Skip to comments.How Will Doctors Handle Uncle Sam Health Care?
Posted on 08/10/2009 12:46:04 PM PDT by neverdem
We can criticize socialized health care, citing statistics and chronicling the historical record of runaway costs and deterioration of quality. But you have to deal directly with Medicare and Medicaid (or perhaps be a former Soviet citizen) to really appreciate the Twilight Zone nature of government-run programs.
Among federal Medicare regulations -- which are over 130,000 pages long -- there is more than ample room for confusion and some humor. After a long search for traction weights (those five pound blocks of metal used to pull fractures out to length) I found them propping open doors to patient rooms in the ER. It is a punishable offense under Medicare regs if the hospital is caught propping open these doors because they are fire doors.
In 30 years, I have never seen nor heard of a significant hospital fire. However, patients suffer every day by being inadequately monitored. Keeping these fire doors closed means the nurse sitting at her desk outside the rooms cannot visually monitor the patients. But, to comply with regulations, all those little rubber doorstops were thrown out. Fortunately, given a choice between poor patient care and ignoring a government mandate, most nurses care more about the patient than about the wishes of a bureaucrat in Washington. Ergo, the nurses commandeered the orthopaedic traction weights. In case of a pop inspection, traction weights at least provide plausible deniability.
Medical "quality" gurus of the Center for Medicare Services are convinced that certain abbreviations are dangerous. After over 100 years of clinical use, we can no longer write MS for Morphine Sulphate because it may be confused with Magnesium Sulfate -- two drugs with totally different indications. Neither can we write MagSO4 for Magnesium Sulfate, even though it is the technical chemical name for the drug. We cannot write cc (an abbreviation every junior high science student understands) because it might be confused with i.u.-- international unit. And, we can't use i.u. because -- you guessed it -- it might be confused with cc!
Like good gulag inhabitants, doctors complied for a while, then some (no one I know, of course) committed little acts of defiance such as making up their own abbreviations because the government watchdogs simply cannot enumerate all the outlawed terms -- though God knows they have tried.
As Medicare decreased reimbursements, physicians found ways of being more efficient while maintaining quality -- presumably the kind of behavior any third-party payor would want. In my case, I used a physicians' assistant to help gather routine data during a new patient encounter. He would do the routine part of the history and physical, and I would do the complex part, utilizing my time explaining the problem and treatment options to the patient. But this quality care was not to be. Medicare decided it would pay me approximately $94 for a new patient visit if I did it all myself (but I would waste much of our visit doing the mundane part of the exam) or it would pay the PA $94 if he did it all himself, as long as I was present to sign off on his plan. That option would have been more lucrative, but a clear compromise of care since I would have been signing off on a plan without first-hand patient knowledge. The quality solution which we had at first implemented would also have been $94 and superior in every way, but this was deemed illegal, subject to a $10,000 fine for being a "split consult" -- we both cant see the same patient the same day and bill as one.
After four years of medical school, five years of residency, and usually a year or two of fellowship, orthopaedic surgeons are the most qualified people to apply splints. Up until last year, I did so. But now, Medicare has determined that only those physicians who are "certified" may do so. Who will certify me, you may well ask? A group of orthotists -- people with no medical degree and (relative to orthopaedists) much more limited experience and training? And this certification would have cost me over $3000 -- a cost exceeding the revenue for placing splints on Medicare patients in my practice.
So, now, these older patients, when taken out of a cast, must travel to another facility, to have a less qualified provider give them a vastly more costly splint. And, the physician can not oversee the process to insure correctness of the application. Medicare is paying more for less quality. (I guess the orthotist lobby is more powerful than the orthopaedic lobby.)
These are not isolated incidents, but emblematic of a daily clinic in Medicare Absurdistan. A psychiatrist once told me that we need three things to remain sane -- the ability to deflect criticism, the ability to laugh at oneself, and the ability to accept the absurd. Until it kills us, government run medicine should provide no end of practice.
Lee Hieb is an Orthopaedic Surgeon, in solo private practice. Her first-hand experience in medicine began in the 1950s, when she accompanied her father on his housecalls in Iowa.
This is a YouTube video that was made of US Rep. Tom Price-6th Dist. GA on Wednesday. Tom is a member of the House Healthcare Committee, and the video was shot in the Wed. Committee meeting. Please watch this to the end and share with everyone you know... after watching it will be apparent why this healthcare legislation MUST be defeated. Tom has said that our Constitution is being burned right before our very eyes. We must, Democrats and Republicans alike, let our “leaders” know that this plan is unacceptable. There has to be a better way than a government takeover! If the Government takes over, it will be one of the most colossal blunders in the history of this Nation!
I figure most doctors will retire. Physician assistants will become the new specialists.
Thanks for the link.
They’ll retire. We’ll see real violence in hospital ERs and doctors’ offices when illegals are given care before Americans.
Looking at many doctors' writing, I'm surprised that more people aren't getting a spray with weasel urine 4 times a day from the pharmacy.
More seriously, I am surprised that prescriptions are still handwritten by the doctor. Unless it is something really unusual, I would have expected it to be computerized and printed to be signed by the doctor a long time ago. That way a full name and instructions can be printed on the prescription instead of abbreviations and the computer can cross check against reasonable quantities and known alergies. McDonalds won't sell a freaking McNugget without a comuterized record, so how do doctors get away with handwriting stuff?
This is doomed to failure. I heard Pelosi on the tv the other day and in just ONE sentence I knew national health care as imagined by the Democrats will hurt us all.
She said simply that, “Premiums (payments) will be capped, not benefits.”
How’s that for a soundbite, hmmm?
Many physicians, including myself, will go to a cash only practice and not have to be bothered with insurance, medicare/medicaid billings and the associated overhead costs. In fact, many such practices, and concierge medicine, already exist everywhere, and probably will become the norm.
Do you really think you can reject Obama’s health care juggernaut, work for cash and still keep your medical license?
Doctors will be hanging out on street corners, side by side with drug dealers.
As folks walk by, they will whisper “Psst, quality health care...” trying to hook up clients.
There is going to be a real shortage of Docs. I was a member of the “Physicians Club.” I loved my patients and the families. The system drove me crazy. I never did one thing for financial gain in 40 years and then I hear Obama tell us that we do. Excuse me but he can “shove it.” I wouldn’t work for these folks for any amount. As far as the Physician Commission to review coverage, they will be ideologs who will specialize in saying “NO”.
A psychiatrist once told me that we need three things to remain sane — the ability to deflect criticism, the ability to laugh at oneself, and the ability to accept the absurd.
I don’t do very well with that third one. Maybe I am not sane.
We will give up our hospital privileges and perform our exams and procedures at our clinic or at the outpatient surgical centers. It’s already happening. Many opthalmologists, ENT’s, plastic surgeons, OMFS, orthopedic surgeons, urologists, dermatologists, and general surgeons no longer come to the hospital at all. If a case is too complex or the patient too critical, they get sent to the ER for the on call folks to take care of. EMTALA is an unfunded mandate and it’s about to get worse.