MEDICAL TUESDAY . NET

NEWSLETTER

Community For Better Health Care

Vol VI, No 6, June 26, 2007

 

In This Issue:


1.                  Featured Article: Intel's Andy Grove Pitches a Plan for Fixing Health Care

2.                  In the News: Regulating Insurers Won't Cut Health Costs

3.                  International Medicine: Europeans Flee Socialism: What Part Don't We Understand? 

4.                  Medicare: More Spending, No Results, Raymond J. Keating, SBE

5.                  Medical Gluttony: Urgent Care Plus Office Evaluation for a Minor Sunburn

6.                  Medical Myths: Farm Subsidy Bill Promotes Public Health

7.                  Overheard in the Medical Staff Lounge: Harvesting the Roadway for Revenue

8.                  Voices of Medicine: Understanding the Taxonomy Code, Vital Signs

9.                  From the Physician Patient Bookshelf: The Anatomy of Hope by Jerome Groopman, MD

10.              Hippocrates & His Kin: We Now Have a Target for People to Shoot At

11.              Related Organizations: Restoring Accountability in Medical Practice and Society

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MOVIE EXPLAINING SOCIALIZED MEDICINE AND MICHAEL MOORE'S SICKO

Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the truth about socialized medicine. Clements' strategy is to release the documentary this summer when Michael Moore's pro-socialized medicine movie "SICKO" is released. This movie can only be made in time if Clements finds 200 doctors or health care executives willing to make a tax-deductible donation of $5K. Clements is also seeking American doctors willing to perform operations for Canadians on wait lists. Clements is the former publisher of "American Venture" magazine who made news in 2005 for a property rights project against eminent domain called the "Lost Liberty Hotel."
For more information visit
www.sickandsickermovie.com or email logan@freestarmovie.com.

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1.      Featured Article: Intel's Andy Grove Pitches a Plan for Fixing Health Care, WIRED, by Kristen Philipkoski , 05.02.07

Andy Grove, the Intel co-founder and one of the most important technologists of the modern age, wants to fix the broken U.S. health care system with -- surprise, surprise -- technology. But there's a twist.

As technology executives get older, they seem to inevitably become interested in health care. The Bill and Melinda Gates Foundation has had a major impact on global health. Steve Case, former CEO of AOL, has just launched Revolution Health, a health management site. They're joined by Grove, former chairman and CEO of Intel, who is touring the lecture circuit proselytizing his solutions for the troubled health care system.

Call it fear of mortality, opportunism or altruism -- Grove sees a major breakdown in a system that leaves nearly 50 million Americans uninsured and emergency rooms closing down in droves. There's also a business case. Health care is a $2 trillion-a-year industry -- as Grove notes, 20 times larger than the chip business -- that's only getting bigger as baby boomers enter their autumnal years.

Grove became interested in health care in the '90s after surviving prostate cancer. More recently, he was diagnosed with a mild form of Parkinson's disease. The Holocaust survivor, entrepreneur and inventor whose biographer, Harvard Business School professor Richard Tedlow, says he could hold his own beside Benjamin Franklin, believes the health care problem must be broken into sub-problems that can be solved separately. Tackling health care as a whole won't happen without a cataclysmic event (think New Deal), Grove has been saying in recent lectures.

Grove breaks the problem of health care into three manageable chunks. Two have technological solutions -- but not complex tech. Grove wants to keep the technology as simple as possible, a surprising idea for a man who put millions of transistors on a chip.

First: Keep elderly people at home as long as possible (an idea he calls "shift left"). . . . In one year, if a quarter of the people now living in nursing homes went home, it would save more than $12 billion, Grove says.

Second, Grove advocates addressing the uninsured by building more "retail clinics" -- basic health care centers in drugstores and other outlets . . .

Lastly. . . In his vision, every patient carries a USB drive containing his or her medical records, which any doctor can download. . .

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2.      In the News: Regulating Insurers Won't Cut Health Costs

Daniel Weintraub: Regulating insurers won't cut health costs, Sacramento Bee, June 10, 2007

California's Democratic lawmakers -- hoping to exert downward pressure on health care costs -- are half way to passing a law that would force insurance companies to get the state government's permission before increasing their rates.

Passing such a law might make legislators feel better. And it would probably be popular with beleaguered consumers tired of paying ever higher premiums. But it wouldn't do much good. It might even make things worse.

Insurance companies, for all their maddening business practices, are mostly just moving money around in the health care business. They are the middle man. They collect a ton of premiums from a broad group of people and then pay most of it in medical bills for the relative few who get sick or injured each year. About 85 percent of the money they take in goes right back out in payments to doctors, hospitals, labs and drug companies.

It is difficult for some people to accept, but insurance companies are not responsible for the rising cost of health care. Those costs can be traced to other factors that play a far bigger role.

First, as a society, we use a lot more health care than we used to, because cultural norms have changed, scientific advancements have made medical care more worthwhile, and as the baby boomers and their parents age, they are getting sicker and needing more care.*

Second, technology is driving up the cost of medical care. New gadgets and gizmos, from titanium knees to robotic surgery to full-body scans, are giving us access to medical procedures and tests that we never had before.

That stuff costs a lot of money.

Third, the medical care infrastructure in this country is growing more expensive. Just look around your community at all the new medical office buildings and hospital wings under construction. The people who work inside those buildings have also seen a steady increase in their incomes.

Regulating insurance rates wouldn't affect any of those things. It would instead seek to limit insurance company overhead and profits.

To see how little this would do to reduce costs, look at what has happened in California in recent years. According to reports on file with the Department of Managed Health Care, the seven largest insurers have seen their revenues climb from $45 billion in 2002 to $71 billion in 2006. That sounds ominous. These firms are taking in 58 percent more than they were just a few years ago.

But guess what? During that same period, the medical expenses those seven companies paid out on our claims climbed from $40 billion to $62 billion. That's an increase of 55 percent.

Everything else -- administration, marketing and profits -- went up by $4 billion, or 80 percent. But all of that overhead combined still totals just $9 billion on $71 billion in revenues, or about 13 percent. That number includes profits, which came to $2.9 billion last year, or less than 5 percent of revenues.

Take away the profits -- all of them -- and assume the companies would have charged us that much less, and their revenues would have risen by 51 percent instead of 58 percent. In other words, if you want to take a significant bite out of the cost of health care, you're just going to have to look somewhere else.

How could rate regulation make things worse? If regulators decide that a reasonable profit is, say, 5 percent of revenues, the insurance companies would then have a perverse incentive to see costs go up. The more they paid out for hospitals, doctors and drugs, the more money they would make.

But that doesn't mean health insurance regulation is not going to happen. The Assembly passed the bill, AB 1554 by Dave Jones of Sacramento, last week. Now it goes to the Senate.

Gov. Arnold Schwarzenegger opposes rate regulation but has endorsed several other moves to hem in the insurance industry. He wants to require insurers to cover anybody who applies for a policy, regardless of pre-existing conditions. And he wants them to charge nearly the same rate to everyone who buys a particular package of benefits, with variations only for age and geography . . . **

www.sacbee.com/weintraub/story/212859.html

[* The additional item that drives up health care costs is a gluttonous attitude perceived as concern for one's own health. For example, patients can demand twice as many consultations, three times as many laboratory tests, and four times as many x-rays as is necessary at no additional costs to themselves but serious costs to the insurance carrier. The insurance carrier as the middleman simply adds this cost to the premiums to keep up with this gluttonous behavior which drives up everyone's costs including those who are frugal in their health care utilization. No proposed political plan addresses this cause and no politician would touch this since it would be the third rail killing their re-election. Thus, there can be no logical political solution to controlling health care costs. Another mechanism has to be found.]

[** In addition to the variations for age and geography, there should be additional charges for personal induced medical risk that can easily be projected. Why should patients who practice healthy living subsidize those that double and triple their health care costs through risky behavior? Smokers (cigarette consumption in the last ten years), overeaters (a BMI or body mass index over 35 or history of a gastric bypass procedure in the last ten years), over drinkers (more than two drinks a day or a history of alcoholism or a DUI in the past ten years), or those who practice anal intercourse (in the last ten years) all carry huge and measurable increases in health care costs that are personally induced. All add significant costs for those that avoid risky behaviors. By charging for these personally induced health care risks, the health care costs for those that strive to live healthy lives would be greatly reduced. It may also allow those with diabetes, heart disease, hypertension, COPD and other diseases not of their own making to be insurable.]

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3.      International Medicine: Europeans Flee Socialism: What Part Don't We Understand? 

Europeans' flight from Europe By Paul Belie, The Washington Times

Last year more than 155,000 Germans emigrated from their native country. Since 2004 the number of ethnic Germans who leave each year is greater than the number of immigrants moving in. While the emigrants are highly motivated and well educated, "those coming in are mostly poor, untrained and hardly educated," says Stephanie Wahl of the German Institute for Economics.

In a survey conducted in 2005 among German university students, 52 percent said they would rather leave their native country than remain there. By "voting with their feet," young, educated Germans affirm that Germany has no future to offer them and their children. As one couple who moved to the United States told the newspaper Die Welt: "Here our children have a future in which they will not have to fear unemployment and social decline." There are two main reasons why so-called "ethno-Germans" emigrate. Some complain that the tax rates in Germany are so high that it is no longer worthwhile working for a living there. Others indicate they no longer feel at home in a country whose cultural appearance is changing dramatically.

The situation is similar in other countries in Western Europe. Since 2003, emigration has exceeded immigration to the Netherlands. In 2006, the Dutch saw more than 130,000 compatriots leave. The rise in Dutch emigration peaked after the assassinations of Pim Fortuyn and Theo van Gogh. This indicates that the flight from Europe is related to a loss of confidence in the future of nations which have taken in the Trojan horse of Islamism, but which, unlike the Trojans, lack the guts to fight.

Elsewhere in Western Europe immigration currently still surpasses emigration, though emigration figures are rising fast. In Belgium the number of emigrants surged by 15 percent in the past years. In Sweden, 50,000 people packed their bags last year—a rise of 18 percent compared to the previous year and the highest number of Swedes leaving since 1892. In the United Kingdom, almost 200,000 British citizens move out every year.

Americans who think that the European welfare state is the model to follow would do well to ponder the question why, if Europe is so wonderful, Europeans are fleeing from it. European welfare systems are redistribution mechanisms, taking money from skilled and educated Europeans in order to give it to nonskilled newcomers from the Third World.

Gunnar Heinsohn, a German sociologist at the University of Bremen, warns European governments that they are mistaken if they assume that qualified young ethnic Europeans will stay in Europe. "The really qualified are leaving," Mr. Heinsohn says. "The only truly loyal towards France and Germany are those who are living off the welfare system, because there is no other place in the world that offers to pay for them. . . It is no wonder that young, hardworking people in France and Germany choose to emigrate," he explains. "It is not just that they have to support their own aging population. If we take 100 20-year-olds [in France or Germany], then the 70 [indigenous] Frenchmen and Germans also have to support 30 immigrants of their own age and their offspring. This creates dejection in the local population, particularly in France, Germany and the Netherlands. So they run away."

On Monday Francois Fillon, the new French prime minister, said that "Europe is not Eldorado," emphasizing that his government intends to curb immigration by those who only seek welfare benefits. "Europe is hospitable, France is an immigration country and will continue to be so, but it will only accept foreigners prepared to integrate," he stressed. Europe cannot afford to be "Eldorado" for foreigners any longer, because it has stopped being "home" for thousands of its own educated children, now eagerly looking for opportunities to move to America, Canada, Australia or New Zealand—white European nations outside Europe. . .

Europe's welfare system is causing a perverse process of population replacement. If the Europeans want to save their culture, they will have to slay the welfare state.
    
Paul Belien is a European writer. He is editor of The Brussels Journal and an adjunct fellow of the Hudson Institute.

www.washingtontimes.com/functions/print.php?StoryID=20070605-092649-8531r

Government Medicine does not decrease the cost of healthcare, it only bankrupts the state.

--Europe's Flight from Socialized Medicine

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4.      Medicare: More Spending, No Results, Raymond J. Keating, SBE, May 17, 2007

SBE Council Small Business Fact of the Week:  Health Care - More Spending, No Results

The overriding assumption at work in recent times when it comes to health care is that more government is better. But let's take a quick look at some data.

First, state and local government spending on health and hospitals increased from $115.9 billion in 1995 to $170.2 billion in 2005, according to the latest numbers from the U.S. Census Bureau.  That was a 46.9% jump, compared to inflation registering 22.4% (as measured by the GDP price deflator) over the same period. 

. . . total federal health-related spending (including health services, research, Medicare and veteran's health care) exploded over this period - from $291.7 billion in 1995 to $577.9 billion in 2005, which registered as a 98% increase.

So, what resulted from this rapid increase in spending?  If we go with the favorite number cited in the media and by politicians - that is, the number of uninsured - the answer is absolutely nothing.

The raw numbers of uninsured actually increased - from 40.6 million in 1995 to 46.5 million in 2005.  If you look at these as a share of the population, 15.4% were uninsured in 1995 versus 15.9% in 2005.

Nonetheless, the push for more government persists, even if matters do not turn out as planned by the politicians.  A front page story in the April 30 New York Times showed that Maine's effort to impose universal health care coverage has fallen woefully short of its goals to cover the uninsured; 60% of those covered under the new plan already had health coverage; costs have run far ahead of expectations; expected savings have not materialized; and funding for the program has proven costly for private insurers and businesses. What's the answer offered by Gov. John E. Baldacci? Naturally, it involves even more government, including mandating that individuals have coverage, penalties on employers for not offering insurance, more subsidies, more Medicaid cost controls (i.e., price controls), and having the state run the program.

In neighboring Massachusetts, politicians are still trying to figure out the health care plan featuring an individual mandate instituted by former Governor Mitt Romney and the state legislature, according to a May 10 story in the Boston Globe.  They have not started collecting the taxes imposed on business for the program, and are not sure how much they actually will amount to in the future.  Naturally, some in the legislature are mentioning a bigger tax on business.

But a glimmer of hope emerges now and then.  The Wall Street Journal noted on May 14 that the Democratic controlled state house in Illinois unanimously rejected a huge gross receipts tax proposed by Gov. Rod Blagojevich (D) to fund health care.

If state officials really want to do something constructive in terms of making health care more affordable, they could start with mandates.  As the Council for Affordable Health Insurance reported in its "Health Insurance Mandates in the States 2007," the number of state mandates now tops 1,900, compared to a mere handful in the late 1960s.  CAHI estimated that state mandates jack up "the cost of basic health coverage from a little less than 20% to more than 50% depending on the state."  The equation is simple: reduce mandates, costs fall, and health care becomes more affordable.

Raymond J. Keating, Chief Economist

www.sbecouncil.org/news/display.cfm?ID=2183

[With politicians being very creative in finding new taxes (e.g. gross receipts tax), we need a constitutional amendment to limit each of the three levels of government to two taxes with limits on each. For instance, the federal government should be limited to a personal income tax (ten percent limit) and an excise tax (ten percent limit) on imports, exports and interstate commerce. The state government should be limited to a personal income tax (five percent limit) and a sales tax (five percent limit). Local government should be limited to a property tax (one percent limit) and a use tax (licenses, permits and registration fees). If we don't do this, we'll find Americans will be replaced by foreigners just like Europe is being replaced.]

 Government is not the solution to our problems, government is the problem.

- Ronald Reagan

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5.      Medical Gluttony: Urgent Care Plus Office Evaluation for a Minor Sunburn  

Mrs. Harkens saw that her legs were somewhat pink one evening and promptly went to the urgent care center. The doctor on duty noted that the slightly rosy hue started at the dress hemline and the pattern on her feet matched the sandal straps. A number of tests were ordered. Follow up with her personal physician was suggested and she complied. The exam was the same. After the second evaluation, she accepted that this was indeed related to her sun exposure and would apply an OTC soothing lotion.

At approx $125 for an urgent care evaluation and $100 for an office evaluation, with an insignificant $10 co-pay that is totally ineffective in moderating gluttonous medical appetites, what would it have taken to reduce health care costs?

Medical review can only work in retrospect. Not paying either the urgent care center or the doctor as a penalty for the patient seeking care is very regressive and shifts blame to innocent providers.

A medical education program is frequently mentioned. To whom would this be directed? This lady was a retired primary grade teacher. Would she have gone to some course to learn medical aspects of ordinary living? This would not have any significant effect.

Would running all these requests for care through an "Ask a Nurse" program have been more effective? Two of our patients, both nurses, have participated in the "Ask a Nurse" program. One worked for an HMO and routinely referred patients to their personal physician on the next working day. One worked for a health care system and routinely referred patients to the hospital emergency room. Neither approach saved any costs. Further, the medical liability for either system, should it deem no further evaluation is required, is insurmountable.

If the patient had to pay a percentage of the costs, what would have happened? We did a progression analysis of the problem in a very rough fashion. By using numbers that reflected 10%, 20%, 30% or 40% of the total cost involved, at what percent did the patient decide on a lower cost? We found that 10% was essentially the current copay on office calls and had no effect. We found that 20% did cause some patients to think about their share, but did not find it universally restraining. We found that 30% causes essentially all patients to earnestly seek a lower level of care - whether it be urgent care, or actually postponing seeing their physician until the next day. We did not find this restricted or omitted necessary care. We found that 40% did cause restriction of care when care was thought important.

Hence, to prevent over utilization of outpatient medicine, the co-pay should be about 30% of the charge with insurance paying the other 70%. Insurance should guard against exorbitant charges by basing reimbursements at the 90 percentile of all charges for a similar service - the maximum charge that 90% of physicians utilize. Hence, if a claim comes in that is exorbitant, the insurance should reimburse 70% of the 90 percentile level.

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6.      Medical Myths: Farm Subsidy Bill Promotes Public Health

In the current June issue of Dr Andrew Weil's Self Healing Newsletter, Dr. Weil states "the link between farm bill subsidies and poor health in this country can no longer be ignored. Two of the largest crops backed by the farm bill - corn and soybeans - are used to make high-fructose corn syrup and soy oil, cheap ingredients that are significant contributors to obesity, diabetes, and other chronic diseases. In addition, this bill helps shape school lunches, affects the cost of food, and determines what is grown locally or imported. . . Subsidies are the reason it's cheaper to have a soda with chicken nuggets and French fries for lunch than it is to have a fresh salad. . ."

[Government subsidies generally bring about the opposite of what Congress intended. That's not necessarily saying that all lawmakers are evil, as the President of the Mises Institute alleges, but in the Congressional arena the thirst for power to determine and control the destiny of other citizens overwhelms any logical, moral or beneficial endeavor so that the harm done can neither be seen nor recognized, or even enter their stream of consciousness to modify their own future behavior.]

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7.      Overheard in the Medical Staff Lounge: Harvesting the Roadway for Revenue

Citrus Heights, three suburbs out from Sacramento, recently became a city with their own Police.

Dr. Sam: I was making a left turn into a shopping center the other day and got pulled over for not yielding the right of way. It was solely based on the officer noticing that the other car's brake lights came on even though he did not see the car needing to slow down. Has anyone else had a run-in with the Citrus Heights police?

Dr. Dave: I stopped at a Stop Sign and as I pulled away, I was stopped and cited. I pointed out that I had made a full stop. The officer said, "But you didn't stop the required three full seconds before proceeding."

Dr. Edwards: Did you notice the morning news when only Citrus Heights reduced their speed limit to 40 MPH even though the cities on both sides are still 45 MPH? Citrus Heights cops were making mass arrests, citing multiple cars. Two officers worked in tandem and stopped a slew of cars at once. With the costs of speeding tickets, two officers could net more than a thousand dollars every 15 to 20 minutes for the newly incorporated city.

Dr. Michelle: I got stopped recently also. I never get a ticket. Why is the CH Police so aggressive?

Dr. Rosen: I suppose the cost of setting up a new city that has no industry is huge. This is their primary source of revenue.

Dr. Ruth: But they have a huge shopping center that should make them a lot of money.

Dr. Rosen: The property tax, a county tax, probably creates revenue for the county government. The sales tax, a state tax, probably creates revenue for the State of California.

Dr. Yancy: So it looks like they are only left with harvesting the roadways for their existence.

Dr. Milton: They surely must have had a lot of in-service training to finely hone the variances of the new laws. California was one of the pioneer states in allowing a right turn on red after a stop. Formerly, you could only make a right hand turn from the right lane. Now some intersections are marked for right hand turns from up to three lanes on red.

Dr. Edwards: Also in the past, when making a left turn, you had to remain in the same or slower lane. Now you can turn left into any lane.

Dr. Ruth: I learned that one the hard way. I made a right hand turn after a full stop on red when I thought it was safe, but the officer said there still was one car in the opposing lane waiting to make a left hand turn and I was supposed to wait until all cars in the oncoming left turn lane had emptied out.

Dr. Dave: My medical assistant's husband has had so many run-ins with the Citrus Heights police he'll now travel 10 miles out of the way to avoid the city entirely.

Dr. Sam: But there seems to be an element of brutality. I have never felt that police were brutal. I've rubbed shoulders with a lot of fine officers in the emergency rooms here and elsewhere, especially in county hospitals. When I was stopped, not having had a ticket in 20 or 30 years, I immediately got out of the car and greeted the officer as a gentlemen like I've always done. But he shouted at me to get into the car and as I proceeded to do so, I must not have done it fast enough because he grabbed me and tossed me into the seat and slammed the door on my legs, which caused several cuts and bruises.

Dr. Michelle:  Aren't you going to sue him or the city?

Dr. Sam: When I presented this to the judge, I asked the judge to throw this case out since the officer admitted that he was around the corner waiting at a red light 600 yards away and he based his case on seeing a brake light coming on. He admitted that he didn't see the car slow down from braking. I presented evidence that Ford Motor Company got sued because their brake lights didn't come on before the car was actually braking, industry promptly corrected the problem. Since then, all car brakes are very sensitive to touch and the brake lights come on as soon as the foot moves from the accelerator to the brake before any pressure is applied. Watching the brake lights does not mean that a car has to slow down for another auto to make a turn. Hence, I had plenty of time for the left turn.

Dr. Ruth: Well did it work?

Dr. Sam: It just irritated the judge. Even when the officer admitted he was in the process of pulling his gun on me as he injured me, she just said I might have a case against the city but she fined me $171. My car insurance premium went up $200 a year for three years.

Dr. Yancy: I think I'll no longer shop at the Citrus Heights' Sunrise Mall.

Dr. Rosen: I'll join you on that one. When Macy's, Penney's and Sears start losing money, harvesting the Citrus Heights streets will come to a screeching halt.

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8.      Voices of Medicine: A Review of Local and Regional Medical Journals

Understanding the Taxonomy Code, Vital Signs, Publication of the Fresno-Madera Medical Society

National Provider Identifiers: Are You Ready? David A. Ginsberg, President of PrivaPlan Associates, Inc.

Recently there has been confusion about the taxonomy code and how it interacts with the National Provider Identifier ("NPI"). Physicians and their staff must understand how these are related to ensure your claims are processed correctly as the NPI is phased in.

For those readers who have completed an NPI application you will have noticed it requires at least a primary taxonomy code for Type 1 NPI numbers that are assigned to individuals.  Organizations who apply for Type 2 NPI numbers may submit more than one taxonomy code. Certainly if you have a NPI subpart number (for example a cardiology practice that has an imaging center will likely show the imaging center as a subpart) you will need to submit more than one taxonomy code.  Remember incorporated individuals need to have both a Type 1 and Type 2 NPI.

The taxonomy code like the NPI is a 10 digit number; it is a number that describes a health care provider or organization's clinical specialty. The taxonomy codes were developed to replace the numerous specialty classifications health plans use; these classifications are often different from health plan to health plan.  Additionally there has been wide spread concern that the specialty designations are not specific enough in some cases to describe a physician's (or other provider's) sub specialty, or in the case of dual or multiple specialty physicians.

The taxonomy code, like the NPI is one of the HIPAA transaction code sets. Like the ICD9 or CPT codes it is a code set that has been designated for use in relevant HIPAA standard transactions such as electronic claims. Taxonomy codes have actually been in place as a required field on electronic claims (the "837" standard transaction) since the HIPAA Transaction Code Set rule went into effect on October 16, 2003. However, many health plans have not enabled the edit in their systems to require the taxonomy code. This is beginning to change. On January 1st, Medicare began requiring the taxonomy code on all electronic Institutional claims. As health plans begin to implement the NPI watch for their requiring the taxonomy code as well on electronic claims. To read more, you can download the file at www.fmms.org/pdf/Apr07_VS_FINAL.pdf.

To read the VOM Archives, go to www.healthcarecom.net/voicemed.htm.

To read VOM in Sacramento Medicine, go to www.ssvms.org/articles/0703vom.asp. 

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9.      Book Review: The Anatomy of Hope by Jerome Groopman, MD

THE ANATOMY OF HOPE- How People Prevail in the Face of Illness by Jerome Groopman, MD, Random House, Inc, New York, © 2004, ISBN-0-375-75775-0, 248 pp, PB $14.95 (US) $21 (Can).

Jerome Groopman in his first book in 1997, THE MEASURE OF OUR DAYS - New Beginnings at Life's End, focused on "End of Life" issues after losing his father to what he considered incompetent medical care. wwwhealthcarecom.net/bkrev_MeasureOfOurDays.htm In this, his third book, he tries to understand why some people find hope despite facing severe illness, while others do not. And can hope actually change the course of a malady, helping patients prevail?

He looked for the answers in the lives of several extraordinary patients that he cared for over thirty years. They led him "on a journey of discovery from a point where hope was absent to a place where it could not be lost." In the process, he learned the difference between true hope and false hope and describes times when he foolishly thought the later was justified. He also describes instances where patients asserted their right to hope and he wrongly believed that they had no reason to do so. He felt that because they held on to hope, even when he felt that there was none, the patients survived.

In a number of examples, he explores his patients' religious beliefs. He describes one woman of deep faith who showed him that even when there is no longer hope for the body, there is always hope for the soul. He credits his patients for helping him see another dimension in the anatomy of hope.

Groopman thinks that many of us confuse hope with optimism, a prevailing attitude that "things turn out for the best." But he thinks that hope differs from optimism. Hope does not arise from being told to "think positively" or from hearing an overly rosy forecast. Hope, unlike optimism, is rooted in unalloyed reality. Without a uniform definition of hope, his patients taught him that "hope is the elevating feeling we experience when we see - in the mind's eye - a path to a better future. Hope acknowledges the significant obstacles and deep pitfalls along that path. True hope has no room for delusion."

Groopman believes that hope gives us the courage to confront our circumstances and the capacity to surmount them. He was well into his career when he came to realize this. He states that for all his patients, hope, true hope, has proved as important as any medication he might prescribe or any procedure he might perform. Making a diagnosis and finding the optimal therapy were essentially detective work. Solving a complex case and identifying the best treatment is indeed an exhilarating intellectual exercise. But the background and stories of patients' lives give doctors the opportunity to probe another mystery: How do hope and despair factor into the equation of healing?

After three decades in the practice of hematology and oncology, Groopman only gave a passing nod to hope as he labored from the bedside to the laboratory bench. As a rational scientist, trained to decode the sequence of DNA and decipher the function of proteins, he fled the fairy-tale claims of hope, slamming the door, closing off his mind to seriously considering it as a catalyst in the crucible of cure. What he eventually found missing had to be learned from experience, both as a physician and as a patient.

As a patient for some nineteen years after failed spine surgery, Groopman lived in a labyrinth of relapsing pain and debility. It was rekindled hope that gave him the courage to embark on an arduous and contrarian treatment program and the resilience to endure it. "Without hope, I would have been locked forever in that prison of pain. . .  It seems to exert potent and palpable effects not only on my psychology but on my physiology."

As a scientist, Groopman began to distrust his own experience as he set out on a personal journey to discover whether the energizing feeling of hope can in fact contribute to recovery. He found that there is an authentic biology of hope. Researches are learning that a change in mind-set has the power to alter neurochemistry. Belief and expectations can block pain by releasing the brain's endorphins and enkephalins that mimic the effects of morphine. In some cases, hope can also have important effects on fundamental physiological processes like respiration, circulation and motor function. Thus, hope can have a domino effect making each step of improvement more likely. It changes us profoundly in spirit and in body. To read more, please go to www.delmeyer.net/bkrev_AnatmyOfHope.htm.

To review the Physician Patient Bookshelf, go to www.delmeyer.net/PhysicianPatientBookshelf.htm.

To peruse Reviews topically, go to www.healthcarecom.net/bookrevs.htm.

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10.  Hippocrates & His Kin: We Now Have a Target for People to Shoot At

Jim Sanders reports Health Care for Millions Advances. Setting the stage for fireworks, Democrats in each house of the Legislature passed separate bills Thursday to guarantee medical care for millions of uninsured Californians. "We now have a target for people to shoot at," Senate President Pro Tem Don Perata said at a news conference shortly after passage of his Senate Bill 48 and Assembly Bill 8.

We have always associated Lawmakers targeting Healthcare more like Wyatt Earp and Doc Holliday squaring off at OK Corral at Tombstone, Arizona - not really a rationale debate.


Health Insurance Is Not the Only Means to Health Care

Last week, a 30-year-old Hispanic man came in because of his cough. He coughed, he said, as soon as he entered his house on returning from work. He also coughed much of the night. I attributed this to his feather pillows and feather bed. His wife said the furniture was overstuffed with goose down. His pulmonary function tests confirmed asthma, which was largely reversible with an inhaler. So I went over a dust, feathers, and dander elimination program. On the way out, I reduced the fee for this unfortunate man and family without health insurance. While doing so, the wife casually mentioned that it would be difficult to eliminate all the feathers from their house. They had spent more than $11,000 on the new goose down overstuffed furniture for their family room.

There seems to be a lot of people that can afford many nice things including paying for their medical care. Why do the bureaucrats want to force such people to support the health insurance industry?


Health Insurance May Not Mean Health Care

A 70-year-old retired salesman came to the office for a pulmonary consultation including a Pulmonary Function Test and a Chest X-ray. He gave my receptionist a signed check made out to me and told her to put in the fee. After the evaluation, I thanked him for coming in and was curious why he didn't obtain an evaluation through his regular HMO insurance? He said it was such a hassle to get adequate evaluation and would have spent three months of work wading through denials, filing forms, and putting his doctor through a lot of trouble. He figured the cost of the harassment in terms of hours spent far exceeded paying me a $150 consultation fee, a $225 pulmonary function test and an $80 chest x-ray, all done within one hour. He said he wanted to keep tabs on his emphysema and would be back next year.

Politicians don't seem to understand that getting everyone health insurance does not provide everyone health care. Some with health insurance have to bypass their policy to get health care. Why do they always have this knee-jerk reaction?


The presidential confidence rating has sunk to 30 percent approval. This is being touted far and wide by Congress, whose approval ratings are now at 14 percent. How can you cast aspersions when both are in the toilet? If Congress dips much lower, they will sink from the toilet to the sewer. I know that's where a lot of disease is present, but does that really make Congress an expert on health care reform?

Why would anyone trust the incompetent in Washington DC to even discuss health care reform?


Congressman's Money

A thief stuck a pistol in a man's ribs and said, "Give me your money." The gentleman, shocked by the sudden attack, said "You cannot do this; I'm a United States Congressman!"

The thief said, "In that case, give me my money!"


Your Money Or Your Life.

Bob Hope tells the story of being held up at gunpoint and the robber demands, "Your money or your life." Bob looks off into the sky and the robber gets impatient. "Hurry up, I don't have all day."

To which Bob replies, "Don't rush me, I'm thinking."


To read more vignettes, go to www.healthcarecom.net/hhkintro.htm.

To read about doctor's current struggles in healthcare, go to www.delmeyer.net/hmc2006.htm.


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11.  Physicians Restoring Accountability in Medical Practice, Government and Society:

•                      John and Alieta Eck, MDs, for their first-century solution 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. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?" go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.

•                      PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.emergiclinic.com. Read his letter sent to Senator Fred Thompson during the summer of 2000 after meeting with a representative from his office for about an hour. It was later forwarded to Senator Bill Frist and Representative Bill Jenkins. It received only perfunctory responses from the offices of each. Seeing the futility of trying to effect change through the political process, I have not wasted anymore time trying to persuade the men who represent us at the level of the federal government. To read more on Dr Berry, please click on the various topics at his website.

•                      PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. http://home.earthlink.net/~doctorlrhuntoon/. Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.

•                      Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."

•                      Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS - Pay In Full At Time Of Service, the "Cash-Based Revolution." The patient pays in full before leaving. Because doctor charges are anywhere from 25-50 percent inflated due to administrative costs caused by the health insurance industry, you'll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to www.simplecare.com. 

•                      Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to www.libertyhealthgroup.com/Liberty_Solutions.htm. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.

•                      Dr. Elizabeth Vaughan is another Greensboro physician who has developed some fame for not accepting any insurance payments, including Medicare and Medicaid. She simply charges by the hour like other professionals do. Dr. Vaughan's web site is at www.VaughanMedical.com.

•                      Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html. She will be remembered for her important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government's efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at 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 www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm; for Politicians cannot manage a health care system, go to www.ssvms.org/articles/0609gibson.asp.

•                      Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.

•                      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 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: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see 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.
To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to
www.semmelweissociety.net.

•                      Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.

•                      Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks' topics or click on archives to see the last two years' topics at www.newsmax.com/pundits/Medicine_Men.shtml. Read this week's column on "Who should make Medical Decisions."

•                      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.  Be sure to scroll down on the left to departments and click on News of the Day in Perspective: CDC wastes hundreds of millions of dollars, Coburn report says or go directly to it at http://www.aapsonline.org/nod/newsofday442.php. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site, which provides valuable information on a monthly basis. This month, be sure to read IS CONSUMER-DIRECTED CARE SAFE? Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. www.jpands.org/ There are a number of important articles that can be accessed from the Table of Contents page of the current summer 2007 issue. Don't miss the excellent articles on Common Sense or the extensive book review section which covers a dozen great books this month.

            Be sure to put the AAPS 64th Annual Meeting to be held on October 10-13, 2007, in Philadelphia/Cherry Hill, NJ, on your planning calendar.

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Words of Wisdom

Peter Drucker's Insights: Those who perform love what they're doing. I'm not saying they like everything they do. That's something quite different. Everybody has to do a lot of routine. Every great pianist has to do three hours of playing scales each day. And nobody will tell you they love it. You have to do it. It's not fun, but you enjoy it because even after forty years you still feel the fingers improving. Pianists have wonderful expression: "I practice until I have my life in my fingers." Action Point: Practice until you have your life in your fingers. www.peter-drucker.com/

Mark Hurd, CEO, HP: "I'm not a big vision guy. I think it was Einstein who said vision without execution is a hallucination." http://online.wsj.com/article_print/SB117831845901692745.html (subscription required)

P. J. O'Rourke: Giving money and power to government is like giving whiskey and car keys to teenage boys. www.pjorourkeonline.blogspot.com/

John T Kennedy in commenting on P. J. O'Rourke's book, Parliament of Whores: I find it even more offensive when government officials are likened to whores. It's terribly unfair to compare government officials to whores. It slanders whores. What have whores ever done to deserve being compared with government officials? www.anti-state.com/kennedy/kennedy3.html

Some Recent or Relevant Postings

Groopman: The Anatomy of Hope www.delmeyer.net/bkrev_AnatmyOfHope.htm

Groopman: The Measure of Our Days www.healthcarecom.net/bkrev_MeasureOfOurDays.htm

Cassell: DOCTORING - The Nature of Primary Care Medicine www.delmeyer.net/bkrev_Doctoring.htm

In Memoriam

Jim Clark, sheriff and segregationist, died on June 4th, aged 84, The Economist, June 14, 2007.

Our Ignoble past: The Alabama brute was an indispensable enemy to the civil-rights movement

GETTING ready for a day's work in the mid-1960s, Jim Clark dressed like a soldier. Sheriff's shirt, extra large, to take a man of 16 stone and more than six feet tall. Sheriff's trousers similar. Tie round his neck. Silver helmet, sometimes worn at a rakish angle when the heat and humidity made it slip off his head. Black leather belt with a holster for his sidearm, a .38 calibre pistol. Truncheon, rope and cattle-prod. Silver sheriff's star and, as the final touch, a small white button pinned on a lapel or beside his tie, reading "Never". Never to letting the n****** overcome him.

He did not always take the cattle prod. But, as a cattle-raising man in the pleasantly rolling country round Selma, Alabama, he knew the use of the things to ginger up creatures of a slow disposition: people "of low mental IQ", who nonetheless claimed they should have the right to vote, and who hung around the steps of the Selma courthouse until they were summoned inside to read "constitutionality" or "institutionalisation" [sic] without stumbling, or to say how many bubbles there were in a bar of soap, until they were laughingly pushed out again. Blacks understood the prodder. Mr Clark and his men once made 165 teenage nuisances run out of town and go on running, mile after mile, prod after prod, until they threw up with exhaustion. And if blacks still got uppity he could wrestle them to the ground like a steer before branding, one knee lodged tight in their stomach. . . To read the rest of the story of the big brute from Alabama, please go to www.economist.com/obituary/PrinterFriendly.cfm?story_id=9333348

On This Date in History - June 26

On this date in 1945, the United Nations Charter was signed in San Francisco. Although it is riddled with controversy, it has provided a Forum for international dialogue.

On this date in 1948, the Berlin airlift began when the United States and Great Britain began supplying West Berlin by air to overcome the Soviet sea and land blockade. Today, we are always searching for alternatives for any obstacles in our path, which shows our ingenuity.

After Leonard and Thelma Spinrad