Saturday, February 27, 2010


I wasn't sure at first so I had to check it out. It turned out that it is true. The health insurance that the government gives to our soldiers and their families is TRICARE. It was already bad enough that it paid less then Medicare and far less than the Blue Cross that other federal employees have, but guess what? By law it is tied to the Medicare rates. So as of monday, our troops and their families will have their TRICARE cut by 21%. If there is anyone who deserves a "Cadillac" Health Insurance policy it is our troops. Instead, we give it to Congressmen and office sitting, every holiday taking governent employee. Does the Federal Government even try to care?

Why shoot for par when all you get is a boogie!

On March 1st, the Federal government has decided to impose a 21% cut in physician reimbursement for any Medicare covered service. Physicians themselves have not had a pay increase since 1983 and infact reimbursement has gone down because of inflation. Anyway, if you participate in Medicare, your revenue that runs the practice is going way down. Since Medicaid is tied to Medicare and Medicaid is 60% of Medicare, Medicaid is now so low that what was left of the physicians who took it are leaving. Before the cut, Medicare was paid about 75% of what private insurance pays for your care.

So, physicians accross the country are deciding this weekend. If we participate (Par) in Medicare, you get at least the 21% cut. So if you shoot for the par, the government gives you a bogey. If you opt out, Medicare patients must pay you out of their pocket and then try to get reimbursed from the government. There is one catch, if you opt out you have to wait 2 years to opt in. Anyway, it looks like many docs are opting out. I can only imagine the outrage when all the seniors who have to pay for their care and then try to get the government to reimburse them!

It is what it is. Perhaps this is what is needed to knock some sense into Congress. People might see how screwed up the government is because now its their money that they have to get back!

Friday, February 19, 2010

Medicaid Kaiser Soze

The whole Kaiser Soze situation has got much worse in the last few months. As the percentage of patients with goverment insurnace goes up, the number of docs who will actually see it is going way down. When I met with our Senator I explained this to him. He had some data that showed the number of docs who had signed up with Medicaid and was of the belief that this meant that those docs would see all the Medicaid patients. I had to set him straight on the Medicaid Kaiser Soze pricipal. When you have to take call, many docs will take Medicaid so they get something for having to see the patient in the ER on the basis of something is better than nothing. But when it comes to seeing them in the office, just try to get an appointment! The long and short of it, just because you have signed up for Medicaid does not mean you have to see them. In our area the pediatricians have been so devastated by Medicaid and SCHIP that they will say they take those insurances but they have so limited their office templates that they are basically not seeing any government payors.

I told the Senator, its like Kaiser Soze, Medicaid is everywhere but when you call and try to get an appointment, it is nowhere.

Defensive Medicine Almost Kills

I have heard attorneys try to argue that defensive medicine does not exist or that it is not prevalent, I have even heard them that the reason doctors order so many tests is because they make money on them. I would love to have those attorneys spend a few nights in the ED and see the reality. First, we dont get paid for the test, we dont get paid for the results. We do pay if a year later we have to face a lawyer who asks why we didnt order the test. This has got so ingrained that our medical students and residents dont ask what tests should be run but what tests can be run. So it was the other night. A patient came in with what appeared to be a classic migraine. One that they had before. The doc ordered the standard tests, (doesnt matter if they have insurnace or not, because it doesnt matter to an attorney), one of the tests was a uncontrasted CT of the head. The intracranial part was normal but there was some question of a tortuous carotid vs a skull base lesion. Since he could not rely that the patient would follow up to have this evaluated, the doc ordered the contrast scan of the skull base. The patient then had a bad reaction to contrast and went into shock and had to be resuscitated back in the ED and ended up intubated.

So, was the doc ordering the tests to get money? No, we dont get paid by the test. Why was the second scan ordered, CYA? The result of the defensive medicine? The patient got intubated, spend time in the ICU and had a MI from the epi given during the contrast reactionn

Tuesday, February 2, 2010

"Qu'ils mangent de la brioche",

I came accross this from the CBC news. Newfoundland and Labrador Premier Danny Williams is set to undergo heart surgery in the US. So, why would he leave the Canadian Health System for his care. Could it be because of the wait, the lack of specialists, the lack of post-operative services such as dialysis? He is after all in charge of healthcare in his province! What does he know that he doesn't want the rest of Candada to know?

Monday, February 1, 2010

La costra nastra damas

Just so I can say you heard it here first. Well actually we were sitting in the lounge when one of the docs was asking for advice about how best to take care of a radiation injury to the pelvis of a lady and we got to talking about nukes. Somehow we figured out how to take care of here and then went to other radiaton injuries, which then went into nuclear weapons. This led to Iran, and then out came the prediction. The general consenses was that Iran is going to touch off a small yield nuke on or about 2/11/2010. I am not sure how we got there, but there it is. The nuclear prediction of a bunch of docs. Lets see if we are right.