You get basically a page of stories about this incident?

I finish surgery, the paperwork, and head home around 2:30 AM.  I then see Mr. J for the next 3 days after clinic. After discharge, Mr. J comes to the clinic regularly over the next several months for checks and x-rays and advice and guidance. Total charges for all the work, time, expertise, and liability risk is $5000. Mr.

Jones has his own landscaping business.  He has no insurance.  He never pays a bill.  I cannot abandon his care– it is unethical and against the law (abandonment). I get tired of this happening and stop taking call at the hospital. Losers in this scenario–the physician, the hospital (less coverage), and future patients–insured or not- who would benefit from my expertise. Here is a partial solution– but first, a brief preamble. Health care system transformation will need to be incremental, not revolutionary– otherwise, the kind of horse-trading and compromises that resulted in the bloated, inefficient, restrictive system of Medicare result.

Here’s the partial solution. Guess what happens at the end of the year when I file my taxes?  Can I deduct the $5000 in bad debt as a “”business loss””?  No. By simply allowing physicians to credit bad medical debt from their income (like other businesses can with losses related to products, etc.), physicians would be have a huge incentive to provide a certain amount of care to the poor. It needs to be a credit and not a deduction as a deduction would return only 35 cents on the dollar at best.

So, there it is– tax relief to the providers of care for the amount of “”free care”” provided.  No new bureaucracy.  Incentives, not punishment For some more info on EMTALA see this lawyer’s site. Spread the love Categories: Physicians Tagged as: Physicians “,””,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/2006/02/03/tech-crm-in-health-care-its-about-time/”,”200″,”OK”,” This vendor says that the time is right for real aggressive CRM from health plans. He’s optimistic, but he might be right Spread the love Categories: Uncategorized Tagged as: Startups “,””,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/2007/04/17/tech-health-2-0-article/”,”200″,”OK”,” This article in Government Health IT by Brian Robertson is a reasonably good description of the basics behind Health care 2.0. It doesn’t really feature much in the way of actual Health2.0 players other than Revolutions, but it does interview the guy who runs the Health2.0 wiki, Johannes Ernst, who is a leader in the Health2.0 movement (even though he’s more of a general techie than a health care guy).

Oh and I just noticed that Tony Chen has a rather better rundown of Health2.0 companies on his site —Hospital impact – Consumer’s Guide to the top Healthcare 2.0 websites. Spread the love Categories: Uncategorized Tagged as: Startups “,””,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/2007/07/12/policy-debating-sickos-impact-by-john-irvine/”,”200″,”OK”,” Since opening a week ago, Michael Moore’s latest documentary has focused unprecedented attention on the U.S.reduslim controindicazioni healthcare system. The film has brought angry protests outside movie theaters. Standing ovations from audiences. And provoked angry debate in the nation’s editorial pages. It has also done fairly well at the box office, drawing far more viewers to theaters than many experts had predicted.

  According to the Hollywood Reporter, the film finished second in per-theater gross last weekend, bringing in $11.3 million at 700 screens across the country — rather a respectable showing for a movie that specializes in disturbing subjects that Americans would generally rather not talk about. So far, Sicko has generated exactly the kind of controversy that the critics predicted it would.  Moore has  already had to deny that he is planning a trip to Iran next month to view the film at an Islamic film festival. (The story turned out to be a rumor spread by conservative opponents.  The filmmaker says he received an invitation from the Iranians but declined to accept.) This week he was on CNN, lambasting the network for its healthcare coverage and getting into a near shouting match on The Larry King Show with medical correspondent Dr. Sanjay Gupta over some of the stats used in the film. Moore went on to accuse the network of colluding with the film’s opponents, pointing out that one of Gupta’s researchers, Paul Keckley, the former head of Vanderbilt’s Center for Evidence Based Medicine and a current Deloitte consultant, has done a lot of work for big health insurers and pharma companies. (Something that could be said of a fair number of people working in the field, as THCB readers know all too well.) Could Keckley be censoring the network’s coverage?  Moore wondered out loud to himself and not-very-subtly.  The theatrics aren’t a surprise to anyone who has followed Moore throughout his career. Not surprisingly, the attack drew a rather hurt denial from Gupta on his CNN blog. Meanwhile, Moore is living up to his reputation for drawing attention to himself. Earlier this week, the filmmaker published a leaked internal memo on his web site allegedly authored by the Blue Cross communications department.  The document reviewed the film – acknowledging that the documentary is a slickly done piece of work. [Follow the link and scroll down to read the whole thing.] The review begins as follows: “”You would have to be dead to be unaffected by Moore’s movie, he is an effective storyteller. In Sicko Moore presents a collage of injustices by selecting stories, no matter how exceptional to the norm, that present the health insurance industry as a set of organizations and people dedicated to denying claims in the name of profit.

Denial for treatments that are considered “”experimental”” is a common story, along with denial for previous conditions, and denial for application errors or omissions. Individual employees from Humana and other insurers are interviewed who claim to have actively pursued claim denial as an institutionalized goal in the name of profit. While Humana and Kaiser Permanente are demonized, the BlueCross and BlueShield brands appear, separately and together, visually and verbally, with such frequency that there should be no doubt that whatever visceral reaction his movie stirs will spill over onto the Blues brands in every market.”” Will the public hold health care providers and insurers accountable for the lapses Moore documents in his film? That remains to be seen. For many Americans who haven’t been paying attention, the documentary is undoubtedly a wake up call. There seems little doubt that people will start to ask more questions when they walk into their doctor’s office or when they sit down to pick an insurer, which is certainly enough to make some people uncomfortable. There is also little doubt that the film has added to the already fiercely burning debate between supporters of a free market based system and a government run universal healthcare system. PODCAST REVIEW: Here’s THCB contributor Dr. Eric Novack’s take on the film from his radio show last Sunday. Two thumbs up? Er, No.

Here’s Part 1 and Part 2. Eric and I will get into this a little later on, we hope!RELATED: “”Sicko and Healthcare Reform””, Maggie Mahar’s piece on THCB drew thousands of readers  and led to excellent discussion. Spread the love Categories: Uncategorized Tagged as: Policy, Uncategorized “,””,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/2005/03/25/health-plans-kp-gadlfy-update-and-my-commentary/”,”200″,”OK”,” The Gadlfy gets some good press in a Bay Area blog called SFist which notes her side of the story and not Kaisers. The story is called David Versus Goliath — And Goliath’s Bigger Brothers, Backed By The Persian Army –to give you an idea of where it’s coming from. They also credit THCB for fair and balanced coverage, and frankly I think I’m the only one calling for reason and moderation in this whole thing. But what’s been the damage to a great non-profit health care institution?  Perhaps nothing, but now rightly or wrongly they’ve been castigated as a bad employer, they’ve had their proprietary data on the Health Connect program up for all their competitors and potentially hackers to see, and worse they’ve had to admit in court to a patient privacy violation that they waited at least 5 months and maybe much longer to reveal to the  patients concerned. And this says nothing about trying to rather brazenly blame the whole thing on the Gadfly — not that she’s blameless, but she couldn’t have done this without their sloppiness. Kaiser should be getting great kudos for its roles in promoting IT in health care and running disease management programs.

But instead what happens if you do a Google news search about KP? You get basically a page of stories about this incident?  And it could all have been avoided with a decent handling by middle management and HR of the exit of the Gadfly, which included a small settlement and a no-sue confidentiality agreement. Dumb, dumb, dumb. Spread the love Categories: Uncategorized Tagged as: Insurers “,””,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/2004/11/04/blogs-blogger-bloggered-quick-wanted-ad/”,”200″,”OK”,” Yet again Blogger seems to be down. I’ll leave you cynics with this thought and be back with my conclusions on the impact of the elction tomorrow. Wanted: 58 million people to support the elimination of human rights, promote torture, plunge their children into monstrous debt, and aid in the elimination of civil liberties at home and international law abroad.

An opposition to the principles of the Enlightenment and rational thought is useful. Adherence to obscure interpretation of vague texts written 1900 years ago, selected a couple of centuries later by a brutal dictator who wanted his subjects to worship him as God, is also helpful. Apply at the polling booth on Nov 2. Spread the love Categories: Uncategorized Tagged as: Uncategorized “,””,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/2006/12/18/blogs-dmitriys-round-up-on-the-hc-blogging-summit/”,”200″,”OK”,” All at  Blogging Summit Coverage, Trusted.MD Launch, Partnership with Transmarx and Plans for 2007. Spread the love Categories: Uncategorized Tagged as: Uncategorized “,””,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/2005/04/08/pharma-squaring-the-circle-on-pfizers-job-cuts/”,”200″,”OK”,” Over at the Pharma Marketing Blog and on the Pharma Marketing list-serv John Mack is confused about Pfizer’s real intentions. Is Pfizer eliminating up to 11,000 sales rep jobs or isn’t it? A WSJ article states: “”In another cost-cutting plan, Pfizer plans to streamline its U.S. force of 11,000 sales representatives.”” Then in the next paragraph it also says “”Chief Executive Hank McKinnell didn’t give details on the job cuts, but did say few jobs would be lost in the company’s sales division.”” (Significant cuts in a force with) 11,000 jobs seems like more than a “”few”” so I am at a loss to understand what Hank actually said or meant. John asked for the list’s take on this.

  Remembering this article from THCB regular The Industry Veteran in which he suggested that Hank made about $50m a year (even though Forbes says it’s closer to $17m), I suggested that the solution to John’s quandary is simple: If Hank makes give or take $50m a year (as The Veteran believes), and a sales rep makes $100K, then it takes 500 sales reps to equal one CEO.  So if you fire 11,000 reps you’re really only cutting  22 “”real”” jobs. They’re never going to cut the whole workforce so any amount is less than 22 and that’s just a “”few”” in Hank’s terms. (You are all welcome to do the real math if you want, but I’m no good at dividing by 17!!) Spread the love Categories: Uncategorized Tagged as: Pharma, Uncategorized “,””,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/2006/12/31/policy-peak-oil-and-healthcare-by-dan-bednarz-ph-d/”,”200″,”OK”,” Dan Bednarz from Energy & Healthcare Consultants in Pittsburgh, PA is pretty concerned that you health care types don’t seem to be concerned about Peak Oil. What you say, you’ve never heard of Peak Oil? Better read this then! America’s healthcare predicament will be resolved in the context of the worldwide energy emergency idiomatically known as “peak oil.” In short, the era of cheap, abundant fossil fuels is entering its twilight and medicine — virtually cut-off from this awareness—is exposed to the consequences. Like any other system healthcare requires energy and resources to function; fossil fuels, especially petroleum, provide both. A brief explanation of the geology of peak oil is needed. In the spring of 1956 petroleum geologist M. King Hubbert presented his peak oil hypothesis to a convention of his peers. He told them that production of light (low viscosity), sweet (low in sulfur compounds) crude oil in the lower 48 states, at that time rising exponentially, would peak and then enter into irreversible decline around 1971.

Although he was preeminent in his field, most of his colleagues dismissed or ridiculed his forecast. In 1972 his prediction was confirmed. Hubbert also said: “it appears that the culmination [i.e., peak] of world production [of petroleum and natural gas] should occur within about half a century.” Fifty years later, with production ostensibly unable to surpass 85 million barrels per day, we may be riding “Hubbert’s Peak.” We will not know definitively about peak oil until we are past it. Think of it this way: in Hank Aaron’s final years his home run production was: 47 (his peak), 34, 40, 20, 12, and 10. A majority of Americans consistently tells opinion pollsters that healthcare is a right; yet this majority simultaneously cringes at the countervailing ideas of rationing and being denied the right to choose their doctors. Accordingly, the administrative, legal and fiscal structure of American healthcare represents a pastiche of regulatory and free-market incentives addressing: 1.) controlling costs, which are driven by technological innovations, malpractice and liability insurance, rising energy and petroleum-based equipment prices; and inefficiencies, waste and fraud; 2.) coverage for 45 million uninsured citizens and several million more who are underinsured; and 3.) needed improvements in quality on an absolute basis as well as relative to other industrial nations.

Reviewers of healthcare reform concede the failure of incrementalism and the imperviousness of the system to genuine improvement and, therefore, call for fundamental change, which the coming energy crisis –an unexpected and inescapable exogenous event– will produce. Parallel to peak oil, our nation’s ability and willingness to perpetuate current financing of medicine is threatened by growing foreign trade and budget deficits, deteriorating national infrastructure, and the costs of war. The especial significance of peak oil, however, is that, in addition to posing a fiscal risk, it threatens the structure of healthcare simply because medical facilities consume large amounts of fossil fuel for climate control, to operate equipment, and in their vast array of medical and ancillary products –most disposable after one use, manufactured overseas and shipped here with (formerly) cheap fossil fuels.