Friday, March 26, 2010

Its only $5!

I cant talk too much about it as all I can think is that the President and Congress have reinforced what makes medicine more expensive and charged it to us and our children. Although we in medicine are surrounded by examples of this it is apparent that none of our congressmen or senators bothered to investigate the issues themselves. Here is what I found out in five minutes. I needed an antibiotic so I called several pharmacies, I found out that my copay would be $5 and they assured me that that was all I had to pay. I then called back later and asked how much it would be if I paid cash. It was a generic antibiotic. It was $31 at Wallgreens, $29 at CVS, $17 at Kroger, $3 at both Kmart and Wallmart.

Yeah, I guess Congress and the President are right, it is the drug companies and the insurnace companies that are screwing us!

Thursday, March 18, 2010

Federal healthcare sandwich: Hold the Mayo and the greens

With all talk of the government taking over healthcare, we are already seeing how good the government care is. Earlier, the Mayo Clinic is Scotsdale stopped taking Medicare and now Walgreens is no longer accepting any new Medicaid patients in the state of Washington. In both cases, the reason is simple, poor reimbursement and excessive unfunded mandates.

I looked at what we could do in our practice to cut costs and at the same time continue to provide the best care we could. The big thing would be to move more testing and treatments in house. This way we could package care plans for a cheaper price. Well, it turns out, the reimbursement is set by the government and the Federal Stark Law prevents us from consolidating.

So, we cant lower the prices of our care because they are set by the government, and we cant cut costs because of the government. Now, they think the solution is more government. Its like they want to make a sandwitch to feed the nation that has no bread and nothing between the slices.

Sunday, March 14, 2010

Good for Goose? how bout Gander?

I just saw yet another congressman claim that what we need in the US is a single payor system for healthcare. I guess my ADD kicked in and I thought, well this Congressman is a trial attorney. I wonder what he would think if we applied the same concept to tort law? I mean you can make all the same arguments. "Give everyone access", "Its a right" etc. So, I started looking up to see if anyone else had the same idea.

Someone did!

I wonder if Congress could pass the healthcare bill if they just erased the words healthcare in the whole thing with legal care?

Saturday, March 13, 2010

"Obama Care"

Got this in the Email.

Obama had a physical recently.Hes 48yo.His physical included a virtual colonoscopy and a cardic CT scan.Do any of you think you would have been able to get prior authorization for either of these procedures?I dont think so.Niether were indicated .Too bad for him...he was just exposed to a serious amount of unnecessary radiation.What a contradiction this man is.Have any of you ever included these procedures as part of a physical in an asymtomatic ,healthy 48yo man?And what does this say to the country when hes ramming thru healthcare legislature that many Americans oppose.

Sunday, March 7, 2010

25 guage IVs

Easy to get but cant do anything with them. Our medical centers are overwhelmed right now with outofstate Medicaid. The patients who have it think that they are entitled to everything but somehow cant seem to find anyone in their state who will take it. Their own medical centers have cut back so far that they are on "divert" for almost everything. As a result, the patients have to go out of state where they have to be seen because of EMTALA. Of course this Medicaid pays next to nothing so our centers are even farther in the red.

There is this belief that the problem is that we have so many uninsured and we have to get them insurance. The insurance is worth not when it does not pay what it costs to take care of the patients. Sure, you can jump up and slap your back and say you got people insurance, but you have done is make it worse. The state that the Feds tout about healthcare reform, has actually just pushed its patients out of state and stuck someone else.

If we want to make medicine cheaper, we have to make it more efficient and more competitive. We cant be efficient when the nurses who do most of the healthcare have to spend 85% of their productivity doing Federal CMS JACHO mandated paperwork. Where patients are not able to negotiate the price of their own care. Where diagnostic tests and procedures are determined because of potential lawsuits rather than evidence based studies. When the healthcare industry has to support the trial lawyer industry. Where the Federal Government is the one who actually sets the prices of all medical care. (All Medicaid, Tricare, BCBS etc fees are tied to the Medicare rates).

If the Feds expand Medicaid, the rest of healthcare will collapse. It is like a 25 guage IV in a septic patient. Not really good for much.

Saturday, March 6, 2010

Three beers

I dont know why patients lie when you ask them how much they drink or if they use illegal drugs. We are not asking to arrest them or anything. I have even tried the "its off the record" thing and explain that it is important so we know what to look for and to prepare for things. It doesnt matter. The worst alcoholic will always say he only has about three beers a day and the worst heroin addict will tell you the needle marks are from chiggers. The little old lady will go into DTs and the businessman will have SVT from crystal meth. You came to us for help, so let us help you. We ask the questions for a reason. The reason could save your life.

Friday, March 5, 2010

(re)tardive dyskinesia

It seems that whenever a politician is about to see why healthacare costs so much, they jerk their head away and refuse to look at the situation directly. I would love to give them some cogentin, put them in a Miama J and force them to actually spend some time in the trenches and see what is happening.

First and formost, I want them to take their dog to the vet. The vet does not take insurance. The vet gives you an itemized bill for the care. Interestingly, for a check up that includes vaccinations and routine blood tests, the vets in our area charge $115. For the same exam with one fewer test and vaccination for a child, Medicaid pays $27. Hmm! What would happen if the vet had to see dogs who had, Medicaid? He would have to charge others more!

When you mandate that someone gets a service at a rate below what it actually costs to do, you have to make up the difference somewhere. Since Medicaid and Medicare have not increased their reimbursements, the shortfall has to be made up by the private payors. So, private insurance goes up. Congressman are yelling because the healthinsurance rates in the state for private insurance companies are going up by 20 to 30 % and blame the insurance companies. The reality is that the state has cut its Medicaid so to keep its healthsystem running the money has to come from private payors. The state has also increased the number on Medicaid and done nothing to decrease the number of illeagals.

Who is really to blame for the cost of healthcare?