Posted in Access to healthcare, Crony Capitalism, Economic Issues, Healthcare financing, Influence peddling, Medical Costs, Medical Practice Models, Organizational structure, Patient Choice, Patient Safety, Patient-centered Care, Policy Issues, Quality, Uncategorized

Surgeon Sues Orlando Health Over ‘Forced’ Referrals | Medpage Today

Jay Wolfson, PhD, a health policy expert at the University of South Florida in Tampa, said this case “goes to the heart of physician clinical autonomy.”

Hospitals use various methods to ensure that physicians refer patients to its own entities, including non-compete agreements that prohibit doctors from practicing medicine in a set geographic area around their place of employment during their contract, or even after termination.

A 2018 survey of 2,000 doctors in five states found that 45% of primary care physicians were bound by this sort of non-compete agreement, though hospital-based physicians are less likely to be restricted by these clauses.

https://www.medpagetoday.com/special-reports/exclusives/84571

Posted in Education, FDA, Government Regulations, Medical Costs, Patient Safety, Policy Issues, Technology, U.S. Security, Uncategorized

Is that a Centipede I See in My Capsule?? | MedPage Today

Eban: They knew I was coming. They had let me come in, but I saw a very different world within these plants through whistleblowers. I worked with a lot of whistleblowers who had contacted me — or I had made contact with them — who were showing me documents, showing me photographs, giving me really the sort of gory details of what was happening in these plants and the kinds of crazy decisions that were being made like failing drugs, drugs that had glass particles in them were being approved to be dispensed. Broken down, rusted equipment that was leaving metallic fragments in pills. Those were being dispensed.

Illicit use of ingredients. You can’t just swap ingredients. But they had drugs that were dissolving improperly, so they just haphazardly changed things up to try to get better data to show the FDA. All of this was taking place in a kind of lawless regulatory environment. They’re not afraid of their own regulators. They’re afraid of the FDA, but what they have built is an elaborate system to trick the FDA. Our FDA has all but volunteered to be tricked because we announce our inspections in advance overseas. We give 3 months’ notice. They send in data fabrication teams.

https://www.medpagetoday.com/podcasts/anamnesis/84501

Posted in Access to healthcare, advance-pricing, Affordable Care Act (ObamaCare), CPT billing, Deductibles, Economic Issues, Employer-Sponsored Health Plans, Government Regulations, Health Insurance, Healthcare financing, Medical Costs, medical inflation, out-of-pocket costs, Patient Choice, Policy Issues, Uncategorized

On the Importance of Price Transparency

Dollar-under-magnifying-glass-1024x910On the importance of transparency… may I present exhibit A: https://www.medpagetoday.com/publichealthpolicy/ethics/83459

Pay particular attention to the content of the last paragraph!!! 

“The Affordable Care Act mandates that health insurers cover all federally recommended vaccines…at no charge to patients,…

Kaiser Health News looked at what its own insurance carrier, Cigna, paid for those free flu shots. At the high end, it shelled out $85 for a flu shot given at a Sacramento, California, doctor’s office that was affiliated with Sutter Health, one of the largest hospital chains in the state. Further south, in Long Beach, Cigna paid $48 for a shot.

Prices in the Washington, D.C., area went even lower, to $40 per shot at a CVS in Rockville, Maryland, and to $32 per shot at a CVS in downtown Washington that’s less than 10 miles away from the Rockville location.

Picture1.pngOne expert told KHN that the variation has nothing to do with the cost of the drug, but stems from secret negotiations between health plans and providers. While patients are expected not to care since the shot is free to them, these costs come back to bite in the form of higher premiums — which is one of the major complaints about the ACA.”

Posted in Access to healthcare, Accountable Care Organizations, American Presidents, big government, Doctor-Patient Relationship, Economic Issues, Electronic Health Records, Health Insurance, Medical Costs, medical inflation, Medicare, Patient Safety, Policy Issues, Uncategorized

How Medicare Ruined American Healthcare | Medpage Today

Regarding the King-Anderson bill, the forerunner of Medicare, touted by JFK which eventually was defeated in the Senate…

“Edward Annis, MD, spoke eloquently to an empty Garden and to one of the biggest TV audiences of the times.

He explained directly to viewers: “This is not health care insurance … It will put government smack into your hospitals … deciding who gets in, who gets out, what they get, and what they don’t get. … This King-Anderson Bill is a cruel hoax and a delusion. … It will stand between the patient and his doctor. And it will serve as a forerunner of a different system of medicine for all Americans.”

In the late 1990s I asked Dr. Annis what was in the King-Anderson Bill that enabled him to predict in 1962 the insolvency of Medicare and the coming government takeover of healthcare. He replied with a smile, “Cost-plus financing. It was a license to steal.”

Indeed, Medicare ushered in unbridled spending for two decades before approaching insolvency.

But, as predicted by Dr. Annis, the system became insolvent by the early nineties… Hospitals and many providers became addicted to the easy money and abused the system. Why not? Cost-plus meant guaranteed profit.

Faced with Medicare insolvency, the insurance lobby persuaded Hillary Clinton to have secret meetings, without physician input.

Though Hillarycare never became law, the effort brought a sea change. Patients could no longer choose their doctor. Insurance companies now owned the patients. Participation in HMOs rose from 10% to 50%. Your doctor could no longer refer you to the best hospital or consultants if they were “out of network.” The doctor-patient bond had been successfully severed.

Medicare does not mandate who gets into hospitals, but it forces patients to get out by paying for only a limited number of days.

For the past two decades, hospitals have aggressively been buying up medical practices. The goal is to establish accountable care organizations (ACOs). Private practitioners are being elbowed out slowly but surely. General practitioners (GPs) cannot admit a patient to the hospital without “hospitalists” taking over. Hospital surgeons cannot refer to private surgeons, etc. Even the concierge model will be wiped out.

The Medicare approach to ACOs requires three things: 1) electronic medical records, 2) a “Quality Care Protocol,” and 3) a “Protocol for the Elimination of Non-Compliant Physicians.”

This is the ideal rationing system.

The computer will eventually dictate all allowed testing and treatments according to a “quality,” or more likely “cheapest way to do it,” protocol. Providers will ration according to the computer or they will fall into the “protocol for elimination of non-compliant physicians.”

In the new system, no one has a doctor. Doctors have a shift. The doctor you see on the morning shift has absolutely no responsibility for you when his/her shift is over or on a day off. A nurse practitioner takes the patient history and physical, further fractionating care. A system like this requires that all doctors are created equal. They are not.

Politicians and bean counters have never understood healthcare delivery. It was used and abused as a political tool.

No one listened to the warning of Dr. Annis. The AMA is often demonized by historians for opposition to Medicare, but it understood healthcare delivery and the destructive nature of cost-plus financing. I blossomed in the Golden Age of Medicine and bear witness to the fall.

Source: How Medicare Ruined American Healthcare | Medpage Today

Posted in Disease Prevention, Education, Evidence-based Medicine, outcomes, outcomes measurement, Patient Safety, primary care, Protocols, Uncategorized

Fish Oil Flops for Asthma Control in Overweight Youth | Medpage Today

Fish oil supplementation was not associated with improvements in asthma-related outcomes among overweight/obese teens and young adults with uncontrolled asthma in randomized trial.

Six months of treatment with 4 g/day of fish oil did not improve self-reported asthma control or breathing test outcomes or reduce urgent care visits and severe asthma exacerbations relative to soybean-oil placebo, reported Jason E. Lang, MD, of Duke University, and colleagues in Annals of the American Thoracic Society.

https://www.medpagetoday.com/allergyimmunology/asthma/77628

Posted in Education, Government Regulations, Influence peddling, Organizational structure, outcomes, outcomes measurement, Patient Safety, Policy Issues, Quality, Uncategorized, Unsettled Science

Worried About Your Certification Exam? Look to Heavens | Medpage Today

All too often, a physician’s strategy during the certification examination is not necessarily to provide the right answer, but instead, to give the “expected” answer. My post last week about guidelines led many readers to write that they could not ignore the guidelines — even if they believed that they were wrong — because the guidelines represented the “expected” answers to questions asked during the recertification process.

If a clinician had independently read and analyzed the literature and had reached a conclusion that differed from that in a guideline, they would still need to provide the guideline-directed answer to the question during the formal examination.

For many physicians, the more you know, the more likely it is that you will get the question wrong.

Last week, the New York Times ran a story about the certification process in the discipline of — astrology!

Source: Worried About Your Certification Exam? Look to Heavens | Medpage Today