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Monday, July 18, 2016
Laboratory Results: Do you receive them ?
https://www.dropbox.com/s/9598jagn1oso8w9/One%20of%20the%20problems%20with%20medical%20care%20is%20the%20lack%20of%20internal%20controls%20in%20a%20practice.doc?dl=0
One of the problems with medical care is the lack of internal controls in
a practice.
Example:
About two weeks ago I noted a growing lump on my scalp. I went t
o see a dermatologist (a former
colleague of mine). He did a biopsy and said he would call me in t
wo or three days with the diagnosis.
He also said that if the biopsy was
positive
he would refer me to a plastic surgeon that used a surgery
center. (he did not have hospital privileges). There was some concern since I am
on blood thinners for a
stroke and several AMIs with several stents following multiple angioplasties
placing me at a higher risk. I
was concerned about the possibility of another stroke or AMI if Clopid
ogrel was stopped.
I waited four days with no telephone call. Finally, I called to find o
ut what the diagnosis was, and I was
told it was a squamous cell skin cancer. I then spoke to a receptionist who said
she would speak to the
medical assistant
...
.still no call back. I asked if they were going to make a referral to the
plastic surgeon
or should I call ? Answer
“
we will call you later this afternoon and let you know.
Good morning, it is now tomorrow and six days have gone by since the
biopsy.
My gut feeling is to find another plastic surgeon (not the one he referred m
e to) (birds of a feather, flock
together.)
Moral of the story
...
..do not be passive about lab results. Call, call, call until you
get an answer. Not
hearing anything creates great anxiety for anyone. You paid for the lab work
, you paid for the doctor
visit. This type of thing borders on negligence. Do not be passiv
e
...
it
s your life.
I have
fired
my dermatologist, especially in light of the fact I chose him sinc
e he was a former
colleague. (30 years ago). If your MD is over the age of 60 ask if they
have hospital privileges. An
unknown secret is that many senior MDs give up their hospital privileges due
to age or an unwillingness
to take call. Being an MD is a
marathon
, not a sprint. That is not to say that MDs who do not use
hospitals are bad doctors
......
..just prudent and self-aware.
Of course this is an anecdotal story. Perhaps he does call and respond to ot
her patients he has operated
upon.
P.S. He advertises himself as a
cosmetic surgeon
using lasers, creams and anti-aging compounds. In
today
s world almost any MD can call themselves
“
cosmetic surgeons
. I have seen Family Doctors
offering skin laser surgery for age spots. Always check with a hospital about th
eir privelges and what
department in the hospital they are assigned to. They should be a surgeon wi
th a designated specialty.
If this can happen to a physician, God help the rest of you. One of the problems with medical care is the lack of internal controls in
a practice.
Example:
About two weeks ago I noted a growing lump on my scalp. I went t
o see a dermatologist (a former
colleague of mine). He did a biopsy and said he would call me in t
wo or three days with the diagnosis.
He also said that if the biopsy was
positive
he would refer me to a plastic surgeon that used a surgery
center. (he did not have hospital privileges). There was some concern since I am
on blood thinners for a
stroke and several AMIs with several stents following multiple angioplasties
placing me at a higher risk. I
was concerned about the possibility of another stroke or AMI if Clopid
ogrel was stopped.
I waited four days with no telephone call. Finally, I called to find o
ut what the diagnosis was, and I was
told it was a squamous cell skin cancer. I then spoke to a receptionist who said
she would speak to the
medical assistant
...
.still no call back. I asked if they were going to make a referral to the
plastic surgeon
or should I call ? Answer
“
we will call you later this afternoon and let you know.
Good morning, it is now tomorrow and six days have gone by since the
biopsy.
My gut feeling is to find another plastic surgeon (not the one he referred m
e to) (birds of a feather, flock
together.)
Moral of the story
...
..do not be passive about lab results. Call, call, call until you
get an answer. Not
hearing anything creates great anxiety for anyone. You paid for the lab work
, you paid for the doctor
visit. This type of thing borders on negligence. Do not be passiv
e
...
it
s your life.
I have
fired
my dermatologist, especially in light of the fact I chose him sinc
e he was a former
colleague. (30 years ago). If your MD is over the age of 60 ask if they
have hospital privileges. An
unknown secret is that many senior MDs give up their hospital privileges due
to age or an unwillingness
to take call. Being an MD is a
marathon
, not a sprint. That is not to say that MDs who do not use
hospitals are bad doctors
......
..just prudent and self-aware.
Of course this is an anecdotal story. Perhaps he does call and respond to ot
her patients he has operated
upon.
P.S. He advertises himself as a
cosmetic surgeon
using lasers, creams and anti-aging compounds. In
today
s world almost any MD can call themselves
“
cosmetic surgeons
. I have seen Family Doctors
offering skin laser surgery for age spots. Always check with a hospital about th
eir privelges and what
department in the hospital they are assigned to. They should be a surgeon wi
th a designated specialty.
If this can happen to a physician, God help the rest of you.
Saturday, July 16, 2016
The Illicit Perks of the M.D. Club and why Physicians are burning out The New York Times
The Illicit Perks of the M.D. Club
Now and then I share the experiences physicians witness, even in their own nor family's care. For them it is also a challenge. Pity the ordinary patient citizen.
I received an email from Doximity, a closed professional social media site restricted to physicians. On Doximity we all share elevator talk...the few seconds of intercourse discussing patient experiences among peers. (probably illegal under the shield of HIPAA regulations. These regulations have become more than burdensome, because they do effect patient care.
This story spells out one or more such situations a physician experiences in his own care or that of a friend or family. This process consumes an inordinate amount of time during an appeal process. One case in particular concerning a serious lumbar disc illuminates the tension of reading a guideline of prior treatment pursuant to approving a request for an MRI. MRIs by the way are considered standard practice for serious back injuries. Prolonged herniated disc problems often lead to permanent nerve injury and disability.The insurance company insisted on a six week waiting period before an MRI was approved. Their decision is based upon the fact and MRI costs $ 1,000, not the welfare of a patient.
From a Medical-legal standpoint this places the physician in jeopardy, despite his order for an MRI. Had the patient presented at an emergency department an MRI most likely would have been ordered. And since it was in an acute emergent condition it would have been pefrormed immediately and without a prior authorization. The risk of a legal incident in the emergency setting would pre-empt any decision by the insurer. The hospital or MRI center would be the loser if an insurer retroactively did not authorize a payment. (they do not like losing money with smaller margins.). The insurance company is under control, unless the physician insists using his authority to protect the patient.
This scenario occurs multiple times a day for most MDs. It is a major cause for burnout, which most patients are aware occurs often early in a physician's career.
Many articles now discuss the rising tide of physician burnout, and suicide. How can it be prevented?
The loss of physician authority and the complex tension between advocating for the patient and the bottom line for health insurers creates a conundrum for the doctor. She (he) has been placed in a repeating cycle of conflict, a chronic emotional enui leading to a similar state as PTSD.(post traumatic stress disorder). Only in this case it is not post-traumatic, it is ongoing on a daily basis.
This may be the primary cause for physician burnout and suicide Doctors have been trained to work long hours and to deal with emergencies, even in the middle of the night.
Read the entire article here...
The Illicit Perks of the M.D. Club - The New York Times
Next time you are denied a test or procedure, call your insurance company and protest vehemently. You probably won't get very far.
Insurers must share liability for thier medical malfeasance...It must not sit on the shoulders of your physician.
Now and then I share the experiences physicians witness, even in their own nor family's care. For them it is also a challenge. Pity the ordinary patient citizen.
I received an email from Doximity, a closed professional social media site restricted to physicians. On Doximity we all share elevator talk...the few seconds of intercourse discussing patient experiences among peers. (probably illegal under the shield of HIPAA regulations. These regulations have become more than burdensome, because they do effect patient care.
This story spells out one or more such situations a physician experiences in his own care or that of a friend or family. This process consumes an inordinate amount of time during an appeal process. One case in particular concerning a serious lumbar disc illuminates the tension of reading a guideline of prior treatment pursuant to approving a request for an MRI. MRIs by the way are considered standard practice for serious back injuries. Prolonged herniated disc problems often lead to permanent nerve injury and disability.The insurance company insisted on a six week waiting period before an MRI was approved. Their decision is based upon the fact and MRI costs $ 1,000, not the welfare of a patient.
From a Medical-legal standpoint this places the physician in jeopardy, despite his order for an MRI. Had the patient presented at an emergency department an MRI most likely would have been ordered. And since it was in an acute emergent condition it would have been pefrormed immediately and without a prior authorization. The risk of a legal incident in the emergency setting would pre-empt any decision by the insurer. The hospital or MRI center would be the loser if an insurer retroactively did not authorize a payment. (they do not like losing money with smaller margins.). The insurance company is under control, unless the physician insists using his authority to protect the patient.
This scenario occurs multiple times a day for most MDs. It is a major cause for burnout, which most patients are aware occurs often early in a physician's career.
Many articles now discuss the rising tide of physician burnout, and suicide. How can it be prevented?
The loss of physician authority and the complex tension between advocating for the patient and the bottom line for health insurers creates a conundrum for the doctor. She (he) has been placed in a repeating cycle of conflict, a chronic emotional enui leading to a similar state as PTSD.(post traumatic stress disorder). Only in this case it is not post-traumatic, it is ongoing on a daily basis.
This may be the primary cause for physician burnout and suicide Doctors have been trained to work long hours and to deal with emergencies, even in the middle of the night.
Read the entire article here...
The Illicit Perks of the M.D. Club - The New York Times
Next time you are denied a test or procedure, call your insurance company and protest vehemently. You probably won't get very far.
Insurers must share liability for thier medical malfeasance...It must not sit on the shoulders of your physician.
Wednesday, July 13, 2016
Affordable Care Act causing more mega=-mergers
Two mega-mergers in the health insurance industry are sparking intense debate over cost and competition.
California has two health insurane regulatory agencies: 1. Commissioner Dave Jones, and 2.Shelley Roullaard and the Dept of Managed Health Care. The Department of Manged Health Care came into existence about 20 years ago when the boom in HMOs occured.
California Insurance Commissioner Dave Jones has criticized both deals — Anthem-Cigna andAetna-Humana — as being anti-competitive, and he has asked the U.S. Department of Justice to block the mergers on antitrust grounds. Jones has questioned whether policyholders will see much of the savings these companies tout in their proposed acquisitions.
But California’s other insurance regulator, Shelley Rouillard at the Department of Managed Health Care, approved the Aetna deal with a condition that the company try to keep future rate increases to a minimum. She hasn’t weighed in on Anthem’s merger.
Meanwhile, another key regulator reviewing the deals — Connecticut Insurance Commissioner Katharine Wade — has come under scrutiny because of her extensive ties to Cigna.
Chad Terhune of California Healthline discussed these developments, and the potential impact of industry mergers on consumers and market competition, last Friday on WNPR’s “Where We Live” in Connecticut.
California’s Bifurcated Regulatory View of Health Insurance Mergers | California Healthline
Affordable Care Act causing more mega=-mergers
Two mega-mergers in the health insurance industry are sparking intense debate over cost and competition.
California has two health insurane regulatory agencies: 1. Commissioner Dave Jones, and 2.Shelley Roullaard and the Dept of Managed Health Care. The Department of Manged Health Care came into existence about 20 years ago when the boom in HMOs occured.
California Insurance Commissioner Dave Jones has criticized both deals — Anthem-Cigna andAetna-Humana — as being anti-competitive, and he has asked the U.S. Department of Justice to block the mergers on antitrust grounds. Jones has questioned whether policyholders will see much of the savings these companies tout in their proposed acquisitions.
But California’s other insurance regulator, Shelley Rouillard at the Department of Managed Health Care, approved the Aetna deal with a condition that the company try to keep future rate increases to a minimum. She hasn’t weighed in on Anthem’s merger.
Meanwhile, another key regulator reviewing the deals — Connecticut Insurance Commissioner Katharine Wade — has come under scrutiny because of her extensive ties to Cigna.
Chad Terhune of California Healthline discussed these developments, and the potential impact of industry mergers on consumers and market competition, last Friday on WNPR’s “Where We Live” in Connecticut.
California’s Bifurcated Regulatory View of Health Insurance Mergers | California Healthline
Affordable Care Act causing more mega=-mergers
Two mega-mergers in the health insurance industry are sparking intense debate over cost and competition.
California has two health insurane regulatory agencies: 1. Commissioner Dave Jones, and 2.Shelley Roullaard and the Dept of Managed Health Care. The Department of Manged Health Care came into existence about 20 years ago when the boom in HMOs occured.
California Insurance Commissioner Dave Jones has criticized both deals — Anthem-Cigna andAetna-Humana — as being anti-competitive, and he has asked the U.S. Department of Justice to block the mergers on antitrust grounds. Jones has questioned whether policyholders will see much of the savings these companies tout in their proposed acquisitions.
But California’s other insurance regulator, Shelley Rouillard at the Department of Managed Health Care, approved the Aetna deal with a condition that the company try to keep future rate increases to a minimum. She hasn’t weighed in on Anthem’s merger.
Meanwhile, another key regulator reviewing the deals — Connecticut Insurance Commissioner Katharine Wade — has come under scrutiny because of her extensive ties to Cigna.
Chad Terhune of California Healthline discussed these developments, and the potential impact of industry mergers on consumers and market competition, last Friday on WNPR’s “Where We Live” in Connecticut.
California’s Bifurcated Regulatory View of Health Insurance Mergers | California Healthline
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