Patient Safety - Medical Justice

The SGR Band-aid & Why We All Should Care

August 15, 2024March 6, 2010 by Jeffrey Segal, MD, JD

The real problem is with the SGR itself. Medicare’s reimbursement for treatment needs to be addressed, revised so that it compensates fairly and equitably. Once the matter has been dispensed of, doctors can return their full attention to treating patients instead of worrying about how to keep the doors open for those patients…
Pardon me, Mr. President, but could you tell your stage dressers that it takes more than a garment to make a doctor, and more than those props to get the American people to believe that physicians are actually endorsing such a pathetic and woefully inept excuse for Health Care Reform?

From The Trenches (Healthcare Reform for the Real World) #4: Support Innovation

August 15, 2024March 5, 2010 by Jeffrey Segal, MD, JD

From The Trenches

(Healthcare Reform for the Real World)

#4: Support Innovation

This is the fourth in a series examining the problems in our health care system from the real world where patients get sick and injured, and doctors and other health care providers work to heal them. In the series, we’ll identify the actual non-political problems, and offer sound, sensible solutions that we can enact ourselves to reduce risk and increase patient safety.

Today’s medical industry is full of amazing technologies, things we never dreamt of 50 years ago; X-rays no longer need to be “processed,” oxygen levels are found with a meter, temperature with an instant temp gun. Computers keep track of inventory, monitor patients’ vitals, and we’re about on the verge of standardized, digital medical records. But much of this technology is obscenely profitable for the few, at the cost of many. Certainly that’s the way Capitalism works. It provides incentive to develop new technologies and abilities. But can be a double-edged sword. Consider this:

A diabetic’s test strips are his/her miner’s canary, the way s/he can tell if blood glucose levels are safe or if they’re causing damage to the body. With Type-2 diabetics, it’s not quite as crucial as with Type-1 patients (who administer insulin by injection) The industry developed complex and capable pumps, but those little devices cost about $6K each, and require maintenance supplies that are also very expensive. Those without pumps still have to do things the old-fashioned way, with syringes. (Granted, the needles have become much finer — so small that they’re often entirely painless.) So long as there’s money to be made, especially on a recurring basis, companies will be there, funding new developments. But what happens when a technology stands to eliminate a profitable item? Then our Capitalist system can suppress the innovation. Consider this:

Dr. Ren of the University of Florida developed a sensor chip capable of accurately detecting blood glucose levels (amongst things) from one’s breath. That may just seem clever to some, but for the millions of diabetics in this world, people who must stick themselves in their fingers every day, it’s a minor godsend. Great idea! No more sticking oneself, and no more test strips. HURRAY! But it may never see the market.

House Giveth, Senator Bunning Taketh Away; 21% SGR Cut Ahead!

August 15, 2024February 27, 2010 by Jeffrey Segal, MD, JD

Meanwhile, doctors would end up doing without 100% of their payments for Medicare patients unless and until the Senate acts.

From The Trenches (Healthcare Reform for the Real World) #3: Pre-Existing Conditions

August 15, 2024February 22, 2010 by Jeffrey Segal, MD, JD

From The Trenches

(Healthcare Reform for the Real World)

#3: Pre-Existing Conditions

This is the third in a series examining the problems in our health care system from the real world where patients get sick and injured, and doctors and other health care providers work to heal them. In the series, we’ll identify the actual non-political problems, and offer sound, sensible solutions that we can enact to reduce risk and increase patient safety.

Pre-existing conditions are a nightmare of the health care insurance. The specter of pre-existing conditions affects not only the cost of healthcare, but also the very health of patients. Patients who are concerned that they will be diagnosed with something (pre-existing) that prevents them from getting health care insurance in the future may give inaccurate information to their doctors in attempts to avoid that diagnosis. Some avoid treatment altogether, allowing the disease / condition to progress further than necessary, before they’re finally forced to seek help.

In a significant way, we all have pre-existing conditions, in that we are born with genetic propensities to develop certain diseases.

Humana and the Exclusions — Why Healthcare Reform is of Vital Importance

August 15, 2024February 4, 2010 by Jeffrey Segal, MD, JD

Humana sent out a sales pitch from John Terry, Vice President, Sales. “You may be able to switch to a HumanaOne plan that could lower your monthly premiums.” Count the caveats in that? “May” and “Could” and “switch”… all presuming, of course, that you’re not only insured, but insurable. This pitch was aimed towards the self-employed amongst us, and calls those people “self-insured.” They even congratulate the self-insured on the ability to switch health insurance plans. (“Applications are subject to underwriting approval. Waiting periods, limitation, and exclusions may apply.”) Append extensive sales pitch and claims that you “may” be pleasantly surprised by their rates. (I may be the secret son of JFK too, but I’m not holding my breath on that either. — Ed.) Then, at the bottom, there is a list of conditions for which you “may be denied coverage, if you have been diagnosed with, or in the last five years* (varies by state) been treated for, any of the following conditions:

“AIDS/HIV, Anorexia or Bulimia, Cancer, Chronic Obstructive Pulmonary Disease (COPD), Crohn’s Disease, Depression, if hospitalization required, Diabetes, Emphysema, Fibromyalgia, Heart Attack Stroke or Angioplasty, Hepatitis or Liver Disease, Organ or Tissue Transplant…” It goes on to say that individuals who are severely obese, underweight or undergoing or awaiting the results of diagnostic tests, treatments, surgery, biopsies, or lab work may also be denied coverage. Ditto expectant mothers OR fathers, or children under 2 weeks of age.”

From The Trenches (Health Care Reform for the Real World) #2: Access Solutions

August 15, 2024February 3, 2010 by Jeffrey Segal, MD, JD

From The Trenches

(Healthcare Reform for the Real World)

#2: Access Solutions

This is the second in a series examining the problems in our health care system from the real world, where patients get sick and injured, and doctors and other health care providers work to heal them. In the series, we’ll identify the actual, non-political problems, and offer sound, sensible solutions that we can enact ourselves to reduce risk and increase patient safety.

Last time, we visited the Nature of the Problem and showed how the advent of the bureaucracy of modern medicine and defensive medicine were causing an access problem. This time, we’ll take a better look at that problem, and present a few variations on practical solutions. We encourage discussion, and hope you’ll weigh in with your thoughts.

In the case study previously mentioned, the patient had Type 2 Diabetes, had acquired a stomach virus and was unable to keep down the oral medication that treated his condition. While it was a legitimate concern that the patient maintain a level of Metformin to control blood glucose levels, the symptoms were not particularly suggestive of H1N1. Since the patient complained only of the vomiting and nausea and concerns about not being able to take his medication, it’s likely that a conservative approach would have been to prescribe Ondansetron to control the vomiting. Instead, because it was a weekend and the patient had no access to his regular physician, the RN line recommended the E.R. That was defensive medicine. Then the E.R. visit itself, which included a simple test to see if he had a flu virus, basic bloodwork, and an EKG (just in case, the otherwise healthy patient is Diabetic, after all,) and a bag hung to rehydrate. An hour or two in the E.R. on a slow evening, and $2600 later, the patient walks out with a script for Ondansetron and instructions to return if symptoms don’t improve within a couple days.

From The Trenches (Health Care Reform for the Real World) #1: Nature of the Problem

August 15, 2024January 25, 2010 by Jeffrey Segal, MD, JD

From The Trenches

(Healthcare Reform for the Real World)

#1: Nature of the Problem

This begins a series of examination of the problems in our health care system from the real world where patients get sick and injured, and doctors and other health care providers work to heal them. In the series, we’ll identify the actual non-political problems, and offer sound, sensible solutions that we can enact ourselves to reduce risk and increase patient safety.

Some 35-40 years ago, people would see a physician PRN — as needed. They’d call up and go in to the doctor’s office, and wait to be seen. If there was an emergency, that person would go ahead of the others, so anyone who had need of urgent care would be tended to. If it was after hours or on the weekend, the answering service would patch you through to your doctor, or the doctor who was “on call,” taking care of his patients while he or she was away or unavailable. You’d explain the symptoms, the doctor would then either say it could wait for an appointment, tell you to go to the pharmacy to pick up the prescription he/she called in, or meet you at the hospital if that was necessary. My family physician didn’t have front OR back office staff. A surgeon and surgical nurse instructor, yet he had no need of staff to take care of his patients. And that was in Chicago, in the 1970’s. It stayed that way until about 20 or so years ago, and the system worked well. Then the trouble started.

Drug Manufacturers Back For a Second (Make that Third) Helping At Healthcare Reform Table

August 15, 2024January 17, 2010 by Jeffrey Segal, MD, JD

It seems they’re all coming out of the woodwork, demanding something in exchange for supporting the proposed health Care Reform bills. The drug companies are just the latest to announce that they “won’t be able to support” the bill unless it provides them with twelve years of exclusivity for expensive prescription drugs. (Since when do all of these Special Interest groups even have a say in the matter? Just sell your products as best you can on the open market!) In the final moments before the vote, at least one state was promised that the Federal Government would pay all the increases in Medicare costs for their state — forever — if their representative would vote in favor of the bill. Then, before that… oh, wait, that was the drug companies again.

Wasn’t it the drug companies who had just raised prices in anticipation of more windfall profits from all the newly insured? There was even an article in some big-city paper about it, and how it was the same way once before, when Medicare was expanded or somesuch. But isn’t it poor form to go back for seconds before everyone has had their first helpings?

Sure, companies are for-profit. Can’t very well blame them for trying to do what they’re built to do, can we? Then again, there’s another saying: “I don’t mind you making a profit, but do you have to make it all on me?!”

Breast Cancer Screening

August 15, 2024November 18, 2009 by Jeffrey Segal, MD, JD

By now, most of you have probably heard about the suggested new standards for breast cancer screening; including raising the age from forty to fifty, performing tests less frequently, and perhaps even having doctors stop teaching women to self-examine for lumps. There are reasons cited by people on both sides of this subject. There are … Read more

Preaching to the Choir About Healthcare Reform

August 15, 2024November 7, 2009 by Jeffrey Segal, MD, JD

The entire nation is still ablaze, talking about the healthcare reform bills. Some of the fire has been lost, owing to the way that things aren’t materializing in D.C., but the subject remains a hot topic. We within the medical profession engage loudly these days, and mostly in solidarity. The one point we’re most clear about is that any real reform MUST include a way to stop doctors from being sued just because people hope to score a jackpot judgment. We have talked about it, blogged about it, YouTube’d about it, Tweeted about it… but almost always to our peers, to each other.

It’s time to stop preaching to the choir. This message needs to get out further. Handing it to Washington, D.C. isn’t the answer. That’s already been done, and the politicians have largely – and conveniently – ignored it, (presumably because so many of their peers and cronies are lawyers making large bank on the problem.) The White House’s hand-picked, head-bobbing yes-men made their Dog & Pony Show appearance on the lawn, but nobody bought that one. What it’s going to take is for the everyman, our patients, to recognize how much those frivolous lawsuits are costing them, both financially and in terms of the quality of care we’re able to provide. Then perhaps their voices will rise up and Congress will have no choice but to address the issue.

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