April 1st, 2011 by Debra Gordon in Health Policy, Opinion
No Comments »
Who would have thought when we first looked upon you a year ago, barely formed, still somewhat embryonic, that you would have grown so much in just a year, and created so much, well, trouble? Yes, I’m talking about you, health reform. After all, aren’t you the reason for the sea change in Washington? Aren’t you behind several pending appeals that will get to the Supreme Court? Aren’t you the reason that the country is going to hell in a handbasket?
But wait. Let’s look at some other major milestones of the past year.
— You sent $250 checks to Medicare beneficiaries to help cover the “donut hole” in their drug coverage.
— You created special insurance pools designed to provide health care NOW to people with preexisting conditions who can’t get coverage.
— You allowed parents to keep their kids on their health insurance until the children turn 26, providing a major safety net.
— You did away with lifetime caps, enabling those with some serious medical conditions to continue receiving health insurance.
And that’s just in a year. Imagine what the next year and the year after that will bring. So I’ll say it again, Happy Birthday, Healthcare Reform. May you live to a ripe old age and only get better.
*This blog post was originally published at A Medical Writer's Musings on Medicine, Health Care, and the Writing Life*
April 1st, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
No Comments »
The larger the bureaucracy the more inefficient a system becomes. Several things can happen in the decision making process.
1. The decision making process can become opaque rather than transparent.
2. Decisions are made by a committee by consensus.
3. Consensus committee decisions might not sharply define the original goals.
4. Blame for errors gets dissipated.
5. Decisions are only as good as the information that is gathered.
6. Changing a wrong decision can be difficult and costly.
President Obama’s healthcare reform law is creating 256 new agencies to gather information and recommend decisions for other agencies to write regulations.
The following decision is being made by an agency in Washington state. It is not only the wrong decision, but is a decision that will set back the care of Type 2 Diabetes Mellitus 15 or 20 years. It is a decision being made using the wrong information. Read more »
*This blog post was originally published at Repairing the Healthcare System*
March 31st, 2011 by John Di Saia, M.D. in Opinion
No Comments »
For years I have avoided Medicare breast reductions for a number of reasons:
(1) Poor pay for hours of work. An average breast reduction when done to a high standard usually takes 3-4 hours. I do not staple the closure.
(2) Medicare patients due to their age are at higher risk for wound healing problems.
(3) 90 day global fee period – These patients routinely need follow-up care and that care is not billable.
Recently I ignored my better judgment and performed the operation for a lady in whom back pain (ICD-9 724.5) and back surgery had been long term problems. She also had a pretty nasty rash (ICD-9 692.89 Dermatitis and eczema [in the infra-mammary fold]) under her right breast that just wouldn’t go away. These of course were all in addition to the usual diagnosis of large breasts (ICD-9 611.1 Hypertrophy of breast.)
Medicare showed me yet another reason for my hesitation to do these cases when they denied payment for the operation saying it was not medically indicated. They will probably pay on appeal, but the thought that I should have to appeal the case adds insult to injury.
*This blog post was originally published at Truth in Cosmetic Surgery*
March 30th, 2011 by Emergiblog in Health Policy, Opinion
1 Comment »
We hear so much about health care fraud and how much it costs us all in terms of higher Medicaid, Medicare and private insurance costs, and if we could just rein in this fraud we could make our health care system pay for itself.
My trusty Mac widget dictionary defines fraud as:
- a person or thing intended to deceive others, typically by unjustifiably claiming or being credited with accomplishments or qualities and
- wrongful or criminal deception intended to result in financial or personal gain.
Well, I’m wondering, what is actually considered fraud?
Let me give some examples, and help me understand whether or not this is fraudulent behavior. The examples are purely hypothetical and do not represent any known individuals, living or dead, or specific situations in any known emergency department, living or dead. Read more »
*This blog post was originally published at Emergiblog*
March 29th, 2011 by AnneHansonMD in Opinion, Research
No Comments »
I briefly scanned the Robert Wood Johnson synthesis report on mental and medical co-morbidity so I thought I’d summarize the highlights for the blog. If you’d rather watch the recorded web seminar you can hear it here.
The report relied on systemic literature review to look at the relative risk and mortality associated with co-morbid medical and mental health conditions. The looked at studies using structure clinical interviews, self-report, screening instruments and health care utilization data (diagnostic codes reported to Medicaid).
This is what they found:
- 68 percent of adults with a mental disorder had at least one general medical condition, and 29 percent of those with a medical disorder had a comorbid mental health condition
- These findings support the conclusion that there should be strong integration of medical and mental health care Read more »
*This blog post was originally published at Shrink Rap*
