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Medicare Ramps Up Rationing Of Cardiac And Orthopedic Care

With the announcement that the Center for Medicare and Medicaid Services (CMS) will begin auditing 100% of expensive cardiovascular and orthopedic procedures in certain states earlier this week, we see their final transformation from the beneficent health care funding bosom for seniors to health care rationer:

The Center for Medicare and Medicaid Services will require pre-payment audits on hospital stays for cardiac care, joint replacements and spinal fusion procedures, according to the American College of Cardiology in a letter to members. Shares in both industries fell with Tenet Healthcare Corp., the Dallas- based hospital operator, plunging 11 percent to $4.18, the most among Standard & Poor’s 500 stocks. Medtronic Inc., the largest U.S. maker of heart devices, dropped 6 percent to $34.61.

The program means hospitals won’t receive payment for stays that involve cardiac care or orthopedic treatment until auditors have examined the patient records and confirmed that the care was appropriate, Jerold Saef, the reimbursement chair for the Florida chapter of the American College of Cardiology, wrote in a Nov. 21 letter to members. The review process is expected to take 30 days to 60 days, beginning January 1, Saef said.

This is not at all unexpected. In fact, Read more »

*This blog post was originally published at Dr. Wes*

Reducing Health Care Spending: When Rationing Resources Goes Too Far

A sure-to-be controversial article appears in the Chicago Tribune earlier this asking the sensitive question of ‘Health care at any age, any cost?:’

“If you want to save all lives, you’re in trouble,” said Callahan, co-founder of The Hastings Center, a bioethics research institute in New York, and a faculty member at Harvard Medical School, in an interview. “And if you want to save all lives at any cost, you’re really in trouble.”

Callahan and co-author Nuland, a retired professor of surgery at Yale School of Medicine who wrote the best-selling “How We Die,” were both 80 when the article was published.

“We need to stop thinking of medicine as an all-out war against death, because death always wins,” said Callahan.

The article goes on the make some bold demands of doctors: Read more »

*This blog post was originally published at Dr. Wes*

The Health Care Rush During The Holiday Season

Like Christmas season advertising, the holiday crunch for procedural medicine is coming earlier every year.

Perhaps that’s why the posting on this blog as suffered: we’re busier than ever.

Why is this?

I suspect it’s because of a variety of forces that are coming together to create the great procedural “perfect storm” this time of year.

Perhaps the most important contributor to the holiday rush is the patients themselves. Patients are Read more »

*This blog post was originally published at Dr. Wes*

Would The Occupy Wall Street Movement Be Effective In Health Care?

As Occupy Wall Street spread across the nation, I can’t help but wonder if the same movement could occupy health care. After all, the basic tenants of the movement involve protesting against social and economic inequality, corporate greed, and the influence of corporate money and lobbyists on government. In the “Occupy” movement, there is a feeling there’s an inside game and the game is rigged.

It would seem, then, that our new health care law, written by corporate interests and heavily influenced by lobbyists, could become a ripe target for the movement. We are beginning to see Read more »

*This blog post was originally published at Dr. Wes*

Even With Health Care Reform, Many Will Still Encounter Problems

Trudy LiebermanA couple weeks ago I walked the streets of Lincoln, Nebraska, talking to men and women about whether they thought Washington was listening to their economic concerns.  Jeff Melichar manages his family’s Phillips 66 gas station on the city’s main street, and one of his big financial problems happens to be health insurance.  The more we talked, the more I realized what a jam he could be in down the road because of a loophole in the health reform law, which has received almost no press coverage or public discussion: If you have health insurance from your employer, you may have to keep it whether or not it’s adequate or affordable.  Buying less expensive or better coverage from one of the state “exchanges” or shopping services will be off limits.  So despite all that talk about consumer choice, for many like the Melichars, there may be no choice.

Melichar’s wife is eligible for health insurance from the optical company where she works.   But the family waited until this fall to enroll when the firm offered coverage they finally could afford.  Their premium is Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

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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