This is something I haven’t seen reported on elsewhere, but according to the ACEP 911 Legislative Network Weekly Update, there was an interesting twist in the Democrats’ proposed SGR fix:
The latest plan increases physician payments by 1.3% for the remainder of this year and by an additional 1% in 2011. In 2012 and 2013, physician services would be separated into two categories, or “buckets.” One bucket would be for E&M services (including emergency department, primary and preventive care) and the other group would include all other services. The E&M bucket would increase at the same rate as the U.S. gross domestic product (GDP) plus 2%, while the other group would receive a payment increase of GDP plus 1%.After 2013, the payment formula would revert back to the current SGR formula, which means physicians would face cuts in the range of 30-35% unless Congress intervenes.
So it’s another temporary fix, kicking the can past the next presidential election. But it’s the first one I have seen that attempts to address the gross disparity in reimbursement for procedural services compared to the cognitive services. It bypasses the RUC and almost every other existing mechanism for determining reimbursement under the MPFS.
I’m not sure what happened with this proposal. I don’t think it was in the version of legislation the House passed, so I think it might be dead. But the situation is so in flux that who really knows? If nothing else, it’s an encouraging sign that policymakers know the problem exists and are willing to throw out possible solutions. This one may be dead, but it’s a good start.
*This blog post was originally published at Movin' Meat*
I was about to leave work a few nights ago when EMS was dispatched to a 10-50, which is a motor vehicle accident.
Enough years in emergency care and that tone makes your radar, but doesn’t create much of a blip. Many of those crashes have EMS arrive, only to discover no injuries. Some have patients transported, with minor problems that lead to their speedy evaluation and discharge from our ER. A few have serious, life-threatening injuries. They take all our speed, skill and attention to save life and limb. And often, require transfer to other facilities.
But this last call was none of those. Around 1AM the radio traffic crackled back to dispatch (which we could hear in the emergency department): “Probable Signal Nine.” Signal Nine means the victim is dead at the scene. Not “Dead On Arrival” (DOA) at the hospital, but no hospital necessary.
I knew the paramedics were finished when they asked dispatch to call for the coroner. And my heart sank a little. For all that a multi-trauma is work, I’d rather do it anytime than have someone die, and someone learn of the death. Read more »
*This blog post was originally published at edwinleap.com*
Dr. Wes and Kevin, M.D. have both written reviews of the documentary film “The Vanishing Oath.” I started the process rolling of trying to get the film shown locally. No date yet, but looks like it will happen before the year is out.
This is not a new phenomenon in medicine (or any profession). Dr. Robert Goldwyn wrote a nice essay on the some of the issues that can lead to burnout, though not once did he mention burnout specifically. The title says much:
“I Bargained on Working Hard as a Surgeon, Not Working Hard to Be Able to Work Hard as a Surgeon”
The preceding title is a quote from a letter written by a resident in the last year of his training (S. A. Teitlebaum, August 20, 1994). It reflects the gloom besetting the young in particular but certainly not them exclusively. We all are uneasy about our futures, professionally and economically. Bandied in the corridors at a national meeting was a dismal figure: 1:100,000, the presumed proper ratio, as determined by Health Maintenance Organizations, of plastic surgeons to population. That 1 million Americans need only 10 plastic surgeons seems wrong and idiotic to me, but it makes good economic sense to health providers and insurance companies. Their coffers swell as they collect the same or higher premiums while curtailing what they provide.Read more »
Medical malpractice is a major issue that divides doctors and lawyers — with patients often left in the middle. I wrote last year in USA Today that reform is sorely needed, mainly to help injured patients be compensated more quickly and fairly than they currently are:
Researchers from the New England Journal of Medicine found that nearly one in six cases involving patients injured from medical errors received no payment. For patients who did receive compensation, they waited an average of five years before their case was decided, with one-third of claims requiring six years or more to resolve. These are long waits for patients and their families, who are forced to endure the uncertainty of whether they will be compensated or not.
And with 54 cents of every dollar injured patients receive used to pay legal and administrative fees, the overhead costs clearly do not justify this level of inefficiency.
In this video excerpt from The Vanishing Oath, a film directed by Ryan Flesher, M.D., perspectives from both sides are given, and it’s easy to see why this contentious issue isn’t going to be resolved anytime soon:
*This blog post was originally published at KevinMD.com*
It seems that each year, I just miss National Dog Bite Prevention Week, which is the third full week of May. As you know, it’s June already. But can it ever hurt to review such important information?
More than 4.7 million people a year receive bites from man/woman’s best friend. If you have read this blog for very long, you know I dearly love my dogs — deceased ones (Columbo, Ladybug, and Girlfriend) and the living one, Rusty. I have no illusions that dogs bite, and given the right provocation I think mine would (although most of the time they are totally harmless and would just invite you in to rob me).
Most dog bite-related injuries occur in children 5 to 9 years of age. Almost two thirds of injuries among children 4 years or younger are to the head or neck region. Dog bites are a largely preventable public health problem, and adults and children can learn to reduce their chances of being bitten. Read more »
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It seems that each year, I just miss 
