Physicians, Business, Professional and Information Technology Communities
Networking to Restore Accountability in HealthCare & Medical Practice
Tuesday, June 22, 2004
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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. 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 or single-payer health care felt these meetings were counter productive and they essentially disappeared. Rationing, a common component of government medicine throughout the world, was introduced into the United States with Health Maintenance Organizations (HMOs), under the illusion that this was free enterprise. Instead, the consumers (patients) lost all control of their personal and private health-care decision making, the reverse of what was needed to control health care costs and improve quality of care.
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In This Issue:
1. Is It Possible to Comply with so Many Health Care Mandates?
2. Is Killing Alzheimer Patients Really Humane?
3. Whatever Happened to Medical Idealism and Charity?
4. This Week’s Review of Corporate Socialized Medicine - Otherwise Known as Managed Care - Part II
5. Medical Gluttony: HIPAA is Expensive, Protects Addicts and Prevents Quality Care
6. Medical Myths: Mammograms Save Lives.
7. Overheard in the Medical Staff Lounge
8. The MedicalTuesday Recommendations for Restoring Accountability in Medical Practice, HealthCare and Government
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1. Is It Possible to Comply with so Many Health Care
I chanced to find myself walking with a junior administrator at my hospital. Making polite conversation, I inquired how things were going in the administrative wing of the hospital. Are the government mandates causing any significant problems? He replied that there were so many mandates it was impossible to comply with all of them. Part of his job was to evaluate the consequences of not complying with each mandate. This information would then give the senior administrators the necessary information to prioritize which mandates were the most important to follow. Some mandates are so onerous that they may be changed before they can be enforced.
When so many laws (mandates) are passed that no one can observe all of them, then you have a nation of lawbreakers. You can then get conviction after conviction for total servitude. - Ayn Rand
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2. It Was Ten Years Ago When President Reagan
Announce He Had Alzheimer
The ceremonies of the two weeks ago raised the level of consciousness for patients with Alzheimer's Disease. Many of our readers will remember the speech that President Reagan gave in 1994 announcing that he was entering the Alzheimer's world. Most of us cannot fathom either that world which the patient and family live in or the implications for health care. The Netherlands has handled the problem very expeditiously by allowing doctors to kill Alzheimer's patients considering this action to be "the humane way." However, from personal contact with doctors from Europe, there are always financial underpinnings to such actions.
An anonymous email from a nurse was forwarded to me. It
gives a more humane story: It was a busy morning in the emergency room,
approximately 8:30 am, when an elderly gentleman, in his 80's, arrived to have
stitches removed from his thumb. He stated that he was in a hurry as he had an
appointment at 9:00 am. I saw him looking at his watch and decided I would
evaluate his wound. So I talked to one of the doctors, got the needed supplies
to remove his sutures, and redress his wound. I asked him if he had a doctor's
appointment this morning, as he was in such a hurry. The gentleman told me no,
that he needed to go to the nursing home to eat breakfast with his wife. She was
a victim of Alzheimer's Disease. As I finished dressing his wound, I asked if
she would be worried if he was a bit late. He replied that she no longer knew
who he was, that she had not recognized him in five years. I was surprised, and
asked him. "And you still go every morning, even though she doesn't know
who you are?" He smiled as he patted my hand and said. "She doesn't
know me, but I still know who she is."
The Alzheimer story will be posted at http://www.delmeyer.net/MedInfo2003.htm.
The family of President Reagan remarked that on the morning when he died, he had a brief lucid moment where he seemed to recognize his wife Nancy and possibly his children as he breathed his last and quietly died. No one knows how much subliminal cognition a patient with Alzheimer's disease has. Maybe killing such patients is more barbaric than humane. We have to remember that in most cases the pain of dying is usually felt more deeply by the family and loved ones. Patients generally die quietly without pain. How can killing a human being ever be humane for either the patient or the family? It may be less costly in financial terms, but the emotional costs to the family are far greater.
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3. Medical Idealism and Realities
Philip R Alper, MD, Internal Medicine and Endocrinology in Burlingame, California, writing in the San Mateo Country Medical Association Bulletin, http://www.smcma.org, tells about his experience as a preceptor for medical students. They spend their summers in inner cities, emergency rooms, and medical outposts abroad, hoping to make a difference to the disadvantaged and the desperate. They are quite modest, but they have big dreams. Alper recalls, "Weren't we all like that at one time? And if that is the way we were, what happened to us?" Why did one study show women OB-GYN residents as having more measurable compassion than their male colleagues at the outset of their residencies, but showed no difference by the time they completed their training?
He then digresses to a meeting of the World Health Care Congress he attended. CEOs, CFOs, and CIOs of dozens of health care corporations mingled and broke into small groups for presentations and discussion. In addition to the political and economic types, the medical directors of many health plans were also invited, something that he was told was highly unusual in such high-level gatherings. Clinical guidelines, best practices, error prevention, pay for performance, and value for the dollars expended dominated the discussion designed to facilitate the reshaping of medicine. By the third day, Alper observed that the perspective of the practicing physician was considered superfluous. Physicians had been studied and were "known." To health policy "players," doctors appear to resemble a herd of cattle, to be maneuvered, manipulated, and molded. The same powerful corporations that have their own crack Human Resources departments approach physicians as if we are inhuman resources. Bizarre as it sounds, the very people who dehumanize us desire humanity from us.
Mission Cataract is a national program to improve eyesight by offering free cataract surgery to individuals without insurance, or any other financial means to pay for surgery. The Surgeon, anesthesiologist, nurses and staff donate their time to these unfortunate individuals in medical need. This was the second year that Ophthalmologist, Keith Liang, MD, http://www.liangvision.com , of Sacramento's Center for Sight participated in this program. Dr Liang sent out more than 500 notices last March to physicians, optometrists, seniors, and churches informing them of the program. There were 10 referrals and of those six had the appropriate medical indications for cataract surgery and these were done last month. Physicians continue to quietly provide free care or charity which doesn't show up on the radar screen of those that think all health care should be free - and then rationed. But why weren't there hundreds of referrals and ten free cataract operations? Is that all the charity and uninsured need for eye surgery in a community of more than one-half million residents? Several patients told me there is TV publicity cautioning patients that free care is inferior care. How unfortunate that they don't extrapolate that to free government care which really is inferior care.
Dr Alper concludes that doctors aren't saints. We can't legitimately blame all our shortcomings on others. But we are not ready to walk away from our patients despite the increasing stresses of practice. It helps that the spark that brought us into medicine continues to warm us from within. To read Dr Alper's entire article go to http://www.smcma.org/Bulletin/medical_idealism_and_realities_a.html.
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4. This Week’s Review of Corporate Socialized
Medicine - Managed Care - An Albatross in the Digital Age
Last month, I was forced to attend a managed care organization (MCO) quarterly meeting. By "forced" I mean that reimbursement for caring for the HMO portion of my practice would be reduced if attendance was missed. I noted my last reimbursement check was reduced for not attending the previous meeting. The MCO reduces my consultation fee by about $80, my office visits by about $40, and my pulmonary function tests by about $120, even though they were less than a third of the hospital charge for similar tests. A small portion of the money that was withheld is returned to the physicians based on a formula of compliance which changes on a regular basis. Since only one-fourth of the office managers attended the last quarterly office manager meeting, there will now be a reduction in my fees if my office manager does not attend (which she always does).
One of the presentations at last month's meeting was by a pharmacist who told the doctors that their prescribing habits utilized too many expensive antibiotic drugs and, in general, were excessive. When the pharmacist was backed into a corner by a pediatrician's questions, a paid MCO medical director politely told the doctors that, for instance, there was no reason to use antibiotics for upper respiratory infections in children until they were sick for at least ten days. Can you imagine a pediatrician with four years of medical school and four years of internship and pediatric training being told by an administrator how he should treat pediatric patients? Quality of care is reduced by external forces that control physicians and prevent their performing in an optimal state. As Linda Peeno, MD, stated in an address, "Managed care is the practice of medicine by business."
Because of the adverse publicity of MCOs and HMOs for inadequate care, they are now embarking, with good media exposure, on ways to make sure that certain criteria are met by reviewing and policing the claims. This quarter, they are evaluating Chlamydia screening and Cholesterol screening. This, however, is based on faulty data. I pointed out that I accumulated all their requests for Lipid panels (which includes cholesterol and triglycerides) on diabetics that they had sent me on last year’s review and I had done all of them. In other words, their records of tests not done were 100 percent in error. The response was that they are working on improving accuracy.
The next reimbursement incentive would be based 50 percent on utilization, 25 percent on clinical aspects and 25 percent on participation. The Managed Care Industry is suffering from illusions of costs savings and quality control by employing digital technology. In practice, their digital technology creates more work rather than improving efficiency. Their web-based technology has also delayed patient care. It appears that these procedures are designed as a policing and coercive mechanism to force compliance rather than for quality-of-care reasons. All of this would be unnecessary if health care were in the open and competitive market and administrative cops become unemployed.
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5. Medical Gluttony: HIPAA is Expensive, Protects
Addicts and Prevents Quality Care
As we were concluding the consultation on a 24-year-old lady last month, she requested a prescription of Vicodin. She said she had hip dysplasia since childhood with back pain radiating down her leg. Since her prior records were not available, we gave a prescription for 30 tablets to be taken once a day when the pain got so bad her usual pain pills wouldn't control it. We allowed two refills. She was out of pills in three weeks and wanted an early refill. We increased the two remaining refills to 45 tablets per month and scheduled a visit in two months and requested his prior records.
After her insurance with an effective date of February 1, 2004, was billed, we received a report that her coverage was cancelled on February 29, 2004. We then sent her a statement. The billing clerk recognized her name from other physician practices which had experienced the same activity with this patient. When the next refill request came in early we asked the pharmacy for her drug profile and found that she had obtained 30 to 60 Vicodin a month from another doctor. We declined to further increase the quantity and noted in the chart that no refills would be authorized. We also notified the physician to whom we "sign out." However, she had already made an appointment with him. Initially, he was going to cancel the appointment and then remembered HIPAA (Health Insurance Portability and Accountability Act). He considered that the information might not be authorized and, therefore, he felt he would have to see her. Furthermore, he felt he could not avoid a prescription for how would he have known her drug history? Furthermore, under California law he could be prosecuted for not alleviating pain. Thus his consultation would also be a donation of services to an addict.
We then became aware that she had similar patterns at five other chain pharmacies where prescriptions show up on a central computer for the entire chain. During the past five months, she had up to eight prescriptions for Vicodin at each of five pharmacy chains written by a total of 17 different physicians. All, of course, donated their time for one or two visits until the first insurance form was processed and denied.
In the past when physicians were allowed to cooperate with each other, this sort of behavior would have been stopped cold in its tracks. However, with the HIPAA regulations, medical information can no longer be shared. We thought we should probably report this patient to the authorities and were cautioned that would be violating her privacy. We would be reporting information that HIPAA feels we should not have had.
The medical grand rounds at my hospital this week concerned prescribing limitations on controlled substances. When discussing this patient's situation with the faculty that presented this conference, neither the doctors nor the pharmacist were sure of the legal implications of reporting the case. Others had a definite opinion without unanimity. However, after hearing of other experiences of running afoul of government regulations, we felt the risk that reporting might have on our medical licensure exceeded the risk to this patient by continuing her addiction for another month until our last refill was exhausted. It is unlikely that she will return for another appointment. She will more likely try to get free office calls and Vicodin prescriptions with some of the other 300 physicians along this medical avenue.
Government is not the solution to our problems,
government is the problem.
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6. Medical Myths: Mammograms Save Lives.
Some ten years ago a Stanford professor, Eugene Robin, MD, wrote a column in the San Francisco Examiner on health issues. In one column he warned that excessive mammograms can cause the very disease that they are designed to protect. Shortly after that column appeared, he was relieved of writing any further columns. His comments were not politically correct for the United States. But now there surfaces similar comments from the United Kingdom. To read the UK version of mammograms, which is in a different stage of development from that found in the US, please see http://www.wddty.co.uk/healthstories/Breast%20Cancer/index.asp.
As Dr Semmelweis found out two centuries ago, some who practice at the forefront of medicine, even if it saves lives, are not accepted by their peers; or as in this case, by the media which represents the people's perceptions of medical peers, even if incorrect.
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7. Overheard in the Medical Staff Lounge
Dr Michael mentioned that his patient with Lupus and Sjögren's syndrome (dry mucous membranes of the eyes and mouth ) was given a prescription for a new medication, Salagen, which produces artificial saliva. She sent the prescription in with her credit card info to cover the copay. Three days later she received a call from the mail order pharmacy to confirm whether she really wanted $379 charged to her credit card. She told them, "I think my mouth just became moist. I won't be needing the medication after all."
Isn't it amazing how financial responsibility puts health care in perspective? But did you get the second point? Some would say it shows why we need universal coverage to cover such items. However, this patient already had health insurance and drug coverage. Government plans, such as the VA and Medicaid, would simply deny the medication as a non-covered item and possibly even prevent purchase by those that could afford it. Universal coverage just makes sure that everyone has the same poor quality health care. Then everyone can be (un)happy.
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8. MedicalTuesday Supports These Efforts of the Medical and Professional Community in Restoring Accountability in Medical Practice, HeathCare and Government
• 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. Be sure to read his article on how the Robert Wood Johnson Foundation, is a using "Cover the Uninsured" as a ruse to promote single payer HeathCare by government mandate. Read the whole article "Health Coverage Does Not Equal Health Care" at www.emergiclinic.com. Read Dr Berry’s response to Physician’s Support of Single-Payer Health Care or Socialism at http://www.delmeyer.net/hmc2004.htm#by%20Robert%20Berry.
• 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. A number of brochures are available on line about a practice that is becoming increasingly popular. The AP article: for April 27 http://apnews.myway.com/article/20040404/D81O7R7O0.html
• 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.
• John and Alieta Eck, MDs, for their first-century approach to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment, and apart from the government. Please visit them at www.zhcenter.org. For their article “Are you really insured?” go to http://www.healthplanusa.net/AE-AreYouReallyInsured.htm.
• Madeleine Pelner Cosman, JD, PhD, Esq, has made important efforts in restoring accountability in health care. Please visit http://www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government’s efforts in criminalizing medicine, and the introduction to her new book, Who Owns your Body. For other OpEd articles that are important to the practice of medicine and health care in general click on her name at http://www.healthcarecom.net/OpEd.htm
• David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at http://www.ssvms.org and additional articles such as Health Care Inflation at http://www.healthplanusa.net/DGHealthCareInflation.htm.
• 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. These "Extra"-legal services are necessary services that your lawyer does not offer. Stay posted with a wealth of information at http://www.peerreview.org. “The Center for Peer Review Justice now has a Joint Venture Partner so we can offer Headhunting for those MDs who have been DataBanked and can not find a new job. This is a fee based service where the fee is paid by both the doctor and facility.”
• Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848 no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. He then went to St Rochus Hospital in the city of Pest and reduced the epidemic of puerperal fever to 0.85 percent. The rate in Vienna was still 10-15 percent. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: All we ask is that peer review be done with “clean hands.” To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see http://www.delmeyer.net/HMCPeer.htm#by%20Verner%20Waite%20and%20Robert%20Walker. To see Attorney Sharon Kime’s response, as well as the California Medical Board response, see http://www.delmeyer.net/HMCPeerRev.htm Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD. For the current website to see some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to http://www.semmelweissociety.net
• 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 HeathCare–physicians, nurses, pharmacists, psychologists, all health professionals and all concerned individuals are urged to join.
• Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column that is at NewsMax. Please log on to review the last five weeks topics or click on archives to see the last two years topics at http://www.newsmax.com/pundits/Medicine_Men.shtml. This week’s column is on "Canada's Health System Dream Turns to Nightmare” and can be found at http://www.newsmax.com/archives/articles/2004/6/9/113918.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, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. The News of the Day: Charles Thomas Sell, D.D.S, has been held in prison for nearly 7 years without trial. When the magistrate judge ordered him to be forcibly drugged with antipsychotic medication against his will, supposedly to render him competent to stand trial, he appealed to the district judge. When he lost that, he appealed to the Court of Appeals for the Eighth Circuit, and AAPS filed an amicus brief in his favor. When he lost 2-1 there, he sought rehearing en banc, again with the assistance of an AAPS amicus brief. He lost 5-4 on his petition, and then appealed to the U.S. Supreme Court. AAPS again filed a brief in favor of the Court hearing the case. The U.S. Supreme Court finally held in his favor and stopped the forced drugging. Read the entire sordid story at www.AAPSonline.org. Be sure to scroll down on the left to departments and click on News of the Day and then click on "Court holds hearing on Dr. Sell's motion to be tried on pending charges. - 5/31/2004." The “AAPS News,” written by Jane Orient, MD, and archived on this site, providing valuable information on a monthly basis. Thomas Sowell observes that in 1909, people spent less than 18 percent of their income for housing. Now that the government got into providing housing in 1937 with a rash of “green tape” 28 million Americans spend more than 30 percent of their income for housing. She quotes Linda Gorman who gave other examples in natural gas, airlines, trucking where deregulation increased volume and innovation with costs falling 30 to 40 percent. “There is every reason to expected the same benefits from deregulating medicine.” The net burden of regulation probably exceeds the annual cost of insuring 44 million people according to Christopher Conover of Duke University. Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, and the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents page of the current issue.
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Del Meyer, MD, CEO & Founder
P. J. O'Rourke: "Giving money and power to government is like giving whiskey and car keys to teenage boys."
Winston Churchill: “The inherent vice of capitalism is the unequal sharing of the blessings. The inherent blessing of socialism is the equal sharing of misery."
The Chaplain of the Senate was asked whether he prayed for the Senators. "No," he said, "I pray for the country."
See some recent postings below.
Charles B Clark, MD: A Piece of the Pie: What are we going to tell those bright-eyed little boys and girls who are going to be the doctors of tomorrow? When there isn’t anything left for them, are we going to tell them we didn’t fight because the changes were inevitable anyway? What are we going to say when they ask us why we laid down and died when things got a little tough? Are we going to feel good about ourselves when we tell them it’s all right because we got a piece of the pie? Read Dr Clark at http://www.healthcarecom.net/CBCPieceofPie.htm
Ada P Kahn, PhD: Foreword to Encyclopedia of Work-Related Injuries, Illnesses and Health Issues. Dr Kahn came to Sacramento in February and I joined her on a Channel 31 interview about her book. I was privileged to write the foreword which we’ve posted at http://www.delmeyer.net/MedInfo2004.htm To purchase the book, go to http://www.factsonfile.com/ and type in KAHN under search.
Henry Chang, MD: WEIGHT LOST FOREVER - The Five Second Guide to Permanent Weight Loss suggest daily weights to stem the weight loss before it becomes a problem and, if it does, how to take it off and keep it off. Congratulations to Dr Chang for winning the Sacramento Publishers and Authors 2004 award for “Best Health Book of the Year.” Read our review at http://www.healthcarecom.net/bkrev_WeightLostForever.htm.
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
On This Date in History - June 22
On this date in 1970, President Richard Nixon signed into law the bill that gave eighteen year olds the right to vote.
In Dr Mitrione's trial, the judge stated that the
government's key witness lied to a significant degree.
Question: Why doesn’t the government's witness get indited for perjury?
Answer - 1: When someone lies on behalf of government, it is not perjury.
Answer - 2: When someone says the truth against the government, he can be prosecuted for perjury.
The Result: You lose either way.
An Entrepreneur's Story: AriadneCapital.com (http://www.ariadnecapital.com) provided the initial funding for MedicalTuesday and the Global Trademarking. Julie has a clear vision in her mind of the world that she wants to live in, and it's considerably different from how it looks now. If you're an entrepreneurial woman, or if you've lost hope or are having difficulty envisioning success, (if you'll forgive a little nepotism), the following article may be of interest to you. http://observer.guardian.co.uk/business/story/0,6903,1237363,00.html
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