Physicians, Business, Professional and Information Technology Communities
Networking to Restore Accountability in HealthCare & Medical Practice
Tuesday, February 24, 2004
MedicalTuesday refers to the meetings that were traditionally held on Tuesday evenings where physicians met with their colleagues and the interested business and professional communities to discuss the medical and health care issues of the day. Mondays and Fridays were busy days in most medical practices, and on Wednesdays and Thursdays physicians traded half days off to compensate for the night and weekend work. Thus, MedicalTuesday was the only day of the week that most physicians could get together. As major changes occurred in health care delivery during the past several decades, the need for physicians to meet with the business and professional communities became even more important. However, proponents of third-party health care felt these meetings were counter productive, and they essentially disappeared. Health care rationing was introduced in this country through government-endorsed Health Maintenance Organizations (HMOs) and Managed Care Organizations (MCOs) under the illusion that this was free enterprise. Instead, the consumer (the patient) lost all control of personal health care decision making, the very antithesis of freedom.
MedicalTuesday welcomes you to the reestablishment of this network between physicians and the business and professional communities using the innovation of the World Wide Web. We have included the Information Technology community because of its important application in the provisions of health care. Recently, the governments involvement with Information Technology through HIPAA produced disastrous results. Patients are recognizing that with this additional government intrusion, their private and confidential information is made available, without their knowledge, to other government bureaucracies that have no need to be involved in their health care. In addition, the free exchange of confidential health care information between doctors and health care providers necessary for a patients health and welfare is being obstructed.
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In This Issue:
1. Greenspan Tries to Instill Responsibility for Social Security and Medicare Entitlements
2. Are HealthCare Jobs Also in Jeopardy of Going Offshore?
3. Doctors Must Follow 250,000 Pages of Medical Directives, Laws, Rules and Regulations
4. This Week's Reference to Socialized Medicine
5. Medical Gluttony or Excessive HealthCare Costs
6. Overheard in the Medical Staff Lounge
7. The MedicalTuesday Recommendations for Restoring Accountability in Medical Practice, HealthCare and Government
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1. Greenspan Tries to Instill Responsibility for
Social Security and Medicare Entitlements
It's difficult to remain focused on our primary goal of reducing health care costs and making health care affordable and accessible to all Americans, and by extension to the rest of the world, when there are so many political interferences. There is also the danger of being labeled as biased and insensitive. However, improving the human condition is a risky endeavor and subject to many sound bites from those with ulterior motives (without much substance).
Alan Greenspan, Chairman of the Federal Reserve Board, recently told Congress that they should make President Bush's tax cuts permanent and cover the trillion dollar costs by trimming future benefits in the Social Security and other entitlement programs, in particular Medicare. As chairman of a Social Security Commission on funding crises in 1983, he had already maintained that the promised program benefits greatly outweighed the government's ability to pay for them. He recommended indexing the retirement age since the population is living so much longer. Greenspan also stated that there is some urgency in doing this now because of a looming wave of 77 million Americans from the baby-boom generation nearing retirement. Why wait until the government discovers it does not have the resources to meet the baby boomers needs?
When Social Security was implemented, the average life expectancy was less than the retirement age of 65. If it had been indexed, Social Security benefits, which includes Medicare, would now start at age 75, the current average life expectancy in the US. Had this occurred, Social Security, and subsequently Medicare, would have remained solvent. With 40 million Americans already receiving government benefits, it will be impossible to restore fiscal responsibility after an additional one-fourth of Americans receive government benefits. No politician would risk the wrath of so many voters by instilling responsible fiscal policies at that time.
It is beyond the stretch of reality for so many Americans, including organized and unionized medicine and physicians running for public office, to still feel we can fund and pay for the health care of the remaining two-thirds of Americans. It is important to look back to the democracy-to-entitlement sequence described by a professor in Scotland. Only by knowing the dynamics can we avoid the following sequence:
A professor at the University of Edinborough once stated, "A democracy cannot exist as a permanent form of government. It can only exist until the voters discover that they can vote themselves money from the public treasury. From that moment on, the majority always votes for the candidates promising the most money . . . with the result that a democracy always collapses over loose fiscal policy [which is] followed by a dictatorship.
The average of the world's great civilizations has been two hundred years. These nations have progressed through the following sequence: from bondage to spiritual faith, from spiritual faith to great courage, from courage to liberty, from liberty to abundance, from abundance to selfishness, from selfishness to complacency, from complacency to apathy, from apathy to dependency, from dependency back into bondage."
Professor Joseph Olson of Hamline University School of Law, St. Paul, Minnesota, believes the U.S. is now somewhere between the "complacency" and "apathy" phase of this definition of democracy, with some 40 percent of the nation's population already having reached the "governmental dependency" phase.
The Mission of MedicalTuesday is to prevent the bondage that will occur with single-payer or socialized government medicine!
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2. Are HealthCare Jobs Also in Jeopardy of Going
George Will, in his Washington Post OpEd column this week, gives the prize for the pithiest nonsense to House Speaker Dennis Hastert for stating, "An economy suffers when jobs disappear." Politicians cannot grapple with the reality that "the economy did not seem to be suffering in 1999, when 33 million jobs were wiped out - by an economic dynamism that created 35.7 million jobs." In a recent Wall Street Journal OpEd column, Carly Fiorina, CEO of Hewlett Packard, put this in perspective as they began outsourcing jobs. HP and the eight-member Information Technology think tank have invested $80 billion in Research and Development, capital expenditures, education and employee training in the U.S. over the past three years alone. We're betting on - and investing in - America. It's why HP, with a market presence in 178 countries, will always be based here, and why we have 60,000 workers here - because America is the most innovative country on earth. It won't stay that way if we run away from the reality of the global economy. More than 70,000 computer programmers have lost their jobs since 1999, but more than 115,000 higher paid computer software engineers have gotten jobs since 1999.
George Will points out that politicians focus on the 3,000 jobs that IBM is sending overseas rather than the 4500 jobs IBM is creating this year. They focus on the $25 million Delta Airlines is saving as a result of sending some reservation services to India rather than how this is improving the health and security of the jobs and pensions of most airline employees. How many medical jobs are made more secure when practices send their transcriptions to India? Or physician call centers? And, recently, x-ray interpretations?
A friend tells me that the average wage of an engineer in Silicon Valley is about $60,000 per year for a 40+ hour week. That same job can now be outsourced to India to a fully trained engineer with the same skills for $20,000 per year. The engineer in India works a 12-hour day for six days, averaging 72+ hours a week. This increases productivity almost fivefold for the same cost. ($100,000 in salary for an American to work the same hours that the Indian works for $20,000.)
How can a physician's office productivity be increased? It is estimated that the paper work, delays for managed care oversight, treatment authorization requests, treatment denials, reexamining of the patient to determine alternate modes of covered therapy, Medicare and Medicaid micromanaging, insurance company delays in payment, insurance companies demands to doctors on how to practice medicine, pharmacy costs secondary to restricted formularies, telephone calls from pharmacies to ask for alternate drug treatments, cost of re-billing and third billing, unpaid phone consultations, unpaid email consultations, (to name just a few), decrease the productivity of a physician's office by at least 30 to 40 percent. The physicians listed at the end of this newsletter have eliminated most of these costs and have been able to reduce their professional fees by 30 to 40 percent by accepting only cash payment. Today's newspaper advertises a total body CT scan (head, chest, heart, abdomen, pelvis and bone density) for $600 or $1,000 for a patient and spouse. Paying cash at the time of service eliminates all the paper work and delays mentioned above and results in a 60+ percent reduction in the usual fee.
In 2002, a surgical practice in Chicago reported that 66 percent of its total revenue came from claims originally underpaid or denied by health plans. This revenue would have gone uncollected if the practice had not implemented auditing and health-plan appeal strategies. According to the Advisory Board Co, approximately 67 percent of denials are recoverable by implementing claims audit and appeal strategies. There is now an entire CD-ROM program available to collect what insurance companies deny. How can a physician, who already averages a 65-hour work week, spend additional time and money to hire extra employees to navigate the drag in our system? The answer is to eliminate all the road blocks that make health care inefficient. The payment for services should be straight forward and not require another bureaucracy to navigate the previous bureaucracy.
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3. Madeleine Pelner Cosman, JD, PhD, Esq, States
Doctors Must Follow 250,000 Pages of Medical Directives, Laws, Rules and
In our November 25, 2003 newsletter, we discussed that you may own your body parts, but Who Owns Your Body,? the title of a book in progress by Dr Madeleine Cosman, a medical law attorney. She points out how the government has superior rights to yours in deciding and controlling treatment, or withholding treatment, of your body. She also reminds the public that America's physicians must obey 132,720 pages of government directives, laws, rules and regulations, including 111,000 pages of rules that directly control Medicare. Recently, the government attempted to replace the 8000-code Current Procedural Terminology (CPT) system with a new 170,000-code system that will further complicate medical billing and make it even more costly. (HealthPlanUSA is in the process of simplifying the 8000 codes to half or one-fourth that number.) There are 761,000 practicing physicians subject to the increasingly criminal medical laws. Choosing the wrong CPT billing code can be punishable by fines, and possible jail terms, and has nothing to do with the quality of medical care. Dr. Cosman's book is a key to unlocking meanings of these restrictions upon physicians and patients. For a discussion of the False Claims Act and Qui Tam Actions and Emergency Medical Treatment and Labor Act please see www.healthplanusa.net/MPCosman.htm. The Introduction to Dr Cosman's book can be found at www.healthplanusa.net/MC-WhoOwnsYourBodyIntro.htm, where the Chapter Summaries will also become available for your review.
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4. This Week's Lesson About Socialized Medicine
I have a Japanese-American patient who lost her husband some years ago. Being a war bride, she considered returning to Japan where her sister, brother and aunt still live. She went to visit them with the intention of possibly starting the return process. In view of her need for immediate access to health care, she felt it was important to check the accessibility of health care in her homeland, should she return.
She has had relatively resistant tuberculosis that has been reactivated three times in three decades. She has had bilateral chest surgery to remove scarred cavitary dead lung tissue in both upper lobes and a mutilating thoracoplasty, a process where five upper ribs were collapsed in order to place that portion of the lung at relative rest. This facilitates healing when drugs are less than effective. She had one activation on receiving a cortisone shot from a dermatologist. Her pulmonary function is about one-fifth normal, below that required for major surgery.
She found that Japan has universal health care. She thought this should provide the care she needed for her lung disease. As she explored the issues with her family and the local hospitals, she discovered that Universal Health Care did not mean Universal Access to HealthCare. She observed people waiting months for treatment. She came to the conclusion that if she had another tuberculosis reactivation in Japan, she would likely die before treatment could be obtained.
When I saw her again for the next annual exam and x-rays, she stated that although she had no family in this country, save for a sister-in-law in Wisconsin, she would not return to Japan and its universal health care because she would not have immediate access to this health care, something she enjoys in the United States. She continues to come in for her annual exam or whenever she feels her pulmonary state is getting worse.
The key concept if you missed it, is that she feels the United States has a more universal access to health care than her country with its government-provided universal health care. Why are there still some individuals that want to take our access to health care away from us and replace it with a government program that can't deliver? It appears that the chief of our federal reserve bank (Item 1) doesn't feel we can even deliver our current promise for providing seniors with the present level of coverage.
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5. Medical Gluttony or Excessive HealthCare Costs
In this section, we point out the excess costs that our third-party health care system engenders. It is pervasive and relatively immune to the concept of reality. This disconnect is made possible because of the lack of personal responsibility stemming from multiple causes. A frequent generic problem is the patient who comes in for an annual physical examination, when a physical examination of his body is the furthest from his mind. Sometimes he resents disrobing and having his body examined. Instead he is speaking of complete chemistries, lipid panels, thyroid panels, arthritis panels, x-rays, CTs, MRIs, multiple consultations in order to obtain a colonoscopy, ultra sounds and other examinations, all limited only to the extent of his medical search on the internet. When he is told that his last set of studies were normal and that current guidelines suggest a five- to ten-year interval between certain tests, he's convinced that we are working against him in concert with the insurance company. His expectations preclude learning anything about health care needs. Learning is only facilitated by placing HealthCare in the open competitive Medical MarketPlace. When the patient has to pay a percentage of the health care cost, the entire attitude and frame of mind changes from that of a wanting more and more childish attitude to that of a mature adult asking, "Doctor, which test do you think I really need that cannot be put off until next year?" There is a 500 percent savings in health care costs in performing a test that should be done every five years rather than every year. In the last issue we quoted John Sheils of the Lewin Group who stated, "There is very little in health care you can trim off," which is an administrative understanding of the issues. There are hundreds of percents that can be trimmed off when the patient is financially motivated to do so. Health care is very elastic, flexible and postponable, as the rest of world has well demonstrated with year-long waiting lists.
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6. Overheard in the Medical Staff Lounge
An internist was mentioning that his patient declined a physical examination of her body and only wanted tests performed, including a mammogram that came back with a normal report. She had felt a lump for several months which she had not disclosed to her physician. After another three months or so she decided to come back and have her doctor examine her since she felt this large lemon-size mass in her breast just under the skin could be important, even if it was not seen on the mammogram. It turned out to be a ductal carcinoma. Some of her lymph nodes were positive. She had such faith in modern technology that she tried to bypass the standard procedure of a medical evaluation. It may have cost her her life.
A traditional medical evaluation first includes the complete medical history, which requires about 30 minutes on the initial visit and gives about 65 percent of the information necessary to determine the diagnosis. The complete physical examination, which takes about another 15 minutes, confirms this information and may give 10 percent further diagnostic information. The last 15 minutes of the first hour on a new patient is used to begin treatment and to determine what further laboratory, x-rays and other tests are needed. This treatment and further testing improves the diagnosis another 15 to 20 percent. The information becomes available and is discussed on the return visit. Thus, an amazing 90 to 95 percent of a diagnosis is established by one consultative and follow-up visit when following this routine. Of course, follow-up examinations may take only 10 or 15 minutes but always rely on the recorded detail of the initial complete examination.
The lady mentioned above, by avoiding the physical examination of her breast, delayed treatment of her cancer more than six months. It is possible that the cancer spread may have occurred during this six-month period of relying on technology rather than the results of the full examination sequence. As IT use increases and streamlines many of the steps involved, it is even more important that your physician evaluate all the data on a continuing basis. It is the patient's life that is always at stake.
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7. MedicalTuesday Supports These Efforts of the Medical and Professional Community in Restoring Accountability in Medical Practice, HealthCare and Government
Madeleine Pelner Cosman, JD, PhD, Esq, President of Medical Equity. This week we add Dr Madeleine Cosman to our list of individuals making important efforts in restoring accountability in health care. Please visit www.healthplanusa.net/MPCosman.htm to view some of her articles that are important to the practice of medicine and health care in general.
David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. We also add Dr David Gibson for his contributions to the free Medical MarketPlace. His series of articles in Sacramento Medicine can be found at www.ssvms.org and additional articles at www.healthplanusa.net/DavidGibson.htm. Congratulations are in order for getting a series of articles into Organized Labor including Fraud, Why Does Health Care Cost So Much, and The Feminization of Medicine and its Implications. www.sfbctc.org
Dr Richard B Willner, President, Center Peer Review Justice Inc, reports his latest success story and the secret of helping doctors keep their medical license. On a daily basis, doctors are reviewed, are suspended, lose their medical licenses and go to jail on trumped-up charges that most attorneys don't understand. To stay posted with a wealth of information see www.peerreview.org.
PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, provides prompt care for many of the injuries and illnesses treated in Emergency Rooms at a fraction of the usual emergency room fees. For a listing of his fees and payment policy see www.emergiclinic.com. To see how Medicare treats doctors who don't participate in the rules and regulations, click on Medicare's absurd impact on PATMOS.
Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), www.sepp.net, for making efforts in Protecting, Preserving, and Promoting, the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals, with a special page for our colleagues in nursing. Several free newsletters are available. Be part of protecting and preserving what is right with American Healthcare physicians, nurses, pharmacists, psychologists, all health professionals and all concerned individuals are urged to join.
Dr Vern Cherewatenko for success in restoring private-based medical practice which has grown internationally through the SimpleCare model network, www.simplecare.com. Any patient or provider may become a member of SimpleCare. There is a section on the History of Complementary and Alternative Medicine which is becoming increasingly popular.
Dr David MacDonald started Liberty Health Group, www.LibertyHealthGroup.com, to assist physicians in controlling their own medical benefit costs for their staff and patients. There is extensive data available for your study. He is available to speak to your group on a consultative basis.
Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column that is now at NewsMax. Please log on to read or subscribe at www.newsmax.com/pundits/Medicine_Men.shtml. This week's column is on Doctors vs Government and can be found at www.newsmax.com/archives/articles/2004/2/18/102139.shtml.
The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine and loss of medical privacy. Be sure to scroll down to departments and The AAPS News, written by Jane Orient, MD, and archived on this site providing valuable information on a monthly basis. Scroll further to their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. The website is a cyberspace library for books of interest, brochures, the journal, as well as congressional testimonies, fraud, economics, action alerts and health care news. It's worth spending an hour a month on a MedicalTuesday to review items of medical and health-care interest.
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Stay Tuned to the MedicalTuesday.Network and Have
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We appreciate the international response we are receiving and look forward to meeting some of you at international meetings. Apparently, professionals throughout the world look up to America to solve the health care problems without government enslavement. With your help we can do this.
Del Meyer, MD, CEO & Founder
"If you think health care is expensive now, wait until you see what it costs when it's free." - P.J. O'Rourke
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Tammy Bruce: The Death of Right and Wrong
(Understanding the difference between the right and the left on our culture and
Reviewed by Courtney Rosenbladt