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Hospitalist Recommends A Way Out Of Medicare And Medicaid

Ask yourself this question:  Would you pay 20-30% less in insurance premiums if it meant you were locked into one hospital system for your health care?  I would.  That’s  what one hospital system in Massachusetts is offering to provide.  It is, essentially, a concierge hospital plan.   You or your employer will pay a set premium, which the hospital is offering at a 20-30% discount, and you get all your health care needs in their system, only going to a competing hospital system if they are unable to provide your necessary services.

What a great idea.  In fact, it’s an idea I have thought about previously for Happy’s hospital.  Why shouldn’t Happy’s hospital offer direct premiums to large and small business employers in our city in exchange for reduced pricing?  I’d sign up.  My health insurance premiums cost over $12,000 a year.  In the eight years of my practice, I’ve probably sent over $100,000 to health insurance companies and realized less than $10,000 in expenses.

It’s a concept who’s time has come.  In fact, direct concierge hospital plans also offer patients and their employers the opportunity for tiered pricing for special amenities  (flat screen television service, pet therapy dog service, dialysis spa, designer ostomy covers, wine vending machines, free soda machines, gourmet cookies, closer parking,  door-to-door service, and 24 hour special access to their physicians and nursing staff).

No more worries about Read more »

*This blog post was originally published at The Happy Hospitalist*

When Age Plays A Role In Medical Decision-Making

Missed Diagnosis Lawsuit and the Dynamics of Age Related to Risk

Years ago I had the opportunity to care for Mr Smith, a 101 year old man who presented to the hospital with chest pain and shortness of breath. Besides having  101 year old heart and lungs that tend to follow their own  biological clock,  this man also had a massive chest tumor filling 85% of one side of his thorax.

Whoah really?  What does that mean in a 101 year old man?  Most folks this age have exceeded the normal bell curve distribution of life and disease.  When you reach 101 years old, there isn’t a lot of chronic anything you can catch with the expected time you have left on earth.

Every now and then, however, we find patients who are the exception to the rule, such as the 101 year old guy that present with a new cancer diagnosis.  That’s where being an internist comes in handy. Read more »

*This blog post was originally published at The Happy Hospitalist*

Medicare Only Covers Some Medications During A Hospital Stay

One of the worst parts of my job over the years has been to tell patients I was going to bring them into the hospital as an observation status because they did not have any criteria for full inpatient status.  There is a huge difference in how CMS pays for hospital care (excluding critical access hospitals) between inpatient versus observation.

Observation is considered outpatient.  Medicare will pay for observation hospital services for up to 48 hours to allow physicians a chance to observe the patient and determine if they need to have an inpatient hospital admission.  Observation was never intended to be used as a holding pit  to help social workers arrange for a nursing home transfer during normal business working hours because it can’t be arranged, on either end, at 10 pm on a Friday night.
What used to be a moral family obligation to care for loved ones too weak to care for themselves has now been relinquished to the role of hospitals and hospitalists.  And we all pay for it.  Families have abandoned their loved ones for good.  It’s really quite sad.  Bringing patients into the hospital for the purpose of arranging a nursing home transfer is, in my opinion, a form of Medicare fraud, since these patients have no intention of being fully admitted.

But it’s paid for and will always be paid for, except when Read more »

*This blog post was originally published at The Happy Hospitalist*

Fifteen Years Ago Vs. Today: How Much Debt Do Med Students Accumulate?

The total debt cost of medical school has become obnoxious.  When I started medical school 15 years ago this month, I took out approximately $2,000 a month in loans.  $1,000 a month for all living expenses, including food, rent, utilities and entertainment and $1,000 a month for tuition and related expenses.  I got out of medical school with just under $110,000 in loans for which I am currently paying back at a rate of $500 month for 30 years.

I learned the other day that a family medicine resident recently completed medical school with almost $250,000 in medical school loans. Family medicine?  $250,000?  Are you crazy?  If that resident can lock in a 30 year loan at 3.5%, they’re looking at monthly payments of $1,200 a month for the rest of their lives.  With current tax rates, this family resident will need to earn at least Read more »

*This blog post was originally published at The Happy Hospitalist*

Study Shows That Medicare Pays More For Patients Cared For By Hospitalists

Association of Hospitalist Care With Medical Utilization After Discharge:  Evidence of Cost Shift From a Cohort Study.

That’s the title of the latest medical study making the viral rounds.  I had an opportunity to read the study in full.  I called Happy’s hospital library and Judy had the pdf article in my email in less than 24 hours.  Now, that’s amazing.  Thanks Judy for a job well done.  You deserve a raise.

Presented in the August 2nd, 2011 edition of the journal Annals of Internal Medicine, Volume 155 Number 3 Page 152-159, the study concludes that decreased length of stay and hospital costs associated with hospitalist care are offset by higher medical utilization and costs after discharge.

In summary, hosptitalist patients had an adjusted length of stay 0.64 days shorter and $282 less than patients cared for by primary care physicians, but total 30 day post discharge costs were $332 higher.  These additional charges were defined as 59% from rehospitalization, 19% from skilled-nursing facilities, and 22% from professional and other services.

OK fair enough.  Let’s come to that conclusion.  Let’s say Read more »

*This blog post was originally published at The Happy Hospitalist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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