Medicare is “a program under the U.S. Social Security Administration that reimburses hospitals and physicians for medical care provided to qualifying people over 65 years old.”

Everybody pays into the Medicare bucket — if you pay taxes that is. In other words, you’re paying for those non-compliant diabetics who have to undergo dialysis and lower extremity amputations.

“I can’t be bothered to stick my finger every flippin’ day, take those damn blue pills, or not eat sugar. Hell, I’ve been drinking sweet tea every day for fitty years!”

“But Mr. Robertson, you could suffer from some very serious complications if you don’t manage your diabetes.”

“Naw. Ma pa had da sugar disease and he did OK. Lived to be 95 and ate biscuits n’ gravy every mornin’. That sugar disease don’t affect me or my family.”

You’re paying for these incompetent idiots. Doesn’t that piss you off? It certainly gets under my skin.

Medicare Likes Games

Take a look at this recent article from the Association of American Physicians and Surgeons:

If the provision survives, physicians would get a 0.5% pay increase in 2008 and 2009, instead of projected cuts of 9.9% and 5.0%.

Before you get too excited:

The tiny physician payment increases would be offset by 11% cuts in 2010 and 2011. Specialty societies report that the various cost-control schemes will pit physicians against each other—for example, it sets up an advisory panel to re-do Relative Value Units (RVUs) for “over-valued” services.

Let’s take a look at some basic math. Pay increases of 0.5% per year for two years instead of projected cuts of 9.9% and 5.0% This is a net increase of 15.9% However, cuts in 2010 and 2011 add up to 22%, leaving physicians with a net pay decrease of 6.1% Factor in inflationary costs and docs are pedaling backwards.

Other changes include abolishing “Health Opportunity Acounts,” the provision that allows HSA-programs in Medicaid; repealing a provision of the Medicare Modernization Act that restricts the use of general revenues to fund Medicare; and raises fees of certified nurse midwives to equal those of obstetricians. There is a plethora of new requirements that enrich some interest groups and kill off others.

Democrats plan to pay for the bill by boosting federal tobacco taxes and hiking taxes on insurance companies by $2 per person.

On the whole, the bill contains “the most sweeping changes in decades” to American medicine—changes that will affect every American, stated Rep. John Shadegg (R-AZ). It marks a sharp turn away from a re-invigorated private market and toward government-run medicine.

Watch out. Physicians are poised to be the next government employee. Ask any government worker: The paychecks suck.

Popularity: 13% [?]

Universal health care is something that will face this nation probably sooner rather than later. I am not a supporter of universal health care, and strongly believe that health care is a privilege, and not a right.

Lawmakers in Connecticut are proposing an additional 3% tax to physician’s revenue in order to fund universal health care. Needless to say, these doctors aren’t happy.

“I am willing to stay … but this bill and unrelenting overhead costs are putting me out of business. My electrical rates have doubled, my liability insurance has tripled … even after 23 years in practice, I struggle every week to make my employees’ payroll.”

This is a sad fact that is plaguing more and more practices today as costs continue to increase and insurance reimbursements continue to fall. Dr. Gourlie goes on to say:

“Taxing doctors to fund health care for the underserved is not the solution, and it will result in less care for everybody.”

I completely agree with the above statement. Why should physicians, who are already suffering from decreased insurance payouts and higher overhead, be forced to fund something that shouldn’t happen in the first place?

Proponents state that the tax will generate $600 million for the state and be offset by $300 million in federal reimbursement. The plan also calls to increase Medicaid reimbursement by up to 30%.

But, for physicians whose Medicaid reimbursements are a small fraction of their total revenues, this offset might not equilibrate earnings. Furthermore, the increased Medicaid reimbursement doesn’t cover overhead expenses such as storage or breakage for drugs.

It makes me angry when my hard-earned money (some of which I use to pay for my own health care through insurance) goes towards paying for people who are too lazy or don’t have enough drive to either get health insurance, make enough money to pay cash for health care, or find a job that offers a decent health package.

I pay for my health insurance, just like I pay for my car. We’re not giving out cars to those who can’t afford them, and we shouldn’t be giving out health care to those people either. It taxes the system as a whole, and those people who can afford health care are ultimately left with fewer resources at their disposal. In the end, it is the people like Dr. Gourlie who work hard for what they have, being faced with funding the whole shebang.

For all of those people who want universal health care, how do you expect to fund it? Would an additional 3% tax to your gross earnings be something you’d be excited about? Think about that before talking about the benefits of universal coverage. The money has got to come from somewhere.

via: [Courant, SDN]

Popularity: 6% [?]

I was browsing around the SDN forums the other day and came across a thread that quickly turned into the discussion of outsourcing. I was pretty interested in the topic, and came across an interesting article after doing some research. The article is two years old, but is a good read nonetheless.

I’ve always heard people say that outsourcing will never happen. This can’t be further from the truth. If you read the article, you’ll find that it is already happening. The reality is that residents and physicians don’t want to believe that it is happening as it imposes serious threats to their livelihood. If you dig further, you can find other stories as well.

The imaging charter was presented to the FDA and there was no objection from the FDA regarding conducting the review in India. This review resulted in cost and time savings for the sponsor, and demonstrates another avenue for US companies to reduce clinical trial expenses.

Radiology has been used as a test bed for outsourcing, primarily due to the digital nature of films and ease of transporting data quickly through network pipes to the other side of the world. There are now firms dedicated to reading films during “off peak” hours. They are often located in Australia or India, as this allows for our late-night films to be read by somebody who’s in the middle of their normal workday.

Of course this brings up concerns regarding accreditation and liability, but since the practice of outsourcing continues, the problems are most likely too minor to warrant any stop to sending films overseas. Despite some of these concerns, both sides of the fence honestly believe that outsourcing and telemedicine are the wave of the future. It simply increases productivity while decreases cost.

I’ve always said that medicine is simply business, and we’re beginning to see stronger evidence of that. With the exponential increase in technology advancements (via Moore’s Law), it’s only a matter of time until telemedicine becomes so cheap that it will be foolish for all hospitals not to adopt some form of it.

What does this mean for future doctors? I honestly don’t know. I do believe that some of the more technologically-advanced specialties such as radiology and even pathology will most likely become the ones that see mass outsourcing first. Outsourcing plain old patient care and physical exams probably won’t happen for awhile, but these types of specialties will have their own problems soon enough as more students favor lifestyle over brute force hours.

How do you feel about outsourcing? Will the ease of outsourcing have an effect on how you choose your specialty? Or, do you not feel that it’s something that you will have to worry about in your lifetime?

Popularity: 4% [?]

Sound crazy? It is. A pediatrician has refused to treat a patient because the patient’s mother has tattoos. In fact, Dr. Gary Merrill has the following sign in his office:

“This is a private office. Appearance and behavior standards apply.”

This means that patients cannot have body piercings, tattoos, and many other strict requirements. And, guess what guys? The AMA reserves the right that Dr. Merrill can do what he wishes in his private office - and can refuse treatment in non life-threatening situations.

Chalk a win up for private physicians that are running businesses. Just like McDonald’s can refuse service if you’re without shirt and shoes, Dr. Merrill is making his own rules of what can and cannot occur inside his business. I think this is a good thing.

Tasha Childress’ response after Dr. Merrill refused to treat her daughter’s ear infection?

I felt totally discriminated against, like I wasn’t good enough to talk to, Tasha Childress said, like he didn’t have to give me any reason for not wanting to see my daughter because I have tattoos and piercings.

You would think that this guy was the only pediatrician in town. If patients aren’t happy with the services rendered, simply go see another doc.

Problem solved.

via: [KGET News]

Popularity: 6% [?]

While probably not going to change anything, a recent study published in the Journal of Surgical Research has shown that decreasing work hours alone does little to perceived patient care.

Note the keyword above - perceived.

The study was conducted among 156 surgical residents and had an excellent 94.5% response rate and consisted of surgical residents already regulated by work-hour restriction (maximum 80-hour work week) and residents who had not previously been regulated by work-hour restrictions.

The problem is not in the decreased work hours. Anybody with any common sense is going to realize that you are more efficient and more on top of your game if you’re well-rested. Just look at pilots in the commercial airline industry - they don’t let those guys work insane hours.

The flaws in patient care were found to be primarily in communication among residents. More precisely, we’re talking about cross-coverage and shit like that. In other words, whenever a resident passes on his census to a covering resident, that communication needs some improvement.

What’s interesting about this study is that it looked at decreased work hours versus patient care. The study found no improvement in patient care with decreased work hours. Now, many will look at this and say “so decreasing work hours doesn’t work.”

Not true. Decreasing work hours is a reasonable method to ensure that residents provide better care to patients. The residents are better rested, have more of a life, and everybody wins.

Another study needs to be done that looks at improving communication among cross-covering teams. That’s the real problem. Sure, it took this study to begin pointing that out, but let’s not give decreasing work hours a bad rap for failure to provide patient care improvements.

Popularity: 3% [?]