of requests for specialty care appointments were denied for Illinois children with Medicaid while only 11% of appointment requests were denied for Illinois children with private insurance.
The difference between insurance for medical services and access to medical services becomes even more apparent.
Now states are planning to cut Medicaid payments to providers even further.
Watch what happens to access.

As Medicare and Medicaid reimbursements decrease further and further, what happens to hospitals? In Massachusetts, they file for bankruptcy. Nearly 25% of Massachusetts hospitals lost money last year. Two hospitals that had each been providing care for more than 120 years filed for bankruptcy last month.

Medical malpractice plaintiff’s attorney puts out press release (a.k.a. advertisement) warning that doctors can be held responsible for physician assistant negligence if doctors “don’t exercise proper authority” over the physician assistants. Guess what. Any time that there is a bad outcome, there will be allegations of improper exercise of authority.

States say that federal government owes them $4 billion for “errors” in failure to pay for medical care of disabled Americans. With interest and penalties, the amount of money the states will receive is probably about … oops. Sorry. That’s only when people owe the federal government money.

Physicians in federal government practice much less defensive medicine than their private sector counterparts. Why? There is “less fear of malpractice in the federal system.”
The CEO of Jackson Healthcare (the company that performed the survey) notes that “physicians in the private sector are the only physicians in the world who are personally financially liable for mistakes.”

It isn’t just Medicaid patients that are being turned away from medical practices. Recent Archives of Internal Medicine survey shows that increasing numbers of medical practices are turning away patients with commercial insurance. The decreases aren’t huge, but there is a trend. Acceptance of patients with private insurance dropped from 93.3% in 2005 to 87.8% in 2008, whereas acceptance of patients with Medicare only declined from 95.5% to 92.9%.
I’m betting that if the survey delineated the types of commercial insurance that weren’t being accepted, there would be a large discrepancy in which insurers were and were not accepted. Certain insurers are much less provider-friendly than others **cough, hack** CIGNA **hack, choke**
A Medical Economics article on the same subject is here.

An evaluation for “Gentile Pain,” a patient who gets cut-rate Botox injections and other “Tales from the ER” with Dr. Killpatient. Check it out. A bit of trivia … Dr. Killpatient was actually an alias used by Bugs Bunny when Elmer Fudd was being evaluated for rabbititis.

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11 Responses to “Healthcare Update 07-11-2011”

  1. Matt says:

    Fed physicians also have no possibilty of making more money for their “defensive medicine”.

    Of course they also dont make as much money.

    • Doc4now says:

      Stop implying physicians make more money by ordering more tests. Last time I checked, I don’t own stock in Labcorp or imaging centers, and I’m not my own radiologist. You obviously have no idea what you are talking about and are just trying to be inflammatory.

      • Matt says:

        Why is it that “defensive medicine” doesn’t decrease in the private sector when “reforms” are enacted then? The very reforms physicians claim are necessary to reduce defensive medicine?

      • WhiteCoat says:

        Federal system operates under the Federal Tort Claims Act. In many cases, there is legal immunity for medical care. Doctors don’t have to worry about being on the receiving end of a multimillion dollar lawsuit, being denied insurance for malpractice suits, or being denied hospital privileges because they were named one too many times in the National Practitioner Data Bank.

        Tell me how the “very reforms” physicians desire replicate these conditions.

        We will never be able to sue our way to better health care.

      • Matt says:

        “Tell me how the “very reforms” physicians desire replicate these conditions.”

        No one has said that. You physicians have told us that damage caps on those injured the worst would curb defensive medicine. It hasn’t. It’s your claim, not mine. Now it appears you’re saying absolute immunity would do it. But it doesn’t appear you’re willing to take the pay cuts that go with that sort of thing. Having your cake and eating it too, I guess.

        Interestingly, immunity for medical care doesn’t mean no malpractice. It just means us taxpayers pick up the tab rather than the insurance company who contracted to do so. Physicians practically never pick that tab up themselves.

        “We will never be able to sue our way to better health care.”

        True. That’s why I’ve never said we could. Better healthcare is up to providers to offer. Or soon, it will all be the government’s job. Then you’ll get your full immunity. I’ll be interested to hear if the tradeoff was worth it to you.

      • Matt says:

        ““physicians in the private sector are the only physicians in the world who are personally financially liable for mistakes.””

        I like this statement – it shows you the hubris of physicians. They do not believe they SHOULD be liable for their mistakes, even though the vast majority go uncompensated.

        I guess we could also say that US physicians are the highest paid profession in the world by at least 33% over the next highest. With much reward comes much responsibility. You of course, do not have to take that reward, and can accept the lesser salaries that government entities offer for your services and then not be financially liable for your mistakes.

    • throckmorton says:

      Matt:

      The physicians at our medical center have no financial interest in any of the diagnostic procedures. As to the Fed system, they docs are reviewed against community standards. So, if the community standard is that every headache gets a CT of the head, so does every Federal patient.

  2. Marilyn says:

    Nearly 25% of Massachusetts hospitals lost money last year. Two hospitals that had each been providing care for more than 120 years filed for bankruptcy last month.

    Hmmm…too important to fail…maybe the government should step in and bail them out? GMC? Government Medical Custodians?

    /sarc

  3. Marilyn says:

    oops…the government created the mess.

  4. Eliza says:

    At our so freaking busy I want to quit and start occupying wall street (just kidding) EMS system we have 2 people (and about 50 more that need to be) that are on our refusal list. They call and our first responder truck goes and makes sure they’re alive and then leaves. No ambulance is ever dispatched. It cut at least 400 calls a year, as they both call nearly every day. Of course, one is in the fed pen right now for punching a cop, so we wouldn’t have to worry about him anyway.

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