http://www.kevinmd.com/blog/2008/01/reader-letters-primary-care-crisis-dont.html#comments
I was just thinking (living) this. On a related note, Medicare wants to cut payments to physicians by 10%, and almost all insurers base their pay scale on Medicare. One congressman said this would not be a problem because doctors will keep taking Medicare because it is covers so many patients. We'll stop covering patients when we go out of business. I gotta figure a way to see more people in less time while providing more comprehensive care.
http://www.healthbeatblog.org/2007/08/wall-street-can.html#more
A post about approval for a drug for prostate cancer. It brings up a variety of important issues. Makes you shudder, too.
http://www.healthbeatblog.org/2007/11/your-yearly-phy.html
OK, I've found a new favorite blog. This post echoes my thoughts about the annual check up or physical. Of course, this writer is a heck of a lot better than me.
http://www.healthbeatblog.org/2007/11/autismanother-e.html
Did you know that autism affects 1 out of every 150 children? Me neither.
And finally, click on this link to help donate a free mammogam to someone, or something like that.
http://www.thebreastcancersite.com/
Showing posts with label medicine. Show all posts
Showing posts with label medicine. Show all posts
Sunday, January 20, 2008
Thursday, December 27, 2007
cancer
http://blogs.chron.com/cancerdiva/
If you are a doctor, or a person with cancer, this insider's view of cancer is a must read. Sometimes I forget to realize that people with illnesses are people, too
If you are a doctor, or a person with cancer, this insider's view of cancer is a must read. Sometimes I forget to realize that people with illnesses are people, too
Tuesday, December 25, 2007
17 year old with Leukemia denied payment for treatment
http://www.cnn.com/2007/HEALTH/conditions/12/21/teen.liver.transplant.ap/index.html?eref=rss_topstories
So many issues to bring up, where to start?
1. She had a 65% chance of living 6 months with the transplant. Does that make the transplant mandatory? What if there was another possible recipient with a greater chance of living longer and healthier? 2 out of 3 people live 6 months- I would not take those odds for me, I would for my kids.
2. Everyone is saying the insurance company should pay for every transplant. I think that these should be made on a case by case basis, with some basic criteria as a baseline. Those transplants ain't cheap, and the after care is not easy on the recipient. Remember, a bone marrow transplant from her brother caused the liver failure.
3. CIGNA did not kill the girl, leukemia and liver failure did. Cigna had nothing to do with the leukemia and liver failure.
4. One newspaper editorial said that if a doctor says a procedure is OK, then it should be covered by the insurance company. I appreciate the vote of confidence, but you don't want me to have absolute power to order treatments for you. There is too much new information with new treatments with new benefits and new side effect to just let me run amok. Most doctors, like most people in general, will chose the treatment that pays the doctor best. The pendulum has swung too far in the insurance companies' favor, but physicians still need that check to our authority.
5. The payment for the transplant was refused on December 11th. The family could have given an OK, then sought media attention to pay for it (it probably costs more than a million dollars, so it's not easy to pay for). To say the insurance company stopped the transplant is false- CIGNA decided not to pay for it. When your insurance refuses to pay for your MRI, you can still get one, you just have to pay for it.
6. What was the girl's condition at the time the transplant was denied? Was she in a coma at that time? Why isn't that part of the media story?
7. It's so sad when a kid dies. I hope the family an come to terms with the fact that she died amidst all of the legal battles.
So many issues to bring up, where to start?
1. She had a 65% chance of living 6 months with the transplant. Does that make the transplant mandatory? What if there was another possible recipient with a greater chance of living longer and healthier? 2 out of 3 people live 6 months- I would not take those odds for me, I would for my kids.
2. Everyone is saying the insurance company should pay for every transplant. I think that these should be made on a case by case basis, with some basic criteria as a baseline. Those transplants ain't cheap, and the after care is not easy on the recipient. Remember, a bone marrow transplant from her brother caused the liver failure.
3. CIGNA did not kill the girl, leukemia and liver failure did. Cigna had nothing to do with the leukemia and liver failure.
4. One newspaper editorial said that if a doctor says a procedure is OK, then it should be covered by the insurance company. I appreciate the vote of confidence, but you don't want me to have absolute power to order treatments for you. There is too much new information with new treatments with new benefits and new side effect to just let me run amok. Most doctors, like most people in general, will chose the treatment that pays the doctor best. The pendulum has swung too far in the insurance companies' favor, but physicians still need that check to our authority.
5. The payment for the transplant was refused on December 11th. The family could have given an OK, then sought media attention to pay for it (it probably costs more than a million dollars, so it's not easy to pay for). To say the insurance company stopped the transplant is false- CIGNA decided not to pay for it. When your insurance refuses to pay for your MRI, you can still get one, you just have to pay for it.
6. What was the girl's condition at the time the transplant was denied? Was she in a coma at that time? Why isn't that part of the media story?
7. It's so sad when a kid dies. I hope the family an come to terms with the fact that she died amidst all of the legal battles.
Sunday, December 23, 2007
Primary care issues- can we survive
www.memag.com/memag/Medical+Practice+Management%3A+Business+Operations/Practice-Overhaul-Contest-Turnaround-help-for-inco/ArticleStandard/Article/detail/479380?contextCategoryId=43934
The article above is about a private practice that is trying to improve business practices without compromising patient care. What I find interesting is the idea that PCP's should see 30-35 patients a day. It's do-able, but not preferable. Patients want more time from their doctors. Doctors need to see more patients as reimbursement per patient is decreasing. The current practice models are not sustainable in the long-term unless all of us join large groups.
Meanwhile, concierge practices see 10-15 people per day and make more money- without having to deal with insurance hassles. More money per patient and fewer patients calling after hours. It sounds great for me, but I can't say the same thing for the general public (especially the general public in the lower 75% income group). As someone with a struggling new practice, I have to choose between the bird in the hand (low reimbursement insurance covered patients- of whom there are many) and the bird in the bush (a concierge practice- where I have to hope that there are at least 250 families willing to give me $2,500 per family to care for them). I definitely need to phrase it as $200 per month.
But with practices going out of business and large group practices being slow to move into some of the new suburbs, the general public is beginning to lose access to health care services due to a lack of PCP's. This is a problem for both the poor and the middle class. I don't have a solution that is workable, I'm just saying this is an unrecognized problem.
http://laissezfairehealthcare.com/2007/12/22/primary-care-physicians-an-endangered-species/
Another aticle addressing the practice of primary care medicine. I can't add anything to this except to say, "yep, he's right".
http://www.thehealthcareblog.com/the_health_care_blog/2007/12/bad-medicine-ho.html
And finally, the most comprehensive blog post I found on the subject.
The article above is about a private practice that is trying to improve business practices without compromising patient care. What I find interesting is the idea that PCP's should see 30-35 patients a day. It's do-able, but not preferable. Patients want more time from their doctors. Doctors need to see more patients as reimbursement per patient is decreasing. The current practice models are not sustainable in the long-term unless all of us join large groups.
Meanwhile, concierge practices see 10-15 people per day and make more money- without having to deal with insurance hassles. More money per patient and fewer patients calling after hours. It sounds great for me, but I can't say the same thing for the general public (especially the general public in the lower 75% income group). As someone with a struggling new practice, I have to choose between the bird in the hand (low reimbursement insurance covered patients- of whom there are many) and the bird in the bush (a concierge practice- where I have to hope that there are at least 250 families willing to give me $2,500 per family to care for them). I definitely need to phrase it as $200 per month.
But with practices going out of business and large group practices being slow to move into some of the new suburbs, the general public is beginning to lose access to health care services due to a lack of PCP's. This is a problem for both the poor and the middle class. I don't have a solution that is workable, I'm just saying this is an unrecognized problem.
http://laissezfairehealthcare.com/2007/12/22/primary-care-physicians-an-endangered-species/
Another aticle addressing the practice of primary care medicine. I can't add anything to this except to say, "yep, he's right".
http://www.thehealthcareblog.com/the_health_care_blog/2007/12/bad-medicine-ho.html
And finally, the most comprehensive blog post I found on the subject.
Wednesday, August 1, 2007
Health Care- system
http://www.nytimes.com/2007/07/29/health/29Cancer.html?_r=1&th&emc=th&oref=slogin
You can do whatever you want to with healthcare funding, but this is the biggest problem out there. Disjointed care makes it real hard to take care of a mobile population. And with the general lack of consensus on treatment guidelines, and the regional variability of quality facilities and staff....
http://www.nytimes.com/2007/07/27/us/27infect.html?_r=1&oref=slogin
Meanwhile, how a good SYSTEM can solve a problem in the health field.
http://www.chron.com/disp/story.mpl/headline/metro/5008923.html
I like how researchers always say,"Just give us more money for (insert diagnosis here) research and we'll get you a cure. SOON!!" Plus- heart disease kills more people than cancer. I'm cool with cancer research, but I don't think it will lead to a cure in the next 10 years if the state of Texas invests $1,000,000 a day for 10 years. Science does not work this way. It's trial and error and trial again.
You can do whatever you want to with healthcare funding, but this is the biggest problem out there. Disjointed care makes it real hard to take care of a mobile population. And with the general lack of consensus on treatment guidelines, and the regional variability of quality facilities and staff....
http://www.nytimes.com/2007/07/27/us/27infect.html?_r=1&oref=slogin
Meanwhile, how a good SYSTEM can solve a problem in the health field.
http://www.chron.com/disp/story.mpl/headline/metro/5008923.html
I like how researchers always say,"Just give us more money for (insert diagnosis here) research and we'll get you a cure. SOON!!" Plus- heart disease kills more people than cancer. I'm cool with cancer research, but I don't think it will lead to a cure in the next 10 years if the state of Texas invests $1,000,000 a day for 10 years. Science does not work this way. It's trial and error and trial again.
Saturday, July 28, 2007
Heroic medical personnel not indicted
http://blog.kir.com/archives/2007/07/good_news_for_d_2.asp#comments
I can't write about this case rationally. I can't believe anyone would prosecute a case like this unless they had very clear evidence a physician or other hospital employee was murdering patients. After 4 days, if the staff had any ability to think at all, it's a miracle. Instead of being heroes, the hospital staff (but not the administrators?!?!?!) are paraded around like criminals. Shameful.
I can't write about this case rationally. I can't believe anyone would prosecute a case like this unless they had very clear evidence a physician or other hospital employee was murdering patients. After 4 days, if the staff had any ability to think at all, it's a miracle. Instead of being heroes, the hospital staff (but not the administrators?!?!?!) are paraded around like criminals. Shameful.
Friday, July 20, 2007
Sicko moment
With apologies to Michael Moore....
A particular health insurance company has been the bane of my existence. They lost my paperwork when I enrolled. Their physician payment rates are lower than anyone else's, unlike their stock price or bonuses to their executives. They have been hosing patients, too- increasing payments and having inconvenient "glitches" causing them to lose money in their HSA accounts.
Then when they said I could get paid to see their patients, they entered the wrong address, phone number and Tax ID number, so they could not send any payment for 3 months. Then, they denied payment on some claims because we did not submit them properly (with address and Tax ID number matching their database) within 90 days. According to our calculations, this company owes my office at least $10,000.
But here's the kicker: this week, they actually mailed me a bill.
Yep, they claimed to have overpaid my office for one claim, so they want a refund. Insurance company "X" has gone from underpayment, to denying payments, to charging payments when doctors see their patients.
On a related note, the same company was going to fine doctor's offices $50 every time one of their patients was sent to a non-contracted lab.
A particular health insurance company has been the bane of my existence. They lost my paperwork when I enrolled. Their physician payment rates are lower than anyone else's, unlike their stock price or bonuses to their executives. They have been hosing patients, too- increasing payments and having inconvenient "glitches" causing them to lose money in their HSA accounts.
Then when they said I could get paid to see their patients, they entered the wrong address, phone number and Tax ID number, so they could not send any payment for 3 months. Then, they denied payment on some claims because we did not submit them properly (with address and Tax ID number matching their database) within 90 days. According to our calculations, this company owes my office at least $10,000.
But here's the kicker: this week, they actually mailed me a bill.
Yep, they claimed to have overpaid my office for one claim, so they want a refund. Insurance company "X" has gone from underpayment, to denying payments, to charging payments when doctors see their patients.
On a related note, the same company was going to fine doctor's offices $50 every time one of their patients was sent to a non-contracted lab.
Monday, June 25, 2007
ALLI- made you look
Alli- the new FDA approved weight loss medication, is a low dose version of prescription Orlistat.
Have you noticed how many FDA approved prescriptions have gone over the counter?
Prilosec, Zantac, Pepcid, Claritin, Mucinex, Alli- just to name a few.
I think it's good that if a medication proves to be safe and effective, consumers can get them without a prescription and without having their insurance pay. It saves the system money while still helping the patient get the care they need. The only real drawback is that people think that the Over-the-counter medications are somehow now "less strong". Alli is less strong that Orlistat because it has fewer milligrams per dose.
Don't forget to stay near a restroom with Alli
Have you noticed how many FDA approved prescriptions have gone over the counter?
Prilosec, Zantac, Pepcid, Claritin, Mucinex, Alli- just to name a few.
I think it's good that if a medication proves to be safe and effective, consumers can get them without a prescription and without having their insurance pay. It saves the system money while still helping the patient get the care they need. The only real drawback is that people think that the Over-the-counter medications are somehow now "less strong". Alli is less strong that Orlistat because it has fewer milligrams per dose.
Don't forget to stay near a restroom with Alli
Friday, June 22, 2007
Ranking hospitals and unintentional consequences
http://www.nytimes.com/2007/06/22/us/22hospital.html?th&emc=th
Another NY Times article about ranking hospitals. I would like to believe that there is a way to objectively rank hospitals and doctors. I want to know if I'm doing a good job and how I can improve. However, I also want to avoid being sued if I'm not THE best doctor. I'm sure most hospitals feel the same way.
But the public (rightfully) want to know which hospitals are better than others. But we don't know how to find that out, or even what questions to ask to find out. In general, hospitals in poorer areas have worse mortality scores. Is it because the patients are sicker when they arrive at the hospital, or because they receive poor care. I can think of a number of cases I have inherited where a patient who I'd never seen before is assigned to me, and they are on death's doorstep. If I continue to take these patients, my "scores" will decrease, just like for the hospital that takes these patients.
3 points I'd like to make
1. Most hospitals are average, and half are below average. The real litmus test should be "acceptable". What if the worst hospital was still acceptably good?
2. Doctors and hospitals will cherry pick the least sick patients. And death certificates will become less accurate to help "massage the data".
3. As mentioned at the end of the article, people will go to the better hospitals, leaving less resources for the "inferior" ones. So people will lose valuable time in cases of stroke, sepsis and heart attacks, while some hospitals will become more profitable.
4. Hospital systems will close their campuses in poorer areas. If poorer areas always have worse scores, and worse scores means less funding, and less funding means closing all of the hospitals.....
Another NY Times article about ranking hospitals. I would like to believe that there is a way to objectively rank hospitals and doctors. I want to know if I'm doing a good job and how I can improve. However, I also want to avoid being sued if I'm not THE best doctor. I'm sure most hospitals feel the same way.
But the public (rightfully) want to know which hospitals are better than others. But we don't know how to find that out, or even what questions to ask to find out. In general, hospitals in poorer areas have worse mortality scores. Is it because the patients are sicker when they arrive at the hospital, or because they receive poor care. I can think of a number of cases I have inherited where a patient who I'd never seen before is assigned to me, and they are on death's doorstep. If I continue to take these patients, my "scores" will decrease, just like for the hospital that takes these patients.
3 points I'd like to make
1. Most hospitals are average, and half are below average. The real litmus test should be "acceptable". What if the worst hospital was still acceptably good?
2. Doctors and hospitals will cherry pick the least sick patients. And death certificates will become less accurate to help "massage the data".
3. As mentioned at the end of the article, people will go to the better hospitals, leaving less resources for the "inferior" ones. So people will lose valuable time in cases of stroke, sepsis and heart attacks, while some hospitals will become more profitable.
4. Hospital systems will close their campuses in poorer areas. If poorer areas always have worse scores, and worse scores means less funding, and less funding means closing all of the hospitals.....
Saturday, June 16, 2007
Insider's view of cancer
http://blogs.chron.com/cancerdiva/2007/06/cat_scans_xrays_and_why_the_ma_1.html
I don't know what it's like to have cancer. I don't want to know. I do know when I talk to people with cancer, I try to treat them like they are alive and normal. Because they actually are alive and normal. Even when it's obvious they only have a few hours to live, if they're conscious, I'm cracking jokes and talking about my kids or sports (note, that's all I do in general).
Anyway, I'm babbling. Just pass this along to someone you know who has cancer.
I don't know what it's like to have cancer. I don't want to know. I do know when I talk to people with cancer, I try to treat them like they are alive and normal. Because they actually are alive and normal. Even when it's obvious they only have a few hours to live, if they're conscious, I'm cracking jokes and talking about my kids or sports (note, that's all I do in general).
Anyway, I'm babbling. Just pass this along to someone you know who has cancer.
Thursday, June 14, 2007
How do you quantify the cost and benefits of......
Interesting article about the cost and quality of medicine.
http://www.nytimes.com/2007/06/14/health/14insure.html?_r=1&th=&adxnnl=1&oref=slogin&emc=th&adxnnlx=1181827004-6oB1hqitpNuq9p0obBHcIA
3 things I think I think (apologies to Sports Illustrated's Peter King)
1. OK, how do you pay for quality? And is every complication a sign of poor quality?
2. Patients who are high risk will be denied treatment. Why treat someone when you will lose money?
3. What if the hospitals that had better scores for bypass surgery did bypass surgery on people who should have had the less expensive and less risky angioplasty? Overall, their costs would have been higher as far as less effective care.
http://www.nytimes.com/2007/06/14/health/14insure.html?_r=1&th=&adxnnl=1&oref=slogin&emc=th&adxnnlx=1181827004-6oB1hqitpNuq9p0obBHcIA
3 things I think I think (apologies to Sports Illustrated's Peter King)
1. OK, how do you pay for quality? And is every complication a sign of poor quality?
2. Patients who are high risk will be denied treatment. Why treat someone when you will lose money?
3. What if the hospitals that had better scores for bypass surgery did bypass surgery on people who should have had the less expensive and less risky angioplasty? Overall, their costs would have been higher as far as less effective care.
Wednesday, June 13, 2007
A bad ER outcome
Um, this is bad. I can't add anything to it.
http://www.msnbc.msn.com/id/19207050/?GT1=10056
http://www.msnbc.msn.com/id/19207050/?GT1=10056
History and Medicine
I was a history major. I'm now a doctor. It's good to see that I've influenced at least one university. http://www.chron.com/disp/story.mpl/metropolitan/4884548.html
A history major for doctors. I'd love it if it didn't sacrifice foreign languages (which often help a person understand history better).
A history major for doctors. I'd love it if it didn't sacrifice foreign languages (which often help a person understand history better).
Wednesday, June 6, 2007
More Avandia news
There's an old saying,"There's lies, damned lies, and statistics." I think the varying reactions to the Avandia study by Glaxo show this to be true.
http://www.nytimes.com/2007/06/06/health/06fda.html?_r=1&th=&adxnnl=1&oref=slogin&emc=th&adxnnlx=1181189602-EX1reIBUf/kYB+kfUp7hKg
So who's right?
For my money- I'd like to see more studies present results with "Number Needed to Treat" and "Number Needed to Harm" data. For instance, "This study shows if you treat 50 patients with drug x- you will prevent one death and two heart attacks. You need to treat 1500 people to get liver function problems that are reversible. You need to treat 20,000 people to kill someone with drug x." Instead, I get a lot of statistical static and an editorial that emphatically states I need to prescribe more drug x.
http://www.nytimes.com/2007/06/06/health/06fda.html?_r=1&th=&adxnnl=1&oref=slogin&emc=th&adxnnlx=1181189602-EX1reIBUf/kYB+kfUp7hKg
So who's right?
For my money- I'd like to see more studies present results with "Number Needed to Treat" and "Number Needed to Harm" data. For instance, "This study shows if you treat 50 patients with drug x- you will prevent one death and two heart attacks. You need to treat 1500 people to get liver function problems that are reversible. You need to treat 20,000 people to kill someone with drug x." Instead, I get a lot of statistical static and an editorial that emphatically states I need to prescribe more drug x.
Tuesday, June 5, 2007
A cure for the health care system
How can the US of A improve its anemic health care scores? We rank 5th among the 5 industrial nations (Canada, Great Britain, New Zealand, Germany and USA) that share data about life span, infant mortality, and cost of care. And we don't need to blame Congress, Big Pharma, Insurance companies, doctors, hospitals, or Ralph Nader.
Get a physical.
Less than half of the people with insurance get the recommended screening tests and vaccines for their age and gender. Simple things like fair skinned people getting their spouse to look at their skin once a month can save thousands of lives. Ladies, get your mammograms and Pap smears. Guys, bend over once a year- look at what ladies go through in the previous sentence. And everyone needs to get checked for colon cancer, high blood pressure, cholesterol and diabetes. Even if you believe in Alternative Medicine- go to your Alternative Medicine Practitioner once a year.
oh, and don't forget your eye doctor and dentist appointments, too.
Get a physical.
Less than half of the people with insurance get the recommended screening tests and vaccines for their age and gender. Simple things like fair skinned people getting their spouse to look at their skin once a month can save thousands of lives. Ladies, get your mammograms and Pap smears. Guys, bend over once a year- look at what ladies go through in the previous sentence. And everyone needs to get checked for colon cancer, high blood pressure, cholesterol and diabetes. Even if you believe in Alternative Medicine- go to your Alternative Medicine Practitioner once a year.
oh, and don't forget your eye doctor and dentist appointments, too.
Saturday, June 2, 2007
Drug companies' and doctors
This is why people don't trust "Big Pharma". And why I go to Canada for their Family Medicine conference.
http://www.berkshireeagle.com/ci_6001976?source=most_emailed
I found this on the KevinMD blog.
http://www.berkshireeagle.com/ci_6001976?source=most_emailed
I found this on the KevinMD blog.
Taking a shot at shots
http://www.slate.com/id/2166939/?nav=navoa
The anti-vaccine crowd is at it again. Although it is a known fact that there are side effects to vaccines (some of them serious or even fatal), vaccines were the leading health breakthrough of the 20th Century. I'm OK if you say antibiotics are the leading breakthrough. Either way, my generation did not have to deal with polio hospitals. Between my parents and in-laws (4 people total), 3 of them lost at least one sibling to an infectious disease that is now vaccine preventable. Simply put, the risk of taking vaccines is much lower than the risk of living in a vaccine free world.
Which makes me ask the following:
1. Since people die from peanut allergies, why aren't these people trying to get peanuts banned?
2. Do they really think drug companies ("Big Pharma") are really out to kill people with shoddy products? I mean, doesn't that lead to fewer people to purchase drugs?
3. A lot of people worry about "drugs" but not "natural" or "alternative" medications. Why don't they think that "natural" medications can have side effects?
4. Aren't bacterial and viruses natural?
5. Why don't "alternative" practitioners willing to do their own double blind/placebo controlled trials? (My guess is if they do a "scientific" study, they will be doing what they oppose, namely putting science over intuition and tradition)
6. Have you ever seen a pill, capsule, or gelcap in the wilds of nature? Me neither.
The anti-vaccine crowd is at it again. Although it is a known fact that there are side effects to vaccines (some of them serious or even fatal), vaccines were the leading health breakthrough of the 20th Century. I'm OK if you say antibiotics are the leading breakthrough. Either way, my generation did not have to deal with polio hospitals. Between my parents and in-laws (4 people total), 3 of them lost at least one sibling to an infectious disease that is now vaccine preventable. Simply put, the risk of taking vaccines is much lower than the risk of living in a vaccine free world.
Which makes me ask the following:
1. Since people die from peanut allergies, why aren't these people trying to get peanuts banned?
2. Do they really think drug companies ("Big Pharma") are really out to kill people with shoddy products? I mean, doesn't that lead to fewer people to purchase drugs?
3. A lot of people worry about "drugs" but not "natural" or "alternative" medications. Why don't they think that "natural" medications can have side effects?
4. Aren't bacterial and viruses natural?
5. Why don't "alternative" practitioners willing to do their own double blind/placebo controlled trials? (My guess is if they do a "scientific" study, they will be doing what they oppose, namely putting science over intuition and tradition)
6. Have you ever seen a pill, capsule, or gelcap in the wilds of nature? Me neither.
Another ethical dilemma- childern and Medicaid
http://www.slate.com/id/2167190/?nav=navoa
This article is about Medicaid and doctors' payments. Since Medicaid has lost my application 3 times, I'm not currently accepting Medicaid patients (I won't get any money for seeing them until they complete my paperwork). They pay 25-50% less than other insurers. They require more paperwork for referrals and therefore cost me more time (and money) when I see their patients. And they kept me on their provider list after I switched jobs and had to dis-enroll from Medicaid- but medicaid staffers kept signing me up as various patients' PCP. This meant that not only would I not get paid to see the patient, but any other doctor who saw the patient would not get paid either.
At any rate, I'll have to decide whether or not to take any Medicaid patients. As much as I pride myself on accepting patients that other doctors won't, I have to be practical and stay in business, or else I ain't helping anyone.
On a related note, I'll start doing cosmetic procedures this month. I picked procedures that insurance companies do NOT cover. market economics at its best.
This article is about Medicaid and doctors' payments. Since Medicaid has lost my application 3 times, I'm not currently accepting Medicaid patients (I won't get any money for seeing them until they complete my paperwork). They pay 25-50% less than other insurers. They require more paperwork for referrals and therefore cost me more time (and money) when I see their patients. And they kept me on their provider list after I switched jobs and had to dis-enroll from Medicaid- but medicaid staffers kept signing me up as various patients' PCP. This meant that not only would I not get paid to see the patient, but any other doctor who saw the patient would not get paid either.
At any rate, I'll have to decide whether or not to take any Medicaid patients. As much as I pride myself on accepting patients that other doctors won't, I have to be practical and stay in business, or else I ain't helping anyone.
On a related note, I'll start doing cosmetic procedures this month. I picked procedures that insurance companies do NOT cover. market economics at its best.
Friday, May 25, 2007
experts say Avandia not as dangerous as thought
http://www.medscape.com/viewarticle/557198?src=mp (registration required)
It looks like some medical experts are not too happy with the coverage of the Avandia/cardiovascular risk study. Apparently the limitations of the study stating that Avandia carries an increased risk of cardiovascular events were not noted. Also, the accompanying editorial was written by physicians who make a living saying that medication "x" is dangerous and the FDA needs to do a better job of oversight. Finally, there is concern that the New England Journal of Medicine should not have published the study at all, implying another lesser known journal should have published it. The media coverage is also questioned. This doesn't make for good press in the local newspaper, but it helps me answer patients' questions.
One other point, patients (and the media) tend to believe the doctors who say that medicine "x" is bad for you and can harm you more than doctors who say a product is safe. Meanwhile, doctors are raked through the coals for being pawns of the pharmaceutical companies, while the ones who complain about the FDA and "Big Pharma" make a nice living and a nice name for themselves if they keep finding drugs to condemn. What happens to them if too many drugs are safe?
It looks like some medical experts are not too happy with the coverage of the Avandia/cardiovascular risk study. Apparently the limitations of the study stating that Avandia carries an increased risk of cardiovascular events were not noted. Also, the accompanying editorial was written by physicians who make a living saying that medication "x" is dangerous and the FDA needs to do a better job of oversight. Finally, there is concern that the New England Journal of Medicine should not have published the study at all, implying another lesser known journal should have published it. The media coverage is also questioned. This doesn't make for good press in the local newspaper, but it helps me answer patients' questions.
One other point, patients (and the media) tend to believe the doctors who say that medicine "x" is bad for you and can harm you more than doctors who say a product is safe. Meanwhile, doctors are raked through the coals for being pawns of the pharmaceutical companies, while the ones who complain about the FDA and "Big Pharma" make a nice living and a nice name for themselves if they keep finding drugs to condemn. What happens to them if too many drugs are safe?
Thursday, May 24, 2007
Ask your doctor about....
Well, Avandia is the latest medication to have a major advisory after being in the market for a number of years. No one is calling for it to be withdrawn from the market (yet), but patients are being asked to "call your doctor".
Given that I learned about this from the New York Times, I think I only know what the patients know. I have gotten an e-mail from Medscape (a service owned by WebMD, registration required) about Avandia, but I got it one day after the story broke in the print media. I used to take the New England Journal of Medicine, but for major stories like this one, the press release comes out 2 days before the journal gets to my mailbox. Given that most doctors use a computer as often as Paris Hilton says "no", it is rather difficult to get important messages out to physicians.
So go ahead and call your doctor, but please provide us with the reference article, because we probably have not read it yet.
Given that I learned about this from the New York Times, I think I only know what the patients know. I have gotten an e-mail from Medscape (a service owned by WebMD, registration required) about Avandia, but I got it one day after the story broke in the print media. I used to take the New England Journal of Medicine, but for major stories like this one, the press release comes out 2 days before the journal gets to my mailbox. Given that most doctors use a computer as often as Paris Hilton says "no", it is rather difficult to get important messages out to physicians.
So go ahead and call your doctor, but please provide us with the reference article, because we probably have not read it yet.
Subscribe to:
Posts (Atom)
