by Medical Justice | Feb 27, 2010 | Healthcare Reform, News / Events, Patient Safety
Unless some last-minute miracle happens, on March 1, 2010, physicians will lose 21% of their pay for Medicare patients. The House has already paved the way for this to be resolved, but the Senate refused to pass even a temporary measure that would stave off the reduced rate of pay, while they figure out what they’re doing with the Healthcare Reform.
Who is behind this? A retiring Republican Senator from Kentucky, Jim Bunning. His complaint? It would add to the national debt. So, Senator, you think physicians should lose anther 21% from an already meager payscale because this one thing would increase the national debt?
It’s not just the doctors who will be hurt by this. Some physicians simply cannot afford the cut and will be forced to stop accepting Medicare payments. Where will those patients go for their healthcare? Perhaps the Senators would care to tell those patients in need exactly why it is that their health is deemed less important than the myriad other items that also increase national debt?
There is some talk of the CMS withholding Medicare payments for the time being, so that the funds can be paid at the proper rate when the checks do get cut. This assumes that the Senate will pass the temporary legislation, and eventually pass a permanent measure to resolve the deficiency. Meanwhile, doctors would end up doing without 100% of their payments for Medicare patients unless and until the Senate acts.
One thing you can be sure of is that they wouldn’t be failing to act if it was their paychecks on the line.
It isn’t the first time Jim Bunning has blocked a bill maliciously. Have a look at what this illustrious Senator’s REAL issue was when he blocked the extension of unemployment benefits. It was about him missing a basketball game?!
Contact information him:
Senator Jim Bunning
316 Hart Senate Office Building
Washington, DC 20510
Main: 202.224.4343
Fax: 202.228.1373
by Medical Justice | Feb 22, 2010 | Healthcare Reform, Patient Safety
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. (more…)
by Medical Justice | Feb 4, 2010 | Healthcare Reform, Patient Safety
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.” (more…)
by Medical Justice | Feb 3, 2010 | Healthcare Reform, Patient Safety, Risk Management
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. (more…)
by Medical Justice | Jan 25, 2010 | Healthcare Reform, Patient Safety, Risk Management
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. (more…)
by Medical Justice | Jan 17, 2010 | Healthcare Reform, Patient Safety
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?!” (more…)
