Tuesday, June 22, 2010

SGR $%$^&* for Patients

A great explanation of the whole SGR mess from a great sage!!!


Opting out

There was a called board meeting of the medical staff of one of our big medical centers last night. The hospital is concerned about how many of the docs are opting out of Medicare and how it will affect the center. They knew most of the internists and FPs in the area were opting out but then the hammer hit. So were all the hospitalists! This basically meant that when you go the hospital you are responsible for payment and then you have to figure out how to get reimbursed from Medicare. Then the head of the Emergency Department Physicians group announced the same thing.

Over the course of the meeting it became clear, that the same thing was happening to the other medical centers in our area. I guess Obama was right that this healthcare bill was going to be great for the economic growth, In the collections industry.

Monday, June 21, 2010

This really SUCCinylcholines?

As I came in to the OR this morning it looked like a feeding frenzy at the pharmacy. Each CRNA and MDA were in line hoping to get some meds. There is a nationwide shortage of propofol, fentanyl, etomidate, succinylcholine and many of the other drugs that are used for anesthesia. These are all the generic cheap ones! I had to find out why so I called the main distrubution pharmacy. Since these drugs are generic, the profit margin in minimal and the liability risk is high, so there are not many companies making them in the US. In fact, most of the drugs are imported. The FDA has cracked down on inspecting the drugs but since the FDA is so slow, there is a huge delay getting them in to the country. On top of it, the FDA has decided that all older drugs must have the same testing that the new ones do, so to sell an older drug that has worked for years, someone has to pay the billions to run all the new tests on it. Of course no one wants to, so companies are just selling what they have and really not making any more.

So, when you have to have your emergency surgery just think, Attorneys and politicians have taken away your anesthesia!

Early bird get eaten by the worm

We take call a week at a time. This means that for a week I am zooming all over the city to different hospitals at different times. I've noticed something. When I am going in from 3am to about 9am, I will hardly ever see an Obama bumper sticker. When I am done at one of the hospitals and then driving to another later in the day, I see them. There seems to be a lot that can be inferred. This seems to be independent on traffic as the rush hour is over by the time you see the Obama stickers. The same is true later in the day. You never see them during the 430 to 700 rush.

Saturday, June 19, 2010

Blue Phonorrhea

By law, we have to provide translation services out of our own pocket to any patient that does not speak engligh fluently. Since most of the patients who need the phones are also illegals we are paying for their care also out of our pocket. Anyway. Because you have to have a translator available at all times and there are so many illegals, the hospital went and got these blue phones. They have two handpieces. You pick up one handpiece and that patient picks up the other. It automatically calls an interpreter who then translates. This way you can comply with the governments unfunded mandate yet again. So, today on rounds I had to see eleven patients who had these phones. Of course all were illeagals. Each time you pick up the phone, there is a connection fee and then so much per minute. Of course the pateint's love them and use them to complain about everything. The average cost per patient per day is $212. Since the patients dont pay for it, the cost is of course passed on to others which eventually is the docs and the taxpayers.

As I made my way around the hospital, the blue phones there everywhere. They are only brought into the rooms of the patients who dont speak english. Suddenly, I was called stat to the ED. I had to explain to this MS-13 hombre that he needed to go to the OR asap. There was no translator, so I asked for one of those D+++ phones. I was told that we were out of them. I said "what do you mean, we have 160 of them!". The answer was that they were all in use, there were over 45 in use just in Labor and Delivery!

People wonder why healthcare is so exensive, somebody has to pay to take care of all the illegals and their mandated phones!

Friday, June 18, 2010


In our medical center every patient who comes in on the surgical service has their chart reviewed as part of quality assurance. If there is a complication, it is recorded and categorized and entered into a data base. These complications can be wound infections, extended hospital stays, nosocomial infections, bleeds, etc. This database is constantly under analysis. Whenever there is a bump where the number of complications excedes the set levels that are determined nationally, it is said to fallout. Somethings such as an operative death or post operative death automatically fall out. So do all major complications. When something falls out, it is sent to be reviewed. Complications are kept per procedure, per patient, per unit etc.

This week was rough. One of our physicians "fellout". That is to say, he had more complications that his peers and those nationally. When this happens, all his complications are immediately sent for review. In this review, we inspect to check for clinical decision making, technical competence, wisdom and knowledge base. Many times the review finds that the particular surgeon just happened to be on call when bad things happen such as dead bowel from mesentaric ischemia or STEMIs with right main disease. This week the review brought out more questions than answers. So, I had to suspend the doc pending further investigation.

I have heard all these attorneys say the problem is that we physicans do not police ourselves. In fact we will stop a doctor from practicing while we investigate to be sure patients are not harmed. It is all part of the bylaws that you practice in the hospital. Do attorneys suspend each other from practicing while they investigate their competence?

Saturday, June 12, 2010

Take your President to Work Week

Received in my email today:

This past week has been horrendous. I have had 5 of seven days on ER call with busy days including 30+ patient office days (half days actually) while instituting and impossible EMR, and doing 2-3 cases each night from the ER and 6 to 7 cases per day in the general OR. As I was driving back to the hospital last night at 11pm for the third time, I thought of a great idea. The American College of Surgeons or the AMA should suggest that President Obama and some of our Congressmen/women join us for TAKE YOUR PRESIDENT TO WORK WEEK! I'm not talking about some p****Mayo Clinic or Harvard surgical service. I'm talking about some grassroots bluecollar down home time on the surgical service of everyman's community hospital. Just follow a general surgeon around for one week, Monday to Monday. He'll see:

1) The EMR slow us down like those puncture strips that cops throw infront of criminal vechicles.

2) The amount of non-reimbursed time that we spend answering phone calls, doing charts, waiting, driving and caring for patients.

3) The complete joke the 80 hour work week is for residents.

4) The incredible effort put forth by the entire medical team at our hospitals and the ridiculous risk we take from from opportunistic attorneys.

5) Just how good our healthcare system is even in the far corners of this country, and how misleading the "experts" are when they see otherwise.

6) Most of all, he will see the good job our doctors are doing before they start to rapidly exit the profession that he is making more and more frustrating every day.

Mr. President, come along for one week and educate yourself before you destroy the good things in our system. As you finish your one week on Monday, I'll remind you that for us the next day is never a day off.

I have a few to add of my own:

7) See how many illeagals we are seeing and taking care of and how they deplete the resources that allow us to take care of our citizens.

8) See the amount of fraud that is our disability system.

9) See first hand the incredible heroism of our police, fire and EMTS who put their lives on the line for others.

10) See how government red tape and Stark Laws have made medicine so expensive.

11) Let the President order the diagnostic studies and be responsible for all the outcomes so he can decide what is defensive medicine or not.

Sunday, June 6, 2010

Dr. Obama

It has been pointed out to me that your anterior communicating artery has been bleeding profusely and that every minute it bleeds you lose cerebral cortex. I will do my best to schedule time to look at it between meeting with basketball teams, golf dates and trips to help my friends. After a month or so, instead of decisive action, I will appoint a commission to look into the matter composed of political appointees and public relations people who will spend several months looking at the issue from a political safe point of view after which I hope the problem will just go away. The commission will have no power, it will just make recomendations which I will pass on so that the person on the scene will be held accountable instead of me. I wish you well and remember, I am in charge.