On Monday, September 29, 2010, the U.S. Senate made two attempts to repeal a relatively minor but unpopular aspect of the Healthcare Reform laws. Though both Democrats and Republicans agreed that the aspect was an unwarranted burden on businesses, they could not agree on either of two bills devised to reform the reformation. The offending aspect, which requires that those who pay out more than $600 per year to any one entity must file a 1099 form, was intended to provide an increase in revenues by increasing compliance with an existing tax law which already requires the filing of a 1099 form under the same circumstances.
Jeffrey Segal, MD, JD
Legislators Bring 13-Month Bandaid Bill
For what seems like centuries now (hyperbole, or prophecy?) Congress has been putting patches and bandaids on Medicare payments, approving continued pay at (barely) tolerable rates, a month at a time, a few months here and there. In June of 2010, President Obama signed a bill delaying the cuts another six months. Now December 1 looms, less than one week away, and that 23% Medicare payment cut is before us yet again (with an additional 1% cut coming on January 1, 2011). So what does the House do? Propose a slightly longer bandaid.
Cell Phones, Heath Information and Physicians
Recently the Pew Internet and American Life Project released results of a study it had conducted by Princeton Survey Research Associates between August 9th and September 13th of this year. The study looked at the use of cell phones to access health or medical information. Here’s what they found: 17% of cell phone users have … Read more
From Subprime Loans to Financing Lawsuits
Here’s history in the making.
At one time, before many of us were born, plaintiffs had to bankroll their own lawsuits. There, they would pay the attorney for his time and counsel. The plaintiff bore the entire risk for the outcome. But, if he won, he kept the entire pile of money, minus his expenses paid to the attorney.
The next – and dominant – paradigm: contingency fees. There, the risk is transferred to the attorney. In exchange for accepting that risk, the attorney keeps a healthy portion of any settlement / judgment after expenses. That amount is generally 33 to 40%. Naturally, the plaintiff’s attorney must diligently assess the risk / benefit for each opportunity. If the attorney loses, the plaintiff does not go bankrupt.
Enter the modern age.
Third party financing of lawsuits, as reported in the NY Times on November 15th:
More About Being an Expert Witness
By Joseph Horton, MD (This is a follow up to Dr. Horton’s earlier blog Patience is the Hunter’s Greatest Weapon) When I began my academic medical career, Chuck Kerber was with me when I was going over a talk I was about to give. I was understandably nervous about it. I set up the slides … Read more
Not Picture Perfect: Shark Bites and Lawsuits
Todd Murashige was surfing off the coast of Oahu, Hawaii on September 9, 2009. He was attacked by a 12 foot tiger shark. The injury to his leg was life threatening. Murashige was rushed to Queens Medical Center in Honolulu. While in the emergency room, he and his injuries were photographed. In a lawsuit filed … Read more
Surgeon Sentenced to Jail Time (HIPAA = Need To Know)
In classified environments, information is only available on a need-to-know basis. If you have no official business pertaining to a file, then you don’t need to know. Healthcare professionals should consider HIPAA to be a similar environment.
Last year, Congress passed HITECH, which tightened restrictions on healthcare privacy and increased penalties for transgressions. Unauthorized access to patient records can lead to jail-time. A surgeon working as a researcher at UCLA was sentenced to jail under the HIPAA. What happened? Here’s the rest of the story:
Huping Zhou, a cardiothoracic surgeon, was working at the UCLA School of Medicine as a researcher. His employment was terminated, but UCLA’s IT department didn’t block his access to electronic medical records at the same moment; it took the university some time to process retraction of the doctor’s authorization to the database. In that interrum, Dr. Zhou accessed and read his immediate supervisor’s medical records, as well as those of former co-workers. Then, over the next few weeks, his curiosity led him to remotely access of other medical records he was unauthorized to see, including those of celebrity patients.
Magazine Proves MD Ratings Are Questionable
We have long questioned the validity of physician rating systems. Not just one, or some, but all MD rating systems. Even if you put two doctors in an identical circumstance, notions that the comparison between them is significant is questionable. 5280 Magazine, a publication for the Mile High city, may seem to be the exception. In reality, they prove the point for us.
Seeing the cover, though it seems quite charming. Smiling physician, complete with lab coat. A critical mind might expect a negative, though. After all, naming the top 2oo+ doctors within a city of 8000 practitioners is certain to be exclusionary. When one delves in and reads the story, though, it seems the rare exception. They’re not taking patient critiques. Quite the opposite, they’ve asked physicians to rate each other, and even gone so far as to do so in a positive fashion. They ask area physicians which doctor THEY would most trust, within a given specialty. Certainly that’s a fair appraisal, right? After all, it’s physicians performing the ratings, looking for the best. What could possibly be more fair than that?
Their methodology may seem entirely free of malevolence, without bias. Thinking it through, though, reveals the flaws. It’s still a popularity contest, even though qualified physicians are performing the “appraisals”. When you ask someone who THEY trust the most, that’s still a subjective opinion, perhaps based on many irrelevant factors. Most certainly, though, the result will come from within those physicians the individual comes into contact with, and therein lies the fatal flaw. A physician who is a social butterfly is going to be known by more people. If his reputation is that of an expert of great renown, if he speaks or educates often within the field, that will make it seem all the more certain that he’s the one to trust most, the best. The contest continues to ignore the fact that there may be several better practitioners within the field who are simply less celebrated. Perhaps they’re simply too busy treating patients with their excellence to be giving lectures or blowing their own horn. Regardless of the reason, they’re less known than the social butterfly, and yet the well-known figure is the one likely to gain the most votes.
Patience is the Hunter’s Greatest Weapon
by Joseph Horton, MD
I was raised by a pair of criminal lawyers in New Orleans. Being raised by wolves is not intrinsically pleasant, but it does give one a certain sense of being invulnerable to specious attacks—like while being on a witness stand. The inevitable education about courtroom and trial procedure doesn’t hurt either.
Of the two, my mother was the litigator. Tiny in size (I’m 5’3” tall and I dwarfed her), in court she stood, oh, about 11 feet tall, breathed fire, and was bulletproof. It was not a good idea to cross her there—or anywhere else, come to think of it.* One of the things that she drilled into my head was the First and Second Laws of cross-examination.** The First Law is never to ask an opposing witness a question you don’t know how he’s going to answer. The Second Law covers what to do on the very rare instances when it is OK to ask a question you don’t know how they’re going to answer: refer to the First Law.
It always amazes me how many opposing attorneys missed that lecture. Probably half the time I’ve been to trial as an expert witness, I get asked a question that there is no way they can know how I’ll answer. My best guess is that they believe that, since I really am physically small (and gray and nebbish-looking), I can’t possibly help anyone’s case but theirs. Best bet is to look as unassuming as you can, and wait for the opening. (Remember that patience thing?) Then overwhelming force usually stops the attack.
A couple examples:
Curbside Consults are Kosher: A Breath of Fresh Air
How often are we told as doctors? You can’t do this. Don’t do that.
We are sometimes made to feel as if we are two-year-olds.
Now for the good news. An article published by Victor Cotton, MD, JD* pushes the opposite position. Curbside consults. If you follow the basics, you’re on safe ground. A breath of fresh air.
As a neurosurgical resident, we were cautioned to avoid curbside consults. Attending physicians admonished us to get the formal consult. At Ben Taub County Hospital, our service was busy. The internal medicine service was busy. Everyone was busy. The one commodity we did not have was time.
I was forced to use the following strategy to coax an internist to see my patient – one suffering from a head injury, in the Neuro-ICU, with a gazillion lines penetrating his skin and a blood sugar of 450.
“I know you are really busy and I hate to bother you. I have a patient with severe head injury and a blood sugar of 450. Do you give one amp or two amps of insulin?”
“What! Don’t do anything. We’ll see your patient in a matter of moments.”
Mission accomplished. The more stupid I sounded, the easier it was to get a consultant to the patient’s bedside.
That made no sense to me then. It makes no sense to me today.
