Monday, June 30, 2014

Why You Can't E-mail Your Doctor

From Slate: "Why you still can’t email your physicians with a simple question. (Hint: It's not their fault.)"

As an interesting contrast, many "direct pay" or "concierge" medical practices work hard to provide e-mail consultation services between patients and doctors.  These medical practices aren't bound by the same Medicare rules as many conventional practices.

Friday, June 27, 2014

Direct Pay Practice In Colorado Springs

MedPageToday recently featured a direct-pay practice by Dr. Mark Tomasulo based in Colorado Springs, CO: "Determined Doc Retrofits Family Medicine".
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.

"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.
I hope Dr. Tomasulo's practice thrives!

(Note: I have no commercial or other affiliation with his PeakMed practice.)

Wednesday, June 25, 2014

VA Scandal Whistleblower Speaks Out

CNN reported yesterday: "VA deaths covered up to make statistics look better, whistle-blower says".

One horrifying 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.
Another excerpt:
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.
I applaud her and other brave whistleblowers for speaking out.  I hope those responsible for setting such apparently criminal policies are held fully accountable.

And a couple of other related stories;

The Denver Post has also picked up the story of Robert LeChevalier and Monica Hughes.

Anders Ingemarson offers "A Prescription For Curing VA Care".

Tuesday, June 24, 2014

Hsieh Forbes Column: 8 Star Trek Technologies Moving From Science Fiction To Science Fact

My latest Forbes piece is a change of pace from the usual health policy discussion. Instead, I decided to have a bit of fun and write about, "8 Star Trek Technologies Moving From Science Fiction To Science Fact".

Some of the 8+ technologies (or story elements) of Star Trek that I discuss include:
1) Warp Drive
2) Universal Translator
3) Handheld Computers
4) Medical Tricorder
5) Energy Weapons
6) Androids
7) Teleportation
8) Intelligent Aliens
9) Other Technologies
Although 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.

For more details, read the full text of "8 Star Trek Technologies Moving From Science Fiction To Science Fact".

I had a lot of fun working on this latest Forbes piece.  I hope you enjoy reading it as much as I enjoyed writing it! 

(And I'd like to thank Ari Armstrong for his blog post on Microsoft and Skype Translator that inspired this article.)

Monday, June 23, 2014

2015 Crunch

Sarah Kliff at reports, "States don't know how they'll pay for year two of Obamacare".

Here's the introduction:
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.

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...
Like the initial "free" sample of heroin, states are finding that the downstream costs of participating in ObamaCare are more than they like.

Wednesday, June 18, 2014

ObamaCare Costs Rise Due to Subsidies. Unexpectedly!

The Los Angeles Times reports, "Obamacare subsidies push cost of health law above projections".

From the article:
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.

In other words, the expanded "coverage" has come at the cost of a massive redistribution of wealth through the tax system.  Those who had insurance previously are thus paying for many others' health insurance as well as their own.

Tuesday, June 17, 2014

CBS Cites Me on Gun Violence

I recently learned that I was cited by CBS News in their 6/11/2014 story, "Is gun violence a public health issue?"

The article covers the growing desire by some to frame gun violence as a "public health" issue. 

I'm deeply opposed to attempts to "medicalize" issues that are more properly in the realm of law enforcement -- especially when many of those advocates appear to be attempting to leveraging the (real or perceived) prestige of the medical profession to push for more gun control laws.

The CBS story also noted the following debate within the medical community:
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.

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...
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".

And I very much appreciate the exposure from CBS News!

Friday, June 13, 2014

Doctor Waits Outside the VA

The Associated Press notes, "Outside the VA, waits for doctors can vary widely".

One excerpt:
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.

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.
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:
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.
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.

We'll find out soon enough.

Tuesday, June 10, 2014

VA Scandal Updates

Yesterday, the VA released details of its own internal audit of the waiting time scandal.

One important finding: "13 percent of VA schedulers have said they were told to falsify appointment-request dates to give the impression that wait times were shorter than they really were".

As an example of other problems, the Miami Herald reported:

"One year before he was appointed senior executive physician for the Miami VA Healthcare System in 2010, Vincent A. DeGennaro surrendered his medical license in New York, stemming from a disciplinary finding in a Florida case of a patient who died under his care at a Fort Lauderdale hospital."

As Twitter reader @seven2521 noted, Dr. DeGennaro is "Banned from practicing medicine in New York, but ok to practice medicine on Veterans."

Thursday, June 5, 2014

Is The Employer Mandate Dead?

In his latest piece at the American Spectator, David Catron predicts that "The Employer Mandate Is a Goner".

In particular, he notes growing chorus from thoughtful people on the political Left (as well as the Right) arguing that it will cause serious economic harm. Whether this will translate into legislative action is a separate question, of course. But it's a good start in the right direction.

(For more details, read the full text of "The Employer Mandate Is a Goner".)

Wednesday, June 4, 2014

Licensed Dentist Attacked for Charging Too Little

The Institute for Justice has taken on a new case, "Licensed Dentist Attacked for Charging Too Little".

Here's the video and more details about the case:

From the IJ announcement:
When is it illegal for a licensed dentist in Arkansas to clean teeth? When he also happens to be a licensed orthodontist.

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.
(Related: "How Medical Licensing Laws Harm Patients and Trap Doctors", Paul Hsieh, PJ Media, 10/1/2012)

Tuesday, June 3, 2014

Reynolds On VA Scandal and "Greed"

Glenn Reynolds (aka "Instapundit") has a good piece in USA Today: "VA scandal exposes greedy socialism".

One important point:
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.

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.
(For more, read the full text of "VA scandal exposes greedy socialism".)