For the past couple years, our country has done a lot of talking about health care reform. Much of that centered on providing universal access to health care services. After that comes ways to reduce costs; pivotal to providing health care for everyone. Missing are serious discussions about Defensive Medicine and Tort Reform. It’s as though these items are off the table, presumably because reforming these elements would cut into the legislature’s fellow attorneys’ profits. Thin excuses are provided; such as statements claiming that unfettered civil suits are necessary to ensure that a patient is not violated — even when proposed reforms would not affect patients’ right to direct compensation for actual costs incurred. We at Medical Justice aren’t looking for immunity from civil recourse. We’re simply after reasonable limits, to eliminate the temptation to sue in hopes of receiving a jackpot award. When 3/4 of all medical malpractice suits are found to be baseless, it’s only right that doctors be relieved of the drains on time, energy and finances that defending against such frivolous cases require. But perhaps we’ve been using the wrong term. Rather than calling it Tort Reform, perhaps we should start asking for Health Justice. Continue Reading »

Tags: healthcare, Jeff Segal, medical malpractice suit, Reform, Tort

Perception holds that the United States has best possible health care and the days of fearing pregnancy are a thing of the past.  To be fair, Maternal Mortality is rare, just 11 women in 100,000 pregnancies back in 2005.  But it’s on the rise.  A new report sponsored by the California Department of Health shows that the incident of Maternal Mortality has steadily grown over the past decade, rising to about 17 people in 100,000 in 2006.   Statistically, it is safer for women in Poland, Croatia, Italy and Canada to give birth than it is here in the U.S.  While there are a number of factors, including hemorrhage, deep-vein thrombosis, blood clots, and underlying cardiac disease, much of the risk is connected to C-sections.  Dr. Mark Chassin, president of the Joint Commission, says that “as many as half of those deaths are preventable.”

One contributing factor is that more obese women are becoming pregnant — about 20 percent of all pregnant women in the U.S. these days are obese.  Obesity, a danger in and of itself, becomes an even more problematic during pregnancy.  What’s more, the obesity often suggests that a C-section is in order… which leads to the next cause for concern.

The CDC’s figures suggest that 31 percent of the mothers who died had chosen to have a C-section.  What is in question is whether that was an actual preference or a policy decision.  Studies consistently demonstrate higher mortality rates as a result of C-section deliveries — especially when the woman has had multiple C-sections.  The mother herself may not prefer the C-section but many hospitals mandate C-sections for women who have had them before: even when this policy can increase the risk factors for the expectant mother and there may be no specific reason why the mother cannot deliver naturally

If C-sections are more dangerous, and multiple C-sections create an even higher risk, why would hospital policies require that a woman who has had a C-section before deliver by C-section again?  When a standard policy contradicts patient safety, it seems clear that the policy must be modified.

Health care reform isn’t just a problem for the government.  We, health care providers and patients, must take proactive steps to reform our health care systems; even when these steps mean questioning standard policies.

Tags: c-section, maternal mortality, obesity, Patient Safety, pregnancy

With Senator Bunning’s 5-day filibuster out of the way, the Senate was finally able to pass a month-long delay on SGR cuts (and extend unemployment benefits.)  But a month-long extension is hardly a cure.  It’s hardly a band-aid.   The real problem is with the SGR itself.  Medicare’s reimbursement for treatment needs to be addressed and revised so that it provides fair and equitable compensation. Then doctors can return their full attention to treating patients instead of worrying about how to keep the doors open for those patients.

Meanwhile, President Obama continues with the dog and pony show, lab coat props all around, suggesting that physicians are solidly behind the feeble excuse of health care reform.  Pardon me, Mr. President, but could you tell your stage dressers that it takes more than a garment to make a doctor, and more than those props to get the American people to believe that physicians are actually endorsing such a pathetic and woefully inept excuse for Health Care Reform?

The SGR (so-called Sustainable Growth Rate) method of compensation is really just one symptom of the diseased health care system.   The U.S. House of Representatives passed a bill to replace the dysfunctional SGR system back in November 2009.  Yet it sits unanswered by the Senate; who just keep us all on the edge of our seats, passing temporary band-aids one after another.  The real solution is the honest intent to pay physicians fairly for services provided.

Historically, politics stayed out of medical practices.  Perhaps it’s time that physicians let their patients know what’s going on in Congress BEFORE the situation becomes untenable.  Most patients are largely unaware of all of the problems with the SGR.  Perhaps if their constituents were to tell Senators to get serious about Medicare compensation, then the Senate would pass something more significant that a 30-day band-aid.

What’s certain is that no practice can afford to continue providing care to patients at any lower reimbursement rate.  It’s difficult (read: impossible) to sustain a practice at the current rate.  The money has to come from somewhere.  We will all pay the price, every member of our society, one way or the other.  Why not simply agree to compensate physicians fairly for the services they provide, instead of looking for ways to shortchange the people who dedicate their lives to keeping us all alive and well?  Indeed, the solution has more to do with appreciation than band-aids.

Tags: compensation, Medicare, Reform, SRG

From The Trenches

(Healthcare Reform for the Real World)

#4: Support Innovation

This is the fourth in a series examining the problems in our health care system from the real world where patients get sick and injured, and doctors and other health care providers work to heal them. In the series, we’ll identify the actual non-political problems, and offer sound, sensible solutions that we can enact ourselves to reduce risk and increase patient safety.

Today’s medical industry is full of amazing technologies, things we never dreamt of 50 years ago; X-rays no longer need to be “processed,” oxygen levels are found with a meter, temperature with an instant temp gun. Computers keep track of inventory, monitor patients’ vitals, and we’re about on the verge of standardized, digital medical records.  But much of this technology is obscenely profitable for the few, at the cost of many.  Certainly that’s the way Capitalism works.  It provides incentive to develop new technologies and abilities.  But can be a double-edged sword.  Consider this:

A diabetic’s test strips are his/her miner’s canary, the way s/he can tell if blood glucose levels are safe or if they’re causing damage to the body.  With Type-2 diabetics, it’s not quite as crucial as with Type-1 patients (who administer insulin by injection) The industry developed complex and capable pumps, but those little devices cost about $6K each, and require maintenance supplies that are also very expensive.  Those without pumps still have to do things the old-fashioned way, with syringes.  (Granted, the needles have become much finer — so small that they’re often entirely painless.)  So long as there’s money to be made, especially on a recurring basis, companies will be there, funding new developments.  But what happens when a technology stands to eliminate a profitable item?  Then our Capitalist system can suppress the innovation.  Consider this:

Dr. Ren of the University of Florida developed a sensor chip capable of accurately detecting blood glucose levels (amongst things) from one’s breath.  That may just seem clever to some, but for the millions of diabetics in this world, people who must stick themselves in their fingers every day, it’s a minor godsend.  Great idea! No more sticking oneself, and no more test strips.  HURRAY!  But it may never see the market. Continue Reading »

Tags: breakthrough discoveries, diabetes, health care reform, Innovation, U of FL, University of Florida

President Obama was spot on when he said, “The fact is, health reform only works if you take care of all these problems at once,” while talking about increasing costs of health care and exclusionary  health insurance company’s practices.  We couldn’t possibly agree more on those two points.  Unfortunately, what is proposed does not address all of the issues.  Tort Reform, the only cure for Defensive Medicine, is blatantly, glaringly lacking.  Why, then, are he and the rest of the Democrats insisting on pushing through a plan without Tort Reform?  Why are they planning to use Reconciliation (an ironic choice of terms) to force through a “plan” which does not address all of the problems at once?

The motive may seem to be political.  If one appraises such things along preferences in party line, it would seem as though the Democrats are hellbent, bound and determined to cram their concept down the throats of the American people, whether the people like it or not.  They’ve categorically refused to start over on designing a HCR package. Obama has parted from fellow Democrats by saying that a piecemeal strategy would not work.

Why, then, would President Obama be so determined to force a plan through?  Is he so worried about his legacy that he’d push a half-baked plan on through Congress?  Surely he’d have to realize that it would be a huge mark against his presidency.  So why continue to push for the unpopular Reconciliation tactic?  A clue to his motivations may be found in what he said while speaking against postponing.  President Obama retorted, “We have debated this issue thoroughly, not just for a year, but for decades.”

Therein lies great truth.  Medical professionals have known for decades where the problems are to be found.  It starts with the AMA, and their codings, coinciding all too conveniently with the insurance companies and their Policies and Procedures list.  From that list, clerks have effectively been practicing medicine.  It continues through to the greedy lawyers hawking their services on daytime television, which led us to the need for Tort Reform.  Then there are the pharmaceutical companies, HMOs, and the lot — all of this “progress” that has us losing track of the basics of a doctor/patient relationship based on trust and respect.  We know what the problems are, but we’re not doing anything about them.  We weren’t even allowed a seat at the table.

The point of pushing HCR through via Reconciliation very likely has nothing at all to do with actually enacting a weak plan.  Though it would begin collecting funds immediately by taxation, the proposal wouldn’t do anything constructive for at least 3 years, more likely a decade.  What such an action DOES do, though, is to force the hand of Congress.  By passing a vastly flawed program, the onus is upon subsequent sessions of Congress to patch the holes, or come up with a better plan.  Once something ill-conceived has been passed, Congress cannot simply ignore and forget HealthCare Reform.  They must take action.   That may very well be what the President had in mind all along.

Tags: health care reform, legacy, Obama, Reconciliation, tactic

Great podcast from MDWhistleblower on defensive medicine

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click to play :: Defensive Medicine

Tags: defensive medicine, Podcast