Reagan Quotes

This was forwarded to me from a friend by email. Whether you liked Reagan or not, some of his quotes are classic and refreshing.




"Here's my strategy on the Cold War: We win, they lose."
- Ronald Reagan

"The most terrifying words in the English language are: I'm from the government and I'm here to help."
- Ronald Reagan

"The trouble with our liberal friends is not that they're ignorant: It's just that they know so much that isn't so."
- Ronald Reagan

"Of the four wars in my lifetime none came about because the U.S. was too strong."
- Ronald Reagan

"I have wondered at times about what the Ten Commandment's would have looked like if Moses had run them through the U.S. Congress."
- Ronald Reagan

"The taxpayer: That's someone who works for the federal government but doesn't have to take the civil service examination."
- Ronald Reagan

"Government is like a baby: An alimentary canal with a big appetite at one end and no sense of responsibility at the other."
- Ronald Reagan

"If we ever forget that we're one nation under God, then we will be a nation gone under."
-Ronald Reagan

"The nearest thing to eternal life we will ever see on this earth is a government program."
- Ronald Reagan

"I've laid down the law, though, to everyone from now on about anything that happens: no matter what time it is, wake me, even if it's in the middle of a Cabinet meeting."
- Ronald Reagan

"It has been said that politics is the second oldest profession. I have learned that it bears a striking resemblance to the first."
- Ronald Reagan

"Government's view of the economy could be summed up in a few short phrases: If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it."
- Ronald Reagan

"Politics is not a bad profession. If you succeed there are many rewards, if you disgrace yourself you can always write a book."
- Ronald Reagan

"No arsenal, or no weapon in the arsenals of the world, is so formidable as the will and moral courage of free men and women.
- Ronald Reagan

Forecast for FLOYDS KNOBS, IN (on a scale of 1-12):

Today's allergy levels: Friday - 10.2/High

Today's predominant pollen:Oak, Mulberry and Grass.

Workforce 2010

In the most recent issue of Trustee magazine, they speak about the employee workforce of 2010. There are many of the same themes we have discussed in other postings, but a very nice and concise review.

[Trustee: the magazine for health care governance]


It lists the four major fundamental areas that Trustees should proactively address to prevent serious personnel issues. These include (1) Medical science, (2) Technology, (3) Demographics, and (4) Economics.

The article specifically addresses how the Board can help facilitate these changes. The conclusion pretty much sums up the situation.

Conclusion

In the next five years, health care delivery will be reorganized around service lines that focus on consumers’ needs, not traditional “fiefdoms.” Collaborative teams—not hierarchical departments—will be key to successful organizational transformation. Tightening labor markets will necessitate retaining and retraining workers.

The relationship between a hospital and its workers—especially its physicians—will necessarily be redefined by those health care systems that thrive in the next few years. However, necessary changes in the workforce will not happen automatically. Trustees and CEOs must start providing vision, strategies and resources now so that their managers can begin making operational changes to move the workforce in the right direction over the next five years.

There is a paradigm shift in how hospitals have to cooperate with employees and physicians for future success. In my opinion, FMHHS will have an increasingly difficult time because of the current leadership mindset.

ER Visit

This past weekend, I had the opportunity you might say to spend a couple of hours in the ER with one of my patients. The family had called me at home concerned their family member was having a stroke. They were at the ER and it was overflowing with patients and families. They were concerned they would be ignored.

I called the ER and spoke with the physician. The triage personnel adequately assessed the patient and family concerns and brought him back immediately even before I had gotten off the phone with the physician. This was excellent triage care and assessment by the staff.

Since I was cutting trees and trimming my hillside at the time of the phone call, I jumped in the shower, and then headed down to the ER. On my arrival, the situation was worse than described. The ER doctors were frustrated because they couldn’t get patients back to be examined and couldn’t get patients up to the floors because of lack of beds. There were at least 19 more patients waiting to be registered.

Since my patient had a potentially life-threatening condition, they shuffled beds and patients and got him into a room.

The nursing staff was exceptional. Even though they were extremely busy, each one performed their jobs in exemplary fashion. They assisted me and my patient and expedited his care and we were able to get his workup completed in about an hour and have him ready for the Intensive Care Unit. He was found to have a subdural hematoma and bleed in his brain. He has done extremely well thanks to the excellent care of the ER staff.

Although the staff is working in extremely difficult situations with seemingly little support and understanding from those in positions of power, I commend their courage, fortitude and positive attitudes they display.

The new ER is scheduled to open on May 1st. This should help with getting patients into the ER to be evaluated, but if the bed situation upstairs isn’t rectified, it will be a mute point.

Physician Competition increasing

Competition between physicians and the hospital is increasing. The surgeons have all but abandoned the thought of collaborating with Floyd in a joint venture for an outpatient surgical center.

They are more and more convicted to build the surgical center on their own. Trust is a very big issue. They continually see example after example of how some in administration will tell you what you want to hear and later “stab you in the back” or “screw you any way they can”. These were direct quotes from some surgeons.

It appears that many are finally “seeing the light” and are willing to make a definite stance. This is exactly what I said would eventually happen because of the current environment and leadership at Floyd. The Board of Directors will have some very tough decisions to make in the near future and their decisions will ultimately make the difference between long term success or short term appeasement.

If the surgeons develop the surgical center without the hospital, should the hospital build one of their own? It is a huge investment of capital and if most of the local surgeons are committed to their own center, would it be financially smart? The hospital already is struggling to meet the costs of the new $65 million addition and is behind in the projected number of heart cases. An additional revenue sucking adventure could cause other services to be jeopardized.

We’ll be following to see what transpires.

Forecast for FLOYDS KNOBS, IN (on a scale of 1-12):
Today's allergy levels: Tuesday - 5.3/Medium
Today's predominant pollen: Oak, Maple and Sycamore.

More unhappiness and wasteful spending

There is more discontent among the Medical staff and employees. The computer system in the Emergency Room has many bugs and little response from the company on potential fixes. The learning curve is high and it slows down patient care. The nurses cannot even try to use it for “true” emergencies. The doctors are really frustrated since they made statements and sent a letter to Administration in opposition to the system after their on-site reviews. The system was not functioning at the two places they visited and the responses they received were not real favorable. They were unaware at the time they visited these sites the decision to purchase this particular system was already made by administration.

Administration really was not concerned about their opinions. They just wanted to be able to say that physicians and staff were involved in the process. This is a repetitive theme.

The surgery department along with someone in the purchasing department recently purchased new orthopedic equipment without ever asking the orthopedic surgeons. In fact, the Board had approved the purchase 2 years ago of all new Stryker orthopedic equipment which the orthopedic surgeons loved and were using daily. No one can answer why this new equipment was purchased and why the surgeons were not asked. This was a huge waste of money and someone should step up and take responsibility for the decision and the spending.

Trust has been the topic of concern between physicians and administration. I have stated many times before that it will continue to cause problems and a financial impact on the hospital. The Board members should be asking for some accountability for the two problems mentioned above and not accept the typical lip-service and lame excuses from administration.

Forecast for FLOYDS KNOBS, IN (on a scale of 1-12):

Today's allergy levels: Monday - 10/High

Today's predominant pollen:Oak, Maple and Sycamore.

More United info from the WSJ

The Wall Street Journal has certainly been proactive in bringing to light the United Healthcare issues and I along with many other physicians am really ecstatic. In Tuesday’s edition they continue to expand on the potential illegal practice of how and when the CEO and others took their stock options.

The CEO William McGuire currently draws a salary of $8 million dollars plus bonuses. He has use of the company jet and has unrealized gains on stock options of $1.6 billion. This far exceeds those of Jack Welch (General Electric) or Louis Gerstner (IBM).

The WSJ ‘s analysis of the timing of 12 option grants that were taken between 1994 and 2002 found that if these grants were taken randomly, “the odds of their occurring at such propitious times were about 1 in 200 million.”

The healthcare crisis is a major problem in the United States. It is not hospitals and physicians that are raping the system. It is insurance companies and other corporate practices such as these that will be our downfall.

The people providing the services should be compensated fairly and corporate excess such as these should be eliminated.

Forecast for FLOYDS KNOBS, IN (on a scale of 1-12):
Today's allergy levels:
Friday - 9.1/High
Today's predominant pollen:
Oak, Maple and Sycamore.

Another United scandal

United Healthcare CEO and others in the company appear to be in more hot water. The Wall Street Journal had a follow-up story Monday April 17th about the questionable stock options the CEO and others have been taking.

It appears as if they somehow take their stock options at a time when the stocks are at their lowest or have recently plummeted. This has been consistently occurring since the 1990’s. The SEC is examining the pattern of these options and subsequent trades.

Spokesmen for the Company have called the practices “appropriate”. The question remains; “appropriate for whom?”

If stock options are granted, they should be on defined dates during the year and the optioned stocks taken at the value for that day. Being able to choose the low values and then subsequently being able to sell at the higher values is cheating and unfair. But this has been occurring on a regular pattern according the WSJ.

I hope the SEC finds they have broken the rules and slaps a huge fine or jail time on the crooks. This pattern, as defined clearly in the WSJ, is far worse than the Martha Stewart scandal. Why should they be protected?

There could be a huge healthcare savings if corporate profits were regulated as tightly as others in the medical profession.

Forecast for FLOYDS KNOBS, IN (on a scale of 1-12):

Today's allergy levels: Thursday - 9.9/High

Today's predominant pollen:Oak, Maple and Ash.

New ideas to cover the uninsured

This was passed on to me from the ISMA (Indiana State Medical Association). Although this organization acts as if they want input, it seems strange that no physicians in Southern Indiana knew about this. They are reportedly using the same consulting firm that the State of Mass. used to develop their newest program to help solve the uninsured problems.

Physicians are certainly not opposed to helping solve the uninsured problem, but expanding the already broken Medicaid system to include everyone up to the 300% of poverty level is definately not the answer. If they cannot fix the Medicaid system, there will not be doctors for these patients to see.

Forecast for FLOYDS KNOBS, IN (on a scale of 1-12):

Today's allergy levels:
Wednesday - 10.6/High

Today's predominant pollen:
Oak, Maple and Ash.

Board and Commissioners meeting

The Hospital Board met privately with the County Commissioners earlier this month. The Board re-iterated the need for physicians being members. They presented the Commissioners with articles, consultant reports, facts from Hendricks County Hospital in Indy, recommendations from the Medical Staff and support from the Medical Society. It appeared to have fallen on deaf ears. Some in attendance did not get the impression that the Commissioners would do anything this year. The feeling was it would appear as if they made an error in judgment if they were to now appoint a physician.

If anyone looks at the past 3 months of hospital statistics, financial and satisfaction numbers, diversion days, staffing issues, and gauges of employee satisfaction, they would easily see that we have taken several steps backwards from just a year ago. Accountability to the Board has suffered because they do not receive the needed information to make informed decisions and keep abreast of the ongoing problems.

The Commissioners did make an error in judgment and should admit the mistake. When asked why they did not reappoint me to the Board, Mr. Frieberger stated that I had threatened him and Mr. Reisert stated he didn't support the reappointment because of that. Mr. Frieberger is not telling the truth and fabricating stories to save face. He did not like being held accountable for his actions. If the threat of accountability is what he is referring to, then he is right. I hold people accountable for their actions. There is no threat implied.

Forecast for FLOYDS KNOBS, IN (on a scale of 1-12):
Today's allergy levels: Tuesday - 10.6/High
Today's predominant pollen:Oak, Maple and Ash.

Meeting with Cochran and Sipes

We had the opportunity to meet with Bill Cochran and Connie Sipes on Wednesday, April 12th. I arranged the meeting to discuss many concerns physicians have with our current healthcare environment. We had good attendance from physicians and were able to spend 2 hours in open dialogue with them. Here is a summary of the meeting.

Meeting Summary 4/11/06

Persons attending:
Rep. Bill Cochran
Senator Connie Sipes
Dan Eichenberger M.D.
Vasit Broadstone M.D.
Mary Lynn Bundy M.D.
Jay Hockman M.D.
Steven Gray M.D.
Art Boerner M.D.
Stuart Eldridge M.D.
Phillip Johnson M.D.
Steve Baldwin M.D.
Steve Reagan M.D.
Carol Borden M.D.
Cam Graves M.D.
Steve Pahner M.D.
Guy Silva M.D.
Dan Akin M.D.,
Homer Ferree M.D.
Scott Waters (Board Attorney)

Issue Summary:

Medicaid Managed Care

• System is broken
• 4 separate entities trying to manage same number of patients with 90% of money that the State couldn’t manage it on last year
• Has added a tremendous amount of red tape, paperwork, and hassles to our offices
• Patients are switched from provider and plans sometimes without knowledge and sometimes without reason. This causes problems especially with OB doctors because of the change in plans and their payment
• Some MCO’s have dropped physicians who have high utilizing patients forcing them to accept one of the other MCO’s thereby getting the high utilizing patients out of their MCO
• Payments from MCO’s are held, delayed or simply not paid
• Office of Medicaid oversight complaints and the ability to get successful resolution from the MCO is unsuccessful
• Filing a complaint with the Office of Medicaid oversight about the MCO requires filing every claim that is not paid individually meaning the physician would have to literally send hundreds of individual complaint forms for the same problem.

Medicare

Medicare fee schedule has always been the baseline standard that all other insurers based their fee schedules.

Medicare fee schedule has not increased and in fact, for the first part of this year, dropped 4.4% to primary care. It has been brought back to the 2005 levels.

Fees have not kept up with inflation, cost of living, or other medical costs

Other insurers used to pay at the 140-175% of the Medicare schedule and now United Healthcare, and Humana are at or below Medicare and most others are barely above the Medicare rates.

Offices cannot survive with these reimbursements when all of our expenses continue to increase. The only ways to maintain a practice is to cut costs, cut employees, or see more patients. Most physicians have made all the cuts they can and cannot see any more patients without sacrificing patient care.

The part D drug program is horrendous for primary care physicians. There are 42 different plans and each has their own formulary. Getting overrides and prior authorizations for drugs patients have been taking for years takes a tremendous amount of time, paperwork, phone calls, faxes etc, just to get 1 drug approved.

If this doesn’t change, we will consider dropping Medicare or charging for every override and prior authorization.

Every Medicare Part D plan should have to offer the same formulary coverage.

Malpractice

Indiana has been number 1 in malpractice payouts per 1000 physicians for the past couple of years [Kaiser statehealthfacts.org: 50 State Comparisons: Number of Paid Medical Malpractice Claims, 2003]

Every time a physician is even named in a suit, it counts against them from the malpractice carrier even if the complaint is later dropped

There are only two Malpractice carriers in Indiana and they can drop physicians without specific reason or documentation forcing them to then go into the State program

60% of OB/Gyn docs have been denied coverage by these two carriers and have entered into the State plan at $96,000/year

Anyone can file a “suit” and it can be done off the internet with the review panel. They then sue in State Court, with or without an attorney (pro se)

The review panel does not cost the plaintiff anything, but it is always a “ding” on the physician’s record even when the review panel finds in favor of the physician.

The state program offers only “occurrence only” policies which are more expensive. Claims made policies are inferior from physicians perspectives but are a lot less expensive

Discussed Health courts and the model based on workers comp. courts
[PPI: Health Courts Advance in Congress by David Kendall ]
[PPI: Health Courts: Fair and Reliable Justice for Injured Patients by Nancy Udell and David B. Kendall ]
[Harvard School of Public Health and Common Good to Develop New Medical Injury Compensation System, press release of Thursday, March 16, 2006, Harvard School of Public Health]
[Regulation Magazine Vol. 14 No. 4]
[Executive Summary: Code Blue: The Case for Serious State Medical Liability Reform]

Legislative Issues

Senate bill 124 concerning Most Favored Nation Clauses was allowed to die. [Legislative NewsMarch 20, 2006]

House Bill 1382 concerning fee schedules was allowed to die [Legislative NewsMarch 20, 2006]

Senate Bill 161 concerning the moratorium continues to prevent physicians from investing in other entities and ties our hands from maintaining income that has been lost by other healthcare related cuts. [Legislative NewsMarch 20, 2006]

Senate Bill 140 was allowed to die. This is clearly a tactic that the insurers use to force physicians into otherwise unacceptable network contracts [Legislative NewsMarch 20, 2006]

Contracting Issues

• Insurers do not provide complete fee schedules
• Physicians cannot bargain as a group and cannot discuss fee schedules or contracts because of collusion
• Insurance companies are allowed to know what their competitors fee schedules are
• Contract language has consistently been pro-insurers
• Physicians have little recourse other than dropping the plans which then creates access problems for patients.

Immediate Things to be done

• Working together, develop some immediate recommendations to the Governor for some Executive orders that could bring rapid assistance to the MCO problems in Medicaid and the Malpractice dilemma.
• Establish the working group that Mr. Cochran mentioned. I would be happy to work with the group and could get as many other physicians as needed
• Immediately have the state offer “Claims Made” policies for physicians in the State Malpractice program
• Immediately place a co-pay on Medicaid visits
• Immediately begin working on Health court system and focus group for restructuring the Malpractice process and payment from the “cap” fund
• Immediately get payments from the Medicaid MCO’s to the physicians and stop the delay tactics

Overall, we were pretty surprised on how little our legislators understood about the current environment. They were very understanding and listened intently and we'll see how this information is utilized. Meetings are just meetings if nothing comes from them. We'll see how this particular meeting rates in the next few weeks/months.

Forecast for FLOYDS KNOBS, IN (on a scale of 1-12):

Today's allergy levels: Monday - 7.8/Medium

Today's predominant pollen:Oak, Maple and Ash.

MP3 players and hearing loss

Are MP3 players harmful to your ears and/or hearing? There is a lot of new research trying to answer the problem. The evidence does support that the intensity of the sound as well as the duration over time can be harmful and potentially cause permanent damage. Multiple newspapers and medical organizations have published articles on the topic. A few are linked below.

[The Budding Health Problem Of Earbuds - CBS News]
[Hearing loss: MP3 players can pose risk - MayoClinic.com]
[Teens' MP3 Habits May Up Hearing Loss - Health and Medical Information produced by doctors - MedicineNet.com]

The bottom line is:
Minimize the duration of listening
Certainly cut back on the volume

Soft classical or country music is a very good option!!

Forecast for FLOYDS KNOBS, IN (on a scale of 1-12):

Today's allergy levels: Friday - 10.1/High

Today's predominant pollen:Oak, Maple and Ash.

Kentuckiana crisis

Some have questioned statements made about physicians leaving or changing their practices because of the current healthcare environment. Here are some of our local statistics.

According to the Kentucky Medical Association in 2004, Kentucky has lost 36 percent of its practicing neurosurgeons, 29 percent of its general surgeons and 25 percent of its obstetricians.

Based on the Associated Press, January 13, 2004 report, it stated the state's unpredictable legal system rewards excessive litigation and fosters frivolous lawsuits. The physicians' medical liability insurance rates increases in 2002-2003 ranged from an average of 64 percent for obstetricians and internists to greater than 200 percent for some emergency room physicians.

Nearly one-fourth of physicians surveyed by the Kentucky Medical Association indicated that medical liability insurance rate increases make them consider whether to leave the state and 170 physicians said it has affected their ability to perform services such as obstetric care.

Here are a few more statistics and sources:

The Knox County Hospital in Barbourville was forced to close its OB department in 2003 due to escalating medical liability insurance rates. The nearest hospital is 40 miles away. Ashland's Bellefonte Hospital in Greenup County also was forced to close its OB department that same year. The four obstetricians at the hospital had to give up their practice due to high insurance rates. (Kentucky Medical Association)

Kentucky's deteriorating practice environment continues to result in physicians leaving the state or retiring early. Between January 2000 and December 2002, the state has lost more than 1,200 physicians, nearly one-third to neighboring states and another one-third to early retirement. (Louisville Courier-Journal, Nov. 11, 2003)

Two major Kentucky insurers have filed for rate increases from 29 to 57 percent. Health facilities may see increases greater than 150 percent. (Insurance Journal, May 20, 2003)

In Pikeville, three of four obstetricians who deliver babies at Pikeville Methodist Hospital have received medical liability insurance coverage cancellation notices, and the fourth said he might yet receive one. "There's no way that I could do 800 deliveries by myself," said Dr. James Pigg, the lone obstetrician in Pikeville. (Louisville Courier-Journal, Nov. 11, 2003)

Pregnant women in eastern Kentucky will have a much more difficult time finding a doctor to deliver their baby since two hospitals that provided obstetrics — Knox County in Barbourville and Our Lady of Bellefonte in Ashland — have recently closed their doors, according to Dr. Joe Davis, an obstetrics and gynecological specialist in Bowling Green, "In the past few years, it's hit Kentucky significantly, especially in my specialty," said Dr. Davis. (Bowling Green Daily News, February 26, 2004; Kentucky Medical Association)

Many people act as if Indiana is a better state to practice, but again, the statistics do not necessarily support the conclusion. We do have a review panel that malpractice cases are first examined. We do have caps on damages with a patient compensation fund reserve.

The problem is that no one is guarding the reserve fund and therefore Indiana in paying out more claims than any other state per physician as seen in the Kaiser statistics.
[Kaiser statehealthfacts.org: 50 State Comparisons: Number of Paid Medical Malpractice Claims, 2003]

This is all supportive of why we need to be more active in our County and State Societies and rid physicians of the complacency mind-set that got us to this position.

Today's allergy levels for FLOYDS KNOBS, IN:Thursday - 10.3/HighToday's predominant pollen:Cedar/Juniper, Elm and Birch.

Obesity in kids

The Couriers article on childhood obesity reinforces what most of us already know. Our society is getting fatter. It is not just a childhood problem, but a societal problem.
[U.S. children are getting fatter, survey finds]

Parental perceptions of obesity are a very important aspect of the overall problem. Identification is only an initial step and perhaps the easiest. Helping families understand obesity and admit the problem, while working effectively with them toward treatment and prevention represents a much more complex issue. Attitudes and behaviors of parents and children related to exercise, eating, and child obesity remains a major area of intervention.

Parental perception is not always dependable as demonstrated in two recent studies by researchers. (Baughcum, Chamberlin, Deeks, Powers, & Whitaker, 2000; Myers & Vargas, 2000) In these studies, a substantial percentage of parents failed to identify their obese children as overweight at all. Parental recognition and acceptance that their child is overweight is vital if interventions are to be initiated and successful.

Physicians need to educate parents more at their routine well child visits. Some parents feel the growth curve correlates with parenting skills. Some misinterpret the percentage on the curve as being a percentage of how they rate as parents. Parental perceptions of their children's growth measurements must be carefully assessed and clarified.

Parents also influence the nature and amount of physical activity in which children engage and it is most likely through an interaction of direct and indirect influence. Parents have direct influence by providing an environment that nurtures physical activity in the child, and have indirect influence through modeling physical activities themselves. Children 4 to 7 years of age whose parents were physically active were nearly six times as likely to be physically active compared to peers where neither parent was physically active (Moore et al., 1991).

Genetics certainly play a role in obesity, but eating habits, exercise habits and lifestyles are ingrained in kids by the age of 7-10. Statistics show that if they are overweight by this age, they will battle weight their entire lives. Our kids need us to set healthy examples. They learn and model what they see.

Today's allergy levels for FLOYDS KNOBS, IN:
Wednesday - 8.9/High
Today's predominant pollen:
Cedar/Juniper, Elm and Birch.

What are DRG's

Over the weekend, we were enjoying a little Mexican food with some friends and I was asked why the hospital left notes for physicians and prompted them to discharge patients.

From a business standpoint, my friend didn’t understand why hospitals would want patients out of the hospital. He thought the longer a patient stayed, the more money was made.

This would have been true some 20-30 years ago. At that time, hospitals were paid based on charges. The more tests, labs, x-rays, and days in the hospital meant more gross charges and ultimately more revenue.

Then came government intervention and the DRG system.

DRG or Diagnosis Related Groupings are an American patient classification system that describes the types of patients treated by a hospital (i.e. its case mix).

The DRGs work by grouping the 10,000+ ICD-9 (diagnoses) codes into a more manageable number of meaningful patient categories (close to 500 now). Patients within each category are considered similar clinically and therefore should be similar in terms of resource use and allocations.

Using these broader groupings, Medicare, and now most major Insurers, contract with hospitals to pay for services by DRG categories rather than individual charges.

This means that a patient with a heart attack will fall into a certain DRG classification and statistically should have an average length of stay in the hospital of a defined number of days. This DRG is associated with a certain reimbursement rate by the Insurer and is set by Medicare based on “obscure” criteria and relative value units.

So now, for hospitals to make money, they want patients out of the facility in less than the days allotted for “average length of stay”. In addition, there are no additional charges for tests etc. while in the hospital. The hospital is given one lump sum to cover the entire hospital stay. If physicians begin ordering lots of tests unrelated to the DRG classification, the hospital basically eats the additional costs.

This is a very simplified explanation of how the overall system works. Additional DRG classifications can be added to patient while in the hospital, but there has to be more documentation etc. and they are not always accepted.

So the theme in the past was, “the more you did, the more you made”.

Now it is; “the less you do, and the quicker you do it, the more you make”

I am not sure this is advancement in Medical Care!

Upcoming Meeting

Hopefully everyone enjoyed this beautiful Spring weekend. Spring brings new life as we are reminded with the foliage returning and the grass growing. As we begin a new week, some of us are glad to return to work and face the daily challenges that each of our careers bring. For some, like me with this past weekend, work may actually be relaxing. I didn't realize how long the "honey-do" list had grown.

I love what I do and taking care of patients. It brings happiness to my life as well as a sense of fulfillment and accomplishment. These are all good things for the soul.

As with all jobs, there is typically a downside. For us, it is the insurance and the bureaucracy . But this week, we have an opportunity to meet with Senator Connie Sipes and Rep. Bill Cochran. I arranged a meeting on Wednesday evening to have both of them meet with physicians to discuss pressing issues.

We are looking forward to venting our frustrations in hope that they can begin to grasp the complexity and seriousness of the current healthcare situation in Floyd County. Most people feel better when someone at least takes the time to listen. We have little hope that any major changes will occur based on our meeting, but it does give one a sense of understanding. That goes a long way to renewing our sense of purpose.

Words and composition

Living in the 21st century places us in a unique position. We live in an age of television, cell phones, text messaging, and internet and are quickly becoming a wireless world. With all of these advances, what are we losing?

The simple answer is words and composition.

For thousands of years people communicated primarily through words, spoken directly to one another. Information moved almost exclusively by speech. Other forms of communication such as poetry, music, paintings and print were limited because of resources and supply. Chiseling in stone was time consuming.

The major Cultural Revolution began with the invention of the printing press. It is no accident that the print culture was followed closely by the Reformation, the Renaissance, and Enlightenment. Print appeals to reason, to analysis, to objectivity and to order. We can spend time analyzing and studying printed material unlike an oral argument that doesn’t seem to hang around. Print is able to handle exposition unlike any other form of communication.

Until very recently, most of the world was almost exclusively a print culture. Public discourse and debate was carried on through print—books, pamphlets, and newspapers. Early America was almost unanimously literate to some degree. Preachers wrote out their sermons and read to their congregations. Debates were delivered from manuscripts and as a result, people quickly developed complex, thorough arguments for government, economics and religion.

The advancements seen in the past century has altered and hindered our print culture. Television radically changed our society. We have become a picture dependent society. A picture may speak a thousand words, but it doesn’t do it in the same style or grace. Printed literature is systematic, organized, and logical. You start at the upper left and read across and down. Pictures place no restrictions. You see the pictures in its entirety and then focus on what interests you. Pictures can be presented in such a rapid fashion that there is little time for thought or reflection. It becomes pure emotion.

This is also noted in the teaching shift from phonics to whole word style. I believe kids lose the rational thinking when this method of teaching is used. They see and recognize the word much like they see a picture, but fail to understand the logic of what made the word. I think transitioning back to phonics based teaching would be a benefit.

Words can deal with abstract concepts whereas pictures cannot. Words can explain ideas and concepts whereas pictures can just show you the result. Words appeal to the intellect and pictures appeal to emotions. Commercials wanting you to donate money to starving children don’t just use words to tell you, they show pictures because it strikes emotions. Words can also stimulate emotions especially with poetry, but still not as powerfully as pictures.

Emotions are not intended to master us; they should be the servants of our intellect and will. Our society tends to be moving away from this concept and it has two significant consequences.
1. We fail to analyze and reflect on specific issues.
2. Our instinctive reaction to people and circumstances is rapidly becoming emotional rather than rational.

We tend to avoid situations that we believe will be emotionally challenging and therefore in relationships we will fail to resolve conflicts. It becomes easier to avoid them. I counsel people to write letters to their spouses or relatives during times of conflict. It helps both individuals to organize their thoughts and rationally deal with the issues. A letter is something that you can see, touch, and feel and it stimulates your brain through multiple pathways that words alone cannot.

Reading and writing is the antidote to the excessive emotionalism of our current culture. Our current culture requires mental attitudes and skills developed only through reading and writing. Composition is not simply an art form to enhance the curriculum, but a fundamental skill to prepare kids and adults for working in this complex technological society. It also teaches and helps everyone debate effectively, reason rationally, and resolve conflicts rather than avoiding them.

Humana

Humana is also a leading cause of physician dis-satisfaction. They are one of the worst when trying to get tests ordered for patients. We spend more time with preauthorization, denials, appeals and phone calls then we do with any other company.

Patient care suffers because of delays and denials. In addition, they are routinely one of the companies that continually reimburses lower than medicare rates.


The corporate CEO and executive salaries are listed in these reports.






We have begun the process of negotiating with them, but once again face the same obstacles of having minimal leverage.

We sent Humana 3 independent fee schedules from three of our better payors. Their email response was as follows:

Laura,
The two major payors that we look at are United and Anthem. Without asking for specifics, are these rates representative of either of those payors?

Thank you,

Darin Lancaster
Provider Contracting
Humana Kentucky Market
(502) 580-5014
Dlancaster1@humana.com

As you can see, they are not interested in anything other than United and Anthem. As long as the three of them can manipulate the fee schedules, they will retain the largest market share.

If physicians did this, we could be charged with collusion.

Class action against Humana

Humana has certainly reaped rewards from the newest government entitlement program. Medicare part D covers drugs for those enrolled in the program. The government basically handed this program over to insurance companies to manage. There are now approximately 42 different programs to choose from and senior citizens are left to make some tough decisions.

Companies like Humana use all sorts of marketing and sales tactics to get these vulnerable people to choose their program. They know that once they are in the Part D program the companies will have a better chance of getting them to choose other plans.

The courier reported on this in the following article. Humana drug plans beset on two fronts. The following excerpt shows one of the issues that Humana is being accused.

In a Jan. 26 letter to Medicare officials, Stark accused Humana of "coercing" seniors interested in the company's drug plans to buy a more expensive managed-care plan instead. Such plans cover doctor and hospital care as well as drugs.

Inspector General Daniel Levinson of the Department of Health and Human Services, which oversees Medicare, told Stark on Feb. 8 that his office would look into the matter.

This comes as no surprise to physicians. We see patients being misled and misguided on a daily basis by these companies. This particular issue was brought to the attention of Congressman Stark because Humana was touting their marketing strategies on Wallstreet.

Physicians have no problems with offering drug coverage, but the government should have established a defined formulary that all companies had to follow. The current system allows each of the 42 programs to offer a different formulary.

Physicians never know which drug is on which plan and most physicians do not even look at what insurance the patient is on when we are evaluating them.

This is a typical bureaucratic mess. They evidently didn’t get adequate input from the people who actually have to use the program.

Over-inflation of Insurance Losses

A recent study by the Foundation for Taxpayer and Consumer Rights suggests that medical malpractice insurers have routinely over-inflated their losses by billions of dollars creating a “crisis” and using it to justify enormous increases in physicians’ premiums. Losses between 1986 and 1994 were overstated by 46 percent annually. The researchers found that insurers reported $39 billion in losses, but only paid out $27 billion in claims.

They also found a correlation during economic downturns when investment incomes were lower than expected, that the insurers annual statements to regulators were even more over-inflated. In 1989 loss estimates were 66percent overstated and in the last 4 years or so, the overstated losses have led to huge rate increases in the cost of malpractice coverage to physicians.

There is a real need for insurance reform. This same organization has some thoughts and recommendations that certainly sound reasonable. Below are some of their thoughts.
This info comes from the following source:
http://www.consumerwatchdog.org/malpractice/fs/?postId=997&pageTitle=How+to+Address+the+Insurance+and+Malpractice+Crises+Facing+the+Nation

The real cause of the cyclical insurance crisis, and the driving force behind the contrived malpractice lawsuit crisis, is the cash flow underwriting practices of the insurance industry. Unless the destabilizing premium surges and mismanagement caused by the "insurance cycle" are stopped, the result will be periodic "crises" in the insurance market, each an opportunity to scapegoat victims' rights in order to cloak massive premium gouging, arbitrary cancellations and reduced coverage. California's Proposition 103 is a model:

Limit insurance rates, expenses, loss projections and profits. One of the reasons that the insurance industry has been able to squeeze its customers in the malpractice insurance market and elsewhere is the lack of serious regulation and oversight of the industry. Most state regulation of insurers is weak to non-existent, reflecting the fact that officials responsible for oversight are typically beholden to the industry through previous or promised employment. Following the lead of California, there must be greater regulation of the industry's prices and underwriting practices. To prevent wild fluctuations in insurance rates and instability that can lead to insolvency, state insurance departments should set upper and lower limits on permissible rates that insurance companies may charge. All rate increases should be subject to the prior approval of an insurance commissioner, who should be accountable directly to the voters by election. Similarly, insurers should be prohibited from arbitrarily canceling or refusing to renew policies. There must be more effective insurance disclosure laws, so that citizens, consumers and policymakers can review lawsuit and claims information to determine the extent of malpractice claims, whether the price of premiums is justified, and what further measures need to be taken to limit malpractice. Finally, state insurance departments need more resources to effectively and independently monitor the industry.

Repeal the industry exemption from the antitrust laws. The insurance industry is not subject to federal regulation and it is exempt from the federal antitrust laws, and even from Federal Trade Commission scrutiny without explicit Congressional approval. Congress should repeal these barriers to competition and oversight.

Mandate fair rating practices to reward good doctors. Currently, insurance companies use narrowly defined subcategories to classify physicians who apply for malpractice liability insurance. Because there are so few physicians in some of the specialties, insurers cannot spread the risk effectively: the result is extremely high premiums for certain specialties, such as obstetricians. These rating systems force a majority of good doctors to subsidize the few bad ones. (It should be noted, however, that physicians collectively bear some responsibility for higher premiums to the extent that they do not discipline negligent physicians within their own ranks.)

Instead, insurance companies should be required by law to spread risk more equitably by placing physicians in a reduced number of underwriting categories. However, in order to differentiate poor doctors from the rest of the pool, insurance companies should charge rates based on a physician's own experience with malpractice claims. This practice, known as "experience rating," is much the same as the practice of rewarding good drivers with a discount on their auto insurance. It would ensure that doctors with histories of negligence or incompetence pay more, and doctors with clean records would be rewarded with lower rates.

Protect the Doctor-Patient Relationship. In 1990, the Texas Medical Association invited doctors who had practiced at least 20 years without a malpractice lawsuit to explain how they handle their relationships with their patients. Over 200 doctors responded, and almost all of them focused on improving communication with patients as the key to avoiding lawsuits. In the current era of profit-driven medicine, protecting the doctor-patient relationship -- and the ability of doctors to properly treat their patients -- is essential. Force insurance companies to cooperate. Insurance companies should be required to forward all claims and settlement information involving malpractice claims against physicians, hospitals and other medical professionals to state licensing boards.

As you can see, there are certainly areas that could be changed to make things fairer. If nothing changes, we can anticipate further loss in physicians and access by patients.

JCAHO Challenge

In January of this year, the Centers for Medicare & Medicaid Services commonly referred to as CMS announced plans to evaluate a new organization to accredit Hospitals. This will be the first time in 40 years that Hospitals will have another option.

The new organization is TUV Healthcare Specialists out of Cincinnati. TUV has consulted for years in hospitals to prepare them for Joint Commission surveys. The impetus for another alternative really began when JCAHO announced it would begin collecting patient-level data from hospitals and sell the information and analyses to third parties.

The idea of selling this information was very alarming to hospitals and certainly questioned the trust of JCAHO. In addition, many hospitals have questioned whether JCAHO standards are really the best way to improve quality care for patients.

TUV has a strategy to link the Medicare survey strategies to ISO 9000 standards. This would be different from JCAHO because their current evaluation does not focus enough on process improvement.

At the present time, there are only JCAHO and the American Osteopathic Organization that can formally accredit hospitals in order for them to receive Medicare funds. JCAHO surveys about 4500 hospitals per year and AOO surveys only about 300 per year.

The monopoly may be on its way out!