MedicalTuesday Weblog

MEDICARE
All Medicare providers (e.g. physicians, NPs, PAs, etc.) are eligible to earn a 1 percent incentive on their total Medicare Part B allowed charges by electronically prescribing a total of 25 times from Jan. 1 to Dec. 31, 2011 and having at least 10 percent of their total Medicare Part B charges made up of denominator codes.
Additionally, providers who want to avoid a 1 percent penalty in 2012 must report an e-prescribing measure through their claims at least 10 times between Jan. 1 and June 30, 2011. Furthermore, providers who successfully report the e-prescribing measure in 2011 will also be exempt from a 1.5 percent penalty in 2013. CMS requires that this submission be performed through claims; providers are not allowed to use a registry or electronic health record (EHR) to avoid the penalty in 2012.
If you plan to participate in the EHR incentive program in 2011, you will not be eligible to collect the 1 percent e-prescribing bonus. CMS does not allow physicians to collect both bonuses. However, since NPs and PAs are not eligible for the Medicare EHR incentive program, they can continue collecting the e-prescribing bonus.

Clearly practicing medicine will continue to be more complex over time. If your wondering if there are better practice opportunities that fit your unique needs in these complex times reply [email protected]​hcare.org.

To relieve the complexity, many physicians are eliminating Cecil, Harrison, and our other Hippocrates Modern Colleague, and just subscribing to the Medicare Newsletters which will guide and direct you to do the best practices for remuneration and not be influence by using the Best Practices Cecil, Harrison and their Kin.
Del Meyer, MD

Lean Health Care vs Gluttony in Pain Management

A frequent occurrence in front line medicine as practice by family physicians, internists and emergency room physicians is the patient’s demands for laboratory proof of almost any diagnosis, whether it’s peptic disease or a fractured rib. Or even a sprained ankle. Articles have been written on the examination of the ankle, taking into account the type of injury and whether an x-ray will prove helpful. ER physicians who are experts in this diagnosis are not allowed to make clinical diagnosis by the patients who demand an x-ray. It the physician spends time explaining the reason for no further tests, the patient will listen politely and still demand an x-ray. A physician can spend the equivalent of two appointment times ($250) explaining why further testing is not necessary, the patient will always win having the unnecessary expense expended by either returning to the ER when the next doctor arrives and state his ankle is still painful. Frequently he may not have even taken the prescribed analgesics. That’s why as an intern, I always carried a bottle of extra-strength Tylenol and would give out two pills with a cup of water in the triage room and continue my triage rounds. Sometimes before I returned to the same place in the triage ward, perhaps 45 to 60 minutes later in the busy county hospital, the ankle pain would be resolved. When asked, what were the two marvelous pills you gave my wife, I would only state they were extra strength PAIN pills. I found out rapidly in my internship, if I stated they were Tylenol, they would be back very soon with the same pain. By not mentioning Tylenol the pain would generally be resolved--sometimes permanently.

Mitt Romney is in The Wrong Political Party; Maybe Even the Wrong Country.

Mitt Romney is in The Wrong Political Party; Maybe Even the Wrong Country.

 

OBAMACARE = ROMNEYCARE: Your signature government-run health care experiment in Massachusetts was a dismal failure. Nonetheless, in May 2009, you cited it as one of your "best ideas," praised it in July 2009, and in May 2009 said that "the best path to healthcare reform is to let the American people make their own decisions, not have those decisions forced on them by government."

 

[Never mind that RomneyCare forced decisions on individuals residing in Massachusetts.]

 

Your health care plan formed the basis for Obama's Socialist health care "reform." (The Daily News Record via FR/CATO/The Salt Lake Tribune via FR/The Boston Globe via FR/Fox News via FR/The Boston Globe via FR)

In other words, Mr. Romney, you are RINO, a Socialist, and a traitor to these United States. You praised Obama (CNN via FR) and attacked Palin (Politico via FR) at least once.

 

The WSJ describes Mitt Romney as being to the left of Barrack Hussein Obama. If Mitt Romney becomes the Presidential Nominee for the Republican Party in 2012 and Barrack Hussein Obama the Presidential Nominee for the Democratic Party in 2012, will there be a real choice or merely a paved road to Socialistic Destruction of the two century old greatest democracy ever created on Earth and a return to Serfism?

 

It is past time to realign the political parties to create a real choice, a Socialist Party and a Constitutional Party. Mitt Romney should be happy in the Socialist or current Democratic Party next to Obama. Then the opposite party cleanse of it’s Socialists could give us a real choice. 

 

Are lawmakers medical illiterates?

The recently enancted health care law was not reviewed by the congressmen who passed it nor by the citizens at large.

A report in the news stated that congress is fairly unknowlegeable about Medical Care. They depend on their staff assistants to modify and implement the law which they aggree is unworkable to make it work.

Since this is a major change in our personal health care, including it's confidentiality, this seems like a poor way of improving our health care in this country.

When the uninformed and medically illiterate attempt to improved health care, it will always be catastrophic.

The only solution is to vote all present incumbents out of office.

Elect a major constitutional and conservative majority to impeach the president and reverse all billls that he signed and resume health care reform.

Health care reform must include eliminating the socialistic HMO bureaucracy which the public misinterprets as free enterprise.

In free enterprise doctors would have the opportunity to compete with the doctor down the street both in fee and quality.

Under the HMO socialistic setup, the worst doctors get the same payment as the best, the very antithesis of a free market situation.

Under free enterprise, the best and most efficient doctors would compete not only on price, but also on quality of care.

It's ime to throw out all government programs such as managed care and allow competition to reduce health care costs. Competition or the free market is the most ruthless way to decrease the cost of health care. Everyone benefits--except maybe the HMOs.

The only way to do this is vote all incumbents out of officie in November.

Del Meyer, MD

Was Natasha Richardson's death preventable?

Natasha Richardson, 45, daughter of Vanessa Redgrave, died on Wednesday, March 18, 2009, at Lennox Hospital in New York after a ski accident on Tuesday, March 16, 80 miles from Montreal taking a skiing lesson on a bunny slope. She initially turned down medical treatment but an hour later complained of a severe headache and was taken by ambulance to a hospital.

Although she was only an hour ambulance ride away from Montreal, the worlds second largest French city, two days later she was taken to New York Lennox Hospital with emergency life saving surgery not having been done.

An autopsy of the actress Natasha Richardson on Thursday indicated that she died of a brain hemorrhage caused by “blunt impact” to her head, the chief medical examiner for New York City said. The official cause of death was an epidural hematoma.

Although she may have died in the United States if the accident would have happened, all the reports fail to recognize the deficiencies of Canadian Medicare that is available in nearly every city in America. Ms Richardson had her warning when the headache occurred one hour after the accident which normally alerts any physician to an impending catastrophic bleed requiring immediate burr holes in the scalp and possibly craniotomy. This was not done during the two days in Canada despite being within one hour via ambulance ride to hospitals in a world class French Canadian city

The news accounts focused on safety measures and helmets. These are excellent comments for the future of others. None seemed to be focused on what was really necessary to save her life after the accident. Perhaps no one wants to admit that we have the number one world class healthcare that half of the country thinks needs improving. However, they are talking about payment reform, not healthcare reform. Even though the World Medical Association rates America behind Columbia in care, we have never seen anyone flee American Care for that available in Columbia. The rating agencies never rate anyone without socialized medicine as having appropriate care. Hence, the falsely low standing of America noted in these prejudicial polls. (If you would flee from America for better care elsewhere, give us your story at the blog above.)

Universal availability of care saves more lives than universal access. American has universally available care. Canada has universal access to a waiting list. Care may never be rendered. In this case it was tragic.

Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

Board Certification

"Grandfathered" Board Certification? Fair or Unfair? Legal or Illegal?

Is it fair that the older board certified physicians do NOT have to undergo MOC (maintenance of cerfitication) or re-certificaton because they have been 'grandfathered' in? Is it legal to do this? Is it ethical to do this? The intent of MOC and re-certification is to maintain or increase the quality of healthcare, but if you exempt a large number or percentage of physicians from the process, are you really doing the public any good? I feel that if a specialty organization requires its members to participate in the MOC or to re-certify, then all of its members should have to participate in the process. Elitism has no place in modern medicine and older physicians should undergo the same oversight and evaluation as younger physicians.   ****************************************************************************   The certificate that was at one time a mark of special distinction is now required to make a living. The ABMS has actively fostered this trend, and as a result is now in the position to charge whatever they want for something you have to have. One of the wisest senior clinicians I ever knew told me (in a different context) "Beware of those who create the need for themselves". The unfortunate recertifiers have a lifetime of ever-increasing fees to look forward to, the proceeds of which will be used to create more and more hoops that they have to jump through. I refuse to apologize for not having to participate in this rat race. I would urge those that are required to recertify to consider banding together and boycotting the whole process. It needs to be torn down and reconstructed.   **********************************************************   Okay. I'm an old guy; I don't have to take the recertification exams. But what's wrong with you youngsters? First, no one has ever proven that recertification does, indeed, improve the quality of health care. It's a speculation. Possibly a valid one. But not proven. Second, why is it that you youngsters put up with it? Certification and recertification has created a multi-million dollar industry whose major goal isn't improvement of health care: the goal is to continue the growth and profitability of this multi-million dollar industry! Do they have to justify the enormous costs of the examinations? No. Do they have to justify the physicians' travel costs, lodging and meals? No. Do they have to justify the length of time these recertification exams take away from patient care? No. While the medical boards cannot quantify just how much recertification exams improve health care, they can quantify how they arrive at the costs of the examinations. Will they do that? Of course not. In my estimation, a recertification examination should cost no more than $50 or $100. That medical boards should be able to design effective examinations that a doctor can take at leisure in his home in front of his computer screen. As each question is answered, the system should easily be able to tell the doctor if the chosen answer is right or wrong, and it should be able to supply educational facts and reasons for the correct answer, along with educational facts and reasons about any selected wrong answer. For no cost beyond that initial $50 to $100, the doctor should be able to re-take the examination again and again until he passes. But, again, the agenda of the medical boards is not education and improvement of health care. The agenda is to maximize the income the boards receive from those examinations. So why do you youngsters so blithely plunk down your money and proceed down the recertification path?   ****************************************************   One malpractice study indicated that board certification has a high loss ratio than fully trained non-certifide physicians.

Quality Improvement Will Make Health Care More Expensive

Physicians are probably the most highly trained, sophisticated workers in the world. After four years of college, physician training begins with four years of medical school and continues with four to eight years of postdoctoral work and supervised clinical experience. These newly trained physicians are then sent into the world at about age 34 to enter the work force as doctors who assist people with diseases and other health matters. As long as the patient pays the bills, they receive efficient care. Even when Blue Cross came along with expensive hospital coverage, the patient still paid the professional fees and kept expenses tight to the vest. If this arrangement had remained in effect without government intrusion, health care today would be about half of the present cost. It would be affordable to everyone.

The county hospitals did an excellent job of giving quality of care to the poor, usually with physicians donating their professional services. Most doctors I knew would plan to donate 8 to 10 hours a week to this charity. It was a good feeling for physicians and surgeons, and the patients we saw were deeply appreciative. Many told their families of the well-know doctors who took care of them in the county hospitals. All county hospitals had interns and residents to take care of these patients on an hour-to-hour basis with back up by the private doctor with whom they made the morning attending rounds.

There was no such item as uninsured. Everyone was covered by his or her hospital insurance, by his personal check, or by the county welfare departments. Hospital insurance could be equated with high deductible insurance since the physicians' fees could be considered the deduction, although always affordable. For those that couldn't afford these fees, all the physicians I knew would provide them with free care. Physicians expected to give ten percent of their time to charity, either in their own offices or at the county hospital.

Then the cry came from unions, governments and socialists that it was demeaning to go to county hospitals as charity cases; these patients should be placed in the mainstream of health care. This resulted in the Kerr-Mills bill, the first significant intrusion into general health care. However, this didn't pacify the cry for Medicare which came along in 1965 and resulted in socialized medicine for everyone over 65 years of age. Then all the disabled were added. Then all the patients on kidney dialysis were added. Medicaid was also implemented to replace the Kerr-Mills aid for the poor.

These huge programs caused the largest inflation in health care costs the world has ever seen. Hospital construction boomed to take care of all the people that now wanted first-class inpatient services that in the past were happy with outpatient or county hospital services. The county patients never understood the economics of health care any better than their own. They padded down in the hospitals and were usually able to get a few extra days of free care. The daughter of one patient refused to take her mother home on December 23 stating that it was cruel to burden them with her care just before the holidays. It would be better if she could stay for an extra week until all the festivities were over and the guests had returned home. Why should anyone be concerned about an extra week of "mother" sitting at $2,000 a day? Isn't that what free care is all about?

Physicians have been criticized for the last three decades as being the cause of most of the excessive health care expenses. The whole managed care system was implemented by the government to control health care costs and much of it was directed against physicians. I remember managed care meetings where the managers were almost in tears saying, "Why can't you docs just put away your pen? That would save us a lot of money." I received a personal call from the CFO saying that he noticed I saw most of my heart and lung patients four times a year. Wouldn't three times a year be adequate? That will save us 25 percent of our cost of office calls. So the big push was less tests, less office visits, less consultations, less procedures, and less of anything that costs.

Now we have total reversal. With the emphases in the last several years to improved the highest level of health care in this country and make it an even higher quality, there has been a big push to make sure more tests, consultations and procedures are ordered. Lipids are requested to be checked more frequently, even if normal. Mammograms in later life are still requested yearly, even though many authorities recommend every second or even third year. Same for pap smears. At the medical grand rounds at the University of California at Davis, a visiting GI professor stated that far too many colonoscopies are done. He even suggested that unless there are risk factors, one procedure in the 60s was adequate and if a polyp was found, a second procedure in the late 60s or early 70s. The HMOs, presumably for PR purposes, are now recommending colon screenings starting at age 50. The gastroenterologists are being overwhelmed with the number of colonoscopies that are being requested, and their schedules are quite full. Colonoscopies are not an inexpensive procedure.

Bureaucrats feel that doctors are not adequately performing all these supposed procedures and, therefore, have concluded that physician care is inferior. This attitude will not really improve the quality of care but will make health care considerably more expensive. The impression of many of the physicians suggests that health care expenses will increase 25 to 30 percent with questionable improvement. With health care consuming close to 20 percent of GDP, these are significant cost increases.

Social Security would have remained viable if the age of retirement would have been the index for life expectancy. Then over the past 80 years, the retirement age would have increased to 75 and Social Security would have remained viable. There was no way that with retirement years now twenty years longer than in the 1930s, the worker could pay an extra twenty years for everybody to live off of everybody else. There is no Social Security depository - benefits are paid out of the Social Security taxes.

The same situation should hold for Medicare. To preserve Medicare, it should have been indexed with Social Security. At the current Social Security threshold, benefits would start at age 67. It should also be gradually indexed to age 75 according to current actuary life expectancy. Medicare would then have remained viable.

But Medicare will crash sooner if the current proposed Secretary of Health and Human Services gets his way and lowers the age for Medicare to 55. This will precipitate disaster since the current unfunded liability of Social Security, Medicare, Medicaid and SCHIPPS programs is estimated at ninety-nine trillion dollars. The president-elect's infusion of one trillion dollars in new taxes will have no effect on these liabilities. But they will keep the crowds pacified until the next elections. Rather like the Romans who kept the masses pacified by throwing the Christians to the lions.

Restaurants for Hearing Impaired

It is estimated that 90 % of people with vision loss generally obtain glasses to correct their loss. It is estimated that only 25 % of people with hearing loss obtain hearing aids. Hearing aids are very good at amplifying the sound and bring the volume back to normal. However, all hearing loss is not conductive. Much of it is perceptive--unable to distinguish between many words.

The audiogram easily measures the hearing loss with a curve which we all are familiar with. However, it's the perception or discimination score that is far more important. This is the part of an audiogram when the audiologist turns up the back ground noise and repeats the works for you to say back to her. One frequently finds discrimination scores that are in the 80s and 90s which means that you are able to correctly identify 80-90% of the words stated. If it is 80%, you hear 8 words out of ten. Thus people with hearing impairment of the perceptive type with an 80 % score can discriminate 8 words out of ten. That is why people with hearing impairment don't hear the first word or two and always work backwards to determine the first word of a sentence. It is important for people talking to a person with hearing aids, to always speak in sentences. To say "yes" or "no" is seldom understood. So always say, "Yes, you can." or "No you can't" for proper understanding by the person with loss of hearing.

However, if your discrimination score, when the audiologist plays street noise or restaurant or kitchen noise and goes through the same work recognition test and your score drops to 40%, that means you hear four words out of ten and you no long can put a sentence together. That's why people with hearing aids watch your lips very carefully since lip reading helps understanding. Never talk to a person wearing hearing aids from his back or side. Wait until you have his attention and speak to him directly from the front.

People with hearing problems of the peception type with poor discrimination scores, have huge problems when dining. WIth back ground noise, they have great difficulty communicating across the table.

We are in the process of rating restaurants to facilitate those with hearing loss dine. We would like your help when you dine to rate the restaurant whether they are sensitive to people with hearing loss. When you make a reservation and ask for a quiet table was it quiet? Were they sensitive to your predicament and tried to accommodate?

Please respond to this blog with your rating of the restaurants. Although we are in the Sacramento area, we are interested in restaurants throughout California and adjacent states being rated for travelers. Our long term goal is to rate restaurants throughout the country for all travelers.

Delbert H Meyer, MD
Hearing score: 80%
Discrimination score: 40%

Do the CMA and CNA still represent Doctors and Nurses?

Doctor’s organizations as well as the nurses’ organizations are for government medicine. Both have supported single payer issues in past elections. Are both organizations working against their own members’ welfare? Do these professional organizations give a bad image to the public in regards to their members? Don’t the sick and dying assume that doctors and nurses think like their leadership? Do both professional groups need to find another professional organization to represent them?  What organizations? Should the local medical societies affiliate wtih the Association of American Physicians and Surgeons represents doctors in private practice?

Tell Congress: Keep Your Medicare Money!

We don’t want your pay raise, says a leading physician group, responding to the American Medical Association’s effort to stop payment cuts scheduled to go into effect beginning in January 2006, and replace them with a pay raise.

In a memo sent to Members of Congress today, the Association of American Physicians and Surgeons writes: “Some other medical groups have been telling you that proposed cuts in physician payments will harm seniors by creating a crisis in access to physicians. But we disagree. There’s already a problem, and it has nothing to do with the new rates.”

In ads and on their website, the AMA says that its survey shows that 38% of its members will cut the number of new Medicare patients they accept if the first round of cuts goes into effect in 2006. They not only call for a halt to the cuts, but a change in the Sustainable Growth Rate (SGR) that would provide for pay raises in 2006 and subsequent years.

In its memo, AAPS refutes the AMA conclusions and tells the government they don’t [want] a pay raise, but instead lays out the case for less government interference.

“Our surveys show many physicians ALREADY refuse new Medicare patients. In fact, about 33%. But even more alarming is that 40% already restrict services they’ll perform to current Medicare patients. (See Disheartened Doctors, Patient Problems: AAPS Biannual Survey of Physicians on Medicare and Patients’ Access to Care, Journal of American Physicians & Surgeons, Winter 2004.)

“But here’s what you need to know: the reason they do so is NOT because of money. When asked, it’s the government ‘hassle factor.’ The two leading reasons given were ‘billing and regulatory requirements, and hassles and/or threats from Medicare carriers/government.’ Payment rates were down the list."  To read more, please go to www.medicaltuesday.net/medicare.asp.