The blog of Freedom and Individual Rights in Medicine (FIRM)
When the dust settles, the clinic, PeakMed, will house two conversation-oriented consultation rooms fitted with large, landscape-framing windows, and an in-house lab and pharmacy stocked with wholesale prescriptions.I hope Dr. Tomasulo's practice thrives!
"The point for me is to save you as much money as I possibly can. And provide a service to you that makes you want to come see me," he says.
Tomasulo is gearing up to treat patients in this all-in-one direct pay clinic of his own design, devoid of all third-party oversight. That also means he won't even bill insurance companies or Medicare...
Monthly subscription fees for patients will range from $25 per month for children up to 18 to $85 for adults 65 and older. Subscriptions will include unlimited office visits, 24-hour physician access, and nearly at-cost prescriptions and onsite lab work.
Tomasulo says he intends to encourage all of his patients to maintain a catastrophic policy for hospital coverage. "Our goal is to provide primary care, not all-encompassing care. It's imperative that someone has insurance. You would never want to go without insurance," he says.
Another excerpt:Beginning early last year, DeWenter said she was also instructed to hide the crisis at the Phoenix VA medical center by concealing new requests for treatment. This was at a time when the VA was paying bonuses to senior staff whose facilities met the goals of providing care in a timely manner for veterans, typically within 14 days.New requests by veterans wanting treatment were actually stuffed into a drawer, to make the books look better, according to DeWenter.Asked what happened to the new requests for appointments, DeWenter said: "They went into a desk drawer.... That would be the secret list."There was "no doubt" it was, in fact, a secret list, she said.
I applaud her and other brave whistleblowers for speaking out. I hope those responsible for setting such apparently criminal policies are held fully accountable.But at least seven times since last October, records that showed that veterans died while waiting for care -- records which DeWenter personally handled and had entered in details of veterans' deaths -- were physically altered, or written over, by someone else, DeWenter said in an exclusive interview with CNN. The changes, or re-writes, listed the veterans as living, not deceased, essentially hiding their deaths.The alterations had even occurred in recent weeks, she said, in a deliberate attempt to try to hide just how many veterans died while waiting for care, by trying to pretend dead veterans remain alive."Because by doing that, that placed (the veterans) back on the wait list," said DeWenter, explaining she believes that the purpose of "bringing them back to life" in the paperwork and putting the veterans back on the electronic waiting list was to hide the fact that veterans died waiting for care.
1) Warp DriveAlthough some Star Trek technologies are still clearly in the realm of science fiction (e.g., the warp drive), others like the medical tricorder are coming close to reality. And some design elements (like the flip-style communicators of Star Trek: TOS) have already come and gone as consumer products in the real world.
2) Universal Translator
3) Handheld Computers
4) Medical Tricorder
5) Energy Weapons
6) Androids
7) Teleportation
8) Intelligent Aliens
9) Other Technologies
More than a dozen states decided to build new health insurance marketplaces under Obamacare. Now, they need to figure out how to pay the costs of running those massive websites.Like the initial "free" sample of heroin, states are finding that the downstream costs of participating in ObamaCare are more than they like.
The Affordable Care Act provided federal grant funding for states to get their new web portals up and running. The Obama administration doled out $4.6 billion in grants to states launching their own marketplaces.
But Obamacare also requires state exchanges to become self-sustaining by the start of 2015. That means every state exchange that will operate next year now needs to figure out how to pay their bills. Every marketplace needs to be able to pay staff (which sometimes number in the hundreds), maintain office space and continue running outreach campaigns to increase the insurance rate.
"There won't be any big pot of federal money," says Elizabeth Carpenter, a director at health research firm Avalere...
The large subsidies for health insurance that helped fuel the successful drive to sign up some 8 million Americans for coverage under the Affordable Care Act may push the cost of the law considerably above current projections, a new federal report indicates.
Nearly 9 in 10 Americans who bought health coverage on the federal government’s healthcare marketplaces received government assistance to offset their premiums...
Premiums that normally would have cost $346 a month on average instead cost consumers just $82, with the federal government picking up the balance of the bill. While the generous subsidies helped consumers, they also risk inflating the new health law’s price tag in its first year.
Earlier this week at the American Medical Association's annual meeting, a fierce debate erupted over whether the AMA's Continuing Medical Education program should offer a course on gun violence prevention. Some members support the idea of integrating medical professionals -- not only mental health workers -- into anti-violence efforts. But others worry that this may put physicians in a position of becoming social workers, which is not something there is time for in a busy emergency room or doctor's office.I'm glad that most physicians still choose not to ask patients about gun ownership. For more on this, see my Forbes piece from January 2013, "Why Doctors Should Not Ask Their Patients About Guns".
Controversy has also flared around the idea of whether doctors should ask patients whether they keep guns in the home. Some doctors believe it's appropriate, just like asking about other factors, like smoking or alcohol use, that impact a patient's health.
Others consider it invasive or misguided. Dr. Paul Hsieh, co-founder of a group called Freedom and Individual Rights in Medicine, argued in Forbes that it could "compromise the integrity of the doctor-patient relationship."
A majority of -- 58 percent in an American College of Physicians study -- say they do not ask their patients about guns...
Need routine primary care? The average wait to see a family physician for the first time ranged from 66 days in Boston to just five days in Dallas, according to a survey in 15 large cities by health care consulting firm Merritt Hawkins.It's interesting that the waits are so long on Boston. As CNN reported last year, (10/2/2013) this is related to the Massachusetts "RomneyCare" plan:
And doctors are bracing for new demand from millions of people newly insured through the federal health care law.
“To say it’s an easy solution to the VA problem — we’ll just have them get care in the community — overestimates the capacity the community has to absorb these folks,” said Dr. Yul Ejnes of the American College of Physicians.
One unanswered questions is how bad waiting times will get in the rest of the country as ObamaCare kicks in, given that almost every other state has a far worse physician-to-population ratio than Massachusetts.When the Massachusetts law kicked in, wait times to get an appointment at primary care physicians' offices increased significantly, and they've remained high ever since, according to an annual survey from the Massachusetts Medical Society. And Massachusetts has the second highest physician-to-population ratio of any state.When patients couldn't get doctor's appointments they once again turned to emergency rooms.
When is it illegal for a licensed dentist in Arkansas to clean teeth? When he also happens to be a licensed orthodontist.(Related: "How Medical Licensing Laws Harm Patients and Trap Doctors", Paul Hsieh, PJ Media, 10/1/2012)
In 2013 Dr. Ben Burris ran afoul of Arkansas' law when he started offering low-cost teeth cleanings at his orthodontic offices. Ben's practice Braces By Burris has 11 offices around the state. In part because of his success Ben feels a strong need to give back to the community so he started offering simple teeth cleanings for $99 for adults and $69 for kids, a fraction of what other dentists charge for the same service. He saw the program as a great way to expand access to care for Arkansans.
Within weeks, Ben was told by the Arkansas State Board of Dental Examiners that he was breaking the law and that his license would be revoked if he continued offering the cleanings. Arkansas prohibits licensed dental specialists like orthodontists from doing work outside of their specialty even though they are qualified to practice general dentistry. These kinds of restrictions arbitrarily limit access to care and drive up prices for consumers.
Faced with the threat of seeing his practice ruined and his 100+ employees out of work, Ben suspended the program.
Now Ben and his colleague Dr. Elizabeth Gohl are fighting back. Together with the Institute for Justice they filed a federal lawsuit on May 27, 2014 to defend their right—as licensed dentists—to perform basic dental services. The 14th Amendment protects the right of professionals to offer services that they are perfectly qualified to perform. This case is about eliminating irrational protectionist laws and expanding access to affordable dental and medical care for Americans everywhere.
People sometimes think that government or "nonprofit" operations will be run more honestly than for-profit businesses because the businesses operate on the basis of "greed." But, in fact, greed is a human characteristic that is present in any organization made up of humans. It's all about incentives.(For more, read the full text of "VA scandal exposes greedy socialism".)
And, ironically, a for-profit medical system might actually offer employees less room for greed than a government system. That's because VA patients were stuck with the VA. If wait times were long, they just had to wait, or do without care. In a free-market system, a provider whose wait times were too long would lose business, and even if the employees faked up the wait-time numbers, that loss of business would show up on the bottom line. That would lead top managers to act, or lose their jobs.
In the VA system, however, the losses didn't show up on the bottom line because, well, there isn't one. Instead, the losses were diffused among the many patients who went without care -- visible to them, but not to the people who ran the agency, who relied on the cooked-books numbers from their bonus-seeking underlings.