August 2008

All Stories

Field of Bariatric Surgery

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Field of Bariatric Surgery
If I Knew Then - Dr. John Morton, MD, Discusses the Field of Bariatric Surgery
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Classic take: Never say never

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The following is a reader take by WhiteCoat, originally published on 4/7/2008.

WellPoint and Aetna are now putting into widespread implementation a refusal to pay for what have been deemed "never" events.

The theory for payment denials is that if medical providers are not paid when certain unwanted outcomes occur, situations leading to those unwanted outcomes will be avoided.

Some events on the "never" list ...

High Cholesterol

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High Cholesterol
If I Had - High Cholesterol - Dr. Howard Hodis, MD
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Difference Between Academic vs. Private Practice

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Difference Between Academic vs. Private Practice
If I Knew Then - Dr. Alfredo Sadun, MD, PhD - Discusses the Difference Between Academic vs. Private Practice
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Medicare’s dismal pay for performance

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Their embarrassingly small 1.5% bonus payments have physicians questioning whether the extra record-keeping is worth it:

It took a lot of paperwork and screwed up billing because we had to charge 1 cent per code so that the Medicare carrier's computer would pick up the charges, and then had to manually write off that charge afterward.
In essence, the bonus equaled one extra 99213 office visit every other day. ...

Referral patterns

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A reader writes:

Primary care doctors don't know all the resources for a given medical problem in their geographical area. They will tend to go to whomever is their acquaintance or on the staff of the hospital that they are on the staff of. I found that two of the leading surgeons in the country for a problem that I had were at the regional ...

Soft sell

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DTC drug advertisements are facing increasing scrutiny. To get around this, drug companies are resorting the "unbranded advertising", where the name of the drug isn't mentioned in the commercial. This relieves them of the responsibility of listing all the side effects of the medication.

Banning drug companies from advertising medications would be easier.

Utilization review doctors

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In California, these doctors are not required to be licensed within the state, and have the power to veto any diagnostic or treatment plan by a patient's primary physician.

Worse, they cannot be disciplined:

A huge snag in the system is that utilization review doctors without California licenses cannot be disciplined by the Medical Board of California for unprofessional conduct because they aren't under board jurisdiction. Neither can they ...

Compromise

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Miles Zaremski suggests a compromise to health care reform, blending the ideas from the left and right:

Why not provide a basic layer of health protection for all Americans funded with taxpayer dollars, with any additional coverage paid for by the individual, the employer, or both through the private sector? In this way, every citizen will be guaranteed a certain level of health care, while letting market forces take care ...

Get ready for the ICD-10 codes

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The switch from ICD-9 to ICD-10 codes is supposed to happen in 2011.

Providers get to look forward to almost a 10-fold jump in number of codes, but also an increase in claim denials:

HHS is predicting that claims-error rates will rise between 6 and 10 percent of all claims at the ICD-10 implementation date, up from a normal 3 percent rate typically seen for annual updates of ...

Primary care’s total collapse

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A reader writes:

I'm a hospitalist, and the primary care crisis here is getting really scary. Even as a hospitalist, you can't imagine how many times a day I get asked by the lay public, "Are you taking new patients?"

Any thoughts about how the "falling house of cards" is going to appear? My prediction is sometime in the next 2-3 years. The issues just get ...

250-yard rule

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A reader asks this question:

I was wondering if you can answer a question on the 250-yard rule. I work in an emergency room and heard on the radio there was a stabbing in the same block as the hospital. Is it my obligation to leave the ER with a the physician and run to the site.? EMS was called and the police were responding.

Prostate surgery

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The PSA test for prostate cancer screening has come under fire. First of all, it's not very specific - meaning there is an unacceptable false positive rate (i.e. positive test in the absence of disease) for prostate cancer. This leads to biopsies and surgery that may not be needed.

The implications of this is becoming more widely publicized. Men are starting the realize the downsides of ...

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