Monday, April 19, 2010

Best intentions, wrong actions

As I was drinving home on the interstate, traffic started slowing down and a police care shot past me. In a few minutes I came up to the accident. I saw that they were doing chect compressions so I pulled over to help. They were pumping chest so I announced that I was a doctor and apnd new CPR and ALS and leaned the patients head over to start mouth to mouth since they were not ventilating. One of the people there, I think a road ranger pushed me in the chest away from the victim and askem me who I was. I told him again that I was a doctor. He wanted to now where I worked. I told him again but said you need to ventilate him . Pumping the chest doesnt do anything if the patient is not ventilating. I showed the police officer my medical licence and he said that didnt mind if I helped but I cant take over. I explained to him that if they dont ventilate the victim he will die. About this time an ambulate came. The gut was feeling for a radial pulse. I reached over and checked the carotid, too late.

I know the guy was trying to do what was right and his intentions were the best. A good thing to do though is when you dont know what you are doing and someone does, it might be good to listen to them. I dont know if the victim could have been saved, I do know though that he had no chance when you dont ventilate.

Sunday, April 18, 2010

Press 2 if you have Medicare

Instead of fixing the SGR, Congress pushed off the fix for a few months. SGR is a formula that is designed to decrease doctors fees for Medicare. Doctors big issue with Medicare is that the rates are about the same as they were in 1983 without an adjustment for inflation. Unfunded government mandates have increased but the reimbursement has not. Admittedly, docs were probably paid too much in 1983 but now times are different. To make the numbers look good for the healthcare plan, they used the cut numbers which include a 20% or so cut in physician reimbursement. This pretty much reimburses less than what it costs to provide the care. Anyway, our biggest primary care group of over 200 doctors has just decided enough is enough and limited its Medicare slots to less than 1 per doc per day. (45% of thier docs decided just to drop Medicare). They already do not take Medicaid. The specialists have already limited Medicare to patients that the primary care docs personally calls for an appointment.

"Thank you for calling Greater Metro Cardiothorasic Consultants' appointment line. Keeping your heart healthy is our business. If you have private insurance such as Blue Cross, United, Etna or Cigna please press 1 and one of our schedulers will be right with you to schedule a timely and convenient appointment. If you have Medicare, Medicaid or other government funded insurnance press 2 and you will be directed how to submit an appointment request in writing. Please be aware you will need your primary care doc to personally call one of our physicians. We will then get back to you in writing in 9 to 12 weeks with an answer to your request. If you are granted an appointment, it will on a space available basis."


It seems now even the New York Times has figured it out in this article where they show how they expect Obamacare to be like Romneycare. More cost, less care! "Healthy people, in effect, began to subsidize people who needed more healthcare. The healthier customers soon discovered that the higher premiums were not worth it and dropped out of the plans. The pool of insured people dropped to the point where many of them had high healthcare needs. Without healthier people to spread the risk, the premiums skyrocketed, a phenomenon known in the trade as the "adverse selection death spiral". (New York Times 4/18/2010)

Sunday, April 11, 2010

Allergic to HIPPA and JACHO

After a case, I was writing post-op orders. I instinctively go to the front of the chart where the patients allergies would be in bright red letters. Instead, all it said with a JACHO HIPPA approved sticker is "patient has an allergy". So, now you have to pour through all the computer and emr generated junk to actually find the allergy. I couldn't help myself, so I had to ask. Aparently, this is some new HIPPA JACHO thing. Infact, the patients name is not even supposed to be on the chart.

I know that to stay in business, JACHO does its best to invent new ways to create paperwork and to decrease actual patient care, and that the government likes to make new regulations without thinking of the consequences, but this just seems stupid.

Thursday, April 8, 2010


Call this week has been busy. Each night has had its fill of the latest SP/GAK (status post getting a++ kicked). Evey patient seem s to say that they were hit with a tire iron. I dont know about you, but the tire thing in my car is this little flimsy thing that is hard as heck to get out and is only about 10 inches long. Even if I was mad, I dont think I could figure out how to get that thing out, much less figure out how to use it to hit someone. I stopped at Autozone to get some tranny fluid and asked if they had any tire irons. They didn't. In fact they weren't even sure where to go to get one and suggested Tractor Supply. So I guess you should watch out if you are at Tractor Supply.

What ever happened to axe handles and baseball bats. Well I know about baseball bats. A good wood baseball bat will set you back a bit. An aluminum just doesnt seem bad a+++, and a composite is both expensive and flashy. You cant buy lead pipes anymore, copper can be sold for top dollar and no one is afraid of PVC. I guess 2x4s are the only way to go. I wonder if my nexy SP/GAK will be a 2x4xface?

Better stop doing what works!

One of the things that has helped decrease costs was the rise of the ambulatory surgery centers. These are outpatient centers that can do many different types of surgeries. Because they do not have the overhead of the hospitals, they were able to do surgeries for far lest cost. Medicare and insurance companies recognized this and reimbursed them less, but since these were private enterprises, they flourised. A great example, is that a cholecystectomy costs is 2/3 cheaper to have in a surgery center. So, in their great healthcare bill, what did Congress and the President do? Medicare will no longer allow cases to be done in surgery centers. So, it wants to pay 2 times as much for the same thing! Good thing these guys are in charge of the economy!

Monday, April 5, 2010

You get what you dont pay for!

The State of Massachusetts passed an emergency regulation to keep health insurance companies from have a huge price hike in their rates to offset the mandated care imposed by the state. The issue, it is the non-proffit health insurance companies that are affected and are the ones fighting. Since the companies have to cover all the things that the states require but can not use actuarial data, the non-proffits are going broke. The only way they can stay afloat is to raise their rates. Hey, come to think of it. Isnt the government like a big non-proffit? (politicials and their friends excluded?) So, in Massachusetts, the state is telling what has to be insured, tells what rates the insurance companies have to charge and the result is insolvency. Good thing Obamacare is different. Oh, wait a minute. Nevermind, it is the same thing.