Their embarrassingly small 1.5% bonus payments have physicians questioning whether the extra record-keeping is worth it:
It took a lot of paperwork and screwed up billing because we had to charge 1 cent per code so that the Medicare carrier’s computer would pick up the charges, and then had to manually write off that charge afterward.
In essence, the bonus equaled one extra 99213 office visit every other day. Most physicians would find it easier to squeeze in the extra visits rather than jump through bureaucratic hoops for minimal payment.

Technorati Tags: cancer, breast cancer, technology, brain cancer

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Technorati Tags: cancer, breast cancer, technology, brain cancer

A reader writes:
Primary care doctors don’t know all the resources for a given medical problem in their geographical area. They will tend to go to whomever is their acquaintance or on the staff of the hospital that they are on the staff of. I found that two of the leading surgeons in the country for a problem that I had were at the regional academic medical center, but my doctor recommended people at the local community hospital. I have since in discussion found that to be a common pattern.It is true that I tend to refer to people I know. In my case, that tends to be the community specialists. I’ve met these physicians, talked with them, and read their consultant notes more frequently. I’m able to gauge patient satisfaction by asking how their experience was with a particular specialist.
I always give the option of going into Boston, or to a larger tertiary care center. The caveat is that I am not familiar with the specialists down there, so other than the reputation of the institution, I can’t give a more personal recommendation.
I try to present the pros and cons of both scenarios, but the ultimate choice is the patient’s.

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DTC drug advertisements are facing increasing scrutiny. To get around this, drug companies are resorting the “unbranded advertising“, where the name of the drug isn’t mentioned in the commercial. This relieves them of the responsibility of listing all the side effects of the medication.
Banning drug companies from advertising medications would be easier.

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In California, these doctors are not required to be licensed within the state, and have the power to veto any diagnostic or treatment plan by a patient’s primary physician.
Worse, they cannot be disciplined:
A huge snag in the system is that utilization review doctors without California licenses cannot be disciplined by the Medical Board of California for unprofessional conduct because they aren’t under board jurisdiction. Neither can they be prosecuted in the states in which they do have licenses, because those states don’t have jurisdiction in California.
These hired guns have a huge say in treatment and diagnostic decisions, and cannot be held accountable.
What a scam.

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Think physicians are rich or overpaid? You should read this.

Technorati Tags: blogging, technology, blog

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Buckeye Surgeon talks about a difficult case. The statistics are not on the patient’s side when they present with this.

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Mr. Jack of all trade is the one who knows all the important details in each trade, enough to help one get through a task. But though he has know-how in every field and industry, it is usually limited to an average level. Because of this, he becomes the “go-through” man for other people, the default guy in tight situations, but not the “go-to” guy, the one who will surely close the deal.

To be good in a lot of things means one has to spread himself thin, and by doing so leaves little opportunity to build the skill set required for one trade. This makes it difficult to advance to a higher level of expertise in a field. Without any specialization, Mr. Jack will have a hard time earning an outstanding claim that he can be recognized for. In the end, though his contribution might be significant, he is prone to stay in the shadow.
In tight situations, a Jack can be relied on to save the day, but the success is usually short lived. While the task is completed, a Jack’s intervention would most probably be the temporary solution, which will be enhanced or improved by an expert later on, that then will wash away the previous win.
Aside from feeding on fleeting plaques of appreciation to hang on his wall of pride, a Jack of all trade stands a slim chance in becoming a King. With so much to learn, so much to do, and so many […]

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As the cliche goes, the ink is barely dry on this year’s budget when action starts on the next one.
Yesterday the Executive Office of Health and Human Services held the first of two public hearings on their FY2010 budget. Yesterday’s event took place at the Reggie Lewis Center; a similar hearing was held today […]
Technorati Tags: cancer, breast cancer, technology, brain cancer, cancer treatment

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Technorati Tags: cancer, breast cancer, health, technology, brain cancer, cancer treatment

I’ve been saving our “Health Care Humor” tag for when/if Mitt Romney is selected as VP candidate, and has to walk back from chapter 58, his campaign’s claim for his signal achievement, but this new statement from McCain health plan author John Goodman is too good to pass up.
He claims that anyone who can go […]
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I’ve been saving our “Health Care Humor” tag for when/if Mitt Romney is selected as VP candidate, and has to walk back from chapter 58, his campaign’s claim for his signal achievement, but this new statement from McCain health plan author John Goodman is too good to pass up.
He claims that anyone who can go […]

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This midwife does about 200 to 300 births a year, at $1,000 per birth.
It doesn’t sound like she worries about malpractice. Is it because the Amish are less likely to sue?

Technorati Tags: health, free, life, ebook, women, nutrients

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Technorati Tags: health, free, life, ebook, women, nutrients

Miles Zaremski suggests a compromise to health care reform, blending the ideas from the left and right:
Why not provide a basic layer of health protection for all Americans funded with taxpayer dollars, with any additional coverage paid for by the individual, the employer, or both through the private sector? In this way, every citizen will be guaranteed a certain level of health care, while letting market forces take care of levels of health care above a certain floor.
One question needs to be answered before anything gets done. Namely, whether health care a right or not.
The country is split as to the answer to that question, mostly along partisan lines. Simply Googling this question will return a wide array of opinions. I’ve made my opinion on this quite clear in the past.
The easiest way to settle this would be to hold a national referendum, simply asking voters if there should be a right to health care.
This needs to be resolved first before proposing any health reform plan.

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I still have trouble getting those Smiling Bob Enzyte commercials out of my head.
Now the company’s founder is going to be doing some hard time.

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The switch from ICD-9 to ICD-10 codes is supposed to happen in 2011.
Providers get to look forward to almost a 10-fold jump in number of codes, but also an increase in claim denials:
HHS is predicting that claims-error rates will rise between 6 and 10 percent of all claims at the ICD-10 implementation date, up from a normal 3 percent rate typically seen for annual updates of ICD-9.
The cost of the switch will be $1.64 billion dollars. Isn’t the government supposed to take the initiative on saving administrative health care dollars, instead of allowing this bureaucratic nightmare to happen?

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A reader writes:I’m a hospitalist, and the primary care crisis here is getting really scary. Even as a hospitalist, you can’t imagine how many times a day I get asked by the lay public, “Are you taking new patients?”
Any thoughts about how the “falling house of cards” is going to appear? My prediction is sometime in the next 2-3 years. The issues just get worse and worse. And even from the inpatient viewpoint, I can tell you *nobody* is happy about the death of the PCP.Even when we take care of people in-house, we’re finding it harder and harder to find someone to send them to on the outside.
It’s getting scary all around. I worry about who’s going to take care of my own parents - their PCP is in his 70s.
Physicians have been banging the primary care shortage drum for the last few years. Only recently has mainstream media caught on and have started writing articles about it.
I don’t think we’re at total collapse yet. The situation is grim, but it is not perceived by the politicians to be severe enough to warrant action yet. Recent polling has health care trailing Iraq and the economy on the list of voter concerns.
Discussing the issues surrounding the primary care crisis and getting patients on our side is imperative. I try to do this with my blog and the various opinion pieces I write for the USA Today. Political action has to be forced by the public.
I anticipate […]

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Technorati Tags: health, media, blog

How not to do it.

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There is a difference, says ENT physician Bruce Campbell, and it rests in the relationships.

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A reader asks this question:I was wondering if you can answer a question on the 250-yard rule. I work in an emergency room and heard on the radio there was a stabbing in the same block as the hospital. Is it my obligation to leave the ER with a the physician and run to the site.? EMS was called and the police were responding.
We have much debate over this situation. Some employees feel it fits into the 250-yard rule, others feel it does not. Can you help us answer this question and set the record straight?
I have no idea. Can anyone help answer this question?

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The PSA test for prostate cancer screening has come under fire. First of all, it’s not very specific - meaning there is an unacceptable false positive rate (i.e. positive test in the absence of disease) for prostate cancer. This leads to biopsies and surgery that may not be needed.
The implications of this is becoming more widely publicized. Men are starting the realize the downsides of treatment, and understanding that more medicine isn’t necessarily better.
Tara Parker-Pope writes about a study where one in five men regretted undergoing prostate surgery. This suggests that the risks and complications of the treatment course were not fully understood by the patients.

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There is a clampdown on drug company gifts to physicians. Congress is even getting involved with the regulation.
But when it comes to influencing politicians, the sky’s still the limit. Just take a look at the pharmaceutical presence at the national conventions.

Technorati Tags: health

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