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PECOS: A Back Door Way To Force All Physicians To Accept Medicare?

This upcoming January 4, 2010 will prove an important date for any physician who prescribes durable medical equipment for their patients to use in the home.  The Centers for Medicare and Medicaid Services (CMS) have implemented an internet-based enrollment process for Medicare termed PECOS, another progeny of the 1996 HIPAA legislation.  PECOS stands for Provider Enrollment, Chain and Ownership System and was created in large part to prevent fraud.  Yet when I called the PECOS helpline, fraud was not a concern, and it was explained to me that PECOS is an internet version of my Medicare Application.

Since my practice makes house calls, we treat a variety of home-bound patients unable to make it to a doctor’s office without great effort.  We care for stroke patients, quadriplegics, those with end-stage pulmonary disease, and many simply weakened by the effects of advanced age.  Most need equipment like mattresses to prevent recurrent pressure sores, wheelchairs, nebulizer machines, or oxygen.  A patient depends on their physician’s ability to order anything necessary, and it is imperative this be done without creating an exorbitant financial burden or by denying them a Medicare benefit already paid for. But, according to our Home Supplier, if we haven’t enrolled by January 4 then our Medicare & Medicaid patients will have to pay 100% of the cost for any equipment prescribed. Read more »

Secrets to Weight Loss: The Body Doesn’t Lie

Now a couple weeks after Thankgiving, an important concept to remember is the following:

The body doesn’t lie.

We’ve all eaten a little too much. If we’ve done any exercise, then it is likely standing in line during Black Friday (or clicking the mouse on Cyber Monday). We should not be shocked about some weight gain. Although my patients find it hard to believe, the body doesn’t lie and are stunned that they continue to gain weight in subsequent office visits. It can’t be due to anything they are doing. Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

Is Medicine No Longer A Calling?

As I sit here in a medical innovation conference – I find myself becoming more and more angered by one of the speakers. A man with an MBA and fancy title from PriceWaterhouseCoopers is lecturing us about how doctors are essentially money-grubbing, change-resistant, quality-care avoiding “pains in the you-know-what,” obstructing progress in healthcare reform and blocking technology adoption.

His lack of understanding of the complexity of medical care was breathtaking. And yet, he expresses a sentiment that I’ve witnessed all too many times.  Here are a few choice quotations: Read more »

The Flu Vaccine: A Break Up Letter

Dear Influenza Vaccine:

I am sorry to be so formal, but using your pet name, “flu shot”, doesn’t seem appropriate in a letter like this.  I am also sorry to be writing this letter; I don’t want you to be hurt and I don’t want others to think bad of you.

I just don’t love you any more and want out of our relationship.

Don’t get me wrong; I still think you save lives.  You are strong, noble, and deserving of appreciation.  You give to my patients what I seek to give them: a longer life with less sickness, and you do so without much cost.  I will never think badly of you in that way.  I even want to continue meeting with you every year.  I don’t want to lose touch.

But things have gotten hard for me.  You give so much to others, yet you make my life so very hard.  I never know how many people will want you, and yet I have to order you six months or more in advance.   Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Trapped in Family Medicine. Can This Marriage Be Saved Act I: The PCP Encounter

Last week, I introduced the key characters in the parody of family medicine which I entitled, Trapped in Family Medicine. Can This Marriage Be Saved.

As the scene opens, we see a typical day in the waiting room of a family practice: the primary care physician (PCP) is 45 minutes behind schedule. The room is packed with frustrated patients who glare accusingly at the receptionist, transferring their feelings of resentment to her for this routine and expected predicament.

Every few minutes someone storms to the front desk, demanding: “How much longer will it be before I’m seen?” … “My time is valuable.” …“I’ll send the bill for my time to PCP and see how he likes it!”…“What makes the PCP so special?”… “This wait happens every time I come and I’m not waiting anymore!”
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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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